Drug Misuse: Prevention, harm minimization and treatment PDF
Preview Drug Misuse: Prevention, harm minimization and treatment
Drug Misuse Prevention, harm minimization and treatment JOIN US ON THE INTERNET VIA WWW, GOPHER, FTP OR EMAIL: WWW: http://www.thomson.com GOPHER: gopher.thomson.com ICDpE A service of FTP: ftp.thomson.com EMAIL: [email protected] Drug Misuse Prevention, harm minimization and treatment Jan Keene Senior Lecturer Applied Psychosocial Studies University of East Anglia Norwich IUlll SPRINGER-SCIENCE+BUSINESS MEDIA, BY Distributed in the USA and Canada by Singular Publishing Group Inc., 4284 41st Street, San Diego, California 92105 First edition 1997 © 1997 Jan Keene Originally published by Chapman & Hall in 1997 Typeset in 10/12 pt Palatino by Mews Photosetting, Beckenham, Kent ISBN 978-0-412-64280-7 ISBN 978-1-4899-3300-3 (eBook) DOI 10.1007/978-1-4899-3300-3 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act, 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the Copyright Licensing Agency in the UK, or in accordance with the terms of licences issued by the appropriate Reproduction Rights Organization outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed on this page. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made. A catalogue record for this book is available from the British Library § Printed on permanent acid-free text paper, manufactured in accordance with ANSI/NISO Z39.48-1992 and ANSI/NISO Z39.48-1984 (Permanence of Paper). For Bill, again. Contents Acknowledgements IX Introduction - why social and health care professionals should Xl know about drug misuse Part One An Introduction to Drug Misuse: Talking to Drug Misusers 1 1 The extent of drug misuse 3 2 Talking to recreational drug misusers 17 3 Talking to high-risk drug misusers 32 4 Talking to dependent drug misusers 56 5 Institutional drug misuse 82 Part Two Research and Practice: Talking to Professionals 91 6 Drug prevention and education 93 7 Harm minimization 124 8 Treatment 175 9 Institutional control 243 Part Three Practical Guidelines 253 10 A sequential helping process 255 11 Professional practice: skills and responsibilities 299 Appendix - A brief glossary of drugs 318 References 320 Index 343 Acknowledgements With thanks for data collection and conversation to Roger Duncan, Darren James, Norman Preddy, Helen Trinder and Hor and colleagues. Most of all, I would like to thank all the drug users who contributed. Introduction - why social and health care professionals should know about drug misuse At the time of writing (1996), it is apparent that drug misuse is becom ing far more widespread and diverse, among young people especially, than was ever imagined possible. This has profound practical implications for professionals in the health and social care fields. This situation is compounded by extensive media coverage contributing to misunderstanding, and unnecessarily complicating the health and welfare task. PROFESSIONAL NEEDS Studies in this field have identified a widespread need for information and skills. There is very little appropriate training for generic profes sionals in the social or health care fields (Galanter et al., 1989; Farrell, 1990; Harrison, 1992) and such training often lacks a cohesive theoreti cal approach (Gorman, 1993). Social and health care professionals report a lack of knowledge about drug misuse and the kinds of problems asso ciated with it. They are unsure how far they are equipped to deal with these problems and whether it is their job to do so. They do not know where to go for help and advice or where to refer clients. Despite this lack of confidence, the majority of health care and social welfare workers have (often without realizing it) a basic understanding of the problems associated with drug misuse and the practical skills necessary for work ing with drug misusers. This potential can only be utilized, however, if practitioners have an understanding of the different kinds of drug-related problems and knowledge of the relevance of their own skills and the range of back-up services available. This book is therefore designed, first, to give indepth understanding of recreational drug misuse, risky drug misuse and In this book, the term drug misuse is employed throughout to refer to the non-medical use of any drug that is intended only for use in medical treatment and the use of drugs that have no recognized or accepted medical purpose. xii Introduction dependence and, second, to inform about prevention, harm minimiza tion, treatment and control, in order that professionals can identify, assess and work with different kinds of drug misusers. It also aims to give information about the wide range of multidisciplinary and special ist professionals who can contribute in this field. BACKGROUND The ancient Greek word for drug has three meanings: a cure or remedy, a poison and a magical charm. This book will consider these meanings in the modern sense: drugs as medication and as a solution to problems; drugs as dangerous to health; and drugs as magical and hedonistic. In the recent past, policy and practice guidelines have often been based on a misunderstanding of the diversity and complexity of drug misuse. Professionals have confused different types of drug misuse and/ or attempted to compress all types into one narrowly defined cate gory, i.e. all drugs are good or bad. This is the first mistake: it is prefer able to go right back to the ancient Greeks and try to understand the range of different effects of drugs on different people. Practitioners first of all need to understand the complexity of drug misuse in order to develop realistic concepts and construct useful cate gories for assessment. After this, they are in a position to identify clearly the main risks and problems in the different categories and so to deter mine which type of intervention is most appropriate. They have three main sources of information about drug problems: first, there is a range of statistical information on different drug misusing populations; second, there are the results of academic research; and third, there is professional and clinical experience. Unfortunately, there are limitations to each of these three expert sources and each pro duces its own (often conflicting) 'evidence' about drug problems. There is, of course, one other source of information, not often explored and standing in even greater contrast to the other three - the views of the drug misusers themselves. These may be collected from a variety of sources but when they are looked at as a whole it becomes evident that they can be ordered into broad categories using common themes that emerge clearly on analysis. What is often regarded as an undifferen tiated form of behaviour, drug taking, and moreover one which defies any form of ordering because of the unpredictable patterns of misuse, can be seen in fact to fall into distinct groupings. It is no accident that these are recognized by the drug misusers when talking about them selves and about other people. It is not, of course, possible to explore all the different forms of drug misuse with equal thoroughness simply because the research evidence is far from complete. Moreover, there is great variation in the amount of Three different kinds of drug misuse xiii information that we have, very often for straightforward practical reasons. Drug misuse which occurs at raves or which is the reason for attendance at an agency is much easier to identify, describe and analyse than that which takes place as a solitary activity in the privacy of one's home. Our understanding of drug misuse must therefore inevitably be partial and if professionals are to practise in an informed manner, to wait for a fully comprehensive account is unrealistic. As our knowledge of drug misuse enlarges, it will be possible to expand our range of possible solutions to problems. In the meantime, we need to bear in mind con stantly that the research evidence provides only a series of glimpses into the enormous and complex area of drug misuse. There is, then, a need to understand drug misuse itself. This can be approached in different ways. In this book the first way is talking to drug misusers, that is, using qualitative research data to gain insight into, and understanding of, other people. This is then placed in the con text of statistical and scientific research in the field. This comprehensive understanding is in turn used as a foundation for building practically useful assessment procedures and appropriate practice methods. THREE DIFFERENT KINDS OF DRUG MISUSE: UNDERSTANDING THE DIFFERENT REASONS FOR USING DRUGS 1. Why do people experiment and then continue to misuse recreation ally (as in starting to drive cars and then learning to drive properly and to enjoy it)? People may initially do something frightening as a result of social pressure and peer influence but then, as with an acquired taste, learn to appreciate its intrinsic qualities. 2. Why do they continue to misuse in a dangerous way, despite the risk (as in driving when tired or incapable or beginning to race cars)? When the costs and risks become higher, the motivation for continu ing may be greater or qualitatively different. 3. Why do they continue to misuse when dependent/addicted (as in when cars and driving become the main priority and other things assume less importance)? There may be several reasons at once, from physical addiction and psychological dependence to a need for some remedy or self-medication for other problems. It is necessary to make a distinction here between problems which cause drug misuse (as a remedy) and problems arising from drug misuse itself, as the solutions will be determined accordingly. However, the abstract argument about which came first is as useful as arguing about chicken or egg: the relationship is best described as circu lar rather than in unidimensional causal terms, problems and drugs each contributing to some extent to each other.
The list of books you might like
