Van Hout Marie Claire, Norman Ian, Rich Eileen, Bergin Michael
School of Health Sciences,Waterford Institute of Technology,Waterford,Ireland.
Florence Nightingale Faculty of Nursing and Midwifery,King's College London,London,UK.
Behav Cogn Psychother. 2017 May;45(3):238-252. doi: 10.1017/S1352465817000030. Epub 2017 Feb 10.
Misuse of codeine-containing medicines is an emerging public health issue.
We present the application of Liese and Franz's (1996) cognitive developmental model of substance abuse to the trajectory from legitimate codeine use for pain, towards that of therapeutic and other forms of misuse, and physical and psychological dependence. It illustrates a cognitive behavioural analysis of the experiences of codeine misusers - which 'surfaces' the specific beliefs, thoughts, emotions and behaviours of this group of hidden codeine dependent individuals, who are distinct and unique from other opioid-dependent cohorts.
In-depth one-to-one interviews with codeine misusers and dependent individuals in Ireland (n = 21) and South Africa (n = 25) are analysed and applied to Liese and Franz's (1996) cognitive developmental model of substance abuse.
Misuse and dependence pathways are maintained by the interplay between physiological determinants relating to pain, withdrawal and tolerance, and psychological influences such as therapeutic need, pre-empting of anticipated physical pain, pleasure from the dreamy sedative opiate effect of codeine and relief of emotional distress. Progression towards habitual use and misuse for therapeutic and intoxication purposes appears to be mediated by external environmental triggers pertaining to availability, internal meta-cognitions around physical pain and emotional distress, and increasing importance of codeine in the life of the user.
The concept mapping of codeine misuse and dependence presented here could provide psychological therapists working with individuals experiencing problems with codeine, misusing codeine and those with iatrogenic dependence, with an enhanced understanding of the key concepts involved in misuse and recovery pathways.
含可待因药物的滥用是一个新出现的公共卫生问题。
我们将利泽和弗兰兹（1996年）的药物滥用认知发展模型应用于从用于止痛的合法可待因使用，到治疗性及其他形式的滥用，再到身体和心理依赖的轨迹。它展示了对可待因滥用者经历的认知行为分析——这“揭示”了这群隐藏的可待因依赖个体的特定信念、想法、情感和行为，他们与其他阿片类药物依赖群体不同且独特。
对爱尔兰（n = 21）和南非（n = 25）的可待因滥用者和依赖个体进行深入一对一访谈，并将其应用于利泽和弗兰兹（1996年）的药物滥用认知发展模型。
滥用和依赖途径是由与疼痛、戒断和耐受性相关的生理决定因素，以及诸如治疗需求、对预期身体疼痛的预先防范、可待因梦幻般的镇静阿片类药物效果带来的愉悦感和情绪困扰缓解等心理影响之间的相互作用维持的。向习惯性使用以及出于治疗和中毒目的的滥用的进展似乎是由与可得性相关的外部环境触发因素、围绕身体疼痛和情绪困扰的内部元认知，以及可待因在使用者生活中日益增加的重要性介导的。
此处呈现的可待因滥用和依赖的概念映射可为与有可待因问题、滥用可待因以及医源性依赖者打交道的心理治疗师提供对滥用和康复途径中关键概念更好的理解。
