Leadership in Drug and Alcohol Abuse Prevention

Insights from Long-Term Advocates

David S. Anderson, David S. Anderson

• Publisher: Routledge
• Year: 2019
• ISBN:
  9780429959561
• Edition: 1
• Topic: Psychology
• Subtopic: Addiction in Psychology
• Index: Psychology

Leadership in Drug and Alcohol Abuse Prevention blends the wisdom of numerous long-term professionals addressing drug and alcohol issues with helpful strategies and current science.

Organized around the Pyramid of Success that emphasizes Competence, Confidence, and Commitment, this book offers practical and grounded approaches for better addressing substance abuse issues. Included are insights from 50 contributors, featuring professional perspectives from practitioners with decades of experience. While issues of substance abuse are not readily solved or cured, they can be better addressed – more effectively, more efficiently, and more appropriately. This timely resource offers a unique blend of science-based strategies and resourceful foundations for implementation.

Designed for those working either directly or indirectly with problems associated with substance use disorders, this book will aid those in a wide variety of settings, whether in schools, communities, business, or government.

Part I

Competence

Competence is a central component of the Pyramid of Success. This represents the knowledge base of the individual, and also includes the requisite skills for addressing the topic or issue. Competence requires that the knowledge be current and relevant, representing a sound understanding of the latest issues and strategies. Being competent means being skillful, whether through years of work and/or substantive grounding and practice. Being competent is not a particular endpoint, as skills will increase over time and new knowledge and practices will emerge.

Competence is all about having the skill and the background. Without competence, individuals will proceed in an unsubstantiated manner. Imagine any professional, service provider, laborer, or other person offering services or direction without the grounding. If a person has other elements of the Pyramid of Success, without the competence, this would result in a hollow effort not grounded in current science or quality practice. Thus, detailed study, renewal training, mentoring, and quality implementation are all integral to competence.

1Understanding the Nature of the Concern

Individual Perspectives

When thinking about leadership in any field of study, the appropriate starting point is understanding the overall context of the issue. It is important to know about the current status of affairs for the issue, and also to understand what is needed or wanted. If the status quo is satisfactory, then there may be no need for change, unless the leadership wants improvement or modifications. The obvious context of this is that some type of review or assessment is needed to ascertain whether or not change is warranted, and if so, what different circumstances or outcomes are needed.

Why state the obvious at the beginning of this first chapter of this book? Simply put, it is to make very clear that, with drug and alcohol issues, the status quo is not acceptable. The current state of affairs with the misuse and abuse of substances is not where we as a society, whether in the United States or elsewhere, want to be. As leaders and as concerned individuals, we know that we do not want to leave situations surrounding drugs and alcohol as they are; we know that we are not satisfied with the presence of drug- and alcohol-related problems in families, work settings, schools, or communities, and more generally throughout states, the nation, and other nations throughout the world.

Consider for a moment the fact that every one of us is aware of at least one individual about whom we have had, or currently have, concerns about their personal use of drugs and/or alcohol. How about the eight-year-old who drank a beer, mimicking a parent’s behavior. Consider a high school student who tried marijuana to escape some of life’s challenges, or a college student who wanted to impress friends with how much he or she could drink. Or how about a middle-aged adult who had a couple of glasses of wine during a dinner interview with a prospective employer. Are there concerns with a factory worker who was hung over when showing up at the plant? Would this be different if it was a teacher? A bus driver? A surgeon or a lawyer, an accountant or a store clerk? An airline pilot? Is it different if this individual had smoked a joint, and that most yet not all of the immediate effects were gone when adopting these professional responsibilities?

In each of these situations, and countless more, we can identify areas of concern. Beyond that, each of us has different points of view about what behaviors are of concern, and which of these warrant some attention. Our perspectives may be based on the age of the person, the specific substance or its quantity, the effects, the circumstances, or other factors. Further attention to these areas of concern are found in Chapter 3 (Why Be Concerned?).

The main point is that substance abuse issues abound in our society. We can document areas where progress has been made, and we can also document areas where changes are needed. Significant amounts of research have been done to document areas of need; further, many areas remain where research has not been sufficient or is not conclusive.

This chapter highlights some areas of individual concern regarding drugs and alcohol. Included are some data points and contextual issues helpful as foundations for efforts addressing drug and alcohol issues, whether in prevention, treatment, or recovery. Some key factors – certainly not all! – are incorporated regarding the individual perspectives on this topic. The next chapter examines parallel issues from an environmental or overall societal perspective.

Overall Context and Definitions

The essential starting point is to provide a contextual framework and brief definitions. This is helpful for this book’s readership, and also to serve as a model for dialog with others in family settings, schools, communities, workplaces, and elsewhere. While much more detail on these topics and issues is found in textbooks, monographs, scientific papers, and resources, this overview is essential for the necessary limitations of this volume. Further, this brief overview will help provide a foundation for the contents of this book; much more detail is provided in the specific chapters, as well as with many of the Professional Perspective segments found in each chapter.

First, why are both terms used when talking about “drugs and alcohol”? Generally speaking, the word “drug” encompasses any substance that, because of its chemical nature, affects a living organism. “Drug” includes alcohol; however, alcohol is separated here to specify clearly that it is to be included. Tobacco fits within the construct of “drug”; however, while most of the content of this volume is relevant, it is not the primary emphasis. With this volume, the focus is on substances that, by their nature and use patterns, can result in immediate harm to self or others. While “drug” includes legal and illegal substances (defined by the law), it also includes licit and illicit (what is generally accepted or not accepted by society). “Drugs” do include prescription and over-the-counter substances, which are generally used in appropriate and non-harmful ways. The primary focus within this book is upon identifying strategies to reduce the illicit, harmful, and/or inappropriate use of any drug, including alcohol.

A basic principle is that the body doesn’t know what a person is putting into it; it just responds to what is placed in it. Thus, much of what is discussed throughout this book will be the same regardless of the specific ingredients. That is, when addressing prevention, intervention, treatment or recovery, much will be the same. When addressing individual factors, like the reasons for use, the substance itself may vary but the reasons may be the same. Certainly, different effects occur based on the substance itself and its innate effects; and other effects occur because of the individual, such as his/her expectations (see more in Chapter 4). Further, a protocol or procedure appropriate for one substance (e.g., heroin) may not be appropriate for another (e.g., alcohol); however, many factors cut across all substances in some form.

Finally, it is important to highlight that any use of a substance – alcohol or drug – is not necessarily harmful, bad, or undesirable. The aim espoused in this book, and reflected by so many professionals, is to reduce the negative consequences associated with substances. Research findings document that alcohol may, for some or for many people, be healthy (or at least not harmful) under certain circumstances. The important factor is to determine what is most appropriate – for this person, under these circumstances, at this point in time. Looking ahead to Chapter 4 (Foundational Factors) and Chapter 6 (Skills for Prevention and Education), it will be important to incorporate the principles defining the effects of a drug, as well as the factors of “guidelines” and the distinction between prevention and promotion. Having those more clearly defined will be most important in developing appropriate “next steps” for action.

Regarding definitions, these apply to both drugs and alcohol. Further, when considering drugs, the distinction is not made between those drugs used for medical purposes under a physician’s direction and those used under other circumstances (whether prescribed or not).

• Abstainer – an individual who does not use substances
• Use – any consumption of drugs or alcohol
• Misuse – use of a substance in a problematic matter, yet done so unintentionally
• Abuse – use of a substance in circumstances or doses that significantly increase the potential for harm, or use outside generally acceptable behavior
• Harm – negative consequence (physical, emotional, cognitive, social, financial, legal, or other) to oneself or others as a result of substance use
• High-Risk Use – consumption of a substance that results in increased likelihood of short- or long-term negative consequences
• Dependence/Addiction – compulsive need to use a substance; inability to stop use, whether situational or immediate, in spite of negative consequences.

Usage Patterns among Adults

Drugs and alcohol have significant documentation regarding usage rates. These are found by looking at various patterns of use, most commonly lifetime, annual, month, and day. Similarly, the amount of use at one time (dosage), with alcohol in particular, is examined. With adults, over two-thirds of adults (70.1%) have consumed alcohol in the last year, with 56.0% reporting use in the last month; for the lifetime, this is 86.4% of individuals aged 18 or older. Binge drinking (generally four drinks for women and five drinks for men, on the same occasion) is found with one-quarter (26.9%) of adults aged 18 or above; heavier alcohol use (binge drinking on five or more days in the last month) is found among 7% of adults.

With drugs, it is estimated that 24.6 million Americans aged 12 or more used an illicit drug in the last month, from data in 2013.¹ This represents just under 10% of the population (9.4%). When excluding marijuana, use of other drugs appears to have stabilized in the past decade. Cocaine use has lowered over this time period; currently this is 1.5 million people.² Methamphetamine use increased to 595,000 in 2013, up from 353,000 in 2010. Marijuana use has increased; current use (2013) was reported at 19.8 million users (7.5% of people aged 12 and older), increasing from 14.5 million people (5.8%) in 2007. Similarly, opioid use has increased, with about one-quarter of patients prescribed opioids for chronic pain misusing them.³

Much more information about adult drug usage patterns is available from various sources at the national level; the most helpful starting points are the federal agencies dealing specifically with these topics: the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, and the Centers for Disease Control and Prevention. This is not to negate other nonprofit or academic research initiatives, as these often have helpful and resourceful materials and findings.

Insights gathered from long-term advocates provide further background about the nature of the problems with drugs and alcohol, particularly as they affect individuals. Consider the following:

When talking about drugs and alcohol, I think that they are tied together.

Bill Modzeleski

Alcohol is I think a lot more problematic. There is a huge difference because of the illegality of drugs.

Thomasina Borkman

So I wish that we could change the way people view things, bringing in more of the whole global impact of those two things, alcohol and other drugs.

Carla Lapelle

There is a group that try heroin and say “I’m never doing that again; that was really stupid.” But heroin is a really fast addicting drug so you get somebody who reports that it was pleasurable, “I’m going to try it again” and then they try it again, and then they try it again, and who knows that may be enough for them to adjust and say “Well I have to, I can’t snort, I have to inject, I need more” and they may then do this more frequently.

Gail Milgram

There is almost a civil rights issue associated with drug use; “it’s your body, your brain, you can do what you want and if you develop a problem you need to have insurance to get treatment.”

Mark Gold

Alcohol abuse is not th...