Framing substance use as "recreational" is neither accurate nor helpful for prevention purposes.

This debate paper discusses six reasons why the term "recreational substance use" should be avoided. (1) Social norms and beliefs are drivers of behavior; therefore, the normalized use of the term conveys injunctive norms of a fully socially acceptable substance. Injunctive norms are the most important drivers of initiation into substance use. (2) The illusion of being in control, suggesting that if consumed for leisure and recreation it can easily be controlled; (3) Idealized social representations that fuel an idealized image of an alternative glamourous or mindful consumption culture; (4) Downplaying potential harms; (5) The implicit promise of everyday pleasure, the ever-growing potency of cannabis products does not fit the narrative of its use for recreation; (6) Industry as a trojan horse branding discourse of the concept of medical cannabis to normalize the image of non-medical use: to complement "therapeutic" with "recreational". "Recreational use" is a subjective ill-defined term. This debate paper aims to find a better terminological solution, honestly denominating with a neutral, unbiased, and objective connotation what is now called "recreational use". Thus, we propose using the term "non-therapeutic" use.

Lo que la COVID nos podría enseñar sobre los dilemas y retos de la prevención / What COVID could teach us about the dilemmas and challenges of prevention

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[SBIRT model as a prevention strategy against addiction with and without substance in teenagers.] / El modelo SBIRT como estrategia de prevención de las adicciones con y sin sustancia en adolescentes.

A high prevalence of adolescent substance use, risky consumption patterns and the decrease in the age of initiation, together with the growth of non-substance addictions, represent a huge challenge for Public Health. This suggests the need for a change of focus in the work of the primary care settings, which must be more proactive in the early detection and intervention. Although there are some previous experiences in Spain, we do not have a duly standardised system, based on clinical practice and validated in consulting rooms, which could be used in a general, simple, and guaranteed manner. The SBIRT (Screening, Brief Intervention and Referral to Treatment) model, developed in the United States and conceived from a Public Health perspective, might represent such a paradigm shift. The aim of this paper was to provide researchers and professionals with a review of the available evidence in different countries, with a view to implementing it in Spain, where SBIRT remains a challenge. In addition, theoretical and technical foundations, and potential of the SBIRT are described. Not only its possible benefits and opportunities are put on the table, but also the shortcomings, limitations and needs that must be overcome for SBIRT implementation to be possible.

La alta prevalencia del consumo de sustancias entre los adolescentes, los preocupantes patrones de consumo y el descenso de las edades de inicio, junto al crecimiento de las adicciones sin sustancia, suponen uno de los grandes desafíos actuales en materia de Salud Pública. Ello sugiere la necesidad de un cambio de enfoque en la labor de los dispositivos de Atención Primaria (AP), que han de ser más proactivos en la detección e intervención precoz. Aunque en España existen algunas experiencias previas, no disponemos de una sistemática debidamente protocolizada, fundamentada clínicamente y validada en las consultas, que pueda ser utilizada de forma generalizada, sencilla y con garantías por los profesionales. El modelo SBIRT (Screening, Brief Intervention and Referral to Treatment), desarrollado en Estados Unidos y concebido desde un enfoque de Salud Púbica, representa ese cambio de paradigma. El objetivo de este trabajo, además de dar a conocer los fundamentos teóricos, técnicos y potencialidades del SBIRT, fue poner a disposición de investigadores y profesionales una revisión de la evidencia disponible en diferentes países, de cara a su posible implantación en España, donde a pesar de la existencia de experiencias precedentes puntuales, constituye todavía una cuenta pendiente. Se ponen sobre la mesa no sólo los posibles beneficios y oportunidades, sino también las carencias, limitaciones y necesidades que han de superarse para que la implementación del SBIRT sea posible.

"Tell Me How Much Your Friends Consume"-Personal, Behavioral, Social, and Attitudinal Factors Associated with Alcohol and Cannabis Use among European School Students.

BACKGROUND: Substance use in European adolescents remains a serious health concern. Assessing what affects adolescents' substance use is crucial for implementing effective prevention. This study aims to examine alcohol and cannabis use-related behavioral, social, and attitudinal variables that might directly be considered to guide prevention responses for adolescents. METHODS: Cross-sectional data of 78,554 15-16-year-old school students from the 2011 European School Survey Project on Alcohol and Other Drugs (ESPAD) from 26 European countries were analyzed. Self-reported drunkenness in the last 30 days and cannabis use in the last 12 months served as dependent variables. To investigate which factors are associated with risky substance use, multivariable logistic regressions were used. RESULTS: 17.7% of respondents reported drunkenness in the last 30 days, and 14.9% used cannabis in the last 12 months. The most important predictor for risky substance use was the perception that most/all of their friends engaged in substance use behavior, followed by lack of parental support, low personal adherence to rules, and low school performance. CONCLUSION: Interventions addressing the perceived descriptive norms either directly or by changing environmental cues, opportunities, and regulations, as well as effective parenting and academic support may prevent and reduce risky substance use behavior among adolescents.

Cannabis use among adolescents: Risk pattern, implications and possible explanatory variables. / Consumo de cannabis entre adolescentes: patrón de riesgo, implicaciones y posibles variables explicativas.

In contrast to the achievements with other substances, it has not yet been possible to reduce the levels of cannabis use, the most used illegal substance among Spanish adolescents. The objective of this paper consists of updating levels of use (incorporating ages 12 and 13), estimating high-risk use and analyzing possible associated variables. For this purpose, a correlational method was used consisting of the administration of a survey to compulsory secondary school and high school students from the autonomous community of Galicia (Spain) in 2016. Results obtained from a sample of 3,882 Galician adolescents aged 12 to 18 (M = 14.52; SD = 1.72) reveal that the percentage of adolescents currently using tobacco and cannabis is higher than that of those using tobacco alone (12.7% vs 10.5%). This implies not only a higher probability of using other illegal substances, but also of developing rather high-risk use pattern, binge drinking or even experiencing problematic Internet use or cyberbullying. From a preventive perspective, the results reveal that personal variables such as self-esteem, assertiveness, social skills or impulsiveness have really weak explanatory power compared with other variables related to the setting of rules and limits by parents. One of the main conclusions of this paper is the need to adopt a comprehensive prevention approach.

Contrariamente a lo que ocurre con el resto de sustancias todavía no se han logrado disminuir los niveles de consumo de cannabis, que sigue siendo la droga ilegal más consumida entre los adolescentes españoles. El objetivo de este estudio consiste en actualizar los niveles de consumo (incorporando la franja de edad de 12-13 años), estimar los consumos propiamente de riesgo y analizar las posibles variables asociadas. Para ello se ha utilizado una metodología correlacional consistente en la realización de una encuesta a estudiantes de ESO y Bachillerato de la comunidad autónoma de Galicia (España) en el año 2016. La muestra final estuvo compuesta por 3.882 adolescentes gallegos de entre 12 y 18 años (M = 14,52 y DT = 1,72). Los resultados obtenidos revelan que a día de hoy es ya mayor el porcentaje de adolescentes que consumen tabaco y cannabis que únicamente tabaco (12,7% vs 10,5%) y que ello no sólo implica una mayor probabilidad de consumir otras sustancias ilegales, sino también de desarrollar un patrón consumo de alcohol de riesgo, de Binge Drinking o incluso de experimentar un Uso Problemático de Internet o de ciberacoso. Las variables personales como la autoestima, la asertividad, las habilidades sociales o la impulsividad tienen una capacidad explicativa realmente débil, en comparación con otras variables vinculadas al establecimiento de normas y límites por parte de los padres. Una de las principales conclusiones de este trabajo es la necesidad de adoptar un enfoque de prevención integral.

Consumo de cannabis entre adolescentes: patrón de riesgo, implicaciones y posibles variables explicativas / Cannabis use among adolescents: Risk pattern, implications and possible explanatory variables

Contrariamente a lo que ocurre con el resto de sustancias todavía no se han logrado disminuir los niveles de consumo de cannabis, que sigue siendo la droga ilegal más consumida entre los adolescentes españoles. El objetivo de este estudio consiste en actualizar los niveles de consumo (incorporando la franja de edad de 12-13 años), estimar los consumos propiamente de riesgo y analizar las posibles variables asociadas. Para ello se ha utilizado una metodología correlacional consistente en la realización de una encuesta a estudiantes de ESO y Bachillerato de la comunidad autónoma de Galicia (España) en el año 2016. La muestra final estuvo compuesta por 3.882 adolescentes gallegos de entre 12 y 18 años (M = 14,52 y DT = 1,72). Los resultados obtenidos revelan que a día de hoy es ya mayor el porcentaje de adolescentes que consumen tabaco y cannabis que únicamente tabaco (12,7% vs 10,5%) y que ello no sólo implica una mayor probabilidad de consumir otras sustancias ilegales, sino también de desarrollar un patrón consumo de alcohol de riesgo, de Binge Drinking o incluso de experimentar un Uso Problemático de Internet o de ciberacoso. Las variables personales como la autoestima, la asertividad, las habilidades sociales o la impulsividad tienen una capacidad explicativa realmente débil, en comparación con otras variables vinculadas al establecimiento de normas y límites por parte de los padres. Una de las principales conclusiones de este trabajo es la necesidad de adoptar un enfoque de prevención integral

In contrast to the achievements with other substances, it has not yet been possible to reduce the levels of cannabis use, the most used illegal substance among Spanish adolescents. The objective of this paper consists of updating levels of use (incorporating ages 12 and 13), estimating high-risk use and analyzing possible associated variables. For this purpose, a correlational method was used consisting of the administration of a survey to compulsory secondary school and high school students from the autonomous community of Galicia (Spain) in 2016. Results obtained from a sample of 3,882 Galician adolescents aged 12 to 18 (M = 14.52; SD = 1.72) reveal that the percentage of adolescents currently using tobacco and cannabis is higher than that of those using tobacco alone (12.7% vs 10.5%). This implies not only a higher probability of using other illegal substances, but also of developing rather high-risk use pattern, binge drinking or even experiencing problematic Internet use or cyberbullying. From a preventive perspective, the results reveal that personal variables such as self-esteem, assertiveness, social skills or impulsiveness have really weak explanatory power compared with other variables related to the setting of rules and limits by parents. One of the main conclusions of this paper is the need to adopt a comprehensive prevention approach

The theoretical model of the school-based prevention programme Unplugged.

Unplugged is a school-based prevention programme designed and tested in the EU-Dap trial. The programme consists of 12 units delivered by class teachers to adolescents 12-14 years old. It is a strongly interactive programme including a training of personal and social skills with a specific focus on normative beliefs. The aim of this work is to define the theoretical model of the program, the contribution of the theories to the units, and the targeted mediators. The programme integrates several theories: Social Learning, Social Norms, Health Belief, theory of Reasoned Action-Attitude, and Problem Behaviour theory. Every theory contributes to the development of the units' contents, with specific weights. Knowledge, risk perception, attitudes towards drugs, normative beliefs, critical and creative thinking, relationship skills, communication skills, assertiveness, refusal skills, ability to manage emotions and to cope with stress, empathy, problem solving and decision making skills are the targeted mediators of the program.

¿Confiamos demasiado en el valor de la cognición y de la educación en la prevención? / Do we place too much faith in the value of cognition and education in prevention?

Muchas estrategias de prevención todavía se basan predominantemente en conceptos cognitivos e informativos y se asume, implícitamente, que los seres humanos actúan de manera racional, ponderando riesgos contra placeres en situaciones relacionadas con el consumo. Los estudios sobre la efectividad de las intervenciones preventivas y los estudios etiológicos sin embargo destacan la importancia central del control de impulsos y de los procesos automáticos como determinantes de los comportamientos de riesgo, incluyendo el consumo problemático de drogas. Las intervenciones de prevención eficaces muchas veces incluyen elementos de presión normativa, supervisión de los hijos, incentivos y oportunidades, y otras componentes cuyo modus operandi no es necesariamente consciente. Estos principios preventivos son eficaces en varios ámbitos comportamentales: uso problemático de substancias, delincuencia y comportamientos violentos y antisociales. Sin embargo se utilizan poco en la práctica preventiva. La preponderancia de intervenciones basadas únicamente en procesos cognitivos y enfocados en el individuo conlleva también una serie de problemas éticos

Many prevention strategies are still predominantly based on cognitive and informational concepts, implicitly assuming that humans act rationally and weigh risks against pleasures in consumption-prone situations. Research on aetiology and on the effectiveness of prevention interventions nevertheless highlights the crucial roles of impulse-control and of automatic processes as determinants of risk behaviours, including problematic substance use. Effective preventive interventions often include elements of normative pressure, parental monitoring, incentives and opportunities, and other components whose modus operandi is not necessarily conscious. These preventive principles are effective in several behavioural domains such as problematic substance use, delinquency and violent antisocial behaviours. They are however seldom used in prevention practice. The preponderance of interventions that are solely based on cognitive processes and are focused on individuals also entails a number of ethical problems

"Unplugged," a European school-based program for substance use prevention among adolescents: overview of results from the EU-Dap trial.

The EU-Dap study aimed to develop and evaluate a school-based curriculum for the prevention of substance use among young people. The school curriculum, "Unplugged," is based on social influence approach and addresses social and personal skills, knowledge, and normative beliefs. It consists of 12 one-hour interactive sessions delivered by teachers. Its effectiveness was evaluated through a randomized trial involving 7,079 pupils of seven European countries. Unplugged was effective in reducing cigarette smoking, episodes of drunkenness, and the use of cannabis at short term. This association, however, was confined to boys, with age and self-esteem as possible explanations of this difference. Beneficial effects associated with the program persisted at fifteen-month follow-up for drunkenness, alcohol-related problems, and cannabis use, and were stronger among adolescents in schools of average low socioeconomic level. These results are of scientific importance and may inform the adoption of effective public health interventions at population level.

Prevención familiar del consumo de drogas en Europa: una revisión crítica de los programas contenidos en EDDRA / Family prevention of drug use in Europe: a critical review of EDDRA programs

En la adolescencia temprana, la familia es uno de los principales agentes de riesgo/protección del inicio del consumo de drogas. Su influencia en la adquisición de hábitos de salud le convierte en diana preferente de intervenciones preventivas. El objetivo es realizar un análisis comparado de los programas de prevención familiar europeos. Se analizaron 85 programas de prevención familiar contenidos en la base de datos EDDRA (Exchange on Drug Demand Reduction Action), perteneciente al Observatorio Europeo de las Drogas y Toxicomanías. Fueron analizados todos los programas incluidos en la base, que abarca el periodo 1998-2011. El 53% de los programas proceden de sólo 4 países (España, Alemania, Portugal e Irlanda). El 89% son inespecíficos o de promoción de la salud. Proporcionar información sobre drogas es el principal objetivo que persiguen los programas. Algo más de la mitad de los programas (59.7%) informan haber realizado evaluación de resultados. El 70.59% de los programas no plantea entre sus objetivos ninguno de los factores de riesgo propuestos en las principales teorías. A pesar del sólido marco teórico y de la evidencia empírica sobre los factores de riesgo familiares, los programas de prevención presentan una gran dispersión en sus objetivos, técnicas y componentes. El grado de adecuación a las teorías es muy bajo y la evaluación sigue siendo la asignatura pendiente. Se plantean críticas sobre el funcionamiento de la base EDDRA (AU)

In early adolescence, family is one of the main risk/protection agent for drug misuse. Its influence on health habits acquisition makes family a key target for prevention programs. The aim is to conduct a comparative analysis of European family prevention programs. For this purpose, 85 programs were reviewed. Programs were retrieved from EMCDDA database EDDRA (Exchange on Drug Demand Reduction Actions). No time period was delimited; hence time span was 1998-2011. 53% of all programs came from 4 countries (Ireland, Germany, Portugal and Spain). 89% were unspecific drug prevention or health promotion programs. Providing information about drugs is the main objective pursued by the majority of the programs. Over half the programs (59.7%) report having undergone an outcome evaluation process. Regarding the program objectives, 70.59% do not address any of the risk factors proposed by the main theories in international literature. Despite the solid theoretical framework that supports coherent evidence about family risk factors, prevention programs’ objectives and components have a low theoretical compliance rate and the level of evaluation continues to be a challenge. Some aspects of the EDDRA functioning are reviewed (AU)

Methods for synthesizing findings on moderation effects across multiple randomized trials.

This paper presents new methods for synthesizing results from subgroup and moderation analyses across different randomized trials. We demonstrate that such a synthesis generally results in additional power to detect significant moderation findings above what one would find in a single trial. Three general methods for conducting synthesis analyses are discussed, with two methods, integrative data analysis and parallel analyses, sharing a large advantage over traditional methods available in meta-analysis. We present a broad class of analytic models to examine moderation effects across trials that can be used to assess their overall effect and explain sources of heterogeneity, and present ways to disentangle differences across trials due to individual differences, contextual level differences, intervention, and trial design.

Environmental drug prevention in the EU. Why is it so unpopular?

Adolescents go through changes in their neurobehavioural and psychosocial functioning that can result in their desire to conform to peer norms taking predominance over cognitive impulse control mechanisms. This can help explain why, when peers are present, adolescent behaviour may not be significantly modified by what they know about risks and consequences. This finding has implications for prevention as it points to the importance of responses that actively target the environment in which substance use takes place, and where social norms are formed and supported. In practice however, across Europe information-only prevention approaches - despite a weak evidence for their effectiveness - continue to be most commonly used. Why this is the case is the question addressed by this editorial. A definition for environmental prevention is also provided: as strategies that aim to alter physical, social and economic environment without relying on persuasion. Boundaries of the definition with health promotion are discussed and the available evidence for the efficacy of this perspective reviewed, as is the information on the availability of environmental prevention within Europe. These data do not support the contention made by some member states that their prevention strategies are comprehensive and cover all addictive substances. Overall, although environmental approaches are becoming more common, they are disproportionately found in the North of Europe, and are most noticeable in three areas: at the macro-level in tobacco bans and alcohol policies, in strategies to improve the school environment and ethos, and in local level policies to regulate recreational settings.

The effectiveness of a school-based substance abuse prevention program: 18-month follow-up of the EU-Dap cluster randomized controlled trial.

AIM: To evaluate the effectiveness of a school-based substance abuse prevention program developed in the EU-Dap study (EUropean Drug Addiction Prevention trial). MATERIALS AND METHODS: Cluster Randomized Controlled Trial. Seven European countries participated in the study; 170 schools (7079 pupils 12-14 years of age) were randomly assigned to one of three experimental conditions or to a control condition during the school year 2004/2005. The program consisted of a 12-h curriculum based on a comprehensive social influence approach. A pre-test survey assessing past and current substance use was conducted before the implementation of the program, while a post-test survey was carried out about 18 months after the pre-test. The association between program condition and change in substance use at post-test was expressed as adjusted prevalence odds ratio (POR), estimated by multilevel regression models. RESULTS: Persisting beneficial program effects were found for episodes of drunkenness (any, POR=0.80; 0.67-0.97; frequent, POR=0.62; 0.47-0.81) and for frequent cannabis use in the past 30 days (POR=0.74; 0.53-1.00), whereas daily cigarette smoking was not affected by the program as it was at the short-term follow-up. Baseline non-smokers that participated in the program progressed in tobacco consumption to a lower extent than those in the control condition, but no difference was detected in the proportion of quitters or reducers among baseline daily smokers. CONCLUSION: The experimental evaluation of an innovative school curriculum based on a comprehensive social influence approach, indicated persistent positive effects over 18 months for alcohol abuse and for cannabis use, but not for cigarette smoking.

The effectiveness of a school-based substance abuse prevention program: EU-Dap cluster randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of the school-based drug abuse prevention program developed in the EU-Dap study (EUropean Drug Abuse Prevention trial) in preventing the use of tobacco, alcohol and drugs at the post-test. METHODS: Cluster Randomised Controlled Trial. Seven European countries participated in the study; 170 schools (7079 pupils 12-14 years of age) were randomly assigned to one of three experimental conditions or to a control condition during the school year 2004/2005. A pre-test survey assessing past and current substance use was conducted before the implementation of the program. The program consisted in 12-hour class-based curriculum based on a comprehensive social-influence approach. A post-test survey was carried out in all participating schools, 3 months after the end of the program. The association between program condition and change in substance use at post-test was expressed as adjusted Prevalence Odds Ratio (POR), estimated by multilevel regression model. RESULTS: Program effects were found for daily cigarette smoking (POR=0.70; 0.52-0.94) and episodes of drunkenness in the past 30 days (POR=0.72; 0.58-0.90 for at least one episode, POR=0.69; 0.48-0.99 for three or more episodes), while effects on Cannabis use in the past 30 days were of marginal statistical significance (POR=0.77; 0.60-1.00). The curriculum was successful in preventing baseline non-smokers or sporadic smokers from moving onto daily smoking, but it was not effective in helping baseline daily smokers to reduce or stop smoking. CONCLUSION: School curricula based on a comprehensive social-influence model may delay progression to daily smoking and episodes of drunkenness.

Análisis de pastillas como prevención selectiva / Pill-testing as selective prevention

En los últimos años, ha habido una creciente preocupación en la Unión Europea por el contenido de las pastillas que se venden bajo el nombre de éxtasis, debido a que éstas muchas veces podrían estar compuestas por otro tipo de sustancias. Sin embargo, es muy difícil tomar las medidas de prevención puesto que los consumidores de éxtasis constituyen un grupo diana al que es difícil llegar para informarles sobre los riesgos de salud ya que estas personas no acceden a los sistemas tradicionales de prevención. El análisis de pastillas originalmente surgió como respuesta específica a la adulteración de las pastillas pero ahora se revela también como una estrategia innovadora para alcanzar grupos de riesgo específicos. Si bien algunos países cuentan con información comparable sobre el modo de operación y los objetivos de los proyectos de análisis de pastillas, el debate sobre este tema sigue siendo candente ideológico. En este artículo se revisan los argumentos más frecuentes que giran en torno a estas intervenciones. La semi-legalidad de muchos de estos proyectos es, a su vez, causa y efecto de la escasez de evaluaciones más rigurosas en este campo. No obstante, la información disponible en este momento permite definir ciertos criterios de calidad (estrategia, formación, equipamiento) y de investigación (AU)

Concern in the European Union has increased during the past years about the content of pills sold as ecstasy. However, within this context, the challenge of taking the necessary prevention measures is great – in particular to approach and inform hard-to-reach target groups such as ecstasy consumers about health risks, as these groups do not access the traditional drug care systems. On-site pill testing originally emerged as a concrete response to the adulteration of pills commonly sold as ecstasy but is revealing now as an innovative means to approach specific risk groups. Although some countries nowadays offer comparable information regarding modus operandi, contents and aims of on-site pill testing projects, discussions about this issue are still very vivid and, sometimes, ideological. The present article’s aim is to provide an objective overview of goals, methods, results and evaluation efforts of pill-testing projects. This overview gathers and discusses the most common opinions about these projects. The pseudo-legality of most projects is both the cause and consequence of the lack of rigorous evaluations in this area. Nevertheless, the information available nowadays in Europe opens the possibility of defining research and quality criteria (strategy, training, equipment) for pill testing projects (AU)

Análisis de pastillas in situ / Pill testing in situ

El análisis de pastillas in situ es una forma de prevención secundaria que surgió como respuesta específica al problema de la adulteración de las pastillas vendidas bajo el nombre de éxtasis. Si bien en la actualidad algunos países de la Unión Europea cuentan con información comparable sobre el estado de desarrollo, el modo de operación, el contenido y los objetivos de los proyectos de análisis de pastillas, el debate sobre este tema sigue siendo candente y muchas veces subyace un trasfondo ideológico. En este artículo se compilan y revisan los argumentos más frecuentes que giran en torno a estas intervenciones a fin de llegar a una valoración concluyente y más realista, ponderando sus evidencias positivas y exponiendo los puntos débiles. La semi-legalidad de muchos de estos proyectos es, a su vez causa y efecto de la escasez de resultados de investigaciones más rigurosas en este campo. Por otra parte, esto dificulta un debate realmente científico y no alcanza para llegar a una recomendación política concluyente sobre este tipo de intervenciones. No obstante, el nivel de información disponible en Europa en este momento permite definir criterios de calidad (estrategia, formación, equipamiento) y de investigación para los proyectos de análisis de pastillas. Para llegar a una valoración demostrable sería más útil a largo plazo implementar estos criterios de calidad en los proyectos de análisis existentes en vez de 'diabolizarlos' a priori con fundamentos lábiles (AU)

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Intervenciones preventivas en la primera infancia en Europa / Preventive drug interventions in childhood in Europe

En pocas regiones Europeas existen programas suficientemente estructurados que puedan darnos una imagen clara y conclusiva sobre las posibilidades y mejores formas de actuación en este campo. Para dar una visión global de la situación Europea se ha acudido a la (a) literatura internacional accesible, (b) información extraída de informes nacionales de los estados miembros al OEDT y (c) descripciones de programas en este ámbito, contenidos en el sistema EDDRA del OEDT. Intervenciones con niños pequeños, sea en los jardines infantiles sea en las familias, son relativamente raras en la UE, a pesar de la importancia que se les atribuye siempre en todas las publicaciones sobre prevención de drogodependencias. En muchos casos, intervenciones que se dirigen a niños pequeños se concentran en hijos de toxicómanos, dejando de lado a las poblaciones de niños con perfil de riesgo muy parecido, probablemente por una fijación en experiencias y perspectivas de servicios de tratamiento, en vez de usar conceptos verdaderamente preventivos de salud pública. En este artículo se identifican y discuten varios conceptos de actuación utilizados en Europa, que pueden servir de base para intercambios e innovaciones que realmente corresponden a las necesidades holísticas de la salud pública (AU)