Free Nursing Essays - Alcohol And Drug Abuse And Its Relation To Health Services And Community Care
To analyze issues involved in the development and provision of health and community care. This will involve critical analysis of literature relative to community care and three issues which affect the target group - disorder focused and related to alcohol and drug abuse. We will consider these groups within the context of community care, what is available, what is not, what should be, and/or policy initiatives/provision. The three issues are contextualized as to why we selected this area.
The Department of Health is responsible for all policies addressing alcohol and drug abuse and takes major initiatives to promote healthy lifestyle and community care for people affected by alcohol and drug abuse. The Health Department emphasizes the need to promote the development of a personal health plan of individuals, based on who they are, what they want and what their circumstances are.
According to DoH, 'Health is inextricably linked to the way people live their lives and the opportunities available to choose health in the communities where they live'. There have been major improvements in health and life expectancy over the last century and on the most basic measures, people are living longer than ever before (DoH report, 2005).
The Department of Health further points out that the role of the National Health Service (NHS) is to
'foster and expand a comprehensive range of community health improvement services that includes specialist practitioners who know how to:
- help people develop their understanding and skills to improve their own health;
- strengthen community action for health to tackle inequalities; and
- work with communities, offering training, advice and support to a broad range of health professionals'. (DoH report, 2004)
The emphasis of the Health Department is to work with entire communities to promote community care and encourage a health care plan among people who need it. In specialist cases of alcohol and drug misuse as we will discuss in this paper, the NHS has special initiatives that promote community care for affected individuals.
In this discussion, our focus is primarily on alcohol and drug abuse and its relation to health services and community care. We provide a critical analysis of the literature available in community care of alcohol and drug abusers and go on further to discuss three key issues in community care namely -
- Assessment of Individual needs
- Implementation of Care programme
- Policies and Provisions for Control and Treatment
To specify the extent of the problem of abuse the Department of Health has provided the a statistical report given in Appendix I below. The Statistics for Drug treatment provided by the NHS is given in Appendix II below.
The Department of Health has provided a Local Authority Circular that gives guidance to local authorities (LAs) on the provision within community care of services for adults who misuse alcohol and/or drugs, after the coming into force of Sections 42- 0 of the National Health Service and Community Care Act 1990. This circular forms the statutory basis for local authorities for assessment of need, provisions of services and placement of people in residential care who are under 18 and who misuse alcohol and drugs in accordance with the Children Act 1989 and associated guidance and Regulations (DoH LA Circular, 1993).
Community Care of Alcohol and Drug misusers -
The legal procedures lay down the following clauses for community care associated with alcohol and drug misuse. According to the legal circular provided by the DoH,
LAs should plan for continuity of services for alcohol and drug misusers under the new community care arrangements, and, as a priority they should ensure that:
- community care plans property reflects the needs of these user groups;
- the special circumstances of these people are recognized and reflected in appropriate procedures for assessment and care management. (DoH, LA Circular, 1993)
The legal and social responsibilities of the Local Authorities in provision of community care for alcohol and drug abusers can be stated as follows:
- From 1993, by virtue of the NHS and Community Care Act 1990, LAs' responsibilities for arranging and funding the social care of alcohol and drug misusers will be:
- 1. Assessing the needs of the local population for alcohol and drug services;
- 2. Including services for alcohol and drug mis-users in their community care plans;
- 3. Assessing the social care needs of individual alcohol and drug mis-users;
- 4. Arranging appropriate packages of care, which may include a range of options.
In addition to the social responsibilities of the local authorities in providing care and social and financial support to alcohol and drug misusers, the health authorities have a different set of responsibilities. The health authority is responsible for fundinghealth care from general allocations and despite community care arrangements, funding allocations remain unaffected. Treatment of alcohol and drug abusers, including counseling can take place in residential or non-residential settings and new community care arrangements do not affect health authorities' responsibilities for funding the healthcare element of any alcohol and drug service (Hulse, 2004). Local authorities are expected to examine and consider alcohol and drug abuse cases within the community and draw up agreements with health authorities for covering arrangements for funding treatment and rehabilitation services for people with alcohol and/or drug problems. Thus funding for community care of people who are affected by abuse problems are mainly provided by the health authorities and mediated by the local authorities who determine what type of financial help would be provided to the individuals and for how long.
Community care for alcohol and drug abusers however go beyond mere financial support from health and local authorities and several other means of support and community care are provided (DoH, 2004; Plant et al, 1990).
In keeping with the Human Rights Act, 1989, the first priority of the Health Department is to protect adults who are at risk of abuse. The DoH reiterates that the need for immediate action is to ensure that vulnerable adults, who are at risk of abuse, receive protection and support (DoH, 2000). In order to create a framework for action, the Health Department has encouraged responsible agencies to work together to ensure a coherent policyof protection for individuals who are at risk of abuse and are especially vulnerable. The government has developed policies against abuse at a national as well as local levels and have repeatedly emphasized that statutory agencies should work together in partnership, as specified by the Health Act of 1999 and ensure that appropriate policies, procedures and practices are in place and implemented locally by the local authorities (DoH, 2004). The local authorities thus should collaborate with private and public agencies to help in coordinating local policies to protect vulnerable individuals from abuse and provide them with support and community care (DoH circular, 1993). For these purposes, inter-agency policies, procedures and joint protocols and coherent strategies are expected to be developed by the Health Department and private agencies.
The type of community care provided to alcohol and drug misusers is dependent on several factors. These factors are determined by considering the following questions that the DoH considers -
- which adults are 'vulnerable'?
- what actions or omissions constitute abuse?
- who may be the abuser(s)?
- in what circumstances may abuse occur?
- patterns of abuse; and
- what degree of abuse justifies intervention? (DoH report, 2000)
The term 'abuse' can refer to a violation of civil or human rights by the person concerned or any other associated person. In certain cases, individuals are forced to enter into drug or alcohol habits against their intentions due to coercion or fear (see Ruston, 1991; DoH, 2000). The Health report against abuse reemphasizes the fact that agencies not only have a responsibility to provide social support to abusers but also have a duty to do identify perpetrators of abuse.
Before providing community care, however several factors are considered to assess the needs of an abused individual and these include determining
- whether the person is suffering harm or exploitation?
- Does the person suffering or causing harm/exploitation meet the NHS and Community Care Act (1990) eligibility criteria?
- Is the intervention in the best interests of the vulnerable adult fitting the criteria and/or in the public interest?
- Does the assessment account for the depth and conviction of the feelings of the person alleging the abuse? (DoH report, 2004)
- Depending on the assessment using these factors and questions, the local authorities, NHS and private agencies determine whether a person should or should not be receiving community care.
- Thus from the discussion above, the first major point of analysis of any community care service provided to alcohol or drug mis-users seem to be related to
- 'Assessment of Individual Needs' - this is associated with several legal, social and clinical factors as well as definition of abuse and criteria established by the NHS and other health agencies.
After the initial stage of Assessment, we turn to the next phase of community care that is the actual working of care centres, the approaches to care of abusers and the modus operandi of NHS and community care services. So from a question of 'who should be provided with care' our focus shifts to what kind of care is provided and how it is provided in care centers.
The health department stresses the need for an inter-agency framework for management and community care and identifies the following network as elements of an inter-agency administrative framework. The relevant agencies identified are:
- commissioners of health and social care services;
- providers of health and social care services;
- providers of sheltered and supported housing;
- regulators of services;
- the police and other relevant law enforcement agencies (including the Crown Prosecution Service);
- voluntary and private sector agencies;
- other local authority departments, eg housing and education;
- probation departments;
- DSS Benefit Agencies;
- carer support groups;
- user groups and user-led services;
- advocacy and advisory services;
- community safety partnerships;
- services meeting the needs of specific groups experiencing
- violence; and
- agencies offering legal advice and representation. (DoH, 2000)
The roles and responsibilities of all the agencies that are related to providing community care and support to substance abusers are clearly stated these duties can be categorized according to different levels including operational; supervisory line management; senior management staff; corporate/cross authority; chief officers/chief executives; and local authority members. The work done is thus distributed at several levels and across different departments that are expected to collaborate and coordinate to provide the best of services for affected individuals.
Some of the issues that have to be considered are -
- 1. Evaluation of community understanding and the extent to which people are aware of the policies and procedures for protecting vulnerable adults against any kind of abuse;
- 2. Links with other systems for protecting those at risk and emphasis on multi-agency collaborative working for example, agencies involved in child protection, domestic violence, victim support and community
- 3. Evaluation of how agencies are working together and how far the policy continues to be appropriate and whether policy or procedural changes are necessary at all;
- 4. The extent to which operational guidance or advice on abuse provided by health agencies continues to be appropriate in general and, in accordance with reported cases of abuse, in particular;
- 5. Evaluation of the training available to staff of all agencies;
- 6. The performance and quality of services available for the protection of vulnerable adults who are already considered for community care provisions or are considered as potentially vulnerable;
- 7. The conduct of investigations in individual cases and whether justified support are being provided, whether legal criteria are being met; and
- 8. The development of services, both legal and social to respond to the needs of adults, who have been abused or have been forced to engage in substance abuse.
Thus the second issue in consideration within our discussion of support provided to alcohol and drug misusers as provided by the Department of Health, is
'Implementation of Care Programme' - The processes that have to be followed in order to implement a proper care programme are related to regular monitoring of disability, gender and ethnicity; referral issues as to whether the person is already known to any agency, particularly social services, or whether it is a new referral; types of abuse referred to using commonly agreed categories and whether the person considered can be considered as engaged in some kind of substance abuse; the location in which abuse took place is also important; the outcomes of investigation; the user/carer views on how policy has worked for them should be taken occasionally to understand the efficacy of the policies and health procedures and along with certain other technical information on the number and source of referrals; the information about the abused person, such as age, client group; and the statistical count on the number of investigations and case references within the community should also be considered.
For implementation of a care program, special care plans have been provided to Local authorities and health agencies. The LA community care plans are expected to address the needs of the population for alcohol and drug services, and show the local arrangements for delivery of community care. The patterns an prevalence of alcohol and drug misuse within an area should be taken into account while considering a health or care strategy. It is also expected that service provisions should respond to the needs of the total population for which the LA has responsibility(DoH Circular, 1993). This will include people who live within the area that are within the administration of the local authority in consideration. While development of plans, other statutory bodies should be considered and there is expected to be extensive collaboration between health authorities and the Probation Service and other specialist service providers. Residential care facilities and residential services are also important for alcohol and drug misusers and these care homes should offer different treatment approaches, so that people are provided with services that are appropriate to their needs (DoH Circular, 1993). Alcohol Concern and SCODA (the Standing Conference on Drug Abuse) provide extensive information on residential services to be provided to alcohol and drug mis-users within a community (see Plant 1990, DoH, 2000). Within residential homes, the length of treatment programmes in a residential setting varies between three weeks and eighteen months. This means a quick admission and discharge of alcohol and drug abusers within residential care facilities and provision of extensive services with a carefully implemented care programme practiced and recommended by the NHS and Department of Health.
There are however new policies and framework for care of alcohol abusers. Since 2002, Models of care for the treatment of adult drug misusers (MoCDM ), as given by the NHS has provided a framework for the commissioning and provision of adult drug treatment services in England (NHS, 2005; NTA report, 2005). The recent introduction of Alcohol Harm Reduction Strategy for England (Prime Minister's Strategy Unit 2004) has provided a new role for the National Treatment Agency in relation to alcohol treatment and several national and regional frameworks related to alcohol and drug abuse treatment and control have been provided.
We move on to the next major issue in our analysis of community care for alcohol and drug abuse clients and this is related to
Policies and Provisions for Control and Treatment - Control and treatment of abuse has been the major concern of the Government and Department of Health that has worked in association with the National Health Service (NHS) and National Treatment Agency (NTA) to deliver updated and appropriate health care and community services for affected individuals. As we have already discussed in care programmes, Models of care for the treatment of adult drug misusers (MoCDM), has been given as a possible treatment framework for such clients. According to the NTA, Models of care sets out a national framework for the commissioning of adult treatment for drug misuse (drug treatment) and advocates a systems approach to meeting the multiple needs of drug and alcohol misusers. Models of care is based upon guidance, quality standards, current evidence, and good practice in drug treatment in England and sets down a general and national framework for drug treatment that is standardised and applicable widely, considering legal, social and clinical aspects. Models of care considers drug treatment modalities like rehabilitation, medication and day programmes, with special group considerations such as minority and ethnic issues and cross-cutting issues of self help groups, complementary therapies etc (NTA report on Models of Care, 2005).
The more specific Alcohol Harm Reduction Strategy (2004) provided by the Prime Minister's Strategy Unit lays down a series of measures that aim to
- tackle alcohol-related disorder in town and city centres
- improve treatment and support for people with alcohol problems
- clamp down on irresponsible promotions by the industry
- provide better information to consumers about the dangers of alcohol misuse.
Several policies and provisions are being considered by the Government and Department of Health that seems to take the problem of alcohol and drug abuse not just from the perspective of treatment but also of control as we have discussed.
Three critical issues of assessment, implementation of care and policies have been discussed in this essay to provide a broad overview of the care framework provided to alcohol and drug abusers and we also give a critical appraisal of the care literature and procedures that seem to drive the National Health Services in the context of alcohol and drug abuse.
Alcohol and drug abuse disorders(1986 Nov)
Alcohol and drug abuse disorders :2nd Indo-US symposium: Papers and discussion.
NIMHANS publication ; no 20
Alcohol and drugs :research and policy /edited by Martin Plant ... [et al.].
Edinburgh:Edinburgh University Press & WHO Regional Office for Europe,1990.
Alcohol and other drugs.
National Center for Alcohol Education.
Alcohol, drug, and related mental health problems : a pilot curriculum for primary care providers /developed by National Center for Alcohol Education [for] US Department of Health and Human Services, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute on Alcohol Abuse and Alcoholism.
Washington, DC :The DHHS,1980.
Alcohol and drug problems :a case studies workbook /edited by Gary Hulse.
South Melbourne, Vic. ;Oxford :Oxford University Press,2004.
Also see DoH publications:
No secrets: guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse
Department of Health and Home Office, 2000
Choosing Health: making healthier choices easier
Public Health White Paper, Department of Health, 2004
LAC (93)2: Alcohol and drug services within Community Care
Local Authority Circular, Department of Health, 1993
Alcohol Harm Reduction Strategy
For Statistics - See DoH publications
Smoking, drinking and drug use www.dh.gov.uk
National Treatment Agency for Substance Misuse (NTA) - National Programmes on Alcohol and publications on Models of Care.
Appendix I - Statistical report on Alcohol Abuse, DoH report, 2004
In England in 2002, around two fifths (37%) of men had drunk more than 4 units of alcohol on at least one day in the previous week: just over one fifth of women (22%) had drunk more than 3 units of alcohol on at least one day in the previous week.
In England in 2002, 21% of men had drunk more than 8 units of alcohol on at least one day in the previous week, and 9% of women had drunk more than 6 units.
In 2002, average weekly alcohol consumption in England was 17.0 units for men and 7.6 units for women.
In England in 2002, 27% of men and 17% of women aged 16 and over drank on average more than 21 and 14 units a week respectively. Drinking at these levels among men has remained stable at about 27% since 1992: for women it has risen from 12% to 17% in the same period.
In 2003, a quarter (25%) of pupils in England aged 11-15 had drunk alcohol in the previous week; the proportion doing so has fluctuated around this level since the mid 1990s.
In the United Kingdom, expenditure on alcohol as a proportion of total household expenditure has fallen from 7.5% in 1980 to 5.7% in 2003. (DoH Statistical report on Alcohol, 2004)
Appendix II - Statistical Report on NHS Drug Treatment
- 160,450 individuals were recorded as in contact with structured drug treatment services in England 2004/05. This is a 27% increase on figures for 2003/04 (125,545)
- Applying similar data analysis methodology to the data used for the 1998/99 baseline for the drug strategy PSA treatment target, there has been an 89 per cent increase in the number of individuals in contact with structured drug treatment services over this period. The target is to have an increase of 100 per cent between 1998 and 2008.
- 53% (55,650) of clients who were discharged remained in treatment for 12 weeks or more following triage assessment in 2004/05. In 2003/04 this was reported as 52% (21,954).
- 120,700 individuals (75% of those treated in the year) either successfully completed treatment in 2004/05 or were retained in treatment on 31 March 2004. 2003/04 figures reported 90,500 (72%).
- 15,800 individuals (28% of those discharged) successfully completed treatment in 2004/05. 2003/04 figures reported 13,000 (29%).
- 104,900 individuals (ie 65% of those in treatment) were retained in treatment on 31 March 2005. 2003/04 figures reported 77,500 (61%).
- 98,400 individuals presented to structured drug treatment services in 2004/05. The figure reported for 2003/04 was 79,600.