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Perceptions of Addiction  among  Street Recruited Heroin Users Lindsey Mills* Dixie J. Koo* Dale D. Chitwood** *California...
Background <ul><li>The concept of “Addiction” </li></ul><ul><ul><li>Central Question:  What is addiction? </li></ul></ul><...
Objectives <ul><li>The primary goals of this presentation are to: </li></ul><ul><ul><li>1.  Examine the explicit definitio...
Methods <ul><li>Sample:  </li></ul><ul><li>Data used for this presentation are part of a larger prospective study that was...
Methods <ul><li>Procedure:  </li></ul><ul><ul><li>Eligibility Criteria for participation in the parent study: </li></ul></...
Methods <ul><li>Procedure:   </li></ul><ul><ul><li>Ethnographic Interview </li></ul></ul><ul><ul><ul><li>Past and present ...
Demographic Profile (N=40) Race / Ethnicity Gender Age Category N = 40 Percent Black non-Hispanic 21 52.5 Hispanic / Latin...
Conceptual Categories Category N  Description of Heroin Addiction As: 1.  Usage 4 Inevitable and a necessary consequence o...
Conceptual Categories Category N  Description of Heroin Addition As: 7.  Addictive Personality 3 A type of person who poss...
Intersection of Conceptual Categories of Heroin Addiction
Examples:  Intersection of Conceptual Categories  37.5 %  37.5 % 35.0 %
Four Dimensions Heroin Use Control Psychological Physiological N = 18 45.0 % Usage N = 35 Process N = 28 N = 36 90.0 % 70....
Multi - Dimensional Note:  This Venn diagram is for illustrative purposes and does not indicate the extent or magnitude of...
Limitations <ul><li>Various Non-Random Techniques </li></ul><ul><ul><li>Snowball sampling </li></ul></ul><ul><ul><li>Purpo...
Discussion <ul><li>Perceptions of heroin addiction among sniffers support and refute the four perspectives of heroin addic...
Policy Implications <ul><li>Treatment programs and modalities </li></ul><ul><ul><li>Perspective </li></ul></ul><ul><ul><ul...
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WSC Conference 2008

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Perceptions of Addiction among Street Recruited Heroin Users

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WSC Conference 2008

  1. 1. Perceptions of Addiction among Street Recruited Heroin Users Lindsey Mills* Dixie J. Koo* Dale D. Chitwood** *California State University, Fullerton **University of Miami Supported by NIDA grant R01 DA10655
  2. 2. Background <ul><li>The concept of “Addiction” </li></ul><ul><ul><li>Central Question: What is addiction? </li></ul></ul><ul><li>No definitive, universally agreed upon definition of heroin addiction </li></ul><ul><li>Incorporating the “user” perspective </li></ul><ul><li>Current perspectives of heroin addiction </li></ul><ul><ul><li>Biological </li></ul></ul><ul><ul><li>Sociobiological </li></ul></ul><ul><ul><li>Psychological </li></ul></ul><ul><ul><li>Socio-psychological </li></ul></ul>
  3. 3. Objectives <ul><li>The primary goals of this presentation are to: </li></ul><ul><ul><li>1. Examine the explicit definitions and perceptions of heroin addiction among sniffers </li></ul></ul><ul><ul><li>2. Identify an array of perceptions of heroin </li></ul></ul><ul><ul><li>addiction among sniffers </li></ul></ul>
  4. 4. Methods <ul><li>Sample: </li></ul><ul><li>Data used for this presentation are part of a larger prospective study that was designed to study the efficacy of HIV risk-reduction programs among heroin sniffers. </li></ul><ul><li>Parent Study: A stratified network based (snowball) sample of 466 African American, Hispanic, and non-Hispanic whites male and female heroin sniffers were recruited from the streets of Miami-Dade County, FL between August 2001 and December 2005. </li></ul><ul><li>Geographic target areas were selected for recruitment by identifying the communities which were known to have high rates of heroin use. </li></ul><ul><li>Supplemental Study of Heroin Addiction: 40 ethnographic qualitative interviews were conducted on a sub-sample of 250 sniffers who were participants in the larger parent study </li></ul>
  5. 5. Methods <ul><li>Procedure: </li></ul><ul><ul><li>Eligibility Criteria for participation in the parent study: </li></ul></ul><ul><ul><ul><li>18 years of age or older </li></ul></ul></ul><ul><ul><ul><li>Resided in Miami-Dade County for at least 6 months </li></ul></ul></ul><ul><ul><ul><li>Sniffed heroin at least once a week for the past 6 months </li></ul></ul></ul><ul><ul><ul><li>May not have been injected more than 12 times in their lifetime and not injected in the past year </li></ul></ul></ul><ul><ul><ul><li>No evidence of track marks </li></ul></ul></ul><ul><ul><ul><li>Not been enrolled in a drug treatment program for the last 6 months </li></ul></ul></ul><ul><ul><ul><li>Urine screen positive for opiates </li></ul></ul></ul><ul><ul><ul><li>Consistency of self-report with staff knowledge of street behavior </li></ul></ul></ul><ul><ul><li>Informed consent, confirmatory urine analysis, interview, and blood draw for HIV were obtained </li></ul></ul>
  6. 6. Methods <ul><li>Procedure: </li></ul><ul><ul><li>Ethnographic Interview </li></ul></ul><ul><ul><ul><li>Past and present drug use, addiction histories, and transition from initial use of heroin use to addiction </li></ul></ul></ul><ul><ul><ul><li>One section of the interview explicitly asked the participant for his/her own perception of addiction </li></ul></ul></ul><ul><ul><ul><ul><li>“ Tell me, what does addiction mean to you?” </li></ul></ul></ul></ul><ul><ul><ul><ul><li>“ How would you define addiction?” </li></ul></ul></ul></ul><ul><li>Analysis Guided by Grounded Theory </li></ul><ul><ul><ul><li>A qualitative methodological technique to help formulate a theory about perceptions of addiction among sniffers </li></ul></ul></ul>
  7. 7. Demographic Profile (N=40) Race / Ethnicity Gender Age Category N = 40 Percent Black non-Hispanic 21 52.5 Hispanic / Latino 10 25.0 White non-Hispanic 9 22.5 Category N = 40 Percent Male 24 60.0 Female 16 40.0 Category N = 40 Percent 20 -30 10 25.0 31 – 40 12 30.0 41 – 50 12 30.0 50 + 6 15.0
  8. 8. Conceptual Categories Category N Description of Heroin Addiction As: 1. Usage 4 Inevitable and a necessary consequence of using heroin at all 3. Control 35 Control through the monitoring of behavior and/or the regulating of heroin use 2. Process 14 Not immediate but the result of continued use 4. Mental 24 Manipulated by a strong will of the mind 5. Boredom 7 A product of an unoccupied mind 6. Desire 9 A reflection of a desire, want, or yearning for heroin or its high
  9. 9. Conceptual Categories Category N Description of Heroin Addition As: 7. Addictive Personality 3 A type of person who possesses personality traits that are susceptible to heroin addition 8. Physical Dependence 26 Physiological and chemical adaptation to heroin 9. Withdrawal 21 Illness and pain associated with the physical side of heroin 10. Heroin vs. Crack/Cocaine 18 Cocaine / Crack-cocaine = mental addiction Heroin = physical addiction 11. Heroin as Medicine 9 A cure for withdrawal symptoms
  10. 10. Intersection of Conceptual Categories of Heroin Addiction
  11. 11. Examples: Intersection of Conceptual Categories 37.5 % 37.5 % 35.0 %
  12. 12. Four Dimensions Heroin Use Control Psychological Physiological N = 18 45.0 % Usage N = 35 Process N = 28 N = 36 90.0 % 70.0 % 87.5 % Control Mental Addictive Personality Desire Boredom Withdrawal Physical Dependence Heroin as Medicine Heroin vs. Cocaine/crack- cocaine
  13. 13. Multi - Dimensional Note: This Venn diagram is for illustrative purposes and does not indicate the extent or magnitude of overlap between dimensions. <ul><li>Heroin Use is the least mentioned dimension </li></ul><ul><li>Control was important to almost all sniffers </li></ul><ul><li>All but one sniffer (97.5%) had multi-dimensional perceptions of addiction </li></ul><ul><li>The uni-dimensional sniffer viewed addiction as controllable </li></ul><ul><li>5 sniffers intersected in all four dimensions </li></ul>
  14. 14. Limitations <ul><li>Various Non-Random Techniques </li></ul><ul><ul><li>Snowball sampling </li></ul></ul><ul><ul><li>Purposive sampling </li></ul></ul><ul><li>Selection Bias </li></ul><ul><ul><li>Perceived responsiveness </li></ul></ul><ul><ul><li>Findings may not be generalized to all heroin sniffers </li></ul></ul><ul><li>Recall Bias </li></ul><ul><ul><li>Retrospective data </li></ul></ul><ul><ul><li>Reflections of sniffers may not be accurate </li></ul></ul>
  15. 15. Discussion <ul><li>Perceptions of heroin addiction among sniffers support and refute the four perspectives of heroin addiction </li></ul><ul><li>Past studies have looked at heroin addiction on a macro level and left out the intimate experiences of the individual users </li></ul><ul><li>Explicit definitions of heroin addiction among sniffers adds dimensions that previously had been underdeveloped </li></ul><ul><li>The diverseness of heroin users experiences increases the difficulty of capturing perceptions of heroin addiction in one simple definition </li></ul>
  16. 16. Policy Implications <ul><li>Treatment programs and modalities </li></ul><ul><ul><li>Perspective </li></ul></ul><ul><ul><ul><li>Current Approach: Socio-psychological </li></ul></ul></ul><ul><ul><ul><li>Proposed Approach: Experiences and perceptions of users </li></ul></ul></ul><ul><ul><li>Identifiers </li></ul></ul><ul><ul><ul><li>Current Approach: Different types of addicts </li></ul></ul></ul><ul><ul><ul><li>Proposed Approach: Different types of addiction </li></ul></ul></ul><ul><ul><li>Outcomes </li></ul></ul><ul><ul><ul><li>Current Approach: Cessation of the drug </li></ul></ul></ul><ul><ul><ul><li>Proposed Approach: Measured by experience/perception change </li></ul></ul></ul><ul><li>By understanding the user perspective, it will help providers develop and tailor intervention plans to the addict by their personal view of addiction </li></ul>

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