Factors in successful narcotics renunciation

The process of acceptance among rheumatoid arthritis patients in Switzerland: a qualitative study

BACKGROUND

Rheumatoid arthritis (RA) is a chronic, painful disease with many injurious psychological effects. Acceptance is an important component of pain management and is associated with improved quality of life, and lower levels of pain and depression. While studies have begun to identify the stages of acceptance, little is known about factors influencing the ease and speed with which patients pass through these stages.

OBJECTIVE

To explore the main stages through which RA patients pass and the strategies they adopt to learn to live with the pain, and to identify factors shaping patients' capacities to achieve acceptance.

METHODS

A qualitative study involving 20 semistructured interviews with RA patients in the Italian-speaking region of Switzerland was conducted. Analysis of the data followed the precepts of grounded theory.

RESULTS

Although the present study revealed that acceptance is not a smooth or linear process, five main stages in patients' struggles to accommodate the newly imposed limitations were, nonetheless, identified: naming the illness; realizing the illness; resisting the illness; 'hitting the bottom'; and integrating the illness. Diagnosis proved to be an especially tortuous stage in the case of RA, and the effects of delayed diagnosis continued to be felt during the subsequent stages. Patients' understanding of the notion of acceptance and the strategies that they used to achieve it were also explored.

CONCLUSIONS

Diagnosis of RA is notoriously difficult. Beyond the clinical difficulties, structural reasons for late diagnosis (symptoms being neglected by patients and medical professionals) were identifed. Delayed diagnosis hindered the acceptance process throughout, and led to more resistant behaviour and to a struggle to achieve the optimal formula for acceptance - accepting the losses of prepain life while still pursuing personal goals.

Addicts' narratives of recovery from drug use: constructing a non-addict identity

Sociological accounts of the process of recovery from dependent drug use have emphasised the importance of the individual constructing a non-addict identity for themselves. Following Giddens we identify the process of providing a narrative of their recovery as one of the mechanisms by which addicts may seek to achieve this. The narratives of recovery which are the subject of this paper were elicited in the course of semi-structured interviews with a sample of 70 recovering addicts. There were three key areas in which the addicts' narratives of recovery could be seen to be constructing a non-addict identity for the individual; firstly, in relation to the reinterpretation of aspects of their drug using lifestyle; secondly, in relation to the reconstruction of their sense of self and thirdly, in relation to the provision of convincing explanations for their recovery. In certain respects, the addicts' narratives of recovery are similar to the accounts of recovery provided by drug workers and addictions researchers. The paper argues that the correspondence between addicts' own accounts of their recovery and those of professional drug workers may be not so much the result of the intrinsic nature of the recovery process as a product of the socially constructed nature of the narratives and the fact that the latter may have been developed in conjunction with those working in the drug treatment industry.

The elderly and the use of illicit drugs: sociological and epidemiological considerations

Debates over the prevalence of elderly illicit drug addicts in the population divert our attention from this group as a viable study population. Due to their decelerated lifestyle, low crime rates, and our attitudes toward the elderly as nonstreet drug users, they are likely to remain hidden from the public eye. This paper reviews past trends in drug misuse among the elderly, the lifestyle of those addicted to drugs, the complications associated with drug misuse and aging, and the problems that the elderly face with traditional treatment programs. Given our aging society, is the study of elderly street addicts and users an important area of concern?

Circumstances surrounding needle use transitions among injection drug users: implications for HIV intervention

Injection drug users (IDUs) are at increased risk of infection with the human immunodeficiency virus (HIV). Intervention programs aimed at reducing the spread of HIV in this population typically incorporate a range of risk reduction strategies, including encouragement to move from injection to noninjection. However, very little is known about the factors associated with needle use transitions, either spontaneous or in response to intervention. We report a study in which a cohort of IDUs were asked about the reasons they stopped and restarted injection. Of 855 IDUs, 179 (21%) had had a least one 12-month period of noninjection since they first injected. Almost one-half of the reasons given for stopping injecting related to personal crises, characterized by major shifts in attitude to drugs and/or life more generally, and often generated by pressures in significant relationships. Concerns about HIV were cited by only one respondent. Many of the factors associated with transition out of needle use in the study population are not readily amenable to intervention. The implications of this for HIV risk reduction programs are discussed.

A Rogerian view of drug abuse: implications for nursing

Drug abuse and the concept of addiction are explored utilizing Martha E. Rogers' conceptual system of unitary human beings, resulting in a novel and thought-provoking view of this health behavior. Following an overview of Rogers' concepts, principles, and theories, the example of the heroin addict is reviewed, conceptualizing the addict as a high-frequency, diverse human energy field integral with a low-frequency, impoverished environmental field. Drug use provides an alternative way to participate in the mutual process. The drug "high" is conceptualized as providing a means to increase one's awareness of the four-dimensional nature of reality. The integral nature of human and environment is illustrated with examples of increasing diversity in each due to human drug use. Addiction is discussed as are other aspects of the environmental field. Finally, nursing interventions at the individual and environmental levels are presented.

Natural Recovery from Addiction: Some Social-Psychological Processes of Untreated Recovery

This is a report of an exploratory in-depth study of the social-psychological processes of untreated recovery. Data for the study comes from focused interviews with a sample of 201 ex-addicts (half untreated, half treated) located by means of the snowball referral method. Findings indicate that personal motivations to stop using opiates usually arise out of the lifestyle, police activities and environment of illicit opiate use—out of the “changes” addicts experience trying to maintain expensive habits. Individuals respond differently to such changes. Some sink into profound despair and act when they are forced to. Others weigh the consequence of future opiate use and make rational decisions to change, while still others just drift into something else because their commitment to opiate use and the lifestyle was only tenuous. Once addicts decide to quit, they must leave the scene, break all ties with opiate users and create new interests, new social networks, new social identities. Some persons do this by their own efforts while others use existing institutions. Six patterns of recovery were discerned and it was concluded that the “maturing out” concept is not sufficient to describe all the different variations. In addition to maturation, we found that some addicts become converts to religious, social or communal causes, some retire (give up the drug but maintain the lifestyle). Others use opiates in certain situations and change when the situation changes and some move on to other drugs (usually alcohol).

Natural Recovery from Heroin Addiction: A Review of the Incidence Literature

This paper reviews the literature in an area which has received little attention of drug researchers — spontaneous remission. The paper reviews all the research studies that have looked at the phenomena of the “natural” recovery from heroin addiction — natural in the sense that some addicts manage to stop using heroin and not become re-addicted without the help of treatment intervention. Some areas for future research are also suggested.

The causes of heroin addiction-- a review of the literature. Part II

Theories on the causes of heroin addiction are reviewed in this two part article. Part II reviews the literature that considers the family of the addict and the stepping stone theory.