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Connecticut Best Practices Technical Assistance and Building Prevention Capacity to Address Prescription Drugs, Tobacco, Marijuana, and Heroin Wethersfield,

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Presentation on theme: "Connecticut Best Practices Technical Assistance and Building Prevention Capacity to Address Prescription Drugs, Tobacco, Marijuana, and Heroin Wethersfield,"— Presentation transcript:

1 Connecticut Best Practices Technical Assistance and Building Prevention Capacity to Address Prescription Drugs, Tobacco, Marijuana, and Heroin Wethersfield, CT Nov 29, 2010 Jo Romano, CAPT NE RT Associate Matt Myers, CAPT NE RT Associate

2 Objectives for the Day Increase knowledge and deepen understanding about the impact and consequences of Prescription Drug Misuse, Tobacco, Marijuana, and Heroin Identify Risk Factors and Evidence Based Strategies for the prevention of Prescription Drug Misuse, Tobacco, Marijuana and Heroin.

3 Objectives for the Day (contd.) Determine shared risk factors and strategies across problem areas including underage drinking, Prescription Drug Misuse, Tobacco, Marijuana and Heroin Examine sample community logic models for Prescription Drug Misuse, Tobacco, Marijuana and Heroin to provide effective TA to local communities Identify challenges and solutions for TA

4 Overview of Prescription Drug Misuse, Tobacco, Marijuana and Heroin Share what we know about: Prescription drug use and misuse Tobacco Marijuana Heroin Cultural considerations Availability Onset usually under 18 Low perception of harm

5 Prescription Drug Consequences Opioids, including OxyContin and Vicodin, depress the respiratory system and may be fatal if taken in large doses. Prolonged use of central nervous system depressants like Valium and Ambien can lead to serious withdrawal symptoms, including seizures 1.

6 Prescription Drug Health Consequences High doses of stimulants like Adderall and Dexedrine can cause irregular heartbeat, high body temperature, and cardiovascular failure 1. Excessive amounts of dextromethorphan, the active ingredient in over-the-counter cough medicine, can lead to vomiting, increased heart rate, high blood pressure, and impaired coordination 1.

7 Risk Factor Sample Strategy Social Access/Availability Community Norms Prior Marijuana Use Early Initiation Prescription Drugs Risk Factors and Strategies Project Northland Coalitions / Marketing Lock Medicine Cabinet Take Back Program Parent Monitoring Reconnecting Youth Parental Internet Controls

8 Risk Factor Sample Strategy Community Mobilization Skill Enhancement Training Information Dissemination Strengthening Families Parent Approval Parent/Sibling Use Lack of Awareness Perception of Harm Transitions School Climate Change Prescription Drug Risk Factors and Strategies (contd.)

9 Logic Model Community- Specific Risk Factors Long-Term Outcomes Short-Term Outcomes Strategies Resources and Inputs

10 Sample Community Logic Model Problem: Prescription Drugs Community- Specific Risk Factors Long-Term Outcomes Reduction in Use Delayed Onset Reduction in Availability Access Ease of Availability Short Term Outcomes Increased awareness of risk of improper storage Increased use of safer storage and/or disposal practices Increased demand for take-back programs Increased perception of harm or social disapproval Strategies Resources and Inputs Community Norms Perceived Risk Drug Dispersal Take-Back Program Social Marketing Lock Up Your Medicine Cabinet Collect and analyze data on the intervention Recruit local DEA or police department to staff take-back event. Collect and analyze data on the intervention Develop a marketing plan Partner with media Secure earned and paid media

11 Prescription Drug Use Some Considerations for TA Providers What drug(s)? –Pain relievers, stimulants, psychotherapeutics Non medical use or misuse (with prescription) –Different risk factors and strategies Poly-substance abusers Communities may not have resources to work with prescription monitoring programs Sources for young people are mostly social

12 Prescription Drug Use Some Considerations for TA Providers What are challenges and pitfalls communities may face when planning and implementing for Prescription Drug Misuse Prevention? What resources can you provide and/or will you need to provide effective TA?

13 Tobacco: Health Consequences Heart disease is the leading cause of death in Connecticut. Smoking is the leading cause of heart disease 3. Women who reported smoking during pregnancy were 1.5 times more likely to experience premature labor. Connecticut reports spending over $1.6 billion on health care expenditures attributable to tobacco use each year. The consequences of secondhand smoke include increased risk of respiratory illness and asthma 6.

14 Tobacco: Mental Health Consequences 45% to 88% of individuals with schizophrenia smoke cigarettes and 40% to 60% of individuals with clinically significant depression use cigarettes. These rates are substantially higher than those of the general population 7. ADHD is associated with higher rates of smoking and an earlier onset of smoking 7.

15 Risk Factor Sample Strategy Coalition Development Cessation Interventions/NOT Mentoring / Across Ages Environmental Strategies* Access and Availability Community Norms Prior Use/Mixed Drugs Onset of Use Parent/Sibling Use SMART Leaders/Life Skills Tobacco Risk Factors and Strategies

16 Risk Factor Sample Strategy Prevention Policies Information Dissemination Perception of Harm Workforce Tobacco Risk Factors and Strategies (contd.)

17 Sample Community Logic Model Problem: Tobacco Community- Specific Risk Factors Long-Term Outcomes Reduction in Lifetime Tobacco Use Easy Access to Tobacco Short-Term Outcomes Decrease in Compliance Failure Rates Increase in Accurate Perception of Smoker Prevalence Increase in Intentions Not to Smoke Strategies Resources and Inputs Normative Beliefs Prevalence estimates; Motivation to comply with other smokers; Beliefs Compliance Checks Normative Education Curriculum infusion Collect and analyze data on the intervention Recruit staff and/or train youth to conduct compliance checks Develop and distribute vendor education packets Collect and analyze data on the intervention Identify staff to design and implement intervention Vendor Education

18 Tobacco Use Some Considerations for TA Providers There are possibilities for efficient of use youth across tobacco and alcohol Youth can be effective in working on policy initiatives Counter-advertising may be an efficient, low-cost strategy Environmental scanning is a useful assessment method coalitions can employ to gather visible information on local conditions surrounding tobacco

19 Tobacco Use Some Considerations for TA Providers What are challenges and pitfalls communities may face when planning and implementing for Tobacco Prevention? What resources can you provide and/or will you need to provide effective TA?

20 Marijuana Consequences Of those individuals who initiate use during adolescence, one in six will go on to become marijuana dependent 4,6. Heavy adolescent users have shown deficits in learning, attention, and memory even after one month of abstinence 9.

21 Marijuana: Mental Health Consequences Marijuana users may have an increased risk of schizophrenia. In fact, researchers have estimated that 14% of schizophrenia diagnoses could be prevented if marijuana use was similarly prevented 3,4. Heavy marijuana use has also been linked to depression, suicide, and panic disorder 3,5.

22 Community Mobilization Project Northland Environmental Strategies Keepin It R.E.A.L. Risk Factor Sample Strategy Access/Availability Community Norms Early Age of Onset Peer Approval Marijuana Risk Factors and Strategies

23 Social Refusal Skills Guiding Good Choices Drug Free School Zone Social Norms Campaign Risk Factor Sample Strategy Prior Use/Mixed Use Peer Use School Performance Perception of Harm Marijuana Risk Factors and Strategies (contd.)

24 Sample Community Logic Model Problem: Marijuana Community- Specific Risk Factors Long-Term Outcomes Reduction in Lifetime Marijuana Use Reduction in Delinquency Academic Failure Short-Term Outcomes Increase in School Bonding Improved Academic Achievement Reduction in Problem Behavior Strategies Resources and Inputs Lack of Commitment Low Bonding to School Academic Skills Enhancement Enhanced Socialization Social Support Collect and analyze data on the intervention Purchase curriculum, train teachers, provide booster sessions Collect and analyze data on the intervention (e.g., Raising Healthy Children) Provide teacher/ staff development workshops Provide booster session Interactive Curriculum

25 Marijuana Use Some Considerations for TA Providers Available literature is largely focused on illicit drug use The relationship between drugs and crime is key Perception of harm and social disapproval are influenced by the observance of peers using Reduced influence of parental attitudes from middle to high school Easy social access is a strong factor Environmental strategies are being studied Parental monitoring shows promise

26 Marijuana Use Some Considerations for TA Providers What are challenges and pitfalls communities may face when planning and implementing for Marijuana Prevention? What resources can you provide and/or will you need to provide effective TA?

27 Enjoy Lunch!

28 Heroin: Health Consequences 35% of admissions to drug and alcohol treatment programs in Connecticut during 2006 listed heroin as the primary substance of dependence 3. Heroin dependence is associated with serious withdrawal symptoms, including vomiting, cold flashes, joint pain, insomnia, intense craving for the drug, and involuntary movements. If a heavily dependent user is already in poor health, sudden heroin withdrawal may lead to death 4

29 Heroin: Health Consequences Street heroin can contain toxic additives that damage the cardiovascular system, causing serious and permanent damage to vital organs. Questions around drug purity and dose can lead to fatal overdose 4. Prolonged use can lead to collapsed veins, diseases of the liver and kidney, infection of heart valves and lining, and serious damage to the respiratory system 4. Injection of heroin can put users at risk for infectious disease, including HIV/AIDS and Hepatitis 4.

30 Heroin: Mental Health Consequences Psychiatric disorders are common among those with substance use disorders. National data have demonstrated that about 20% of those with a current substance use disorder also have at least one current mood disorder, and 18% have at least one current anxiety disorder 6. Nearly one-third of adolescents in treatment for heroin dependence/abuse have a co-occurring psychiatric disorder 5.

31 Heroin Cultural Considerations Heroin abuse among women who are pregnant may result in spontaneous abortion 4. Heroin abuse during pregnancy and associated factors like poor prenatal care and nutrition can lead to low birth weight, which can put babies at risk for later developmental delay 4. Infants born to mothers who have regularly abused heroin during pregnancy may be born heroin dependent, which can result in serious medical complications for the baby 4.

32 Project Northland Harm Reduction Approach Civil Anti-Drug Remedies Risk Factor Sample Strategy Access/Availability Prior Use Age of Onset Heroin Risk Factors and Strategies Treatment

33 Counseling Family Management Risk Factor Sample Strategy Family Conflict Child Abuse Heroin Risk Factors and Strategies (contd.)

34 Sample Community Logic Model Problem: Heroin Community- Specific Risk Factors Long-Term Outcomes Reduction in Lifetime Heroin Use Reduction in Delinquency Perception of Harm Short-Term Outcomes Increased Perception of Harm of Heroin Use Increased Access to Mental Health and Treatment Services Improved Access to Parenting Skills Training via Drug Court Referrals Strategies Resources and Inputs Low Parental Care Family Conflict Curriculum Drug Court Collect and analyze data on the intervention Curriculum, teacher training Hire and train community outreach workers Collect and analyze data on the intervention Court and enforcement partnerships Community Outreach Worker Education and Referral

35 Heroin Use Some Considerations for TA Providers Difficult to influence access to diverted pharmaceuticals Can be difficult to define and access the target population Some strategies are considered risk reduction Non-traditional sectors need to play strong roles –Prescribers, treatment, criminal justice, hospitals

36 Heroin Use Some Considerations for TA Providers What are challenges and pitfalls communities may face when planning and implementing for Heroin Prevention? What resources can you provide and/or will you need to provide effective TA?

37 What is a Health Disparity? Health disparities (also called healthcare inequality in the U.S.) refer to gaps in the quality of health and health care across racial, ethnic, sexual orientation and socioeconomic groups. The Health Resources and Services Administration defines health disparities as "population-specific differences in the presence of disease, health outcomes, or access to health care."

38 Special Populations Sexual Orientation: LGBT Active Military and Veterans Homeless Older Adults Women Youth Race Ethnicity: African Americans, Alaska Natives, American Indians, Asian Americans, Hispanics/Latinos, and Pacific Islanders

39 Contributing Factors to Disparity Poverty Access to health care Individual and behavioral factors Educational inequalities Disability Geographic location: urban or city Mental Illness

40 How Are Disparities Interrelated? Example: Education and Health High level of education brings longer life span, easier access to health services Less education predicts higher levels of health risks such as obesity, substance abuse and violence Good health is associated with academic success Poor health predicts substance abuse, inadequate physical activity, emotional abuse, teen pregnancy, and poor performance in school

41 Multi-Cultural Risk Factors and Strategies Risk Factor / Causal Factor Sample Strategies Integrated Care Families Veterans/MilitaryEducational InequityYoung Mothers Lock The Medicine Cabinet Campaign Poverty Project Northland Home Visits Guiding Good Choices Maternal SmokingMental Health Nurse/Family Partnerships Cognitive Behavioral Therapy

42 Common Risk Factors Across Multiple Problems Tobacco, alcohol, marijuana, prescription drug misuse, heroin, other drug use, anti-social behavior, depression, sexual behavior and drunk/drugged driving are common among young people (Biglan, Brennan, Foster, & Holder, 2004) These problems are interrelated; moreover the same young people tend to engage in multiple problem behaviors The approach should concentrate on affecting the risk and protective factors influencing the involvement with multiple problems

43 Behavioral Health Connections to Substance Abuse Substance Abuse Mental Health Problems DepressionSuicide Serious Psychological Distress

44 Success with Common Risk Factors The Seattle Social Development Project (SSDP) shows that 15 years after a childhood intervention ended: 11% had fewer mental health disorders* 12% had fewer STDs* 9% were at or above the median in socio-economic * attainment SSDP is a long term study and intervention that looks at the development of positive and problem behaviors among adolescents and young adults. * Results are in comparison to the control group used for the study.

45 Finding the Fit The following are three criteria that determine the best fit to include in a comprehensive prevention plan: Conceptual fit: Is the intervention relevant? Practical fit: Is the intervention appropriate? Strength of evidence: Is the intervention evidence- based?

46 Working Across Sectors Start with who is at the table Think strategically about new partnerships Develop an outreach strategy Create a plan for tracking changes in multiple problems

47 Risk Factor Community Specific Risk Factor(s) Strategy Sector or Domain Strategy Sector Primary Priority Secondary Priority Risk Factor Goal: To identify a risk factor that is common to both underage drinking and your second priority Pre-populate the chart. Include: –Community-specific risk factors (your choice) for underage drinking –Identified strategies –Community sectors with which you are already working Add your second priority –Include risk factors, strategies, and sectors with which you will work Analyze –Review the chart. Look for risk factors that have the potential to efficiently impact multiple drugs or problems –Look for similar strategies in the same sector or domain Cross-Walking Risk Factors

48 Enforcement Levels Early Initiation Access Community Specific Risk Factor(s) Strategy Partner or Sector 1) Party Patrols 1) Law Enforcement Underage Drinking Marijuana Social Competence 1) Compliance Checks 1) Business 2) Project Alert 2) School 1) After-School Program 1) School 2) School 2) After-School Program Already Identified Risk Factors Data Sources in Binder Strategy Tables in Binder Risk Factor for Second Priority Literature Review in Binder Risk Factor for Second Priority Literature Review in Binder Already- Identified Risk Factors

49 Cross-Walking Risk Factors : Create An Example Text Community Specific Risk Factor(s) Strategy Partner or Sector Underage Drinking Prescription Drugs Text

50 Primary Health Care Talking Points for TA Providers Substance abuse, mental health and primary health care share risk factors Substance use and abuse contributes to physical and mental health conditions early on Poor primary care contributes to substance abuse Patients not diagnosed and often not treated

51 Analyzing Risk Factors Thinking through Risk Factors that Cross Multiple Problems

52 Gambling and Alcohol Conceptual Model of Hypothesized Predictors of Youth Problem Behaviors Socialization Factors Parental Monitoring, Peer Delinquency Individual Factors Impulsivity, Moral Disengagement Gambling Alcohol Misuse Delinquency Drug Use Socio-demographic Factors Gender, Age, Race, SES Source: Shared Predictors of Youthful Gambling, Substance Use, and Delinquency 2007

53 Suicide and Alcohol Depression Other Risk Behaviors (Alcohol-Related Consequences Suicide- Related Behavior Alcohol Use

54 Selecting Common Risk Factor(s) Considerations for TA Providers Resources, focus on primary priority –Efficiency is critical with the secondary priority Relative strength of the relationship of risk factor to the priority –All risk factors are not equal Age of target population –Factors gain and lose strength as the target ages Similar strategies and domains –Practical, conceptual, levels of evidence

55 Risk Factors Across Problem Areas Some Considerations for TA Providers What are challenges and pitfalls communities may face when planning and implementing for Risk Factors across Problem Areas? What resources can you provide and/or will you need to provide effective TA?

56 TA Challenges and Next Steps Identify challenges and pitfalls you may face when providing TA Find solutions to meet those challenges

57 Next Steps: Planning for TA Strategic plan for TA roll-out Guidance document Community training Community assessment tool Tool development What resources do you need from whom? What else?

58 Resources and Take-Aways


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