Prevention of Substance Abuse Chapter 16 JUST SAY NO ! FRIENDS DON’T LET FRIENDS DRIVE DRUNK USE A DESIGNATED DRIVER ! THIS IS YOUR BRAIN ON DRUGS !
<ul><li>Most people agree that prevention efforts should be an important component of any comprehensive approach to substance abuse, but professionals and funding sources have not made prevention a high priority </li></ul><ul><li>Possible reasons for this are that: </li></ul><ul><ul><li>past prevention efforts have tended to yield only modest influences in changing patterns of drug use, and </li></ul></ul><ul><ul><li>Current, ongoing substance abuse is dramatically visible and thus receives more attention </li></ul></ul>
Defining Prevention <ul><li>Prevention in this context pertains to the avoidance or alleviation of problems associated with substance abuse </li></ul><ul><li>Prevention of substance abuse has traditionally been divided into three types of intervention: </li></ul><ul><li>Primary Prevention – Attempts to avoid substance use or abuse before it has a chance to occur. </li></ul><ul><li>One goal is to preclude the initial use of a substance by encouraging young people to turn down invitations to use, e.g., “Just Say No” campaigns </li></ul>
<ul><li>Another goal for some substances is the development of responsible attitudes and substance-use behaviors, such as responsible drinking behaviors in Designated Driver campaigns </li></ul><ul><li>Secondary Prevention – Interventions designed to prevent substance-use problems just as the early signs of abuse begin to appear. Central to such efforts is the early identification of drug problems. Examples are legal responses of alcohol education courses for DUI offenders </li></ul>
<ul><li>Tertiary Prevention – Treatment interventions with persons well beyond the early stages of substance abuse or dependence. The goals are to terminate use of the substance and thus avoid further deterioration in the person’s functioning </li></ul><ul><li>Tertiary prevention and substance abuse treatment are comparable activities and have already been discussed </li></ul><ul><li>This chapter will emphasize primary and secondary prevention activities </li></ul>
Models of Prevention <ul><li>Three major prevention models have evolved </li></ul><ul><li>Sociocultural Model – Dominant approach in the United States that posits social norms directly influence substance use </li></ul><ul><li>Prevention efforts derived from this model try to influence the entire climate of drinking within a culture </li></ul><ul><li>This model has been used primarily to prevent alcohol abuse, e.g., Wilkinson’s proposals for modifying drinking patterns culturally, though it has implications for prevention of other substances </li></ul>
<ul><li>As the goal of the sociocultural approach is not the cessation of drinking but rather changes in social norms regarding drinking, some have argued that it may encourage drinking. Other criticisms are: </li></ul><ul><ul><li>May not be widely applicable due to diverse cultures and subcultures in many countries </li></ul></ul><ul><ul><li>Fails to account for the value and pleasure many people attach to heavier drinking </li></ul></ul><ul><ul><li>Assumes attitudinal changes in the culture will result in the desired behavioral change </li></ul></ul><ul><ul><li>Does not adequately take into account physical problems associated with alcohol consumption, i.e., cancers, liver, and stomach ailments </li></ul></ul>
<ul><li>Examples of the prevention efforts consistent with the sociocultural model are the “ Just Say No” campaign and the advertising efforts of the Partnership for a Drug-Free America </li></ul><ul><li>Distribution of Consumption Model – Has three central propositions: </li></ul><ul><ul><li>Proportion of heavy drinkers in a culture is positively related to the mean level of alcohol consumption. In other words, the number of heavy drinkers in a society increases with society’s per capita consumption </li></ul></ul>
<ul><ul><li>Heavier alcohol consumption increases the probability of alcohol problems, such as mental/emotional, physical, and social problems, and </li></ul></ul><ul><ul><li>Societies should attempt to reduce the negative consequences of drinking by reducing alcohol consumption across the culture. This is done usually by restricting the availability of alcohol </li></ul></ul><ul><li>Examples of restricting availability are raising the price of alcohol relative to income, limiting the hours that bars and taverns can be open, and raising the minimum drinking age </li></ul>
<ul><li>Proscriptive Model – The most basic in principle, focuses on prohibiting the availability of substances and emphasizes total abstention from drug use </li></ul><ul><li>If a person uses it is not seen as a societal problem but instead as a product of a person’s character flaw </li></ul><ul><li>The most important application to alcohol use was Prohibition, however, for decades there has been a strong proscriptive approach to drug use in this country </li></ul><ul><li>This approach, though popular, has not made any significant contribution to the prevention of substance-abuse problems </li></ul>
Principles of Drug Abuse Prevention <ul><li>Table 16.1 outlines the National Institute on Drug Abuse “prevention principles” relevant to the implementation of prevention programs for children and adolescents </li></ul><ul><li>Release of these principles has been described as a landmark event in prevention science </li></ul><ul><li>Summarize what years of scientific study reveals about the nature of substance use and abuse and how to prevent it </li></ul><ul><li>Thus, considered influential in the development and implementation of a variety of prevention interventions </li></ul>
Current Topics in Prevention <ul><li>Noteworthy trends in prevention activities toady are: </li></ul><ul><ul><li>Increasing focus on family (especially parental) involvement in prevention programs </li></ul></ul><ul><ul><li>Attention to resistance-skills development, specifically strategies to use in avoiding pressures to use drugs </li></ul></ul><ul><ul><li>Developing programs in conjunction with more broad-based communitywide strategies – e.g., school-based intervention presented in conjunction with messages communicated through mass media outlets </li></ul></ul>
<ul><ul><li>Identifying subgroups most at risk for alcohol and other drug misuse and developing programs specifically for them, e.g., inner-city youths, Native American youths, minority youths, and college students </li></ul></ul><ul><ul><li>Focusing on not initiating the use of “gateway” drugs, alcohol, tobacco, and marijuana in particular, where use typically precedes use of harder drugs such as cocaine, heroin, and LSD </li></ul></ul><ul><ul><li>Programs designed to minimize risk or negative consequences associated with any substance use </li></ul></ul>
Education and Mass Media Efforts <ul><li>The most common and pervasive substance-abuse prevention interventions have been education and mass media efforts </li></ul><ul><li>Traditionally, aimed at adolescents and young adults, visible groups at risk for substance abuse, but more recently efforts have extended to children, e.g., most states now require drug and alcohol education in the school curricula </li></ul><ul><li>Such courses have been shown to increase knowledge levels but have not been so successful in changing substance-use patterns. In fact in some cases, students were found in the short run to escalate their drug use </li></ul>
<ul><li>In recent years there has been an increasing use of parents in prevention programs, especially in programs that focus on children </li></ul><ul><li>The growing emphasis on parents derives from the view that substance use is a family concern </li></ul><ul><li>Mass Media – Communications designed for widespread distribution, such as advertisements, films, and printed materials </li></ul><ul><li>Succeed in raising levels of knowledge and awareness about drugs, yet changes in attitudes and actual drug use behavior have not been found consistently </li></ul>
Affect-Oriented Programs <ul><li>Programs incorporate an “affective” component which includes values clarification and decision-making </li></ul><ul><li>Values Clarification – A common component of affect-oriented prevention programs; typically involves exploration of one’s own needs and beliefs regarding drugs </li></ul><ul><li>Though such programs do help to clarify personal views on substance use, indications to date suggest that such approaches do not have an impact on drug use behavior </li></ul>
Alternative Behaviors and Resistance-Skills Training <ul><li>Programs that focus on developing alternative to drug use make sense in theory, but have not revealed particular benefits in terms of substance-use behavior </li></ul><ul><li>Resistance-skills training interventions have shown more promise </li></ul><ul><li>Focus is on training young people to recognize and resist pressure to use drugs </li></ul><ul><li>The most widely used program in use today is DARE (Drug Abuse Resistance Education) </li></ul><ul><li>Though it has widespread use, it has not fared well in research evaluations </li></ul>
Worksite Programs <ul><li>Prevention programs are sometimes located at worksites, where the goal is to identify drug abusers and to intervene when drug problems interfere with job performance </li></ul><ul><li>Primary prevention efforts such as posters, mailings, and guest speakers may be included to heighten employee awareness and to set the stage for employees who are abusing to seek treatment, programs generally concentrate more on secondary than on primary prevention </li></ul><ul><li>The effectiveness of Employee Assistance Programs (EAPs) are rarely evaluated </li></ul>
Programs for College Students <ul><li>Abuse of alcohol – whether chronic or sporadic – long has been a problem on college campuses </li></ul><ul><li>There is a higher prevalence of alcohol use than in the general population and an increase in alcohol-related problems over the past 20 years </li></ul><ul><li>An estimated 40% of college students are heavy drinkers, defined as having five or more drinks in a row in the past two weeks </li></ul><ul><li>A variety of prevention programs have been established on college campuses but alcohol misuse continues to take it’s toll </li></ul>
A Snapshot of Annual High-Risk College Drinking Consequences (Table 16.2) <ul><li>Death : 1,700 die each year from alcohol-related unintentional injuries, including motor vehicle crashes </li></ul><ul><li>Injury : 99,000 are unintentionally injured under the influence of alcohol </li></ul><ul><li>Assault : More than 696, 000 are assaulted by another student who has been drinking </li></ul><ul><li>Sexual abuse: More than 97, 000 are victims of alcohol-related sexual assault or date rape </li></ul><ul><li>Unsafe sex : 400,000 had unprotected sex, and more than 100,000 report having been too intoxicated to know whether they had consented to having sex </li></ul>
<ul><li>Academic problems : About 25% report missing class, falling behind, doing poorly on exams or papers, and receiving lower grades overall due to their drinking </li></ul><ul><li>Health problems/suicide attempts : More than 150, 000 develop and alcohol-related health problem, and between 1.2% and 1.5% indicate that they tried to commit suicide within the past year due to drinking or drug use </li></ul><ul><li>Drunk driving : 2.1 million drove under the influence of alcohol last year </li></ul><ul><li>Vandalism : 11% report they have damaged property while under the influence of alcohol </li></ul>
<ul><li>Property damage : 25%+ of administrators from schools with low drinking levels and 50% from schools with high drinking levels report “moderate” or “major” problem with alcohol-related property damage </li></ul><ul><li>Police involvement : About 5% of 4-year students involved with police or campus security as result of their drinking & 110, 000 students are arrested for an alcohol-related violation such as public drunkenness or DUI </li></ul><ul><li>Alcohol abuse or dependence : 31% met the criteria for a Dx of alcohol abuse and 6% for a Dx of alcohol dependence in the past 12 months </li></ul>
Closing comments on Prevention <ul><li>The full potential of prevention interventions has not yet been tested </li></ul><ul><li>Before this potential can be assessed, more resources from state and federal agencies are needed </li></ul><ul><li>Critical in future research will be the design and evaluation of programs for specific cultural subgroups, the creation of programs geared toward the specific developmental levels of children and teenagers, parental involvement programs, and programs aimed at providing alternatives to alcohol and drug use </li></ul>
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