EPIDEMIOLOGY OF DRUG ABUSE:A REFRESHER MODULE ON DRUG ABUSE RESEARCH

Meeting Of Caribbean National Observatories In Drugs

Bridgetown, BarbadosJune 14-16, 2005

Dr Ken-Garfield Douglas

What would the presentation cover?

Elements of drug abuse epidemiology The current state of the science (new methods, new challenges, new issues)Qualitative methods highlightedConsideration in going from research to policy to practiceLessons learned from quantitative research in the Caribbean (school surveys)

Working definitions (drug abuse research)

Drug abuse research help countries to obtain better information about the nature and extent of drug use and drug abuseIt provides systematic methods to collect qualitative data about drug use and quantitative data on patterns and consequences of drug use or abuse

What is the focus of epidemiological research

Drug abuse epidemiologic research focuses on understanding the nature, extent, consequences, and etiology of drug abuse across individuals, families, age groups, gender, communities, and population groups.

What is the role of epidemiological research

Epidemiologic research plays a critical public health role by providing an estimate of the magnitude, impact, and risk of drug abuse on a population

What are some of the outputs of epidemiological research

Lays the foundation for:developing strategies to treat and prevent drug abuse

plan and evaluate drug abuse services; and

suggest new areas for basic, clinical, and treatment research.

What is the true value of drug abuse research?

The value of drug abuse research lies in the dissemination of research information which helps to address the issue of public perceptions about drug abuse and at the same time educates the public about drug abuse and addiction.

The value of what we have done

The vast majority of our epidemiology research had been quantitative in nature

Not much of the information collected have be consistently disseminated in-country and region-wide

Most of our present knowledge comes from generic research conducted outside the region

Present knowledge gaps for the region

The origins and pathways to drug abuse – a comprehensive understanding of the factors and processes that predisposes and or protects and individual from drug abuse

Drug use and adverse behavioural and social consequences – and understanding of the nature and extent of drug-related consequences and their development

Present knowledge gaps for the region

Application of applicable research methodologies that screens clients to appropriate treatment modalities

A notable lack of multiple/logistic regression analysis

Research/evaluation on the effectiveness of our prevention programmes (Are they tested-effective, what fruits are they bearing)

Present innovative methodologies (new methods, challenges and issues)

The application of social work and social science theory and methods in substance abuse research Triangulation of methods (combining

qualitative and quantitative approaches)

Computer assisted approaches for collecting data have promise

Present innovative methodologies (new methods, challenges and issues)

The Use of Geographic Information Systems (GIS); e.g. in assessing substance abuse prevention resource

Operational research particularly around standardizing treatment and prevention practices

The twin epidemic – the spread of HIV disease primarily in the context of illicit drugs use

Lets unravel the issues around: “the pathways to drug abuse”

The major emphasis has been to stimulate innovative investigations that enhance our understanding of:

(1) drug use patterns and trends within and across populations;

(2) interplay of social interactions, social environment, structural context with individual behavioural characteristics and genetic vulnerability;

The pathways to drug abuse

(3) causal mechanisms leading to onset, maintenance, and remittance of drug abuse, as well as protective mechanisms that reduce the risk of drug abuse; and

(4) drug abuse over the life course, including developmental processes that influence drug use trajectories and behavioural, health, and social consequences of drug abuse.

The pathways to drug abuse

Some cross-cutting issues in drug abuse research:gender differences in the nature and extent

of drug-using behaviours, in the pathways and determinants of initiation, progression and maintenance of drug abuse

HIV/AIDS and drug abuse are frequently referred to as twin epidemics, and whenever possible, it is essential that epidemiologic studies address this interrelationship

The pathways to drug abuse

Some cross-cutting issues in drug abuse research:Methodological innovations should

seek to address transitions in stages and trajectories of drug abuse, inter-generational transmission of drug abuse, and heterogeneous pathways to and consequences of drug abuse.

The pathways to drug abuse

Examples of the types of research topics to be explored under pathways to drug abuse include, but are not limited to, the following: Emerging and current trends Social epidemiology of drug abuse Drug abuse psychopathology: co-morbidity and

vulnerability Developmental consequences of drug abuse Social and behavioural consequences of street

drugs Drug markets and behaviour economics

The pathways to drug abuse - Social epidemiology of drug abuse Drug abuse research has focused

largely on individual risk factors, while the universe of determinants includes individual, family, neighbourhood, community, population-specific, and societal factors

Lets briefly look at some findings from a regional study in the area of social epidemiology (risk and protective factor study secondary school students)

What are risk and protective factors?

Risk factors are characteristics in the community, family, school and individual’s environments that are known to increase the likelihood that a student or individual will engage in one or more problem behaviors

Protective factors are characteristics that are known to decrease the likelihood that a student will engage in problem behaviors

National Drug Commission – February ‘04

What did the survey find?

Risk Factors:Of the 22 risk factors evaluated – three groups

can be identified: Those of great concerns (overall scores above

the normative average of 50 points)

Those of border-line concerns (below the normative score but within overall average of 47 points)

Those of no particular concern (below the overall survey average score of 47 points)

National Drug Commission – February ‘04

Risk factors of great concern

• Community disorganization• Poor academic performance• Laws and norms favourable to drug use • Friends’ delinquent behaviour• Personal transition and mobility• Low neighbourhood attachment• Gang involvement

National Drug Commission – February ‘04

Risk factors of borderline concern

• Poor family supervision• Poor family discipline• Parental attitude favourable towards

anti-social behaviour• Peer reward for anti-social behaviour• Parental attitude favourable towards

ATOD

National Drug Commission – February ‘04

Overall protective factors scores

0 10 20 30 40 50 60 70

community reward for prosocial involvement

family attachment

family opportunities for prosocial attachment

family reward for prosocial attachment

school opportunities for prosocial involvement

school rewards for prosocial involvement

religiosity

social skills

beliefs in the moral order

National Drug Commission – February ‘04

Base/average

Triangulation revisited: (Qualitative Research)Qualitative methods – has an emphasis on

process and an in-depth understanding of perceived meanings, interpretations and behaviours

It gives an internal perspectiveIt is the kind of research that produces

findings not derived from statistical procedures or other means of quantification.

Qualitative Research

Qualitative methods are significant for drug abuse research because it helps not only in the design of questionnaires but also to help formulate meaningful research questions, conduct appropriate statistical analysis and even interpret the results

Qualitative Research

Key components of Qualitative research

1. Ethics and informed consent (some guidelines) the purpose of the research and the potential risks

must be made explicit to the subjects they must have the right to choose whether or not

to participate the researcher responsibility is to determine that

no harm may come to the subject as a result of participation

Qualitative Research

2. Observation

3. Qualitative interviews

4. Analysis of the textual data (content analysis)

5. Experienced/qualified investigators (usually ethnographers or researchers with background in anthropology and sociology)

From Research to Policy to Practice

Research (gathering the evidence)Policy (applied guiding principles and

strategies)Practice (activities/programmes)

Our key question – “Of what value is research in making this

link?”

From Research to Policy to Practice Effective strategies to deal with the problems of

drug abuse must be "as complex as the problem itself

Success will be found only when public safety and public health professionals use science and not ideology as the foundation of those strategies

policies should be based on the best available knowledge and analysis and should be judged by the results they produce rather than by the intentions they embody

From Research to Policy to Practice

One needs to be cautious about over-generalizing from any particular research finding, however many studies of substance abuse and crime offer direction for a "fundamental rethinking of our current practices" and for new public policy initiatives

Some practical application

Lets look at these data points and rationalize the possible next steps in terms of policy and practice (programmes or interventions)

STATUS OF INMATES and DRUG USE STATUS OF INMATES and DRUG USE AT RECEPTIONAT RECEPTION

PERCENTAGE DISTRIBUTION

POPUL THC OPIATES COCAINE POLYUSE

CONVICTED 37.0 61.5 23.1 42.3 34.6

REMAND 39.0 48.4 22.6 25.8 22.6

CIVIL OFFENCE 21.7 60.0 13.3 46.7 40.0

Treatment, rehabilitation and Treatment, rehabilitation and perceived need for treatmentperceived need for treatment

22% had been in treatment 22% had been in treatment 41% had counseling or rehabilitation 41% had counseling or rehabilitation 25% perceive the need for treatment 25% perceive the need for treatment

In addition, of those in need of treatment:In addition, of those in need of treatment: 47% positive for marijuana47% positive for marijuana 63% positive for cocaine63% positive for cocaine 42% positive for opiates (heroin)42% positive for opiates (heroin)

NEEDS ASSESSMENTNEEDS ASSESSMENT

HIGH LEVEL OF USE

HIGH PERCEIVEDNEED FOR TREATMENT

PREVIOUS CONTACT WITH TREATMENT, COUNSELING OR REHABILITATION

FAILED PSYCHOMETRICTEST

TREATMENT

Figure 1: Prevalence of Cigarette UseFigure 1: Prevalence of Cigarette Use

0 5 10 15 20 25 30 35 40

Bahamas

Barbados

St Kitts and Nevis

St Lucia

St Vincent/Grenadines

Suriname

Dominica

Guyana

Grenada

Trinidad and Tobago

Turks and Caicos Islands

Brisish Virgin Islands

Regional Average

lifetime annual current

Figure 10: Prevalence of Inhalant UseFigure 10: Prevalence of Inhalant Use

0 2 4 6 8 10 12 14 16

Bahamas

Barbados

St Kitts and Nevis

St Lucia

St Vincent/Grenadines

Suriname

Dominica

Guyana

Grenada

Trinidad and Tobago

Turks and Caicos Islands

Brisish Virgin Islands

Regional Average

lifetime annual current

Figure 13: Age of First Use of CigaretteFigure 13: Age of First Use of Cigarette

01020304050

60708090

100

9 or less 10 or 11 12 or 13 14 or 15 16 +

Figure 16: Age of First Use of InhalantsFigure 16: Age of First Use of Inhalants

0102030405060708090

100

9 or less 10 or 11 12 or 13 14 or 15 16 +

What now?

More research?Greater emphasis on

advocacy?More/better interpretation of

our information into actions?

My recommendation

A monograph of all the current research (last five years) done in the region

Making the information available on lineTranslating the information into possible

credible actions: from a policy perspectiveas well as from a practice perspective

(implications and possible best practices in terms of programmes and interventions)