Evaluation Research in Regard to Primary Prevention of Drug Abuse

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ISBN 92-828-2913-8 ISSN 1018-5593
European Commission
Social Sciences
&267$
Evaluation Research in Regard to
Primary Prevention of Drug Abuse
Edited by
Alfred Springer & Alfred Uhl
Ludwig-Boltzmann-Institute for Addiction Research
Vienna - Austria
Directorate-General
Science, Research and Development
Brussels 1998 EUR 18153 EN

II
Contents
Preface of the Editors
(Alfred Springer & Alfred Uhl)................................................................. 1
Evaluating Drug Prevention: An Introduction
(Ambros Uchtenhagen & Katarzyna Okulicz-Kozaryn)........................... 5
Country Reports: An Overview, Including Some Remarks about
Socio-Cultural Determinants of Primary Prevention and its
Evaluation
(Alfred Springer) .....................................................................................19
Building Expertise in Life Skills Programme Adaptation and
Evaluation: The Experience of "Leefsleutels"
(Annick Vandendriessche)...................................................................... 65
Mia’s Diary: An Alcohol and Drug Primary Prevention Programme
for the Nordic Countries
(Line Nersnæs) ........................................................................................ 77
Evaluations of Substance Use Prevention Programmes Implications or
Illicit Drugs
(Mark Morgan)........................................................................................ 91
Evaluation of Primary Prevention in the Field of Illicit Drugs:
Definitions - Concepts - Problems
(Alfred Uhl)........................................................................................... 135
Index.......................................................................................................... 222

Evaluation Research in Regard to Primary Prevention of Drug Abuse
1
Preface of the Editors
Alfred Springer, Chairman COST-A6-WG2
Alfred Uhl, Research Co-ordinator
___________________________________
We joined the COST-A6-action of the European Commission right from its
beginning in December 1992. In the first workshop of that research
initiative held in Zurich, we agreed to organise a work group on the
evaluation of primary prevention (COST-A6-WG2). Our first step was to
identify relevant experts from different countries in the European region
who were then asked to produce country reports describing the situation of
primary prevention and its evaluation in their countries.
In June 1994 we organised a first meeting of international experts in
Vienna. At this meeting we were happy to welcome several outstanding
experts from the field of prevention evaluation as invited speakers. The
aim of this initial meeting was to constitute an international working group
on "Evaluation Research in Regard to Primary Prevention of Drug Abuse"
within the COST-A6-Action of the European Union. The participating
experts in this first COST-A6-WG2 meeting decided to split up the task
into three distinct subprojects.
• Project A was to give an overview over evaluated prevention projects
throughout Europe focusing on illicit drugs based on Country Reports
from participating countries (co-ordinator Alfred Springer).
• Project B was to utilise the vast amount of experience regarding the
evaluation of primary prevention programmes focusing on legal drugs
for the field of illicit drugs. This subproject titled "Evaluations of
Substance Use Prevention Programmes: Implications for Illicit Drugs"
was carried out based on literature by Mark Morgan.
• Project C was of theoretical nature. The goal of this subproject named
"Evaluation of Primary Prevention in the Field of Illicit Drugs:
Definitions - Concepts - Problems" was to reach a consensus among
international experts over these theoretical matters (co-ordinator Alfred
Uhl).

Preface of the Editors
2
The work on these subprojects proceeded in agreement with our working
plan and was finished in 1997. While developing our own project we were
confronted with the situation that two other projects in the fields of
primary prevention and evaluation research were initiated by other
international bodies and institutions in Europe:
• The Pompidou Group ("Co-operation Group to Combat Drug Abuse and
Illicit Trafficking in Drugs within the Council of Europe") started an
initiative to develop a "Handbook Prevention" and
• the EMCDDA ("European Monitoring Centre for Drugs and Drug
Addiction") started another action to develop a manual for programme
planners and evaluators ("Evaluation of Drug Prevention Intervention").
In charge of the Pompidou Group project were Jaap van der Stel and
Deborah Voordewind in co-operation with Wim Buisman (Jellinek
Consultancy, Amsterdam). A final report of this programme is due in 1998.
In charge of the EMCDDA project are Christoph Kröger, Heike Winter
and Rose Shaw (IFT, Munich). A final report of this programme is due in
1998 as well.
During the running time of all the three projects a close collaboration - a
true network development - took place. Knowledge and manpower from
the COST-A6-WG2 action and from the Pompidou group initiative were
fed into the EMCDDA action from the very start of the EMCDDA action.
Members from COST-A6-WG2 and from the Pompidou group initiative
met with EMCDDA representatives in Lisbon in 1995 for a constitutional
meeting of the EMCDDA project.
The major positive outcome of this early involvement was an agreement
between the co-ordinators of all three projects to co-operate in a manner
• that duplications and rivalries are avoided,
• that synergy effects are utilised through exchanging information and
supporting each other,
• that a consistent use of terminology is guaranteed as far as possible and
• that all three projects refer to each other, pointing out the specific
emphasis of the other projects to the interested public.

Evaluation Research in Regard to Primary Prevention of Drug Abuse
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The aims of all three projects were defined as clearly distinct from each
other:
• The goal of the COST-A6-WG2 - Project A was defined to give a
comprehensive overview over evaluated primary prevention projects in
Europe.
• The COST-A6-WG2 - Project B was aiming at an utilisation of existing
scientific evidence concerning evaluation of prevention in the field of
licit drugs for the field of illicit drugs.
• The COST-A6-WG2 - Project C focused on exact definitions and
methodological problems.
• The Pompidou Group Project "Handbook Drug Prevention" has a very
global approach covering a variety of practical aspects from programme
development to implementation and evaluation.
• The EMCDDA Project focuses on practical instructions for programme
planners and evaluators who are to evaluate their own prevention
interventions before or after their implementation on a routine basis.
There is hardly any overlap in major contents and the projects are far from
duplicating each other - on the contrary, they can be seen as
complementing each other. Very helpful in this regard was also that several
experts contributed to more than one project.
For the format of the presentation of our final report we chose to document
our results in the chronological sequence of the progression of the project.
The country reports we collected in the first phase of our project and the
insights gained thereby concerning the rather poor state of the art in the
evaluation of primary prevention initiated an effort to deal with the topic
on a more fundamental level.
The presentations of the adaptation process of the QUEST programme for
the situation in Belgium and of the school based drug education
programme "Mia's Diary", which is widely used in the Scandinavian
countries, have been chosen as practical examples of prevention
programmes characterised by very high standards and also for a specific
approach to adapt programmes to different socio-cultural contexts.
The subproject "Evaluations of Substance Use Prevention Programmes
Implications for Illicit Drugs" carried out by Mr. Morgan as a
comprehensive literature overview provided us with the necessary back-
ground for further theoretical and methodological steps.

Preface of the Editors
4
The summarised country reports and the Mark Morgan’s literature
overview constituted the starting point for the Delphi-type consensus study
on definitions and methodological concepts, based on very detailed inputs
from 21 international experts.
We have to thank all the excellent experts who donated a lot of time and
knowledge to collaborate in the COST-A6-WG2 project without any
financial reward, as invited speakers in one of the work group meetings, as
authors of country reports, as active participants in the consensus study on
definitions and methodological problems, as authors of chapters in this
publication and/or as valuable partners in discussing relevant topics with
us on an informal basis. We name them in alphabetical order: Stefan
Brülhart (Suchtpräventionsstelle, Zurich), Gregor Burkhart (EMCDDA,
Lisbon), Xavier Ferrer (A.B.S. and CEUDROG, Barcelona), Maria Xesús
Froján Parga (Universidad Autonoma de Madrid), Willy F.M. De Haes
(Rotterdam), Osmo Kontula (University of Helsinki) (Christoph Kröger,
IFT, Munich), Han Kuipers (Trimbos Institute, Utrecht), Ralph Kutza (IFT,
Munich), Mark Morgan (St. Patrick’s College, Dublin), Alice Mostriou
(Eginition Hospital, Athens), Margareta Nilson (EMCDDA, Lisbon),
Katarzyna Okulicz-Kozaryn (Inst. Psychiatry and Neurology, Warsaw),
Flavia Pansieri (UNDCP, Vienna), Ulf Rydberg (Karolinska Hospital,
Stockholm), Chafic Saliba (Cndt, Lyon), Reginald G. Smart (ARF,
Toronto), Enrico Tempesta (Universita Cattolica del Sacro Cuore, Rome),
Alberto Tinarelli (Sert, Ferrara), Ambros Uchtenhagen (ISF, Zurich),
Annick Vandendriessche (Leefsleutels vzw Jongeren, Brussels), Brit Unni
Wilhelmsen (University of Bergen, Bergen), Heike Winter (IFT, Munich).
Their personal expertise - hopefully - will help to improve the future
situation of prevention evaluation in Europe. Last but not least we have to
acknowledge Klemens Widensky (LBISucht, Vienna) for reading and
correcting the text repeatedly throughout the project.

Evaluation Research in Regard to Primary Prevention of Drug Abuse
5
Evaluating Drug Prevention:
An Introduction
Ambros Uchtenhagen, ISF, Zurich, Switzerland
Katarzyna Okulicz-Kozaryn, Institute of Psychiatry and Neurology,
Warsaw, Poland
___________________________________
1 The need for developing evaluation research
(Ambros Uchtenhagen)
1.1 From belief to science to practice
Drug prevention as a professional task has emerged in pluralistic societies
where traditional beliefs and lifestyles no longer guarantee generally
accepted forms of substance use, limits of use and use patterns.
Transgressors traditionally were not regarded as suffering from a specific
condition; they were morally judged, outcast or punished. Prevention was a
part of the educational mainstream how to live a life which is compatible
with societal norms. As such, prevention and its effects did not need to be
scientifically tested.
Since norms and lifestyles have lost much of their educational value, and
since contradicting norms and lifestyles coexist in pluralistic societies,
everybody has to find his or her way between personal needs, given
opportunities and their chances and risks. The opportunities for substance
use are abundant, and apart from specific rituals in specific milieus,
substance use is mainly geared by individual expectations.
The prevailing theory nowadays, among a large number of addiction
theories, is the self-medication theory: people use substances in order to
better control and adapt their emotional and/or cognitive state and their
behaviour. The prevailing concept, on the other hand, is the disease
concept of substance related conditions (World Health Organisation 1991).
In this context, drug prevention has the task to guide people how to avoid
negative experience and substance related conditions, eventually how to
make best use of available substances without undue risks.

Evaluating Drug Prevention: An Introduction
6
Such a prevention concept cannot be of value without empirical evidence
of its own effects. Should drug prevention be helpful in order to reduce
negative experience, there is a need for defined goals and strategies which
have been tested.
The implementation of empirically tested prevention strategies has again to
consider carefully what is helpful for whom and under what circumstances.
The practice of drug prevention, the step from scientific evidence to
practice, calls for professionalism, not less than the step from belief to
science.
1.2 The basic conflicts of drug prevention and the needs for
a scientific basis for prevention
Evaluation starts with clearly defined goals of preventive activities.
Systematically speaking, we may differentiate between the prevention of
• any use of a given substance
• problematic or harmful use
• compulsive use (dependence).
From a Public Health point of view, the extent of use in a given population
may be at stake, calling for strategies such as decreasing the number of
users by reducing the availability of the substance, by postponing the age
when use starts, by increasing the efforts to stop or decrease already started
use e. a. An essential issue in Public Health is the reduction of harmful use
and its negative implications for the health system and on economy.
These goals often are perceived as being in conflict with each other.
Especially, preventing harmful use is considered to be permissive, in
contrast to a prohibitionist position. This basic conflict is even more
accentuated when it comes to illegal substances, which per se are
prohibited, but are more or less widely used, and where an intention to
reduce harmful use can also be a legitimate goal.
The conflict is also more problematic where ideological positions are
involved, such as religious rules (e.g. against the use of alcoholic
beverages) or, on the other hand, questions of professional or cultural
identity involving the use of substances.

Evaluation Research in Regard to Primary Prevention of Drug Abuse
7
Finally, a basic conflict concerns the economic and/or political interests
which may be hurt by preventing substance use. Living conditions, lack of
adequate opportunities, excessive working hours, living far from one’s
own family etc. eventually increase the risks for substance abuse; any
structural changes reducing such risks are bound to hurt some interests.
There is a saying that "No drug prevention can be effective unless it hurts
somewhere!".
The only way to overcome this kind of conflicts and to avoid a passive
evasion from conflict or, even worse, engaging in a kind of
pseudo-prevention which hurts nowhere - the only way is to carefully
document which goal and which strategy is helpful under what
circumstances. The conflict proneness of drug prevention is another
argument for developing a scientific basis ensuring an optimum of positive
effects and a minimum of harm produced by prevention itself.
1.3 Evaluation of drug prevention in Europe and the need
for concerted action
Some efforts have been made in order to gain an overview over the state of
the art in European countries. We may mention two collections of selected
drug prevention programmes: the one by Zaccagnini et al (1993) includes
75 projects from 14 countries, the other by Negreiros (1994), initiated on
behalf of the Council of Europe, describes 47 projects from 18 countries.
Both overviews demonstrate the wide spectrum of preventive approaches,
with a majority of activities focusing on drug information and drug
education. Both overviews also include information on evaluation efforts.
In many of the described projects, some form of evaluation was foreseen.
Negreiros mentions some form of monitoring or process evaluation in 32
projects, an impact assessment in 19 projects, and a combination of both in
14 projects; no evaluation was foreseen in 3 projects only. However, there
is very little information on details and especially on evaluation results,
revealing a general scarcity of prevention evaluation knowledge.
A lack of evaluation theory, methodology and practice, and also a lack of
networking among experts engaging in prevention evaluation, became
clearly visible. It also became evident that national efforts alone cannot be
sufficient in this domain. Concepts and instruments for comparative
research on an international level are indispensable. World Health
Organisation made a first attempt to produce guidelines for assessing
alcohol and drug prevention programmes (WHO, 1991a).

Evaluating Drug Prevention: An Introduction
8
This invited an initiative to be taken in the framework of the COST social
science action A6 "Evaluation of action against drug abuse in Europe".
This project started in December 1992, expiring by end of 1997. It gained
participation from 15 countries and developed working plans for separate
working groups which dealt with prevention evaluation, treatment
evaluation, evaluation of drug policies and of drug related delinquency;
another working group was designed for developing research instruments
and protocols to be used in evaluation research. Each working group has
established a network of experts, including observers from the Groupe
Pompidou, from World Health Organisation, from the European
Commission (Uchtenhagen 1994, 1996).
The working group on the evaluation of prevention, chaired by A. Springer
of the Viennese Ludwig-Boltzmann-Institute for Addiction Research,
decided at an early stage to focus on primary prevention. It initiated a
comprehensive Delphi study conducted by A. Uhl from the Ludwig-
Boltzmann-Institute for Addiction Research, organised workshops on
specific topics and stimulated national efforts to improve prevention
evaluation projects. It also invited country reports reviewing the state of
the art in the participating countries.
This book presents selected results of the working group’s activities. It is
my privilege to express my gratitude to all those who contributed to
making these activities a worthwhile exercise, and especially to the
members of the working group and their chairman.
1.4 References
Negreiros, J.: Drug misuse prevention projects in Europe. University of
Porto (Portugal), Co-operation group to combat drug abuse and
illicit trafficking in drugs (Pompidou Group). Council of Europe
(P-PG (94) 25), 1994
Springer A, Uhl A: Primärprävention des Drogenmißbrauchs und ihre
Evaluation. Erfassung der österreichischen Situation und
Diskussion der Rahmenbedingungen in Europa und in den USA.
Ludwig-Boltzmann-Institut für Suchtforschung, Wien, 1995
(Manuskript)
Uchtenhagen A: Evaluation of action against drug abuse in Europe:
a COST social science project. Eur Addict Res 1, 1-2: 68-70,
1994

Evaluation Research in Regard to Primary Prevention of Drug Abuse
9
Uchtenhagen A: COST A-6 Evaluation of action against Drug Abuse in
Europe. Progress report. Eur Addict Res 2, 1 : 6-65, 1996
World Health Organisation: Programme on substance abuse. Guidelines
for assessing alcohol and drug prevention programmes,
WHO/PSA/91.4, 1991a
World Health Organisation: International Classification of Diseases.
Clinical descriptions and diagnostic guidelines. Geneva, 1991b
Zaccagnini, J. L. et al.: Catalogo de programas de prevencion de la
drogadiccion. Promolibro Valencia, 1993
contact address:
Ambros Uchtenhagen
ISF, Konradstraße 32
CH-8005, Zurich, Switzerland
Tel: +41 1 2734024
FAX: +41 1 2734064
e-mail: uchtenha@isf.unizh.ch

Evaluating Drug Prevention: An Introduction
10
2 Some remarks on research based evaluation
(Katarzyna Okulicz-Kozaryn)
2.1 Reasons to do evaluation
Concerning evaluation of primary prevention we may think about a
number of various sets of scientific activities and reports. The term
"evaluation" has various denotations. One, very general description of
"evaluation" says that it is the process of seeing if we accomplished what
we set out to achieve (Hawkins, Nederhood, 1987). This general meaning
allows us to apply the term "evaluation" to different activities, serving
different purposes and different groups of people.
There are different reasons for doing evaluation (Moberg, 1984). The most
obvious, and the first one coming to one’s mind is the assessment of a
prevention programme’s effects. Many evaluation studies are conducted
because programme developers, sponsors and field workers want to know
if their programme really works as expected. Evaluation studies of this
type are concentrated on the outcomes of a particular programme.
Evaluation goals may be much more global and reach far beyond the
impact of specific prevention programmes. The purpose may be to assess
the value of theories behind prevention programmes. This kind of
evaluation is a very important and interesting issue, particularly for
scientists: Are they useful? Is their application leading to a better
understanding of the drug use phenomenon? etc. These questions go
further than questions about the effectiveness of a single intervention.
Answers can be generalised to other prevention programmes. To obtain
generalisable data several fundamental methodological criteria concerning
study design and measurement instruments have to be met.
Somewhere in between the evaluation of specific evaluation programmes
and evaluation theory is the evaluation of prevention concepts. The central
question is if a class of related programmes characterised by a similar
approach is promising. In evaluating prevention approaches the quality of
design has high priority as well. This kind of research can give answers
about prevention strategies (What to do?), programme activities (How to
do it?) and target population (For whom?). The main goal of evaluation
concerning particular preventive strategies is to decide if this type of
intervention is worth being disseminated, to decide if it should it be

Evaluation Research in Regard to Primary Prevention of Drug Abuse
11
recommended for implementation at other sites or for other groups of
people. Answers to these questions are crucial for decision makers.
Evaluation may also satisfy the needs of programme developers and staff.
Especially when the main reason for doing evaluation is to improve a
programme. Evaluation may serve to identify problem areas and to choose
better strategies to deal with arising problems.
Evaluation may also permit better planning of future activities. Through
asking present programme participants about their needs and expectations
we can collect very useful information. We may e.g. find out, what are the
gasps in our service, what are the trends in our target population (i.e.
changes in types of drugs widely used), how many participants we may
expect in the next edition of our programme.
The accomplishment of any one of the above goals would be impossible
without careful description of programme activities: What has been done?
For how many participants? Are the programme elements understandable
and feasible? What was the feedback from our clients? This kind of
evaluation is often named "monitoring" or "process evaluation" and it
constitutes a fundamental basis for all other evaluation studies.
The most unpleasant and even frightening purpose of evaluation for
practitioners is that of accountability. Funding agencies want to know how
their funds were used. How many clients were served? How much time did
the staff spend on the programme? Collecting these kinds of data may be
very boring for prevention practitioners. From their perspective, it may
look as a waste of time because this kind of evaluation generally provides
information of marginal use for programme improvement or assessment of
programme results. On the other hand, this kind of activity may be very
important from an economic point of view.
2.2 Some problems related to outcome evaluation
The purpose of a specific evaluation project determines what kind of data
need to be collected. If evaluation is considered to assess the effectiveness
of a programme, a policy or a strategy, the most important data are data
concerning the outcome and not data concerning the process. To collect
credible outcome data in the field of primary prevention, an evaluator has
to face a lot of theoretical and methodological problems.

Evaluating Drug Prevention: An Introduction
12
2.2.1 Problems related to the study design
Designs determine the quality of data gathered and may determine
conclusions about programme effectiveness (Fitz-Gibon, Morris, 1987;
Hawkins, Nederhood, 1987). Among researchers there are hardly any
serious controversies about the fact that a true experimental design is
basically superior to any other design. It allows to compare the effects on
programme participants with the effects on people not having participated
in prevention activities. But there are many situations where only
quasi-experimental designs are realistic under real-life conditions. Even if
experimental designs are considered in the first place, the researches are
frequently confronted with serious interfering factors causing deviations
from the experimental design and resulting in less then optimal data
quality.
A fundamental problem is associated with random assignment. Under
everyday conditions it is not always possible to assign subjects randomly
to experimental or control conditions (Boyd, 1994; Holder et al., 1995)
Sometimes it is virtually impossible not to offer any preventive
intervention to randomly selected individuals or cohorts, without causing
them to seek for alternative sources. Sometimes the target population is so
small that there are not enough cases to assign randomly to experimental or
control conditions. Limitations in the assignment of schools or local
communities to different conditions are also well known.
2.2.2 Problems related to outcome variables
Primary prevention is defined as interventions to prevent the onset of a
substance use problem. Consequently the target population for primary
prevention consists of persons - usually children and adolescents - who
haven’t started to use drugs or who do not use them in a harmful way yet.
Evaluation of primary prevention means that we are trying to assess
changes in a dimension (drug use or problems related to drug use) that are
not yet present and may or may not develop in the future. In dealing with
the evaluation of a drug prevention programme for primary school students
we should be aware that expected behavioural changes resulting from the
programme may not be measurable for several years. Waiting for such a
long time for the results of an evaluation is usually not acceptable to
people engaged in prevention and/or evaluation. Funding agencies want to
know if their money was invested well, the programme staff is interested in
the results of their work, programme developers are waiting for a

Evaluation Research in Regard to Primary Prevention of Drug Abuse
13
confirmation of their background theories, and evaluators are interested in
publishing their research findings. As a matter of fact evaluation con-
clusions are often based on short-term results, measured just after the end
of a preventive intervention. By definition primary prevention focuses on
behaviour of low prevalence in most target populations. Therefore it is
unrealistic to expect significant changes in behaviour in a short time
period.
If we do not have time to wait for future behavioural changes, the only
realistic alternative is to use "intermediate variables" known to relate to
relevant behavioural changes in the future. In this context it is assumed
that the presence or intensity of some features of individuals plays a
significant role in amount and frequency of drug use. The concept of risk
and protective factors is presently predominant in primary prevention.
Modern prevention programmes are frequently based on studies
concerning the relationship between drug use and individual factors (i.e.
knowledge, attitudes, personality), family factors (i.e. family history of
drug use, parental norms on drugs, parent-child relationship), or peer
influence. But the relationship between various factors and drug use still
remains uncertain. Results of studies concerning risk and protective
factors, literature overviews and meta-analyses are not always convergent
(Hansen, Rose, Dryfoos, 1993; Botvin, 1990; Howkins, Catalano &
Morris, 1992; Morgan, 1998). Some approaches seem to be more
promising though than others.
As long as the prevalence of drug use is still increasing people trying to
cope with alcohol and drug problems cannot afford the luxury to refrain
from actions and passively wait until researchers formulate final statements
about the most effective prevention strategies (Holder et al., 1995).
Prevention programmes are often based on popular opinions and guesses
without clearly formulated direct and indirect (mediating) goals. For some
programme developers and decision makers (as well as for some
evaluators!) explicitly stated programme goals do not have to be congruent
with the dependent variables measured in the study and many conclusions
about programme effectiveness are formulated on the basis of surrogate
(intervening) variable measures (Dielman, 1995). E.g. a claim to prove
effectiveness of a drug prevention programme may be derived of parti-
cipants’ knowledge or attitudes towards drugs.
2.2.3 Other problems
Another fundamental problem commonly found in evaluation is that
evaluators are often engaged too late (Fitz-Gibon, Morris, 1987).

Evaluating Drug Prevention: An Introduction
14
Programme developers usually concentrate on prevention activities while
they conceptualise their programmes and any serious planning of
evaluation is beyond the scope of their interest in this phase. They do not
begin to think about evaluation before their programme has been finalised.
Evaluation starts to be an issue after the newly developed programme has
already been implemented or is going to be implemented soon. Whenever
evaluators are engaged too late, they have to work under time pressure and
they do not have enough sufficient time to plan their evaluation project
adequately. Sometimes there is not even time to do any baseline
measurements. This lack of time may impede the quality of measurement
instruments to assess the overall programme goals as well as other
programme objectives (related to the intermediate steps along a continuum
of change described in the theoretical model of the programme. This could
i.e. be "improvement of life skills", "knowledge", "attitudes towards
drugs", etc.).
Still another fundamental problem is related to financial limitations. In the
field of drug prevention it is much easier to obtain funds for interventions
than for research on intervention effectiveness. As a result, many
interventions are being implemented without any evaluation at all or with
insufficient evaluations produced by the fact that evaluators have to limit
their research designs according to available sources (Schaps et al., 1981;
Tobler, 1986; Ferrer et al., 1995; Springer, 1998). Financial limits often
influence sample size and/or study design. If there are insufficient funds
available it may e.g. not be possible to include a reference group.
A scientific proof of effectiveness may be difficult for other reasons too.
There are few interventions in the field of drug prevention that their
authors describe as stable and completed (Fitz-Gibon, Morris, 1987). Each
programme implementation may bring to light new problem areas and
possibilities how to improve an intervention. Commonly founders believe
that programmes that have already been implemented once are principally
perfect and they expect summative statements about programme
effectiveness. This may lead to situations, where programmes that still
require further modifications are prematurely subjected to outcome
evaluation, even though further formative evaluation should be planned to
improve the programme before any summative evaluation should be
considered (Uhl, 1998).
A lack of standardisation in programme implementation may also influence
evaluation results. Whenever people delivering the programme
(programme multipliers) are not well prepared, or are not motivated to
keep the quality of programme implementation, or if they are freely

Evaluation Research in Regard to Primary Prevention of Drug Abuse
15
changing programme content, it may deteriorate the programme’s impact
(Hansen et al.; 1991).
2.3 The need for co-operation
External evaluators of primary prevention programmes usually have been
trained to understand various theoretical, methodological and practical
research problems. Consequently they are primarily interested in research
issues while sponsors, decision makers, programme developers and staff
members are primarily interested in content; i.e. in delivering prevention
services. Because of this conflict in background and orientation, it is very
important for the scientific process, to consider who has control over
whom in this process: the external evaluators or the others (Boyd, 1994;
Holder et al., 1995)
When prevention interventions are initiated by researchers in order to
evaluate the intervention, the probability that methodological problems and
theoretical problems can be avoided by applying an advanced design is
greatly increased. Keeping certain methodological standards allows the
attainment of ambitious evaluation goals. Through this kind of study it is
possible to test prevention theory and the effectiveness of prevention
approaches. Under these circumstances it is also feasible to collect data on
long-term effects.
Interventions controlled by programme developers or decision makers are
generally much more challenging for evaluators. The evaluators have to
deal with situations created by others and to compromise between
methodological standards and real life conditions. In this situation it is
much more difficult to obtain credible results since experimental or even
quasi-experimental designs are often not applicable. On the other hand
though, studies of a naturally occurring and programme-driven
interventions may significantly improve our understanding of naturally
occurring prevention process since the interventions are conducted under
real life conditions and not artificial ones. These findings therefore may
more easily be generalised to larger populations.

Evaluating Drug Prevention: An Introduction
16
Presently the majority of drug prevention programmes are developed and
implemented outside of scientific centres. Unfortunately there is a
considerable lack of established and accepted standards for the evaluation
of "naturally occurring" projects. It would be useful to have standards
addressing the special characteristic of programme-driven evaluation.
2.4 References
Botvin, G.: Substance Abuse Prevention Theory, Practice, and
Effectiveness. In: Tonry, M.; Wilson, J. Q. (Eds.): Drugs and
Crime: Annual review of research in crime justice. Vol. 13,
461-519, University of Chicago Press, Chicago, 1990
Boyd, G. M.: Methodology of Evaluative Studies. Paper presented at the
Workshop on Evaluative Studies on Alcohol Prevention
Programs, Warsaw, 1994
Dielman, T. E.: School-Based Research on the Prevention of Adolescent
Alcohol Use and Misuse: Methodological Issues and Advances.
In: Boyd, G. M.; Howard, J.; Zucker, R. A. (Eds.): Alcohol
Problems Among Adolescents: Current Directions in Prevention
Research. Lawrence Erlbaum Associates Publishers, Hillsdale,
N.J. Hove, 1995
Ferrer, X.; Duran, A.; Larriba, J.; Spieldenner; J.: Catalogue of Educational
Materials on Drugs. Selected from the European Union and
Central and Eastern European Countries, Phare Project on Drug
Demand Reduction, 1995.
Fitz-Gibon, C. T.; Morris, L. L.: How to Design a Program Evaluation.
Sage Publications, Inc., Newbury Park, 1987
Hansen, W. B.; Graham, J. W.; Wolkenstein, B. H.; Rohrbach, L. A.:
Program Integrity as a Moderator of Prevention Program
Effectiveness: Results for Fifth-Grade Students in the
Adolescent Alcohol Prevention Trial, Journal of Studies on
Alcohol, 52, 6, 1991
Hansen, W. B.; Rose, L. A.; Dryfoos, J. G.: Causal Factors, Interventions
and Policy Considerations in School based Substance Abuse
Prevention. Report submitted to the Office of Technology
Assessment United States Congress, Washington DC, 1993
Hawkins, J. D.; Catalano, R. F.; Miller, J. Y.: Risk and Protective Factors
for Alcohol and Other Drug Problems in Adolescence and Early
Adulthood: Implications for Substance Abuse Prevention.
Psychological Bulletin, 112, 1, 64-105, 1992

Evaluation Research in Regard to Primary Prevention of Drug Abuse
17
Holder, H.; Boyd, G.; Howard, J.; Fly, B.; Voas, R.; Grossman, M.:
Alcohol-Problem Prevention Research Policy: The Need for a
Phases Research Model. J. Pub. Health Pol. 16, 3, 324-346, 1995
Moberg, D. P.: Evaluation of Prevention Programs: A Basic Guide for
Practitioners. Wisconsin Clearinghouse, Madison, 1984
Morgan, M.: Evaluations of Substance Use Prevention Programmes
Implications for Illicit Drugs. In this publication, 1998
Schaps, E.; DiBartolo, R.; Moskowitz, J.; Palley, C. S., Churgin, S.: A
Review of 127 Drug Abuse Prevention Program Evaluation. J.
Drug Issues, 1981
Springer, A.: Country Reports: An Overview, Including Some Remarks
about Socio-Cultural Determinants of Primary Prevention and its
Evaluation. In this publication, 1998
Tobler, N. S.: Meta-Analysis of 143 Adolescent Drug Prevention
Programs: Quantitative Outcome Results of Program Participants
Compared to a Control or Comparison Group. Journal of Drug
Issues, 16, 4, 537-567, 1986
Uhl, A.: Evaluation of Primary Prevention in the Field of Illicit Drugs
Definitions - Concepts - Problems. In this publication, 1998
Wilson, J. Q. (Ed.): Drugs and Crime: Annual Review of Research in
Crime and Justice, 13, 461-519, University of Chicago Press,
Chicago, 1990
contact address:
Katarzyna Okulicz-Kozaryn
Institute of Psychiatry and Neurology
1/9 Sobieskiego, 02-957, Warsaw, Poland
Tel: +48 22 422650
FAX: +48 22 6425375

Evaluating Drug Prevention: An Introduction
18

Evaluation Research in Regard to Primary Prevention of Drug Abuse
19
Country Reports:
An Overview, Including Some Remarks
about Socio-Cultural Determinants of
Primary Prevention and its Evaluation
Alfred Springer
LBISucht, Vienna, Austria
___________________________________
Results of an International Study
within the COST-A6 Action
of the European Union

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Contents
1 Methodology............................................................................................ 21
2 The instrument......................................................................................... 21
3 Results...................................................................................................... 26
3.1 The country reports........................................................................... 26
3.1.1 Austria......................................................................................... 27
3.1.2 Belgium....................................................................................... 28
3.1.3 Czech Republic ........................................................................... 28
3.1.4 Finland......................................................................................... 29
3.1.5 France.......................................................................................... 29
3.1.6 Germany ...................................................................................... 30
3.1.7 Greece.......................................................................................... 31
3.1.8 Ireland.......................................................................................... 32
3.1.9 Italy.............................................................................................. 32
3.1.10 The Netherlands........................................................................ 32
3.1.11 Poland........................................................................................ 34
3.1.12 Spain.......................................................................................... 35
4 Summary.................................................................................................. 37
4.1 Typology of programmes.................................................................. 37
4.2 Aims of programmes ........................................................................ 37
4.3 The background of the problems of evaluation; socio-cultural
reconsideration................................................................................ 38
4.3.1 The problem of outcome evaluation........................................... 38
4.4 Excursus: Major trends in prevention in the USA and in
Europe. A comparison.................................................................... 40
4.4.1 Prevention philosophy................................................................. 40
4.4.2 Primary prevention as a component of drug policies................. 41
4.4.2.1 The situation in the USA ......................................................42
4.4.2.2 European attitudes................................................................. 44
4.4.3 Impact on evaluation issues........................................................ 46
5 Appendix - three examples of original country reports as illustration... 49
5.1 Report of Poland............................................................................... 49
5.2 Report of Greece............................................................................... 53
5.3 Report of France............................................................................... 60
6 References................................................................................................ 63

Evaluation Research in Regard to Primary Prevention of Drug Abuse
21
1 Methodology
Our objective was to gain information about ongoing primary prevention
and the state of its evaluation throughout Europe. To fulfil this aim country
reports from as many European countries as possible were collected.
Experts were recruited through official channels and through snowballing.
On the one hand we contacted the officials concerned in the different
countries and asked them to nominate experts known to be competent and
prepared to undertake the venture. Additionally we used our own
knowledge and expertise to identify eminent experts in the field.
The experts were asked to identify those programmes in their countries that
had been implemented more or less properly in a scientifically proper way
and evaluated in some way. To arrive at comparable answers we developed
a questionnaire, targeting important issues concerning the research field
and also included questions concerning the experts’ estimation of the
programmes and projects.
2 The instrument
A General data on projects
A1 Project title:
A2 Key-persons / key-institutions
A3 What state is the project currently in?
• already finished?
• ongoing?
• in a planning stage?
• I don’t know and couldn’t find out?
A4 Have there been any publications, official presentations or grey
literature yet regarding the project?
• yes no ?
• If yes, please give a full citation of all related papers or articles and if
• possible, please include a photocopy of the article or articles.
• If the material is not published in an international journal, please
give the name and address of at least one author:

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B Data relating to the primary prevention programme
B1 Abstract goals concerning illicit drugs, such as
• less consumption
• later onset of consumption
• safer use
• harm reduction in terms of health problems
• harm reduction in terms of social problems
• harm reduction in terms of public disorder
• harm reduction in terms of immoral conduct
• no goals specified explicitly
• etc.
describe in detail: ...................................................................................
B2 Details on programme structure, such as
• Is there a written concept
• How many sessions were planned
• Who is carrying out the programme
• How is the staff trained to do the job
• How much time is used for staff training
• etc.
describe in detail: ...................................................................................
B3 Type of programme in terms of
• target population (e.g. school based, community based, mass media
campaign, training of educators, teachers, physicians, policemen,
parents etc., change of law or policy etc.) and
• size of target population (e.g. nation wide media campaign, one
school including 12 classes, etc.).
describe in detail: ...................................................................................

Evaluation Research in Regard to Primary Prevention of Drug Abuse
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B4 Techniques used, such as
• general health education
• changing lifestyles
• changing attitudes
• social skills training
• deterrent information
• factual information
• offer of alternatives to drug taking
• clubbing
• modification of drug laws (e.g. decriminalisation of mere
consumers, compulsory treatment of addicts, more severe legal
sanctions for consumers etc.)
• modification of drug policy (e.g. offer of syringe exchange,
offering low level intervention, etc.)
• change of police strategy (e.g. tolerate scene, focus on large scale
dealers, etc.)
• change of treatment policy (e.g. making methadone maintenance
available)
• etc.
describe in detail: ...................................................................................
B5 Drugs mentioned in programme, such as
• no drugs mentioned at all
• only illicit drugs mentioned
• only medical drugs mentioned
• both legal and illicit drugs mentioned
• only specific drugs mentioned (e.g. cannabis, heroin, cocaine)
• etc.
describe in detail: ...................................................................................

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C Data relating to evaluation
C1 What targets were/will be evaluated?
• operational objectives (internal targets), like "Did the information
reach the target population?"; "Was the programme concept carried
out as planned?", etc.
• intermediate targets (surrogate targets) associated to the final goals
but not primary goals by themselves, like e.g. attitude change,
increased self-esteem, higher information level, etc.
• ultimate targets (primary targets) like e.g. less drug consumption,
later onset of drug consumption, harm reduction, less problematic
use, etc.
describe in detail: ...................................................................................
C2 How was the study sample defined?
describe in detail: ...................................................................................
C3 Sample size and drop-out rate?
describe in detail: ...................................................................................
C4 How often were data collected and at what time schedule?
describe in detail: ...................................................................................
C5 How were the data collected, resp. what data were used?
• surveys / population surveys
• telephone interview
• face-to-face interview
• questionnaire presented by investigator
• mailed out questionnaire
• public statistical data
• police records
• treatment records
• other
describe in detail: ...................................................................................
C6 Was the programme successful and if yes, in which dimension(s)?
describe in detail: ...................................................................................
C7 Were there specific problems worth explicitly mentioning?
describe in detail: ...................................................................................

Evaluation Research in Regard to Primary Prevention of Drug Abuse
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D Global part
D1 Personal summary on the different projects mentioned
Please give a generalising overview out of your personal impressions over
the state of evaluation on primary prevention research regarding illicit
drugs in your country.
D2 Conclusions: What conclusions do you personally draw out of the
present state of evaluation in your country and how do you feel
about prevention and evaluation of prevention in this field
generally
• Which prevention concepts do you think are promising and which
concepts are worthless?
• How do you define the limitations of evaluation in this field?
• etc.
D3 Is there anything like an official national prevention concept in
your country?
If yes,
• what is the concept like?
• is it available as a written document?
• is there a gap to implementation?
• are there any relevant groups openly in opposition to the concept
and who are they?
D4 Please indicate names and addresses of other researchers and
institutions in your country that are active in the field of
prevention evaluation?

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3 Results
3.1 The country reports
Finally experts from the following countries agreed to co-operate in the
action:
• Austria: Alfred Springer
• Belgium: Annick Vandendriessche
• Czech Republic: Official statement; no defined author
• Finland: Osmo Kontula
• France: Chafic Saliba
• Germany: Christoph Kröger
• Greece: Alice Mostriou
• Ireland: Mark Morgan
• Italy: Alberto Tinarelli
• Poland: Katarzyna Okulicz-Kozaryn
• Spain: Maria Xesús Froján Parga
• The Netherlands: Han Kuipers
The reports we received differed widely concerning content and punctual-
ity. Some of the country representatives reported on each single project
they were able to identify and proved worthy to be documented, others
only described the projects globally and gave a summary on the overall
situation of prevention and evaluation in their countries.
Therefore the results of our initiative cannot in all cases be presented
according to the outline we developed, but they are more or less a
summary of the country reports we received. The summaries presented
here are partially composed using original wording of the country’s
experts. In some cases we have completed the reports using some
information from official documents. We will nevertheless use the outline
as a guideline for our interpretation.

Evaluation Research in Regard to Primary Prevention of Drug Abuse
27
3.1.1 Austria
During the 90ies many preventive actions were started in different
Austrian provinces. Prevention was officially declared to be of central
importance.
The leading background philosophy of primary prevention in Austria is to
include drug abuse prevention in the more general field of health education
and to develop a prevention concept that focuses on the prevention of
"addiction" and not of "drug use". The concept addresses primarily
"unspecific" social and psychological aspects. Drug specific issues are
only touched marginally.
The abstract goals concerning illicit drug use are basically abstinence
oriented but at the same time nevertheless heavily influenced by concepts
of harm reduction. The message given out is predominantly not a "no
drugs"- message but a "safe use" message.
In Austria different types of projects and programmes are in action. They
are ranging from isolated information campaigns to more structured
programmes on community level. Most of the activities are carried out in
the context of school education and are seen as a central component of the
health education concept. It is therefore typical that the first larger effort,
done in a structured way, was the preparation of educational material for
adolescents aged 13 - 18 years as a common project of the Ministry of
Health, the Ministry of Education and experts from the education sciences.
This project has been evaluated.
A recent promising development is peer group oriented projects. They
commonly include evaluation components. One of these projects will start
a co-operation on the European level within the "Europeer" research
project.
All together we may conclude that the evaluation has not developed
sufficiently until now. Very few preventive efforts have been covered by
proper process evaluation and outcome evaluation is almost totally
missing. In cases where some kind of evaluation had been included from
the very beginning of a project -as in the case of the educational material
mentioned above - some major difficulties have disqualified the evaluation
process.
Concerning outcome evaluation the very strict personality centred
approach of "addiction prevention" represents a main obstacle.

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3.1.2 Belgium
According to the Belgian report, primary prevention in this country is
oriented towards health promotion and health education. Concerning its
theoretical reference frame mainly the social learning approach is used.
Apart from this there is no national prevention concept, since there seems
to be a certain degree of conflict prevailing between the levels of the
political system (regional and federal) and within the regional departments
concerning central issues like "harm reduction".
Out of the prevention programmes which are implemented in the French
and the Flemish parts of Belgium two projects are described in depth and
discussed. Both belong to the school based drug education approach:
• "Skills for Adolescence" and
• "QUEST"
The analysis of the material leads to the conclusion that in Belgium only
few programmes are actually evaluated. This trend is changing though,
since VIG, the umbrella organisation for health promotion clearly stated
that proper evaluation is necessary in order to get projects funded. This
organisation even offers training in e.g. how to deal with the problem of
external evaluation.
3.1.3 Czech Republic
In the Czech Republic primary prevention is seen as a major challenge
nowadays. Priority is given to preventive efforts towards children and
youngsters through school education, family, peers and role-makers among
music, sports and other popular personalities. It is a field of
interdisciplinary co-operation. The National Centre for Health Promotion,
a national agency run by the Ministry of Health in co-operation with the
Ministry of Education, focuses on methodology and development of model
programmes. Co-ordination is being provided by the National Drug
Commission. There is also a notable activity of NGOs. The NGO sector
has been involved in prevention programmes for schools, in projects of
"teaching the teachers", in "peer education programmes", in the production
of printed materials / leaflets, in the organisation of exhibitions and in
sponsoring concerts of popular music as well. In the field of primary
prevention the Czech Republic has been involved in several international
projects within PHARE, Group Pompidou, WHO. No information
concerning evaluation of all these efforts has been provided in the report.

Evaluation Research in Regard to Primary Prevention of Drug Abuse
29
3.1.4 Finland
The problem of illicit drug use in this country is comparatively small sized.
Therefore only a small number of prevention programmes has started yet.
The programmes carried out have been small-scale and almost regularly
programme evaluation has been insufficient. Other typical features of
Finnish drug prevention are a relatively large amount of teaching materials
produced for prevention purposes and the implementation of a large sector
of prevention by voluntary organisations and citizens. Totally missing is an
evaluation of efficacy and impact.
Most of the Finnish primary prevention programmes seem to aim at
practical results in the subjects. Evaluation has typically played a minor
part in any programmes and is not considered an objective in itself. In
other words, programmes aiming at developing better future programmes
are rare exceptions.
Five projects that have been evaluated are described and discussed in the
report. One of them was the empirical basis for a thesis on special
education to get a university degree and this project used a true
experimental design. Based on the report we can conclude that the quality
of evaluation was not sufficient in all other programmes.
3.1.5 France
Chafic Saliba, the French expert described and discussed many projects.
He covered a wide range of preventive activities using a variety of
different approaches. In his report a total of 170 activities / materials were
reported. Out of this bulk of material Dr. Saliba selected and discussed 9
highly divergently evaluated projects, using very different designs. Among
them are programmes for school-based drug education, mass media
campaigns and video clips and their evaluation, the alternatives (sports
against drugs), interactive theatre (role-acting) in the sense of DARE.
The report mentioned that at a whole 170 prevention activities could be
identified and that again 170 educational tools for the implementation of
the programmes had been produced. Primary prevention is seen as a high
profile venture and receives support from varied sources. Evaluation is
estimated to be highly important too. The reality of prevention though
presents a very different picture. The high intentions do not result in
adequate actions.

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According to Mr. Saliba two main causes are to blame for that situation.
The first problem is the nowadays prevalent interpretation of a causal
relationship concerning drug abuse, which could be named "fundamen-
talist". In France like in other western European countries the main interest
in prevention background theories is directed at the latent causes of
addiction which remain hidden in the individual’s psychic structure and are
very difficult to detect and therefore also very difficult to influence. Dr.
Saliba is very critical concerning this interpretation. He thinks that this
frame of reference impedes the prevention programmes on all levels of
implementation. These problems start already with the programmes’
conceptualisation and are also influencing the evaluation of the projects.
The second problem is closely linked to the first one. It consists of lack of
clarification of the aims of the intervention and of the outcome criteria.
They are very vague and complex. This contributes to the difficulties
concerning outcome evaluation and fosters an evaluation approach which
relies nearly exclusively on the evaluation of the number of persons
reached and of the implementation quality. The quality of implementation
is usually evaluated using again very vague concepts and subjective
categories like "satisfaction/dissatisfaction".
The interpretation of programme results is very difficult because of serious
methodological problems. It is nearly impossible to draw valid conclusions
and generalisations out of them. This is also due to major changes in the
programme during the time of its implementation.
3.1.6 Germany
In this country many actions and programmes are carried out in the field of
primary prevention of drug use. Few of them have been evaluated though.
Evaluation is primarily done in projects sponsored by the German Federal
Government. These projects are major mass-media campaigns and some
"model type projects". The evaluation of these campaigns and projects is
done professionally and financed by the Government and the Federal
Centre for Health Education (Bundeszentrale für gesundheitliche
Aufklärung).
Usually, universities are neither involved in primary prevention nor in
evaluation nor in related research activities. Several regional groups that
do primary prevention evaluate some of their work, but in most cases this
evaluation does not have high priority in the projects. Often the results are
not even published because they do not meet minimum scientific research
standards. There are some information systems available that distribute
information on on-going and past prevention projects in the field of

Evaluation Research in Regard to Primary Prevention of Drug Abuse
31
primary prevention. Most projects do not have money or time for extensive
evaluation.
Most evaluation work concentrates on projects with the objective of
training mediators in the prevention field. Outcome evaluation is
interpreted as a very difficult task to implement.
In the German report 12 prevention activities are described and discussed
following our outline:
• Bundesmodellprogramm Mobile Drogenprävention (DHS, Hamm)
• Forschungsvorhaben auf dem Gebiet "Biologische und psychosoziale
Faktoren von Drogenmißbrauch und Drogenabhängigkeit" (IFT,
München)
• Prevention of substance abuse in schools by means of life skills training
(IFT, München)
• Der Rausch des Lebens; Plakatserie (Aktion Jugendschutz, Bayern)
• Sag doch was (mobile Drogenprävention Bayern, Fachhochschule
Würzburg)
• Seminar: Auszubildende und Drogenkonsum (Fachstelle für Prävention;
Bottrop)
• Kinder stark machen - eine Anzeigenkampagne (Bundeszentrale für
gesundheitliche Aufklärung, Bonn)
• Sunrise (Zentralstelle für Suchtvorbeugung, Kiel)
• Das nordrhein-westfälische Programm zur Sucht- und Drogenprävention
(Universität Bielefeld)
• Train the Trainer-programme (Zentralstelle für Suchtvorbeugung, Kiel)
• Echter Rausch kommt von innen (Zentralstelle für Suchtvorbeugung &
Bund für drogenfreie Erziehung)
• Spielzeugfreier Kindergarten (Aktion Jugendschutz, Landesarbeitsstelle
Bayern e.V.)
3.1.7 Greece
In Greece many rather unstructured preventive actions are going on. None
of them seem to have been evaluated. In the academic field the leading
philosophy is to include primary prevention of drug use and abuse into the
overall health education in schools. A programme with the aim of
"Education for Health to prevent dependence and addiction" has been done

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in Athens. In that case process evaluation as well as outcome evaluation on
selected variables have been carried out.
3.1.8 Ireland
A substance abuse prevention programme to be used in schools was
developed by the Departments of Health and Education in Ireland during
1990. This effort has been evaluated. This evaluation involved a
quasi-experimental design in the sense of a comparison of pilot schools
and control schools with a stringent statistical and quantitative strategy.
The programme itself used several approaches to prevent substance abuse
based on some conceptions of the influence that underpins initiation to
various substances and did not rely on any single model of intervention.
The central concept is that social skills and understanding may be critical
in assisting young people to make independent decisions on these matters.
The evaluation included process variables and outcome variables. It
indicated that the programme was implemented in accordance with its aims
and objectives in the classrooms and that the programme had positive
effects on attitudes and beliefs regarding substance use, compared to a
matched control group. Social behaviour and beliefs that were targeted in
the programme were shown to be strongly related to reported substance
use.
Since effects on the organisational level were not examined the eventual
impact of the implementation of the programme could not be defined.
3.1.9 Italy
Many preventive efforts have been started, but no systematic evaluation
has taken place. On the other hand as a result of some cultural changes and
a shortage of money evaluation has become an increasing issue.
3.1.10 The Netherlands
In the Netherlands primary as well secondary prevention-activities play an
important role.
Primary prevention is almost always practised in schools. Secondary
prevention takes place at the location of drug (ab)use directly. The latter
approach also includes (secondary) schools, but not to a large extent.

Evaluation Research in Regard to Primary Prevention of Drug Abuse
33
Since 1980 there has been a steady increase in primary prevention
activities and even more increase in secondary prevention (special
activities for risk groups). Actually the basic philosophy of the Dutch
prevention policy follows the concepts of health education and of harm
reduction.
The following principals are typical of Dutch education programmes,
based on research and practice:
• Emphasis on individually responsible choice regarding risky substances
and risky habits.
• Focus on background and reasons for use and abuse (in opposition to an
emphasis on information about substances)
• Less emphasis on dangers of using substances (horror stories) because
this might lead to more experimenting with drugs.
• Educational messages on the use of hard drugs should promote
"abstinence".
• Educational messages on the use of cannabis should promote "caution";
it is not experimenting but excessive (ab)use that should be prevented.
• Educational messages on drugs should be "low profile". The messages
should function as "behavioural advice", as part of a comprehensive
approach of alcohol and drug education programmes or general health
education curricula in schools and training courses. This broader
approach prevails in many current programmes.
Concerning the theoretical background of the Dutch prevention system the
most recent activities in the field of primary prevention of illicit drug use
are based on a theoretical framework derived from social psychology
backed up by empirical evidence from research on the effects of health
education programmes.
The most common strategy of discouraging people from using drugs is
through information, education and health promotion.
But also other approaches to improve the living conditions of people in
poor social and economic positions are used. In that respect the Dutch have
developed the concept of "social innovation", a policy to offer socially
deprived groups new opportunities for (re)integration into society
(education, housing, employment schemes).

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An interesting aspect of Dutch prevention work is also that interventions
are set on locations in meeting points used by members of youth culture
group.
Furthermore an important aspect of the Dutch policy is that drug
prevention has developed from "spontaneous education" (aimed at the
public in general) to "planned programmatic" prevention, based on
research and analysis of specific target groups. In that sense preventive
thinking has gradually achieved a more professional level. The implication
of these changes is that prevention programmes are only warranted if they
meet certain standards of analysis, pre-testing, planning and evaluation.
Nevertheless research on the effects of prevention activities appears to be
very scarce. Only a few examples of research on primary prevention
activities fitting to the definition can be found. Some of them were
conducted in the mid-seventies and early eighties; only one very recently.
A typical overview of selected drug prevention programmes written for the
occasion of the Drug Prevention Week 1994 listed 11 programmes. These
activities differed in strategy and methodology. In eight out of the eleven
programmes no formal evaluation had been done. Outcome evaluation had
been conducted in one case only. For another study outcome evaluation
has been planned.
3.1.11 Poland
Modern trends in drug prevention in Poland can be identified starting from
the mid-80ies on. Now there are more and more programmes, aiming at a
wide range of reasons of drug use and designed to actively involve
participants. With the growing market of evaluation programmes the need
for evaluation research also has increased. This has led to a major change
in the quality of primary prevention in Poland. While some years ago most
intervention studies were based on the simplest design (post testing only),
nowadays often quasi-experimental designs are implemented. One of the
current problems in that context is the lack of ability to adapt evaluation
questions more adequately to the contents or goals of the programme.
There is also a shortage of scientific instruments. The most promising
development in drug prevention in Poland seems to be the community
approach. The evaluation of that promising approach is very difficult
though. Nevertheless there are several community based projects going on
and their results will be known in the near future. In the Polish report five
projects, which are actually implemented in Poland, are described and
discussed focusing on evaluation problems.

Evaluation Research in Regard to Primary Prevention of Drug Abuse
35
3.1.12 Spain
During the last fifteen years there has been a boom in the idea of
prevention within the field of drug dependency. The failure of repressive
and welfare solutions to the drug problem and above all the evolution of its
social perception have been major causes of this boom. In general the
target of prevention programmes is focused on the preconditions for drug
addiction, of which it would be useful to have both conceptual and
working definitions (level of self-control, social skills, potential risks,
educational achievement, etc.) and a clear idea of the aims of preventive
intervention in these variables.
In Spain only few of the prevention programmes have been evaluated - and
there are even fewer that include a description, how the evaluation was
carried out. That leads to the conclusion that in spite of many prevention
efforts carried out in Spain one cannot conclude whether the results are
positive or negative since in most cases nothing is known about the actual
results. It seems that a certain chaos reigns in the field of drug prevention
programmes, undoubtedly partially due to a lack of knowledge in
evaluators regarding evaluation designs.
Most of the preventive interventions take place in schools. The target
populations are mainly school children and adolescents of school age and
to a lesser extent school teachers, who are trained to act as preventive
agents (mediators).
A systematic review of all the prevention programmes that could be
identified showed the following facts:
• Less than half the programmes reviewed included data concerning
evaluation. This evaluation was regularly limited to simple
documentation of the number of participation and attendance of the
distinct groups the programme was directed to.
• Questionnaires are the most utilised instruments for programme
evaluation. The majority of them has been developed specifically for the
actual programme, although the efficacy of the programme is also
evaluated by the number of attendants or participants and by the number
of courses and seminars carried out.
• The number of programmes which include evaluation components is
minimal. Some of them inform that they are using or will use follow-up
forms, questionnaires, surveys, but provide no specific information
concerning type and scope of the planned evaluation.

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• Most of the programmes included no evaluation of basic objectives and
there are several examples where evaluation was done in a quite
superficial and vague manner. That may be due to the fact that the
majority of the programmes presented had very global, unspecific or
confusing objectives.
• As a general rule, there was a lack of operative expertise, which made it
impossible to establish clear hypotheses and to define specific variables.
Because of this it is commonly hard to judge, if the initial objectives had
been achieved or not.
• Most often structural objectives were evaluated, especially relating to
the level of participation in courses and/or seminars but without
specifying whether that participation went hand in hand with learning of
their contents or if this had reached all the target populations.
• Almost none of the programmes informed whether the introduction was
carried out in accordance with the initial proposal or, in case not, what
the differences were and what caused them.
• None of the programmes included an evaluation of costs or of the
cost/benefit relation.
• Intermediate objectives were usually not evaluated. Only 8% out of the
reviewed projects contained information concerning the evaluation of
such variables and even they provided no information concerning the
planned methodology.
• Nor have final objectives been evaluated.
• As for the results, many of the programmes do not provide any kind of
information. It is relatively frequent for the people in charge of the
programme to name the programme efficient simply on the basis of
participation aspects without any reflections on changes or on impact
variables.

Evaluation Research in Regard to Primary Prevention of Drug Abuse
37
4 Summary
We received detailed information about 43 programmes. According to the
descriptions we received the following overview over the programmes
concerning structure of the programmes, type and aims is possible.
4.1 Typology of programmes
Tab. 1: Type of Programmes; Target Groups
kindergarten-programme 1
school based drug education 18
mass media campaigns; video clips 3
development of educational material 3
training of trainers 8
community action 2
youth culture and risk groups intervention 3
peer leader education 1
role-playing; interactive theatre 2
commercials; posters 2
4.2 Aims of programmes
Tab. 2: Drug Specific Aims
information 14
drug abuse resistance training 7
total abstinence message --
reduction of incidence 2
less consumption 16
later onset of drug experimentation 4
harm reduction; safer use 7

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Tab. 3: Non Drug Specific Aims
skill training 15
attitude change 13
alternatives to drugs 5
health education 14
Tab. 4: Type of Drugs Targeted
legal and illegal drugs 14
illegal drugs only 8
no specific drugs 1
no drugs at all 2
The evaluation most frequently done was restricted to operational
objectives (assessment of the quality of the programme and its
implementation). Outcome evaluation focusing on attitudinal changes also
took place in some cases.
The evaluation of programme efficacy concerning drug taking behaviour
continues to be an unsolved problem. Such efforts took place in a very
limited number of programmes. Impact evaluation seems to be missing
totally. As it seems research is nowhere done on the relationship between
the boom in prevention efforts and the development of drug use and the
changing patterns of consumption in the communities during the 90ies.
4.3 The background of the problems of evaluation;
socio-cultural reconsideration
4.3.1 The problem of outcome evaluation
Ideally any prevention programme’s objective has to influence behaviour.
Drug abuse prevention therefore has to aim at behavioural issues of drug

Evaluation Research in Regard to Primary Prevention of Drug Abuse
39
use. We have labelled them "primary aims" in our outline. Due to
methodological reasons on different levels most of these primary
aims/specific outcome variables are very difficult to assess, some of them
cannot be assessed at all under regular research conditions.
This complicated situation of the outcome oriented evaluation of primary
prevention has led to a search for alternative methods and strategies of
evaluation which might be more easily implemented.
The mainly used alternatives can be found in two directions.
• the definition and assessment of intermediate (behavioural) variables.
• Many authors now propose the process oriented or management-focused
approach as a proper way out.
In the USA where the methodology of the process-focused way has been
stressed, the effectiveness of prevention in itself is in a certain way always
determined in regard to outcomes.
In that context the power and the impact of the national drug policy in the
80ies for instance was documented in figures of consumption. The results
of the "War On Drugs" strategy were interpreted as encouraging since in
the early 80ies promising changes in drug taking behaviour were
observable.
That means that researchers and politicians in the United States of America
did not do without outcome evaluation while promoting the process-
oriented approach, but that they used figures drawn from epidemiological
data collections like national consumption - household-studies as frame of
reference.
It could be argued if this is a scientifically proper way. Of course, I think
that some criticism of the approach described above suggests itself. The
relationship might be virtual; and of course one cannot trust the consump-
tion figures. In the political climate of the war on drugs a strong tendency
to under-reporting had to be expected, while in the more liberal situation of
the seventies perhaps over-reporting was the prevailing bias. The decrease
in consumption as documented in household figures might therefore be a
product of the policy changes, but not in the sense it has been interpreted
but in the sense of a reduction of the trustworthiness of the results.
But the question remains, how we should cope in Europe with the
problems arising out of the avoidance of outcome evaluation as related to
changes in drug taking behaviour and or addictive behaviour.

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40
In that context it seems necessary to point out where the emphasis on
process evaluation started and to reflect on differences between the
prevention systems in the USA and in Europe to come to conclusions
concerning the transferability of certain approaches from one cultural
frame to the other.
As a baseline for such considerations it is also of interest to outline
common trends in European prevention approaches.
One the one hand there is no such a system as a common European
prevention philosophy or common strategy. Our study on the country
reports indicates that there are many approaches in use not only on the
international level but also in the different countries themselves. But at the
same time some features are observable which allow to describe European
prevention as distinct from the American way.
It is clear enough that most concepts used in the European Union have
been developed in the United States. But how they are used, under which
conditions and with which objectives depends on the general drug policies
in the different states. These policies also define the general philosophy of
the aims of primary prevention. The differences can easily be illustrated by
using two very distinct systems like the drug policies in the USA and the
Netherlands.
It is well known that in the US a highly repressive attitude was the
prevailing one from the mid-80ies into the early nineties, usually called
"War on Drugs". On the other side, the Netherlands have always been
interpreted as an example of a highly individualised and liberal approach
to drug consumption as well as concerning the strategies they use to keep
drug related problems under control (Engelsman, 1990).
These different philosophies have an impact on the prevention approaches.
This impact can be illustrated by the following comparison. To develop
that comparison official documents containing declarations about drug
policies have been used.
4.4 Excursus: Major trends in prevention in the USA and in
Europe. A comparison
4.4.1 Prevention philosophy
Drug prevention US-style: "War on Drugs" background philosophies
• Ultimate objective: to dissuade people from ever trying drugs

Evaluation Research in Regard to Primary Prevention of Drug Abuse
41
• Ultimate goal: to enable individuals to remain free from alcohol, tobacco
and illicit drugs and also from steroids over his/her entire lifetime
• Ultimate strategy: to co-ordinate prevention with treatment and law
enforcement as part of a comprehensive strategy
In the United States the basic philosophy of prevention is prohibition. This
prohibition is directed against the use of all psychoactive substances,
independent of their legal status. In this approach there is - ideologically -
no place for "harm reduction" or for the concept of "safe use". As the
slogan states: "The only safe use is no use!"
In contrast to it in the Netherlands most prominently, but in many other
European countries as well, the approach of harm reduction has gained
high profile. There is basically also the assumption of the possibility of
safe use of psychoactive substances, since in Europe generally a sharp
distinction is made between "legal" and "illegal" drugs. The concept of
alcohol prohibition has never been very popular in Europe.
Another major difference between the American and the European
approaches runs in the same direction. While in the USA prevention
philosophies ask for "denormalisation" of drug use and of drug users
through different means including media representation, in Europe and
especially in the Netherlands the opposite model of the "normalisation" of
drug use and users has been developed. This "normalisation" is a declared
goal of the Netherlands’ drug policy.
A further major difference between the two drug control cultures lies in the
fact that the Netherlands locate drug use and drug problems into the health
sector, while in the USA substance abuse and its problems are primarily
considered to be moral and societal evils and only secondarily as health
problems. Therefore in the USA the overall moral judgement of drug use is
much stronger and much more devastating than in most European regions.
And there exists also a major difference concerning the involvement of the
criminal law system into the control of substance abuse. While the official
way in the Netherlands tries to minimise the impact of criminal law, the
USA are relying very strongly on that tool.
4.4.2 Primary prevention as a component of drug
policies
These basic or background philosophies of drug policies curb and shape
also the ideas concerning the objectives, aims and strategies to be applied
to prevention issues.

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42
4.4.2.1 The situation in the USA
In the United States prevention efforts are defined as an element of the
"War On Drugs" and have to follow the basic assumptions and aims of this
particular approach. Therefore the ultimate objective of prevention is "to
dissuade people from ever trying drugs", the ultimate goal is "to enable
individuals to remain free from alcohol, tobacco and illicit drugs and also
from steroids over their entire lifetime" and the ultimate strategy is "to
co-ordinate prevention, treatment and law enforcement as part of a
comprehensive strategy."
This does not mean that intermediate aims are excluded. These
intermediate aims are defined as partial effects in the sense that the
receivers of the preventive message are not prevented from ever using
drugs, but that the programmes used may very well contribute towards a
person ultimately living a drug free life or at least decrease the likelihood
of the user becoming addicted and a burden to society.
According to the experts’ opinion in the USA these partial effects can be
obtained through the implementation of diverse strategies:
• by programmes that:
• lower school dropout rates,
• increase enrolment in post secondary education,
• increase employment rates,
• increase participation in drug free activities,
• decrease time spent with drug-using friends,
• develop various coping skills;
• by programmes which can delay the onset of first use of a drug.
These - according to the prevailing European attitude - seemingly
"realistic" intermediate aims are nevertheless understood as a kind of
compromising; the ultimate goal of prevention is lifelong abstinence as
said before.
In the US the following strategies are accepted as promising to reach the
defined ultimate or primary goal of lifelong abstinence from psychoactive
substances:
• school based programmes,
• media campaigns which propose "denormalisation" of use,

Evaluation Research in Regard to Primary Prevention of Drug Abuse
43
• monitoring of risk populations and of (mostly young) individuals at
risk,
• resistance training against social pressure to use drugs with strong
directions against drug use,
• drug free activities,
• early childhood programmes,
• strong community coalitions (between different social agents: church,
industry, schools, parents, etc.) against drug use,
• user accountability;
This last item is of special interest. In this approach the drug user is to be
blamed for all the evil effects his habit may bring to him, his family and to
society. In this attribution of guilt even the impact of the criminal drug
traffic is included.
These are the strategies or methods which are accepted in the official USA
literature as useful.
Some others are labelled as "non promising" or even "obsolete". They
include:
• the legalisation approach
• responsible use messages
• harm reduction approaches
• providing only information without strong directions against drug use
• scare technique
• self esteem exercises
• "magic bullets" (slogans, unstructured campaigns, unstructured
anti-propaganda, etc.)
• Peer group work also is criticised to have very limited effects.

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4.4.2.2 European attitudes
Let’s now have a look at some contrasting European views. For instance
on Bühringer’s very precisely formulated goals of drug education
(Bühringer, 1992).
GOALS OF DRUG EDUCATION
AREA 1 AREA 2
responsible use of psychoactive
substances high level of general
competence
to raise/strengthen the
awareness of social rules
concerning
to improve the ability to identify
stress factors and to cope with
consumption them
to renounce the use of certain to stren
g
then self-confidence
substances (illicit drugs, etc.) self-esteem
to renounce le
g
al dru
g
s use to im
p
rove the abilit
y
for
under certain conditions communication
(like gravidity, etc.)
to use the substances in a
moderate way and in accepted
situations
to improve the ability to be
aware of the function of drug
use: consumption only
no use as substitute for human
needs or to solve problems

Evaluation Research in Regard to Primary Prevention of Drug Abuse
45
Of interest for the actual level of our discourse are the drug specific goals
mentioned by Bühringer. One can see that Bühringer’s main objective or
goal is "responsible use" of psychoactive substances- exactly the message
which is classified obsolete in the US. Furthermore Bühringer accepts the
possibility of safe use and is strongly in favour of the harm reduction
approach in the case of licit substance use, where it is the explicit goal to
educate people to avoid the use of drugs in certain social situations and
psychic states, where use could be dangerous or addictive. There is also a
strong split between licit and illicit substances. One the one hand the
attitude concerning illicit drugs is prohibitive, on the other hand
concerning alcohol it is permissive with the message of responsible use.
The goals as formulated in area two are strongly following the theories of
the importance of the influence of risk factors and protective factors on
drug use and are also compatible with the goals of health education resp.
The "Health for All" concept of the WHO.
The differences between the ideological fundaments of prevention in
America and Europe are also responsible for differences in the single
components of the prevention systems. Let’s look for instance at one of the
major approaches in primary prevention, school based drug education.
In the United States the ideal school based programme consists of three
components. The first component is a comprehensive prevention
curriculum on all grade levels which includes:
• a clear message of No Use of illicit drugs, tobacco and alcohol
• an encouragement of civic responsibility and respect of the law
• the raising of the awareness of being healthy and drug free
• accurate information about drug effects
• teaching how to resist peer pressure to use drugs
But a school based programme should also include as second component a
strict drug free school policy and as third component the offering of drug
free activities for the students.
The aims of drug education as formulated by an excellent European expert
like de Haes (1990) sound similar if one looks at them superficially. In
reality they are very different.
While the American programmes are a mixture of directive information
about drugs, social influence and training in direct relation to the drug
problem and political education the interpretation of de Haes is highly per-

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sonality oriented and focuses only slightly on the drug issue. There is no
message of "No Use", there are no strong directions against drug use, only
the strengthening of already existing attitudes in relation to drugs. The
conclusions he draws are very similar to the ones articulated by Bühringer.
It is interesting that both, Bühringer and de Haes are giving their proposals
as a result of the analysis of mostly American literature. It seems that this
was possible, as both authors only focused on the programmes described
and missed to analyse the socio-cultural background and context of these
programmes and therefore also their strong relations to the "War on
Drugs"- approach.
It has to be pointed out that Bühringer’s and de Haes’s views are not
isolated ones, but rather representative of the state of the art of prevention
and of ideas about prevention which have been developed in the greater
part of Europe.
That conclusion is the outcome of the comparative research of many
European country reports about prevention and evaluation of prevention. It
therefore seems justified to draw a comparison between the American and
European prevention efforts and to classify them as separate systems,
which are corresponding in some aspects, but are highly different in many
very important aspects. The most important conclusion may be that we
cannot assume that personality strengthening methods in use in the USA
under the special conditions of the War on Drugs policies will have the
same or even a comparable effect on drug using behaviour when used in
Europe under highly different conditions of social control in a cultural
space where drug policies are more likely to accept a broader and very
complex set of attitudes concerning drug use.
4.4.3 Impact on evaluation issues
Drug education programmes in many European regions are aiming more at
personality development and personality change than on a direct influence
on drug using behaviour. These aims cannot easily be assessed. It is for
instance not possible to use a weak method like the use of consumption
surveys as outcome references.
De Haes (1990) correctly stated that generally the assessment of the effect
of personality strengthening approaches is even more difficult than the
impact of drug specific strategies because of the aims stated. Measurement
instruments have to be developed that relate to the personality dimensions
one wishes to influence. Existing psychometric scales tend to be not

Evaluation Research in Regard to Primary Prevention of Drug Abuse
47
appropriately specific. Very often instruments related to the dimensions
one wants to influence will not be available. Constructing such a
psychometric scale takes a number of years if one wants to ascertain the
reliability and validity of the measurements made. This effort is most often
not made, thus the measured effects remain doubtful. Are any pseudo
effects shown, or are the existing effects not revealed?
That means that we have to rely on theories or even assumptions
concerning the causes of drug taking and addiction and their proper use
and implementation in prevention efforts. But are the theories proven
enough and can we trust the theory-based designs of such efforts
concerning their outcome efficacy, so that we are able to do without
outcome evaluation at all?
In the realm of behaviour change in general and drug education or primary
prevention of drug abuse things seem really difficult.
We have to be aware that we neither have really confirmed and sound
information in respect to the nature of the problem of drug taking and
addiction at our disposal nor do we have sufficient evidence concerning
effective drug education strategies. At the given state of the art a
programme which eventually proves highly adequate if we use the
approach of process evaluation can easily be without any impact on the
behaviour of the treatment group.
Some authors certainly think that we are in a miserable position. Take for
instance the critical view of Nicholas Dorn (1990) that could be labelled
"British scepticism": He stated:
"Drug education internationally has been more concerned with presenting
or implying particular images of drug users, than with realistic appraisals
of practical possibilities. Therefore:
1. The ’Just Say No - Approach’ just doesn’t work. It is based on the
unrealistic assumption that people experiment with drugs because they
are argued into doing so and lack the skill to act independently.
2. The ’Person-Focused Approach’ doesn’t work either. It is based on the
equally false assumption that people experiment with drugs because
they lack self-esteem or decision making abilities."

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48
Dorn might be right. We have to take this position into account and should
be very cautious indeed to embrace the now dominant interpretations of the
psycho-social background of drug use and of addiction channelled into the
construction of particular images of drug users. We should be equally
cautious of the message that if we accept these constructions we can do
without outcome evaluation, as some people embrace the promises given
and the hopes awakened by a new drug.
At the time given and keeping the eye on the development of some
addiction prevention ideologies it is definitely necessary to come to
conclusions concerning the relevance of theories about drug consumption
problems for prevention programmes and their evaluation and concerning
minimal standards of such programmes. If we don’t do so, we leave the
field to a blind pragmatism and to wild speculations becoming reality in a
vicious circle of self fulfilling prophecies.

Evaluation Research in Regard to Primary Prevention of Drug Abuse
49
5 Appendix - three examples of original country reports as
illustration
5.1 Report of Poland
A General data on projects
A1 Project title:
Sunrise
A2 Key-persons / key-institutions:
Regina Kostrzewa, Zentralstelle für Suchtvorbeugung,
Kiel
A3 What state is the project currently in?
• already finished? ……..............................................-
• ongoing? ...................................................................x
• in a planning stage?..................................................-
• I don’t know and couldn’t find out?.........................-
A4 Have there been any publications, official presentations or grey
literature yet regarding the project?
• yes  no : ? 
ready in two month
• If yes, please give a full citation of all related papers or articles and
if
• possible, please include a photocopy of the article or articles.
• If the material is not published in an international journal, please
give the name and address of at least one author:
B Data relating to the primary prevention programme
B1 Abstract goals concerning illicit drugs, such as
• less consumption ......................................................x
• later onset of consumption ......................................x
• safer use ...................................................................-
• harm reduction in terms of health problems ............-
• harm reduction in terms of social problems ............-
• harm reduction in terms of public disorder..............-
• harm reduction in terms of immoral conduct...........-
• no goals specified explicitly.....................................-
• etc..............................................................................-
describe in detail: .................................................................................

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B2 Details on programme structure, such as
• Is there a written concept - yes
• How many sessions were planned - unknown
• Who is carrying out the programme
Zentralstelle für Suchtvorbeugung
• How is the staff trained to do the job
Train the trainer programme and preliminary
discussion
• How much time is used for staff training - depends on the
staff
• etc.
describe in detail: ...........................................................................................
B3 Type of programme in terms of
• target population (e.g. school based, community based, mass media
campaign, training of educators, teachers, physicians, policemen,
parents etc., change of law or policy etc.) and
• size of target population (e.g. nation wide media campaign, one
school including 12 classes, etc.).
describe in detail:
in schools for pupils between 16-17 years
B4 Techniques used, such as
• general health education...........................................-
• changing lifestyles....................................................x
• changing attitudes.....................................................x
• social skills training..................................................x
• deterrent information................................................-
• factual information ...................................................-
• offer of alternatives to drug taking...........................x
• clubbing ....................................................................-
• modification of drug laws (e.g. decriminalisation of mere
consumers, compulsory treatment of addicts, more severe legal
sanctions for consumers etc.) ...................................-
• modification of drug policy (e.g. offer of syringe exchange,
offering low level intervention, etc.)........................-
• change of police strategy (e.g. tolerate scene, focus on large scale
dealers, etc.)..............................................................-
• change of treatment policy (e.g. making methadone maintenance
available)...................................................................-
• etc..............................................................................-
describe in detail: ...................................................................................

Evaluation Research in Regard to Primary Prevention of Drug Abuse
51
B5 Drugs mentioned in programme, such as
• no drugs mentioned at all .............................................................x
• only illicit drugs mentioned..........................................................-
• only medical drugs mentioned...................................................... -
• both legal and illicit drugs mentioned.......................................... -
• only specific drugs mentioned (e.g. cannabis, heroin, cocaine)..-
• etc.................................................................................................. -
describe in detail: ...................................................................................
C Data relating to evaluation
C1 What targets were/will be evaluated?
• operational objectives (internal targets), like "Did the information
reach the target population?"; "Was the programme concept carried
out as planned?", etc.
• intermediate targets (surrogate targets) associated to the final
goals but not primary goals by themselves, like e.g. attitude change,
increased self-esteem, higher information level, etc.
• ultimate targets (primary targets) like e.g. less drug consumption,
later onset of drug consumption, harm reduction, less problematic
use, etc.
describe in detail: ...................................................................................
C2 How was the study sample defined?
describe in detail: after every project
C3 Sample size and drop-out rate?
describe in detail: ...................................................................................
C4 How often were data collected and at what time schedule?
describe in detail: ...................................................................................
C5 How were the data collected, resp. what data were used?
• surveys /population surveys .....................................-
• telephone interview ..................................................-
• face-to-face interview...............................................-
• questionnaire presented by investigator...................x
• mailed out questionnaire...........................................-
• public statistical data ................................................-
• police records............................................................-
• treatment records ......................................................-
• other..........................................................................-
describe in detail: ...................................................................................

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C6 Was the programme successful and if yes, in which dimension(s)?
describe in detail:
yes, but not enough participation
C7 Were there specific problems worth explicitly mentioning?
describe in detail:
problems in organisation
D Global part
D1 Personal summary on the different projects mentioned
Please give a generalising overview out of your personal impressions over
the state of evaluation on primary prevention research regarding illicit
drugs in your country.
D2 Conclusions: What conclusions do you personally draw out of the
present state of evaluation in your country and how do you feel
about prevention and evaluation of prevention in this field
generally
• Which prevention concepts do you think are promising and which
concepts are worthless?
• How do you define the limitations of evaluation in this field?
• etc.
D3 Is there anything like an official national prevention
concept in your country?
If yes,
• what is the concept like?
• is it available as a written document?
• is there a gap to implementation?
• are there any relevant groups openly in opposition to the concept
and who are they?
D4 Please indicate names and addresses of other researchers and
institutions in your country that are active in the field of
prevention evaluation?

Evaluation Research in Regard to Primary Prevention of Drug Abuse
53
5.2 Report of Greece
A General data on project
A1 Project title:
Education for Health preventing dependence and addiction:
Experience of a H.E. pilot project aiming at preventing drug abuse in a
community oriented approach applied in a suburb of Athens (Greece)
A2 Key-persons / key-institutions
A. Kokkevi, A. Mostriou, E. Lentaki, C. Stefanis
Department of Psychiatry Athens University Medical School
A3 State of the project
Already finished
A4 Publications
See Annex 1
B Data relating to the primary prevention programme
B1 Abstract goals concerning illicit drugs:
The aim of the so called "Education for health preventing dependence and
addiction" programme is to enhance in the long term, both the individual’s
own understanding and problem-solving capacities in relation to his health,
and the social and cultural environment of the community in which the
individual lives. Drug abuse is not considered as a specific and isolated
subject: by focusing upon the whole person, the programme is directed
towards those problems associated to drug use.
B5 Drugs mentioned in programme:
Both legal and illegal

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C Data relating to evaluation:
The evaluation procedure performed two main functions:
• Formative evaluation aimed at testing the feasibility of the project
through the assessment of its development and acceptance by the school
and the community.
• Summative evaluation, aimed at collecting information for assessment
of the outcome of the H.E. programme.
Pupils, parents, teachers and the authorities were involved in the
assessment of the project.
C1 How was the study sample defined:
Pupils, who followed the programme for 3 years, parents, teachers
involved in the programme as well as pupils of a control school for the
outcome evaluation
Sample size: No Drop out rate
Pupils of target school: 151 / 142 9%
Pupils of control school: 126 / 96 8%
No of teachers involved: 31 / 25 8%
Parents interviewed 379 14%
Parents answering questionnaire 372 10%
C2 How often were data collected and at what time schedule?
Before, during (every year) and after implementation of the
programme
C3 Methods and techniques of the evaluation:
In order to attain the aims mentioned above, monitoring techniques (close
documentation of the events and experiences of the project) and social
research techniques (surveys on the needs of pupils, teachers and the
community) were used leading to critical reflection upon the results by the
project team.
The tools used for the process and outcome evaluation were:

Evaluation Research in Regard to Primary Prevention of Drug Abuse
55
• Questionnaires filled in by pupils of the target school as well as by
pupils of a control school investigating health needs, behaviour linked
with health risks, attitudes, values and beliefs towards health.
• Interviews given by parents and questionnaires filled in by them
providing us with social and health indicators on the families involved
in the project as well as on their beliefs, attitudes and life style as
regards to health.
• Questionnaires filled in by teachers concerning their health habits and
knowledge, their educational methods, their attitude towards H.E. and
its implementation in the school curriculum. All questionnaires were
filled in before and after the implementation of the programme.
• Records kept by teachers through out the 3 year period on the
experience they had with H.E. in the classroom.
• Records kept by the school co-ordinator and community co-ordinator on
activities related to the project.
C4 Results of the programme:
After the three year application of the programme, outcome evaluation
results were based on the following data:
a) Participation
-Teachers’ involvement:
In Hymettus, 50% of the teaching staff implemented the programme on a
voluntary basis during the first year. The number of teachers involved in
the programme decreased every year: persuading teachers to collaborate in
an innovating programme is a difficult task, but keeping them motivated
while carrying out the whole project is a much more demanding situation.
- Pupils’ involvement:
The interest shown by the pupils during the implementation of the
programme was almost unanimous as quoted by the teachers. Half of the
pupils were also involved in the extra curricular activities although most of
them took place during their leisure time. Pupils acceptance and active
involvement in the programme was a major incentive for teachers to apply
it.
-Community involvement:
Although parents did not have a participation in community activities
through the years of the project implementation, however, most parents

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were aware of the subjects presented in school during the H.E. sessions
and had discussed about them with their children.
b) Reactions to the programme:
− At the end of three year application of the pilot project, most teachers
accepted that the programme had a positive impact on themselves, their
pupils and their own family.
They agreed that the programme should be inserted officially in the general
curriculum of the school.
− Pupils' response was very positive and was considered as a major
incentive for the teachers’ to continue applying the programme in spite
of the difficulties encountered.
− Parents’ commitment:
Answers given by parents to an anonymous questionnaire during the
final stage of the programme show that they seemed more optimistic
than during the initial stages of the programme regarding the influence
they can have on their children in order to avoid the use of drugs. Some
of them even declared having tried to reduce smoking and drinking and
unanimously, they asked for the programme to carry on.
c) Knowledge, attitude and behavioural changes:
Knowledge, attitude and behavioural changes were measured through
answers given by the pupils themselves, before and after the
implementation of the programme in the target school as compared to
answers given by pupils in a control school. The outcome evaluation
showed the following:

Evaluation Research in Regard to Primary Prevention of Drug Abuse
57
Knowledge and attitude changes:
− More boys of the target school as compared to the control school admit
the dangers of smoking, alcohol abuse and use of illegal drugs, while
more girls in the target school admit the dangers of alcohol abuse and
use of legal drugs (medicines).
− Boys and girls of the target school show more reservation when talking
about the probability for them to smoke, use alcohol or illegal drugs in
the future.
Behavioural changes:
- Smoking and alcohol use by boys:
- Smoking and alcohol use by boys increased during the 3 years of
the implementation of the programme in both the target and the
control school.
This finding was to be expected since pupils were three years older
when the outcome evaluation took place. We note however that
more boys in the target school agree to try and quit smoking as
compared to the control school.
- Abuse of alcohol increased in the control school while it decreased
in the target school
- Four times as many pupils in the control school as compared to the
target school report having got drunk at least once in a lifetime
- Smoking and alcohol use by girls:
- Increase in smoking is observed only in the control school
- Occasional alcohol use increased more in the control than in the
target school
- Five times as many girls report having got drunk in the control
school as compared to the target school at least once in a lifetime
- Use of legal and illegal drugs.

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- Use of legal and illegal drugs:
The actual number of pupils using legal drugs without prescription, for
other reasons than medical ones, as well as pupils having tried or used
more than once illegal drugs, was very small in both schools. However the
increase of illegal drug use by boys as well as the increase of both legal
and illegal drugs by girls is bigger in the control than in the target school.
Process and outcome evaluation of the pilot project in Hymettus lead us to
the following general conclusions: Managing the development of the
project in Hymettus, involving teachers, parents authorities and political
key persons, gaining the approval and active involvement of the pupils and
assessing the impact of the programme on them, made it possible to
propose the expansion of the programme to a larger number of schools.
C5 Specific problems in the project
Constraints encountered during the implementation of the programme were
the following:
1. Curriculum development of drug misuse prevention:
- Finding teachers who would implement the programme on a voluntary
basis
- Assisting teachers in their health education role
- Keeping teachers motivated
- Providing appropriate educational material for teachers and pupils
2. Linking school and community H.E. was a challenge to face. There were
definite difficulties in:
- raising awareness of the community that Health prevention relies upon
assuming responsibility for one’s own health
- strengthening co-operation and contacts between school and community
- actively involving pupils and teachers in the health promotion activities
taking place in the community
- getting parents and the local community involved

Evaluation Research in Regard to Primary Prevention of Drug Abuse
59
3. Administrative and legislative provisions:
In order to deal with bureaucratic difficulties encountered while planning
implementing the programme, administrative and legislative provisions
had to be taken. These were possible only through systematic contacts with
key persons in order to:
- prove to politicians, authorities, the media and through them to broader
community that PRIMARY PREVENTION is at least as important as
THERAPY in resolving the addiction problem of young people and
certainly that is worth investing in.
- convince key persons that primary prevention is based on education. It is
TEACHERS in the schools themselves who deal with health education
(H.E.) must be developed within the context of the school curriculum
- increase the awareness of administrators and organisations of the need
for long term commitment to innovations that are planned for several
years in order to ensure programme continuity
- adapt legislation to support H.E. and more specifically drug misuse
prevention
D Global part
In Greece, it is only recently that professionals involved in Public Health
acknowledged the fact that health education (H.E.) should be seen in the
broad sense of health promotion - its main objective being to help
individuals acquire the appropriate knowledge and the motivation to adopt
and maintain healthy patterns of behaviour in their lifestyles. Up to this
day however, the approach of most prevention programmes is mainly
informative.
In order to implement health promotion programmes in schools initiatives
have been taken by the Department of Psychiatry of Athens Medical
School. These are mainly epidemiological research picturing the drug
situation in Greece, school surveys and pilot projects for the
implementation of health promotion programmes in schools.
An increasing number of communities in Greece started to implement drug
prevention programmes - including school health education - supported by
their respective Municipalities. Funds are however usually limited and
programme continuity is often not ensured.

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5.3 Report of France
A PROJET: CREDIT1
B DONNEES GENERALES CONCERNANT LE PROJET
B1 TITRE:
Programme d’Education pour la Santé et Prévention des Toxicomanies et
du SIDA dans les Alpes-Maritimes: 1989-1990
B2 PERSONNES/INSTITUTIONS DE REFERENCE
P. J. SIMON
Comité Départemental d’Education pour La Santé, Alpes-Maritimes
(CODES)
Centre de Recherche de Documentation et d’Information en Toxicomanie
(CREDIT)
10, avenue Malausséna - 06000 Nice
B3 ETAT ACTUEL DU PROJET:
terminé :en cours  en préparation 
B4 PUBLICATIONS:
oui : non 
Programme d’Education pour la Santé et Prévention des Toxicomanies et
du SIDA dans les Alpes-Maritimes: 1989-1990.
Rapport d’évaluation, juin 1991
C DONNEES RELATIVES AU PROGRAMME DE PREVENTION
PRIMAIRE
C1 RESUME DES OBJECTIFS CONCERNANT LES DROGUES
ILLICITES
Action globale d’éducation pour la santé, donc par définition non
spécifique "toxicomanies".
Un des objectifs était de permettre aux jeunes d’évoluer quant à leurs
REPRESENTATIONS et CONNAISSANCES (santé, toxicomanie, SIDA).
Ceci en facilitant le dialogue et en développant la participation des jeunes
et des personnels des établissements scolaires.
C2 STRUCTURE DU PROGRAMME

Evaluation Research in Regard to Primary Prevention of Drug Abuse
61
Le concept général annoncé: Education pour la santé, approche
GLOBALE, PARTICIPATIVE et INTEGREE.
Action expérimentée dans 6 établissements scolaires. Dans chaque
établissement des personnes ont été "choisies" et formées (6 mois).
Programme de formation non décrit. Une session de 2 jours centrée sur la
communication est signalée. L’action faisait partie du projet
d’établissement et s’est déroulée sur une année scolaire: septembre 89 -
juin 90, avec différentes formes d’interventions et de productions (vidéo,
peinture, dessins, textes, chansons, journaux, ...)
C3 TYPE DE PROGRAMME EN TERMES DE
* population cible (qualité)
Six établissements scolaire avec une classe par établissement. La
répartition devait être aléatoire. En fait choix plutôt délibéré et désignation
de classes jugées comme plutôt difficiles.
* population cible (taille)
126 élèves de 13 à 16 ans.
B4 TECHNIQUES UTILISEES:
EDUCATION POUR LA SANTE: Le principe général de la méthode
pédagogique adoptée est décrit comme suit: "Eviter le discours moral,
mieux comprendre les croyances et les représentations des jeunes, mieux
communiquer".
Techniques utilisées et formes d’intervention ont varié selon les
établissements, comme indiqué plus haut.
B5 DROGUES MENTIONNEES DANS LE PROGRAMME
Aucune d’une façon spécifique. L’évaluation aborde la perception des
"DROGUES DURES", du CANNABIS, TABAC et ALCOOL.
C DONNEES RELATIVES A L’EVALUATION
C1 INDICATEURS (CIBLES) EVALUES OU A EVALUER:
Objectifs opérationnels: déroulement du programme.
Objectifs intermédiaires: Perception de la santé et des risques.
Evolution des attitudes, opinions et comportements.
Système relationnel (groupe d’amis, famille).
C2 DEFINITION ET CHOIX DE L’ECHANTILLON:

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Groupe expérimental: les élèves des 6 classes concernées.
Groupe témoin: élèves n’ayant pas participé dans des établissements
scolaires différents.
Le choix devait être aléatoire, or il a été possible de constater une
différence entre les 2 groupes au départ. Les classes du groupe
expérimental ont en fait été désignées car jugées "en difficulté".
C3 TAILLE DE L’ECHANTILLON ET TAUX DE CAS PERDUS
219 élèves répartis en 2 groupes, expérimental (n=126) et témoin (n=93).
Aucune indication sur la mortalité expérimentale, qui semble toutefois
assez réduite.
C4 PLAN D’OBSERVATION
Observation (questionnaire) avant (début de l’année scolaires) puis après
(fin de l’année) avec deux groupes expérimental et témoin.
C5 MODALITES DE RECUEIL DE DONNEES ET DONNEES
UTILISEES
Questionnaire abordant l’ensemble des paramètres évoquées. Analyse
qualitative et quantitative des réponses.
C6 RESULTATS POSITIFS ET DIMENSIONS CONCERNEES
Le processus s’est déroulé conformément aux objectifs, notamment en
matière du travail interpartenarial et participatif souhaité. Au niveau de
l’impact du programme: amélioration du climat relationnel. Meilleure
maturation des projets professionnels des élèves. Impact positif sur certains
indicateurs du mal-être telle que l’anxiété. Amélioration des connaissances
et aussi correction de certaines idées fausses, notamment
à propos du SIDA.
C7 PROBLEMES SPECIFIQUES QUI MERITENT D’ETRE
RELEVES:
Biais lié à la sélection du groupe expérimental.

Evaluation Research in Regard to Primary Prevention of Drug Abuse
63
6 References
Buisman, W. R.: Drug Prevention in the Netherlands. Hilversum, 1994
Bühringer. G.: Drogenabhängig. Wie wir Mißbrauch verhindern und den
Abhängigen helfen können. Freiburg: Herder, 1992
Centre National de Documentation sur les Toxicomanies (Ed.): Jalons pour
des actions de prévention. Guide critique des outils de
prévention des toxicomanies. Lyon, 1994
Dorn, N.: British Policy on Prevention. In: Ghodse et al. (Ed.), 1990; op.
cit.
Engelsman, E. L.: Dutch policy; on the management of drug-related
problems. In: Ghodse et al. (Ed.), 1990; op. cit.
Ghodse, H. A.; Kaplan, C. D.; Mann, R. D. (Ed.): Drug Misuse and
Dependence. Casterton Hall, Carnforth: Pantheon, 1990
de Haes, W. F. M.: Problems of Evaluation. In: Ghodse et al. (Ed.), 1990;
op. cit.
Kunz, G.: Primärprävention an Schulen als Beitrag zur Suchtprophylaxe.
Diplomarbeit. Wien, Juni 1995
Künzel-Böhmer, J.; Bühringer, G.; Janik-Konecny, T.: Expertise zur
Primärprävention des Substanzmißbrauchs. IFT-Bericht Bd. 60.
München, 1991
PEDDRO: International Annotated Bibliography on the Prevention of
Drug Abuse Through Education. UNESCO, 1994
Smart, R. G.; Fejer, D.: Drug Education: Current Issues, Future Directions.
ARF Books No.3; Toronto, 1974
The Drug Policy in the Netherlands. December 1992 version. Ministry of
Welfare, Health and Cultural Affairs and Ministry of Justice. The
Netherlands, 1992
Understanding Drug Prevention. An Office of National Drug Control
Policy White Paper, Washington DC, May 1992
Zaccagnini, J. L.; Colom, R.; Santacreu, J. (Ed.): Catalog de programas de
prevencion de la drogadiccion. Valencia: Promolibro, 1993

Country Reports
64
contact address:
Alfred Springer
LBISucht, Vienna, Austria
Tel: +43-1-8882533-112
FAX: +43-1-8882533-77
e-mail: alfred.springer@api.or.at

Evaluation Research in Regard to Primary Prevention of Drug Abuse
65
Building Expertise in Life Skills
Programme Adaptation and Evaluation:
The Experience of "Leefsleutels"
Annick Vandendriessche
Programme Director of "Leefsleutels", Flanders, Belgium
___________________________________
Paper Presented at the
COST-A6-WG2 Workshop
"Socio-Cultural Aspects of Primary Prevention of
Drug Abuse and its Evaluation"
December 13th and 14th 1996 in Vienna

The Experience of "Leefsleutels"
66
Contents
1 History...................................................................................................... 67
2 From adaptation to development............................................................. 67
3 Goals and instruments.............................................................................. 68
4 Some changes in "Life Skills for Youngster" .........................................68
5 Levels of difference................................................................................. 69
6 Evaluation................................................................................................ 70
6.1 Limitations to the effect study.......................................................... 71
6.2 Results............................................................................................... 71
6.2.1 Formative study........................................................................... 71
6.2.2 Process study............................................................................... 72
6.2.3 Effect study.................................................................................. 72
7 Actions for "Life Skills for Youngster" .................................................. 73
8 Influence on the programme development of "Life Skills in Action".... 74
8.1 Training............................................................................................. 74
8.2 Books ................................................................................................ 74
9 Practitioners towards evaluators..............................................................74
10 Development process.............................................................................75
10.1 Basis................................................................................................ 75
10.2 Working group/pilot group............................................................. 75
10.3 Sources of feedback........................................................................ 75
11 Conclusion............................................................................................. 76

Evaluation Research in Regard to Primary Prevention of Drug Abuse
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1 History
In 1990 "Leefsleutels" ("Life Skills1") in Flanders started with the pro-
gramme "Life Skills for Youngster" ("Leefsleutels voor Jongeren") an ad-
aptation of the American drug prevention programme "Skills for Adoles-
cence" developed by Quest International. This programme is used with
12-14-year-olds in Flanders while the age range in the US is wider
(10-14-year-olds). In 1990 the programme was already in use in several
European countries. We started our adaptation from the Swiss version.
In 1994, after four years of experience with "Life Skills for Youngster"
("Leefsleutels voor Jongeren"), we started to adapt another programme -
the "Skills for Action" programme - suited for 15-18-year-olds. This
adaptation "Life Skills in Action" ("Leefsleutels in Actie") deviated even
more from the original programme than "Life Skills for Youngster".
Since then, we have developed from scratch and still are developing
various new initiatives, oriented to specific risk groups or certain specific
issues: e.g. a programme for youth in institutions, a programme for youth
workers, a programme for youngsters in special education, a special
module on alcohol, drugs and traffic, implementation workshop, etc.
2 From adaptation to development
To sum it up, we moved from programme adaptation to real programme
development. One of the resources allowing us to develop new
programmes was an external evaluation study carried out between 1991
and 1994. Another resource was the network we developed including
approximately 10000 trained persons in Belgium, of whom a large group
has worked with the "Leefsleutels" programmes from one through six
years by now. Around 40% of the first graders in secondary school are
confronted with "Life Skills for Youngster" at school. Among their
teachers we find a large group of skilled and motivated people to supply us
with feedback. The last resource is our trainers who acquired a huge
experience in working with the target groups.
1 The word "Leefsleutels" translates into "Life Skills". The literal translation for "Leefsleutels" is
"Life Keys".

The Experience of "Leefsleutels"
68
3 Goals and instruments
Our programmes have a number of common goals. "Leefsleutels" does
drug prevention by
• training youngsters "life skills", like "listening", "expressing feelings",
"decision making", "saying yes", "saying no", "risk taking",
"goal-setting", etc.
• promoting positive relations at home, in school and in the community
• reinforcing of personal and social responsibility
This is done based on three approaches:
• The first approach is books that we edit and distribute; thus creating
resources for pupils, parents and teachers.
• The second approach is training of teachers and educators. Three or four
days of workshops, where the participants experience a group process,
learn from each other, sit on pupils chairs and prepare and try out some
try-out lessons for their colleagues.
• The third approach is networking. We try to keep teachers together and
reinforce their skills using a magazine, follow-up days, regional
meetings, thematic meetings and regional co-ordinators ready to assist
the schools.
The programme for the 12-14-year olds contains 70 lessons, to be spread
over 2 years. The programme for the 15-18-year olds contains 50 lessons
to be spread over 2 to 4 years.
Goals in "Life Skills for Youngster" are "group building",
"self-confidence", "listening skills", "dealing with feelings and emotions",
"friends", "peer pressure and conflicts", "home", "critical decision
making", "drugs" and "planning ahead".
4 Some changes in "Life Skills for Youngster"
When in 1990 a group of 28 pioneers (teachers, drug prevention workers)
followed the first Leefsleutels workshop, they agreed that there was a good
base here for doing drug prevention in schools, but that this material was
too American and needed to be adapted.
About ten of them participated actively in the adaptation process.

Evaluation Research in Regard to Primary Prevention of Drug Abuse
69
Some of the changes we made are:
• We dropped the if-then notion. In the American version statements, like
‘If you do this game, teacher, you will have such a process in the class”,
"If you follow these steps, pupil, you will get those results”, etc. are
used too often.
• We added several lessons about negative feelings and issues. E.g. about
a friend who leaves you, about a friend hurting you, about you hurting a
friend, about frustration, about things you fail in, etc. How to cope with
the fact that you won’t reach certain goals, you have set for yourself, e.g.
because of socio-economic factors.
• We changed the lessons on drugs. "Just Say No”, doesn’t work in
Europe. We want youngsters to learn to make their own choices,
knowing all factors.
• Another difference is the issue of complexity. We actually recognised
this as a value in our versions. For some lessons it is an objective to
make the pupils doubt. Sometimes we must authentically communicate
to the pupils that what he thought to be true might not be true, without
imperatively giving another answer.
• Finally, we don’t only train teachers to "go ahead with the material”. We
give them follow-up support. So that, back in the day-to-day reality after
a workshop, they still have access to support. This is more complicated,
but important to guarantee a long-term implementation.
5 Levels of difference
If you look at these examples, you see that the changes go far beyond
simple translation. If you take a foreign programme, you can work on
different levels.
Translation. You can simply translate and reformulate it.
Cultural adaptation. You can use other examples and situations, other
stories and illustrations. You can talk about football instead of rugby etc.
This is quite simple.
Deeper adaptation.
• The examples given in the paragraph Changes in "Life Skills for
Youngster", have more to do with a deeper level of adaptation. Here we
recognise the different starting situation of Flemish compared with
American teachers. Flemish teachers received a less interaction-oriented

The Experience of "Leefsleutels"
70
training. Furthermore, in many schools there still is a strong accent on
acquiring knowledge as such.
• The concept of a friend, a comrade, a girlfriend is different.
• On the occasion when American trainers came over to run a pilot
workshop, we could see and they recognised that they were not so used
to dealing with a critical audience.
Programme development. The last level is programme development, which
we started in the context of "Life Skills in Action", the programme for
15-18-year-old. From there on, we moved further to programme
development from scratch (e.g. programme for youth in institutions).
Recent literature concerning the subject, other framework, other activities,
taking into account the typical situation of teachers, schools, pupils and
health educators were taken into consideration. In this programme, only a
small percentage of the original material is kept. We discussed with the
original programme makers to understand why they chose their way of
working.
• E.g. they decided for a less interactive programme, because they
followed their teachers. And teachers in high school are less trained to
interactive teaching than teachers for 10-14-year-old. We consciously
chose to keep a very interactive approach, since our teachers for the
younger age group don’t get much training in interactive teaching either
and the interactive approach did work with them. In this regard we
didn’t want to follow the original version. Furthermore, interaction is
very important when prevention is concerned.
6 Evaluation
It was in the adaptation process of "Life Skills for Youngster" that the
question for evaluation arose:
• To further develop and improve the programme.
• To know how the programme was implemented (if we programme
makers survey the results ourselves, that could falsify the results,
especially because at that time the programme was offered free of
charge).
• We needed credibility and were seeking authority as a social profit,
private organisation, in a sector dominated by public funded
organisations.

Evaluation Research in Regard to Primary Prevention of Drug Abuse
71
The evaluation was done by the University of Gent for Flanders
(Laboratorium voor Interactionele Psychologie) and by the University of
Liège in the French speaking Community of Belgium
(Centre d’Enseignement et de Recherche en Education pour la Santé).
It became a three-step study:
• A formative phase. What kind of programme is this? Which theory does
it base itself on?
• In a second step we evaluated the process. How are the teachers, the
schools applying this programme?
• Parallel to this an effect study was carried out. How does the programme
affect the pupils?
6.1 Limitations to the effect study
Teachers didn’t have much experience with the programme. Our first
workshops were in September 1990. The effect study occurred between
November 1993 and June 1994. Thus, most of the teachers involved had
only had one year of experience with the programme. The pre-test was
done quite late. The school year starts in September. The pupils already
had worked with the programme for two months by the time the pre-test
was administered. The post-test was too early, considering that 75% of the
users had applied the programme spread over two school years. The
questions were sometimes formulated in a language too difficult for the
students. Important groups were excluded from the study sample (pupils
from special schools). Finally, it is difficult to find good measurement
instruments for small changes in quite small populations.
6.2 Results
6.2.1 Formative study
The programme was reported to be in line with recent literature on drug
prevention. The programme is operationalising a lot of wide-spread,
theoretical concepts. The adaptation process was described as thorough.
We received some concrete suggestions on how to reformulate goals and
objectives, so that they could actually be achieved. E.g. "pupils will learn
to listen better" is too vague.

The Experience of "Leefsleutels"
72
6.2.2 Process study
The process study gave us very interesting information about the
application of the programme.
• application: 67% of the teachers in the study used it one hour a week.
During the year of the study, they went through two to four chapters.
Only 35% of the teachers really followed the order of the lessons. There
is a clear tail-effect in the application: the last lessons of each chapter
are used less, and the last chapters are also used less. E.g. "Life Skills
for Youngster" contains seven chapters. From the 33 classes observed,
26 worked with chapter one. Only five worked with chapter six.
• Teachers feel insufficiently informed about certain areas, like
developmental psychology, personal and social skills, the advantages
and disadvantages of drug use. They feel confident with active methods
like talking in a circle, group work, but not so confident with more
demanding active methods like role-play, brainstorming and energisers.
• Internal support is expected and needed. It is expected mostly from
pupils and the director, and in a lesser extent from social workers and
colleagues. The director supports the programme less after the start of
the implementation. Very positive methods are work with parents,
exchanges with other schools and additional groups of trained persons in
their own school.
• External support occurs through follow-up-days. But only 50% of the
trained teachers actually used this opportunity. An other way to get
support is through following other forms of trainings. 73% of the trained
teachers followed other trainings, linked to the subject of "Leefsleutels".
6.2.3 Effect study
The effect study gave the following results:
• an increase in self-confidence of pupils
• a positive effect on class climate
• improvements in aspects like feeling lonely, difficulty of making friends
were lower in classes with "Leefsleutels"
• an improvement of skills to express themselves (especially talking about
problems, with parents and friends)
• an increase of well-being of pupils in the class

Evaluation Research in Regard to Primary Prevention of Drug Abuse
73
The effect study doesn’t show a change in drug consumption, but it is
clearly in line with the goals of the first chapters of the programme "Life
Skills for Youngster". It is only these chapters that have been taught to
many classes in quite a complete way in the time frame of the study.
7 Actions for "Life Skills for Youngster"
Some actions were undertaken as a consequence of the evaluation for "Life
Skills for Youngster"
• Dissemination of results: we organised study days and articles were
written in different educational magazines concerning the issue.
• Attention to the theoretical background of the programme was
reinforced; e.g. on training, the trainers explicitly make the link between
the theoretical model and the activities the workshop participants have
had. In the second adaptation of "Life Skills for Youngster", a lot of
attention went to this aspect and how we can stimulate it to be read more
often.
• A specific part on the development of adolescent was written
• In the methodology and in our magazine, a more detailed explanation
was given about the short versions you can apply if you have less time,
with a clear explanation about goal and time frame
• a follow-up day on implementation of the programme was developed, to
help teachers and school directors with their implementation problems
• a day for directors was developed. Even though we encourage directors
to come to our workshop, they can’t always find the time. On such a
day, they get an overview of the programmes, and the trainer goes into
depth with them on their role in the programme.
• We have other workshops under development that deal with what the
teachers expressed as a lack. E.g. other active methods, teamwork at
school.
• We have appointed a co-ordinator per province to assist schools in the
implementation process.

The Experience of "Leefsleutels"
74
8 Influence on the programme development of "Life Skills in
Action"
8.1 Training
The American programme puts forward a three day workshop. The effect
hereof is a one-shot motivation of teachers, but this doesn’t secure the
implementation. Coming back to real classroom situations, a teacher might
feel: "it’s not like at the workshop, so I can’t do much with this." In the
European versions of the adolescence programme we already set up
structured follow up days and a networking system. We do this again for
"Life Skills in Action". And give particular attention to a number of
aspects, since we have teachers without much teachers training
More attention to demonstration lessons and animation techniques is
given, as well as clear processing moments and using different processing
methods. Furthermore, if we look at the evaluation study, teachers
obviously have problems to plan their lessons realistically and adequately
for their pupils groups. That’s why this is explicitly practised in the
follow-up days.
8.2 Books
Tools for personal planning and evaluation of the teachers’ work are
included. These help along with the attention to this element at the
workshop. Each lesson also has a slightly different structure than in the
other programme, with a section specifically providing animation tips for
each lesson. After each exercise, possible processing questions are put.
9 Practitioners towards evaluators
From our experience as practitioners, we would like to share some ideas
with you.
• Be aware of which evaluation you demand when. Try to have a very
open discussion with the evaluator about what is possible at the stage of
the programme you are in. E.g. for an effect evaluation, the group was
quite limited, the time frame short and the experience of teachers with
the programme was small. Is it then most adequate to have such a study?
• Be aware of the different goals the different parties have. Negotiate a
clear contract. As a practitioner, finding elements to improve your
programme is very important. A university has most interest in

Evaluation Research in Regard to Primary Prevention of Drug Abuse
75
producing articles it can publish, and the sponsor wants to know if it’s
worth investing in this project. Thus, a common evaluation project has
to be drawn, where certain expectations will be fulfilled and others
maybe not. If this is not clearly negotiated, it creates problems later.
• Objectivity doesn’t mean no interaction during the study. Participants to
the study found questions too difficult. This could have been avoided if
we, as practitioners, had been through the questions beforehand.
10 Development process
Finally, I am providing you with some key steps in an adaptation or
development process.
10.1 Basis
We departed from an available basic concept and from literature. This is a
written basis to start from, be it original or not. If possible, discuss this
written concept with its authors, to get more background information on
the educational environment and find out if that is similar to your
background.
10.2 Working group/pilot group
We utilised a working group of trained teachers. Those went through a
pilot workshop with pilot books. They all had a mandate from their
principals. The necessary time to work at this had to be guaranteed. There
were feedback sessions with the whole group, and days with a subgroup of
teachers, who participated more actively. We regarded the books really as
pilot versions, with the openness to change and revise important parts of
them. The workshop was also completely changed after the pilot
workshop. An adaptation of the workshop model is very important as well.
10.3 Sources of feedback
We used different sources of feedback:
• Feedback from the pilot group through feedback sessions
• Feedback from the pilot group through questionnaires
• Feedback from experts doing site visits

The Experience of "Leefsleutels"
76
Finally, the concept has to be reviewed, making use of all this information.
In this programme, we worked together with Flanders, the French
Community of Belgium and Holland, which didn’t make it easier to
develop the programme, but which was perceived as an extremely fruitful
experience by everyone involved.
11 Conclusion
Adaptation and evaluation clearly interact with each other. They stimulate
quality in the work of practitioners. It’s a way to use evaluation not only to
"prove" the programme, but also to "improve" it.
We are happy to notice an increasing attention for evaluation by Flemish
authorities and field workers. On the Flemish level, we discuss how we can
make evaluation more practical (effective, but not too heavy for the
schools involved and not too costly for the financier). On European level,
we notice this attention as well.
Thanks to these experiences, we monitor our activities more and more
through the years. Next to that, we are considering an external evaluation
again - if we can find funds to finance it.
12 References
Orban M., Marichal E., Colin P., Verjus N., Piette S., Czapla S & Wuidar
H., Evaluation du programme Clefs pour l'Adolescence en
Communauté française de Belgique, Centre d'enseignement et de
recherche en éducation pour la santé de l'Université de Liège,
Belgique, 1995
Van Oost P., De Backer G., De Potter B.& Maes L., Onderzoeksrapport:
proces- en effectevaluatie van het programma 'Leefsleutels voor
Jongeren', unpublished report, universiteit Gent, Belgium, 1995
contact address:
Annick Vandendriessche
Leefsleutels vzw Jongeren
Leopold II laan 63 bus 3
B-1080 Brussels, Belgium
Tel: +32 2 4216720
FAX: +32 2 4216729
e-mail: leefclefs@club.innet.be

Evaluation Research in Regard to Primary Prevention of Drug Abuse
77
Mia’s Diary:
An Alcohol and Drug Primary
Prevention Programme for the Nordic
Countries
Line Nersnæs
Department of Research and Health Promotion
Norwegian Ministry of Health and Social Affairs, Oslo, Norway
___________________________________
Paper Presented at the
COST-A6-WG2 Workshop
"Socio-Cultural Aspects of Primary Prevention of Drug
Abuse and its Evaluation"
December 13th and 14th 1996 in Vienna

Mia’s Diary
78
Contents
1 Short introduction to the educational programme and the underlying
assumptions behind the implementation................................................. 79
2 The theories behind the programme........................................................ 80
3 The evaluation approach.......................................................................... 83
4 A brief presentation of the main results .................................................. 85
5 Concluding remarks................................................................................. 87
6 References................................................................................................ 89

Evaluation Research in Regard to Primary Prevention of Drug Abuse
79
1 Short introduction to the educational programme and the
underlying assumptions behind the implementation
Mia’s Diary is an alcohol and drug primary prevention programme,
developed as a result of a Nordic co-operation. It is part of the general
effort to delay onset and minimise involvement of substance use among
adolescents. The Nordic Committee on Narcotic Drugs has been
responsible for the compilation of the material. The Nordic Committee on
Narcotic Drugs comes under the auspices of the Nordic Council, which is a
forum for joint discussions between the parliaments and governments of
the Nordic countries.
Currently in the Nordic countries there is a large number of educational
programmes aimed at preventing alcohol and drug use among adolescents.
The programmes offer different preventive strategies and all claim to
represent the best solution to how this education should be implemented
most successfully. Mostly these programmes are based on modern
pedagogical theories and have been carefully worked out. Anyhow many
of the programmes in use in the Nordic countries have been developed in
the United States and are deeply rooted in the American culture, which
makes the transmission to the Nordic reality a bit difficult. An example can
be the commonly used Quest programme "Skills for growing", developed
at the Quest Institute. The background of initiating a joint Nordic
educational programme must be seen in the light of the request to develop
a programme mirroring Nordic conditions and Nordic culture, to be used in
schools in the Nordic countries. It was thought that having similar social
and cultural backgrounds, the Nordic countries could well share the same
educational package. Mia’s Diary was implemented in all the Nordic
countries during 1994 except in Iceland.
Mia’s Diary was written by Jørgen Svedbom, an assistant professor at
Jønkøping University College in co-operation with students from a lower
secondary school in Sweden. The educational programme is built around a