STAGE 4. Selecting the theoretical approach

What steps should be completed?

Step 1: Select the theoretical approach or approaches on which the intervention will be based

PUBLIC HEALTH MODEL

What are its bases?

This model/approach considers that health is conditioned by the reciprocal relationship between three elements: the host, the agent and the environment. In the case of drug use, the agent is the substance and, by extension, the elements associated with it, such as those related to its marketing and form of presentation (packaging, inclusion or not of health warnings and information on the risks associated with substance use, etc.). The host is the person and, by extension, population groups defined by specific variables and exposure to risk factors and protection factors (socioeconomic status, education, age, sex, etc.). The environment is the social and physical context in which drug use occurs, including the family, friends, school, neighbourhood or community, and the normative, social and cultural context (price, regulations on sales, publicity, drug use in public places, etc.).

Based on the realisation that information itself is not enough to change behaviours, actions to influence the individual and their peer group employ a combination of information and developing personal and social competencies to increase individual resistance to drug  use through training in techniques to cope with social pressure to use drugs ("group pressure") and to protect individuals through actions such as drug education, developing drug-free environments or modifying forms of use to reduce the risks and damage associated with it.

Which determinants can be addressed?

Personal and contextual determinants: personal ones are those that affect the host, and contextual ones are orientated towards the agent and the environment. These include age of initiation of drug use, the prevalence of use, beliefs and attitudes towards drugs, social skills, regulation of drug use, accessibility and availability of substances, the price of substances on the market, and the morbidity and mortality associated with drug use.

Practical implications

When applied to drug addiction, this model/approach attempts to raise individual resistance to the agent (e.g., by training in how to resist "group pressure"), protect individuals against the agent (e.g., with drugs education), isolate the host from the agent (e.g., with regulatory measures to create tobacco-free spaces) or to modify the agent to reduce its harm (e.g., reduce the alcohol content of alcoholic beverages or use single-use syringes to prevent sharing with other people). The latter is the principle underpinning many harm- reduction programmes.

 

Reference:

Bukoski Wj. (1995). A Framework for Drug Abuse Prevention Research. In: C.G Leukefeld and Bukoski, eds. Drug Abuse Prevention

Intervention Research: Methodological Issues. Rockville: National Institute on Drug Abuse, pp. 11-31.