Interventions delivered to young people in non-school settings for the prevention of drug use

Drug use is widespread among young people including those still at school.Taking drugs is not a medical problem in itself but can affect physical andmental health and social functioning. People may become dependent on drugs, and use of low risk illicit drugs can escalate into use of higher risk
drugs. In schools, programs have been introduced to prevent or reduce drug use among young people. Non-school settings for interventions include youth
clubs, primary care centres, colleges, with families and in the community. Srategies can target entire populations or be directed at specific groups,
often those at high risk.
The review authors identified 17 controlled studies, 9 cluster randomised studies with 253 clusters and 8 individually randomised studies with 1230
participants. All but two of the studies were conducted in the USA. The other studies were in the UK and China. Follow-up periods varied from at
completion of the intervention to six years. The studies were too few and each intervention too different to draw any firm conclusions on whether
non-school based interventions prevent or reduce drug use by young people.The interventions with suggested benefits need further evaluation before it
can be firmly established that they are effective. One of two studies of motivational interviewing suggested that this intervention was beneficial on
self-reported cannabis use. Three family interventions (Focus on Families, Iowa Strengthening Families Program and Preparing for the Drug-Free Years)
were evaluated, in two separate studies, and may have been beneficial in preventing self-reported cannabis use. The latter two programs were
compared to the school-based Life Skills Training program. All of the eight studies of family interventions included contact with parents, in family
groups or in separate sessions for parents and their children. Multicomponent community interventions did not have any strong effects on
drug use. There were five studies, four of which added the community component to a school drug education program. Education and skills training
was not effective in two studies.
Many of the studies lacked blinding and had high numbers of participants lost to follow up. No study reported cost outcomes.

Authors' conclusions: 

There is a lack of evidence of effectiveness of the included interventions. Motivational interviewing and some family interventions may have some benefit. Cost-effectiveness has not yet been addressed in any studies, and further research is needed to determine whether any of these interventions can be recommended.

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Background: 

Interventions intended to prevent or reduce use of drugs by young people may be delivered in schools or in other settings. This review aims to summarise the current literature about the effectiveness of interventions delivered in non schools settings.

Objectives: 

(1) - To summarise the current evidence about the effectiveness of interventions delivered in non-school settings intended to prevent or reduce drug use by young people under 25;
(2) - To investigate whether interventions' effects are modified by the type and setting of the intervention, and the age of young people targeted;
(3) - To identify areas where more research is needed.

Search strategy: 

We searched Cochrane Central Register of Controlled Trials (CENTRAL - The Cochrane Library Issue 4, 2004), MEDLINE (1966-2004), EMBASE (1980-2004), PsycInfo (1972-2004), SIGLE (1980-2004), CINAHL (1982-2004) and ASSIA (1987-2004). We searched also reference lists of review articles and retrieved studies.

Selection criteria: 

Randomised trials that evaluated an intervention targeting drug use by young people under 25 years of age, delivered in a non-school setting, compared with no intervention or another intervention, that reported substantive outcomes relevant to the review.

Data collection and analysis: 

Two authors independently assessed trial quality and extracted data. Results were tabulated, as studies were considered too dissimilar to combine using meta-analysis.

Main results: 

Seventeen studies, 9 cluster randomised studies, with 253 clusters, 8 individually randomised studies with 1230 participants, evaluating four types of intervention: motivational interviewing or brief intervention, education or skills training, family interventions and multi-component community interventions. Many studies had methodological drawbacks, especially high levels of loss to follow-up. There were too few studies for firm conclusions. One study of motivational interviewing suggested that this intervention was beneficial on cannabis use. Three family interventions (Focus on Families, Iowa Strengthening Families Program and Preparing for the Drug-Free Years), each evaluated in only one study, suggested that they may be beneficial in preventing cannabis use. The studies of multi component community interventions did not find any strong effects on drug use outcomes, and the two studies of education and skills training did not find any differences between the intervention and control groups.

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