|Responding to Drug and Alcohol Problems in the Community (WHO, 1991, 109 p.)|
|7. Simple evaluation of efforts to reduce drug and alcohol problems|
When a community resolves to take action against alcohol and drug problems, it invests resources in the hope that the programmes it establishes will be beneficial. All too often, however, it is assumed that good intentions and the utilization of resources are all that is required. To be effective, the programmes need to be based on good information about the nature and extent of alcohol and drug problems in the community. Therefore, gathering good information is the first task to be undertaken. The gathering of information can be quite simple and informal, or it can be very extensive, requiring special research skills. No matter what resources are available to a community, at least some basic information is required before programmes can be planned. Readers should also consult Chapter 2, which provides guidance on the collection of data about alcohol- and drug-related problems.
Types of information to gather
Three kinds of information will be important:
· the nature of alcohol and drug use in the community,
· the specific kinds of problem caused by their use and the kind of people affected by them, and
· what powers and influences in the community can be brought to bear on these problems.
More specifically, the answers to the types of question listed below will be valuable in planning and evaluating preventive activities:
· Which drugs are used? How are they taken? What are the characteristics of the users? What are the chief reasons for use? What is the pattern and environment of use? Are there specific trends in use (such as a new drug)?
The more that is known, the more specific the programme objectives can be, and the easier it will be to target preventive activities at particular high-risk groups or those with high-risk behaviour.
· What community problems are caused by drugs? Are there: health problems, such as cirrhosis or respiratory ailments? behavioural problems, such as absenteeism from school or work? family problems, such as domestic violence? work problems, such as poor performance or injuries on the job? financial problems, such as wages being spent on drink or drugs? Iegal problems, such as arrest? In general, the more that is known about the specific kinds of problem the better.
Such information will help define where, within the community, alcohol and drug problems have their greatest impact, and who might take an interest in reducing such problems. Also, such information will be valuable, later, for gauging the success of the preventive activities.
· Which organizations make important decisions that could affect the use of drugs and alcohol? Who are the key decision-makers? How are price and availability of the various drugs determined? Which laws are relevant, and how are they enforced? Which professional and voluntary workers are interested in alcohol and drug problems? Which other individuals or groups (such as the mass media) might be willing to take action? What other health or social problems (such as child nutrition or AIDS) are affected by alcohol and drug use, and what organizations are involved in tackling those problems?
Gathering information to answer questions such as those listed above will help you to plan your intervention programmes, and give you a basis against which to measure your successes. Without this basic understanding, it will be difficult to establish realistic goals and objectives for your efforts, and it will be almost impossible to develop priorities.
Methods of gathering information
Many different methods may be used for gathering such information, from the very simple to the very complex. Sometimes, much of the information already exists in one form or another, perhaps in various reports or in the minds of people who have been studying or observing these problems for some time. In some areas with ample resources, it is possible to gather very comprehensive information prior to starting a preventive programme. In other areas, simple, inexpensive methods may need to be used (see Chapter 2).
How to gather the information necessary for evaluation
Some of the problems posed by alcohol and drugs are urgent, and require urgent action. Sometimes, it may seem that there is not enough time to gather all the relevant information before planning an action programme. However, the following procedures will help to ensure that best use is made of existing information and may help to avoid major mistakes in the rush to do something.
· Identify issues that are already well known. Make a list of the major issues and policies that are thought to be relevant to community problems, especially if they have not been acted upon. An example might be that schoolchildren seem to have easy access to various drugs and that nobody appears to be doing anything about it.
· Identify key individuals who are knowledgeable. Interview them to learn what they believe are the major problems and what short-term and long-term approaches might be worth while. Compile a list of their ideas. Useful people to interview would be religious and civic leaders, police, school principals, doctors and hospital administrators, business executives, and others who have probably seen the effects of alcohol and drug use. These individuals may be able to suggest other people to talk to, and may later be enlisted to support the community-wide effort.
· Review existing documents. Sometimes reports have been prepared by academics and professionals, but are not widely available. They might include information on certain types of problem, such as hospital emergency admissions, school truancy, and public awareness and concern about various health and social problems. These documents may provide important information about the problems, and about the people with experience in assessing them and trying to do something about them.
· Use the information gathered in the above steps to prepare a preliminary report. Use this report to generate ideas from community leaders about how to address alcohol and drug problems. Sometimes, such a report will have the effect of making prevention a high priority for the community. This can lead to the development of an action plan, which can become the focus for both immediate and long-term efforts to reduce alcohol and drug problems. The report may also serve to generate wide support and increased resources for the implementation of the plan, especially if all sectors of the community have been involved in the discussions and feel they have a stake in the preventive programme.
Typical uses for the information
Information gathered as described above can be very useful in planning, implementing, and evaluating a preventive programme. For example, suppose that you learn that, although there is relatively little inhalant use in your community, there is increasing use among schoolchildren in a nearby community, and that inhalants are becoming more easily available in your area. Because teachers and parents may not be familiar with the substances being inhaled, the practice of inhaling, or the immediate health or behavioural consequences, they may not be aware that there is a problem, and therefore may not be able to intervene. Thus, a programme to inform teachers and parents about the substances, their sources, the inhaling practices, and the signs of inhalant use might be of high priority as a preventive measure.
Or, suppose that you learned that workers at a local factory were spending most of their wages on alcohol on pay-day. While the consequences of such spending would hurt the families of the workers, it would also have a negative impact on the factory, in the form of reduced output. Thus, the factory manager may be interested in working with members of the community to reduce the heavy drinking, and may contribute resources to the effort that would not have been available if the programme had been directed solely at the drinkers in their drinking environment.
So, information gathering can have a very practical benefit in determining which particular alcohol or drug problems are most serious, and which should have priority. It can also help in organizing various parts of the community, once people learn how the problems are having a negative effect on society. Further, the information provides a basis for comparison later, to see just how effective the various parts of the programme have been.