Addiction is defined as a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works. These brain changes can be long lasting and can lead to much harmful, often self-destructive, behavior.
- failure to fulfill major role obligations;
- legal problems;
- social or interpersonal problems;
- dependence (addiction)
Any natural or manufactured substance—legal or illegal—that can alter the functioning of the brain and the body.
Hamilton made a dramatic shift this week towards prioritizing harm reduction as a strategy for dealing with drug abuse.
As part of that plan, the board of health approved plans to offer clean crack pipes, expand Hamilton’s opioid overdose-reversing naloxone program, as well as begin exploring the viability of local safe injection sites for intravenous drug users (pending budget debates).
But why is there such a need for those kinds of programs?
- City approves free crack pipes, moves towards safe injection site study
- Opioid overdose deaths nearly double, as Hamilton’s dead remembered
It’s because drug deaths are rising, the city says, while emergency room visits that are drug-related are higher in Hamilton than the rest of the province.
A harm reduction approach, the city says, saves lives, lowers disease rates and improves “public order” (ie: lowering the number of people shooting up in alleys and leaving needles behind).
The project’s aim is to target those youth in schools and in the community who are at a high risk of committing crimes related to drug and substance abuse. To date, the project has recruited 2,332 school-based youth and 203 community-based youth. Approximately 40% of these youth (1,024) had parental consent to participate in the evaluation. The following table provides a summary of the baseline rates (prior to treatment) of cocaine, marijuana, alcohol and cigarette use for youth participating in the evaluation.
|Type of Drug/Substance Use||Experimental Group Baseline Percentage||Comparison Group Baseline Percentage|
|CocaineHave you used cocaine at least 10 times in the last 30 days?What % of youth did not use cocaine within the last 30 days?||.6%99.4%||1.7%98.3%|
|MarijuanaHave you used marijuana at least 10 times in the last 30 days?What % of youth did not use marijuana within the last 30 days?||8%92%||15.3%84.7%|
|AlcoholDid you drink alcohol at least 10 times in the last 30 days?What % of youth did not drink any alcohol within the last 30 days?||29.2%70.8%||25.4%74.6%|
|CigarettesDid you smoke cigarettes at least 10 times in the last 30 days?What % of youth did not smoke any cigarettes within the last 30 days?||6.6%93.4%||5.1%94.9%|
N=1001 (Note: The evaluators are using standardized TND questions in accordance with the Model Program.)
Table 1 indicates that the youth in the experimental and comparison groups used relatively no cocaine within the last 30 days prior to the start of the program. Their use of marijuana prior to the program is relatively higher, although a majority of the youth prior to the start of the program had not used marijuana within the last 30 days. The baseline data does suggest, however, that approximately one-third of the youth had consumed alcohol within the last 30 days prior to the program. Approximately 6% of the youth consumed cigarettes within 30 days prior to starting the program. Any baseline differences between the experimental and comparison groups were controlled in the multivariate analyses.
The main limitations identified for the evaluation to date are the limited proportion of TND participants assenting/consenting to the evaluation component and, consequently, the limitation in follow-up data up to 12 months.
The recruitment of participants for the comparison group has been relatively slow, resulting in much fewer comparison cases in relation to the TND participants, which has reduced the statistical power and decreased the reliability of the between-group analysis. This limitation has also decreased the reliability of the cost effectiveness analysis, as comparison group data is needed to accurately calculate the cost in order to create effects related to drug and substance abuse reductions.
Fidelity and attendance are positive from a program implementation standpoint; however, there are limitations in terms of being able to determine whether varying fidelity levels have an impact on the results. Having more cohorts (classes) will allow for enough variability to test the relationship between program implementation and impacts.