Which of the Following Is Not a Secondary Prevention Strategy for Family/relational Conflict?

Ch. two: Prevention and the Continuum of Care

The theories explored in our various modules so far have implications for the prevention of substance misuse and substance use disorders, including (simply not limited to) delaying or preventing substance utilize initiation. The Substance Abuse and Mental Health Services Administration (SAMHSA) produced a Fact Sail through the Centre for the Application of Prevention Technologies discussing prevention as part of a behavioral wellness continuum of care. The Fact Sheet includes a diagram built on the foundational work presented in an earlier Institute of Medicine study diagramming the human relationship between prevention, handling, and maintenance in mental health intendance (IOM, 1994). This continuum of intendance framework is applicable to intervening effectually substance misuse and substance use disorders, and with the addition of health promotion embraces much of what is important in the recovery support services motility (Bersamira, in press).

This is how the Fact Sail described the different "wedges" of the spectrum:

• Promotion: "These strategies are designed to create environments and conditions that support behavioral health and the power of individuals to withstand challenges. Promotion strategies besides reinforce the entire continuum of behavioral health services" (SAMHSA, due north.d., p. two). The promotion strategies described in the SAMHSA Fact Sheet include interventions that address resilience factors considered in our Chapter one discussion; strengths-based strategies designed to promote well-being and positive functioning.
• Prevention: "Delivered prior to the onset of a disorder, these interventions are intended to prevent or reduce the risk of developing a behavioral health problem, such every bit underage alcohol use, prescription drug misuse and abuse, and illicit drug utilize" (SAMHSA, n.d., p. 2).

• • Universal prevention refers to interventions delivered to the general population without differentiating between persons at dissimilar risk levels. For example, schools may deliver drug awareness and resistance education (Dare) programming to all students regardless of their vulnerability/run a risk constellation. Mass media campaigns are another case of universal efforts. In much of the prevention literature, the term "primary" prevention is used to describe efforts that occur before any sign of the target trouble appear—universal prevention interventions are often applied.
  • Selective prevention is more targeted than universal, and these interventions would be directed towards populations identified every bit having a potential somewhat greater than the general population for developing the focal problem. For example, it might exist aimed at youth who live with 1 or more than parents/family unit members engaged in substance misuse. In some prevention literature, the term "secondary" prevention is used to describe efforts that occur earlier the target problem appears and delivered to populations deemed to be "at risk" of the problem emerging—this could involve selective prevention interventions. Selective prevention is akin to a severe weather "watch" to keep a watchful eye on things, rather than a "alert" that the event is on the verge of happening.
    
  • Indicated prevention is even more targeted, delivered to populations/groups of individuals exhibiting/expressing warning signs foreshadowing evolution of the focal problem. For case, to prevent alcohol use disorder interventions might be directed to youth/emerging adults engaged in binge drinking, preventing this beliefs from becoming heavy drinking and a substance utilise disorder. Every bit the focus increases, preventive interventions may become increasingly resource-intensive and intrusive which makes the focus beneficial. A great deal of effort and resource would be wasted if these intensive interventions were delivered to a large portion of the general population unlikely to develop the problem anyhow. In some prevention literature, the term "tertiary" prevention is used to draw efforts that occur early in emergence of the target trouble—this could involve indicated prevention interventions or early intervention in the class of treatment. Indicated prevention is akin to a astringent weather "alert" equally a more imminent threat than a "watch."
• Treatment: "These services are for people diagnosed with a substance use or other behavioral health disorder" (SAMHSA, n.d., p. two). Unlike prevention, treatment services are designed to identify individuals experiencing or exhibiting the focal problem—preferably as early on in its development every bit possible, before it becomes increasingly severe and more difficult to treat. Ideally, the treatment services delivered are those with the strongest evidence supporting their use under the circumstances involved.

• Recovery (the Fact Sheet reverts to the term "Maintenance" in the text, despite their Recovery characterization on the diagram): "These services back up individuals' compliance with long-term treatment and aftercare" (SAMHSA, northward.d., p. 2). The diagram mentions long-term adherence to treatment as plumbing fixtures into this category, which may or may not reflect what happens during/post-obit handling for substance use disorder. For example, engaging in mutual help/support programming (such every bit Alcoholics Anonymous/AA, Narcotic Anonymous/NA, SMART Recovery, Women for Sobriety, LifeRing, Gloat Recovery, and others) may be a part of both the treatment continuum and the recovery/maintenance continuum.

Additional points made in the Fact Sheet include the fact that interventions practise not necessarily fit into just one category. For example, a universal prevention intervention may take the form of wellness promotion. The term relapse prevention also may introduce a scrap of defoliation hither: preventing a relapse to the old behavior is not usually considered part of the prevention continuum; it is usually considered role of the recovery/maintenance portion of the continuum of care.

Additionally, the fact canvass suggests that risk and protective factors may exist both correlated and cumulative. On one hand, a person with one vulnerability or risk cistron may be more than probable to have multiple vulnerability and risk factors (positively correlated). This person also may take fewer resilience or protective factors, as well (negatively correlated with run a risk/vulnerability). On the other hand, a vulnerability or risk gene introduced early on on may have developmental impacts that compound the person's vulnerability or gamble over time. For case, beingness known equally someone who uses alcohol, tobacco, or other drugs as a immature boyish might lead to that person being labeled, shunned, and stigmatized past peers. This, in turn, leaves that person vulnerable to social isolation and being attracted to a "deviance promoting" peer group, which compound the vulnerability and risk for substance misuse. The risk and vulnerability load just keeps getting heavier and heavier. Risk and vulnerability factors influence one another, underscoring "the importance of (1) intervening early, and (2) developing interventions that target multiple factors, rather than addressing individual factors in isolation" (SAMHSA, n.d., p. 7).

Just as handling interventions need to be developmentally appropriate, and then exercise prevention interventions. Children and adolescents are qualitatively different from adults; simplifying or "dumbing down" interventions for adults is not sufficient adaptation for younger populations. Because the take a chance and vulnerability factors are different at different periods of the life cycle, preventive efforts need to exist tailored to what is relevant and salient at different periods (SAMHSA, n.d.). Preventive interventions too demand to be appropriate for the vulnerability/risk mechanisms operating at different life periods. For example, if the concern is ease of access to substances, intervention might be targeted at the neighborhood/community or policy level rather than individuals; if the business is to build initiation resistance skills, the intervention might exist aimed at the individual level.

The SAMHSA Fact Sheet presented a gear up of tables of adventure and protective factors for substance apply disorder mapped to broad developmental period. These tables can assistance inform prevention strategies and used O'Connell, Gunkhole, & Warner (2009) as their source. Their tables are replicated [with small-scale modifications] here and represent general mental health prevention goals at early ages.

Infancy and Early Childhood Competencies: Infants begin understanding their own and others' emotions, to regulate their attention, and to acquire functional language
Take a chance Factors	Protective Factors
Individual: difficult temperament Family: parental drug/alcohol utilize, common cold and unresponsive [caregiver] behavior	Individual: self-regulation, secure attachment, mastery of advice and language skills, ability to make friends and go along with others Family: reliable support and discipline for caregivers, responsiveness, protection from harm and fright, opportunities to resolve disharmonize, adequate socioeconomic resources for the family School/customs: support for early learning, admission to supplemental services such every bit feeding and screening for vision and hearing, stable and secure attachment to childcare provider, depression ratio of caregivers to children, regulatory systems that support high quality of care

Centre Childhood Competencies: Children larn how to make friends, become along with peers, and understand appropriate behavior in social settings
Risk Factors	Protective Factors
Individual: poor impulse control, sensation-seeking, lack of behavioral self-control, impulsivity, early on persistent behavior problems, attention deficit/hyperactivity disorder, feet, low, hating behavior Family: permissive parenting, parent-kid conflict, low parental warmth, parental hostility, harsh discipline, kid abuse/maltreatment, substance use among parents or siblings, parental favorable attitudes toward booze and/or drug employ, inadequate supervision and monitoring, low parental aspirations for child, lack of or inconsistent discipline Schoolhouse/customs: school failure, low commitment to school, peer rejection, deviant peer group, [favorable] peer attitudes toward drugs, alienation from peers, law and norms favorable toward alcohol and drug use, availability and access to booze	Individual: mastery of academic skills (math, reading, writing), following rules for behavior at habitation and school and in public places, ability to make friends, practiced peer relationships Family: consistent bailiwick, language-based rather than physically-based discipline, extended family support Schoolhouse/community: healthy peer groups, school engagement, positive instructor expectations, effective classroom management, positive partnering betwixt schoolhouse and family, school policies and practices to reduce bullying, high bookish standards

Adolescence Competencies: Adolescents focus on developing good health habits, exercise critical and rational thinking, seek supportive relationships [and extend autonomy skills]
Risk Factors	Protective Factors
Individual: emotional problems in childhood, conduct disorder, favorable attitudes toward drugs, rebelliousness, early on substance use, hating beliefs Family: substance employ among parents, lack of adult supervision, poor attachment with parents Schoolhouse/community: school failure, low commitment to school, not college leap, aggression toward peers, associating with peers [engaged in substance utilise], societal/community norms nigh alcohol and drug use	Individual: positive physical development, academic achievement/intellectual development, high self-esteem, emotional self-regulation, expert coping skills and problem-solving skills, date and connections (in schoolhouse, with peers, in athletics, employment, faith, culture) Family: family provides predictable structure with rules and monitoring, supportive relationships with family members, clear expectations for behavior and values Schoolhouse/community: presence of mentors and back up for development of skills and interests, opportunities for engagement within schoolhouse and customs, positive norms, articulate expectations for behavior, physical and psychological safety

Early on [Emerging] Machismo Competencies: Individuals learn to balance autonomy with relationships to family unit, make independent decisions, and get financially contained
Risk Factors	Protective Factors
Individual: lack of delivery to conventional adult roles, antisocial behavior Family: leaving habitation School/community: attending college, peers [engaged in substance use]	Individual: identity exploration in love and work and developing a world view, subjective sense of adult status, subjective sense of self-sufficiency, making independent decisions, becoming financially contained, futurity orientation, achievement motivation Family unit: residual of autonomy and relatedness to family unit, behavioral and emotional autonomy School/customs: opportunities for exploration in work and school, connectedness to adults outside of family unit

Impairment Reduction as Prevention

Y'all may remember learning about Impairment Reduction as a policy strategy way back in our start form module—that the goal is to reduce potential harms to individuals, families, communities, and society associated with substance use/misuse/apply disorder, even if the substance utilize behavior does not end. Impairment reduction policies, therefore, represent a type of prevention endeavour—preventing the associated harms. Damage reduction approaches are non limited to policy efforts: they too are applied at the individual level. For instance, strategies to: reduce an individual's risk of infection, accidental injury, or illness exposure associated with substance misuse; reduce the chances of accidental overdose; or protect from criminal/sexual violence associated with substance utilise.

Another possible interpretation of prevention is intervention to slow, halt, or reverse progression from substance utilize to substance apply disorder. As you learned in Module 4, there exists evidence suggestive of a developmental course of substance use disorder/addiction, even if in that location too exists variability in the class and its expression. Consider the developmental picture of average ages at which different events occurred in the lives of a group of individuals in handling for booze use disorder (Schuckit, et al.,1998). Notice how many years (8!) were present between the average age at when blackouts due to drinking first occurred and when these men and women entered into handling for alcohol use disorder: a impairment reduction strategy might involve shortening this time span to reduce the physical, social, legal, and other harms that might accrue during that lengthy time span.

Prevention Examples

In their book affiliate near preventing booze and drug problems, McNeece and Madsen (2012) identified a host of efforts and strategies, including at the policy level. At this point, y'all should turn to the McNeece and Madsen (2012) chapter to become familiar with how they describe master, secondary, and 3rd prevention (aligned with universal, selective, and indicated prevention) and their review of the following types of prevention efforts:

• Public Data and Education
• Programs Directed at Children and Adolescents
• Programs Directed at College and Academy Students
• Service Measures
• Technologic Measures
• Legislative, Regulatory, and Economic Measures
• Family and Community Approaches
• Spirituality and Religious Factors
• Cultural Factors

Don't forget to return to this coursebook for Chapter 3!

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Source: https://ohiostate.pressbooks.pub/substancemisusepart1/chapter/ch-2-name-5/

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