Opiate addicts in and outside of treatment

180 Pages·2010·4.76 MB·English

Opiate addicts in and outside of treatment;
Different populations?
Opiaal verslaafden binnen en builen de drugshulpverlening:
Verschillende populaties?
Proefschrlft
Ter verkrijging van de graad van doclor aan de
Erasmus Universiteit Rotterdam op gezag van de
rector magnificus
prof.dr. P.W.C. Akkermans, M.A.
en volgens hel beslui! van he! college voor promoties
De open bare verdediging zal plaalsvinden op
woensdag 22 oklober 1997 om 13.45 uur.
door
Maria Anne Eland-Goossensen
geboren Ie Zwolle
ISBN 90-74234-9-4
No part of this book may be reproduced in any form or by any means without
permission of the author.
© M.A. Eland-Goossensen
September 1997
DWM drukkerij
Westeinde 2, 3146 BZ Maassluis
Tel: 0 I 0-591 0033
Promotle commlssle
Promotoren: Prof.dr. H.F.L. Garretsen
Prof.dr. W.J. Schudel
. Mw. dr. L.A.M. van de Goor
Overige led en: Prof.dr. P.J. van der Maas
Prof.dr. J. Passchier
Dr. G.M. Schippers
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I
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Voor mijn overleden oma's
Maria Jansen en Adriaantje Monster.
Zij zouden ook 9(8ag verder hebben ge/eerd,
maar zij hadden de tijdgeest legen zioh.

Contents
1. General Introduction 9
2. Study design, methods and materials 11
2.1 Opiate addicts in and outside of treatment: A combination of clinical and 12
field research
2.2 Heroin users without treatment 22
2.3 Snowball sampling applied among opiate addicts outside of the treatment 32
system
2.4 Supplement 45
3. Problems with drug use and problems In other life areas 47
3.1 Profiles of heroin addicts in different treatment conditions and outside of 49
treatment
3.2 Heroin addicts in and outside of treatment compared at severity of problems 64
and need for help
3.3 Drug use career and treatment history of opiate addicts in and outside 78
of treatment
4. Comorbld psychopathology 89
4.1 Opiate addicts in and outside of treatment compared on psychopathology 90
4.2 Drug use career and psychiatric history of opiate addicts with no, 105
moderate or severe psychiatric history
4.3 Screening for psychopathology in the clinical practice 119
5. Processes of addiction and help-seeking behaviour 129
5.1 Heroin addiction careers: downward spiral or controlled descent? 130
5.2 Factors that influence help-seeking behaviour of opiate addicts 143
5.3 Methadone supply in The Hague: clients'views 153
6. General conclusions and discussion 163
7. Summary 169
8. Samenvattlng 173
Dankwoord 177
Curriculum Vitae 179

Section J
1. General Introduction
The core of this study is related to the insight that the population of opiate addicls is quite
an invisible group. Some paris of this group can be identified at treatment institutions and in
prisons. However, a large pari of the opiate addicls is hard to detect. This is because their
illegal activities are often hidden and because many of them move frequently from one place
to another. Although some are easy to spot at public places, these are very hard to
approach for research.
For years stUdies have been performed in the different echelons. Researchers studied
criminal behavior of addicts in prison. Others analysed factors that influenced treatment
success of addicts in drug treatment settings. Again others described the life of the drug
using subculture by participant observation. Each data set was used to answer the specific
research questions and that was it. This study is a first step to a more holistic approach.
Separated pieces of information do not satisfy anymore. What is needed is comparable
information gained in all known subgroups of the population. Only in that way the most
complete view on opiate addiction can be reached. The next step is to repeat these
measurements in the different subgroups regularly. In that way a consequent monitoring of
the population will become possible, of which policy makers, clinicians and researchers will
benefit.
In this thesis characteristics of opiate addicts who apply for a methadone programme, a
clinical detoxification programme, a drug free therapeutic community and opiate addicts
outside of treatment are described. A comparison is made of the nature, severity and extent
of drug use and the accompanying medical, legal, employment, social and mental complex
of problems. On the basis of this comparison the following questions will be discussed:
Which factors are linked with the decision of opiate addicts to seek professional help? and
Which factors are linked with the choice for a specific type of treatment? The study design
and the results are presented in four sections, which are structured according to the central
research questions they provide answers for. Each section contains three chapters. Section
two describes the outline of the study and the methods used in detail. Section three
presents problems with drug use and accompanying problems. Section four focuses on
comorbid psychopathology (dual diagnosis). In section five processes of addiction and
help-seeking behaviour are discussed. The final section six contains the conclusions,
general discussion and a summary.
9
Study design, methods and materials
10