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...
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