Kukho imiqondiso emininzi engabonakalisa ukusetyenziswa kakubi kweziyobisi , kwaye le miqondiso ibonakala ngokucacileyo kubo bobabini abachaphazelekayo kunye nabahlobo kunye nosapho. Uninzi lwabantu abasebenzisa kakubi izinto baqonda ngokubaluleka kokubaluleka kwezinto ezinobomi babo, kodwa kunzima ukucela uncedo. Ungenza njani, njengomthandayo, ukufikelela kunye nokuxhasa umhlobo wakho okanye ilungu lentsapho?
Uxhomekeke kukuphi ukuxhomekeka kwezinto?
Ukuxhomekeka kwezinto kuxhomekeke ekusebenziseni okuqhubekayo nokugqithiseleyo ngokufumana into, nangona ulwazi oluqhubekayo lokusebenzisa lubangela iingxaki kwiinkalo ezininzi zobomi. Iingxaki ezijongene nabantu abasebenzisa kakubi izinto ezinxulumene neengxaki zobudlelane, iingxaki zomthetho, ukuxhatshazwa kwemali kunye nemiphumo ehambelana nomsebenzi.
Abantu abaninzi bakholelwa ukuba ingxaki evimbela abantu abaxhomekeke kwintlobo ekufuneni uncedo iyayiphika, kodwa umlutha uyazi ukuba i-substance iye yaba yinto ebaluleke kakhulu. Basenokuba nethemba lokufihla ukugula kwabo kwabanye ngenxa yentlukwano ehambelana neengxaki zokusetyenziswa kweziyobisi. Kwaye nangona abantu abaninzi bexhalaba bakholelwa ukuba ukukhubazeka kwabo kuguqulwe xa bekwazi ukufumana umsebenzi, bafumana ukuba abahlobo, abasebenza nabo kunye nosapho baxhalabele ixesha elide ngaphambi kokuba bavume ingxaki.
Ukuqonda ukuLungisa
Qaphela ukuba ukusetyenziswa kakubi kweziyobisi kubonwa njengesifo-i-American Medical Association ilinganiswe kwisithuba esingaphezu kwesiqingatha se-minyaka edlulileyo kwaye ivakalise ukuba ngumlwelwe, kungeyona inkathazo yokuziphatha okanye ubuthathaka obubi.
Uphando ukususela ngelo xesha liye laxhasa imodeli yokusetyenziswa kakubi kweziyobisi kunye nokuxhomekeka njengemiphumo ye-genetics, iimpembelelo ebuntwaneni bokuqala, ubuhlanga kunye nezinye izinto. Nangona uphando alufumananga isizathu esisodwa sokusetyenziswa kakubi ngokweziyobisi okanye ukuxhomekeka, uphando olunzulu lubonisa ukuba abanye abantu basengozini enkulu kunabanye, njengabantu abathile basengozini enkulu yesifo sikashukela okanye umhlaza wekolon.
Ukuba unomdla malunga nokusetyenziswa kakubi kwezidakamizwa ngokwakho okanye ngumhlobo okanye ilungu lentsapho, kukho amanyathelo ambalwa angakunokuthatha ibhola phambili.
Izinyango Zonyango
Kukho iindlela ezahlukeneyo zokonyango ukuxhomekeka kwe-opioid nokusetyenziswa kakubi.
Buprenorphine
Umgca wokuqala wonyango i-ofisi esekelwe kwi-pharmacological okanye unyango olusekelwe kwi-medication kunye ne-buprenorphine, imithi yecalingci ekhusela i-opioid receptors kwingqondo ekuthintela iimpawu zokuyeka ukungahoxisi ngaphandle kokubangela inani elifanayo le-sedation okanye i-euphoria ehlangene ne-opioid agonists.
I-buprenorphine yonyango yolondolozo ilawulwa ngekliniki yokunakekelwa kweprayimari. Olunye uphando olutshanje eBaltimore lufumene ukuba emva kweenyanga ezili-12, iipesenti ezingama-57 zezigulane ezaphathwa kwiinkqubo zokunyamekela eziphambili ziseyonyango. Kule nqela, izigulane zineenqanaba ezingama-67 zeepipi ezi-opioid-negative. Izigulane ezigcinwe kwi-buprenorphine okanye i-methadone aziguquleli kwesinye isiyobisi sokusetyenziswa gadalala: zizonke ziyeza kunyango oluchanekileyo olumiselwe ngumgqirha ofanelekileyo.
I-DEA yaiver iyimfuneko yokumisela i-buprenorphine okanye i-Suboxone (buprenorphine kunye ne-naloxone, ukukhubaza ukujova nokusetyenziswa kakubi). Abantu abathobela unyango banako ukulungisa ubudlelwane, babambe imisebenzi, kwaye basengozini encinane yobundlobongela besitalato, ubundlobongela kunye ne-HIV.
Bafezekisa ukuzinza okubangela ukuba uthathe inxaxheba ngokupheleleyo kwiindlela zokuziphatha kunye nezinye iindlela zokucebisa.
IMethadone
I-Methadone yi-opioid eyenziweyo eyenza iintlungu zentlungu kwi-system ye-nervous kunye nokunciphisa ukunyamezela kunye nokudibanisa kunye ne-heroin kunye neziyobisi ze-opioid. Isebenza ngonyango lokurhoxiswa kwi-opioid kwaye isetyenziswe kunyango oluxhaswa ngamachiza enomsoco opioid. Inokunikezwa nge-injection, kwifom ye-liquide, okanye njenge-tablet okanye i-tablet. Kumele ihanjiswe kwinkqubo eqinisekisiwe ngu-SAMSHA (Ukusetyenziswa kakubi kweMpahla kunye noLawulo lweeNkonzo zezeMpilo yengqondo.) Unyango lweMethadone lunempumelelo xa usetyenziselwa ubuncinci beenyanga ezili-12, nangona izigulane ezininzi zifuna unyango lwexesha elide.
Naltrexone
I-Naltrexone yonyango olongezelelweyo lonyango olusetyenziswa rhoqo kangako ukuxhomekeka kwe-opioid. Ikhusela ngokupheleleyo i-opioid receptors kwaye ngenxa yoko, ukuthobela kungabangela ingxaki kwizigulana ezingakhuselekanga. I-injection yexesha elide, iVivitrol, yindlela yokwenza i-naltrexone eyanciphisa ukuthotyelwa, efuna iilenki zenyanga.
CBT kunye nezinye iindlela zokwelapha
Olunye unyango oluye lwalubonakalisa ubuncwane bodwa okanye luhlangene nolunye uhlobo lwonyango lubandakanya unyango lweendlela zokuziphatha kunye nokunyusa ukunyusa okukhuthaza. Ulwaphulo lokuziphatha kentsapho lunika izicwangciso zokusebenzisa iimpawu ezintsha zokuphucula umgangatho wendawo.
Ulawulo oluPhezulu
Ngamanye amaxesha ukulawulwa kwexesha elifanelekileyo kusetyenziswa xa abantu abanokuxhomekeka kweziyobisi banelungelo lokunyangwa ngumqeshi okanye kwinkqubo yenkundla. Kwindlela yokulawulwa kwemigqaliselo, ukungaphumeleli ukuthobela iziphumo zonyango ekulahlekelweni komsebenzi, ukuvalelwa entolongweni kunye nokulahleka kwedumela. Ulawulo oluqhubekayo lunokubambisana nezikhuthazo ezintle okanye ezikhuthazayo.
Isisombululo seshumi elinambini
Ukuququzelela isishumi elinambini isicwangciso esakhiwe ngokubaluleka ukuba ukubandakanyeka kwiqela elixhasa uxhaso olunjengeNarcotics Unonymous and Alcoholics Unonymous lunokunceda abantu ukuba bazigcine bezinqanda. Nangona kukho ubungqina bokuba le ndlela iphumelele kunyango lokusetyenziswa kakubi kotywala kunye nokuxhomekeka, ubungqina bokusebenza ngempumelelo kubantu abaxhomekeke kwi-opioid akukacaci.
Umlutha okanye utywala unokufumana inzuzo ebusweni obutsha kunye nemisebenzi enokuthi ingabangelwa yimibutho yenkxaso efana ne-NA okanye i-AA. Iintlanganiso zikhululekile kwaye ziyafumaneka jikelele kwihlabathi. Ezi nkqubo zincike ekuvunyelweni kwesifo sengxaki yokusebenzisa izidakamizwa, ukuzinikela kumandla aphezulu, kunye nobudlelwane phakathi koontanga abangenayo.
Uncedo olujoliswe kwiNtsapho
Uphando olupapashwe kwi-Archives General Jikelele lwe-Psychiatry lubonise ukuba xa izigulane zihambelana neenkqubo apho zanikwa ubuncinane ubuncinane beeseshoni zengcali ezintathu ezibhekiswe kuzo kwaye iintsapho ezibalulekileyo, iingxaki zengqondo kunye neengqesho zithuthunyiswe ngamaphesenti angama-30 xa kuthelekiswa naxa zifakwa " "Iinkqubo zonyango.
Unyango lwendawo yokuhlala lukhuthazwa ngabacebisi abaninzi-ngakumbi ukuba intsapho ifuna uncedo lokutyelela isikhungo sonyango lokuhlala kwiingcebiso. Kodwa, kukho ubungqina obuncinane bokuxhasa unyango lwendawo yokuxhomekeka kwe-opioid. Iziphumo zokufunda zilukhuni ukuza, kodwa uphando olushicilelwe ngo-2014 lufumene iipesenti ezingama-29 zezigulane kwiqela elidala elineminyaka eyi-18 ukuya kweyama-24 lalingenanto ngonyaka. Uphononongo olufanayo luye lwaphawula ukuba umonakalo ohambelana neenkqubo zokunyanga zendawo yokuhlala zokuxhomekeka kwe-opioid kwintsholongwane kunye nolutsha olutsha lwaba luninzi lokudlula ixesha emva kokuba unyango xa ukunyamezela kwesigulane kuye kwancipha kakhulu. Ukufundwa kwesinye sezigulane kwiziko lokunyanga elineshumi elinanye eNorway kufumane ukufa okungaphezulu kwama-15.8 kwithuba leveki ezine emva kokushiya isikhungo sonyango esingenasiphelo sempilo. Ababhali beengxelo baphetha ukuba umngcipheko wokufa kwi-opioid overdose ngeli xesha leveki le-4 "kwakunzima kakhulu ukuba amanyathelo okukhusela athatyathwe." Lo mkhuba uyaqhubeka, wenza umngcipheko wokugqithisa ngokwexesha emva kokukhupha umbandela wokwenene.
Ukuphonononga iziphumo
Ngethuba lokunyanga, izifundo ezincedisayo ziya kuqinisekisa ukuba umntu ochaphazelekayo uye wakhula ukusilela kwondlo okanye ezinye izifo ezinxulumene nokusetyenziswa kakubi kweziyobisi. Imbali epheleleyo yonyango iya kubakhokela unyango, njengokuba abantu abaninzi abagxekayo beyinyamekela impilo yabo kunye nokuzinyamekela kuyinkalo ebalulekileyo yonyango oluyimpumelelo. Ngoko, ukuphuculwa kwempilo jikelele kuya kwiziphumo ezinqwenelekayo.
Kwakhona kubalulekile ukuqwalasela imilinganiselo eyongezelelweyo yempembelelo yonyango xa ugqiba ukuba ngaba unyango lusebenza okanye alusebenzi. Nangona ukuzithiba kubonwa kubalulekile, empeleni, kunzima ukufezekisa. Ukunciphisa ubungozi, ukuzinzisa ubudlelwane, nokubuyisela abantu kwimisebenzi evelisayo kunye neyanelisayo kuzo zonke iziphumo ezichanekileyo ezinxulumene neyeza ezincediswa unyango.
Ukwamkela Uncedo
Icandelo elilula kakhulu lokuvavanya utywala kakubi kunokubonakaliswa kweengxaki ezityholweyo. Ukubonisana kunye neengcali zezokwelapha kukuvuma ukungahambi kakuhle. Ukwamkelwa kunokuba nzima kumguli kunye nosapho, kodwa ulwazi olunceda lunokufumaneka luyakhuthaza kakhulu kunoma ubani olwa noxinzelelo lokusebenzisa isicatshulwa esibangela iingxaki kwiindawo ezahlukeneyo zobomi babo.
Izigidi zabantu abaneengxaki zokusetyenziswa kakubi kweziyobisi ziye zanyangwa ngempumelelo kwaye ngoku ziphila ubomi obonwabileyo, kodwa akukho ziqinisekiso kumachiza. Impumelelo iya kuxhomekeka kwimimandla emininzi, kodwa uguquko onokululawula njengelungu lentsapho ukuqaphela ingxaki kunye nokuzimisela ukufumana isisombululo. Umlutha awukho ukuziphatha okusilelayo-kuyisifo esiqhubekayo kwaye esinokubulala.
> Imithombo:
> McLellan AT, Woody GE, uLuborsky L, O'Brien CP, iDruley KA. "Ukunyuka kweNtsebenzo yeZonyango zokuShatshazwa kweziyobisi: Isifundo sokuPhelelwa kweMonde-Ukwelashwa kweMpilo." I-Journal ye-Nervous and Mental Disease. 1983; 171 (10): 597-605.
> I-Nowinski J. I-step-step-facilitation. Ku: Iindlela zokuLawula ukusetyenziswa kakubi kweziyobisi / ed. uKathleen M. Carroll. UBetdada: Isiko seSizwe sokuSetyenziswa kakubi kweziyobisi, (iNIH Publ no-00-4151), ngoJulayi 2000. http://www.drugabuse.gov/ADAC/ADAC1.html
> URavndal E, u-Amundsen EJ. Ukufa phakathi kwabasebenzisi beziyobisi emva kokukhutshwa kwonyango lokugula: unyaka o-8 wokufunda. Ukusetyenziswa kotywala kotywala. 2010; 108: 65-69.
> Volkow, N. D. (2012, Disemba). Isiqalo | ISizwe lesiZwe sokuThatshazwa kweziyobisi (NIDA).
> Webster LR, uWebster R. Ukuqikelela ukuziphatha okuphazamisayo kwizigulane eziphathwe nge-Opioid: ukuqinisekiswa kwangaphambili kwengozi ye-Opioid. I-Med Med. 2005; 6 (6): 4.