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Gordon (1987) in the area of disease prevention,[9] and later Kumpfer and Baxley in the area of substance use[10] proposed a three-tiered preventive intervention classification system: universal, selective, and indicated prevention. Amongst others, this typology has gained favor and is used by the U.S. Institute of Medicine, the NIDA and the European Monitoring Centre for Drugs and Drug Addiction. Level Definition Primary prevention Methods to avoid occurrence of disease.[6] Most population-based health promotion efforts are type. Secondary prevention Methods to diagnose and treat existent disease in early stages before it causes significant morbidity.[7] Tertiary prevention Methods to reduce negative impact of existent disease by restoring function and reducing disease-related complications.[8] Tier Definition Universal prevention Involves whole population (nation, local community, school, district) and aims to prevent or delay the abuse of alcohol, tobacco, and other drugs. All individuals, without screening, are provided with information and skills needed to prevent the problem. Selective prevention Involves groups whose risk of developing problems of alcohol abuse or dependence is above average. Subgroups may be distinguished by traits such as age, gender, family history, or economic status. For example, drug campaigns in recreational settings. Indicated prevention Involves a screening process, and aims to identify individuals who exhibit early signs of substance abuse and other problem behaviours. Identifiers may include falling grades among students, known problem consumption or conduct disorders, alienation from parents, school, and positive peer groups etc. Outside the scope of this three-tier model is environmental prevention. Environmental prevention approaches are typically managed at the regulatory or community level and focus on ways to deter drug consumption. Prohibition and bans (e.g. on smoking, alcohol advertising) may be viewed as the ultimate environmental restriction. However, in practice, environmental preventions programs embrace various initiatives at the macro and micro level, from government monopolies for alcohol sales through roadside sobriety or drug tests, worker/pupil/student drug testing, increased policing in sensitive settings (near schools, at rock festivals), and legislative guidelines aimed at precipitating punishments (warnings, penalties, fines). |
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