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Are any of the preventive approaches to problem drug use among young people proving effective, asks Sarah Wellard.

For once there is some good news about young people and drugs. According to the latest statistics,¹ the numbers of young people experimenting with drugs is stabilising.

Eighteen per cent of 11 to 15 year olds in England say they have taken drugs in the past year, compared with 20 per cent in 2001. Cannabis is by far the most commonly used illegal drug but 4 per cent of 11 to 15 year olds say they have tried a class A drug (including ecstasy) and 1 per cent have used heroin. And among 16 to 24 year olds in England and Wales the percentage who say they have used drugs has stayed at around the 30 per cent level for the past eight years.

But the bad news, according to Howard Parker, director of the Social Policy Applied Research Centre at Manchester University and pioneering researcher on drugs, is that problem drug use is continuing to rise, despite a proliferation of services aimed at prevention. He says: "Recreational drug use is stable but the problem scene is rising outside the big cities."

So are we doing enough to prevent young people from developing drug problems and are we getting it right? The answer seems to be that we don’t really know because research on drugs prevention is inconclusive. A five-year longitudinal study commissioned by the Home Office known as "Blueprint" is several years away from completion.

Penny Fraser, researcher on drugs prevention at rehabilitation agency Nacro, acknowledges that the evidence base for prevention work isn’t particularly strong. However, she continues, "it’s always difficult to show you are preventing something that might not happen anyway. There is research evidence from smaller studies that drug education can delay the onset of drug taking." Which is significant because the younger someone starts experimenting, the more likely they are to develop drug-related problems later on.

Fraser has recently completed an evaluation of seven drugs prevention projects in the North West funded by the Manchester, Salford and Trafford Health Action Zone.² The study concluded that several techniques can be effective, ranging from mentoring and giving information and advice to peer approaches and diversionary work.

Skilled drugs workers are able to combine all of these approaches in the course of their work. Norman Saggers, a detached youth worker in north London, says that the essence of his approach is to build a relationship with a young person who is experimenting with drugs so that he can begin to challenge attitudes and behaviour. Saggers works on the streets, talking to the teenagers he encounters, mostly cannabis users aged between 13 and 19.

"You don’t necessarily go straight in and talk about drugs," he says. "You go back more than once and after a while you get the chance to explain what you are doing. We give facts about drugs and take a harm minimisation approach - you explore the risks and the consequences of smoking in different places. You get them to see that cannabis does have side-effects and to work out the cost of their habit. What would they rather do with that money? It’s making them realise that there are consequences and they do have choices."

Saggers adds: "Everyone has different reasons for taking drugs and there’s no magic programme. In youth work it’s always difficult to prove effectiveness. Often it’s not until several years on when you meet someone again that you realise, yes, maybe that did help."

Fraser believes it is important that drug prevention work is not conducted in isolation and addresses other difficulties in young people’s lives. Most young people who experiment don’t become problem users, but factors such as living in an area where drugs are easily available, being homeless or in care or being excluded from school make a young person much more vulnerable to developing drug-related problems. She points out: "Drug use becomes a problem if you can’t afford to fund your habit. A £10 a day habit might be manageable if you’re in employment, but is a problem if you’re getting involved in crime to finance it."

Jo Butcher, co-ordinator of the Drug Education Forum, agrees that prevention work should take a holistic view of young people’s needs. She says: "We know that young people who start using drugs earlier are likely to be those with other issues in their lives. You can get them doing role-plays to learn how to look after themselves but then they are going to walk back into a very difficult environment. You do need to support their parents and deal with other elements in their lives."

Butcher believes there is no "one size fits all" solution and that a range of methods is important, from school-based approaches focusing on life skills to local helplines and drop-in centres. She says: "It’s about creating a climate where a young person feels able to discuss issues. Students in the classroom need to know who they can approach to find out more."

However, Parker takes a bleaker view of the value of prevention strategies. "People have faith in drug prevention messages," he says. "We hang on to them for political and emotional reasons. Sometimes there are marginal gains from programmes with very charismatic people running them. Quite often young people take information from them about which drugs are most dangerous, but there isn’t anything which is effective."

He believes prevention strategies need to focus much more on the dangers of heroin and wants the message taken out to those most at risk - young people already heavily involved in the recreational drugs scene. "For some reason we haven’t educated teenagers about heroin. There’s been too much focus on ecstasy. It should be the Amsterdam message: ‘say no to crack and heroin’."

According to Parker, in some provincial towns initiation to heroin is starting earlier, at around 15. His research challenges the stereotype of highly vulnerable youngsters who are homeless or in care or who have parents who use drugs. "We did vulnerability tests on 86 users," he says. "Most didn’t fit that high-risk profile. A lot had two parents who were working and a car. A lot of them don’t start off socially excluded but they end up so.

"Kids don’t understand what heroin is and how it affects them. It’s a subtle addictive drug. For a while they are walking on water - they can handle a £10 a day bag and it’s several years in before they’ve got a serious problem."

Parker believes a lot more needs to be done to pick up heroin users early, because they won’t come forward spontaneously for treatment. "Many areas have done nothing to develop an under-18s service. Some services which do exist are seeing heavy cannabis or ecstasy users but not people using crack and heroin. They [teenage heroin users] are a very challenging group to work with. There is some brilliant work but overall provision is very patchy."

Marcus Roberts, head of policy at Drugscope, agrees that the shortage of treatment provision for young people is a matter of concern. He says: "We need more designated services for young people who may have different drug problems to adults - often the focus is recreational drug use and poly drug use. But we shouldn’t be doing it at the expense of prevention. We need to be doing both."

¹ Statistics on Young People and Drug Misuse 2002, Department of Health, 2003

² Fraser and Seddon, Drug Prevention for Vulnerable Young People: Research Briefing 3, Nacro, 2003