Essay on American History To 1700 - 942 Words

The writings of Columbus, Castillo, and de la Casas represented vastly different points of view of the Spanish conquests of the Americas. In his first letter, Christopher Columbus mostly focused on the political victory of the voyage and arriving in the Indies (p. 32), and the splendor of the landscape including palm trees, mountains, and beautiful birds (p. 33). In the subsequent letter to King Ferdinand of Spain, Columbus seems selfish and one-sided (somewhat understandable considering that he was begging Ferdinand for forgiveness of his crimes (p. 35). Bernal Diaz del Castillos account, however, was not clouded by much bias or opinions at all. Because Castillo was just a simple foot soldier (Castillo p. 42) and was left to follow†¦show more content†¦33). After having been plotting against by his own men (p. 34), and being unsuccessful in governing, the weary explorer pleads with the King to let him leave the lands in America and perform a pilgrimage to Rome to convey his forgiveness (p. 35). Christopher Columbus once a confident man ready to take up the task and explore the New World, became downtrodden with the inability govern and carry out his personal wishes and those of the country he was serving. Cortes and Montezuma experienced moments of tension in their interactions with each other. Before they even met, Cortes was sent many gifts of gold and silver by one of Montezumas men, Quintalbor (Castillo p. 43). Montezuma specifically chose to send Quintalbar because his body and facial features closely resembled those of Cortes (Castillo p. 43). Both of these actions show that Montezuma was all ready becoming fearful that these strange men were going to threaten his land. Unfortunately, his gift-giving was counterproductive because it made Cortes and his men excited that the land was plentiful with gold. This ultimately became the reason that they attacked Tenochtitlan (Castillo pp. 43-44). The first time Cortes and Montezuma met face to face, Montezuma made a grand entrance, most likely to show Cortes how powerful he was. He wasShow MoreRelatedThe New World s Was Anything But Fair And Equal Between Men And Women1259 Words   |  6 Pagesnew world in the 1700’s was anything but fair and equal between men and women. The utopist idea of the hundred pilgrims signing the First American governing document, Mayflower Compact (Plymouth, MA-1620) was about to be rocked by centuries of racial discriminations. The Stono rebellion will trig various changes in the Colonies, this event will reshaped the 1700s’ racial status, and provide Southern states with a great opportunity to capitalize on its outcome. North America in 1700s was engaged inRead MoreWhat I Learned From Taking American Civilization 1700905 Words   |  4 PagesAt the beginning of the semester I wrote an assignment addressing what I wanted to learn from taking American Civilization 1700. I went through the course syllabus and I chose skills that I thought were important for me to know better as well as important to my future career as a teacher. Two skills that I did not list that I wanted to work on were comparing and contrasting. Comparing and contrasting are two skills that I thought I was quite good at and had no problems with. When it came to do theRead MoreThe Evolution Of The Education1566 Words   |  7 Pagesestablished as one of the first forms of Colonial education (The History of Education in America.). Grammar-Latin schools were founded as an educational institution for the children of the upper class, where boys could prepare for a role in the Church or State. 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The AutobiographyRead MoreThe American Revolution : A Historiographical Introduction846 Words   |  4 PagesThe American Revolution, also known as the U.S. War of Independence, started in the early 1700s and ended in the late 1700s. This war was started in an attempt to end the tension between the American colonies and the British government. After reading the article, â€Å"The American Revolution: A Historiographical Introduction,† provided by The British Library, and â€Å"The Historiography of the American Rev olution† by Michael Hattem, I have a better overall understanding of how the history of the AmericanRead MoreFrance - Change over Time Essay (French Revolution)1156 Words   |  5 Pages*As the title indicates, this is a change/continuity AP essay written for World History class. 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Research from the National Coalition for Women and Girls in Education (NCWGE) has shown that when Title IX was introduced in 1972, girls were able to participate in any state-funded activity, resultingRead MoreCongressional Acts that Helps Uplift African Americans1041 Words   |  5 PagesThe Search For Throughout history, there has been a struggle for equality and justice. The oppression that African Americans have received throughout the generational period in which they first arrived in America has continued to be a raging war. Article I, Section 8 of the American Constitution enabled Congress to have certain rights and authorities over the laws. In the evaluation of the 1700s, 1800s, 1950s, and 1990s, the prolific effects can be seen through specific Congressional Acts. BetweenRead MoreAmerica Needs Gun Control Laws Essay903 Words   |  4 Pages Guns have been the weapon of choice for some of the most brutal massacres on America soil. Since early history guns have been used mainly for militia and defense purposes. But, the development of new gun technology has made firearms more accessible and deadly. Although the second amendment gives the right to bear arms, guns should be controlled and monitored by the government because guns have contributed to a lot of killings in America and will increase crime rates. Gun control can be definedRead MoreBrief Overview of American Literature From Plymouth to the 1800s657 Words   |  3 PagesThe trace in literature and history from Plymouth and Virginia colonies through the Jeffersonian Enlightenment to the transcendentalists represented by Emerson and Hawthorne all begins with John Smith, whom had been granted by a charter from King James I reached Virginia in 1607. The settlers landed in what was Jamestown ready to begin the dangerous undertaking of surviving in a new environment. Dealing with harsh winters, lack of drinking water, and the spread of disease made life in Jamestown difficult

Argumentative Essay On Euthanasia - 1302 Words

Bryan Euyoque 4/24/17 Economics behind Euthanasia In an ethics class I took in high school, I have learned about many controversial topics. One that caught my attention specifically was euthanasia or the â€Å"right to die† as some call it. There are many types of Euthanasia, including active and passive. In class we debated the difference between the two and why passive euthanasia is legal and active is not. Active euthanasia is defined as â€Å"a person directly and deliberately causing the patient s death.† (Forms of euthanasia) Passive euthanasia is when â€Å"death is brought about by an omission of a certain thing required for life to continue.† (Forms of euthanasia) Examples of passive euthanasia would†¦show more content†¦If the point of euthanasia is to end suffering, then passive euthanasia does not seem like a good option. (The conventional Doctrine) When it comes to passive euthanasia the disease is what kills the individual. Those who qualify for passive euthanasia are mostly suffering from excruciatingly painful diseases. Passive euthanasia does not seem like the way to go if minimizing pain is the goal. As a result, â€Å"in many cases where it is right to let a patient die, it is also right to practice active euthanasia† (The conventional Doctrine) Those not in favor of euthanasia believe it is wrong to kill another human being even if it means saving them a lot of pain. An argument those who oppose euthanasia use is that â€Å"euthanasia weakens society’s respect for the sanctity of life† (Anti-euthanasia arguments) Sanctity of life means â€Å"Human life must be respected regardless of age, gender, race, religion, social status or potential for success. Life is good in and of itself, not just as a means to achieve an end.† (Arguments against euthanasia). In other words, no one has the power to end another person’s life regardless if their intentions are good or bad. Laws like â€Å"The Universal Declaration of Human Rights† were created to legally enforce the sanctity of life. Euthanasia would be a violation to this law thus should not be legal. Subsequently the argument from nature by J. Gay-Williams is also used inShow MoreRelatedEuthanasia Essay - Pro Euthanasia Argumentative Essay1148 Wo rds   |  5 PagesImani Henry Mr. Dowie Honors English 9 1/13/17 Pro Euthanasia Argumentative Essay Euthanasia is the act of intentionally killing someone to end suffering, with and without their consent. This practice has been around since the beginning of time and has been practiced by different cultures all over the world. In the United States currently, only 5 states allow the option of euthanasia. All states throughout the USA should allow the act of euthanasia. Considering it is within the 1st amendment due toRead MoreArgumentative Essay On Euthanasia754 Words   |  4 PagesEuthanasia In 1478-1535 euthanasia was first mentioned in the book â€Å"utopia† by sir Thomas More. The utopian priests encouraged euthanasia when a patient is terminally ill or dying. The earliest American statute explicitly to outlaw assisted suicide was enacted in NewYork 1828. Until the end of the nineteenth century euthanasia was regarded as a peaceful death and art of accomplishment, it was often referred to as â€Å"de euthanasia medica prolusion†. (life.org) When a person commits an act of euthanasiaRead MoreArgumentative Essay On Euthanasia1195 Words   |  5 Pagesaided death (PAD) is a problem that should be decided on once and for all. Euthanasia, similar to physician aided death, has a history dating back to the ancient Greeks and Romans (Haerens 1). In their culture, human life was not valued as it is now. While in extreme pain or suffering, they would take a shot of lethal poison. In the ancient times, 19th century, and now, there are doctors that oppose the practice of euthanasia because of the Hippocratic Oath- an ancient Greek oath that doctors takeRead MoreArgumentative Essay On Euthanasia839 Words   |  4 Pages Euthanasia is a very controversial and sensitive topic because of the ethical, legal, and moral issues of it. In the United States alone, it is illegal almost everywhere, however; it’s legal in Colorado, Vermont, Montana, Washington D.C., Oregon, Washington, and California. But, what exactly is euthanasia? Euthanasia can be categorized in three different ways; voluntary euthanasia, non-voluntary euthanasia, and involuntary euthanasia. Voluntary euthanasia is when a patient agrees to receive assistanceRead MoreArgumentative Essay On Euthanasia1828 Words   |  8 PagesEuthanasia Is your life really yours? Can a person decide on his or her death? If ‘yes’, what circumstances we would consider and what is a boundary between calling it â€Å"help† or ‘killing†? These questions point to euthanasia, a highly debatable issue. As described by Hermsen (520) euthanasia or mercy killing involves painlessly ending a life of an individual suffering from chronic and incurable illnesses or a permanent coma. It gives individuals authority over their lives where it allows them aRead MoreArgumentative Essay On Euthanasia715 Words   |  3 PagesEuthanasia (Physician-Assisted Suicide) Euthanasia has been around for a long time. In 1990 every state had laws that made assisting suicide a felony. Assisted suicide been in the news since the 1990s. A supporter of euthanasia Dr. Jack Kevorkian played an important role in more than 100 suicides before he was charged with murder. In Oregon voters passed the death with dignity act in 1994, but a lawsuit blocked its enforcement until 1997, when it went into effect. The consideration of potentialRead MoreArgumentative Essay On Euthanasia752 Words   |  4 PagesEuthanasia is the termination of a very sick person’s life in order to relieve them of their pain and suffering. Euthanasia is from a Greek word meaning easy death. The person who undergoes euthanasia usually has an incurable condition and in some cases wants their life to be ended. Euthanasia can be done at the request of a person which is voluntary but at the same time if a per is too sick and is unable to make the decision the family/next of kin inline , do chose or the court makes the decisionRead MoreArgumentative Essay On Euthanasia943 Words   |  4 Pagesthrough passive suicide. euâ€Å"Passive euthanasia occurs when a person is allowed to die due to the deliberate withdrawal of treatment that might keep them alive† (Pg.124)and prolong their life. It is a legal way of hastening death in a calm manner. Its methods are not the same as active suicide. The main difference is that it simply consists of removing treatments that would prolong life, instead of prescribing lethal doses of medicine to kill someone. Passive euthanasia is not as controversial for theRead MoreArgumentative Essay On Euthanasia994 Words   |  4 PagesThe term Euthanasia is quite a hot debate these days, even back in last century. People consider this as a process where people choose to end their lives with no physical pain by ingesting a pill, which also known mercy killing and assisted suicide. Due to the effect, many comments are about whether this way of killing should be legal or forbidden. Jack Kevorkian, an euthanasia proponent, was well known as â€Å"Doctor Death† who was a physician give patients the choice of mercy killing. Yet, he was arrestedRead MoreArgumentative Essay On Human Euthanasia1433 Words   |  6 PagesHuman Euthanasia It is a shared understanding that human life must be valued under any circumstance, and it should not be terminated for whatever reasons unless it is a natural occurrence. The value and respect for human life were behind the debate against â€Å"the death row† in many states and countries around the world. In addition, religion places high value in human life, basing on the claim that it is a sin to end one’s life. However, there have been instances where ending the life of another person

Critial Investigation of the etiology of juvenile idiopathic arthritis Free Essays

Introduction Juvenile idiopathic arthritis is an umbrella term which includes all forms of arthritis that begin before the age of sixteen, of over six week’s duration, and of unknown cause. (Petty el al 2004) With various contributing environmental and genetic factors, arthritis is an autoimmune disease. Ongoing research, into the etiology of juvenile idiopathic arthritis, has identified the most common risk factor as infection in combination with genetic susceptibility. We will write a custom essay sample on Critial Investigation of the etiology of juvenile idiopathic arthritis or any similar topic only for you Order Now An autoimmune reaction occurs as a result of an infection or trauma, this causes synovial hypertrophy and chronic joint inflammation in genetically susceptible individuals. (Rabinovich 2010). Juvenile idiopathic arthritis is a genetically complicated characteristic in which many genes are important as indications at the onset of the disease. Both the IL2RA/CD25 and the VTCN1 genes have recently been identified as juvenile idiopathic arthritis susceptibility loci (Hinks et al 2009) .Pathogenesis has many other contributing factors such as stress and maternal smoking. (Prince et al 2010) The International League of Associations for Rheumatology (2004) classification of Juvenile idiopathic arthritis, JIA, includes seven subtypes: Systemic onset JIA, oligoarticular, polyarticular RF-positive and RF-negative, Enthesitis-related arthritis, Juvenile ankylosing spondylitis, and ‘‘other.’’ The most common type of JIA is Oligoarticular.60% of children, mainly girls under 5, with JIA have this type. During the first 6 months Oligoarticular affects between one and four joints. The knees, ankles and wrists are the most affected. After 6 months it can spread to more than four joints and is known as ‘Extended oligoarthritis’ affecting 2 in 5 children. Affected children are moody and difficult as a result of their symptoms, which include joint stiffness in the morning and joint pain. Walking may be delayed in very young children. 1 in 5 children also have inflammation of the eye, Uveitis. Children who carry antinuclear antibodies in their blood are most at risk of uveitis. (Arthristis Research UK, 2010) Polyarticular arthritis, which again is more common in girls, affects 20% of children with JIA. (Arthristis Research UK, 2010) Polyarthritis mainly affects the joints of the hands and feet, which become painful, swollen and stiff. This type can often affect more than one joint, usually over 4, at a time. The child can often become unwell and pain may be accompanied by a fever. About 10% of children will have the rheumatoid factor (RF), meaning that their blood contains an antibody similar to that often found in adult rheumatoid arthritis. Most RF-positive children are girls, typically aged 10 or over. RF-positive children can have a more severe form of the disease which, without early intervention, can result in long-term joint damage. It is unlikely that RF-positive children will be free from Polyarthritis with symptoms continuing into adult life. Permanent remission is more often seen in children who are RF-negative. (David and Lloyd 1999, pg 207) About 10% of cases of arthritis in children are systemic. This type of arthritis affects girls and boys equally but is more often seen in under fives. (Arthritis Research UK, 2010). This severe and potentially fatal form of JIA includes children who have arthritis associated with marked systemic features. Systemic arthritis can be identified by a fever which persists daily for at least two weeks either at the onset or prior to the arthritis. One or more of the subsequent systemic features must also occur, these are a rash, generalised lymphadenopathy, liver or spleen enlargement and serositis (inflammation of the serous tissue, which lines the major organs including the heart and lungs.) Every child is different. Some children will fully recover after one bout of systemic arthritis. Others could have symptoms that come and go for several years and a number of children go on to develop polyarthritis but have no further fever attacks. (Arthritis Research UK, 2010) Psoriatic arthritis affects less than 10% and is most commonly found in girls aged 8 to 9 years. Psoriasis, a skin condition causing a widespread flaky skin rash is prevalent.The rarer form, Enthesitis-related arthritis usually affects boys aged eight and over. The main symptoms are arthritis in several joints at once, often located at the sacroiliac joint. Enthesitis-related arthritis has a genetic risk factor with children carrying, the HLA-B27 gene. This gene is an indicator common with some adult forms of arthritis. However affected children don’t always go on to suffer in adult hood. (Arthritis Research UK 2010) Although Munro et al (2009) reported that there are no specific tests for the diagnosis of JIA. Diagnosis is made on both clinical findings and investigations. A literature review, by Munro et al (2009), reports that past research recommends documenting the range of motion in all joints, the extent of joint swelling, the presence of bony overgrowth and whether affected joints are affected by muscle atrophy and weakness. Significant trauma, fever, in particular if it is persistent for 10 days or without clear cause or coupled with a rash also need to be evident.. Rheumatoid factor and antinuclear antigen screening tests should be conducted although children with an infection or current pathology may have positive findings, and the tests should not be used as a definite diagnosis of JIA. Inflammation, identified with a raised white cell or platelet count,may also be identified by during a full blood screening. T-lymphocytes play an essential role in the pathophysiology of JIA. They release pro-inflammatory cytokines and favour a type-1 helper T-lymphocyte response. An abnormal interaction between type 1 and type 2 T-helper cells has been hypothesized. Research into T-cell receptor expression; confirm recruitment of T-lymphocytes specific for synovial antigens. Evidence of a disorder in the humoral immune system is identified by the increased presence of autoantibodies, increased serum immunoglobulins, existence of circulating immune complexes or complement activation. Chronic inflammation of the synovium is characterized by B-lymphocyte infiltration and expansion. Macrophages and T-cell invasion are linked with the release of cytokines, which induce synoviocyte proliferation. (Rabinovich 2010) JIA, if badly managed, can have a number of consequences such as growth failure, leg length discrepancy, contractures, scoliosis, blindness (secondary to untreated chronic anterior uveitis), Macrophage activation syndrome, disability and many more. Psychosocial problems are also evident. JIA sufferers are predominantly affected by pain. When treating children in pain, doctors and parents must first understand the physiology of pain and why children have different reactions. The International Association for the Study of Pain (2007) defines pain as â€Å"An unpleasant sensory and emotional experience which we primarily associate with tissue damage or describe in terms of such damage, or both.† This definition recognises that pain is a perception and not a sensation as many believe. Pain can be categorised into nociceptive, or neuropathic. Sustained activation of the nociceptive system caused by tissue injury results in pain described as nociceptive . While neuroplastic changes are evidently involved, nociceptive pain is alleged to arise as a result of the normal activation of the sensory system by noxious stimuli, a process that utilises transduction, transmission, modulation and perception. Direct injury or dysfunction of the peripheral or central nervous system results in Neuropathic pain. The injury could be to either neural or non-neural tissues. (American Medical Association, 2010) There has been several pain mechanism theories proposed over the last 50 years. The specificity theory, described in 1664 by Rene Descartes, proposes that pain impulses travelled along a dedicated pathway from receptors in the periphery to a specialised pain centre in the brain, resulting in a mechanical behavioural response. Descartes described each nerve as having a specific function, with free nerve endings being called pain receptors. (Thomas 1998, pg 6) It suggests that the greater the damage or injury then the more sever the pain. (Brannon and Feist , 2000) This theory can be supported to the extent that there are some specialised nerves in the human body however others can have numerous functions or detect several types of stimuli. On the other hand this theory does not explain the variable nature of pain. Furthermore no pain centre has ever been identified; current research suggest multiple areas of the brain detect and respond to the pain stimuli. (David and Waterfield 199 9) In 1962, Weddel (cited by Thomas 1998) states that there is no separate system for perceiving pain, rather that pain is due to intense peripheral stimulation of non-specific receptors. This in turn produces a pattern of nerve impulses, which is interpreted centrally as pain. The pattern theory proposed that strong and mild stimuli produced different patterns of impulses. (Thomas 1998, pg 6) This theory ignores the specialism of some receptors and does not account for conditions in which a gentle touch can trigger episodes of neuralgia (David and Waterfeild 1999) The best explanation to date is the pain gate theory, proposed by Mezack and Wall in 1965. (David and Lloyd 1999, pg28) The theory suggests that stimulation of nerve endings evokes nervous impulses that are transmitted by three systems located in the spinal cord. The substania gelatinosa in the dorsal horn of the spinal cord, the dorsal column fibres and the central transmission cells act to stimulate or inhibit nocioceptive impulses. The transmission of impulses from the afferent fibres to the spinal cord transmission cells is modulated by the spinal gating mechanism in the dorsal horn. The gating mechanism is influenced by the amount of activity in the larger-diameter fibres. Larger diameter fibres are thought to be inhibiter, thus closing the pain gate, the opposite occurs when smaller fibres are stimulated: pain is transmitted and the gate opens.(Melzack and Wall, 1996) In addition descending control from various structures in the brain can also inhibit the relay and close the g ate. On reaching the brain, the impulses are further modified and integrated with other sensory input. On arrival at the brain the impulses are felt as pain. It is important to understand that those afferent fibres do not have a fixed response but are subject to modification even before they reach the pain gate and after they reach the brain. (David and Lloyd 1999, pg 28) The pain gate theory was the first to appreciate that pain can be affected bypsychological factors. A person may be able to control pain be altering their state of mind. For example if a person is able to distract themselves from the pain then less impulses are sent to the brain therefore not enough stimuli are present to open the gate. (Salvano and Willems 1996, pg 15) In summary experiences of pain are influenced by many physical and psychological factors such as beliefs, prior experience, motivation, emotional aspects, anxiety and depression can increase pain by affecting the central control system in the brain. The specificity theory and the pattern theory suggests that pain occurs only due to damage to body tissue while the gate control theory claims that pain may be experienced without any physical injury and individuals interpret pain differently even though the extent of injury is the same. The gate control theory also suggests that pain can be controlled by the mind. The author’s understanding is that Juvenile idiopathic arthritis produces nociceptive pain, through recurrent inflammation of the joints. Inflammation releases chemicals such as histamine and bradykanin, which are detected by nociceptors which then activate noxious impulses to the dorsal horn. Once enough impulses are generated to â€Å"open the gate† neural areas responsible for perception and response activate. The perception and level of response is influenced by the state of mind. Pain impacts on the lives of children, with arthritis, by limiting activities, disrupting school attendance, and contributing to psychosocial distress (Kimura and Walco 2006). A study by Schanberg et al (2003) investigated levels of pain in 41 children with arthritis by the daily completion of pain diaries. They found that 70% of the children had significant amounts of pain, on 60% of the days, with 38% having pain daily. Children often describe the pain associated with JIA as â€Å"aching,† â€Å"sharp,† â€Å"burning,† and â€Å"uncomfortable† (Antony and Schanberg 2003). Research also suggests that children with JIA have a lower pain threshold than their healthy counterparts. (Hogeweg et al 1995) This could be due to the children’s brains, were pain is processed, changing due to long exposure to noxious impulses. The perception of pain in children with JIA could also be influence by the cognitive capabilities and age. Beales et al (1987, cited i n Antony and Schanberg 2003) suggest that cognitive development impacts pain perception due to the association and understanding of the child’s condition. For example all the children , despite their age, described the pain as â€Å"aching† but younger children did not associate it with anything unpleasant , older children, however,are more likely to relate their joint feeling to their arthritis-related disability. Therefore with cognitive maturation, children become capable of connecting internal sensations with internal pathology and the potentially serious consequences. Hence, older children with arthritis may become more distressed by the sensation, resulting in increased reported pain intensities as the child’s age increases. (Antony and Schanberg 2003). There is a mounting body of research indicating to the importance of psychosocial variables in the pain incidence of children with JIA, consisting of emotional distress, stress, and mood. Also significant is the child’s perception and coping strategy with their pain. Moreover, a number of studies have described the role of parental and familial factors in child pain, specifically parental psychological health, parental pain history, and the nature of the way in which family members interact with one another. Addressing these issues while managing the condition may help to reduce pain, elevate mood, and improve overall quality of life for children with arthritis. (Antony and Schanberg 2003). A child’s pain needs to be assessed at each appointment, whether by a doctor or physiotherapist. Pain can be assessed both subjectively and objectively. It is important to gain a good description of areas affected, the intensity, type and severity of the pain. A more objective measurement is a Visual analogue scale, completed by the child and a VAS global assessment of disease and function completed by the parents. (Pounty 2007) A multidisciplinary approach, to the management of Juvenile idiopathic arthritis, is considered best practice. Treatment is aimed at controlling inflammation and minimising its effects on the joints. For the best outcome, awareness of complications of both disease and therapy and the psychosocial effects of the illness on both the child and family is essential. (Davidson 2000) Treating the pain can sometimes be the only intervention during a physiotherapy session. Both pharmalogical and non-pharmalogical methods are used to treat pain in JIA.Guidelines for the management of childhood arthritis,The British Paediatric Rheumatology Group (2001), are available and new research is continuing to improve treatments. Most JIA children are Initial treatments include intra-articular long-acting corticosteroid injections and NSAIDs. NSAIDs control pain and inflammation and are usually given for 4 to 8 weeks before starting treatment with a second-line agent. Naproxen, tolmentin, diclofenac, and ibuprofen are commonly used and are usually well tolerated with little gastrointestinal discomfort. The choice of NSAID may be based on the taste of the medication and the convenience of the dosing regimen. Naproxen is prescribed most frequently. Indomethacin is a potent anti-inflammatory medication commonly used to treat ERA and SOJIA, however side effects include headaches, difficulty in concentrating, and gastrointestinal upset. These can be counter acted with other medications. (Weiss and Ilowite 2005) A literature review (Hashkes and Laxer 2005, Cited by Munro et al 2009) looked at the affects of NSAIDS on JIA. These were inconclusive as the participants receiving all forms and doses of NSAIDs achieved significant improvements in the outcome measures and no individual NSAID was shown to have a clear advantage over others. The immune system can be suppressed and the progress of arthritis slowed down, as well reducing the inflammation, by the use of diseases modifying anti-rheumatic drugs (DMARDs) (National Rheumatology Society 2008) Methotrexate is most commonly used for JIA. Random controlled placebo trials and dose finding trials have shown that DMARDs can be effective in polyarticular and oligoarticular arthritis although not in systemic arthritis. (Prince et al 2010) Both physiotherapy and occupational therapy can reduce the impact of JIA, on the daily lives of children. Physiotherapy has a number of treatments that can be utilised to reduce pain. Physical therapy and exercise programs have been shown to be helpful in reducing pain in children with arthritis and should therefore be encouraged, especially since children with arthritis tend to be less physically active and may have become de-conditioned (Kimuru and Walco 2006). Exercise can have an analgesic effect. If using the Pain gate theory, movement can help to close the gate by providing a distraction. Exercise is also good for the healing process. Satallite cells, which can only be activated through exercise, are important for muscle growth and repair. They can be stimulared to either replace damaged muscle cells or add muscle cells. (Poutney 2007, pg 234) A literature review, by Long and Rouster-Stevens (2010), highlighted the importance of exercise in the treatment of JIA. Current studies show that inactivity can lead to deconditioning, disability, decreased bone mass, and reduced quality of life. While progress in pharmacology has improved the lives of patients with JIA, management should also consist of a moderate, regular exercise program or more active lifestyle. The literature suggests physical activity may improve exercise capacity, reduce disability in adulthood, improve quality of life and, in some patients, lessen disease restrictions. . There is however limited evidence of the effect of strength training in children with JIA. Fisher et al (2001) monitored the effects of resistance exercise, via isokinetic equipment, in 19 children with JIA. Children were given an 8 week, personalised progressive programme.Participants demonstrated significant improvement in quadriceps and hamstring strength and endurance, contraction speed of the hamstrings, functional status, disability and performance of timed tasks. Despite the limited evidence, it is recommended that a programme of strength training may be beneficial with JIA. Recommendations for healthy children can be used as a guide. The American Academy of Paediatrics (2001, cited by Maillard 2010) recommends that to increase strength and fitness, low resistance for 15 repetitions is ideal for children. They suggest twenty to thirty minute sessions, two to three times weekly. There is evidence that there is no benefit to increasing the amount of sessions. (Maillard 2010) Hydrotherapy is also advocated for JIA. The effects of hydrotherapy are gained with the combined effect of the warmth, the buoyancy and the fun element of the treatment. Hydrotherapy aims to reduce pain and muscle spasms, increase joint range of movement, and increase muscle strength. Epps et al (2005) found that following two months of hydrotherapy combined with land based exercise there was an increased quality of life and reductions in the impact of the disease in 47% of children with active juvenile arthritis. Pain relief from the heat generated from the pool could be replicated using heat pads or a hot bath. Heat relaxes your muscles and stimulates blood circulation. In relation to the pain gate theory thermal receptors may detect a raise in temperature, impulses are generated which help to close the gate in the dorsal horn, reducing the amount of noxious impulse to the perception area therefore providing relief Conversely cold packs could be used to reduce inflammation and therefore reduce the amount of impulses generated by chemorecepters. (Arthritis Foundation 2011) Alternative therapies are often used to aid pain relief (Feldman et al 2004). Massage is found to be effective on depression, anxiety, mood, and pain (Walach et al 2003). Field et al (1997) investigated the use of massage on children with JIA. Parents massaged their child for 15 minutes per day, for 30 days. They found that the self assessed pain scales decreased as well as cortisol levels lowering, reducing their stress and anxiety. It is possible that the touch from massage helps to reduce pain by closing the gate in the dorsal horn. In conclusion, juvenile arthritis is a painful condition that affects a child’s social, educational and physical life. Pain is a major contributor to the lowered quality of life experienced by these children. Relief can be found in many interventions. A multidisciplinary approach is best practice. The evidence suggests that a combined programme of physiotherapy and medication can help to reduce pain and improve function in these children References American Medical Association.(2010) ‘Pathophysiology of Pain and Pain Assessment.’ Chicago [online]. Available at:http://jhuleah.files.wordpress.com/2010/08/dr-moore-reading-1-ama_painmgmt.pdf (Accessed on 10th March 2011) Anthony.K, Schanberg. L, (2003) ‘Pain in children with arthritis: A review of the current literature’ Arthritis Care Research, 49(2), pages 272–279[online] available at: http://onlinelibrary.wiley.com(Accessed on 14th March 2011) Arthritis Foundation (2011) ‘using heat and cold’ [online] Available at: http://www.arthritis.org/use-heat-cold.php (Accessed on 14th March 2011) Arthritis Research UK (2010) ‘Juvenile idiopathic arthritis (JIA, arthritis in childhood)’ . Available at: http://www.arthritisresearchuk.org(Accessed on 14th March 2011) British Paediatric Rheumatology Group (2001) ‘Guidelines for the Management of Childhood Arthritis’. Rheumatology, 40(11), pp1309-1312, [Online]. Available at: http://rheumatology.oxfordjournals.org (accessed on: 16th March 2011) Brannon, L. Feist, J.(2000), Health Psychology: An Introduction to Behaviour and Health ,4th ed , USA: Brooks/Cole, David.C, Lloyd.J (1999) ‘Rheumatology Physiotherapy’. London: Mosby International limited Davidson.J.(2000) ’Juvenile Idiopathic Arthritis: a clinical overview European Journal of Radiology, 33( 2), pp 128-134,[Online]. Available at: www. Sciencedirect.com (Accessed on 12th March 2011) Epps.H, Ginnelly.L, Utley.M, Southwood.T, Gallivan.S, Sculpher.M, Woo P.(2005) ‘Is hydrotherapy cost-effectiveA randomised controlled trial of combined hydrotherapy programmes compared with physiotherapy land techniques in children with juvenile idiopathic arthritis.’ Health Technol Assess. 9(39), pp1-59, [Online]. Available at: http://www.ncbi.nlm.nih.gov (Accessed on 12th March 2011) Feldman.D, Duffy.C, De Civita.M, Malleson.P, Philibert.L, Gibbon.M, Ortiz-Alvarez.O, Dobkin.P (2004) ‘factors associated with the use of complementary and alternative medicine in juvenile idiopathic arthritis’ Arthritis Care Research, 51(4), pages 527–532,[online]. Available at: (Accessed on 10th March 2011) Fisher NM, Venkatraman JT, O’Neil KM, (2001) ‘The effects of resistance exercises on muscle and immune function in juvenile arthritis.’ Arthritis Rheum, 44(9), pp276, [Online]. Available at:www.medscape.com(Accessed on 12th March 2011) Hinks A, Ke X, Barton A, et al. (2009) ‘Association of the IL2RA/CD25 gene with juvenile idiopathic arthritis’. Arthritis Rheum, 60(1), pp251-7, [Online]. Available at: http://onlinelibrary.wiley.com(Accessed on 10th March 2011) Hogeweg.J, Kuis.W, Oostendorp.A, Helder.R, (1995) ‘General and segmental reduced pain thresholds in juvenile chronic arthritis’ Pain, 62(1), pp11-17, [Online]. Available at: www.sciencedirect.com (accessed on 10th March 2011) Hull.RG, (2001). ‘Management guidelines for arthritis in children.’ Rheumatology, 40, pg1308, [online]. Available at: http://rheumatology.oxfordjournals.org (Accessed on 12th March 2011) International Association for the Study of Pain (2007) ‘IASP Pain Terminology’[Online]. Available at: http://www.iasp-pain.org(Accessed on 12th March 2011) International League of Associations for Rheumatology, Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J, Prieur AM, Suarez-Almazor ME, Woo P. (2004) ‘International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001.’Rheumatology,31(2), pp390-2, [Online]. Available at: http://www.jrheum.org (Accessed on 12th March 2011) Kimura.Y, Walco.G, (2006) ‘Pain in children with rheumatic diseases’ Current Rheumatology Reports , 8(6), pg480-488, [online] Available at: www.springerlink.com. (Accessed on 11th march 2011). Long,.A, Rouster-Stevens.R, Kelly. A (2010) ‘The role of exercise therapy in the management of juvenile idiopathic arthritis’ Current Opinion in Rheumatology , 22( 2), p 213–217, [Online]. Available at: http://journals.lww.com/co-rheumatology (Accessed on 12th March 2011) Maillard.S(2010) ‘Physiotherapy for Juvenile Idiopathic Arthritis’ [lecture] Great Ormond Street Hospital, London [online] available at:www.vadlo.com (accessed on: 12th March 2011) Melzack.R, Wall.D (1996) ‘The challenge of pain’ 2nd ed.London: Penguin, Munro.J, Haesler.K, Rada.J, Jasper.A, (2009) ‘Juvenile idiopathic arthritis: a literature review of recent evidence’ NHMRC,[online] available at: http://www.racgp.org.au (Accessed on 10th March 2011) National Rheumatology Society (2008) ‘Methotrexate in Rheumatoid Arthritis’ [Online] available at:http://www.nras.org.uk (Accessed on 10th March 2011) Petty.R, Cheang.M, Malleson.P, Oen.K, Cabrel..N, Rosenberg.A (2004) ‘Predictors of pain in children with established juvenile rheumatoid’. Arthritis Care Research, 51(2), pp222-227, [Online]. Available at: : http://onlinelibrary.wiley.com (Accessed on 14th March 2011) Poutney.T (2007) ’Physiotherapy for Children’. Philadelphia: Elvieser Prince.F, Otten.M, van Suijlekom-Smit.L, (2010) ‘Diagnosis and management of juvenile idiopathic arthritis.’ BMJ,341,c6434, [Online]. Availbel at: www.bmj.com (accessed on: 16th march 2011) Rabinovich (2010) ‘Juvenile Rheumatoid Arthritis’ Available at: http://emedicine.medscape.com/article/1007276-overview(Accessed on 14th March 2011) Schanberg L, Anthony KK, Gil KM, Maurin EC(2003) ‘Daily pain and symptoms in children with polyarticular arthritis.’ Arthritis Rheum, 48, pp1390–1397, [Online]. Available at: http://onlinelibrary.wiley.com( Accessed on 14th March 2011) Thomas.V, (1998) ‘Pain : its nature and management ‘ London : Bailliere Tindall Walach H, Guthlin C, Konig M. (2003) Efficacy of massage therapy in chronic pain: a pragmatic randomized trial. J Altern Complement Med.; Vol 9: pg 837-846. 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Social Context Assessment and Case Formulation Solution

Question: Describe the client's family and social context. Assessment and case Formulation including psychosocial needs (supported by references). Describe the substance abuse model- Abstinence and rationale. Outline of counselling and treatment process--- residential detox then residential rehabilitation with partner. Client outcomes- challenges and supports such as cultural programs, religious organisation- pastor support for education, sporting organisations, recreational PCYC........ Identify ethical issues likely to arise. Answer: As Ruby seems to be neglected by her parents and feels that they have no time for her, it seems that this is the main cause of her alcohol addiction. Hence, the cognitive behavioral model will be involved in the treatment of Ruby, as this method is focused on making individuals learn that how their personal feelings, thoughts, and behaviors, like alcohol drinking, in this case, are connected and various methods to break this kind of connections. The treatment plan will include helping the client analyze and recognize her environment, as well as, analysis of the methods of responding to the various cues to utilize alcohol, as well as, to develop new ways and methods of response to these different cues. Further, this treatment plan will involve the cognitive therapy and will attempt in reducing excessive and rapid emotional reactions, as well as, the self-defeating attitude of the client by modifying her faulty thinking, as well as, maladaptive beliefs which are responsible for these k ind of reactions (Kumpfer, 2002). Moreover, this treatment plan will involve strategies that will focus on the various behavioral aspects and ways of coping instead of thinking or running away from the situation. Hence, it will involve the participation of the client in relapse prevention programs and other training programs for the development of the cognitive, behavioral, as well as, abstinence skills. This treatment method will include 12-16 sessions, usually for more than 12 weeks and will focus on developing interpersonal skills, as well as, strategies to help client expand her social support connections and other coping skills. The physical and psychological aspects that may occur in this case are changes in the behavior of the client as she is asked to refrain herself from the alcohol use. It may lead to the aggressive or angry behavior. Moreover, the difficulty faced by the client during the early stages of the plan to refrain herself from the alcohol can lead to the event o f relapse. Hence, proper monitoring and participation in the relapse prevention events and various other supporting programs are highly recommended (Worley, Tate, McQuaid, Granholm, Brown, 2013). As Sammy is highly addicted to alcohol with the habit of drinking alcohol as soon as he wakes up and due to the deterioration of his health status caused by alcohol drinking, the use of abstinence model or 12-step model will be used in the treatment of Sammy. As this method involves the multi-disciplinary and is abstinence-oriented, hence, it will help Sammy to stop consuming alcohol and abstain himself from drinking. Firstly, this treatment plan will involve the teaching and educate the client about the use of alcohol as a major problem and its extent. Secondly, this method will involve the motivational interviewing process while counseling with the client for a better understanding of his alcohol addiction and resolving the problem (Winters, Stinchfield, Latimer, Lee, 2007). Thirdly, this method will involve different individual and group therapies, the collaboration of the method with other supporting teams like PCYC and religious organizations for physical and recreational activ ities, as well as, will involve inpatient detoxification, various rehabilitation services, as well as, other outpatient services. This method will also involve the spiritual orientation and will include other symptomatic treatments for the upliftment of the clients health status. This plan will be followed for at least 28 days with participation in the twelve step programs and meetings (Lammertink, Lhrer, Kaiser, Hambrecht, Pukrop, 2008). Moreover, it will also include aftercare plan for supporting ongoing recovery of the client after the completion of the treatment plan as it is the life-long process. The physical and psychological challenges that may occur in this case is the occurrence of the serious symptoms that may occur when there is no alcohol consumption all of a sudden. Hence, it requires close medical monitoring of the patient due to his deteriorated health condition and alcohol addiction. Moreover, the chances of relapse are also there even if abstinence is achieved dur ing the treatment process, thus, requiring the after care plan utilization (Khalsa, Treisman, McCance-Katz, Tedaldi, 2008).As Amira is a heroin addict and has been arrested for soliciting, the use of a cognitive behavioral model, as well as, pharmacological treatments will be the preferred method of treating Amira. The foremost step in the treatment plan will be the detoxification or chemical withdrawal of the client from heroin. The second step to be followed after detoxification of the client will be the use of various classes, as well as, therapy sessions that will help the client in coping the situation and overcoming the desire of using of heroin again ("Maintenance Treatment of Heroin Addiction. Evidence at the Crossroads", 2004). The next step of this treatment plan will be the maintenance after the completion of the treatment program. It involves follow-up care by participation in the 12-step programs like Narcotics Anonymous and other supporting groups besides the individu al therapy (Connell, 2006). Residential training for the period of about 30-90 days will be undertaken depending upon the addiction of the client and her improvement. The physical and psychological challenges that can be experienced by the patient may involve various withdrawal symptoms experienced by the patient on stopping heroin use like vomiting, bone pain, restlessness, insomnia, cold flashes (Blanken, Hendriks, van Ree, van den Brink, 2010). Moreover, there can be extreme cravings for the heroin experienced by the patient in association with the withdrawal symptoms, which can lead to the relapse of the heroin addiction. Hence, the use of medical treatment during the process of detoxification is very important to minimize these withdrawal symptoms, as well as, the extreme cravings for the heroin use. Hence, the treatment plan will include the medically assisted detoxification process, cognitive-behavioral therapy, various educational and motivational lectures, individual, as w ell as, group counseling programs, family therapy, and the incorporation of the 12-step program as a after care plan (Future Challenges For Heroin And Other Opioid Substitution Treatment", 2008). Introduction Drugs, as well as, substance abuse are found to be the major contributing problem worldwide and has become the major problem observed among teenagers. It has been observed that several youngsters do drugs to show they are cool or because they are pressured by the peers into doing drugs. It has been found that the peer pressure has been the concerned problem regarding the drug abuse. People who are a substance or drug addict have no control over their lives and lacks the understanding regarding their surroundings. Risk factors like lack of emotional or mental resources to cope up with the stress, requiring sudden relief from distress, or having a low tolerance to handle the stress and frustration are commonly found to be the reasons for drug addiction (Shepard, 2002). In this article, I will seek to review the case of the Australian movie character, Samson in the movie titled Samson and Delilah, who is involved in the substance abuse and is a petrol sniffer. Case study Description of the character: Samson is a teenager who lives in the remote Aboriginal area of the Central Australia. He used to live with his brother and shares the battered cinder-block apartment with his elder brother. The apartment is dirty and, besides having the refrigerator, which has no eatables or food inside it, the house does not have any other kind of the real furniture. The community where he lives is surrounded by empty beer cans, milk crates, as well as, abandoned cars and litters the poor, as well as, an oppressed community where he survives. The life of Samson is miserable, and he used to live in the extreme conditions. Due to the poverty and poor conditions of his family, he has become addicted to substance abuse and sniffs petrol to alleviate his boredom and physical hunger. He wants to learn guitar and his brother has the reggae band. However, his brother does not allow him to play his instrument. Hence, to amuse himself besides beating his physical hunger, Samson has become a substance addict and used to sniff petrol for his personal amusement and to overcome his miserable life due to the poverty and isolation. He finds petrol sniffing to be the way of coping his loneliness and boredom he has in his life. Samsons petrol sniffing addiction increases and worsens day by day due to which he is losing the touch with the real world (Gorman, 2009). Evaluation of the case: Samson is a petrol sniffer, and his addiction is increasing day by day as he wishes to overcome the harsh cruelty of his life. His psychosocial needs indicate that Samsons addiction to the petrol sniffing is to overcome his physical hunger and boredom as he belongs to the poor family and lives in an isolated community with his brother. His brother is not supporting in nature and devoid of having family relations due to the absence of family, Samson is found to be involved in the addiction. Moreover, the use of illicit substances, alcohol, as well as, tobacco is found to be the cau se, as well as, effect of the great suffering seen among the Indigenous people. The statistics have shown that about 28 % of the Indigenous people are found to be more involved in the substance and drug abuse as compared to the other Non-Indigenous people. The isolation of the Indigenous people from the white community and the sufferings they have faced has led to the use of illicit drugs. The inequality and the lower standards of living of the Indigenous people like lack of education, healthy housing, proper sanitation, food resources, as well as, unemployment are the factors that have inclined the client to the addiction (Gorman, 2009). Substance abuse model for the client: Depending upon the condition and level of addiction in Samson, the abstinence-based addiction counseling is chosen to treat the addiction of the client. Through counseling, as well as, through continued support, the client will be recovered from the addiction as long as the client maintains the abstinence from the petrol sniffing for a lifelong term (Laudet Stanick, 2010). The main and foremost goal of this substance abuse model is to help Samson achieve, as well as, to maintain the abstinence from the petrol sniffing and other addictive behaviors and chemicals. The secondary goal of this treatment model is to help him recover all the damage and negative impacts the client had faced due to the addiction (Dawson, 2000). Rationale: The abstinence-based addiction counseling will work initially by making the client understand the problem and by motivating him to recognize the occurrence of his problem, as well as, the related irrational thinking with this problem. Next, the patient will be encouraged and motivated to achieve, as well as, maintain the abstinence from the petrol sniffing. Moreover, through this counseling model of substance abuse, we will develop the required and important psychosocial skills, as well as, the spiritual development that will be helpful to the client to continue his abstinence from the substance in the lifelong process of recovery. This approach will actively lead to the formation of the strong and healthy therapeutic alliance among the client (Dodge, Sindelar, Sinha, 2005). Interventions: As Samsons addiction is worsening day by day, therefore, I will follow the Abstinence-focused addiction counseling method for treating his addiction problem. The abstinence treatment model of substance abuse will initially be focused on the diagnosis mainly on the comprehensive evaluation of the client, which recognizes and determines that addiction is the biological, social, as well as, a psychological disease. Hence, the initial and foremost phase of this model of treatment of substance abuse will require the process of detoxification that will be medically supervised. Moreover, the comorbid diseases and health issues that can be associated with the petrol sniffing, as well as, dual diagnosis of the diseases like bipolar disorder, depression, hyperactivity disorder, or attention deficit disorder will also be diagnosed, as well as, treated whatever the case may be (Chi, Sterling, Campbell, Weisner, 2013). The treatment for the substance abuse will involve the use of cultural interventions, individual cognitive based behavioral therapies, group therapies, partner therapy, as well as, the relapse prevention measures and therapy. The use of cultural interventions has found to offer the promise and hope of recovery from various kinds of addictions and substance abuse for Indigenous people. From the use of various sweat lodges to the implementation of traditional teachings, the regionally based interventions will be practiced. The use of cultural elders that will help the client to assume their traditional role and will be a constant reminder to him about his native cultural and traditional norms will be followed. Art therapy that will include traditional teachings and social culture programs will also be followed. Psycho-therapeutic practices involving spiritual and cultural domains will help the client to identify his tradition and culture (Rowan et al., 2014). Besides giving traditional teachings, will work in collaboration with the supporting te ams like Uniting Church that works for the upliftment of indigenous people and acknowledges their rights. Uniting Church is the community service provider and provide various scholarships for training and education, employments, and work for the benefit of Indigenous People (Cardelus, Lowman, Eshete, 2012). Hence, this will help the client to overcome the social determinants of his life that have forced him towards addiction. Moreover, the client will be enrolled in the petrol sniffing prevention program where the client will participate in the volatile substance rehabilitation program, will be re-engaged in various cultural activities like hunting, visit to sacred places, fishing, as well as, learning the stories. Moreover, there will be implementation of various education and communication strategies, activities for strengthening and supporting the Indegenous people community, and evaluation of the progress of the client (Bryce, Rowse, Scrimgeour, 2010). Moreover, the use of cog nitive behavioral therapy, acceptance and commitment therapy, and narrative therapy. Client Outcomes: The outcome of this treatment model will be positive for the client as it focuses on the underlying reasons responsible for the addiction of the client to the substance abuse. Moreover, this model helps in overcoming and dealing with the medical, religious, as well as, the psychological components. This treatment plan also includes the after treatment programs that motivate and encourages the patient to continue his abstinence to the substance abuse. The total abstinence is the main motto of this program. The use of the cognitive behavioral therapy will help the client to understand the link between his addictive behavior and his surroundings and environment. Moreover, this therapy will help him to analyze his feelings that insist him to petrol sniffing and will provide ways to overcome these kind of feelings and situation (Moyers Houck, 2011). The use of the acceptance and commitm ent therapy will help the client overcome psychological disorders. It is a mindfulness therapy and will aim to help the client learn, as well as, grow as a result of his sufferings. Moreover, this therapy will help the client to develop the detached relationship to his thoughts and feelings. While, the narrative therapy will help the client to re-map his future by heading in a positive and a sober direction. This therapy will highlight the positive past experiences of the client that will motivate him and will become the building blocks for his successful future (Marsh, Dale, Willis, 2007). However, during the process of this treatment of substance abuse, the client will face various difficulties and challenges as it will be very difficult for him to refrain himself from petrol sniffing suddenly. Due to this, the client may be unwilling or unable to remain adhered to the treatment program. Frequent dropouts, as well as, withdrawal symptoms can also occur as a result of this. Moreov er, lapses can often occur during the early period of this treatment plan. Hence, motivational, as well as, supporting services are very much required and important for the clients adherence to the treatment program (Galanter, 2007).Ethical issues likely to arise in this case: The ethical issues related to the clients confidentiality, cultural background, and societal status are likely to arise in this case. Respect of the client in respect of his cultural background and social status is very important. As the client belongs to the poor economical status and to the Aboriginal community, it is likely that his counseling process is being affected by these parameters. However, this behavior is beyond the ethical norms and is the breach of the code of ethics, which states that the person should be treated and counseled irrespective of his caste, creed, color, and background (Scott, 2000). Moreover, as this treatment and counseling process is solely focused on abstinence process, it may work against the will of the client at certain times due to the clients desire of drug addiction and in the case of relapse. Other ethical issues that may arise in this case can be negligence or improper counseling and treatment method for the substance abuse of the client due to the inability of his to pay for the process. As the client is poor and inefficient in paying for the counseling process and providing any other kind of financial support, it is likely to happen that these parameters might affect the whole counseling process (Bretteville-Jensen, 2006). The confidentiality, equality, and autonomy are the few ethical concerns likely to arise in this case. Conclusion The abstinence model involves the comprehensive, as well as, the multi-disciplinary approach focusing on the treatment of various kind of addictions that is abstinence-related. Various kinds of elements, as well as, methods that are widely related with the foremost treatment method while following this model involves individual therapies, group therapies, motivational and encouraging lectures, multi-disciplinary staff, recovering individuals as counselors, a therapeutic milieu, family counseling, various therapeutic oriented work assignments, utilization of the Twelve Step program, family counseling, daily evaluation of the clients progress, attendance of the client at AA meetings, as well as, provision of various opportunities to the client for recreational and physical activity (Notley, Blyth, Maskrey, Pinto, Holland, 2014). Even after the completion of the treatment plan, the clients are encouraged to participate and involve in the meetings and after care programs. This model has the main focus on identifying the chemical dependency to be the main problem. This model is neither punitive nor blaming, and it emphasizes on seeking the treatment to be the best and appropriate response to the chemical dependency problem. Hence, this method besides helping in achieving the abstinence from the substance abuse also provides the measures favoring the continuity of this abstinence for a life long term (Reichel Bevins, 2009). References Future challenges for heroin and other opioid substitution treatment. (2008). Addiction, 103(6), 967-968. Blanken, P., Hendriks, V., van Ree, J., van den Brink, W. (2010). Outcome of long-term heroin-assisted treatment offered to chronic, treatment-resistant heroin addicts in the Netherlands.Addiction, 105(2), 300-308. Bretteville-Jensen, A. (2006). Unresolved Issues Associated With Current Economic Models of Substance Abuse. Substance Use Misuse, 41(4), 605-606. Bryce, S., Rowse, T., Scrimgeour, D. (2010). Evaluating the petrol-sniffing prevention programs of the Healthy Aboriginal Life Team (HALT). 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