Chapter 16 - Prevention

Initiatives that fall short of the mark 

When Canada’s Drug Strategy was launched in 1987, the government acknowledged that most federal initiatives had focused on reducing supply and that there had to be more emphasis on prevention. Of the $210 million initially allocated to the first five-year strategy, no less than 32% was earmarked for prevention. In the second phase of the strategy, which ran from 1992 to 1997, the total budget increased to $270 million, with a similar percentage earmarked for prevention.

In 1994, the Government of Canada introduced the National Strategy on Community Safety and Crime Prevention and created the National Crime Prevention Council, now the National Crime Prevention Centre (Department of Justice). When Phase II of that strategy was launched in 1998, funding was $32 million annually; by 2001, funding had increased to more than $65 million. The strategy is aimed at reducing crime and victimization by addressing their root causes through a social development approach. Crime prevention through social development (CPSD) is a long-term, proactive approach. It is directed at removing those personal, social and economic factors that lead some individuals to engage in criminal acts or to become victims of crime. The National Strategy is investing in projects that address risk factors in people’s lives, such as abuse, violence, poor parenting and drug and alcohol abuse. [1][5]

 

Where do things really stand? The stakeholders are probably in complete agreement that there is a need for prevention. But they are equally unanimous that the actions that have been taken are short of the mark. Otherwise stated, everyone talks prevention, but no one does much about it. The observations made before the Committee cover five sets of considerations: (1) there is not enough prevention; (2) prevention lacks focus; (3) there is not enough evaluation of preventive measures; (4) prevention and social messages about cannabis are contradictory; and (5) there are exemplary practices and successful preventive measures that need to be promoted more widely.

 

Not enough prevention

For many organizations, police departments and government agencies involved in the war on drugs, it is clear that there is not enough prevention. That view is measured in terms of spending levels and cuts in prevention staff.

 

Think of the last time that you saw a drug prevention message on television. Probably one that many of us would recognize is the fried egg commercial representing what happens to your brain. Unfortunately, that was an American ad. I cannot recall a recent anti-drug ad on television. We have produced proactive materials on many other issues in our country. There are campaigns on tobacco and breast cancer. We really have very little material in the drug prevention area. We are not saying that we want more money for policing and arresting people. We agree with the current balance. We think that not only crime prevention, but also drug awareness is a vital tool in making a difference. […] We believe, first, that there is a role for police in prevention and awareness as well as in enforcement. We have excellent partnerships with teachers, parents and community groups. Community policing has really started to come together in the last 10 years. […] One of our problems is that some of our programs are dated. Very little effort is put into the prevention aspect. I do not want to be quoted exactly on dollars. However, a report about a year ago indicated that the United States spent about $12 per capita on prevention and awareness. In Canada, the comparative figure was less than $1. I think it was in the area of 20 cents or 30 cents. [2][6]

  

Since 1988 and 1989, when we had the Really Me campaign, we have had no federal or, in B.C., provincial campaign speaking about drugs. […] When there was a decrease in consistent prevention messages and the National Drug Strategy ended, I witnessed numerous community coalitions and task forces on drugs that dried up and went away and no provincial funding followed it. I watched in Nakusp, Penticton, the Sunshine Coast, Whistler and many other places as excited people were no longer able to keep going because the attention in the country turned to the population health bandwagon. There was a loss of interest, funding levels and prevention, and at the same time, an increase in messages about hemp, “medical marijuana” and other ideas. […] When you have this going on for years, common sense would tell you we would have some erosion in the gains we had made in consumption. With that, and with some of the changes in drug sentencing and enormous growth in cannabis availability, certainly in British Columbia, it is no wonder we see these changes. [3][7]

 

[Translation] Third observation: efforts to prevent substance abuse are clearly inadequate. The task involves budget (increase allocations for prevention in various areas), coordination (provide a better framework for practices in this area) and research (establish clear program evaluation parameters, determine the effectiveness of existing programs, promote winning strategies). There is a particular need for more substance abuse prevention initiatives in the following areas:

--         schools (beginning in middle school) and other areas of young people’s lives (e.g., streets, parks, youth centres);

--         workplaces;

--         front-line services in the health and social services system. [4][8]

 

We had an excellent Canadian program developed in Nova Scotia in conjunction with the Nova Scotia Addictions Foundation known as PACE, the Police Assisted Community Education. We, along with a pharmacist, a doctor, a nurse and some athletes were among the people that went to schools to talk to the students about peer pressure, why some students feel compelled to use drugs, about stealing and different moral ethics, and other subjects relating to drug use. Unfortunately, because of the budget cuts, the programs were cut. The money for evaluations, for increasing the program, or for improving the program no longer exited. [5][9]

 

In the 1970s and 1980s, there was support for community-based ongoing prevention efforts. However, in the 1990s, the federal and provincial governments cut a lot of the funding and there has been commensurate rise in drug use. During that same period, multi-faceted prevention efforts such as those directed at tobacco, seat-belts, fire safety, fitness, and dental health, to name a few, made major inroads. [6][10]

 

Prevention of social and health problems is often the poor cousin of practice. Whether in health or in justice, the reality is that much more is spent on treatment and intervention after the fact than on prevention. This is true for health issues in general and illegal drugs in particular.

According to the study by Single et al.,[7][11] the direct and indirect cost of illegal drug abuse in 1996 was approximately $1.5 billion. Of that amount, $400 million was spent on law enforcement (police, Customs, courts, correctional services, etc.), and approximately $35 million was spent on prevention, that is, roughly 2% of the total, compared with more than 25% on efforts to fight drugs. Put a different way, the per-capita cost of illegal drugs is roughly $48; by comparison, about $12 is spent on drug control, and about $1 on prevention.[8][12] We agree with other stakeholders that spending on prevention is woefully inadequate.

Prevention lacks focus

Preventing cannabis use probably requires a different approach than preventing the use of heroin or ecstasy. By the same token, prevention of use by students will not be handled the same way as prevention of use by street kids, and preventive measures aimed at Aboriginal youth will be different from those aimed at white youth. We will see in the next section that the risk factors and protective factors are not the same for all social groups.

However, stakeholders point out that prevention messages and the way they are delivered are often inaccurate. We see either universal messages the real effectiveness of which is hard to measure, or messages that are aimed at specific social groups but are not necessarily geared to the reality of the people being targeted.  

 

[Translation] Of particular note are weaknesses in secondary prevention. Programs aimed more specifically at high-risk groups are not enough. There is little effective screening where early intervention might make all the difference in preventing problems from getting worse, and this is true not only of youth, but of client groups of all ages. There is at present a lack of consistency in the messages being conveyed and the initiatives being taken. There is a lack of program stability. And in some areas, a great deal of ground has been lost (e.g., gradual loss of substance abuse prevention educators). [9][13]

 

Prevention is not ‘one size fits all.’ Broad population approaches are needed, but so too are narrow focussed activities that target a specific risk group. Of course, prevention is proactive. It promotes personal responsibility. It is highly cost effective: For the cost of one treatment centre, you can fund prevention initiatives that reach hundreds and, indeed, thousands of kids. [10][14]

 

If the focus is prevention, the objectives have to be clarified: is the goal to prevent use, at-risk behaviour or abuse? The chosen preventive measures will be fundamentally different depending on what objectives are set. This point was made in a recent document produced for Health Canada on best practices in the area of prevention:

 

Clear and realistic goals that logically link program activities to the problems and factors found in a community are necessary to guide implementation. Clear and measurable goals will permit evaluation to determine whether the program achieved its objectives. Goals will vary with the community and the circumstances; however, important considerations for all programs are the points at which use and problematic use of different substances generally begin. […] Accordingly, for youth who are not yet using (i.e., either not considering use or thinking about use) the program aim would be primary prevention. Programs working with a population largely consisting of youth who have initiated use and continue to use, a secondary prevention or harm reduction aim makes most sense. Each of these aims logically lead to particular activities and messages (e.g., use of more intensive approaches with those using or preparing to use). [11][15]

 

With respect to prevention, there is also a sense that anything and everything is possible by adopting anti-drug rhetoric. However, as we will show in the next section, preventive measures have to zero in more on known risk and protective factors. And because there are many risk factors, preventative action should be multifaceted and involve the community.

 

There is not enough evaluation of preventive measures

Another reason there is not enough prevention is that no one takes the time or devotes the resources to evaluate programs and demonstrate their effectiveness. As the saying goes, an ounce of prevention is worth a pound of cure. Similarly, one dollar invested in prevention saves five dollars down the road. That may be true, but proving it is something else.

Conducting evaluation studies is not an easy task. If they are to be credible, studies often require a complex methodology. They are also expensive. And most importantly, they cannot – or at least should not – be rushed in order to meet political timelines: to determine, for example, whether a program aimed at preventing drug use among youth is effective, “graduates” have to be monitored for no less than a year (normally at least three years) after they received the program. Canada is not in the habit of doing evaluative research, and, as we saw for Canada’s Drug Strategy, we did not set clear objectives or provide the means to evaluate initiatives.

As a result of this situation, prevention – a weak segment if ever there was one – pays the price when even the smallest budget cut is made.

 

One of the biggest problems is that our programs have never had an evaluation component. Whenever we had the opportunity to implement new programs, it was done “quick and dirty.'' There was very little money. Our only approach was to pump something out and see if it worked. We have all learned that if you are going to do something, do it properly. We should set up new programs with evaluative components in order to know that we are doing the right things at the right time for the right people. In other words, programs should consider the message, the messenger and effectiveness. [12][16]

 

The Committee is of the opinion that any future Canadian drug strategy will have to include mechanisms and resources to evaluate the various components and in particular to evaluate preventive measures.