The Life of the Heroin User

Heroin is a worldwide scourge and a seemingly intractable one. The Life of the Heroin User: Typical Beginnings, Trajectories and Outcomes is the first book to apply a biographical approach to the lifecycle of the heroin user from birth until death. Chapters address each stage of the user's life, including childhood, routes to use, the development of dependence, problems arising from addiction, death and options for treatment and prevention. Drawing on over two decades of experience in the field of opium research, Shane Darke examines major theoretical approaches to the development of opiate dependence and the efficacy of treatment options for opiate dependence. Key points are presented at the end of each chapter. The most detailed review available of what is likely to happen to the dependent heroin user, this is an important book for clinicians, researchers and students in the fields of drug and alcohol studies and public health.

SHANE DARKE is Professor at the National Drug arid Alcohol Research Centre, University of New South Wales, Sydney, Australia.

List of tables	p. xi
Foreword	p. xiii
Preface	p. xv
Heroin and addict 'careers'	p. 1
Introduction	p. 1
What are the opioids?	p. 2
How common is heroin use?	p. 5
The dependence liability of heroin	p. 6
The major harms of heroin use	p. 8
Costs to society	p. 10
The addict 'career'	p. 12
Summary	p. 14
Parents and childhood	p. 16
Introduction	p. 16
Social disadvantage	p. 16
Parents of heroin users	p. 18
Parental substance abuse	p. 18
Parental psychopathology	p. 21
Genetics and heroin dependence	p. 22
Childhood sexual and physical abuse	p. 27
Childhood psychopathology of the heroin user	p. 30
Summary	p. 32
Early teenage years: the onset of substance use	p. 34
Introduction	p. 34
The gateway hypothesis	p. 34
The evidence for gateway theory	p. 36
Alternative interpretations of drug initiation sequencing	p. 37
Trends in the age of substance use initiation	p. 40
Early licit substance use among heroin users	p. 41
Tobacco	p. 41
Alcohol	p. 42
Early illicit substance use among heroin users	p. 44
Cannabis	p. 44
Psychostimulants	p. 45
Early sexual activity	p. 47
Summary	p. 48
The mid to late teens: commencing heroin use	p. 50
Introduction	p. 50
Initiating heroin use	p. 50
Age of initiation	p. 50
Routes of heroin administration	p. 55
Injection	p. 55
Smoking	p. 56
Transitions between routes of heroin administration	p. 58
The harms of early stage heroin use	p. 59
Summary	p. 61
The 20s and 30s: heroin and polydrug use	p. 63
Introduction	p. 63
Heroin use patterns	p. 63
Polydrug use patterns	p. 64
Alcohol	p. 65
Benzodiazepines	p. 66
Psychostimulants	p. 67
Drug-related problems	p. 68
Overdose	p. 69
Health	p. 70
Psychopathology	p. 74
Social disadvantage	p. 76
Crime	p. 77
Summary	p. 80
The drug treatment cycle: remission and relapse	p. 81
Introduction	p. 81
What are the main treatments for heroin dependence?	p. 81
Detoxification	p. 82
Drug-free residential rehabilitation	p. 83
Opioid maintenance therapies	p. 85
Antagonist maintenance therapies	p. 89
The treatment cycle	p. 90
What does successful treatment achieve?	p. 90
Drug use	p. 90
Drug-related problems	p. 92
What predicts remission and relapse?	p. 94
Client characteristics	p. 94
Treatment characteristics	p. 96
Summary	p. 97
The older heroin user: the 40s and beyond	p. 99
Introduction	p. 99
Do heroin users 'mature out'?	p. 99
The 'maturing out' hypothesis	p. 99
Drug use patterns of the older heroin user	p. 100
Morbidity and the older heroin user	p. 104
Physical morbidity	p. 104
Psychopathology	p. 107
Mortality risk and the older heroin user	p. 109
Summary	p. 109
Death: rates and causes	p. 111
Introduction	p. 111
Rates of mortality	p. 111
The demography of death amongst heroin users	p. 112
Age and mortality	p. 112
Gender and mortality	p. 113
Causes of death	p. 114
Overdose	p. 114
Disease	p. 117
Suicide	p. 118
Trauma	p. 120
Summary	p. 121
Conclusions: an inevitable life and death?	p. 122
The lifecycle: a retrospective	p. 122
Clinical implications	p. 123
An inevitable trajectory?	p. 123
Prevention	p. 124
Treatment	p. 125
Harm reduction	p. 129
Needle and syringe provision	p. 130
Overdose prevention	p. 131
Medically supervised injecting centres	p. 132
Concluding remarks	p. 133
References	p. 135
Index	p. 177
Table of Contents provided by Ingram. All Rights Reserved.

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The Life of the Heroin User

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Author Biography

Table of Contents

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