Addictions: Treatment and Prevention

Compulsions and Addictions

Establishing a difference between addiction and compulsion can be a challenging matter, as these notions coincide in several key features. Both of the phenomena can be described as the inability to control behavior that may offer temporary relief from anxiety. However, addictions professionals must be able to distinguish between the two matters. On the one hand, compulsion is a strong desire to behave in a certain way that may be connected to obsessive thoughts (“What’s the Difference”).

On the other hand, addiction is the inability to stop practicing a harmful habit despite its negative consequences, as it is connected to the physical or psychological pleasures (“What’s the Difference”). Therefore, these two notions differ in one crucial characteristic.

It is beneficial to look at two terms in an example to acquire a better understanding of the phenomena. Hoarding is a psychological disorder that may have negative consequences for a person and his or her friends and family. Therefore, it can be treated as an addiction, as it is a failure to discontinue a habit despite its adverse effects. However, the behavior is not associated with physical or psychological pleasure. It is connected to the fear of negative emotions from parting with an object. Hence, hoarding is a compulsion, as it is the consequence of obsessive thoughts and feelings.

Unique Features of Addictions Treatment

Counselors having a personal history of addiction is a unique feature of the field of addictions. While the phenomenon was relatively widespread in the 1970s, such history does not make a specialist more effective in treating the condition. There is no doubt that a person who has had the first-hand experience in the matter may seem more accountable for addicts. Indeed, many theoretical ways of treating gambling have failed due to being very far from reality (Gupta et al. 576).

However, a person who has recovered from distress can think that he or she has found a unique method to treat all cases, which is also untrue. Therefore, while a personal history of addiction can be used as an example of a piece of evidence, it cannot be considered a beneficial factor for treating addiction.

The other unique aspects of the addiction field in comparison with the general field of mental health are cases of counselors acquiring addictive behaviors and patients resisting treatment due to overconfidence. According to Muñoz et al., many prevention and treatment strategies fail because patients do not recognize they have a problem or may acquire a habit (509). Additionally, the same phenomenon of overconfidence in doctors who have access to addictive substances may lead to drug abuse. In short, the failure to acknowledge the danger of addictive behaviors is connected to the distinctive features of the addiction field.

Prevention Programs for Target Populations

Addictions in veterans is a significant problem worldwide that requires public attention. Men and women returning home after experiencing warfare are often diagnosed with post-traumatic stress disorder (Lazar 460) or physical pains (Matteliano 398).

The ailments are treated with addictive substances, such as sedatives, antidepressants, and painkillers (Witkiewitz 513). As veterans have access to controlled drugs, they are in danger of misuse and the resulting emergence of harmful behavior. Additionally, according to Chevalier, returning veterans have spiritual problems, moral issues, and often lack a sense of community, purpose, and meaning (328). All the factors mentioned may lead to substance use disorder in veterans.

One of the most effective prevention programs for the target population is mindful-based treatment. This type of intervention is based on the Buddhist perception of suffering and is different from the traditional cognitive approach. The mindful-based method rests upon contemplation of thought process and avoidance of addictive substances to relieve psychological pains (Witkiewitz 515). Therefore, it is a viable alternative to traditional prevention models.

Works Cited

Chevalier, Lydia et al. “Gaps in Preparedness of Clergy and Healthcare Providers to Address Mental Health Needs of Returning Service Members.” Journal of Religion and Health, vol. 54, no. 1, 2014, pp. 327-338. Springer Nature. Web.

Gupta, Rina et al. “Problem Gambling in Adolescents: An Examination of the Pathways Model.” Journal of Gambling Studies, vol. 29, no. 3, 2012, pp. 575-588. Springer Nature. Web.

Lazar, Susan G. “The Mental Health Needs of Military Service Members and Veterans.” Psychodynamic Psychiatry, vol. 42, no. 3, 2014, pp. 459-478. Guilford Publications. Web.

Matteliano, Deborah et al. “Adherence Monitoring with Chronic Opioid Therapy for Persistent Pain: A Biopsychosocial-Spiritual Approach to Mitigate Risk.” Pain Management Nursing, vol. 15, no. 1, 2014, pp. 391-405. Elsevier BV. Web.

Muñoz, Yaromir et al. “Graphic Gambling Warnings: How They Affect Emotions, Cognitive Responses and Attitude Change.” Journal of Gambling Studies, vol. 29, no. 3, 2012, pp. 507-524. Springer Nature. Web.

“What’s the Difference Between an Addiction and a Compulsion?” Go Ask Alice! Web.

Witkiewitz, Katie et al. “Mindfulness-Based Treatment to Prevent Addictive Behavior Relapse: Theoretical Models and Hypothesized Mechanisms of Change.” Substance Use & Misuse, vol. 49, no. 5, 2014, pp. 513-524. Informa UK Limited. Web.

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Gender Identity and Addiction Treatment

Being a male or female cannot make a distinction in the incidence of addictive conduct and treatment requirements. Studies affirm that males from the age of twelve years are highly probable of reporting present substance abuse as compared to females. For instance, males are nearly two times as probable of using marihuana as females. Presently, females deemed drug addicts or alcoholics are viewed as pervert and promiscuous (van Wormer & Davis, 2012).

Addiction amid women is greatly stigmatized when judged against amid men and that could be a severe hindrance to obtaining assistance. Females who have drug addiction problems could thus be deemed suffering from a double tragedy since they are females and in addiction for that matter. Many females in addiction articulate a great deal of dishonor and regret due to their incapacity to perform tasks as expected of them by the community.

Addiction treatment should recognize the significance, in addition to the task of the socioeconomic concerns and dissimilarities amid women. Addiction treatment should also acknowledge the ascribed tasks and gender anticipations across cultures, which influence the approach of the community towards women with drug addiction problems. The treatment programs ought to employ an incorporated and multidisciplinary approach to females’ treatment while ensuring a gender receptive treatment situation across settings.

Addiction in females could be attributed to every kind of trauma, such as sexual assault (van Wormer & Davis, 2012). Studies affirm that handling addiction in conjunction with trauma in an incorporated manner could enhance outcomes as compared to offering treatment under some outlined conditions. A long duration of distressing abuse, typical of the majority of women in addiction, results in low self-worth and self-hatred that compels the women into conditions of more abuse.

When judged against males, females have a likelihood of having a shorter gap between frequent use, commencement of addiction, and start of treatment. Regardless of a shorter duration of use, when women get in treatment of the problems, the severity is normally the same as men’s. Females suffer a great extent of the physiological destruction earlier in the addiction, for instance, cirrhosis, heart diseases, and hepatitis (van Wormer & Davis, 2012).

The effects linked to addiction could be intensified in females. For instance, women’s liver seems more susceptible to the effect of alcohol consumption; accordingly, more females in addiction die from such effects as compared to males. In addition, females have weaker general physical well-being, mental fitness, and higher death rate from addiction problems as compared to males.

Attributable to the greater impact of addiction in females when compared to males, many studies and caregivers propose the application of women-only programs in treatment (van Wormer & Davis, 2012). Such programs would greatly facilitate females’ chances for realizing and retaining recuperation from addiction.

Other factors of effective addiction treatment encompass tackling some of the hindrances to successful treatment that many females encounter, adjusting the objectives and practices of the programs to contain the necessity for support, less showdown, skills teaching, and the implementation of empowerment models of transformation.

The women-only programs could employ female personnel to ensure that female addicts feel more at ease sharing their problems and worries (Donovan et al., 2012). Other treatment programs encompass the solution-focused approach, which deals closely with the addict. When clients are doubtful of their desired changes, motivational interviewing methods assist in the exploration of the significance of the problems and creation of a decision regarding their inspiration to change.

References

Donovan, D. M., Bigelow, G. E., Brigham, G. S., Carroll, K. M., Cohen, A. J., Gardin, J. G., & Wells, E. A. (2012). Primary outcome indices in illicit drug dependence treatment research: Systematic approach to selection and measurement of drug use end‐points in clinical trials. Addiction, 107(4), 694-708.

van Wormer, K., & Davis, D. (2012). Addiction treatment: A strengths perspective (3rd ed.). Boston, MA: Cengage Learning.

Opioids Addiction in the United States

The growing addiction, abuse, and overdose of opioids in the United States are some of the main concerns among the federal agencies involved in safeguarding public health. Every day, more than 130 people die of opioids abuse across the country, and such a figure mirrors a national crisis that affects public health as well as social and economic welfare (Opioid overdose crisis, 2019). This paper will deepen some aspects of the widespread misuse of opioid pain medications, an epidemic which is burdening the nation with a sizable death rate and huge social expenditures.

The addiction and abuse of opioid pain relievers (OPR) has become a serious problem in the United States. Since the late 1990s, OPR have been spreading across the country with limited control, in the conviction that patients treated with them would not have become addicted (Opioid overdose crisis, 2019). However, diversion and misuse led to an overall over-prescribing, creating a drug overdose scenario so dramatic that the White House was pushed to declare the opioid epidemics as a national emergency on October 26, 2017 (Presidential memorandum for the heads of executive departments and agencies, 2017).

In just fifteen years, the percentage of OPR use in the United States has dramatically rocketed. Consumption of such semi-synthetic opioid medications as hydrocodone and oxycodone has increased exponentially (Kolodny et al., 2015). The phenomenon has reached alarming proportions, affecting the public health status and weighing upon the health expenditure consistently. In 2017, almost 50,000 people died of opioids overdose, while about 1.7 million Americans suffered from OPR use disorders and more than 650.000 from heroin use disorder (Opioid overdose crisis, 2019). Inevitably, such figures affect the global economy of the country, involving not only the cost of health care, but also addiction treatments, lost productivity, and criminal justice procedures.

The White House initiative represents a critical stance toward the reduction of OPR abuse and OPR-related deaths, giving strength to a series of policies developed over the last decade to re-frame the opioid addiction. Thorough research has made it clear that OPR abuse is not just a juvenile problem but an epidemic of addiction that involves society at every level and age (Kolodny et al., 2015). However, despite all the efforts, opioids abuse is still on the rise.

To respond to the opioid crisis effectively, the U.S. Department of Health and Human Services, other federal agencies involved, and healthcare providers need to focus on clearly defined objectives. Firstly, a massive information campaign should make people aware of the risks of OPR abuse, highlighting that their consumption is as dangerous and addictive as the consumption of heroin. Secondly, healthcare policymakers should support research on pain and addiction, as well as promote the use of remedies such as buprenorphine and methadone to treat opioid addiction (Kolodny et al., 2015). Finally, the epidemics should be controlled through improved public health surveillance.

At the turn of the millennium, an overly simplistic approach to opioid pain medications has led to a dramatic epidemic of OPR addiction, resulting in large death rates related to abuse and overdose of opioids. Scientific and social research has uncovered the importance of the problem, emphasizing how it burdens the U.S. expenditures from many perspectives.

Over the last decade, the scientific community and politicians have called for strong actions to inform, prevent, and limit the incidence of opioid abuse, yet without attaining satisfactory outcomes. Indeed, the recent stance of the White House gives weight and authority to strike against opioids abuse, paving the way to further research and policies.

References

Kolodny, A., Courtwright, D. T., Hwang, C. S., Kreiner,P., Eadie,J. L., Clark, T. W., & Alexander, G. C. (2015). The prescription opioid and heroin crisis: A public health approach to an epidemic of addiction. Annual Review of Public Health, 36, 559-574. Web.

Opioid overdose crisis (2019). Web.

Presidential memorandum for the heads of executive departments and agencies (2017). Web.

Heroin Addiction Educational and Preventive Program

Introduction

Heroin addiction is a problem that bothers millions of people around the whole world. Multiple attempts are taken to prevent this type of dependency and protect the population against heroin in its various forms. Today, it is a well-known fact that heroin cause human death. Still, not all people are aware of such detail as that about 115 American people die every day (National Institute on Drug Abuse, 2018). The development and promotion of service delivery programs are serious steps to protect people against heroin addiction. People should be educated on how to dangerous heroin can be in their lives and for the lives of their family members and friends. In this paper, special attention to an educational program to prevent heroin addiction will be paid through explaining its goals, basic tenets, ethnic, social, and cultural considerations, and ethical concerns.

Description, Goal, and Mission of a Preventive Program

The creation of a preventative program is a serious step that should meet certain requirements and standards. It may be a community-based program with a number of laypersons being involved in it (Wheeler, Jones, Gilbert, & Davidson, 2015). In addition, preventive programs are expected to include the description of risk factors and other conditions under which people are exposed to this addiction (Albert et al., 2015). The chosen educational program meets both these requirements as its goals are to identify the risk factors of heroin addiction, recognize the steps to overcome this health problem and develop an action plan that can be appropriate for communities.

The mission of the chosen program is to educate people about the threats of heroin. Nowadays, it is officially reported that more than 15 million people use illicit opioids that contribute to heroin addiction (Schottenfeld & O’Malley, 2016). Still, the unofficial number of addicted people remains unknown. It is wrong to expect that all people can be educated in terms of one program. Therefore, it is necessary to focus on one particular community to achieve positive results and promote change. The participants of this program have to get access to the information about heroin addiction globally and recognize the suggestions that can be made locally. The main peculiarity of this educational program is to determine the number of participants who are the people with unsuccessful attempts to quit drug use or mentally challenged people of a different age because of drug abuse. First, the participants work with a variety of sources about heroin available to them, and then, they discuss their personal experiences and outcomes to share their knowledge.

Basic Tenets of the Etiology Model

The etiology of heroin abuse may be explained in a variety of ways. The reasons for why a person decides to try heroin depends on different factors, including physiological problems, psychological changes, or social concerns. Jadidi and Nakhaee (2014) offer three main categories to describe the etiology of drug abuse: biological, social, and psychological. This model is a good solution for a service delivery program as it helps to identify different perspectives and guide the participants.

Education about heroin has to be developed through the prism of the chosen three tenets of the model. First, the participants have to define the biological causes of their addiction and share if their problems are genetic or not. Some people are just not able to resist the impulses and make a decision to try heroin because of poorly developed brain function (Horvath, Mista, Epner, & Cooper, 2016). Second, social tenets such as poverty and unemployment or vice versa, richness, and a variety of options can challenge people and make them consider heroin as a solution to their problems. Finally, this educational program focuses on the psychological tenet, proving that personal concerns, the lack of social support, or family problems can be a reason for taking drugs and future drug abuse. This program has the type of model with the help of which people can define and share their emotions.

Ethnic, Cultural, and Social Considerations

Special attention to ethnic, cultural, and social considerations must be paid in terms of this educational program. Though some people think that race or ethnicity defines their decision to take drugs, such thought has to be removed from this program. The peculiar feature of this educational program is that any person despite their ethnic or cultural background can ask for help and get the required explanations, support, and understanding. For example, several years ago, people used to think that the Black male population is the main contributor and user of drugs, including heroin. Today, the investigations show that “women, non-Hispanic white individuals, and people with higher incomes and private insurance” suffer from drug addiction (Schottenfeld & O’Malley, 2016, p. 437). Therefore, the re-consideration of ethnic, cultural, and social issues is required to understand better the nature of heroin addiction.

This program invites all people who are ready to cooperate and admit that they have a problem. The diversity of people who suffer from heroin addiction is impressive today, and it is wrong for program developers to create strict ethnic or cultural boundaries. The chosen educational program aims at overcoming social concerns, but focusing on the solution of problems and readiness to share them with the community.

Ethical Considerations and Concerns

Ethical considerations and concerns should not cause new problems and doubts among the potential members of the program. The implementation of the educational program under analysis is the step the shows how equality and respect determine the relationships between different people. This service delivery program offers education to people. Therefore, ethical considerations may touch upon the presence of fair and similar resources to all participants, the possibility to solve doubts within a group, and the use of appropriate behavioral models in terms of which prejudice and pride can be eliminated. In addition, commitment to the participants and confidentiality cannot be neglected. If the participants do not want to involve their parents, they are welcome to address their friends for help or, vice versa, never inform friends or colleagues about possible problems, but make drug abuse as a family-centered concern (Jadidi & Nakhaee, 2014). Collaboration and trust between the participants of the program are the key factors in exchanging and improving their knowledge.

Conclusion

To conclude, the chosen prevention program with the goal to identify the risk factors or heroin addiction and to create a plan for the community to prevent abuse complications can help many people in their intentions to stop using heroin. Sometimes, people may be ready to recognize heroin addiction as their problem, but cannot succeed because of weak social or family support. Therefore, the community-based educational program free from ethnic, cultural, and social considerations is the solution that can be offered. Heroin addiction is a serious problem that requires a strong plan of action. This educational program meets the requirements and guides people.

References

Albert, D., Belsky, D. W., Crowley, D. M., Bates, J. E., Pettit, G. S., Lansford, J. E., … Dodge, K. A. (2015). Developmental medication of genetic variation in response to the fast track prevention program. Development and Psychopathology, 27(1), 81-95.

Horvath, A. T., Mista, K., Epner, A. K., & Cooper, G. M. (2016). Biological causes of addiction. Web.

Jadidi, N., & Nakhaee, N. (2014). Etiology of drug abuse: A narrative analysis. Journal of Addiction, 2014. Web.

National Institute on Drug Abuse. (2018). . Web.

Schottenfeld, R. S., & O’Malley, S. S. (2016). Meeting the growing need for heroin addiction treatment. JAMA Psychiatry, 73(5), 437-438.

Wheeler, E., Jones, T. S., Gilbert, M. K., & Davidson, P. J. (2015). Opioid overdose prevention programs providing naloxone to laypersons – United States, 2014. Morbidity and Mortality Weekly Report, 64(25), 631-635.

Stop Heroin Addiction: Service Delivery Program

Goal and Mission of an Educational Program

Heroin addiction was identified as a dangerous condition that could lead to a variety of serious health implications. In addition, the negative influence of the substance presents societal challenges, especially for communities where heroin is being sold illegally. Thus, the goal of an educational program associated with heroin abuse is identifying risk factors for addiction, developing steps for overcoming it, and creating an action plan to educate communities on how to prevent it from occurring in the future. The overall mission of the program is to make sure that participants overcome the problem of heroin abuse through having information and tools necessary for dealing with the issue.

It is important to mention that an educational program is especially relevant in specific cultural contexts because heroin addiction is prevalent in separate cultural groups. This means that methods of dealing with addiction also vary across these groups. While some use counseling, others gravitate toward medicine-oriented treatment. Overall, the educational program targeted at overcoming the issue of heroin abuse is providing communities with all-encompassing information on the most appropriate ways of dealing with the problem. The cultural variable should be at the center of the program due to the variability of approaches toward the issue.

With regard to the program’s general description, it is expected that it will be divided into four main stages. The first stage includes the preparation for the program, taking into account the cultural, ethnic, racial, and ethical considerations of a target group. The second stage is associated with the selection and enrollment of participants suitable for passing the program. Inclusion criteria will involve the history of substance abuse, unsuccessful efforts to quit the use of drugs and mental and physical challenges associated with abuse. Participants of any age, gender, ethnicity, and social status will be enrolled. The third stage implies lessons that participants will attend to get relevant information on overcoming heroin abuse. At the final stage, educators will conduct a survey to determine participants’ satisfaction with the program and identify what they have learned during the course.

Support for the Use of the Model in the Educational Program

With the permeation of evidence-based practice within the context of developing health care policies and systems, models that deal with the analysis of specific problems are expected to align with the initiative (Glasner-Edwards & Rawson, 2010). Within the educational program, the etiology model was chosen for analyzing the nature of addiction to heroin within the sociological perspective. Key tenets of the etiology model are associated with the identification of specific attributes that a group or community has in order to determine what expectations and norms are linked to overcoming healthcare (or any other) challenges. In addition, personal characteristics of an individual are also included in the etiology model because they can help researchers identify how different perspectives of separate people can contribute to shaping the approach of the group toward overcoming substance abuse.

The model was identified as useful for researching richer accounts of substance abuse risk factors as compared with the infrequent use of drugs (Jadidi & Nakhaee, 2014). Learning about people’s stories about their experiences with heroin addiction can give scholars extensive cultural information, as well as help, prioritize preventative measures for increasing findings’ practicality. Researchers have underlined the fact that opinions of different cultural groups on addiction and methods of dealing with it can support the views of experts. This is so because laymen’s conceptualization of risks associated with the use of the addictive substance is richer because some of them have experienced the problem first-hand.

The etiology model will allow educators to recognize how well a specific suggestion or intervention will be received by the program’s participants. Since adherence to a proposed program is the key to overcoming substance addiction, the etiology model should be used for connecting culture-specific treatment in areas such as community, social context, and connection to individuals (Rowan et al., 2014). When dealing with representatives of minorities, the etiology model will help researchers identify the extent of incorporating specific educational and interventional plans. For instance, for the Aboriginal population, it may be an effective strategy to combine a holistic model, which is familiar to them, with contemporary medical interventions for treating addiction. Aboriginal and other minority populations will need educators to pay more attention to connecting mental, physical, emotional, and spiritual aspects of well-being to facilitate participants’ awareness of their addiction and lead them toward recovery (Rowan et al., 2014). Overall, the etiology model makes it possible for educators to develop a cohesive strategy for addressing the issue of substance addiction through analyzing specific characteristics of the group that participates in the educational program.

Ethnic, Cultural, and Social Considerations

Specifics and differences of program participants can be attributed to various ethnic, cultural, and cultural considerations. Participants can exhibit differences in their knowledge, traditions, beliefs, religion, as well as attitudes toward different life phenomena. Because of this, program facilitators and implementers should communicate with community leaders to gain relevant information on how a specific population should be approached in the delivery of useful information. Some questions for exploration may include “What is the community’s history? What norms and traditions exist? What are the community trends and demographics? What are the community’s specific interests, needs, and assets?” (Centers for Disease Control and Prevention, 2014, p. 7). An understanding of racial, ethnic, and cultural characteristics of program participants is also necessary for “appreciating the diversity of human dynamics and to educate clients effectively” (SAMHSA, 2014, p. 4). Several considerations regarding this point should be taken.

First, it is important to examine the ethnic heritage of the educational group and whether drug use belonged to the heritage. Second, at the planning stage of the educational program, facilitators should identify whether the cultural experiences of a specific group can influence the attitude toward the educational program, especially when presented information goes against established cultural norms. Some cultural groups can have a negative attitude toward the use of medication and prefer holistic methods of recovery. The example of Native Americans is applicable to this case (“Native American communities and mental health,” 2016). Third, racial considerations, such as the prevalence of substance abuse within a specific group with certain racial characteristics, should be evaluated. For instance, as mentioned in the findings of the Henry J Kaiser Family Foundation, KFF (2016) report, non-Hispanic whites have the highest rate of opioid overdose deaths, which means that extra attention should be paid to the characteristics of this particular group. The exploration of risk factors that increase the likelihood of opioid overdose in a given population is another step taken at the preparation stage for an educational program.

Ethical Concerns

Since the etiology model implies considerations associated with racial, ethnic, and cultural characteristics of a population, taking into account some ethical issues that may arise is instrumental. As mentioned by DeCamp et al. (2018), implementers of educational programs can face a variety of ethical challenges in regard to their commitment to both individual participants and broader groups. Because of this, there should be a significant shift “from clinical to public health ethics” concerning the welfare of group participants (DeCamp et al., 2018, p. 372).

In the realm of public health ethics, the facilitators of an educational program should take into account several units of concern. First, group welfare, safety, and protection from harm should be established as primary ethical principles. Secondary ethical principles should include equity and protection of participants’ liberty rights (DeCamp et al., 2018). When it comes to paradigmatic ethical issues that can arise during the educational program, the following three points should be mentioned:

  • Issues with determining fair resource allocation at times of struggles for resources;
  • Tensions that exist between individual decisions and recommendations given during the educational program;
  • Influencing individual choices through the use of behavioral coaching.

When developing an educational program to address the challenges associated with heroin addiction, facilitators should have respect for participants’ humanity as well as the right for them to make informed decisions based on personal opinions. This means that the goal of the program should require educators to enforce their judgment in helping participants make the right decisions concerning overcoming heroin abuse through different methods. Informed decision-making supported through the collaboration between participants and their educators is the final goal of ensuring the just and ethical approach toward program implementation.

References

Centers for Disease Control and Prevention. (2014). Web.

DeCamp, M., Pomerantz, D., Cotts, K., Dzeng, E., Farber, N., Lehmann, L., … Tilburt, J. (2018). Ethical issues in the design and implementation of population health programs. Journal of General Internal Medicine, 33(3), 370-375.

Glasner-Edwards, S., & Rawson, R. (2010). Evidence-based practices in addiction treatment: Review and recommendations for public policy. Health Policy (Amsterdam, Netherlands), 97(2-3), 93-104.

Jadidi, N., & Nakhaee, N. (2014). Etiology of drug abuse: A narrative analysis. Journal of Addiction, 2014, 352-359.

KFF. (2016). Web.

(2016). Web.

Rowan, M., Poole, N., Shea, B., Gone, J. P., Mykota, D., Farag, M., … Dell, C. (2014). Cultural interventions to treat addictions in Indigenous populations: Findings from a scoping study. Substance Abuse Treatment, Prevention, and Policy, 9, 34-39.

SAMHSA. (2014). A treatment improvement protocol. Improving cultural competence. Rockville, MD: U.S. Department of Health and Human Services.

Drug Addiction: A General View of New Concepts

Introduction

In the modern world of today, the word ‘drugs’ is synonymous with clandestine abuse of substances. Such abuse entails constant and excessive usage of drugs to create feelings of happiness and blot out reality despite its well-known harmful effects. The substances misused are mostly unlawful substances , or in several cases even legal substances . Drug abuse turns into drug addiction when the drug ceases to exist as a choice and turns into an essential need (Cutter, Jaffe-Gill, Segal & Segal). Drug addiction is defined as the recurring inability to avoid drug use despite prior decisions to do so (Qureshi, Al-Ghamdy & Al-Habeeb). It has developed into a major problem that is currently plaguing almost every nation in the world irrespective of whether they are developed, under-developed or undeveloped or whether their people are prosperous or poor.

Main body

Several causes have been identified that lead to drug abuse. The first cause is to seek relief from mental illnesses. The National Alliance on Mental Illness reported that nearly 50% of drug addicts are burdened with mental illnesses like depression, schizophrenia or bipolar disorder (Cutter et al.). The second cause is to look for thrills. Users are curious to try out a drug and judge for themselves if the reportedly ‘high’ feeling is indeed experienced (Cutter et al.). A study conducted in 1987 revealed that thrill-seeking behavior could be hereditary (Qureshi et al.). The third cause is peer emulation. Users who are weak-minded or peer adulating, tend to imitate others and use the drug not because they really want to, but in order to appear ‘cool’ and ‘one of the group.’ This is a powerful cause in case of school and college students. In addition, young men easily become victims to peer emulation because it is the male tendency to value autonomy (Goldenberg & Goldenberg, 56). The last cause is to escape from emotional suffering brought about natural calamities , as well as personal difficulties in life such as bad grades, failed relationships, stress, isolation and disesteem. Although the drug user knows that the drug cannot and will not deal with the personal difficulty effectively, still the temporary relief obtained from its usage can be so alluring that the harmful effects of the drug seem insignificant (Cutter et al.). Such relief occurs when the psychoactive drug acts directly on those parts of the brain that exercise control over emotions and actions, generating positive feelings in the addict (Qureshi et al.).

Drug addiction has several harmful effects on the addicts, their friends and family. The first is danger to physical health. Drug addiction involves long-term molecular and cellular modification. Drug addicts are in real danger of damaging physical organs like the heart, liver and lungs. Drug addiction is fast emerging internationally as a formidable conduit for the expansion of deadly infectious diseases like AIDS, hepatitis and tuberculosis (Qureshi et al.). The second effect is a serious dent in the finances of the drug addicts and their family members. It is natural and necessary for the family to generate savings to develop a reasonable standard of living. The money family members earn is regarded as ‘family income’ (Goldenberg & Goldenberg, 15). The drug addict splurges their hard earned savings on his or her drug addiction, thereby contributing to financial instability in the family. There are also high possibilities of addicts’ jobs or school enrolment being put into grave jeopardy, which is another worrying finance-related factor. The third effect is alienation of family members. A family relationship is characterized by love and loyalty (Goldenberg & Goldenberg, 4). Instead of giving love and affection to other family members, the drug addict’s erratic behavior tends to break the close bond that exists in the family. Drug addicts are unable to relax or have fun without imbibing drugs. They alternate between mood swings, angry tirades, incoherent speech, irritation, hysterical behavior and general change of attitude. This is accompanied by widespread neglect of responsibilities towards the family (Cutter et al.). The fourth effect is endangering of reputation in the eyes of society. A family is an institution that is imbedded in society (Goldenberg & Goldenberg, 23). Drug addicts frequently resort to money borrowing, selling of household articles and stealing money from others. These crimes, in addition to the crime of possessing and using drugs, could well result in arrest and incarceration, thereby bringing disgrace to the addicts and their spouses.

Conclusion

In conclusion, there is no doubt that drug addiction has nothing but bad effects on the addicts and those near and dear to them. The only way to alleviate the problem is for the addict to obtain treatment as quickly as possible. Psychological intervention has now become more accessible to people in the U.S as compared to the pre-War days (Goldenberg & Goldenberg, 101). Addicts should realize that it is not only them that need help but their family members too are hurting and need help (Goldenberg & Goldenberg, 20). It would greatly help if the addicts’ family members take an active interest, encourage and participate in the treatment process as such a response will not only act as a self-confidence booster for the addicts, but will also make them realize the reliability and value of their loved ones. It would greatly help if the spouses can rope in the support of a network of friends, extended family, clergy, neighbors and employers to contribute to the recovery of the addicts (Goldenberg & Goldenberg, 11).

References

Cutter D., Jaffe-Gill E., Segal R. & Segal J. “Drug Abuse and Addiction: Understanding the Signs, Symptoms and Effects.” 2008. Web.

Goldenberg H. & Goldenberg I. “Family Therapy: An Overview.” USA: Brooks Cole. 2007.

Qureshi N.A., Al-Ghamdy Y.S. & Al-Habeeb T.A. (2000). “Drug Addiction: A General View of New Concepts & Future Challenges.” Eastern Mediterranean Health Journal. 2008. Web.

Drug and Alcohol Abuse: Insights from a Campus Lecture

Unfortunately, drugs and alcohol have become a part of human life many centuries ago. Nowadays, people still use drugs and alcohol. However, now many people understand the danger of drug and alcohol abuse. Some think that there are only a few addicts who are treated in special places. However, there are lots of those who use alcohol or drugs in all communities. Therefore, it is possible to find people who have real problems with drugs or alcohol, even in such groups as athletes and student leaders.

For instance, Paul Chabot, MPA, Ed.D. came to Iona College to talk about drugs and alcohol with student leaders and athletes. It turned out that many students did not understand the danger. Paul Chabot delivered a really great lecture. He shared his own experience, he gave some statistic data, and he told about the experiences of other people. The main message of his lecture is that young people should not only avoid using drugs or alcohol, but they should carry out a mission, which is as follows: “Live the absolute best life that you can, challenge every wrong that you see before you…” (IonaCollegeVideos, 2011).

It is important to add that the lecture was really informative. Paul Chabot revealed precise data, which are quite frightening. People never think of the problem if they do not see the exact number of people who suffer or even die. Besides, the lecturer showed a really illustrative video. The 22-year-old girl who had health problems because of drugs was examined. It turned out that her brain was in a very poor state. Paul Chabot’s association concerning the chase for the Rabbit was really great. Admittedly, the lecture broadened the horizons of many students who were there.

Apart from the really interesting and informative lecture, it was a great chance to observe young people’s reactions. It could seem that the audience (athletes and student leaders) would agree with the lecturer. However, it turned out that some students did not share the opinion of the lecturer. For instance, when Paul Chabot was talking about marihuana, students reacted in a bit strange way. Some students did not see the danger. Many students started discussing the use of marihuana. It seemed that some students thought marihuana was a kind of medication. It was obvious that some young people did not think that they could become addicts. Such kind of reaction was quite unexpected. Of course, it is necessary to have a closer look at people’s reaction, and it will become clear who is an addict, who can become an addict, who understands the danger, and who can carry out the mission.

Therefore, it is quite useful to attend such events. It is interesting to observe young people (who are not supposed to use any substances) listening to a lecture about drug and alcohol abuse. It is possible to see individuals who have (or have had) health problems because of drugs and those who still do not understand the danger. Interestingly, the lecturer mentioned group thinking. Such lectures can be a good illustration of the group thinking. I would recommend attending such kind of event as it can be very helpful. It is possible to observe people’s reaction on different types of information (statistics, personal experiences). It is also possible to see reaction of those who can become addicts and those who will not use drugs or alcohol. Thus, it is possible to state that attending this kind of lecture can be a very useful experience.

Reference List

IonaCollegeVideos. (2011). A Little Reality Check on “Drugs” – Paul Chabot. YouTube.

Connecticut Community for Addiction Recovery

Introduction

Connecticut Community for Addiction Recovery (CCAR) is mainly concerned with alcohol and drug-related problems especially the rehabilitation of individuals who have been addicted. The community has a self-drive to give back to society by reaching out to those who have been overwhelmed by drug and substance abuse. In general, CCAR operates under two broad and clearly defined objectives. To begin with, the organization is determined to improve how recovery programs for drug-addicted individuals are usually carried out. In other words, the organization came to the realization that most rehabilitation and recovery programs for drug-related cases are not viable enough to change the whole menace brought about by the abuse of alcohol and other drugs. In order to achieve this, CCAR is currently employing advocacy programs by voicing out issues that are of great importance in the recovery process. For instance, the community is keen on gathering the latest and up to date information on the causes as well as solutions for the problem. Secondly, the organization operates on the philosophy of self-determination by using its advocates on the ground as living proofs that recovery of drug-related victims is indeed a possibility. Therefore, those who have been rehabilitated are being incorporated in the entire program as instruments of change.

Main Body

Another elaborate strategy being employed by CCAR is the indiscriminate provision of support services for victims after the recovery process. This has been found to be a necessary ingredient in the rehabilitation process since it largely sustains and maintains the recovery process. It is also imperative to mention that much of the activities of the community organization receive external funding from the State of Connecticut. Other sources of funding include private donations as well as foundations. Additionally, the community organization has also been able to achieve its set goals by adhering to its foundational principles. For example, those who have been under the recovery process are psychologically motivated in the sense that they can indeed fully recover if they believe that they are in the recovery process.

Moreover, they are also supposed to acknowledge the fact that pathways towards recovery are numerous and so while one method can work for a certain group of individuals; it may not be the same case with other victims. From the video lecture on YouTube, I have learned that alcohol and substance abuse is a growing problem in our society today and its impacts should neither be ignored nor underestimated. As a matter of fact, it is evident that alcohol and drug-related problems are no longer a preserve of the youth as it used to be in the last few decades bearing in mind that those who have been abusers at their youthful stages have moved on with the menace to old age. Furthermore, I have learned that funding for Non-governmental organizations that are out there to reach affected communities is still a nightmare since most of these organizations are not well endowed with the self-revolving fund to enable them to carry out their rehabilitation activities with much ease. It is worth to mention that limited funding has proved to be a real obstacle towards the full recovery cycle of victims.

Conclusion

Finally, it is imperative to reiterate that this internet video lecture has wealth of much-needed information on how recovery and rehabilitation of alcohol and drug-related individuals can be reached out albeit of the existing challenges. Therefore, I would definitely recommend this field trip to others.

Caffeine Addiction as a Mental Disorder

Life Pleasant and Hazardous

How many people enjoy life? Most, one may say. And what are the pleasures people enjoy? Reading a good love story or being enthusiastic with the new best-seller, thriller by King, or probably you like very good movies. The list is to be completed with every own taste. And isn’t enjoying life through the meals or drink pleasant? One can say it is and will definitely be right. But is that kind of pleasure pleasant? Or maybe hazardous?

The problem called substance addiction is widely spoken about and is learned very much from all the facets of modern society. Any drug that is cocaine, heroin, opium, alcohol, tobacco abuse, or some other drug abuse is not pleasant anymore when conditioned to addiction, and its withdrawal is painful.

Caffeine addiction

“A single cup of coffee a day is enough to get you hooked on caffeine, it is revealed today” (p. 26, Mark Prigg). The problem of caffeine abuse is so regular in society that caffeine addiction is called common today.

The questions to ask students, for instance, concerning the quantity of coffee drank per day, the sum of money spent on it for some period of time, and the main is there any predisposed need of abusing caffeine. Aspects concerning professional interests can be of pros and cons of including the caffeine withdrawal syndrome in the DSM. Rebecca Brinker employed for Starbucks says on average, there are around 400 to 500 people who buy a coffee a day, not including the faculty. Sometimes, there are repeat customers who will buy coffee three or four times a day, and their best seller is Frappuccino and Caramel Macchiato. And from the coffee makers and distributors part, the questions of the profit and quality of the coffee sold are concerned. Professor Roland Griffiths, involved in researching the problem of caffeine abuse from, says that caffeine is the best known in the world and commonly used stimulant and its cheapness and easy availability stand for the easy and simple way of getting and maintaining. And continuing the research conclusion, Griffiths states that caffeine addiction, when reducing the daily dose, causes the suffering a number of withdrawal symptoms such as tiredness, headache, difficulty concentrating, and so forth. That is today’s reality.

An average citizen Steve Pavlina recalls when after connecting his life with programming PC games, he began drinking coffee, often sometimes every day of the month, sometimes breaking the habit, but it was cyclical anyway. But then there was the book “Pour Your Heart Into It” by Schultz. As Steve says, the author made a gourmet coffee sound in a manner that Steve embarked on a Starbucks kick at once. And after that tried all gourmet coffees, espressos, soy lattes known to make his mind about Starbucks coffee. And Steve can not find better coffee than those made by Starbucks.

Many physicians, amid which professor Griffiths, anticipate caffeine addiction should be included in the next edition of the Diagnostic and Statistical Manual of Mental Disorders, which is compiled by the American Psychiatric Association and regarded to be the veritable bible of mental disorders among medical professionals.

Despite Steve Pavlina’s awareness and a big interest in Starbucks coffees, there is a professional view on the problem expressed by the psychologist, whose surname she wanted not to mention, named Nancy, which says there are many things that might be of addictive nature for a human mind or body and psychologists debates on whether this or that substance addictive are groundless for the main goal of the psychologists is to aid people to live better lives. And it is a rather pragmatic question stipulated by the professionals need to debate about, but not by the addiction nature itself.

But like any problem, this one concerning caffeine abuse is multifaceted. And professional view stipulated by, probably, some specific aspects and the average coffee user or abuser view is the matter of long and active discussions, but if something is problematic for someone, then someone shows think over it in order not to get sick or addicted.

Bibliography

Drop That Cup: ‘Caffeine Addiction’ Joins the List. (2004). The Washington Times, pp. A09, A11.

GARETH SMITH: Why Is My Heart Beating So Fast? (2004). Sunday Mail, p.49.

Just One Cup of Coffee a Day Makes You a Caffeine Junkie; MENTAL HEALTH FEARS AFTER STUDY. (2004). The Evening Standard, p.26.

Pavlina, S. (2005). . 2008. Web.

Addiction: Methods and Approaches

Introduction

For me, I agree with the viewpoint that there is a fundamental difference in the way in which the methadone maintenance approach and the therapeutic community approach view the nature of addiction, as such this paper will attempt to express my views as to why they are different and justify why such views are accurate. First and foremost it must be noted that the main difference between the methadone maintenance approach and the therapeutic community approach is that the former believes in illegal substance abstinence through the use of substitute methadone prescriptions while the latter utilizes an approach that proscribes complete abstinence from any and all drugs, this drug-free ideology utilized by the therapeutic community approach is the main point of contention between it and methadone maintenance and as such which will be further explored in this paper in order to understand why this is so.

What is Methadone?

Before proceeding with the rest of the paper, it is deemed necessary to elaborate on the effects of methadone so as to enable a greater understanding of how and why it works in substance abuse rehabilitative treatment. Methadone is basically a synthetic opiate in that while it is chemically dissimilar to substances such as heroin, it does act on the same neural receptors for these drugs and, as such, have similar effects. On the other hand, methadone has a far longer durational effect period lasting 24 to 48 hours as well as having the capacity to “block” the pleasurable (euphoric – defined as getting “high”) effects of similar types of opiates.

This enables a greater degree of stability during the process of drug withdrawal and actually prevents patients from using various illegal substances since the effect no longer works. In essence, the methadone maintenance approach helps to relieve the “craving” patients feel when off drugs and due to the nature of its consumption which is oral this creates a far safer method of relieving drug addiction since it prevents the spread of HIV, hepatitis and other forms of diseases transmissible through sharing needles as heroin and drug addicts are often seen doing.

Two Categories of Intervention

Basically, the two approaches to be discussed in this paper can be divided into two categories of drug addiction intervention, namely pharmacotherapy and psychosocial treatment. Pharmacotherapy, as its name implies, administers drugs to patients as a means of treating a disease or substance abuse addiction. In essence, this particular category of treatment firmly believes in the use of drugs as the most effective, immediate and most of all convenient form of therapy due to results often manifesting themselves after only a few treatment sessions (Degenhardt et al., 2009: 9 – 14). Psychosocial treatment, on the other hand, believes in the ability of a group or community-led interventions, without the use of drugs, as an effective means of enabling an individual to overcome substance abuse addiction (Worley et al., 2008: 209).

This method of approach often uses group sharing exercises, experience sharing, group/ buddy support systems, normalization of daily behavior through the creation of routines as well as other forms of group/community-based intervention that utilizes multiple support systems in the form of other individuals within the same program as a means of constraining behaviors and predilection related to addiction (Worley et al., 2008: 209).

What is Addiction?

Before proceeding with the sections presenting arguments detailing the different perspectives regarding the nature of addiction to the methadone maintenance approach and the therapeutic community approach, it is necessary to give a brief elaboration on the concept of addiction and how it functions.

The concept of addiction is defined by studies such as Pescor (1952) as consisting of a physical or psychological dependence on a particular type of psychoactive substance ranging from illegal narcotics to alcohol, and cigarettes or it can be classified as a form of psychological dependency on a particular action such as masturbation, shopping, gambling, etc. (Pescor, 1952, 471 – 475). In essence, addiction can be viewed as an adverse action that has distinctly negative consequences on a person’s life. Furthermore, it is noted that over a certain degree of time an addiction continues to increasingly manifest itself as not just an additional activity but rather an action that a person “needs to do” in order to feel normal (Round table, 2007: 6 – 8).

Raymond (1975) explains that addictions can actually be separated into two distinct types consisting of either a physical or psychological dependency, while there are certain overlapping instances it is noted that certain types of addiction such as shopping or gambling are considered to be categorized under psychological forms of dependency while smoking and drinking are at times considered physical forms of dependency (Raymond, 1975: 11). Overlapping occurs when psychologists consider the psychological element of dependency, meaning why a person has a particular form of addiction (such as why does a person smoke) beyond merely looking at the body’s dependency on that particular type of substance/action (Kolesova, 2003: 39).

Methadone Maintenance

Based on the article Conversation with David Deitch (1999), which interviewed David Deitch, an expert in the field of substance abuse treatment who examined the individual effectiveness of either methadone maintenance or the therapeutic community approach, explained that both methods have a different concept of what they think of as “the nature of addiction” in that the methadone maintenance approach categorizes addiction as a physical compulsion brought about by the long term introduction of narcotics into the body (Conversation with David Deitch, 1999: 791 – 795).

This, over time, creates a chemical imbalance wherein the body’s chemical system has grown used to the presence of particular narcotic substances resulting in the “craving” sensation often felt by addicts which is not only caused by addiction to the pleasurable sensations created by these drugs but is also caused by the body attempting to normalize itself by triggering the need to have a chemical it is used to having reintroduced into its system.

This particular form of “craving” is similar to individuals who smoke wherein the body gets used to the daily consumption of nicotine resulting in the chemical being considered a normal aspect of the body’s daily biological functions. In fact, the use of methadone maintenance is actually quite similar to the use of nicotine patches and gum wherein the body receives a supplementary source of the chemicals it graves until it is “taught” to no longer feel the need to have such a chemical in its system. This is done by gradually lowering the needed dosage over a period of time until the craving disappears.

Therapeutic Community Approach

Going back to the interview of Davind Deitch (1999), the concept of addiction for the therapeutic community approach is based on the idea that an individual’s addiction to drugs is a direct result of psychological maladjustment and as such can be changed through the use of rehabilitation whereby individuals suffering from substance abuse addiction can be taught to relearn or reestablish functioning skills, physical and emotional health as well as being able to reestablish for themselves a functional lifestyle (Conversation with David Deitch, 1999: 791 – 795). Studies such as Day and Doyle (2010) that have examined the therapeutic community approach have stated that the psychological compulsion to take drugs is based on a “cycle of destruction” wherein the more drugs a person takes, the more likely they are of distancing themselves from social and emotional support resulting in a dysfunctional lifestyle which further necessitates the need to take drugs (Day & Doyle, 2010: 380 -384).

As such, in order to facilitate what is described as a “rehabilitative lifestyle,” all drugs (even methadone) are banned from the program, and patients are kept within a group/community-style housing unit where they are slowly accustomed to being able to live normally. Other forms of psychological compulsions, such as those described by Smiley –McDonald, and Leukefeld (2005), can range from depression, desperation, hopelessness, anti-social tendencies, living environment, etc. (Smiley-McDonald & Leukefeld, 2005: 574 – 583). Geraghty (2011) described these factors as facilitators of drug use and, as such, need to be tackled during the rehabilitation process in order for them to actually be able to resist the temptation to take drugs after the program is completed (Geraghty, 2011: 878 – 884).

Supporting Arguments

Based on the facts presented so far in this paper, it can be seen that the methadone maintenance approach ascribes to the physical nature of addiction and attempts to resolve this by utilizing pharmacotherapy. The therapeutic community approach, on the other hand, ascribes to the psychological nature of addiction and utilizes the psychosocial method of intervention as a means of treating patients. What must be understood is that from the viewpoint of the therapeutic community approach addiction can be controlled by “normalizing” patients by exposing them to routines, a support group and a means of dealing with the source of the addiction however in order to do so it prescribes a method where the patients are placed in a communal home where they are able to establish the initial normalizing practices that would lead towards behavioral readjustment.

For the therapeutic community approach, addiction is a result of psychological maladjustment, whether in the form of anti-social tendencies, the lack of effective social bonds, and an otherwise abnormal method of emotional and behavioral development. As such, it presents the notion that a patient will regress back into addiction so long as these particular facets of their personality are not addressed

Application of Social Control Theory

It must also be noted that the therapeutic community approach has similar elements to the social control theory developed by Travis Hirschi which especially states that all individuals actually have the potential to engage in socially unacceptable behavior however it is the “bond” they share with society whether in the form of friendships, recognition of societal rules and norms of conduct, parental influences, etc. that prevent them from actually committing such actions (Higgins et al., 2009: 949 – 951).

In the case of the therapeutic community approach researchers such as Higgins et al. (2009) believe that the reason why people take drugs is because they lack the necessary social bonds and routines that prevent them from engaging in such actions and it is only by establishing these “bonds” with individuals and society that makes a person less likely to take drugs and as a result enables them to live normal lives (Higgins et al., 2009: 949 – 951).

While the methadone maintenance approach does take into account the psychological aspects of addiction, it places a greater emphasis on the physical nature of addiction wherein it is the chemically endued cravings caused by years of substance abuse that causes addiction to manifest itself. Thus in order to resolve it from the perspective of this particular approach is to tackle the problem from a physical perspective and remove the physical dependence on narcotics.

Which method is the most effective?

While this paper has so far established the different concepts of the nature of addiction as utilized by the two approaches elaborated on, a certain question comes to mind regarding the two approaches examined, namely “which approach is the most effective?” Rather surprisingly when examining the case of either approach, it was discovered that in studies such as those by Korte et al. (2011) which examined which approach was the most effective it was determined that when categorizing patients into three distinct categories such as “low, medium and high” with each level ascribing to the level of drug addiction and psychological imbalance it was discovered that both approaches actually have distinctly similar results in the number of people successfully rehabilitated and even in the number of people that went back to normal drug use (Korte et al., 2011: 358 – 366).

It was only in the “high” levels of the experiment that there was a slight change with methadone maintenance showing slightly better results. (Korte et al., 2011: 358 – 366) The results of this are rather startling in that is appears that neither method actually outpaces the other and calls into question whether a more appropriate approach would be to just combine both methods in order to maximize their individual effectiveness.

Conclusion

Based on the findings of this paper it can be seen that the view that the methadone maintenance approach to addiction is based on different conceptions of the nature of addiction as compared to the therapeutic community approach is in fact accurate due to the form basing itself on the physical nature of addiction while the latter focuses on the psychological basis of addiction.

Reference List

‘Conversation with David Deitch’ 1999, Addiction, 94, 6, pp. 791-800, Academic Search Premier, EBSCOhost. Web.

Day, A, & Doyle, P 2010, ‘Violent offender rehabilitation and the therapeutic community model of treatment: Towards integrated service provision?’, Aggression & Violent Behavior, 15, 5, pp. 380-386, Academic Search Premier, EBSCOhost. Web.

Degenhardt, L, Randall, D, Hall, W, Law, M, Butler, T, & Burns, L 2009, ‘Mortality among clients of a state-wide opioid pharmacotherapy program over 20 years: Risk factors and lives saved’, Drug & Alcohol Dependence, 105, 1/2, pp. 9-15, Academic Search Premier, EBSCOhost. Web.

Geraghty, J 2011, ‘Drug policy, intravenous drug use, and heroin addiction in the UK’, British Journal of Nursing (BJN), 20, 14, pp. 878-884, Academic Search Premier, EBSCOhost. Web.

Higgins, G, Mahoney, M, & Ricketts, M 2009, ‘NONSOCIAL REINFORCEMENT OF THE NONMEDICAL USE OF PRESCRIPTION DRUGS: A PARTIAL TEST OF SOCIAL LEARNING AND SELF-CONTROL THEORIES’, Journal of Drug Issues, 39, 4, pp. 949-963, Academic Search Premier, EBSCOhost. Web.

Kolesova, LS 2003, ‘Adolescents as a Group That Is Vulnerable to Narcotics Addiction and HIV Infection’, Russian Education & Society, 45, 4, p. 39, Academic Search Premier, EBSCOhost. Web.

Korte, J, Magruder, K, Chiuzan, C, Logan, S, Killeen, T, Bandyopadhyay, D, & Brady, K 2011, ‘Assessing Drug Use during Follow-Up: Direct Comparison of Candidate Outcome Definitions in Pooled Analyses of Addiction Treatment Studies’, American Journal of Drug & Alcohol Abuse, 37, 5, pp. 358-366, Academic Search Premier, EBSCOhost. Web.

Pescor, MJ 1952, ‘THE PROBLEM OF NARCOTIC DRUG ADDICTION’, Journal of Criminal Law, Criminology & Police Science, 43, 4, pp. 471-481, International Security & Counter Terrorism Reference Center, EBSCOhost. Web.

Raymond, FB 1975, ‘A Sociological View of Narcotics Addiction’, Crime & Delinquency, 21, 1, p. 11, International Security & Counter Terrorism Reference Center, EBSCOhost. Web.

‘Round table: When is an addict not an addict?’ 2007, New Statesman, 136, pp. 6-15, Literary Reference Center, EBSCOhost. Web.

Smiley-McDonald, H, & Leukefeld, C 2005, ‘Incarcerated Clients’ Perceptions of Therapeutic Change in Substance Abuse Treatment: A 4-Year Case Study’, International Journal of Offender Therapy & Comparative Criminology, 49, 5, pp. 574-589, Academic Search Premier, EBSCOhost. Web.

Worley, M, Gallop, R, Gibbons, M, Ring-Kurtz, S, Present, J, Weiss, R, & Crits-Christoph, P 2008, ‘Additional Treatment Services in a Cocaine Treatment Study: Level of Services Obtained and Impact on Outcome’, American Journal on Addictions, 17, 3, pp. 209-217, Academic Search Premier, EBSCOhost. Web.