How Do Marginalised Young People who are in Contact with Alcohol and Other Drug Services Understand their Alcohol and Other Drug Use and ‘Addiction’? (original) (raw)
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This report presents findings from a national qualitative research project on experiences of alcohol and other drug addiction, dependence or habit in Australia, undertaken between 2014 and 2016. Drawing on in-depth qualitative interviews, the study was designed to collect and analyse the personal accounts of people who describe themselves as having an alcohol and other drug addiction, dependence or habit. It aimed to generate much-needed new insights into the range of experiences that make up life for people with drug use experiences of this kind. Interviews were conducted with 60 people from diverse backgrounds living in cities and regional areas of Victoria and New South Wales, Australia. Interview questions addressed participants’ experiences of living with addiction, including how consumption fits into daily life, coping with stigma and discrimination, experiences of treatment, and views on the idea of recovery. The report details the study’s findings on these key themes and, where appropriate, recommendations for improving policy and service provision.
Tackling Problem Drug Use: A New Conceptual Framework
Successful ‘recovery’ from long-term problem drug use has depended largely upon understanding and tackling the physiological and psychological nature of drug dependence; however, drawing upon research and practice in Liverpool, England, the author questions whether this discourse is sufficient given the changing nature, context and attitudes towards drug consumption in the twenty-first century. This article emphasises the importance of incorporating structural and social factors. Drawing upon qualitative data from three separate studies, the author illustrates how stigmatisation, marginalisation, and social exclusion are significant debilitating components that have tended to be overlooked. This paper contributes new insights into the damaging impact of political rhetoric and structural discrimination that has placed many long-term drug users vulnerable to relapse. In response to these findings the author offers a new conceptual framework for practice that incorporates and pro-motes an understanding of the social nature and context of long-term drug dependence.
How drug policy should (not) be: Institutionalised young people's perspectives
International Journal of Drug Policy, 2011
Background: Drug prevention is insufficiently tailored to the needs of vulnerable groups and often concentrates on the general population. Methods: A qualitative youth-centred design, based on group techniques was used to ask vulnerable young people about their needs and expectations regarding drug prevention practices. Participants comprised 160 young people, aged 12-21 years who had emotional and behavioural disorders and who lived in institutions in the mental health care system in Flanders. Results: Findings showed that common prevention and education practices are often insufficient or not applicable to the participants' situation. The young people criticised the institutions' reaction to drug use because it tried to control and sanction their use and paid scant attention to their reasons for drug use. They also held negative views about drug treatment. Their experiences had taught them that control and sanctioning were the dominant reactions to drug use. Conclusion: If drug (prevention) policy is to appeal to vulnerable young people, their views on what would make a good prevention policy must be taken into account.
Mental Health and Substance Use: Dual Diagnosis, 2012
Working with clients with multiple and complex needs represents a significant challenge for drug and alcohol services. Many clients presenting to these services have multiple and complex needs, associated with, but not limited to, cognitive impairment and/or contact with the criminal justice system. This article examines a subset of recent scholarly literature associated with provision of drug and alcohol services to clients with complex needs and its connections with drug and alcohol service provision by non-government drug and alcohol services in New South Wales (NSW), Australia. A limited literature review of scholarly literature related to working with clients with complex needs was undertaken. Publications were included if they specifically discussed policy or programmes associated with multiple and complex needs postdating 2000. An examination of service provision by metropolitan, regional and remote non-government drug and alcohol services followed the literature review. The scholarly literature around programmes working with clients with complex needs suggests that it is often difficult to disentangle complex needs, such as cognitive impairment and offending behaviour. Five case studies representing real-world practices from the examination draw together the scholarly literature and the landscape of service provision as described by drug and alcohol services in NSW. The aim of this article is to explore the drug and alcohol service delivery landscape in NSW in the context of literature relating specifically to the intersection of complex needs such as cognitive impairment, contact with the criminal justice system and unstable accommodation.
Understanding Problematic Drug Use: A Medical Matter or a Social Issue?
his paper questions the notion that problem drug use is essentially a physiological medical problem that requires coercive treatment, from which success are measured by way of drug testing to determine the abstinence from the drug. The article argues that the causes and solutions to problem drug use are much more to do with socio-economic factors than physiological or psychological factors. In particular it explores the connections between the emergence and sudden rise in problematic drug use that occurred across the UK in the mid 1980s, with de-industrialisation and the decline of opportunities for unskilled non academic young people. Further the paper critically examines the notion of the ‘problem drug user’, in particular how those identified and labelled, are perceived and treated by wider society, and how this adversely impacts upon drug rehabilitation and social integration.
Making voices heard: access to health and social services for substance users
2008
Foreword cannot be responsible for solving drug problems, rather such responsibility is shared between an individual drug user and the community in which he or she lives. Thus, drug use must be treated according to scientific research and not an ideology. Ideology may only lead to a stricter repression, a breach of fundamental human rights or to apathy, ignoring calls to recognise science and profession as well as deficient actions. It is necessary to check appropriateness and effectiveness of existing assistance programmes for such groups. The present reports contain information on rights to health, appropriate health care and social security for vulnerable groups. Our publication intends to raise awareness on partnership communication under which a drug user and an expert together decide on a treatment suitable to their views and opportunities. It advocates cooperation and a balance of various high threshold and low threshold approaches, a greater involvement of outreach work as a method to approach 'hidden' populations and a larger investments into preventative approaches. We hope that the information collected on extremely moving stories on (not) overcoming obstacles will contribute towards better accessibility, attainability and acceptance of health care and social services for drug users. As drug users may also be co-creators of programmes and at the same time co-responsible for their challenges, the results of treatment are better. Empowering drug users, together with assistance on personal growth, acknowledges them as entities within different system frameworks. It means joint elimination of barriers and replacing obtrusive role of medicated or criminal entities, with a distribution of decision-making power and responsibility between all the subjects. To this end, it is necessary to enable setting up self-help groups for drug users. Within the context of respecting a democratic approach and human rights, it is important to also support organised meetings for individuals and groups who, due to their vulnerability and life deprivation, cannot help themselves. The reports draw attention to unsatisfied needs of 'hidden' drug users and their needs for social integration. Taking everything into consideration, we are aware of fundamental deficiencies. The book mainly reports on aspects of drug users and it does not take into consideration the needs of their extended family, as well as of experts and their organisations. One can refer to an old saying that 'everyone sees the world through his own eyes'. It will therefore be important to continue learning about the needs of all subjects in solving drug problems. We wish to stimulate a more constructive dialogue, improve the exchange of information between different partners, working on enforcing rights of all threatened and vulnerable groups, and at the same time, point to their shared responsibility for addressing difficulties. Mag. Dušan Nolimal, Msc, Dr. med., Head and main researcher of the Slovenian team 8 Contents Partner organisations in five European member states developed and implemented the study in their own country, adapted to the local situation and to their specific target group. The organisation Enghaven in Denmark focussed its research on barriers to access to social and health services for homeless people, sex workers and drug users. Unfortunately, the report of this Danish study could not be included, due to problems in the process of the research. The Research Institute on Drug Studies (RIDS) in Hungary centred its research on barriers to access to social and health treatment for problem drug users currently out of treatment. The goal of this study was to reveal the reasons why this high-risk group was denied any given form of treatment and needle exchange programmes-or if they did gain entry, what difficulties they were facing. The research sample of this study consisted of 67 problem drug users. The pilot test took place in March 006 and data collection took place from April 006 to July 006. The results of the Hungarian study showed that methadone maintenance treatment and drug rehabilitation services were particularly hard to access, while needle exchange services and day care were judged easily accessible. Long waiting lists were one hindrance mentioned A last important remark is that organisations that strive to involve their target groups have to make sure that preconditions are met for the members of that target group. Working with drug users for example means that participants need to be able to fulfil their daily needs, like taking methadone. It may also mean paying them for their activities in order to boost their motivation. Organisation Country Research focus Research Institute on Drug Studies Hungary Barriers to access to social and health services for problem drug users currently out of treatment. 1 3. Barriers to treatment and needle exchange among problem drug users in Budapest been in treatment with those who had been seeking treatment. The basic difference between members of the two groups is the length of their drug career: those seeking treatment had been using drugs for a longer period of time-that, presumably, is the reason why they are seeking help. 3.3 Methods Problem drug use According to the EMCDDA definition, the problem drug user is one who uses a drug intravenously and/or one who has been using opiates, cocaine and/or amphetamine related substances regularly and for a long time (EMCDDA, 1999.). Drug use treatment When using the definition of problem drug use, we made use of EMCDDA guidelines (EMCDDA, 00.). According to these, any provision aimed at health-and/or psychosocial disorders so that complete or partial abstinence from drugs is reached, is qualified as treatment, as long as it takes place in a well-defined environment. Using this definition, we may define as treatment the following: outpatient services; residential services; drug rehabilitation; day care/provision; methadone maintenance; and psychosocial forms of care offered by low-threshold services. Although needle and syringe exchange does not qualify as treatment, we have looked at circumstances of and obstacles to accessing this service as well.
PLOS ONE, 2023
Background Early intervention alcohol and drug (AOD) programs for disadvantaged young people have the potential to substantially decrease the need for future intervention, however there is little research about how young people use these programs or the substance use and other outcomes of such programs. This paper uses data from an Australian AOD early intervention program, The Street Universities, to: describe young people's participation; examine changes in substance use and wellbeing over 90 days; and assess which young people are most positively impacted Methods Data come from a prospective study of new attendees, measuring retention in and attendance patterns in an 'engagement' program focussed on arts and lifestyle activities (n = 95), and a routine service dataset collected from seven years of therapeutic intervention (n = 3,893), measuring substance dependence (SDS), psychological distress (K10) and quality of life (EQoL) Results Analysis reveals that young people were retained in the program at high proportion (63% at six months) and more than half of these returned at a frequency of weekly or more often. Young people participating in the therapeutic component of the program reported significant improvements in all key wellbeing indicators with SDS, K10 and EQoL scores significantly improving (at p < .001). These improvements occurred rapidly, within the first 30 days, and were maintained over the 90 day study period. Moreover, young people with the highest SDS and K10 scores and lowest quality of life at baseline experienced the most positive changes.
Harm, tangible or feared: young Victorians' adverse experiences from others' drinking or drug use
The International journal on drug policy, 2014
Harms from alcohol experienced by someone other than the drinker have received increasing attention of late, but have not been compared to harms from others' drug use. The aim of the current study is to compare the reported harms that are attributable to the alcohol use of others to those attributable to drugs, distinguishing between different types of harm in order to highlight how reported harms may be influenced by perception and social standing of use of the substance. Respondents aged 16-24 from Victoria, Australia, completed the Victorian Youth Alcohol and Drug Survey (n=5001), including questions on demographics, drug and alcohol consumption, on the types of harms they experienced attributable to drugs and alcohol, as well as harms they perpetrated after using drugs or alcohol. For both drug and alcohol related harms, reports of harms loaded into two groups using multiple correspondence analysis: tangible harms such as assault, and amenity impacts such as being annoyed by...
Social Science & Medicine, 2008
This article uses qualitative interviews with 53 problematic drug users who had dropped out of treatment in England, UK to explore how they describe the stigmatisation of drug users and drug services. It discusses the construction of the category of the junkie through its association with un-controlled heroin use and criminality. It shows how some drug users carefully manage information about their discreditable identities by excluding themselves from this category, while acknowledging its validity for other drug users. The junkie identity was generally seen as shameful and therefore to be avoided, although it holds attractions for some drug users. For many of the interviewees, entry to treatment risked exposing their own activities as shaming, as they saw treatment as being a place that was populated by junkies and where it becomes more difficult to manage discreditable information. The treatment regime, e.g. the routine of supervised consumption of methadone, was itself seen by some as stigmatising and was also seen as hindering progress to the desired 'normal' life of conventional employment. Participation in the community of users of both drugs and drug services was perceived as potentially damaging to the prospects of recovery. This emphasises the importance of social capital, including links to people and opportunities outside the drug market. It also highlights the danger that using the criminal justice system to concentrate prolific offenders in treatment may have the perverse effects of excluding other people who have drug problems and of prolonging the performance of the junkie identity within treatment services. It is concluded that treatment agencies should address these issues, including through the provision of more drug services in mainstream settings, in order to ensure that drug services are not seen to be suitable only for one particularly stigmatised category of drug user.
Harm Reduction Journal
Background: Drug users' organizations have made progress in recent years in advocating for the health and human rights of people who use illicit drugs but have historically not emphasized the needs of people who drink alcohol. Methods: This paper reports on a qualitative participatory needs assessment with people who use illicit substances in British Columbia, Canada. We held workshops in 17 communities; these were facilitated by people who use illicit drugs, recorded with ethnographic fieldnotes, and analyzed using critical theory. Results: Although the workshops were targeted to people who use illicit drugs, people who primarily consume alcohol also attended. An unexpected finding was the potential for drug users' organizations and other harm reduction programs to involve "illicit drinkers": people who drink non-beverage alcohol (e.g. mouthwash, rubbing alcohol) and those who drink beverage alcohol in criminalized ways (e.g., homeless drinkers). Potential points of alliance between these groups are common priorities (specifically, improving treatment by health professionals and the police, expanding housing options, and implementing harm reduction services), common values (reducing surveillance and improving accountability of services), and polysubstance use. Conclusions: Despite these potential points of alliance, there has historically been limited involvement of illicit drinkers in drug users' activism. Possible barriers to involvement of illicit drinkers in drug users' organizations include racism (as discourses around alcohol use are highly racialized), horizontal violence, the extreme marginalization of illicit drinkers, and knowledge gaps around harm reduction for alcohol. Understanding the commonalities between people who use drugs and people who use alcohol, as well as the potential barriers to alliance between them, may facilitate the greater involvement of illicit drinkers in drug users' organizations and harm reduction services.