Prevention of Substance Abuse

Prevention measures are aimed at changing attitudes and behaviour towards substance abuse and are more effective when targeted at particularly at risk groups:

• 16-24 year olds
• Unemployed
• Truants
• Excluded students
• Prostitutes
• Homeless

At risk individuals can be identified by GPs who may deal with members of families in which there is heavy drinking and be able to provide preventative advice. Psychiatrists may also meet patients with APD who are at a greater risk of alcohol abuse.

This aims to match a substance abuse prevention strategy to specific groups of people depending on their experience of drug problems, as a 'one size fits all' approach would be ineffective for a large number of people. There are 3 levels, each with a specific aim:

• Primary --> To prevent the start of drug use. Under 11s to teenagers
• Secondary --> To prevent or reduce experimentation among 'at risk' groups e.g. teenagers
• Tertiary --> To reduce or stop drug use amongst existing users e.g. heavy drinkers, smokers

• Presentations about the cosequences of substance abuse
• Aim to schock and upset an audience in the hope that they will change both their attitude and behaviour in the the future
• Create a cognitive dissonance when as individual holds conflicting beliefs about something they are involved in e.g. "smoking helps me to cope but it will give me lung cancer

Reserach known as the Yale studies and carried out by Janis and Hovland, identified three main factors that need to be taken into consideration when using fear appeals:

• Source factors- Expertise, trustworthiness and status of the source of the communication all effect the success of the appeal
• Message factors- The type of appeal, conclusion made and type of arguments used are all aspects to be considered with the most important being that the message is comprehensible and gives a clear and direct message
• Audience factors- Consideration must be made over how persuadable the audience is as well as their intelligence, self-esteem, and initial views. For example, people with high self-esttem are likely to be influenced by a fear appeal for a long time after the appeal itself

• Aim- To find out the effect on interest, attitudes and behaviour of different levels of fear arousal concerning the consequences of poor dental hygiene
• Method- Participants were given a questionnaire on dental hygiene and then split into four groups, one beaing a control and the other three receiving lectures of varying fear factor. A questionnaire was then filled in immediately after and one week later
• Results- High fear group showed the most anxiety immediately after but the low fear group showed the most change one week later
• Conclusion- Some fear arousal is helpful but high fear is ineffective
• Evaluation- Some people are more sensitive to fear due to differing levels of self esteem and anxiety. Hovland et al (1953) pointed out that the complexity of the message and whether it is one or two sided should be matched to the audience. The main criticism is that the study looks at dental hygiene as opposed to substance abuse

Studied two groups of smokers:

• Group 1- given medical information on a type of lung cancer that could be avoided by stopping smoking
• Group 2 (high fear group)- given same informaton and also received details of how life threatening the cancer was
• Results- Group 2 were found to more frightened but more likely to reject the information and less likely to stop smoking

• Fear arousal appeals rarely take into account the reasons for beginning the substance abuse in the first place
• They are often not targeted at specific groups e.g. cigarette packets, and should instead be aimed at high risk groups
• They may not be effective because the message may be too threatening for some people and mean they 'switch off' because it makes them too anxious. For this reason, low fear appeals may be more effective
• It has been argued fear-arousal appeals are most effective in preventing substance abuse in the first place, as people who haven't yet started don't need to switch themselves off from the message, as it doesn't yet apply to them (anothe rexample of the importance of targeting at risk groups with the right message)
• The unexpected results obtained from the studies such as Janis and Feshbach have led to the inverted U theory- Yerkes Dodson Law. This proposes that the relationship between arousal (fear) and behaviour change can be demonstrated in a U-shaped curve on a graph

• Not all studies have supported the inverted U theory, instead efficacy has been identified as a factor in the effectiveness of fear arousal appeals--> efficacy refers to the extent to which people feel that they can deal with a threat to their health, this depends on whether they think that the preventative action will work and whether they think they are capable of doing it

Extended parallel process model (Witte 1992)

• Includes both high fear and self-efficacy
• It recognises that a simple picture produces high fear but no change in attitude towards smoking, instead it combines this with a message that quitting will lead to improved health (for self and others) and advice and guidance on how to quite, high efficacy occurs, resulting in the individual being much more likely to stop the substance abuse
• E.g. Hospital and GP flyers, the back of buses, bill boards, cigarettes packets, magazines and newspapers

• A way of making people resistant to persuasion, changing their attitudes and behaviour
• Aims to 'immunise' people from social pressures, advertising and other pressures that may influence them to abuse substances (reflects the social influence explanation for substance abuse)

Four factors have been identified as important for social inoculation to be effective:

• Knowledge- the programme should convey knowledge and facts about the negative effects for health, social, economic and other consequences of substance abuse
• Discussion- the programme should allow for discussion about how a person's substance abuse may be affected by peers, family and media
• Skill development- people should be helped to develop communication skills, arguments and social skills to resist the influence of others--> Role play
• Public commitment- people make a public commitment that they won't take or abuse certain substance

McAlister et al

• Used social innoculation training to help teenagers resist peer pressure to smoke and were then followed up a number of years later
• Found that those who has received the training were significantly less likely to smoke compared to teenagers who hadn't received the training. It is more effective when they are taught to deal with peer pressure/ criticism for not taking a substance

Cuijpers (2002)

• Aim- To evaluate the short/long term effectiveness of the healthy school and drugs project in Dutch school in reducing problem drug use
• Method- Compared students that from 9 schools that used the programme to students from 3 schools who didn't using a survey before and 2 and 3 years after
• Results- Programme led to an increase in knowledge of substance and some reduction their use, reduction less obvious 2 years later but still significant for alcohol. The programme had little effect on attitudes or sense of efficacy
• Conclusion- The programme led to a reduction in drug use, particularly short term
• Evaluation- Later studies suggest little impact from the programme and little effect on later dependence. It is more effective to use the identified 4 factors

• The two studies suggest that social innoculation can be effective in reducing substance use in young people
• There has been little research investigating the effectiveness of social innoculation with older people or those bordering on becoming substance abusers e.g. a heavy drinker on the verge of becoming an alcoholic
• Evidence that links social influence to drug use are correllations not cause and effect
• The Cuijper study suggests the effect of social innoculation wears off one or two years after the programmes ans so refresher sessions are needed to maintain its effectiveness
• For social innoculation to work, the charcteristics of the person inocualting the others are important e.g. status, expertise, trustworthiness ect.

Refers to a system for helping people to lead a healthier life and develop attitudes and behaviours that will result in good health.

According to Sarafino there are 3 main factors to health promotion:

1. Individual Factors

• This includes habits, behaviours, attitudes and beliefs held by the individual
• Addictive behaviours are resistant to change and so incentives must be used for change e.g. the knowledge that abstinence will leave to a healthier lifestyle
• Contingency contracts, Motivational interviews

2. Interpersonal factors

• This is the social factors that involved in explaining the cause of substance abuse e.g. friends and family who are suggested to act as role models to the abuser
• May involve changing their social life
• Motivational interviews are used to explore motives and changes that need to be made
• AA, Social inoculation, CBT

3. Community Factors

• Health promotion and education which takes place within a person's own community is thought to be more effective than national campaigns
• Communities may have specific values and behaviours that the campaign can focus on
• The campaign may take place in schools, the workplace or in the community

Moher et al (2005)- Reviewed the effectiveness of work-based attempts to stop smoking (out of date)

Results:

• Group therapy, councelling and nicotine replacement therapy increased the number of people stopping smoking, compared to controls
• Self-help materials had little effect
• Whole workforce programmes did not reduce smoking, although competition and incentive-based schemes did increase attempts to stop
• Bans decreased smoking during the day but had little effect on total consumption

Conclusion: Workforce programmes are most effective when focused on the individual

Strengths

• 2006 survey on 11-15 yr olds said that 60% could remember having lessons on substance abuse and learnt important information as well as feeling more able to refuse drugs as a result
• Many students said that they had overestimated how many of their friends smoke and drink, supporting the theory on perceived norms
• Over 60% of schools reported that the students themselves had helped with the development of its drug's policy, meaning they were involved
• The use of teenage peer mentors has been successful as they can offer credible, positive role models to young people who are finding it difficult to resist peer pressure

Limitations

• A 1991 Scottish study reported that whilst their students had improved knowledge of drugs as a result of lessons, there was no change in student's attitudes or behaviour