Research treatment and policy regarding substance abuse exist on a continuum. New questions come from changes and developments in the policy environment. New research findings give insight on how to better shape and tailor policies. This paper discusses the relationship between epidemiology, etiology and evidence based practice with respect to drug use and their role in the broader context of the research-treatment-policy continuum.
The evidence based practice philosophy is a praxis-oriented movement that calls for greater reliance on scientific evidence is being extended to treatment approaches that are supported by evidence gathered in psychological and sociological studies and that incorporates biological research findings. One key program in the evidence based practice treatment movement is the Iowa PIC, one of the first state mandated programs designed to facilitate the collaboration between all stakeholders including researchers, treatment providers, consumers and policymakers. but focus on different aspects of the process. Evidence based practice also delineates a specific set of interventions and strategies, and it specifies the correct list of medications under specific criteria. It also expands opportunities for more comprehensive treatment options outside of the standard treatment model. Emphasizing the psychosocial context in which disease arises, evidence based practice inherits and extends this insight on the ground. Iowa PIC, for example, assigns emphasis towards prioritizing the role of communities and community based treatment options for sustainable care.
The challenge for evidence based practice practitioners, as detailed in the Iowa PIC report, is deploying this environment on the ground. Once the treatment standards model have been articulated, resources must be available for its implementation. Change management practitioners must be available in order to assist with organizational change and transformation. Evidence based practice standards also require organizations to create policy space and revision in order to adequately replace and replace the old methods with new. Current approaches of disseminating research information are geared toward researchers, such as conference presentations and journal articles. However, simple translation of treatment processes into manuals and or other guidelines does not give us a reason for implementation. Organizational factors that influence adoption and implementation must be considered. Risk-taking leaders of agencies may be quick to adopt new practices, but line staff with low pay, high burnout and often low education is expected to implement the practice. Both agency directors and line staff must be taken into account in an implementation plan.
The starting place in evidence based practice treatment is evidence. Etiological theory is the core of this evidence that informs the praxis-based policy. Through etiological study, researchers gain a picture of what vulnerability looks like in development, what are the contingency factors that can exacerbate vulnerability or potentially protect and heal. Much of what is known about etiology is collected through epidemiology, whose goal is to gather information about quantity, geographic location, causal factors and schema of various other risk factors (Shier 2010). Factors of risk and the illnesses they implement in society have a nonrandom distribution, hence the necessity arises to define the problem and identify the population (Scheier 2010). Risk, and its complex interplay with operative variables, helps researchers understand the roots of addiction from where they start. Kenneth Griffin's (2010) paper sheds light on a range of critical developmental aspects of one's life that may increase risk factors drug use early in adolescence. Using cross panel statistical research data, this study compares life span trajectories in order to gain a long range viewpoint on causal factors leading to adult clinical outcomes. Ultimately, this disparate domain of knowledge comes together with the help of psychosocial theory, thus entering the collection of theories and models used in etiological explanations of drug use (Shier 2010). Chapter 3 and 4 look at the interplay of development in brain regions and systems that regulate critical aspects of behavior, emotions, cognitions, and the perception of risk and reward using both psychosocial emphases as well as neuropsychiatric takes. Themes of cognitive and affective influences are reflected in the entry by researchers Kassel, Hussong, Andrea, Wardle, Veilleux, Heinz, Greenstein, & Evatt (2010) discuss existing evidence on the use of drug use and depression. They consider research to identify key contextual variables in a young person's life that might explain the ways in which drug use can mediate psychological well being, including affect dis regulation, in adolescence. The sections on diversity provides a new and exciting opportunity to understand how cultural factors may add further complexity and demonstrates how these ideas may incorporate into more comprehensive discussion of risk and protective factors in substance use and abuse (Beatty 2010). Finally, chapter 6 introduces the domains of peer and family influences into the fold (Klewer 2010). As a group, the contributors emphasize how a multidisciplinary approach will bring us closer to a useful etiological model. Persons in development states have multiple anchors in the social environment, including family; peers; non familial mentors such as coaches, and clergy. These areas are addressed by several contributors in a manner that comprises more of a broad theoretical overview of how they might be of importance.
Etiology is one stop on the value chain in the research – policy - treatment pipeline. Etiology forms the basis of our derived knowledge about the epidemic. Evidence based practice approaches make the derived insights of risk and protective factors, social and psychological determinants and contingencies, and how these may react within an individual. This approach takes etiology front and center in its treatment and preventative approach because it informs program members about the process of lifespan development. This development gives us insight into how families, peers, the psychosocial environment and maturation and other ways that youth collect information about the world. Evidence based practitioners can tailor specific strategies based on the findings of this research in combination with knowledge from epidemiology discovered at the population level.
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