PRIMARY DRUG ABUSE PREVENTION - Risk Factors and Protective Factors

by Brian T. Lynch, MSW

Every instance of drug use is also a transaction between the users and the suppliers, whether the supplier is a dealer, a friend trying to be helpful, or a parent that leaves prescription pills in easy reach. On the user side of the transaction, the decision to partake always meets some need or desire on the part of the user. How strong the need or desire to take a drug is a variable, and therefore potentially controllable. It is important to understand what needs are being met when a young person decides to partake in drugs or alcohol. The lists below are among some frequent motivators that lead to drug transactions and drug use. Each of these factors can be modulated by family or community interventions. Still, this is just one side of the transaction. 

On the other side of the equation is the availability and cost of the product being consumed and the economic pressures on the supply side of the equation. Just like any transaction, the lower the price or availability of the product, the more likely a transaction will occur. Factors affecting price and availability includes not just law enforcement interdiction but market factors in the legal and the illegal drug trade, the strength of a profit motive for individual dealers, the  pain management and prescribing practices of doctors, the economic pressures of small business owners selling cigarettes or alcohol to minors, the amount of peer pressure is applied to sell or give drugs to others, the vigilance of parents in keeping products in the home out of the reach of their children, etc.

Primary prevention includes all the things we can do as families and a society to forestall or eliminate an individual's preliminary exposure to addictive substances. It is the efforts undertaken to eliminate the various needs (or demands) that initiate drug transactions in the first place.

The following is a collection of ideas on the topic from various sources with the URL links to some of the material and my own thoughts provided in the bracketed text. My purpose is to initiate or support public dialogue about what can be done to fix our drug problems. Let me begin with some ideas as to why children try drugs in the first place.

Here are some of the reasons young people have given for taking drugs :

To fit in
[The need to belong and feel accepted and valued is a powerful and universal human need that is denied to children who are marginalized, bullied, or made to feel incompetent in their social environment. This leads youth to seek acceptance in alternative and sometimes more socially maladaptive peer groups where they are more at risk for substance abuse. Making sure our youth feel connected, engaged, and valued within their families and the community is a protective factor that reduces the risk of substance abuse. Anti-bullying efforts in schools, identifying and intervening children who are being marginalized by their peers, and teaching teachers how to be more effective managers in the social milieu of their classrooms are other steps that should be taken.]

To escape or relax
[The ever-growing competitive trends in education and youth sports programs have placed unprecedented pressure on today's youth beginning at an early age. This places youth at an ever-increasing risk of turning to drugs to relieve their stress. Little league sports programs once focused on the social developments that helped children learn how to work together and support each other as a team. Today, there is an increasing focus on developing star players' individual talents and on winning as the major objectives. We may need to rethink our whole approach to both academic achievements and youth sports programs. A protective factor in preventing substance abuse might be to find ways to reduce the stress we place on children in school and in organized sports.]

To relieve boredom

[Students whose parents work and who are not in some after-school programs come home to an empty house. Some researchers say that the most at-risk time for children to abuse substances is after school before parents come home from work. Younger children especially need guidance and leadership in structuring their recreational activities. Children also need appropriate socialization opportunities. Unstructured leisure time leads to increases in time spent on passive entertainment such as watching TV or playing video games or engaging in online activities such as chat rooms. These can lead to lethargy and depression as well as boredom. It places kids at greater risk of substance use to relieve boredom and depression. An alternative would be after-school efforts to help children identify and develop their interests and skills other than traditional sports activities.  We need a strengths-based approach to helping children develop skills in dance, acting, music, art, debate,, chess and other such alternative activities]

To seem grown-up [There are several aspects to this one. First, parents are primary role models for younger children. What parents do helps define what seems normal for adult behavior. If parents smoke, drink, and use drugs, this greatly increases the likelihood that their children we try these activities as part of their social development. Then there is the aspect of a child's exposure to the social behavior of older cohorts in the family, schools, or the community. To the extent that substance abuse becomes a community-wide problem, the younger cohorts will see the substance use by older youth as grown-up behavior. Then there is the impact of media depiction of drugs on television and in the movies. Parental monitoring and the exercise of discretion in what shows children which has an impact on a child's future behavior is an example of a protective strategy to lower the risk of future abuse.]  

To rebel [, I believe that most youth rebellion has its origins in family life. Dysfunctional families are often either overly slack or severe in their discipline. Other factors may include weak parent/child bonding, unreasonable expectations, parental hypocrisy, cultural clashes between immigrant parents and children raised in American culture, extreme economic or social stress, and the many factors that can lead to rebellious youth. Children who can't relate appropriately to family or social norms, can't respond positively to adult supervision and guidance, or reject cultural norms are at great risk for substance abuse. Every social policy and community-based support system that strengthens parents and families, prevents or ameliorates child abuse, and strengthens family functioning help to protect children from substance abuse as well.]

To experiment [For kicks! This is no small reason. Researchers have discovered that the human brain is not fully developed until people are in their early to mid-twenties. The last area of the brain to develop is the area responsible for evaluating risky behavior and modulating impulsive behavior. Yes, there is a reason why youth are impetuous. It is part of nature's plan that young adults should be risk-takers. It is suggested that this helps facilitate sexual exploration and the necessary social separation that must take place for people to become fully autonomous adults. Unfortunately, it also promotes many other risk-taking behaviors that never existed in our distant past. This now includes experimenting with dangerous substances that can produce physical addictions before people realize they are addicted. Recognizing this and providing youth with developmentally appropriate information about the risks associated with substance abuse is a protective factor. Enhancing risk awareness through public education increases the chances that youth will not engage in such risk-taking behaviors.]

http://www.drugfreeworld.org/drugfacts/drugs/why-do-people-take-drugs.html

Here is another, slightly more comprehensive list of reasons:

1. People suffering from anxiety, bipolar disorder, depression, or other mental illnesses use drugs and alcohol to ease their suffering.

[Early screening and identification of mental illness or psychological disorders in children is essential to help prevent substance abuse. They need both treatment for their condition, help in developing social coping skills among their peers and developing more tolerance and understanding of mental illness in the general population to reduce the stigma and added barriers that these children face.]

2. People see family members, friends, role models, or entertainers using drugs and rationalize that they can too. [What are your thoughts?]

3. People become bored and think drugs will help.  [What are your thoughts?]

4. People think drugs will help relieve stress. [What are your thoughts?]

5. People figure if a drug is prescribed by a doctor, it must be ok.

[Here is where doctors and the whole medical profession need to rethink their pharmaceuticals approach in general and pain management and mental illness treatment specifically. First, pharmacies need to keep better records regionally integrated with other pharmacies to identify suspicious patterns of certain classes of prescription drug sales. Second, doctors and medical staff need better training in identifying not just the symptoms of drug addiction in patients but in identifying patients who may be at risk before prescribing potentially addictive drugs.]

6. People get physically injured and unintentionally get hooked on prescribed drugs. 

7. People use drugs to cover painful memories of their past. [What are your thoughts?]

8. People think drugs will help them fit in.

9. People chase the high they once experienced.

http://ezinearticles.com/?9-Reasons-Why-People-Abuse-Drugs-and-Alcohol&id=6276647

[Let's not forget that addictive urges from prior use of addictive substances are another major factor here. Researchers have discovered that tobacco is so addictive that smoking just one cigarette for the first time can produce neurochemical changes that trigger an urge for nicotine up to six months later. This points up a curious aspect of addiction that is often overlooked. Urges and desires have very different neurochemical origins in the brain, and urges are far more powerful controllers over our behavior. But urges and desires are virtually indistinguishable from each other when we simply choose to fulfill them, as we do in the early stages of addiction. It isn't until we choose to resist the behavior to fulfill what we believe to be a desire that we discover the full power that neurochemical urges have over our behavior.]

The following are selected excerpts from the Office of National Drug Control Policy - Preventing Drug Abuse

Prevention is most promising when it is directed at impressionable youngsters. Adolescents are most susceptible to the allure of illicit drugs. Delaying or preventing the first use of illegal drugs, alcohol, and tobacco is essential. Evidence from controlled studies, national cross-site evaluations, and CSAP grantee evaluations demonstrate that prevention programs work. However, prevention programs are not vaccinations that inoculate children against substance abuse. Sadly, significant numbers of young people who participate in the best programs will use drugs. The "no-use" message must be reinforced consistently by parents, teachers, clergy, coaches, mentors, and other caregivers.

While all parents are critical influencers of children, parents of children aged eight to twelve are especially influential. Children in this age group normally condemn drug use. Such attitudes and attendant behavior are easily reinforced by involved parents. Parents who wait to guide their children away from drugs until older ages when youngsters are more readily influenced by peers or may have started using alcohol, tobacco, and other drugs, decrease their ability to positively influence children.

[This suggests that a comprehensive community drug abuse prevention program should include parent education and guidance component for parents who have children between the ages of seven and eight years old. The idea would be to provide parents with the knowledge and guidance they need to strengthen their child's ability to refrain from the initial use of harmful substances such as tobacco, alcohol, prescription or illegal drugs.]

Children whose parents abuse alcohol or other drugs face heightened risks of developing substance abuse problems themselves. [Perhaps school-based prevention programs should be routinely sending substance abuse educational materials and community treatment resource information home to the parents.]

There is significant evidence that carefully planned mass media campaigns can reduce substance abuse by countering false perceptions that drug use is normative. For all their power to inform and persuade, the media alone are unlikely to bring about large, sustained changes in drug use. https://www.ncjrs.gov/ondcppubs/publications/policy/99ndcs/iv-b.html

[Identifying specific individuals at risk for substance abuse and engaging them in a specific prevention effort is an effective component in a comprehensive community prevention plan. It requires the training and equipping of parents, teachers, physicians, coaches, and others who regularly contact young people in the community.]

[Some evidence] .. suggests that the most promising route to effective strategies for preventing adolescent alcohol and other drug problems is through a risk-focused approach. This approach requires identifying risk factors for drug abuse, identifying methods by which risk factors have been effectively addressed, and applying these methods to appropriate high-risk and general populations. http://psycnet.apa.org/journals/bul/112/1/64/

A general consensus in the literature on drug abuse prevention suggests certain school-based prevention programs can achieve at least modest reductions in adolescent drug use. http://www2.gsu.edu/~wwwche/drug%20curriculum.pdf

[School-based substance abuse prevention programs can be an effective component of an overall community strategy for the early prevention of substance abuse. Research has identified eleven factors that contribute to successful school-based programs. This information helps select a curriculum and evaluate school-based treatment programs.]

Conclusion

Once a drug addiction problem becomes an epidemic in the community, the pressure to act becomes overwhelming. The most immediate attention usually focuses on law enforcement interdiction of drugs and treatment for the addicted. These are expensive, complex, and time-consuming community actions that take time to ramp up and bear fruit. The pressure for law enforcement and treatment actions stretches local budgets and quickly overshadows our underfunded, underappreciated primary prevention efforts. Yet, primary prevention efforts are the most cost-efficient and effective methods to reduce our drug abuse problems. Arresting drug addicts doesn't reduce the availability or cost of the products. It is also ineffective if it doesn't involve treatment on demand for drug users. Treatment on demand requires more of a financial and social commitment than most communities can make. Interdicting drugs and arresting drug dealers can raise the cost and reduce the availability of drugs. Still, if addicts go untreated, this raises crime rates as they turn to criminal activity to pay for their habits. Unless there is a holistic, comprehensive, and community-wide approach to substance abuse prevention, where primary prevention efforts receive some priority, the problem of drugs will continue to be a plague on our culture.



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