Monday, 11 August 2008

The role of 'drug, the person and their social context' in the development of problematic drug use and recovery

In yesterday's Blog, I pointed out that the effects of a drug (or alcohol) on an individual are determined by an interaction between the drug, the person and their social context (commonly known as 'drug, set and setting' in the field). This principal holds in a variety of situations.

For example, the ‘person’ and ‘social context’ factors influence early substance use and the likelihood that a person will develop problematic use and addiction. In general, individuals are less likely to develop substance use problems if they have fewer complicating life problems, more resources (social, personal, educational, economic), and opportunities for alternative sources of reward. One explanation is that these individuals develop a weaker attachment to the substance in that for them substance use does not serve as many emotional, psychological or social needs.
On the other hand, people are in general more likely to develop substance use problems if they have complicated personal problems (e.g. co-occurring mental health issues), few personal resources, and live in a deprived social environment offering few alternative rewards. 
Serious substance use problems often occur as part of a larger cluster of psychological, medical, family and social problems. However, it must be remembered that addiction can affect anyone, whatever their age, gender, financial situation, family stability, intellect, religion, or race. 
A variety of factors can change problematic substance use once it has developed. For some people, the problems are transitional in nature and they mature out of them as their setting changes, e.g. other life events become more significant, such as setting up a home with a loved one. Other people spend years misusing substances and suffering negative consequences and losses, before dying without overcoming their problems.  Most people, however, experience multiple attempts either to stop using or to bring their use under better control before they eventually resolve their substance use problems.
The ease with which people overcome substance use problems, and achieve recovery from addiction, is largely dependent on two factors, namely problem severity and recovery capital. Recovery capital is the quantity and quality of internal (‘person’) and external (‘social context’) resources that one can bring to bear on the initiation and maintenance of recovery. The interaction of problem severity and recovery capital shapes both the prospects of recovery and the intensity and duration of resources (e.g. formal treatment) required to initiate and sustain recovery.
In general, it is easier to resolve substance use problems at earlier and less severe stages of problem development. Moreover, substance use problems are easier to overcome if a person has good internal and external resources.


ellewasal said...

The aetiological model you describe is a very useful way to think about the interaction between "host" (the person including their genetic heritage) and "agent" (the substances the person uses) and "environment" (the person's family and social background, their education and work, their resources etc.) Obviously it is an analogy based on medical disease. It therefore makes sense to suggest that we attend to the parts of the equation we can improve, providing reources that the person can assimiliate. It is also sound to suggest that earlier interventions at less severity will need less resources and will achieve more success than later interventions at higher severity. It seems to me that our commissioning and service structures for both mental health and substance use treatment are often built around gateways that restrict access, allowing only most severe cases to receive treatment, and relegating tier 2 and 3 clients to delayed or inadequate services that do not really provide the client with the resources you suggest as being essential to resolve the problem. There are obviously exceptions. Are you aware of any data that illustrates tier 2 and 3 treatments, results and costs compared to tier 4?

Mike said...

At last a succinct explanation of how an individual more often than not overcomes a substance use problem. Its a shame the powers that be cannot grasp the fact that problem severity and recovery capital have more to do with it than the so called government defined "client journey" and how many are "cured". I will be sending your blog to my boss at the DAAT where I work as he is striving to develop his understanding of the whole recovery debate. Brilliant!

David Clark said...

I doubt there is any good research of the type you mean in the UK. Complicated to do well.

David Clark said...

Thanks Mike for kind comment. I wish all DATT teams read my Blog - I would love to know how many are. And how many understand recovery.