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‘Tonic’, ‘fuel’ and ‘food’: Social and symbolic aspects of the long-term use of psychotropic drugs
Abstract
This paper examines some of the many dimensions of meaning that psychotropic drugs can have for those that use them on a long-term basis. It aims to shed light on the problem of psychological dependence on these drugs, and the different forms this dependence can take. To put this study in context, some of the recent literature on psychotropic drug use is reviewed, before reporting the findings of the pilot-study. From this data a classification of chronic users into three different ‘types’—called ‘Tonic’. ‘Fuel’ and ‘Food’—has been developed, each of which embodies a different perspective on psychotropic drugs, their symbolic meanings, and modes of usage. It is hoped this classification will be useful to clinicians and others working in this field.
... There is some literature exploring the meanings adults attach to medications (van der Geest and Whyte, 1989;Britten, 1996Britten, , 2008Whyte et al., 2002;van der Geest, 2010;Chamberlain et al., 2011;Dew et al., 2014Dew et al., , 2015, particularly prescription medications (Helman, 1981;Lipshitz-Phillips, 1982, 1984;Conrad, 1985;Shoemaker and Ramalho de Oliveira, 2008;Webster et al., 2009). However, the meanings children attach to medications have been largely neglected. ...
... A number of researchers have looked at the varying meanings that adults attach to specific prescription medications. For example, when studying the use of psychotropic drugs among those with a range of conditions including anxiety and insomnia, Helman (1981) found that these medications were viewed as tonic, fuel or food. Helman (1981) argued that those who saw psychotropic drugs as a tonic used the drugs to self-medicate and conveyed a sense of choice over their medication use. ...
... For example, when studying the use of psychotropic drugs among those with a range of conditions including anxiety and insomnia, Helman (1981) found that these medications were viewed as tonic, fuel or food. Helman (1981) argued that those who saw psychotropic drugs as a tonic used the drugs to self-medicate and conveyed a sense of choice over their medication use. Those who saw the drugs as a fuel felt these medications helped them fulfil their social relationships, but shared responsibility for their successes with the drugs. ...
By exploring the meanings children and their parents attached to two household treatments for childhood epilepsy (antiepileptic drugs and emergency medications), this paper broadens our understanding of the ways in which children view their medications and how these views can impact on their adherence to treatment. The paper draws on data collected during 2013 and 2014 from 24 families across the UK that had a child with epilepsy aged 3-13 years. In-depth semi-structured interviews were conducted with the parents and 10 children participated in autodriven photo-elicitation interviews. Parents' and children's perceptions of medications were compared and contrasted and the findings show that although both parents and children viewed medications as an unpleasant necessity, parents' concerns centred on the perceived side effects of medications, whereas the children commented on the process of ingesting medications. Additionally, some of the children had to learn that their medications were a preventative measure, as they originally viewed them as a cure. Furthermore, among the children, it was found that treatment could be seen as either a positive or negative symbol of difference. Lastly, emergency medications were often viewed as a saviour, particularly by parents. Through this analysis, the study shows that the meanings children attached to medications were often linked to the form the medication took and that the way in which children perceived their medications had implications for their adherence; indeed, those who viewed their medications as an unpleasant necessity and those who initially saw their treatment as a cure were most likely to stop taking their medications. Consequently, this paper contributes to the current literature on the meanings individuals attach to treatments by providing the first detailed insight into children's views on epilepsy medications and by illustrating the similarities and differences in children's and parents' perspectives.
... Medical sociological research has examined patients' perspectives of taking medication. Previous research into patients' perspectives of taking medication has shown that patients' decision-making is based on personal beliefs about their illness and medicines (Conrad, 1985;Donovan and Blake, 1992;Adams et al. 1997;Helman, 1981;Britten, 1994;Morgan and Watkins, 1988;Dowell and Hudson, 1997 (Department of Health, 2001) has been published. The document has reported that an observation often made by healthcare professionals involved in the treatment of chronic illness is that patients understand their disease better than the healthcare professional. ...
... The findings concerning respondents' perceptions of antidepressant medication in this study had features in common with those of other sociological studies which have investigated patients' personal understanding of their medication (Donovan and Blake, 1992;Adams et al. 1997;Helman, 1981;Morgan and Watkins, 1988;Conrad, 1985;Britten, 1994;Dowell and Hudson, 1997). However the relative emphasis of different themes differ between studies. ...
The World Health Organisation (2001) has predicted that depressive disorder will be the highest cause of disease in the developed region by 2020. Studies have shown that compliance with antidepressant medication is approximately 50% after 3 months of therapy (Maddox et al. 1994; Lin et al. 1995) whereas it is recommended that medication is taken for at least 4 to 6 months (Paykel and Priest, 1992). Little is known about patients' perspectives of treatment at the initial stages of therapy and the influence of these on decision-making. This thesis presents an in-depth view of patients' decision-making regarding medication at the beginning of treatment for depression in primary care and informs the development of healthcare services in supporting individuals in their decision-making. Preliminary fieldwork involved meeting with local self help groups of national organisations for people with depression. Further to this, patients beginning courses of antidepressant medication were identified through general practice surgeries. A semi-structured interview, based on the combination of a qualitative interview and 3 quantitative instruments, was administered on 2 occasions after commencement of therapy. The qualitative component of the interview was audio taped, transcribed verbatim and coded. With regards to the quantitative data, bivariate analysis was carried out to identify factors which distinguished between those who continued with their mediation and those who discontinued. Out of 171 eligible patients who were invited to participate, 51 completed a first interview and 41 of these subsequently completed a follow-up interview. Twenty two respondents were male and 29 were female. The age of respondents ranged from 19 to 61. The majority reported their ethnic group as White Non Irish. All social classes were represented amongst the respondents. Antidepressant medication which had been prescribed included SSRIs, tricyclics and venlafaxine. Analysis of interview data demonstrated that decision-making about taking antidepressant medication was a complex process. Few factors distinguished between those who continued with their medication and those who discontinued. Respondents identified both positive and negative aspects of taking antidepressant medication. Positive aspects included a return to normal life and functioning whereas negative aspects included stigma, adverse drug reactions and dependency. Respondents assessed their circumstances at a particular point in time and made a decision as to whether or not it would be beneficial to take medication. Decisions about taking antidepressant medication were made alongside consideration of other treatment strategies. The level of personal involvement which respondents wished to have concerning decisions with their medication varied both between respondents and at different points of therapy. Respondents required a large amount of information to support their decision-making, including that concerning adverse drug reactions, process of recovery, dosage and dependency. Current healthcare services did not provide all information needs. Roles were identified for the community pharmacist in order to meet information needs, thereby enabling them to support individuals in maintaining adherence to treatment. This role of maintaining adherence to treatment has been identified for pharmacists in the management of people with mental health problems by the RPSGB (2000). The constraints which need to be overcome in order for pharmacists to fulfill such roles are also reviewed.
... Medications carry meanings not only about those who choose to use them, but also about those who choose not to (Cohen et al., 2001). Pills impact relationships with others and conceptions of oneself as an agent and as a moral individual (Vuckovic and Nichter, 1997;Helman, 1981;Barsky, 1983). ...
... Despite availability of opiates and analgesics, their medical necessity and legitimacy (and the legitimacy of those requesting them) is questioned by many physicians (Crowley-Matoka and True, 2012). Unlike medications that legitimate illness (Helman, 1981;Barksy, 1983), pain medication confers suspicion, particularly when mapped onto existing racial, ethnic, and gender stereotypes (Rouse, 2009). Some studies, for example, find that African Americans, Latinos, and women (Calderone, 1990;Bartley and Fillingim, 2013;Pletcher et al., 2008) are less likely to be prescribed opioids in emergency department visits for all types of pain. ...
... Le médecin est le prescripteur légal de cette consommation licite. Il justifie l'initiation ou la poursuite par sa caution étiopathologique et dédouane en quelque sorte le patient d'une éventuelle dépendance (Helman, 1981). Ce qui nous amène à nous interroger sur l'importance que prend aujourd'hui la réponse médicale face à l'augmentation de la demande de médicaments psychotropes. ...
... Nos résultats se rapprochent sur quelques points de ceux d'Helman qui, a la suite d'une étude qualitative auprès de consommateurs, avait proposé une typologie différenciant les attitudes des continus et des occasionnels (Helman, 1981). Les consommateurs continus croient en l'efficacité médicale des psychotropes, notamment en cas de problèmes. ...
Among the factors which try to explain differences comporte~ments of consumers, a significant place should be given to the attitudes towards psychotropic drugs and dependence. Our work describes the attitudes of 372 consumers aged from 49 to 64 and analyses those attitudes according to sociodemographic characteristics and continuous trajectories – when the consumption was not stopped even one month from 1994 to 1998 – or occasionally. The instrument sent in 1999 by mail presents 14 assertions, to be appreciated according to 4 modalities going from «completely agree» to «rather disagree». The attitudes analysis underlines two governing ideas. The first one evokes the consumers submission to psychotropic associated with a greater welfare desire. They perceive their attachment to those drugs and accept the idea that it would like to be able to do without them, but half of consumers does not do it because their consumption follow a continuous type trajectory. There is a consensus on the assis~tance to greater welfare, but also on the wish of living free of this help. They feel psychotropic drug use as the response to a need which they do not systematically associate with the presence of a pathology. Uncertainty on the statute of the pain is raised. The second replaces the role of the physician: changes doses with the doctor’s agreement and drug part in a relation which wants to be above all therapeutic. Some practice self medication and autonomous management of their treatment. The development of self medication under medical control and the assumption of a link between non-observance and confidence toward physician mustn’t be over looked and should form the subject of later searches. There is initially, and above all consumers characterized by their continuous or occasional consumers attitudes, and not by their sociodemographic characteristics. Occasional consumers are aware of the negative effects of these drugs, deny the dependence or estimate that the control of their consumption protects them from this risk.Whereas continuous consumers believe in medical effectiveness of psychotropic while toning down the positive impacts they can have on their quality of life. They feel bound to take these drugs, and admit this consumption involves a dependence.
... Recently, researchers demonstrated an increased likelihood of being dependent on BZDs as defined by DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Text Revised) criteria for substance dependence (American Psychiatric Association, 2000) among older persons who believed themselves to be addicted. In addition to being associated with a greater risk of substance dependence, this feeling of being addicted might explain why some older people continue to use BZDs for some time beyond what is considered to be clinically effective (Helman, 1981;P. Voyer, Cappeliez, Perodeau, & Preville, 2005;P. ...
... The correlation between their subjectively determined BZD dependence and the objective determination of BZD dependence was high (P < 0.0005). Patients demonstrated insight into their own addiction, suggesting that a sense or feeling of addiction is among the set of factors likely responsible for persistent BZD use (Helman, 1981;P. Voyer, Cappeliez, Perodeau et al., 2005;Voyer, McCubbin, Preville et al., 2003). ...
Long-term use of benzodiazepines carries considerable personal consequences such as memory loss and functional impairment. In addition, use over time may bring about dependence and habituation thus leading older persons to believe they cannotdiscontinue the drug and to experience withdrawal symptoms should its use suddenly cease. The frequency of such negative consequences remains unclear. The purpose of this study is to determine the prevalence of self-rated addiction among older persons and its associated factors. Face-to-face computer-assisted interviews were conducted in the homes of 2,785 persons aged 65 years and over, randomly selected from across the Province of Quebec, Canada. Of the 707 users of benzodiazepines, 43% considered themselves addicted. They were more likely to be 75 years or over, to suffer from panic disorder, to believe that health professionals are ready and available to discuss emotional problems with them, and to be less than satisfied with their social relationships. This study showed that a large proportion of benzodiazepine users rated themselves as addicted. These findings indicate that it is important for nurses to screen older adults living in the community to identify those who continue to use benzodiazepine beyond the recommended therapeutic time frame, perceive themselves to be dependent, and could potentially benefit from participation in a withdrawal program.
... From the perspective of the social sciences, drugs in this group have been analysed as a function of illness behaviour (Murray et al. 1982) and health service use (CafTerta and Myers 1990), as a social problem (Gabe and Bury 1988), as an aspect of social control (Gabe and Lipshitz-Phillips 1984), in the context of media treatment (Gabe et al. 1992), in the management of everyday life (Gabe and Thorogood 1986), in prescribing practice (Gabe and Williams, 1986), and in the context of public policy (Ettorre 1991). However, since the 1980s few studies have been earned out on the views of the patients themselves and the meaning that benzodiazepine use may have for them, particularly investigations using qualitative methodologies (but see Cooperstock and Lennard 1979;Helman 1981;Gabe and Lipshitz-Phillips 1982;1984). ...
... Their relationship with benzodiazepines was not passive; each time a pill was taken the community-based participants weighed up the risks, benefits and level of need and considered the dose limits they had placed on themselves, with long-term use the accommodation between the individual and their anxiety or insomnia was compounded by a second relationship with their medication. This is in some contrast to typologies depicting degrees of control and dependence developed by Helman (1981) and Gabe and Lipshitz-Phillips (1984). These tend to be more unidimensional. ...
Since the late 1970s there has been a marked decline in the prescribing of the benzodiazepines. Yet long-term use of this drug persists despite widespread media condemnation and growing professional concern. The study seeks to illuminate this phenomenon by deploying qualitative methods to investigate the meaning that such medication has for the users themselves and their styles of management. In-depth interviews were conducted with fifteen community-based users and seven members of a self-help group. From this material a typology was developed that reflected the relationship users had formed with their medication. The key dimensions in this typology were the degree of dependency on the drug, the perceived level of risk associated with it, and underlying attitude. The relationships to the drug reflected in the typology were suggestive of a pattern of self-regulation and active management by users, rather than dominance and control by practitioners. Furthermore, the investigation indicated that characteristics of the medication regime itself—such as type of drug and dose exert an influence on the attribution of meaning and the place of the drug in users' lives. While a characterisation of patient subculture has real potential for application in clinical practice, there are also implications within medical sociology for theories of medicalisation and social control.
... Ainsi, la crainte de la dépendance pourrait être reconvertie par certains patients, comme le montre Cecil Helman, en un phénomène résiduel au regard des bénéfices vécus dans l'automédication, et être contrebalancée par le sentiment de maîtriser sa propre santé, voire d'accéder au bien-être. On aurait affaire dans ce cas à une consommation quasi ostentatoire, ou disons à un choix ou à un mode de vie qui affirme sa légitimité (Helman 1981). Dans une perspective plus relationnelle, le travail de Delphine Dupré-Lévêque tend à montrer que l'initiation du recours chez la personne âgée peut être assimilée à une reprise d'influence : elle signale un problème qui oblige les descendants à porter de nouveau attention à leur parent (Dupré-Lévêque 1996). ...
... In their review Lilja and Larsson (1994) found that risk factors for becoming dependent on benzodiazepines are daily dose, period of usage, drug preparation used, personality of the drug user, patient's use of alcohol, and cultural beliefs. Social scientists paid attention to social, cultural, and psychological factors influencing the use of benzodiazepines (Cooperstock et al. 1982;Helman 1981;Golombock 1989Golombock , 1991. ...
This paper documents debates over benzodiazepine-based tranquillizers and hypnotics-sedatives in Finland and Sweden during the period of 1981–1994. It looks at the emergence of benzodiazepine dependence as a social problem in medical journals, newspapers, magazines, and administrative documents. The paper analyses the role of the media, experts, authorities, the drug industry, and patient organizations in the claims-making process. It compares Finnish and Swedish cases and locates the position of patients as self-conscious actors in the debates.
In Sweden there was genuine debate where physicians, medical authorities, and patient organizations took part. The public media had an important role in defining the status of the problem. The Finnish discussion was composed of single articles or debate articles, but did not form an interactive debate. Finnish authorities did not debate publicly with physicians or other actors. In the Swedish debate patients took part as self-conscious actors, while patients were missing from the Finnish debate.
Finally, the author considers the change in actor relations in medicine, drug, and health politics, and concludes that it may be more and more difficult for the traditional actors to marginalize the patient.
... Among other things, critics were concerned that compliance reinscribes physician power (Heszen-Klemens, 1987;Trostle, 1988;Waitzkin, 1993;Zuckoff, 2012). Similarly, some social scientists recast compliance as rational, wresting it from its more common frame of deviance (Aronson, 2007;Bell et al., 2007;Conrad, 1985;Donovan & Blake, 1992;Helman, 1981;Zola, 1980). These critiques acknowledged that patient behavior is not only logical when viewed relative to individual preferences, but may reflect community norms (Stimson, 1974). ...
... Although drug efficacy is evaluated by pharmacological action, studies have shown that this onedimensional perspective is insufficient; the 'real impact of the medicines' is connected to several interwoven dimensions of individual biology and socio-cultural dynamics [6]. Therefore, psychotropic drugs can have several meanings for people who use them [7], and can have different effects (contrary to the biomedical principle that psychotropic drugs prescribed in certain doses have identical effects in all patients) depending on the illness experiences of individuals and how they interpret the effectiveness of psychotropic drugs in the context of their lives [6]. In high income countries, adequate access to psychotropic drugs is achieved by sustainable financing and reliable supply systems [4], whereas low-and middle-income countries (LMICs) have inadequate finance and supply systems thus limiting the access to psychotropic drugs. ...
Background:
Psychotropic drugs play an important role in the treatment of mental, neurological and substance use disorders. Despite the advancement of the use of psycho-pharmaceuticals in the developed countries, the psychotropic drug production and supply chain management in low- and middle- income countries are still poorly developed. This study aims to explore the perceptions of stakeholders involved in all stages of the psychotropic drug supply chain about the need, quality, availability and effectiveness of psychotropic drugs, as well as barriers to their supply chain management. The study was conducted among 65 respondents from the Kathmandu, Chitwan and Pyuthan districts, grouped into four categories: producers, promoters and distributors (N = 22), policy makers and government actors (N = 8), service providers (N = 21) and service users/family members (N = 14).
Results:
The respondents reported that psychotropic drugs, despite having side effects, are 1) needed, 2) available in major regional centers and 3) are effective for treating mental health problems. The stigma associated with mental illness, however, forces patients and family members to hide their use of psychotropic drugs. The study found that the process of psychotropic drug supply chain management is similar to other general drugs, with the exceptions of strict pre-approval process, quantity restriction (for production and import), and mandatory record keeping. Despite these regulatory provisions, respondents believed that the misuse of psychotropic drugs is widespread and companies are providing incentives to prescribers and retailers to retain their brand in the market.
Conclusions:
The production and supply chain management of psychotropic drugs is influenced by the vested interests of pharmaceutical companies, prescribers and pharmacists. In the context of the government of Nepal's policy of integrating mental health into primary health care and increased consumption of psychotropic drugs in Nepal, there is a need for massive education and awareness as well as strict monitoring and supervision to avoid the misuse of psychotropic drugs.
... I Sverige kunde man konstatera att det skedde en markbar okning av antalet långvariga brukare (Isacson et al. 1992 , 1975, (Riska 1993 1975(Riska 1993 doser, den tid man anvant drogen, det preparat man anvant, samt anvandarens personlighet, alkoholvanor och kulturella varderingar. Samhallsvetarna faste i sin tur uppmarksamhet vid de sociala, kulturella och psykologiska faktorer som påverkar anvandningen (Cooperstock et al. 1982;Helman 1981;Golombock 1989Golombock , 1991. Bruket av bensodiazepiner okade mycket snabbt i Finland och Sverige på 1960-talet och i borjan av 1970-talet. ...
... Dans le cadre de la relation entre patients et médecins, les écrits témoignent amplement de la centralité du médicament et de son rôle symbolique (Helman 1981 ;Montagne 1988). La nature même de cet objet technique permettrait de réifier la maladie, la douleur, et de faire converger des perspectives profanes et professionnelles éventuellement divergentes vers cette issue concrète (Van der Geest et al. 1996 ;Sachs et Tomson 1992). ...
Résumé
Cet article emprunte une approche socioculturelle de la problématique de la vieillesse par rapport au médicament. Il appréhende avec un regard critique le phénomène « médicament » à travers trois énoncés de relations : le « médicament-obligation » comme qualificatif de la relation des personnes âgées au médicament ; le « médicament-concession » en tant que trame de fond de la relation thérapeutique entre médecin et patient âgé ; le « médicament-compassion », enfin, comme métaphore du rôle des médicaments psychotropes en lien avec le statut de la vieillesse dans nos sociétés occidentales avancées.
... Our starting point was a recognition that remarkably little sociological attention had been given to pharmaceuticals until recently. Early work was undertaken by only a few scholars and focused on particular types of medications such as minor tranquillisers (Cooperstock and Lennard, 1979;Helman, 1981;Gabe, 1990Gabe, , 1991Lipshitz-Phillips, 1982, 1984) or specific drugs such as Opren or Halcion (e.g. Abraham, 1995;Abraham and Sheppard, 1999;Gabe and Bury, 1996). ...
... 'screws up my mind', 'clouds my mind', 'something to cling to'). Likewise in Helman's (1981) study in London of psychological dependence and psychotropic drugs, he uses the metaphors 'tonic', 'fuel' and 'food' to summarize the meanings that his study subjects gave to their medications. This current study builds on the notion of a typology but broadens the domain beyond metaphors to encompass larger themes of impact and identity over time. ...
Background and Purpose: Researchers in social work and beyond have urged those in mental health to more fully embrace research into the subjective experience of pharmacotherapy among people with serious mental illness (Floersch et al., 2007, Jenkins et al, 2005; Mintz, 2001). Often using symbolic interactionism as a theoretical frame, previous studies have examined, for example, patient-staff communication (Rhodes, 1984), the use of metaphors (Helman, 1981), issues of self-identity (Carder et al, 2003), medication as a symbol of hope, struggle, and control (Usher's 2001), and, importantly, as an avenue to normality (Knudsen, Hansen, Traulsen, & Eskildsen, 2003). This study attempts to build on that body research with a specific client group served in a local community program, and then immediately transform the findings into program enhancement.
This community-based qualitative inquiry asks: what is the meaning and impact of taking psychiatric medications in the lives of people with severe mental illness living in a residential program. The specific study objectives are (1) to create a typology of meaning and (2) use the findings to enhance specific programming to better reflect the role and importance of medication issues in the everyday lives of residents.
Method: Consistent with related inquiries, the research derives from an interpretive paradigm and relies on a thematic analysis of semi-structured interview data. A staff-resident Advisory Panel guided the research. Participants were 21 adults with extensive histories of mental illness, numerous hospitalizations, currently taking multiple medications. In addition to the interviews, participants each created a color drawing related to their experience with medication, which they titled and interpreted themselves. In addition to a member check, a peer consultant supervised the audit trail of data reduction to support rigor.
Findings: The main results are the distillation of themes into a typology of meaning with 7 dimensions:
Psychiatric medication as
1. a positive force across several dimensions of experience.
2. as tolerated fact of life.
3. as primarily an internal and individual experience.
4. as a prominent part of the story and evolution of one's mental illness.
5. as basis of gratitude and source of victory over past struggles.
6. as necessary for prevention of relapse and protection of humanness.
7. as a symbol of differentness and dependency.
Conclusions & Implications: Among this group of residents, it is clear that taking medication is not a benign act. Rather, taking psychiatric medication is something that incites meaning, influences identity, and impacts life. There is also conundrum: medication can be an avenue to full humanness and a more positive life experience, but also can be the source of felt differentness, resignation and melancholy. The Advisory Panel generated 12 different initiatives for program change, currently being implemented. These include sponsoring a Summer Book club for staff and residents, publishing a collections of life stories, conducting skills training sessions on how to talk with your prescriber about psychiatric medication, and changing intake assessment forms to allow new residents to talk more about their experience with medications and the evolution of their mental illness.
... Helman demonstrated that users of psychotropic medication classified drugs as 'tonic', 'fuel', and 'food', and that these categories correlated with patterns of use. 26 Some patients with MOH appear to use medication for headache not only as a means to relieve symptoms, but also to prevent an expected headache. The drugs have become 'food' that the patients think needs to be taken on a regular basis. ...
Background:
Medication-overuse headache (MOH) is common in the general population, and most patients are managed in primary health care. Brief Intervention (BI) has been used as a motivational technique for patients with drug and alcohol overuse, and may a have role in the treatment of MOH.
Aim:
To explore GPs' experiences using BI in the management of patients with MOH.
Design and setting:
Qualitative study in Norwegian general practice.
Method:
Data were collected through four focus group interviews with 22 GPs who participated in an intervention study on BI for MOH. Systematic text condensation was used to analyse transcripts from the focus group interviews.
Results:
The GPs experienced challenges when trying to convince patients that the medication they used to treat and prevent headache could cause headache, but labelling MOH as a diagnosis opened up a space for change. GPs were able to use BI within the scope of a regular consultation, and they thought that the structured approach had a potential to change patients' views about their condition and medication use. Being diagnosed with medication overuse could bring about feelings of guilt in patients, and GPs emphasised that a good alliance with the patient was necessary for successful change using BI to manage MOH.
Conclusion:
GPs experience BI as a feasible strategy to treat MOH, and the technique relies on a good alliance between the doctor and patient. When using BI, GPs must be prepared to counter patients' misconceptions about medication used for headache.
... Bien que les ethnologues se soient depuis longtemps intéressés aux recours thérapeutiques des populations qu'ils étudiaient, ainsi qu'à l'ajustement des dispositifs de la médecine occidentale à leurs systèmes de soins, il a fallu attendre Logan (1983) ou, dans notre pays, Fassin (1985) pour que des travaux portent sur les spécialités industrielles. En Europe, les études ont très vite pris pour thème les médicaments psychotropes (Helman, 1981). Lorsque nous dûmes construire le projet (1) dont nous donnons ici les résultats, seule la sociologie (Dupuy et Karsenty, 1974 ;Ferry-Pierret et Karsenty, 1973) ou l'anthropologie de la science (Akrich, 1995) exploraient ce domaine en France (2). ...
Persée est un programme de publication électronique de revues scientifiques en sciences humaines et sociales. L'intégralité des collections imprimées de revues est numérisée et mise en ligne sur un portail qui offre un accès à l'ensemble de ces collections et des possibilités avancées d'exploitation de ces corpus numérisés. Les revues font l'objet d'une sélection pour garantir la cohérence de l'offre éditoriale et scientifique du portail. / Persée is a program which was created for the digital publication of scientific journals in the field of the humanities. The entire printed collection of journals is digitized and published online through a portal which offers access to the collections as well as advanced functionalities which facilitate and enhance use of the portal's resources. The journals are selected by an editorial board, thereby guaranteeing the collection's scientific coherence.
... While there is no literature on how many older benzodiazepine-using women live alone, this number is likely to be high. Prior research has suggested that socially isolated older adults relate to their psychotropic medications in symbolic ways; medications can be viewed as having human qualities such as 'a helper' or 'a security' (27). Substituting social supports, activities or companions who offer 'help' or 'security' with benzodiazepines that symbolically fill these roles serves to medicalise social isolation and loneliness. ...
We examined qualitative data from a larger study of benzodiazepine-using women older than 65 years, living in the United States for subjective experiences of loneliness and social isolation.
Data from semistructured interviews with seven participants discussed aspects of social isolation or loneliness. Following a phenomenological design, data were coded and analysed for experience.
Three themes emerged: 'Dislike being alone'; 'Loneliness and isolation'; and 'Social isolation causes negative feelings'.
Social isolation and loneliness are negative aspects of the lived experience for older benzodiazepine-using women and the loss of companions and transportation is important to this experience. Being isolated can cause depression, fear and insecurity. Future research should consider the role psychotropic medications have in coping with social isolation and loneliness among older adults. Clinicians should be aware of social isolation and loneliness in late life and discuss non-pharmacologic treatment options with their ageing patients.
... 'screws up my mind', 'clouds my mind', 'something to cling to'). Likewise in Helman's (1981) study in London of psychological dependence and psychotropic drugs, he uses the metaphors 'tonic', 'fuel' and 'food' to summarize the meanings that his study subjects gave to their medications. This current study builds on the notion of a typology but broadens the domain beyond metaphors to encompass larger themes of impact and identity over time. ...
This community-based qualitative inquiry asks: what is the meaning and impact of taking psychiatric medications in the lives of people with severe mental illness living in a residential program. Participants were twenty-one adults with extensive histories of mental illness, numerous hospitalizations, currently taking multiple medications. In addition to a thematic analysis of semi-structured interviews, participants each created a color drawing related to their experience with medication, which they titled and ‘interpreted’ themselves (see http://blog.vcu.edu/kbentley/). The main finding is a distillation of themes into a seven dimension typology of the meaning. A staff-resident Advisory Panel guided the research, and final results take into account participant feedback and member checking. Included here are plans and hopes for using the findings to enhance specific programming at the residential program to better reflect the role and importance of medication issues in the everyday lives of residents.
... I was overweight at the time and I went and I started taking it and I liked the results. The use of pharmaceuticals to self-medicate has been noted elsewhere for other populations (Helman, 1981;Nichter, 1996;Sung, Richter, Vaughn, Johnson, & Thom, 2005). Two other categories of misuse, however, appear to be more specific to the college setting: the misuse of prescription drugs for recreational and academic purposes. ...
Although recent increases in collegiate prescription drug misuse have generated a great deal of concern, there are few analyses available that examine the socio-cultural factors influencing these trends. This article attempts to address this gap in knowledge by providing an analysis of several socio-cultural factors influencing pharmaceutical misuse by college students. Prescription drugs are put to a number of different purposes in the collegiate setting, including self-medication, socio-recreation, and academic functioning. Such misuse is acceptable in a social context where individuals deliberately attempt to experiment with drugs. Widespread knowledge regarding effects, dosages, and compatibilities with other drugs, coupled with the extensive availability of pharmaceuticals in collegiate social circles, makes this class of drugs an attractive alternative to other psychoactive substances. These factors underscore several implications for substance abuse prevention efforts on college campuses and suggest a number of important issues for further research.
... Nous pouvons ici, à l'instar d 'Helman (1981), considérer la consommation comme une habitude de vie, le médicament revêtant des fonctions symboliques dans la vie de tous les jours. Ce médecin note que la personne âgée souffrant de solitude entretient un rapport particulier avec le médicament. ...
... It is possible that seniors are promoting such prescription renewals because they hold positive perceptions about the drugs. It has been demonstrated that the longer the duration of ASH use, the more positive the senior's perception of the drug (Chambers & White, 1980;Clinthorne, Cisin, Balter, Mellinger, & Uhlenhuth, 1986), and, similarly, that seniors tend to minimize the potential harmful effects of these drugs (Chambers & White, 1980;Helman, 1981). ...
At least 2 decades of descriptive research on factors associated with psychotropic drug use by the elderly in the community has failed to yield convergent results. The authors posited that duration of use may have been confounding results of previous studies, since variables influencing initial use may not be those influencing long-term use. They conducted a secondary analysis of the elderly respondents in the cross-sectional 1998 Quebec Health Survey (n = 3,012). Results clearly show that factors associated with ASH use vary with duration of use. Apart from depression, medical and mental health factors significant for short-term use are not associated with long-term use. The only factors found that explain long-term but not short-term use were gender (female) and health perception (less than positive). These findings suggest that over the long term it is unlikely that mental health therapeutic benefits explain ASH use. The authors hypothesize that drug dependency could play a role in long-term use. They therefore encourage community health nurses to implement withdrawal programs in order to reduce harmful long-term consumption. Plus de deux décennies de recherche descriptive sur les facteurs associés à l'usage des psychotropes chez les personnes âgées n'ont pas permis d'aboutir à des résultats convergents. Les auteurs avancent que la durée de la consommation pourrait avoir brouillé les résultats des études antérieures, étant donné que les variables influant sur la consommation initiale pourraient être différentes de celles qui influent sur la consommation de longue durée. Ils ont procédé à une analyse secondaire des sujets interrogés lors de l'Enquête de santé menée au Québec en 1998 (n = 3,012). Les résultats démontrent clairement que les facteurs associés à la consommation variaient en fonction de la durée de celleci. Le cas de la dépression mis à part, les facteurs d'ordre médical et de santé mentale prépondérants associés à l'usage à court terme ne pouvaient être associés à la consommation à long terme. Les seuls facteurs susceptibles d'expliquer la consommation de longue durée mais non la consommation de courte durée étaient le sexe (féminin) et la perception de l'état de santé (moins que positive). Ces conclusions indiquent qu'il est peu probable que ce soit les bienfaits thérapeutiques pour la santé mentale qui expliquent un recours prolongé à ces médicaments. Les auteurs émettent l'hypothèse que l'accoutumance aux médicaments pourrait être en jeu. Ils encouragent par conséquent les infirmières en santé communautaire à mettre en oeuvre des programmes de sevrage dans la perspective de réduire la nocivité de la consommation de longue durée.
... Another is that it collapses individual variability within a single stereotype. The power of tranquillisers appears to be such that everyone who takes them is likely to become 'addicted', though studies of tranquilliser users have not shown this to be the case (Helman 1981, Gabe and Lipshitz-Phillips 1984, Gabe and Thorogood 1986. ...
The purpose of this paper is to illustrate the value of insights from media studies for medical sociology by focusing on the cultural and ideological messages transmitted in newspaper coverage of tranquilliser dependence. An analysis of 62 stories recounting the experiences of individual tranquilliser users reveals that journalists concentrate on two kinds of person – the celebrity and the ordinary user- in their reports. The ways in which the press deploys these users' experiences of tranquilliser dependence and withdrawal and their relationship with the medical profession are then analysed, with particular attention being given to the cultural and ideological meanings embedded in its descriptions of such experiences and relations. The paper ends with a discussion of the reasons for the transmission of such meanings by the press and their possible effect on different audiences.
... Plusieurs tendent en effet à documenter le potentiel toxicomanogène des médicaments psychotropes, et en particulier des benzodiazépines, et s'entendent sur l'existence d'un syndrome de sevrage lors de l'arrêt brusque de la médication (Cohen et Collin, 1997). La dépendance la plus probante demeurerait cependant la dépendance psychologique, liée à l'importance symbolique accordée à ce médicament par les consommateurs, quel que soit leur âge (Helman, 1981;Gabe, 1991;Ettore et al., 1994). ...
Résumé Un nombre important de personnes âgées consomment des médicaments psychotropes (notamment benzodiazépines et antidépresseurs) et une forte proportion d'entre eux y recourent de façon chronique et à long terme. Le phénomène semble en outre se maintenir malgré la multiplication des preuves scientifiques concernant les effets nocifs de cette utilisation. À partir de l'analyse d'entretiens conduits auprès de consommateurs âgés, cet article met en évidence qu'au-delà des caractéristiques individuelles, des attitudes et des valeurs largement véhiculées dans notre société par rapport à la vieillesse, au vieillissement et aux médicaments psychotropes sont à l'oeuvre pour encourager un recours chronique et à long terme de ces produits. Après avoir exposé le questionnement sociologique qui sous-tend le phénomène, nous prendrons appui sur les résultats d'une recherche qualitative pour mettre au jour ces valeurs et ces normes et esquisser le cadre de ce que l'on pourrait désigner comme une socialisation de la consommation de psychotropes chez les personnes âgées.
... Along side the biomedical meanings, medications may have many additional meanings to patients living with chronic illnesses. Drugs may symbolize, among other things, dependence or independence, malevolence or benevolence, toxin or tonic, normality or stigma, sickness or health, fuel, food, status, affection, or escape (Adams et al., 1997; Conrad, 1994; Gabbard & Kay, 2001; Helman, 1981; Karp, 1996c; Montagne, 1988 Montagne, , 1996 Nichter & Vuckovic, 1994; Rogers et al., 1998; Trostle et al., 1983; Vuckovic, 1999; Vuckovic & Nichter, 1997). A medication itself may have potent symbolic meanings, as in the case of Prozac ® or Viagra ® (D. ...
... During the 1980s, social scientists have responded to this challenge and provided new ideas on the social and cultural aspects of psychotropic drug use. For example, there have been sociological accounts of the social and cultural meanings of psychotropic drug use (Cooperstock and Lennard 1979, Helman 1981, Gabe and Thorogood 1986, Montagne 1985, of pathways to use (Caflferata and Meyers 1990) and of how tranquillisers have become a public issue and constructed as a social problem in Britain (Gabe and Bury 1988. These new social scientific ideas on tranquilliser use have added valuable information to the previous mapping of the socio-demographic characteristics of the users in the research of the 1970s (Cooperstock and Parnell 1982). ...
The purpose of this paper is to lay the foundation for the development of a gender-sensitive perspective on psychotropic drug use. This paper reviews existing research on psychotropic drug use and highlights gender biases in three ways. First, a review of the early work on gender differences in tranquilliser use reveals how ‘one-dimensional’ accounts are offered by proponents who are either ‘no-objections’, ‘cautious-no- answer’, ‘women's-role’ or ‘political’ advocates. Second, with special reference to women, a critical review of the two predominant discourses, the medical and the sociological, are outlined. It is argued that they have a common approach that makes women's drug use invisible. The paper concludes that the approach prevailing in current research is individualistic and gender blind and needs to be complemented with an analysis that problematises gender.
In this chapter, we update and extend our previous analysis of drug use among youth and emerging adults (aged 18-25) in North America (Quintero and Nichter 2011) and reiterate a call for ethnographies of pharmakon: substances that straddle the medicine-drug continuum used as resources in the everyday self-management of bodies, minds, moods, and identity in what some researchers have come to refer to as the regulation of chemical selves .We update some trends previously covered in our 2011 chapter and draw attention to emerging trends in tobacco, cannabis, and prescription psychoactive drug (PPD) use. We also draw attention to displays of alcohol and drug consumption in digital spaces and the extent to which it renders substance use normative. Focusing attention on consumption posts and displays in social media further provides us an opportunity to examine gender dimensions of drug use and identity management not covered in our original chapter. In addition to highlighting evolving trends in substance use, we suggest issues demanding future anthropological research. In our conclusion, we specifically address the need for research on substance use among youth for recreational and self-medication purposes in the time of COVID-19.
This thesis reviews the cultural history of western depressive symptoms and critically examines the epidemiology of Neurotic Depression world wide. It argues that such studies and vocabularies are deeply embedded within "white British and western European" institutions, and predicated on a western epistemology. This is followed by an overview of major research methods to study folk models of mental disorders. Using established clinical anthropological methods, a clinical ethnographic instrument, the EMIC, initially developed in India, is culturally adapted for white Britons in London (the UK EMIC for Depression). 47 white Britons with a diagnosis of Neurotic Depression (ICD-9), attending psychiatric services for the first time, are interviewed for their experience of illness: presenting idioms of distress, perceived seriousness and outcome, experience of stigma, ideas of causation, and help seeking. The study also examines the relationship between such personal meaning of suffering with objective professional biomedical assessments. Results reveal that the expression of illness features, including symptoms, are governed by both popular and professional ideas of depression. Women present considerably later for help, with predominant somatic symptoms whilst men report more psychological idioms. 55 discrete models of causation are elicited. Although there is considerable stability of causal explanations over time, subjects hold multiple contradictory and overlapping ideas of causation suggesting a high degree of pluralism. These results challenge the current methodology of national public mental health campaigns. The development of a culturally sensitive stigma scale is an additional result of this study. Idioms of sadness together with psychological explanations are associated with high stigma, those of anxiety together with somatic explanations with less stigma. The thesis concludes that the concept of a universal psychopathological model for Neurotic Depression is problematic.
This article looks at the use of bush and other home remedies amongst Afro-Caribbean women in Britain.
Interviews concerning medicine cabinets in the home, conducted with retired persons and/or people living in rural areas, in lower Normandy (France), and all mentioning psychotropic medication, are analysed from the standpoint of profane categories. In these interviews medications much less than for nerves much greater than appear to stand apart from other medicines. a position which is confirmed by an analysis of the respondents' discourse. In this region where ethnological investigation has not revealed traditional remedies for the ailments that are currently treated by these medications, treatment much less than for nerves much greater than falls into the category of everyday hygiene rather than being seen as medical. Reducing depression to a much less than nerve sickness much greater than avoids any involvement of psychiatry. This categorisation has an impact on self-medication. on compliance and dependence in relation to these medications, and provides insight into the problems raised by consumption of certain psychotropic medications in our country.
Sleep complaints by older adults constitute a very common situation faced by health care providers. However, not all professionals respond to the complaint the same way. Some will briefly assess the complaint and resort rather quickly to medication while others will assess the complaint carefully in order to exclude the diagnosis of primary insomnia and prescribe alternative interventions to improve sleep. When medicine is prescribed, the type of compound often selected is benzodiazepine. However, benzodiazepine carries a significant risk of adverse reaction, including drug dependency, both of which are clinical problems that should not be underrated, especially when treating a subjective complaint and not a specific diagnosis.
Following Foucault's work on disciplinary power and biopolitics, this article maps an initial cartography of the research areas to be traced by a genealogy of pharmacological practice. Pharmacology, as a practical activity, refers to the creation, production and sale of drugs/medication. This work identifies five lines of research that, although often disconnected from each other, may be observed in the specialized literature: (1) pharmaceuticalization; (2) regulation of the pharmaceutical industry; (3) the political-economic structure of the pharmaceutical industry; (4) consumption/consumerism of medications; (5) and bio-knowledge. The article suggests that a systematic analysis of these areas leads one to consider pharmacological practice a sui generis apparatus of power, which reaches beyond the purely disciplinary and biopolitical levels to encompass molecular configurations, thereby giving rise not only to new types of government over life, but also to new struggles for life, extending from molecular to population-wide levels.
This article examines the lay appropriation of so-called functional foods that are marketed to enhance health and well-being and/or to reduce the risk of disease. Previous research has shown that consumers are skeptical of functional foods and inclined to contrast them with natural and non-technological foods. We argue that taking into account the hybrid nature of functional foods at the borderline between food and medicine provides a useful starting point for an analysis of lay appropriation, i.e. understanding and adoption of the new products. We first present results from earlier studies on lay conceptions of healthy eating and of medicines, and then analyze the role of these in the lay appropriation of functional foods. In this analysis, we make use of findings from both our own studies and those of other researchers, and give consumers a voice by presenting quotations from a qualitative study carried out in Finland in 2004. We claim that the food medicine dichotomy can in many respects explain the ways in which consumers conceptualize functional foods and adopt them in their daily eating.
INTRODUCTION
La consommation pharmaceutique des Français, plus de 134 milliards de francs en 1997, confère à la France le deuxième rang des pays de l’Organisation de coopération et développement économique après les États-Unis1. La consommation médicamenteuse générale ambulatoire a subi une forte élévation dans les pays industrialisés au cours des dernières décennies. Pour déterminer les raisons de cette onsommation, jugée excessive par certains, de nombreuses études médico-économiques ont été conduites permettant de déterminer certains facteurs qui, à morbidité égale, lui sont associés. Il apparaît que les femmes, les personnes âgées et les personnes qui appartiennent aux catégories socioprofessionnelles élevées sont les plus gros consommateurs. Au sein de cette croissance globale, une classe médicamenteuse spécifique se distingue : les psychotropes, dont les plus utilisés sont les
anxiolytiques, les hypnotiques et les antidépresseurs. La consommation française est la plus importante des pays de l’Union européenne3. Aux USA et en Europe, les prescriptions de médicaments psychotropes font partie du quotidien des médecins généralistes4. Les études menées sur la compréhension des mécanismes de recours aux psychotropes montrent qu’ils obéissent à des facteurs variés : émographiques, professionnels, psychoaffectifs, environnementaux, sociaux5 Des travaux internationaux sur l’augmentation de la consommation de psychotropes ont tenté de les isoler : la morbidité, le sexe féminin mettant en évidence des « différences de genre », l’âge élevé, l’appartenance aux catégories socioprofessionnelles intermédiaires, l’isolement social ainsi que les événements de vie et la capacité à
y faire face. Dans le volet 1 de notre recherche, nous avons cherché à compléter ces études et à décrire la population - mère sur laquelle porte l’intégralité de nos travaux de recherche présentés ici en identifiant et en quantifiant les facteurs pouvant influer sur la consommation de psychotropes.....
The aim of the study was to describe patient experiences of medication. Patients with asthma/allergy were interviewed in depth twice with 8 years between. The interviews were analysed according to the phenomenographic approach and three categories, one with four sub-categories, were identified: ‘access to medicine is important to relieve discomfort and to avoid fear’, ‘medicine damages your body and your identity without curing the illness’ (because ‘you can become immune or addicted’, ‘the ability of your body to heal itself is weakened’, ‘your body’s own signals are camouflaged’ and ‘you become stigmatised’) and ‘production and distribution of medicine is a profit-seeking commercial undertaking which is not primarily aimed at curing the patient’. Medication experiences were stable over time. Sociological and biological survival must be compared in an open discussion along with the patient’s and health professional’s different reasons for how they take or prescribe medication.
This study aimed to determine if self-reported social support and life events explained differences in levels of anxiety and depression among 109 elderly psychotropic drug users compared to 90 nonusers (aged 62 to 98). Two thirds of the respondents were French-speaking, mostly female (82.1%) and widowed (57.4%), and recipients of a home care program in Montreal, Canada. The life event and social support scales, broken down by item value, did not differentiate users from nonusers, except for feelings of loneliness reported by 40% of users compared to only 16% of nonusers (p < .001). Analysis of the relation between psychiatric symptomatology and psychosocial variables, broken down by item value, showed greater sensitivity among users to perceived (subjective) lack in social support. In contrast, only “feelings of loneliness” had an effect on the level of mental health of nonusers. There was no effect with regard to objective items of social support.
Cikkunkben a placebohatas nagymertekben elhanyagolt, a magyar es idegen nyelvű irodalomban alig szereplő problemajat tekintjuk at. Celunk a placeborol szolo elmeletek kritikai elemzese, illetve lehetőseg szerint egy, a gyakorlattal is osszhangban levő osszefoglalo elkepzeles felvazolasa. A targyalt mintegy husz jol elkulonithető elmelet hat nagyobb csoportba sorolhato: biologiai alapokon nyugvo elmeletek (endogen opiat peptid műkodes, klasszikus es operans kondicionalas stb.), a „teljes gyogyszerhatashoz” kapcsolodo elmeletek (antropologiai megkozelites, az orvos mint placebo stb.), szocialpszichologiai magyarazatok (attribucio, kognitiv disszonancia redukcio, onbeteljesitő joslatok stb.), tovabbi pszichologiai magyarazatok (pszichodinamika, feltekei lateralizacio stb.), szuggesztiohoz kapcsolodo elmeletek, es vegul a szemelyisegvonas-megkozelites. Az altalunk javasolt elkepzeles alapja egy komplex bio-pszicho-szocialis modell, amely kozos rendszerben targyalja a biologiai, pszichologiai valamint tarsadal...
▪ Abstract This review discusses pharmaceuticals as social and cultural phenomena by following their “life cycle” from production, marketing, and prescription to distribution, purchasing, consumption, and finally their efficacy. Each phase has its own particular context, actors, and transactions and is characterized by different sets of values and ideas. The anthropology of pharmaceuticals is relevant to medical anthropology and health policy. It also touches the heart of general anthropology with its long-time interest in the concepts of culture vs nature, symbolization and social transformation, and its more recent concerns with the cultural construction of the body and processes of globalization and localization. The study of transactions and meanings of pharmaceuticals in diverse social settings provides a particularly appropriate empirical base for addressing these new theoretical issues.
Although use of depressant medications is associated with a number of risks for older people (e.g. drug-drug and alcohol-drug interactions, dependence, falls), very little is known about the factors that lead to use of depressant medications, especially use of benzodiazepines. Physicians clearly play a role in prescribing these drugs, but there are likely to be other influences on use patterns, such as the social context that defines the appropriateness of use, the types of symptoms defined as needing depressant medications, and so on. The social context of use of depressant medications was examined using survey data from 826 persons aged 65 years and older. About 30% of respondents were using depressant medications, with most use to alleviate sleeplessness, stress or pain, and most regular users reporting considerable psychological dependence on continued use (especially for use of tranquillizing drugs). Overall, respondents who used depressant medications consumed about the same amount of alcohol as non-users and considerably more prescription drugs. This suggests that depressant medication users are at risk of alcohol-drug and drug-drug interactions and that alternatives to use of depressant drugs should be sought where possible. Use of depressant medications was positively related to use by spouse, other family and friends, suggesting that the use of depressant medications may well be influenced by the social context that frames use.
RÉSUMÉ
L'objectif de la présente étude était de tester un modèle de cheminement causal de l'effet du stress et divers autres facteurs sur l'utilisation de psychotropes par des personnes âgées en nous appuyant sur des facteurs d'ordre individuel plutôt que social. Les participants étaient des bénéficiaires d'un service de maintien plutôt que de soins à domicile. Les données sont basées sur une série de deux entrevues (à une semaine d'intervalle) faites au domicile de 99 utilisateurs de médicaments psychotropes provenant d'une banlieue socialement défavorisée d'une grande ville canadienne. Le modèle de cheminement causal initial contribue à une partie appréciable (19%) de la variance dans la consommation de psychotropes. Les prédicteurs qui composent notre modèle final, expliquant 17 pour cent de la variance dans la consommation de médicaments sont l'âge, le sexe, les attitudes envers les psychotropes et les événements de vie. Les personnes plus jeunes consomment plus de psychotropes que les plus vieux. Une attitude positive envers les psychotropes et le fait d'appartenir au sexe féminin est associée à un niveau de consommation élevé. L'analyse de cheminement causal n'a pas confirmé notre modèle de consommation de psychotropes en fonction du stress et a plutôt mis à jour de nouvelles questions liées aux facteurs sociaux. Des explications sont offertes à cet effet. Des suggestions de recherche futures ainsi que les retombées cliniques des données sont présentées dans la conclusion.
IntroductionEmerging Drug Use Trends in Socio-Cultural ContextConclusion
ReferencesFurther Reading
Social scientific studies of prescribed drag use have played an important part in heightening awareness that their use can best be understood when considered within a social context. From a sociological point of view, however, these studies often suffer from limitations which restrict their descriptive and explanatory power. This paper discusses these limitations before attempting to develop an alternative approach which focuses on the meanings attached to prescribed drug use, and relates these meanings to the ways in whch the users of these drugs manage their everyday lives as members of particular collectivities. In order to bridge the gap between stracture and experience prescribed drugs are conceptualised as resources which, along with other material and socio-cultural resources, are both differentially available and variously experienced. Taking minor tranquillisers/hypnotics (e.g. Valium, Mogadon) as a test case attention is focused first on these drags' availability to samples of black and white working-class women and the meanings which they attribute to these drags. The different patterns of drug use which are found are then related to these women's varying access to and experience of a range of other resources (including paid work, social supports, leisure, cigarettes and religion). This provides a basis for explaining different patterns of drug use and hopefully illustrates the usefulness of ‘resource’ as a bridging concept between social structure and everyday life.
Qualitative approaches have gained an increased prominence in health services and pharmacy practice research in recent years. Although the numbers of qualitative studies are small compared with those using survey methodology, a substantial body of work has been undertaken in pharmacy practice and related settings. The aim of this paper is to review research employing qualitative interviews in terms of the methodological issues and problems that this approach presents and to explore how these have been addressed. Study objectives, sampling procedures, data collection, processing and analysis and issues of validity, reliability and generalisability will be discussed.
Objective
To contribute to an understanding of young women's perspective on using selective serotonin re-uptake inhibitors (SSRIs).
Method
Eight in-depth interviews and four re-interviews were conducted with young women (aged 21–34) using SSRIs. Informants were recruited through pharmacies in Copenhagen, Denmark. Pharmacy personnel identified potential participants based on dispensed prescriptions and gave them a contact letter with information about the study.
Key findings
When suffering from emotional problems, the women saw themselves as dysfunctional in their daily lives. They felt that they deviated from what is considered “normal” in society and thus felt stigmatised. When the women contacted their physicians they were prescribed SSRIs. After starting the medication, the women felt that they could once again function in everyday life and they felt relieved. However, the women also associated taking SSRIs with Stigmatisation due to the reputation of the medicines as “happiness pills” and the association with mental instability. The women concealed their emotional problems and medication from most people in their social networks. This was the result of the women's own anticipation of being stigmatised and their fear of negative reactions from others if they revealed the truth.
Conclusion
The young women using SSRIs felt stigmatised, initially due to their emotional problems. After the women were diagnosed, the stigma was reclassified and then became associated with taking SSRIs. The women coped primarily by trying to pass for normal. Our findings show that the SSRI users attach psychological and social meanings to their use of the drugs. Pharmacy professionals need to be aware of such meanings if they are to enhance their role in patient care.
Consumption of benzodiazepines (BZDs) is common among seniors. When used over a long period of time, BZDs can induce dependence. The present study aimed to equip nurses with valid screening questions for detecting BZD dependence among seniors, applicable to clinical practice and based on the DSM-IV-TR version. A random sample of 707 BZD users aged 65 years and over was screened for BZD dependence using the DSM-IV-TR criteria for substance dependence. To predict a diagnosis of BZDs dependence, sensitivity and specificity were computed for each pair of items. Results showed that an affirmative answer to 'Have you try to stop taking this medication?' and 'Over the past 12 months, have you noticed any decrease in the effect of this medication?' led to a sensitivity of 97.1% and a specificity of 94.9% to detect BZD dependence. Asking these two simple questions can be easily integrated into clinical practice and have considerable potential for identifying cases of BZD dependence.
The benzodiazepines are remarkably effective anxiolytic drugs. However, they are prone to misuse by both physicians and patients. They should be used in clearly defined clinical situations for short periods, at the lowest possible dosages. Although rare, toxicity can be severe. These agents should be used with caution in persons likely to abuse medication, in the elderly, in patients with glaucoma and in patiens with known hepatic impairment. Sudden cessation may be followed by a withdrawal state.
Benzodiazepines are among the most commonly prescribed drugs in the world. In contrast to their extensive use, the therapeutic indications and potential of benzodiazepines are limited. All benzodiazepine derivatives available in Canada are similar structurally and in their pharmacologic actions. Few have specific advantages over any others. For example, no benzodiazepine has been shown to be superior to chlordiazepoxide in the treatment of acute anxiety, chronic anxiety neurosis or insomnia. Barbiturates should not be prescribed for these problems since benzodiazepines are just as effective and are safer. Persons more than 70 years old should receive initial doses of benzodiazepines 50% less than those prescribed for younger persons, and individuals with cirrhosis should receive chlordiazepoxide or diazepam in one third the usual dose; oxazepam or lorazepam should be considered for these two groups of patients. Diazepam and chlordiazepoxide should not be given intramuscularly. Benzodiazepines should be prescribed only when clearly indicated and only for the necessary length of time.
The prescribing of psychotropic drugs by general practitioners was assessed by analysing the drug treatment of all patients referred from general practice to a psychiatric outpatient clinic over four years. Of the 287 patients, 220 were taking one or more of 56 different psychotropic drugs at referral, diazepam being the most common. Benzodiazepines and barbiturates had been taken for significantly longer than other drugs, and, of a total of 342 drugs, 61 had been prescribed regularly for over a year. Half of the drugs were considered to be incorrectly prescribed on pharmacological grounds, the main errors being unnecessarily prolonged regular treatment, incorrect dosage (particularly common with antidepressants), and polypharmacy with drugs of similar pharmacological action. A basic grounding in the pharmacology of psychotropic drugs might help practitioners to avoid prescribing errors of this kind.
Implicit images of human behaviour influence most research endeavours. Studies of patients' “compliance” with doctors' instructions have generally used an ideal image of the patient as a passive, obedient and unquestioning recipient of medical instructions. Divergence from this ideal—“defaulting”—is seen as irrational in the light of medical rationality. The blame for “default” is seen as lying with the patient. The research problem is then to find out what there is about the patient that makes him a defaulter. This is a view of the problem from the point of view of the medical profession. An alternative approach from the perspective of the patient is suggested. The focus is then on the social context in which illnesses are lived and treatments used. A more active view patients is entailed in which patients have expectations of the doctor, evaluate the doctor's actions, and are able to make their own treatment decisions. Rather than “defaulting” being found in certain types of individuals, almost anyone can be a “defaulter” at some time or another.
IN VIEW of the availability of newer, apparently safer drugs (benzodiazepines), the Institute of Medicine was asked by federal agencies to review the status of short-acting to medium-acting barbiturates in medical practice. The drugs originally of concern to policy-makers were commonly prescribed sleeping pills (hypnotics) containing secobarbital, pentobarbital and amobarbital. From the viewpoint of public-health policy, little or no concern was expressed about phenobarbital or butabarbital, which are prescribed mostly to provide daytime sedation or to control epileptic seizures; unlike the hypnotics, these barbiturates are only infrequently used in suicide and rarely in drug abuse. The Institute of Medicine decided . . .
Two hundred and forty-one patients, 173 females and 68 males, completed questionnaires designed to identify their knowledge of drugs and attitudes to doctors' prescribing behaviour. These results were compared with those of 35 ancillary staff, 277 schoolchildren, 55 student nurses, 69 medical students, and 78 general practitioners. Although over 80 per cent of patients thought that heroin was a drug, only 10 per cent thought that penicillin should be so classified. Only two per cent of patients thought it was safe for doctors to prescribe without first seeing the patient, although 80 per cent of general practitioners thought that this was sometimes acceptable.Seventy per cent of doctors thought that antibiotics, tranquillizers, hypnotics, and antidepressants were over-prescribed and nearly half the patients appeared to agree with them.More patients thought that antibiotics were designed to kill viruses than bacteria, over a quarter thought that these preparations were the best form of treatment for a cold, and almost half expected diarrhoea to be treated with an antibiotic.Doctors need to spend more of their time in simple health education. By doing so they could reduce their future workload and the nation's drug bill.
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Differences in perception of behavior as signs of “mental” illness among eight ethno-religious groups were examined in a study of over two thousand representative New Yorkers. Perceptions of thirteen vignettes describing varying degrees of deviant or problematic behavior were ascertained and twelve of these were used in constructing a Guttman attitude scale. Ethno-religious differences were then considered by frequency of distribution of scale types. The Puerto-Rican group was found to have the most distinctive distribution.
This pilot study examined patients' perceptions of, and attitudes towards, psychotropic drug-taking. Fifty chronic users of benzodiazepines in two Middlesex group practices were interviewed, and data were collected on their knowledge, experience and expectations of these drugs.The data suggest that psychotropic drug-taking has become an important part of many patients' self-image and of their social relationships, and that these factors should be taken into account when dealing with psychological dependence on psychotropic drugs.
The Tranquillizer War
- Pekkanen
Who prescribes? The Illusion of Power Sharing in the Surgery
- Dajda
Prescribing as Social Exchange
- Hall
Deviance as Success: The Double Inversion of Stigmatised Roles
- Jackson
Psychotherapy and Psychopharmacology
- Pfefferbaum
Ethno-Religious variations in perceptions of illness
- Guttmacher
More Secret Remedies: What They Cost and What They Contain
- British Medical Association
Going to See the Doctor
- Stimson
Attitudes to Health and Use of Health Services of Two Generations of Women in Social Classes 4 and 5
- Blaxter