Translation of Figure 1 Drug and Alcohol Use Trajectories Cessation, moderate use InitiationPrimary prevention Disease, trauma, death Cessation, moderate use Start of dependenceSecondary prevention Disease, trauma, death Spontaneous remission Period of dependenceHarm reduction Disease, trauma, death Relapse TreatmentTertiary prevention Disease, trauma, death Relapse ReintegrationSupport Disease, trauma, death Céline Mercier, Ph.D. November 2001
The Trajectory of Dependence Initiation Start of dependence Period of dependence Treatment and rehabilitation Reintegration
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
Start of Dependence Faster in women (daily use) Partner a daily user (W) Use for the effects (W, M) Influence of friends (M)
Period of dependence In men, more: –simultaneous drug use (alcohol, cocaine, heroin) –selling –B&E and robbery with assault –contact with the legal system
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)
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)
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
Treatment In men: –referred by legal system or pressure from spouse –more legal problems –more episodes (inpatient and outpatient)
The Rehabilitation Process “Getting out then adapting”: –Decision –Action –Stabilization –Maintenance Recent users and long courses Support
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
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?
Conclusion Processes rather than states “Passages” Intense periods (crises, gains) and periods of stabilization
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