Drug Education Prevention - Early Intervention Treatment The Differences Explained

What is drug education? Drug education involves teaching people about legal and illegal drugs. It is concerned with providing information, exploring issues, and helping people to develop their confidence and ability to make healthy lifestyle choices. The three overarching aims of drug education are to: 1. ". #. increase knowledge and understanding of the benefits, risks and conse uences of using drugs! explore attitudes towards drugs and drug users! and develop personal and social skills to enable people to communicate effectively, recognise choices, make healthy decisions, and access help and support when needed.

Drug education should cover all drugs. Drug education usually begins in the early years of school, where children learn about the safe and appropriate use of medication. $s they progress, young people learn about the other drugs they will most commonly encounter such as tobacco, caffeine, alcohol, cannabis, and party drugs in ways that are developmentally appropriate. Drug education should always take into account young people%s views, so that it is both appropriate to their age and ability, and relevant to their particular circumstances. &esearch has shown that certain models of drug education can achieve modest reductions in the use of cannabis, alcohol and tobacco among young people! and delay the onset of their use. Drug education also has a role in reducing the risks associated with drug use, reducing the amount of drugs used, and helping people to stop. The best available world'wide programmes as one that:

research

identifies

effective

drug

education

address knowledge, skills and attitudes! provide developmentally appropriate and culturally sensitive information! challenge misconceptions that young people hold about drug use! use interactive education techni ues such as discussion, small group activities and role play! and involve parents(carers as part of a wider community approach.

What is drug prevention? Drug prevention refers to services and programs designed to prevent the harmful drug use. )urrent prevention initiatives support abstinence from drug use, but also acknowledge that some people choose to use drugs, and so aim to minimise the risks and harms associated with drug use.

*ometimes, a three'tiered definition of prevention is used:

primary prevention+the prevention of uptake of drugs secondary prevention+the prevention of problematic use and the escalation of use tertiary prevention+reduction of use and of harm among users.

)onsidered by many to be the ,true% form of prevention, primary prevention focuses on interventions to reduce the likelihood of non'users starting to use substances of any sort. )ontemporary drug prevention is informed by an understanding of risk factors that operate at the personal, interpersonal and social levels. &isk factors that propel young people toward drug abuse include being alienated from, or unattached to, school, living in neglectful, dysfunctional or abusive family situations, having friends who use drugs, having easy access to drugs, initiating drug use early and lacking a positive sense of themselves and the future. )onse uently, prevention programs aim to reduce the impact of those factors and enhance protective factors such as attending school, achieving success, developing and maintaining supportive relationships and providing early assistance to those facing problems. &egardless of the approach, all prevention strategies aim to: 1. ". #. -. .. minimise the number of people using drugs! reduce drug supply and demand! delay the onset of first time drug use! reduce the harm caused by drugs to self and society! and enable those who have concerns about drugs to seek help.

)ommunity and support services already play a significant role in prevention, by helping communities to build on protective factors against harmful drug use. /ffective drug prevention revolves around education and positive alternatives. 0irst and foremost, the idea is to keep people away from drugs by providing the information and support they need to make healthy lifestyle choices. It is also important to give people 1especially young people2 somewhere to go and something better to do than use drugs. Diversionary activity 1such as music mixing, computer courses, after'school programmes2 is becoming an increasingly popular drug prevention strategy. What is early intervention? /arly intervention is about prevention, rather than a cure. It involves using past experiences to identify potential problems before they arise! dealing with undesirable habits and life'styles before they become problematic! and addressing substance misuse before it becomes dangerous. *ubstance misuse agencies will therefore be able to identify the needs of young people at an earlier point than would previously have been the case! facilitate improved access to the range of substance misuse services available! and improve access to other services.

The "33" 4odel of )are framework, which outlines the range of services that should be available to every D$$T, emphasises the need for drug treatment agencies to coordinate their services and work closely with other general health, social care, criminal 5ustice, housing education and employment agencies. 0urthermore, the 6ome 7ffice, the Department for /ducation and *kills, and the Department for 6ealth are expected to adopt a collective, cross'governmental approach to the issue of young people and drugs in line with Every Child Matters. In short, all agencies and organisations providing services for young people should be e uipped to identify substance misuse before it becomes acute in the knowledge that problematic drug use can often develop as a result of concurrent mental health, social, and(or economic problems. In practice this means that the range of possible approaches and tier 1 and " level interventions delivered by agencies must be young person'friendly and conceptually holistic, and informed by evidence'based practice, with the aim of reducing the use of )lass $ drugs! as well as the fre uent use of any drug by young people, especially the most vulnerable. Tier 1 services are aimed at all young people, and provide substance misuse education, information and referrals to support services. Tier " services are for ,vulnerable groups,% and provide drug related preventative and targeted education, advice, and appropriate support for those young people who have been identified as being at risk of developing problems around substance misuse. The terms of service provision this translates as: advice, guidance and support for young people and their families! advice, guidance and support targeted at vulnerable and at risk groups! the early identification of need! and tailored support to best meet the needs of the various clients, and client groups. There is an urgent need for targeted interventions aimed at those groups of young people deemed to be most at risked of developing problematic drug use. /arly intervention initiatives need to be part of mainstream service delivery or linked to other early intervention work with vulnerable and(or at risk young people 1detached and outreach work! 8ositive $ctivities for 9oung 8eople'8$98! 9outh Inclusion programmes2. What is drug treatment? Drug treatment for young people is very different from that of adults. *ubstance misuse in young people is often a result of complex dysfunction between the young person and the family, school and environment. )ognitive and behavioural approaches, family'based approaches, motivational enhancement and relapse prevention therapies have empirical support from the adult literature and much in common with cognitive behavioural therapies for young people with behavioural problems. 6owever, although the evidence indicates that treatment is effective, young substance misusers are heterogeneous and no single approach is universally effective. There have been only two descriptive outcome studies on adolescent substance misuse in the :;. 7ne has been on adolescent alcohol dependence, the other on young heroin'dependent people treated with methadone by an innovative community service 1Doyle et al, 1<<-! )rome et al, 1<<=, "3332. 4uch more work

has been carried out in the :nited *tates. 6owever, in the studies evaluated there were a range of methodological problems, such as little standardisation in assessment of substance use, misuse and dependence! self report as the ma5or source of information! and inconsistency in the information elicited regarding social, educational and familial background. There have been few well'controlled studies of specific treatments for adolescent substance misuse. )atalano et al 11<<32 reviewed "< treatment outcome studies. $lthough many of these studies had design flaws, the authors concluded that ,some treatment% was superior to ,no treatment%. They also concluded that there was little evidence to suggest that particular modalities were more effective and that conclusive controlled studies had not been undertaken. 0actors for success included staff characteristics, the availability of special services and family participation. >ength of treatment was related to reduced alcohol and drug misuse in residential treatment programmes. )haracteristics that predicted poor compliance were younger age of onset, serious alcohol misuse, use of multiple drugs and severity of behavioural disorder. 8redictors of relapse included cravings for alcohol, low involvement in work, and little involvement in hobbies and other leisure activities. Information based methods There is considerable evidence from health and social care fields that an information based approach has useful effects when the information is given in non'complex presentations 18owell et al, "3312. 8eer support and advice is a further low'cost intervention that has proven useful in similar situations 1*hah et al, "3312. rief! miminal or short-term interventions The advice given in brief or minimal interventions is non'5udgemental, personalised if possible, and supported by self'help materials. 0or example, a primary care worker may suggest that ,smoking is not good for your health%, or say, ,have you looked at your liver test results that indicate you are damaging your liver by continuing to drink alcohol.% The term may also refer to an long session of motivational interviewing, or six sessions of cognitive behavioural therapy. There is good evidence of the effectiveness, and cost'effectiveness, of these interventions with alcohol misusers in primary care settings, in accident and emergency departments and in educational settings 1>ongborough et al, "3312. This type of approach has also proven effective with cigarette smoking 1&ichmond ? $nderson, 1<<-2. /ven if success rates are relatively modest, if widely and consistently applied there could be gains to public health. Psychological modalities There is some evidence for the effectiveness of )@T, 1" step approaches and behavioural therapy. )ounselling is a widely used term in the adult literature. It is a form of intervention that can represent a wide range of theoretical models including psychodynamics as well as cognitive'behavioural and person centred approaches. The important ob5ectives include! problem solving, ac uisition of social skills, cognitive change, adaptive patterns of thought, behaviour change and systemic change A inclusive of family systems.

There are a variety of family therapies, but they have much in common and broadly similar goals. 0amily therapy approaches have received most attention in clinical research on treatment for adolescents with substance misuse. In a meta'analysis, *tanton ? *hadish 11<<B2 found support for the superiority of family therapy 1but no family education or support2 for adolescent substance use disorders over other modalities. Pharmacological agents *ome young people using substances have conditions that can be ameliorated by pharmacological means, occasionally as the main interventions but almost always as an ad5unct to psychosocial interventions 1D76 1<<<2. The pharmacological management of young substance misuses poses considerable difficulties. $part from nicotine replacement therapy and buprenorphine medications for detoxification, the use of pharmacological agents for substitution or relapse prevention have not been licensed for use, and are not recommended for use, in anyone under the age of 1= years old. There are very few empirical data concerning their use in this age group. The ma5ority of adolescents are not dependent and so do not generally re uire detoxification 1*tewart ? @rown, 1<<.2. Psychiatric disorders *ubstance'misusing young people referred to services often have a complex co' morbidity, conduct disorder, attention'deficit hyperactivity disorder and affective symptoms, as well as educational and psychosocial disadvantages. *ome will have behaviours suggestive of borderline personality disorder, and a very few will have early'onset psychosis, wheather schiCophrenic or bi'polar. $ssessments may confirm the presence of psychosocial impairment related to a perhaps previously unrecognised or untreated co'morbid disorder and clinicians should then consider the appropriateness of medication. It is imperative for agencies to be able to recognise when young people%s mental health might be deteriorating and refer to services that are able to meet those needs. )$46* services should be taking the lead on such cases where co'morbidity presents. "onclusion )ognitive behavioural therapies and family therapy adapted to young substance users are both looking like good ways of working with this client group. 6owever, much more research into the effectiveness of treatment for this client group is needs. 4oreover, whatever the treatment label, new friends, success at school or work, emotional support from families, self help and structured activities are important components. Treatment must take into account age, gender, disability, ethnicity, cultural background, and barriers to change at the outset of treatment, and therapist empathy influences outcome. 0amily involvement is key and programmes based mainly on adult models are not appropriate.