Primary prevention

The primary health care service is in a position to meet people's needs and to deliver health care to individuals or families at their homes or workplaces. It would be quite unrealistic to expect the primary health care worker to develop complex or specialized activities. However, the PHC worker can provide a very cost-effective service by using relatively simple skills of listening, communication, and counseling. In order to develop primary health care services directed towards drug and alcohol problems, PHC workers will have to undertake the interrelated activities described below.

Identify drugs currently used In the community

The PHC worker should learn about the drugs in use locally, as well as the consequences of excessive use. It must be emphasized that information has to be quite detailed. It may be, for example, that a local home brew is mixed with cheap alcohols that are extremely toxic.

Identify the ways In which drugs and alcohol are used In the community

The ways in which drugs are used in a community tend to change frequently. Minor tranquillizers might be used secretly by certain groups, who buy them from a friendly pharmacist or get them through medical prescriptions. Alcohol is supplied without restrictions in many countries, but it will not be easy to find the places where very young children drink cheap alcoholic beverages. There may also be open-air places where children meet to sniff gasoline or glue, under the guise of playing or chatting.

Teenagers and young adults use drugs, or combinations of drugs, according to the fashion. It is also important to detect any intravenous use of drugs, because of the associated infections.

Information and education to promote health

PHC workers are in a position to disseminate relevant information on drugs and alcohol to the community. They can put up posters in the places where most people are likely to see them. They can also distribute reading matter to special groups or organizations, such as parents' organizations. Finally, PHC workers might be invited to conferences on drug- and alcohol-related problems in schools, sporting associations, mothers' clubs, etc. More important than information dissemination is the education of people through a two-way process of communication and interaction. For example, it is quite natural to talk about drug and alcohol problems with pregnant women or young mothers. Most of the time, it will be possible to educate people about the prevention of drug and alcohol abuse without specifying that there is a special programme to combat such problems.

Integrating primary health care work with that of other groups

The PHC worker should work with groups, such as schoolteachers, police, district commissioners, churches, clubs, volunteers, and traditional healers. If the PHC worker is able to develop good interpersonal and leadership skills, he or she will find it much easier to mobilize the community and organize specific voluntary groups to deal with drug- and alcohol-related problems.