Psychotropic Drugs, Prevention and Harm Reduction

This book promotes the interaction between research and professional practices in the field of prevention and harm reduction. Through the scientific work and experience of human and social sciences researchers and medical social actors, research and action assist one another in illuminating the problems associated with the consumption of psychotropic drugs and in developing intervention strategies.Over the course of several chapters, contributed by attendees of the Psychotropics, Prevention and Harm Reduction Put to the Test By “Human and Social Sciences workshop, a range of varied themes are explored within the scope of drugs and their uses. Both the socio-historical context of drug uses and the construction of prevention and harm reduction public policies in light of scientific knowledge are covered, as well as the issue of release, mobilization and/or negotiation of prevention and harm reduction standards, both for professionals and drug users.

• Presents acts that formalize the first day of study initiated by the network of young researchers at the Psychotropes and Societies Intervention
• Offers a multidisciplinary view on the understanding of the use of psychotropic substances
• Includes different analyses to stimulate reflection

• Language: English
• Publisher: Elsevier Science
• Release date: Aug 30, 2017
• ISBN: 9780081023730

Book preview

Psychotropic Drugs, Prevention and Harm Reduction

Imaine Sahed

Antony Chaufton

Addictions Set

coordinated by

Jean-Jacques Perseil

Edited by

Table of Contents

Cover

Title page

Copyright

Foreword

Knowledge is power

Preface

Introduction

Part 1: Prevention in Care Environments: Approaches and Practices

1: Scientific Data and Political Decisions in the Field of Addictive Behaviors

Abstract

1.1 Introduction

1.2 A particularly complex field for decision makers

1.3 Heterogeneous decision-making during the last two decades

1.4 Summary

2: Social Sciences and Practice Renewal: From Prevention, to Identification, to Early Intervention

Abstract

2.1 Introduction

2.2 Redefining prevention

2.3 What organization and what strategy: organizational expertise

2.4 Conclusion

Part 2: (Re)designing Prevention: Multidisciplinary Outlooks

3: The Beautiful Life With or Without Drugs: Questions on Emancipation

Abstract

3.1 Introduction

3.2 Theoretical framework on dependency and addiction

3.3 Transgression and emancipation

3.4 Conclusion

4: Tobacco and Alcoholic Beverage Consumption of European Adolescents: Substitutes or Complements? The Value of an All-encompassing Policy

Abstract

4.1 Introduction

4.2 Previous studies

4.3 Analysis framework

4.4 Data and descriptive statistics

4.5 Price elasticity and cross-price elasticity results

4.6 Discussion

4.7 Conclusion

4.8 Appendix: robustness test

4.9 Acknowledgements

5: Animated Images, Words Coming Alive, Reflection in Motion

Abstract

5.1 Introduction

5.2 Why animated images?

5.3 Practical session

5.4 What perspectives?

Part 3: Psychotropic Uses and Health Policies: International Perspectives

6: Towards the Addiction of Adolescents Under Public Protection: Paradoxical Contextualization

Abstract

6.1 Introduction

6.2 The moral area

7: Socio-anthropological Contributions to the Senegalese Harm Reduction Program

Abstract

7.1 Introduction: drugs in Africa

7.2 Subject matter of the presentation

7.3 Harm reduction origins in Senegal: UDSEN project

7.4 Drug user profile in Dakar

7.5 Implication and contribution of social sciences

7.6 Discussion

Part 4: Prevention and Harm Reduction at the User Level

8: Promoting Harm Reduction Personal Strategies by Means of Drugs Checking: Its Use in CAARUD

Abstract

8.1 Introduction

8.2 Drugs checking and harm reduction

8.3 Subjectivity and objectivity of the consumption experience

8.4 Co-production of knowledge for harm reduction

9: Initiation to Injection: A Community Challenge

Abstract

9.1 Introduction

9.2 The first shoot: between apartment and squat… an experience between friends

9.3 Methodology

9.4 Within the injecting community: status among peers

9.5 From the initiator’s point of view

9.6 Conclusion: what perspectives?

List of Authors

Index

Copyright

First published 2017 in Great Britain and the United States by ISTE Press Ltd and Elsevier Ltd

Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms and licenses issued by the CLA. Enquiries concerning reproduction outside these terms should be sent to the publishers at the undermentioned address:

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Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

For information on all our publications visit our website at http://store.elsevier.com/

© ISTE Press Ltd 2017

The rights of Imaine Sahed and Antony Chaufton to be identified as the authors of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act 1988.

British Library Cataloguing-in-Publication Data

A CIP record for this book is available from the British Library

Library of Congress Cataloging in Publication Data

A catalog record for this book is available from the Library of Congress

ISBN 978-1-78548-272-4

Printed and bound in the UK and US

Foreword

Anne Coppel

Knowledge is power

Psychotropes & sociétés (Psychotropics & Societies) gathers work deriving from a long history – numerous publications could fit under this title. However, if most experts as early as the 1970s recognized the close link between the psychotropic uses of drugs and their social context, the will to understand in order to act is relatively recent. This new field of expertise emerged during the 1990s and faced many obstacles. To put this evolution toward a new approach into perspective, it is enough to mention here two seminars that marked research prior to this new paradigm. In 1970, one of the very first seminars on the topic was published under the title Ivresse chimique et crise de civilisation (Chemical Intoxication and Civilization Crisis). The French people had just discovered that a new generation born after World War II was using illicit drugs. How could we doubt the association between drugs and society when the consumers themselves claimed credit for an emancipating project? Two decades later, social science researchers were officially approached by the government. A research group, RDG, was created in 1991 and led to the seminar Psychotropes, politique et société (Psychotropics, Politics and Society), in which I took a part. It was a turning point because it was no longer just about establishing the scene, research was responsible for informing the public debate which had been restricted since the 1980s to laxity or repression. Defined by Alain Ehrenberg, the RDG program offered to take into account all the psychotropics, whatever their legal status, in all their aspects (production, distribution, consumption), to develop a plurality of centers of expertise with the collaboration of foreign researchers. This program was partly implemented with the creation of the OFDT (French Observatory of Drugs and Drug-addictions) in 1993. In a hurry, the French have hastily tried to catch up, partly to the deficit of public health. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) asked for the development of epidemiologic studies that could be compared from one country to the other but, beyond institutional constraints, a new expertise based on public health policies was going to greatly disrupt both our ways of acting and our ways of thinking.

At the end of the 1980s, the AIDS threat, a fatal and contagious disease, was the turning point. The situation demanded swift and efficient action. The evaluation studies were a reaction to this emergency. They also answered another requirement, as harm reduction policies aim at reducing the adverse health consequences of drug use rather than eliminating drug use, in contrast with the usual objective of the fight against drugs. In the health field, these new approaches were the source of an amazing development of research in France, as well as at the international level, but this development encountered specific obstacles in France. La défaite de la santé publique (The Failure of Public Health Policies), the title of Aquilino Morelle’s book dealing with the contaminated blood scandal, was one of these obstacles. The lack of research in the field of psychotropics was only one specific case of public health deficit, as shown by the series of scandals from mad cow disease to asbestos in the 90s, but the argument justifying public health defiance was specific to the debate regarding the drug issues, as public health measures were accused of being too soft, lenient and lax by many and of being a pretext for social control by others. Another obstacle is a French tradition of social science research which refuses to be at the service of action in contrast to the more pragmatic and empirical Anglo-Saxon social sciences. Field research is traditionally undervalued and, in addition, the issue of psychotropic drug use is still considered as a fringe topic in institutional research fields. Research responding to the demands of action is even more marginal since it is necessarily multidisciplinary. Understanding the meaning of psychotropic drug use implies taking context into account, one of those multidisciplinary words referring both to sociology and economy, to anthropology as well as political sciences. The mistrust towards social sciences feeds off phenomena complexity: what authorizes the researcher to retain one variable rather than another? The answer lies partly in the construction of these new research fields, which developed their own methodology and conceptual tools.

Despite all these obstacles, research has nonetheless experienced a significant development during the last two decades. Thus, the research published here offers a good overview of the different problems that forged the alliance between practitioners and researchers. Without claiming to synthesize, we single out here a first question addressed from different angles the published works, the question of consumer practices. Whether it is harm reduction policies, care or prevention, intervention tools cannot omit the meaning that the user gives to his/her uses. Except for counter-culture movements, uses of illicit psychotropic drugs are not asserted, they are most often undescribed, but drugs that modify states of consciousness always assume the same functions ranging from emancipation to integration, along with, for example, a transition function from one social environment to another in search of a new personal and social identity, or even in order to comply with life’s everyday demands, and finally to escape into intoxication, which also has its own logic. It is the same for legal psychotropic drugs, whose meanings are little studied as they seem obvious. Thus, poly-consumptions are a constant, whether the products are legal or illegal, and, in this respect, taking into account the joint uses of alcohol and tobacco is a necessity for prevention.

Whether licit or illicit, these consumptions must be studied in their context according to the groups people belong to. In youth-directed prevention, peer groups became evident but community approaches are still restricted to fringe practices such as injection. The more ambitious community health approaches combine the different actors not only in diagnosis, but also in action. According to this logic, doing research on drugs analysis, considered as a tool for producing and sharing knowledge, has focused on comparing professional practices and consumption practices. Yet, if the issue of practices is crucial for action, it is confronted by the complexity of the actors’ logics, as noted by the issue of early intervention. Difficulties are both conceptual and methodological, and if research on practices is involved in increasingly numerous works, the quality of the research is still based on the understanding of the situations, which obviously encourages the suspicion of subjectivism or partiality afflicting such qualitative approaches. Public debate demands statistics and the assessment of public health policies complied with this requirement. With undeniable results, such as an HIV infections decrease, harm reduction policies developed a consensus of expertise in France, as well as at the international level. However, it is remarkable that this quantitative approach ignores a critical determiner for results: the actors’ practices. When treating opioid dependence, it was shown that good practices determine results. Despite the lack of research, there is every reason to think that it is the same for all harm reduction or prevention tools. It is still necessary to be given the means to develop this complex research. The quality of practice is a kind of open secret: education, care, outreach, all the actors concerned, whether professionals or beneficiaries of the actions, know what good practices are. As for prevention, it is believed a priori that good practices are those that provoke exchange and reflection, which, for example, are targets of the projection of animated short films. The task remains to identify the determiners of good practices in order to validate and pass them on.

Another issue raised here by some studies is drug supply. This approach is traditionally studied for legal psychotropics, along with the whole range of regulations, from prohibition of sale to minors to marketing strategy limitations. Drug supply in the illegal market is little studied, mainly because access to the field faces specific obstacles, and also because there is a lack of will to learn. The fight against drug trafficking is not assessed according to its results, a fact that Latin American countries devastated by counter-productive consequences deplore nowadays. Therefore, Alain Tarrius’ work on the distribution of chemical drugs to teenagers should be welcomed. The concept of moral area developed in this research