The Effectiveness of Services for Alcohol Users as Influenced by Drug Misuse
Introduction
One of the problems that our society faces today is the problem with addiction. Addiction may come in many forms and is usually associated with negative ideas or concepts. This concept of addiction would automatically suggest one person’s excessive wanting for something, and because the world at present has become more open to a lot of vices and worldly things, the concept of addiction may not be considered as something new. However, although the addiction of several individuals may not be as taboo as before, the serious consequences that follow it may become inevitable.
Addiction can be associated with many things, and the most common type of addiction is alcoholism and drug use and misuse. Alcoholism and substance misuse are two different addictions, but are related to one another due to the effects that each addiction presents to many individuals. Both addictions, when not controlled, can lead to serious illnesses and even death. These do not only destroy the lives of the persons obsessed in consuming them, but destroys also the lives of the people around them. In short, these addictions affect the whole society as well. This issue becomes relevant for alcoholism and substance misuse is attributed to many crimes present in the society today. These addictions are also relevant for appraisal and discussion for additional information and knowledge regarding the actions made by the society in seeking treatment for the patients suffering from the problem. This gives us the chance to assess the effectiveness of the existing policies and to focus on improving these existing policies for better provision of treatment and prevention.
Given these, this paper seeks to appraise the effectiveness of the services provided for alcoholics, as influenced by the public perceptions of drug users. This paper also discusses the harm caused by drugs and the determinants of substance use and misuse. It also evaluates the competing perspectives in health care provision in relation to drug addiction and the policies existing to lessen the drastic impact of substance use and misuse in the society. These will be discussed and evaluated by presenting various facts regarding the issues and some studies done by some researchers.
Determinants of Substance Use and Misuse
It has been reported that people take a variety of substances because they either enjoy what substances do for them, or because they do not like what happens if they do not have them (2006). Most substance misuse problems are related to legally available and widely accepted substances, and only a minority of substance misuse involves illicit drugs (2006). Several determinants or factors can be recognized in relation to substance use and misuse, and these involves a number of perspectives, namely the anomie perspective, the career perspective, the conflict perspective, the functionalist perspective, the social control perspective, the social disorganization perspective, and the social learning perspective.
The Anomie Perspective – (2002) reports that this perspective looks at substance use as a resource, opportunity, or means in people’s reaction to their specific social structural conditions (). As resource, substance may be used to achieve material success, and may be initiated and sustained to gain social status (2002). As opportunity, substance may be used to excuse failure in the life struggle, and may be attempted to escape from active social functioning, and as means, substance may be flaunted as a coping mechanism (2002). It may be instituted as a routine defense against disappointment, frustration and strain in personal experience with society (2002). This perspective can be used to explain the use and misuse of substances as a coping mechanism, excuse, escape, defense, or rescuer (2002) of the person addicted to drugs. This usually becomes the primary goal of the drug addict, to run away from the harshness and reality of life.
The Career Perspective – It draws from the career dynamics theory in management and organizational studies and parallels substance use and abuse to the employment career that features upward and downward mobility over the individual life span (2002). Its basic theme is that substance use and abuse invoke an evolutionary process that not only causes physiological, psychological, and personal changes across the user’s life span, but also has economic and social impacts on their living environment (2002). Moreover, (2002) emphasized that for drug users, a general use career pathway runs through nonuse, initiation, experimentation, escalation, habituation, problematic experiences, treatment, temporary abstinence, relapse, maturing out, retirement and total abstinence (). Individual variations, however, can occur in every possible combination due to user characteristics, drug effects, and social factors (2002). This perspective can determine the substance use and misuse of an individual as a means of answer to his or her problems regarding work-related issues, such as those mentioned.
The Conflict Perspective – This perspective views substance, substance use and users as sites, vehicles, or carriers of division, tension, conflict, or confrontation between or among individuals, groups, institutions, social classes, or other identifiable units (2002). In addition, they can serve as either means or ends, or become both causal and consequential, in general class struggles and in small groups (2002). It discusses substance use and abuse to localized conflict within the individual, among siblings or partners, or between personal beliefs and social perceptions, between parents and children, and between husband and wife (2002).
The Functionalist Perspective – It examines substance use and abuse in the context of the larger social system (2002). This perspective points out that people use substances to escape from hardships, to relieve boredom, or to gain attractive experiences (2002). This perspective explains that the users and abusers identify drugs as an aesthetic, aphrodisiac, ideological, political, religious, research, therapeutic and psychological support (2002), which escalates drug’s function and importance to the individual.
The Social Control Perspective – This perspective begins with the unnecessary and harmful nature of substance use, and assumes that substance use is an unnatural, irrational, abnormal, and deviant behavior (2002). It explains that a few who use substance begin with a loosening or a lack of proper restraints in the family, school, work, or other social settings, and once they engage themselves to these things, then they may experience a further loss of control in their life (2002). This perspective emphasizes that the use and misuse of substances and the alcoholism of an individual could be influenced by external factors. These factors include the parental alcohol or drug abuse, poor communication across the generational line, inconsistent and harsh discipline by parents or teachers, inadequate training and monitoring in school, physical abuse and neglect by adult figures and affiliation with delinquent peers (2002).
A good example for this perspective is the study indicated in the research done by (2004), which assesses the relation between family and social network norms and the use of illicit substances. It has been reported that in a prospective cohort study of 996 adolescents in Sydney, Australia, marijuana exposure through friends and siblings was a primary determinant of current marijuana use (2004). Parental illicit drug use also has been associated with illicit drug use by adults in some studies, and use of illicit drugs by members of one’s social networks is associated with a greater likelihood of drug use (2004).
The Social Disorganization Perspective – This perspective defines the effect of the environment of the individual and how they are lured or forced into substance use, deviance, or criminal activity in the face of difficulty from the new environment or due to their individual mis-adjustment (200249). This perspective emphasizes that substance use is a reaction to and a syndrome of social disorganization, as for instance, many migrants and newcomers frequent go to bars and other substance-serving facilities because they are away from their families and they are lonely (2002). They believe that their loneliness, frustration and grief can be answered through alcohol and drugs. In addition, people smoke cigarettes, drink alcohol, or use drugs because they are idle, they are aimless, and they are entrenched in their familial, tribal, ethnic, or territorial enclave (2002).
The Social Learning Perspective – (2002) reports that this perspective focuses on the behavioral dimension of substance use and how it is acquired as a human behavior (p. 175). This perspective suggests that substance use and abuse is a learned process so it can also be unlearned through engagement in group sessions and positive associations, such as family, school, community, and employment organizations (2002, pp. 178-179).
These perspectives and determinants can give us an understanding that there are several factors affecting an individual for substance use and misuse. These factors are crucial for they determine the perceptions and the attitudes of the individuals using drugs. From the given facts, it can be evaluated that external factors, such as the environment, work, family, peers, and many others dictate the behavior and the decision of individuals to engage in taking and abusing drugs. The consumption of these substances is often consequences of strong emotions, such as grief, loneliness, depression, anxiety and desperation. These facts lead us to assess the public perception of drug users and abusers. It is important to note what the society thinks of these individuals to properly and effectively assess the actions done by the government and their family for treatment and prevention. (2006) reports that society’s contempt for addicts is again because of a lack of awareness and because most people treat addiction as a moral issue or dismiss it as a sign of weakness (p. 3). Most become addicts because their lives have become dysfunctional for some reason and they find solace in certain drugs ( 2006). In addition, while personal factors may play a role in causing stress, society is as much to blame, for through such stress factors as the high degree of competition for jobs, the great disparities in income and the crumbling of values, the rise of addiction levels can be attributed ( 2006).
Moreover, most often, parents feel helpless and unable to handle the situation ( 2006). One reason for this is while awareness programs are focused on the dangers of taking drugs, the public is told very little about where to go for treatment ( 2006). This would not only lead to the confusion of the public but would also lessen the chance of many individuals to undergo treatment. One good example, as reported by (2006) is that the educated in India did eventually find out the real problem for the citizens belonging to lower income groups (). The 1990 study revealed that a large proportion of addicts were farm laborers or factory workers who were usually out of a job ( 2006). In industrial towns such as Kanpur, Dhanbad, Surat and Baroda, the problem had become serious, for not only do the families of such victims find it difficult to cope because it is usually the breadwinner who is ensnared, but getting proper treatment is almost a miracle, nor are awareness programs able to get across to them ( 2006).
Furthermore, there is also a tremendous amount of confusion with regard to modes of treatment, as voluntary efforts are wrongly viewed with a great deal of skepticism, such as in having consultation and treatment with the Narcotics Anonymous ( 2006). It has been reported that psychiatrists are usually the first to be contacted, but given the enormous shortage of manpower, the amount of time they can devote to patients is insufficient, so relatives of addicts usually blunder their way through the various treatment options ( 2006). Furthermore, the public’s perception indicates the lack of trust in an addict, and thus becomes a suspect in the eyes of society, forcing members of his family to hide the facts from others ( 2006). Instead of actually helping the addict and the affected family, they often receive veiled threats and emotional blackmail ( 2006). Such threats and blackmail threatens many individuals to reveal their addiction and prevents them from securing treatment. This leads to further addiction and other societal and personal problems of the addict. Another problem presented by public perception is the problem being faced by the reformed addicts. Most would-be employers view them with suspicion and are hesitant to take on anyone who admits he or she has had a problem with drugs ( 2006). This is because of the negative perception the public and the society implies on the image of a drug addict. Creating awareness among them is critical because what reformed addicts need is an opportunity to build up their self-esteem, which is normally destroyed by their addiction and if they are not given a chance to do so, they usually head back to drugs ( 2006).
Healthcare Provisions for Drug Addicts
Knowing the determinants and the negative effects of drug addiction, these give us the idea that the effects of drugs can somehow be similar to the effects and consequences of alcoholism. It can be deduced that treating drug addiction can be as good as treating alcoholism, and presents tons of positive effects to the alcoholics, to the drug addicts and to the society as well. Drug addicts and substance users can be subjected to several treatments depending on the type of substance that they consume. One of the treatments is the Agonist Maintenance Treatment, or often-called the methadone treatment program, which is for opiate addicts and uses a long-acting synthetic opiate medication administered orally for a sustained period at a dosage sufficient to prevent opiate withdrawal (2005). Another treatment is the Narcotic Antagonist Treatment Using Naltrexone, which is also for opiate addicts and is conducted in outpatient settings although initiation of the medication often begins after medical detoxification in a residential setting (2005). The third provision of treatment is the Outpatient Drug-Free Treatment, which costs less that residential or inpatient treatment and often is more suitable for individuals who are employed or who have extensive social supports, as low-intensity programs may offer little more than drug education and admonition (2005). Lastly is the Long-Term Residential Treatment, which provides care 24 hours per day, generally in non-hospital settings (2005). It has been reported that the best-known residential treatment model is the therapeutic community, but residential treatment may also employ other models, such as cognitive-behavioral therapy (2005).
According to (2006), he argues that treating drug addiction can be most effective in a community setting, for it gives a recovery and cure rate that is better than with institutionalized treatment, giving only a success rate less than 20%. He adds that with the advances in medical science, drug addicts can be put on substitution medications by the general practitioner, almost like the treatment of individuals with diabetes mellitus and hypertension (2006). The advantage of using substitution medication is that the patients can go back to their regular work and thus thousands of working hours will be saved (2006). Furthermore, the drug addict can live a normal life and bring benefit to their families and country, by making them feel confident within the society (2006). As a consideration, the doctors should work with the police, law and regulatory enforcement officers (2006) for better distribution and implementation of treatment in the society.
As an appraisal, the community-based treatment for drug addicts is much more appropriate and effective. This is because through this way of treatment, the drug addict can have the realization of regaining the trust of the people around him or her, including his or her family. Through community-based treatment, the recovering drug addicts can interact with their families and the community, which will be much more helpful for their speedy recovery. This would enable them to gain back their confidence in facing the world and their personal problems. With conventional treatments, the recovering addict and his or her family would be pressured to improve the condition, and this somehow induces only the recovery of the addict. Through the community-based treatment, the recovering addict can freely interact with many individuals, including other recovering addicts for improvement and development. An occasional group talk can be organized for keeping track of the conditions of each recovering addict and thus can contribute to their inspiration for quick recovery. Through community-based recovery, the recovering addict can also participate in community activities, which would also give him or her the chance to know his or herself better. Although the exposure to drugs and some other substances of the recovering addict can be a risk, the family, friends, concerned citizens, doctors and other healthcare practitioners can serve as guide to implement treatment for immediate recovery. These can also serve as a good motivation for alcoholism treatment. Community-based treatment can also be a better solution for the treatment and cure of alcoholics. Through this, the alcoholics can also experience the same benefits as the non-alcoholics. Similarly, risks of additional exposure to alcohol can be a result of the action, but through proper guidance, the alcoholic can achieve immediate recovery.
Policies Regarding Substance Use and Misuse
A number of agencies around the world are making and constructing policies regarding substance use and misuse. One of these policies is the Dutch drug policy. It has been reported that together with the United Kingdom, the Dutch drug policy has been one of the most widely discussed approaches to addressing drug problems, particularly those related to the spread of HIV and other blood-borne diseases among injection drug users (2003). The main aim of the drug policy in the Netherlands is to protect the health of individual users, the people around them and society as a whole (2003). It also provides for a balance of demand reduction, which is pursued through active policies of prevention and care, and supply reduction, which focuses on organized crime (2003). Another aim of the policy is to address drug-related nuisance and the maintenance of public order (2003). This policy produces a Netherlands, which has a well-established social safety net with adequate social benefits, free medical care and generally free legal and social care, with drug treatment being readily available and generally free (2003).
Another existing policy regarding drugs is the White House Office of National Drug Control Policy or the ONDCP, which was established in 1988 by the Anti-Drug Abuse Act (2006). It has been reported that its goal is to establish policies, priorities, and objectives to eradicate illicit drug use, manufacturing and trafficking, drug related crime and violence, and drug-related health consequences in the United States (2006).
However, despite the aims of many policies to eradicate and alleviate the negative effects of drug addiction, it is still a given fact that drug pushing and drug addiction are considered a nuisance in the society around the world. Despite the intentions of many agencies and governments to do something about the problem, the issue of drug abuse is still very persistent. This just clearly indicates that many individuals participate in illegal acts involving drugs. This somehow suggests that existing policies regarding substance use and misuse are not effective or lacks the capacity to prevent individuals from drug addiction. This means that policy-makers must improve on making their policies and assess the situation in their country very well. In this way, a much more appropriate law can be implemented. This would be beneficial for the society and for the law-making individuals as well.
Conclusion
The problem of the society regarding alcoholism and drug addiction presents a myriad of consequences, which could create and lead to more problems. The addiction to alcohol and the addiction to drugs go hand-in-hand, as each type of addiction can lead to committing crimes in the society. This paper presented and discussed the certain aspects that determine substance use and misuse, and enable us to give an understanding why some individuals opt to engage in drug addiction. The discussion in this paper also includes the perspectives in healthcare provisions, which could be helpful in the treatment of the drug addict. Similarly, the proposed treatments can also be applicable in the treatment and services for alcoholics. These services would not only improve the lives of the addicts but improve the condition of the society as well. Another point made by this paper is the evaluation of some of the existing drug policies in the United States and in the Netherlands. This evaluation leads us to conclude that despite the presence of certain laws and policies regarding drugs, many countries are still experiencing many drug problems. With these, it can be concluded that policies are not that effective to eradicate drug addiction and even alcoholism in the society. Each needs discipline to at least lessen addiction in the society. We must all help one another in supporting treatment for alcoholics and drug addicts to foster a brighter and better society for the next generation.
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