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This chapter focuses on the perspectives and experiences of knowledgeable adults. Child welfare workers, other community professionals (educators, counselors, law enforcement personnel, and substance misuse treatment providers), and foster parents described their experiences with families involved with methamphetamine. They described children's exposure to environmental danger, chaos, neglect, abuse, loss, and isolation. They believe that children develop anti-social beliefs and practices such as lying and stealing, drug misuse and violence. They described children as displaying psychological, emotional, and social disturbances. They also described individual variation in functioning across children that they attributed, in part, to individual, familial, and community characteristics. They noted a need for effective child mental health services in rural areas, and substance misuse treatment for their parents.

This chapter explores the extent to which the misuse of drugs and/or alcohol is associated with offending behaviour and the nature of that association. The answers to those questions are more complex than might at first appear and are used to suggest some practice implications for those working with substance misuse in a criminal justice context. Both alcohol and drug misuse are dynamic risk factors for offending behaviour, included as part of a holistic assessment of risk. For those offenders where substance misuse is indicated, this risk assessment may be supplemented by specialist assessments focusing on the substance misuse in more detail. This chapter also considers the social context of alcohol and drug use and their complex relationships with crime. It discusses what is known about effective interventions, with a particular focus on responsivity and the motivation to change. The chapter seeks to help practitioners clarify the complex relationship between substance use and offending behaviour and the implications for responsivity.

This chapter examines the influence of youth culture on social class differences in health behaviours. The findings indicate that problematic risk behaviours such as smoking and hard drug misuse during youth are strongly associated with social deprivation and that dietary patterns during childhood and youth vary significantly according to socio-economic status. It also considers the impact of two factors of the socio-economic trajectories of children and young people: education and the experience of being in care.

This chapter discusses other forms of substance abuse (i.e., illicit drugs and prescription medications) in late life, in general, and in relation to retirement, in particular. Drawing from the results of the authors’ own 10-year study as well as from other studies, the chapter seeks to answer such questions as the following: How widespread is drug abuse/misuse in the older population, and what are the consequences of such behavior for individuals, their families, and society? What individual characteristics and demographic factors (e.g., age) might influence the use of illicit drugs or misuse of prescription drugs in late life? And can factors related to retirement (bridge employment, age at retirement) be identified as affecting individuals’ vulnerability to abusing substances other than alcohol?

This chapter explores the changing concepts and terminology used to describe drug, alcohol, and tobacco use in selected European countries during the 1970s and 1980s. Focusing on Austria, Italy, Poland, and the UK, the chapter sets terminological change in the context of long-running debates over how to describe substance use and its associated problems. Drawing on an analysis of policy documents, including laws, government reports, and circulars, the chapter points to variations both between countries and across substances. By the end of the period, however, there were some signs of greater homogeneity, partly as a result of international influences. Yet national differences in concepts and terminology remain, suggesting that there is continuing uncertainty about how to describe and deal with substance use.

The concept of ‘social evil’ is one that resonates in modern Britain. The consultation exercise, which is described in this chapter, tapped into issues about which people cared deeply. A number of themes stand out in the analysis of responses: individualism, declining community and greed; misuse of drugs and alcohol; declining values; social virtues; family breakdown and poor parenting; inequality and poverty; and apathy, failed institutions and a democratic deficit. These themes are specifically discussed and they stand out. However, six further themes deserve particular mention since, despite being less dominant, they are clearly important issues that participants in the consultation felt especially strongly about. These are: violence and crime; gender inequality; religion; social diversity, immigration and intolerance; health and social care; and the environment. Cutting across all the responses to the online consultation came an overarching sense of unease about rapid social change.

Systems thinking in public health is an analytic approach that takes a broad perspective to a health issue or challenge and considers the interrelated pieces and dependencies at play within the larger context of that issue. Systems thinking describes the interconnected factors that combine to contribute to many of the complex public health challenges practitioners face in their day-to-day work. Key to systems thinking is the idea that to truly solve a public health problem, one must understand and change the way the system works to create and sustain that problem. Changing just one part of a system can have incomplete (or even adverse) effects on overall outcomes. A systems thinking approach to the opioid epidemic involves understanding that a combination of factors that address various components and structures of the system is warranted to curb opioid misuse and addiction trends at the local, state, and national levels.

This chapter states that the growing sexual equality has made it possible for more women to leave abusive and unhappy homes. It also contends that there have been many moral improvements since the 1950s, but also distinct areas of decline. In addition, it is argued that the latter include family breakdown, drug and alcohol misuse, welfare dependency and violent crime; all linked to a loss of binding ‘social capital’. It starts by describing the growth of violent crime. There has been a collapse of the traditional nuclear family and there seems little doubt that there has, in recent years, been a decline in social capital. The two big questions addressed are: why have the values changed, and what should be done about it?

The management of medicines is a fundamental component of contemporary nursing care and a pervasive form of therapeutic intervention in healthcare (Medicines Partnership, 2002). In this chapter, we will focus on the skills and underpinning knowledge that you need to enable you to undertake an in-depth assessment of an individual’s use of medication, and how you can work in partnership with him or her to optimize safe, effective use, regardless of care setting. We will not address factors associated with the scheduled administration of medicines undertaken (for example, during the traditional ward drug round), although the principles articulated in this chapter are transferable. Likewise, the principles of good medicine management are also applicable to all of the chapters in this book on core conditions and health needs. Medicines are used to promote health, and to prevent, control, and treat disease. However, they are potent substances. All have side effects, and many interact adversely, not only with other medicines, but also with common fruit, vegetables, and food products. Ethnicity, race, age, weight, and gender can also affect an individual’s response to a specific medicine. Public access to medicines has increased hugely in the past decade, and prescriptive authority is no longer the sole right of medical practitioners. Nurses, pharmacists, physiotherapists, podiatrists, optometrists, and radiographers are now all able to prescribe a wide range of drugs. Patient group directions enable nurses and other health professionals to supply and administer drugs to patients without referral to a doctor, and medicines are increasingly available without prescription to purchase over the counter from a number of retail outlets and over the Internet. At the outset, it is clearly important to understand what we mean by ‘medicines management’; you will then appreciate the extent of your responsibilities and the skills that you need for competent practice. Medicines management is a complex subject and there have been several attempts to define it. The Audit Commission (2001: 5) defines it as:…the entire way that medicines are selected, procured, delivered, prescribed, administered and reviewed to optimise the contribution that medicines make to producing informed and desired outcomes of patient care….

This chapter focuses on the preparation and care of adult patients undergoing elective surgery, the associated challenges, and supporting evidence in providing safe and effective care. A key principle is the identification of relevant health issues and optimizing comorbidities prior to admission for surgery, which will minimize cancellations on the day of surgery. Informed consent, patient education, and teamworking all contribute to effective care and efficient service delivery. To provide the optimum healthcare, it is essential that the health professional has a full understanding of the patient’s physical and psychological health and social history, allowing tailored care to be shaped and implemented. It is important that the patient understands the associated risks and benefits of planned treatment. Patients often present for elective surgery with comorbidities. In optimizing the treatment, it is possible to prevent negative consequences related to planned care, and to increase the patient’s understanding of these so that he or she they can make an informed choice. Gathering information prior to admission is important because patients are often anxious on the day of surgery, and medication/anaesthetic agents can render them unable to provide clear decisions relating to treatment. This is commonly referred to as the preoperative assessment (POA), but is probably better referred to as patient preparation. Patient preparation is the process by which a patient’s health status is identified and comorbidities made known to the relevant healthcare professionals. The healthcare professional will interpret the information, decide on additional investigations and examinations, and then determine the risk factors associated with the patient’s health and the anticipated anaesthetic and surgical intervention. The patient must be informed of the risk and benefits and be provided with sufficient information to ensure an informed choice. Integral to patient preparation is the anticipation of potential outcomes, including length of hospitalization, ability to complete activities of daily living, and discharge planning. The process will involve the patient and his or her carer(s) and all healthcare professionals appropriate to the individual patient in primary and secondary care. It may be that, at the end of the patient preparation stage, the patient decides not to proceed with surgery.