week 6 - prevention and determinants

Question 1

What is a risk factor?

Answer 1

Risk factors predict initiation to drug use and risk of problems associated later in life

Question 2

What are protective factors?

Answer 2

Protective factors mediate or moderate risk factors

Question 3

Do risk and protective factors always directly influence drug use?

Answer 3

No, Risk and Protective factors may not directly influence drug use. Example, low socio-economic status

Question 4

What is a key protective factor?

Answer 4

Resilience
Ability to be well adjusted and interpersonally effective in the face of an adverse environment

Question 5

What is take home naxalone?

Answer 5

• 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

Question 6

What are determinants?

Answer 6

The range of risk and protective factors that make someone more or less likely to develop a drug use disorder

Question 7

Risk factors are either a snowball or snowstor, what does this mean.

Answer 7

• 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”

Question 8

What are some risk factors prior to birth?

Answer 8

Social disadvantage
Family breakdown
Genetic influences
Maternal smoking & alcohol use

Question 9

What are some protective factors prior to birth?

Answer 9

Birth outside of Australia

Question 10

Key risk factor - low socioeconomic status

Answer 10

• 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

Question 11

Differences by Drug Type

Answer 11

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

Question 12

14–17-year-olds and 18–24-year-olds

Answer 12

• 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

Question 13

Risk factors - Trauma

Answer 13

• 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?

Question 14

Risk factors - Genetics

Answer 14

-Genetic / biological
Examples:
◦ Variations in the metabolism of substances
◦ Temperament
◦ Behavioural problems
◦ Personality factors

Question 15

Protective factors – Ethnicity?

Answer 15

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.)

Question 16

Aboriginal people who drink do so at harmful levels

Answer 16

“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.”

Question 17

What are key risk factors in infancy and pre school?

Answer 17

parental neglect and abuse

Question 18

What are key risk factors in primary school (5-11years)

Answer 18

Early school failure
Conduct disorder
Aggression

Question 19

What are key protective factors in infancy and pre school?

Answer 19

Easy temperament

Question 20

What are key protective factors in primary school (5-11years)

Answer 20

Social & emotional competence
Shy & cautious temperament

Question 21

Risk Factors – Family Factors

Answer 21

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

Question 22

Risk Factors - Education

Answer 22

 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

Question 23

Protective Factors - Education

Answer 23

 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

Question 24

Risk factors of secondary school (12-17years)

Answer 24

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

Question 25

Protective factors of secondary school (12-17years)

Answer 25

Attachment to family
Low parental conflict
Parental communication and monitoring
Religious involvement

Question 26

Risk Factors - Personality

Answer 26

 Personality traits
◦ Rebelliousness, non conformity, low sense of responsibility, resistance to authority…
◦ Sensation-seeking traits /adventurous personality

Question 27

Risk Factors – Age of Initiation

Answer 27

 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

Question 28

Risk Factors - Peer factors

Answer 28

 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

Question 29

How does society/culture effect A&D use?
(Macro-Environmental risk factors)

Answer 29

• social norms
  -legal response
• role model
  -help options

Question 30

Major risk factors for adulthood (18-64 years)

Answer 30

Frequent drug use in late adolescence
Unemployment in early adulthood
Mental health problems

Question 31

Major protective factors for adulthood (18-64 years)

Answer 31

Well-managed environment for alcohol use
Marriage in early adulthood

Question 32

Major risk factors for retirement (65 +years)

Answer 32

Losing a spouse
Retirement
Loneliness & reduced social support
Poor health

Question 33

Major protective factors for retirement (65 +years)

Answer 33

Good health
Social support

Question 34

General Protective factors

Answer 34

 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

Question 35

Protective determinant - connection

Answer 35

• 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)

Question 36

What does prevention mean?

Answer 36

“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”

Question 37

What exactly are we trying to prevent?

Answer 37

 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?

Question 38

Can we teach/build resilience?

Answer 38

Yes we can

the core ingredient in building resilience is the child’s relationship to those who care about them

Question 39

Prevention Levels

Answer 39

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

Question 40

Prevention Targets

Answer 40

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

Question 41

Clarifying Prevention Objectives

Answer 41

 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

Question 42

Research Support for Prevention

Answer 42

 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?

Question 43

APS Position

Answer 43

“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.”

Question 44

Binge drinking campaign - 2009

Answer 44

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”

Question 45

Research Support for Prevention

Answer 45

 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…)

Question 46

Where we need to do more…

Answer 46

 Binge drinking
 Smoking/Vaping
 Methamphetamine
 Emerging Psychoactive Substances
 Evaluation of prevention strategies
 Community prevention/parenting/family support

Question 47

Summary

Answer 47

 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.