Perspectives In Psychology Substance Use-Free PDF

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Table of contents,Introduction 1,Background 2, Brief history of substance use and its regulation 2. The effects of substances 4,Prevalence of substance use in Australia 6. Substance use and harm 8,Addiction 9,Intoxication 10. Regular use 11,Dependence 11,DSM definitions of harmful substance use 11. The burden of substance use 12,Substance use and mental health 13.
Substance use and suicide 14,Approaches to drug harm in Australia 15. Understanding substance use 17,The biopsychosocial model 18. Stages of change 19,Preventing harmful substance use 21. Risk and protective factors 22,Early intervention 24. Interventions to treat harmful drug use 26,Assessment 26.
Pharmacological interventions 27,Psychological interventions 29. Cognitive Behavioural Therapy CBT 29,Motivational Interviewing 30. 12 step programs 31,Therapeutic communities 31,Comparison of treatment approaches 32. Relapse and relapse prevention 33,Summary 36,References 38. Introduction, The use of psychoactive substances in the form of alcohol and other drugs.
AOD is a common human behaviour The vast majority of adults include some. form of substance use in their lifestyle There is however tremendous variation in. the amount and type of substances that different individuals and groups consume. at different times Harmful substance use can have a major negative impact on. the wellbeing of individuals families and communities and is a growing concern in. Australia and internationally There is considerable controversy regarding. appropriate responses to harmful substance use at all levels individual family. community national and international, As a profession and science psychology has much to offer in terms of theory. research and practice in the AOD field Psychological training provides many skills. that provide valuable contributions to the AOD field in terms of prevention and. treatment interventions education research and policy and psychologists need. to be encouraged to apply their knowledge in this area Despite the obvious. biological action of psychoactive substances current evidence indicates that. standard behavioural principles and processes still apply to AOD problems. Substance use occurs within a social cultural and psychological context and. harmful substance use frequently occurs within a broader cluster of psychological. problems The interventions most strongly supported by outcome research. recognise this complexity and are fundamentally psycho social in nature research. further suggests that even where pharmacological interventions are. recommended such as the use of substitution therapies the efficacy of these. interventions is enhanced by the use of concurrent psycho social interventions. Many psychologists practice and research directly in the AOD field while for. others substance use issues are highly relevant to their practice or research In. the APS 2002 discussion paper Psychology and Substance Use Potential. Contributions and Professional Training Needs all psychologists were. recommended to have adequate knowledge and skills in this area because of the. widespread normative nature of substance use its substantial impact on human. behaviour and wellbeing and its prevalence in clinical settings. This paper aims to briefly outline current knowledge regarding substance use from. a psychological perspective It is hoped that this will highlight the contributions of. psychology to the AOD field and encourage further application of psychological. science in research practice and comment in the field of AOD issues. Please note that the AOD field is extremely dynamic in terms of research activity. and the development of prevention and treatment programs and practice This. paper provides an overview of some of the major issues as informed by research. reviewed at the time of publication in April 2005 The paper does not aim to. comprehensively cover the field and it must be emphasised that new information. is emerging daily,Background, Substance use and AOD experiences can only be fully understood by recognising. the contributions of the drug itself the individual who takes the substance and the. context in which the substance is taken The social cultural and even historical. contexts in which a substance is taken can significantly affect both the drug. experience and consequences of use for any one person or group of people. Substance use is fundamentally a social act we obtain consume and construct. the experience of using alcohol or other drugs in relation to others The rituals. associated with the consumption of alcohol and other drugs are an important part. of creating meaning in relation to this behaviour Keenan 2004 p 65 The. media cultural and religious practices workplaces families and friends as well as. the legal and health care systems are all part of the spectrum of influences. creating our beliefs and actions associated with substance use Discussion and. debate on AOD use should not focus solely on substances and individual users. but must also consider valuable information and knowledge regarding the context. in which substances are used Keenan 2004,Brief history of substance use and its regulation. Substance use is not a new phenomenon Throughout history psychoactive. substances have been commonly used for a variety of purposes from medicines. to important components of rituals and ceremonies see Lang 2004 For. the consumption of alcohol dates back at least 8000 years. tobacco has been used for thousands of years, opium use was evident in Mesopotamia at least 7000 years ago. cannabis has been known by many names in many languages over the course. of human history, hallucinogenic mushrooms are referred to in ancient Hindu texts and there is.
archaeological evidence dating back to at least 7500 BC of the use of a. hallucinogen derived from cactus and, a wealth of evidence shows that drunkenness and associated public disorder. has been widespread throughout history, Substance use has always been and continues to be a part of ordinary human. The history of substance use shows how different types of substances have. spread throughout the world and how usage trends have changed over time. Many substances were originally introduced to communities as exotic substances. brought back from world travels In this way substances were exported across. cultures and many substances that were initially used for ceremonial or medical. purposes became popular for recreational purposes, Historical responses to coffee drinking provide an insight into the changing nature. of substance use During the 17th century which was a time of considerable. political upheaval coffee houses became the meeting places for political radicals. and intellectuals As a consequence coffee became viewed by many people as. an evil substance Charles II wanted coffee banned and women petitioned that. coffee made men unfruitful disorders domesticity and interfered with business. Davies 1986 p 26 Similarly in Arab countries in the 16th century prohibitions. were placed on coffee and some sellers of coffee beans were executed coffee. houses were believed to be dens of iniquity Yet coffee is now an integral and. accepted part of most western cultures A contrast is the history of tobacco use. which was once widely accepted and even encouraged in some societies but is. now increasingly regulated and socially sanctioned. Governments have always had major stakes in the manufacture distribution and. sale of alcohol and other drugs For example the British controlled most of the. opium poppy cultivation and sale in India in the 18th and 19th centuries Owen. 1968 and the Germans were involved in the production of cocaine in the 19th. century Friman 1999 Political conflict over the control of territory and supply. routes related to drug distribution has been occurring since at least the 16th. century and has escalated to the level of drug wars at certain points in history. For example through the Opium Wars with China in the mid19th century Britain. established control over the opium producing areas of India Berkhout. Robinson 1999, In the early 20th century in the United States USA substance dependence was. made into a criminal problem through Prohibition A war on drugs was. proclaimed and the USA has strongly promoted this stance in other countries. ever since, Profound social consequences result from the drug war approach and viewing.
drugs as a social menace particularly if the substance use is associated with a. particular marginalised social group e g crack cocaine for young urban blacks in. the USA The media becomes instrumental in conveying this sense of menace to. the general public providing a moralist stance and generating a perceived need. to protect vulnerable social groups such as women and young people Morgan. Wallack Buchanan 1988 The result is an increased criminal justice response. which then smothers alternative responses Underlying political agendas are often. at work for example in the USA ending the world trade in opium was important. to appease the Chinese government to ensure their cooperation in supporting the. USA as the world economic power Morgan Wallack Buchanan 1988 The. outcome however is that particular social groups through their association with. the use of the prohibited substance become classed as deviant and are further. marginalised, In Australian history laws regarding the legality or illegality of certain drugs have. been politically driven and had little to do with the level of use or possible harms. that the substances themselves might cause For example the restriction of. opium began in Queensland in 1897 with the Aboriginal Protection and Sale of. Opium Act see Berkhout Robinson 1999 This Act made it unlawful for. doctors chemists and wholesale druggists to possess or supply opium but only if. it was intended for sale to Aboriginal peoples These restrictions were extended to. Asian migrants in response to concerns regarding their migration into Australia. White Australians continued to purchase their opiates over the counter until the. Second World War and doctors continued to prescribe heroin for labour pain and. the terminally ill until 1953 In response to pressure from the USA which the. Australian Government originally resisted the importation of heroin was banned in. 1953 and the States and Territories followed suit to prohibit over the counter. sales of heroin preparations Davies 1986, In contrast Britain has never completely outlawed heroin preparations although. their use has been heavily restricted since 1908 Davies 1986 Unlike Australia. Britain continues to use heroin in clinical settings For example the British Medical. Journal reported results of a randomised trial of nasal diamorphine heroin for. analgesia for children and teenagers with clinical fractures concluding that nasal. diamorphine spray should be the preferred pain relief over intramuscular. morphine Kendall Reeves Latter 2001, Importantly prohibitionist and drug war approaches have been shown. historically to have little impact on levels of substance use and even less impact. on the level of harm associated with substance use The small gains that law and. order campaigns and prohibition approaches have achieved have not been lasting. Lang 2004 While effective prohibitions have resulted in temporary decreases in. the use of targeted substances other consequences of prohibition have negated. this impact These other consequences include supply sources finding other. destinations for their trade supply sources eventually developing new supply. routes into the original destination and other substances filling the gap in supply. Consequently little reduction is achieved in the level of overall usage Increased. money spent on supply reduction through criminal justice and customs has. generally paralleled increased rather than decreased consumption of an ever. greater variety of substances both licit and illicit This does not mean that these. approaches do not have their place but rather that they cannot be the sole basis. of substance use regulation, Furthermore the licit drug industry is a significant contributor to the Australian. economy In 2001 2002 5 1 billion in tobacco and 2 9 billion in alcohol taxation. revenue excluding GST components was received by governments which. meant that on average each person in Australia during that period of time. contributed approximately 421 per year in drug taxes excise and franchise fees. Australian Institute of Health and Welfare AIHW 2003 The pharmaceutical. industry also contributes substantially to the Australian economy. It must be acknowledged that substance use is a fundamental and normative part. of the human condition,The effects of substances, Alcohol and other drugs are psychoactive substances with the capacity to alter.
mood cognition and behaviour They can be categorised into three main groups. depending on the dominant effect the substance has on the central nervous. system depressant stimulant or hallucinogen Whelan 2004. Depressants slow down the activity of the central nervous system and are. associated with feelings of relaxation slower reflexes and reduced pain and. anxiety Depressants include alcohol volatile substances e g glue aerosols. solvents and petrol minor tranquilisers e g benzodiazepines such as . others substance use issues are highly relevant to their practice or research In the APS 2002 discussion paper Psychology and Substance Use Potential Contributions and Professional Training Needs all psychologists were recommended to have adequate knowledge and skills in this area because of the

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