Interventions For Substance Abuse Amongst Young People

Despite the fact that young people are most often the healthiest group of people in the population (Emmelkamp, and Vedel, 2006), there is concern about the extent to which this group engages in risk-taking behaviours, including the consumption of drugs and alcohol and the abuse of these substances. Such activities expose them to problems ranging from the individual health level to the costs incurred during rehabilitation (Berglund, Thelander & Jonsson, 2003). Rehabilitation needs often include mental health and psychiatric solutions due to the mental health and social problems caused by drinking and the consumption of illegal drugs.

In the UK, the use of psychoactive substances has become a major activity among the youth population. For example, it has been shown that 50% of young people in the age bracket 16-24 years have used an illicit drug on at least one occasion in their lives. This project also exposed that the most commonly used drug is cannabis which is used by 40% of youths aged 16-19 years and a shocking 47% of 20-24 year olds. Amphetamine then follows which is used by 18-14% of the above age groups. Between 2011 and 2012, 20,688 young people accessed substance misuse services, with the majority of this number accessing services for abuse of cannabis (64%) or alcohol (29%) (National Drug Treatment Monitoring System, 2012). Over half of the users were aged 16 to 18 (53%), whilst the rest were aged under 16 (National Drug Treatment Monitoring System, 2012). About two thirds (64%) of the young people who accessed specialist substance misuse services in 2010-11 were male. Overall, females accessing substance misuse services for young people are younger with 19% of males aged under 15 years compared to 27% of females. Almost half of the young people entering specialist substance misuse services are recorded as being in mainstream education, such as schools and further education colleges, followed by a further 19% in alternative education, such as schooling delivered in a pupil referral unit or home setting. A further 19% are recorded as not in education or employment. However, it should be noted that education and employment status was reported for only new young people entering specialist services during the year. Therefore, the total will be lower than that of all young people (National Drug Treatment Monitoring System, 2012). Referrals to drug and alcohol treatment services commonly come from youth offending teams, although around 14% of referrals come from mainstream education institutions and 7% are made up of self-referrals. Perhaps surprisingly referrals from the Child and Adolescent Mental Health service (CAHMS) make up only 3% of referrals (National Drug Treatment Monitoring System, 2012).
These figures paint a perhaps surprising picture. For example, more young people are referred to specialist drug and alcohol services from mainstream education than specialist educational centres, suggesting that substance abuse could be far rifer amongst young people as might be expected. It could be argued that failure of school authorities to take a more effective preventative approach to drug and alcohol abuse may be contributing to the overall problem. These figures also suggest that immediate attention and intervention must be offered to young people to reduce negative outcomes associated with such high drug use.
The statistics reveal that there is a high rate of drug and substance abuse among young people in the UK. The high of level concern about the use of illicit drugs and substances has an effect on health, educational and political discussions in the UK. The government’s national strategy for ten years on drug misuse views young people as a critical priority group in need of quick prevention and treatment intervention (Keegan and Moss, 2008) and recognises the need to improve our understanding of the role played by illicit drugs and substances in the lives of such young people. Educators, health practitioners and policy makers should have comprehensive understanding when it comes to discussions involving the abuse of illicit drugs. For example, the Government must take into account factors such as a lack of understanding amongst young people as to the laws that govern different classes of illegal drugs.
Abuse of alcohol and other drugs leads to the destruction of cognitive and emotional development in young people and exposes them to an increased possibility of accidental injury or even death. Finally, there is also a risk of users becoming drug dependent. Abuse of drugs and alcohol by young people can also lead to such negative consequences as coronary heart diseases, lung cancer, AIDS, violent crime, child abuse and unemployment (Gurnack, Atkinson & Osgood, 2002). As a result, individuals indulging in the use of alcohol and other drugs incur tremendous costs in their individual lives, their family lives and even their future careers. Society is also not exempt as it pays a price in different ways. For instance, society incurs extra costs in health care, drug and alcohol treatment, law enforcement and supporting the seriously affected families who have been rendered helpless by the situation.
There are many reasons why young people become involved in substance abuse. From a sociology perspective it has been argued that the recreational abuse of drugs has become ‘normalised’ (Parker, Measham and Aldridge, 1995) among certain groups of young people. However, Shiner and Newburn (1997) have argued that this theory is reductionist and simplifies the reasons behind a young person’s choice to abuse drugs. In reality, the reasons as to why a young person may begin to abuse drugs can range from having poor adult role models who may also use drugs and alcohol as a way of coping or even a genetic predisposition toward poor self-regulatory behaviours (Spooner and Hall, 2002). Evidence shows that adolescent alcohol and drug abuse is not influenced by a single factor but a large number of factors which are not necessarily confined to any single part of the an adolescent’s world (Connors, Donovan & DiClemente, 2001).
The environment in which a person lives is very instrumental when it comes to the kind of life that people lead, especially young people. If the environment is for example characterized by pronounced unemployment then young people in such an environment will indulge in activities that make them forget even for a moment the realities of the unemployment situation. If, for example, in their immediate environment young people face the situation of a large supply of drugs and everyone around them is abusing drugs or alcohol, then it is easy for such young people to adopt this kind of lifestyle and become drink or drug abusers. The above explanation shows that the kind of environment a young person stays in has a very direct influence on the habits that are finally adopted by this group of young people.
Young people naturally have the tendency to try new things and to find out how it feels doing something new. Young people in the United Kingdom are not an exception and most of them usually try drinking and drugs just to explore and find out what the experience is like. This however results in the young people becoming victims of the consequences that follow (Woo and Keatinge, 2008).
The Defence Mechanism
A good number of young people use drugs specifically to assist them in easing trauma that may result from unsatisfactory relationships and also physical or emotional abuse that may arise from families or homes that lack happiness.
Promotion and Availability
There is always a great amount of pressure from advertisement of alcohol over the media. The colourful nature of these promotions is often very enticing and mostly misleading. In the promotions or commercials, alcohol is glamorised hence the young people are influenced to indulge and as a result end up facing the dire consequences.
This review will analyse the different interventions utilised when working with young people who abuse drugs and alcohol. These include those carried out by mental health workers, religion-orientated interventions, community based interventions and more psychiatric, medication based interventions. Motivational based interventions are also discussed.
Aims and Objectives
The aim of this project will be to review and critically evaluate the literature regarding different interventions for young people who abuse drugs and alcohol in the UK. To achieve this aim the project has set the following objectives:
To critically examine the interventions for young people (aged 16 to 21) who use drugs and alcohol in UK, with the aim of providing recommendations to improve the care given to the youths who are addicted or at risk of substance abuse.
To use secondary data to identify the importance of different interventions in dealing with young people (age 16 to 21) who use drugs and alcohol in the UK.
Interventions for young people aged 16 to 21 who use drugs and alcohol has elicited varied opinions from professionals involved in their care. This has been a result of the often complex and varied needs of young people with substance abuse issues, such as mental health issues (Weaver et al., 2003), social exclusion (Fakhoury and Priebe, 2006) and involvement with the criminal justice system (Hamdi and Knight, 2012; Lundholm et al., 2013). Therefore, there is often disagreement on where the intervention should focus primarily.
Various strategies have been advanced to address the involvement of young adults in drugs and substance abuse. For example, medication by mental health nurses in cases of addiction (Bennett and Holloway, 2005). However, due to the variety of interventions available for treating young people with substance abuse disorder, it is important to continuously review the literature in this area and pin point the most effective interventions for treating this group of individuals.
[Client must write some words here on why they have chosen this topic (this is essential according to the assignment brief).]
In preparation for this critical literature review, a number of sources including journals, articles and health text books were used. The search was conducted using computerised databases which enabled access to literature on interventions for young people who abuse drugs and alcohol. Examples of such databases are given below:
The Department of Health
NHS Evidence (National Institute for Health and Clinical Excellence, 2012).
PsycINFO (American Psychological Association, 2013).
PubMed (National Center for Biotechnology Information, 2013).
Google Scholar (Google, 2013).
net (EMAP Publishing, 2013).
Nursing and Midwifery Council publications (Nursing and Midwifery Council, 2010).
Royal College of Psychiatrists useful resources (Royal College of Psychiatrists, 2013).
Royal College of Nursing library services (Royal College of Nursing, 2013).
These databases contained numerous useful sources such as journal articles, recommendations, guidelines and reviews that were used to gather evidence relevant to interventions for young people who abuse drugs and alcohol. Search terms used included; ‘drugs and substance abuse’, ‘alcohol abuse’, ‘effects of alcohol abuse’, and ‘intervention measures for drugs and substance abuse[1]’. It was not uncommon for a search to produce many results. Therefore, for any search that produced more than 50 results, the first 50 results were observed to pick out the most relevant and interesting studies. The remaining results were not looked at because of time constraints[2]. In addition to searching for relevant sources through online databases, reference lists within articles were also utilised to search for other relevant sources.
Inclusion Criteria
For an effective review of the subject area, there was a need to select relevant articles to achieve the set objectives. Therefore, only sources relevant to intervention for young people who abuse drugs and alcohol, papers published in the English language and papers published after the year 1999 were selected. Although sources pertaining to studies carried out in the USA were still considered relevant, a priority was given to sources from the UK. If a source had used an adult sample but was still considered relevant and useful then it was considered for inclusion.
Exclusion Criteria
General papers on drugs and substance abuse not specific to youths, papers published in languages other than English and published before the year 1999 were not included.
An example search strategy when using one of these sources, the British Nursing Index, is given below.
Search Strategy Example: British Nursing Index (BNI).
Through citing the term ‘intervention for young people who abuse drugs and alcohol’, 5,000 articles were gathered without limiters. Limiters such as ‘role of mental health nurses’ and ‘only book and journals concerned with drugs and substance abuse’ were applied to the second search, which reduced the output to 2,034 books and journals. In the third search, additional limiters such as year of publication (2000-2012) were applied, which then reduced the number of books and journals to 734. After all further limiters were applied, such as articles that only used an age group of 16 to 21 years as participants, 70 journals and books were chosen for further analysis. Only 23 articles were considered relevant for this review and analysis due to their in depth exploration of the subject and their meeting of inclusion and exclusion criteria.
Interventions for substance abuse serve a number of purposes including reducing use of illicit or non-prescribed drugs and curbing problems related to drug misuse, including health, social, psychological and legal problems and last but not least tackling the dangers associated with drug misuse, including the risks of HIV, hepatitis B and C and other blood-borne infections and the risks of drug-related death.
Prevention and intervention are usually categorised into primary (direct prevention), secondary (early identification of the problem and subsequent treatment) and tertiary levels (late identification and treatment). Furthermore, interventions are now often categorised into population wide interventions, selective interventions aimed at only high risk groups and early interventions for at-risk groups (Cuijpers, 2003). The nature of interventions has also evolved over the years. Twenty to thirty years ago the emphasis was on providing young people with information and buffering moral values whereas in the more modern era, a social dimension has been added and young people are taught resistance skills to avoid peer pressure (Gilvarry, 2000).
Alcohol related deaths are rife in the UK, with 8,748 alcohol related deaths in the UK in 2011 (Office for National Statistics, 2013). However, there were 1,883 noted drug related deaths in 2010, a decrease of 299 from 2009 (Ghodse et al. 2012). These statistics reflect the importance of interventions for drug abusers, which could be protecting some individuals from the most extreme consequence of substance abuse.
Mental Health Interventions
Research has evidenced that Major Depressive Disorder (American Psychiatric Association, 1994) is often co-morbid in young people who abuse drugs and alcohol (Sutcliffe et al., 2009; Marshall and Werb, 2010; Marmorstein, Iacono and Malone, 2010). Due to the potentially devastating effects of depression at both the individual (Galaif et al., 2011; Petrie and Brook, 2011) and societal level (Sobocki et al., 2006), substance abuse is viewed as something that must be dealt with swiftly and effectively. This co-morbidity of mental illness and substance abuse means that mental health nurses are often involved in interventions with young people. Mental illness is a psychological anomaly that is generally associated with distress or disability that is usually not considered to be a component of an individual’s normal development (Nursing and Midwifery Council, 2008). Despite the fact that standard guideline criteria are used all over the world to define mental illness, diagnosis and intervention is often incredibly complex, especially when substance abuse is also a factor.
Community services are offered to people with such problems through assessment by different psychiatrists and clinical psychologists, or sometimes social workers. All these professionals use methods of observation and inquiries through asking questions to help establish any given patient’s condition. Mental health nurses are often at the front line in providing care and support in both hospitals and the community. In the United Kingdom, mental health nurses play a great role in taking care of young people with mental disorders and mental illnesses that may have developed as a result of substance abuse (Department of Health, 2012). They offer counselling services in order to help people focus on their goals or outcomes; help people develop strategies that support self-care and enable individuals and their families to take responsibility for and participate in decisions about their health. They provide a range of services including education, research and knowledge sharing and evidence informed practices.
They also perform the role of addiction counsellors in order to provide intake co-ordination, assessment, treatment and follow-up care for youths with addictions, mental illness and mental health problems using common assessment tools. They can provide health promotion, prevention and early detection of problematic substance use; use core competencies and knowledge in addictions and a full range of withdrawal management services including detoxification services using best practice treatment protocols, outreach, prescribing, counselling, and harm reduction However, mental health nurses are often faced with challenges that hinder them from successfully achieving their goals. Challenges include non co-operation of the patients’ families and also the complex nature of patient problems (Nursing and Midwifery Council, 2008). In a comprehensive review, RachBeisel, Scott and Dixon (1999) found that there was a much higher prevalence of substance abuse amongst individuals with mental illness and that the course of mental illness was significantly negatively influenced by the abuse of illegal substances. These findings highlight a key issue in mental health interventions for young people who abuse substances, namely that it is important to determine the relationship between the substance abuse and mental illness before allocating a suitable intervention. For example, if a young person has developed a mental illness as a result of abusing substances, a mental health focused intervention may not be appropriate as it would not be treating the root of the problem or the reason why the young person started to use illegal substances in the first place.
Psychiatric and Medical Interventions
Psychiatric and medical based interventions refer to the treatment of substance abuse in a young person by a psychiatrist who is medically trained and able to provide an additional dimension of treatment than a psychologist or mental health worker is able to. An example of this is the prescription of methadone, a synthetic opiate that is used to help young people withdraw safely from heroin use. The National Institute for Health and Clinical Excellence (2007) recommend a psycho-social approach when treating individuals with substance abuse disorder and advocate the use of medication. However, use of medication with young people who are suffering from substance abuse disorders should be used with care due to the risk of dangerous side effects (Webster, 2005).
Motivational Interventions
Motivational interventions are brief interventions used by professionals to enhance a young person’s motivation to change and stop abusing substances (Tevyaw and Monti, 2004). In a review of the effectiveness of motivational interviewing (Smedslund et al., 2011) it was found that although motivational interviewing techniques were more effective at reducing the extent of future substance abuse when compared to no intervention, the technique was no more effective when compared to other types of intervention. For example, motivational interviewing was no better at reducing extent of substance abuse that simply assessing a patient and providing feedback. The authors reviewed 59 studies that had been accessed from a range of online databases. This is a reasonable number of studies as the body of literature on motivational interviewing as an intervention for substance abuse is quite limited. However, the authors failed to collect evidence on other measures of efficacy such as a reduction in future criminal prosecution for drug offences or improvement in overall quality of life. The efficacy of motivational interviewing has been studied in young people in particular by McCambridge and Strang (2003). 200 young people from inner city London were randomly allocated to either a motivational interviewing condition or a non-intervention education control condition. All participants were aged between 16 and 20 and were using illegal drugs at the time of the study. The motivational interviewing intervention consisted of a brief, one hour face-to-face interview and self-reported changes in the use of cigarettes, cannabis, alcohol and other drugs was used as the outcome measure both immediately after the interview and at a three month follow up point. It was found that in comparison to the control group, young people who received motivational interviewing as a brief intervention reduced their use of cigarettes, alcohol and cannabis. Although these results initially seem in favour of motivational interviewing as an intervention for young people who have substance abuse issues, it should be noted that self-report measures are very open to bias and it is possible that the reported reduced use of drugs and alcohol was much higher than the actual reduction in use. This was reflected in a follow up study by the same authors 12 months later (McCambridge and Strang, 2005) where it was found that the difference in reduction in substance use between the experimental and control groups found after three months had completely disappeared. This result suggests that although motivational interviewing may be an effective short term intervention for treating young people with substance abuse issues, it has no enduring effectiveness over a long period of time. This may be due to a lack of follow-up support for young people and the brief nature of the intervention.
Community-Based Interventions
Community drug and alcohol services offer interventions such as comprehensive assessment and recovery care planning, support and care co-ordination, advice and information, stabilisation, counselling and relapse prevention and motivational interviewing (Nursing and Midwifery Council, 2008). Hepatitis B vaccinations, Hepatitis C testing and referral to treatment for these diseases, are also essential due to the risk of infections through needle sharing. Like most interventions, these community services are aimed at promoting recovery from addiction and enabling the achievement of individual goals, helping individuals to remain healthy, until, with appropriate support, they can achieve a drug-free life. This may involve stabilising service users on prescribed substitute medication to improve withdrawal symptoms and to reduce cravings. In their review of community-based interventions, Jones et al. (2006) found a limit on the effectiveness of such interventions, especially when it came to long term and enduring effect for reducing substance abuse. The results suggested that a change in community-based interventions was needed. Morgenstern et al. (2001) found a very high level of satisfaction among community based substance abuse counsellors who had received training in delivering cognitive behavioural therapy (CBT) to clients. This suggests that perhaps one way of increasing the effectiveness of community-based interventions would be to equip community-based workers with a wider range of skills with which they can help young people suffering from substance abuse. Supporting this recommendation was a study by Waldron and Kaminer (2004) who found that use of CBT was associated with clinically significant reductions in substance abuse amongst adolescents.
Religious Interventions
Some interventions are religious in nature. For instance, the United Methodist Church follows a holistic approach which stresses prevention, involvement, treatment, community organization, and advocacy of abstinence. The church could be argued to have a progressive role by offering a spiritual perception on the issue of substance abuse. Another popular religious based approach to tacking alcohol abuse in particular is the 12-step program offered by Alcoholics Anonymous. Individuals are commonly encouraged or possibly even required cut any acquaintances with friends who still use alcohol. The 12-step programme motivates addicts to stop consuming alcohol or other drugs and also it helps to scrutinize and modify the habits related to their cause of addiction. Numerous programs accentuate that recovery is a long-lasting process with no culmination. For drugs which are legal such as alcohol, complete abstinence is recommended rather than attempts at moderation which may cause relapses. Fiorentine and Hillhouse (2000) found that participants in a 12-step program stayed in future treatment for a much longer period of time and were much more likely to be able to complete a 24-week intervention programme. It was also found that a combination of a 12-step program and an alternative substance abuse intervention was more effective than either treatment alone. This suggests that providing young people with interventions in isolation may not be the most effective way of helping them overcome their substance abuse. However, literature on religious based interventions tends to focus on adults and although still applicable to the treatment of young people in many ways, young people may be put off by the religious nature of these 12-step programmes and may be intimidated by the group nature of the treatment. In support of this criticism, Engle and MacGowan (2009) found that only two out of 13 adolescent group treatments of substance abuse could be categorised as showing potential efficacy in treating young people with these problems.
Family-Oriented Interventions
It has been argued that the family has a central role in both increasing and reducing the risk of problem behaviours in young people such as substance abuse (Vimpani and Spooner, 2003). A review by Velleman, Templeton and Copello (2005) echoed this view that the family can have both a positive or negative impact on a young person’s risk of substance abuse. Kumpfer, Alvarado and Whiteside (2003) have identified that support for families based within the home, family education and skills training, improving parental behaviour and time-limited family therapy are all highly effective forms of family-based interventions for young people with substance abuse issues. However, as research has shown that the family can also play a role in increasing risk of substance abuse, professionals must be confident that family therapy is suitable and not run the risk of worsening a young person’s relationship with their family and in turn worsening their substance abuse.
School-Based Interventions
Education about the use of drugs and alcohol within schools has been advocated as a preventative intervention for young people at risk of substance abuse disorder. Fletcher, Bonell and Hargreaves (2008) found that interventions focused around encouraging a positive school environment and improving young peoples’ relationships was associated with a reduction in risky substance abuse. However, part of this conclusion was based on the review of observational studies, which are open to bias and subjectivity.
This essay has reviewed a number of sources regarding the efficacy and suitability of certain interventions for young people with substance abuse issues. A key limitation of much of the literature is the tendency to put emphasis on drugs as a generic material with very little distinction is made between different types of illicit substances. With the very varied effects of different drugs on the user, it could be argued that the specific reasons for a young person’s drug usage will have an impact on the effects that a drug has. For example, stimulant drugs will most likely be used for nervous system arousal, while other drugs such as alcohol and cannabis are sedatives and cause nervous system depression. These kinds of drugs can be termed as instrumental drugs since the reasons behind their usage correspond to the effect of the different kind of drug that is used (Brick, 2008). Therefore, it might be useful for professionals to base their interventions on the types of substance abused.
From the above literature review it is evident that there is need for mental healthcare especially to help young people who are adversely affected by the use of drugs and other substance abuse. Some youths suffer from psychiatric disorders as a result of indulgence in drugs and substance abuse. Others experience mental problems that need serious rehabilitation measures taken in order to counter such problems hence emphasis should be laid on the care that is to be given to the young people affected by any of the above problems caused by the abuse of drugs and other substances. Therefore, mental health interventions remain an important intervention for young people.
A number of recommended adjustments in healthcare to cater for young people struggling with abuse have been identified. For example, there should be an increased application of various musical strategies in helping patients suffering from various mental health conditions as a result of substance abuse (Connors, Donovan & DiClemente, 2001), as this kind of intervention appears to be lacking in use with young people.
Another main limitation in research that aims to measure the effectiveness of intervention measures is the lack of control that researchers have. It would be considered unethical if young people with drug abuse problems were randomly allocated to intervention procedures, especially if one was chosen as a control condition and was not believed to be effective in treating substance abuse issues. This means that it can be difficult to compare intervention methods. Another limitation lies in the types of measure researchers’ use to measure effectiveness of intervention methods. For example, a self-report measure may be used to assess whether young people have either stopped or at least reduced their intake of illicit substances. This type of questionnaire may also be used to see if the young people are seeing a positive result from receiving an intervention. However, self-report measures are open to social desirability bias meaning that many young people may fabricate their answers in order to either please the professionals who are involved with helping them or to conceal ongoing substance abuse.
The review has also emphasized the causes or triggers of alcohol and drug abuse among young people in the United Kingdom showing that the environment a young person stays in is one of the greatest factors that lead to indulgence in alcohol, drug and substance abuse. Other factors like enjoyment, peer pressure, promotions in the media and rebellion are also causes of alcohol, drug and substance abuse among the youth in the United Kingdom (Gurnack, Atkinson and Osgood, 2002). More focus on these root causes could help improve prevention and reduce the need for later intervention, which has a poor track record of success.
Finally, there is need according to the literature review to improve media perception of mental health patients in order to help alleviate the conditions of psychiatric disorders that are caused by the indulgence of young people in alcohol, drug and substance abuse (Berglund and Thelander, 2003). This doesn’t indicate failure in the mental nursing services but it just implies that mental health workers and psychiatrists need reinforcement in order to positively contribute to successful intervention (Califano, 2007). This suggestion is based on the need for a more holistic approach when it comes to treating young people with substance abuse issues, where the effect on all areas of their life including their mental health must be taken into account during intervention.
Strengths of this Critical Literature Review
Secondary data was reviewed in this project, which provided larger scope on choices of information for the project. In addition this review was able to identify key areas for improvement of health condition interventions for youths affected by substance abuse.
Limitations of this Critical Literature Review
This literature review was small in scale, since word and time limits were set. Although 23 articles were selected for review, this number could have been improved. This could have provided a greater depth of understanding of the study area. In addition, limited time implicated how the review was to be carried out. The review was to be carried out in a period of less than three months during which time more than 23 articles were to be accessed and critically analysed.
American Psychiatric Association, 1994. DSM-IV. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association.
American Psychological Association, 2013. PsycINFO. [online] Available at: [Accessed 26 March 2013].
Bennett, T. and Holloway, K. (2005). Understanding drugs, alcohol and crime. Maidenhead: Open University Press.
Berglund, M., Thelander, S. and Jonsson, E. (2003) Treating alcohol and drug abuse: An evidence based review. Weinheim: Wiley-VCH.
Brick, J. (2008) Handbook of the medical consequences of alcohol and drug abuse. New York: Haworth Press.
Califano, J. A. (2007). High society: How substance abuse ravages America and what to do about it. New York: Public Affairs.
Center for Mental Health Services (U.S.). (2005) Possible alcohol and substance abuse indicators. Rockville, Md.: U.S. Dept. of Health and Human Services.
Connors, G. J., Donovan, D. M. and DiClemente, C. C. (2001) Substance abuse treatment and the stages of change: Selecting and planning interventions. New York: Guilford Press.
Cuijpers, P. (2003) Three decades of drug prevention research. Drugs: Education, Prevention and Policy, 10(1), pp. 7-20.
Department of Health (2012) Not Another One: Yet More Policies to be Read, Signed and Filed. London: HMSO.
EBSCO, 2012. Cumulative Index to Nursing and Allied Health Literature. [online] Available at: [Accessed 26 March 2013].
EMAP Publishing, 2013. Nursing Times. [online] Available at: [Accessed 26 March 2013].
Emmelkamp, P. M. G. and Vedel, E. (2006). Evidence-based treatment for alcohol and drug abuse: A practitioner’s guide to theory, methods, and practice. New York: Routledge.
Engle, B. and MacGowan, M.J. (2009) A critical review of adolescent substance abuse group treatments. Journal of evidence-based social work, 6(3), pp. 217-243.
Fakhoury, W.K.H. and Priebe, S. (2006) An unholy alliance: substance abuse and social exclusion among assertive outreach patients. Acta Psychiatrica Scandinavica, 114(2), pp. 124-131.
Fiorentine, R. and Hillhouse, M.P. (2000) Drug treatment and 12-step program participation: The additive effects of integrated recovery activities. Journal of Substance Abuse and Treatment, 18, pp. 65-74.
Fletcher, A., Bonell, C. and Hargreaves, J. (2008) School effects on young people’s drug use: A systematic review of intervention and observational studies. Journal of Adolescent Health, 42(3), pp. 209-220.
Galaif, E.R., Sussman, S., Newcomb, M.D. and Locke, T.F. (2011) Suicidality, depression, and alcohol use among adolescents: A review of empirical findings. International Journal of Adolescent Medicine and Health, 19(1), pp. 27-35.
Ghodse, H., Corkery, J., Schifano, F., Piolanti, A., Trincas, G. and Melchiorre, G.D. (2012) Drug related deaths in the UK. Annual Report 2011. London, UK: International Centre for Drug Policy.
Gilvarry, E. (2000) Substance abuse in young people. Journal of Child Psychology and Psychiatry, 41(1), pp. 55-80.
Google (2013) Google Scholar. [online] Available at: [Accessed 26 March 2013].
Gurnack, A. M., Atkinson, R. M. and Osgood, N. J. (2002) Treating alcohol and drug abuse in the elderly. New York: Springer Publications.
Hamdi, N.R. and Knight, R.A. (2012) The relationships of perpetrator and victim substance use to the sexual aggression of rapists and child molesters. Sexual Abuse – A Journal of Research and Treatment, 24(4), pp. 307-327.
Home Office (2012) Illicit drug use among 16-24s tales Drug Misuse Declared: Findings from the 2011/12 Crime Survey for England and Wales. [online] Available at: [Accessed 27 March 2013].
Jones, L., Sumnall, H., Witty, K., Wareing, M., McVeigh, J. and Bellis, M. (2006) A review
of community-based interventions to reduce substance misuse among vulnerable and
disadvantaged young people. London: National Institute for Health and Clinical Excellence.
Keegan, K. and Moss, H (2008) Chasing the high: A firsthand account of one young person’s experience with substance abuse. New York: Oxford University Press.
Lundholm, L., Haggard, L., Moller, J., Hallqvist, J. and Ingemar, T. (2013) The triggering effect of alcohol and illicit drugs on violence crime in a remand prison population: A case crossover study. Drug and Alcohol Dependence, 129(1-2), pp. 110-115.
Marmorstein, N.R., Iacono, W.G. and Malone, S.M. (2010) Longitudinal associations between depression and substance dependence from adolescence through early adulthood. Drug and Alcohol Dependence, 107(2), pp. 154-160.
Marshall, B.D.L. and Werb, D. (2010) Health outcomes associated with methamphetamine use among young people: a systematic review. Addiction, 105(6), pp. 991-1002.
McCambridge, J. and Strang, J. (2003) The efficacy of single-session motivational interviewing in reducing drug consumption and perceptions of drug-related risk and harm among young people: result from a multi-site cluster randomised trial. Addiction, 99, pp. 39-52.
McCambridge, J. and Strang, J. (2005) Deterioration over time in effect of Motivational Interviewing in reducing drug consumption and related risk among young people. Addiction, 100(4), pp. 470-478.
National Center for Biotechnology Information (2013) PubMed. [online] Available at: [Accessed 26 March 2013].
National Drug Treatment Monitoring System (2012) Statistics for young people in specialist drug and alcohol services in England 2011-12. London, UK: National Drug Treatment Monitoring System.
National Institute for Health and Clinical Excellence (2007) Drug misuse: psychosocial interventions: full guidelines. London: National Institute for Clinical Excellence.
National Institute for Health and Clinical Excellence (2012) NHS Evidence. [online] Available at: [Accessed 26 March 2013].
Nursing and Midwifery Council (2008) Code, Standards for conduct, performance and ethicsfor nurses and midwives.
Nursing and Midwifery Council (2010) Publications. [online] Available at: [Accessed 26 March 2013].
Office for National Statistics (2013) Alcohol-related deaths in the United Kingdome, 2011. London, UK: Office for National Statistics.
Parker, H.J., Measham, F. and Aldridge, J. (1995) Drugs futures: changing patterns of drug use amongst English youth. London: Institute for the Study of Drug Dependence.
Petrie, K. and Brook, R. (2011) Sense of coherence, self-esteem, depression and hopelessness as correlates of reattempting suicide. British Journal of Clinical Psychology, 31(3), pp. 293-300.
RachBeisel, J., Scott, J. and Dixon, L. (1999) Co-occuring severe mental illness and substance use disorders: A review of recent research. Psychiatric Services, 50(11), pp. 3.
Royal College of Nursing (2013) RCN library services and archives. [online] Available at: [Accessed 26 March 2013].
Royal College of Psychiatrists (2013) Useful Resources. [online] Available at: [Accessed 26 March 2013].
Shiner, M. and Newburn, T. (1997) Definitely, maybe notThe normalisation of recreational drug use amongst young people. Sociology, 31(3), pp. 511-529.
Smedslund, G., Berg, R.C., Hammerstrom, K.T., Steiro, A., Leiknes, K.A., Dahl, H.M. and Karlsen, K. (2011) Motivational interviewing for substance abuse. Cochrane Database for Systematic Reviews, Issue 5.
Sobocki, P., Jonsson, B., Angst, J. and Rehnberg, C. (2006) Cost of depression in Europe. The Journal of Mental Health Policy and Economics, 9(2), pp. 87.
Spooner, C. and Hall, W. (2002) Preventing drug misuse by young people: we need to do more than ‘just say no.’ Addiction, 97(5), 478-481.
Sutcliffe, C.G., German, D., Sirirojn, B., Latkin, C., Aramrattana, A., Sherman, S.G. and Celentano, D. (2009) Patterns of methamphetamine use and symptoms of depression among young adults in Northern Thailand. Drug and Alcohol Dependence, 101(3), pp. 146-151.
Tevyaw, T.O. and Monti, P.M. (2004) Motivational enhancement and other brief interventions for adolescent substance abuse: foundations, applications and evaluations. Addiction, 99, pp. 63-75.
Velleman, R.D.B., Templeton, L.J. and Copello, A.G. (2005) The role of the family in preventing and intervening with substance use and misuse: a comprehensive review of family interventions, with a focus on young people. Drug and Alcohol Review, 24, pp. 93-109.
Vimpani, G. and Spooner, C. (2003) Minimising substance misuse by strategies to strengthen families. Drug and Alcohol Review, 22, pp. 251-254.
Waldron, H.B. and Kaminer, Y. (2004) On the learning curve: The emerging evidence supporting cognitive-behavioural therapies for adolescent substance abuse. Addiction, 99, pp. 93-105.
Weaver, T., Madden, P., Charles, V., Stimson, G., Renton, A., Tyrer, P., Barnes, T., Bench, C., Middleton, H., Wright, N., Paterson, S., Shanahan, W., Seivewright, N. and Ford, C. (2003) Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. The British Journal of Psychiatry, 183, pp. 304-313.
Webster, L.R. (2005) Methadone-related deaths. Journal of Opioid Management, 1(4), pp, 211-217.
Woo, S. M. and Keatinge, C. (2008) Diagnosis and treatment of mental disorders across the lifep. Hoboken, N.J: John Wiley & Sons.
Appendix A
Search Term: “Drugs and substance abuse.”

SourceNumber of Relevant Hits
Department of Health0
NHS Evidence5597
Google Scholar1,070,000
Nursing and Midwifery Council59
Royal College of Psychiatrists477
Royal College of Nursing library services1,753

Search Term: “Alcohol Abuse.”

SourceNumber of Relevant Hits
Department of Health0
NHS Evidence6893
Google Scholar1,480,000
Nursing and Midwifery Council138
Royal College of Psychiatrists629
Royal College of Nursing library services1,654
Search Term: “Effects of alcohol abuse.”

SourceNumber of Relevant Hits
Department of Health0
NHS Evidence5476
Google Scholar1,430,000
Nursing and Midwifery Council40
Royal College of Psychiatrists531
Royal College of Nursing library services2,590

Search term: “Intervention measures for drugs and substance abuse.”

SourceNumber of Relevant Hits
Department of Health0
NHS Evidence3169
Google Scholar174,000
Nursing and Midwifery Council23
Royal College of Psychiatrists302
Royal College of Nursing library services3,250

Appendix B
TitleFirst AuthorPublication Year
1Drug treatment and twelve-step program participation: the additive effects of integrated recovery activities.Fiorentine2000
2A critical review of adolescent substance abuse group treatments.Engle2009
3Co-occuring severe mental illness and substance use disorders: A review of recent research.RachBeisel1999
4Statistics for young people in specialist drug and alcohol services in England 2011-12National Drug Treatment Monitoring System2012
5Substance abuse in young people.Gilvarry2000
6The efficacy of single-session motivational interviewing in reducing drug consumption and perceptions of drug-related risk and harm among young people: results from a multi-site cluster randomised trial.McCambridge2004
7The role of the family in preventing and interviewing with substance use and misuse: a comprehensive review of family intervention, with a focus on young people.Velleman2005
8School effects on young people’s drug use: a systematic review of intervention and observational studies.Fletcher2008
9A review of community-based interventions to reduce substance misuse among vulnerable and disadvantaged young people.Jones2006
10Motivational enhancement and other brief interventions for adolescent substance abuse: foundations, applications and evaluations.Tevyaw2004
11Motivational interviewing for substance abuse.Smedslund2011
12On the learning curve: the emerging evidence supporting cognitive-behavioural therapies for adolescent substance abuse.Waldron2004
13Testing the effectiveness of cognitive-behavioral treatment for substance abuse in a community setting: within treatment and posttreatment findings.Morgenstern2001
14Family-based interventions for substance use and misuse prevention.Kumpfer2003
15Deterioration over time in effect of Motivational Interviewing in reducing drug consumption and related risk among young people.McCambridge2005
16Drug misuse: psychosocial interventions: full guideline.National Institute for Health and Clinical Excellence2007
17Substance abuse treatment and the stages of change: Selecting and planning interventions.Connors2001


What Can We Do to Stop Abuse Animals.

Recently animal abuse is increasing around the world. People are treating animal as non – feeling creatures. They use them for food, clothing, entertainment, and so on. These are some of the biggest crimes humans are doing against speechless creatures. There are many ways to prevent animal abuse but the most importantly everybody should treat animals with respect. First of all, we have to make authorities aware of the fact that animals are being ill-treated by people when you witness them.
Laws will make these people realize their mistake. For example, there was a Singaporean who broke his dog’s legs, just because his dog has eaten his food. One of his neighbors who saw this reported to police. After that this man had to pay $500 for his action. Other examples in Vietnam people hunt elephant for stuck or cows for food. Secondly, recently on some websites appear more videos of animal abuse on the part of young people. This has proven they do not respect and love animals. We should teach them how to treat animals.
Especially with a children, you have to teach children how to treat animal with kindness and respect and considers them as friend. Thirdly, always comply with the laws about animals in your local area. And tell everyone to do it. For example, The Society for the Prevention of Cruelty to Animals (SPCA) in Singapore always takes care of animals, which are neglect and abuse. In conclusion, people should learn more about animal. They are like humans and they need love and care. We have to respect animal.


The Relationship of Childhood Sexual Abuse to Teenage Pregnancy

Running Head: RESEARCH ARTICLE REVIEW Research Article Review The Relationship of Childhood Sexual Abuse to Teenage Pregnancy Ashlee L. Glover Lindenwood University The Relationship of Childhood Sexual Abuse to Teenage Pregnancy I. Questions and Answers 1. “The purpose of this study was to examine the relationship between childhood sexual abuse and teenage pregnancy” (Roosa, Tein, Reinholtz, & Angelini, 1997). 2. “Three research questions guided this effort.
First, do women who were sexually abused as children and women who had teenage pregnancy have similar developmental backgrounds (sociodemographic and risk factor profiles)? Second, does the risk for teenage pregnancy differ, based on whether a woman was sexually abused as a child, sexually precocious, or both? Third, does childhood sexual abuse contribute to an increased risk of having a teenage pregnancy after the influence of other factors related to teenage pregnancy (e. g. , social class) have been accounted for” (Roosa et al. 1997)? 3. “We expect victims of sexual abuse to have first voluntary coitus earlier, to be less likely to use contraception, to be more likely to participate in high-risk sexual behaviors (e. g. , sex with strangers), and to have a higher number of sexual partners than their peers who were not sexually abused” (Roosa et al. , 1997). 4. The variables being studied is sexual history, High-risk sexual behavior, Sexual abuse, Sexual history pathways, childhood physical abuse, and High-risk behaviors. Roosa et al. , 1997). 5. The participants were 2,003 women, 18 to 22 years old, living in Arizona. (Roosa et al. , 1997). 6. “Participants completed the questionnaire alone or in groups. They recorded their responses on computer-scored answer sheets to ease data entry and minimize errors. After completing the questionnaire, a participant placed her answer sheet in an envelope, sealed the envelope, and gave it to either the project manager or agency representative” (Roosa et al. , 1997). 7. We used chi-square and analysis of variance to compare sociodemographic and risk factor profiles of (a) women who were sexually abused as children with their non-abused peers and (b) women who had teenage pregnancy with those who did not. Next, we compared the incidence of teenage pregnancy for five sexual history pathways using chi-square. Finally, we used logistic regression to determine whether experiences of childhood sexual abuse contributed to risk for teenage pregnancy after the influences of other variables had been accounted for” (Roosa et al. 1997). 8. “The results of our study do not support arguments that sexual abuse is a major contributor to the risk for teenage pregnancy” (Roosa et al. , 1997). 9. The importance of the findings is that childhood sexual abuse contributed little to the likelihood of teenage pregnancy. The severity of sexual abuse was not significantly related to teenage pregnancy. Sexual abuse followed by sexual precocity was related to a higher risk of teenage pregnancy for some. (Roosa et al. , 1997). 10. The results were limited by two methodological factors. First, the sample, although large, was a sample of convenience from a single state, and participants were slightly more educated than the average for this cohort. Second, this was a cross-sectional study that relied on the recall of events that occurred several necessary years prior to the survey” (Roosa et al. , 1997). 11. “It may be important for future studies to identify factors that explain the risk associated with sexual abuse for these subgroups” (Roosa et al. , 1997). It was also stated that in the future longitudinal studies are necessary to establish causality. Roosa et al. , 1997). II. Summary The United States has the highest rate of teenage pregnancy with about 25 percent of all U. S. women having a pregnancy by the age of 18 (Roosa et al. , 1997). The purpose of this study was to determine if childhood sexual abuse is a factor associated with an increased risk for teenage pregnancies (Roosa et al. , 1997). Recent studies have reported that sexual abuse is more common among pregnant teenagers than in general population and therefore could possibly be a major contributor to teenage pregnancy.
Many mechanisms have been proposed to explain the linkage between childhood sexual abuse and teenage pregnancy. Roosa et al. , (1997) outlined several mechanisms including (a) some teenage pregnancies may be the direct result of sexual abuse, (b) childhood sexual abuse may socialize female victims to believe that their purpose in life is to fulfill the sexual needs of others, (c) the lowered self-esteem of sexual abuse victims may make them more vulnerable to males’ sexual advances, and (d) victims of incest may plan pregnancies as a means of escaping from their victimization.

Three research questions guided this effort: First, do women who were sexually abused as children and women who had teenage pregnancy have similar developmental backgrounds (sociodemographic and risk factor profiles)? Second, does the risk for teenage pregnancy differ, based on whether a woman was sexually abused as a child, sexually precocious, or both? And for those who experienced both abuse and precocity, does the relative timing of these events make a difference in risk for teenage pregnancy?
Third, does childhood sexual abuse contribute to an increased risk of having a teenage pregnancy after the influence of other factors related to teenage pregnancy (e. g. , social class) have been accounted for? (Roosa et al. , 1997) The variables being studied are sexual history, high-risk sexual behavior, sexual abuse, sexual history pathways, childhood physical abuse, and high-risk behaviors. Sexual history was assessed by asking about the respondent’s age of menarche, first coital experience, use of birth control, and pregnancy (Roosa et al. 1997). Any pregnancy occurring before age 18 was labeled a teenage pregnancy. High risk sexual behavior was described as anyone who had sex for alcohol, drugs, or money; having sex with strangers, having multiple sex partners, and not using birth control (Roosa et al. , 1997). Roosa et al. , (1997) used five mutually sexual history pathways to examine the relationship between childhood sexual abuse and teenage pregnancy: One pathway represented those who reported no precocious sexual activity and no sexual abuse before the age of 18.
A second pathway represented women who were sexually abused before age 18 with no precocious sexual activity. A third pathway represented those who had been abused before their first precocious sexual experience. A fourth pathway represented those who had been abused before age 18 but after their first precocious sexual experience. A fifth pathway represented participants who had not experienced any sexual abuse before the age of 18 but who were sexually precocious. The last measures used were childhood physical abuse.
Eight questions dealing with pking and hitting adapted from the Conflict Tactics Scale (Roosa et al. , 1997). Participants were 2,003 women, 18 to 22 years old, living in Arizona (Roosa et al. , 1997). Participation was limited to this age range to reduce reporting bias due to widely varying time intervals since sexual history events occurred (Roosa et al. , 1997). The women were recruited at 44 sites in urban and rural areas throughout Arizona (Roosa eta l. , 1997). Participants completed the questionnaire alone or in groups, with assistance from the project manager (Roosa et al. 1997). They recorded their responses on computer-scored answer sheets to ease data entry and minimize error (Roosa et al. , 1997). To analyze the results chi-square and analysis of variance were used to compare sociodemographic and risk factor profiles of (a) women who were sexually abused as children with their non-abused peers and (b) women who had a teenage pregnancy with those who did not (Roosa et al. , 1997). Next, they compared the incidence of teenage pregnancy for five sexual history pathways using chi-square (Roosa et al. , 1997).
Finally, they used logistic regression to determine whether experiences of childhood sexual abuse contributed to the risk for teenage pregnancy after the influences of other variables had been accounted for (Roosa et al. , 1997). Using data from 2,003 women this study took three approaches to examine the relationship between childhood sexual abuse and the likelihood of teenage pregnancy. The results of the study did not support the argument that sexual abuse is a major contributor to the risk for teenage pregnancy (Roosa et al. , 1997).
Childhood sexual abuse contributed little to the likelihood of teenage pregnancy in this sample (Roosa et al. , 1997). According to Roosa et al. , (1997), it may be important for future studies to identify factors that explain the risk associated with sexual abuse of different subgroups. Regardless of the strengths of associations found or the number of factors statically controlled, it cannot be determined which relationships may be casual and which may be spurious (Roosa et al. , 1997). Longitudinal studies are necessary to establish causality.


Psychological, Sexual or Physical Types of Child Abuse

Child abuse is physical, sexual and/or psychological abuse or neglect of a child or children, especially by parents or guardians.
It covers all types of physical and/or emotional abuse, sexual abuse, neglect, neglect and exploitation for commercial or other purposes that cause real or potential damage to the health, survival, development or dignity of the child. relationship with responsibility, trust or authority. Often the confusing methods of hiding with ordinary violence, parents try to be “guardians” of the lives of their own children.
By ignoring another attitude, children cannot adequately assess the situation, therefore they do not try to defend themselves, they consider themselves guilty. Child abuse is a global problem with serious consequences for life. The statistics on this subject are quite inaccurate.

Physical abuse of children occurs in all socioeconomic groups, but racial and socioeconomic factors affect the frequency and severity of abuse. A quarter of adults reported experiencing physical abuse during childhood.
Example 1: Domestic Violence and Child Abuse
Domestic violence and child abuse have a tendency to go hand in hand. In the past, people overlooked the fact that in most households where domestic violence kids present, child abuse and neglect also occurs. An improvement in the collaboration between child protection and domestic violence services is vital for workers to identify, interdict, and resolve the issues related to abuse in all forms.
Cross training and interagency cooperation will greatly reduce abuse and increase the efficiency in which help is administered. 4-29-2011 SWK 311 Domestic Violence and Child Abuse Some parents abuse their kids because they have an alcohol or drug problem, or they have an extreme temper and they take it out on their kids, some parents abuse their kids because the parents went through something traumatic. Some parents abuse their children because they were abused when they were children, and then, you get some people who are just plain cruel and enjoy abusing children.
In most instances domestic violence in the family structure also has an impact on the existence of child abuse. Households that experience some form or another of domestic violence also have higher rates of child abuse/neglect issues. We should recognize that domestic violence can also be associated with child abuse and improve the collaboration between child protection and domestic violence services. Child buse and neglect in the context of domestic violence can be played out in a variety of ways; the same perpetrator may be abusing both mother and children, probably the most common scenario; the children may be injured when “caught in the crossfire” during incidents of adult domestic violence; children may experience neglect because of the impact of the violence, controlling behaviors and abuse on women’s physical and mental health; or children may be abused by a mother who is herself being abused.
Evidence is emerging in cases where both domestic violence and child abuse occur represent the greatest risk to children’s safety (Stanley 1997) and that large numbers of cases in which children are killed have histories of domestic violence(Wilczynski 1996). The man of the family is usually the root cause of the problem, however child protection services has a history of focusing on the mother, despite the fact that men are estimated to be responsible for half of the incidents of physical abuse of children, and the majority of the most serious physical abuse.
Most interventions by Child protection have focused on the woman, even when their violent male partners have been known to have committed the abuse of children. This is problematic because this gender bias can result in women being held accountable for “failing to protect” their children from the actions of men who use violence against them and therefore a failure to hold men accountable for the effects of their violence on women and children. An understanding of how domestic abuse effects child abuse is crucial in developing strategies to combat the child abuse problem.
For child protection services to be effective there needs to be an understood collaboration between them and the domestic violence services. Child protection agencies have been slow or failed to recognize the contribution of domestic violence to many situations of child abuse and neglect. Some differences are that child protective services usually deal with involuntary clients, whereas domestic violence service workers deal with people on a voluntary basis.
Child protective services deal with women who may be at a very different stage in recognizing and dealing with the violence in their relationships, than women who contact domestic violence services. For a collaboration to be effective, both agencies must understand each other’s work, what it is and what it isn’t. They must also appreciate the constraints, pressures, and limitations under which they are both operating. Both entities need to realize that domestic violence goes hand in hand with child abuse and vice-versa. Strategies should also be changed by child protection agencies in reference to their approach of men.
They need to learn about legal approaches to contain the violent men, so that they do not merely rely on threats to a mother to physically remove her children. They also need to learn to relate to abused women in ways that do not replicate the controlling and threatening behaviors of the perpetrator. Some interesting ways so that the two agencies could work together is cross-training, integration, and specialized teams. Mandatory cross-training would enable both agencies to realize the identifying factors and how to go about handling them. It would enable the agencies to see the powers and limitations of each other.
Integration of the agencies will also enable them to use to their resources to their fullest potential. It is kind of like the Sherriff’s department and the city police, both are basically doing the same task, but they are two separate entities who rarely communicate with each other. If they merged together and integrated all of their resources they would probably be more efficient. The same goes with child protection and domestic violence services. Specialized teams would also be very beneficial because they could use their special skills to handle very tricky situations.
The teams could team up with the police and court system to find a way to handle the situation. Establishing this “common ground” approach between the two agencies will significantly reduce child abuse in domestic violence households. In response to the growing recognition of the intersection of domestic violence and child abuse and neglect, significant efforts are being made to improve the collaboration between domestic violence and child protection services. This is very important to recognize that one usually affects the other. We must understand and use every available resource to combat the problem.
Instead of standing there with our hands tied behind our backs not being able to do anything, let’s use every available tool and resource that is available to help the child. Anything that can be done to save or at least help any child that is in an abusive situation is worth it.

Stanley, N. 1197, ‘Domestic Violence and Child Abuse: Developing Social Work Practice’, Child and Family Social Work, Vol. 2, No. 3, pp. 135-146
Wilczynski, A. 1996, ‘Risk Factors for Child and Spousal Homicide’, Psychiatry and Behavioral Disorders: Family Law Issues, LAAMS Publications, Bondi Junction

Example 2: Child Abuse And Abandonment
Unfortunately, it is occurring more and more in today’s society that these defenseless children are being robbed of their childhood innocence and happiness and are being forced to face the cruel reality of our world at far too young an age. These Children are victims of neglect and abuse, primarily caused by family members or people they are close to. Child neglect is the most common form of abuse, and is therefore the main subject that will be covered in this essay.
This disturbing and extremely common, yet rarely talked about topic effects at least one out of every 10 children under the age of 14 in Canada alone. Child abuse and neglect are one of the largest problems occurring in society, and in order for the situation to improve, we need to stop ignoring the fact that it is a daily reality, and become better educated on the topic and how to prevent it. After all, the children of today are the future of tomorrow, and they deserve to start their lives surrounded by love, and free from fear and pain.
Many children these days take the love, support, and presence of their parents for granted, often starting arguments over unimportant things and getting upset when things do not go their way. Sadly, what they do not realize is that a large number of children do not get to know what a parent’s presence feels like, let alone having their constant love and support. Millions of children around the world suffer from abuse and neglect, and wake up every morning fearful of what the day will hold.
There is no exact definition that holds enough value to be able to describe the fear and pain that these young children go through each day, but by law, child abuse has been defined as “an act, or failure to act, on the part of the parent or caretaker that results in the death, serious physical or emotional harm, sexual abuse, or exploitation of a child, or which places the child in an imminent risk of serious harm. ” There are four kinds of child abuse; physical, sexual, emotional and neglect. All kinds of abuse are illegal in Canada and the United States.
Although each type f child abuse is of great importance, neglect is the most common form of child mistreatment in Canada (accounting for 62% of all reported abuse cases), and can cause damage even more severe than that of any other form of abuse. Neglect is when the caregiver does not provide necessary attention to the child’s safety, physical, emotional or psychological needs. In severe cases, neglect can lead to abandonment, which is when a parent relinquishes permanent rights and claims to a child outside legal adoption.
Child abandonment is a severe problem, accounting for almost half (43.3%) of all fatal child abuse cases. In Canada, there are over 15, 980 neglected children, and that number is only a rough estimate, because the majority of neglect cases are left unreported. The children that are more at risk of becoming victims are disabled children, who are twice as likely, and aboriginal children, who make up the majority of child abuse and neglect victims in Canada. Many parents or caregivers who neglect and abandon their children do so because they suffer from depression, lack of initiative, futility, a low level of education, a poor socioeconomic status, unemployment, substance abuse or social isolation.
Other factors that could lead to neglect and abandonment can include that the child was the outcome of sexual assault or incest, or is perceived by the caregiver as an obstacle to personal achievements. If a child suffers from neglect, signs of the abuse may include severe need of medical or dental care, frequent school absences, stealing food, begging for money, dressing inappropriately for the weather, not answering questions directly about his parents or caregivers, and drastic changes in personality and appearance. If a child is reported as being neglected or abused, Children’s Aid Society (CAS) goes to inspect the home.
If the accusations prove true, the child is then taken from the parent or caregiver (either temporarily or permanently, depending on the severity of the abuse), and is places either in the custody of another relative, or in foster care. The sentence of the caregiver depends on how severe the abuse or neglect is, and can vary from having to pay a fine, to losing custody of the child, to being imprisoned. As Canadian citizens and members of our community, it is our duty to protect the children by reporting any signs of abuse or neglect to the authorities.
Unfortunately, not many people do so, and by consequence, the young children have no voice, and are forced to continue suffering in silence. One may not think that child abuse and neglect has much of an impact for the population, but in reality, it largely affects many aspects of today’s –and tomorrow’s- society. Economically, child abuse is very costly. Once a child had been taken out of the custody of his or her parents, they are often taken to hospitals where their medical needs are taken care of, and then placed into foster homes.
The treatment and trips to the hospital quickly become very costly, and the foster care alone costs the country over $6 billion a year. Also, each abandoned child could cost the government over $3,000 a day. Although the money is going towards the great cause of providing abused and abandoned children with a better life, it is a completely avoidable matter that is costing extreme amounts of money. Also, there has been a dramatic increase in child abuse and neglect since 1991, and the numbers are still growing. If this trend continues, there will be more children who are abused than those who are not.
What this will mean for society is higher taxes, and adults who have more issues and lower skill levels. The effects of abuse and neglect on children are that they have poor social skills and lower education levels, a higher rate of mental and physical disabilities, delinquency, violence, drug abuse and depression. In addition, abused or neglected children have a higher tendency to abuse and neglect their own children later in life. This means that a large portion of our world will be governed by physically and emotionally damaged adults, who may do the same to their own children.
This will result in many socioeconomic problems for our future. As was said before, the children today are the future of tomorrow, and if we want a good future for our world, we need to treat the children properly and give them the knowledge and love they deserve to become well-rounded adults. Countless organizations around the world work to improve the issue of child abuse, neglect and abandonment, as it is an increasingly important problem in our society. However, I have only selected one organization to write about- The Door of Hope.
The Door of Hope is an organization located in Johannesburg, South Africa that has a mission to rescue and receive any abandoned, abused or orphaned babies and children in and around their city. They work to provide a temporary Christian home for all the children while seeking a forever family, suitable long term care or other permanent care for each one. The Door of Hope organization began in 1999, when the pastor of a small church in Johannesburg, named Cheryl Allen, learned that a high number of newly born infants were being abandoned.
Cheryl realized that many of the young women abandoning their babies may have acted differently had there been an alternative. The church then made a “baby bin” in the side of the wall, where mothers could place their infants who would then be brought into the church and taken care of by the volunteers. When news spread, babies began being brought in by police, community members, hospitals and clinics. By having complete faith and reliance in God, the ministry has grown, and saves over 100 children’s lives each year.
Because this organization is still relatively small, they only have a few fundraisers, but are working hard to get more activities and more people to raise awareness and support their cause. Their annual fundraisers are; the Barnyard Fundraiser, a production that lets you experience the music and famous icons of the 80’s. It is a fun-filled all night event of music, comedy and dancing that includes dinner. They also sell Door of Hope memorabilia at the entrance.
Another one of their fundraisers is the Momentum 94.7 Cycle Challenge, which is a bicycle race held in South Africa for any level of cyclist. They ask that participants do their best to raise as much money as possible for the cause, and that they purchase a door of hope shirt to wear on the day of the race. The Door of Hope is a strictly Christian organization that fully believes and trusts in God’s plan. Therefore, there are many possible parables and Beatitudes that could be connected to Door of Hope, but it is the fifth Beatitude that I think represents them the best; “Blessed are the merciful, for they shall obtain mercy.”
Mercy is having love towards those that are miserable and those that need some type of help or assistance. The merciful are those who are compassionate towards those who need mercy, and go out of their way to make the effort to help. Cheryl Allen and the volunteers at Door of Hope truly show that they are merciful by taking abandoned, abused and orphaned infants and children, many of whom are extremely ill or problematic. They spend their days tending to these young children to make sure they get the love and attention they need for no pay whatsoever, and are extremely humble about it.
I believe that this is what makes them so merciful. They give all they have to help these infants, yet ask for nothing in return. The only reward they need is to see a child’s smile, knowing that their life has been saved, and that they will now be able to live to their fullest potential. If someone wanted to support the Door of Hope Organization, they could either send a donation in the form of a cheque through the mail or by credit card over the internet. They could also “adopt a cot”, which is sending a monthly donation to provide a child with a bed and necessary supplies.
A third option, which would be for the most dedicated of supporters, is to go volunteer at the organization. They accept international volunteers and will help pay for your travel and stay, but you must fundraise as well. The international volunteers have to be 18-60 years of age, will stay from 1-12 months and will help with the babies daily, along with other responsibilities. I think that the Door of Hope is a truly spectacular organization, and I hope that when I graduate from Highschool, I will be able to help as an international volunteer.
In conclusion, child abuse and neglect is an extreme problem plaguing our society, and we need to help bring a stop to it. If not, the effects of this abuse will impact many aspects of our future, as well as damaging the lives of countless children and denying them of their full potential. Become an active member of your community, and when you suspect a child is being abused, do not hesitate to report it. You could be saving their life.
Example 3: Cycle of Violence and Child Abuse Intergenerational Transmission
The “cycle of violence hypothesis” is a theory that mainly seeks to clarify why and how the behavior of an individual who commits family and domestic violence may transform dramatically with time. Furthermore, this theory provides an understanding of the reasons why an individual who has been a victim of either domestic or family violence would go on facing a violent situation (Finkelman, 1995). The term “intergeneration transmission” refers to the occurrence of something between generations.
It further described as a process that allows for people to recognize the modalities of conflict that relate to the generations which preceded the birth of an individual (American Heritage Dictionary, 2006). It is the objective of this paper to explain in detail the “cycle of violence” hypothesis as it relates to the intergenerational transmission of mistreating children. The “cycle of violence” hypothesis relates to the intergenerational transmission of mistreating children as exhibited via the principles of social learning theory.
Here a parent that is usually physically punitive would most likely have a child that becomes aggressive because that is the kind of response pattern the child has been accustomed to (Kalverboer, Genta, & Hopkins, 1999). This theory puts it that violent actions are learnt through positive reinforcement patterns and is more often than not imitated. It is important to note that when a child grows up with such a parent, the child will exercise such kind of an approach in raising their own offspring, thus this cycle of violence is in a position to persist through to the future generations.
In addition to this, a parent plays that most crucial role in the life a child (Tomison, 1996). Genetic components of aggressive behavior (Kalverboer, Genta, & Hopkins, 1999) equally result in a cycle of violence in which children are maltreated and it is generational. Under this, it is assumed that the predisposition of a parent for violence is inherited by a child. This inherited predisposition perpetuates the cycle of maltreatment especially towards children thus increasing the probability of such children subsequently maltreating their own children.
Thus the cycle is fueled in the sense that through genes, generations of abusive parents persist. The interaction of environmental and genetic factors is a major factor to consider when relating the cycle of violence to intergenerational transmission of mistreating children. A mere genetic predisposition simply puts a person at the risk of expressing violent behavior but then it takes the interaction of environmental and genetic factors to actually produce the greatest risk of the display of violent behavior (Kalverboer, Genta, & Hopkins, 1999).
When a child has inherited the genes of abusive character from the parents, it is the surrounding environment that fuels the degree of this behavior because of the experiences and thus they are carried forward to their children. As a consequence, the cycle of violent behavior in terms of child maltreatment is perpetrated (Tomison, 1996). According to a research done on intergenerational transmission of abuse, an examination was done where by the history of a parent in terms of abuse in relation to their abusive behavior toward the children was hypothesized (Pearsa & Capaldi, 2001).
Furthermore, the effect of the extent of an abuse and the possibility of the concerned individual becoming abusive were equally considered. From this study it was reported that the parents who had an abusive childhood were more likely to take part in abusive behavior in the next generation. These findings illustrate that the “cycle of violence” has a great link to the intergenerational transmission of mistreating children (Tomison, 1996).
Much as there is a lot of evidence to connect the cycle of violence to the intergenerational transmission of mistreating children it is important to note that not all people who experience an abusive childhood become abusive parents in future. In addition, the cycle of violence can be broken via social support programs especially to the single parents (Langeland & Dijkstra, 2006). Another way through which this vice can be eradicated is via the support from the spouse who realizes the partner could have been a victim of abuse in their childhood.
It is also important to consider positive moves such as focusing on interventions that would prevent the cycle of violence from persisting through to other generations.

American Heritage Dictionary. (2006). The American Heritage® Dictionary of the English Language, Fourth Edition . New york: Houghton Mifflin.
Finkelman, B. (1995). Child Abuse: Short- and long-term effects. London: Taylor & Francis. Kalverboer, A. F. , Genta, M. L. , & Hopkins, J. B. (1999). Current issues in developmental psychology: biopsychological perspectives.
New Mexico: Springer. Langeland, W. , & Dijkstra, S. (2006). Breaking the intergenerational transmission of child abuse: Beyond the mother-child relationship.
Child Abuse Review , 4 (1). Pearsa, K. C. , & Capaldi, D. M. (2001). Intergenerational transmission of abuse: a two-generational prospective study of an at-risk samplesmall star, filled.
Child Abuse & Neglect , 25 (11). Tomison, A. M. (1996). Intergenerational Transmission of Maltreatment. Retrieved May 10, 2010, from http://www. aifs. gov. au/nch/pubs/issues/issues6/issues6. html

Example 4: Discipline Versus Child Abuse
Is there such a thing as too much discipline? How far can a person go with discipline before it turns into child abuse? How do a person know if they are performing child abuse? These are the three main questions that raise a debate when the subjects discipline and child abuse are put in one sentence. What some people might call discipline others may say is child abuse. Gaining the knowledge and education of what is right and what is wrong is the key to preventing discipline from becoming child abuse.
As stated in the American Heritage College Dictionary, discipline is defined as “training expected to produce a specific character or pattern of behavior. ” Child abuse is defined as “mistreatment of a child by a parent or guardian, including neglect, beating, and sexual molestation” on dictionary. com. Unfortunately, a parent or guardian training a child to produce a specific character or pattern behavior may lead to mistreating or neglecting a child unintentionally. It is legal to pk a child but it is also illegal to beat them.
Spanking a child may be considered as light licks on the legs or bottom. Beating a child may consist of bruising or drawing blood. But what works for one child might not be any good for the other. One child can learn a lesson from a pking but if a parent pk’s the other child, it might not have an effect on him at all. That is when alternatives come in. Either way a parent decides to punish that child, that parent’s point will be made or that child will have learned a lesson. There is nothing wrong with disciplining a child for doing something he was not supposed to have done.
Punishing a child will serve as a warning to let that child know that if he ever did something bad again, there will be a consequence. There are many ways to discipline a child without performing child abuse. For example, if a child is at school and acts inappropriate towards his peers or the teacher, he can be giving a pking, a timeout or some of his privileges can be taken away from him. That child might think the parent is being mean or obnoxious, but that entire time that parent is really showing how much they love and care for that child. As a kid, I would get into trouble a lot.
Of course there would be a consequence, and a few words that came along with it. I will never forget the words my mother said to me as I received my pking: “I am only doing this because I love you and I want you to do what is right no matter what the situation is. If I do not whip you, you will continue to do the same thing, so I have to teach you a lesson. ” As I got older, I realized that she really cared. I felt that I did not want to embarrass her or myself any longer and that is when I decided that I was going to do what was expected of me.
Parents have the right to lead their kids by example but they must do it the right way. On the other hand, damaging a child’s self-esteem, self confidence and making him feel unloved or wanted is considered to be child abuse. Why would a parent want to see their child suffer, especially without any cause? If a parent does not want another person or child harming their child intentionally, then why would that parent commit abuse? There are many examples of child abuse but I decided to press the issue on one example. A woman just found out that she has gotten pregnant.
The pregnancy was unplanned and the baby’s father does not want to be a part of that new life, but she decides to keep the child. When the baby arrives, the woman is frustrated because she realizes she cannot take care of herself and the baby mentally, physically, emotionally or financially. The woman now decides to take her anger and frustrations out on the child and that is where the abuse comes in because she does not know what else to do. Sometimes not disciplining a child can be considered child abuse as well.
Everyone knows that a parent has to let a child be child. But when a parent lets the child get away with things a little too much, it is time to let that child know that enough is enough. Since that child feels that he has not been stopped before, he has the right to continue to do what he pleases. The parent needs to tell the child that they are the adult and he is the child will definitely set the boundaries. The parent is going to ruin that child if they let him into the world thinking that he can do what he please.
That is the first step to abusing that child and others are going to do the same if do not step in to guide him. The parent has to learn to say ‘NO’ every once in a while so the child can get used to hearing that word. The parent has to know that they cannot be their child’s best friend and the child has to abide by their rules. If a parent does not start at home by forcing the rules upon the child, then they are giving the world permission to keep the abuse up. Again, the three main questions come to mind. Is there such a thing as too much discipline?
How far can you go with discipline before it turns into child abuse? How do you know if you are performing child abuse? A parent might feel that no one can tell them how to raise their child. So they may feel the need to punish the child however they want. The parent says it is discipline. The outside world might say it is child abuse if they see a child is being mistreated in a way that they feel that is not right. A parent might have their own personal reasons to why they punish their child the way they do.
Maybe it is discipline—then again it may be child abuse. There are people out in the world that feel that they can care for a child better than that child’s parent. Sometimes those people are eager to take that child that they feel are being abused away from that parent. I would tell those parents to choose a more logical way of what they do to their child and how they do it. However a parent decides to punish their child is on them. The parent just need be careful of how they do it because they might not have their child any longer–or even worse, thrown in jail!
Example 5: Mental Retardation and Child Abuse
Sling Blade is a film about a mentally retarded individual by the name of Karl, who murders his mother and her lover – Karl’s classmate – at the age of twelve.  Subsequently, Karl is institutionalized.  Upon release, Karl returns to his hometown where he befriends a young boy, Frank.  The boy’s father had committed suicide, and his mother is dating Doyle, who abuses both Frank and his mother.  Eventually, Karl is responsible for the murder of Doyle as well, as he must put an end to the abuse that he is witnessing in the lives of Frank and his mother.
The story of the film is atypical seeing that Karl is a mentally retarded individual who takes action against child abuse.  Scientific research, on the other hand, has revealed that it is usually the mentally retarded individual who must suffer abuse simply because he cannot take care of himself.
As an example, Morse, Sahler, and Friedman studied twenty five children who had been abused, out of which forty two percent were mentally retarded.  All except one of the mentally retarded children in the study had already been diagnosed as mentally retarded before they were abused.  Hence, it is obvious that the abusers knew that the mentally retarded children are vulnerable to abuse.
According to Morse, Sahler, and Friedman, people who spend time with mentally retarded children are usually aware that these children are not always able to physically or verbally defend themselves.  Moreover, these children are not always able to describe their abuse to others.  Typically, they are also unable to differentiate between proper and improper verbal communication and/or physical contact, regardless of whether the physical contact is sexual or violent in nature.
Lastly, mentally retarded children are truly dependent on other people for all manners of assistance.  This makes them more trusting toward their caretakers as well as others.  Also according to the authors, passivity as well as compliance stem from the trust and dependency of the mentally retarded child.  Those who abuse mentally retarded children are, therefore, taking undue advantage of the trust shown by these children.
Sandgrund, Gaines, and Green have also conducted a study on children.  Out of one hundred and twenty children studied by the authors, sixty had been abused, thirty had been neglected, and another thirty had not been abused at all.  The authors reported that twenty five percent of the abused children in their study had been diagnosed as mentally retarded.
Twenty percent of the neglected children had similarly been recognized as mentally retarded, while only three percent of the children who had never been abused were mentally retarded.  The findings of this study reveal that mentally retarded children are quite likely to be abused.
The fact that Karl of Sling Blade was never abused – rather, he had the intelligence to differentiate between proper and improper verbal communication and/or physical contact – shows that the film is about an unusual mentally retarded individual.  Sandgrund, Gaines, and Green write that mentally retarded children are normally hesitant to report instances of abuse because they fear losing the essential relationships with their caretakers.
Furthermore, these children are not always believed if they manage to report abuse.  Seeing that Karl was not afraid to lose his caretaker at the time he killed his mother reveals that this mentally retarded child was definitely not a typical one.
McFadden has also written about the abuse of mentally ill children, including those who are mentally retarded.  Reporting a study conducted by the New York State Commission on Quality of Care for the Mentally Disabled, McFadden writes that abuse in institutions for mentally retarded children is higher than abuse in institutions for children who are mentally fit.  Also according to the author:
In analyzing those cases, the commission found that abuse most often occurred in leisure- time areas, such as recreation rooms and sleeping quarters, where children congregate without structured activities.  It also found that boys over 12 years of age and children who exhibited disturbing conduct were at the highest risk of abuse.
In 16 percent of the cases, the study said, a finding of abuse or neglect was made by the reporting facility.  In another 18 percent, the facility found misconduct by an employee but no evidence of abuse.  In 66 percent, some corrective action was taken and in nearly 20 percent disciplinary action was taken against at least one employee.
Most of those responsible for the abuse or neglect were not new employees.  The study said 80 percent of them had worked at the facility at least one year and 50 percent had been employed more than three years (McFadden).
Karl was fortunate because his mother did not abuse him.  He was not abused in an institution either.  All the same, research evidence suggests that mentally retarded children are highly vulnerable to abuse.  In unusual cases, perhaps mentally retarded individuals like Karl may be able to struggle against child abuse.  Then again, they might have to take drastic actions such as those of Karl in order to end child abuse.  After all, mentally retarded individuals are not considered credible if they simply manage to report abuse.
Works Cited

McFadden, Robert D. “Child Abuse High in New York Mental Centers.” New York Times. 1
Dec 1987. 17 Nov 2007.
Morse, C.W., O.Z. Sahler, and S.B. Friedman. “A Three-Year Follow-Up Study of Abused and
Neglected Children.” American Journal of Diseases of Children. Vol. 120 (1970): pp. 439-446.
Sandgrund, H., R. Gaines, and A. Green. “Child Abuse and Mental Retardation: A Problem of
Cause and Effect.” American Journal of Mental Deficiency. Vol. 79 (1974): pp. 327-330.
Sling Blade. Dir. Billy Bob Thorton. 1996.

More examples:

Cyber Bullying Essay
Animal Testing Essay
Macbeth Essay
Happiness Essay
Critical Thinking Essay