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Substance abuse problems arise from the interaction of many causes, ranging from those that are individual to those that are societal in nature. Prevention is vital to sustaining a healthy and productive community and workforce. Young people report that getting alcohol, tobacco and most illicit drugs is very easy. Young people who abuse drugs become adults who abuse drugs, and all drug abusers place a burden on our society. Research has clearly linked Alcohol, Tobacco and Other Drug abuse with most of the social and health issues confronting communities today.
Today’s youth consider themselves immune to disease and injury and are susceptible to peer pressure with increasing age. They are also greatly influenced by messages and environments that glamorize and accept drug use and experimentation as a social norm. Certain aspects of the Hip Hop movement constantly exposes youth to messages that demean women, glamorize drug use, sex, violence and other high-risk practices. Community norms and parental perceptions supportive of substance use also contribute to the problems.
Research by the Center for Substance Abuse Prevention (CSAP) and others have clearly shown that a single prevention strategy used in isolation is not effective in reducing substance use among youth. A comprehensive strategy that addresses both individual and environmental approaches on many levels at the same time is most effective.
The Alliance advocates for and promotes prevention along the continuum and incorporates several prevention models in our programs geared toward youth. These models include: Risk Focused Prevention (Catalano and Hawkins); Technology of Prevention (Lofquist), Resiliency (Bonnie Benard), programs that are grounded in theory and have concrete indicators of success and Science-Based Prevention principles based on research and practical experience which have been instrumental to the successful development and implementation of prevention activities (CSAP, NIDA).
The Alliance’s adheres to the following definition of prevention developed by William A. Lofquist, "Prevention is an active, assertive process of creating conditions and/or personal attributes that promote the well-being of people." Our comprehensive approach are based on the Institute of Medicine’s (IOM) prevention classifications:
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Universal – includes activities targeted to the general public or a whole population group that has not been identified on the basis of individual risk. (This is also referred to as population base prevention.)· Selective – includes activities targeted to individuals or a subgroup of the population whose risk of developing a disorder is significantly higher than average.
· Indicated – includes activities targeted to individuals in high-risk environments, identified as having minimal but detectable signs or symptoms foreshadowing disorder or having biological markers indicating predisposition for disorder but not yet meeting diagnostic levels.
IN DEKALB
Underage substance use and adult substance abuse represents a significant public health and societal problem in our county. Data from the Youth Risk Behavior Survey conducted by the DeKalb County Board of Health and DeKalb County Schools (2003) indicates several important trends in the county’s school age population.
Alcohol Use
· 69.5% of high school students reported having at least one drink of alcohol on >1 day during their lifetime. Students in grades 11 and 12 were significantly more likely than students in grade 9 to report this behavior. Black students were significantly more likely than students of other races to report this behavior.
· 28.7% reported having at least one drink of alcohol in the past 30 days. Students in grade 11 were significantly more likely than students in grade 9 to report this behavior. Hispanic/Latino and White students were significantly more likely than Black students to report this behavior.
· 10.1% reported having >5 drinks in a row one or more times in the past 30 days. Students in grade 11 were significantly more likely than students in grade 9 to report this behavior. Hispanic/Latino and White students were significantly more likely than Black students to report this behavior.
Marijuana Use
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36.5% of high school students reported using marijuana one or more times during their lifetime. Students in grades 10, 11 and 12 were significantly more likely than students in grade 9 to report this behavior. Black students were significantly more likely than students of other races to report this behavior.· 17% reported using marijuana one or more times during the past 30 days. There were no significant differences between genders, race/ethnicities or grade levels.
Tobacco Use
· 13.6% of high school students reported using any tobacco during the past 30 days. Hispanic/Latino and White students were significantly more likely than Black students to report this behavior.
· 8.8% reported they smoked cigars, cigarillos or little cigars on > of past 30 days. Males were significantly more likely than females to report this behavior. Hispanic/Latino was significantly more likely than Black students to report this behavior.
· 2.3% reported using chewing tobacco, snuff or dip on >1 of past 30 days. Males were significantly more likely than females to report this behavior.
· 51% of high school students reported ever tried cigarette smoking. Students in grades 11 and 12 were significantly more likely than students in grade 9 to report this behavior.
· 9.5% of students reported smoking cigarettes on >1 of past 30 days. Students in grade 11 were significantly more likely than students in grade 9 to report this behavior. Hispanic/Latino and White students were significantly more likely than Black students to report this behavior.
· 5.3% reported smoking cigarettes daily. White and other race students were significantly more likely than Black students to report this behavior.
Other Drugs
· 10% of high school students reported they sniffed glue, breathed the contents of aerosol spray cans or inhaled any paints or sprays to get high one or more times during their lifetime. Students in grade 9 were significantly more likely than students in grade 11 and 12 to report this behavior. White students were significantly more likely than Black students to report this behavior.
· 3.9% reported they sniffed glue, breathed the contents of aerosol spray cans, or inhaled any paints or sprays to get high one or more times during the past 30 days. Students in grade 9 were significantly more likely than students in grades 10, 11 and 12 to report this behavior. Hispanic/Latino, White and Black students were significantly more likely than students of other race to report this behavior.
· 3.4% reported using any form of cocaine, including powder, crack or freebase, one or more times during their lifetime. White students were significantly more likely than Black students to report this behavior.
· 1.4% reported using any form of cocaine, including powder, crack, or freebase, one or more times during the past 30 days. No significant differences existed between genders, race/ethnicities or grade levels.
The above data show that by far the preferred substance of abuse for youth is alcohol, followed closely by marijuana in DeKalb. The Alliance is committed to developing and/or enhancing plans to augment already existing prevention efforts or introduce new efforts.
We believe strongly that evaluation should be an integral part of program planning to assure that programs are based on the effective principles of prevention that have been identified in research. Thus, over the past 16 years The Alliance has maintained a vested interest in developing and implementing well-designed evaluation strategies to determine program effectiveness, document needed program modifications and sustain the effort. This philosophy is consistent with the current national focus on outcomes over the past several years.
We have incorporated the following Prevention Principles developed by The National Institute on Drug Abuse (NIDA) for all youth programming:
1. Prevention programs are designed to enhance "protective factors" and move toward reversing or reducing known "risk factors."
2. Prevention programs target all forms of drug abuse, including he use of tobacco, alcohol, marijuana and inhalants.
3. Prevention programs include skills to resist drugs when offered, strengthen personal commitments against drug use, and increase social competency (e.g., in communications, peer relationships, self-efficacy and assertiveness), in conjunction with reinforcement of attitudes against drug use.
4. Prevention programs should include interactive methods, such as peer discussion groups, rather than didactic teaching techniques alone.
5. Prevention programs include a parents’ or caregivers’ component that reinforces what the children are learning – such as facts about drugs and their harmful effects – and that opens opportunities for family discussions about use of legal and illegal substances and family policies about their use.
6. Prevention programs are long-term, over the school career with repeat interventions to reinforce the original prevention goals.
7. Family-focused prevention efforts have a greater impact than strategies that focus on parents only or children only.
8. Community programs that include media campaigns and policy changes are more effective when they are accompanied by school and family interventions.
9. Community programs should strengthen norms against drug use in all drug abuse prevention settings – the family, the school and the community.
10. Prevention programming should be adapted to address the specific nature of the drug abuse problem in the local community.
11. The higher the level of risk of the target population, the more intensive the prevention effort must be and the earlier it must begin.
FACTS
1. The Robert Wood Johnson Foundation, a national leader in health policy, has deemed substance abuse the number one health problem in the U.S.
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2. Substance abuse problems create great personal suffering and loss for individuals, families and communities. It is implicated in family conflicts, divorce, separation and family violence.
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3. Substance abuse is associated with child neglect and abuse, missed school days, school failure, delinquency, and youth fatalities. It is the cause of lost work productivity, unemployment and financial problems.
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DID YOU KNOW
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Youth form their opinions about alcohol by age 12.
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By 8
th
grade, 52 percent of adolescents have consumed alcohol, 41 percent have smoked cigarettes, and 20 percent have used marijuana.
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Each day nearly 5,000 youth age 12 to 17 try a cigarette for the first time. Between one third and one half of youth who try cigarettes will go on to become a daily smoker
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More than 40 percent of youth who start drinking at age 14 or younger develop alcohol dependence, compared with 10 percent of youth who begin drinking at age 20 or older.
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In 2000, ore than 2 million youth aged 12 to 17 reported using inhalants at least once in their lifetime.
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In 2000, almost 7 million persons aged 12 to 20 (under the legal drinking age) was a binge drinker. The rate of binge drinking among underage persons (19 percent) was almost as high as among adults 21 or older (21 percent).
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Approximately one in four American children lives with a chemically dependent parent. Before their 18
th
birthday, 28.6 percent of U.S. children will live in a home with alcohol abuse or alcoholism.
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TREATMENT FACTS
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Treatment Works!, but treatment efforts are challenged by easy access to illicit drugs in the Metro Atlanta area. 8A Metro Atlanta is the southeastern transshipment center for the movement of illicit drugs across the south. In recent years, Metro Atlanta has been elevated in drug trafficking culture to status as a local distribution center for trafficking out of Mexico. 8
A Cocaine, especially crack, remains the most illicit drug in the Metro Atlanta area and is readily available at both the wholesale and retail levels. 8
A Marijuana remains the most widely abused drug in Georgia. 8
A MDMA and GHB are the most popular club drugs in Georgia. 8
A Methamphetamine is no longer the drug of choice in primarily rural areas, but is increasing in popularity in Metro Atlanta. 8
(Source: Drug Enforcement Administration, Drugs and Drugs of Abuse, State Fact Sheet, GA 2002)
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The four most common types of treatment programs are outpatient drug-free, outpatient methadone, long-term residential and short-term inpatient. All reduce drug use. 9A Numerous studies indicate treatment for alcohol and other drug abuse is highly effective, resulting in improved public health and safety and reduced costs to society. 9
A Drug treatment reduces drug use by 40- to 60 percent and significantly decreases criminal activity during and after treatment. 10
A Time in treatment and treatment completion as associated with better outcomes. Studies suggest that a minimum of several months in treatment is needed for sustained recovery. 9
A Injecting drug users who do not enter treatment are up to six times more likely to become infected with HIV than injecting drug users who enter and remain in treatment. 9
A For many people, substance abuse is a chronic, relapsing health condition and more than one episode of treatment may be required before improvement. 9
A Treatment is cheaper than the alternatives: 9
Cost per year for cocaine $ 2,722
Cost per year for methadone maintenance (heroin) $ 3,500
Cost per year for residential treatment (cocaine) $12,467
Cost per year for probation $16,691
Cost per year for incarceration $39,600
Cost per year for untreated addiction $43,200
DEFINITIONS
Substance Abuse is repeated use of a drug despite harmful consequences. This may include failure to meet work, family or school obligations, use in physically hazardous situations (DUI), legal or personal problems resulting from the use of the drug. 11
Substance Dependent, or Addiction, includes repeated use despite harmful consequences, but also includes:
1. Tolerance – needing more of the drug to feel the desired effects.
2. Withdrawal – unpleasant physical symptoms when the drug is not available.
3. Compulsive Use – using more of the drug than intended, unsuccessful attempts to quit or cut down despite strong desire to stop, thoughts and daily activities revolve around use of the drug, withdrawal from family life and recreational activities in order to use.
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"Addiction is a serious illness. Health, finances, relationships, careers all can be ruined. The abuse of drugs and alcohol is by far the leading cause of preventable illnesses and premature deaths in society. The importance of substance abuse treatment cannot be overstated, and fortunately many effective treatments are available. The road to recovery, however, begins with recognition."
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REFERENCES
1 Barthwell, Andrea M.D. Comments made during presentation to ONDCP 25-Cities
Initiative, Atlanta, GA. May 2004.
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Lofquist, William. Discovering the Meaning of Prevention. A Practical Approach toPositive Change. AYD Publications. 3 rd Printing, August 1989.
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Substance Abuse: The Nation’s Number One Health Problem. Robert Wood JohnsonFoundation. February 2001.
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Office of Juvenile Justice & Delinquency Prevention. Substance Abuse: The Nation’sNumber 1 Health Problem, 2001.
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One in Four Children Exposed to Family Alcohol Abuse or Alcoholism. NationalInstitutes of Health News Advisory.
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Alcohol, Tobacco & Illegal Drug Use. U.S. Department of Health & Human Services,2002.
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Children of Substance Abusers Initiative Fact Sheet. Office of National Drug ControlPolicy. Web site accessed 11/25/03.
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Drugs & Drugs of Abuse. State Fact Sheet, Georgia. Drug EnforcementAdministration. 2002.
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Substance Abuse: The Nation’s Number One Health Problem, prepared by theSchneider Institute for Health Policy. Brandeis University.
10 Leshman, Alan I. Science-Based Views of Addiction. The Journal of the
American Medical Association, October 1999.
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Diagnostic & Statistical Manual of Mental Disorders, 4 th Edition. American Psychiatric Association. Accessed 11/25/03 www.psych.org12
Statement. American Psychiatric Association website, copyright 1999. Accessed11/25/03, www.psych.org/public_info/substance.cfm
