"It was like a huge weight had been lifted off my shoulders. I could see other people getting and staying off the drugs, so there was no reason why I couldn’t do it. That day was a turning point for me."
Monday 28 July 2008
A journey into and out of heroin addiction - Part 4
In this briefing we have the concluding part of Lydia's journey. A second attempt at treatment seems to helping Lydia to make headway into her recovery from addiction and to finally start being the person she wants to be.
Monday 21 July 2008
A journey into and out of heroin addiction - Part 3
Life for lydia has got a lot worse since part 2. In this briefing we follow Lydia's life as it spirals down into prostitution and crack addiction. Her first foray into treatment has failed and things just seem to be getting worse and worse for her.
"I felt like I had been failed. I had put everything into treatment and trying to change, but nothing had worked. I couldn’t really see any way forward – I felt trapped in a vicious cycle. That was until I met a friend who told me about the amount of money I could make working on the streets."
Wednesday 2 July 2008
A journey into and out of heroin addiction - Part 2
In my last Background Briefing, we began the story of Lydia’s journey into addiction. In this Briefing, we hand over to the imaginary character of Lydia, to explain how addiction took control of her life, and her first experiences of treatment.
“Trying to juggle being in treatment and getting enough money for my heroin habit was really difficult. My days were taken up with being at the treatment centre, so I had to take risks to get money in the evenings. It was becoming increasingly difficult, but I couldn’t see a way out. I felt like I was losing even more control of my life.”
“Trying to juggle being in treatment and getting enough money for my heroin habit was really difficult. My days were taken up with being at the treatment centre, so I had to take risks to get money in the evenings. It was becoming increasingly difficult, but I couldn’t see a way out. I felt like I was losing even more control of my life.”
Friday 27 June 2008
A journey into and out of heroin addiction
In this briefing I decided to use a fictitious character's life as the viewpoint to learn about addiction, as I feel it is important to look at the nature of the problem with which we are dealing.
'Addiction is a multi-faceted problem, involving psychological, biological and sociological aspects. Addiction is about people’s lives. It is about their substance-using careers. There are an infinite number of pathways in to and out of addiction. Here, I start to look at one person’s life, an imaginary life drawn from the lives of many people I have met or heard about. In later Briefings, we will consider what we can learn from Lydia’s life as a heroin addict, and as a recovering/recovered heroin addict, in order to help other people.'
A letter to a friend
In this briefing, I describe my thoughts about my change of career to an old neuroscience friend in America.
'I remember our times together in the neuroscience field very fondly. It was great! However, as you know, the time came when I felt I was not doing what I wanted to do – help people. Despite what I had achieved, and the great talk I could give on addiction and the brain, I felt that my work – and that of most other neuroscientists – was not actually helping people overcome substance use problems. I certainly made the right decision to leave neuroscience! I’m now in a fascinating field and I know that I am doing something that will contribute to helping people, albeit indirectly.'
Wednesday 21 May 2008
Nature of the problem: Addiction as a chronic disorder (part 3)
In this Briefing, it is emphasised that we must be careful how we communicate the message about the chronic nature of addiction.
‘Appropriate treatment for chronic addiction is not simply a succession of short term detoxifications or treatment stays. Appropriate continuing care requires personal commitment to long term change, dedication to self management, community and family support and monitoring.’
‘Appropriate treatment for chronic addiction is not simply a succession of short term detoxifications or treatment stays. Appropriate continuing care requires personal commitment to long term change, dedication to self management, community and family support and monitoring.’
Nature of the problem: Addiction as a chronic disorder (part 2)
In this Briefing, we continue to focus on a major problem: while addiction resembles other chronic disorders, society uses an acute model of care for treatment.
The striking similarities between severe substance use problems and chronic medical disorders do not imply that similar disease processes underlie these disorders. However, it does strongly suggest that we should be using chronic or continuing care strategies for substance addiction that resemble those used for other chronic medical disorders.
‘Importantly, the acute care model sets the field (and individuals) up to fail. This erodes long-term societal confidence in addiction treatment as a social institution.’
The striking similarities between severe substance use problems and chronic medical disorders do not imply that similar disease processes underlie these disorders. However, it does strongly suggest that we should be using chronic or continuing care strategies for substance addiction that resemble those used for other chronic medical disorders.
‘Importantly, the acute care model sets the field (and individuals) up to fail. This erodes long-term societal confidence in addiction treatment as a social institution.’
Tuesday 29 April 2008
Nature of the Problem: Addiction as a chronic disorder
In the next set of Briefings, we look at the time course of addiction and how it influences the way that we should be building systems, including for the delivery of treatment, that help people find recovery. In this first Briefing, we look at acute and chronic disorders and how they are managed in today’s medical world.
‘The terminology used to describe addiction can be influential in a variety of ways. It can shape people’s attitudes towards whether they can overcome addiction, shape the way we deliver treatment and the way we help people along the path to recovery, and influence society’s attitudes towards people with substance use problems.’
‘The terminology used to describe addiction can be influential in a variety of ways. It can shape people’s attitudes towards whether they can overcome addiction, shape the way we deliver treatment and the way we help people along the path to recovery, and influence society’s attitudes towards people with substance use problems.’
Along the Route to Recovery: Choosing the form of help required to change behaviour
In this Briefing we look at some of the factors that are likely to influence decisions about what route to recovery a person chooses to pursue.
‘Once a person has made a decision to attempt to change, the ways they approach this objective must start from their knowledge about how to change and what assistance might be available.’
‘Once a person has made a decision to attempt to change, the ways they approach this objective must start from their knowledge about how to change and what assistance might be available.’
Treatment of Substance Use Problems: Reflections (Part 2)
This Briefing continues our reflections on the treatment of substance use problems.
‘There are many different ways that people overcome addiction, and no two people take identical pathways to recovery.’
‘There are many different ways that people overcome addiction, and no two people take identical pathways to recovery.’
Treatment of Substance Use Problems: Reflections (Part 1)
This Briefing reflects on a variety of aspects related to treatment of substance use problems.
‘People present for treatment, advice and support at various stages of their substance using career. Therefore, treatment agencies need to be able to respond to a variety of different situations that may involve different interventions.’
‘People present for treatment, advice and support at various stages of their substance using career. Therefore, treatment agencies need to be able to respond to a variety of different situations that may involve different interventions.’
Recovery and Communities of Recovery (Part 4)
This Briefing concludes our look at the definition and conceptual boundaries of ‘addiction recovery’.
‘Recovery is the experience (a process and a sustained status) through which individuals, families, and communities impacted by severe alcohol and other drug (AOD) problems utilise internal and external resources to voluntarily resolve these problems, heal the wounds inflicted by AOD-related problems, actively manage their continued vulnerability to such problems, and develop a healthy, productive, and meaningful life.’
‘Recovery is the experience (a process and a sustained status) through which individuals, families, and communities impacted by severe alcohol and other drug (AOD) problems utilise internal and external resources to voluntarily resolve these problems, heal the wounds inflicted by AOD-related problems, actively manage their continued vulnerability to such problems, and develop a healthy, productive, and meaningful life.’
Recovery and Communities of Recovery (Part 3)
During this Background Briefing we look at the definition and conceptual boundaries of ‘addiction recovery’.
‘Is someone who has overcome heroin addiction, but still smoking cigarettes, in recovery?’
‘Is someone who has overcome heroin addiction, but still smoking cigarettes, in recovery?’
Recovery and Communities of Recovery (Part 2)
This Background Briefing looks at recovery and treatment.
We look at the work of William White, author of one of the truly great books in this field, Slaying the Dragon: The History of Addiction Treatment and Recovery in America.
‘Treatment is a tool, albeit a valuable one for many people, not an end in its own right.’
We look at the work of William White, author of one of the truly great books in this field, Slaying the Dragon: The History of Addiction Treatment and Recovery in America.
‘Treatment is a tool, albeit a valuable one for many people, not an end in its own right.’
Recovery and Communities of Recovery (Part 1)
This Briefing continues to look at recovery, this time introducing the writings of William White and colleagues in the US.
‘… in the field today we tend to be very problem-focused, rather than what we should be, solution-focused.’
‘… in the field today we tend to be very problem-focused, rather than what we should be, solution-focused.’
Helping People Towards Recovery
This Background Briefing describes the skills, values, and knowledge that workers need to facilitate recovery in people seeking help for mental health problems. We point out that this research provides insights that can help improve treatment standards in our field.
‘…recovery is an individual process, with the person themselves defining what living well means to them. Recovery is not an endpoint, but an ongoing process of growth, discovery, and change.’
‘…recovery is an individual process, with the person themselves defining what living well means to them. Recovery is not an endpoint, but an ongoing process of growth, discovery, and change.’
Heroin Overdose (Part 3)
This Briefing continues to look at various ways of reducing the number of heroin overdoses and overdose deaths, and looks at the responsibility that we all share in trying to do this.
‘Police should not attend a non-fatal overdose unless essential’
‘Police should not attend a non-fatal overdose unless essential’
Heroin Overdose (Part 2)
In the second of three articles on heroin overdose, this Briefing considers various ways to reduce the number of heroin overdoses and overdose deaths, and looks at the responsibility that we all share in trying to do this.
‘We know from considerable research in the health field that telling someone something helpful does not necessarily change attitudes, and changing attitudes does not necessarily change behaviour.’
‘We know from considerable research in the health field that telling someone something helpful does not necessarily change attitudes, and changing attitudes does not necessarily change behaviour.’
Heroin Overdose (Part 1)
As Part 1 of this series on heroin overdose, this Briefing summarises some of the main research findings focusing on the incidence and possible causes of heroin overdose.
“Another counterintuitive finding is that at autopsy a large proportion of overdose fatalities have relatively low blood morphine concentrations…”
“Another counterintuitive finding is that at autopsy a large proportion of overdose fatalities have relatively low blood morphine concentrations…”
What the Science Shows, and What We Should Do About It (Part 5)
This Briefing completes the main recommendations from a major new book based on the views of America’s leading clinicians and researchers of how treatment would look if it were based on the best science possible.
‘An unsuccessful outcome is a failure of treatment, not the person, and warrants trying a different approach.’
‘An unsuccessful outcome is a failure of treatment, not the person, and warrants trying a different approach.’
What the Science Shows, and What We Should Do About It (Part 4)
This Background Briefing continues to describe the main recommendations from a major new book based on the views of America’s leading clinicians and researchers of how treatment would look like if it were based on the best science possible.
‘Substance use problems must be understood and addressed in the larger context of personal and social issues.’
‘Substance use problems must be understood and addressed in the larger context of personal and social issues.’
What the Science Shows, and What We Should Do About It (Part 3)
This Briefing continues to describe the main findings and recommendations from a major new book based on the views of America’s leading clinicians and researchers of how treatment would look if it were based on the best science possible.
‘The clients of counselors who are higher in warmth and accurate empathy show greater improvements in substance use problems. As early as the second session, clients’ ratings of their working relationship with the counselor are predictive of treatment outcome.’
‘The clients of counselors who are higher in warmth and accurate empathy show greater improvements in substance use problems. As early as the second session, clients’ ratings of their working relationship with the counselor are predictive of treatment outcome.’
What the Science Shows, and What We Should Do About It (Part 2)
In this Briefing we continue to describe the main findings and recommendations from a major new book based on the views of America’s leading clinicians and researchers of how treatment would look like if it were based on the best science possible.
‘It appears that actively doing something toward change may be more important than the particular actions that are taken. The traditional wisdom that, ”It works if you work it” appears to be true of many routes to change.’
‘It appears that actively doing something toward change may be more important than the particular actions that are taken. The traditional wisdom that, ”It works if you work it” appears to be true of many routes to change.’
What the Science Shows, and What We Should Do About It (Part 1)
This Briefing starts to describe the main findings and recommendations from a major new book based on the views of America’s leading clinicians and researchers of what treatment would look like if it were based on the best science possible.
‘Most people who recover from drug problems do so on their own, without formal treatment. The stages and processes of such “natural” change are indistinguishable from those that occur with treatment, and are common across the spectrum of problem severity. In this sense, effective interventions facilitate and perhaps speed natural change processes.’
‘Most people who recover from drug problems do so on their own, without formal treatment. The stages and processes of such “natural” change are indistinguishable from those that occur with treatment, and are common across the spectrum of problem severity. In this sense, effective interventions facilitate and perhaps speed natural change processes.’
Some of My Favourite Reads (Part 3)
This Briefing concludes the perusal of my bookshelves to describe more interesting books in the field.
‘Once again, I am going to tease you with a wide range of material.’
‘Once again, I am going to tease you with a wide range of material.’
Theories of Cravings and Urges
This Background Briefing describes craving and urges for drugs and alcohol, and briefly outlines some of the underlying theories.
“It [craving] can vary in intensity, sometimes reaching a level that can overwhelm the individual in totality, dominating the thoughts, feelings and actions of the individual to the exclusion of all else.”
“It [craving] can vary in intensity, sometimes reaching a level that can overwhelm the individual in totality, dominating the thoughts, feelings and actions of the individual to the exclusion of all else.”
Stages and Processes of Change (Part 3)
This Briefing completes a look at the Transtheoretical Model of Change by considering the different dimensions of change and their interactions.
“In fact, effective change depends on doing the right things (using the right processes) at the right time.”
“In fact, effective change depends on doing the right things (using the right processes) at the right time.”
Stages and Processes of Change (Part 2)
In this Background Briefing we continue a description of the Transtheoretical Model of Change, focusing on the cognitive and behavioural activities that facilitate change. The extent to which each of these processes is used depends on what state of change the person who has a problematic behaviour has reached.
“However, punishment is rarely used by people who change themselves or by therapists, since it neither leading to lasting change nor is ethical. Rewards are often used successfully to change behaviour.”
“However, punishment is rarely used by people who change themselves or by therapists, since it neither leading to lasting change nor is ethical. Rewards are often used successfully to change behaviour.”
Stages and Processes of Change (Part 1)
This Briefing begins a description of a major influential model in the field, the Transtheoretical Model of Change, developed by James Prochaska, Carlo DiClemente and their colleagues.
“Prochaska and colleagues proposed that change comprises a series of six stages that “takes place over time and entail a series of tasks that need to be completed before progressing to the next stage.”
“Prochaska and colleagues proposed that change comprises a series of six stages that “takes place over time and entail a series of tasks that need to be completed before progressing to the next stage.”
Social Learning and Coping Models (Part 2)
This Briefing continues a look at the social learning model of substance use and misuse, focusing on self-efficacy, another key element of SLT. Self-efficacy is the level of an individual’s confidence in their ability to organise and complete actions that lead to particular goals.
“The self-efficacy of a person who has developed problematic drinking following long-term use of alcohol to cope with life’s stressors is likely to have been badly affected by the excessive drinking, so they are even less likely to feel confident about using alternative coping strategies when faced with stressful situations.”
“The self-efficacy of a person who has developed problematic drinking following long-term use of alcohol to cope with life’s stressors is likely to have been badly affected by the excessive drinking, so they are even less likely to feel confident about using alternative coping strategies when faced with stressful situations.”
Social Learning and Coping Models (Part 1)
During this Briefing we look at the relevance of social learning and coping models to our understanding of substance use and misuse.
Social Learning Theory (SLT), developed by Albert Bandura in the mid-1970s, has impacted strongly in this field. In essence, SLT describes the effect of cognitive processes on goal-directed behaviour. It considers the human capacity for learning within a social environment through observation and communication.
“For example, learning to drink occurs as part of growing up in a particular culture in which the social influences of family, peers and popular media shape the behaviours, expectancies and beliefs of young people concerning alcohol.”
Social Learning Theory (SLT), developed by Albert Bandura in the mid-1970s, has impacted strongly in this field. In essence, SLT describes the effect of cognitive processes on goal-directed behaviour. It considers the human capacity for learning within a social environment through observation and communication.
“For example, learning to drink occurs as part of growing up in a particular culture in which the social influences of family, peers and popular media shape the behaviours, expectancies and beliefs of young people concerning alcohol.”
Conditioning Models of Addiction (Part 3)
This Briefing describes how stimuli associated with the pleasurable effects of drugs can strongly influence behaviour.
“‘Wanting’ is not ‘liking’ - a person may strongly want a drug without actually liking the experiences that it produces.”
“‘Wanting’ is not ‘liking’ - a person may strongly want a drug without actually liking the experiences that it produces.”
Conditioning Models of Addiction (Part 2)
In this Briefing we look at the role of classical conditioning in substance use and addiction, considering conditioned withdrawal, conditioned drug-opposite responses and conditioned tolerance, and conditioned drug-like responses.
“If the person were to attend a school play one evening, without going to the pub, their body’s compensatory mechanisms would come into play but not be diminished by the physiological effects of alcohol. The person would experience the opposite subjective effects to those produced by alcohol, i.e. anxiety.”
“If the person were to attend a school play one evening, without going to the pub, their body’s compensatory mechanisms would come into play but not be diminished by the physiological effects of alcohol. The person would experience the opposite subjective effects to those produced by alcohol, i.e. anxiety.”
Conditioning Models of Addiction (Part 1)
This Briefing describes the processes of operant and classical conditioning, as well as positive and negative reinforcement, and looks at how they are involved in problematic substance use and addiction.
“… in this model, addiction can be viewed as involving the “development of a habitual behaviour pattern that is independent of any conscious evaluation that might be taking place about the costs and benefits of the behaviour.”
“… in this model, addiction can be viewed as involving the “development of a habitual behaviour pattern that is independent of any conscious evaluation that might be taking place about the costs and benefits of the behaviour.”
The Disease Model of Addiction
In the next Background Briefings, we look at theories of addiction, beginning with the disease model. This model is central to the philosophy of Alcoholics Anonymous (AA) and the 12-step Minnesota Model.
“At the heart of this model or theory is that addiction is characterised by a person’s inability to reliably control his use of alcohol or drugs, and an uncontrollable craving or compulsion to drink alcohol or take drugs.”
View Briefing.
“At the heart of this model or theory is that addiction is characterised by a person’s inability to reliably control his use of alcohol or drugs, and an uncontrollable craving or compulsion to drink alcohol or take drugs.”
View Briefing.
Some of My Favourite Reads (Part 2)
This second Briefing continues my perusal of my book shelves and describes some of my other favourite reads in the field.
“I hope that my selection both inspires you and helps you in your work.”
“I hope that my selection both inspires you and helps you in your work.”
Some of My Favourite Reads (Part 1)
I decided to do two Briefings to share with readers some of the books in the field that I have most enjoyed.
“… and no, I haven’t cut a special deal with authors, publishers or Amazon!”
View Briefing.
“… and no, I haven’t cut a special deal with authors, publishers or Amazon!”
View Briefing.
Saturday 26 April 2008
The Drug Experience: Heroin (Part 10)
This Briefing concludes our look at the seminal research from the 1980s which involved interviews with people who had recovered from heroin addiction without treatment.
“Ultimately, the self identity and perspective as an addict can become so deemphasized and distant that cravings for the addictive drug become virtually nonexistent. For all practical purpose, the addict can be said to have recovered.”
“Ultimately, the self identity and perspective as an addict can become so deemphasized and distant that cravings for the addictive drug become virtually nonexistent. For all practical purpose, the addict can be said to have recovered.”
The Drug Experience: Heroin (Part 9)
In this Briefing we continue to look at Patrick Biernacki’s research, which involved interviews with 101 people who had recovered from heroin addiction without treatment.
People who have been addicted to heroin report experiencing cravings for the drug long after they have given up using. Many people who have relapsed and gone back to using the drug after a period of abstinence attribute their relapse to their cravings for the drug.
“Thus, when people experienced heroin cravings, they “reinterpreted their thoughts about using drugs by placing them in a negative context and supplanted them by thinking and doing other things.”
People who have been addicted to heroin report experiencing cravings for the drug long after they have given up using. Many people who have relapsed and gone back to using the drug after a period of abstinence attribute their relapse to their cravings for the drug.
“Thus, when people experienced heroin cravings, they “reinterpreted their thoughts about using drugs by placing them in a negative context and supplanted them by thinking and doing other things.”
The Drug Experience: Heroin (Part 8)
This Briefing continues to look at the research of Patrick Biernacki in the mid-1980s showing that people can recover from heroin addiction without treatment.
“The social relationships, interests and investments that develop in the course of abstinence reflect the gradual emergence of new identities and corresponding new perspectives. Now the abstaining individuals know what they do not want to do but also what they would like to do and become.”
“The social relationships, interests and investments that develop in the course of abstinence reflect the gradual emergence of new identities and corresponding new perspectives. Now the abstaining individuals know what they do not want to do but also what they would like to do and become.”
The Drug Experience: Heroin (Part 7)
Many people believe that if you try heroin, then you are on the path to ruin. They consider that addiction to heroin is inevitable, and the route to being drug-free again is extremely difficult, if not impossible. Many treatment professionals believe that it is essential that a person who becomes dependent on heroin has treatment to recover.
During this Background Briefing we look at the research of Patrick Biernacki in the mid-1980s, which shows that people can recover from heroin addiction without treatment.
“Thus, few, if any stories circulate in the addict world about people who have succeeded in their voluntary efforts to stop further opiate use.”
During this Background Briefing we look at the research of Patrick Biernacki in the mid-1980s, which shows that people can recover from heroin addiction without treatment.
“Thus, few, if any stories circulate in the addict world about people who have succeeded in their voluntary efforts to stop further opiate use.”
The Drug Experience: Heroin (Part 6)
This Briefing continues to look at the process of recovery from dependent drug use, as described in seminal research by James McIntosh and Neil McKeganey.
Nearly all the interviewees described previous attempts at trying to stop taking drugs which ended in failure. These failed attempts are not simply a waste of time and they may play a significant role in the process of recovery.
“One of the reasons why the transition is so difficult is because the individual has to get used to an almost entirely different way of life. The drug using lifestyle has provided much of the meaning, structure and content of the person’s life, often for many years, then all of a sudden it is gone and something has to take its place.”
Nearly all the interviewees described previous attempts at trying to stop taking drugs which ended in failure. These failed attempts are not simply a waste of time and they may play a significant role in the process of recovery.
“One of the reasons why the transition is so difficult is because the individual has to get used to an almost entirely different way of life. The drug using lifestyle has provided much of the meaning, structure and content of the person’s life, often for many years, then all of a sudden it is gone and something has to take its place.”
The Drug Experience: Heroin (Part 5)
During this Background Briefing we start to look at the process of recovery from dependent drug use, as described in seminal research by James McIntosh and Neil McKeganey.
“… the theme that dominated their interviewees’ accounts “is their concern to recapture a sense of value and self-respect; in other words, a desire to regain a positive self. Whereas earlier attempts to abstain tend to be utilitarian in nature and geared to achieving a particular practical outcome – such as getting one’s partner to return or avoiding losing one’s children – what characterises the successful attempt is a fundamental questioning and rejection of what one has become, together with a desire and resolution to change.”
“… the theme that dominated their interviewees’ accounts “is their concern to recapture a sense of value and self-respect; in other words, a desire to regain a positive self. Whereas earlier attempts to abstain tend to be utilitarian in nature and geared to achieving a particular practical outcome – such as getting one’s partner to return or avoiding losing one’s children – what characterises the successful attempt is a fundamental questioning and rejection of what one has become, together with a desire and resolution to change.”
The Drug Experience: Heroin (Part 4)
This Briefing continues to describe the experiences of heroin users who have their lives seriously affected by their drug use, looking at how they live with their addiction.
Many users report how their behaviour and personality changed during their drug-using days. They often felt that they acted very out of character.
“You’ve got no boundaries, which is wrong. And you lose all of your emotions, you know. You don’t feel guilty, it’s just, ‘Me, me, me, I want that, I need that’, and you don’t think of others, what it does to others.”
Many users report how their behaviour and personality changed during their drug-using days. They often felt that they acted very out of character.
“You’ve got no boundaries, which is wrong. And you lose all of your emotions, you know. You don’t feel guilty, it’s just, ‘Me, me, me, I want that, I need that’, and you don’t think of others, what it does to others.”
The Drug Experience: Heroin (Part 3)
During this Background Briefing we continue to describe the experiences of heroin users who have their lives seriously affected by their drug use, focusing on heroin withdrawal.
“There’s no sign that says, ‘you’re now entering addiction’, there’s no big sign that says, ‘you’ll need to stop now, if you go once more that’s you’. You just cross that line and you don’t realise you’ve crossed it until you try to stop. I didn’t think about withdrawal symptoms or anything like that ‘cos I always had access to money.”
“There’s no sign that says, ‘you’re now entering addiction’, there’s no big sign that says, ‘you’ll need to stop now, if you go once more that’s you’. You just cross that line and you don’t realise you’ve crossed it until you try to stop. I didn’t think about withdrawal symptoms or anything like that ‘cos I always had access to money.”
The Drug Experience: Heroin (Part 2)
In this Briefing, we start to describe the experiences of people whose lives are seriously affected by heroin. The experiences are based on those described in the seminal book “Beating the Dragon” by James McIntosh and Neil McKeganey, and our own research with clients on the Peterborough Nene Drug Interventions Programme.
“The most frequently cited reasons for trying heroin are curiosity and a desire to comply with the expectations of others, particularly of a peer group. However, there is little indication that heroin users are pressurised to take the drug for the first time – the vast majority feel that they have made their own decision.”
“The most frequently cited reasons for trying heroin are curiosity and a desire to comply with the expectations of others, particularly of a peer group. However, there is little indication that heroin users are pressurised to take the drug for the first time – the vast majority feel that they have made their own decision.”
The Drug Experience: Heroin (Part 1)
During this Background Briefing we set the scene for forthcoming Briefings on the heroin experience. We emphasise the necessity to consider the role of drug, set and setting when considering the impact heroin has on lives.
“It is a drug that is so controversial that when two Scottish researchers published a paper that identified 126 long-term heroin users in Glasgow who were not experiencing the health and social problems normally associated with the drug, there was an outcry from certain circles. Some people considered it irresponsible that such research was published.”
“It is a drug that is so controversial that when two Scottish researchers published a paper that identified 126 long-term heroin users in Glasgow who were not experiencing the health and social problems normally associated with the drug, there was an outcry from certain circles. Some people considered it irresponsible that such research was published.”
The Drug Experience: Cocaine (Part 3)
In this Briefing we conclude our examination of the seminal study by Dan Waldorf and colleagues on heavy cocaine use, with a focus on stopping use of cocaine.
“It is commonly stated that drugs come to dominate identities and lives. This was true in the most problematic cases in the Waldorf study. However, for the large majority of the sample, identities and lives usually dominated drug use. This is a critical fact that must be remembered when we try to help people overcome problems caused by drugs and alcohol.”
“It is commonly stated that drugs come to dominate identities and lives. This was true in the most problematic cases in the Waldorf study. However, for the large majority of the sample, identities and lives usually dominated drug use. This is a critical fact that must be remembered when we try to help people overcome problems caused by drugs and alcohol.”
The Drug Experience: Cocaine (Part 2)
This Briefing continues an examination of the seminal study by Dan Waldorf and colleagues on heavy cocaine use. We look at controlled cocaine users in this study, and describe factors that might contribute to this form of drug consumption, and mitigate against the descent into cocaine addiction.
“Whilst cocaine is often portrayed as a powerful reinforcing psychoactive drug, we sadly do not often hear that its powers are also mediated by users’ norms, values, practices, and circumstances. We underestimate the powers of social, social psychological and cultural aspects, whilst overestimating the pharmacological power of the drug.”
“Whilst cocaine is often portrayed as a powerful reinforcing psychoactive drug, we sadly do not often hear that its powers are also mediated by users’ norms, values, practices, and circumstances. We underestimate the powers of social, social psychological and cultural aspects, whilst overestimating the pharmacological power of the drug.”
The Drug Experience: Cocaine (Part 1)
During this Briefing we explore the dynamic world of heavy cocaine use as revealed in a provocative, high-quality study by Dan Waldorf and colleagues. This research, conducted in the US in the 1980s, challenged many of the prevailing myths about cocaine.
There is a good deal of misinformation about cocaine, which does little to help society tackle the problems that excess use of this drug can produce. Waldorf and colleagues set out to study cocaine users and present their world as they see it, without making moral judgements about the drug-using behaviours.
"Some heavy users noted psychological transformations. The world that had once been good to live in became a place that was far less hospitable – paranoia increased and depression sometimes developed.”
There is a good deal of misinformation about cocaine, which does little to help society tackle the problems that excess use of this drug can produce. Waldorf and colleagues set out to study cocaine users and present their world as they see it, without making moral judgements about the drug-using behaviours.
"Some heavy users noted psychological transformations. The world that had once been good to live in became a place that was far less hospitable – paranoia increased and depression sometimes developed.”
Hidden Heroin Users
In this Background Briefing we describe an important research study conducted by Roy Egginton and Professor Howard Parker at the end of the 1990s that illustrated the life experiences of a group of young heroin users, and offered a practice and policy framework for intervening in their drug journeys to social exclusion.
“The sample were initially very naïve and ill-informed about heroin. They did not understand its subtle potency and addictiveness, and had little idea where a heroin career might take them.”
“The sample were initially very naïve and ill-informed about heroin. They did not understand its subtle potency and addictiveness, and had little idea where a heroin career might take them.”
The Normalisation of Recreational Drug Use (Part 2)
In this Briefing we continue to look at the seminal research study conducted by Professor Howard Parker and colleagues which provided essential insights into British youth culture and the role of drugs and alcohol among adolescents during the 1990s.
Howard Parker and colleagues described four distinct drug pathways that young people in their study had taken during their adolescence. These are considered in this Background Briefing.
“… today’s young drug takers are of both sexes, come from all social and educational backgrounds and are in most other respects conventional.”
Howard Parker and colleagues described four distinct drug pathways that young people in their study had taken during their adolescence. These are considered in this Background Briefing.
“… today’s young drug takers are of both sexes, come from all social and educational backgrounds and are in most other respects conventional.”
The Normalisation of Recreational Drug Use (Part 1)
This Briefing looks at a seminal research study conducted by Professor Howard Parker and colleagues which provided essential insights into British youth culture and the role of drugs and alcohol among adolescents during the 1990s.
“The findings suggested that recreational drug use had become widespread amongst British youth. Over 36% of the sample had tried an illicit drug by age 14, and this increased to 51% by age 16, and 64% by age 18.”
“The findings suggested that recreational drug use had become widespread amongst British youth. Over 36% of the sample had tried an illicit drug by age 14, and this increased to 51% by age 16, and 64% by age 18.”
The Drug Experience and Beyond: Amphetamine
This Background Briefing looks at the experience of taking amphetamine, including the subjective pleasurable experiences of initial use, amphetamine-induced anxiety and psychosis, and withdrawal symptoms following long-term use. We also briefly consider various factors that can influence the amphetamine experience.
“The person… may experience periods of paranoia and anxiety when taking the drug, and periods of deep depression when not taking the drug. The impact of this on psychological well-being can be considerable.”
“The person… may experience periods of paranoia and anxiety when taking the drug, and periods of deep depression when not taking the drug. The impact of this on psychological well-being can be considerable.”
The Harms and Risks of Substance Use
During this Briefing we reflect on the various ways that drugs and alcohol can cause harm, and describe a variety of risk factors. We also emphasise the importance of providing realistic and objective information about the harms caused by substance use.
“With drugs nothing is always. Their use does not carry a guarantee of danger, but neither is their safety guaranteed. What one needs to ask about any substance is not whether in absolute terms it is safe, but rather the degree of risk which may attach to its use.”
Griffith Edwards
“With drugs nothing is always. Their use does not carry a guarantee of danger, but neither is their safety guaranteed. What one needs to ask about any substance is not whether in absolute terms it is safe, but rather the degree of risk which may attach to its use.”
Griffith Edwards
Should Recreational Drug Use be Criminalised? (Part 2)
This Background Briefing continues to look at the arguments of the philosopher Douglas Husak about drug laws in the US, this time focusing on the negative effects of prohibition.
“In Illinois, the state with the highest rate of black male drug offenders behind bars, a black man is 57-times more likely to be sent to prison on drug charges than a white man.”
“In Illinois, the state with the highest rate of black male drug offenders behind bars, a black man is 57-times more likely to be sent to prison on drug charges than a white man.”
Should Recreational Drug Use be Criminalised? (Part 1)
During this Background Briefing we continue to look at the regulation and control of drugs by presenting the views of the philosopher Douglas Husak about the justice of drug laws in the United States.
Douglas Husak combines hard fact and rigorous moral reasoning in his cogent analysis of the drug law debate in his book “Legalize This! The case for decriminalising drugs.” We summarise his arguments – and do not offer our own view - to help the reader decide how they feel about the central question of the justice of drug laws. Whilst Husak argues about the situation in the US, much of what is said is relevant to the UK.
“I think the sheer scale of incarceration of drug users makes prohibition the worst injustice perpetrated by our system of criminal law in the 20th century. Only the institution of slavery and the despicable treatment of the Native Americans are greater injustices in the United States.” Douglas Husak
Douglas Husak combines hard fact and rigorous moral reasoning in his cogent analysis of the drug law debate in his book “Legalize This! The case for decriminalising drugs.” We summarise his arguments – and do not offer our own view - to help the reader decide how they feel about the central question of the justice of drug laws. Whilst Husak argues about the situation in the US, much of what is said is relevant to the UK.
“I think the sheer scale of incarceration of drug users makes prohibition the worst injustice perpetrated by our system of criminal law in the 20th century. Only the institution of slavery and the despicable treatment of the Native Americans are greater injustices in the United States.” Douglas Husak
The Regulation and Control of Drugs (Part 2)
In this Briefing we continue to look at the development of laws regulating recreational drug use, in particular in America which has influenced world drug policy so strongly.
“In 1986, the editor in chief of Newsweek began a full page editorial with the assertion that, ‘An epidemic [of illicit drugs] abroad in America, as pervasive and dangerous in its way as the plagues of medieval times.’ In the 14th century, the “Black Death” killed about 75 million people in a few years.”
“In 1986, the editor in chief of Newsweek began a full page editorial with the assertion that, ‘An epidemic [of illicit drugs] abroad in America, as pervasive and dangerous in its way as the plagues of medieval times.’ In the 14th century, the “Black Death” killed about 75 million people in a few years.”
The Regulation and Control of Drugs (Part 1)
In this Briefing we begin to look at factors that have influenced the development of laws regulating recreational drug use, in particular influential happenings in America.
“It is generally assumed and rarely argued that it [prohibition] is all done for the greatest good, to help reduce the heath and social problems caused by drugs. However, a closer look at the origins of prohibition reveals a more complicated picture. Ideological, political and economic interests play a major role.”
“It is generally assumed and rarely argued that it [prohibition] is all done for the greatest good, to help reduce the heath and social problems caused by drugs. However, a closer look at the origins of prohibition reveals a more complicated picture. Ideological, political and economic interests play a major role.”
Historical Perspectives: Cocaine
This Background Briefing traces the history of cocaine, linking the Incas, Freud, Thomas Edison, Sherlock Holmes and Coca Cola.
“Coca-Cola originally contained cocaine and was advertised as the brain tonic and intellectual soda-fountain beverage.”
“Coca-Cola originally contained cocaine and was advertised as the brain tonic and intellectual soda-fountain beverage.”
Wednesday 23 April 2008
Historical Perspectives: Opium, Morphine and Opiates (Part 3)
We conclude our brief history of the opiates by looking at the massive increase in heroin use that occurred in America and the UK during the later parts of the 20th century.
‘The American problem really took off in the 1960s with the increased supply of cheap black market heroin. There were about 50,000 heroin addicts in 1960 and this number rose to 500,000 by 1970. Heroin use became increasingly associated with ethnic minorities and urban poverty. The drug rooted itself in social deprivation. Property crime became an integral part of the American heroin epidemic and occurred at a level never seen before.’
Read Briefing.
‘The American problem really took off in the 1960s with the increased supply of cheap black market heroin. There were about 50,000 heroin addicts in 1960 and this number rose to 500,000 by 1970. Heroin use became increasingly associated with ethnic minorities and urban poverty. The drug rooted itself in social deprivation. Property crime became an integral part of the American heroin epidemic and occurred at a level never seen before.’
Read Briefing.
Historical Perspectives: Opium, Morphine and Opiates (Part 2)
We continue a brief history of the opiates, which includes describing the different responses of the United States and Britain to opiate problems in the earlier parts of the century.
‘Heinrich Dreser had synthesised diacetylmorphine in 1898, which he called heroin because of its heroic possibilities for treatment. The company Bayer marketed it for coughs, for which it was effective with less side effects than morphine.’
Read Briefing.
‘Heinrich Dreser had synthesised diacetylmorphine in 1898, which he called heroin because of its heroic possibilities for treatment. The company Bayer marketed it for coughs, for which it was effective with less side effects than morphine.’
Read Briefing.
Historical Perspectives: Opium, Morphine and Opiates (Part 1)
In this Briefing, we trace the history of the opiates, from use in Summarian and Assyrian civilisations through to the Opium wars between China and Britain and the cultural impact of opium smoking by Chinese in the Californian gold fields.
‘It was estimated that between 16,000 and 26,000 shops sold opiates in Britain in the 1850s. One London chemist had 378 different opiate preparations on his shelf.’
‘It was estimated that between 16,000 and 26,000 shops sold opiates in Britain in the 1850s. One London chemist had 378 different opiate preparations on his shelf.’
Psychoactive Drugs: From Absorption to Elimination
We look at factors that can influence indirectly the way that psychoactive drugs impact on the brain and influence behaviour. This Briefing describes examples of individual differences in drug response that can arise from these factors.
‘These differences in absorption of cocaine (and other drugs) impact at a behavioural level in several ways, one of which concerns long-term behavioural change. The learning of a habit – which is the psychological process underlying dependence – is influenced by the time interval between the act of drug-taking and the drug’s rewarding impact on the brain. The shorter the interval, the greater the likelihood of the drug-taking habit developing.’
‘These differences in absorption of cocaine (and other drugs) impact at a behavioural level in several ways, one of which concerns long-term behavioural change. The learning of a habit – which is the psychological process underlying dependence – is influenced by the time interval between the act of drug-taking and the drug’s rewarding impact on the brain. The shorter the interval, the greater the likelihood of the drug-taking habit developing.’
Drugs, Chemicals, The Brain and Behaviour
The sixth Background Briefing summarises briefly how psychoactive drugs influence chemical and electrical events in the brain, and how these changes may relate to their effects on behaviour.
Reminds me of the many days (25 years) I spent as a neuroscientist working with the neurotransmitter dopamine. I’m living in a very different world now!
‘Drugs of misuse cause a cascade of events in the brain that underlie their psychological effects. Of course, trying to understand the way that pharmacological effects at a cellular level are translated into psychological experiences is extremely complex and fraught with difficulties.’
Reminds me of the many days (25 years) I spent as a neuroscientist working with the neurotransmitter dopamine. I’m living in a very different world now!
‘Drugs of misuse cause a cascade of events in the brain that underlie their psychological effects. Of course, trying to understand the way that pharmacological effects at a cellular level are translated into psychological experiences is extremely complex and fraught with difficulties.’
Drug Choices … and the Loss of Choice
In this Background Briefing, I look at the choices that provoke a relationship with drugs or alcohol – and how these choices change as dependency takes hold.
I also look at a definition of dependence or addiction, as described by Griffith Edwards. Addiction can be seen as an impairment in a person’s ability or power to choose. The drug becomes more important to the person than other aspects of their life, which the majority of us would consider as essential.
‘In one word, trapped. I knew I had the ball and chain from that day onwards … I could see no light at the end of the tunnel whatsoever. It had got me, I was being sucked down every day further and further.'
I also look at a definition of dependence or addiction, as described by Griffith Edwards. Addiction can be seen as an impairment in a person’s ability or power to choose. The drug becomes more important to the person than other aspects of their life, which the majority of us would consider as essential.
‘In one word, trapped. I knew I had the ball and chain from that day onwards … I could see no light at the end of the tunnel whatsoever. It had got me, I was being sucked down every day further and further.'
Alcohol Dependence
In this Background Briefing, I look at the alcohol dependence syndrome as originally described by Griffith Edwards and Milton Gross. The alcohol dependence syndrome was viewed as a cluster of seven elements that concur, existing in degrees of severity rather than as a categorical absolute.
This description rapidly became accepted and used for looking at dependence to other drugs.
‘There is no signpost to a person becoming dependent. Whilst a severely dependent person is easy to recognise, it can be difficult to detect a problem in the early stages.’
This description rapidly became accepted and used for looking at dependence to other drugs.
‘There is no signpost to a person becoming dependent. Whilst a severely dependent person is easy to recognise, it can be difficult to detect a problem in the early stages.’
Drug, Set and Setting
In my third Background Briefing, I point out and provide evidence of the fact that the effects of a drug are not just dependent on the drug itself, but also on personal factors (set) and the setting. Wired In now describes this as the ‘drug, person and their environmental context.’
In this article, I also describe one of most amazing pieces of research in the substance use field. A large-scale study revealed that 10 – 15% of US servicemen had become addicted to heroin during the Vietnam War. However, only 6% those veterans who participated in the study became re-addicted to the drug in the US, despite half of this population initially trying the drug on their return.
'This research contradicted the commonly held belief that heroin addiction is an inevitable consequence of using the drug, and that once it has taken hold it is virtually impossible for the user to give up the habit. It provides a good example of the ways in which changes in social circumstances can have a powerful effect on the way people use drugs.’
In this article, I also describe one of most amazing pieces of research in the substance use field. A large-scale study revealed that 10 – 15% of US servicemen had become addicted to heroin during the Vietnam War. However, only 6% those veterans who participated in the study became re-addicted to the drug in the US, despite half of this population initially trying the drug on their return.
'This research contradicted the commonly held belief that heroin addiction is an inevitable consequence of using the drug, and that once it has taken hold it is virtually impossible for the user to give up the habit. It provides a good example of the ways in which changes in social circumstances can have a powerful effect on the way people use drugs.’
Psychoactive Drugs and the Drug Problem
In my second Background Briefing, I describe a classification of psychoactive drugs based on their major mode of action on the mind. The classification groups drugs into stimulants, sedatives, opiates, hallucinogens, and drugs with mixed actions.
The multitude of of factors that influence the way that a drug can affect a person, and that ultimately can contribute to a drug problem, are briefly introduced.
'There is a long and tangled path between the psychoactive drug and the drug problem in today's society.'
DDN (10/01/05)
The multitude of of factors that influence the way that a drug can affect a person, and that ultimately can contribute to a drug problem, are briefly introduced.
'There is a long and tangled path between the psychoactive drug and the drug problem in today's society.'
DDN (10/01/05)
Drugs in Society
Society has clung to the notion that some psychoactive drugs are 'good' whilst others are 'bad'. The 'good/bad' drug distinction sometimes becomes synonymous with 'safe/dangerous'.
But how reliable are these classifications? Can we honestly say that the judgements society makes about drugs and drug users are based on a clear understanding and objective analysis?
'The sufferer is tremulous and loses his self command; he is subject to fits of agitation and depression... As with other such agents, a renewed dose of the poison gives temporary relief, but at the cost of future misery.' From a medical textbook published in 1909.
What is the drug? Find out in the first Background Briefing, published in November 2004.
But how reliable are these classifications? Can we honestly say that the judgements society makes about drugs and drug users are based on a clear understanding and objective analysis?
'The sufferer is tremulous and loses his self command; he is subject to fits of agitation and depression... As with other such agents, a renewed dose of the poison gives temporary relief, but at the cost of future misery.' From a medical textbook published in 1909.
What is the drug? Find out in the first Background Briefing, published in November 2004.
An Introduction
I have been writing a Background Briefings column in Drink and Drugs News since November 2004, soon after the UK magazine was launched. I'm going to link to all articles in this Blog, but since there are over 50 please bear with me as I slowly put them up on this site.
My thanks to Claire Brown and Ian Ralph of CJ Wellings Ltd, the publishers of DDN, who have 'put up' with me and my ramblings all this time.
Please remember that these articles are copyright. By all means, circulate them as much as possible, but you should not be using them for financial gain.
My thanks to Claire Brown and Ian Ralph of CJ Wellings Ltd, the publishers of DDN, who have 'put up' with me and my ramblings all this time.
Please remember that these articles are copyright. By all means, circulate them as much as possible, but you should not be using them for financial gain.
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