Introduction
Reducing the demand for drugs means enabling people to increase control over their health and improving their health behaviour in relation to alcohol and other legal and illegal drugs. In Lithuanian society, as elsewhere in Europe, problems with alcohol are very common, and problems with other drugs are increasing - especially among young people. The human and economic costs of the misuse of drugs are very high for the society. In rough outline, the abuser and his/her family bear half these costs - which indicates the catastrophic economic and social consequences for the user and family members. Spending money on prevention is very cost-effective.

During more than 10 years of independence, Lithuania has developed a national drug policy strategy and implemented several programmes to combat the increasing use of drugs among young people. These endeavours have been assisted by international organisations as the European Union Phare Multi-beneficiary Programme, the Council of Europe Pompidou Group, the United Nations International Drug Control Programme and European Cities Against Drugs.

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In1999, the Pompidou Group Drug Demand Reduction Staff Training Project (DRSTP II) identified a lack of printed material in Lithuanian language to be used for training of trainers in Local Community Drug Prevention e.g. community leaders, educators, health workers, NGOs, etc. A team of Lithuanian authors, experienced in implementing local drug demand reduction programmes, has now produced a Handbook with essential information and practical advice for others. The Handbook aims to be a Basic Reader, supporting the development of primary and secondary prevention in the local community. It is intended for self-study, but it is recommended that the material can also be presented during a workshop, a seminar or a conference. The target groups are primarily social and medical professionals, but anyone who has interest in local community preventive work will find this book useful.

The philosophy of the Handbook builds on new developments in preventive research. The basic - and traditional - approach, of providing drug information and education to individuals, will not automatically change their health behaviours. Success stories in changing health behaviour include, in addition to basic information, methods for developing personal social skills and systems for community development in order to create supportive environments for health. These methods and systems will have a much greater chance of reducing the demand for drugs than the more traditional health education activities.

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However, delivering these approaches means organisational change in communities, schools and workplaces, and social skills training for members of these organisations. For example, prevention education in schools means much more than a lesson about the effects of alcohol and drugs; it concerns all physical, social and organisational processes connected with pupils' daily well-being. A prerequisite for such developments is effective national drug policy and legislation. It also requires national expert teams and national institutions being able to support local developments. Therefore, the implementation strategy of the Handbook is based on the development of local policy action plans in municipalities and local organisations or settings.

The implementation of prevention strategies can be separated into three parts - but they always need to be undertaken in simultaneous combination:

Primary prevention is directed at the whole population (or a large part of it) in the local community. It addresses all structures, conditions and/or measures that prevent undesirable outcomes.

Secondary prevention selects, by early detection, groups or individuals at risk, and makes early interventions. It addresses structures, conditions and/or measures that prevent and interrupt a possible but undesired development.

Tertiary prevention provides care, treatment and other late interventions. It addresses structures, conditions and measures that reduce the consequences of a problem and aims to eventually prevent any aggravation or repetition of the problem.

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The whole strategy can be described as a traffic light system. Primary prevention means keeping the population at the green light. The amber light is for early detection and prompt action, and red light is for effective treatment of drug misusers, taking them back to green light again. This Handbook focuses mainly on primary and secondary prevention. Tertiary prevention requires a separate manual.

This Handbook will support the ongoing process in Lithuania towards better drug prevention. It will help to support a process which pays attention to the local community, based on policy development, scientific and social knowledge and increased intersectorial and community participation.

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