International Standards on Drug Use Prevention. UNODC/ WHO Second Updated Edition. Wadih Maalouf, Ph.D.

Transcription

1 Prevention that WORKS! Healthy and safe development of children and youth International Standards on Drug Use Prevention UNODC/ WHO Second Updated Edition Wadih Maalouf, Ph.D. Global Programme Coordinator Division of Operation Drug Prevention and Health Branch Prevention, Treatment and Rehabilitation Section : wadih.maalouf@un.org

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3 "Our joint commitment to effectively addressing and countering the world drug problem" We reaffirm our determination to tackle the world drug problem and to actively promote a society free of drug abuse in order to help to ensure that all people can live in health, dignity and peace, with security and prosperity, and reaffirm our determination to address public health, safety and social problems resulting from drug abuse. Increase the availability, coverage and quality of scientific evidence-based prevention measures and tools that target relevant age and risk groups in multiple settings

4 Prevention that WORKS! Healthy and safe development of children and youth International Standards of Drug Use Prevention What is prevention, how it works and why it is important?

5 Traditional approaches (scare tactics, fear arousal) J u s t s a y N DRUGS (focus on resisting peer pressure) (information provision)

6 .. drug use is not caused by lack of information but what would be better factors explaining and predicting drug use? Satisfaction with the prevention program? Academic performance? Warm and close communication with parents? Exposure to drugs and drug use? Selfesteem? Awareness of risks? Having many best friends? Pro-social attitudes? Conflicts? Ability to control emotions?

7 Shifting the paradigm Prevention as science/ science guiding practice Initiation to substance use is not the result of a free choice but an interplay of internal and external risk and protective factor. To prevent a problem before it happens, the factors that predict the problem must be changed.

8 Forming the evidence base for prevention Brain function in a social context

9 Prevention = supporting children and young people to reach their developmental goals

10 Developmental Phases Each stage of development, from infancy to early adulthood, is associated with a certain expected range of: intellectual ability language development cognitive, emotional and psychological functioning social competency skills Each needs attention to prevent the onset of drug use and dependence!!!

11 Drug use is a developmental problem Wagner, F. A., & Anthony, J. C. (2002). From first drug use to drug dependence; developmental periods of risk for dependence upon marijuana, cocaine, and alcohol. Neuropsychopharmacology, 26(4),

12 Even under normal conditions, the adolescent prefrontal cortex is not completely connected! Movement Sensation Judgment Vision Reward Coordination Memory Pain

13 The Imbalanced Adolescent Brain Emotional responses are heightened Double Jeopardy! Cognitive controls are immature Emotional Reactivity Cognitive Regulation

14 Infancy Protective Traits, Skill Sets & Experiences: Responsiveness to the environment and caregivers interactions Caregivers who are responsive Surroundings that provide stimulation Learning how to be effective in having needs met Easy to soothe Not temperamental

15 Early Childhood Factors Predictive of Later Social Competence: Language Cooperation Control of emotions Collective conscience Social and emotional skills (including perception of others emotions) Problem solving

16 Middle Childhood Emergent Executive Cognitive and Emotional Regulatory Functions: Maintaining attention Controlling emotions Social inclusivity Effective communication Receptivity to others Accurate perception of emotion

17 Adolescence Integral to self-regulation of emotion and behavior: Social and emotional skills to establish stable relationships Sensitivity to feelings & needs of others Conflict resolution Prosocial skills Impulse control

18 In summary: Each developmental phase has specific goals/ markers of successful development Each phase has different risk and protective factors, that interact with each other and influence development Prevention needs to look different for each targeted age! Some phases transitions can be especially critical/ vulnerable!

19 Environmental and Personal Influences impacting Developmental Outcomes

20 Interaction of Personal Characteristics and the Micro- and Macro-Level Environments

21 Therefore, Multiple settings! Multiple ages!

22 Vulnerabilities that are common to many risky behaviours (1/3)

23 Vulnerabilities that are common to many risky behaviours (2/3)

24 Vulnerabilities that are common to many risky behaviours (3/3)

25 In particular, against youth violence and child maltreatment

26 Why is Drug Use Prevention Important? Substance use prevention = Supporting healthy development in general, preventing MANY risky behaviours and health conditions

27 First edition SECOND EDITION!!!

28 How do they compare?

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32 #ListenFirst

33 DOES THE EVIDENCE SUPPORTS THE FACT THAT PREVENTION WORKS?

34 Example of results early childhood education (Campbell et al 2002)

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36 Example: Meth Initiation Results at 4½ Years Past Baseline (when life skills based prevention (LST) only, and when in combination with parenting skills (SFP) Source: Spoth, R., Clair, S., Shin, C., & Redmond, C. (2006). Long-term effects of universal preventive interventions on methamphetamine use among adolescents. Archives of Pediatrics and Adolescent Medicine, 160,

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40 Source: National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, USA

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42 Source: Duailibi, S.; Ponicki, W.; Grube, J.; Pinsky, I.; Laranjeira, R.; and Raw, M. "The effect of restricting opening hours on alcohol-related violence," American Journal of Public Health, 97(12): , 2007.

43 Source: Duailibi, S.; Ponicki, W.; Grube, J.; Pinsky, I.; Laranjeira, R.; and Raw, M. "The effect of restricting opening hours on alcohol-related violence," American Journal of Public Health, 97(12): , 2007.

44 100 Effects of Smoking Ban In France on Smoking Prevalence Percent Bars Restaurants Workplaces Source: Fong, G.T., Craig, L.V., Guignard, R., Nagelhout, G.E., Tait, M.K., Driezen, P., Kennedy, R.D., Boudreau, C., Wilquin, J-L., Deutsch, A., and Beck, F. (2013). Evaluation of the smoking ban in public places in France one year and five years after its implementation: Findings from the ITC France survey. Bulletin Epidemiologique Hebdomadaire (Paris France), 20:

45 Environmental policies in the context of a comprehensive EB prevention system They are effective but: Changes in legislations are costly To be effective require an engagement at the community level in its different social structures. This engagement can be done through a process of activating all elements discussed in the standards The sum of these elements make these environmental policies more feasible and effective

46 Why Implement Evidence-Based Practices? Disadvantages May appear to go against conventional wisdom Requires new skills and specialized training Challenge of fidelity of implementation and adaptation to the specific needs of the target group and population and the availability of resources Requires monitoring and assessments

47 Forming the evidence base for prevention Brain function in a social context

48 Why Implement Evidence-Based Practices? Advantages Gives target groups and populations the best interventions, techniques, and policies that are available Offers the possibility to deliver services in a more effective and efficient way Provides a more rational basis to make policy decisions Possibility to achieve continuity and more uniformity of service delivery > enables to monitor and evaluate what is done Possibility to know for sure what are the outcomes, and to improve Clarification on missing links and shortcomings in our current scientific knowledge

49 Why Implement Evidence-Based Practices? Advantages It works. It is ethical.

50 USES OF THE STANDARDS? Back up and support political decision w scientific evidence Gives insight on ongoing interventions not previously considered part of drug prevention strategy Strengthen drug prevention response by cross check ongoing programme suitability and match with age/risk group, characteristics that makes it effective/not/iatrogrenic. Identify gaps in Strategy where you have not capitalized on and where additional programmes of support are needed Help you meet your development goals, cross support ongoing strategies (crime, violence, violence against children, education, etc )

51 TAKE HOME MESSAGES

52 Message #1 Do NOT improvise

53 Message #2 There are MANY strategies that are effective in preventing substance use

54 Message #3 Evidence-based prevention strategies prevent also many other risky behaviours, promoting the healthy & safe development of children & youth

55 Message #4 The earlier the better

56 Message # 5 It is never too late

57 Message # 6 Let us use our resources better

58 OK, I will try again There is a science behind drug prevention What sounds intuitively good very often has been shown NOT TO WORK, or, worse, TO HAVE BEEN COUNTERPRODUCTIVE Use an evidence-based programme See the Standards and the registries If not, base your self on empirical research, theories of behavioural change, and EVALUATE the EFFECTIVENESS of your programme

59 Break the negative cycle!

60 Start a new positive cycle!

61 UNODC and WHO Ms. Giovanna Campello Ms. Hanna Heikkila Ms. Asma Fakhri Ms. Heeyoung Park Ms. Shima Shakory-Bakhtiar Ms. Elena Gomes de Matos Mr. Ludwig Kraus Ms. Nandi Siegfried Ms. Valentina Baltag Ms. Faten Ben Abdel Aziz Dr Dzmitry Krupchanka Ms. Susan Norris Dr. Vladimir Poznyak

62 Prevention that WORKS! Healthy and safe development of children and youth International Standards on Drug Use Prevention UNODC/ WHO Second Updated Edition Wadih Maalouf, Ph.D. Global Programme Coordinator Division of Operation Drug Prevention and Health Branch Prevention, Treatment and Rehabilitation Section : wadih.maalouf@un.org