Heroin addiction: the past and future--论文代写范文精选

这个新计划已被证明是有效的治疗海洛因成瘾方法，药物滥用流行在马来西亚已经超过一个世纪。在20世纪早期,鸦片等主要药物滥用，主要是英国殖民主义者将中国移民带到马来西亚。下面的essay打学费进一步讲述。

Abstract 
  Substance misuse, in particular heroin addiction contributes to health and social problems. Although effective medical treatment was available, earlier efforts confined the treatment of heroin addicts to in-house rehabilitation which required them to be estranged from the community and their families for 2 years. The inhouse rehabilitative programme, implemented for at least three decades has produced low abstinence rates. On the other hand, being ‘away’ meant that many heroin addicts faced employment problems and family relationship difficulties upon completing the in-house rehabilitation. However, recently, the concerted efforts by various government and non-government organisations, and the acknowledgement that heroin addiction is a medical illness has resulted in a revamp to approaching treatment of heroin addiction. At present, methadone substitution programmes have been offered as part of treatment programme for heroin addicts in Malaysia. This new programme has been shown to be effective in treating heroin addiction and would need support and cooperation from all groups involved. Keywords: heroin, addiction, methadone, substitution, narcotic

 Introduction 
  Substance abuse has been prevalent in Malaysia for more than a century. In the early 20th century, the main drug of abuse was opium which was mainly consumed by Chinese immigrants who were introduced by the British colonialist to work in Malaya. In the later part of the 20th century, consumption patterns changed where heroin became the abused substance of choice and Malays were the main ethnic group involved in heroin abuse compared to other ethnic groups (1, 2). By the later part of the 20th century, the prevalence of heroin abused increased substantially and this made the Malaysian government consider heroin addiction as a threat to national security. Early government response included: the formation of the national anti-drug task force to control trafficking and to rehabilitate heroin addicts, and legislation where mandatory death sentence was implemented for those who smuggled more than 15 grams of heroin (3). It is mandatory for heroin addicts found to be drug positive to undergo compulsory rehabilitation for two years (4).

  Up to 28 government drug rehabilitation centres, costing approximately RM 50 million were established, where each center accommodated up to 500 inmates at any one time (5). The centres, managed on a total abstinence philosophy however produced poor results. Reports showed that as high as 85% of heroin addicts relapsed after completing their rehabilitation at these centres (4, 6). In response to the poor results, substitute treatment with methadone was recently introduced as part of treatment programme for heroin addicts (7).

 Challenges to treating heroin addiction in Malaysia- the past 
  Heroin misuse contributes to complicated health and social problems to our country. Despite three decades of managing these problems, outcomes are unpromising and poor. Among the reported contributory factors are: (i) treatment policy which had been confined to a single treatment modalitythe regimental rehabilitation programme, (ii) despite strong published evidence that addiction to drugs is a medical condition, earlier approach had totally ignored the medical therapeutic approach. The medical profession was only recently invited to review the policy of treatment for heroin addiction in Malaysia (iii) the stigma of the illness and rehabilitation treatment which resulted in heroin users hesitant of seeking early treatment. Heroin users were reported to fear rejection by the community and of losing their freedom once they entered a rehabilitation programme (6-8).

  Thus, as a consequence of ineffective treatment approach, there has been a continually increasing number of infectious diseases among heroin users and an escalating incidence of HIV and/or AIDS in Malaysia (8). The Ministry of Health, Malaysia reported that the cumulative number of HIV infections up to December 2005 was 71,000 cases, where more than 10% cases were AIDS positive. Most of the HIV infected persons are males (82 %) aged 20-40 years (6). One of the requirements of rehabilitation was that a heroin addict needed to be placed as in-house resident for two years (3). This resulted in majority of heroin addicts being forced to resign or losing employment. 

  At the end of 2 years, by the time they leave the centres, they lose the opportunity to work (2). This could be one reason why many of rehabilitation inmates resort to crime once discharged from in-house rehabilitation centres. Some heroin addicts reported that they perpetrated crime in order to support themselves and their families. However this is partially truthful as it was observed that many perpetrated crime to support their addictive heroin habit. This is because forced abstinence while in the rehabilitation centres do not cure the heroin addiction. Once discharged from the centres, and without strict abstinent enforcement, they relapse to their previous heroin usage (6-8). The types of crimes commonly perpetrated by heroin addicts included snatch theft, selling drugs, fraud and house breaking (9). The involvement of heroin addicts in crime may result in imprisonment.

  Thus, another problem and another second stigma is added. In this case, imprisonment further confirms the community’s view that heroin addicts are criminals and should be alienated, hence resulting in total rejection from the community and from their families (2). The resulting alienation may cause depression and loss of hope. This emotional state will worsen their heroin addiction, making it challenging for the therapist and clinician to motivate them for treatment (8). The combined rejection by the community and family limits the heroin addict to confide in their peer heroin addicts. Ultimately, the heroin addict’s condition will get worse, and this is the time when they may start sharing needles. 

  This could explain the whole cycle of addictive behaviour and how it correlates with HIV and AIDS. It is very unfortunate that in the past, the medical community dealt with these heroin addicts after they had already contacted these horrendous complications (6, 8). The sharing of needles by heroin addicts’ also exposes their spouses at risk of HIV and AIDS (6). There were many instances where husbands, who were heroin addicts with AIDS transmited the disease to their spouses and children (7). This is another disaster, which could have been prevented if the addiction cycle was intervened with appropriate medical treatment. The consequence of failed rehabilitation treatment not only affect heroin addicts but also their family members (4). 

  More than 50% of heroin adicts who underwent rehabilitation programmes were the breadwinners of their family. For the family, the loss of their sole breadwinner to two year rehabilitation programme caused loss of financial and emotional support. This caused family stress which further disrupted the family system. This could be one explanation why the children of heroin addicts are at more risk of social and mental problems and of becoming heroin addict themselves. Both professionals and the public have expressed concern about the failure of the in-house rehabilitation treatment programme in tackling heroin addiction in Malaysia (4, 8). It is therefore timely for the government to look at the process of how to maximise the cost benefit of the rehabilitation programmes. For instance, the duration and the type of heroin addict who needs such treatment should be reviewed. One of the suggestions is that the duration of stay should be shortened to less than 6 months.（essay代写)

  The advantages of shorter rehabilitation include: firstly, this maintains the heroin addicts within the community without depriving them of their employment potential or maintaining as breadwinners of the family. The second advantage would be the cost saving to the government. It was reported that each addict cost RM3, 000 per month to rehabilitate. Thus reducing in-house rehabilitation to less than six months will incur less than a quarter of the total cost spent at present. Nonetheless, the most expensive cost is still borne by the heroin addicts’ family who suffer at being left to fend for themselves mentally and financially. This loss is of course is unquantifiable in Ringgit and Cents (7).（essay代写)

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