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ResumenAbstract
ORIGINAL
ADICCIONES
www.adicciones.es
■ ISSN: 0214-4840 / E-ISSN: 2604-6334
■ Received: May 2023; Accepted: October 2023.
■ Send correspondence to:
Víctor José Villanueva-Blasco. Valencian International University, C/ Pintor Sorolla, 21, 46002, Valencia, Spain. Tel: +34-961.924.993. E-mail:
vjvillanueva@universidadviu.com
Systematic review on the characteristics and ecacy of
school preventive programs for drug addiction in Spain
Revisión sistemática sobre características y ecacia de
los programas preventivos escolares en
drogodependencias en España
Víctor José VillanueVa-Blasco*,**; Jorge Medina-Martínez*; JaVier zaragoza**,***.
* Faculty of Health Sciences. Valencian International University, Valencia, Spain.
** Spanish Network on Research on Primary Attention on Addiction (RIAPAD), Spain.
*** Faculty of Educational Sciences, University of Zaragoza, Huesca, Spain.
The school environment is of great relevance in the prevention of drug use
in students because it is where they spend most of their time and, since
education is compulsory until upper secondary school in Spain, interventions
in this area can reach the majority of children up to that stage. The objective
of this systematic review is to determine the level of ecacy of the school
preventive programs that have been implemented in Spain. Following the
PRISMA recommendations, a systematic literature search was carried out in
the Web of Science, PubMed/MEDLINE, Embase, Scopus, and Cochrane
Library databases. The search yielded 274 studies, of which 29 studies were
selected. It was found that 48 drug addiction prevention programs have
been implemented in Spanish school context, of which only 18 (37.5%) had
an evaluation of their eectiveness following the criteria and standards of
eective prevention. Conversely, the programs that were not evaluated are
far from these standards in their design. It is concluded that there are two
models of school prevention of drug addiction in Spain: a model that meets
this description; and another model classied as “pseudo-prevention”, since
its design does not meet the standards of eective prevention nor has its
preventive ecacy been demonstrated.
Keywords: preventive programs, school setting, intervention, ecacy
evaluation, systematic review
El ámbito escolar adquiere una gran relevancia en la prevención del
consumo de drogas en estudiantes, ya que es donde pasan una mayor parte
del tiempo y, puesto que en España la enseñanza es obligatoria hasta los 16
años, las intervenciones en este ámbito pueden alcanzar a la mayoría de
niños en esa etapa. El objetivo de esta revisión sistemática fue determinar
qué nivel de ecacia presentan los programas preventivos escolares que se
han implementado en España. Siguiendo las recomendaciones PRISMA,
se llevó a cabo una búsqueda bibliográca sistemática en las bases de
datos Web of Science, PubMed/MEDLINE, Embase, Scopus y Cochrane
Library. La búsqueda arrojó 274 estudios, de los cuales fueron seleccionados
29 estudios. Se ha identicado que en España se han implementado 48
programas preventivos en drogodependencias en el contexto escolar, de los
cuales tan solo 18 (37,5%) cuentan con evaluación de su ecacia siguiendo
los criterios y estándares de una prevención ecaz. Por el contrario, los
programas que no han sido evaluados distan en su diseño de estos estándares.
Se concluye que en España conviven dos modelos de prevención escolar de
las drogodependencias: un modelo que responde a esta denominación; y
otro modelo calicado como “pseudo-prevención”, dado que su diseño no
se ajusta a los estándares de la prevención ecaz ni su ecacia preventiva ha
sido demostrada.
Palabras clave: programas preventivos, ámbito escolar, intervención,
evaluación de ecacia, revisión sistemática
ADICCIONES, 2023 · ARTICLES IN PRESS
2023 ■ ARTICLES IN PRESS
ADICCIONES
PUBLISHED BY:
ARTICLES IN PRESS
2023
FUNDED BY:
ISSN / 0214-4840
E-ISSN / 2604-6334
Systematic review on the characteristics and ecacy of school preventive programs for drug addiction in Spain
School-based prevention is one of the most
widely-used strategies for guaranteeing that the
educational and socio-environmental conditions
at school are the most conducive to the healthy
development of students. Schools can provide an optimal,
ecient and eective environment for intervention (Deogan
et al., 2015; Lassi et al., 2015; Pereira & Sanchez, 2018).
Universal prevention has a broader focus, according to the
classication proposed by Gordon (1987), but one which is
less intense than selective and indicated prevention, which
target more specic populations with greater problems
related to drug use, albeit at greater expense.
Over recent decades, drug addiction prevention
programs have proliferated with dierent characteristics.
One of the most widely-used criteria for their classication
is the intervention strategy used. Authors such as Tobler
(1986) and Tobler et al. (2000) categorised preventive
programs into the following typologies: 1) focused on
information; 2) focused on aective education; 3) combining
information with emotional education; 4) psychosocial in
nature; 5) focused on developing resilience skills; 6) focused
on developing generic skills (social and life); and 7) focused
on the promotion of alternatives (skills and/or activities).
According to international standards for drug use
prevention (United Nations Oce on Drugs and Crime
[UNODC], 2018), the most eective school preventive
programs have the following characteristics: they a) are
based on models of competency and social inuence;
b) use interactive methods; c) have a duration of 10-
15 structured sessions, with booster sessions; d) are
implemented by trained experts; and e) train personal and
social skills (such as coping skills, decision-making, and
substance use resistance), address risk perceptions, and
dispel misconceptions about the normative nature and
expectations of substance use.
The set of characteristics of eective school preventive
programs specied by Villanueva (2017) (Table 1) is based
on various meta-analytic reviews (see Cuijpers, 2002a;
Faggiano et al., 2008a; Hansen, 1992; Skara & Sussman,
2003; Thomas et al., 2013; Tobler et al., 2000; Tobler &
Stratton, 1997; Winters et al., 2007).
Table 1
Characteristics of eective prevention programs in the school environment
Theoretical foundations - Proven theoretical model with empirical evidence.
Program Orientation
- Social inuence.
- Life skills model.
- Multicomponent model.
Level of education - Age-appropriate program implementation.
- Greater ecacy if applied between 11 and 14 years of age.
Target sustances - By age and prevalence of use.
- Preferably alcohol and tobacco, followed by cannabis.
Main components
- Negative consequences of short-term use.
- Focus on subjective social norm: subjective perception of behaviour and attitudes in the environment
regarding drug use. Correction of erroneous conceptions about the prevalence of drug use among peers.
- Techniques to cope with indirect social inuences and resist social pressure towards drug use.
- Training in life skills and positive social interaction.
- Reinforcement of attitudes against the use of drugs and personal commitment against drug use.
Methodology - Active, participatory and interactive.
Sessions - Minimum recommended number of 10 sessions.
- Includes booster sessions once program is completed.
Administrators
- Professional experts.
- Suitably trained teachers.
- Participation of peers with prosocial prole and against drug use.
Application
- Sustainable in time, long-term.
- Application of complete program.
- Methodological rigour.
- Application of necessary adjustments.
Assessment
- Rigorous assessment essential to reect positive eects.
- Information on missing data.
- Behavioural change.
- Control group without intervention.
Related aspects - Gender perspective in design, implementation and assessment.
- Consideration of interculturality.
ADICCIONES, 2023 · ARTICLES IN PRESS
Víctor José Villanueva-Blasco, Jorge Medina-Martínez, Javier Zaragoza
In the Spanish context, a meta-analysis (Espada et
al., 2015a) and an assessment of effectiveness based
on a review of various meta-analyses (Fernández et al.,
2002) identified that the school prevention programs
showing greater effectiveness a) included models for
education in health and social learning b) addressed the
social influence involved in drug use, c) had an active
methodology, d) used a combination of oral, written
and audiovisual support, e) were implemented by
professionals and teachers jointly, with the participation
of peers, and f) had booster sessions.
Despite the availability of evidence on what works and
what does not work in prevention, the transfer to practical
application still seems be a work in progress, with preventive
programs of dierent levels of eectiveness coexisting
with programs yet to be assessed (Medina-Martínez &
Villanueva-Blasco, 2023). This may be due to the lack of
greater visibility and recognition of preventive programs
that have been shown to be eective, given that, in the
Spanish school context, awareness-raising or information
interventions unsupported by empirical evidence continue
to be carried out. The National Strategy on Addictions
2017-2024 (Delegación del Gobierno para el Plan
Nacional sobre Drogas [DGPNSD], 2018) and the 2021-
24 Addictions Action Plan (DGPNSD, 2022) state one of
their priorities to be the improvement of the availability
and eectiveness of prevention programs based on
empirically veried data. These strategies at the national
level indicate that the coverage of preventive programs
has been decreasing and that they are rather focused on
education. As improvements, they therefore propose a
greater focus on the social conditions promoting drug use,
and that universal coverage of evidence-based programs
that meet quality criteria be guaranteed (DGPNSD,
2018).
The following research questions are thus posed: To what
extent do preventive programs implemented in Spain show
characteristics in line with the standards of eective school
preventive programs? Furthermore, in the expectation of
nding that some programs comply with the standards while
others do not, is the fact of having their ecacy assessed
an indicator that the program’s design is in accordance
with said eective prevention standards? Consequently, the
general objective of this systematic review was to determine
the level of ecacy of the school preventive programs that
have been implemented in Spain. The specic objectives
were: 1) to identify the characteristics of school preventive
programs applied in Spain; 2) to recognize which ones have
been assessed and how eective they are; and, nally, 3) to
compare the characteristics of school preventive programs
that include ecacy assessment to those that do not.
Method
Search strategy and information sources
For the rst objective, a search was carried out in the
Xchange portal and best practice databases (EMCDDA,
n.d.), evidence-based prevention (Socidrogalcohol, n.d.)
and the best practice for addictions portal (DGPNSD,
n.d.). For this purpose, country and prevention scope limits
were set to target programs carried out in Spain and in the
school environment.
For the second objective, a systematic review was
carried out on 01/14/2023, applying the criteria as stated
in Preferred Reporting Items for Systematic Review and
Meta-Analysis (PRISMA) (Page et al., 2021).
A structured electronic bibliographic search was
conducted in ve databases (Web of Science, PubMed/
MEDLINE, Embase, Scopus, and Cochrane Library)
to retrieve peer-reviewed articles published in English
or Spanish, with no date limit. The search strategy
combined multiple previously agreed keywords, which
were developed by breaking down the objective. The
Population, Intervention, Comparison and Outcomes
(PICO) framework was followed in conducting the
literature search. References extracted from each of the
database searches were grouped and stored in a RefWorks
library. Searches were performed and duplicates removed
by the lead author of this manuscript.
The search strategy included the keywords “Spain”,
“alcohol”, “tobacco”, “cannabis”, “school prevention” and
synonyms. These terms were combined creating the
following search strategy: “Spain” AND (“school prevention”
OR “school intervention” OR “preventive program” OR “school-
based” OR “school environment”) AND (“alcohol” OR “tobacco”
OR “cannabis” OR “marijuana”). Additionally, a reverse
search was performed by reviewing the reference lists of the
studies to identify articles not indexed in these databases.
Similarly, preventive programs with scientic publications
on their ecacy but not indexed in good practice portals
were also considered as part of the rst objective.
Eligibility criteria
Regarding the second objective, two reviewers (M-M and
V-B) evaluated the studies that met the following inclusion
criteria in the initial search processes: studies that a) included
preventive programs in the school environment; b) were
carried out in Spain; c) addressed alcohol, tobacco and/or
cannabis use; d) were published in peer-reviewed scientic
journals; and e) were written in English or Spanish.
Exclusion criteria were: a) articles that addressed
behavioural addictions; b) bibliographic and systematic
reviews, meta-analyses, books, book chapters and
conference communications; c) studies focusing on
interventions to reduce drug use without published results;
d) preventive interventions not protocolized as a program;
and e) studies that did not assess program results.
ADICCIONES, 2023 · ARTICLES IN PRESS
Systematic review on the characteristics and ecacy of school preventive programs for drug addiction in Spain
Selection process
Two authors (M-M and V-B) identied the studies found
in three steps following literature guidelines (Gunnell et
al., 2020). First, article titles and abstracts obtained in
the initial search were screened and selected on the basis
of the above disaggregated eligibility criteria. Second,
full-text articles were analyzed in detail and screened for
eligibility. Third and nally, the bibliographic references
of all selected articles were checked manually to identify
relevant articles missed in the initial search strategy. The
search process is summarized in Figure 1, created using
the recently updated PRISMA tool for creating owcharts
(Haddaway & McGuinness, 2020).
The review of scientic articles reporting on studies
assessing the ecacy of preventive programs in drug
addiction in Spain yielded a total of 274 records. After
removing duplicates, 173 studies were obtained for title and
abstract review while 134 were excluded. The full text of
39 articles was thus reviewed. After 10 were excluded, the
systematic review comprised 29 articles.
Data extraction
Two authors (M-M and V-B) independently and
systematically extracted data from the nal list of included
studies. The following categories of manuscript features
were identied and recorded: a) program name, b)
authorship, c) year, d) substances, e) target population, f)
level of prevention (i.e., universal, selective or indicated), g)
theoretical model (e.g., Theory of Reasoned Action, Social
Development Model, etc.), h) application methodology
(e.g., audiovisual, interactive, etc.), i) number of sessions,
j) administrator prole (i.e., faculty, external experts,
etc.), k) main components, and l) publications of ecacy.
Discrepancies between the authors were resolved by
consensus decision. All extracted data were synthesized
and grouped using tables created with Microsoft Excel.
Assessment of methodological quality
The methodological quality of the articles was assessed
using the Mixed Methods Appraisal Tool (MMAT) (Hong
et al., 2018). The MMAT is a critical appraisal tool designed
for systematic reviews that include quantitative, qualitative,
and mixed empirical studies. In the case of randomized
controlled trials (RCTs), the RCT scale was used, while the
non-randomized quantitative study scale was used in the
case of quasi-experimental studies.
The assessment of each study’s methodological quality is
presented in Tables 2 and 3. All studies met a minimum of
40% of the criteria and the average percentage of criteria
met was 67.6%.
Figura 1
Diagrama de flujo
Total de registros (n = 274)
Registros identificados de:
Embase (n = 77)
Web of Science (n = 24)
PubMed/MEDLINE (n = 50)
Cochrane Library (n = 60)
Scopus (n = 60)
Búsqueda inversa (n = 3)
Registros eliminados antes del cribado:
Registros duplicados eliminados (n = 101)
Registros tras eliminar
duplicados
(n = 173)
Registros revisados (título y
resumen)
(n = 173)
Registros excluidos por título y resumen
(n = 134)
Registros revisados para
elegibilidad (texto completo)
(n = 39)
Registros excluidos (n = 10):
Intervención sin resultados publicados (n = 4)
No evaluación de resultados (n = 2)
Póster de congreso (n = 2)
Intervención preventiva no protocolizada en
forma de programa (n = 1)
No trata sobre prevención del consumo de
drogas (n = 1)
Solo abstract (n = 1)
Registros incluidos en la revisión
(n = 29)
Identificación de estudios vía bases de datos
Cribado
Incluidos
Identificación
Figure 1
Flow chart
Identication of studies through databases
IdenticationIncluded Screening
Total records (n = 274)
Records identied in:
Embase (n = 77)
Web of Science (n = 24)
PubMed/MEDLINE(n = 50)
Cochrane Library (n = 60)
Scopus (n = 60)
Reverse search (n = 3)
Records eliminated before screening:
Duplicate records removed (n = 101)
Records excluded (n = 10)
Intervention lacking published results (n = 4)
No assessment of results (n = 2)
Conference poster (n = 2)
Preventive intervention no protocolised as
program (n = 1)
Did not deal with drug use (n = 1)
Abstract only (n = 1)
Records excluded by title and abstract
(n = 134)
Records after removal of
duplicates (n = 173)
Records screened (title and
abstract) (n = 173)
Records screened for eligibility
(complete text)
(n = 39)
Records included in review
(n = 29)
ADICCIONES, 2023 · ARTICLES IN PRESS
Víctor José Villanueva-Blasco, Jorge Medina-Martínez, Javier Zaragoza
Results
Table 4 lists the preventive programs identied through
good practice portals and through the search for studies
assessing their ecacy. Information is provided on
authorship and year of publication, substances addressed,
target population, level of prevention, underlying
theoretical models, application methodology, number of
sessions, administrator proles, main components and the
publications found regarding their ecacy.
As can be seen (Table 4), of the total 48 programs
analyzed, 41 have a universal prevention frame (83.7%),
of which 30 address drinking (73.17%), 29 smoking
(70.73%), 16 cannabis (39.02%), and three drugs in
general without specifying which (7.32%). Four selective
prevention programs were analyzed (8.2%), of which
three address drinking (75%), one cannabis use (25%), one
general drug use without specifying which ones (25%) and
none is focussed on smoking. For indicated prevention, two
programs were detected (4.1%), of both of which address
drinking (100%), and tobacco (100%), with one addressing
cannabis (50%), and none drugs in general. Finally, two
programs (4.1%) address various levels of prevention.
Table 2
Methodological quality assessment for ECA
Reference
P1
P2
P3
P4
P5
% compliance
Alarcó-Rosales et al. (2021) Yes Yes Yes No Yes 80
Caria et al. (2011)
Yes
No
Yes
No
Yes
60
Cutrín et al. (2021)
Yes
Yes
Yes
No
Yes
80
Espada et al. (2014) Yes Yes Yes No Yes 80
Espada et al. (2015b) Yes No Yes No No 40
Faggiano et al. (2007) Yes No Yes No Yes 60
Faggiano et al. (2008b)
Yes
No
Yes
No
Yes
60
Faggiano et al. (2010)
Yes
No
Yes
No
No
40
García et al. (2005) Yes No Yes No Yes 60
Gonzálvez et al. (2015) Yes Yes Yes No No 60
Gonzálvez et al. (2016) Yes Yes Yes No No 60
Gonzálvez et al. (2018)
Yes
Yes
Yes
No
Yes
80
Leiva et al. (2018) Yes Yes Yes Yes No 80
Luna-Adame et al. (2013)
Yes
No
Yes
No
Yes
60
Romero et al. (2017)
Yes
Yes
Yes
No
Yes
80
Valdivieso et al. (2015) Yes Yes Yes Yes No 80
Vargas-Martínez et al. (2019)
Yes
No
Yes
No
No
40
De Vries et al. (2003) Yes Yes Yes No Yes 80
De Vries et al. (2006)
Yes
Yes
Yes
No
No
60
Note. P1: Was randomization correctly done? P2: Were the groups comparable at the beginning? P3: Were there complete results data? P4: Were the results
assessors blinded to the intervention provided? P5: Did the participants adhere to the assigned intervention?
Table 3
Methodological quality assessment for quasi-experimental studies
Reference
P1
P2
P3
P4
P5
% compliance
Ariza et al. (2008)
Yes
Yes
Yes
No
Yes
80
Ariza et al. (2013) Yes Yes Yes Yes Yes 100
Barón-García et al. (2021)
No
No
Yes
No
Yes
40
Cabrera et al. (2022) Yes Yes Yes No Yes 80
Calafat et al. (1995)
Yes
Yes
Yes
No
Yes
80
Espada et al. (2012)
No
Yes
Yes
No
Yes
60
Gómez-Fraguela et al. (2002) Yes Yes Yes No Yes 80
Hernández et al. (2013)
No
Yes
Yes
No
Yes
60
Moral et al. (2009) No Yes Yes No Yes 60
Villanueva et al. (2021)
Yes
Yes
Yes
No
Yes
80
Note. P1: Were participants representative of the target population? P2: Were the measurements suitable to both the result and the intervention (or exposure)?
P3: Were there complete results data? P4: Were confounding factors taken into account in design and analysis? P5: During the study period, was the interven-
tion administered (or did exposure occur) as planned?
ADICCIONES, 2023 · ARTICLES IN PRESS
Systematic review on the characteristics and ecacy of school preventive programs for drug addiction in Spain
Table 4
Information on the preventive programs included in the review
Program Substance Target
population Level Theoretical
model
Application
methodology
Nº sessions
(nº booster
sessions)
Administrator
prole
Main
components
Publication of
ecacy
A no fumar ¡me
apunto! Tobacco
Minors
aged 12-16,
teachers and
family
Universal n.s. Interactive,
participative n.s. Teachers
Risks, benets
of not smoking,
beliefs, group
and advertising
pressure,
interpersonal
and cognitive
skills, emotional
control
-
ALCAZUL
Alcohol,
tobacco,
cannabis
Adolescents
aged 12-18 Universal
Theory of
reasoned action
(Fishbein & Ajzen,
1975)
Community n.s. Experts and
monitors
Healthy leisure,
drug information,
prosocial
attitudes,
sensation
seeking
-
ALERTA ALCOHOL Alcohol Adolescents
aged 16-18 Selective I-change model
(de Vries, 2017) Online 6n.s.
Benets of
not drinking,
attitudes, social
inuences,
self-ecacy,
resistance skills
Vargas-
Martínez et al.
(2019)
Cine y Educación
en Valores 2.0
Drugs in
general (n.s.)
Minors aged
6-16 and their
teachers
Universal n.s. Audiovisual n.s. n.s. Cinema and
values -
Construyendo
Salud
Alcohol,
tobacco,
cannabis,
others
Minors aged
12-14 Universal
Theory of
reasoned
action (Fishbein
The& Ajzen,
1975), Social
development
model (Hawkins et
al., 1992), Theory
of self-derogation
(Kaplan, 1996),
Multi-stage social
learning model
(Simons et al.,
1988), Problem
behaviour theory
(Jessor & Jessor,
1977), Self-control
theory (Hirschi
& Gottfredson,
1988),
Interactive,
participative
16 (9
booster) Trained teachers
Information
component,
decision making,
self-image
and self-
improvement,
emotional
control, social
skills, tolerance
and cooperation,
leisure and free
time
Gómez-
Fraguela et al.
(2002), Luna-
Adame et al.
(2013)
Construye tu
Mundo
Alcohol,
tobacco,
cannabis
Minors aged
3-16 Universal n.s. Active learning,
IVAC n.s.
Teachers
Empathy,
attitudes
towards health
protection, self-
esteem, attitudes
towards drugs,
decision making,
assertiveness
-
Déjame que
te cuente algo
sobre… Los Porros
Cannabis Minors aged
13-16
Universal,
selective
Theory of
reasoned action
(Fishbein & Ajzen,
1975)
Interactive 5 Educators/monitors
Informational,
attitudinal,
normative
and aective
components of
the decision-
making balance
-
DINO Educación
Preventiva de
Drogas para
Preadolescentes
Alcohol,
tobacco
Minors aged
10-12 Universal
Systemic model
of guided
intervention
(Álvarez, 1987)
Interactive n.s. Teachers
Self-esteem,
social skills,
decision making,
information
about drugs,
social inuences,
healthy habits
-
ADICCIONES, 2023 · ARTICLES IN PRESS
Víctor José Villanueva-Blasco, Jorge Medina-Martínez, Javier Zaragoza
Program Substance Target
population Level Theoretical
model
Application
methodology
Nº sessions
(nº booster
sessions)
Administrator
prole
Main
components
Publication of
ecacy
DISCOVER.
Aprendiendo a
vivir
Alcohol,
tobacco,
cannabis,
others
Minors aged
10-16
Universal
n.s. Interactive 9-13 Trained teachers
Self-esteem,
conict
resolution, risks,
relational skills,
decision making
-
En la huerta con
mis amig@s
Alcohol,
others
Minors aged
5-10 their
families and
teachers
Universal n.s. Audiovisual n.s. Teachers
Healthy habits,
psychoaective
and social
development
-
En Plenas
Facultades
Drugs in
general (n.s.)
Young people
aged 18-25 Universal n.s. Peer to peer n.s. Students
Awareness
raising about
drug abuse
and addictions,
risky sexual
behaviours
and sexually
transmitted
infections
Barón-García
et al. (2021)
Entre Todos
Alcohol,
tobacco,
cannabis
Minors aged
10-16 Universal n.s. Cooperative
learning 6-13
Experts and trained
teachers
Information
about drugs,
attitudes, values,
motivations, self-
esteem, social
skills, decision
making, healthy
habits, leisure
and free time
-
EmPeCemos
Alcohol,
tobacco,
cannabis
Minors aged
5-10 and their
families
Indicated n.s. Interactive 12 (3
booster)
Trained therapists
Emotion
recognition, self-
control, problem
solving and
decision making,
social skills
Romero et al.
(2017)
Galilei
Alcohol,
cannabis,
others
Adolescents
aged 15-
21 PCPI
(Vocational
training)
Selective
Theory of
reasoned action
(Fishbein & Ajzen,
1975), Problem
behaviour theory
(Jessor & Jessor,
1977), Social
development
model (Hawkins et
al., 1992)
Interactive 14 Trained teachers
Intentions to
use, attitudes to
drugs, normative
beliefs, eects
of drugs, life
skills, social
and resistance
skills, emotional
management,
impulse control,
stress control
-
ITACA Tobacco Minors aged
12-16 Universal
Theory of triadic
inuence (Flay,
1999)
Participative 22 Teachers
Social and
advertising
inuences,
information
about smoking,
resistance
skills, emotion
management,
interpersonal
skills, self-
esteem, critical
thinking,
problem solving
Leiva et al.
(2018)
Juego de llaves
Alcohol,
tobacco,
cannabis
Minors aged
11-16
Universal
n.s. Online 6-12 Trained teachers
Emotional
management,
cognitive
strategies, social
interaction,
leisure and free
time, information
on drugs, values
-
ADICCIONES, 2023 · ARTICLES IN PRESS
Systematic review on the characteristics and ecacy of school preventive programs for drug addiction in Spain
Program Substance Target
population Level Theoretical
model
Application
methodology
Nº sessions
(nº booster
sessions)
Administrator
prole
Main
components
Publication of
ecacy
KAMELAMOS
GUINAR -
Queremos Contar
Alcohol,
others
Roma
population:
minors
aged 6-12,
adolescents
aged 13-18,
women aged
18-32
Selective
Competency
model (Albee,
1980) Interactive n.s. Professionals and
volunteers
Information
about drugs,
group pressure
resistance skills,
leisure and free
time
-
La Aventura de
la Vida
Alcohol,
tobacco,
others
Minors aged
6-11 Universal
Life skills
education
model (WHO,
1994), Theory of
reasoned action
(Fishbein & Ajzen,
1975), Social
development
model (Hawkins
et al., 1992),
Developmental
model
(Kandel, 1980),
Constructivist
theory (Piaget,
1962; Vygotsky,
1962)
Audiovisual,
interactive n.s. Teachers
Information
and attitudes
towards drugs,
risk perception,
normative
perception, life
skills
-
Mantente REAL
(anteriormente
keepin’ it REAL)
Alcohol,
tobacco,
cannabis
Minors aged
11-15 Universal n.s. Participative 12 Teachers
Pressure
resistance skills,
personal and
social skills,
communication,
assertiveness,
problem solving
Cutrín et al.
(2021)
Me llamo Marcos.
Jóvenes y Estilos
de Vida
Alcohol Adolescents
aged 15-18 Universal n.s. Audiovisual n.s. n.s. n.s. -
Nexus. Programa
para la prevención
del consumo de
drogas
Alcohol,
tobacco
Minors aged
10-13 Universal
Theory of
reasoned action
(Fishbein & Ajzen,
1975),Multi-stage
social learning
model (Simons et
al., 1988), Social
development
model (Hawkins
et al., 1992),
Developmental
model (Kandel,
1980), Problem
behaviour theory
(Jessor & Jessor,
1977), Theory of
self-derogation
(Kaplan, 1996),
Sensation
seeking theory
(Zuckerman, 1979)
Interactive,
participative 12 Trained instructors
Information
on drugs, risk
perception,
normative
beliefs,
social inuences,
resilience skills,
communication
skills, emotional
intelligence, self-
esteem, leisure
and free time,
tolerance and
cooperation
-
¡ÓRDAGO! Afrontar
el desafío de las
drogas
Alcohol,
tobacco,
cannabis
Minors aged
12-16 Universal
Theory of
reasoned action
(Fishbein & Ajzen,
1975), Social
development
model (Hawkins
et al., 1992),
Developmental
model
(Kandel, 1980),
Constructivist
theory (Piaget,
1962; Vygotsky,
1962), Social
learning theory
(Bandura, 1977a)
Participative 32 Trained teachers
Information on
drugs, beliefs,
attitudes, social
inuences,
self-esteem,
decision making,
resistance to
group pressure,
leisure and free
time
-
ADICCIONES, 2023 · ARTICLES IN PRESS
Víctor José Villanueva-Blasco, Jorge Medina-Martínez, Javier Zaragoza
Program Substance Target
population Level Theoretical
model
Application
methodology
Nº sessions
(nº booster
sessions)
Administrator
prole
Main
components
Publication of
ecacy
PASE.bcn (ESFA) Alcohol,
tobacco
Minors aged
12-13 Universal ASE model (de
Vries et al., 1995) Interactive 7 (6-5
booster)
Trained teachers
Drug eects,
group and
advertising
pressure,
normative
education,
resistance skills,
future planning
Ariza et al.
(2008), de Vries
et al. (2003),
de Vries et al.
(2006)
Prevención del
consumo de
drogas
Alcohol,
tobacco,
cannabis,
others
Minors aged
12-17 Universal
Social learning
theory (Bandura,
1977a),
Developmental
model (Kandel,
1980), Health
Education Model
Participative 9
Teachers
and external
professionals
(psychologists and
pedagogues)
Knowledge
about drugs,
decision making,
social and group
pressure
-
Programa de
intervención
psicosocial
Alcohol Adolescents
aged 12-18 Universal n.s. Participative 8
External
professionals and
trained teachers
Information on
drinking, myths,
risk perception,
social and
resistance skills
Moral et al.
(2009)
Programa de
Prevención de
Drogodependencias
“CINENSINO”
Alcohol,
tobacco
Minors aged
11-13 and
their teachers
Universal
Theory of
reasoned action
(Fishbein &
Ajzen, 1975),
Susceptibility
hypothesis
(Mansilla & Vega,
1999)
Participative 12 Teachers
Knowledge about
drugs, risks,
critical thinking,
self-esteem,
decision making,
assertiveness,
resistance to
group pressure,
healthy leisure
-
Programa de
prevención del
IAMS
Alcohol,
cannabis
Adolescents
aged 13-18 Universal
Development
theories,
ecological
perspective &
predictive theories
of drug use
Interactive,
participative 3External
professionals
Information on
drugs, social
learning and
social inuences,
risk perception
Cabrera et al.
(2022)
Programa de
promoción de
la salud para la
prevención del
tabaquismo
Tobacco Minors aged
12-14 Universal n.s. Participative 8
Teachers
Eects of
smoking,
assertiveness,
resistance skills,
critical thinking
García et al.
(2005)
Programa Engoe Drugs in
general (n.s.)
Students
aged over
12, teachers,
families,
young
people with
problematic
use (aged
14-21)
Universal,
selective,
indicated
Comprehensive-
sequential model,
multisystemic
theory
n.s. n.s. External
professionals
Emotional and
social skills, value
education
-
Programa
escalonado de
prevención escolar
- “Protegiéndote”
Alcohol,
tobacco,
cannabis
Minors aged
3-16, teachers
and families
Universal Biopsychosocial
model Interactive 10 Trained teachers
Information on
drugs, emotional
control, social
skills, problem
solving and
decision making,
habits in school
learning
-
Programa de
Prevención de
Drogodependencias
para educación
primaria BRÚJULA/
BRÚIXOLA
Alcohol,
tobacco,
others
Minors aged
6-12 and their
families
Universal
Theory of
reasoned action
(Fishbein & Ajzen,
1975), Theory
of planned
behaviour (Ajzen,
1985), Health
Education Model
Participative 9Teachers
Healthy habits,
social skills,
personal identity
-
ADICCIONES, 2023 · ARTICLES IN PRESS
Systematic review on the characteristics and ecacy of school preventive programs for drug addiction in Spain
Program Substance Target
population Level Theoretical
model
Application
methodology
Nº sessions
(nº booster
sessions)
Administrator
prole
Main
components
Publication of
ecacy
Programa
preventivo en
Cataluña
Tobacco Minors aged
11-15 Universal n.s. Participative 7School nurses
Eects of
smoking, social
and advertising
inuence, critical
thinking
Valdivieso et
al. (2015)
Programa
Rompecabezas
Drugs in
general (n.s.)
Adolescents
aged 16-21
in at-risk
situations,
teachers in
non-formal
education
centres and
vocational
training
Selective
Problem
behaviour
theory (Jessor
& Jessor, 1977),
Developmental
model (Kandel,
1980)
n.s. n.s. Teachers and
external experts
Information
on drugs,
leisure and free
time, personal
development,
social skills,
responsibility at
work
-
Programa Saluda Alcohol,
others
Minors aged
12-14 Universal n.s. Participative 10
Teachers,
psychologists,
social workers and
educators, monitors,
sociocultural
animators
Problem solving
and decision
making,
healthy leisure,
social and
resilience skills,
information on
drugs, public
engagement,
self-
reinforcement
Espada et
al. (2012),
Hernández et
al. (2013)
Project EX Tobacco Adolescents
aged 14-19 Universal
Motivation model,
Coping skills,
Personal
commitment
Participative 8 Teachers and health
educators
Self-control,
withdrawal
control, emotion
and stress
management,
goal setting, self-
esteem
Espada et al.
(2014), Espada
et al. (2015b),
Gonzálvez
et al. (2015),
Gonzálvez
et al. (2016),
Gonzálvez et
al. (2018)
PPCDE
Alcohol,
tobacco,
others
Pre-school,
primary,
compulsory
secondary,
higher
secondary
students and
their teachers
Universal
Theory of
reasoned action
(Fishbein &
Ajzen, 1975),
Developmental
model (Kandel,
1980), Social
learning theory
(Bandura, 1977a),
Self-ecacy
theory (Bandura,
1977b),
Lifestyle model
and conditioning
risk factors
(Calafat et al.,
1985)
Debate/
discussion,
conversations
n.s. Teachers and
external experts
Information
on drugs,
self-esteem,
social and
resistance skills,
healthy values,
decision making,
emotional
control, healthy
leisure
-
RyR2
Alcohol,
tobacco,
cannabis
Adolescents
aged 18 Universal
Cognitive-
behavioural and
social learning
theories
Participative
12-15 External
professionals
(psychologists and
educators)
Problem solving,
emotional
competences,
social inuences,
critical thinking,
empathy, social
and negotiation
skills, values
Alarcó-Rosales
et al. (2021)
Respir@ire Tobacco Minors aged
12-16 Universal Health Education
Model Participative 16 Teachers
Knowledge about
drugs, attitudes,
social and
resistance skills,
decision making
-
ADICCIONES, 2023 · ARTICLES IN PRESS
Víctor José Villanueva-Blasco, Jorge Medina-Martínez, Javier Zaragoza
Program Substance Target
population Level Theoretical
model
Application
methodology
Nº sessions
(nº booster
sessions)
Administrator
prole
Main
components
Publication of
ecacy
Sé Tú Mismo/a
Alcohol,
tobacco,
cannabis
Minors aged
12-14 Universal
Models of social
inuence and
competence
Interactive 10
Experts in
drug addiction
prevention
Communication
skills, emotional
education,
empathy,
assertiveness,
normative
education, drug
information,
resistance skills
Villanueva et
al. (2021)
Sobre Canyes
i Petes
(anteriormente
xkpts.com)
Alcohol,
cannabis
Minors aged
14-16 Universal ASE model (de
Vries et al., 1995) Interactive 5Trained teachers
Knowledge about
drugs, social and
peer pressure,
skills training,
problem solving
Ariza et al.
(2013)
SUSPERTU
- Programa
de Apoyo a
Adolescentes
Alcohol,
tobacco,
others
Adolescents
aged 13-20
in at-risk
situations and
their families
Indicated
Social learning
theory (Bandura,
1977a),
Biopsychosocial
model
Participative and
dynamic 25 External
professionals
Knowledge about
drugs, attitudes,
self-esteem,
emotional
control, decision
making, healthy
leisure, social
and resistance
skills, school
performance
-
¿Te apuntas? Alcohol,
others
Minors aged
9-11 Universal
Self-esteem
improvement
model (Kaplan et
al., 1986), Theory
of reasoned
action (Fishbein
& Ajzen, 1975),
Developmental
model (Kandel,
1980), Social
learning theory
(Bandura,
1977a), Problem
behaviour theory
(Jessor & Jessor,
1977)
Participative 5n.s.
Decision
making and
problem solving,
social and
communication
skills, critical
thinking, leisure
and free time
-
Tú decides
Alcohol,
tobacco,
others
Minors aged
12-16 Universal
Developmental
model (Kandel,
1980)
Interactive 6Trained teachers
Information on
drugs, decision
making, social
and resilience
skills
Calafat et al.
(1995)
Unplugged
Alcohol,
tobacco,
cannabis
Minors aged
12-14 Universal
Social inuence
model (Sussman
et al., 2004)
Interactive 12 Trained teachers
Knowledge about
drugs, social
and resilience
skills, normative
education,
intrapersonal
skills,
assertiveness,
critical thinking,
coping strategies,
decision making,
problem solving,
goal setting
Caria et
al. (2011),
Faggiano et
al. (2007),
Faggiano et
al. (2008b),
Faggiano et al.
(2010)
¿Vivir el momento? Alcohol,
tobacco
Minors aged
12-14 Universal n.s. n.s. 5n.s.
Problem solving,
resilience skills,
prosocial values,
healthy leisure,
critical thinking
-
ADICCIONES, 2023 · ARTICLES IN PRESS
Systematic review on the characteristics and ecacy of school preventive programs for drug addiction in Spain
Preventive programs with eectiveness
evaluation studies
ALERTA ALCOHOL (ALCOHOL ALERT)
Vargas-Martínez et al. (2019) noted that the program
showed a statistically signicant reduction in binge drinking
after four months of follow-up. This eect was greater
the greater the adherence to the program, that is, when a
greater number of completed sessions were attended. The
intervention did not show a signicant increase in health-
related quality of life; it was, however, shown that those
who reduced the number of binge drinking occasions
perceived higher health-related quality of life, as did those
with greater adherence to the program.
Construyendo Salud (Building Health)
Gómez-Fraguela et al. (2002) reported that the program
achieved a smaller increase in smoking and drinking
in the intervention group (IG) compared to the control
group (CG), with the eect maintained after 15 months.
At follow-up, after 27 and 39 months, these dierences
seemed to diminish and were no longer signicant. The
three-year follow-up showed a signicant reduction in
the level of general use of cannabis, tranquilizers and
amphetamines. However, Luna-Adame et al. (2013)
reported that no preventive eects on smoking were found,
neither immediately nor after a year, but that it could be
eective in preventing an increase in the level of tobacco
consumption.
EmPeCemos (Let’s Get Started)
Romero et al. (2017) reported that participation in the
program was associated with more unfavourable attitudes
toward drugs and lower intention to use tobacco and
alcohol. Signicant eects were also observed in smoking
prevention, with a lower frequency both in lifetime and
last-month smoking in IG. While there were no signicant
dierences in the frequency of alcohol or cannabis use,
such dierences were found in the amount of alcohol
drunk, with a lower number of drinks and episodes of
drunkenness in IG compared to CG.
En Plenas Facultades (Of Sound Mind)
Barón-García et al. (2021) reported that program users
signicantly improved their level of knowledge about drugs
and sexuality by the end of the sessions. However, there is
no evidence on the eects on drug use behaviour.
ITACA (ITHACA)
Leiva et al. (2018) reported that no statistically signicant
dierences were found in the incidence of regular smoking
or smoking initiation in IG and CG. Therefore, there is
no evidence that the program is eective in preventing
smoking in adolescents.
Mantente REAL (Stay REAL)
Cutrín et al. (2021) noted that relatively smaller increases in
drinking were observed in IG compared to CG. There was
a statistically signicant reduction of binge drinking and
episodes of drunkenness, as well as a marginally signicant
decrease in the frequency and quantity of alcohol drunk.
This program was therefore shown to be eective in curbing
the increase in drinking at the beginning of adolescence
and preventing problematic use.
PASE.bcn (ESFA)
The IG in this program reported signicantly less weekly
smoking, more anti-tobacco attitudes, as well as signicantly
higher scores on social self-ecacy and negative intentions
toward tobacco (de Vries et al., 2003). The signicant eects
Program Substance Target
population Level Theoretical
model
Application
methodology
Nº sessions
(nº booster
sessions)
Administrator
prole
Main
components
Publication of
ecacy
Y tú, ¿qué piensas?
Alcohol,
tobacco,
others
Adolescents
aged 13-18
Universal
n.s. Audiovisual,
debate n.s. n.s.
Leisure and free
time, analysis
of advertising
and fashion,
interpersonal
skills
-
Y tú, ¿qué sientes? Drugs in
general (n.s.)
Adolescents
aged 13-18
Universal
n.s. Audiovisual,
reection n.s. n.s. Emotional
component -
5 top secrets sobre
el cannabis Cannabis Adolescents
aged 15-18 Universal
Theory of
reasoned action
(Fishbein & Ajzen,
1975)
Participative 7Teachers/
educators/ monitors
Information
on cannabis,
consequences,
eects, myths
-
Note. ASE: Attitudes-Social inuences-Self-ecacy; ESFA: European Smoking Prevention Framework Approach; IAMS: Madrid Health Service Addiction Institute; IVAC: Research,
vision, action and change; n.s.: not specied; PASE.bcn: Prevention of substance addictions at school; RyR2: Reasoning and Rehabilitation V2.
ADICCIONES, 2023 · ARTICLES IN PRESS
Víctor José Villanueva-Blasco, Jorge Medina-Martínez, Javier Zaragoza
for beliefs about the benets of not smoking continued at
24 and 30 months of follow-up, and were maintained after
30 months for social self-ecacy (de Vries et al., 2006). At
12, 24 and 36 months, the number of new regular smokers
was signicantly lower in IG (Ariza et al., 2008), although,
according to another study (de Vries et al., 2006), this eect
disappears in the long term.
Programa de intervención psicosocial
(Psychosocial intervention program)
Moral et al. (2009) reported that the program showed a
signicant reduction in the amount of alcohol drunk weekly
at two, seven and 12 months of follow-up. It also showed
a strengthening of attitudes against drinking and greater
resistance to group pressure. Likewise, in the 12-month
follow-up, attitudinal strengthening was maintained in the
Family IG and the Basic Awareness IG, showing greater
ecacy of the empowerment and skills training programs
compared to those that were merely informative.
Programa de prevención del Instituto de
Adicciones de Madrid Salud (IAMS) (Prevention
program of the Madrid Health Addictions Institute)
Cabrera et al. (2022) reported a signicant decrease in
IG compared to CG in the intention to drink alcohol and
smoke cannabis, as well as in positive attitudes towards their
use, and increased risk perception. Furthermore, it showed
a signicant reduction in drinking in the last month and
a reduction in the perception of social pressure. However,
regarding cannabis, the dierences in its use were not
signicant and the intervention did not seem to produce
changes in self-ecacy to resist consumption.
Programa de promoción de la salud para la
prevención del tabaquismo (Health promotion
program for smoking prevention)
García et al. (2005) pointed out that there was a smaller
increase in smoking experimentation, as well as a lower
percentage of daily smokers, in IG compared to CG.
Similarly, more negative attitudes toward smoking
developed. The program presented positive eects in
the short term in modifying attitudes and use, but these
decreased in the medium term (eight months of follow-up).
Programa preventivo en Cataluña (Preventive
program in Catalonia)
Valdivieso et al. (2015) reported that this program reduced
the prevalence and incidence of smoking by 25% and
26%, respectively, but did not nd statistical signicance.
Thus, there is no clear ecacy evidence.
Programa Saluda (Healthy Greetings Program)
The program increased social and problem-solving skills,
and reduced short-term substance use intentions (Espada
et al., 2012; Hernández et al., 2013). At 12 months, there
was a signicant reduction in alcohol use (Espada et al.,
2012). Hernández et al. (2013) reported that it reduced the
percentage of drunken episodes, decreased the perception
of social pressure, increased knowledge about alcohol and
synthetic drugs, and resulted in a higher percentage of
participants carrying out healthy leisure activities (reading
and other outdoor activities).
Project EX
The program has been shown to have immediate eects
by signicantly reducing the intention to smoke, exhaled
CO levels, and nicotine dependence (Espada et al., 2014,
2015b; Gonzálvez et al., 2015, 2016, 2018). Similarly, it
caused marginal positive eects regarding knowledge
about tobacco (Espada et al., 2014) and motivation to quit
smoking (Espada et al., 2015b). These factors inuenced
IG participants to reduce smoking compared to CG
(Espada et al., 2015b; Gonzálvez et al., 2015, 2016, 2018)
and some to stop smoking (14.28%) (Espada et al., 2015b).
These changes were maintained after six months (Espada
et al., 2015b) and one year (Gonzálvez et al., 2015, 2016,
2018), which shows the ecacy of the program in reducing
long-term tobacco use.
Reasoning and Rehabilitation V2 (RyR2)
Alarcó-Rosales et al. (2021) noted that, at six months,
compared to CG, IG showed a signicant reduction in daily
smoking, drinking (including episodes of drunkenness),
and frequency of cannabis use. These positive eects
were maintained at 12-month follow-up, although the
improvements in daily smoking and drunken episodes
showed some reduction.
Sé Tú Mismo/a (Be Yourself)
Villanueva et al. (2021) found that the Be Yourself program
was eective in moderating the increase in cannabis use
in the last 12 months, so that IG participants were less
likely to use than their CG counterparts. Furthermore,
the probability of use in the last 30 days decreased in
IG compared to previous consumption, while in CG
consumption increased. Although the preventive eects
decreased at six months of follow-up, IG was still less likely
to use cannabis than CG.
Sobre Canyes i Petes (All about Pints and Joints)
Ariza et al. (2013) reported that at the 15-month follow-up,
a signicant reduction of 29% was observed in past-month
cannabis users in IG. These reductions were 34% and 36%
when the “acceptable IG” or “qualied IG” subgroups
were considered, respectively. That is, greater adherence
to program implementation was associated with greater
reduction in cannabis use.
ADICCIONES, 2023 · ARTICLES IN PRESS
Systematic review on the characteristics and ecacy of school preventive programs for drug addiction in Spain
Tú Decides (You Decide)
Calafat et al. (1995) point out that there was evidence of a
slowdown in the growth curves of alcohol and tobacco use
in IG compared to CG, in addition to other positive eects
(encouraging active attitudes against drug availability,
greater responsibility and willingness to seek help for
classmates with drug problems, and improved family
communication). Positive eects were still maintained
at the two-year follow-up, although moderate drinkers
increased in IG. In GC, there was a progressive increase in
consumption across the entire study.
Unplugged
This program signicantly reduced alcohol-related
problem behaviours and drunkenness (Caria et al., 2011;
Faggiano et al., 2008b). Despite not showing an overall
reduction in drinking, IG non-drinkers and occasional
drinkers progressed towards frequent drinking less often
than in CG (Caria et al., 2011). At 18 months, the reduced
risk of drunken episodes continued to persist (Faggiano et
al., 2010).
Regarding tobacco, smoking prevalence was lower in
IG, which included activities with parents, compared to
CG (Faggiano et al., 2007). Likewise, a reduction in the
number of daily cigarettes was shown (Faggiano et al.,
2008b). This eect disappeared at 18 months (Faggiano
et al., 2010), although the intervention was eective in
preventing non-smokers from starting to smoke, compared
to CG (Faggiano et al., 2008b, 2010).
With cannabis, the prevalence of use was shown to be
signicantly lower in IG than in CG (Faggiano et al., 2007),
an eect that persisted at 18 months (Faggiano et al., 2010).
However, the eects on cannabis use were of marginal
statistical signicance (Faggiano et al., 2008b).
Comparison of the characteristics of assessed and non-
assessed preventive programs
Table 5 presents the comparison of the main dening
characteristics of the assessed preventive programs versus
those that were not assessed.
Discussion
The present study attempted to discover the extent to
which school-based preventive programs implemented in
Spain have characteristics in line with the standards of
eective school preventive programs, and which ones have
been assessed.
In terms of the rst objective, determining the
characteristics of the school preventive programs
applied, it is evident that universal prevention is the most
Table 5
Comparison of characteristics between preventive programs assessed and not assessed
Programs with ecacy assessment Programs lacking ecacy assessment
Substances Alcohol (72.22%), tobacco (66.67%), cannabis
(44.44%), other (16.67%), n.s. (5.56%)
Alcohol (73.33%), tobacco (63.33%), cannabis (36.67%),
other (36.67%), n.s. (13.33%)
Target population Adolescents aged 12-14 Adolescents aged 10-16, at-risk populations
Level Universal (88.89%), selective (5.56%), indicated
(5.56%)
Universal (80%), selective (10%), indicated (3.33%), various
(6.67%)
Theoretical model Comprehensive social inuence models.
n.s. (38.89%)
General health education or biopsychosocial models.
Some social inuence models.
n.s. (36.67%)
Application
methodology
Interactive (role-playing, gamication, debates, group
discussions)
Audiovisual, Community, online, participative
Nº sessions (nº
booster sessions)
8-12 (3-9 booster sessions).
n.s. (5.56%)
5-12 (no booster sessions).
n.s. (40%)
Administrator
proles
Teachers (61.11%), external professionals (38,89%),
school nurses (5.56%), students (5.56%)
Teachers (60%), external professionals (36.67%),
volunteers (3.33%), n.s. (20%)
Main components Information on drugs alongside general life skills
training, social and personal skills, emotional
control, healthy leisure alternatives, resistance to
social and advertising pressure, and normative
education
Only emotional component.
Only informative component.
Only healthy leisure alternatives.
Some include general life skills training.
Note. n.s.: not specied.
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Víctor José Villanueva-Blasco, Jorge Medina-Martínez, Javier Zaragoza
implemented in Spain, while selective and indicated
prevention is in the minority. Nevertheless, according to
Oord (2000), selective and indicated prevention programs
have some advantages over universal prevention programs,
such as the possibility of treating problems earlier and
potentially being more ecient; Furthermore, eects have
been documented which are up to nine times greater than
with universal prevention programs (Bröning et al., 2012).
Regardless of the level of prevention, and congruent with
Kandel’s Stage Theory (1980), it is observed that alcohol
is the most frequently addressed substance, followed by
tobacco and, lastly, cannabis. School-based preventive
programs thus focus mainly on the use of legal drugs and,
much less so, on illegal ones.
Regarding the age ranges of the target population,
considerable variability was observed. While some programs
reported a range of 2-3 years, which would be equivalent
to application across two school years, other programs had
a higher range, rising to 13 years. This suggests a need to
reect on the suitability of programs and their components
for specic ages, as advised by scientic evidence and quality
standards (EMCDDA, 2011; Robertson et al., 2004). The
application of a preventive program across a broad age
range does not seem appropriate since the needs related
to substance use are dierent, as indicated by a variety of
theories and authors (i.e., Jessor & Jessor, 1977; Kandel,
1980; Simons et al., 1988). It is also known that risk and
protective factors vary with age. (Salvador & de Silva,
2010; U.S. Department of Health and Human Services,
2016). The eectiveness of the dierent components may
therefore be dierent when working with wide age ranges,
complicating the real assessment of their ecacy.
With regard to the theoretical model that these 48
programs use as a reference, which also determines the
components involved, wide variability is observed. Most
notably, 37.5% did not report a theoretical reference.
This fact represents a limitation in compliance with
quality standards since the importance of starting from a
theoretical model for the design of preventive programs
has been indicated (Becoña, 2001). As stated by Vadrucci
et al. (2016), any prevention intervention must be based on
recognized theories since all hypotheses must be based on
theoretical postulates.
Among those studies using a reference model, there is
great variability, with some programs focusing more on
life skills and social inuence components, while others
are more focused on informational, emotional and healthy
leisure components. In this regard, as pointed out by
UNODC (2018) and Villanueva (2017), the evidence
indicates that competency and social inuence models are
the most eective.
In relation to application methodologies, although all
programs generated signicant changes in knowledge
about drugs, non-interactive programs did not have positive
eects on attitudes or drug-use behaviour (Fernández
et al., 2002). For interactive programs, however, several
studies (Cuijpers, 2002b; Fernández et al., 2002; Porath-
Waller et al., 2010; Roona et al., 2000; Tobler et al., 2000)
have established their ecacy in: a) reducing smoking; b)
reducing drinking; c) reducing driving under the inuence
of alcohol; d) reducing the use of cannabis and other illicit
drugs; and e) delaying the age of substance use onset.
Therefore, merely informative programs tend to be less
eective than those based on social learning theory and
having an active methodology (Moral et al., 2005), which
is why international prevention standards (UNODC, 2018)
recommend adopting interactive methods in preventive
programs.
The application intensity of the program or number
of sessions, including booster sessions, also varied, as
did the application methodologies and the administrator
proles. In relation to the number of sessions, UNODC
(2018) and Villanueva (2017) indicate a recommended
minimum of 10 structured sessions, with booster sessions.
Indeed, programs involving a greater number of sessions
have been shown to have a positive impact on the use of
both legal and illegal drugs (Soole et al., 2008). However,
simply having a greater number of sessions or booster
sessions did not mean that a program was necessarily more
eective, since ecacy depends largely on the orientation
of the program and the methodology used. For its part,
given that the positive eects achieved in the short term by
preventive interventions usually fade over time, subsequent
consolidation or booster sessions are recommended
(Fernández et al., 2002; McGrath et al., 2006; Ramos et
al., 2010; Robertson et al., 2004).
Regarding administrator proles, the empirical evidence
does not seem to provide a clear answer. Gázquez et al.
(2011) did not nd signicant dierences in smoking
reduction when the preventive intervention was carried
out by teachers as compared to psychologists. Moral et al.
(2005) and Espada et al. (2002), however, found greater
ecacy when programs were carried out by experts.
Likewise, students who have been trained in the prevention
of drug use have also been described as a good option
(Klepp et al., 1986). Various authors (Espada et al., 2015a;
Fernández et al., 2002; Villanueva, 2017) recommended
that they be implemented by professionals and teachers
together, with the participation of peers. International
standards (UNODC, 2018), meanwhile, recommend is
that preventive programs should be carried out by a person
trained in the eld of drug addiction prevention.
In short, the analysis of the characteristics of the school-
based preventive programs being applied in Spain leads
us to report a wide heterogeneity which, in many cases,
does not correspond to the standards of eective school
preventive programs.
ADICCIONES, 2023 · ARTICLES IN PRESS
Systematic review on the characteristics and ecacy of school preventive programs for drug addiction in Spain
This nding is linked to the other two study objectives,
namely, analysing which preventive programs have
been assessed and what their ecacy is, and whether
they presented characteristics in line with the evidence
on eective preventive programs, as opposed to those
programs that were not assessed.
Of the 48 school preventive programs analyzed, only
18 (37.5%) had publications in scientic journals in
which their results were assessed. The programs with
ecacy evaluations were: Project EX, Unplugged, PASE.
bcn, Construyendo Salud, Programa Saluda, ALERTA
ALCOHOL, En Plenas Facultades, EmPeCemos, ITACA,
Mantente REAL, Programa de intervención psicosocial,
Programa de prevención del IAMS, Programa de
promoción de la salud para la prevención del tabaquismo,
Programa preventivo en Cataluña, RyR2, Sé Tú Mismo/a,
Sobre Canyes i Petes, and Tú Decides.
Of these ecacy assessed programs, those shown to be
most eective had the following characteristics: a) they are
consistent regarding the age of the target population and
the components they incorporate, adjusted to the 12-14
year range, where the highest prevalence of use is found
for alcohol, tobacco and cannabis, and focusing on these
substances; b) they are based on comprehensive social
inuence models; c) they oer from 7 to 16 sessions and
have booster sessions; d) they incorporate components
focusing on knowledge and information, social and personal
skills (decision making, empathy, eective communication,
control of emotions and stress, assertiveness, self-esteem,
motivation, problem solving), healthy leisure, resistance to
social and advertising pressure, critical thinking, general
life skills training and normative education; and e) they
are applied using interactive methodologies, including
activities such as role-playing and gamication. That is to
say, the characteristics of these programs are in line with
international standards and previous scientic evidence on
eective school preventive programs.
In sum, although there are several considerations to
take into account when choosing a preventive program
to be implemented in a school, based on the ndings of
this study, the two programs that were shown to be most
eective are Project EX and Unplugged. Their ecacy
was consistently supported by several studies, which makes
them the best choice for application in the school context.
In addition, Unplugged has the advantage that it addresses
both alcohol, tobacco and cannabis use, while Project EX
focuses exclusively on smoking.
Conversely, preventive programs lacking assessment
of their ecacy, or with such assessment limited to the
information component, without referring to behavioural
change in substance use, have characteristics which are far
from congruent with the evidence on eective school-based
prevention. Regarding age, their ranges are wide, implying
a mismatch between age and the components addressed,
given that these programs do not include sessions staggered
by age, but rather apply the same program at dierent
ages. They are based mostly on general health education
or biopsychosocial models, only occasionally incorporating
aspects of social inuence models. The number of sessions
to be implemented is usually lower than the recommended
10 and booster sessions are generally not contemplated. In
this sense, it is also notable that four out of ten programs
did not report the number of sessions, which is indicative
of a lack of protocolization and planning. The components
incorporated were mostly informative, emotional or
focused on healthy leisure alternatives; this contrasts with
scientic evidence, which has shown that these components
oer the lowest level of ecacy or can even be iatrogenic
if the information provided is not age-adjusted (Becoña,
2001; Moral et al., 2004). Regarding the application
methodology, it is noted that it was usually audiovisual, at
community level, online or participatory, none of which
allow the level of interaction to be clearly established,
which is what has been determined to be most eective.
This study is not without limitations. Firstly, in the
majority of cases, the assessment of drug use was carried
out using self-completed questionnaires, which may
therefore present memory or social desirability biases;
however, there are some articles that controlled for the
latter bias with the bogus pipeline technique (Luna-Adame
et al., 2013). Secondly, some studies had a very small
sample (Alarcó-Rosales et al., 2021; Hernández et al.,
2013; Romero et al., 2017), so it may not be representative
of the target population and the results are dicult to
generalize. Thirdly, it is worth highlighting the attrition
bias due to participant drop-out in longitudinal studies that
were extended over time.
Conclusions
The ndings of this study clearly indicate that two school-
based drug addiction prevention models coexist in Spain.
On the one hand, there is a model based on the design of
programs applying the principles and standards of eective
prevention, which have also made eorts to demonstrate
their ecacy through scientic studies. On the other
hand, we have a model that can be described as “pseudo-
prevention” (Medina-Martínez & Villanueva-Blasco,
2023), if we understand that addiction prevention is a
science and that, consequently, both its design and practice
must be based on scientic evidence and the demonstration
that it really oers preventive results.
The ndings of this study therefore converge with
the priority of the Action Plan on Addictions 2021-24
(DGPNSD, 2022), stating the interest in improving the
availability and ecacy of prevention programs based
on empirically veried data, as well as with the program
accreditation process through the best practice for
ADICCIONES, 2023 · ARTICLES IN PRESS
Víctor José Villanueva-Blasco, Jorge Medina-Martínez, Javier Zaragoza
addictions portal (DGPNSD, n.d.). Socidrogalcohol (n.d.)
was a pioneer in Spain in its page on Evidence-Based
Prevention, which established categories for programs
based on whether or not they had been correctly assessed
and whether they showed positive results. These initiatives
have guided the way forward to greater awareness of
prevention practice within a framework of scientic
evidence and best practice. Other complementary
initiatives could be to limit public nancing only to the
implementation of those programs with demonstrated
ecacy, and to those whose design is aligned with the
principles of eective prevention and are committed to
carrying out an assessment of their ecacy. Likewise,
it is known that having eective preventive programs is
not enough if they are not implemented rigorously or, if
adjustments are necessary, that these are informed through
a process assessment. Therefore, there is an evident need
for the professionalization of prevention through the
accreditation of professionals under standardized criteria,
or the requirement of university degree qualications to
work in the professional eld.
Funding
This study was funded by the Instituto de Salud Carlos III,
Red de Investigación en Atención Primaria de Adicciones
(RIAPAd; grant RD21/0009/0015).
Conict of interests
The authors declare no conict of interest. The funders
played no part in study design, in data collection, analysis
or interpretation, in the writing of the manuscript, or in the
decision to publish the results.
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