Preventing harmful substance use by supporting families.

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Preventing harmful substance use by supporting
families.
Professor John W. Toumbourou, PhD Chair in Health
Psychology, Deakin University VicHealth Senior
Research Fellow, Centre for Adolescent Health,
Murdoch Childrens Research Institute
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The National Drug Research Institute The
Centre for Adolescent Health
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Authors

• Wendy Loxley, John W. Toumbourou, Tim Stockwell,
  Ben Haines, Katie Scott, Celia Godfrey, Elizabeth
  Waters, George Patton, Richard Fordham, Dennis
  Gray, Jann Marshall, David Ryder, Sherry Saggers,
  Lena Sanci and Jo Williams
• With contributions by
• Susan Carruthers, Tanya Chikritzhs, Simon Lenton,
  Richard Midford, Pamela Snow and Catherine Spooner

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Toumbourou, J.W., Stockwell, T., Neighbours, C.,
Marlatt, G.A., Sturge, J., Rehm, J. (2007)
Interventions to reduce harm associated with
adolescent substance use. The Lancet, 369, 1391
-1401.
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Trends in youth alcohol and drug use
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Increased social marketing expenditure
Legislation smoke free spaces, sales to minors
White et al, (2004) National School Survey
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Secondary school illicit drug use - some
reductions

• Cannabis use
• (lifetime use 12-17 29 1999 to 25 2002)
• Other illicit use
• (lifetime use 12-17 13 1999 to 11 2002)

White et al, 2004 Schools survey
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National Drug Strategy Annual Report, 2005
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Why has illicit drug use reduced?

• effective policing / supply reduction
• employment
• generational cycles
• harm minimisation treatment
• prevention

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SOME EVIDENCEto link reductions in illicit drug
use to policy interventions
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alcohol
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GOOD EVIDENCE that harm minimisation policies
have reduced alcohol-related mortality
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National Alcohol Indicators Bulletin. 6
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the trends are not so clear for other
alcohol-related harms
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Some groups such as young people and young women
show particularly increased rates
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Age 15 - Females
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National Alcohol Indicators Bulletin. 7
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We are not monitoring developmental harm

• Female heavy alcohol use contributing to problems
  with infants children
• Early use increasing levels of dependence
• Mental health impacts (eg., self-harm)
• Brain impacts

Prevention Clearinghouse No. 13, 2004
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There is little political will to limit alcohol
availability
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Growth in liquor licenses Victoria
Turning Point - National Alcohol Strategy, 2006
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complex cause problems require integrated
solutions
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Reduced adolescent tobacco and alcohol use
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Reduced adolescent tobacco and alcohol use
Reduced adult tobacco and alcohol use and harm
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Reduced adolescent tobacco and alcohol use
Universal programs Regulation Taxation Enforcement
Education Family sensitive policies
Reduced adult tobacco and alcohol use and harm
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Targeted early intervention Maternal and parental
support infancy, pre-primary and primary school
Reduced adolescent tobacco and alcohol use
Universal programs Regulation Taxation Enforcement
Education Family sensitive policies
Population-level outcomes Reduced drug use, harm,
dependence, mental health problems and crime
Reduced adult tobacco and alcohol use and harm
Targeted and selective adult Interventions (all
drugs) Brief interventions, harm reduction
treatment and involvement of family
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harm reduction
demand reduction
supply reduction
setting
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Different Pathways
early life childhood
adolescence adulthood
Loxley et al, 2004
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what works?
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0 Limited investigation. ý Evidence is
contra-indicative. O Warrants further
research. Evidence for implementation.
Evidence for outcome effectiveness. Evide
nce for effective dissemination.
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??? High priority for implementation and
maintenance

• Tobacco taxation to create price disincentives
• Enforcement of passive smoking regulations
• Alcohol taxation hypothecation, wine excise
• Random Breath Testing visible, high rate
• Brief interventions for tobacco and alcohol
• Treatment Programs
• Needle and Syringe Programs
• Hepatitis B Vaccination

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early yearsprenatal to preschool
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0 Limited investigation. ý Evidence is
contra-indicative. O Warrants further
research. Evidence for implementation.
Evidence for outcome effectiveness. Eviden
ce for effective dissemination.
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Integrate early years and drug treatment
investments

• Parents in drug treatment should be
  systematically targeted for support.
• Support should be evidence-based and focus both
  on drug treatment and strategies to encourage
  healthy child development.

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primary school
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0 Limited investigation. ý Evidence is
contra-indicative. O Warrants further
research. Evidence for implementation.
Evidence for outcome effectiveness. Eviden
ce for effective dissemination.
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improving primary school social environments
substance use
school

• Schools and Families Educating Children
• Seattle Social Development Project
• Good Behaviour Game
• Linking the Interests of Parents and Teachers
• Child Development Project
• Fast Track
• Kids Matter

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secondary school
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0 Limited investigation. ý Evidence is
contra-indicative. O Warrants further
research. Evidence for implementation.
Evidence for outcome effectiveness. Eviden
ce for effective dissemination.
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improving secondary school social environments
substance use
school

• School Transitional Environment Program
• Olweus Anti-Bullying Program
• The Gatehouse Project
• School Drug Policy
• Health Promoting Schools

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There is a growing that to enhance development
across the lifespan
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we need to support families
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trends in families

• high rates of family breakdown family
  complexity
• work involvement (responsibilities, long hours)
  - family community impacts
• uneven economic advances (disadvantaged
  communities schools)
• higher fertility in disadvantaged groups
• increasing child abuse and neglect

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The Resilient Families program Advancing the
health of young Australians by improving early
secondary school environments
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The Resilient Families team John W. Toumbourou,
Alison ShorttConstance JenkinJohn Bamberg
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Resilient Families2004 to 2006
NHMRC Funded Randomised School Trial
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Aims

• Improve adolescent educational outcomes and
  reduce alcohol misuse
• Enhance school and family protective factors
• Increase family involvement in secondary school
• Reduce marginalised peer groups

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Resilient Families Program

• 10-week Student Curriculum
• Evening Parenting Adolescents Quiz
• 8-week PACE Parenting Groups
• Parent Education Handbooks
• Encouraging a community of parents

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The Evaluation

• 24 disadvantaged Catholic and Government
  secondary schools in metropolitan Melbourne were
  randomly assigned (62 of approached)
• 12 schools did the Resilient Families
  intervention and surveys
• 12 schools students were surveyed without
  intervention
• 2,300 Year 7 students (55) surveyed in 2004 and
  95 resurveyed annually in 2005 2006

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Baseline Findings - 2004

• In Year 7 the intervention versus control
  students were similar
• 33 reported prior alcohol use

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Year 2 - 2005

• In Year 8 intervention students showed overall
  advantages in family and school adjustment
  compared to those in the non-intervention schools
• Higher family attachment (OR 1.4)
• Improved school rewards
• Improved school attendance
• Increased anxiety

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Year 2 - 2005

• Students were doing even better in the 10 of
  families where the parents had attended the
  parent education activities
• Improved school grades
• Reduced bullying
• Improved social problem solving
• More adolescent-parent conflict

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Year 3 - 2006

• Database still being analysed
• Preliminary trend - The intervention reduced
  Year 9 alcohol use and misuse

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The future

• Reductions in harmful alcohol and drug use
• Community integration of program mix
• Families in primary schools
• Families in secondary schools
• Positive youth development
• Evidence-based

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