Substance abuse is immoral
Alcohol, drugs and the like - which preventive measures help?
There are different reasons why people resort to addictive substances. Their effect depends on the type of drug, how it is used and the physical condition of the user. Preventive measures against the abuse of drugs must therefore take into account the various causes, forms of use, circumstances of use and its consequences.
The World Health Organization defines a drug as any substance that can change functions in a living organism. In humans, this applies to the freely accessible “stimulants” coffee and tea, alcohol and tobacco as well as to sleep, sedative and pain relievers, stimulants or to “soft”, “hard”, “natural” or “ artificial ”drugs like hashish and marijuana, intoxicating mushrooms, inhalants, opium, cocaine, ecstacy, LSD, speed, crystal meth or new psychoactive substances (NPS).
Legal drugs are substances the acquisition and use of which is not prohibited by law, but may be restricted (e.g. prohibition of the sale of alcohol to children, ban on smoking in restaurants) or for which restrictions have been specified after consumption (e.g. ban on driving after consumption of alcohol).
Illegal drugs are substances the acquisition and use of which - except for therapeutic purposes - is prohibited and subject to punishment, although the prosecution and extent of criminal prosecution can be regulated differently.
The distinction between legal and illegal drugs is often made on the basis of a culture-specific tradition, although harmful effects of any drug can be demonstrated regardless of its legal status.
The term addiction was used by the World Health Organization (WHO) until 1963. According to the prevailing opinion at the time, this meant the pathological psychological or physical end state of dependence. The addict has the no longer controllable desire to procure the required drug and in some cases also to increase the dose. The consequences of addiction can be physical (e.g. organ diseases), psychological (e.g. loss of orientation) and social (e.g. isolation, criminalization). In order to avoid stigmatizing addicts, it was initially replaced by the terms “abuse” and “dependency”, and from 1969 by four defined classes of use:
- Unauthorized use is a use that is not tolerated by society.
- Dangerous use is a use with likely harmful consequences for the consumer.
- Dysfunctional use occurs when psychological or social demands are impaired.
- Harmful use has already caused harmful consequences (cell damage, mental disorder).
These designations have in the International Classification of Diseases and Health Problems (ICD-10) Entrance found.
In the 10th revised version of the ICD-10, a distinction is made between “harmful use” and “addiction syndrome” in connection with the consumption of psychotropic substances. The former arises from the consumption of psychotropic substances, which leads to damage to health. The dependency syndrome stands for a group of behavioral cognitive and physical phenomena that develop after repeated substance use. Typically, there is a strong desire to ingest the substance, difficulty controlling use, and prolonged use of the substance despite harmful consequences. Substance use is given priority over other activities and obligations. It develops an increase in tolerance and sometimes physical withdrawal syndrome. The dependency syndrome can relate to a single substance (e.g. tobacco, alcohol or diazepam), to a group of substances (e.g., opiate-like substances), or to a wide range of pharmacologically different substances.
in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) the American Psychiatric Association the term “addiction” is still found. This is described as a complex condition, a chronic brain disease that causes compulsive substance use despite harmful consequences. The expression of addiction is that people are so fixated on substance use that it takes control of their lives.
The International Classification of Functioning, Disability and Health (ICF) defines the urge for addictive substances as a mental function that manifests itself in the urge to consume substances, including those that can lead to abuse.
In addiction medicine, the term substance demand or Craving used, which characterizes the continuous and almost invincible desire of an addict to consume his addictive substance (alcohol, tobacco, other drugs).
The term addiction is still widespread in everyday language and is still used very often by the media.
Abuse, dependency or addiction can be substance-dependent (e.g. with alcohol, nicotine) and substance-independent (e.g. with gambling addiction, internet addiction, anorexia).
are required to prevent, limit, or reverse the negative effects of drug use
- for those affected themselves, e.g. in the case of illnesses triggered by addiction
- for the social environment, e.g. in the case of "co-dependency" within the family
- for companies, e.g. if costs arise for the employer due to absence from work
- for the welfare state, e.g. through burdens on the insurance carriers
Different forms of prevention are distinguished depending on the target group and the time of the measure:
Under Primary prevention one understands all measures which should contribute to avoid the dangerous consumption of drugs.
Secondary prevention means working with drug users who are at risk or who are already addicted.
Tertiary prevention refers to aftercare or measures that are intended to avoid a possible relapse into drug use.
A distinction can be made according to the scope and the goals of prevention:
Universal preventionwhich aims to inform and educate as broad a population as possible about the consequences of drug consumption.
Selective prevention aims with specific offers at groups with risky behavior.
Indicated prevention is aimed at those who have already developed problems.
The ideas of successful prevention work have changed over time with the changing theories about the causes of addiction and addiction:
For a long time, addiction was seen as deviant behavior on the part of an individual: as a result of inconsistent character, immoral behavior, or a physical illness. Attempts have therefore been made to help those affected through education, moral instruction or medical treatment.
With industrialization, alcohol consumption by workers became a problem, as both work performance and costly work equipment were at risk; Young people were considered particularly vulnerable. This was countered by bans, discipline and placement in institutions. Since the supply of alcohol was also considered to be the cause of harmful behavior, serving times were restricted (e.g. in England) or the production, sale and consumption of alcoholic beverages were prohibited (e.g. in the USA).
After "light" drugs such as hashish and marijuana became increasingly fashionable in the 1960s, designer drugs such as LSD became available and "hard" drugs such as heroin and cocaine were no longer used as "social drugs", prevention work was expanded to include illegal drugs . Deterrence and sanctioning should prevent their use and shut down the market for illicit drugs.
In the 1970s, as part of the general reform policy, the therapy facilities were expanded as the number of drug addicts had increased. With the rise in psychological and pedagogical degrees at universities, prevention work has increasingly become a field of activity for educators, psychologists and psychotherapists in addition to medical professionals.
Since the 1980s there has been more research into the various causes of addictions and the legal drugs alcohol and nicotine have been increasingly included in prevention. Not only the person concerned, but also their family and social environment were given greater consideration (“systemic approach”).
At the end of the 1980s, the increasing spread of synthetic drugs corresponded with changed lifestyles in the leisure society (e.g. ecstacy). Due to extensive health promotion, the goal of primary addiction prevention has been extended to general well-being.
The promotion of life skills in kindergarten and school has been the focus of prevention work since the 1990s. In the second half of the 1990s, experiences and findings from secondary and tertiary preventive drug help found their way into primary prevention, the primary goal of which is now no longer seen in general abstinence, but in risk reduction and damage limitation.
Since the turn of the millennium and based on the experience that despite extensive awareness-raising campaigns, extensive counseling and therapy offers and stricter controls, the consumption of legal and illegal drugs has not decreased, but has stagnated at a high level or even increased (e.g. party drugs)
- legal regulations against consumption strengthened (e.g. in cigarette advertising)
- the attempt to dry up the market for illegal drugs is intensified (e.g. through extensive drug searches)
- Comprehensive regional, national and international campaigns funded (e.g. through the European Youth and Alcohol Action Plan)
- accelerates the “contextual” prevention work (e.g. through community-oriented concepts)
There are concepts and measures for drug prevention on a global level (UNODOC: 2015), in the EU (2012) and on a national level (Drug Commissioner of the Federal Government: 2012; 2015), with national ideas increasingly adapting to international requirements.
The national strategy of the federal government on drugs and addiction policy from 2012 assumes that successful prevention must be target group-oriented.
In the various old and new voluntary and professional initiatives, groups, associations and state institutions that are dedicated to prevention and therapy, some of these concepts, but also a mixture of these (multi-modular prevention), are taken into account. While some anti-drug campaigns favor measures that date back to the era of industrialization (and thus achieve successes, e.g. in the groups of Alcoholics Anonymous, AA), others apply more recent or the latest findings from the educational, medical or psychological sciences (the effectiveness of which has to be proven in some cases).
The main goals of drug prevention
Health promotion is the central model; Preventive measures set substance-specific and substance-unspecific goals
Personal resources (e.g. personal strengths, ability to say “no”) are encouraged
The focus is on risk behavior; If drug consumption cannot be prevented, the start should at least take place as late as possible in life, because this reduces the risk of permanent dependence
In the case of existing drug use, the harmful effects should be reduced ("Harm Reduction") or the avoidable damage should be minimized ("Safer Use")
Not only the individual at risk, but the entire social context - family, kindergarten, peer group, school, clubs, community - should be mobilized against entering into dangerous drug use ("contextual prevention")
Not selective or individual measures, but concepts that are designed to last over a longer period of time are implemented.
Since it is still doubtful which measures will actually be successful, the evaluation of projects and programs is considered essential.
The building blocks of successful prevention programs
Ever since the United States experimented with “rational behavior change strategies” in the 1960s, it has been proven that information about the adverse health effects of drug use alone neither prevents entry nor accelerates exit. Education campaigns can even have negative effects on the target group of young people if they stimulate curiosity behavior. Education about drugs and their problematic effects is successful if:
- Parents of young people at risk are reached and sensitized to recognize consumption and its effects and to react appropriately
- Educators in kindergartens, teachers from different schools, trainers in sports clubs acquire the basic knowledge necessary to deal with the endangered age group
- Children and adolescents acquire and disseminate the medically and psychologically secured knowledge about the negative consequences of consumption themselves, because the knowledge acquired through the “flow effect” has a stronger behavioral control than lectures, flyers given by experts (even if they are made suitable for young people) and posters
- the Internet is used because this medium has a high level of acceptance among young people and virtual (also anonymous) interaction is possible; a final evaluation of such projects is not yet available
- Media projects spread well-founded attitudes and norms on the subject of legal and illegal drugs and present risk situations convincingly
- Health literacy is an effective way of preventing entry into consumption through school settings that contain both cognitive and affective-behavioral elements, or “social vaccination” that builds resistance to social pressure
Advice during pregnancy
Prevention during pregnancy and breastfeeding is important for two reasons: on the one hand, sensitivity and thus the willingness to change behavior is often increased during this time; on the other hand, unborn babies and infants are particularly at risk if they are exposed to harmful substances. IRIS is an online program specially designed for women to help them abstain from tobacco or alcohol during pregnancy: www.iris-plattform.de.
The dilemma of any previous parenting work in drug prevention is that parents of children and adolescents at risk often do not make use of the offers that are offered to them. Successful parenting takes into account:
- Children and adolescents who use drugs come from households with single parents or patch work families. Often, when the parents are separated, the interests of the children are not adequately taken into account, which is why targeted advice and care offers are necessary
- Special programs have been developed for children from families at risk of addiction, such as TRAMPOLIN: http://www.projekt-trampolin.de/
- Parent schools help insecure couples raise their children. Offers must not be centered on deviant behavior, but must address everyday parenting (“How much pocket money do I give my child?”); Concepts supported by regional media (e.g. a "parent forum" in daily newspapers) are particularly successful
- Neighborhood initiatives based on the model of commercial campaigns can successfully organize meetings that also reach families who are otherwise hardly accessible
- Self-help groups run by parents who pass on their experience in dealing with drug-dependent children to other parents have a positive effect, e.g. http://www.elterngegendrogen.ch/
- Adolescents and children should be encouraged to influence their parents' addictive behavior in an educational way (not through instruction, but e.g. through photo exhibitions, poster competitions)
- ELSA is an internet-based program that aims to provide support to parents of children and young people at risk of addiction: www.elternberatung-sucht.de
Measures in toddlerhood and kindergarten
The kindergarten is an important place for drug prevention. Toy-free weeks can reduce passivity and enable an active lifestyle, meals prepared together promote health awareness at an early stage and games strengthen the ability to make independent decisions later in life, even against peer pressure.The Federal Center for Health Education (BzGA) has been offering support for preventive prevention in this development phase for more than 20 years with the project “Make children strong”: www.kinderstarkmachen.de/. In the NEST project, the federal initiative “Early Help” offers special material for the work of specialists in family work: www.fruehehilfe.de/nest-material.
Concepts for clubs and associations
Studies show that membership in clubs and associations has a preventive function. This is surprising because, for example, drinking rituals are practiced in some sports clubs and performance-enhancing agents are only tried because of the pressure to succeed that some coaches exert. The preventive effects of club life, however, lie in strong social control, the monitored norms and the ritualization, chronologization and habitualization of behavior. The preventive function can be increased if those responsible in the clubs (e.g. youth trainers) are made aware of the drug problem: www.alkoholfrei-sport-geniessen.de/home/ The National Doping Prevention Plan provides, among other things, through the formation of networks and an intensive one Coordination between the partners to make even better use of the resources for prevention in sport. www.gemeinsam-gegen-doping.de/.
Prevention in schools
What speaks in favor of schools as a place of preventive measures is that children can be reached for preventive measures over a long period of time. The school time represents the sensitive phase for the acquisition and stabilization of behavioral habits, the implementation and evaluation of preventive measures are also facilitated by the organizational structure of the school. In addition to measures geared towards individual cases (behavioral prevention), structural measures can also be carried out (relative prevention).
- For the primary school, the Klasse2000 project offers ideas for health promotion and prevention. The long-term consequences of the measures were positively evaluated: http://www.klasse2000.de/
- “Becoming independent” is a teaching program for health promotion, addiction and violence prevention as well as personality development in primary school: http://www.eigenstaendighaben.de
- The class climate of trust, mutual acceptance and support plays an important role in life skills programs: www.unicef.org/lifeskills/
- For pupils from the 8th grade, the project "Klarsicht" offers an interactive hands-on course on the problems of tobacco and alcohol consumption: http://www.klarsicht.bzga.de/
- Active forms of learning (e.g. “learning through teaching”) improve the success of prevention programs www.ldl.de.
- Resources must be created that enable the new skills learned in the context of the course content to be used in everyday school life.
Peer Group Concepts
Since the group of peers very often determines the norms of drug consumption, this prevention work relies on the fact that drug-critical information disseminated via the peer group has a very high influence on the attitudes and behavior of the individual members. A distinction is made between:
- Peer involvement: in peer consulting or counseling, young people advise other young people; in peer education, trained young people take on the task of conveying information about health-promoting attitudes; in peer project management, knowledge is conveyed to peers with time-limited activities (e.g. plays, video clips)
- Peer support: sees itself as a procedure that has arisen within a scene with the aim of using self-help potential and the competence of those affected and providing mutual support and coping with life
- The project “INSIST - Internet-based 'Social Norms' Intervention for Preventing Substance Use by Students” uses the so-called social norms approach. Here, students are first asked about their own consumption and then informed in the form of feedback about the actual and often overestimated addictive substance or drug user in their own peer group.
The effectiveness of peer approaches is controversial; it has been proven that the young people actively involved are those who benefit most from these measures.
Gender specific measures
Since gender has a significant influence on the cause and type of drug use as well as different forms of addiction (e.g. 95 percent of those treated for adolescent anorexia are female), these measures address girls and boys differently. The goal is:
- For girls: the strengthening of self-determination and personal responsibility, the acquisition of male-dominated skills, the improvement of one's own body image as well as support in professional and private future planning, e.g.
- For boys: the ability to successfully cope with life and appropriate social integration, the promotion and expansion of general skills (e.g. conflict management), as well as dealing with ideals of masculinity.
Extracurricular youth work
In the institutions of extracurricular youth work, the prevention work can build on the voluntary nature of participation and respond to the inclinations and personal strengths of the individual youth.
Company addiction prevention
Young people and adolescents can be reached for measures during their vocational training. As a holistic program, Prev @ WORK aims to anchor addiction prevention as part of occupational health and safety in company health management. The main target group are trainees who acquire knowledge on the subject of addiction in seminars, reflect on their own consumption behavior and thereby learn how to use addictive substances responsibly and in a risk-competent manner.
Addiction prevention in the Bundeswehr
Since members of the Bundeswehr can also run the risk of becoming dependent on substance-related or substance-independent dependencies, special measures have been developed for this group of people, e.g. a self-help initiative: www.soldatenselbsthilfe-sucht-bundeswehr.de/
Cooperation with discos and restaurants
Since drugs are consumed more frequently in these facilities, cooperation with the operators is a prerequisite for the success of projects (e.g. information booth, discussion evenings, entry ban for consumers and dealers), which are all the more positive, the lower the fluctuation of visitors. Specific consumption can also be addressed, e.g. drugchecking is an offer to users of Ecstacy to test the purchased substance for impurities; this is intended on the one hand to protect against the use of contaminated drugs, but at the same time to enable informative discussions about the dangers; the success is controversial.
Through increased alcohol and drug controls in road traffic, control of compliance with the protection of minors in bars, discos, at events, festivals, etc., a selective influence on the driving behavior of young people is achieved (e.g. the number of alcohol-related accidents resulting in death).
In the social environment, a steering committee made up of representatives from various institutions (e.g. kindergartens, schools, clubs and associations, churches, youth clubs, politics, police) is established, which plans, controls and evaluates measures related to the municipality or district according to the current situation. The advantage of this concept is that specific problems can be recorded and addressed and the various actions within a common action horizon take effect. Coordinated measures within a contextual project can be:
- Set norms against drug use in the family, school and community, communicate these in all institutions and sanction violations
- Accompany legislative measures with school- and family-oriented interventions
- Carry out enjoyment programs
- Discover and strengthen resources in the communities
- Develop Agenda 21 initiatives to define goals that give meaning to collective actions and thus also to individual actions.
Substance related programs
A number of prevention programs are directed against the entry and / or harmful use of certain substances or substance groups.
- The “Kenn-Dein-Limit” program was developed for adolescents and young adults, which among other things offers interactive options to prevent alcohol abuse: www.kenn-dein-limit.info/ Other alcohol prevention programs are, for example: www.weniger-Trinken-online. de or "Hart am Limit HalT": www.halt-projekt.de/
- There are also programs against nicotine addiction: www.rauch-frei.info/app/ or drug addiction
- The problematic use of cannabis products should be prevented by: “Qui the Shit”: www.quit-the-shit.net
Programs for non-substance-related forms of dependence
Preventive measures are also necessary in the event of harmful gambling or internet usage that is no longer controllable. The prevention campaign “Be online with measure and fun” is aimed particularly at young people: www.ins-netz-iegen.de.
Country-specific measures and municipal projects:
Numerous preventive measures of their own have been developed and implemented in the German federal states: e.g. MINDZONE (Bavaria), Legal Highs (Lower Saxony), Drug Scouts (Saxony), Checkpoint C (Saxony-Anhalt).
A large number of German districts and municipalities have also set up offices for addiction counseling or support independent organizations with such measures, e.g. the addiction prevention center in Hamburg: li.hamburg.de/spz, the specialist office for addiction prevention in Dortmund www.suchtvorbeugung-dortmund.de/, Berlin www.berlin-suchtpraevention.de, or Frankfurt aM www.fachstelle-praevention.de.
Initiatives and measures from smaller and larger institutions and associations:
Ministries, associations, clubs and individual self-help groups are active in a large number of campaigns at the federal, state and municipal levels. The Federal Center for Health Education (BZgA) is the specialist authority for health education, it develops strategies for health education and prevention and implements them in nationwide campaigns: http://www.bzga.de/.
The German Central Office for Addiction Issues (DHS) is an amalgamation of the associations active in addiction prevention and help for addicts - associations of free welfare, self-help and abstinence associations and public service providers of addiction aid: http://www.dhs.de/.
The central associations of the health insurance companies have adopted common and uniform fields of action and criteria for services in primary prevention and workplace health promotion. Churches, charities and self-help groups help and support. Condrobs was founded as a self-help initiative and is today active throughout Bavaria in many municipalities in prevention, addiction counseling, addiction help and therapy: www.condrobs.de/.
Quality assurance in prevention
If one differentiates between “output” and “outcome” in prevention, then it is not the number of measures that has to be checked, but their actual effectiveness. This is done, for example, through evaluation systems such as PrevNet and Dot.Sys from the BZgA. Both systems serve to promote the transparency of the nationwide prevention measures, to provide quality-assured information and to continuously improve the networking of specialists nationwide.
- Böckem, J./Jungaberle, H./u.a., (2015), High Sein. An educational book, Berlin.
- German Institute for Urban Studies (Ed.) (2011): Documentation. Exemplary strategies for community addiction prevention. Addiction prevention for children and adolescents in special life situations, Berlin.
- The Drug Commissioner of the Federal Government (2012): National Strategy for Addiction and Drug Policy, Berlin.
- The Drugs Commissioner of the Federal Government (2015): Drugs and Addiction Report. Berlin.
- European Monitoring Center for Drugs and Drug Addiction (2015): European Drugs Report. Trends and developments. Luxembourg 2015.
- Greca, R. (2009): Prevention as a program-oriented service, in: Greca, R. / Schäfferling, St./Siebenhüter, S. (Ed.): Danger to young people from alcohol and drugs? A case study on the effectiveness of preventive measures, Wiesbaden.
- Greca, R./Schäfferling, St./Siebenhüter, S., (2009): Danger to young people from alcohol and drugs? A case study on the effectiveness of preventive measures, Wiesbaden.
- Greca, R. (2012), Harm Reduction at the Community Level in Critical Alcohol Consumption in Adolescents. Measures - Effectiveness - Outlook, in: Schmidt-Semisch, H./Stöver,H. (Ed.), Drinking with meaning? Harm reduction in alcohol consumption, Frankfurt a.M.
- Hurrelmann, K. / Klotz, Th., / Haisch, J., (Eds.) (2014), textbook. Prevention and Health Promotion, Bern.
- Kraus, L./Papst, A./Piontek,D. (2011): European Student Study on Alcohol and Other Drugs 2007 (ESPAD) Survey of 9th and 10th grade students in Bavaria, Berlin, Brandenburg, Mecklenburg-Western Pomerania and Thuringia, Munich.
- State Institute for Education and Teaching Stuttgart (2002), Addiction prevention for boys. A handout for teachers for information on addiction prevention in Baden-Württemberg, Stuttgart.
- Marlatt, G.A./Witkiewitz, K. (2002): Harm reduction approaches to alcohol use: Health promotion, prevention, and treatment, Addictive Behaviors 27, pp.867-886.
- Metzinger, A., (2012) Addiction prevention: practical help for kindergarten and elementary school, Hohengehren.
- Quensel, S. (2010): The misery of addiction prevention. Analysis - Criticism - Alternative. Wiesbaden.
- Council of the European Union (2012): EU Drugs Strategy 2013-2020, Brussels.
- Spaeth, M./Weichold, K./Silbereisen, R. K./Wiesner, M. (2010): Examining the differential effectiveness of a life-skills program (IPSY) on alcohol use trajectories in early adolescence. In: Journal of Consulting and Clinical Psychology, 78, pp. 334-348.
- United Nations Office on Drugs and Crime (UNODC) (2015): 2015 World Drug Report. new York
- United Nations Office on Drugs and Crime (UNODC) (2015): International Standards on Drug Use Prevention, Vienna.
Prof. (em.) Dr. Rainer Greca, Professor of Sociology at the Catholic University of Eichstätt-Ingolstadt
Projects: inter alia for cooperation between medical and social services (“Sprengel Fahrt”) and for contextual drug prevention (“Out of the Blue”)
Catholic University of Eichstätt-Ingolstadt,
At the Schanz 49
Telephone (0841) - 9371881
Created on September 27th, 2004, last changed on October 8th, 2015
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