Prevention refers to the action of intervening in a situation to stop a certain action from happening due to its potential precarious outcome. In the context of this discussion, prevention refers to the steps taken or framework employed in stopping an individual from misusing, overindulging, or abusing substances such as drugs. In essence, the end game of the preventive strategies is to interdict addiction of the individual to the substances. This concept can also be referred to as a primary prevention technique. On the other hand, tertiary prevention relates to a process or series of steps taken to improve the quality of life of the addicted individual by reducing the existing disabilities and impairments thereby minimizing the suffering or deleterious effects of the substance. Tertiary prevention is saliently bolstered during remission of the addict for at least six months where the intervention techniques are most effective.
According to Ch.12 Powerpoint (2018), throughout the recorded history, almost all cultures use substances that contain psychoactive properties which, subsequently affect mood, brain function, and perception. Substances used, abused, or misused vary wildly and are not singularly limited to hard drugs such as cocaine, heroin, and other OTC drugs but also include common psychoactive drugs such as caffeine, nicotine, opiates, and alcohol. The latter batch such as caffeine and nicotine is a group of drugs used every day in most households without conscious knowledge or awareness of their addictive properties. As such, by the time most individuals realize their addiction to the substances, they might have already developed substance-related disorders. Consequently and most often coincidentally, most of the individuals realize their addiction after being diagnosed with substance-related disorders. This phenomenon is also generalized for all the other drugs with most of them resulting in substance use disorders and substance-induced disorders.
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Manifestations of the substance-related or induced disorders warranting diagnosis take the form of abnormal behavior necessitating primary or tertiary preventive strategies. To this end, the paper aims at providing a discourse that articulates the differential and various primary and tertiary preventive techniques for substance/alcohol addictions. Ultimately, personal opinions regarding useful and substantial strategies will be provided with correlation to outside literature or research.
Primary Preventive Strategies
The most effective technique of employing primary preventive strategies is through preemptive interdiction of substance use, misuse, and abuse. In other words, the efficacious nature of primary preventive strategies is hinged on the tendency and certitude of stopping addiction by curbing or managing drug abuse and misuse. Essentially, through managing substance and alcohol use and misuse behavior which result in detrimental substance-induced disorders, addiction is often inhibited. Primary prevention as the name suggests is the first line of action taken towards alleviating potential addictions and the resultant disorders.
According to Trova (2015), other than cardiovascular conditions, no additional medical condition culminates in significant dysfunction and premature deaths as opposed to alcohol-related issues. WHO (2000) reports that young individuals are substantially at risk of substance use owing to their stage in life where behavioral patterns are formed and shaped by peers and role models among other cultural, socioeconomic, psychosocial, and social factors resulting in substance use. In essence, WHO notes that the role of the community in preventing abuse and addiction should be proactive and participatory rather than reactive to the services designed and implemented by external agencies and individuals. In other words, the revered organization is recommending more innovative and creative strategy in preventing the addictions rather than the traditional approaches that have to some extent become obsolete.
In contemporary society, substance use, abuse, and addiction are prevalent in the young population. Indeed, as elaborated above, the young generation exists in a time where its behaviors are easily manipulated, and as such, it is through this opportunity that innovative preemptive measures can be implemented to influence the behaviors of this population for long-term health benefits or outcomes. This phenomenon is based on the rationale that individuals have the greatest capacity to individually influence their health outcomes as well as the quality of life provided they are empowered with the appropriate skills, information, and means. As such, these individuals can thus make proper decisions and take action to bolster their health and that of the community. The above concept is what WHO refers to as the health promotion concept, a central approach in the prevention of alcohol and substance addiction consistent with the public health model.
Thus, WHO ascertains that among the innovative primary preventive strategies is making contributions towards developing and implementing healthy public policies and laws. In this regard, policymakers should be proactive and conscious of the constant changing environment surrounding substance use and abuse. This includes new types of drugs in the market with high psychoactive effects, new ways of abuse and misuse, and the supply chain of these drugs from the sources to peddlers and finally the users. An additional preventive technique is the creation of a safe and supportive environment that strengthens community action. This strategy transcends the rudimental mandate of forming support groups and thus incorporates efforts and partnership from organizations such as the North Coastal Prevention Coalition which facilitates community-level prevention approaches. Even though the NCPC is localized to the San Diego County, its approaches and preventive interventions in the county can be generalized and applied across the nation in the bid to change community norms, availability, and access contributing to substance use and addiction.
The central objective of primary preventive strategies and approaches is reducing the risk factors while maximizing protective factors at both environmental and individual level. According to Lindsey (2003), a fundamental primary strategy is the dissemination of information and creating awareness regarding the consequences and deleterious effects of substance use and resultant addiction. However, the dissemination of information should be hinged on risk assessment relating to the problematic use of and addiction substances (Trova, 2015). This approach provides comprehension and insight into the holistic scope of substance use and addiction. As such, with the knowledge and insight, dissemination of information can be incorporated with education and jointly delivered to the public. Moreover, education, awareness, and information can be popularized or passed along through the incorporation of the same into the education curricula as an innovative primary prevention technique. Since the target populations are the youths and young adults, this approach should be targeted at all levels of education (primary, secondary, and tertiary) to which these populations are exposed.
Distracting these populations from drug use and dependence through enhancing their vocational and livelihood skills is an essential and innovative means of preventing addiction through substance use. Bolstering the vocational and livelihood skills of these individuals will increase their chances of employment thereby fostering independence while alleviating idleness which is a key catalyst to indulgence in substance use accruing from peer pressure. Sociologists can as well emphasize the importance of family ties through forums to parents and the community where parents serve as the primary role models to children and youth. The forums could include parent support groups, family counseling, and parent-peer groups meant to sharpen parenting skills (WHO, 2000).
Technology can also be a great arsenal in innovative prevention of addiction and substance use. As such, innovative technology such as the Alcohol Ignition Interlock Device and Alcolocks could be materialistic in the long-term prevention of drug misuse and ultimately addiction. Ultimately, government agencies and the medical fraternity in their mandate to curb addictions resulting from substance abuse and misuse can put in consorted efforts in reducing the retail sales of synthetic drugs. These efforts should strictly be directed to those drugs with the potential to mimic lethal hard drugs such as methane, marijuana, opioids among others. However, the communities should be involved at the local, national, and international level to stop not only the supply but also the selling of the substances. In essence, by reducing supply and availability, demand for the drugs drops and so does the use, abuse, misuse, and addiction.
Tertiary Preventive Strategies
Tertiary interventions strategies are the last line of defense in the fight against alcohol and substance addiction. In other words, though these strategies have a close correlation to secondary strategies, their application comes as an option of last resort when the addict is in remission. Tertiary strategies are mostly applied as a means of preventing the addict from relapsing. According to Trova (2015), tertiary interventions are aimed at motivating the addicts to abstain from alcohol or other addictive substances that create dependence, hamper relapses, and foster the adoption of new behaviors that support the transformation from substance dependence. NIAAA (2018) reports that tertiary prevention encompasses approaches taken to minimize the existing disabilities and impairments thereby alleviating suffering accruing from the abuse of alcohol and substance abuse.
According to Ch.12 PowerPoint (2018), lifetime incidence rates range between 5.4 percent and 12.5 percent for alcohol dependence and between 13.2 percent and 17.8 percent for alcohol abuse. Other substances such as Amphetamine have a lifetime dependence incidence rate of 1.5 percent. These statistics illustrate the dire nature of addiction within the nation warranting tertiary interventions. Given the fact that most of the individuals at this phase have developed substance use and induced disorders, essential tertiary prevention would be follow-up psychotherapeutic interventions of the dependent or addicted individuals. The approaches under this strategy include motivational interviewing and other treatment strategies such as meditation and acupuncture. The rationale behind including the treatment strategies above is that tertiary interventions are also treatment approaches to the resultant issues (disorders) of alcohol and substance addiction.
On the other hand, motivation is a key tertiary strategy, especially in curbing relapses during the remission period. According to Lindsey (2003), motivation is not only central to change but also multidimensional, interactive, and dynamic. Nonetheless, this strategy should be implemented in a manner which conforms to the Transtheoretical model, an integrative model of behavior transformation. The focus of the model and the strategy, therefore, is empowering the individual to make better and tenable decisions during the transformational process. Here, the following five stages of change should be employed; precontemplation, preparation, contemplation, action, and maintenance. However, clinician or physicians should allow the addict to move through the stages rather than enforcing a linear development in the process to transform his or her behavior. The following is a description of the Transtheoretical Model stages as a pivotal tertiary prevention strategy.
Precontemplation - this stage refers to the remission period whereby the subject does not intend to undertake any action in the short-term (six months). As such, approaches include avoiding being judgmental and providing support both emotionally and spiritually through building trust.
Contemplation - here, the subject is thinking of changing or transforming his or her behavior over the next six months. Besides, the subject should be made aware of the pros and cons of change as well as relapse. However, physicians should accept and recognize denial as normal, normalize drug use, avoid labeling, and accept individual differences regarding education, skills, money, and race.
Preparation - in this stage, the subject is ready for action in the immediate future, usually a month. The approaches include listening rather than directing the client, aiding the candidate in negotiating potential barriers, exploring treatment expectancies as well as the client’s role, and offering advice and expertise upon provision of consent.
Action - candidates have made significant strides towards behavior change in the past six months. Monitoring the candidate is critical in preventing relapse of the individual. Approaches involve rewards for behavioral and diet change as well as exercise. Also, it is crucial to acknowledge the candidate’s difficulties and aid him/her in rejuvenating him/herself.
Maintenance - this is the final stage where individuals and physicians strive to alleviate relapse. Fundamental approaches here include motivation and building confidence in the candidates to continue and complete their transformation process. Also, it is essential to support the candidate’s self-efficacy and optimism and his/her lifestyle changes and strengths.
Personal Opinion
From the discussion above, both preventive strategies are essential and critical in the community’s and individual’s well-being. However, I believe that primary prevention has the greatest potential of curbing addiction but only if applied competently. Indeed, as Trova (2015) states, primary preventive strategies such as Alcohol Ignition Interlock Device and Alcolocs have been deemed to be successful in curbing alcohol abuse, for instance, in Greece where results have been positive. In essence, the rationale behind the preference to primary prevention strategies over tertiary ones is the fact that the former is proactive as opposed to the latter which are reactive and only employed after the damage has been done regarding addiction development of disorders.
Besides, the primary preventive techniques are beneficial compared to tertiary ones because while tertiary prevention is subjective on a single individual, primary interventions can be applied on a broader scale thereby impacting and reaching a wider population. To this end, primary interventions have the greatest possibility of influencing positive behavior than tertiary interventions. Indeed, Linsey (2003) contends that primary prevention strategies are significant in preventing and delaying the use of alcohol and other substances, primarily if the interventions are implemented at an early age.
Conclusion
Prevention as a general term is crucial in inhibiting the deleterious nature of substance use, abuse, misuse, and addiction. This is achieved through two fundamental categories of strategies referred to as primary and tertiary preventive strategies. As such, the paper fleshes out the central and most notable primary preventive strategies including dissemination of information, Alccolocks, incorporation of information regarding substance use and abuse in education curricula, empowering parenthood, and developing individual and vocational skills to alleviate idleness. On the other hand, tertiary strategies of prevention revolve around the Transtheoretical Model, which encompasses five strategies; pre-contemplation, contemplation, preparation, action, and maintenance. Other approaches under the tertiary preventive strategy include psychotherapeutic follow-ups, motivational interventions, and other treatment methods such as acupuncture and meditation. However, of the two approaches, primary prevention stands out based on its proactive nature and ability to impact and reach a greater population as opposed to tertiary prevention techniques which are subjective. Nonetheless, despite their differential nature and preference of one over the other, both prevention strategies and the subsequent tenets therein provide a holistic scope on the prevention of substance use and abuse, and as such, both are quintessential.
References
Chapter 12 PowerPoint. (2018). Views of abnormal behavior: Substance-related disorders.
Lindsey, V. V. (2003). Primary, Secondary and Tertiary Youth Prevention Programs. Journal of Addictive Disorders . Retrieved from http://m.breining.edu/jad03vl.pdf
NIAAA. (2018). Module 3: Preventing alcohol abuse and dependence. Retrieved from https://pubs.niaaa.nih.gov/publications/social/module3prevention/module3.html
Trova, A.C., Paparrigopoulos, T., Liappas, I., & Ginieri-Coccossis, M. (2015). Prevention of alcohol dependence. Psychiatriki, 26 (2): 131-40. https://www.ncbi.nlm.nih.gov/pubmed/26197102
World Health Organization. (2000). Primary Prevention of Substance Abuse, A Workbook for Project Operators. Retrieved from https://www.unodc.org/pdf/globalinitiative/initiative_activities_workbook.pdf
