Preventing Prescription Drug Abuse

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Feb 14, 2012 - schools, and communities about prescription drug abuse and ... 3 For example, the Broward County, Florida, “Operation Medicine Cabinet”;.
Preventing Prescription Drug Abuse in Adolescence: A Collaborative Approach

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Although the abuse of illegal drugs has decreased over the last two decades, the abuse of prescription drugs by adolescents has increased dramatically. According to the 2006 report of the Substance Abuse and Mental Health Services Administration, 9.1% (5.2 million) adolescents ages 12–17 abused prescription drugs in the previous year (Colliver, Kroutil, Dai, & Gfroerer, 2006). Furthermore, among 12–13 year olds, prescription drugs are the most commonly abused drug (i.e., used for reasons other than the prescribed treatment). This should be a cause for alarm among parents, educators, and health professionals because when prescription drug abuse occurs before age 16, there is an increased risk for addiction and abuse of psychotherapeutic drugs later in life.

While parents are concerned about adolescent use of illegal drugs, they are frequently unaware of the abuse of prescription drugs. Moreover, they are unaware of the dangers of prescription drug abuse (see Table 4.1). According to the National Institute on Drug Abuse (2009), the family is one of the main sources of these drugs, and parents often voluntarily provide their children access to prescription drugs. Parents (27%) and adolescents (56%) alike consider such drugs to be safer than “street” drugs and, therefore, more acceptable (Community Anti-drug Coalitions of America, 2008). This could be attributed, in part, to the Food and Drug Administration’s (FDA) relaxation of prohibitions against direct-to-consumer advertising in the late 1990s. Specifically, the FDA issued guidelines that allowed pharmaceutical companies to advertise prescription drugs on television using specific drug names and the conditions they treat, as well as more flexibility in providing information about the risks of drugs compared with print ads (Center for Drug Evaluation and Research, 2009). As a result, Americans who watch average amounts of television may be exposed to more than 30 hours of televised prescription drug advertising per year (Brownfield et al., 2004). Communities and schools are beginning to recognize the urgent need for action to combat the increasing levels of prescription drug abuse by adolescents. Consequently, schools and communities have begun to examine intervention strategies specific to prescription drug abuse (Twombly, Holtz, & Agnew, 2010), and preliminary research indicates that such interventions may be effective (Spoth, Trudeau, Shin, & Redmond, 2008). The National Center for Mental Health Promotion and Youth Violence Prevention (2010) Table 4.1

The Dangers of Prescription Drug Abuse Drug Type

Brand Name

Dangers

Pain Killers

Vicodin, OxyContin, Percocet

inability to concentrate, apathy, depressed respiration, death

Depressants

Klonopin, Valium, Xanax Soma, Ambien

loss of coordination, depressed respiration, lowered blood pressure, coma, death

Concerta, Dexedrine, Ritalin

increased heart and respiratory rates, hostility and aggression, suicidal or homicidal tendencies, convulsions, cardiovascular collapse

Stimulants

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By Beth A. Jones, Ph.D., Harry Fullwood, Ph.D., and Melissa Hawthorn, M.S.

Communities and schools are beginning to recognize the urgent need for action to combat the increasing levels of prescription drug abuse by adolescents. recommends involving various members of the community (e.g., doctors, law enforcement, and legislators) in programs designed to prevent adolescent prescription drug abuse. Furthermore, the Community Anti-drug Coalitions of America (2008) endorses a multifaceted approach for raising awareness and educating parents, schools, and communities about prescription drug abuse and prevention strategies. In addition, various states and communities are already implementing programs aimed at increasing public awareness,1 educating parents,2 or reducing the availability of prescription drugs.3 Thus, the goal of this article is to provide a framework for a collaborative approach to prescription drug abuse prevention that will bring together families, schools, and the community. The authors aim to outline a prevention “tool kit” that can be adapted and utilized as necessary by community prevention awareness teams for use in a variety of settings (e.g., rural or urban areas). FORMING A PREVENTION AWARENESS TEAM

The formation of a prevention awareness team (PAT) is vital to the utilization of this toolkit, as it is this team that will develop, implement, and evaluate the prescription drug abuse prevention program. Ideally, the team will incorporate representatives from schools, parent organizations, the student body, civic organizations, medical professionals, and legal professionals (see Table 4.2). We recommend appointing a school counselor (preferably middle or high school level) as the chair of the PAT, as he/she could act as a liaison between the school(s) and the community. This recommendation is made for several reasons: the time commitment that chairing the PAT would require (making it difficult for the school administrator to take on); on most campuses, the school counselor is already involved in the D.A.R.E. campaign; and the school counselor routinely visits classrooms to deliver lessons on similar topics (character education, etc.). Additionally, See for example, the New Jersey National Council on Alcoholism and Drug Dependence (http://www.ncadd-middlesex.org)

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For example, the Ford City, Pennsylvania, “Drugs Kill Dreams” campaign; contact Judge Gary DeComo: 724-763-7866

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For example, the Broward County, Florida, “Operation Medicine Cabinet”; contact Jonathon Fisherman at [email protected]

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Preventing Prescription Drug Abuse in Adolescence: A Collaborative Approach, continued

Steps to Creating a Collaborative Prescription Drug Abuse Prevention Program Forming the Prevention Awareness Team (PAT) ✔ Appoint a chair or co-chairs for the PAT (i.e., school counselor and PTO president). ✔ Chair or co-chairs assemble the exact membership of the team. Our recommendations for membership would include: a school principal, the school nurse, health/science educators, student representatives (i.e., the student body president or student council members), the city manager or a city council representative, a member or members from community organizations (i.e., Rotary International, Lions Club International, and/or Kiwanis International), a local pharmacist, a pediatrician or family physician, local business owners, a legal representative from the community, and local media personnel. Developing a Prescription Drug Abuse Prevention Program ✔ Educate team members ✔ Gather data specific to the geographic area and formulate a needs assessment ✔ Identify objectives for program implementation ✔ Identify target audience and potential outlets for program implementation ✔ Evaluate and select materials to be included as part of a community outreach campaign. (These may include, but are not limited to, posters, brochures, video presentations, testimonials, and print ads.) Implementing and Evaluating the Program ✔ Administer pre-tests to sample group ✔ Deliver pilot presentation ✔ Collect post-test data and other feedback ✔ Review feedback and make any necessary changes ✔ Implement program to entire intended audience ✔ Conduct outcome measures ✔ Incorporate any needed changes into program and plan for additional venues for program presentation

although the focus of the PAT is prevention, the school counselor is the only person on the school campus with the necessary training and certification to advise, design, and implement interventions for teens with abuse issues. To accompany the chair, we believe that inviting the Parent Teacher Organization (PTO) president to serve as a co-chair of the PAT would help communicate that parents are equal partners in the process. The PAT should meet weekly upon inception and then approximately once or twice a month thereafter to evaluate progress, incorporate any needed changes, and plan for further implementation.

awareness and aligning the team toward its common goal. Next, the PAT should gather data specific to their geographic area and conduct a needs assessment. By doing so, the PAT can pinpoint any particular drugs (e.g., pain killers, stimulants) that are a problem in their area, as well as any specific patterns related to cultural groups, age groups, gender, or specific school campuses. Based on the needs assessment, the PAT can identify program objectives, target audiences, and potential outlets for program implementation. Another major responsibility of the PAT is coordinating outreach materials to ensure that parents are aware of the risks and prevalence of prescription drug abuse by adolescents (Twombly & Holtz, 2008). This outreach could be in the form of informational pamphlets and fliers, presentations at school and civic events, and/or through media outlets such as newspaper ads. Public health media campaigns could also be used to emphasize the importance of the issue and provide accurate information to parents, teachers, and teens. All outreach efforts should contain certain core elements: a baseline assessment of awareness regarding prescription drug abuse and its dangers; correct information about the frequency of prescription drug abuse among adolescents and the risks posed; and concrete strategies and information that parents can use in conversations with adolescents. The outreach should also make parents aware of their roles as gatekeepers of prescription drugs and provide suggestions on how to secure and monitor prescription drugs in the home. Finally, providing parents with information about teens’ motivations behind prescription drug abuse (e.g., to get high, as a means of self-medication) may help them combat the problem (McCabe & Boyd, 2012; Twombly & Holtz, 2008). The PAT should utilize a science-based approach to drug education (Twombly & Holtz, 2007). A science-based method of addressing drug abuse relies on factual information and seeks to increase knowledge about the impact of drugs on the body. This is in contrast to programs that seek to frighten teens and that carry judgmental messages regarding drug abuse. Another basic premise of the science-based educational approach is that it does not contain overt messages against all prescription drug use (Twombly & Holtz, 2008). Instead, science-based education focuses on the unique characteristics of prescription drugs, their legitimate medical use, and the impact the drugs can have on the body and brain. Indeed, research has shown that science education can be ©Kenneth C. Zirkel/iStockphoto.com

Table 4.2

DEVELOPING A PREVENTION PROGRAM

The PAT members should begin by familiarizing themselves with the nature and severity of the issue. Prescription for Danger: A Report on the Troubling Trend of Prescription and Over-the-Counter Drug Abuse Among the Nation’s Teens (Office of National Drug Control Policy, 2008), is one great resource for raising team

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Americans who watch average amounts of television may be exposed to more than 30 hours of televised prescription drug advertising per year. www.TPRonline.org

Specifically, Twombly and Holtz (2007) recommend using a series of lessons that are presented sequentially and build on one another. In this approach, a lesson about the brain sets the stage for later lessons regarding the physiological effects of prescription drugs and that prescription drugs work by changing brain function. Such changes can be beneficial when there is a deficit or imbalance of certain neuro-chemicals, but can be devastating to a healthy brain. The information can be tailored to the type of prescription drugs most frequently abused by teens in the community. For example, sleeping difficulties, and anxiety and stress are the two most frequently cited reasons why teens abuse prescription drugs (Boyd, McCabe, Cranford, & Young, 2006). Information about the effects of abusing drugs to treat such problems should be accompanied by concrete non-pharmacological strategies to increase coping skills and decrease stress among teens. Teens who are at risk of using prescription drugs to self-medicate would potentially benefit greatly from the distribution of this information as it will provide an understanding of the consequences of abuse and alternatives to self-medicating. A similar approach may be used to educate parents, school personnel, and the community regarding prescription drug abuse, awareness, and prevention (Twombly & Holtz, 2008). According to the 2006 National Survey on Drug Use and Health, 70% of abused prescription drugs were obtained from a family member or friend compared to 19% from a doctor. Thus, the program targeted at parents and teachers should also educate them about the risks of prescription drugs and their roles as gatekeepers. Additionally, the program should provide parents and teachers with concrete strategies to use in educating teens about the risks of prescription drug abuse. The steps for developing a prescription drug abuse prevention program are outlined in Table 4.2. There are a number of online resources available for use in building a drug prevention program (see Table 4.3). The PAT can access television ads and videos about prescription drug abuse. These include informational videos and accounts of personal experiences. The TeenDrugAbuse website (www.teendrugabuse.us/prescription_ drug_abuse.html) offers free downloads of anti-drug art work Table 4.3

Online Resources to Utilize as Part of the PAT Tool Kit  AntiDrug website, sponsored by The National Youth Anti-Drug Media Campaign: www.theantidrug.com  D.A.R.E. Evaluation Tool: www.dare.com/home/Resources/ documents/DAREReport0821_final.pdf  Monitoring and Evaluating Youth Substance Abuse Prevention Programmes: www.unodc.org/pdf/youthnet/ action/planning/m&e_E.pdf  Prescription for Danger: A Report on the Troubling Trend of Prescription and Over-the-Counter Drug Abuse Among the Nation’s Teens: www.theantidrug.com/pdfs/ prescription_report.pdf  Prevention and Treatment Resource Press: www.ptrpress. com/substance-abuse/prescription-otc.html  TeenDrugAbuse website: www.teendrugabuse.us/ prescription_drug_abuse.html

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persuasive and increases knowledge about the risks related to drug abuse and changing student attitudes about drug abuse (Johnson et al., 2006; Twombly & Holtz, 2007).

Adolescents whose parents express a strong disapproval of drug use are far less likely to engage in substance use. for t-shirts, a presentation about prescription drug abuse, and videos. Additionally, many materials are available in Spanish. The AntiDrug website (www.theantidrug.com) offers a Teen Prescription Drug Abuse Package that includes a brochure, a video, a format for discussion of the video, form letters for use by school and medical professionals, as well as print ads. The “Resources” link on this website also provides an evaluation for parents to explore how well they know their teenager. This evaluation is aimed at helping parents determine if their teenager is exhibiting any warning signs of drug abuse. Lastly, the Prevention and Treatment Resource Press (www.ptrpress.com/substance-abuse/ prescription-otc.html) has materials specifically related to prescription drug abuse that are available for purchase. Included as part of these materials is a quiz entitled “What is Your Drug IQ?” that could be a useful resource in determining the level of awareness their targeted audiences possess regarding prescription drug abuse. IMPLEMENTING AND EVALUATING THE PROGRAM

After the materials for the program have been selected, the PAT is ready to begin pilot presentations. Such presentations will allow the PAT to evaluate the program and make needed changes before full-scale implementation in the chosen venues. These presentations should include a pre-test regarding awareness of several elements of prescription drug abuse. This pre-test should incorporate questions regarding prevalence of drug abuse, drugs commonly abused, sources for obtaining prescription drugs, and the dangers of prescription drug abuse. After presentation of the program, the PAT representative(s) would conduct a post-test and gather other feedback from the target group. The PAT would review the feedback and make any necessary changes. Finally, the program would be presented to the entirety of the target audience. However, the PAT will continue to meet, assess the effectiveness of the program, evaluate the need for changes in the program, and pinpoint other venues available for program presentation. Because a basic premise of the PAT is that it be tailored to the individual needs of a particular community, a one size fits all evaluation tool is not appropriate. Rather, the PAT will need to construct evaluation tools that are reflective of their specific program objectives. It is likely that the PAT will need to utilize a combination of evaluation tools to get a complete picture of program effects. These evaluations may involve questionnaires; interviews of students, parents, teachers, and/or community members; discussion groups; case studies; and observations of the availability of information in the community as compared The Prevention Researcher

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Preventing Prescription Drug Abuse in Adolescence: A Collaborative Approach, continued

to a baseline. Monitoring and Evaluating Youth Substance Abuse Prevention Programmes (United Nations, 2006) is a very helpful resource to consult as the PAT determines which types of assessment best suits their program needs and objectives. Additionally, survey questions that D.A.R.E. administered to fifth, seventh, and ninth graders to assess the effectiveness of curriculum materials may serve as a guide when selecting possible questions for student surveys (Darnell & Emshoff, 2008). The steps for implementing and evaluating a prescription drug abuse prevention program are also outlined in Table 4.2.

Beth Jones

CONCLUSION

Abuse of prescription drugs by early adolescents exists and in alarming numbers. However, parents and the community are typically unaware of the problem and tend to underestimate their influence on their children’s choices (Office of National Drug Control Policy, 2008). Parents are much less likely to discuss the risks of prescription drugs than they are illegal drugs, and parents believe that prescription drugs are safer to abuse than illegal drugs (Community Anti-drug Coalitions of America, 2008). Because adolescents whose parents express a strong disapproval of drug use are far less likely to engage in substance use, it is imperative that parents and the community be educated on the issue. We have presented a collaborative model, based on best 

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Harry Fullwood

Melissa Hawthorn

Beth A. Jones ([email protected]) holds a B.S. in Interdisciplinary Studies, with an emphasis in Special Education, and a M.S. in Educational Psychology, with specializations in Special Education and School Counseling, from Texas A&M University. She earned a Ph.D. in Curriculum and Instruction, with a concentration in Special Education, from Louisiana State University. Jones spent seven years as a special educator in the Texas public schools and currently serves as an Assistant Professor of Special Education at Texas A&M University-Commerce. Harry Fullwood holds a B.A. and a M.T. in Special Education from Central State College, Edmond, Oklahoma and a Ph.D. in Psychology and Special Education from the University of Oklahoma, Norman, Oklahoma. He taught special education in the Oklahoma City public schools and spent 42 years training special education teachers at Texas A&M University-Commerce. Fullwood is retired and enjoys traveling and fishing. Melissa Hawthorn earned a B.S. in Psychology from East Texas State University-Texarkana and two M.S. degrees in Applied Psychology and Counseling from Texas A&M University-Commerce. She is currently pursuing her doctoral degree in psychology from Texas A&M University-Commerce. Hawthorn’s research is in the area of decisionmaking and memory.

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References

Boyd, C.J., McCabe, S.E., Cranford, J.A., & Young, A. (2006). Adolescents’ motivations to abuse prescription medications. Pediatrics, 118, 2,472–2,481. Brownfield, E.D., Bernhardt, J.M., Phan, J.L., Williams, M.V., & Parker, R.M. (2004). Direct-to-consumer drug advertisements on network television: An exploration of quantity, frequency, and placement. Journal of Health Communication, 9, 491–497. doi:10.1080/10810730490523115. Center for Drug Evaluation and Research. (2009). Guidance for Industry: Consumer-Directed Broadcast Advertisements. Rockville, MD: Food and Drug Administration. Available www.fda.gov/RegulatoryInformation/Guidances/ucm125039.htm Colliver, J.D., Kroutil, L.A., Dai, L., & Gfroerer, J.C. (2006). Misuse of Prescription Drugs: Data from the 2002, 2003, and 2004 National Surveys on Drug Use and Health (DHHS Publication No. SMA 06-4192, Analytic Series A-28). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Retrieved November 14, 2011 from http://oas.samhsa.gov/prescription/TOC.htm Community Anti-drug Coalitions of America. (2008). Teen Prescription Drug Abuse: An Emerging Threat. Retrieved October 21, 2011 from www.theantidrug.com/pdfs/resources/teen-rx/ CADCA_Strategizer52.pdf Darnell, A.J., & Emshoff, J.G. (2008). Findings from the Evaluation of the D.A.R.E. Prescription and Over-the-Counter Drug Curriculum. Atlanta, GA: Emstar Research Inc. Available online at www.dare.com/home/Resources/documents/DAREReport0821_final.pdf Johnston, L.D., O’Malley, P.M., Bachman, J.G., & Schulenberg, J.E. (2006). Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 2005. Ann Arbor, MI: University of Michigan News and Information Services. Retrieved June 1, 2011 from www.monitoringthefuture.org/pubs/monographs/overview2005.pdf McCabe, S.E., & Boyd, C.J. (2012). Do motives matter? Nonmedical use of prescription medications among adolescents. The Prevention Researcher, 19(1), 10–12.

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practices research, which outlines a process for accomplishing these intended outcomes. The development of a prevention awareness team and the utilization of the resources within this toolkit should serve as an excellent first step in the amelioration of this potential health risk.



The National Center for Mental Health Promotion and Youth Violence Prevention (2010). Prescription Drug Abuse by Adolescents. Retrieved October 21, 2011 from www.promoteprevent.org/publications/prevention-briefs/prescription-drug-abuseadolescents National Institute on Drug Abuse (2009). Understanding and addressing prescription drug abuse among adolescents. Counselor, 10(3), 10–15. Retrieved March 10, 2011 from www.counselormagazine.com/component/content/article/31-adolescents/ 926-understanding- and-addressing-prescription-drug-abuse-among-adolescents Office of National Drug Control Policy. (2008) Prescription for Danger: A Report on the Troubling Trend of Prescription and Over-the-Counter Drug Abuse Among the Nation’s Teens. Author. Available online at www.theantidrug.com/pdfs/prescription_report.pdf Spoth, R., Trudeau, L., Shin, C., & Redmond, C. (2008). Long-term effects of universal preventive interventions on prescription drug misuse. Addiction, 103, 1,160–1,168. Twombly, E.C., & Holtz, K.D. (2007). A science education curriculum to curb youth drug use: Implications for practice and public policy. Informing Public Health, 2, 1–4. Available online at www.kdhrc.com/publications/pdf/briefs_no2_060309.pdf Twombly, E.C., & Holtz, K.D. (2008). Teens and misuse of prescription drugs: Evidence-based recommendations to curb a growing societal problem. Journal of Primary Prevention, 29, 503–516. Twombly, E.C., Holtz, K.D., & Agnew, C.B. (2011). Resonant messages to prevent prescription misuse by teens. Journal of Alcohol and Drug Education, 55, 38–52. United Nations. (2006). Monitoring and Evaluating Youth Substance Abuse Prevention Programmes. Author. Available online at www.unodc.org/pdf/youthnet/action/ planning/m&e_E.pdf

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