Substance Misuse - Essay Example

SUBSTANCE MISUSE Policy analysis of Working Together to Reduce Harm (The Substance Misuse Strategy for Welsh 2008-2018) Introduction Substance misuse and the harm caused by it is well known, and although its definition varies according to context, cultural practices, popular beliefs, local legislation has important role to play in reducing the harm it may cause. Substance misuse has been defined by illicit use of substances, deliberate or unintentional. The UK has the highest level of addiction and misuse in Europe. It has been acknowledged that substance misuse can harm the misuser both physically and mentally, and this harm may extend to the people and environment through the misuser's actions. Therefore, it is considered to be a major public health and social issue (Goulden and Sondhi 2001). In the year 2004 to 2005, 14% men and 8% women of the age range 16-59 had the history of illicit drug use in the previous year. The main problem substances were opioids. Most of the people attending treatment programmes were polysubstance abusers involving a range of illicit substances and alcohol. Reports indicated increased use of cocaine in comparison to cannabis, amphetamine, and LSD. The problem is more acute in the younger age group of the age range of 16-24 years, with a recorded percentage of 33% men and 21% women. The most commonly abused substances were cannabis, cocaine, and ecstasy. There is another dimension of the harm caused by substance abuse. Those who abuse substances through injection route, the major harm caused by it is contamination with and transmission of blood-borne viruses. There have been reports of sharing needles directly and sharing other equipments. These may lead to HIV, hepatitis C, hepatitis B, sepsis, and thrombosis with or without embolism. Substance misuse may lead to overdosage leading to death, and there had been reports from Welsh. Substance misuse has been closely linked with crimes and offenses (Welsh Assembly Government 2007). Given such harmful effects of substance misuse, there should be local legislation and policies to prevent harm related to substance misuse. Welsh is not an exception of that. The total economic and social cost of Class A drug misuse in Welsh amounts to 780 million a year and 90% of this has been connected to drug related crimes. Welsh Assembly Government has employed a 10-year strategy spanning between 2008-2018, which is known as Working Together to Reduce Harm with a goal to work in the framework of a National Agenda to tackle and reduce all harms associated with substance misuse (Eaton et al. 2007). The key aims of this agenda are individual harm reduction, avoiding stigmatization of substance misuse, creating support services that foster education, prevention, and treatment, improving quality of these services, enhancing availability of these services, and enabling better use of resources through application of evidence-based decision making in order to improve treatment outcomes. Skill development is an important parameter of this strategy since this work can only be accomplished through better use of resources where partners and providers work together. Therefore personnel development of the workforce in the areas of related skills stands ground. The developed workforce then makes connections through different agencies and services as far as relevant services are concerned (Foxcroft et al. 2003). This strategic service framework must be user friendly in that the services provided would focus on the needs of the users. The development and delivery of these services would embed as core principles of Welsh Assembly Government, namely, sustainability, equality, and diversity with stress on the issues with children and young people. Obviously, this deals with the public health issue of substance misuse in a far broader perspective and aims to deal with the sociopolitical issues related to substance misuse in this population while placing equal stress to the treatment of conditions of harm caused by substance misuse, in which prevention is also an important recognised aspect (Meyers et al. 2002). It is true that in Wales, the considerable harm caused by substance misuse is a key priority as far as the health policies are concerned, and the target groups are individuals, families, communities, and society as a whole. Moreover, it has been recognised that it is an important contributor to health inequalities. Therefore, the approach should be to address the changing patterns of this abuse by the young people in order to enhance the existing opportunities and choices. The most important consideration should be targeted to alcohol (Welsh Assembly Government 2008). Apart from the social harm caused by these agents directly or indirectly, it has been recognised by the authorities that the future health burden with substance abuse particularly when polysubstance are involved may turn up to be huge. The time trend of substance abuse demonstrates that as time passes on this tendency tend to increase, leading to entrenchment of the users into different substances such as alcohol, cocaine, and cannabis. Therefore, the best strategy would be to identify individuals who are at risk, beginning, and the young. Health education and information exchange play important roles in this strategy, and a public health framework may indeed provide favourable results (Skobdo et al. 2007). If the aims of such policies are to reduce the risks of transmission of infectious diseases, drug-related deaths, and the social and criminal consequences of such behaviours, then the stages of change model may be effective, specifically if they are begun at the outset, although it has been argued that this model is just a conceptual framework, and in reality these stages of problem substance abuse may be more fluid leading to movement of behaviour in both directions. It has been recommended that all professionals must avoid working in isolation and they must work together with common goal and through partnership with local shared care arrangements. This approach may allow appropriate care and support to the individuals so the management aims not only the medical treatment, but also target psychosocial interventions. Therefore, the harm reduction approach should culminate into reduction in substance abuse, reduction in periods of substance misuse, reduction in risk of relapse, reduction in need for criminal activity to finance drug misuse, and improvement in personal and social functioning (Welsh Assembly Government 2005). The framework of joint services seems to be appropriate since evidence from research has demonstrated that no single approach is ever successful in fulfilling the aims of the healthcare authorities to control substance misuse behaviour. Studies have amply demonstrated that environmental factors embedded in the society or community, drug factors and legislations leading to availability and affordability, and individual factors and other psychiatric disorders all play their roles in sustaining the substance abuse behaviour in any individual. If the causes are multifactorial, the solutions are expected to be multifactorial also, and only a joint approach from multiple agencies dedicated to a common goal can accomplish this (Welsh Assembly Government 2004). The medical management definitely holds strong ground, but medical team may be inadequate the address the root social cause of misuse. Moreover, health assessment and assessment of willingness to modify the abusing behaviour needs relationship building which can be only achieved through community participation, where a social work framework may be able to accomplish the desired goal. Therefore it is advisable that no team should work in isolation and all teams must take advantage of shared care format advised in this document. It has been rightly stated that a large proportion of education, prevention, early intervention, and treatment services may work together to achieve the goals mentioned before (National Treatment Agency For Substance Misuse 2006). This account puts considerable stress on controlling alcohol consumption. There is a need for joint approach. However, the case of alcohol abuse is different. Alcohol has been traditionally used as a social lubricant. It has been recognised to be easing tension and anxiety and facilitating social intercourse. However, beyond a certain point, this can be really harmful specially when used over the limit or in association with other substances of abuse (Welsh Assembly Government 2007). Therefore education and counseling have important roles to play while alcohol misuse is considered to be socially and culturally induced misuse which needs to be controlled with appropriate education and motivation. The education as has been proposed must include a socially and culturally delivered component with clear message incorporating physical, psychological, social, and legal parameters. It has been argued that since young people will misuse substances at any cost, it better to design education so they may use these in a safe way. In response to this argument, it has been stated that this simplistic approach wound not work, and appropriate control on misuse and harm reduction would need a complex approach (Department Of Health (England), The Scottish Government, Welsh Assembly Government and Northern Ireland Executive 2007). Many examples have indicated that a public health approach involving blanket coverage of all the issues would not work efficiently and therefore, since there is no one single type of substance abuser, there should always be a multi-agency approach to cover this problem. This justifies the approach of working together. However, it is also to be noted that substance misuse and societal understanding of these are culturally mediated, and there would always be stigmatization of these groups of unfortunate, yet misguided people. The official and governmental thinking in this area of working together through public health strategies, specially in collaboration with crime enforcement seems to be diametrically opposite (Welsh Assembly Government 2005). Conclusion Substance misuse is a problem in Wales, and Welsh Government has adopted a long term plan which aims to reduce harm related to substance misuse. The harms related to substance misuse have been well delineated in literature, and evidence indicates that the very problem of substance misuse originate from culturally and socially derived reasons. The magnitude of the harm related to substance misuse covers many aspects of life and other areas. Apart from the medical consequences, there are other social and legal harms that may originate from substance misuse. With the aim of reducing harm based on evidence, a multiagency approach has been proved to be useful where all agencies have been recommended to be working together to provide support, education, treatment, and motivation to change behaviour. Despite arguments against this policy, it is expected that this policy may work wonders if implemented appropriately through various service agencies. References Department Of Health (England), The Scottish Government, Welsh Assembly Government And Northern Ireland Executive (2007). Drug misuse and dependence UK guidelines on clinical management. London: Department of Health (England), Edinburgh: The Scottish Government, Cardiff: Welsh Assembly Government and Belfast: Northern Ireland Executive, 2007. Eaton, G. et al. (2007). United Kingdom drug situation: annual report to the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) 2007. Lisbon: EMCDDA, 2007 Foxcroft, D. et al.(2003) Primary prevention for alcohol misuse in young people. Cochrane Database of Systematic Reviews, Issue 3, 2003. Goulden, C. and A. Sondhi (2001) 'At the Margins: Drug Use by Vulnerable Young People in the 1998/99 Youth Lifestyles Survey', Home Office Research Study 228. London: Home Office Research Development and Statistics Directorate Meyers, R. J. et al. (2002). A randomized trial of two methods for engaging treatment-refusing drug users through concerned significant others. Journal of Consulting and Clinical Psychology, 70 (5), pp.1182-5. National Treatment Agency For Substance Misuse (2006). Treating Drug Misuse Problems: Evidence of Effectiveness. London: National Treatment Agency for Substance Misuse, 2006 SKODBO, S. et al. (2007) The Drug Interventions Programme (DIP): addressing drug use and offending through 'Tough Choices'. (Research Report; 2), London: Home Office, 2007. Welsh Assembly Government (2004). Making the Connections: Delivering Better Services for Wales. Cardiff: Welsh Assembly Government, 2004. Welsh Assembly Government (2005). Framework for Commissioning of Substance Misuse Services. Cardiff: Welsh Assembly Government, 2005. Welsh Assembly Government (2005). Substance Misuse Treatment Framework for Wales Needle Exchange Service Framework. Cardiff: Welsh Assembly Government, 2005. Welsh Assembly Government (2007). Working Together to Reduce Harm: The Substance Misuse Strategy for Wales 2008-2018. P. 1-79. Welsh Assembly Government (2007). Progress Review Report to the inaugural meeting of the National Monitoring Group for Drug Related Deaths in Wales. Cardiff: Welsh Assembly Government, 2007 Welsh Assembly Government (2008). Substance Misuse Treatment Framework Carers and Families of Substance Misusers A Framework for the Provision of Support and Involvement. Cardiff: Welsh Assembly Government, 2008. Read More