Prescription Drug Abuse

Prescription Drug Abuse Introduction. When we think of drug addicts and abuse we normally think of people who take the common street drugs such as cocaine, crack, heroine, or other illegal drugs. However most people dont realize or take seriously the growing number of abusers of prescription drugs currently in our country. There is a common misconception that just because a doctor prescribes a certain drug that that is somehow safer and different than using the so-called street drugs. After all, you are being given a prescription to take the drug by your physician, and it is not illegal or a crime. However, we must realize that addiction isnt limited to just illicit drugs on the street, but often doctor prescribed medications as well. Prescription drugs have improved and saved countless numbers of lives over the years as many new breakthroughs have been achieved in science and medicine in treating a variety of known diseases. â€Å"However, using these drugs without the supervision of a physician or for purposes different from their intended use can lead to serious adverse consequences, including death from overdose and physical addiction. Because many prescription drugs are often opiate based, when abused, these drugs can be as addictive and dangerous as illegal drugs.† 1) (Pat Moore Foundation | Prescription Drug Abuse, 2009). According to (M.D ,Volkow, 2005), director at the National Institute on Drug Abuse, 2) â€Å"an estimated 48 million people (ages 12 and older), have used prescription drugs for non-medical reasons, which represents approximately 20 percent of the U.S. population.† Additionally, 3) â€Å"in 2000, about 43 percent of hospital emergency admissions for drug overdoses (nearly 500,000 people) happened because of misused prescription drugs, and in â€Å"2006 alone, 700,000 emergency room visits were attributed to prescription drug overdoses.† 4) (Thibodeau, 2009). This type of drug abuse is increasing at an alarming rate because of their widespread availability, including online pharmacies which have made it much easier for anyone regardless of age to acquire drugs without a prescription. (Prescription Drug Abuse Information | Drug Rehab Programs, 2009). 3) â€Å"One of the most common and primary methods of obtaining prescription drugs by addicts is by doctor shopping according to the Drug Enforcement Administration (DEA).†5) This method refers to a person who continually searches out different doctors to prescribe the same medications in order to feed their addictions. I think most of us either know or have known individuals or even family members who have resorted to this type of behavior in order to get prescription drugs for this purpose. The most common types of drugs that are often abused are central nervous system depressants such as benzodiazepines or tranquilizers, frequently prescribed for anxiety and sleeping disorders, opioids and narcotics for pain relief, and stimulants such as those given for attention deficit hyperactivity disorder, (ADHD), narcolepsy, and obesity. 6) (Prescription Drug Abuse Chart Drugs of Abuse and Related Topics NIDA, 2009) â€Å"For example, U.S. prescriptions for stimulants (including those taken for ADHD) increased from around 5 million in 1991 to almost 35 million in 2007. Prescriptions for opioid painkillers such as oxycodone (OxyContin) and hydrocodone (Vicodin) increased from 40 million in 1991 to 180 million in 2007.† 7) (Mayo Clinic, 2008). I feel the reasons for this significant increase in prescription drug abuse is simple. We live in a society today that tells you a pill can cure and solve all of your problems no matter what they are. All we have to do is turn on the television and see the constant bombardment of advertisements for the latest prescription drugs on the market. As a result, the pharmaceutical industry is making billions of dollars off of people and is certainly not going to complain, thus encouraging and driving the epidemic even more. Furthermore, these drugs are relatively easy to obtain and are socially acceptable by the vast majority of the public compared to illegal drugs. In just the past several years, we have seen the emergence and proliferation of many â€Å"pain clinics† throughout the United States. Although not all are bad, some of these facilities as stated by 8) (Silverman Brown, MD, 2009), â€Å"are often non-physician owned and operate just inside the law. The physicians who practice in these facilities are rarely accredited through board certification processes, and many take no insurance and advertise confidential, cash only services. Some even advertise armed guards in the waiting rooms. With no oversight, these facilities serve as a source for a continuous supply of controlled substances to often times addicted and sometimes naÃÆ' ¯ve people. It is not uncommon to find patients of these facilities receiving tens of thousands of milligrams of opioid medications each month.† With these types of programs and clinics operating and encouraging such drug abuse, I feel that the people who really need these medications are often the ones who suffer, such as individuals with painful terminal diseases and illnesses like cancer. I experienced this first-hand with my mother several years ago when she was diagnosed with terminal lung cancer that had metastasized to her bones, and helplessly watched her suffer from pain. While she was undergoing radiation treatments at a cancer clinic, her doctor there stated that she should use Advil to help with her pain and that the government was cracking down on schedule drugs that were prescribed. My response to this is, if cancer patients cant get the necessary pain medications they desperately need, yet addicts can get all they want, then there is something very wrong with this country we live in and our health care system. Conclusion. What is important to recognize and become aware of about prescription drug abuse is that it is much the same as other forms of illegal drug abuse such as cocaine or heroin, and no one is immune. It can be just as dangerous and deadly as other illicit drugs, and affects individuals of all ages, races, gender, and socio-economic backgrounds. It can also destroy families, jobs, and homes as well as having fatal health consequences. In fact, use of prescription drugs now causes more deaths than heroin and cocaine combined, according to the U.S. Drug Enforcement Administration.† 9) (Treatment Solutions Network, 2009). Furthermore, with the recent tragic and untimely deaths of celebrities such as Michael Jackson, Anna Nicole Smith, and Heath Ledger related to prescription drug abuse, I feel this problem is finally being brought to the forefront and exposed, bringing a much needed awareness to the dangers and consequences of abusing prescription drugs. References: 1) Pat Moore Foundation | Prescription Drug Abuse. (n.d.). . Retrieved December 6, 2009, from http://www.patmoorefoundation.com/prescription-drug-abuse 2 M.D ,Volkow, N. (2005). NIDA Research Report Series Prescription Drugs: Abuse and Addiction. Retrieved December 6, 2009, from http://www.drugabuse.gov/ResearchReports/Prescription/Prescription.html 3) Prescription Drug Abuse Information | Drug Rehab Programs. (2009). . Retrieved December 6, 2009, from http://www.prescription-drug-abuse.org/ 4) Thibodeau, D. (2009, October 20). Prescription drug abuse now tops illegal drug use | GoDanRiver. Retrieved December 7, 2009, from http://www2.godanriver.com/gdr/news/local/danville_news/article/prescription_drug_abuse_now_tops_illegal_drug_use/14771/ 5) Drug Addiction Doctor Shopping Chronic Pain Medication Addiction. (2009). . Retrieved December 6, 2009, from http://www.drug-addiction.com/doctor_shopping.htm 6) Prescription Drug Abuse Chart Drugs of Abuse and Related Topics NIDA. (2009). . Retrieved December 6, 2009, from http://www.nida.nih.gov/DrugPages/PrescripDrugsChart.html 7) Mayo Clinic. (2008). Prescription drug abuse MSN Health Fitness Addiction|Quit Smoking. Retrieved December 6, 2009, from http://health.msn.com/health-topics/addiction/articlepage.aspx?cp-documentid=100211994 8) Silverman, MD, S. M., Brown, MD, L. (2009). Prescription Drug Abuse: In the US and Florida. Retrieved December 7, 2009, from http://www.hgexperts.com/article.asp?id=6649 9) Treatment Solutions Network. (2009). Prescription Drug Abuse and Addiction. Retrieved December 6, 2009, from http://www.treatmentsolutionsnetwork.com/prescription-drug-abuse.html Prescription Drug Abuse Prescription Drug Abuse Sophia Ranta   Ã‚   Combing through the stories on the internet, I came across a shocking, testimonial of a woman who became addicted to OxyContin. Her name was Cheryl. She suffered from Fibromyalgia, which caused her to be in constant pain. When her pain became too unbearable, she went to see her family physician. Immediately, her physician prescribed her OxyContin, but stressed how important it was to follow the correct amount of dosage. At first, she was careful and cautious. Very quickly, Cheryl liked the feeling of not being in pain anymore. She craved the drugs potency, so she began abusing the drug. Some of the side effects that Cheryl suffered from were: weight loss, black-outs, isolation, no personal hygiene care, and general chaos all around her. Even though she visited her doctor every month, he never spent more than 10 minutes with her. She was able to trick him into writing a new prescription every time. Eventually, the way she broke her addiction was when she overdosed and suffered from ca rdiac arrest. The doctors were able to save her life.   Then she began the long road of recovery and rehabilitation. Since the administration of opiates is often unintentionally overused and abused, with addictions abounding, a new perspective is needed to create appropriate care plans for patients. First and foremost, in order to gain a new perspective, it would be helpful to obtain a greater understanding of prescription opiate abuse. ONeil and Hannah describe prescription drug abuse as the use of a legend drug in a way not intended by an authorized prescriber of the medication. The intent of prescription drug abuse is to obtain an altered state of mood or behavior. Prescription drug abuse frequently involves circumventing the intended route of drug administration. This is a statement that gives a clear understanding of what drug abuse is as a whole. Opiates are prescribed by doctors to control pain. With the prescription of opiates there is a specific individualized care plan that doctors carefully go over with each patient. There are two sides to prescription opiate abuse: intentional and unintentional. Intentional abuse is having the mind set of misusing the prescription. Patients who intentionally manipulate their care plan do so because they desire the high that comes fro m using the drug. A second reason, people choose to self-medicate is to dull emotional pain. The other form of opiate abuse is unintentional. Patients taking opiates due to pain may take more than their prescribed amount because they think they can cure the cause of their pain. This inadvertently leads to addiction. Having a greater understanding of opiate abuse will provide knowledge in accessing whether an individual is addicted to their prescription or not. Next, this new perspective requires an understanding of how the brain is negatively impacted by opioids. Narcotics and opiates can become extremely addictive. But how does that work within the brain and all the science behind it? Hagaman gives an excellent representation of how the brain is affected from opiate usage. Opiates are considered extremely addictive and this addiction can affect the structure and function of the brain. Opiates can alter the brain and affect ones motivation and emotions. The brain changes over time and hence a persons behavior changes. Moreover, if one uses a high enough dose of drugs, frequently enough, and over a long period of time, the drugs can change the way the brain works. The way in which the nerve cells communicate is changed so a compulsive, out of control use develops despite experiencing some of the many side effects. More specific effects of opiates on the brain include changes in the synapses and shapes of brain cells. Chronic use is linked w ith structural changes in the size and shape of specific neurons. That is to say that there is a difference noticed in the brain between a chronic opiate user and an occasional user (Hagaman). The human brain is a complex organ that when manipulated, can affect the entire body and throw it off balance. The science of the manipulation of the brains neurotransmitters when exposed to narcotics is explained. Narcotic painkillers bind to opiate receptors which are typically bound by special hormones called neurotransmitters. When painkillers are used for a long period of time, the body slows down production of these natural chemicals and makes the body less effective in relieving pain naturally. That is because narcotic painkillers fool the body into thinking it has already produced enough chemicals as there becomes an overabundance of these neurotransmitters in the body. Existing neurotransmitters have nothing to bind with, as the drugs have taken their place on the opiate receptors (Ef fects 2015). Thus, the brain produces less of its own neurotransmitters to relieve pain, and becomes dependent upon the opiates. The human brain is a delicate organ that when distorted, struggles to regain normal cognitive function and the ability to maintain homeostasis for survival.   Other organs can also be injured. Painkiller use and abuse also can affect nerve cells. Additionally, based on the manner in which the drug is used, painkiller abuse can cause long-term heart damage and increase the likelihood of a heart attack (Effects 2015). Medical care personnel need to fathom the perils narcotic painkillers can have on the human body. It is necessary for health care workers to understand how the brain is negatively impacted by narcotics. Third, to continue building this new model, education is necessary to teach about true addiction and the need to create appropriate medical care solutions. Society today sees drug abuse only coming from illegal drugs and not from prescribed drugs. Opiates are one of the most often prescribed pain medications. The abuse of opioid drugs is a public health epidemic that has been growing since the mid-1990s (Maxwell 2015). To recognize and stop the opiate abuse, education is necessary for the public. Having the knowledge to identify prescription drug abuse can lower the risk of addictions. Even now schools are introducing programs to explain and warn the dangers of overuse of prescription drugs. RX for Understanding is one resource widely used. This training program, resources, and tool kit empower principals, teachers, school nurses, and other specialized instructional support personnel to begin a dialogue in their schools about prescription drug abuse. Schools can use this program to i nform parents, students, and educators about the growing problem of prescription drug abuse through school assemblies, lesson plans, and informational materials for teens and parents (Embrey 2014). In time, the goal is that the general public will have a broader comprehension of the dangers of prescription drug abuse which will carry over into the medical setting. In the meantime, education must be provided to patients and family on the potency and hazards of long term use of opiates. Second, education of physicians could also greatly reduce the growth of this trend. Understanding prescribing patterns, as well as the perceptions of adverse effects associated with these agents, is crucial because these physicians play a critical role in curtailing the prescription drug abuse epidemic, said Catherine S. Hwang of the center for drug safety and effectiveness and the department of epidemiology at the Johns Hopkins Bloomberg School of Public Health, Baltimore, and her associates (Moon 201 5). Physicians need to be informed of the adverse pattern of prescription drug misuse as much as students. Third, health care providers require an understanding of the psychological effects of long-term drug use in order to treat patients with compassion and wisdom. If patients cannot trust their physicians, their pain may be compounded by feelings of isolation and fear (Johnson 2007). Perception is a powerful lens by which decisions and responses are made. Johnson introduces a triad of factors in understanding the psychological aspect of addiction. The first includes a patients biology (brain chemistry and genetics). The second involves self-medicating, in which patients use medications in response to feeling helpless about emotions generated in interpersonal situations or to treat a psychiatric disorder. The third aspect notes that addictive drugs may serve as a companion, substituting for meaningful relationships with other people. A physician may feel trapped by this combination of factors when the patient behaves in a subtly complex way and attempts to get his or her feeling of helplessness understood by the physician. As a result, the physician may feel compelled to issue a prescription as the only way to immediately disengage from an uncomfortable encounter. Unfortunately, this same process is likely to recur at the next visit (Johnson 2007).   Grasping a greater knowledge and understanding of the psychological side is imperative in guiding those who suffer from addiction to safety. Effective care can be given when caregivers have proper understanding of the potency and danger involved in the use of narcotics. Continuing on with education, another element in constructing this new medical perspective, is the need for health care workers to be educated to recognize signs and symptoms of pain, as well as the use of alternative methods to address pain relief. Pain demands an answer. Having pain is very common in older adults, but it is never normal. There is almost always a real problem behind pain (Resources). Understanding what causes the pain is crucial in knowing how to treat it. Arthritis and Muscle pain are quite common in the elderly. When pain is severe enough, patients may lose the ability to move comfortably or be incapable of doing activities of daily living. Sleeping may become so painful that it would not be enjoyable anymore. Pain can lead to other problems such as losing the ability to move around and do everyday activities. The sufferer may have trouble sleeping, experience bad moods, or develop a poor self-image. In addition, people with pain often become anxious or depressed. They may be at greater risk for falls, weight loss, poor concentration, and difficulties with relationships (Resources). Once understanding the patients level of pain, health care workers can formulate a plan of treatment. Health care workers need to provide different methods for relieving pain before administering addictive narcotics. Resources suggests several methods to be used first, before embarking on a long road of recovery from addictive opiates. Treatments such as physical therapy, massage, heat and/or cold packs, exercise, and relaxation therapy may be tried first (Resources). These methods are all non-narcotic options. Non-narcotics pain medication, other options are offered Acetaminophen is recommended as the safest type of pain reliever for long-term use (Resources). Acetaminophen pain medication includes the following: Ibuprofen, Aspirin, Naproxen. These treatments may be beneficial and eliminate the need for narcotics. Having a broader base of treatment options, may help to reduce the risk of addiction to opiates as well as administer comfort to the patient. A fifth point to consider with this new medical model must include detoxification as part of the plan of care. An example of this detoxification piece is the organization ISIS. Nevertheless, there is a place in primary care for community detoxification in substance misuse, as demonstrated by the primary care service pioneered at the Integrated Substance-misuse Islington Service (ISIS) by NHS Islington. ISIS is a primary care open access drug service that assesses and processes drug users for treatment. If patients have complex needs, they are directed to the appropriate services (Fernandez 2011). Patients may need to go from an acute hospital setting into a detox center before entering a skilled nursing facility for rehab. An acute hospital setting provides a quick detoxification of the body to remove the potency of the drugs by pumping the stomach for example. This gives the patient an immediate solution from the overdose of drugs. The detox center is the next step in the rehabilita tion process. The detox center offers a specific plan for each individuals needs. Patients suffering from drug abuse will go through a detoxification program provided by their local detox center. There are two types of detoxification: community and inpatient. The inpatient detoxification regimen consists of a five- to ten-day admission to a specialist centre for patients who present with a profile that is clinically risky for example, polydrug use with mental health problems. Community detoxification is for patients who have a minimal risk profile however, this often excludes patients with alcohol and substance misuse (Fernandez 2011). Fernandez gives an organized and complete layout of what a patients plan of care for detoxification should look like. Including detoxification into a patients plan of care will ensure that the process of detox is performed safely and effectively. Based on the patients individualized needs, each detox center will provide a plan of care for the rehabi litation to come. The importance of a detoxification center is to safely assist each patient with the cleansing of their body from the drug toxins. Next, the new medical model will allow for doctors to be better informed of the patients history with opiates and narcotics. When interviewing a patient about their history with pain medications, doctors and medical care workers need to have discernment about asking the right kinds of questions. Examples of questions that need to be asked would include the following. Do you have a history of seizures or epilepsy? Have you had previous treatment for alcohol dependence? What previous detoxification regimens have you completed? Do you have any mental health issues that could compromise the detoxification regimen? Have you had any recent liver function tests? (Fernandez). Other examples of questions could include: How long have you been taking narcotics? How often? What was the original prescribed amount? Do you have a history of using narcotics? Do you have any relatives that have suffered from addiction? These are only a selected few questions that should be asked of a patient with a h istory of narcotics. In determining the right kind of care plan, doctors need to better comprehend what each patient has been through. Obtaining a greater understanding of a patients history can help to distinguish what the proper treatment should be. Furthermore, this new medical model requires anger management training to better help equip those who are going through detox. Anger is known to be included in the side effects from drug abuse. Anger is a big problem for many people and its often one of the complicating factors for those struggling with addiction (Roes 2007). The anger can become compounded due to the process of detoxing that a patient must go through. Hazardous situations can occur when a patient is struggling with the detoxification. For example, the patient might try to harm themselves, lash out at the medical care workers that are trying to help them, or even family and friends who are trying to support them through the detox. Some examples of ways to help a patient decrease from anger or improve anger management are expounded upon by Roes. First, count to 10. Or 110. This simple and time-tested practice really helps. The more time a client buys by postponing anger, the more likely he/she will act rationally rath er than emotionally. Second, relaxation techniques are often helpful: deep breathing, listening to soothing music, taking a hot bath, etc. These calm the physical sensations associated with anger. Third, distraction (thinking about something else) also can help. As our thoughts turn to another topic, there are fewer thoughts to feed our anger. Finally, do something incompatible with anger. Kiss your spouse, or pet your dog. These types of activities can help displace anger with more agreeable emotions (Roes 2007).   These are just a few examples to help a patient deal with the side effect of anger. Another example is given in guiding an aggravated patient to a calm level. Keeping a log also can be helpful. If clients list what they think, how they feel, and how they choose to act in an angry situation, they can become more aware of their triggers. They also can become more aware of what thoughts feed their anger, and what thoughts starve it. The more deeply ingrained the ange r problem, the more likely it is that cognitive, rather than solely behavioral, interventions will promote lasting change (Roes 2007). Focusing on cognitive interventions can help the patient slow down to think rationally. One of the ways to help patients think rationally is to have a list of questions to ask themselves. Examples of questions could include: What just happened to make me angry? Was it what was said? How it was said? Or who said it? How am I going to respond without hurting myself or someone else? These questions can be personalized by health care workers to address the type of anger the patient is experiencing.  Ãƒâ€šÃ‚   It is essential for medical care providers to know how to assess each situation involving drug abuse and anger management. Moreover, this new medical model can be useful in understanding how cognitive therapy can aid with anger management, a secondary by-product of addiction. Roes gives a great representation of how anger management can be facilitated with the use of cognitive therapy. Cognitive therapy has proven successful for even the most severe problems of anger management. For perpetrators of domestic violence, for example, the belief that its OK to use anger, power, and control to get what you want might be a focus of therapy. Successful change to a more prosocial type of thinking would reduce both the anger and the likelihood of victimizing others (Roes 2007).   The term prosocial means being able to interact with people in a persons social setting.   Being prosocial means a persons behavior is positive and helpful when interacting with others. Those who are becoming prosocial are learning to focus on integrating positively with others, so they will be more careful to control their anger. Redirecting neurological pathways can help in correcting the damage that has been done to the brain.   Cognitive therapy can help a patient retrain their brain so that anger is not their first response. This type of therapy, overall, can reduce the amount of anger a patient experiences, because they have become better prepared to deal with situations that create anger. Cognitive therapy has proven to aid with anger management, a secondary by-product of addiction. In conclusion, a new perspective is needed to create appropriate care plans for patients suffering from prescription drug abuse. One must obtain a greater understanding of prescription opiate abuse. The brain is negatively impacted by opioids. Education is necessary to teach about true addiction and the need to create appropriate medical care solutions. The need for health care workers to be educated to recognize signs and symptoms of pain, as well as the use of alternative methods to address pain relief is essential. The plan of care must include detoxification. Doctors must be better informed of the patients history with opiates and narcotics. Anger management training should be included to better help equip those who are going through detox. Cognitive therapy can aid with anger management. As previously mentioned, Cheryl was only trying to control the pain she was experiencing. However, she loved the feeling of being pain free and was able to manipulate her doctors into continuous ly prescribing her pain medication without closely monitoring her. The personal testimony of Cheryl demonstrates the flaws of prescription opiates and the addictions that are taking place. Since the administration of opiates is often unintentionally overused and abused, with addictions abounding, a new perspective is needed to create appropriate care plans for patients that will help save lives. Work Cited Embrey, Mary Louise, and Libby K. Nealis. The right prescription for prevention: many adultsincluding parents and school staff membersare unaware of the dangers of prescription drug use and abuse. Principal Leadership, Apr. 2014, p. 12+. Academic OneFile, go.galegroup.com/ps/i.do?p=AONEsw=wu=lom_accessmichv=2.1id=GALE%7CA367798950it=rasid=8c6cc8d9dba4acf2bc9afcc7a481afda. Date accessed 25 Feb. 2017. Fernandez, Jeff. Detoxing Dependent Drinkers in Primary Care. Mel.org, Royal College of Nursing Publishing Company, May 2011, find.galegroup.com/nrcx/retrieve.do?sgHitCountType=Nonesort=DateDescendprodId=NRCtabID=T007subjectParam=Locale%2528en%252C%252C%2529%253AFQE%253D%2528su%252CNone%252C18%2529detoxing%2Band%2Bdrugs%2524resultListType=RESULT_LISTsearchId=R2displaySubject=searchType=BasicSearchForm ¤tPosition=1qrySerId=Locale%28en%2C%2C%29%3AFQE%3D%28KE%2CNone%2C18%29detoxing+and+drugs%24subjectAction=DISPLAY_SUBJECTSinPS=trueuserGroupName=lom_accessmichsgCurrentPosition=0contentSet=IAC-DocumentsdocId=A257218281docType=IAC. Date accessed 27 Feb. 2017. Hagaman, Jennifer. Opiates on the Brain. Opiates on the Brain, web.csulb.edu/~cwallis/483/opiates_on_the_brain.html. Accessed 28 Feb. 2017. Johnson, Brian, et al. Reducing the Risk of Addiction to Prescribed Medications. 15 Apr. 2007, go.galegroup.com/ps/retrieve.do?tabID=T002resultListType=RESULT_LISTsearchResultsType=SingleTabsearchType=SubjectGuideForm ¤tPosition=11docId=GALE%7CA162871567docType=Disease%2FDisorder+overviewsort=RelevancecontentSegment=prodId=AONEsubjectParam=Q2contentSet=GALE%7CA162871567searchId=R1userGroupName=lom_accessmichinPS=truedisplaySubject=Prescription+drug+abusesubjectAction=VIEW_SUBDIVISIONSsearchQueryId=Q2>+. Date accessed 25 Feb. 2017. Maxwell , Jane Carlisle. The Pain Reliever and Heroin Epidemic in the United States: Shifting Winds in the Perfect Storm. Journal of Addictive Diseases, 24 Jan. 2015, www.tandfonline.com/doi/full/10.1080/10550887.2015.1059667?src=recsys. Date accessed 24 Feb. 2017. Moon, Mary Ann. Opioid prescriptions falling as risk perception rises. Internal Medicine News, 1 Jan. 2015, p. 13. Academic OneFile, go.galegroup.com/ps/i.do?p=AONEsw=wu=lom_accessmichv=2.1id=GALE%7CA402347517it=rasid=522c6a9f59ff4af35e5b16ec105c86e1. Date accessed 25 Feb. 2017. ONeil, Michael, and Karen L. Hannah. Understanding the cultures of prescription drug abuse, misuse, addiction, and diversion. West Virginia Medical Journal, vol. 106, no. 4, 2010, p. 64+. AcademicOneFile, go.galegroup.com/ps/i.do?p=AONEsw=wu=lom_accessmichv=2.1id=GALE%7CA237942597it=rasid=cf3d399c91b954af8322f68a7a6d999a. Date accessed 24 Feb. 2017. Prescription Drugs. NIDA for Teens, USA.gov, National Institute on Drug Abuse, teens.drugabuse.gov/drug-facts/prescription-drugs. Date accessed 24 Feb. 2017. Resources. Health in Aging, www.healthinaging.org/resources/resource:eldercare-at-home-pain/.   Date accessed 26 Feb. 2017. Roes, Nicholas A. When anger complicates recovery. Addiction Professional, Nov. 2007, p. 48+. Health Reference Center Academic, go.galegroup.com%2Fps%2Fi.do%3Fp%3DHRCA%26sw%3Dw%26u%3Dlom_accessmich%26v%3D2.1%26id%3DGALE%257CA172176738%26it%3Dr%26asid%3D57e34cb3d45dbadee3b3b8596892f346. Accessed 2 Mar. 2017. The Effects of Painkillers on the Brain and Body. Maryland Addiction Recovery Center, 12 Feb. 2015, www.marylandaddictionrecovery.com/effects-of-painkiller-on-the-brain-and-body. Date accessed 28 Feb. 2017.

Practicum Paper

After gain such Insight Into back grounds I believe that It Is detrimental for every man that was to govern or shepherd a flock to be well equipped in the area of biblical back grounds. Although It Is not a sufficient, It Is very necessary to gain the understanding that comes from the text. Background is also another crucial hermeneutical tool. That can give us proper insight to the true understanding ot what the author was trying to say to the readers of that day. And if the readers in this modern day can get the real message that the original author was trying to convey to the modern day audience.I believe that pastors and teachers should get the highest level of back ground although history is not the only way to interpret the passages of In scripture but the background trom non-canonlcal and socio-cultural standpoints can give the readers a better way to look at how and why the scriptures were constructed and format of the passages These studies of backgrounds Just show us why th ese passages were spoken to the speclflc passages and then allow the teachers to correctly apply it to their flock.But first pastors/ teacher need to have the most hollstlc meaning before they can deliver a message ot scripture because It Is God holy and divine word and they have to be careful on what they are trying to say because If they do not understand what the author is trying to say to the specific audience then the message cannot be properly deliver to Gods intended audience, and then because false teaching and sends the followers of Christ astray because they did not have the proper meaning because there was no broad study of why this passage was written and why it was constructed and formatted in that fashion. . There are many ways that the Backgrounds can help and assist teaching and pastoring ministries. This mostly helps with the leaders getting a better understand f the overall meaning in the passages of the bible. And the only way is use hermeneutical methods. A herme neutical tool can be backgrounds and background is not just the historical even but it's also talking about the culture at the time and the perception ot the culture to the event and how they reacted to events. These different uses and aspects of background can Just make it easier to grasp the meaning of the author in the passage.If the leaders of the teaching and pastoral mlnlstrles want to give what God was trying to tell HIS people then they must do the research and focus on the background and help shape the meaning of the book or assage. And then they will Interpret the context ot which the passage was written and why they needed to hear the passage. And then the ministries can contextualize the passage in the proper manner and make it applicable to this day in age This helps because readers normally contemporize the bible and forget that there was an original audience that were not living in the same type of culture we live into today.God knows what He wants to say but It Is ou r job to tind who He Is saying to, why He is saying it, and how it can be applied toour modern life. And that is why it so Important for the interpretation, that the ministries know why the passage Is written and that they apply It correctly and they do not allegorize the passage and then they w ge tne proper meaning ana tnen tnls study can nelp tnem. 3. Background Is a very important and vital to our u comprehension of the bible.However, since we know that it is necessary, we also need to be aware that it is not sufficient and it will not get us to the meaning by itself. This is a way that this can hurt the background study because they can possibly hold the background to highly ranked in the interpretation process and use this tool as the only tool. But if they do they can get too caught up in the event and culture and then totally ignore the text.This practice shows that the implications and applications of the text are not significant because the readers are only looking at the distinct even that text mentions. The text most of the time does not even focus on the event, and those who put the backgrounds higher on the totem pole will normally try to find the significance of the background even though text may not even refer to the specific even but because it highlights that event they will dig deeper and forget what the message of the text is trying to onvey to the readers in this day and the time that it was written.But if they use the backgrounds as a secondary tool to help interpret the text then it is a helpful took and then the translation of the meaning will not be lost and then the background study is helpful and no longer hurting their understanding of the passage. 4. The theological ontology of scripture should speak to the application of the readers as a correct model to perform a hermeneutic. Although, backgrounds is not the only way to go about reading and looking for interpretation it can be starting point.It is very ecessary to help comprehen d what the author was saying and why he was saying that, and this is very beneficial to the readers and researchers today. Because this is the correct theoretical way of getting information from the passages of scripture. Although, background focuses on the events and culture, we can still see as readers the spiritual impact that Jesus had in the Old and New Testament on the events, political fgures, and cultures of the day. The theological implications in the backgrounds can help us define what we are looking for to use to better understand the scriptures provided to us.

Brand Extension – Furniture

In today’s fierce competition, organizations are driven to reach, strengthen their existences in particular markets, and become a multinational enterprise by taking a mixture of policies including finding new market, developing new features, or even performing a merger and acquisition (M&A). Concerning the developing market, this paper discuses and recommends corporate brand strategy for two companies that are proposed to merge; they are Habitat and Fabprefab. The discussion will first elaborate overviews of Habitat and Fabrefab including the elaboration of each strengths and weaknesses that will benefit the merger.In addition, this paper will also elaborate the benefits and perils of mergers and a concept of developing brand strategy. In the end, we provide recommendation for the merged companies, Habitat and Fabprefab, since it is potentially experiencing downfall. The recommendation should take into account considerations that ensure the delivery of best service and creativ e, strategic and economically sustainable ways to transfer the tangible and intangible values of a brand into new product (service) categories, new markets or new industries. Brand Extension – Furniture/Home furnishing Goes Prefab I. IntroductionIn order to broaden organization reaches, strengthen their existences in particular markets, and become a multinational enterprise, managements of the organization can take a mixture of policies including finding new market, developing new features, or even performing a merger and acquisition (M&A). Mergers and Acquisition (M&A) is one example that a business performs to keep their business growing and getting bigger. This makes sense since the number of M&A is getting bigger every year. According to the Securities Data Company, the dollar value of U. S. (M&A) in 1996 recorded a 27 percent increase to US$658.8 billion from US$518 billion in 1995. While an M&A becomes a corporate strategy, marketing strategy interprets the corporate st rategy to match the market characteristics and customers’ needs. Therefore, marketing department becomes the front liner of the company since marketers, people who work at marketing department, are those who made actual contact with customers within their daily operations. Their responsibilities are to generate constructive views of customers about their company. Therefore, it is their responsibilities to comprehend what customer really wants and how they want to be treated.This is important to ensure the products are saleable in the market. Under such circumstances, it is not a great surprise that term ‘marketing oriented management’ emerges in today’s management practice in order to help organizations to focus in serving customers. Concerning corporate and marketing strategies, this paper will discus and recommend corporate brand strategy for two companies that are proposed to merge; they are Habitat and Fabprefab. The discussion will first elaborate ove rviews of Habitat and Fabrefab including the elaboration of each strengths and weaknesses that will benefit the merger.In addition, this paper will also elaborate the benefits and perils of mergers and a concept of developing brand strategy. II. Proposed Mergers between Habitat and Fabprefab II. 1 Habitat Habitat is furnishing company that established in UK, especially London, in 1966. Within the over 40 years of operation, the company now serves in more than 76 stores worldwide in which 42 of them are in UK, 24 are in France, and the rests are in Spain (5), Germany (5), and other countries through franchise system. Like other furniture companies, Habitat also has wide range of products for living room, dining room to kitchen, and bathroom.In internet era, the company has also provided online catalogue although it has not enable the any online transactions. II. 1. 1 Habitat and Needs for Strategic Partnership By definition, alliance is an agreement between two or more individuals or companies that agree to perform particular action in order to achieve a common goal (Web Finance, 2005). Since the intention of a strategic alliance is to give strengths to each entity, therefore, each entity has to have particular strength that is beneficial for other allies. In this situation, the parties involved (allies) have harmonizing strengths.As explained above, strategic alliance in business situation has potential benefits and disadvantages. The intention of a strategic alliance is to grow a company’s revenue without the need to incur high expansion costs. Although Habitat is a large company, we see that the company is in need to perform strategic partnership so that they can quickly exist in target market and gain improved brand awareness. For that reason, we suggest that Habitat should perform strategic partnerships with other furniture companies or with supplier in order to gain one or more benefits as following:†¢ enable a company to enter a new market wi th new products and services without incurring costs of research and development for the products †¢ widening the market reach without the need to establish a new branch offices †¢ increase the volume of production output †¢ use new technology that simplify the process while enhancing the quality of products †¢ Speed up the research and development by sharing costs and resources (BDC, 2006). II. 1. 2 Habitat and Intention to be Real Estate Brokerage Service Real estate brokerage service has its own level of competition that Habitat may not comprehend yet.It means that Habitat should focus on developing core competences as furnishing retailers instead of extending services into real estate brokerage that Habitat does not have any experience in the industry (Habitat, 2006). We would rather suggest habitat to perform strategic partnership with multinational companies that have wide market penetration in locations that Habitat does not exist yet. This is in line with the one of the benefits of strategic partnership as mentioned above (Habitat, 2006). II. 1. 3 Habitat and construction serviceAlthough construction service is not Habitat core competence but construction service has relation with furnishing industry. It means that Habitat could enter the construction service but they had better to perform alliances with one company in the industry instead of by establishing its own company. The form of alliance could be the first options of using Habitat’ product in construction projects that require completed full furnished buildings or need an advisor to design furniture for building projects.

Tu Quoque - Ad Hominem Fallacy That You Did It Too!

Fallacy Name:Tu Quoque Alternative Names:You did it too! Fallacy Category:Fallacies of Relevance Ad Hominem Arguments Explanation of the Tu Quoque The Tu Quoque fallacy is a form of the ad hominem fallacy which does not attack a person for random, unrelated things; instead, it is an attack on someone for a perceived fault in how they have presented their case. This form of the ad hominem is called tu quoque, which means you too because it typically occurs when a person is attacked for doing what they are arguing against. Examples and Discussion of the Tu Quoque Usually, you will see the Tu Quoque fallacy used whenever an argument has gotten very heated, and the possibility of civil, productive discussion may have already been lost: 1. So what if I used an ad hominem? You insulted me earlier.2. How can you tell me not to experiment with drugs when you did the same thing as a teenager? As you can see, the arguers in these examples are trying to make the case that what they have done is justified by insisting that the other person has also done the same. If the act or statement in question was so bad, why did they do it? This fallacy is sometimes referred to as two wrongs dont make a right because of the implication that a second wrong makes everything alright. Even if a person is completely hypocritical, though, this does not mean that their advice is not sound and should not be followed. Tu Quoque and Sincerity This fallacy can also occur more subtly, for example, by attacking a persons sincerity or consistency: 3. Why should I take your arguments for vegetarianism seriously when you would accept a transfusion of blood that has been tested using animal products, or accept medication that has been tested using animals? The reason this example qualifies as a tu quoque fallacy is because the argument reaches the conclusion I dont have to accept your conclusion from the premise you dont really accept your conclusion either. This looks like an argument against the consistency of an argument for vegetarianism, but it is actually an argument against a person arguing for vegetarianism. Just because a person fails to be consistent does not mean that the position they are arguing for is not sound. You can be inconsistent in following a sound principle and consistent in following an unsound principle. This is why the consistency with which a person follows what they are arguing for is irrelevant when it comes to the validity of their position. Of course, this doesnt mean that it is illegitimate to point out such glaring inconsistencies. After all, if a person does not follow their own advice, it may be that they dont believe it themselves - and if that is the case, you can ask why they want you to follow it. Or maybe they dont understand what they are saying - and if they dont understand it, it is unlikely that they will be able to present an effective defense for it. You Would Do It Too A closely related tactic is to move from saying you did it, too to saying you would do it too if you had the chance. In this way, people can construct arguments like: 4. The leaders of that country are insane, and would attack us if they had the chance - so we should attack them first and thus protect ourselves.5. Christians would persecute us again if they were given the opportunity, so whats wrong with persecuting them first? This is fallacious for the same reason that the usual tu quoque is a fallacy - it doesnt matter what someone else would do if they had the chance because that alone doesnt make it right for you to do it yourself.

The Impact Of International Trade On The Environment

Introduction Since technology has been developing even better than before, it leads the new way of communication, transportation system, or even doing business across countries. This conditions also proved by the free trade agreement that expanded by World Trade Organisation (WTO). This situation leads to a new conflict in the International trade between countries, whether it is triggered by protectionism interests or for environmental reasons. Economists, environmental experts, and experts of international law have been aware of the existence of this conflict since 1970. Undeniably international trade can lead to a positive or negative impact on the environment.1 The positive impacts of international trade, among others are: first, increase the people’s per-capita income of a country. This may lead the people to pay more attention to environmental causes rather than figuring out how to meet their basic needs. Secondly, the country with higher per-capita income will have better infrastructure in terms of environmental policy. On the other hand, the negative impacts of d oing international trade, among others are: first the occurrence of excessive exploitation of natural resources. Thus, to reduce the negative impact, WTO has integrated the concept of sustainable development in the international trade. Utilization of natural resources must be consistent with the objectives of sustainable development. 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Concept of Learning Essays - 973 Words

THE CONCEPT OF LEARNING Kaplan University SS124-29 Professor Missy Madden-Schlegel September 26, 2010 Learning is defined as an experience that produces lasting change in the mind of the person receiving the knowledge. Learning can be conscious as in memorizing scriptures from the bible and unconscious as in something happening without any deliberate efforts (Schacter et. al., 2009). From an education standpoint, learning can also involve helping people by giving information that they can use in life. For the purposes of psychology, learning is considered a change in behavior. In the case of Adam and Teri as described in the text, their learning occurred on the day their daughter turned one; September 11, 2001. They†¦show more content†¦It was not necessary for Margie to touch the stove because she saw that it was the wrong thing to do. She observed the negative impact it had on her brother when he touched it. If the results had been favorable for Rodney, I believe Margie would have imitated whatever her brother did. In looking at how observational learning occurs in regards to the Bobo experiment, I see that after observing the adult model behave aggressively with the Bobo doll, the children behaved in like manner. They too were very aggressive with the doll – kicking it, punching and jumping on it. This was the result of no direct reinforcement from anyone. Bandura’s idea that for observational learning to occur one must give attention to the behavior, retain the observation of the behavior, have the motor skills to carry it out and also have the motivation to do so is true. †¢ Give Attention: In order to learn something it is necessary to pay attention to what is going on. 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Content of Human Services Addressing Inequality in Australia

Question: Discuss about theContent of Human Servicesfor Addressing Inequality in Australia. Answer: Introduction Australia has been the home of refugees, and the UN Convention has a signatory with the country. Hundreds of thousands of refugees migrated to Australia over past two decades. The major forces that have driven this influx have as result of war from neighboring countries, civil unrest, and persecution. More than ten years the world countries adopted the Millennium Declaration, the countries agreed to create an equal and just world, embracing equality and solidarity as imperative in this 21st century. There emerged Millennium Development Goal which integrates all principles outlined in Millennium Declaration that describe the importance of balance. (Castles, 2009) Australia has tried to install policies to curb the increasing influx of refugees. One of the policies includes mandatory deportation (Brager, 2012) established in 1992 that any non-citizen in the country without a legal visa to deported. In 2012, the government of Australia transferred and detained all refugee without a visa to Nauru or Papua New Guinea. Refugees have sidelined in many organizations. Denied space to work and some have harassed. Discrimination against the refugees has also reported in many organization. Gender inequality among the refugees exists in many working places (Fincher R, 2011). The women in many cases have been affected. Neglecting women's rights, discrimination on job opportunities and low pay compared to their male counterpart. Inequality based on income, the refugees have received a small salary and to some extent accept nothing leading them to remain in abject poverty. (Robinson, 2011) Health Issues The most marginalized people with poor health services in Australia include the refugees. Refugees are prone to many increased health risks. The greatest health needs to force by individuals pre-migration factors and experiences, differences in selection procedure and the resettlement criteria. The crisis is even more striking for refugees held in detention, as mental health often attacks the long delay in the status determination due to anxiety, depression, and stress (Murr, 2010). Health issues of refugees in many organizations have not addressed with immediate effect. Health problems have ranged from an inadequate shelter, lack of proper sanitation, sterile water to sustain health and good hygiene, lack of adequate food which lead to poor nutrition conditions and increased transmission of diseases due to overcrowded. Discrimination Refugees in Australia face discrimination in both law and practice. They face discrimination on various grounds; most known include race and ethnic origin, religion and status. The source of discrimination experienced by asylum seekers in the Australia reflects many other who go through the same barrier of discrimination. Major areas that where discrimination one can witness include employment, access to other goods and services, and accommodation. For example, involve harassment and violence in public places. Women, especially from Afghanistan and Iraq, have forced to wear a veil. (Hugo, 2010) On the other hand, the take of government on refugees portrays in laws which are themselves discriminatory. Some may direct or indirect discriminatory on the ground of religion, ethnicity, and status. Refugees who entered the country with legal document were commissioned official programs for resettlement, by contrast, having been picked illegally selected by immigration officials. The selection has left many boat people to suffer discrimination on the fact of their social status contrary to international standards. (Fincher, 2011) The penalty that the refugees charged when entering the countrys jurisdiction Contrary to the agreement on the refugee convention. They are withheld access to many settlement services and social support and even disintegrated with their family members. (Miller, 2013) Disability The detention of refugees threatens the goal of integration of general community and the international conventions. The biggest challenge is to provide the disabled refugees appropriate services in the different organizations. The rights of physically disabled refugees challenged by the introduction of harsh policies in Australia hence denying them ability to present themselves in many organizations. In many international organizations elaborate very categorical on emphasizing refugee with disabilities have access to services to meet their basic needs (Anderson, 2009). However, the United Nations high Commissioner for Refugees detentions guidelines dictate that physical and mental disabled refugees detained on the direction from the qualified medical personnel that their health and welfare will not distract during their stay in the detention camps. They must also access to sanitary facilities. (Correspondence, 2009) Other international organizations that give the direction of refugees with disabilities include; the UN Standard Rules on Persons with Disabilities, which provides an upper hand on equality for refugees with a disability. Objectives of the Change Proposal Equality of the Opportunities To speed up the development agenda in Australia all discriminated persons among them refugees should integrate into community development by setting aside socio-economic and political positions (Carr, 2013). Focusing on the manifestation of exclusion such as health, education and different level of income instead of focusing on structural factors like inadequate access to resources and discrimination has narrowed extraordinary measures aimed at addressing the inequality (Council, 2013). More attention should place on matter underlying economic, social, and cultural which lead to inequality. Migration Policies The government should revoke them and establish other swift and acceptable policies, friendly policies that will leave every refugee in the land comfortable. Creating well-managed migration policies which will accommodate sustainable immigration regulations into national development plans. With no doubt, the system will reduce inequality, provide jobs even to the refugees and the entire economic growth. (Brager, 2012) Improving Governance and Access Justice Strengthening governance at the organizational level where governance is weakest. The governance system in Australian refugees camps is complexly calling for changes. For an instant, the department of human service should create several groups working to ensure security is guaranteed the groups may in two categories: one made up of refugees and the other by agencies such as NGOs and UNHCR mandated to oversee all activities of refugees camps. (Carrington, 2011) Many of the refugees live far away from justice and legal aid providers. Lack of legal knowledge and financial power make them lack support to air their grievances. Therefore, the Australian government should bring legal services very closer to the refugees and give them machinery to advocate for their rights, capacity building for policy making, and creating awareness on human rights. (Correspondence, 2009) Enhancement on Transformational Change Addressing on the reduction of inequality with an insight of transformational change will follow the suit of Millennium Declaration and will check on government and organizations accountability and transparency to improve agenda that is inclusive and non-discriminatory. However meeting inequality targets will require synergy with other factors such addressing discrimination and structural cause together with causes of conflicts. Therefore, the government should mandate and put mechanism tools to assess, and monitor the broad perspective of policies on socio-political as well as economic rights. (Australia, 2010) Benefits of Addressing Inequality in Australia Refugees crisis in the country has challenged. Not even the local administration but also the international governments and this require great approach and mechanisms that will lead every party satisfied: both the refugees and the organizations. The following benefits accrue from the change proposal; (Carrington, 2011) It will enhance the highest possible niche of support and aid in the restrictive ways. The policies should emulate and designed to make sure all refugees including the disabled, have got the opportunity to contribute and participate in many arenas maximally in all aspect of organizations. Reduce mortality and morbidity rates among the refugees through implementing several mechanisms: involvement of refugees in planning and effecting the policies concerning their matter, meet the specific basic needs of refugees, the introduction of good health and nutrition facilities system, and we a duo-sectorial and preventative health strategy in all organization. The change proposal will bring about accountability and transparency. The above objectives will hold the organization accountable for progress towards development goals. Accountability and transparency will promote and enhance the service delivery and meet the refugees need by getting those jobs hence reducing unemployment among the refugees. (Carrington, 2012) The proposal will lead to easy access to information to reduce barriers to socio-political contribution. The organization will emulate appropriate services and lay down proactive policies and social connection that influence social context and lead to inequality and discrimination. The proposal is addressing the need for legislative reforms and immediate implementation, which elaborate the issues of discrimination and refugees exclusion and respond to their rights accordingly. Strength and Weaknesses Although the proposal will impact on service delivery system, it fruits will barely take long. The issue of legislative changes, for example, will need deep insight and extensive looking on both sides of positive and adverse. The increase of advocacy effort will provide the representative with education on the values of refugees programs and also improve the social cohesiveness between the refugees and communities in the Australia. Active efforts of the proposal will enhance the security check process for resettlement of refugees and impeach the current procedural step. It will also lead to adjustment of security monitoring process to allow dynamism in evaluating inadmissibility victual. Weaknesses Include The proposal will require the huge budget to implement it. The proposal may have inconsistencies because it does not have a sharing approach. The change proposal does not outline the migration channel in case of pressure. Works Cited Anderson, R., 2009. Settlement Dispersal of immigarnts and Refugees in Europe. Working Paper Series, 4(2), pp. 3-8. Australia, A. C. O., 2010. Economic,civil, and Social Contribution of Refugees and Humanitarian Entraint, Sydney: Refugees Council of Australia. Carr, J., 2013. Creating Employment and Education for Refugees. Given a Chance, 26(12), pp. 33-42. Correspondence, U., 2009. Operation Protection ijn Camps and Settlement, Sydney: UNHCR. Council, B. L., 2013. Analysis on the Situation of the REfugee Camps from the rule of law aspect. The iland Journal, 11(1), pp. 32-37. Fincher R, S. P., 2011. The Complex contentsof Inequality in creating Unequal futures. Sydney, allen and Unwin. George Brager, S. H., 2012. Changing Human Services. 2nd ed. new York: Free Press. Hugo, G., 2010. Immigrant Settlement outside of Australia capital city. Popul. Space Place, 14(43), pp. 553-571. K Carrington, R. H., 2011. Benefit and Burden of the Migration. 2 ed. London: Oxford. K Carrngton, A. M., 2012. The Social Costs and Benefits of Migration to Australia. 5 ed. Armidde: University of New England. Miller, L. E., 2013. Manging Human service. 4th ed. New York: Quorum Books. S Castles, M. M., 2009. The Age Of Migration. 3rd ed. New York: Palgrave Macmillan. S Murr, S. S., 2010. immigration and refugees health care in Australia. Australia Health Review, 4(1), pp. 2-5. V robinson, R. A., 2011. Spreading the Burden. Policy Press, 5(3), pp. 23-25.