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In this essay I will discuss illicit opiate use, its prevalence within adults and the effects of problematic drug dependency on family members as well as the individual. I will explore the diversion of offenders into treatment by the Criminal Justice System by referring to current government drug policy, briefly identifying relevant legislation. I will also explore the discrimination experienced by individuals within this client group, which has contributed to their social exclusion and stigmatisation, strongly influenced by the negative stereotypical images portrayed by the media. I will provide an analysis of two relevant explanatory theories, concluding by identifying the relevance of the discussed theories in supporting the effective assessment and intervention undertaken by social work practitioners working within substance misuse services.
Figures taken from Home Office statistics on drug misuse within England in 2008/09 estimate that one in ten adults aged 16 - 59 years have used one or more illicit drug within the last year (www.statistics.gov.uk). The National Drug Treatment Monitoring Service (NDTMS) reporting on behalf of the National Treatment Agency (NTA) for Substance Misuse also report that 210,815 individuals aged 18 years and over, received structured drug treatment during 2008/09. Defined by the NTA as problem drug users, 101,075 of this figure received treatment specifically for illicit opiate use and a further 66,181 for combined illicit opiate and crack cocaine use (www.nta.nhs.uk).
However, it can also be argued that as the figures quoted by the NTA are based on information gathered from those accessing drug treatment services, they are not proportionate to the actual number of individuals within the UK who currently use illicit substances. A large number of people that use illicit substances do not go on to develop long-term problems, however, this cannot be said for a significant proportion of individuals. This is also suggested by (Davies et al 2008) who argues that a significant number of people do not develop problems as a result of their illicit substance misuse. He also suggests that the true figure of people experiencing problematic drug use is difficult to estimate, due to it's illegality, the attached stigma and shame meaning that for many, their use remains hidden unless they are considered to be putting themselves and other people at risk, or seek help, thus coming to the attention of substance misuse services. Many individuals report frequently engaging in recreational drug use and describe no long-term effects it is only when drug use becomes problematic and begins to impact on society that is no longer considered acceptable.
The NTA, Models of Care: Update 2006 focused primarily on adult drug users, was originally published in 2002. It is the national framework for the commissioning of drug treatment for adults in England and details the four levels of service provision currently available (Goodman 2009). The Models of Care: Update 2006 calls for greater emphasis in relation to the need for reducing drug-related harm due to a higher risk of blood born viruses, mortality, overdose and serious infection, resulting equipment sharing and injecting practices of opiate dependent individuals and advocates that for the adoption of a harm reduction model within local communities (www.nta.nhs.uk).
Harm minimisation is the term commonly used within substance misuse services, which provides a wide range of interventions including education on safe storage, drugs and their effects, hepatitis B vaccinations and the somewhat controversial, prescribing of oral substitute medication. The 2006 update reports on the high concentration of adults experiencing problematic drug dependency within prison, with an average figure of 84,500 drug-misusing prisoners in custody during the course of a year. It reports that in 2004/05 approximately 17 per cent of clients, were referred into treatment via criminal justice agencies (www.nta.nhs.uk).
In 2008 the government revealed a new ten-year drug strategy focused on protecting families and communities. Their four main areas of work included the protection of communities through robust enforcement to tackle drug supply, drug-related crime and anti-social behaviour. Preventing harm to children, young people and families affected by drug misuse. Through the delivery of new approaches to drug treatment and social re-integration, as well as public information campaigns, and community engagement (www.drugs.homeoffice.gov.uk)
(Goodman 2009, pg. 85) refers to current government policy as both "a carrot and stick" approach. He argues that although this strategy encourages substance misusers to undertake treatment. Many, may not want to access drug rehabilitation and the increased resources available, despite contact with the CJS, causing them to be at risk of targeting and prosecution if they maintain their drug use. Reinforced by the Drugs Act 2005 early intervention schemes such as arrest and referral, which utilise the opportunity provided by arrest to compulsorily screen individuals for substances and subsequent treatment, will mean individuals who may not consider themselves as offenders are also drawn into the CJS. This is supported by (Payne et al 2009) who considers the effects of treatment on individuals coerced into treatment by the CJS and Probation, removing the individuals' ethical right to decide whether or not to access treatment. He also goes on to question the effectiveness of treatment which is typically provided on a voluntarily basis by drug services and suggests that offenders, specifically, are more likely to be less motivated to change feeling under pressure to accept treatment rather than face punishment resulting from the swift disposal to prison.
Gossop (2005) cited by (Goodman 2009) however, acknowledges that a high number of individuals seeking treatment are law abiding. He discusses research undertaken by the National Treatment Outcome Research Study (NTORS) in which 50% of NTORS clients reported "committing no acquisitive crimes and two-thirds reported committing no drug related offences during the period before admission [to treatment]". He goes on to suggest that a correlation between drug dependency and crime is not inevitable. However (Goodman 2009) does highlight vulnerable groups who may be susceptible to substance misuse, including the prison population, women with childcare responsibilities, individuals with damaging childhood experiences and children of injecting drug misusers.
In contrast (Adams et al 2009 pg.129) cite Gilman (2000) who refers to drug use as an "equal opportunities recruiter" they suggest that the conventional image of a drug user has been challenged by studies which have found that gender, ethnicity and social economic background are no longer the main predictors when considering illicit drug use.
Problems that can occur as a result of becoming psychologically and physically dependent on drugs include relationship and family breakdown, loss of employment, physical illness and mental health difficulties. Continued use of illicit substances by drug users, many of whom, are already on the fringes of society can also lead to fatality, as well as contact with the Criminal Justice System (CJS). This further compounds their ability to contribute to society by engaging in education and paid employment, which is again diminished by the need to fund their dependency often leading to criminal activity. Continuing a cycle of deprivation and poverty that in turn impacts on the wider community as well as the individual.
Not surprisingly, in attempting to understand the far reaching effects of poverty, social deprivation and the relationship between social exclusion and the use of illicit substances. Research undertaken by the Joseph Rowntree Foundation identifies four groups at greater risk of recurrent poverty; these include single parents, those with limited education, the unemployed and individuals who are economically inactive (www.jrf.co.uk). These groups are also bear a strong resemblance to the vulnerable groups discussed earlier by (Goodman 2009).
Another explanation for high levels of continued opiate and crack use is the associated psychotic, physical, uncomfortable and painful symptoms of withdrawal experienced by the individual (Davies et al 2008). As a result of experiencing unpleasant withdrawal symptoms the individual continues to use illicit substances to avoid feeling unwell or dealing with difficult emotions. This is supported by (Goodman 2009) citing Gossop (2003) who argues that a significant number of individuals with problematic drug use have experienced personal trauma and problems that predate any drug/alcohol difficulties. Substances are therefore often used to blot out psychological and social problems.
(Davies et al 2008) discusses the shame and stigma attached to drug dependency, which he argues is intensified by media enhanced stereotypes of junkies which portray drug using individuals as addicts, weak-willed, liars and undeserving criminals. (Burke & Parker 2007) also discuss the impact of stigmatisation by association experienced by the families of problematic drug users who are often excluded at a social and institutional level by loss of relationships with external family, friends and a lack of support from services. They go on to argue that in reality, despite the support given by families, which can significantly improve the outcomes of professional assistance, they are excluded by non recognition of their needs and their contributions of care and support overlooked due to limited understanding. This is also compounded by the maximum sentence of seven years for possession of a class (A) drug, which further enforces the view that drug users are criminals who should be punished and excluded from society. However, it is the family that handle the real impact of drug use by adopting an caring role and living with the effects of drug dependency, as well as the individual labelled by society as deviant.
(Agu et al 2008) discuss labelling theory, which is used to explore how the social response to crime is determined and how certain behaviour is classified as deviant or criminal. Powerful professionals who are able to exercise a considerable amount of social control such as probation, police and CJS are often found to apply these labels. They go on to state that judgements made by society resulting in exclusion, stigma and discrimination lead individuals further into criminality, the label thus becoming a self-fulfilling prophecy. Becker's (1963) study on the outcome of negative stereotypes and adverse effect on future behaviour of individuals labelled criminal in the USA is cited by (Agu et al 2008). Becker suggests that once a label is applied, the individual may then choose to organise their lives around the label, adopting their new identity in the process.
The use of language employed central government, such as a "war on drugs" and campaigns featuring emancipated substance misusers, as well as negative stories concerning the number of acquisitive crime committed and images in the media help to influence the public perception of problematic addiction creating a moral panic (Agu et al 2008).
(Cunningham 2008) discusses the functionalist perspective on moral panic, which is seen as a vehicle, separating those considered as deviant from the rest of society, uniting the majority whose shared values and norms are considered to be under threat. In the current climate an example of this could be the threat to local communities, resulting from increased crime and the considerable cost to taxpayers in alleviating the health problems created as a result of substance misuse on an already strained health service. They go on to cite Durkheim's views on crime who believed that in today's society, crime was both inevitable and functional as it enabled society to develop and change by providing an mechanism where values and shared norms could be clarified. Durkheim argued that by drawing attention to rules a line is drawn between "normal" and "deviant" members of society. Providing clarity for those considered as "normal" in regard to what is acceptable conduct also ensuring "deviant" members receive punishment where appropriate. Reaction to the threat results in the stigmatisation of such individuals through the application of policy and legislation, ensuring the moral consensus remains intact.
Bronfenbrenner's (1979), ecological systems theory as cited by (Smith et al 2003) is often used in developmental psychology and can provide good insight, as to why individuals become drug dependent by exploring influential factors within their life course. They go on to discuss the microsystem, which refers to individual experiences within the immediate environment of the child and is considered to have the greatest impact. This includes the interaction between parents and siblings and behaviour observed within the home by the child, as well as teachers and peers within the school environment. The mesosystem explores the link between influential factors directly experienced by the child within the microsystem, and their impact. The exsosystem refers to the larger social system, which although does not involve the direct participation of the child, affects them indirectly also impacting on their development. This can include factors, such as the local neighbourhood, housing, wider family, school environment and peers. The macrosystem explores the ideology behind wider social and cultural factors such as social class, values, current economic and political climate, which has a cascading effect in the interactions of the levels, discussed.
(Crawford & Walker 2007) refer to another level known as the chronosystem, which considers the influence of time on development within the life course. This level may include external factors such as the death of a primary carer or sibling and internal factors such as the physiological changes that occur with age, effecting how the child responds to environmental factors during development.
The application of systems theory in working with substance misuse is useful in exploring the links and interaction between the levels discussed. This can give the worker a deeper understanding of the factors, which have caused the individual to use substances. In my work with drug dependent adults I have found their experiences within the microsystem in early childhood to be the most significant. Events as witnessing domestic abuse, experiencing sexual, emotional and physical abuse or significant trauma, like the death of an parent can also greatly influence their actions in later life. Often substances are used to blot out emotional or psychological pain. The quality of parenting received and models of behaviour observed which might include the consumption of alcohol and illicit substances within the home and associated views of the wider family and peers also seem to have a strong influence on subsequent behaviour. Although systems theory explores the effects of wider society, cultural and social-economic factors on the child, there are gaps. For example it does not, adequately explain why despite a considerable number of individuals, potentially predisposed to negative influencing factors within their life course, do not go to use or become dependent upon illicit substances.
In conclusion it is clear that the current drug strategy of central government is to reduce the strain on the National Health Service, prison's and crime by adopting a harm minimisation approach as opposed to that of total abstinence. Rather than addressing the entrenched social problems, which include, education, housing, poverty and unemployment. In order to assess and intervene effectively social workers should consider both the psychological and sociological perspectives when working with service users within substance misuse. The problem of drug dependency should not be considered in isolation but all aspects impacting upon the individual considered so that a holistic approach is incorporated in order to avoid further discrimination and aid successful treatment.