Category: Abuse

Contingency management

Contingency management is a behavioral treatment for patients with substance abuse problems (Hart & Ksir, 2015). Patients may receive immediate rewards in the forms of vouchers that can be changed for special goods or personal services. People with drug-free urine samples get vouchers (Hart & Ksir, 2015). The peculiar feature of this treatment is the possibility to increase a reward in case drug-free urine samples repeat.

When urine tests are positive, rewards are withheld. Contingency management drawbacks are the cost of rewards that makes this therapy available to a small population and the necessity to use a gambling-based method for patients who already suffer from a certain type of dependence. It is hard to be confident in the effectiveness of this behavioral treatment and give guarantees that drug abusers cannot return to their habits as soon as they receive rewards. Still, this system has certain benefits, including the possibility to affect the patients behavior without their awareness and the increase of motivation to avoid harmful substance use.

Effects of contingency management

Festinger, Dugosh, Kirby, and Seymour (2014) investigated the effects of contingency management among patients with cocaine dependence through a clinical research study. The participants were Philadelphia citizens recruited from consecutive admissions from a local program. They had to recognize themselves as cocaine users.

In general, 222 participants were randomly chosen for urine tests being taken three times per week and being rewarded with vouchers or cash in case of negative tests. Cash- and voucher-based contingency treatment turned out to be both effective for patients who demonstrated a reduction of cocaine use and improved attendance (Festinger et al., 2014). Such treatment can be effective for small populations due to the price that has to be spent on rewards for all participants. Therefore, other psychological treatments like motivational enhancement or cognitive-behavioral therapies can be offered for learning and supporting patients.

Prevention

Drug prevention is a task for many organizations (Hart & Ksir, 2015). Is a pro-drug site were credible and non-judgmental information about various plants, chemicals, and other related issues is presented from academic, medical, and experimental points of view.  Is a governmental source where much information about the negative aspects of drugs and their impact on human lives is given.

The main comparison includes the directions chosen by the developers of such sites. Only negative stories and the impact of drugs without the possibility to recognize drugs positive sides. Is a loyal source where developers try to inform people but not to explain why drugs are dangerous.

Both sites have a positive impact on me because they help to understand how unpredictable the nature of drugs can be. Still, misleading information can be found in both sources. Erowid does not contain any negative comments or persuasions. Dry facts are given providing people with an opportunity to develop a positive attitude to substances. Just Think Twice is full of negative stories and pictures with no possibility to understand that drugs can be used for medical purposes. Therefore, people younger than me may be confused by the information given and the inability to comprehend what kind of conclusion they should make or what goal should be achieved.

To develop a good anti-drug site, I would like to focus on both, positive and negative, aspects of drugs to educate people and underline that drugs cannot take one side. It is always a choice, and people should not be prevented from taking it, but have to be aware of how to make the right choice and evaluate a situation. The legalization of drugs is a serious issue that has to be considered in a new site to inform about the outcomes of illicit drug use.

References

Festinger, D.S., Dugosh, K.L., Kirby, K. C., & Seymour, B.L. (2014). Contingency management for cocaine treatment: Cash vs. vouchers. Journal of Substance Abuse Treatment, 47(2), 168-174.

Hart, C., & Ksir, C. (2015). Drugs, society and human behavior (16th ed.). New York, NY: McGraw-Hill Education.

Drug abuse is a social problem, which is prevalent in society. A study done in 2016 has shown that the increase in substance misuse is attributed to the disconnect between the social context of addiction and neuroscience (Sunshine Behavioral Health, n.d.). In society, addicts experience marginalization and progressive social exclusion. The latter refers to situations when individuals are denied access to services, benefits, and opportunities in the society, whereas marginalized drug users are considered of less advantage than others. Those suffering from drug abuse are excepted from socialization and employment opportunities, and are judged by others inhibiting seeking for help and contributing to its continuity. This essay will examine how society influences drug abuse, theoretic perspectives which explain the problem, and how it emerged and is perpetuated.

Influence of Society on Drug Abuse

Society plays a significant role in influencing drug abuse since most addictions arise from family issues such as childhood maltreatment, domestic violence, and sexual abuse. These social problems may lead to substance misuse by individuals trying to ease pain. Moreover, such social factors as deviant peer relationship, bullying, and gang affiliation contribute to substance use. Additionally, individuals with mental disorders such as hyperactivity disorder (ADHD), depression, and posttraumatic stress disorder, are often at a greater risk of addiction.

Theoretical Perspectives on Drug Abuse

The functionalist theory describes drugs as a functional part of society by illustrating how the public contributes to the continued existence of the problem. This concept best explains drug abuse as it shows the reasons behind the prevalence of the issue. The functional perceptions on the community are as follows: to individuals, drugs have a positive physiological effect and create employment for groups and the criminal justice system. The society becomes dysfunctional from both legalized and illegitimate medicines. This theory

The conflict theory emphasizes the negative impact of drugs on society and provides an understanding of substance misuse through three perspectives. Primarily, people from poor urban areas abuse drugs because they want to feel better living poor conditions; in addition, drugs are usually a source of income in such places and do not require higher educational qualifications (University of Minnesota, 2015). The second view of the concept is based on considering the racial, ethnic prejudice and inequality mark as the factors determining why some drugs are illegal and the criminal judgment on these substances. Lastly, the theory highlights how multinational corporations have a great influence on the drug market and sales of legal substances such as tobacco and alcohol. In maximization of profit, these corporations try to influence America and other nations to actively use their products.

Emergence and Perpetuation of Drug Abuse

Drug abuse emerged as a result of societal needs, demands, and pressures on individuals. The functionalist theory takes substance misuse in a new perspective on how it has helped many lives. Furthermore, drug abuse has led to the development of employment opportunities (University of Minnesota, 2015). The system of criminal justice has provided thousands of job opportunities to individuals who handle drug abuse cases. Corporations which are concerned with addicts help people to manage the habit and also offer employment. The conflict theory, which emphasizes three dimensions of drugs, offers explanation of why people exploit medications, influential factors on substance misuse, and how international corporations have a great influence on the ill use of prescriptions. This concept provides insight into people valuing profit over the life.

Conclusion

Drug abuse is one of the main problems affecting people in United States. The society has contributed to the continued misuse of drugs today, either through bad parenting or the environment where individuals are raised. Through the theories of conflict and functionalism, people gain insight on the misuse of drugs. Addicts are judged and excluded from services, benefits, and opportunities that would otherwise improve their condition.

References

Sunshine Behavioral Health. (n.d.). The social context of addiction. Web.

University of Minnesota. (2015). Social problems: Continuity and change (pp. 300-307). Minneapolis, MN: University of Minnesota Libraries Publishing.

Introduction

Alcohol consumption during pregnancy is a major public health problem. Despite the recommendation to abstain, many women still continue to drink alcoholic beverages while expecting. According to the report published in The American Journal of Preventive Medicine, in 2018, 11.3% of pregnant women reported having at least one drink in the past 30 days, and 4% of women reported binge drinking (qtd. in Fetal Alcohol Spectrum Disorders (FASDs), 2020).

The studies show that alcohol exposure during pregnancy is harmful to the brain of the baby and may result in fetal alcohol spectrum disorders (FASDs) (Fetal Alcohol Spectrum Disorders (FASDs), 2020). It is one of the leading causes of mental health issues in children, leading to irreversible lifelong consequences (Roozen et al., 2018). In addressing the issue of alcohol consumption during pregnancy, an interdisciplinary team needs to focus on increasing awareness and the development and implementation of prevention strategies and FASD detection and prevention guidelines.

Literature Review

The current literature on the issue of alcohol consumption during pregnancy explores the negative effects that alcohol has on the fetus and mother, the reasons behind current recommendations, and the measures to address the problem. One of the most important questions explored in the studies is the amount of alcohol that can be considered safe during pregnancy. Although most health organizations recommend complete abstinence during pregnancy, there is not enough evidence to claim that low levels of alcohol consumption have serious negative effects on fetus development. Despite the lack of evidence, however, it is recommended for interdisciplinary teams to encourage abstaining from alcohol during pregnancy as a precautionary measure.

The article by Subramoney et al. (2018) reviews the literature on the effects of prenatal alcohol exposure on early child development. Based on the results of the analyzed studies, it concludes that drinking alcohol during pregnancy is proven to have widespread negative effects on fetal growth and development (Subramoney et al., 2018). These effects are believed to spread to the early stages of child development up to the preschool age and include, apart from severe FASDs conditions, lower IQ scores, poorer motor abilities, and emotional and behavioral problems (Subramoney et al., 2018). The article reports the lack of information on the effects of low levels of alcohol consumption and suggests that further studies are required to investigate these effects.

The article by Roozen et al. (2018) studies maternal alcohol consumption patterns with the aim to determine which types of drinking behavior most strongly predict FASD. It concludes that the current knowledge of the effects of different alcohol consumption patterns on pregnancy is limited and requires further research (Roozen et al., 2018). However, it is clear that the more severe alcohol consumption is, the more it is in need of intervention.

The article by Dejong et al. (2020) explores the fetal and neonatal effects of maternal alcohol consumption. It claims that alcohol use during pregnancy poses risks to a developing fetus and is the most common cause of birth defects and developmental disabilities, with FASDs being one of the most severe outcomes (Dejong et al., 2020). Other adverse health effects associated with alcohol consumption include miscarriage, preterm labor, and stillbirth (Dejong et al., 2020).

The article focuses on the recommendations and measures to be taken to prevent alcohol exposure in pregnant women. They include screening, structured questionnaires aimed to determine prenatal alcohol use and identify women with drinking problems, and medical interventions to encourage abstinence (Dejong et al., 2020). The article stresses the importance of better understanding the mechanism of alcohols impact on pregnancy, early identification, and the development of therapeutic strategies to mitigate its effects to improve maternal and fetal outcomes.

In most articles, the issue of alcohol consumption recommendations is addressed. It is stated that despite conflicting and inconclusive evidence on the negative effects of small amounts of alcohol on fetus development, public health recommendations are consistent (Roozen et al., 2018). According to Dejong et al. (2020), the American College of Obstetricians and Gynecologists, Center for Disease Control (CDC), Surgeon General, and various international medical societies recommend complete abstinence during pregnancy. The common principle is that abstinence is the safest approach to prevent any possible risks to the unborn child.

However, there are studies that question whether the complete abstinence recommendation is adequate and should be universally applied. Roozen et al. (2018) argue that special attention should be given to specific risk groups, such as heavy drinking women, for whom complete abstinence does not seem feasible. As they may not be able to completely eliminate their alcohol intake due to personal or environmental factors, the complete abstinence recommendation seems unrealistic and unethical (Roozen et al., 2018). For them, the more achievable goal would be to moderate their alcohol intake enough to decrease the risk of FASD.

The article by Armstrong (2017) discusses the recommendations from the perspective of women who experience anxiety and stress after realizing that they have been drinking at the early stage of pregnancy. It claims that complete abstinence advice instills in women the idea that any drinking is as risky as heavy drinking (Armstrong, 2017). Armstrong argues that the recommendations should be evidence-based, and the current evidence does not suggest that low levels of alcohol consumption have serious negative effects on the fetus. FAS occurs mainly in babies born to women who drink heavily during pregnancy, while occasional drinking does not have such an effect and should not be stigmatized.

The study by Mamluk et al. (2017) aims to determine the effects of low-to-moderate in order to understand whether the current recommendations need to be updated. It claims that there is not enough evidence to suggest whether light alcohol consumption during pregnancy affects infant outcomes and what is the safe limit of alcohol consumption (Mamluk et al., 2017). Based on the results of the study, it can be concluded that the current complete abstinence recommendations are a precautionary measure. The lack of evidence creates confusion for health professionals and pregnant women and contributes to inconsistent guidance and advice.

Conclusion

In order to address the issue of alcohol abuse during pregnancy, the interprofessional team should consider the current trends and recommendations on maternal alcohol consumption. The literature on the subject suggests that drinking during pregnancy has serious negative effects on the fetus that also influence early child development. The risks increase depending on the level of alcohol consumption. Although there is not enough evidence to suggest that light drinking during pregnancy is as risky as heavy drinking, most health organizations recommend complete abstinence during pregnancy. It is the recommendation that should be observed when developing prevention strategies, taking measures to increase public awareness, and addressing individual patients needs.

References

Armstrong, E. M. (2017). Making sense of advice about drinking during pregnancy: Does evidence even matter? The Journal of Perinatal Education, 26(2), 6569. 

Dejong, K., Olayeai, A., & Lo, J. (2020). Alcohol use in pregnancy. Clinical Obstetrics and Gynecology, 62(1), 142155. Web.

Fetal Alcohol Spectrum Disorders (FASDs). (2020). Centers for Disease Control and Prevention. Web.

Mamluk, L., Edwards, H., Savovic, J., Leach, V., Jones, T., Moore, T., Ijaz, S., Lewis, S., Donovan, J., Lawlor, D., Smith, G., Fraser, A., & Zuccolo, L. (2017). Low alcohol consumption and pregnancy and childhood outcomes: Time to change guidelines indicating apparently safe levels of alcohol during pregnancy? A systematic review and meta-analyses. BKJ Open, 7(7), 113. 

Roozen, S., Peters, G.-J., Kok, G., Townend, D., Nijhuis, J., Koek, G., & Curfs, L. (2018). Systematic literature review on which maternal alcohol behaviors are related to fetal alcohol spectrum disorders (FASD). BMY Open, 8, 112. 

Subramoney, S., Eastman, E., Adnams, C., Stein, D., & Donald, K. (2018). The early development outcomes of prenatal alcohol exposure: A review. Frontiers in Neurology, 9, 1108. 

Homelessness is one of the most critical issues aroused in the United States of America. The number of homeless people is continuously increasing, creating a severe threat to a countrys general well-being. Mosites et al. claim that The year 2017 became a turning point in the USAs history because the number of persons experiencing homelessness (PEH) was over 550,000 (1). According to Eiseman (14), intense psychological pressure is the critical cause of drug addiction. Thus, being under an unstable emotional state because of not having shelter, people start using drugs that play a detrimental role in homeless peoples lives. The problem of substance abuse disorders in the homeless community can be solved. To that end, the US Government must provide mental and medical support to homeless drug addicts.

The issues of drug addiction and homelessness are intimately connected. Drug-taking behavior is usually provoked by various intra- and extra- forces (Eiseman et al. 5). The examples of intra forces would be emotional instability and psychological disorders, while problems in a family or workplace are examples of extra forces (Eiseman et al. 5). The loss of shelter is one of the critical factors that lead to substance use disorders. Generally, two theories explain the linkage of drug addiction and homelessness. They are developing drug-taking behavior due to the loss of shelter and the loss of the house due to substance use disorders progress.

According to the first theory, the drug-taking behavior develops as a result of the loss of accommodation. Being incapable of resisting the obstacles caused by the loss of housing, people start taking drugs, hoping to release their sufferings. However, instead of the feeling of relief, drug takers become highly vulnerable to mental and physical diseases. Moreover, Zwarenshtein offers a practical explanation of drug-taking while being homeless. The author claims that Stimulants, for example, may help people to stay awake at night when it is most unsafe to be unaware of ones surroundings (par. 23). Besides, certain kinds of drugs provide short-term comfort and reduce coldness (Zwarenshtein par. 23). Hence, there is an impressive number of cases when drug-taking behavior becomes a cause of accommodation loss.

In the second theory, substance disorder abuse is viewed as a reason for the loss of shelter. Being involved in the complex net of drugs, people become incapable of taking control of their lifestyles, fund management, relationships with family members, and friends. Psychotropic substances have numerous adverse ramifications on peoples quality of life. Zwarenshtein explains that the drug-taking may lead to instances of being kicked off the house by parents or a spouse or being fired from the job (par. 24). Receiving a lousy recommendation from the employer, the drug takers are incapable of earning money for living and eventually become homeless. Therefore, substance disorder abuse may become a primary reason for the loss of shelter.

Regardless of the circumstances that lead the addict to homelessness, drugs have adverse effects on the majority of life aspects. Firstly, the homeless drug takers have numerous psychological disorders such as schizophrenia, bipolar disorder, severe anxiety, etc. (Eiseman 42). Since mental health plays a crucial role in peoples general well-being, drug addicts are incapable of living a fulfilled life. Secondly, substance disorder abuse negatively influences the socio-cultural aspect of life. According to Zwarenshtein, drugs cause the weakening of peoples social and institutional connections such as belonging to a church, having a network of friends, or having work and business relationships (par. 18). Thus, the drug-taking behavior has an impressive number of negative consequences on the vulnerable group  homeless addicts. It has a disruptive effect on human beings physical and mental health and negatively influences the social and cultural aspects of life.

Since the issue of drug abuse has numerous adverse effects, the solution to the problem should be implemented immediately. Rather than finding out why psychotropic substances use causes homelessness or why homelessness leads to drug addiction, the question should be examined from a broader perspective. The elimination of factors that cause substance use disorder and homelessness is a useful method of dealing with drug abuse in the homeless community. The primary cause of the problem is politics that hurt peoples ability to afford daily needs, secure steady employment, afford rent, be part of a stable rather than transient community, and enter rental housing market (Zwarenshtein par. 47). Therefore, the issue of drug addiction among homeless people should be solved from the roots  the governments lack of assistance. By preventing the new cases of homelessness and substance use disorders and helping people on the streets, the government can solve the problem effectively and in a short time frame.

Firstly, the federal authorities should stabilize the current political situation and minimize the risks of home loss. Being predisposed to numerous financial difficulties, sometimes people are incapable of covering all their expenses. As a result, they get into an intricate net of business operations that lead to money debts. The worldwide crisis caused by COVID-19 pandemic is one of the most suitable examples of political instability within a country. Experiencing financial problems and suffering from psychological pressure caused by the threat of being infected, people became extremely vulnerable. As a result, the number of drug addicts increased during the spring of 2020 (Bukszpan par. 23). Therefore, the governments primary aim is to ensure the financial stability of every citizen. It can be reached by opening new opportunities for employment, expanding the range of people to receive subsidies, increasing the unemployment benefits, maternity benefits, disability benefits, pensions, etc. Improving living conditions in the country will help reduce the number of people suffering from drug addiction and decrease homelessness rates. Thus, the stabilization of the countrys political situation is a powerful tool for preventing massive substance disorder abuse among the homeless.

Secondly, the government should focus on providing psychological and mental support to the current homeless drug addicts on the streets. People who have lost their homes and use psychotropic substances are incredibly vulnerable to physical and mental diseases. Consequently, they seek help from specialists to improve their health conditions. The primary duty of the government is to provide support to people who need it. Hence, the launching of new campaigns and the establishment of organizations that would monitor homeless drug addicts mental and physical health is crucial in solving the problem.

A bright example of the organization helping people deal with drug addiction was established during the COVID-19 outbreak in 2020. According to Bukszpan, Google, Facebook, and Twitter have cooperated to partner with the non-profit Center for Safe Internet Pharmacies (CSIP) (par. 1). As a result of this partnership, an online platform Tech Together was launched to help people with substance use disorders during the worldwide Coronavirus pandemic (Bukszpan par.1). The principal aim of Tech Together is to provide psychological support to the drug addicts and spread awareness among the population through hashtags, likes, comments, and reposts in social media. As a result of launching this online platform, between early March and late April 2020, Rehab.com had seen a 393% increase in treatment seekers (Bukszpan par. 23). Hence, the organizations assisting drug addicts are a useful tool for overcoming the problem.

Although Tech Together is designed to deal with drug addiction during the pandemic, the organizations concept is exceptionally successful. According to Bukszpan (par. 23), the number of drug addicts received help increase by 393% during the spring of 2020. This impressive statistic proves the effectiveness of the organization. Therefore, the government has to encourage the establishment of similar associations that would focus on dealing with homelessness alongside drug addiction. Since Tech Together was developed to help people during social distancing and lockdown, it offers help through messengers, social media, and online communication. In the case of substance use disorders and homelessness, the support should be provided to the vulnerable group directly on the streets. Thus, the groups of medical workers and psychologists have to interact with homeless drug addicts directly and provide them with medical and psychological support. By leaving the concept of Tech Together but changing the operation principles, the government can launch a new powerful organization what would significantly contribute to the solving of homeless drug addicts issue.

Drug addiction and homelessness are two overlapping problems. Therefore, the solution to the issue should be involved, with all the causes of substance use disorders and homelessness being taken into consideration. The negotiation of the homelessness and drug addiction rates is the primary responsibility of the government. Consequently, the country authorities should deal with the problem in two steps. The first step is to stabilizing the inner political situation to prevent new cases of home loss and drug addiction. The second step is the assistance of the current homeless drug addicts on the streets by establishing the organizations focused on psychological and medical support. The adverse ramifications of substance use disorders accompanied by homelessness should not be underestimated. Thus, the government should put maximum effort into resolving the problem.

Works Cited

Bukszpan, Daniel. Google, Facebook, Twitter Team Up to Support Addiction Recovery During Pandemic. CNBC, 2020, Web.

Eiseman, Seymour et al. Drug abuse: Foundation for a psychosocial approach. Routledge, 2019.

Mosites, Emily, et al. Risk for Invasive Streptococcal Infections among Adults Experiencing Homelessness, Anchorage, Alaska, USA. Emerging Infectious Diseases, vol. 25, no. 10, 2019.

Zwarenshtein, Carlyn. The Mischaracterized Relationship Between Drug Use and Homelessness. Filter, 2020, Web.

Frustration usually co-occurs with substance abuse. The research question is whether substance abuse can reduce frustration. This problem is significant because there is a gap in literature addressing this question. Whereas there is evidence that frustration can lead to drug use, the question whether drug abuse can reduce frustration requires further research.

The main variables are the substance abuse and the levels of frustration. The substance abuse is an independent variable, and the levels of frustration are a dependent variable. The Rosenzweig Picture-Frustration Study (P-F Study) will be used for measuring the frustration of drug abusers (Rosenzweig, The Rosenzweig Picture-Frustration Study).

The hypothesis that will be tested in this study is that there is a negative relationship between substance abuse and individuals frustration.

The data necessary for testing this hypothesis, approving or disapproving it includes the influence of substance abuse on individuals mood. For this purpose, a sample of addicted individuals coming into a rehabilitation center can be tested before the beginning of treatment and at the end of the course. The data retrieved from a Picture-Frustration Study before the beginning of treatment can be used for evaluating the levels of frustration under the influence of substance.

The data received after the end of the course will show the levels of frustration in the same individuals without the influence of substance. Importantly, the same individuals should participate in the study so that their individual peculiarities could be taken into account. The data necessary for supporting this hypothesis will include the lower levels of frustration before the beginning of the course of treatment as compared to the levels of frustration after the end of the treatment course. In case if the opposite results are achieved, the hypothesis will be disapproved.

An exploratory study investigating the influence of drug abuse upon the perceived quality of life in the addicted individuals was carried out by Jessica Maeyer, Wouter Vanderplasschen and Eric Broekaert. The researchers focused on the concept of quality of life as a treatment outcome indicator perceived as important by the addicted individuals undergoing treatment. The researchers organized focus group discussions in different treatment settings to define the patients perceptions of indicators affecting their quality of life (Maeyer, Vanderplasschen and Broekaert 108). The main finding of this study was that the treatment course affects the patients social well-being, and effective social network is needed for supporting them during the treatment courses.

Kim Mueser, Jennifer Gottlieb, Corrine Cather, Shirley Glynn, Roberto Zarate and Melinda Smith conducted an investigation among the relatives of substance addicted individuals participating in the family intervention studies. The main goal of researchers was to investigate the relationship between antisocial personality disorder (ASPD), mental illnesses and addiction of those who abuse drugs. The data on the social well-being and the levels of frustration in addicted individuals was retrieved from their relatives reports (Mueser, Gottlieb, Cather, Glynn, Zarate and Smith 54).

An important finding of this research that is relevant to the hypothesis of research outlined earlier was that the clients with ASPD and addiction have worse mental health functioning at the beginning of the intervention studies as compared to the results reported by the relatives of clients who had been involved into the long-term interventions. This finding contradicts the hypothesis of the research outlined above and, therefore, deserves serious consideration.

Works Cited

Maeyer, Jessica, Wouter Vanderplasschen and Eric Broekaert. Exploratory Study on Drug Users Perspectives on Quality of Life: More than Health-Related Quality of Life? Social Indicators Research 90 (2009): 107  126. Print.

Mueser, Kim, Jennifer Gottlieb, Corrine Cather, Shirley Glynn, Roberto Zarate and Melinda Smith. Antisocial Personality Disorder in People with Co-Occurring Severe Mental Illness and Substance Use Disorders: Clinical, Functional, and Family Relationship Correlates. Psychosis: Psychological, Social and Integrative Approaches 4.1 (2012): 52  62. Print.

Rosenzweig, Saul. The Rosenzweig Picture-Frustration Study. Mental Measurements Yearbook. 1981. Web.

Sexual abuse refers to the act of forcing an individual to take part in a sexual behavior against their own free will. It can also be referred to as sexual molestation. The most common mode is rape, which is defined as forced sexual intercourse initiated by one person or a group of people against another person without the individuals consent and will.

Rape is sometimes referred to as sexual assault and is classified according to the various forms through which it takes place. For instance, date rape takes place between two individuals who are well acquainted with each other, hence the victim knows the rapist. This form of rape majorly involves close friends or people who are dating, although in most cases the rape victim is drugged to incapacitate them so as to ensure they do not offer resistance.

Rape can also occur in times of war where soldiers take advantage of the helpless women and children thus forcing them to have intercourse. It also takes place where the ruling authority forces individuals to be involved in prostitution. More so, rape can also take place after the consent of the other person, but through lies and fraud. This form of rape is referred to as deceptive rape.

Gang rape occurs when a group of people conspires to rape an individual. It is common among drug users, especially drunkards (Sobsey, 2012). The two final forms of rape are spousal and infant rape. Spousal rape is where a partner forcefully involves the other partner in sexual intercourse, while statutory rape occurs when an adult forcefully initiates sexual intercourse against children below the age of eighteen. Incest rape involves cases where relatives are raped by close relatives.

Certain social factors can be assumed to be the predisposing factors for rape, especially in societies that are deeply rooted in beliefs of male sexual entitlement. This also goes hand in hand with societies that associate physical strength and male dominance over women thus promoting male chauvinism.

In such social settings, women have no option but always give in to mens sexual demands, and any attempt by women to resist sexual advances from men is regarded a taboo. Other societies regard marriage as an obligation by women to relentlessly offer intercourse to men without excuses or whatsoever (Sobsey, 2012). These societies encourage male sexual dominance and in the process making women prevalent victims of rape since men are justified to use force and violence to achieve their objectives. The other social factor for rape is that most people associate rape with women and hardly understand rape against men. Men are generally regarded superior and masculine, thus they fail to seek assistance when they fall prey to rapists for fear of being mocked and ridiculed.

Personal and psychological state of mind can also be a predisposing factor for rape. Men who are naturally sexually hostile and violent are mostly the culprits of rape as they are antisocial and rarely associate with others (Sorenson, 2007). Research shows that such men are usually violent towards women and even fellow men since they have a false feeling of having excess energy. They do not perceive the effects of rape on the victim, hence will always associate sex and aggression.

The most commonly reported forms of rape are date and acquaintance rape. These two forms are committed by culprits well known to the victim and can easily be avoided through self-respect and developing a sense of caution and keenness. The first step towards protection against these kinds of rape is by avoiding secluded places, including your own house. This reduces chances of abrupt and unaware approach by anybody. An individual should also state the type of relationship they are willing to be part of so as to know the outcome from such relations. This will shun off any queer sexual advances and acts that may drag one into sexual acts by constantly keeping you within the limits of the relationship.

People under the influence of alcohol easily fall prey to rapists. For this reason, one is advised to always stay sober and avoid excessive consumption of alcohol (Baur, 2009). When going to parties where drinks are served take what you are used to and in less quantities. Futhermore, ensure you attend the party in the company of friends so that you watch over each other. A common drinking observation has it that one should never taste any of his drinks once you lost sight of it.

During first and blind dates, it is advisable to have company and avoid secluded places for such occasions (Sorenson, 2007). This ensures that there is always an active third party watching over and ready to help should anything arise. Again, once you feel uneasy or suspect anything that may threaten your sexual security, it is advisable to walk out. Although prevention is always encouraged and practiced, sometimes date rape or acquaintance rape may still occur despite all these precautions. In such cases, instinctive actions such as running, screaming and fighting back are encouraged so as to avert any impeding rapist and in the process alert the general public.

References

Baur, S. (2009). The Intimate Hour: Love and Sex in Psychotherapy. Boston: Houghton-Mifflin Company.

Sobsey, D. (2012). Violence and Abuse in the Lives of People With Disabilities: The End of Silent Acceptance? Baltimore: Paul H. Brookes Publishing Company.

Sorenson, S. (2007). Violence and Sexual Abuse at Home: Current Issues in Spousal Battering and Child Maltreatment, New York: Haworth Press.

Substance abuse refers to the pattern of continued use, despite adverse consequence. Socio-cultural determinants of substance abuse imply to social factors that affect the outcome of drug abuse. The group characteristic determines social-cultural determinants and the general beliefs in history of the set community. For instance, smoking was considered fashionable in the early times. Currently, it is prohibited in some communities. The alienations of individuals in a new environment trigger people to abuse drugs.

Emerging adulthood has been a significant contributor to drug abuse widespread. The youths gain freedom during the transition stage of adolescence to adulthood hence they abuse the drugs without fear of the parents. The exposure to colleges where there is so much freedom and culture of excessive drinking is continuously contributing to widespread use. Students abuse drugs while trying to cope with up with the new environments of studies and trying to fit the new social settings.

The significant direct cost is arising from substance abuse results from health care. For instance, The cost of acute care and psychiatric hospitalization, specialized inpatient treatment, ambulatory care and doctors fees, visits to a family doctor and drugs prescribed to treat a substance abuse problem. (J Rehm et. al, 2006).Absolute proportional cost is spend according to the attributable ratio.

Law enforcement cause of direct cost arising from substance abuse. Surveys are done by the police officers to estimate the number of people abusing drugs. The police officers are highly paid to carry out the practice. Some people cultivate substances that are prohibited.substance abuse triggers people to do the robbery that can be driven by the lack of money to purchase the drug substances. Substance abuse makes one intoxicated hence behaving abnormally which can lead to criminal assault (J Rehm et. al, 2006).

Indirect costs in this case refer to lost productivity in the workplace or at home resulting in whole or in part from the abuse of substance. (J Rehm et. al, 2006).People get injured and become ill triggered by substance abuse being unable to work. Individuals who could have highly contributed to the economy become inactive hence level of economic growth is reduced. An individual in a certain profession may die as a result of substance abuse. There is an interval of period before he or she is replaced.

Physical cost related to substance abuse vary depending on the type of drug. The body system is severely affected, for instance; the brain is affected by addiction. Substance addiction, makes changes, and this affects the body system. Physical cost is closely related to the psychological cost. Drug addiction leads to psychological harm as well as changing ones social skills.

Addiction to drug and substance use is linked to the crimes and accidents. According to (NCADD, 2014) ,Drugs is often related to murder, rape, robbery, aggravated assault, burglary, larceny/theft, serious motor vehicle offenses with dangerous consequences, arson and hate crimes. The drug addicted people are likely to commit suicide when they have done any crime that may lead them to jail and due to lack of mental judgment.

Interpersonal relationships refer to how different people interact. There are various types of these relationships for instance family and professional relationship. Substance abuse leads to physical violence, traumatization of children and neglect in the family as well as verbal assaults in different environments, places of work (Alcohol Reab.com, 2015).

The dynamics of addiction involve the likelihood to influence others to be addicted; there is gradual obsession with addiction substance (Psychcentral, 2007). The damaging associated with job and romantic relationship. There is great significant to involve the addicted person with new addictive behavior. Many promises to quit the addiction that is usually followed by distress and relapses.

Denial is involved when individual does not admit the fact hence acting in a way to show that even if painful occasion happened did not exist. People employ refusal in their day to day existence to avoid working with hurtful emotions (Psychcentral, 2007). For example, individuals who are usually operating alcohol will reject the fact by informing you how nice they perform their work and romantic relationship.

Storm unsatisfactory views as well as urges. To have an illustration an adolescent that is confused together with anxiety, wrath in addition to increasing sexual urges may turn out to be obsessive and initiate showcasing before childhood actions they have prolonged due to the fact get over, including bedwetting.

Intellectualization is the overemphasis upon pondering when up against an unacceptable impulse, predicament or perhaps habits devoid of hiring any emotions whatsoever that can help mediate as well as to put thoughts straight into an emotive, human context. Rather than handle the particular unpleasant associated emotions, somebody may well use intellectualization in order to long distance by themselves from your impulse, event or perhaps habits (Psychcentral, 2007).

Rationalization is getting something right diverse light-weight as well as featuring a new evidence pertaining to ones ideas as well as conducts industry by storm some modifying reality. As an example, a female exactly who commences dating a man your woman, enjoys and also believes the earth involving is suddenly left the person pertaining to no motive (Psychcentral, 2007).

Reaction formation is the renovating including irritating and also risky inner thoughts of their opposites. As an illustration, a lady that is infuriated using the woman would choose to terminate the job may be excellent for the boss. Shes will work well without showing any adverse feelings.

References

Alcohol Reab.com. (2015). Substance Abuse and Interpersonal Relationships. Web.

J Rehm et. al. (2006). The Costs of Substance Abuse in Canada 2002. Ottawa: Center of Substance Abuse.

NCADD. (2014). Drugs and Crime. Web.

Psychcentral. (2007). Common Defence Mechanisms. Web.

Introduction

Substance abuse is not a new problem the human society faces as drugs have been used for centuries. However, the scale of the problem is quite alarming these days. For instance, it was estimated in 2012 that almost 10% of the population (23.9 million teenagers and adults) used illicit drugs (Sue, Sue, Sue, & Sue, 2015). Illicit drugs include cocaine, cannabis, illegally obtained prescription medications. At that, almost 9% of the US population had a substance-abuse disorder in 2012.

People suffering from substance-abuse disorders name different reasons for using and starting to use drugs. Researchers have identified two major factors affecting drug-taking behaviors. These are biological and environmental influences. Some people have a genetic predisposition and are prone to developing addictions, while others are heavily influenced by the environment. However, it is clear that both types of factors interact and shape peoples behavior. This paper examines different ways biological and environment influences interact and affect drug-taking behavior.

Genes Moderating Environmental Effects

First, it is necessary to note that the ongoing research on the matter has not led to definite answers, and it is still quite unclear which factors are central. However, it is possible to identify three ways biology and environment interact affecting peoples drug-taking behavior. One of these types of interaction is associated with the moderation of environmental influences.

It has been acknowledged that some genes may moderate environmental factors. For instance, the monoamine oxidase-A gene is associated with peoples significant resistance to violence and antisocial behavior (Byrd & Manuck, 2014). In simple terms, people having such genes are likely to avoid using drugs even when they can be exposed to some environmental influences. These individuals do not develop substance-abuse disorders, even if they try some substances. They are also less likely to take drugs in the first place. Interestingly, Byrd and Manuck (2014) claim that the association between the gene and environmental influences is less evident in females.

Biological Factors Enhancing the Effects of the Environment

The weak association between MAOA gene and more prosocial behaviors in females can be explained by biological influences. It has been acknowledged that females are less resistant and are more likely to develop addictions as compared to males (Fattore, Melis, Fadda, & Fratta, 2014). This peculiarity is often associated with hormones produced in male and female bodies. Fattore et al. (2014) state that females are specifically prone to abusing prescribed drugs that are related to treating depression and other psychological issues. At that, males are still more likely to try drugs in their search for new experiences or pleasure (Sue et al., 2015). Therefore, it is possible to emphasize that males and females are prone to substance use, but the factors affecting their behaviors differ.

Inheritance is another factor associated with increased vulnerability to substance use and abuse. Bardo, Neisewander, and Kelly (2013) state that extensive research on the matter shows that people inherit psychological and biological traits that enhance the chances of their using drugs. Peoples sensitivity can often be inherited. In simple terms, people who have certain inherited genes may be unable to resist the craving for drugs. In other cases, people inherit some psychological traits associated with enhanced desire or even need to have new experiences or gain pleasure. Nevertheless, Bardo et al. (2013) also mention that environmental influences can moderate biological factors (such as inherited predisposition, the impact of different hormones, and so on).

Some psychological traits are closely related to peoples drug-taking behaviors. For instance, impulsivity is one of these characteristic features (Sue et al., 2015). Bardo et al. (2013) note that the association between impulsivity and risky behaviors is evident at an early age. It is acknowledged that adolescents having this feature are more likely to try drugs and develop substance abuse.

Another individual difference is sensation seeking. Some people tend to have an increased need to seek new experiences, which often leads to the use of drugs. Clearly, the combination of these individual features (and other traits associated with risky behaviors) increases the risk of developing substance-abuse disorders. The effects of these features are specifically apparent in adolescence.

Environmental Influences

It has been acknowledged that environmental influences are often central to peoples drug-taking behaviors (Bardo et al., 2013). When discussing environmental factors affecting peoples drug-taking behaviors, it is necessary to take into account the period when people are more likely to start using or abusing drugs. It is found that drug addictions are developed, and first drug-taking experiences occur in adolescence and early adulthood (Sue et al., 2015). These are also the periods when people form identities, seek their place in society, and start making numerous decisions (that are often serious and life-changing). Hence, such factors as peer pressure, socioeconomic status, employment status, family issues, and so on should be considered.

One of the most influential factors is peer pressure, as it often becomes the reason for trying and also abusing drugs (Sue et al., 2015). Peer pressure can affect both males and females. However, in males, it is often associated with becoming a part of a group. For example, a male teenager may be a member of a gang where drug use is common. Whereas, females often start using drugs to handle issues and treat their depression (Sue et al., 2015). Therefore, males use drugs to show their commitment to a groups values and their loyalty while females start using drugs in order to try to escape from negative feelings when they are not accepted or understood within a group.

Which Factors Are More Influential?

As has been mentioned above, it is still unclear which factors, environmental or biological, are more influential when shaping peoples drug-taking behaviors. For instance, even studies exploring drug behaviors in twins have not provided a clear answer to this question (Bardo et al., 2013). Many researchers argue that environmental factors are central to shaping peoples behavior. Thus, twins with similar genes and inherited traits often develop differently when exposed to different environments. Siblings also have a significant influence on each others drug-taking behavior. Altonji, Cattan, and Ware (2017) found that younger siblings often start using drugs if their older siblings are substance users or abusers. Importantly, the association between siblings behaviors is strong in males, while females are less prone to such influences.

Nevertheless, it is necessary to note that these studies have numerous limitations. They cannot be regarded as the illustration of environmental factors dominance. First, not all researchers take into account a complete set of genes and inherited traits when studying behaviors and environments of twins and siblings. Therefore, it is often unclear whether the participants have similar biological traits. Environments are also rather different, as numerous factors are usually combined.

The Most Appropriate Approach

The analysis of the existing evidence on the matter shows that the most appropriate way to analyze biological and environmental influences on peoples drug-taking behaviors is the analysis of both types of factors. The combination of environmental and biological influences has different impacts on individuals. For example, an impulsive person is at a higher risk of trying drugs. However, the death or suffering of a family member or a close one related to the use of substances can make the individual resistant. At the same time, high levels of MAOA genes may prevent a person from using drugs even if the individual is under considerable pressure from peers.

Conclusion

In conclusion, it is necessary to note that researchers have identified many ways biological and environmental influences interact and affect peoples drug-taking behaviors. In some cases, biological factors enhance environmental influences. Sometimes biological factors moderate the effects of environmental influences and prevent people from using drugs or developing substance-abuse disorders. However, in the majority of cases, these factors and influences are intermingled, and it is hard or even impossible to identify central or less important factors leading to substance use and abuse.

Therefore, it is crucial to pay attention to all (or as many as possible) factors affecting peoples drug-taking behaviors. Family history, traits of characters, particular genes, gender, socioeconomic status, relationships with peers, and the like should be taken into account. This comprehensive approach may help in identifying paradigms and even patterns associated with the use of drugs. As a result, researchers will develop strategies to help people (especially adolescents) avoid using and abusing any substance.

References

Altonji, J., Cattan, S., & Ware, I. (2017). Identifying sibling influence on teenage substance use. Journal of Human Resources, 52(1), 1-47.

Bardo, M., Neisewander, J., & Kelly, T. (2013). Individual differences and social influences on the neurobehavioral pharmacology of abused drugs. Pharmacological Reviews, 65(1), 255-290.

Byrd, A., & Manuck, S. (2014). MAOA, Childhood maltreatment, and antisocial behavior: Meta-analysis of a gene-environment interaction. Biological Psychiatry, 75(1), 9-17.

Fattore, L., Melis, M., Fadda, P., & Fratta, W. (2014). Sex differences in addictive disorders. Frontiers in Neuroendocrinology, 35(3), 272-284.

Sue, D., Sue, D. W., Sue, S., & Sue, D.M. (2015). Understanding abnormal behavior. Stamford, CT: Cengage Learning.

The Hispanic community is one of the rapidly growing populations in the American community. Although they are non-natives in the country, their presence is slowly being recognized not only in democratic processes but also in the social order. One of the states with significant populations of the Hispanic community in California. This study will focus on alcohol and substance abuse among the female gender population proportion (12-20 years and 25-45 years).

Alcohol and substance abuse is a common practice in many parts of the American community. Statistics indicate that there is a variation of behavior among adolescents from different ethnic backgrounds in California. There are rising concerns on substance use disorders as portrayed by different individuals. The two independent factors involve drug and substance abuse prevalence in Hispanics and Whites from California (Barrera et al., 2019). The following hypothesis is applicable in this case:

H₁: Alcohol and substance abuse are more prevalent among the Hispanic female adolescent and the youth (12- 20 years) than among Hispanic women of the working group (25-45 years) in California.

Ideally, alcohol and substance abuse have multiple effects on human health. The practice can lead to use disorder, addiction, and mental health concerns. At the same time, the adolescents may become vulnerable to different social ills while women in productive age may affect the fetus health. These problems seem to vary across the population age groups and may have imperative impacts on economic growth. There are more than 40 million Hispanics living in the US, out of which half are concentrated in California and Texas. Problems of mental illness and drug/substance-induced death are common among this group. Data from California indicate that between 2014 and 2017, 1 in every 13 women used alcohol while pregnant and exposed their fetus to danger. Likewise, there are co-occurring substance use disorders and other mental illnesses among adolescents and adult women. To solve these challenges, the government should initiate public awareness and health education programs to help girls and women understand the implications of alcohol and substance abuse.

To clarify the existence of the following hypothesis, a confidence interval of the sample might be calculated with the help of a basic formula, which includes the consideration of the sample mean (M), sample size (n), standard deviation (s), and the desired confidence level (Kim et al., 2017). Thus, when taking a population variance of approximately 1000 people, the sample size of the study will be 157 people. Given that the hypothesis is based upon the age between 12 to 45 years, the sample mean will be 28, 5 with a standard deviation of 2. With a confidence level of 95%, it can be estimated that the index will constitute [28.187, 28,813], i.e., the true mean of the peak age of substance and drug abuse among the Hispanic population claims to be approximately 28 years.

The pattern of the following interval might be observed in the following graph, where the x-axis depicts the likelihood of substance abuse, and the y-axis defines the approximate age:

References

Barrera, I., Sharma, V., & Aratani, Y. (2019). The prevalence of mental illness and substance abuse among rural Latino adults with multiple adverse childhood experiences in California. Journal of Immigrant and Minority Health, 21(5), 971-976.

Kim, H. J., Luo, J., Chen, H. S., Green, D., Buckman, D., Byrne, J., & Feuer, E. J. (2017). Improved confidence interval for average annual percent change in trend analysis. Statistics in Medicine, 36(19), 3059-3074.

Abstract

This paper investigates the efficacy of multidisciplinary and non-multidisciplinary approaches in child abuse management. Evidence of increased prosecution rates increased medical referrals, and increased provision of medical examinations show that a multidisciplinary approach is highly effective. Conversely, confusion, jurisdictional disputes, and weak investigations (during the detection, reporting, and management of child abuse cases) may arise if non-multidisciplinary approaches are adopted, thereby exposing children to further maltreatment. This paper positions the efforts of health workers at the axis of child abuse management because they are highly qualified in detecting and preventing child abuse. Indeed, their combined efforts with law enforcement officers provide a powerful front for managing child abuse cases. Comprehensively, this paper shows that the multidisciplinary approach is more effective in managing child abuse cases because it advances the best interests of the victims.

Key Words: Multidisciplinary, Non-multidisciplinary, Child Abuse, Prosecution rates, Health Workers, Law Enforcement, Mental health, Trauma, Medical Examination, Inter-Agency partnerships

Introduction

Child abuse manifests in different forms. However, sexual abuse, physical abuse, emotional abuse, and neglect outline the most common types of child abuse. Colleen (2007) says the incidences of child abuse in the United States have increased in the last decade. Annually, about 5% of minors become victims of child abuse (Colleen, 2007). This figure translates to about 3,000,000 cases of child abuse reported yearly (about 1,400 of these cases lead to fatalities) (The National Childrens Advocacy Center, 2006; Colleen, 2007). These statistics show that child abuse is among the leading causes of mortality in infants and children (with about half of all the children who have experienced child abuse suffering a high risk of experiencing the same maltreatment in the future). Physicians have taken a proactive approach to address this problem. Some of them have used a multidisciplinary approach in doing so, while others have adopted a non-multidisciplinary approach as well.

The National Childrens Advocacy Center (2006) says the adoption of the multidisciplinary team approach in addressing child abuse issues dates back to the early seventies. Then, few people disputed the importance of integrating the efforts of different health departments, law enforcers, therapists, and even community groups in addressing child abuse and neglect issues. A formal platform for ensuring seamless inter-agency collaboration emerged (most agencies had differing goals and perspectives). Agencies that differed from the multidisciplinary approach chose to manage the issue alone. A non-multidisciplinary approach premises on the concept of reductionism. This concept perceives child abuse as a sum of several parts (The National Childrens Advocacy Center, 2006). Through this understanding, the non-multidisciplinary approach only relies on one aspect of causality, through a preclusion of emergent phenomena (the support of non-multidisciplinary approaches in addressing child abuse mainly stem from the inadequacies of the multidisciplinary approach). This paper evaluates the effectiveness of both approaches in addressing child abuse issues. In this study, the key indicators include prosecution rates, mental health referrals, and the provision of medical examinations.

Prosecution Rates

Prosecution rates normally show the efficacy of child abuse interventions. Historically, there have been low prosecution rates of child abuse cases (American Prosecutors Research Institute, 2004). However, the adoption of a multidisciplinary approach in arresting and prosecuting offenders has led to a significant increase in the rates of prosecution. For example, a study sponsored by the National Institute of Justice and the Office of Juvenile Justice and Delinquency Prevention identified that the adoption of a multidisciplinary approach has led to high felony convictions in child abuse cases (American Prosecutors Research Institute, 2004). Consequently, there has been an increase of convictions, from about 70% in the eighties to about 95% today (Goodyear-Brown, 2011). This significant rise in prosecution rates came from the adoption of a multi-agency approach in prosecuting child abuse offenders.

The efficiency of the multidisciplinary approach in increasing the number of prosecutions stems from earlier studies that investigated the role of the classical organization theory in determining the efficiency and effectiveness of state departments in prosecuting child abuse offenders (Maguire, 2009). Max Weber was at the center of the formulation of the classical organization theory when he suggested that successful organizations adopt a closed system approach (Maguire, 2009). His ideology stemmed from the belief that organizational success came from strict compliance with bureaucratic principles and ideologies. Evidence accumulated from the last three decades shows that the closed systems approach is ineffective in realizing organizational success (Maguire, 2009; Goodyear-Brown, 2011). Instead, there has been a significant shift in philosophy from the closed systems approach to the open systems approach. If we extrapolate these findings to this study, we find that the open systems approach supports the multidisciplinary approach of managing child abuse cases. The structure contingency theory, for example, acknowledges the importance of including environmental factors in solving social issues (The National Childrens Advocacy Center, 2006). This approach informs inter-agency collaboration because, unlike the non-multidisciplinary approach, it considers environmental factors in managing child abuse cases.

Martin & Besharov (1991) were among the first researchers to use the above theories in the assessment of child abuse cases. In their study, Martin & Besharov (1991) said, neither number of officers in the department, nor the organizational location of specialists, had an effect on arrest rates, and that fewer cases are closed by the arrest in agencies with specialized sexual abuse squads than in other agencies (p. 7). Their views proved to be useful in understanding how organizational structures in the police department allowed for the adoption of a multidisciplinary approach in managing child abuse cases (the views of the researchers however relied on qualitative impressions of the respondents) (Martin & Besharov, 1991). The researchers also found out that most police departments were highly insensitive to the plight of patients and their families, whenever they managed child abuse cases (Martin & Besharov, 1991). This led to increased trauma to the victims, thereby reducing the rates of prosecution. Institutional failures have forced many police departments to be open about seeking the support of other agencies (inter-agency approach). In detail, the inter-agency approach involved the realization of joint efforts by different agencies in addressing child abuse. The San Diego Police department is one agency that has greatly benefitted from the adoption of the multiagency approach in prosecuting child abuse offenders. Colleen (2007) says, San Diegos multiagency approach involves coordination among child protective services (CPS), the police, the medical community, and the prosecutors office (p. 119).

Evidence shows that the non-multidisciplinary approach for addressing child abuse cases has often resulted in poor management of such cases. For example, in the seventies and eighties, child protection services (CPS) assumed the sole responsibility of protecting children from abuse (Maguire, 2009). They often undertook their activities with little or no assistance from the police. In fact, CPS only required the police to stand guard, only when the children were withdrawn from their families and transferred into protective homes (sometimes, child protective services would not even seek the services of medical practitioners in ascertaining the degree of abuse) (Maguire, 2009). This non-multidisciplinary approach led to many problems that failed to protect children from further abuse. Maguire (2009) says, The lack of communication, coordination, and cooperation between community helping agencies resulted in frustration, duplication of effort, jurisdictional disputes, weak investigations, and tragedies (p. 157). Through the problems realized from adopting a non-multidisciplinary approach, child protection services acknowledged the need to share the responsibility of protecting children from child abuse by collaborating with other agencies. This way, they started to appreciate the importance of the multidisciplinary approach, as opposed to the non-multidisciplinary approach, in managing child abuse.

Mental Health Referrals

Mental health referrals outline among the most important processes and outcomes for children who have experienced child abuse. Multidisciplinary approaches for addressing child abuse issues have largely helped to increase the number of mental health referrals. Mainly, increased agreements between juvenile justice systems and mental health systems have helped to realize this outcome (Franklin & Harris, 2006). Sometimes, courts help to increase the number of referrals by ordering abused children to attend counseling sessions and receive guidelines on how to conduct visitations and reunification plans.

A study conducted by the Office of the Family and Childrens Ombudsman (OFCO), in 2008, affirms the positive progress made by adopting a multidisciplinary approach in health referrals (Washington State Institute for Public Policy, 2009). The study established that between 2006 and 2008, an effort to integrate the activities of different agencies increased the rate of mental health referrals to about 96,000 (Washington State Institute for Public Policy, 2009). Nine categories outlined the most active agents in this study. They included corrections personnel, DSHS employees, medical professionals, law enforcement personnel, mental health professionals, foster care providers, social service professionals, educators, and child care providers (Washington State Institute for Public Policy, 2009, p. 1).

Maguire (2009) commented on these findings by saying that the high rates of referrals witnessed through the adoption of the multidisciplinary approach also stemmed from the legal requirement for state agents to report incidences of child abuse. The state also required the agents to refer abused children to mental health facilities (or counseling programs) whenever they detected a victim underwent some type of trauma (ideally, all children who have undergone trauma from child abuse and neglect should go for counseling). Maguire (2009) also cited inputs from third parties (who are not required to participate in the rehabilitation of abused children) as contributors to higher referral rates for the multidisciplinary approach. These third parties included the inputs of friends, neighbors, and strangers who know the victims. Comprehensively, the referrals made by the contributors not only aimed to rehabilitate the abused children, through mental health therapy but also helped to recommend the prosecution of known sex offenders. In fact, the Washington State Institute for Public Policy (2009) explains that about 47% of the referrals made by the agents were for mental treatment, while about 60% of the referrals aimed to support law enforcement activities. The latter group of referrals often led to further investigations into child abuse cases (and occasionally, the removal of children from their homes into foster care).

Most of the mental health referrals outlined above are subject to other factors that affect the measures for addressing the child abuse. For example, when the resolution of child abuse cases existed outside the realms of the official child protection law, alternative solutions always seemed attractive (Franklin & Harris, 2006). For example, Ludwig (1981) says that if people could refer a solution to a community service provider, they often chose this option. Public health services, counseling, and other family services therefore provided an alternative for rehabilitating abused children outside the realms of child protection services.

Provision of Medical Examination

This section of the report acknowledges the role of medical examinations in child abuse cases. Goodyear-Brown (2011) says medical exams are very important in treating abused children, especially when they experience physical or sexual abuse. Medical evidence in child abuse cases often provides satisfactory and powerful evidence to convict child abuse offenders. Since child abuse victims may not provide a clear narration of their ordeal, medical examinations often provide a holistic picture of what may have happened. When prosecuting offenders, medical examination results provide protection for prosecutors when the defense intends to discredit cases, based on the absence of medical results (American Prosecutors Research Institute, 2004). For example, in sexual abuse cases, the presence of semen, sexually transmitted diseases (STD), and tissue damage may make it difficult for defense teams to discredit a prosecutors case.

The usefulness of medical examinations in addressing child abuse depends from the efficiency and expediency of the exams. In many child abuse cases, medical examinations are inconclusive because of procedural issues, or the lack of timely reporting of child abuse cases (Goodyear-Brown, 2011). Poor or inconclusive medical results often come from the adoption of non-multidisciplinary approaches of addressing child abuse. Notably, non-multidisciplinary approaches lead to the loss of medical evidence, or the failure to prosecute offenders. For example, if law enforcement officers do not understand the importance of a timely medical exam in child abuse cases, a victims wound or injuries may heal, thereby leading to the loss of evidence to corroborate the claim. Part of the problem lies in officer training. Kinnear (2007) says that a survey of about 200 police academies in the US showed that many officers did not have the skills or knowledge to manage child abuse cases. Most of the officers interviewed said they only had a general understanding of how to manage child abuse cases. This challenge may undermine the efficiency of the multidisciplinary approach. Interestingly, the American Prosecutors Research Institute (2004) says the high rate of inconclusive medical exams in non-multidisciplinary approaches of managing child abuse does not mean there will be fewer prosecutions. In fact, the American Prosecutors Research Institute (2004) says that in one jurisdiction in the US, the high number of inconclusive medical results has not affected the rate of prosecution for child abuse cases.

The greatest challenge for achieving conclusive results of medical examination is the fragility of medical evidence. Seminal fluid, bleeding, and bruises (just to mention a few) are common medical evidences that may not last for long. However, a multidisciplinary approach to addressing child abuse issues often leads to better identification and recording of these medical evidences. For example, a timely collaboration of law enforcement officers and physicians may lead to the timely identification of medical evidence that could be useful in prosecution. A multidisciplinary approach of addressing child abuse cases also creates fewer traumas for victims because children are often scared to narrate their ordeals.

The American Prosecutors Research Institute (2004) says many child advocacy centers use the multidisciplinary approach for examining children by allowing a holistic medical evaluation of the children at once. The comprehensive exam eliminates the possibility of the victims experiencing multiple encounters of evaluation (possibly at different sites). By conducting comprehensive medical exams, physicians may come up with comprehensive results of the medical examination because they can easily check for every medical possibility that may arise from the abuse. Comprehensively, the adoption of the multidisciplinary approach helps to expedite medical examinations, thereby improving their roles in providing medical evidence for prosecution.

Conclusion

After weighing the findings of this paper, the importance of adopting a multidisciplinary approach in addressing child abuse surfaces as the most effective approach to protecting children from such maltreatments. This paper acknowledges the effectiveness of an inter-agency approach by health workers, law enforcers, judicial officers, community workers and other agencies in preventing and prosecuting child abuse cases. The role of health workers especially surfaces in this paper as the most important piece of managing child abuse because such cases normally take a medical twist (physical injuries, mental health trauma, and sexual abuse). It is therefore unsurprising for Beth & Crisp (2006) to say that health workers are among the most qualified people to detect child abuse or identify children who have a high risk of experiencing the same. However, to maintain their relevance, health workers need to appreciate the importance of inter-agency training when preparing new and existing health workers to manage child abuse cases. Notably, the importance of increased collaboration between community health workers and physicians is valuable here because their increased collaboration prepares them to manage child abuse better.

Through a comprehensive analysis of child abuse and its antecedents, this paper show that the efficiency of the multidisciplinary approach spills over to all the three issues covered in this paper  prosecution rates, provision of medical examination, and mental health referrals. For instance, this paper shows that the adoption of a multidisciplinary approach leads to increased medical evaluations by healthcare workers (increased medical evaluations increase the body of evidence needed for successful prosecution). This outcome easily depicts the success that could occur from the increased collaboration between physicians and law enforcement officers. Comparatively, the non-multidisciplinary approach proves to be an ineffective model for combating child abuse cases because it precludes effective coordination and communication (which are important in protecting children from child abuse). Evidence of the classic organization theory also affirms this fact because it outlines that it is untenable for organizations to operate as closed systems. This is particularly true for law enforcement agencies because they need help from other agencies (like healthcare institutions) to prosecute child offenders. The open systems approach (multidisciplinary approach) is therefore more effective in protecting children from child abuse because it emphasizes the role of the environment in addressing child abuse. Future research should however identify which inter-agency partnerships provide the best combination for managing child abuse.

References

American Prosecutors Research Institute. (2004). Investigation and Prosecution of Child Abuse. New York, US: SAGE.

Beth, R., & Crisp, P. (2006). Nurses perceived training needs in child protection issues. Health Education, 106(5), 381  399.

Colleen, K. (2007). Child Abuse: Approach and Management. Am Fam Physician, 75(2), 221-228.

Franklin, C., & Harris, M. (2006). The School Services Sourcebook: A Guide for School-Based Professionals. Oxford, UK: Oxford University Press.

Goodyear-Brown, P. (2011). Handbook of Child Sexual Abuse: Identification, Assessment, and Treatment. London, UK: John Wiley & Sons.

Kinnear, K. (2007). Childhood Sexual Abuse: A Reference Handbook. New York, US: ABC-CLIO.

Ludwig, S. (1981). A multidisciplinary approach to child abuse. Nurs Clin North Am, 16(1), 161-5.

Maguire, E. (2009). Police organizational structure and child sexual abuse case attrition. Policing: An International Journal of Police Strategies & Management, 32(1), 157  179.

Martin, S., & Besharov, D.J. (1991). Police and Child Abuse: New Policies for Expanded Responsibilities. Washington, DC: National Institute of Justice.

The National Childrens Advocacy Center. (2006). Multidisciplinary Teams and Collaboration in Child Abuse Intervention. Web.

Washington State Institute for Public Policy. (2009). Outcomes of Referrals to Child Protective Services: Comparing Reporters. Web.