Challenges to Implementing the Harm Reduction Approach

The latest edition of this best-selling textbook by Miles and Huberman not only is considerably expanded in content, but is now available in paperback. Bringing the art of qualitative analysis up-to-date, this edition adds hundreds of new techniques, ideas and references developed in the past decade. The increase in the use of computers in qualitative analysis is also reflected in this volume. There is an extensive appendix on criteria to choose from among the currently available analysis packages. Through examples from a host of social science and professional disciplines, Qualitative Data Analysis remains the most comprehensive and complete treatment of this topic currently available to scholars and applied researchers.

The self-medication hypothesis of addictive disorders derives primarily from clinical observations of patients with substance use disorders. Individuals discover that the specific actions or effects of each class of drugs relieve or change a range of painful affect states. Self-medication factors occur in a context of self-regulation vulnerabilities--primarily difficulties in regulating affects, self-esteem, relationships, and self-care. Persons with substance use disorders suffer in the extreme with their feelings, either being overwhelmed with painful affects or seeming not to feel their emotions at all. Substances of abuse help such individuals to relieve painful affects or to experience or control emotions when they are absent or confusing. Diagnostic studies provide evidence that variously supports and fails to support a self-medication hypothesis of addictive disorders. The cause-consequence controversy involving psychopathology and substance use/abuse is reviewed and critiqued. In contrast, clinical observations and empirical studies that focus on painful affects and subjective states of distress more consistently suggest that such states of suffering are important psychological determinants in using, becoming dependent upon, and relapsing to addictive substances. Subjective states of distress and suffering involved in motives to self-medicate with substances of abuse are considered with respect to nicotine dependence and to schizophrenia and posttraumatic stress disorder comorbid with a substance use disorder.