Epidemiology Abuse: Epidemiological and Psychosocial Models of Drug Abuse

Abstract

Epidemiological and psychosocial approaches to drug abuse are discussed, with specific reference to the limits of the narrow epidemiological model when applied to the dynamics of heroin addiction, especially the elimination of heroin supply. During the early sixties there was much controversy between medical and psychosocial models of drug abuse with respect to methadone maintenance treatment programs versus drug free treatment programs. Frequently drug abuse treatment facilities would refuse to have both types of programs available, but after some time the differences which were thought to be irreconcilable were in fact reconciled and the field moved towards a synthesis of drug free and methadone maintenance approaches. The same thing needs to occur with respect to epidemiological and psychosocial approaches to drug abuse. The current narrow epidemiological approaches to drug abuse focus on heroin itself and ways of eliminating heroin supply. Psychosocial models are concerned with alienation, societal inadequacies, and psychological deficiencies of addicts. Psychosocial approaches define heroin addiction as a symptom of a more widespread social and psychological malaise, while narrow epidemiological approaches consider the heroin addiction itself the sole problem. Epidemiological and psychosocial approaches to drug abuse should be integrated so that much valuable information produced by epidemiologists such as the dynamics of the spread of heroin addiction, the period of time that addicts remain infectious, and the natural life-history of epidemics can be combined with knowledge produced by psychosocial approaches to fashion a more comprehensive approach to drug abuse. An epidemiologically based approach calling for stringent control of heroin distribution to non-addict populations coupled with easy access to low cost heroin for addicted persons would reflect an appreciation of the psychological/social/political realities involved in addiction as well as a grounding in epidemiological principles and data.