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Drug dependence: opiates and stimulants

from Medical topics

Published online by Cambridge University Press:  18 December 2014

By
Michael Gossop
Edited by
Susan Ayers ,
Andrew Baum ,
Chris McManus ,
Stanton Newman ,
Kenneth Wallston ,
John Weinman  and
Robert West
Michael Gossop
Affiliation:
Institute of Psychiatry
Susan Ayers
Affiliation:
University of Sussex
Andrew Baum
Affiliation:
University of Pittsburgh
Chris McManus
Affiliation:
St Mary's Hospital Medical School
Stanton Newman
Affiliation:
University College and Middlesex School of Medicine
Kenneth Wallston
Affiliation:
Vanderbilt University School of Nursing
John Weinman
Affiliation:
United Medical and Dental Schools of Guy's and St Thomas's
Robert West
Affiliation:
St George's Hospital Medical School, University of London
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Summary

The nature of the disorder

Drug misuse is a complex and multifaceted phenomenon which can be understood in terms of three dimensions: consumption behaviours, problems; and dependence. Although conceptually distinct, in reality these dimensions tend to be related (sometime closely) in a number of ways.

Opiates and stimulants (predominantly heroin and crack cocaine) are among the drugs most commonly used by people presenting for treatment, and dependence upon these drugs is the most common reason for treatment. However, the classification of drug problems by specific substance can be misleading. Most drug misusers who require treatment are heavy and problematic users of more than one drug (Gossop, 2001).

Multiple drug use may involve the concurrent or sequential use of different substances. Among the reasons for multiple drug use are:

  • drug enhancement (several drugs may be used at the same time to increase the desired effects)

  • modification of effect (e.g. to counteract the adverse or unwanted effects of one or more drugs as with cocaine and heroin used together so that either the heroin takes away some of the unpleasant overstimulation of the cocaine, or the stimulant offsets the sedation of the heroin)

  • substitution (taking a different drug as a substitute where the preferred drug is not available).

Assessment and setting treatment goals

Assessment is not an impersonal procedure to be completed prior to treatment. It is an important first stage of treatment. The therapist should use assessment as an opportunity to encourage the involvement of the drug user in their own recovery.

Type
Chapter
Information
Cambridge Handbook of Psychology, Health and Medicine , pp. 679 - 682
Publisher: Cambridge University Press
Print publication year: 2007

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References

Ball, J. & Ross, A. (1991). The Effectiveness of methadone maintenance treatment. New York: Springer.
Bradley, B., Phillips, G., Green, L. & Gossop, M. (1989). Circumstances surrounding the initial lapse to opiate use following detoxification. British Journal of Psychiatry, 154, 354–9.Google Scholar
Brown, B., Kinlock, T. & Nurco, D. (2001). Self-help initiatives to reduce the risk of relapse. In Tims, F., Leukefeld, C. & Platt, J. (Eds.). Relapse and recovery in addictions. New Haven: Yale University Press.
Clare, A. (1977). How good is treatment? In Edwards, G. & Grant, M. (Eds.). Alcoholism: new knowledge and new responses. London: Croom Helm.
Leon, G. (2000). The therapeutic community: theory, model, and method. New York: Springer.
Einstein, S. (1966). The narcotics dilemma: who is listening to what?International Journal of the Addictions, 1, 1–6.Google Scholar
Emrick, C. D. (1999). Alcoholics Anonymous and other 12-step groups. In Galanter, M. & Kleber, H. D. (Eds.). The American Psychiatric Press Textbook of Substance Abuse Treatment (2nd edn.) (pp. 403–12). Washington, DC: American Psychiatric Press, Inc.
Gossop, M. (2001). A web of dependence. Addiction, 96, 677–8.Google Scholar
Gossop, M. (2003). Drug addiction and its treatment. Oxford: Oxford University Press.
Gossop, M. & Grant, M. (1990). The content and structure of methadone treatment programmes: a study in six countries. Geneva: World Health Organization. (WHO/PSA/90.3).
Gossop, M., Griffiths, P. & Strang, J. (1994a). Sex differences in patterns of drug taking behaviour: a study at a London community drug team. British Journal of Psychiatry, 164, 101–4.Google Scholar
Gossop, M., Marsden, J., Stewart, D. & Kidd, T. (2003). The National Treatment Outcome Research Study (NTORS): 4–5 year follow-up results. Addiction, 98, 291–303.Google Scholar
Gossop, M., Powis, B., Griffiths, P. & Strang, J. (1993). Sexual behaviour and its relationship to drug taking among prostitutes in south London, Addiction.Google Scholar
Gossop, M., Powis, B., Griffiths, P. & Strang, J. (1994b). Multiple risks for HIV and hepatitis B infection among heroin users. Drug and Alcohol Review, 13, 293–300.Google Scholar
Heather, N. & Stallard, A. (1989). Does the Marlatt model underestimate the importance of conditioned craving in the relapse process? In Gossop, M. (Ed.). Relapse and addictive behaviour. London: Routledge.
Hubbard, R. L., Craddock, S. G., Flynn, P., Anderson, J. & Etheridge, R. (1997). Overview of 1-year outcomes in the Drug Abuse Treatment Outcome Study (DATOS). Psychology of Addictive Behaviors, 11, 279–93.Google Scholar
Hubbard, R., Marsden, M., Rachal, V.et al. (1989). Drug abuse treatment: a national study of effectiveness. Chapel Hill, NC; London: University of North Carolina Press.
Kosten, T., Morgan, C., Falcione, J. & Schottenfeld, R. (1992). Pharmacotherapy for cocaine-abusing methadone-maintained patients using amantadine or desiprimine. Archives of General Psychiatry, 49, 894–8.Google Scholar
McLellan, A. T., Arndt, I., Metzger, D., Woody, G. & O'Brien, C. (1993). The effects of psychosocial services in substance abuse treatment. Journal of the American Medical Association, 269, 1953–9.Google Scholar
Marlatt, G. A. & Gordon, J. R. (1985). Relapse prevention. New York: Guilford Press.
Marsch, L. A. (1998). The efficacy of methadone maintenance interventions in reducing illicit opiate use, HIV risk behaviour and criminality: a meta-analysis. Addiction, 93, 515–32.Google Scholar
Miller, W. R. (1983). Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 1, 147–72.Google Scholar
Miller, W. R. & Rollnick, S. (1991). Motivational Interviewing. New York: Guilford Press.
O'Brien, C. (1994). The treatment of drug dependence. Addiction, 89, 1565–9.Google Scholar
Ouimette, P. C., Finney, J. W. & Moos, R. H. (1997). Twelve step and cognitive–behavioural treatment for substance abuse: a comparison of treatment effectiveness. Journal of Consulting and Clinical Psychology, 65, 230–40.Google Scholar
Ouimette, P.C., Moos, R. H. & Finney, J. W. (1998). Influence of outpatient treatment and 12–step group involvement on one–year substance abuse treatment outcomes. Journal of Studies on Alcohol, 59, 513–22.Google Scholar
Selwyn, P., Feiner, C., Cox, C., Lipshutz, C. & Cohen, R. (1987). Knowledge about AIDS and high–risk behavior among intravenous drug users in New York City. AIDS, 1, 247–54.Google Scholar
Shiffman, S. (1989). Conceptual issues in the study of relapse. In Gossop, M. (Ed.). Relapse and addictive behaviour. London: Routledge.
Simpson, D. D. (1997). Effectiveness of drug-abuse treatment: a review of research from field settings. In Egerton, J. A., Fox, D. M., Leshner, A. I. (Eds.). Treating drug abusers effectively. Oxford: Blackwell.
Simpson, D. & Sells, S. (1990). Opioid addiction and treatment. Malabar: Krieger.
Stewart, D., Gossop, M., Marsden, J. & Strang, J. (2000). Variation between and within drug treatment modalities: data from the National Treatment Outcome Research Study (UK). European Addiction Research, 6, 106–14.Google Scholar
Stimson, G., Donoghoe, M., Lart, R. & Dolan, K. (1990). Distributing sterile needles and syringes to people who inject drugs: the syringe exchange experiment. In Strang, J. & Stimson, G. (Eds.). AIDS and drugs misuse. London: Routledge.
Stitzer, M., Bigelow, G. & Gross, J. (1989). Behavioral treatment of drug abuse. In Karasu, T. B. (Ed.). Treatments of psychiatric disorders: a task force report of the American psychiatric association, Vol. 2.Washington, DC: American Psychiatric Association.

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