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Evidence and Practice in Drug Prevention

Evidence and Practice in Drug Prevention. Charli Eriksson Professor in Public Health, Director National Center for Child Health Promotion, Örebro University. www.ncff.nu. Aims of this presentaion. To clarify some key concepts

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Evidence and Practice in Drug Prevention

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  1. Evidence and Practice in Drug Prevention Charli Eriksson Professor in Public Health, Director National Center for Child Health Promotion, Örebro University www.ncff.nu

  2. Aims of this presentaion • To clarify some key concepts • Practice, Knowledge, Evidence, Evidence-based Practice, Evidence-informed Policy • To outline possible development of an scientific or evidence advisory committee within ECAD

  3. Ambition • From belief • to knowing

  4. Knowledge for prevention Good intentions is not enough • Evidence-based interventions is needed • Knowledge from controlled trials under optimal conditions ….. • Knowledge is possible from different kinds of practice-based evaluations …. • Reflection over practical experiences

  5. Key Concepts:Practice Drug prevention, control and treatment Addiction Addiction

  6. Actions to reduce drug-related harm • Infrastructures, services • Legal system, administration, organizations, networks • Groups, communities, population • Individuals • Developing services • Advocacy, Networking Organizing • Social mobilization • Development of individual skills

  7. Mechanisms of harm • Toxic and other biochemical effects of drugs • Psychoactive actions resulting in intoxication • Dependence

  8. Psychoactive Dose Pattern/volume of Dose Mode of Administration Context of use Toxic effect Intoxication Dependence Social reaction to use Effects on fetus Overdose Injury Infectious disease Chronic illness Role failure Criminal punishment stigma How toxic effects, intoxication, and dependence are relate to drug dose, use patterns, and mode of administration, and in turn mediate the consequences of drug use for drug user (Babor et al 2010)

  9. Alcohol is not an ordinarycommodity

  10. Risk and Protective Factors Domain Individual Family Peer School Community Risk Factors Early Aggressive behavior Lack of Parental Supervision Substance Abuse Drug Availability Poverty Protective Factors Impulse Control Parental Monitoring Academic Competence Antidrug Use Policies Strong Neighborhood Attachment

  11. What makes the psychoactive substances so symbolically powerful? • Valued physical goods • A social behavior with strong symbolic value • Power to change behavior, mood, motor coordination, and judgment • Potentially causing addiction, dependence

  12. Why people use drugs • The powerful ability to act on brain mechanisms that affect motivation, thinking, mood, and perhaps most importantly, the experience of pleasure • Reinforcement • Genetic predisposition and broader familial influences • Availability

  13. To develop knowledge about alcohol and drug prevention Successfactors Barriers

  14. What is driving the development? • Traditions? • Values? • Needs? • Knowledge? • Money? • …..

  15. What governs the preventive policies? Ideologic inspiration Evidence from experience from research Old Policy New policy Common sense Changing situation

  16. Knowledge Needs • Distribution in the Population • Causal web – Determinants and Mechanisms • Consequences for individual and society • Interventions – methods for change • Policy and Implementation

  17. Knowledge • Plato established the main criteria for • True and secure knowledge = episteme • Opinion and beliefs = doxa • Aristotle added two forms of practical knowledge • Techne = primarily linked to handcraft and creative activity • Phronesis = ethical and political life

  18. Challenges • To do right things = Making priorities • To do things right • = Having competence

  19. Knowledge • Theoretical-scientificknowledge • = to know • Practical-productiveknowledge • = to be able • Knowledge as practical wisedom = to be wise Making PRIORITIES Having COMPETENCE

  20. The Principles • What helps? • What hurts? • Based on what evidence?

  21. The Evidence Concept • It the amount of evidence enough for drawing conclusions in either direction? • The roles for evidence, which are used in science, are systematic collection of data in an attempt to reduce bias that is inherent in more anecdotic evidence

  22. Grading of Evidence • Systematic review of the literature including quality assessment of research studies • Hierarchies of evidence

  23. Development of the Concept of Evidence • The restricted interpretation – randomized studies • Decision-making based on the best available evidence • Practical experience – Best practice • Acceptable and demanded actions in the target group

  24. Evidence-based Practice • Emerged in the early 1990’s from the field of medicine • Requires the integration of the best research evidence with our clinical expertise and our patients’ unique values and circumstance

  25. Evidence-based Practice Situation and Cirumstances Professional Expertise Target Group Preferences and Actions Best Evidence (Haynes et al, 2002)

  26. Steps in an Evidence-based Practice • Converting information needs related to practice decisions into well-structured questions. • Tracking down, with maximum efficiency, best evidence with which to answer them • Critically appraising that evidence for its validity, impact (size of effect) and applicability (usefulness in practice) • Integrate the appraisal of evidence, clinical experience and client values and preferences into practice and policy decision • Evaluate

  27. For a global, evidence-informed policy • International scope of problem • Need for comprehensive knowledge • Focus on evidence • A public good perspective

  28. Evidence-informed • Leaves ample room for many other forces to affect public policy • Democratic processes (voting), religious values, cultural norms, and social traditions can and should affect how societies respond to harmful drug use.

  29. Challenged by the complexity of our dynamic reality

  30. ECAD and Evidence • In line with the aims of ECAD • Promoting making priorities and strengthening competences for comprehensive initiatives against drug in European cities • Organizing a scientific advisory committee or a committee for evidence for ECAD

  31. Do Plan Evaluate Research integrated Evidence-process Judge Collect Review DEVELOP KNOWLEDGE SHARE KNOW- LEDGE USE KNOW- LEDGE Implement Publish REFLECTION

  32. Bridging the Research-Practice-Policy Gaps • We need: • Knowledge about effective methods and tools • Time and skilled personnel • Leadership and administrative support • Shared language concerning concepts and tools

  33. Long-term drug prevention and control is possible Thank you for your attention

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