From the early 20th century to the present day, an overview of the origins of drug use prevention, past mistakes and the current situation in this field
By the Dianova team – Over the past 40 years, prevention has become a key focus of public intervention in many areas, including responses to social issues such as alcohol and other drug use. Prevention strategies are now most often part of a comprehensive approach combining prevention, treatment and harm reduction, and taking into account the needs of people who use drugs and those of society as a whole.
These initiatives are developed on the basis of applied research in the humanities and social sciences, and their implementation and evaluation are based on scientifically validated strategies designed to answer one key question: do they work?
Understanding risk factors is crucial in modern drug prevention interventions, as it enables us to address the root causes of substance use and promote protective factors such as strong family bonds, engagement with school, and community support – Image by stokpic from pixabay, via Canva
Rather than raising awareness of the ‘dangers of drugs’, most initiatives today prefer to target risk factors and protective factors at the individual, family, community and environmental levels. These interventions are designed to be person-centred, while taking into account the many complex interactions between personal and environmental factors that may make certain populations more vulnerable to substance use or addiction. However, this has not always been the case. So what was prevention like before? Is prevention today so different from what it was in the past?
The origins of prevention: combating the ravages of alcohol
All forms of prevention stem from the 19th-century school of thought influenced by Pasteur’s work on the spread of disease: hygienism. This developed in a society plagued by diseases such as tuberculosis and cholera, which were widespread in most European countries, as well as in India, the United States and Canada.
With regard to substance use, it was alcohol that initially became the focus of efforts in Western countries. . In the countries concerned, the Industrial Revolution caused a profound change in drinking habits and exacerbated related problems. The advent of industrialization precipitated a period of exponential growth in the production, transportation and commercialization of alcohol. In urban areas, which experienced a significant increase in population following the rural exodus, millions of workers, reliant on their employers and lacking in social rights, found solace in alcohol, which had become readily available and inexpensive. Alcohol consumption increased significantly, as did the associated problems.
At the time, excessive drinkers were seen as a threat to their jobs, their families and society as a whole. In response, the temperance movement gained strength in America and Europe in an effort to combat alcoholism.
The temperance movement, a group of religious associations and leagues committed to combating the social ills of alcoholism, fought against the consumption of alcohol in the name of morality, good manners and the protection of the family unit. The influence of this movement grew until it reached its zenith in the early 20th century with the advent of alcohol prohibition laws, not only in the United States, but also in Canada, Finland and Russia – with the results we all know.
“The voluntary slave” – press illustration published in “La Fraternité” (France) for the Popular Anti-alcoholic league, author Adolphe Willette – circa 1875 – Adapted from screenshot from L’histoire par l’image
What about illegal drugs?
At the dawn of the 20th century, the concept of ‘illegal’ drugs had yet to be established. Europe and America had recently discovered a ‘remarkable substance’ – cocaine – lauded for its medicinal properties, touted as a panacea for all maladies. Initially imported in small quantities for medical research, its use grew rapidly, particularly within the medical community, and it was prescribed to treat a wide range of ailments, from toothache to morphine addiction. Sigmund Freud himself considered at the time cocaine to be a highly effective medicine for depression and stomach problems without causing addiction or side effects. With regard to cannabis and hashish, these were still available for purchase in all reputable pharmacies, while heroin, a registered trademark of the Bayer pharmaceutical company, was regarded as a sovereign remedy for… coughs.
It should be noted that the issue of substance addiction had not yet manifested itself in the context of affluent, colonizing nations. Elsewhere, the perspective was somewhat different: in a distant country – China – opium had already been wreaking havoc for several decades.
Introduced and marketed by Europeans, it had become a pervasive national scourge affecting millions of Chinese people. Opium addiction is a prime example of the impact of colonialism on local societies: not only did it trigger two wars against Western powers concerned solely with their economic interests (profits from the opium trade), but it also had profound social and political consequences that are still felt today.
The Western countries’ ‘honeymoon’ with drugs was not to last. The problems they posed became apparent rapidly and, under the influence of American temperance leagues, they swiftly transitioned from being regarded as a universal remedy to being perceived as a threat to society and moral values. This marked the beginning of American policies predicated on drug control (or the war on drugs, depending on one’s perspective), which would shape global policies in this domain for over a century.
The demonization of ‘drugs’
The demonisation of drugs, the effects of which were felt from the beginning of the 20th century, is closely associated with a set of social, racial, political and economic dynamics that resulted in the stigmatization of both the substances themselves and the people who consumed them. As early as 1906, the United States initiated the legislative process, and the phenomenon grew until it culminated in a particularly restrictive and repressive international drug control policy – but that is another matter.
In the 1930s, the American government initiated a media offensive involving the use of racist stereotypes, sensationalist media, and political propaganda to portray cannabis as a dangerous substance that led to violence, insanity, and moral decay.
The process of demonizing drugs was gradual yet unstoppable. The discourse surrounding narcotics such as morphine, opium and heroin was initially shaped by their association with specific demographic groups, namely minorities, the economically disadvantaged, and migrants. This demonization continued over the following decades, fuelled by media sensationalism and public panic, particularly around the use of cocaine and cannabis – substances that were claimed to be the root cause of criminal behaviour and moral corruption.
The criminalization and stigmatization of substances and those who use them have had a profound impact. Not only have they perpetuated and reinforced racist prejudices against Afro-descendant, Latin American and other historically marginalized communities, but they have also completely distorted the approaches and prevention efforts implemented subsequently.
Early drug prevention initiatives
Before the 1960s, the ‘drug phenomenon’ was virtually non-existent in industrialised countries. Apart from a few opium enthusiasts, alcohol and tobacco reigned supreme in the field of substance addiction.
From the 1960s onwards, there was a rapid increase in the use of illegal drugs in the United States, particularly among the counterculture movement. The use of LSD and cannabis – and, to a lesser extent, amphetamines and heroin – spread and became a symbol of rebellion against authority, as part of a broader movement focused on social change.
Within the collective imagination, the 1960s are often regarded as the golden age of illegal drug use. This period was characterised by widespread use of cannabis, as well as the significant distribution of heroin among children in impoverished neighbourhoods. Notable figures such as Timothy Leary, a prominent Harvard professor, popularised the effects of LSD. However, an analysis of historical data reveals that the phenomenon was not as widespread as is commonly believed. Conversely, however, there was a marked increase in the perception of risk associated with drugs. For instance, in 1969, a mere 4% of American adults reported having used cannabis at least once. However, 48% of respondents indicated that drug use was a serious problem.
While many current prevention efforts have a solid theoretical basis and evidence of effectiveness, historic prevention strategies were often based on intuition and guesswork, with an emphasis on such scare tactics as the one depicted above (“Your brain on drugs” campaign, initially launched in 1987)
The notion of prevention as a concept was first developed in the early 1960s within the domain of mental health and behavioural disorders. In the context of drug policy, the first initiatives were echoing the pervasive fear of drugs that was prevalent in both America and Europe during that period. Logically, the primary initiatives were consistent with the propaganda campaigns initiated in previous decades with the objective of demonizing cannabis. The objective of these initial prevention initiatives was not to promote education, but rather to instil a sense of fear and intimidation.
‘People of my generation were taught that cannabis caused acne, blindness and sterility. It was a tactic based on fear, not on educating people.’
Children and young people in the 1960s and 1970s were no more stupid than anyone else and just as observant. They quickly realised that the messages promoted by schools and families did not correspond to reality.
So simple, ‘Just Say No’.
In 1971, Richard Nixon declared drug abuse ‘public enemy number one’ and launched a widespread campaign against drug use, distribution and trafficking. This marked the beginning of a government policy that led to the incarceration of both traffickers and users. The policy would have far-reaching consequences for many countries, whilst in the United States it would have a disproportionately negative impact on the Black community.
The notion that one should ‘Just Say No’ to drugs is predicated on a rudimentary interpretation of the rational choice model, according to which people choose their behaviour in order to maximize rewards and minimize costs (negative consequences).
Nancy Reagan at a “Just Say No” rally at the White House in May 1986 – White House Photographic Collection, public domain
The D.A.R.E. programme: information is not enough
From 1983 onwards, this concept became central to the D.A.R.E. (Drug Abuse Resistance Education) programme. Initially implemented in Los Angeles, this school-based programme aimed to help young people understand that the harmful consequences of drug use far outweigh any perceived benefits. Young people can therefore avoid these consequences by refusing to take drugs.
The D.A.R.E programme’s model was based on three key elements: 1) drugs are bad; 2) when children understand how bad drugs are, they will avoid using them; and 3) the message is more effective when delivered by police officers, who are considered credible.
The programme was subsequently developed in the United Kingdom, and a similar model was adopted elsewhere in Europe during the same period — notably by associations of rehabilitated individuals — which replaced the credibility of police officers with that of former drug users ‘who could speak from experience’.
In response to findings on the ineffectiveness of the DARE programme, a new curriculum was developed (2009) with a stronger focus on interactive activities and decision-making skills, moving away from the traditional lecture-based approach by a police officer – AI-generated image, via Canva
Over the years, the programme has been the subject of extensive study. One study found that people who completed the programme had higher levels of drug use than those who did not. Another study found that teenagers enrolled in the D.A.R.E programme “were just as likely to use drugs as those who received no intervention”.
The impact of popular culture
The aim here is not to portray the D.A.R.E. programme or similar interventions solely in an unfavourable or ridiculous light. Even though it has lost its central position, the programme is still implemented in most US states, and according to its website, it has been developed in 29 countries since its creation. It is true that the programme has since been adapted to incorporate various aspects, such as resistance to peer pressure and the development of social skills.
However, these initiatives face a major difficulty from the outset. As we know, experimentation and risk-taking are part of normal adolescent development, which is why providing young people with detailed information about different substances is likely to arouse their interest in these drugs, especially if the information is not presented in an appropriate manner. Secondly, this type of strategy only has an impact on young people who are susceptible to alarmist messages because of their cognitive patterns, and is not effective for everyone else, as we now know.
Officers in the DARE programme would sometimes arrive in sports cars seized from drug traffickers to exemplify their message on drugs and crime (Crime does not pay) – A Pontiac Firebird in D.A.R.E. livery in Evesham Township, New Jersey – image: Jay Reed – Flickr, licence: CC BY-SA 2.0
Furthermore, when talking about drugs, one must also consider the influence of popular culture, which, without openly glorifying substance use, often portrays alcohol, tobacco, and other drugs in a favourable light, particularly at an age when young people are most receptive.
We now know that providing information about drugs is not enough to make for a good prevention policy. While education and awareness can always play an important role, they are not sufficient, nor even necessary, to prevent addiction.
Should we talk about drugs to prevent drug use?
According to Dr Rebecca Haines-Saah, who spoke at a webinar organised by Dianova last May, the most effective drug prevention strategies do not focus on drugs, but on much broader social issues, such as reducing poverty, combating discrimination and implementing targeted community programmes.
Some prevention strategies even choose not to mention drugs at all, yet they have proven effective in reducing substance use by focusing on broader social, environmental and behavioural factors.
These approaches aim to create conditions that indirectly discourage drug use, particularly by strengthening social skills and improving people’s living conditions. For example, programmes focused on improving the school environment, teaching social skills or promoting healthy lifestyles can have a positive impact on reducing substance use without explicitly targeting drugs.
Similarly, family interventions that strengthen parent-child relationships and improve communication can also help prevent substance misuse by targeting underlying risk factors. These strategies highlight the importance of a holistic approach to prevention that goes far beyond direct drug education.
Prevention is a science
Preventing substance use – i.e. the use of all psychoactive substances regardless of their legal status – involves helping people, particularly young people, to avoid using substances. If they have already used substances, the objective is to prevent them from developing substance use disorders (problematic use or dependence).
However, the overall objective is much broader, as highlighted by the UNODC in the second edition of the International Standards on Drug Use Prevention. It also involves ensuring that children and adolescents grow up healthy and safe, so they can fulfil their potential and become active and productive members of society.
Drug prevention is now grounded in research and evidence-based practices. This multi-disciplinary field has developed over the last forty years, aiming to improve public health by identifying risk and protective factors, assessing the efficacy of preventive interventions, and identifying optimal means for dissemination and diffusion – AndreyPopov from Getty Images, via Canva
There is now a vast body of literature on substance use prevention. Its aim is to highlight effective and less effective strategies based on scientific evidence in order to guide decision-makers and practitioners in the field in their choices. Despite this, prevention activities are still sometimes poorly prepared and based primarily on beliefs or ideologies rather than scientific knowledge.
At Dianova, we believe that addiction prevention, particularly among young people, must take into account societal changes (new drugs, new patterns of use, changes in legislation, etc.) using scientifically validated strategies based on standards and methodological guidelines.
These strategies are based in particular on:
- The acquisition of psychosocial skills (problem solving, decision-making, interpersonal skills, stress management, etc.),
- Interventions aimed at developing parenting skills (e.g. communication skills, conflict management, setting boundaries, etc.),
- Prevention strategies tailored to young people with vulnerability factors (e.g. those whose parents suffer from substance use disorders) and taking into account gender perspectives, abandoning androcentric strategies that obscure the situation of girls and LGBTQI+ communities.
In conclusion, we must bear in mind the mistakes of the past so as not to repeat them and, above all, understand that no prevention system is sufficient on its own. Whatever approach is chosen, effective prevention systems must be evidence-based and integrated into broader, balanced systems that focus on health promotion, the treatment of substance use disorders, risk and harm reduction, and countering drug trafficking.
Effective, science-based programmes that can make a real difference to people’s lives can only be developed by integrating all these elements.
Source: https://www.dianova.org/publications/a-brief-history-of-drug-prevention/
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The Princess of Wales is patron of The Forward Trust, a charity devoted to assisting addicts to remain abstinent from their drug of addiction. She has just spoken out forcefully against the view that addiction is weakness of will or any kind of moral problem.
“Addiction is not a choice or a personal failing,” she said, implying thereby that it was a medical condition like any other, such as Parkinson’s disease or multiple sclerosis. She said that “people’s experience of addiction in still shaped by fear, shame and judgment, and that this ought to change”.
I am sure that HRH meant well, and that she feels genuine sympathy for addicts; but unfortunately, her view is simple, unsophisticated, dehumanising and empirically false.
It is dehumanising because, by denying that addiction is a choice, it deprives addicts of their agency both in theory and to a certain extent in practice. If, after all, you persuade someone that he does not make a choice in doing something, you also persuade him that choice cannot prevent him from doing it. He is not a human being like you and me, but a helpless feather on the wind of circumstance.
This turns him into an object, not a subject, both to himself and others. Such a view is implicitly degrading, demeaning and far from compassionate. It implies the need for an apparatus of care to look after him, much as one would look after an animal in a menagerie, with kindness but not with much respect.
Take the case of the injecting heroin addict and think what he has to do and learn to become such an addict. He has to learn where to obtain heroin and how to prepare it. He has to learn to disregard its unpleasant side effects. He has to overcome a natural aversion to pushing a needle into himself. This is not something that just happens to him.
Moreover, not only do most addicts take the drug for some time before becoming physically addicted to it, but they are fully aware in advance of the consequences of taking the drug long-term. Addicts are not “hooked” by heroin, as they often put it; rather, they hook heroin.
It is untrue that addicts require a professional apparatus to overcome their addiction. Millions of people have given up smoking, though nicotine is addictive. During the Vietnam War, thousands of American soldiers addicted themselves to heroin and gave up, with almost no assistance, one they returned home.
In 1980, Porter and Jick pointed out that people treated with strong painkillers as in-patients in hospital did not go on to become addicts once they left hospital. This was unfortunately interpreted to mean that such drugs were not addictive; but, on the contrary, it shows that addiction, in the sense of continuing addictive behaviour, is not straightforwardly a physiological condition.
At the root of the Princess’s misapprehension is the post-religious or secular view that if a person is the author of his own downfall, he is due no sympathy or compassion. It is a highly puritanical view, and since we do not want to be puritans, we make the problem a medical one instead. But since we are all sinners and the authors of our own downfall, at least in some respect or other, this also has the corollary that sympathy or compassion is due to no one when he needs it.
The Princess appears to think that if you say to an addict that he has behaved, and continues to behave, foolishly and badly, you are necessarily saying to him, “Go away, darken my doors no more”. She seems to think that the truth, far from setting people free, will imprison them until someone comes along with a technical key to unlock them.
Of course, some addicts benefit from assistance, but not for the reasons the Princess supposes. Medication may reduce their physical sufferings, and if we take once more the example of injecting heroin addicts, we discover that they may well have so destroyed their relations with everyone – their families and friends – that there is no one to whom to turn if they desire to change their ways. They thus need a helping hand, but this is not the same as removing fear or stigma (a very necessary, though not sufficient, aid to civilised life). Though she did not mean them to be so, the Princess’s words were not so much demoralising, as amoralising.
Source: https://www.telegraph.co.uk/gift/51db8fdbd5d80cb6