Abstract: Background: strategies to prevent initiation of non-injectors into injecting are rare. A brief intervention with this aim, offered to current injecting drug users (IDUs), has been evaluated. Methods: baseline behavioral and attitudinal data were collected using structured interviews with 86 IDUs. Participants were re-interviewed immediately after the intervention and at 3-month follow-up (n = 73). Results: it was feasible to deliver the intervention, which was acceptable to both drug users and drug workers. IDUs' disapproval of initiating non-injectors significantly increased after the intervention. Participants injected in front of fewer non-injectors in the subsequent 3 months (falling from 97 to 49). Requests for initiation fell from 36 to 15 and the number of people initiated dropped from 6 to 2. Conclusions: these results, the cheapness and ease With which such an intervention can be delivered, suggest that by incorporating such interventions into drug work it may be possible to reduce the number of ...

Abstract: This paper aims to redress the imbalance in current methadone evaluations by investigating the views and experiences of drug users themselves. The research was funded by the Scottish Office and involved semi-structured, qualitative interviews with 80 illicit drug users currently receiving prescribed methadone. All interviews were audio-recorded with full transcription and analysis of the transcribed material was carried out using the software package, Winmax. The study revealed that the respondents' comments were consistent with the views often expressed by professionals. That is, service users valued the ability of methadone to reduce illicit drug use, to decrease drug-related harm and to prevent crime; and were worried by abuse of the prescribing system and the fact that methadone was addictive and caused similar problems to, or worse problems than, heroin. Additionally, service users were concerned about, and often prioritized, the impact of prescribed methadone on their health, physical and emotional ...

Abstract: In 1996 an innovative multidisciplinary community drug service for adolescents was established in Stoke on Trent, UK. For the first time the profile of adolescent heroin dependents who access the service is described. A picture of extreme vulnerability emerges: early age (mean = 11.8 years) of initiation into substance use, rapid development of heroin dependence, concurrent polypro use, injecting behavior and deliberate self-harm. Retention in treatment was achieved in 80%, despite a background of social deprivation and criminality. This local information extends and confirms national data. The policy response must be the establishment and outcome evaluation of n few pilot projects.

Abstract: The increase in youth homelessness in the UK and also internationally, although a cause for public concern, is proving resistant to efforts to contain it. Perhaps an association with drug misuse is...

Abstract: Young people looked after by social services have been identified as being at increased risk of having, or developing substance misuse problems. Despite such claims, there is a distinct lack of research on the extent and nature of substance use among 'looked after' young people. This paper reviews the published literature on substance use among this population and presents the preliminary findings from a Home Office Drugs Prevention Initiative (DPI) evaluation of a drug prevention intervention among young people living in a residential care establishment. A comparison of these findings with other research data on substance use among young people suggests that 'looked after' young people's substance use is higher than that of the general youth population. Although the substance use was generally recreational and not considered by the young people themselves to be problematic, this level of use, at this life stage, could place them at increased risk of movement into more problematic drug use in ensuing year...

Abstract: Parents play a key role in their children's education and social development and therefore can be very influential to their children's learning about drugs. Despite this there has been little research done to date that explores parents' perceptions. This paper reports research from questionnaires, which sampled 947 parents of 14–16-year-olds, telephone interviews of 60 of these responses and six focus groups of primary and secondary school parents. The issues explored included parents' concerns, needs and knowledge of drugs issues in respect to their children as well as parents' perspective on drug education. The results show that parents are concerned about drugs in relation to their children, and report that drugs are easily available to young people and very much part of today's youth culture. The study revealed that parents are largely misinformed about the drug situation and request accurate and up-to-date information. They are unaware of their children's school drug policies and programmers and feel...

Abstract: It has been argued that considerable untapped potential exists to reduce the burden of illness, harms and other untoward consequences associated with alcohol and drugs through the more effective utilization of the skills of health and other human services workers. To achieve this, improved systematic education and training of key personnel is required. This literature review identifies various issues pertaining to best practice in alcohol and drug education and training. Questions relating to who should be taught, what should be taught, how should it be taught and, when we might know that it is effective are addressed. The relationship between the educational process and the utilization of acquired knowledge and skills in the work place is a complex, non-linear phenomenon. An interactive set of variables operates to determine activities undertaken in any work environment. The nature and level of education received by the professional is one of several key variables. Nonetheless, it is a key factor over wh...

Abstract: Sociological and clinical perspectives are combined to provide insight into motives for drug use and cessation. Drug use appears less problematic from a sociological perspective, many drug users just 'grow out of it', or use drugs in a controlled way. However, relapse rates are higher, and controlled use is less likely, among clinical populations. Despite the greater heterogeneity of community samples, motivational or protective factors (e.g. avoidance of certain situations) appear similar to clinically based research. Cessation is linked to negative consequences of drug use. Non-avoidance of drug use settings (e.g. social pressure), and intrusive thoughts (e.g. cravings) about drugs emerge as the greatest cause of relapse. Emergent themes of avoidance and intrusion indicate that 'post-traumatic stress' research could provide an interesting avenue for future clinical approaches.

Abstract: With increased prisoner numbers, many European Union member states have begun to consider the possibility of drug demand reduction interventions within the criminal justice system. In this paper the results of a six month study of drug demand reduction activity within the criminal justice system (CJS) of the member states of the European Union are presented.The extent of activity at the arrest stage varies widely between states. The two most common objectives of interventions aimed at drug using arrestees are to provide information and to encourage contact with treatment services. The extent of activity at the court stage was difficult to establish, however, in many countries legislation exists which extends the possibility of drug treatment as an alternative to a legal sanction. There is a considerable and increasing range of interventions focused on drug users in prison. All countries provide some form of demand reduction activity within this context. Many respondents indicated a very low level of drug ...

Abstract: The year 1988 saw the publication of the influential first AIDS and Drug Misuse report from the Advisory Council on the Misuse of Drugs (ACMD, 1988) in the UK. Most of the policy documents and developments of practice in the intervening years can be seen as merely following through on the recommendations from this seminal 1988 report. Ten years on, it is appropriate to take stock of the situation and to describe some of the successes, reflect on the failures, and speculate on possible new areas of development in the harm reduction field. This paper comprises four parts. Firstly, what was new about the health risk facing the broader population of drug injectors—and how did this lead lo the public health approach that was adopted to dealing with the problems of HIV amongst injecting drug misusers? Secondly, an examination is required as to how concerns about HIV transmission have brought a new focus to the work of existing treatment services, as well as being the birthright of the new services established i...

Abstract: There is evidence that drug use by young people is on the increase. As concern about youthful drug use has heightened, so increased attention has been paid to providing education and treatment with the aim of preventing or reducing use, or reducing harm. Although targeting interventions is problematic it is important and, consequently, the focus on 'high risk' groups has intensified. As research confirms the link between drug use and delinquency, it is therefore felt that the criminal justice system provides one possible means of identifying a ueiy significant target population: young offenders. This paper looks at what is known about the levels and types of drug use among young offenders, examines drug-related interventions within the youth justice system, and concludes by looking at tuio developing programmes in the East and West Midlands which are currently being evaluated by the author.

Abstract: Since 1990, the National Board of Health in Denmark has conducted annual alcohol campaigns targeting the general public. The campaigns have had high penetration as regards awareness and knowledge of unit guidelines, which is the central message of the campaigns. The campaigns have thus been able to introduce and increase the knowledge of unit guidelines from an absolute zero before the campaign in 1990 to 52% of the adult population knowing their own guideline in February 1997. There is general acceptance to the campaigns in society where approximately 90% find the campaigns a good or very good initiative. It is concluded, that a continuous effort is necessary to maintain and increase the effects of the campaigns.

Abstract: With the increase in drug use and abuse among young people special 'high risk' populations merit particular consideration. Those with substance use disorder commonly have co-morbid psychiatric problems, present with complex needs that require more intensive interventions, specific expertise, training and a variety of appropriate services. Barriers to treatment effectiveness may result from inappropriate and inaccessible services and poor co-ordination between adult and child services. A thorough assessment is important for treatment planning. The variety of settings and effectiveness of treatment modalities are reviewed. The relative lack of well-controlled empirical studies focusing on treatment approaches specifically for young people with drug and alcohol abuse and co-morbid psycho-social problems is discussed. Engagement and retention of these 'high risk' young people in services requires a new collaboration between agencies with a common strategic vision. There is a particular need to research and ri...

Abstract: It has been argued by many involved in the treatment and prevention of drug-related problems that policies of prohibition have been largely ineffective, that they produce a range of health, social and economic harms, and may well have contributed to an increase in the use of some illicit drugs. Policy makers in some countries are considering the adoption of strategies which aim to reduce harm without necessarily eliminating drug use. One strategy has been to decriminalize some substances. In Australia, two States have decriminalized the use of cannabis, and other states are considering this move. Fifty-five cannabis users contacted through a Western Australian university completed an anonymous questionnaire which (i) explored their experiences as cannabis users under the current policy of prohibition where any use or possession is a criminal offence; and (ii) asked for their predictions about their cannabis-related behaviour under a theoretical system of cannabis policy based on the South Australian Cannabis Expiation Notice (CEN) system. Under a CEN system, personal use, possession and cultivation of cannabis for personal use is not a criminal offence and attracts a fine. Six key areas relating to cultivation of cannabis for personal use and minimizing harm associated with cannabis use were explored. The findings suggest that under a CEN-like system: cannabis users would probably cultivate significantly more of their personal-use cannabis; cannabis users' access to other illicit drugs, and use of other licit and illicit drugs, may be reduced; and use of the oral ingestion method of administration would probably increase. However, results suggest that under a CEN-like system: a black market for cannabis would probably still exist; consumption of cannabis by cannabis users, at least initially, may increase slightly; and the system would discriminate against the poorer segments of the population. This research provides some support for the introduction of an alternative model of cannabis policy to prohibition in States that operate like Western Australia. However, the CEN system is probably not the ideal system from a harm minimization perspective.

Abstract: This short report quantifies the lifetime prevalence of substance use among a sample of 557 school pupils drawn from the independent school sector in Scotland. The mean age of these respondents was 14.4 years (range 11–18). A majority of the sample was female. Almost two-thirds (62.9%) of the sample reported lifetime use of tobacco. More than half (57.3%) of these smokers had done so within the past 28 days. Alcohol had been consumed by most of the sample, with a majority (61.4%) reporting having experienced at least one episode of drunkenness. As with smoking, more than half of respondents (61.2%) who had ever experienced drunkenness had done so during the previous month. More than one-quarter (26.0%) reported having used an illegal drug. In line with other studies, the drug most likely to be used was cannabis. Use of any other drugs was comparatively low (11.0%). By secondary school year five (ages 16–17) a majority (56.6%) of these respondents had tried an illegal drug. These data indicate that a high ...

Abstract: There is currently a huge gulf between the lax regulatory framework surrounding tobacco products and the stringent restrictions governing alternative nicotine delivery devices, despite that fact that both products effectively supply the same drug. Tobacco products therefore enjoy immense marketing advantages. Individuals who want or need to obtain nicotine have little choice other than to obtain it from tobacco. This situation is worsened by the fact that cigarettes cause death and disease in at least half of all long-term users, whereas many existing alternative nicotine delivery devices cause little or no harm. This regulatory situation adds to the tobacco-related disease toll and is a denial of consumer rights. Other consequences include suppression of innovation (with respect to development of less harmful nicotine products), and vast profits for tobacco companies, allowing them to contest proposed public health measures. Nonetheless, pressure for changes to existing regulatory measures has inexorably...

Abstract: This paper considers political changes in Bulgaria and their influence on the diffusion and use of alcohol and drugs. Specific cultural characteristics connected with the use of alcohol and drugs are discussed and the misuse of drugs by different age groups and by different social groups (juveniles, students, military men) is described, as is the diffusion of HW-infection and cases of AIDS in Bulgaria. Finally, the paper comments on educational and social programmes and centres for prevention and cure in Bulgaria.

Abstract: It is 10 years since the now famous statement by the Advisory Council on the Misuse of Drugs that, The spread of HIV is a greater danger to individual and public health than drug misuse. Accordingly, services which aim to minimise HIV risk behaviour by all means should take precedence in development plans' (ACMD, 1988), and the acceptance, at least for a time, of harm reduction as a legitimate goal for drug service provision. However, 2 years earlier Mersey Regional Health Authority (MRHA), now part of North West Regional Health Authority, had already planned such an approach in response to the urgent need to prevent the spread of HIV amongst a drug-misusing population estimated to be as high as 20,000 (DHMU, 1990). This paper looks at the development of services on Mersey and at events since then.

Abstract: ‘Harm reduction’ is now discussed as a new strategy for tobacco control. The strategy can, however, be pursued in several different ways. Some of those may reduce harm for the individual concerned, but might-at the same time-eventually not reduce the total harm done, from a public health point of view.

Abstract: (1998). The case for harm reduction in smoking. Drugs: Education, Prevention and Policy: Vol. 5, No. 2, pp. 125-127.

Abstract: Cannabis has been identified in several recent surveys to be the most widely tried illicit drug among young people in the UK. These studies have shown that use increases with age and is also associated with social class. However few in-depth qualitative studies have been undertaken to explore the social context of cannabis use and none has taken a longitudinal perspective. This paper reports the findings of a study which followed up 15-year-old males three times over an 18 month period. Quantitative and qualitative data are drawn on to explore the processes involved in cannabis use. Using detailed case studies, the importance of the friendship group as a locus for contact with cannabis and a means of learning about its use is explored and it is argued that the meanings young men attach to their cannabis use can be understood in the social context of their transitions to adulthood.

Abstract: Increasing concern is being placed upon the long-term outcomes of pupils excluded from school and their possible increasing involvement in drug use and crime. Data presented in this paper explore levels of drug USE and offending behaviour of a sample of 14-Z6-year-olds excluded from school. Interviews were conducted with 86 school excludes attending Pupil Referral Units (education centres for young people excluded from school) in North West London during 1996, as part of an ongoing evaluation of a drugs education intervention being delivered by the Home Office Drug Prevention Initiative. The majority of the excludes lived in single parent families with nearly two-thirds having no adult wage earner. Over half of subjects were from ethnic minority backgrounds. Offending behaviour among the sample was high. Nearly all had committed a criminal offence, with nearly half having committed an assault or wounding, and nearly a third having committed a burglary. Levels of lifetime, current drug use, and the range o...

Abstract: In spite of years of drug wars and, in many countries, failure to implement harm-reduction approaches to HIV, drug use, drug injection, and IDU-associated HIV epidemics have spread to new countries and to many new individuals in countries where drug use and/or injection have been present for decades. Furthermore, the use of scapegoating rather than harm reduction seems to lead to worse medical care for IDUs with HIV and thus to higher probabilities of multi-drug resistant tuberculosis and other epidemic consequences. When we ask why such failed policies continue, issues of political economy, of what needs to be changed, and of how such change can occur become important. Long-term global economic trends towards reduced profit rates and heightened Competition, and the pressures these put on governments and corporations, have produced a period in which fundamental issues of political and economic structure are at stake; and, often, the response is a divide-and-rule politics to promote stability. National pol...