Drug abuse prevention and treatment

1. Drug abuse prevention and treatment 授課教師：賴滄海教授 1-8-2010

2. Learning Objectives • Major types of drug prevention program • Levels of prevention program • Alternatives to drug use • Principles that characterized effective drug treatment • Pharmacological strategies to treat addiction

3. Potential Factors that Influence Potential Factors that Influence Drug Use Individual influence Genetics, Personality traits, Attitudes and beliefs, peer resistance skills。 Interpersonal and societal influences Parents, Community, Peers, School policy, Local law enforcement, Personal situation

4. Potential Factors that Influence Drug Use • Environmental influences Federal laws, Minimum purchase age, Portrayal of alcohol, tobacco and drugs on TV and movies, Marketing of alcohol, Cost of alcohol and drugs

5. Primary Prevention Program (Risk reduction before abuse) Interpersonal factors Affective education (emotional literacy), Values clarification Resilience training Assertiveness training Refusal skill Drug information and education

6. Primary Prevention Program • Small group factors Peer mentoring, counseling Conflict resolution Demonstrate misconception of peer norm Alternatives to drug use recreational, cultural, athletic Strengthening families

7. Primary Prevention Program • Systems level Strengthening school-family link Strengthening school-community group links Strengthening community support system Media advocacy efforts Reducing alcohol marketing

8. Secondary Prevention Program Intervening in early abuse Identification of abuse subgroups and individual diagnosis Early intervention coupled with sanction Teacher-counselor-parent team approach Developing healthy alternative youth culture Recovering role model

9. Tertiary Prevention Program Intervening in advanced abuse • Assessment and diagnosis • Referral into treatment • Case management • Reentry

10. Common school-based drug prevention approaches • Cognitive Teach pharmacology of drugs How they are used Long-range consequences of use (usually through scare tactics)

11. Common school-based drug prevention approaches • Affective Raise self-esteem Teach value and life skill (typically do not include drug information)

12. Common school-based drug prevention approaches • Combined cognitive and affective Teach problem solving, decision making, peer pressure resistance skill Provide drug information to connect life skill and drug use and consequences

13. Common school-based drug prevention approaches • Social learning Teach how to identify pressure from peers, media, advertising families Teach resistance skills, counterargument Student role play and practice resisting

14. Common school-based drug prevention approaches • Normative education Correct misconceptions Demonstrate actual norms through discussion, develop nonuse norms

15. Family-based prevention program • Risks factors Chaotic home environment Ineffective parenting Lack of mutual attachment and nurturing

16. Family-based prevention program • Protective factors Strong parent-child bonds Clear rules of conduct Communication of values High level of supervision Parental warmth, affection and support

17. Family-based prevention program • Reach families of children at each stage • Train parents in behavior skills to reduce conduct problems in children Improve parent-child relation Consistent discipline and rule making Monitor children’s activities

18. Family-based prevention program • Drug information for parent and children • Enhance protective factors • Provide access to counseling services for families at risk

19. Principles of treatment • No single treatment is appropriate for all individuals • Treatment needs to be readily available • Attends to multiple needs of the individual

20. Principles of treatment • Must be assessed continually and modified as necessary • Remaining in treatment for an appropriate period is critical • Counseling and behavioral therapy are critical component

21. Principles of treatment • Medications are an important element of treatment • Addicted individual with coexisting mental disorder should have both treated • Treatment does not need to be voluntary • Medical detoxification is only the first step

22. Principles of treatment • Possible drug use during treatment must be monitored continuously • Should provide assessment for infectious disease • Recovery can be a long-term process

23. Drug prevention programs in USA • BACCHUS and GAMMA peer education network Boosting Alcohol Consciousness Concerning the Health of University Students Greeks Advocating Mature Management of Alcohol

24. Drug prevention programs in USA • FIPSE • Fund for the Improvement of Postsecondary Education Drug Prevention Program Peer-based effort Curriculum infusion Improvisational theater group Strategies to change misconception of use Alternative events Change marketing of alcohol near campus

25. Drug prevention programs in USA • DARE Drug Abuse Resistance Education Presented in the classroom by uniformed police officers • Drug Courts

26. Alternatives for a drug abuser • Physical Athletics, exercise, hiking Dance, yoga Carpentry, swimming Outdoor work

27. Alternatives for a drug abuser • Sensory Sensory awareness training Sky diving, scuba diving Experiencing beauty of nature

28. Alternatives for a drug abuser • Emotional Individual counseling Group therapy Instruction in psychology of personal development

29. Alternatives for a drug abuser • Interpersonal Group therapy Instruction in social custom Confidence training Volunteerism

30. Alternatives for a drug abuser • Social Activity in positive social change Helping the disadvantaged Tutoring handicapped individuals Ecology action

31. Alternatives for a drug abuser • Political Political service Lobbying for nonpartisan projects Field work with politician and public officials

32. Alternatives for a drug abuser • Intellectual Reading, debate and discussion Creative games and puzzle Self-hypnotics Training in concentration

33. Alternatives for a drug abuser • Creative-aesthetics Nongraded instruction in producing/or appreciation art, music, drama Creative hobbies

34. Alternatives for a drug abuser • Philosophical Discussions, seminar Courses on ethics The nature of reality Relevant philosophical literature Exploration of value systems

35. Alternatives for a drug abuser • Spiritual-mystical • Nonchemical methods of spiritual development • Study of world religions • Mysticism • Meditation, yogic techniques

36. Detoxification-Sedative/hypnotics *Substitution with longer-acting barbiturates for shorter acting CNS depressant – (abrupt withdrawal may cause life-threatening seizure) *Gradually reduce the longer-acting barbiturates *To treat Alcohol and barbiturate- need increased dose *To treat barbiturate and heroin- barbiturate first

37. Detoxification-Alcohol • Delirium tremens • Phenobarbital, Librium and Diazepam are commonly prescribed to prevent withdrawal symptoms • Treatment for malnutrition and Vit. Deficiency • Diasulfiram – blocks ethanol metabolism, resulting in headache, flushing and nausea • Acamprosate – maintaining abstinence of alcohol

38. Detoxification- tobacco • Nicotine transdermal patches • Nicotine gum • Nasal spray • inhalers

39. Detoxification-Heroin • Clonidine (Catapres) to relieve some withdrawal effects (vomiting, diarrhea) • Substitution with methadone, buprenorphine for heroin • Counseling to modify drug seeking behavior

40. Treatment- Amphetamines • Behavior intervention to modify thinking pattern, improve cognitive skill, change expectation, increase coping with life’s stress

41. Detoxification- Cocaine • Outpatient versus Inpatient • Benzodiazepines to relieve anxiety • Bromocriptine, levodopa to relieve craving • Desipramine and imipramine to relieve depression and craving • Counseling, support from family, friends and coworkers

42. Twelve steps by AA • We admitted we were powerless over alcohol-that our lives had become unmanageable • Came to believe that a Power greater than ourselves could restore us to sanity • Made a decision to turn our will and our lives to the care of God as we understood Him

43. Twelve steps by AA 4. Made a searching and fearless moral inventory of ourselves 5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs 6. Were entirely ready to have God remove all these defects of character

44. Twelve steps by AA • 7. Humbly asked Him to remove our • shortcomings • 8. Made a list of all persons we had harmed, • and became willing to make amend to • them all

45. Twelve steps by AA 9. Made direct amends to such people wherever possible, except when to do so would injure them or others 10. Continued to take personal inventory and when we were wrong promptly admitted it

46. Twelve steps by AA 11. Sought through prayer and meditation to improve our conscious contact with God as we understood Him, praying only for knowledge of His will for us and the power to carry that out 12. Having had a spiritual awakening as the result of these step, we tried to carry this message to alcoholics, and to practice these principles in all our affairs

47. Final report • Sent to ahai@mail.tcu.edu.tw • Date: before 24.00 January 21, 2010