Drug users' lay consultation processes: symptom identification and management

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Abstract
We present findings from a National Institute on Drug Abuse funded study of drug use and health care. Our data indicate that stigmatization of illicit drug-users in health care settings and health care providers' diagnostic focus on the contributions of drug use to their illnesses delays treatment, lengthens hospitalizations, and increases health care costs. Our findings show that, not unlike their conventional counterparts, drug users consult their peers for advice, self-treatment, referrals to services, or simply to obtain non-judgmental counsel prior to or in lieu of seeking formal care. Such lay consultation processes influence symptom recognition, attribution, and management as well as the process of formal care seeking and its timing. Discussions with drug-using peers shape perceptions of potential problematic health care interactions. In this regard, interviewees and their lay consultants believe that to be labeled as a drug user, either through self-admission or medical diagnosis, compromises the care they receive. We conclude our chapter by discussing appropriate strategies to improve the quality of care and lower the health care costs of treating drug-using patients. Such interventions include acknowledging and supporting existing lay consultation processes, disseminating better health care information through and within drug users' networks, and encouraging health care providers to conduct more holistic evaluations of drug users' health and illnesses.

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