Drug abuse as well as alcohol and tobacco use is the leading cause of all preventable deaths and illnesses in the United States. The awareness by the public about the medical consequences of abusing substances has over the last 15 years been awakening as a result of the ever-increasing rate of AIDS prevalence among substance abusers. However, AIDS only represents a tip of the iceberg to the problems presented by substance abuse. Tobacco, alcohol and other drugs contribute to half a million deaths yearly. This represents a ratio of one in every four deaths. The morbidity as a result of legal and illegal drug abuse is also of equal devastation. Substance abuse has tremendous cost in terms of the loss of productivity and its demand on the heath care resources. This is as a result of viral and bacterial infections from illicit drugs injections, cardiopulmonary diseases and cancer as a result of smoking and vehicular crash and cirrhosis from alcohol among other complications. This excerpt will offer a review of information regarding the risk as well as the protective factors that aid in the development of substance abuse as well as the effectiveness of interventions meant to prevent substance use in this population. It will mainly focus on the Romano Family case study and produce relative literature that would aid in the family’s treatment and prevention of further substance abuse.
The Romano family case study
The Romano children exhibit most of the symptoms present in substance abusing adolescents. This include: sudden change in personality in areas such as discipline, school attendance and grades; the children have also been reported to have outbreaks of tempers and flare ups, two of the children actually insulted their respective teachers; a withdrawal from necessary responsibilities; a change in the overall attitude of the adolescent; loss of interest in some of the child’s favorite pursuits; a change of friends as well as being reluctant to be visited by friends; sudden aggression, nervousness and jitteriness; difficulties in being attentive; increased secretiveness; deterioration of grooming. The symptoms exhibits often differ from one individual to another as well as across different substances abused (Fisher & Harrison 2011). However, the most glaring symptom in any case of substance abuse is a radical change in one’s behavior. Other physical symptoms amongst substance abusers include impaired motor skills, memory impairment, slurred speech and attention impairment.
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Substance abuse is often classified into three classes. Substance use comprises the occasion use of drugs and alcohol without advancing to tolerance or experiencing withdrawal symptoms when one is not on drugs. Substance abuse comprises the continual use of drugs while having the knowledge that it us creating, physical, social and psychological problems (Maguin, Zucker, & Fitzgerald, 1994). Once a person develops dependence, then they experience substance use over a loner period than they had anticipated or intended, they struggle with controlling the use of the substance without any success, a lot of time is spent sourcing the drug, using it and recovering from it, there are frequent episodes of detoxification and intoxication, continuous substance use even when there is knowledge of the physical, social and psychological problems of the usage, withdrawal symptoms, increased tolerance, using the substance to relieve the effect of withdrawal symptoms. For dependence to be diagnosed, then, at least three of these factors must be present. In the case of the Romano children, they are not. They as such mostly fall in the stage of use and some in the substance abuse stage considering the behavior changes and social damage in their respective classes, insulting teachers and fighting other students (Fisher & Harrison 2011).
Diagnosis and treatment of substance abuse in Romano Family
The younger a child starts engaging in drug usage, the higher the risk is that he/she will develop substance abuse disorder later on into adulthood as well as suffer from serious associated health consequences. Six of the Romano children have displayed symptoms of substance abuse. To make matters worse the youngest of them is 6 years. As such, their situation needs immediate remedy. This is because of the consequences of using drugs especially at such a young age. Accidental and intentional fatalities that are associated with the usage of alcohol and drugs in the adolescent population are the leading cause of preventable deaths in the 15-24 year population bracket. Alcohol consumption in this population presents the highest risk of academic underachievement, depression, delinquency and teenage pregnancies. Drug use has also been presented as one of the contributing factors to the rise in HIV infections witnessed between 1985 and 1990. Research shows that this period also presented the crack cocaine epidemic. The lifestyle of drug and alcohol abusing places the victim in a more precarious position of getting infected due to the reduction in inhibitions, impaired judgment and the sex-for-drugs phenomena (NIDA Notes, 2002).
Predictive risk factors
The risk-protective theory is the most relevant model in attempting to develop an evidence- based model to provide diagnosis and treatment options for the Romano family substance abuse problem. According to these theories, addiction to drugs develops as a result of a complex interplay between the victims, the agent (alcohol/drugs) and the individual’s environment. Interactions between cognitive, social, cultural, personality attitudinal and developmental factor is usually the determinant of substance abuse in children. As an individual, one might be pre-disposed to alcohol and drug use as a matter of their genetic makeup. The family is usually a culprit in initiating the first influence to drink alcohol, smoke or use other drugs. Other factors that are related to adolescent drug use include poor school performance, low religiosity poor self image, family dysfunction, parental rejection over- or under-controlling parents and divorce. In the case study, the parents are mostly absent from their children’s lives because of their busy work programs. This can be considered a factor as the children may be feeling neglected. The parents’ absence has also helped the substance abuse habit to continue uninhibited so far (Belcher, & Shinitzky, 1998).
Peer influence is also a leading factor of initiating adolescent into drug abuse. Children predisposition to abuse drugs often pushes them to seek out others who have similar inclination. The Romano family children seem to adopt this model in their abuse which affects all six of them, a large number in one family by any one’s standards. They have shunned peer groups in their school and only associate with one another. In this case the influencing peers are the siblings. If there substance abuse is peer based then it is likely for them to be easier to abstain from the habit as opposed to if a psychological dysfunction is present (Belcher, & Shinitzky, 1998).
In the community, African American and their Hispanic counterpart are likely to obtain drugs in a relatively easier and cheaper way than their white peers. This exposure is however misleading as the white adolescents have a higher reported rate of substance abuse that their African American counterparts. However, the adolescents in populations in lower privileged neighborhood were most likely to be exposed to cocaine up to five times more than those in privileged areas (Belcher, & Shinitzky, 1998).
The likelihood that a child will develop externalizing disorders can be traced back to preschool years. Oppositional defiant disorders, conduct disorders and attention-deficit/hyperactivity disorders observed in children during their preschool years are likely to develop as a child grows older. This conditions even if mild in the early years may advance into severe symptoms such as aggression, stealing and substance abuse. Another factor is difficult temperament in children that is characterized by negativity, moodiness, provocations and poor compliance may lead to the child being ostracized or criticized by authority figures. If this occurs in the family, it presents the model of coercive parenting that is present in families where the children adopt delinquency and substance abuse (Belcher, & Shinitzky, 1998).
Protective factor comprise those characteristics present in the individual, his/her family as well as in the environment which are able to prevent individuals from adverse outcomes. The Romano family is most likely lacking in offering a nurturing home where the children and the parents are in open communication and the children have parental support that is positive. Personality traits such as self-control, self-concept, self-esteem, academic achievement and social competence also aid in raising the resiliency of the adolescent to avoid substance abuse. The challenge Model is utilizes the resiliency principles on the capacity of the individual to respond as well as to manage his/her life. It states that an individual has the capacity of achieving past the negative factors that might be in their life. As such, a chaotic family does not necessarily condemn an individual to be damaged forever. The challenge model comprises of seven principles in the facilitation of healthy and adaptive development of individuals: independence, insight relationships, humor, initiative, creativity and morality. Developing effective prevention strategies relies on considering both risk factors and protective factors (Belcher, & Shinitzky, 1998).
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If the Romano children were also able to establish friends with positive oriented peers at school who understand the problems presented by substance abuse, then these friends are bound to improve their resilience against the habit. The parents also have a role to play, by establishing a sufficient parenting model despite their busy schedule. The parents are also described as normal by the teachers and as such are in a position to represent as protective factors to their children. On their part, the teachers and the school is committed to the welfare of the students as witnessed by their concern and follow up of the Romano case. The school also has clear rules and expectations regarding the use of drugs by students. The family should also aim at exposing their children to a supportive and safe family. This community should have a negative attitude towards the use of drugs. There are also many positive services and activities that are available to the youth which the family should enroll the children in to occupy their free time when the parents are away. Educational and treatment approaches are also presented by such communities to assist the adolescents suffering from substance abuse (NIDA Notes, 2002).
Children and adolescents present a big challenge in the diagnostic of substance abuse disorder. It is usually likely for the diagnostic evaluation to focus on a particular coexisting disorder or pre-morbid condition for example depression and/or conduct disorder. This can result to the substance abuse being missed or overlooked. This is a common challenge in adolescents as they will often fear being punished for their actions and will in most cases deny ever attempting drugs. They may also feel threatened if the person interviewing them is not sufficiently sensitized with regard to the problem aspect of substance abuse. The need for adolescents to experiment as well as push the limits also presents a point of confusion. The evaluation of substance abuse will therefore require the careful collection of information that can be quantified regarding the pre-existing conditions associated with the abuse. A rational treatment plan cannot be implemented without the performance of an accurate diagnosis which includes an evaluation of the pre-existing problems and the degree and type of dependence/abuse (NIDA Notes, 2002).
Effects of alcohol
Alcohol remains the number one substance used by both the youth and adults across the world. The effects are present of this substance can be seen in the youth, within the family, the justice system and the public health sector. Alcohol consumption patterns revealed in studies on such aspects as drinking and driving and binge drinking provides predictive information that is crucial in the fight against substance abuse. Figures from 2005 indicate that the rate of alcohol use in populations aged 12 years and older stands at 9.7 percent. In a state like Arizona, one out of every four individuals indicated that had engaged in binge drinking in the month that preceded the survey. Although alcohol use by adults is of concern, its effect on underage drinkers is alarming. Alcohol is said to kill almost seven more times more underage drinker than a combination of all the other illicit drugs. In addition to this, children’s drinking is a high risk factor for perpetrating violence, falling victim of violent situation and also being involved in violent accidents such as car crashes. Alcohol also has deleterious effect on the mental, physical and emotional development in the students. In particular it contributes to academic underachievement of students and their eventual failure as productive individuals in the society (Fisher & Harrison, 2011).
Underage drinking increases the risk of children to develop academic problems, make poor decisions, engage in criminal behavior, engage in risky sexual activities, perpetrate sexual and physical assaults (such as fighting in the case of the Romano children), be victims of both sexual and physical assaults, increase their likelihood of dying young as well as posse a risk to damage their brains irreparably. In addition to the negative effect of underage on the development of the youth, on road safety and on the judicial system, it also possess financial burden on the society that is extraordinary. Handling the various areas of alcohol abuse by the youth such as community treatment programs requires allot of money and resources and is as such a burden to the community (Fisher & Harrison, 2011).
Research indicate that in situations where a child starts drinking before they are 15 years old, then the risk of them developing alcohol-related problems in their adulthood increases fivefold. Alcohol also posses a risk of harming the brain of an adolescent: stunting brain development. The information generated by these researches provides parents as well as other adults with more reasons why they should act to protect and ensure the health and safety of the children not only in America but worldwide (Fisher & Harrison, 2011).
Impact of substance abuse among diverse populations
By 2003, the United States reported a 9.1 percent of the population said to be suffering from substance use disorder, this is roughly 21.6 million people. 154 million of these were alcohol dependent with drug dependence affecting 44 million. A combination of alcohol and drug dependence was found in 3 million of them. The adolescents and children in the country are feeling the effects most as almost 25 percent of them live in household where the adults or parents are binge or heavy drinkers. A child in every ten children in the country is also said to live in a household that uses illicit drugs. The impact of these is that children grow up with physical and mental drawbacks. A child of an alcoholic parent is at a higher risk of developing alcohol use than any other child and also suffers other mental health problems. Boys are likely to develop externalizing behavior disorders and the girls internalizing behavior disorders both of which predispose them to substance abuse. Children with parents who are illicit drug abusers have a tendency to demonstrate irresponsible, impulsive or immature behavior, have poor school attendance, low IQ score and have behavioral problems that may also involve anxiety and depression. Ion addition, they are also likely to manifest fearfulness, negative concepts of self, loneliness and concentration impairment. All this increase their risk of engaging in substance abuse. The problems of substance abuse also bring considerable shame and associated stigma to their lives which presents a problem of identification in them (Fisher & Harrison, 2011).
Adolescents engage in use and abuse of substances for various and complex reasons. Most of these reasons can be explained by biological theories, for example, disease model and the social learning theories which focus on environmental factors. The Romano Family case study, as would many cases involving school going children, points mainly to the risk-protective factor theory to explain the children’s substance abuse. This theory is able to distinguish between high and low risk factors leading to the development of the problem of substance abuse amongst school going children and as such help in establishing effective treatment programs for the patients.
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