1. Prevention in the Rapidly Changing Field of Substance Use Disorders

2. Prevention
In what cultures/areas of the world don’t they engage in mood-altering substances?
Trying vs. using vs. abusing
When does substance use start?
When should prevention start?
Let’s establish a working definition of prevention.
Prevention of use, misuse or disorder?
27 million Americans use illicit drugs or misuse prescription meds

3. Prevention What do we mean by “prevention”?
Never trying alcohol or drugs?
Not getting addicted?
Not letting it adversely affect our lives?
When it comes to substance use, what do we really mean when it comes to prevention?
Let’s establish a working definition of prevention.
Prevention of use, misuse or disorder?
27 million Americans use illicit drugs or misuse prescription meds
Get a working a working definition

4. Prevention Substances can’t be abused…
People abuse themselves and others for and with substances.
How have we prevented other behavior-based epidemics?
Spread of
Goal:
Preventing use from turning into a substance use disorder
How does the medical model help?
Breaks stigma and informs folks that it’s a brain disease

5. Why Try Drugs? Curiosity Peer Pressure Escape Depression Anxiety
Stress
Low Self-Esteem
Trauma
Loneliness
Many here in this room have tried different drugs…many drink alcohol regularly…
Without ruining their lives…

6. “MY DOCTOR PRESCRIBED IT TO ME”
% of addiction to opioids (benzos, etc) that started with a prescription

7. Overview Defining Prevention Medical Model ASAM Stigma Vocabulary
Establish definition
Establish that trying drugs isn’t the issue or the goal
Segue: why does it become a problem for so many people?
Medical Model
ASAM
Stigma
Vocabulary
Signs & Symptoms
Includes risk factors & support
Types of Early Intervention/Prevention
EAP
Hospitals
PCP

8. SUD or MHD?

9. American Society of Addiction Medicine (ASAM)
Addiction is a chronic disease of the brain’s reward system
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

10. Medical Model of Addiction
Pancreas produces too little insulin
Reward system produces increased certain chemicals

11. Are All Brains Created Equal?
Intellect
Anxiety
Depression
Level of Insulin
Level of Cortisol
Addiction
Some brains are smarter than others…
Some brains are more anxious than others…
Some brains…
Some brains become addicted faster than others.
Addiction depends on how something affects your…

12. American Society of Addiction Medicine (ASAM)
Addiction is a chronic disease of the brain’s reward system
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

13. Reward System
Many different things activate the brain’s reward system, and the degree to which they activate it determines whether or not you LIKE or LOVE something…
Things you love activate your reward system:
Chocolate
Cars
Golfing or boating
Sports
Wine
Whatever it is for you…
“The degree to which you like or love something more than someone else, reveals the difference in how strongly that things triggers your brain’s reward system.”
And here’s what it looks like.

14. Brain Function
These are actual brain scans of two different people watching a Miami Heat game.
The red and yellow represent more intense pleasure than the green.
Who do you think is more likely to watch any basketball game?
Who’s more likely to buy season tickets?
Who’s more likely to want to watch the playoffs instead of taking you to dinner for your birthday?
It’s the same, exact thing with opiates.

15. Risk and Protective Factors
Risk Factors:
Low parental monitoring
Family history of substance use or MH disorders
High levels of family conflict
Low involvement in school
Abuse/neglect
History of use in adolescence
Community level risk factors vs. individual risk factors
No single individual/community factor determines whether an individual will develop problem
Risk/protective factors can be modified through prevention programs

16. Signs of Substance Use
Sometimes it's difficult to distinguish normal teenage moodiness or angst from signs of drug use. Possible indications that your teenager or other family member is using drugs include:
Problems at school or work — frequently missing school or work, a sudden disinterest in school activities or work, or a drop in grades or work performance
Physical health issues — lack of energy and motivation, weight loss or gain, or red eyes
Neglected appearance — lack of interest in clothing, grooming or looks
Changes in behavior — exaggerated efforts to bar family members from entering his or her room or being secretive about where he or she goes with friends; or drastic changes in behavior and in relationships with family and friends
Money issues — sudden requests for money without a reasonable explanation; or your discovery that money is missing or has been stolen or that items have disappeared from your home, indicating maybe they're being sold to support drug use

17. Signs of Mental Health Issues
Problems at school or work — frequently missing school or work, a sudden disinterest in school activities or work, or a drop in grades or work performance
Physical health issues — lack of energy and motivation, weight loss or gain, or red eyes
Neglected appearance — lack of interest in clothing, grooming or looks
Changes in behavior — exaggerated efforts to bar family members from entering his or her room or being secretive about where he or she goes with friends; or drastic changes in behavior and in relationships with family and friends
Money issues — sudden requests for money without a reasonable explanation; or your discovery that money is missing or has been stolen or that items have disappeared from your home, indicating maybe they're being sold to support drug use

18. Prevention and Parenting
How many have kids < 17?

19. Prevention and Parenting
Evidence-based family skills training programs have been found to be the most effective way to prevent substance use among children and adolescents. These programs target the whole family and offer skills-building for parents on monitoring and supervision of children's activities, communication and setting age appropriate limits. Read more.
Schools: Schools have been an important setting for UNODC to reach many children and adolescents with prevention activities. Evidence-based drug education based on life skills that offer personal, social, resistance and communication skills, as well as information about the short- term effects of drugs through a series of session offered by trained teachers. Read more.
Workplace: UNODC has many years of experience in working with employers and employees together to develop and implement policies against substance abuse in the workplace. Such policies are designed to promote the health of employees by preventing substance abuse and assisting those with a drug dependence problem. Read more.
Monitoring and Evaluation: For practitioners who want to improve the monitoring and evaluation of their programs for the prevention of substance and drug abuse, we provide some useful guidelines and training materials. Read more.
Makes this all one slide

20. Prevention and Parenting
Be a role model. As a parent, your attitude toward alcohol, cigarettes, and drugs is one of the greatest influences on whether your child will use substances. If you have a substance abuse problem, get help. If you quit, your teen is more likely to get help early if he or she starts abusing a substance.
Share your beliefs. Even though they may not act like it, most children listen to what their parents tell them. Talk with your teen about the effects of substances on emotions, schoolwork, and health. If you have a family history of abuse problems, talk with your teen about his or her increased risk for the same problems.
Stay connected. Know your teen's friends. Know where your teen is at all times. Set times when the family is expected to be together, such as at mealtimes. Plan family outings or other family fun activities.
Be fair and consistent. Extremes of discipline can increase the risk of substance abuse. Set reasonable consequences for unacceptable behavior, and consistently carry them out. Praise your teen for his or her successes. Expect your teen to follow the household rules. Use a parent-teen contract to write down expected behaviors and consequences if the plan is not followed.
Encourage activities. Keep your teen busy with meaningful activities, such as sports, church programs, or other group involvement. Teens who feel good about themselves are less likely to use alcohol and drugs.
Get informed. Learn about the substances commonly abused by teens. Talk with a doctor. Find out how the drugs work, what their street names are, and what the signs of being under the influence are.

21. Stigma History of stigma Weak, moral failure, etc.
“Someone who abuses drugs”
“Addict”

22. Prevention Family Dynamics Meaning (Victor Frankl)
Purpose/Contribution
Treatment for underlying issues
Connection (Reference Ted Talk)
Mindfulness
Surgeon General’s Report?
Shift in thinking about SUD – similar shift that occurred with HIV/AIDs

23. Early Intervention/Prevention
What do we do about it?
How do we know what we’re doing works?
This is your argument for this section: Prevention is a mix of 1) professional treatment and 2) universal principles of human need: connection.

24. Prevention/Early Intervention
At one point, the “experts” said that punishment was the way to extinguish behavior..we now know this isn’t true.
Opioids for pain management
Tie in this to your presentation title.
Prevention/early intervention techniques

25. Prevention & Early Intervention
EAP
Hospitals
PCP
DUI
School
(Surgeon General) individuals, families, community leaders, law enforcement, health care professionals, policymakers, researchers

26. Connection
How can we get people who are feeling disconnected…connected.

27. Summary No one organization, company, or group can do it alone.
Proper diagnosis, not stigma
Treat it with proven methods
Make it accessible
Compassion

28. Questions?