hooked or sick

8/14/2019 Hooked or Sick

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Addictire Beha r i o u r ~ , . V o l . 4 . p p . 1 8 5 t o 1 9 1 . 0306-4603i7910401-0185S02.00i0 P e r g a m o n P r e s s L i d 1 97 9. P r i n t e d i n G r e a t B r i t a i n

" H O O K E D " O R " S I C K " : A D D I C T S ' P E R C E P T I O N SO F T H E I R A D D I C T I O N

J R I C H A R D E I SE R a n d M I C H A E L R ' G o s s o PInst itute of P sychiatry and Bethlem Roya l and Maudsley Hospitals, London

Abs tract--In a s tudy concerned with addicts ' perceptions of their own dependence on drugs,40 outpatients (30 male, 10 female) at tending a London drug dependence c l inic were individuallyadministered a 15-i tem at t i tude quest ionnaire and an abbreviated (10-i tem) mea sure of locusof control . Subjects ' own agreeme nts with most o f the 15 i tems correlated highly with theirest imates of the responses of other drug cl inic pat ients to these i tem s, but showed l i t t le relat ionto locus of control.A p r incipa l compon ents analy sis conducted on thes e rat ings revealed two factors whichtogether accounted for 31.5% of the var iance. Factor I , labelled as "Hooked" loa de d m ostheavily on i tem s reflect ing a perceived inabil ity to give up drugs. Factor 2, labelled as "Sick",reflected a perception of one's addiction as a s ickness which doctors could cure, and an acknowl-edgem ent of person al problems general ly. The 14 subjects wh ose preferred drug was heroindid n ot d iffer , on average, from the rem aining 26 in terms of their score s on Factor 1, butobtained s ignificantly low er scores than the others on the "Sick " factor. Im plications for t reat-me nt, and for the concept of the "sick role" in relation depen dence, are discussed.

T h e d e f ic ie n ci e s s u r r o u n d i n g a s s u m p t i o n s o f a u n it a r y " a d d i c t i v e p e r s o n a l i t y " o r o fh o m o g e n e i t y a m o n g d r u g a b u s e r s , a r e n o w w i d e ly r e co g n i ze d , a n d r e c e n t r e s e a rc h i n t od r u g d e p e n d e n c e h a s i n c re a s i n g ly f o c u s e d u p o n b e h a v i o u r a l a n d p e r s o n a l i t y d if fe r en c e sw i t h in t h e d r u g a b u s i n g p o p u l a t i o n . D i ff e re n c e s h a v e b e e n f o u n d b e t w e e n t h o s e r e ce i v in ga n d n o t r e c e i v i n g p r e s c r i p t i o n s f o r o p i a t e s ( B l u m b e r g e t a l . , 1 9 7 4 ) , b e t w e e n i n p a t i e n t sa n d o u t p a t i e n t s ( G o s s o p & R o y , 1 9 76), b e t w e e n o r a l a n d i n t r a v e n o u s u s e rs ( G o s s o p ,1 9 78 a ), b e t w e e n u s e r s o f h e r o i n a n d o f o t h e r d r u g s ( T e a s d a l e , 1 9 7 2 ; H e l l e r & M o r d k o f f ,1 97 2), a n d b e t w e e n m a l e a n d f e m a l e a d d i c ts ( G o s s o p , 1 97 6). S t i m s o n ( 19 7 3) a l s o l o o k e da t so c ia l a n d b e h a v i o u r a l d i ff e re n c es w i th i n a r e p r e s e n t a t i v e s a m p l e o f L o n d o n h e r o i na d d i c t s , a n d d e s c r i b e d f o u r d is t in c t s u b - g r o u p s .

I t is , h o w e v e r , b e c o m i n g i n c r e a s i n g l y c l e a r t h e c o g n i t i v e f a c t o r s , s p e ci f ic a l ly a d d i c t s 'p e r c e p t i o n s o f t h e i r o w n a d d i c t i o n a n d t h e i r o w n a b i l i t y o r w i s h t o o v e r c o m e it , a r ea n i m p o r t a n t f e a t u r e o f d r u g a d d i c t i o n . R o b i n s e t a l . ( 1 97 4 ) f o u n d t h a t , o f a s a m p l eo f 4 9 5 A m e r i c a n s e r v i c e m e n w h o s e u r in e s w e r e p o s i t iv e f o r o p ia t e s w h e n d i s c h a rg e df r o m V i e t n a m , o n l y 7 ~o s ti ll s h o w e d s ig n s o f d e p e n d e n c e w h e n c o n t a c t e d 8 - 1 2 m o n t h sl a te r . A l s o , i n a s t u d y o f t h e v a r i a b l e s r e l a t e d t o l e n g t h o f s ta y o n a n i n - p a t i e n t d r u gd e p e n d e n c e u n i t, G o s s o p (1 9 7 8 b) f o u n d t h a t t h e s in g l e m o s t e f fe c ti v e p r e d i c t o r w a st h e a d d i c t s ' o w n e x p r e s s e d d e s i r e f o r t r e a t m e n t . S i m i l a r ly , E i s e r & S u t t o n ( 19 7 7) h a v ea r g u e d t h a t c i g a r e t te s m o k e r s ' p e r c e p t i o n s o f t h e p r o b a b i l i t y t h a t t h e y c o u l d g i v e u ps m o k i n g i f t h e y a t t e m p t e d t o d o s o m a y b e a n i m p o r t a n t p r e d i c t o r o f w h e t h e r t h e yi n fa ct m a k e s u c h a n a t t e m p t .

T h e q u e s t i o n o f a d r u g - u s e r ' s p e r c e p t i o n o f h i s o w n a b i l it y t o a b s t a i n t o u c h e s u p o nt h e s o c i o l o g i c a l c o n c e p t o f t h e " s ic k r o l e " ( P a r s o n s , 1 95 1). R o b i n s o n ( 19 7 2) h a s p o i n t e do u t h o w t h e d i s e a s e c o n c e p t o f a l c o h o l i s m ( J el li n e k, 1 960 ) m a y c a s t t h e a l c o h o l i c i nt h e r o l e o f a " s i c k " p e r s o n , h e l p l e s s t o c o n t r o l h i s o w n d e p e n d e n c e o n a l c o h o l o r " c u r e "h i m s e l f w i t h o u t m e d i c a l i n t e r v e n t i o n . S i m i l a r ly , E is e r (1 9 78 ) h a s s u g g e s t e d t h a t c i g a r e t t es m o k e r s ' p r e p a r e d n e s s t o l a b e l t h e m s e l v e s as " a d d i c t e d " m a y m a k e i t m o r e d if fi cu ltt o p e r s u a d e t h e m t o s t o p t h r o u g h t h e i r o w n e f f o r t s .A p r e l i m i n a r y a t t e m p t h a s b e e n m a d e t o i n v e st i g a te s u ch f a c t o rs i n d r u g a d d i c t io nt h r o u g h t h e n o t i o n o f l o c u s o f c o n t r o l ( R o t t e r , 1 9 66). B e r z in s & R o s s ( 19 7 3) s u g g e s t e dt h a t o p i a t e a d d i c t s h a v e a h i g h in t e r n a l l o c u s o f c o n t r o l , a n d S t r a s s b e r g & R o b i n s o n( 19 7 4) r e l a t e d i n t e r n a l i t y t o p o s i t i v e p s y c h o l o g i c a l a d j u s t m e n t a n d s e l f - c o n c e p t a m o n gd r u g u s e r s . H o w e v e r , t h is r e l a t i o n s h i p h a s n o t b e e n c o n f i r m e d b y a l l s t u d ie s . I n d e e d

185


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186 J. RICHARDEISER an d MICHAELR. GOSSOpTable 1. Classification of subjects by preferred drug: ag e, sex, marital status, route and prescription frequencies

MeanPreferred drug N age

PrescribedMarital status Route of abuse drugs bySex Divo rced/ lntra- clinic"M ale Female Sing le Marr ied Separa ted venous Oral Yes NoHero in 14 35.5 I 1 3 5 2 7 14 0 13 1Physepton e 5 22.4 3 2 5 0 0 5 0 5 0Am phetamines 5 26.2 5 0 5 0 0 3 2 0 5Barbiturates 2 25.5 1 I 1 0 1 1 1 0 2I& other sedativeslBenzodiazepines 4 26.5 2 2 1 2 1 0 4 1 3Codeine/Chlorod yne 4 26.8 2 2 4 0 0 I 3 1 3Multiple 5 28.8 5 0 3 1 1 4 1 2 3Cannabis 1 52.0 1 0 1 0 0 0 I 0 140 30.0 30 10 25 5 10 28 12 22 18

;' The d rug prescribed is not necessarily the subject 's drug of preference.C u r r i e et al. ( 1 9 7 7 ) f o u n d a s l i g h t ( b u t s t a t i s t i c a ll y s i g n i f i c a n t ) n e g a t i v e c o r r e l a t i o nb e t w e e n i n t er n a l i t y a n d m a r i h u a n a u se .

T h e p r e s e n t s t u d y t h e r e f o r e d e s c ri b e s t h e p a t t e r n o f i n d i v i d u a l v a r i a t i o n o c c u r r i n gw i t h i n a s p e c if ic g r o u p o f a d d i c t s w i t h r e g a r d t o t h e i r e x p r e s s e d f e el in g s o f p e r s o n a lc o n t r o l , p e r c e iv e d d e p e n d e n c e o n d r u g s a n d e x p e c t a t i o n s f o r tr e a t m e n t . I n a d d i t io n ,t h e s t u d y t a k e s a c c o u n t o f t h e e x te n t t o w h i c h a n i n d i v i d u a l a d d i c t m a y i d e n ti fy w i t h ,o r s e e k t o d i f f e r e n ti a t e h i m s e l f f r o m , o t h e r d r u g - u s e r s .

M E T H O DS u b j e c t s

T h e 4 0 s u b j e c ts w h o t o o k p a r t i n t h is s t u d y w e r e s e e n i n t h e o u t - p a t i e n t s d e p a r t m e n to f t h e D r u g D e p e n d e n c e C l i n ic a t t h e M a u d s l e y H o s p i t a l d u r i n g t h e p e r i o d O c t o b e r1 9 7 6 t o J a n u a r y 1 9 77 .* T h i s c li n ic s e es a b o u t 1 0 0 i n d i v i d u a l s w i t h d r u g p r o b l e m s d u r i n ga 1 2 m o n t h p e r i o d . O f t hi s n u m b e r , a c o n s i d e r a b l e p r o p o r t i o n a r e o p i o i d a b u s e rs w h or e ce i ve s o m e m a i n t e n a n c e p r e s c r ip t i o n . A l t h o u g h t h e r e a re a n u m b e r o f p a t ie n t s w h oh a v e r e m a i n e d o n a s t a b l e d o s e o f d r u g s f o r s o m e t i m e , i t is t h e c l i n i c' s p o l i c y t or e d u c e th e p re s c r i be d d o s e w h e r e v e r p o s s ib l e a n d i n - p a t i en t w i t h d r a w a l a n d t r e a t m e n ta r e o f f e re d a s t h e m o s t s u i t a b l e w a y o f g i v i n g u p d r u g s . I t i s n o t t h e p o l i c y o f t h ec li n ic t o p r e s cr i b e a m p h e t a m i n e s , b a r b i t u r a t e s o r o t h e r n o n - o p i o i d d r u g s , t h o u g h t hi sis d o n e i n e x c e p t i o n a l c a s es .

A d e t a i l e d d e s c r i p t i o n o f t h e s a m p l e is g i v e n i n T a b l e 1 . D i v i d e d a c c o r d i n g t o p r e f e r r e dd r u g , th e h e r o i n u s e r s c o n s t i t u t e t h e l a r g e s t s u b - g r o u p . T h e m e a n a g e o f t h e s e i n d i v i-d u a l s , m o s t o f w h o m w e r e r e c e i v in g a p r e s c r i p t i o n f r o m t h e c li n ic , w a s 3 5 .5 y r . T h em e a n a g e o f t h e o t h e r s u b j e c t s w a s 2 7 y r , a n d o f t h e s e o n l y n i n e o u t o f 26 w e r e r e c e i v i n ga p r e s c r i p t io n f r o m t h e c l i n i c -- f iv e o f w h o m w e r e p h y s e p t o n e u s er s .

T h e p r e d o m i n a n t p a t t e r n o f d r u g - t a k i n g a m o n g B r i t is h c l in i c a t t e n d e r s a t th e t im eo f t h is s t u d y i s m u l t i p l e d r u g a b u s e . F o r t h i s r e a s o n , s u b j e c t s w e r e c a t e g o r i s e d i n s e v e r a ld i f fe r e n t w a y s r e g a r d i n g t h e i r d r u g - t a k i n g h a b i ts , in c l u d i n g b y p r e f e r r e d d r u g . T h u s ,i t s h o u l d n o t b e a s s u m e d t h a t s a y t h e " h e r o i n " g r o u p , o r th e " a m p h e t a m i n e " g r o u pu s e d n o o t h e r d r u g s i n a d d i t i o n . T h e m u l t i p l e d r u g a b u s e c a t e g o r y r e f e rs o n l y to t h o s ef ew in d i v i d u a l s w h o s e d r u g h a b i t s w e r e su f fi c ie n t ly v a r ia b l e o r i n d i s c r i m i n a t e t o p r e c l u d et h e p o s s i b i l i ty o f c l a s s if y i n g t h e m a c c o r d i n g t o a n y s i n g le p r e f e r r e d d r u g .Th e q u e s t i o n n a i re

E a c h s u b j e c t w a s f ir s t p r e s e n t e d w i t h a s m a l l d u p l i c a t e d b o o k l e t , w i t h t h e f a c in gp a g e p r e s e n t i n g i n s t r u c t io n s w i t h in f o r m e d s u b j e ct s t h a t it c o n t a i n e d " s o m e c o m m e n t so f t h e k i n d t h a t p e o p l e a t t e n d i n g d r u g c li n ic s m a k e f r o m t i m e t o t i m e . " T h e r e m a i n i n g

*We wis h to thank Dr P. H. Connell for permitt ing us to approach his patients.


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Addicts" perception s of the ir addiction 1871 5 p a g e s o f t h e b o o k l e t c o n t a i n e d t h e 1 5 i t e m s l i s t e d in f u ll i n T a b l e 2 , i n f o u r s e p a r a t er a n d o m o r d e r s , p r i n t e d a b o v e t w o r a t i n g s c a le s i n t h e f o r m o f c o n t i n u o u s 1 0 c m l i n e sw i t h n o i n t e r m e d i a t e l a b e ls o r d i vi s io n s . T h e f i rs t w a s l a b e l le d " N o t a t a l l th e w a yI f e el " a t th e l e f t - h a n d e x t r e m e , a n d " V e r y m u c h t h e w a y I f e e l " a t t h e r i g h t - h a n de x t r e m e ; th e s e co n d w a s l ab e ll e d c o r r e s p o n d i n g l y " N o t a t a l l - - v e r y m u c h t h e w a y 1t h i n k m o s t o t h e r p e o p l e a t t e n d i n g t h is c l in i c fe e l" . S u b j e c ts w e r e i n s t r u ct e d t o m a r ka c r o s s a t t h e a p p r o p r i a t e p o i n t o n e a c h s c a le , a n d t h e i r re s p o n s e s w e r e c o d e d n u m e r i -c a ll y fr o m 0 to I 0 0 b y m e a s u r i n g t h e d i s t a n c e i n m m o f e a c h c r o s s f r o m t h e l e f t- h a n de x t r e m e . H i g h e r s c o r e s t h u s r e fl e ct g r e a t e r e n d o r s e m e n t o f a n i t e m f o r o n e s e l f o r o t h e r s .Personal control scale

A f t e r c o m p l e t i n g th e q u e s t i o n n a i r e , s u b j e c ts w e r e h a n d e d a s in g l e s h e e t c o n t a i n i n g1 0 p a i r s o f s t a t e m e n t s s e l e c t e d f r o m R o t t e r ' s ( 19 6 6 ) I - E s c a l e . S p e c if i ca l l y , t h e s e w e r ei t e m s n u m b e r 2 , 9 , 11 , 1 3, 15 , 1 6, 18 , 2 0, 25 a n d 2 8 , a n d w e r e c h o s e n o n t h e b a s i so f M i r e l s ' ( 19 7 0) f a c t o r a n a l y s is o f R o t t e r ' s s ca l e . T h e 1 0 i t e m s w e r e a m o n g t h o s e w h i c hl o a d e d m o r e h i g h ly o n t h e f i rs t o f M i r e l s ' f a c to r s , it e m s c o n c e r n i n g s t u d e n t g r a d e sa n d l e a d e r s h i p h a v i n g b e e n d i s c a r d e d a s i n a p p r o p r i a t e . A c c o r d i n g t o M i r e l s (p . 2 27 ):" E a c h o f t h e s e i te m s p i t s a s t a t e m e n t w h i c h a f f ir m s t h e r e s p o n d e n t ' s c o n t r o l o v e r h i so w n d e s t i n y a g a i n s t o n e w h i c h a s s ig n s s u c h c o n t r o l t o e x t e r n a l f o r ce s " . E a c h s u b j e c tw a s re q u i r e d t o i n d i c a t e w h i c h s t a t e m e n t i n e a c h p a i r c a m e c l o s e r t o h is o w n p e r s o n a lf ee li n gs , a n d t h e n u m b e r o f i t e m s in w h i c h h e e n d o r s e d s t a t e m e n t s o f t h e f o r m e r t y p ew a s c o u n t e d . H i g h e r s c o r e s w i t h i n a r a n g e f r o m 0 t o 1 0 w e r e t h u s i n d i c a t iv e o f am o r e " i n t e r n a l " a s o p p o s e d t o " e x t e r n a l " lo c u s o f c o n t r o l o r i e n t a t i o n .Procedure

S u b j e ct s w e r e te s t e d i n d i v i d u a l l y b y e it h e r o f t h e t w o a u t h o r s , d u r i n g t h e n o r m a lh o u r s o f t h e o u t - p a t i e n t s c li ni c, w h i c h m o s t s u b j e ct s t y p i c a l l y a t t e n d e d a t f o r t n i g h t l yi n t e rv a l s . A l l w e r e t e s te d i m m e d i a t e l y b e f o r e o r a f t e r th e i r r e g u l a r i n t e r v ie w w i t h ap s y c h i a t r is t b u t t h e s t u d y w a s p r e s e n t e d a s a " p ie c e o f r e s e a r c h " i n d e p e n d e n t o f t h e i ri n t e rv i e w . P a r t i c i p a t i o n w a s v o l u n t a r y ( t h r e e fu r t h e r s u b j e ct s w e r e a p p r o a c h e d b u tr e f us e d t o t a k e p a r t) , a n d c o n f i d e n t i a l it y w a s e m p h a s i z e d s o t h a t, f o r i n st a n c e , s u b j e ct sw e r e a s s u r e d t h a t t h e i r r e s p o n s e s w o u l d n o t b e s h o w n t o t h e p s y c h i a t r i s ts a s a b a s isf o r d e c i d i n g w h e t h e r o r n o t t o l e t t h e m h a v e d r u g s o n p r e s c r i p t i o n o r r e d u c e t h e i rd o s e .

R E S U L T SW e f ir st c o m p a r e d t h e r a t in g s g i v e n to e a c h o f t h e 1 5 i t e m s o n t h e " S e l f " a n d " O t h e r s "

s c a le s b y t h e t o t a l s a m p l e o f 4 0 s u b je c t s. T a b l e 2 s h o w s t h e m e a n s f o r e a c h i t e m o ne a c h s c a le , t h e v a l u e s o f t fo r t h e d i f fe r e n c e b e t w e e n e a c h p a i r o f m e a n s , a n d t h e v a l u e so f r fo r th e c o r r e l a t i o n b e t w e e n t h e t w o s e t s o f r a t i n g s o n e a c h i te m . A s c a n b e s e e nt h e r e w a s a s i g n if i ca n t p o s i t iv e c o r r e l a t i o n b e t w e e n t h e " S e l f " a n d " O t h e r s " r a t i n g so n a l l b u t t w o o f t h e i t e m s . I n a d d i t io n , e i g h t o f t h e i t e m s s h o w e d s i g n if i ca n t" S e l f " - " O t h e r s " d i f f er e n ce s . B r o a d l y s p e a k i n g , t he s e d i ff e re n c e s im p l y th a t s u b j e ct s e i t h e rs a w , o r ch o s e t o p r e s e n t t h e m s e l v e s , a s h o l d i n g m o r e " c o o p e r a t i v e " a t t i t u d e s t h a n o t h e rp a t i e n t s a t t h e c li ni c. B e a r i n g i n m i n d t h a t s o m e o f t h e s e d i ff e r en c e s m i g h t b e a t t r i b u t a b l et o s u b je c t s b e in g u n c e r t a i n o v e r h o w o t h e r s f el t a n d c o n s e q u e n t l y t e n d i n g t o g i v e r a t i n g st o w a r d s t h e c e n t r e o f t h e s c a le , t h e t h e m e t h a t e m e r g e s is o n e o f s u b j e c ts g e n e r a l l yp r e s e n t i n g t h e m s e l v e s , in c o m p a r i s o n t o o t h e r s , a s g o o d a n d g r a t e f u l p a t i e n t s , r a t h e rt h a n a s m e r e e x p l o i t e r s o f th e c l i n ic s y s t e m .

S u b j e c t s ' r a t i n g s f o r " S e l f " o n t h e 1 5 i te m s , a n d t h e i r t o t a l i n t e r n a l s c o r e s o n t h eP e r s o n a l C o n t r o l s ca le , w e r e t h e n s u b m i t t e d t o a p r i n ci p a l c o m p o n e n t a n a ly s is . T a b l e 3s u m m a r i z e s t h e r e s ul ts o f a t w o f a c t o r s o lu t i o n a f t e r v a r i m a x r o t a t i o n . I t m u s t b e r e m e m -b e r e d t h a t t h e n u m b e r o f s u b j e c ts i n v o l v e d i s v e r y s m a l l f o r s uc h a n a n a l y s i s . O u ri n t e r p r e t a t i o n o f t h e f a c t o r s i s t h e r e f o r e i n t e n d e d a s a t e n t a t i v e b a s i s f o r f u t u r e r e s e a r c ha n d d i s c u ss i o n , r a t h e r t h a n a s a d e fi n i ti v e d e s c r i p t i o n o f u n d e r l y i n g s t r u ct u r e . F a c t o r 1,


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188 J. RICHARD EISER and MICHAEL R. GOSSOPTable 2. Overall mean scores for "self" and "others" on the 15 items

Mean for Mean for "Self" vs. "'Others"Item "self . . . others" t (39) rI. I'm terrified of withdrawal. 61.40 73.40 2.92** 0.663***2. 1 find drugs help me cope with my

personal problems. 55.95 60.95 1.03 0.597***3. I'm frightened about what drugs maybe doing to me. 57.50 57.70 0.03 0.364*4. 1 wouldn't have any personal problemsif there wasn't so much hassle aboutgetting drugs. 33.80 52.98 3.48*** 0.548***5. l guess l'm really addicted. 69.43 70.18 0.15 0.525***6. ! don't think the clinic has anythingto offer me except a script. 24.83 56.05 6.01"** 0.509***7. Getting stoned is one of the things thatgives me most pleasure in life. 47.75 63.13 2.61" 0.375*8. If I really wanted to, I could gire updrugs. 55.33 49.03 1.33 0.607***9. I've never made a serious effort togive up drugs on my own, 30.10 38.88 1.46 0.368*10. 1 don't think I could ever turn downdrugs if someone offered them to me. 44.50 57.65 2.15" 0.408**11. 1 think of my addiction as a sickness. 56.20 59.50 0.60 0.494***12. I think other people are to blame for mebeing addicted today. 21.70 44.10 3.71"** 0.21013. l'm sure that doctors can help me giveup drugs. 41.65 56.35 2.60* 0.489***14. I've got every right to go on takingdrugs if I want to. 55.65 71.83 3.07** 0.494***15. I don't feel read)' to give up drugsright now. 60.60 58.53 0.34 0.229* P < 0.05, **P < 0.01, ***P < 0.001, 2-tailed probabilities.N o t e : Scale is from 0 = "'Not at all the way I (others) feel" to 100 = "Very much the way I (others)

feel".acc oun tin g for 19.0~ of the total varia nce, is marked especially by a feeling that oneis not ready to give up drugs, nor able to do so, a terror of withdrawal, a preparednessto label oneself as "really addicted", and a tende ncy to blame others for one's add icti on(Ready, Give up, Withdrawal, Addicted and Blame items respectively). Individuals withhigher scores on this factor also tend to have less confidence in their ability to turndow n drugs if offered to them (Offered), and achieve rather more external scores onthe Pe rsona l Co ntr ol scale. Facto r 2, accou nti ng for 12.5~o of the variance, is associatedpartic ularly with a feeling that one has less right to take drugs, greater confidencein doctors' ability to help, greater fear of the effects of drugs, a feeling that the clinichas more to offer than a prescription, and a preparedness to describe one's addictionas a sickness (Right, Doctors, Frightened, Script and Sickness items). One item (Hassle)shows moderately large loadings in reverse directions on the two factors. High scorerson factor 1 feel that they woul d not have any pers onal proble ms if they could getdrugs easily, whereas high scores on factor 2 d o feel they would have personal problemseven if they could get drugs easily. In summ ary, high scorers on factor I may be saidto see themselves as "hooked" whereas those scoring high on factor 2 may be saidto see themselves as "sick".

As has been mentioned, when subjects were classified according to their drug ofpreference, the 14 heroin users comprised the largest subgroup. We compared these14 heroin users with the remaining 26 subjects, both in terms of their individual factorscores, and in terms of their r atings o n the separate items. The first factor failed todiscr imina te the her oin users for the re mai ning subjects, with seven heroin users obta in-ing factor scores above, and seven below the median for the total sample. Apparently,therefore, the heroin users as a group saw themselves as neither more nor less "hooked"than the other drug users in our sample. However, on the second factor, only threeheroin users obtained factor scores above the median for the total sample, and 11


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Addict s " pe rcep t i ons o f t h e i r add ic t i onT a b l e 3 . P r i n c i p a l c o m p o n e n t f a c t o r m a t r i x a f t e r v a r i m a x r o t a t i o n w i t h K a i s e rn o r m a l i z a t i o n , t w o f a c t o r s o l u t i o n

18 9

I te m F a c t o r 1 F a c t o r 2 C o m m u n a l i tyI . W ithdr aw al 0 .600 0 .024 0 .3612 . Co pe 0 .148 0 .189 0 .0583 . Fr ig h ten ed - 0 .002 0 .466 0 .2174. Ha ssle 0.409 - 0 .434 0.3565. Ad dicted 0 .560 -0 .21 7 0 .3616 . Scr ipt 0 .007 -0 . 41 3 0 .1717. Sto ne d - 0 .027 0.023 0.0018 . G i v e u p - 0 . 6 1 7 - 0 . 0 9 5 0 .3 8 99. Effor t -0 .1 81 0 .276 0 .10910. Offe red 0.359 0.108 0.14111. Sickness 0.166 0.382 0.17312. Bl am e 0.422 0.182 0.21113. Do c to r s - 0 . 1 90 0 .481 0 .2 6 714 . R igh t - 0 . 2 2 2 - 0 . 4 95 0 .2 9415. Re ad y 0.645 - 0 .070 0.421Pe rson al con trol - 0 .267 0 .036 0 .072

P e r c e n t a g e s o f t o t a lv a r i ance accou n ted f o r 19 .0 12.5

o b t a i n e d s c o r e s b e l o w t h e m e d i a n ( C h i 2 = 7 .0 3, d . f . - - 1 , P < 0 .0 1 ), s u g g e s t i n g t h a th e r o i n u s e rs , r e l a t i v e l y s p e a k i n g , d i d not t e n d t o s e e t h e m s e l v e s a s p a r t i c u l a r l y " s i c k "o r i n n e e d o f p s y c h i a t r i c t r e a t m e n t . T h i s i s b o r n e o u t b y t h e s c o r e s o n t h e s e p a r a t ei t e m s ( se e T a b l e 4 ) w i t h h e r o i n u s e r s b e i n g f a r le s s i n c l i n e d t o s a y t h a t t h e y t h o u g h to f t h e i r a d d i c t i o n a s a s i ck n e s s , r e p o r t i n g r e l a t i v e ly l i t t l e p l e a s u r e f r o m g e t t i n g s t o n e do r f e a r o f t h e c o n s e q u e n c e o f t h e i r d r u g u s e ; t h e y w e r e r a t h e r m o r e p r e p a r e d t o l a b e lt h e m s e l v e s a s a d d i c t e d a n d a l s o ( m a r g i n a l l y ) l e s s c o n v i n c e d t h a t d o c t o r s c o u l d h e l pt h e m g i v e u p d r u g s , a n d m o r e i n s i s t e n t t h a t t h e y h a d m a d e s e r i o u s e f f o r ts to g i v eu p d r u g s o n t h e i r o w n ( S i ck n e s s , S t o n e d , F r i g h t e n e d , A d d i c t e d , D o c t o r s a n d E f f o r ti t e m s r e s p e c t i v e l y ) .

W h e n s u b j e c t s w e r e c l a s s i fi e d a c c o r d i n g t o o t h e r c r i t e r i a , t h e r e w e r e f e w s y s t e m a t i cd i f fe r e n c e s in t e r m s o f t h e i r q u e s t i o n n a i r e r e s p o n s e s . T h e 1 0 f e m a l e s w e r e m u c h l e s sc o n f i d e n t t h a n t h e 3 0 m a l e s i n t h e i r o w n a b i l i ty t o t u r n d o w n d r u g s i f t h e y w e r e o f f e r e d

T a b l e 4. C o m p a r i s o n s b e t w e e n h e r o i n u s er s a n d u se rs o f o t h e r d r u g s : m e a n s c o r e son th e 15 i t em s ( ra t i ngs f o r " s e l f " ) and th e Pe r s ona l C on t ro l s ca l eP r e f e rr e d d r u gH e r o i n O t h e r d r u g tI tem (N = 14) (N = 26) (38)

1. W ithd ra wa l 71.00 56.23 1.302. Co p e 55.43 56.23 0.063 . Fr ig h ten ed 36 .79 68.65 2.44*4. Ha ssle 37.29 31.92 0.445. Ad dic ted 84.43 61.35 2.09*6. Scrip t 35.00 19.35 1.447. S ton ed 27.43 58.69 2 .74**8. G ive up 54.71 55.65 0.089. Effort 16.29 37.54 1.73t10. Offe red 32.29 51.08 1.4411. Sickne ss 34.93 67.65 2.85**12. B lam e 13.14 26.31 1.3513 . Do cto rs 27.00 49.54 1 .86 t14. Rig ht 63.57 51.38 0.9715. Re ad y 67.07 57.12 0.86Pe r s ona l con t ro l 5 . 64 5 .0 8 0 .6 9

f P < 0 . 1 , *P < 0 . 0 5 , **P < 0 . 0 1 , 2 - t a il edNote: M a x i m u m s c o r e o n i t e m s 1 t o 1 5on Pe r so na l C on t ro l S ca l e = 10 ( In t erna l) .

p rob ab i l i t i e s .= 100 ("Ve ry much the way I fee l");


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7/7

Addicts' perceptions of their addiction 191t o a p r o g r a m m e o f t r e a tm e n t d i r ec t ed t o w a r d s l o n g - t e r m m a i n t e n a n c e . A d d i c ts w h or e ga r d t h e m s e l v e s a s m o r e " S i c k " m i g h t b e m o r e l ik e l y to g i v e u p d r u g s , a n d t o c o -o p e r a t e w i t h t r e a tm e n t p r o g r a m m e s t h a t a i m e d t o w i t h d r a w t h e m f ro m d r u g s , w h i l s ta t t h e s a m e t i m e d e a l i n g w i t h t h e ir o t h e r p e r s o n a l p r o b l e m s . S i n c e t h e t w o f a c to r sa r e o r t h o g o n a l , a n d n o t o p p o s i n g p o l e s o f a s i n g l e d i m e n s i o n , s o m e a d d i c t s w i ll re g a r dt h e m s e l v e s a s b o t h " H o o k e d " a n d " S ic k " . F o r t h e s e, t h e p r o g n o s i s f o r a d e q u a t e s o c i a lf u n c t i o n i n g w o u l d s e e m t o b e m o r e c o m p l e x a n d l e ss e n c o u r a g i n g . T h e f e el in g s t h a to n e w o u l d h a v e p e r s o n a l p r o b l e m s e v e n w i t h o u t d r u gs s u g g e st s t h a t a m a i n t e n a n c ep r o g r a m m e c o u l d r e p r e s e n t n o m o r e t h a n a p a rt ia l s o l u t i o n f o r s u c h p a t i e n t s . A t t h es a m e t i m e , s u c h p a t i e n t s ' fe e li n g s o f in a b i l i ty t o g i v e u p d r u g s a n d o f u n w i l l i n g n e s st o d o s o , m a y m a k e it m o r e d i ff ic u l t fo r t h e t h e r a p i s t t o e s t a b l i s h t h e k i n d o f r e l a t i o n s h i pw i t h t h e m i n w h i c h p o s i t i v e c h a n g e c o u l d b e a c h i e v e d .

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ences between those given an opiate script and those not given one. International Journal oJ'the Addictions,1974, 9, 205-220.Currie, R. F., Perlman, D. & Walker, L. Marihuana use among Calgary youths as a function of samplingand locus of control. Brit ish Journal afAddiction, 1977, 72, 159-165.Edwards, G. The British approach to the treatment of heroin addiction. In G. Edwards, M. Russell, D. Hawks& M. MacCafferty (Eds). Dru os and Druy D ependence, Westmead: Saxon House, 1976.Eiser, J. R. Discrepancy, dissonance and the "dissonant" smoker. International Journal o f the Addictions,1978, 13, in press.Eiser, J. R. & Sutton, S. R. Smoking as a subjectively rational choice. Addictive Behaviours, 1977, 2, 129-134.Gossop, M. R. Drug dependence and self-esteem. International Journal o f the Addictions, 1976. I I, 741-753.Gossop. M. R. A comparative study of oral and intravenous drug dependent patients on three dimensions ofpersonality. International Journal o f the Addictions, 1978a, 13. 135-142.Gossop, M. R. Drug dependence: A study of the relationship between motivational, cognitive, social andhistorical factors, and treatment variables. Journal o f Nervous and Me ntal Disease , 1978b 166, 44-50.Gossop, M, R. & Roy, A. Hostility in drug dependent individuals: Its relation to specific drugs, and oralor intravenous use. British Journal o f Psychiatry, 1976, 128, 188-193.Heller. M. E. & Mordkoff, A. M. Personality attributes of the young nonaddicted drug abuser. InternationalJournal of the Addictions, 1972, 7, 65-72.Jellinek, E. M. The Disease Concept o f Alcoholism, Highland Park, N J: Hillhouse Press, 1960.Mirels, H. L. Dimensions of internal versus external control. Journal o f Consultinq an d Clinical Psycholooy,1970, 34, 22(~228.Osnos, R. Psychiatric and psychological factors involved in the amenability to treatment of drag dependentindividuals. In H. Brill, J. Cole, P. Deniker. H. Hippius & P. Bradley (Eds) Neuropsychopharmacolooy,New York: Excerpta Medica, 1967.Parsons, T. The Social System. Chicago, MI: Free Press, 1951.Robins, L. N., Davis, D. HI & Goodwin, D, W. Drug use by U.S. Army enlisted men in Vietnam: a follow-upon their return home. American Journal o f Epidemioloyy, 1974, 99, 235-249.Robinson, D. The alcohologist's addiction: Some implications of having lost control over the disease conceptof alcoholism. Quarterly Journal o f Studies on Alcohol, 1972, 33, 1028-1042.Rotter, J. B. Generalised expectancies for internal versus external control of reinforcement. Psyeholo,qicalMono9raphs, 1966, 80, (Whole No. 609).Seligman, M. E. Helplessness, San Francisco, CA: Freeman, 1975.Stephens, R, & Levine, S. The "'street addict role": Implications for treatment. Psychiatry, 1971.34, 351-357.Stimson, G. V. Heroin and Behaviour. Shannon: Irish University Press, 1973.Strassberg, D. S. & Robinson, J. S. Relationship between locus of control and other personality measuresin drug users. Journal of Consultino and Clinical Psychology, 1974, 42, 744-745.Teasdale, J. The perceived effect of heroin on the interpersonal behaviour of heroin-dependent patients, anda comparison with stimulant-dependent patients. International Journal o f the Addictions, 1972, 7, 533-548.

hooked or sick

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