Evidence and Practice in Drug Prevention
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Transcript of Evidence and Practice in Drug Prevention
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Evidence and Practice in Drug Prevention
Charli ErikssonProfessor in Public Health, Director
National Center for Child Health Promotion, Örebro University
www.ncff.nu
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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
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Ambition
• From belief
•
• to knowing
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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
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Key Concepts: Practice
AddictionAddiction
AddictionAddiction
Drug prevention, control and treatment
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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
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Mechanisms of harm
• Toxic and other biochemical effects of drugs
• Psychoactive actions resulting in intoxication
• Dependence
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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)
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Alcohol is not an ordinary commodity
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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
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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
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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
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To develop knowledge about alcohol and drug prevention
Success factors Barriers
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What is driving the development?
• Traditions?
• Values?
• Needs?
• Knowledge?
• Money?
• …..
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What governs the preventive policies?
Ideologicinspiration
Evidence
Changing situation
fromresearch
fromexperience
Commonsense
OldPolicy
Newpolicy
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Knowledge Needs
• Distribution in the Population
• Causal web – Determinants and Mechanisms
• Consequences for individual and society
• Interventions – methods for change
• Policy and Implementation
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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
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Challenges
• To do right things
= Making priorities
• To do things right
• = Having competence
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Knowledge
• Theoretical-scientific knowledge• = to know
• Practical-productive knowledge• = to be able
• Knowledge as practical wisedom
= to be wise
Making PRIORITIES
Having COMPETENCE
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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
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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
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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
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Evidence-based Practice
Best Best EvidenceEvidenceTarget Group
Preferences and Actions
Situation and Situation and CirumstancesCirumstances
ProfessionalProfessional ExpertiseExpertise
(Haynes et al, 2002)
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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
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For a global, evidence-informed policy
• International scope of problem• Need for comprehensive
knowledge• Focus on evidence• A public good perspective
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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.
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Challenged by the complexity of our dynamic reality
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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
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DEVELOP KNOWLEDGE
Evidence-process
CollectReview
Judge
SHARE KNOW- LEDGE
USE KNOW- LEDGE
PublishImplement
PlanDo
Evaluate
Research integrated
REFLECTION
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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
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Long-term drug prevention and control is possible
Thank you for your attention