Hackensack New Jersey is a densely packed, lively city. From our windshield survey, we observed members of the community outside their apartment complexes, grocery stores, and around schools. Another focal point for the city is the hospital, where we observed hospital workers taking a break from work, or on their commute to work. The community members are visible, with a vast majority of them being hispanic, middle to older age. This may have been because at the time of our windshield assessment most children would be in school. The lack of children we saw can be positive, showing most of them are more than likely at school.
Most of the housing in Hackensack are apartment complexes. Also, there are stores aimed at lower income residents such as family dollar. With a majority of the housing being cramped apartment complexes and the lower income stores, Hackensack appears to be a lower economic city. The city of Hackensack has a well known, large hospital, Hackensack University Medical Center. This is a major health resource for the residents, with multiple services such as an emergency room, pediatric unit, and so on. Aside from the hospital, residents also have private practice health services available to them, such as Dr.Allen Sapadin dermatology, a dental office, and primary care services.
Transportation wise, there is a bus transit service available to members of the community. Within Hackensack we observed a fire station, police station, and ambulance system. Again, residents in Hackensack have more convenient access to health care, with the hospital being in their own town.
Hackensack is a vastly diverse community. The population is made up of 36.5% Hispanic, 29.3% white, 22.4% African American, 9.9% Asian and 1.3% multiracial (Data USA, 2016). The average age of a Native-born resident is 35.6 years old while it is 41.8 years old for a foreign born citizen (Data USA, 2016). The citizenship rate of Hackensack is 78.2% which is much lower than the national average of 93%. Due to the high rate of foreign born citizens there are several languages spoken in the area; Spanish, Tagalog, Hindi, Arabic and other Asian languages. 36% of residents speak another language other than English (Data USA, 2016).
Most of the foreign born citizens of Hackensack are from the Dominican Republic, Ecuador and Jamaica (Data USA, 2016). Hackensack has a large population of military personnel. There are 124 primary care physicians, 126 dentists, 200 mental health professionals and 38 other providers in Hackensack (Data USA, 2016). The average family has 1 car, drives about 30 minutes away to work and only 35.3% of residents own their homes in Hackensack (Data USA, 2016).
Substance Abuse is a problem in Hackensack. Every year about 10 people die from substance abuse according to the 2016 Community Health Needs Assessment Report of Hackensack University Medical Center. While in the entire state of New Jersey, 16 people die from opioid overdose each year (Data USA, 2016). 286 people admit to having a substance abuse problem (Substance Abuse overview, 2016). 37 residents use crack/cocaine, 82 used heroin, 54 used marijuana, 15 used other opiates, 19 abused alcohol and 3 are using unknown substances (Substance Abuse overview, 2016).
As previously stated, in our windshield study we saw that a majority of the housing in Hackensack consists of apartments. In a Data USA report, the national average percentage for homeownership is 63.6%. In Hackensack, the homeownership rate is only 35.3% (Data USA, 2016). This shows that the housing demographics we observed during our windshield study correlate with the statistical demographic found.
As well, we observed that there are many healthcare facilities throughout Hackensack. There are various different healthcare opportunities available. Specifically, there are multiple substance abuse treatment program in Hackensack. We passed by the Bergen County Department of Health Services. This company houses an addiction recovery program. This was one of the treatment centers we drove by. However, through research, we found that there are five substance abuse treatment centers in Hackensack. As well, there are many more in the surrounding areas (SAMHSA, 2016).
Hackensack, New Jersey is rapidly becoming a town that greatly contributes to the drug epidemic we so commonly see today. Hackensack has a population of 44,271 residents, with 67% above the age of 29. (U.S Census Bureau,2016). A 2016 substance abuse overview report found that 37 residents used crack/cocaine, 82 used heroin, 15 used other opiates, 54 used marijuana, and 91 abused alcohol (Substance Abuse overview, 2016). That makes for a total of 286 residents involved with substance abuse (substance abuse overview, 2016).
Hackensack New Jersey has a higher number of abusers than the surrounding areas, where the number of abusers may not even hit double digits. Another important aspect to keep in mind is the fact that there are likely abusers who are not on record. Since Hackensack has such a higher amount of abusers than the surrounding cities, it is a city that needs focus, resources, and drive for a safer, clean, and drug free community.
Hackensack has many residents living in poverty. Residents living in poverty may not have access to proper drug resistance education, drug rehabilitation, and other similar sources. This makes the 14% living in poverty susceptible to drug abuse, and makes it more difficult to get help for the substance abuse (Data USA, 2016). The homeownership rate is 35.3%, dramatically lower than the national rate of 63.6% (Data USA, 2016). This means many residents may not have a stable home to rehabilitate, grow, and flourish in.
Based upon our community assessment, Hackensack, New Jersey has a very concerning problem with substance abuse. Substance abuse has many consequences. It may lead to secondary conditions, multiple hospitalizations, loss of employment or social supports, and unfortunately, death (Serenity, 2018). Within this community, substance abuse is an extremely challenging health concern that requires attention and intervention.
In a 2016 Community Health Needs Assessment Report completed by Hackensack University Medical Center, researchers asked key informants if they viewed substance abuse as a problem in their community; 52.9% identified it as a major problem (CHNA Report, 2016). As well, many of the key informants disclosed that their lives have been negatively affected by substance abuse. Not only do those in power, but many members of the community, view substance abuse as a community health problem in their area.
In Hackensack, New Jersey, a major health problem is hospitalization and/or death related to substance abuse. A major aspect of substance abuse relates to hesitation towards or lack of access to treatment. In Hackensack University Medical Center’s Community Health Needs Assessment, respondents were asked whether they ever sought professional help for an alcohol or drug related problem. The results displayed that very few subjects, less than 3%, had reached out for help (CNHA, 2016). There are many causes that may contribute to this lack of seeking treatment, which lead to the negative consequences of substance abuse.
A major factor contributing to lack of treatment to prevent complications of substance abuse includes cost and insurance-related issues. A social services provider explained how many detox and treatment facilities do not have many available beds for those without insurance (CNHA, 2016). This has a strong effect on treatment, because the New Jersey Substance Abuse Monitoring System identified 951 people, or 36%, lacked health insurance (Substance Abuse Overview, 2016). As well, even with the population of insured community members, insurance plans may only cover a limited amount of substance abuse treatment, leading to inadequate treatment of addiction.
Another factor that contributes to inadequate management of substance abuse is the lack of health education on substance abuse and treatment. From the younger population, up through older age adults, many are inadequately educated on prevention, recognition, and treatment of substance abuse. Without the proper tools to prevent addiction from forming, and recognizing when addiction of occuring, many people or their loved ones, can quickly become affected by substance abuse.
Typically, people may receive the most substance abuse education while in high school. Only around 40% of those admitted for substance abuse issues had attended high school or some college (Substance Abuse Overview, 2016). Without attending high school, these respondents may not have received the mandatory substance abuse education that most students learn during high school. This may have contributed to their lack of knowledge on the details and impacts of substance abuse. In the 2017 American Community Survey, Hackensack was cited as having a 12% high school dropout rate (Town Charts, 2018). Therefore, with this rate of dropouts, it may correlate with the increasing number of those affected by substance abuse.
Continuing, there may be lack of education on substance abuse treatment available to those in Hackensack. A social services provider and a community leader disclosed that most people don’t know of the resources available to them, or how to access treatment in their area (CHNA, 2016). According to the Substance Abuse and Mental Health Services Administration, within 5 miles of the center of Hackensack, NJ, there are multiple substance abuse treatment specialists and/or centers (SAMHSA). However, even with these resources available, people may not know about them, or how to access them. As well, there can be barriers like lack of transportation to these facilities. If people were educated on their options, they would have much easier access to treatment, and more people would probably be able to be adequately treated.
Lastly, another contributing factor to the problem of substance abuse is the associated stigma. Stigma contributes to avoidance and denial of the problem (CNHA, 2016). In today’s society, mostly everyone has a personal connection to someone who is affected by substance abuse. Very often, this issue is kept a secret within families. Many people with substance abuse problems may be hesitant to seek treatment due to fear of consequences from the stigma against substance abuse. Substance abuse stigma may result in unemployment, negative interpersonal relationships, shame, lack of support, etc. (Luoma et al., 2007). A study investigating the role of stigma in substance abuse treatment revealed that many people suffering hid their addiction from others in order to avoid the negative outcomes (Luoma et al., 2007). If people were able to openly disclose their substance abuse issues to others, it may improve their willingness to seek treatment and the success of that treatment. An un-stigmatized support system may be beneficial to those in need of substance abuse treatment.
A strategy of primary prevention that can be implemented to decrease the consequences resulting from substance abuse is through education. The education will be targeted at younger populations, specifically in middle and high school. This is because, according to the World Health Organization, primary prevention for substance abuse entails preventing the substance abuse from ever occurring (WHO, 2018). Therefore, adequate education about drug use and the terrible consequences should be provided in schools, to deter them from using substances. As well, this education should include strategies and tips on avoiding peer pressure, which may further assist in the choice to not abuse drugs. The National Academy of Sciences explained that the classroom-based education should include skills for social resistance, involve active participation, positive knowledge and attitudes towards substance abuse, and emphasizing the norms for not using substances (SAMHSA, 2016). Having this mandatory education in schools can help students to develop responsible and healthy behaviors that may make them less likely to develop substance abuse problems.
It is important that these substance abuse education programs are taught efficiently. In the past, substance abuse prevention programs focused on using scare tactics. It has since been found that these programs tend to be ineffective. Programs were more effective when they were based off of theory, and took into account all the factors that may precipitate abusing drugs.
For immediate evaluation of effectiveness of our substance abuse education within schools, we would evaluate if the teaching was successful. To do this, we could test the students’ knowledge through a written evaluation with questions about potential scenarios they may encounter. As well, we could have the students act out and partake in mock situations where they may encounter drugs, or be pressured to use drugs. This would help us to determine if the students truly know how to put their newly learned knowledge into action.
Secondary prevention is screening and identifying substance abuse early in the addiction cycle. This screening would occur as young as elementary age, to determine if a child needs early education and support to prevent substance abuse. The goal of screening at a young age is to prevent a potential future drug addiction. If a child has grown up around substance abuse, that child would be likely to continue a life of substance abuse themselves. Sometimes they turn away. Everyone should receive education on substance abuse. It should be part of health education in the school system. Some screening would also be suggested for adolescent to older adults. The goal of screening later in life would be to uncover a developing addiction, and provide resources for sobriety before the addiction becomes more severe. Evaluation of this screening strategy would be weather or not at risk children developed an addiction, and if those in the early stages of addiction were able to get sober.
A study done by Stanford school of Medicine recognized that there are a lot of individuals with drug abuse disorders who are underdiagnosed and undertreated. This study evaluated the effectiveness of the screening tool DAST. This study affirms that “drug screening instruments can help to identify individuals with drug use disorders and problems and to facilitate their treatment” (Leyva, 2017). The DAST is an open ended formated screening, asking questions such as “How many days in the past 12 months have you used drugs other than those required for medical reasons?”. Using open ended questions instead of yes/no allows for this screening to obtain more specific information from each participant. This study found the DAST was 97% sensitive and 91% specific for drug use disorders (Leyva, 2017). The DASt was sensitive to gender, age, race/ethnicity, marital status, educational level, and PTSD status (leyva, 2017).
Using the DAST-2 drug screening tool for adolescents to older adults would be effective in Hackensack. It obtains not only details of the drug abuse, but also the demographics of the drug abuser. This screening would pinpoint those who need the help most, since it asks specifically the amount, type, and time of the drug use. Those who are more severe can be picked and focused on more heavily for tertiary treatment. The DAST-2 could also apply for children. Those adolescents and older adults whom are found to have a drug abuse issue may also have children. Their children may be offered screening for how much of this abuse they see at home, and if it is severe, the child can be offered tertiary support to avoid following into the drug abusers habit.
The goal of tertiary level care is to help the client become a healthy, active individual in society and reduce complications of drug abuse. The objectives are to limit the feeling of withdrawal, limit cravings and use of drugs. This is done in a facility where the client can have support groups, relapse and prevention support and health restoring programs. These facilities also screen for health problems related to the substance abuse. The steps to take to accomplish this goal are to educate the public, provide resources on substance abuse and provide support during hospitalizations/death. The Bergen County Department of Health has a recovery program.
To evaluate the effectiveness of our strategies, but over a longer time period, we would have to compare the statistical data on substance abuse within Hackensack. The 2016 resources like the Department of Human Services’ Substance Abuse Overview and the Community Health Needs Assessment should be re-evaluated in later years to determine if there are decreases in the amount of people that have been hospitalized for substance abuse-related complications, overdoses, and deaths.
