CHAPTER 13: Prevention Substance Abuse Counseling: Theory and Practice Fifth Edition Patricia Stevens Robert L. Smith Prepared by: Dr. Susan Rose, University of the Cumberlands

Overview of Chapter Types of Prevention Prevention: A Brief History Comprehensive Prevention Community Prevention Risk and Protective Factors Life Skills Training (LST): Effectiveness of a Comprehensive Prevention Approach Steps to an Effective Prevention Program Implications for Counseling

Types of Prevention Primary Health Model of Prevention Primary: Use – Development Goal: To prevent or delay the beginning of use Secondary: Misuse/Abuse – Psychological Dependence Goal: To help novice or experienced users discontinue or limit their use Tertiary: Addiction – Dependence Goal: Same as relapse and relapse prevention

Types of Prevention IOM (Institute of Medicine) Classification Scheme for Prevention Planning Universal Level: targeted to the general population Selective Level: targeted to the at-risk populations Indicated Level: targeted to persons or groups who already show problems as a result of ATOD use and who require intervention to halt or ameliorate these difficulties Comprehensive Delivery of Programs and Services: the current accepted prevention paradigm

Prevention: A Brief History Knowledge-Attitudes-Behavior (KAB) Model (1960’s – 1970’s) Presentations were supplemented by an array of scary antidrug films, dire warnings of possible consequences, stereotyping of users, overstatements about the “likely” addiction that would follow from experimentation, and moralizing about the destructive lifestyle Based on fear, zeal and moralistic attitude, not scientific knowledge Unproductive and potentially counterproductive

Prevention: A Brief History 1970’s – 1980’s Approaches Affective education: Helping students identify and express their feelings; Helping them feel valued and accepted; building self-esteem Values Clarification: Assisting students in decision-making skills Teaching Alternatives: Relaxation, Meditation, Exercise, Involvement with the arts, etc. Development of Personal and Social Skills: Problem-solving, Self-Management, and Leadership Skills Recognition of Peer Pressure and Methods of Resistance

Prevention: A Brief History Project D.A.R.E. (Began in 1983) Normative Education (1980’s): Environmental approach that can be incorporated into a wider, more comprehensive strategy of ATOD prevention Aspects of Environmental or Ecological perspective Norms: perceived rules of behavior or values that influence a person’s attitudes and actions. In preventative terms, Norms set limits or establish guidelines that are the background or framework for ATOD use/abuse Embedded systems offering reciprocal causality: Individuals are influenced by families, which, in turn, are influenced by social networks, and vice versa.

Prevention: A Brief History Proactive Prevention Model Incorporates strategies of earlier models Primary Prevention: Providing services to prevent abuse among non-users Secondary Prevention: Reducing the likelihood that at-risk individuals will develop problems Tertiary Prevention: helping abusers into recovery Distinguished from previous approaches by its two main components: Emphasizing the importance of providing accurate information about communities and normative environments Focusing on healthy, positive attitudes and behaviors of community members

Comprehensive Prevention Attempts to address multiple levels of intervention and multiple populations. Takes into account the variety of factors that may be involved in the problem and the available theories for addressing these factors, integrating multiple strategies in a collaborative effort. Incorporates a view of the wider environment and ecology within which the problem resides Considers diversity Is developmentally appropriate Attends to the effects and consequences of ATOD abuse Presumes that prevention is a long-term effort

Community Prevention CASASTART CASA: Children at Risk, from the National Center on Addiction and Substance Abuse at Columbia University START: Striving Together to Achieve Rewarding Tomorrows Components of Program Case Management Family Services Educational Services After-school and Summer Activities Mentoring Incentives Community policing and enhanced enforcement Juvenile Justice Intervention

Risk and Protective Factors Table 13.1 (Pages 346-347) An ATOD prevention model utilizing risk and protective factors should encompass: The agent The individual The environment

Life Skills Training (LST) Effectiveness of a Comprehensive Prevention Approach (http://lifeskillstraining.com) Most widely researched and evaluated prevention programs with children and youth It is a primary prevention, school-based, universal classroom program that addresses a number of critical prevention components in an integrated way Basic Structure Geared toward middle school students Consists of 15-17 class periods of approximately 45 minutes each in the first year “Booster” sessions: 10 in the second year and 5 in the third year

Life Skills Training (LST) Effectiveness of a Comprehensive Prevention Approach cont. Components General Self-management Skills: Problem-solving, Decision-making, Critical Thinking, Coping Strategies General Social Skills: Effective Communication, Developing Healthy Friendships Information/Skills that specifically address drugs and their use: Awareness of social influences to use, normative education tactics

Steps to an Effective Prevention Program Planning must be conducted and/or affirmed by a representative group of stakeholders Community Collaboration is recommended Address Core Questions Table 13.2, Page 352

Steps to an Effective Prevention Program Effective prevention planning begins with: Needs clarification Assessment Development of goals and measurable objectives supported by consistent evaluation procedures

Implications for Counseling The Advocacy Role includes involvement in collaborating with different stakeholders in devising and promoting prevention strategies. Counselors must have the knowledge base and skills necessary for prevention work.