Prevention of Alcohol and Other Drug Problems What We Can Do in the Office

Prevention of Alcohol and Other

Drug Problems

What We Can Do in the Office

Prevention of Alcohol and Other

Drug Problems

What We Can Do in the Office

What We Can Do!What We Can Do!

• Adopt a Resiliency Approach

• Know the Risk Factors

• Look for Early Sn and Sx

• Give Prevention Messages






• Adopt a Resiliency Approach• Adopt a Resiliency Approach

Resiliency/Protective FactorsResiliency/Protective Factors

• A sense of purpose and future• Healthy expectations and a positive

outlook– Spiritual foundations and relationships

• Having an opportunity to contribute and be seen as a resource– A sense of belonging, spiritual

connectedness

• A sense of purpose and future• Healthy expectations and a positive

outlook– Spiritual foundations and relationships

• Having an opportunity to contribute and be seen as a resource– A sense of belonging, spiritual

connectedness

• Effectiveness in work, play and relationships– “Playing together”, having fun together

• Self-esteem and an internal locus of control– Caring, support, acceptance, respect,

openness, honesty, trust, inter-independence

• Effectiveness in work, play and relationships– “Playing together”, having fun together

• Self-esteem and an internal locus of control– Caring, support, acceptance, respect,

openness, honesty, trust, inter-independence


• Problem solving/critical thinking skills

• Self-discipline– Reinforce healthy behavior

• A relationship with a caring adult role model– Positive role models affect emotional

growth

• Problem solving/critical thinking skills

• Self-discipline– Reinforce healthy behavior

• A relationship with a caring adult role model– Positive role models affect emotional

growth


• Supportive networks and social bonds

• A sense of humor– Healthy teasing, not ridicule; help

them break out of seriousness

• Norms and public policies that support non-use

• Supportive networks and social bonds

• A sense of humor– Healthy teasing, not ridicule; help

them break out of seriousness

• Norms and public policies that support non-use







www.drugabuse.govwww.drugabuse.gov

Drugs, Brains,and Behavior: The Science of Addiction; NIDA, March 2007

Risk FactorsRisk Factors

Risk FactorsRisk Factors - - Science Based DataScience Based DataRisk FactorsRisk Factors - - Science Based DataScience Based Data

Family history of alcohol or other Family history of alcohol or other drug abuse drug abuse • Children of Alcoholics have a Children of Alcoholics have a four four

timestimes greater risk of becoming greater risk of becoming addicted to drugs addicted to drugs

Family history of alcohol or other Family history of alcohol or other drug abuse drug abuse • Children of Alcoholics have a Children of Alcoholics have a four four

timestimes greater risk of becoming greater risk of becoming addicted to drugs addicted to drugs

Risk FactorsRisk FactorsRisk FactorsRisk Factors Favorable attitude toward alcohol Favorable attitude toward alcohol

and other drugsand other drugs• Groups that accept and Groups that accept and

encourage heavy drinking or encourage heavy drinking or other drug useother drug use

• Beliefs like: Beliefs like: It can’t happen to me”, “I can It can’t happen to me”, “I can handle it” handle it” are very dangerousare very dangerous

Favorable attitude toward alcohol Favorable attitude toward alcohol and other drugsand other drugs• Groups that accept and Groups that accept and

encourage heavy drinking or encourage heavy drinking or other drug useother drug use

• Beliefs like: Beliefs like: It can’t happen to me”, “I can It can’t happen to me”, “I can handle it” handle it” are very dangerousare very dangerous

Risk FactorsRisk FactorsRisk FactorsRisk Factors

Parental drug misuse and/or Parental drug misuse and/or abuse abuse

Early onset of drug useEarly onset of drug use

Parental drug misuse and/or Parental drug misuse and/or abuse abuse

Early onset of drug useEarly onset of drug use

The Progression of UseThe Progression of UseThe Progression of UseThe Progression of Use

alcoholparty drugs alcoholparty drugs marijuanamarijuana

heroinheroin

MAJOR PROBLEMSMAJOR PROBLEMS

cocainecocaine

tobacco inhalants Rx drugs

tobacco inhalants Rx drugs

Young brains are especially susceptible to alcohol and other

psychoactive addictive drugs



Norm Volkow Ph.D., Director of Natl. Inst. Drug Abuse

245

Prefrontal Cortex - last area to developPrefrontal Cortex - last area to develop

Blue represents maturing of brain areas

Images of Brain Development in Healthy Children,

Teens and Young Adults

Images of Brain Development in Healthy Children,

Teens and Young Adults

Brain development is ongoing during adolescence and continues into the early twenties contrary to what was previously thought

Brain development is ongoing during adolescence and continues into the early twenties contrary to what was previously thought

Dangers of Drug Use

substantia nigra substantia nigra

locus ceruleus locus ceruleus DrugDrugPerfrontal Cortex seat of judgment, reasoning,

problem solving; enables us to assess situations, make decisions, plan for the future and keeps our emotions and desires under control (governs impulsivity, aggression,…)

Perfrontal Cortex seat of judgment, reasoning, problem solving; enables us to assess situations, make decisions, plan for the future and keeps our emotions and desires under control (governs impulsivity, aggression,…)

Dangers of Drug Use


locus ceruleus locus ceruleus DrugDrug

Limbic system involved in the pleasure response; also regulates emotions and motivations, such as fear, anger, and is involved in early learning and memory processing,…

Limbic system involved in the pleasure response; also regulates emotions and motivations, such as fear, anger, and is involved in early learning and memory processing,…


locus ceruleus locus ceruleus

Limbic SystemLimbic System

Frontal CortexFrontal CortexYoung brains are especially

susceptible to alcohol and other psychoactive addictive drugs



• Less planned thinking• More impulsive• Less self control• Higher risk takers

Brain Research ConclusionsBrain Research Conclusions

1. Young brains are more susceptible to drug use than adults

2. Using drugs while the brain is still developing may have profound and long-lasting results:

• Learning ability & emotional development

3. Implications of these studies are enormous for parents

1. Young brains are more susceptible to drug use than adults

2. Using drugs while the brain is still developing may have profound and long-lasting results:

• Learning ability & emotional development

3. Implications of these studies are enormous for parents

Nora Volkow M.D., Director NIDA, Drug Addiction, 2006Nora Volkow M.D., Director NIDA, Drug Addiction, 2006

Young adults may be less likely to develop serious alcohol

and other drug problems if the age of first use is

delayed beyond childhood or adolescence

Young adults may be less likely to develop serious alcohol

and other drug problems if the age of first use is

delayed beyond childhood or adolescence



Beliefs & attitudes

Family conflict and Family conflict and stressstressPoor parent-child relationship:Poor parent-child relationship:

• Lack of monitoring and supervisionLack of monitoring and supervision• Inconsistent or excessive disciplineInconsistent or excessive discipline• Lack of caring and supportLack of caring and support

Family conflict and Family conflict and stressstressPoor parent-child relationship:Poor parent-child relationship:

• Lack of monitoring and supervisionLack of monitoring and supervision• Inconsistent or excessive disciplineInconsistent or excessive discipline• Lack of caring and supportLack of caring and support



Beliefs & attitudes Parent’s use and attitudes



Beliefs & attitudes• Association with drug-using peersAssociation with drug-using peers• Lack of involvement in school, Lack of involvement in school, church, and community church, and community (attitudes)(attitudes)• Little commitment to academicLittle commitment to academic achievement achievement

• Association with drug-using peersAssociation with drug-using peers• Lack of involvement in school, Lack of involvement in school, church, and community church, and community (attitudes)(attitudes)• Little commitment to academicLittle commitment to academic achievement achievement


Portrayal of ATOD on TV and Portrayal of ATOD on TV and in moviesin movies

Advertising impact on norms Advertising impact on norms and behaviorand behavior

Portrayal of ATOD on TV and Portrayal of ATOD on TV and in moviesin movies

Advertising impact on norms Advertising impact on norms and behaviorand behavior

Commercials, Advertisements, Commercials, Advertisements, and Internetand Internet Deceptive ads on the Internet …Deceptive ads on the Internet …

• ““Valium releases stress on spot, Valium releases stress on spot, allowing more self confidence”allowing more self confidence”

• Web sites detail a drugs synthesis information, list of ingredients and how much you should pay for a dose

Deceptive ads on the Internet …Deceptive ads on the Internet …• ““Valium releases stress on spot, Valium releases stress on spot,

allowing more self confidence”allowing more self confidence”• Web sites detail a drugs synthesis

information, list of ingredients and how much you should pay for a dose

Make Some RulesMake Some RulesKeep computers in a central area Monitor use Tell kids, despite what they may see on the Internet, there is no safe way to get highTell them about the dangers of drug use

Keep computers in a central area Monitor use Tell kids, despite what they may see on the Internet, there is no safe way to get highTell them about the dangers of drug use

Risk FactorsRisk FactorsRisk FactorsRisk Factors

Availability and cost of alcohol Availability and cost of alcohol and other drugsand other drugs

Poor enforcement of laws Poor enforcement of laws concerning alcohol and illegal concerning alcohol and illegal drug usedrug use

Availability and cost of alcohol Availability and cost of alcohol and other drugsand other drugs

Poor enforcement of laws Poor enforcement of laws concerning alcohol and illegal concerning alcohol and illegal drug usedrug use

The more risk factors a The more risk factors a person has the greater person has the greater their risk for developing their risk for developing alcohol, tobacco, or other alcohol, tobacco, or other drug problemsdrug problems

The more risk factors a The more risk factors a person has the greater person has the greater their risk for developing their risk for developing alcohol, tobacco, or other alcohol, tobacco, or other drug problemsdrug problems








Early Sn & Sx of Drug Use/AbuseEarly Sn & Sx of Drug Use/Abuse

• Behavioral changes• Pay attention to child’s attitude:

– Argumentative, hostility• Disregard for household rules, curfew • Isolating and withdrawing from family

and friends• Change in friends, deteriorating

relationships • Evidence of lying or secrecy• Decline in academic performance

• Behavioral changes• Pay attention to child’s attitude:

– Argumentative, hostility• Disregard for household rules, curfew • Isolating and withdrawing from family

and friends• Change in friends, deteriorating

relationships • Evidence of lying or secrecy• Decline in academic performance

Signs & Symptoms of Drug Use/AbuseSigns & Symptoms of Drug Use/Abuse• Decreased interest in sports

and other activities• Changes in weight,

eating/sleeping• Depression, fatigue, even

anxiety• Missing household money,

medication or alcohol• Bloodshot eyes, consistent

runny nose, cough, bronchitis– Incense, eye drops, odors on

clothing, hair or in bedroom

• Decreased interest in sports and other activities

• Changes in weight, eating/sleeping

• Depression, fatigue, even anxiety

• Missing household money, medication or alcohol

• Bloodshot eyes, consistent runny nose, cough, bronchitis– Incense, eye drops, odors on

clothing, hair or in bedroom

Signs & Symptoms of Drug Use/AbuseSigns & Symptoms of Drug Use/Abuse

• Dizzy and trouble walking

• Difficulty remembering recent events

• Carelessness with grooming

• Drug paraphernalia: clothing, posters, jewelry, ... promoting drug use

• Dizzy and trouble walking

• Difficulty remembering recent events

• Carelessness with grooming

• Drug paraphernalia: clothing, posters, jewelry, ... promoting drug use

We need to be aware of the signs and symptoms of abuse and take positive action when there is a

problem

We need to be aware of the signs and symptoms of abuse and take positive action when there is a

problem










Give Prevention Messages to:

Give Prevention Messages to:

• Parents • Adolescents

• Women• Pregnant Women

• Adults• Older Adults

• Parents • Adolescents

• Women• Pregnant Women

• Adults• Older Adults

Adopted from Medical/Dental Specialty ProgramAdopted from Medical/Dental Specialty Program

General ApproachGeneral Approach

Support healthy lifestyle choices:• Encourage good health habits:

–Eating a healthy diet–Stress reduction–Exercising–Getting enough sleep–Relaxing–Bonding activities

Support healthy lifestyle choices:• Encourage good health habits:

–Eating a healthy diet–Stress reduction–Exercising–Getting enough sleep–Relaxing–Bonding activities

General ApproachGeneral Approach

• Incorporate drug prevention activities wherever possible:

–In your practice

Look for “teachable moments”

• Incorporate drug prevention activities wherever possible:

–In your practice

Look for “teachable moments”

www.inhalants.org

ParentsParents• Talk to parents about the resiliency

factors and encourage them to support their adolescents in: – School performance– Setting goals– Positive expectations– Structuring free time– Evaluating peer groups– Building self-esteem – Community service – Social skills and decision-making

ability

• Talk to parents about the resiliency factors and encourage them to support their adolescents in: – School performance– Setting goals– Positive expectations– Structuring free time– Evaluating peer groups– Building self-esteem – Community service – Social skills and decision-making

ability

ParentsParents

• Educate parents about the risks of ATOD misuse and abuse in their children:

– Impairment risks: judgement problems, drinking/driving, increased risks for accidents, risky sexual behavior

– Health problems: multiple problems

– Life consequences: doing poorly in school, not attaining goals

• Educate parents about the risks of ATOD misuse and abuse in their children:

– Impairment risks: judgement problems, drinking/driving, increased risks for accidents, risky sexual behavior

– Health problems: multiple problems

– Life consequences: doing poorly in school, not attaining goals

Tips for ParentsTips for Parents

• Be a good listener• Be a good listener


• Give clear no-use messages about alcohol and other drugs– Start early, be ongoing

– Change the nature of your discussion as your child’s brain develops through the years

• Give clear no-use messages about alcohol and other drugs– Start early, be ongoing

– Change the nature of your discussion as your child’s brain develops through the years

Past Month Use vs. Parents’ Feelings About Substance Abuse

Past Month Use vs. Parents’ Feelings About Substance Abuse

Past Month

Substance Use

Strongly

Disapprove

Somewhat Disapprove or

Neither Approve nor Disapprove

Marijuana 4.9% 26.9%

Cigarettes 8.3% 45.3%

Alcohol 13.0% 40.0%

SAMHSA 2002 data

What do you tell them?Dangers of Drug Use

What do you tell them?Dangers of Drug Use

• High potency:– Altered state – no longer in control– Disinhibitory effect

• Adulterants – tainted drugs

• Unpredictable effects

• Problems in sporting activities:– Decreased coordination and performance

ability– Reduced exercise tolerance

• High potency:– Altered state – no longer in control– Disinhibitory effect

• Adulterants – tainted drugs

• Unpredictable effects

• Problems in sporting activities:– Decreased coordination and performance

ability– Reduced exercise tolerance

Dangers of Drug UseDangers of Drug Use

• High risks for:– Impairment and

accidents– Health problems– Addiction

• Effects on the mind and emotions

• High risks for:– Impairment and

accidents– Health problems– Addiction

• Effects on the mind and emotions


• Help your child deal with peer pressure to use drugs

• Example:– If 85% of the students know someone who

regularly uses marijuana then…

• Role play situations of refusing to use ATOD

• Help your child deal with peer pressure to use drugs

• Example:– If 85% of the students know someone who

regularly uses marijuana then…



• Get to know your child’s friends and parents

• Get to know your child’s friends and parents


• Monitor your child’s whereabouts– Call other parents,

find out what’s going on

• Monitor your child’s whereabouts– Call other parents,

find out what’s going on


• Supervise teen activities– When parents impose rules and

standards of behavior, their teens are at much lower risk …

• Maintain an open and honest dialogue with your child

• Supervise teen activities– When parents impose rules and

standards of behavior, their teens are at much lower risk …

• Maintain an open and honest dialogue with your child

Educational campaigns that

stress personal responsibility

and immediate health and

impairment dangers of

alcohol and other drugs use

are effective prevention tools




impairment dangers of

alcohol and other drugs use





impairment dangers

of alcohol and other drugs use





impairment dangers

of alcohol and other drugs use


24.6

16

8.1

43.1

28.8

15.9

65.5

52.5

71.9

58.3

38.932.1

0 20 40 60 80

12th

10th

8th Lifetime

Annual

Past Month

Binge Drinking

Percent of 8th, 10th,and 12th gradersreporting alcohol use

Monitoring the Future 2009 Data

Underage Drinking:Underage Drinking:

Dangers of Teen Binge DrinkingDangers of Teen Binge Drinking

• Binge drinkers are 5X more likely to have sex• 18X to smoke cigarettes• 4X to smoke marjuana• 4X to get into physical fights w other teens• Have a higher rate of suicide• Causes them to make rash and dangerous

decisions; loss of internal control• Alcohol leading cause of accidents, murder and

rape among teens• Alcohol causes 150,000 ER visits by teens

THE MOST DANGEROUS DRUG OF ALL

• Binge drinkers are 5X more likely to have sex• 18X to smoke cigarettes• 4X to smoke marjuana• 4X to get into physical fights w other teens• Have a higher rate of suicide• Causes them to make rash and dangerous

decisions; loss of internal control• Alcohol leading cause of accidents, murder and

rape among teens• Alcohol causes 150,000 ER visits by teens

THE MOST DANGEROUS DRUG OF ALLCenter for Disease Control and Prevention

24.6

16

8.1

43.1

28.8

15.9

65.5

52.5

71.9

58.3

38.932.1

0 20 40 60 80

12th

10th

8th Lifetime

Annual

Past Month

Binge Drinking

Percent of 8th, 10th,and 12th gradersreporting alcohol use

Monitoring the Future 2009 Data

Underage Drinking:Underage Drinking:

Remember: Everybody isn’t doing it!

AdolescentsAdolescents

• Talk to adolescents about:– Their intentions and attitudes

– Peer pressure

– Evaluating peer group


• Talk to adolescents about:– Their intentions and attitudes

– Peer pressure

– Evaluating peer group


AdolescentsAdolescents

• Educate about their risks of ATOD use:– Impairment dangers (accidents)

– Health risks

– Risky sexual behavior

– Deceptive advertisements

• Educate about their risks of ATOD use:– Impairment dangers (accidents)

– Health risks

– Risky sexual behavior

– Deceptive advertisements

Women Women

• Support healthy lifestyle choices

• Present information about sensible limits

• Educate regarding increased risks:– Risk for impairment – ATOD use on fertility


• Present information about sensible limits

• Educate regarding increased risks:– Risk for impairment – ATOD use on fertility

Women Women

• Educate regarding increased risks:– Risk of osteoporosis

– Risk of breast cancer

– Liver failure at lower doses than men

– Risky sexual behaviors when under the influence of alcohol and other drugs

• Educate regarding increased risks:– Risk of osteoporosis

– Risk of breast cancer

– Liver failure at lower doses than men

– Risky sexual behaviors when under the influence of alcohol and other drugs

All Adults All Adults

• Support healthy lifestyle choices:– encourage good health habits: stress

reduction through exercise and other creative activities

• Discuss health and impairment risks associated with increased alcohol/drug use:– Symptom manifestations– Brief Interventions

• Support healthy lifestyle choices:– encourage good health habits: stress

reduction through exercise and other creative activities

• Discuss health and impairment risks associated with increased alcohol/drug use:– Symptom manifestations– Brief Interventions

All AdultsAll Adults

• Present information on sensible limits Guidelines for Alcohol Consumption:– Greater risk for alcohol problems in

COA’s– Inform them about medication

interactions– Support positive choices and discuss

alternatives

• Present information on sensible limits Guidelines for Alcohol Consumption:– Greater risk for alcohol problems in

COA’s– Inform them about medication

interactions– Support positive choices and discuss

alternatives

Older AdultsOlder Adults


• Inform them about changes in physiology with aging (health/impairment risks):– Decrease in water content of the body, slower

metabolism– Falls, confusion, memory problems, insomnia,

depression – Medication interactions between alcohol, OTC

or prescription drugs


• Inform them about changes in physiology with aging (health/impairment risks):– Decrease in water content of the body, slower

metabolism– Falls, confusion, memory problems, insomnia,

depression – Medication interactions between alcohol, OTC

or prescription drugs

Let’s Work Together

and

Really

Make a Difference!

Let’s Work Together

and

Really

Make a Difference!

Documents

Prevention of Alcohol and Other Drug Problems What We Can Do in the Office