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Informasi tentang Ecstacy

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  1. 1. Behavioural Intervention: An Approach to the Ecstasy Problem Foong Kin, Ph.D. & Vemala Devi, M.Sc. Centre for Drug Research, USM Paper presented at the National Public Health Conference, Ministry of Health, Kuala Lumpur, April 2001
  2. 2. Synthetic Drug Explosion (LSD, Amphetamines, Ecstasy, etc.) • Begun in the mid 1980s • Emergence of a new sub-culture: the rave phenomenon • Illicit production,trafficking & consumption surpassed heroin
  3. 3. STIMULANT ABUSE • Stimulants used to enhance vitality, improve mood and escape reality • 2 groups of synthetic stimulants i.e. amphetamine group and ecstasy group • Attractiveness of stimulants is their action on CNS
  4. 4. MDMA (Ecstasy) Abuse • The love drug • European discotheques (mid-1980s) • Linked with explosion of dance music • Used by an elitist section of population
  5. 5. Source: National Narcotics Agency Methamphetamine Abuse Year N % of total addicts identified 1997 255 0.70 1998 772 2.05 1999 774 2.19 2000 1,284 4.70
  6. 6. Source: National Narcotics Agency Amphetamine Type Stimulants & Other Psychotropic Pills Abuse Year N % of total addicts identified 1997 264 0.73 1998 264 0.70 1999 168 0.48 2000 612 1.76
  7. 7. ATS SEIZURES Year Syabu (kg) Ecstasy (#) Psy. Pills (#) 2000 208.10 49,901 145,486 1999 5.41 55,975 329,265 1998 6.44 9,231 1,724,104 1997 2.09 40,990 1,356,989
  8. 8. Ecstasy… just the facts • 3,4-MithileneDioxyMethAmphetamine (MDMA) • Developed in 1914 by Merck • Historically used for anti-fatigue, anti- depressant & appetite suppresant • Similar to the stimulant amphetamine and the hallucinogenic mescaline – can produce stimulant and psychedelic effects • Taken orally as tablet or capsule
  9. 9. PROFILE OF ABUSERS • Teens and twenties • Often educated • Relatively privileged social background • Recreational purposes • Social context of dance scene
  10. 10. Sought-after Effects • Energizing effects • Profoundly positive feelings • Empathy for others • Elimination of anxiety • Feeling of serenity/calmness • Enhancement of performance, communication & sensual experience • Mild euphoric rush • Suppress need to eat, drink, or sleep
  11. 11. Short-term Side Effects • Jaw tightening • Brief nausea • Sweating • A dry mouth and throat • A loss of appetite • Difficulty in coordinating body These all lead to a user having weakened physical and mental conditions the next day after use. Extensive use over several days can lead to anxiety, panic, confusion and insomnia
  12. 12. Potential Dangers/ Health Risks • Heat stroke due to dehydration • Increased heart rate and blood pressure • Suppression of the immune response • Psychiatric disturbances e.g. anxiety, confusion, depression, paranoia, hallucination • Brain damage • Severity of adverse reactions to synthetic impurities
  13. 13. BRAIN SCAN Sumber: National Institute on Drug Abuse, USA
  14. 14. Current Strategies to Curb the Spread • Supply reduction (law enforcement, legislation) • Demand reduction (prevention, education, treatment)
  15. 15. DRUG ABUSEPROGRAMCONTINUUM PROGRAM TYPE: Information Initial Drug Experience Education Alternatives Intervention Treatment Rehabilitation Non-use of Drugs Experimental Occasional or Frequent Use Integral Part of Lifestyle Drug Abuse Recovery Maintenance of Drug-free Lifestyle
  16. 16. Principles in Promoting Behaviour Change • Understanding individual and environmental risk factors influencing behaviour, i.e. ecstasy abuse • Identify important target groups for targeting behaviour change • Application of theories from social communication, behaviour and psychological sciences to change behaviours
  17. 17. Risk Factors in Ecstasy Abuse Among Malaysian Youths • Little is known • Lack systematic study • Only anecdotal data available; mostly from law enforcement and medical practitioners
  18. 18. An Ecological Perspective: Levels of Influence in Ecstasy Abuse Intrapersonal Factors Knowledge, attitudes, beliefs, and personality traits Interpersonal Factors Social influence of family, friends, peers Institutional Factors Rules, regulations, policies, and informal structures Community Factors Social networks and norms Public Policy Local, state, federal policies and laws
  19. 19. Prevention Approaches • Information dissemination/media campaigns • Affective education • Alternatives • Resistance skills • Personal and social skills training
  20. 20. Application of Theoretical Frameworks to Prevention • Health Belief Model (Rosenstock, 1974) • Social Learning Theory (Bandura, 1977) • Problem Behaviour Theory (Jessor & Jessor, 1977)
  21. 21. Drug use is a socially learned, purposive and functional behaviour, and a result of the complex interplay of environmental and individual factors
  22. 22. Health Belief Model Vulnerability Benefits Seriousness Cues Self-efficacy No Barriers Likelihood of taking health action
  23. 23. An individual is less likely to abuse ecstasy if: • Perceives that he is susceptible to ecstasy- related problems • Thinks that using ecstasy would result in serious consequences • Sees immediate benefits of non-use • Perceives an absence of barriers to action • Know how to resist influence (has self- efficacy) • Is reminded/supported (media campaigns, advice from others, etc.)
  24. 24. Social Learning Theory Person EnvironmentBehaviour
  25. 25. Social Learning Theory Behaviour change is influenced by 1. Reciprocal determinism: person and environment continually interact  change the environment to facilitate behaviour change 2. Expectations about outcomes of behaviour  motivate person to adopt new behaviour by telling about benefits
  26. 26. Social Learning Theory 3. Behavioural capability: having knowledge and skills to perform a desired behaviour  train the person with skills 4. Self-efficacy: confidence in one’s ability to successfully perform a specific action  enhance confidence 5. Observational learning (modeling)
  27. 27. Problem Behaviour Theory • Problem behaviour is a result of a complex interaction of: –Personal factors (cognitions, attitudes and beliefs) –Physiological and genetic factors –Perceived environmental factors
  28. 28. • Drug use is perceived as functional, serving as a way to coping with: – Boredom – Social anxiety – Rejection – Gaining admission to a peer group
  29. 29. Problem Behaviour Theory (multilevel approach) 3 levels of analysis/behaviour change –Level of behaviour –Level of personality –Level of environment
  30. 30. Health is enhanced by: 1. Weakening or eliminating behaviours that compromise health 2. Strengthening/introducing behaviours that enhance health
  31. 31. Personality Approaches • Make adolescents realise the misperception to believe that benefits of drug use outweigh the risks • Believe there are alternative ways of coping with anxiety, establishing effective interpersonal relationships or achieving any other desired goal
  32. 32. Environmental Approaches 1. Factors aimed at resisting or avoiding health-compromising behaviour a. Reducing availability of ecstasy b. Media campaigns to discourage use c. Social and policy sanctions for drug-related activities
  33. 33. Environmental Approaches 2. Environmental supports for health- enhancing behaviours a. Positive peer relations b. Drug-free activities for adolescents c. Health/fitness programmes
  34. 34. An Integrated Approach to Prevention • Integrate 3 theories • Each theory suggests special areas of emphasis • HBM – identify personally oriented goals for intervention • SLT – teaching of appropriate skills (Assertiveness, stress management, & interpersonal communication to resist environmental pressures) • Problem behaviour theory – Person focused (skills building activities) – Environmentally focused
  35. 35. Ecstasy abuse prevention should: 1. Eliminate or at least reduce to the greatest extent possible environmental influences promoting or facilitating use – Decrease availability of ecstasy • Through law enforcement (raids, urine screening) • Having drug free night spots (“Drug Free Discos”) – Dialogue, persuasion of club owners and employees – City Council and police working together
  36. 36. –Reduce visibility of negative ecstasy-using role models –Increasing the visibility of attractive, high-status (non- ecstasy role models) –Altering attitudes and social norms concerning acceptability of ecstasy use and abuse (laws, media campaigns)
  37. 37. 2. Develop preventive intervention designed – To reduce susceptibility/vulnerability to the various environmental factors promoting ecstasy use – To reduce motivation to use ecstasy
  38. 38. Examples of Measures • Teaching of specific skills designed to resist social influences to use ecstasy (techniques for resisting peer pressure) • Making adolescents aware of sources of influence and skills to counter them
  39. 39. Examples of Measures • Enhance self-esteem, perceived control, self-confidence, self- satisfaction, and assertiveness • Teach life skills (decision-making, goal setting, social skills, assertiveness) • Provide an array of general coping skills (anxiety reduction and problem solving)
  40. 40. Communication Programmes to Promote Behaviour Change Objectives of programme: –Inform –Change attitudes –Teach skills and specific steps on how to resist initiation of ecstasy use
  41. 41. Important Principles in Message Design • Be relevant (youth input) • Personalise the message • Be specific to the different target goups • Use emotional positive appeal • Be clear and simple • Be interesting
  42. 42. How to the Deliver Message? What Media and Channel? • Choice dependent on characteristics of target groups and objectives of the message – e.g. general public (TV/newspapers) – Night spot goers (use distribution methods close to the techno culture (posters, youth magazines, flyers, T- shirts, post cards, etc.) – Peer education approach (mouth-to – mouth propaganda – Ecstasy outreach workers
  43. 43. Effective Prevention Strategy • Multiple components • Uses programme providers and delivery channels that efficiently reach target population • Provides ongoing intervention throughout the initiation of ecstasy use
  44. 44. 3 Pronged Strategy • Monitoring • Control • Targeted Prevention
  45. 45. YA TIDAK