INTRODUCTION TO THE STUDY
1.9 Definition of terms and key words
1.9.7 Prevention and Intervention
There are no one-size-fits–all solutions and prevention planners cannot expect to rely on a single “canned” prevention programme (Gilchrist, 1994; Wechlser et al. 2000). Many factors affect a prevention initiatives success. A program developed in one environment may not translate well to another (Gilchrist, 1994).
There is a need for research that not only investigates the prevalence of substance use and abuse but also looks at the intervention and programmes that are currently in place and those that should be in place (Gilchrist, 1994). During the last 30 years the amount of research and theory related to the prevention of alcohol and other drug use has increased considerably (Gilchrist, 1994). However, this increase in attention has not always been well focused or systematic (Gonzalez, 1994). Most alcohol and drug- related research has simply described current rates and patterns of use. A
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second category of research has focused on identifying precursors and predictors of adolescents‟ drinking and other drug use (Gilchrist, 1994).
For the most part, these studies have been fragmented and have not provided practitioners with consistent direction to design effective alcohol and other drug prevention programmes (Cummings, 1997). There has also been a lack of current preventative programmes and a lack of a theoretical perspective to help define and interpret relevant data (Cummings, 1997).
Relevant research is scarce and one-dimensional (Cummings, 1997) and thus the development of preventive interventions and programmes has proceeded somewhat separately from that of the descriptive research (Gilchrist, 1994).
Drug epidemiological research on tobacco, alcohol and other drugs has and should inform the field of substance use and abuse prevention.
Johnston (1997) outlines eight ways in which drug epidemiological research has and should influence substance use and abuse prevention:
epidemiological studies (E studies) provide continuous information on the types of drugs most widely used, their changing forms of administration, and some of the problems which are caused by their use, thereby serving an agenda-setting function,
E studies document the ages of initiation and cross-time changes in substance use and abuse helping to target preventions at appropriate age groups,
E studies help define the subgroups of the population that are at most at risk of developing drug use patterns and problems of different kinds,
ongoing E studies provide information on what would have happened in the relevant historical/development period in the absence of the intervention,
E studies provide evidence on current statistical and social norms in the peer group with regard to substance use, which can be used strategically in the design, content and implementation of the prevention programmes,
E studies can also be used to measure the extent of young people‟s exposure to and assessment of various prevention initiatives,
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E studies provide relevant national data and
Ongoing E studies provide information with which the combined effects of societal forces – intentional and non-intentional, programmatic and simply historical – may be assessed (Johnston, 1997).
Moore and Forster reported in 1993 that there was a widespread concern in our society about adolescent use and abuse of alcohol and other drugs.
In 2001, Lowe reported about there is an increasing concern re the health- relate behaviour of young people, especially in relation to binge drinking.
Today, adolescent drug and alcohol use is still a major concern, which is evident from the previous review of research in the area of young people and substance use (Marais et al., 2002: Peltzer & Phaswana, 1998; Peltzer et. Al., 2003; Pludemann et al., 1999; Rocha-Silva, 1998).
Prevention
Prevention is defined broadly as an intervention designed to change the environmental and social determinants of drug and alcohol use and abuse, including discouraging the initial use of a drug and preventing the progression to more frequent use among at-risk populations (United Nations International Drug Control Programme, 2000). Essentially prevention addresses the following main components:
creating awareness,
educating people about drugs and their harmful health and social effects
promoting anti-drug norms and pro-social and personal life skills to develop anti-drug attitudes
avoid engaging in drug use;
promoting supportive environments and healthier alternative,
more productive and fulfilling behaviours and
lifestyles that are free of drugs (United Nations International Drug Control Programme).
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Primary prevention seeks to reduce the evidence of problem occurrence among substance users i.e. to prevent the emergence of new problems or cases (Coyne et al. 1994; Fresh Tools for Effective School Health, no date.). Lowering the number of existing cases in a population (prevalence) represents secondary prevention, a compatible but different perspective from primary prevention (Coyne et al. 1994). To reduce the incidence of a designated problem in a targeted group, efforts are directed at lowering stressors and increasing supports so that dysfunction is lowered and eradicated in designated target group members (Coyne et al. 1994).
Primary prevention uses two main methods for intervention:
competency enhancement and wellness, which involves education, training and information giving in order to enhance the life-styles of people and
human systems change strategies and consultation in order to provide sufficient support.
For primary prevention goals to be reached, both competency enhancement and human system methods are necessary (Coyne et al., 1994).
The first step in creating prevention programmes and increasing school based interventions in the area of student substance abuse is to create a substance use policy. Students, whose schools lack clear alcohol and other drug policies, are more likely to experiment with substances (Gausted, 1993). While good policy alone cannot reduce alcohol and other drug use, it is the crucial and vital foundation for an effective effort against alcohol and other drug abuse (Gaustad, 1993). Policy‟s establish a long-range set of goals and creates an overall tone that will support specific actions (Gaustad, 1993).
The aims of any alcohol and drug prevention programme directed at young people should be realistic, with the main goal being the prevention or reduction of harms associated with alcohol and other drug use, as opposed to preventing use completely (Alcohol and Drug Prevention, 1999). Alcohol and drug prevention programmes should be
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comprehensive, including different components that complement each other, such as media campaigns, in centre programmes, and policy interventions (Alcohol and Drug Prevention, 1999). Alcohol and drug programmes should be continuously evaluated in an effort to determine what works and what does not work. Already known is that zero tolerance and other “hard line” approaches such as strict enforcement of regulations in an effort to maintain an alcohol and drug free environment do not work and may increase the risk of serious problems (Kuh, 1994). These programmes tend to end up punishing students who are experimenting, as most young people do, and discouraging those students who are experimenting who are at risk of developing problems from getting the help they need (Alcohol and Drug Prevention).
Because substance use is a necessary precondition to abuse and dependence, prevention efforts can and should be directed at initial use, containing use, or progression in use to block the later development of substance dependence and addiction (US Congress, 1994).
Designers of prevention programmes must concretely define the programme‟s mission and boundaries i.e. what the programme is and is not expected to accomplish (Gilchrist, 1994). All prevention programmes have a political aspect or rationale that sustains and supports them. To be successful preventative interventions demand considerable energy and resources (Wechsler & Weitzman, 1996; Gilchrist, 1994). The correspondence between the shape, focus and rationale of the initiative with the community, offender and correctional centre‟s definitions of appropriate action are critical to the success of the prevention programme (Gilchrist, 1994). A context-sensitive rationale for the prevention programme must be developed. The programme must focus on the dynamic interaction between the offender and the environment (Clement, 1994). Such an interaction is crucial to developing and maintaining the behaviour that enhance health and reduce drug use. The overall goal is to have a social environment that supports and sustains individual behaviour change (Clement, 1994).
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There is limited literature on what correctional centres do to counteract the problem of substance use and abuse amongst its inmates and hence some of the material to be discussed and reviewed is located in the school environment as that is what has arose as prevalent in the literature.
Behavioural and attitudinal interventions as prevention.
Behavioural interventions have been more successful than education in reducing students alcohol use (US Department of Health and Human Services, 2000). Although attitudinal and behavioural change is complex, university personnel who develop prevention programmes and policies should do preliminary research on attitude development and change prior to implementing policies and interventions (US Department of Health and Human Services, 2000). This research might provide crucial information to help university personnel understand how students‟ attitudes affect their patterns of substance use and vice versa (Slappy, 1995, as cited in Scott &
Ambroson, 1994). This could only increase the likelihood that successful, meaningful interventions are employed. Developing campus based interventions and policies on alcohol and other drugs without a thorough examination of the student‟s attitudes and use patterns (prevalence) and a sound theoretical knowledge and understanding of the change process may simply result in intervention and policy failure and an enormous waste of human and financial resources (Scott & Ambroson, 1994).
Programs aimed at students‟ heavy drinking should target freshman at entry or possibly earlier (Kuo et al, 2002). Since students who live with their parents are less likely to engage in heavy drinking, parents may play a potentially important role in prevention efforts ( Kuo et al, 2002)