Pfungwa dzako Nekuchengetedzwa Kwemagariro Zvinobatsira Kana Iwe Ukava Muropa
Inodzorwa heroin inoshandiswa here? Vakawanda vanoshandisa zvinodhaka vanoshamisika kana heroin inotungamirirwa - kushandiswa kwekushandura heroin pasina kutengesa - zvinogoneka. Kunyangwe ichi ichi chiri pasi pekutsvakurudzwa kwenzvimbo yekudhakwa, uye nyanzvi dzakawanda dzinotsanangura kuvashandisi ve heroin vachiita zvepabonde uye vanotambura nezvinetso zvakakomba, pakave nekutsvakurudza kunoratidza kuti vamwe vashandisi ve heroin vanoenda nguva nenguva vachishandisa heroin vasingamboiti mishonga.
Zvakaita Ongororo
Dr. Norman Zinberg weHarvard Medical School akaita basa remakiriniki nevashandisi vezvinodhaka kwemazana makumi maviri emakore uye akaongorora ruzhinji rwevanhu vakanga vari kushandisa zvinodhaka zvisina kukodzera, zvakadai se heroin . Akaona kuti havasi vese vashandisi vezvinodhaka vakakundikana kutonga pamusoro pekushandisa kwavo uye vakava vodhakwa, uye izvo zvakagadziriswa uye kugadzirisa zvaive zvikonzero zvinokosha pakusarudza kana kana munhu asina kurasikirwa kutonga kwekushandisa kwavo zvinodhaka.
Kugadzirisa uye kugadzirisa, izwi rinoreva mamiriro ekufunga kwemushandisi wezvinodhaka, kana "kuisa," uye nzvimbo iyo iyo mishonga inotorwa, kana "kuisa," yakawanikwa ine simba guru kune vanhu vanoshandisa Zvinodhaka zvinodhaka zvinotanga kuve chidhakwa kwavari.
Kunyangwe zvakare muna 1962, Dr. Zinberg akawana kuti vanachiremba vakanga vasingadi kupa mishonga inorwadza kune avo vaida, nokuti vanotya kuti varwere vaizopindwa muropa. Kunyange zvakadaro kutya uku kwakabva kune zvemagariro evanhu uye netsika zvechiremba, kwete pazviri.
Muzvokwadi, Zinberg akaona kuti vashomanana vashoma vari muchipatara vakave vakapindwa muropa nekuraira opioid. Ichi chaiva chiitiko chekutanga cheZimbberg chekugadzirisa kunogona kukanganisa kunotevera kusvuta.
Stigma Pakati Physicians
Apo isu tingatarisira kuti vanachiremba vave vavariro uye vasina kukodzera nenzira iyo vanoona varwere vavo, hapana chinogona kuwedzera kubva muchokwadi.
Kuongororwa kwakaitwa munguva pfupi yapfuura kwakaratidza kuti vanachiremba vane kunyanya kunetseka pamusoro pezvinyorwa zvemishonga inorwadza maopiate, nemaonero avo evarwere ivo vari kufunga kuenzanisira mishonga inorwadza kuti iparadzaniswe pakati pevaya vanoonekwa se "vanorwara vanorwara," uye avo vari inofungidzirwa kuva "kutsvaga zvinodhaka."
Vanachiremba vanowanzofunga kuti kutonga varwere nenzira iyi chikamu chebasa ravo, sezvo vachiyera kuenzanisa pakati pekunoderedza marwadzo e "vechokwadi" varwere vanorwadziwa pavanenge vachidzivisa kuvepo kuti vari kubvisa kusagadzikana kwevaya vari kungotsvaka mishonga.
Mukutsvakurudza heroin yeBrithani yakashandura mumakore ekuma1960, apo heroin inogona kurairwa zviri pamutemo kune avo vakanga vakadhakwa, Zinberg vakaona kuti kune maviri akasiyana siyana e heroin muropa - avo vaitungamirirwa mukushandiswa kwavo, uye vaiva nehutano uye hunobudirira hupenyu , uye avo vakanga vasina kudzora mumashandisirwo avo, vakazviona sevasina maturo, uye vaiva nemararamiro ezvakaipa.
Asi isati yasvika pakurambidzwa kwe heroin muBrithani, hapana maitiro akanga asiri chikonzero chekusagadzikana kwemagariro evanhu, kuparwa kwemhosva, kana kusununguka kwevanhu. Zvakare, Zinberg akaona izvi sechiitiko chepamutemo che heroin muBritain panguva iyoyo.
Zinberg akadzidzawo heroin kushandiswa nekuvhiringidza mauto eAmerica muVietnam, iyo yakanga yakawandisa uye isingadzorwi, uye yakaona sekuedza "kubvisa" kushungurudzika kwavaiva nako ikoko. Kamwe chete pavakadzokera kumusha uye vakanga vasiri kunze kwekusarura kwevanhu veVietnam, 88% havana kutaurira heroin kushandisa, kunyange zvazvo vakawanda vaiva nezvinetso zvakakosha.
Powell, shamwari yaZinberg, akawana kuti zvaikwanisika kuti vanhu vashandise heroin nguva nenguva - boka rinonzi "chippers." Vanhu ava vaifarira kushamwaridzana nevanhu vasina kushandisa zvinodhaka kushandiswa neshamwari, uye vakachengetedza zvakasimba pamusoro pekushandisa kwavo heroin, kuderedza shure pakarepo pavakaona zviratidzo zvekuvimba.
Chidzidzo ichi chakaratidza kuti kushandiswa kwakashandiswa kwe heroin kwaigona.
Kubatsira kwavanoitwa naHerinomi kuchengeta Kudzora
Sezvo basa raZinberg richifambira mberi, akaronga kuti zvikamu zviviri zvinokosha zve "kugadzirisa" kwekushandisa zvinodhaka zvakakosha mukugadzirisa miganhu uye kutonga kunenge kushandiswa. Izvi zvaive mitambo uye zvigaro zvevanhu. Mitambo inofanirwa kutaridzika maitiro emafambiro, uye kurambidzwa kwemagariro evanhu ndiwo maitiro anochengetedzwa nevashandisi vezvinodhaka, nemitemo yavo yakabatana yekufambisa. Zvisarudzo zvinosanganisira mitemo yakarongeka inoratidza mararamiro evanhu vakawanda, zvakadai semitemo yemishonga , uye inosanganisira mitemo isina kukodzera, isina kunyorwa pakati pevashandi vezvinodhaka izvo zvinorega kushandiswa kwezvinodhaka, zvakadai sokuziva muganhu wako.
Makumi emakore gare gare, pfungwa dzakatanga kurongwa neZinberg dzichizopedzisira dzichiratidzwa mukuonekwa kwekudhakwa . Bhuku Rekuongorora uye Rokusimudzira reMental Disorders, Fifth Edition, iro rinozivikanwawo seDMM-V kana DSM-5, rinoratidzika zvakajeka pakati pemafungiro ekushandiswa kweopioid, iyo inosanganisira maitiro ekutsvaga zvinodhaka uye kushandiswa kwechisimba, uye hupenyu hwehupenyu hwehupi hunosiya , izvo zvinogona kuitika kumunhu upi zvake ari kuderedza kana kumisa kushandiswa kweopioid, kusanganisira vanhu vane maopioid mishonga vasina kukodzera.
Pasinei nekutsvakurudza uku, ruzhinji rwekutsvakurudza runoratidza kuti heroin imishonga inokuvadza zvikuru, inowanzoendesa kune nguva yakareba yekudhakwa, zvinetso zvakakomba zvehupenyu zvine chokuita nekushandiswa, uye nehupamhi hwekudzokera zvakare. Kana usina kutora heroin kare, zvakachengeteka kusaisa pangozi iyo.
Sources
American Psychiatric Association. Kuongorora uye Statistical Manual ye Mental Disorders (Fifth Edition). Washington DC: American Psychiatric Association, 2013.
Powell, D. "Chidzidzo chevatyairi vevashandisi venguva dzose heroin." Arch Gen Psychiatry 28 (4), peji 586-94. 1973.
Zinberg, N. Drug, Set, uye Kugadzirisa: Nheyo Yokudzora Zvinodhaka Zvinoshandiswa. Yale University Press. 1986.