daksya
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Joined: 09 Feb 2006
Posts: 391
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 Posted: Fri Sep 15, 2006 7:27 pm Post subject: MANY - Hl, So - Epi - Invisible drug users: different? |
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A comparison of 'visible' and 'invisible' users of amphetamine, cocaine and heroin: two distinct populations?
Robson P, Bruce M.
Addiction, 1997.
Abstract:
| Quote: | AIM: To compare the characteristics of heroin, cocaine and amphetamine users having no history of contact with services with those of a group in contact.
METHOD: Multiple agency sampling and field work which included 'snowballing' using 'privileged access interviewers'. Each subject underwent a structured interview which included the Severity of Dependency Scale (SDS), and completed a confidential, self-report questionnaire.
SETTING: Three contrasting provincial urban locations.
PARTICIPANTS: Five hundred and eighty-one regular users of the target drugs. Of these, 380 (65%) denied any contact with police or helping agencies in connection with drug use.
FINDINGS: Most zero-contact users (79%) expressed little or no concern about their drug use, and no wish for help or advice. They were much more likely to use stimulants only; less likely ever to inject any drug or, for those that did, to share equipment; less likely to use opioids, amphetamine or cocaine powder on a daily basis; more likely to use Ecstasy; and yielded significantly lower SDS scores for all target drugs save crack. Prevalence of crack use was lower, but the proportion of daily users was the same as in the contact group. Most (69%) contact users remained concerned about their drug use, but 58% expressed little or no confidence that local services could meet their needs. In both groups, SDS scores for cocaine powder were comparable to those for cannabis, LSD and Ecstasy. Of the 495 cannabis smokers identified (85% of the sample), 72% reported daily consumption.
CONCLUSIONS: The findings are consistent with the hypothesis that 'visible' and 'invisible' drug users are distinct populations in terms of behavioral characteristics, vulnerability to compulsive use, and prevalence of drug-related problems or concern. Purchasers and providers with limited resources should concentrate on improving the range and quality of services for users already in contact rather than attempting to uncover invisible populations. On the basis of SDS scores, cocaine HCI seems to have a relatively modest addictive potential. |
Full study link:
Excerpts:
Table 4: Prevalence of injecting in the contact and zero-contact groups
Table 5: Severity of dependence (SDS) scores in the contact and zero-contact groups
| Quote: | Most surveys of illegal drug use focus upon individuals identified through contact with general practitioners, social services, police, probation or specialist drugs agencies in the statutory or non-statutory sectors. Arguably, most of these people will have made contact with a helping agency because they are concerned about problems associated with their use of drugs, and have an expectation that these services may be able to provide a solution.
Drug users not in contact with services have not been extensively studied. It remains uncertain whether these `invisible’ consumers are simply at an earlier stage in the evolution of their drug use, or if they possess attitudinal or behavioural characteristics which reliably differentiate them from users who are visible because of the medical, social, or legal problems they have encountered.
. . .
Data collection was carried out by fieldworkers in three locations: High Wycombe (Buckinghamshire), Corby (Northamptonshire) and Oxford City. These places were chosen for their easily definable boundaries and contrasting urban characteristics. One of the authors (M.B.) was fieldworker in Oxford. The other two fieldworkers were both 29-year-old males recruited on the basis of their familiarity with the local drug scene, and their organizational and inter-personal skills. One (J.C.) was a graduate with experience as a community youth worker, the other (M.L.) was a carpenter with a past history of heroin addiction.
An initial sample of drug users was obtained through approaches to GPs, social services, probation, statutory and non-statutory agencies and the police, radio and newspaper advertisements, outreach workers (Oxford only), and the local contacts of the fieldworkers. For inclusion in the study subjects had to be using amphetamine, cocaine or heroin at least monthly for three of the last four months and prepared to give informed, written consent to participate. Students with out-of-term homes outside the defined locations were excluded.
. . .
Information was obtained using a structured interview designed to be completed within 30 minutes so as to maximize compliance, and a confidential self-assessment questionnaire exploring injecting habits and aspects of sexual behaviour which was placed by the subject in a sealed envelope so as to be sure it would not be seen by the interviewer.
. . .
Five hundred and eighty-one users of heroin, cocaine, or amphetamine completed interviews and questionnaires, of whom 185 (32%) were female. The average age of the sample was 26 years with a range of 15 to 49 years, and threequarters were between the ages of 17 and 31. In order to make possible a follow-up study at a later date, subjects were asked if they were prepared to provide a contact address.
. . .
The average age of first use of each drug was as follows: cannabis 15; LSD 17; amphetamine 18; heroin 20; ecstasy 21; other opioids 21; cocaine powder 21; crack cocaine 24 years.
. . .
SDS scores correlated significantly with frequency of use for all drugs (Spearman correlation analysis; p values all , 0.0001 except for Ecstasy (p 5 0.01), and LSD (p 5 0.005)). To permit correlational analysis with route of administration, numerical values were ascribed as follows: oral 5 1; nasal 5 2; smoking 5 3; injection 5 4. A significant correlation between SDS score and route of administration was found in the case of amphetamine (p = 0.001), heroin (p < 0.0001) and other opioids (p = 0.02) only.
. . .
This study involved one of the largest groups of `invisible’ drug users reported to date, but several limitations should be kept in mind when considering the results. Interviewers reported that approximately 5% of potential subjects declined to participate because of concerns about confidentiality. These were much more likely to fall into the zero-contact category. There were probably others who heard of the study on the grapevine and took steps to avoid friends or acquaintances who were acting as PAIs on the assumption that there was much to lose and little to gain in admitting to an illegal activity, even to a friend. This element of self-selection, the sourcing of the samples from three particular urban areas, and the fact that identification of subjects depended upon such arbitrary factors as the skill and contacts of the individual fieldworkers and the ability of various agencies to attract clients, mean that caution should be exercised in generalizing the findings.
. . .
Although it is possible that the zero-contact group is simply at an earlier stage in the `drug career’ than the contact group, the similarities in duration of drug history and gender ratio across groups argue against this explanation.
. . .
The Severity of Dependence scale is established as a reliable and valid measure of dependence (Gossop et al., 1995). Scores correlate in other samples with objective indicators of dependence, and it has been noted that they tend to be higher in subjects who have sought help with drug-related problems than in those who have not (Gossop et al., 1995). It is interesting to compare the SDS scores for the different drugs with those published from other samples. For example, mean heroin SDS score for a group of 200 drug users, half of whom had had no contact with services, was 8.3 (Gossop et al., 1992), an almost identical figure to this overall sample (8.1). Gossop et al.’ s figures for cocaine and amphetamine were 2.5 and 1.5, respectively.
. . .
Our results, in common with the findings of Gossop and his colleagues in their various studies (Gossop et al., 1992, 1994a, 1994b, 1995) suggest that cocaine HCI has a relatively low addictive potential in comparison with heroin. SDS scores relating to cocaine powder seem remarkably low in both groups, but particularly so in the zero-contact group where the mean score is a third of that associated with cannabis (Table 5). The studies give support to the conclusion of Murphy, Reinarman & Waldorf (1989; summary, p. 427) that '... addiction is not a uniform outcome of sustained use and that long-term controlled use [of cocaine] is possible’. In contrast, SDS scores for crack cocaine were much higher in our total sample (5.7),
which probably represents a different dimension of risk. This is consistent with the findings of Gossop et al. (1994a). |
Supplementary material:
Tags: t-MANY t-CB t-CO t-ST t-HE t-OP t-LSD t-PSY t-MDMA t-Hl t-So t-Epi |
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