What is included with this book?
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 |
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