Introduction. Depressive symptoms are common in opioid and crack users. Effective clinical treatment of depression in this group requires an understanding of their views about causation, the course of effects of the illness and treatments. Good qualitative evidence is available about these areas for people who are depressed in non-drug using groups; there is a lack of such evidence in drug-using groups.
Aim. The aim was to examine lay beliefs about depressive symptoms for users of heroin and crack cocaine
Setting: Primary care in Middlesbrough, UK
Methods and participants. A total of 17 semi-structured interviews were conducted with patients currently using heroin and crack cocaine, who were receiving treatment for both drugs and also antidepressants for depressive symptoms. One focus group of service users also provided data. The data were analysed by standard qualitative methods.
Findings. The participants shared an understanding that depression might cause drug-use, that both depression and drug taking might share common antecedent causes and that drug taking might lead to depression. The latter connection was usually articulated in terms of the adverse social consequences of drug-taking leading to depression. Examples of stigma were common, and the participants were often isolated with few true ‘friends’. This impacted on self-management techniques for treating depression.
Conclusions. As for non-drug using patients with depression, views about ‘depression’ differ significantly from medical models. However the drug taking also impacted significantly on their views about causation, effects of the depression and treatment strategies.