Substance Abuse Prevention PDF

PATH-216 PREVENTION OF SUBSTANCE ABUSE  Learning outcomes By the end of the module participants should be able to: 1. Define the substance abuse. 2. Describe the Symptoms and Signs of substance abuse. 3. Understand the initiation of substance use. 4. Identify the reasons why pe...

PATH-216 PREVENTION OF SUBSTANCE ABUSE  Learning outcomes By the end of the module participants should be able to: 1. Define the substance abuse. 2. Describe the Symptoms and Signs of substance abuse. 3. Understand the initiation of substance use. 4. Identify the reasons why people use alcohol and other drugs 5. Recognize the Risk factors & Protective factors of substance abuse 6. Consequences of substance abuse 7. Identify Recognize the Prevention of substance abuse 2  Definition of Substance A substance refers to any chemical, drug, or compound (natural or synthetic) that can alter an individual’s physical, mental, or emotional state when consumed. These substances may be legal (such as alcohol or prescription medications) or illegal (such as cocaine or heroin).  Definitions of Substance Abuse Substance abuse: It is the behavior of excessive use of a substance to modify or control mood or state of mind in a manner that is illegal or harmful to oneself or others. Symptoms and Signs of Substance Abuse Abuse of alcohol and other drugs affects people: Emotionally: such as aggression, burnout, anxiety, depression, paranoia, and denial. Behaviorally: Slow reaction time, impaired coordination, Slowed or slurred speech, irritability, excessive talking, inability to sit still, limited attention span, and poor motivation or lack of energy. Physically: Weight loss, sweating, chills, and smell of alcohol.  Tolerance "Tolerance" describes changes in the way an addict reacts to a drug, where he needs more of the drug to get the same effect as before. OR When after repeated administration, increasingly larger doses of a drug must be administered to obtain the same effects as the original use.  “Substance dependence” The physiological state of neuro-adaptation produced by repeated administration of the drug necessitates continued administration to prevent the appearance (symptoms) of the withdrawal syndrome. Alcoholism means alcohol dependence. “Substance dependence” Additional problems: Experiences withdrawal when not using. Withdrawal: The psychological and physiological reactions to abrupt cessation of a dependence-producing drug.  Showing Rebound. Rebound: The exaggerated expression of the original condition sometimes experienced by patients immediately after cessation of an effective treatment Seems unable to stop. Preoccupied by “getting” and “using”. Tolerance (needs more to get the same effect). Gives up important things to use. Compulsions or cravings to keep using.  “Substance dependence” Addiction to alcohol and other drugs could be: Chronic: Once you have developed an addiction problem to deal with it, recovery requires life long abstinence (refraining from engaging in certain behaviors or activities) and active participation in recovery groups. Progressive - There are signs and symptoms of addiction, no known cure, affecting every area of addict's life: physical, mental, emotional, and spiritual. Addiction gets worse over time can be gradual or rapid, depending on the drug. Repeated use causes progressive damage. Primary – It is the main problem that needs to be treated, not secondary to something else. Terminal/Permanent – Once addicted to a drug, always addicted and to all drugs, not just the drug of choice. If not stopped, often leads to disease and possibly death. Disease is marked by denial: Denial is a common psychological response or characteristic associated with that disease. The individual may refuse to acknowledge the presence, severity, or consequences of the illness.  “Initiation of substance use” - Smoking is the most important factor - The risk of moving on to marijuana is 65 times greater for persons who smoke or drink. - The risk of moving on to cocaine is 104 times greater for persons who use marijuana - The more risk factors someone has the greater likelihood to use substances.  Ways of Use of Substance Ways that people use alcohol and other drugs:  Smoking or Inhaling  Snorting or Insufflation  Oral Ingestion  Injection Why do people use alcohol and other drugs  Stress Relief and Coping Mechanism  Social Influence and Peer Pressure  Recreational and Pleasure-Seeking  Curiosity and Experimentation  Dependency and Addiction Consequences of Substance Abuse In addition to effects on the body, other consequences occur at individual level family level community level. Consequences of Substance Abuse Individual level:  Aggressiveness,  Injuring himself or others,  Risky driving leading to harming himself and others,  Infections locally or blood-borne  Smoking leads to lung cancer  Life revolves around substance use.  Consequences of Substance Abuse Family level:  Money on substance leads to family conflicts,  Family conflict becomes destructive (emotionally and/or physically)  Money on substances replaces other family needs  Money on substance use treatment drains family resources  Consequences of Substance Abuse Community level:  To get money, substance abusers may steal, use violence, or engage in crime  Drug syndicates may commit violent crimes and/or recruit youth for illegal activities  Violence and illegal activity that may harm individuals and/or create an environment of mistrust.  Who uses a Substance? Dependent on the balance between Risk Factors and Protective Factors “RISK FACTORS 1. Chaotic home environment. 2. Ineffective parenting. 3. Little mutual attachment and nurturing. 4. Parental/sibling substance abuse or mental illness. 5. Academic failure. 6. Inappropriate/shy classroom behavior. 7. Poor social coping skills. 8. Perceived external approval of drug use 9. Associations with deviant (misguided) people.  “PROTECTIVE FACTORS ” 1. Strong family bonds. 2. Parental engagement in the child's life. 3. Clear parental expectations & consequences. 4. Academic success. 5. Conventional norms about drugs and alcohol. 6. Strong bonds with pro-social institutions (School, Community, Mosque).  Prevention of Substance Abuse  Primary prevention  Secondary prevention  Tertiary prevention Primary prevention To prevent initiation of substance, use or delaying the age at which use begins. TWO STRATEGIES 1- to reduce supply 2- to reduce demand through:  Minimise the Risk Factors, and Support the Protective Factors  Prevention of Substance Abuse  Primary prevention  Secondary prevention  Tertiary prevention Secondary prevention To target individuals in the early stages of psychoactive substance use, to prevent substance use from becoming a problem and thereby limit the degree of damage to the individual.  Prevention of Substance Abuse  Primary prevention  Secondary prevention  Tertiary prevention Tertiary prevention To end dependence and minimize problems resulting from use/abuse. This is to enable the individual to achieve and maintain an improved level of functioning and health. This is also called rehabilitation and relapse prevention. Introduction to Epidemiology Learning outcomes: By the end of this module participants should be able to understand: Epidemiology definitions Core functions & key concepts Different Morbidity Rates Design study Determinants of disease Types of Risk Factors Some examples of risk factors in epidemiology  Epidemiology definitions Epidemiology is study of the distribution and determinants (factors) of health-related states or events in specified populations, and the application of this study to the control of health problems. Epidemiology is a fundamental science of public health that focuses on understanding the distribution, determinants, and control of health and disease in populations. It is a discipline that combines elements of biology, social sciences, statistics, and medicine to study patterns of health and illness. Epidemiology definitions: Other Definitions:  Beyond the basic definition, epidemiology is also understood as: The method used to find the causes of health outcomes and diseases in populations. This science of public health uses systematic and data-driven approaches to understand the pattern of health-related states or events.  Core Functions of Epidemiology Epidemiology serves to identify the frequency, patterns, and causes of diseases in populations. It helps in planning and evaluating strategies to prevent illness and as a guide to managing patients in whom the disease has already developed. Key Concepts: ⚬ Distribution: Investigates who is affected by a disease, when, and where. ⚬ Determinants: Studies the factors that influence disease occurrence, including biological, environmental, and lifestyle factors. ⚬ Control of Health Problems: Applies research findings to develop interventions to prevent and control health issues.  Methodology: Epidemiologists use various study designs to investigate health-related events (such as cross-sectional, cohort, Epidemiology is vital for the continuous and case-control studies). They also employ statistical improvement of public health, providing the analysis to interpret data and make informed evidence base for health conclusions about health risks. policy and actions. Public Health Impact: The insights gained from epidemiological studies shape public health policies and practices by identifying risk factors for disease and targets for preventive healthcare. Comparative role of Public Health Professional and Epidemiologist Public Health Professional Role: A public health professional develops and implements programs to promote population/community health and well-being. Example: Designing and leading a national campaign to reduce tobacco use through policy advocacy, awareness creation, and community-based interventions. Epidemiologist Role: An epidemiologist studies disease patterns, causes, and effects to inform public health decisions. Example: Investigating a cholera outbreak in a region to identify the source, mode of transmission, and risk factors, and recommending control measures to prevent further spread.  Roles During the COVID-19 Outbreak Public Health Professional Role: Leading the overall response to the pandemic by coordinating strategies at local, national, and global levels. Example: o Developing public awareness campaigns to promote mask-wearing, hand hygiene, and vaccination. o Advising governments on policies such as lockdowns and travel restrictions. o Establishing infrastructure for mass vaccination programs and testing sites.  Roles During the COVID-19 Outbreak Epidemiologist Role: Investigating the spread, patterns, and determinants of COVID-19 to provide evidence for control measures. Example: o Analyzing data on infection rates (total cases, new cases), hospitalizations and deaths to identify hotspots and predict future trends. o Conducting contact tracing to break transmission chains. o Studying vaccine effectiveness and the impact of its variants to guide immunization strategies. Both Public Health Professional and Epidemiologist played a critical role in mitigating the pandemic's impact, working collaboratively to safeguard public health.  Distribution of Disease ⚬ Person (who): Looks at the characteristics of individuals that affect their likelihood of becoming ill, such as age, sex, ethnicity, occupation, and behaviors. ⚬ Time (when): Refers to the temporal (time related) distribution of diseases, including trends over time and seasonal variations. ⚬ Place (where): Involves the study of geographical patterns and the impact of location on the occurrence of diseases.  Morbidity Morbidity has been defined as any deviation, subjective or objective, from a state of physiological or psychological well-being. Measures of morbidity frequency characterize the number of persons in a population who newly become ill (incidence) or were already ill at a given time (prevalence).  Rate In epidemiology, a rate is a measure of the frequency with which an event occurs in a defined population over a specified period of time.  Morbidity Rates Incidence Rate: Is the number of new cases (of disease or event) in a specified population during a specified period of time, usually expressed per 100,000 individuals (e.g. new cases of measles among children). It is calculated as: Incidence Rate= No. of new cases × 100,000 Population at Risk Morbidity Rates: Attack Rate: Is a specific incidence rate for a particular disease over a specific period of time. It measures the risk of disease among those people exposed to a certain exposure (e.g. food poisoning because of eating contaminated mashed potatoes). Morbidity Rates: Prevalence Rate: Is the total number of individuals who already have an attribute or disease at a particular time, divided by the population at risk of having the attribute or disease at that time (e.g. prevalence of hypertension in a community). It is calculated as: Prevalence Rate= Total number of cases with attribute or disease × 100,000 Total Population at risk Morbidity Rates: Relationship between Incidence and Prevalence In a steady-state situation, in which the rates are not changing and population is stable, the following equation applies: Prevalence = Incidence × Duration of Disease Study Designs: Study designs Are a crucial element in epidemiology for investigating the distribution, patterns, and determinants of diseases. Common study designs used in Epidemiology: Observational Studies: These do NOT involve any manipulation by the researcher. Instead, the researcher observes & records information as it occurs naturally. Case Reports and Case Series: Are detailed presentations of a single patient or a group of patients with a similar diagnosis. Common study designs used in Epidemiology, cont: Cross-sectional Studies: Assess the prevalence of health outcomes or determinants of health in a population at a single point in time. Eg.: Prevalence for cases of lung cancer among smokers at a point of time. Case-control studies: Compare individuals with a disease (cases) to those without the disease (controls) to identify the risk factors that may contribute to occurrence of the disease retrospectively. Eg. Comparing lung cancer smokers with normal smokers. Cohort Studies: Follow a group of people over time to see how their exposures affects their outcomes. Eg. Following smokers over time to look for developing lung cancer. Common study designs used in Epidemiology, cont…: Experimental Studies: These involve some level of intervention by the researcher, such as the administration of a treatment or a behavior change. ⚬ Randomized Controlled Trials (RCTs): Participants are randomly assigned to either the intervention group or the control group to measure the effect of the intervention. ⚬ Community Trials: Are similar to RCTs, but the units of randomization are communities or groups rather than individuals. Common study designs used in Epidemiology, cont…: Ecological Studies: Examine the relationship between exposure and disease with data at the group level rather than the individual level. Meta-Analyses: Combine data from multiple studies to derive conclusions that have greater statistical power due to the increased sample size.  Importance of Study Designs Each study design has its strengths and weaknesses and is chosen based on the research question, ethical considerations, and practical constraints. For instance, RCTs are considered the gold standard for determining causality but may not always be feasible or ethical. Observational studies are more common when RCTs are not possible, but they may be more prone to bias. Understanding these study designs is essential for interpreting the results of epidemiological research and for designing studies that can provide reliable and valid data for public health decision-making.  Determinants of Disease Determinants of disease are the factors that can influence the occurrence of disease and include a wide range of forces, from genetic to environmental factors. Determinants of disease can be classified into: ⚬ Biological: Genetics, age, sex. ⚬ Environmental: Living conditions, climate, pollution. ⚬ Behavioral: Lifestyle choices, dietary habits. ⚬ Social: Socioeconomic status, community support networks.  Risk Factors In epidemiology, risk factors are characteristics or conditions that increase the likelihood of a person developing a disease or health problem. They can be environmental, biological, behavioral, or social.  Some examples of risk factors in epidemiology Biological Factors: Such as age, sex, genetics, and ethnicity. Environmental Factors: Including exposure to pollutants, climate, and living conditions. Behavioral Factors: Like smoking, alcohol consumption, diet, and physical activity. Socioeconomic Factors: Such as education level, income, and occupational hazards. It is important to note that having one or more risk factors does not mean that a person will definitely develop a disease, but it does increase the chances compared to individuals without the risk factors.  Determinants of Disease Types of Risk Factors: o Modifiable: These are factors that can be changed, such as lifestyle habits, including smoking, diet, and exercise. o Non-modifiable: These include factors that cannot be changed, like age, gender, and genetic predisposition.  Determinants of Disease Measuring Risk: Epidemiologists often use measures such as incidence rates and prevalence proportions to quantify the risk associated with certain factors. Causality: It refers to the Causative Factors for any disease. Risk factors can be associated with a higher likelihood of disease, they do not necessarily cause the disease. Establishing causality requires further research and evidence.  Determinants of Disease Interactions: Multiple risk factors can interact in complex ways to influence the likelihood of developing a disease. For example, the risk of heart disease is influenced by many factors, such as: diet, exercise, smoking, and genetic factors (multifactorial causes). Understanding risk factors is crucial for developing prevention strategies and health policies aimed at reducing the incidence of diseases and improving public health outcomes.  Challenges in the field of Epidemiology Challenges or limitations within the field of Epidemiology that could affect the accuracy or validity of epidemiological studies may include: 1. Data Quality: Inaccurate or incomplete data can lead to erroneous conclusions. 2. Bias: Systematic errors in the design or conduct of a study can distort results. 3. Confounding Variables: Factors that are related to both the exposure and the outcome can mislead the association between them. 4. Sample Size: Too small a sample size may not represent the larger population well.  PATH-216 Safety and Injury Prevention  Learning objectives Safety and Injury Prevention By the end of this session the learner will be able to: 1. Define an injury 2. Define an accident 3. Know the differences between accident and injury 4. Identify the levels of prevention 5. Identify the principles of road traffic accident prevention 6. Minimize workplace injuries 2  Definition of Injury Safety and Injury Prevention An injury is defined as physical or psychological harm or damage to the body, typically caused by an external force or event. It refers to any condition in which the normal structure or function of a body part or organ is disrupted or impaired. Injuries can range from minor, such as cuts, bruises, or sprains, to severe, including fractures, burns, or traumatic brain injuries. 3  Injuries can occur in various settings, such as accidents, sports activities, workplace incidents, or acts of violence. The severity and consequences of an injury can vary widely depending on factors such as the type, location, and extent of the damage, as well as the individual's overall health and access to medical care.  Definition of accident An accident is an unexpected or unintentional event that results in harm, damage, injury, or loss. Safety and Injury Prevention It refers to an incident that occurs without deliberate intent or premeditation. Accidents can take many forms such as: 1. Traffic accidents. 2. Slip and fall accidents. 3. Occupational accidents. 4. Home accidents. 5. Sports and recreational accidents. 6. Medical accidents. 5 7. Natural disasters.  Preventing accidents is an important goal in various fields, including safety engineering, public health, and workplace safety.  Differences between injuries and accidents Domains Injuries Accidents Safety and Injury Prevention Definition An injury refers to harm or damage An accident refers to an unexpected or caused to a person's body, mind, or unintentional event that causes harm, emotions. It can be the result of damage, injury, or loss. It can involve a various causes, including accidents. wide range of incidents, such as car crashes, falls, or workplace mishaps. Nature An injury focuses on the actual harm An accident emphasizes the event or or damage suffered by a person. It incident that leads to the injury. It is the can be a physical injury, such as a occurrence or happening that results in broken bone or a cut, or it can be a harm or damage. non-physical injury, such as 7 emotional trauma or psychological Domains Injuries Accidents Scope The term "injury" is broader and The term "accident" specifically refers encompasses various types of harm to events or incidents that result in or damage, regardless of the cause. It physical harm or damage. It typically can include injuries caused by implies that the harm was unintentional accidents, but it also covers injuries or unexpected. resulting from intentional acts, medical conditions, or other factors.. Cause Injuries can result from accidents, but Accidents are generally associated with and they can also arise from other causes. unintended or unplanned events. They intention For example, a person can sustain an often occur due to factors like injury through deliberate actions, negligence, human error, mechanical such as physical assault, self-harm, or failures, or environmental conditions. medical procedures. Domains Injuries Accidents Legal and Injuries are commonly assessed for Accident: In legal and insurance Insurance liability and compensation purposes. contexts, accidents may be investigated The focus is on determining the to establish liability and assess fault. The extent of harm suffered and the emphasis is on understanding the responsible party, irrespective of circumstances surrounding the event and whether it resulted from an accident determining responsibility for the or other causes. resulting injury or damage. Principles of road traffic safety Education Safety and Injury Prevention Enforcement and of traffic laws awareness Time Infrastructur Vehicle Speed e and constrain safety management s engineering Collaboration Vulnerable and road users Partnerships are needed because partnerships road traffic incidents (RTIs) do not have a single cause and no organization or sector can solve the global road safety challenge. 10  Factors that influence traffic accidents TIMING HUMAN VEHICLE ENVIRONMENT Safety and Injury Prevention Pre- Age Defects Visibility Event Experience Breaks Pavement Alcohol Tires Signals Drugs Avoidance Systems Construction Speed Event Belt Use Air Bags Guard Rails Helmet Use Automatic Seat Belts Medians Tolerance Crashworthiness Breakaway Posts Post- Age Post-crash EMS System Event Physical Condition Fuel Leaks First Responder Fire Bystander Care 11 Automatic seat belt Medians Breakaway Post Guard Rails  Steps to minimize workplace injuries 1. Develop and enforce safety policies. Safety and Injury Prevention 2. Conduct regular safety training. 3. Identify and control hazards. 4. Encourage reporting and investigation of incidents. 5. Promote ergonomic practices. 6. Maintain equipment and machinery. 7. Encourage a culture of safety. 8. Provide appropriate personal protective equipment (PPE). 9. Monitor and address workplace stress. 10. Regularly review and improve safety measures. 13  Creating a safe work environment is a shared responsibility that requires commitment and involvement from both employers and employees. By implementing these strategies and fostering a culture of safety, organizations can significantly reduce the risk of workplace injuries and promote the well-being of their workforce.  What are the levels of prevention In the field of public health, there are three levels of prevention: Safety and Injury Prevention Primary Prevention: Primary prevention aims to prevent the occurrence of a disease or health condition before it ever occurs. The focus is on preventing the initial development of the condition and reducing risk factors, such as health education and promotion, Immunizations, and Legislation and policies. Secondary Prevention: Secondary prevention focuses on early detection and intervention to prevent the progression of a disease or health condition in individuals who already have it but may not yet show symptoms. The aim is to identify the condition as early as possible to provide timely treatment and prevent further complications. such as Regular screenings and diagnostic tests, Early intervention 15 programs, and Follow-up care. Tertiary Prevention: Tertiary prevention aims to minimize the impact of an existing disease or condition and prevent further deterioration, disability, or complications. It focuses on managing and rehabilitating individuals who already have a diagnosed condition, such as rehabilitation programs, support groups and self-management programs, and Disease management and surveillance.