Abstract

This paper will undertake an insightful discourse by evaluating and examining the findings and discourses of peer-reviewed and recently conducted existing articles that launch scientific inquiry into the impact of early intervention and drug abuse treatment programs administered across the public and private healthcare facilities. The paper will also examine a wide array of existing academic research on the leading theories and therapies focused on treating drug addictions and substance use disorders, and determine the most effective medium of treating patients with high rates of recovery and improved life quality.

Keywords: Drug addictions, early interventions, private healthcare, public healthcare, harm reduction, medicinal treatments, behavioral therapies.

 

Introduction

Drug addiction and substance use disorders have long been the subject of research and clinical education, and today, academics and researchers have gained significant insight into the dynamics of patients who suffer from substance abuse, and the psychological and physiological impact of these addictions. Despite the prevalence of effective intervention programs and rehabilitation measures, the scourge of drug addiction continues to plague communities and individuals across the world. This necessitates a scientific inquiry into the impact of the use of different drug intervention programs. These include both, privately and publically funded programs, and an analysis of the most noteworthy theories in order to adopt the most effective strategy to combat drug addictions and substance abuse.

A substance abuse disorder is characterized as a medical illness that clinically exhibits itself with health impairments, lack of social functioning and lack of control over substance use. Academics have highlighted that substance abuse tends to vary in terms of its complexities, duration and severity, and each case can be classified from being mild to severe on the basis of its unique feature and traits. In 2015, around 20.8 million patients, between the ages 12 and older, were diagnosed with substance use disorder upon fulfilling the criteria. (Medina, 2015)

As we attempt to retrace the historical archives of the treatment for drug addictions and substance abuse, we discover that a vast majority of the treatments have been conducted under the specialty substance use disorder programs, and did not include the facilities of primary or general healthcare services. Over the years, there has a significant shift towards delivering drug addiction and substance abuse intervention treatments as a general healthcare practice. Patients who suffer from a mild to moderate drug addiction or substance use disorder can be treated through the general healthcare system, however, those who are fighting severe addictions and substance use disorders are likely to require specialty treatment and facilities.

Today, there is a wide spectrum of facilities, strategies and healthcare services available that allow improved identification, treatment and management of symptoms related to substance use addictions and disorders. Academics have deduced that the most effective strategy to help an individual combatting substance use challenges or an individual who is at risk to develop a substance use addiction is to stage an intervention as early on as possible. This strategy has been recognized all over the world for its effective and proactive approach. An early intervention allows experts to detect the condition at an early stage, which prevents the drug action for progressing and worsening. This realization has made the screening processes for drug addictions and substance use a part of mainstream and general healthcare services. It allows experts and doctors to detect substance use problems, and then, they can decide if it is necessary to stage an intervention. The addition of screening substance use problems and drug addiction has enhanced the continuum of treating these disorders and addictions. Today, these substance use problems can be treated with a wide range of effective, research-driven strategies, medications, supportive facilities and behavioral therapies. However, there is a wide spectrum of constraints that do not allow these services to be widely adopted across the spectrum of healthcare facilities. These constraints include lack of sufficient resources, lack of adequate training, and insufficient workforce in the healthcare industry. (Rieckmann et al., 2010)

Substance use disorders and drug addictions usually tend to exhibit themselves during adolescence, and in certain cases, they tend to progress towards severity. If the individual continues to misuse substances and drugs, the disorder or addiction can progress in complex manners. Presently, substance use problems are diagnosed in terms of three classifications: mild, moderate and severe. Treatments and intervention programs for substance use disorder are devised to aid individuals in eliminating their substance use dependence or reducing harmful behavior. It focuses on enhancing their social functioning and wellbeing, and preventing the risk factors of a relapse. Substance use treatments and intervention programs have proven efficient in improving the health and wellbeing of the patient, and bringing about positive economic impacts by preventing relapses. Existing research reveals that substance use treatments are effective at enhancing the health, productivity levels, social functioning and life quality of the patients. Moreover, the amount of money spent on treatments for substance use help the general healthcare system and individuals cut down costs for healthcare facilities, and the criminal justice system. (Ettner et al., 2006)

There is a plethora of scientific research and evidence-based discourses that reveal that there are effective treatments for substance use disorders that bring about positive results. However, the recurrence rates for substance use disorder are around the same as those for chronic ailments, such as hypertension and diabetes. Recovery from drug addictions and substance use problems is possible with the presence of a comprehensive range of treatments and intervention programs. Research reveals that around 1 in every 10 individuals suffering from a substance use problem are administered any kind of specialty treatment. A vast majority of the treatments used to treat patients with severe substance use problems do not involve the primary or general healthcare facilities. However, a dramatic tilt has been witnessed in the delivery of early treatments and intervention programs, making it a significant practice in the mainstream general healthcare system.

There is an overwhelming amount of evidence that highlights are clinically proven medications can be significantly effective in helping patients suffering from serious substance use disorders but they are not being administered to a large population of patients. There are several medications that can be used for the treatment of opioid use disorders and alcohol dependency, but existing treatments and intervention programs are not offering these medications to the patients. Similarly, there are medications available to offer an effective treatment for other substance use disorders, including methamphetamine, cocaine, and marijuana, but they are not being incorporated into the mainstream drug use treatments. There is sufficient scientific evidence to support that screening tests offer a reliable and efficient medium of detecting substance abuse and misuse problems, and they allow physicians or specialists to suggest a diagnosis and the most suitable form of interventions. Evidence further reveals that these intervention programs and physical advice proves successful in treating mild cases of substance use or alcohol abuse disorders.

As opposed to leaving substance use disorders untreated and unchecked, treating these disorders through in-patient, residential or outpatient procedures offers a more cost-effective solution. The underlying agendas and methods of treatments used to treat substance misuse tend to be similar to those for treating chronic ailments. These treatments aim to bring about a reduction in the major systems until they are no longer problematic for the patients. These treatments aim to enhance social functioning, and health and wellbeing of the patients. These treatments are also administered to patients who are suffering psychiatric illnesses and substance use disorders. The major features of these treatments include medicines, behavioral therapy and recovery support services. Over the years, behavioral therapy has proven to be one of the most effective medium of treating substance misuse disorders and drug addictions. However, evidence reveals that behavioral therapy has not been sufficiently incorporated in most mainstream treatments for drug addictions and substance use disorders. Research reveals that incorporating the use of electronic technology, such as electronic health records or telehealth, can bring about dramatic improvements in detecting, engaging, monitoring and providing supportive care to the patients struggling with drug addictions and substance misuse problems. (Pasareanu et al., 2015)

Mild cases of substance misuse and drug addiction can be quickly and reliably detected in a wide array of clinical and social settings. These are extremely common cases that tend to be less severe and can be easily prevented from progression with motivational interventions, regular monitoring and persistent supportive care. This process is termed as guided self-change. On the other hand, chronic cases of severe substance use disorders tend to be more complex and complicated. These severe cases often require specialized substance misuse or substance use disorder treatments, and persistent post-treatment monitoring to ensure that the patient has fully recover and is in full remission. In order to address a wide range of substance use problems and drug addictions, there are a wide range of treatments and services, which include early diagnosis, early intervention, preventive measures, treatments, behavioral therapies, and post-treatment recovery support. Research reveals that a clearly majority of treatments for drug addictions are administered in the form of specialty substance use disorder treatments, and these treatments tend to differ in terms of their intensity, clinical goals, and setting of treatment delivery.

It is pertinent to note that early intervention programs and treatments can be administered in a wide array of settings, including healthcare facilities, school healthcare facilities, primary healthcare services, and mental healthcare facilities. These early intervention programs are devised for patients struggling with substance misuse or mild drug addictions. These early intervention programs are typically administered when an individual consults a healthcare professional for another medical ailment and is not requesting treatment for a substance misuse problem. The objectives of an early intervention program is to cut down the harmful risk factors of a substance misuse problems, and to eliminate risk habits and behavior that can lead to physical or psychological harm. These early intervention program seek to enhance the health and wellbeing, social functioning, and they seek to prevent the progression of a substance use problem into a severe drug addiction of substance use disorder. These intervention programs also allow healthcare professionals to understand the need for specialty treatments and substance use disorder medications for full recovery.

Early intervention allows healthcare professionals to gain valuable insight into the risk factors of substance use, and devise strategies to eliminate or prevent use-related risk factors and behaviors. These treatments prove effective in initiating patient engagement and motivation for self-recovery. Research reveals that early intervention treatments and programs offer a connection between treatment and early prevention. Individuals who are suffering from severer cases of drug addictions or substance misuse can benefit from early intervention as a strategy to engage them in prevention and treatment. (Garner et al., 2014)

Methodology

In order to gain an insightful understanding of our subject matter, drug addictions and the impact of private and publically funded intervention programs, we have chosen the qualitative method of examining and studying existing literature. In this paper, we will be examining recently published peer-reviewed articles. These articles will be reviewed and synthesized to provide information and gain a stronger understanding of the various themes of our topics. It will allow us to understand the various aspects and findings of different authors, gaining insight into the subject matter from various different perspectives.

This form of qualitative research will allow us to gain a constructivist view of the subject matter, and understand the various dimensions that come into play with the help of naturalistic and subjective analysis. It will allow us to gain a more dynamic understanding of the various categories of drug addictions and substance use problems, alongside the various aspects of intervention programs. As we examine the findings and articles of various researchers, we can gain greater insight into the lives and habits of patients who experience drug addiction, what they go through, and how the treatments and intervention programs are designed to help these patients. It will allow us greater insight into the lives of the patients and the impact of intervention programs from a wide range of perspectives. Each author or research tends to study a subject matter from a different research lens, powered with a different set of methodology and techniques. Studying multiple peer-reviewed articles will allow us to study drug addictions and the impact of intervention programs from multiple perspectives and research lens. (Kielmann et al., 2012)

We will undertake an insightful discussion by reviewing the works and findings of various researchers, and attempt to draw a well-supplemented conclusion, supported by noteworthy articles and fact-centered information.

Discussion

In this chapter, we will undertake a lengthy and well-supported discussion based on a wide array of peer-reviewed articles to examine the effectiveness and impact of private and public interventions against drug addictions and substance use disorders. We will review the public and private interventions across multiple countries across the world, with a special focus on Canada. We will then proceed towards examining the leading theories and treatments that have allowed striking improvements in treating drug addictions. Lastly, we will undertake a discussion on the impact of drug legalization and whether it holds the potential to bring about significant reductions in drug addictions and substance use problems.

a)     Private versus Publicly-funded Initiatives

As we examine the history of private healthcare services for preventing, diagnosing and treating drug addictions and substance use disorders, we see that traditionally, these services have been administered separately from general healthcare services and mental health treatments. It is pertinent to note that for decades, substance abuse or drug addictions have been regarded as a criminal act or a social problem, and individuals suffering from these problems had very few options and treatments. For a considerably long period of time, preventing or treating drug addictions was not a responsibility accepted by all healthcare facilities, and individuals combatting these problems had access to very few options for treatments and cure. Majority fo the insurance offerings also did not offer coverage for treatments focused on substance abuse or drug addictions.

Private Treatments & Interventions

Manuel et al., (2015) reveals that over the years, the private sector and private practitioners have introduced a strategy that has integrated the prevention, treatment and recovery models and allowed its availability across various healthcare facilities and systems. This integration has enhanced the quality of treatments offered to combat drug additions, alongside improving accessibility. Over the years, developing countries have introduced certain healthcare reforms and laws, which have facilitated the treatment and recovery processes offered by private practitioners and healthcare facilities. Over the years, private healthcare facilities and practitioners have worked to reduce the disparities and costs, allowing individuals to access a wide range of treatments and services.

An examination of private healthcare practices reveal that the separation of mental healthcare and treatments for drug addictions from general healthcare facilities has given birth to a wide range of challenges in effectively coordinating healthcare practices. There is need for directing efforts to encourage the integration of interventions, screening tests, medications, and treatments across general healthcare facilities, and specialty drug addiction treatment programs. Evidence reveals that closely integrating drug addiction-related treatments and therapies with general healthcare facilities will allow improvements with both practices. Drug addictions and substance use disorders are medical ailments, and the designed treatments to cure these ailments tends to have an impact on the physical and mental health of the patient. Integrating treatments can eliminate a wide array of disparities in healthcare facilities, improve treatment outcomes and reduce the costs of private drug addiction interventions for the individuals and their families. Evidence further reveals that individuals struggling with drug addictions primarily reach out to doctors and healthcare facilities seeking treatment for other maladies or ailments as opposed to their drug addictions. They are likely to visit general healthcare facilities as opposed to taking specialty treatments for substance use disorders. Well-supported evidence reveals that the private sector must focus on integrating healthcare facilities for general and drug addiction-related treatment to boost efficiency and provide superior quality treatments. Private practitioners and facilities have introduced a wide range of chronic care and home care models, which can also be applied to the treatment and management of drug addictions and substance use disorders. A dynamic development that has facilitated private practitioners and healthcare facilities across many countries, including Canada, United States and others, is the inclusion of substance use disorder treatments in the healthcare insurance coverage. Many small and large insurance plans allow coverage for prevention and treatments for drug addictions and substance use disorders.

Well-supported arguments put forward by Levy et al., (2016) recounts the advantages of healthcare delivery organizations, such as accountable care organizations (ACOs) and health homes, in terms of integrating healthcare facilities and improving the quality of treatments. The private sector has enhanced the functioning of care delivery organizations, alongside the community healthcare facilities, which are being rapidly expanded to adequately address the demands of substance use disorder and drug addiction prevention, treatments and recovery services. Another dynamic feature of private healthcare intervention that has made it impactful is the incorporation of healthcare IT infrastructure. Health IT is rapidly expanding to bring about greater collaboration and communication amongst healthcare practitioners. It allows enhanced collaboration and integrated treatments, alongside protecting the privacy of the patients. This infrastructure has allowed private healthcare facilities to expand the access of healthcare facilities, train the workforce, enhance coordination, and reach out to drug addicts who are resistant towards treatments. These facilities reap greater success in positive treatment outcomes and recovery services as opposed to traditional treatments and therapy settings.

Evidence also brings to light the racial and ethnic disparities in the private healthcare system, and these disparities can be addressed by allowing health insurance coverage to a wide number of people. Puddy et al., (2011) reveals that in a wide range of healthcare facilities and settings, the workforce allocated for substance use disorder and drug addiction treatments is incapacitated to fulfill the requirements of integrated and effective healthcare. The current workforce of general healthcare facilities remains undertrained to effectively handle patients suffering from drug addictions and substance use disorders. Private healthcare facilities require a bigger, diverse and well-trained workforce that boosts a formidable skillset in preventing, diagnosing, treatment and managing drug addictions with “personalized care” and integrated delivery of healthcare facilities and treatments. Diverse healthcare facilities are the need of the hour, and they have an instrumental role to play in addressing the needs of the patients suffering from substance misuse and drug addictions. Private facilities need to improve their processes of screening patients for drug addictions and substance use disorders, and providing preventive care interventions to prevent severe drug addictions and the damaging health consequences. They need to improve their early intervention programs to prevent the severity of a drug addiction or substance misuse problem. Practitioners and healthcare facilities must focus on engaging patients into an integrated treatment, and treating drug addictions of various levels of severity with different approaches and treatments. There is a great need to provide seamlessly coordinated care across healthcare systems and social services, and these patients must be facilitated with a number of services, including housing support, child welfare, criminal justice, employment support, and most importantly, recovery services. Patients must be monitored for a long period of time with follow-up treatments and recovery monitoring services.

As seen in the case of the United States, Nelson et al., (2017) reveals that healthcare facilities across the US enjoy varying levels of diversity and integration. The healthcare facilities are marked with immense diversity and wide-ranging workforces that are established with a diverse range of financial, technological and structural models. Healthcare facilities are divided across a wide range of healthcare organizations which provide primary healthcare, specialty treatments for drug addictions in residential and outpatient settings, mental health facilities, school clinics, community healthcare facilities, emergency healthcare departments, clinics for infectious diseases, general hospitals and more. It is pertinent to note that majority of the individuals struggling with drug addictions or substance use disorders do not regard their conditions as a problem, and hence, they do not seek out treatment of their own volition. Many who regard their conditions as serious do not consider themselves in need for treatment or are simply not ready to be treated. Many others do not seek treatment because they are not aware of the treatments and facilities that exist and are also unaware of the procedures that allow them to access these treatments. However, a theme that remains prevalent across a wide range of scientific discourses is that individuals struggling with drug addictions or substance use disorders do access healthcare facilities to seek treatment for other ailments, primarily drug overdose, injuries or illnesses, alongside chronic health ailments, such as HIV/AIDS, depression, or heart ailments. Therefore, it is important to integrate substance use disorder and drug addictions screening in other healthcare facilities to identify these problems and offer the patients the appropriate healthcare and treatments.

Mild cases of drug addictions in private healthcare facilities have received a better response to short periods of counselling and therapies, while severe cases of drug addictions are often accompanied by severe chronic health ailments, which require intensive outpatient therapy or specialty resident treatments. There is need for a wide range of healthcare facilities and greater diversity across healthcare institutions to effectively address the needs of patients suffering from drug addictions.

The American Society of Addiction Medication (2001) sheds light on the history of substance use disorders, drug addictions, mental ailments and general healthcare facilities across the private and public sector. It is interesting to note that Alcoholics Anonymous (AA) came into practice in 1935 to address the disparity and absence of adequate facilities for substance use disorders and drug addiction in the general medical facilities and mental health treatments. Drug addictions and alcoholism largely went untreated, and even if it was treated, it was mostly done in mental health facilities and asylums, as opposed to genera healthcare facilities. The political and social landscape of the 1970s had a significant impact on the separation of general healthcare facilities and treatments for drug addictions. Until this period, drug addictions and substance misuse were generally regarded as criminal behavior or social problems, and they were largely addressed through civil interventions and criminal justice systems. These patients were involuntarily committed to prison-operated “narcotic farms”, psychiatric facilities or other confinement facilities. However, the onset of the Vietnam War changed the dynamics considerably because the United States welcomed a large population of college students and Vietnam War veterans who were aggressively using drugs, alcohol and becoming addicted to a wide range of intoxicating substances. This period witnessed a wide range of arrests and punishments associated with drug addictions, until it emerged as a major political and socio-economic challenge for the United States government. The country underwent a major exercise to bring about significant expansions and improvements in prevention and treatment facilities for drug addictions and substance misuse problems.

It is pertinent to note that despite the overwhelming need for a national program to offer drug addiction treatments, the healthcare systems and workforce was simply untrained for this challenge. Another major aspect to note is that healthcare systems and practitioners were not eager to embrace patients struggling with substance use disorders and drug addictions. This led to the emerging of new drug addiction treatment facilities, which expanded to over 14,000 locations across the US. These facilities allowed a wide range of treatments for diverse substance use disorders and drug addictions, except for managing withdrawal systems. These facilities were financially, structurally, culturally and geographically different and diverse from general healthcare facilities.

McLellan (2000) puts forwards well-supported arguments to explain that these healthcare facilities put forward an innovative approach towards addressing the burgeoning challenges of drug addictions and substance misuse problem. First and foremost, these delivery programs that were different from the rest of the general healthcare facilities, paved the way for the development of efficient and affordable strategies focused on changing behavioral practices and treating chronic ailments associated with drug addictions. However, it is pertinent to note that separating the treatments for drug addictions from general healthcare practices also gave birth to a wide range of challenges in the availability of healthcare options and quality of treatments provided to the patients. It served the purpose of reinforcing the belief that drug addictions are different from other chronic ailments and medical conditions. For a considerably long period of time, mainstream healthcare facilities and hospitals failed to address drug addiction related health conditions, despite the wide range of scientific inquiries and research that revealed higher prevalence rates of drug addiction amongst patients treated in emergency healthcare facilities.

An overview of the private sector reveals that the continued practice of separating general healthcare facilities from drug addiction and substance use disorder treatments has proven to be an expensive and damaging endeavor, and in some cases, it has even proven fatal for the patients. Sobell (2005) offers an evaluation of the world healthcare environment, which reveals that the presence of drug addictions tends to increase the risk of the patient for suffering from other chronic ailments and expensive medical illnesses, including heart diseases, strokes, diabetes, asthma, arthritis, and more. Despite the overwhelming consequences of drug addiction on the physical and mental wellbeing of the patient, very few schools of medical health, nursing, dental or pharmaceutical training train their students on the practices of identifying, preventing, treating and managing drug addictions.

Even in this day and age, there are many healthcare practitioners and facilities that hesitate before treating patients with medication-assisted treatments (MAT), particularly the medications that help with the management of opioid use disorders, such as buprenorphine and methadone. This hesitation has stemmed from the wrongful and misguided perceptions about the consequences of these medication-assisted treatments, and the beliefs that these treatments relieve one addiction with another addiction. This belief has emerged as a major complication that has hindered the widespread adoption of effective and well-research medication-assisted treatments across drug addiction treatment facilities. The treatment providers and substance use disorder facilities that do incorporate these practices have a tendency to prescribe insufficient doses of these medications for insufficient periods of time, which leads to a failure of the treatment, particularly in case of severe disorders and drug addictions. This failure of treatment further reinforces the belief that medications are ineffective. There is a wide pool of scientific evidence that reveals that if used adequately, MAT can bring about significant reductions and can even eliminated drug abuse and addictions, alongside the associated infectious and chronic ailments to restore the health and functioning of the patient.

 

Public Treatments & Interventions

Publically funded treatments and programs for drug addictions and interventions are typically conducted in public healthcare facilities. These programs are run and funded by the government to address the social, economic and political challenges created by drug addictions and the prevalence of substance misuse problems. In this paper, the researcher will take a look at the public initiatives and intervention programs launched by the government of Canada, as it is most relevant to our research objectives.

Well-supported academic treatises reveal that Canada is combatting against the hazard of drug addiction and substance misuse, which is a mainstream health issues. The country and its public healthcare sector has advanced towards adopting a health-focused approach of identifying, preventing, treating and managing drug addictions. Statistics Canada (2017) reveals that the Government of Canada has adopted improved regulations and processes to protect and support Canadian citizens who are battling against drug addictions and substance misuse. In December 2016, the Canadian Health Minister announced a reformed strategy to deal with drug addictions and substance use disorders, termed as the ‘Canadian Drugs and Substances Strategy (CDSS). CDSS outlines the Canadian federal response to combat all substance misuse and drug addiction problems, including the cannabis addiction, opioid overdose cases, and marks a shift towards legalizing cannabis with strict regulations and monitoring. The Government of Canada has undertaken initiatives to consult the Canadian public on effective solutions and strategies to improve the public healthcare approach towards drug addiction and substance misuse problems. The public healthcare of Canada presently allows an effective treatment for drug addictions, and the government is also focused on “reducing stigma” around drug addictions and problematic substance misuse. Evidence-based treatments and prevention systems are being introduced, and the public healthcare strategy is focused towards reducing harm and supporting indigenous communities. Statistics reveal that alcohol is the most common cause of substance misuse challenges amongst Canadians. In 2015, 3.3 million Canadians were recorded as to have consumed sufficient amounts of alcohol to increase their risks for injuries. Moreover, the same year, 4.3 million Canadians consumed sufficient amounts of alcohol to increase their risks for chronic ailments, primarily liver damage. Around 4 million Canadians, above the age of 15, revealed that they are reliant on at least one illegal intoxicant, including cocaine, heroin, cannabis, ecstasy, hallucinogens or methamphetamines.

The Canadian Centre on Substance Use and Addiction (2018) reports that cannabis is the most widely used drugs amongst Canadians, and it is largely affects Canadians between the ages of 15 and 24, as opposed to adults older than 25. In 2014, the estimated total cost of drug addictions born by Canada was $38.4 billion.

The Government of Canada has adopted a multi-faceted strategy of combatting drug addictions and substance misuse problems by dividing responsibility across multiple government levels. The government collaborates with multiple stakeholders and civil society partners, with a specified role for each stakeholder. The Canadian Government funds these initiatives and provides support and leadership through laws and legislations, regulations and tightened control towards substances. The public healthcare initiatives are marked with research-driven strategies, and objectives of raising public awareness around the issues of drug addiction. The public healthcare facilities provide preventive care, drug addiction treatments and harm reduction therapies to specific communities and groups, including military groups, veterans, federal prisoners, First Nations and Inuit. Municipal and provincial governments across Canada are responsible for delivery effective prevention, treatment and harm reduction facilities to the citizens, alongside other social and healthcare facilities.

The professional medical associations, research organizations, universities and civil society groups collaborate with local public healthcare facilities, health units and harm reduction services to innovate and improve healthcare practices. These organizations provide a wide range of services, including preventive care, harm reduction services, treatments, recovery and monitoring, educational programs, and outreach to spread awareness. The newly implemented CDSS has guided the public healthcare response towards drug addiction towards “four pillars”, which are: prevention, treatment, harm reduction and enforcement.

As guided by the CDSS, the public healthcare facilities are responsible for working towards enhanced preventive care and treatment initiatives, with particular emphasis on harm reduction, and therapeutic services for drug-affected individuals, families and vulnerable communities. The public healthcare facilities increasingly collaborate with the civil society, research organizations and other healthcare units to address drug addictions as a social and healthcare challenge. The treatments are focused on innovative strategies to prevent, identify and treat, and focus on harm reduction. Leyton (2014) reports that the public healthcare sector is increasingly focused on reducing the stigma associated with drug addictions, and promoting the healthcare needs and rights of individuals combatting drug addictions. There is an increase in the research-driven departments within the Canadian healthcare sector, which has brought about striking improvements in the development and implementation of evidence-based treatments and programs delivered across provinces, municipalities and indigenous communities. As guided by the CDSS, the Canadian public healthcare approach is an integration of prevention, treatment, harm reduction, and awareness and outreach to reduce stigmas and vulnerable communities. The public healthcare sector in Canada has welcomed the arrival of a wide array of drug addiction-related programs, clinics and facilities that are offering educational and treatment facilities. For instance, Toward the Heart, an initiative of the BC Centre for Disease Control, published a several reading material and research articles to reduce stigmas around drug use and encouraged the adoption of non-stigmatizing behavior as a means to help people combatting drug and substance misuse problems with their recovery.

Treatments across the public healthcare facilities revolve around immediately addressing drug overdose or other distressful situations, to providing long-term care and recovery services for managing drug addictions. Patients from different socio-economic backgrounds tend to undergo different treatments and recovery paths. Certain public healthcare practitioners believe in substituting street drugs and toxic substance with medicinally prescribed drugs and substances. Many other public healthcare programs are focused on behavioral therapies, family therapies, mental health treatment, and social aspects such as housing and employment opportunities for sustainable recovery. Khan (2017) highlights that the public healthcare system needs to focus towards tailoring treatments and therapies based on the individual needs and conditions of the people suffering from drug addictions. There is need to advance the continuum of care, with a stronger emphasis towards screening and early intervention, managing withdrawal symptoms and the process detoxification, inpatient and outpatient treatments, long-term recovery and monitoring, and follow-up treatments with cognitive behavioral therapy. Evidence supports that public healthcare facilities can improve their recovery rates by tailoring the treatment to the unique conditions, socio-cultural backgrounds, trauma and medical history of the patient. There is also great need to incorporate medications, primarily naltrexone and methadone, into the treatment to elevate physical and mental wellbeing, reduce harmful symptoms and cravings, and prevent drug overdoses. Presently, the public healthcare system deploys the use of several medications to treat alcohol misuse disorders and opioid disorders, however, effective medicinal treatments are not accessible for all kinds of patients suffering from drug addictions. The public healthcare sector also needs to prioritize non-medical support and leading therapies for treating drug addictions in conjunction with other treatment services.

There are multiple examples highlighted by the National Institute on Drug Abuse (2018) as one of the most effective treatments in the Canadian public healthcare system. For instance, the Addiction Recovery and Community Health Clinic (ARCH) operated by the Royal Alexandra Hospital in Edmonton collaborates with the emergency department and inpatient settings to provide preventive care and drug addiction treatments, alongside assisting patients with income support programs, housing support, and other healthcare services to address physical and mental illnesses. Portage, in Montreal, works as a specialized drug rehabilitation center that allows women drug users and patients to remain with their children throughout the treatment and focuses on improving their parenting skills and communications.

 

However, it is also important to note that these treatments are not available and accessible to patients across the spectrum. When a patient is ready to be treated, which is rarely the case in substance misuse or abuse disorders, treatments must be readily available and easily accessible. Hawk et al., (2015) reports that a very small population of patients in Canada who seek out treatment and recovery for drug addictions can access healthcare facilities and programs. Statistical data reveals that only 15% of the Canadian respondents with a substance use problem, between the ages 15 and older, had access to all the healthcare facilities they needed. Drug addiction and substance use patients are greatly challenged by the unavailability of treatment options and healthcare facilities. This problem is further augmented by the fact that there is an insufficient number of trained healthcare professionals to offer effective drug addiction treatments and recovery services to the people when and where they need them. There is another grave challenge posed by the lack of healthcare, social and law enforcement stakeholders, which is prevalent across most public healthcare sectors across the world. Canada boosts a wide range of private drug addiction and substance use treatment providers, however, these facilities are largely unregulated and do not offer superior quality of care. These private facilities can often risk the safety of people seeking care for drug addictions due to their minimum quality control and consumer protection standards. Given the expensive nature of private drug addiction and rehabilitation services, majority of the Canadians are unable to access these facilities, especially the drug users who hail for marginalized and vulnerable communities.

An examination of the public healthcare sector, as explained by Canadian Agency of Drugs and Technology in Health (2015), reveals that the primary responsibility of administering prevention and treatment services to the residents is allocated to the provincial and territorial governments. The federal government is responsible for funding direct healthcare initiatives across various communities and populations. The Government of Canada has collaborated with First Nations and Inuit peoples to improve the accessibility of “culturally appropriate” treatment services for drug addictions, substance misuse problems and mental wellbeing. Research has identified a great need for improving the accessibility of evidence-driven treatment services for affectees across Canada. There is also a need for improving the education, skills and training for public healthcare providers to allow them a better understanding of drug addictions and substance use problems.

 

b)    Leading Theories & Accessibility

The most popularly implemented theories of treating drug addiction comprise of the cognitive behavioral theory, patient and family counselling, 12-step facilitation treatment (TSF) and behaviorally oriented family counselling. However, it is important to note that these therapies are largely accessible by patients and drug addiction affectees who seek out treatment from the private sector. A common citizen who is riddled with a low-income status and socio-economic challenges cannot access these treatments and facilities.

Finney et al., (1988) has highlighted a well-supported body of research that suggests a wide range of effective psychological and psychosocial treatments for helping adults struggling against substance misuse problems and drug addictions. These include motivational enhancement therapy, cognitive behavioral treatment, contingency management, 12-step facilitation treatment, and behaviorally oriented family counselling. The community reinforcement approaches, and motivational interviews are also effective approaches to combat drug addictions. It is important to note that a collaboration of psychosocial treatments with medicinal approaches and behavioral therapies are essential to incorporate the social processes that aid individuals with preventive care against the development of substance use problems. Petraitis et al., (1995) has highlighted four relevant theories that have been implemented to incorporate the major social processes that offer protection against the initiation and progression of drug addictions or substance use disorders. These are the social control theory, behavioral choice theory and behavioral economics, stress and coping theory and the social learning theory. These approaches are focused on the identification of the social processes and aspects that facilitate prevention, and these include friendships, social networks, families and the workplace environment.

Moos (2006) reports that the social control theory promotes a strong connection with family, friendship network, school network, work environment, religion and other traditional features of society that encourage positive behavior and discourage deviant behavior and indulgence in substance use. These connections allow more effective monitoring and supervision to prevent deviant behaviors and the initiation of substance abuse. If these social bonds are not present or have a weak influence, individuals tend to be more likely to initiate substance use and engage in deviant behavior, such as excessive consumption of drugs and alcohol. The major reason behind the weak social connections is lack of effective monitor to shape behaviors. This is common amongst families that do not have a structure of supervision or emotional bonds. It can also occur in friendship networks that encourage deviant behavior and disruptive values, lack of supervision and monitoring in work and school settings can also promote substance use and drug addictions.

Bickel and Vuchinich (2000) explains that the behavioral choice theory and behavioral economics is relevant to the perspectives of social control and it lays a strong emphasis of the involvement of activities that protect individuals against deviant behaviors and substance use. The behavioral choice theory lays great emphasis on the social context and the reward mechanisms associated with the avoidance of substance abuse. These rewards encourage individuals to avoid being exposed to illegal substances and drugs, and to avoid opportunities to use these substances. These reward systems also avoid the substance use problems from escalating, and worsening. The theory also observes that in certain cases, the substance use can be regarded as a reward when the individual lacks accessibility to employment opportunities, educational facilities, religious pursuits and other activities.

Bandura (1977) explains that the social learning theory regards the problems of drug addiction and substance use as a consequence of behaviors and attitudes learnt by the role models, adults and peers of the individual. The paradigm of learning through role models reveals that individuals can adopt substance use and drug addictions after observing and imitating substance use behaviors from their adults and peers. Over time, with continued social reinforcement and positive outcomes of substance use, these habits and behaviors are cemented as severe drug addictions and substance use problems.

Kaplan (1996) regards the stress and coping theory as one of the causes of substance use. It dictates that stressful life challenges, be it financial, social, personal, emotional, work-related or others, can cause social alienation and lead to drug addictions and substance misuse. For instance, a work-related problem, an interpersonal conflict with the administration, financial challenges related to mortgage or bankruptcy, an abusive relationship, unfair treatment from family or friends, an abusive childhood and lack of life control can push an individual towards substance misuse and drug addictions. These stressful situations are regarded as the stressors, while substance use is regarded as a coping mechanism to respond to these stressors as a means to gain positive reinforcement, relaxation or comfort. The social control theory focuses on creating structures for guidance, support, emotional bonding and goal monitoring to help drug affected communities and individuals towards the path of recovery. Behavioral choice theory and behavioral economics models treatments on the basis of traditional activities that are regarded as rewards and encourage individuals to avoid substance use and opportunities to be exposed to drugs. Social learning theory is largely focused on the observation and imitation of habits and behaviors of adults and peers, known as “role models”. The stress and coping theory outlines a treatment and therapy strategy that is focused on increasing the self-confidence of the patient, and developing enhanced coping skills to effectively manage highly-stressful and high-risk circumstances without succumbing to substance misuse.

Family and patient counselling is another form of therapeutic approach that takes into account a wide range of behavioral and social therapies that share the notions of family engagement, bonding, intervention and monitoring. The family is regarded as a cohesive and strong system that is capable of encouraging change and improvements in the individuals that belong to the system. The therapy is focused on using the strength and influence of the family to bring about positive changes and reinforce the avoidance of substance abuse. Family therapy as part of the treatment for drug addictions serves a wide range of integral purposes. It utilizes the resources and bonds of a family to develop strategies for coping and positive reinforcements for the patient. It focuses on introducing new ways to live a life without substance abuse and drugs. It also reduces the impact of chemical reliance on the individual patient and the family. It utilizes the support and strength of the family to reinforce the values of a drug-free lifestyle that is focused on mental wellbeing and physical strength. In this form of counselling, the family is treated as a unit and the individual receives this treatment within the family system context. The pursing who is abusing drugs or illegal substances will understand the impact and consequences of this deviant behavior for the entire family. This counselling focuses on staging family intervention and therapeutic approaches using the relationships and bonds between family members.

However, it is pertinent to note that this form of counselling and treatments are largely limited to private healthcare facilities and rehabilitation centers. These treatments are often introduced by private practitioners and therapists who introduce family counselling sessions, discussions, and problem solving programs. Some sessions allow the entire family to partake in group discussions, while other focus on a single relationship. Public facilities, on the other hand, largely focus on cognitive behavioral therapies and medicinal treatments. They are largely focused on treating the patient as one individual and focusing on his/her behaviors and recovery as opposed to including the family in the treatment process. While family counselling is an effective strategy that advances towards a wide range of social, economic and emotional support, it is not accessible for a wide range of patients, particularly those from low-income and marginalized backgrounds.

c)     Drug Legalization

Impact of Legalizing Drugs

The legalization of certain popular and widely abuse illegal substances, such as marijuana, has been widely debated as a potential strategy to reduce substance abuse behaviors and spread awareness about the uses of the drug. It is widely believe that such initiatives aimed to legalized marijuana can aid in undermining the stigma associated with drug abuse, and spread more awareness to reduce substance abuse cases.

Degenhardt et al., (2018) reports that Cannabis is the most widely abused drug across the world, and over the last twenty years, its consumption and dependence has increased at alarming proportions. In the 2016, the United Nations Office on Drugs and Crime revealed that around 192 million cannabis users across the world, ranging between 15 and 64 years of age. The highest number of cases of cannabis use disorders (CUDs) in the world have been reported from Canada and the United States of America. Over the last few years, the recreational use of cannabis has been legalized and decriminalized across many areas and territories of the US and Canada. Many states across the US, including California and Colorado, have legalized the use of cannabis in a bid to eliminate the black market of marijuana, enhance quality, promote greater safety mechanisms, make medical cannabis easily available and accessible, increase tax revenues, reduce gang and drug violence, and other objectives.

Krcevski-Skvarc (2018) reports that many countries across the world have introduced drug legalization policies, and public healthcare facilities, research-driven organization and healthcare professionals are analyzing existing research and policymaking tools to establish well-regulated and efficient policies for the legalization of Cannabis. However, those who oppose the legalization of drugs raise several significantly important concerns with regards to the addictive potential of cannabis, second-hand exposure to cannabis misuse, and the associated mental and chronic ailments associated with the recreational use of cannabis. Opponents of legalizing cannabis also highlight the negative consequences of altering perceptions and attitudes towards cannabis that impact the safety, life quality and driving behaviors. The exact impact of legalizing cannabis or other drugs remain unclear and threatens to unleash a wide range of forces that can promote and encourages substance abuse and deviant behavior.

Dragone et al., (2019) reports that the legalization of Cannabis has been implemented in contrastingly fewer jurisdictions, including Canada, Uruguay, the Netherlands, and some states across the United States. However, the recently conducted research and academic discourses focused on Cannabis are increasingly examining the changes in cannabis abuse and misuse outcomes before and after the legalization. However, there has not been any insightful scientific inquiry into the implications of legalizing cannabis in areas and countries where the use of recreational or medicinal marijuana has been decriminalized and legalized. Very few studies have examined the popularity and usage of cannabis after legalization, and majority of these studies revealed significant increases in cases of cannabis use and misuse. For instance, marijuana considerably increase in Washington, while in Colorado, the legalization of recreational cannabis witnessed a substantial increase of marijuana use amongst undergraduate students. The legalization of marijuana has also been linked with an increase in cardiac-related deaths and cardiovascular diseases.

Destrée et al., (2018) reports an increase in cardiac-induced deaths and mortality reduces in the aftermath of legalizing marijuana across multiple states in the United States. However, these increases were also concurrent with decreased rates of opioid prescriptions, especially in the states where legal cannabis dispensaries were established. However, tobacco sales also continued to rise across these states. The legalization of cannabis in certain US states did not bring about any impact or change in the compliance rates of chronic pain patients who were being treated with opioids. In states where medicinal marijuana was legally available, researchers noted a significant increase in serious mental health ailments, primarily bipolar disorder and schizophrenia, as compared to the periods before cannabis was legalized. However, while the researchers established an associated between frequent cannabis usage and impulsivity, they could not establish a relationships between the rates of impulsiveness and population-based usage of the drug.

Crépault (2014), an insightful report published by the Centre for Addiction and Mental Health (CAMH), reveals that there is certain evidence that supports the therapeutic advantages of incorporating marijuana in treating inflammatory bowel diseases, neuropathic pain, the symptoms of chemotherapy and epilepsy amongst children. However, the use of marijuana is also related to a wide range of ailments and adverse effects on the physical and mental health. The regular use of marijuana can lead to a wide range of health risks and concerns. For instance, it can reduce the healthy development of the brain amongst the youth, it can encourage the adoption of other harmful drugs, to can lead to anxiety, depression, injuries, and dying due to motor vehicle collisions. It can also trigger the symptoms of schizophrenia, addictions, and chronic bronchitis. It is argued that as witnessed in the marijuana legalization experience of Colorado, legalizing the drug in Canada can lead to a significant increase of using recreational marijuana amongst adults. This would, in turn, lead to the increase of a wide range of health risk factors, mobility issues and more. It has the potential of increase marijuana-induced traffic accidents and motor vehicle collision deaths. Experts argue that given the vast potential of increase risk factors and adverse health outcomes associated with the legalization of marijuana, in Canada and Colorado, it is advisable to focus on improving strategies on control marijuana, preventing marijuana use and addictions, and devising harm reduction programs.

There is great need to improve the frameworks for legalizing marijuana and the availability of medicinal marijuana, alongside providing affected individuals greater access to treatments. Increasing awareness about marijuana cannot be linked directly with the legalization processes but as a standalone strategy to educate the masses about the effects of the drug. Legalization of marijuana offers governments a vast potential of increasing tax revenues, which can be spent on public healthcare facilities and educational programs. It can also undermine the criminal elements of the marijuana black market and gang-related drug wars, and its adverse impacts on society. However, legalizing marijuana can also lead to an increased prevalence of multiple chronic health and mental health ailments. It can also increase the usage of the drug, and marijuana-induced injuries and accidents. The only strategy to undertake an effective legalization process is by ensuring that children and the youth cannot access the drugs, by increasing initiatives to spread awareness and knowledge about the adverse health effects of the drug, and to prevent marijuana users from driving when impaired.

 

Harm Reduction Programs

Harm reduction programs have long been a subject of debate, and many countries across the world, alongside global healthcare organizations, have endorsed it as a demonstrably useful strategy in creating drug addictions, substance misuse and alcohol abuse disorders. It proves immense useful in rural settings.

Wolfe & Csete (2016) explain that harm reduction is based on the notions that individuals have the right to safety and support even if they are not willing or prepared to put an end to drug use or seek treatment. The approach of harm reduction revolves around present drug users and individuals with substance use problems the choices that can spread awareness and help them understand the need to protect their mental and physical health. For instance, harm reduction programs can be viewed as offering sterile injections and equipment to patients who are addicted to injecting drugs in order to cut down the risk factors of hepatitis C or HIV transmission. They are focused on treating patients with strong medical supervision and oral medications, primarily buprenorphine and methadone, to reduce the risk factors of overdose and injecting opiates, such as heroin. Harm reduction is largely focused on addressing and highlighting the risk factors to health.

Harm reduction programs are essential for highlighting and combatting a wide array of public healthcare and social challenges. For instance, communities do not ban or prohibit drunk driving to undermine or discourage people from driving after consuming excessive amounts of alcohol. Instead, they can undertake certain harm reduction precautions or measures, such as establishing social communities to assign non-drinking drivers, offer free transportation or subsidized transportation for those who have consumed alcohol excessively. The harm reduction approach for drug use is also similar in its approach and focuses on introducing measures that cut down risk factors as opposed to eliminating the problem entirely. In certain cases, harm reduction programs can function as a connection towards drug reliance treatment, or it can often eliminate the drug use completely. Many harm reduction programs often include initiatives like drug consumption areas or rooms where patients can use drugs under strict medical supervision. Heroin prescriptions, supervised administration or drugs and allowing the distribution of naloxone to opioid users and their family members are harm reduction strategies to reverse the risk factors of a fatal drug overdose. Many communities and housing programs adopt the harm reduction approach of offering alternative housing or shelter without mandating individuals to cease drug use in a bid to reduce increases in chronic homelessness and the social and healthcare risk factors it can lead to.

An assessment conducted by the UNODC and WHO (2008) supported harm reduction as the “guiding principle” that allows health programs and drug conventions to be more effective and successful. It holds immense potential as a successful treatment for reducing drug dependence through a low-threshold treatment that is focused on reaching out to a large number of patients who may be willing or unprepared for being treated for their drug use or substance abuse disorders. Superior quality harm reduction programs are focused on addressing the needs of individuals who engage in drug abuse “where they are” and are focused on building up their capacity to safeguard themselves against the harmful health hazards of the severity of their drug usage and dependency. Harm reduction focuses on a lower threshold of treatments that facilities drug dependence therapies and other healthcare services to patients who have remained resistant to treatments with higher thresholds. It involves encourage the socio-economic uplifting of the people who use drugs without compelling them to abstain from their drug use patterns. It revolves around preventive care and interventions by spreading awareness and educations, and lifting the socio-economic circumstances by offering housing and employment opportunities.

 

Conclusion

After an insightful evaluation of well-supported research and a wide range of recently conducted academic discourses, it is safe to conclude that today, there are a wide array of treatments, strategies and healthcare services to identify, prevent, treat, manage and eliminate substance use problems and drug addictions. Research reveals that one of the most effective strategy to aid individuals combatting substance use or drug abuse challenges is by staging an early intervention before the habit progresses into a severe disease with aggressive usage patterns and increased drug dependence. This strategy has been widely recognized across private and public healthcare sectors, however, the availability and accessibility of these drug abuse treatment services is market with disparity between patients ranging from various socio-economic backgrounds. The screening for substance use and drug addictions has become more prevalent across public and private healthcare facilities and it allows for an early detection of drug abuse problems, which can facilitate an early intervention and a timely treatment to pave the road towards recovery.

There has a wide addition of treatments and healthcare services that address drug addictions and substance use disorders with an evidence-based approach that involves medicinal treatments, behavioral therapies, harm reduction services, family and patient counselling and more. The continuum of care for drug abuse and substance misuse problems has become more effective and accurate, and is driven by research and evidence-based medications. However, there are a wide range of challenges that limit the widespread prevalence and availability of these drug abuse treatments and services. These include shortages of skilled healthcare professionals and workforce, insufficient training for treating patients struggling with drug dependency and severe drug abuse, lack of sufficient resources, and lack of attention to the vulnerable and high-risk communities. Early intervention is the most effective strategy to combat against drug abuse and substance abuse, particularly if it is co-existing with mental health disorders or chronic physical ailments. (Udo, 2015)

There is a wide array of scientific data and evidence to reveal that substance use disorders can be treated effectively with the help of comprehensive strategies focused early intervention, early detection, and incorporation of strategies that focus on achievable recovery outcomes. However, there is a large disparity in the availability of specialty treatments and preventive care services to people struggling with drug abuse problems across the spectrum of a society. Research reveals that only 1 in every 10 individuals suffering from a substance use disorder has access to any kind of specialty treatment or healthcare services. The majority of treatments designed for substance use disorders and drug abuse treatment programs do not feature any involvement of the general healthcare facilities and primary hospitals. However, there is an increasing shift in the prevalence of mainstream facilities and health practitioners that allow early intervention and incorporate the treatment of drug abuse in general healthcare facilities that can be accessed by people from all socio-income backgrounds and severity levels of drug addictions.

There is considerable scientific evidence to reveal that medications are one of the most effective medium of treating severe cases of drug addictions and substance abuse problems, but they remain underused and ineffectively used across both, private and public healthcare facilities. There is an insufficient number of practicing healthcare physicians or treatment programs that offer medications to treat alcohol use disorders and opioid use disorders. The process of screening is one of the most effective medium to reliability and easily detect the prevalence of substance misuse and drug addictions amongst individuals, particularly those who are unprepared to seek treatment, and stage an early intervention. There is a need for incorporating a culture of drug screening amongst public and private healthcare facilities as they are the most effective manner of initiating treatment amongst patients suffering from mild symptoms or severity of drug addictions and alcohol use disorders. Evidence reveals that there is a greater need to increase inpatient, residential and outpatient treatments for drug abuse and addiction disorders.

In terms of training and education for the skill-building of private and public healthcare practitioners and professionals in treating drug use and substance abuse disorders, there is a need to learn to treat substance use disorders in the same manner as chronic ailments and mental health ailments are being treated by professionals. The goal and objectives of the treatment must be focused on identifying, preventing and treating the ailment to reduce problematic symptoms, improve life quality, and eliminate the risk factors to the physical and mental health of the patient. Private and public healthcare facilities must be focused on incorporating treatments based on medications, behavioral therapies, counselling, recovery services and harm reduction services.

Behavioral therapies have reaped immense success in both public and private healthcare facilities, emerging as an effective treatment for drug addictions and substance use disorders. However, majority of these effective behavioral strategies and therapies are implemented with a wide range of accessibility constraints and they being under-used by healthcare practitioners across the public sector. (Kline-Simone et al., 2016)

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