Compensatory and mimetic conditioned responses to effects of heroin in addicted persons

Study 1: The aim of this study was to analyze in persons detoxified of heroin, compensatory conditioned responses (CCRs) that are opposite to the unconditioned physiological, and subjective effects that are induced by this substance. The procedure consisted in presenting slides with images of neutral stimuli (NSs) and conditioned stimuli (CSs) of heroin to both non-addicted and detoxified addicted persons. The evaluated responses were heart rate (HR) and desire for heroin (DH). Study 2: The aim was to facilitate the emission of mimetic conditioned responses (MCRs) to the unconditioned physiological, and subjective effects of heroin in detoxified heroin addicts. Three different stimulus series were manipulated: SA, during which the participant remained alone; SB, administration of a needle prick given by the researcher; SC, performance of the 'pump' ritual without drug by the participants. The responses measured were HR and DH. The results of both studies are considered, respectively, to be indicators of compensatory and mimetic conditioned responses

Anticipatory conditioned responses to subjective and physiological effects of heroin in addicted persons

Study 1: The aim of this experiment was to analyze in persons detoxified of heroin, conditioned responses (CRs) that are opposite to the unconditioned physiological and subjective effects that are induced by this substance. The basic procedure consisted in presenting slides with images of neutral stimuli (NSs) and conditioned stimuli (CSs) of heroin to both non-addicted and detoxified addicted persons. The evaluated responses were conductance (C) and self-perception of abstinence symptoms (SAS). The results are considered to be indicators of compensatory conditioned responses (CCRs) (conditioned abstinence). Study 2: The aim of this experiment was to facilitate the emission of mimetic conditioned responses (MCRs) to the unconditioned subjective effects of heroin in detoxified heroin addicts. Three different stimulus series were manipulated: SA, during which the participant remained alone; SB, administration of a needle prick given by the researcher; SC, performance of the «pump» ritual without drug by the participants. The response measured was SAS. The results are considered to be indicators of MCRs. The results of both studies are discussed in the context of the environmental specificity model of anticipatory responses to the effects of drugs.Estudio 1: El objetivo de este experimento fue analizar en personas desintoxicadas a la heroína respuestas condicionadas (RCs) opuestas a ciertos efectos fisiológicos y subjetivos de esta droga. El procedimiento consistió en presentar diapositivas con imágenes de estímulos neutros (ENs) y estímulos condicionados (ECs) de la heroína a personas no adictas y a personas adictas desintoxicadas. Las respuestas evaluadas fueron conductancia (C) y autopercepción de síntomas de abstinencia (ASA). Los resultados se consideraron como indicadores de respuestas condicionadas compensatorias de los efectos de la heroína (abstinencia condicionada). Estudio 2: El objetivo de este experimento fue facilitar en personas adictas desintoxicadas a la heroína la emisión de respuestas condicionadas miméticas (RCMs) de los efectos subjetivos incondicionados de la heroína. Para ello se utilizaron tres series estimulares: SA, serie control; SB, el investigador administra un leve pinchazo; SC, el participante realiza el ritual de “bombeo” sin droga. La respuesta medida fue ASA. Los datos obtenidos se consideraron como indicadores de RCMs. Los resultados de ambos estudios se discutieron desde el modelo de la especificidad ambiental de las respuestas anticipatorias de los efectos de las drogas.Estudo 1: O objectivo desta experiência foi analisar em pessoas desintoxicadas de heroína, respostas condicionadas que são opostas a certos efeitos incondicionados fisiológicos e subjectivos desta droga. O procedimento consistiu em apresentar diapositivos com imagens de estímulos neutros (ENs) e estímulos condicionados (ECs) da heroína a pessoas não aditas e a pessoas aditas desintoxicadas. As respostas avaliadas foram condutância (C) e autopercepção de sintomas de abstinência (ASA). Os resultados consideraram-se como indicadores de respostas condicionadas compensatórias dos efeitos da heroína (abstinência condicionada). Estudo 2: O objectivo desta experiência foi facilitar em pessoas aditas desintoxicadas da heroína a emissão de respostas condicionadas miméticas (RCMs) dos efeitos subjectivos incondicionados da heroína. Para isso utilizaram-se três séries de estímulos: SA, série controlo; SB, o investigador administra uma leve picada; SC, o participante realiza o ritual de “bombear” sem droga. A resposta medida foi ASA. Os dados obtidos consideraram-se como indicadores de RCMs. Os resultados de ambos os estudos são discutidos a partir do modelo da especificidade ambiental das respostas antecipatórias dos efeitos das drogas

A critical analysis of user satisfaction surveys in addiction services: Opioid maintenance treatment as a representative case study

Background: Satisfaction with services represents a key component of the user's perspective, and user satisfaction surveys are the most commonly used approach to evaluate the aforementioned perspective. The aim of this discursive paper is to provide a critical overview of user satisfaction surveys in addiction treatment and harm reduction services, with a particular focus on opioid maintenance treatment as a representative case. Methods: We carried out a selective critical review and analysis of the literature on user satisfaction surveys in addiction treatment and harm reduction services. Results: Most studies that have reported results of satisfaction surveys have found that the great majority of users (virtually all, in many cases) are highly satisfied with the services received. However, when these results are compared to the findings of studies that use different methodologies to explore the patient's perspective, the results are not as consistent as might be expected. It is not uncommon to find that "highly satisfied" patients report significant problems when mixed-methods studies are conducted. To understand this apparent contradiction, we explored two distinct (though not mutually exclusive) lines of reasoning, one of which concerns conceptual aspects and the other, methodological questions. Conclusion: User satisfaction surveys, as currently designed and carried out in addiction treatment and harm reduction services, do not significantly help to improve service quality. Therefore, most of the enthusiasm and naiveté with which satisfaction surveys are currently performed and interpreted - and rarely acted on in the case of nonoptimal results - should be avoided. A truly participatory approach to program evaluation is urgently needed to reshape and transform patient satisfaction surveys. Keywords: patient satisfaction, substance abuse treatment services, harm reduction services, patient-centered evaluation, service user perspective, user involvemen

Captación de participantes en el programa experimental de prescripción de estupefacientes en Andalucía (PEPSA)

ResumenEsta nota tiene como finalidad describir los pasos seguidos en el proceso de captación de los participantes en el ensayo andaluz de prescripción de heroína intravenosa. El programa experimental de prescripción de estupefacientes en Andalucía (PEPSA) compara el tratamiento de heroína respecto a la metadona oral, en la mejoría de la salud física y mental y la integración social. Dada las características de la población diana (usuarios de heroína por vía intravenosa en situación de exclusión social para quienes no han sido efectivos los tratamientos disponibles), se planificó un abordaje específico para acercar dichas personas al estudio. Tras una investigación previa sobre la distribución de la población diana en la ciudad de Granada, se dividió ésta en 3 zonas. Se acudía a los principales centros de reunión (plazas, comedores sociales, dispensarios de metadona) y se concretaba una cita con un médico del PEPSA. El trabajo apoyado en iguales ha sido una herramienta fundamental en este proceso de captación, y ha facilitado el acercamiento a la población diana. Asimismo, este trabajo ha permitido entablar contacto con usuarios de drogas que no acceden a los servicios sociosanitarios, por lo que la labor del equipo de captación también ha sido educar en la reducción de daños y ofrecer alternativas sociales y sanitarias más allá del ensayo.AbstractIn this field note we describe the steps followed in the process of recruiting participants for the experimental drug prescription program in Andalusia (PEPSA). This trial is a comparative, randomized, open study of the difference between intravenous heroin treatment and oral methadone for socially excluded, opiate-dependent patients, in whom other available treatments have been unsuccessful. Because this is a hidden and hard-to-reach population, a specific approach was planned to put as many patients as possible in touch with the program. A previous study of the target population’s distribution in the City of Granada was performed and the city was divided into three areas. Potential participants were interviewed in squares, soup kitchens and methadone dispensaries by outreach workers and peers, who suggested they make an appointment with a PEPSA physician. Peer-driven intervention was a crucial instrument in this recruitment procedure, allowing greater access to the target population. Furthermore, this approach allowed contact with drug users who do not attend health and social services. The work of the outreach team involved educating these users in harm reduction and offering them health and social alternatives beyond the clinical trial

Inconsistent condom use among socially excluded heroin users Uso inconsistente del condón en los usuarios de heroina en situación de exclusión social

The study focused in sexual behaviour among socially excluded heroin users, identifying factors associated with inconsistent condom use. Data was collected in the cities of Granada and Seville between July and October 2000, through a structured questionnaire, to 391 participants. Twenty two and 15% of participants have made consistent use of condoms in vaginal sex in the last year with occasional and regular partners respectively. There is a greater likelihood of inconsistent condom use with occasional partners among users who had had oral sex, and who does not know if their partner(s) inject or injected drugs. For regular partners those who have an injecting partner and do not speak with their sexual partners about AIDS have a higher probability to do not use always a condom. For both groups, when always the partner is who propose the use of condoms (when used) and not themselves, the risk not to use it is near 4 times more than when thems elves propose to use it. Speaking about condoms and AIDS with mate, partners and family, and learning to negotiate the use of condoms seems to be the most important strategies to be approached for this sample, from the social and health care system in order to promote a protected sex.El objetivo del presente trabajo es analizar las conductas sexuales entre los usuarios de heroína, en situación de exclusión social, y conocer los factores asociados al uso inconsistente del condón en sus relaciones sexuales (coito vaginal) con parejas ocasionales y estables. Los datos fueron recogidos en las ciudades de Granada y de Sevilla entre julio y octubre de 2000, a través de un cuestionario estructurado, a 391 participantes. El 22 y el 15% de los participantes han hecho un uso consistente del condón durante el último año con sus parejas ocasionales y estables, respectivamente. Se ha encontrado una mayor probabilidad de un uso inconsistente del condón con las parejas ocasionales entre usuarios que habían practicado el sexo oral, y que desconocen si su(s) pareja(s) se inyecta drogas. En cuanto a las parejas estables, las que se inyectan y no hablan de sida entre ellos mostraron una probabilidad más alta de no utilizar consistentemente el condón. Para ambos grupos, cuando la pareja es quien siempre propone el uso del condón, el riesgo de no utilizarlo es de 4 veces más que cuando son ellos mismos quienes proponen su uso. Hablar sobre condones y sida con los amigos, las parejas y la familia, así como aprender a negociar el uso del condón, parecen ser las estrategias más apropiadas para el abordaje de esta población, de cara a promover un sexo protegido dentro del sistema sociosanitario

Drugs and social exclusion in ten European cities.

The aim of this study was to describe social characteristics seen among socially excluded drug users in 10 cities from 9 European countries, and identify which social exclusion indicators (i.e. housing, employment, education) are most closely linked to intravenous drug use. A cross-sectional survey was undertaken. Interviews were held in social services centers, town halls, streets, squares and other usual meeting points of the target population. The sample comprises 1,879 participants who have used heroin and/or cocaine and certain derivatives (92.3%) over the last year. Males accounted for 69.7% of the sample, and the mean age was 30.19 years. Participants were recruited in 10 cities: Seville and Granada, Spain; Cologne, Germany; Vienna, Austria; Brussels, Belgium; Athens, Greece; Dublin, Ireland; London, England; Lisbon, Portugal, and Perugia, Italy. Measurements were obtained using structured face-to-face questionnaire, conducted by privileged access interviewers. The study found that cannabis, heroin and cocaine are the most widely used substances. In the total sample, 60.2% injected drugs during the last year, 45.9% reported having hepatitis C; 54.9% have been in prison; 14.2% are homeless; 11.3% have a regular job, and 35.2% are involved in illegal activities. Hierarchical logistic regression analysis (injectors and non-injectors) showed that older participants have a greater likelihood of injecting than younger ones. Social exclusion variables associated with intravenous drug use are incarceration, homelessness, irregular employment, and delinquency. Participants who abandoned or were expelled from a drug treatment program are at greater risk of injecting drugs than participants who have never had treatment, are currently in treatment or have been released. Conclusion: Personal, social, and economic conditions are all linked in a process of social exclusion that compounds problem drug misuse. Given the findings of this study, we believe that there is a clear need for specific programs targeting specific groups, i.e., distinct strategies must be set in place, in line with the profile and needs of the patient in each context