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How drug users with depression view their condition: a qualitative study

How drug users with depression view their condition: a qualitative study. Dr Charles Cornford MD FRCGP The Fulcrum Practice, Middlesbrough. What do we know about depression and drug use?. Common ¹ Three types of connection ² Drug use causing depression Depression causing drug use

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How drug users with depression view their condition: a qualitative study

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  1. How drug users with depression view their condition: a qualitative study Dr Charles Cornford MD FRCGP The Fulcrum Practice, Middlesbrough

  2. What do we know about depression and drug use? • Common ¹ • Three types of connection ² • Drug use causing depression • Depression causing drug use • Both sharing common causative factors • Outcomes for depression or drug treatment not adversely affected ¹³ 1 Darke 2009 2 Rounsaville 2004 3 Conner 2008

  3. Depression and qualitative studies • Depressive ‘careers’¹ • Typology of causation ² • Management techniques, blotting out symptoms, engagement in activities and with others ³ 1 Karp 1994 2 Kangas 2001 3 Cornford 2007

  4. Aims • To investigate how heroin and crack cocaine users with ‘depression’ describe their condition

  5. Method • Qualitative (semi-structured interviews and one focus group) • Recruitment criteria: Receiving methadone/subutex and an antidepressant • Interview schedule: ideas about causation, effects of condition(s), management • All interviews recorded and fully transcribed, analysed standard qualitative techniques

  6. Results • Total approached:25 • Interviewed: 17 (11 male) • All interviewed in the surgery • Average age 34.5 (range 26-47) • All had used heroin and all but one crack cocaine

  7. Causation • Vague onset of ‘depression’ • All three mechanisms • Events leading to depression and social networks where drug taking the norm • Drug taking leading to consequences which caused ‘depression’.

  8. Causation: adverse events leading to ‘depression’ and drug taking • ‘I just got put on a truck with bloke that I didn’t even know and moved to a new school with no one I didn’t know and that’s when it all started… So then I started getting into trouble and that and I started meeting people with the drugs’

  9. Effects of drug taking/depression • Loss • ‘Stigma’ • Isolation

  10. Stigma • Few stigmatising ideas about ‘depression’ • Drug-taking discrediting and a cause of depression

  11. Stigma • ‘Then I’ll use the heroin to come down which you’ll have heard a thousand times, and then I do feel absolutely terrible, you feel the guilt and the you feel worse in yourself for what you’ve done’

  12. Isolation • Drug acquaintances rather than friends • Some alternative ideas

  13. Isolation • ‘But they’re not in my eyes, they’re not friends. They’re just acquaintances or just people who I know… They’ve all let me down and they’ve all shit on me so to speak and that.’

  14. Isolation: family • ‘I’ll make a phone call to my mother so, er, even though I blame her for like years ago, it’s just, that’s the only other person I’d talk to’

  15. Management • Blocking out depressive thoughts • Few ‘self-help’ mechanisms • Problems with ‘talking’ • ‘Drugs’ and antidepressants • Beliefs about antidepressant medication • Keeping ‘level’ • ‘Addiction’ worries

  16. Antidepressants • ‘I carried on taking ‘em and I started feeling a lot better, ‘cause like my mind racers and it stopped that’

  17. Summary • The three types of connection confirmed, but: • Stress on adverse events leading to ‘at-risk’ social networks • Drugs lead to depression indirectly • Stigmatising effect of drug taking, and a causation factor for ‘depression’ • Isolation • Non-medical views about antidepressant action

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