Recommendations for research
- 1. Long-term consequences of drug use
- 2. Identifying current practice and provision
- 3. Effectiveness and cost effectiveness of drug misuse prevention interventions for groups vulnerable to drug misuse
- 4. Acceptability of drug misuse prevention interventions
- 5. Effectiveness of digital technologies
- 6. Use of image- and performance-enhancing drugs
The advisory committee has made the following recommendations for research.
What are the long-term consequences of drug use?
We identified little evidence on the long-term health and social consequences of using drugs. This made it difficult to determine the full consequences and effect of drug use on people in groups at risk. In particular, there was limited evidence on the long-term effects of using drugs other than cannabis. More evidence on the long-term consequences of drug use would enable more accurate modelling of the costs of drug use. This would in turn allow more accurate modelling of the cost effectiveness of drug misuse prevention interventions.
What drug misuse prevention activities are currently used in the UK for groups at risk of drug misuse?
It is unclear what current practice is, and what provision is currently in place, for drug misuse prevention in groups at risk in the UK. Studies in the current review showed that active interventions were no more effective than current practice (as received by a control group). In addition, there is a lack of UK-based studies, and it is not clear whether the current practice that was used as a control group in studies conducted elsewhere is applicable to the UK population.
It is not clear how many of the people that are referred to drug misuse prevention services attend (or are brought to) the services. Identifying existing practice and provision will allow new drug misuse prevention activities to be compared with current practice, identify gaps in current provision, and determine what proportion of people referred to drug misuse prevention services do not attend (or are not brought) to services.
3. Effectiveness and cost effectiveness of drug misuse prevention interventions for groups vulnerable to drug misuse
What is the effectiveness and cost effectiveness of drug misuse prevention interventions for groups vulnerable to drug misuse in the UK?
We identified limited evidence of effectiveness or cost effectiveness of interventions for groups vulnerable to drug misuse in the UK. In particular, no evidence was identified on the effectiveness and cost effectiveness of drug misuse prevention interventions for people involved in commercial sex work or who are being sexually exploited, people not in employment, education or training, and people who attend nightclubs and festivals.
Most of the evidence identified comes from studies in the US. Furthermore, it was unclear which components of interventions were essential for effectiveness and cost effectiveness.
The differential effect of interventions on groups at risk needs to be established, particularly for people with multiple vulnerabilities. The accuracy of tools for assessing vulnerability to drug misuse also needs to be determined. Interventions of interest include one-to-one skills training, information and advice as part of planned outreach activities, and wider behaviour change strategies. It is also important to know whether the effectiveness of interventions is affected by the content and framing of the message, the mode of delivery, where the intervention is delivered and the intended recipient of the intervention.
Primary outcomes of interest include a direct measure of drug use. Longer term outcomes (longer than 1 year) from longitudinal studies are needed. Research on location-based interventions, for example at nightclubs or festivals, would provide prevention data for hard-to-reach groups and those who do not access existing services. Research could also consider prevention in people with multiple vulnerabilities and the use of new psychoactive substances.
How acceptable are drug misuse prevention interventions among groups vulnerable to drug misuse in the UK? How acceptable are drug misuse prevention interventions among practitioners in the UK? How can acceptability be improved for groups that are vulnerable to drug misuse and practitioners?
We identified little evidence on the acceptability of drug misuse prevention interventions for groups vulnerable to drug misuse. The evidence that was available was limited by the small number of studies and participants, and in the overall quality of the studies.
Acceptable interventions are important to increase the uptake of interventions and reduce the number of people who do not attend (or are not brought to) services following a referral. Studies are needed on interventions that are acceptable to people with different levels of self-efficacy and understanding about health. It is also important to know which interventions are more acceptable to particular groups at risk. Interventions that are more acceptable to practitioners are more likely to be implemented with groups at risk. Research on the framing of messages, such as abstinence-based approaches, is needed because some ways of framing interventions may be more acceptable than others to people in groups at risk. Research is also needed on who delivers the interventions, as this may also affect the acceptability of an intervention.
How effective and cost effective are digital technologies, such as web-based interventions, online self-assessment or targeted new media, for drug misuse prevention among groups at risk in the UK?
We identified limited evidence on digital interventions and targeted new media, with existing studies focusing on web-based and text messaging interventions. Interventions and assessments that use digital technology are potentially more cost effective than those delivered face to face and could be used for prevention activities in groups at risk who are harder to reach or who do not present to services. The use of digital technology could also allow people to use sources of support anonymously and help maintain engagement.
Research is needed on effectiveness, cost effectiveness and acceptability of interventions and self-assessment using digital technology. Studies could compare interventions delivered using digital technology with face-to-face interventions. Studies could also look at using interventions that use digital technologies as part of a stepped care model.
What are the most effective and cost effective interventions to prevent and reduce the use of image- and performance-enhancing drugs?
No evidence was identified for interventions to reduce the use of image- and performance-enhancing drugs. Several different types of drugs can be classed as image- and performance-enhancing, including drugs that are used by people trying to lose weight (such as laxatives), those used to gain weight or increase physical performance (such as anabolic steroids), and those used to increase cognitive ability (such as methylphenidate). People using these drugs may not identify as drug users, making it difficult to provide preventative interventions. In addition, image-and performance-enhancing drugs are available online and can be accessed by a wide range of people.