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NIDA Strategic Plan (Continued)
Strategy 1: Give Communities Science-Based Tools To Prevent Drug Abuse and Addiction
The adoption of effective drug abuse prevention programs by communities
nationwide will significantly reduce the toll of drug abuse and addiction on our society, especially our Nation's youth. Over the next 5 years, research advances in the following areas will significantly enhance our Nation's prevention efforts:
- Understanding of the genetic and environmental risk
and protective factors that can prevent or lead to drug abuse
and addiction;
- Enhancement of the assessment of drug problems at a local level
by providing communities with effective research-based tools;
- Translation of research-based prevention principles for the specific
needs of local communities;
- Determining the link between drug abuse and infections such as HIV
and hepatitis to reduce the local impact of these devastating illnesses.
Understanding what determines vulnerability to substance abuse is crucial to
the development of effective prevention programming. At this point, there is
no evidence that a single, unique factor determines which individuals will abuse drugs; rather, drug abuse appears to develop as the result of a variety of genetic, biological, emotional, cognitive, and social risk factors that interact with features of the social context. Thus, both individual-level factors and social context-level factors appear to make an individual more or less at risk for drug abuse and influence the progression from drug use to drug abuse to drug addiction.
NIDA-supported research has already identified many risk factors associated with the development of drug problems. These factors typically have been organized into categories that represent individual, familial, and social risks. For example, we now know that individual-level risks include shy, aggressive, and impulsive personality traits and poor academic achievement; and family-level risks include poor monitoring by parents and exposure to substance use by parents and siblings. School-level risk factors include a pro-drug-use norm and availability of drugs on or near the school campus; and community-level risks include lack of positive academic and recreational programming for children and adolescents after school hours and on weekends, as well as low levels of law enforcement with respect to minors' use of licit and illicit substances. This sampling of risk factors illustrates the breadth and complexity of the risks that can confront any one person.
For many years, our focus was on discovering the factors that put people,
particularly children, at risk for drug use, abuse, and addiction. We now
know that there are also protective or resiliency factors that protect individuals from developing drug-related problems. NIDA-supported research has already uncovered many such protective factors that operate at the individual and contextual levels through the family, peer group, school, community, workplace, and the media, among others. Examples of protective or resiliency factors include a stable temperament, a high degree of motivation, a strong parent-child bond, consistent parental supervision and discipline, bonding to prosocial institutions, association with peers who hold conventional attitudes, and consistent, community-wide anti-drug-use messages and norms. An accumulation of protective factors may counteract the negative influences of a few risk factors.
The challenge for the future is to understand how risk and protective factors interact to make individuals more or less vulnerable to trying drugs, abusing drugs, and/or becoming addicted to drugs. Additionally, we must understand the unique risk and protective factors that contribute to drug abuse among minority populations. This knowledge will allow prevention researchers and providers to design programs that can be more effectively tailored to individual needs.
Over the past 20 years, researchers have developed and tested a variety of
efficacious prevention programs and have analyzed them to identify what
we have come to know as fundamental principles of effective drug abuse
prevention (see box). As useful as these principles are, they are quite general
and must now be taken to a new and greater level of specificity. Prevention
programs cannot simply be replicated in any new setting: they must be
responsive to the special characteristics of different locales and settings as
well as to differences in the needs and responses of audiences that may vary
in gender, ethnicity, and age. We also need to determine how to best tailor
programs to subpopulations that are at increased risk for drug abuse.
Preventing Drug Use Among Children and Adolescents: A Research-Based Guide
In March 1997, NIDA published the first science-based guide to drug abuse
prevention. After a NIDA-convened national prevention research conference
in September 1996, a group of NIDA researchers compiled "Preventing Drug Use Among Children and Adolescents." The 38-page booklet provides prevention principles that a school or community can use to implement a prevention program specifically tailored to meet each community's particular needs.
From extensive research with children and adolescents, we know that
because prevention is basically a process of education and behavior change,
and because behavior is shaped in a social context, changing children's behavior must involve not just the school environment, but teachers, peers, parents, and the entire community. Many of the principles necessary as a base for an effective prevention program that encompasses all of these groups are outlined in NIDA's research-based prevention guide. The guide first identifies risk and protective factors that can be used in determining who may or may not be more or less likely to develop drug abuse problems. The risk and protective factors help to set the primary targets for prevention intervention.
The guide then uses science-derived principles to establish the content,
structure, and delivery of the selected intervention. In short, the content
should target all forms of drug abuse, should include skills for resisting offered drugs, should include interactive methods, and should also include a parents' or caregivers' component that reinforces what the children are learning. The structure of the intervention should be long-term and family-focused if possible, include media campaigns, and work toward strengthening norms against drug use. The delivery of the intervention should be age-specific, developmentally appropriate, culturally sensitive, and adapted to address the specific nature of the drug abuse problem in the local community. All of these suggestions for developing effective interventions are based on elements of prevention programs that have been consistently found to be effective in preventing drug use. Many of these principles, as well as specific examples of successful prevention interventions, have been compiled into the prevention guide.
NIDA is now diligently working to make sure that its science-based principles of prevention are used in real-life prevention programming. The public response to the guide has been tremendous, and more than 200,000 copies have been distributed to schools and communities across the country; additional requests average about 20,000 per month. The challenge for the future is that NIDA continue to work with local communities to ensure that effective prevention programs are implemented and evaluated at the community level.
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To give communities the science-based tools to prevent drug abuse, we must
have research in several emerging areas of prevention. Strategies are needed
that can help communities to better determine their own local needs and
their readiness for interventions. For example, communities must be given
the epidemiological tools to assess their needs. Research is needed also to
aid understanding of the organization, management, financing, and delivery
of prevention services. In the treatment arena there are established systems
such as clinics, hospitals, outpatient centers, HMOs, and clinician training
and certification systems. However, there are no defined systems for provision
and financing of prevention services or training and credentialing of providers. Thus, it is difficult to determine how decisions are made about prevention implementation. A full understanding of these issues will help integrate prevention strategies and programs into existing community-level service delivery systems and sustain them.
There is little doubt that prevention efforts can play a critical role also in breaking the link between drug abuse and HIV infection, which leads to the
development of AIDS. This is even more true now that research has proven
the strong connection between drug abuse and other infectious diseases, such
as hepatitis B, hepatitis C, and tuberculosis. Drug abuse is now the major risk
factor identified in new cases of AIDS, hepatitis B, hepatitis C, and tuberculosis in the United States, and a growing number of cases of these infectious diseases are now reported among the partners of intravenous drug users. In addition, the majority of HIV-infected newborns have mothers who were infected through their own drug use or through sexual activity with a drug user. Research is also demonstrating that minority populations may have unique risks that must be addressed.
NIDA-funded efforts have repeatedly shown that even small amounts of
education and counseling can help drug users modify those behaviors that
put them at risk for acquiring and transmitting HIV, hepatitis, or tuberculosis, even without total abstinence from drug use. NIDA's Center on AIDS and Other Medical Consequences of Drug Abuse will spearhead the Institute's efforts to expand outreach to educate populations at risk about the relationship between drug abuse and serious infectious diseases, and it will support research to expand our understanding of the link between drug abuse and infectious diseases as well as the other health consequences of chronic drug exposure.
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