week 6 - prevention and determinants Flashcards
What is a risk factor?
Risk factors predict initiation to drug use and risk of problems associated later in life
What are protective factors?
Protective factors mediate or moderate risk factors
Do risk and protective factors always directly influence drug use?
No, Risk and Protective factors may not directly influence drug use. Example, low socio-economic status
What is a key protective factor?
Resilience
Ability to be well adjusted and interpersonally effective in the face of an adverse environment
What is take home naxalone?
- Prenoxad ® 400ug doses in 0.4 ml (2mg/2ml syringe) for intramuscular use
- Nyxoid ® recently available for intranasal administration: 1.8 mg in 0.1 ml
- Now available over the counter and on prescription (S3 and S4)
- Supplied through Needle Syringe Program
What are determinants?
The range of risk and protective factors that make someone more or less likely to develop a drug use disorder
Risk factors are either a snowball or snowstor, what does this mean.
- 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.
- “The more risk factors that persist over longer periods of time, the greater the subsequent Impact”
What are some risk factors prior to birth?
Social disadvantage
Family breakdown
Genetic influences
Maternal smoking & alcohol use
What are some protective factors prior to birth?
Birth outside of Australia
Key risk factor - low socioeconomic status
- Social disadvantage / low SES
- Highest drug use and problems exist in areas with low SES characteristic
- Low Social Status and the increasing disparity between the rich and the poor have been noted to impact upon morbidity, morality, and other health-risk behaviours such as drug use. This most likely arises through economic discrepancies producing personal and interpersonal insecurities, tensions, and conflict, which negatively influence physical and mental health, well-being, coping, and competence of individuals in the community
Differences by Drug Type
Most advantaged were more likely to have recently used, differences by drug type:
- Hallucinogens 6.1times
- Cocaine 3.9
- Inhalants 2.8
- Pharmaceutical stimulants 2.7
People in the lowest SE areas were 1.6 times more likely to have recently used pain-relievers and opioids
14–17-year-olds and 18–24-year-olds
- There was a 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
- Adverse Childhood Experiences (ACEs)
- How might people think drugs are “helping” them with trauma?
- How might trauma impact treatment?
Risk factors - Genetics
-Genetic / biological
Examples:
◦ Variations in the metabolism of substances
◦ Temperament
◦ Behavioural problems
◦ Personality factors
Protective factors – Ethnicity?
Depends on a number of factors
◦ Some indication being born outside Australia is protective
- Family cohesion, rules and cultural norms, and parental supervision
◦ Also can be a risk factor ◦ Low SES communities, family trauma, social isolation
- Indigenous risk factor
◦ Not biological/genetic
◦ Related to poverty, disadvantage, cultural dispossession & exclusion, & some other cultural factors (sharing culture, no traditional rules for alc.)
Aboriginal people who drink do so at harmful levels
“While Aboriginal people generally drink less than non-Aboriginal people, those who do are more likely to drink at hazardous levels. Unfortunately, many
reports focus on these results rather than the fact
that generally they drink less.”
What are key risk factors in infancy and pre school?
parental neglect and abuse
What are key risk factors in primary school (5-11years)
Early school failure
Conduct disorder
Aggression
What are key protective factors in infancy and pre school?
Easy temperament
What are key protective factors in primary school (5-11years)
Social & emotional competence
Shy & cautious temperament
Risk Factors – Family Factors
Many family risk factors to consider
◦ Harmony vs. conflict
◦ Family relationships or support
- Parent and family drug use
◦ Parental role modelling risks - Modelling less influential than quality of relationships & parental family management techniques, e.g., alcohol use at parties
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
◦ Including positive relationships with adults
Minimises boredom
Enhances intelligence
Development and identification of talents
Explore future aspirations
Environment supporting positive health behaviours
Risk factors of secondary school (12-17years)
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 of secondary school (12-17years)
Attachment to family
Low parental conflict
Parental communication and monitoring
Religious involvement
Risk Factors - Personality
Personality traits
◦ 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
◦ Developmental impact of drug use
Reasons for earlier onset?
◦ Peer associations
◦ Familial and societal norms
◦ Trauma/mental health issues
Risk Factors - Peer factors
Strong predictor of later drug abuse
Not “just” peer pressure
◦ Peers have a strong immediate influence on choices
◦ Peer modelling (social learning theory)
◦ Shared sense of: Alienation/Rebelliousness/Sensation seeking
How does society/culture effect A&D use?
(Macro-Environmental risk factors)
- social norms
-legal response - role model
-help options
Major risk factors for adulthood (18-64 years)
Frequent drug use in late adolescence
Unemployment in early adulthood
Mental health problems
Major protective factors for adulthood (18-64 years)
Well-managed environment for alcohol use
Marriage in early adulthood
Major risk factors for retirement (65 +years)
Losing a spouse
Retirement
Loneliness & reduced social support
Poor health
Major protective factors for retirement (65 +years)
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 determinant - connection
- rat park experiment
when a rat is put in an empty cage with two water bottles (one drug one normal) it gets addicted to the drugged water and eventually dies of malnutrition - found that drugs are uncontrollable and led policies for 40 years
- another experiment put lots of rats in a cage (rat park) with access to both normal or drugged water –> the rats chose not to use the drugs
- took it a step further –> put rats in a lonely cage and got them addicted to drugs and then put them in the rat park (the rats eventually stopped using them all together)
What does prevention mean?
“Prevention refers to 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 exactly are we trying to prevent?
Drug use
◦ Or at least 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?
Can we teach/build resilience?
Yes we can
the core ingredient in building resilience is the child’s relationship to those who care about them
Prevention Levels
Levels of prevention strategies
◦ Primary: 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: 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: Reducing harm
Reducing use or potential harms among regular users
E.g. NSPs, controlled drinking, drink driving campaigns
Prevention Targets
Targets of prevention strategies
◦ Universal: targeting whole populations
National campaigns, advertising programs
◦ Selective: subgroups with above-average risk
School-based programs, Alcohol free communities
◦ Indicated: individuals with detectable symptoms
Counselling, advice lines, educational pamphlets
Clarifying Prevention Objectives
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
Research Support for Prevention
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
More research required?
APS Position
“While the ‘alcopop’ tax is an example of a targeted
measure designed to offset the enticement of young
people into an alcohol-soaked culture, such
legislation—by itself—will not change Australia’s
drinking culture.”
Binge drinking campaign - 2009
Research support for the campaign?
RSOD: Risky single occasion drinking
◦ “In the adjusted analysis, those reporting frequent RSOD had significantly lower odds of recognising the campaign message compared to those not reporting frequent RSOD”
Research Support for Prevention
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
Summary
Range of risk and protective factors from Individual, family and societal context
Drug use and abuse cannot be explained in terms of an immediate or single cause
◦ Interventions that focus on single risk factors highly unlikely to be effective
Effective prevention focuses on multiple risk and protective factors
The more successful programs maintain intervention activities over a number of years and incorporate more than one intervention strategy.
