Introduction
The belief that a Substance Use Disorder develops because of the action of the drug is still prevalent in many countries, however, scientific evidence tells us otherwise. Only 10% of the population develops a problem, and some substances are proving to be more effective in the treatment of mental health problems. Heroin is even proving to be more effective than methadone in profiles resistant to its substitution, as long as its dispensation is controlled, passes the appropriate quality controls and is attended from a person-centered approach. https://www.emcdda.europa.eu/publications/insights/heroin-assisted-treatment_enAlthough all this may seem new, the reality is different. The first person to observe and publish on the subject was Zinberg. His studies are collected in the accompanying book, "Drug, Set and Setting" in 1984, barely a decade had passed since the control and criminalization of drugs;
The study was based on monitoring the consumption of two groups, one that maintained controlled use and the other that abused the drugs, over a period of almost 5 years. It identified critical, relevant factors and also disproved certain myths that were used as an argument to initiate the war ON drUgS.
Critical variables
- Ability to maintain drug-free drug use: 59% of controlled users were able to abstain from using opioids even when they were available, compared to only 17% of compulsive users.
- Frequency of daily use: Controlled users had significantly lower peak frequency of opioid use. Only 23% had used opioids more than once a day, compared with 87% of heavy users.
- Compulsive use of other substances (in reference to opiates): Fewer controlled users (59%) than compulsive users (83%) had ever used a non-opiate drug compulsively.
- Number of adverse effects: Fewer controlled users had experienced adverse reactions to opioids and, when they did, were more likely to take new precautions or discontinue use.
- Previous treatment: Only 41% of controlled users had been treated for drug use, compared to 77% of compulsive users (this means that the current model chronifies people).
- Current functioning and employment: A greater number of controlled users were working full time (37%) compared to compulsive users (10%).
- Self-reported job performance and job satisfaction: 71% of controlled users reported that they were "doing well" at their job, compared to 62% of compulsive users. In addition, more controlled users (55%) than compulsive users (39%) reported that they liked their job.
Relevant results
Substance factors;
Regarding the substance, the most interesting thing he discovered was not the effects that determined its use, but rather which ones did not;- Ease of obtaining opioids: No significant differences were found between the two groups in terms of ease of obtaining opioids.
- Number of sources to obtain opioids: Both groups had a similar number of sources to obtain opioids.
- Drug trafficking: No differences in current drug or opiate trafficking were observed between the two groups.
- Types of drugs used: There were no significant differences in the number of types of drugs used currently or in the past.
- Drug availability: No differences were found in the history of significant reduction or increase in opioid use due to availability or lack thereof.
- Method of administration: No significant differences were found in the way opioids were administered, including the use of injections. Although all persons in uncontrolled use made use of the injected route, many persons in controlled use did as well. This is an influencing factor, but not a determining factor.
- Type of opioid used: No differences were observed in the use of "hard" opioids such as heroin or "soft" opioids such as codeine.
- Circumstances of first opioid use: No differences were found in variables such as age at first use, reaction to first use, or number of attempts before achieving a "high".
Personal factors
Personality- Passivity vs. activity; intimacy vs. isolation; rebelliousness vs. conformity; awareness of affect vs. distance from affect; distortion of reality vs. acceptance of reality.
- The results indicated that compulsive users were more passive, more distant from affect and more distorting of reality than controlled users.
- Family context: No significant differences were found in aspects such as difficult family background, family violence, parental discipline or school problems;
- Family bonding: However, controlled users were more likely to rate their relationship with their mother and family cohesion during their childhood as "close".
- Compulsive use: Compulsive users were more likely to use opioids for reasons such as "euphoria", "escape", "risk-taking" and "relief from depression";
- Controlled use: On the other hand, controlled users were more likely to have "healthy" motives such as social, recreational and relational use.
- Only 20% of controlled users considered opioids to be extremely important to them, compared to 73% of compulsive users.
Context
Social environment
- Number and type of friendships: Controlled users tend to have more friendships and different friendship groups compared to compulsive users.
- Peer influence on use style: Controlled users generally use opioids in the company of other controlled users, whereas compulsive users tend to use opioids with other compulsive users.
- Partner's influence on use style: No significant differences were found in whether the partner uses opioids or his or her opinion of the subject's opioid use. However, the partner's style of use was strongly associated with the subject's style of use.
Access to information and implementation of risk reduction strategies
- Rules for safe use: Controlled users tend to follow more rules to minimize the risks associated with opioid use.
- Perceived consequences: No significant differences were found between the two groups in terms of their perception of the negative consequences of opioid use, such as legal problems occlusive and respectful of users' experiences (this casts doubt on the effectiveness of the widely used fear-based prevention).
Harm Reduction Therapy
If you need therapeutic accompaniment, from the SAE, a service with which we collaborate, they can assist you by applying another perspective to the treatment. Although the website is not in English, it is possible to request therapy online and in English.
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