“I Know It Is Going to Ruin Their Life:” Fortune-Telling, Agency, and Harm Reduction in Narratives Concerning Injection Initiation Assistance

ObjectivesThe HIV epidemic in India is concentrated in key populations such as people who inject drugs (PWID). New HIV infections are high among young PWID (≤30 years of age), who are hard to engage in services. We assessed perspectives of young PWID to guide development of youth-specific services.SettingWe conducted focus group discussions (FGDs) with PWID and staff at venues offering services to PWID in three Indian cities representing historical and emerging drug use epidemics.ParticipantsPWID were eligible to participate if they were between 18 and 35 years, had initiated injection as adolescents or young adults and knew adolescent PWID in their networks. 43 PWID (81% male, 19% female) and 10 staff members participated in FGDs. A semistructured interview guide was used to elicit participants’ narratives on injection initiation experiences, barriers to seeking harm reduction services, service delivery gaps and recommendations to promote engagement. Thematic analysis was used to develop an explanatory model for service engagement in each temporal stage across the injection continuum.ResultsInjection initiation followed non-injection opioid dependence. Lack of services for non-injection opioid dependence was a key gap in the preinjection initiation phase. Lack of knowledge and reliance on informal sources for injecting equipment were key reasons for non-engagement in the peri-injection phase. Additionally, low-risk perception resulted in low motivation to seek services. Psychosocial and structural factors shaped engagement after established injection. Housing and food insecurity, and stigma disproportionately affected female PWID while lack of confidential adolescent friendly services impeded engagement by adolescent PWID.ConclusionsDevelopment of youth-specific services for young PWID in India will need to address unique vulnerabilities and service gaps along each stage of the injection continuum. Scaling-up of tailored services is needed for young female PWID and adolescents, including interventions that prevent injection initiation and provision of confidential harm reduction services.

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Young and invisible: an explanatory model for service engagement by people who inject drugs in India

10.1101/2021.02.23.21252222 ◽

2021 ◽

Author(s):

Lakshmi Ganapathi ◽

Aylur K Srikrishnan ◽

Clarissa Martinez ◽

Gregory M Lucas ◽

Shruti H Mehta ◽

...

Keyword(s):

Drug Use ◽

Harm Reduction ◽

Opioid Dependence ◽

People Who Inject Drugs ◽

Structured Interview ◽

Explanatory Model ◽

List Type ◽

Structural Factors ◽

Injection Initiation ◽

Service Engagement

ABSTRACTIntroductionThe HIV epidemic in India is concentrated in key populations such as people who inject drugs (PWID). New HIV infections are high among young PWID (≤ 30 years of age), who are hard to engage in services. We assessed perspectives of young PWID across three Indian cities representing historic and emerging drug use epidemics to guide development of youth-specific services.MethodsWe conducted focus group discussions (FGDs) with PWID (ages 18-35 years) and staff at venues offering services to PWID in three cities (Aizawl and Imphal, Northeast India and Amritsar, Northwest India). A semi-structured interview guide was used to elicit participants’ narratives on injection initiation experiences, motivating factors and barriers to seeking harm-reduction services, service-delivery gaps, and recommendations to promote engagement.Thematic analysis was used to develop an explanatory model for engagement for each temporal stage across the injection continuum: (a) pre-injection initiation, (b) peri-injection initiation and (c) established injection behavior.Results43 PWID (81% male, 19% female) and 10 staff members participated in FGDs. Injection initiation followed non-injection opioid dependence. Lack of services for non-injection opioid dependence was a key gap in the pre-injection initiation phase. Lack of knowledge and reliance on informal sources for injecting equipment were key reasons for non-engagement in the peri-injection phase. Additionally, low risk perception resulted in low motivation to seek services.Psychosocial and structural factors shaped engagement after established injection. Housing and food insecurity, and stigma disproportionately affected female PWID while lack of confidential adolescent friendly services impeded engagement by adolescent PWID.ConclusionsDevelopment of youth-specific services for young PWID in India will need to address unique vulnerabilities and service gaps along each stage of the injection continuum. Scaling-up of tailored services is needed for young female PWID and adolescents, including interventions that prevent injection initiation and provision of confidential harm-reduction services.STRENGTHS AND LIMITATIONSThe findings in this study represent some of the first qualitative data to explore engagement with services, specifically among young PWID in India.The study was conducted in multiple cities representing older and emerging injection drug use epidemics. The inclusion of multiple cities adds strength to the findings.We did not recruit adolescent PWID due to constraints rendered by laws pertaining to informed consent in India.Although all PWID we recruited had initiated injection in adolescence or young adulthood, the preponderance of older PWID in our study limits the conclusions we can draw about the needs of adolescent PWID.

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Unknown and Under-Researched: The Anatomy of Drinking Under Control Programs

SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice ◽

10.1024/0939-5911/a000504 ◽

2017 ◽

Vol 63 (5) ◽

pp. 277-288

Author(s):

Harald Klingemann ◽

Justyna Klingemann

Keyword(s):

Quality Of Life ◽

Harm Reduction ◽

Evaluation Studies ◽

Mission Statements ◽

Community Response ◽

Limited Resources ◽

Admission Criteria ◽

Control Programs ◽

Institutional Order

Abstract. Introduction: While alcohol treatment predominantly focuses on abstinence, drug treatment objectives include a variety of outcomes related to consumption and quality of life. Consequently harm reduction programs tackling psychoactive substances are well documented and accepted by practitioners, whereas harm reduction programs tackling alcohol are under-researched and met with resistance. Method: The paper is mainly based on key-person interviews with eight program providers conducted in Switzerland in 2009 and up-dated in 2015, and the analysis of reports and mission statements to establish an inventory and description of drinking under control programs (DUCPs). A recent twin program in Amsterdam and Essen was included to exemplify conditions impeding their implementation. Firstly, a typology based on the type of alcohol management, the provided support and admission criteria is developed, complemented by a detailed description of their functioning in practice. Secondly, the case studies are analyzed in terms of factors promoting and impeding the implementation of DUCPs and efforts of legitimize them and assess their success. Results: Residential and non-residential DUCPs show high diversity and pursue individualized approaches as the detailed case descriptions exemplify. Different modalities of proactively providing and including alcohol consumption are conceptualized in a wider framework of program objectives, including among others, quality of life and harm reduction. Typically DUCPs represent an effort to achieve public or institutional order. Their implementation and success are contingent upon their location, media response, type of alcohol management and the response of other substance-oriented stake holders in the treatment system. The legitimization of DUCPs is hampered by the lack of evaluation studies. DUCPs rely mostly – also because of limited resources – on rudimentary self-evaluations and attribute little importance to data collection exercises. Conclusions: Challenges for participants are underestimated and standard evaluation methodologies tend to be incompatible with the rationale and operational objectives of DUCPs. Program-sensitive multimethod approaches enabled by sufficient financing for monitoring and accompanying research is needed to improve the practice-oriented implementation of DUCPs. Barriers for these programs include assumptions that ‘alcohol-assisted’ help abandons hope for recovery and community response to DUCPs as locally unwanted institutions (‘not in my backyard’) fuelled by stigmatization.

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Motivational Interviewing: Ein Literaturüberblick

SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice ◽

10.1024/suc.2001.47.3.171 ◽

2001 ◽

Vol 47 (3) ◽

pp. 171-188 ◽

Cited By ~ 6

Author(s):

Ralf Demmel

Keyword(s):

Motivational Interviewing ◽

Harm Reduction ◽

Motivational Enhancement Therapy ◽

Motivational Enhancement ◽

Motivationale Interventionen

Der dysfunktionale Konsum psychotroper Substanzen geht in der Regel mit einem Zwiespalt zwischen Abstinenzvorsatz bzw. der Absicht, den Konsum zu reduzieren, einerseits und dem Wunsch oder Zwang, den Konsum fortzusetzen, andererseits einher. Das von Miller und Rollnick (1991) beschriebene Motivational Interviewing (MI) ist ein zugleich klientenzentrierter und direktiver Behandlungsstil, der dieser Ambivalenz Rechnung tragen und somit Veränderungsbereitschaft erhöhen soll. Miller und Rollnick (1991) nennen fünf Prinzipien motivationaler Gesprächsführung: <OL><LI>Empathie, <LI>Widersprüche aufzeigen, <LI>Wortgefechte vermeiden, <LI>Nachgiebig auf Widerstand reagieren und <LI>Selbstwirksamkeit fördern.</OL> Diese Prinzipien stimmen mit den Annahmen (sozial-) psychologischer Modelle der Einstellungs- und Verhaltensänderung überein. Seit Ende der achtziger Jahre wurden vorwiegend in den angelsächsischen Ländern verschiedene motivationale Interventionen zur Sekundärprävention und Behandlung von Substanzabhängigkeit und -missbrauch entwickelt, die den von Miller und Rollnick (1991) formulierten Behandlungsprinzipien entsprechen (der Drinkers Checkup, Motivational Enhancement Therapy, das Harm-Reduction-Programm BASICS, Brief Motivational Interviewing, Brief Negotiation sowie eine Reihe weiterer motivationaler Kurzinterventionen). Vor dem Hintergrund der bislang vorliegenden Literatur erscheint insbesondere die Durchführung standardisierter motivationaler Interventionen zur Reduktion dysfunktionalen Alkoholkonsums bzw. der negativen Konsequenzen eines fortgesetzten Alkoholmissbrauchs gerechtfertigt. Voraussetzungen einer Optimierung des Behandlungserfolgs sind neben der Identifikation zentraler Wirkmechanismen u.a. eine fortlaufende Prozess-Evaluation der Implementierung motivationaler Interventionen sowie eine evidenzbasierte Ausbildung.

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