Workforce professionalisation and remembering Jeff Lee

This week, we say goodbye to our dear friend and mentor, Jeff Lee, the founding Executive Director of ISSUP. Jeff was a steadfast advocate for the professionalization of prevention, insisting that those working in this field should be appropriately specialized. He often reminded us that while generalists and treatment specialists are well-meaning and deeply embedded within their communities, they are not always best placed to develop and implement evidence-based prevention systems. Jeff emphasized that prevention must be treated as a distinct science—one that is grounded in rigorous research and guided by interventions drawn from a contextually appropriate evidence base, rather than selected merely because they sound promising.

I had hoped to have this conversation with Jeff in person, but his health deteriorated, and an attempt to visit him in the UK was disrupted by visa complications. If I had the chance, I would have asked him: what do we do in settings where there is already a shortage of human resources for mental health and substance use disorders, let alone dedicated specialists in prevention? The 2020 WHO Mental Health Atlas paints a stark picture: globally, there are just 13 mental health workers per 100,000 people, with low- and middle-income countries (LMICs) facing even more dire shortages—sometimes as few as 2 per 100,000. In these settings, prevention is often left to passionate activists, policymakers, and professionals with personal or close-to-personal experiences with substance use. While their dedication is invaluable, many lack the specialized training necessary to critically assess evidence and implement best practices.

It is, of course, possible for non-specialized individuals to gain foundational knowledge through capacity-building opportunities, such as those available on the ISSUP platform or through academic institutions. However, within formal education, content on substance use disorder prevention and management is often fragmented; nested within broader curricula rather than presented as a comprehensive, standalone discipline. Moreover, prevention and addiction treatment require an interdisciplinary approach; a well-trained practitioner must understand not only clinical interventions but also the structural determinants of substance use, from policy frameworks to socioeconomic factors that shape vulnerability, social capital, and long-term recovery trajectories. In working with my own postgraduate students, my goal has always been to instil this broader understanding—ensuring that their expertise is grounded in both scientific evidence and a deep awareness of their societal role.

So, how do we move the field forward? Not just in prevention, but across the entire spectrum of intervention, when we face persistent resource constraints but have willing individuals eager to contribute? In my view, national drug action plans should provide a strategic blueprint, outlining how practitioners, civil society, and policymakers can coordinate their efforts at national and municipal levels. These plans should define required levels of training, offer pathways for certification, and establish mechanisms for collaboration—ensuring that interventions are coordinated, evidence-based, and sustainable, with robust mechanisms for mentorship. Without such structure, well-meaning but poorly directed efforts risk doing more harm than good.

I imagine Jeff would have nodded at all of this and then, in his characteristic way, reminded us that protecting the specialty of prevention must remain a priority. He might have said, “There’ll be nowhere to drive if we don’t start building the road,” and I would have agreed wholeheartedly. We must continue to push for the availability of prevention and treatment services while being mindful of what structures already exist, consulting the best available evidence, and engaging with experts to refine our approaches. And as we move forward, we must also build mechanisms for monitoring and evaluation, contributing to the growing evidence base so that ineffective approaches can be discarded, and promising interventions refined.

That is how we honour Jeff’s legacy—not just by remembering his words, but by ensuring that the road he worked so hard to build continues to expand, leading future generations of prevention professionals toward a more effective, evidence-based, and professionalized workforce.

Rest easy, Jeff.