Substance Abuse Interventions in Mental Health

The provided content presents various studies and articles related to substance use disorders, including comorbidities with mental illnesses, early intervention strategies, and the impact of age at first alcohol use on the development of alcohol disorders. Additionally, it highlights the importance of relapse prevention, particularly among individuals with severe mental illnesses. The articles also explore the effects of substance abuse on utilization of mental health services, costs of care, and violence associated with severe mental illness. Furthermore, it discusses prenatal substance abuse, its short- and long-term effects on the exposed fetus, and the potential impact of the baby-boom generation on substance abuse among elderly persons.

Alcohol

Alcohol misuse can be defined as an excessive consumption of alcohol on the daily basis
more than lower risk limits of alcohol intake. Over alcoholism puts individuals at high risk in
terms of health hazards (Swartz and et.al., 2014). The present essay explores the key issues
related to alcohol misuse. It also studies the trends of psychoactive substances at national and
global level. In addition to this, the essay discusses several reasons that trigger alcohol abuse
among individuals and features the impact of over consumption on individuals as well as society.
Besides this, it also elaborates the concepts of alcohol misuse and various theoretical
perspectives related to the topic. Apart from this, essay covers the pharmacodyanamic and
pharmacokinetic characteristics of over alcoholism in the context of UK.
It has been observed that high intake of alcohol leads to serious health consequences in
UK. According to statistical data, approximately 6490 deaths occurred in England due to over
alcoholism. After obesity and smoking, misuse of alcohol is considered as the biggest risk factor
for long term diseases and death in UK (Barrowclough and et.al., 2014). Therefore, it is
estimated that alcohol has 10 percent of total burden of death and diseases in the UK. In addition
to this, statistics of 2013-14 indicate that there were 10,59,210 hospital admissions due to alcohol
related diseases, injuries and conditions in the UK (Patterson and Jeste, 2014).
Alcohol has been playing a central role in all human cultures and civilizations since 4000
BC. It has been widely used by all societies of the globe and its effects have been present in
human civilizations throughout history (Monti and et.al., 2012). There are various evidences that
explain that development of agriculture gave rise to human evolution and civilization. It can be
elaborated that cultivation of grains was done not only for growing food but also for brewing
purposes to manufacture beer and other alcoholic beverages. It has been evident that every
human civilization has explored different processes to manufacture beer and wine. From the
ancient records of alcohol usage, cultural drinking has been a social activity (Hasin and et.al.,
2012)
). This culture can be referred to customs and activities related to consumption of alcoholic
beverages during various occasions. There are various types of drinking that prevail in human

societies. These include Social, Binge, Speed drinking and Session. Social drinking is practiced
among individuals in a casual manner without the intention of getting drunk (Alterman, 2014).
People have been celebrating good news by having few drinks among groups or in social
gatherings since historic times. Session drinking is associated with the consumption of large
amount of alcohol during a session or social occasion without getting heavily intoxicated. Binge
drinking can be defined as drinking excess of alcohol. It is a pattern of consuming alcohol that
elevates the concentration of blood alcohol above a recommended limit (Baethge and et.al.,
2014).
Alcohol has been used as a powerful symbolic tool in almost all societies of the world to
manipulate cultural and social facets. There are four symbolic uses of alcohol within societies
that are explored in various cross cultural studies. First symbolic use is as an indicator of social
status among individuals. Second is as a label that outlines the nature of social scenarios or
occasions (DeWit and et.al., 2014). Third use is as a statement of association and the fourth use
is to differentiate gender. There is historic evidence that shows that adoption of foreign alcoholic
beverages also entails the adaptation of drinking attitude and patterns within a society. There is
cross cultural variation in the manner individuals behave when they consume alcohol (Humeniuk
and et.al. 2012). For example: in UK culture, alcohol consumption is often associated with
aggressive and anti-social behavior whereas in Mediterranean culture, drinking activity is
considered as not against the traditional norms. Attributes of variation do not rely on genetic
differences but are largely associated with different cultural opinions about alcohol and
expectancy related to its implications as well as social norms related to over alcoholism (Ernst
and et.al., 2014).
It has been analyzed in cross cultural studies that alcohol consumption is a norm
governed activity in all the cultures. Drinking is often hedged by norms and regulations which
are self-imposed on individuals. Analysis of cross cultural studies discovers that there are several
universal constants that regulate drinking behavior within global societies (Connors and et.al.,
2012). These include norms related to solitary drinking, restriction to alcohol consumption on
women and children, social control on drinking behavior etc. It has been revealed in several
research studies that these self-imposed norms on alcohol consumption customs largely influence
intake and behavior rather than legal and political control. However, there are no proper

evidences to explain uniformity of restrictions over use of alcohol among females. Research
studies indicate that prevalence of restriction on female drinking is due to non-cultural
determinants and is primarily physiological (Behnke and et.al., 2013).
There are various theories that explain the concepts of use and misuse of alcohol among
individuals. The Moral Model states that alcohol addiction is an outcome of individual’s
weakness and flaws of character. It has been observed that people have least sympathy for
individuals who misuse alcohol as they believe that lack of moral strength leads to this drinking
behavior. This model states that people who have strong character do not indulge in alcohol
misuse (Gonzalez and Rosenheck, 2014). In addition to this, this model is commonly applied to
dependency of illegal substances which is probably due to political or social causes. However,
moral model has no therapeutic value.
Another theoretical model that is widely used for explaining the concept of alcohol
misuse is Disease Model. The model states that alcoholism is an illness which is an outcome of
impairment of neurochemical or behavioral activities. Reliability of this model makes it suitable
for the implementation in care settings (Schoenbaum, Zhang and Sturm, 2014). Many treatment
procedures suggest that dependencies on alcohol misuse is related to behavioral dysfunctions and
therefore, diseases model involves few components of physical and mental disorders (Swartz
and et.al., 2014).
Biological model explains genetic inclination towards certain drinking behavior. This
model states that behavioral traits related to alcohol misuse are inherited by one generation from
the previous generation through genetic factors (Wu, Kouzis and Leaf, 2014). Many researchers
have explored that biological determinants greatly influence the dependency on alcohol among
individuals.
Social Learning Theory states that individuals observation of others engaging in drinking
behavior can induce development of alcohol addiction. In other words social model observe
alcohol abuse as a learned behavior that emerge from behavioral processes (Drake, Wallach and
McGovern, 2014). Theorists of social model lay emphasis on individual environment
interactions as factors of drinking behavioral. Many people observe that behavior and reactions
and start to imitate them. It is often observed among individuals that alcoholism is a way to cope
with stressful situations (Gonzalez and Rosenheck, 2014).

The Psychological model explains human behavior in the context of alcohol abuse.
According to psychodyanamic theories, over alcoholism prevail among individuals due to
negative traumatic events and troubled relationships. It has been observed alcohol consumption
may help in coping with stress which results from tragic life incidents (Sobell, Sobell and Ward,
2013). There are various findings that show that some people indulge in over consumption of
alcohol because they do not want to show their true emotions related to traumatic life incidents.
Others face difficulty in self care and tend to misuse alcohol as they lack the capability to calm
themselves. In addition to this many individuals have low self esteem and in order to hide their
true self they misuse alcohol (Barrowclough and et.al., 2014).
There are number of risks and protective factors that undermine the theoretical
perspective of alcohol misuse. Researcher have observed that number of risk factors significantly
increases the chances of alcohol misuse at a very young age. More the number of risks factors
experienced by children or teenagers higher is the probability of getting addicted to alcohol. It
has been observed in several studies that by reducing the determinants of risks in children life
the susceptibility of health and social issues can be minimized significantly (Barrowclough and
et.al., 2014). Risk and protective factors prevail at every level at which humans interact with
others and society in which they live. Individuals add different qualities and traits while carrying
out every interaction. In addition to this, at every interaction these factors bring positive or
negative tone. For example for an individual there are four different levels I which they interact.
These include individual, peer family and community levels (Swartz and et.al., 2014). Talking
about individual level there are various risks factors that affects alcohol misuse among them.
These are low elf esteem, inherited biological determinants, psychological disturbances,
aggressive behavior, rebelliousness, academic failure, lack of education about alcohol misuse,
teen pregnancy, etc. The protective actors at individual level that can reduce the vulnerability of
alcohol misuse include sense of well being, sound knowledge on risks associated with alcohol
abuse, sense of bonding with family and friends, social competence, optimistic approach towards
life, channelizing energy towards creative activities . All these protective factors help the person
to minimize the use as well as misuse of alcohol in UK.
At peer level, the risk factors involved are wrong notion of considering alcohol use as a
cool thing, lack of sexual education and reinforcement of negative expectations within peer

group and lack of information on negative consequences on alcoholism. Protective factors that
may prevent alcohol misuse at peer level include disapproval of alcohol, involvement in creative
activities rather than drug and alcoholism (Sobell, Sobell and Ward, 2013). At family level the
risk factors involved are lack of bonding among family members, history of alcohol misuse,
conflicts, physical abuse, loss of job, etc. In order to deal with these risk factors there are
protective determinants such as consistency of parenting, sense of responsibilities among family
members, harmonious relationship , supportive and caring attitude, education, engagement of all
members while making decisions and clear guidelines over use of alcohol.
Pharmacokinetics is referred to the study of body responses to foreign substances.
Alcohol is foreign substance and how human body absorbs, distributes and remove alcohol are
the vital topics that are studied in this study. There are various factors that affect transfer of
alcohol in human system (Gonzalez and Rosenheck, 2014). These factors include molecular size
and shape of alcohol, chemical constituents of alcohol and the method of transfer. Alcohol is the
most widelu used drug across the globe. It has been obserrved that moderatye intake is associated
with various health benefits but over consumption leads to severe health and social consequences
(Barrowclough and et.al., 2014). In UK, current guidelines over alcohol use discourage binge
drinking for individuals . The absorption and distribution of alcohol occurs in the following
manner. The molecule of alcohol is a tiny polar molecule that has both lipophilic and hydophilic
traits. These qualities help sin the expatiation of Pharmacokinetics within human body. The
lipophilic traits elaborate how alcohol gets absorbed by diffusion taking place in cell membranes.
On the other hand hydrophilic coupled with polar characteristics of alcohol molecule elaborate
how alcohol is soluble in water.
Blood Alcohol Concentration (BAC) can be defined with the help of various factors that
impact the rate of absorption, distribution, metabolism and elimination of alcohol from human
body. Since alcohol is soluble in water it can easily pass through cell membranes and most of
which is absorbed by stomach and intestines. The metabolism and removal factors of alcohol are
considered more consistent than the absorption and distribution (Swartz and et.al., 2014). A
small quantity of alcohol absorbed in the body is eliminated unchanged in sweat and urine
however majority of proportion is removed through oxidation process. Oxidation occur in many
organs of human body including stomach and intestines. The outcomes of alcohol metabolism

are very detrimental that negatively affects the health of individuals who intake high quantities of
alcohol. Long term misuse of alcohol leads to severe diseases such as liver cirrhosis (Sobell,
Sobell and Ward, 2013).
Psychoactive substances are refer to those substances that changes the functions of brain
that results into alteration in the mood and copiousness of an individual. The current trends of
psychoactive substances in UK measures are elaborated in the following manner. There are
different patterns of alcohol use among people of UK. There are people aged 15 years and above
who have never consumed alcohol which constitute around 15 percent of UK population (Drake,
Wallach and McGovern, 2014). As per the statistics of 2013, nearly 15 percent of men and 20
percent of females do not drink at all. These are the people who are at lowest risk of developing
alcohol related problems. However it has been observed that 5 percent of men who drink on
weekly basis in England are at higher risk of alcohol related harm. Among these 5 percent men
belong to the ages between 55 and 65 according to the statistical data of the year 2013. the health
survey report of England features the drinking habits of various groups of people that include the
frequency ad amount of alcohol intake . According to the statistical figures there was as fall in
the number of men who drink on a weekly basis. It can be observed that the rate is decreased
from 22 percent to 13 percent in case of frequent drinking. Similarly the rate reduced from 13 to
8 percent in case of females indulged in frequent intake of alcohol. In case of Binge drinking
nearly 31 percent of men and 24 percent of females in UK drank to levels on one or more days in
a week. It is also indicated in the survey reports that older people including 20 percent of males
and 10 percent of females aged 65 and above drink to harmful limits (Barrowclough and et.al.,
2014). The data also shows that the pattern of alcohol misuse has increased among older
population in the past two decades.
The hazardous drinking in UK is defined as drinking pattern that increases the risk of
development of serious harm to health of individuals. These harms may be physical, emotional
and social. The prevalence of hazardous drinking in UK was approximately 24 percent as per the
statistical figures in the year 2007.
The hazardous drinking leads to fatal consequences in UK. As per the statistical data of
2013, the number of alcohol related deaths which were registered in UK was 8416. It cab be
analyzed that the age specific death rates from alcohol misuse is noticeable lower since 2000.

Nearly 66 percent of males died due to alcohol related deaths in UK (Alcohol-related Deaths in
the United Kingdom, Registered in 2013, 2016). The trends in alcohol induced deaths indicate
that mortality rate is the highest among older people including both men and women.
There are various limitations of statistical reports related to alcohol misuse. First the
secondary data available for the research is limited. Secondly the access of relevant online
articles is not free which obstruct the research work to form relevant conclusion.
In a nutshell use of alcohol has played a central role in human civilization and evolution
since ages. The cultural variation become the most critical factor that determine the behavior of
individuals in various societies. The essay develops deep understanding of the link between
cultural and asocial aspects that induce the use of alcohol among individuals. Apart from this,
the easy covers various theories and models that are useful in explaining the concept of alcohol
abuse among individuals. There are several risk factors that negatively aggravate the risk of
health and social consequences among people who indulge in heavy drinking. In addition to this
there are various protective determinants that overcome the risk factors. Apart from this study
also provides detailed account of Pharmacokinetics and pharmadyanamics of alcohol misuse
among individuals of UK. Besides this, current trends of a alcohol use in UK has been included
in the above essay.

REFERENCE
Books and Journals
Alterman, A., 2014. Substance abuse and psychopathology. Springer.
Baethge, C., and et.al., 2014. Substance abuse in first-episode bipolar I disorder: indications for
early intervention. American Journal of Psychiatry.
Barrowclough, C., and et.al., 2014. Randomized controlled trial of motivational interviewing,
cognitive behavior therapy, and family intervention for patients with comorbid
schizophrenia and substance use disorders. American Journal of Psychiatry.
Behnke, M., and et.al., 2013. Prenatal substance abuse: short-and long-term effects on the
exposed fetus. Pediatrics. 131(3). pp.e1009-e1024.
Connors, G.J., and et.al., 2012. Substance abuse treatment and the stages of change: Selecting
and planning interventions. Guilford Press.
DeWit, D.J., and et.al., 2014. Age at first alcohol use: a risk factor for the development of
alcohol disorders. American Journal of Psychiatry.
Drake, R.E., Wallach, M.A. and McGovern, M.P., 2014. Special section on relapse prevention:
Future directions in preventing relapse to substance abuse among clients with severe mental
illnesses. Psychiatric Services.
Ernst, M., and et.al., 2014. Decision making in adolescents with behavior disorders and adults
with substance abuse. American Journal of Psychiatry.
Gonzalez, G. and Rosenheck, R.A., 2014. Outcomes and service use among homeless persons
with serious mental illness and substance abuse. Psychiatric Services.
Hasin, D.S., and et.al., 2012. Analyses related to the development of DSM-5 criteria for
substance use related disorders: 2. Proposed DSM-5 criteria for alcohol, cannabis, cocaine and
heroin disorders in 663 substance abuse patients. Drug and alcohol dependence. 122(1). pp.28-
37.
Humeniuk, R., and et.al., 2012. A randomized controlled trial of a brief intervention for illicit
drugs linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in
clients recruited from primary health‐care settings in four countries. Addiction. 107(5). pp.957-
966.
Monti, P.M., and et.al., 2012. Adolescents, alcohol, and substance abuse: Reaching teens
through brief interventions. Guilford Press.
Patterson, T.L. and Jeste, D.V., 2014. The potential impact of the baby-boom generation on
substance abuse among elderly persons. Psychiatric Services.
Schoenbaum, M., Zhang, W. and Sturm, R., 2014. Costs and utilization of substance abuse care
in a privately insured population under managed care. Psychiatric Services.
Sobell, L.C., Sobell, M.B. and Ward, E., 2013. Evaluating alcohol and drug abuse treatment
effectiveness: Recent advances. Elsevier.
Swartz, M.S. and et.al., 2014. Violence and severe mental illness: the effects of substance abuse
and nonadherence to medication. American journal of psychiatry.
Wu, L.T., Kouzis, A.C. and Leaf, P.J., 2014. Influence of comorbid alcohol and psychiatric
disorders on utilization of mental health services in the National Comorbidity Survey.
American Journal of Psychiatry.
Online

Alcohol-related Deaths in the United Kingdom, Registered in 2013, 2016. [Online] Available
through: <http://www.ons.gov.uk/ons/rel/subnational-health4/alcohol-related-deaths-in-
the-united-kingdom/2013/stb---alcohol-related-deaths-in-the-united-kingdom--registered-
in-2013.html> [Accessed on 23rd January 2016].