Substance and non-substance addictions – Rethinking prevention

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05 Jul / Substance and non-substance addictions – Rethinking prevention

What are we talking about when we speak of substance and non-substance addictions? Why is prevention important to society? What are the impacts of prevention on general health? These questions were the guidelines for structuring this paper, in which the conceptualization of prevention and prevention practices are systematically discussed. Furthermore, some emerging challenges in the development of preventive strategies are raised.

The present paper starts with a theoretical debate, supported with empirical evidence and literature.  This aims to highlight the complexity of preventive strategies in today’s society, is sustained of “…the importance of the involvement of individuals as agents of the construction of (and reflection on) contexts of action”(Abrantes, Henriques, Pereira and Veloso, 2014:2).

Substance and non-substance addictions

In the understanding of addictions as compulsive behaviours, addiction has traditionally been associated with the use of psychoactive substances. However, in recent years, challenges have emerged which have made it necessary to broaden this approach and the subsequent responses. This led to the adoption of the term ‘Addictive Behaviours and Dependencies’ (SICAD, 2013).

Public policies have reflected this trend, with the introduction of the National Plan for Reducing Addictive Behaviours and Dependencies 2013-2020 (SICAD, 2013) and the Guidelines for Health Education (Pereira and Cunha, 2017). In these guidelines, Addictive Behaviours and Dependencies are defined as “…«addiction processes»… impulsively and compulsively characteristic behaviour in relation to different activities or actions” (Pereira and Cunha, 2017: 58).

Psychoactive substances, either naturally or synthetically occurring, are those which change the functioning of the central nervous system when consumed. It can be legal or illegal to consume, grow or manufacture psychoactive substances, depending on the national legal framework and international conventions. “Addition… is the repeated behaviour which produces pleasure and relieves tension, especially in the early stages, can lead to a loss of control, severely disturbing daily life, family, work and social routines, which can exacerbate over time and lead to an addiction” (Pereira and Cunha, 2017: 70). This repeated behaviour may or may not be motivated by a substance, as in the case of gambling or technology dependencies.

Gambling-related issues may arise from gambling itself, which involves betting systems and financial risk, or from gaming, which involves interactivity with others and indicators of success and game progression (Vilar, Duran and Torrado, 2017; Clark, 2014). Problems associated with technology dependence involve the abusive or uncontrolled use of digital platforms and networks, such as social networks and online games.

Importance of prevention in society and its health impacts

Traditionally, prevention relied predominantly on the distribution of information leaflets and on the promotion of play activities. Aimed mostly at young people, such preventive actions aimed to increase the individual’s level of information and occupation. Although there is no general evaluation for the efficacy of these strategies, it can be argued that they had little impact (if any) in changing behaviours and attitudes of the target group (UNODC, 2015; EMCDDA, 2011). Thus, the relationship between the cost of such strategies and their benefits and outcomes must be questioned.

In recent years the concept of prevention has evolved; it is now understood as a complex process which is established as part of the educational mission, and is present in areas such as the development of critical thinking, and in preparation of the conscious, autonomous and ethical decision-making process. In order to improve the quality of preventive actions, but also to demonstrate the social and economic impact of such strategic, holistic and integrated approaches, recent decades have seen the development of the science of prevention.

According to Spoth et al. (2006), for each €1 spent on prevention, approximately €10 will be saved from the health, social and criminal burden of addiction. The World Health Organization estimates that non-communicable diseases now account for around 60% of all deaths worldwide. These are deaths that are not due to bacterial or viral infections, or to parasitic diseases; rather, these are deaths resulting from lifestyle decisions (WHO, 2018).

This growing recognition of the health implications of lifestyle choices is the basis, both of and for, public health and welfare policies. Improvements in health not only have direct impacts on wellbeing, but also on the growth of income levels, and consequently on investment in education, training and productivity. As such, the importance of introducing and sustaining science-based prevention interventions is paramount.

A healthy and safe population carries the improvement of their lifestyles. This is the field of science-based prevention, as part of a broader effort to ensure the necessary conditions for the development of those who are less vulnerable and more resilient, acting for the social empowerment of individuals and groups.

Challenges of Prevention

The work of evidence-based prevention allows strategies to be developed which are appropriate for the particular vulnerabilities of the target group. This adaptation takes place on two levels: the first is related to the scope of the intervention, and the other is related to the context. In terms of the scope, prevention can be directed at society as a whole (environmental or universal prevention); directed at vulnerable groups at greater risk of developing problems related to addictive behaviours (selective prevention); or it can focus on interventions directed at individuals at risk (indicated prevention). The contexts of interventions are diverse, ranging from families, schools and communities to workplaces, nightlife settings, and the media.

In each preventive intervention, there are specific issues and challenges relating to the characteristics of the group and the context, but also in relation to the strategies that are used and their scientific support, both theoretical and methodological.

Effective evidence-based interventions should identify and implement policies and practices which are adapted to the needs of targeted individuals, as well as monitor the quality of the intervention and the outcomes for the participants.

In this scenario of increasing complexity and demand, professionals and decision-makers in the field of prevention need specialised training that allows them to develop evidence-based prevention strategies adapted to different groups and their contexts. Such is the case of training programmes based on the Universal Prevention Curriculum (UPC) and the adapted version to the European context (EUPC).

Information regarding the required skills and responsibilities of prevention professionals is recent and somewhat limited, which has led to poorly-defined and inconsistent descriptions of such expert job roles (Gabrhelik, et al., 2015). The term ‘prevention professionals’ generally applies to professionals who are responsible for the planning, implementation, and monitoring of prevention interventions and/or policies within a defined geographical area. These individuals may supervise other prevention workers who help to deliver or monitor prevention interventions.    

In this context, some of the fundamental skills required for professionals are: i) general, personal and social skills, such as communication and interaction; ii) intervention skills, such as preventive strategies, personal and social development, decision-making processes, and project management (including monitoring and evaluation procedures); iii) multi-disciplinary skills necessary for adapting preventive strategies to the needs of targeted individuals and contexts, including diversity sensitivity (cultural, gender and other diversities).

Of the competencies presented above, those related to the monitoring and evaluation of preventive interventions are especially important. This is because they are the most directly related to the production of results and scientific evidence, which sustain the balance between the initial design of the intervention and its adaptation. Evaluation is a form of research which allows the short-, medium- and long-term outcomes of prevention to be systematically analysed, in addition to the factors related to these outcomes. “To evaluate is to value and judge rigorously, logically and coherently the state, evolution and effects of problems, actions, devices and organizations upon which we are intervening” (Guerra, 2007: 206). Ideally, all stages of the preventive intervention should be evaluated (i.e. the planning, development, implementation and follow-up), allowing information to be gathered to improve the intervention and its quality.

More specifically, monitoring and evaluation allows: the measurement of results and impact; verification of which segments of the population responded best to the intervention; comparison of costs and benefits; and comparison of the effectiveness between interventions.

As evaluation should be based on research, in this paper we stand for several forms of knowledge production – knowledge for action and knowledge in action, in the expression of Guerra (2007). This means that it is necessary to diversify methodologies and approaches in order to evaluate preventive interventions.

This diversity implies not only collating results from several sources, but also the mobilization of less common methodologies which can prove to be very effective in uncovering information that is difficult to access through more traditional methods. The case of visual methods can be used as an example (Henriques and Candeias, 2013).

Here, it is important to mention an additional challenge faced by prevention and prevention professionals at the present moment: the scientific dissemination of results and the knowledge produced. This challenge is particularly pertinent to the Portuguese reality and language, because there are very few publications in this academic field.

Bibligraphic References 

Abrantes, P., Henriques, S., Pereira, I., Veloso, L. (2014). O lugar do outro na investigação sociológica: novas propostas metodológicas, CIES e-Working Paper Nº 176/2014, Lisboa: CIES

Clark, L. (2014). Disordered gambling: the evolving concept of behavioural addiction. Annals of the New York Academy of Sciences 1327, 46-61.

EMCDDA – European Monitoring Centre for Drug and Drug Addiction (2011). European drug prevention quality standards, Luxemburgo: EMCDDA

Gabrhelik, R., Foxcroft, D., Mifsud, J., Dimech, A. M., Pischke, C., Steenbock, B., Bulotaité, L., Mulligan, K. (2015). Quality plan for prevention science education and training in Europe. Oxford: Science for prevention academic network

Guerra, I. (2007). Fundamentos e processos de uma Sociologia da Ação – o planeamento em ciências sociais, S. João do Estoril: Princípia

Henriques, S., Candeias, P. (2013). Self-portraits of reintegration: the use of visual methods in addiction research. In Fountain, J., Wouters, M., Korf, D. J. (Eds), Snapshots of social drug research in Europe, Lengerich: Pabst Science Publishers, 69-72

Pereira, F., Cunha, P. (Coords.) (2017). Referencial de Educação para a Saúde, Lisboa: Ministério da Educação – Direção Geral da Educação; Direção-Geral da Saúde

SICAD (2013). Plano Nacional para a Redução dos Comportamentos Aditivos e das Dependências 2013-2020, Lisboa: Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências

Spoth, R. L., Clair, S., Shin, C., Redmond, C. (2006). Long-term effects of universal preventive interventions on methamphetamine use among adolescents. Archives of paediatrics & adolescent medicine, 160(9), 876.

UNODC – United Nations Office on Drugs and Crime (2015). International Standards on  Drug Use Prevention, Viena: United Nations

Vilar, G., Duran, D., Torrado, M. (Coords.) (2017). Linhas de orientação técnica para a intervenção em comportamentos aditivos e dependências sem substância: a perturbação do jogo, Lisboa: Serviço de Intervenção nos Comportamentos Aditivos e nas Dependências

WHO – World Health Organization (2018). Managing epidemics: key facts about major deadly diseases, Licence: CC BY-NC-SA 3.0 IGO

Susana Henriques

PhD in Sociology – specialization in Education, Communication and Culture (ISCTE-IUL); Master in Communication, Culture and Information Technology (ISCTE-IUL);
Degree in Sociology (ISCTE-IUL)

Researcher at CIES-IUL; LE@D, UAb

Assistant Professor Department of Education and Distance Education, Universidade Aberta. She the responsible professor in subjects: graduation in Education; Post Graduation in Social Education and Juvenile Studies (where she has coordination functions); MSc Information Management and School Libraries, Pedagogical Supervision, School Administration and Management; PhD in Education. She coordinates the Specialized Training on Addictions Prevention. 

Areas of interest in research: Sociology of education and communication – elearning, media literacy, educational leadership; Research Methods; Prevention and health education

Natalie Broughton

Postgraduate student at the Public Health Institute, Liverpool John Moores University, studying on the Public Health (Addictions) MSc programme. She has an undergraduate degree in Psychology (BSc). Her general research interests include all aspects of substance use, mental health, and gender inequalities in public health. She has a particular interest in reducing drug-related harms in nightlife settings, the gendered nature of substance use and menstrual poverty. 

Natalie is currently undertaking an Erasmus+ traineeship at Universidade Aberta, Portugal, where she is working as a research assistant in the field of prevention. She is also a volunteer for Check!n, a harm reduction intervention delivered in nightlife settings across Lisbon. In Liverpool, Natalie volunteers with Time To Change, a campaign to reduce mental health-related stigma and discrimination, as well as the Merseyside branch of the Fawcett Society, where she campaigns for gender equality.