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The evidence for prevention: Lessons from the substance abuse field

The evidence for prevention: Lessons from the substance abuse field. Aim. To suggest a framework for organizing prevention research, policy, programming To identify evidence-based prevention measures To introduce Health Canada’s prevention principles Sources:

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The evidence for prevention: Lessons from the substance abuse field

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  1. The evidence for prevention: Lessons from the substance abuse field

  2. Aim • To suggest a framework for organizing prevention research, policy, programming • To identify evidence-based prevention measures • To introduce Health Canada’s prevention principles Sources: • Health Canada’s compendium of best practices (2001) • Holder’s review of prevention research (2003) • WHO review of evidence for substance abuse prevention (2003)

  3. Method for identifying evidence-based practices • clear goals targets for the review • review of review approach • two or three targeted search on poorly represented areas • rated articles for quality of research design and outcomes • identify best rated programs • identify themes arising from these programs

  4. Problems have not developed Problems have developed Traditional Public Health Model Primary Prevention Secondary Prevention Tertiary Prevention Institute of Medicine Model (US) Universal Prevention Selective Prevention Indicated Prevention Treatment

  5. Universal prevention • Target: general population • not experiencing substance use problems • not especially at risk • Aim: to prevent, or delay use or abuse • Data of interest: age of first use, past month and 12 month use patterns (age & gender differences), frequency & quantity • Evidence based responses: environmental policy measures (taxation, minimum age laws); educational (social influences life skills training) and media campaigns.

  6. Selective prevention • Target: Youth/families experiencing particular challenges due to various risks: academic problems, family dysfunction, poverty, or family history (that may include genetic predisposition) • Aim: reduce the influence of these risks and prevent or reduce substance use problems by building on strengths such as coping strategies and other life skills • Data of interest: percent facing various risk factors • Evidence based responses: headstart programs, family programs, Eggert’s progam

  7. Indicated prevention • Target: those who abuse substances but do not meet the criteria for dependency • Aim: to reduce substance abuse and prevent dependency • Data of interest: binge use, hazardous drinking, driving after drinking or cannabis use, experiencing 2 or more substance use problems, unable to stop using, being warned by police • Evidence based responses: motivational approaches; family-based approaches

  8. Building a Strong Framework • Address protective and risk factors • Seek comprehensiveness • Ensure sufficient program duration and intensity

  9. Striving for Accountability • Base program on accurate information • Set clear and realistic goals • Evaluate the program • Address program sustainability from the beginning

  10. Understanding and Involving Young People • Recognize youth perceptions of substance use • Account for the implications of adolescent development • Involve youth in program design and implementation

  11. Creating an Effective Process • Develop credible messages • Combine knowledge and skill development • Use interactive group process • Give attention to teacher or leader qualities and training

  12. Harmful / iatrogenic effects • Negative effects can occur through prevention • single vs multiple drugs prevention • for those already using • resistance skills when not accompanied by normative info • antisocial behaviour when grouping high risk youth

  13. Sources • Prevention of psychoactive substance use: a selected review of what works in the area of prevcention, World Health Organization, Feb 2003. www.ndri.curtun.edu.au/pdfs/who_review.pdf • Strategies for reducing substance abuse problems: what research tells us. Unpublished paper presented at Kettil Bruun Society mtg, Fremantle, Australia, Feb 2003 • Health Canada, Preventing substance use problems: a compendim of best practices, 2001 http://www.hc-sc.gc.ca/hppb/cds-sca/cds

  14. Thank you! The CCSA provides a national focus for efforts to reduce health, social and economic harm associated with substance abuse and addictions

  15. Themes Identified • Building a strong framework • Striving for accountability • Understanding and involving young people • Creating an effective process

  16. Compendium contents • Discussion on trends in use (Canadian) • Discussion on 14 prevention principles • 33 programs from the published literature that produce positive outcomes from sound empirical approach • 39 Canadian programs that reflect prevention principles

  17. Classification of Programs

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