National Amphetamine-Type Stimulant Strategy Background Paper

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Chapter 4: Prevention and Harm Reduction
4.1 What is prevention?
Various strategies have been used to prevent drug problems, such as law enforcement
approaches to prevent and disrupt production and supply, community based information and
awareness raising programs, and strategies that aim to prevent and/or reduce problems in
those who are currently engaged in drug use. In their extensive review of the literature on
prevention, Loxley and colleagues (2004) defined prevention as:
measures that prevent or delay the onset of drug use as well as measures that protect
against risk and reduce harm associated with drug supply and use (p.xiii).
Prevention approaches are typically generic to all drug types and may be adapted to
address a specific drug class, such as amphetamine-type stimulants (ATS). The most
common classification for these strategies is as follows:
1. Primary prevention – prevent and reduce initiation of drug use (for example,
education programs warning of the risks of drug use and supply control strategies);
2. Secondary prevention – reduce the up-take of high-risk drug use, such as injecting
and dependence, to prevent problems in those already engaged in drug use
(for example, targeting interventions to current users to ensure that they avoid
injecting); and
3. Tertiary prevention - prevent behaviours that lead to significant social and/or
individual harms among dependent users (for example, reducing the risk of HIV
or Hepatitis; reducing the risk of overdose).
An alternative conceptualisation of prevention was suggested in 1994 by the United States
Institute of Medicine, and based on the level of risk of disorder in various target groups, as
follows:
1. Universal prevention – target whole populations at average risk;
2. Selective prevention – target specific groups at increased average risk;
3. Indicated prevention – target individuals with early emerging problems.
According to both these models and, as indicated in the definition of prevention provided
above, the nature of and methods used in any prevention strategy will depend on the
specific aims and intended audience or targeted behaviour/contexts. Strategies that aim
to inform the broad community about drug use and drug risks are likely to be distinguished
from strategies that are aimed at preventing use among school aged children, and
strategies that aim to reduce the problems arising from injecting behaviour.
The range of different ATS prevention strategies therefore includes broad strategies (e.g.,
targeting the whole community, through mass media campaigns; focusing on all schoolaged
children, through school drug education; preventing use and problems among