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Russell Webster

Russell Webster

Criminal Justice & substance misuse expert and author of this blog.

What is environmental drug and alcohol prevention?

Traditional substance use prevention has focused on warning or informing about risks or on skills-based interventions. Why not aim to limit unhealthy behaviours by changing the environment in ways which influence people’s choices?

Environmental prevention in Europe

Environmental prevention policies and interventions seek to limit opportunities for unhealthy or risky behaviour or promote the availability of healthier options in order to prevent problems associated with substance use. They do so by altering the environment in ways that can unconsciously influence behaviour, thus complementing more established approaches that seek to build knowledge and skills. 

A new (21 February 2018) report from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) provides an overview of the range of environmental prevention interventions used in the substance use field and, based on a survey of prevention experts, paints a first picture of the extent to which environmental prevention measures are currently used in Europe as a starting point for future research.

Environmental prevention complements the more established approaches of providing information/warnings and skill/competence development.

Traditional substance use prevention approaches in Europe have predominantly focused on warning and informing people of the risks and consequences of drug use and/or informing them of safer ways to use substances. More recently, developmental approaches aimed at helping young people to develop the necessary social skills and competences to avoid substance use have been used alongside informational approaches.

These types of interventions focus on the individual as the main driver of behavioural change. The role of executive functions and how they develop during childhood and are influenced by upbringing is often neglected. It has been claimed that an over-reliance on approaches that fail to consider executive functions contributes to the persistence of health inequalities. Many behaviours we perform every day are automatic and are generally reactions to common and familiar stimuli, demonstrating the importance of environmental and social cues, and of automatic processes in influencing behaviour. This may explain the limited success of prevention approaches that focus solely on individual responsibility for decision-making and self-control.

What is environmental substance misuse prevention?

In the report, the EMCDDA offers a first operational definition of the concept and an initial overview of where and how such interventions are being used across Europe. The definition identifies three categories of environmental prevention measures: regulatory, economic and physical.

Environmental prevention policies and interventions build on current interest in these approaches and seek to provide a stimulus that evokes healthier decisions. This can occur through altering the design of the environment, or aspects of it, to influence choice (‘choice architecture’). 

For example, physical changes may include bars providing glasses for alcohol that are taller and narrower, but with smaller volumes, tending to make people drink less. Similarly, changes to the economic environment, such as increasing the price of tobacco, may discourage smokers. Regulatory changes can include legislation to constrain undesirable behaviours, such as cannabis use in public places, under-age drinking or drinking and driving.

The web-based questionnaire at the heart of the publication generated responses from 117 subjects (from 27 countries) with knowledge of substance use environmental prevention measures.

The questionnaire considered a number of environmental prevention measures for illicit drugs, alcohol and tobacco and asked respondents whether they were available nationally or locally.

Of the 49 measures presented to the experts answering the survey, 39 referred to regulatory or economic environmental prevention measures and 10 referred to physical environmental prevention measures.

Regulatory prevention

The category of regulatory prevention includes a very wide range of measures with different objectives. Most common, of course, are the legal prohibitions about drug use and drug dealing, offences of drink and drunk driving et cetera. 

The sale of alcohol is subject to strict licensing systems in every country. There have, of course, been massive changes around tobacco with the banning of smoking in public places in very many countries. 
 
However, also within the regulatory prevention category, comes the decriminalisation of some substances, particularly cannabis, in a growing number of countries. This, of course, represents a very different approach to drug prevention where the quality of a substance can be (for the main) regulated and guaranteed and subject to mainstream health education information like any other product. It also serves to draw a stronger societal distinction between sanctioned and illegal substance use.
 

Economic prevention

 Economic prevention approaches have become a key focus in the UK over recent years. Duty on tobacco has been increasing at a rate higher than inflation for many years and we have had much discussion of Minimum Unit Pricing for Alcohol. The current situation is that the English government has backed off from an earlier (David Cameron) commitment while the Scottish government is going ahead; introducing a minimum unit price of 50 pence due to come into force in May 2018. Other measures include ensuring that soft drinks are priced moderately in pubs and clubs so as not to disincentivise drinkers who want to moderate their alcohol consumption.
 

Physical prevention

 Physical prevention is another category which covers a wide range of measures from serving drinks in smaller volume (taller, narrower) glasses to avoid pouring in excess amounts to providing more and longer opening alternative recreational facilities for young people in particular (youth clubs, sport clubs, arts venues etc.) to removing cigarette machines from public places. 
 

Conclusion

Of course, many of these approaches have been widely used for many years, although not classified under the banner of environmental substance misuse prevention.

Nonetheless, there are clear advantages to naming and highlighting these approaches in order to encourage policy makers to routinely consider introducing them.

Why should we not be looking to disrupt excessive or risky drug and alcohol consumption in the same way as so many other human behaviours have been subjected to rapid change in the digital age?

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