Chapter 8: Drug Use and Prevention

By the end of this chapter, you should be able to:

• Examine the dominant beliefs and attitudes in our society with regard to chemical use. (LO1)
• Explain the effects of addiction on individual, family, and community. (LO4)
• Outline and critique current intervention and treatment modalities used in the field. (LO5)

History of Prevention

Drugs have been in use for centuries, as this book shows. And as long as they have been around, there have always be users that abused them. As groups identified the potential negative consequences with extreme and prolonged usage, there were measures put in place to try and mitigate addiction. In the United States alone, there have been periods of prohibition, attitudes that addiction is a moral failing or a criminal offense, and only in recent years has it been considered a disease (American Addiction Centers, 2022).

Drugs like morphine and cocaine have been used for their healing potential since the 1800s. But as the years went by moving into the 1900s, there was more emphasis on stamping out illicit drug use while even more exotic drugs became available, like marijuana and hallucinogens (American Addiction Centers, 2022). The first asylum for those afflicted with alcoholism opened in 1864. As the public slowly began to accept alcoholism as a serious problem, more places like this opened. Now, there are thousands of drug rehabilitation programs that have a variety of treatment options. Care is usually best when it is tailored to the patient, so what a person experiences will vary from one individual to another (American Addiction Centers, 2022).  Another option for users, that arose following the end of prohibition, is known as Alcoholics Anonymous (or AA) was founded in 1935. This has a spiritual-based way of overcoming addiction and it has evolved to create Narcotics Anonymous (NA), Cocaine Anonymous (CA), and Marijuana Anonymous (MA) (American Addiction Centers, 2022). Today, AA is available in roughly 180 nations, with membership estimated at over two million.

Concepts of Prevention

Prevention strategies have a wide reach, from terrifying scare tactics to abstinence to resiliency training. There are two iterations that will be briefly discussed here, the first is from the CDC (n.d.) and the other is the public health model from the National Institute on Drug Abuse (2022).

3 Part Prevention Model

This model has three levels of prevention categorized by primary, secondary, and tertiary prevention activities (CDC). There is cons

• Primary Prevention: This form of prevention takes place before drugs are taken (non-users). There is clear agreement that this is the most important part of this model (Kempf et al., 2017). This largely involves education.
• Secondary Prevention: Here users are screened to identify any predisposition for a disease with preventative health care; this is also known as intervention.
• Tertiary Prevention: This is managing the disease or treatment, after the effects have been experienced by the user. Usually this means to slow or stop the progression.

Four Strategic Goals

The National Institute on Drug Abuse aims to support and continue to research drug use, prevention, and treatment. There are four goals and four priority focus areas. To read more detailed information, follow this link to the NIDA Strategic Plan (2022).

Goals:

• Goal 1: Identify the causes of drug use and addiction across a lifespan
• Goal 2: Develop new strategies to prevent drug use and its consequences.
• Goal 3: Develop new treatments to help individuals achieve and maintain recovery.
• Goal 4: Increase the impact of public health programs and research.

Focus Areas:

• Examine the interactions of drug use and factors influencing use.
• Increase the development rate of treatments.
• Address real-world problems.
• Advance relationships between research, science, and public health.

Pregnancy and Birth

Substance use and abuse during pregnancy is a major concern. Drugs cross the placental barrier and will affect the fetus.  Moreover, when they are born, they will experience the effects of withdrawal (Stone, 2015;Inaba, 2011).  Drug usage may also interact negatively with other health problems. Additionally, it has been found that sometimes pregnancy is the reason for drug usage, using drugs to cope with the stressors associated with unexpected pregnancy (Mburu et al., 2020)

In many cases, pregnant addicts do not have prenatal care or the post-natal care required to manage the addiction appropriately (Inaba, 2011; Stone, 2015). Interviews conducted by Rebecca Stone (2015), showed that many women use alcohol or drugs during pregnancy. Those interviewed experienced isolation while hiding from health care or criminal justice personnel. The barriers to treatment, in addition to the isolation, was challenging for these individuals and often discouraged them from seeking the appropriate treatment during their pregnancy. Kristin Trainor and her study: Material Substance Abuse Disorder: A Look at Provider Stigma, Attitudes, and Beliefs (2022) provided information regarding the beliefs and attitudes exhibited by care workers toward women with substance abuse disorder. Follow the link to read the full study and review the chart on page 12 to see the results.

Fetal alcohol spectrum disorder (FASD) includes other conditions like fetal alcohol syndrome (APA, 2022), alcohol-related neurodevelopmental disorder and alcohol-related birth defects (Inaba, 2011).

Youth and School

Alcohol is a prominent issue in schools, though tobacco and marijuana are not far behind in their use and abuse (Sanchez-Puertas et al., 2022) and substance abuse among youth has grown due to the pandemic (Layman et al., 2022). Prevention is effective when taught in schools (Inaba, 2011), especially when using materials that are adapted to the specific age group like adolescents or college students. Some studies suggest that real information should be used, but to not use scare tactics or vulgar content in order to frighten students away from using the drugs (Tahlil & Auyub, 2021). A suggested route for drug use prevention in schools include (Tahlil & Auyub, 2021):

• Train students how to say no to drug use, providing them with skills that can be generalized.
• Create relevant policies to decrease the supply available to students.
• Reduce the consequences of using substances by providing appropriate treatment and counseling.

It may be beneficial to make the content engaging and use different forms of media to promote student confidence and resilience. Offering engaging materials may also shift their views about drugs and promote the effectiveness of the overall prevention program (Murah et al., 2020) Moreover, school-based programs that promote the effective use of social skills and the education they receive, will see the most benefits (Sanchez-Puertas et al., 2022).

Adulthood and Drugs

Drugs have permeated many different components of adult life, including sex, work, military, and as humans age. Each of the following sub-categories provide a brief glimpse into how drugs have played a role.

Love, Sex, and Drugs

Some drugs have permanently shifted the attitudes toward sexuality, like Viagra or Cialis (Inaba, 2011). But all drugs have the capacity to affect users either by lowering inhibitions or changing sexual functioning. Many drugs used for sexual experiences do not effect the user outside sex, but sometimes drugs can trigger aggression or violence that is sexual in nature (Inaba, 2011; Simmons & Singer, 2006). Other drugs, like those administered with needles can spread sexually transmitted diseases, which affect millions of people (Saing et al., 2022).

Work and Drugs

Substance abuse can occur as a technique to manage the workplace experience and associated stressors (Osei-Nimo et al., 2022). Drugs can be used to feel relaxed or even to increase cognitive functioning (Baum et al., 2021). Substance abuse costs employers billions of dollars each year due to decrease in productivity and increases in healthcare costs (Inaba, 2011). In some cases, like in laborer positions in manufacturing or construction, using drugs while working poses a terrible safety risk both for the user and other employees. (Deria & Lee, 2020). And while the workplace may not be the place to resolve these challenges, it can be a place to educate and share prevention programs, to help mitigate these situations (Smook et al., 2014).

Drug Testing

It is not uncommon for workplaces to require drug testing prior to beginning employment. But they can also require random, periodic, or incident-related drug testing as well. Tests can range from saliva to urine to hair to more advanced drug tests.

Military and Drugs

Elderly and Drugs

Inappropriate medication use by elderly people is a public health problem and varies greatly, often called polypharmacy (Guaraldo et al., 2011; Chang et al., 2020). There is an urgent need to correct this problem, but it is a complex problem with many potential ways to combat the issue (Kurczewska-Michalak, 2021). Street drug usage drops dramatically after the age of 65, but the use of alcohol and prescription drug use are proven issues in this community. The elderly often experience stronger side effects than their younger counterparts, but often the signs of abuse are missed by healthcare professionals (Inaba, 2011).

References

American Addiction Centers Staff (2022, May 30). History of drug abuse. American Addiction Centers. https://drugabuse.com/addiction/history-drug-abuse/

American Psychological Association (2022). Fetal alcohol syndrome. APA. https://dictionary.apa.org/fetal-alcohol-syndrome

Baum, M., Sattler, S. & Reimann, M. (2021). Towards an understanding of how stress and resources affect the nonmedical use of prescription drugs for performance enhancement among employees. Curr Psychol https://doi.org/10.1007/s12144-021-01873-7

CBS Mornings (2021, April 29). “They’re lawless”: Current, formater Navy SEALS allege criminality, drug use within ranks [Video]. YouTube. https://www.youtube.com/watch?v=TS7oQu161zQ

Centers for Disease Control (n.d.) Picture of America: Prevention [Infographic]. https://www.cdc.gov/pictureofamerica/pdfs/picture_of_america_prevention.pdf

Chang, T.I., Park, H., Kim, D.W., Jeon, E., Rhee, C., Kalanter-Zadeh, K., Kang, E., Kang, S., & Han, S. (2020). Polypharmacy, hospitalization, and mortality risk: a nationwide cohort study. Sci Rep 10, 18964. https://doi.org/10.1038/s41598-020-75888-8

Deria, A. & Lee, Y. (2020). Drug use: Impact, rules, regulations, and mitigation practices in the construction industry in the U.S. Safety, 6(2). https://doi.org/10.3390/safety6020032

DrugTalkTV (2013, April 17). What is a drug test and types of drug testing [Video]. YouTube. https://www.youtube.com/watch?v=KuUCccs4njE

Guaraldo, L., Cano, F., Damasceno, G., Rozenfeld, S. (2011). Inappropriate medication use among the elderly: A systematic review administrative databases. BMC Geriatrics, 11. https://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-11-79

Inaba, D. (2011). Uppers, downers, all arounders: Physical and mental effects of psychoactive drugs. CNS Productions.

Infographics Show, The (2021, February 21). Insane drugs given to soldiers to win wars [Video]. YouTube. https://www.youtube.com/watch?v=VVEwdNrcL8o

Johns Hopkins Medicine (2016). Beyond addiction: The center for addiction and pregnancy [Video]. YouTube. https://www.youtube.com/watch?v=8spdUppJLTc

Kempf C., Llorca P-M., Pizon F., Brousse G., & Flaudias V. (2017). What’s new in addiction prevention in young people: A literature review of the last years of research. Frontiers in Psychology. 8:1131. doi: 10.3389/fpsyg.2017.01131

Khan Academy (2015, July 15). Drug use prevention – school programming and protective factors [Video]. YouTube. https://www.youtube.com/watch?v=LunoLU3XFKc

Kurczewska-Michalak M, Lewek P, Jankowska-Polańska B, Giardini A, Granata N, Maffoni M, Costa E, Midão L and Kardas P (2021) Polypharmacy Management in the Older Adults: A Scoping Review of Available Interventions. Front. Pharmacol. 12:734045. doi: 10.3389/fphar.2021.734045

Layman, H.M., Thorisdottir, I.E., Halldorsdottir, T., Sigfusdottir, I., Allegrante, J., Kristjansson, A. (2022). Substance Use Among Youth During the COVID-19 Pandemic: a Systematic Review. Current Psychiatry Reports, 24, 307–324. https://doi.org/10.1007/s11920-022-01338-z

Mburu, G., Ayon, S., Mahinda, S. & Khoshnood, K. (2020). Determinants of Women’s Drug Use During Pregnancy: Perspectives from a Qualitative Study. Maternal Child Health Journal, 24, 1170–1178 . https://doi.org/10.1007/s10995-020-02910-w

McFadden, S. (2020. January 8). Addiction: A story of stigma, a story of hope [Video]. YouTube. https://www.youtube.com/watch?v=HHiN7JftdcY