17/1/2020
Interview with the especialist

Matej Kösir

1. What works in the prevention of substance abuse?
We all (hopefully) agree that the authorities and other responsible institutions should invest their resources on effective evidence-based prevention practices, which are based on scientific theories and needs assessment, correspond to the age and the level of risk of target groups, and are culturally adapted and evaluated, especially regarding the outcomes and impact on target populations. All prevention interventions should be implemented by trained staff and the programme should be carefully planned from the beginning until the end. Regarding school-based programmes, the support should be provided from the entire school staff (including management), wider school community (including parents), local authorities, and other key local stakeholders. Prevention interventions should also be based on adequate intensity and duration, and interactivity. They could include some effective components such as normative education, social and personal skills training, and emphasis on short-term effects of substance use rather than on information on long-term consequences, which seems to be irrelevant and ineffective for children and young people.

2. What specially works in the prevention of alcohol use?
Prevention interventions are at their best in a context where authorities try to limit overall alcohol consumption by means of supportive legal regulations good rules. The World Economic Forum and the World Health Organization (WHO) recommend, based on scientific knowledge, governments to implement three types of legislative measures. They call these measures »best buys«, because they are both effective and affordable. The first measure they recommend is raising the price of alcohol. Given the risks and costs of consumption, the product alcohol is in many countries too cheap and thereby too easily obtainable which is extra risky for especially young people and excessive drinkers. The second measure is to limit the availability of alcohol. For example, by limiting the number of outlets and to set a sales age limit of 18 or 21 years. The third measure is the establishment of a ban on alcohol marketing and sponsoring. To obtain sustainable support for these three measures, systematic information about alcohol as an addictive, carcinogenic psychoactive substance and about the personal and social consequences of drinking is of large interest.

3. What substances causes more harms nowadays?
Based on rather experimental and to some extent controversial analysis by Prof David J Nutt published in the Lancet journal in 2010, substance-specific and substance-related harms for some substances can be estimated from health data and other data that show alcohol, heroin, and crack cocaine as having much larger effects than other substances. If we want to estimate the harm caused by specific substance as correctly as possible, then we have to take into consideration not only health data (such as mortality, damage to physical health, addiction, mental health problems etc.), but also social harms (especially harm to others). These include road traffic and other accidents at home, substance-related violence and crime, costs to economies, communities, families etc. Considering all the criteria (health and social), it is clear that alcohol is by far the most harmful substance in the world and we definitively have to do more in this area in the near future.

4. Should prevention strategies focus on improving environment (e.g. settings) or individual behaviour of people?
In my opinion, both approaches are equally important. There is a complex world where people are subjected to multiple environmental influences and prevention interventions try to help them to adjust their behaviour and support their health and well-being. However, if there is a strong support in policies and rules, people improve their behaviour much easier, although they are sometimes forced in a way to do so. I often take an example from my friend Prof Mihela Erjavec from Bangor University (United Kingdom) to explain my opinion: a family doctor who smokes tobacco and eats fast food. They do not lack information about the harmful effects of smoking and poor diet. Right? They clearly have a lot of willpower, because they have persisted through a long and arduous course of studies and specialisation to achieve their goal of becoming a doctor. So why are they damaging their health and shortening their life? In this case, environmental strategies (such as ban on smoking in and around hospitals or limited density of fast food kiosks in the area of hospitals) could help much more than any other intervention based on information and awareness, healthy lifestyle promotion among doctors or non-binding hospital guidelines on smoking prevention and healthy diet.

5. How can parents talk about drugs to their children?

Discussing drugs with children is an insufficient strategy. Why? Friends exert a great influence on their behaviour – peer pressure or (better) peer affiliation. Nightlife and other activities influence their behaviour. Advertising and informal norms influence their decisions. Teens already have access to all the information they need, but usually disregard it as outdated or not relevant to them. Simply talking to children about drug issues has no impact on their substance use. The time and also the quality of time parents dedicate to children is essential as a preventive measure.

6. Must parents monitor their children and teens?
Among most effective preventive strategies are child supervision and setting family rules that parents have to stick to. How to supervise is rather common question among parents. The answers are multiple. Knowing where your children go and with whom when outside home. Managing schedules and controlling their economy (e.g. pocket money). Monitoring their activities. Being familiar with their friends. Being in contact with their friends’ parents. Participating with other parents in prevention activities etc. Parental permissiveness is the main risk factor for substance use among children and youth. Parental control works as a preventive factor if exercised effectively and consistently, especially when supervising access to substances and children’s activities outside the home. To prevent substance use, it is essential to give clear and effective rules about what is not allowed.

7. Are scare tactics helpful in prevention?
Not at all. They should be avoided completely. It is understandable why some people feel that showing the more terrifying results that can occur from substance use will »put people off« using them. The reality is that the research would indicate this does not work! It may have a short-term impact on some. It may even have a longer-term impact on those who are never likely to become involved. However, as a single strategy it is very likely to fail. Many years ago, my friend Jeff Lee from ISSUP perfectly explained this question in one of our joint publications. Young people are always able to see such portrayals of substance use as »unrealistic« - it does not match their own experience of what happens when others they know and see use them. They are also good at the »it will never happen to me« and »my Granny smoked for 70 years and she was ok« response. Young people live in the here and now and not in the long-term future outcomes area. We know from the research into brain development that young people’s brains during adolescence are prone to seek pleasure and excitement and that their ability to consider consequences of behaviour comes later (not before they are 24 or 25 years old). This is another reason why this approach is not a good and helpful approach.

8. What motivates your working in the field of prevention?
During my professional career in public administration in the field of public health many years ago, I realized that prevention is not well developed in my country (Slovenia) and that the majority of public funds are invested in ineffective and even harmful practices. That motivated me at that time (in 2006) to establish my own private prevention research and development institute (UTRIP) together with my wife Sanela Talić and start focusing all my work on improving the situation in Slovenia and wider. It is still far away from perfect, so I still have pretty much the same motives as at the beginning – improving things in prevention policies and practice, advocating for more regular and sustainable funding for civil society organisations, disseminating evidence-based interventions all over Europe, bridging the gap between prevention science and practice etc. However, UTRIP has nevertheless achieved a lot as prevention think tank in the last decade, it has been involved in more than 25 European Union (EU) funded projects and programmes, it has collaborated with referential institutions and organisations from all over the world (also from Brazil). In the meantime, prevention becomes my lifestyle. I live prevention 24 hours a day, so I will probably die doing something in prevention.

9. How Obid can contribute to your work?
Obid as a responsible institutions has to become a national »champion« in this field in your country by a) promoting and supporting further development of prevention science and practice, b) bridging the gap between academics, policy and decision makers and practitioners, c) advocating for implementation of international prevention standards and evidence-based policies and practices (especially in the field of alcohol and tobacco), d) investing in education and training of prevention workforce, and e) supporting regional and local authorities and civil society organisations in the process of developing effective regional and local prevention systems. It would be an honour for UTRIP if we can contribute to the work of Obid as well with many years of experience and expertise in this field. Let us make Brazil a better place for everybody together, especially for children and youth. Thanks!

Matej Košir is the Director of UTRIP. He has been working in the field of addiction prevention and alcohol, tobacco and other drugs (ATOD) related policies for the last 21 years. He is an author, co-author and reviewer of scientific articles and papers, and external evaluator of EC-funded projects in the field of health and research. He is a lecturer and facilitator of trainings and workshops in the field of prevention and advocacy. He has been a Postgraduate Research Assistant at the Oxford Brookes University (UK) in the period of 2015-2016. He has been a senior consultant of the World Bank Group in the field of alcohol policy and prevention between January 2017 and June 2019. He is a coordinator of the Prevention Platform network, which includes more than 40 supporting institutions and organisations (mostly NGOs) in Slovenia. He has been involved in more than 25 EU-funded projects in different European Union’s programmes (e.g. Health Programme, 7th Framework Programme, Erasmus Plus Programme, Justice Programme, Drug Policy Initiatives Programme, Drug Prevention and Information Programme, Lifelong Learning Programme, Youth Programme, European Social Fund etc.). The European Society for Prevention Research (EUSPR) has awarded him with “Leading European Prevention Science Practitioner Honour” in 2017. He is a Prevention Science PhD student at the Faculty of Education and Rehabilitation Sciences, University of Zagreb (Croatia).