Does recovery-oriented treatment prompt heroin users prematurely into detoxification and abstinence programmes? Qualitative study.

ABSTRACT

AIMS: (i) To consider whether or not recovery-oriented treatment might be prompting heroin users prematurely into detoxification and abstinence programmes; (ii) to explore the findings with reference to Foucauldian theory. METHODS: Longitudinal qualitative data comprising 57 audio-recorded interviews, which captured heroin users' views and experiences of treatment duration. Participants included 30 heroin users (15 men; 15 women) starting a new episode of treatment, of whom 27 (14 men; 13 women) were re-interviewed after 3 months. Recruitment occurred in community drug services, pharmacies and residential treatment settings in Southern England, UK. Transcribed data were systematically coded and analysed inductively. FINDINGS: All participants wanted to be free from heroin and prescribed substitute drugs. Individuals were often impatient with the detoxing process and some reduced dosages of substitute medication faster than prescribers recommended, occasioning cross addiction and relapse. Previously unsuccessful rapid detoxifications induced slower recovery attempts. Participation in residential rehabilitation facilitated client realisation that recovery required time and effort. CONCLUSIONS: Recovery-oriented treatment can prompt heroin users prematurely into detoxification and abstinence programmes with negative consequences. The desire to detoxify quickly can be interpreted through Foucault's concepts of 'self-governance' and 'resistance;' heroin users' participation in decision-making processes reflects notions of 'agency;' and clients' willingness to adopt longer approaches to recovery following past negative detoxification experiences and exposure to residential rehabilitation confirms their commitment to be 'well.' The experiential knowledge of heroin users who have personally attempted recovery is a crucial resource for both those contemplating their own recovery and those advocating recovery-oriented services.