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Foundations of Prevention
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  1. Foundations of Prevention

  2. 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

  3. AN INTRODUCTION TO DRUG ABUSE

  4. 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”

  5. 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)

  6. 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

  7. 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

  8. THE WORLD’S DRUG PROBLEM AND THE BUSINESS OF DRUGSTHE MAIN DRUGS OF ABUSE

  9. 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

  10. 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)

  11. 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

  12. 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

  13. THE CARIBBEAN PRESPECTIVE

  14. THE CARIBBEAN REGION AS A TRANSIT ZONE EUROPE UNITED STATES TRANSIT ZONE STORAGE AREA PRODUCER COUNTRY

  15. 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

  16. PRINCIPLES OF PREVENTIONDEFINITON OF PREVENTION CLASSIFYING PREVENTION INITIATIVES- RISK AND PROTECTIVE FACTORS-EARLY SIGNS-HIGHEST RISK PERIODS-PROGRESSION OF DRUG USE

  17. 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.

  18. 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

  19. Stages of Prevention –Secondary Prevention • Secondary prevention, or early intervention, aims to reduce existing risk and harmful behaviour and symptoms as early as possible

  20. 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.

  21. 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

  22. 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.

  23. 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.

  24. Risk and Protective Factors • Risk factors can increase a person’s chances for drug abuse, while protective factors can reduce the risk.

  25. 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.

  26. 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.

  27. 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.

  28. 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

  29. 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

  30. 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

  31. 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.

  32. 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.

  33. What are some of the things we need to know in order to develop meaning full programmes

  34. What are the highest periods for drug abuse among youth? • 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

  35. When and how does drug use starts and progress? • 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

  36. www.drugabuse.gov

  37. Prevention Programs Should . . . . 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

  38. Prevention Programs Should . . . . 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

  39. Prevention Programs Should . . . . . .Target all Forms of Drug Use . . . and be Culturally Sensitive www.drugabuse.gov

  40. Prevention Programs Should . . . . Include Interactive Skills-Based Training • Resist drugs • Strengthen personal commitments against drug use • Increase social competency • Reinforce attitudes against drug use www.drugabuse.gov

  41. Prevention Programs Should be. . . . 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