For an overall approach to prevention: basic critical considerations
Author: F. RÜEGG
Pages: 177 to 184
Creation Date: 1985/01/01
This article pleads for a comprehensive approach to the prevention of drug abuse, one which involves individuals throughout their lives and takes account of their psycho-social characteristics and spiritual values, as well as of differences among individuals. Certain drug abuse prevention programmes are identified as being counterproductive, such as inconsistent and incongruous programmes of the media that glamorize the life of celebrities who are abusing drugs, or drug information material that concurrently publicizes the use of legal drugs. Depersonalized drug education programmes have also proved to be counterproductive. Assistance and rehabilitation programmes for drug dependent persons and programmes for prevention of drug abuse among the young population, particularly children, should be provided simultaneously to avoid being caught up in a "vicious circle of assistance", brought about by disinterest in prevention and unrealistic expectations of society. The emphasis of prevention programmes should be on people rather than on drugs themselves.
It is apparent that, up to now, development programmes have not succeeded, as universal remedies, for drug problems in replacing traditional values that ensure the cohesion of society. Any such programmes should be evaluated carefully to determine which aspect of development may be a cause of drug abuse and which prevents it. Recent associations of young people seeking spiritual values and helping drug addicts to stop taking drugs and to be reintegrated into society are among the most promising approaches because they involve young people in helping youngsters of their own age rather than promoting intervention by formal institutions. The family is also one of the promising community resources that can be utilized for the prevention and reduction of drug abuse.
A title as thought-provoking as that used by Helen Nowlis in "Drugs demystified" [ 1] illustrates how the drug phenomenon is no longer an exclusive matter for specialists, regardless of whether we are dealing with the drug user, the drug addict or the drug dealer, or considering the work of the therapist, the representative of the law or the expert who is trying to reduce the illicit supply of drugs. The phenomenon of drug abuse today is like that of violence : it appears in a raw and diffuse state. One can therefore speak of gratuitous drug addiction in that addicts are no longer able to give explicit reasons for resorting to drugs.
Abundant literature on the subject of drug addiction suggests that the approach to the prevention of drug abuse should not be based on generalizations or on seeking miracle cures. A few of the prevention programmes reviewed by the author are based on a comprehensive approach to the drug problem, taking into account the psycho-social factors of the milieuin which drug abuse occurs rather than focusing merely on the drugs themselves.
It is very clear that the abuse of drugs is becoming more common, not only in the sense that more people are involved but also because more and more drugs are being used. After trying to Control the use of nicotine and alcohol, it became apparent that all psychoactive substances could be abused and that it would be very difficult to submit so many substances to formal control. It is, therefore, logical to Conclude that effective prevention programmes must be concerned at least as much, if not more, with the abuse of a substance as with the substance itself.
With regard to the causes of drug problems, the publications concerned with these problems almost invariably continue to list causal factors ranging from isolation through poverty, unemployment, industrialization and failed socialization to existential malaise.
Without analysing the general aspects of the phenomenon and its causes, and the means of determining such causes, a critical evaluation is given of certain controversial remedies which are commonly applied.
The media is perhaps the most controversial, often playing an ambiguous role in drug-related matters. Attention is drawn to certain inconsistencies and paradoxes to which the media often resort in dealing with the prevention of drug abuse. This practice is also observed in many other domains.
If people in the industrialized countries are suffering from overeating, the problem is by no means limited to food. Regardless of the accuracy of scientific facts contained in information intended for a given audience, it is necessary to inquire into the capacity of the audience to understand and to assimilate the intended information. The drug problem is one of the major world problems today, but it is no different from other scourges with deep social implications, which are equally difficult to cope with. Nevertheless, the media, seeking to create awareness, provoke feelings of guilt among the public with regard to these problems.
Continuing to draw an analogy between overeating and drug abuse, one might ask, "What is the balance of the information received?" For example, a brochure devoted to narcotic drugs and young people has no qualms about including advertisements for two stimulant medicaments that are advertised as being quite safe to use. This is a perfect illustration of the comment that in most cases drugs are dealt with in isolation, as if the way in which they are abused could be isolated from a very widespread mental climate inherent in the consumer society, where malaise, suffering, loneliness and aging are perceived as mere physical deficiencies which, like hunger, can disappear if only a sufficient quantity of the appropriate substance is ingested. The question is raised as to how one may hope to make a target group aware of the dangers of drug abuse if at the same time that group is assailed by advertising which has the opposite effect. This is equally true of articles and broadcasts devoted to drug problems that are immediately preceded or followed by reports about the glamorous life of certain stars who, on occasion, undoubtedly abuse drugs. It may, therefore, be argued that the everyday exposure of ordinary people to contradictory information deprives them of their capacity to make proper judgements regarding the subject. It is obvious that this kind of pseudo-information can have counter-productive effects.
It should be noted that extraordinary results have been obtained in the rehabilitation of drug addicts by applying the numerous methods developed by different institutions throughout the world which have been pioneers in this field. Nevertheless, it is important that consideration be given to prevention, bearing in mind the fact that if the rehabilitation of even a large number of addicts is achieved, it does not prevent the possibility that a larger number of young people may become addicts. A help and care programme for drug addicts and a programme for the prevention of drug abuse among "high-risk" young people, particularly children, should be provided at the same time to avoid their being caught up in what may be called the "vicious circle of assistance", which is brought about by disinterest in prevention and increasingly unrealistic expectations, of which some aspects related to youth have been described clearly by Bergeret [ 2] , but which have now been extended to include the whole of society.
The model of comprehensive assistance from the cradle to the grave, the origins of which dates back to the eighteenth century, is now recognized and advocated throughout the world. It should be mentioned that the problem discussed here has a political character, which makes it a matter of intense emotions - a fact that sometimes prevents any careful reflection on the subject. Additional problems are also involved in helping people who are at the margin of society, a group which include a large number of drug addicts; they often reject the assistance offered to them or exploit it [ 3] . The question is raised as to whether the marginalization of individuals goes far beyond the crisis of adolescence and that of the economy to which it has often been attributed.
From the point of view of effective prevention, it has nevertheless been realized that all efforts to achieve uniform integration in a standardized society, which refuses to recognize differences and the marginalization of certain groups of people, are by the very nature of things doomed to failure. Furthermore, in a society where the proportion of people receiving assistance exceeds that of those not receiving assistance, the question is raised as to how long the latter will be willing and able to subsidize aid given to the former, who have become privileged by living at the expense of others. But it is true that the rejection of work as well as of standards and established values of society are constant factors in the conflict between the generations. It has, however, been noted universally that drugs can no longer be considered as the path to an artificial paradise ; they can only lead to a "nothingness" which is not related to any philosophy. Materialism has obviously reached its lowest level, while "nausea" has become popular.
The emergence of a cult of pure survival [ 4] , characterized by passivity, parasitism and the rejection of any form of struggle or commitment, has also been observed. This cult is manifested in the unrealistic demands made by young people who often are unwilling to make concessions. This lack of realism has a clear relationship with drug addiction : from this point of view, drugs are more mental or ideological than chemical.
An eminent authority in rehabilitation, Dom Picchi, maintains that despite the influence of many factors, the drug addict is a responsible person who has chosen to take drugs ; however, drug-taking represents the wrong choice, a solution of convenience [ 5] .
The prevention of drug abuse refers to a large extent to drug education and information. A simple course on drugs at school will not automatically prevent the problem from arising. Impersonal and incongruous information cannot replace interpersonal education ; experts in psychology have described the negative effects caused by depersonalized education : the impossibility of following a model and of developing a critical spirit [ 1] , [ 2] . It is worth noting that, to facilitate the development of appropriate educational programmes, the Catholic International Education Office devoted its World Congress held at Bangkok in 1982 to the topic of education in values [ 6] .
Research on the nature and extent of drug problems, as well as programmes to cope with such problems, have mainly focused on industrial societies. It is, however, well known that many developing countries are confronted at the same time with problems common to industrialized societies, e. g. drug addiction, unemployment and violence, as well as with those problems common to developing countries such as destabilization of traditional social units and hunger. Although the drugs used in a number of developing countries are less sophisticated, the ravages to which the abuse of these drugs gives rise are severe and widespread.
There are people who consider that development is the universal remedy which will solve the drug problem because, in their opinion, it is hunger and poverty which drive people in some developing countries to take drugs. Dr. Olivenstein supplements this simplistic view with the felicitous remark : "In South America poor people take drugs to still their hunger. But from what hunger do our children suffer today?" [ 7] .
Any remedy proposed for drug problems must evaluate carefully which aspects of development may cause drug abuse and which may prevent it. It is increasingly apparent that up to now development programmes have not succeeded in replacing certain traditional values which assure the cohesion of these societies.
While there are tendencies in the developing countries to abandon old institutions to make room for new ones, the industrially developed world, after having discarded old institutions and in view of the ineffectiveness of supplanted ones, is searching to utilize the resources of traditional institutions such as the family in the prevention of drug abuse.
The United Nations is frequently calling upon "community resources" either to promote social advancement or measures to prevent and reduce drug abuse. The family is one of these resources. The family has been rediscovered, somewhat in the way that nature has been rediscovered by the ecologists who have given it a new name "environment". We must be under no illusions : the family has changed to such an extent that it can no longer be defined satisfactorily for everyone. It is nevertheless paradoxical that it is in developed industrial societies where only remnants of the family subsist that people are turning to it to cope with social problems and to promote social well-being, while in the developing societies the family is undergoing the inevitable disintegration, which is so often criticized, but for which very little preventive action has been taken. The social sciencies, having engaged in Criticism of traditional values, are now reintroducing them as if they had invented them : the family is a good example. With regard to the prevention of drug abuse, there are still other traditional values which should be mentioned here, such as the affirmation of the need for the harmonious development of the child and the establishment of a solid system of values which is so essential for the psycho-social development of adolescents [ 2] .
The family can offer potential resources for social well-being and for the prevention of drug abuse. This was brought out clearly by the recent International Congress *, which was organized by the International Centre for Family Studies and which took place at Milan in 1984. Eminent theoreticians and practitioners from many countries evaluated the resources available in the family and outlined the ways of applying them both in the prevention and treatment of drug addiction. Agreement appears to have been reached on the view that the family is particularly effective in- the primary prevention of drug abuse, mainly in the education of children. Owing to the fact that the structure of the family is a microsociety, it can ensure a balanced growth of the child, providing a means for a child to learn social laws and to develop its personality. To fulfil this role, the family must be a living organism and not merely the common place of residence of its members.
The Congress also brought out the complementary nature of the various community resources, showing that the family cannot enjoy the exclusive role in the prevention of drug abuse. The importance of the activities of peer groups is undeniable, although the present exaggerated increase of the number of such groups that exercise specialized activities seems to interfere with the quality of relationships. The scout movement has certainly proved its worth in preparation for life and in forming values [ 8] . With respect to International Youth Year, some reference should be made of the emergence of new forms of youth associations, which are less institutionalized and less formal than those of the past. These are often confessional groups that are striving to achieve spiritual values, which go beyond comradeship, humanitarianism and social demands.
Nowadays erudite studies have to be carried out to confirm the simple fact that the equilibrium of a family and of the children is based on harmony of the couple and on love and that, to achieve the equilibrium, it is essential that young people learn to be responsible and to have ideals.
Although the family offers potential resources that can be utilized for the prevention and reduction of drug abuse, it nevertheless bears certain inherent risks for its adolescent members. When an adolescent is undergoing the "crisis", which is characteristic of the adolescent age and a normal part of the growth process leading towards achieving some degree of autonomy, the adolescent may reject his or her family. This rejection may be very painful to the family, particularly to the parents, who often misunderstand the adolescent's natural needs for independence and, by overreacting, may push the adolescent into a new conflict, which often leads to involvement with drugs.
* The proceedings of the Congress can be obtained at the following address: CISF, via Monte Rosa 21, I-20149 Milan, ltaly.
In the opinion of the author, the phenomenon of drug abuse constitutes a warning, a refutation of exclusive materialistic belief in progress. The recent quest by young people for spiritual values is apparent in different forms. Sometimes these efforts lead to incomplete and deviant forms of pseudo-religions or pseudo-traditions, but more often the quest for spiritual values takes the form of a genuine reversal of roles, i. e. the drug addict becomes the therapist. A tribute should be paid to the dedication of many young people for their anonymous efforts to control drug abuse. This type of therapeutic involvement, in which youth help youth within the population from which the majority of drug addicts are recruited, is among the most promising approaches because it involves young people in helping other young people of their age rather than the intervention of formal institutions. It is difficult to evaluate the effectiveness of this approach to the prevention of drug abuse, but there is no doubt that positive results have been achieved.
The non-governmental organizations that promote transcendental values certainly have an important role to play in the prevention of drug abuse, particularly in primary prevention. These can train young people to the extent that they will be prepared to face the difficulties which they will confront in day-to-day life. .
For its part, the International Catholic Child Bureau has decided to devote its future activity to the problem of children confronted by a spiritual void, after having initiated, together with other non-governmental organizations, a programme for the benefit of street children and youth. This decision also signifies a determination to attack the problem of drug abuse prevention at its roots, in the hope that this will help to eliminate the demand for drugs. In the long term, this can overcome an increasing spread of drug abuse and associated problems.
This history of ideas has taught us, notably since the research carried out by Ariès [ 9] , to put accepted ideas into perspective. The history of the family, the history of values, of which happiness (often confused with simple comfort and ease) and freedom certainly represent, even at present, the least contested of accepted ideas, still remain to be researched.
In his message to young people at Viterbo in 1984, Pope John Paul II said :
"Contemporary man, proud of the extraordinary scientific progress he has achieved, is inclined to seek the solution to his internal problems in the technical expedients which he employs to overcome the difficulties which he encounters in the external world" [ 10] .
Helen Nowlis, Drugs demystified (Paris, UNESCO Press, 1975).02
J. Bergeret, "Young people, drugs . . . and others", Bulletin on Narcotics (United Nations publication), vol. 33, No. 4 (1981), pp. l -14.03
J. M. Richard, "Les limites de l'action sociale, une intervention sociale dans la zone?", Pro Juventute ,Zürich, No. 3 (1982), pp. 3 - 12.04
O. Clément, "Religion of life", France Catholique ,No. 1982 (1983), p. 10.05
Dom Picchi, Intervista sulla droga e sul uomo (Rome, Centro Italiano di Solidarietà, 1983).06
Eduquer aux valeurs pour les sociétés de lean 2000(Brussels, Catholic International Educational Office, 1982).07
C. Olivenstein, Drogas e Drogados (Sao Paulo, Editora Pedagogica e Universitaria Ltda, 1982).08
Report of the International Catholic Conference of Scouting on the occasion of International Youth Year, Brussels, 1982.09
P. Ariès, L'enfant et la vie familiale sous l'ancien régime (Paris, Seuil, 1960).10
L'Osservatore Romano, 12 June 1984, p. 8.