Abstract
This thesis is based on the harm-reducing treatment with medically prescribed heroin at the ambulant treatment centre KABS Hvidovre. Heroin treatment is used as an example of the increasing tendency to medicalize drug abuse and drug treatment. This thesis intends to convey knowledge on how drug treatment, in the hands of health professionals, is carried out in practice. The focus of this study will be on the nurses in the heroinclinic, as they are a crucial profession in the treatment, because of their daily contact with the treatment users. More specifically this study intends, by qualitative interviews, to explore what characterises the nurses’ approach in the heroin treatment. Consisting of four questions, relevant strategies, intentions and problem understandings, will be studied in a critical hermeneutic perspective. First part of the thesis’ analysis describes some of the strategies used in practice by nurses in the heroinclinic. The nurses strive to “keep the heroin treatment on a clinical level” which, in their understanding, concerns creating and conserving a social environment in the clinic, that differs from the subcultural environment of drug abuse. The nurses cannot substantiate this strategy, but it is profound in their understanding of what treatment is, that it is “something segregated from the abuse environment”. The nurses seem not to be aware of alternatives to their understanding of treatment, as it seems obvious to them, and therefore could be an understanding similar to doxa. As part of their strategies to create this “treatment environment”, words from the drug abuse/street environment is replaced with medical terms, and the users is prohibited to speak - as the nurses put it -“drug talk” and “street language”. The nurses also regard it as part of the heroin treatment, to educate the users to behave with good manners. This, with the intention that this “treatment” environment will affect the users behaviour, and socialize them in a long-term perspective. This is done with the best intentions of helping, and the nurses do not seem to be aware, that this educational act can be offending to the users dignity. Second part of the analysis focus on a strategy to work with highly individualized aims in the heroin treatment. There are no common objectives, and the users requests are prioritized higher than health professional judgements of the users needs. This strategy indicates a view on the user, as a person who acts rational, independent and responsible, and whom can make harm reducing and foresighted aims for his own life. The nurses are very neutral in their opinion of the users treatment aims, and the only requirement is that the users conditions must not be deteriorated. This strategy is assumed to be entirely positive, but the nurses neglect the fact, that there is a risk that the users chance of improvement and recovery may not be utilised to its full potential. Also, the nurses seems to think that the users will not experience defeats because of this strategy, and they are not aware, that with freedom to decide your own aims, follows the responsibility and blame for not achieving them. In third part of the analysis the nurses’ intentions with their strategies is illustrated. It became clear that the nurses think of the users as a highly stigmatised group in society, and that they aim for the treatment to decrease the stigmatisation. The strategies mentioned above (the treatment-environment and the education of good manners), is supposed to result in society’s acceptance of the user, and also to improve the users self-image. In the nurses’ view, the user can now understand himself as a patient with a disease eligible to treatment, because of the medicalization of heroin drug treatment. The nurses do not seem to be aware that their strategy may not result in a normalisation of the user, but may lead to a fake adaption, in hope that they can live up to the nurses expectations about the treatments normalising effect. The fourth part of the analysis pointed out some characteristics of the nurses’ problem understanding. It became clear that there exist no common understanding of drug use and addiction among the nurses, but that the understanding of these phenomena depends on each nurses’ individual pre-understanding. In spite of variations in the problem understanding, the nurses expressed a very distinct illness-understanding of drug abuse and addiction which, for example, was shown in their comparing heroin treatment for drug users with diabetes patients medicated with insulin. The “illnessmodel” of understanding can in some way legitimate the heroin treatment, and may help the nurse to master her practice. Also the illness-understanding justify the nurses profession to treat heroin addicts. In spite of their use of the illness-model, when talking about treatment, the nurses articulate a psychosocial understanding, when asked to explain the cause of drug addiction, and they point out the users miserable childhood and life traumas, to cause the drug abuse. The nurses very much emphasises on the drug users choice in their understanding of drug addiction, which indicates the tendency to leave out significant risk factors (such as poverty, lack of education, unemployment) in their understanding of the user and his addiction. Generally the nurses’ problem understanding is permeated of an individual focus, and they primarily use explanation on an individual level. Understandings with focus on an individual level should always be supplied with understandings that includes the context of the individuals, since this is crucial for understanding the individuals actions, and crucial in the hopes of meeting the users with empathy and acknowledgement.