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Overview of Substance Abuse Prevention

Overview of Substance Abuse Prevention. Karol L. Kumpfer, Ph.D. Professor Dept. of Health Promotion And Education University of Utah Salt Lake City, Utah. Major Increase In Adolescent Substance Abuse (30-Day Use) from 1992 to 1998. 102% Increase in Illicit Drug Use in 12 to 17 Year Olds

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Overview of Substance Abuse Prevention

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  1. Overview of Substance Abuse Prevention Karol L. Kumpfer, Ph.D. Professor Dept. of Health Promotion And Education University of Utah Salt Lake City, Utah

  2. Major Increase In Adolescent Substance Abuse (30-Day Use) from 1992 to 1998 • 102% Increase in Illicit Drug Use in 12 to 17 Year Olds • 73% Increase in Illicit Drug Use in 12 to 13 Year Olds • 102% Increase in Marijuana Use in 12 to 17 Year Olds • 33% Increase in Cigarette Use in 12 to 13 Year Olds • Highest Rates in New Cocaine Users in Youth • 500% Increase to Highest Incidence Rate in Heroin Use in Youth Source: 1998 National Household Survey (DHHS)

  3. Virginia Slims Effect: By 1995 8th Grade Girls Exceeded Boys Use of Half of all Major Drugs Prevalence Rate Source: 1995 Monitoring the Future

  4. Costs of Substance Abuse are Staggering • The Personal, Social, Economic Costs of substance abuse are about equal to $1,200 per person per year • A family of four persons is losing about $4,800 per year in income. • Policy makers want quick fixes. • The Drug Czar’s Office of National Drug Control Policy has $200 million for a media campaign. :

  5. Governments Need Evidence-based Programs and Policies Based on Science not Hunches • Example: While the Synar Amendment Congress passed in • FY 96 has reduced access to tobacco by minors to a 20% buy-rate, research found no relationship to adolescent tobacco use.

  6. Such Major Use Increases Should Produce Increased ONDCP Federal Prevention Funding: • However, no one seemed to care—not parents, teachers, media, politicians, or community leaders Why? Possibly because many parents, teachers, political leaders used drugs themselves in late 60s and 70s,

  7. Example: CSAP’s Discretionary Grant Funds Went Down When Illicit Drug Use Went Up

  8. Interdiction budget and prevalence of drug use among 12th graders, 1981 - 2000 NOTE: Budget for 1999 as enacted; for 2000 as requested. Prevalence data are from the Monitoring the Future study.

  9. from the Latin word praevenire which means... “to come before” or to prevent Prevention

  10. Prevention is a proactive process that empowers individuals and systems to meet the challenges of life events and transitions by creating and reinforcing conditions that promote healthy behaviors and lifestyles. Definition of Prevention...

  11. Prevention can be defined as a collaborative community process to plan and implement multiple strategies that: reduce specificrisk factorscontributing to tobacco, alcohol and drug use, and related behavioral problems among youth, and strengthen a set ofprotective factorsto ensure people’s health and well-being. Definition of Prevention Based on Risk/Protective Factors

  12. Good News & Bad News Good News: • We know how to prevent drug abuse by strengthening families, schools, and communities. Bad News: • Prevention of drug abuse is not easy. There are no quick fixes. A media campaign is not enough.

  13. Federal Funders Have Lists of Approved Evidence-based Model Programs • Best practices or effective evidence-based programs listed in: • NIDA “Red Book” Preventing Drug Use Among Children and Adolescents, 2003 2nd Ed. (19 programs) www.drugabuse.gov • OJJDP Strengthening America’s Families (35 programs with 7 exemplary replicated programs) www.strengtheningfamilies.org • SAMHSA National Registry of Effective Programs and Practices-NREPP (2005) www.preventionregistry.org

  14. NIDA publication for further reading

  15. Federal Funders Have Lists of Approved Evidence-based Model Programs • Best practices or effective evidence-based programs listed in: • Department of Education’s Safe and Drug-free Schools Program (DoEd) (8 programs) www.ed.gov • Office of Juvenile Justice and Delinquency Prevention (OJJDP) BluePrints for Violence Prevention (10 programs) www.colorado.edu/cspv/blueprints • International Cochrane Collaboration Reviews in Medicine and Public Health (Foxcroft, et al., 2003) for school substance abuse prevention programs www.cochranecollaboration.org

  16. The Great Disconnect Research Practice

  17. Building the Bridge Research Practice

  18. Vision for the Future Research Practice

  19. The Bridge is the IOM* Phases of Substance Abuse Prevention Research NIH: NIDA/NIAAA/NIMH CSAP/DoEd/OJJDP/CDC STATES Basic Biomedical Research I Hypothesis Develop-ment II Methods Develop-ment III Controlled Intervention Trials IV Defined Population Studies (KDs) V Demonstra-tion and Imple-mentation (KAs) Nationwide Prevention and Health Services Program (Block Grants) Research on Applications Applied Research Applications of Research Sources: Mrazek, P.J. and Haggerty, R.J. (eds.), Reducing Risks for Mental Disorders, Institute of Medicine, Washington, DC: National Academy Press, 1994. Jansen, Glynn & Howard, 1996; Greenwald and Cullen, 1995

  20. AGENT/DRUG Public Health Service (PHS) Prevention Triangle Model SUPPLY REDUCTION • INTERDICTION • CROP ERADICATION • POLICY AND LAWS • REDUCE ACCESS • INCREASE COST INDIVIDUAL CHANGE PROGRAMS • KNOWLEDGE • ATTITUDE/NORMS • SKILLS HOST/PERSON ENVIRONMENT • SYSTEM CHANGE • FAMILY • SCHOOL • COMMUNITY

  21. Treatment Case Identification Standard Treatment for Known Disorders Indicated— Diagnosed Risks Youth Prevention Maintenance Compliance with Long-Term Treatment (Goal: Reduction in Relapse and Recurrence Selective— High Risk Groups Universal— General Population Aftercare (Including Rehabilitation) The Intervention Spectrum for Behavioral Disorders Source: Mrazek, P.J. and Haggerty, R.J. (eds.), Reducing Risks for Mental Disorders, Institute of Medicine, Washington, DC: National Academy Press, 1994.

  22. Three Types of Prevention Interventions 1.Universal (prevention with general population) 2.Selective (prevention with high-risk groups, such as children of alcoholics, inner city youth, pregnant unmarried girls, etc.) 3.Indicated (prevention with identified problem youth already manifesting a risk factor, i.e., school dropouts, delinquent youth, youth already smoking or drinking, etc.) Source: (Mrazek & Haggerty, IOM, 1994).

  23. Primary Distinguishing Features of Types of Prevention • Who is the prevention program designed for (low, medium, or high risk youth)? • Length or dosage? (Longer dosage more risk factors). • Cost? Longer, more intensive programs for high risk, indicated youth cost more. • Staffing Level Needed? Indicated programs for youth with identified precursors (conduct problems) generally require better trained staff.

  24. Prevention Programs Seek to Reduce Risk Factors by Increasing Protective and Resilience Factors • 1. Risk Factor Approach to Prevention • 2. Protective Factor Approach • 3. Resilience Approach (Bernard, 1998) • 4. Social Development Model Approach (Hawkins, Catalano, et al., 1992, 2002) • Who is at risk for ATOD problems or addiction? Students with high risk and low protection and resilience.

  25. Relationship Between Substance Use and Abuse Problems ATOD Use None Light Moderate Heavy At Risk Dependent Problem Low Risk Severe Moderate Small ATOD Problems None

  26. Individual Risk Factors • Family History of Alcoholism or Drug Abuse • Genetic Susceptibility • Early starters of conduct disorders • Aggression mixed with shyness • Sensation or Thrill Seeker • Emotional Management Difficulties • Low Intellectual Capabilities • Few Assets or Resilience Skills

  27. Family Risk Factors • Parental drug use and positive use attitudes • Lack of love, caring, and support • Low expectations for children’s success and school performance • Lack of adult supervision and severe or inconsistent discipline • Lack of family organization (e.g., routines and rituals, family holiday gatherings) • Poor family management or communication • Sexual and physical abuse

  28. School Risk Factors • Early elementary school academic difficulties • Low school attachment, bonding • Lack of opportunities for involvement • School norms favorable to ATOD use • Poor school role models • Unsupportive school climate • High ATOD use students at school • Lack of prevention programs

  29. Peer Risk Factors • Rejection by pro-social peers in elementary school • Lack of social skills • Association with drug-using peers • Peers have a positive attitude about tobacco, alcohol or drug use • Associates with anti-social peers • Lacks peer resistance skills

  30. Community Risk Factors • Economic and Social Deprivation • Low Neighborhood Attachment • Community Disorganization • High Transitions and Mobility • Community laws and norms favorable to drug use • High availability

  31. Which of These Risk Factors are Most Important? How do these risk factors mediate other risks (order themselves)? Need a tested etiological, causal model to answer these questions.

  32. Self-Control F = .21 M= .27 Academic Self-Efficacy Normed Fit Index F: .90 M: .90 F = .19 M= .16 F = .71 M= .71 F = .88 M= .88 F = .43 M= .36 F = .62 M= .55 Social and Community Prevention Environment Female: (n=5,488) Male: (n=3,023) F = .12 M= .17 Pathways to Substance Use for High Risk Youth (Kumpfer, Whiteside, & Turner, 2003) Family Bonding Family and Peer Norms Family Supervision No Substance Use

  33. Biological Risk Factors for Alcohol and Drug Abuse (Kumpfer, 1986) 1. Overstressed Youth Syndrome • Difficult Temperament • Hyperactivity • Rapid Brain Waves • Autonomic Hyper-reactivity 2. Prefrontal Cognitive Dysfunction 3. Different Liver Metabolism 4. FAS/FAE

  34. INTERNAL RISK AND PROTECTION BY AGE IN THE BASELINE SAMPLE(n= 9,875) More Protection More Risk

  35. BY PROTECTING AND RESTORING CHILDREN’S NATURAL HABITAT(Szapocznik, 2000) HOW SHALL WE BUILD A BETTER FUTURE FOR OUR CHILDREN?

  36. Uphill Battle to Save Our Children • It is more difficult for families to raise children in a media world which devalues human life by glamorizing drugs, violence, and impersonal sex; and demeans healthy intimacy and human life. • Parents are spending less time with children so who is raising our children? • Media spends billions on advertising

  37. Uphill Battle to Save Our Children • CARING COMMUNITIES ARE MORE LIKELY IN CITIES AND NEIGHBORHOODS THAT ARE BUILT FOR FAMILIES AND NOT FOR CARS.

  38. PREVENTION IN JEOPARDY • Increasing demand for treatment in 2000’s • Call to “close the treatment gap” • Can’t do that with kids still falling off the cliff • Need long-term, not short-term fixes

  39. Prevention Solutions • Increase Public Education on Prevention • Disseminate Evidence-based Program • Increase Funding for Prevention • Increase Coordination and Advocacy

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