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