Does Interventions for Substance Abusers Help - Essay Example

Running Head: Health Care Practice Interventions For Substance Abusers: Does It Help of Introduction Substance abuse and dependence has become one of the most important areas of concern among the social and health care systems. The "compulsive need to take a drug despite awareness and experiencing of serious adverse affects" marks the personality of a drug addict. (Volkow, 2004) The effect of this abuse is apparent in many areas of life, and includes health and social concerns, the emotional and mental anguish to the patient and the persons close to them, and the effects it can produce on a broader scale on the different sectors of life. Also, the recent researches point to the severe and long lasting changes that can take place in a person due to drug abuse as well as improper and loss of voluntary control. (Volkow, 2004) Both drug abuse and dependence are taken as separate entities in medicine. Addiction is defined as the "intense desire for the drug with and with an impaired ability to control the urges to take the drug even at the expense of serious adverse consequences." (Volkow, 2004) Similarly, drug dependence is defined as the "withdrawal symptoms seen in patients after the discontinuation of the drugs take place, but demonstrate different adaptation patterns seen in drug addicts." (Volkow, 2004) The efforts that have been put into this issue are substantial all over the world. This issue is not a problem of one area or civilization only, but affects all the societies in more or less some way. The efforts have been largely in educating the general public about the negative effects of substance abuse, the health care plans curtailing to the needs of the abusers and dependants, social counseling and help for people related to these sufferers, and psychological and mental health provisions so as to avoid any social issues like abuse, violence etc. The questions that are put on such efforts are simple. Do they work And of these efforts, which do and which don't. Apart from researches related to the psychological factors and medical paraphernalia related to substance abuse, it is now under study to find out the advantages of the different interventions in actually reducing drug and substance abuse. More so what evidence is present that supports interventions This report focuses on the evidences collected from various studies and reports and evaluates the impact and future aspects of these interventions. The report is formatted to highlight the issue and the different consequences of substance abuse and dependence. This report focuses on the issue of substance abuse and dependence in the UK, and therefore evidence pertaining to UK. It highlights the different strategies that are being undertaken in health and social care sectors. It looks into the needs of patients with substance abuse and dependence, the different studies that have been conducted with results. It is hoped that this study will contribute in making a clearer picture regarding interventions for substance abuse and dependence. TYPES AND HEIRARCHIES OF EVIDENCE. Substance abuse and dependence is becoming a prevalent and increasingly dangerous feature of the modern society. This issue sadly, has encompassed a large variation of age groups, including adolescents, teens, adults and the elderly. (Drug Abuse, How It Can Be Reduced 2005) Many factors make up this picture, and factors such as cultural aspects, availability, frequency, and use must also be taken into consideration. The management of such cases therefore becomes all the more difficult, as the factors that predispose these age groups to substance abuse are variable. The interventions are very variable, and therefore, an issue of debate in all countries of the world as to which are better suited to the needs and cultural and social norms of the societies. The debates revolve around issues of availability of drugs and methods of reducing, preventing and eliminating drugs. (Drug Abuse, How It Can Be Reduced 2005) Some state that emphasis should be placed on reducing the circulation of drugs, where as others approach the matter from the curing point of view, that is how to manage such cases and reduce incidences of consequences like HIV and AIDS etc. (Drug Abuse, How It Can Be Reduced 2005) The current statistics available are very dim. With time these substances are getting more and more concentrated or purified, and despite the expected reduction in the production rates of cocaine and such substances from the leading substances producing countries of the world, saved stock piles still remain. The number of illicit drug users has increased to 200 million worldwide, of which 200,000 people have fallen victim to the dependence. (Drug Abuse, How It Can Be Reduced 2005) Added to the confusion is the generation of synthetic opioid, which are far more concentrated and far more easily available to the consumer. Electrostimulation is becoming another increasingly popular method of brain stimulation akin to taking drugs. No significant controls have been placed as yet in this area. (Drug Abuse, How It Can Be Reduced 2005) There are many substances that are defined as abusive or dependant substances. These include alcohol, cannabis, cocaine, marijuana, heroine, ecstasy etc. Drinking is perhaps one of the most prevalent of these substances, which in an individual can occur in a variety of forms. Types of drinking include every day excessive drinking habits, intoxication due to excessive consumption, health deterioration as a result of drinking habits, and dependency. (WHO, Screening and Brief Intervention for Alcohol Problems in Primary Health Care, 2007) To address the issue, WHO has proposed and implemented the system of audit or screening in many countries of the world. By doing so, WHO aims to identify individuals who are in extreme need for dependence and abuse treatments due to excessive alcohol consumption In collaboration with the primary care setups, it aims to reduce and treat successfully cases of dependence. (WHO, Screening and Brief Intervention for Alcohol Problems in Primary Health Care, 2007) When considering cases of parents who are in substance abusers and dependants, the picture suddenly becomes very wide. It is not only the individual who becomes affected but also his or her children. This makes parents unable to provide the necessary needs of the child while he or she is growing up, resulting in the breakdown of the social fabric.(SCIE, 2004) Many methods have been introduced in order to address the issues of dependence. These interventions take many forms and have been designed to address the needs of the patients as individuals. Since the susceptible age groups for substance abuse are highly variable and have different issues, pressures and needs, the plans have been tailor made to address each age group in its own manner. (NHS & NTA, 2007. Treatment Planning for Adult Services.) THE RESEARCH PROCESS: The sources were gathered from various medical journals and libraries, which focused on the particular issue of advantages of interventions in substance abuse. The UK archives were searched mostly, but some of the literature was also looked up from US sources. The journals used in the search mainly included searching archives from psychiatric journals, epidemiological journals and WHO reports on the matter. Along with these other searches looked up were under the headings of the cognitive and behavioral changes within different age groups of populations, as well as the effects of various mental illnesses in the probability of increasing or causing drug abuse. The search engines used in the internet search included google, Athens, questia and student central, and full text articles with relevant citations and references were selected. Abstracts were not included in the documentations. The journals related to medicine, sociology and epidemiology and psychiatry were the main areas of research, with some studies being more referred into the report due to their authenticity and the amount of evidence and insight that they helped in developing in the report. The researches carried out included the epidemiology of substance abuse and the effects on the individuals, both medically and socially. As the prevalence of substance abuse in UK is highest amongst children and adolescents, therefore more room has been given to it in order to outline the reasons for such increased incidences and prevalence. World Health Reports have been studied and included where appropriate, in order to devise a clearer picture of the current situations and challenges. Key words for researches included advantages of health care interventions in substance abusers, evidence based medicine, rates of increase or decrease in substance abuse in UK, neurological and psychological outcomes and reasons for substance abuse, substance abuse epidemiology in UK and other such related searches. CRITICAL APPRAISAL OF STUDIES There are many studies that are now identifying as to what leads to drug abuse and dependence in a particular person. The genetic factors which were not considered a contributory factor in the probability of drug abuse, now occupy up to 60% effects, meaning that genetic factors are one of the most prevalent causes which drive a person towards drug abuse. (Volkow, 2004) These are then aided with the various environmental factors, which include low socioeconomic status, and low parental support, along with the ease with which the drug can be available. This risk becomes all the more in cases who demonstrate some form of mental illness. And can show different types of relationship with it. Such studies have clearly pointed out that by preventing and treating various mental illnesses at an early age, one may be able to reduce and prevent new cases of drug abuse and dependence. (Volkow, 2004) The stubbornly rising numbers of substance abusers and dependents in the younger generations of US and Europe (with increased incidents in UK) leaves little doubt for the need to addressing the issue. (Fischer, McArdle, Crome, 2003) Such cases become largely ignored in essence, and may become evident for routine examinations relating to "intoxication, accidental or violent injury, self harm, sexually transmitted disease, teenage pregnancy and psychiatric disorder". (McArdle, 2004) Usually such cases arise due to different social issues affecting the child and adolescent which are acting as destructive elements for the child's psychology. The themes are mainly family based, where conflicts of parents and children, issues of parents, abuses in the form of physical, sexual and mental abuse, and factors such as declining or poor performance in the different aspects of school education. (McArdle, 2002) The above mentioned factors are a clear indication of examining and observing a child if he or she is undergoing such turmoil, and when assessing the root causes of the child's inclination to the substance abuse. By understanding the core issues of the child, better progress can be made in helping and guiding such individuals with fewer chances of relapses or reversals in the treatments. The effects that can occur in the youth as a consequence to substance abuse can include "dependence, use of other substances, physical consequences, reduced cognitive performance with mental illnesses including schizophrenia." (Fergussen, 2000 and Bolla, 2000) These can be then followed by "sexual disinhibition and teenage pregnancy issues, self harm upto and including death." (Schiffano, 2000) Study 1: There are many intervention studies carried out on young drug abuse patients that vouch for the success of prevention and healing of drug abusers. The numerous reviews were carried out by selecting studies and correlating their results. Vaughn and Howard (2004) conducted a study that reviewed many of the studies carried out by different institutes and organizations regarding intervention therapies for adolescents and young adults. Their methods included a total of 15 studies, of which 13 consisted of randomized control trials. The time frame of these studies was variable, which was from 4 weeks to 44 weeks in duration. The narrative analyses of this study included many aspects of drug abuse and dependence which included different forms of therapies applied the cognitive behaviour therapies, and coping and life skills trainings. (Vaughn & Howard, 2004) Vaughn and Howard were able to conclude that psychosocial interventions were one of the best methods in treating substance abuse patients especially in adolescents. They were specifically able to show the positive benefits of family therapy and cognitive behaviour therapy. (Vaughn and Howard, 2004) Vaughn's study was perhaps one of the stronger studies when compared to others. This was because the inclusion criteria were able to include a variety of age groups and gender and ethnic persons, giving it a variety as well as a general outlook. However, the studies mainly included more males than females, and many of these had some history of trouble with the law, and some were on probation. Majority of the participants included persons from the lower socioeconomic status. (Vaughn & Howard, 2004) This inclusion of the wider variety gave it a more characteristic depth and helped in identifying the different aspects of the intervention therapies. With time evidence is increasing that the use of cannabis is the most prevalent in the UK population. Cannabis is highly dangerous due to its effects of dependence on the user. Cannabis, mainly used as a relaxant or social gathering is used be more than a quarter of the 16 year olds in UK along with high figures in the older age groups. (Maddock & Babbs, 2006) And for such cases, it has been seen that conducting therapies such as "motivational interviewing, cognitive-behavorial therapy, and relapse preventions" indeed improve the outcomes of the patients. (Maddock and Babbs, 2006) Many studies are now available that have shown effectiveness of intervention strategies in the coping of such cases. Among the first successful research studies was from Stephen and his colleagues in 1994, which proved the increased ability of the patients to resist substance abuse as a result of cognitive therapy. (Stephen, 1994) A similar study in these patterns by Stephen also demonstrated the efficacy of group discussions and individual counseling in reducing substance dependence. Study 2: The second significant study regarding the efficacy of intervention techniques comprised of a review that was carried out by Williams and Chang in 2000. William and Chang studied the studies which introduced a variety of intervention techniques for persons who were poly drug users.(Williams & Chang, 2000) 8 studies were related to the study of the effects of intervention therapies on drug abstinence, where as 13 studies reviewed the effects of intervention therapies on the reduction of substance abuse. The interventions included in-patient and out patient intervention techniques, community and counseling programs and family therapy. Williams was successful in demonstrating the most positive effect of interventional therapies in substance abstinence and reduction in many of the patients, which was as high as 40% at the end of six months therapy. And these incidences rose to about 60% at the end of the year. (Williams and Chang, 2000) William, like Vaughn, was able to show the most effective therapy to be family therapy, and was able to show that therapies are better to help in prevention than no therapies. (William & Chang, 2000) The study was although a successful one, but lacked in some respects. For example, there was no accounting of follow ups, no control groups, and the results did not include dropouts. Most of the reports obtained about abstinence and reduction were gathered from the parents and not the cases themselves. In many of the studies, although the follow-ups were conducted, they were either too short termed or too long termed. (Williams & Chang, 2000) Budney in 2000 explored with success the possibility of implementing contingency management as an aid to psychological therapies normally instituted to such patients. (Budney, 2000) FACTORS AFFECTING EVIDENCE BASED PRACTICE When considering the efforts and researches regarding preventive strategies, it is saddening to find that not much effort has been put in assessing the implications of preventive programs. It is now a well known fact that substance abuse is increasingly seen in cases of mental illnesses. And in case of cannabis evidence points to it being a promoter of schizophrenic state of the patients. (Blow, 2004) Brief interventions were designed to help an individual identify his or her own abuse problem and in doing so motivate him or her to quit it.(WHO, Screening and Brief Intervention for Alcohol Problems in Primary Health Care, 2007) The application of this system has been carried out in many countries with many positive results. Perhaps the reasons of its success and increased implementation laid in the facts that these strategies were highly cost effective along with increased cure rates and ease of administrations. (WHO, Screening and Brief Intervention for Alcohol Problems in Primary Health Care, 2007) The different phases of this strategy aim in concise manner to address the issues of the individual and to restore him or her in a healthy state to the society. Interventions in the case of children substance abuse would include adequate history taking, acquisition of correct information from the patient and referring cases according to their needs. Medical history taking and approach however, is not successful if true results are desired. A familiarization with the background of the case, as well as recognizing and eliminating the causes of his or her state must be recognized by the practitioner, and addressed as per need. This clearly demonstrates the complex nature of the problem and the efforts that must be placed in helping such individuals. (McArdle, 2004) Such issues can also be addressed via different liaisons between different parties and by utilizing the services of support agencies and juvenile justice systems. The studies demonstrate remarkable improvements in children and adolescents. This may or may not be followed up by a "substitution therapy", in which the doctor may prescribe a drug, within safe limits, as an alternative to the substance, and gradually tapering off. This technique is now termed as the "pediatric addiction medicine." (McArdle, 2004) Evidence based medicine sprung out from the observations that researches made applications in real medicine decades after institution, leading to tremendous loss to time and resources, with inestimable amount of morbidity and mortality. (Panzano & Roth, 2006) Although it has been given much approval from various health care circles, it is still too early that evidence based medicine become a norm in health care settings. The problem gets complicated due to the complex political issues, cost benefit issues, and strategic outcomes. (Hebert & Langely, 2002) These practices can be classified as "independent and substitute practices." (Hebert & Langely, 2002) The risks associated with evidence based management include factors like "utility, scientific evidence, evidence from the field, relative advantage etc. "(Hebert & Langely, 2002) It is perhaps still too early to judge the effects that evidence based medicine can have in treating cases of substance abuse, however, psychiatric and mental care provision in individual cases may no doubt provide a positive improvement in such patients. REFLECTION ON LEARNING By implementing interventional therapies in to the health care system, it will be much easier to follow-up and closely monitor the patients. Interventional therapies have not been a very significant part of the primary care practice, and the only area that seems to be working is the emergency treatment or pharmaceutical therapies that are instituted to such patients. Not much importance is given to the social and behavioral modification techniques that may in fact, have more benefits than just giving supplemental treatments. The primary health care sector is the most active and the most exposed health care sector to a majority of the patients, and can be highly contributory in not just assessing and contributing to the identification of drug abuse patients, but will be the most efficient place and method to deal and treat it. With more and more accumulation of the information in this matter, primary care can then be able to give valuable insights and suggestions about the ways substance abuse and dependence can be identified and treated. Simply put, primary health care sector is one of the main contributors in treating cases of dependence and substance abuse, but its full potential still needs to be recognized and implemented. Motivational interviewing, coping strategies, and relapse prevention are some of the areas that can be easily incorporated within the primary health care setup. Motivational interviewing helps the patient in increasing his or her will power to rid of the abusive substance. It involves four principles, expression of empathy to the patient, developing discrepancy, offering new and different perspectives to the patient regarding his or her condition, and supporting his or her own self efficacy. The method has been successfully implemented with good results obtained so far. (Maddock and Babbs, 2006) Coping strategies are based on four principles of "delaying, distracting, de-catastrophising and de-stressing" (Maddock and Babbs, 2006) Relapse prevention, as described by Marlatt and Gordon (1985) state that this implementation is aimed at cases that have proven resistant to normal methods of substance abstinence, or cases who have demonstrated frequent relapses. By helping the patient get through the different low phases of abstinence from abuse, the practitioner is able to help the patient recover from the condition at a quicker pace. (Marlatt and Gordon, 1985) CONCLUSION: The list of such interventions is still growing, as newer methods and approaches are being applied in handling cases of dependence. All in all, many benefits can be expected from such interventions, in terms of financial implications and savings, reducing mortality, morbidity, and health care, and in terms of the social benefits that such implications can provide. The application of evidence based practice can be highly beneficial to the substance abuse therapy strategies; however, research and planning must be put into it. As far as understanding the role that substance abuse interventions has in prevention of new cases. It is now widely believed that by early institution of such efforts in different school and educational and social programs will help in preventing new cases from developing. Also by constant screening and evaluation of the different populations can also be helpful in identifying and treating such cases. Special follow-up of cases who are suffering from any form of mental illness predisposing him or her to substance abuse is also important and can show considerable success. By increasing awareness within the population about the negative effects of drug abuse, one may be able to reach out to more people than done alone; in this regard the role of media can be very helpful. By understanding the different interventional therapies and by instituting such, the patient as well as the family and the close circle of the patient will be better able to cure the patient back to health. The role of interventional therapies is gaining wide acceptance with positive results. The need now is to positively implement such findings and along with other methods, be used in the prevention and healing patients who have become victim to drug and substance abuse. References Fredric C. Blow, Stephens J. Bartels, Laurie M. Brockman, Aricca D. Van Citters. 2004. Evidence Based Practices for Preventing Substance Abuse and Mental Health Problems in Older Adults. http://www.samhsa.gov/OlderAdultsTAC/EBPSuicidePreventionsectionFINAL.pdf Retrieved January 11, 2007 Bolla K, Brown K, Eldreth D, et al. Dose-related neurocognitive effects of marijuana use. Neurology 2002;59:1337-43 Budney, A. J., Higgins, S. T., Radanovich, K. J., et al (2000) Adding voucher-based incentives to coping skills and motivational enhancement improves outcomes during treatment for marijuana dependence. Journal of Consulting and Clinical Psychology, 68, 1051-1061 Denis, JL Hbert Y, Langley A, et al: Explaining diffusion patterns for complex healthcare innovations. 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