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Addiction Trajectories

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  1. Addiction Trajectories Céline Mercier, Ph.D. Senate Committee on Illegal Drugs Ottawa, December 10, 2001

  2. Addiction Trajectories • The notion of trajectory • Methods • The trajectory of dependence • Trajectory and timeline • Going further...

  3. The Notion of Trajectory • Key words: • Phases / Stages • Time / Succession • Passages / Transitions

  4. Translation of Figure 1 Drug and Alcohol Use Trajectories Cessation, moderate use Initiation Primary prevention Disease, trauma, death Cessation, moderate use Start of dependence Secondary prevention Disease, trauma, death Spontaneous remission Period of dependence Harm reduction Disease, trauma, death Relapse Treatment Tertiary prevention Disease, trauma, death Relapse Reintegration Support Disease, trauma, death Céline Mercier, Ph.D. November 2001

  5. Methods • Prospective • Retrospective • Transversal • Quantitative approach • Qualitative approach

  6. The Trajectory of Dependence • Initiation • Start of dependence • Period of dependence • Treatment and rehabilitation • Reintegration

  7. Initiation • By a man, except for prescription drugs (W) • A friend /acquaintance (M), a spouse (W) • Peer influence • Curiosity, relief (W), kick (M) • Gift (W) • Continuation: use greater by female spouse • Termination: marriage, children; social use

  8. Start of Dependence • Faster in women (daily use) • Partner a daily user (W) • Use for the effects (W, M) • Influence of friends (M)

  9. Period of dependence • In men, more: • simultaneous drug use (alcohol, cocaine, heroin) • selling • B&E and robbery with assault • contact with the legal system

  10. Period of Dependence • In women, more: • sedatives and prescription drugs • fraud • contact with mental health system (depression, anxiety) • physical health problems • risks (violence, behaviour involving high risk of contracting sexually transmitted diseases, HIV, infections, pregnancy, children)

  11. Breaking Dependence • Spontaneous remission/maturing out (change in lifestyle) vs. • Treatment (work on dependence) • Reasons: • lifestyle (fatigue and weariness, (M, W) • the drug itself (loss of of interest, secondary effects (recent users), cost) • consequences (health, family, illegality)

  12. Treatment • In women: • referred by social or health workers • earlier, not as long, more attrition • more serious substance abuse problems • more problems • less family support • less access and more consultations in general services

  13. Treatment • In men: • referred by legal system or pressure from spouse • more legal problems • more episodes (inpatient and outpatient)

  14. The Rehabilitation Process • “Getting out then adapting”: • Decision • Action • Stabilization • Maintenance • Recent users and long courses • Support

  15. Reintegration • Conformity or marginal reintegration • Differentiated changes in each area • Duration of career and intensity of involvement in drug world influence process, type and quality of reintegration • Need for models and rebuilding identity

  16. Trajectory and Timeline • Are there average durations for each phase? • Are there ideal durations? • To what extent does the duration of the phases influence course and outcome?

  17. Conclusion • Processes rather than states • “Passages” • Intense periods (crises, gains) and periods of stabilization