Contains WHO and Other guidelines for promotion of health for reducing substance use in Indian setting. Delivered at Workshop

1. HEALTH PROMOTION FOR
REDUCING SUBSTANCE ABUSE
Samantaray, Narendra nath.
(2016)
Faculty Clinical Psychologist
Mental Health Institute
SCB Medical College &
Hospital, Cuttack
Email id:
narendra.samantaray@gmail.co
m

2. What is Substance Abuse?

3. Facts 1
 Worldwide psychoactive substance use is estimated at 2
billion alcohol users, 1.3 billion smokers and 185 million
drug users (UNDCP/WHO, 2002).
 4% of the global burden of disease is attributed to
alcohol,
 which contributes to 3.2% of deaths and 4.0% of the
disability.
 One of the leading risk factor for disease burden in
developing countries, the third largest risk factor for
developed countries (Doran, 2003;WHO, 2004).

4. Facts 2
 Substance behaviour is not only shaped by individual
choices and motivation but also strongly influenced by
organizational, economic, environmental, and social
factors (WHO, 2004; WMA, 2005).
 Many studies prove environmental cues and reinforces
exert an important influence (Geller et al., 1991).
 These influences may include social cues, such as use
by family members and peers, or images of alcohol
use promulgated by advertising and media (USDHHS,
1997a).

5. Facts 3
 Despite the scope of alcohol related problems
globally, there is increasing evidence of effectiveness
of some prevention strategies.
 Over the past three decades, high-income countries
experienced a substantial reduction in mortality and
morbidity from substance-related cases, traffic
cases(Peden et al., 2004).
 These are attributed to behavioral changes
associated with public education, organizational
policies, legislation, law enforcement, and economic
actions, in multiple settings involving multiple sectors
(Commonwealth Department of Health and Aging,

6. So what idea we get or can be
summarized from above facts?
 Therefore, approaches that attempt to bring about
change in drinking behavior through education
alone are likely to have limited or no success
(Gielen & Sleet, 2003; Howat et al., 2004; Peden
et al., 2004; Sleet et al., 1989),
 whereas those that combine educational with
other behavioral, environmental, policy and
organizational changes are likely to be the most
effective (Shults et al., 2001; Waller 1998; WHO,
1986)

7. Health Promotion-Definition.
 WHO defines Health Promotion as “ the process
of enabling people to increase control over their
health and its determinants and thereby improve
their health”.
 Consists of balance of individually-focused and
environments focused measures that support
healthy behaviours.

8.  Hence, health promotion is: a combination of
educational, organizational, .economic and
political actions designed with consumer
participation, to enable individuals, groups and
whole communities to increase control over, and
to improve health through changes in knowledge,
attitudes, behavior, policy, and social and
environmental conditions (Howat et al., 2003)

9. Protective Factors
(core of complete presentation)
 well-developed social skills,
 strong family bonds,
 Involvement of parents in lives of children
 attachment to school,
 Self esteem
 and active involvement in the community and religious
organizations
 Strict policies and law
 Recent research suggests that resilience is also an
important factor
 Environmental constraints in getting substance

10. Risk Factors
 Substance abuse by a parent,
(statisticss latter)
 Ineffective parental guidance
 Lack of parent child attachment,
 or a disruptive, abusive family are very strong
predictors,
 as are school failure or experience,
 affiliation with peers showing deviant behaviours
 early experimentation with drugs,
 easy availability of substance in community.

12. All well planned and evidenced
proof management plan
includes??????

13. Health promotion framework for reducing
alcohol related harm.

14. Teaching prevention in Schools
 *Huge chunk of protective as well as risk factors lies
in school.
 School first to detect warning signs
 Peer influence
 Hence, effective school programme consists of
training of social skills, such as decision making,
stress management, communication, conflict
resolution, and assertiveness.
 these programs can enhance awareness and

15. narendra.samantaray@gmail.com

16. 3 interrelated facts regarding Prevention in
school
 Delayed initiation is beneficial, giving children
time to develop social competence and
resistance skills.
 Delay in beginning to smoke during the early teen
years improves the future prognosis for
quitting (The Department of Health and Human
Services, 2005).
 Delayed onset of smoking is also associated with
a lower incidence of disease and death (BGDD,

17. Other operational techniques in
SP
 Increase participation of students in various
programmes
 Link students to supervised recreational
activities,mentoring, and other services
 No tolerance policies to substance
 Sufficient reward system for prosocial behaviour*
 Work on Self esteem
 Prevention is most effective when school
lessons are reinforced by a clear, consistent
social message that teen alcohol, tobacco, and
other drug use is harmful and unacceptable
(Making the Grade, 1999).

18. Now lets see & understand
through certain examples
of well received
programmes of SP around
the globe.

19. Making the Grade: A Guide to School Drug Prevention Programs,
successful school based drug prevention programs incorporate :
 Help students recognize internal pressures, like
anxiety and stress, and external pressures, like peer
attitudes and advertising, that influence them to use
alcohol, tobacco, and other drugs;
 Develop personal, social, and refusal skills to resist
these pressures;
 Teach that using substance is not the norm among
teenagers, even they believe “everyone is doing it”;
 developmentally-appropriate information about the
short-term effects and long-term consequences
 use interactive teaching techniques, such as role
plays, discussions, brainstorming, and cooperative
learning;
 actively involve the family and the community

20. Child Development Project (CDP)
Program Type: Teaching Prevention in Schools.
Target Audience: Elementary school students, their
parents and teachers.
Years in Operation: 1992-present.
Program Goals: To increase student attachment to
school, thereby reducing risk factors that
contribute to substance abuse and other high-risk
behaviours.

21. CDP…..continues
 program focuses on an entire school rather....
 CDP does not address substance abuse directly, its
character building program is designed to reduce risk
factors for alcohol and other drug use

22. Life Skills Training (LST)
 Program Type: Teaching Prevention in Schools.
 Target Audience: Middle school students.
 Years in Operation: 1997-present.
 Program Goals: To teach alcohol and other drug
prevention skills to all middle school students.

23. LST….continues
 LST is one of the best-evaluated substance
abuse prevention programs available, having
been evaluated in 12 rigorous field trials in
developed countries over the past two decades.
 LST provides information on alcohol, tobacco,
and marijuana and addresses substance use risk
and protective factors.
 In the 1999-2000 school year the program
reached approximately 3,968 sixth graders, 3,789
seventh graders, and 3,851 eighth graders.

24. LST….continues
 Curriculum uses a variety of interactive techniques,
including discussions, brainstorming, role playing, and
skill rehearsal.
 Students learn, for example, that contrary to myth,
smoking does not help people relax.
 LST develops personal or selfmanagement skills. Like
managing anxiety, including deep breathing, mental
rehearsal, and muscle relaxation.
 The third module - hones students’ social skills. To
help students feel comfortable in social situations and
less vulnerable to peer pressure.
 Practical training on assertive skills.

25. Reconnecting Youth (RY)
• Midland, Texas
• Program Type: Teaching Prevention in Schools
• Target Audience: High-risk high school students.
• Years in Operation: 1997-present.
• Program Goals: To increase school performance
and decrease drug use and emotional distress.

26. RY…..continues
 RY targets students who fall behind their peers in
school, have high absenteeism, experience a
drop in grades, or drop out of school.
 It includes a semester-long course. The RY class
is taught for 55 minutes each day and includes
four modules: Decision- Making, Personal
Control, Self-Esteem Enhancement, and
Interpersonal Communication.

27. RY…..continues
 RY has three primary goals:
(1) increase academic performance by enhancing
school bonding, school attendance, and grades,
and increasing the number of pre-college courses
taken;
(2) decrease drug involvement by increasing
control over drug use; and
(3) decrease emotional distress by lessening risk
factors, such as depression, and increasing
protective factors, such as self-esteem.

28. Reaching Youths Outside
School

29.  Approximately one-third of all violent juvenile
crimes occur between the hours of 3 p.m. and 7
p.m. when many children are unsupervised.
 Targeted programs during these vulnerable hours
can help prevent, reduce, or delay the onset of
alcohol, tobacco, and other drug use.

30. Building Family Bonds
Involvement
of parent in
lives of
children
Self Esteem
Strong
Family
Bonds Risk
Facto
r
Lack of
Parent
Child
Attachment
Substanc
abuse by
parent
Mental
Illness
Disruptive
family
Inconsistent
discipline

31. Certain Principles for Increasing
Parent Child Bond… (IS & V)
 CREATE OPPURTUNITIES TO TALK
 Rewards for prosocial behaviour, or recognition of
positive behaviours - Remember power of praise
 Communication of limits
 Teaching Responsibility- Self esteem- opportunities to
express themselves and be involved in family,
 Engaging Activities
 Parents aware of their child’s friends- Interesting Stat
 Role Model- Interesting statistics
 Main idea is that we have to match the positive
valence of friendship with family

32. National Institute on Drug Abuse (NIDA) recommends
that family-based prevention should have:
 Train parents in behavioral skills improve parent child
relationships, provide consistent discipline and
rulemaking, and monitor children’s activities during
adolescence;
 Direct services to families with children in
kindergarten through 12th grade to enhance
protective factors; and

33.  Parents have a critical role to play—not only within
the family, but also in collaboration with schools and
community groups.
 Recent research suggests that the most effective
programs promote positive relationships between
parents and children

34. Federal Center for Substance
Abuse Prevention (FCSAP)
 It recommends three family-centered approaches that
show great potential.
 The first, parent and family skills training, teaches parents
how to build protective factors and reduce risk factors
linked to substance abuse.
 These risk factors include communication problems, too
lax or too stringent discipline, parental substance use, and
child abuse or neglect.
 Family protective factors include close-knit familial
relationships, consistent discipline, and parental
supervision of children’s daily activities.
 These programs can improve poor parent-child
communication, child behavior, and parenting skills, and
reduce family conflict. Such interventions are directed at
families with children who have no apparent risk factors for
substance abuse as well as those at moderate and high
risk

35.  The second approach, family in-home support,
provides crisis intervention (such as food, shelter,
clothing) and long-range training.
 Aims to decrease domestic violence, child abuse and
neglect, and child placement in foster care, and
 Are most effective with high-risk children.

36.  Family therapy, the third approach, helps
family members improve the way they
communicate, manage family life, and solve
problems.
 Programs are aimed at families with children at
high risk and are designed to improve family
functioning and reduce antisocial behaviour
among both parents and children.

37.  Dare to be You
 Strengthening Families Program

38. Economic Interventions
Price and taxation:
 Among the most effective measures to reduce
substance.
 Studies have indicated that a rise in price will lead to
a drop in consumption (Babor et al., 2003; Waller,
Naidoo & Thom, 2002; WHO, 2004).
 Decrease in price will likely result in additional alcohol
related deaths (Schancke, 2005).
 Pricing policies particularly effective in reducing
consumption by young people,
 An increase in the real price of alcohol has been
shown to significantly reduce alcohol attributable
harms (Chikritzhs et al., 2005)

39. Organizational
Interventions

40. Licensing:
 Some studies shows prevention regulations
that are aimed at the sellers of alcohol are
more effective than prevention programs that
rely only on education directed at individual
drinkers.
 The power to revoke or suspend a license for
breaches causing traffic crashes (Babor et al.,
2003).

41. Alcohol Availability
 Some studies have described a clear epidemiological
link between alcohol consumption and suicide and
violence (Rossow, 2000; Rossow, Grøholt &
Wichstrom, 2005).
 When Swedish grocery stores were no longer
permitted to sell 4.5% beer, a significant drop in traffic
crashes followed (Babor et al., 2003).
 A number of studies indicate that changing the hours
or days of alcohol sales can influence the incidence of
alcohol related problems (Babor et al., 2003;
Chikritzhs & Stockwell, 2002; Chikritzhs & Stockwell,
2006, McMillan & Lapham, 2006)

42. Policy Interventions
Some examples of laws where evidence supports
such benefits include:
 A reduction of the legal BAC to .05% in Australia
and .08% in the United States (Howat et al.,
1992; Shults et al., 2001)
 Sobriety checkpoints and testing (Jones &
Lacey, 2001; Shults et al., 2001)
 Stricter enforcement of drink driving legislation
(Holder, 1998)
 An increase in the legal drinking age (Shults et
al., 2001)
 Restrictions on advertising and promotion-
Whats beer shampoo??? For this I dont have
any data but??

43. Thanks for the
opportunity to serve
you.

44. Handling Craving:
At the time of intense craving the recovering individual can
call a sober or abstinent friend and tell them he/she feels
like taking a drink/using a drug, and needs help not to do
so. Similarly, recall negative consequences of returning to
substance use - losing one's job, broken family
relationships, etc.
4 Ds
 Delay
 Distraction
 Deep breathing
 Drink water

45.  C. Drink Refusal Skills and Assertiveness:
 Refusal skills are a specific set of skills which are related to
dealing with social pressure. Hence it needs a strong body
language and confident tone of voice from the person while
refusing to drink/use a drug. In this situation one has to respond
rapidly as the delay is likely to increase the urge. Many patients
feel uncomfortable or guilty about saying “no” and think they
need to make excuses for not using.
Saying things like “maybe later,” “we shall see,” just makes it
likely that they will be pressured again to use. This allows for
possibility of future offers.
So “No” can be followed by changing the subject, suggesting
alternative activities, and clearly requesting that the individual
not offer alcohol or other drug again in the future.

46. Dealing with faulty cognitions like overconfidence, helplessness, etc.
 A person’s faulty thought very often becomes a problem for him/her and leads to a
relapse. A simple example is:
“I can stay away from alcohol. Nothing can tempt me.” The consequence is -
going to parties where alcohol may be available, telling myself “I will go, but I’ll not
drink.”
 E. Handling Negative Mood States
Negative mood states like anger, anxiety, fear, depression, guilt, getting upset or bored
easily, irritability, tiredness, restlessness, etc. are associated with relapse. Some people
suggest that addicts frequently relapse as a result of joylessness in their lives.
A few ways to handle this are:
 The first step is to be aware of one’s self-defeating thoughts and depressed mood.
 Realizing the adverse consequences of these negative thoughts.
 Creating opposite (positive) thoughts, challenge negative thoughts.
 Ignoring negative thoughts, not responding to them.
 Accepting oneself as one really is, with strengths as well as limitations.
 Having realistic self-expectations.