Presentation on theme: "EPIDEMIOLOGY OF DRUG ABUSE: A REFRESHER MODULE ON DRUG ABUSE RESEARCH Meeting Of Caribbean National Observatories In Drugs Bridgetown, Barbados June 14-16,"— Presentation transcript:
EPIDEMIOLOGY OF DRUG ABUSE: A REFRESHER MODULE ON DRUG ABUSE RESEARCH Meeting Of Caribbean National Observatories In Drugs Bridgetown, Barbados June 14-16, 2005 Dr Ken-Garfield Douglas
What would the presentation cover? Elements of drug abuse epidemiology The current state of the science (new methods, new challenges, new issues) Qualitative methods highlighted Consideration in going from research to policy to practice Lessons learned from quantitative research in the Caribbean (school surveys)
Working definitions (drug abuse research) Drug abuse research help countries to obtain better information about the nature and extent of drug use and drug abuse It provides systematic methods to collect qualitative data about drug use and quantitative data on patterns and consequences of drug use or abuse
What is the focus of epidemiological research Drug abuse epidemiologic research focuses on understanding the nature, extent, consequences, and etiology of drug abuse across individuals, families, age groups, gender, communities, and population groups.
What is the role of epidemiological research Epidemiologic research plays a critical public health role by providing an estimate of the magnitude, impact, and risk of drug abuse on a population
What are some of the outputs of epidemiological research Lays the foundation for: developing strategies to treat and prevent drug abuse plan and evaluate drug abuse services; and suggest new areas for basic, clinical, and treatment research.
What is the true value of drug abuse research? The value of drug abuse research lies in the dissemination of research information which helps to address the issue of public perceptions about drug abuse and at the same time educates the public about drug abuse and addiction.
The value of what we have done The vast majority of our epidemiology research had been quantitative in nature Not much of the information collected have be consistently disseminated in- country and region-wide Most of our present knowledge comes from generic research conducted outside the region
Present knowledge gaps for the region The origins and pathways to drug abuse – a comprehensive understanding of the factors and processes that predisposes and or protects and individual from drug abuse Drug use and adverse behavioural and social consequences – and understanding of the nature and extent of drug-related consequences and their development
Present knowledge gaps for the region Application of applicable research methodologies that screens clients to appropriate treatment modalities A notable lack of multiple/logistic regression analysis Research/evaluation on the effectiveness of our prevention programmes (Are they tested-effective, what fruits are they bearing)
Present innovative methodologies (new methods, challenges and issues) The application of social work and social science theory and methods in substance abuse research Triangulation of methods (combining qualitative and quantitative approaches) Computer assisted approaches for collecting data have promise
Present innovative methodologies (new methods, challenges and issues) The Use of Geographic Information Systems (GIS); e.g. in assessing substance abuse prevention resource Operational research particularly around standardizing treatment and prevention practices The twin epidemic – the spread of HIV disease primarily in the context of illicit drugs use
Lets unravel the issues around: “the pathways to drug abuse” The major emphasis has been to stimulate innovative investigations that enhance our understanding of: (1) drug use patterns and trends within and across populations; (2) interplay of social interactions, social environment, structural context with individual behavioural characteristics and genetic vulnerability;
The pathways to drug abuse (3) causal mechanisms leading to onset, maintenance, and remittance of drug abuse, as well as protective mechanisms that reduce the risk of drug abuse; and (4) drug abuse over the life course, including developmental processes that influence drug use trajectories and behavioural, health, and social consequences of drug abuse.
The pathways to drug abuse Some cross-cutting issues in drug abuse research: gender differences in the nature and extent of drug-using behaviours, in the pathways and determinants of initiation, progression and maintenance of drug abuse HIV/AIDS and drug abuse are frequently referred to as twin epidemics, and whenever possible, it is essential that epidemiologic studies address this interrelationship
The pathways to drug abuse Some cross-cutting issues in drug abuse research: Methodological innovations should seek to address transitions in stages and trajectories of drug abuse, inter- generational transmission of drug abuse, and heterogeneous pathways to and consequences of drug abuse.
The pathways to drug abuse Examples of the types of research topics to be explored under pathways to drug abuse include, but are not limited to, the following: Emerging and current trends Social epidemiology of drug abuse Drug abuse psychopathology: co-morbidity and vulnerability Developmental consequences of drug abuse Social and behavioural consequences of street drugs Drug markets and behaviour economics
The pathways to drug abuse - Social epidemiology of drug abuse Drug abuse research has focused largely on individual risk factors, while the universe of determinants includes individual, family, neighbourhood, community, population-specific, and societal factors Lets briefly look at some findings from a regional study in the area of social epidemiology (risk and protective factor study secondary school students)
What are risk and protective factors? Risk factors are characteristics in the community, family, school and individual’s environments that are known to increase the likelihood that a student or individual will engage in one or more problem behaviors Protective factors are characteristics that are known to decrease the likelihood that a student will engage in problem behaviors National Drug Commission – February ‘04
What did the survey find? Risk Factors: Of the 22 risk factors evaluated – three groups can be identified: Those of great concerns (overall scores above the normative average of 50 points) Those of border-line concerns (below the normative score but within overall average of 47 points) Those of no particular concern (below the overall survey average score of 47 points) National Drug Commission – February ‘04
Risk factors of great concern Community disorganization Poor academic performance Laws and norms favourable to drug use Friends’ delinquent behaviour Personal transition and mobility Low neighbourhood attachment Gang involvement National Drug Commission – February ‘04
Risk factors of borderline concern Poor family supervision Poor family discipline Parental attitude favourable towards anti-social behaviour Peer reward for anti-social behaviour Parental attitude favourable towards ATOD National Drug Commission – February ‘04
Overall protective factors scores National Drug Commission – February ‘04 Base/average
Triangulation revisited: (Qualitative Research) Qualitative methods – has an emphasis on process and an in-depth understanding of perceived meanings, interpretations and behaviours It gives an internal perspective It is the kind of research that produces findings not derived from statistical procedures or other means of quantification.
Qualitative Research Qualitative methods are significant for drug abuse research because it helps not only in the design of questionnaires but also to help formulate meaningful research questions, conduct appropriate statistical analysis and even interpret the results
Qualitative Research Key components of Qualitative research 1. Ethics and informed consent (some guidelines) the purpose of the research and the potential risks must be made explicit to the subjects they must have the right to choose whether or not to participate the researcher responsibility is to determine that no harm may come to the subject as a result of participation
Qualitative Research 2. Observation 3. Qualitative interviews 4. Analysis of the textual data (content analysis) 5. Experienced/qualified investigators (usually ethnographers or researchers with background in anthropology and sociology)
From Research to Policy to Practice Research (gathering the evidence) Policy (applied guiding principles and strategies) Practice (activities/programmes) Our key question – “Of what value is research in making this link?”
From Research to Policy to Practice Effective strategies to deal with the problems of drug abuse must be "as complex as the problem itself Success will be found only when public safety and public health professionals use science and not ideology as the foundation of those strategies policies should be based on the best available knowledge and analysis and should be judged by the results they produce rather than by the intentions they embody
From Research to Policy to Practice One needs to be cautious about over-generalizing from any particular research finding, however many studies of substance abuse and crime offer direction for a "fundamental rethinking of our current practices" and for new public policy initiatives
Some practical application Lets look at these data points and rationalize the possible next steps in terms of policy and practice (programmes or interventions)
STATUS OF INMATES and DRUG USE AT RECEPTION PERCENTAGE DISTRIBUTION POPULTHCOPIATESCOCAINEPOLYUSE CONVICTED REMAND CIVIL OFFENCE
Treatment, rehabilitation and perceived need for treatment 22% had been in treatment 41% had counseling or rehabilitation 25% perceive the need for treatment In addition, of those in need of treatment: 47% positive for marijuana 47% positive for marijuana 63% positive for cocaine 63% positive for cocaine 42% positive for opiates (heroin) 42% positive for opiates (heroin)
NEEDS ASSESSMENT HIGH LEVEL OF USE HIGH PERCEIVED NEED FOR TREATMENT PREVIOUS CONTACT WITH TREATMENT, COUNSELING OR REHABILITATION FAILED PSYCHOMETRIC TEST TREATMENT
Figure 1: Prevalence of Cigarette Use
Figure 10: Prevalence of Inhalant Use
Figure 13: Age of First Use of Cigarette
Figure 16: Age of First Use of Inhalants
What now? More research? Greater emphasis on advocacy? More/better interpretation of our information into actions?
My recommendation A monograph of all the current research (last five years) done in the region Making the information available on line Translating the information into possible credible actions: from a policy perspective as well as from a practice perspective (implications and possible best practices in terms of programmes and interventions)