Table Of ContentDrug Misuse
Prevention, harm minimization
and treatment
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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
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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.
