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Foundations of Prevention . 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

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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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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 WORLD’S 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 REGION

AS A TRANSIT ZONE

EUROPE

UNITED STATES

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 person’s 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 media—are 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 the highest periods for drug abuse among youth? develop meaning full programmes

    • 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? develop meaning full programmes

    • 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 develop meaning full programmes


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    Prevention Programs Should . . . . develop meaning full programmes

    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 . . . . develop meaning full programmes

    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 . . . . develop meaning full programmes

    . .Target all Forms of Drug Use

    . . . and be Culturally Sensitive

    www.drugabuse.gov


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    Prevention Programs Should . . . . develop meaning full programmes

    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. . . . develop meaning full programmes

    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 . . . . develop meaning full programmes

    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 develop meaning full programmesMODELS

    School-based prevention programmes

    Peer-focused prevention programmes

    Family-based prevention programmes

    Community-based prevention programmes


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    School-based prevention programmes develop meaning full 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 develop meaning full 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 develop meaning full 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 develop meaning full 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 develop meaning full 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 develop meaning full 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 PREVENTION develop meaning full programmesGUIDELINES FOR EVIDENCE-BASEDPREVENTION PROGRAMS AND STRATEGIES


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    Youth/Peer Domain Guidelines develop meaning full programmes

    • Youth Preventive Education and Skill Building

    • Mentoring Programs

    • Tutoring Programs

    • Peer Leadership/Influence Programs


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    Family Domain Guidelines develop meaning full programmes

    • Parenting Education and Skill Building Programs

    • Parent Involvement Strategies


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    School Domain Guidelines develop meaning full programmes

    • 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 develop meaning full programmesEffective 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 develop meaning full programmes

    • 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 develop meaning full programmes

    • 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 develop meaning full programmes

    • Marital harmony

    • Parents abstain

    • Family management

    • Psychologically healthy parents


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    Family Resilience Processes develop meaning full programmes(cont.)

    • Family hardiness

    • Parental support

    • Family bonding

    • Family connectedness

    • Healthy parent-adolescent communication


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    Community Resilience Processes develop meaning full programmes

    • 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 develop meaning full programmes

    • 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 develop meaning full programmes


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    Inter-relationship of Risk Factors for Drug Use develop meaning full programmes

    • 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 develop meaning full programmes

    • 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 develop meaning full programmes

    • 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? develop meaning full programmes

    • 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? develop meaning full programmes

    • 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 develop meaning full programmes

    • 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 develop meaning full programmes

    • 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


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