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Implemented to a and with no impact on the scale or proftability of suffcient scale buy cialis soft 20 mg fast delivery, these programs have the potential the market order cialis soft uk. Offer a wide and easily accessible range of options fghting the drug war generic 20 mg cialis soft mastercard, many countries implement laws for treatment and care for drug dependence order cialis soft master card, and punishments that are out of proportion to the including substitution and heroin-assisted treatment, seriousness of the crime, and that still do not have a with special attention to those most at risk, including signifcant deterrent effect. Invest more resources in evidence-based prevention, a tragic loss of potential for the individual involved, with a special focus on youth. Clearly, the most valuable investment would be in activities that stop young people from using drugs in Preventing and treating drug dependence is therefore the frst place, and that prevent experimental users a key responsibility of governments – and a valuable from becoming problematic or dependent users. In the – have been implemented and proven in a range of face of growing evidence of the failure of these strategies, socio-economic and cultural settings. Governments should ensure that their drug dependence There are a number of ways to make progress on this treatment facilities are evidence-based and comply with objective. We therefore welcome the change of tone millions of citizens are sent to prison unnecessarily, emerging from the current administration50 – with millions more suffer from the drug dependence of President Obama himself acknowledging the futility loved ones who cannot access health and social care of a ‘war on drugs’ and the validity of a debate on services, and hundreds of thousands of people die from alternatives. Getting drug policy right is not a matter for theoretical or intellectual debate – it is one of the key policy challenges of our time. High Commissioner calls for focus on human rights and harm reduction in ashx Accessed 05. Plus programs” System,” International Journal of Drug Policy, Volume 21, (1), 2010, pp. Alex Wodak, Australian Drug Law Assessing supply-side policy and practice: eradication Reform Foundation and alternative development www. Otherwise, almost all medicines can be thrown in the household trash, but only after consumers take the precautionary steps as outlined below. A small number of medicines may be especially harmful if taken by someone other than the person for whom the medicine was prescribed. Many of these potentially harm- ful medicines have specifc disposal instructions on their labeling or patient information to immediately fush them down the sink or toilet when they are no longer needed. Drug narcotic pain relievers and other con- adverse human health effects from Enforcement Administration, trolled substances carry instructions drug residues in the environment. For example, the fentanyl patch, The agency reviewed its drug labels to deadiversion. ResourcesForYou/Consumers/ containers and mix them with “Even after a patch is used, a lot of BuyingUsingMedicineSafely/ an undesirable substance, such the medicine remains in the patch,” EnsuringSafeUseofMedicine/ as used coffee grounds or kitty says Jim Hunter, R. Place the tially dangerous narcotic that could with inhalers used by people who mixture in a sealable bag, empty harm others. A and can enter the environment after medicine that works for you could passing through waste water treat- Find this and other Consumer be dangerous for someone else. Protection Agency take the concerns of fushing certain medicines in the Sign up for free e-mail Bernstein says the same disposal environment seriously, there has subscriptions at www. Research shows that frequently people don’t have enough information, or have the wrong information, about drugs. Knowing the facts makes it easier to talk about drugs in an open and informed way. Every drug has side-effects and risks, but some drugs have more risks than others, especially illegal drugs. These are: What drug is used Who is using the drug (especially their mood and personality) Why they are using the drug Where and How they are using the drug Different drugs create different problems for different people. To begin to understand the problem, you have to know what is happening in the life of the person who is using the drug and what drug they are using. For example, you may take medicine when you are sick, alcohol to help you relax or coffee to help you stay awake. You may experiment with illegal drugs because of curiosity, because your friends are doing it or to escape boredom or worries. This may be because of emotional, psychological or social problems you are experiencing. Some drugs can make you addicted or dependent, where you lose control over your drug use and feel you cannot function without the drug. Some people use more than one drug at the same time – this is known as ‘polydrug use’. Mixing drugs can be dangerous because the effects and side-effects are added together. This includes mixing illegal drugs with legal drugs such as alcohol or medication. For example, taking alcohol with cocaine increases your risk of irregular heart rhythms, heart attacks and even death. Myth “All drugs are addictive” Fact Some drugs can create addiction or dependence much quicker than others. There is no evidence that people get ‘hooked’ after one or two uses, or that everyone who tries a drug will become addicted. Myth “Only drug addicts have a problem” Fact Addiction or dependency is not the only problem drugs can cause. Some people have problems the first time they use a drug, or problems may develop as you use them more often. Drug use can affect your physical and mental health, your family life, relationships and your work or study. Using illegal drugs can also get you into trouble with the law or cause money problems. Myth “All illegal drugs are equally harmful” Fact Different drugs can harm you in different ways. Some drugs, such as heroin, are regarded as more dangerous because they have a higher risk of addiction and overdose, or because they are injected. Myth “My teenager is moody and losing interest in school – they must be on drugs” Fact Parents often ask how they can tell if their child is using drugs. Many of the possible signs, such as mood swings or loss of interest in hobbies or study, are also normal behaviour for teenagers. Find out the details of their drug taking – what they have taken, for how long and why. You can help your child develop a sensible attitude towards drugs, by showing a sensible attitude to your own use of drugs – particularly legal drugs such as alcohol and medication. Myth “Young people are tempted to try drugs by pushers” Fact Most young people are introduced to illegal drugs by a friend or someone they know. In many cases drugs are ‘pulled’ rather than ‘pushed’ – the person asks for it themselves, often out of curiosity. You may feel uncomfortable talking about drugs because you don’t know enough about the subject. If someone you know is taking drugs or you think they are taking drugs: • Listen to them – it is important to understand and respect how they feel; • Keep the lines of communication open; and • Look for more information before you do anything. A number of voluntary agencies also provide education, counselling and treatment throughout the country. To get information on your local services: Freephone: Drugs helpline 1800 459 459 (Monday – Friday, 9am to 5pm) Web: www. They are known as ‘controlled drugs’ and are listed in different groups called schedules. The schedules group drugs according to how useful they are and what is needed to control their use. They have the same general effects as depressants but they cause addiction in a different way. Depressants and sedatives are sometimes called ‘downers’ and stimulant drugs are sometimes called ‘uppers’. For example, cannabis can have depressant effects as well as causing euphoria and ecstasy has both stimulant and hallucinogenic effects. The most common type is called resin, which comes as solid dark-coloured lumps or blocks. Cannabis is usually rolled with tobacco into a ‘joint’ or ‘spliff’ and smoked, but it can also be cooked and eaten.

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The utility of supplemental oxygen therapy and the potential dangers of overly aggressive oxygen supplementation in some pathophysiologic states discount cialis soft 20 mg otc. History-taking skills: Students should be able to obtain generic 20 mg cialis soft with visa, document buy cheap cialis soft 20 mg on line, and present an age-appropriate medical history order cialis soft once a day, that differentiates among etiologies of disease, including: • Quantity, quality, severity, duration, ameliorating/exacerbating factors of the dyspnea. Physical exam skills: Students should be able to perform a physical exam to establish the diagnosis and severity of disease, including: • Accurately determining respiratory rate and level of respiratory distress. Laboratory interpretation: Students should be able to recommend when to order diagnostic and laboratory tests and be able to interpret them, both prior to and after initiating treatment based on the differential diagnosis, including consideration of test cost and performance characteristics as well as patient preferences. Communication skills: Students should be able to: • Communicate the diagnosis, treatment plan, and subsequent follow-up to the patient and his or her family. Management skills: Students should able to develop an appropriate evaluation and treatment plan for patients that includes: • A rapid triage approach to the acutely dyspneic patient. Demonstrate commitment to using risk-benefit, cost-benefit, and evidence- based considerations in the selection diagnostic and therapeutic interventions for dyspnea. Recognize the importance of patient preferences when selecting among diagnostic and therapeutic options for dyspnea. Appreciate the impact dyspnea has/have on a patient’s quality of life, well- being, ability to work, and the family. Recognize the importance of and demonstrate a commitment to the utilization of other healthcare professionals in the diagnosis and treatment of dyspnea. Given the amount of health care dollars that are spent on antibiotic treatment of urinary tract infections as well as the emergence of resistance, it is important for third year medical students to have a working knowledge of how to approach the patient with this complaint, and how to differentiate patients with cystitis from other common causes of dysuria. Presenting signs and symptoms of the common causes of dysuria, including: • Cystitis. History-taking skills: Students should be able to obtain, document, and present an age-appropriate history that differentiates among etiologies of dysuria, including: • Timing, frequency, severity, and location of dysuria. Physical exam skills: Students should be able to perform a physical exam to establish the diagnosis and severity of disease, including: • Percussion and palpation of the bladder to accurately recognize distention and tenderness. Differential diagnosis: Students should be able to generate a differential diagnosis recognizing specific history, physical exam, and laboratory findings that suggest a specific etiology of dysuria. Laboratory interpretation: Students should be able to recommend when to order diagnostic and laboratory tests and be able to interpret them, both prior to and after initiating treatment based on the differential diagnosis, including consideration of test cost and performance characteristics as well as patient preferences. Laboratory and diagnostic tests should include, when appropriate: • Urinalysis interpretation including cells and casts, urine dipstick and Gram stain when appropriate. Communication skills: Students should be able to: • Communicate the diagnosis, treatment plan, and subsequent follow-up to the patient and his or her family. Management skills: Students should be able to develop an appropriate evaluation and treatment plan for patients that includes: • Selecting appropriate empiric antibiotic therapy for cystitis, pyelonephritis or urethritis prior to culture results. Demonstrate commitment to using risk-benefit, cost-benefit, and evidence- based considerations in the selection of diagnostic and therapeutic interventions for dysuria. Recognize the importance of patient needs and preferences when selecting among diagnostic and therapeutic options for dysuria. Recognize the importance of and demonstrate a commitment to the utilization of other healthcare professionals in the treatment of dysuria. A rational approach to patients with fever will help clinicians recognize presentations that need immediate attention, limit unnecessary diagnostic testing in less seriously ill patients, and help inform therapeutic decision making. Physiology of the acute febrile response, including the: • Beneficial and detrimental effects of fever upon the host. Risk factors and co-morbidities that are important in determining the host response to infection (e. Etiology of fever in special populations, including patients with a history of: • Neutropenia due to cancer-related myelosuppression. History-taking skills: Students should be able to obtain, document, and present an age-appropriate medical history that differentiates among etiologies of disease, including: • Chronology, duration and pattern of fever. Physical exam skills: Students should be able to perform a complete physical exam to determine the severity of disease and establish a preliminary hypothesis about the cause of fever. Differential diagnosis: Students should be able to generate a prioritized differential diagnosis recognizing specific history and physical exam findings that suggest a specific etiology: • Infection. Laboratory interpretation: Students should be able to recommend when to order diagnostic and laboratory tests and be able to interpret them, both prior to and after initiating treatment based on the differential diagnosis, including consideration of test cost and performance characteristics as well as patient preferences. Communication skills: Students should be able to: • Communicate the diagnosis, treatment plan, and subsequent follow-up o patients. Basic and advanced procedural skills: Students should be able to: • Obtain blood, wound, and throat cultures. Management skills: Students should able to develop an appropriate evaluation and treatment plan for patients that includes: • Developing an appropriate evaluation plan for patients with fever including ordering and interpreting appropriate laboratory and radiographic studies. Demonstrate commitment to using risk-benefit, cost-benefit, and evidence- based considerations in the selection diagnostic and therapeutic interventions for fever. Appreciate the impact fever has on a patient’s quality of life, well-being, ability to work, and family; recognize the emotional impact of differential diagnosis. Recognize the importance of and demonstrate a commitment to the utilization of other healthcare professions in the diagnosis and treatment of fever. Clinicians must be prepared to identify and correct these disturbances as efficiently as possible, thus making it an important training problem for third year medical students. The differential diagnosis of hypo- and hypernatremia in the setting of volume depletion, euvolemia, and hypervolemia. The most common causes of respiratory acidosis, respiratory alkalosis, metabolic acidosis and metabolic alkalosis. How to calculate the anion gap and explain its relevance to determining the cause of a metabolic acidosis. The types of fluid preparations to use in the treatment of fluid and electrolyte disorders. History-taking skills: Students should be able to obtain, document, and present an age-appropriate medical history that differentiates among etiologies of disease, including: • Eliciting appropriate information from patients with volume overload, including recent weight gain, edema or ascites, symptoms of heart failure, dietary sodium intake, changes in medications, noncompliance and intravenous fluid regimens. Physical exam skills: Students should be able to perform a physical exam to establish the diagnosis and severity of disease, including: • Measurement of orthostatic vital signs. Differential diagnosis: Students should be able to generate a prioritized differential diagnosis recognizing specific history, physical exam, and laboratory findings that distinguish between: • Hypo- and hypervolemia. Laboratory interpretation: Students should be able to recommend when to order diagnostic and laboratory tests and be able to interpret them, both prior to and after initiating treatment based on the differential diagnosis, including consideration of test cost and performance characteristics as well as patient preferences. Communication skills: Students should be able to: • Explain to a patient and his or her family why intravenous fluids are needed. Basic and advanced procedural skills: Students should be able to: • Insert a peripheral intravenous catheter. Management skills: Students should be able to develop an appropriate evaluation and treatment plan for patients that includes: • Writing appropriate fluid orders for the treatment of hypo- and hypervolemia, hypo- and hypernatremia, hypo- and hyperkalemia, hypo- and hypercalcemia. Demonstrate commitment to using risk-benefit, cost-benefit, and evidence- based considerations in the selection of diagnostic and therapeutic interventions for problems related to fluid, electrolyte and acid-base disorders. Demonstrate ongoing commitment to self-directed learning regarding fluid, electrolyte and acid-based disorders. Recognize the importance and demonstrate a commitment to the utilization of other healthcare professions in the treatment of problems related to fluid, electrolyte and acid-base disorders. Knowledge of etiology, risk factors, approach, and management is integral to internal medicine training. Prerequisites: Prior knowledge, skills, and attitudes acquired during the pre-clerkship experience should include: ƒ Ability to perform a complete medical history and physical exam. The common causes for and symptoms of upper and lower gastrointestinal blood loss, including: • Esophagitis/esophageal erosions. Physical exam skills: Students should be able to perform a physical examination to establish the diagnosis and severity of disease, including: • Postural blood pressure and pulse. Laboratory interpretation: Students should be able to recommend when to order diagnostic and laboratory tests and be able to interpret them, both prior to and after initiating treatment based on the differential diagnosis, including consideration of test cost and performance characteristics as well as patient preferences. Laboratory and diagnostic tests should include, when appropriate: • Stool and gastric fluid tests for occult blood. Communication skills: Students should be able to: • Communicate the diagnosis, treatment plan, and subsequent follow-up to patients. Demonstrate commitment to using risk-benefit, cost-benefit, and evidence- based considerations in the selection of diagnostic and therapeutic interventions for gastrointestinal bleeding. Respond appropriately to patients who are nonadherent to treatment for gastrointestinal bleeding.

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Perhaps we’d rather ignore the pager altogether order 20mg cialis soft mastercard, or controlling every outcome cialis soft 20mg lowest price, or curing every disease buy 20mg cialis soft otc, lie many unload on the clerk who keeps paging us order cialis soft 20mg with mastercard. Instead, just stop- spiritual opportunities: to be touched by the unspeakable raw- ping for a few moments and letting ourselves honestly feel our ness of a mother’s grief over her lost child; to be humbled by frustration and fatigue may be what we really need. We may prefer to avoid or ignore such experiences when they arise and run off When we notice diffcult feelings and still accept ourselves, to write our notes in the chart. Yet, medicine is a challenging without self-criticism or denial, we are developing compassion profession in large part because it directly exposes us to the en- for ourselves. Mindfully listening to a patient’s anxieties is Finding and using practices that connect us with our experi- natural for those who’ve made room in their hearts for their ences, from writing in a journal to contemplation to meditation, own fears. By coming back to our own sense of presence, we are then more able to be present to others. Our willingness to connect with ourselves thus becomes a Refection: Suggestions for spiritual well-being stepping-stone to a deeper connection with our patients and • Connect with your purpose. When you are Case resolution washing your hands between patients, notice the The resident mentions these feelings to a hospital chap- specifc way you move them, the sensation of the lain, with whom a dialogue on death and dying begins. Sense your feet on the ground, and the father’s death and so joins a bereavement group. The resident begins to feel less isolated and fnds when attending to other people and concerns all it easier to relate to what patients and their families are day. The resident now makes a conscious effort write, or just be present, can bring you back to to notice things that they are grateful for. So, rather than being open to ourselves and our life, we of physicians during and following a catastrophe. We fail to get into the program we want; someone we love Newton B, Barber L, Clardy J, Cleveland E, O’Sullivan P. Do I need • explore strategies and resources for obtaining a personal a specialist in family medicine or is it better for me to family physician, and see a surgeon or internist directly? We do not have objective measures of what doctors need from Case their personal physicians, nor do we know whether their needs A third-year resident has used the birth control pill previ- differ from those of other patients. She chooses a package evidence that access to a family physician helps to maximize from the samples that are available at the community health. A family physician considers the whole picture of the health needs of the patient and not just The resident is your colleague and does not have a per- the presenting symptom or concern. Review the regulations or A family physician functions as a personal health care consul- recommendations of your licensing college that relate to tant for you and your family. Your family physician keeps a Now pretend that you are the resident’s personal family record of your personal and family health issues and provides physician. Most importantly, your Introduction personal family physician assists you with decisions about your What factors infuence physicians to consult another physician health and health care services. Are these factors dif- ferent from those that prompt other patients to see a doctor? Contact information is available at: self-care decision may seem straightforward for the physician www. Physicians needing physicians Unlike other patients, physicians can access the health care sys- Research is lacking on the decision-making processes that tem and self-diagnose, self-refer and self-prescribe; traditionally, doctors use to determine when and with whom they should however, they have been implored not to do so, but to behave consult about personal or family health issues. In Canada, ac- like “normal” patients and seek treatment recommendations cess to a family physician is a problem for all patients, including from others rather than directing their own care. These four must do the same and negotiate how much participation from characteristics have always been commonplace in the care of you, the patient, will assist with quality decision-making and physician patients. As physician patients we cannot Building a good family physician relationship help but approach our personal medical issues with an expert Robert Lamberts, a physician based in Augusta, Georgia, perspective. However, physician expertise does not necessarily has written a list of rules to assist him to get along with his assist with decision-making; indeed, clouded by subjective con- patients and for his patients to get along with him. Consider cerns, it can sometimes impair decision-making about personal these as you interact with your family physician, and as you health issues. In family medicine, much of our ability to diagnose and ad- Rules for patients to get along with their doctor: vise is based on a trusting relationship with our patients that • Rule 1: Your doctor can’t do it alone. As in all relationships, there must be doctor does not mean you should not ask support and resolve to permit the relationship to grow. As one commentator has written, for there to be a justifed trust between patient and doctor, “the consultation must be distractible. Case resolution • Rule 5: They want to know what is going to be The resident used the services available through her local done and when. I am a good patient, that the patient must always agree with the physician’s recom- believe it or not. Because one shoe doesn’t patient fnd concordance on an approach to care in illness and ft all: a repertoire of doctor–patient relationships. Objectives that only 14 per cent of the participants consumed the recom- This chapter will mended six to eight glasses of water per day, and the majority • describe some of the barriers to adequate nutrition in the (60 per cent) snacked less than once a day (Winston 2008). A workplace, qualitative study in which physicians were interviewed about • discuss how inadequate nutrition can affect physicians their workplace nutrition habits reported that 19 of the 20 par- personally and professionally, and ticipants expressed that they sometimes have diffculty eating • suggest ways in which individual physicians can infuence and drinking during work hours (Lemaire et al 2008). In particular the usual attention to healthy What is the impact of inadequate nutrition on physi- nutrition has been gradually eroded by long sessions in cians? Poor nutrition for physicians during the work day has the operating room and lengthy work days. The resident signifcant consequences, both for the individual physician and regards the nutrition choices at the hospital as unaccept- for the workplace. Physicians have previously described how able and fnds they are missing meals, losing weight and their inability to eat and drink properly during work hours is generally feeling awful on most days. When considering physicians’ nutrition in the For physicians: workplace, the solution should be simple—just make time to • Eat breakfast. However, the issue is not so straightforward, and • Carry healthy and convenient snacks with you. Nutrition in the health care workplace To improve nutrition in the workplace, physicians and health For health care organizations: care organizations must enhance their awareness and under- • Improve the quality and variety of foods available standing of the impact of inadequate nutrition and the barriers in the workplace. Without this knowledge, there will be little • Improve access to nutritious food (e. For example, one study provided a description of some eat, drink and store food from home. They also Case resolution felt that inadequate nutrition had a negative impact on both The resident is facing an issue common to most physi- their ability to complete their work and on their interactions cians—diffculty obtaining adequate nutrition during the with patients, colleagues and other health care professionals. The resident consumed adequate nutrition during a work day had better becomes more aware of the link between nutrition and cognitive function than those who neglected their nutritional well-being. Physicians have identifed several baked rice or whole grain crackers, juice boxes, yogurt practical barriers to healthy eating in the work environment. The resident identifes clean and secure These include lack of time to stop and eat, mostly as a result storage areas on the units where they work and also keeps of staff shortages and workload issues, lack of scheduled a few snacks in their lab coat pocket and locker. The breaks, lack of convenient access to food, poor food choices resident makes time for a healthy balanced breakfast daily. In addition to these practical barriers, physicians have room and ward work schedule. The resident encourages also described how certain attributes of medical professional- the other members of the team to do the same. The ism may in fact hinder their workday nutrition (Lemaire et al resident lobbies the health care organization to improve 2008). For example, doctors have expressed how their strong access to and quality of available nutrition, and to provide work ethic and sense of professionalism discourages them designated, convenient spaces for nutrition breaks. Changing the status quo Many physicians are aware of healthy nutritional choices and Winston J, Johnson C, Wilson S. To overcome these barriers, there needs to be advocacy for ad- equate nutrition in the workplace. Education and dialogue will guide physicians and health care organizations to an increased awareness of the doctors’ nutrition patterns, a facilitation of positive change, and an appreciation of the link between physician nutrition and work performance. As physicians and health care organizations promote the benefts of improved nutrition and workplace wellness, everyone will beneft, given the important link between physician wellness and quality of patient care. Summary Various personal and workplace factors can make it diffcult for physicians to ensure adequate nutrition during their work day. Physicians and health care organizations share a responsibility to improve workplace nutrition by raising awareness, changing nutrition practises and improving access to nutritious food in the workplace. It begins for The medical student most people with deciding sometime during the undergraduate Admission to medical school is a tremendous accomplish- years of university to pursue studies in medicine.

Society loses the productivity and energies of people affected by substance abuse discount generic cialis soft canada. At the macro level 20 mg cialis soft free shipping, prevention and treatment costs associated with drug abuse are phenomenal purchase cialis soft 20 mg fast delivery. In South Africa buy cialis soft 20mg cheap, evidence on the extent, impact of substance abuse as well as its prevention is fragmented and more often not located within a comprehensive theoretical framework that could make it easier to formulate strategies and programmes for combating the drug abuse challenge. Although much research has been done on the subject, little attempt has been done to put all this evidence in a coherent narrative that will put to the fore the extent, and impact of the problem and inform future interventions and the designing of programmes. The objective of this paper is to provide a coherent report on the extent and impact as well as substance abuse intervention programmes within South Africa’s youth population group. The report is wholly based on a comprehensive review of literature on substance abuse in South Africa. The literature search revealed some major gaps in the availability of credible and reliable information on drug abuse. Attempting to define the problem from a young women’s perspective was even more challenging as there is very little primary research conducted in this field. Notwithstanding 4 this, the paper found some valuable papers which have been used to synthesise this document. The United Nations Office on Drugs and Crime has some presence in South Africa through the United Nations Office on Drugs and Crime Southern Africa office. Its drug related mandate includes strengthening the legislative and judicial capacity to ratify and implement international conventions and instruments on drug control, organized crime, corruption, terrorism and money-laundering; reducing drug trafficking; and enhancing the capacity of government institutions and civil society organizations to prevent drug use and the spread of related infections. The main piece of national legislation addressing substance use is the 2008 Prevention of, and Treatment for Substance Abuse Act. The Act provides, among other things, a comprehensive response to combating substance abuse, and offers mechanisms for addressing substance abuse. Section 1 of the Act provides a framework for responding to substance abuse, while Section 2 provides strategies for reducing harm. The Act has been the basis of South Africa’s many programs and strategies for combating substance abuse. The Prevention of, and Treatment for Substance Abuse Act is supported by the Drug Master Plan 2013-17, which sets out the strategies and measures to be used to combat substance abuse. Interventions proposed in the Plan are based on the supply and demand framework, i. Other pieces of legislation relevant (see Table 1) in combating substance abuse include the Liquor Act of 2003, the Tobacco Products Control Amendment Act of 1999, the Road Traffic Amendment Act of 1998, and the Prevention of Organised Crime Act of 1998. In the provinces and municipalities, various pieces of regulations and bylaws exist to combat substance abuse. Table 1 Relevant policies and legislation for substance use Relevant policies and Focus/objectives legislation The National Drug Master Plan Outlines programmes and policies of the government to address substance use problems in South Africa. The National Liquor Act, 2003 The primary focus is on regulation of the liquor industry. The Act seeks to facilitate the alcohol abuse and promote the development of a responsible and sustainable liquor industry; and provides for public participation in liquor licensing issues. Provincial Liquor Bills/Acts Provision of liquor licenses for retail sale of alcohol; establishment of Liquor Boards to; establishment of liquor officers and inspectors; and to provide for appointment of municipalities as agents of the Liquor Board and liquor licensing authorities. Education Laws amendment Act, Provides for random search, seizure, and drug testing at schools. Drugs and Drug Trafficking Act, Prohibition of use of drugs and possession, dealing/supply, manufacture, search and seizure 1992) Minimum Norms and Standards for Specifies acceptable quality of care for people, including children, receiving in-patient and outpatient treatment; 6 In-Patient and Out-Patient regulation of treatment centres to ensure services are delivered in accordance with human rights culture and legal Treatment Centres (National and constitutional frameworks; include special provisions for protection of children. It is an advisory body established in terms of the Prevention of and Treatment for Substance Abuse Act (Act No. Development Communication Conducts mass media campaigns, and social mobilisation and advocacy activities. Soul Buddyz is a special project for children focusing on issues related to substance abuse including relationships, sexuality, bullying, abuse, corporal punishment, disability, road safety and other accidents, like burns and drowning. For every 100 people, 15 have a drug problem and for every 100 Rands in circulation, 25 Rands are linked to the substance abuse problem (Christian Addiction Support, 2016). Jointly, the three drugs accounted for over 86% of all cases treated for drug abuse in 2012. Among persons treated for addiction, 38% were treated for cannabis dependency, followed by methamphetamines at 23%, heroin at 19% and cocaine at almost 6%. A similar trend was noted in a study of five trauma units in Cape Town, Durban and Port Elizabeth. It was found that 14% of the patients tested positive for white pipe (combination of cannabis and metaxalone), 33% for cannabis; and 15% for metaxalone. Although the youthful population of South Africa, which numbers 13 million (15-24 age 8 cohort), creates a window of opportunity, the creativity, innovation, talents and energies of this population will remain fully unharnessed due to substance abuse. Figure 3 maps the trends in substance abuse from the Youth Risk Behaviour Surveys (2002, 2008 and 2011. Although showing a somewhat declining trend, over the counter and prescription are the most abused substances among both males and females outside of dagga. Among males, heroines shows an increase while mandrax, cocaine and tik are on a decline. For females, there seems to be a decline in the incidence of life time substance use outside of dagga. Figure 5 shows a stable, but high cannabis use among youth, with substantial gender disparities. About 50% of the learners had taken alcohol, 30% had smoked cigarettes, 13% had cannabis in their life time, and 7. Substance abuse among learners has gendered dimensions as well, with male learners outdoing their female counterparts in every type of substance abused. In South Africa, cannabis (Dagga) is the third most abused substance by youth after alcohol and tobacco (Morojele et al 2013). Figure 6 to 8 takes a closer look at cannabis use from a survey of Grade 8-10 Western Cape learners (ibid). The picture painted by Figure 9 shows the following, among others,  The prevalence of drug abuse is highest among male learners than female ones  Female learners are more likely to abuse mandrax, methamphetamine and cocaine 13 Figure 9. Proportion (%) of learners who reported lifetime use of different drugs by gender and grade Lifetime Use of Methamphetamine Lifetime Heroine Use Lifetime Cocaine Use 2% 3% 6% 2% 2% 4% 1% 1% 2% 1% 0% 0% 0% Grade 8 Grade 9 Grade 10 Grade 8 Grade 9 Grade 10 Grade 8 Grade 9 Grade 10 Male Female Male Female Male Female Lifetime use of Mandrax Lifetime use of Ecstasy 5. Many learners report that they have been offered, sold or given illicit drugs at schools. Using dagga within school premises, or attending school after drinking alcohol or using data are also reported by many learners. In a bid to frame the interrelationships and intra-relationships of the multiple influences on drug and alcohol abuse behaviour, as well as how they operate at different levels, researchers and practitioners have identified two frameworks; the supply and demand framework and the Bronfenbrenner’s socio-ecological model (Bronfenbrenner, 1993). The Supply and Demand framework has three intervention windows: Demand side, Supply side and Harm Reduction (see Figure 11). On the demand side substance abuse is tackled through poverty reduction strategies, advocacy, education and communication, fostering socio-economic development and advancing anti-substance abuse social policies. On the supply side the key intervention areas include controlling production, sale, marketing and distribution of harmful substances. It also includes law enforcement and where necessary taking legal action against supplies of illegal substances. Harm reduction is based on treatment, aftercare and reintegration of those dependent on substances. The South African Drug prevention Master Plan employs the supply and demand framework. Figure 11: Supply and Demand Framework Demand Reduction Supply Reduction Harm Reduction Poverty Reduction Controlling the production, manufacture, sale, distribution and trafficking of drugsprecursor Treatment materials and manufacturing facilities, Advocacy Controlling the distribution of and access to raw drugs and precursor materials Aftercare Education and Communication Seizing and destroying precursor materials, raw materials and products, refineddrugs, production, manufacturing and distribution facilities, and resources; Development Re-integration of substance dependents with society. Taking legal action on the use, abuse, production, Social Policy Application manufacture, marketing, distribution and trafficking of precursor materials, raw materials and products, refined drugs, manufacturing and distribution and facilities, and resources. The main drawback of the Supply and Demand framework is that it places intervention programmes in silos, with limited vertical and horizontal interactions. In reality, substance abuse is multifaceted challenge that requires a multidimensional and integrated set of intervention strategies. Figure 12 provides a pictorial view of the Bronfenbrenner socio-ecological framework. The framework implies that a substance abuser is affected by different types of environmental systems. The nested structures of these environmental systems begin with the individual domain, moving outwards to the microsystem, the mesosystem and finally, the exosystem. Applications of this framework can be found in Mason, Cheung, & Walker, (2004) for substance use; Yu, Stiffman, & Freedenthal, (2005) on tobacco use; and Marsden, Boys, 16 Farrell, Stillwell, Hutchings, et al.

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