Psychosocial Interventions in Drug Addiction Treatment: Policy Scope Project Assessment 2 Answer
The role of psychosocial interventions in drug addiction treatment
A policy on “psychosocial interventions method in educating, treating and preventing relapses in illicit drug use in long term, even after termination of the intervention”
The policy project has been planned on the role of psychosocial interventions in drug addiction treatment that will be implemented by the hospital CEO, the Department of Health, Australia. The objective of the particular policy is to educate, treat and develop the health conditions of people who use illicit drugs and prevent relapse of addictive behaviour even after the termination of the psychosocial intervention method. The policy paper has discussed different types of psychosocial interventions such as Motivational interviewing, Family therapy, Self-help groups, and Cognitive behavioural therapy validating their effectiveness in line with different studies that have identified those. The paper further demonstrated different policy frameworks implemented in the USA and Canada in order to manage problems of drug use as a social and health care problem, develop approach that ensures prevention, diminishing harm, treatment, and enforcement, as well as managing root causes of drugs. The policy paper further has provided certain recommendations so that it can be implemented accurately.
Why the issue is important:
Background information and health outcome:
Addiction in Australia is the nation’s greatest issue with millions of individuals and their families have been struggling with broad range of substance abuse disorders. Given the population size of Australia, there are large number of population who use drugs. Number of people is Australia who are suffering from some kind of drug dependency is more that 4 million. Use of illegal opioids such as heroin and other medical use of prescription opioid pain medications such as oxycodone has increased to epidemic level. Deaths cause by heroin overdose has increased fivefold from 2001 to 2013 while prescription opioids caused deaths also has increased three folds during the mentioned period (Paul, et al. 2016). All kinds if addiction may cause harm or has risk of harm, opioid addiction has link with very specific health risks such as transmission of different diseases caused by blood transmission including HIV or human immunodeficiency virus and hepatitis C and B. Fortunately effective treatments and psychosocial treatments are available to treat the and manage the ill effects of opioid addiction.
Opioids are psychoactive analgesic drugs that are prescribed for the relief of chronic and acute pain, however their illegal use has risen increasing rates of deaths caused by problematic use of opioid use. Short term effects of opioid use may range from appetite, blood pressure, heart rate, wakefulness, and mood to heart attack, psychosis, stroke, overdose, and even death. Long term effects that may cause due to opioid overdose are heart or lung disease, cancer, mental illness, and others alongside HIV/AIDS and hepatitis (Kingsley and Alper.K 2018). Drug abuse also may have indirect effect on people who are taking them as well as people around them that can include decision-making and impulsivity; sleep; and risk for violence, injury, trauma, and communicable diseases. Wider ill effects of opioid abuse may also be found in employment, educational level, and relationships with people around tem and involvement in criminal activities. Opioid addiction, poisoning and overdose have led to increasing rates of deaths caused by opioids. In 2016, 42,000 Americans, 2800 Canadians and estimated 11.5 million of individuals in the USA have died because of opioid prescriptions in 2017-2018 alone. Hence the health policy of addressing drug addiction through psychosocial intervention has very crucial role on health outcomes. In 2015, 84% deaths related to drug use are caused by opioid use with heroin that usually used in combination that results in more than half of the deaths caused by different kinds of drug abuse. Opioids that cause problems also are prevalent in Asia that accounts for about two thirds of all opiate users (Erin.W.:Peacock and Bachmann 2017).
Between the year 1992 and 2012, opioid use and it’s related of harms and deaths has increased 15 fold and the cost to the Australian government increased 32 fold which has been estimated to change from $8.5 million to $271 million. Opioid related harms and hospitalizations has increased between these years from 600 to about 1500 cases increasing number of hospitalizations due to heroin poisoning since 2001. Deaths due to accidental poisoning has increased from 151 to 270 cases and thus the death rates has increased from 0.78 to 1.19 per 1 million population over ten years. Death rates has increased 1.4 fold in female and 1.8 fold in female due to opioid use (Victoria, et al. 2017).
Socio economic profile:
Drug abuse occurs mostly in people aged between 18 and 35, especially between 18-25, therefore it includes those who have just entered workforce or are just about to enter workforce. Given the high unemployment in many nations, entering into the workforce is one of the major issues that youth faces. Consumption of illegal drugs further minimise their chances of entering or remaining in the workforce while failure to find appropriate job leads to drug consumption. There occurs very strong association between drug taking habit and unemployment in both developed and developing nations. It has been demonstrated by The 1992 British Crime Survey that prevalence of drug abusers among unemployed were 60% higher than among the employed (Fry, Fry and Castanelli.D. 2014). International Labour Organization (ILO) and the European Community, have carried out studies to identify that alcohol and drug abusers result in performance impairments and absence from work owing to their alcohol and drug related issues.
Current policies in place:
A wide range of drug policies are in place in Australia:
Development of the National Drug Strategic Plan in 1991
National health partnership launched in 1996
National Campaign against Drug Abuse introduced in 1985
Initiation of National Drug strategy in 1993
National Drug Strategic Framework was developed in 1998 (Gabriel and Manning 2017)
Potential implications in not taken action:
Drug abuse if not managed properly may lead to further increase in various blood transmission related health issues, mental disorders, diminished work ability of workforce as well as increased rate of morbidity and mortality of not prevented. Heavy drug abuse during teenage may act as barrier in motor skills, logic, reasoning and memory function and even panic attacks and hallucinations. Not only drug users but people around them also are significantly affected such as failure marriages, negative relationship with peers and family members and it also drain family’s financial and emotional resources.
Research findings and criticism:
In current years, significant progress and expansion has been taking place in the development of psychosocial treatment to treat substance abuse and dependence. In different studies psychosocial interventions such as cognitive behaviour therapy, motivational interviewing and relapse prevention have been found effective in address drug abuse. Illicit drug users reports issues in different areas such as social problems, health and psychological issues . Increased importance has been provided in the evidence based care for people with substance abuse which has resulted in significant improvement in their psychological standards. Psychological treatments program are taken to be essential in managing comprehensive disorders related substance use that promote change in behaviour of people .
According to Karen, et al. (2016), psychosocial interventions are well designed psychological and social interventions that are applied to minimise substance related issues in people. Psychosocial interventions are applied in different stages of treatment process in order to recognise the issue, manage it and carry out with social integration. Therese interventions also can be be used in combined with other forms of treatment or alone. Psychosocial intervention is used in the initial stage of problem recognition and analyse the drug problem nature and commit to their changing attitude. Psychosocial treatment is also used in combination with pharmacological treatment. In treating opioid related health issues which is used in maintaining client’s treatment retention and achieve behavioural objectives (Kyle and Jarvis 2015). Owing its flexible nature it is used often used by treatment providers in combination of other treatment approaches where requirement of individual clients are taken into considerations.
This particular intervention can be applied to diversified areas of therapeutic pathways which again depends on theoretical assumptions made by the care professions in regards to the issues that drives drug use in an individual. Motivational interviewing is the conversation use to motivate drug users to growing their own motivation and commitment to change their behaviour. It is applied to assist and support people in various kinds of drug related issues. Motivational interviews are used in various settings and stages of treatment including primary care to outpatient services. Brief interventions is the collaborative style of conversation that is applied for motivating and thus addressing problematic drug use which however is provided within shorter timeframe (Penelope, et al. 2016). Individualised feedback is given to the substance users about the harms and benefits of substance abuse with an aim to develop motivation to change behaviour. The key criteria of effectiveness is that a psychosocial treatment results to minimization or abstinence form substance abuse and thus people get into wider areas of activities such as interpersonal relationships, physical health outcome, psychological health, criminal attitude and employment outcome.
Family therapy is used to manage drug use and the associated issues which is usually provided during adolescence as substance abuse causes a number of problems such as problems at school, psychiatric symptoms, and high-risk sexual behaviour. When the drug problem is identified at young age treating it is considered as the best way to address with the use of systematic approach. Prevention and treatment of adolescent substance is achieved through support of multidimensional family therapy. Self-help groups are non for profit voluntary organization where people carry out meeting for discussing and identifying and addressing drug related issues. Participants seek assistance of each other with senior members who offer support and guide new participants. Cognitive behavioural therapy(CBT) is a term that includes cognitive therapy on its own and in collaboration with different behavioural strategies. Through this behavioural therapy care providers believe to strengthen self-confidence of clients and address the thoughts that are believed to drive the drug abuse. CBT is often found to be effective approach in treating population with drug and alcohol use which also is accepted by clients. Clients are taught with the drivers of the issue and learn strategies to handle those drivers of addiction and thus recovery is achieved. Psychosocial interventions can be used in an array of ways in treatment settings that is in either groups or in individual care based process. Effectiveness of CBT may extend beyond the treatment time and protects from relapse after the termination of the intervention. Psychological treatment is considered as the key to achieve betterment in health and other relevant aspects especially in alcohol and substance abuse (Roberts, et al. 2015). The longer the patients remain engaged with the intervention process, the better his or her long term outcome will be. Nonetheless, although psychosocial treatment has been found to be effective treatment, these have not been included for routine clinical practice. Studies have demonstrated that individuals who had been included in the psychosocial interventions have experienced better outcomes in substance abuse either at the end to while following up with the treatment process (Brener, et al. 2017).
Several psychosocial treatments have been shown to have effective role in improving the health conditions of clients as well as protect them from reoccurring or relapsing even after the intervention tool is completed. Although the evidence for psychosocial intervention is found to be strong, they are not applied for treating people with drug use frequently. Cost is one of the key barriers to integrate psychosocial intervention in formal clinical process for achieving behaviour change interventions (Jonathan and Murnion 2015). These interventional approaches are costly to be implemented and thus need resources and adequate financial support that are usually not available in most of the community based program for treatment. These interventions also can be complex in nature therefore staffs training also is needed so that they ca use these approaches in efficient manner. Additionally clients are required to travel to treatment programs especially in rural areas which may be one of the significant barrier to accessing evidence based care for many clients. Complexity of cases and increased turnover of the staffs it may be difficult to ensure their right implementation (Patrick.D.M 2015).
Implications of research:
It can be summed up that with growing cases of morbidity and mortality and various other ill health effects caused by drug abuse, different types of psychosocial interventions have been found to be effective in changing clients’ attitude towards drug use while addressing various negative outcomes related to it by using it in different settings as well as at different stages of treatment process. Psychosocial interventions have been found to have strong evidence of its effectiveness when use alone as well as in combination with other clinical treatment methods. However, they are not applied for treating people with drug use frequently, even in formal clinical settings, despite its proven positive outcomes. Different barriers that have been identified in this way to right implementation are higher financial support, inadequate staffs availability and training, and reluctance of clients to access the intervention training program are a few of those barriers to implementation if psychosocial intervention in healthcare settings to treat, or prevent reoccurring of drug use.
What is the experience in other jurisdiction?
Summarize policy framework and outcomes
The United States over the last decade has transformed its proposed drug policy into more comprehensive approach which concentrates upon prevention, treatment, and enactment. All state and statutory have their own drug related laws however federal agencies may integrate the CSA in all territories and states. Majority of the drug related crimes are addressed at the state level. Local agencies and state agencies in many cases are aided by federal related to drug arrests. Federal law enforcement along with tribal agencies local, state bodies required by Congress investigating efforts to handle drug abuse and minimise use of controlled substances (Joanne, et al. 2016). Drug related offenses are handled by 222 The Drug Enforcement Administration (DEA) offices throughout the United States that again coordinate with federal agencies and local and state authorities. In order to take adequate actions against drug traffickers, the Organized Crime Drug Enforcement Task Forces (OCDETF) Program was developed that work to identify, attacking drug trafficking organizations by devastating the financial infrastructure. Federal law enforcement has however not affected individual for drug possession but rather has aimed at attacking and destroying organizations that are involved in drug trafficking (Lisa, N. Sacco; 2014). The Harrison Act was an important advancement in American drug policy. Office of National Drug Control Policy was aimed at educating parents, care providers, teachers, health professionals, and business and community leader in supporting youth reject illegal drugs, carry out extensive advertising and public communication programs managing the issues of substance abuse, provide learners with drug prevention programs and policies, encourage communication coordination programs, building partnerships with media, professional sports organizations and entertainment industry about illegal drug abuse, generate and integrate research based principles in prevention programme targeting the American youths (Burns, et al. 2016).
The Canadian Drugs and Substances Strategy (CDSS) has been announced by the Minister of Health Canada in 2016 that guides the federal government’s actions to all the substance use related problems such as opioid overdose and regulation of cannabis and legalization of cannabis. In order to ask Canadians for innovative ideas, the Government of Canada is launching a public consultation with an aim to improve health related approach of federal government to the issues of substance abuse through CDSS. The policy has been initiated to address the root cause of the issue, minimise stigma linked with substance abuse, addressing the requirements of Canadians living with pain, improve access to comprehensive care to substance abuse, supporting aboriginal population, developing creative approaches to minimise harm caused by substance abuse, and addressing the requirements of people with risk (Benedikt, et al. 2016). CDSS has been aiming at encouraging government, the Canadian justice, society, social systems and health care settings to manage problems of drug use as a social and health care problem, develop approach that ensures prevention, harm minimisation, treatment, and enforcement, as well as managing root causes of drugs and development of evidence-based policies and programs with coordination of regions and states (Strengthening Canada’s Approach to Substance Use Issues 2018).
Both the USA and Canada have developed policy frameworks to address the growing concern of substance abuse. Different aspects have been considered in developing and integrating the policy framework so that the ill effects of drug abuse can be minimised, treated and youth are protected from such addicting. Canadian government further has considered the needs of Canadians so that those can be addressed that may lead to drug abuse otherwise. In contrast, USA policy framework has been working to make people aware of negative effects and how they can prevent themselves from substance abuse through implementing research based programs.
In order to apply the specific policy following recommendations must be taken into considerations:
- Although different psychosocial intervention methods care prevalent, clients individual needs must be identified before choosing a particular intervention process so that it needs individual health needs
- Adequate awareness must be promoted especially among youth so that they understand the adverse effects of illegal substance on their physical and mental health, working ability of the drug users and people around them and adopted strategies so that can keep themselves away from drug abuse
- Different promotional campaign and advertisements should be included in the policy program that makes people awareness not only the youth but also their parents, teachers, clinical practitioners so that they can identify the behaviours of the drug users and guide them with adequate support
- Health and social care setting must invest in recruitment and selection procedure so that it owns adequate number of clinical staffs for treating complex health issues that may emerge due to substance use
- The care setting also must develop staffs training program so that the clinical staffs improves their efficiency in identifying behaviour related to drug abuse and treat those through appropriate intervention methods
- Effective motivational strategies and rewards must be in place that ensure that the staffs are satisfied with their workplace that will improve their performance as well as diminish employee turnover
- Required quality management and monitoring tools must be adopted in health care settings that must ensure that the policies are accurately implemented and evaluate at regular intervals
- Proper allocation of resources such as staffs and financial resource must be arranged that are required for policy implementation and thus expected outcomes can be achieved.
It can be concluded that the policy for psychosocial interventions method in educating, treating and preventing relapses in illicit drug use in long term, even after termination of the intervention has to go through a number of stages from its planning to final implementation and must comply with minimum standards to achieve expected outcomes. Hence the CEO of the health care setting must ensure that all the provided recommendations are in place and thus ensure positive results through educating, treating and preventing relapse of drug addiction in future can be met.