Module One

Introduction

### Time {#time .HeadInfSheet}

The anticipated time for the module is 4 hours.

### Learning Objectives {#learning-objectives .HeadInfSheet}

Participants will be able to

-   Identify by name at least three other participants

-   Practice responding to proponents of various viewpoints of
    prevention

-   Understand the history of drugs in America and its impact on current
    viewpoints

-   Review the building blocks of successful prevention

### INFORMATION SHEET {#information-sheet .HeadInfSheet}

# Agenda

These are the modules the Center for Substance Abuse Prevention's
Western Center for the Application of Prevention Technologies recommends
for training prevention professionals. Create an agenda for participants
based on your schedule.

**SECTION 1 Introduction**

-   Welcome

-   Expectations

-   Agenda

-   Participant Manuals

-   Ground Rules

-   Parking Lot

-   Pretest

-   Getting-Acquainted Activity

-   Attitudes About Drugs and Drug Prevention

-   Viewpoints of Prevention

-   History of Drugs in America

-   Evolution of the Prevention Discipline

-   Building Blocks of Successful Prevention

**SECTION 2 Prevention Research**

-   Current Approaches to Prevention

**SECTION 3 Prevention Program Planning**

-   The Strategic Prevention Framework

-   The IOM Classification

-   Prevention Principles

-   Enhancing Prevention Programs

-   Cultural Competency

-   Sustainability

**SECTION 4 Evaluation**

-   Building a Logic Model

-   Developing an Evaluation Plan

-   Measures and Sources of Evaluation Data

-   Internal and External Evaluation

**SECTION 5 The Cultural Context of Prevention**

-   Defining Culture

-   Dimensions of Culture

-   Culture and Prevention Programming

-   Gathering Information about Communities

**SECTION 6 Using Human Development in Prevention**

-   Changes

-   Maslow's Hierarchy of Needs

-   Emotional Development

-   Social Development

-   Moral Development

-   Prevention Strategies Focused on Emotional, Social, and Moral
    Development

-   Brain Development

-   The Medicine Wheel Model of Human Development

**SECTION 7 The Media and Prevention**

-   The Role of Media in Prevention

-   Media Advocacy

-   Media Literacy

-   Social Marketing

-   Scare Tactics

**SECTION 8 The Ethics of Prevention and Bringing It All Together**

-   Ethics in Prevention

-   Review

-   Applying the Information

-   Closing

### INFORMATION SHEET {#information-sheet-1 .HeadInfSheet}

# Viewpoints of Prevention

Represent your viewpoint faithfully in the discussion. You can be
flexible---you can even change your mind---but be sure that you
initially speak from the point of view described below.

1\. THE MORAL CRUSADER

You fervently believe that alcoholism and other drug dependence is a
sin. People who lapse into addiction are morally flawed and will no
doubt go to hell unless they are reformed. People who are strong willed
resist the temptations of drugs and follow the righteous path.

**The key to prevention** is warning and redeeming: warning people not
to be tempted by the evil of drugs and redeeming those who have fallen
under the spell and wish to rejoin society.

**The question you want answered:** If it's bad to use drugs---and it's
obviously bad---why shouldn't we try to get everyone on the straight and
narrow and throw the ones who refuse in prison?

2\. THE SOCIOECONOMIC AND ETHNIC CHAUVINIST

Everything you've seen leads you to believe that alcoholism and other
drug dependence is a malady of the poor and nonwhite. These people use
drugs to escape from their miserable existence, and drug use continues
the cycle of their poverty. They use drugs because they don't know any
better and they perpetuate their travails by becoming dependent.

**The key to prevention** is isolation: keeping addiction in the ghettos
and not letting it spread to the middle and upper classes.

**The question you want answered:** What's wrong with doing a little
triage---cutting off the people who have willingly sold themselves out
and trying to protect the rest of us?

3\. THE DOCTOR

Addiction is clearly a disease. People who are drunk, high, or otherwise
under the influence of drugs need to be cleansed of the substance within
them. You no more tolerate the resistance of the addicted patient than
you would tolerate the resistance of a tubercular patient.

**The key to prevention** is removal: getting drugs out of patients and
getting drugs out of society.

**The question you want answered:** Why don't we just set up treatment
facilities around the country and help those afflicted?

4\. THE SCARE MONGER

> People just don't understand the consequences of using drugs. You can
> overdose, you can become a drunk, you can get into a fatal car crash,
> lose your mind, and so on. If people only realized what horrible
> things could befall them if they used drugs, they'd keep far away.
>
> **The key to prevention** is fear: showing people as graphically as
> possible the lurid consequences of drug use.
>
> **The question you want answered:** Why should we hold back on showing
> people just how horrible using drugs is?

5\. THE EDUCATOR

We live in an enlightened age in which knowledge is power. If people use
drugs, it's only because they're not familiar with them. Once they know
what all the drugs are, how they affect the mind and body, and some of
the history behind different kinds of drugs, they won't be interested in
trying them.

**The key to prevention is** knowledge: giving people as much
information as possible about drugs and drug use.

**The question you want answered:** Why shouldn't we trust people's
innate intelligence and give them all the facts so they can make a safe
and healthy decision about drugs?

6\. THE BLAMER

The reason we're in such a sorry state is because some people aren't
pulling their weight. Parents are bringing up their kids too leniently.
Schools aren't setting good examples. Television, movies, and music are
replete with unhealthy role models. And politicians are bought off by
the big tobacco and alcohol corporations.

**The key to prevention** is accountability: making sure that everyone
tows the line about the harmfulness of drugs.

**The question you want answered:** Why can't we get tougher laws that
will hold parents, schools, media, and politicians to doing their part
to prevent drug abuse?

### INFORMATION SHEET {#information-sheet-2 .HeadInfSheet}

# History of Drugs in America

## Alcohol

Alcoholic beverages have been a part of the Nation's past since the
landing of the Pilgrims. According to "Alcohol and Public Policy: Beyond
the Shadow of Prohibition," a publication commissioned by the National
Institute on Alcohol Abuse and Alcoholism (NIAAA) and prepared by the
National Academy of Sciences, the colonists brought with them from
Europe a high regard for alcoholic beverages, which were considered an
important part of their diet. Drinking was pervasive because alcohol was
regarded primarily as a healthy substance with preventive and curative
powers, not as an intoxicant. Alcohol was also believed to be conducive
to social and personal health. It played an essential role in rituals of
conviviality and collective activity, such as barn raisings. While
drunkenness was condemned and punished, it was viewed only as an abuse
of a God-given gift.

The first temperance movement began in the early 1800's in response to
dramatic increases in production and consumption of alcoholic beverages,
which also coincided with rapid demographic changes. Agitation against
ardent spirits and the public disorder they spawned gradually increased
during the 1820's. In addition, inspired by the writings of Benjamin
Rush, the concept that alcohol was addicting and that this addiction was
capable of corrupting the mind and the body took hold. The American
Society of Temperance, created in 1826 by clergymen, spread the
antidrinking gospel. By 1835, out of a population of 13 million people,
1.5 million had taken the pledge to refrain from distilled spirits. The
first wave of the temperance movement (1825 to 1855) resulted in
dramatic reductions in the consumption of distilled spirits, although
beer drinking increased sharply after 1850.

The second wave of the temperance movement occurred in the late 1800's
with the emergence of the Women's Christian Temperance Movement, which,
unlike the first wave, embraced the concept of prohibition. It was
marked by both the recruitment of women into the movement and a
mobilization to close down saloons. The movement set out to remove the
destructive substance and the industries that promoted its use from the
country. The movement held that while some drinkers may escape problems
of alcohol use, even moderate drinkers flirted with danger.

The culmination of this second wave was the passage of the 18th
amendment to the U.S. Constitution and the Volstead Act, which took
effect in 1920, prohibiting the sale, manufacture, or transportation of
alcoholic beverages within the United States. Although Prohibition was
successful in reducing per capita consumption and some problems related
to drinking, the social turmoil it produced resulted in its repeal in
1933.

Since the repeal of Prohibition, the dominant view of alcohol problems
has been that alcoholism is the principal problem. With its focus on
treatment, the rise of the alcoholism movement depoliticized alcohol
problems as the object of attention; the alcoholic was considered to be
a deviant from the predominant styles of life of either abstinence or
"normal" drinking. The alcoholism movement is based on the belief that
chronic or addictive drinking is limited to a few, highly susceptible
individuals suffering from the disease of alcoholism.

The disease concept of alcoholism focuses on individual vulnerability,
whether it be genetic, biochemical, psychological, or social/cultural in
nature. According to this view, if the collective problems of each
alcoholic are solved, society's alcohol problem will be solved.

Nevertheless, the pre-Prohibition view of alcohol as a special commodity
has persisted in American society and is an accepted legacy of alcohol
control policies. Following the repeal of Prohibition, all States
restricted the sale of alcoholic beverages in one way or another to
prevent or reduce certain alcohol problems. In general, however, alcohol
control policies disappeared from the public agenda as both the
alcoholism movement and the alcoholic beverage industry embraced the
view that "the fault is in the man and not in the bottle."

This view of alcoholism has also been the dominant force in contemporary
alcohol-problem prevention. Until recently, the principal prevention
strategies focused on education and early treatment. According to this
view, education was intended to inform society about the disease and to
teach people about the early warning signs so that they could initiate
treatment as soon as possible. Efforts focused on "high-risk"
populations and attempted to correct a suspect process or flaw in the
individual, such as low self-esteem or lack of social skills. The belief
was that the success of education and treatment efforts in solving each
alcoholic's problem would solve society's alcohol problem as well.

Contemporary alcohol-problem prevention began in the 1970's as new
information on the nature, magnitude, and incidence of alcohol problems
raised public awareness that alcohol can be problematic when used by any
drinker, depending upon the situation. There was a renewed emphasis on
the diverse consequences of alcohol use---particularly trauma associated
with drunk driving, fires, and violence, as well as long-term health
consequences.

## Drugs for Nonmedical Purposes

The history of nonmedical drug use and the development of policies in
response to drug use also extend back to the early settlement of the
country. As with alcohol, the classification of certain drugs as legal
or illegal has changed over time. These changes sometimes had racial and
class overtones. According to Mosher and Yanagisako (1991), for example,
Prohibition was in part a response to the drinking practices of European
immigrants, who became the new lower class. Cocaine and opium were legal
during the 19th century and were favored drugs among the middle and
upper classes. Cocaine became illegal after it became associated with
African-Americans following Reconstruction. Opium was first restricted
in California in 1875, when it became associated with Chinese immigrant
workers. Marijuana was legal until the 1930's, when it became associated
with Mexicans. LSD, legal in the 1950's, became illegal in 1967, when it
became associated with the counterculture.

By the end of the 19th century, concern had grown over the
indiscriminate use of these drugs, especially the addicting patent
medicines. Cocaine, opium, and morphine were common ingredients in
various potions sold over the counter. Until 1903, cocaine was an
ingredient of Coca-Cola®. Heroin, which was isolated in 1868, was hailed
as a nonaddicting treatment for morphine addiction and alcoholism.
States began to enact control and prescription laws, and in 1906,
Congress passed the Pure Food and Drug Act. It was designed to control
opiate addiction by requiring labels that revealed the amount of drugs
contained in products, including opium, morphine, and heroin. It also
required accurate labeling of products containing alcohol, marijuana,
and cocaine.

The Harrison Act (1914) imposed a system of taxes on opium and coca
products, with registration and record-keeping requirements, in an
effort to control their sale or distribution. However, it did not
prohibit the legal supply of certain drugs, especially opiates.

Current drug laws are rooted in the 1970 Controlled Substances Act.
Under this measure, drugs are classified or scheduled according to their
medical use, their potential for abuse, and their likelihood of
producing dependence. The act contains provisions for adding drugs to
the schedule and rescheduling of drugs. It also establishes maximum
penalties for the criminal manufacture or distribution of scheduled
drugs.

## Creation of Agencies to Address Alcohol and Drug Abuse

Increases in per capita alcohol consumption as well as increases in the
use of illegal drugs during the 1960's raised public concern about
alcohol and other drug problems. Prevention issues gained prominence on
the national level with the creation of the NIAAA in 1971 and the
National Institute on Drug Abuse (NIDA) in 1974. In addition to mandates
for research and the management of national programs for treatment, both
institutes included prevention components.

To further prevention initiatives at the Federal level, the Anti-Drug
Abuse Act of 1986 created the U.S. Office for Substance Abuse Prevention
(OSAP), which consolidated alcohol and other drug prevention activities
under the Alcohol, Drug Abuse, and Mental Health Administration
(ADAMHA). The ADAMHA block-grant mandate called for States to set aside
20 percent of the alcohol and drug funds for prevention. In a 1992
reorganization, OSAP was changed to the Center for Substance Abuse
Prevention (CSAP), part of the new Substance Abuse and Mental Health
Services Administration (SAMHSA). While SAMHSA retained its major
program areas, the research institutes of NIAAA and NIDA moved to the
National Institutes of Health.

The Office of National Drug Control Policy (ONDCP) was established by
the Anti-Drug Abuse Act of 1988. ONDCP's primary objective was to
develop a drug control policy that included roles for the public and
private sectors to "restore order and security to American
neighborhoods, to dismantle drug trafficking organizations, to help
people break the habit of drug use, and to prevent those who have never
used illegal drugs from starting." In early 1992, underage alcohol use
was included among the drugs to be addressed by ONDCP.

Although Federal, State, and local governments play a substantial role
in promoting prevention agendas, much of the activity takes place at
grassroots community levels. In addition to funding from CSAP's
Community Partnerships grant program, groups receive support from
private sources, such as the Robert Wood Johnson Fighting Back program.

Today, despite the best efforts of Federal, State, and local
governments, drug abuse continues to pose serious threats to the health
and social and economic stability of American communities. However, two
hopeful trends have been occurring. The knowledge gained through
prevention research (e.g., the results of demonstration projects and
program evaluations) has led to the development of formal theories, best
practices, promising approaches, and rigorous evaluation methods. And,
in the late 1990's, policies, laws, and norms have been changing to
influence the incidence and prevalence of drug use: Tobacco companies
have been forced to stop unethical advertising campaigns geared toward
teenagers, and many communities have increased the price of alcohol and
tobacco through excise taxes and passed ordinances prohibiting billboard
advertisements by the alcohol industry.

## Bibliography:

Center for Substance Abuse Prevention. (1991). *A promising future:
Alcohol and other* *drug problem prevention services improvement.* CSAP
Prevention Monograph 1O (BK1 91).

SAMHSA. *National household survey on drug abuse: Main findings, 1990.*
(1991). BKD67.

Mosher, J. F., & Yanagisako, K. L. (1991). Public health, not social
warfare: A public health approach to illegal drug policy. *Journal of
Public Health Policy, 72*(3), 278--322.

National Clearinghouse for Alcohol and Drug Information. *Prevention
primer.* (1993). Rockville, MD: Author.

National Institute on Alcohol Abuse and Alcoholism. *Alcohol and Public
Policy: Beyond the Shadow of Prohibition.* **[\[Please provide a
complete reference.\]]{.mark}**

### INFORMATION SHEET {#information-sheet-3 .HeadInfSheet}

# A Timeline of Prevention

  ------------------------------------------------------------------------
  TIME         NATIONAL PERSPECTIVE     STRATEGY          ACTIVITIES
  ------------ ------------------------ ----------------- ----------------
  **1950's**   Drugs are a problem of   scare tactics     films and
               the ghetto, used to                        speakers
               escape pain and to avoid                   
               reality.                                   

  **early      Drugs are used to escape scare tactics     films and
  1960's**     pain and to avoid                          speakers
               reality, but they're                       
               more than just a problem                   
               of the ghetto.                             

  **late       Drugs are used to        information       films and
  1960's**     intensify life, to have                    speakers
               psychedelic experiences.                   
               Drug use is considered a                   
               national epidemic.                         

  **early      A variety of drugs are   drug education    curricula based
  1970's**     used for a variety of                      on factual
               reasons: to speed up                       information
               experiences, to                            
               intensify experiences,                     
               to escape, to expand                       
               perceptions, to relieve                    
               boredom, and to conform                    
               with peer behavior.                        

  **mid        Users become more        affective         curricula based
  1970's**     sophisticated and        education and     on
               society develops an      alternatives to   communication,
               increasing tolerance of  drug use          decision making,
               drug use.                                  values
                                                          clarification,
                                                          and self-esteem

  **late       Parents begin to form    affective         social skills
  1970's to    organizations to combat  education,        curricula,
  mid 1980's** drug abuse.              alternatives to   refusal skill
                                        drug use, and     training,
                                        training          parenting
                                                          education

  **mid 1980's Drug use is very         parent, school,   research-based
  to mid       complex.                 and community     curricula,
  1990's**                              partnerships      linkages, and
                                                          peer programs

  **mid 1990's The gap between research replication of    environmental
  to 2000's**  and application is       evidence-based    approaches,
               gradually bridged.       models and        comprehensive
                                        application of    programs
                                        evidence-based    targeting many
                                        approaches        domains and
                                                          strategies,
                                                          evaluation of
                                                          prevention
                                                          programs, media
                                                          campaigns, and
                                                          culturally
                                                          sensitive
                                                          programs
  ------------------------------------------------------------------------

### INFORMATION SHEET {#information-sheet-4 .HeadInfSheet}

# Evolution of the Prevention Discipline

Hundreds of years ago, barbers who used techniques like "blood-letting"
practiced medicine. Fifty years ago, teachers or athletic coaches who
had no formal training in counseling or human behavior conducted school
counseling. And 20 years ago, the treatment of alcohol and other drug
problems was provided by alcoholics and addicts in recovery, who used
only their own recovery experience to help others. Today, physicians
undergo years of academic training and extensive internships. Nearly all
school counselors complete graduate-training programs specifically
designed for this field. Finally, more and more universities have
undergraduate and graduate courses in addiction counseling.

Professions often evolve in this way. As the public comes to understand
the value of or need for a discipline, standards for training and
practice are developed. States develop certification and/or licensure
requirements, and universities develop programs to train people to work
in the profession.

In medicine, barbers weren't very effective in curing illnesses and
diseases. Teachers and coaches were ill equipped to handle the complex
problems of youth in the 1960's. Recovering individuals did not know how
to treat abusers of multiple drugs, culturally and ethnically diverse
clients, women and their children, addicts involved with the criminal
justice system, and clients with co-occurring disorders. Therefore, the
stimulus to develop standards of training and practice for a profession
is often the lack of expertise of practitioners to handle the complexity
of the discipline.

The alcohol, tobacco, and other drugs (ATOD) prevention field is in the
beginning stages of this evolution. Society's need to solve ATOD
problems, combined with a growing body of knowledge of "what works," is
stimulating an effort to increase the professionalism of prevention
providers. In addition, the prevention field has had the burden of
explaining why some highly publicized, widespread prevention programs
have failed to demonstrate an impact on the ATOD use patterns of youth.
Consequently, Federal and State governments have begun developing
certification standards for prevention providers. Universities are
developing courses and internships in prevention. In addition,
government entities that distribute prevention dollars are beginning to
insist that prevention programs use "scientifically defensible"
prevention strategies and programs and use established practices to
evaluate the outcomes of funded programs. A well-trained staff is
necessary to meet these requirements.

This curriculum is designed to help professionalize the prevention
field. We know there are many prevention providers who want to increase
their effectiveness and are eager to find out "what works." And we know
that many college students are interested in working in prevention and
need training and experience to develop entry-level competence. We
designed this curriculum as a general overview of the prevention field
and as a stimulus for further learning.

### INFORMATION SHEET {#information-sheet-5 .HeadInfSheet}

+--------------+-------------------------------------------------------+
| ## Attitude  | Close your eyes and visualize an alcoholic. Now       |
| s About ATOD | visualize a crack addict. What were your              |
|              | visualizations like? What was the ethnic background   |
|              | of your alcoholic? What sex was your crack addict?    |
|              | Did you see a seedy, down-and-out person going        |
|              | through garbage cans? Did you visualize a well-known  |
|              | comedian or a professional athlete? Does a            |
|              | 15-year-old caught with a marijuana joint have a      |
|              | problem? What about the same kid with a bottle of     |
|              | beer?                                                 |
|              |                                                       |
|              | It's essential for professionals who work in the ATOD |
|              | prevention field to examine their attitudes about     |
|              | ATOD. Obviously, knowledge is important and can       |
|              | affect our attitudes. But sometimes we're not even    |
|              | aware of how firmly attitudes are entrenched. For     |
|              | example, most of us know that addiction to alcohol    |
|              | and other drugs is not a function of sex, ethnicity,  |
|              | or socioeconomic class. However, your visualization   |
|              | just now of an alcoholic and a crack addict may have  |
|              | reflected some stereotypes. That's normal and isn't   |
|              | necessarily harmful, as long as we understand that    |
|              | our stereotype does not reflect reality. For example, |
|              | if you work in a prevention program that has a        |
|              | largely white clientele, it would be erroneous to     |
|              | assume that crack is not used in the community. A     |
|              | 15-year-old with a joint or a beer may or may not     |
|              | have a substance problem. Only an assessment can      |
|              | determine this.                                       |
|              |                                                       |
|              | Prevention providers are encouraged to examine their  |
|              | attitudes about ATOD and to learn as much about       |
|              | substances as possible. While you certainly don't     |
|              | need to be an expert in pharmacology, you do need to  |
|              | understand basic information about categories of      |
|              | drugs and their effects. This information should be   |
|              | based on science and not on scare tactics.            |
+--------------+-------------------------------------------------------+
| ##           | Most helping professionals who don't have extensive   |
| Definitions  | training in ATOD find it difficult to determine if a  |
| of Use, Misu | client's substance use is problematic. They may rely  |
| se, Abuse, a | on personal experience and information (or            |
| nd Dependenc | misinfor­mation). Consider the following scenario: A   |
| e/ Addiction | high school counselor gets a call from a student's    |
|              | parent. The young man is 17 years old, came home from |
|              | a party on Saturday night smelling of alcohol and     |
|              | admitted to drinking at the party.                    |
|              |                                                       |
|              | His parents belong to a religious group that          |
|              | prohibits the use of alcohol, so neither has any      |
|              | experience with alcohol or other drug use. They want  |
|              | to know if their son has a problem. The high school   |
|              | counselor did her share                               |
+--------------+-------------------------------------------------------+
| ## D         | of experimentation in adolescence but is a moderate   |
| efinitions o | user as an adult. She assures the parents that nearly |
| f Use, Misus | all adolescents experiment and they have nothing to   |
| e, Abuse, an | worry about. Is she right?                            |
| d Dependence |                                                       |
| / Addiction  | Distinguishing between different levels of use can be |
| -- continued | helpful to the mental health professional in          |
|              | determining the type of intervention that's           |
|              | appropriate for a client. Yet these distinctions      |
|              | aren't appropriate for diagnosis. They simply provide |
|              | a guide for the mental health professional in         |
|              | recommending the course of action for a client. The   |
|              | following definitions are offered to frame the        |
|              | discussion of alcohol- and drug-abuse progression.    |
|              | You should understand that multiple definitions of    |
|              | use, abuse, and misuse exist. These are the           |
|              | definitions we are using for this discussion.         |
|              |                                                       |
|              | Most people use alcohol or other drugs (including     |
|              | caffeine and tobacco) at some point in their life. We |
|              | define "use" as the ingestion of alcohol or other     |
|              | drugs without experiencing negative consequences. Any |
|              | drug can be "used" according to this definition.      |
|              | However, the type of drug taken and the               |
|              | characteristics of the individual contribute to the   |
|              | probability of experiencing negative consequences.    |
|              | For example, it's illegal for minors to drink         |
|              | alcohol. Therefore, any use by a minor is considered  |
|              | abuse, and the probability that our high school       |
|              | student will experience negative consequences from    |
|              | drinking alcohol may be far greater than that         |
|              | probability for an adult. Similarly, the chances that |
|              | an adult will experience negative consequences from   |
|              | shooting heroin are greater than the chances that he  |
|              | or she will experience negative consequences from     |
|              | drinking alcohol.                                     |
|              |                                                       |
|              | When a person experiences negative consequences from  |
|              | the use of alcohol or other drugs, it is defined as   |
|              | "misuse." Again, a large percentage of the population |
|              | misuses alcohol or other drugs at some point. Many    |
|              | people overuse alcohol, become ill, and experience    |
|              | the symptoms of a hangover. This is misuse. However,  |
|              | misuse doesn't imply that the negative consequences   |
|              | are minor. Let's say that an adult uses alcohol on an |
|              | infrequent basis. It's her 30th birthday, and her     |
|              | friends throw a surprise party. She drinks more than  |
|              | usual and, on the way home, is arrested for driving   |
|              | while under the influence (DUI). She may not have     |
|              | problems with alcohol, but in this instance, the      |
|              | consequence isn't minor.                              |
|              |                                                       |
|              | > You may be wondering about the heavy user of        |
|              | > alcohol or other drugs who doesn't appear to        |
|              | > experience negative consequences. First of all,     |
|              | > remember that these definitions are meant to        |
|              | > provide the helping professional with a simple      |
|              | > conceptualization as a guide. Second, the           |
|              | > probability of experiencing negative consequences   |
|              | > is directly related to the frequency and level of   |
|              | > use. If a person uses alcohol or other drugs on     |
+--------------+-------------------------------------------------------+
| ## D         | an occasional basis, the probability of negative      |
| efinitions o | consequences is far less than if one uses them on a   |
| f Use, Misus | daily basis. However, because we are talking about    |
| e, Abuse, an | probability, it's possible that a person could be a   |
| d Dependence | daily, heavy user and not experience negative         |
| / Addiction  | consequences that are obvious to others. We say       |
| -- continued | "obvious" because people may be damaging their health |
|              | without anyone being aware of this for a long time.   |
|              |                                                       |
|              | We define "abuse" as the continued use of alcohol or  |
|              | other drugs despite negative consequences. As we      |
|              | discussed previously, the probability of negative     |
|              | consequences is proportional to the amount one uses,  |
|              | and if a problem is developing with alcohol, it's     |
|              | likely that continued use will become abuse. As an    |
|              | example, let's go back to the DUI the woman got after |
|              | her birthday party. For people who do not have an     |
|              | alcohol or other drug problem, getting a DUI would be |
|              | so disturbing that they would avoid alcohol           |
|              | altogether or at least refrain from driving after     |
|              | drinking alcohol. If, a month after receiving the     |
|              | DUI, the woman was again drinking and driving, this   |
|              | would be considered abuse.                            |
|              |                                                       |
|              | Addiction/dependence is the "compulsive" use of       |
|              | alcohol or other drugs regardless of the              |
|              | consequences. We worked with a man who had received   |
|              | three DUIs in one year. He was on probation and would |
|              | be sentenced to one year in prison if he were caught  |
|              | using alcohol. Yet he continued to drink. We define   |
|              | this man as clearly addicted to alcohol because the   |
|              | negative consequences did not affect his use.         |
+--------------+-------------------------------------------------------+
| ##           | As disciplines develop, they create a body of         |
| Justificatio | theories that drive both research and application. A  |
| n for Theory | theory is a "formulation of apparent relationships or |
|              | underlying principles of certain observed phenomena   |
|              | which has been verified to some degree" (Guralnik,    |
|              | 1984, p. 1475). This curriculum advances the current  |
|              | theories used in substance abuse prevention, which    |
|              | include the perspectives of risk and protection       |
|              | factors, resiliency, and the assets model. Some       |
|              | theories and related research have reached high       |
|              | levels of scientific rigor, which means that they've  |
|              | been tested and have shown some consistent            |
|              | correlations or outcomes. All disciplines support     |
|              | certain theories that attempt to explain why a        |
|              | certain condition exists. In substance abuse          |
|              | prevention, for example, the theory of risk and       |
|              | protection predicts that the greater the number of    |
|              | risk factors, the greater the likelihood that young   |
|              | people will abuse substances at some point in their   |
|              | development. The ultimate goal of this curriculum is  |
|              | to move the field of substance abuse prevention to    |
|              | "praxis."                                             |
|              |                                                       |
|              | Praxis means the combination of both theory and       |
|              | practice. The practice of substance abuse prevention  |
|              | should be enlightened and informed by theory.         |
+--------------+-------------------------------------------------------+

+--------------+-------------------------------------------------------+
| ## J         | One of the challenges we face in prevention is        |
| ustification | understanding theory and the findings from research   |
|  for Theory  | to the degree that we can apply them to our substance |
| -- continued | abuse prevention programs. When we achieve this goal, |
|              | we have engaged in "prevention praxis." If our field  |
|              | didn't have a theoretical base, we'd simply run       |
|              | prevention programs with what we thought or felt were |
|              | the right ideas. We'd try to glean progress from only |
|              | our own observations and wouldn't consider what had   |
|              | been tried, tested, changed and tested again. Theory  |
|              | really helps us understand how to prevent substance   |
|              | abuse and answers questions about why some youth use  |
|              | substances and others do not.                         |
|              |                                                       |
|              | The Substance Abuse Prevention Specialist Training    |
|              | curriculum presents in depth the three most dominant  |
|              | theoretical perspectives today. This doesn't mean     |
|              | that other theories don't exist or that these are the |
|              | three best theories available. Theories change like   |
|              | most things do in life. Thomas Kuhn (1970) identified |
|              | four steps or changes theories cycle through; they    |
|              | are normal science, anomalies, crisis, and            |
|              | revolution. Theory that is accepted as the dominant   |
|              | view in the field is considered normal science.       |
|              | Researchers experiment with new applications of the   |
|              | established theory, extend and refine it, and         |
|              | accumulate knowledge. The second step is the          |
|              | anomalies stage. During this stage, people question   |
|              | why the theory doesn't fit the social problem they're |
|              | trying to solve. Things happen in the social world    |
|              | that the theory can't explain. The third stage is     |
|              | crisis. During this step, questions abound and people |
|              | severely critique the theory; the field shifts its    |
|              | interests, and new theories emerge that propose       |
|              | alternative ways of looking at the social problem.    |
|              | Anomalies amount and accumulate as people begin       |
|              | formally attacking the perspective. The fourth state  |
|              | is called revolution. During revolution the old       |
|              | theory is overthrown, and a new theory establishes    |
|              | itself as the reigning paradigm.                      |
|              |                                                       |
|              | The point of explaining this process is to show that  |
|              | the theories of today may not be the theories of      |
|              | tomorrow. So you may be thinking, why even consider   |
|              | any theory at all if it will go through this process  |
|              | eventually? The answer is that all theories help us   |
|              | understand the larger social context of substance     |
|              | abuse prevention. Without theories to guide us, we    |
|              | simply employ old techniques that may "feel" like     |
|              | they work, but in fact may be harmful. Theories, like |
|              | research knowledge, change over time. This is normal, |
|              | expected, and a valid part of a developing            |
|              | discipline.                                           |
+--------------+-------------------------------------------------------+
| ## B         | The Substance Abuse Prevention Specialist Training    |
| uilding Bloc | curriculum is designed to provide some crucial        |
| ks of Succes | elements of knowledge for the prevention              |
| sful Prevent | professional. This curriculum isn't designed to       |
| ion Programs | answer every question a professional has about        |
|              | prevention, nor is it equipped to be the only         |
|              | learning tool about the field. Instead, this          |
|              | curriculum is designed to jumpstart the learning      |
|              | process for new professionals in the field. It        |
|              | contains science-based information, orients the       |
|              | professional to current issues in prevention, and     |
|              | provides a few of the many essential building blocks  |
|              | you need to know when working in prevention programs  |
|              | or coalitions.                                        |
|              |                                                       |
|              | As with any developing profession, key elements or    |
|              | essential facts need to be presented and explored to  |
|              | train new members in the field. This curriculum has   |
|              | many core modules that are important to understand    |
|              | before implementing prevention programming. Just as   |
|              | the discipline of medicine began by advancing         |
|              | fundamental courses all doctors would need, this      |
|              | curriculum contains fundamental information for all   |
|              | preventionists. This curriculum, as mentioned         |
|              | earlier, is to be viewed as the first step to gaining |
|              | knowledge about the field of substance abuse          |
|              | prevention. Like any discipline, as this body of      |
|              | knowledge grows and expands, the professional must    |
|              | grow and expand to properly apply the principles      |
|              | identified by science. We may find that strategies we |
|              | employ in our prevention programs are no longer       |
|              | working or have been shown to need more rigorous      |
|              | evaluation.                                           |
|              |                                                       |
|              | We are at an exciting time in the evolution of        |
|              | prevention. We know more than ever about what works   |
|              | in substance abuse prevention programming. At the     |
|              | same time, new cohorts of substance abuse prevention  |
|              | specialists and coordinators are demonstrating        |
|              | interest in the field. College campuses are offering  |
|              | courses in substance abuse prevention, and students   |
|              | can earn degrees in this field. This curriculum       |
|              | captures some of the fundamental building blocks that |
|              | all students and prevention professionals need to     |
|              | incorporate into their practice to help advance       |
|              | effective and efficient substance abuse prevention    |
|              | programming at the national, State, county, and       |
|              | community levels.                                     |
+--------------+-------------------------------------------------------+

## References:

Kuhn, Thomas. (1970). *The structure of scientific revolutions* (2nd
ed.). Chicago: University of Chicago Press.

Guralnik, David B. (Ed.). (1984). *Webster's new world dictionary of the
American language.* New York: Simon and Schuster.

### INFORMATION SHEET {#information-sheet-6 .HeadInfSheet}

# Elements of Successful Prevention Programs

-   **The program is facilitated by knowledgeable and competent staff.**

Purpose of the Substance Abuse Prevention Specialist Curriculum

-   **The program is based on sound theory and uses practices grounded
    in research.**

Module 2: Prevention Research

-   **The program is systematically planned and assessed.**

Module 3: Prevention Planning

-   **The program is evaluated.**

Module 4: Evaluation

-   **The program addresses participants from a variety of backgrounds
    and cultures, and it uses a code of ethics.**

Module 5: The Cultural Context of Prevention

-   **The program is developmentally appropriate.**

Module 6: Using Human Development in Prevention

-   **The program incorporates the media.**

Module 7: Prevention and the Media