Substance Abuse Treatment in Community Literature Review

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The inclusion of alcohol and drug education is a vital component of most drug and alcohol abuse interventions, for both the users and non-user. (Montagne et al., 1992). This education can be offered as a preventive measure to beginners of abuse of substances of to the vulnerable group to save the future generations from the menace and the whole society from the drug's association with crime. Alternatively, it should be offered to be taught as part of the educational curriculum in schools

Recent literature reviews have not found enough evidence to convince many researchers that drug and alcohol awareness programs have great impact on changing substance and drug use, attitude and behavior (Eliany et al., 1993). Although it is of great effort, it has been observed that education alone is not enough to change the actual behavior of alcohol and drug use (Tobler et al1976), in the actual examination of the efficiency of education, the challenge is to establish change in knowledge, attitudes and actual behavior leaving us with treatment of substance abuse as the most effective way of reversing the effects of addiction as Montagne (1982) writes.

Leukefeld & Bukoski (1991) reiterate that most people still lack knowledge and understanding or appreciation for three domains and that research does not explain what, and how much of what, that the people learn in one domain that influences another domain and as Montagne et al. (1993) and others have implied, the evaluation of the efficiency of a research process should be found to be coinciding with a program goal. Where it comes to drug and substance education, if the stated purpose is to impact on knowledge, skills and attitudes, then these are the domains to be evaluated and measured by the one who imparts education process but not drug and alcohol using behavior. Alternatively, if the goal of education is always to change behavior though reinforced practice, then actual use of drugs or alcohol should be the outcome to be examined through an empirical means that would be acceptable to most researchers.

Senn (1983) assessed the impact this type of education of abuse as a component of an aftercare program with a group of former substance abusers, half of whom had been incarcerated and undergone treatment in community correction centers. They participated in a university drug and substance abuse awareness and education program. Results, when evaluated showed a tremendous increase in the knowledge on effects of drug and alcohol, a significant decrease in drug and alcohol use attitudes, but not major reductions in actual drug use. It was therefore inferred by Senn that education should be offered to abusers of substances with the intention of changing their knowledge and attitudes, as opposed to attempting to influence drug and alcohol use using behavior.

In a prison Education Program offered by Simon Fraser university, Druguid (1987) reported that the beneficiaries of the program, who were the drug-involved offenders, received education whose content was not solely on drug and alcohol but included all on-campus activities that were offered at the liberal arts colleges. When evaluation was done, a comparison was done between 65 student inmates to 65 non-student inmates and it showed that about 50% of the non-student inmates returned to prison while only about 16% of the student inmates returned there within two years. Druguid says that although the return to drug and knowledge of on substance use were not analyzed, the educational program contributed to a notable impact on the post-release success for the inmates.

A literature on rural drug treatment utilization shows that few studies have illuminated this issue. For example Robertson and Donnermeyer ( 1998) used data from m the National Household Survey on Drug Abuse (HNSDA) and reported that about 5.6% on non-metropolitan and rural illegal substance abusers presented themselves to seek treatments as opposed to 6.6% of the other drug users in the HSDA. The other data from National Longitudinal Alcohol Epidemiologic survey suggests no differences between the urban and rural forks in terms of probability to seek treatment.

A literature by Frohling (1989) indicates that jail and prison populations have grown at an alarming rate in the past many years as result of new convicts. He goes ahead to give the statistical information that 62% of State and Federal prisoners report drug use prior confinement. He adds that the data available from Drug Use Forecasting ( DUF) indicates that over 70% of the arrestees in metropolitan areas test positive for illegal substances.

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( U.S. Department for Justice, 1989)

Twentyman et al. (1982) observe that in alcoholics that are usually in correctional centers, they usually have low assertive skills. Therefore in all those undergoing treatment for substance abuse related complications, assertion training is normally recommended to give the best results to help them respond in difficult situations. The argument that training will address the deficiencies in assertiveness to curb drinking tendencies in alcoholics and to help them reform is an observation also made by Brown et al. (1986), but for the drug users, the investigations are lacking to prove the same issue of lack of assertiveness affects them. This kind of training has only been performed on sampled drinkers but has also not been done on for other drug users and it is included as part of the curriculum for the treatment of those with alcohol addiction in the community correctional centers with an intention of making them regain the power of assertion.

Ferrell and Galassi (1981) researched on the effects of either assertion training or human relations training, to the existing addicts in a normal correctional treatment program with view to reducing drinking and improvement of their interpersonal skills. Among those who were being studied had skill-deficiency or were chronic alcoholics. The Results pointed out that although the two types of treatments led to a comparable sobriety within a 6-week period, the group which was subjected to assertion training had demonstrated remarkable improvement in interpersonal skills as compared to the group which was subjected the human relations training procedure. When a follow-up was done two years later, the results indicated that assertion training group was sober significantly longer than their counterparts in human relations training.

Rist and Watzl (1983), while researching, took a sample of female alcoholics, before and after skills training, in social drinking situations, on how hard it would be for them not to accept a drink offered to them (relapse risk) and on how uncomfortable they would feel in such situations (specific assertiveness). The patients who experienced relapse after three months reported such the situations as difficult to deal with and more uncomfortable than those abstaining patients. Further analyses revealed that the relapse risk affected the two outcome groups than specific assertiveness, thereby creating a general efficiency expectation seen in relation to patients' belief in being able to abstain, that has already been stated at admission.

In a recent study by Pfost et al. (1992), he examined three results of the assertion training that most people consider to be relevant to alcohol addicts: assertive behavior in some negative situations and discomfort experienced in such negative situations which require for assertive behavior; and expectations of assertive tendencies in sober or intoxicated situation. these findings showed that most alcoholics had acquired assertive skills in negative scenarios but less discomfort in such situations, he then believed that intoxication led them to more assertiveness. He found it discouraging that assertion training did not considerably reduce discomfort on the sample alcoholics in negative situations. The training also failed to reduce discrepancy between the views of assertiveness in sober as compared to intoxicated states in a follow up after six weeks.

In summary, as (Chaney, 1989) puts it, assertion training has made considerable gains that improve the tendency of alcoholics to respond well to interpersonal challenges with assertiveness as opposed to drinking behavior. Although the debate as whether the training has impacted positively on increased assertiveness, it has been approved that assertive behavior is usefully critical in a chronic population whose profile can block recovery. Although similar information is lacking for the treatment of drug abusers, it is potential to argue that the same situations are faced by drug use and can be addressed through assertion training in the same way as alcohol training.

Darke et al. (1998) content that correctional centers favor high risks regarding drugs use since overcrowding and high population concentrations promote violent behavior. The consequences of use of drugs in confinements include related drug deaths, suicide attempts and self-harm. Drug use in prison or correctional centers if not checked may be more harmful as some drugs are sometimes sneaked in such facilities where there is unhygienic injecting equipment. In their study of 492 Injectible Drug Users (IDUs), 70.5% reported to be sharing needles while in incarcerations compared to the 45.7% who shared needles before confinements. Of particular concern was the rate of human.....

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