Appraisal of the importance of medically assisted use of substance treatment
|Subject:||🏥 Health Care|
|Topics:||💊 Substance Abuse, Public Health, 👨🏻⚖️ Criminal Justice|
Table of Contents
Substance dependence has cause Problems resulting in high costs to the society such as low productivity, spread of infectious diseases, social and family disorders, crime as well as the excessive deployment of health care. The drug-related problems not only reduces the quality of life but also increases the cost of living in the society. For instance, the estimate in the United States of America, in 1990 the total cost of alcohol abuse was 99 billion dollars, and drug abuse cost roughly US$ 67 billion.
As expected, such problems initiate a conversation in the society as to what a family, employer, school or government is supposed to do so as to reduce the cost drug abuse to the safety of the people and the public health. Few countries have devised the system to deal with the substance abuse problem. The question still stands, why are the treatment options for substance abuse not been positively considered, developed and dispensed to address the issue of dependence on substance.
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What makes an intervention socially worthwhile?
Society’s expectations for “effective” interventions
Family, institutions, and organisations are the major referrals of the addiction cases based on the observation of the problem and if it is attributed to drug abuse. The expected changes to the drug abuse problem are the reduction of the substance abuse problem. The treatment can produce the desired decrease in the use of the drug and therefore the desired enhancement in the associated problem. The coercions are very significant both to the potential patient and to the society because they shape the pact which treatment is given and evaluated.
Expected outcomes from substance abuse treatment
Key healthcare sources anticipate an “effective” treatment for substance reliance to reduce the serious public health and medical risks related to use of drugs such as AIDS, hepatitis along with tuberculosis, and to decrease the uneven deployment of primary health-care services which mainly serve alcohol- and drug-dependent persons. According to the outcome of a study released by the Home Office in February (2013), 99% of the costs is associated with the problem drug users. The annual economic costs of drug abuse in the United Kingdom are between US$ 5.6 billion and US$10.3 billion. A total cost of US$338 million in 2001 was spent on primary care while US$16.5 billion to US$28.4 billion was the total social costs used in services, accident and emergency admissions and drug abuse treatment, the workplace, schools and families of the drug users.
Crime worries every society. Current statistics indicate that 60% of the federal prisoners have substance dependence disorder. 50% of property crimes are committed by drug addicts who want to obtain drugs from the proceeds of crime. The criminal justice system is forced to consider other treatment alternatives for imprisonment after the establishment of the relationship between crime and substance abuse.
To them, the “effectiveness” of medically assisted treatment is measured by crime reductions, incarceration and parole violations rates amongst affected people. Effective medically assisted treatment should address costly as well as socially destructive addiction related problems apart from producing abstinence.
Outcome based on expectations of the public
Based on the discussion above it is rational to consider three outcomes that are relevant to the rehabilitative objectives of the patient, to the public health and safety objectives of the society.
- Elimination of use of alcohol and the illicit drug which is the main purpose of all treatments for substance abuse.
- Enhanced personal health as well as social function. Improvements in the social function, medical and psychiatric health for the patient and the society are important and prevents relapse.
- The decrease in public health and safety threats. The threat comes from behaviour by the drug addicts who spread infectious diseases, property, and personal crimes. For instance trading sex for drugs and sharing needles.
By investing every US$1 in treatment, it reduces the costs of drug-linked crime, theft, and costs for criminal justice by US$4-7(The United States of America, Department of Health and Human Services, Centers for Disease Control, 2015).
Non-treatment alternatives to address substance abuse
Evidence for treatment effectiveness
The focus of the paper is in the controlled and experimental research studies. As its scientific standard, the studies provide the most thorough evidence for questions the policy makers are facing. Can medically assist drug treatment to be effective and at the same time valuable to the society compared to other policy alternatives?
Effects of substance abuse if not treated
Where medically assisted drug use is not applied to a patient, the absence of substance affects the social function, personal and public health. Metzer et.al (2012), studied the injecting drug users and the rate of transmission of infection of HIV during the sharing of needles among the patients addicted to the opiate. This is referred to as in-treatment which is controlled in a medical facility. Also, another group consisted of individuals who are out of treatment for the past one year (Booth, Crowley and Zhang 2014). HIV testing was conducted to all the participants, and it was evident that there was a 60% reduction in the chances of contracting HIV due to the Methadone treatment.
Screening plus brief advice from the physicians can influence the “motivation for treatment” amongst patients and also determine the longer-term health course. The costs of untreated addiction, Svikis et.al (2016) established that the cost of care given to the mother and baby in the treated group was drastically less than the average for the ones getting prenatal care with no drug dependence treatment.
Non-treatment interventions for substance abuse
Globally the construction, maintenance, and operation of jails are expensive. Consequently, imprisonment only, cannot pass for a cost- efficient alternative even if it is effective in reducing the alcohol as well as drug use. Medically assisted treatments may cost nothing and the private treatment of inpatient persons costing as much as US$ 19,000 for 28 days. Many people who have been imprisoned always relapse within one year of incarceration due to nontreatment while in prison.
Combining treatment and non-treatment interventions for substance abuse
A significant and policy-relevant research has observed the effects of merging imprisonment and other legal interventions such as parole and probation with treatment interventions to find out if they are compatible. The presence of synergetic effects in both approaches was looked into, and the results confirmed that to the combination of treatment with a correctional method to the drug abuse problem is possible.
Contemporary addiction treatment?
Detoxification and rehabilitation phases
There are detoxification stage and the rehabilitation phase where relapse is prevented in the drug addicted patient. Both stages are important and “True detoxification” is necessary only for some types of drug addiction, for example, nicotine, opiate, alcohol, benzodiazepines, and barbiturate. To determine the outcome, the detoxification must be followed by rehabilitation where the root cause of the admission is looked into. The two stages are both important to the individual and the society as well.
Components of effective treatment
- spending more time in treatment
- Reinforcement i.e. financial incentives for attendance as well as abstinence
- Having a personal therapist
- Specialised services for psychiatric, family and employment problems.
- Medications to cut craving for drugs and the effects of the drugs. Medication also decreases psychiatric symptom
- taking part in self-help groups after rehabilitation
In the treatment of nearly all chronic illnesses, the expectation is that “effective” treatments should reduce symptoms, enhance function along with preventing relapse, in particular, costly relapse. Hypertension, asthma, and diabetes are not necessarily constant or obstinately lethal, as long as the treatment routine, diet and change in behaviour are followed. Their treatments suggest parallel treatments with that of drug addiction. The drug addiction treatment is not subjected to the same assumption as the chronic illnesses.
Practically, the currently available treatment will never correct the core of the problem but only decrease the severity and number of symptoms.
- Booth, R. Crowley, J. & Zhang, Y. (2014). Substance abuse treatment entry, retention, and effectiveness: out-of-treatment opiate injection drug users, Drug, and alcohol dependence, 42(1), 11-20.
- Metzger, D. et.al (2012). HIV Seroconversion among in and out of treatment intravenous drug users: an 18-month prospective follow-up, 6 (9), 1049-1056.
- Svikis, D et.al (2016). Cost effectiveness of treatment for drug-abusing pregnant women, Drug and alcohol dependence, 45(1-2),105-113.
- United Kingdom of Great Britain and Northern Ireland, Home Office (2013). Drugs minister highlights savings in criminal justice: costs of drug treatment expenditure, press release.
- The United States of America, Department of Health and Human Services, Centers for Disease Control (2015). Policy Issues and Challenges in Substance Abuse Treatment. Www. cdc.gov/idu/facts/Policy.htm