Course of Heroin Addiction Essay Sample
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Course of Heroin Addiction Essay Sample
Discuss the importance and interplay of social, psychological and biological factors in the course of heroin addiction. What therapeutic approaches can be used to treat this form of drug dependence?
Heroin exerts its main effects through psychological mechanisms of action, the user feels a sense of great warmth and well-being and views the world with greatly reduced anxiety and emotional distress. These feelings last for a relatively short period of time of around 4-6 hours. With repeated use the user develops tolerance and the user will need greater quantities of the substance to achieve the same effect. In time, as addiction develops the user lifestyle alters to accommodate spending an increasing amount of time obtaining and consuming drugs. This is likely to lead to difficulties in employment and relationships, with less attention being given to their responsibilities and the needs of others. As a result they may turn to criminal activity to fund their habit, likely entailing physical and emotional hazards and bring them into contact with a dubious assortment of people. This essay will examine how the social, psychological and biological factors interact in heroin addiction and look at what therapeutic approaches exist to deal with this form of dependency.
Substance addiction, in general, is defined as the continued use of a substance despite it being clear that it is harming the individual (DSM IV, 1994). The most common form of treatment in heroin addiction is that of methadone maintenance treatment (MMT). Methadone is a synthetic opioid which acts on the opioid receptors in the brain, producing many of the same effects as heroin, thus acting as replacement therapy and reducing craving. Craving represents a feeling of desire to approach a pleasant stimulus (Oldham and Wright, 2001). At higher dosages methadone can block the euphoric effects of heroin and other similar opioid drugs, reducing the motivation to use illicit substances. MMT has been shown to be medically safe (Williamson, Foreman and White, 1997) even when used for a long period of time or with pregnant women (Kreek, year).
However, freedom from the physiological effects of addiction and mind altering substances does not cure the substance user. He individual is likely to find that issues still exist which led to them developing a dependency in the first place. Methadone simply offers the user the opportunity to obtain treatment to address these long term needs in order to stay abstinent . Studies have consistently shown a reduction in problem behaviours at follow up; fewer psychological and physical problems and involvement in crime is greatly reduced even at six month follow up for users on a outpatient MMT programme (Gossop and Marsden, 1999). The time period of six months is not particularly substantial in relation to drug addiction. However, methadone itself can become a problem with user changing their loyalties in the absence of other drugs. This suggests that many users need a crutch on which to depend upon. The use of methadone although less damaging than heroin; still has its disadvantages in the form of drowsiness and feelings fuzziness of the brain.
Methadone treatment programmes vary hugely in terms of their effectiveness; differing on dosage, entry criteria, prescribing limits and on formulation of methadone used (Gossop, 2003). These factors are may have an impact on the overall effectiveness of the programmes and infer that some participant may be receiving less than optimal treatment. Gossop (2003) in a meta-analysis of how treatment engagement and methadone dose are related to heroin use outcomes among opiate addicts found that not all effective treatments showed direct relationships to outcomes. Furthermore, not all the outcomes were demonstrated as being effective at both of the follow up points. This shows that heroin addiction is a hugely complicated area affecting users on many levels than simply the biophysiological factors.
Gossop (2003) found in a analysis of different methods of treatment that counselling showed some of the most effective factors; the frequency and the content (increased on the clients addiction), had both direct and indirect relationship with heroin use outcomes. This suggests that there is benefit to the client in dealing with issues not directly related to their addiction. Positive perceptions of the programme at both one and six months was strongly related to treatment services and heroin use at six months suggesting the ability of a programme to deal effectively with the clients needs was also a strong mediator in the outcomes. However, Kraft, Rothbard and Hadley (1997) found a contradictory relationship between supplementary services in the form of counselling and abstinence outcomes.
Kraft et al (1997) analysed counselling services at three levels of frequency and found that although the enhanced levels of services involving counselling, medical and psychosocial services produced greater outcomes at 24 weeks, only the heroin abstinence levels for the groups remained significant at one year. This was similar to the results of the moderate treatment level suggesting that the the additional cost of additional services was unworthy. However, motivation for treatment has been found to be predictive of overall outcomes per se. Pitre et al. (1998) found that in a programme of clients referred from the criminal justice system higher motivation for treatment at intake had greater positive outcomes regardless of the type and frequency of counselling they received.
Once a drug user is free of the drugs in their body other aspects of addiction come into force in the form psychological dsyfunction. Franken (2003) examined the brain processes and found overlap existed between the two areas of neuropsychpharmological and psychological, leading him to suggest an integration of methods would be the best way forward. The exact mechanisms in the brain involved in reward remain unclear evidence shows that opioids such as heroin act upon an area of the brain known as the necleus accumbens which are known to be heavily involved in the rewarding effects of drug related behaviour (Herz, 1998). Franken, Kroon et al (2000) showed that the attentional processes of heroin addicts are biased with more heroin related cues being selectively processed than neutral cues. He further showed that the response time on such drug related cues was correlated with self reported craving. Dhonnchadha and Cunningham (2008) found that drug associated memories were associated with the relapse to drugs of abuse.
This was further supported by Czermak et al (2003) in showing that persisting neurobiological changes are at the root of compulsive behaviour in drug abuse, leading to craving and relapse, even after an extended period of abstinence. Both groups of researchers argued that this incentive-motivational state seen in drug abuse is fuelled by the impaired neurobiology and reorganisation of the brain circuits. In order to counteract these facets in addiction they must be addressed to maximise the individuals possibility of a drug free future. Information processing models of addiction theorised on the relationship between the two areas of the mesolimbic system and attentional deficits in drug abuse suggesting that cognitive methods of therapy can be effective in altering these mechanisms. Cognitive behavioural therapy is probably the most well known of these approaches although others do exist.
The focus of cognitive approaches is the development of coping and problem solving which will help in sustaining abstinence from substances of abuse (Kadden, 2000). This involves active participation on the part of the client in identifying high risk situations and developing strategies to deal with them, role playing and homework tasks which the client applies to their unique situation (Kadden, 2000). The replacement of maladaptive behaviour patterns is likely to be most effective where the programme includes outpatient elements allowing for an interaction between the programme and the clients reality. Taxman (1998) noted that in a therapeutic intervention one of the most predictive factors in a client remaining abstinent was their drug related behaviour in response to a degree of freedom in being allowed to visit their place of home. Interventions aimed at reducing the risk involved in this particular context could be hugely beneficial.
Long term freedom from substance addiction involves changing ones lifestyle in a more constructive direction. The social determinates in drug abuse are broad, subtle and subjective. Rose (year) argued that the cultural shift towards individualism is part of a wider problem leading to a general unhappiness in society leading to materialism. Although he recognises the many benefits of a individualistic society he proposes the downsides are the loss of social cohesion and the perception that success lies solely with the individual as opposed to being at least in part dependant upon circumstances. Rose theorises that consumption of drugs is an attempt to dissolve the boundaries of self and ease ones sense of isolation. Furthermore, Alexander argued that modern society discourages by its nature integration, experience of belonging, acceptance and understanding for and from others. This leads to a degree of dislocated individuals who are looking to remedy this situation possibly leading them construct lifestyles which substitute. Heroin in particular is noted for the feelings of warmth and belonging it induces. If these feelings of isolation and lack of understanding from those around them exist in the users experience then addressing them is necessary to increase the likelihood of long term abstinence.
In conclusion to this essay examining the importance and interplay between three factors involved in heroin addiction it is clear that no single factor carries the greatest weight. Each aspect works at a different level to make breaking for freedom from heroin difficult to achieve. Therapeutic approaches must utilise this knowledge as a basis in order to address characteristics of addiction and increase the chance of success in attaining abstinence.