Effects of interventions in the addiction field from a social science perspective, with the example of the prescription of narcotics

The promising results of the medical prescription of narcotics have provoked the new discussion about the mechanisms of effects of therapeutic interventions: is the pure fact of the provision of heroin effectful, is the psychosocial care the most important acting component or is the relief due to decriminalisation responsible for the effects? In case of an interplay of all these aspects which is their relative importance? Assumptions about effect interplays are important for understanding and for the development of a treatment system. In this contribution the results of heroin prescription are interpreted in frame of a sociological model. The basic hypothesis of the model is based on a paradigma of action theory. The heroin dependence is seen as deviant form of social action. Neurobiological changes, personal features, social aspects and societal interpretations are structural elements of this deviant action system. The treatment intervenes within different dimensions of the deviant systems. The aim of the substitution is to change the deviant action system and to initiate a reorganisation. Steps of this reorganisation are a reduction of subcultural drug concentrated actions and reconstruction of the action patterns in the "normal" society. During this process the drug dependent is supported in frame of psychosocial care in different extend. The thesis is set up that sociological understanding of the effects of heroin prescription enables a perception of the reintegration as a process which combines the personal resources of dependents and the responsibility of the society within a emancipatory process. (Author' s abstract)