Foundations
of
Prevention
What would be covered?
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Introduction to drug abuse
Global challenges
Caribbean perspective
Definition of prevention
Basic principles of prevention
Risk and protective factors
Prevention Models
Elements of prevention programmes
Resilience
Risk factor domains for drug use
“Your” perspective
AN INTRODUCTION TO DRUG
ABUSE
Defining drug abuse

Three schools of thought:
• The first two are commonly referred
to as “Medical-pharmacological
Models”…..and
• Third perspectives commonly
referred to as “The Social Deviance
Model”
Defining drug abuse

The use generally by selfadministration of any drug in a
manner that deviates from the
approved medical or social patterns
within a given culture. (social
disapproval) (Jerome Jaffe)
Therefore the basic elements
of drug abuse are:
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The use of any prohibited (illicit drug)
The use of any therapeutic drug other
than for its intended purpose(s)
The intentional use of any therapeutic
drug in amounts greater than
prescribed
Therefore the basic elements
of drug abuse are:
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Excessive use of licit social drugs
(alcohol, caffeine or tobacco)
The taking of two or more intoxicating
substances to obtain a more
pleasurable high
THE WORLD’S
DRUG PROBLEM AND THE
BUSINESS OF DRUGS
THE MAIN DRUGS OF ABUSE
Case study: AFGHANISTAN
(2003)
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80,000 hectares under cultivation
28 of 32 provinces are presently cultivating
Production increased to 3,600 tons in 2003
Average price now $283 US per kg
264,000 families or approximately 1.7million
persons involved in cultivation (7% of the total
population)
Annual income of $1.2 billion
Each family get approx. $3,900 US annually
compared to non-opium growing families GDP
per capita of $184 US
Case study: BOLIVIA (2003)
Third largest producers of coca in the
world
 23,600 hectares under cultivation
 Grown in 2 main areas of the country
(50% legitimate cultivation)
 Production of 28,300 tons in 2003
 Average price now $5.40 US per kg
 Annual income of $153 million
 About 60% of total production used to
produce cocaine (60 metric tons)
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Case study: (2003)
Production is dominated by methamphetamine, followed by ecstasy and
amphetamine
•Most ecstasy laboratories are still dismantled in Europe, but production
is rising in Asia
•Number of dismantled clandestine ecstasy laboratories rises almost 3fold over 1992-2002 period
•Most methamphetamine laboratories are dismantled in North America
Case study: MOROCCO (2003)
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134,000 hectares cultivated (1.5% of arable
land)
Grown in 5 provinces throughout the country
Production of 47,000 metric tons of raw
cannabis and 3,080 tons of resin
96,000 farms (800,000 farmers)
Total revenue of approx. 214 billion US
Annual income per family from cannabis $2,200
US
Total market turnover of Moroccan cannabis
estimated at 12 billion US
THE CARIBBEAN
PRESPECTIVE
THE CARIBBEAN REGION
AS A TRANSIT ZONE
EUROPE
UNITED STATES
TRANSIT ZONE
STORAGE AREA
PRODUCER COUNTRY
Geographic characteristics
Combined land area of 700,000 sq. miles
 independent countries, English, French and
Dutch overseas countries and territories
 multi-lingual, multi-ethnic and multi-cultural
 approximately 37 million people
 four major different languages (English,
French, Spanish and Dutch)
 a variety of judicial systems, diverse
religious and political units
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PRINCIPLES OF PREVENTION
DEFINITON OF PREVENTION
CLASSIFYING PREVENTION INITIATIVES
- RISK AND PROTECTIVE FACTORS
-EARLY SIGNS
-HIGHEST RISK PERIODS
-PROGRESSION OF DRUG USE
Definition of Prevention
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Generally PREVENTION targets
illnesses or disease outcomes and
is often associated with the
process of reducing existing risk
factors and increasing protective
factors in an individual, in highrisk groups, in the community or
in society as a whole.
Stages of Prevention –
Primary Prevention
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Primary Prevention
•aims to avoid the development
of high-risk or potentially
harmful behaviour and/or the
occurrence of symptoms in the
first place
Stages of Prevention –
Secondary Prevention
•Secondary prevention, or early
intervention, aims to reduce
existing risk and harmful
behaviour and symptoms as
early as possible
Stages of PreventionTertiary Prevention
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Tertiary prevention aims to
reduce the impact of the
illness/symptoms a person
suffers. It offers treatment and
rehabilitation for the person
‘dependent’ or ‘addicted’ to
drugs, or whose drug use is
problematic.
Classifying prevention programmes
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Universal Prevention Programmes – These
programmes are the broadest, and
address large groups of people - such as
the general population - or certain subcategories of the population. Universal
programmes mainly have the objective of
promoting health and well-being, and of
preventing the onset of drug use, with
children and young people as the usual
prime focus groups
Classifying prevention programmes
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Selected Prevention Programmes – This
type of programme targets young people
based on the presence of known risk
factors of drug involvement. Targets have
been identified as having an increased
likelihood of initiating drug use compared
to young people in general. These
programmes are aimed at reducing the
influence of the 'risk factors',
developing/enhancing protective factors,
and preventing drug use initiation.
Classifying prevention programmes
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Indicated Prevention Programmes –
Indicated programmes target young
people who are identified as having
already started to use drugs or
exhibiting behaviours that make
problematic drug use a likelihood,
but who do not yet meet formal
diagnostic criteria for a drug abuse
disorder which requires specialized
treatment. Examples of such
programmes include providing social
skills or parent-child interaction
training for drug-using youth.
Risk and Protective Factors
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Risk factors can increase a person’s
chances for drug abuse, while
protective factors can reduce the risk.
CORE PREVENTION PRINIPLES
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Prevention programmes should enhance
protective factor and reverse or reduce
risk factor
• Include skills to resist drugs when offered,
strengthen personal commitments against
drug use, and increase social competency
(e.g., in communications, peer relationships,
self-efficacy, and assertiveness), in
conjunction with reinforcement of attitudes
against drug use.
• Include interactive methods, such as peer
discussion groups, rather than didactic
teaching techniques alone.
CORE PREVENTION PRINIPLES
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Prevention programmes should enhance
protective factor and reverse or reduce
risk factor
• Designed to enhance "protective factors" and
move toward reversing or reducing known
"risk factors."
• Target all forms of drug abuse, including the
use of tobacco, alcohol, marijuana, and
inhalants.
CORE PREVENTION PRINIPLES
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Prevention planning - Family
Programs
• Prevention programs should
include a parents' or caregivers'
component that reinforces what the
children are learning-such as facts
about drugs and their harmful effectsand that opens opportunities for
family discussions about use of legal
and illegal substances and family
policies about their use.
CORE PREVENTION PRINIPLES
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School Programs
• Designed to intervene as early as preschool
to address risk factors for drug abuse, such
as aggressive behaviour, poor social skills,
and academic difficulties
• Programs for elementary school children
should target improving academic and
social-emotional learning to address risk
factors for drug abuse, such as early
aggression, academic failure, and school
dropout
• Programs for middle or junior high and high
school students should increase academic
and social competence
CORE PREVENTION PRINIPLES
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Community Programs
Programs aimed at general populations at key
transition points, such as the transition to middle
school, can produce beneficial effects even among
high-risk families and children, they reduce labeling
and promote bonding to school and community
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Programs that combine two or more effective
programs, such as family-based and school-based
programs, can be more effective than a single
program alone
Programs reaching populations in multiple settings,
e.g., schools, clubs, faith-based organizations, and
the media—are most effective when they present
consistent, community-wide messages
CORE PREVENTION PRINIPLES
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Prevention programme delivery
When communities adapt programs to match
their needs, community norms, or differing
cultural requirements, they should retain core
elements of the original research-based
intervention which include:
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Structure (how the program is organized and constructed);
Content (the information, skills, and strategies of the program);
and
Delivery (how the program is adapted, implemented, and
evaluated).
Programs should be long-term with repeated
interventions (i.e., booster programs) to reinforce the
original prevention goals. Research shows that the
benefits from middle school prevention programs
diminish without follow-up programs in high school
CORE PREVENTION PRINIPLES
Programme Delivery
 PRINCIPLE 13 - Prevention programs should be
long-term with repeated interventions (i.e.,
booster programs) to reinforce the original
prevention goals. Research shows that the
benefits from middle school prevention
programs diminish without follow-up programs
in high school.
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PRINCIPLE 14 - Prevention programs should
include teacher training on good classroom
management practices, such as rewarding
appropriate student behaviour. Such techniques
help to foster students’ positive behaviour,
achievement, academic motivation, and school
bonding.
CORE PREVENTION PRINIPLES
Programme Delivery
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PRINCIPLE 15 - Prevention programs are
most effective when they employ interactive
techniques, such as peer discussion groups
and parent role-playing, that allow for active
involvement in learning about drug abuse
and reinforcing skills.
PRINCIPLE 16 - Research-based prevention
programs can be cost-effective. Similar to
earlier research, recent research shows that
for each dollar invested in prevention, a
savings in treatment for alcohol or other
substance abuse can be seen.
What are some of the things we
need to know in order to
develop meaning full
programmes
What are the highest periods for drug
abuse among youth?
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Around transition periods:
• Puberty
• Entering school – moving to higher levels
• Moving or parent divorce
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Risk appears at every transition from
early childhood through adulthood;
each developmental stage must be
supported with appropriate protective
factor
When and how does drug use starts and
progress?
Use may begin as early as 10/11/12 yrs
 Gateway drugs at play
 At late adolescents – tobacco and
alcohol use may persist and marijuana
and other illegal drugs are introduced
 Early initiation associated with greater
drug involvement
 Abuse associated with levels of social
disapproval, perceived risk and
availability of drugs in the community
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www.drugabuse.gov
Prevention Programs Should . . . .
Reduce Risk Factors
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ineffective parenting
chaotic home environment
lack of mutual attachments/nurturing
inappropriate behavior in the classroom
failure in school performance
poor social coping skills
affiliations with deviant peers
perceptions of approval of drug-using
behaviors in the school, peer, and community
environments
www.drugabuse.gov
Prevention Programs Should . . . .
Enhance Protective Factors
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strong family bonds
parental monitoring
parental involvement
success in school performance
prosocial institutions (e.g. such as
family, school, and religious
organizations)
 conventional norms about drug use
www.drugabuse.gov
Prevention Programs Should . . . .
. .Target all Forms of Drug Use
. . . and be Culturally Sensitive
www.drugabuse.gov
Prevention Programs Should . . . .
Include Interactive Skills-Based
Training
 Resist drugs
 Strengthen personal
commitments against drug use
 Increase social competency
 Reinforce attitudes against drug
use
www.drugabuse.gov
Prevention Programs Should be. . . .
Family-Focused
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Provides greater impact than
parent-only or child-only programs
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Include at each stage of
development
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Involve effective parenting skills
www.drugabuse.gov
Prevention Programs Should . . . .
Involve Communities and Schools
 Media campaigns and policy
changes
 Strengthen norms against drug use
 Address specific nature of local
drug problem
www.drugabuse.gov
PREVENTION
MODELS
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School-based prevention programmes
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Peer-focused prevention programmes
Family-based prevention programmes
Community-based prevention programmes
School-based prevention programmes
Four main programming strategies:
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Information-based programmes –
disseminate information on risky behaviours
Affective education programmes – values
clarification, goal setting, decision making,
self-esteem building, and stress management
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Social influence programmes – resistance
skills, life skills, and normative beliefs
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Comprehensive programmes – combining a
variety of strategies
Peer-focused prevention programmes
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Four main programming strategies:
adolescents can influence their peers
directly through education – an adolescent
describing the consequences of his violent
behaviour can have a strong impact on
other adolescent who could relate to his
situation
adolescent can learn by observing how
peers behave – if a peer handle anger and
solve problems peacefully and
constructively, then youth may try
behaving that way as well
Peer-focused prevention programmes
Four main programming strategies:
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peer influence can work by changing peer group
norms – structured programmes can help
change the norms by fostering the development
of highly visible peer groups who discourage
substance use behaviours
peer programmes can educate students about
true versus perceived dominant peer norms –
teaching adolescents about the true versus
perceived group norms concerning substance
use could result in a decline in substance use
initiation
Family-based prevention programmes
Well-documented family-based
programme methodologies aimed at
prevention can be divided into three
categories:
• parent and family skill training
• family in-home support
• family therapy
Community-based prevention programmes
Advantages of community-based intervention:
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The breath of coverage – e.g. a
community-based approach for reducing
tobacco use by youth involves requiring
anyone involved in any way with the sale
and distribution of tobacco products to
participate in a merchant education
programme. The coverage or exposure is
enhanced because of the shift in the focus
of the intervention from individual buyers
to all points of purchase.
Community-based prevention programmes
Advantages of community-based intervention:
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Visibility and repetitive reinforcement – this can
strengthen norms against behaviour such as
substance abuse or violence. Counteradvertising campaign through many mass media
public service announcements are a relatively
easy way to send multiple message about
dangers of various risky behaviours
Potential for maximizing outcomes – the utility of
community approaches lies in the fact that they
can be focused on policy changes.
SUBSTANCE ABUSE
PREVENTION
GUIDELINES FOR
EVIDENCE-BASED
PREVENTION PROGRAMS
AND STRATEGIES
Youth/Peer Domain Guidelines
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Youth Preventive Education and Skill
Building
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Mentoring Programs
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Tutoring Programs
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Peer Leadership/Influence Programs
Family Domain Guidelines
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Parenting Education and Skill
Building Programs
Parent Involvement Strategies
School Domain Guidelines
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Comprehensive School Reform /Climate
Change
Student Assistance Program
Technical Assistance
Advocacy for School ATOD Policy
Development/Change
Community Domain Guidelines for
Effective Practices
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Social Marketing
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ATOD Prevention Coalition Technical Assistance
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Media Advocacy
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ATOD Policy/Ordinance Development or Change
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Server/Merchant Education and ATOD
Policy/Ordinance/Law Compliance Monitoring
Resilience
The process by which successful
developmental or adaptive outcomes
occur within a high-risk environment
and/or stressful circumstances
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• Risk factors
• Protective factors
Individual Resilience Processes
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Protective Processes:
• Self-perceived competence
• Academic competence
• Healthy interactions with adults
• Religion and prayer
• Anti-alcohol norms
• Social skills
Family Resilience Processes
Marital harmony
 Parents abstain
 Family management
 Psychologically healthy parents
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Family Resilience Processes
(cont.)
Family hardiness
 Parental support
 Family bonding
 Family connectedness
 Healthy parent-adolescent
communication
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Community Resilience
Processes
Student autonomy and influences
 School norms
 School connectedness
 School sense of community
 No tolerance approach
 Local law enforcement
 Higher alcohol prices
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Conclusions
Prevention opportunities exist at the
individual, family, and community
levels
 Prevention can enhance protective
factors in addition to or instead of
decreasing risk factors
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Risk factor
domains for drug
use
Inter-relationship of Risk Factors for Drug Use
• We are often faced with the dilemma of
trying to place risk for substance use into the
usual domains described in the literature:
demographic (age, gender); personal (peer
influence, psychological factors); family
(poverty, culture); and community
(neighbourhood, school).
Inter-relationship of Risk Factors for Drug Use
•However, it might be argued though that for
us risk factors can be grouped into only two
domains:
• (1) contextual factors including societal and
cultural influences, and
•(2) economic factors or
individual/interpersonal factors that takes into
account the individual within the context of
social, behavioural and biological influences
on adolescent decision-making
Inter-relationship of Risk Factors for Drug Use
• Personality factors
• Q, would a greater sense of coherence result
in more protective behaviour
• Family and peer relationships
•Q, is there too much social, behavioural and
biological influence that interferes with decisionmaking (especially among youth/young adults)
• Cultural and environmental factors
• Q, is the societal and cultural influences the
ones to be blamed
Is The Risk Worth It?
• Q, what lessons have we learned
 the largest risk group are our youth
(adolescents)
 in order for prevention to work we need to
advocate among our at risk groups
 knowledge alone with not bring about
behaviour change - need for a positive attitude
 remember - there is a complex interrelatedness among behavioural risk factors
Is The Risk Worth It?
• Q, what opportunities exist for us
• e.g. we can be the advocated for the
reduction of adolescent risk behaviour
Policy implication for substance
abuse prevention
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Policy planning and development
• Policy makers must be fully aware of
drug abuse problems and its social and
economic consequences
• Drug abuse prevention requires longterm commitment
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Research/needs assessment
• Policies must be driven by empirical
evidence
Policy implication for substance
abuse prevention
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Evaluation
• Evaluation must be integrated into
policies project and programmes from
the outset
• Investment must be made for training in
evaluation methods
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Partnerships
• Multi-sectoral and inter-institutional
collaboration helps to pool resources
and develop common strategies
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Foundations of prevention