Prevention methods are applied in different areas and in this blog some topics and programs in primary and secondary prevention will be described. We begin this section with a list of important trends in the anti-drug movement:
the tendency to include the family (especially parents) in the anti-drug movement;
developing the ability to resist, in particular the development of strategies used to avoid pressure to use the drug;
program development in addition to broader social movements. For example, an anti-drug school curriculum may be complementary to messages disseminated through the media;
identification of social groups prone to alcohol and other drugs and the development of programs specifically for them;
increased attention to drugs, the use of which is a direct way to the use of other drugs. While most programs struggle with illicit drugs, some programs focus their attention on preventing the onset of the use of tobacco, alcohol and, in particular, marijuana. They are regarded as “intermediate” narcotic drugs, from which they shift to the use of “hard” drugs, such as cocaine, heroin and LSD;
increasing attention to programs designed to minimize the risk and negative consequences of already started drug use. These programs do not allow the use of drugs, but seek opportunities to minimize the negative consequences associated with their use, for the person and for society.
Prevention methods are applied in different areas and in this blog some topics and programs in primary and secondary prevention will be described. We begin this section with a list of important trends in the anti-drug movement:
The most common anti-drug tools in the United States have become the education and efforts of the media. Traditionally, these programs are designed for adolescents and young people – the two most obvious risk groups. Recently, efforts have been made to extend their influence to children.
The school system is the ideal link for educational work regarding substance use. In fact, many states today require the inclusion of alcohol and other drugs in the school year, although state laws, unfortunately, have not been systematized and translated into accessible instructional programs. Moreover, in the past, the use of such programs has been hampered by the inadequate training of teachers in materials related to alcohol and other drugs. However, in recent years there have been many changes and school programs are becoming increasingly systematized. What happens when courses in alcohol and drugs are introduced? The results are different. The main result is that the general level of knowledge about alcohol and drugs has increased. However, there were no noticeable changes in substance use. In fact, in some cases, it was found that the educational program in the short term increased the use of drugs by students! One way or another, one should be wary of this data until more systematic studies are conducted on the effects of educational programs, especially studies on the long-term aspects of their influence. Although the expansion of knowledge about alcohol and drugs should not be seen only as a way to modify their use.
One of the factors that influences this development of cases is the age at which the study of drugs begins. As a result of data showing that young children have already begun to form their own concepts about intoxication, drinking culture and the consequences of alcoholism, more attention has been paid to educational materials for primary school children. Preparing materials for this level of development is more likely to be more effective than attempts to change more well-established ideas about drugs in high school. As an example of this, consider the attitude to smoking. When scientists wanted to determine the best age for the introduction of anti-smoking programs, they examined 500 students in 6th, 9th, and 12th grades in Massachusetts. The results showed that the greatest effect was in the 6th grades. The researchers had several reasons for this conclusion. The first of them is that only 6.5% of students in the 6th grade described themselves as random or regular smokers, the same was done in the 9th – 21% or in the 12th – 32%. Pupils of the 6th grades also showed less pressure to smoke from their peers than pupils of the 9th and 12th grades, less knowledge about tobacco and the consequences of its use and less awareness about the attitude to tobacco of their parents. In addition to this, many students said they were going to start smoking in the next five years. Thus, training in anti-smoking programs should give the most positive effect in this group of students.
Has to do with the above written and the growing role of parents, who should be models for their children. According to Du Ponto, Director of the National Institute for Combating Drugs: “Interestingly, after a decade of research on the role of parents that we performed, we are rediscovering today that parents, whom we considered ignorant at best and“ problem ”at worst, today They are “a solution to the drug problem.” Although this statement can be considered exaggeration, parents are still an important — and perhaps decisive — element in the prevention of drug use. The decade originates in the premise that the problem of drug use is a family problem. Programs focusing on the contribution of parents try to increase the role of family discussions of alcohol and drug problems so that parents can become a model for children by teaching them not to use narcotic drugs at all or Responsibly approach the use of acceptable drugs, such as alcohol.The meaning of one of these programs, called “The Power of Proper Education”, is to make parents aware of how deep ie the impact of having children on their behavior. Children, especially in the preschool period, directly copy the behavior of their parents when they are looking for a pattern suitable for the situation. The goal of the program is for parents to understand the ways in which they influence their children with regard to drug use and to help parents determine what constitutes “responsible behavior”, for example, in terms of drinking culture.
Educational programs are complemented by the media, i.e. through television, radio, newspapers, magazines, films and specials Printed materials intended for wide distribution, although television and radio are most often used for this purpose. Since media campaigns often consist of repetition of relatively brief messages (for example, 15-second TV spots), the creators of these campaigns usually use a single slogan that combines different material. Examples of the mottos of some modern campaigns are “Just Say No” for drugs and “Know When To Stop Enough”, “Friends Do Not Allow Friends To Drive In Drunk,” for alcohol. Most modern anti-alcohol campaigns are aimed at reducing drunk driving. It is not yet clear how effective such campaigns are, but it is clear that these programs contribute to the dissemination of knowledge about drugs in society. It should be especially noted that the campaigns to prevent drunk driving significantly raised the level of knowledge (for example, knowledge of the legislative definition of intoxication). But just as with other approaches, the attitude changes much less. One way or another, there is no direct evidence that as a result of media campaigns, there have been significant changes in the use of alcohol and drugs. Such an approach may be more successful in affecting specific groups of drug users. The use of education and the media still consumes the main resources for prevention. Their success is manifested mainly in the field of knowledge and to a lesser extent in changing attitudes. Their effectiveness increases as a result of improving the quality of production of advertising appeals, as well as efforts that direct these campaigns to specific social groups. And, of course, more effort needs to be made to increase the likelihood that these approaches will ultimately lead to real changes in drug use.
Many modern programs, especially those that are conducted among young people, contain the so-called emotional component. It involves clarifying values and making decisions. The clarification of values includes self-knowledge, the development of life values and the definition of ways to implement them. These programs reveal to the student a strategy that allows them to make choices in life and apply this technique specifically to situations with alcohol and other drugs. The main objective of the program is that students should be aware of their feelings about drugs and develop their attitude towards them in order to behave in accordance with their individual values in drug-related situations.
The logic of applying an emotional or sensual approach is that thoughts, feelings, attitudes, and values relating to alcohol and other drugs may be as important in a particular situation as knowledge, and may even be the most important. It is still unknown to what extent these programs have a beneficial effect. As in the case of educational programs, no serious research has been done on the effects of such programs. Nevertheless, those studies that were nevertheless carried out showed that the influence of the programs helps to clarify personal views on the use of drugs. Popular in the 1970s and 1980s, these programs are less frequently used today, although some of their elements are incorporated into modern programs in modified form.
Alternative behavior and artwork resist
In recent years, the number of prevention programs that have been focused on developing alternatives to drug use and the ability to recognize and resist pressure forcing them has increased significantly.
The development of alternatives to drug use refers to engaging in various productive activities (for example, sports, various hobby groups, vacations). In theory, this strategy seems reasonable, but in practice it has not shown concrete benefits in relation to substance abuse.
On the other hand, resistance training seems more promising. This training includes a combination of the following informational and behavioral strategies:
Development of the ability to solve problems and make decisions;
Development of the ability to recognize interpersonal and mass (advertising of alcohol and cigarettes) forms of agitation, as well as the ability to resist them;
Increase self-awareness and self-esteem;
Learning the art of coping with anxiety and stress without the use of drugs;
Improving interpersonal qualities, such as the ability to start a conversation;
The development of hardness, ability to express displeasure and anger, as well as the ability to communicate their needs;
Development of an understanding of the effects of drugs on health;Usually in these programs, participants are taught to recognize the social impact that leads to the use of drugs, and also to resist these influences. For example, they are taught to refuse offers to try a drug when it comes from peers. Often programs include the ability to resist the influence of leaders in a group. Analyzing the results of the development of the ability to resist, note positive changes, especially in relation to smoking.
One of the most famous, resistance-oriented programs currently used in America is the DARE Project (Resistance Training in Drug Use). The DARE Project is designed for fifth and sixth graders before they go to high school. The program is based on the premise that schoolchildren need to be taught to recognize the dangers of substance use and to resist indirect and direct coercion to use drugs. In the same way, the program teaches students to recognize and resist peer suggestions and others to experiment with drugs. The program includes from 15 to 20 modules, each of which is conducted by a representative of the official authorities and lasts 45-60 minutes. The modules are devoted to such topics: the art of refusing, risk assessment, decision making, interpersonal skills and the art of communication, critical thinking, alternatives to drug use. The DARE program has achieved positive results in refusing art to schoolchildren, although there are still no data on the long-term impact of these projects on drug use.
Harm reduction social policy
“We are talking about a high degree of risk for young people and families in the United States, but I don’t know of a single continent that would not be in danger of drug and alcohol abuse or a country not affected by them. Young people are at risk around the world, families are at risk all over the world. All communities and institutions of humanity are at risk all over the world, nations in danger. ”
Dr. Benson Bateman, President of the Organization for the Development of Human Resources, The Journal, May 1993
Countries vary greatly in their social policies regarding drug use. Much has been said in this book about the “war against drugs” and the policy of “zero tolerance” in the United States. This policy is opposed to another social strategy called “harm reduction”, used, for example, in England and the Netherlands. The harm reduction policy focuses on minimizing the negative effects of drug use on individuals and society, even if it temporarily supports safe drug use. According to Diana Reli, who heads the Canadian Substance Abuse Center, “Harm reduction builds a hierarchy of goals, outlining the most vital and realistic that should be achieved in the first steps towards safe use or abstinence. This is a pragmatic approach that reveals that abstinence cannot not be a real, not desirable goal for some, especially in the short term. ”
She described two examples of harm reduction policies. The first is Merseyside in England. Pharmacists and police collaborate in Merseyside clinics, who have introduced “a rational approach, including prescribing drugs, providing clean syringes and facilitating, rather than criminalizing, drug addicts.” The advantages of such cooperation include the low incidence of HIV infection among drug addicts, the preservation of jobs for many drug addicts, the reduction of thefts and robberies.
The second example is Amsterdam, where they tried to reduce the harm from drug use by providing medical and social assistance to drug addicts. Part of this strategy was reducing police attention to the possession and use of marijuana and mobile stations distributing methadone. Prison sentences threaten only distributors of “hard” drugs.
So far, this policy has not been adopted in the United States as a whole, but its individual elements are being applied. For example, in the 1960s, supporting methadone programs were introduced throughout the country. They were intended to partially reduce crime among heroin users. Secondly, a syringe exchange program was recently introduced, designed to reduce the risk of the spread of HIV among drug users. However, both of these programs have their violent opponents. Recently, a syringe exchange program has been subjected to fierce attacks, contrary to scientific research, indicating that drug addicts participating in these programs did not use drugs more often, and also that the number of drug addicts did not increase. However, harm reduction approaches are not likely to become more widespread in the near future.
How can osteochondrosis and abdominal pain be associated? The fact is that the nerve supply of the organs located in the thoracic and abdominal cavities is provided by nerves connected with the thoracic spine. For this reason, arising from osteochondrosis in the abdomen, stomach, pancreas, liver, lung pain, it is sometimes very difficult to differentiate from the pains accompanying the true pathologies of these organs.
pains in the stomach
Consequences of infringement of spinal roots can be very serious: in the zone of innervation the vessels are affected, there is a spasm, irritation of the nerve or its paralysis. For example, in the stomach often there are drawing pains. They gradually intensify, heartburn develops, digestion of food is disrupted. Such patients are often mistakenly treated for gastritis, while it is necessary to correct the spinal column in the area of 5-7 thoracic vertebrae. A prolonged course of the disease can lead to the formation of ulcers.
In osteochondrosis, abdominal pains are often nagging, cutting. They can be shingles, poured or localized in the stomach, pancreas, right hypochondrium, in the lower abdomen (right or left).
If the mid-thoracic roots are affected, the pain in the stomach is intensified when moving in the thoracic spine.
When the pathological process is localized in the 8th and 9th roots, the pain sensations are localized in the area of the duodenum and show a tendency to increase with coughing, sneezing, bends, inclinations, and prolonged sitting.
The defeat of the right 7, 8, 9 of the thoracic roots leads to the development of symptoms of cholecystitis: the pain is felt in the right hypochondrium and also increases with movement.
Thoracic and cervical osteochondrosis can provoke both abdominal pains, and diarrhea, constipation, gas formation, intestinal motility disorders.
In the late stages of lumbar osteochondrosis, back pain often radiates to different parts of the lower extremities: gluteal region, thigh, and shin. Sensations are of a different nature, often imitating other pathologies of the nervous and vascular systems of the legs.
Pain in the legs with late osteochondrosis
Because of severe pain, patients often stop – so-called intermittent claudication develops. The clinic of this condition resembles the endarteritis of the vessels of the lower extremities. Differential diagnostics using Doppler study of blood vessels allows to determine the true cause of the pathological condition.
With the formed intervertebral hernia in the lumbar region, the calf muscle syndrome manifests itself. It is characterized by the appearance of severe severe pain in calves, sometimes accompanied by tonic convulsions. Pain sensations can also be trailing, aching. In this case, there is a need for differentiation from chronic venous insufficiency. The difference is the absence of swelling of the legs and the severity of the veins in lumbar osteochondrosis.
When the spine L III is injured, patients can feel chill and cold in the area of the foot, shin. When these symptoms appear, differential diagnosis is performed with a spasm of the arteries of the legs of different origin.
Often the pains associated with osteochondrosis extend to the foot, accompanied by paresthesia, weakening of reflexes, partial or total loss of sensitivity. A similar clinic arises with diabetic peripheral polyneuropathy. In the case of osteochondrosis, the infringement of the nerve root leads to paresthesias propagating in one leg innervated by this spine. With polyneuropathy both limbs are affected.
Back pain is characteristic for osteochondrosis with localization in the lumbar spine.
The loin can hurt due to limited mobility
At the initial stage, patients feel only discomfort, which occurs mainly with prolonged sitting, sudden movements, slopes, after intense physical exertion. However, the disease progresses, and the pain becomes more intense and prolonged.
Back pain is often accompanied by the following symptoms:
restriction of mobility of the affected area of the back;
spasms of lumbar muscles;
pain in the sacrum, buttocks;
a feeling of tingling, numbness, weakness;
pain in the legs;
violation of the functions of the pelvic organs.
With some types of movements (slopes, lifting, twisting of the trunk), painful sensations become much stronger. Many patients feel relieved when walking. Static postures (standing, sitting) leads to increased pain. Deterioration of the condition can be provoked even by coughing and sneezing. In the supine position, the load on the discs is reduced, so that the pain softens.
With osteochondrosis in the cervical, thoracic or lumbar regions, chronically painful sensations occur in the back area, alternating with episodes of severe pain. Experts believe that the aggravation is provoked by disturbances of micro-movements in the intervertebral discs, which trigger an inflammatory response. To stabilize the spine and reduce micromovements, there is a muscle spasm that blocks a certain segment. Spasms lead to acute pain and a sharp limitation of mobility.
Severe pain can last several hours, days or even months. In contrast to chronic, duration and intensity of which do not depend on the degree of tissue damage, acute pain clearly correlates with the degree of damage occurring, since it is a protective reaction of the body to limit mobility in the affected segment and reduce the degree of compression of the nerve roots.
With osteochondrosis of the cervical region, pain in the hands is quite common. The nature of pain can vary depending on the specific localization of the lesion and the degree of compression of the nerve. They can be blunt, sharp, cutting, shooting. When coughing, straining, bending and tilting the head, the pain syndrome becomes worse.
C6 root injury provokes pain in the arm, extending over the outer surface of the shoulder from the forearm and the shoulder strap to the fingers (1 and 2). In the affected areas, sensitivity may increase (hyperesthesia), hypotrophy, contraction of the biceps brachialis reflexes.
If in the osteochondrosis the C7 spine is compressed, the pain spreads along the back and outer surface of the shoulder and forearm towards the 3-finger.
The defeat of the root of the spine leads to the spread of pain along the inner surface of the shoulder, the forearm to the 4 and 5 fingers.
Often simultaneously with pain in the hands of neurological symptoms: a feeling of numbness, tingling.
Pain can appear due to a deep breath
At the chest form of an osteochondrosis very often pains arise in a thorax. They can be long-lasting. Pain sensations are often shrouded, given under the shoulder blade and spread as intercostal neuralgia, which often makes diagnosis difficult. In the chest zone there is often a sensation of crawling. Pain in the chest can be given to the stomach, liver or heart. Despite the property of breast osteochondrosis to mask for other diseases, it can be “calculated” on the basis of several typical signs:
pains occur as a result of unsuccessful turn, sharp movement;
sensations become more intense with a deep inspiration-exhalation;
attempts to raise your hand lead to increased pain;
the slopes of the hull are difficult.
In the case of protrusion or hernia formation, the features of pain in the chest form of osteochondrosis are determined by the direction of the hernia.
With a lateral hernia pain sensations are localized at its level, are of a one-sided nature, local sensitivity loss is possible. The lateral hernia is accompanied by minimal symptomatology. Manifestations are reversible. Pain increases with movement, sneezing, coughing, and laughter.
The formation of the middle hernia leads to the appearance of longer, sometimes permanent pain sensations. The main risk is the probability of compression of the structures of the spinal cord.
Heart pain and asthmatic symptoms in the form of dyspnea often occur with osteochondrosis of the thoracic and cervical divisions. The examination does not reveal cardiac pathologies. Painful sensations can be quite long, without causing changes in the myocardium. Cardiac pains are a consequence of inflammation of the nerve roots innervating the organs located in the chest cavity. They have a number of differences from the true pains in the heart:
Pain syndrome can last from several weeks to several months.
The pain periodically intensifies (within 3-4 days), then again subsided.
They can not be stopped with the use of cardiac drugs.
Pain does not lead to anxiety, fear and does not pose a threat to life.
When the spine column is affected, the intensity of sensations increases.
The mechanisms of development of cardiac pain in osteochondrosis are as follows:
Violation of the innervation of the heart. In this case, pain sensations appear as a result of the spread of impulses to the center of sympathetic innervation of the cardiac muscle.
Reflex mechanism. Osteochondrosis leads to disruption of the innervation of the tissues of the shoulder girdle. As a result, receptors in these regions do not receive enough pulses and influence the innervation centers of the heart. From the side of the central nervous system, such impulses begin to be perceived as painful, which leads to the appearance of cardialgia.
With cervical osteochondrosis, pain sensations often irradiate into the throat area. Degeneration of intervertebral discs in the cervical region often leads to neurovegetative disorders. Since the neck serves as a support for the skull, it is responsible for the movement of the head. The inflammatory process in the nerve fibers provokes the pathological tension of the pharyngeal musculature. The result is the appearance of discomfort and pain in the throat. Since the intervertebral discs of the cervical region are characterized by lateral displacement, pinching of nerves, as a rule, is one-sided. This leads to the appearance of painful sensations mainly on one side.
Pain increases with swallowing, often resemble pain in angina.
Can be accompanied by a strong dry cough.
Patients also complain of a sharp soreness in the neck and an unpleasant sensation of a coma in the throat.
In later stages of osteochondrosis, sensations become permanent, intensified at night.
Although there is no objective interference with breathing and swallowing, patients are afraid to suffocate or choke with food. This leads to the development of neurasthenia, neurotic disorders, depression. Such conditions in turn increase pathological sensations. A kind of vicious circle is formed.