Harm-Reduction Interventions in British Substance-Misuse Services - Literature review Example

Introduction Harm Reduction or harm minimization is one of the most critical aspects of public health policies wherein the overall focus of the policies is on how to reduce the harmful impacts of the recreational drugs or even other high risk/high impact activities. It is critical to note that various studies have indicates the emergences of HIV/AIDS as the direct result of the failure to take appropriate measures. Developing countries or rather poor countries therefore have the largest incidences of the HIV/AIDS due to injection needle insertions causing further complications. In order to overcome harms and complications, it is always important that a comprehensive harm reduction program is planned and executed in such a manner that it minimizes the harm. A comprehensive harm reduction program or activities therefore always aim to take a broader view of the drug use and how it can create harm and what actions can be taken to reduce such harm. Harm reduction therefore does not need to fall into the ambit of harm to the health only however, the social and economic affects of such harm shall also be accounted for.( Dahlgren and Whitehead,1991). It is because of this reason that any initiative aimed at harm reduction must be comprehensive enough to cater to different and diversified determinants of the harm reduction. This literature review will therefore focus on the harm reduction interventions in Britain substance misuse services by reviewing the policies and programs and actions that have been undertaken to reduce the harm associated with the drug use. Harm Reduction UK Harm Reduction Alliance (UKHRA) defines harm reduction in really broader terms and includes really a diversified set of terms to explain and define the term. This definition is however, borrowed from the work of Newcombe who defines harm reduction as “Harm reduction is a term that defines policies, programmes, services and actions that work to reduce the health; social; and economic harms to individuals; communities; and society that are associated with the use of drugs” (Newcombe 1992) The above definition of harm reduction therefore indicate that harm reduction encompasses policies and programmes that are basically aimed at reducing the impact of drug use not only on the individuals but also on the communities as well as a society as a whole. Further, the overall range of harms includes health, social as well as economic harms that can potentially damage not only an individual’s life but also affect the society as a whole. It is critical to note that the use of drugs is considered as a normal phenomenon as it carries lot of health related benefit. As such the harm reduction is considered as pragmatic because it accommodates the use of drugs and does not try to eliminate the use of drugs. This also requires that the drug reduction programs shall carry the kind of humanistic values required to understand and appreciate human values while at the same time set out radical changes that must be aimed at reducing the harmful affects of the drugs. Theoretical Frameworks In order to discuss the issue further, it is important that the harm reduction must be discussed from the perspective of theoretical frameworks. This is because of the fact that any policy initiative, if backed up, theoretical frameworks tends to make greater impact and its results can be easily measured. Further, theoretical frameworks are considered as critical because they offer an opportunity to explicitly formulate the overall aims and strategies that underlie any policy response to any significant issue. It is important to note that most of the health promotion policies are deeply rooted into the realm of sociology, education, as well as psychology and therefore most of the policy responses are also primarily based on such fundamental theoretical knowledge bases. Based on this, there are almost five different types approaches to health promotion including behavioral change etc. Thus the theoretical models of health promotion basically attempt to discuss as to how the health shall be promoted and what parameters shall be considered to make a health promotion initiative a successful one. Beattie’s Model is one of the most important models providing structural analysis of how the health can be promoted. This model relies on 4 different paradigms generated through the overall dimensions of the different modes of the intervention. These four paradigms are: (Beattie, 1991) 1. Health Persuasion Technique 2. Legislative Action 3. Personal Counseling 4. Community Development The above four paradigms are therefore considered as essential for the intervention and promotion of health and any subsequent efforts shall be based on the above. It is critical to understand that the harm reduction initiatives, according to this framework, are often generated through negotiated paradigms. Negotiated paradigm respects the individual autonomy and it is a bottom approach wherein the health promotion work is practiced through practitioners who basically embark on to disseminating the required degree of information as well as knowledge to the individuals to responsibly use the drugs. ( Robotham & Frost, 2005). What is also critical to understand that Beattie’s framework provide four different topologies to be applied and as such it will be overlapping sometimes that the policy initiatives almost fall under all different topologies and overall response becomes a combined application of all the four. Health Persuasion requires the support of the professionals because it is mostly directed at the individuals therefore it requires stronger support from the professionals to carry out this dimension. Further, the legislative action, though requires the support of the professionals, however, it is always aimed at protecting the community as a whole. Personal Counseling however, is considered largely as a private issue wherein the professionals basically attempt to play the role of the facilitator to assist their clients. The final dimension is the community development wherein the overall focus is on the development of the local community through empowerment and improvements in their skill level.(Naidoo & Wills, 2001). Considering the above discussion, following section will discuss the harm reduction interventions in Britain Substance Misuse services. Few important questions such as their overall success as well as how to improve them will also be discussed. Harm-reduction interventions in British substance-misuse services Some of the estimates suggest that there is a general rise in the deaths due to drug related problems. One of the major causes of such deaths is the blood born viruses which are transmitted through the improper use of the injections and as a result they often fall prey of the diseases like Hepatitis C.(Department of Health, 2007). The overall aim of the Government therefore is to improve the health prospects of such individuals who can die prematurely due to imprudent and wrong use of injecting material. History of harm reduction interventions in UK is not new as there have been continuous efforts both at the government level as well as at the individual level to bring forth the changes required to bring positive change within the society. There are many initiatives including needle exchange programs as well as harm reduction strategies that are in practice since last many years. The Alcohol Improvement Program The Alcohol Improvement Program by the Department of health is one of the initiatives by the Department of Health. As a direct result of this program, it has also comprised of the Alcohol Harm Reduction National Support Team which is actively involved in the reduction of the Alcohol related diseases. The outcome or the performance of this team is measured by the actual reduction in the number of Hospital admissions due to alcohol related diseases. (HomeOffice.gov.uk, 2010). Department of Health also fund an online initiative “Alcohol Learning Center” where the e-learning and training is imparted to practitioners as well as others to better understand the harms of using alcohol and how to reduce its harms. (Alcohollearningcentre.org.uk, 2010). .It is critical to note this type of initiative by the government may fall under the paradigm of health persuasion wherein health professionals are duly supported by the Government and other individual groups to carry out their work and contribute towards the social and economic causes of the society. Similarly the National Alcohol strategy is a joint strategy by the home office, department of health as well as other departments of the government outlining the overall policy of the government to fight alcohol and reduce its harm. Ecstasy Harm Reduction UK also had an ecstasy reduction program wherein the efforts were put together to reduce the harms of ecstasy and other dance related drugs. The aim was again basically to target both the society as well as the individual to remain less harmed from the use of any such dance related drugs. Bristol Drug Project is an important local level project which basically helps the individuals to cope with the heroine and crack drug related harms. Under this project, professionals directly work with more than 8000 persons having serious drug related issues in Bristol area only.(bdp.org.uk, 2010). Reducing Drug Related Harm- An Action Plan Government, during 2001, launched a three years action plan to reduce the number of deaths due to the use of the drugs. This action plan was a part of the government’s strategy to cope the drug related diseases. The results of this action plan were satisfactory however, during recent past the occurrences has further increased and Government introduced another drug related action plan during 2007 aimed at reducing the deaths by the abusive use of drugs. This action plan was launched with the joint collaboration of the Department of Health and the National Treatment Agency for Substance Misuse. All Wales Needles Exchange Forum This forum is officially run by the Government of Welsh and is considered as one of the most comprehensive programs that cover a wide range service area. This forum basically service as a discussion point for the needle exchange services however it aims to not only identify the best practices but it also aims to raise the awareness as well as knowledge about the role of needle exchange. From the social perspective wherein the social determinants of health which includes the so called causes of the causes and includes causes such as individual life style, socio-economic conditions as well as living and working conditions. Needle Exchange Programs therefore aim to provide an opportunity to those to avoid harm whose socio-economic status within the society may be low. The individuals who are basically socially isolated due to any of the factors may be more prone to such use of drugs thus providing them needle exchange services near their own homes will offer an opportunity to reduce the social exclusion of the individuals besides providing an opportunity to personally counsel such individuals. This forum therefore aims to provide a complete range of services and support to all those workers and groups involved in providing needle exchange services. Further, with periodic conferences latest findings and research is discussed and shared to improve the knowledge base of the individuals and groups involved in needles exchange program. There are also other smaller online groups which basically support and provide material to the workers engaged in different projects of harm reduction. A similar forum is National Needles Exchange Forum which is basically a group of needle exchange service provider workers who are engaged into the promoting and supporting healthy life style in Britain.(nnef.org.uk, 2010). Such forums therefore are considered as the most significant in terms of providing necessary and vital support to those who are actually engaged in providing services to the community in developing its overall skill level to cope with the abusive use of drugs. Conclusion Improving public health falls within the domain of the welfare State and it becomes the responsibility of the government to steps to provide better health and social conditions to its citizens. Drug related deaths is one of the common causes of premature deaths in the country however, they can be reduced through a systematic introduction of the harm reduction programs so that the overall awareness of the abusive use of drugs can be increased. Government as well as individual groups therefore have undertaken many initiatives to plans. start and execute harm reduction programs within the country. References 1. Alcohol Learning Center [online]. (2010) [Accessed 7 May 2010]. Available from: . 2. Beattie, A (1991). ‘Knowledge and control in health promotion: A test case for social policy and social theory. In: Gabe, J Calnan, M Bury, M , (ed). The sociology of the health service, London: Rouledge, 3. Bristol Drugs Project [online]. (2010) [Accessed 7 May 2010]. Available from: . 4. Naidoo, J , Wills, j (2001). Health promotion: foundations for practice. 2nd. ed. London: Elsevier Health Sciences, . 5. National Needle Exchange Forum [online]. (2010) [Accessed 7 May 2010]. Available from: . 6. Newcombe, R. (1992) The reduction of drug related harm: a conceptual framework for theory, practice and research. In, OHare et al (Eds.) The reduction of drug related harm. London Routledge. 7. 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