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EPIDEMIOLOGY OF DRUG ABUSE: A REFRESHER MODULE ON DRUG ABUSE RESEARCH

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The current state of the science (new methods, new challenges, new issues) ... Drug abuse psychopathology: co-morbidity and vulnerability ... – PowerPoint PPT presentation

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Title: EPIDEMIOLOGY OF DRUG ABUSE: A REFRESHER MODULE ON DRUG ABUSE RESEARCH


1
EPIDEMIOLOGY OF DRUG ABUSEA REFRESHER MODULE
ON DRUG ABUSE RESEARCH
  • Meeting Of Caribbean National Observatories In
    Drugs
  • Bridgetown, Barbados
  • June 14-16, 2005

Dr Ken-Garfield Douglas
2
What would the presentation cover?
  • Elements of drug abuse epidemiology
  • The current state of the science (new methods,
    new challenges, new issues)
  • Qualitative methods highlighted
  • Consideration in going from research to policy to
    practice
  • Lessons learned from quantitative research in the
    Caribbean (school surveys)

3
Working definitions (drug abuse research)
  • Drug abuse research help countries to obtain
    better information about the nature and extent of
    drug use and drug abuse
  • It provides systematic methods to collect
    qualitative data about drug use and quantitative
    data on patterns and consequences of drug use or
    abuse

4
What is the focus of epidemiological research
  • Drug abuse epidemiologic research focuses on
    understanding the nature, extent, consequences,
    and etiology of drug abuse across individuals,
    families, age groups, gender, communities, and
    population groups.

5
What is the role of epidemiological research
  • Epidemiologic research plays a critical public
    health role by providing an estimate of the
    magnitude, impact, and risk of drug abuse on a
    population

6
What are some of the outputs of epidemiological
research
  • Lays the foundation for
  • developing strategies to treat and prevent drug
    abuse
  • plan and evaluate drug abuse services and
  • suggest new areas for basic, clinical, and
    treatment research.

7
What is the true value of drug abuse research?
  • The value of drug abuse research lies in the
    dissemination of research information which helps
    to address the issue of public perceptions about
    drug abuse and at the same time educates the
    public about drug abuse and addiction.

8
The value of what we have done
  • The vast majority of our epidemiology research
    had been quantitative in nature
  • Not much of the information collected have be
    consistently disseminated in-country and
    region-wide
  • Most of our present knowledge comes from generic
    research conducted outside the region

9
Present knowledge gaps for the region
  • The origins and pathways to drug abuse a
    comprehensive understanding of the factors and
    processes that predisposes and or protects and
    individual from drug abuse
  • Drug use and adverse behavioural and social
    consequences and understanding of the nature
    and extent of drug-related consequences and their
    development

10
Present knowledge gaps for the region
  • Application of applicable research methodologies
    that screens clients to appropriate treatment
    modalities
  • A notable lack of multiple/logistic regression
    analysis
  • Research/evaluation on the effectiveness of our
    prevention programmes (Are they tested-effective,
    what fruits are they bearing)

11
Present innovative methodologies (new methods,
challenges and issues)
  • The application of social work and social science
    theory and methods in substance abuse research
  • Triangulation of methods (combining qualitative
    and quantitative approaches)
  • Computer assisted approaches for collecting data
    have promise

12
Present innovative methodologies (new methods,
challenges and issues)
  • The Use of Geographic Information Systems (GIS)
    e.g. in assessing substance abuse prevention
    resource
  • Operational research particularly around
    standardizing treatment and prevention practices
  • The twin epidemic the spread of HIV disease
    primarily in the context of illicit drugs use

13
Lets unravel the issues around the pathways to
drug abuse
  • The major emphasis has been to stimulate
    innovative investigations that enhance our
    understanding of
  • (1) drug use patterns and trends within and
    across populations
  • (2) interplay of social interactions, social
    environment, structural context with individual
    behavioural characteristics and genetic
    vulnerability

14
The pathways to drug abuse
  • (3) causal mechanisms leading to onset,
    maintenance, and remittance of drug abuse, as
    well as protective mechanisms that reduce the
    risk of drug abuse and
  • (4) drug abuse over the life course, including
    developmental processes that influence drug use
    trajectories and behavioural, health, and social
    consequences of drug abuse.

15
The pathways to drug abuse
  • Some cross-cutting issues in drug abuse research
  • gender differences in the nature and extent of
    drug-using behaviours, in the pathways and
    determinants of initiation, progression and
    maintenance of drug abuse
  • HIV/AIDS and drug abuse are frequently referred
    to as twin epidemics, and whenever possible, it
    is essential that epidemiologic studies address
    this interrelationship

16
The pathways to drug abuse
  • Some cross-cutting issues in drug abuse research
  • Methodological innovations should seek to address
    transitions in stages and trajectories of drug
    abuse, inter-generational transmission of drug
    abuse, and heterogeneous pathways to and
    consequences of drug abuse.

17
The pathways to drug abuse
  • Examples of the types of research topics to be
    explored under pathways to drug abuse include,
    but are not limited to, the following
  • Emerging and current trends
  • Social epidemiology of drug abuse
  • Drug abuse psychopathology co-morbidity and
    vulnerability
  • Developmental consequences of drug abuse
  • Social and behavioural consequences of street
    drugs
  • Drug markets and behaviour economics

18
The pathways to drug abuse - Social epidemiology
of drug abuse
  • Drug abuse research has focused largely on
    individual risk factors, while the universe of
    determinants includes individual, family,
    neighbourhood, community, population-specific,
    and societal factors
  • Lets briefly look at some findings from a
    regional study in the area of social epidemiology
    (risk and protective factor study secondary
    school students)

19
What are risk and protective factors?
  • Risk factors are characteristics in the
    community, family, school and individuals
    environments that are known to increase the
    likelihood that a student or individual will
    engage in one or more problem behaviors
  • Protective factors are characteristics that are
    known to decrease the likelihood that a student
    will engage in problem behaviors

National Drug Commission February 04
20
What did the survey find?
  • Risk Factors
  • Of the 22 risk factors evaluated three groups
    can be identified
  • Those of great concerns (overall scores above the
    normative average of 50 points)
  • Those of border-line concerns (below the
    normative score but within overall average of 47
    points)
  • Those of no particular concern (below the overall
    survey average score of 47 points)

National Drug Commission February 04
21
Risk factors of great concern
  • Community disorganization
  • Poor academic performance
  • Laws and norms favourable to drug use
  • Friends delinquent behaviour
  • Personal transition and mobility
  • Low neighbourhood attachment
  • Gang involvement

National Drug Commission February 04
22
Risk factors of borderline concern
  • Poor family supervision
  • Poor family discipline
  • Parental attitude favourable towards anti-social
    behaviour
  • Peer reward for anti-social behaviour
  • Parental attitude favourable towards ATOD

National Drug Commission February 04
23
Overall protective factors scores
Base/average
National Drug Commission February 04
24
Triangulation revisited (Qualitative Research)
  • Qualitative methods has an emphasis on process
    and an in-depth understanding of perceived
    meanings, interpretations and behaviours
  • It gives an internal perspective
  • It is the kind of research that produces findings
    not derived from statistical procedures or other
    means of quantification.

25
Qualitative Research
  • Qualitative methods are significant for drug
    abuse research because it helps not only in the
    design of questionnaires but also to help
    formulate meaningful research questions, conduct
    appropriate statistical analysis and even
    interpret the results

26
Qualitative Research
  • Key components of Qualitative research
  • Ethics and informed consent (some guidelines)
  • the purpose of the research and the potential
    risks must be made explicit to the subjects
  • they must have the right to choose whether or not
    to participate
  • the researcher responsibility is to determine
    that no harm may come to the subject as a result
    of participation

27
Qualitative Research
  • Observation
  • Qualitative interviews
  • Analysis of the textual data (content analysis)
  • Experienced/qualified investigators (usually
    ethnographers or researchers with background in
    anthropology and sociology)

28
From Research to Policy to Practice
  • Research (gathering the evidence)
  • Policy (applied guiding principles and
    strategies)
  • Practice (activities/programmes)
  • Our key question
  • Of what value is research in making this link?

29
From Research to Policy to Practice
  • Effective strategies to deal with the problems of
    drug abuse must be "as complex as the problem
    itself
  • Success will be found only when public safety and
    public health professionals use science and not
    ideology as the foundation of those strategies
  • policies should be based on the best available
    knowledge and analysis and should be judged by
    the results they produce rather than by the
    intentions they embody

30
From Research to Policy to Practice
  • One needs to be cautious about over-generalizing
    from any particular research finding, however
    many studies of substance abuse and crime offer
    direction for a "fundamental rethinking of our
    current practices" and for new public policy
    initiatives

31
Some practical application
  • Lets look at these data points and rationalize
    the possible next steps in terms of policy and
    practice (programmes or interventions)

32
STATUS OF INMATES and DRUG USE AT RECEPTION
33
Treatment, rehabilitation and perceived need for
treatment
  • 22 had been in treatment
  • 41 had counseling or rehabilitation
  • 25 perceive the need for treatment
  • In addition, of those in need of treatment
  • 47 positive for marijuana
  • 63 positive for cocaine
  • 42 positive for opiates (heroin)

34
NEEDS ASSESSMENT
TREATMENT
35
Figure 1 Prevalence of Cigarette Use
36
Figure 10 Prevalence of Inhalant Use
37
Figure 13 Age of First Use of Cigarette
38
Figure 16 Age of First Use of Inhalants
39
What now?
  • More research?
  • Greater emphasis on advocacy?
  • More/better interpretation of our information
    into actions?

40
My recommendation
  • A monograph of all the current research (last
    five years) done in the region
  • Making the information available on line
  • Translating the information into possible
    credible actions
  • from a policy perspective
  • as well as from a practice perspective
    (implications and possible best practices in
    terms of programmes and interventions)
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