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About this book

Key to understanding drug misuse is an awareness of the full range of models that seek to define, explain and treat the problem. This book covers the full breadth of medical, social and psychological approaches to drug use, while retaining focus on the one question which is seldom asked: What do drug users themselves think?

Based on extensive research, Understanding Drug Misuse offers comprehensive analysis of the diversity of drug-related problems, interwoven with frank – and often challenging – user perspectives. Combining theory and research evidence with extracts from the author's own interviews with drug users, this insightful text explores:drug use, drug dependence and discussion of maintenance versus abstinencehealth risks, harm minimization and public health solutionssocial harm, social exclusion, and problems of community safety and crimepractice implications for harm minimization, treatment, after-care and relapse preventionWith practical guidance that will inform all work directly related to drug policy or practice, Understanding Drug Misuse is an essential text for all students taking modules in substance abuse and addiction studies. It also makes fascinating and fundamental reading for specialist and generic workers in the health, social care and criminal justice professions.

Table of Contents

Chapter 1. Care and Control: Drug Dependency, Health Risks and Social Harm

Abstract
Drug use causes three different types of problem, for which there are different solutions. In addition, drugs not only cause different types of problems for individual drug users but also for the communities they live in. Drug dependence itself can involve physiological and psychological dependence and neurological compulsion. Health-related harm can include individual health problems such as overdose and public health problems such as transmission of blood-borne diseases. Social harm can include individual problems such as social exclusion and community problems such as crime.
Jan Keene

Chapter 2. Drug Users’ Perspectives on Drug Use and Dependence

Abstract
This chapter is concerned with respondent beliefs about why they use drugs and their descriptions and interpretations of the effects. It will first examine experiences of starting to use drugs, then experiences of ongoing use and dependency, together with accounts of loss of control, compulsion, craving. Finally it will explore descriptions of stopping drug use, treatment, relapse and experiences of drug services.
Jan Keene

Chapter 3. Reducing Dependence: Approaches to Treatment

Abstract
This chapter will build on the issues identified in the previous chapter by examining research evidence and theories of dependency in order to clarify the professional knowledge base and show how this informs service provision for dependent drug users. However the views and beliefs of drug users themselves should be kept in mind throughout this chapter, as these not only shed light on why services are effective when they are, but also why they might be less useful in some circumstances.
Jan Keene

Chapter 4. Drug Users’ Perspectives on Health Risks

Abstract
Whilst the previous chapters have focused specifically on dependency, this chapter will examine different kinds of risks and problems associated with drug use other than dependency. Drug users here talk about harmful drug use, where there is a direct risk to their own physical and mental health and general well-being.
Jan Keene

Chapter 5. Harm Minimization and Public Health

Abstract
The previous chapter provided the users’ perspective on their drug use, risk taking and needs. Whilst there is less conceptual or theoretical analysis of non-dependent drug use, this chapter examines the research evidence and outlines the type of services available for reducing health related harm among non-dependent and dependent users. Again it is useful to keep the users’ views in mind, as these enable not only a clearer understanding of the problems and issues, but also give an indication of the limitations of service provision and potential for future developments.
Jan Keene

Chapter 6. Drug Users’ Perspectives on Social Harm

Abstract
This chapter will examine the importance of social relationships in influencing drug use, whether starting, continuing, stopping or relapsing. It will explore the social harm caused to individual drug users themselves and also the harm caused by drug users to society. The first type of social harm to individual drug users includes social exclusion, unemployment and homelessness. The second type, social harm to the wider population, includes crime and risks to community safety.
Jan Keene

Chapter 7. Reducing Social Harm: Social Inclusion and Crime Reduction

Abstract
The previous chapter has illustrated how starting drug use is seen, by users themselves, as a social process where they are integrated into a social support network. Similarly, stopping is seen as an anti-social process that involves breaking away from that social support network and relapse as a re-integration with the network. Respondents highlight the difficulty of leaving the drug-using social world, entering a non-using world and perhaps most importantly, the difficulty of transferring between social worlds and the problems of coping with the ensuing periods of social isolation that might be involved in this transfer.
Jan Keene

Chapter 8. Working with Users: Motivation, Maintenance and Recovery

Abstract
The use of drugs is now so widespread that most social and health care professionals are likely to have drug users on their caseload. The previous chapters have given an understanding of the problems and solutions in the field. The following two chapters will address the practical implications for professionals.
Jan Keene

Chapter 9. After-Care: Relapse Prevention and Social Inclusion

Abstract
After-care and relapse prevention are necessary after any change in drug use, whether the client is using illicit drugs more safely, using prescribed drugs or abstinent. Earlier chapters have highlighted the need for continuing support and help over long periods of time. The problem with both harm minimization and treatment interventions is that whilst either approach benefits the client whilst they are in contact, the interventions do not last forever. Research indicates that when the client stops attending the services they start to take risks again or they relapse (Moos, 2008; Laffaye et al., 2008). One of the most important tasks for generic professionals is therefore to support and maintain clients after interventions.
Jan Keene
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