Psychology 317 Chapter 16

1. Psychology 317 Chapter 16 Prevention of Substance Abuse

2. Prevention of Substance Abuse • Benjamin Rush, first Surgeon General, initiated perhaps first drug education program to school individuals on detriments of alcohol. • At the beginning of the 20th century Public Health Authorities eliminated many public health services but not drug abuse. • This has been attributed to the following: • Large numbers of Americans use and get satisfaction from drug use (especially tobacco and alcohol). • Most drugs provide immediate gratification; valued quality in US. • Alcohol and cigarette manufacturers hindered drug prevention efforts by promoting them and by making large political contributions. • Americans do not like being told what to do (Prohibition, Reactance).

3. Prevention of Substance Abuse continued • In the past drug prevention efforts focused on heroin, LSD and cocaine. • Recently attention has shifted to alcohol, tobacco, marijuana, & methamphetamine. • Many experts believe that prevention efforts should focus on the causes of drug abuse: poverty, homelessness, poor education, inadequate health care. • It is difficult to assess success of prevention programs because there is no standard definition of prevention and programs do not have common goals.

4. Definition of Prevention • Prevention defined broadly is avoidance or alleviation of problems associated with substance use. • Most agree that prevention should be an important part of any comprehensive substance abuse program. • But most professionals and funding sources have not made prevention a high priority . • Traditionally, there has been 3 types of prevention programs: primary, secondary, tertiary.

5. Definition of Prevention continued • Primary prevention – Directed at individuals who have never used drugs. • Pertains to avoidance of substance abuse before use begins (Just-Say-No) • Development of responsible attitudes and substance use behavior. (Not driving after drinking or allowing friends to do so)

6. Definition of Prevention continued • Secondary prevention- Interventions applied when problems are first appearing/surfacing. • Frequently used in legal response to drug use- DUI • Individuals ordered to alcohol education classes • Young offenders with first arrest for drug possession ordered to education programs • Emphasis is on nipping drug use problem in the bud

7. Definition of Prevention continued • Tertiary prevention- Intervention used to treat persons beyond early stages of drug abuse • Goal is to terminate use to prevent further deterioration of functioning. • Similar to substance abuse treatment and thus not really prevention.

8. Models of Prevention • Research over the years has led to the development of 3 major prevention models: Sociocultural, Distribution of Consumption, & Proscriptive.

9. Sociocultural Model • Sociocultural model is probably most dominant in US. • It states that social norms directly influence drug use and drug abuse. • Thus prevention efforts should be directed at the cultural climate of drug use.

10. Sociocultural Model continued • Applied to drinking, the model has 3 components: • Emphasis on normative cultural structure • Need to integrate drinking into socially meaningful activities • Emphasis on providing gradual socialization of drinking behavior

11. Sociocultural Model continued • Rupert Wilkinson (1970) is one of the strongest proponents. • He identified 5 proposals for modifying cultural drinking - Need for low level of emotionalism about drinking coupled with no ambivalence about alcohol use. - Distinction between drinking and drunkenness. - Firm taboo on drunkenness after identifying what drunkenness is.

12. Sociocultural Model continued • Integrating alcohol consumption in broader social context. It should be adjunctive to other activities and not the focus of activity. • Serving alcohol only when food is available • Makes it not sole focus of activity • Food slows alcohol absorption and thus rate of drunkenness • Sociocultural approach does not advocate abstinence • This is major sources of criticism

13. Sociocultural Model continued • Sociocultural approach advocates responsible use not no use of alcohol, but when applied to hard drug use, it advocates no use.

14. Distribution of Consumption Approach • Distribution of Consumption approach proposes • Proportion of heavy drinkers in a culture is positively related to mean alcohol consumption. • The heavier the alcohol consumption the greater the probability of alcohol problems. • Negative consequences of drinking can be reduced by reducing alcohol consumption across the culture.

15. Distribution of Consumption Approach continued • Approach developed by Frenchman, Sully Ledermann in 1950’s. • To address #1 he proposed reduction in per capita alcohol consumption. • To address #2 he proposed reducing population’s mean consumption which will reduce mental/emotional, physical, & social problems caused by alcohol.

16. Distribution of Consumption Approach continued • To address #3 he proposed restricting alcohol availability by raising price relative to disposable income, limiting bar and tavern hours, controlling retail sales, raising minimum drinking age.

17. Distribution of Consumption Approach continued • Criticisms include: the model is purely descriptive & provides no insight into reason(s) for drinking; • Normal drinkers may respond differently from heavy drinkers to reduced alcohol availability; • Heavy drinkers less likely to respond to price increase & policies to decrease per capita drinking.

18. Proscriptive Model • Proscriptive approach focuses on prohibition and emphasizes abstention from drug use. • If there is no drug use there is no societal problem. If a person uses, it is not societal problem but character flaw of person. • This model has been applied to alcohol and other drug use. • For decades proscriptive model has been applied to marijuana & heroin, & recently, cocaine and methamphetamine use.

19. Proscriptive Model continued • Key to this model is “Good” people do not use drugs. • Criticisms include results of prohibition in US during 1920’s and 1930’s.

20. Principles of Abuse Prevention • Most common drug abuse prevention interventions have been education & mass media use. • Most states require alcohol & drug education in school curricula. • NIDA (2003) published a series of “prevention principles” to be implemented in prevention programs for children and adolescents. (See Table 16.1)

21. Principles of Abuse Prevention • The principles fall under 3 broad domains • 1. Risk & protective factors • 2. Planning and prevention programs • 3. Actual delivery of prevention programs • (See Table 16.1)

22. Current Topics in Prevention • The most noteworthy trend in prevention activities today are: • Increasing involvement in prevention programs. • Attention to developing resistance skills, specifically strategies to avoid pressures to use drug. • Developing community broad based programs like school-based intervention with mass media communication outlets. • Identifying and developing programs for high at risk groups for alcohol and drug misuse. (eg. Inner city youths, Native American youth, minority youth and college students). • Focusing attention on “gate way” drugs- tobacco, alcohol, marijuana.

23. Current Topics in Prevention continued • Increasing attention to programs designed to minimize risk or negative consequences associated with any substance use that occurs. • Alcohol and drug education courses have generally been shown to increase knowledge levels but have not been as successful in changing drug use patterns. • Recently there has been an increase in parent involvement in prevention programs especially those involving their children.

24. Current Topics in Prevention continued • Mass media campaigns seem to increase knowledge of awareness of drugs but not drug-use behavior. • In recent years prevention programs with resistance-training approach have received much attention. • Resistance-training programs trains young people to recognize and resist pressures to use drugs.

25. Current Topics in Prevention continued • Majority of Fortune 500 companies, plus others, have established worksite programs. • Substance use among employees cost businesses approximately $246 billion annually. • About 60% of cases are due to alcohol use. • Employers find it less expensive to treat workers than to train new workers. • Goal is to identify drug abusing employees early and intervene when drug problem interferes with job performance.

26. Current Topics in Prevention continued • These programs are called EAP (employee assistance programs) and are secondary prevention programs. • A variety of prevention programs have been established on college campuses. • These programs are aimed primarily at alcohol use. • A 2002 Task Force of National Advisory Council on Alcohol Abuse and Alcoholism developed an overview of consequences of alcohol misuse by college students. (See Table 16.2). • The Task Force listed 12 staggering consequences of alcohol use by college students. (See Table 16.2) • Full potential of prevention intervention not yet tested. • More resources from state and federal agencies are needed to do so.