Prevention of Substance Abuse

Although the proscriptive model remains popular with some, it has not made any significant contribution to the prevention of substance-abuse problems. It is well known that Prohibition was less than successful in alleviating problems associated with alcohol use, and other substance-use problems also have continued. Perhaps the major difficulty with the model is that it is too simple to tackle a complex problem. 

The book explores and explains the development of addiction, the various classes of drugs, and the treatment and prevention of substance abuse disorders. With the latest research and data, the authors include ... 

Through the HME process, one or more active pharmaceutical ingredients (API) are blended with at least one molten excipient in an extruder. The API in the extru-date (or HME product) may exist in its crystalline or amorphous state. Some of the applications of pharmaceutical HME include products designed to promote oral absorption, sustained release (either for oral delivery or implants Follonier et al. 1995), targeted release (Doelker 1993 Follonier et al. 1995 Andrews et al. 2008), and prevention of substance abuse (Oshlack et al. 2001 Arkenau-Maric and Bartholomaus 2008). Some of these applications are listed in Table 6.1, where the commercial status and the purpose of the HME process are summarized for several drug products. 

Within this Held, most of the research and results have been focused on the effects of drug therapy on the disorders induced by alcohol, and by the abuse of opiates. For a broader discussion of substance abuse see Chapter 18. In all instances of alcohol or drug abuse the first objective is to wean the patients from the addictive substance, treating or preventing the effects of withdrawal for those substances which cause physical dependence (alcohol, nicotine, opiates, caffeine, certain psychotropic agents such as benzodiazepines, possibly antidepressants). The second phase is the prevention of recurrence or relapse, which relies on a combination of social support, psychotherapy, and pharmacotherapy where available. In this respect, alcoholism is exemplary. 

CASA is a major research and education organization that focuses on publicizing the economic and social costs of substance abuse and on developing and providing effective tools for prevention, treatment, and law enforcement. The organization conducts annual conferences and produces annual reports as well as surveys and research studies. 

The preceding chapters included a great amount of information on alcohol and drugs, their actions, and their use and abuse. The previous chapter concerned the treatment of problems associated with substance use. This brings us to our final chapter, which focuses on the prevention of substance-use problems. 

The third form of prevention, called tertiary prevention, includes interventions used in treating persons who are beyond the early stages of substance abuse or dependence. The goals of tertiary prevention essentially are to terminate use of the substance and thus avoid further deterioration in the person s functioning. Tertiary prevention and substance-abuse treatment (see CHiapter 15) are comparable activities, and prevention efforts are more appropriately viewed as being either primary or secondary in nature. In the remainder of this chapter we accordingly emphasize primary and secondary prevention activities. 

Tertiary prevention, which actually is more treatment than prevention, includes intervention used to treat persons beyond the early stages of substance abuse. 

Health economists continue to advocate greater emphasis on prevention, screening, patient education, wellness education with emphasis on nutrition, smoking, and alcohol use reduction, avoidance of substance abuse, and... 

Weiss, R. D., Najavits, L. M., Greenfield, S. F. (1999). A relapse prevention group for patients with bipolar and substance use disorders. Journal of Substance Abuse Treatment, 16, 47-55. 

Medications will prevent all side effects of substance abuse withdrawal. 

At the beginning of this chapter, it was noted that there is a lack of evidence that prevention has successfully reduced the harms and consequences of substance abuse. However, the substance abuse prevention field has a research-based theoretical model of risk and protective factors to guide it, a conceptuafization of strategies for program implementation, and research on what types of activities work and don t work. In addition, the federal government has spent a considerable amount of money on prevention. Why isn t this whole effort more successful ... 

However, federal incompetence, bureaucracy, and pofitics cannot totally explain the lack of impact of substance abuse prevention. Even if programs have not been systematically gathering outcome data, evidence-based prevention programs and strategies have been implemented in communities across the country through... 

While the issues discussed thus far probably contribute to the fact that prevention has not reduced the harm caused by drug abuse, these issues do not fully explain the situation. At the state and community levels, well-intentioned and hardworking people are often able to overcome federal ineptitude. Furthermore, I have personally seen many state prevention systems and community-based organizations doing an exemplary job of using a risk and protective framework to design and implement evidence-based prevention programs. There must be other factors that explain the failure of substance abuse prevention. 

It would appear that public-sector treatment has positive eflects on alcohol and other drug use and on the consequence of substance abuse and addiction. Additionally, treatment is cost-effective. These outcomes have occurred in spite of the fact that most public-sector treatment clients do not complete treatment nor do they stay in treatment long enough for the maximum benefits. Even though many federal efforts have not been able to demonstrate effectiveness for specific programs, the treatment outcome studies indicate the NDCS treatment dollars have been much better spent than the prevention dollars. 

Youth prevention services are targeted to prevent youth behavioral and mental problems in advance or to address them in the early stages of development. Specifically, it is known that effective prevention services can reduce delinquency, aggression, violence, bullying, and substance abuse in the youth population (Chilenski et al. 2007). Increased effectiveness of prevention services could potentially lower the risk of substance abuse (tobacco, alcohol, drugs) among youths through better social and emotional health. 

Substance abuse programmes prevention and identification of substance abuse of workforce which includes random testing and testing after a construction injury. 

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