Epidemiology abuse: epidemiologic and Psychosocial perspectives on heroin maintenance

Two perspectives on drug abuse have evolved. Epidemiologic approaches treat drug abuse as if it were an infectious disease and deal with it within the framework of host, agent, and environment. Epidemiologists, approaching drug abuse from a public health standpoint, tend to think in terms of supply reduction. Psychosocial approaches focus on the demand aspect of drug abuse. Interest centers on psychological/sociological explanations of drug-taking behavior, such as psychopathology and alienation, and on unintended consequences of supply-reduction strategies. The author proposes that the two models eomplement each other and need to be integrated. A policy of strict supply reduction for nonaddicts coupled with heroin maintenance for addicts is suggested. Such a policy combines epidemiologic emphasis on supply reduction with psychosocial stress on the impractible nature of addiction and the futility of prohibitionlike approaches.