Evidence-based prevention of substance abuse in high school adolescents. The change of a perspective to protect and, at the same time, combat a stigma E. Atzori*, L. Costantino**, C. Medici***, D. Montanaro****, M.D. Montanaro*****, I. Ritacco** (*Clinical Psychologist, Psychotherapist; **Psychiatrist, Psychotherapist; ***Doctor specializing in psychiatry; ****Health Psychologist, Psychotherapist; *****High school teacher) Introduction Early efforts to prevent substance abuse usually rely on providing information and knowledge about negative effects of substances and the problems correlated to their consumption. Aware that an intervention program exclusively based on information dissemination about all problems related to substance abuse can only change attitudes but not behavior, we elaborated a program that includes primary prevention thought to target population before they have developed a disorder, and secondary prevention studied to target persons that have already developed a disorder, in a more comprehensive formative project, which stimulates adolescents to enhance a research about the human mind and human relationships. On the assumption that at the base of sensation seeking there is a loss of interpersonal, intrapsychic and physical sensitivity (M. Fagioli, 2010; E.Atzori, 2011) we included the meetings with students concerning substance abuse in a wide program of Education developing affective relationships* having the aim to sensitise human relationships and their specific and complex facets, using literature, poetry, arts and human sciences.
GRAPHICS 1) What definition would you give for the use of substances. Time 0
Blue The use means the intake of substances in minimum quantities in a time that can be long or short. Red The use means the controlled consumption of substances, you can stop or you can rarely use them Orange The use means an assumption that does not create any problem of health, social, legal or relationships. It is flexible, not mandatory and does not bind only to a specific object of gratification. The subject is able to completely manage the substance and its ability to change the psychic state.
Time 1
T
2) What definition would you give of substance abuse*. Time 0
Blue Abuse means the intake of substances in large quantities at the same time. Red Abuse leads to more frequent use that do not involve addiction Orange ABUSE is a pathological mode of relationship with the substance. It determines an impact on social behavior through the impairment of the functioning of the person in terms of social, emotional and work relationships, with the frequent risk of incurring legal problems.
Time 1
* The project took place during the academic year 2017/18 at the IIS "via Salvo d'Acquisto, 69" of Velletri (Rome). It has developed into two complementary parts: in addition to the issue of substance addiction, gender violence was discussed. The specific literary part concerned the theme of love and the female image in ancient, modern and contemporary literature (poets of the Sicilian School, G. Guinizzelli, G. Cavalcanti, Dante Alighieri, F. Petrarca, G. Boccaccio, E.T.A. Hoffmann, J. Saramago) to reflect with the teachers in the classroom, the psychological and cultural roots of gender violence that can lead to so-called "femicide". To deepen this last aspect the students read and then discussed with the author, helped by a psychiatrist, the novel “Cronaca di un delitto annunciato” [Chronicle of announced crime] by the journalist Adriana Pannitteri.
* The definition of “abuse” has disappeared in DSM-5. According with a largely shared approach, in this paper we mantain the term “abuse”, because it is considered empirically and clinically more valid. Cf. Frances A: Essentials of Psychiatric Diagnosis. Responding to the Challenge of DSM-5. The Guilford Press, New York 2013.
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Methods Given the peculiar connotations of this education and prevention program we decided to structure a multidisciplinary project involving teachers, artists and health professionals expert in Dual Disorder related problems. The questionnaire evaluated the effectiveness regarding the program in the change of beliefs and attitudes in 55 high school students aged 16-19. A first phase involved a survey, through a questionnaire with open answers, on beliefs and opinions related to the most recent epidemiological data on particular aspects: the difference between use, abuse and addiction of substances, reasons underlying the search for substances and the relationship between drug addiction and delinquency, legalization. From the analysis of the answers obtained, we have built a multiple-choice questionnaire in order to translate qualitative data into quantitative data, and to evaluate the change in beliefs and attitudes in relation to the identified issues, through the comparison between the results obtained before and after the programmed intervention. This program included the reading of the stories L’Uomo della sabbia [The Sand Man] by E.T.A. Hoffmann and Il racconto dell’isola sconosciuta [The tale of the unknown island] by Josè Saramago, followed by a meeting in the classroom with two specialists as a stimulus to a research on sensitivity and loss of sensitivity. Later the work included the reading of the book, with the literature and human sciences teachers and discussed Droga. Uso, abuso e dipendenza [Drugs. Use, abuse and addiction] which deals with the subject of substance research, through a multidisciplinary approach, with both scientific and artistic contributions, and which proposes a reading of the phenomenon related to psychological distress and loss of sensitivity in human relationships. The first administration of the questionnaire, which occurred after this phase, allowed us to collect data, in particular: the difference between use/abuse and addiction, the difference between delinquency and drug addiction. Subsequently the students met one of the authors of the book Droga. Uso, abuso e dipendenza, who is an experienced dual disorder psychoterapist. The meeting, lasting two hours, was a possibility to reflect, in which students and teachers were able to ask questions. The analysis of the preliminary results of the test enabled the doctor to direct her presentation, reflecting her long and consolidated clinical experience in a dual diagnosis ward, with the ability to respond to a multitude of demanding questions. The final phase involved retest.
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Results This pilot study demonstrated a significant change in attitudes and beliefs about substance consumption and related problems in students involved, as showed in the graphics. Sources Fagioli M., 2010. Unpublished raw data Atzori E., 2011, La questione della Doppia Diagnosi. Una ricerca sui fattori psichici alla base delle dipendenze patologiche. [The question of dual diagnosis: a research into psychic factors at the origins of addiction]. Il sogno della farfalla, 4, pp.53-74. Costantino L. (Ed.) (2017), Droga. Uso, abuso e dipendenza, [Drugs. Use, abuse and addiction] Napoli:Liguori Video-registration of the meeting available on www.collanadafniecloe.it Pannitteri A., (2017) Cronaca di un delitto annunciato, [Chronicle of announced crime] Roma: L’asino d’oro Aknowledgements Thanks to the teachers Giovanna Carbone and Roberta Chiominto and to the doctor Giovanni Del Missier, who took part in the realization of the project. Thanks also to Nicola Nunziata, who designed the meeting’s poster.
From the comparison of the data the change in the belief about the use of substances is considerable: at time 0 the students showed a clear confusion about the definition of use and the difference between use and abuse. Based on this and in the light of the results at time 1, it could be hypothesized that, with regard to attitudes, students who were habitual substance users, believed they were able to control their use of substances, but in reality it was abuse. 3)
What
definition
Time 0
would Time 1
you
give
for
addiction.
Blue For Addiction we intend to use substances in a certain quantity, always and without being able to do without them. Red Addiction means the point where you can not go back and you need a specific substance to move forward. Orange For Addiction we mean the situation in which the neurobiological changes occurred in the subject, following a repeated intake of a substance, obligate him to take it in order to not incur the biochemical imbalance that determines the abstinence crisis. The substance has become indispensable to maintain an altered neurobiological system in equilibrium.
4) What link can there be in your opinion between delinquency and use of drugs. (You can choose more than one answer) Time 0
Time 1
(Time 0) 69.08% - (Time1) 76.3% There is not always a link. Who steals, commits a crime or pushes drugs can also not use substances (Time 0) 4.7% - (Time1) 21.1% No links (Time 0) 39.5- (Time1) 18.4% The link is not obvious. Antisocial and delinquent behavior, when it occurs, can be determined by frequentation of drug-addicted environments and abstinence crises. (Time 0) 37.2- (Time1) 7.9% People to buy and obtain drugs begin to take illicit actions (Time 0) 4,7- (Time1) 0% Often who use drugs are delinquents
Regarding the question of stigma, the results of the test at time 0 already showed an ability to distinguish the people that commit a crime from the people that take substances, recognizing at the base of the two phenomena distinct motivations which are not always related to each other. The results at time 1 reinforced this aspect. Furthermore we also evaluate the possibility to develop, together with a secondary prevention, a tertiary prevention referred to individuals who already have an established disorder in an effort to prevent it from advancing to the point of disease. With this purpose we introduced to students the possibility to use an internet interactive blog specifically thought to integrate the strengths of school, community intervention and family, to develop more incisive approaches and contemporary combating the stigma in Dual Disorder patients. Moreover our blog has permitted a constant update about themes treated in the classroom and, through the option “Ask an expert” allows students and families to contact health professionals with a nickname, in order to establish a dialogue and lead to the treatment of an onset disorder if necessary. Conclusions These results encourage further preventive interventions based on this multidisciplinary approach.We expect to evaluate their effectiveness with longitudinal studies based on extensive research designs. Dr. Emanuela Atzori Correspondence: emanuela.atzori@tin.it; emanuela.atzori66@gmail.com Copyright © 2018
Journal of psychiatry and psychoterapy based on Human Birth Theory