Tuesday, January 28, 2020

Harm Reduction and Abstinence Based Treatments

Harm Reduction and Abstinence Based Treatments This essay will be constructed into four parts, harm reduction, abstinence based reatments, substance misuse and recovery. There will be a discussion on the history of harm reduction and what harm reduction is in the substance misuse field, for example problematic or harmful behaviour that is caused to the individual or others either socially, psychologically, physically or legally brought on by substance misuse. Secondly an explanation on abstinence based treatments, what they are and what the relationship is between them and harm reduction. Thirdly referring to recovery and what it means in the substance misuse field and what the implications are for the service users. Last but not means least a discussion about the two different approaches and how it impacts on the service user. To conclude a summary of the main points will be made. (136 Harm reduction pilot schemes started back in the 1980s and were a response to reduce the risk associated with harm caused by alcohol problems and injecting drug use, in response to the HIV and AIDS prevention strategy. Harm reduction is a process and not a treatment and should be integrated with other forms of intervention, it reduces the negative consequences of drug use. It is about educating the individuals, carers, partners and family members about the risks involved with their drug use and helping them take responsibility and learn to accept it rather than to ignore it. Most harm reduction interventions are aimed at preventing diseases due to blood- borne viruses (BBV) as well as overdose and other drug related deaths (Tatarsky Marlatt 2010). Harm reduction services include needle exchange services methadone and buprenorphine programmes. Needle exchange provides services where the users have the opportunity to dispose of their old needles, syringes and spoons for example. Moreo ver they will also receive advice and support on safer injecting, reducing injecting and prevention of overdose, they will receive a pack which contains clean injecting equipment to take away, reducing the risk of them sharing equipment with others (NTA 2006). Substitute prescribing such as methadone and buprenorphine programmes, buprenorphine and methadone are licensed for use in opioid dependence where methadone is dispensed in liquid form and buprenorphine is administered by tablet form sublingually (Connock, Juarez-Garcia Jowett, et al 2007). (236) Abstinence based treatment Abstinence means refraining from an activity which is known to be harmful and addictive or reducing this activity with the ultimate goal of being abstinent (McKeganey et al 2006). Doing this involves not taking a particular substance, avoiding areas where this is likely to be on offer or adopting a healthier lifestyle. Abstaining can be difficult to do especially when the substance has been part of their life for so long, this is where the individual has to look at healthier ways to deal with their substance use. This can include a range of abstinence based treatments to help the individuals with alcohol or drug such as Non-drug interventions the twelve step programme (self help) and Psychosocial interventions such as motivational interviewing or CBT. The twelve step programme is a set of guiding principles outlining a course of action for recovery from addiction, compulsion, or other behavioural problems, it was originally proposed by Alcoholics Anonymous (AA) as a method of recover y from alcoholism. Motivational Interviewing is usually offered to achieve and maintain abstinence, it was originally used with problem drinkers but has also been applied to the treatment of illicit drug misuse (Raistrick et al 2006). There are several Pharmacological interventions available to treat alcohol dependence which are disulfiram, acamprosate and naltrexone. These all work in different ways Disulfiram is used for individuals who wish to abstain altogether, if taken with alcohol it can cause some very unpleasant effects; vomiting, headache, palpitations and breathlessness. Acamprosate and naltrexone are an anti-craving drugs used in the maintenance of abstinence (SIGN 2003). However there is an increased risk of overdose or death due to a relapse after a period of abstinence as tolerance levels will have changed to that particular substance (REF). (288) Substance misuse Substance misuse is defined as the use of a substance for a purpose not consistent with legal or medical guidelines (WHO, 2006). It is a misuse of all psycho-active substances including illicit drugs, non-prescribed pharmaceutical preparations and alcohol misuse. People use substances because it makes them feel good, feel different and makes them more sociable. Using substances only becomes misuse when a problem arises such as it having a negative impact on health or functioning and may take the form of drug dependence causing problematic or harmful behaviour to the individual or others either socially, psychologically, physically or legally. (99) Recovery The Recovery Model as it applies to mental health is an approach to mental disorder or substance dependence that emphasises and supports each individuals potential for recovery. Recovery is seen within the model as a personal journey, that may involve developing hope, a secure base and sense of self, supportive relationships, empowerment, social inclusion, coping skills, and meaning. For someone who misuses substances recovery may not be about being totally abstinent it may simply mean still using drugs but in a safe way, for instance having clean works for injecting or substitute prescribing for opioid misuse. Recovery principles bring about the change in the way a service user thinks and aims to produce a change in behaviour, however before these changes can only happen if the person is ready to change, ambivalence may be experienced by the service user and this can affect motivation on a daily basis. Motivational interviewing techniques go hand in hand with the harm reduction mode l as one of the key factors with motivational interviewing is dealing with ambivalence. Prochaska and DiClemente 1983 provide a framework to understand the change process it was originally created to help understand what individuals go through in changing their behavior. it uses 5 principles, precontemplation, contemplation, preparation, action and maintenance (Hansen et al 2008). Service users with little or no motivation and who are not engaging in any attempts to change are seen as being in the pre-contemplation stage as they do not see their behaviour as a problem and there is no need to change it, this could be due to an attempt to change in the past without success and may feel demoralised so may become resistant to change. It is important to engage service users at this stage and build a trusting rapport so that in the future they will be able to turn to the practitioner for help. The contemplation stage is when a person acknowledges that they may have a problem and work towa rds developing motivation to change but could become ambivalent, engaging with the service user in discussion about their ambivalence is the goal at this stage getting them to think about what their problem is and how it is affecting them. Individuals in the preparation stage may want to change and have a plan but need help to do so, the reason individuals may seek treatment could be that their problem is having negative effects on life for example, criminality or job loss. The action stage comes next this is where the service user is actively setting goals to change and will be developing skills to do so, supporting the service user in making these goals achievable are key here, goals need to be small and achievable to the service user. In the maintenance stage the service user sustains changes in behaviour and works towards preventing relapse by identifying the supports around them, at this stage the service user may decide to make long term goals and problem solve how to best acc omplish them. Prochaska and DiClemente 1983 describe a sixth stage and it is the relapse stage the service user reverts to the behaviour they were trying to change, the practitioner should provide support for the individual in a non-judgemental way as they may be feeling ashamed and guilty for relapsing, re-evaluate the stage of change the individual is at explore the relapse episode trying to discover if the relapse was shorter or longer than previous relapses and were they able to reduce their use, this may be an opportunity for the service user and practitioner to work on other relapse prevention techniques. (Prochaska Diclemente 1983). However service users may move back and forth between the stages. This does not represent failure, but rather the nonlinear nature of the model. Recovery is about making the best out of their life and having quality of life and as nurses we should provide support and advice to achieve their goals (Network 26 2009). (660) Both the abstinence model and the harm reduction model have similar goals. The goal in this case is to create a better quality of life for the person receiving the service. Harm reduction approaches are often perceived to be the opposite of abstinence based approaches to drug use and sometimes even as condoning drug use. This is not the case, harm reduction complements abstinence based drug treatment approaches by providing Injecting drug users with the knowledge and tools to stay healthy and alive until they are able or willing to achieve abstinence. Abstinence remains the most effective way of reducing the negative consequences of drug use. For injecting drug users who are unable to remain abstinent, harm reduction measures such as methadone maintenance treatment and needle and syringe programs are ways to reduce negative consequences. For example the abstinence approach to caring for an individual who uses heroin and has HIV service users would find that they would be encouraged t o stop using heroin completely and to abstain from sex. While with the harm reduction programme the individual may be taught how to use heroin more safely i.e. clean needles and spoons and other paraphernalia or to substitute methadone for heroin and to practice safer sex. It can be argued that because abstinence based services were not providing HIV education and preventive tools such as condoms and syringes, individuals using these services would remain unaware of the risks of HIV and how to protect themselves from it. (247) Conclusion In conclusion, the integration of harm reduction and abstinence based treatment is more powerful than either model separately. The abstinence goal provides more room for the more abstract harm reduction work to occur. The accepting atmosphere of harm reduction with the addition of the clarity of the goal of abstinence promote patient retention better than either separately. The implications of this integration is that harm reduction can be more accepted and powerful in the public sector. It is important to look at the wider context of why people use drugs. Taking away a coping mechanism from a drug user may do more harm than good unless the core issues that led to drug use are dealt with in the first, hence the reason the motivational interviewing approach is more empowering for the service user (134

Monday, January 20, 2020

Assessment of a Study of Transformational Leadership Essay -- social i

Assessment of a study of the relationship between transformational leadership, empowerment and organizational commitment Introduction and Purpose of Study The implications of transformational leadership on a firm’s employees and the success of the firm overall are areas of ongoing research according to Ismail, Mohamed, Sulaiman, Mohamad, and Yusuf (2011). The authors make the case that in a changing global environment transformational leadership styles, rather than transactional styles, are a means organizations are using to meet their strategies (p. 90). They argue previous research suggests that some aspects of transformational leadership, such as empowerment, may motivate the followers to unite, change their own goals, and even look beyond their own self-interest to achieve the organization’s interest (p. 90). Thus, the use of a transformational style may impact employee outcomes, especially organizational commitment resulting in increased organizational performance. According to Ismail et al. (2011, p. 91), despite studies showing this important relationship, there is insufficient explanation of how and why transf ormational leadership affects organizational commitment. Their study begins to address the shortfall by studying the mediating effects of empowerment on the relationship between the variables Transformational Leadership and Organizational Commitment. The assessment presented here focuses on the sampling methodologies used by the authors and argues that potential weaknesses in the methodologies limits the conclusions to something less than that which is presented by Ismail et al. (2011, pp. 100-101). This paper will have three following sections. First, there is a methods section to discuss the author... ... approaches rely on random sampling to draw inferences. As the sample drawn from the population becomes less random, the results become skewed, and conclusions become limited and should be viewed with skepticism. Thus, the results reported by Ismail et al. (2011) must be viewed with skepticism. References Burns, R. B., & Burns, R. A. (2008). Business research methods and statistics using SPSS. London: Sage Publications Ltd. Girden, E. R., & Kabacoff, R. I. (2011). Evaluating research articles: From start to finish (3rd ed.). Thousand Oaks, CA: Sage Publications. Ismail, A., Mohamed, H. A., Sulaiman, A. Z., Mohamad, M. H., & Yusuf, M. H. (2011). An empirical study of the relationship between transformational leadership, empowerment and organizational commitment. Business & Economics Research Journal, 2(1), 89-106. Retrieved from http://www.berjournal.com

Saturday, January 11, 2020

China Communist Party

Communist Victory The victory of the Chinese Communist Party (CCP) over the Nationalist faction in the Chinese Civil War was a direct result of numerous influences, both internal and external. However, three important reasons for the CCP’s victory can be attributed to the Japanese attack and occupation of China during World War II, the CCP’s treatment of the Chinese people, and the political failures of the nationalist forces. The combination of these historical events provided a situation that allowed the CCP to defy the odds and take over China.The Japanese invasion of China in 1937 was the setup for the eventual success of the CCP. Although it cost the CCP manpower and resources, the Japanese attack allowed for the formation of a political environment that favored the spread of the communist party. The Japanese help legitimize the CCP by singling it out as a special enemy and instructing the Japanese supported puppet government in the job of exterminating the communi sts in their jurisdictions. The phrase, â€Å"the enemy of my enemy is my friend† applies in this situation.After the mistreatment the Chinese population endured under Japanese occupation, it is easy to comprehend why the Chinese people would gravitate towards a group that was so despised by their main tormenter. The added attention that the CCP received from the Japanese occupiers showed the Chinese people that the CCP was a force to be reckoned with, and a possible threat to Japanese interests in China. This publicity put the CCP’s in the minds of the people as a counter to the Japanese. The Japanese invasion left a power vacuum for the CCP to fill.As the Japanese forces advanced, â€Å"the traditional ruling elite evacuated†¦ and left peasants to defend for themselves during the eight years of occupation. † This allowed for the CCP to move in to the areas without leadership and gave the CCP the opportunity to win over public support. The Japanese militar y expansion into the region forced the KMT forces out of the area, but as Japanese units left the area, the CCP moved in, taking the place of the KMT government. The invasion of China also changed how the peasants viewed China as a whole.Before the invasion, the people â€Å"were a passive element in politics†¦absorbed in local matters and only had the dimmest sense of ‘China’. † However, the Japanese invasion changed how many peasants saw their role in greater population, and focused more on issues like â€Å"national defense, citizenship, treason, legitimacy of government, and the long-range betterment of the Chinese state. † The Japanese attacks on the Chinese people motivated them into shifting their thinking. They now had to think about who was going to protect their lives and property.With both nationalist and communist factions fighting the Japanese army, the interactions of the people and anti-Japanese forces would influence on what side the p eople agreed. In Edgar Snow’s Red Star Over China, Snow shares his account of what he witnessed during his time in China reporting on the actions of the communist party. Snow noticed, â€Å"most of the peasants†¦seemed to support the communists and the Red Army†¦and when asked whether they preferred it to the old days, the answer was nearly always an emphatic ‘yes. † Snow provides detail about the policies that allowed the peasants to favor the new communist rule in their region, writing that, â€Å"the Reds gave land to the land-hungry peasants, †took land and livestock from the wealthy classes and redistributed them among the poor. † The CCP polices also allowed for upper classes to not lose everything but rather †both the landlord and the rich peasant were allowed as much land as they could till with their own labor. † Although some may question the total accuracy of Snow’s work, it cannot be disputed that the policies Snow refers to did indeed influence the people into supporting the communists.Another key point on how the CCP won over the peoples’ support is the rules and policies to which Mao’s followers were forced to adhere. Simple orders like do not steal, return what your borrow, replace what you break, and be courteous allowed the CCP to earn the loyalty of the Chinese people. The communists showed special effort in appealing to women, as they hoped to win over a group of people who were traditionally an oppressed class. Instead of using only force, this respectful behavior towards the people wooed them into the supporting the CCP. The CCP actively took the communist message to the people.The communist way was presented as an ideal society for the Chinese to thrive under, and offered hope to the masses. The CCP sent out propagandists and troupes of actors teaching and entertaining the people the new superior communist way. Nationalist feelings were also stirred by the CCP in the war against the Japanese, aiding in uniting the people under the organized communist resistance. The KMT also played a vital role in the eventual communist victory in main land China. Before the second Sino-Japanese War began in 1937, the KMT focused not on the growing Japanese threat, but instead the communist faction in China.The communist forces retreated, but were not entirely eliminated. This move left open the opportunity for the CCP to grow, adapt and eventually take on the nationalist forces again at a later time. The war with Japan highlighted the failures of the nationalist regime. Hsi Chi in his work Nationalist China at War states that the abuse of the people at the hands of the nationalists â€Å"made the government appear in the people’s eyes as symbol of oppression and exploitation, and provoked widespread disillusionment and alienation among the people.This attitude in relation to the government allowed for the CCP to have a better chance at persuading t he people to join the communist movement. This failure to gain the support of the people is seconded by a soldier in the nationalist army in a letter to America. The soldier, Rau Huang, writes, â€Å"In the early stages of our war against the communists, our government was negligent in not seeking the support of the masses†¦the communists did not neglect this opportunity†¦Ã¢â‚¬  The communist victory in the Chinese Civil War was a major moment in the 20th century.The communist had the fortune to have an environment that allowed their efforts to carry on despite being targeted by two other factions. A prolonged Japanese invasion permitted the CCP to move into regions and garner support from the people that may not have been available otherwise. Without a Japanese attack, a sense of nationalism may have been harder to produce from the populace. The party’s organization and methods to gain the support of the masses would prove vital in the victory as well, showing th e people a new future that could be achieved.The nationalist forces were defeated in part because they didn’t eliminate all the communists before the war with Japan, and their own disorganization and inability to gain support from the people proved to be too much to overcome. Certainly, these are not the only reasons why the CCP succeeded in taking control of China, but these elements each played their part in the puzzle that led to final victory of the Chinese Communist Party. Works Cited Babb, Geoff, â€Å"The Chinese Civil War† (presentation, University of Kansas, Lawrence, KS, October 29, 2012). Chi, Hsi. Nationalist China at War: Military Defeats and Political Collapse, 1937-45.Ann Arbor: University of Michigan Press, 1982. Huang , Ray. â€Å"Letter From Nanking. † Military Review, December 1948. Johnson, Chalmers. Peasant Nationalism and Communist Power, etc. Stanford: Stanford University Press, 1966. Snow, Edgar. Red Star over China. New York: Grove Press , 1968. ——————————————– [ 1 ]. Johnson, Chalmers. Peasant Nationalism and Communist Power, etc. (Stanford: Stanford University Press, 1966), 32. [ 2 ]. Johnson, Peasant Nationalism and Communist Power, 70. [ 3 ]. Johnson, Peasant Nationalism and Communist Power, 69. [ 4 ].Johnson, Peasant Nationalism and Communist Power, 69. [ 5 ]. Snow, Edgar. Red Star Over China. (New York: Grove Press, 1968), 222. [ 6 ]. Snow, Red Star Over China, 222. [ 7 ]. Snow, Red Star Over China, 222. [ 8 ]. Babb, Geoff, â€Å"The Chinese Civil War† (presentation, University of Kansas, Lawrence, KS, October 29, 2012). [ 9 ]. Babb, â€Å"The Chinese Civil War†. [ 10 ]. Babb, â€Å"The Chinese Civil War†. [ 11 ]. Chi, Hsi. Nationalist China at war: military defeats and political collapse, 1937-45. (Ann Arbor: University of Michigan Press, 1982), 190. [ 12 ]. Huang , Ray. â€Å"Letter From Nanking. † Military Review, December 1948.

Friday, January 3, 2020

Understanding the Mind of Hamlet with His Soliloquies Essay

Understanding the Mind of Hamlet with His Soliloquies The term soliloquy is a literary or dramatic form of discourse, within which a character talks to himself and reveals his inner thoughts without addressing a listener. Hamlet uses soliloquies to express his feelings towards his dead father and self loathing to the reader of the play but to none of the characters within it. Hamlet has a complex character and it is important for the audience to be able to understand Hamlet’s feelings on the themes of the play without him having to explain them to another character. Hamlets three soliloquies are guide of how he is feeling at different points of the play. In the first line of Hamlet’s†¦show more content†¦Hamlet compares his Father to Claudius as ‘Hyperion to a satyr’ Using this imagery of Hyperion, a powerful sun god in contrast to a Satyr, a half-man creature Hamlet shows how strongly superior he feels his father was to Claudius. This emotive comparison shows Hamlets obvious mourning for his dead father, which is playing strongly on his mind as his mother is showing such little bereavement. Hamlets self-loathing is also apparent from the second and third soliloquies showing that this is playing on Hamlets mind through out the play. In the second soliloquy he describes himself as ‘coward†¦ pigeon-livered†¦ lacking gall.’ He blames himself for being so cowardly not being able to seek revenge for his father, in this speech Hamlet gets angry with himself, asking rhetorical questions such as ‘why, what an ass am I?’ From this second soliloquy it is apparent that Hamlet is very troubled by his incapability and self-loathing, he talks of actors on the stage and says ‘Had he the motive and the cue for passion that I have? He would drown the stage with tears†¦make mad the guilty†¦Ã¢â‚¬â„¢ Going through Hamlet’s mind is such strong hatred for Claudius and disgust for Gertrude because of their flippant and inappropriate behaviour after the death of Polonius, he can’t understand how these actors who have no realSh ow MoreRelatedHamlet Soliloquies and Their Analysis1527 Words   |  7 PagesHAMLET’S SOLILOQUIES THEIR ANALYSIS In the course of the play, Hamlet has seven long soliloquies. The first of these occurs before he has seen the Ghost. In this soliloquy, Hamlet reveals the grief that has been gnawing at his mind. He wishes that religion did not forbid suicide so that he could kill himself and be rid of this grief. He feels disillusioned with the world. â€Å"How weary, stale, flat and unprofitable, Seem to me all the uses of this world†. 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