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NETWORK A national newsletter on substance misuse management in primary care
Abstinence –
treatment, philosophy and methods
In this two-part article Dr Gordon journeys. Similarly their aspirations
Morse puts the spotlight on the and the way in which they are going to
relationship of abstinence, harm
achieve them vary. But pretty nearly all,
reduction and the 12 Step philosophy.
at some time, want abstinence.
As something often aspired for,
After the initial honeymoon period,
sometimes elusive and sometimes
most drug users want abstinence
achieved by drug users, this article
almost every day of their using careers
is an important reminder that the
– certainly 57% of drug users accessing
practitioner and the individual
treatment services for the first time said
patient need a full spectrum of
that abstinence was the only change
prescribing and treatment options
that they hoped for against 15% opting
from maintenance to abstinence
for harm reduction [1]. The problem of
approaches. In our next issue,
course is that only about 5% of heroin
Gordon will look at detoxification
dependant patients each year achieve
and methods of supporting enduring
durable abstinence. For those who
abstinence. Ed. attempt abstinence but then relapse,
Abstinence and harm
there is the sense of shame and failure
which can provoke even more drug use,
reduction – two sides of
and the very real risk of loss of tolerance
the same coin
leading to overdose. So why is it so
Drug users come from all walks of life,
difficult to achieve, and once achieved,
and all have different stories and different
why is abstinence so difficult to sustain?
…continued overleaf
In this issue
Abstinence as opposed to maintenance has been a lot in the news Following on from the last issue we have 2 practical examples
recently. Gordon Morse in the first of 2 articles squares the circle of the use of practice based commissioning in the substance
between these 2 concepts that should be complementary but are misuse field from Clive Jekyll and Steve Skinner. Its here and its
so often perceived not to be. Pages 1-3. happening! Pages 10-11.
Are you concerned about incorporating formal care planning into Also following on from the last issue we have the second part of Nigel
your clinical practice? Susi Harris gives the full lowdown on pages Modern’s intriguing investigation into supervised consumption as
4-5. a tool for dose induction and assessment. Page 12.
Shooting up report, pages 6-8. A report to guard us against Dr Fixit spoils us this issue, with drug and alcohol abstinence
complacency, Vivien Hope and Susie Huntingdon highlight the by Gordon Morse page 13, alcohol detox by Jeff Fernandez, and
continuing increase in HIV prevalence and an increase in injection shift work and methadone by Chris Ford and Kim Wolff on page
risk behaviour. 14 and a related exercise and methadone piece by Kim Wolff on
page 15.
There is good news in the NICE guidance on Hepatitis C treatment,
pages 7-8 which should make treatment more accessible to more
patients as long as screening effectiveness is improved. Hopefully
We hope you enjoy this issue.
this is a significant move forward but all is not rosy in the primary
care PCT back yard where a public health time bomb awaits…. Jean-Claude Barjolin
Charlotte Tompkins, Laura Sheard and Nat Wright have conducted Editor
a fascinating study on women users injected by other users,
page 9, resulting in clear and useful clinical implications. On the
back of our articles on Shooting Up and on increasing HIV and
Don’t forget that we can e-mail you the newsletter!
Hepatitis prevalence and risky injecting practices, this is a must
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