Evidence and Practice in Drug Prevention

Charli ErikssonProfessor in Public Health, Director

National Center for Child Health Promotion, Örebro University

www.ncff.nu

Aims of this presentaion

• To clarify some key concepts

• Practice, Knowledge, Evidence, Evidence-based Practice, Evidence-informed Policy

• To outline possible development of an scientific or evidence advisory committee within ECAD

Ambition

• From belief

•

• to knowing

Knowledge for prevention

• Evidence-based interventions is needed• Knowledge from controlled trials under

optimal conditions …..• Knowledge is possible from different kinds of

practice-based evaluations ….• Reflection over practical experiences

Good intentions is not enough

Key Concepts: Practice

AddictionAddiction

AddictionAddiction

Drug prevention, control and treatment

Actions to reduce drug-related harm

• Infrastructures, services

• Legal system, administration, organizations, networks

• Groups, communities, population

• Individuals

• Developing services

• Advocacy, Networking Organizing

• Social mobilization

• Development of individual skills

Mechanisms of harm

• Toxic and other biochemical effects of drugs

• Psychoactive actions resulting in intoxication

• Dependence

Psychoactive Dose

Pattern/volume of Dose

Mode of Administration

Contextof use

Toxic effect Intoxication Dependence

Effects on fetus

Overdose Injury Infectiousdisease

Chronic illness

Role failure

Criminal punishment stigma

Social reaction to use

How toxic effects, intoxication, and dependence are relate to drug dose, use patterns, and mode of administration, and in turn mediate the consequences of drug use for drug user (Babor et al 2010)

Alcohol is not an ordinary commodity

Risk and Protective Factors

Risk Factors

Early Aggressive behavior

Lack of Parental Supervision

Substance Abuse

Drug Availability

Poverty

Protective Factors

Impulse Control

Parental Monitoring

Academic Competence

Antidrug Use Policies

Strong Neighborhood Attachment

Domain

Individual

Family

Peer

School

Community

What makes the psychoactive substances so symbolically powerful?

• Valued physical goods

• A social behavior with strong symbolic value

• Power to change behavior, mood, motor coordination, and judgment

• Potentially causing addiction, dependence

Why people use drugs

• The powerful ability to act on brain mechanisms that affect motivation, thinking, mood, and perhaps most importantly, the experience of pleasure

• Reinforcement• Genetic predisposition and broader

familial influences• Availability

To develop knowledge about alcohol and drug prevention

Success factors Barriers

What is driving the development?

• Traditions?

• Values?

• Needs?

• Knowledge?

• Money?

• …..

What governs the preventive policies?

Ideologicinspiration

Evidence

Changing situation

fromresearch

fromexperience

Commonsense

OldPolicy

Newpolicy

Knowledge Needs

• Distribution in the Population

• Causal web – Determinants and Mechanisms

• Consequences for individual and society

• Interventions – methods for change

• Policy and Implementation

Knowledge

• Plato established the main criteria for

• True and secure knowledge = episteme

• Opinion and beliefs = doxa

• Aristotle added two forms of practical knowledge

• Techne = primarily linked to handcraft and creative activity

• Phronesis = ethical and political life

Challenges

• To do right things

= Making priorities

• To do things right

• = Having competence

Knowledge

• Theoretical-scientific knowledge• = to know

• Practical-productive knowledge• = to be able

• Knowledge as practical wisedom

= to be wise

Making PRIORITIES

Having COMPETENCE

The Principles

• What helps?

• What hurts?

• Based on what evidence?

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The Evidence Concept

• It the amount of evidence enough for drawing conclusions in either direction?

• The roles for evidence, which are used in science, are systematic collection of data in an attempt to reduce bias that is inherent in more anecdotic evidence

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Grading of Evidence

• Systematic review of the literature including quality assessment of research studies

• Hierarchies of evidence

Development of the Concept of Evidence

• The restricted interpretation – randomized studies

• Decision-making based on the best available evidence

• Practical experience – Best practice

• Acceptable and demanded actions in the target group

Evidence-based Practice

• Emerged in the early 1990’s from the field of medicine

• Requires the integration of the best research evidence with our clinical expertise and our patients’ unique values and circumstance

Evidence-based Practice

Best Best EvidenceEvidenceTarget Group

Preferences and Actions

Situation and Situation and CirumstancesCirumstances

ProfessionalProfessional ExpertiseExpertise

(Haynes et al, 2002)

1. Converting information needs related to practice decisions into well-structured questions.

2. Tracking down, with maximum efficiency, best evidence with which to answer them

3. Critically appraising that evidence for its validity, impact (size of effect) and applicability (usefulness in practice)

4. Integrate the appraisal of evidence, clinical experience and client values and preferences into practice and policy decision

5. Evaluate

Steps in an Evidence-based Practice

For a global, evidence-informed policy

• International scope of problem• Need for comprehensive

knowledge• Focus on evidence• A public good perspective

Evidence-informed

• Leaves ample room for many other forces to affect public policy

• Democratic processes (voting), religious values, cultural norms, and social traditions can and should affect how societies respond to harmful drug use.

Challenged by the complexity of our dynamic reality

ECAD and Evidence

• In line with the aims of ECAD

• Promoting making priorities and strengthening competences for comprehensive initiatives against drug in European cities

• Organizing a scientific advisory committee or a committee for evidence for ECAD

DEVELOP KNOWLEDGE

Evidence-process

CollectReview

Judge

SHARE KNOW- LEDGE

USE KNOW- LEDGE

PublishImplement

PlanDo

Evaluate

Research integrated

REFLECTION

Bridging the Research-Practice-Policy Gaps

• We need:

• Knowledge about effective methods and tools

• Time and skilled personnel

• Leadership and administrative support

• Shared language concerning concepts and tools

Long-term drug prevention and control is possible

Thank you for your attention