Week 6 - Prevention and determinants Flashcards
Risk Factors
predict initiation to drug use and risk of problems associated later in life
Protective Factors
mediate or moderate risk factors
Key Protective Factor
Resilience - Ability to be well adjusted and interpersonally effective in the face of an adverse environment
do risk and protective factors directly influence drug use?
no
Pharmocology
Pharmacokinetics and pharmacodynamics
Tobacco use patterns
never smoked - increasing
smoked previously - no change
smoke daily - decreasing
which drug was the leading cause of drug induced deaths in Australia?
pharmaceutical opiods
are males or females more likely to die due to drug-induced deaths?
males
Take-Home Naloxone
- Opioid antagonist
- Supplied through needle syringe programs
- Over the counter and prescription
Two types of Naloxone
Prenoxad - intramuscular administration at 400ug doses in 0.4 ml (2mg/2ml syringe)
Nyxoid - intranasal administration at 1.8 mg in 0.1 ml
Determinants
The range of risk and protective factors that make someone more or less likely to develop a drug use disorder
different types of risk factors
- Analogous to a snowball (earlier onset has a
cumulative effect on subsequent, longer term risk trajectory) - snowstorm (multiple risks experienced concurrently that increase likelihood of harmful
drug use)
Major risk & protective factors
Prior to birth
Risk:
- social disadvantage
- family breakdown
- genetic influences
- maternal smoking & alcohol use
Protective:
- born outside of Australia
Risk factors
SES
- Social disadvantage / low SES
- Highest drug use and problems exist in areas with low SES characteristic
- economic discrepancies producing personal and interpersonal insecurities, tensions, and conflict, negatively influencing physical and mental health, well-being, coping, and competence
which drug is most used in low ses individuals
tobacco
Different SES and drug type
More advantaged: cocaine (6.1x), hallucinogens (3.9x), inhalents (2.8x) and pharmaceutical stimulants (2.7x)
less advantaged: pain-relievers and opiods (1.6x)
x = times more likely
14-17 year olds and 18-24 year olds
- decline in the proportion of people aged 14–17 who consumed alcohol at risky levels, from 9.5% to just 5.5% in 2022–2023.
- Illicit use of drugs higher among young females than young males for the first time
Risk factors
Trauma
- Children affected by abuse or neglect have a
higher risk of problems later in life
Risk factors
Genetics
- Variations in the metabolism of substances
◦ Temperament
◦ Behavioural problems
◦ Personality factors
Protective factors
Ethnicity
- family cohesion, rules and cultural norms, and parental supervision
- Also can be a risk factor: Low SES communities, family trauma, social isolation.
- Indigenous risk factors: Related to poverty, disadvantage, cultural dispossession & exclusion, & some other cultural factors (sharing culture, no traditional rules for alc)
Aboriginal people and harmful levels of drinking
generally drink less than non-indigenous but those that do are more likely to drink at harmful levels
Major risk & protective factors
Infancy/Preschool
Risk:
- Parental neglect & abuse
Protective:
- Easy temperament
Major risk & protective factors
Primary school (5-11yrs)
Risk:
- Early school failure
- Conduct disorder
- Aggression
Protective:
- Social & emotional competence
- Shy & cautious temperament
Risk factors
family factors
- Parent and family drug use: parental role modelling risks (Modelling less influential than quality of relationships & parental family management techniques)
Risk factors
Education
Academic failure / Learning or behavioural difficulties at school
◦ May be both a contributor to and a result of drug use
◦ Can result in detachment from school community
◦ Impact on self-perception
Timing important
◦ Year 1 academic failure does not predict later delinquency
◦ Year 5 academic failure does predict later delinquency
Ongoing implications
◦ Poor academic performance can lead to a lack of training or employment opportunities
Protective Factors
Education
- Pro-social contact
- Minimises boredom
- Enhances intelligence
- Development and identification of talents
- Explore future aspirations
- Environment supporting positive health behaviours
Risk Factors
Secondary school (12-17yrs)
- Low involvement in activities with adults
- Perceived high level of community drug use
- Community disadvantage and disorganisation
- Availability of drugs
- Positive media portrayal of drug use
- Parent-adolescent conflict
- Favourable parental attitudes to drug use
- Parental AOD problems
- Parental rules permitting drug use
- Not completing secondary school
- Peers who use drugs
- Delinquency
- Sensation seeking & adventurous personality
- Favourable attitude toward drug use
Protective Factors
secondary school (12-17yrs)
- Attachment to family
- Low parental conflict
- Parental communication and monitoring
- Religious involvement
Risk Factors
Personality
- Rebelliousness, non-conformity, low sense of
responsibility, resistance to authority
◦ Sensation-seeking traits / adventurous personality
Risk Factors
age of initiation
- Earlier initiation increases risk of later abuse
- Reasons for earlier onset:
1. Peer associations
2. Familial and societal norms
3. Trauma/mental health issues
Risk Factors
Peer factors
- Strong predictor of later drug abuse
- Peers have a strong immediate influence on choices
- Peer modelling (social learning theory)
- Shared sense of: Alienation/Rebelliousness/Sensation seeking
Risk and protective factors
Adulthood (18-64yrs)
Risk:
* Frequent drug use in late adolescence
* Unemployment in early adulthood
* Mental health problems
Protective:
* Well-managed environment for alcohol use
* Marriage in early adulthood
Risk and protective factors
retirement/old age (65+ yrs)
Risk:
* Losing a spouse
* Retirement
* Loneliness & reduced social support
* Poor health
Protective:
* Good health
* Social support
General protective factors
- Positive family relationships - clear, consistent boundaries
- Healthy attachments / social bonding - stability and connectedness
- Proactive problem solving - resilience
- Development of a special talent - can lead to pro-drug using peer groups though
- Personality and temperament
- Career goals / aspirations
- Above average intelligence
Protective factors
Rat Park
When rats were given environments that were stimulating and gave them connection to other rats they preferred plain water. If they did imbibe from the drug-filled bottle, they did so intermittently, not obsessively, and never overdosed
Prevention
measures that prevent or delay the onset of drug use as well as measures that protect against risk and reduce harm associated with drug supply and use
What are we trying to prevent?
Drug use - delay initiation
Harm associated with drug use
◦ Route of administration risks
◦ Overdose/excessive use risks
◦ Avoidance of help seeking – e.g. due to legal concerns
◦ Risks of associated problems – e.g. accidents
◦ Harm to others – e.g. Laws prohibiting smoking in public
places
Rather than preventing something:
◦ Increasing resilience/other protective factors
Primary prevention levels
Preventing uptake
- Preventing non-users starting or delaying first use
E.g. Supply reduction methods, education on harms to developing body, school-based and parent education programs
Secondary prevention
Preventing harm
- Reducing risks to experimental/social users & avoiding transition to more regular use or possible harms
E.g. education on risks of addiction, advice on route of administration options
Tertiary prevention
Reducing harm
- Reducing use or potential harms among regular users
E.g. NSPs, controlled drinking, drink driving campaigns
Targets of prevention
universal
targeting whole population
e.g. national campaigns, advertising programs
targets of prevention
selective
subgroups with above-average risk
e.g. School-based programs, Alcohol free communities
targets of prevention
indicated
individuals with detectable symptoms
e.g. Counselling, advice lines, educational pamphlets
When to target
early intervention - as early as possible in developmental pathway
What goals or purposes?
◦ Attitudes
◦ Knowledge
◦ Expectancies
◦ Behaviour associated with drug use (risks)
targeting specific risk factors
- Peer factors, educational involvement etc…
- Best approach is a combination of factors
Adolescent interventions
- Support for classroom based education programs - more effective if interactive, time-intensive and led by students
- Life skills training programs and family based interventions
- Support for regulation of price and availability of tobacco to young people
- Lack of support for effectiveness of alcopop price increases
Universal interventions for illicit drug use
- Diversion programs
- Prohibition:
- May reduce drug use among non-users (Primary)
- Not much evidence it affects current users
- International changes to Cannabis laws have not been associated with significant increase in use
Other universal interventions
◦ Good support for effectiveness of drink driving laws in Australia
◦ Support for public education campaigns Reductions in cigarette smoking and risky drinking
◦ Multi-faceted campaigns are the most effective (advertising, laws, taxes, etc…)
where we need to do more
- Binge drinking
- Smoking/Vaping
- Methamphetamine
- Emerging Psychoactive Substances
- Evaluation of prevention strategies
- Community prevention/parenting/family support
