Funded by: www.sbirtonline.org J. Paul Seale, M.D. Professor & Director of Research Department of Family Medicine Navicent Health & Mercer University School of Medicine Macon, Georgia, USA Setting a Substance Abuse Research Agenda for South Africa: Lessons from the United States and Globally 1
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Funded by: J. Paul Seale, M.D. Professor & Director of Research Department of Family Medicine Navicent Health & Mercer University School.
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Funded by: www.sbirtonline.org
J. Paul Seale, M.D.Professor & Director of Research
Department of Family MedicineNavicent Health &
Mercer University School of Medicine
Macon, Georgia, USA
Setting a Substance Abuse Research Agenda for South Africa:
Lessons from the United States and Globally
1
ObjectivesProvide a global overview of substance abuse and its
impact on multiple sectors of societyDiscuss the importance of gathering epidemiologic
data from multiple sourcesShare lessons learned about substance abuse in
other societies in transitionDescribe examples of prevention & early intervention
programs whichEmploy innovative strategies for reaching oral learnersLink with faith-based organizations to expand servicesOffer culturally-grounded interventionsUtilize schools & clinics as venues for prevention effortsUse values-based education to decrease unhealthy
Shift from developed to developing countriesHigh population growthYounger populationRapid urbanizationIncreasing gender equalityGlobalization of illicit drug economy
“…countries with economies in transition and developing countries have become increasingly affected by illicit drug use, as they have experienced a range of socioeconomic changes. In absolute numbers, there are almost twice as many illicit drug users in [these] countries…”
To bring the power of science to bear on drug abuse and addiction
To reduce the burden of drug abuse and addiction and the related consequences for individuals and society at largeSupport and conduct research across a
broad range of disciplinesEnsure the rapid and effective dissemination
and use of research results to improve practice and inform policy
NIDA’s Drug Abuse Mission To change people’s
perceptions, replacing stigma and shame with a new understanding of addiction as a treatable disease
http://www.hbo.com/addiction/thefilm/supplemental/6212_what_is_addiction.html Southeastern Consortium for Substance Abuse
Neurobiology of addiction has been elucidated—decrease stigma and increase support for prevention, treatment and research by increasing understanding of addiction as a disease
Important role of genetics—contributes 50% of the risk of addiction
Vulnerability of the adolescent brain--risk of addiction increases with early use of alcohol, tobacco or other drugs during adolescence
1. Prevention: Prevent the initiation of drug use and the escalation to addiction in those who have already initiated use2. Treatment: To develop successful treatments for drug abuse and addiction and improve treatment accessibility and implementation.3. HIV/AIDS: To diminish the spread of drug abuse-related HIV and minimize the associated health and social consequences, including AIDS
Interviewed 390 patients in NYC indigent clinic Prevalence of drug abuse: 28%
21% illicit drugs12% prescription drugs
108 reported drug use via interviews/ACASI system18 patients had positive saliva samples (16% of users)
8 reported drug use to interviewer doing diagnostic interview12 reported drug use to computer (ACASI system)6 patients were detected only by saliva testing, so that actual
prevalence=29.2%, not 27.7%—WORTH THE COST?
McNeely et al, 2014
Alcohol and Drug Issues in Traditional Cultures in Transition
Role of alcohol/drugs in developing societies
Impact of life transitions (e.g., going to the city for education, moving to urban areas, dramatic social change) on risk of substance use
Important role of social pressure, especially in traditional societies, in perpetuating problem substance use
Focus Groups: Traditional Drinking Patterns Before significant contact with White culture,
production of alcohol was carefully controlled3 or 4 times a year, on special occasions, made
by an individual with the secret knowledge of how to brew
Hollow out a dugout canoe, fill it with corn mash, cause it to ferment, then call people from the whole surrounding area to come to a celebrationMen: bring bows & arrows, drink and fight to see who
was the strongestWomen: drink and dance until they fell down intoxicated@2-3 days, alcohol ran out, & all went home
Some found they were no longer able to stop, once they started drinking
Drinking became integrated into their way of life, and those who wanted to stop were not allowed to
OUR REALIZATION: NONE OF THE TRADITIONAL U.S. APPROACHES WERE RELEVANT—no funds to set up treatment centers, and self-help groups depended heavily on written materials, for this society where most were illiterate