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Substance Use Disorder Introduction What is Substance Use Disorder? According to Diagnostic and Statistical Manual of Mental Disorders [DSM-5] (2013) Substance use disorder is ter!ed as substance abuse and substance de"endence into a single disorder !easured on a continuu! fro! !ild to se#ere$ %ac& s"ecific substance (ot&er t&an caffeine '&ic& cannot be diagnosed as a substance use disorder) is addressed as a se"arate use disorder (e$g$ alco&ol use disorder sti!ulant use disorder etc$) but nearl( all substances are diagnosed based on t&e sa!e o#erarc&ing criteria$ )n t&is o#erarc&ing disorder t&e criteria &a#e not onl( been co!bined but strengt&ened$ *&ereas a diagnosis of substance abuse "re#iousl( re+uired onl( one s(!"to! !ild substance use disorder in DSM-5 re+uires t'o to t&ree s(!"to!s fro! a list of 11$ Drug cra#ing 'ill be added to t&e list and "roble!s 'it& la' enforce!ent 'ill be eli!inated because of cultural considerations t&at !a,e t&e criteria difficult to a""l( internationall($ )n DSM-)- t&e distinction bet'een abuse and de"endence 'as based on t&e conce"t of abuse as a !ild or earl( "&ase and de"endence as t&e !ore se#ere !anifestation$ )n "ractice t&e abuse criteria 'ere so!eti!es +uite se#ere$ .&e re#ised substance use disorder a single diagnosis 'ill better !atc& t&e s(!"to!s t&at "atients e/"erience$ Additionall( t&e diagnosis of de"endence caused !uc& confusion$ Most "eo"le lin, de"endence 'it& 0addiction1 '&en in fact de"endence can be a nor!al bod( res"onse to a substance$ Substance use disorder 'as t&e ter! t&at 'as used b( t&e res"ondents instead of addiction because for t&e! it 'as !ore sociall( acce"table and !ore acce"ted in t&e !edical field$ Why a social issue? )n t&e 2013 *orld Drug 2e"ort of United 3ations 4ffice on Drugs and 5ri!e (2013) at t&e global le#el t&ere &as been an increase in t&e "roduction and !isuse of ne' "s(c&oacti#e substances t&at is substances t&at are not under international control$ .&e !anufacture and use of substances t&at are under international control re!ain largel( stable as co!"ared 'it& 2006 alt&oug& trends in drug su""l( and de!and &a#e been une+ual across regions and countries and across drug t("es$ Me!ber States t&at are "art( to t&e t&ree international drug control 5on#entions '&ic& 'ere ado"ted to "rotect t&e &ealt& and 'elfare of !an,ind re!ain co!!itted to t&e drug control s(ste!$ %#idence s&o's t&at '&ile t&e s(ste! !a( not &a#e eli!inated t&e drug "roble! it continues to ensure t&at it does not escalate to un!anageable "ro"ortions$
*e &a#e to ad!it t&at globall( t&e de!and for drugs &as not been substantiall( reduced and t&at so!e c&allenges e/ist in t&e i!"le!entation of t&e drug control s(ste! in t&e #iolence generated b( traffic,ing in illicit drugs in t&e fast e#ol#ing nature of ne' "s(c&oacti#e substances and in t&ose national legislati#e !easures '&ic& !a( result in a #iolation of &u!an rig&ts$ .&e real issue is not to a!end t&e 5on#entions but to i!"le!ent t&e! according to t&eir underl(ing s"irit$ *&ile intensified co!"etition in traffic,ing in cocaine &as led to gro'ing le#els of #iolence in 5entral A!erica t&e "roble! 'ill not be resol#ed if drugs are legali7ed$ 4rgani7ed cri!e is &ig&l( ada"ti#e$ )t 'ill si!"l( !o#e to ot&er businesses t&at are e+uall( "rofitable and #iolent$ 5ountering t&e drug "roble! in full co!"liance 'it& &u!an rig&ts standards re+uires an e!"&asis on t&e underl(ing s"irit of t&e e/isting drug 5on#entions '&ic& is about &ealt&$ Ad#ocac( for a stronger &ealt& "ers"ecti#e and an interconnected re-balancing of drug control efforts !ust ta,e "lace$ As e/"erience &as s&o'n neit&er su""l( reduction nor de!and reduction on t&eir o'n are able to sol#e t&e "roble!$ 8or t&is reason a !ore balanced a""roac& in dealing 'it& t&e drug "roble! is a necessit($ .&is includes !ore serious efforts on "re#ention and treat!ent not onl( in ter!s of "olitical state!ents but also in ter!s of funds dedicated for t&ese "ur"oses$ .&is (ear9s *orld Drug 2e"ort s&o's t&e e/tent of t&e "roble! associated 'it& ne' "s(c&oacti#e substances and t&e deadl( i!"act t&e( can &a#e on t&eir users$ .&e issue of ne' "s(c&oacti#e substances is one t&at t&e international co!!unit( 'ill re#ie' at t&e &ig&-le#el session of t&e 5o!!ission on 3arcotic Drugs in 201:$ As is t&e case 'it& traditional drugs international action against t&ese substances !ust focus on addressing bot& su""l( and de!and$ .&e "aucit( of ,no'ledge on t&e ad#erse i!"acts and ris,s to "ublic &ealt& and safet( cou"led 'it& t&e fact t&at ne' "s(c&oacti#e substances are not under international control underscores t&e i!"ortance of inno#ati#e "re#ention !easures and så of good "ractices bet'een countries$ .&e !ultitude of ne' "s(c&oacti#e substances and t&e s"eed 'it& '&ic& t&e( &a#e e!erged in all regions of t&e 'orld is one of t&e !ost notable trends in drug !ar,ets o#er t&e "ast fi#e (ears$ *&ile t&e e/isting international control s(ste! is e+ui""ed to deal 'it& t&e e!ergence of ne' substances t&at "ose a t&reat to "ublic &ealt& it is currentl( re+uired to "ro#ide a res"onse co!!ensurate 'it& t&e un"recedented fast e#ol#ing nature of t&e "&eno!enon of ne' "s(c&oacti#e substances$ So!e countries &a#e ado"ted inno#ati#e a""roac&es to curb t&e rise of t&ese substances but t&e global nature of t&e "roble! re+uires a res"onse based on international coo"eration and uni#ersal co#erage$ Suc& a res"onse s&ould !a,e use of all t&e rele#ant "ro#isions of t&e e/isting international drug 5on#entions$ )n addition in strengt&ening t&e international control s(ste! a s(ste!atic e#aluation of t&e a""ro"riateness of so!e of t&e inno#ati#e a""roac&es at t&e national le#el s&ould be encouraged$
Body )n a tal, about life before during and after re&abilitation t&ere 'ere fi#e "eo"le '&o s&ared t&eir e/"eriences and t&e stories t&e( s&ared 'ere t&e data 'e used$ .&ese fi#e "eo"le ca!e fro! Serenit( at t&e ;uarr($ 8irst of 'as 2o!!el '&o 'as an alco&olic &e is <ust fi#e !ont&s sober t&at is '&( &e 'as unable to s&are a lot of infor!ation since &e is still in t&e "rocess of reco#er($ According to 2o!!el being an alco&olic is difficult it lead to !an( "&(sical co!"lications '&ic& is '&( &e decided to enter t&e re&abilitation center$ After fi#e !ont&s of treat!ent &e &as a lot of regrets or 0marami daw siyang pagsisisi$1 =e also reali7ed all t&e t&ings t&at &e &as done 'rong$ 2o!!el also +uoted t&at 0Alcohol is a drug. Ayaw ko ngtumira! Going straight na ako. Masarap maging sober$1 =e also re!inded t&e (out& '&o attended t&e said tal, to sto" drin,ing and to sto" using drugs$ .&e second to s&are 'as >ouie '&o is no' eig&t !ont&s clean or eig&t !ont&s drug-free$ ?efore entering t&e facilit( &e 'as diagnosed 'it& &eart co!"lications @0A of &is &eart 'as clogged and t&is 'as &is reason to enter t&e facilit($ After eig&t !ont&s of treat!ent &e said to &i!self t&at 0Hindi na ako babalik. Sinusumpa ko na ang drugs$1 =e also told t&e audience not to tr( drugs because (ou 'ill reall( regret tr(ing it$ 3e/t 'as t&e onl( girl '&o s&ared &er stor( Ms$ Biselle$ S&e did drugs for about 1: (ears and no' s&e is 11 !ont&s clean$ S&e t&oug&t t&at drugs 'ere t&e 0cool thing1 t&at9s '&( s&e tried to use it$ S&e also told us t&at s&e is #er( good in "retending t&at9s '&( &er "arents and colleagues 'ere una'are t&at s&e 'as into drugs$ *&ile doing drugs s&e 'as also into ga!bling and '&en s&e 'as @ (ears old s&e 'as alread( into alco&ol$ Drugs and ga!bling are #ices t&at are &ard to sustain because of its &ig& cost$ .&at9s '&( s&e lost &er <ob and an i!"ortant relations&i" basicall( e#er(t&ing t&at 'as i!"ortant to &er 'as lost$ .&at is '&en s&e decided to enter t&e facilit($ S&e is no' glad to reco#er$ S&e e#en told t&e audience t&at u" until no' s&e still t&in,s li,e a c&ild but s&e9s #er( &a""( about it$ After Biselle it 'as Cen9s turn$ Cen 'as a drug addict for 13 (ears$ During t&ose (ears &e 'as also addicted to ga!bling and alco&ol$ =is !indset during t&at ti!e 'as t&at &e does not &a#e a "roble!$ According to &i! &e 'as #er( arrogant t&at ti!e$ =is t&in,ing 'as &i! against t&e 'orld$ *it& t&at t&e ne/t t&ing t&at &a""ened to &i! 'as t&at &e lost &is fa!il( and li,e Biselle &e also lost e#er(t&ing$ =e ended u" in slu!s and streets$ Kaya bago ako magkalat ng todo pumasok na ako ditto sa facility. got educated. !ow" my life is my priority. My brain is still in reco#ery. $ero may mga kailangan paring iwasan na sitwasyon" bagay" at tao.% .&e one '&o 'ra""ed u" t&e tal, 'as Sir 2enato '&o 'as an alco&olic and drug addict for 25 (ears$ During t&ose 25 (ears &e 'as in and out of <ail re&abilitation centers and e/"erienced #irtual deat&s$ According to &i! t&e ter! 0addict1 'as #er( stig!ati7ing$ =e is also fro! a 'ell-off fa!il( and 'as s"oiled as a c&ild$ =e also &ad a good education and did 'as not contented 'it& '&at &e &as$ *&en &e 'as a ,id &e &ad a false sense of confidence and a feeling of entitle!ent$ So &e 'as in#ol#ed in 'rong grou" of friends and t&at is '&ere it all started$ =e told us t&at 0&#ery user is a pusher. Kailangang magtulak$1 *&en &e 'as in <ail &e 'as undergoing correction$ =e 'as !ore e/"osed to s"iritual as"ect of &is life$ .&at is '&en &e decided to sto" and enter t&e facilit($ *it& &is sta( in t&e
facilit( &e reali7ed t&at &e s&ould be able to s&are and i!"art '&at &e learned during &is sta($ 0 '#e e(perienced the change with myself and to be able to sustain that change should be able to share this with others. '#e been there and done that. !ow am trying to make a positi#e contribution to the society$1 .&e good t&ing about Mr$ 2enato is t&at &e is no' stud(ing to beco!e an addiction counselor$ According to &i! t&is is &is 'a( of &el"ing out$ )n addition &e told t&e audience t&at 0)eco#ery takes a lifetime. )eco#ery is my deathbed$1 Conclusion
*it& t&e data t&at 'e gat&ered fro! t&e fi#e s"ea,ers t&ere 'ere certain "ieces of infor!ation t&at 'e find interesting$ 8irst of 'as '&en (ou get addicted to drugs it is not onl( drugs t&at (ou get de"endent on but also 'it& ot&er substances li,e alco&ol$ Second 'as 'e &eard it fro! t&e! t&at alco&ol is !ore fatal t&an illicit drugs$ .&ird is t&at reco#er( ta,es a lifeti!e$ *e t&oug&t t&at after (our session 'it& t&e re&abilitation center (ou are no' 'ell$ ?ut seeing t&e! it reall( loo,s li,e reco#er( 'ill ta,e a lifeti!e$ 8ourt& substance use destro(s not onl( (ourself but also t&e "eo"le around (ou$ >astl( substance abusers do not onl( co!e fro! t&e lo' or "oor class of t&e societ( but also !ore often 'it& t&e &ig& social class$
Insights
5&arlesD Betting to interact 'it& t&ese "eo"le reall( frig&tened !e a little$ 4f course so!e of t&e! are still in t&e "rocess of reco#er($ ) do not ,no' '&at t&eir ne/t !o#e 'ill be$ ?ut t&e funn( t&ing is t&at t'o out of 5 do not loo, li,e substance abusers or substance de"endents$ .&e societ( reall( is un"redictable$ ) also feel "roud for t&ese "eo"le since t&e( are 'illing to c&ange and t&e( are 'illing to &el" t&ose '&o are still in t&e dar, side$ .&ese "eo"le for !e are t&e !ost ca"able of &el"ing ot&er abusers since t&e( are t&e ones '&o 'ere once t&ere and 'as able to co!e out or o#erco!e t&e great &urdle in t&eir li#es$ U"on obser#ation so!e of t&e! 'ere reall( tr(ing to fit in t&e grou"$ *&at to t&e! is 0cooler1 or '&at for t&e! is 0in1 ) guess it9s a !atter of '&o (ou are 'it& and '&o (ou c&oose to be 'it&$ .o cut t&e long stor( s&ort ) t&in, 'e s&ould be accountable of t&e actions 'e do$ *e s&ould be able to face t&e conse+uences of t&e decisions 'e !a,e$ *e s&ould not enter t&ings t&at 'e cannot control or 'e do not need to enter$
.e#esD All of us &as a dar, side in our li#es$ ?ut so!eti!es 'e cannot also bla!e so!e "eole '&( t&e( c&ose a 'rong "at& instead of a rig&t one$ 8or one reason 'e dont ,no' t&eir "ersonal bac,ground and '&o t&e( are inside t&eir fa!il($ Ma(be t&e decided to engage in t&at acti#ities to forget t&eir "roble! and frustration$ .&e lesson t&at ) learned fro! t&is researc& is loo,ing for '&at t&e( are rig&t no' and forgetting t&eir "ast$ .&is researc& re!inds !e t&e stor( about t&e "rodigal son$ *e so!eti!es fall and feel &o"eless but as 'e see t&e real "ur"ose of life 'e c&ange e#er(t&ing in oursel#es$