Zmanjševanje škode in posebna obravnava bolezni odvisnosti. Različni pristopi ali nivoji intervencij? = Harm reduction and specific treatments for addiction. Different aproaches or levels of intervention? An illness-centred perspective
Maremmani, Icro ; Lovrečič, Mercedes
So far, harm-reduction campaigns have been so focusing on personal and social needs of heroin addicts, in order to prevent the consequences of addictive behaviours. An incorrect dichotomy appears to ...be usually thought of when comparing harm-reduction interventions to specific treatments for heroin addiciton. Nevertheless, some of the specific targets in the treatment of heroin addiction, as well as features of mentally ill subpopulations, may be reasonable targets for harm reduction, too. Convergance upon overlaping targets may be hypothesised as long as harm reduction and specific treatment come to share the same therapeutic instruments. opioid-agonists, the primary option for the specific treatment of heroin addiction, may also serve as harm reduction instruments, as long as harm reduction is conceived as means to act upon the same disease, though at low-threshold level. The personal and social impact of possible agonist-mediated harm-reduction would be of particular weight for higher-risk populations, such as mentally-ill heroin users, who have shown sensitive to therapeutical opioid agonism. Harm reduction should be rather regarded as a lower level of approach to more severely disabled subjects, bridging between the street and the clinical settings by a sub-therapeutic but specific pharmacotherapy. Stepping from a harm reduction to a higher level of intervention should represent the ultimate goal of harm reduction itself. Transition to specific treatment is of particular importancefor dually diagnosed addicts, who are expected to be granted greaterrelative benefit, and, otherwise, are likely to be presently excluded from the opportunity of a positive outcome.
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