Outcome research of prevention programmes in the United States has been the subject of a comprehensive review.(21) Programmes should be guided by awareness that the average age of trying alcohol, cigarettes, solvents, or cannabis for the first time is between 11 and 13 years, and that exposure to drugs is now the norm for older teenagers.(22) The two distinct aims are to delay experimentation in younger children and to minimize harm in those over 13, many of whom can be assumed to be dabbling already or to have friends who are doing so. Only those programmes that actively involve students in discussion and debate, and provide relevant skills training such as assertiveness, ways of resisting social pressure, problem solving, stress management, and confidence boosting, have any measurable benefit. Improvement in knowledge without this practical dimension has no effect on behaviour, and scaremongering or moralizing can be actively counterproductive.
Because the large majority of well-integrated children with good familial support are unlikely to sustain long-term damage from transient experimentation, there is a growing awareness of the need to target vulnerable children before serious involvement with drugs or other self-destructive behaviours has been established. A prevention strategy that does not address the social and economic conditions that foster compulsive drug use and ruthless black-marketeering is just tinkering round the margins of the real problem.
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