Promoting Safer Injecting Among IV Substance Users in England and Wales - Report Example

IV The current report looks at clean-use and needle exchange programs (NEP) in the UK, through a preferred stage-based model by Prochasta and DiClemente. While there are many different schools of thought on how to treat addiction, similar goals include cessation of HIV high risk activity such as sharing needles, while going through stages of withdrawal from heroin which may result ultimately in relapse. “Each person must decide for himself or herself when a stage is completed and when it is time to move on to the next stage. Moreover, this decision must come from the inside you (see developing an internal locus of control) -- stable, long term change cannot be externally imposed” (Prochasta and DiClemente, 1984). Countries deal with drug problems in different ways. Heroin as a drug that is shot into the veins via syringe has become even more dangerous worldwide now with the AIDS epidemic, because heroin addicts who share dirty needles are among those likely to get HIV/AIDS, since it is spread in this manner as well as from sexual contact. Sharing dirty needles therefore represents a significant public health risk in the UK, and countries usually have some sort of social services in place or private organizations in place to offer community initiatives to help heroin addicts and also distribute clean needles. In the UK there is a sort of double standard going on. There are these types of programs in place in many areas, but at the same time, the UK is very tough on drugs and condemning drugs is all about the public and their perception. So heroin is criminalized and punished to a large extent, more than it is rehabilitated with things like methadone programs or moderated with things like clean needle programs and NEP (although of course these services also exist in a sort of tandem with the punishment or criminalization). Heroin is a very serious problem worldwide for law enforcement and the criminal justice systems, but it is also a problem for addicts facing health risks such as HIV/AIDS from dirty needles and uncontrollable addiction. Heroin addicts often refer to the process of quitting heroin as “kicking,” and it is a long and grueling process during which the body suffers tremendously. The stage based model best explains how an addict goes through stages of behavior in relation to the substance. “So expecting behavior change by simply telling someone, for example, who is still in the "pre-contemplation" stage that he or she must go to a certain number of AA meetings in a certain time period is rather naive (and perhaps counterproductive) because they are not ready to change” (Prochasta and DiClemente, 1984). As with any addictive drug, with IV drugs there is a process in which the individual starts taking the drug and becomes acclimated to it, before they feel as if, physically or psychologically, they do more than just crave it; they need it. Some drugs only have a psychological addiction, while others have a very real physical addiction. The individual first enjoys the substance, and then begins to feed a physical and psychological craving for it that they are unable to control. In essence, they are out of control at this point in time. This feeling of lack of control being attractive to the person may be a sign of mental illness being associated with drug abuse. More and more in treatment circles, professionals are paying more attention to ways not just to treat the addiction, but also the ways to treat the mental problems that might lie underneath the addiction. This involves looking at, and naming, stages of change in the addict’s presentations of addiction. “The stages of change are: Precontemplation (Not yet acknowledging that there is a problem behavior that needs to be changed) Contemplation  (Acknowledging that there is a problem)… Preparation/Determination (Getting ready to change) Action/Willpower Maintenance and Relapse” (Prochasta and DiClemente, 1984) On a socio-cultural level of subsystem analysis which considers prevention and intervention, many factors can be traced to drug abuse in terms of how this problem is dealt with in either a punitive or preventative manner. Drug abuse harms drug abusers, and their drug use also often brings harm to others, and therefore, society. In the opinion of this report, an effective socio-cultural method of harm reduction does not take this situation as an eye for an eye, and respond by harming the drug abuser (who, in cases more often then not, is already considerably harmed by his/her addiction), but instead focuses on ways in which this harm (ie, the black-market system that keeps many drug sales violent and/or dangerous) can be reduced. As one source states, “decriminalization advocates point out that many if not most of such deaths result from the use of contaminated drugs or drugs that have unexpectedly high potency. The vast majority of these deaths, they say, could be prevented by providing addicts with methadone or other replacement drugs in a clinical setting” (Skolnick, 1994, p. 1637). Thus, making clean needles, methadone, or other drugs available, or even instigating a program in which controlled quantities of heroin are made medically available, along with clean needles, can be seen to reduce the amount of total harm to both the individual and society. This is how the socio-cultural level of spiritual, ethnic, SES, and education can be impacted positively by a juvenile justice system that stresses prevention and treatment over punitive consequence-based solutions that do not focus as much on treatment as they do punishment. This can in turn work in reducing the total harm level as a reflection of Many believe that the population at large, scared by individual crimes that get media attention but ignorant of statistical undertones, is being led to believe that there is no difference between violent and non-violent crime. The media in the UK and globally publicizes violent crime and links it with IV drug use. That is, in response to publicized, violent crime, the population is asked to take a tough stance on crime, which includes both violent and non-violent offenders, who perhaps should be treated differently. A marijuana user and a crack cocaine addict, in other words, are totally different types of criminals. It is interesting that while many people tend to link the drug war with violent crime, many taxpayers also support the medicalization of drugs and want heroin addicts to be able to get clean needles. Therefore, it is perhaps a more important issue of how the drug should be used as a reflection of its acceptance: people tend to support medical use more than legalization, because it is not connected with the negative images of drugs being inextricably linked with violence distributed by mass media. Although some proponents of prohibition see drug use as one impetus of violent crime, proponents of legalization make an interesting argument that “drugs can never be stamped out… The demand for drugs is constant and inelastic; the criminalized status of illegal drugs makes them expensive, and therefore highly profitable to sell… it is criminalization that guarantees ‘business as usual’” (Reuter and Caulkins, 1995). A common subject of drug use and juvenile delinquency has been demonstrated as being a process of peer pressure. “Findings from this study indicate that friends’ delinquency is associated with an adolescent’s own delinquency involvement” (Haynie, 2001, p. 1013). Information is also supplied which suggests that a cohesive delinquent network such as a gang may have more peer pressure for the individual in terms of drug use: “Network density, in particular, emerges as an important component of the delinquency-peer association, with every cohesive networks containing stronger delinquency-peer associations than those that are less cohesive” (Haynie, 2001, p. 1013). In terms of holistic views, it is difficult to determine future trends. “The idea behind the SCM is that behavior change does not happen in one step. Rather, people tend to progress through different stages on their way to successful change. Also, each of us progresses through the stages at our own rate” (Prochasta and DiClemente, 1984) REFERENCE Haynie, D.L. (2001, January). Delinquent Peers Revisited: Does Network Structure Matter? American Journal of Sociology 106(4), pp. 1013-1058. Prochaska and DiClemente,1984 http://www.addictioninfo.org/articles/11/1/Stages-of-Change-Model/Page1.html Reuter, Peter, and Jonathan P. Caulkins (1995). Redefining the Goals of National Drug Policy: Recommendations from a Working Group. Journal of Public Health, p. 1059. Skolnick, Andrew A. (1994). Collateral Casualties Climb in the Drug War. Journal of the AMA, 271(21), pp.1636-1639 NEPs (2010). http://www.ucl.ac.uk/network-for-student-activism/w/NEPs_-_Needle_Exchange_Programs_and_the_battle_against_HIV/AIDS_in_Washington_DC REFERENCE Read More