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A review of the studies on illicit drug use prevention and their strengths and weaknesses

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Index of Canadian Programs Acknowledgements Thanks are extended to the project steering committee members: Appreciation is expressed to those government officials who participated by nominating programs, as well as to Heidi Liepold for her interest and involvement in the project, and the researchers and program managers who took the considerable time required to provide documentation and to describe their programs.

Section 1 - Introduction There has been a general increase in substance use and associated problems among adolescents in this country in recent years. Various government and non-government organizations are being pressed to respond with effective solutions.

This compendium presents evidence-based direction to effective programming for a broad range of prevention activities and should be of interest to educators, community developers, health promoters, law enforcement officers and public health nurses.

Scope of the Compendium What is the best way to prevent substance use problems among young people? What about effective programs to reduce harm for youth already using substances? What Canadian programs show most promise? The compendium gives attention to prevention issues, principles and programs pertaining to all youth, ranging from mainstream to out-of-the-mainstream, and considers a variety of settings, from schools to street level.

While some early childhood initiatives have shown strong preventive effect, they were considered beyond the scope of the investigation. Also, neither tobacco nor performance-enhancing drug use prevention programs were considered unless they reported other substance use results.

Finally, policy-focused initiatives were considered only when linked to programming, but were discussed as an important underpinning to the direct service programs presented in this compendium. Detailed discussion of current drug use patterns of A review of the studies on illicit drug use prevention and their strengths and weaknesses youth is presented because it is crucial to base program decisions on accurate data.

A number of programs that have either shown evidence of effectiveness or show promise are described in detail. To the greatest extent possible, relevant information has been collected from researchers and program sponsors, including aims, intended outcomes, prevention principles emphasized and, whenever possible, cost information.

Complete contact information is included for each program. Each of the programs presented reflects a number of prevention principles; however, it is wise to determine the extent to which programs being considered reflect the principles that are of greatest importance to you, rather than simply adopting a program. The discussion presented in each section is relatively detailed; however, for those interested in investigating issues further, significant points are supported by cited sources to allow for follow-up.

In the appendix, a checklist is provided to guide an analysis of programs in relation to prevention principles. Also included in the appendix are various tools and resources for those interested in pursuing further research. Key Terms Substance use problem prevention: This term is used because it accommodates prevention in two contexts: For the purposes of this compendium, the population of interest is young people in their teen years.

Because psychosocial development is often delayed among high-risk youth, programming for these young people up to approximately age 24 is considered. Prevention necessarily involves a time period prior to the period of interest; consequently, later childhood ages 7-12 issues are also part of this investigation.

Youth are not a homogeneous population. At various points, the compendium accounts for distinctions between sub-populations of youth based on gender, urban-rural differences, level of risk, cultural background and stage of psychosocial development. Universal, selective and indicated prevention: In this compendium, these terms replace the terms, primary and secondary prevention tertiary prevention refers to treatment.

The model was first described by R. Gordon in 1987 and was adapted by the US Institute of Medicine Committee on the prevention of mental disorders in 1994. It was applied to substance use issues by the National Institute on Drug Abuse in a 1997 publication, "Preventing drug use among children and adolescents: The terms are more fully discussed in the Prevention principles section. Methodology Substance Use Patterns of Canadian Youth A key premise of this resource is that prevention activities need to be based on the best available information on the nature and extent of youth substance use problems.

  1. Sexual activity associated with substance use has significant implications.
  2. For GPA the odds ratios ranged from 2. Also, personnel within school health services were informed about the survey, and therefore enabled to be present for the adolescents by the time they answered the questionnaire.
  3. In particular, efforts aiming to increase school-related functioning among adolescents should be aware of the important role of reducing levels of alcohol and illicit drug use e. This section will detail information on age of first use, age and gender differences, age of peak use and problems reported from use.
  4. Therefore, studies employing registry-based information are needed in the investigation on how adolescent alcohol and illicit drug is associated with school functioning. The grade point average GPA was calculated as the average of the student's grades during their time at the school.
  5. In particular, mental health problems are demonstrated as influential factors in relation to both adolescent alcohol and illicit drug use e.

Section 2 of the compendium sets the context for later discussion on principles and programs by detailing the current patterns of youth drug use in Canada. The information presented is based on an analysis of the most recent government surveys as well as key journal articles on the epidemiology of youth substance use in Canada.

This section will detail information on age of first use, age and gender differences, age of peak use and problems reported from use. The following section shows how this information can guide program development. Principles of Youth Substance Use Problem Prevention Section 3 presents 14 principles that represent a consensus of the project team and steering committee on the most important considerations in developing and implementing youth substance use problem prevention programming.

The principles were arrived at through an extensive review of the literature and other consensus-based statements from authoritative bodies. Exemplary Programs from the Scientific Literature Whether a programmer is developing a new program, revising an existing one, or considering the purchase of a marketed program, these principles provide sound direction. This section describes and analyzes 33 programs with a range of aims, target groups and settings that have been shown to be effective through rigorous evaluation.

Among the programs presented are eight that focus on the unique needs of injection drug using IDU youth. Programs in this section were identified through a process which: Among the programs serving IDU youth are treatment programs that are presented in this Compendium because they are engaged in the prevention of harmful effects associated with injection drug use.

Limitations Considerable effort went into conducting a broad investigation and adhering to a strict method; however, the following limitations were noted: Effort was made to obtain direct cost information from authors and sponsors, however the information obtained is uneven and generally weak; due to their being marginalized, IDU youth are not as easily studied or served; as a result, the type of research or documentation made available didn't allow for the same level of confidence in outcomes as was generally the case; follow up contact was made with all "screened-in" candidates, however a small number of principal authors of published programs and sponsors of Canadian programs chose not to participate and were not included in the Compendium.

Section 2 - Substance Use Patterns of Canadian Youth Substance use patterns among young people are determined by many factors and are constantly evolving.

It is important that programs base their activity as fully as possible on data describing current patterns of use.

Age at first use, the proportion of users vs. This section reviews recent national and provincial studies of youth both in and out of school, as well as other key research, to develop a detailed profile of youth substance use in Canada. This information holds a number of important implications for program development that are detailed in the Prevention principles section that follows.

National and provincial student substance use surveys, together with studies of street youth and local epidemiological assessments of problems, provide good information on patterns of use, and offer a sound basis for program development decisions.

A key reference for this investigation was a recent Health Canada review that analyzed and compared findings from surveys conducted in nine provinces between 1994 and 1996. Student surveys give an indication of the substance use patterns of most youth in the 12-19-year-old range i.

The surveys do not include students in private schools, in institutions, those being home schooled, those absent from school, or school drop-outs. Ontario's Addiction Research Foundation now the Centre for Addiction and Mental Health has sponsored the longest ongoing Canadian survey of youth substance use. This series of surveys has shown that, after peaking in 1979, use of most substances by young people declined steadily until the early 1990s. Since then, the use of legal and illegal drugs by students has generally been on an upward trend.

Findings from the 1999 Ontario Student Survey on Drug Use OSDUS indicate that most drug use levels with the notable exceptions of alcohol and tobacco, which have shown an overall decline are now similar to those of the late 1970s - historically the peak period for use.

Footnote 27 Notably, the 1999 estimate for use of hallucinogens other than LSD, e. Nova Scotia has also seen an increase in hallucinogen use during the 1990s. Nationally, among Grade 10 students, use of a number of substances - cannabis, LSD, amphetamines, cocaine and inhalants - increased between 1990 and 1998.

However, past year Ecstasy use increased eight fold from. It is also important to bear in mind that particular sub-groups - for example, older male students - are more likely to use most of these substances and have exceeded these rates in most cases. There is concern about the abuse of these drugs, but not where they a review of the studies on illicit drug use prevention and their strengths and weaknesses prescribed by a physician and used as directed. Generally, the first use of alcohol, tobacco and cannabis by students appears to be occurring at a later age now than in the past.

Footnote 29 However, attitudes have become generally more tolerant of use, with fewer students expressing moral disapproval or perceiving a risk of harm in experimenting with various substances.

The same trend in attitudes has been found in the United States. Footnote 30 Reports of problem use have risen in recent years. Since the early 1990s, there has been a general increase in the percentage of students reporting current use of more than one substance, including use of multiple illicit substances.

In Newfoundland and Labrador, the number of students using alcohol, tobacco, and cannabis increased from 1996 to 1998. The percentage of Nova Scotia students who consider themselves current users of these three substances doubled from 12. There tends to be a strong association between cigarette and cannabis use, with most who smoke cannabis also being cigarette users. As well, most indications point to an increase in the amount of frequent drinking during the 1990s.

Preventing Substance Use Problems Among Young People - A Compendium of Best Practices

Frequency of cannabis use has generally increased across the country during the past decade. It is difficult to identify general trends in use of substances by out-of-the-mainstream youth because this population is quite fluid and information is incomplete. Toronto investigators reported a decrease in drug use, including injection drug use, among Toronto youth between 1990 and 1992. Footnote 31 However, these young people continue to be at risk for an array of health problems, particularly HIV, and hepatitis B and C as a result of injection drug use and needle sharing.

Current Patterns of Use General Prevalence In the late 1990s, on average, one-third to one-quarter of Canadian high school students i. Alcohol is the most commonly used substance by youth, with about two-thirds of all junior and senior high school students having consumed alcohol in the past year.

  1. In the Montreal study, needle sharing was common and seemed to occur soon after initiation of injection drug use. Universal, selective and indicated prevention.
  2. More specifically, crude regression models were utilized, followed by adjustments for age, gender and SES, and finally adjusted for age, gender, SES, and mental health problems. Demographic Information Age and gender were retrieved from registry data.
  3. Footnote 71 However, in a study of youth in British Columbia correctional facilities, more young females 10. Research conducted in Nova Scotia, Footnote 54 Winnipeg Footnote 55 and Calgary Footnote 56 have reported overall mean age of first injection to be 21 or 22 years.
  4. Since the early 1990s, there has been a general increase in the percentage of students reporting current use of more than one substance, including use of multiple illicit substances.
  5. Footnote 59 A lso, it is known that transition between school levels represents a point of vulnerability for some students.

It is important to note these figures represent averages for the full junior and senior high school population and that prevalence of substance use increases with age. The Ontario student survey provides the only province-wide indication of Ecstasy use in Canada, with 4.

This represents a significant increase from 1993 when 0. There is no Canadian information on the prevalence of other club drug use. Limited information is available on injection drug use by students. Analysis of the 1999 Ontario survey found 2. Footnote 34 Substance use is just one of many problems faced by street youth. For these youth, substance use differs in that it serves more as a way of coping with negative experiences both before and after going to the street and has less of a recreational purpose.

Prevalence and patterns of substance use by urban street youth in Canada vary from city to city, but according to the limited information available, appear much higher than student use. Footnote 37 The use of hallucinogens is more common among street youth than among students.

Footnote 40 Compared with student populations, the use of injection drugs among out-of-the-mainstream youth is also considerably higher. Footnote 46 There is evidence to suggest that rural or smaller town street youth use substances for the same reasons as their urban counterparts, but use alcohol predominantly, and other drugs to a lesser extent. Footnote 47 Age at First Use Early onset of alcohol and tobacco use has been associated with later substance use problems.

For example, a recent large US study found that age at onset is a powerful predictor of later alcohol abuse and dependence. The earlier young people begin smoking daily - an indication of dependency - the more cigarettes they are likely to smoke, the less likely they are to quit and the more likely they are to be heavy smokers as adults.

First use of cannabis occurs for a significant number of Canadian youth in Grades 8 and 9. First use of other substances typically occurs in subsequent years. There is limited information available on the average age at which individuals start to inject drugs.