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

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

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

MDMA (Ecstasy) Abuse

• The love drug• European discotheques (mid-1980s)• Linked with explosion of dance music• Used by an elitist section of population

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

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

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

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

PROFILE OF ABUSERS

• Teens and twenties• Often educated• Relatively privileged

social background• Recreational

purposes• Social context of

dance scene

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

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

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

BRAIN SCAN

Sumber: National Institute on Drug Abuse, USA

Current Strategies to Curb the Spread

• Supply reduction (law enforcement, legislation)

• Demand reduction(prevention, education, treatment)

DRUG ABUSE PROGRAM CONTINUUM

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

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

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

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

Prevention Approaches

• Information dissemination/media campaigns

• Affective education• Alternatives• Resistance skills• Personal and social skills

training

Application of Theoretical Frameworks to Prevention

• Health Belief Model (Rosenstock, 1974)

• Social Learning Theory (Bandura, 1977)

• Problem Behaviour Theory (Jessor & Jessor, 1977)

Drug use is a socially learned, purposive and functional behaviour, and a result of the complex interplay of environmental and individual factors

Health Belief Model

Vulnerability

Benefits

Seriousness

Cues

Self-efficacy

No Barriers

Likelihood of taking health action

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.)

Social Learning Theory

Person

EnvironmentBehaviour

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

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)

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

• Drug use is perceived as functional, serving as a way to coping with:

– Boredom– Social anxiety– Rejection– Gaining admission to a peer

group

Problem Behaviour Theory (multilevel approach)

3 levels of analysis/behaviour change

–Level of behaviour–Level of personality–Level of environment

Health is enhanced by:

1. Weakening or eliminating behaviours that compromise health

2. Strengthening/introducing behaviours that enhance health

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

Environmental Approaches

1. Factors aimed at resisting or avoiding health-compromising behaviour

a. Reducing availability of ecstasyb. Media campaigns to discourage

usec. Social and policy sanctions for

drug-related activities

Environmental Approaches

2. Environmental supports for health-enhancing behaviours

a. Positive peer relations

b. Drug-free activities for adolescents

c. Health/fitness programmes

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

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

– 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)

2. Develop preventive intervention designed

– To reduce susceptibility/vulnerability to the various environmental factors promoting ecstasy use

– To reduce motivation to use ecstasy

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

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)

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

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

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

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

3 Pronged Strategy

• Monitoring

• Control

• Targeted Prevention

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