Prevention of problem gambling March 27th, Lethbridge The evidence for prevention: Lessons from the substance abuse field

Prevention of problem gambling March 27th, Lethbridge Aim To suggest a framework for organizing prevention research, policy, programming To identify evidence-based prevention measures To introduce Health Canada’s prevention principles Sources: Health Canada’s compendium of best practices (2001) Holder’s review of prevention research (2003) WHO review of evidence for substance abuse prevention (2003) To suggest a framework for organizing prevention research, policy, programming To identify evidence-based prevention measures To introduce Health Canada’s prevention principles Sources: Health Canada’s compendium of best practices (2001) Holder’s review of prevention research (2003) WHO review of evidence for substance abuse prevention (2003)

Prevention of problem gambling March 27th, Lethbridge Method for identifying evidence-based practices clear goals targets for the review review of review approach two or three targeted search on poorly represented areas rated articles for quality of research design and outcomes identify best rated programs identify themes arising from these programs clear goals targets for the review review of review approach two or three targeted search on poorly represented areas rated articles for quality of research design and outcomes identify best rated programs identify themes arising from these programs

Prevention of problem gambling March 27th, Lethbridge Problems have not developedProblems have developed Traditional Public Health Model Primary Prevention Secondary PreventionTertiary Prevention Institute of Medicine Model (US) Universal PreventionSelective Prevention Indicated Prevention Treatment

Prevention of problem gambling March 27th, Lethbridge Universal prevention Target: general population not experiencing substance use problems not especially at risk Aim: to prevent, or delay use or abuse Data of interest: age of first use, past month and 12 month use patterns (age & gender differences), frequency & quantity Evidence based responses: environmental policy measures (taxation, minimum age laws); educational (social influences life skills training) and media campaigns. Target: general population not experiencing substance use problems not especially at risk Aim: to prevent, or delay use or abuse Data of interest: age of first use, past month and 12 month use patterns (age & gender differences), frequency & quantity Evidence based responses: environmental policy measures (taxation, minimum age laws); educational (social influences life skills training) and media campaigns.

Prevention of problem gambling March 27th, Lethbridge Selective prevention Target: Youth/families experiencing particular challenges due to various risks: academic problems, family dysfunction, poverty, or family history (that may include genetic predisposition) Aim: reduce the influence of these risks and prevent or reduce substance use problems by building on strengths such as coping strategies and other life skills Data of interest: percent facing various risk factors Evidence based responses: headstart programs, family programs, Eggert’s progam Target: Youth/families experiencing particular challenges due to various risks: academic problems, family dysfunction, poverty, or family history (that may include genetic predisposition) Aim: reduce the influence of these risks and prevent or reduce substance use problems by building on strengths such as coping strategies and other life skills Data of interest: percent facing various risk factors Evidence based responses: headstart programs, family programs, Eggert’s progam

Prevention of problem gambling March 27th, Lethbridge Indicated prevention Target: those who abuse substances but do not meet the criteria for dependency Aim: to reduce substance abuse and prevent dependency Data of interest: binge use, hazardous drinking, driving after drinking or cannabis use, experiencing 2 or more substance use problems, unable to stop using, being warned by police Evidence based responses: motivational approaches; family-based approaches Target: those who abuse substances but do not meet the criteria for dependency Aim: to reduce substance abuse and prevent dependency Data of interest: binge use, hazardous drinking, driving after drinking or cannabis use, experiencing 2 or more substance use problems, unable to stop using, being warned by police Evidence based responses: motivational approaches; family-based approaches

Prevention of problem gambling March 27th, Lethbridge Building a Strong Framework Address protective and risk factors Seek comprehensiveness Ensure sufficient program duration and intensity Address protective and risk factors Seek comprehensiveness Ensure sufficient program duration and intensity

Prevention of problem gambling March 27th, Lethbridge Striving for Accountability Base program on accurate information Set clear and realistic goals Evaluate the program Address program sustainability from the beginning Base program on accurate information Set clear and realistic goals Evaluate the program Address program sustainability from the beginning

Prevention of problem gambling March 27th, Lethbridge Understanding and Involving Young People Recognize youth perceptions of substance use Account for the implications of adolescent development Involve youth in program design and implementation Recognize youth perceptions of substance use Account for the implications of adolescent development Involve youth in program design and implementation

Prevention of problem gambling March 27th, Lethbridge Creating an Effective Process Develop credible messages Combine knowledge and skill development Use interactive group process Give attention to teacher or leader qualities and training Develop credible messages Combine knowledge and skill development Use interactive group process Give attention to teacher or leader qualities and training

Prevention of problem gambling March 27th, Lethbridge Harmful / iatrogenic effects Negative effects can occur through prevention single vs multiple drugs prevention for those already using resistance skills when not accompanied by normative info antisocial behaviour when grouping high risk youth Negative effects can occur through prevention single vs multiple drugs prevention for those already using resistance skills when not accompanied by normative info antisocial behaviour when grouping high risk youth

Prevention of problem gambling March 27th, Lethbridge Sources Prevention of psychoactive substance use: a selected review of what works in the area of prevcention, World Health Organization, Feb Strategies for reducing substance abuse problems: what research tells us. Unpublished paper presented at Kettil Bruun Society mtg, Fremantle, Australia, Feb 2003 Health Canada, Preventing substance use problems: a compendim of best practices, Prevention of psychoactive substance use: a selected review of what works in the area of prevcention, World Health Organization, Feb Strategies for reducing substance abuse problems: what research tells us. Unpublished paper presented at Kettil Bruun Society mtg, Fremantle, Australia, Feb 2003 Health Canada, Preventing substance use problems: a compendim of best practices,

Prevention of problem gambling March 27th, Lethbridge Thank you! The CCSA provides a national focus for efforts to reduce health, social and economic harm associated with substance abuse and addictions Thank you! The CCSA provides a national focus for efforts to reduce health, social and economic harm associated with substance abuse and addictions

Prevention of problem gambling March 27th, Lethbridge Themes Identified Building a strong framework Striving for accountability Understanding and involving young people Creating an effective process Building a strong framework Striving for accountability Understanding and involving young people Creating an effective process

Prevention of problem gambling March 27th, Lethbridge Compendium contents Discussion on trends in use (Canadian) Discussion on 14 prevention principles 33 programs from the published literature that produce positive outcomes from sound empirical approach 39 Canadian programs that reflect prevention principles Discussion on trends in use (Canadian) Discussion on 14 prevention principles 33 programs from the published literature that produce positive outcomes from sound empirical approach 39 Canadian programs that reflect prevention principles

Prevention of problem gambling March 27th, Lethbridge Classification of Programs