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Prevention

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In the broadest sense, ____________________ is organized activity designed to avoid or decrease health problems" (Wilson & Kolander, 2011)

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Drug Prevention

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________________ is aimed at preventing and/or decreasing not only health problems, but also social and personal problems (Hanson, Venturelli, & Fleckenstein, 2012)

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Protective factors

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(such as self-control, parental monitoring, anti-drug use policies)

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Primary drug prevention programs

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refer to a very broad range of activities aimed at reducing the risk of drug use among non-users and assuring continued non-use • The emphasis of primary drug prevention programs are aimed at either nonusers who need to be "inoculated" against potential drug use and helping at-risk individuals avoid the development of addictive behaviors • Often targeted to at-risk individuals, neighborhoods, communities, and families

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Secondary drug prevention programs

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consist of uncovering potentially harmful substance use prior to the onset of overt symptoms or problems and/or targeting newer drug users with a limited early history of drug use • The focus is on at-risk groups, such as early experimenters having some abuse problems in order to stop the progression to drugs of abuse

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Tertiary drug prevention

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programs focus directly on intervention • Targets chemically dependent individuals who need treatment so that further disability is minimized • The focus is intervention at an advanced state of drug use/abuse

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Primary, Secondary, and Tertiary

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________ , _______, and _______ programs are often used in combination because, in most settings, all three types of drug users constitute the targeted population

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Theory

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________ is the foundation of all effective prevention and treatment programs. ________ guides the development, implementation, and evaluation of these programs.

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Fear-based, Intrapersonal theories

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• Health Belief Model • Precaution Adoption Process Model • Protection Motivation Theory

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Non-fear-based, Intrapersonal theories

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• Theory of Reasoned Action/Theory of Planned Behavior/Reasoned Action Approach • Transtheoretical Model/Stages of Change

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• Interpersonal theories

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• Social Network Theory

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Ecological theories

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• Social Cognitive Theory • Bronfenbrenner's Ecological Systems Theory

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Scare tactic approach:

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Drug prevention information based on emphasizing the extreme negative effects of drug use by coercing/warning the audience about the dangers of drug use.

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Information-only or Awareness model

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Assumes that teaching about the harmful effects of drugs will change attitudes about use and abuse.

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Attitude change model or Affective education model:

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Assumes people use drugs because of a lack of self-esteem and other personality factors.

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Social influences model:

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Assumes that drug users lack resistance skills.

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Ecological or Person-in-environment model

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Focuses on the causes of drug use resulting largely from the social environment. This perspective emphasizes that it is important to take into account all of the environments that may have an impact on drug use. Friends, acquaintances, roommates, and classmates in dorms, sororities, and fraternities, at parties, cafes, and nightspots can influence students.

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Types of Common Comprehensive Prevention Programs for Drug Use and Abuse

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Harm Reduction Model Community-based Drug Prevention Programs School-based Drug Prevention Programs Family-based Drug Prevention Programs

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Harm Reduction Model

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• Practiced in Netherlands and in the United Kingdom • Meets addicts on their own level • Uses an "open door" policy • Addicts are encouraged to take part in prevention and treatment services • Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live to assist them in reducing attendant harm

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Community Based Drug Prevention

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Very broad and take into account the community's youth, parents, businesses, media, schools, law enforcement, religious or fraternal groups, civic or volunteer groups, healthcare professionals, and government agencies Goal: Provide coordinated programs among many agencies and organizations involved in prevention Emphasizes comprehensive drug abuse

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CADCA

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Community Anti-Drug Coalitions of America (1992) is the nation's leading national substance abuse prevention organization, representing the interests of thousands of community coalitions in the U.S. and around the world

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School-based Drug Prevention

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Drug education in elementary, junior high, senior high, and college level • First attempts of school-based drug prevention included the use of the scare tactic approach : • Drug prevention information based on emphasizing the extreme negative effects of drug use - scaring the audience of potential and current drug users/abusers into not using drugs • Research indicates that the use of scare tactics did not produce successful programs

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Cognitive approach in school-based drug prevention programs:

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If youths understand the dangers of AOD, they will not use them. Strategies: • Teach pharmacology of alcohol and other drugs, how they are used, long- range consequences of use - usually through scare tactics ---Seldomly effective ---Arouses curiosity and encourages experimentation ---Knowledge alone doesn't counteract peer pressure.

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Affective approach in school-based drug prevention programs:

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High self-esteem, values consistent with non-use, and good problem-solving and decision-making skills help youth avoid AOD • Strategies: • Raise self-esteem • Teach values and life skills • Usually don't include information about AOD ---Does NOT decrease rate of use.

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Combined Cognitive and Affective approaches in school-based drug prevention programs:

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Students need both information and life skills to avoid AOD use • Strategies: • Teach problem-solving, decision-making, and peer pressure refusal skills • Provide explicit information about AOD to connect life skills and AOD use and consequences • Effectiveness: ---little consistent effect on reducing the use of ATOD ---some success has been reported (6m-2yr) ---5-10 yrs after program evals are more realistic.

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Normative education approach in school-based drug prevention programs:

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Youth overestimate the extent of AOD use among peers thus may use AOD to feel part of the group • Strategies: • Correct misconceptions • Demonstrate actual norms through discussion • Develop non-use norms • Effectiveness: --Successful with some drugs.

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Social learning/cognitive behavioral approach in school-based drug prevention programs:

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AOD use usually begins in a social setting between grades 5 and 9; Youth need skills for resisting pressures • Strategies: • Teach how to identify pressures from peers, media, advertising, families • Teach resistance skills, model counterarguments • Student role play pressure situations and actively practice resisting • Effectiveness: --Little long term evidence ---sometimes effective

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Family-based Prevention Programs

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Stresses the quality of parent-child interaction, communication skill, child management practices, and family management Primary family risk factors that predispose youth to drug use: Chaotic home environments, particularly in which parents abuse substances or suffer from mental illnesses Ineffective parenting, especially with children with difficult temperaments and conduct disorders Lack of mutual attachments and nurturing

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Step 1

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Identify target population (adolescents, young adults, older adults) • Usually done via a needs assessment

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Step 2

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Choose appropriate level of prevention (primary, secondary, tertiary) • Should match with the target population

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Step 3

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Determine the appropriate theory as the framework for the program • Fear-based, intrapersonal, interpersonal, ecological, etc.

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Step 4

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Identify prevention strategies, setting, and evaluation methods

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Step 5

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Implement the program

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Step 6

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Evaluation program effectiveness

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Shamanism

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take a substance and be guided through a trance

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Egyptians

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5500BC making wine

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Vikings

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800-1,000BC took mushrooms and went to war

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1800s (best years for drugs)

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-no FDA -marijuana appears and is extremely popular -cocaine -hypodermic needle (thought if you injected drugs you wouldn't become addicted) -amphetamines -heroine

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1900s

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-drug regulation starts -Pure Food and Drug Act(no misbranding/adultering food) -Government right to seize -1914 Harrison Narcotic Act (highly regulates narcotics and drugs, only licensed professionals could prescribe) -Clause for Addicts:addiction wasnt seen as a problem and docs still giving out drugs freely -1918 drug trafficking begins -1919 WWII amphetamines -1950 Comprehensive Drug Abuse Prevention+Control Act creates a schedule for drugs at 5 tiers

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2000s

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-bath salts and pain medication -opioids killed 28,000 people in 2014

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Food and Drug Association (drug approval)

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1)start with animal testing 2)small clinical trials with humans 3+4) large testing on humans; could take up 15-20 years

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Drug Use

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equally opportunity affliction= no one is immune

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Use to Abuse

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Excessive Use, Preoccupation, Refusal to admit problem, Reliance

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Basics of Therapy

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comprehensive treatment plan, social support, positive encouragement, make sure they are set up to recover without you, resolve past issues, create trust, increase self-efficacy, acknowledge health disorders

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Life Process Model

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addictions are habitual responses, individual learned their way into addiction and can learn their way back out of it *defies medical model*

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Bronfenbrenner's Ecological System

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multitude of systems as you grow up and we should target all of them in prevention

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Maslow's Hierarchy of Needs

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-motivated by unsatisfied needs (abuse drugs because they don't feel loved, really low self esteem) -lower order fundamentals (basic needs to be met first) -higher order needs (treating the disorder) -even if needs are met, change isnt easy (quitting smoking, unhealthy eating, coffee etc...)

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Stage Developmental Theory

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-precontemplation (denial) -contemplation (considering changing) -preparation (taking steps to implement change) -action (physically doing necessary steps to change) -maintenance (sobriety becoming part of your everyday routine)

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Detox Center

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getting you off the drug, no therapy or counseling, short term

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Residential Therapy

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-short (12 step based, 2-3 weeks) -long (24 hour medical/nonmedical, 10,000-12,000 a month)

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Behavioral Therapy

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family based, group, individual, IOP (intensive out patient, 3 hours 4 times a week go to group), CBT (cognitive behavioral therapy), Motivational interviewing (leading questions to make them realize they make a lot of excuses for their use)

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Antagonist Blocks

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drugs block receptors that receive dopamine

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Agonist Blocks

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makes a receptor work better

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Methadone

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Opiate Addicts, prevents withdraw and decreases craving, agonist-activates receptors preventing withdrawal

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Naloxone

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opioid addiction, antagonist-blocks the neuron, use when overdosing, blocks what drugs are doing makes the nueron fire so you wake up, will feel a lot of pain immediately

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Buprenorphine

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agonist and antagonist, reduce withdrawal symptoms without euphoria, suboxone

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Clonindine

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several substance disorders, not addictive, no special license needed

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Antabuse

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substance abuse disorder, treating alcoholics, disulfiram, causes vomiting nausea flushing if you use while on it

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