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Analyzing the Problem
Current policies regarding illegal drugs are still dominated by the prohibition perspective that was applied to alcohol prior to the repeal. Scutchfield & Keck (2003) say that the focus has been on individual deviance, immorality, and the need to abolish the illegal drug trade. The drug policies of the previous administrations were based on the assumptions that illegal drug use is fundamentally a moral problem; illegal drug policy should focus on deterring use, not on reducing associated health problems. Punitive measures to stem use and supply should dominate in the illegal drug policy. Scutchfield & Keck (2003) say that about 70% of the funds have been dedicated to law enforcement costs, primarily prison construction, criminal justice costs, drug interdiction programs, and other justice programs.
Addressing the drug problem requires a fundamental shift in orientation in the field of public health, which has traditionally addressed alcohol and drug abuse problems primarily at the individual level and developed programs to be delivered to those risks. Patel & Rushefsky (2005) say that defining drug abuse as a public health problem can be beneficial. America’s war on drugs since the 1970s has been based on defining drug abuse as a criminal problem; therefore, billions of dollars have been spent on law enforcement in areas such as stopping drug trafficking and incarceration of drug users (Patel & Rushefsky, 2005). Drug prohibition laws have failed to reduce the amount of drugs available in the United States; drug prohibition has made drugs more dangerous to drug users; drug enforcement has led to an erosion of civil liberties, and drug prohibition has stifled democratic debate over drug policy.
Setting Goals and Objectives
Drug abuse should be treated primarily as a public health issue rather than an issue of individual morality or deviance. Policy should focus on community and societal environments in which individual problems occur (Scutchfield & Keck, 2003). The primary purpose of drug policy should be to reduce drug-related problems. Reducing drug use may be one strategy to reduce drug harm, but it should not be an aim in itself. Scutchfield & Keck (2003) noted that current policies designed to reduce the use of drugs may actually increase drug-related problems due to the violence they foster.
The objective should be given to those drugs that create the greatest risk of harm in the society. On this basis primary attention needs to be given to illegal drugs (Scutchfield & Keck, 2003). Drugs that carry a high risk of addiction or violent behavior also should receive a higher priority in drug policy than drugs with lower risk of such harm.
Prevention, treatment, and recovery measures should dominate drug policy. Scutchfield & Keck (2003) assert that punitive measures targeting drug users should be reserved primarily for drug-related behavior associated with other criminal acts.
Drug policy should be designed in a public health framework with the objective of reducing the adverse social consequences of drug consumption. Patel & Rushefsky (2005) noted that there is a need for scientific research in order to make and evaluate drug policy that is better data on consumption, price of drugs in the illegal market, and the assessment of the effectiveness of drug policies.
Designing the Policy
Defining drug abuse as a public health problem can help redirect some of the resources spent on drug enforcement for the treatment of drug users. More and more states are passing alternative drug reform policies, including the adoption of initiatives on the medicinal use of marijuana, syringe exchanges, and alternatives to jails. Drug abuse should be perceived as a public health issue, because it places extraordinary demands on our public health system. The American Medical Association should be largely involved, because they were the first advocates of medical marijuana.
The program should target all the affected individuals, because substance abuse affects people of all ages, socioeconomic groups, and occupations. The vulnerable populations include children and adolescents, high school dropouts, people with dual diagnoses, individuals with family history of addiction, unemployed individuals, and college students. Instead of relying on historical precedents, cultural biases and emotion, scientific knowledge would be used as the foundation for developing drug control policy from the public health perspective.
Heavy emphasis of the public health policy on drug abuse should be placed on the prevention of substance use, particularly the primary prevention of substance abuse. Decisions to adopt prevention programs would rest on the evidence-based criteria (Thombs, 2006). The policy requires a shift in public policy so that treatment would become the primary method of addressing problems of illicit drug abuse.
The public health policy on drugs should embody the assumption that underpins drug courts. Addiction is, therefore, a disease that largely affects society hence it is a public health problem whose solution is an expanded treatment (Tiger, 2012). The treatment must be forced within a public health model, because the societal costs of addiction justify this coercion.
Public health rationales contain the logic of personal responsibility that can lend themselves to a punitive orientation if, for example, addicts do not actively pursue treatment and, by extension, sobriety. Tiger (2012) says that if treatment of drug abusers is available and works, addicts are obliged to seek it out. The perspective that addiction is a public health problem should not inherently remove it from criminal justice oversight.
Harm-reduction strategies would be adopted by communities to help motivate the affected individuals to move toward abstinence. Thombs (2006) says that the development of public health policy on drug abuse would explicitly consider the potential benefits of some forms of psychoactive drug use in some situations.
Derivative policies from the above conceptualization would be to conduct surveillance activities to determine incidence, prevalence, and harmful consequences of drug abuse. Resources should therefore be devoted to the establishment and implementation of cost-effective treatment and other harm minimization interventions.
Clinical officers should be trained at the undergraduate and post graduate level; continuing medical education levels will provide the required assistance of treating addicted individuals. Community health nurses are the most appropriate workers who can deal with substance abusers in the public health sector. Community health nurses must be aware of their own issues and attitudes towards substance abuse. All physicians with clinical contact should be able to perform age, gender, and culturally appropriate substance abuse screening. They should also be able to provide intervention in patients with addictions.
Thereis a need for improved medical education in substance abuse prevention and treatment. The finances required can be obtained from Office of National Drug Control Policy (ONDCP) which deals with research-based programs for reducing drug abuse and related health and safety consequences. ONDCP has the mandate to come up with national drug abuse policy in association with public health and develop program priorities. Sloboda & Bukoski (2003) say that to support the public health drug abuse prevention policy, ONDCP should allocate $394.2 million in FY 2013. These resources will enhance efforts to effectively prevent and treat drug abuse and drug addiction. The finances will further reduce health and social costs to the public of illegal drug use by reducing the treatment gap. The action plan should involve educating and enabling America’s youth to reject illegal drugs as well as alcohol and tobacco.
Policy Implementation and Monitoring
The implementation of the public health drug abuse policy should rely upon the application of emerging research findings from basic and applied disciplines in order to improve prevention. Sloboda & Bukoski (2003) established that this should include gaining a better understanding of how to improve prevention interventions by focusing on salient genetic and environmental risk and protective factors related to drug abuse and addiction. The program should provide communities with research-based tools to assess drug issues at the local level (Sloboda & Bukoski, 2003). Public health practitioners such as community nurses should translate evidence-based prevention principles to meet the needs of local communities and reduce the devastating effects of the linkage between drug abuse and addiction.
Through public initiatives and good political leadership, there should be well-funded and evidence-based drug abuse monitoring systems in public health. The public health in association with ONDCP should launch comprehensive campaigns and publish their effectiveness towards drug abuse prevention. The effectiveness of increasing physician education in the prevention and treatment of substance abuse should be outlined on the basis of the percentage believed to have received the required treatment. Another important monitoring system for public health effectiveness is the length of staying under treatment. Studies indicate that patients who stay in treatment longer or attend more treatment sessions have better post treatment outcomes than those who do not.
Evaluation should be based on the behavior reflecting the new positive attitudes. Lowinson (2005) says that physicians should evaluate the effectiveness of the policy by evaluating the desired behavior in conjunction with close supervision. The best results can only be evaluated when positive attitudes, behaviors, and favorable results of treatment have occurred in care and rehabilitation facilities. This likelihood of change and positive outcomes should be evaluated if the behavior of drug abuse victims is accompanied by favorable results (Lowinson, 2005). Outcomes should also be evaluated on the basis of the effectiveness of psychosocial counseling for relapse prevention in drug abuse victims.
Reassessment and Review
The public health field should provide a unique and powerful set of tools for conceptualizing and addressing drug problems in our society. The reviews should constitute the percentage of reduction of crisis in the society, reduction in untold tragedies in the lives of individuals, families, and communities (Lowinson, 2005). The reassessment and reviewof this policy and plan requires confronting some of the basic inequities and injustices afflicting our nation. Reassessment and review should be based on increased prevention and treatment services and further build a citizen base for action in wider public health arena.
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