Harm-reduction for unwanted pregnancies and unwanted addictions: an instructive analogy

Authors

  • Colin Brewer Research Director. The Stapleford Centre. London. Enviar correspondencia a: Colin Brewer. Director de Investigación. The Stapleford Centre. London. SW1W 9NP. Reino Unido.

DOI:

https://doi.org/10.20882/adicciones.283

Keywords:

addiction, alcohol, contraception, harm-reduction, heroin, pregnancy, naltrexone

Abstract

Addiction treatment aims to reduce the harm that addiction causes to individuals and society. However, many clinics, especially in the private sector, have ideological objections to using medico-pharmacological treatments and are often critical of other services that do offer pharmacological treatments. This situation contrasts sharply with the attitude of family planning (FP) clinics, even though they too aim to reduce harm. Ironically, the most anti-pharmacological clinics are often those which proclaim most loudly that addiction is a ‘disease’, while avoiding unwanted pregnancy, which is not usually seen as a disease, is widely and effectively achieved with medical techniques. FP clinics typically consider widely varying patterns of sexual behaviour, social contexts and patient attitudes in devising individual treatment plans, while addiction clinics commonly have a one-size-fits-all, take-it-orleave- it approach. Addiction services could learn some useful clinical and ideological lessons from FP clinics.

References

Brewer C. Psychological and pharmacological components of treatment: conflict or co-operation? En: Eds: Philip Bean, Theresa Nemitz. Drug Treatment. What works? London: Routledge; 2004.

Bale RN, Van Stone WW, Kuldau JM, Engelsing TM, Elashoff RM, Zarcone VP Jr. Therapeutic communities vs methadone maintenance. A prospective controlled study of narcotic addiction treatment: design and oneyear follow-up. Arch Gen Psychiat 1980; 37: 179-93.

Keen J, Oliver P, Rowse G, Mathers N. Residential rehabilitation for drug users: a review of 13 months’ intake to a therapeutic community. Fam Pract 2001: 16; 545-548.

Berglund M, Thelander S, Salaspuro M, Franck J, Andréasson S, Öjehagen A. Treatment of Alcohol Abuse: An Evidence-Based Review. Alc: Clin Exper Res 2003, 27: 1645-1656.

Cornish J, Metzger, D, Woody, G, Wilson, D, Mclellan, T, Vandergrift, B, O’brien, C, 1997. Naltrexone pharmacotherapy for opioid dependent federal probationers. J Subst Abuse Treat. 14, 529-34.

Chan KY. The Singapore naltrexone community-based project for heroin addicts compared with drugfree community-based program: the first cohort. J Clin Med 1996; 3: 87-92.

Cornish JW, Metzger D, Woody GE, Wilson D, McLellan AT, Vandergrift B, O’Brien CP. Naltrexone pharmacotherapy for opioid dependent federal probationers. J Subs Abuse Treat 1997; 14: 529-534.

Brewer C. Third time unlucky: a study of women who have three or more legal abortions. J Biosoc Sci 1977; 9: 99-105.

Luker K. Taking Chances. Los Angeles: Univ. of California Press; 1975.

Decision of NY Court of Appeals, 11 June 1996, Griffin vs Coughlin.

Alcoholics Anonymous. Living Sober. London: Jupiter;

p. 60.

Mark TL, Kranzler HR, Song X, Bransberger P, Poole V,

Crosse S. Physicians‘ opinions about medications to treat alcoholism. Addiction 2003; 98: 617-26.

Shuckit MA. Alcohol and depression: a clinical perspective. Acta Psych Scand. Suppl 1994; 377, 28-32.

Davidson K. Diagnosis of depression in alcohol dependence: changes in prevalence with drinking status. Br J Psychiat 1993; 166: 199-204.

McIntosh C, Ritson B. Treating depression complicated by substance misuse. Advances in Psychiatric Treatment 2001; 7: 357-364.

Gelder MG, Marks I, Wolff HH. Desensitisation and psychotherapy in the treatment of phobic states: a controlled clinical enquiry. Brit J Psychiat 1967; 113: 53-73.

Strang J. Sheridan J, Hunt C, Kerr B, Gerada C, Pringle M. The prescribing of methadone and other opioids to addicts: national survey of GPs in England and Wales Br J Gen Pract 2005; 55: 444-51.

Strang J, Manning V, Mayet S, Ridge G, Best D, Sheridan J Does prescribing for opiate addiction change after national guidelines? Methadone and buprenorphine prescribing to opiate addicts by general practitioners and hospital doctors in England, 1995-2005. Addiction 2007; 102: 761-70.

McKeganey N, Morris Z, Neale J, Robertson M. What are drug users looking for when they contact drug services: abstinence or harm reduction? Drugs: Education, Prevention and Policy 2004; 11; 423-35.

Strang J, McCambridge J, Best D, Beswick T, Bearn J, Rees S, Gossop M. Loss of tolerance and overdose mortality after inpatient opiate detoxification: follow up study. BMJ 2003; 326, 959-60.

Arnold-Reed DE, Hulse GK. A comparison of rapid (opioid) detoxification with clonidine-assisted detoxification for heroin-dependent persons. J Opioid Manag 2005; 1:17-23.

Seoane A, Carrasco G, Cabré L, Puiggrós A, Hernández E, Alvarez M, Costa J, Molina R, Sobrepere G. Efficacy and safety of two new methods of rapid intravenous detoxification in heroin addicts previously treated without success. Br J Psychiat 1997; 171: 340-5.

Published

2008-03-01

Issue

Section

Editorial