Primary Prevention Education

Primary prevention education is essential to the success of health system reform. Economic reality alone dictates that we must prevent that which is preventable. Mental health and substance abuse services are critical to any health system reform because they are the gateway to risky behaviors causing chronic disease and numerous other preventable health issues.

Those impacted by substance abuse and mental health issues are at risk for liver disease, one such preventable chronic disease.   Information about liver health and the impact drugs and alcohol can have on this vital organ has been missing in education programs across the nation for decades.  As recent as the mid 1970 little time and resources were allocated to support research and education in medical schools. The non complaining organ did not have a “voice” to alert Congress of the need to study this silent organ. The domino effect has been a lack of information and teaching tools in schools to engage students in understanding the importance of the liver and how drugs and alcohol can severely compromise its ability to perform hundreds of life supporting body functions. Extensive evaluations identify a serious lack of understanding of the important role the liver plays in processing drugs and alcohol and how it can be severely damaged without warning by these substances and hepatitis viruses. Liver health and wellness is missing in the public’s conscientiousness.

The Hepatitis Foundation International (HFI) serves high risk substance abuse and HIV populations as well as minority populations disproportionately affected by hepatitis. HFI has collaborated with SAMHSA for several years providing its liver wellness and prevention of hepatitis and HIV training program called Foundation for Decision Making (FDM)  to over 3500 grantees.  Both CSAT and CSAP and Mental Health administrators have provided an opportunity for HFI to describe the FDM program to their new grantees. However, HFI must subsequently contact each grantee to create an MOU to provide the training for their constituents.  Currently, there is no direct mechanism to support the FDM program through the SAMSHA network.

The FDM program is a 3 to- 6 hour training program depending on the individuals needs of the organization.  It is provided by Thelma King Thiel, chair and CEO of HFI and highly qualified staff.  Evaluations of each training program identify a general lack of knowledge of the importance of the liver and how unhealthy behaviors can lead to exposure to hepatitis, HIV and serious damage caused by drugs and alcohol. The FDM program provides basic information using analogies that various populations can relate to in their daily lives about the important role the liver plays in their ability to maintain their health and well being. Story telling techniques improve retention of information provided for various audiences.  Easily replicated messages are provided verbally and repeated in DVDs for various ages and ethnicities to enhance the ability of the counselor/teacher to share information learned with their constituents. The more extensive program includes role playing and rehearsals of presentations by the attendees.

Extensive post training evaluations and follow up over extended periods of time prove the effectiveness of the Foundation for Decision Making training in empowering individuals to make informed and healthier lifestyle choices. Obviously, individuals can not change what they do not know. Information provided is critically important in addressing the use and abuse of drugs and alcohol among young children as well as adults and especially pregnant women and prevention of hepatitis and HIV.

The Hepatitis Foundation International’s Foundation for Decision Making Training program is the only one of its kind available in the country that has demonstrated effectiveness in promoting healthy lifestyle behaviors, improving immunization rates and encouraging drug abusers to modify their risk behaviors. A NIDA supported study called STRIVE reported that injection drug users demonstrated a two fold risk reduction when provided risk reduction techniques and information about the impact their behaviors could have on the liver, their internal power plant.

In addition, clients in treatment programs have demonstrated improved compliance with treatment regimens once they understand why and how the medication aids in their recovery.  Prevention is far less costly than rebuilding a life destroyed by unknowingly participating in liver damaging activities.

A mechanism to support such liver wellness primary prevention programs directly to grantees is missing in SAMHSA’s current guidelines. Support for a comprehensive training program including trainers and  educational materials is essential to fill the identified gap in currently programs.

A system to support this essential training is needed to address this informational gap. A general policy supporting primary prevention is sorely needed at SAMHSA, CDC, HRSA, OMH, and especially schools.

Primary prevention and liver wellness education are far less costly than treating diseases and conditions that are preventable. if only one person changed risk behaviors and did not contract a hepatitis virus thousands of dollars could  be saved in health care costs per year.