The use of illicit substance is a concern that affects governments the world over. Funds and resources have been channeled to address this concern, but increasingly more and more people are getting absorbed into this abyss that is difficult to get out of. Various policies have been crafted to address this problem but still little is being achieved. Users of illicit substances continually inflate the cost of provision of healthcare by the government, increase the levels of criminal activity in their community, and increased broken family structures among many other negative social effects. However, it is worth noting that one rehabilitated individual is still a win in the war against illicit substance use, and the good news is that human nature always strives to win and eventually the war will be won.
In its simplest definition, illicit substances or illegal drugs refer to those substances that have been prohibited under current drugs legislation (Bennett & Holloway, 2005). In the United States, there are several statutes that define the current legal status of drugs, for example, the Controlled Substances Act (CSA), the Uniform Controlled Substances Act, and The Federal Drug Paraphernalia Statute, although there are many more recent acts that amend and extend the principles of these acts. In terms of legal classification, illicit substances can be defined as those drugs listed in these and more recent updates of these acts. However, three illicit substances tend to define the illicit drug problem over time: Cannabis (Marijuana and hashish), heroin, and cocaine.
Illicit drug use is a deeply embedded characteristic of society associated with illness, death, crime and violence, police action and imprisonment, racial discrimination, inadequate and ineffective prevention and treatment interventions, and property confiscation as well as many ways of human suffering. Worldwide, it is estimated that close to 5 percent of the total population ages 15-64 use illicit substances at least once per year; and in the United States of America, 8 percent of the population aged 12 or older are current drug users. According to Isralowitz & Myers(2011), the problem of illicit substance use attracts more public concern and attention than any other social issue.
This paper presents a review of literature that touches on the offender group: users of illicit substances. To accomplish this, the paper will review various journal articles, presenting a brief summary of each article. The paper will also present some of the legal cases in the United States that relate on users of illicit substances, as well as present the traditional policing model, alternative policing model and other forms of crime and illicit substance use control. The paper will conclude with a brief analysis on my personal view of users of illicit drugs and a conclusion.
Illicit Substance Use and Users in America
A lot has been written on the use of illicit substances and the associated population. This has been so as a result of the recognition that illicit drug use is not only an individual problem, but also a societal problem that affects the entire community. The use of illicit drugs has been associated with many negative societal impacts including increased crime and violence (Bennett & Holloway, 2005), transmission of blood-borne diseases such as the human immunodeficiency virus (HIV) and hepatitis B and C (Marlatt, Larimer, & Witkiewitz, 2011), and many other forms of undesirable human conditions.
Statistical Position of Illicit Drug Users in the United States
According toUnited States Department of Health and Human Services (2012; Kaakinen, et al., 2014), the prevalence of illegal drug use, the particular drugs used, and the methods in which they are taken vary considerably over time, among racial and ethnic groups, across social and economic classes, and among regions of the country or even neighborhoods. In 2011, 21.4 percent of Americans ages 18 to 25 reported that they were current users of illicit drugs; this rate lessened to 6.3 percent among adults age 26 or older. According to SAMHSA (Substance Abuse and Mental Health Services Administration) (2013), as stated by Ingersoll & Rak(2015), the rate of current illicit drug abuse among persons 12 or older increased from 8.1 percent in 2008 to 9.2 percent in 2012. The report further adds that cannabis is the most commonly abused illicit drug, with 18.9 million people abusing cannabis in a month, 1.6 million adults abuse cocaine, and nearly 700,000 adults abuse heroin, an increase of nearly 300,000 since 2007. These findings are consistent with the findings by The National Institute on Drug Abuse(2014).
The report further adds that 2.6 percent of the adult population abused prescription-type psychotherapeutic drugs for non-medical purposes. An estimated 69.5 million Americanswho are aged 12 years or older were users of tobacco product making 26.7 percent population, while 2.9 million person aged 12 and older used an illicit drug for the first time in the year 2012. According to the report, an estimated 22.2 million people above the age of 12were classified with substance dependence or abuse in the year 2012, of this total, 2.8 percent were classified as dependent with respect to illicit drug use. The report concludes by stating that cultural demographics factors are a significant variable for understanding illicit drug use, that is adult males are two times as likely to abuse drugs than adult females.
According to Ingersoll & Rak(2015), it is estimated that nearly a quarter of a billion dollars is spent annually in the United States on medical expenses, lost work productivity, expenses connected to drug-related criminal activity and on other expenses related to illicit drugs and alcohol problems.The National Institute on Drug Abuse(2014)estimates that annually close to $11 billion is spent on healthcare related to illicit drugs, and $193 billion is inclusively spent on illicit drugs in the United States.The majority of this amount is funded by public money, including Medicaid, Medicare, and local state and country sponsored government programs that allocate monies for the treatment ofsubstance and alcohol related concerns for individuals without insurance.These statistics demonstrates how costly illicit drugs are to the United States, and clearly place into context the costs that are associated with the use of illicit substances. It is worth noting that the statistics merely represent the measurable monetary negative externalities of illicit substance use excluding the social costs which are expected to be even higher.
Review of Related Journal Literature
Following are somejournal articles that relate to literature on users of illicit substances.
Magill & Lara(2009) conducted a study titled “Cognitive-Behavioral Treatment with Adult Alcohol and Illicit Drug Users: A Meta-Analysis of Randomized Controlled Trials.” The study aimed atpresenting an inclusive picture of Cognitive-Behavioral Treatment effectiveness for adults diagnosed with alcohol or illicit substance use disorder, as well as to identify Cognitive-Behavioral Treatment effect magnitude. Cognitive-Behavioral Treatment models are recognized as among the most widely used interventions for the treatment or rehabilitation of alcohol and illicit substance disorders. According to the authors, CBT is based on Marllatt and Gordons model of relapse prevention where the treatment targets cognitive, affective and situational triggers for substance use and provide skills training specific to coping alternatives. The article further adds that Cognitive-Behavioral Therapy Treatment for illicit substance useencompasses several strategies. These include: identification of interpersonal and intrapersonal triggers for relapse; training on coping skills; training on drug-refusal skills; and substance use functional analysis; as well as increase in non-use-related activities. The findings of the study revealed that the employment of Cognitive-Behavioral Treatment for users of illicit substance had a high efficacy rate. The results demonstrated that Cognitive-Behavioral Therapy Treatment efficacy was high especially with marijuana users, and larger with women than with men.
Walters, et al., (2014) in their article titled “MAPIT: Development of a Web-Based Intervention Targeting Substance Abuse Treatment in the Criminal Justice System,” discusses the use of MAPIT (Motivational Assessment Program to Initiate Treatment) in the United States criminal justice system as an intervention option to increase clients motivation to the treatment of illicit substance use. According to the authors, MAPIT prescribes a two-session, web-based intervention to encourage substance abuse treatment among clients using illicit substances. This treatment approach amalgamates various intervention models such as social cognitive theory, and motivational interviewing as well as the extended parallel process model. In this approach, two sessions are arranged for the inmate. The first session is scheduled near the start of the probation period of the inmate and aims at motivating the soon to be probated inmate to complete probation, and make life changes in illicit substance use as well as to undergo tests such as HIV and care. The second and last session that is undertaken more or less 30days after the first session emphasizes on goal setting, coping strategies, as well as social support. The two sessions can encompass the use of mobile texts or emails to prompt or remind the individual of their goal. According to the findings of the study with regards to the effectiveness of MAPIT to encourage former inmates to adhere to treatment of the use of illicit substances, the study found that MAPIT focuses on addresses the snags and difficulties that many probation agencies face in an attempt atmaximizing client involvement, in a way that minimizes costs and is compatible with pre-existing service delivery systems. The participants on the other hand state that MAPIT was easy to use, respectful and is helpful in making changes in illicit substance use. The study concludes by adding that MAPIT is still being tested in randomized trials in two United States probation agencies and is expected to be an invaluable tool in assisting former inmates to make changes and sound decisions on the use of illicit substances.
A paper authored by Jhanjee(2014)titled “Evidence-Based Psychosocial Interventions in Substance Use” presents a case for the use of psychosocial intervention in the treatment of addiction to illicit substances. The paper through reviewing literature that pertains to psychosocial issues in addictive disorders, appraises the use of psychosocial treatments. The author states that consistent with various studies, interventions such as cognitive behavioral therapy, relapse prevention as well as motivational interviewing are effective in the treatment of many illicit substance use disorders. The author further adds that psychological treatment has a higher efficacy rate when combined with substitute prescribing, as opposed to when psychological, or medication treatment is used alone, especially for opiate users. The paper concludes by stating that psychological treatment have a high efficacy rate in the treatment of illicit substance use, however, it needs to be expanded to encompass research on the optimal blend of psychological therapies, as well as any particular matching effects. The author posits that psychological interventions are an indispensable and fundamental part of the treatment therapies and attempt should be made to assimilate evidence-based interventions in all substance use disorder treatment programs.
Budney, Roffman, Stephens, & Walker(2007) wrote a paper on “Marijuana Dependence and its Treatment.” The paper aimed at reviewing the problems associated with the use of Cannabis Sativa commonly referred to as marijuana, including distinct properties of the drug dependence, as well as the findings of laboratory research and treatment trials. According to the authors, marijuana is the most abused illicit substance in the United States and Europe. They further add that despite the skepticism with regards to the conception of marijuana addiction and dependence, laboratory, diagnostic and clinical studies as well as epidemiology evidently indicate that the condition exists and results to harm. The paper puts a case for use of various treatment methods which have been proven to address the problem of marijuana use. It proposes the use of MET, CBT, and CM. However, the authors state that the availability of these treatment options is low, even though evidence of the efficacy with substance dependence disorders has been documented for many years. The authors further add that the treatment system in the United States experiences impediments recruiting, training, and retaining treatment staff, insufficient funding, inadequate treatment availability to meet demand, and a slow inclusion of research-based treatment innovations. The paper also states that in the United States very few staffs, especially community-based substance abuse counselors are trained on MET-CBT, and CM despite their proven treatment efficacy.However, the paper concludes that despite all these challenges facing the treatment of marijuana, the good news is that increasingly, marijuana is being recognized as addictive and can result to negative effects on users, and this has resulted to the development of marijuana-specific interventions and treatment material.
Gonzalez, Walters, Lerch, & Taxman(2014) in their paper “The Relationship between DrugUse, Drug-Related Arrests, And Chronic Pain among Adults on Probation,” address the relationship between illicit drug use and chronic health conditions and the treatment seeking behavior of adults incarcerated in the United States justice system. Their study examined whether chronic pain in convicted adults is related with the use of opiate, other illicit drug use, and drug-related arrests in a sample of substance-using probationers. The study hypothesized that probationers suffering from chronic pain-related diagnoses would report more opiate use and drug-related arrests. The study using data from 250 adults who were on probation in the states of Dallas, Baltimore, Texas and Maryland found that probationers who were suffering from chronic pain reported more drug-related arrests than those who without chronic pain. The study further found that adults who were under the supervision of a probation supervisor and were suffering from chronic pain were more likely to be involved in criminal activity, especially drug-related criminal activities in an attempt to self-medicate their physical health conditions. The authors, in concluding, suggest that screening of probationers for chronic pain in the probation setting and consigning to pain management treatment is a necessary step in promoting and ensuring public safety.
Illicit Substance Users Treatment Modalities
Illicit substance abuse and addiction is a serious medical condition. However, it is treatable. Treatment helps in reducing or mitigating the effects of the substance on the brain as well as on the body. In doing so, it enables an individual to improve their physical well-being, everyday functioning, as well as achieve control over their lives. Once in treatment, the efficacy rates of treatment is the same between older adults and young adults.Scientific research since the 1970s has demonstrated that treatment can assist an individual addicted to illicit substance use to stop, avoid relapse, and recover successfully from the addiction.
There are various options available for the treatment of illicit substance use and addiction. Contingent on the substance involved, treatment options may range from medications, behavioral treatments, or a combination of both (NIH SeniorHealth, 2014). The right treatment option for a person is decided on by a substance abuse counselor, a doctor, or any health professional.
Medications mainly work through two approaches.First, by helping with withdrawalsymptoms where the medication assists in suppressing withdrawal symptoms, and second, treating the actual addiction by reestablishing normal functioning of the brain. Various medications have been used for the treatment of substance use. However, while they have been proved to be effective in the treatment of nicotine, opiates, and alcohol, none have been proved for the treatment of addiction to stimulants, cannabis and depressants (NIH SeniorHealth, 2014).
Medications for addiction on illicit substances work by helping the brain adjust to the absence of the abused substance. They work slowly to minimize drug cravings and mental agitation, and thus allow individuals to focus on counseling associated to their treatment. For example, buprenorphine is helpful in the detoxification process by assisting the patient with withdrawal symptoms and in the long run starving off cravings and help prevent relapse.
Behavioral therapies make treatment medications more effective and therefore help individuals stay longer in treatment and avoid relapse. These therapies assist people learn how to change the manner they approach and cope with cravings and triggers that prompt a relapse.There are various types of behavioral therapy treatments. The four main therapy treatments include Cognitive Behavioral Therapy, Motivational Incentives, Motivational Interviewing, and Group Therapy.
CBT aims at helping individuals recognize, elude and contend with situations in which they are most probable to abuse substance or relapse. Motivational Incentives as a behavioral treatment works through offering rewards and privileges for attending counseling sessions, taking treatment medications, and not using the illicit substance.On the other hand, Motivational Interviewing aims at getting individuals to recognize their need for treatment in order for them to take an active role in their recovery. Group therapy aims at helping individuals face their substance use problem and the negative effect that it impacts on their life. This behavioral therapy teaches approaches to address personal problems without abusing drugs or medications.
It is worth noting that illicit substance use is a chronic illness, and therefore it is good to understand that individuals, who are addicted to illicit substances can face a long recovery. Treatment is an ongoing and dynamic process that variates as the needs of the individual patients change, and thus the treatment approach must be tailored to each patient’s needs (NIH SeniorHealth, 2014).
Challenges Faced By Treatment Providers
Treatment providers are the staffs who are charged with rehabilitating and helping illicit substance users to successfully recover from an addiction. To achieve this, they need the support of the government through its various agencies, the community, and most importantly, support and cooperation from the individual.However, these treatment providers face a myriad of challenges in the course of providing these services to the affected population. A study byBudney, Roffman, Stephens, & Walker(2007) identified various challenges faced by treatment providers. These challenges included: inadequate and lack of funding allocation, inadequate access to detoxification and rehabilitation services, and a general lack of trained staff to deliver services, a poor link with other services, as well as a lack of trained staff to deliver services.
The study further identified challenges such as insufficient treatment availability to meet demand as well as a slow assimilation of research-based treatment innovations, both of which act as a hindrance to access to the treatments with high efficacy rates.
Challenges Faced By Users of Illicit Substance
The use of illicit substance use carries with it negative impacts on the user. However, these negative effects not only affect the individual, but also have a spill-over effect to the community surrounding him. Substance abuse results to among many other things, engagement in criminal activities, broken family structure resulting to an increase in single parent families, foster families and, or step families or deteriorated health.
The main challenges faced by the user of illicit substance range from the fear of police arrest, legal problems and subsequent incarceration, addiction to the substance and the unavailability of funds to finance the addiction. The individual is also likely to suffer from victimization and stigmatization, social exclusion by the community,and increased risk and exposure to other illnesses. Other challenges faced by users of illicit substances include: neglect of hygiene and appearance, mood swings, a downward spiral in general attitude, and anger and irritability, as well as deteriorating relationships with friends, coworkers and family. For a user of illicit substances undergoingrehabilitation, the individual is likely to suffer from withdrawal symptoms or a lack of funds to finance the rehabilitation efforts
Legal Cases Related to the Use of Illicit Substances
Legal cases touching on possession or use of illicit substance use have punctuated the United States legal system since the beginning of time.These legal cases have ranged from possession of illicit substance to the prosecution of active users of illicit substances.
One of the legal casesthathas formed a precedent for many court cases touching on the crime of possession of an illicit substance is Supreme Court of Florida case number SC94701: Scott v. State, 808 So. 2d 166 – Fla: Supreme Court 2002. This case was Scott’s appeal to the fifth district court of appeal, subject to a conviction he had received after being found in possession of contraband in a correctional facility. The case examined the element of mens rea in the possession of a controlled substance under the state of Florida Abuse Prevention and Control Act (Fla. Stat. §893.13). In this legal case, the Supreme Court of Florida ruled that an offender can only be subjected to the criminal penalties of the law if and only if the state presented evidence of mens rea. That is, the prosecution expressed fundamentality of the knowledge of the mens rea element of a crime of possession of a controlled substance. The Fifth District Court of Appeal ruled that what the defense argument that the appellant was not in possession of the illicit substance was contradictory and inconsistent with a contention that the appellant had no knowledge of the illicit nature of the drugs.
Another legal case that touched on illicit substance use orpossession was Supreme Court case number 11-702: Moncrieffe v. Holder. The case was touching on the characterization of low-level drug offense as illegal trafficking in a controlled substance, therefore, an aggravated felony or not. In the case, the Supreme Court (2006) ruled that: “a state conviction for marijuana possession with intent to distribute may not be deemed a drug trafficking aggravated felony when the state statute covers conduct such as social sharing of marijuana falling outside the federal ‘Drug Trafficking Crime’ definition.”
Another legal case that touched on illicit substance possession and use is the United States Supreme Court case number 04-2084 of 2006: Gonzales v. O Centro Espirita Beneficiente Uniao Do Vegetal (No. 04-1084) 389 F. 3d 973.The case was by a small religious group known as Uniao Do Vegetal or the Union of the Plants against the Federal Government for seizing a shipment of hoasca, an illegal drug that is used by the religious group during their worship service.The ruling allowed the religious group to continue importing the illicit substance from Brazil and gave them an injunction preventing the confiscation of the illicit substance or the arrest of any of the religious group members. The group posited that the 1993 Religious Freedom Restoration Act (RFRA) exempted them from any legislation prohibiting theimportation and use of hoasca, and that the 1970 Controlled Substance Act (CSA), which prohibits the use of DMT for any purposes, did not trump the group’s religious freedom to use hoasca. The injunction is still in effect.
Various policing models have been employed in the fight against illicit substances. Most law enforcement agencies have focused on out-of-date traditional policing models, some of which have been successful while others have been unsuccessful. That is, despite conscientiouspolicing attempts, considerable and prolonged effects on the street level availability, price or purity of illicit substances have not been achieved. However, more contemporary and alternative policing models have arisen to address the problem of illicit substance use.
Traditional policing models refer to the goals of the early reformers of the police, whose emphasis was to separate law enforcing agencies from other societal activities such as politics, and to hold them accountable only to the law. Through this approach, law enforcing agencies have a narrow range of interventions available to their disposal. They rely entirely on the coercive power of criminal law to gain control, prevent crime and enforce laws. The predominant tool used under this approach is threat of arrest,arrests and seizures. This approach has been employed by law enforcement officers and has proved to be effective in particular situations. However, according to Brodgen & Nijhar(2005)the traditional model has been ineffective in addressing illicit drug use and drug-related crime over the longer term, especially when employed singly without being used hand in hand with other more proactive police responses.
Mazerolle, Rombouts, & Soole(2007) stated that alternative policing models can be employed in the fight against illicit substance use. They suggested that policing approaches that promote quality community participation in solving local crime are most effective in preventing and, or minimizing illicit substance use and drug-related crime.According to The National Institute of Justice (2015), alternative policing models extend beyond the traditional policing models of reactive policing where police respond to calls for services. The alternative policing models emphasize on increased crime prevention, intervention, and response efficacy by use of tools and approaches such as community outreach, crime mapping, suspect location and efficient resource distribution, as well as crime data collection (The National Institute of Justice , 2015).
The most widely employed alternative policing model is community policing. Under community policing, the police, the local community as well as other city agencies are brought together to identify and solve neighborhood crime concerns, as opposed to simply reacting to their symptoms after the fact.
Crime and Illicit Substance Use Control Implemented Through the Community
According to Mazerolle, Rombouts, & Soole(2007), the inclusion of communities in policing is central in solving illicit substance use. The authors refer to this concept as community policing, a policing philosophy that insists on police agencies partnering with non-police agencies and groups to develop responses to crimes such asillicit substance use and other crimes. They posit that community policing is especially effective in addressing illicit substance use as the supply, and production often takes place at the local community level.Sivasubramaniuam & Goodman-Delahunty(2008) further add that community involvement and policing has the added benefits that it enhances the relation between the community and the police, it increase the flow of information and intelligence, it deepen understanding of cross-cultural complexities, as well as increases the visibility of crime. Community involvement also increases the probability of community members complying with the lawand development of effective solutions to tackle community problems.
My Analysis on the Use and Users of Illicit Substances
From the United States statistics on the use of illicit substances, clearly and worryingly a large section of the American population is actively using and dependent on illicit substances. This situation is further worsened by the realization that increasingly more and more people are being absorbed into this population. Thisscenario,in addition to resulting in a higher and unnecessary cost to the taxpayers in form of higher health costs and associated costs, it also results to other negative societal negatives. These societal negatives range from increased crime, broken family structures, and a bloated healthcare system among many other negative impacts.
It is therefore, imperative that policies are put in place to address this concern. These policy interventionscan both be proactive as well as reactive. Proactive policies will assist in preventing and, or minimizing the occurrence of new illicit substance users thereby ensuring that no new cases are reported. Reactive policies on the other hand can purpose to rehabilitate and reform the already affected population by putting in place mechanisms through which such populations can access rehabilitative healthcare with no stigmatization or victimization by either the community or law enforcement agencies. These two approaches will result to a population that is increasingly healthy, productive and committed to building the United States economy.
This paper has presented a review of related literature that touch on the use of illicit substances. In pursuit of this, the essay has presented a brief summary of various journal articles that are based on illicit substance use. The paper has also presented various legal cases that involved illicit substance use, as well as explained the traditional and alternative policing model in the context of illicit substance use. Finally the paper has concluded by presenting my personal perception on the users of illicit substance and a suggestion on an approach that would in the short run curb or minimize the increase in the number of illicit substance users and in the longrun, completelyaddress the problem of illicit substance use.
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Brodgen, M., & Nijhar, P. (2005). Community policing: National and international models and approaches. Portland: Wilan Publishing.
Budney, A. J., Roffman, R., Stephens, R. S., & Walker, D. (2007). Marijuana Dependence and Its Treatment. Addiction Science & Clinical Practice, 4(1), 4-16.
Gonzalez, J. R., Walters, S. T., Lerch, J., & Taxman, F. S. (2014). The relationship between drug use, drug-related arrests, and chronic pain among adults on probation. Journal of Substance Abuse Treatment.
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The National Institute on Drug Abuse. (2014, December` 27). Trends and Statistics. Retrieved January 7, 2015, from National Institute on Drug Abuse: http://www.drugabuse.gov/related-topics/trends-statistics
Walters, T. S., Ondersma, S. J., Ingersoll, K. S., Rodriguez, M., Lerch, J., Rossheim, M. E., & Taxman, F. S. (2014). MAPIT: Development of a web-based intervention targeting substance abuse treatment in the criminal justice system. Journal of Substance Abuse Treatment, 46(1), 60-65.
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