Foundations of Prevention

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Foundations of Prevention
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What would be covered?

• Introduction to drug abuse
• Global challenges
• Caribbean perspective
• Definition of prevention
• Basic principles of prevention
• Risk and protective factors
• Prevention Models
• Elements of prevention programmes
• Resilience
• Risk factor domains for drug use
• Your perspective

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AN INTRODUCTION TO DRUG ABUSE
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Defining drug abuse

• Three schools of thought
• The first two are commonly referred to as
  Medical-pharmacological Models..and
• Third perspectives commonly referred to as The
  Social Deviance Model

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Defining drug abuse

• The use generally by self-administration of any
  drug in a manner that deviates from the approved
  medical or social patterns within a given
  culture. (social disapproval) (Jerome Jaffe)

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Therefore the basic elements of drug abuse are

• The use of any prohibited (illicit drug)
• The use of any therapeutic drug other than for
  its intended purpose(s)
• The intentional use of any therapeutic drug in
  amounts greater than prescribed

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Therefore the basic elements of drug abuse are

• Excessive use of licit social drugs (alcohol,
  caffeine or tobacco)
• The taking of two or more intoxicating substances
  to obtain a more pleasurable high

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THE WORLDS DRUG PROBLEM AND THE BUSINESS
OF DRUGSTHE MAIN DRUGS OF ABUSE
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Case study AFGHANISTAN (2003)

• 80,000 hectares under cultivation
• 28 of 32 provinces are presently cultivating
• Production increased to 3,600 tons in 2003
• Average price now 283 US per kg
• 264,000 families or approximately 1.7million
  persons involved in cultivation (7 of the total
  population)
• Annual income of 1.2 billion
• Each family get approx. 3,900 US annually
  compared to non-opium growing families GDP per
  capita of 184 US

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Case study BOLIVIA (2003)

• Third largest producers of coca in the world
• 23,600 hectares under cultivation
• Grown in 2 main areas of the country (50
  legitimate cultivation)
• Production of 28,300 tons in 2003
• Average price now 5.40 US per kg
• Annual income of 153 million
• About 60 of total production used to produce
  cocaine (60 metric tons)

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Case study (2003)

• Production is dominated by methamphetamine,
  followed by ecstasy and amphetamine
• Most ecstasy laboratories are still dismantled in
  Europe, but production is rising in Asia
• Number of dismantled clandestine ecstasy
  laboratories rises almost 3-fold over 1992-2002
  period
• Most methamphetamine laboratories are dismantled
  in North America

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Case study MOROCCO (2003)

• 134,000 hectares cultivated (1.5 of arable land)
• Grown in 5 provinces throughout the country
• Production of 47,000 metric tons of raw cannabis
  and 3,080 tons of resin
• 96,000 farms (800,000 farmers)
• Total revenue of approx. 214 billion US
• Annual income per family from cannabis 2,200 US
• Total market turnover of Moroccan cannabis
  estimated at 12 billion US

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THE CARIBBEAN PRESPECTIVE
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THE CARIBBEAN REGION AS A TRANSIT ZONE
STORAGE AREA
PRODUCER COUNTRY
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Geographic characteristics

• Combined land area of 700,000 sq. miles
• independent countries, English, French and Dutch
  overseas countries and territories
• multi-lingual, multi-ethnic and multi-cultural
• approximately 37 million people
• four major different languages (English, French,
  Spanish and Dutch)
• a variety of judicial systems, diverse religious
  and political units

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PRINCIPLES OF PREVENTIONDEFINITON OF
PREVENTION CLASSIFYING PREVENTION
INITIATIVES- RISK AND PROTECTIVE
FACTORS-EARLY SIGNS-HIGHEST RISK
PERIODS-PROGRESSION OF DRUG USE
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Definition of Prevention

• Generally PREVENTION targets illnesses or disease
  outcomes and is often associated with the process
  of reducing existing risk factors and increasing
  protective factors in an individual, in high-risk
  groups, in the community or in society as a
  whole.

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Stages of Prevention Primary Prevention

• Primary Prevention
• aims to avoid the development of high-risk or
  potentially harmful behaviour and/or the
  occurrence of symptoms in the first place

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Stages of Prevention Secondary Prevention

• Secondary prevention, or early intervention, aims
  to reduce existing risk and harmful behaviour and
  symptoms as early as possible

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Stages of Prevention- Tertiary Prevention

• Tertiary prevention aims to reduce the impact of
  the illness/symptoms a person suffers. It offers
  treatment and rehabilitation for the person
  dependent or addicted to drugs, or whose drug
  use is problematic.

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Classifying prevention programmes

• Universal Prevention Programmes These
  programmes are the broadest, and address large
  groups of people - such as the general population
  - or certain sub-categories of the population.
  Universal programmes mainly have the objective of
  promoting health and well-being, and of
  preventing the onset of drug use, with children
  and young people as the usual prime focus groups

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Classifying prevention programmes

• Selected Prevention Programmes This type of
  programme targets young people based on the
  presence of known risk factors of drug
  involvement. Targets have been identified as
  having an increased likelihood of initiating drug
  use compared to young people in general. These
  programmes are aimed at reducing the influence of
  the 'risk factors', developing/enhancing
  protective factors, and preventing drug use
  initiation.

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Classifying prevention programmes

• Indicated Prevention Programmes Indicated
  programmes target young people who are identified
  as having already started to use drugs or
  exhibiting behaviours that make problematic drug
  use a likelihood, but who do not yet meet formal
  diagnostic criteria for a drug abuse disorder
  which requires specialized treatment. Examples of
  such programmes include providing social skills
  or parent-child interaction training for
  drug-using youth.

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Risk and Protective Factors

• Risk factors can increase a persons chances for
  drug abuse, while protective factors can reduce
  the risk.

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CORE PREVENTION PRINIPLES

• Prevention programmes should enhance protective
  factor and reverse or reduce risk factor
• Include skills to resist drugs when offered,
  strengthen personal commitments against drug use,
  and increase social competency (e.g., in
  communications, peer relationships,
  self-efficacy, and assertiveness), in conjunction
  with reinforcement of attitudes against drug use.
• Include interactive methods, such as peer
  discussion groups, rather than didactic teaching
  techniques alone.

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CORE PREVENTION PRINIPLES

• Prevention programmes should enhance protective
  factor and reverse or reduce risk factor
• Designed to enhance "protective factors" and move
  toward reversing or reducing known "risk
  factors."
• Target all forms of drug abuse, including the use
  of tobacco, alcohol, marijuana, and inhalants.

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CORE PREVENTION PRINIPLES

• Prevention planning - Family Programs
• Prevention programs should include a parents' or
  caregivers' component that reinforces what the
  children are learning-such as facts about drugs
  and their harmful effects-and that opens
  opportunities for family discussions about use of
  legal and illegal substances and family policies
  about their use.

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CORE PREVENTION PRINIPLES

• School Programs
• Designed to intervene as early as preschool to
  address risk factors for drug abuse, such as
  aggressive behaviour, poor social skills, and
  academic difficulties
• Programs for elementary school children should
  target improving academic and social-emotional
  learning to address risk factors for drug abuse,
  such as early aggression, academic failure, and
  school dropout
• Programs for middle or junior high and high
  school students should increase academic and
  social competence

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CORE PREVENTION PRINIPLES

• Community Programs
• Programs aimed at general populations at key
  transition points, such as the transition to
  middle school, can produce beneficial effects
  even among high-risk families and children, they
  reduce labeling and promote bonding to school and
  community
• Programs that combine two or more effective
  programs, such as family-based and school-based
  programs, can be more effective than a single
  program alone
• Programs reaching populations in multiple
  settings, e.g., schools, clubs, faith-based
  organizations, and the mediaare most effective
  when they present consistent, community-wide
  messages

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CORE PREVENTION PRINIPLES

• Prevention programme delivery
• When communities adapt programs to match their
  needs, community norms, or differing cultural
  requirements, they should retain core elements of
  the original research-based intervention which
  include
• Structure (how the program is organized and
  constructed)
• Content (the information, skills, and strategies
  of the program) and
• Delivery (how the program is adapted,
  implemented, and evaluated).
• Programs should be long-term with repeated
  interventions (i.e., booster programs) to
  reinforce the original prevention goals. Research
  shows that the benefits from middle school
  prevention programs diminish without follow-up
  programs in high school

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CORE PREVENTION PRINIPLES

• Programme Delivery
• PRINCIPLE 13 - Prevention programs should be
  long-term with repeated interventions (i.e.,
  booster programs) to reinforce the original
  prevention goals. Research shows that the
  benefits from middle school prevention programs
  diminish without follow-up programs in high
  school.
• PRINCIPLE 14 - Prevention programs should
  include teacher training on good classroom
  management practices, such as rewarding
  appropriate student behaviour. Such techniques
  help to foster students positive behaviour,
  achievement, academic motivation, and school
  bonding.

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CORE PREVENTION PRINIPLES

• Programme Delivery
• PRINCIPLE 15 - Prevention programs are most
  effective when they employ interactive
  techniques, such as peer discussion groups and
  parent role-playing, that allow for active
  involvement in learning about drug abuse and
  reinforcing skills.
• PRINCIPLE 16 - Research-based prevention
  programs can be cost-effective. Similar to
  earlier research, recent research shows that for
  each dollar invested in prevention, a savings in
  treatment for alcohol or other substance abuse
  can be seen.

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What are some of the things we need to
know in order to develop meaning full programmes
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What are the highest periods for drug abuse among
youth?

• Around transition periods
• Puberty
• Entering school moving to higher levels
• Moving or parent divorce
• Risk appears at every transition from early
  childhood through adulthood each developmental
  stage must be supported with appropriate
  protective factor

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When and how does drug use starts and progress?

• Use may begin as early as 10/11/12 yrs
• Gateway drugs at play
• At late adolescents tobacco and alcohol use may
  persist and marijuana and other illegal drugs are
  introduced
• Early initiation associated with greater drug
  involvement
• Abuse associated with levels of social
  disapproval, perceived risk and availability of
  drugs in the community

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www.drugabuse.gov
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Prevention Programs Should . . . . Reduce Risk
Factors

• ineffective parenting
• chaotic home environment
• lack of mutual attachments/nurturing
• inappropriate behavior in the classroom
• failure in school performance
• poor social coping skills
• affiliations with deviant peers
• perceptions of approval of drug-using behaviors
  in the school, peer, and community environments

www.drugabuse.gov
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Prevention Programs Should . . . .
Enhance Protective Factors

• strong family bonds
• parental monitoring
• parental involvement
• success in school performance
• prosocial institutions (e.g. such as family,
  school, and religious organizations)
• conventional norms about drug use

www.drugabuse.gov
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Prevention Programs Should . . . . . .Target all
Forms of Drug Use
. . . and be Culturally Sensitive
www.drugabuse.gov
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Prevention Programs Should . . . . Include
Interactive Skills-Based Training

• Resist drugs
• Strengthen personal commitments against drug use
• Increase social competency
• Reinforce attitudes against drug use

www.drugabuse.gov
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Prevention Programs Should be. . .
. Family-Focused

• Provides greater impact than parent-only or
  child-only programs
• Include at each stage of development
• Involve effective parenting skills

www.drugabuse.gov
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Prevention Programs Should . . . . Involve
Communities and Schools

• Media campaigns and policy changes
• Strengthen norms against drug use
• Address specific nature of local drug problem

www.drugabuse.gov
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PREVENTION MODELS

• School-based prevention programmes
• Peer-focused prevention programmes
• Family-based prevention programmes
• Community-based prevention programmes

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School-based prevention programmes

• Four main programming strategies
• Information-based programmes disseminate
  information on risky behaviours
• Affective education programmes values
  clarification, goal setting, decision making,
  self-esteem building, and stress management
• Social influence programmes resistance skills,
  life skills, and normative beliefs
• Comprehensive programmes combining a variety of
  strategies

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Peer-focused prevention programmes

• Four main programming strategies
• adolescents can influence their peers directly
  through education an adolescent describing the
  consequences of his violent behaviour can have a
  strong impact on other adolescent who could
  relate to his situation
• adolescent can learn by observing how peers
  behave if a peer handle anger and solve
  problems peacefully and constructively, then
  youth may try behaving that way as well

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Peer-focused prevention programmes

• Four main programming strategies
• peer influence can work by changing peer group
  norms structured programmes can help change the
  norms by fostering the development of highly
  visible peer groups who discourage substance use
  behaviours
• peer programmes can educate students about true
  versus perceived dominant peer norms teaching
  adolescents about the true versus perceived group
  norms concerning substance use could result in a
  decline in substance use initiation

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Family-based prevention programmes

• Well-documented family-based programme
  methodologies aimed at prevention can be divided
  into three categories
• parent and family skill training
• family in-home support
• family therapy

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Community-based prevention programmes

• Advantages of community-based intervention
• The breath of coverage e.g. a community-based
  approach for reducing tobacco use by youth
  involves requiring anyone involved in any way
  with the sale and distribution of tobacco
  products to participate in a merchant education
  programme. The coverage or exposure is enhanced
  because of the shift in the focus of the
  intervention from individual buyers to all points
  of purchase.

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Community-based prevention programmes

• Advantages of community-based intervention
• Visibility and repetitive reinforcement this
  can strengthen norms against behaviour such as
  substance abuse or violence. Counter-advertising
  campaign through many mass media public service
  announcements are a relatively easy way to send
  multiple message about dangers of various risky
  behaviours
• Potential for maximizing outcomes the utility
  of community approaches lies in the fact that
  they can be focused on policy changes.

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SUBSTANCE ABUSE PREVENTIONGUIDELINES FOR
EVIDENCE-BASEDPREVENTION PROGRAMS AND STRATEGIES
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Youth/Peer Domain Guidelines

• Youth Preventive Education and Skill Building
• Mentoring Programs
• Tutoring Programs
• Peer Leadership/Influence Programs

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Family Domain Guidelines

• Parenting Education and Skill Building Programs
  
• Parent Involvement Strategies

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School Domain Guidelines

• Comprehensive School Reform /Climate Change
• Student Assistance Program
• Technical Assistance
• Advocacy for School ATOD Policy
  Development/Change

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Community Domain Guidelines for Effective
Practices

• Social Marketing
• ATOD Prevention Coalition Technical Assistance
• Media Advocacy
• ATOD Policy/Ordinance Development or Change
• Server/Merchant Education and ATOD
  Policy/Ordinance/Law Compliance Monitoring

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Resilience

• The process by which successful developmental or
  adaptive outcomes occur within a high-risk
  environment and/or stressful circumstances
• Requires
• Risk factors
• Protective factors

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Individual Resilience Processes

• Protective Processes
• Self-perceived competence
• Academic competence
• Healthy interactions with adults
• Religion and prayer
• Anti-alcohol norms
• Social skills

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Family Resilience Processes

• Marital harmony
• Parents abstain
• Family management
• Psychologically healthy parents

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Family Resilience Processes (cont.)

• Family hardiness
• Parental support
• Family bonding
• Family connectedness
• Healthy parent-adolescent communication

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Community Resilience Processes

• Student autonomy and influences
• School norms
• School connectedness
• School sense of community
• No tolerance approach
• Local law enforcement
• Higher alcohol prices

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Conclusions

• Prevention opportunities exist at the individual,
  family, and community levels
• Prevention can enhance protective factors in
  addition to or instead of decreasing risk factors

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Risk factor domains for drug use
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Inter-relationship of Risk Factors for Drug Use

• We are often faced with the dilemma of trying to
  place risk for substance use into the usual
  domains described in the literature demographic
  (age, gender) personal (peer influence,
  psychological factors) family (poverty,
  culture) and community (neighbourhood, school).

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Inter-relationship of Risk Factors for Drug Use

• However, it might be argued though that for us
  risk factors can be grouped into only two
  domains
• (1) contextual factors including societal and
  cultural influences, and
• (2) economic factors or individual/interpersonal
  factors that takes into account the individual
  within the context of social, behavioural and
  biological influences on adolescent
  decision-making

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Inter-relationship of Risk Factors for Drug Use

• Personality factors
• Q, would a greater sense of coherence result in
  more protective behaviour
• Family and peer relationships
• Q, is there too much social, behavioural and
  biological influence that interferes with
  decision-making (especially among youth/young
  adults)
• Cultural and environmental factors
• Q, is the societal and cultural influences the
  ones to be blamed

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Is The Risk Worth It?

• Q, what lessons have we learned
• the largest risk group are our youth
  (adolescents)
• in order for prevention to work we need to
  advocate among our at risk groups
• knowledge alone with not bring about behaviour
  change - need for a positive attitude
• remember - there is a complex inter-relatedness
  among behavioural risk factors

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Is The Risk Worth It?

• Q, what opportunities exist for us
• e.g. we can be the advocated for the reduction
  of adolescent risk behaviour

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Policy implication for substance abuse prevention

• Policy planning and development
• Policy makers must be fully aware of drug abuse
  problems and its social and economic consequences
• Drug abuse prevention requires long-term
  commitment
• Research/needs assessment
• Policies must be driven by empirical evidence

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Policy implication for substance abuse prevention

• Evaluation
• Evaluation must be integrated into policies
  project and programmes from the outset
• Investment must be made for training in
  evaluation methods
• Partnerships
• Multi-sectoral and inter-institutional
  collaboration helps to pool resources and develop
  common strategies