1 preventing alcohol abuse and dependence niaaa social work education module 3 (revised 3/04)

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Preventing Alcohol Preventing Alcohol Abuse and Abuse and

DependenceDependenceNIAAA Social Work NIAAA Social Work

EducationEducation

Module 3Module 3(revised 3/04)

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OutlineOutline

Prevention FrameworksPrevention FrameworksPrevention FactorsPrevention FactorsPrevention StrategiesPrevention StrategiesPrevention ExamplesPrevention Examples

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Prevention FrameworksPrevention Frameworks

What is prevention?What is prevention?Actions that minimize or eliminate Actions that minimize or eliminate

conditions known to contribute to a conditions known to contribute to a specific condition, problem, illness, or specific condition, problem, illness, or disorderdisorder

Establishing conditions that enhance Establishing conditions that enhance opportunities to achieve healthy outcomesopportunities to achieve healthy outcomes

Occurs prior to the problem appearing or Occurs prior to the problem appearing or becoming serious/severebecoming serious/severe

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Frameworks Frameworks (continued)(continued)

UniversalUniversal preventive preventive intervention is:intervention is:applied to everyone in applied to everyone in

a population, a population, regardless of risk levelregardless of risk level

benefits outweigh benefits outweigh risks/costs for risks/costs for everyoneeveryone

Universal-Selective-Indicated FrameworkUniversal-Selective-Indicated Framework

©2002 Microsoft Corporation.

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SelectiveSelective prevention is: prevention is: focused on groups focused on groups

whose risk of whose risk of developing the problem developing the problem is above averageis above average

higher “risk” level does higher “risk” level does not mean the problem not mean the problem WILL developWILL develop


Universal-Selective-Indicated FrameworkUniversal-Selective-Indicated Framework


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IndicatedIndicated prevention prevention efforts apply to efforts apply to individuals who:individuals who: exhibit specific risk exhibit specific risk

factors factors oror have conditions that have conditions that

identify them as being at identify them as being at risk for development of risk for development of the problemthe problem


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Public Health prevention Public Health prevention framework:framework: primary, primary,

secondary secondary

tertiarytertiary


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Prevention FactorsPrevention Factors

Within each type of prevention, the Within each type of prevention, the aim is to reduce the occurrence of aim is to reduce the occurrence of new casesnew cases

This is accomplished by:This is accomplished by:

decreasing risk and vulnerability factorsdecreasing risk and vulnerability factors

and/orand/or strengthening protective and resilience strengthening protective and resilience

factorsfactors

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Vulnerability and Vulnerability and ResilienceResilience

Full continuum (low to high)Full continuum (low to high) Factors intrinsic to the individualFactors intrinsic to the individual Biology (genetics, constitution, Biology (genetics, constitution,

hormonal, disability, etc.)hormonal, disability, etc.) Experiences and learning Experiences and learning

(personal history)(personal history) Behaviors and traits (e.g., Behaviors and traits (e.g.,

personality, temperament, etc.)personality, temperament, etc.)©2002 Microsoft Corporation.

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Risk and ProtectionRisk and Protection

– Family and other social Family and other social institutionsinstitutions

– Reinforcers/consequences Reinforcers/consequences (current)(current)

– Access to alcoholAccess to alcohol– Programs, policiesPrograms, policies– Resources, accessResources, access

Full continuum (low to high)Full continuum (low to high)Extrinsic to individual (environmental Extrinsic to individual (environmental

contexts):contexts):


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VULNERABILITYVULNERABILITY

LowLow HighHigh

LowLow I LowI Low II ModerateII Moderate

ProbabilityProbability ProbabilityProbability

RISKRISK

HighHigh III III ModerateModerate IV HighIV High

ProbabilityProbability ProbabilityProbability

Interaction of FactorsInteraction of Factors

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Review of Research on Review of Research on FactorsFactors

Sensation seekingSensation seeking Poor impulse controlPoor impulse control Family Family

behavior/attitudes behavior/attitudes promote alcoholpromote alcohol

Inconsistent Inconsistent parenting/disciplineparenting/discipline

Family conflict/low Family conflict/low family bondingfamily bonding

Academic Academic failure/low school failure/low school commitmentcommitment

RebelliousnessRebelliousness Early onset of Early onset of

alcohol usealcohol use

Individual and Interpersonal FactorsIndividual and Interpersonal Factors

Source: Hawkins et. al, Source: Hawkins et. al, 19921992

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Research Review Research Review (continued)(continued)

Availability of substancesAvailability of substances Economic deprivationEconomic deprivation Poor housingPoor housing Neighborhood disorganizationNeighborhood disorganization Laws/norms favoring alcohol consumptionLaws/norms favoring alcohol consumption

Source: Hawkins et. al, 1992Source: Hawkins et. al, 1992

Contextual & Other Environmental FactorsContextual & Other Environmental Factors

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Prevention StrategiesPrevention Strategies

Shift groups from a higher probability of Shift groups from a higher probability of alcohol use disorders toward a lower alcohol use disorders toward a lower probability. Utilize a combination of probability. Utilize a combination of efforts to:efforts to:

1.1. Increase protective factors Increase protective factors

2.2. Decrease risk factors Decrease risk factors

3.3. Increase resilience factors Increase resilience factors

4.4. Decrease vulnerability factors Decrease vulnerability factors

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Six domains for organizing alcohol Six domains for organizing alcohol prevention effortsprevention efforts (SAMHSA, 2001)(SAMHSA, 2001)::

Individual School

Family Community

Peer Society / Environments

Prevention Strategies Prevention Strategies (continued)(continued)

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Individual DomainIndividual Domain

– Build social and personal skillsBuild social and personal skills

– Design culturally sensitive interventionsDesign culturally sensitive interventions

– Provide alternatives for youth in high risk Provide alternatives for youth in high risk contextscontexts

– Recognize relationships between substance Recognize relationships between substance use and other health/mental health problemsuse and other health/mental health problems


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Family DomainFamily Domain

– Target entire family systemTarget entire family system– Develop bonds between and within Develop bonds between and within

familiesfamilies– Ensure cultural sensitivityEnsure cultural sensitivity– Respond to “isms”Respond to “isms”– Develop parenting skills; train parents Develop parenting skills; train parents – Offer practice opportunitiesOffer practice opportunities– Promote family communicationPromote family communication


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Peer DomainPeer Domain

– Structure alternative supervised activitiesStructure alternative supervised activities– Add social and personal skills building Add social and personal skills building

opportunitiesopportunities– Offer alternative intensive programsOffer alternative intensive programs– Communicate peer norms against alcoholCommunicate peer norms against alcohol– Involve youth in program developmentInvolve youth in program development– Involve youth in interventionsInvolve youth in interventions


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School DomainSchool Domain

– Correct prevalence misconceptionsCorrect prevalence misconceptions– Provide skills practice opportunitiesProvide skills practice opportunities– Use booster sessions to retain skillsUse booster sessions to retain skills– Involve parentsInvolve parents– Communicate commitment to Communicate commitment to

preventionprevention– Control school environment and other Control school environment and other

areasareas


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Community DomainCommunity Domain

– Develop integrated, comprehensive Develop integrated, comprehensive interventionsinterventions

– Community serviceCommunity service– Perform benefit/cost analyses (employers)Perform benefit/cost analyses (employers)– Coalition building and maintenanceCoalition building and maintenance– Assign goals, tasks, and responsibilitiesAssign goals, tasks, and responsibilities– Organize alcohol-free eventsOrganize alcohol-free events– Support a range of prevention activitiesSupport a range of prevention activities– Organize at the neighborhood levelOrganize at the neighborhood level


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Society/Environmental DomainSociety/Environmental Domain

– Media effortsMedia efforts– Beverage server training and liabilityBeverage server training and liability– Increase cost through excise taxesIncrease cost through excise taxes– Limit retail alcohol outletsLimit retail alcohol outlets– Enforce minimum age laws and other policiesEnforce minimum age laws and other policies– Feedback to merchantsFeedback to merchants– Enact/enforce impaired operations deterrence Enact/enforce impaired operations deterrence

lawslaws


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Moving from Strategies to Moving from Strategies to ProgramsPrograms

Target underlying Target underlying contributing factorscontributing factors

Consult literatureConsult literature Assess strengths, barriers, Assess strengths, barriers,

resourcesresources Develop and implement Develop and implement

programprogram Evaluate interventionEvaluate intervention

(Source: CSAP, 1995)(Source: CSAP, 1995) ©2002 Microsoft Corporation.

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Examples of Prevention Examples of Prevention ProgramsPrograms

Life Skills TrainingLife Skills TrainingSeventh Generation ProgramSeventh Generation ProgramProject NorthlandProject NorthlandCommunities Mobilizing for Communities Mobilizing for

ChangeChangeCommunity Trials ProjectCommunity Trials Project

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Program ExamplesProgram Examples

Life Skills TrainingLife Skills Training– Universal strategyUniversal strategy– Youth-targetedYouth-targeted– Cognitive behavioral psycho-educational Cognitive behavioral psycho-educational

approachapproach– 15 sessions to teach general personal and 15 sessions to teach general personal and

social skills; how to resist social influencessocial skills; how to resist social influences– Focus on problem solving, decision-making, Focus on problem solving, decision-making,

self-awareness, effective communication, self-awareness, effective communication, assertiveness, and stress reductionassertiveness, and stress reduction

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Program Examples Program Examples (continued)(continued)

Seventh Generation ProgramSeventh Generation Program– Selective (urban American Indian youth, grades 4-Selective (urban American Indian youth, grades 4-

7)7)– 13 week after-school program plus 5 week booster13 week after-school program plus 5 week booster– Grounded within American Indian cultureGrounded within American Indian culture– Corrects inaccurate stereotypes of Indian drinkingCorrects inaccurate stereotypes of Indian drinking– Enhances personal and cultural values of non-useEnhances personal and cultural values of non-use– Enhances self-esteem and Indian identityEnhances self-esteem and Indian identity– Focuses on decision making and refusal skills Focuses on decision making and refusal skills – Encourages meaningful commitment to not useEncourages meaningful commitment to not use

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Project NorthlandProject Northland– Selective (6Selective (6thth-8-8thth grade, parents, grade, parents,

community)community)– Resistance skills training with homework Resistance skills training with homework

that involved the parentsthat involved the parents– Peer-directed alcohol-free activitiesPeer-directed alcohol-free activities– Student-developed anti-alcohol plays Student-developed anti-alcohol plays

performed for parentsperformed for parents– Newsletters to parentsNewsletters to parents– Community organization efforts to develop Community organization efforts to develop

policies regarding under-age drinkingpolicies regarding under-age drinking

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Communities Mobilizing for ChangeCommunities Mobilizing for Change– Universal (change community and policies Universal (change community and policies

to reduce youth access to alcohol)to reduce youth access to alcohol)– Responsible beverage server trainingResponsible beverage server training– Shortened hours for alcohol salesShortened hours for alcohol sales– Citizen monitoring of alcohol outletsCitizen monitoring of alcohol outlets– Use of police decoys who appeared to be Use of police decoys who appeared to be

underageunderage– Educational programs for youth and Educational programs for youth and

adultsadults

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Community Trials ProjectCommunity Trials Project– Universal (reducing alcohol-related Universal (reducing alcohol-related

injury)injury)– Knowledge, values, and mobilization Knowledge, values, and mobilization – Responsible beverage service practices Responsible beverage service practices – Reduction of underage drinkingReduction of underage drinking– Increasing the “costs” of drinking and Increasing the “costs” of drinking and

drivingdriving– Reducing access to alcohol (controlling Reducing access to alcohol (controlling

outlet density and location)outlet density and location)

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ConclusionsConclusions

Social work prevention activities:Social work prevention activities:

1.1. Provide information Provide information

2.2. Promote awareness and self-efficacy Promote awareness and self-efficacy

3.3. Provide skills building Provide skills building

4.4. Provide healthy alternatives Provide healthy alternatives

5.5. Change norms Change norms

6.6. Foster community collaboration Foster community collaboration

(Source: Bush, 2000)(Source: Bush, 2000)

1 preventing alcohol abuse and dependence niaaa social work education module 3 (revised 3/04)

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selective prevention

serioussevere slide

specific risk factors

resilience factors

environmental factors

protective factors

prevention efforts

factors sensation