Category: Substance abuse

Clinical Treatment of Substance Abusers: Past, Present, and Future is an article by Shulamith Straussner and it addresses several dimensions of substance abuse treatment. The article provides its readers with a detailed overview of the subject matter including historical, current, and future facts. The author of this article concentrates on family-based case studies of substance abusers. In addition, the author of this article draws upon her twenty-five years of experience in clinical treatment of substance abuse when writing this article. The article explores both complex and simple matters concerning clinical treatment of substance abuse. According to the article, it is common for social workers to encounter substance abuse in the course of their practice. Consequently, it is important for social workers to understand the dynamics of clinical treatment of substance abusers. This paper is a review of Straussners article in relation to the issues that are encountered by social workers when they are dealing with substance abusers.

Clinical treatment of substance abusers is a topic that is quite relevant to social science. In this article, the author addresses the past, present, and future dynamics of clinical treatment of substance abusers. This scope of focus gives clinical practitioners a comprehensive understanding of substance abuse treatment. For instance, the author of this article notes that until 1952 alcohol addiction was not classified as a disease. This is information is important to a social worker who is likely to encounter individuals who do not believe that alcoholism is a disease. Straussners article is also relevant to the field of clinical drug abuse treatment because some practitioners are often directly affected by the vice.

It is important, for social workers to engage in a comprehensive understanding of clinical substance abuse treatment, as it is the most modern approach to substance addiction. The article on substance abuse treatment also provides clinical social practitioners with a wealth of information concerning where their practices might be headed in future. There is limited information concerning the future prospects of clinical substance abuse treatment but this article provides useful insight into how the practice might look like in the years to come. Another useful aspect of Straussners article is its summarized arrangement of facts. The author of this article is able to identify the most important issues in relation to clinical social practice (Straussner, 2012). In addition, the author succeeds in arranging these facts in a manner that appeals to a substance abuse clinical practitioner.

According to the author of this article, understanding the past, present, and future of substance abuse treatment is quite important to a social worker. Therefore, Straussner takes her readers through a journey of substance treatment history. The authors approach has a positive contribution towards the effectiveness of the article. For instance, the articles introduction informs the reader that the author is going to make a coherent connection between the past and the future methods of treating substance abuse (Straussner, 2012). The author of this article is able to prove this hypothesis throughout the article. The author begins the article by looking into the history of substance abuse treatment. In this section, the author offers some pertinent information to clinical practitioners. For instance, the article looks back into the era when substance abuse began being recognized as a universal health and social issue. According to the article, substance abuse was initially considered as a social issue before it became a clinical matter. This information is quite helpful to clinical practitioners who might be in the habit of approaching substance abuse only from a clinical point of view. Understanding the connection between social and clinical aspects of substance abuse is vital for stakeholders in the fight against drug addiction.

Straussners article offers useful insight into the current treatment methods for alcohol and other drug addictions. The information that is provided by the article is accurate and up-to-date. For instance, the article explores various addiction management and treatment methods. Social workers are likely to encounter most of the treatment methods that are outlined in the article. It is important to note that the two most popular addiction treatment methods are included in the article. In social work, practitioners are most likely to encounter two substance abuse treatment methods; the twelve-step facilitation therapy and cognitive behavioral therapy. The author of the article also does a good job in outlining scenarios where each treatment method is most appropriate. For instance, the author notes that contingency management requires a lot of social resources for it to be effective. In addition, the article recognizes that because most drugs are illegal, some drug treatment methods such as harm reduction lack government support.

The exemplary case study that is offered by the author has a narrow focus and it might not be beneficial to social workers. The case study focuses on various generations of substance abusers but the author fails to address the connection between the three generations. For instance, the woman in the case study has an alcoholic father and a drug-abusing daughter. Consequently, a competent social worker recognizes that a psychological-focused method of treatment would be most viable method. In Lydias case, pharmacotherapy would be most suitable as a secondary treatment method. The case study puts emphasis on pharmacotherapy at the expense of the more effective psychosocial approaches.

The articles title is Clinical Treatment of Substance Abusers Past, Present, and Future. However, the author of the article addresses the future of substance abuse treatment in a summarized manner. The title of the article promises to engage readers in a comprehensive exploration of the future of clinical substance abuse treatment but the author does not deliver on this promise. Furthermore, the article only addresses the future of substance abuse treatment in a simplistic manner whilst avoiding hypothesizing on complex outlooks. It is also important to note that most of the strategies that the author considers to be futuristic are current. For example, scientists have already embarked on comprehensive studies on brain functions with the view of solving substance abuse problems (Carroll, Ball & Nich, 2006).

Another article that addresses the subject of clinical substance abuse is one by a group of clinical psychologists. The article is titled A Randomized Clinical Trial of Behavioral Couples Therapy Versus Individually Based Treatment for Women with Alcohol Dependence. According to the authors of this article, Behavioral couples therapy and Individual behavioral therapy produce different results when they are employed on women with alcohol addiction problems (Schumm, Kahler & Muchowski, 2014). However, the article notes that mixing couples and individual behavioral therapy produces better treatment results. The article also notes that overall, behavioral couples therapy is better than individuals behavioral therapy.

This article is important to a social worker because it offers credible information on the types of therapy that work best on female clients. Current research indicates that the number of women with substance abuse issues is on the rise (Miller & Rollnik, 2013). Consequently, there is demand for research data that addresses clinical substance abuse remedies that are women-centered. The research findings that are presented in this article can be utilized by social workers when they are dealing with family-related substance abuse problems. For instance, a social worker might have to deal with a child who has an alcoholic mother. Therefore, the social worker can enlist the support of the father to institute behavioral couples therapy.

The other article that addresses the issue of clinical substance abuse is authored by Edle Ravndal and Per Vaglum. The article is a study that focuses on the follow-up treatment of substance abusers over a seven-year period. According to this article, personality disorders are important considerations when pursuing clinical treatment for substance abuse (Ravndal & Vaglum, 2009). In addition, the article also presents research findings that indicate that self-reporting instruments are reliable in the course of clinical treatment of substance abuse. Therefore, the information provided in the article suggests that social workers are at liberty to rely on their clients for information that might be useful during substance abuse treatments. However, the authors of the article indicate that there is a valid degree of error when practitioners are using information that is gathered through self-reporting. For example, in a hypothetical situation, a social worker might be dealing with a drug user who claims that he/she has not had a relapse over a certain period of time. The only way for the social worker to find out if this information is true is through the use of tests. Nevertheless, the social worker can use the information provided by the drug user as part of treatment data and it will be reliable to a certain extent.

References

Carroll, K. M., Ball, S. A., & Nich, C., (2006). Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: A multisite effectiveness study. Drug and alcohol dependence, 81(3), 301-312.

Miller, W.R., & Rollnik, S. (2013). Motivational Interviewing: Preparing People for Change. New York: Guilford Publishing.

Ravndal, E., & Vaglum, P. (2009). The Millon Clinical Multiaxial Inventory II: stability over time? A seven-year follow-up study of substance abusers in treatment. European addiction research, 16(3), 146-151.

Schumm, J. A., Kahler, C. W., & Muchowski, P. (2014). A randomized clinical trial of behavioral couples therapy versus individually based treatment for women with alcohol dependence. Journal of consulting and clinical psychology, 82(6), 993.

Straussner, S. L. A. (2012). Clinical treatment of substance abusers: Past, present and future. Clinical Social Work Journal, 40(2), 127-133.

Teenagers in today’s society are plagued with many school, family, and social troubles, all while still their young minds are still developing. To a teenager trying to fit in or find their place, the biggest of their problems are often social. One of these social problems that teens have to deal with is the presence of drugs. While kids are taught that drugs are bad and detrimental to one’s health, 33.3% of high school seniors in non-medical marijuana states reported using marijuana in 2016 (NIDA, 2016). Whether it’s due to peer pressure, societal influences, or curiosity, drug use in teens is one of the most prevalent issues still impacting communities across the nation. Drug habits and addictions are damaging to one’s health, cost a lot of money, and hurt the relationships in one’s life, while generally lowering one’s quality of life. While schools are aware of the problem in teens, they cannot seem to do enough to help the situation. The main reasons why drug use is still a horrible issue in teens is due to the lack of, or ineffectiveness of drug education, and the absence of significant influence on teenagers to not use drugs.

For teenagers, drugs use is detrimental to their health due to the fact that their bodies and minds are still developing. According to the National Institute on Drug Abuse, 45% of high school students abused alcohol in 2016, and 33.3% abused marijuana (NIDA, 2016). For teens, the most abused drug is alcohol. While legal for adults, alcohol impacts teens more severely than adults in many different ways. For example, drinking during teenage years known as a “critical growth period” has been shown to lead to, “lifelong damage in brain function, particularly as it relates to memory, motor skills (ability to move), and coordination” (Foundation for a Drug Free World, 2017). For other substances besides alcohol, Lubman and Yucal write that use in teens “may increase risk for mental disorder by disrupting neural development in regions critically involved with cognitive and affective function” (Lubman, Yucel, 2008). By analyzing these articles, it becomes clear that substance abuse in teens does long term damage to their fragile, developing brains. By not cutting down the amount of teen drug users, the future of society will be comprised of adults with lower rates of brain functionality. If that isn’t bad enough, kids that drink before age fifteen are four times as likely to have alcohol dependence issues (Foundation for a Drug Free World, 2017).

Drug abuse is shown to have a negative effect on many different aspects of life. In terms of crime, according to the National Council on Alcoholism and Drug Dependence [NCADD], “Alcohol and drugs are implicated in an estimated 80% of offenses leading to incarceration in the United States” (Wilcox, 2015). To add on to this, 80% of offenders abuse drugs or alcohol, and nearly 50% of jail and prison inmates are clinically addicted (Wilcox, 2015). A trend clearly exists between those who abuse substances and commit crimes, for a couple of reasons. For one, most drugs are illegal, and even possession can lead to arrest. Second, drugs and alcohol impair judgement, leading to decisions that one would normally not make while sober. Lastly, one with a drug dependency is more likely to be arrested for robbery or theft, to support their drug habit (Wilcox, 2015). It is important to keep drugs away from teens so that they have less of a reason to be criminals, and are less likely to commit crimes. If teens know drugs are illegal and harmful, why do they still choose to abuse drugs?

A key factor as to why teens abuse drugs is their lack of, or their plain disregardment of, drug education. In 2016, only 31.1% of of high school seniors reported regular marijuana use as harmful (NIDA, 2016). The common perception of regular usage of marijuana as non-harmful shows the ineffectiveness of the current policies regarding drug education. One of the main drug resistance programs intended for teens is Drug Abuse Resistance Education [DARE] (Reaves, 2001). DARE led a campaign known as the “Just Say No” campaign, and was started in high schools and middle schools during the 1970’s to scare teens away from drugs (Engs, Fors, 1988). The goal of the program was to teach kids creative ways to say no to drugs, while boosting kids’ self esteem, two things that DARE insisted would lower drug use among teens (Reaves, 2001). The New York Times did a study on those who did participate in DARE and those who did not, and found no significant difference in substance abuse between the two groups (Reaves, 2001).

The abstinence programs taught in schools do not properly educate or prepare teens for reality (Engs, et al., 1988). The problem being that most schools choose to teach teenage drug prevention through abstinence programs rather than harm minimization. By teaching abstinence programs, teens would see contradictory situations in everyday life. Teens are taught to remain abstinent and not touch substances, but when a parent or peer is having a drink or smoking a cigar, and is still doing well in every aspect of life, the teen wonders, “Why can’t I?” These contradictions to their education prompt curiosity that is inherent in every teen (Engs, et al., 1988). The result is a potentially harmful situation where substances are abused in teenage years, eventually leading to addiction (Engs, et al., 1988). Even though schools were teaching the idea that drugs will ruin your life, this did nothing to deter teen drug usage (Midford 2009).

Teenagers have many different reasons for using drugs. The most common reasons for drug abuse in teens is to rebel, to feel good, to experiment, to avoid the feelings of pain, and the biggest one, to fit in. (Engs, et al., 1988). The influences placed on drug use by peers in a social environment is more often to use rather than to not use. The result is the “prevalence of use among age peers as a validation”, a validation of social status and being “cool” (Midford 2009). As being cool as a teen sometimes involves rebelling against parents and authority, the tendency to rebel and use drugs go hand in hand. This can turn into a slippery slope for teenagers. Those who once used substances around peers to earn their approval, quickly find themselves using substances alone to feel better, or to feel normal again. This peer pressure leads to more addicts and more drug abuse, but peers are not the only thing influencing teens.

Teens are influenced by different elements in American culture, including the drug culture captured by the media. The idea of a drug free youth predominantly fails due to the fact that America is not a drug free society (Engs, et al., 1988). The culture of America has become one where drugs are incorporated in mass media, leaving teens with less drug-free adults to act as role models (Engs, et al., 1988). In popular culture, rappers and musicians are heard and seen on computers, phones, radios, and televisions across the culture. Much of the music that teenagers are listening to include references to all kinds of drugs and risky behaviors. As teenagers, the media being displayed to them has an influence on their actions, and with so many songs and artists glorifying drug usage, teens are more likely to believe that drug usage is popular or “cool”. As famous artists and musicians serve as role models to teens, teens are more likely to engage in drug usage as an effort to emulate their beloved role models.

In order to promote a drug free life for teens, it is necessary to invest in proper drug education that will help to display all the negative aspects of drug use to children. Rather than focusing on unrealistic expectations such as leaving an area where drugs are present or always saying no, drug education should focus on the negative aspects that come with saying yes. Educational programs should show the life of crime that addicts fall into, the lack of money users have due to always having to buy drugs, and the harm that doing drugs really does to your body. An organization that helps to educate teens on all the negative aspects on becoming addicted is the Foundation for a Drug Free World. Rather than employing the “Just Say No” approach of DARE, the Foundation for a Drug Free World uses a more reformed approach to education. Realizing that a kid never encountering drugs in today’s world is a very unrealistic situation, the Foundation for a Drug Free World focuses on harm reduction while promoting moderation to those who choose to try drugs. Rather than alienating users and dividing teens into those who use and those who don’t, the Foundation for a Drug Free World argues that it is never too late to seek help and explains that while there could be no current problems in a teen’s life due to drugs, if the teen continues to stay on their path, negative consequences are sure to come. By devoting time towards proper drug education and using a more reformed system of drug education, America’s youth will finally start to get the help it needs.

Drug usage is one of the worst problems plaguing the nation’s teenage population. Drug use beginning in adolescence hurts the teenager’s self esteem, impacts long term cognition, damages the brain, increases the likeliness of crime, and degrades overall quality of life. Without proper, effective drug education, and a stronger influence on responsible use patterns to counter influences to abuse drugs, the teen population continues to be at risk of the negative effects of drug abuse.

Introduction

Drug misuse is defined as the consumption of harmful medical substances in excessive amounts disobeying the medical guidelines. It has a negative impact on health. Some people who misuse drugs have many social and health problems which lead to the consequence of addiction. Thus, drug misuse refers to a state, when a drug becomes important part of a person’s life and he is completely dependent on that drug. Misuse of drug can effect on physiological and physical dependency of a person(Karpov et al. 2015). Some drugs can cause addiction and all drugs can cause bad health effect. Drug addiction is a complex disease which needs long term extensive treatment. The rush of pleasure for taking excessive drugs can provide temporary solace but later it can cause a serious health issues. The preventative measures of drugs misuse are the first and important step to recover the drug addicted persons. This research paper has analyzed the impact of drug abuse among individual health of teenagers and provided preventative measures for mitigating this issue.

Types Of Drugs

There are seven different types of substances. All these have their own effects on the individual body and their own risks(Types of drugs,2019). These types are

1. Stimulants: Stimulants impact the central nervous system (CNS) of the body, which causes the user to feel ‘speed up.’
2. Depressants : Depressants impacts the CNS of body as stimulants does, but in the opposite effect. They make the person feel as things are slowing down.
3. Hallucinogens: These kind of drugs results in disrupting brain communication.
4. Dissociative: These distort the perception of the reality by the user, and causes users to dissociate themselves or feel like they are watching their own bodies from outside.
5. Opioids: Opioids are very strong pain relievers that makes the user feel euphoria. They are habit-forming, sometimes they can cause addiction even a couple of days.
6. Inhalants: These drugs also cause feeling of euphoria. They are made up of household items and as the name suggests, these drugs are always inhaled and taken in in the form of gases or fumes.
7. Cannbis: It acts like a hallucinogen, as well as depressant. It has a high potential for addiction but it has also many medicinal uses.

Uses of drugs

Utilization of drugs pursues psychotropic as opposed to medicinal purposes. Among the most widely recognized psychotropic drugs are sedatives (opium, morphine, and heroin), psychedelic drugs (LSD, mescaline, and psilocybin), barbiturates, cocaine, amphetamines, sedatives, and cannabis. Liquor and tobacco are additionally some of the time delegated drugs. The term sedate maltreatment is regularly connected to inordinate and addictive utilization of drugs. Since such drugs can have serious physiological and mental, just as social, impacts, numerous administrations manage their utilization (Kolind et al. 2016). For example, some of the drug sellers tend to target youth folk those are intoxicated or alcoholic. On the other hand, using fake prescription, some addicted heads also try to manage drugs illegally from street sources.

Prescribed drugs

The authorities of prescription to assess and embrace treatment approaches that are quality put together and that work with respect to the assets and qualities of the customer’s way of life, singular attributes and encounters, otherworldliness, and family. Among Hispanic/Latina customers, families are commonly an essential piece of the encouraging group of people and can work as an asset in recuperation. Correspondingly, the centrality of family ties may give inspiration to treatment and an awareness of other’s expectations to family. In an examination that assessed the job of family in decreasing or postponing liquor use among youthful Hispanic/Latina females, benefits that assistance improves parental clinics can have long haul constructive outcomes (Drummer and Yap, 2016).

Financial status, age, and time span are related with substance use and substance use issue among network based people. Of specific concern, the 2015 Youth Risk Behavior Survey found a developing predominance of liquor and other medication use among pre-adult Hispanic/Latina females (Petrie et al. 2016). Studies have likewise detached work, conjugal status, and instructive dimension as indicators of liquor utilization and substance use issue among Hispanics/Latinas. In an investigation assessing racial/ethnic contrasts among ladies with co-happening mental and substance use issue, Hispanic/Latina ladies had critical social weakness described by lower financial and instructive status, introduction to savage wrongdoings, and higher rates of criminal equity association (Paul et al. 2018).

Illegal street drugs

Illegal drug use is incredibly harming our young people today, and in their future. It is in the psyche of each parent and open alike. However with the alarm of harming the lives of things to come and it is a fact that availability of drugs and insufficient administration has increased the practices on illegal drug use on the streets. As stated by Hindmarch (2017), from the beginning of the disclosure of cannabis, cocaine, and other illegal drugs, the open has seen the negative results and outcomes of utilizing them. In any case, transient assessments won’t cover them – nor should society need to urge less demanding access to a medication that can prompt reliance, has wellbeing dangers, and diminishes readiness, to give some examples of its contrary results. Through close to home perception, youngsters from age thirteen and up (now and then significantly more youthful), as of now have the friend strain to smoke, drink, be fierce and be explicitly dynamic. Ceasing and sentencing individuals who disseminate the drugs is a decent method to help stop the spread of the substances, yet more cash needs to go to avoiding it. By included requests for anticipation through media, parental help, and government laws, illicit drugs may turn into a panic of the past, not a pattern for what’s to come (Monteith and Glenn, 2018).

There are certain aspects prevailing in the field of illegal use of drugs. However, there is no difference between the categories. In that concern, the important fact is that such usages of drugs has no limitation and excessive intake has caused into mental issues among individuals even in some cases death.

Effects on Health

Taking huge amount of medicines or drug s in an illegal way is harmful to health. As for example drugs that are commonly misused are tobacco, alcohol sleeping tablet and others are very dangerous to health without following medical guidelines. Based on the study of Fang et al. (2016), people in Australia who are taking drugs illegally have faced legal trouble. They also have several students who are using pharmaceutical drugs for non-medical purpose. Many teenagers are using non prescribed medicine in order to reduce their anxiety, stress, pressure and which creates dangerous effect on health. Moreover, from 1999 the death ration by drug abusing has been increased by 4 times (1.6 per 10000 persons respectively) in Australia. Death ratio of the youngsters (Less than 35 years) is greater than the death ratio of other people (abs.gov.au, 2019). As opined by Karpoov (2015) at the schools it has been evident that most of the students start their substance addiction from 14 years of age and all the students have tried the drugs at least once in life. But as per the research results there are students who have negative attitude towards the drug issue. The authors argued that 1% of the parents have a positive attitude towards the drugs which is a very serious issue of Australian society. According to Haffajee, R. L. (2015), when adolescents reach at that stage of life where they are unable to take the pressure of life, their mentality is to take drugs for releasing the pressure, and almost 79% of the middle aged person is taking drugs for this reason. This can be supported with the findings of Emmers, Bekkering & Hannes, (2015), which shows that people are addicted towards the Euphoria created by drugs. Some people are also addictive towards the dizzy effect created by sedatives and depressants. However, they argued that the indiscipline and unhealthy lifestyles of the parents can harm the future generation. Majority of drug abusers think that taking drugs and alcohol is the solution to avoid realities and pressure of life. Person who is addicted to a drug may suffer from social and health problem which may include cardiac problems, respiratory problem, HIV and others. Moreover, it will create mental health problems like suicidal thoughts, anxiety, depression and others. Intake of excessive amount of drugs may also lead people in doing illegal activities and crimes.

Preventative Measures

CAP Theory: Based on the study of Han et al. (2017), Cap control theory refers to the interaction of Cognitive Affective Pharmacologic Effects of taking drug. This theory is also makes several expectations for treatment of drug abuse. CAP theory is associated with the use of drugs with pharmacokinetics drug effect and interaction of individual’s style. Cognitive approach for drug abuser plays a vital role in individuals while moving from experimentation of drug to drug abuse. CAP theory help in reduction of stress from individual minds which is effective for making person free from drug misuse. This theory can help in implementing multimodal approach which is helpful in mitigating faulty thinking and can teach in developing interpersonal skills. This can provide a scope to the drug addict person in coping up with the pain and anxiety which can further help in the building of self-positive image.

Global Initiatives: initial approach for prevention plays an important role among people before they start to depend on drugs. Thus, global initiative will help to stop using drugs among people who are already addicted to it. People under the age of 14 are more willing to use illegal substances as they get forced or influenced by their companions, relatives or from someone who is already addicted. Thus, global initiative helps them to stop by providing guidance and awareness.

Family support and Guidance: Support and guidance that has been provided by family will help to deal with life pressure and will help in gaining ability to accept the realities. Over the year many medical issue is coming in front regarding this drug issues. Not only are the youngsters, but also the middle age people getting affected by doing the over doses of the drugs. Few parents are also involved in this addiction, as results the rate of unhealthy child birth in Australia Haffajee, R. L. (2015). Although the Australian government is implementing strict decision to stop the drug abuse, the people still need to be taught the methods of meditation so they can get a motivation to lead a healthy life.

Conclusion

In the entire study, it has been found that drugs misuse is a serious health issue which can destroy the entire health of an individual. Researchers have also found that facing certain challenges such as doing poorly in school or conflict in family increase the likelihood those boys will abuse substance. Australian government should implement rules and laws that teenagers cannot get easily access to the drugs. Government should provide funds to health professionals, caregivers, medical assistants so that they can arrange camps to provide necessary education about the harmful effects on consuming drugs. As we know that it is long-term treatment to avoid taking drugs, but with the help of government and health professionals, caregivers, it can be easier to take over this issue because teenagers are future of country.

1. References
2. Drummer, O.H. and Yap, S., 2016. The involvement of prescribed drugs in road trauma. Forensic science international, 265, pp.17-21.
3. Emmers, E., Bekkering, G. E., & Hannes, K. (2015). Prevention of alcohol and drug misuse in adolescents: An overview of systematic reviews. Nordic Studies on Alcohol and Drugs, 32(2), 183-198, retrieved from https://journals.sagepub.com/doi/pdf/10.1515/nsad-2015-0019 [Retrieved on 1st February 2019]
4. Fang, H. B., Huang, H., Clarke, R., & Tan, M. (2016). Predicting multi-drug inhibition interactions based on signaling networks and single drug dose-response information. Journal of Computational Systems Biology, 2(1), 1-9, Retrieved from https://www.researchgate.net/profile/Hengzhen_Huang/publication/319136841_Predicting_Multi-Drug_Inhibition_Interactions_based_on_Signaling_Networks_and_Single_Drug_Dose-Response_Information/links/599414c9458515c0ce64f890/Predicting-Multi-Drug-Inhibition-Interactions-based-on-Signaling-Networks-and-Single-Drug-Dose-Response-Information.pdf [Retrived on 1st February 2019]
5. Haffajee, R. L. (2015). Preventing opioid misuse with prescription drug monitoring programs: a framework for evaluating the success of state public health laws. Hastings LJ, 67, 1621, Retrive4d from https://repository.uchastings.edu/cgi/viewcontent.cgi?article=1075&context=hastings_law_journal [Retrieved on 1st February 2019]
6. Han, B., Compton, W. M., Blanco, C., Crane, E., Lee, J., & Jones, C. M. (2017). Prescription opioid use, misuse, and use disorders in US adults: 2015 National Survey on Drug Use and Health. Annals of Internal Medicine, 167(5), 293-301, Retrieved from https://www.doh.wa.gov/Portals/1/Documents/2300/2017/AnnalsInternalMed.pdf
7. Hindmarch, I., 2017. Effects of Prescribed and Over-the-Counter Drugs on Workplace Performance. In Addiction at Work (pp. 87-104). Routledge.
8. Karpov, V. Y., Eremin, M. V., Petrova, M. A., Alifirov, A. I., & Skorosov, K. K. (2015). Modern approaches to preventing drug addiction by means of physical activity and sports. Biology and Medicine, 7(5), 1-4. Retrieved from: http://biolmedonline.com/Articles/Vol7_5_2015/BM-147-15_Modern-Approaches-to-Preventing-Drug-Addiction.pdf
9. Kolind, T., Holm, K., Duff, C. and Frank, V.A., 2016. Three enactments of drugs in Danish prison drug treatment: Illegal drugs, medicine and constrainers. Drugs: Education, Prevention and Policy, 23(2), pp.135-143
10. Monteith, S. and Glenn, T., 2018. Searching online to buy commonly prescribed psychiatric drugs. Psychiatry research, 260, pp.248-254.
11. Paul, A.B.M., Simms, L., Mahesan, A.A. and Belanger, E.C., 2018. Teens, Drugs, & Vegas: Toxicological surveillance of illicit prescription and illegal drug abuse in adolescents (12–17 years) using post-mortem data in Clark County, Nevada from 2005 to 2015. Journal of forensic and legal medicine, 58, pp.20-24.
12. Petrie, B., Youdan, J., Barden, R. and Kasprzyk-Hordern, B., 2016. New framework to diagnose the direct disposal of prescribed drugs in wastewater–a case study of the antidepressant fluoxetine. Environmental science & technology, 50(7), pp.3781-3789.
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Certain social issues are the causes of a broken society and bring pain and sorrow. The Outsiders by S.E Hinton is in Ponyboy’s point of view, after the tragic death of his parents, he is then in the care of his older brothers, Darry and Sodapop. All are in the group that goes by the name of Greasers, there are two gangs, the Greasers and Socs. Throughout the novel, it becomes known that there are certain differences in being a Greaser or a Soc. The Socs are wealthy and dress nice, the Greasers do not dress nice, and the guys wear a lot of grease in their hair, both sides commit crimes but the Socs always get away without leaving the Greasers to blame. People thinking there are huge differences, and the other side being less, it caused deaths, and fighting that will not change anything. Ultimately, in The Outsiders, there are many social issues but the social issues that affect the adolescence are violence, poor parenting/parental neglect, and substance abuse.

To begin with, the first issue in the book that the teens face is violence. For example, when Ponyboy describes “Somebody kicked me hard in the ribs and I yelped in spite of myself…Finally, he kicked me in the head so hard it stunned me, I lay limp, trying to clear my mind and keep from blacking out.” (144, Hinton). This emphasizes how bad the fighting really gets, with possibilities of it getting worse than it already is. It is revealed that in the big rumble, both sides are pointlessly fighting the other side for victory and respect from the side that loses, in the end, it is still most likely going to stay the same way it has always been. The teens face violence that could easily be avoided, and prevent a lot of injuries and death. The teens think violence will fix and resolve the problem when it makes the situation a lot worse. In their mind, fighting is the

Certain social issues are the causes of a broken society and bring pain and sorrow. The Outsiders by S.E Hinton is in Ponyboy’s point of view, after the tragic death of his parents, he is then in the care of his older brothers, Darry and Sodapop. All are in the group that goes by the name of Greasers, there are two gangs, the Greasers and Socs. Throughout the novel, it becomes known that there are certain differences in being a Greaser or a Soc. The Socs are wealthy and dress nice, the Greasers do not dress nice, and the guys wear a lot of grease in their hair, both sides commit crimes but the Socs always get away without leaving the Greasers to blame. People thinking there are huge differences, and the other side being less, it caused deaths, and fighting that will not change anything. Ultimately, in The Outsiders, there are many social issues but the social issues that affect the adolescence are violence, poor parenting/parental neglect, and substance abuse.

To begin with, the first issue in the book that the teens face is violence. For example, when Ponyboy describes “Somebody kicked me hard in the ribs and I yelped in spite of myself…Finally, he kicked me in the head so hard it stunned me, I lay limp, trying to clear my mind and keep from blacking out.” (144, Hinton). This emphasizes how bad the fighting really gets, with possibilities of it getting worse than it already is. It is revealed that in the big rumble, both sides are pointlessly fighting the other side for victory and respect from the side that loses, in the end, it is still most likely going to stay the same way it has always been. The teens face violence that could easily be avoided, and prevent a lot of injuries and death. The teens think violence will fix and resolve the problem when it makes the situation a lot worse. In their mind, fighting is the only way, the best way and show the other side what they really are, when they could handle problems without conflict. In addition, when Ponyboy thinks, “I’m drowning, I thought, They’ve gone too far… A red haze filled my mind as I slowly relax” (56, Hinton). This is important because as Ponyboy illustrates how he is being drowned by Bob who happens to be a Soc and gets close to passing out. This also exposes on how much the Socs will go as far as killing for having Ponyboy and Johnny hanging out with their girlfriends. After Johnny saves Ponyboy by killing Bob, violence got to the point where it ends in death. The torture that Ponyboy received led to him being saved, this violence also could have been avoided and just been talked out. Violence is so common to everyone and so many regretful things became the result of it all. In conclusion, violence happens so much among the teens that it gets harder to avoid and results with death and harder to deal with.

Another social issue that the teens struggle with is parental neglect and poor parenting. Specifically, when Dallas exclaims “Shoot, my old man don’t give a hang whether I’m in jail or dead in a car wreck or drunk in the gutter.”(88, Hinton). This depicts how his dad in specific does not care if Dallas is dead or not. This displays how Dallas’ father somewhat is neglecting him, it is he has parented Dallas very poorly. The poor parenting Dallas receives from his father is probably what shaped him into the person he ended up being. As a result, that is the most likely the reason why Dallas does so much crime and other bad things, he was not raised well to know manners and how to act right. Moreover, when Ponyboy and Johnny wake up after falling asleep in the lot and Johnny says he is going to sleep in the lot and Ponyboy thinks “Johnny’s parents didn’t care if he came home or not.” (59, Hinton). This hints that if it is not poor parenting it is parental neglection that a child is dealing with, it is always something, even if it is not as major as poor parenting or being neglected by parents. It alludes to Johnny would rather stay and sleep in the lot than go home to his parents. Johnny is abused at home, and it is bad to the point where Johnny would rather not be at home and sleep outside in the cold. Being so poorly treated has caused him sleeping outside or not being home a normal thing. All in all, in the book another issue the teens, struggle with parental neglection or poor parenting, that it is normal to face for the teens.

Lastly, the most destructive social issue the teen’s experience is substance abuse. To illustrate, when Ponyboy thinks, “Everybody in our neighborhood, even the girls smoked….Johnny had been smoking since he was nine, Steve started at 11.” (97, Hinton). It becomes known that smoking at a very young age is not uncommon or not unnatural to them. They abuse the act of smoking; smoking is so normally done to relax or calm them down. In fact, Darry does not smoke for the sake of keeping good health, everyone else justs smoke without thinking of the consequences, they do not think it is wrong. Especially that they start so young, they fall more into the risk of getting addicted as they grow, which can cause a lot more complications. It is good that Darry does not smoke because he wants to stay in good health, but everyone else starting young, their health will be terrible in the future. Furthermore, when Ponyboy observes “Five Socs were coming straight at us, and from the way they were staggering I figured they were reeling pickled… They smelled so heavily of whiskey and English leather I almost choked”(54, Hinton). As Ponyboy emphasizes the five Socs going towards him and Johnny, that they’re drunk. As it was explained they are in Greaser territory, it portrays what people will and can do when drunk. It is so off-putting to know is the people that sold beer to underage kids, not caring about all the possibilities of it going terribly wrong. Thus, the last but one of the biggest social issue the teens in the book go through substance abuse; Substance abuse is so destructive, it caused the teens death and misery.

In conclusion, the adolescence is badly affected by the issues of substance abuse, violence, parental neglect or poor parenting, All because the two sides thought they were so different. Especially the Socs; they thought the Greasers were less than them. The only difference was the Greasers living in poverty. Violence, abuse of the substance, parental neglect and poor parenting is what impacted things terribly. In the end, no matter how many tragic events occurred, the pointless fighting will never stop. The violence and murder will continue; Teens will get drunk and go out driving, smoke and pop pills, poor parenting and neglection will happen to much more children. Peace and living equally in a clean world is something they will never experience.

Substance use is rapidly becoming one of the most prevalent issues in today’s society. According to a survey by the WHO, 164 million people had an alcohol or drug use disorder in 2016. A major part of the population dealing with these issues are the adolescents. Studies by Belcher and Schinitzky (1998) have shown that substance abuse during adolescence can become a problem later on during adulthood. Moreover, several factors play a role in adolescents indulging in the use of substances such as cigarettes, alcohol, marijuana, etc.

A study designed to assess the knowledge and attitude of adolescents towards the factors that influence substance abuse by Philip (2019) provides insight into why adolescents engage in substance abuse. The descriptive study focused on a sample of 100 from Koshy’s Group of Institutions in Bengaluru, consisting of adolescents aged between 18-23 selected through convenient sampling technique. Three different kinds of tools were used to collect data from the sample. The first tool collected Baseline variables (age, gender, type of family, style of family, religion, course, use of substance in family and by whom, previous knowledge); the second tool involved a structured knowledge questionnaire on factors influencing substance abuse, and third tool was an attitude questionnaire on factors influencing substance abuse. The results of the study showed that, in a majority of the adolescents, there was a significant association between adolescence knowledge and attitude regarding factors influencing substance abuse. A significant association was identified between knowledge, attitude, and the selected demographic variable (such as style of family, use of substance in family, type of family) as well. A positive attitude in adolescents towards the factors indicates a good level of knowledge about the same. The results of the study intend to assist in the tackling of the substance abuse problem by focusing on the preventive level, which can be done through an avoidance of the factors that lead to the abuse; for this counselling and education are essential. There are thus direct implications on nursing education, nursing research and nursing practice as well.

Alhyas’s (2017) study on adolescents’ perception of substance use and factors influencing its use among adolescence in Abu Dhabi provides further insight into the minds of adolescents in the modern world. The study used a focus group, qualitative approach to understand the perception of substance use among adolescents- factors that influence and prevent usage. The sample consisted of forty one 13-18 year old teenagers from Abu Dhabi, who were further divided into focus groups based on age. These groups were further divided based on gender. Screening questionnaires were handed out in the neighborhoods of Abu Dhabi, based on which ten adolescents from each neighborhood were chosen. The method used was interview, and all the interviews were recorded and transcribed. The QRS NVivo software was used for data analysis, which enabled sorting and arranging of information that had been transcribed. Three categories were studied: awareness of substances and harm due to usage, gender role, factors affecting use. The results indicated that awareness of substances differed based on age groups; for instance, while the 17-18 years group could name different types of alcohol, the 13-14 years group referred to it as “Khamr”, which means liquor. Awareness of associated harm is low- for example, while some adolescents could name physiological illnesses associated with substance use, others spoke of the relaxing effect it could have. The information was acquired from different sources, of which school was not a part. Thus, substance use campaigns in schools is a viable preventative method. Community and family-based programs can also be incorporated. Moreover, it was observed that certain substances were associated with specific genders: while smoking was seen as too masculine for girls, shisha was seen as a viable alternative. Smoking was avoided by female participants as a means of saving family honor, while male participants indulged in smoking to appear more manly. Substance use is was found to be influenced by a number of factors. Bad parent-adolescent relationships, high levels of peer pressure, boredom and easy accessibility increased usage, while religion, education about the physical problems, and implementation of consequences by communities hindered usage. Strengthening family bonds and communication, and implementing regulations that prevent selling of substances to underage individuals could reduce usage. The study also suggested that, in schools, counsellors dedicated to identifying and addressing high-risk students, and implementation of CCTV could also help in reducing substance use.

Smith and Cyder’s (2016) article is a review of empirical studies on urgency theory, as per which positive and negative urgency traits result in impulsive action following unusually high levels of positive or negative emotions. The aim of the article was to examine the current validity of urgency hypotheses, understand the role of urgency in substance use, and suggest new research areas. Findings suggest the urgency traits increase risk of substance use. While other impulsivity factors like sensation-seeking can dispose one to use, negative urgency greatly increases this risk- it could result in very high levels of consumption. The hypothesis that urgency traits can predict onset and increase of substance use is supported by empirical research. As per one study by Settles and colleagues, positive urgency levels of 5th graders measured in spring, predicted onset and increase of drinking in 6th grade. This predictive nature is uniform across races and genders. The third hypothesis that urgency traits increase risk behavior by biasing psychosocial learning has been backed up. For instance, negative urgency results in binge drinking to cope with a distressing situation, which is fueled by the belief that drinking helps reduce distress- which in turn increases the drinking behavior. The fourth hypothesis, that urgency would increase with onset of puberty was studied by Boyle and colleagues, who discovered that negative urgency steadily increased post-puberty, which in turn resulted in a steady increase in drinking behavior. The fifth hypothesis was based on the functioning of brain systems. When exposed to an emotion-triggering stimulus, normal functioning would result in actions that attend to the stimulus, while also ensuring that long-term goals are not compromised. The hypothesis that individuals with high urgency traits may have variations in such functioning, in terms of short-term goals being attended to as opposed to long-term ones, has been backed by research. This is because negative urgency results in reduction of top-down processing, and an increase in bottom-up processing. As per the sixth hypothesis, urgency could be linked to levels of dopamine and serotonin, which have varied due to gene polymorphisms, resulting in a different pattern of alleles on the genes. Carver and colleagues have proven empirically that the proposed allele pattern on the serotonin receptor gene, when combined with childhood adversity, is linked to a factor that has been named “feelings trigger actions.” As per the review, for substance use, positive and negative urgency traits can increase use, and thus are studied as one urgency trait. Since usage can be triggered by several factors, the logical approach would be to reduce the tendency to indulge in such rash behaviors when subjected to high levels of emotions. Dialectical Behavior Therapy focuses on teaching individuals adaptive ways of responding to negative emotions. When dealing with positive urgency based risky behavior, individuals can be taught to keep the positive mood going by carefully analyzing potential consequences of actions due to the mood. The article also vouches for future avenues for study, including testing the predictive nature of the urgency trait over long time periods and at different stages of development; form an integrated model of emotion-processes as predictive of substance use risk; development of animal models to potentially identify pharmacological and therapeutic interventions; formation of interventions.

There are other factors as well that promote substance use among adolescents. The study by Dijkstra et al. (2015) throws light on how delinquency in adolescence is linked to the ‘maturity gap’, where adolescents are stuck between biological and social maturation, which motivates them to engage in delinquency to emphasize their maturity. This could also be one of the reasons why adolescents engage in substance use. This study explores the extent to which this discrepancy predicts delinquency and substance abuse, hypothesizing that the lack of autonomy in decision making would predict conflict with parents, particularly for biologically mature adolescents, which in turn would be related to increasing levels of delinquency and substance use. The sample included 1,884 students who were participants of Social Network Analysis of Risk behavior in Early adolescence (SNARE) study. Data was collected and analyzed using the participants’ responses to questionnaires containing self-reports, and peer nominations were assessed, done thrice over a one-year period. Delinquency, substance use, pubertal status, autonomy in decision making and conflict about decision making were measured by recording the participants’ responses to questions posed by the researchers. Path models for delinquency and substance use was computed separately using Mplus 7.2 (Muthe´n and Muthe´n 1998). The findings revealed that conflict with parents plays an important role in the relationship between maturity gap and delinquency, linking the both together. Adolescents who were more mature and more autonomous experienced a greater increase in conflict with parents which in turn predicted increasing levels of delinquency. Finding also showed that the maturity gap was also suitable for explaining substance abuse among adolescents. The same was applicable for both boys and girls.

Handley et al. (2015) focused on maltreatment as a child as a factor in substance use. The study focuses on whether disadvantaged neighborhoods confer risk for substance use disorders among adolescents with maltreatment histories. Neglect, emotional abuse, physical abuse and sexual abuse were the maltreatment subtypes considered. The participants of this study consisted for 411 adolescents chosen from an investigation of the developmental sequelae of childhood maltreatment. The sample included both treated and maltreated adolescents. Majority of the participants experienced multiple subtypes of maltreatment. Both the participants and their parents were interviewed, and they were assessed based the interviews and self-report measures. Various modes of assessment were used to measure the variables. The Neighborhood Environment for Children Rating Scale (Coulton, Korbin, & Su, 1999) was used to measure neighborhood safety. Neighborhood poverty was measured using the US census data. Drug availability was measured using a report of 3 items created by the researchers. Adolescents T-tests and chi-square comparisons and two sets of multiple-group structural equation models (SEMs) were used to identify relationships between the variables. The results indicated that neighborhood disadvantage was associated with more marijuana-dependence symptoms among maltreated but not among non-maltreated adolescents. Those who were subjected to multiple subtypes of maltreatment were prone to be more dependent on marijuana use. With respect to alcohol abuse, the neighborhood disadvantage, but not maltreatment, was observed to be associated with the adolescents’ alcohol-dependence symptoms. The study also indicates that the likelihood of early drug use increases twice to four times as much with each additional adverse childhood experiences. This also points to why people engage in drug use from an early age.

Yet another study throws light on why adolescents engage in substance use. Daniel, Krishnan and Gupta’s (2017) study was aimed at identifying the percentage of male adolescents in Sunder Nagari, New Delhi, who were using substances, the kinds of substances used, the reasons behind usage, and potential ways to reduce it. The sample consisted of 110 adolescents above 11 years of age, who could read and write either Hindi or English. The method used was a cross-sectional survey. The materials used were a demographic questionnaire, and a structured questionnaire with a reliability coefficient of 0.94. The data collected was analyzed using SPSS version 17.0. 55.38% of the participants were currently using substances- out of this, 60.65% of them were indulging in substance use every month (one to two times). 44.26% of the boys had begun using substances before they turned 13 years old. As for causes for substance use, 57.38% wanted to be liked by peers, 24.6% wanted to feel like adults, and only 13.11% used it because they liked the substance. Tobacco was most commonly used- 77.05% indulged in this. Inhalants were used by 26.23% and alcohol was used by 11.47%. Majority of the participants were getting the substances from their peers. After analysis based on association, it was found that the variables of educational level, family type and number of siblings had a significant impact. The participants who had completed education less than 10th std, were from nuclear families, and had less than two siblings, were most prone to substance use.

Jones, Lynam, and Piquero (2015) adopts a different approach. Their study aimed at testing Hirschi’s predictions about the reconceptualization of self-control. Hirschi, going against previous research which focuses on personality-based notions of self-control (Cauffman, Steinberg, & Piquero, 2005; Grasmick et al., 1993), emphasizes on social bonds as indicators of what inhibits people from engaging in offending or antisocial behavior. This study seeks to explore his reconceptualization of self-control. The sample 2,071 participants from schools participating in the Drug Abuse Resistance Education (DARE) program. A follow up study was then conducted on 1,429 participants from the original sample. The final sample consisted of 1,002 participants between 19 and 21 years of age. Data regarding substance use, perceived costs, perceived rewards, personality links to impulsive behavior (LoP and sensation seeking), etc. was measured. LoP was measured using a “narrow” impulsivity scale (Eysenck & Eysenck, 1978) and sensation seeking was measured using Zuckerman’s (1994) TAS scale. Using models, the relationships between the variables was examined. The findings suggest that although bonds (inhibitors) exert an effect on substance abuse (with respect to cigarette, marijuana, and more serious substance use) which was consistent with Hirschi’s claims. However, they are not mediated by perceived costs. Perceived rewards, on the other hand, was found to influence substance use and was found to be a consistent mediator of inhibitors/bonds and impulsivity.

Aggressive behavior and drug use have been shown to have a relationship with delinquency and failure at school. A study by Gázquez, et al. (2016) aimed at finding whether social support plays a role decision-making regarding drug use and the behavior of adolescents. The study hypothesized a positive relationship between drug use and violent behavior. The sample consisted of 822 high school students from eight schools from the city of Almeira. Data was collected using Peer Conflict Scale and the Multidimensional Scale of Perceived Social Support, as well as an ad hoc questionnaire on drug use. The results indicated that all types of aggression were positively correlated with tobacco use. Substance use was found to be related to perceived social support by the adolescent’s peer group and to aggressive behavior. Both alcohol and tobacco use were found to be positively correlated with peer and significant other support. Both were also found to be negatively correlated with family support which means that the more the participants indulge in the consumption of alcohol and tobacco, the less they perceive the support they received from family members.

Researchers are also interested in considering substance use as indicators of future behaviors, as evidenced by the study conducted by Patrick, Schulenberg and O’Malley (2016). The aim of the study was to identify whether substance use during high school can act as an indicator of future college attendance and success. The sample of this study was spread across 28 cohorts following young people over a seven year period, starting from the senior year of high school. The study also focused on college attendance patterns, variations in attendance (based on cohort, gender, etc.) and predictors of college attendance. Data was analyzed by observing patterns and computing prevalent statistics, chi square tests for equality and a series of three multivariate logistic regression analyses. The results, with respect to substance use, indicate that cigarette and illicit drug use in high school can lead to lower educational attainment and college dropout. Substance use and educational difficulties are also reciprocally related, as seen by the study by Bachman (2008). The results further indicate that students who engaged in binge drinking while in high school were more likely to graduate than dropout from high cool, provided that they did not indulge in the usage of marijuana, cigarettes or other illicit drugs. Analysis not controlling usage of other substances revealed that binge drinking led to higher dropout rates among men, while a faster increase in the same accounted for them staying in college. Although high usage of substances in high school may lead to future educational difficulties, moderate use of alcohol reflects the opposite, which could be due to socialization and social integration.

Since substance use among adolescents is a growing concern, numerous programs and interventions are being implemented regarding the same. Das, et al’s study (2016) focused on interventions for substance abuse (smoking/tobacco use, alcohol use, drug use and combined substance abuse) and its effectiveness in preventing substance abuse among adolescents. Forty six studies were systematically reviewed based on a few criteria: literature published upto December 2015 were reviewed, and reviews targeting both adolescents and youths were included. All available published systematic reviews on interventions for adolescent substance abuse were included. Two abstractors reviewed literature from Cochrane Library and PubMed based on the criteria and narrowed down the number of studies. Reviews included those containing interventions for tobacco/smoking use (n=20), alcohol use (n=16), drug use (n=2) and combined substance abuse (n=16). Data was then individually extracted from each study in a standardized form. The quality of the reviews was assessed using the 11-point assessment of the methodological quality of systematic reviews (AMSTAR) criteria. The findings indicate that among smoking/tobacco interventions, school-based prevention programs and family-based intensive interventions are effective in reducing smoking, as re mass media campaigns of reasonable intensity over extensive time periods. School-based interventions have also been found to be effective in reduction of alcohol abuse and those based on a combination of social competence and social influence approaches have shown protective effects against drugs and cannabis use. School-based primary prevention programs are also effective in the case of combined substance abuse. The study also vouches for the use of online and digital platforms as having potential to improve substance abuse outcomes among adolescents.

From this, it is evident that there are numerous factors contributing to substance use among adolescents. Even though it is a growing concern, various intervention programs and awareness programs do play a role in reducing the risk of substance use. Further research into these fields provide more hope of progress for the future.

References

1. Alhyas, L., Al Ozaibi, N., Elarabi, H., El-Kashef, A., Wanigaratne, S., Almarzouqi, A., … & Al Ghaferi, H. (2015). Adolescents’ perception of substance use and factors influencing its use: a qualitative study in Abu Dhabi. JRSM open, 6(2), 2054270414567167.
2. Daniel, L. T., Krishnan, G., & Gupta, S. (2017). A study to assess the prevalence and pattern of substance use among male adolescents in suburban area of Delhi. Indian Journal of Social Psychiatry, 33(3), 208.
3. Das, J. K., Salam, R. A., Arshad, A., Finkelstein, Y., & Bhutta, Z. A. (2016). Interventions for adolescent substance abuse: An overview of systematic reviews. Journal of Adolescent Health, 59(4), S61-S75.
4. Dijkstra, J. K., Kretschmer, T., Pattiselanno, K., Franken, A., Harakeh, Z., Vollebergh, W., & Veenstra, R. (2015). Explaining adolescents’ delinquency and substance use: A test of the maturity gap: The SNARE study. Journal of Research in Crime and Delinquency, 52(5), 747-767.
5. Gázquez, J. J., Pérez-Fuentes, M. D. C., Molero, M. D. M., Martín, A. B. B., & Sánchez-Marchán, C. (2016). Drug use in adolescents in relation to social support and reactive and proactive aggressive behavior. Psicothema, 28(3), 318-322.
6. Handley, E. D., Rogosch, F. A., Guild, D. J., & Cicchetti, D. (2015). Neighborhood disadvantage and adolescent substance use disorder: The moderating role of maltreatment. Child maltreatment, 20(3), 193-202.
7. Jones, S., Lynam, D. R., & Piquero, A. R. (2015). Substance use, personality, and inhibitors: Testing Hirschi’s predictions about the reconceptualization of self-control. Crime & Delinquency, 61(4), 538-558.
8. Patrick, M. E., Schulenberg, J. E., & O’Malley, P. M. (2016). High school substance use as a predictor of college attendance, completion, and dropout: A national multicohort longitudinal study. Youth & society, 48(3), 425-447.
9. Philip, M. J. (2019). ASSESSING THE KNOWLEDGE AND ATTITUDE REGARDING THE FACTORS INFLUENCING SUBSTANCE ABUSE AMONG THE ADOLESCENCE. Paripex-Indian Journal Of Research, 8(6).
10. Smith, G. T., & Cyders, M. A. (2016). Integrating affect and impulsivity: The role of positive and negative urgency in substance use risk. Drug and Alcohol Dependence, 163, S3-S12.

“Clinical Treatment of Substance Abusers: Past, Present, and Future” is an article by Shulamith Straussner and it addresses several dimensions of substance abuse treatment. The article provides its readers with a detailed overview of the subject matter including historical, current, and future facts. The author of this article concentrates on family-based case studies of substance abusers. In addition, the author of this article draws upon her twenty-five years of experience in clinical treatment of substance abuse when writing this article. The article explores both complex and simple matters concerning clinical treatment of substance abuse. According to the article, it is common for social workers to encounter substance abuse in the course of their practice. Consequently, it is important for social workers to understand the dynamics of clinical treatment of substance abusers. This paper is a review of Straussner’s article in relation to the issues that are encountered by social workers when they are dealing with substance abusers.

Clinical treatment of substance abusers is a topic that is quite relevant to social science. In this article, the author addresses the past, present, and future dynamics of clinical treatment of substance abusers. This scope of focus gives clinical practitioners a comprehensive understanding of substance abuse treatment. For instance, the author of this article notes that until 1952 alcohol addiction was not classified as a disease. This is information is important to a social worker who is likely to encounter individuals who do not believe that alcoholism is a disease. Straussner’s article is also relevant to the field of clinical drug abuse treatment because some practitioners are often directly affected by the vice.

It is important, for social workers to engage in a comprehensive understanding of clinical substance abuse treatment, as it is the most modern approach to substance addiction. The article on substance abuse treatment also provides clinical social practitioners with a wealth of information concerning where their practices might be headed in future. There is limited information concerning the future prospects of clinical substance abuse treatment but this article provides useful insight into how the practice might look like in the years to come. Another useful aspect of Straussner’s article is its summarized arrangement of facts. The author of this article is able to identify the most important issues in relation to clinical social practice (Straussner, 2012). In addition, the author succeeds in arranging these facts in a manner that appeals to a substance abuse clinical practitioner.

According to the author of this article, understanding the past, present, and future of substance abuse treatment is quite important to a social worker. Therefore, Straussner takes her readers through a journey of substance treatment history. The author’s approach has a positive contribution towards the effectiveness of the article. For instance, the article’s introduction informs the reader that the author is going to make a coherent connection between the past and the future methods of treating substance abuse (Straussner, 2012). The author of this article is able to prove this hypothesis throughout the article. The author begins the article by looking into the history of substance abuse treatment. In this section, the author offers some pertinent information to clinical practitioners. For instance, the article looks back into the era when substance abuse began being recognized as a universal health and social issue. According to the article, substance abuse was initially considered as a social issue before it became a clinical matter. This information is quite helpful to clinical practitioners who might be in the habit of approaching substance abuse only from a clinical point of view. Understanding the connection between social and clinical aspects of substance abuse is vital for stakeholders in the fight against drug addiction.

Straussner’s article offers useful insight into the current treatment methods for alcohol and other drug addictions. The information that is provided by the article is accurate and up-to-date. For instance, the article explores various addiction management and treatment methods. Social workers are likely to encounter most of the treatment methods that are outlined in the article. It is important to note that the two most popular addiction treatment methods are included in the article. In social work, practitioners are most likely to encounter two substance abuse treatment methods; the twelve-step facilitation therapy and cognitive behavioral therapy. The author of the article also does a good job in outlining scenarios where each treatment method is most appropriate. For instance, the author notes that contingency management requires a lot of social resources for it to be effective. In addition, the article recognizes that because most drugs are illegal, some drug treatment methods such as harm reduction lack government support.

The exemplary case study that is offered by the author has a narrow focus and it might not be beneficial to social workers. The case study focuses on various generations of substance abusers but the author fails to address the connection between the three generations. For instance, the woman in the case study has an alcoholic father and a drug-abusing daughter. Consequently, a competent social worker recognizes that a psychological-focused method of treatment would be most viable method. In Lydia’s case, pharmacotherapy would be most suitable as a secondary treatment method. The case study puts emphasis on pharmacotherapy at the expense of the more effective psychosocial approaches.

The article’s title is “Clinical Treatment of Substance Abusers Past, Present, and Future”. However, the author of the article addresses the future of substance abuse treatment in a summarized manner. The title of the article promises to engage readers in a comprehensive exploration of the future of clinical substance abuse treatment but the author does not deliver on this promise. Furthermore, the article only addresses the future of substance abuse treatment in a simplistic manner whilst avoiding hypothesizing on complex outlooks. It is also important to note that most of the strategies that the author considers to be futuristic are current. For example, scientists have already embarked on comprehensive studies on brain functions with the view of solving substance abuse problems (Carroll, Ball & Nich, 2006).

Another article that addresses the subject of clinical substance abuse is one by a group of clinical psychologists. The article is titled “A Randomized Clinical Trial of Behavioral Couples Therapy Versus Individually Based Treatment for Women with Alcohol Dependence”. According to the authors of this article, Behavioral couples therapy and Individual behavioral therapy produce different results when they are employed on women with alcohol addiction problems (Schumm, Kahler & Muchowski, 2014). However, the article notes that mixing couples and individual behavioral therapy produces better treatment results. The article also notes that overall, behavioral couples therapy is better than individuals behavioral therapy.

This article is important to a social worker because it offers credible information on the types of therapy that work best on female clients. Current research indicates that the number of women with substance abuse issues is on the rise (Miller & Rollnik, 2013). Consequently, there is demand for research data that addresses clinical substance abuse remedies that are women-centered. The research findings that are presented in this article can be utilized by social workers when they are dealing with family-related substance abuse problems. For instance, a social worker might have to deal with a child who has an alcoholic mother. Therefore, the social worker can enlist the support of the father to institute behavioral couples therapy.

The other article that addresses the issue of clinical substance abuse is authored by Edle Ravndal and Per Vaglum. The article is a study that focuses on the follow-up treatment of substance abusers over a seven-year period. According to this article, personality disorders are important considerations when pursuing clinical treatment for substance abuse (Ravndal & Vaglum, 2009). In addition, the article also presents research findings that indicate that self-reporting instruments are reliable in the course of clinical treatment of substance abuse. Therefore, the information provided in the article suggests that social workers are at liberty to rely on their clients for information that might be useful during substance abuse treatments. However, the authors of the article indicate that there is a valid degree of error when practitioners are using information that is gathered through self-reporting. For example, in a hypothetical situation, a social worker might be dealing with a drug user who claims that he/she has not had a relapse over a certain period of time. The only way for the social worker to find out if this information is true is through the use of tests. Nevertheless, the social worker can use the information provided by the drug user as part of treatment data and it will be reliable to a certain extent.

References

Carroll, K. M., Ball, S. A., & Nich, C., (2006). Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: A multisite effectiveness study. Drug and alcohol dependence, 81(3), 301-312.

Miller, W.R., & Rollnik, S. (2013). Motivational Interviewing: Preparing People for Change. New York: Guilford Publishing.

Ravndal, E., & Vaglum, P. (2009). The Millon Clinical Multiaxial Inventory II: stability over time? A seven-year follow-up study of substance abusers in treatment. European addiction research, 16(3), 146-151.

Schumm, J. A., Kahler, C. W., & Muchowski, P. (2014). A randomized clinical trial of behavioral couples therapy versus individually based treatment for women with alcohol dependence. Journal of consulting and clinical psychology, 82(6), 993.

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Introduction

• Opioid crisis – a serious public health issue;
• Opioids commonly abused;
  • Heroin & prescription opioid medications, e.g., codeine;
• Highly addictive – induce endorphin release (Mayo Clinic, 2018);
• Opioid abusers are a vulnerable population:
  • Potential addiction & mental disorders;
  • Injection-related infections & death from overdose;
  • Limited access to addiction interventions.

The rising rate of opioid use raises serious public health concerns. The potential for addiction to opioids like heroin and prescription medications for short-term pain relief, such as methadone, is high (Hahn, 2011). These substances bind to opioid receptors in the brain to induce endorphin release, which causes short-lived pleasure effects (Mayo Clinic, 2018). Besides the risk factors that lead to opioid misuse, issues of addiction, mental disorders, injection-related infections, overdose deaths, and limited access to treatment make opioid abusers a vulnerable population.

Health Risks & Substance Abuse

• Known health risk of opioid use are:
  • Injection-related infectious diseases, e.g., hepatitis C & HIV/AIDS (Dan & Giroir, 2018);
  • Overdose deaths – oral/parenteral route causes a fast release;
  • Drug dependence & addiction (Mayo Clinic, 2018);
  • Opiate withdrawal symptoms;
  • Psychological effects: euphoria, respiratory depression, etc. (Dixon & Xiong, 2018).

Substance abuse is linked to poor health outcomes. Dan and Giroir (2018) identify injection-related infections, such as hepatitis C and HIV/AIDS, and deaths resulting from a drug overdose as the primary effects of opioid abuse. Specifically, oral or parenteral administration causes a fast release of these formulations, resulting in euphoric states, respiratory depression, and suppressed pain sensation (Wixon, 2018). The short-lived pleasure effects associated with opioid use increases the risk of repeated abuse and addiction (Mayo Clinic, 2018). Other health risks include decreased gastrointestinal motility, nausea, and vomiting.

Relative Statistics

• Disparity – disproportionate burden of disease & mortality:
  • According to the CNN Library (2018):
    • >2 million people – opioid dependent;
    • >64,600 overdose deaths: 66.4% opioid-related;
    • >300,000 opioid overdose deaths since 2000 (The White House, 2018).
• Fivefold rise in opioid overdose mortality (Dan & Giroir, 2018):
  • Hepatitis C prevalence in abusers tripled: 2010-2016 (Dixon & Xiong, 2018).
• In 2015, >97m people abused prescription drugs (Dixon & Xiong, 2018).

Disparities in morbidity and mortality rates exist between substance abusers and other populations. The CNN Library (2018) estimates that over two million people are either opioid dependent or have misused prescription drugs. Overdose deaths in this population are about 64,600 annually, adding up to 300,000 mortalities since 2000 (The White House, 2018). A threefold increase in hepatitis C prevalence among abusers was reported between 2010 and 2016 (Dixon, 2018). A fivefold increase in opioid overdose mortality was recorded over the same period.

Health Impact

• Social issues related to opioid use:
  • Opioid addiction & dependence;
  • Stress, domestic violence & abuse;
  • Unproductive society;
  • Family or marital problems;
  • Poor educational outcomes – young age;
  • Problems with law enforcement (antisocial personality);
  • Risk of injection-related infections;
  • Mental disorders:
    • Comorbid mood/anxiety disorders, e.g., paranoid disorder & borderline disorder.
  • Risky or thrill-seeking behavior;
  • Heavy tobacco use;
  • Severe depression or anxiety;
  • Risk of fentanyl poisoning – cocaine adulteration (Katz, 2017).
• Environmental issues – vulnerability results from:
  • Poor or disadvantaged neighborhoods – Appalachia:
    • High overdose deaths in Appalachia & New England (Katz, 2017).
  • Limited access to quality treatment;
  • Lower literacy levels – social status;
  • Social exclusion and isolation;
  • Environmental stress – dull environments;
  • An influx of cheap opioids, e.g., fentanyl.
• Economic issues: increased health utilization costs:
  • Cost of addiction & treatment:
    • More physician visits;
    • Mental health services – $6bn for opioid 2018 programs (CNN Library, 2018);
    • Hospital admissions;
    • ED visits;
    • Physical or emotional trauma;
    • Substance abuse therapy (Hahn, 2011).
• Economic issues:
  • Medical expenses – treatment of comorbidities – hepatitis C:
    • High prescription costs: >5 times that for nonabusers;
    • Drug dependence.
  • Legal ramifications – drug-related crime;
  • Wages and employment – unproductive society;
  • Absenteeism from work:
    • Reduced productive time.
  • Fatal cost – overdose-related deaths.
• Cultural issues:
  • Lifestyle appeal – nonmedical opioid use (euphoria):
    • Administration: snorting (62%) & IV (26%) (Hahn, 2011).
  • Misuse of prescription (pain relief) drugs;
  • Relief from stress;
  • Peer influence;
  • Availability of cheap opioids;
  • Poor regulatory safeguards.

Opioid use is linked to various effects on social health. First, it leads to the problem of opioid addiction or dependence that affects normal functioning. It also a risk factor for psychological stress, domestic violence, and abuse (Dixon & Xiong, 2018). Opioid addiction often predisposes individuals to poverty, unemployment, and family problems or broken relationships due to impaired social functioning. Young abusers are likely to report poor educational outcomes and criminal behavior or legal problems. The risk of infections, including HIV/AIDS, is also high because of the sharing of injection needles among addicts.

Other social consequences of substance use include a predisposition to psychiatric disorders, including comorbid mood and anxiety disorders. Poor mental health is a serious problem faced by users that impacts their relationships and well-being in the society. Opioid abusers may also exhibit risky or thrill-seeking behaviors, exposing themselves to health hazards or sexually transmitted infections. Recreational use of opiate derivatives or prescription drugs will lead to heavy tobacco use, which increases the risk of respiratory problems and lung cancer (Katz, 2017). These chronic conditions reduce the productivity and quality of life of the addicts. It also increases the risk of fentanyl poisoning due to cocaine adulteration.

Opioid use affects and is shaped by a host of environmental factors. It is highest in poor or disadvantaged regions. Katz (2017) demonstrates that trends in opioid use show a geographical variation with disproportionate overdose deaths reported in impoverished areas such as Appalachia. These regions have a limited access to treatment, lower literacy levels or social status, and an influx of cheap opioids like fentanyl. Exposure to environmental stress also increases the likelihood of substance use. Dull environments that are devoid of opportunities for interpersonal interaction and support can also predispose individuals to substance abuse. Social exclusion and isolation of addicts render them homeless and destitute.

The economics of opioid use highlight the scope of the problem of substance abuse and its impact on the healthcare system. Opioid addicts make more physician or ED visits than non-users do. They are also heavy users of inpatient mental health services, trauma care, and substance abuse therapy (Hahn, 2011). Medical costs for this population is up to “eight times higher than for non-abusers”, i.e., $15,884 versus $1830 per individual (Hahn, 2011, p. 109). Thus, the cost burden of opioid abuse to the health care system and health insurance is significant. Increased federal spending on addiction treatment and rehabilitation will affect primary care in other critical areas.

The medical expenses related to opioid use have a significant impact on the healthcare system. Specifically, the treatment costs for comordities, such as hepatitis C, and fantanyl poisoning are higher among abusers than non-abusers (Hahn, 2011). There is also the issue of high spending on prescription drugs. Another economic aspect is the legal ramifications of opioid use. Abusers are more likely to engage in crime, straining law enforcement resources and correctional facilities. Opioid abuse creates an unproductive society, increases absenteeism from work due to drug dependence effects, and can lead to death.

A number of cultural stressors aggravate the problem of opioid abuse. A culture of lifestyle appeal drives many people to use nonmedical opioids for relaxation and euphoria. The preferred routes of administration by 62% and 26% of users include snorting and injection, respectively (Hahn, 2011). The misuse of prescription drugs without physician directions, availability of cheap opiate derivatives, and poor regulatory safeguards are other cultural issues exacerbating this problem. The nonmedical use of opioids is meant to bring relief from stress and pain. Peer influence and alcohol abuse also contribute to the abuse of hard drugs, including opioids.

Recommendations

• Improving the health outcomes of this population:
  • Physician & patient education:
    • Screening, intervention, referral, & opioid treatments (SBIRT) (Hahn, 2011);
  • Prescription monitoring programs:
    • Reduce abuse practices;
    • Reporting opioid abuse to law enforcement;
  • Proper patient identification at the chemist;
  • Multidisciplinary pain management:
    • Routine checks to deter abuse;
• The release of abuse-deterrent formulations:
  • Slow-release properties.
  • Neutralizing antagonists.
  • Unpleasant side effects (Hahn, 2011).
• Controlled opioid distribution.
• Access to addiction treatments, e.g., methadone (Katz, 2017).
• Safe injections:
  • Medical supervision of injection-drug addicts.

Diverse measures are recommended for improving the health outcomes of opioid abusers. Physician education on effective tools for screening, intervention, referral, and treatment (SBIRT) can help identify and help at-risk individuals (Hahn, 2011). Provider-led prescription monitoring programs can be crucial in reducing abuse practices. These measures may involve reporting patients abusing opioids to law enforcement. Proper identification of the patient at the point of sale is recommended to restrict or control nonmedical use of these drugs. Additionally, multidisciplinary pain management approaches can also improve this population’s health outcomes. Referrals to specialists that use alternative methods will help curb the problem of opioid and prescription drug abuse.

Supply-side variables can also help improve the health outcomes of substance users. Pharmaceutical firms are developing drugs that could counteract the effects of opioid abuse and addiction. Among the mechanisms of action considered in designing these formulations are slow-release properties, neutralizing antagonists to deter overdose, and unpleasant side effects at high dosage levels (Hahn, 2011). Other measures with a potential to reduce the health outcomes of the abusers include controlled distribution of the drugs and the provision of addiction treatments like methadone (Katz, 2017). Medical supervision can also ensure safe injections to prevent infections such as hepatitis C and HIV/AIDS.

Policy Changes

• Adequate appropriation for medication-based addiction treatment (Katz, 2017).
• Removal of barriers to Medicaid coverage.
• Legislations promoting private health insurance.
• Prosecuting prescribers flouting the law.
• Electronic prescribing policies at the hospital level.
• Safe opioid prescribing.
• Severe penalties for drug trafficking.
• Preventive measures – educating people on opioids & effects.

Policy changes are required to tackle the opioid crisis in the country. In this view, ensuring adequate appropriation for medication-based addiction treatment and removing Medicaid barriers to inpatient care for addiction are necessary (Katz, 2017). Mandatory coverage of addiction-related treatment by private insurers would also improve the outcomes of opioid addicts. Prosecuting prescribers flouting the FDA-approved dosage levels would deter substance misuse. At the hospital level, electronic prescribing would prevent medication errors. Severe penalties for drug trafficking and awareness programs can also prevent opioid abuse.

References

CNN Library. (2018). Opioid crisis fast facts. Web.

Dan, C., & Giroir, B. P. (2018). Integrating infectious disease prevention and treatment into the opioid response. Web.

Dixon, W. D., & Xiong, G. L. (2018). Opioid abuse. Web.

Hahn, K. L. (2011). Strategies to prevent opioid misuse, abuse, and diversion that may also reduce the associated costs. American Health & Drug Benefits, 4(2), 107-114. Web.

Katz, J. (2017). Short answers to hard questions about the opioid crisis. The New York Times. Web.

Mayo Clinic. (2018). How opioid addiction occurs. Web.

The White House. (2018). The opioid crisis. Web.