Medicinae+non+opus+est,+ut+magis+iustum+peius+(Latin)

= //‘The drugs don’t work, they just make it worse...’// – ‘Addiction’ = = =

**Unit Co-ordinator: Julie-Anne Carroll **
Tutor: Judith Meiklejohn  Student : Steven Attrill (n8840946)




 * Cultural Artefact **

 I have chosen this photograph because I found this simple image captured a moment from where addiction revolves around. That of a young boy with the hands of a supporting parent, whether he has had drugs touch his life yet or an image of the past before the disaster of drugs had. In either event, “innocence is the first casualty of war” (Platoon, 1986) and this image has the duality of both.

 This is an image that also serves to remind, one simple fact, no one sets out to be a drug user. There’s no high school counselor who encourages this path or a degree in being a user. This image serves to remind that victims are not just the one, but in fact resonates through family, friends, work and the community. Addiction is a curse, which hides behind the drugs and won’t let go easily.

 Alcoholics Anonymous (AA) has become a strong support for users and those who suffer the effects of drugs illicit or not, it is the abuse and compulsion that does the damage. AA is quoted as saying “Drugs are essentially poisons; the amount taken determines the effect. A small amount acts as a stimulant (speeds you up). A greater amount acts as a sedative (slows you down). An even larger amount poisons and can kills” (Alcoholics Anonymous, 1992).


 * Literature Review and Public Health **

 But many drugs have another liability: they directly affect the mind. They can distort the user’s perception of what is happening around him or her. As a result, the person’s actions may be odd, irrational, and inappropriate and even destructive (Alcoholics Anonymous, 1992).

 With this in mind the damage is not just limited to the individual but also those around them and often spreads into the wider community through violence, disassociation, withdrawal, destructive behaviour, et.al; of a lost and confused individual, in a society where conformity is necessary and values compliance, these negative anti-social behaviours are not easily tolerated but worse still not understood as a Public Health Issue.

 Alcoholics Anonymous (AA) State:

 “A substance addiction meets two criteria:

 • **You have difficulty controlling how much you use or how long you use.**  //For example, one drink leads to more drinks, or one line of Cocaine leads to more//.(Alcoholics Anonymous, 1992).

 • **You continue to use even though it has negative consequences to your life.**  //For example, you continue to shoot up even though it has hurt your relationships.//”(Alcoholics Anonymous, 1992).

<span style="font-family: Arial,Helvetica,sans-serif;"> These two criteria define all addictions, and like any out of control addiction, a better understanding was required. So in 1993 the Australian Institute of Health and Welfare (AIHW) at the behest of the Australian government commissioned the National Drug Strategy Household Survey Report (NDSHSR). This grew out of a national policy for alcohol, tobacco and other drugs, starting in 1985 as the National Campaign Against Drug Abuse (AIHW, 1993).

<span style="font-family: Arial,Helvetica,sans-serif;"> It was realized that an ongoing survey was needed of the average Australian household and would be compiled each three years. It would include ages from 12 years onward, men and women, varying cultural and ethnic backgrounds, and across as a large regional and demographic base as possible (AIHW, 1993).

<span style="font-family: Arial,Helvetica,sans-serif;"> To ensure comparable data, there were several questionnaires used to collect data for the survey. A version of the questionnaire was prepared for respondents aged 14 years or older, and a separate, shorter, version of the main questionnaire was developed for respondents aged 12–13 years. However, questions in both questionnaires were in the same sequence. The questions in common were identically worded for each questionnaire. To remove the possibility that the order of possible responses within questions might affect the likelihood of selection, response lists were rotated so that blocks of possible answers were presented in equal numbers across all samples. The drop and collect questionnaire had three rotations for both those aged 14 years or older and 12–13 years, and respondents self-completed the entire questionnaire (AIHW, 1993).

<span style="font-family: Arial,Helvetica,sans-serif;"> The aim was to measure and to explain why “The use and misuse of licit and illicit drugs is widely recognized in Australia as a major health problem and one that has wider social and economic costs” (AIHW, 1993).

<span style="font-family: Arial,Helvetica,sans-serif;"> In subsequent surveys it became evident that “Illicit drug use is a major risk factor for ill health and death, being associated with HIV/AIDS, hepatitis C, low birth weight, malnutrition, infective endocarditis (leading to damage to the heart valves), poisoning, mental illness, suicide, self-inflicted injury and overdose” (AIHW, 1993). Research determined that “In Australia, it is estimated that 2.0% of the burden of disease in 2003 was attributable to the use of illicit drugs” (Begg et al. 2007).

<span style="font-family: Arial,Helvetica,sans-serif;"> Drug use is an escalating, serious and complex problem that is directly linked and / or contributes to thousands of deaths, significant illness, disease and injury, social and family disruption, workplace concerns, violence, crime and community safety issues (AIHW, 1993). In the 2010 NDSHSR, Collins & Lapsley (2008) went further than Begg et al. (2007) and “estimated that the economic costs associated with licit and illicit drug use in 2004–05 amounted to $56.1 billion, of which tobacco accounted for 56%, alcohol 27%, illicit drugs 15%, and alcohol and illicit drugs acting together 2%” (AIHW, 1993).

<span style="font-family: Arial,Helvetica,sans-serif;"> The methodology and findings of the AIHW have directed the action of policy makers of the Australian government and organizations like Foundation for a Drug-Free World, to shape and direct their actions to best engage and communicate the issue to both sides of the coin, in an effort to solve the problem of illicit and unregulated drug use.

<span style="font-family: Arial,Helvetica,sans-serif;"> It is recognized that single solution approaches will not resolve the issue, and that only working in conjunction with all parties on both sides such as health care providers, law enforcement, all tiers of government, voluntary and involuntary groups and bodies, et.al need to work with the individual and groups for functional outcomes, in a supportive ongoing roles.

<span style="font-family: Arial,Helvetica,sans-serif;"> In a 2010 article by Dunbar, D., Howard I. Kushner and Scott Vrecko (2010, March) stated “Scientists tend to reduce addiction to the domain of the pathological body, whereas social scientists often produce analyses that seem to overlook that drugs are chemical substances, that drug users have bodies, and that the contemporary sciences are altering the ways that we understand and act upon substances and bodies. Although critical studies are essential, we believe that it is also vital to overcome the biology/culture dualism”.

<span style="font-family: Arial,Helvetica,sans-serif;"> With this competition between these two competing ideologies, it has been a stumbling block in the treatment and the approaches that have and are being attempted to help treat the issue of drug addiction. This being said each side has the intention to help but when challenged by addiction has seen varying results of success and failure.

<span style="font-family: Arial,Helvetica,sans-serif;"> In the article ‘Tackling Addiction: Drug and Alcohol Review’ McCrohan, R(2011) a contrasting view has been written for policy-makers, clinicians, researchers and students; and examines the shift in policy and treatment direction in the UK; and policy makers in Australia have shown interest in. “This is a shift towards articulating and incorporating recovery into policy and treatment directions. It explores definitions that state abstinence as the goal of recovery and contrasts this with definitions that describe recovery as a meaningful and satisfying life defined by each person. This includes having control over and input into one's life and the personal and unique process for each person, with no right or wrong way to recovery” (McCrohan,2011).

<span style="font-family: Arial,Helvetica,sans-serif;"> With this direction as a guide, the treatment plan in Australia has moved towards a preferred self-motivation and self-directed therapy to achieve any true meaningful result. This basis has flowed out to other active groups and bodies to emphasize the actions of the individual is key to the outcome.


 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Cultural and Social Analysis **

<span style="font-family: Arial,Helvetica,sans-serif;"> In an article by Lisa Maher and David Dixon (1999) they reported on “ethno-graphic research in Sydney’s principal street-level drug market, and integrating perspectives from research in policing and in public health, argued for a shift in policing priorities, rejecting suggestions that the law constrains the ability of police to subordinate law enforcement to other objectives”. This proposed a fundamental change from pursuing the individual consumer for any reason of having illicit drug possession, to recognizing the nature of drug addiction and dependency meant that an individual would be allowed to hold small personal quantities of certain classes of illicit drugs (Note this is still dependent on the relevant State or Territory within Australia). This recognized that drug use could now be understood as an addiction and that the user, was suffering not just from the drugs, but also that the addiction can alter their perceptions and behaviour, and differs from an uninfluenced person.

<span style="font-family: Arial,Helvetica,sans-serif;"> In the book ‘Drug Abuse and Addiction in Medical Illness: Causes, Consequences and Treatment’ by [| Joris C]. Verster; [| Kathleen] Brady and Marc [|Galanter] (2012, page 20) stated that “There are wide variations between countries and regions in substance use (problems). Differences are often hard to explain but contributing factors may include policies, availability, economic and (youth) cultural factors and the availability of preventive and harm reduction measures. Generally, (formal) drug policies are not strongly associated with prevalence of drug use, while the reverse is true of alcohol”. They also went on to discuss that depression, intertwined with friend and familial issues can lead to vulnerability and can be leading factors in substance abuse.

<span style="font-family: Arial,Helvetica,sans-serif;"> [| Joris C]. Verster; [| Kathleen] Brady and Marc [|Galanter] (2012, page 279) also discussed gender differences that were demonstrated in the genetic and environmental factors contributing to depression. They concluded that for females that half the risk for depression was due to genetic and specific environmental factors, whereas for males it was largely due to genetic factors which could lead to depression and substance abuse. Their findings suggest the possibility that genetics can play a role in the vulnerability to substance abuse risk and depression, along with specific stresses are associated with this comorbidity.

<span style="font-family: Arial,Helvetica,sans-serif;"> The basis for the choice of my artefact, was that the underlying message needs to be “understanding through education and awareness” starts with empathy; and that to confront drugs and the curse of addiction, the need to raise awareness from the shadows and clichéd mental imagery of the general populous. To stop sufferers of drug addiction concealing and / or denying their problem(s) for fear of rejection and persecution; which results in hindering their recovery. As AA members are quoted to say “I’m not cured, I’m only recovering! And it has been ‘x’ days since I last…”, proving no one is infallible from falling from the pedestal, and that recovery is not a cure.

<span style="font-family: Arial,Helvetica,sans-serif;"> This has always been the strongest weapon on the war on drugs, that understanding through education raises awareness, not only for sufferers but also those who want to help. After all this is not a war on people, rather a call to arms to challenge those who feed and prosper from the commerce of illicit drugs, these are the targets of governments and organizations involved in the fight. Then public health experts can focus on the aid and treatment of the sufferer, with the support of an educated and tolerant society.

<span style="font-family: Arial,Helvetica,sans-serif;">Yet the real achievement of treatment and recovery has widely varying results, which has had policy makers’ chase this elusive goal, with changing therapies and methodologies tried or even simply rehashed in the attempt to help.

<span style="font-family: Arial,Helvetica,sans-serif;"> The one true known outcome is that without the engagement and perseverance of the individual, any treatment will fail and they will relapse into drug use. That the health care providers need to address both the mental and physical issues in the treatment process and that the environment plays a key role as well; by offering varying types of treatment programs such as residential treatment (in-patient), out-patient, local support groups, addiction counseling, mental health, orthomolecular medicine, extended care centers, recovery or [|sober houses], and medical care. Awareness of age and gender-specific programs can play a part in the treatment regime also.


 * <span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">Analysis of the Artefact **

<span style="font-family: Arial,Helvetica,sans-serif;"> Finally the phrase that started my wiki was the foundation of this journey ‘The drugs don’t work, they just make it worse...’ as at first glimpse what appears to be one thing really is quite another, just like the image. I have written about this journey from the place of an observer, and I might add with great safety, but the words simply fail to express the loss you will see in the eyes of a sufferer. The emptiness of what it meant to be a person with family, friends and possessions. This is the confrontation that awaits me as a Paramedic, to kneel before the husk of a devoured person, who in the end without help will lose even hope.

<span style="font-family: Arial,Helvetica,sans-serif;"> I have been asked to reflect on what I have learnt? The mind numbing facts and plans above do little, to help me face the foretold image of loss that I will sadly confront in a relentless cycle of sorrow. Drugs are the vengeful opponent, who ashamedly boasts success in the data scales of the point scoring bureaucrats and rarely reports the escapee from a society gorging on the negative news.

<span style="font-family: Arial,Helvetica,sans-serif;"> Like the escaped prisoner of war stories told, and the reality that few ever do; but for the one or two who can, I hope the tale of fortune will reach me in my moment of treatment for myself and my oncoming patient. That for me the ‘half cup full’ fable will shield and halt me from following in a path of lethargy coveted by a curse of the ‘lotus-eater’ (Greek Mythology, Odysseus). lethargic Lotus-Eaters

**<span style="font-family: Arial,Helvetica,sans-serif; font-size: 140%;">‘The drugs don’t work, they just make it worse...’ **

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** Reflections - Commented Links ** = = Harm minimisation - an oxymoron? = = The addiction

**<span style="font-family: Arial,Helvetica,sans-serif;">Unit Co-ordinator: Julie-Anne Carroll **
<span style="font-family: Arial,Helvetica,sans-serif;">Tutor: Judith Meiklejohn <span style="font-family: Arial,Helvetica,sans-serif;">Student : Steven Attrill (n8840946) **<span style="font-family: Arial,Helvetica,sans-serif; font-size: 120%;">References ** <span style="font-family: Arial,Helvetica,sans-serif;">Alcoholics Anonymous. (1992). The Origin of our Serenity Prayer. Retrieved October 1, 2013, from []

<span style="font-family: Arial,Helvetica,sans-serif;">Australian Drug Foundation. (2012). Drug Law in Australia. Retrieved 2013, September 22, from http://www.druginfo.adf.org.au/topics/drug-law-in-australia

<span style="font-family: Arial,Helvetica,sans-serif;">Australian Institute of Health and Welfare. (2011, July). 2010 National Drug Strategy Household Survey report. Drug Statistics Series, 25(1), 1-150. Retrieved from [].

<span style="font-family: Arial,Helvetica,sans-serif;">Begg, S., Vos, T., Barker, B., Stevenson, C., & Lucy Stanley and Alan D Lopez (2007, May). The burden of disease and injury in Australia 2003. Australian Institute of Health and Welfare, 88. Retrieved from http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442459747.

<span style="font-family: Arial,Helvetica,sans-serif;">David Collins and Helen Lapsley (2008). The costs of tobacco, alcohol and illicit drug abuse to Australian society in 2004/05. Australian Institute of Health and Welfare, 9. Retrieved from http://www.nationaldrugstrategy.gov.au/internet/drugstrategy/publishing.nsf/Content/mono66/$File/mono66.pdf.

<span style="font-family: Arial,Helvetica,sans-serif;">Dunbar, D., Howard I. Kushner and Scott Vrecko (2010, March). Drugs, addiction and society. BioSocieties, suppl. Special Issue, 5(1), 1. Retrieved from http://search.proquest.com.ezp01.library.qut.edu.au/docview/1008871528/fulltextPDF?accountid=13380. || || <span style="font-family: Arial,Helvetica,sans-serif;">Foundation for a Drug-Free World. (2006). The Truth About Drugs. Retrieved October 1, 2013, from http://www.drugfreeworld.org/drugfacts/crystalmeth/the-truth-about-drugs.html

<span style="font-family: Arial,Helvetica,sans-serif;">Google Images. (2013, October 1). Images. Retrieved 2013, October 1, from https://www.google.com.au/search?site=imghp&tbm=isch&source=hp&biw=1366&bih=612&q=drug+use&oq=drug+use&gs_l=img.3..0l10.1472.3618.0.8749.8.8.0.0.0.0.387.1574.2j2j3j1.8.0....0...1ac.1.29.img..3.5.778.6fVTEeYbcwE

<span style="font-family: Arial,Helvetica,sans-serif;">Lisa Maher and David Dixon (1999). Law Enforcement and Harm Minimization in a Street-level Drug Market. The British Journal of Criminology, 39(4), 488. Retrieved from http://bjc.oxfordjournals.org/content/39/4/488.full.pdf+html.

<span style="font-family: Arial,Helvetica,sans-serif;">McCrohan, R. (2011, January 10). Tackling Addiction. Drug and Alcohol Review, 30(1), 113. Retrieved from http://onlinelibrary.wiley.com.ezp01.library.qut.edu.au/doi/10.1111/j.1465-3362.2010.00284_3.x/full;jsessionid=6489C2A9160A0F8AC2877EB1E0FED084.f03t03.

<span style="font-family: Arial,Helvetica,sans-serif;">Luke Roman and Monica Roman (2010). Odysseus. Encyclopaedia of Greek and Roman Mythology (1st ed., pp. 342). (Original work published 2010). Retrieved from http://www.qut.eblib.com.au.ezp01.library.qut.edu.au/patron/FullRecord.aspx?p=495838&echo=1&userid=VO94Lta58%2b4ZUfzVIqhyWQ%3d%3d&tstamp=1382397632&id=6628B8E6B8365968DB0F8DE0601A35E430482FED.

<span style="font-family: Arial,Helvetica,sans-serif;">Stone, O. (1986, December 24). Platoon. Retrieved October 22, 2009, from http://www.imdb.com/title/tt0091763/

<span style="font-family: Arial,Helvetica,sans-serif;">Verster, J. C., & Kathleen Brady and Marc Galanter (2012). Epidemiology of Alcohol and Drug Use. In J. C. Verster, K. Brady, & Marc Galanter and Patricia Conrad (Eds.), Drug Abuse and Addiction in Medical Illness : Causes, Consequences and Treatment (1st ed., pp. 20). Retrieved from [|http://reader.eblib.com.au.ezp01.library.qut.edu.au/%28S%28qymasxqenfk1xbs4mkwpi45y%29%29/Reader.aspx?p=973531&o=96&u=VO94Lta58%2b4ZUfzVIqhyWQ%3d%3d&t=1381644519&h=5653470E4A8B704125928AE00ECD951A2E991187&s=10377259&ut=245&pg=1&r=img&c=-1&pat=n#].

<span style="font-family: Arial,Helvetica,sans-serif;">Verster, J. C., & Kathleen Brady and Marc Galanter (2012). Epidemiology of Alcohol and Drug Use. In J. C. Verster, K. Brady, & Marc Galanter and Patricia Conrad (Eds.), Drug Abuse and Addiction in Medical Illness : Causes, Consequences and Treatment (1st ed., pp. 279). Retrieved from http://reader.eblib.com.au.ezp01.library.qut.edu.au/%28S%28qymasxqenfk1xbs4mkwpi45y%29%29/Reader.aspx?p=973531&o=96&u=VO94Lta58%2b4ZUfzVIqhyWQ%3d%3d&t=1381644519&h=5653470E4A8B704125928AE00ECD951A2E991187&s=10377259&ut=245&pg=1&r=img&c=-1&pat=n#.

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Reflections - Commented Links Harm minimisation - an oxymoron? The addiction