Social determinants of health (SDOH) have been recognized as factors contributing to the increase in health disparities. Personal health behaviors are essential determinants of health status. While individual choices are obviously crucial, most of what influences health is beyond the scope of individual decisions and is determined by the environment, working conditions, and our social stratification (Thisted, 2003). Social determinants have various impacts on factors including intrapersonal, interpersonal, community, institutional factors, and public policies.
Social, economic, and political systems play an additional role in determining both the environment where people live and their ability to gain access to the resources such as food, shelter, and medical care. People tend to make individual lifestyle decisions within a social context. The use of drugs is, in some way, a response to social breakdown and an essential factor in worsening the increasing inequalities in healthcare.
Chronic addiction is the compulsion of using drugs, alcohol or engaging in specific behaviors despite the pending consequences. Addiction has narrowly been defined as a physical reliance on a particular substance and generally as the lack of power towards a particular type of behavior (Bulbena et al., 2017). Addiction is seen as a driver and a consequence of the broadening health disparities evident today. Addiction to drugs and alcohols is experienced in various parts of society, but the unequal societies often exhibit higher levels of drug addiction. In societies, individuals with low socio-income status, those experiencing marginalization and have limited power, have a higher chance of becoming addicted to substances. In addition, these individuals have a high probability of using these substances in a risky manner, and are prone to suffering various health consequences from addiction and will struggle with recovery (Thisted, 2003). At the last part of the socio-economic scale, individuals who have dependence on money and power increase the inequality and various societal challenges.
In an average setting, nearly half of the populations have used illegal drugs at some point in life, and many of these individuals often engage in heavy drinking at least once every week. Even so, most people who use alcohol and drugs do not always become addicted to them; this is the same way where most people who gamble, eat, or exercise do not develop an addiction to these activities. For most people using drugs, especially beginning in their late teens to early 20s, quitting or minimizing the consumption in their mid-20s are more common than when they started using (Hood, Gennuso, Swain, & Catlin, 2016). Constant use of substances means that the body continually builds up a tolerance, to the extent that when the use of the substance is halted, there are cases of withdrawal syndromes.
The above case also applies in the case of behavioral addiction, which shows a typical underlying process to behaviors that are considered addictive. It makes more sense that everyone has the potential of becoming an addict, and specific biological, psychological and social factors shape the possibility of this more or less likely for every individual to a particular time in life. There are several ways through which a person can engage in abusive substance use, and particular reasons for a person to start using substances. Whether it’s the use of legal or illegal substance, it will be based generally on the social context and motivation, and the accessibility of the substance (Marmot, 2018). Usually, it begins with substance providing relief from pain and for pleasure.
For individuals who eventually have a problem in using substances, they may start depending on the drug for different functions, such as, engaging in social activity and engaging in functions like regulation of emotions, or relieving physical pain. For others who often seek specific ways of finding pleasure or getting rid of pain, the substance can become valued to the extent that there are specific parts of life that may lose importance. As an individual always repeats this action, other parts of their life loose meaning. The addiction takes over by becoming mundane and something that they engage with automatically and habitually. As a result, such an individual becomes less able to self-control.
The primary objective of the community approach is a lasting change in lifestyle for the addicted individual. In this case, some principles are set along with the development of social, economic, and educational skills, which facilitate pro-social change in abuse of the substance (Barton & Henderson, 2016). The first principle follows that since the community approach follows residential procedures, participants are expected to spend their time and have most of their needs met in their location. Several activities that discourage alcohol and the use of drugs are developed through group processes.
Unlike other conventional treatment approaches, the Community Reinforcement Approach (CRA) focuses mainly on the context where substance abuse takes place and recognizes that this context differs among every person in the program individual (Marino, Campbell, Pavlicova, Hu & Nunes, 2019). As a result, the CRA approach is formed in a way that it allows therapists to shape the person through making them adopt the components that can be effective. Moreover, the CRA approaches mainly look at the internal and external triggers that lead to abuse and note the positive and negative consequences of abusing the substance. Meanwhile, other approaches, such as the motivational approach assume that the responsibility and capacity of change are dependent on the individual (Marino, Campbell, Pavlicova, Hu & Nunes, 2019). While these strategies can be useful in helping clients to identify harmful patterns of behavior, they do not work effectively in allowing a person to change their behavior and to solve their problem using coping strategies.
Community Reinforcement Approach is a treatment of choice because it is a two-way method of therapy, focusing on the significance of feelings, thoughts, and expectations. It involves traditional social methods using counter-conditioning and supervision of contingency in dealing with the issue of addiction. Importantly, the approach weakens the connection that underlies addictive circumstances and normal social reactions. Strategies that therapists used in the CRA approach are such as the repeated behavioral practice of methods like relaxation and distraction and exploring reinforcements and consequences (Kraan, Dijkstra & Markus, 2018). The primary objective is to weaken the triggers that lead to addictive behavior and to offer an alternative and a more appropriate response.
References
- Barton, J., & Henderson, J. (2016). Peer support and youth recovery: a brief review of the theoretical underpinnings and evidence. Canadian Journal of Family and Youth/Le Journal Canadien de Famille et de la Jeunesse, 8(1), 1-17.
- Bulbena, A., Baeza‐Velasco, C., Bulbena‐Cabré, A., Pailhez, G., Critchley, H., Chopra, P., … & Porges, S. (2017, March). Psychiatric and psychological aspects in the Ehlers–Danlos syndromes. In American Journal of Medical Genetics Part C: Seminars in Medical Genetics (Vol. 175, No. 1, pp. 237-245).
- Hood, C. M., Gennuso, K. P., Swain, G. R., & Catlin, B. B. (2016). County health rankings:
- Kraan, A. E., Dijkstra, B. A., & Markus, W. (2018). Treatment delivery of the community reinforcement approach in outpatient addiction treatment. Evaluation and program planning, 70, 61-66.
- Marino, L. A., Campbell, A. N. C., Pavlicova, M., Hu, M., & Nunes, E. V. (2019). Social functioning outcomes among individuals with substance use disorders receiving internet-delivered community reinforcement approach. Substance use & misuse, 54(7), 1067-1074.
- Marmot, M. (2018). Social Determinants, Capabilities and Health Inequalities: A Response to Bhugra, Greco, Fennell and Venkatapuram.
- relationships between determinant factors and health outcomes. American journal of preventive medicine, 50(2), 129-135.
- Thisted, R. A. (2003). Are there social determinants of health and disease?. Perspectives in Biology and Medicine, 46(3), S65-S73.
