A qualitative study investigating the association between social exclusion, stigma and long term problem drug use in a New Zealand town

<p>Background: The aim of this study is to investigate the association between problematic drug use (PDU) and social exclusion and stigma in a deindustrialised New Zealand town (DNZT). The purpose of this research is to capture the perceptions; experiences and life course journey of individuals with long term problematic drug use (IPDUs) and contribute new knowledge and understanding of this lived experience. Method: A review of national and international literature related to the phenomena of social exclusion, stigmatisation and problematic drug use was conducted to theoretically inform the study. The small-scale study employed a qualitative approach that involved a non-probability sample that met the criteria for long-term problematic drug use. This allowed respondents to share their perceptions and experiences of social exclusion, stigma and PDU in their own words and by their own frames of reference. The researcher occupied a position of insider. Following transcription of the interviews a six stage thematic analysis was conducted on the data. Findings: The downward social and psychological trajectory of this respondent group began before the respondents encountered long-term unemployment and before the onset of problematic drug use, initiated at an early age by common experiences of trauma, exclusion and damaged home environments. For this cohort it appears problematic drug use may have become a coping mechanism or relief from the reverberating impact of stigma, exclusion and marginalisation. Conclusion: The cohort interviewed show significant experiences of stigma, trauma and a disrupted life journey. These experiences became considerably exacerbated by problematic drug use and it appears most of the respondents have internalised and embraced a permanent status as ‘addicts’ with limited expectation of change. Respondents spoke of being ‘parked’ on methadone in respect of their drug problem and excluded from employment. This research suggests there is a need to look beyond the presented problem of addiction and its apparent solution of methadone maintenance treatment (MMT) and explore a more holistic strength-based approach that addresses issues of inequality, social care and discrimination.</p>

A qualitative study investigating the association between social exclusion, stigma and long term problem drug use in a New Zealand town

<p>Background: The aim of this study is to investigate the association between problematic drug use (PDU) and social exclusion and stigma in a deindustrialised New Zealand town (DNZT). The purpose of this research is to capture the perceptions; experiences and life course journey of individuals with long term problematic drug use (IPDUs) and contribute new knowledge and understanding of this lived experience. Method: A review of national and international literature related to the phenomena of social exclusion, stigmatisation and problematic drug use was conducted to theoretically inform the study. The small-scale study employed a qualitative approach that involved a non-probability sample that met the criteria for long-term problematic drug use. This allowed respondents to share their perceptions and experiences of social exclusion, stigma and PDU in their own words and by their own frames of reference. The researcher occupied a position of insider. Following transcription of the interviews a six stage thematic analysis was conducted on the data. Findings: The downward social and psychological trajectory of this respondent group began before the respondents encountered long-term unemployment and before the onset of problematic drug use, initiated at an early age by common experiences of trauma, exclusion and damaged home environments. For this cohort it appears problematic drug use may have become a coping mechanism or relief from the reverberating impact of stigma, exclusion and marginalisation. Conclusion: The cohort interviewed show significant experiences of stigma, trauma and a disrupted life journey. These experiences became considerably exacerbated by problematic drug use and it appears most of the respondents have internalised and embraced a permanent status as ‘addicts’ with limited expectation of change. Respondents spoke of being ‘parked’ on methadone in respect of their drug problem and excluded from employment. This research suggests there is a need to look beyond the presented problem of addiction and its apparent solution of methadone maintenance treatment (MMT) and explore a more holistic strength-based approach that addresses issues of inequality, social care and discrimination.</p>

Investigation of factors associated with low adherence to treatment of codependency in family members of psychoactive substance users

The aim of this study was to investigate possible factors that prevent adherence to the treatment of codependent family members of problem drug use individuals. A quasi-experimental study was carried out with 133 relatives of psychoactive substances users who called the Brazilian drug hotline (Ligue 132) between 2013 and 2015, from the five regions of Brazil. The following instruments were used: General service protocol; Family assistance protocol; Holyoake Codependency Index; Behavioral Adherence Scale; and Adherence Factor Questionnaire. Univariate analysis of data was performed for categorical variables and Chi-square test for comparison between variables, with p < 0.05. The sample showed a predominance of women (91.7%), especially mothers (82.7%). Among the investigated factors, alcohol as the substance involved in the problem showed a significant association with the non-adherence to treatment through teleintervention of family members.

Workshop: Better prison health for better public health

According to the latest data, in 2018 about 590,000 people were held in prison on any given day in the EU, and more than double in the entire region. People in prison face multiple and complex health care issues, including a higher prevalence of communicable diseases than the general population. These are likely to be the result of a combination of overlapping, and sometimes interlinked, risk factors for infection, ill-health, and incarceration, such as problem drug use. Incarceration may facilitate the offer of quality health care services to people who are otherwise hard to reach and provide an occasion to target socially deprived groups who often have low level of healthcare access when in the community. Delivering health protection and harm reduction programmes in prisons not only benefits the prison population but also has the potential to reduce the risk of transmission of some infectious diseases in the community, intervening earlier in the natural history of disease. They are also likely also to have a knock-on effect in supporting individuals’ reintegration into community life and future health - providing a ‘community dividend’ to health interventions in prisons. Yet, such health gains may be diminished by suboptimal integration with community services. Continuity of care, or throughcare, between prison and community services is a mainstay of any health care interventions delivered in detention, especially when tackling chronic conditions (e.g. HIV, mental illnesses) or problem drug use. The World Health Organization (WHO) has long supported the concept of prison health as an inseparable component of public health. This view is enshrined by the principle of Equivalence of Care between prison and community, endorsed by the United Nations in the Nelson Mandela Rules. During the 2019 WHO Prison Health Conference in Helsinki, it was acknowledged that prisons contribute to achieving the UN’s Sustainable Development Goals through improving health, reducing health inequalities and provide a fairer and safer society for all. However, a number of challenges hampers the successful implementation of such a concept, including the need for evidence-based decision making, inter-sectoral partnerships and adequate monitoring systems. This workshop will provide attendees with a comprehensive overview of prison health and the relevance of a multi-sectorial public health approach to frame and address it. The workshop will be structured around three main topics: governance of prison health and current models in Europe; health issues and disease burden in the prison population; current and future perspectives for evidence-based approaches to prison health. The discussion of two case studies, problem drug use and HCV micro-elimination, will create the context for an in-depth analysis of key challenges for prison health implementation, reflecting on aspects such as health needs, equity, multidisciplinarity, continuity of care, monitoring and community dividend. Key messages Provide a comprehensive picture of the main challenges of prison health in Europe, the public health issues affecting the prison population and how these relate to community public health systems. Reflect on how public health systems need to incorporate prison health into their strategies for reducing inequalities and improving health outcomes of vulnerable and socially deprived populations.

Men and the Drug Buzz: Masculinity and Men’s Motivations for Illicit Recreational Drug Use

The purpose of this article is to explore the motivations behind some men’s recreational use of illicit drugs from a gender standpoint. The rationale for this analysis stems from men’s predominance as illicit drug users and their likelihood of experiencing problem drug use and becoming a part of an over-represented population in drug treatment services. Explanations for men’s problematic/addicted patterns of drug use often point to marginalisation, disadvantage, and/or men’s tendency towards problematic health behaviours. This article argues that men’s illicit recreational drug use is often glossed over as a gendered activity and receives less scrutiny than problematic/addicted patterns of drug taking. It examines the drug-taking motivations of 20 Irish men who identified as illicit recreational drug users to expand on and deepen current explanations for men’s illicit recreational drug use. The article demonstrates how men engage in drug use for complex and contradictory reasons that include embodied quests for pleasure and excitement, achieving connection with other men, and performing or contravening masculinities in homosocial contexts.

Trends in addiction treatment in Irish prisons using national surveillance data, 2009–2014

Purpose Many studies show that incarcerated populations have higher rates of problem drug use than the general population. The purpose of this paper is to analyse trends in addiction treatment demand in prisons in Ireland from 2009 to 2014 using available national surveillance data in order to identify any implications for practice and policy. Design/methodology/approach National surveillance data on treatment episodes for problem drug and alcohol use from 2009 to 2014, collected annually by the National Drug Treatment Reporting System (NDTRS), were analysed. Findings In total, 6 per cent of all treatment episodes recorded by the NDTRS between 2009 and 2014 were from prison services. The number of prison service treatment episodes increased from 964 in 2009 to 1,063 in 2014. Opiates were the main reason for treatment, followed by alcohol, cocaine and cannabis. The majority (94–98 per cent) of treatment episodes involved males (median age of 29 years) and low educational attainment, with 79.5–85.1 per cent leaving school before completion of second level. The percentage of treatment episodes with a history of ever injecting drugs increased from 20.9 per cent in 2009 to 31.0 per cent in 2014. Practical implications This study can help policy development and service planning in addiction treatment in prison as it provides an insight into the potential needs of incarcerated populations. It also provides a baseline from which to measure any changes in provision of treatment in prison over time. Originality/value This is the first study to analyse treatment episodes in prison using routine surveillance data in Ireland. Analysis of these data can provide useful information, not currently available elsewhere.

Time to look beyond ageing as a factor? Alternative explanations for the continuing rise in drug related deaths in Scotland

Purpose The purpose of this paper is to examine the reasons and risk factors that explain the threefold increase in drug-related deaths from 267 in 1996 to 934 in 2017 in Scotland. The authors explore the known links between deprivation and problem drug use (PDU) and discuss the impact of drug policy and service provision on PDU and drug-related deaths. Design/methodology/approach Using quantitative data sets from the National Records of Scotland (NRS) for drug-related deaths registered in 2017 and data sets from the Scottish Index of Multiple Deprivation (SIMD), we produce statistical data on mortality rates relating to areas of deprivation, gender and age. Findings The data highlight the disproportionate number of deaths in the most deprived areas in comparison to the least deprived areas and the national average. Findings indicate that one quarter of male and female DRD in 2017 were under 35. When examining the least deprived vingtile, drug-related deaths account for 2.84 per 100,000 population. Based on this mortality rate calculation, the amount of drug-related deaths are 23 times higher in the most deprived area than the least deprived area. Research limitations/implications The research design uses data obtained from the NRS and data from Scottish Multiple Index of Deprivation. Due to the limitations of available data, the research design focused on SIMD population vingtiles. Practical implications This research contributes to making unarguable links between entrenched structural inequality and increased drug-related death. Social implications This paper contributes to knowledge on the need for drug policy advisors to recognise the importance of deprivation that plays a major part in risks of problematic drug use and harms. Originality/value While several national data sets have published information by SIMD vingtile, no published research has sought to investigate the disproportionate number of deaths by population in the most deprived areas.