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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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