Substance misuse and/or abuse, can have significant impacts of the person’s physical and mental health, and the association between drug use, crime and social deprivation, it too can have an impact on society (Meier, Donmall, Barrowclough, McElduff and Heller, 2005). Carly was 14 years old when she was taken into care, after living in a home environment of abuse and violence. Kelly (2000) and Margolin and Gordis (2000) both noted that family violence can prevent psychosocial development in children, and further findings from Reid and Crisafulli (1990), Lindahl (1998) and Buehler, Anthony, Krishakumar, Stone, Gerald and Pemberton (1997) show children externalising problems. Kitzmann, Gaylord, Holt and Kenny (2003) carried out research to identify how violence between partners affects children. They found that violence leads to externalising problems and increased aggression, and these effects were amplified when the violence was physical, rather than verbal, which can be applied to Carly, as she experienced violence. Family violence has shown to be a factor in the abuse of alcohol and drugs (Geller and Ford-Somma, 1984, pp.90). Fergusson and Lynskey (1997) found that those who experienced abusive behaviour during their childhood showed higher rates of drug misuse and mental health problems. This is supported by Smith and Thornberry, (1995) as they find that drug abuse can be caused by maltreatment as children and Widom, (2000) who noted how abuse as a child results in higher likelihoods of drug abuse, and aggressive behaviour.
After Carley left her abusive home, she was sent to a care home, where she was exposed to a range of recreational drugs, and often binged on cheap alcohol. This could be a result of her background, as the aforementioned research suggests, but other factors may participate. Scholars (Steinberg and Silverberg, 1987; Hartup, 1983 and Erikson, 1968) have found that an individual’s peer group can influence their socialisation and interests, while being within a group of peers. Bauman and Ennett (1996) found that peer pressure can have an influence on an individual, which includes substance misuse, and this is further supported by Hawkins (1982) and Robin and Johnson (1996). Within Carley’s case, it is likely that the use of cannabis is common within her and her peers’, as adolescents have increased likelihood of cannabis use, if their peers either use it themselves, or condone its use (Kandel, Kessler and Margulies (1978). The use of long term and regular cannabis use in young people has shown a strong link to abusing other substances later in life (Hall, 2015). This can be seen as Carly used a variety of drugs when she was younger, and has since moved onto a much stronger drug, heroin. Further findings show that regular cannabis use can lead to psychosis and cognitive impairment in adulthood. The most common drugs used in the UK are cannabis (the most common), powdered cocaine (second most common), ecstasy and LSD (Home Office, 2016). As we can see, the likelihood of Carley using cannabis is high, but with powdered cocaine, perhaps not so. Although it is common, it is much more expensive then cannabis. Taking into consideration that she consumes, cheap, alcohol, is it likely that other substances more readily available would be used. For this case, the assumption will be that she uses cannabis, alcohol, and solvents, as it is cheap, readily available and easy to get, and is a common substance misuse with adolescents (Pentel, 1984) and trends have shown that solvent abuse can lead to cannabis and alcohol use (Jacobs & Ghodse, 1988).
The effects of alcohol can have serious impacts on young people as alcohol impairs both motor functions and cognition, and can alter moods (Shokri-Kojori, Tomasi, Wiers, Wang and Volkow, 2017). As Carley engages in engages in anti-social and violent behaviour, alcohol consumption could help promote this behaviour through reduced cognitive functions, and could easily be injured as motor functions are also impaired. Talk to Frank (2018) indicates how binging on alcohol can lead to strokes, liver damage, high blood pressure, cancers and injury due to the reduction of motor functions. The use of cannabis can make Carley anxious and suspicious, and can lead to panic attacks and paranoia (Talk to Frank b) and reduced cognitive capacity (Volkowet al., 2016). Research has shown that heavy or frequent use of cannabis in adolescents has been linked to chronic psychosis (Andréasson, Allebeck, Engström & Rydberg, 1987; Zammit et al., 2002; Van Os et al., 2002; Fergusson, Horwood & Swain-Campbell, 2003; Weiser, Knobler, Noy & Kaplan, 2002; Alvarez-Jimenez et al., 2012; Foti, Kotov, Guey & Bromet, 2010; Di Forti et al., 2013; Galvez-Buccollini et al., 2012; Di Forti et al., 2009; Di Forti et al., 2015). Solvent abuse has effects such as euphoria and excitement, but can also lead to sedation, delusions and hallucinations (Cohen, 1975).
If Carley was to use both substances, the interaction could cause further harm to her. If she was to enter a state of psychosis, while being under the influence of alcohol, she could easily harm herself accidentally, or be in a situation that is making her unsafe (like a fight). This could lead to serious injury, or being taken advantage of. If Carley was to be under the influence of solvents, it could make her vulnerable, especially if taken with other drugs, as it could cause psychotic episodes to worsen, lead to unconsciousness if consumed with alcohol, for example. There is the possibility that her situational awareness is reduced, and may not understand the danger she could be in, especially if she is fighting with others.
Carley has been known to engage in anti-social behaviour and get into fights. A method of explaining this could be through the Life Course Perspective (Elder, 1998). This perspective states that the interactions a child has with their family, creates blueprints for their later life. Caspi, Bem and Elder (1987) explains how early interactions results in the creation of environments that mirror the past environments. Tyler (2006) adapts to say that some youth may encounter more disruptive pathways, which leads instability that can affect them throughout their journey to adulthood. This means that it would be likely for Carley to put herself in hostile and anti-social situations, as this is what she is accustomed to. A possible counteraction to this is Hodges and Tizard (1989) who investigated the impacts that institutional upbringing on children. They found that those who were adopted formed good attachments with their new families, whereas those who returned to their original home, did not. Further findings show that those who spent time in an institution (like a care home), showed difficulties forming and keeping social relationships and attachments, especially with peers.
Carley spent some time in and out of foster homes when she was younger. This indicates that there were issues with her, as at face value it appears the fosterers could not keep her permanently. While there is no clear evidence, it may be a result of a few situations. It could be that her alcohol and drug use has continued to cause issues, as the aforementioned reflects the impacts and affects it can have on Carley. It may be that the foster family simply could not cope with her behaviour. After an individual receives a foster home, externalising problems was common in adolescents, especially if they came from a home background of abuse (Nadeem et al., 2017). Brown and Bednar (2006) found that common reasons for ending a foster placement were: danger to the fosterer’s family, the individual could not adapt to their home and the fosterer could not handle their behaviour. Further finds show that risk factors to placement breakdowns include multiple unsuccessful attempts of fostering and if there was a deficit of external support. Given these potential situations, it is likely that they can be applied to Carley. Carley’s drug and alcohol use could have prevented her from adapting to her new home, especially as these have severe effects on her mentality and behaviour. The effects of substance misuse could be the defining factor for her inability to find a stable home, or building family relationships, and keeping them, takin into account that she regularly engaged in fighting, this could also make the fosterers worried for their family’s safety.
After Carley found a new flat at 18, she met Callum. He was a regular user of heroin, and introduced it to Carley, and she began to smoke it a first to make her feel more relaxed. This shows how Carley has moved on to harder substances, and her motivations also changed. Initially, her substance misuse was influenced by her peers, whereas now it seems it is used as a method of coping and relaxing after being introduced to it.
The use of drugs can have an impact on an individual’s social network. Sociological theories suggest that one’s social life is based on the social interactions they have with others, and that one’s social network supply the interactions to others, and this allows one to understand, learn about, and try to deal with difficulties (Pescosolido, 1992). This theoretical basis can be applied to Carly, as her interactions within foster and care homes have taught her how to handle difficult situation, in this case, resorting to substance misuse and violence. Her relationship with Callum has led to her using harder drugs, and transferring from smoking to injecting, but then she was used as a prostitute in order to source their drugs. Research has found that young adults who conduct risky sexual behaviour, such as prostitution, or sex in exchange for drugs, is influenced by their environment, and social network (Boyer et al., 2013; Boyer et al., 2014; Ellen et al., 2015; Edwards, Iritani and Hallfors, 2006; Cubbin, Santelli, Brindis and Braveman, 2005; Walls and Bell, 2011). Furthermore, exchange of sex for drugs and money is associated with substance misuse (Kaestle, 2012; Woods-Jaeger et al., 2013; Raiford et al., 2014; Patton et al., 2014), and injecting drugs (Edwards el at., 2006; Reilly et al., 2014). Further research (Potterat et al., 1998; Nadon, Koverola and Schlundermann, 1998; El-Bassel et al., 1997; Kuhns, Heide and Silverman, 1992) has shown a high amount of substance misuse within women who are prostitutes, with the key rationale being to fuel their drug addiction (Gossop, Powis, Griffiths and Strang, 1994; Weeks, Grier, Romero-Daza and Puglisi- Vasquez, 1998). Weeks et al., also noted that the gain they receive from drugs, overpowers the negative emotions from their actions. Young, Boyd and Hubbell (2000) argue that, prostitution may continue in order to fuel their addictions, so they can use drugs as a method of dealing with the psychological distress caused by their actions. This can be applied to Carley, as she was forced to go into prostitution, in order to fuel both her and Callum’s addictions. The degrading nature of her actions has also led to the increase of her alcohol consumption, and even stretch to how she has been a victim of domestic violence by Callum. Through the aforementioned research, we can see how substance misuse can both affect Carley herself, her social network through adolescence to adulthood, and how it affects her relationship with Callum.
Newcomb and Bentler (1998) found that the use of drugs increases drug and alcohol problems, and health and family issues. Research has shown that family is a key factor in the intervention and prevention of substance misuse and that substance misuse can affect families and as whole, and individual family members (Valleman, Templeton and Copello, 2005). Quality of parenting has been a factor to the reduction of drug use (Yoshikawa, 1994), and scholars have found that parental behaviour and attitudes can influence substance misuse (Repetti, Taylor and Seeman, 2002; Clark 2004; Olsson et al., 2003; Ary, Tildesley, Hops & Andrews 1993; Forney, Forney & Ripley 1989). The cohesion of an individual and their family can also have an impact on drug use choice and can dissuade them to not have drug users as friends, reducing the likelihood of drug use (Kandel & Andrews, 1987). Research has shown that family members’ health and wellbeing can be compromised by relatives who abuse drugs and alcohol (Orford, 1990; Orford et al., 2005), and scholars have reported that living with a drug abusive family member can cause stress and strain within the family (Velleman and Templeton, 2003; Orford, 1998; Velleman, Arcidiacono, Procentese & Sarnacchiaro, 2008). Furthermore, significant amount of stress can be experiences by relatives of drug users, which is seen psychologically, and physically (Copello. Orford, Velleman, Templeton & Krishnan, 2000). Using this research shows us that because Carley did not have a stable family relationship, with quality parenting, would have made her more likely to use drugs, as that natural deterrent and preventative measure was not in place for her.
Comorbidity of Mental health problems and drug misuse has seen a relationship with an increase in violence (Scott et al., 1998), high costs to services, such as police and the NHS (Hoff and Rosenheck, 1999) and increase in poor treatment outcomes for the service users (Carey, Carey and Meisler, 1991). Within the NHS, the management of comorbidity is a priority (Banerjee, Clancy and Crome, 2002), and within a study by Weaver et al., (2003), three quarters of the sample of drug service patients has at least one psychiatric disorder.
In 2013, worldwide, 250 million people took an illicit drug and there were 187,100 fatalities due to drugs worldwide (United Nations Office on Drugs and Crime, 2015). In the US, it was estimated that eight per cent of the population were considered to have substance use disorder, however, less than one per cent received treatment (SAMHSA, 2014). Whilst there is variety of substance misuse treatment plans that use evidence based foundations, relapse rates after one year, sit at sixty percent (Maisto, Pollock, Cornelius, Lynch & Martin, 2003; Witkiewitz & Masyn, 2008). Mindfulness is the meditation on the present moment, whilst being non-judgemental observing the moments experiences (Kabat-Zinn, 2003, p.145). Scholars have argued that mindfulness is a promising treatment for those who abuse drugs (Chiesa & Serretti, 2014; Katz & Toner, 2013; Zgierska et al., 2009). Mindfulness enhances cognitive awareness, facilitating awareness of consciousness, better monitoring of emotional and cognitive processes (Garland, Gaylord & Park, 2009), accepting thoughts and feelings rather than judging them. Research by Garland, Manusov et al., (2014) and Witkiewitz, Bowen et al., (2014) has found that mindfulness could help increase meta cognition awareness of the craving, drug use and seeking cognitive processes. Further findings suggest that mindfulness can increases the user’s attention to triggers and urges to use drugs, which allows the user to interrupt the cognitive cycle and psychological mechanisms by learning to use positive coping strategies. Mindfulness training can teach users to not react to stress and the urges to use drugs (Garland, 2014). Advanced mindfulness training can desensitise user’s the key triggers that encourage substance misuse, and focus their attention on their breathing or other stimuli (Garland et al., 2014a; Witkiewitz, Bowen et al., 2014b), mindfulness training could increase management of stress, reducing the effects of stress induced substance misuse. Research has shown that mindfulness can affect the cognitive functions responsible for rumination (mentally replaying negative situations that have happened in the past) and drug use related factors, reducing the risk of relapse and cravings for the drug (Garland Froeliger and Howard, 2014b; Hölzel et al., 2011).
One variation of mindfulness in mindfulness based relapse prevention. Acceptance and Commitment Therapy (ACT) (Hayes, Strosahl and Wilson, 1999) is the use of theory of cognition and behaviour to increase self-control by recontextualising maladaptive cognitions and experience acceptance (Hayes, 2004) for nicotine addicts. Research by Gifford et al. (2004) found that ACT showed increased results in the long run when compared to other therapies, such as nicotine replacement therapy. Research shows that the attempts to supress thoughts increases unwanted thoughts, not decrease them (Wegner, 1997; Wegner, Schneider, Carter and White, 1987). Linehan et al. (1999) found that Dialect Behaviour Therapy, significantly reduced drug use to those who received Treatment-As-Usual (TAU) community based programmes, and that the majority of participants taking DBT maintained their participation compared to TAU.
Cognitive Behavioural Therapy (CBT) has been implemented for drug and alcohol disorders. The Cognitive Behaviour (CB) model of relapse (Marlatt and Gordon, 1985) was created to respond to high risk situations, to impose a healthy coping strategy that reduces the effects of urges to use drugs. Research shows that community reinforcement or other relapse prevention enforcement, paired with contingency management (Budney and Higgins, 1998) and pharmacotherapy and relapse prevention (Fiore, Smith, Jorenby and Baker, 1994) and one of the most successful treatments, especially with poly-drug use. Relapse prevention in particular, is highly effective with cocaine use (Schmitz, Stotts, Rhoades and Grabowski, 2001) and cannabis dependency (Roffman, Stephens, Simpson and Whitaker, 1990). Studies have shown that for drug addictive disorders have been both effective and efficient in treatment (Carroll, 1996; Kadden, 2001; McCrady and Ziedonis, 2001). CBT has been shown to be a cost effective and clinically effective in abstinence within alcoholics (Finnery and Monahan, 1996; Kadden, 2001; Longabaugh and Morganstern, 1999) and aids the prevention of relapse (Carrolll, 1996; Irvin, Bowers, Dunn and Wang, 1999). Carroll (1996) investigated the effectiveness of relapse prevention in cocaine, smoking, marijuana and alcohol addiction, and found it to be more effective then no treatment, but as effective compared to support groups (Stephens, Roffman and Simpson, 1994) and interpersonal and interactional therapies (Ito, Donovan and Hall, 1988). Scholars have also found that the use of relapse prevention also reduces the negative effects that occur when relapse has happened (O’Malley et al., 1996 and Davis and Glaros, 1986). Carroll argued that the positive impacts of relapse prevention may continue over time, whereas other treatments may not, only impacting the user for a short amount of time (Carroll, Rounsaville and Gawin, 1991; Hawkins, Catalano, Gillmore and Wells, 1989 and Carroll, Rounsaville, Nich and Gordon, 1994).