Recovering Heroin Users Research Articles

<p>An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification</p>

BackgroundGiven that fewer than 50% of countries provide Opioid Agonist Maintenance Therapies (OAMT), it is important to assess whether other substances act as a substitute for heroin in recovering heroin users who receive detoxification models of treatment. There is a dearth of prospective studies from low-and-middle-income countries evaluating these patterns of substance use.Methods300 heroin users from the Gauteng province of South Africa were assessed on entry into inpatient detoxification and then followed-up 3 and 9 months after leaving treatment. Treatment consisted of 1 week of detoxification followed by 6–8 weeks of psychosocial therapy. We measured the overall changes in the prevalence of heroin, alcohol and other drug use at baseline and postrehabilitation. Comparison of these outcomes at enrolment, 3 months and 9 months was performed by a Generalised Estimating Equation (GEE) with the outcome as the dependent variable, observation point as the independent variable, and participant as the repeated measure. Injecting status and treatment completion were included as covariates. We also measured the individual pathways between heroin and alcohol use in the 210 participants that were seen at all three timepoints.ResultsOf the original cohort, 252 (84.0%) were re-interviewed at 3 months and 225 (75.0%) at 9 months. From baseline to 3 months, the proportion of past month heroin users decreased significantly to 65.5%; however, during this time, the proportion of past month alcohol users increased from 16.3% to 55.2% (p<0.0001). When assessing the pathways between heroin and alcohol use at an individual level, 55.4% (n-97) of those who were past month alcohol abstinent prior to rehabilitation were using alcohol at 3 months. From 3 to 9 months the proportion of heroin users increased to 72.4% (p<0.0001), and during this time, the proportion of alcohol users decreased.ConclusionAfter detoxification, a significant reduction in heroin use was observed with a concomitant increase in alcohol consumption. Under these circumstances, alcohol may have acted as a substitute for heroin in the short term. The initial reduction in heroin use 3 months postrehabilitation was followed by increased consumption 6 months later. This observation supports the need for interventions to prevent, monitor and treat high levels of alcohol use in heroin users post detoxification. The provision of OAMT is a necessary consideration to address both the risk of increased alcohol intake as well as the decline in heroin abstinence rates.

Drugs: Bodies Becoming “Normal”

"People say, “don’t you ever want to come off?” I don’t know. The thought of me getting up without taking something is totally... to me that’s normal. If I haven’t taken anything then I’m not normal. And for me to even, I can’t contemplate not taking something, you know. I’m not a lost cause. I know what my problem is. It’s other people that want me to stop. I don’t want to stop. I don’t want to. Does that make sense to you?" (Mya) This extract is taken from an interview that formed part of my doctoral research looking at people’s experiences of injecting drug use and treatment services in London, UK. Here I consider one of the ways participants described their use of drugs through a concept of becoming “normal.” I pay particular attention to Mya’s account and explore the very sense-making that her question (above) demands. Mya uses the concept of normality not only to reflect how drugs have become part of her everyday routines, or part of feeling normal, but actually in materially becoming herself—in embodying a “normal body.” As she puts it, “if I haven’t taken anything then I am not normal.” In this sense, Mya’s problem is not the drugs, but the people who want her to stop taking them. This understanding is important for challenging recent policy shifts towards reducing opiate replacement/substitution services in the UK (HM Government; Home Office).

Income Generation in Recovering Heroin Users: A Comparative Analysis of Legal and Illegal Earnings

Research has shown employment to be a central mediator to sustained recovery and community reentry for substance abusers; however, heroin users have lower employment rates and report lower mean incomes than other drug users. The authors of the present study assessed income-generating behaviors of substance users recruited from substance abuse treatment facilities (N = 247). Heroin users had higher mean incomes from illegal sources. Further, logistic regression analysis found heroin use to increase the likelihood of engagement in illegal income generating behaviors. As these results increase the likelihood of involvement in the criminal justice system, the implications for heroin specific treatment and rehabilitation are discussed.

Recovering a Fecal Habitus: Analyzing Heroin Users' Toilet Talk

There is a particular silence around the social life of defecation. Little analyzed, rarely discussed in polite conversation, it largely appears only at moments of dysfunction. For active heroin users, digestion is often characterized by such dysfunction and experienced through constipation; recovery, a welcome return to defecating ‘normally.’ Drawing on interviews with active and recovering heroin users in southern England, we focus on this moment of transition in order to illuminate the experiences and transitions between a dysfunctional, constipated body and ‘normal’ defecation. We discuss the contrast between candor in talk in active use with the silences surrounding defecation talk in recovery, and analyze these twin shifts within the context of a historical progression within Europe toward ever-increasing levels of masking defecation from social life. Located thus, this analysis of the tipping point between constipation and ‘normality,’ disclosure and embarrassment, provides a powerful lens through which to view the invisibility of defecation in contemporary British social life.

‘I just want to be normal’: An analysis of discourses of normality among recovering heroin users

Research that has explored the lives of men and women recovering from heroin addiction has reported that users often claim that they 'just want to be normal'. Working within a Foucauldian tradition, we argue in this article that the notions of 'governmentality' and the 'norm' are especially apposite to understanding the ubiquity of this aspiration. Here we focus not on the formal institutions of governance that encourage individuals to adhere to social, cultural and political norms, but rather seek to explore recovering users' accounts of normality as they are envisaged and expressed. The reported empirical data were generated from interviews with 40 men and women in England at various stages of recovery from heroin use. The analytic focus is upon the accounts of normality articulated during the interviews in order to identify the ways in which being normal is presented by the participants. In keeping with the methodological tradition of discourse analysis we identify six discursive repertoires of 'normality talk' that transcend the accounts. It is concluded that the negotiation of normality is a precarious route for this social group. Articulations of a desire to be normal are replete with tensions; there are expressions of both resistance and resignation. Despite claims by some contemporary social theorists that diversity is the 'new normality', the accepted bounds of 'difference' are limited for those who have been addicted to heroin.

Techniques and transitions: A sociological analysis of sleeping practices amongst recovering heroin users

This paper seeks to make sense of the sleeping practices of people who are recovering from heroin use. It brings together two hitherto unrelated literatures: the sociology of sleep and studies on heroin use and recovery. Conceptual resources developed within the sociology of sleep are deployed to facilitate the analysis of interview data generated as part of a qualitative investigation into the everyday lives of recovering heroin users living in England. Twenty one men and 19 women were interviewed with 37 of the 40 being interviewed twice, giving a corpus of 77 interviews. Without exception all the participants in the research experienced extensive sleeping problems that were not only exacerbated by the pharmacological effects of heroin, but were made worse by the way of life that accompanied their using. Irregular and anarchic sleeping practices mirrored the study participants’ disrupted and difficult lives. Attempts to establish sleep routines, and normative sleeping patterns, constitutes an important marker of recovery, but after years, and for some decades, of chaotic, intermittent and irregular sleeping, cultivating sleep presents a series of difficult challenges. Their embodied biographies of heroin use constrain the promotion of sleep, and attempts to develop rituals and routines to restore sleeping patterns are confounded by the involuntary aspects of sleep and their recalcitrant bodies. These findings are significant because not only is the quality of sleep critical to health outcomes but it also forms an important but hitherto relatively overlooked aspect of recovery from heroin use.

‘I don’t think there’s much of a rational mind in a drug addict when they are in the thick of it’: towards an embodied analysis of recovering heroin users

Much of the sociological literature on recovery from heroin use has been located within the symbolic interactionist tradition and has revealed the salience of identity for the recovery process, and has focused upon actors' cognitions. By contrast, less attention has been paid to former users' bodies. The aim of this paper therefore is to focus upon the embodied aspects of recovery from heroin use. To this end, we deploy the notions of bodily 'dys-appearance' and 'habitual action' as sensitising concepts to undertake an analysis of data generated by 40 qualitative interviews carried out with 21 men and 19 women who are overcoming their addiction to heroin in England. Analytically, we distinguish between using bodies and recovering bodies. In the case of the former, 'habitual action' is relatively urgent and routinised; in the case of the latter, however, habitual action is more difficult to maintain because the bodily dys-appearances associated with the transition from heroin use are relatively more multifaceted and unfamiliar. The body techniques associated with embodied reproduction of using and recovering bodies can be pre-cognitive, easily overlooked and yet, embedded as they are in mundane, everyday activities, they constitute a crucial part of the process of recovery from heroin.

What is the role of harm reduction when drug users say they want abstinence?

Quantitative survey data indicate that most drug users starting treatment want abstinence rather than harm reduction (McKeganey et al., 2004). This finding has been seized upon by those seeking ‘evidence’ that abstinence is the bedrock of recovery and harm reduction is a negative and oppositional philosophy. However, all research involves questions of meaning, definition and value and an alternative research paradigm and different study design can provide important additional insights into treatment aspirations, including the desire for abstinence. Qualitative interviews conducted with 30 recovering heroin users (15 males and 15 females) in Southern England in 2009 confirm that those starting treatment often report a desire for abstinence. Nonetheless, drug users are frequently uncertain about their ability to achieve this and can have very different and inconsistent understandings of what being abstinent means. We suggest that the work of the critical theorist Habermas (1970, 1991) could improve our understanding of abstinence and is consistent with recent efforts to achieve a working definition of recovery. Importantly, our qualitative data also reveal that drug users have treatment aspirations that extend far beyond their drug consumption. They additionally want to improve relationships, engage in meaningful activities, acquire material possessions, and achieve better mental and physical health. Moreover, these broader life goals are often inextricably linked to their drug taking. From this, we conclude that both abstinence and harm reduction discourses should more routinely prioritise the many diverse ‘wellness’ goals that so clearly motivate treatment clients. The harm reduction field will then likely find that it has more in common with abstinence-oriented services and the broader recovery agenda than it might otherwise have imagined.

Adherence to hepatitis C treatment in recovering heroin users maintained on methadone

Injection drug users are often denied hepatitis C (HCV) treatment due to concerns about adherence, despite limited data about the impact of such common issues as psychiatric illness and intercurrent drug use. We sought to define the impact of these and other potential adherence barriers in a real-world sample of recovering drug users. We conducted a prospective observational study of 71 methadone-maintained patients who received interferon and ribavirin combination therapy in a community-based clinic with expertise in treating addictive disorders. Adherence measures were conducted with monthly interview, medication counts, and urine toxicology testing. Overall, 48 (68%) were adherent, and adherent patients were significantly more likely to achieve a sustained virologic response (42 vs. 4% in nonadherent patients). Patients with and without a prior psychiatric history were similarly adherent (64 vs. 72%, respectively, P>0.5), and the initiation of new psychiatric medications during HCV treatment was associated with improved adherence overall (P=0.02) and in patients that did not report a preexisting psychiatric diagnosis (P=0.04). Trend towards reduced adherence in patients without a period of abstinence was seen before initiating HCV treatment, 46 vs. 72% of those who had been abstinent for at least 1 month (P=0.10). Although occasional drug users were similarly adherent to those who were completely abstinent, patients who relapsed to regular drug use showed a significantly lower level of adherence (P=0.03). We conclude that the majority of methadone-maintained drug users can adhere to HCV treatment, even those with psychiatric illness and relatively limited pretreatment drug abstinence. Lack of pre-HCV treatment drug abstinence and regular drug use during HCV treatment may be relative barriers to medication adherence, but the initiation of psychiatric medications during HCV treatment may be a helpful intervention. This report provides further evidence for an individualized approach to HCV treatment that does not categorically exclude patients with potential barriers such as mental illness and limited drug abstinence.

Education by peers is the key to success

We are a Latino, a white guy and an African American, and we are all peer educators in the hepatitis C programme at Organization to Achieve Solutions in Substance Abuse, Inc. (OASIS), a not-for-profit medical clinic in Oakland, California. We are all recovering heroin users who got hepatitis C from using needles and we all managed to stop using drugs. In the same way, we all went through hepatitis C treatment; one of us was a sustained responder, one a non-responder, and one a relapsing non-responder who is still on maintenance interferon. We have written this paper to tell our story. We believe that good education about hepatitis C encourages people to take better care of themselves, get tested and treated when necessary, and can motivate them to cut down or stop using drugs. In short, we use hepatitis C to encourage people to get their lives together. Many of the people we have educated go out to the community and educate other people who need it. We invite others to join our struggle, because we never thought we would make it this far.

The impact of barriers to hepatitis C virus treatment in recovering heroin users maintained on methadone

Although most cases of hepatitis C virus (HCV) infection are associated with injection drug use, there are few data regarding the impact of putative barriers such as psychiatric disease and intercurrent drug use on HCV treatment outcomes. To define the impact of characteristics often cited as reasons for withholding HCV treatment, we studied HCV treatment in a real world sample of 76 recovering heroin users maintained on methadone. Overall, 21 (28%) had a sustained virological response and 18 (24%) discontinued treatment early. Although there was a modest decrement in response rates in patients reporting a preexisting psychiatric history ( p = .01), neither intercurrent drug use nor short duration of pretreatment drug abstinence led to significant reductions in virological outcomes ( p = .09 and p = .18, respectively.) We conclude that injection drug users can be safely and effectively treated for HCV despite multiple barriers to treatment when they are treated in a setting that can address their special needs.

Dissociative Phenomena Among Recovering Heroin Users and Their Relationship to Duration of Abstinence

ABSTRACT This study is an investigation of trauma and dissociation in 100 Israeli recovering patients with drug use disorder. The respondents showed more emotional, physical and sexual traumatization than an Israeli clinical sample, and their levels of dissociation were similar to those previously measured in Israeli patients diagnosed with Posttraumatic Stress Disorder and Acute Stress Disorder (Somer, Dolgin, & Saadon, 2001). Male respondents with higher trauma scores were more likely to report dissociative experiences during their drug use (chemical dissociation). Drug-free high-dissociators were more likely to report depersonalizing and derealizing experiences when they had been using drugs. Stronger dissociative experiences during drug-use related to more psychological distress during inter-use craving. A relationship between psychological distress during inter-use craving and psychological dissociation measured in a detoxified state was also established. Length of abstinence from illicit substances was best predicted by lower levels of psychogenic dissociation and by longer durations of psychosocial treatment. While findings imply that tenacity in treatment could be a sustaining process associated with abstinence from drug use, they also suggest that without a thorough resolution of trauma-related dissociation, successful treatment outcome is less likely.