Informasi tentang Ecstacy

2. Behavioural Intervention:
An Approach to the Ecstasy Problem
Foong Kin, Ph.D. &
Vemala Devi, M.Sc.
Centre for Drug Research, USM
Paper presented at
the National Public Health Conference,
Ministry of Health,
Kuala Lumpur, April 2001

3. Synthetic Drug Explosion
(LSD, Amphetamines, Ecstasy, etc.)
• Begun in the mid 1980s
• Emergence of a new sub-culture:
the rave phenomenon
• Illicit production,trafficking &
consumption surpassed heroin

4. STIMULANT ABUSE
• Stimulants used to enhance vitality,
improve mood and escape reality
• 2 groups of synthetic stimulants i.e.
amphetamine group and ecstasy group
• Attractiveness of stimulants is their action
on CNS

5. MDMA (Ecstasy) Abuse
• The love drug
• European discotheques (mid-1980s)
• Linked with explosion of dance music
• Used by an elitist section of
population

6. Source: National Narcotics Agency
Methamphetamine Abuse
Year N
% of total
addicts
identified
1997 255 0.70
1998 772 2.05
1999 774 2.19
2000 1,284 4.70

7. Source: National Narcotics Agency
Amphetamine Type Stimulants &
Other Psychotropic Pills Abuse
Year N % of total addicts
identified
1997 264 0.73
1998 264 0.70
1999 168 0.48
2000 612 1.76

8. ATS SEIZURES
Year Syabu
(kg)
Ecstasy
(#)
Psy. Pills
(#)
2000 208.10 49,901 145,486
1999 5.41 55,975 329,265
1998 6.44 9,231 1,724,104
1997 2.09 40,990 1,356,989

9. Ecstasy… just the facts
• 3,4-MithileneDioxyMethAmphetamine
(MDMA)
• Developed in 1914 by Merck
• Historically used for anti-fatigue, anti-
depressant & appetite suppresant
• Similar to the stimulant amphetamine and the
hallucinogenic mescaline – can produce
stimulant and psychedelic effects
• Taken orally as tablet or capsule

10. PROFILE OF ABUSERS
• Teens and twenties
• Often educated
• Relatively
privileged social
background
• Recreational
purposes
• Social context of
dance scene

11. Sought-after Effects
• Energizing effects
• Profoundly positive feelings
• Empathy for others
• Elimination of anxiety
• Feeling of serenity/calmness
• Enhancement of performance,
communication & sensual experience
• Mild euphoric rush
• Suppress need to eat, drink, or sleep

12. Short-term Side Effects
• Jaw tightening
• Brief nausea
• Sweating
• A dry mouth and throat
• A loss of appetite
• Difficulty in coordinating body
These all lead to a user having weakened physical
and mental conditions the next day after use.
Extensive use over several days can lead to anxiety,
panic, confusion and insomnia

13. Potential Dangers/
Health Risks
• Heat stroke due to dehydration
• Increased heart rate and blood pressure
• Suppression of the immune response
• Psychiatric disturbances e.g. anxiety,
confusion, depression, paranoia,
hallucination
• Brain damage
• Severity of adverse reactions to synthetic
impurities

14. BRAIN SCAN
Sumber: National Institute on Drug Abuse, USA

15. Current Strategies to
Curb the Spread
• Supply reduction
(law enforcement, legislation)
• Demand reduction
(prevention, education,
treatment)

16. DRUG ABUSEPROGRAMCONTINUUM
PROGRAM
TYPE:
Information
Initial Drug
Experience
Education Alternatives Intervention Treatment Rehabilitation
Non-use
of Drugs Experimental
Occasional or
Frequent Use
Integral Part
of Lifestyle
Drug Abuse
Recovery
Maintenance
of Drug-free
Lifestyle

17. Principles in Promoting
Behaviour Change
• Understanding individual and environmental
risk factors influencing behaviour, i.e. ecstasy
abuse
• Identify important target groups for targeting
behaviour change
• Application of theories from social
communication, behaviour and psychological
sciences to change behaviours

18. Risk Factors in Ecstasy
Abuse Among Malaysian
Youths
• Little is known
• Lack systematic study
• Only anecdotal data available;
mostly from law enforcement
and medical practitioners

19. An Ecological Perspective:
Levels of Influence in
Ecstasy Abuse
Intrapersonal
Factors
Knowledge, attitudes, beliefs, and
personality traits
Interpersonal
Factors
Social influence of family, friends,
peers
Institutional
Factors
Rules, regulations, policies, and
informal structures
Community
Factors
Social networks and norms
Public Policy Local, state, federal policies and
laws

20. Prevention Approaches
• Information dissemination/media
campaigns
• Affective education
• Alternatives
• Resistance skills
• Personal and social skills
training

21. Application of Theoretical
Frameworks to Prevention
• Health Belief Model (Rosenstock,
1974)
• Social Learning Theory (Bandura,
1977)
• Problem Behaviour Theory (Jessor &
Jessor, 1977)

22. Drug use is a socially
learned, purposive and
functional behaviour, and
a result of the complex
interplay of environmental
and individual factors

23. Health Belief Model
Vulnerability
Benefits
Seriousness
Cues
Self-efficacy
No Barriers
Likelihood of
taking health
action

24. An individual is less likely
to abuse ecstasy if:
• Perceives that he is susceptible to ecstasy-
related problems
• Thinks that using ecstasy would result in
serious consequences
• Sees immediate benefits of non-use
• Perceives an absence of barriers to action
• Know how to resist influence (has self-
efficacy)
• Is reminded/supported (media campaigns,
advice from others, etc.)

25. Social Learning Theory
Person
EnvironmentBehaviour

26. Social Learning Theory
Behaviour change is influenced by
1. Reciprocal determinism: person and
environment continually interact
 change the environment to facilitate
behaviour change
2. Expectations about outcomes of
behaviour
 motivate person to adopt new behaviour
by telling about benefits

27. Social Learning Theory
3. Behavioural capability: having knowledge
and skills to perform a desired behaviour
 train the person with skills
4. Self-efficacy: confidence in one’s ability
to successfully perform a specific action
 enhance confidence
5. Observational learning (modeling)

28. Problem Behaviour
Theory
• Problem behaviour is a result of a
complex interaction of:
–Personal factors (cognitions,
attitudes and beliefs)
–Physiological and genetic factors
–Perceived environmental factors

29. • Drug use is perceived as functional,
serving as a way to coping with:
– Boredom
– Social anxiety
– Rejection
– Gaining admission to a peer group

30. Problem Behaviour Theory
(multilevel approach)
3 levels of analysis/behaviour
change
–Level of behaviour
–Level of personality
–Level of environment

31. Health is enhanced by:
1. Weakening or eliminating
behaviours that
compromise health
2. Strengthening/introducing
behaviours that enhance
health

32. Personality Approaches
• Make adolescents realise the
misperception to believe that
benefits of drug use outweigh the
risks
• Believe there are alternative ways of
coping with anxiety, establishing
effective interpersonal relationships
or achieving any other desired goal

33. Environmental
Approaches
1. Factors aimed at resisting or
avoiding health-compromising
behaviour
a. Reducing availability of ecstasy
b. Media campaigns to discourage
use
c. Social and policy sanctions for
drug-related activities

34. Environmental
Approaches
2. Environmental supports for health-
enhancing behaviours
a. Positive peer relations
b. Drug-free activities for
adolescents
c. Health/fitness programmes

35. An Integrated Approach to
Prevention
• Integrate 3 theories
• Each theory suggests special areas of
emphasis
• HBM – identify personally oriented goals for
intervention
• SLT – teaching of appropriate skills
(Assertiveness, stress management, &
interpersonal communication to resist
environmental pressures)
• Problem behaviour theory
– Person focused (skills building activities)
– Environmentally focused

36. Ecstasy abuse prevention
should:
1. Eliminate or at least reduce to the greatest
extent possible environmental influences
promoting or facilitating use
– Decrease availability of ecstasy
• Through law enforcement (raids, urine
screening)
• Having drug free night spots (“Drug Free
Discos”)
– Dialogue, persuasion of club owners
and employees
– City Council and police working
together

37. –Reduce visibility of negative
ecstasy-using role models
–Increasing the visibility of
attractive, high-status (non-
ecstasy role models)
–Altering attitudes and social norms
concerning acceptability of
ecstasy use and abuse (laws,
media campaigns)

38. 2. Develop preventive intervention
designed
– To reduce
susceptibility/vulnerability to the
various environmental factors
promoting ecstasy use
– To reduce motivation to use
ecstasy

39. Examples of Measures
• Teaching of specific skills designed
to resist social influences to use
ecstasy (techniques for resisting peer
pressure)
• Making adolescents aware of sources
of influence and skills to counter
them

40. Examples of Measures
• Enhance self-esteem, perceived
control, self-confidence, self-
satisfaction, and assertiveness
• Teach life skills (decision-making, goal
setting, social skills, assertiveness)
• Provide an array of general coping
skills (anxiety reduction and problem
solving)

41. Communication Programmes
to Promote Behaviour Change
Objectives of programme:
–Inform
–Change attitudes
–Teach skills and specific steps on
how to resist initiation of ecstasy
use

42. Important Principles in
Message Design
• Be relevant (youth input)
• Personalise the message
• Be specific to the different target
goups
• Use emotional positive appeal
• Be clear and simple
• Be interesting

43. How to the Deliver Message?
What Media and Channel?
• Choice dependent on characteristics of
target groups and objectives of the
message
– e.g. general public (TV/newspapers)
– Night spot goers (use distribution
methods close to the techno culture
(posters, youth magazines, flyers, T-
shirts, post cards, etc.)
– Peer education approach (mouth-to –
mouth propaganda
– Ecstasy outreach workers

44. Effective Prevention
Strategy
• Multiple components
• Uses programme providers and
delivery channels that efficiently
reach target population
• Provides ongoing intervention
throughout the initiation of ecstasy
use

45. 3 Pronged Strategy
• Monitoring
• Control
• Targeted Prevention

46. YA TIDAK