John Lilja

Perspectives on preventing adolescent substance use and misuse.

This article reviews different theoretical models concerning the prevention of substance use by adolescents. The models differ in their concepts and in their assumptions. Because the models describe different parts of the substance use problem, they can be combined to provide the basis for the design of information-based prevention programs. For example, in order to understand adolescent development, identity models or attachment models can be used. To understand adolescent norm changes, cultural models or peer system models can be applied. To understand how adolescents cope in specific situations where alcohol and other drugs are available, models that include concepts like self-esteem, drug expectations, existing norms, and perceived control of substance use can be employed. All preventive programs need to be pretested as well as evaluated both during and postprogram. The models mentioned may be used as frameworks in an evaluation, i.e., the variables and the assumptions in the models can be used as hypotheses to establish whether the desired results are achieved as a consequence of the selected strategies and techniques in the preventive program. A greater knowledge of the social and psychological processes preventing substance use will put us in a better position to influence and understand adolescent substance use in the future.

Evaluation of drug use prevention programs directed at adolescents.

The aim of this article is to present a theoretical model of how to undertake evaluations of prevention programs directed at adolescents. Based on the results from metaanalyses of outcome studies of school-based programs, this article concludes that interactive programs tend to be more effective than not only those mainly intended to increase factual knowledge about tobacco, alcohol, and illegal drugs, but also those initiatives aimed at influencing adolescents’ attitudes toward those substances. The interactive strategy corresponds to problem-based learning or the interactive educational approach, now widely popular in educational circles. These outcome studies have provided us with important knowledge. However, there are relatively few evaluation investigations that analyze in substantive detail the process by which adolescents change their alcohol, tobacco, and illegal drug-use behavior, and alter their perceptions about these substances. In an ongoing intervention study based on an interaction framework, involving all youngsters in the ninth grade (15–16 year olds, n = 300, undertaken in year 2001–2002) in the Aland Islands, Finland, the students’ perceptions regarding the risks involved in illegal drug use could not be altered. Neither was it possible to decrease the alcohol or tobacco consumption during this school year. However, what did occur was that a number of expectations regarding alcohol were changed, which, in turn, might influence the patterns of alcohol use by the target group. The ways students in the Alands celebrate the end of junior high school are culturally embedded, and this may explain the lack of success in decreasing their alcohol consumption and tobacco use at the end of the ninth grade. Based on the analysis, a combination of outcome and process evaluations is recommended in order to reach a better understanding of how school prevention programs may achieve the desired goals.

“Mental mirrors” of pharmacists: How do pharmacists perceive their over‐the‐counter customers?

The aim of this study was to analyse how a sample of Finnish pharmacists perceived a number of video‐taped customers requesting over‐the‐counter medicines. The conceptual basis of the study was cognitive psychology.

Toward a theory of social pharmacology: the actor-spectator paradox applied to the psychotropic prescribing process.

Traditionally, drug prescribing was regarded as part of the physicians decision-making role. However, recently it has been recognized that such a perspective is insufficient to understand the psychotropic prescribing process. To understand this process, a drug communication perspective is necessary. This article describes the actor-spectator paradox and its influence on drug communication and psychotropic drug prescribing. The actor-spectator paradox postulates that the actor and the spectator have divergent perspectives about the cause of the actors behavior. The spectator makes assumptions about the actors cognitive system other than the actor herself is making. This difference is often the basis for misunderstandings between a health professional and a patient. If a health professional can learn to make more realistic assumptions about a patients cognitive system, communication between the two will improve. In the same way a patient has to learn to make more realistic assumptions about the cognitive systems of health professionals. The actor-spectator paradox can be applied to different areas of Social Pharmacology such as the diagnosis of patients suffering from mental health problems, drug compliance, informed consent, and the prescribing of psychotropics.

Toward an integrative approach in the analysis of dependency problems.

This article takes some preliminary steps towards an integrated analysis of dependency problems e.g., long-term tranquillizer use, alcohol dependence, problematic use of narcotics. It argues for the need to outline important theoretical, epistemological, and methodological prerequisites in the analysis of the complex dynamic developmental processes involved in dependency problems. The dynamic process leading to dependence can be studied by the aid of an artificial science neural network approach in combination with a mixed method strategy including a clarification of a combination of different epistemological positions. It is intended that the empirical output of this complex strategy will provide a starting point for a new theoretical analysis which, in turn, will lead to new and more relevant input variables in the neural network approach that will help us to extend our knowledge of the dynamic processes leading to dependency. [Translations are provided in the International Abstracts Section of this issue.]

Empathy as a communication strategy in the pharmacy — a study based on cognitive and behavioural analysis

Objective — To evaluate an educational intervention that aimed to improve the level of empathy shown by pharmacy staff to their customers.

IDENTITY, COGNITIVE STRUCTURE, AND LONG-TERM TRANQUILLIZER USE: A MULTIDIMENSIONAL APPROACH

The article discusses different theoretical perspectives that are relevant in analysing long-term tranquillizer use. The theories mentioned are, e.g., behavioral theory models, cognitive models, humanistic and existential models, transpersonal identity models, psychodynamic reasoning, sociological and anthropological perspectives. A multidimensional model focusing on the connection between identity structure and long-term tranquillizer use is presented. The article argues for the use of mixed methodological strategies, e.g., quantitative and qualitative methods. The implications of the “actor–spectator paradox” for the analysis of data are also discussed in some detail. [Translations are provided in the International Abstracts Section of this issue.]

How pharmacy students interpret ‘silence’ in pharmacist‐customer communications

Objective To improve communication in the pharmacy we need to be more knowledgeable about the processes that lead to good communication. In a series of studies, video‐vignettes have been used to analyse how pharmacists and pharmacy students assess customers, and how this influences the provision of drug information. The studies are based on a combination of cognitive psychology, attribution theory and discourse analyses. The aim of this study was to analyse how pharmacy students and management science students at Åbo Akademi University interpreted pharmacy‐customer interactions when pharmacists handled requests for prescribed drugs.

Chapter 1. Introduction: using narrative research methods for the analysis of use and misuse of alcohol and drugs.

Introduction : Using narrative research methods for the analysis of use and misuse of alcohol and drugs

How Cultural Factors Influence School-Based Substance Use Prevention Programs

This article analyzes school-based substance use prevention programs, comparing programs in the United States and Nordic countries, explores how cultural factors influence the ways in which prevention programs are designed and implemented, and how evaluation is affected by design and implementation.