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Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.
All across the United States, individuals, families, communities, and health care systems are struggling to cope with substance use, misuse, and substance use disorders. Substance misuse and substance use disorders have devastating effects, disrupt the future plans of too many young people, and all too often, end lives prematurely and tragically. Substance misuse is a major public health challenge and a priority for our nation to address. The effects of substance use are cumulative and costly for our society, placing burdens on workplaces, the health care system, families, states, and communities. The Report discusses opportunities to bring substance use disorder treatment and mainstream health care systems into alignment so that they can address a person's overall health, rather than a substance misuse or a physical health condition alone or in isolation. It also provides suggestions and recommendations for action that everyone-individuals, families, community leaders, law enforcement, health care professionals, policymakers, and researchers-can take to prevent substance misuse and reduce its consequences.
Harm reduction entails policies, programs and practices aimed at reducing the harms associated with the use of psychoactive drugs in people who are unwilling or unable to stop. The focus is on the prevention of harm, rather than on the prevention of drug use itself. Harm reduction has been a principle of Australia¿s approach to drug use for several decades. However, recent overdose deaths and hospitalisations at music festivals have highlighted the clear harms of illicit drug use and prompted a debate over the introduction of pill testing, with political leaders being reluctant to implement the measure.
Since the First International Conference on the Reduction of Drug-Related Harm, held in 1990, the term 'harm reduction' has gained wide currency in the areas of public health and drug policy. Previously the field was characterized by heated struggle between prohibition and legalization of addictive substances, and this debate tended to obscure practical, collective approaches. Harm reduction, an approach which encompasses various policy directives and program initiatives was inspired by the positive outcomes of such public measures as needle-exchange programs for reduction of HIV risk, methadone maintenance programs, education on the risks of tobacco use, and programs designed to limit alcohol consumption. The essays in this book illustrate the scope and vigour of the emerging harm reduction model. The essays, drawn from seven international conferences on harm reduction, cover a wide variety of topics, including public policy, women and reproductive issues, the experiences of special populations, human rights; defining and measuring harm, and intervention. Researchers and practitioners will benefit from the varied papers in the volume, which combine insights into policy-making and front-line outreach efforts with comprehensive conceptual and empirical approaches. Harm Reduction represents an important initiative in making academic work accessible and useful to a larger community, and provides guidance for the development of effective policies and programs.
The EMCDDA's 10th scientific monograph, entitled Harm reduction: evidence, impacts and challenges provides a comprehensive overview of the harm reduction field. Part I of the monograph looks back at the emergence of harm reduction approaches and their diffusion, and explores the concept from different perspectives, including international organisations, academic researchers and drug users. Part II is dedicated to current evidence and impacts of harm reduction and illustrates how the concept has broadened to cover a wide range of behaviours and harms. Part III addresses the current challenges and innovations in the field. The core audience of the monograph comprises policymakers, healthcare professionals working with drug users, as well as the wider interested public -- EU Bookshop.
The opioid crisis in the United States has come about because of excessive use of these drugs for both legal and illicit purposes and unprecedented levels of consequent opioid use disorder (OUD). More than 2 million people in the United States are estimated to have OUD, which is caused by prolonged use of prescription opioids, heroin, or other illicit opioids. OUD is a life-threatening condition associated with a 20-fold greater risk of early death due to overdose, infectious diseases, trauma, and suicide. Mortality related to OUD continues to escalate as this public health crisis gathers momentum across the country, with opioid overdoses killing more than 47,000 people in 2017 in the United States. Efforts to date have made no real headway in stemming this crisis, in large part because tools that already existâ€"like evidence-based medicationsâ€"are not being deployed to maximum impact. To support the dissemination of accurate patient-focused information about treatments for addiction, and to help provide scientific solutions to the current opioid crisis, this report studies the evidence base on medication assisted treatment (MAT) for OUD. It examines available evidence on the range of parameters and circumstances in which MAT can be effectively delivered and identifies additional research needed.
Harm Reduction is a philosophy of public health intended as a progressive alternative to the prohibition of certain potentially dangerous lifestyle choices. Recognising that certain people always have and always will engage in behaviours which carry risks, the aim of harm reduction is to mitigate the potential dangers and health risks associated with those behaviours. Harm Reduction in Substance Use and High-Risk Behaviour offers a comprehensive exploration of the policy, practice and evidence base of harm reduction. Starting with a history of harm reduction, the book addresses key ethical and legal issues central to the debates and developments in the field. It discusses the full range of psychoactive substances, behaviours and communities with chapters on injecting, dance drugs, stimulant use, tobacco harm reduction, alcohol use and sex work. Written by an international team of contributors, this text provides an essential panorama of harm reduction in the 21st century for educators and researchers in addiction and public health, postgraduate students and policy makers.
Addiction is increasingly being recognized as a major global public health issue, and an ever-growing number of medical specialties, psychological and social science training programs, and professional associations are including addiction as part of their training and continuing education curricula. The first edition of this book presented an overview of the spectrum of addiction-related problems across different cultures around the globe. Sharing the experience and wisdom of more than 260 leading experts in the field, and promoted by the International Society of Addiction Medicine, it compared and contrasted clinical practices in the field of addiction medicine on the basis of neurobiological similarities as well as epidemiological and socio-cultural differences. Building on the success of this inaugural edition, and taking into account the formal and informal comments received as well as an assessment of current need, this textbook presents general updated information while retaining the most requested sections of the first edition as demonstrated by the number of chapter downloads. It also provides a basic text for those preparing for the ISAM annual certification exam. Written by some 220 international experts, it is a valuable reference resource for anyone interested in medicine, psychology, nursing, and social science.
Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.
This volume addresses the interface of two major national problems: the epidemic of HIV-AIDS and the widespread use of illegal injection drugs. Should communities have the option of giving drug users sterile needles or bleach for cleaning needs in order to reduce the spread of HIV? Does needle distribution worsen the drug problem, as opponents of such programs argue? Do they reduce the spread of other serious diseases, such as hepatitis? Do they result in more used needles being carelessly discarded in the community? The panel takes a critical look at the available data on needle exchange and bleach distribution programs, reaches conclusions about their efficacy, and offers concrete recommendations for public policy to reduce the spread of HIV/AIDS. The book includes current knowledge about the epidemiologies of HIV/AIDS and injection drug use; characteristics of needle exchange and bleach distribution programs and views on those programs from diverse community groups; and a discussion of laws designed to control possession of needles, their impact on needle sharing among injection drug users, and their implications for needle exchange programs.