Phoenix Brown
08911037
Abbey Diaz

The Artefact:
Amy Winehouse - Rehab
Amy-Winehouse.jpg

The above artefact is of the song ‘Rehab’ by the late singer Amy Winehouse. It represents her struggle with addiction to substances such as alcohol and illicit drugs that have plagued her for most of her life. The most notable lyrics such as ‘They tried to make me go to rehab but I said no, no, no’ is a relation to her family, friends and doctors urging her to undergo the abstinence based method of recovery: rehabilitation.

The Public Health Issue Central to the Analysis
Drug addiction, in all its complexity, is an illness that is characterised by intense and, at times, uncontrollable drug craving along with compulsive drug seeking and use that persist even in the face of devastating consequences (National Institute on Drug Abuse, 2009). Treatment of this illness is not simple as drug addiction has multiple dimensions and disrupts so many aspects of an individual’s life (NIDA, 2009). Abstinence and harm minimisation are two methods that aim to aid those with a substance addiction problem. The preferred and most effective treatment option for drug users is constantly debated among health professionals. The artefact is a representation of how a treatment method needs to be tailored for the individual and not used as a ‘one size fits all’ model. Often abstinence and harm minimisation strategies are presented as ‘opposites’ or as conflicting approaches to treating drug abuse (Corcoran, K., Dolan, K., Larney, S., Wodak, A. and 2007). In this wiki both of the treatment options will be discussed in terms of how each of them approaches drug addiction and their individual effectiveness.

Literature Review
There is no doubt that illicit drug use and abuse is a growing issue in Australia with numerous negative effects on health. Based on responses to the 2004 NDSHS, recent illicit drug use was most prevalent among persons aged between 18 and 29 years in 2004, with almost one in three people (31%) in this age bracket having used at least one illicit drug in the last 12 months. According to a study by Professor Louisa Degenhardt from the National Drug and Alcohol Research Centre at the University of New South Wales, 52 million people in the world are dependent on drugs and opioid dependence has been outlined as the biggest killer and cause of disability (The Australian, 2013). “Our results clearly show that illicit drug use is an important contributor to the global disease burden,” says Prof Degenhardt (National Drug and Alcohol Research Centre, 2013, para.5). However Treatment of this illness is not simple, as drug addiction has multiple dimensions and disrupts so many aspects of an individual’s life (NIDA, 2009). There is often great debate on whether a harm minimisation or abstinence based approach should be taken when regarding the treatment of those addicted to alcohol or drugs.
Whittle (2010) states that harm minimisation is a policy that focuses on preventing the associated harm from substance abuse in contrast to policies that seek primarily to reduce the use of drugs. The foundational argument for harm minimisation is that there has never been, and never will be, a drug free society (DPA, n.d). The repercussions and dangerous activities that harm minimisation strives to avoid are risky behaviours and injection methods, particularly intravenous drug use such as injection by syringes, drug addiction/dependence, abuse and other health problems (Whittle, 2010).

The National Campaign Against Drug Abuse has been a key policy of Australian state and federal governments since its launch in 1985 (Australian Government Department of Health, 2004). Its policies aim to improve the health, social and economic outcomes of alcohol and drug users in relation to the individual and the community (Nolte, 2006). Rather than reducing or eliminating alcohol or drug use, interventions are designed to prevent or reduce associated harms by incorporating three approaches; supply reduction, demand reduction and harm reduction (Nolte, 2006).
Supply reduction strategies are defined as efforts to disrupt or reduce the manufacturing and distribution of illicit drugs (Drug and Alcohol Office, 2013). This is achieved through civilian law enforcement such as legislation and sometimes military forces.
Demand reduction is defined as strategies to reduce the uptake or desire of illicit drugs (Drug and Alcohol Office, 2013). Community development projects and media campaigns are examples of some of the schemes to achieve this.
The implementation of harm minimisation strategies uses interventions to reduce the harm associated from drug use for individuals and communities rather than striving for immediate abstinence. Denning (2001) states that the majority of the health promoting intervention methods include peer education, drug education videos, health fairs, needle syringe services such as exchanges, supervised injection rooms as well as methadone maintenance.

Although harm minimisation can be successful in treating substance addiction for some, it’s important to match the treatment with the needs of the individual. Heather and Robertson’s studies (2006) have suggested that the attainment of a stabled and controlled drinking or substance use pattern becomes more difficult as a function of severity of dependence. Coleman (2006) has stated that many people discover they cannot use their drug in a recreational style; the most seriously addicted choose the path of abstinence because for them, it’s all or nothing. “Hence, while not necessary for recovery in the strictly logical sense, abstinence does become necessary for the optimal treatment of many severely dependent individuals,” (Heather and Robertson, 2006, para.4).

Types of abstinence methods can include therapeutic communities, rehabilitation centres, recovery or sober houses, medication and counselling (Department of Health and Human Services, 2001). A study by McKeganey, Morris, Neal and Robertson (2004), revealed that when drug users were asked what changes they wanted when they attended their treatment facility, 56.6% responded that abstinence was the only change they hoped to achieve from attending the drug agency. Though transition from drug dependency to total abstinence is a long journey, research by The American Public Health Association (2011) revealed that abstinence from drugs and alcohol (including intermittent abstinence) is associated with a lower risk of mortality.

Health professionals such as Susie Mclean of the International HIV/AIDS Alliance (2012) argues that an abstinence based approach to drug addiction is costly with only a modest success rate due to the influx of people relapsing after they have been through the detoxification and rehabilitation processes. Mclean (2012, para.3) states Relapse rates are particularly high in programmes that compel people to stop using drugs which suggests that it is only when individuals reach a point in their lives where they are ready and able to stop using illegal drugs that abstinence-based programmes can succeed.”
On the other hand, celebrities such as Russell Brand have advocated for abstinence-only methods of treating drug addiction. Currently a synthetic opioid called methadone is being prescribed to drug users due to its long lasting effects, ability to help stabilize addicts and prevent heroin withdrawal symptoms (Hasuik, 2008). "We might as well let people carry on taking drugs if they're going to be on methadone," Brand (2012, para.5) says. "Obviously it's painful to abstain, but at least it's hope-based."
The World Health Organisation (2006) concurs, stating that there can be little conflict between the approaches if abstinence-based organisations implemented harm reduction services into its methods. “It is possible to incorporate harm reduction into therapeutic communities while still promoting abstinence,” (Corcoran, Dolan, Larney and Wodak, 2006, para.7). Harm minimisation approaches can provide illicit drug users with the knowledge and tools to stay safe and disease free until they are able to achieve and maintain abstinence (Corcoran, Dolan, Larney and Wodak, 2006).


Cultural and Social Analysis
When addressing the health issue of drug abuse, it is important to consider each individual’s social and cultural backgrounds that can be influential in the risk of developing an addiction. Social and cultural factors can affect people by determining their risk of developing an addiction and whether treatment is a viable option. These determinants can limit availability to resources, access to social welfare systems, marginalisation and compliance with medication (Galea and Vlahov, 2002). Social determinants of drug use can include class, gender and race which can influence the access to resources, exposure to marginalisation, roles and expectations (Hetherington and Spooner, 2004). “For example, people from low socio-economic classes have poorer health and are more likely to use tobacco, to drink alcohol in a high-risk manner and to use illicit drugs,” (Hetherington and Spooner, 2004, page.7).

Abbott and Chase (2008) have stated that culture can shape the approach to and behaviour regarding substance use and abuse. Culture is often responsible for the formation of the expectations about the potential problems associated with drug use (Abbott and Chase, 2008). “Initiation into excessive substance use may occur during periods of rapid social change, often among cultural groups who have had little exposure to a drug and have not developed protective normative behaviour,” (Abbott and Chase, 2008, para.9). A sudden flux of outside influences on native cultures can cause devastating loss to ethnic or cultural identity (Abbott and Chase, 2008). Therefore native or indigenous people are more at risk of developing a substance addiction as the loss of cultural identity has impacted on their education on this issue. Additionally, culture in terms of immigration affects the prevalence of drug abuse as those who immigrated for economic reasons tend to be poorer, less educated and younger than the overall population (Centre for Substance Abuse Treatment, 2009). Thus the cycle of drug abuse continues as there is often a link between drug use and addiction is more likely to develop among young people from lower social classes (Palmer, n.d).

Awareness of the determinants that pose an individual risk to someone developing a drug addiction needs to be raised in order for treatment of those affected to be effective. Those who are unemployed are likely to experience marginalisation and are more prone to become drug-dependent (Hetherington and Spooner, 2004). These determinants can exacerbate their problems and thus prevent them from seeking or benefitting from treatment (Hetherington and Spooner, 2004). Treatment options that cater for those from a low socio-economic background or unemployed need to be tailored according to their individual needs.
Youth who are from low socio-economic backgrounds and/or have a low performance at school may be at risk of developing drug use. The London House of Commons (2012) have advocated for the importance of educating all young people about the harmful effects of legal and illegal drugs. Increasing the awareness of this issue will require rigorous analysis of drug education and prevention work, ensuring money is only spent on what works and particularly the long term consequences of drug use, (House of Commons, 2012).

Analysis of Artefact and Learning Reflections
Upon reflection of the song ‘Rehab’ by Amy Winehouse, its autobiographical context tells the story of a musician who is haunted by her own personal demons of alcoholism and drug use. The singer had a few stints in rehabilitation to treat her drug and alcohol addiction, which unfortunately was unsuccessful, with her eventually overdosing in her home on July 23, 2011.
This song is a solid representation on the topic of seeking help to treat an addiction and the struggles that inevitably encompass this health issue. The debate between a harm minimisation or abstinence based approach can often leave those seeking help, including Winehouse, with a method that isn't catered for their individual needs. This assignment has provided me with insight into the nature of drug addiction and the need to tailor treatment options to the individual and not adopt a one-size-fits all model. Each person responds differently and has their own way of dealing with their struggles; therefore it would be more beneficial to adapt treatment accordingly. Before undertaking this assignment, it was my personal opinion that the only way a person could overcome a drug addiction was to abstain altogether. I have learnt that everybody deals with addiction in their own way and it is important to remain open minded about this issue. In the future when I am undertaking an assignment I will approach it with an unbiased viewpoint, willing to accept all the possibilities and outcomes. Impartiality and a neutral outlook will provide me with objectivity and the ability to think ‘outside the box’ when it comes to verifying actual or factual knowledge.

Reflection


Comment one - Eating Up The World
http://healthcultureandsociety2013.wikispaces.com/share/view/64697674

Comment two - Capital Beef
http://healthcultureandsociety2013.wikispaces.com/share/view/64697804

References

Abbott, P., & Chase, D. (2008, January 1). Culture and Substance Abuse: Impact of Culture Affects Approach to Treatment. Psychiatric Times. Retrieved October 31, 2013, from
http://www.psychiatrictimes.com/articles/culture-and-substance-abuse-impact-culture-affects-approach-treatment

Brand, R. (2012, August 12). Russell Brand: methadone is a bad way to treat heroin addicts. The Guardian. Retrieved October 28, 2013, from http://www.theguardian.com/culture/2012/aug/12/russell-brand-methadone-treating-heroin-addicts

Chapter 6: Substance Abuse Among Specific Population Groups and Settings. (2009). Centre for Substance Abuse Treatment,. Retrieved October 31, 2013, from
http://www.ncbi.nlm.nih.gov/books/NBK83240/

Coleman, M. (2006, 03). Abstinence versus harm reduction.Issues, 74, 45. Retrieved October 28 from
http://search.proquest.com/docview/220293802?accountid=13380

Corocan, K., Dolan, K., Larney, S., & Wodak, A. (2006). The Integration of Harm Reduction into Abstinence-based Thereputic Communities, A Case Study of We Help Ourselves Australia. National Drug and Alochol Research Centre. Retrieved October 28, 2013 fromhttp://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/TR.263.pdf


Degenhardt, L. (2013, August 29). First analysis of global drug dependence reveals opioids responsible for the greatest burden of death and illness. National Drug and Alcohol Research Centre. Retrieved October 20, 2013, from http://ndarc.med.unsw.edu.au/news/first-analysis-global-drug-dependence-reveals-opioids-responsible-greatest-burden-death-and

Denning, P. (2001). Strategies for implementation of harm reduction in treatment settings.Journal of Psychoactive Drugs,33(1), 23-6 Retrieved October 28 from
http://search.proquest.com.ezp01.library.qut.edu.au/docview/207974549/141815BDE5F77C5EF58/1?accountid=13380

Drug: Breaking the Cycle. (2012, December 3). House of Commons Home Affairs Committee. Retrieved October 31, 2013, from
http://www.publications.parliament.uk/pa/cm201213/cmselect/cmhaff/184/184.pdf

DrugFacts: Treatment Approached for Drug Addiction. (2009). National Institute on Drug Abuse. Retrieved October 20, 2013 from
http://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction

Galea, S., & Vlahov, D. (2002). Social Determinants and the Health of Drug Users: Socioeconomic Status, Homelessness and Incarceration. The National Centre for Biotechnology Information. Retrieved October 31, 2013, fromhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913691/pdf/pubhealthrep00207-0140.pdf

Harm Reduction. (n.d). Drug Policy Alliance. Retrieved October 31, 2013, from
http://www.drugpolicy.org/harm-reduction

Harm Reduction. (2013, March 11). Government of Western Australia Drug and Alcohol Office. Retrieved October 28, 2013 from http://www.dao.health.wa.gov.au/vsu/pages/harmreduction.htm

Hasiuk, M. (2008, Sep 05). Juiced up; legal methadone is the little known backbone of vancouver's harm reduction approach to drug addiction. it's also a tidy business for pharmacies that routinely break their industry's own regulations.Vancouver Courier. Retrieved October 28 from http://search.proquest.com/docview/359510797?accountid=13380

Hetherington, K., & Spooner, C. (2004). Social Determinants of Drug Use. National Drug and Alcohol Research Centre. Retrieved October 31, 2013, from
http://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/TR.228.pdf

Heather, N. and Robertson, I. (1983), Why is Abstinence Necessary for the Recovery of Some Problem Drinkers?. British Journal of Addiction, 78: 139–144. doi: 10.1111/j.1360-0443.1983.tb02495.x

Mckegany, N., Morris, Z., Neale, J., & Robertson, M. (2004). What Are Drug Users Looking For When They Contact Drug Services: abstinence or harm reduction? Drugs: education, prevention and policy, 11(5), 423-435. Retrieved October 28, 2013, __http://informahealthcare.com/doi/pdf/10.1080/09687630410001723229__

Mclean, S. (2012, August 15). Russel Brand shouldn’t speak for everyone on drugs policies. The Independent. Retrieved October 20, 2013 from http://blogs.independent.co.uk/2012/08/16/russell-brand-shouldnt-speak-for-everyone-on-drugs-policies/

Nolte, D. (2006). Harm Minimization. David Nolte Pharmacy. Retrieved October 31, 2013, fromhttp://www.nolte.com.au/html/harm_minimization_.html

Palmer, G. (n.d). Drug use, The Poverty Site, Retrieved November 1, 2013, from
http://www.poverty.org.uk/38/index.shtml

Scott, C. K., PhD., Dennis, M. L., PhD., Laudet, A., PhD., Funk, R. R., B.S., & Simeone, R. S., PhD. (2011). Surviving drug addiction: The effect of treatment and abstinence on mortality.American Journal of Public Health, 101(4), 737-44. Retrieved October 28 from http://search.proquest.com/docview/860165699?accountid=13380

Statistics on drug use in Australia 2006, (2007, April 12). Australian Institute of Health and Welfare. Retrieved October 20, 2013, from
http://www.aihw.gov.au/publication-detail/?id=6442467962

Study rams home Australia’s drug problem. (2013, August 29). The Australian. Retrieved October 20, 2013, from
http://www.theaustralian.com.au/news/nation/study-rams-home-australias-drug-problem/story-e6frg6nf-1226706256356

Substance Abuse Treatment For Drug Users in the Criminal Justice System. (2001) Centres for Disease Control and Prevention. Retrieved October 25, 2013, fromhttp://www.cdc.gov/idu/facts/cj-satreat.pdf

Whittle, T. N. (2010). Redefining success: A harm reduction evaluation of abstinence-based drug education. (Order No. 1479697, The George Washington University). ProQuest Dissertations and Theses, , 64. Retrieved October 28 fromhttp://search.proquest.com/docview/749763917?accountid=1338