![Page 1: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/1.jpg)
A Comprehensive primary health care approach to ICE, alcohol and other
drugs
John BoffaJohn BoffaChief Medical Officer Public HealthChief Medical Officer Public Health
Assoc Prof., NDRIAssoc Prof., NDRI
![Page 2: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/2.jpg)
Introduction
1. The Epidemiology of metamphetamines in the NT
2. ICE and Alcohol – the need for a combined approach
3. The neuroscience of Addiction
4. The 3 streams of care in effective treatment
5. The social determinants of addiction and Early Childhood
![Page 3: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/3.jpg)
![Page 4: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/4.jpg)
![Page 5: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/5.jpg)
![Page 6: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/6.jpg)
![Page 7: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/7.jpg)
ICE and Alcohol
Methamphetamine, including ICE, dependence is currently a very big problem for a small number of people and their families.
Alcohol dependence is a very big problem for a large number of people and their families and of much greater harm to the community as a whole
There is a common approach to both treatment and primary prevention so we need to address both together
![Page 8: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/8.jpg)
Focus on illicit drugs puts Australia’s drinking problem on ice
June 2015 The ConversationBut another – largely unremarked on – negative outcome of the strong focus on ice is that it takes the spotlight away from the harms of excessive alcohol use, which is actually a bigger problem in Australia. A reported 2.1% of Australians have used some form of methamphetamine in the last 12 months while 15.6% of people aged 12 or older have consumed 11 or more standard drinks on a single drinking occasion in the same period.
![Page 9: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/9.jpg)
Focus on illicit drugs puts Australia’s drinking problem on ice
June 2015 The Conversation
Of the 1,565 solved homicides in Australia between 2000 and 2006, 729 (47%) were classified as alcohol-related. Both people had consumed alcohol in 60% of these cases, only the offender in 21%, and only the victim in 19%. Of the homicides involving an intimate partner relationship, between 2000 and 2006, 44% were related to alcohol.
![Page 10: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/10.jpg)
![Page 11: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/11.jpg)
Figure 1 Wholesale PAC Supply – Tennant Creek
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
2007 2008 2009 2010 2011 2012 2013 2014
PA
C (
Lit
re)
Total Total Wine Total Spirits Total Beer Cider
![Page 12: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/12.jpg)
![Page 13: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/13.jpg)
Many people still see drug & alcohol
addiction as a moral problem to be
handled through the criminal justice
system rather than through a health lens.
![Page 14: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/14.jpg)
THE NEUROSCIENCES REVOLUTION OF THE NEUROSCIENCES REVOLUTION OF
THE LAST 20 YEARS HAS GIVEN US THE LAST 20 YEARS HAS GIVEN US
EXTENSIVE NEW INSIGHTS INTO THE EXTENSIVE NEW INSIGHTS INTO THE
PATHOPHYSIOLOGY OF ADDICTIONPATHOPHYSIOLOGY OF ADDICTION
![Page 15: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/15.jpg)
![Page 16: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/16.jpg)
Science must replace ideology as the
foundation for the treatment of drug
addiction: AMT????
![Page 17: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/17.jpg)
A KEY PRINCIPLE IN
UNDERSTANDING
ADDICTION
Drug use is a voluntary, preventable behaviour….
![Page 18: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/18.jpg)
but...
Drug addictionaddiction is not just
“a lot of drug use”.
![Page 19: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/19.jpg)
Drug Addiction
Compulsive drug seeking and use, even knowing the negative health and social
consequences
![Page 20: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/20.jpg)
ADDICTED RAT
“even knowing the negative
consequences”
![Page 21: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/21.jpg)
![Page 22: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/22.jpg)
Exercise
![Page 23: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/23.jpg)
The Rat Park Experiment
![Page 24: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/24.jpg)
Virtually all drugs of abuse
“hijack” the dopaminergic
mesolimbic reward system in
the brain
• Ventral tegmental area• Nucleus accumbens• Limbic system• Orbitofrontal cortex
![Page 25: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/25.jpg)
![Page 26: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/26.jpg)
Le Foll, B. et al. CMAJ 2007;177:1373-1380
IN ADDITION, A NUMBER OF THE BRAIN’S IN ADDITION, A NUMBER OF THE BRAIN’S OTHER CHEMICAL MESSENGER SYSTEMS OTHER CHEMICAL MESSENGER SYSTEMS
ARE AFFECTED BY THESE DRUGSARE AFFECTED BY THESE DRUGS
EACH DRUG
Drug recept
or
![Page 27: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/27.jpg)
Drug addiction is a Drug addiction is a chronic relapsing chronic relapsing
brainbrain disease disease
Drug addiction is a Drug addiction is a chronic relapsing chronic relapsing
brainbrain disease disease
![Page 28: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/28.jpg)
The addicted brain is distinctly, biologically different from the non-addicted brain, including:
• Receptor function and availability
• Metabolic activity
• Responsiveness to environmental cues
• Gene expression
![Page 29: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/29.jpg)
Dopamine D2 Receptors are Lower in Addiction
DA
D2
Rec
epto
r A
vaila
bili
ty
control addicted
Ice & Cocaine
Heroin
Alcohol
DA
DA
DA
DA DA DA
DA
Reward Circuits
DA DA DA DA
DA
Reward Circuits
DA
DA
DA
DA DA
DA
Drug Abuser
Non-Drug Abuser
![Page 30: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/30.jpg)
Patchy, reduced brain blood flow in heroin patient = less brain
activity
NORMAL HEROIN
![Page 31: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/31.jpg)
ALCOHOLALCOHOL
METHAMPHETAMINEMETHAMPHETAMINE
NORMAL
NORMAL
![Page 32: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/32.jpg)
Drug users have increased brain responses to drug related images
NORMALALCOHOLIC
![Page 33: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/33.jpg)
![Page 34: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/34.jpg)
NORMAL ADDICTEDNORMAL
![Page 35: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/35.jpg)
The addicted brain shows distinct changes which do improve with which do improve with
continued cessation of drug usecontinued cessation of drug use
NORMALNORMAL ACTIVE ACTIVE HEROIN USEHEROIN USE
1 YEAR 1 YEAR DRUG FREEDRUG FREE
![Page 36: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/36.jpg)
METHAMPHETAMINEMETHAMPHETAMINE
![Page 37: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/37.jpg)
The principles for treating
drug addiction are the
same as for treating other
chronic relapsing illnesseschronic relapsing illnesses
such as asthma, diabetes,
arthritis or multiple
sclerosis.
The principles for treating
drug addiction are the
same as for treating other
chronic relapsing illnesseschronic relapsing illnesses
such as asthma, diabetes,
arthritis or multiple
sclerosis.
![Page 38: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/38.jpg)
• Rapid induction of remission
• Supportive maintenance of
remission
• Expectant observation
• Rapid, non judgmental re-treatment of relapse if or when necessary
![Page 39: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/39.jpg)
Treating drug addiction is not like fixing a
ruptured appendix or a broken bone
ONE OPERATION
WILL NOT CURE IT !!
![Page 40: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/40.jpg)
A good treatment outcome is: A good treatment outcome is:
• A significant decrease in drug or alcohol use
• Long periods of abstinence with only occasional relapses
![Page 41: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/41.jpg)
Drug addiction is aBRAINBRAIN disease that is expressed in BEHAVIORALBEHAVIORAL ways and which occurs in a SOCIALSOCIAL context
![Page 42: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/42.jpg)
Service delivery model: 3-stream approach with care coordination and case management
![Page 43: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/43.jpg)
![Page 44: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/44.jpg)
Extended Abstinence is Predictive of Sustained Recovery
It takes a year of abstinence
before less than half relapse
Dennis et al, Eval Rev, 2007
After 5 years – if you are sober, you probably will stay that way.
![Page 45: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/45.jpg)
SOCIAL CONTEXTSOCIAL CONTEXT
![Page 46: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/46.jpg)
![Page 47: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/47.jpg)
![Page 48: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/48.jpg)
![Page 49: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/49.jpg)
![Page 50: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/50.jpg)
![Page 51: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/51.jpg)
![Page 52: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/52.jpg)
Australian Early Development Index
![Page 53: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/53.jpg)
![Page 54: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/54.jpg)
% of children in Normal IQ Range (>84) % of children in Normal IQ Range (>84) by Ageby Age (longitudinal analysis) (longitudinal analysis)
Martin, Ramey, & Ramey. 1990. American Journal of Public Health
![Page 55: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/55.jpg)
CONGRESS CHILD CARE EARLY LEARNING STUDY
Collette Tayler
Isabel Brookes
![Page 56: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/56.jpg)
![Page 57: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/57.jpg)
Preliminary analysis – Language Development
• Preliminary analysis of completed follow-up language assessments show an average language development gain of 7 months in a 3.5 month period.
![Page 58: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/58.jpg)
Preliminary analysis – Language Development
![Page 59: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/59.jpg)
Conclusions
1. ICE is a problem which is not out of control, is very treatable and is nowhere near the problem of alcohol
2. There is a common way of treating ICE, Alcohol and other drugs and this works
3. The social context of drug addictions is key to understanding the differential effects of drugs on different population
4. Early Childhood programs are key to the primary prevention of addictions
![Page 60: John Boffa Chief Medical Officer Public Health Assoc Prof., NDRI A Comprehensive primary health care approach to ICE, alcohol and other drugs John Boffa](https://reader033.vdocument.in/reader033/viewer/2022051001/5697bff51a28abf838cbd72e/html5/thumbnails/60.jpg)
`THANK
YOU