Hilary Klee

Drug misuse and motherhood

This book combines accounts from drug using mothers and practitioners responsible for their care offering many insights into the nature of womens dependence on drugs and the impact this has on mothering. Also revealed are those aspects of current practice that need urgent attention in the task that lies ahead for both health and social services.

Violent Crime, Aggression and Amphetamine: what are the implications for drug treatment services?

Substance use has long been associated with violent behaviour, particularly the use of alcohol and stimulants. This paper presents findings from a study of the effectiveness of treatment services for amphetamine users, describing profiles for those reporting violent and aggressive behaviour and documenting their experiences. The sample (n = 86) comprised two groups: amphetamine users seeking drug treatment and a matched case control group of amphetamine users who were not receiving treatment. Forty-seven per cent of the sample reported having committed a violent crime, and half of them associated the violence with their amphetamine use. In addition, 62% repeated ongoing problems with aggression which were related to their amphetamine use. A wide range of factors are discussed in this paper, using established models of association between drug use and violence, and also exploring issues such as the interaction of alcohol and other drugs, the effects of trying to abstain from amphetamine, psychological co-morbidity, the impact of amphetamines reputation for inducing aggression, and conversely, amphetamine as a drug of choice over alcohol to try to minimize aggressive behaviour. The paper concludes with a discussion of the problems posed by aggressive and violent behaviour for amphetamine users seeking treatment.

Crime and Drug Misuse: Economic and Psychological Aspects of the Criminal Ctivities of Heroin and Amphetamine Injectors

Much of the theorizing about the relationship between acquisitive crime and illicit drugs is based upon studies of heroin misusers. In this paper the association between crime and drug misuse is explored using data from two groups of respondents-heroin injectors and amphetamine injectors. Comparisons between these two groups of drug misusers revealed differences that are incompatible with simple theorizing in terms of economic factors. Results suggest that a variety of factors are involved which include those that are non-economic in origin and may be related to the drug of choice.

Drug use among the young homeless: coping through self-medication:

Research has shown that illicit drug use is now a common feature of homelessness. A main aim of the study was to examine the role that drugs played in the lives of young homeless people. Two hundred young homeless drug users (aged 14–25 years) were interviewed. Respondents reported a variety of health problems. Respiratory infections, aching limbs and weight loss were the most common, but of greater concern was mental health and 82% reported psychological symptoms: depression, sometimes severe and often chronic, anxiety and aggression. A very high proportion (43%) had attempted suicide, mostly through drug overdose. Three-quarters of the sample said they used drugs to self-medicate their symptoms. Drug use is one form of stress management that is widely adopted by many people, whether homeless or not, but the particular nature of the stressors endemic in the homeless lifestyle leads to a much increased vulnerability to such selfmedication when other coping strategies fail.

Interviewing Illicit Drug Users: Observations from the Field

Matched case control studies are rare within the field of illicit drug research. This paper describes the practical problems involved in undertaking such a project, and details some of the issues that arose in conducting in-depth longitudinal interviews with illicit drug users. Some problems were specific to a matched case design, some were common to most social research: establishing trust, trying to ensure privacy during the interview, and possible communication problems. Others were more pertinent to interviews with illicit drug users: respondent intoxication, potential mental health problems, concerns about possible aggression, and dilemmas about witnessing illegal acts. This paper aims to make explicit the process of conducting longitudinal research with illicit drug users in the hope that it will encourage other social researchers to share their experiences and their strategies for negotiating fieldwork obstacles and hazards.

Hepatitis C testing and injecting risk behaviour: the results of a UK based pilot study

Abstract We investigated the impact of hepatitis C testing on injecting risk behaviour reported by opiate using injecting drug users (IDUs). Semi-structured interviews and focus group discussions were carried out in two areas: the city of Manchester, England and the predominantly rural area of northwest Wales. The interview data collected suggested that awareness of hepatitis C virus (HCV) status by an IDU had a variable range of impacts on injecting risk behaviour. A negative HCV test could lead to lower injecting risk behaviour. The impact of a positive test varied. It was apparent that current implementation of HCV testing in the districts studied is often occurring without informed consent or with inadequate pre- and post-test counselling. The results may therefore not reflect what could be achieved with a comprehensive and properly managed screening program. The IDU focus groups concluded that the important determinants of injecting risk behaviour were availability of clean injecting equipment and whether the individual was withdrawing from opiates. Less important were knowing whether the other people injecting with them were HCV positive or negative, who those other injectors were and whether the IDU had been tested.

The role of substitute therapy in the treatment of problem amphetamine use

The aim of the project was to examine the effectiveness of treatment services for amphetamine users in the North West of England. Semi-structured interviews were conducted by researchers in a longitudinal matched case-control design in which each client was matched with an amphetamine user not in contact with services. Interviews yielded quantitative data which were subjected to standard statistical tests, and also rich qualitative data that provided further insights into their attitudes and behaviour. This paper reports on the subgroup of drug agency clients who were prescribed dexamphetamine (PDAs) and the changes in their use of street amphetamine. Analyses comparing prescribed clients with their controls revealed a significant reduction in amount and frequency of street amphetamine consumption over the first 3 months of treatment. Such changes in amphetamine use were most marked in the first month of treatment. Comparisons between PDAs and clients in treatment but not receiving a prescription (NPDAs) ...

Drugs and Youth Homelessness: Reducing the risk

The increase in youth homelessness in the UK and also internationally, although a cause for public concern, is proving resistant to efforts to contain it. Perhaps an association with drug misuse is one of the most serious social consequences of this trend, threatening the health of many young people with long-lasting effects. The family history and the current privations of the lives of 200 young, homeless drug users in Greater Manchester were studied in depth. The primary aim was to reveal the nature and range of coping responses to the hazards they faced. A major way of coping was through self-medication with drugs. The young and newly homeless, if not using drugs already, were likely to be absorbed into a drug-oriented community. lf they were, like many young people, using drugs recreationally, then their involvement was likely to increase. Older, long-term users were using more drugs and using them more frequently. Possible interventions are discussed that recognize the heterogeneity of the homeless p...

Attitudes of Amphetamine Users Towards Treatment Services

Amphetamine users form the second largest group of illicit drug users in Britain, yet rarely present to treatment services. It is unknown whether this is due to a relative lack of need in comparison with other drug users, or a result of the opiate orientation of drug services. This paper presents data on attitudes to services from a matched case control study of amphetamine users in treatment, undertaken in the Northwest of England. Respondents’ attitudes to and expectations of treatment services, and their previous experiences of treatment are described, and the factors which influenced clients to overcome the barriers and present for treatment are explored. The paper concludes with a consideration of strategies that could increase the relevance and accessibility of services to amphetamine users at an earlier stage of their drug-using career in order to avoid the need for crisis interventions later.

Amphetamine Misuse: The Effects Of Social Context On Injection Related Risk Behaviour

The influences of interpersonal relationships and the social environment on injection risk behaviour are explored in this paper. Data from a study of the lifestyles of amphetamine users in the North-West of England are used to reveal the relationships between social interactions and risk. Differences were found in the factors implicated in the two aspects of sharing. Passing on used injection equipment was largely influenced by social factors. Accepting equipment from others was associated with perceptions of dependence and the use of needle-exchanges. Implications for theory are suggested and the difficulties of intervention noted.