Report of the Expert Group on Drug Abuse Reduction

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ABSTRACT

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Pages: 3 to 17
Creation Date: 1983/01/01

Report of the Expert Group on Drug Abuse Reduction *

ABSTRACT

An Expert Group on Drug Abuse Reduction, meeting at Vienna from 6 to 10 September 1982, indicated that effective approaches to the prevention and reduction of drug abuse should be based on an integrated strategy that harmonized a variety of measures and interventions; isolated measures were found to be seldom effective. It was also essential to promote positive alternatives to drug abuse. The full involvement of concerned non-governmental organizations, as well as the mobilization of community resources in programmes on prevention and reduction of drug abuse, held great potential. Information and educational and training programmes should be carefully designed for specific audiences. The training of personnel who could contribute to preventing and reducing drug abuse was most effective when carried out in a working environment and merited continued effort and the deployment of additional resources. All resources for the prevention and reduction of illicit demand for drugs should be allocated in response to identified needs and should aim at realistic targets. The use of these resources and their effects should be evaluated and monitored at all stages of their application.

* The following experts participated in the group : Yasmeen Ahmed, Clinical Psychologist, Psychiatry Ward, Civic Hospital, Karachi, Pakistan : Amechi Anumonye, Professor of Psychiatry, College of Medicine, University of Lagos, Lagos, Nigeria ; Dorothy Black, Department of Health and Social Security, Alexander Fleming House, London, United Kingdom of Great Britain and Northern lreland : Gerhard Behringer, Project Director, Addiction Research Group, Max-Planck Institute for Psychiatry, Munich, Federal Republic of Germany : Carmen Garcia Linan, Centros de lntegraciĆ³n Juvenil, A. C., Mexico City, Mexico: Robert Philip Irwin, Chairman, Department of Health Studies, School of Education, Canberra College of Advanced Education, Belconnen, Australia : Richard Lindblad, Associate Director for Policy and Programme Development, National lnstitute on Drug Abuse, Rockville, Maryland, United States of America ; and Udomsil Srisangnam, Assistant Professor, Department of Psychiatry, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. In addition, two persons took part as observers : Minoru Shikita, Chief, Crime Prevention and Criminal Justice Branch, Centre for Social Development and Humanitarian Affairs, Vienna International Centre, Vienna, Austria : and Nicole Friderich, Chief, Section of Education Concerning the Problems Associated with the Use of Drugs, United Nations Educational, Scientific and Cultural Organization, Paris.

Introduction

In accordance with a decision of the Commission on Narcotic Drugs during its twenty-ninth session, a meeting of an Expert Group on Drug Abuse Reduction was held at Vienna from 6 to 10 September 1982 with the objective of "exploring those approaches to drug abuse reduction which have proven most useful in order that the experience gained thereby could be made more widely available". The meeting was part of the first year of the Five Year Programme of Action adopted by the General Assembly in the context of the International Drug Abuse Control Strategy set in motion by General Assembly resolution 36/168 of 16 December 1981.

In opening the meeting, the Director of the Division of Narcotic Drugs drew attention to the general situation regarding measures to prevent and reduce drug abuse that had been undertaken by the Commission on Narcotic Drugs in February 1982. One major problem was the absence of reliable information on the exact nature and extent of drug abuse. A second area requiring attention was the evaluation or assessment of approaches used to prevent or treat drug abuse. The Director noted that there was a paucity of financial resources during a period of economic crisis. It might be of advantage to encourage the involvement of non-governmental organizations at national and regional levels, as well as the local communities. Work to prevent and reduce drug abuse did not operate in a vacuum, the Director stated; it was part of a complex attack on all phenomena associated not only with the illicit supply of, and traffic in, narcotic drugs but also with the increasing flood of psychotropic substances being diverted from licit channels or clandestinely manufactured for abuse.

The meeting was attended by eight experts selected on the basis of their expertise in the subject matter and to ensure an equitable geographic representation. The United Nations Centre for Social Development and Humanitarian Affairs and the United Nations Educational, Scientific and Cultural Organization (UNESCO) were represented by observers. The International Labour Organisation and the World Health Organization had been invited to send representatives in an observer capacity but were unable to attend the meeting.

Amechi Anumonye was elected Chairman of the Meeting and Robert P. Irwin was elected Rapporteur.

General discussion

At the invitation of the Chairman, participants outlined their personal experience with drug-abuse control and indicated the situation in their respective countries and regions. In general, the number of substances available, and therefore liable to abuse, was increasing and certainly the availability of drugs was one factor increasing abuse. Multiple drug abuse, frequently in combination with alcohol, was also increasing. There was a growing tendency to abuse drugs that were not under international control, and, in that connection, the benzodiazapines were frequently mentioned. The average age of abusers seemed to be decreasing.

As far as preventive and treatment measures were concerned, it was the experience of all participants that the most effective measures were based on the total environment of the addict or of the person or group at risk. There must be a consistent linkage not only between preventive and treatment measures but also between those measures and other disciplines concerned with the total welfare of individuals, communities and societies. There were insufficient funds in most countries to support expensive specialist units that provided a service in comparative isolation from those provided for other community needs. Therefore, economic factors alone indicated that total community involvement, drawing, for example, on health and social-care agencies and on the resources and manpower of voluntary or non- governmental bodies, would be most effective. For the same reason, out-patient treatment was to be preferred to in-patient treatment.

Primary prevention was probably more effective when it was not drug- specific. Undirected production and dissemination of information on the dangers of drugs appeared to have very limited effectiveness and could well be counter-productive. The media, through sensational reporting and advertising campaigns, had often had the effect of increasing the consumption of drugs not under international control. A more positive approach would be to encourage the media to use their potential to reduce the demand for drugs.

The group was of the opinion that much could be achieved by educating the medical profession, pharmacists and others concerned with the prescription and dispensing of drugs for medical purposes, in order to avoid the spread of abuse through inappropriate prescribing. Better training could be given through universities and professional schools for doctors, pharmacists and nurses. Influence could be exercised through professional associations that are non-governmental organizations in consultative status with the United Nations and also through the bodies licensing medical practitioners. Similar emphasis on more and better education and training should be applied to the whole range of professional groups able to influence the situation. More work should also be done to train those in contact with high-risk groups (e. g. lorry drivers abusing amphetamines), by working through professional and occupational associations or unions.

In order to reduce abuse of drugs under international or national control, it appeared essential to seek effective measures of ending in-appropriate use or misuse of drugs that were regarded as socially or culturally acceptable, particularly alcohol and a range of minor tranquillizers. However, any effective approach to prevention or reduction of drug abuse must consider not only the drug but also the individual and the environment in planning and applying countermeasures.

It was critically important to assess real needs accurately before the adoption of countermeasures. There was a gradual move in this direction, and it should be reinforced so that policies would not be adopted that were based only on subjective impressions, particularly when these impressions were not those of the community directly concerned but of persons from outside the area. Much remained to be done in this area. It was essential to avoid a situation, which had occurred frequently in the past, where those in policy-making positions had been unaware of, or unwilling to accept, the existence of any drug-abuse problem. Recognition of the problem had then been followed by over-reaction, which often led to an un-targeted media approach to emphasize the dangers of drug abuse. The disadvantages of such techniques had been clearly demonstrated. It was vital that all interventions should be in context, and, consequently, it was essential to establish the facts regarding the epidemiology of drug abuse and equally important to evaluate the effectiveness of countermeasures that had been undertaken in other countries and communities before adapting these measures for introduction into a given situation.

Preventive approaches

It was probably counter-productive to make too sharp a distinction between preventive approaches and other measures to counter illicit demand. The whole field of work against drug abuse should be approached as a linked series of interventions that required careful orchestration in order to meet assessed needs. Experience indicated that a broad-based approach of that nature was most productive.

In the past, needs and goals had probably not always been realistically assessed. At the national level, and possibly.at the international level, there might have been a tendency to set unattainable objectives. At the local or community level, too little attention had frequently been paid to the needs that the communities themselves regarded as desirable and attainable. The redressing of both those factors had produced beneficial results.

Controls to reduce the availability of drugs for abuse

The availability of drugs had a direct influence on increasing abuse. There was therefore every reason to continue to apply existing controls, provided that they could be adequately enforced. Only with general social consensus could controls be consistently maintained and the laws on which those controls depended held in repute.

There was no reason to believe that legalization was an effective strategy. Indeed, it seemed likely that any weakening of controls, for instance by legalizing cannabis, would result in a massive increase in the misuse of that drug. That would add further problems to those already arising in a number of countries from the misuse of alcohol.

In pursuing preventive measures, it was frequently necessary to justify the continued exercise of legal controls intended to reduce the availability of drugs for abuse. The justification was much more convincing and therefore effective when there was harmony between legal controls (which were frequently based on the international drug-control treaties), medical controls and what might be called social and cultural controls. Harmony should be sought in respect of attitudes not only towards the misuse of drugs covered by the international treaties but also towards the misuse of non-controlled drugs including alcohol, tobacco, solvents and the so-called minor tranquillizers.

Involvement of non-governmental and volunteer organizations at all levels

The group fully supported the prominence given by the Commission on Narcotic Drugs in formulating the International Drug Abuse Control Strategy and the basic five-year programme of action 1 to the crucial need to involve non-governmental and volunteer organizations at all levels and, to the fullest extent, in as many aspects as possible of the whole range of work against drug abuse. The group suggested that the Commission might wish to consider making specific recommendations on this matter to Governments and non-governmental organizations in consultative status. Experience had indicated that when the involvement foreseen by the Commission was generated, appropriately guided and integrated, results were consistently beneficial.

The support and involvement of non-governmental and volunteer organizations were frequently the only means of supplementing inadequate national and local budgets. Organizations of this kind were entitled to expect a point of reference for their work and an adequate network of contacts, information, training facilities and related support services to ensure cohesion of approaches and of interventions.

In one country efforts to provide joint training for staff of such organizations had improved inter-agency understanding and cohesion of policy and practice. Some training was supported by training "kits". The "kits" were most useful when they contained basic facts, including preventive strategies and targets, with examples, as well as simple techniques for planning, monitoring and evaluating preventive activities. Thus, organi zations and staff members were enabled to plan their activities according to local needs, and improvements were possible as an ongoing process.

Official records of the Economic and Social Council. 1981. Supplement No. 4 (E/1981/24), annex II.

A useful technique to encourage such organizations to make an input into a drug-abuse-related field was to provide some central government "pump-priming" finance for the first few years of the organizations' involvement. Thereafter, the funding of drug-related activity should ideally be undertaken either by the organization itself from within its own resources or with financial support from local health and social-service authorities.

In general, non-governmental organizations and volunteer bodies were able to react faster than their counterparts in Governments. They frequently developed a high level of commitment to the prevention or reduction of drug abuse or to other supportive activity. They could be encouraged to develop close and valuable contact with other volunteer organizations and particularly with social services maintained by religious groups. The latter were often an untapped asset with very considerable potential for work against many manifestations associated with drug abuse.

Volunteer organizations were most effective when they were responding to the actual need of the community or society in which they operated. Attempts by Governments to go beyond a coordinating, leadership and facilitating role or to impose any specific approach or intervention from above had frequently proved expensive and less effective than had been hoped. A better policy was to stimulate awareness of needs from the smallest community level. Frequently the non-governmental organizations were well-placed to do so.

Dissemination of information

Experience indicated that, while the accuracy of information disseminated was important, it was not the only factor to be taken into consideration. In order to avoid misunderstanding or the emergence of undesirable curiosity, it was crucial that such information should be not only accurate but also objectively presented. Scare techniques were to be avoided and a more positive approach should be sought. The ill-effects of drug abuse had often been over-dramatized, with the result that occasional or experimental drug users, who had some knowledge of the drug in question, ridiculed the information on the basis of their own experience. At a different level it was important to avoid increasing anxiety in an individual who was misusing drugs and whose state of mind might already be in part responsible for the drug addiction.

It was important to choose the targets to ensure that the information was responsive to the needs in those target groups. Undirected information, disseminated on a "scatter" basis through the mass media, provided no opportunities to assess needs or obtain accurate feedback and was therefore to be avoided.

There was an advantage in establishing the capacity to produce and disseminate accurate basic information and in enabling groups to use it to example was the rapidly growing number of parent groups in one country. The groups were countering the illicit demand for drugs through efforts directed towards strengthening family relationships, reducing media and public messages that glamourized drug use and commenting on proposed and existing drug -abuse legislation. They needed the support of basic informational material to accomplish their goals.

The parent groups were able to influence the kind of local television programmes and other entertainment available in their communities and to use local pressure to work against any proliferation of shops selling drug paraphernalia or literature that tended to encourage drug abuse.

Community participation

Broad community participation had undoubtedly produced the best Educational programmes designed to prevent or counter illicit demand in schools were most effective when linked to programmes that would no doubt vary slightly in content and presentation for parents and the immediate community. Unless this linked approach was pursued, the effectiveness of programmes directed to children in schools could not be fully effective. Such programmes were particularly difficult and required special study in circumstances where the educational level of the children was markedly different from that of the parents. Various audio-visual techniques had been used in a number of environments and appeared to have been successful.

The principle of community involvement had widespread applicability, not only in educative preventive approaches but also in enabling the total acceptance and integration of the drug user into the community's social and employment opportunities. In certain areas, strong community resistance to this concept had been recognized as a major obstacle to rehabilitation.

Countermeasures designed to prevent or reduce illicit demand based on community involvement should be structured with specific reference to the community or society in which they were to be applied. Specific programmes needed to be planned at the local level in order to best respond to community needs. The most effective technique was to generate approaches from within the community itself: informal committees could be encouraged to identify community leaders and then to identify problems and needs.

Such local problems and needs might at first sight appear to have no direct bearing on drug abuse. Nevertheless, this technique would often lead to the community itself recognizing drug-related problems and also producing solutions from within its own resources with a minimum of external input. In many societies it appeared that the importation or, even worse, the imposition of ideas or norms from outside built up resistance that was extremely difficult to overcome.

Above all, it was important that preventive and treatment programmes involving communities and groups were flexible. There should be simple built-in evaluation techniques; leaders within a community or group would thus be able to learn from their own experience and to modify the approaches being used accordingly.

Because of the vulnerability of youth to drug abuse, much could be gained by encouraging the community to regard the school as an integral part of the community. That was, regrettably, not always the case. However, provided there was sufficient trust between parents and teachers, it had been possible to involve parents in curriculum development, with one objective being the inclusion of drug-education programmes within a wider educational discipline.

Teachers frequently had no experience in drug-abuse recognition or drug education. There were therefore several needs. A prime need was to provide responsible factual information, particularly on new drug problems. A second need was to encourage teachers to examine their own attitudes to drug use and the impact of such attitudes on any message they were transmitting. A further need was to include training in methods of recognizing, preventing and countering illicit demand for drugs in the normal syllabus of all teacher training institutions and to introduce such training into refresher or other courses for teachers who were already in a post. A useful device was to ask for volunteers from within the teaching cadre to deal with drug-related problems and education during an interim period.

Teachers, as one element within a community, were often typical of untapped official or governmental resources. There were numerous other similar resources at community level. Existing programmes and personnel could frequently be legitimately used to support activities to reduce drug abuse, provided a broad-based and comprehensive approach was attempted. Savings in cost could be considerable.

One primary objective should be to increase the awareness of society as a whole when faced with actual or potential drug-abuse problems. It was important to increase the awareness of all who might be able to-recognize the symptoms of abuse or to provide counters to those symptoms. In that context, for instance, some abuse of volatile solvents in one country had been countered by generating a system of voluntary restraint on the part of retailers, thus restricting the availability of such solvents.

Approaches to counter illicit demand

Treatment should be based whenever possible on, and be responsive to, an individual&rsquos motivation and needs. The needs of an experimental or occasional drug user would, for instance, be entirely different from those of an individual with a prolonged history of abuse. The most effective approaches could not, however, be undertaken if the decision to intervene was based entirely on an assessment of an individual&rsquos potential for achieving a drug-free existence, whether in the short or long term.

Short-term gains should not be ignored in the search for ideal long-term solutions. Detoxification, for instance, even if taken alone, could be valuable in temporarily reducing the illicit demand for drugs. Similarly, drug-taking clients should not be rejected because they did not regard drug taking as their most serious problem. They should be encouraged and enabled to address other related problems, which might include their physical health or the side-effects of drug taking. This was not always an easy balance to achieve because of the cost of maintaining the necessary services. However, it was probably the only effective policy in the long run, because the motivation of patients was likely to change during treatment as a series of different interventions was brought to bear on them.

More attention might be given to assessing the reasons for recidivism where it occurred. There was a tendency to blame recidivism exclusively on the patient and to disregard numerous other possible reasons. There were almost bound to be relapses and the need for further intervention in the treatment of any client. All counters to illicit demand were most realistically seen- as part of a long-term process, with interventions responding to specific needs at any given time. Longitudinal studies demonstrated clearly that the greater the number of valid interventions, the better the prognosis. Measurements of improvement could usefully include both the extent to which actual drug consumption and drug-related criminal behaviour had been reduced and the extent to which productive activity had been increased.

All available experience indicated that best results were obtained when interventions were not isolated from each other and when medical, educational and social measures were pursued in harmony. There was one reservation : drug-addicted persons frequently used one system against another to obtain maximum advantage. To counter that tendency, cross-referencing between the agencies or individuals providing interventions was essential.

The broad multi-disciplinary approach had proved most useful. The technique was to build -up a series of flexible multiple responses along the whole continuum of the treatment process leading to the eventual rehabilitation and reintegration of a patient. Experience indicated that that was probably best achieved by building around an out-patient approach. Provided all agencies were encouraged to introduce their specialized input at the right time, the acquisition of additional skills by members of those agencies was not necessary. Frequent problems affecting the drug-taking habits of an individual might, for instance, include inability to find reasonable accommodation or employment. The best technique was to supplement and complement personnel trained to deal with illicit demand for drugs with personnel from other relevant generalist fields.

One idea was a team approach. In this context, experience indicated that volunteers or others without professional qualifications could be trained to deal with a wide range of problems that had previously been regarded as capable of solution only by medical or other professionals.

As part of the development of a broad-based strategy it was important to move away from over-reliance on the medical treatment model. It had been clearly demonstrated that detoxification, while it could reduce demand for illicit drugs in the short term, did not alone overcome the long-term problem. It was only one of a wide range of approaches, which might include improving an individual's physical condition, lifting social pressures not related to drugs or improving self-respect. It had also been shown that effective detoxification from opiates and barbiturates could be carried out without resident medical staff but with medical supervision and rapid access to medical advice.

One aim of any strategy to prevent or counter illicit demand must be that individuals or groups at risk be guided and encouraged away from demand for illicit drugs. In this context, encouraging non-competitive exercise and physical fitness appeared to show promise.

The search for a range of acceptable alternative activities should begin among the groups at risk. If alternative activities were imposed, these were not likely to be acceptable and were not therefore viable options.

Interesting and potentially valuable new techniques were designed to enable drug users to learn to live within an open community that did not use drugs. This could be done by placing drug users with foster families or by encouraging them to enter open communities made up of equal numbers of persons with drug-using histories and non-drug users. In these communities, they were able to learn, inter alia, that drug users were not the only people with problems. More importantly, they learned that it was possible to live without drug abuse.

Information and training

As a basic principle, the development of material and the training of personnel in its use should proceed in parallel. Training material should be specifically designed to meet the needs of the target group. As already noted, the early involvement of personnel from an identified target group had proved valuable and cost-effective.

Information on drug abuse and training on countermeasures should form a normal part of curricula in medical schools, schools of pharmacy, teacher training colleges and courses designed for professionals likely to be working in drug abuse. Advantage was gained by training trainers to reduce costs and to achieve a maximum multiplier effect. For this purpose the production of training kits had been found very useful. In-service training was generally very successful, and trainees studying in foreign countries gained most when enabled to gain skills in a practical working institution. Training of personnel on a multi-disciplinary team basis had been very useful.

Training was required to increase or heighten the awareness not only of health professionals but also of a wide range of others, inside and outside government service, who could help to prevent or reduce the illicit demand for drugs. The best results were obtained by channelling basic facts to connected associations or institutions and encouraging them to produce the final training material. Information was most readily absorbed when it was received from peers, whether these were doctors, dentists, managers or youth leaders.

Training should also be given to traditional healers, where they existed, so as to help them avoid contributing inadvertently to the spread of drug abuse through their treatment practices and to overcome drug abuse if it occurred. Training could also be given to members of religious orders who were actively searching for ways in which they could help to improve society.

Means of assessing needs

Effective assessment of needs should be broadly based to identify and give priority to factors beyond the immediate needs of the drug user. Such factors included the social context, health, behaviour related to the drug use, the balance of factors supporting interventions and the management of interventions. Placing priorities on these factors and stating objectives was an important part of the process of assessing needs.

No single approach to assessing needs was, however, generally applicable. As a general principle, consistent studies to measure changes in needs and the availability of resources to meet those needs were preferable to single, ad hoc studies. All countries needed data on the drug-abuse situation that were as accurate as possible. It was best to concentrate only on the data that were necessary, bearing in mind that data on drug abuse alone, without supporting material on health, leisure use or the sociological environment for example, were of limited value.

Taking account of the circumstances in many countries, both industrialized and developing, useful results were often obtained by avoiding the use of complex systems for data collection. Simple documentation and techniques could effectively be employed at the local community level to assess needs without reliance on computer technology.

Evaluation

In respect of evaluation, the group agreed that there was every advantage in establishing long-range objectives at the national level and in making them widely known, thus mustering public support for declared policies and making the public aware of any threats that had been identified.

Objectives should be realistic. It was not, for instance, realistic to expect that drug abuse would end; however, a reasonable objective was to achieve a desirable change in the level of drug abuse, possibly in specific environments.

Evaluation could be carried out by measuring the achievement of short- term goals, e. g. during treatment, thus providing a learning process for staff and enabling rapid changes in the application of any intervention. Similar evaluating approaches could be employed at most working levels.

The evaluation of drug-abuse reduction should include an analysis and interpretation of the situation before, during and after treatment. It was essential to define clear programme objectives for interventions: in the first stage, the process of the intervention should be assessed; the second stage should measure the impact on the person in the programme; long-term outcomes for the community were assessed at the third stage of evaluation. It was important that the level of assessment should match the level of the objective.

Development of community resources

The working group considered that the importance of community resources, including both official professional services and non- governmental and voluntary bodies, was growing and that these resources were an essential and necessary element not only in the prevention of drug abuse, as previously mentioned, but also in the reduction of drug abuse. The use of community resources was seen to broaden more productively the range of interventions available for treatment, including in this context rehabilitation, after-care and social integration.

The basic principle of coordinating community efforts was to help people to help themselves in promoting general well-being, preventing drug abuse and integrating former drug abusers into their community.

Uncoordinated efforts to reduce drug abuse were often counter- productive and unlikely to meet community expectations. For example, any relative lack of government effort to control licit drugs compared with greater government effort to counter illicit demand for drugs might be an area where expectations were not being realized.

Through the integration of interventions into the local community context, government programmes could be co-ordinated with programmes of non-governmental organizations. That had the advantage of increasing community acceptance of intervention programmes to prevent and reduce drug abuse and would encourage the involvement of community resources.

Community resources should be widely drawn from families, schools, religious groups, youth organizations, recreational organizations, treatment services, commerce, industry, rehabilitation services, the judiciary and enforcement services.

The group emphasized the importance of using existing community systems and organizations. While situations would differ between and within countries, it was essential that programmes should be developed that were consistent with the local situation.

In the development of community resources, it was essential to have :

  1. Coordination of group efforts ;

  2. Increased communication between personnel of professional services and members of informal community groups ;

  3. Integration of specific drug-treatment services into the general health and social services ;

  4. Provision of support from government services for the community to the activities of self-help groups.

In some countries, multi-disciplinary in-service education involving voluntary and professional personnel had facilitated these cooperative developments. Similarly, cooperation in sharing information and planning complementary programmes had provided essential links for community-based development.

An identified outcome of cooperation had been a trend to change the nature of the care provided to drug-dependent people and thus avoid reinforcing the stereotype and the isolation of the "drug addict", which might have maintained the drug abuse.

One useful measure was to nominate a liaison worker to facilitate communication and co-ordination and to act as a resource for community involvement. In some countries, that person could be chosen by and from the community for training and education for this role. It was considered that community resources should be identified in terms of:

  1. The people to be involved ;

  2. The money available for the local area ;

  3. The expertise available in the community (e. g. social, health, educational, management, economic, legal);

  4. The availability of locations where interventions could be undertaken;

  5. Time available.

Recommendations

The group formulated the following recommendations:

  1. Governments, non-governmental organizations in consultative status with the United Nations, and all non-official or voluntary bodies concerned at the local, national, regional and international levels should be encouraged to direct more human and financial resources in a co-ordinated effort to solve identified problems and to meet genuine needs associated with the phenomenon of drug abuse.

  2. The attention of Governments and of specialized agencies should be drawn to the fact that the most effective approaches to drug abuse reduction should be developed on the basis of the most accurate available data, including epidemiological data, on the incidence, prevalence and other characteristics of drug abuse. These data are necessary at both national and local levels as a basis for the adequate assessment of needs and the allocation of resources. The role of the World Health Organization in respect of epidemiological data was considered to be especially important in this regard.

  3. Governments and specialized agencies should be requested to re- examine the extent to which official or statutory resources and existing programmes could be mobilized to support integrated and broad-based countermeasures to the multiple factors that contribute to the emergence of drug abuse.

In the general context of its recommendations, the group emphasized the following points:

  1. The most effective approaches to drug abuse reduction appeared to be based on an integrated strategy that linked and harmonized a wide variety of countermeasures, interventions and responses and that was designed to influence not only the individuals but also the community and society. Measures taken in isolation were seldom, if ever, effective;

  2. It seemed clear that benefit could be derived from giving greater prominence to that part of the Strategy and Policies for Drug Control that stressed the promotion of positive alternatives to drug abuse as a useful approach leading to reduction of abuse. The subject merited further study and might be given equal prominence to the emphasis provided to the overall objectives of prevention and treatment;

  3. The mobilization of community resources to prevent and reduce drug abuse had given evidence of great potential in a number of countries and communities and merited continued support from all concerned. In that context, the full involvement of the family and the school was of great importance ;

  4. The need for carefully planned educational and training techniques and programmes designed to be adapted by specific audiences remained of paramount importance. The most valuable training material had been prepared with the involvement of representatives of the target audience so as to be applied by them ;

  5. Training of personnel to reduce drug abuse was most effective when carried out in a working environment. The inclusion of drug-abuse questions in professional qualifying examinations had been useful in stimulating education surrounding drug-abuse issues. That technique could be applied to a wide range of concerned professions and should be supplemented by practical field training. Similar techniques might be used to encourage responsible prescribing habits by medical personnel ;

  6. Efforts to enrol the skills of the media in positive action for drug- abuse reduction should be considered. Undirected and sensational massmedia campaigns, frequently over-emphasizing the horrors of drug abuse, had not been generally useful and might be counter-productive in their effects. The role of the media in dramatizing in glamorous settings popular figures who were drug abusers was a matter for serious concern ;

  7. Before establishing short- and long-term objectives, at both local and national levels, care should be taken to determine needs and to identify achievable targets that were acceptable to the community, based on the use of available resources and susceptible of achievement in a realistic time frame. In that connection, sharing of experience on successful programmes would be a useful practical measure, and an exchange procedure would be particularly helpful for programmes at the community level ;

  8. The evaluation and monitoring of all approaches to reduce drug abuse was essential and should be an integrated part of, and a continuous process in, all drug-abuse reduction programmes. Whenever that strategy had been adopted, it had contributed usefully to personnel training and the development of programmes and had enabled approaches to be adjusted rapidly so as to meet goals most efficiently ;

  9. Available evidence indicated that the impact of approaches to prevent and reduce illicit demand for controlled drugs would be enhanced if concurrent emphasis were placed on reducing the use of socially acceptable substances, such as alcohol and tobacco, and on preventing the in-appropriate use of non-controlled substances with an abuse potential.