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Preventing Alcohol Preventing Alcohol Abuse and Abuse and
DependenceDependenceNIAAA Social Work NIAAA Social Work
EducationEducation
Module 3Module 3(revised 3/04)
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OutlineOutline
Prevention FrameworksPrevention FrameworksPrevention FactorsPrevention FactorsPrevention StrategiesPrevention StrategiesPrevention ExamplesPrevention Examples
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Prevention FrameworksPrevention Frameworks
What is prevention?What is prevention?Actions that minimize or eliminate Actions that minimize or eliminate
conditions known to contribute to a conditions known to contribute to a specific condition, problem, illness, or specific condition, problem, illness, or disorderdisorder
Establishing conditions that enhance Establishing conditions that enhance opportunities to achieve healthy outcomesopportunities to achieve healthy outcomes
Occurs prior to the problem appearing or Occurs prior to the problem appearing or becoming serious/severebecoming serious/severe
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Frameworks Frameworks (continued)(continued)
UniversalUniversal preventive preventive intervention is:intervention is:applied to everyone in applied to everyone in
a population, a population, regardless of risk levelregardless of risk level
benefits outweigh benefits outweigh risks/costs for risks/costs for everyoneeveryone
Universal-Selective-Indicated FrameworkUniversal-Selective-Indicated Framework
©2002 Microsoft Corporation.
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SelectiveSelective prevention is: prevention is: focused on groups focused on groups
whose risk of whose risk of developing the problem developing the problem is above averageis above average
higher “risk” level does higher “risk” level does not mean the problem not mean the problem WILL developWILL develop
Frameworks Frameworks (continued)(continued)
Universal-Selective-Indicated FrameworkUniversal-Selective-Indicated Framework
©2002 Microsoft Corporation.
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Frameworks Frameworks (continued)(continued)
IndicatedIndicated prevention prevention efforts apply to efforts apply to individuals who:individuals who: exhibit specific risk exhibit specific risk
factors factors oror have conditions that have conditions that
identify them as being at identify them as being at risk for development of risk for development of the problemthe problem
©2002 Microsoft Corporation.
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Frameworks Frameworks (continued)(continued)
Public Health prevention Public Health prevention framework:framework: primary, primary,
secondary secondary
tertiarytertiary
©2002 Microsoft Corporation.
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Prevention FactorsPrevention Factors
Within each type of prevention, the Within each type of prevention, the aim is to reduce the occurrence of aim is to reduce the occurrence of new casesnew cases
This is accomplished by:This is accomplished by:
decreasing risk and vulnerability factorsdecreasing risk and vulnerability factors
and/orand/or strengthening protective and resilience strengthening protective and resilience
factorsfactors
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Vulnerability and Vulnerability and ResilienceResilience
Full continuum (low to high)Full continuum (low to high) Factors intrinsic to the individualFactors intrinsic to the individual Biology (genetics, constitution, Biology (genetics, constitution,
hormonal, disability, etc.)hormonal, disability, etc.) Experiences and learning Experiences and learning
(personal history)(personal history) Behaviors and traits (e.g., Behaviors and traits (e.g.,
personality, temperament, etc.)personality, temperament, etc.)©2002 Microsoft Corporation.
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Risk and ProtectionRisk and Protection
– Family and other social Family and other social institutionsinstitutions
– Reinforcers/consequences Reinforcers/consequences (current)(current)
– Access to alcoholAccess to alcohol– Programs, policiesPrograms, policies– Resources, accessResources, access
Full continuum (low to high)Full continuum (low to high)Extrinsic to individual (environmental Extrinsic to individual (environmental
contexts):contexts):
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VULNERABILITYVULNERABILITY
LowLow HighHigh
LowLow I LowI Low II ModerateII Moderate
ProbabilityProbability ProbabilityProbability
RISKRISK
HighHigh III III ModerateModerate IV HighIV High
ProbabilityProbability ProbabilityProbability
Interaction of FactorsInteraction of Factors
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Review of Research on Review of Research on FactorsFactors
Sensation seekingSensation seeking Poor impulse controlPoor impulse control Family Family
behavior/attitudes behavior/attitudes promote alcoholpromote alcohol
Inconsistent Inconsistent parenting/disciplineparenting/discipline
Family conflict/low Family conflict/low family bondingfamily bonding
Academic Academic failure/low school failure/low school commitmentcommitment
RebelliousnessRebelliousness Early onset of Early onset of
alcohol usealcohol use
Individual and Interpersonal FactorsIndividual and Interpersonal Factors
Source: Hawkins et. al, Source: Hawkins et. al, 19921992
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Research Review Research Review (continued)(continued)
Availability of substancesAvailability of substances Economic deprivationEconomic deprivation Poor housingPoor housing Neighborhood disorganizationNeighborhood disorganization Laws/norms favoring alcohol consumptionLaws/norms favoring alcohol consumption
Source: Hawkins et. al, 1992Source: Hawkins et. al, 1992
Contextual & Other Environmental FactorsContextual & Other Environmental Factors
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Prevention StrategiesPrevention Strategies
Shift groups from a higher probability of Shift groups from a higher probability of alcohol use disorders toward a lower alcohol use disorders toward a lower probability. Utilize a combination of probability. Utilize a combination of efforts to:efforts to:
1.1. Increase protective factors Increase protective factors
2.2. Decrease risk factors Decrease risk factors
3.3. Increase resilience factors Increase resilience factors
4.4. Decrease vulnerability factors Decrease vulnerability factors
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Six domains for organizing alcohol Six domains for organizing alcohol prevention effortsprevention efforts (SAMHSA, 2001)(SAMHSA, 2001)::
Individual School
Family Community
Peer Society / Environments
Prevention Strategies Prevention Strategies (continued)(continued)
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Individual DomainIndividual Domain
– Build social and personal skillsBuild social and personal skills
– Design culturally sensitive interventionsDesign culturally sensitive interventions
– Provide alternatives for youth in high risk Provide alternatives for youth in high risk contextscontexts
– Recognize relationships between substance Recognize relationships between substance use and other health/mental health problemsuse and other health/mental health problems
Prevention Strategies Prevention Strategies (continued)(continued)
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Family DomainFamily Domain
– Target entire family systemTarget entire family system– Develop bonds between and within Develop bonds between and within
familiesfamilies– Ensure cultural sensitivityEnsure cultural sensitivity– Respond to “isms”Respond to “isms”– Develop parenting skills; train parents Develop parenting skills; train parents – Offer practice opportunitiesOffer practice opportunities– Promote family communicationPromote family communication
Prevention Strategies Prevention Strategies (continued)(continued)
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Peer DomainPeer Domain
– Structure alternative supervised activitiesStructure alternative supervised activities– Add social and personal skills building Add social and personal skills building
opportunitiesopportunities– Offer alternative intensive programsOffer alternative intensive programs– Communicate peer norms against alcoholCommunicate peer norms against alcohol– Involve youth in program developmentInvolve youth in program development– Involve youth in interventionsInvolve youth in interventions
Prevention Strategies Prevention Strategies (continued)(continued)
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School DomainSchool Domain
– Correct prevalence misconceptionsCorrect prevalence misconceptions– Provide skills practice opportunitiesProvide skills practice opportunities– Use booster sessions to retain skillsUse booster sessions to retain skills– Involve parentsInvolve parents– Communicate commitment to Communicate commitment to
preventionprevention– Control school environment and other Control school environment and other
areasareas
Prevention Strategies Prevention Strategies (continued)(continued)
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Community DomainCommunity Domain
– Develop integrated, comprehensive Develop integrated, comprehensive interventionsinterventions
– Community serviceCommunity service– Perform benefit/cost analyses (employers)Perform benefit/cost analyses (employers)– Coalition building and maintenanceCoalition building and maintenance– Assign goals, tasks, and responsibilitiesAssign goals, tasks, and responsibilities– Organize alcohol-free eventsOrganize alcohol-free events– Support a range of prevention activitiesSupport a range of prevention activities– Organize at the neighborhood levelOrganize at the neighborhood level
Prevention Strategies Prevention Strategies (continued)(continued)
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Society/Environmental DomainSociety/Environmental Domain
– Media effortsMedia efforts– Beverage server training and liabilityBeverage server training and liability– Increase cost through excise taxesIncrease cost through excise taxes– Limit retail alcohol outletsLimit retail alcohol outlets– Enforce minimum age laws and other policiesEnforce minimum age laws and other policies– Feedback to merchantsFeedback to merchants– Enact/enforce impaired operations deterrence Enact/enforce impaired operations deterrence
lawslaws
Prevention Strategies Prevention Strategies (continued)(continued)
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Moving from Strategies to Moving from Strategies to ProgramsPrograms
Target underlying Target underlying contributing factorscontributing factors
Consult literatureConsult literature Assess strengths, barriers, Assess strengths, barriers,
resourcesresources Develop and implement Develop and implement
programprogram Evaluate interventionEvaluate intervention
(Source: CSAP, 1995)(Source: CSAP, 1995) ©2002 Microsoft Corporation.
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Examples of Prevention Examples of Prevention ProgramsPrograms
Life Skills TrainingLife Skills TrainingSeventh Generation ProgramSeventh Generation ProgramProject NorthlandProject NorthlandCommunities Mobilizing for Communities Mobilizing for
ChangeChangeCommunity Trials ProjectCommunity Trials Project
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Program ExamplesProgram Examples
Life Skills TrainingLife Skills Training– Universal strategyUniversal strategy– Youth-targetedYouth-targeted– Cognitive behavioral psycho-educational Cognitive behavioral psycho-educational
approachapproach– 15 sessions to teach general personal and 15 sessions to teach general personal and
social skills; how to resist social influencessocial skills; how to resist social influences– Focus on problem solving, decision-making, Focus on problem solving, decision-making,
self-awareness, effective communication, self-awareness, effective communication, assertiveness, and stress reductionassertiveness, and stress reduction
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Program Examples Program Examples (continued)(continued)
Seventh Generation ProgramSeventh Generation Program– Selective (urban American Indian youth, grades 4-Selective (urban American Indian youth, grades 4-
7)7)– 13 week after-school program plus 5 week booster13 week after-school program plus 5 week booster– Grounded within American Indian cultureGrounded within American Indian culture– Corrects inaccurate stereotypes of Indian drinkingCorrects inaccurate stereotypes of Indian drinking– Enhances personal and cultural values of non-useEnhances personal and cultural values of non-use– Enhances self-esteem and Indian identityEnhances self-esteem and Indian identity– Focuses on decision making and refusal skills Focuses on decision making and refusal skills – Encourages meaningful commitment to not useEncourages meaningful commitment to not use
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Program Examples Program Examples (continued)(continued)
Project NorthlandProject Northland– Selective (6Selective (6thth-8-8thth grade, parents, grade, parents,
community)community)– Resistance skills training with homework Resistance skills training with homework
that involved the parentsthat involved the parents– Peer-directed alcohol-free activitiesPeer-directed alcohol-free activities– Student-developed anti-alcohol plays Student-developed anti-alcohol plays
performed for parentsperformed for parents– Newsletters to parentsNewsletters to parents– Community organization efforts to develop Community organization efforts to develop
policies regarding under-age drinkingpolicies regarding under-age drinking
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Program Examples Program Examples (continued)(continued)
Communities Mobilizing for ChangeCommunities Mobilizing for Change– Universal (change community and policies Universal (change community and policies
to reduce youth access to alcohol)to reduce youth access to alcohol)– Responsible beverage server trainingResponsible beverage server training– Shortened hours for alcohol salesShortened hours for alcohol sales– Citizen monitoring of alcohol outletsCitizen monitoring of alcohol outlets– Use of police decoys who appeared to be Use of police decoys who appeared to be
underageunderage– Educational programs for youth and Educational programs for youth and
adultsadults
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Program Examples Program Examples (continued)(continued)
Community Trials ProjectCommunity Trials Project– Universal (reducing alcohol-related Universal (reducing alcohol-related
injury)injury)– Knowledge, values, and mobilization Knowledge, values, and mobilization – Responsible beverage service practices Responsible beverage service practices – Reduction of underage drinkingReduction of underage drinking– Increasing the “costs” of drinking and Increasing the “costs” of drinking and
drivingdriving– Reducing access to alcohol (controlling Reducing access to alcohol (controlling
outlet density and location)outlet density and location)
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ConclusionsConclusions
Social work prevention activities:Social work prevention activities:
1.1. Provide information Provide information
2.2. Promote awareness and self-efficacy Promote awareness and self-efficacy
3.3. Provide skills building Provide skills building
4.4. Provide healthy alternatives Provide healthy alternatives
5.5. Change norms Change norms
6.6. Foster community collaboration Foster community collaboration
(Source: Bush, 2000)(Source: Bush, 2000)