Prevention Flashcards
Risk Factors for Substance Misuse (Adolescent and Young Adult)
early initiation of substance use
early and persistent problem behaviour such as emotional distress and aggressiveness
rebelliousness against parental and other authority
favourable attitudes towards substance use
peer substance use
genetic predisposition
family conflict
favourable parental attitudes towards substance use
family history of substance use
academic struggles beginning in elementary school
lack of commitment to education and school attendance
low cost of alcohol in the community
high availability of substances in the community
positive media portrayal of alcohol, tobacco and other drugs
low neighbourhood attachment
low socioeconomic status
high degree of transition and mobility
Prevention Initiative Levels
- Primary
- Secondary
- Tertiary
Primary prevention level
occuring before a person begins to use substances. The goal is to prevent or delay the onset of first use.
secondary prevention level
occuring once a person has begun to experiment with drug use. The goal is to prevent more frequent, regular use.
tertiary prevention level
occuring after substance use has become problematic. The goal is to reduce the harm associated with use or, if possible, achieve complete abstinence.
Prevention Programs focus on:
- those who chose to abstain from drug use
- those who chose to postpone drug use
- those already using drugs
- those experiencing difficulties with their current drug use
- those experiencing difficulties with the use of drugs by relatives or friends
- the larger family system
prevention programming:
Three prevention focuses that can be adopted within the risk continuum
(1) universal
(2) selective
(3) indicated or targeted
the risk continuum
no risk: health enhancement
low risk: risk avoidance
at risk: risk reduction - early intervention
intervention required: tx/rehabilitation
INDICATED PREVENTION
- designed to prevent the onset of substance misuse in individuals who are showing early danger
- for those who are already using or involved with psychoactive drugs
- programming is individualized and can include a formal counselling component
- targets injection drug users (IDUs) and teaches them harm-reduction techniques with or without a goal of abstinence
SELECTIVE PREVENTION
- targets subsets of the total population that are deemed to be at risk for substance misuse
- A more intensive approach targets specific subgroups deemed to be at greater risk
- Those with:
academic struggles;
family issues and dysfunction;
issues of poverty;
problematic social environments; and
a family history of substance misuse
UNIVERSAL PREVENTION
- addressing the whole population
- such as all Grade 9 students or all parents of high school students, with the aim of promoting the health of the population or preventing or delaying the onset of substance use
Selective Prevention Programs
Programs have:
- smaller numbers of participants per group
- recipients who are known and who are specifically recruited to participate in the intervention
- longer and more intensive structure
- more intrusive intervention, with a goal of changing existing behaviours in a positive direction
- a higher degree of skill among program leaders and staff
- a greater cost per participant
- a greater likelihood of demonstrating change
prevention program components
- knowledge
- attitudes and value
- skills
prevention program components: KNOWLEDGE
- the concept of abstinence and alternative behaviours to drug use
- definitions of drugs and psychoactive drugs, drug misuse, and drug dependency
- how different contexts and situations influence personal values, attitudes, beliefs, and behaviour in relation to drug use
- how different drugs can affect a person’s ability to perform tasks
- the impact of media messages on the health behaviour of society
- the importance of self-esteem, self identity, self concept
- the rights and responsibilities of interpersonal relationships
prevention program components: Attitude and Values
- a value stance regarding drug use and the confidence to act on those values
- the significance of the social and cultural influences on beliefs
- empathy and acceptance of a diverse range of people
- individual responsibility for health and universal health protection
- personal beliefs about drugs and their effects on decisions
prevention program components: SKILLS
- the ability to communicate constructively with parents, teachers, and peers
- giving and receiving care in a variety of health-related situations
- setting short- and long-term health goals
- demonstrating conflict, aggression, stress, and time-management skills
- identifying and assessing personal risk and practising universal protection
- developing assertiveness and dealing with influences from others; working effectively with others; and coping with change, loss, and grief
A Prevention Programming Framework
- address protective factors, risk factors, and resiliency
- ensure sufficient program duration and intensity
- use accurate information
- set clear and realistic goals
- monitor and evaluate the project
- addresses sustainability from the beginning
- account for the participant’s stage of psychosocial development
- recognizes youth perceptions of drugs and community’s use of drugs
- involve youth in program design and implementation
- develop credible messages delivered by credible messengers
- combine knowledge and skill development
- use an interactive group process
- provide sufficient attention to teacher/leader qualities and training
Prevention strategies
- information strategies
- normative education
- perceived harm reduction
- social influence education
- advertising pressures education
- protective factors
- resistance (refusal) skills
- competence enhancement skills training
- persuasion strategies
- counselling strategies
- tutoring/teaching strategies
- peer group strategies
- family strategies
- recreational activities
- harm minimization/harm reduction
- affective education
- resilience development
information (prevention) strategies
Teaching facts about the legal, physiological, and psychological consequences of psychoactive drug use and misuse
normative education (prevention) strategies
Makes students aware that most people do not use drugs and do not think drug use is “cool”
Perceived Harm Education: prevention strategies
Teaching about the risks and short- and long-term consequences of alcohol and other drug use
social influence Education: prevention strategies
Teaches to recognize external influences, such as social and peer pressure
social influence Education: prevention strategies
Teaches to recognize external influences, such as social and peer pressure
Advertising Pressures Education
Teaches individuals to recognize the purposes and effects of social media, advertising, and other media, and the cognitive skills to resist these influences
Protective Factors:
Teaches, supports, and encourages the development of positive aspects of life, such as helping, caring, goal setting, and challenging students to live up to their potential
Resistance (Refusal) Skills:
Teaches how to recognize and resist pressure from others to use drugs
Competence Enhancement Skills Training:
This approach teaches generic social and personal skills
Persuasion Strategies:
Influencing attitudes or behaviours regarding drugs through persuasive messages
Counselling Strategies:
Peer, self-help, or professional counselling programs for those experiencing both drug- and non-drug-related personal and family problems
Tutoring/Teaching Strategies:
Peer or cross-age tutoring or teaching to assist in enhancing academic achievement
Peer Group Strategies:
Attempts to strengthen or exploit natural peer group dynamics to inhibit drug use
Family Strategies:
Efforts aimed at strengthening parenting skills and family relationships to address student drug issues
Recreational Activities:
Programs to occupy leisure time and provide alternative activity other than drug use
Harm Minimization/Harm Reduction:
Imparts information to reduce the harm stemming from substance use and to promote safer drug-using skills
Affective Education:
developing positive self-esteem, good interpersonal skills, and decision-making ability
Resilience Development:
development of social competence; increasing bonding; communicating high expectations for academic, social, and work performance; maximizing opportunities for students’ meaningful participation in the school environment or employees in a work environment; and creating partnerships with families and community resources
Effective Programming Components
- bonding
- social competence
- cognitive competence
- moral competence
- spirituality
- clear and positive identity
- recognition for positive behaviour
- opportunity for pro-social involvement
- resilience
- emotional competence
- behavioural competence
- self-determination
- self-efficacy
- belief in the future
- pro-social norms
School-based Programs should:
- be evidence-informed
- involve parents and the wider community
- involve the entire school
- be taught in a sequentially developmentally and appropriate school health curriculum
- be based on students’ expressed needs and responsive to their developmental, gender, cultural, language, socioeconomic, and lifestyle differences
- be initiated before drug use begins
- be harm-minimization focused
- use interactive teaching techniques
- use trained peer facilitators to lead discussions
- utilize the classroom teacher as central in the education process
- be practical, immediate, relevant information on the harms associated with drug use, influences that promote drug use, and normative student drug use
- focus on general social skills training, including the values, attitudes, and behaviours of the broader community
- consider the interrelationship among the individual and the student’s social context
- focus on drug use that is most likely to occur initially, to minimize experimentation that becomes integrated and ultimately excessive use
education programs
- BRAVO (Building Respect Attitudes and Values with Others)
- DARE (Drug Abuse Resistance Education)
- Kids in the know
- MADD
- Racing against drugs
- VIP (Values, Influences, and Peers)
- Weeding out drugs
Ineffective (prevention) Programming Features examples
- single-shot assemblies and testimonials by former drug dependent persons
- inadequate facilitator training, preparation and instruction
- presentations where abstinence is the only criteria of success
- fear arousal and scare tactics
- no parental involvement
what works for prevention
- Knowledge: information about short term and long term health consequences
- Attitudes about drug use : feedback from school surveys of peer drug use; analysis of media and social influences that promote pro drug attitudes; perception adjustment regarding actual peer use
- Drug refusal-based interpersonal skills: drug refusal skills; assertiveness skills; communication skills; safety skills
- Intrapersonal skills: coping skills; stress reduction techniques; goal setting; decision-making/problem solving
- Active involvement: student-generated role plays; participation between peers; supportive comments from peers; peer modeling of appropriate behaviour; rehearsal of drug refusal skills; sufficient practice time; developmentally appropriate activities
What is Family Programming
The goal of family skills programs is not only to decrease substance misuse, but to positively affect parent-child family relations by increasing family cohesion, decreasing family conflict, and decreasing family health and social problems overall
- the greatest risk to family programming are the PARENTS OWN DRUG USE
Family Programming Options
- Information sharing (harm reduction)
- parental skills training
- parents support (counselling for parents)
- family interaction (family counselling)
The best family harm reduction practice:
- parents having dinner with their children
- As frequency of family dinners increases, reported drinking, smoking, and other drug use decreases.
- this is a correlational finding and not causation
- Being together is what decreases risk; speaking and listening to one another and giving children undivided parental attention
