Good Practice
Indicated Prevention
Some young people who use substances regularly are not yet addicted but are at high risk of becoming dependent. These youth usually experience many other health and social problems and should receive Indicated Prevention, a more intensive programme that often involves outreach to identify, engage and work with youth to minimize the harms associated with their lifestyle.
A small percentage of students in school experience significant problems, including those stemming from substance use. For these young people, counselling or more intensive treatment based on a good assessment is important. A range of other services, including intervention, case management and referral to deal with various problems, is often necessary for these students and needs to be available from schools or community agencies.
For some families with serious problems, family therapy has been shown to be an effective component of a comprehensive strategy. Family therapy helps family members communicate more effectively with each other, understand how the family works and better solve family problems. Family therapy can help family members improve their feelings about one another, decrease poor behaviour and develop skills for being together in a healthy way. Therapy can also help to enhance parenting skills.
Youth that are living on the street and using substances in risky ways need a variety of support, with a focus on minimizing day-to-day harms as they deal with life on the street. Street youth say that having a decent place to live is, by far, the most important factor in getting off the street. Opportunities for leisure, recreation, community service or alternative schooling have been found to be helpful with some higher risk youth. Called the "alternatives approach", these opportunities may be most appropriate for youth who are not in school, those who are not supervised fully by parents or other adults and those who do not normally have access to a variety of activities. Some of these youth like to take risks and may do well in alternative programmes that offer excitement and adventure. These programmes may motivate some youth to get counselling or another form of help for their problems.
Those that work with high-risk youth need to be aware that problems can arise when they are brought together in new groups. Forming new groups has been found in some cases to increase problem behaviours, including substance use. It has been suggested that members of these groups will sometimes approve and encourage each other's anti-social behaviour.
Because injecting drug use poses serious health risks (i.e., overdose, HIV and hepatitis C infection), intensive efforts are needed. Young people may be particularly at risk because they have less experience with injecting drugs, they may have wrong information and may feel pressure from older injecting drug users. Regular approaches for reaching youth and providing prevention programming will not likely work for these young people. Instead, creative outreach approaches involving other young people are more successful. Also, research suggests that making new, sterile injection equipment more available may reduce one of the more important problems resulting from injection drug use -- blood-borne diseases such as AIDS and hepatitis C.
Young people are more likely to overdose than older drug users. Some countries and communities are experimenting with or considering developing safe injecting facilities as a way of reducing overdose deaths while also reducing transmission of blood-borne infections and minimizing public nuisance. At this point, the effectiveness of such facilities is not known and they remain controversial.
Indicated Prevention programmes are clearly required to address more serious substance use problems, but they also tend to be the most costly to develop and implement. One of the challenges with Indicated Prevention programmes is in attracting high-risk youth to join and stay in the programme until it is finished. It is best when a community has a combination of Universal, Selective and Indicated programmes available to work with young people, from those at low-risk to those at high-risk.
References:
Western Regional Center for the Application of Prevention Technologies, Best practice: Family therapy (general) (http://www.open.org/~westcapt/bp53.htm).
Caputo, T., Weiler, R., and Anderson, J., The Street Lifestyle Study. Health Canada, 1996.
Tobler, N., Drug Prevention Programs Can Work: Research findings. Journal of Addictive Diseases, Vol. 11 No. 3, 1992.
Paglia, A., Tobacco Risk Communication Strategy for Youth: A Literature Review. Health Canada, 1998.
Dishion, T.J., Andrews, D.W., Preventing Escalation of Problem Behaviors with High-Risk Young Adolescents: Immediate and 1-Year Outcomes. Journal of Consulting and Clinical Psychology, Vol. 63 No. 4: 538-548, 1995.
Kipke, M., Unger, J., Palmer, R. et al., Drug Use, Needle Sharing, and HIV Risk Among Injection Drug-using Street Youth. Substance Use and Misuse, Vol. 31, 1167-1187, 1996.
Martinez, T., Gleghorn, A., Marx, R. et al., Psychosocial Histories, Social Environment, and HIV Risk Behaviors of Injection and Non-Injection Drug-using Homeless Youths, Journal of Psychoactive Drugs, Vol. 30, #1, 1998.
Donohoe, M.C., Hall, W., Opioid Overdose: Trend, Risk Factors, Interventions and Priorities For Action. World Health Organization, 1998.
Joint Select Committee into Safe Injecting Rooms, Report on the Establishment or Trial of Safe Injecting Rooms. Parliament of New South Wales, 1998.
Offord, D., Selection of Levels of Prevention, Addictive Behaviours, Vol. 25 No. 6, 2000.
Source:
G. Roberts, et al., (2001). Preventing Substance Use Problems: A Compendium of Best Practices. Health Canada.