Challenges and Opportunities in Drug Demand Reduction (Continued)
Haydée Rosovsky
Technical Secretary
National Council on Addictions
Ministry of Health
Mexico
I am very happy and I am very proud to
participate in this plenary session together with
outstanding professionals in this field. I’m going
to make some remarks that have to do with the
challenges we have to face whenever we do
prevention that is targeted to the youth. I’m
referring to drug use prevention among youth.
First of all, I would like to say that prevention is
the best possible strategy for our programs. This
is where we would like to invest all of our
resources and we would like to have abundant
resources for this purpose. Unfortunately,
prevention at present in Mexico has to go hand-in-hand with various important treatment
actions because we already have an important
proportion of the population who started to use
drugs a few years ago and that are now
presenting problems that require therapy.
From the standpoint of the youth, what I’ve
been able to observe and what my colleagues at
National Institute of Psychiatry have read in
international literature is that the most, let’s say,
universal, recommendation is that prevention
should start as early as possible. Preventive
programs that expect to achieve a very
important impact when targeted to youngsters
after puberty or in middle school or in high
school do not seem to be as effective as
programs that begin from the time the child
begins to develop. What’s the reason for this?
Well, the concept of prevention that seems to be
the most successful one is the one dealing not
only with substance abuse but also with an
environment that promotes positive behaviors
and lifestyles that are created from the earliest
childhood. In these models, the use of drugs
makes us feel better and as we heard a moment
ago from the presentation of our NIDA
colleague, there is a search for relieving pain or
looking for pleasure. All of these behaviors
would not necessarily be sought when there are
other sources of satisfaction in individual’s lives.
Another important element of this education for
life, as we call it, is a proper management of
emotions: growing up in environments where
freedom goes hand-in-hand with responsibility,
and one in which individuals learn to grow up
feeling self-assured and having a realistic
judgment about their self-esteem.
In certain environments, prevention among the
youth is more successful. And this is, these are
the ones we should focus on. Let me mention
some of these sites where we should reinforce
our actions. And I think this is important
because many prevention efforts do not reach
their target population. Let me give you an
example. Let’s say we want to do a lot of
prevention in the setting of health care, the
primary health care setting for instance. In the
case of the young people, we’re not going to be
very successful because youngsters seldom go
to primary health care centers. We see mainly
young children, or adults that go for
immunization or for a specific problem. But
teenagers do not represent the most frequent
clients of primary health care centers.
Therefore, the type of educational and
information materials that we use are not going
to reach our youngsters. But where are they?
They are at schools, and this is something that
is universally recognized. However, I would like
to state that basic science is more universal,
because in the end, biologically speaking we
have more commonalties among us humans.
Whenever we refer to behaviors and to our
preventive work, we find many reservations
about international recommendations.
There are some recommendations, for instance,
that stem from the experience of institutions in
the United States like SAMHSA. And these
recommendations cannot necessarily be
successfully taken to Mexico. We need to do a
translation or an adaptation and take some
aspects that are applicable, but exclude others
that are not. For instance at schools you know
that unfortunately, in Mexico, the mean
schooling level of the education, of the
population continues to be quite low. An
important proportion of our youth, especially
women, quit school at a very early age.
Fortunately, this situation is changing. We are
making progress, but we are still very far from
having all of our youngsters completing high
school, or graduating from high school, let alone
giving to all of them the opportunity of going to
college. This is only available for a minority.
Therefore, although the school is a very
important setting for prevention, we cannot
expect that the young population that we want
to reach with preventive actions are all going to
be at schools.
It’s precisely the young people who are at risk
for drug use, those who quit school probably
because of their personal life situations that
make them be very vulnerable, and expose
them to drug use. Another setting where we
would have to work is the community. You were
given an example of this today and you will hear
about many more later, those who approach the
younger coalitions or coalitions of the young,
many of which are represented here, but also at
the community at the neighborhood level, in
small towns. The young people are moving, are
there, and they are very active. They are not
necessarily at home. They are out in parks, out
in the street. They are playing. They are having
fun. Some of them are even working in the
streets. That’s why we should approach them
wherever they are. And as I already said, there
are many young people who are part of the
labor force, of the working force. Some work
under very poor conditions that further expose
them to drug use. For example, those working in
certain areas of big cities where there is
prostitution or where one finds adult centers like
nightclubs where one can easily have access to
drugs, or sell to your economic need see the
need for working in prostitution or as beggars.
There is another group of young people who
work, but they are not necessarily so much
exposed to drug use. They may work in
supermarkets and self-service stores and maybe
they combine work with school.
Another very important setting is that of
recreation centers. These are meeting places for
the young people. And here we may include
those who play sports. Young people like bars,
discos, going to places to listen to rock bands.
And probably in every country and in the
different regions of our countries, we may find
different habits of the young people in doing this
type of activity. But I think that each one of us,
in our own country need to define these
different settings, to determine what our target
population is. In working for the youth, in doing
prevention efforts, we think that there are
certain actions that we are trying to undertake
in Mexico that may have a very important
impact. And that they be carried out only under
the condition of having a very good coordination
with other sectors. It’s a fact that the
government alone cannot take care of this
problem. And the government cannot and
should not take care of this problem alone.
We are becoming more and more aware of the
need to work jointly with equality, without one
of the parties being submissive to another one,
and with a different group of youth. Preventive
programs, as I said, cannot be universal for the
reasons that I already mentioned, but there are
other reasons, for example, cultural aspects,
different values, gender aspects. And there are
risk factors and protective factors that pertain to
the different groups, cultures, regions, even
inside one single country. Yesterday we heard
some experiences about research. And let me
say that this is the reason why research is so
important for prevention purposes. Prevention
needs to be research-based. Research can guide
us as to what’s going on, what’s the status of
the problem in different population groups so
that prevention and treatment resources can be
more successfully allocated. As I said, we heard
yesterday about the construction of the gender
idea, and the different perspectives one finds in
different cultures. We heard about self-esteem,
assertiveness, and in two neighbor countries like
Mexico and the U.S., something might mean
something totally different. For example, for a
young Mexican woman, being assertive may
sound like being too aggressive or a behavior
that will make her unaccepted vis-a-vis the boys
of her community. So these are aspects that in
my view should be based on research.
I also think that drug use prevention cannot lie
within community and government programs as
if it were something separate for resource
utilization purposes. We would like to undertake
comprehensive action. Drug use prevention
needs to be part of many other health
programs. Why? Because we know that
substance use and abuse is an extremely
important risk factor. For example, for HIV AIDS
transmission, for unwanted pregnancies,
accidents, violence and dropping out of school.
All of these are important challenges, but there
are other important challenges we face in our
prevention efforts. We frequently see that
different organizations use different conceptual
frameworks for prevention. And often, they are
not only not complementary, they are opposed.
And this unfortunately, leads to confusion
among the population, and efforts are
neutralized or there is suspicion about what’s
being done.
We also see quite frequently preventive actions
that are not permanent enough and that are not
consistent with other actions that are
undertaken by a different group. That’s why, in
order to reach our young population, in the case
of mass media campaigns, we need to see that
whenever they are broadcast, it must be a time
when the young people can hear them or watch
them. This is something we need to think about
and we have with us some examples of the
work we have been doing. Part of this we have
done for a few years. Other actions are more
recent. And we’re working in the setting of
families and communities. To do prevention
among the youth, we also need to work with
their parents, with their religious leaders. This is
something that has to do with the cultures and
traditions of every country. You heard Sofia this
morning telling us about the youth coalition. We
have great hopes for what is being done. And
the youth have told us that they are suspicious
about adults and they don’t trust either adults or
governments or institutions. At least this is the
case in Mexico. So, we need to take this to
account and ask the young people of our
country to become the most active agents of
prevention. Let’s ask them to be, with ourselves
as facilitators, and give them the tools that they
need.
The educational setting is very important as well
for us. We have started to organize student
organizations against addiction under the model
of building a drug-free life. This is a model that
we have used with other institutions. We have a
crusade with teachers. We know that the
preventive experiences at the school setting
should be part of the school’s educational
programs. These should not be actions that are
isolated or that are done intermittently. They
should be part of the material that teachers use
and be part of the internal school regulations.
In the work setting it is important to develop ad
hoc programs that consider the socio-economic
stratum of individuals and that facilitate a timely
provision of preventive treatments. In the
recreational setting, one of the things we’re
doing now is to work with owners of discos, bars
and nightclubs. They want to get together on
this because it’s not good for them to have
accidents or drug problems in their centers or
discos. So, we have found a possibility to work
together with them and we will have the
specifics quite soon.
Finally, actions towards responsible alcoholic
drinking. In Mexico the age at which one can
drink is 18 years. This is younger than in the
United States. We know there are certain
individuals that should not drink because they
are prone to addiction or dependency. But there
are many other individuals who may have
drinking problems. There are very interesting
programs aimed at changing this and promoting
responsible drinking. We also have actions in
cultural and sports centers. This is based on
what we have learned from our young people.
