Identifying Europe’s information needs for effective drug policy
Lisbon, 6-8 May 2009
Parallel sessions: Practice
Parallel session B. From prevention to treatment – finding the right setting for the right group
Title of the presentation: Indicated prevention – targeting those most at risk
Name: Joerg M. Fegert
Affiliation/Institution: University of Ulm, Child and Adolescent Psychiatry/Psychotherapy
Address: Steinhoevelstrasse 5, D-89075 Ulm
e-mail: joerg.fegert@uniklinik-ulm.de
Bio note:
Medical director and chair of child and adolescent psychiatry/psychotherapy at the University
of Ulm, Students’ Dean of the medical faculty of Ulm, Member of different expert groups of
German State and National Ministries, European and US professional societies.
Main research interests: Child neglect and abuse, prevention research and early intervention.
Interdisciplinary psychosocial interventions in specific target groups, ethics, patient safety and
clinical trials.
Abstract:
In a thematic paper for the EMCDDA (2009) we defined indicated prevention as preventive
interventions that are targeted at the individual. The individual presents voluntarily or is
referred to an expert and/or is identified on an individual level, based on a professional’s
evaluation. In the case of substance abuse prevention, the individual might exhibit substance
use but does not fulfil criteria for dependence and/or shows indicators that a highly correlated
with an individual risk of developing substance abuse later in life.
This well-known risk that can be identified on the individual level e.g. a psychiatric disorder,
school failure or social behaviour and these can be the context for new preventive
interventions. The aim of indicated prevention is not necessarily to prevent the initiation of use
or the use of substances but to prevent the development of dependence or to diminish the
frequency and to prevent dangerous substance use.
Policy makers could want to intervene in 6 mayor domains: The individual domain, family,
peer group, school context, institutional context like foster care or out of home placement and
at the community level. Based on a literature search for all these contexts potential high risk
groups can be identified. It is important to understand the neurobiology of addiction when
designing prevention programs because all drugs of abuse activate the reward system
through increasing dopaminergic neurotransmission.
Two future foci for program development in the European Union are recommended:
First focus: large trials with established best practice programs for at risk individuals
generating feasibility data for role out strategies in different societies.
Second focus: Development, description and manualization, evaluation and implementation of
new programs for children refer to psychiatric or psychological institutions, for children in
foster and institutional care and for incarcerated adolescent.
Related publications:
Fegert JM, Schepker R, Keller F, Ludolph A, Plener P, Williamson AE, Volmer-Bertele N,
Weninger L, Kapusta ND, 't Hart-Kerkhoffs L: Preventing later substance use disorders in atrisk children and adolescents. A review of the theory and evidence base of indicated
prvention. In: EMCDDA Thematic Papers. Edited by Addiction EMCfDaD. Lissabon; 2009.
Kölch M, Schnoor K, Fegert JM: Ethical issues in psychopharmacology of children and
adolescents. Current Opinion Psychiatry 2008, 21(6):598-605.
Schmid M, Goldbeck L, Nuetzel J, Fegert JM: Prevalence of mental disorders among
adolescents in German youth welfare institutions. Child and Adolescent Psychiatry and
Mental Health (online journal www.capmh.com) 2008, 2:2 (28 January 2008).