The+Solution+To+An+Addicts+Life+-+Abstinence+or+Harm+Minimisation

= The Solution To An Addicts Life - Abstinence or Harm Minimisation =
 * Zoe Hackett n8797013 - Michelle Newcomb**

=**Cultural Artefact**=  This artefact can be found as the cover image of Mary Micrograms ‘Just Say Know: Strategies for Harm Reduction’ blog. Within this artefact you can see all the ways drug addicts use, including needles, sharing pills, snorting and smoking drugs. However the ‘safety first’ symbol in the centre followed by ‘because you can’t get high when you’re dead’ draws attention to harm minimisation interventions to increase drug addicts quality of life. From this image it is clear that harm minimisation is not a cure but instead provides interventions to increase the health and life expectancy of drug addicts.

=**Public Health Issue**= The public health issue that this cultural artefact represents is illicit drug use. World Health Organisation (WHO) estimated that 5.4% of total burden of disease globally is due to illicit drug use. According to the world WHO Dr Shekhar Saxena (WHO, 2010), “Illicit drugs are harming millions of people in many ways, from becoming dependent on such substances to causing a range of other health problems, such as injuries, cardiovascular diseases, HIV and hepatitis C or cancers.” In particular the artefact demonstrates the importance of harm minimisation interventions in preventing the death of these individuals. Harm minimisation is one of two methods that are currently being used world wide as an illicit drug treatment while the other option is abstinence as there is no single treatment that can be applied to all people (Coleman, 2006). =**Literature Review**= Currently within Australia there are two methods which are being utilised to help address the public health issue of illicit drug use; harm minimisation and abstinence. In 1985 the Australian government originally implemented the National Drug Strategy (NDS) in response to the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) epidemic. Due to its success it is still used today help prevent drug abuse (Duff, 2004; Ministerial Council on Drug Strategy [MCDS], 2011). The latest NDS ranges from 2010 to 2015 and supports the harm minimisation approach towards illicit drug users to improve the health, social and economic outcomes of the individual and the communities affected (MCDS, 2011). Harm minimisation is not associated with minimising the use of drugs itself but instead minimising the harms associated with drug use and contains three pillars; demand reduction, supply reduction and harm reduction (Weatherburn, 2008; MCDS, 2011). Demand reduction aims to delay and prevent the uptake of drug use, decrease the use of drugs within communities, support individuals to recover from drug dependence and reunite drug users within the community. One of the best ways to reduce the demand of an illicit drug is to introduce a treatment (Weatherburn, 2008). The main reason why drug users will stop using is due to adverse pharmacological effects, trouble with police, the cost of the illicit drugs and the lifestyle associated with illicit drug dependence (Weatherburn, 2008). Since the late 1950’s Australia began offering methadone treatment for opiate addicts to help reduce the incidence of heroin users and achieve abstinence (Bell, Burrell, Indig and Gilmour, 2006). Methadone treatment has been considered a success due to studies finding that it can reduce drug addicts long-term health risks including HIV and hepatitis C virus (HCV) transmission, reduce mortality, illegal drug use and decrease criminal activity within communities (Gjersing, Butler, Caplehorn, Belcher & Matthews, 2007; Gowing, Farrell, Bornemann, Sullivan, & Ali, 2006). In 2001 the National Evaluation of Pharmacotherapies for Opiod Dependence (NEOPD) evaluated the outcome of methadone treatment in Australia by compiling data from thirteen separate clinical trials from 1996-2000 (Mattick, Digiusto, Doran, O’Brien, Shanahan, Kimber, Henderson, Breen, Shearer, Gates, & Shakeshaft, 2001). The evaluation determined that methadone treatment was a cost effective treatment for heroin addicted drug users. It also found that individuals that remained in treatment were more likely to reduce heroin use and eventually become abstinent compared to drug users that did not complete the treatment often resulting in relapses (Mattick et al., 2001). Finally it is important to note that every demand reduction strategy has the possibility to generate harm (Weatherburn, 2008). Reducing the demand relative to supply may result in illicit drugs decreasing in cost and becoming more affordable for drug users. In particular methadone treatment can result in patients selling their methadone to others, giving it to their children or selling it for money to buy other illicit drugs (Weatherburn, 2008). The second pillar of harm minimisation is supply reduction. Supply reduction focuses on reducing the supply of current and emerging illicit drugs (Ministerial Council on Drug Strategy, 2011). According to Measham (2006), “socio-economics and cultural influences on fluctuations in demand, supply-side production, promotion, licensing, access, and sales policies and practices play an important part in patterns of consumption.” By reducing the supply of only one illicit drug, some drug users will change to another drug as seen in 2001 when Australia experienced a sudden but sustained decrease in heroin availability (Degenhardt, Conroy, Day, Gilmour, & Hall, 2005). The shortage of heroin resulted in a decrease in the frequency of heroin use, decrease in the number of heroin overdoses and also reduced the number of heroin-related police incidents however there was an increase in consumption of other illicit drugs including cocaine and methamphetamine (Degengardt et. al., 2005). Currently in Australia the supply of illicit drugs is monitored by border and domestic border policing also known as customs, laws against illicit drugs and policies set in place by all levels of the government. By putting in place these procedures and policing it deters and decreases the supply of illicit substances. However the problems with these laws are that majority of the time only the drug user is charged rather than the drug dealer and therefore not reducing the supply. Thus in order for harm minimisation to be maintained and successful it requires the community, government and law enforcing agents to be proactive and work as one (MCDS, 2011). The final pilar of harm minimisation is harm reduction. Harm reduction focuses on reducing the adverse health, social and economic impacts of drug use for the individual, their families and the communities (MCDS, 2011). The prime example of harm reduction is the needle and syringe program (NSP) in Australia. NSP reduces harm to drug users by offering clean injecting equipment, education and information on health care issues and drug related harm, and also facilitates entry into drug treatment (Australian Government Department of Health and Ageing, 2010). NSP is considered to be the gold standard in regard to the Australian Medical Association and is endorsed by WHO, Joint United Nations Programme on Acquired Immune Deficiency Syndrome (UNAIDS) and the United Nations Office of Drugs and Crime (UNODC) (Australian Government Department of Health and Ageing, 2010). NSP has been available in Australia since 1986 and was implemented in response to the epidemic of HIV and the potential threat this virus caused to the Australian community. This program has been found to not only be succeful in reducingharm but also, cost effective. Between 1991 and 2000 the Australian Government invested $130 million dollars into the NSP resulting in an estimated 25000 cases of HIV and 21000 cases of HCV in injecting drug users (IDU’s) prevented and saved the economy between $2.4 to $7.7 billion dollars in medical expenses (Australian Government Department of Health and Ageing, 2010). By reducing the number of IDU’s with HIV and HCV ultimately reduces the chances of sexual partners, children and the general population from contracting these diseases. However this harm reduction policy has come under high scrutiny due to many people believing that the government is condoning illegal drug use and creating the first step to legalisation of these drugs (Des & Don, 1995). In fact the aim of the NSP is to prevent the poor health and social harm associated with illegal drugs (Des & Don, 1995). The other method, apart from harm minimisation, to address the public health issue of illicit drug use is abstinence. The leading abstinence model is the Minnesota model. The Minnesota model was first used to treat alcoholics in alcoholics anonymous and has now been adapted to be used for drug and other addictions (Morojele, & Stephenson, 1992). It is considered a multimodel therapeutic approach and can include group and individual therapy, family education and support and other methods (U.S. Department of Health and Human Services National Institutes of Health, 2000). The sessions are run by a multidisciplinary team including counsellors, psychologists and nurses all of which help to plan and assist each patients treatment process (U.S. Department of Health and Human Services National Institutes of Health, 2000. This approach to substance abuse aims to achieve lifetime abstinence from alcohol and other mood-altering chemicals and an improved quality of life. This is achieved by following a 12-step philosophy with the final goal being a change in personality, basic thinking, feeling, and acting in the world (U.S. Department of Health and Human Services National Institutes of Health, 2000). Many drug users relapse and fall out of the program. This is thought to be due to non-attendance at regular meetings and personal beliefs and attributions (Morojele & Stephenson, 1992). The two methods which are used to curb the public health issue of illicit drug use in Australia both have there benefits and consequences. Harm minimisation seeks to reduce harm to the individual and ultimately family and the greater community. However as explained above affecting the demand or supply of an illicit drug can cause harm. Abstinence on the other hand seeks to provide the individual a life without alcohol and other drugs. As many drug users relapse this method is not always effective but is the ultimate goal. Therefore harm minimisation methods need to be in place to improve these individuals’ health outcomes and increase their quality of life.

=**Cultural and Social Analysis**= Drugs are a chemical substance that affects the normal function of the body and/or the brain (UNODC, 2008). Illicit drugs is a term that is used to describe drugs that are under international control and produced, trafficked and/or consumed illegally (UNODC, 2013). The use of illicit drugs is a major public health issue in Australia, with approximately 1000 deaths and 2% of burden of disease in 2003 associated with illicit drug use (AIHW, 2007; AIHW, 2011a; AIHW, 2011b). According to the 2010 national Drug Strategy Household Survey the number of people using illicit drugs over the age of 14 has increased from 13.4% in 2007 to 14.7% in 2010. The survey also found that illicit drug use was higher in males compared to females. In Australia the main illicit drugs are cannabis, meth/amphetamines, ectasy, lysergic acid diethylamide (LSD), cocaine and heroin (National Drug & Alcohol Research Centre [NDARC], 2007; AIHW, 2011; AIHW, 2005). All of these drugs are more commonly used by males aged 20-29 years of age except cannabis (NDARC, 2007). Cannabis is one of the biggest concerns with approximately 5.5 million Australians having tried cannabis over the age of 14 (NDARC, 2007; AIHW, 2011a; AIHW, 2011b). Cannabis was found to be used most commonly by high school students, fully employed individuals and people who generally lived at home (NDARC, 2007). Community surveys on Meth/amphetamine use have found that recreational users come from various backgrounds while the chronic dependent drug users are typically from low socioeconomic status (Kaye & Darke, 2000). Other community studies found that majority of meth/amphetamine users are generally young adults that live in shared accommodation or with their parents and have low income generally relying on government allowances (Lynch, Kemp, Krenske, Conry & Webster, 2003; McKetin, McLaren & Kelly, 2005). Ectasy’s main users like meth/amphetamines live in shared housing with parents and children however they are generally well-educated and engaged in full-time employment or tertiary education (NDARC, 2007). Cocaine unlike the other drugs has two distinct groups of users; the high socio-economic status group all had regular or above average income and were educated. The other group came from low socioeconomic status with the male users unemployed while the female users often worked within the sex industry, had lower levels of education and were involved in criminal activity (NDARC, 2007). Heroin and LSD were commonly used by people from low socioeconomic background that were unemployed (NDARC, 2007). Depending on the illicit drug used, there are different groups at risk however the most common at risk groups include homosexuals and bisexuals who are three times more likely than a heterosexual to use illicit drugs (AIHW, 2011b). Aboriginal and Torres Strait Islanders are the second biggest group at risk (AIHW, 2011b). This is perhaps as many of these individuals fall under unemployed, low socioeconomic status, never being married or live in remote or very remote areas all of which the AIHW have outlined as being the main cause of illicit drug use (AIHW, 2011b’ NDARC, 2007). Marxism and Otherness are two social theories which may act to reduce the illicit drug use within Australia. Marxism focuses on closing the gab within class, gender, race and ethnicity and as the research shows these groups are the ones affected most by illicit drugs (Carroll, 2013a). Thus by closing the gap between these groups may help in resolving the public health issue. The social theory of ‘otherness’ focuses on the fact that people create relationships but then struggle with domination and power ultimately realising that conquering another or enslaving another does not conquer the world (Carroll, 2013b). By implementing this social theory into this public health issue may allow one to see that by dominating or over powering these at risk groups will not help or reduce the public health issue of illicit drug use. Instead one needs to consider implementing the social theories of Marxism and Otherness by focusing interventions of harm minimisation and abstinence at these groups to reduce the public health issue of illicit drug use. =**Artefact Analysis and Reflection**= The cultural artefact I have used in this assignment demonstrates that harm minimisation interventions are required to prevent the death of illicit drug users and improve their health. This artefact displays how there is not just one way a drug user uses instead there are multiple ways and therefore we need to implement various interventions based on how the illicit drugs are used. I believe that this was a great artefact for my argument on harm minimisation and abstinence as it outlined that no matter what, we need to maintain a person’s safety first before we can take any further steps toward abstinence. It clearly outlines the need for harm minimisation in improving these individuals' quality of life. Before commencing this assessment I had a ‘right-sided’ opinion on drug users as I believed that it was very much the individual’s choice to use and become clean via abstinence. However upon researching this topic I have found that society has a major influence on these individuals in terms of both using and seeking treatment. By researching this topic it has allowed me to understand that in order to reduce this public health issue it must be a society effort and involves multiple forms of treatments and not just abstinence. Completing this assessment piece has taught me to make my own decisions on what is a public health issue and what is just media’s way of gaining viewers. This assignment has taught me that when encountering a health or social problem to determine if it is actually a problem by firstly defining the problem, then measuring and counting the problem, locating the determinants and finally combining the knowledge to gain an informed response that is socially sensitive and culturally safe. =Reflection= [] [] [] http://healthcultureandsociety2013.wikispaces.com/Treatment+vs.+Incarceration.+An+evaluation+of+legislation%2C+criminal+activity+and+the+effect+of+moral+panic+surrounding+illicit+drugs. =**Reference List**= Australian Government Department of Health and Ageing. (2010). National Needle and Syringe Programs Strategic Framework 2010-2014. Canberra: Australian Government Australian Institute of Health and Welfare. (2011a). Drugs in Australia 2010. 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