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Preventing and treating

drug use
Chapter 7
Models for prevention
0 The National Institute on Drug Abuse
recommends that prevention programs be
designed to enhance protective factors and
reversing or reducing known risk factors:
1 Protective factors (associated with reduced
potential for drug use)
2 Strong and positive bonds within a prosocial
family and institutions
3 Parental monitoring
4 Clear rules of conduct consistently enforced
5 Success in school
6 Adoption of conventional norms about drug
use

7 Risk factors (make the potential for drug use


more likely)
8 Chaotic home environments
9 Ineffective parenting
10 Inappropriately shy or aggressive behavior;
poor coping skills
11 Failure in school performance
12 Perceptions of approval of drug-using
behaviors

INFORMATIONAL MODEL
13The standard educational approach has
been to present factual information about
the dangers of substance abuse.
It was assumed that increased knowledge
14

would serve as an effective deterrent by


enabling students to make rational
decisions not to use drugs.
15Although intended to frighten students
away from dangerous substances, these
lectures often contain so much
misinformation or exaggeration that they
raise students’ skepticism and jeopardize
all drug education efforts.
THINKING POINT
D.A.R.E. and Scared Straight programs
16

have been used in the U.S. for roughly 30


years.
The intention is to frighten youth into not
17

using drugs. Many high schools have


D.A.R.E. officers.
18This program has continually been shown
by research to be ineffective and in some
cases counterproductive, with some
students who graduate from D.A.R.E.
actually being more likely to drink or do
drugs than students who don’t participate.

19 Why is this program still popular when it


has been proven to be ineffective?
20 Is it really possible to “scare” someone
out of doing something they want to do?

AFFECTIVE MODEL
21A broad approach to drug abuse prevention
involves affective or humanistic education.
These affective efforts are designed to
22
enhance self-esteem, to encourage responsible
decision making, and to enrich students’
personal and social development.
23The bases of this approach are assumptions
that:
24 Substance abuse programs should aim at
developing prevention-oriented decision
making concerning the use of licit or illicit
drugs.
25 Such decisions should result in fewer
negative consequences for the individuals.
26 The most effective way of achieving these
goals is by increasing self-esteem,
interpersonal skills, and participation in
alternatives to substance use.

RECONNECTING YOUTH
27 Reconnecting Youth is a peer
group approach to building life
skills for high school students
who are at risk for dropping out.
28 Four life skills training units:
29 Self-esteem enhancement
30 Decision making
31 Personal control
32 Interpersonal communication

SOCIAL INFLUENCE/
LEARNING MODELS
33The social influence approach attempts
to “inoculate” students against using
dangerous substances,
34 By making the students aware of the
social pressures they are likely to
encounter and teaching skills that
promote refusal.
35The social learning approach views
chemical abuse from the perspective of
learning theory; that is, like other behavior,
it is learned through modeling and
reinforcement.
36 Through instruction, demonstration,
feedback, reinforcement and behavioral
rehearsal the youngster is taught life-
coping skills that have a rather broad
range of applications, including drug
resistance.

PREVENTION RESEARCH
Research into the effectiveness
37

of prevention programs has


revealed mixed or inconclusive
results.
38Research has found that while it
is relatively easy to increase
knowledge and change attitudes,
it is more difficult to bring about
long-term sustained behavior
change.
TECHNICAL PROBLEMS
AND CRITICISMS
39Difficulty in producing and
implementing effective drug abuse
prevention programs could be related
to some of the technical aspects of
these programs.
School drug education staff are often
40

more enthusiastic about their


programs’ effectiveness than the
empirical data warrant.
41Researchers have cautioned that
“when socially deviant youths are
required to participate in the school
setting in peer-led denunciation of
activities they value, they are more
likely to become alienated than
converted” (Baumrind, 1987: 32).

DRUG TESTING
Drug testing first appeared in the
42

1960s as a part of methadone


maintenance programs.
43With the passage of the Drug Free
Workplace Act (1998) and Omnibus
Transportation Employee Testing Act
(1991), drug testing also became a
standard feature in the workplace as a
way to measure worker productivity and
to ensure public safety.
44Drug testing of prospective employees
has become almost routine at many
large corporations:
45 About 61 percent of major U.S.
companies administer pre-employment
drug tests.

DRUG TESTING PROCESS


Drug testing has spawned a
46

growth industry; various methods


are used:
47 Urinalysis is the most common;
complaints of false positives.
48 Gas chromatography/mass
spectroscopy (GC-MS) is the most
accurate test (95-99% accurate), but
also the most expensive; about $100
per specimen.
49 At best, drug testing can
determine that the subject has used
a drug recently; it cannot determine
when or how much.

DRUG TESTING CASE


LAW
50 Foran intrusive act such as mandatory drug testing to
be constitutional, there must be a “compelling interest”.
51 In 1989 the Supreme Court upheld the testing of
railroad employees for drugs after an accident and ruled
that personnel of the U.S. Customs Service in sensitive
positions must submit to drug testing even in the
absence of “individualized suspicion” (Skinner v.
Railway Labor Executives’ Association, 109 S.Ct. 1402).
52 In an Oregon case the U.S. Supreme Court (6–3)
approved of the random urinalysis of public school
athletes as a condition of their continued participation
in sports (Vernonia School District v. Acton, 515 U.S.
646 [1995]).
53 In 2002 the Supreme Court, in a 5–4 decision (Board
of Education v. Earls, 536 U.S. 822), extended Vernonia
by upholding an Oklahoma school district’s policy of
requiring students engaged in virtually all extracurricular
school activities to submit to random drug testing.

THINKING POINT
54 You have just been hired for a new job
working at a fast food restaurant. Your
employer tells you that you must submit to
a drug test before you can begin work. Your
responsibilities at work will consist of filling
orders for sodas and ice cream.
55 Should fast food workers be tested for
drugs?
56You have just been hired as a new
professor in your college’s Criminal Justice
Department. You will be teaching a class
on Drug Use and Abuse. You ask your
department chair if you will be subjected to
a drug test prior to teaching. She says no.
57 Should professors be tested for drugs?

TREATMENT
There are probably as many
58

approaches to treating and preventing


drug abuse as there are theories
explaining the phenomenon.
59Unfortunately, drug abuse is unlike
diseases whose etiology, and therefore
treatment and prevention, appears to
be clearly physiological.
Like the quest for an explanation of
60

drug abuse, the search for a cure,


particularly a “magic bullet” in the form
of a chemical cure, has a history that
cautions us to be skeptical.

THE CURE INDUSTRY


Whatever the treatment
61

approach of contemporary
programs, there are three
standard components:
62 Screening identifies individuals
with hazardous or harmful drug use,
or drug dependence, as well as
associated risk behaviors.
63 Assessment and Diagnosis
frequently uses references common
to the mental health field.
64 The Treatment Plan is developed
with the client and establishes goals
based on identified needs and sets
interventions to meet those goals.

MEDICATION-ASSISTED
TREATMENT
65 A
variety of treatment approaches use
chemicals, often as a supplement to or in
conjunction with some other form of clinical or
behavioral therapy.
66 Opiod antagonists-
67 Substances that block or counteract the effects
of opiates.
68 A dose as small as 0.25 mg of Naloxone will
block the effects of heroin for ten house, but does
not reduce the “drug hunger” of addicts.
69 Chemicals for detoxification-
70 The use of chemicals to facilitate drug
withdrawal can serve to attract drug abusers into
treatment and increases the probability that they will
complete detoxification.
71 Opiod agonists-
72 Certain synthetic substances have a chemical
makeup similar to that of opioids.
73 The most widely used agonist, methadone, a
wholly synthetic narcotic, was developed in Germany.

METHADONE
Possible Effects
74 Euphoria
75 Drowsiness
76 Respiratory depression
77 Constricted pupils
78 Nausea
Effects of Overdose
79 Slow breathing
80 Shallow breathing
81 Clammy skin
82 Convulsions
83 Convulsions
84 Possible death

METHADONE
85 Tolerance and withdrawal
86 Physical and psychological
dependence is high
87 Most common symptoms of
withdrawal- watery eyes, runny
nose, loss of appetite, tremors,
panic, cramps, nausea, chills and
sweating
88 Medical uses
89 Analgesic
90 Treatment of dependence
91 Dangers
92 Addiction
93 Death via overdose

CHEMICAL RESPONSES
TO COCAINE ABUSE
Cocaine agonists and
94

antagonists that typically affect


these neurotransmitters have
been tested as possible treatment
agents.
But no drug has emerged that
95

effectively treats the cocaine-


dependent patient.
THERAPY
Treatment based on
96

psychological theories can be


broadly divided into those that
are:
97 psychoanalytically oriented –
sometimes referred to as dynamic
or clinical
98 and those that utilize some
form of behaviorism.

BEHAVIOR MODIFICATION
Behavior modification is a treatment
99

approach based on learning theory.


100 The strength of psychoactive
substances as positive reinforcers and
the negative reinforcement associated
with abstinence provide conditioned
responses.
101 Aversion Treatment: shaping
behavior by applying punishment or aversive
stimulation
102 Cognitive Behavior Therapy: strives
to have drug abusers understand their
cravings and develop coping skills
103 Motivational Interviewing:
addresses a specific problem when a person
may need to make a behavior or lifestyle
change and is reluctant or ambivalent about
doing so

DRUG COURTS
104 Established as a result of court
and prison overcrowding, special drug
courts have proven popular.
105 In 1989, a special drug court was
established by judicial order in Miami,
Florida.
106 This high-volume court expanded
on traditional drug defendant diversion
programs by offering a year or more of
court-run treatment.
107 Defendants who complete this
option have their criminal cases
dismissed.

THERAPEUTIC
COMMUNITIES
108 A generic term for residential,
self-help, drug-free treatment
programs that have some
common characteristics.
109 The primary aims of the
therapeutic community are:
110 a global change in lifestyle
reflecting abstinence from illicit
substances
111 elimination of antisocial
activity
112 increased employability
113 prosocial attitudes and value

CHEMICAL DEPENDENCY
(CD) PROGRAMS
114 Short-term residential programs,
often referred to as chemical
dependency units, are often based on
the Minnesota Model of treatment for
alcoholism.
115 These programs involve
116 a three- to six-week inpatient
treatment phase,
117 followed by extended outpatient
therapy or participation in twelve-step
self-help groups such as Narcotics
Anonymous or Cocaine Anonymous.
118 Many CD programs are located in
a health care facility, which can
increase the cost of treatment.

ALCOHOLICS
ANONYMOUS (AA)
119 The Alcoholics Anonymous (AA)
approach of using public confession and
commitment and mutual aid concepts can
be found in a number of nineteenth century
temperance organizations.
120 Established in the 1930s, became
known as “Alcoholics Anonymous” after the
title of founder William Wilson’s book
about curing alcoholism through religion
and openness.
121 The AA program requires an act of
surrender—an acknowledgment of being an
alcoholic and of the destructiveness that
results—a bearing of witness, and an
acknowledgement of a higher power.

NARCOTICS ANONYMOUS
(NA)
122 Created in 1940s as an outlet
from AA because AA was opposed to
allowing heroin addicts join.
123 There are more than 20,000
registered NA groups holding over
30,000 weekly meetings in more than
100 countries.
124 NA membership is open to all drug
addicts, regardless of the particular
drug or combination of drugs used.
125 As in AA, there are no dues or fees
for membership, although most
members contribute in meetings to
help cover expenses.