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Prevention is a key component of any effective drug strategy. It needs to span the entire spectrum of addictions services, and also needs to be well integrated into the health and social service system. Prevention encompasses a wide range of goals: minimizing individual and community risk factors; preventing or delaying onset of use; ensuring that use does not spiral into addiction; limiting the negative health and social impacts; and slowing the spread of disease. There is great potential to reduce the economic costs and human suffering associated with problem substance use through effective policy and practices. Prevention is an essential component.
Dan Reist, with the Centre for Addictions Research of BC, says, "Prevention is a necessary element in the foundational principle on which addiction services is built: preventing and reducing the harm associated with problem substance use and addictive behaviours. This is an interactive process and depends on people engaging with information, and connecting with other people and with their broader community, in a way that changes their behaviour."
There is a broad spectrum of programs and activities that come under the umbrella of prevention of substance use problems. Different strategies are appropriate for different groups of people. There are many diverse aims and goals that fall under the category of prevention.
An important concept when thinking about substance use prevention is risk and protective factors. Protective factors are those that can help a person avoid having problems with substance use. Examples of protective factors include having good decision-making skills, an ability to cope with stress and other difficulties, a stable home life and good relationships with one's family, and high self-esteem. While all of us have some innate protective factors, they can also be developed or enhanced. Risk factors are factors whose presence puts someone at higher than average risk of developing problems related to substance use. Presence of risk factors does not mean that someone will develop substance use problems, but the more risk factors are present, the higher the chances that problems may occur. Examples of risk factors for substance use problems include having difficulties in school, lacking positive coping skills, living in poverty, disrupted family background and low parental supervision, having a mental disorder, being a victim of abuse, and having had a stressful life-change (such as retirement or divorce).
All prevention programs aim to increase protective factors and minimize or manage risk factors. Universal prevention focuses on broad social messaging, with the aim of shifting social norms in protective ways, for example:
preventing cigarette producers from advertising at sporting events
when a celebrity or respected public figure speaks out against practices such as drinking and driving
public awareness campaigns to reduce social acceptance of smoking
not allowing advertisements for alcoholic beverages to air on television before 9pm
encouraging parents to be involved with their children and build strong family relationships.
Targeted prevention aims at a group of people who are prone to certain risk factors. The broadest kind is generally targeted at youth, aiming to delay or prevent the first use of substances. Education is a crucial component of such programs, since young people will be better able to make good decisions if they have accurate information about the substances and associated risks. However education about substances and their effects is only one part of prevention. Equally important are programs that seek to enhance or develop protective factors and minimize risk factors. Examples of targeted prevention include:
teaching young people coping skills and enhancing their decision making abilities
providing young people with reliable information about substances, their effects, and the associated risks
providing excursions and other activities for residents in a seniors' complex, to reduce isolation
conducting after-school activity programs in lower income neighbourhoods, to provide recreational options for children living in poverty.
There are also a range of indicated prevention interventions that are directed at people exhibiting specific risk factors. The programs develop or enhance protective factors, while also directly addressing relevant risk factors. Indicated prevention activities may include:
providing counselling or other supports to victims of abuse to support them in coping with past trauma
outreach programs for recent retirees, including information on appropriate use of medications and alcohol
day programs for adolescents who have had disciplinary problems at school involving substance use (e.g. who have been caught smoking marijuana at school)
educational pamphlets to accompany antidepressant medications, explaining proper use of the medications and advising moderate alcohol intake.
Prevention activities continue across the spectrum of addictions services. Early intervention programs that aim to identify use in its early stages are a form of prevention, since their aim is to prevent a substance use problem from spiralling into a full-blown addiction. All forms of intervention programs incorporate aspects of prevention that aim to prevent the problems from getting any worse. For instance, an intensive treatment program aims not only to stop the person from using substances in inappropriate ways, but also aims to rebuild positive coping skills and other aspects of the person's life that can ensure the treatment program has a lasting impact on improving their lives, for example, by providing employment skills training.
A crucial component of all prevention programs is high quality information that is accurate and balanced. If a child is taught to say "No" to drugs, with the message that drug use destroys people's lives and jeopardizes their future, this alone may not be an effective prevention message. Such messages, while true, do not present a balanced picture. The child may observe older siblings or friends experimenting with substances, yet not experiencing any adverse effects and still succeeding at school. This observation may cause them to discount their prevention education altogether.
A more balanced message may contain information about various substances and their effects, and realistic accounts of the risks involved. While it may be the case that the vast majority of homeless injection drug users smoked marijuana as their first use of illicit drugs, it would be inaccurate to communicate that smoking marijuana makes it likely that the user will end up as a homeless injection drug user, since that group is only a small proportion of all marijuana smokers. Realistic messages about substances, their effects, and associated risks, accompanied by programs to enhance decision making skills, are likely to have greater impact than unbalanced information.
There are resources available for parents looking to inform themselves about substance use issues, in order to be able to address their children's questions. Marsha Rosenbaum, a drug education expert and a mother, has a website with practical advice on drug education, including feedback from teenagers. This site is accessible at www.safety1st.org. In BC we have a provincial agency that produces fact sheets and other information, available at www.preventionsource.org.
When evaluating information relating to substance use, consider the following questions:
Who is the source of the information?
What is their aim or motivation in providing the information?
On what basis are claims made?
Can you see evidence that it is based on scientific studies that are conducted by respected authorities?
In your opinion, does it present a balanced view?
Does it claim to know everything, or does it acknowledge gaps in our understanding of certain issues?
Is it respectful, encouraging people to think and make their own decisions?
Reliable, evidence-based information forms the basis for any prevention activity. Informed people who have positive coping mechanisms, good decision making skills, and feel well-integrated and supported within their environments are better able to make healthy choices. Prevention of substance use problems is about building resilient individuals that have the necessary skills to withstand life's ups and downs, have trusted loved ones that they can depend on in times of need, and knowledge about the risks involved in various behaviours.
The Many Faces of Prevention
Prevention activities encompass any policy or practice that aims to prevent or reduce the harm associated with problem substance use by intervening before the particular problem emerges. These activities can include:
public information campaigns on the dangers of second hand smoke
educating recent retirees on appropriate use of alcohol and medications employment skills programs for recovering addicts
education about safe injecting practices for injection drug users, to prevent the spread of disease
providing accurate information on substances, their effects, and associated risks to parents of teenagers
distribution of pamphlets in conjunction with the dispensing of anti-psychotic medications, to convey information about the effects, risks, and appropriate use
Role of Parents
Studies have found that most kids consider their parents to be the most reliable source of information on drugs and alcohol, but many parents are hesitant about raising these subjects with their kids. Here are some examples of what parents can do to reduce the chances that their children will experience problems with substance use:
Model responsible and moderate behaviours with medical and non-medical substances, e.g.:
never drink and drive, and only drink moderately when children are around
limit use of painkillers and other medications to when they are absolutely necessary
try to avoid smoking in front of children
do not ask children to handle cigarettes or hold an alcoholic drink for an adult
Teach good coping mechanisms and decision making skills by example – e.g., if you've had a bad day at work, have a hot bath instead of a stiff drink
Teach decision making skills by empowering your children to make certain decisions that affect them
Set reasonable boundaries and have a discipline style that is firm and consistent, but not autocratic
Provide your children with consistent encouragement and support to build self-esteem. This will make them more confident and secure, and they will be better equipped to deal with life's problems and make healthy choices
Talk to your children about substances, and listen to their questions and concerns rather than lecturing
Let your kids know that you are always available to talk to them if they have problems or concerns, or if they need advice on a difficult issue
Inform yourself about substances and their effects, so that you will be able to communicate good information
Don't be afraid to ask for help if you're facing a challenging parenting situation
Sources
Alberta Alcohol and Drug Abuse Commission. Keeping kids addiction free. http://parent.aadac.com/prevention/keeping_kids_addiction_free_overview.asp
Alberta Alcohol and Drug Abuse Commission. Parent information series. http://parent.aadac.com/prevention/parent_info_series.asp
Centre for Addictions Research of BC. (2004-2006). Substance Information Link. www.silink.ca
Rosenbaum, M. (2002.) Safety first: A reality-based approach to teens, drugs, and drug education. San Francisco: Drug Policy Alliance.
Links in the Sources section are up to date as of June 2006
