Drug Demand Reduction - Basic Principles

Gad Paul Kilonzo

Introduction The complex nature and multiplicity of factors that contribute to the emergence of drug abuse calls for a major departure from relatively simple approach to the prevention of physical illness due to such condition as infections. Drug abusers, for example, far from being the unwilling recipients of a pathogenic invasion, actively procure the offending agent. Agent directed prevention (supply reduction) alone appears to be an inadequate approach in drug abuse prevention. A balance is needed between control of the offending agent and the single most important item in the etiological constellation, that is drug seeking behavior. Multiplicity of social environ-• mental factors that contribute to drug abuse, calls for directing prevention efforts to the whole social environment including the drug abuser. Drug demand reduction efforts are, therefore, directed at the community as a whole.

Multidimensional Approach
The United Nations comprehensive multi-disciplinary outline of future activities in drug abuse control also emphasizes the multidimensional causes of drug abuse and the necessity of multidimensional and multi-disciplinary approach in prevention that takes into account the drugs being used, the abuser, and the psychological, social, cultural and economic setting in which drug abuse occurs. It emphasizes the importance of paying equal attention to supply and demand reduction as well as focussing on motivation for healthy life styles and deterrence to drug abuse (UN 1987). This was the consensus of experts in the field of drug abuse prevention from around the globe who reviewed experience and results of studies on the subject. Motivation for healthy lifestyles involves promoting an environment that rewards drug-free existence, and deterrence emphasizes the adverse consequences of illicit supply of drugs and illicit drug use behavior. It is becoming increasingly apparent that both approaches are important in achieving lower levels of drug abuse in the community. The objectives of a prevention programme should therefore include reduction of supply, reduction or elimination of demand for illicit drugs, and creation of a sociocultural climate that promotes healthy life styles that are superior alternatives to the cheap, fake and transitory pleasures and comforts that drug abuse provides. Reduction of supply involves the suppression or eradication of sources of illicit supply of drugs such as cultivation, production, transport/ sale and in any other way that contribute to the availability of illicit drugs. Demand reduction involves preventing or discouraging people from developing interest in abuse of drugs, as well as treatment and rehabilitation of addicts. The comprehensive multi disciplinary outline emphasizes linking the two approaches, thus breaking the link between supply and demand. Drug Demand Reduction The underlying objectives of such measures are promoting and maintaining the health of the individual; the mind, the body, and the social sphere; promoting and maintaining the social fabric at the family, community and national level is equally important. Promotion and maintenance of political stability and security is Crucial. On the other hand drug abuse can undermine political and social stability. Essential elements of prevention programmes include long-term sustained activities integrated into normal activities of education, leisure, cultural pursuits, work and spiritual recourse. Short-lived projects are of limited value and may be counter-productive. National commitment is therefore a necessary component of successful drug prevention programmes. It is also important to make a distinction between information and education. In addition to providing knowledge, education also entails an attempt to transmit or change attitudes and values of individuals and society. Education goes beyond acquisition of knowledge to learning of new patterns of behavior. It involves the whole community in transmission of behavior related messages. Education, therefore, has more enduring and fan-caching effects (UNESCO 1987). It is important at the outset, however, to inform the public and policy makers of the harmful effects of drug abuse to be able to gain support for policy development, for necessary legislation and to sustain educational programmes. Another very vital component is community involvement and community mobilization against drug abuse. The degree of community permissiveness and tolerance of drug abuse influences the extent of drug abuse in the community. Community action at the

grassroots is also very effective in reducing demand for drugs of abuse. Experience in drug demand reduction indicates that successful programs are those that address individuals on every locus along a continuum of risk of being exposed to drug abuse and getting into drug seeking behavior. The continuum of risk of drug abuse is from no risk, low risk, moderate risk and high risk. Individuals in low risk are not yet exposed to drugs, those at high risk are already dependent on drugs (Eliany and Rush 1992). It is important, therefore, that the necessary variety of demand reduction programs should be operating in the community, involving as many sectors as possible, all providing consistent message and opportunities towards drug free life styles.

Assessment and monitoring of extent of drug abuse
A description of extent of abuse, definition of risk populations and analysis of factors influencing drug abuse are essential components of planning preventive measures and monitoring progress and evaluating the impact of preventive activities. Machinery for monitoring availability of illicit drugs and trends of abuse is an important aspect of this.

Prevention through education
Education with regard to promotion of healthy drug free lifestyles may be targeted to individuals within formal and general education system, as well as their families and communities. It is observed in the CMO (UN 1987): "Prevention through education should be considered as a continuous process, the objective of which is to seek and improve understanding of the long-term and immediate causes of recourse to drugs; to help young people and adults to find solutions to their difficulties and lead their lives without resorting to drugs. Indications are that the impact of preventive education is greatest when it:
a. Takes place in its appropriate social, economic and cultural setting; b. Is integrated into overall framework of academic, social and cultural setting; c. Promotes a healthy drug-free life style as a primary goal, as opposed to placing emphasis on abstinence from drugs and on negative effects of drug abuse; d. Reaches individuals before they are exposed to the drug sub-culture and other influences that contribute to initial drug use;

Does not involve elements that evoke curiosity or the desire to experiment with narcotic drugs (detailed positive descriptions of euphoria etc), but clearly indicates the negative, harmful consequences of drug abuse | and emphasizes the positive effects of alternative activities and a life style 1 free from narcotic drugs and psychotropic substances; and Does not contain details which might make access to illicit drugs easy, such as detailed descriptions of methods and routes of illicit traffic of narcotic drugs, places of origin of illicit production, non-medical uses' of narcotic drugs etc." CMO pg 18 (UN 1987). Other Avenues of Preventive Education Most aspects of human activities and settings offer an opportunity for preventive education. The workplace provides a unique situation to emphasize the harmful effects of drugs and alcohol such as loss of productivity, low efficiency, increased accidents, possible loss of livelihood and the like. Non-governmental organizations, civic groups and religious organizations can be powerful agents for change. They need effective co-ordination to ensure consistency with the overall national approach. The community and relevant national agencies should promote community recreational and cultural activities that provide alternatives to drug abuse. Hialthy recreation and sports can contribute immensely to improving social adaptation, sense of responsibility and enhanced self-esteem. The mass media are powerful agents of information and change in the "community. Again quoting from the CMO (UN 1987):

"The mass media reach a vast audience every day. While the media's potential contribution to the campaign for preventing drug abuse is enor mous, their publications and broadcasts can also be damaging and counter productive. The use of inaccurate or misleading terminology regarding narcotic drugs and psychotropic substances and their properties, such as the artificial distinction between 'hard' and 'soft' drugs, the advocacy of legalization of the non-medical use of drugs, the glamorizing of drug abuse songs, movies, and other commercial products, the emphasis given reports of street value of seizures to the enormous profits to be made from the illicit

1. Eliany, M and Rush, B (1992) How Effective are Alcohol and other Drug Preventionand Treatm ent Program review of Evaluation Studies. A Canada's A s? Drug Strategy Baseline Report. Health and W elfare Canada, January 1992.
2. UN(1987). ThecomprehensiveMulti-disciplinaryOulineofPreventionofIllicit traffic of Narcotics and Psychotropic Substanses and Drug abuse International Conference on Drug Abuse and Illicit Trafficking, Vienna, fune 1987.

3. U N ESC O (1987) Educating A gainst D rugUA buse. ations Educational, and Cultural Organization. nited N Scientific

Drug Abuse Prevention Programmes
piiko Nikander and Joseph Mbatia

Demand reduction
Unless demand for drugs in the community is diminished, supply reduction efforts can never be completely successful. Pressure must be brought to bear, not only where the drug abuse chain starts-with the cultivators, processors and traffickers, but also where it ends- with the drug abuser. According to the International Narcotic Control Board (INCB), "too little is known about the actual extent of drug abuse, patterns of abuse and shifts in such patterns. Periodic epidemiological surveys are essential to devising effective demand-reduction programmes targeted at high risk populations" They are also essential in determining how well existing demand reduction programs are working. Public awareness is critical to the success of demand reduction programmes. Its purpose is to make the public understand the dangers of drug abuse and to mobilize public participation in the war against drugs. Preventive education campaigns can be quite effective in creating a climate which discourages drug use. Since 1990 Tanzania has been the scene of a massive public awareness campaign focusing on the effects of drug abuse on the individual, families, public health and the economy. Before 1980, illicit drug use in the country was insignificant and no one would have anticipated the current level of drug abuse. In recent years drug abuse has become an important sociopolitical issue, partly as a result of active preventive education against drug abuse campaigns. One effect of a successful public awareness program is to encourage people to take direct action against the problem. Although it is important that the government be committed to addressing the problem, government can have the most far-reaching effect if through the "Drug Abuse Control Commission" government institutions, NGO'S and religious groups involved in antidrugs campaigns are well coordinated. Common ingredients of successful prevention programmes According to Marin and Colen 1971 and ICAA 1988, prevention programs have a greater like lihood of success if they:
Have a clear goal of no use of illegal drugs.
Treat young people as individuals and address their individual needs.

Provide information that is factual and credible. Recognize cultural differences and tailor their strategies accordingly. _ Teach young people to be responsible

for their actions. Are led by dedicated men and women who have the capacity to be both tough and compassionate. Most experts in demand reduction field agree that with drug education we should try to create an atmosphere in which youngsters are convinced that there are more interesting substitutes in life. In our opinion the educators need to be aware of the following points to create such an atmosphere. 1. Drug information should not be based on feelings or emotions. It should be factual. 2. Outside lecturers often give a feeling that there is something interesting in the drugs, something that their own teachers can't tell. Perhaps their own teachers should be the ones giving the drug information. 3. Drug information should not be authoritative or forbidding because risk taking is common in young people. 4. To mention about risks surrounding drugs use is nonsense because adolescents want to take risks any way. 5. one them. Emphasis gets should from not them. be To on talk how about , to use these specific drugs will encourage and the youngsters to pleasure try

6. The cured addicts should not be invited to schools because it gives a picture that drug addiction is easily won. 7. There should not bea lot of lectured facts and then leaving the youngsters to decide by themselves on whether to use or not to use drugs. 8. Drugs should not be given much importance with regard to desired effects. Instead they should be played down and all the positive substitutes should be promoted and advocated. The more neutral thejfffojrrjaHnn ig ^p less interest therejvjUJ2earrjQng.th£._ youngsters. Drugs should be mentioned' as a dull substitute for the really nice things in life.

Information is not prevention It is easy to give facts about drugs by information. However it is difficult to influence individual attitudes towards drugs by information alone. There is no evidence of any successful information programme in the world which can be recommended as effective in prevention of drug abuse. A campaign against drug abuse can act as an advertisement for drugs, especially campaigns which are emotional because they often make the problem worse rather than prevent it. What is better than information is providing activities which assist youngsters to develop their own in terests and giving opportunities in which youngsters can improve their own potential and feel a sense of achievement. Developing all kinds of creative activities is the best prevention of drug abuse. AU the hobbies and activities in which youngsters can feel needed in a social environment are important in prevention. Some social aspects of prevention There are two ways: To reduce availability and to reduce the need to use drugs. Reduction of availability may blf more or TwtTaTTTpes of clrugs are " used than the amount used. This depends mainly on law enforcement bodies. Demand reduction on the other hand involves many social agen cies. More effective prevention information may be that which takes into account personal facts and relationship problems than information about drugs. A holistic approach is thought to be more effective in reducing the need to use drugs. Although drug information is not effective in prevention, it still must be given, together with comprehesive social competence strategies. can be treated like just another_rjroblem in adolescent life. Preventive work at its best is connected with whatever work or activities already being done by youngsters. It should be part of the environment in which the youngsters already are.
It is important to find out how many youngsters belong to high risk groups, especially youngsters who have been abused by adults when very young and who have

failed to experience adult help. Also important is how the psychological and social well-being of these youngsters is being taken care of. It is more effective to offer these youngsters good psychosocial environments and services.

Drug prevention in school
Schools can do a lot by providing youngsters with opportunities to develoj "their social participation and their personal potentials. When doing thi schools are indirectly doing good drug prevention. It is easy to talk abom drugs while integrating with existing school subjects such as healtl education, culture, social science and psychology. The teachers opinion i{ very important to their students, so much that teachers must recognizs everybody even when meeting outside the school or on the way to school. It gives the youngsters a feeling of importance. In school it is not important to seek out the users or the abusers; to look for drug abuse symptoms or talk about who is in trouble because of drugs. In school it is more helpful and constructive:- To be ready for discussions. -,^To be factual and neutral when discussing drug abuse. - To avoid outhoritarian relationships. - ,To try to understand both causes and consequences of problems and fo treat them accordingly.

The Abuser .Studies which have looked at life styles of y oungdrug abusers show that the abuser is lonely even in school. He or she needs caretaking, however Tnot only for the drugs, but all areas of his/her functioning.
As a teacher you should not: \ Pity him/her, because it will isolate him/her even more. Treat him/her differently, because he/she already feels different. Think he/she is worse than the others, because he/she already feels worse. Think he/she is infectious, because this leads,,to alienation-despair. The identified abuser needs: J Contacts even if he tries to avoid them. A lot of timejo solve jyoblems in a supportive environment. Safe surroundings; school can be it, especially when it is unsafe at home. _ Factual and realistic answers to scaring questions. Help to seek caretaking by identifying available resources in his local community. Management of free time One of the established causes of deviant behaviour in the young is poor management of free time. Therefore any type of work which helps youngsters to grow into well balanced adults is an important component of prevention against drug abuse. Drug information is only a small portion of drug abuse prevention which has to be complemented with coordinated social growlth programmes. Preventive work should not be isolated from the usual activities of the youngster; it should be part of them. It should be connected to the life and environment known by the youngster. It is important to try to draw youngsters who are isolated and alone together %ith the better adjusted youngsters during free time activities. This may improve self esteem and provide a chance for social learning through the



Those who are working with drug prevention should try to influence decision makers to create environments and atmospheres in which all the youngsters feel at home. In such groups the following can be discussed:- drunkenness and intoxication

_ the factors that influence the feeling of intoxication the use of drugs _ the harmful effects of drugs drug abuse the health risks of drugs

Government responsibilityV National policy makers should be sensitive to the problem and needs for programme changes and should support adaptations and innovations in demand reduction (ICAA-1988), To facilitate and stimulate these, the National Drug Abuse control Commission in Tanzania should ensure periodic review of the drugs problem and of existing programmes of demand reduction. The commission should encourage adaptation and innovation through guaranteeing the continued availability of resources to the programmes whether material, personnel or in financial form.
Procedures should be developed to assist programme managers and service providers (e.g. Ministry of health) to identify and analyze adaptations and to assess how the process of adaptation, based on continuous feedback, may be used io improve programmes and services. National data retrieval and referral centres should be

established to provide such assistance. National and local training programes based on materials produced nationally and internationally should be utilized to improve awareness and the capacity to adapt programmes in accordance with changing needs. All demand reduction programems are affected by interaction with other programmes, disciplines and particular factors in any given locality. This interaction can provide strength to support needed change, but it can also cause conflicts, thus minimizing effective use of limited resources. The commission should foster cooperative approaches between demand reduction programmes including wide involvement between different specialists and concerned persons to aid adaptation and the implementation of new ideas within a coordinated demand reduction strategy. Similarly law enforcers should cooperate responsibly not only in their supply reduction endeavors, but also link well with demand reduction programmes.

1. Alcohol and Alcoholism: (1979) The Report of a Special Committee of the Royal College of Psychiatrist. The Free Pros-Macmillian Publishing Co. Inc. New York. 2. INCB-U983) Report of the International Narcotic Control Board for 1983 - United Nations -New York. E//NCB/1983/1 • 3. International Council on Alcohol and Addictions: (1988) Project report. Demand Reduction Practice - A worldwide review of innovative approaches related to the reduction of demand for dependence producing drugs. Problems of Drug Education. 4. Marin, P., and Cohen, A.Y. (1971) Understanding Drug Abuse and Adult's. Guide to Drugs and The Young. Harper and Row, Publishers New . York. 5. Victor F. Lief: (1972) Drug Abuse: Models of Treatment and their Consequences. Drug Abuse and Social Issues. 2nd Int. Symp., ]erusalem,: P.7-21. 6. WHO (1987). Adverse Health Consequences of Cocaine Abuse. Publications of WHO, Geneva.


7. Willoughby D: (1988) Cocaine, Opium, Marijuana: Global Problem, Global Response. U.S. Information Agency.

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