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Community opinion on Collingwood substance abuse prevention needs Hetherington, Tom Tom 1992

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COMMUNITY OPINION ON:COLLINGWOOD SUBSTANCE ABUSE PREVENTION NEEDSBy:Tom HetheringtonB.S.W., University of Victoria, 1981A THESIS SUBMITTED IN PARTIAL FULFILLMENT OFTHE REQUIREMENTS FOR THE DEGREE OFMASTER OF SOCIAL WORKinTHE FACULTY OF GRADUATE STUDIESSCHOOL OF SOCIAL WORKWe accept this thesis as conformingto the required standardTHE UNIVERSITY OF BRITISH COLUMBIAJune 1992© Thomas John Mcclean Hetherington, 1992.In presenting this thesis in partial fulfilment of the requirements for an advanceddegree at the University of British Columbia, I agree that the Library shall make itfreely available for reference and study. I further agree that permission for extensivecopying of this thesis for scholarly purposes may be granted by the head of mydepartment or by his or her representatives. It is understood that copying orpublication of this thesis for financial gain shall not be allowed without my writtenpermission.(Signature)Department of  School of Social WorkThe University of British ColumbiaVancouver, CanadaDate^ July 14, 1992DE-6 (2/88)ABSTRACTThis study gathered data on: What are the community identified substance abuse prevention needs in a culturally diverse, low income, urban community?The study focused on the Collingwood area ofVancouver as it is a multicultural,low income, andurban neighborhood.The study identified community opinion on localprevention needs by interviewing twelve area residents,eleven social service providers, and two distributionemployees (total n=25). A content analysis methodologywas used to identify ten frequently cited themes underattitudinal and strategic classifications.The results indicate resident and providerdifferences. Residents are tolerant and providers viewthis tolerance as denial.Residents favor social control and treatmentstrategies; providers favor attitude change andholistic strategies.^Existing resources were seen asfragmented and early prevention education as beingcentral to a comprehensive strategy. The implicationsof these findings for planners is discussed.Abstract^ iiTable of Contents List of figuresAcknowledgments^ viChapter One - Introduction ^ 1Importance to Social WorkDefinition of Substance Abuse PreventionExtent of the problemPurpose of the researchAbuse PreventionConsumer attitudesResearch designDesign RationaleDefinitionsCommunity ProfileSummaryChapter Two - Literature Review ^ 17IntroductionThe Extent of the ProblemThe Extent of the Alcohol ProblemThe Scope of the Drug ProblemRationale for Consumer SurveysLocal Community StudiesCommunity Tolerance towards ConsumptionPrevention Paradigms and their ImplicationsThe Role of Public Policy in PreventionSummaryChapter Three - Methodology ^ 44PurposeSample SelectionSocial Service Provider SelectionResidents SelectionDistributor SelectionSummary of Subject SelectionMeasuresDevelopment of QuestionsReliability and ValidityData AnalysisSummaryChapter Four - Presentation of Findings^63Introduction- iv -AttitudesCollingwood, a community of communities?"If substance use does not affect me it is none ofmy business"Substance use is part of a Social ContextSubstance abuse: health, family, and social costsSubstance abuse and the criminal subculture"Fragmented... under coordinated and under fundedresources""Advertising makes too big a deal of it""Government should put it's money where it's mouthis"A change in societal attitude is needed"A continuum of services available to everyone"SummaryChapter Five - Discussion^ 85IntroductionImplications of Attitudinal ThemesThe Consumption ModelSubstance abuse and the criminal subcultureWalk the walkStrategiesDevelopmental PlaceInterpersonal and family implicationsFragmented... under coordinated and under-fundedresourcesGovernment CommitmentA continuum of servicesLimitations of the studyImplications for future researchConclusionBibliography^ 101Appendices^ 113Appendix A: Certificate of approvalAppendix B: Resident characteristicsAppendix C: Explanatory letterAppendix D: Service provider characteristicsAppendix E: Permission to be interviewed letter- v -Appendix F: Interview GuideAppendix G: Sample of Interview NotesList of FiguresFigure i. Map of Collingwood- vi -AcknowledgmentsMy appreciation goes out to the many people whohelped bring this project to completion. Thank-you tothe members of The Collingwood/Champlain HeightsCommunity Substance Abuse Prevention Committee fortheir assistance, belief, and trust. I know thatreading, second rating, and editing page after page ofcopy is a difficult and trying task. Thank-you Jim,Paula, and Gary for doing this. Thank-you toCollingwood Neighbourhood House for theiradministrative help and moral support.A special note of appreciation goes to Ingrid forher editing and support, especially for beingunderstanding about those "stay at home" weekends andher sharing of the word processor. Thank-you to mynephew Brad for his assistance with the libraryresearch. Finally, thank-you to my committee membersRoop Seebaran and Dr. Mary Russell for their invaluableadvise, assistance, and patience.My heartfelt thanks to all of you.Tom1CHAPTER ONE: INTRODUCTIONThis study gathered data on: What are the community identified substance abuse prevention needs in a culturally diverse, low income, urban environment. Thestudy attempts to provide data helpful to localprevention planners and for academic purposes bystudying community attitudes towards substance abuseprevention. Other local studies have focused onspecific ethnic group attitudes towards prevention needs(Legge, 1989; Urban Native Needs, 1988) or studiedsmaller non-urban communities (Neilson, C., Morris, B.,& Mason, T., 1988; Mason, T., Morris, B., and Neilson,C., 1989; Schultz, L. and Bryne, G., 1989). None havestudied multicultural, low income, urban environments.This research attempts to provide exploratory data onthat topic.Importance to Social WorkUrban substance abuse prevention needs were selectedfor study as social workers are frequently required todeal with substance abuse related problems. Forexample, child welfare workers must respond to substance2related "parental inability", health care workers to theimpact of substance related injury and disease, andjustice workers to the results of substance relatedcrime. In addition all three fields need to deal withproblems related to Fetal Alcohol Syndrome and NarcoticAddiction Syndrome. Obviously, successful attempts atdecreasing and preventing substance abuse will result ina decrease in related problems.Social service professionals are charged with theresponsibility to assist people overcome individual andsocial problems. Traditionally, drug and alcoholprograms have focused on helping those that are addictedor helping those who are affected by someone'saddiction. Only recently have we moved beyond helpingabusers and their families and attempted to preventabuse before usage becomes problematic (Ashley andRankin, 1988).Definition of Substance Abuse PreventionProfessionals and community members tend to havediffering definitions of substance abuse prevention.For some, prevention is primarily an education processthat targets children and youth. For others, preventionattempts to decrease the negative consequences ofdysfunctional usage. This study defines substance abuse3prevention as any activity designed to hinder orforestall the dysfunctional use of alcohol and otherlicit drugs, and to obstruct and hinder all usage ofillicit drugs.Extent of the problemAs 10% of adult Canadians can be classified asalcoholic and as 20% experience family or violenceproblems as the result of alcohol consumption, alcoholabuse must be seen as Canada's number one drug problem(Survey Canada, 1990). While substance use in allcategories except cocaine is decreasing, the negativefinancial and social costs of substance abuse remains asignificant concern (Alcohol and Drugs in Canada,1989).Many diseases such as, liver failure, kidneydisease, and fetal alcohol syndrome are the directresult of alcohol abuse (Liquor Policy Review [LPR],1987; Alcohol and Drugs in the Workplace, 1987; Alcoholin Canada, 1989).Many deaths occur due to accidents that result fromthe physical and mental impairment commonly resultingfrom substance abuse (Alcohol and Drugs in theWorkplace, 1987; Counterattack, 1990). One half of the747 Canadian drivers killed in road accidents in 19854had a .15 alcohol level (Alcohol in Canada, 1989). Thisis twice the legal limit.The financial costs of substance abuse are not bornjust by the abuser; rather, the costs of substance abusealso affects the abuser's family and the widercommunity. Even non-users are affected if only in thatthey must pay higher taxes to deal with the results ofthe problem. Alcohol and Drugs in the Workplace (1987)reports that:"the negative results of alcohol consumption costthe Province over two billion dollars per annum,five times the amount earned through liquor sales ondealing with the negative results" (p. 4).The need for the addicted to obtain money to buyillicit drugs leads to increased theft, law enforcement,court, and insurance costs (Wardlaw, 1986).Besides the health problems associated withsubstance abuse, the behavioral impairment resultingfrom abuse has an impact upon the abuser's familial andsocial environment. The lowering of inhibitionsexperienced by many substance abusers increases familialand societal violence, and substance abuse is frequentlya factor in child abuse and neglect (Ashley & Rankin,1988; Wachtel, 1989).5Worker productivity and safety is also negativelyimpacted by substance abuse (Alcohol and Drugs in theWorkplace, 1987).Purpose of the ResearchThis study attempts to provide exploratory dataregarding community opinion on the substance abuse needsin a multicultural, low income, urban community. Theactual community under study is the Collingwoodneighborhood of Vancouver, British Columbia. Thisresearch is a necessary first step in defining localneed as it is the first time that Collingwood'ssubstance abuse prevention needs have been examined. Itis hoped that the results can be generalized to similarurban areas and be helpful to those interested insubstance abuse prevention programming.Abuse PreventionResearch shows that prevention strategies candiscourage use and abuse (Botvin, Baker, Dusenbury,Tortu, and Botvin, 1988; Alcalay, 1983; and Flay,1986). These programs aim at preventing substance abusethrough a myriad of methods. Some attempt to decreasecommunity consumption rates (e.g. the British Columbia6Provincial Government's "TRY Program" and awarenesscampaign to discourage alcohol consumption by pregnantwomen). Other strategies attempt to change communityattitudes towards use (e.g. The United StatesGovernment's "Just Say No Program"). Other strategiesattempt to influence children and youth through schooland peer group approaches. School based programs suchas the Vancouver School Board sponsored Secondary School"Counterattack Club Program" is but one example of apeer based strategy. Traditionally Government has alsoattempted to influence consumption through public policyand legislation. Legislation passed by both UnitedStates and Canadian legislators in the 1930's was adirect attempt to prohibit alcohol consumption. TheBritish Columbia Liquor Control Act prohibits alcoholconsumption by those under nineteen years of age and theCanadian Narcotics Control Act and the Food And Drug Actprohibits or controls the consumption of certain otherdrugs and substances.While it is difficult to measure the effectivenessof these approaches at reducing consumption, it isinteresting to note that alcohol and drug consumptionrates have fallen since the mid 1980's. This mayindicate that there is a positive relationship betweenthe establishment of many of these prevention programs,in the late 1970's and early 1980's and decreasingconsumption rates starting in the mid 1980's. Moreresearch is required, however, before such correlationcan be convincingly demonstrated.Consumer Attitudes This study focuses on the identification ofcommunity attitudes by sampling both professional andresident informants. While professionals are wellplaced to comment on certain aspects of community need,authors such as Larsen (in Russell, 1990), note thatconsumer opinion is necessary to counteract "supplierdominated" and incomplete data. This problem ismagnified with disadvantaged consumers as they oftenlack the economic resources to allow choice betweenservices and the political power to influence the actualoperation of services. Consumer opinion was sought bythis study in the attempt to rectify the imbalancebetween service suppliers and consumers.Research DesignThe study identified community opinion on localprevention needs by interviewing twelve area consumers(residents, n1=12), eleven social service providers(n2=11), and two distribution employees (n3=2). A8twelve question interview guide containing both commonand supplementary subgroup questions were asked. Thequestions were selected to meet six specific researchobjectives.Field notes were transcribed, coded, and groupedusing content analysis into significant themes. Thethemes were then further analyzed and discussed.Design Rationale The research used operational inquiry, qualitativemethodology, interviews, and content analysis toidentify substance abuse prevention needs.Qualitative methods were used in combination with aneeds focused interview guide to identify communityprevention themes. According to Patton (1989),qualitative methodology is:"particularly oriented toward exploration,discovery, and inductive logic... categories ordimensions of analysis emerge from open-endedobservations as the evaluator comes to understandthe patterns that exist in the empirical world understudy" (p. 44).The development of the interview guide drew heavilyon the work of McKillip (1987). According to McKillip,9need focused research must be designed around twojudgements: "(a) services available to a population are(or are not) adequate; and (b) if inadequate, specificactions will correct the inadequacy (p. 7). Given therelationship between "needs" (inadequate services) andspecific actions, this study attempts to both identifyexisting needs and discuss possible actions (strategies)to address those needs.Due to the needs and solution focus of the research,the study used the five steps of Need Analysis suggestedby McKillip (1987). McKillip describes these steps as:1) the identification of users and uses; 2) thedescription of the target population and the serviceenvironment, 3) the identification of problems andsolutions, 4) the assessment of the importance of theneeds; and 5) the communication of results.Due to the absence of previous local research onsubstance abuse prevention and the qualitative focus ofthis study, the research design was largely exploratoryin nature. According to Patton (1989):"responses to open-ended responses permit one tounderstand and capture the the points of view ofother people without predetermining those points ofview through prior selection of questionnairecategories" (p. 24).- 10 -Given the qualitative and exploratory nature of thisstudy, a face to face, open-ended interview format wasselected as the most productive and feasible method toexplore these new data. It was also hoped that thesense of human connectedness that can develop in face toface and responsive conversation would have helped toactivate research subjects in future prevention efforts.A content analysis methodology was used to analyzethe data. According to Berelson (in Bailey, 1978):"content analysis is a research technique for theobjective, systematic, and quantitative description ofthe manifest content of communication" (p. 276). Bailey(1978) asserts that content analysis "first constructs aset of mutually exclusive categories that can be used toanalyze documents, and then records the frequency withwhich each of these categories is observed in thedocuments studied" (p. 277).This data was then analyzed and frequently occurringthemes were noted, identified, and discussed.Definitions Substance Abuse, Alcoholism, and Addiction: Alcohol and Drugs in the Workplace, in 1987, definedalcoholism as:"a disease characterized by the repetitive andcompulsive ingestion of... ethanol (alcohol)... asto result in interference with some aspect of theperson's life, be it health, career, interpersonalrelationships, or other required societaladaptations. Alcoholism represents a dysfunctionalor maladaption to the requirements of everydaylife."Mueler and Ketchum (1987), support the Report'sdefinition. They describe current community attitudetoward substance use as being permissive and tolerant aslong as one can function appropriately in society.Need: Neysmith (1983) notes that need can be"conceptualized in a variety of ways but all emphasizeits judgemental and relative nature. This must be keptin mind when undertaking a needs study for the purposeof defining and providing services" (p. 8).The study provides data on normative, felt,expressed, and comparative needs (Neysmith, 1983;McKillip, 1986). Normative needs are those that aretypically defined by experts regarding desiredprofessionally acceptable standards. Most normativedata was obtained from interviews with local areaprofessionals. Felt needs are those that an individual- 12 -believes must be met in order to maintain individuallydefined standards. Several open-ended questions wereselected for use in this study to elicit individualopinion on "felt" substance abuse prevention needs.Expressed needs are typically those that are articulatedwith regards to specific services. This study askedseveral questions regarding existing services that weredesigned to elicit data on expressed needs. Comparativeneeds are those that compare the individual's perceivedneeds with those of others. This study collected dataon comparative needs by asking a specific questionregarding unique ethnic, age, or gender relatedsubstance abuse prevention needs.Obviously, all of the needs identified by this studyare subjective in nature and vary between individuals.Neysmith (1983) cautions:"these (subjective) factors must be taken intoconsideration if the information is to be useful andthe developed service utilized" (p. 11).Community ProfileVancouver, like many other Canadian cities, hasexperienced considerable change in the recent years.The city has grown from a frontier outpost of largelyEuropean and First Peoples residents, into a- 13 -multicultural urban center serving a region of nearlytwo million residents.Early immigrants were typically of Europeanbackground. In recent times however, most off shoreimmigration is from Pacific rim countries. Vancouver,therefore, is a city in transition and social plannersare faced with a myriad of changing social problems.In terms of substance abuse prevention, very littlehas been done to study needs in such ethnically diverseurban settings. Most local studies have focused onspecific ethnic group prevention needs (Legge, 1989;Urban Native Needs, 1988) or studied smaller non urbanenvironments (Neilson, C., Morris, B., & Mason, T.,1988; Mason, T., Morris, B., and Neilson, C., 1989;Schultz, L. and Bryne, G., 1989).Collingwood is an approximately eight squarekilometre area of Vancouver, B.C. located in the eastcentral area of the City (figure 1). It consists of thearea between East 45th Avenue, East 22nd Avenue, NanaimoStreet, and Boundary Road (the boundary betweenVancouver and the Municipality of Burnaby).According to the 1986 Canadian census (StatisticsCanada), almost 26,000 people live in Collingwood.Approximately 50% of the population speak English as afirst language, 25% speak Chinese or Vietnamese, 13%COLLINGWOOD- 14 -Figure 1: Map of Collingwood- 15 -speak languages originating in the Indian subcontinent,5% speak Spanish, and 6% speak other languages. Of allhouseholds 70% have children and single parent familiesrepresent 14.5% of the population. Of area residentsover 15 years old 70% have literacy rates below thegrade nine level. Approximately, 16% of area residentsare under 12 years old, 16% are aged between 12 and 24,and 68% are over 24 years old while 21% are seniorcitizens.In 1986 annual average income of all Vancouverfamilies was $39,9086; the average median was $32,418.The Collingwood average family income was $33,076 andthe median family income was 32,418.^This dataindicates that Collingwood's average family income was$6832 less than the city average and the median $1600less. Given these below average income levelsCollingwood can be defined as being a lower income area.Summary Substance abuse has a serious impact on thecommunity. Traditionally, researchers have focused onapproaches that have attempted to "pick up the pieces".Only recently have social planners begun to developorganized strategies designed to prevent substance abusebefore it becomes a problem.- 16 -Most local research on prevention needs have studiedsuburban or semi-rural environments or specific ethnicgroups. Very little research exists on the preventionneeds of multicultural, low income neighbourhoods. Thisstudy attempts to provide data on these needs.In the following chapter, relevant statistics,indicating current consumption trends will be reviewedto determine the scope of the abuse problem. Thisreview is followed by an examination of the role ofcommunity attitudes upon usage and several theoreticalprevention paradigms are presented and discussed.- 17 -CHAPTER TWO - LITERATURE REVIEWIntroductionThree areas of literature were reviewed by thisstudy. Reports and statistics were reviewed in theattempt to understand the extent of the problem. Thisexamination is particularly important to those that mustbalance competing needs and set spending priorities.Local studies and articles were examined tounderstand the impact of community attitudes onidentifying substance abuse prevention needs.Understanding community attitude and consumersatisfaction is helpful to those designing programs thatreflect community attitudes and to those attempting toinfluence them. Finally, literature regardingtheoretical prevention paradigms was reviewed to providea theoretical framework to those attempting to developspecific prevention programs.The Extent of the ProblemThis study draws heavily on the 1987 work of J.McKillip, Needs Analysis: Tools for the Human Services and Education. McKillip, suggests that National orProvincial statistics can be used to determine need in- 18 -local studies as: "prevalence rates for demographicgroups from smaller areas are the same as rates for....groups on a larger level (p. 45 Holzer, Jackson, &Tweed 1981, in McKillip, 1987)".The benefits of using this data is that it isreadily available, inexpensive, and can act as proxymeasures of the local situation or problem (McKillip,1987).As few statistics exist dealing specifically withCollingwood substance use and abuse, a variety ofconsumption, social, legal statistics covering Canadian,British Columbian, and Collingwood patterns and trendshave been reviewed as part of this study. A review ofthese data gives some indication of local trends andpatterns.Also, as Collingwood is a multicultural community,data focusing on Chinese, Vietnamese, Spanish speaking,Indo-Canadian, and Native prevention needs werereviewed and reported. These documents were used toexamine the scope of the alcohol and drug problemgenerally and Collingwood's problems specifically.The Extent of the Alcohol ProblemAlcohol abuse is the number one drug problem inCanada: 80% of Canadians are drinkers and 10% have- 19 -alcohol related problems. In 1986, conservativeestimates cited the Canadian ratio between profits fromthe sales and the money spent to address problems as$3.78 billion vs. $5.25 billion (Alcohol in Canada,1990).Some Reports, such as, The Report on Alcohol and Drug Abuse in the Workplace  (1987), cited social costsas being five times higher than the money received inincome. At the same time, Canada has the eighteenthlowest per capita consumption rates of twenty-eightindustrialized countries (Alcohol in Canada, 1990).Canadian consumption peaked in 1980 at 11.3 litresof absolute alcohol per person per year. This rate fellto 10.2 litres in 1986. This represents an 8%decrease. Since 1986, this pattern of decreasing usagehas continued, with the highest decreases occurring inthe youngest and oldest groups. While these trends areencouraging, current consumption rates remain almosttwice the 1950 (5.9 litre) rate (Alcohol in Canada, 1990).In 1986, 11% of current drinkers, drink more thanfour times per week and 6% have more than 15 drinks perweek. Approximately 20% of Canadians reportexperiencing family problems or violence as the resultof drinking (Survey Canada, 1990). In 1985, 10.3- 20 -million trips per month were made by impaired drivers.Half of these trips were made by 3% of the population.One half of all car fatalities are the result ofimpaired driving. The 16 to 19 age group have thehighest car fatality rates, many of which involvedintoxication (Alcohol in Canada, 1990).Generally speaking, men drink more than women (88%vs. 78%) and men consume more at a sitting. This gap isnarrowing as more men are now not drinking or drinkingless. Separated, divorced, and single people consumethe most alcohol per week. Widows are the least likelyto be current drinkers (Survey Canada, 1990).Higher income and education groups drink morefrequently than lower income and education groups, butthe lower income and education groups drink more at asingle sitting (Survey Canada, 1990).While declining consumption rates among the youngare encouraging, the earlier one starts drinking thegreater the likelihood of developing alcohol relatedproblems in adulthood. Unhappily, the first time medianalcohol usage in B.C. appears to be decreasing. In1986, it was 14 years of age; a dramatic decrease from1956 median age of 18 years of age (B.C. Policy Review, 1987).B.C. has the highest alcohol consumption rates of- 21 -all Canadian Provinces, (1982: 12.5 litres; 1986: 11.2litres; and 1989: 10.9 litres). These rates indicate a2.7% decline in average consumption since 1985. (B.C. Liquor Distribution Branch [BCLDB], 1990).Impaired drivers arrest statistics have fallen bymore than 50% since 1977. Vancouver is 8% below theProvincial average in terms of impaired driving charges(Counterattack, 1989).Collingwood consumption patterns are difficult todetermine. The Senlac Liquor Store (located inCollingwood at Kingsway and Senlac Street), soldapproximately $10 million worth of product in 1989.This represents an 11% decrease in sales since 1982.This decrease does not necessarily measure localconsumption patterns as it does not take into accountpopulation growth nor increased non-Governmental outlet"off sales" from other distributors. Senlac statisticsindicate that residents prefer beer (7.5% above theprovincial average) over spirits (10% below theaverage) and wine (5% below the average) (BCLDB Annual Reports, 1986 to 1989).It is interesting to note that Collingwood'spreference for beer over wine and spirits may be anindicator of class preference in drinking patterns. TheCanadian survey on Alcohol and Drugs (1989) notes that- 22 -higher income respondents tended to drink more wine andspirits than low income respondents.The Scope of the Drug ProblemLicit Drugs Canadians are high users ofPrescription drugs (1985: 8% sleeping pills; 6%tranquilizers; 2% pep pills). B.C. and Quebec have thehighest provincial usage rates (Drugs in Canada, 1990).Women use more prescription drugs than men at aratio of 1.7 to 1 and doctors more frequently prescribedrugs to women than men, even when patients presentsimilar symptoms. In 1982, seniors surpassed middleaged women as the highest prescription drug user group.Lower income groups use at higher rates than higherincome groups (Survey Canada, 1990).Collingwood's lower economic status and high numberof single female residents could be indicative of highlicit drug consumption rates.Illicit Drugs Generally speaking, illicit druguse is lower in Canada than the U.S.A. Cocaine and"crack" use is much lower than in the U.S.A. and someresearch suggests that it is not as large a problem asreported. In 1982, 3.3% of Canadians reported usingcocaine at least once in their lifetime: by 1987, 6.1%- 23 -reported at least once in lifetime use (Drugs in Canada, 1990).Use of other illicit drugs is decreasing (usagepeaked in the mid 1980's). In 1980, 20% of Canadiansreported at least once in lifetime use and 12% werecurrent users. In 1989, 23% reported once in lifetimeuse and 6% were current users (Drugs in Canada, 1990).B.C. has the highest illicit drug use of all theCanadian Provinces. In 1989, 9.6% of British Columbianswere current users (Survey Canada, 1990).In 1987, 30% of B.C. adolescents had used cannabisand 14.2% had used hallucinogens in the previous year,and 52% of adolescents claimed that marijuana was fairlyeasy to get.A review of B.C. police statistics reveals thatheroin charges peaked in 1978, at 0.324/1000 and havedeclined to a low of 0.087/100 in 1989. Cannabischarges peaked in 1982 at 3.860/1000 and fell to3.080/1000 in 1989. Controlled and restricted drugssimilarly peaked in 1983 and have been decreasingsince. Conversely, cocaine charges rose from 0.071/1000in 1979 to 0.951/1000 in 1989 (B.C. Police Statistical Summary, 1990).If Collingwood's illicit drug use patterns resemblethose reported by these studies, we would expect area- 24 -youth to be the largest group of illicit drug users.Their most frequently used drug is likely marijuana.Local use of illicit drugs should be decreasing,although cocaine usage is probably on the rise.Rationale for Consumer Surveys According to McKillip, client surveys, due to theirexposure to the service, tend to measure clientsatisfaction and choice. Client surveys are also citedas being particularly helpful when identifyingbarriers. As the client group targeted in communityprevention programs is the residents, "client" relateddata was obtained from residents and people involved inrecovery from substance abuse (e.g. AlcoholicsAnonymous).Also, as is noted by Russell (1990): "only bysystematically soliciting client feedback that iscomprehensive and informative, can the imbalance ininfluence between consumers and suppliers of socialservices be rectified" (p. 44).McKillip notes that key informant surveys are notedas being normally inexpensive and relatively easy touse, but tend to provide data which is limited andfocused on specific agency need.- 25 -Local Community Studies Ethnic Studies Legge's 1989 study used selfreported questionnaires and interviews (n=328) withChinese, Vietnamese, Indo-Canadian, and "Latin"community members (n2=233) and "key informants" (n1=95)to determine B.C. ethnic alcohol and drug educationneeds. Legge notes that: Chinese men drink frequentlybut moderately, Vietnamese men drink more frequently andin higher amounts than the Chinese; Latins (Spanishspeaking) men were found to be frequent heavy drinkers;and Indo-Canadian men tend to be weekend drinkers (morethan four drinks per sitting).Chinese people are perceived as not toleratingdrunkenness; Vietnamese and Latins accept occasionalinebriation. All groups view teen and femaleintoxication as being unacceptable and cite single menas being most in need of prevention services.Illicit drug use was not reported as a major concernin any group except the Latins. Spanish speakers wereparticularly concerned about substance usage amongyouth.Generally, these groups saw the need for a range ofprevention services in English as well in their nativelanguages. As Collingwood has significant percentagesof the ethnic groups studied by Legge, we can speculate- 26 -that the area shares many of these consumption patterns.Native people are seen as needing culturallysensitive approaches that recognize the unique problemsfaced by Native people (Native Needs, 1988).Suburban and Rural Studies Mason, Morris, andNeilson (1988), studied the Squamish area's Alcohol andDrug Program needs by surveying community informants(n1=498) and interviewing Health, Justice, and Schoolprofessionals (n2=42). The authors found that existingprograms were effective but insufficient to meetcommunity needs. Youth and family services wereidentified as being the greatest need. The study notesthat most alcohol and drug problems are life-stylerelated and that community attitudes that tolerate orencourage alcohol and drug abuse need to be changed.Mason et al. suggest that more youth orientatednon-substance related recreation programs are especiallyneeded. This could explain why usage is high amongyouth in the northern Regions where recreational optionsare fewer. Generally, the study found that more effortshould be put towards awareness and education campaignsto confront denial and raise "the public conscience"about the effects of substance abuse. The authors alsosuggest stricter enforcement of existing laws.- 27 -Neilson, C., Morris, B., & Mason, T. (1989),interviewed and surveyed a random sample of arearesidents (n1=190) and selected key informants (n2=44)to study the Whistler area's alcohol and drug preventionneeds. The study included several informants involvedin the distribution of alcohol in their key informantgroup.The study found that a majority of respondentsbelieved that alcohol abuse was a significant problemfor the community. Approximately 25% of respondentsreported that some member of their family had a problemwith substance abuse.Neilson et al. report boredom and isolation as beingthe major causes of substance abuse. Increasedrecreation and social activities were the most oftencited solution to alcohol and drug problems. Teens andyouth were seen as being the most in need of non-drugrelated social activities. Increased education andawareness, psychological services, and law enforcementwere also reported as being significant substance abuseprevention needs.Schutz, L. & Bryne, G. (1989), studied substanceabuse prevention needs in Port Moody, Port Coquitlam,and Coquitlam (Tricities). The study used thirteenprofessional group meetings and a mail out parent- 28 -survey (n2=232) to identify youth substance abuse needsin the Tricities.The study's results were used to make elevenspecific recommendations regarding potential solutionsto youth substance abuse prevention needs in theTricities. The study identified the following: (1)further research in non-suburban, non-middle classcommunities, (2) development of the local task force,(3) increased government funding, (4) target the entirecommunity for awareness campaigns, (5) personalize theimpact of the problem, (6) focus on education andprevention, (7) increase community involvement, (8)concentrate on elementary schools, (9) comparativestudies, (10) use former users in publicity campaigns,and (11) more prevention program volunteers.While these non-ethnic focused studies do provideinteresting data, their relevance to Collingwood must bebalanced against differences in the communitiesstudied. Both the Squamish and Whistler areas are muchmore rural than Collingwood. Further, Whistler is aresort community that promotes, according to the study'sauthors, a "party atmosphere" focusing on the "weekendcrowd". This party and tourist community focus,encourages the community to have a tolerant attitudetowards alcohol consumption and intoxication.- 29 -The Tricities study, focused exclusively on youthneeds in three suburban communities. This study notesthat one of the limitations of their study was the"middle class" demographics of the sample. The youthfocus and its middle class nature limit the relevance ofthe Tricities study to Collingwood's needs.Community Tolerance towards ConsumptionIn order to interpret community opinion on substanceabuse prevention it is helpful to understand communityand consumer attitudes and tolerance levels. Ashley andRankin (1988), provide a conceptual framework forunderstanding the attitudinal diversity regardingacceptable alcohol consumption. The authorsconceptualize community attitudes as falling into fourcategories: (1) morally wrong, (2) disease, (3)integration, and (4) population consumption.The morally wrong to consume model is held bycertain religious groups such as Baptists, Mormons,Muslims, and Sihks. For these groups the consumption ofalcohol is viewed as being sinful, therefore, anyconsumption is unacceptable and wrong. These groupstend towards prohibition and abstinence as being thepreferred prevention approaches.The disease model, held by groups such as Alcoholics- 30 -Anonymous, view addiction as being a disease, therefore,they tend to view prevention efforts as needing to focuson high risk groups. Individuals who view substanceabuse as a disease tend to view prevention asencouraging those predisposed to addiction to abstain orto encourage those effected by the disease to seektreatment at its early stages.The integration model defines alcoholism as the"failure to integrate alcohol use into everydayfunctions of society." The integration model isfrequently used by those who drink alcohol but who alsotend to view addiction and alcoholism as a moralweakness. The authors argue that this model has led tosociety tending to ignore increasing health and socialcosts as it presumes that the majority can drink alcoholwithout becoming addicted. They note that this modelhas dominated North American policy making since the mid1940's. The ideas represented by the integration modelalso lend support to the functional definition ofalcoholism expressed by writers such as Mueler andKetcham (1987).The population consumption model focuses on thecommunity. The central thesis is that if averagepopulation consumption rates are decreased the hazardousresults of over drinking will also be decreased. Smart- 31 -(1987), points out that decreasing provincialconsumption rates in Quebec, Ontario, and Alberta,between 1974 and 1983, have resulted in a decrease inalcohol related problems in Quebec and Ontario.We can expect community opinion on substance abuseprevention to reflect individuals holding each of thesebeliefs towards prevention. Researchers, therefore,must attempt to be aware of the prevention orientationof the data source, as that attitude will color and biasthe data and will influence their perception of possiblesolutions.Prevention Paradigms and their Implications McKillip (1987), argues that there is a relationshipbetween how one defines needs and the resultingsolutions. Further, he asserts that the identificationof needs inevitability leads to an examination ofservices designed to met those needs. As these two"judgements" are interrelated, a comprehensiveliterature review must discuss both dimensions toachieve a complete understanding of the issue.This next section discusses the theoreticalparadigms frequently used by prevention planners. Inrecognition of the interrelationship between thedefinition of need and the resulting prevention- 32 -approach, examples are provided for each paradigmdiscussed.Johnston, Amatetti, Funkholder, and Johnston,(1988); discuss nine theoretical paradigms commonly usedwhen addressing substance abuse prevention needs. Thesetheories are: (1) social learning, (2) cognitivedissonance, (3) developmental, (4) behavioral intention,(5) social development, (6) health behavior, (7) druginvolvement stages, (8) deviant response, and (9)sensation seeking.Social learning theory sees drug using behavior asbeing learned through the influences of reward,punishment and social modeling. When attempting toinfluence usage decision making towards non-use sociallearning theory frequently uses a team or group approach(often involving "near peers" and other modelingrelationships) in the attempt to establish non-usingnorms. For example, public education campaigns that usecultural trend setters to promote a non use message,abstinence support group programs such as AlcoholicsAnonymous, and the school based "Dry Grad Program" use asocial learning prevention approach. Public educationcampaigns that stress the negative consequences (e.g.imprisonment), of substance abuse is another example ofthe use of this approach.- 33 -A social learning approach is most frequently usedby contemporary substance abuse prevention planners(e.g. if you drink, don't drive).Gullotta and Adams (1982), note that the goal ofprevention education is to increase social learning andknowledge, in the hope that this will result inincreased manifestation of the desired behavior. Theyfurther note that apparently successful educationalapproaches include multifaceted features beyond stricteducational tools. They assert, therefore, thatsubstance abuse education programs: "need to utilizeevery available tool, while using multiple theoreticalperspectives to achieve some degree of success" (p.418).Coombs, Santana, and Fawzy (1984), suggest that druguse is a learned behavior that occurs with youth raisedin a variety of social conditions. They assert thateducating parents how to have more positive interactionswith their children will result in increased childself-esteem and increased determination to resistpressure to use from drug using peers.Strickland and Pittman (1984), integrate peer basedsocial learning and media exposure to reduce substanceuse. The authors argue that these two theories arerelated and that we must have a more comprehensive- 34 -explanation of adolescent problem drinking if we want toreduce it.Alcalay (1983) found that the most preventionfocused media campaigns seek to increase knowledge or tochange behavior and attitudes, in the hope that behaviorwill change as a consequence. Alcalay argues that thisassumption is now being challenged by researchers. Sheasserts, rather, that these campaigns tend to reinforcealready accepted behavior. She argues that the mediadoes not change the behavior of those who have alreadycome to the decision to use. She also notes that oneweakness of mass media campaigns is that they do notallow feedback nor interaction. This lack ofinteractiveness and the tendency to view the individualas an object and not unique human being, lessen theimpact of the message being communicated.Cognitive dissonance theory holds that what one'sbeliefs and attitudes are reflected in one's behaviorand that when they are not, the individual experiences acertain "cognitive dissonance" that he or she willattempt to eliminate. Prevention programs using thistheoretical perspective tend to "cognitively inoculate"individual community members largely by promoting verbalnon-use messages. For example, public education- 35 -campaigns that promote the message that "cool" peopledon't use drugs is an attempt to associate popularityand social desirability with drug abstinence. In thisexample, cognitive dissonance theorists would hold thatif the individual comes to believe that being "cool" andusing drugs are incompatible, people desiring to be"cool" will have to say no to drugs or else their"coolness" would be in question.Interestingly, Williams, Ward, and Gray (1985),found the "credibility" of the communicator to be themost significant factor in accepting a non-use messagein one school based prevention program.The United States Government sponsored "Just Say No"campaign is one well known example of the use of thisapproach.Frequently, social dissonance programers will backup the non-use message with the teaching of refusalskills. One method of teaching refusal skills is forthe teacher to verbally describe a drug taking socialsituation and help individuals identify strategies thatthey can use to avoid usage. The teacher may also userole play techniques to provide the student anopportunity to practice using these techniques.Gullotta and Adams (1982), discuss using a similarapproach with youth. The authors attempt to promote- 36 -feelings of self worth as a means of reduction of thelikelihood of substance abuse. While a myriad of selfworth techniques exist, programs using this tool attemptto reinforce and strengthen the individual and his orher environment rather than focus on stemming the supplyof the substance.Developmental theory conceptualizes human life asbeing organized around meeting certain age appropriatebehavioral, social, and intellectual goals.Developmental theory holds that prevention programsshould be designed in recognition of the developmentalplace of the target population. For example, childreneight to twelve are typically seen as not being able tothink abstractly, therefore, substance abuse preventionprograms designed for this age child should be concreteand give a non-ambiguous non-use message.Ericksen (1956), viewed adolescents "as impatientidealists" who are in search of identity; their questionbeing "who am I?" Prevention programs aimed atteenagers using this approach attempt to help youth formpositive non-use identities around their ideals.Oeting and Beauvais (1986), take a developmentalorientation when they discuss drug use and the peeridentification process in adolescence. They point outthat understanding and using the adolescent's peer group- 37 -as a change agent is an important factor inunderstanding and preventing usage.Behavioral intention theory suggests that a person'sattitudes, beliefs, sense of normalcy, and expectationscan be used to predict the likelihood of that persondemonstrating a specific behavior. Behavior is seen asbeing influenced by a number of variables that linktogether to produce a specific behavior. Johnston etal. (1988), suggest that the predictability of aspecific behavior is influenced by four centralcriteria; (1) the nature of the action, (2) target, (3)context, and (4) time. An individual will be influencedby all of these factors and a change in any one of themmay have significant impact on the behavior. Forexample, if the nature of the action is intoxication,the target is alcohol, the action is driving a car, andthe time is rush hour, an individual may not choose todrive a car. However, if the time variable is changedto four a.m., the same individual may choose to drive.Also, behavioral intention theory highlights theimportance of social norms of influencing behavior. Forexample, one social group might perceive it to beacceptable and normal to drink and drive (e.g. peopleliving in isolated locations) while another group doesnot (e.g. people living in high traffic volume areas).- 38 -Knowing and attempting to influence a group's sense ofnormalcy can therefore serve as a valuable preventiontechnique. For example, people living in isolated areascould be informed about the higher number of single caraccidents and deaths resulting from impairment.Gullotta and Adams (1982), suggest that efforts thatattempt to change normative (accepted community levelsof tolerance) drinking and drug taking behaviors, suchas media campaigns, education, and legal fiat, are threecommonly used community mobilization tools.The social development model uses attachmentsbetween individuals and other social units to influencesubstance usage. Ideally, social development theoryseeks to create a positive peer group while at the sametime it ensures that society provides a clear andconsistent messages about usage and abuse. Thisapproach is frequently used by social minorities, suchas the native peoples, as a central preventionphilosophy.Gullotta and Adams (1982), cite natural care giverand self help groups as social units that can influencesubstance abuse prevention. These groups typicallyorganize around a specific problem in the attempt tosolve it. Mothers' Against Drunk Drivers (M.A.D.D.) andthe "Dry Grad Program" are examples of use of this- 39 -approach. Gullotta and Adams note that these types ofprograms provide a good starting point in thedevelopment of a comprehensive prevention program. Theycaution, however, that a comprehensive program must bebuilt around a combination of research, theory, andpractise in order to minimize substance abuse insociety.Health behavior theory views substance abuseprevention as part of a larger health strategy thatstresses the benefits of having a holistic perspectiveon the impact of an activity upon an individual'ssocial environment and his or her physical and mentalhealth. Prevention techniques using this orientationtend to promote health-enhancing behaviors that includethe individual's entire behavior repertoire.Swisher (1984) used cognitive approaches and asocial alternatives program to influence adolescentusage. He found that information alone was noteffective in reducing teenage usage but that thisapproach must be reinforced by involvement in a non-usesocial alternative group. Swisher adds that thiscombined approach was successful and "cost effective."Drug involvement stages theory views initiation todrug usage to be predictable given the presence of anumber of situational, interpersonal, and psychological- 40 -factors. Understanding and manipulating these factorsis seen as being essential when influencing usage orbehavior change. Approaches using this orientationfocus on early education aimed at gateway target drugssuch as cigarettes or alcohol.Botvin, Baker, Dusenbury, Tortu, and Botvin (1988),conducted a three year, large sample study ofeffectiveness of a school based prevention program inreducing cigarette smoking. The program resulted in asignificant reduction in cigarette smoking in theprevention program group.Deviant response theory views drug use and alcoholabuse as a manifestation of an individual trying to gainstatus within a deviant subgroup. This usage is seen asbeing an attempt to boost self-esteem. It isinteresting that some people seem to reject sociallyacceptable methods of increasing self esteem whileembracing other "deviant" methods of accomplishing thesame goal. This is a complex question which couldeasily become the topic of a separate thesis.Sensation seeking theory holds that an individualhas a need for sensory stimulation, and that substanceuse provides one opportunity to meet this end. Thistheory is often used by those who point out that thenumber of people reporting drug use decreases after age- 41 -thirty and that young men have higher sensation seekinglevels and alcohol consumption levels than young women.The Role of Public Policy in Prevention Public policy attempts to influence consumption byusing Government regulatory means to controlconsumption. Johnson et al, argue that alcohol relatedproblems decrease as the price for alcohol increases.They assert that by raising the minimum alcohol purchaseage, shortening the hours of sale, and otherdistribution controls results in a general decrease inalcohol related problems.MacDonald (1986) notes that changes in legislationin four American States designed to provide moreconvenient access to wine (sales in retail stores),resulted in a modification of consumption patterns.While wine sales increased, beer and hard liquor salesremained about the same. MacDonald concludes thatconsumers did not switch from beer and spirits to wine,rather the amount of wine that wine drinkers dranksimply increased.Smith (1986) notes that the number of alcoholrelated traffic problems and accidents increased in fourAustralian States in the six years immediately followingthe lowering of the drinking age from twenty to- 42 -eighteen. The Task Force on Substance abuse in the Workplace (1987), notes that while raising the drinkingage in B.C. would probably decrease the number ofalcohol related problems among young drinkers, theCanadian Charter of Rights and Freedoms, which sets theage of majority at nineteen makes such a moveimpossible.Casswell (1985) discusses some of the"organizational politics problems" that acted asbarriers to public efforts to stabilize or reducealcohol consumption rates in New Zealand. Among thegreatest opponents to these efforts were the "alcoholindustry, the advertising industry, and sportingorganizations." These groups all rely on alcohol salesas a source of income. Pressure from these groupstended to create political resistance to theestablishment of programs designed to decrease alcoholconsumption.Finally Johnston et al. (1988) suggest that aholistic approach that coordinates general healthpromotion activities, programs for targeted groups,media persuasion campaigns, and public policy in commonstrategy is needed. They conclude that: "a rationalprevention policy will have hundreds of items in it...they will all have to be done (p. 584)."- 43 -Summary The literature clearly demonstrates that alcoholismand substance abuse is a serious and costly socialproblem. A number of theoretical paradigms existregarding substance abuse prevention and it has beensuggested that multiple aspects of these paradigms needbe organized into effective prevention program.The following chapter will describe the steps andtheoretical framework used by this study to identifycommunity prevention needs.- 44 -CHAPTER THREE - METHODOLOGYPurpose The question posed in this study was, what are thecommunity identified substance abuse prevention needs ina culturally diverse, low income, urban environment.This data was collected to assist in the development ofan effective substance abuse prevention strategy forcommunities exhibiting these characteristics.As part of the larger research question six morespecific areas of investigation were addressed.i) to what extent is the community aware ofexisting substance abuse prevention programs?ii) what are the ways and means that communitymembers consider existing prevention services mightbetter meet the area needs?iii) what are community member perceivedbarriers, strengths, and gaps in existing substanceabuse prevention efforts?iv) what are current substance abuse preventionneeds as identified by local professionals,distributors, and community residents?v) what are the target groups for futuresubstance abuse prevention efforts?- 45 -vi) what are community priorities as identifiedby community members?Sample SelectionThis study used a small purposefully selected sample(n=25). McKillip (1987) argues that in even in smallscale limited surveys, samples should be selected thatprovide a variety of perspectives. He labels thismethod as "purposeful sampling". Purposeful samplinguses representatives of various subgroups and attemptsto measure variability and not central tendency.Consumer (resident) and supplier (service providersand distributors) opinion was solicited in recognitionof the importance of balancing community input inprevention planning.Each group was considered to have a differentperspective on substance abuse prevention.Two criteria were used to define the resident samplepopulation: nineteen years of age, and principledomicile maintained in Collingwood.Recruitment of volunteers through posters located atcentral community facilities was unsuccessful.Subsequently, two local community servicecommittees, the Area Services Committee and theCollingwood/Champlain Heights Community Substance Abuse- 46 -Prevention Committee (C.C.H.C.S.A.P.C.)., and threesubstance abuse community services, AlcoholicsAnonymous, Narcotics Anonymous, and Alanon werecontacted to ask for their assistance. All of theorganizations contacted were asked to publicize the needfor subjects and to ask interested potential subjects iftheir name and telephone number could be given to theresearcher. These organizational contacts then gavethese names to the researcher, who subsequentlycontacted them by telephone. Twenty-one potentialresident subjects were identified in this manner.Of the 21 residents, 12 were selected for interviewif the subject met one or more of the followingcriteria: first language other than English, young adultage group (under 35), former substance abuser, male (tobalance female predominance in the client group), andresidence in the less densely populated and commercialsouthern third of the study area (different communityfocus towards the Champlain Heights area).The final group of twelve subjects was thereforepurposefully selected around five variables: language,age, gender, recovery, and place of residence. Thefinal sample selected included all the E.S.L. (3), allunder thirty-five years of age (3), and all recovering(1) subjects. Four men were selected to add gender- 47 -balance and one resident who lived near in the southernthird of the area (see Appendix B: ResidentCharacteristics).Social Service Providers SelectionTotal sample of service providers was eleven(n=11). The sample included five categories: socialservice workers, school, medical, police, andrecreation. These categories were selected as theyrepresent major prevention groupings for services listedin community service directories and this study soughtto select two representatives each category.The central selection criteria used for serviceproviders was employment in an agency included in atleast one of the five service categories. In order toidentify these services providers, the Area ServicesCommittee was approached and asked to assist inparticipant identification. Explanatory Letters(Appendix C) were circulated at one of the Committee'sregular meetings.The service providers responding to this requestwere asked to briefly describe the substance abuseprevention aspects of their work and were assigned toone of the service categories. As a result of thisprocess seven service providers were identified either- 48 -through volunteering themselves or by discussing thestudy with their colleagues. This group contained twosocial service workers, two recreation workers, onemedical worker, one school representative, and onepoliceman. In order to complete the sample, theresearcher then directly approached relevant agencies: 4medical clinics, 2 school counselling offices, and thelocal police detachment.These agencies were initially contacted by telephoneand follow up Explanatory Letters sent to agreeingagencies.One school subject and one medical worker wereidentified as a result of these contacts. A secondpolice subject could not be recruited and was replacedby a child protection worker.After this sample was selected, it was noted thatthe absence of a multicultural perspective was ansignificant deficit. It was decided that amulticultural service provider be added to the study.The final service provider sample (n=11) consistedof: three social service workers, two recreationworkers, two school workers, two medical workers, onepolice worker, and one multicultural worker (Appendix D:Service Provider Characteristics).- 49 -Distributor SelectionDistributors of intoxicating substances have regularcontact with users and abusers, therefore their opinionsare useful when examining the area's prevention needs.While distributor input is helpful, it is also open tobias as the distributor makes money from sales. He orshe may not want to encourage a decrease in consumptionas that will impact upon profit.The original study targeted five types of localdistributors: liquor store employees, pharmacists,licensed premises employees, licensed restaurantservers, and drug traffickers. These classificationswere chosen as they represent the five main distributionoccupations occurring in Collingwood.The other selection criteria was that the subject'swork site or distribution point must be physicallylocated in Collingwood.Due to the limited resources available, the study,targeted a subject sample to include one distributorfrom each distribution classification for inclusion inthe study.Subjects from this group proved to be the hardest torecruit. No distributors were recruited using communityposters or third party recruitment methods. Due to thislack of respondents, three licensed premises, three- 50 -licensed restaurants, one retail liquor outlet, andthree pharmacies were targeted for special recruitment.The managers of these outlets were directly approachedand the researcher explained the research project.If the manager was not available, the researcherexplained the project to the presenting employee andleft a copy of the explanatory letter for the manager toread.Recruitment efforts for the drug traffickercategory, due to the illegal nature of that activity,presented special recruitment problems. The researcherattempted to recruit traffickers by word of mouth,guarantying anonymity.Two residents said that they knew a drug trafficker andsaid that they would approach him or her regardingparticipation in the study, none came forward.A hotel manager and a pharmacist agreed toparticipate in the study (n3=2) as a result of theseefforts. Due to the small number of identifieddistributors and the similarities of this group toservice providers, their data was collapsed into theservice provider data and subsequently treated as oneunit of analysis (n2=13).- 51 -Summary of Subject selectionThe study targeted three sample groupings: consumers(residents), providers, and distributors. Each groupwas selected on the basis of having differentperspectives on area needs.Consumer selection attempted to select a crosssection of twelve subjects using linguistic, age,gender, recovery, and geographic criteria. Elevenservice providers were selected using serviceclassifications, and two distributors were selectedbased on their work environment (Hotel and Pharmacy).In total twenty-five (n=25) subjects were includedin the final sample.All respondents were required to sign a permissionto be interviewed form before being interviewed(Appendix E: Permission to be interviewed).Measures As very little data exists on what are the substanceabuse prevention needs identified by community membersin a culturally diverse, low income, urban environment,an unique interview guide (Appendix F: Interview Guide)was developed. The interview guide was organized toobtain data on each of the study's objectives. All 3- 52 -sample groups were asked to respond to each of theobjectives in a slightly different manner in each of theinterview guides.All respondents were asked to specifically providedata on each objective as follows:(1) community awareness of substance abuse programs;service providers (see #3), residents (see #13), anddistributors (see #24).(2) how existing prevention programs might bettermeet area needs; service providers (see #8), residents(see #19), and distributors (see #21).(3) community barriers and strengths; serviceproviders (see #12), residents (see #16), anddistributors (see #23).(4) prevention needs; service providers (see #9c),residents (see #17), and distributors (see #21).(5) target groups; service providers, residents, anddistributors were all asked the same "target related"question (see #3).(6) community priorities: service providers (see#9a), residents (see #18), and distributors (see #25).All respondents were asked a number of commonquestions regarding the nature community problemsassociated with substance abuse (see #1), the- 53 -seriousness of substance abuse problems (see #2),specific group needs (see #3), and acceptable alcoholconsumption levels (see #4).Development of Questions The development of the Interview Guide questionsdrew heavily on the questions asked on five other localstudies (Legge, 1988; Legge, 1989; Mason et al., 1988;Neilson et al., 1989; Schutz & Bryne 1989). Thequestions asked in these other studies were transcribedand relevant questions grouped around this study'sobjectives.The questions were then modified, reworded, orcollapsed together to increase their clarity andrelevance to the study. A group of selected questionswere then pretested with one resident and one serviceprovider. After the interview process the pre-testsubjects were asked about the questions' effectivenessat gathering data on the objectives under examination.Based on this feedback, some questions were againreworded or collapsed together; while others wererejected as being inappropriate.These questions were then divided into threecategories: common, supplementary, and descriptive.Common questions were asked of all the respondents- 54 -and were designed to gather data on four core issues andrelated objectives: neighborhood substance abuseproblems; the seriousness of these problems; whichindividuals and community groups have special preventionneeds; and acceptable usage levels (see #1 to #4).Different supplementary questions were asked foreach of the three respondent groups. These questionswere designed to gather data on issues that arise due totheir residence or employment in the community.Descriptive information was collected on a facesheet and in questions asked in the interview guideitself. The face sheet was developed specifically forthis study and it was designed to collect largelydemographic data.Reliability and Validity Miles and Huberman (1984) argue that: "Qualitativedata... are a source of well-grounded, rich descriptionsand explanations of processes occurring in localcontexts" (p. 15). They continue by noting thatqualitative studies have a certain quality of"undeniablity". Similarly, Bailey (1978), asserts thatfirst-person accounts of events or feelings have acertain "face validity." While face validity oninterview data can be damaged by the respondents- 55 -ulterior motives (such as pleasing the interviewer withperceived correct answers). However, in needsassessments, "content (face) validity is normallysufficient."The researcher attempted to increase face validityof this study by: paraphrasing and probing subjectresponses and by maintain a non-judgemental and curiousattitude.Paraphrasing is a technique whereby the interviewerrepeats back the theme or idea expressed by therespondent in the interviewer's own words. Typically,the paraphrased statements represent the interviewer'sinterpretation of the subject's remarks and can be askedin a curious manner. For example, a subject made a longstatement regarding the undesirabilty of allowing anumber of well dressed youths with pagers to hang arounda local convenience store. The interviewer paraphrasedthis as: "so you see a lot of these kids at the store?"The subject answered "yes". The researcher alsosuspected, due to the inflections and non-verballanguage used, that the interviewee had suspicionsregarding these youth. The researcher subsequentlyprobed with: "do you suspect that they are involved insome kind of problem behavior?" The subject againresponded in the affirmative and continued on to- 56 -describe his concerns about "gang activity."As is demonstrated in this example, paraphrasingallows the interviewer the opportunity to validate orclarify interpretation of the opinions expressed by thesubject and to reject incorrect interpretations. Probescan be used to tease out the accurate meaning ofambiguous verbal and non-verbal language and toencourage the subject to provide more clarifying data.Non-judgemental paraphrasing and probing were alsoused in situations where the researcher had reason toquestion the data being provided. For example, onedistributor said that he never had a problem with peopletrying to pass fraudulent prescriptions. The researcherprobed with: "so there has never been one case?" Thisquestion lead to the subject clarifying that, "yes,people tried from time to time but they tended to stayaway from his store."As the above example illustrates, curiousnon-judgemental questioning can be used to softlychallenge suspect data and obtain insight into thepossible hidden motives. As Holsti (in Bailey, 1978)notes:"content validity is usually established though theinformed judgement of the investigator. Are the- 57 -results plausible? Are they consistent with otherinformation about the phenomena being studied (p.289)."Patton (1990) states that qualitative methods are usefuland frequently unavoidable when acceptable, valid, andreliable measures do not exist. In these situations,Patton suggests that gathering descriptive informationis more appropriate that using untested qualitativemeasures, even though the validity and reliability ofthose results are suspect.Some limitations of this study include the use of asingle measure, the Interview Guide, and the reliance oncommunity opinion as the major source of data.According to Patton (1990) and McKillip (1986),qualitative data obtained by single measures such asinterview guides, are typically weak in terms of theirreliability and validity.Miles and Huberman suggest that there are threetypical biases frequently found in qualitative studieswhich involve field work data collection mechanisms(such as in anthropological studies). Holistic fallacy(1) refers to the tendency of interpreting events withmore congruence than is the reality. This typicallyresults from "lopping off the loose ends" that do not- 58 -fit with the other data (such as excluded outliners).Elite bias (2) is the over weighting of data from"high-status" informants and underrepresenting datacoming from lower-status informants. "Going native" (3)(losing objectivity) refers to a process whereby theresearcher is coopted into the perceptions of localinformants. The authors note that these tendenciescorrespond to three research related judgementalheuristics: representativeness, availability, andweighting.This study attempted to minimize the impact of "morecongruence than is the reality" and over-weighting byselecting three different sample classifications andincluding a varied profile in selected subjects. Theuse of a common data analysis methodology and theinclusion of all data for analysis also increasedvalidity.The researcher further attempted to maintainobjectivity by spending time away from the site anddiscussing the research project with non-involved(hopefully more objective) colleagues.Data Analysis Given the exploratory nature of the study and theuse of qualitative open-ended questions, this study used- 59 -a content data analysis methodology.Content Analysis: Nan (1976) describes contentanalysis as: "any methodological measurement applied toa text for social science purposes. Or, any systematicreduction of... recorded language, to a standard set ofof statistically manipulable symbols representing the...frequency of some characteristics" (p. 217).Nan continues that these units can be "semanticunits" typically consisting of words or groups of wordscontaining similar content. These groups are typicallycalled themes. The researcher using this approach, canstudy the frequency of the appearance of certain wordsor themes occurring in a text or texts. Nan notes thatthematic coding minimizes the problems associated withsimply counting words appearing in different contextsand, consequently, provides more meaningful data.Bailey (1978), describes the goal of contentanalysis as taking a verbal, nonquantative document andtransforming it into quantitative data. Baileydescribes the first step of the content analysis processas the construction of mutually exclusive and exhaustivecategories that can be used to analyze the data. Thesecond step is to record the frequency with which thesemantic unit appears in the document. Bailey suggeststhat the categories are developed by examining the- 60 -documents to ascertain common elements. He notes that:"only by letting the categories emerge from thedocuments... can the goals of mutual exclusiveness andexhaustiveness be met" (p. 279).Bailey describes a theme as the "moral, purpose, orgoal of a document or portion of a document" (p. 281).He cautions that as a theme does not have a spatialboundary and is somewhat subjective in nature, it willtend to have low intercoder reliability.Patton (1990) notes that: "Content analysis requiresconsiderably more than just reading what is there.Generating useful and credible qualitative findingsthrough observation, interviewing, and content analysisrequires discipline, knowledge, training, practice,creativity, and hard work" (p. 11).Analysis procedure: McKillip suggests a five stepprocedure is useful when analyzing data. Step oneinvolves typing out interview transcripts, including theidentity number of the respondent. In step two aportion of the responses are examined and tentativecategories identified. McKillip notes that answersshould be placed in mutually exclusive categories (onlyplaced once) and that it may be helpful to break someanswers into smaller units prior to categorization.Step three involves writing a definition of each- 61 -category. In step four, responses and categories are tobe second rated. Step five involves reorganizing theresponses and categories based on the feedback of thesecond rater.In this study, step one involved transcribinginterview notes immediately after the interview.Whenever possible, these notes contained directquotations of the key phrases and words used by therespondent. Where this was not possible (e.g., theresponse was too long winded), paraphrasing techniqueswere used to summarize the opinions expressed.Frequently, these paraphrased summaries were checked forvalidity. This would be done by asking the respondent,during the interview, if a certain paraphrase adequatelydescribed the stated opinion. These quotes andparaphrases were then transcribed (Appendix G: Sample ofInterview Notes) and used as the primary data from whichthe results were drawn.The interviews were not audio recorded as it wasbelieved that recording would increase recruitmentdifficulties and inhibit some respondents from answeringquestions fully.Over thirty semantic unit categories were developedfrom generating a list of frequently occurring themesand the responses were placed into appropriate- 62 -categories. Semantic themes cited by three or morerespondents were considered to be significant and werereported as results.Based on discussions between the second raters andthe researcher, the semantic unit categories werecollapsed together into ten macro themes and regroupedunder two broad classifications (attitudes andstrategies).The data was interpreted using this conceptualparadigm.Summary The methodology used in this study included using anopen-ended interview guide to interview a total oftwenty-five substance abuse consumers, serviceproviders, and distributors regarding their opinions onlocal substance abuse prevention needs.The resulting data was analyzed using contentanalysis techniques to identify significant communitythemes.In the following chapter the thematic results ofthis study are presented.- 63 -CHAPTER FOUR - PRESENTATION OF FINDINGSIntroductionThe data elicited by this study was analyzed using acontent analysis. Two broad thematic classificationsemerged: attitudes and strategies. A total of tenspecific themes were identified and assigned to one ofthese classifications. Each classification contained atleast four themes.The four attitudinal themes were: (1) the right ofthe community to limit individual alcohol consumption;(2) the definition of substance abuse is related to thesocial context; (3) substance abuse and the criminalsubculture; and (4) the need to change societalattitude.The six strategic themes were: (5) the absence ofgovernment commitment towards prevention; (6) thefragmented prevention services system; (7) the role ofadvertising and promotion on consumption; (8) the costsof abuse; (9) the need for a for a continuum of service;and (10) the existence of Collingwood as a distinctcommunity.This Chapter will present these attitudinal andstrategic themes using actual quotations whereverpossible, to illustrate the significant semantic units- 64 -used to identify the theme. To be consideredsignificant a theme will have been cited by at leastthree respondents.Attitudes Attitudinal themes address the importance ofindividual and community values and beliefs inidentifying substance abuse prevention needs. Thesocial context within which a behavior occurs tends todefine whether that behavior is normal or deviant.Identification of community attitudes is thereforecentral to understanding the nature of communityprevention needs.Interestingly, residents and service providerstended to have differing attitudes regarding substanceabuse prevention. For example, there was a strikingdifference regarding the seriousness of the problem.Residents were more tolerant of usage unless they werepersonally affected by abuse whereas service providerstended to be concerned about the costs of usage andsubstance abuse. Further, many providers tended tolabel community tolerance as "community denial".These attitudinal themes and resident and provideropinions are presented in more detail in the followingsection.- 65 -1) "If substance use does not affect me it is none of my business": The most significant theme to emergeinvolved the right and responsibility of the communityto limit individual alcohol consumption. The majorityof residents tended to agree with the respondent whostated, "if substance use does not affect me it is noneof my business." Another resident similarly commented,"drinking is O.K. if it does not interfere with yourlife or someone else's." A minority of residentsfavored complete abstinence, believing that anyconsumption was too much. The majority believed thatoccasional use, sufficient to induce intoxication, wasacceptable. As one resident put it: "a certain amountof drinking and intoxication is seen as being normal."Even respondents who supported abstinence did notfavor complete prohibition, they tended to agree withone respondent who believed that we do not have "theright to limit other people's choices."Conversely, service providers were typically deeplyconcerned about the extent and impact of substance abuseand much more prepared to be proactive towardspreventing usage. For example, the child welfare workerclaimed that substance abuse is behind 95% of her cases"in one way or another"; the doctor claimed that most ofhis case patients' deaths are the result of- 66 -"life-style diseases", and the youth worker who saidthat "most of the children" involved in her agency'sprograms were involved in problematic substance usage.These beliefs reflected in increased commitment towardsprevention planning.2) Substance use is part of the social context: The majority of both resident and service providerrespondents believed that a definition of whatconstitutes substance abuse is determined in large partby the social context within which the consumptionoccurs. This social context includes; individualgenetics, family of origin experiences, poverty, socialisolation, childhood trauma, developmental place,available recreational pursuits, social pressures, andcultural values.Many respondents believed individual geneticheritage was a predisposing factor. This belief isdemonstrated in the statement made by one resident:"alcoholism runs in families... most alcoholics I knowcome from drinking families." Several respondents notedfamily of origin experiences and life experiences asalso being predisposing factors. As a service providerstated, "substance abuse does not exist by itself:social isolation, poverty, physical and sexual abuse,- 67 -and other forms of trauma are all mixed together... youcan't just isolate it (one factor) out of theindividual's context."The notion that substance abuse was an attempt todeal with stress was also cited by many respondents.For example, single parents living in poverty wereidentified by a significant number of respondents ashaving special problems. One resident summarized thisbelief by commenting: "single parents just needsomething to get them through the day... they are downon life. It helps them forget for awhile... they havetrouble facing life's pressures."Many respondents cited the belief that a decrease inthe social pressures arising from poverty would decreasesubstance abuse. As one resident put it, "we need tohelp people solve day to day problems... especiallyeconomic ones." Several respondents noted the need forincreased child minding and day care in this context.Several respondents stated that other social factorsand contexts encourage substance abuse. Youth were seenas being particularly vulnerable to the influence ofsubstance using peers. As one service provider noted,"sometimes kids use drugs to be cool for theirfriends."Another service provider noted the absence of- 68 -non-drinking social centers for adults: "the bar is theonly available social outlet, if you like to listen tomusic, dance, and meet people... where else is there togo?"There was a high level of agreement by bothresidents and service providers that the cultural valuesof the new Canadian groups had an impact on areasubstance abuse. The non-substance use values of groupssuch as the Sikhs and the negative social stigma placedon drunkeness by groups such as the Chinese werecommonly cited as being positive community influences.Several respondents noted that these groups alsohave special problems. One resident believed that, "itis hard for many of them... they come from societieswhich support total abstinence. When they get to Canadathey experience a sort of cultural pull from their moreCanadianized drinking peers."Another resident expanded on this theme by noting:"sometimes you see guys in turbans drinking in theircars in the alley... it looks like they're drinking insecret... if they wear a turban they are not allowed todrink you know."3) Substance abuse and criminal subcultures: Mostresidents suggested that there was a relationship- 69 -between substance abuse and "criminal activity" of allkinds.Predictably, hotel bars, and social clubs were citedas being noisy ("you hear them half way down the blocksometimes... especially around closing time"); violent("there are often fights in the parking lot"), andcenters for other sorts of drug abuse ("when I wait atthe light to cross the street, I can smell the potdrifting from the parking lot").The Aerial Light Rapid Transit (A.L.R.T.) stations,certain convenience stores, the adult format HaidaCinema, the pool hall, and Collingwood Park were allcited as being substance abuse problem areas. The exactrelationship of these areas to substance abuse ishowever unclear. While these sites were mentioned by asignificant number of residents, the problems involve awide range of criminal and antisocial activity of whichalcohol and drug related problems are only a part.Certain convenience stores were noted as a problembecause, "there are a lot of well dressed kids alwayshanging around... I wonder where they get the moneyfrom?"Another resident noted that the "expensively dressedyoung men with pagers that you see around (the store)...are probably gang involved."- 70 -A service provider stated: "teenagers tend to scareaway some people from places such as RecreationCenters... their rough housing and tough look areparticularly difficult for our seniors to take."A significant number of residents criticized theliquor store for "tolerating bootlegging to minors. Oneresident reported that he, "parked at the Safewayparking lot on two successive Friday nights and... sawlots of teen vehicles and bootlegging going on."Another resident, noted that in spite of existingbootlegging problems, "the store really tries to keepthings clean and under control."The Haida Cinema was criticized for the "bad crowd"that is attracted to its "adult format" films.Collingwood Park and the alleys around the Park werecited as being a "drug drop area" and as having "a lotof open drinking in the summer."Several locations were cited as being a substanceabuse problem area because of the presence of visiblecultural minorities. For example, Collingwood Park wasseen as being a problem by one resident because of the"number of old Sikh men that sit around the wadingpool." It should be mentioned that the pool in questionis no longer in use as a wading pool.It appears that in the minds of many residents the- 71 -presence of groups of young rambunctious people dressedin one or another manner, groups of turbaned old men,and X-rated film patrons are frightening in and ofthemselves. This feeling may have more to do with fearof different kinds of people than it does with substanceabuse. This theme was less strongly expressed byservice providers.4) A change in societal attitude is needed: Mostservice providers discussed the need to change societalattitude as being one of the most important aspects ofsubstance abuse prevention. One service providersuggested that "society needs to change its pattern ofacceptance and encourage taking responsibility. We needto confront denial and overcome stigma and shame."Another service provider commented, "we must getpeople to recognize the problem, as a problem, before wecan mobilize them to fight it."Several service providers held beliefs similar toone respondent who noted, "we all have compulsivebehaviors to deal with... we must teach kids thatseeking help for them is O.K. and normal."The majority of residents did not express the needto change societal attitudes; rather they favoredprevention services for children and youth and treatment- 72 -and enforcement approaches for adults.Strategies: Six significant themes emerged that identified areasof potential strategic action for planners. Thesethemes point to the need for increased governmentfinancial and legislative commitment towards prevention,holistic thinking when providing treatment relatedservices, and the need to examine the notion of whatconstitutes a community when developing preventionservices.5) "Government should put it's money where it's mouth is": Most service providers and many residentswere critical of government commitment towardsprevention. For example, one service provider suggestedthat "the Government has a high financial interest inalcohol sales... to decrease sales will reducerevenue." Several respondents believed that:"Government should direct the money from alcohol salesback into prevention and treatment programs." Oneresident stated: "they (the Government) should put theirmoney where their mouth is."These sentiments were related to the secondstrategic theme of "fragmented resources."- 73 -6) "Fragmented... under coordinated and under-funded resources": A significant number ofservice providers believed that the existing resourcessystem was "fragmented and under funded."Generally, respondents were either not aware of manyof the existing prevention programs or were critical ofat least some aspects of them. Prevention programs wereseen "as having a too limited definition of abuse andprevention." One service provider described thedelivery system as being "physically and structurallyisolated from the community".By contrast, the privately sponsored AlcoholicsAnonymous was viewed by all of the respondents as beinga much valued and successful treatment resource. It wasdescribed in terms such as: "its a mainstream resource","the only thing that works in the long run," and "thatis where I'd tell a friend to contact if they neededhelp." One service provider added, however, that "A.A.isn't for everyone." This respondent continued: "thespirituality aspect of it is a problem for some people."A significant number of respondents favored raisingthe drinking age, however many also believed it would be"impossible to enforce" or that it "would only deal withthe symptoms."- 74 -Public schools were the second most frequently citedpotential prevention resource. As one respondent putit, "they have a captive audience and we must startyoung." Both resident and provider respondents believedthat "prevention programs should be built into theschool curriculum starting at the lower grades." Onerespondent noted, "schools must go beyond just tellingkids to say no... they should teach life skills,decision making, refusal skills, and legal outcomes."Another stated that, "education is our strongestweapon... it is the only way to stop the problem."A service provider noted however, "Schools are beingasked to do so much these days... they are alreadyoverloaded with non-academic needs."Alcohol and drug clinics tended to be seen in apositive light ("good counsellors"), but they were alsocriticized for having "long wait-lists", "limited officehours", and as being "too far away."Most residents cited the police as being animportant prevention resource and as "doing a good jobunder the circumstances". Most critics cited lowstaffing levels and increased work load as limiting thepolice role in prevention. As one service providernoted, "the police budget has not kept up withincreasing population growth and increased demands on- 75 -police time." Another provider stated, "the police aretoo busy flying from call to call... there is littletime left for prevention."Several residents wanted increased police presenceand visibility. As one resident put it, "I wish thatthey would get out of their cars and walk around more."Interestingly, none of the respondents spontaneouslymentioned the British Columbia Government's "TRY"campaign as a prevention resource. The researcher did,however, ask many respondents a probing question aboutTRY near the end of the interview. Once this probe wasasked, approximately seventy percent of respondentsstated awareness of the program and could identify atleast one aspect of it. The television commercials,posters, and telephone line were the most frequentlynoted TRY services.A significant number of respondents appeared to becritical or cynical about the TRY program. As oneservice provider noted, "to just say no makes it seemtoo easy and leads to blame... the approach is allwrong, it implies a lack of moral fiber in substanceabusers." Another service provider said flippantly:"TRY, try what?"7) "Advertising makes too big a deal of it":  Many- 76 -respondents in both groups commented on the role ofadvertising and promotion on increasing consumption.Several respondents believed that advertising andmanifestations of popular culture (such as televisionand films), leave the impression that "everything goodthat happens, happens with a drink in hand." Oneservice provider echoed this sentiment by stating:"advertising makes too big a deal out of it... to besexy etc. you must use alcohol."This belief lead several respondents to call forincreased legislative restrictions on alcohol and drugadvertising. This sentiment was echoed by onerespondent who stated: "we need to present drinking in amore balanced way... it is now largely promoted in apositive manner."Respondents holding these views tended to favor thepromotion of public education campaigns, increasedcontrol of advertising, and increased prevention relatedpolitical lobbying with policy and decision makers.A resident suggested: "we have got to make those whomake big dollars from sales pay, for preventionprograms."8) Substance abuse: health, family, and social costs: Most service providers believed that substance- 77 -abuse results in a wide range of health, family, andsocial problems. They also noted that the generalpublic and the government tend to minimize these costs.One of these many cited problems was the high financialcost of treating substance related health problems. Asone service provider pointed out: "alcohol relateddiseases are a central factor in very many emergencyhospital admissions."The nature of this relationship was echoed by onehealth service professional, "between ten and twentypercent of my patients have a substance abuse problem,not including tobacco related problems." He continued,"life-style diseases are the greatest killers."Poor personal relationships, decreased school andwork performance, and family violence and break-up wereall cited as social costs by a large numberrespondents. One child protection worker stated thatsubstance abuse was "behind 95% of child protectioncases in one form or another." Several residents notedthat women are "particularly vulnerable to violence asthe result of a spousal substance abuse." As oneresident put it, "some people seem to think that the manis king and that women are nothing, women in thesesituations often get beat up when the man drinks."A significant number of respondents tended to- 78 -believe that substance abuse is becoming more of aproblem for women. As one respondent noted, "women arenow being portrayed as drinkers... as a role model forwhat a modern women is."A service provider noted that prescription drugmisuse and abuse was an increasing problem for olderwomen: "a lot of older women are dependent on theirhusbands to get their emotional needs met, therefore,widowhood brings increased risk of substance abuse."One recovering alcoholic noted that, "female alcoholicsand drug addicts suffer more than men because ofincreased shame and social stigma. Men are seen asletting off steam... it is different for women."Young people were also identified as having specialneeds. Children in substance abusing families werecited by a significant number of respondents as havingunique problems. As one school based provider noted,"these kids (living with alcoholic parents) arereluctant to talk about their problems out of fear ofopening the family closet... this inhibits them fromseeking help."Another service provider noted, "the majority of thekids in our programs have some degree of alcohol or drugusage that gets them into trouble sometimes."A long term resident noted that, "kids walk a fine- 79 -line... they have to be friendly to local drug types,while at the same time, not become involved in theirantics."The need to educate parents was a frequently citedprevention need. As one service provider stated, "wemust remind parents what it was like to be a teenager."Another suggested that, "parents ideas come from thirtyyears ago and they are no longer relevant to the currentcontext." Still another respondent noted, the need toeducate both parents and teachers to "identify substanceabuse problems and what to do once they have."Generally speaking, the respondents saw the need formore "grassroots" family and children's socialalternatives and services. One resident summed it up as"we need a place where parents can go for help withtheir kids."9) "A continuum of services available to everyone": Service providers frequently cited the needfor multidimensional prevention strategies. As oneprovider stated, "we need to develop programs that honorand value all people and offer a continuum of servicesavailable to everyone." Or, as another provider put it,"we need a network of counselling and a coordinatedstrategy."- 80 -Another service provider stated that we should "drawon existing resources more fully... operate communityevents and engage in more outreach." Still anotherrespondent stated that "we must have a multiculturalfocus and use non-traditional approaches in new types ofresources." One provider suggested that there needs tobe "more social permission to disclose our own (serviceproviders) problems."Several service providers cited the need for higherstandards (qualifications and training) for preventionworkers and the need for increased evaluation ofexisting programs. For example, one service providerstated: "many programs for kids are run by bigger crooksthan the kids are." Another service provider believedthat "in order for programs to be effective, staff haveto have a professional attitude and be paid well."Several service providers were critical of simplecampaign approaches: "they (public campaigns) would onlyhelp to a point... if the causes of substance abuse arelow self-esteem or a family that doesn't care, educationwon't help."One respondent involved in recovery stated, "youcan't educate addiction away... I am not sure thataddiction can be prevented... the best we can hope foris that people seek help sooner, before they have lost- 81 -everything."10) Collingwood, a community of communities? Several themes emerged regarding the absence of a sharedsense of community identity and values, and the impactof the transitional nature of the community on substanceusage. This theme lead many respondents to question ifCollingwood is really a distinct community.One frequently cited theme was the belief thatCollingwood lacks cultural homogeneity and a commonlyshared sense of history. Collingwood is seen as being acultural mosaic. One respondent suggested thatCollingwood is not really a community of "people livingand doing things together." A service provider believedthat Collingwood was "really just a bunch of parkinglots off of Kingsway." Many of these respondents tendedto view area residents as moving into the area due tothe availability of affordable housing, and not becauseof the community's ambience and perceived desirability.For these respondents, Collingwood is, at best, "acommunity of communities."Many respondents questioned the existence ofCollingwood as a distinct community and consequentlyquestioned the feasibility of developing community basedprevention strategies.- 82 -A second related theme was that Collingwood isviewed as being "a launching pad for new Canadians."Typically residents were described as "arriving fromoverseas... buying a house... establishingthemselves... and then moving on as soon as theireconomic situation permits."Many respondents argued that this results in anabsence of commitment to the long term interests of thecommunity.Longer term residents expressed the belief thatCollingwood was a community but now it no longer is. Aresident noted that "thirty years ago, we used to knoweveryone and drop by to visit... now we don't even knowour neighbors... we certainly don't socialize withthem." Another resident put it as, "I used to know allthe stores and go to shop in them, now I don't even knowwhat to do with the products that they sell in them."Another resident stated, "people now go downtown toshop... going downtown used to be such a big deal."Many longer term residents were saddened by recentchanges to the area. Several were concerned about theimpact of increasing numbers of Non-Christian,Non-Caucasian, and Non-English speaking residents. Asone resident noted "we used to be lily white... nowthere are mostly dark faces on the streets." Another- 83 -stated that "we were a working class Irish Catholiccommunity... it is sure not that way now!"Several respondents cited increasing populationdensity and changes in the transportation system asnegatively impacting on the area's sense of identity.One respondent said, "the Skytrain has sure changedthings, more noise, more people, and more negativeaction on the streets." Another resident noted, "weused to walk or take the tram... now when people visitthey are usually from other areas and they come by car."Many respondents did not view Collingwood as asingle and well defined community, many identified theneed to develop a sense of community as an essentialfirst step in the development of any neighborhood basedprevention programs. One respondent put it as, "thecommunity needs to be strengthened first... then weshould focus on specific problems." This opinion wasechoed by another respondent, who stated, "a mobilizedlocal community is the key... identify a specific issueand stick to it."In recognition of Collingwood's multicultural makeup, several respondents cited the need for programmingin different languages.- 84 -SummaryThis chapter has used an attitudes and strategyclassification system to present the ten mostsignificant themes that emerged from the data. Thesethemes have demonstrated the importance of values andculture in establishing levels of community toleranceand denial about substance usage. They also describethe costs of the resulting abuse and the impact ofgovernment priorities on existing resources andconsumption.In the next chapter, the implications of theseresults will be discussed.- 85 -CHAPTER 5 - DISCUSSIONIntroductionThis chapter discusses the implications of thecommunity identified substance abuse prevention themesfor planners. Resident and service provider opinion iscompared and a number of important attitudinal andstrategic issues are discussed. The limitations of thestudy and the implications for future research are alsoexamined.Implications of Attitudinal Themes Most of the residents had a relatively tolerantattitude towards substance usage. Many serviceproviders believed that this tolerance was in factdenial. These attitudinal differences create a dilemmafor planners. Do they support a tolerant positiontowards substance abuse or work towards challengingalleged community denial?As approximately eighty percent of Canadians drinkalcohol (Survey Canada, 1989) it is not surprising thatthe majority of residents believed that alcohol use isacceptable to "occasionally have fun," "to celebrate afestive occasion," or "to enhance a meal or some othersocial occasion."- 86 -This tolerant attitude represents a localmanifestation of what Ashley and Rankin (1988) label theintegration model. Individuals holding this view,conceptualize abuse as a failure to integrate alcoholconsumption into day to day life. Further, onceconsumption becomes problematic (failure to integrate),residents tend to view substance abusers as either beingsomehow morally deficient or as having a disease. Thoseholding the morally wrong model tend towards control andpunishment as preferred prevention techniques; thoseholding the disease model support treatment and earlyintervention. As Ashley and Rankin note the integrationmodel has led to society largely being tolerant ofconsumption, ignoring prevention measures, and the costsassociated with usage and abuse.Abstinence based approaches ("there wouldn't be anyproblem if people never touched the stuff"), willpredictably meet with resistance from drinking communitymembers and it is unlikely that abstinence approacheswould be effective.Also, as is discussed by Meichenbaum and Turk(1987), nonadherence to medical treatment is typicallyestimated to be in the 30% to 60% range. We canspeculate that nonadherence to non-medical drug andalcohol programs will be even lower, especially- 87 -by those who are addicted. Predictably the more thatone challenges so called "social drinking" and "denial"the more one will meet resistance by those who drink oruse drugs.The Consumption Model In spite of the predictableresistance that prevention planners will have to facefrom "social drinkers", planners will have to change thecommunity's tolerant attitude in order to significantlyreduce drug and alcohol problems in society. Perhaps,the most effective way to do this without alienatingthose who hold to the integration model is to promotewhat Ashley and Rankin have labelled the consumptionmodel.The consumption model leads to attempts at reductionof average consumption rates in the belief that such adecrease will result a decrease in substance relatedproblems. This approach does not demand abstinence,rather it encourages limiting frequency and amountsconsumed. This approach permits planners to engage inpublic education campaigns that highlight the dangers ofusage (i.e., drinking and driving, workplaceintoxication, and drinking during pregnancy); while atthe same time rending support to abstinence, control,and treatment strategies.Such an approach maximizes the opportunities to- 88 -garner broad based community support and enhance thelikelihood of adherence. For example, planners using aconsumption approach could argue, that product promotionadvertising should be controlled or at least balancedwith prevention orientated advertising.The impact of promotional advertising on consumptionrates can be seen by comparing Canadian consumptionrates. Canadian consumption patterns increaseddramatically from the early 1950's. This is also theperiod when the population was exposed to increasedalcohol and drug advertising.It is also interesting that consumption began todecrease after the mid 1980's which is the periodimmediately following increased restrictions on alcoholand drug advertizing.^It must also be notedthat the current trend towards decreased averageconsumption may have other sources than just advertisingcontrols and increased prevention programing. Forexample, there has been an increased emphasis placed ongeneral health promotion campaigns such asParticipaction.Theoretically, as consumption related approachesgain community support and credibility, they will havethe secondary benefit of confronting issues such ascommunity denial.- 89 -Planners must not simply rely on large scaleattitudinal campaigns as the only method to reduceconsumption rates. Planners should also pressuregovernment to reduce the accessibility of alcoholthrough limiting the opening hours of distributionpoints, limiting the number of distribution points, andthrough the provision of more resources towardsenforcement of existing laws. They should encourageprevention and treatment approaches that targetindividuals and groups and work towards inclusion ofprevention components into existing programs.Substance abuse and the criminal subculture Manyrespondents associated substance abuse with a criminalsubculture and identified a number of subcultures astarget groups requiring special prevention services.There was a tendency for respondents to suspiciouslyassociate certain visible groups with substance abuse(i.e., "adult movie" viewers, well dressed teenagers,and turbaned old men). This tendency appeared to beassociated with fear of being harmed by one of thesegroups' members or simply fear of the unknown.Planners must be cautious, therefore, whendeveloping programs designed for alleged high substanceabuse groups. They are well advised to verify thatsubstance abuse is in fact a problem before targeting- 90 -these groups for special attention. Planners shouldinclude cross cultural dimensions into their strategicplans."Walk the walk" Planners will also have toencourage change on a more personal micro level. Theymust model appropriate attitudes and behavior andencourage others to do the same. For example, onemodelling technique can be as simple as starting withnon-alcoholic beverages when listing the drinksavailable to guests at a social function. As peopleinvolved in the twelve step movement remind us, "we mustwalk the walk and not just talk the talk."Strategies:While changing community attitudes is the mostimportant prevention need, a comprehensive preventionprogram must develop specific strategies designed toassist members of targeted groups. Community membersidentified six strategic themes. The implications ofthese themes are discussed in the next section.Causation One strategic implication was thatplanners should identify the factors that lead tosubstance abuse and then develop programs designed tominimize those factors in high risk groups. As onerespondent put it, "in order to stop it you got to find- 91 -out why people get hooked in the first place."While no definitive causation exists research andcommunity opinion agree that a number of biological,environmental, and social factors appear to bepredisposing variables. These causation theories mustbe critically examined by planners before being acceptedas popular belief is not always complete nor accurate.For example, respondents tended to believe thatsocioeconomic status impacted upon substance abuse. Thebelief was that the more affluent were under lesseconomic pressure, therefore, the poor have more needdrink to escape from life's pressure. According to a1989 Canadian Survey, the rich drink more frequently butconsume less at a sitting than do the poor.While, this data does support reportedself-medication/social escape drinking patterns by thepoor, it also indicates that the affluent also havesubstance abuse needs that are particular to theirsocioeconomic class.Planners interested in a comprehensive preventionapproach must therefore critically review causationrelated research before committing large sums of publicmoney on prevention programs.Developmental Place Planners should developprevention programs that are developmentally appropriate- 92 -for targeted populations. For example, the tendency forillicit drug usage to peak at age 18, the tendency foraverage alcohol consumption rate to decrease with age,and the tendency towards increasing seniors prescriptiondrug usage rates (Survey Canada, 1990) are of obvioussignificance to planners. Not only should these groupsbe targeted for special programing, the programing mustalso be appropriate to the developmental place of thegroup to be effective.Interpersonal and family implications Whilesubstance abuse was cited as being a problem in manyways, its impact on interpersonal relationships andfamily life was the most frequently cited problemtheme. If planners want to address family relatedsubstance abuse prevention needs, they will have tostruggle with some basic ethical decisions. Plannerswill have to decide to what degree the state orcommunity has the right or responsibility to intervenewith substance abusing families or individuals.For example, if we are to accept this study's datathat "it (substance abuse) is behind ninety-five percentof child protection cases, in one way or another", thenwe must decide if the community has the right tointervene and remove children from substance abusingparents, and if so, at what point? Further, do we have- 93 -the right to accept children living in substance abusingfamilies into prevention or "survival" programs withouttheir parents' permission? Do the benefits of suchactions warrant the possible negative impact on thechild's relationship to his or her family and parents?Do we have the right to prevent a fetal alcoholbirth by somehow ensuring that pregnant women don'tdrink, or don't drink beyond a certain limit? Thiswould be difficult without containment. Do we have theright to restrict people from drinking alcohol in theirown homes if they tend to resort to family violence whendrunk?As consumers did not view limited alcohol use asbeing overly problematic, they tended towardsnon-interventionism in favor of individual rights.Planners and legislators may, therefore, need to educateand convince the consumer group that the substance abuseproblems are serious enough to challenge individualrights in favor of community rights.^Interventionlimitations must be established that encourage a maximumamount of family and system related outreach; whilerespecting the general rights of individuals andfamilies to privacy."Fragmented... under coordinated and under -funded resources" Planners wanting to identify ways and means- 94 -that existing programs might better meet community needsshould address the perceived fragmentation of services.According to respondents, planners must work towardsstrengthening community networking and coordinationefforts. This can be accomplished by supporting localinitiatives such as the Area Substance Abuse Committeeand the Area Services Network.Local coordination groups must develop a broaddefinition of substance abuse and accept the use of avariety of approaches including both treatment andprevention strategies. They should lobby with local,Provincial, and Federal Government agencies forincreased funding, integration of services, healthpromotion and substance abuse awareness campaigns.Generally speaking, planners must take a holisticapproach to substance abuse prevention. Localprevention programming should assist and support alreadyexisting programs, target specific groups and needs, andencourage the development of a sense of community.Besides organizing on a neighborhood level, plannersshould assist ethnic organizations and affinity groupsto develop culturally appropriate, area wide preventionprograms.Government Commitment Many respondents werecynical about government commitment towards funding- 95 -prevention programming. Planners holding this viewshould publicize the health, social, and financialrepercussions of alcohol abuse and challenge the notionthat the revenue government receives from alcohol salescovers these costs. Generally, planners shouldencourage government to direct more funds towardsprevention programs, arguing that a general decrease inconsumption will result in lessened long term social andfinancial costs.Minimally, planners should lobby government toredirect "profits" from alcohol sales towards preventionprogramming. GovernMent should also require beveragealcohol companies to match the money spent on productpromotion with money targeted for prevention orientatedpublicity campaigns."A continuum of services" A significant number ofservice providers cited the need for a multidimensionalapproach to substance abuse and "a continuum of servicesavailable to everyone."Planners should conceptualize substance abuseprevention as being relevant to every community memberand develop a range of strategies targeting the entirecommunity. Public media campaigns, legislative change,support to existing prevention groups, services topeople negatively affected by substance abuse, need to- 96 -be supported, as do programs designed to help peoplesolve social and economic problems, deal with emotionaland psychological stress, and help involve people inhealth enhancing behavior.Several service providers noted the need forplanners to normalize the need to seek help and ensurethat prevention and treatment programs are accessible toall. Planners should encourage alcohol and drugprofessionals to engage in more outreach, decentralizetheir various helping systems directly into thecommunity, and provide more flexible working hours.Generally, planners should view substance abuse asbeing the result of a number of interrelated factors. Acomprehensive prevention program would requirestrategies that address all of these factors. AsJohnson et al. (1987) remind us: "a multifacetedapproach is necessary as no single model will beeffective for all audiences."Limitations of the study:This study contained a number of limitations thatnegatively affected the reliability and validity of thedata. One limitation of this study was the use of asingle measure, the Interview Guide, and the reliance oncommunity opinion as the major source of data.- 97 -According to Patton (1990) and McKillip (1986)qualitative data obtained by single measures such asinterview guides, are typically weak in terms of theirreliability and validity.A study's reliability can be made more robust,through the use of a range of triangulation techniques.One technique frequently used by needs assessments suchas those of Mason et al. (1988), Neilson et al. (1989);and Legge (1989) is to use two operational measures tomeasure the same concept. Typically, qualitativestudies use a quantitative measure to increasereliability.Due to limited financial, personnel, and technicalresources the study did not use this method oftriangulation. The study's use of a single measure andthe absence of a second measure and/or other methods oftriangulation, supplies data that has weak reliabilityacross populations and that possesses only a certainface validity.Another major limiting factor is that the interviewswere not audio recorded; rather a field note takingsystem, relying on note taking ability and memory, wasused to collect and transcribe the data. Errors ofmemory, recording and transcribing will all tend toweaken the reliability of the data.- 98 -Another limitation affecting reliability is that allof the respondents were a minimum of 19 years of age,therefore, the opinions expressed directly by childrenand youth are not included in the findings.It is also important to note that the inability ofthe study to recruit individuals who admit to currentlyabusing alcohol or drugs and the high number ofresidents abstaining from the consumption of alcohol(six abstainers) tend to limit the study's validity.Finally, the small sample size (n=25) and non-randomsample selection process does not meet the requirementsof statistic probability. The use of a purposefulselection process, while not increasing the study'sstatistical reliability, does provide a wide range ofinformants from differing perspectives and, therefore,increases the study's internal reliability.Purposeful sampling limitations also exist, whichfurther erode the study's reliability. Residentsubjects tended to be older, Caucasian, and Englishspeaking. E.S.L. subjects were under-represented in theresident sample. Further, as the researcher only speaksEnglish and as the resources available to the projectdid not permit the engagement of bilingual researchstaff, the language of the interview was English.Non-English speaking respondents are not, therefore,- 99 -adequately represented in the sample.Implications for future research:This study provides exploratory data on the littleresearched topic of neighborhood substance abuseprevention needs. Future studies should use a largersample and several measures, including some form ofquantitative survey, to further explore the themesidentified by this study. A new study should alsocollect base line data, useful to those that want totest the eventual effectiveness of a locally developedstrategic plan.Conclusion:This study gathered and analyzed data on: what arethe community identified substance abuse preventionneeds in a culturally diverse, low income, urbanenvironment? The results indicate there are severaldifferences between resident and service providerattitudes towards substance abuse. Residents tendtowards tolerance of "functional" substance abuse.Service providers label this tolerance as denial andplace a higher priority on prevention. Serviceproviders would describe the greatest prevention need tobe a change in community attitude. 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Vancouver: UBC.- 113 -Appendix A: Certificate of Approval The University of British Columbia^B90-358Office of Research ServicesBEHAVIOURAL SCIENCES SCREENING COMMITTEE FOR RESEARCHAND OTHER STUDIES INVOLVING HUMAN SUBJECTSCERTIFICATE^of APPROVALINVESTIGATOR:UBC DEPT:INSTITUTION:TITLE:NUMBER:CO-INVEST:APPROVED:Russell, M.Social WorkCollingwood Neighbourhood HouseCommunity opinion on substance abuseprevention in CollingwoodB90-358Hetherington, T.JAN 21 1991The protocol describing the above-named project has beenreviewed by the Committee and the experimental procedures werefound to be acceptable on ethical grounds for researchinvolving human subjects.THIS CERTIFICATE OF APPROVAL IS VALID FOR THREE YEARSFROM THE ABOVE APPROVAL DATE PROVIDED THERE IS NOCHANGE IN THE EXPERIMENTAL PROCEDURESM^4M^4M^50E0- 114 -KEYres.#^- resident number.sex - sex of the resident: M = male; F = female.age^- age of resident.yrs. - number of years of area residence.occ.^- occupation of resident.m.s. - marital status: M = married; S = single.recruit. - agency that recruited resident:1 = Alcoholics Anonymous2 = The Collingwood Business Association3 = The Collingwood United Church4 = The Collingwood Neighbourhood House5 = The Nisha Family and Children's Services.lang.^- first language spoken: E = English; 0 = Other.:Characteristics SummaryAverage age = 54.1Average length of area residence = 23.5Total females = 7; total males =5.- 115 -Total English as first language = 9; total English as secondlanguage = 3.Recruitment source totals: 1 = 1; 2 = 1; 3 = 2; 4 = 4; and 5= 4.- 116 -Appendix C: Explanatory LetterCOMMUNITY OPINION ON SUBSTANCEABUSE PREVENTION IN COLLINGWOODThe Collingwood Champlain Heights Community SubstanceAbuse Committee is sponsoring research on substance abuseprevention in the Collingwood area. Our intension is toidentify existing substance abuse prevention needs in theCollingwood area and make recommendations regarding futuresubstance abuse prevention efforts.As part of this process, we are completing a number ofinterviews of area residents, drug and alcohol distributors,and professionals, to obtain opinions on local substanceabuse prevention needs. From these interview results we willdevelop a questionnaire style needs assessment and makerecommendations regarding the future development of a localprevention strategy.We have asked committee members to help us recruitsubjects for this project. We have asked them to pass thisletter on to people that they believe are interested in thetopic and who may be willing to be interviewed. Obviously,as you are reading this letter, one of our members believesthat you may be willing to be interviewed.Confidentiality Guaranteed. The identity of selectedrespondents will be known only to the researcher. Uponselection, all subjects will be issued an identity number andthis number will be the sole means of linking your identityto your responses. In this way you will be assured that youridentity will remain confidential to the researcher, TomHetherington.Selection and Interview Process: If you are interestedin being interviewed, please contact the researcher, TomHetherington, by telephone. Selected subjects willrecontacted by the researcher by telephone and an interviewtime and place arranged.Interviews will not be tape recorded and you retain the right to refuse to participate or withdraw at any time without jeopardy. The interview will take less than one hourto complete. You will not receive any financial remunerationfor your involvement.Remember we are investigating substance abuseprevention. Prevention means: promotion of a healthylife-style without dependency on alcohol and drugs.For more information contact: Tom Hetherington at251-5849.- 117 -Appendix D: Service Provider and Distributor Characteristics.s.p.# sex age employment1 F 33 youth and family2 F 45 child protection (MSS)3 F 53 church adult outreach4 F 34 multicultural worker5 M 55 police6 M 54 high school counsellor7 M 42 elementary school counsellor8 F 36 nurse9 M 61 recreation manager10 F 26 recreation worker11 M 27 medical doctor12 M 41 hotel employee13 M 45 pharmacy employeeKEYs.p.#^- respondent number.sex - sex of the respondentage - age of the respondent.employment - nature of work in Collingwood.Summary of Service Provider and Distributor CharacteristicsTotal females = 6; total males = 7.Average age = 42.5 years.- 118 -Appendix E: Permission to be interviewedI understand that the Collingwood/Champlain HeightsCommunity Substance Abuse Prevention Committee isinterviewing local community members on the question of"what constitutes an effective substance abuseprevention program for the Collingwood area?" I realizethat these interviews will be used to develope a"strategic plan" designed to meet these preventionneeds.I also understand that these interviews will be usedin a University of British Columbia, School of SocialWork research project. This project is being supervisedby Dr. M. Russell and the results will be used by TomHetherington as part of his Masters of social workthesis. I agree to permit my interview to be used forthis purpose.I understand that my identity will be known only tothe researcher and that I will be issued an identitynumber. This number will be the sole means of linkingmy identity to responses. I have been assured that, myidentity will be kept in confidence, by the researcher,Tom Hetherington.Interviews will not be tape recorded and I retain the right to refuse to participate or withdraw at any time without jeopardy. I understand that the interviewwill take less than one hour to complete and that I willnot receive any financial remuneration for myinvolvement. I further understand that I can contactthe researcher at any time should I have any questionsor concerns regarding the research. This contact can bemade by contacting Tom Hetherington at 251-5849.Remember we are investigating substance abuseprevention. Prevention means: promotion of a healthylife-style without dependency on alcohol and drugs.[1 I assure that:I have volunteered to be interviewed withoutcoercion or promise of reimbursement;I have received a copy of this consent;and I agree to be interviewed.[1 I do not agree to be interviewed.SIGNED:DATE:- 119 -Appendix F: Interview Guide COMMUNITY OPINION ON SUBSTANCE ABUSE PREVENTIONIN COLLINGWOOD.FACE SHEETInterview #DateOccupation ^Age ^Male  FemaleLocation of Interview1. Do you live in Collingwood (between 22 Ave. to 45Ave. and between Nanaimo and Boundary, Vancouver)?YES^NO2. Do you work in the Collingwood area (between 22 Ave.and 45 Ave. and between Nanaimo and Boundary,Vancouver)?YES^NOInterviewee's ethnic backgroundInterviewer's CommentsCOMMON QUESTIONS 1. In what ways does substance abuse presentdifficulties for Collingwood residents? (Provideexamples only if necessary. i.e., family problems,violence).2. Do you think the problem is:a) Alcohol:Is: not serious [ ] Minor [ ] Moderate ( ] Serious [b) Illicit Drugs (e.g., marijuana, cocaine, heroin)Is: not serious [ ] Minor [ 1 Moderate ( I Serious [ ]- 120 -c) Prescription Drugs:Is: not serious [ ] Minor [ ] Moderate [ ] Serious [ ]3. Who is affected by substance abuse and in whatways?NOTE TO INTERVIEWER: fill in the information on thosegroups mentioned by the interviewee. If after probing,the respondent is having difficulties answering, ask:"Would any of the following groups be affected?" andread the list.who is affected^substance & in what wayby substance abusei) familiesii) single peopleiii) single parentsiv) youthv) elderlyvi) menvii) womenviii) other4. What do you consider to be acceptable personaldrinking habits? What should be acceptable communitylevels?SERVICE PROVIDER QUESTIONS5. Briefly summarize the nature of your work (or ofyour agency's work). Do you specialize in a particulararea or work with particular kinds of people?6. What programs or services are offered by theagency (ask for brochure if possible).- 121 -7. Are you aware of any alcohol/drug prevention programs that are available in the Collingwood area?If yes, what are they?NOTE TO INTERVIEWER: ask questions regarding content,methods used, which ones seem to work best, for whatpopulations?8. How could existing programs be improved?9. What kinds of programs are needed? (if necessary,PROBE for opinions on increased community education,increased law enforcement, legislative change [some sortof prohibition and/or control] or development of otherhealth promoting alternatives? If the respondent citesnon-educational programs probe for more detail.)a) Who should such programs be designed for?b) What information should be included in educationfocused programs? (if necessary, PROBE about alcohol anddrugs, available resources, legal implications,life-styles training, aids for parents)c) What problems/issues/concerns should be addressed?(provide examples only if necessary, peer pressure,intergenerational conflict.)10. Which individuals and/or organizations couldeffectively deliver the programs? (Provide examplesonly if necessary i.e., community organizations,immigrant services, schools, doctors, alcohol/drugagencies, media, etc.)a) Please explain why you believe they would beeffective?11. What community strengths and resources will aidin developing local alcohol and drug preventionprograms?12. What are the barriers to the development of aneffective substance abuse prevention program inCollingwood?- 122 -COMMUNITY RESIDENT QUESTIONS13. What services and resources currently exist tomeet the alcohol & drug related needs in Collingwood?What do you know about them? How did you find out aboutthem?14. Do you think that the general public is aware ofthese services? Why/why not?15. Who would you turn to if someone you knew wantedhelp with an alcohol or drug problem?16. What are the barriers to the development of aneffective substance abuse prevention program inCollingwood? What implications does the multiculturalnature of Collingwood have upon substance abuseprevention?17. Are there any particular areas of the communitywhere substance abuse appears to be particularlyproblematic? Why?18. What are some possible solutions to alcohol anddrug problems in Collingwood? (if necessary PROBE foropinions on increased community education, increased lawenforcement, legislative change [some sort ofprohibition and/or control] or development of otherhealth promoting alternatives? If the respondent citesnon-educational programs probe for more detail.)19. Which individuals and/or organizations couldeffectively deliver the programs? (Provide examplesonly if necessary i.e., community organizations,immigrant services, schools, doctors, alcohol/drugagencies, media, etc.)DISTRIBUTORS QUESTIONS20. Briefly summarize for us the nature of your work(or of your agency's work). Do you specialize in aparticular area or work with particular kinds of people?- 123 -21. As someone who is involved with the sale ordistribution of alcohol or drugs, what do you see asbeing some of the substance abuse issues that areparticular the your work situation?22. Do you see a need to change the controlregulations of your business in order to minimize thepotential of substance abuse by your clients? Why/whynot?23. What are the barriers to the development of aneffective substance abuse prevention program inCollingwood?24. Who would you turn to if someone you knew wantedhelp with an alcohol or drug problem?25. What are some possible solutions to alcohol anddrug problems in Collingwood? (if necessary PROBE foropinions on increased community education, increased lawenforcement, legislative change [some sort ofprohibition and/or control] or development of otherhealth promoting alternatives? If the respondent citesnon educational programs probe for more detail.)26. Which individuals and/or organizations couldeffectively deliver the programs? (Provide examplesonly if necessary i.e., community organizations,immigrant services, schools, doctors, alcohol/drugagencies, media, etc.)CONCLUDING COMMON QUESTIONS27. Do you have any other suggestions or comments youwould like to make?28. We are interested in hearing what other communitymembers think about this subject. If you know any othercommunity members that could agree to an interview orwant to be involved in the work of the committee, pleaseask them to contact our office.- 124 -Appendix G: Sample of interview notesRESIDENT female, 24, recreational/day care worker. Lives withparents. Resident in area 17 years. Christian, UnitedChurch.1. DIFFICULTIES?- "prevalent in low income areas." "income hasrelationship to problems." "more need for out reach."OTHER?:- people now tend to "stick to themselves now." "theydon't know their neighbours." I heard evidence ofsubstance abuse.CHANGES OVER TIME? - "dramatic increase of substance abuse in schools.""increased violence in isolated incidents."2. PROBLEM IS?i) alcohol is MINOR.ii) illicit drugs is SERIOUS.- "drug drops in area." "I don't know how much stays inthe area."iii) prescription drug abuse level is NOT KNOWN.3. WHO IS AFFECTED?i) YOUTH? "focus should be on them." "educate parentsto educate their kids."ii) OTHER? "the entire community." "the neighbourhoodhas a bad reputation." I see "more negative action onthe streets."NEGATIVE ACTION? 7/11, gangs and threats. "Collingwood Park is a droparea (according to friend who lives across the street)."3a. WHAT IS ACCEPTABLE USAGE? - "We all need to be aware of our limits and live withinthem."- "drinking is O.K. if it does not interfere with yourlife or the lifes of others."- illicit drugs are not O.K. as they are "addictive."- prescription drugs are "necessary for some people,sometimes however they are over prescribed"WHY? - doctors sometimes prescribe them "to get patients offtheir backs."- 125 -4. SERVICES IN AREA?- "no special programs." A.A.5. IS THE GENERAL PUBLIC AWARE?"In metro Vancouver, yes." I am not aware of anyneighbourhood programs. "we like the idea but not in mybackyard."6. WHO WOULD YOU TURN TO?"yellow pages or agency services book to identifyagencies." "N.D.P. Community Handbook."TRY PROGRAM?- "I don't know much about it." "I think it says thatcommunity should take more responsibility."7. BARRIERS?- "fear of getting involved."WHY? - "some seniors are afraid of drugs and won't go nearthem." its is "scary as people get hurt sometimes.""emotionally taxing." "lack of community spirit."IS COLLINGWOOD A COMMUNITY? - no. Collingwood "is not community of people workingtogether."MULTICULTURAL? - no. "no obvious substance abuse in E.S.L. families atpreschool." different for Caucasians - "more physicalabuse." "of 12 Caucasian families in preschool 3 hadsubstance abuse problems and 2 may have had problems."8. PROBLEM AREAS?- "Killarney Park ice rink is a drop off point."MR. SPORT?- "they are usually so drunk that they are not scary."9. SOLUTIONS?- "education is the strongest weapon." "maybe morepolicing might be effective but it will probably justcause the problem to move." "an attitude change isnecessary".ATTITUDE CHANGE?- for example: "educators need to take a strongerstance." "not taking action means acceptance."LEGISLATIVE CHANGE? - "present laws are O.K." "the more you say know themore they will say yes."YOUTH? - "more recreational alternatives." the goal should be- 126 -"getting kids to do things for themselves." They "needto develop more self esteem."WHO SHOULD DELIVER PROGRAMS? - "Community Centers, Parks and Recreation, Schools, andthe Church, but not many young people go to theseplaces".

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