Illicit Drugs Use And Prevention Research Paper

Illicit drugs that are widely used include central nervous system stimulants (such as crack cocaine, cocaine, and amphetamines), central nervous system inhibitors (opiates, heroin and sedative-hypnotics such as benzodiazepines or barbiturates), or hallucinogens (hemp products such as marijuana or hashish, LSD, and phenocyclidine) (AOD 1995). Some goods employed as illicit drugs have legal uses also; examples are home and office products containing solvents or propellants, the fumes of which can be inhaled. Finally, so-called designer drugs are derivatives of illicit substances that technically are not illegal, but produce comparable effects. Experimentation with illicit drugs may lead through various mechanisms involving social, psychological, and pharmacological connections to dependency and abuse (Des Jarlais and Hubbard 1997).

This research paper describes ways to combat illicit drug abuse at a national level, including equivalent products, a task that has been characterized as a failure in twentieth century health promotion (Fielding 1999). After the introduction to the situation in the United States and Europe—broadening the perspective is impossible as even authorities have only a vague conception of illicit drug use in many sites (United Nations International Drug Control Programme 1997)—attention turned towards evidence concerning the significance of prevention efforts in communities, schools, and families. Obviously, more is already known than have been put into practice—it is important to disseminate the knowledge—but nevertheless more research is needed on the results of general social policy measures, community and family interventions, and interventions directed to those already marginalized.

1. Breadth And Risk Factors Of Illicit Drug Use Abuse

Quantitative information on use exists from industrialized countries including the United Sates (Johnson et al. 1996, NIDA 1997) and most European countries (EMCDDA 1998). Having had at least one occasion of use seems to be a quite variable phenomenon in terms of type of drug, period, region, and ethnic group in the United States. Substantial geographical variability is observed in Europe also, from which a much more limited time series is available.

It is noteworthy that though the countries with statistical information available are usually classified as illicit drug consumers as opposed to producers, this labeling does not describe the situation accurately: drugs are also consumed where they are produced. Development of a global illicit drug use information system is timely.

Statistics on illicit drug use are based on self-reporting. While there are good reasons to have doubts about the accuracy of this information (Hser 1997), many experts (including Preston et al. 1997) have provided evidence about its usefulness. Only surveys are feasible and their results permit reliable comparisons of time points and cultures even though level-of-use estimates based on them are diluted.

United Nations’ experts (United Nations International Drug Control Programme 1997) contend that global illicit drug consumption is higher than ever. Surveys indicate accordingly that both experimentation with drugs and their regular use have increased substantially in industrialized countries since World War II. At present illicit drugs involve both genders in the age range from early teens to young adulthood almost equally. In the United States, tenth graders (15–16 years of age; this is the age of the average first user) reported in 1996 the following lifetime use of illicit drugs: marijuana 42 percent, inhalants 18 percent, hallucinogens 11 percent, cocaine 7 percent, crack cocaine 4 percent, heroin 2 percent, stimulants 17 percent, and steroids 2 percent. As a comparison, the daily use of marijuana was admitted by about one in every 10 lifetime users of teen age, and 30 days’ consumption of the above-mentioned drugs varied between one third and one sixth of their respective lifetime consumption among US teenagers.

In 1997, at least experimenting with hemp products was admitted by 33 percent of 15–16-year-olds in the UK, 18 percent in Denmark, but only 3 percent in Greece. The corresponding figures for solvents were 20 percent, 12 percent, and 7 percent, and for amphetamines 18 percent, 2 percent, and 4 percent, which represent high, medium, and low ranges of their respective consumption in the 14 European Union countries (EMCDDA 1998). While some calming information exists about the former socialist countries situated in Europe (EMCDDA 1998), this area must be included among those that need a better monitoring system for reliable conclusions (eesv MSDP 1998).

There are numerous risk factors for drug use (Newcomb 1994) involving cultural and structural, interpersonal, psychosocial, or biogenetic factors. Cultural and societal risks include drug use promoting social norms, economic hardships, and drug availability. Among the interpersonal influences are family use, favorable familial attitudes, family or peer conflict and economic difficulties, and connections to peers using drugs. Psychosocial determinants involve earlier persistent problem behavior, rebelliousness, poor school achievement, early experimentation, and positive drug attitudes. Among the biogenetic causes, genetic susceptibility and psycho-physiological vulnerability to drug effects must be mentioned.

2. Ways To Control Illicit Drugs

Illicit drugs are consumer goods subject to economic laws of supply and demand. Increases in world travel, opening of national borders, deregulation of trade and finance, and political instability and conflicts have led into increased supply of these drugs. To reduce the supply, countries have started to network in many ways, including cooperation in such international organizations as the United Nations and World Health Organization. The traditional goal of control politics has been the elimination of illicit drugs from the market. When in fact drug use has increased in spite of efforts to achieve the opposite, some European countries have added harm reduction as a goal for educating youth in general (Uhl and Springer 1998).

International cooperation of law-making and law-enforcing organizations is one of the instruments to control illicit substance use (Van der Stel 1998). Another vital method involves social policy directed to the prevention of marginalization of citizens. Societies form a web of complex social systems in which the role of governmental control varies. Irrespective of their position in that dimension, a few countries have already established health political programs for illicit drug prevention. They, like all health promotion programs (Green 1999), must be implemented in the basic social units, communities.

2.1 Community Programs To Influence Supply And Demand

Aguirre-Molina and Gorman (1996) described community programs in drug prevention in the United States, although few of them exist in large numbers. These are comprehensive, empowering, and developmental community-based interventions that target multiple social systems and employ manifold strategies. They aim at all factors in the environment that contribute to the risk or protective factors. Programs already tested and three decades of experience with cardiovascular community programs encourage the continued cooperation of prevention workers and researchers.

Community-based programs usually cannot affect the production and manufacture of drugs (although this may be possible), but they can influence drug availability and access. Second, community organization involves both law enforcement and the local media, and can involve broad-based community change interventions. Furthermore, high-risk groups of people or high-risk neighborhoods need to be focused upon. Third, community-based intervention programs may aim at individuals at different phases of their life cycle.

2.2 School Programs To Control Demand

Drug education can be directed to different audiences: in the most general form, it is directed to populations via the mass media in community programs. The next lower level is that of groups—most notably school classes. Finally, education may be executed on a face-to-face basis to individuals. As youth is the subpopulation most at risk and can be addressed in school programs, these have be the main focus of efforts and most of the research.

School programs have been largely developed and implemented in the United States (Tobler 1997, Kreft and Brown 1998), but they have also been applied in Europe (White and Pitts 1998, Uhl and Springer 1998). Programs properly tested involve contents such as knowledge (drug effects, social influences, actual use of drugs), emotions (self-esteem, self-awareness, values), refusal skills (drug refusal, public commitment, cognitive behavioral skills, nondrug support systems), more generic or life skills (communication, assertiveness, decision making, coping, social, goalsetting skills), safety skills (own-peer security when drugs are used), extracurricular activities (job, sports, culture, leisure time, community work), or what can be termed prosocial activities (peer counseling, homework, rewards, parent and/or community involvement). Participation of the peer group in the program implementation varies on the dimension of noninteractive vs. interactive. In the list above, the divide is between programs clarifying emotions and teaching refusal skills: programs dealing with knowledge and emotions are noninteractive, the rest are interactive.

Kreft and Brown (1998) present sharp critique directed towards the poorly conducted bulk of illicit drug education studies. Dusenbury and Falco (1997) also note that extra care must be taken when making a purchase among programs available. The review by Tobler (1997), however, enumerates studies defying that criticism and uses sound meta-analytic techniques to yield conclusions, but not, however, verifying whether multilevel modeling important for school studies where students of same class unit have a common environment has been adopted or not. White and Pitts (1998) came to essentially the same results also.

Only interactive school programs of drug education can be deemed effective. Among the interactive programs, the highest effects were observed for general life-skills programs, followed by programs having either prosocial nonschool activities or social influence as content. Second, the effects when they exist are usually modest in size. As effect size estimates are bound to be subjective, it is helpful to contend that if an effect size of interactive programs were to be observed in a study concerning effects of medicines, a recommendation for use would be made. Third, the effect includes postponing experimentation—often the interactive programs’ effects are to be seen for 3 years. Fourth, when programs were implemented in larger groups, the effectiveness attenuated, except among multicultural audiences. This may indicate either poorer administration of larger programs and or increasing methodological problems posed by larger intervention to internal validity. Fifth, sizeable effects in postponing drug experimentation have been observed in small studies using interactive delivery. Sixth, the effects seem to be equivocal for different drugs.

Educational programs have been targeted at audiences from 8 to 25 years old in a variety of settings including schools and colleges, community settings, the family, medical therapeutic settings, and mass media (White and Pitts 1998). Tobler and White and Pitts made it clear that most of the available programs are meant for school and for primary and secondary prevention. There is a serious lack of programs to be implemented in other contexts or directed at groups at special risk (White and Pitts 1998).

2.3 Family-Based Interventions To Increase Prosocial Bonding And Help With Problems

The community and schools have to be named as important contexts of the above interventions. The possible sites of impact include recreational and religious settings, work, and, importantly, the family, in which the primary socialization takes place. Because of centrality of the family in illicit drug use prevention, this contexts attracts primary interest.

Biglan and Metzler (1998) noted that drug use among young people is associated with engagement in diverse problem behaviors and certain parental practices (lack of effective monitoring, discipline, and positive involvement with children). Three types of family interventions can be discerned: universal to the general population of families, selective to families with high-risk youth, and indicated interventions to dysfunctional families with many risks (Kumpfer 1998). Of these, the most significant from the public health perspective are universal interventions (Catalano et al. 1998).

At the beginning of the twenty-first century, some promising interventions involving the social developmental model, using prosocial bonding family, school, and peers as a protection against the development of conduct problems, school misbehavior, and drug use, are in the evaluation phase. It is

hypothesized that strong prosocial bonding to others reduces the risk of substance abuse. It can be expected that the success of this undertaking is dependent on the extent to which prosocial involvement within the family is available to the child, skills necessary in participating in the family interactions, and rewards punishments provided by parent for conforming nonconforming with the family expectations and beliefs. As in the case of community research, more studies need to be reported before definite conclusions of their real worth can be arrived at.

3. Conclusion: Towards More Effective Cooperation

Illicit drug abuse prevention continues to be an important task of health promotion, both nationally and internationally. Although all undertakings in prevention may not be easily evaluated (a good example of which is international control measures), scientific rigor should always be aimed at when making the choice. Only school-based programs have been reliably evaluated so far, leading to a recommendation of adopting interactive programs relying on life or refusal skills. Both community and family interventions seem to be important to consider, although they need to be applied and then evaluated further before firm conclusions can be made. At the highest level, national policy goals need to be adapted to changing circumstances in many countries, a global information system should established, and international cooperation at all levels strengthened for the success of prevention and developing its objectives.

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