Abstract
Social representations of addiction and the resulting stigmatization have been widely described and studied in the literature, but their effects are no less problematic. These representations, which also occur in care settings, generate a climate of distrust which damages the therapeutic relationship, and its ethical quality. This article, combining clinical experience and an ethical stance, offers an original, innovating approach to the existence of distrust in care relationships in the area of addiction. Pragmatic approaches deriving from the human sciences and analytical philosophy provide an invitation to escape from the demanding climate of mistrust, and to take the gamble on trust so as to improve the quality of interactions between protagonists in care. In complementary fashion, a sociology of action can combat the disquiet generated by distrust through a new commitment to innovating forms of action. This “poetic” mode of action is legitimized by the reflection that backs it up, and by its presentation to peers qualified to approve it. Finally, continental moral philosophy underlines the importance of a carefully weighed commitment on the part of caregivers and addicted patients towards promises aiming to support a sincere care relationship, without damaging the therapeutic dynamic or the ethical quality by providing too many safety nets. This reflection is intended to achieve better identification of the clinical and ethical issues raised by mistrust, and inclusion of these aspects in the training of personnel and in care provision planning.
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References
Ahern, J., J. Stuber, and S. Galea. 2007. Stigma, discrimination and the health of illicit drug users. Drug and Alcohol Dependence 88(2–3): 188–196. doi:10.1016/j.drugalcdep.2006.10.014.
Anzieu, D. 1990. Psychic envelopes. London: Karnac Books.
Arendt, H. 1958. The human condition. Chicago and London: The University of Chicago Press.
Beck, F., S. Legleye, and P. Peretti-Watel. 2003. Penser les drogues: Perceptions des produits et des politiques publiques, EROPP 2002 [Thinking drugs: Perceptions of substances and public policies, EROPP 2002]. Paris: OFDT. Retrieved from http://www.ofdt.fr/ofdtdev/live/publi/rapports/rap03/epfxfbj1.html. Accessed 19 July 2013.
Bion, W.R. 1961. Experiences in groups, and other papers. London: Tavistock.
Costes, J. M., O. Le Nézet, S. Spilka, and C. Laffiteau. 2010. Dix ans d’évolution des perceptions et des opinions des Français sur les drogues [Ten years of evolution of the perceptions and opinions of the French people on drugs]. Tendances (71). Retrieved from http://www.ofdt.fr/ofdtdev/live/publi/tend/tend71.html. Accessed 19 July 2013.
Gambetta, D. 2000. Can we trust trust? In Trust: Making and breaking cooperative relations, ed. D. Gambetta, 213–237. Oxford: University of Oxford.
Goffman, E. 1986. Stigma: Notes on the Management of Spoiled Identity. New York: Simon and Schuster.
Guarino, H., S. Moore, L. Marsch, and S. Florio. 2012. The social production of substance abuse and HIV/HCV risk: an exploratory study of opioid-using immigrants from the former Soviet Union living in New York City. Substance Abuse Treatment, Prevention, and Policy 7(2): 1–14. doi:10.1186/1747-597X-7-2.
Jauffret-Roustide, M., J. Cohen, I. Poisot-Martin, B. Spire, M. Gossop, and M.P. Carrieri. 2012. Distributive sharing among HIV-HCV co-infected injecting drug users: The preventive role of trust in one’s physician. AIDS care 24(2): 232–238. doi:10.1080/09540121.2011.596515.
Keyes, K.M., M.L. Hatzenbuehler, K.A. McLaughlin, B. Link, M. Olfson, B.F. Grant, and D. Hasin. 2012. Stigma and treatment for alcohol disorders in the United States. American Journal of Epidemiology 172(12): 1364–1372. doi:10.1093/aje/kwq304.
Larios, S.E., S. Wright, A. Jernstrom, D. Lebron, and J.L. Sorensen. 2011. Evidence-based practices, attitudes, and beliefs in substance abuse treatment programs serving American Indians and Alaska Natives: A qualitative study. Journal of Psychoactive Drugs 43(4): 355–359.
Livingston, J.D., T. Milne, M.L. Fang, and E. Amari. 2012. The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction 107(1): 39–50. doi:10.1111/j.1360-0443.2011.03601.x.
Luhmann, N. 1979. Trust and Power. Chichester: John Wiley and Sons.
MacIntyre, A.C. 2007. After virtue: A study in moral theory. Notre Dame: University of Notre Dame Press.
Palamar, J.J. 2012. A pilot study examining perceived rejection and secrecy in relation to illicit drug use and associated stigma. Drug and Alcohol Review 31(4): 573–579. doi:10.1111/j.1465-3362.2011.00406.x.
Ralley, C., R. Allott, D.J. Hare, and A. Wittkowski. 2009. The use of the repertory grid technique to examine staff beliefs about clients with dual diagnosis. Clinical psychology & psychotherapy 16(2): 148–158. doi:10.1002/cpp.606.
Reyre, A., O. Taïeb, J. F. Rouchon, T. Baubet, E. Hirsch, and M. R. Moro. 2010. In-quiétude et souci de soi comme éthique dans les relations thérapeutiques avec les patients addictés [Disquiet and care of the self as an ethics of care relationships with addicted patients]. Psychotropes 16(1): 9–19. doi:10.3917/psyt.161.0009.
Ricoeur, P. 1996. Les paradoxes de l’identité [The paradoxes of identity]. Information psychiatrique 72: 201–206.
Ricoeur, P. 2005. The course of recognition. Cambridge, MA: Harvard University Press.
Ritson, E. 1999. Alcohol, drugs and stigma. International Journal of Clinical Practice 53(7): 549–551.
Semple, S.J., S.A. Strathdee, J. Zians, and T.L. Patterson. 2012. Factors associated with experiences of stigma in a sample of HIV-positive, methamphetamine-using men who have sex with men. Drug and Alcohol Dependence 125(1–2): 154–159. doi:10.1016/j.drugalcdep.2012.04.007.
Soulet, M.-H. 2005. Confiance et capacité d’action. Agir en contexte d’inquiétude [Trust and ability to act. Acting in a climate of disquiet]. In C. Balsa Confiance et lien social (p. 31–55). Fribourg: Academic Press Fribourg.
Taïeb, O., A. Reyre, J. F. Rouchon, T. Baubet, and M. R. Moro. 2008. Théories de la lecture et addictions: du Lecteur Modèle au Patient Modèle [Theories of reading and addictions: From model reader to model patient]. Evolution psychiatrique 73(4): 685–699.
Taïeb, O., S. Chevret, M. R. Moro, M. G. Weiss, A. Biadi-Imhof, A. Reyre, and T. Baubet. 2012. Impact of migration on explanatory models of illness and addiction severity in patients with drug dependence in a Paris suburb. Substance Use & Misuse 47(4): 347–355. doi:10.3109/10826084.2011.639841.
Thom, D.H., S.T. Wong, D. Guzman, A. Wu, J. Penko, C. Miaskowski, and M. Kushel. 2011. Physician trust in the patient: Development and validation of a new measure. Annals of Family Medicine 9(2): 148–154. doi:10.1370/afm.1224.
Thylstrup, B., and M. Hesse. 2008. Substance abusers’ personality disorders and staff members’ emotional reactions. BMC Psychiatry 8(21). doi:10.1186/1471-244X-8-21.
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Reyre, A., Jeannin, R., Larguèche, M. et al. Care and prejudice: moving beyond mistrust in the care relationship with addicted patients. Med Health Care and Philos 17, 183–190 (2014). https://doi.org/10.1007/s11019-013-9533-x
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DOI: https://doi.org/10.1007/s11019-013-9533-x