People Affected by Alcohol and Substance Abuse
According to the 2010 National Health Survey, 51% of legal adults use alcohol regularly. Simple alcohol and substance use differs from both abuse and dependence. Substance abuse indicates a maladaptive pattern of substance use that leads to significant impairment or distress. Substance dependence, on the other hand, indicates addiction, where an individual can develop tolerance, withdrawal, or compulsive drug-taking behavior. Both use and abuse/dependence can have negative health effects and increase a person’s health risk potential. Overall rates of alcohol and substance use and abuse have been declining slowly over the last four decades, though rates of certain drug abuse have increased.
The country has experienced a small decrease in nonmedical drug use among all surveyed groups from 2002 to 2008. This is a positive change, as the 1990s saw an increase in illicit drug use for children ages 12 to 17. Marijuana use among high school seniors was 33.7% in 1980 and then declined for a period through 1991. In 1995, marijuana use rose drastically to 21.2% and has declined only slightly since, to 20.6% in 2009. Cocaine use among high school seniors followed a similar trajectory. In 1985, the rate of cocaine use among this vulnerable age group was 6.7%. Since then, it has hovered between 1% and 2%, with a 2009 rate of 1.3% (see Figure 1.9) (U.S. Department of Health and Human Services, 2011a).
Figure 1.9: Substance abuse in the past month among persons 12 years of age and over
A bar graph depicts the incidence rates of mental illness in Americans in three age groups (18-25 years, 26-49 years, and 50+ years) in 2010. Americans 18-25 years old suffered the most mental illness proportionately compared to older age groups. Those 26-49 years old suffered mental illness proportionately more than older individuals; and those 50+ years old suffered less mental illness in 2010 than all younger age groups.
Illicit drug use has declined only slightly for the age groups between 12 and 25, but the rate has remained almost constant for the age groups 26 and over.
Center for Disease Control and Prevention. (2010). Retrieved from http://www.cdc.gov/nchs/data/hus/hus10.pdf#061
In 2010, 50.9% of legal adults reported regular alcohol use, and 13.6% of respondents reported occasional alcohol use. There were 14,406 alcoholic liver disease deaths in the United States in 2007, and 23,199 nonaccident and nonhomicide alcohol-related deaths (CDC, 2012a). Figure 1.10 shows that alcohol use declined overall among high school seniors, with 72% in 1980 and 43.5% in 2009. Hard data is not available as to the reason for this decline, but it is thought to be due to more strict enforcement of laws regulating access to alcohol and community-based prevention programs.
Figure 1.10: Alcohol use among high school seniors
A line graph depicts the percentage of persons age 12 or older who engaged in substance abuse in the period of a month during 2002, 2007, and 2008. The persons are divided into six age groups (ages 12-13; 14-15; 16-17; 18-25; 26-34; and age 35 and over). In all three years studied, substance abuse was lowest in ages 12-13; peaked at ages 18-25; and gradually declined for those ages 35 and over.
Overall, alcohol use among high school seniors has declined over the last three decades.
Centers for Disease Control and Prevention (CDC). (2012a). Retrieved from http://www.cdc.gov/nchs/data/hus/hus10.pdf#062
Emergency room reports provide many statistics on alcohol and drug abuse in the United States. These reports are made via the Drug Abuse Warning Network (DAWN), through the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration. There were 4.6 million drug-related emergency department visits across the nation in 2009. Of these, approximately 50% were related to side effects of medications that were taken correctly. The rest included 27.1% related to nonmedical use of prescription drugs; 21.2% of DAWN-reported cases involved illegal drugs; and 14.3% involved drugs and alcohol combined (National Institute on Drug Abuse [NIDA], 2011a).
The Drug Abuse Resistance Education (DARE) program was founded in 1982 as an effort by law enforcement to educate adolescents about the hazards (both health and lifestyles) of illicit drug use. As discussed earlier, there has been a measurable decrease in illicit drug use by adolescents. Do you believe that programs like DARE have had an effect on this reduction? If not, what other factors do you believe may be responsible?
Indigent and Homeless People
Photo of a homeless teenager sitting on the sidewalk with his head down and arms folded.
Courtesy of Richard Thornton/Shutterstock
Of the more than half a million people who are homeless on a given night, a growing percentage of that number are families.
Homeless people have an extremely high risk for negative outcomes. Homicide, suicide, mental illness, chronic illness, and acute illness all plague the homeless population. Hunger and exposure to the elements are the immediate concerns government and community groups work to alleviate in the homeless population. Creating positive, permanent outcomes for America’s homeless takes resources and an understanding of the people in need of aid.
In 2009, an estimated 643,067 homeless people were both in shelters and on the streets on a given night. The Department of Housing and Urban Development (HUD) estimates that homeless numbers held steady from 2009 to 2010, but that the number of homeless families has increased in relation to the number of homeless individuals (U.S. Department of Housing and Urban Development [U.S. HUD], 2011). HUD’s 2010 Annual Homeless Assessment Report to Congress found a decline in long-term homelessness, credited largely to the Homelessness Prevention and Rapid Re-Housing Program.
Immigrants and Refugees
Immigration to the United States has increased in fits and starts since the year 1820, with some years seeing less immigration than others. Migrants obtaining legal permanent resident status in 2010 totaled 1,042,625 (U.S. Department of Homeland Security, 2010). Both legal and illegal migrants and refugees present unique challenges to America’s social welfare system.
Language barriers strain resource delivery to the migrant population. Educators have developed English as a Second Language (ESL) programs to address the educational needs of migrant and refugee children. Health care organizations purposefully seek bilingual employees who communicate well with patients. Differences in ethical and social norms sometimes prohibit migrants from seeking assistance for housing, health care, and other needs.
The United States office of Citizenship and Immigration Services oversees all legal immigration to the country. Programs exist for the naturalization of foreign-born adopted children, work visas, marriage, citizenship through naturalization, and for those seeking asylum. Legal immigration through the appropriate channels better enables resource delivery to migrant populations. However, legal immigration does not automatically give the foreign-born person the same access to publicly funded health care programs. Special programs exist for aiding refugees. Refugees are different from immigrants because they are forced to flee their home country, as opposed to immigrants who come and leave freely. The federal Office of Refugee Resettlement (ORR) provides critical resources for refugees seeking asylum in the United States.
In the United States, people hold very different attitudes toward immigrants and refugees. These attitudes range from the belief that illegal immigrants drain our resources and bring those that prey on them, such as drug dealers and con artists, to peaceful neighborhoods to the belief that by providing the needed resources, the common good will improve. Do you perceive that there is a benefit to providing these resources?
Case Study: Macro Perspective Versus Micro Perspective: The Patient Protection and Affordable Care Act of 2010
We have seen all of these principles of social theory in the debate over the Patient Protection and Affordable Care Act of 2010 (PPACA) (One-Hundred Eleventh Congress, 2010). The PPACA was signed into law by President Barack Obama and was his signature legislative project. Both President and First Lady Obama dedicated themselves to improving the health and access to health care of all Americans. The primary focus of the PPACA is to limit the power of the private health insurance companies to deny claims and coverage, to improve affordability of health care, and to expand the qualifications for Medicaid.
The Pareto principle that the common good actually has a negative effect on some is at the heart of the debate. One side argues that reforming America’s health care system is vital for the public good. The opposition argues that the reforms called for in the PPACA will cost the collective a great deal but will benefit only a few. A similar but slightly different argument given is that a few will be forced to pay for the collective. Both of these arguments are based on the concept that the common good (in this case, reform of the health care system) is not good for all.
Wrapped up in the economic concerns over the PPACA is the issue of individual rights versus the common good. Americans worry that a single-payer system would take away individuals’ rights to select their own doctors and dictate their own course of health care. This concern is based on the macro versus micro dichotomy, as public policy works on a macro scale but greatly alters our micro influences.
Any society that wants to call itself modern must recognize the populations most at risk of negative outcomes and provide resources to help create positive outcomes for these vulnerable groups. Doing so adds to the health and economic viability of the community. But an “all for one, and one for all” model does not always work on a large scale. Resource allocation must be done thoughtfully to create the most positive outcomes for the most people. Statistical data on vulnerable populations helps inform public policy decisions that equalize fairness as much as possible while providing for those in need. At a pivotal point in America’s history, following a recession that saw many people lose health care access, recognizing who is vulnerable and how to help them is key for improving the chances of positive outcomes for individuals and the community as a whole.
Why is it important for society to help ensure that the health care needs of the special populations described in this chapter are met? Are the methods of data gathering that are described able to provide enough information to enable well-informed and intelligent decisions by policymakers?
Visit the following websites to learn more about the topics covered in this chapter:
Louisville, Kentucky, Farm to Table program:
World Health Organization
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