Category: Abuse

Introduction

Children are the future of the nation as they are expected to enjoy the best things humanity has, acquire all knowledge it possesses, and contribute to the formation of a new, better world. For this reason, their upbringing, education, and health are the primary concerns of adults and parents. Unfortunately, there are still many problems in these areas that precondition severe issues in the future. For instance, domestic violence is a stressor that affects children negatively and preconditions critical alterations in their mentalities.

Main body

The fact is that today, regardless of multiple attempts to create a beneficial environment for children, many of them experience various forms of domestic violence. For instance, parents might use too severe measures and punish children physically, causing them pain and preconditioning the development of mental problems. Moreover, in problematic families, or in households where adults suffer from drug abuse, children might also be beaten or experience other forms of violence, including psychological or sexual ones. It causes severe mental problems that lay the basis for the new flaws in the future.

One of the adverse effects of domestic violence is the overall deterioration of the health of the nation. Individuals who were raised in complex conditions and suffered from manifestations of various abusive or aggressive behaviors might also have issues with their own children as they do not know the appropriate way to educate young people. It stimulates the appearance of new generations with even more complex problems.

Conclusion

Altogether, domestic violence aimed at children remains of the significant causes for the deterioration of the health of the nation and its degeneration as it shapes mentalities in inappropriate ways. It is critical to devote attention to this issue to ensure that its rates will be decreased and children will be able to enjoy one of the best periods of their lives.

Abstract

This paper identifies the prevalence, correlates, and negative implications of substance abuse among African American women. Several efforts have been devised to prevent substance abuse but family therapy has been effective especially when it is designed to be culturally sensitive. Several complex issues and limitations have also been cited in the programs that are used for the African American community. These issues are because the treatment is applied to individuals from diverse backgrounds.

Approximately one-third of the American population is affiliated with a minority group either by ethnicity or race. Culture is very significant in the treatment of substance abuse problems because the patients experiences of culture come first and they have great implications on their clinical experience.

The styles of coping, stigmatization, social support, and settings of treatment that are related to substance abuse are influenced by culture. Its pertinent therefore to understand culture as a very wide concept affecting a group of people in terms of their shared norms, beliefs, and values based on ethnicity and identity affiliations.

Introduction

Family-centered treatment is an all-inclusive approach that deals with the biological, psychological, social, and spiritual nature of substance abuse behavior. The approach is often highly individualized and genders sensitive especially when addressing this problem among women. The gender-sensitive aspect is predicated on the distinguishing characteristics that are evident in the womens physiology, experiences, socialization, culture, and relative statuses.

This treatment is focused on treatment that is designed around maintaining affiliations and developing healthy relationships with other people particularly the family members and children to be specific.

The family-centered treatment offers a full range of benefits that address several problems that women with substance abuse behavior face, their children, and other family members as well. A mother diagnosed with substance abuse is the main client of the family-centered treatment approach together with her children and other members of the family as her co-clients. Women who get into the program of family-centered therapy show a high likelihood of taking responsibility.

There are, however, some few families that have fathers as the primary caretakers and hence the main clients of the family-centered treatments but these are uncharacteristic.

African-American Statistics

The African Americans comprise 13% of the American population and this community is very diverse in it comprises people from different regions of the world like the Caribbean, African Canada, and Bermuda (McKinnon, 2003, p. 27). This group of people has also shared a history of slavery, segregation, and some form of racism that is institutionalized. African Americans differ from other communities in American in terms of social statuses, culture, way of life, self-perception, aspirations, and heredity.

The Office of Applied Studies- NHSDA (2003) reported that in 2000, about 34% of the African Americans were consumers of alcohol from age 12 and above, the white had a 51 percentage and Hispanic and Latinos had a percentage of 40. On the other hand, 6% of the African-Americans used illicit substances same as the whites.

Africa Americans that are being admitted to substance abuse treatment comprise 24% of admissions and out of those that were perceived to need help, 25% of them had unmet needs (Office of Applied Studies NHSDA, 2003). This was at twice the number of whites with unmet needs.

Family-Centered Therapy for African American Women

The primary goal for employing family-centered therapy for women suffering from substance abuse problems, their children, and other close family members is to improve their outcomes (Stewart, 2004, P. 219). To achieve this goal, the program should have a strong structure that comprises interventions, a model of approaches, and efficient services that will help to reach and retain women (Werner et al, 2007, p. 13).

This will be a gender-responsive program that will take into consideration the needs specific to women in all aspects. In comprehensive models, offering clinical therapy include services that are relevant to addressing medical and biopsychosocial concerns that are related to addiction (Werner et al, 2007, p. 16). These services include detoxification, screening, treatment plan, intervening crises, counseling and education, drug monitoring, medication, and continued care.

The support services include employment readiness services, life skills, parenting skills, and recovery of community support services. There are three types of family-centered approaches; parenting and family skills training, family in-home support, and family therapy (Werner et al, 2007, p. 30).

The named approaches target the dynamism of the entire family in the community instead of individuals. The approaches also address the known risk and protective factors that could reduce the chances of women beginning and continuing to abuse substances (Stewart, 2004, P. 219). There are several approaches besides the three in this paper. However, these three have a common basic logic as below

Parenting and family skills training: the family structure, its functioning and values have a great impact on the ability of children to develop prosocial skills and cope with the challenges they face in life. When parents are a trend on better skills of parenting and handling family issues, they are in better positions of nurturing and protecting their children and helping them develop prosocial character (Stewart, 2004, P. 221). Parents can deal with challenging children as well. This approach is used for families with children at high risk of exposure to substance abuse.

Family in-home support: this approach targets families at greater risk of abuse because of the many risk factors or open exposure to risk factors. This family would find preventative measures very appropriate. Such families could have children placed outside the home because they are falling apart.

The in-home support takes into account the risks involved simultaneously and develops interventions to the unique family needs (Stewart, 2004, P. 221). The goal of this approach is to reduce chances of domestic violence, neglect, child abuse and prevent extreme measures like placing children in foster homes or juvenile delinquent facilities.

Family Therapy: this approach focuses on the families at greater risk because of multiple risk factors or greater exposure to a certain risk factor. The intervention here is set to enhance family functioning and decrease juvenile delinquency, crime, parents abusing children, and recidivism among other antisocial conducts (Stewart, 2004, p. 223). The family members are in a better position of developing better interpersonal skills, improving communication, and dealing with intricate family dynamics.

This reduces negative behaviors and improves perception towards each other and created an environment for family interaction. Parenting skills are improved and there is no inappropriate control over children.

Continuum of Family-Centered Therapy

There are five progressive steps (Werner et al, 2007, p. 5) involved where family-based services are provided:

• Step 1: treating of women with family involvement  this treatment plan addresses family matters and the goal is to enhance the outcome by involving the family
• Step 2: Treat mother with children involved  the children are included in child care but are not given therapeutic services. The goal is to enhance women results still
• Step 3: treating women and children  both the women and their children have treatment plans and are provided with relevant therapeutic services to enhance results and improve parenting skills (Werner et al, 2007, p. 5)
• Step 4: family services  children are involved in therapy and other services are extended to the rest of the family members. The objective is to enhance the results of children and women and improve parenting skills (Werner et al, 2007, p. 5).
• Step 5: family-centered treatment  the service providers develop treatment plans for every family member where each of them is treated individually and then as a family collectively. The goal is to enhance childrens outcomes, improve parenting skills, and better family functioning (Werner et al, 2007, p. 5).

Womens ego development is based on making and maintaining associations, however, substance use disrupted this and this therapy seeks to establish harmony to recover healthy family functioning. The approach can mitigate individual and family risk factors (Werner et al, 2007, p. 5).

Conclusion

This family-centered approach for African American women has two main advantages. First, their substance abuse, dependence, and successful intervention have a strong relationship with family, particularly the children. The family also influences treatment and relapse, however, the second advantage is that about 70% of the African Americans entering interventions programs have children. This means that the children have a greater risk of child neglect, developmental challenges, and exposure to adolescent substance abuse.

The therapeutic care that would improve parenting skills, the prognosis of the condition, and the outcomes are very beneficial in protecting the children. If the entire family is treated, the outcomes of each member are improved and simultaneously enhance communication and coordination of adult members and their ability to support each other hence the family is healed.

Reference List

McKinnon, J. (2003). The Black Population in the United States: March 2002. Current Population Reports. Washington, DC: U.S. Census Bureau, p. 20541.

Office of Applied Studies, Substance Abuse and Mental Health Services Administration (2003). The NHSDA Report: Children Living With Substance-Abusing or Substance-Dependent Parents. Web.

Stewart, P.E. (2004). Afrocentric Approaches to Working with African American Families. Families in Society 85(2):217224.

Werner, D., Young, N.K., Dennis, K, & Amatetti, S. (2007). Family-Centered Treatment for Women with Substance Use Disorders  History, Key Elements and Challenges. Rockville: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA).

Substance abuse is a common problem and affects adults across the lifespan. It refers to excessive and uncontrolled consumption of various psychoactive substances, including alcohol and illicit drugs, and can develop into a substance use disorder (SUD) and addiction that may severely impact ones mental and physical health and the overall quality of life (Cleary & Thomas, 2016). The occurrence of SUD is influenced by multiple individual and environmental factors, including gender, socio-economic status (SES), and so forth. Considering that SUD and addiction often impact multiple areas of a persons life simultaneously, they are usually treated through comprehensive strategies, involving interprofessional collaboration. Available interventions, risks, and factors contributing to substance abuse in adults will be discussed in the present paper.

Epidemiology and Influences

Epidemiological data indicate that alcohol use disorders (AUDs) are more prevalent than illicit drug use disorders (IDUD). The results of the 2014 National Survey on Drug Use and Health (NSDUH) revealed that alcohol dependence or abuse was reported by 16.3% of respondents, whereas IDUD was found merely in 6.5% of survey participants (Lipari & Van Horn, 2017). Together, these adverse conditions affect over 20 million adults in the United States (Lipari & Van Horn, 2017).

Among demographic influences contributing to SUD, ethnicity, and gender seem to be the most essential. Throughout the lifetime, the prevalence of both AUDs and IDUDs is higher in males (36% and 12.3%) than in females (22.7% and 7.7%) (Grant et al. 2015). Native Americans also tend to develop SUDs more frequently than people of other ethnicities. Lifetime AUD prevalence in them equates to 43% compared to 33% in Whites, 23% in Hispanics, and 22% in Blacks (Grant et al. 2015). IDUD prevalence in Native Americans is 17.2% compared to 10.8% in Whites, 9.9% in Blacks, and 7.2% in Hispanics (Grant et al. 2015).

As for SES, it affects the incidence of AUD and IDUD differently. The lifetime prevalence of alcohol abuse is greater in higher-income people, whereas low-income individuals are at a higher risk of drug abuse (Grant et al., 2015). Additionally, the overall neighborhood environment and cultural environment may be linked to the SUD incidence. Whereas such neighborhood stressors as crime and poverty increase the risk of SUD, religiosity and wider social networks are considered to be protective factors against this adverse condition (Delker, Brown, & Hasin, 2015). The provided research findings show that to address the problem of substance abuse, a comprehensive methodology targeting a wide range of factors must be implemented.

Risks and Interventions

Epidemiological studies show that younger adults (18-29 years old) are at a higher risk of substance dependence than middle-aged and older adults. The lifetime prevalence of AUD and IDUD in them is 37% and 14.2% respectively, compared to 34.4% and 12% in middle-aged adults and 13.4% and 2% in older adults (Grant et al. 2015). The health risks to which adults are exposed as a result of substance abuse differ as well. Young and middle-aged adults face the risk of alcohol overdose and poisoning, heart problems, diabetes, damages to the reproductive system, respiratory problems, and sexually transmitted diseases (Schulte & Hser, 2014). Older adults tend to suffer such conditions as diabetes, cancers, heart attack/stroke, cirrhosis, and accidental injuries due to abuse of various substances (Schulte & Hser, 2014). Besides that, SUDs in adults is often accompanied by depression, anxiety, insomnia, phobias, and other psychological disorders, including dementia/Wernicke-Korsakoff in older adults (Schulte & Hser, 2014). However, the relationships between SUD and mental disorders are usually complex and dynamic because individuals often consume alcohol and drugs to cope with already existing traumas and problems.

Considering a great variety of their negative impacts on health, SUDs can be intervened by using many pharmacological and psychosocial methods. To treat addiction, patients can be prescribed such medications as Methadone and Naltrexone, which block receptors involved in forming addiction responses (Treatment approaches, 2019). Though these remedies proved to be effective, especially when treating alcohol and opioid addictions, they have multiple side effects. Compared to them, psychological interventions, including counseling and cognitive-behavioral treatment that aim to modify patients coping strategies and mindsets, are safer (Jhanjee, 2014). By helping individuals to adopt healthier behaviors and change adverse life conditions, psychosocial interventions allow attaining long-term, sustainable results. However, they are usually time-consuming and can be relatively expensive. Moreover, the overall treatment success in their case largely depends on patients levels of motivation, which may be difficult to maintain independently.

Interprofessional Collaboration

Effective services aimed to reduce the burden of SUD are normally collaborative. However, according to Vourakis (2013), interdisciplinary collaborative addiction education and practice are still underdeveloped in the United States. It means that nurses should take initiative to educate themselves regarding multiple aspects of SUD and engage in networking and partnering as part of their team or independently to address the raise prevent substance abuse. They may work with and learn from existing organizations, such as CASPAR that provides social, psychological, and medical services for people across the substance use/abuse/recovery continuum (CASPAR, n.d.). This organization carries out outreach functions and works to demarginalize the people with SUDs (CASPAR, n.d.). Following CASPARs example, nurses as practitioners can perform SUD screening together with psychologists or/and physicians and link those at increased risk of substance abuse to relevant support services (Puskar et al., 2016). As educators, nurses can also collaborate with multiple private and public organizations working with adults (especially those at increased risk of SUD due to their SES and ethnic background) to disseminate information about SUD and factors defining its progression. Only with the help of other multidisciplinary professionals, a nurse can address the problems related to living conditions of those with SUD and help to prevent the problem at the community level.

References

CASPAR. (n.d.). Web.

Cleary, M., & Thomas, S. P. (2016). Addiction and mental health across the lifespan: An overview of some contemporary issues. Issues in Mental Health Nursing, 38(1), 2-8.

Delker, E., Brown, Q., & Hasin, D. (2015). Epidemiological studies of substance dependence and abuse in adults. Current Behavioral Neuroscience Reports, 2(1), 15-22.

Grant, B. F., Goldstein, R. B., Saha, T. D., Chou, S. P., Jung, J., Zhang, H.,& Hasin, D. S. (2015). Epidemiology of DSM-5 alcohol use disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry, 72(8), 757-766.

Jhanjee S. (2014). Evidence based psychosocial interventions in substance use. Indian Journal of Psychological Medicine, 36(2), 112-118.

Lipari, R. N., & Van Horn, S. L. (2017). Trends in substance use disorders among adults aged 18 or older. The CDHSQ Report. 

Puskar, K., Lee, H., Mitchell, A. M., Kane, I., Albrecht, S. A., Frank, L. R., & Houze, M. P. (2016). Interprofessional collaborative education for substance use screening: Rural areas and challenges. Online Journal of Rural Nursing and Health Care, 16(1), 76-96. 

Schulte, M. T., & Hser, Y. I. (2014). Substance Use and Associated Health Conditions throughout the Lifespan. Public Health Reviews, 35(2). Web.

Treatment approaches for drug addiction. (2019).

Vourakis, C. (2013). Interprofessional collaboration in addressing alcohol and other drug abuse in health care settings. Journal of Addictions Nursing, 24(1), 1-2.

Introduction

Substance abuse has been a great problem across the world and in particular, the abuse of alcohol. The United States has been faced with serious implications as a result of the issue of alcohol abuse. For this reason, there is increasing health promotion and disease prevention strategies that have been put in place to try and mitigate the increase in the effects of alcohol abuse, and mostly the diseases related to the risk of abuse.

Main body

Whereas light to moderate alcohol consumption could have some benefits to the consumer, excessive drinking has severe adverse impact on health. Just like other drugs, toxicity of alcohol is based on dosage (Larimer & Cronce, 2002, p. 153). In the United States, when the consumption of alcohol exceeds two drinks per day per person, this is regarded as alcohol abuse. Drinking affects judgment and therefore, excessive drinking can lead to risky behavior resulting into immediate and harmful health effects.

There are deleterious effects that are associated with the abuse of alcohol and these include among others accidents and injuries, risky sexual behavior, alcohol poisoning, and aggression (Malow et al, 2001, p. 105). Of particular concern is the binge drinking since is associated with immediate consequences like violence accidents and other risky conduct.

Statistics show that over 22 million Americans struggle with the problem of alcohol abuse. Worse of it is that about 95% of them are not aware that they are having this problem. Still, a big percentage of those who appreciate that they have the problem have made unsuccessful attempts to stop the problem (Malow et al, 2001, p. 105).

Health Profile of alcohol abusers is characterized by problems that come as a result of poor judgment and impaired thinking hence risky behavior. In the modern society, alcohol abuse is a serious problem that is leading to more health issues. Alcohol abuse is simply explained as condition where an individual consumes more alcohol that she/he cannot control oneself (Room, 2005, p. 521). The person ends up engaging in risky conclude due to intoxication.

Alcohol abuse can definitely precipitate into alcoholism, where the victim becomes dependent on alcohol. Alcohol-related problems are increasingly becoming a serious concern in public health because, alcohol is now very readily available to young people especially college students (Knight et al, 2002, p. 264). An important observation is that many of these alcohol-related problems are seen among non-dependent consumes who are basically harmful drinkers or as WHO would put it, hazardous consumers (Knight et al, 2002, p. 264).

Drink alone: alcohol abusers tend to drink alone so as to hide the misconduct from friends and family. This can happen before attending social events (Knight et al, 2002, p. 264).

Loss of control: Besides, an individual who abuses alcohol can try quitting and coming back several times. The person can begin with a limit in mind but ends up taking more than she/he planned (Room, 2005, p. 521).

Blackout: alcohol abusers often suffer episodes of blackout or complete memory loss of cetin events that took place when they were drunk (Knight et al, 2002, p. 264).

High tolerance: an individual can begin to require more alcohol in order to get drunk. The euphoria produced by alcohol becomes normal to such people. Denial  alcohol abusers do not usually admit that they have a problem and often become aggravated when this issue is addressed to them (Room, 2005, p. 521). They even say they can stop anytime they want and some may have tried stopping before to no avail.

The health impact of the reckless consumption of alcohol can be immediate or long-term. These effects are also cumulative and they critically contribute to the social and mental cost of medical care. These problems include unprotected or unintended sex because of lack of control brought about by the drink (Malow et al, 2001, p. 105).

Studies indicate that college students who drank heavily had high chances of engaging in unplanned sex than those who did not. These students were also less likely to use protection and as a result they are likely to suffer the consequences which include contraction of sexually transmitted diseases and HIV/AIDS (Malow et al, 2001, p. 108).

Because alcohol abusers usually get easily provoke and the high that alcohol brings causes irrational decision. This is the reason why there are high crime rates among alcohol abusers (Larimer & Cronce, 2002, p. 154). These group of people often gets involved in physical fights, accidents, and even suicides and homicides.

Intervention Strategies Applicable

Family is a crucial component in the treatment of the problem of alcohol abuse among youths (Brook et al, 1990, p. 123). The public health service  PHS is now more than ever dedicated to attaining the health promotion objectives of the Healthy People 2010. The use of family theory is related to the priority of this paper which is intervention of alcohol abuse and therefore will be used for the intervention. To begin with, family has various definitions include the unit where a person was born, the biological kin and even some unrelated people can consider themselves family due to mutual commitment (Brook et al, 1990, p. 123).

Families can live under one roof or in different households but the connection remains strong. Studies have shown that family play a protective role to alcohol abuse because of there are some precursors associated to the initiation of the abuse (Ashery et al, 1998, p. 43).

Families offer protection and considered as the first defense mechanism where psychological strength can be obtained. This includes building self-esteem so as to alleviate vulnerability to drug abuse (Larimer & Cronce, 2002, p. 156). In most of the situations, the family may not be able to offer the required nurturance and defense and therefore it becomes a risk factor that increases vulnerability (Malow et al, 2001, p. 109). This means is pertinent to understand family interventions program to offer protection and negate the initiation of alcohol abuse.

Health promotion is the process that gives people the ability to control and improve their health. In order for a person to attain an absolute state of social, mental and physical wellness, that individual should be able to recognize and realize objectives (Room, 2005, p. 521), to satisfy needs and to adjust or cope with the situation. Health promotion is based on several theories, trans-theoretical, social learning, reasoned action and the health belief model among others (Larimer & Cronce, 2002, p. 156).

In practical application, health promotion is a standard option that is used in the process of drug abuse treatment and can be considered as the foundation of the prevention message. This has a major advantage that it does not have conflicting principles and most people will therefore agree on its theory (Larimer & Cronce, 2002, p. 162).

Value expectancy theories comprise numerous models which indicate that an individuals behavior can actually be predicted them. These theories are greatly used in the treatment of alcohol abuse and other drugs treatment. Under this theories is one critical one, the health belief model which is very effective (Ashery et al, 1998, p. 43). This model relates the theories of decision making to a persons perceived capacity to select one option from a number of health behaviors.

The underlying concept behind this is that behaviors are brought about by two major variables; the value an individual attaches to a certain outcome and the persons approximation of the probability of a certain action eliciting a certain result (Ashery et al, 1998, p. 43). The individuals motivation to act is based on whether or not that individual expects that he/she will achieve a particular health related outcome (Friedman et al, 2003, p. 67). This model offers the basis of predicting health-related behavior.

Health belief model in treatment of alcohol abuse can be very effective and it focuses on three things;

1. Dire consequences from alcohol abuse
2. High chances that these consequences will come true
3. The efficiency of abstaining or consuming in moderation

These three things greatly affect the behaviors of young drinkers where they considered moderation (Friedman et al, 2003, p. 67). This program has been applied before in colleges and it has worked effectively. To make it even more effective, the program can have wider personal impact when there is great emphasis on the susceptibility of the abusers to alcohol-related problems like accidents and poor relationship with parents (Friedman et al, 2003, p. 69).

To younger people, these problems are more relevant compared to addressing medical issues like cardiovascular problems or psychological issues. The first two principles of susceptibility and severity push the need to have an alcohol education program. The third principle of health belief indicates that alternative behavior will be beneficial in coping with the problem.

When this model challenges the conventional wisdom concerning the inability on knowledge to change behavior, then knowledge of risk of excessive drinking repercussions when well communicated by a credible means, can persuade and therefore be a very good instrument for decreasing the demand which eventually is the most efficient way of cutting drug use.

The Role of Advanced Practice Nurse (APN)

The APN is very crucial in the alcohol abuse program especially when the family intervention is involved. The nurses duty has been to show compassion and empathy with teaching and preventing and these skilled can be effectively used in alcohol intervention. The ANA describes the role of the APN as having expanded to the provision of psychotherapy prescription of medication and consultancy services as regulation and statute dictates (American Nurses Association 2000, p. 12).

The APN has the ability based on training and education to offer services like of psychiatric counseling both on short and long term basis to groups and individuals. The nurse is trained on active listening and by this she/he is able to develop the most appropriate therapeutic process that learning and the required results can be obtained (ANA, 2000, p. 12). The relationship that develops between the nurse and the patient leads to development of a step-wise process that seeks to achieve the set goals. At the end, the nurse enables the satisfaction of the patient need of stable emotional and social stability.

Conclusion

The main objections of the promotion and prevention program is; to ensure reduced substance abuse among the young people so as to protect their health and to improve quality of life; to educate the general population so that many of them can disapprove alcohol abuse, especially young people and to increase awareness among the people that they can be able to perceive the risks associated with substance abuse.

Reference List

American Nurses Association (ANA). 2000. Psychiatric Mental Health Nursing: Scope And Standards Of Practice. Washington, DC: American Nurses Publishing.

Ashery, R., Robertson, E., & Kumpfer, K. (1998)(Eds.). Drug Abuse Prevention Through Family Interventions. NIDA Research Monograph 177, NIH Publication, No. 99-4135, pp. 42  159.

Brook, J.S., et al., (1990). The Psychological Etiology Of Adolescent Drug Use: A Family Interactional Approach, Genetic, Social & General Psychology Monographs, 116(2), 111-267.

Friedman, M.M., Bowden, V.R., & Jones, E.G. (2003). Family Nursing: Research, Theory, And Practice (5th Ed). Upper Saddle River, NJ: Prentice Hall.

Knight, J.R., et al. (2002). Alcohol Abuse And Dependence Among U.S. College Students. Journal Of Studies On Alcohol, 56(6), 263-270.

Larimer, M.E & Cronce, J.M. (2002). Identification, Prevention, And Treatment: A Review Of Individual-Focused Strategies To Reduce Problematic Alcohol Consumption By College Students. Journal Of Studies On Alcohol Supplement, 14: 148-163.

Malow, R.M., et al. (2001). Substance-Abusing Adolescents At Varying Levels Of HIV Risk : Psychosocial Characteristics, Drug Use, And Sexual Behavior. Journal Of Substance Abuse, 13,103117.

Room, R.B. (2005). Alcohol And Public Health. The Lancet, 365(9458), 519-530.

Statement of the Problem

In the article, the researcher has paid close attention to the findings and used them to explain his hypothesis on the reason as to why the Mexican women are reluctant to report cases of domestic abuse. However, the researcher has not paid close attention to the literature that would help in the formulation of the hypothesis for the project. This work does not therefore blend literature and research in an appropriate way to clearly define the phenomenon of interest, i.e. factors influencing disclosure of abuse by women of Mexican origin.

Qualitative research mainly entails detailed verbal descriptions of characteristics, cases, settings, people or systems obtained by interacting with, interviewing, and observing the subjects (Thomson, 2007). The author clearly explains why the subject matter calls for qualitative research method to help in the identification of the issues and explicitly tackle the issue of abuse of women of Mexican origin. In addition, the qualitative research method would enable the researcher to undertake the study on different perspectives, which would help in identification of the viewpoint of women of Mexican descent on violence subjected towards them.

The philosophical underpinnings of the research are clearly described. Generally, philosophical underpinnings capture the meanings and inconsistencies among certain groups of people (Jaye, 2002). The research clearly explains the reasons why women of Mexican descent are reluctant to report cases of violence towards them by their partners. In addition, to undertake an effective qualitative research, there must be a priori knowledge (Jaye, 2002).

This is clearly illustrated in the literature that is used in the research. Qualitative research is also interpretive as it tries to understand the values, experiences, opinions and behaviors of other people (Jaye, 2002). Moreover, the findings of the research are based on Mexican women who are in different settings, hence enabling a better interpretation of the information.

Purpose

The purpose of conducting the research is made very clear, as it incorporates public health, criminal justice, and human rights perspective on the study on violence against women of Mexican origin. The author looks at the various perspectives of violence on women, either physical or emotional perpetrated by an intimate partner or someone who used to be intimate to them. The author also disregards the severity of the violence in undertaking the research.

Violence on women ultimately affects their health and medical conditions.

The author clearly explains the relevance of the study to nursing, which tries to come up with methods, which may help in encouraging women living with intimate partner abuse (IPA) to disclose to the nurse. The author proposes that nurses should ask a few questions that will encourage disclosure, rather that not ask any questions, as the women are generally not willing to disclose IPA if not asked mainly because they may feel embarrassed. However, even after being asked, women may still not disclose, or they may lie or may deny living with IPA.

Method

The research findings are highly dependent on the method used to collect data. Use of data collection methods, which are not compatible with the purpose of the research usually leads to unreliable or unfitting results. The main purpose of the research is to determine factors that contribute to the non-disclosure of violence on women of Mexican origin. Therefore, in undertaking the research, several women of Mexican origin are put to test.

In this research, a sample of women who have been proved to be living with IPA, as well as other categories of Mexican women are used to collect the data. This category of women include those over the age of 18 years, any woman of Mexican descent and women who were unknown to the author. By incorporating other categories of women who have not reported cases of domestic violence being subjected to them, the author tries to get the opinion of women on the domestic violence and hence determine the possibility of them reporting cases of living with IPA, should they be faced with such a situation.

In addition, some of the women in this category may in fact be living with IPA but are generally denying or lying on the possibility of living with IPA. Therefore, by incorporating the view of people in this category, the researcher ensures that the findings will be as accurate as possible. However, the research does not measure the frequency of the domestic violence on the women to determine the severity of the IPA and hence determine the relationship between IPA and reporting. In addition, the researcher does not factor the age of the women to determine the reluctance to report cases of violence. Therefore, though the method of data collection used tackles most of the issues, it does not explicitly tackle all the issues involved in IPA and non-disclosure by the women.

Sampling and Data Collection

The researcher describes the selection of the participants in the study. These include women who have a history of domestic violence, those 18 years and above, of Mexican descent and those who are not known to the author. However, the description of women who were involved in the research is ambiguous as the author describes some of those who belong to the same category but they were classified separately.

Purposive sampling is one of the methods employed in the collection of data for qualitative research. In the purposive non-random sampling, the number of people who are used in the collection of data is generally not important; the most significant factor is the criteria used to select people used in the research (Wilmot, n.d.). In the research, the author uses 26 women to determine their reluctance to report cases of abuse. This number is generally small to enable the researcher find out the reasons why the Mexican women in general are reluctant to report cases of domestic violence subjected towards them. However, the criteria used to select the sample makes the research findings relevant to the Mexican women in general.

The informants who were chosen for the collection of the data are appropriate to inform the researcher on the information that is relevant to the study. This is generally due to the fact that the informants had at one time denied the existence of violence subjected towards them by their partners. Hence, they can give first hand information to the researcher on the reasons as to why Mexican women are reluctant to disclose incidences of IPA. Hence, by selecting these women, the researcher ensures that he factors in human experience into the findings. In addition, the researcher factors in the enquiry on children of the participants that underpins the human experience of the study.

The data collection strategies are vital in determining the outcome of a research project. The strategies that are employed are mainly dependent on the sample size and the available budgetary allocation for the project (Wilmot, n.d.). The data collection strategies directly determine the outcome of research studies. Hence, they should be clearly outlined in any research. The collection of data for the research was via semi-structured questionnaire, which was used to provide narrative response to the questions.

Data saturation occurs at the point when the researcher has asked as many questions to the respondent as possible such that any other question that he may ask may not have any significance in the study. The primary author asked the respondents as many questions as possible and stopped when data saturation occurred.

In any research, the credibility is dependent on the method of collection of the data for the study. In the research, the author clearly explains the procedures that were taken in the collection of the data. In addition, measures must be taken to determine the accuracy of the data obtained. In this case, the researcher used the Short Acculturation Scale for Hispanics (SASH), a very reliable method that is used to determine the accuracy of information provided by Hispanics based on the language used.

Human Subject Protection

Protection of human subjects in a research project is an issue that is considered very vital in any research. There are various methods used to protect the human subjects in any research. These human subjects can be protected through informed consent to participate in the research (Williams, 2005), and through code-naming of the participants of the study to protect their identity. In the research, informed consent was achieved verbally between the examiner and the participants of the study. In addition, the researcher used pseudonyms to obtain information for the study, thus protecting the identity of people involved.

Data Analysis

Several methods are used to analyze data in a qualitative research. The data from this research came from the interview transcripts from open-ended exploratory interviews. One of the methods used by researchers to analyze data is the constant comparative analysis, which was originally developed for use in the grounded theory methodology of Glaser and Straus (Thome, 2000). In this method, the research compares the different data, tries to come up with similarities or differences, and formulates questions to determine the reasons for the similarities or the differences. Constant comparative analysis is well suited to determine certain behaviors in humans, which can be explained by the fundamental human social processes (Thome, 2000).

This method has been used by the author in the research. The author clearly explains to the reader, the processes that were undertaken in the analysis of the research data from the code-naming to processing data to determining the demographic factors using a computer package known as Statistical Package for Social Sciences (SPSS). In addition, peer-debriefing sessions with a licensed professional counselor were done to enhance the rigor and prevent threat to validity of the data obtained from the research. Thus, the researcher remains true to the data obtained from the research.

Every qualitative research must be credible to have any significance. To address credibility of the research, data management with a professional in the specific field of research is required to offer explanation on certain phenomenon, which may not be clear to the investigator. In undertaking the research the researcher does frequent peer debriefing sessions with a qualified professional counselor to address the credibility of the data obtained. In addition, peer reviews with other qualitative researchers were done to clarify the findings of the study.

Audibility of the research helps in understanding it. Thus, for the research to be audible, the processes must be clearly documented, which were undertaken in carrying out the study to the reader. The reader can easily follow the thinking of the researcher in undertaking certain measures. Here, the researcher questions women on whether they knew the existence of the shelter for people living with IPA to determine whether some of the them fail to go to the shelter due to lack of knowledge or they may know of the existence of the shelter, but are simply not responsive towards it.

Most of the research findings have a wide area of application. Hence, the above research can be used in various situations, which are outside the study situation. The research findings may be used by counselors in formulating treatment therapies for Mexican women who are living with IPA. In addition, the research findings may help in criminal litigations on abusive partners. Thus, the findings of the research may be of great interest to other people who are not involved in the study.

As stated above, the research uses Constant Comparative Analysis to analyze the data. The analysis strategy is most favorable for analysis qualitative data. In addition, the researcher uses media debriefing to determine the validity of the data. All the above ensure that the data is as accurate as possible for the analysis.

Findings

To help the reader understand the research findings, the researcher presents the findings of the research in a certain context, which the reader can clearly understand. In presenting the findings of the research, the research considers the fact that all women who were involved in the research so that, they had an obligation to care for their families. In most of the findings, the researcher tries to show disclosure of the IPA is generally not favorable to the women due to various factors, which are beyond their control.

The findings of the research explicitly explain the social and cultural conditions, which the Mexican women are faced with. The researcher explains the repercussions; which women may be faced with due to their disclosure of the IPA. The author also explains the attitudes by the family members and support, which may be offered upon reporting cases of IPA. All the above help the reader in forming a clear perspective of the experiences which the women are faced with which may encourage or discourage them from reporting cases of IPA.

The findings of the researcher show that willingness of the relevant people to listen to the women who are faced with IPA may increase the reporting of IPA to the relevant bodies. This is evidenced by the fact that the respondents of the research could go into great detail to explain how they were subjected to abuse.

Conclusions, Implications and Recommendations

The findings of the research can be used in a variety of areas. According to the author, the research findings can be used by policy makers to help in the formulation of necessary policies, which will help protect the Mexican women from IPA. In addition, the author explains on how the research findings can be used by healthcare providers. The formulation of recommendations reflects the true findings of the study in that they recommend the healthcare providers to ensure to ensure that they ask questions on IPA to encourage them to speak out on IPA.

The study was undertaken using a small sample; hence, the author recommends that future studies should be made using larger samples to determine various other settings, which affect the willingness to access the outreach services of the women of Mexican origin.

References

Jaye, C. (2002). Doing Qualitative research in general practice: Methodological utility and engagement. Family Practice, Vol. 19, No. 5. Oxford: Oxford University Press. Web.

Thome, S. (2000). Data Analysis in qualitative research. EBN notebook. BMJ. 

Thomson, R. (2007). Qualitative research study design. Training in Research in Reproductive Health/Sexual Health Geneva 2007. 

Williams, E.D. (2005). Federal Protection for Human Research Subjects: An Analysis of the Common Rule and Its Interactions with FDA Regulations and the HIPAA Privacy Rule. CRS Report for Congress. 

Wilmot, A. (n.d.) Designing sampling strategies for qualitative social research: with particular reference to the Office for National Statistics Qualitative Respondent Register. Web.

Introduction

Drug abuse is one of the most prevalent crimes in the world. It is a concern for both local governments and international organizations. In fact, many countries around the world have understood that they cannot win the war on drugs without a proper international cooperation. This came after the assessment that drugs abuse is classified among the most rapidly rising crimes all over the world. it has been ranked second only after human trafficking. In the past decades, local governments of several countries worldwide have been putting much efforts and resources in fighting this phenomenon. Their first reaction was to enable strict rules and juridical regulations in an attempt to limit drug abuse. They saw this phenomenon as an ever rising menace for the safety and security of their citizens and society. Thus, the justice system was introduced with various measures designed in dealing with the rising drug abuse tendency. Some of the latest measures were the introduction of what has come to be known as therapeutic justice. One of the most famous parts of these measures was the introduction of drug courts whose mandate is to hear cases related to drug related offences, which are minor in nature. The purpose of these new courts introduced in the juridical system was to prevent individuals with minor abuses step up their offenses to major ones. However, since the time of their introduction, a fierce debate has been ranging on whether the introduction of drug courts as an important advancement by the justice system in dealing with the drug abuse menace.

The purpose of this paper is to make a clear assessment and look in greater depths on therapeutic justice, the introduction of drug courts and how effective are they. An important assessment will be done to see if at all they are curbing this ever-rising trend of drug abuse. This is an important evaluation since the fight against drug abuse is something that society considers a priority and is keen in finding the right solution for it (Amy. 2009).

The drug courts

The first drug court was established in 1989. At the time it was clear that it was necessary and indispensable for the justice system to come up with an urgent measure of curbing drug abuse. The need was to try and help drug addicts who were already hooked to slowly get out of the practice. Since then, more than 1,500 courts of such a nature have been established throughout all the country. Therapeutic justice is a term that was first used by the author Winick. He was a legal scholar and used the term while he was trying to establish the best way in which a drug court could function effectively. According to his view, therapeutic justice appears like a practical guide on how drug courts should operate. However, a radical and thorough examination of the concept reveals that it brings complicated issues especially when it comes to the definition of justice of citizens (Nolan, 2002).

The aim of the drug courts is to reduce the rate of drug offenders, especially among the juveniles, by trying to prevent their accession to major offenses and abuses.

In the recent past use of drug courts became very popular among individual states. One of the reasons why this happened perhaps is the fact because the federal government consistently offered support for them in the form of funds and grants. One analyst has been quoted saying that the introduction of therapeutic justice and the aspect of drug courts is a great advancement in the justice system as it now focuses on the needs of an individual rather than equality and justice for all. To many authors and scholars who support this concept, it is a revolution that has been long overdue in the justice system (Amy, 2009).

To be able to understand this concept clearly it is necessary to have a clear picture of what it is and what it is not. Being a new concept and practice, therapeutic justice has been portrayed in many faces and versions. Some of them are quite misleading and opposite of the truth. A good start as an example is the concept of drug courts. If we have to consider legally what a court is, then it is impossible to deem these organizations as courts. In fact, they do not technically qualify to be referred to as courts. Thus to label them as drug courts are quite misleading and far from the truth. From a juridical point of view, courts of any nature or level can only be established by an Act of Parliament. Thus, these drug courts are therefore, programs that are created administratively to offer social services (Nolan, 2002).

Drug courts are quite different from what we label as traditional courts, which are established through the judicial system. While traditional courts aim at guaranteeing justice and fairness for all by punishing the offenders, the so called drug courts these days shift the attention to the offender.

Their claim is that offenders who are found guilty of a drug related offence require aid and help rather than imprisonment. The idea of drug courts and therapeutic justice is not as new. Although it has begun gaining popularity only recently, its roots can be traced back in the year 1899. However, for a long time this concept was reserved for the juvenile courts until our times when it was discovered that even adult offenders were in dire need of such a social service. Incorporating this idea into the mainstream courts was also difficult as the judicial system vehemently opposed the move terming as a direct obstruction of justice for the greater majority. It argued that although the idea of drug courts was well intended, it could not be exchanged with the process of the rule of the law. However, with time the idea of drug courts has slowly been assimilated and the judicial system has embraced therapeutic justice as part of the ordinary court process (Marilyn, 2003).

While this revolution and very important advancement in the judicial system now knows as therapeutic justice is considered to be the promised salvation that we all have been waiting for, it is important to look at some other aspects of the issue. One of these important other issues is that of the costs that this new concept requires us to bear. To begin with some analysts argue that the incorporation of such a concept in the mainstream judicial system is a big threat to the attainment of justice, which is the main aim of courts. as described above, it is also a misleading term which may lead to misunderstandings and confuse peoples perceptions about what a court should be about. This is because while implementing this new institutional concept, the courts and the judges will be obliged to depart or shift slightly from the juridical procedure toward a more compromising methodology. As such they are likely to compromise their delivering of justice for the aggrieved party. The conflict comes due to the fact that this methodology of therapeutic justice is more concerned with the achievement of particular intended results rather than impartiality of the judicial system or fairness (Nolan. 2002).

The people who are in support of this concept do recognize these dangers but dismiss them as mere disadvantages which can be easily overcome. However, it remains a matter of fact that these loopholes are quite serious and can lead to miscarriage of the justice system itself.

Thus, what was intended to be a mode of fighting drug abuse can turn into a collateral damage for the entire system. Yet, the advocates of drug courts and therapeutic justice do have some justifications with which they support their arguments. To begin with, they argue that these social programs are very effective. According to supporters of the drug courts, all offenders who have gone through this program are less willing to turn back to committing drug related offences. Furthermore, for that minority which decides to go back into crime commission the rate is far much lower than the rate prior to the use of drug courts. By so doing, these advocates of this concept argue that public and government resources are saved as there are not as many people who have to be confined in prisons. In addition, it reduces the congestion that characterizes the prison systems in the country (Marilyn. 2003).

Secondly, therapeutic justice brings about institutional harmony which is essential in fighting the drugs abuse phenomena.

This happens because drug courts are indulged to collaborate with other governmental agencies or non-governmental organizations. The traditional courts used to work independently without involving other stakeholders. For example, with the introduction of drug courts the judges assigned had to consult with other people related to the issue. This was true especially for those in charge of social programs in order to achieve the desired results of therapeutic justice. Drug courts have also made the general public to have respect for the judicial system by involving it into the process. The traditional judicial systems appeared to alienate the public as they were not allowed to participate in the attainment of justice. However therapeutic justice brings in a whole lot of different agencies and organization most of which are social oriented (Amy. 2009).

These are some of the main advantages of this system. Nevertheless, there are many disadvantages some of which could be quite costly if they were to be ignored. Firstly therapeutic justice has been seen to cause a great strain on the resources due to its approach. The approach of the drug courts is that of a court composed of its own judges. This means that many judges are required to be employed exclusively for this purpose. This means that the government has to spend more on judge salaries and related expenses. In addition judges have to personally supervise the treatment of their drug offenders which are being administered. This supervision takes a great amount of time and as a result there is a backlog of cases that await hearing. Although one of the aims of drug courts as mentioned earlier is to ensure unity between courts, this purpose is defeated by the fact that drug courts are special as they were established separately from the mainstream courts (David, 1972).

Another critique is that therapeutic justice is also seen as a concept that has brought about disturbance when it comes to the separation of powers and independence in the three forms of state authority. They do this by allowing judges to come up with decisions and solutions which are supposed to be made by particular people in their various duly elected positions. By doing so the line that divides the lawmakers, the interpreters of these laws and those with the mandate to implement the laws becomes blurred and sometimes non-existent (Nolan, 2002).

The impartiality and objectivity of judges has also been heavily compromised with the introduction of therapeutic justice. In addition to conducting the judging process, the judge is required to be part of the team that conducts the therapy sessions. The main aim in the therapy process and sessions is to achieve certain result which is to ensure that the offender who is hooked in drugs will be able to come out clean.

When participating in these sessions, there is a likelihood that the judge may bend some of the ethical normative in place in an attempt to ensure that the desired results are achieved. As a result, the impartiality and objectivity of the judge are compromised and the purpose of the whole process is at risk. Now, this becomes a complex issue, where the judge who is supposed to be the adjudicator becomes engaged in the therapy sessions as his independence is lost (Bruce, 2005).

These social programs have also been evaluated to serve as interfering with the judgment of the judge.

They serve as a form of substitution for individual judgment with their various checks of the process of therapeutic justice. By doing so the process results in the formation of a loophole which can easily lead to abuse of power. The separation of the three forms of power within a state, the impartiality and autonomy of the judicial system (the justice equal to all emblem), the rule of law and the due process have always formed the bedrock for the sound foundations on which is based the juridical system of the United States along with its legal principles (Marilyn, 2003).

Conclusion

As one can understand from what is written above, therapeutic justice unfortunately seems to compromise all of the above mentioned established achievements. This form of justice may be deemed as important steps forward for the judicial system but still it has so many negative collateral effects and causes so many damages that rather it would be best to label it a retrogressive move. Such a move may, and will, snatch away the constitutional right of every citizen to be accorded justice in a court of law. If all these loopholes are to be ignored, the result will be the equivalent of putting away the judicial system and following the law of the jungle (Gray, 2001). While there are times all these loopholes need to be addressed and necessary amendments made to ensure that the greater majority still enjoy their rights to have equal justice.

References

Amy, D. (2009). Law, literature, and therapeutic jurisprudence, New York: Carolina Academic Press.

Bruce, J. (2005). Civil commitment: a therapeutic jurisprudence model. London: Oxford University Press.

David, B. (1972). Therapeutic Justice. London: Minnesota Law Review Foundation.

Gray, J. (2001). Why has our drug laws failed? Temple, MI: Temple University Press.

Marilyn, M. (2003). Therapeutic Jurisprudence, New York: Federation Press.

Nolan, M. (2002). Therapeutic justice: The efficacy of the drug court movement in Georgia. New York: Sunny Press.

Substance abuse and poor mental health form some of the biggest concerns of society. People of all ages especially the young are influenced by substance abuse. Child and spousal abuse, school failure, teen pregnancy, becoming infected by sexually transmitted diseases including AIDS, frequent disruptions in the family, personal life and work and incarceration have complicated the lives of the involved. The impact on the health indicators is tremendous. Drug abuse is the non medical use of a drug and would mean that a person is using a drug without proper prescription contrary to the labeling instructions or using an illicit drug.

Incarceration

Incarceration is one of the consequences of inadequate treatment of co-occurring substance abuse and mental disorder. Inmates who have a double diagnosis are usually more likely to be homeless and would have been charged with violent crimes unlike other inmates (McNiel, 2005). There are 2.2million people behind bars. 95% of them would be leaving prison at some time in their lives and two thirds of them would be re-arrested. They would have difficulty integrating into society due to their substance abuse and addiction (Gever, 2007). Lack of proper treatment inside and outside the prison makes them vulnerable to failure. They would have difficulty in securing housing and jobs. Substance abuse would have made them commit crimes. A large number of crimes would have been committed like peddling drugs apart from using them, indulging in drunken driving and causing accidents and fatalities, stealing to buy drugs and wreaking violence. 81% of the inmates are usually five-time offenders with regular drug use (weekly use for one month at least) and 41% would be first time offenders (NCASA). These inmates also had the misfortune of remaining in jail for longer periods. It is evident that many people who need treatment badly are in jail. Multiple service delivery is the essential requirement here.

Women

There has been a dramatic increase in the number of women entering prison for drug offences (Zlotnick, 2002, p.2). The lack of viable treatment for these women is a problem. Incidents of interpersonal violence were reported from them. A higher rate of recidivism was also reported from these women who were subject to increased incidences of physical and sexual abuse (Zlotnick, 2002, p.2). The illicit drug use and interpersonal problems were the main ones in their lives. Post traumatic stress disorder was the commonest of the mental illnesses affecting these women inmates. The rates of PTSD were 3 times that in the general population. Childhood abuse is strongly related to PTSD (Zlotnick, 2002, p. 3). A high level of co-occurrence of PTSD and substance abuse is seen in incarcerated women and a severe course is a result. PTSD predisposes the women to 5 times more incidence of substance abuse than those women without PTSD. The women with both showed lesser compliance with treatment, a worse course of substance abuse, more medical illnesses and more admissions for treatment, greater recidivism and exhibit greater criminal behavior (Zlotnick, 2002, p.3). Most of the women with both PTSD and substance abuse were associated with the more severe drugs. They also showed greater sleep disturbances than those with only substance abuse. Those with co-occurring PTSD and substance abuse were found to have poorer psychosocial functioning due to interpersonal problems, homelessness, unemployment and child maltreatment (Zlotnick, 2002, p. 4).

Reentry and the requirement of treatment

Treatment has reduced addiction which has been a major cause of re-entry into jail and lowered the numbers returning to jail for a new offense which again would be related to substance abuse and addiction. The inmates who had been involved in a residential treatment program in prison had a 9-18% lesser chance of recidivism than the other inmates who received no treatment (Gever, 2007). Drug relapse rates were lower by 15-35% (Reentry Policy, 2005). These figures improved when treatment was continued outside prison without break. Prisoners who completed the residential program and then continued with a community based after- care program had lesser rates of re-incarceration. The re-incarceration rate for prisoners who continued treatment was 25% only when compared to the group which never had any care and had 42% re-incarceration while the group which participated in some care but dropped out had a 64 % rate (Re-entry Policy, 2005). Some studies have shown a 50% lower rate for those who continued treatment when compared to those who did not. Successful treatments are sufficiently long in duration and help offenders effectively change their behaviors with the criminal justice system helping to ensure compliance with treatment (Taxman, NDCIR). Several barriers limit the inmates access to treatment. These are identified as lack of treatment, lack of access to public benefits and lack of employment (Gever, 2007).

Lack of treatment

All prisons may not have available treatment. Only 40% of all correctional facilities had this treatment. However only a dismal figure of 10% institutions participated was between 70-85% people needed it. This comes to the figures of 150000 and 680000. There is also no follow-up. It is easy for a released prisoner to go back to his old habits of drugs and crime. Severe addiction problems require in-patient services. A system whereby the prisoners on parole or if convicted for some types of crimes cannot avail of social service or benefits for assistance stops them from taking appropriate treatment (Gever, 2007). Some states have refrained from enforcing this law. Preventing access to public houses could interfere with their access to treatment. Public housing is not available to ex-offenders. Many of them are homeless. Finding work is another obstacle. Their poor education is a problem but those who secure jobs remain out of jail. One study found that 70 % of parolees were unemployed. 21% had full time jobs (Gever, 2007).

Alternatives are being investigated for the prisoners who face re-incarceration for substance abuse problems. The drug court has been set up for the treatment of non-violent offenders. If the treatment is completed successfully, the dismissal of charges or a reduced sentence results (Gever, 2007). Discussion is on for treating substance abuse outside the correctional facility. It can be concluded that treatment outside and inside the prison lowers the incidence of recidivism. The most effective services are yet to be implemented. Evidence based treatment programs can be effective in slowing recidivism.

Strained budgets are hampering effective services (Gever, 2007).

Healthy People 2010

The Healthy People 2010 programme has addressed the major health indicators of public health concerns in the United States (Healthy people 2010, 2000). Strategies and action plans have been drawn up for each of the indicators. The objective is to create healthy people in healthy communities. Substance abuse and mental health form two of the many indicators of health addressed. However there is only a passing reference to the problem of co-occurring substance abuse and PTSD in women inmates. The proportion of inmates receiving substance abuse treatment in correctional facilities is to be increased (Healthy People, 2000, p. 26-43). The goal of Healthy People 2010 for substance abuse is to reduce substance abuse to protect the health, safety and quality of life for all especially children

Data to highlight the community problem 100000 deaths have been related to alcohol consumption (McGinnis, 1993). Another 12000 deaths have been attributed to drug abuse and AIDS. Annual economic costs have been estimated to be running to the tune of $167 billion from alcohol abuse and $110 billion for drug abuse in 1995 (Harwood, 1992). This would amount to saying that every citizen has to spend $1000 for meeting the cost of health care, vehicle crashes, crime, productivity loss and other undesirable outcomes like poor mental health associated with substance abuse.

20% of the population is estimated to have mental illness, mostly depression. This amounts to 19 million people having mental ill health. Only 23% of these people received treatment. Two thirds of the suicides have been accounted for by people with depression (Healthy people 2010, Leading health indicators). 78% of all inmates in the U.S jails have been found to have co-occurring substance abuse and a mental disorder (McNiel, 2005).

The hospital approach for treatment would have been due to drug use for reasons of dependence, suicide or psychic effects. The commonest motives were found to be suicidal attempts and dependence, each accounting for 35 %. 55% of these events occurred in the age group 16-34 and 44 % in the higher age group beyond 35 years. Whites answered 54% of the episodes and African Americans to 25% (HHS, 1999). The alcohol-related visits due to drug abuse accounted for 2.4 % of all emergency department visits or 2.2 million visits. The two commonest diagnoses were dependence and abuse (Li, 1998). There was a suggestion that most of the young and with trauma were intoxicated (Barnett, 1998). To reduce these alcohol-related visits, policy measures that help to diminish the number of vehicle crashes and violence may help.

Health risk behaviors are usually initiated in principle at the impressionable period of adolescence, developed into youth and established in adulthood. Hispanic students had the greatest likelihood of driving with a person who had been drinking. State surveys of the Youth Risk behavior Surveillance System showed a median of 34.1% of adolescents who had driven in the last 30 days with a driver who had been drinking. Local surveys showed a median of 31.4% (HHS, 1999).

Literature indicated that an average of 60% of homicide offenders committed the offence while drinking (Murdoch, 1990). Drugs and alcohol had been behind many firearm-related deaths (Pacific Center for Violence Prevention, 1994). In 1996, many of the arrestees for violent offences like robbery, assault and using weapons were under the influence of drugs. Two thirds of intimate partner violence victims revealed the influence of alcohol. 75 % of spousal violence victims spoke of alcohol abuse. 31% of victimized strangers claimed that alcohol had been used by the offender (US Department of Justice, 1997).

Female inmates showed drug possession convictions which were higher by 41% and drug trafficking by 34% (U.S.Department of Justice, 1999a). 40% of the female inmates were under the influence of drugs while only 32% of men were so. The prevalence rates for drug dependence in women prisoners were about 26 to 63% while alcohol dependence ranged from 32 to 36%. The current rates are 30-52% for drug dependence and 17-24% for alcohol dependence (Zlotnick, 2002, p.2). The women in prison are 5 times more likely to abuse alcohol and 10 times more likely to abuse drugs than those in the general population.

Epidemiological model

The epidemiological model is set in a community based format. The vision is Healthy People in a Healthy community. The aim is to teach the people to build a community coalition to build a healthier and happier place to live, work and play. A healthy community enables people to maintain a high quality of life and productivity (Healthy People in Healthy Communities, 2001). Key organizations and individuals would be mobilized to help build the coalition community. Various health problems are to be tackled with community help. Health indicators and their targets have been put together and the means of achieving these targets have also been suggested in the Healthy People 2010 Program. The problem of incarcerated women with co-occurring

substance abuse and PTSD could also be handled in a similar manner through community effort while outside jail and with cooperation of jail authorities while in prison.

Sex race, ethnicity and age distribution

Substance abuse appeared to affect all races, ethnic and economic groups alike.

Alcohol was the most commonly used and was similar for race and ethnicity (p.26-6). Next in incidence came tobacco use and then illicit drug abuse. The usage among the adolescents showed that the whites and Hispanics used more alcohol (35.1 and 29.4%) than the African Americans (22.3%). Tobacco was most used by the whites (26.9%) in comparison to the other two groups which showed the incidence of 20.4% and 16.2% respectively. Illicit drugs were most used by whites (16.9%) and Hispanics (17.4%) than African Americans (14%).

It has been found that initiation to substance abuse began at 13.1 years for both alcohol and drugs and is common for all communities (p.22). The objective of the Healthy People program is to increase the age of initiation to 16.1 for alcohol and 17.4 for drugs and proportion of adolescents who remain free of alcohol to 29% from the 19% of 1998 and of drugs to 56% from the 49% of 1998 (p.23).

Influence of education, income and poverty levels

Disparities in income and education and socio-economic status do not apparently affect substance abuse and mental health problems. However they affect the incarcerated people who are homeless, do not have the privileges of citizens for health care and who go into the habit of re-incarceration.

Major risk factors for poor health outcomes

Older adolescents and adults who had co-occurring substance abuse and mental disorder needed appropriate treatment for both. When treatment is designed for either, the chances of the affected getting appropriate treatment is less as they would be shunned by both departments (Healthy people, p.26-7). The older age group above 65 had a higher risk of alcohol-related problems even though their consumption was much less. Problems also could arise from alcohol-drug interactions in this group of people as they would be taking medications for many illnesses. Alcoholism could lead to memory deficits and dementia (p.26-7). The adolescents who started before 14 years of age had the risk of falling into dependence later. A family history of alcoholism predisposed adolescents to follow suit. Excessive drinking increased the risk of alcohol-induced disorders depending on the amount, duration and patterns of consumption and a vulnerability to alcohol related consequences (Healthy People, p.26-3).

Morbidity and mortality

High blood pressure, heart arrhythmias, heart muscle disorders and stroke are some of the illnesses that could be caused by long term alcoholism. Morbidity can also be seen as cancers of the oesophagus, mouth, throat and larynx. Cirrhosis and other liver disorders have been associated with alcoholism. The outcome for patients with hepatitis C is worsened with cirrhosis. The risk for developing cancers of the colon and rectum is increased. The risk of women developing breast cancer is increased if they take 2 or more drinks daily. Sexually transmitted diseases including HIV are rampant.

Mortality is increased when injuries and deaths occur from alcohol-related motor vehicle crashes, falls, fires and drownings. Homicide, suicide, domestic violence, child abuse and high-risk sexual behavior have been associated with alcoholism. Delayed mortality can be attributed to the progress of cancers, cirrhosis and HIV.

Drug-induced deaths are caused by psychosis, dependence, suicide and poisoning from intentional and accidental reasons. Mere declining initiation or the number of cases or the intensity of abuse are not the only factors that influence the reduction in the statistical figures. Prevention of suicide, accidental poisoning and the knowledge of fatal interactions between drugs are also contending factors for saving lives.

One of the leading causes of cirrhosis is sustained alcohol consumption and cirrhosis is one of the 10 leading causes of death (Hasin D., 1990). It is the replacement of healthy liver tissue with scarred tissue and thereby disturbing the normal functions of metabolism. Better treatment availability and better management have reduced the cirrhosis deaths since 1973. The costlier beverages also must have deterred many.

Levels of prevention for the substance abuse and mental health problem

Concerted efforts through the enforcement of the laws pertinent to alcohol abuse have reduced the incidence. These laws are the raising of the minimal drinking age to 21 years, revoking of licenses of those who drive while drunk, lowering the level of blood alcohol limits for youth and adults and raising the prices for alcoholic drinks. Combined community programs involving the city departments and private citizens have also contributed to the diminished incidence (Healthy People, 2000).

The Healthy People aims to reduce the deaths and injuries caused by alcohol and drug-related motor vehicle crashes. Alcohol related deaths are to be reduced from 5.9 in 1998 to 4 per 100000 in 2010 and the alcohol-related injuries from 113 in 1998 to 65 in 2010. Another initiative of Healthy People is to reduce cirrhosis deaths from 9.5 per 100000 in 1998 to 3 in 2010. The number of drug-induced deaths is to be reduced from 6.3 per 100000 population in 1998 to 1 in 2010. Emergency department visits for substance abuse-related events are to be reduced by 35 % from 542544 visits in 1998 to 3500000 visits by 2010. Alcohol-related hospital emergency department visits are also to be reduced. Ensuring that adolescents are not driven by a driver who had been drinking is essential in reducing alcohol-related deaths by vehicle crashes and injuries. The target aimed at is to reduce the present statistics of 33 % in 1999 to 30 %. Intentional injuries are to be reduced through the effort of the local communities and their surveillance systems. Prevention and treatment programs may be directed at violence related to substance abuse. Reducing the cost of lost productivity by implementing the various policy measures and being stringent with laws is another goal of the Healthy People Program. Efforts would be made to increase the age at first use of both alcohol and drugs. The main aim is of course to take children from adolescence to adulthood without indulging in alcohol or drugs. Prevention activities would concentrate on strengthening the ability of children to reject these substances while in adolescence so that the chances of carrying these favored skills and attitudes into adulthood are high. Once in adulthood, they are no longer amenable to suggestions and family constraints (p. 24). The number of children who reported that they were free from alcohol and drugs is rising due to prevention activities. The proportion of adolescents not using alcohol or illicit drug in the past one month is to be increased from 79% to 89%. The Healthy People Program aims at increasing the proportion of persons with co-occurring substance abuse and mental disorder who receive treatment for both (Healthy people, p. B18-15) Interventions TIP 17 Drug courts have found that the previous method of punishing for substance abuse has not made an impact on the drug problem. The criminal justice system believes in using long term therapy for controlling the drug problem (TIP).

The Best intervention for Substance Abuse and Mental Illness in incarcerated women

Integrated treatment for co-occurring substance abuse and PTSD would offer better results and provide relief for both faster (Zlotnick, 2002, p.4). The dual diagnosis causes a more severe course and is involved with greater psychosocial impairment than when either occurs singly. PTSD needs to be addressed earlier so as to elicit a better outcome. Not doing so may carry the risk of relapse and recidivism.

Four approaches have been described. Abuegs 12 session relapse prevention model is used for the therapy of elderly patients with alcoholism (1994). A coping-skills model is the form of therapy suited for dual diagnosis. A 25-session cognitive behavioral psychotherapy called Seeking Safety may be used here (Najavits, 2002). It has a combination of coping skills and exposure. Relapse prevention is also involved. Brady and his colleagues also used coping skills and (in vivo and imaginal) exposure model (2001). Substance dependence PTSD Therapy was a combination of relapse prevention and in vivo exposure (Triffleman et al, 1999).

Incarcerated women are not offered the therapy which has exposure. They may drop out or exhibit increased distress. Incarcerated women have drawbacks in self soothing and affect regulation. History of childhood abuse may be behind the problem. Male and female incarcerated inmates require different therapies (Zlotnick, 2002, p.6). Seeking Safety intervention appears to be the best for incarcerated women. Problems like impulsiveness, anger, maladaptive lifestyles are targeted and skills to manage these behaviors are taught. Cognitive behavioral therapy of substance abuse, treatment of PTSD, treatment of women and educational research are the four aspects dealt with in Seeking Safety intervention. The therapy aims at abstinence from substances and personal safety from self harm, HIV risk and domestic abuse. Sessions concentrate on subjects like honesty, asking for help, setting boundaries, integrating the split self, compassion, and taking good care of yourself. Past relationships are discouraged to eliminate the possibility of retraumatization. The patients sense of control is restored (Najavits, 2002). The patient is followed up for months. Change in severity of abuse is checked at intervals. Various instruments are used to check the patient at intervals to understand the progress with therapy. Seeking safety has a high degree of acceptability among incarcerated women. Half the women no longer met the criteria for PTSD at 3 months. Therapy did not exhibit an obviously positive outcome for substance abuse as the women were still in prison. The retention rate was higher than in other studies (Zlotnick, 2002, p.16). However many of the women returned to prison. A continuum of therapies would have provided significant relief.

Incarcerated women must also be provided reproductive health services (Clark, 2006). There could be high risk of sexually transmitted diseases including HIV, pregnancies, inconsistent birth control, inconsistent condom use, multiple partners and unplanned pregnancies. These ladies, probably living in abject poverty would not be having insurance or welfare help for their needs. Incarceration may be the only way they can secure some general health care, reproductive health care and preventive health care. They still are not liable to get preventive services like Pap tests for cervical cancer detection, STD screening, family planning or preconception counseling (Clarke, 2006).

Jail diversion and the role of the police

The role of the police is significant when a disordered person is taken into custody for a crime. The policeman has to decide whether the individual is just eccentric or not mentally fit to be placed in a cell. He has to coordinate with the local mental health facility to decide what to do with the person. Managing the mentally ill would require hospitalization. The police department and the mental health facility have a written agreement for maximum cooperation. Police realize that alcoholics and addicts are not received well in hospital. The attitude of the health facility is prejudiced. Sometimes persons who can be sent home easily and have not done anything serious are informally disposed of (Steadman, p.2). The persons if found not having much of a mental problem may be arrested. The third option is to divert a mentally ill person who needs therapy badly to a mental health facility after securing their diagnosis. This is jail diversion. Early detection, diversion, targeted crisis intervention, stabilization and linkage all mean that safe pre-trial detention occurs (Steadman, p.7).

Healthy People 2010 Advice

The treatment gap is to be reduced (Healthy people, 2000, 26-43). This gap is the difference between the number of people who need treatment for substance abuse and the number who are already on treatment. Efforts need to be taken at the National level to correctly estimate the treatment gap, develop plans to increase the capacity and eliminate the barriers which are preventing access. Adolescents, females and the elderly must be addressed. The proportion of inmates in correctional institutions who are to take treatment must be increased. The number of people who are incarcerated for drug offences like possession, trafficking and violence crimes has increased. (Healthy People, 2000, 26-43). Without treatment they have a greater risk of repetition. Increasing the number of admissions of substance abuse patients for injection drug use is one method of reducing cases. The target is 200000 admissions by 2010. Reducing the treatment gap for alcohol is another method to control the incidence.

Current Best Practices

Empirically oriented scholars are attempting to integrate practice and research.

(Rubin, 2007, 406). Evidence-based practice is the process by which practitioners ensure that their clients receive the best and the latest and most effective interventions. Taking into account various parameters like diagnosis, age, gender, ethnicity and problems, the practitioner formulates an answerable question regarding the needs of the client. The next step would involve the search for the best evidence available to answer the question. The scientific validity and the usefulness of the evidence are then appraised (Rubin, 2007, 406). The treatment options are delineated and based on the practitioners experience, some practical adjustment is made. This is then applied and the outcome is assessed. The community approach to the goals of Healthy People 2010 greatly involves the nursing profession which rubs shoulders with the community. They are the ones who can influence the community and bring the needy for treatment interventions (Rubin, 2007, 406).

References

Abueg, F.R., et al. (1 994). Enhanced relapse prevention training for posttraumatic stress disorder in alcoholism: A treatment manual. National Center for PTSD: Menlo Park, CA.

Brady, KT., Dansky, BS, Back, SEI Foa, EB, &Carroll, KM. (2001). Exposure therapy in the treatment of PTSD among cocaine-dependent individuals: Preliminary findings. Journal of Substance Abuse Treatment, 21,47-54.

Barnett, N.P.; Spirito, A.; Colby, S.M.; et al. Detection of alcohol use in adolescent patients in the emergency department. Academic Emergency Medicine 5(6):607-612, 1998.

Burrow-Sanchez, J.J. (2008). Perceived competence in addressing student substance abuse. The Journal of School Health Vol. 78, No. 5, 2008, Proquest Education Journals

Clarke, J.G. (2006). Reproductive Health Care and Family Planning Needs Among Incarcerated Women. American Journal of Public Health, Vol. 96, No.5 Pg834-839, 2006, American Public Health Association.

Gever, M. (2007). Prisoner Reentry and Lack of Substance Abuse Treatment Coverage. National Conference of State Legislatures.

Harwood, H.; Fountain, D.; and Livermore, G. The Economic Costs of Alcohol and Drug Abuse in the United States, 1992. NIH Pub. No. 98-4327. Rockville, MD: National Institutes of Health (NIH), 1998.

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Rubin, A. and Parrish, Danielle. (2007). Challenges to the Future of evidence based practice in social work education. Journal of Social Work Education, Vol 43, No. 3, 2007, p 405, Proquest Educational Journals

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The discussion on substance use should be based on three distinctions made between use, abuse, and dependence. Substance use is taking of alcohol and drugs. Substance abuse is a maladaptive pattern of drug or alcohol use that leads to clinical impairment or distress. Substance abuse is manifested in failure to fulfill adaptation at work, school, or home. It may lead to physical hazards and legal problems. It causes social and interpersonal problems. Substance dependence is manifested in tolerance and withdrawal. Dependence or addiction appears when a substance is taken in larger amounts, and there is a persistent desire to use more. A dependent individual spends most of his time trying to obtain the substance and/or recover from its effects. Fundamental social and occupational activities are reduced because of addiction.

Planning for drug abuse prevention starts with the assessment of the type of drug problem within the community. It is necessary to determine the level of risk factors to raise awareness of the nature of the abuse problem and to develop a guide for the best prevention programs to address drug abuse problems within the specific community context. The next step includes an assessment of the communitys readiness for the prevention program. Additional steps necessary to educate the community on prevention programs should be taken before the prevention effort launch. Current programs are continuously reviewed to address the emerging needs of the community. Finally, drug abuse prevention programs cooperate closely with community organizations providing youth services. Regular meetings with leaders of youth services may provide valuable insight on drug abuse prevention.

The prevention principles are exceptionally beneficial as they offer scientific guidance and support for adapting effective prevention programs based on scientific research. Moreover, prevention principles give an opportunity to meet the specific needs of the community. Diverse principles, for example, explain why it is important to include a family-based program or address the drug abuse program through a school setting. Furthermore, principles are essential in helping the community to select the best prevention program with the consideration of the unique features of their community. Thus, parents, educators, and community leaders are empowered to plan how, when, and where to implement the prevention program for the greatest effectiveness.

There are many types of drug abuse prevention programs; however, all of them are community-based. Drug abuse is rarely a problem of individual essence. Research reveals that drug abuse is a matter of peer pressure, role models, conflicts in schools, and other personal factors. Therefore, the most effective drug abuse prevention programs are community-based. There are also family-based drug abuse prevention programs that involve all members of the family in the prevention effort. Social influence-based drug abuse prevention program, for example, has a successful preventive effect on young people. The most important preventive factors come from within the family setting because the family environment has the greatest impact on the child.

In conclusion, drug abuse is a serious social problem. Undoubtedly, the personality factors should not be ignored; however, the increasing number of drug addicts among young people suggests that social factors overweigh the personality ones. The family has undoubtedly the most significant impact on the development of a child and his/her choices in life. Therefore, the most effective drug abuse prevention program should start at the family level.

Addiction, overall, and alcohol abuse, in particular, remain one of the biggest public health threats to modern society. Although economic and psychological aspects of the problem are widely addressed, the social implications and costs of alcoholism are often unacknowledged. Despite the lack of insight, the issue creates numerous dangers for both society and the abuser himself. This paper will examine the social costs of alcohol abuse problems, in particular, the external rise of violence and the private stigma surrounding addiction.

Firstly, alcohol dependence, as a global issue, causes numerous external damages to the society, surroundings, and close social circle of the abuser. For instance, the consistent rise in violence can be considered one of the most dramatic changes directly caused by alcohol abuse. Joshua links excessive alcohol usage with costs associated with crime and motor vehicle accidents, injuries to the drunken drivers and others, material damage from accidents, hospitalization (64). As the aggressiveness in alcohol-dependent people grows as a result of their addiction, more damage is done to other people, public spaces, and society overall. According to researchers, From a healthcare perspective, only costs pertaining to healthcare are relevant; however, a social perspective includes an increase in crime, costs of law enforcement and rehabilitation (Joshua 65). Ferguson managed to connect psychological health and substance dependency with a criminal offense by tracking what exactly creates the global issue of violence. According to Ferguson, a significant portion of crime among the adolescent age group is caused by the offenders alcohol use (3). Consequently, it can be concluded that alcohol dependency causes damage not only to the individual but also to the community.

While people who suffer from this addiction experience issues from both medical and psychological perspectives, their social exclusion also creates a stigma that diminishes their quality of life and leads to internal social damage. Some of the harm connected to heavy drinking arises from social reactions to drinking and intoxicated behavior; drunkenness is stigmatized, particularly when the drinker is poor (World Health Organization 16). As a rarely addressed discrimination, it imposes harmful perceptions that later lead to worsening the patients addiction and, consequently, reducing the likelihood of their recovery. Furthermore, stigma is rated as one of the most likely barriers to recovery and successful social integration (Hammarlund et al. 116). Unlike many other implications like violence and economic costs, discrimination is the primary reason that affects psychological health and stops people from seeking help. As WHO notes, In part reflecting the stigma, reverse causation can also play a role; for very heavy drinkers, the drinking may reduce their employability and social standing (16). Thus, when an addicted person is mistreated, that leads to them being more psychologically dependent on their drug of choice, which then loops back to the negative perception and lack of recovery.

In conclusion, both external effects of alcoholism in the form of criminal activity and internal costs like discrimination are some of the reasons why substance abuse is a pressing issue in modern communities. Although alcohol addictions external costs appear immense, the hidden social difficulties like stigma and associated psychological stress lead to the inability to recover. Substance dependence is linked with heightened violence and is one of the leading reasons for public health threats like traffic accidents. However, these complications can be avoided if social stigma is eliminated.

Works Cited

Ferguson, Julianna, The Relationship Between Juvenile Alcohol Abuse, Depression, and Violence. 2018. PhD dissertation. University of Maine Research Commons. Web.

Hammarlund, Rebecca et al. Review of The Effects of Self-Stigma and Perceived Social Stigma on The Treatment-Seeking Decisions of Individuals with Drug- And Alcohol-Use Disorders. Substance Abuse and Rehabilitation, vol. 9, Nov 2018, pp. 115-136. Informa UK Limited.

Joshua, John. The Market and The Social and Private Costs of Alcohol Abuse. The Economics of Addictive Behaviours, 2017, pp. 59-71. Springer International Publishing.

World Health Organization. Global Status Report on Alcohol and Health 2018: Executive Summary. WHO, Geneva, 2018.

The research, which has been carried out, analyzes the causes and effects of drug addiction among teenagers. It focuses on this particular age group because according to statistical data, people from thirteen to nineteen are the most susceptible to this disease. It is necessary to do the following tasks: first, we should discuss substance abuse as a form of deviant behavior because addiction, itself, is also a violation of the rules, established in the society. Secondly, we need to identify the underlying causes of this phenomenon, in particular, social, psychological, and cultural. Finally, this research must analyze its impacts on teenagers and the way it is reflected in their behavior.

Before analyzing the causes of addiction among teenagers, we have to look at this issue from sociological point of view. As it has already been mentioned before, substance abuse is an act of deviance. Then the question arises, how this notion can be defined. According to a widely held opinion, it is a form of conduct, contradicting or violating the rules, adopted in the society. However, some scholars do not agree with such definition, saying that it disregards some very important points (Bryant, 24).

For example, they argue that very often, deviance is a persons response to abnormal or (poor) conditions of living (Clinard, 32). Besides, in their opinion, violation of the rules or norms is a form of protest against some principles, which can be out-of-date. Nevertheless, in this particular case, we should also take into account psychological peculiarities of the teenagers, who are vulnerable than any other age group. In addition, we should consider substance addiction as a cultural issue and the role of educators in the struggle against drug abuse.

As regards the social factors, we can single out the following ones: poverty, competitive nature of the life and inability to accept the values and principles of the society. At first glance, it may appear that financial difficulties can hardly result in substance addiction among teenagers but statistical data may prove this statement. For instance, according to the information, published by National Center for Health Statistics approximately 57 per cent of teenagers, who take drugs, live beyond poverty level (Shulamith Lala , 158 ). Very often, their parents have to be more concerned with financial problems and their children are virtually neglected.

Apart from that, in inner cities drugs are much more available than it is in more safe districts. Naturally, it is officially declared that police makes every attempt to stop drug sale in these areas, as statistics suggest this issue remains disregarded. Some sociologists believe that there is the so-called insular poverty, in other words a group of people who cannot meet financial standards of the society, and it seems that the government prefers to overlook these people as if they were not a part of the community (Freilich, 91). Such neglect has many negative effects, including drug addiction among teenagers living in these districts.

While analyzing the origins of substance addiction among teenagers we must also pay attention to some traits of modern American society, namely its competitive nature. Werner Krieglstein in his book Compassion: New Philosophy of the Other argues people (not only teenagers) are made to believe that they must be productive, efficient, and competent in order to survive in this natural selection or competition, while the pleasures of life have to be sacrificed for the sake of success (Krieglstein, 167). Teenagers use drugs to protest against such philosophy. To some extent, drug abuse is a form of rebellion against such social doctrine. We can also say that drug abuse is the rejection of the values, accepted in the society, especially the importance of material wealth. Morris Freilich argues that, it is not always a deliberate act and very often teenagers do not fully realize the reasons of their behavior (Freilich, 44).

Naturally, such theory can easily be questioned because there is no numerical information, supporting it, but such view cannot be ignored because the tendency to reject the values of consumerism doctrine appeared a long time ago, but it has not been fully studied. Perhaps drug addiction among teenagers is one of its forms.

It is also necessary to discuss substance abuse as a cultural phenomenon. As Glen Hanson says teenagers, tend associate drugs with the so-called cool behavior. Partly, it can be explained by the negative influence of popular culture especially cinema. Many teenagers want to copy the behavior of their idols or popular icons, for example, some of Hollywood stars, or famous musicians, who often make drugs look somewhat fashionable (if such wording is appropriate in this case). Many sociologists say that mass media have not realized their influence on the young generation (Hanson, 121). Naturally, the government cannot impose any restrictions on television because such measures would contradict the basic principles of the US constitution, particularly the freedom of speech.

We should also discuss psychological traits of teenagers, first their vulnerability. Family problem often make them take drugs, especially it concerns domestic violence. Recent research that has been conducted by Christine Fewell, indicate that approximately 49 percent of young addicts were or are abused at home. For them, drugs server as a protection or shield, defending them from everyday problems.

We can also say that the role of educators has often been underestimated. For instance, many schools are trying to launch before and after schools programs in order to increase academic performance and keep teenagers away from drugs or any other form of deviant behavior. The main problem is that many parents fail to see the importance of such measures. In their view, they are just a waste of time. Unfortunately, the government seems to share their opinion. Certainly, that such policy is not officially declared but statistical information indicates that the role of educational institutions is undervalued. For instance, schools, especially in inner cities are not properly supported by local authorities, furthermore school administration and police has not learned how to work with each other.

The impacts of substance abuse can be discussed from several points of view. First, it should be borne in mind that that each kind of drugs has its own effects and it is hardly possible for us to generalize. However, we can speak out several common features. First, any addict is becoming dependant, limited because his or her actions are mostly driven by the desire to consume drug and it is reflected on several levels. As regards the financial aspects, we should first speak of the crime wave. According to the US Department of Justice, approximately 13 percent of property crimes in the country are committed by teenagers (Glen R. Hanson, 177). In the majority of cases, this crimes spring from substance addiction.

Among other problems, that American society has to overcome is poor academic performance, especially in public schools, located in inner cities. In this case, we should speak first about the negative influence of marihuana. Although this drug does not arouse any severe complications, its long use can easily result in memory impairments, which certainly do not contribute to successful studying. It seems that students are not even aware of all the consequences of addiction. They believe that it does no harm to their physical or mental health. Such organization as DARE tries to increase parents and students awareness but such campaign can never be successful, unless educators and mass media participate in it. Additionally, educational institutions should come up with the new policies. They usually focus on the dangers of substance abuse, which in fact turns into bullying..Every teenager is inclined to resist any form of threatening or warning (even if it is for his own good). Probably, it will be more prudent to show that there are things much better and satisfying than drugs.

The harmful influence of drug abuse can be seen in the way that drug-addict behave. They are inclined to violence, especially if we are speaking about hard drugs such as cocaine, heroin, LSD etc. Five percent of all violent crimes in the country are committed by teenagers addicted to substance (Hanson, 255). Another aspect of this issue is the estrangement between parents and their children. Perhaps, it is a far-fetched conclusion but drugs threaten the unity and connectedness of the family. They also affect a persons self-esteem, especially if we are speaking about people ranging from 17 to 19. When a teenager realizes that, the dependence makes him or her weak and fragile, such person is very likely to suffer from inferiority complex. The inability to conquer this disease strikes a heavy blow on self-esteem. In the long term, it can lead to depression or even suicide.

To conclude, drug addiction can be explained by such factors as the impact of mass media, psychological peculiarities of this age group, namely, longing for new experiences, tendency to emulate the behavior of other people (peers). In addition to that, it is quite possible for us to say that educational institutions do not take an active part in the struggle against drug addiction mostly due to the insufficient support of the government. As for the impacts, we can mark out such low academic performance, crime, hooliganism, or any other form of deviational behavior. Secondly, we should not overlook family problems, which arise out of addiction, especially the estrangement between parents and children. Overall, the situation that has recently emerged reminds a vicious circle or deadlock almost impossible to break. Nevertheless, this problem is solvable because if the government and community understand the whole danger of drug addiction.

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