Hello everyone and welcome back. In our past sections we have been talking about different types of drugs, treatments, screening, etc. In this section we will begin talking about prevention of substance abuse occurring in the first place. Let's begin by going to slide two.

As we can see here there are many levels of prevention. They can basically be broken down into three basic groups; primary, secondary, and tertiary. So let's talk about primary levels of prevention first.

As we can see in slide three, primary prevention is related to general deterrence and it can include a broad range of activities. The major goal of primary prevention is to reduce the risk of substance abuse from people who are not using in the first place. Consequently these kinds of programs target at risk neighborhoods and communities, however, it can also target particular types of families, it can target schools, it can target groups of individuals in religious communities, and on and on and on. So again, the focus is on reducing the risk for drug use among non-users.

The focus of primary prevention can be at different aspects or levels and as we can see in slide four there are a variety of different levels that one can look at under interpersonal factors. Primary prevention focuses at different levels or aspects of analysis. The first level as we can see here on slide four focuses on the interpersonal factors that one may have. So, for example, one might focus on education, or values, or even assertiveness or refusal skills. One might also focus specifically on drug education.

A different level of analysis might focus on small group aspects. So, for example we might focus on peer mentoring, or working with conflict, we might also find alternatives for drug use as well. This may focus at the community level or even at the individual level. One aspect that we might focus on is increasing the strength of the family unit itself. This might work with communication skills, focusing on bonding time, and assorted other things.

The third aspect of primary prevention might focus at the community level. Here you might strengthen school and family ties, or, the school community links in general. Another way is to focus on media advocacy and these might include PSA's or assorted other things. The community might focus on specific efforts such as trying to reduce cigarette marketing on billboards or trying to reduce the amount of alcohol consumed my young folk or by young adults. So in general, primary prevention focuses on people who aren't really using and they are trying to make sure that these people do not start using.

That is in contrast to the second type of prevention shown in slide seven which is secondary prevention. Secondary prevention specifically targets at-risk groups. It can also target early experimenters or even high-risk populations, as well. Basically, what it is designed to do is to stop the progression of drug use and to stop individuals going from a gateway drug to other drugs. Finally, secondary prevention efforts can even focus on stopping gateway drug use. This is more difficult but can be done.

Now there is a variety of secondary intervention stratiegies that one can use. First of all, one may use assessment strategies where you identify specific subgroups then target those groups for interventions, or you may target interventions with specific couples that may include sanctions so it may include some kind of treatment component, as well. It may even include a teacher-counselor-parent team approach in helping youth not use. Generally the idea is to identify and to then develop healthy alternatives to drug use that may include sports, after school programs, scouting, or even other alternatives such as hiking, or working on cars, or whatever it may be. The key is that it has to be interesting for the youth.

Tertiary prevention, as we see in slide nine, is the third major group. This is an advanced state of drug use or abuse prevention. It is very similar to drug treatment. It may include assessments, referrals, case management, and assorted other things. So in general these three levels of prevention are used in a wide variety of contexts. The key you need to focus on in which type you are going to use with which target group for example, using a secondary prevention approach for primary folk who aren't even using may be counter productive. The same is true for using a primary prevention approach for individuals in a tertiary group. So the key is that you need to know who your target groups are and how to work with them.

Now when one talks about prevention, once you have gotten a bit of a historical perspective about what we have done in the past. As we can see in slide ten we have used a wide variety of approaches. For example, we have used prohibition. For example, China prohibited the sale and use of opiates and this actually caused the opium wars with Great Britain. We have had other types of movements such as temperance movement. This was related to alcohol and was basically designed to stop the sale of alcohol. Some of those laws are still on the books today, such as Blue Laws, etc. The big thing about prohibition is that it may reduce the sales and use of alcohol, and prohibition actually did that, but it caused all sorts of other illegal behavior.

In the 1950's prevention to a little bit different approach. As we can see in slide eleven, drugs were primarily the problem in the ghetto. Then it spread outside the ghetto. Basically drugs were used to escape pain and reality. The primary intervention of the 50's and 60's was scare tactics and they used all sorts of movies and speakers to try to tell individuals how bad drugs actually were.

As time progressed, as we see in slide twelve, in the late 1960's drugs had become a national epidemic. They were primarily used to intensify life. The intervention at that time was still providing information, didn't really use scare tactics anymore because they didn't really work, but they used films and a wide variety of speakers to basically try to prevent drug use.

As we moved into the 70's drugs were used for all sorts of reasons. As we can see in slide thirteen they were used to enhance experiences, to relieve boredom, expand perceptions, etc. The interventions of those times became a little more formalized. We began to actually use drug education with a wide variety of factual information. It began in kindergarten and went all the way through late high school.

By the mid 1970's however, drug use had become basically tolerated by society. As we see in slide fourteen, the users had become much more sophisticated in the types of drugs they were using and how they are using them. The interventions however were still drug education, providing some kind of alternative, and developing a more formalized curriculum.

As time continued on from the 70's and the 80's groups began to form to combat drug abuse. These were usually parents or parent-teacher associations. The interventions as we see in slide fifteen were all sorts of things. There were education, trying to find alternatives, training to reduce drug use, etc by a wide variety of folk.

From the 1980's on as we see in slide sixteen, drug used became recognized as being very complex. There were models developed for very specific types of drug abuse. The models were then tested for their effectiveness. The key starting in the eighties was that research was the way to really identify what worked and what didn't and you had to get good reliability. The interventions were varied. Evaluation was really the key to all of them. What you wanted to do was define and determine whether or not your program was working. It also included media perceptions and the medias participation. A lot of the television and movie programs became very culturally sensitive to drug use.

So how did we make these drug prevention programs more effective? Well, as we can see in slide seventeen there is a variety of different things that we can do. We can focus on a wide variety of things but the key is that we have to develop a deliberate plan of methodology. You have to preview a previous history of the use, and develop a link between the messages conveyed with what was learned and other aspects of a persons life. You also had to promote a wide variety of programs and evaluate and allocate your resources. Ultimately, the big thing about all of this is that you had to evaluate constantly what was going on.

So what were some targets of prevention programs? Well, as we can see in slide eighteen attitude change was a big one. Basically try to change the attitude about something in a society and as we have found from mistakes from a wide variety of other types of interventions it takes a long time. Attitude changes are also very difficult to measure. It makes us feel good, but often times it does not make any kind of behavioral change.

A classic example of attitude change is shown on slide nineteen. Drunk driving, for example, we have had a wide variety of drinking and driving campaigns and around Christmas time everyone says all sorts of things such as "Do not drink and drive." Everyone says it is bad and as a consequence from all these different things, so that is the attitude change that we have had about it. However, many people still continue to do that and I would suspect that many individuals that you know have drunk and drive in the last week. Racial Prejudice is another example. In the past we had separation of the races. The interventions were then school integration and other techniques, bussing etc. As a result of that the attitudes toward race have changed somewhat. However there is still a lot of separation in a wide variety of communities. If you look outside of politically correct contexts, basically you do not see a lot of change, and that is unfortunate.

Another type of approach as we see in slide twenty are information/awareness approaches. Basically it is assumed information about something will cause attitude or behavioral changes. This is one of the most commonly used techniques and it is often used with public service announcements, billboards, etc. The idea is to increase knowledge about some particular issue however the problem is again is that knowledge about something usually does not create behavioral changes. All one has to do is look at condom use or abstinance in relation to the problems going on with HIV right now and seeing HIV and a wide variety of other /STD's/ continue to increase.

Behavioral interventions, as we see in slide twenty-one, are a little different. It can be done using a wide variety of techniques. They are also very easily measured. For example, if you tax a product what do you see? You see the rates usually go down, the problem is you can also have a side effect and that has classically been happening with cigarettes. You can also use a wide variety of law envorcement techniques such as drunk driving interventions. Put lots of police in the street, use lots of check points, bartender training, and DWI rates go down. So in essence, behavioral interventions tend to be more focused, easily evaluated, and they tend to be more effective in reducing or changing some particular aspect of behavior.

Now, there is a wide variety of other models and I have listed a couple of these on slide twenty-two. For example, the affective education model basically assumes individuals use drugs because of a lack of self-esteem. So you increase self-esteem and the youth do not use drugs. Well, as we can see here, it is very hard to test that hypothesis and also even though we focus really heavily on self-esteem in schools it still does not change a lot of the drug use behavior. The social influence model is a little bit different. It assumes individuals lack resistance skills and so what we do is target techniques to basically train people to resist drugs. A classic example of that is in D.A.RE and other programs. It is very easy to train these individuals but it is very hard to maintain the effects of the non-drug use.

Now I would be remiss if not examining one other groups sets of interventions and these are shown in slide twenty-three. These are called comprehensive prevention programs and are very large scale. So for example, you might have a community-based prevention program which encompasses a variety of different agencies and community groups. Or, you might have a school-based drug prevention program which might include drug testing, counseling, discussions of drug use, etc. And you also have a wide variety of family-based prevention programs that often times people use.

Now there is some various variables that decrease drug use and I have listed a few of these here on slide twenty-four. The main one is family involvement. The more times youth is involved in their family, the more bonding occurs, the less drug use there is. After school activities are also very important and the more likelihood there are school activities the less likelihood that kids are using drugs. The same way with church involvement. If a child is involved in their church they tend to not use drugs as much.

The big thing though, and as we see in slide twenty-five, is that parents sometimes have all sorts of ideas about what they think is cool for their kids and as we see here is that what is cool for parents is not necessarily cool for the kids. And, what is cool for the kids is not necessarily cool for the parents. All you have to do is look at clothing styles, music, etc. However, parents do provide several things. They provide stability and boundaries for their children. If you have no boundaries within the family unit you have anarchy and anything goes. It is also very hard when both parents are working and as a consequence you need to find other alternatives. So parents, if they are going to be out working, and both are in the workplace, they need to find alternatives for their children, in essence to reduce the risk of substance abuse.

So in conclusion as we see in slide twenty-six, there are lots of programs out there, however many of them have minimal success. There are lots of issues out there that are very, very important. CSAT, or the Centers for Substance Abuse Prevention, has also been promoting what we call "best practices." These are practices that are developed and tested in the communities and in the marketplace. They work! CSAT requires that states only use best practices approaches. And, the approaches that states are using must be evaluated. CSAT is also requiring that all state agencies getting federal funding have individuals that are certified prevention specialists on staff. This is then being promoted down from the state level to the community level. That is, if you want to get any federal pass through money in the future you are going to have to have certified prevention specialists on staff. That is not going to be an option, it is a requirement.

Well that concludes this section as kind of an overview of prevention. In our next section we are going to begin talking specifically about the Idaho Logic Model and then we will talk about some other aspects of prevention programs. Until then, we hope you have a great day and we will be looking forward to talking with you soon.

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