Ecstacy
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Transcript of Ecstacy
Behavioural Intervention: An Approach to the Ecstasy Problem
Foong Kin, Ph.D. &
Vemala Devi, M.Sc.
Centre for Drug Research, USM
Paper presented at the National Public Health Conference,
Ministry of Health, Kuala Lumpur, April 2001
Synthetic Drug Explosion(LSD, Amphetamines, Ecstasy, etc.)
• Begun in the mid 1980s
• Emergence of a new sub-culture: the rave phenomenon
• Illicit production,trafficking & consumption surpassed heroin
STIMULANT ABUSE
• Stimulants used to enhance vitality, improve mood and escape reality
• 2 groups of synthetic stimulants i.e. amphetamine group and ecstasy group
• Attractiveness of stimulants is their action on CNS
MDMA (Ecstasy) Abuse
• The love drug• European discotheques (mid-1980s)• Linked with explosion of dance music• Used by an elitist section of population
Source: National Narcotics Agency
Methamphetamine Abuse
Year N% of total
addicts identified
1997 255 0.70
1998 772 2.05
1999 774 2.19
2000 1,284 4.70
Source: National Narcotics Agency
Amphetamine Type Stimulants & Other Psychotropic Pills Abuse
Year N % of total addicts identified
1997 264 0.73
1998 264 0.70
1999 168 0.48
2000 612 1.76
ATS SEIZURES
Year Syabu (kg)
Ecstasy (#)
Psy. Pills (#)
2000 208.10 49,901 145,486
1999 5.41 55,975 329,265
1998 6.44 9,231 1,724,104
1997 2.09 40,990 1,356,989
Ecstasy… just the facts
• 3,4-MithileneDioxyMethAmphetamine (MDMA)
• Developed in 1914 by Merck• Historically used for anti-fatigue, anti-
depressant & appetite suppresant• Similar to the stimulant amphetamine and the
hallucinogenic mescaline – can produce stimulant and psychedelic effects
• Taken orally as tablet or capsule
PROFILE OF ABUSERS
• Teens and twenties• Often educated• Relatively privileged
social background• Recreational
purposes• Social context of
dance scene
Sought-after Effects• Energizing effects• Profoundly positive feelings• Empathy for others• Elimination of anxiety• Feeling of serenity/calmness • Enhancement of performance,
communication & sensual experience• Mild euphoric rush• Suppress need to eat, drink, or sleep
Short-term Side Effects
• Jaw tightening• Brief nausea• Sweating• A dry mouth and throat• A loss of appetite• Difficulty in coordinating body
These all lead to a user having weakened physical and mental conditions the next day after use.
Extensive use over several days can lead to anxiety, panic, confusion and insomnia
Potential Dangers/Health Risks
• Heat stroke due to dehydration• Increased heart rate and blood pressure• Suppression of the immune response• Psychiatric disturbances e.g. anxiety,
confusion, depression, paranoia, hallucination
• Brain damage• Severity of adverse reactions to synthetic
impurities
BRAIN SCAN
Sumber: National Institute on Drug Abuse, USA
Current Strategies to Curb the Spread
• Supply reduction (law enforcement, legislation)
• Demand reduction(prevention, education, treatment)
DRUG ABUSE PROGRAM CONTINUUM
PROGRAM TYPE:
Information
Initial Drug Experience
Education Alternatives Intervention Treatment Rehabilitation
Non-use of Drugs Experimental
Occasional or Frequent Use
Integral Part of Lifestyle
Drug Abuse
Recovery
Maintenance of Drug-free Lifestyle
Principles in Promoting Behaviour Change
• Understanding individual and environmental risk factors influencing behaviour, i.e. ecstasy abuse
• Identify important target groups for targeting behaviour change
• Application of theories from social communication, behaviour and psychological sciences to change behaviours
Risk Factors in Ecstasy Abuse Among Malaysian
Youths
• Little is known
• Lack systematic study
• Only anecdotal data available; mostly from law enforcement and medical practitioners
An Ecological Perspective: Levels of Influence in Ecstasy
Abuse
Intrapersonal Factors
Knowledge, attitudes, beliefs, and personality traits
Interpersonal Factors
Social influence of family, friends, peers
Institutional Factors
Rules, regulations, policies, and informal structures
Community Factors
Social networks and norms
Public Policy Local, state, federal policies and laws
Prevention Approaches
• Information dissemination/media campaigns
• Affective education• Alternatives• Resistance skills• Personal and social skills
training
Application of Theoretical Frameworks to Prevention
• Health Belief Model (Rosenstock, 1974)
• Social Learning Theory (Bandura, 1977)
• Problem Behaviour Theory (Jessor & Jessor, 1977)
Drug use is a socially learned, purposive and functional behaviour, and a result of the complex interplay of environmental and individual factors
Health Belief Model
Vulnerability
Benefits
Seriousness
Cues
Self-efficacy
No Barriers
Likelihood of taking health action
An individual is less likely to abuse ecstasy if:
• Perceives that he is susceptible to ecstasy-related problems
• Thinks that using ecstasy would result in serious consequences
• Sees immediate benefits of non-use• Perceives an absence of barriers to action• Know how to resist influence (has self-efficacy)• Is reminded/supported (media campaigns,
advice from others, etc.)
Social Learning Theory
Person
EnvironmentBehaviour
Social Learning Theory
Behaviour change is influenced by
1. Reciprocal determinism: person and environment continually interact change the environment to facilitate
behaviour change
2. Expectations about outcomes of behaviour motivate person to adopt new behaviour
by telling about benefits
Social Learning Theory
3. Behavioural capability: having knowledge and skills to perform a desired behaviour train the person with skills
4. Self-efficacy: confidence in one’s ability to successfully perform a specific action enhance confidence
5. Observational learning (modeling)
Problem Behaviour Theory
• Problem behaviour is a result of a complex interaction of:
– Personal factors (cognitions, attitudes and beliefs)
– Physiological and genetic factors
– Perceived environmental factors
• Drug use is perceived as functional, serving as a way to coping with:
– Boredom– Social anxiety– Rejection– Gaining admission to a peer
group
Problem Behaviour Theory (multilevel approach)
3 levels of analysis/behaviour change
–Level of behaviour–Level of personality–Level of environment
Health is enhanced by:
1. Weakening or eliminating behaviours that compromise health
2. Strengthening/introducing behaviours that enhance health
Personality Approaches
• Make adolescents realise the misperception to believe that benefits of drug use outweigh the risks
• Believe there are alternative ways of coping with anxiety, establishing effective interpersonal relationships or achieving any other desired goal
Environmental Approaches
1. Factors aimed at resisting or avoiding health-compromising behaviour
a. Reducing availability of ecstasyb. Media campaigns to discourage
usec. Social and policy sanctions for
drug-related activities
Environmental Approaches
2. Environmental supports for health-enhancing behaviours
a. Positive peer relations
b. Drug-free activities for adolescents
c. Health/fitness programmes
An Integrated Approach to Prevention
• Integrate 3 theories• Each theory suggests special areas of
emphasis• HBM – identify personally oriented goals for
intervention• SLT – teaching of appropriate skills
(Assertiveness, stress management, & interpersonal communication to resist environmental pressures)
• Problem behaviour theory– Person focused (skills building activities)– Environmentally focused
Ecstasy abuse prevention should:
1. Eliminate or at least reduce to the greatest extent possible environmental influences promoting or facilitating use
– Decrease availability of ecstasy• Through law enforcement (raids, urine
screening)• Having drug free night spots (“Drug Free
Discos”)– Dialogue, persuasion of club owners
and employees– City Council and police working
together
– Reduce visibility of negative ecstasy-using role models
– Increasing the visibility of attractive, high-status (non-ecstasy role models)
– Altering attitudes and social norms concerning acceptability of ecstasy use and abuse (laws, media campaigns)
2. Develop preventive intervention designed
– To reduce susceptibility/vulnerability to the various environmental factors promoting ecstasy use
– To reduce motivation to use ecstasy
Examples of Measures
• Teaching of specific skills designed to resist social influences to use ecstasy (techniques for resisting peer pressure)
• Making adolescents aware of sources of influence and skills to counter them
Examples of Measures
• Enhance self-esteem, perceived control, self-confidence, self-satisfaction, and assertiveness
• Teach life skills (decision-making, goal setting, social skills, assertiveness)
• Provide an array of general coping skills (anxiety reduction and problem solving)
Communication Programmes to Promote Behaviour Change
Objectives of programme:
– Inform
– Change attitudes
– Teach skills and specific steps on how to resist initiation of ecstasy use
Important Principles in Message Design
• Be relevant (youth input)• Personalise the message• Be specific to the different target
goups• Use emotional positive appeal• Be clear and simple• Be interesting
How to the Deliver Message?What Media and Channel?
• Choice dependent on characteristics of target groups and objectives of the message– e.g. general public (TV/newspapers)– Night spot goers (use distribution
methods close to the techno culture (posters, youth magazines, flyers, T-shirts, post cards, etc.)
– Peer education approach (mouth-to –mouth propaganda
– Ecstasy outreach workers
Effective Prevention Strategy
• Multiple components
• Uses programme providers and delivery channels that efficiently reach target population
• Provides ongoing intervention throughout the initiation of ecstasy use
3 Pronged Strategy
• Monitoring
• Control
• Targeted Prevention
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