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. Author manuscript; available in PMC: 2007 Sep 20.
Published in final edited form as: Soc Sci Med. 2007 Apr 17;64(12):2578–2593. doi: 10.1016/j.socscimed.2007.02.049

Table 1.

Doctor-user patterns of interaction

Dimensions 1 Focused on drug dosage (n=6) 2 Focused on compliance (n=8) 3 Focused on the person (n=10) 4 Focused on drug Prescription (n=4)
Doctor’s function Prescriber only Authoritarian and paternalistic Professional experienced in drug dependence White-coat dealer
Relative positions Utilitarian Dissymmetry (Physician: judge and decision-maker) Participation-contractualisation (supervised autonomy) Manipulation
Place of the prescription Central: physician tends to increase the dose Central: physician tends to reduce the dose Therapeutic tool treatment - dosage negotiated Nearly exclusive topic of physician-user interaction
Misuse and response When they are mentioned, the physician interprets them as a problem of dosage Kept secret because of fear of dosage reduction. Often kept secret by fear they would threaten the physician’s trust Not mentioned
Therapeutic plan Strict drug maintenance, for the physician (divergent plans) Adoption of a linear treatment outline vs. unstable situations (divergent plans) Joint proposal(Therapeutic alliance) No expectations of treatment
Self-image Still a junkie Ex-junkie (Role of good patient) Person in own right Client-customer (Acts the role of the good patient)
Incongruities over time Distancing and rupture:

  • -User becomes progressively more independent in treatment management

  • -Increasing gap between what is said and what is done, which can lead to rupture or manipulation

 Transference and the risk of isolation

  • Difficulties in coping with situations of vulnerability

  • Discrepancy and disappointment

 Dissembling reaches deadlock