Opiate addicts in and outside of treatment; Different populations?

The core of this study is related to the insight that the population of opiate addicls is quite an invisible group. Some paris of this group can be identified at treatment institutions and in prisons. However, a large pari of the opiate addicls is hard to detect. This is because their illegal activities are often hidden and because many of them move frequently from one place to another. Although some are easy to spot at public places, these are very hard to approach for research. For years stUdies have been performed in the different echelons. Researchers studied criminal behavior of addicts in prison. Others analysed factors that influenced treatment success of addicts in drug treatment settings. Again others described the life of the drug using subculture by participant observation. Each data set was used to answer the specific research questions and that was it. This study is a first step to a more holistic approach. Separated pieces of information do not satisfy anymore. What is needed is comparable information gained in all known subgroups of the population. Only in that way the most complete view on opiate addiction can be reached. The next step is to repeat these measurements in the different subgroups regularly. In that way a consequent monitoring of the population will become possible, of which policy makers, clinicians and researchers will benefit. In this thesis characteristics of opiate addicts who apply for a methadone programme, a clinical detoxification programme, a drug free therapeutic community and opiate addicts outside of treatment are described. A comparison is made of the nature, severity and extent of drug use and the accompanying medical, legal, employment, social and mental complex of problems. On the basis of this comparison the following questions will be discussed: Which factors are linked with the decision of opiate addicts to seek professional help? and Which factors are linked with the choice for a specific type of treatment? The study design and the results are presented in four sections, which are structured according to the central research questions they provide answers for. Each section contains three chapters. Section two describes the outline of the study and the methods used in detail. Section three presents problems with drug use and accompanying problems. Section four focuses on comorbid psychopathology (dual diagnosis). In section five processes of addiction and help-seeking behaviour are discussed. The final section six contains the conclusions, general discussion and a summary.