Treating the drug user: built-in conceptual problems.
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Biomedical subjects
Publications and source records attributed to S Einstein.
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A review of the increasing literature describing various drug education efforts and programs suggests that few of the critical issues presented in this article have been considered in program planning and implementation. Second, research has demonstrated that although drug education programs can increase drug knowledge relatively easily, it is more difficult to modify attitudes; that is, changes in knowledge are not paralleled by changes in attitudes. Third, many, if not most, programs have been found to have no effect upon drug use. A number of programs have reported reduced drug use, while a few others have reported increased drug use. Fourth, there is no evidence that greater knowledge about drugs per se stimulates their use. The fact that drug users know more about drugs than nonusers doesn't mean that knowledge leads to use. It has been suggested (Stuart, 1974) that drug education might stimulate use by (1) providing students with facts that overcome beliefs which inhibit use, (2) changing attitudes that prevent use, (3) encouraging students to think of themselves as potential users by virtue of having been included in drug education programs, and (4) providing specific information which serves to facilitate the use of drugs. One should, of course, consider the obvious possibility that greater knowledge results from use rather than vice versa. Fifth, there appears to be little predictable relationship between values communicated by drug education programs, values held by recipients, value changes and drug use, or abstinence. The same can be said about behavioral styles. When one goes beyond the limitations of drug/drug user stereotypes--to include people and the almost unlimited types and number of available chemical substances which we must learn to adapt to and cope with--one is confronted by the reality that drug education, as currently designed and practiced, may be irrelevant to individual and group needs. Sixth, drug education appears to have little or no effect upon the increased availability of increasing numbers and types of powerful active chemical substance for more and more segments of the population. Drug education is at best a parallel phenomenon to chemical coping, which necessitates drug availability as well as the process of social pharmacology. Seventh, to date drug education has had no predictable effect upon either the mystification or demystification of drugs, drug use, drug users, or abstinence.(ABSTRACT TRUNCATED AT 400 WORDS)
A self-help schema is presented which delineates the minimal factors that should be considered in the development or maintenance of any self-help effort. The schema is simply a skeleton which is to be filled out by the specific needs of a given effort within a given context. Its importance lies in the hope that it may serve as a catalyst for the creation of useful and usable self-help models which are also evaluatable.
A series of concepts and definitions of community and self-help are presented for use in the development of models for intervention in which clarity in the community's role will reinforce self-help ventures.
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This article reviews a series of issues, concepts, and factors which are critical to any treatment process in terms of a selected number of drug user treatment programs. These programs include the most often used and reported on ones in the literature: methadone maintenance, outpatient (drug-free and general) therapeutic communities, and detoxification. The central thesis of this article is to remind the reader that current evaluation reports, between any number of types of programs, while being statistically seductive, may be conceptually meaningless. What is most often compared may be uncomparable.
A drug use intervention outreach project was developed which relied upon the active participation of health, welfare, employment, rehabilitation, social educational, social-legal control, and national security agencies. A variety of explicit and implicit goals, techniques, and data collection techniques were mutually agreed upon by the agencies in order to confidentially register untreated drug users, alcoholics, and medicinal misusers; to integrate them into treatment; to train staffs of participating agencies; to assess the adaptive functioning of children living with drug-using alcoholic parents and/or siblings; to empirically document substance misuse in one area of Jerusalem, and to develop a model for outreach. Sixty-seven drug users were "discovered", 12 were already in treatment. A number of the project's goals were achieved; others were not. The project is being continued for a second year.
A ministudy was carried out with 50 male and female adults who are "regular" cigarette smokers to investigate the potential role(s) which contagion plays in smoking. Notwithstanding their reports that they were introduced to smoking by others 40% of the time, only 12% reported-remembered initiating someone else to smoking. The report of self-activated cigarette use is congruent with with most views about smoking, but not regarding drug use. As long as drug use intervention utilizes contagion as a concept, deviance as a classification and varieties of isolation as control techniques will be associated with drugs, users, and drug use. By definition, social substances have no source of contagion by others. The decision to use or abstain is viewed as being personal notwithstanding the reality that is related among other factors to a variety of market economies.
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This paper proposes that the continued pessimism regarding the treatment of the drug user and the anticipated-related poor outcome results may/can be overcome by paying attention to four significant factors associated with the treatment process. These are a clearer understanding of the factors initiating treatment and their associated models, the goal systems used, criteria for selecting treatment agents, and treatment as a temporal process for all who are or should be involved in it. If these factors are not better understood and more effectively utilized, treatment planning becomes a happening and treatment failure becomes a built-in self-fulfilling prophecy.
Thirty-nine male and female adult Jewish and Arab street drug users from Jerusalem, currently in treatment, were interviewed to explore various factors associated with their own initiation into drug use and their initiation of others. These factors included the source and context of initial drug use, first drug used, physical and psychological drug reactions, and the types of gains derived from turning others on. The most significant findings from this ministudy are that the majority of drug users did not initiate anyone else into drug use, and that those who did reported a variety of nonmonetary gains.
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