Stimulant drug misuse strategies and treatment options available - Essay Example

Running head: Stimulant drug misuse treatment options and harm reduction effectiveness Stimulant drug misuse strategies and treatment optionsavailable Against harm reduction effectiveness for young people Shirley Bongbong University of UK Abstract UK drug treatment policy aims to reduce the harm to individuals and communities resulting from drug misuse. Patients were commonly referred to multidisciplinary community services, rehabilitation facilities which include prescribing and detoxification. Given the number of professional services that a misuser can drop in to seek help in stopping the addiction and its related withdrawal symptoms, U.K. has launched the harm reduction program to aid and educate the misuser on the proper use of injection equipment including dosage administration. Although it serves to provide appropriate information on the harmful effects of drugs misuse, the fear of producing professionals which are deliberately government supported substance abusers and ageing population of paramount drug tolerance concerns a lot of medical practitioners especially those thatwere commissioned for the services. This paper serves to argue the effectiveness of the harm reduction theory to fulfill reduction of criminal offense and drug misusers. There is the danger of the commissioned drug treatment services to post as accomplice to the generation of a growing population of legally walking addicts and offenders. Introduction The criminal justice system (CIS) has a large portion of arrestees in England which at their time of arrest were tested positive for one or more drugs. Almost 63% of London arrestees were tested positive for heroin or cocaine use. It is acknowledged that these drug users and offenders made up a significant proportion of the criminal justice population. Referral schemes aims to exploit opportunities provided by arrest that may lead to coerce drug users to seek treatment. Arrest referral schemes aims to bridge the gap between the CIS and treatment services by identification of drug user detainees and referring them to treatment right after arrest. Referral is not considered as an alternative to prosecution in U.K. courts. This is a proactive local treatment services strategy where drug courts seeks to combine judicial supervision, sanctions and comprehensive treatment, random and frequent drug testing part of regular case management and reviews to commissioning support services. Imprisonment in England and Wales offers drug users Counseling, Assessment, Referral, Advice and Throughcare (CARAT) services which was established in 1999. CARAT offers drug using prisoner's assessment, detoxification and access to a range of post release support services in the community. Detoxification includes counseling, abstinence programs, self-help groups and help in any event of relapse. The CIS serves as an opportunity to contact problematic drug users who had little exposure to treatment and helping services. It would appear that a minority can be helped and succeed in changing drug using and offending behavior while the majority fails. The cost effectiveness of such interventions is not yet known. Harm reduction was introduced as a double edged concept that strives to embrace social harm while all the while addressing the incidence of drug related crimes and still medically weaning a person off harmful drug-related behaviors. It is a question of being a health care practitioner of case management approach or playing games on how to address social illness. This paper examines the available drug treatments and interventions for young people including the criminal justice system and comparing it with the created harm reduction method. The effectiveness and the practicality of the system will answer the question of whose harm in shaping these drug services by harm reduction is being directed into this openly competing system. The drug clinics in UK were set up in 1968where medical practitioners in treatment centers brought heroin addicts treatment under stricter control. The thrust is to prescribe sufficient heroine in an effort to eliminate choices for black market drugs. This is being done with the hope that the addicts who had experienced contact with a clinic staff may be influenced and motivated to come off drugs in due course. The rationale behind the giveaways is to lessen offenders commit crimes to obtain funds for the drug (Fleming 1995, p. 173-177). The main benefit is a medically less complicating pure drug supply compared to the impure materials in street circulation. Then it came to the thoughts of the policy makers that a handful of over-prescribing doctors were responsible for the increase of young heroine addict's population that they replaced heroine provision with methadone injectables in 1970. They believed that some patients cannot for the time being function without the drug but who has the potential and the ability to live a normal useful life as a stabilized addict. The patients shall now be maintained in by longer acting methadone injectables rather than taking the option for drug withdrawal (Ernest 1995, p. 64-70). This action may not need frequent injections because of their long term effect. Then in 1976 oral methadone were introduced as the clinics drug of choice (Shane & Zader 1996, pp. 1765-1772). The clinics were gradually maintaining long term patients and staffs getting demoralized. It resulted to a system overload which made a dramatic shift to time-limited prescribing programs. However this led to the disadvantage of the system being a failure since unwilling addicts will always go back to using street drugs once they reached their six months methadone stabilization period. The cost of methadone as well as the cost of research and treatment centers will fulfill to shape the future of methadone maintenance Britain policy. Discussion Definition of stimulant drugs Stimulants are a kind of a habit forming psychoactive drug whose chemical substance acts primarily on the central nervous system and alters brain function enhancing neural transmission. Stimulants increase the amount of norepinephrine and dopamine in the brain neurotransmitters (Barlow et al 2005, p.390). The result of which is an increase in the blood pressure and heart rate of the user due to constricted blood vessels. Different stimulants have different actions on the body but all of them cause mental or physical stimulating effect. This is seen as an increased physical energy, clarity and speed of thought. Stimulants change the mood, perception, consciousness, and behavior of the user. Other effects include dilated pupils and decreased appetite. Understanding drug dependency Drug dependence is taken in the form of physical dependence and withdrawal symptoms. Person who develops psychological dependence known as addiction compulsively uses the drug to maintain bodily comfort and feels it keeps his well-being. Psychological dependence is as powerful as physical addiction which forms habit patterns. Withdrawal symptoms follow after the removal or abstinence of a drug. Addiction is usually followed by drug tolerance. The person's system has developed reduced response to a drug that may lead users to take larger doses to obtain the desired effect. Classification of stimulant drugs Stimulant drugs include amphetamines, cocaine, crack and inhalants. Caffeine is the most widely used stimulants in the world consumed mainly in the form of coffee (Spinella 2005, p. 41), tea, cola drinks, chocolates, and cocoa. Caffeine is addictive hence people who abruptly stops drinking coffee experiences some form of withdrawal symptoms. An average cup of coffee contains about 100-150 mg. of caffeine and produces mood elevation, decreased fatigue, and increased alertness. Amphetamines are synthetic stimulants widely prescribed for weight loss or depression. The use of this drug is common for people who seeks to stay awake and thinks drugs improves their mental performance. The common medical used of amphetamines are narcolepsy, childhood hyperactivity, and overdose of depressant drugs. A dose of 2.5-5 mg. has a duration effect of four hours (Coon 2005, p. 240). Methamphetamines, a much potent variation of amphetamine, are considered as one of the largest drug problem which can be snorted, injected, or eaten. This can be made cheaply in backyard laboratories. A dose of 125 mg. has a duration effect of 4-6 hours. Cocaine is a powerful central nervous stimulant that produces feelings of euphoria, alertness, well-being, boundless energy and pleasure. Cocaine reduces hunger, is habit forming, lessens pain and bolsters self-confidence. Nicotine is the stimulant that is usually found in cigarettes or cigars which appears to enhance memory and attention and improve performance on simple, repetitive task. Nicotine enhances the mood but also appears to relax the user and reduce stress. It depresses the appetite but creates dependence on tobacco products. Routes of drug administration Stimulant drugs are said to interfere with the users mental functioning. This notion that drugs cripple the mind remains a joke to the users. Understanding the route of drug administration to the brain will make us comprehend more of the effects of the brain on the human body. The chemical nature of the drug affects the absorption, distribution and elimination of the stimulant that was introduced to the body. Appropriate concentrations at target site of action were usually taken in large doses to achieved desired effect. Drug moves from site of administration to the tissue or cells of action affecting bioavailability during the process. Stimulants are either taken orally, by inhalation, or through injection. Injection is faster because it skips absorption process and introduces the drug direct to the bloodstream. Inhalation is done either by smoking or snorting. In intranasal administration, the drug is being snorted and absorbed through the lining of the nasal sinuses down to the lungs. Oral administration takes the drug to the gastrointestinal system. It takes the drug from the mouth, to the esophagus, and down to the stomach where bioavailability is being affected. From the stomach, it passes to the small intestine then proceeds to the liver. The liver makes drugs water soluble. The kidney easily filters them out of the blood because of its solubility. Large doses make the liver works harder eventually damaging the liver by processing large amount of impurities. The liver's role is to filter circulating blood, remove toxic substances, store vitamins, help in digestion, control the concentration of body fluids, and regulates blood clotting. This helps us understand why a lot of abusers develop liver diseases. The drug is then taken from the liver by the bloodstream to the brain neurotransmitters. Stimulants, being fat soluble, has the ability to pass through into the brain. Neurotransmitters are naturally occurring brain chemicals needed for the transmission of nerve messages which is essential for the function of emotions, perception, and behavior. Stimulants affect the brain by increased release of dopamine and norepinephrine and by interfering with the reuptake of the two chemicals from their synaptic clefts. The interference results to an increased level of dopamine and norepinephrine at the affected synapses creating an imbalance in these neurotransmitters. The behavior is then affected by the chemical imbalance and alters the mood. The brain then craves for repeat performance fundamentally creating the addiction. Effects of stimulant drugs Taking high doses of stimulants results in irregular heartbeat and dangerously high body temperatures. This may lead to potential cardiovascular failure or lethal seizures (Seymour 1987, p. 166). To some people it may develop some feelings of paranoia or hostility. Amphetamines abuse causes vomiting, diarrhea, chills, sweating, and cramps. At larger doses this leads to an extremely high blood pressure, fatal heart attacks, and disabling strokes. The user may suffer crippling fatigue, depression, confusion, uncontrolled irritability, and aggression after an amphetamine binge. Repeated use damages the brain of the user and creates psychosis, paranoid delusions that result to violence, suicide, and harm to self or self-injury. Cocaine abuse can expose first time users to risk of having convulsions, heart attack or stroke. Withdrawal symptoms are fatigue, anxiety, paranoia, boredom and anhedonia. Anhedonia is the inability to feel pleasure. Withdrawal symptoms of nicotine are drowsiness, nervousness, loss of energy, headaches, irregular bowel movements, cramps, palpitations, tremors, and sweating. Abuse may lead to respiratory illnesses and asthma. Frequent use of caffeine leads to nervousness and insomnia. A larger dose of 400 mg. may cause irritability, nervousness, insomnia, irregular heartbeat, and increased blood pressure. A user is likely to develop tolerance which starts the stage for physical dependence. Withdrawal symptoms are usually headache, lethargy, and nausea. Patient Assessment Assessment does not only involve the nurse or healthcare assessing the patient. The patient himself is appraising and assessing medical services from the first contact. Assessment is seen to be the beginning of a good intervention carefully extracting information and getting effective feedback through effective communication. Deciding on the appropriate help to offer the patient may require realistic negotiations in terms of progress and stopping prescribed programs to move in another direction. Assessments include information on the patient's ability to function in various aspects of daily life. We need to understand the course of the disorder and their degree of well-being and satisfaction with their life's status. Socio-psychological dynamics influence the effects of treatment, relapse, and recovery process. Drugs misuse and abuse are causing problems in other areas of life functions namely emotional, vocational, social, and physical (Cisler 2005, p. 119). There is a need to develop composite outcome measures that will incorporate changes in both substance abuse and life problems to speedy recovery and outcome satisfaction. These composite measures may introduce provision for better criteria of outcome compared to abstinence which normally gives problems of relapse. Assessments take sharper delineation of the effects of stimulant and substance abuse in different drug intervention treatment programs. We must have greater understanding of the process of change during recovery or relapse and that means covering the positive as well as the negative life changes of the patient concerned (Keller et al 2002, p. 399+). Measurements may be straightforward which means assessing only the individual's objective status. This information will aid providers on treatment planning and progress evaluation on an individual clinical level. Thoughts, feelings, behaviors, stress, and other emotional responses are components of complex interactions of genetic, physiological, behavioral, and environmental factors. Recognition of the importance of these influences affects the body's ability to remain or become healthy or to overcome disease. The history of intervention is marked by the rise and fall of misconceptions and ineffective therapies and ill-conceived notions of how the body works. We must start to consider that emotional processes such as stressful activities influence nearly all systems of the body and directly influence the pathophysiology of disease. Psychological processes and emotional states influence the etiology and progression of disease. This also contributes to the patient's resistance and vulnerability to illness. Stress affects the immune system through a complex array of neural and hormonal pathways (Baum & Posluszny 1999, p. 137). Investigations of specific relationships and mechanisms underlying tobacco, drugs and substance abuse refers to problems on stress and pressures from their respective sociopsychological environment profiles. To manage a patient's treatment program does not only mean managing the medical treatment but it does extends to their individual environmental context to be able to define the root cause of the addiction or substance abuse and misuse. The combination of social pressures and immediate reinforcers may induce people to try stimulants and other drugs even if they do not intend to abuse. Stress is one cause of substance abuse. Stress also appears to be a major cause of relapse after cessation and often leads to resumption of substance abuse. Stress is a result of nonspecific aspects of dealing with environmental change, demand or threat, through some models of stimulus solely manifested in terms of responses. Stress reduces physical activity and can cause harm if prolonged or very intense. Stimulant drugs have no specific treatments. However, advice and information about the drugs and its adverse effects are available. Somehow health care has resorted to include advices on safe drug use to reduce potential harm. Aware of the fact that illicit drug use can never be safe, harm reduction focus on reducing morbidity and mortality in relation to complications that may arise fromoverdose or injecting techniques. Motivational factors are central to the understanding, prevention, and treatment of a person's context of substance abuse. Life events can instigate a change in problem substance abuse considering that substance abuse do not occur in isolation but as part of behavior clusters. Drug problems are often linked to a variety of other heath, social, employment and criminal issues. Interventions that target a broader range of life functions are more successful in resolving drug and alcohol problems than the particular actions that were taken (Clark 2007, p. 15). Drug use occurs in the context of life problems and abstinence does not rely solely on drug use for reinforcements. Substances are often used as a response to stress. Prevalence of drug misuse among young people NHS Health and Social Care Information Center National Statistics Drug use, smoking and drinking among young people in England in 2005: headline figures Table 1 Proportion of pupils who had taken drugs in the last month, by sex and age: 1998-2005 All pupils 1998-2005 Age Year 1998 1999 2000 2001 2002 2003 2004 2005 % % % % % % % % Boys 11 years 0 1 3 4 4 4 4 4 12 years 2 2 2 4 5 5 4 5 13 years 4 4 6 11 9 11 8 8 14 years 10 12 14 17 20 17 17 16 15 years 19 21 23 25 26 25 21 22 Total 7 8 10 13 14 13 11 11 Girls 11 years 0 1 2 2 3 3 1 3 12 years 2 2 3 4 3 5 4 4 13 years 3 5 5 9 8 8 7 8 14 years 9 9 11 15 15 18 13 16 15 years 16 17 19 22 19 22 20 19 Total 6 7 8 11 10 12 9 10 Total 11 years 0 1 3 3 4 4 3 3 12 years 2 2 3 4 4 5 4 4 13 years 4 5 5 10 8 9 7 8 14 years 10 11 13 16 18 17 15 16 15 years 18 19 21 24 23 23 21 20 Total 7 7 9 12 12 12 10 11 DRUG USE, SMOKING AND DRINKING AMONG YOUNG PEOPLE IN ENGLAND IN 2005: Table 2 Over 9,000 pupils' aged 11 to 15 in 305 schools in England completed questionnaires in the 2005 autumn term. The survey shows that 11% of pupils aged 11 to 15 had taken drugs in the last month while 19% of pupils had taken drugs in the last year. They are said to be the most vulnerable groups in 2008. The survey provides estimates of the prevalence of drug use in 2005. Treatment options for young people who are misusers of stimulant drugs Drug intervention helps the substance abuser recognize the extent of their problem who usually is not aware their dependence and addiction is already out of control. This is a very difficult and delicate matter and must use the proper strategy and timing during the process. The Department of Health has provided Models of Care (2002) which classifies drug treatment services with their respective drug treatment provider. They are tier 1 non-specific (general); tier 2 open access; tier 3 community services; tier 4a specialist services (residential); and tier 4b highly specialist (non-substance misuse). Much of the drug misusers qualify with the tier 2 open access services which are further classified into three categories: Advice and information services, drop-in service, and harm reduction services. Advice and information service is provided in an accessible and easily understood manner with regards to context, language, and comprehensibility to the readers and users. It can be conveyed through verbal, written or audio-visual. Information topics that are usually covered are effects of drugs misuse to the body especially its psychological and physical implications; guidance and advice on how to stop addiction safely; harm reduction information and guidance; and the health care commissioned for the services. Community prescribing specialist under tier 3 community services offers the provision of a medically supervised substitute to an illicit drug misuser which aims to maintain the individual's tolerance to the drug of misuse. The most common pharmacotherapy in U.K. is substituting heroin with opioid oral methadone. Community prescribing GPs in tier 3 encourages the importance of a shared care approach between primary GP and secondary specialist drug treatment services. Shared care is a model that reflects close cooperative work between agencies or services directly involving the treatment of individual drug misuser. Shared care is a joint participation of specialists and GPs in the planned delivery of care of drug misusers through an enhanced information exchange beyond routine discharge and referral letters (Stationery 1999). This involves selection of clinician responsible for the day-today management of the patient's medical needs including prescription of substitute drugs. Shared care arrangements are present in all health Authorities in England and Wales and Health Boards in Scotland and Northern Ireland complete with local service contracts and research arrangements for primary and secondary care services. Narconon drug and alcohol rehabilitation programs are entirely drug free solely relying on nutrition and nutritional supplements which makes it either psychiatric or medical. It serves to employ a different kind of drug treatment therapy in the form of social education drug rehabilitation model (Narconon 2005). Abusers enrolling with the program are treated as students and not patients. Upon enrolment they are given complete physical examination with periodic medical review as individually needed. Narconon program may be tailor made to suit individual needs and fit their respective schedules. Narconon believes that the road out from bad experience is through personal recognition of responsibility on one's condition. Drugs and alcohol creates nutritional deficiency of vitamin C, B complex, and niacin. Experience shows that a person receiving vitamins and mineral energy eases drug withdrawal to a more comfortable transition relieve of any physical aches and pains. CBT is a short term treatment for cocaine abusers which is a flexible, individualized approach adaptable to a wide range of patients. The patient's thoughts, feelings and circumstances before and after the cocaine use are clearly identified in order to assess the determinants that lead to cocaine abuse. The individual is being help to cope effectively the challenges and problems of adult life while in treatment. It also involves coping skills training that can benefit the patient long after treatment (Monti et al. 1999, p. 107). It focuses on identifying and reducing habits associated with drug use by substitution of a more enduring positive activities and rewards. If properly addressed, CBT may help patients expand their social support networks and build enduring drug free relationships. Patients received more attention and work with a single therapist over time. Individual treatment provides flexibility in scheduling sessions and eliminates problems of waiting to form sufficient number of recruits to form a group. CBT intended to produce initial abstinence and stabilization offering 12 to 16 sessions for 12 weeks. This is seen as a preparation for longer term treatments. It is highly compatible with a variety of other treatments. Harm reduction program treatment option for young drug misusers London launched a new drug strategy to be taken from the Home Office and shifted to an evidence-based public health approach. With no strong evidence base for continuing a criminal justice based strategy, the annual cost of drug crime could be channeled towards health and well-being (DDN 2007 4). The Drugs and Health alliance are concern where this strategy might go when there is lack of public consultation. The public health approach to harm reduction is facilitated, non-coercive and non-punitive drug treatment strategy that guarantees general, good, basic health care. It aims to avoid criminalizing and stigmatizing users but seeks to understand the factors that brought them to their present state which calls for public health to be put at the heart of UK drugs policy. Harm reduction services fulfills a drug related harm reduction function where it operates to educate drug abusers on how to safely inject and use their respective addictive substances safely. The needle exchange operates by providing sterile injecting equipment to injecting drug users which aims to dispose of surrendered used injecting equipment to eliminate infection. Harm reduction scheme offers immunization against hepatitis B; information on prevention of HIV ad hepatitis; advice and information on overdose prevention and response; advice and information of safe sex and drug problems; and provides referral to other treatment services. The International Harm Reduction Association (IHRA) has broadened its scope from illicit drugs to all psychoactive substances including tobacco and alcohol. Harm reduction approach explicitly accepts the continued use of substances in their efforts to reduce the associated harmful effects (McNeill & Bridge 2007). This includes provision of sterile injections, safe substitute treatments, outreach and peer support, or advice on how to use drugs as safely as possible. One alternative to tobacco is smokeless tobacco called snus which is found to be less harmful than smoking but still chemically harmful. IHRA provides free online collection of key documents and resources to improve international awareness of tobacco harm reduction approach.Nicotine Replacement Therapies (NRT) include products like nicotine gums, patches, nasal spray, inhalators, tablets and lozenges widely available for purchase and prescription. Suggested stimulant drug treatment option for young people The factors that promote effective treatment are rapid access, systematic assessment and retention, comprehensive approach to care management and coordination or shared care intervention approach. Many young people begin to experiment with drugs at the age of 13 or 14. Being too young to make informed decisions, they do not realize the risks they face. Early detection and interpretation of symptoms affects their decision to seek care and related diagnosis and treatment outcomes. Deliverance of the treatment must also make some degree of determination to the cause of drug misuse. Social environment could be the main key to creating stress in these young people that led them to drug misuse. Stress provides a model for understanding and predicting the impact of specific emotional distress. Stress is an important mediator of health-behavior relationships because of its broad effects that may influence a range of bodily systems and behaviors. Stress increases blood pressure and heart rate that contributes directly to heart disease, hypertension, and cardiac events. CBT is perfect for them so this shall not be limited to cocaine abusers only. There must be a tailor made program for these young people to learn to manage their drug addiction. Narconon nutrition and nutritional supplements drug treatment therapy is an excellent shared care for this group. Being young at age with a world of opportunities and life ahead of them, harm reduction may prove to be a vital reduction of their brain functions. They do not know how to make informed decisions so there is a very big possibility that the offer might be taken as an advance stage drug abuse free flow of supply. The intention is to set them free not to create some form of attachment to the drugs they wanted to be set free. Arrest by referral is not good for these young misusers since the jail and arrest idea will probably implicate to making it a normal life for them and the jail environment is simply not the place for people who can't manage their own lives. Conclusion The measure for commission is based on the number of people being seen and treated which does not have any implication of commitment. The movement toward being involved has no clear definition of a successful outcome makes practitioners stand in the middle of confusion as to their role to counter substance misusers. What shall they actually do when a person comes to their help as clients Will it be some kind of abstinence or plain and simple mythical state of drifting off into the ether exercising measure and control As practitioners they aim to focus some movement for their clients towards freedom from what limits them and threatens them that requires a substantial change in the person being treated both in lifestyle and operational behavior. A period of abstinence allows the client to meet themselves, take stock, and decide what to do next which needs therapy. Therapy being the bridge between competent case management and successful outcomes needs abstinence and not free flowing supply of what they are trying to outlive. The myth of addiction arises from freedom. Freedom to stare into an abyss with no sense of who or what it is that has been set free. Harm reduction just made that freedom legally impressed on misusers to do the things by which they had become addicted with the choice to take the stuff they had come to the practitioners for help to stop the abuse. Becoming addicted then seems to be an attractive option for the misusers and an attractive commission for the centers. There is no stopping to producing an ageing population of opiate dependent people whose conditions will require an opiate based pain killer since methadone maintenance is now rooted in UK policy. Drugs supports tolerance and it is fearsome and dreadful to see what future brings to this country. The process of change presents the internal and external experiences that enable a person to move confidently from one stage to the next. This helps to identify the markers of change by which a person can accomplish the stage tasks and move along the stages of change. The resulting decisional balance will help the person take action or not in his own freedom and freewill. Harm reduction believes that one of the reason people are becoming stuck with standard therapeutic provisions is their unmet needs diversity requirements. Current UK drug laws are based on moral panic and waste funds on futile supply-reduction activities. Only the group of most serious drug offenders shall go to prison while the addicts shall be delivered to treatment programs whose centerpiece is in the drugs intervention programs. Coercing offenders into maintaining engagement with their drugs treatment program as they journey into the criminal justice interventions and arrest referral schemes, gets them in and out of custody. Not to attend becomes an offense in itself which is a disproportionate, distorted English drugs strategy focus on heroine crack profile targets. The public health and harm reduction initiatives may have been sidelined which failed to prevent spread of hepatitis and HIV among problem misusers (Crumpton 2004, p. 200+). There are a growing number of young people turning to use and misuse substances like alcohol and cannabis which the town cannot treat because England has totally separated alcohol and drug strategies extended to relevant commissioning and service provisions (Parker 2007, p. 7). This makes a drinking weekend cocaine user not qualified for treatment for any of the two services where policy seems to be blocking blocks to engagement. UKPDC published an independent report which reveals UK as the highest level of drug abuse problems and second highest level in drug-related deaths in Europe. This seems to question the effectiveness of UK drug policies despite government attempts to control the demand and supply of illegal drugs. The bulk of Britain's drug problems are in its drug-related harm and social problems occurring among people dependent on class A drugs heroine and cocaine. A change in the policy could well be appreciated if the service providers will now be a one stop shop. Since people who are engage in drug misuse tend to abuse alcohol and other related drugs as well. Drug addiction does not produce adherence to responsibility and shared care does not promote diligence in getting his treatment complete. Lining up from one clinic to another is just too much for an addict who does not even know how to manage his life. Besides one medical practitioner who can really sympathize with this people is enough to treat one and engage him to a complete and very comprehensive drug abuse intervention. The problem now lies with the facilities and the training of medical practitioners and service providers. If Britain has afforded to pay for the drugs in harm reduction then it can definitely pay for the facilities and training of these medical practitioners. If government has been so keen and preventing the use of these illicit substances and has been so keen on decreasing the population of substance abusers then they must not be an arm in the supply of unwanted drugs. Maybe government has forgotten to consider the effects of these drugs on the brain that they permitted the continued use of these illicit drugs with the proper orientation of its administration. Let me ask policy makers then for how long they are willing to wait for these people to go totally nuts before stopping the abuse The future of these drug misusers as tomorrow's policy makers can already be predicted at this very moment. We don't want production of cocaine and opiate users as future Britain policy makers. Every pound spent on harm reduction is a pound deducted from rehabilitation and the real fight against drugs. From the very fact that heroine addicts with clinical supervision can move from addiction to being clean without methadone intervention makes harm reduction as dangerous and may left misusers on it to die. Colwyn Bay may see UK's first needle vending machine proposed by North Wales Police which offers service outside of working hours (Hughes 2006, p. 4). This sounds like a money-saving scheme, unpopular and no sympathy nor care with high probability of machine misuse. Unstaffed and unsupervised, it defeats the prime purpose of harm reduction. A taken for granted policy, the treatment progress could well endanger lives and is easily predicted. Public agencies and civil society organizations claims favor for new governance by which welfare and health care programs have been the prime subjects. The central argument is the capacity of these commissioned treatment service to enhance responsiveness and quality of public policies by bringing to work public agencies and private organizations helping each other. The effort of the state should simply help drug users survive abstinence state. The present governance responds to drug abuse tensions by allowing plurality of actors and ideas to interact and compete in public sphere. This no longer assures public order and public health. The governance seems to take time observing trends with no directions (Walti & Kubler 2003, p. 499+). References Barlow, D. et al. (2005). Abnormal psychology: An integral approach. Belmont, CA: Thomson Wadsworth. Baum, A. & Posluszny, D. (1999). Health psychology: Mapping biobehavioral contribution to health and illness. Annual Review of Psychology, 137. Cisler, R. et al. (2005). Quality o life as an outcome measure in alcoholism treatment research. Journal of Studies on Alcohol, 66(4), 119+. Clark, D. 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WALES: Tokens Will Be Sold and End Up in Wrong Hands; Row over Plan for Needle Machine "It Sounds like a Money-Saving Scheme.It Is Unstaffed and Unsupervised.A Cheaper Alternative to Paying for a Proper Centre with Staff'. Daily Post, p. 4. Keller, T. et al. (2002). Parent figure transitions and delinquency and drug use among early Adolescent children of substance abusers. American Journal of Drug and Alcohol Abuse, 28(3), p. 399+. McNeill, A. & Bridge, J. (2007, April 23). Seeing past the smoke. DDN Virtual Magazine, p. 11. Retrieved May 5, 2007. Website: http://www.drinkanddrugs.net/features/april0407/seeing_past_the_smoke.pdf Monti, P. et al. (1999). Coping-skills training and cue-exposure therapy in the treatment Of alcoholism. Alcohol Research & Health 23(2), p. 107. Narconon (2005). Drug intervention. Drug Rehab and Alcohol Treatment Centre. Retrieved May 5, 2007 Website: http://www.drugrehab.co.uk/drug-intervention.htm NHS (2005). 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Policy Studies, 31(4), p. 499+. Read More