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HSCI180 CH 17-18 Treating & Preventing substance abuse.docx

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Simon Fraser University
Health Sciences
HSCI 180
Julian Somers

Chapter17 –Preventing SubstanceAbuse Society’s Attempts to Limit Drug Availability 1. As long as there is a market for drugs, there will be people to supply them a. To attack the source of the problem, the demand for drugs must be eliminated 2. Drugs will never disappear, so people need to learn to live in a world that includes them 3. Our society has accepted the continued existence of tobacco and alcohol despite the harm they cause  Is it possible to teach people to coexist with legal and illegal substances & live in a way that their health are not impaired by them? Defining Goals and Evaluating Outcomes  Goal of this book = education = so person knows about the info and make better decision about personal drug use, understand drug use by others  Traditionally, programs that present negative info about drugs = goal is prevention o Programs should be evaluated according to how many students in the program later tried drugs o Until the early 1970s, most drug prevention programs were not evaluated Drugs in the Media  Don‘t be a Patsy Advertisement Campaign o The ads showed an over-protective mother ―patting down‖ her daughter before she left the house.  Shift in 1980s ―This is your brain on drugs ads‖ - overstated the harmful effects of drugs on young people. o These types of embellishments decrease the credibility of drug educators and lead young people to reject all drug-related information from so-call informed sources. Types of Prevention Depends on drug-using status of person  Primary prevention o Aimed at young people who have not yet tred drugs o Encourage abstinence – help teach to view potential influence of drugs on their lives o Danger of introducing, arousing curiosity  Secondary prevention o Aimed at people who have experimented, but not serious o Goal is to prevent use of more dangerous substances or develop more dangerous forms of use o Eg encourage responsible use of alcohol among postsecondary students  Tertiary prevention o Aimed at people have been through treatment or who stopped using a drug on their own o Goal is relapse prevention Institute of Medicine’s “continuum of care”  Includes: Prevention, Treatment, Maintenance  Prevention efforts are categorized according to intended target population: o Universal prevention = for an entire population  Example: all students of school/community o Selective prevention = for high-risk groups within a population  Example: doing bad at school, live in poorest beighbourhood o Indicated prevention = for individuals who show signs of developing problems  Example: child who smoke at young age, adult arrested for 1 offence of DUI School Based Prevention Programs   Advantage: o Drug use prevalent before adulthood  Influence their beliefs/expectation in childhood before it is established o Efficient way to reach majority every year o Equipped for enforcing broad spectrum of education programs Prevention Programs in Schools Knowledge-Attitudes-Behavior Model  Presentations by police and former users, teach teachers, who teach children o Often include traditional scare tactics and/or pharmacological information o **Approach assumes that increasing student knowledge about drugs will change their attitudes and that these changed attitudes will be reflected in decreased drug-using behavior  Questionable - Students with more knowledge about drugs tend to have more positive attitudes about drug use o Effective in increasing knowledge about drugs o Ineffective in altering attitudes or behavior o Concerns raised that drug education programs were actually teaching students about drugs that they otherwise wouldn’t have been exposed to  Evaluation of effectiveness depends on program goals o Goals: Never experiment with drugs OR make rational decision about drug use o Findings: students more likely to try BUT less likely to abuse o Result: Teaching students to make rational decision about their own drug use with the goal of reducing the overall harm produced by misuse and abuse Affective Education  Affective domain focuses on emotions and attitudes, which may underlie some drug use  Students use drugs to produce: excitement or relaxation, power or control, or in response to peer pressure  Goal for children: o To know and express their feelings o To achieve altered emotional states without drugs o To feel valued and accepted 1. Values clarification: Teach students to recognize and express their own feelings and beliefs o Students have factual info about drugs – but lack ability to make appropriate decision o Emphasis on teaching generic decision-making skills – analyze and clarify own values o Parents hard to accept- not direct antidrug approach AND may run contrary to values of parents o The Canadian Home and School Federation supports the application of formal values clarification programs in all Canadian schools.  Recommend consultation with parents/teachers ! 2. Alternatives to drugs o Person wants to experience altered state of mind o Teach student ―natural highs‖ - relaxation exercises, meditation, vigorous exercise, or sports o Alternatives need to be realistic and tailored to particular audiences (not everyone can go skydiving) 3. Personal and Social Skills o Personal/social failure (not involved in clubs, low grades) cause drug use o Teach student how to communicate and give success experiences o Eg students operate a school store; Have older tutor younger, give sense of competence Anti-Drug Norms  1984 review of drug prevention programs o Most have no appropriate evaluation component o Few success in terms of actual substance abuse prevention o Increased knowledge = no impact on substance abuse o Affective education approaches appear too experiential and place too little emphasis on skills necessary to resist pressure to use drugs  Anti-drug norms programs were developed in part in response to these findings  Refusal skills and pressure resistance strategies o Psychological inoculation = recognize peer pressure, refusal skills, self-assertion, social skills training o Eg Film that demonstrates effective ways of responding  Follow-up student discussion  Practice with techniques presented in the film o Effective in reducing cigarette smoking among adolescents, adopted for other drugs/behaviours  National Anti-Drug Strategy in Canada o Canada‘s approach to prevention is directed through National Anti-Drug Strategy, launched Oct 2007. o Collaborative effort among Health Canada, the Department of Justice, and Public Safety Canada o Three plan: prevent use, treat dependencies, combat illegal distribution o Campaign DrugsNot4Me teach coping and refusal skills – unevaluated effectiveness  Drug-free schools o 1986: Government began providing direct aid to local school districts for drug-prevention activities o School policies that do not condone drug use or underage alcohol use (eg locker search, expulsion of students, ban tobacco on school grounds even for teachers and staff) o Different from value free approach in 1970s – this want to make clear that society and school do NOT accept drug use Social Influence Model  Many approaches to drug-abuse prevention have been tried with smoking behavior. - Advantages: 1. Huge proportion – easy to measure behaviour change 2. Clear health consequences– good consensus over goals: prevent youth from becoming smokers 3. Easy to verify self-reported use of tobacco through saliva tests  Findings: o It is possible to design effective smoking prevention programs o Information about the delayed consequences of smoking (e.g., lung cancer) is relatively ineffective o Presenting information on immediate effects (e.g., shortness of breath) is more effective  Five key elements of the social influence model 1. Training refusal skills – refuse without being negative, be assertive, insist right 2. Public commitment – make pledge infront of peers 3. Countering advertising – ―inoculate‖ students to question advertisements  Question inconsistencies - healthy and attractive – but bead breath and yellow teeth  Taught to analyze and discover hidden messages 4. Normative education – teach not to overestimate how many peer smokes – show realistic picture, real statistics, counter the ‗Countering the ―everybody is doing it‖ attitude 5. Use of teen leaders – tell kids that little of their friends smoke, attitudes, how to refuse  Criticize that mode assume that all students need training in social skills or refusal skills  Students make active, conscious decisions in preparation for trying smoking and becoming smoker  Risk and protective factors have more influence on drug behavior than any information or education program devised Drug Abuse Resistance Education (DARE)  Developed in 1983 in Los Angeles; Widely accepted initially despite lack of studies supporting its effectiveness  Delivered by trained, uniformed police officers o Elements of social influence model  Refusal skills, teen leaders, and public commitment o Elements of affective education  Self-esteem building, alternatives to drug use, decision making  Studies on effectiveness of DARE o 1994: affect self-esteem - but no evidence for long-term reduction in drug use o 1994: increase knowledge about drugs / social skills - but the effects on drug use were marginal o 2004: only have small and not significant effect  Despite failure to demonstrate a significant impact of the DARE program on drug use, it continues to be widely used  instead have additional programs  By the early 1990s DARE programs were found in all Canadian provinces, except Quebec. o Currently, there are approximately 75 000 students being taught the DARE program in 1600 Canadian schools by 855 active DARE Officers. Prevention Programs that Work?  In 2010, the Canadian Centre on Substance Abuse released the Portfolio of Canadian Standards for Youth Substance Abuse Prevention. o Made to guide school/families in prevention and reduction of illegal drug use by Canadian Youth age 10-24 o Funded through Canada‘s National Anti-Drug Strategy.  Some programs have been demonstrated to have beneficial effects on actual drug use o ALERT: Based on social influence model  Smoking – no change in initiation – but more likely to quit / keep low rates  Reduce initiation of marijuana smoking! o Life Skills Training: Based on social influence model  Teaches resistance skills, normative education, media influences, and general self-management and social skills  Lower marijuana, alcohol, tobacco use after six years Community Programs Peer Programs  Peer influence approaches o Believe that opinion of peers can influence child  Open discussion, may be about drugs or just build positive relationship, sense of belonging, communication  Peer participation programs o Focus on youth in high-risk areas o May involve activities such as paid community service o Almost NEVER focus on drug – goal is to becoming member of society Parent and Family Programs  Informational o Basic info on drugs and effects - how to tell if child is using, o Make parents aware of their own alcohol and drug use o Rationale = well-informed parents – can teach appropriate attitudes & recognize potential problems  Parenting skills o communication, decision-making, setting goals and limits, and when and how to say no to a child o remove risk factor ―poor family relationship‖ – strengthen communication  Parent support groups o Group of parents meet regularly to discuss problem solving, parenting skills  Family interaction o Families work as a unit to examine, discuss, and confront issues relating to drug use  Example: Strengthening Families program o Targets children of substance abuse parents o Goals = improving parenting skills + family relationships + increasing children‘s skills o Eval: reduces tobacco and alcohol use in children + reduces substance abuse in parents Community Programs  Advantage: o Coordinated approach at different levels can have a greater impact o Programs can be controversial - but if involve many groups can receive more widespread community support o Can involve other resources, including local businesses and the public media  Communities Mobilizing for Change on Alcohol is one of SAMHSA‘s model prevention programs o Works for community policy changes and encourages participation of many community organizations and businesses Workplace Programs  Most consistent feature of workplace programs is random urine screening (in USA)  All companies and organizations that obtain grants or contracts from the federal government have to adopt a ―drug-free workplace‖ plan  The Government of Canada expects employers to state clearly that drug use on the job is unacceptable.  Employees need to be notified of the results of viol
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