The choice of intervention will depend on the type of drug use problem and the reasons why it exists. Not all interventions are equally effective. For example, improving knowledge is often not accompanied by a change in behaviour. Studies have shown that:
• a single-shot educational strategy is usually not very effective and the impact not sustainable.
• the use of printed materials alone is not effective.
• a combination of strategies, particularly of different types, for example an educational one plus a managerial one, always produces better results.
• focused small-group and face-to-face interactive workshops have been shown to be effective, if effective trainers or moderators are used.
• monitoring and feedback and peer review are very effective strategies but require the agreed use of certain standards (for example STGs) against which to judge the prescribing.
• economic incentives can be very powerful ways of changing behaviour; however, poorly thought-out incentives may lead to unexpected behaviour and the promotion of inappropriate use.
• regulatory interventions may have unintended impacts that may be worse than the intended change (substitution of a less appropriate drug for a banned drug, for example).
Box 7.3 summarizes recommended strategies and approaches, and box 7.4 demonstrates the effectiveness of a combined intervention strategy used in Uganda.