Introduction
Drug addiction is one of the worse problems encountered by nations worldwide. It has been a known fact that in addition to the increasing cases of drug abuse, other problems such as high crime rates are also expected. Medical professionals and psychologists claim that drug addiction is actually triggered by psychological incapacities and personal problems, making drug addiction a case that needs medical attention. These two factors that encompass the issue of drug addiction raise contradicting views on what treatment is appropriate for heroin abuse or for any forms of drug misuse. Heroin addiction is a health issue as claimed by other health agencies and committees ( 2004); on the other hand, the public fears the increasing rates of criminal acts out of drug influence. Nations, particularly in the British region, are indeed finding it difficult to address this two-factorial issue.
Today, drug addiction is one of the major problems of society. This menace has spread throughout the world in both advanced and impoverished countries (1995). Heroin, LSD, marijuana, hashish, cocaine, codeine, morphine, novocaine, ganja and brown sugar – the most commonly used drugs – are openly being sold even in public places, and are readily available on the streets. The drug problem of a plague that consumes an estimated $78 billion per year of public money, exacts an estimated $73 billion a year from consumers, is responsible for nearly 50 per cent of the million Americans who are today in jail, occupies an estimated 50 per cent of the trial time of our judiciary, and takes the time of 405,000 policemen -- yet a plague for which no cure is at hand, nor in prospect.
Once a person gets into clutches of this demon, they find it impossible to rid themselves of it. If they try to avoid it, they suffer from vomiting, muscle cramps, convulsions, and delirium (1998). This evil which has made man its slave leads him to lying, stealing and even killing. The condition of drug addicts is so miserable that they deserve our pity and not contempt. Drugs might be used recreationally and their continued use might arise from their attempt to self-medicate themselves to treat anxiety and depression (:1996). Continued drug use might arise because of isolation and marginalization. There is a theory that individuals affected with both disorder have a certain vulnerability predisposing them to both. Another theory holds that the patient had the substance abuse problem first which affected his or her brain functioning and behavior, leading to a mental illness.
Legal substances, approved by law for sale over the counter or by doctor's prescription, include caffeine, alcoholic beverages, nicotine, and inhalants, Prescription drugs such as tranquilizers, amphetamines, benzodiazepines, barbiturates, steroids, and analgesics can be knowingly or unknowingly over prescribed or otherwise used improperly (1989). In many cases, new drugs prescribed in good conscience by physicians turn out to be a problem later. For example, diazepam (Valium) was widely prescribed in the 1960s and 70s before its potential for serious addiction was realized. In the 1990s, sales of fluoxetine (Prozac) helped create a $3 billion antidepressant market in the United States, leading many people to criticize what they saw as the creation of a legal drug culture that discouraged people from learning other ways to deal with their problems. At the same time, readily available but largely unregulated herbal medicines have grown in popularity; many of these are psychoactive to some degree, raising questions of quality and safety. Prescription drugs are regulated by the Food and Drug Administration and the Drug Enforcement Administration.
Prescription drugs are considered illegal when diverted from proper use (Milhorn, 1990). Some people shop until they find a doctor who freely writes prescriptions; supplies are sometimes stolen from laboratories, clinics, or hospitals. Morphine, a strictly controlled opiate, and synthetic opiates, such as fentanyl, are most often abused by people in the medical professions, who have easier access to these drugs. Other illegal substances include cocaine and crack, marijuana and hashish, heroin, hallucinogenic drugs such as LSD, PCP (phencycline or “angel dust”), “designer drugs” such as MDMA (Ecstasy), and “party drugs” such as GHB (gamma hydroxybutyrate).
A lot of individuals play around with possibly addictive drugs. Addiction is much more than plain and simple drug use. It is characterized exclusively as an obsessive pattern of drug-seeking and drug-taking actions that occurs to the detriment of most other activities. The key issues in addiction, for that reason, are why a number of vulnerable persons go through a changeover from casual drug use to obsessive patterns of drug use.
There have been numerous models to give explanation to the phenomenon of addiction and each field of explanation has been sustained by a number of empirical proofs. These diverse fields continue to be incorporated into a more inclusive model of addiction. At present the biopsychosocial paradigm of addiction (and roots of addictive behavior) shapes the foundation of treatment ( 1997) Thus, one would take for granted that it is the most established and widely used. In contrast to the disease paradigm it looks at addiction as a complex behavior model having sociological, biological, psychological and behavioral elements. These takes account of the incidence of longing, immediate contentment at the risk of continuing damage, unpredictable alteration in psychological and physical conditions. Addictive behavior is differentiated from other behaviors by the person’s pathological, great contribution in drug use, the yearning to carry on the utilization and lack of command over it. It is as a result difficult to perceive it in the context of a habit.
Drug Abuse, Health and Legal Policies
Addiction to drugs is characterized mainly of the intake of drugs. This might be ingested or smoked. The more common type of substance that is frequently abused by individuals is cannabis. Cannabis has been deemed as an atypical drug, in that it did not interrelate with the brains’ reward arrangement. Nonetheless, research has exposed that the active element of cannabis, delta-9-tetrahydrocannabinol (THC), constructs improvement of brain-stimulation reward in rodents, at (proportional) spells within the series of individual udner 1992). Studies have similarly shown that cannabinoid receptors in fields connected with brain reward and that THC boosts dopamine levartin, 1996) It is these reward structures that addicted individuals have trouble prevailing over.
Moreover, the succeeding tolerance to the results of drugs and withdrawal when drug utilization ceases are both the consequence of neuroadaption , 1997). Animal models have revealed that stressful stimuli trigger the dopamine reward system, so susceptibility to relapse from abstinence is hypothesized to take place. Accordingly, drug utilization carries on in an effort to steer clear of the symptoms that tag along if drug utilization ceases ( 1997).
It is often recognized that drug-related crime are triggered by the violence that is brought about by the altered state of mind that illicit drugs induce. In attempting to comprehend the manners in which alcohol and drug utilization may have a say to violent actions, it is similarly imperative to deem the manner in which substance abuse is about human actions generally. A number of attempts have been carried out in the study of psychological expectancies in relation to alcohol's consequence on actions (Grube et al 1994), the connection involving alcohol and cognitive functioniet al 1993), and the dynamic developmental consequences of untimely introduction to alcohol and aggression among young individuals (White et al 1993) and among women who have been wronged as kids and as grown-ups (Widom & Ames 1994).
Comparable work has tried to recognize the connection involving illicit drugs and behavior, even though as a result of the interest centered on the indiscretion of these substances; this organization of work have the tendency be most caught up with unlawful behaviors that may well be connected with drugs. Instances from this literature takes account of assessments of the connections involving drug use and criminal behavior amongst juvenilesn 1993); associations involving substance use and domestic aggression ( 1995); the manners in which the employment and circulation of illicit drugs are connected to all kinds of crime, principally nonviolent property misdemeanorer 1994); and the effects of drug employment on the capability to sustain interpersonal relationships ( 1996).
Health workers have an important role in the social resolve of substance abuse. However, the discussions in this part of the paper will be on account of the resolve of the health workers in dealing with substance abuse among the public. One issue is the participation of health workers in treatment schemes for substance abuse. Increasing the contribution of health workers in substance abuse treatment scheme would perk up the success of this very important service area. The underlying principle for such extended contribution takes account of development in direct services to customers, assessment and accountability of schemes, assessment on practice concerns, and growth of new treatment paradigms.
Health workers are skilled in and accustomed to positive therapeutic methods that present the best possibility of productively employing and assisting chemically dependent consumers. The notions of self-evaluation and examinations for practice development acquire comparatively diminutive attention in substance abuse treatment schemes. This lack of evaluation is partially due to the diverse origins and historical separation of substance abuse treatment from the conventional medical and mental health care arrangements. Health workers can carve up the development of substance abuse treatment by launching higher norms of professional accountability and by scheming and performing research on key programmatic concerns. For instance, health workers are well prepared to break through in generating instruments to track clients' treatment development and effects for their programs.
Within the the Drug and Alcohol Action Teams (DAAT) programmes continue to address national and local government objectives in the provision of treatment across all tiers of the profession. I attended the recent launch of the DAAT Programme for 2004/05 (6th May 2004) in the borough of Hounslow, Middlesex. Key themes and objectives of the DAAT’s work programme were presented and the local DAAT Treatment Plan had been agreed by the National Treatment Agency. There were many themes, however the DAAT’s top priorities for 2004/05 for the borough of Hounslow are as follows:
· Development of a Young people’s Substance Misuse Service
· Reducing waiting times and improving GP prescribing levels.
· Developing clearer responses to crack cocaine.
· Developing provision to reflect more sophisticated understanding of needs of Hounslow’s diverse communities.
· Improving data collection, including joint working with CDRP
(2004)
Advocates for expanded drug treatment argue that new programs will more than pay themselves in reduced crime, improved health and fewer broken families. It's not clear which, if any, government and / or approaches really work, however counsellors working together in partnership with other service providers continue their endeavour in seeking appropriate therapeutic interventions with clients who misuse substances.
Drummond (1995) declares that, traditionally, we may oscillate between perceiving addiction as a medical hindrance and a social amiss. Similarly, the therapy of addiction has conceded in the course of sequences of medical attention ensued by disciplinary crackdowns.
Unfortunately, addiction models and consequent treatment approaches have been rigidly constructed. It is this generic programming and lack of flexibility that results in high recidivism and poor success rates. The completion of treatment, the "treated" individual is usually returned to the same environment that s/he struggled with prior to entering that program.
“The expectation is that the client is better equipped in dealing with the problems s/he entered treatment with. The degree to which many clients are able to cope is usually not sufficient to ensure long-term stabilization. Success ultimately boils down to an individual's personal decisions.” (1995).
The individual's capacity to decide would be less inhibited if s/he had a broader range in which to choose from. The current disease model short-circuits treatment potential. In fact, it holds an element of damage in itself, in that there seems to be a mentality of labelling accordingly (Drummond:1995).
Frequently, upon failing in treatment, a client is offered another chance by the same agency ("to get it right (:1995)"). Programs are more often than not geared toward delivering curricula that suits the protocol of the agency. Many programs tend to facilitate the same basic treatment to all clients, and fail to distinguish first time clients from "recycled" clients (2001). If the person in relapse enters another agency, s/he is likely to be re-assessed, and there's a good chance that the client will be subjected to the same treatment regimen as previously prescribed, only the new program will have a different name.
The 12 steps of Alcoholics/Narcotics Anonymous are the foundation of many treatment centres. A.A. originated in the 1930s (Hay:2001). There is no cost, and it was designed as an outlet for chronic alcoholics who choose to attend. To administer treatment from a 12 step orientation is a question of ethics. It is important to note, if a program mandates attendance, let alone operates solely on the principles of the 12 steps and charges for such "services," it conflicts with the notion of anonymity and the intrinsic features of AA. They may be a good supplement for many in recovery, but the 12 steps should not be the main component for any agency (Harwin and Forrester:2002).
The Future
Drug misuse may immediately merit the suggestion whether a person should be rehabilitated, corrected, punished, or indeed, treated ( 1993). Furthermore, the notion of chemical dependency as "disease" warrants examination. Just as there are an assortment of drugs and those who use them, there exists a rather diverse population for which treatments should also vary. (2000) implies that where a doctor's criteria of what constitutes abuse or dependency of alcohol or (other) drugs are generally restricted to medical and psychological aspects. More specifically, noted that rarely are the consequences of harmful use actually restricted to one or two spheres of a person's life. (:2000) The restricted aspects have set the premise for narrow minded thinking. Furthermore, it widens the gap of unsuccessful treatment.
Clinician and client attitudes and behaviors within an episode play a key role (1998). For example, clients who are willing to disclose past and present psychiatric symptoms have a higher potential for forming a therapeutic alliance (1990). Furthermore, the clients of crisis clinicians who are supportive and who make efforts to engage them in the relationship ( 1995) shows more improvement. The working alliance is also important. More specifically, clients and clinicians who agree on goals are more likely to have successful referrals
With regard to the attitudes and behaviors of clinicians, mental health services providers tend to be supportive and substance abuse counselors tend to be confrontational; thus clinicians serving those with a dual diagnosis are caught in the dilemma of balancing the two approaches in treatment episodes (2000). In particular, it is critical that the clinician not be overly negative in his or her approach, because a negative approach can lead to decompensation or to a return to alcohol or drug use; rather, confrontation should be introduced gradually.
The Powerless-Empowerment Scale, which was developed by investigating its reliability and viability, demonstrated initial promise as an instrument that can be used in a variety of settings in the substance abuse field. Two important questions in the field of substance abuse counseling involve the degree of responsibility that clients should assume for their recovery and how much power they have to overcome their addictions. Traditional counseling approaches represented by Alcoholics Anonymous, the Twelve Step Model, and recently (1976) have made an important contribution to the disease model of addiction, in which substance abusers are seen as victims that should not be blamed or punished for behaviors that are essentially involuntary. With the assumption of blamelessness may also come the philosophy of powerlessness, which has been very much a part of traditional substance abuse treatment approaches?
Other theorists seem to take a more moderate and balanced position and regard loss of control and powerlessness as matters of degree rather than absolutes. Regardless of the theoretical position, powerlessness is a key factor in substance abuse treatment. The individual is "suffering from a disease not unlike other diseases in which choice, will, and moral conviction do not, for the most part, make much difference". On the other hand, recent work by (1998) has suggested a philosophically different, if not opposite, approach to substance abuse treatment. Their approach tends to focus on empowerment, self-efficacy, and personal control. In this approach, "treatment should focus on enhancing the client's feelings of personal mastery, especially through the provision of opportunities to plan for and practice appropriate coping behaviors" (1990). Specifically, cognitively oriented counseling targets two areas: "(a) changing distorted thinking about substance abuse, and (b) increasing adaptive coping responses" . In summary, empowerment theory focuses on personal control and the development of an internal belief in an ability to manage life in general, including addictions.
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