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HLT 214 - Substance Use and Abuse - Textbook

Chapter 15. Prevention, Harm Reduction, and Recovery from Addiction

Learning Objectives

  1. Describe levels of prevention of substance use and abuse.
  2. Describe the importance of drug testing in the prevention of substance use and abuse. 
  3. Define harm reduction in substance use and abuse.
  4. Describe the role of a community health worker in health education programs for prevention of substance use and abuse.

Overview of Terminology

Use- refers to experimentation or low frequency, typically irregular, use of alcohol or illicit drugs.

Abuse- refers to regular and/or compulsive use of alcohol or illicit drugs.

These terms distinguish on the basis of whether the use of alcohol or drugs has or has not become a significant feature of the person’s lifestyle. Clinicians diagnose substance abuse if, in a twelve-month period, a person is in one or more of the following situations related to drug use:

  • Fails to meet obligations, such as missing work or school
  • Engages in reckless activities, such as driving while intoxicated
  • Encounters legal troubles, such as getting arrested
  • Continues to use despite personal problems, such as a fight with a partner.

Addiction- implies physiological dependence, is more severe and involves tolerance (increased need for the substance in order to achieve the desired altered state of consciousness) and withdrawal (mental or physical symptoms after stopping drug use). The behavioral patterns are:

  • Being unable to stop once using starts
  • Exceeding self-imposed limits
  • Curtailing time spent on other activities
  • Spending excessive time using or getting drugs
  • Taking a drug despite deteriorating health

Levels of Prevention

Primary, Secondary, and tertiary prevention of Substance abuse

Primary prevention aims to prevent disease or injury before it occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviors that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur. Primary prevention includes those measures that prevent the onset of illness before the disease process begins. In the context of addiction, the goal of primary prevention is to ensure that the problems of substance abuse does not occur. Primary prevention aims at preventing the initiation of substance abuse or delaying the age of initiation and reduces the incidence of substance use disorders. Primary prevention targets young people before they start using or experimenting with substances.

Secondary prevention aims to reduce the impact of a disease or injury that has already occurred. This is done by detecting and treating disease or injury as soon as possible to halt or slow its progress, encouraging personal strategies to prevent re- injury or recurrence, and implementing programs to return people to their original health and function to prevent long-term problems. Secondary prevention refers to strategies to detect persons with early signs of drug abuse or a history suggestive of drug abuse and interventions aimed at preventing addiction and relapse and its consequences. Secondary prevention programs target those individuals who have already started using substances. Secondary prevention includes those measures that lead to early diagnosis and prompt treatment of a disease. Breast self-examination is a good example of secondary prevention. This program aims at controlling the degree of damage to the individual by preventing substance use from becoming a problem.

Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. This is done by helping people manage long-term, often-complex health problems and injuries (e.g., chronic diseases, permanent impairments) in order to improve as much as possible their ability to function, their quality of life and their life expectancy. Tertiary prevention interventions are essentially forms of treatment aimed to prevent worsening conditions and the emergence of secondary problems. Tertiary prevention involves the treatment of people who have already been affected by a disease, or activities to prevent an established disease from becoming worse. In context of addiction, measures such as rehabilitation tertiary prevention programs are sometimes referred to as rehabilitation and relapse prevention. This form of prevention program aims at helping persons who use drugs achieve sobriety, by making the individual drug free thereby minimizing the problems associated with its use. It strives to enable the individual to attain and maintain improved levels of personal and social functioning and health.1, 2

Drug testing can be applied at all levels of prevention. Drug screening not only serves as a way to deter drug use, it can also monitor compliance with sobriety programs throughout the course of secondary and tertiary prevention. The minimum standard for most Employee Drug Testing Programs is the SAMHSA 5 list of drugs. Using the SAMHSA 5 list of drugs gives employers the confidence to know that they are starting on firm ground. Because of federal requirement, most employment drug testing companies offer, at least, a basic 5 panel drug test which checks for drugs in these 5 common categories, including Amphetamines (Amphetamines, Methamphetamines, Speed); Cocaine (Cocaine, Crack, Benzoylecgonine); Marijuana – THC Tetrahydrocannabinol (Cannabinoids, Hash); Opiates (Heroin, Opium, Codeine, Morphine); and Phencyclidine (PCP). Drug prevention programs are designed to provide the education and support necessary to diminish drug dependency in communities, schools and the workplace. Drug abuse prevention has become an important first step in informing specific individuals about the dangers of addiction, prevention techniques and where to find recovery help if it should be deemed necessary.

Programs should make sure to address all aspects of drug abuse. This includes underage use of legal drugs such as alcohol and tobacco, illicit street drugs, inhalants and the inappropriate use of legal drugs such as prescription and over the counter drugs. These programs must also be tailored to the specific needs of the audience. Having specialized programs for different genders, ages, cultures and ethnicities only make the programs more effective. Drug prevention programs seek to involve the family, community or workplace in the prevention process. To be effective, communities need to sustain the progress. This often requires continued leadership and financial support.3, 4

Programs for Drug Abuse Prevention

Health Education programs are important in the prevention of substance use and abuse and can be applied at any of the levels:

  • Family Based Drug Prevention. The prevention of drug abuse should start at the family unit level as early as possible. Home-based drug prevention education helps develop self-awareness and the enhances parent-child communication skills and family bonding. Parental supervision and involvement are critical in adolescents. Parents must not only have a plan to educate their children on the dangers of drug use and abuse, but they must also establish and enforce family rules. This includes creating an effective system of monitoring their children's activities through an appropriate level of parental oversight.
  • School Based Drug Abuse Prevention Programs. Drug abuse prevention should be addressed as early as preschool. Preschool children can benefit from learning how to handle aggression, solve problems, and communicate better so that they can avoid putting themselves at risk for drug abuse later in life. School health programs in middle and high school should focus on peer relationships, communication, assertiveness, drug resistance skills and developing anti-drug attitudes. School based prevention programs should be sustainable for the best level of success.
  • Community Based Drug Abuse Prevention Programs. Communities that make an effort to come together in the fight against drugs are sure to make an impact in the prevention of drug abuse. There are many places to establish these prevention programs including schools, churches and community-based clubs.

Drug abuse is a growing problem and prevention should be a priority in all of our homes, schools, workplaces, and communities.

Harm Reduction Programs

Harm reduction acknowledges that completely abstaining from drugs isn’t a realistic solution for everyone and that many people worldwide use drugs and alcohol in spite of the strong efforts of various organizations and governments to promote total abstinence. Believing that no one should suffer or die from preventable causes, those running these programs attempt to mitigate the damage associated with drug abuse and addiction. According to the Harm Reduction Coalition, the principles of harm reduction are:

  • Acknowledging that drug use is inevitable and choosing to reduce the harms of drug use instead of disregarding them.
  • Understanding that drug use is a complicated phenomenon and that some methods of drug use are safer than others.
  • Determining that quality of life is the criteria for successful approaches and rejecting the idea that total abstinence is the only way to address the issue of drug abuse.
  • Using non-judgmental services and providing resources to people who use drugs and their communities, without forcing them to participate.
  • Making sure that drug users have a voice in the programs and policies of which they are a part.
  • Seeing drug users as the ones who have the primary role in preventing the harms of drug use and empowering them to share information and support each other.
  • Accepting that factors such as poverty and racism can impact people’s ability to deal with the consequences of drug use.
  • Facing the realities and risks of drug abuse and harnessing appropriate social support to overcome the challenges

Harm reduction can be very effective. Studies have found that cities that have needle and syringe programs have an average annual decrease in HIV prevalence of 18.6%, compared with an annual average increase of 8.1% in cities without these programs.

Harm reduction can encompass a number of different approaches. The main areas of focus are the reduction of harm associated with alcohol and opioid addiction, the prevention of overdose deaths, and the reduction of infectious disease transmission such as HIV/AIDS and Hepatitis C.5-8

Chapter Review and Discussion Questions

  1. What is primary, secondary, and tertiary prevention in relation to addiction.
  2. Discuss the types of programs for drug abuse prevention.
  3. Describe the goal of harm reduction.
  4. Outline the components of harm reduction.
  5. Describe the role of community health workers in the prevention of addiction and promotion.