The life of people is extremely closely connected with society. The community and all its components in various organizations, traditions, and established trends impact both a person’s life and health. In some places, people have more access to technology and opportunities to self-actualize more effectively. In other areas, a lack of infrastructure and necessary institutions leads to a decline. In the context of the relationship between health and society, five social determinants are usually considered, demonstrating the state of the environment in economic, social and other contexts (U.S. Department of Health and Human Services, n.d.). Each of these elements is critical to human health and well-being. For example, the presence of economic instability, supported by the lack of a sufficient number of hospitals, will have a noticeable negative impact on people’s health in such a community.
Consequently, the study of society and its various components is an essential element, without which it is impossible to correct existing problems and provide quality medical care on a large scale. This paper aims to research the community of the city of Keansburg, located in the state of New Jersey. While most of its homes and infrastructure appear to be reasonably well maintained at first glance, a closer look reveals a significant number of problems. According to the windshield survey, houses in the east of Keansburg are gradually unkept, with intoxicated people on the streets. Despite their deplorable condition, they have nowhere to go for medical help since there is not a single hospital in the city. Accordingly, one of the most fundamental problems associated with the city is the problem of substance abuse.
The use of various psychoactive substances is a fairly common problem that receives a lot of attention. Thanks to the multitude of programs to combat alcoholism and drug addiction, the number of people involved in substance abuse is gradually decreasing every month (Substance Abuse and Mental Health Services Administration, 2020). However, despite these measures, in the context of some towns, the situation remains highly depressing. According to statistics for 2018, among all cities in New Jersey, Keansburg is in 19th place in terms of the number of cases of heroin use (Davis, 2019). Unfortunately, by 2020, the situation had not improved: of 333 drug users, 169 used heroin (Department of Human Services, 2021). The situation is worse only in two regions of New Jersey, which is a clear demonstration of the negative dynamics of the development of this problem.
In addition, the region has a problem with alcoholism, which affects 22 percent of all abusing citizens. Finally, the remaining victims of substance abuse use all other types of drugs in equal proportions, from cocaine to marijuana. The scale of this problem is only amplified by the fact that the city has 25 rehabilitation centers for almost 14 thousand residents (“Keansburg, NJ drug rehab programs,” 2021). Despite the reasonable number of specialized institutions, their resources and tactics are not enough to correct the substance abuse. Thus, the problem of the distribution of various narcotic drugs and, first of all, heroin is a problem for the entire community of this city and requires the adoption of preventive measures. Current actions in this context have shown their inconsistency, clearly demonstrated by the statistics deteriorating every year.
The significance of this problem for the entire community is formed due to several factors at once. First, the constant use of various drugs is associated with the need to obtain them. According to statistics, the economic situation in Keansburg is below average, as shown by the size of wages (“Keansburg, NJ,” n.d.). Consequently, people will either spend the funds they need to survive or commit crimes, which severely affects both the region’s state and the people living in it in the long term. Secondly, substance abuse is associated with many different concomitant diseases. According to research, heroin use leads to the active development of skin and soft tissue infections due to substandard and dirty injection equipment (Bauman et al., 2019). From a medical point of view, such diseases are associated with the need for surgical intervention. However, Keansburg stands out for its lack of any hospital, and the number of medical offices is minimal. Thus, even if people need help and are willing to visit health facilities, they will not have this opportunity. Therefore, the identified problem is critical and relevant for this society.
Although many factors from different fields of activity are associated with the formation of this problem, the theory of social determinants allows them to be analyzed from the perspective of health care. In the context of the situation in the community in question, first of all, the element of economic stability deserves to be mentioned. According to official statistics from the United States Census Bureau (2019), the poverty rate in Keansburg is 26.3 percent, 2.5 times the U.S. average. The same situation was observed through the windshield survey in the form of a large number of homeless people and the presence of a large number of houses for sale. Low living standards and socioeconomic status accompany, among other things, alcohol consumption and the formation of various kinds of addictions (Fitzgerald & Zucker, 2021). In addition, lack of money will be a barrier to accessing health care services, especially in the absence of a nearby health center.
In addition, the lack of funds will affect the availability of health insurance, which is directly related to the quality and volume of medical services. Statistics show that 5.4 percent of Keansburg residents do not have health insurance (United States Census Bureau, 2019). Consequently, this situation serves as the basis for the aggravation of the existing cases of substance abuse. This situation corresponds to the social determinant of health care access and quality. At the moment, residents of Keansburg have practically no access to medical facilities. According to a windshield survey, no large hospitals were found in the city. At the same time, there are 25 rehabilitation stations in the city for taking various kinds of drugs. Still, their impact on the situation in the community is exceptionally insignificant (“Keansburg, NJ drug rehab programs,” 2021). Thus, despite its multicomponent and complexity, the problem existing in Keansburg society can be analyzed through social determinants of health. In turn, such an analysis leaves room for various medical programs to improve the current situation.
First of all, it is necessary to focus on developing the healthcare sector and the involvement of the current community in the medical system. Using an evidence-based approach based on three key components is possible to do this most effectively: the best available evidence, clinician expertise, and patient preference. In addition, it is necessary to take into account the possibility of collaborations and the use of resources that already exist in the community. Several basic principles were identified from the studied literature, according to which intervention can be developed. First of all, it is necessary to establish a detection system and address substance use (Winters et al., 2018). This will not only reduce the scale of the current problem rapidly but also prevent its development in the future. In addition, treatment and intervention should not only focus on substance abuse but also take into account other factors. Thanks to this, the accompanying problems of housing and social needs can be solved (Winters et al., 2018). In the context of Keansburg, the most appropriate approaches indicated in the literature may be to create a therapeutic community and web-based therapy.
The problem with substance abuse is difficulty in quitting drugs and the need for lengthy and diligent treatment. It is necessary to have a developed health care system to provide these elements, which is practically absent in the city. From a nursing point of view, it is necessary to use the resources that are already available. Therefore, the creation of hospitals and the development of an infrastructure network cannot be considered realistic options. However, on the other hand, the existing network of rehabilitation centers can be used to create a therapeutic community. This approach focuses on society, seeing it as the primary driver of change, which is in line with the Healthy People 2030 initiative (Winters et al., 2018). Nurses working in these centers can spread the knowledge of mutual assistance, thus gradually setting the stage for treatment. In addition, nurses in existing public institutions such as schools can also act as partners.
Finally, a different approach to solving this problem can be using modern technologies to disseminate therapeutic methods. As shown by a windshield survey and official statistics, almost ¾ of Keansburg residents access the Internet (United States Census Bureau, 2019). Since it can be difficult to establish contact with victims of substance abuse directly in the city due to the lack of suitable sites, digital methods of solving this issue may be more relevant. In addition, they will allow respecting the patients’ interests, which is extremely important for evidence-based interventions. First, Internet resources allow one to maintain anonymity, which is extremely important for victims of substance abuse and is actively used by Alcoholics Anonymous fellowship (Stone et al., 2017). Secondly, the need to visit any specific location can be associated with money spending, which is problematic for Keansburg residents. In this context, this problem will be much less relevant due to the presence of the Internet for most people.
Thus, the problem of substance abuse in Keansburg can be solved by using two evidence-based practices: creating a therapeutic community and digital means of consultation. The main problem for solving this situation is the lack of medical assistance in this community, because of which nursing resources are extremely limited. For effective implementation of treatment, it is necessary either to cooperate with the existing structures or use another media. The first option involves cooperation with rehabilitation centers and small medical offices. Engaging with society at these levels can help change the social situation by bringing about the first changes. Using the web approach comes with benefits in terms of anonymity and a lower cost for help. However, it is recommended to combine both approaches for the greatest efficiency, forming a therapeutic community both on the network and in different organizations. Such actions will not be able to eliminate this problem due to its complexity completely. However, they will help create the basis for further action.
References
Bauman, Z. M., Morizio, K., Singer, M., Hood, C. R., Feliciano, D. V., & Vercruysse, G. A. (2019). The heroin epidemic in America: A Surgeon’s perspective. Surgical Infections, 20(5), 351-358.
Davis, T. (2019). NJ towns with most heroin abuse cases: New data 2019. Patch.
Department of Human Services. (2021). Substance abuse overview 2020 Monmouth County.
Fitzgerald, H. E., & Zucker, R. A. (2021). Socioeconomic status and alcoholism: The contextual structure of developmental pathways to addiction. In H. E. Fitzgerald, B. M. Lester, & Zuckerman, B. (Eds.), Children of poverty (pp. 125-148). Routledge.
Keansburg, NJ. (n.d.). Data USA.
Keansburg, NJ drug rehab programs — Inpatient, free, detox and outpatient treatment. (2021). Drug-Rehabs.
Stone, D. A., Conteh, J. A., & Francis, J. D. (2017). Therapeutic factors and psychological concepts in alcoholics anonymous. Journal of Counselor Practice, 8(2), 120-135.
Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 national survey on drug use and health.
United States Census Bureau.(2019). Keansburg borough, New Jersey.
U.S. Department of Health and Human Services. (n.d.). Social determinants of health.
Winters, K.C., Botzet, A.M., Stinchfield, R., Gonzales-Castaneda, R., Finch, A.J., Piehler, T.F., Ausherbauer, K., Chalmers, K., & Hemze, A. (2018). Adolescent substance abuse treatment: A review of evidence-based research. Adolescent Substance Abuse, 141-171.