New Directions California. Prevention Panel

Transcription

1 New Directions California Prevention Panel Jeffery N. Wilkins, M.D., DFAPA, FASAM Lincy / Heyward-Moynihan, Chair in Addiction Medicine Vice Chair, Dept. of Psychiatry Cedars-Sinai Med Center Professor, Dept. of Psychiatry David Geffen School of UCLA

2 Conflict of Interest Disclosure Jeffery N. Wilkins, M.D. Member, Board of Directors Psychological Trauma Center Brent Shapiro Foundation for Drug Awareness California Society of Addiction Medicine (also, President-Elect)

3 Definitions of Prevention Primary, Secondary, and Tertiary Universal, Selective and Indicated Prevention Environmental

4 Primary, Secondary, Tertiary 1. Primary prevention avoids the development of a disease (e.g. majority of population-based health promotion activities). 2. Secondary prevention activities are aimed at early disease detection (e.g. increasing opportunities for interventions to prevent progression of the disease and emergence of symptoms Early Detection/Early Intervention) 3. Tertiary prevention reduces the negative impact of an already established disease by restoring function and reducing disease-related complications.

5 Universal, Selective, Indicated Addresses entire population (national, local community, school, district) with aim to prevent or delay problems. No screening process. Focus on groups with greatest risk of developing problems (e.g. screened by age, gender, family history, economic status, etc.) Screening process identifies individuals who exhibit early signs of problems. Gordon (1987), Kumpfer and Baxley (1997)

6 Prevention of Substance Abuse Universal School curriculum, education-based assemblies, etc. Selective Special programs for students identified with mental health problems (e.g. learning disorders, anxiety, depression, psychotic or personality disorders) Indicated Screening of students for presence of active or historical substance abuse, falling grades, conduct disorders, alienation from parents, school, and positive peer groups etc.

7 Environmental Prevention Targets regulatory or community level. Interventions focused to deter developing problem Examples Bans on smoking in workplace, alcohol advertising Government monopolies for alcohol sales Roadside sobriety or drug tests Worker/pupil/student drug testing/backpack searches Increased policing in sensitive settings (near schools, at rock festivals) Legislative guidelines aimed at precipitating punishments (warnings. fines, criminal prosecution).

8 Examples of Preventive Medicine Hand washing and immunizations Various examinations and screening tests tailored to an individual's age, health, and family history Where is Alcohol, Drug and Smoking Prevention?

9 Proposed Federal Five-Fold Demand Reduction Initiative A. Thomas McLellan, Ph.D., former Deputy Director of the Office of National Drug Control Policy 1. Create a national system of evidence-based Prevention Prepared Communities 2. Train mainstream healthcare to screen and intervene in emerging substance abuse problems 3. Expand and incorporate addiction treatment into mainstream healthcare. 4. Create protocols for safe management of drug-related offenders within the community 5. Collect and report performance-oriented indicators of substance use and use-related problems

10 Select References: Gordon, R. (1987), An operational classification of disease prevention, in Steinberg, J. A. and Silverman, M. M. (eds.), Preventing Mental Disorders, Rockville, MD: U.S. Department of Health and Human Services, Kumpfer, K. L., and Baxley, G. B. (1997), 'Drug abuse prevention: What works?', National Institute on Drug Abuse, Rockville.