Addressing Substance Abuse Among Young Adults

Introduction

In the contemporary world, one of the key urban health issues seen among all age group of population and mainly the young adults are substance abuse. This is evident from the report of WHO which mentions that 270 million people between 15-64 years are globally found to be involved in illicit use of psychoactive drugs and face drug use disorder (WHO, 2021). Substance abuse is referred to as pattern of harmful use of mood-altering substances such as psychoactive drugs, solvents, legal highs and others by the individual (Seitz et al, 2019). Substance abuse is a major health problem because it leads to development of major health issues such as cancer, cardiovascular disease, respiratory complications and others (Seitz et al., 2019).

In this study, an analysis of the prevalence and prevention of substance abuse in the London Borough of Southwark is to be presented. For this purpose, the rationale behind the choice of the health issue as substance abuse and the location is to be discussed. Thereafter, the urban context and health determinants present in the Southwark that influences impact of the health issue is to be explained. The health consequences and implications of substance abuse on the area of Southwark is to be identified. The strategies and intervention in tackling substance abuse in the Southwark us to be identified and discussed through analysis of the gathered data. Further, recommendations are to be presented to more effective control the prevalence of substance abuse in the London Borough of Southwark.

Rationale

Substance abuse among adults (18-45 years) is chosen as the health issue to be discussed in the London Borough of Southwark because it is one of the priority health issues being faced in the area similar to the national condition among the specified age group. This is evident as in 2017, it is reported that 1500 adults are actively involved in drug misuse or substance abuse services and more than 700 adults were involved in injecting illicit and harmful drugs in regular manner (southwark.gov.uk, 2018). Moreover, 429 hospital admission for substance abuse of illicit drugs in 3-year period (2012-2015) by adults (18-50 years) is reported in Southwark among which 57% are male and 43% are female with 14 patients been twice admitted for substance abuse-related health issue (southwark.gov.uk, 2020). These figures led to consider that the London Borough of Southwark is ranked 8th highest among the boroughs in London to be reported of increased prevalence of substance abuse (southwark.gov.uk, 2020). The neighbouring borough were ranked within 10 according to national condition revealed that the substance misuse is not only isolated local problem but a national problem which is required to be discussed to understand its cause and determine way to manage it (southwark.gov.uk, 2020). Therefore, discussion regarding substance abuse in the Southwark is focussed to develop better concept regarding the health issue and way of its management.

Urban context and determinants

The substance abuse which is the key health issue been focused in the study is an urban health issue because of many social and environmental determinants present in the urban area compared to the rural area. One of the determinants is income inequality that is highly existing in the urban area which influences the substance abuse issue to be present in urban environment compared to the rural area (Bor, Cohen & Galea, 2017). It is evident as after 2017 financial year, it is revealed that the income inequality in the urban areas in the UK increased from 33.4% to 34.6% indicating a fall of income among the poorest 40% individuals compared to the 10% richest (ONS, 2020). Moreover, in Southwark, the income inequality is raised by 1.5% which worse than the average in London (trustforlondon.org.uk, 2020).

In urban areas, most of the everyday needs such as housing, food and others are seen to be priced at high range which makes it criteria for the person living in the urban area to have adequate income and financial stability (Grando et al., 2017). However, the income inequality created in the urban area leads the poorer individuals to be avoided to manage effective living compared to the rich people. It leads the financially deprived and poor individuals being unable to meet their needs become depressed and stressed about the way to management their livelihood. The deteriorated mental condition out of financial instability created by income inequality among the lower-class of individuals makes them to involve in substance abuse to overcome the sorrows and negative emotions. This is because the substance abuse of drugs helps to create sedating impact on the individuals in helping them momentarily forget their emotional pain and shortcomings to relax (Kollamparambil, 2020).

The presence of lack of employment among people is another determinant and urban context that influences substance abuse to be an urban health issue instead of being rural. This is because employed people are required to retain healthy prospect in their life to avoid reduction of productivity which otherwise may make them lose their jobs and face poor financial condition (Gateri & Nyakwana, 2018). However, the unemployed people are seen to live a carefree life as they are not concerned about their productivity and health as they are not bound to any responsibilities (Currie, Jin & Schnell, 2019). The lack of employment leads the people in the urban areas to additionally develop mental stress and depression regarding the way they are to manage their everyday needs and bear the cost of living (Noel et al.2017). This condition leads them to involve in substance abuse so that they can get relief from the emotional pressure (Noel et al.2017). In the UK, it is seen that 4.8% of the people in the urban settlements are unemployed compared to 2.7% in rural settlements (assets.publishing.service.gov.uk, 2019). Moreover, in Southwark, the unemployment rate from 2017-2020 has increased by 2.4% which informs that more people lack work and are facing economic instability that may be affecting to cause stressed and their involvement in substance abuse activities (trustforlondon.org.uk, 2020). This indicates that more unemployment is present in the urban area which is leading more people in the urban areas to be depressed and involve in substance abuse making the condition to be an urban health issue.

The physical environment with infrastructure in the urban areas acts as key determinant that influence substance abuse to be health problem present mainly in the urban area (Gentner & Leppert, 2019). This is evident as increased clubs, restaurants and pubs are present in the urban area which are not available in the rural environment. The pubs and clubs act as key area in the urban environment where dealing and transfer of drugs and illicit substances occur to allow people involved in their use avail them (Kelly & Vuolo, 2019). For example, in the Southwark, 175 pubs and clubs are present in the area which has not changed since 2017 (standard.co.uk, 2021). The clubs and pubs provide safe environment for the drug traffickers to provide drugs and substances to the people to make them develop addiction towards its use with time (Tutenges & Bøhling, 2019). Thus, it can be considered that substance abuse is urban health issue because increased presence of social network and support are present in supporting substance abuse in the area compared to rural environment.

The presence of increased number of rich and wealthy people in the urban areas are considered to be another social determinant that support increased substance abuse and makes it an urban health issue. This is because individuals from affluent families are seen to have high expectations from their parents who rarely provides them time to support their growth out of being busy in their own life. It leads the individuals to often fail and being bashed by their parents which make them depressed life (Singer et al, 2019). Moreover, the lack of friends and family support among the affluent children make them feel lonely and mentally depressed leading them to involve in substance abuse to overcome the mental stress and frustration in life (Singer et al, 2019). For example, Southwark is referred as the ninth richest locality in London and is one the concerned area in London Brough where high substance activities are reported (standard.co.uk, 2021). This indicates that presence of riches and affluence in families apart from poverty and unemployment also lead to involve individuals in substance abuse activities making the problem as urban issue as most of the affluent families live in urban area and not the rural area.

The study by Nielsen et al. (2017) mentions that presence of increased population would indicate more substance abuse and illicit use of drugs as seen in urban areas. This is because increased density urban areas lead people to live in close communities and neighbourhood with low income. It makes the families live in harsh condition and face inexplicable poverty that is linked with causing substance abuse or misuse by people. This is because such condition promotes more depression, stress and desperation among people regarding lack of potential things in life and they involve in drug abuse making the substance abuse mainly an urban issue (Nielsen et al, 2017). The presence of easy transportation in the urban areas leads any individuals to easily move around places and get access to drug and substance deliver sources or services to avail them for use (Hymel, 2019). Thus, the easy access to drug services in urban areas leads substance abuse to be considered as prevailing health issue in the urban environment compared to rural area. It is evident as 9.8% of the population in urban areas in the UK are seen to be involved in substance abuse compared to 7.7% of the population in the rural areas (assets.publishing.service.gov.uk, 2019a).

Public health consequences and Implications of Urban health issue

The pubic health consequence of substance abuse is that it creates risk of various diseases for them, hindered social interaction environment and negatively affects their quality of life and well-being. As mentioned by Shaimardanova et al (2020), substance abuse of illicit drugs like heroine, cocaine and others impacts the young adults to develop drug-induced psychosis and mental health problem. This is because substances such as cocaine, heroine and others impact on disrupting the normal neural communication process occurring in the central nervous system (CNS) by attaching with dopamine to block its recycling process of getting retransmitted. It leads to development of dopamine in the synapse that leads to pleasurable and hallucinating effect (Linker, Cross & Leslie, 2019). The hallucinating effect caused by substance abuse in young people leads them to face hindrance in showing productivity at work or in life as they cannot differentiate between real and unreal condition. This in turn negatively affects their progress in professional life and develop mental disorder with time (Barrett et al., 2018). As criticised by Poloni et al. (2019), substance abuse impacts the individuals to be alienated from the society and stigmatised by the peers to avoid interacting with them. This leads the person involved in substance abuse to remain lonely and isolated in the society as well as deprived from positive contribution from the peers and families which are required in supporting their enhanced quality life and well-being.

The substance abuse affects the adult and young individuals to create family crises and jeopardise various aspects of the family life that leads to create family dysfunction. This is because young and adult on substance abuse due to influence of the drugs are unable act normally and show aggressiveness that disrupts the development of normal familiar and harmonious environment need in framing a supportive family (Chen, 2018). As argued by Kim et al. (2019), substance abuse impacts the person to be violent to others. This is because substance abuse weakness self-control and effective analytical thinking power of the people which leads them unable to control their emotions and make evaluation of the consequences of their actions. It makes the substance abusers show violence towards other when they are defied or not accepted in any manner in the society (Geyen & Bailey, 2021). Moreover, adequate money is required in buying drugs and alcohol which may not always be available for the person who have been addicted to the substances. This addictive behaviour leads them to be desperate to access the substance and they involve in causing violence and crime to earn gather money to continue the substance abuse activities which are pleasurable need for them (Geyen & Bailey, 2021).

The substance abuse impacts the individuals to create depletion of financial and economic resources of the family, which in turn, creates hindrance in availing basic life needs for the family. It eventually contributes to the dysfunctional formation of family structure which ruins the social and family life of the individuals as well as their family members (D'Angelo & Her, 2019). Moreover, the loss of finances due to substance abuse impacts the individuals to face poverty, homelessness and others (D'Angelo & Her, 2019). As criticised by Stockman et al. (2020), substance abuse impacts the individuals and general population to experience needle-based diseases such as hepatitis and HIV/AIDS. This is because syringes used in administering harmful drugs are repeatedly used and shared among the drug misusers that leads them to transfer any person infected with HIV or hepatitis to be transmit the disease-causing organisms to others leading to affect many individuals in the population (Stockman et al, 2020). The substance abuse effects individuals to develop mental health issues which makes them be at higher risk of executing attempted suicide, show hindered psychomotor skills, express short-term memory and others. These conditions compromise the well-being and health of the individuals (Stockman et al, 2020).

The substance abuse impacts the society and the government to face increased economy loss. This is evident as total cost of illicit drug trade as substance abuse in the UK is considered to be nearly £19 billion a year from which no taxes are paid and instead government require to implement additional budget in controlling its growth (assets.publishing.service.gov.uk, 2020). The consequence of substance abuse is that it supported increased mortality rate of the population and increased hospitalisation of individuals due to drug-related disorder. This impacts the government require spending increased amount of finances in creating additional healthcare services which are otherwise not require if effective substance control is been implemented (assets.publishing.service.gov.uk, 2020). The consequence of substance abuse among individuals is that it affects their progress in career and education. This is because the substance abuse leads to affect the memory and lower the efficiency of individuals in making constructive cognitive thinking required for academic and career progression (Rawat, Petzer & Gurayah, 2021).

The rising substance abuse as health issue impacts the health services to make the professionals in the field such as clinicians and nurses to develop new skills and management regarding the way drug-related disorder are to be controlled. It requires increased contribution of funding from the government and health organisation to be made so that the health services providers are able to be effectively trained in tackling the substance abuse risk and health consequences in people (Babor et al., 2017). The substance abuse as health issue impact the health services to identify and frame different nature strategies and techniques to be implemented in the form of health campaigns educating and creating awareness among the people regarding the health consequences of the health problem. This is because the health service organisation understands that effective awareness and promotion of knolwdege regarding substance abuse could make people to avoid using them, which in turn, would help in resolving the hindered health environment caused by the condition among the general population (Pinedo, 2020).

Strategies and Interventions for substance abuse control in Southwark

In Southwark area, the strategies taken to control substance abuse affluence include development of deaddiction centre, rehab facility, social support services and others. For example, “Change, Grow, Live Southwark” is one of the adult drugs and alcohol control treatment services which is established in Southwark and freely available to extremely clinically vulnerable individuals above the age of 18 years and living in the area. The services provide prescribed medications to individual in helping them recover from the substance abuse condition. They allow the individuals accessing the services to avail assistance over phone or email (southwark.gov.uk, 2021). The other social service present as intervention for substance abuse control in Southwark for supporting young people who are within 25 year of age is “Healthy Young People (HYP) Southwark”. It is an integrated health and well-being service for the young people for which people are to pay and avail it (southwark.gov.uk, 2021).

An Alcohol Action Plan 2017-2020 is developed in Southwark with the vision to aware residents in the area about the harmful effect of alcohol and to empower them in taking action in reducing the impact of alcohol as substance abuse among families and communities (southwark.gov.uk, 2018). For the establishment of this purpose, it is planned to protect families and communities from harmful impact of alcohol (southwark.gov.uk, 2018). The other intervention taken in Southwark for managing substance abuse promotion of use of Drinkline and Talk to Frank as helpline by any individuals trying to overcome impact of drug abuse (southwark.gov.uk, 2021). The Southwark Council has also developed Alcoholics Anonymous and Narcotics Anonymous groups that meets at different location in the area to share experience and provide support to any people in the area who are trying to recover from substance abuse dependency. They act as therapeutic groups to allow people under substance abuse, share ideas and information regarding the way they can cope with the condition and recover from it (southwark.gov.uk, 2021).

In the Southwark, both paid and free rehabilitation institutions are established for supporting people to overcome substance abuse without thinking of financial condition (southwark.gov, 2021). The free rehabilitation present in the area include St Thomas Hospital, AA Meeting Southwark and other (southwark.gov.uk, 2021). The establishment of these initiation which provide free care for substance abuse control are effective for the poor people to overcome substance abuse and be sober to lead a health life (southwark.gov.uk, 2021). However, the paid rehabilitation residential centre such as Primerose Lodge in Southwark for controlling substance abuse are found to be effective for individuals who have financial efficiency to pay and avail them. These institutions are seen to contain advanced equipment and services compared to the free care is supporting better and early recovery from substance abuse by people (southwark.gov.uk, 2021).

The advantage with the implementation of free or private rehab facilities and services in Southwark is that it allowed delivering one-to-one group session support and provide customised treatment to enhance recovery from substance abuse of the individual by meeting their specific needs and demands (southwark.gov.uk, 2021). The services are also effective to be implemented in the areas as they helped in analysing the mental state of the individuals and provide assistance to overcome depression and stress without involving in substance abuse (southwark.gov.uk, 2021). Thus, the services focused on the determinants of mental health that is one of the key aspects influencing substance abuse growth among people. The rehabilitation services are outpatient as well as inpatient programs where the outpatients are freely treated, and inpatients require to send money in availing the care (southwark.gov.uk, 2021). This create challenge for the poor individuals to avail inpatient care which are safer in helping people detox from alcohol and drugs without any temptations to further use them (southwark.gov.uk, 2021). Thus, the services did not focus on resolving the economic instability that also impacts availing care support for control of substance abuse.

The challenges faced while implementation of mentioned intervention for substance abuse control in the Southwark is that poor coordination from individuals, discrimination and stigma, inconsistent and untrained workers (southwark.gov.uk, 2021). The lack of coordination and support from the substance abusers even after making them aware of the harmful impact of substance abuse creates hindrance for the successful delivery of social care services for controlling drugs and alcohol use. This is because they by avoiding accepting and following the services leads hindered implementation of the intervention (southwark.gov.uk, 2021). The lack of trained workers also create challenge in implementation of the intervention. This is because the adequate skills and knowledge in assessing and influencing substance abusers to take part in the program to control the condition is unable to be achieved (southwark.gov.uk, 2021).

Recommendations

Recruitment of Skilled worker: The consideration of the substance abuse control in Southwark led to develop recommendation that increased number of trained workers have previous knowledge and skill regarding management substance abusers are to be recruited. This is because they would be able to act skilfully to determine the psychological condition of the people involved in substance abuse and determine the right therapy as well as medication to be provided to help them recover and control their habit in limited time. Moreover, they would able to deliver consistent care without error to the people to overcome the habit of substance abuse with ease.

Development of Health Promotion Campaign: The other recommendation is that better evidence-based health promotion campaign are to be intricately implemented in the borough. This is to allow evidential information to the delivered to people to effectively educate them about harmful effect of substance abuse and they can avoid them at the initial stage by avoiding substance abuse habit. Moreover, the campaign is to highlight the need of support of the family and communities along with mention the parental duties to be followed by parents in upbringing of children so that the young adult does not involve in substance abuse and have a safe future.

Rehabilitation opportunity for Substance abusers: The people who are involved in substance abuse are to be supported for effective social and economic rehabilitation. In this purpose, it is recommended that services in Southwark are to be built where professionals would be involved in supporting substance abusers to apply and get jobs so that their mental health can be improved, and they can be engaged in productive actions to avoid being inclined to involve in substance abuse.

Conclusion

The above discussion informs that substance abuse is a key issue in the London borough of Southwark. This is evident as increased number of people are involved in the action and are suffering health issues which is leading them to face increased hospitalisation and early mortality. The substance abuse in mainly a urban health issue because the increased transportation, enhance communication with people, availability of clubs and others other situation support easier availability of substance such as alcohol and drugs to be used. Moreover, the increased economic instability and higher unemployment in the urban area negatively affects the mind of the individuals to make them prone to substance abuse, in turn making it an urban health issue to be tackled. The intervention taken in managing substance abuse at Southwark are implementation of social service and support, drug management helpline, rehabilitation centre and services and others. The recommendations to effectively overcome substance abuse issue in the urban area is recruitment of trained worker in managing the issue, increased health promotion and better rehabilitation of the substance abuser after they cope and overcome the issue.

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