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Heroin Addiction and Related Clinical Problems: 2019, 21, N1 (pages: 21 - 28)

Practitioners' Experiences of Working with Dual Users of Heroin and Crack Cocaine. A Thematic Analysis

Heidebrecht F., and Macleod M.B.

Summary: Background: Crack/cocaine use is highly prevalent among individuals accessing pharmacological treatment for heroin dependency. Quantitative research studies have shown that dual users of heroin and crack/cocaine have worse treatment outcomes in Agonist Opioid Treatment (AOT) programmes compared to heroin-only users, however, no specific psychosocial interventions have been proposed. Aim: The aim of this study was to explore the experience of substance misuse practitioners of providing treatment to heroin and crack/cocaine users. Methods: The study was conducted in three community services in London, UK. A thematic analysis was performed on semi-structured interviews with seven practitioners from diverse ethnic backgrounds, two females, three currently in leading positions, with an average age of 40 years (27-49), and average work experience of 12 years (2-20). Results: Two themes with several sub-themes were identified: The high and the low (Reasons for drug use, Patterns of heroin and crack use, Behaviour); Facilitating change (Worker-client relationship, Working with the drug use, Working with additional issues). The participants highlighted the importance of exploring the use of both drugs, associated personal constructions, and the experience of pleasure. They discussed the medication as a supporting rather than a main intervention, and the need for workers to be creative and skilled in engaging clients with a constantly-changing presentation, using flexible rather than structured interventions. Practitioners identified several patterns of using heroin and crack/cocaine, and discussed suitable interventions. Conclusion: Psychosocial interventions need to be better integrated with AOT, and tailored to individual needs according to the pattern of dual use.