Introduction
In essence, substance relapse is a situation of ‘converting back’ by an individual from a condition after a short or long term abstinences from using any drugs. In drug addiction and substance abuse, it can be defined as “the resumption of the use of drugs after leaving it for some time” (Cherry Dillon and Rugh, 2002). For substance abuse relapse among women, it is the issue of resumption of females to substance abuse after they have recovered from using such drugs.
The WHO defines substance abuse as “the harmful or hazardous use of psychoactive substances which include illicit drugs and alcohol”. A prolonged or repeated use of such substances can lead to addiction which is usually evident with continued use of the substances despite the fact that physical and mental deterioration is being noticed. In fact, various researchers in the world have come up with different conclusions and suggestions regarding the causes, effects, solutions and recommendations on how to deal with substance abuse and relapse not only among women but also in all genders.
Problem Statement
Substance abuse has been a problem here not only in The US but across the entire globe since the colonial days even earlier in other parts of the world. Tobacco, morphine, opium and alcohol, were all among the earliest substances of abuse in this nations. In most recent years there have been efforts focused on the issues of substance abuse amongst women and its impact on families. Many issues have arisen during the approach to this problem. Many experts on the topic have different views on the size, causes and resolution of substance relapse prevention among female substance abusers.
Marlette, in 2005, concluded in his research that “more policies should be drafted and strictly implemented to curb substance abuse. But the policies are not uniform to allow for the general implementation across the board”. He continued to suggest, “developing countries should be helped to fight substance abuse through provision of resources and helping them implement international agreements on reducing substance abuse by developed countries” (Marlette, 2005).
Untreated cases of substance abuse, addiction and relapse especially among women, adds significant effects to communities and families. “The main effects that can be immediately noticed are; property and violence crimes, criminal and court related costs, health care utilization costs, lack of child support, prison expenses for the government, welfare and foster care costs, child abuse, unemployment and emergency room visits” ((Marlette and Donovan, 2005).
This paper will deal specifically with substance abuse relapse among women. It will outline the specific trends of substance abuses and relapse in New Jersey especially on gender basis. It will also look at the literature and background on the subject outlining the effects of substance abuse, how relapse occurs and how best to address it. Finally, it will critically analyze the current and previous approaches that have been developed with a view to curb relapse among women.
The Effects of Relapse in women Population
Substance abuse has continued to increase among males and females all over the world with men taking a larger share. “The most worrying trends are that more children and women are beginning to use drugs which are even worse” (Wang, 1999) and they are the ones who are easily affected by relapse due to their vulnerability. A single case is the incident in Virginia where an 11 year old boy who was driving at a very speed caused multiple accidents on the highway in May, 2007. This and other cases where an increased number of women and children are taking drugs and even if they are assisted, they tend to have little response-relapse- causing medics, families and leaders sleepless nights.
“In the U.S, more Hispanics and the black-Americans are beginning to adopt a culture where abuse of drugs is common in a case where this institution is terming ‘the worst trend’” (WHO, 2004). This has been attributed to technology advancement, increase in number of immigrants from Africa, modernization in our society and increase in drug smuggling into the U.S. “Commonly abused substances include; Tobacco, Alcohol, Marijuana , Cocaine, Heroin, Methamphetamines, Club drugs, Ecstasy, GHB, Rohypnol, Examine, LSD and mushrooms” (Cherry Dillon and Rugh, 2002).
Case Study of Substance Abuse in New Jersey
The city of New Jersey is situated between the major industrial areas of Pennsylvania and New York thus making it one of the major areas which is at crossroads concerning drug abuse. With huge traffic coming from both eastern and southern cities, New Jersey can be considered as one of the states which are vulnerable to drug smugglers. Substance abuse statistics available are used to determine the trends which range from legal to abuse consequences.
The U.S has developed networks to gather information from substance abuse agencies, Medicare centers and other organizations to help it monitor trends and make necessary injunctions. Such data will enable people to actually fight the practice in order to analyze the direct and indirect effects of substance abuse not only among women but to other members of population. In a recent study by Marplot, 2004, “approximately 1 in 5 individuals between the ages of 16 and 59 have confessed to have at least abused one of the drugs considered to be harmful in their lifetime”.
The same study continues to indicate that “more men and women have abused the drugs more than the young ones and it has become difficult for them to leave the practice even after treatment. In New Jersey, the number of women who had substance abuse problems between the years 2001-2003 was 48% while the men were 51%. In overall, 19.5 million persons over the age of 12 years use illegal drugs in the U.S each year translating to 9,360 deaths occurring annually. 1.6% of this occurs in New Jersey State” (Drug RADAR Network Agency, New Jersey, 2004).
My plan on the Intended Research
The first step on how I will effectively address the issue of substance relapse among the women is to identify the main cause of relapse among this chosen population. Research reveals that, the main causes of substance relapse after substance abuse include; chaotic home environment, ineffective parenting, lack of nurturing and parental attachment, factors related to a child’s socialization outside the family may also increase risk of drug abuse and association with deviant peer groups among other factors (Miller and de Vernal, 1992).
The main symptoms of substances abuse/relapse can be easily noticed by family members and they include; irritability and aggressiveness, difficult in controlling use, declining performance at work or in school, forgetfulness, hopelessness, selfishness, neglect of other interests and activities, strong desire to take the substances, increased tolerance, frequent hangovers, withdrawal syndrome, planning substance abuse in advance, among others. The pattern of continued pathological use of non-medical drugs or any other legal medication that results in adverse effects inclusive of extensive social effects such as failure to meet family responsibilities, legal issues or school obligations are the main descriptions of substance abuse (Parks, 2004).
The ongoing debate concerning the relapse rate in both women and men on substance abuse especially in the U.S and western Europe Recent studies have suggested that future, it will be easier to treat cases of substance abuse and not relapse. The reason for this is that people will be moving from one drug to the other making it difficult to handle one at a time.
Understanding Comprehensively Relapse among women
Substance abuse relapse is a condition where one feels to have failed to recover fully from addiction to drugs or substance abuse despite the fact that they have gone under a professional recovery plan. It means that one comes back or is tempted to use the drugs even after they have undergone a medical response process. Relapse of substance abuse is a common problem that can have devastating effects on the victim especially physical and emotional impacts (Brown, 1999). It requires good communication and counseling between the counselor and the patient. Recovery from substance abuse especially women is not a complete failure to eradication but a step further in real sense a positive way to strengthen the process of recovery that is difficult to address given the complexity nature of the issue.
There are three ways of severity of relapse which is normally used to determine the most suitable medical or counseling response. The first level is slip where the victim briefly resumes drug use but have no signs of drug dependence or symptoms of addiction. The second level is several level of drug abuse. “This is the most severe form because the victim resumes substance abuse for several days during the treatment process” (Parks, 2004). This should be used as a learning process where the patient should learn from experience and prevent further relapse. The last level is the sustained dug use evidenced by resumption of addiction. The victim of substance abuse fully relapses to addiction and eventually drops out treatment and those medics and counselors need to start from scratch.
The relapse process
Any use of a substance after a period of abstinence is a measure of the relapse rates. Previous research by Lorimar, M. & Palmer, and R in 1999 has indicated that “temporal patterning of the relapse process and that the circumstances under which the process occurs across all the genders is under is difficult to comprehend especially by unprofessional persons and the victims themselves”. Hence the commonalities across all substance abusers are an indication of the relapse rates and it involves a sense of perceived control and self-efficacy.
Risk factors
While appreciating the fact that the relative level of substance abuse and misuse among the women generation is somewhat lower than that for the youth and middle aged population, the level of developing substance abuse problems among the women is quite high. This can be associated with the fact that substance abuse related conditions are more pronounced because of the psychological changes that increase and alter the effects of substance abuse among the women. For instance, studies that have been conducted to show the nature and statistics of the drinking habits and onset of drinking have indicated that less than a third of the women who engage themselves in alcoholism started at an early age.
The reason for this is that there are chances that stress, depression, and peer pressure could contribute to women substance abuse. Substance abuse can be considered to be a global issue owing by the magnitude of money changing hands on drugs. No wonder a number of billionaires in the world today have linked their wealth on the illicit trade. “Reports reveal that the illegal drug business accounts for $400 billion of world trade, and is second only to the worldwide arms market, it is larger than the global iron and steel industries.”(Cherry, Dillon, & Rugh, 2002).According to the World Drug Report of 2000, at any one time, there are at least 180 million drug abusers in the world with a majority of them involved in Heroine consumption, others in cocaine and alcohol use among other drugs. Of this group, the report noted that there is a worrying trend that has evolved and that more of women are now engaging in drug and substance abuse (Cherry Dillon and Rugh, 2002).
This revelation has put medics on the spot in that the women are people with weak body systems and sometimes medical ailments that come with gender biological composition hence the need to have a different approach of dealing with substance abuse among the women. This however calls for increased funding and other resources such as the personnel to handle the high number of cases of elderly substance abusers. In the U.S for example, a lot of funds has been used to address this issue, “Indeed, on the average, the federal government has spent well over $10 billion a year on drug control for at least the last ten years. Currently, fifty-two federal agencies have a stake in drug control, and each must justify its budget.” (Cherry, Dillon, & Rugh, 2002)
Biological Basis behind Substance Relapse
There is clear evidence that substance relapse has a biological basis for example the spread of nerve impulses through arrangement of circuits may result to a person feeling good with regards to particular occurrence and to keep in mind that it is a pleasurable experience. Persistent substance relapse alters the nerve circuits in distressed brain sections which are normally linked to the development of drug endurance in human beings. Also relapse can be experienced as rewarding when biological basis of drug addiction is considered. The biological basis of drug addiction takes the form of substance relapse behavior explained to be resulting from a necessity to external inspiration.
Research also indicates that once an individual become addicted to particular drugs, his brain become basically trapped into thoughts that he must use the drug in order to survive and he equates such drugs to basic needs such as food. Biologists argue that the use of drugs leads to the human brain to discharge certain chemical known as dopamine which is a substance that is released when either negative or positive occurrences happens in human beings life process. This chemical i.e. dopamine has been indicated to be very crucial to human beings motivation, learning and memory activities in human beings. Further studies also reveal that substance relapse interrupt the normal body systems which leads to increase in release of chemical dopamine in the body.
For instance addicts of cocaine have been noted to be having smaller amount of dopamine receptors thus making their brains to react negatively to factors considered to be of prime importance for example basic needs which would otherwise result to happiness to normal human beings. Also to some extent lack of adequate dopamine receptors in the brain may be accredited to the negative effects of the drugs; however, in other instances some persons naturally have small amounts of receptors from birth. Also those individuals diagnosed with obesity disorders have few amounts of dopamine receptors in the brain which as a result yearn for the sensory information that food offers to their body systems. (Kenna, Nielsen, Mello, Schiesl, and Swift, 2007)
The biological basis of substance relapse requires an individual to fully comprehend the fundamental means by which diverse drugs trigger the reward system of a human being. In order to understand such basic mechanisms drug classes must be considered for example the depressants for instance benzodiazepines and the use of alcohol functions by augmenting receptor e.g. methadone and morphine which are narcotics functions by imitating endorphins which are chemicals formed by human being body and has impact alike to those of dopamine receptors. Depressants are however, referred to as downers since it enhances relaxation and reduction of pain in human being consuming such drugs for example narcotics. Stimulants class of drugs on the other hand augments dopamine receptors indication in the reward structure either by obstructing its absorption or through straightforwardly inspiring its discharge. Stimulants such as cocaine, nicotine and amphetamines are commonly referred to as uppers since it results to heightened vigilance and energy among those who use such drugs. Stimulants are reportedly said to causing enjoyable feeling in human beings bodies which is accompanied by high euphoria which in turn results to users wanting more and more of such drugs. (Kenna, Nielsen, Mello, Schiesl, and Swift, 2007)
Drug addiction brings about the subject of probable detrimental consequences on the enlargement of new neurons in mature people thus suggesting further evidence that the biological basis of drug addiction is strong in human being’s life. The psychological dependency actually depends on the individuals mind, whereby once the person starts using the drug he sets his mind that he can not survive without using drugs this drug is thereafter usually considered as a basic need in the individuals’ daily life. For this case we find that research conducted shows that once the drugs are administered they cause the brain to produce the dopamine chemical which is regarded as a factor in the learning, reminiscence and the motivational experiences of the brain since it only occurs when an event which is either positive or negative happens, therefore the administration of this drugs prove to be interfering with the stated functions of the brain.
Recommendations on how to Solve Substance Relapse
The solutions to the substance relapse problem can either be prevention or treatment. It should be noted that this techniques apply to all affected individuals and not women only.
Prevention
Since substance abuse and relapse in general may start during adolescent or childhood, it is possible that prevention efforts in community and schools settings be strengthened to curb relapse. Recent programs championed by the office of Drug Abuse and Prevention in U.S have focused more in educating vulnerable groups such as women and children. “The programs are intended to teach resistance skills and how to fully keep away from drugs. Through education and the media, support and service groups are seeking to educate women on the importance to support their families and help their children keep off from drugs” (Pham-Kanter, 2001).Most psychologists believe that women are better positioned to handle relapse among themselves because of the interactions and hormonology factors. The programs should therefore be focused on first helping women understand the consequences of drug abuse and then on how to deal with relapse. “Effective treatment and prevention of relapse has been in the past very difficult but recently, through research, the behavior has been finally understood and that it is clear that prevention aimed at children and adolescence and drug education offers not only a better method of eliminating substance abuse but also the best chance to prevent relapse” (Marlette and Donovan, 2005).
Management of substance abuse and relapse
World Health Organization has indeed played a huge role in the management of relapse of substance abuse and prevention especially among the vulnerable groups? It has supported countries to reduce and prevent problems caused by the use of psychoactive substances in terms of regulations and policy implementation. “Its main mandate is to recommend reduction and prevention mechanisms which can able to prevent relapse and assess substance that highly contribute to relapse hence able to advise the U.N on what regulations to pursue” (Pham-Kanter, 2001). The department of Mental Health and substance Abuse under it has been mandated to overlook issues of curbing relapse and also substance abuse in general.
Scientific research which has been conducted in the past have shown that “effective treatment for relapse on substance abuse can help people completely recover from destructive behaviors after undoing treatment or recovery process from substance abuse”(Brown,1999). This means that people can successfully remove themselves from a life of substance abuse through effective treatment and long-term commitments. Women can be assisted through formation of women groups and organizations to handle issues of relapse among women only. This will be more efficient as it will be having all the necessary resources and time to look at individual clients and victims. Closer monitoring of patients especially at the gender level will go a long way in reducing incidences of relapse occurring.
Pharmacotheraphies
“It is to a greater or lesser extent that certain drugs have been manufactured and developed to assist in solving issues of relapse development” (Parks, 2004). They include opioid medications such as methadone, buprenorphine, morphine, oxycodone etc. which have been used as remedies of relapse. One of the most successful ones include bogaine which, according to medics, can help reduce the temptation of going back to substance abuse and is specifically suited for narcotics and alcohol. It is believed to interrupt both psychological cravings and physical dependence on stimulants, nicotine and alcohol. Parks, in his book ‘Relapse prevention therapy’ explains “morphine enables the patient to cease substance abuse ‘in order to avoid the psychological, legal, financial, social, and physical consequences that can be caused, especially by extreme abuse’” (Parks, 2004). Other antidepressants are able to moderate substance use particularly narcotics. All these Pharmacotheraphies have helped in the reduction of relapse of substance abuse for all genders.
Rehabilitation Procedures
Most of the judicial systems have been able to convict substance abusers to rehabilitation programs and to cope with withdrawal symptoms. The detoxification process of relapse involves the abrupt cessation of drug use and physical tolerance of the temptation. Medics promote the use of rehabilitation strategies to minimize effects of relapse since it is a slow but sure process of withdrawal. The method involves the use of psychological dependency which attempts to teach and train the victim new methods of freely interacting with a drug-free environment and avoid relapse. “Isolation of victims or patients of relapse from people who are still substance abusers is very important as it prevents them from admiring the practice” (Brown, 1999). In some organizations, moderations are utilized to allow substance abusers to re-examine their habits and compare themselves before and after stopping the practice. Many other programs utilize rehabilitation initiatives to make their initiatives more effective.
Justice systems
Drug involved offenders have frequently been cycled through the judicial system whereby the substance abusers have become common to probation officers and police officers. This is an evidence that relapse is common and that the judicial system is doing very little to address it. According to a report by American Psychiatric Association, 1999, it reveals that jails, prisons, juvenile detention centers and other correctional facilities get congested, all stakeholders in the medical field are examining newer solutions to prevent relapse. One of the methods is the criminal justice settings where substance abusers who are most likely to be criminals are only allowed to re-enter back into the community when they have completely recovered from substance abuse and are not likely to be affected by relapse.
Relapse Prevention Therapy (RPT)
RPT was originally designed as a maintenance program for replace victims. “RPT entails treatment of addictive behaviors which is used as stand-alone program that in most cases is designed to teach individuals to try and maintain changes initiated in the treatment process” (Pham-Kanter, 2001). Each person has an effective response system to cope with incidences of high risk situations but the problem is the guts to do so” (Pham-Kanter, 2001). Post-implementation survey on suitability of RPT has shown that relapse had decreased significantly as a result of the program. Pham-Kanter explains “RPT strategies are categorized to three groups; lifestyle modification, coping skills training and cognitive therapies”. “RPT strategies round up to both cognitive and behavioral techniques and approaches that provide victims of relapse with ways to reframe their habits once more and change processes in learning experiences with setbacks on how they can meet challenges of recovery” (American Psychiatric Association, 1999). Life modifications strategies include; exercise, spiritual practices, meditation among others.
Relapse prevention over time
Relapse can be prevented over time as demonstrated by Marlette in all his books and studies on relapse. The author approaches the issue by demonstrating how helping victims of substance abuse to cope with the effects of relapse in an effort to achieve non-addictive behaviors. In fact he suggests that “Most episodes of drug abuse can be managed without seriously interrupting the treatment process”. The main prevention of relapse is, “cognitive and behavioral and it is only applicable to victims who are willing to undergo moderation and serious abstinence” (Wang, 1999).
Sponsor of the Research
This research will not only benefit the medical service organizations but it will be applicable to all those organizations and individuals who in one way or another are faced with the problems of substance relapse. It will provide focus and insight to the management of the emergency medical service organizations as well as portraying to the individuals the importance of ensuring a good environment free from drug abuse
It should be noted that this is an exploratory study and therefore more time and financial resources will be required to carry out the research in order to find the relevant information that will reflect the issues of substance relapse in women. Therefore, the biggest limitation is that of availability of funds because the study will require the researcher to reach to a wider population through interviewing many respondents. Since this research project is more objective in its scope, World Health Organization through the Department of Health will fund the whole research study. The main patron of the research will be the officer in charge of New Jersey department of health and he will be monitoring the way the funds will be used. The overall cost of the research will be approximately USD 15,000 and the funds will be evenly distributed through ought the period of research.
Conclusion
Women have recently become drug addicts because of social and economic reasons. Women in our society today are seeking to be equal to men hence may want to smoke, drink and behave like men resulting in high cases of substance abuse relapse among women. Substance abuse relapse among women is therefore possible even after a long period of time and that it is possible they can behave just like other chronic diseases such as asthma or diabetes thereby strict approaches should be adhered to. To treat substance abuse among women many factors should be put into consideration and they include; meeting individual needs of the women who are affected, financial support, counseling services ands strict laws to govern substance abuse.
Although various approaches have been used to prevent and control relapse, there are other pyschoeducatioinal approaches that should be used to integrate traditional modalities and outpatient treatment programs to enable substance abusers completely recover and reduce any chances of developing relapse.
The best approaches according to mental researchers must centre on the 12-step programs developed by the U.N but which have never been taken seriously. The 12-step programs account for behavioral change and its treatment format is structured to focus on individual’s responsibility of preventing and monitoring relapse episodes. Relapse prevention should be able to include skills training and didactic components that encourage intensive counseling and understanding of the fact that substance abuse has adverse consequences. Marlette, in 2005, concluded in his research that “more policies should be drafted and strictly implemented to curb substance abuse. But the policies are not uniform to allow for the general implementation across the board”. He continued to suggest, “developing countries should be helped to fight substance abuse through provision of resources and helping them implement international agreements on reducing substance abuse by developed countries” (Donovan, D. M., & Marlette, 2005).
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