There has been a growing enthusiasm for interventions which seek to ensure successful progression through key developmental life stages from the earliest months and years through to young adulthood as a means of preventing mental health, crime and substance use problems. There is something fundamentally appealing about the idea of nurturing and supporting young people so that they are more resilient to the potential problems of modern life. There is also strong evidence that problems with early development are causally related to these other later problems as well as suggestive evidence that early interventions can reduce the risk of substance-related problems. The sharp end of this emerging paradigm, however, is whether funding for existing programs for adolescents and adults should be diverted to further developing such interventions. I believe there are at least five strong reasons why regardless of how much funding is directed towards early interventions, we need to maintain and expand universal interventions targeting alcohol and tobacco in particular. There is insufficient space here to detail the evidence but I hope that the arguments will be of interest Ð forthcoming NDRI publications will fill in the gaps.
1. Adolescent and adult drug use are powerful influences on children
Older siblings, parents, adult role models and celebrities model drug use in ways that influence future drug use patterns. If we let up on evidence-based strategies to help older Australian cut down or quit drug use such influences will be to the detriment of other early intervention programs.
2. Most adolescents who use legal drugs are low or average risk on social and developmental measures
The Prevention Paradox applies in relation to which kids use legal drugs in a risky fashion: while those with high risk scores in relation to social and developmental issues are more likely to smoke regularly and binge drink, the bulk of children who engage in these behaviours are of low or average risk. Studying data from a major Victorian school survey of risk and protection factors for multiple problem behaviours supports this assertion (Bond et al, 2000).
3. Early use of legal drugs is a strong predictor of later substance use problems
There is now a large literature indicating that early use of legal drugs is a predictor both of later problems with these drugs but also with illicit drugs. The argument for causal pathways has not been won but it would be courageous to assert that these strong relationships have absolutely no causal basis.
4. The evidence-base for effectiveness is strongest- especially for young people
Policies which modify the price and availability of legal drugs, especially to young people, have a particularly strong evidence base e.g. via taxation and enforcement of underage purchase laws. There is immense scope for improving our policy responses in these areas, especially for alcohol.
5. The health, social and economic consequences of legal drugs are vastly greater than those of illegal drugs
The facts behind this assertion may be familiar to most people in the drug and alcohol field, but it is worth emphasising that alcohol misuse still contributes more to injury and that tobacco and alcohol kill more than 20 times the number of Australians each year than do all other drugs.
Development and evaluation of early intervention programs should be a national priority. However, while we await for a world in which unemployment, poverty, low educational attainment and family discord are eliminated, we need to maintain best efforts to reduce risky adult drug use and minimise the associated harms.
Bond L, Thomas L, Toumbourou J, et al. Improving the Lives of Young Victorians in our Community: A Summary Report. Melbourne: Community Care Division, Victorian Department of Human Services, 2000.