Focus on substance abuse: Substance Abuse Is a Wellness Issue

As the abuse of alcohol, tobacco, and other drugs becomes more prevalent, it takes an increasingly heavy physical, emotional, and economic toll on society. Newly emerging patterns of drinking and drug use are now causing rates of injury, disability, and death to increase, leading to decreased levels of productivity in many regions of the world. These trends are even more alarming given the fact that substance abuse is no longer a predominantly "male" problem, but is fast becoming an issue of concern among women-especially those in their childbearing years-and youth. As addiction spreads throughout all segments of the population, the societal burden mounts. This issue of CommonHealth is the second in a two-part series focusing on behavioral healthcare. While the first installment in the series highlighted the connection between the physical, mental, and behavioral aspects of overall health, this issue delves into substance abuse and its impact on the well-being of individuals, families, communities, and society as a whole.

The articles found in both issues of this two-part series seek to demonstrate that good health is not determined by physical well-being alone. The choices people make each and every day-what they eat or drink, whether or not they exercise, and even what information they obtain from their doctors-all combine to determine how their bodies react to the stress of life. Increasing awareness of this among healthcare policymakers, practitioners, and patients should be a goal of all partnerships as they develop new programs and fine-tune existing ones. By viewing the physical, mental, and behavioral aspects of health as three integral components of a person's overall well-being, AIHA partners can devise effective, sustainable programs that draw from the varied experience and resources of many community stakeholders.

While it often manifests itself physically, substance abuse is, at its very core, a social disease and must be treated as such. This presents unique challenges to healthcare providers who are adept at clinical care, but need to learn new skills to treat ailments that stem from behavioral patterns. Community-based healthcare delivery outlets such as AIHA partnership Primary Care and Women's Wellness Centers are ideal settings for educating patients on the harmful effects of smoking, drinking, and taking drugs; detecting the early warning signs that often accompany increased use of substances; treating those suffering from addiction and its consequent health problems; and counseling family members on ways of dealing with the emotional and/or physical turmoil that so often results from substance abuse.

Other ways of addressing the health problems that result from behavior choices may be less clear. This issue of CommonHealth looks at various approaches to this dilemma. As with the Fall 2000 issue, the articles within this issue underscore the inextricable link among the physical, mental, and behavioral elements of health. The issue begins with an overview of substance abuse, then moves on to a discussion of its prevalence and the toll it takes on society by Jennifer Hillebrand and Maristela Monteiro. Lev Sverdlov's article delves into how the mythology surrounding alcohol in Russia affects social attitudes toward substance abuse and treatment, while Jeanne Trumble Hejduk and Stephen Dilts look at the link between substance abuse and mental illness. Other articles focus on what healthcare providers can do to prevent abuse and treat patients with abuse problems, and several options for dealing with addiction. These include discussions of the role of the general practitioner and ways to form an effective doctor-patient relationship with adolescents, as well as descriptions of 12-step treatment programs, the philosophy and approach of therapeutic communities, and highlights of several successful model prevention programs.

The entire healthcare community-from high-level policymakers to individual clinicians-shares the essential task of guiding patients away from harmful behaviors and toward healthier lifestyle choices. Providing treatment for conditions that already exist is only half of the equation in any effective healthcare system. By increasing public awareness through proactive education and outreach programs-as well as offering services that address the mental, behavioral, and physical elements of wellness-practitioners can help people take responsibility for their own well-being and thereby improve the health status of individuals and communities alike.