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In this paper there will be an examination of contemporary issues in relation to substance use and how it is viewed by society. From the outset, the reasons why people use substances will be explored along with an explanation of the differences between problematic and non problematic drug use in order to gain an understanding of the many reasons why substance use is so prevalent in today's society. To add to this, there will be an analysis of the current laws, policy's and political ideology that forms the categorisation and classification of substances within the UK, in an attempt to bring about an insight into the various approaches, interventions and rehabilitative strategies that have been implemented in contemporary times. From here, an idea of how the handling of substance use and how it is dealt with will be explained based on modern approaches since the heroin epidemic in the 1980's.
Perhaps one of the most ambiguous contemporary challenges for drug treatment lies in the question of why people use substances. This has been widely argued over the years and has provided much research which has led to the creation of models of drug use, the free will model, the disease model, the moral and the bio-psycho-social model. The 'free will model' attributes freedom of choice as a major cause of substance use, whereas the 'disease model' suggests genetic predisposition as a key factor in substance use. The moral model which is perhaps the oldest model sees substance users as weak willed and deviant. On the other hand, the bio-psycho-social model points towards the environment the person grows up in with contributing factors such as unemployment, poverty, low educational attainment and crime being associated with the reasons why a person chooses to use substances and it is in the bio-psycho-social model where all these models and arguments are encompassed. According to Maisto and Krenek (2009:51) 'Each set of factors alone, biological, psychological or social, is lacking in its attempt to provide a satisfactory explanation for substance use disorders alone'. The bio-psycho-social approach takes into account the holistic needs in a substance user's life and has been growingly used in the intervention and prevention of problematic substance use.
A further challenge remains in the economics of illicit substance supply. Wherever there is a demand there will be a supply and it is yet another problem that bears heavily on the treatment of substance users.
In 2003/04 the size of the UK illicit drug market was estimated to be £5.3 billion and Drug trafficking is considered to be the most profitable sector of transnational criminality and to pose the single greatest organised crime threat to the UK. (UK Drug Policy Commission, 2008).
With such sums of money, the treatment of substance users becomes very difficult as the drug trade is often the catalyst for many to become involved in drugs. It can also trap substance users as their substance use gets in the way of them making money and therefore pushes them further into debt and then this in turn, can increase the substance user's intake in order to emotionally escape the burdens of debt and fear for unpaid debts which could possibly have life threatening consequences depending on the amount of debt and level of involvement in the trade. Furthermore, involvement in the trade can lead to consequences such as prostitution, turf wars and firearms offences, these consequences impede the possibility of treatment as contact with the judiciary could lead to a lengthy prison sentence or possibly death.
The challenges that stem from substance use can also manifest themselves in the treatment process because while in treatment many users report numerous problems, with employment generally being high on the list. This may be because 'getting problem drug users ready for employment and training and keeping them in employment is difficult and expensive' (National Audit Office, 2010) similarly, many of them may have been imprisoned before and may have accessed treatment facilities within the prison, unfortunately some of these drug users are freed without an aftercare plan nor an advocated progression route to employment with the help of relevant professionals, Waller and Rumball (2004:297) reiterate this suggestion 'the efforts of health and social professionals is focused on risk reduction, supporting prisoners through detoxification, medication and education about the risks of overdose'. This apparent focus on the immediate needs is referred to as 'crisis intervention' and according to Ghodse (2010:177) 'Is unlikely to have much rehabilitative value unless the staff succeed in referring the drug abuser onwards to a longer term programme'.
Drug related infections pose yet another challenge to treatment and is possibly one of the most destructive forces in terms of the way the drug user perceives the need for treatment because 'The majority of users who start injecting continue to do so throughout their career' Carnwath and Smith (2002). And it is injecting unsafely which is blamed for many of the drug related infections found today. For numerous drug users, a diagnosis of hepatitis C is considered manageable as modern medicines and treatments have become more effective, however, it is with a diagnosis of hepatitis B or HIV (Human Immunodeficiency Virus) where apathy towards drug treatment can begin to manifest and although these diseases are treatable and manageable, they have can have serious psychological effects and cause the drug user to begin experiencing such feelings as guilt, shame and anger which in turn, can lead to more serious consequences as Falvo (2005:249) argues 'Guilt, self blame, fear of abandonment and fear of imminent painful death can lead to self destructive behaviours, including attempted suicide'.
Further challenges for drug treatment lie in the attitudes of a society. Stigmatisation from sections of society is yet another barrier that substance users and treatment services alike have to face in the effort to integrate substance users back into society. Many people in society carry different views on substance use and attitudes can vary depending on the area, the substance and the prevalence of substances in that area. Heroin, for example, is one of the most demonised drugs in the UK and has been since the 1980's, according to Robertson (1987:43) 'Politicians, press and a proportion of the public are unanimous in their condemnation of heroin use as the major, if not the greatest, social evil of our times'. These negative attitudes and social stigmatisation often force the substance user to avoid accessing treatment because of the shame of their lifestyle and it seems as though not much has changed in the attitudes of society as opinions are still as negative, albeit among the public. In a recent report by the UK Drug Policy Commission (UKDPC), author Charly Lloyd explains society's recent views and the severity of such negative attitudes and the effect it has on the numerous aspects of a drug user's life-
'The junk of society - dangerous, unpredictable and, crucially, only having themselves to blame is how society thinks of drug users and former users. The extreme stigma attached to drug addiction represents a massive obstacle to rehabilitation and recovery; hindering access to treatment, securing work and housing and rejoining society, and lasting for very long periods of time'.
Political ideology and policy construction are at the forefront in any discussions relating to substance use and treatments. Many attempts have been made by government to halt the destruction that problematic substance use can bring, however, many of those attempts have been severely criticised for lack of understanding of the problem and the reluctance to move with the times in terms of substance use. The 1980's conservative government is a typical example of this as there was panic because of the outbreak of HIV and quickly the government moved to reduce harm to the public. This was a period when harm reduction practices were brought in and were relatively successful as Parker (2001:7) states 'It was shown that secondary prevention- harm reduction initiatives can be very effective management tools especially in respect of public health goals'. Nonetheless, this success in public health policy had all but been removed in the coming years with the focus on health seeming to disappear from the labour policies. The focus on drug use as criminal, it appears, had become central to labours policies which in turn led to a rethink of harm as a whole and put the blame solely on the user. 'Whereas harm reduction in the 1980's and early 1990's meant reduction of harm to the drug user, by the late 1990's it had come to mean harm, by the drug user, to those emblematic families and communities. (Lart, 2008)