Drug Misuse, Treatment and Harm Reduction - Report Example

Drug Misuse, Treatment and Harm Reduction: Young People and Alcohol Introduction Alcohol consumption is considered a norm in many cultures. Many people consume alcohol for social and recreational purposes. However, over the years excessive consumption of alcohol (alcohol misuse) has become a major concern for the government, policy makers, health practitioners and the public in general due to various detrimental effects to it. Alcohol misuse has been linked to a wide range of negative health and socio-economic outcomes that have significantly put a strain on healthcare systems and government expenditure (Rassool 2009).For instance, alcohol misuse has been linked to liver diseases, malnutrition, heart diseases, cancer, violence, road carnage, criminal behaviour, and financial problems, family and relationships dysfunction among many other issues (Cargiulo 2007; Pyne et al 2002; SA Health 2012; Stevenson 2005). Although alcohol misuse is an issue that affects all age groups, young people between the ages of 11 to 30 years are the most affected age group (Galanter et al 2006). Studies have shown the prevalence of alcohol misuse among young people have far-reaching health and socio-economic consequences than that of the elderly population (IAS 2013; Windle & Windle 2005). It is therefore crucial for suitable interventions to be implemented in order to address alcohol related problems among young people. This paper seeks to critical examine alcohol misuse among young people between the age of 11 to 30 years. Foremost, it examines the prevalence of alcohol use and misuse in this age group based on available evidence. Secondly, it explores a wide range of health service and treatment options that can be offered for young people with alcohol-related problems. In this case, the paper will explore the theoretical underpinnings, efficacy, limitations and areas that require improvement for each treatment option. Subsequently, this paper will discuss the concept of harm reduction and how it is applicable to young people and alcohol related problems. Prevalence of Alcohol Use/ Misuse According to Windle & Windle (2005) alcohol misuse among young people occurs at high rates thus leading to potentially adverse effects in critical domains of life such as academics, family, relationships and occupational achievements. A study by Warwick et al (2009), established that excessive alcohol in the UK is more prevalent among young people between the ages of 18 to 24 years. Although alcohol consumption among young people in the UK appears to have decreased, the amount and frequency of consumption has increased significantly (Warwick et al 2009). A survey conducted by NHS Information Center established that the prevalence of underage drinking in England is wide spread. Atleast 43% of the young people (11-15 years) involved in the survey reported that they have consumed alcohol at least once (IAS 2013b). Similarly, a study by Hagger-Johnson (2011) established that in the UK, 51% young people between the ages of 11 to 15years have reported having used alcohol. Alcohol was found to be more prevalent than drug use and smoking. The study further established that in most cases the frequency of alcohol consumption in the UK started at the age of 11 years and increased with age. According to a study conducted by Harker (2012), 7% of men and 2% of women between the ages of 16 to 24 years drink 5 or more days in the course of the week. The study found that young people are more likely to drink excessively. It was established that 36% of men between the ages of 16 to 24 years had drunk more than 4 units in least one day as compared with 20% of men aged 65 and over. The study further found that 37% of women between the ages of 16-24 years exceed 3 units on at least one day whereas only 11% of women aged 65 and over exceed 3 units in a day (Harker 2012). Studies from different countries around world have established that college students have a higher prevalence of alcohol drinking and alcohol-use disorders, than non-college youth. (Dawson et al 2004; Karam, Kypri & Salamoun 2007; Kypri et al 2005). This is largely attributed to peer influence and the development phase where college students want to exercise their freedom associated with being away from parents, family and other long standing relationships (Karam, Kypri & Salamoun 2007). In their study, Gunter, Hansen & Touri (2008) established that alcohol consumption is wide spread among adolescents in the UK and other countries. This trend has been so since the mid-1990s. In most cases, experimentation with alcohol begins in the course of pre-teenage years (Gunter, Hansen & Touri 2008). Moreover, Saban and Flisher (2010) found that alcohol misuse problems are more common in young people with depression and anxiety disorders. Based on data from the World Health Organisation (WHO) alcohol misuse among adolescents and young adults has been increasing globally (WHO 2011) however in European countries alcohol use amongst young people has slightly decreased (Hibell et al., 2012). It is estimated that 4% of the world global burden of disease is caused alcohol misuse especially by young people. Generally, men tend to consumer more alcohol than women (Kerr-Correa, Igami, Hiroce, & Tucci 2007), but the sex disparity is lesser at a younger age (Schulte, Ramo, & Brown, 2009). According to Windle & Windle (2005) alcohol consumption starts in early adolescence, increases significantly in young adulthood and then declines over the years with age. Treatment Options Over the years, different treatment models and health services for alcohol related problems have been developed in a bid to prevent or address alcohol dependency and the various health and socio-economic problems brought about by alcohol misuse. While there is no standard approach for addressing alcohol related problems, some treatment options have been found to be more effective for addressing alcohol-related problems among young people (Singer & Brenner 2006; Zernig et al 2000). This section examines two treatment options that have proved to be effective in addressing alcohol related problems among young people. These treatment options include; cognitive behavioral therapy and medication Cognitive Behavioral Therapy (CBT) Cognitive Behavioral Therapy (CBT) is an approach to alcohol misuse treatment that aims at enhancing the cognitive and behavioural skills of alcohol users in order to enable them control their impulses and change behaviour linked to alcohol misuse. Using this approach, the patient with the help of a therapist work to identify and change maladaptive thought patterns which contribute to alcohol misuse. CBT focuses on anticipating likely problems and improving the self-control of patients by helping them build and nature effective coping strategies. Some of the specific CBT techniques include; extensive exploration of the positive and negative consequence of continued alcohol misuse, continuous self-monitoring to identify cravings early and situations that are likely to put one as risk of use and nurturing strategies for coping with cravings and avoiding triggers or high risk situations (Volkow 2011). Practices in CBT are grounded on classical behavioural theories such as social learning theory by Albert Bandura. Bandura’s social learning theory holds that human behaviour such as alcohol misuse to be prompted by a reciprocal interaction between cognitive, environmental and behavioural influences (Esptein & McCrady 2009). It further postulates that people learn through observation, modelling and imitation. In essence, behaviour can be learned and unlearned through observation, modelling and imitation (Bandura 1963). Hence in CBT, alcohol misuse is viewed as a habit that can be learned and unlearned. As far as the treatment of substance addiction is concerned, CBT has received the most empirical validation and has been found to be effective in relapse prevent (Felgoise, Nezu, Nezu & Rinecke 2006). There is considerable evidence in literature that suggests that CBT is effective in addressing alcohol related problems especially among young people (Esptein & McCrady 2009; Volkow 2011). A study by Martin (2008) found that CBT interventions have a success rate of 40% to 70 % when it comes to reducing drinking. The study found that CBT enhances the coping skills of patients with alcohol related problems by equipping them with cognitive and social skills that help them to control the urges or impulse of alcohol misuse (Martin 2008) Although CBT has been found to be effective in minimising alcohol misuse, Martin (2008) notes that this treatment options has several limitations. First, the effectiveness of this intervention is highly dependent on the motivation of the patient towards addressing behavioural patterns associated with alcohol misuse. CBT is largely based on the assumption that the patient is alreadty motivated to minimise or stop alcohol misuse and they only require the skills to do so. However, this is not always the case. In some instance the patient may not be motivated to minimise or stop alcohol misuse. Secondly, Martin (2008) argues that CBT may not be effective for addressing cases of patients with long history of alcohol misuse since their cognitive functioning may be severely impaired thus making it difficult for them to acquire necessary cognitive and social coping skills that facilitate behaviour change. In order to improve the effectiveness of CBT, this approach should be combined or used alongside other treatment interventions such as pharmaceutical treatment and participation in support groups (Esptein & McCrady 2009; Martin 2008). Pharmaceutical Treatment Pharmaceutical treatment modality mainly relies on the use of medicine to manage alcoholic tendencies. This treatment modality is often used for patients with a long history of chronic alcohol misuse. It significantly helps with challenges associated with alcohol withdrawal, mood and anxiety disorders linked to alcohol misuse (Labbate et al 2012; Mack, Harrington & Frances 2010). Patients with a long history of alcohol misuse and unstable medical conditions are more likely to be placed under pharmaceutical treatment mainly because they develop complicated withdrawal effects that may spur hallucinations, agitation, delirium, cognitive impairments, changes in blood pressure, ataxic gait cardiac arrest and seizures when withdrawn from alcohol for a certain period of time. A pharmaceutical treatment approach helps in the reduction and management of symptoms brought about by alcohol withdrawal in a number of ways. Firstly, the use of this treatment modality enables relatively comfortable detoxification thus allowing the patient to move forward without using alcohol. Secondly, it minimises severe symptoms such as cardiac arrests and seizures. Thirdly, a pharmaceutical treatment approach prevents the progression of severity of withdrawal syndrome that is likely to occur with time (Labbate et al 2012; Mack, Harrington & Frances 2010). A number of medications are often used to facilitate this treatment approach. Key among them include; mood-altering drugs such as antidepressants. Antidepressant medications have been used for many years the treatment of alcoholics. Since alcoholism and depression are often interlinked, antidepressants help to stabilise patients’ mood thus reducing their inclination to consume alcohol (Labbate et al 2012; Mack, Harrington & Frances 2010). Other types of medicines often used in the treatment of alcohol related issues include; benzodiazepines and antipsychotic drugs. Benzodiazepines are often used to address alcohol withdrawal syndrome. In patients with severe alcohol withdrawal effects such as changes in blood pressure, ataxic gait cardiac arrest and seizures, this drug helps to minimise severe symptoms such as cardiac arrests and seizures and prevents the progression of severity of withdrawal syndrome. On the other hand, antipsychotic drugs are often used when a patient undergoes withdrawal symptoms characterised by delirium and hallucinations. These drugs help to minimise such symptoms and enables relatively comfortable detoxification thus allowing the patient to cope without using alcohol (Labbate et al 2012). Although the use of pharmaceutical treatment modality has been found to be suitable in addressing withdrawal symptoms in patients with a long history of chronic alcohol misuse, there are several limitations associated with the use of this intervention (Labbate et al, 2012). Petralli (2004) argues that the use of this treatment modality may encourage drug dependency. When patients continually use these drugs to alleviate the discomfort that they experience after withdrawing from alcohol, they may gradually develop a strong affinity for these drugs and begin to rely on them for sustenance of normalcy. Further this treatment approach is limited due to the fact that it does not address the underlying causes of drug misuse such behavioural, cognitive and environmental factors. Instead, it focuses on relieving symptoms associated with alcohol withdrawal (Petralli 2004). In order to enhance the effectiveness of pharmaceutical treatment modality, this approach should used alongside other treatment interventions such as cognitive behavioural therapy or participation in support groups (Martin 2008; Petralli 2004). Harm Reduction Harm Reduction approach to treatment is an emerging practice that goes beyond from abstinence-only treatment and focuses on prevention and preventative care. This approach encompasses a set of practical strategies that aim at minimising negative implications associated with alcohol misuse. This approach does not focus on behaviour only but also the harm associated with the behaviour. For instance, alcohol misuse among young people can be linked to liver diseases, malnutrition, heart diseases, cancer, violence, road carnage, criminal behaviour, and financial problems, family and relationships dysfunction among many other issues (Cargiulo 2007; Pyne et al 2002; SA Health 2012; Stevenson 2005). In this case, the harm reduction approach would focus on minimising and alleviating such implications associated with alcohol misuse. Unlike other approaches which aim at alleviating alcohol withdrawal effects or enhancing the cognitive and behavioural skills of alcohol users in order to enable them control their impulses and change behaviour linked to alcohol misuse (Labbate et al 2012; Volkow 2011), the harm reduction approach extend beyond the individual and aims at minimising the negative consequences associated with alcohol misuse. In essence it can be argued that the harm reduction is more holistic and inclusive in nature (Denning 2002; Tatarsky 2007). Proponents of the harm reduction model hold that alcohol misuse and other unhealthy behaviors manifest themselves on a continuum from non-problematic to severely problematic. Hence, they is need to employ an approach that not only targets the individual but also provide remedy to the surrounding issues that affect individual behaviour. As a result, practitioners who use this approach focus on minimising the associated harm experienced by individuals, families, and surrounding communities (Denning 2002; Tatarsky 2007). As far as young people and alcohol misuse is concerned, the harm reduction approach is pertinent and can significantly help to address issues linked to alcohol misuse. To a large extent harm reduction as a model of intervention is motivational in nature. Its use among young people is likely to increase their desire for better and healthier lives. Many young people who abuse alcohol face problems such as low-self-esteem, depression, peer pressure, abuse and past traumatic events. As a result, they need an approach that extends beyond their alcohol misuse and touches on broader and underlying issues that contribute to their alcohol. Harm reduction approach provides a holistic and more relevant approach for dealing with issues surrounding young people and alcohol misuse. This approach meets the patient where he or she is. It is founded on the principle of empowerment and acceptance and aims at propelling patients to a better well-being without putting unnecessary demand and pressure on the patient (Denning 2002; Tatarsky 2007). Generally, harm reduction presents an appropriate philosophy to underpin treatment strategies mainly because it is holistic, patient-centered and focuses on empowering the patients towards the realisation of better health outcomes. References Bandura, A., 1963, Social Learning and Personality Development. Holt, Rinehart, and Winston New York. Cargiulo, T., 2007, "Understanding the health impact of alcohol dependence". American Journal of Health-System Pharmacy vol 64, no. 5, pp.5–11 Dawson, D. A., Grant, B. F, Stinson, F.S. & Chou, P. S., 2004, “Another look at heavy episodic drinking and alcohol use disorders among college and non-college youth”, Journal of Studies on Alcohol and Drugs vol 65,pp. 477-489. 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