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Part 5-- Approaches to substance abuse prevention.  This last section will draw on information presented throughout the full course in order to make sense of the difficulties involved in developing effective prevention strategies.  The application of available prevention research will be discussed with examples of approaches that have shown promise for reducing use and/or its negative impacts.  We will cap-off this section with the groups’ presentations of specific drugs.

Dates:  December 1 - December 8

Readings :

From R-C--

§  Chapt. 16 (Drug abuse prevention and education), Pages 327-360.

***Online quiz over Chapter 16 to be completed between Dec. 8 and 6:00pm Dec. 10  (20 pts.)***

IN-CLASS EXAM over PARTS 4 & 5 (120 pts.), Tuesday, DEC. 14.  On Societal issues and History of legal control of drugs, Prevention, and Marijuana, including lecture information from 11/10 – 12/8, assigned readings.

GOALS of prevention:

The primary goals are to

1.   reduce use, limiting the number of users and the types of substances used and

2.  delay use in those that will use.  Regarding the second goal, delaying the start of use reduces harm during a child’s development and reduces risk for developing addiction and abusive patterns of use.  Recognizing that at least some proportion of the population will use psychoactive substances, further goals of prevention include

3.  preventing the transition from “use” to “abuse,” and

4.  diminishing harm resulting from use.  This last would include not only ways to make use safer (e.g., needle exchanges, safer-drinking strategies), but also movement into treatment and prevention of relapse once treatment is completed.           

 

Public Health refers both to different levels of prevention and of intervention. 

“Levels of prevention” refer to where in the issue’s development the focus is: Before it starts, as it develops, or after it has developed as a problem. 

“Levels of intervention,” on the other hand, refer to the focus for the strategy (e.g., community-focused, systems-focused (e.g., families, peers), or individual-focused).

Levels of prevention are typically categorized as being primary, secondary, or tertiary. 

·  Primary prevention refers to activities undertaken prior to an individual using.  Most educational programs fit under this, but so do programs designed to reduce drug availability (e.g., law enforcement). 

·  Secondary prevention refers to activities applied during the early stages of drug use and would encompass attempts to prevent the transition from use to abuse.  Early diagnosis, crisis intervention, and economic changes such as increasing alcohol taxes can decrease use and interrupt problematic patterns of use. 

·  Tertiary prevention takes place at later (advanced) stages of drug abuse and refers to actions to avoid relapse and maintain health status after therapy.  This is essentially the extended aspect of drug treatment.

Levels of Intervention are categorized as Universal, Selective, or Indicated.

·  Universal Intervention refer to efforts focused on every eligible member of a community.  These are programs aimed at an entire group (rather than individuals) and include media campaigns, policies that affect all members of a community equally, such as taxes and laws, and educational programs provided to all students regardless their risk level.  Potential benefits are expected to outweigh costs for everyone. 

·  Selective Intervention are more focused at a more systems domain where higher-risk subgroups are targeted (e.g., children from homes where family members have a history of drug use or college students in general). 

·  Indicated intervention is individual-focused interventions and represents the most time and financially-intensive programs. These include prevention efforts targeted at individuals, for example those who show signs of developing problems, e.g., after receiving a DUI or completing treatment.

Be sure to refer to Table 16-1 to see how these levels relate.  Also, note again how risk factors and protective factors play a role in prevention.

Primary prevention -- refers to activities undertaken prior to an individual using.

Specifically, we dealt with factors in drug education that affect their effectiveness.  Factors such as fear.  Remember Rogers' Protection-Motivation theory regarding when and how fear messages can be effective.

In summarizing what makes an effective program, several things were listed:

Two overriding principles were:

  1. Be research-based and theory-driven.
  2. Integrate multiple areas of person's life (broad-based and integrative). Doomed for failure if restricted to classroom.

In dealing with the information provided, the following were noted:

  1. Give developmentally appropriate information.
  2. Include normative information.
  3. Include adequate and sufficient follow-up.
  4. Make non-use and non-users seen as attractive role-models (and that means attractive to the target audience, not some grown-up 'ideal').

Techniques for providing the information included:

  1. Use interactive techniques.
  2. Be aware of social and cultural factors in the issues raised and techniques used.
  3. Appeal to both genders.
  4. Focus attention on the participants, to make it personally relevant.
  5. Actively involve parents and families.
  6. Interact with community.

Be sure to note the uses and limits of fear described in the book and class.

For the different techniques summarized in the text, note the ways that they try to meet their goals (e.g., by focusing on one type of drug or specified group) and relate that back to the outlined principles.

Secondary Prevention

The forms of prevention and intervention that will be focused on in the present section are secondary (activities applied during the early stages of drug use encompassing attempts to prevent the transition from use to abuse) and can happen at any of the levels of intervention: universal, selective, or indicated. 

Several types of activity are relevant here:

·        Educating,

·        detecting,

·        monitoring,

·        methods for interrupting use, and

·        methods for maintaining non-use or reduced use. 

As with universal, primary prevention approaches previously discussed, carefully determined and articulated goals are key for development and implementation of successful secondary prevention programs. 

Compared to primary prevention, however, there is less agreement about the desired goals or on effective approaches to meet those. 

·        Goals aimed at those who are already using may be to eliminate further use, reduce use, or reduce harm if use will continue. 

·        The aim may be to help the individual or may be more focused on preventing harm to others. 

·        Which goals are chosen affect not only steps taken by those doing the prevention activities, but also actions and decisions made by those targeted. 

It makes a difference if detection of use will bring about an opportunity for help quitting versus job loss, prosecution, or athletic ineligibility.

In class, the importance of understanding where someone is in relation to their drug use behavior and in relation to wanting to change was noted.  The Stages of Change model is discussed as a way to gauge how to focus interventions:

The Stages of Change Model

1.     Precontemplation: Unaware or under-aware of a problem; no intention to change.  “As far as I am concerned, I don’t have any problems that need changing.”

2.     Contemplation: Aware that the problem exists; seriously thinking about overcoming it but have not made a commitment to take action; weighing pros and cons related to change.  “I have a problem and I really think I should work on it.”

3.     Preparation: Intending to take action for change; have plans for change; can take preparatory actions (e.g., make appointment), but may not follow through or follow advice.  “I’m trying to do something about my problem, but can’t keep with it.”

4.     Action: Steps are taken to modify behavior, experiences, or environment to overcome the problem.  Action is not only starting the necessary steps but continuing with them until health change criteria met.  “I am really working hard to change.”

5.     Maintenance: Working to prevent relapse and consolidate gains made during action; a continuation, not an absence, of change.  “I may need a boost right now to help me maintain the changes I’ve already made.”

  1. Termination: No longer tempted by the unhealthy behavior that needed to be changed.  “That was me before, but now it’s a non-issue.”

Source: Author from Prochaska, J.O., DiClemente, C.C., & Norcross, J.C. (1992).  In search of how people change: Applications to addictive behaviors.  American Psychologist, 47, 1101-1114.

 

There are many points of overlap between primary and secondary prevention (e.g., use of social norms), but also things that make secondary prevention more difficult.  The difficulties come about precisely because the targets have had experience with the drug.  Think about what that prior or ongoing experience might do to affect receptiveness or acceptance of messages.

 

Make sure you review the approaches to secondary prevention used on college campuses and in the workplace.  Also, note the techniques and issues related to drug testing.

 

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