Prevention, Intervention & Public Health
(Public Health 209.27: 7/10/2008 - 8/14/2008; Thursdays 6:10 - 8:40 PM; 224 Ross Hall)
COURSE DESCRIPTION: The epidemiology, pathology and physiology of substance abuse and its treatment will be reviewed, with emphasis on the preventable complications and sequelae of the different stages of use, abuse and addiction. Substance abusers will be examined as a key population for biopsychosocial interventions to protect them, their families, communities and the general public. Various public health interventions will be explored at all possible points of contact with drug abusers, both in and out of treatment. Current national initiatives relevant to drug abusers and related public health issues will be reviewed.
PROFESSOR: Alan Trachtenberg, MD, MPH
COURSE ANNOUNCEMENTS:
Announcements will be placed here. Please try to check this area each Wednesday night or Thursday morning. Any last minute changes to Thursday evening's session will be posted, as will other current events at the intersection of substance abuse and public health.
FOR INSTANCE:
7/27/2007:
EVIDENCE BASED PREVENTION INTERVENTIONS
This searchable database (http://casat.unr.edu/bestpractices/search.php) includes interventions that have been shown to be effective in preventing substance abuse and/or the risk factors for substance abuse. Information is provided regarding training, technical assistance and/or materials that facilitate replication of each practice. Use the check boxes to indicate on which variable(s) you would like to conduct a search of evidence based drug prevention interventions. When you click the button near the bottom of the page ("Find Matching Practices"), an 'OR' search will be completed. Select as many attributes that interest you. The results will be ranked based on how many programs have matching attributes to the criteria you specify.
TO CONTACT THE PROFESSOR (for GW or class business):
Please call in the evenings: 301-984-8843; EMAIL using: 2create.yourMD@gmail.com;
OR PREFERABLY:
Please use the confidential web-based messaging function on the 2Create homepage (in the upper right-hand corner, you may have to scroll to the right to see it) or try going directly to the Sign Up New User Page .
OUTSIDE OF CLASSROOM HOURS, questions on class content are best addressed on the 2Create Blog at: (http://2createyourmd.blogspot.com/) . This is intended to facilitate an ongoing, web-based class discussion for everyone to benefit from everyone else's questions. Email questions of a non-private nature will generally be answered on the Blog, or in class, rather than by reply email. Questions of a private nature will be received and answered via the web-based messaging function on the 2Create website. Remember that (as always) regular email is NEVER confidential.
GRADING METHOD: Grading will be based on classroom participation, timely completion of assignments, one quiz, and a brief student paper on a public health or treatment program intervention against drug abuse or defined health consequence(s) of drug abuse. Optional assignments for extra credit will also be made available at the bottom of this page.
REQUIRED READINGS: Links to all readings will be found on the class schedule below, underneath the session for which they are due. Please try to read them prior to that class session.
OTHER ASSIGNMENTS: Are also noted on the class schedule below. Assigned work (other than reading) is due by the beginning of the class following when it was assigned.
QUIZ: The quiz will be based on both the required readings and class sessions. The quiz format will be short answer, multiple choice and/or True/False type questions.
FINAL PAPER: This can be thought of as kind of a mini-proposal, in which you will define a specific population and a health outcome relevant to the course (something to do with substance abuse and/or its sequelae) and propose an intervention to be applied to your defined population. The intervention should be expected to beneficially affect that outcome. Specifically, your paper must:
1) Justify the health outcome chosen (prevalence, morbidity, mortality, cost, etc.) as the target of the intervention;
2) Specify the population to whom you plan to apply your intervention, and how you will find/access/reach/identify them;
3) Give the rationale for the intervention, including a summary of the evidence base for it (How does it work? How well does it work?);
4) Describe the intervention, including the resources needed, target population, expected effectiveness, any risks involved and setting (pick a specific agency, program or institution from which you would be conducting the intervention);
5) Describe how the intervention could (and whether it should) be evaluated;
6) Include adequate references appropriate to the topic, with correctly formatted citations that contain adequate information for the reference to be retreivable by the reader from the primary source. (At least a few references are expected to the peer-reviewed literature. To ease their retreivability, weblinks to their abstracts in Medline or on the Journal site are appreciated. Citations from the popular press or ".com" websites are suitable for events or quotations, however, not for claims of scientific or biomedical evidence. Citations from other websites will be evaluated on an individual basis as to their credibility.);
7) Have correct spelling, punctuation and grammar; and
8) Be as long as necessary, but no longer than is necessary, to address items 1-6.
You can choose anything from a prenatal or school-based program for primary prevention of drug abuse to a harm reduction intervention to a treatment-based tertiary prevention approach against HIV progression. You may want to approach the paper as if you are working in a particular agency that has some juridiction or mission related to the problem. For instance, a city public school system, an addiction treatment program or a state or county health department. Placing your project in an agency you have worked in or would like to work in might make your paper more relevant and interesting for you. OR, you can choose to place yourself wherever you can best conduct and/or evaluate the intervention in which you are most interested.
EXAMPLES OF PREVIOUS PAPERS ARE POSTED AT: Papers on Public Health Interventions in Substance Abuse
NOTE: Format, grammar, spelling and other aspects of the written presentation of your ideas are very important to the success of those ideas in the real world of public health and/or policy. Please take advantage of the GWU Writing Center if you have any potential concerns in these areas. The GWU Writing Center conducts free, one-on-one, 50-minute conferences with highly trained undergraduate and graduate students to assist you with course assignments, term papers, theses, applications, and resumes. They can help students at all stages of the writing process.
The George Washington University Writing Center
550 Rome Hall; Phone: (202)994-3765
gwriter@gwu.edu (http://www.gwu.edu/~gwriter)
DISCLAIMERS & DISCLOSURES: Professor Trachtenberg offers the following opinions, analyses and data under the doctrine of academic freedom; NOT as a representative of any agency with which he is, or may have ever been, associated. What follows is a synthesis of what I believe to be the most current materials from the best experts in the fields of addiction medicine and public health, as seen through the lenses of my own clinical and public health experience. All opinions are subject to change without notice. Stay tuned...
CLASS SCHEDULE & ASSIGNMENTS:
Class: Thursday evenings, 6:10-8:40 PM, 7/10/2008 - 8/14/2008
(Attendance will be taken).
Session 1) 7/10/2008: Welcome, syllabus, introductions, disclaimers, overview of topic, neurophysiology and pharmacology.
SYLLABUS
OVERVIEW OF SUBSTANCE ABUSE IN PUBLIC HEALTH
ASSIGNMENT: Establish username and password for confidential web-based messaging w/instructor at http://www.2create.yourMD.com. See log-in area at upper right corner of front page (you may have to scroll to the right to see it) or try going directly to: sign up. Click on the instructor's name, then provide some basic information. Please do include Date of Birth (or at least Year of birth). Do not enter your social security number. Once you are registered, use the "general" message category to send the instructor a message with a couple of sentences about your particular interests in substance abuse or why you wanted to take this class. Ignore the site's information on paid consultation; You have already paid GW.
Session 2) 7/17/2008: Overview of drugs, drug classes, drug schedules, drug agencies and drug regulation in the US; Drug Abuse Epidemiology and History; Sources of data and information on substance abuse in the US.
REQUIRED READINGS:
Actual causes of death in the United States, 2000. Mokdad et al. JAMA 2004;291:1238--45.
NIDA: Commonly Abused Drugs OR (local PDF of NIDA Table)
NIDA 2007 Publication: Drugs, Brains, and Behavior - The Science of Addiction
OR (Local PDF: The Science of Addiction; NIDA 2007)
Addiction Versus Dependence in DSM-V by O'Brien, Volkow & Li -
Am J Psych 163:764-765, May 2006 OR (LOCAL PDF COPY)
Drug Schedules and the Controlled Substances Act (CSA) pp 1-9 (http://www.usdoj.gov/dea/pubs/abuse/1-csa.htm)
OPTIONAL READINGS:
DEA Introduction to Drug Classes
(Note: In general, DEA publications should be taken with a grain of salt,
but these are not too bad.)
"Narcotics" (Opioids, really: The term "Narcotics" is a legal one sometimes
misused interchangeably with "Opioids." [+/- cocaine])
Stimulants
Depressants
Cannabis
Drugs of Abuse Chart
Themes in Chemical Prohibition By William L. White; From:
Drugs in Perspective, National Institute on Drug Abuse, 1979
A Drug War Carol: the History of American Drug Control in Comic Book Form
FDA, DEA and the Drug Approval & Scheduling Process
NIDA Research Report: Hallucinogens and Dissociative Drugs.
Session 3) 7/24/2008: QUIZ ON READINGS for last week and this week (and 1st two classes). Epidemiology and Medical Complications of Drug Abuse.
HANDOUT: Psychiatric and Behavioral Aspects of Alcohol & Drug Abuse; Initiation & Progression.
REQUIRED READINGS:
Pathology of Drug Abuse (NOTE: The statement in this reading about MDMA causing brain damage is unsubstantiated)(http://library.med.utah.edu/WebPath/TUTORIAL/DRUG/DRUG.html)
Comorbidity between substance use disorders and psychiatric conditions by Marc A. Schuckit [ADDICTION, Vol. 101 Issue s1 - September 2006] OR (LOCAL PDF COPY)
NIDA Research Report: Prescription Drugs: Abuse and Addiction.
NIDA Research Report: Inhalant Abuse.
CSAT Treatment Advisory: Anabolic Steroids.
OPTIONAL READING:
Medical Consequences Of Substance Abuse by MD Stein
in Psychiatric Clinics of North America; June, 1999. 22(2):351-70.
Public Health and Injection Drug Use. MMWR 5/18/2001 Vol 50, No MM19;377
Epidemiology of HIV/AIDS --- United States, 1981--2005
MMWR 6/2/2006 Vol 55, No MM21;589
Nestler E: The Neurobiology of Cocaine Addiction.
NIDA Science & Practice Perspectives Volume 3, Number 1 - December 2005
"How Do They Measure Up?" Examining Drug Use Surveys and Statistics: Sources (Part 1) & Problems (Part 2) by Earth & Fire Erowid. (Erowid Extracts. Nov 2005; 9:12-21)
ASSIGNMENT for session 4: Use the web-based messaging function to send the instructor your proposed topic for the final paper and receive a reply with your quiz grade. Your topic proposal should specifically describe:
1) The intervention you plan to apply;
2) The population you plan to apply it to and how you will find/access/reach them;
3) The health outcome you plan to prevent/affect & how you will measure it; and
4) Categorize your outcome intervention as universal, selective, indicated and/or primary, secondary or tertiary prevention.
Session 4) 7/31/2008: Substance Abuse Treatment; discussion of paper topics.
HANDOUT: Drug Classes & Administration Routes, Epidemiology & Effects.
REQUIRED READINGS:
CDC Fact Sheets on Substance Abuse Treatment: 6 items, 22 pages total
NIDA: Principles of Drug Addiction Treatment: A Research Based Guide
National Voluntary Consensus Standards for the Treatment of Substance Use Conditions: Evidence-Based Treatment Practices (National Quality Forum) (http://www.qualityforum.org/pdf/reports/sud/sudexesummary.pdf)OR
LOCAL PDF COPY
NIAAA Alcohol Alert #66: Brief Interventions (2005) [ PDF ]
OPTIONAL READINGS:
Alcoholism and Substance Abuse by Donald Warne (chapter from Rakel's INTEGRATIVE MEDICINE, 2nd Edition, 2007).
NIDA Research Report: Therapeutic Community.
12-Step Participation as a Pathway to Recovery
Principles of Drug Abuse Treatment for CRIMINAL JUSTICE POPULATIONS:
A Research Based Guide
Ira Marion: Methadone Treatment at Forty
Neurobiology of Opioid Dependence-Implications for Treatment
Session 5) 8/7/2008: Prevention Interventions; Policy Issues.
Handouts/Slides: Drug Policy, Prevention & Treatment
REQUIRED READINGS:
NIDA: Preventing Drug Abuse among Children and Adolescents, A Research Based Guide
Safety First: A Reality-Based Approach to Teens and Drugs; by Dr. Marsha Rosenbaum
CDC: Access to Sterile Syringes
CDC: Syringe Disinfection for Injection Drug Users
Testing Drugs vs. Testing For Drug Use: Private Risk Management In The Shadow Of The Criminal Law by Dr. Robert MacCoun OR (LOCAL PDF COPY)
OPTIONAL READINGS:
Drug Use Prevention & Education (And Comments on DARE) by Dr. Jeff Ratliff-Crain
Beyond Zero Tolerance: A comprehensive, cost-effective approach to high school drug education and student assistance
CDC: Drug Users and the Structure of the Criminal Justice System, August 2001
CDC: Women, Injection Drug Use, and the Criminal Justice System; August 2001
Session 6) 8/14/2008: Topics of special class interest; Evaluations; Turn in final papers; Fond farewells.
Extra Credit Exercises for the Student:
1) Psychosis After Ultrarapid Detox & Switch Methadone to Hydrcodone for 12 Days /
SHREERAM, McDONALD & DENNISON; Falls Church, VA
http://indicatorshandbook.org/
Indicator reporting
programs are a valuable tool to
illustrate local substance use problems and track the impact of efforts to
address them. Community leaders use indicator reporting programs to identify
their most important local substance use problems, focus community prevention
and treatment strategies, and measure the results of new policies and
programs.
This website, a companion to a new Join Together
publication, will help you build an effective indicator program for your
community. We suggest you start here:
How to Use
This Site.
Links:
Al-Anon
http://www.al-anon.alateen.org/
Alcoholics Anonymous
http://www.alcoholics-anonymous
The Alcohol Epidemiologic Data Directory; Per
capita alcohol consumption, based on alcohol sales data
http://www.niaaa.nih.gov
The Alcohol Epidemiologic Data Directory, Per
capita ethanol consumption for states, census regions, and the United States,
1970?2002
http://www.niaaa.nih.gov
The Alcohol Epidemiologic Data Directory, Per
capita and per drinker ethanol consumption for selected states, 1986-99
http://www.niaaa.nih.gov
The Alcohol Epidemiology Program, University of
Minnesota. Sample Alcohol Policies
http://www.epi.umn.edu/alcohol
The Alcohol Policy Information System (APIS)
http://alcoholpolicy.niaaa.nih
The American Society of Addiction Medicine
http://www.asam.org/
Behavioral Risk Factor Surveillance System
(BRFSS)
http://www.cdc.gov/brfss/
Campaign for Tobacco-Free Kids
http://www.tobaccofreekids.org/
Centers for Disease Control and Prevention
http://www.cdc.gov/
Center for Science in the Public Interest Alcohol
Policies Project
http://cspinet.org/booze/
The Distilled Spirits Council
http://www.discus.org/
Drug Abuse Warning Network (DAWN)
http://dawninfo.samhsa.gov/
Drug and Alcohol Services Information System
(DASIS)
http://www.drugabusestatistics
Drug-Free Communities Grants
http://drugfreecommunities
Drug-Free Marion County, Indianapolis, Indiana
http://www.drugfreemarioncounty
Drug-Related ICD-9-CM Diagnoses and Diagnostic
Related Groups. National Institute on Drug Abuse. Assessing Drug Abuse Within
and Across Communities, In press. Rockville, MD: The Institute, 2005
http://www.drugabuse.gov/DESPR
East County Community Change Project, San Diego
County, California
http://www.publicstrategies
Environmental Tobacco Smoke (ETS)
? Secondhand Smoke
http://www.cdc.gov/tobacco/ets
Geographical Information Systems (GIS)
http://www.gis.com/
Indicator
Checklist (pdf)
Join Together.
Fighting Back Lessons
Learned, 2005
http://www.jointogether.org/y
Join Together.
Rewarding Results: Improving the Quality of
Treatment for People with Alcohol and Drug Problems, Recommendations from a
National Policy Panel, 2003
http://www.jointogether.org/y
Join Together.
Substance Abuse: Improving the Quality of
Treatment, Join Together Action Kit 2002
http://www.jointogether.org/y
MADD Report Card
http://www.madd.org/stats/0
Marijuana Anonymous
http://www.marijuana-anonymous
Marin Institute.
Solutions to Community Alcohol Problems: A
Roadmap for Environmental Prevention,
2005
http://www.marininstitute.org
The Methadone Treatment Locator
http://www.atforum.com/SiteRoot
Monitoring the Future
http://www.monitoringthefuture
Narcotics Anonymous
http://www.na.org/
National Center for Statistics and Analysis
http://www-nrd.nhtsa.dot.gov
National Center on Substance Abuse and Child
Welfare (NCSACW)
http://www.ncsacw.samhsa.gov/
The National Forensic Laboratory Information
System (NFLIS)
http://www.deadiversion.usdoj
National Highway Traffic Safety Administration,
Fatal Accident Reporting System
http://www-fars.nhtsa.dot.gov/
National Incident Based Reporting System (NIBRS)
http://www.ojp.usdoj.gov/bjs
National Institute on Drug Abuse.
Principles of Drug Addiction Treatment: A
Research-Based Guide, October 1999
http://www.nida.nih.gov/PODAT
National Survey on Drug Use and Health (formerly
called the National Household Survey on Drug Abuse)
http://www.oas.samhsa.gov
National Uniform Crime Reporting Program (UCR)
http://www.fbi.gov/ucr/ucr.htm
New Futures, Portsmouth, New Hampshire
http://www.new-futures.org/
The Office of Safe and Drug-Free Schools (OSDFS)
Grants
http://www.ed.gov/about
ONDCP "Help Your Community" website
http://www.helpyourcommunity
Partnership Attitude Tracking Study
http://www.drugfree.org/portal
Planned Parenthood Affiliate State Office
http://www.plannedparenthood
QuitNet.com registrants by state/county
http://www.quitnet.com/q_corp
SAMHSA Buprenorphine Physician Locater
http://buprenorphine.samhsa
SAMHSA Model Programs database
http://modelprograms.samhsa
CFID=84197&CFTOKEN=11393486
SAMHSA's Office of Applied Studies provides
length of stay and completion rate data by state
http://www.drugabusestatistics
SAMHSA treatment database also lists licensed
treatment programs by ZIP Code
http://findtreatment.samhsa
Sample Billboard Survey Form (pdf)
http://faceproject.org/freerepo
Secular Organizations for Sobriety
http://www.secularhumanism.org/
Self-Management and Recovery Training (SMART
Recovery)
http://www.smartrecovery.org/
State Alcohol Advertising Laws: Current Status
and Model Policies
http://camy.org/research
StateHealthFacts.org
http://www.statehealthfacts
State liquor commissioners or Alcohol Beverage
Control Commissions (ABC)
http://www.marininstitute.org
State Tobacco Activities Tracking and Evaluation
(STATE) System
http://apps.nccd.cdc.gov
State Traffic Safety Information has state by
state data on traffic crashes by BAC level
http://www.nhtsa.dot.gov/stsi/
The Tax Foundation
http://www.taxfoundation.org
211
http://www.211.org/status.html
The Underage Drinking Enforcement Training Center
http://www.udetc.org/
Youth Risk Behavior Surveillance System
http://www.cdc.gov/HealthyYouth
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