CHAPTER 8 Drug Use and Prevention
IntroductionCradle to Grave
Prenatal ExposureChildhood ExposureAdolescent ExposureYoung Adult ExposureMiddle Age ExposureSenior ExposureElderly Exposure
ConceptsGoals
Prevent disease from beginningStop inappropriate/destructive behaviorReverse/Restore
ConceptsMethodology
Reduce SupplyReduce DemandReduce Harm
History - USTemperanceProhibition 1919-1933
Reduced PH/legal problemsDecreased alcohol consumptionIncreased org crimeDecreased concern and treatment
opportunities
HistoryScare Tactics
‘Factual’ materialDrug Information
Has little effect aloneSkill Building
Self esteemCopingReinforcement - optimism, empathy,etcSupport Systems
Change environmentCommunity
Needs analysisExisting systemsChange laws/policies – availabilityIncrease fundingTraining/planning
Public HealthGenetic predispositionContributory environmentAgent introduces the disease
Control the above,control the disease
FamilyThe least utilized to dateProbably the most importantSupport for parents
Their own problemsKid’s problems
Prevention methodsSupply Reduction
PoliceDOJ – FBI – INS – DEATreasury – Alcohol, TobaccoDOTDOD
Supply ReductionInterdictionBorder crossing manpowerLimit precursorsReduce org crimeMore severe lawsLaw enforcementDisrupt money laundering
Supply ReductionIncreased prison termsChild custodyIncrease prison populationLarge cost, minimal successDrug Courts
Demand ReductionHealth/Crime problems reduced if:
Never develop a problemNever progress to addictionThose addicted get treatment and succeed
Demand ReductionPrimary
Promote non-use abstinenceHelp young people refuse 1st useDelay 1st useEncourage alternatives
Demand ReductionSecondary prevention
Halt useInterventionDrug Courts, etc.
ProblemsSecrecy/concealment1st use to abuse time
Demand ReductionTertiary prevention
Stop further damageGroup interventionCue extinctionFamily therapyPsychopharmacological Healthy lifestyleSupport/aftercare
Harm ReductionMinimize personal/social oroblemsSubstitution – methadone maintenanceDesignated driverTobacco/alcohol ad regulationResponsible use educationDecriminalization?Adducts reduce habits ?Addicts totally design/manage their
treatment ??
ChallengesLegal – much larger problem than illegalChemical solutionsNo quick fixesNever doneHarder and harder (low-hanging fruit)No single solutionFUNDING
PreventionPregnancy/Birth
Prenatal CareDirect effects
Alcohol – FAS, ARND, SIDS
Cocaine/amphetamines Developmental Epilepsy Withdrawal ADHD Anger management
Pregnancy/BirthOpioids
More severe than stimulants Growth retardation Miscarriages Placenta abruptio Premature/low birth weight SIDS Withdrawal – potentially fatal
Marijuana Pregnancy prevention
Developmental Verbal/memoryDistractibility Startles
Pregnancy/BirthPrescription/OTC
Congenital abnormalities – benzosStimulantsWithdrawal
Nicotine Reduces fetal oxygenMiscarriageLow birth weightWeaker nursingLower IQ
Pregnancy/BirthCaffeine
??
Youth & SchoolDrugs
InhalantsAlcohol Tobacco
Age of 1st use – those who have:Tried cigarettes – 86% still use in 12th gradeBeen drunk – 83% still are getting drunkTried marijuana – 76% still using
Youth & SchoolConsequences
AddictionSuicideDate rapeDrowning – other accidental deathsCrime
>50% of arrestees positive Student financial aid
Youth & SchoolRisk factors
Physical, sexual, emotional abusePregnancyPovertyEmotional/mental disturbancesLow self esteemJuvenile justice systemPeer tolerance/encouragementBoredomNo school policies/rules/referral serviceFamily tolerance
Youth & SchoolProtective measures
Strong FamilyStrong position on drugs/alcohol/sexStrong spiritual sense and community
involvementAttachment to clean and sober adult
Youth and SchoolPrevention
Primary Zero Tolerance Life-skills/peer resistance Normative education Must be continual – not one-shot Parents – parents skills
Youth and SchoolPrevention
Secondary Strict policies Teacher staff training Parent training Follow-up/support groups Community services
Youth and SchoolPrevention
Tertiary – students with a problem Support groups – peers Testing???
CollegePrevention
Primary Normative assessment Regulation Alcohol/tobacco/drug free dorms Greek system Develop and Enforce policies Education
CollegeOther risks
Sexual assaultSTDs
Chlamydia Gonorrhea Trichomonas HIV/AIDS
Needle transmission Hepatitis Abscesses/endocarditis HIV/AIDS
Needle Exchange
WorkPrevention
EAP Primary – Education/Training Secondary – policies/procedures Tertiary – referral
Testing Pre-employment Reasonable cause Post accident Periodic Rehab Compliance Welfare Random
WorkTesting
UrineBloodHairOral fluidSweat
WorkCollectionScreeningConfirmationCertifying ScientistMRO
WorkDrugs
AmphetaminesCocaineCannabinoidsOpiatesPCP
Elderly Prevention
Primary Re-education Counseling
Secondary Recognition
Healthcare Friends/family
Tertiary Slow patient therapy