This study was a randomized effectiveness trial of the use of incentives to improve treatment retention and post-treatment outcomes among parolees in community treatment. Parolees entering community treatment were randomized to incentives (N = 104) or brief education (N = 98). It was hypothesized that the use of incentives to increase treatment retention would result in improved post-treatment outcomes (i.e., arrest, employment, and drug use), but at 18 months post-intake, there were no group differences for any outcome. In secondary analyses, rearrest by 18 months post-intake was predicted by substance use, greater number or severity of psychological symptoms, treatment non-completion, unemployment, and younger age. Contrary to expectations, results indicated that participants who received incentives for attendance had arrest, employment, and drug use outcomes similar to those who received a brief education session. Our findings, in concert with those of several other researchers, suggest that there may be certain populations or settings where incentives may not be effective.
We use a risk environment framework to qualitatively examine pathways into substance use and abuse among Mexican female sex workers on the U.S.–Mexico border. Life history interviews and ethnographic observations were conducted with female sex workers to uncover how the border context shapes patterns of substance use. The findings illustrate that, for many women, initiation into sex work is contextualized within immigration, the global economy, and demands and desire for financial autonomy. Paradoxically, many find autonomy within sex work as they increase their ability to support their families and themselves. As women become more entrenched in sex work, however, they are put on a path toward substance abuse beginning with alcohol then cocaine and heroin. This identification of specific substance use pathways and trajectories has important implications for the development of prevention and intervention programs that can help curtail problematic drug use that can lead to negative health consequences.
The military is described as a social context that contributes to the (re-)initiation or intensification of cigarette smoking. We draw on data from the 1985-2014 National Survey of Drug Use and Health (NSDUH) and the Wisconsin Longitudinal Study (WLS) to conduct complementary sub-studies of the influence of military service on men’s smoking outcomes across the life course. Descriptive findings from an age–period–cohort analysis of NSDUH data document higher probabilities of current smoking and heavy smoking among veteran men across a broad range of cohorts and at all observed ages. Findings from sibling fixed-effects Poisson models estimated on the WLS data document longer durations of smoking among men who served in the military and no evidence that selection explains the observed relationship. Together, these results provide novel and potentially generalizable evidence that participation in the military in early adulthood exerts a causal influence on smoking across the life course.
This multisite randomized block experiment examines the efficacy of the seamless system of care for probationers (an integrated probation model combined with substance abuse treatment intervention onsite at a probation office). The sample consists of 251 drug-involved probationers randomized into probation with referral to community treatment or the seamless system of care. Key outcomes are examined over a 1-year period by recidivism risk level. When compared with probationers in the control group, the findings are that those in the seamless system of care group had fewer drug use days overall, less alcohol consumption, improved treatment initiation and adherence, but a higher number of days incarcerated. Low-risk seamless system participants had the most favorable outcomes compared with other study conditions. This study demonstrates the importance of tailoring interventions to the risk level of the probationer, and that the seamless system works better for lower risk offenders with substance use disorders.
Relapse to substance abuse is a global problem and is conceptualized as an integral component of the recovery process. Global statistics on rates of relapse after substance abuse treatment are disturbingly high, averaging about 75% within a 3- to 6-month duration after treatment. This study sought to gain full understanding of the factors that precipitate relapse among substance abusers in Ghana. Data were collected through in-depth interviews with 15 relapsed substance abusers who were previously treated for substance abuse, and three mental health professionals at a psychiatric rehabilitation unit in Ghana. Findings showed that seven factors, including positive/negative emotional reinforcements, sense of loss, interpersonal conflicts, peer influence, familial, religio-cultural, and treatment-based issues complot to instigate and maintain the relapse cycle. The findings provide valuable insights into the relapse phenomenon in Ghana. Clinicians should actively engage family members in the relapse prevention process, and provide insight into religio-cultural relapse precipitants.
This study uses data from 564 African American women to examine the correlates of lifetime prevalence of a sexually transmitted infection (STI). Specifically, we test the effects of perceptions about the availability of African American males, five partner characteristics, and drug history. At the bivariate level, women with an STI diagnosis were significantly more likely to have dated a man who was married, older, had sex with another man, involved in concurrent partnerships, and had been incarcerated. About half of the participants stated it was difficult to find an eligible African American male and attributed the limited pool of same-race partners to drug trafficking, a lack of monogamy, and high rates of incarceration. Multivariate analyses revealed having dated a man who had concurrent sexual partnerships or had been incarcerated, as well as drug use during sex were positively associated with ever having an STI. Individual and contextual implications are addressed.
Because high drop-out rates have long plagued drug treatment programs, researchers have spent considerable energy searching for risk factors to predict dropout, with only limited success. In this ethnographic study of a long-term residential treatment program, I argue that failure in residential treatment does not stem from high-risk individual-level characteristics, but from the inherent difficulties of making a turning point in drug treatment. Drug users enter treatment at unstable points in their life course, when they are least equipped to handle stressful experiences. Yet entrance into treatment introduces new stressors, particularly the adaptation to a new, demanding environment. I argue that the very characteristics of residential treatment that enable a drug addict to desist—surveillance, routine activities, rules, and confinement—also make her want to escape. This article elaborates on institutional dilemmas that make treatment difficult and unpredictable, presenting an alternative to the risk factors approach to dropout.
Improper prescribing of controlled substances (IPCS) contributes to opioid addictions and deaths by overdose. Studies conducted to date have largely lacked a theoretical framework and ignored the interaction of individual with environmental factors. We conducted a mixed-method analysis of published reports on 100 cases that occurred in the United States. An average of 17 reports (e.g., from medical boards) per case were coded for 38 dichotomous variables describing the physician, setting, patients, and investigation. A theory on how the case occurred was developed for each case. Explanatory typologies were developed and then validated through hierarchical cluster analysis. Most cases involved physicians who were male (88%), >40 years old (90%), non-board certified (63%), and in small private practices (97%); 54% of cases reported facts about the physician indicative of self-centered personality traits. Three explanatory typologies were validated. Increasing oversight provided by peers and trainees may help prevent improper prescribing of controlled substances.
Little is known about the stigma of anabolic steroid use despite clear implications for treatment-seekers and for public policy development. We investigated the predictors of steroid stigma and contextualized the results by comparing steroids with marijuana. Undergraduates (N = 304) completed measures of drug stigma, exposure to drug users, and history of drug use. Participants stigmatized steroid use more than marijuana use—a very large effect. Participants reported less exposure to steroid users. Nevertheless, 15% of participants reported having a steroid-using friend. History of drug use, but not exposure to steroid users, predicted lower steroid stigma. Drug use and exposure both predicted lower marijuana use stigma. The amount of stigma expressed toward steroids is commensurate with that of "hard" drugs, such as heroin, likely constituting a formidable barrier to treatment. The public’s difficulty empathizing with male body image insecurities may partially explain why exposure to steroid users did not predict lower stigmatization.
American attitudes toward marijuana have varied greatly from the time it was criminalized in the 1930s through the present day, and public opinion favoring the legalization of marijuana has steadily risen since 1990. It is generally well accepted that the media played a large role in shaping not only marijuana laws but also the general public’s attitudes toward marijuana. As such, this study utilized General Social Survey data to examine the relationship between media exposure and attitudes toward the legalization of marijuana from 1975 through 2012, 1975 through 1990, and 1991 through 2012. The findings indicate that while media exposure was not significantly related to attitudes about marijuana legalization from 1975 through 1990, both television and newspaper exposure had a significant positive relationship with favor toward the legalization of marijuana from 1991 through 2012.
The past decade has seen a remarkable liberalization of marijuana policies in many parts of the United States. We analyze data from the National Survey on Drug Use and Health (NSDUH) for coinciding changes in the marijuana market from 2002 to 2013, including market size, number and demographics of customers, and varying means of acquiring the drug. Results suggests that (a) the national market has grown, especially in terms of the number of daily users; (b) marijuana users remained economically "downscale" over this period, and in many ways resemble cigarette users; (c) distribution networks appear to be professionalizing in a sense, as fewer users obtain marijuana socially; (d) the typical purchase has gotten smaller by weight but not price paid, suggestive of a trend toward higher potencies; (e) marijuana expenditures vary by user group; and (f) respondents with medical marijuana recommendations differ from other users in systematic ways.
We tested the assumption that theories of drug use are able to account for behavior across varying contexts and populations by examining whether control, learning, and elaborated theories provide similar explanations for adolescent drug use in adjacent generations. We used data from the Rochester Youth Development Study and Rochester Intergenerational Study which followed a sample of adolescents starting at age 14 and their oldest biological child. Cross-generational analysis between theoretical variables measured at age 14 and drug use measured at approximately ages 15 and 16 were used. Regression models testing for each theoretical framework found that in general, they appear to operate similarly in adjacent generations. We conducted 14 tests of equality for pairs of coefficients across the generations; no statistically significant differences were observed. Overall, these theories offer general explanations for adolescent drug use with respect to risk and protective factors for parents and their children. Theoretical and policy implications are discussed.
The main body of research on addiction and pathological narcissism has focused on the study of their co-occurrence by applying Diagnostic and Statistical Manual of Mental Disorders (DSM) definitions for these clinical phenomena or by assessing trait narcissism in substance-dependent populations. Clinically informed comprehensive conceptualizations of narcissism which focus on its phenomenological range from vulnerability to grandiosity have not been applied in studying the specific narcissistic disturbances that underlie the relationship between these comorbid conditions. Aiming to examine this relationship, this study compared the presence of pathological narcissism, and more specifically narcissistic grandiosity and vulnerability, in substance-dependent individuals in treatment with individuals from the general population. Comparisons indicate that substance-dependent individuals experience significant narcissistic disturbances more likely related to vulnerability than grandiosity. Shame, rage, and self-esteem contingent upon external validation comprise the intrapsychic and interpersonal vulnerability. Implications for the clinical conceptualization of pathological narcissism as well as for substance dependence treatment interventions are discussed.
This investigation assessed whether alcohol consumption was negatively related to grade point average (GPA) among a nationally representative sample of college students. Items from the American College Health Association’s National College Health Assessment (N = 22,424) were investigated. One-way ANOVAs and logistic regression analyses were conducted. Results revealed that respondents with lower GPAs consumed a greater number of drinks compared with those with higher GPAs. Students with higher GPAs engaged in heavy episodic drinking less than students with lower GPAs. Number of drinks consumed was the strongest predictor of academic performance; the likelihood of being an A student decreased with each drink consumed. Similarly, binge drinking was the strongest predictor; the likelihood of being an A student decreased as binge drinking increased. The dynamic, interdependent relationship between alcohol and GPA documented herein confirms previous research, which delineates reduced academic performance as a function of alcohol consumption.
Religiosity tends to negatively influence substance use among emerging adults because religious communities can serve as pro-social reference groups and provide alternative resources for coping with stress and negative life events. The relationship may also be mediated, however, by differences in family attachments and drug- and alcohol-using peer associations. With data from a nationally representative panel study, I implemented longitudinal structural equation modeling to simultaneously assess both direct and indirect effects of religiosity on substance use. While a substantive portion of its effect is mediated by substance-using peers, it is mostly direct, and increasingly so as individuals transition from late adolescence to emerging adulthood. Furthermore, religion appears to be a particularly effective social institution, as religiosity decreases contemporary substance use but is not itself affected by prior substance use. Religiosity may thus be beneficial with regard to certain short- and long-term health outcomes related to substance use during emerging adulthood.
What are the determinants of public support for marijuana legalization? In the last 3 years, Uruguay and the states of Colorado and Washington have legalized the production, sale, and consumption of recreational marijuana. Although Uruguay and the United States have followed different paths toward legalization, these cases provide an excellent opportunity to explore the relationship between drug policy implementation and public opinion in different political contexts. Using logistic regressions on data from the 2014 AmericasBarometer cross-national surveys conducted in Uruguay, the United States, and El Salvador, this article examines citizen views toward marijuana regulation and the individual determinants of support for legalization in a comparative fashion. Results underline the role of political socialization variables in those countries in which legalization is being debated. Across countries, some of the most important factors for predicting positive attitudes toward marijuana regulation are related to political tolerance, ideology, and the views toward the government.
When drug-using and lawbreaking women are mothers, their competence as mothers is often questioned because good mothers are not supposed to do such things. Consequently, they are often labeled as unfit mothers. This qualitative study seeks to examine the experience of motherhood in substance-using and lawbreaking mothers. Interviews with 38 substance-using women who had broken the law were conducted. Women in our study embrace two models of motherhood: one is an idealized view of motherhood as worthwhile, gratifying, and true to social expectations, and the other a model of the "deviant good mother," which conforms more closely to their deviant lifestyle. Both of these models influence the way that these mothers perceive their substance use, their criminal behavior, and the possibility of being a good mother. The "deviant good mother" model also allowed them to build (or rebuild) a positive and fulfilling maternal identity.
Patterns of flows of cocaine across the United States are identified using open-source price data. The data set consists of wholesale prices for powdered cocaine for 112 U.S. cities published biannually by the National Drug Intelligence Center (NDIC) between 2002 and 2011. For each of the 6,126 possible unique pairs of cities in the sample, cocaine is inferred to flow from the city with the lower price to the city with the higher price if the prices in the two cities show a correlation that exceeds a threshold value. This threshold value is calibrated using data on anecdotal city-to-city flows published by the U.S. Department of Justice. The results show a striking pattern of cocaine flows from the south and west of the United States to the north and east. A cluster analysis of cities based on inward and outward links is used to classify each city as a "source," "destination," "transit," or "isolate."
This study investigates the potential stages of drug use. Data from the longitudinal Cohort Study on Substance Use Risk Factors were used (N = 5,116). Drug use (alcohol, tobacco, and 16 illicit drugs) over the previous 12 months was assessed at two time points. Patterns and trajectories of drug use were studied using latent transition analysis (LTA). This study’s substantive contributions are twofold. First, the pattern of drug use displayed the well-known sequence of drug involvement (licit drugs to cannabis to other illicit drugs), but with an added distinction between two kinds of illicit drugs ("middle-stage" drugs: uppers, hallucinogens, inhaled drugs; and "final-stage" drugs: heroin, ketamine, GHB/GBL, research chemicals, crystal meth, and spice). Second, subgroup membership was stable over time, as the most likely transition was remaining in the same latent class.
Research on drug use often fails to account for drug dealing in most analyses of violence and other systemic risks associated with illegal drugs. The current study examined whether drug dealing, independent of its connection to drug use, increases involvement with delinquent peers, violence, weapons, and other drug-related conflicts. Data were drawn from the first two waves of the Toledo Adolescent Relationships Study (N = 1,148). Hierarchical linear models were used to investigate changes in these behaviors that resulted from the respondents’ involvement in drug dealing and drug use. Results indicate that involvement in drug dealing, controlling for drug use, increases violence and other systemic risks to a level that drug use alone is not likely to achieve. Findings also show, however, that drug use among dealers may reduce violence and limit contact with delinquent peers.
General strain theory (GST) hypothesizes that youth are more likely to engage in delinquency when they experience vicarious victimization, defined as knowing about or witnessing violence perpetrated against others, but that this relationship may be attenuated for those who receive social support from significant others. Based on prospective data from youth aged 8 to 17 participating in the Project on Human Development in Chicago Neighborhoods (PHDCN), this article found mixed support for these hypotheses. Controlling for prior involvement in delinquency, as well as other risk and protective factors, adolescents who reported more vicarious victimization had an increased likelihood of alcohol use in the short term, but not the long term, and victimization was not related to tobacco or marijuana use. Peer support did not moderate the relationship between vicarious victimization and substance use, but family support did. In contrast to strain theory’s predictions, the relationship between vicarious victimization and substance use was stronger for those who had higher compared with lower levels of family support. Implications of these findings for strain theory and future research are discussed.
To examine access to needed resources among low-income methamphetamine-using females, we conducted interviews with 30 women living in poor suburban communities of a large southeastern metropolis. As an invisible population in the suburbs, underserved by social services, the women remain geographically and socially anchored to their poor suburban enclaves as transit, treatment, and education remain out of reach. The longitudinal study included three interviews over a two-year period. Resources needed by the women were identified in the first interview and a list of available services was provided to them. In subsequent interviews, we asked how they accessed the services or barriers encountered and discussed these further in focus groups. Using a social capital framework in our qualitative analysis, we identified three processes for accessing needed resources: formal, informal, and mediated. Implications for policymakers and social service providers are suggested, and models for future development proposed.
The current study examined whether attitudes toward the acceptability and stigma of medical marijuana are affected by its method of administration and the severity of illness being treated. Participants (200 men, 409 women, 2 omitted) were assigned to experimental conditions differing according to illness severity, and rated the acceptability, stigma, legal concerns, and willingness to use medical marijuana administered through 10 different administration methods. Marijuana administered in ways resembling traditional medication (e.g., pills) was judged the most acceptable, and had the least stigma. Conversely, marijuana administered in ways resembling recreational use (e.g., cigarettes/joints) received high stigma and low acceptability ratings. Stigma and legal concerns were lower, and acceptability was higher when treating more serious conditions. Results are discussed in terms of why an understanding of the social connotations accompanying different administration methods and reasons for marijuana use is an important complement to understanding pharmacokinetics and drug efficacy.
The link between drug use and crime has been broadly described, but little detail is known about the contributions of alcohol and drug dependence to different types of offending. Data were drawn from the 2010 Arrestee Drug Abuse Monitoring II (ADAM II) program to examine the relationships between dependence, offense type, and severity among recent male arrestees (N = 3,006). A substantial proportion (ranging from 15% to 39%) of arrestees across all offense types and severity levels endorsed drug-dependent items. Smaller proportions (between 5% and 16%) of arrestees endorsed alcohol-dependent items. Drug dependence was associated with higher odds of receiving felony charges and higher probability of being charged with a substance-related offense. Alcohol dependence was associated with lower odds of felony charges, but greater probability of being charged with a violent offense. Assessment and treatment provisions need to be systematically implemented to reduce these types of offenses.
The purpose of this study was to document the prevalence of Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) among urban and rural methadone maintenance treatment (MMT) patients and to examine differences in knowledge of HIV and HCV among this population. We compared 147 MMT patients attending urban versus rural clinics in Kunming, Yunnan, China, concerning their serostatus and knowledge of HIV and HCV. The rates of HIV and HCV seropositive status were higher among rural patients. Both urban and rural patients showed limited HIV and HCV knowledge. Recent opioid injection and geographic area were strong predictors of HIV and HCV serostatus. The lack of knowledge of HIV and HCV among both urban and rural MMT patients suggests the need to strengthen current HIV and HCV education programs in MMT clinics. In addition, prevention programs should take into consideration geographic characteristics of the target population.
Development of a profile of those who drink and drive is needed to more effectively deter this behavior. Using data from the 2001 NSDDAB (National Survey of Drinking and Driving Attitudes and Behavior), Bertelli and Richardson found that the existence of DUI (driving under the influence) statutes impacts only those least likely to drink and drive, while concern for the likelihood of arrest and individual agreement with the goals of drinking and driving laws significantly reduces propensity for almost everyone except the "extreme ‘hard core’ drinking drivers." Using the same NSDDAB items, this study examined propensity to drink and drive for a sample of 58 offenders in a local DUI Court program. A majority of these known DUI offenders were problem drinkers. Results show that DUI offenders were not deterred by DUI statutes and perceptions of DUI law enforcement. Implications for deterrence theory and the legal legitimacy hypothesis are discussed.
In this study, we assess an alternative strategy for health interventions, namely, two-sided messages. A 3 x 2 between-subjects factorial experimental design investigates the effect of three different anti-binge drinking messages (i.e., one-sided, two-sided non-refutational, and two-sided refutational) on strongly and weakly issue-involved adolescents’ binge drinking intentions after exposure to peer pressure. A sample of 185 adolescents between the age of 15 and 19 participated in the experiment. The results show that when adolescents’ involvement with binge drinking is strong, a two-sided refutational as well as non-refutational message result in lower binge drinking intentions than a one-sided message. When adolescents’ involvement with binge drinking is weak, binge drinking intentions are not influenced by message sidedness.
In this article, we present findings from a qualitative National Institute on Drug Abuse-funded study of nonmedical prescription drug users in the San Francisco Bay Area. We interviewed young adults between the ages of 18 and 25 years, who used prescription drugs nonmedically at least 12 times in the 6 months prior to the interview. Employing Aker’s Social Learning Theory and Zinberg’s Drug, Set, and Setting, we explore the factors that contributed to participants’ choices to begin using prescription drugs nonmedically. Social Learning Theory provides the framework for understanding how deviant behaviors are learned and imitated, while set and setting emphasizes the psychological and social contexts of initiation and the ways in which the set and setting of the initiating user were influenced by exposure, motivation, access, and setting. Together, social learning, and set and setting allow us to understand the interaction of individual and social factors contributing to nonmedical prescription drug use initiation.
Restrictive deterrence is the process whereby offenders limit the frequency, magnitude, or seriousness of their offenses to avoid pain. Prior research on drug dealing and restrictive deterrence largely focuses on the effect of formal control, or political sanction. Bentham, however, suggests there are four other types of sanction that may deter offenses: moral, sympathetic, religious, and physical. This paper explores whether and how each sanction type restricts drug sales among a sample of 29 young, suburban, middle-class drug sellers. We conclude by discussing the usefulness of studying interconnections between the sanctions and by outlining the reasons to choose Bentham’s sanction typology in future work.
It is plausible that features of the social environment combined with experiences of discrimination may help further explain experiences of depression among illicit drug users. We examined the influence of census tract-level characteristics and multiple forms of individual-level discrimination on lifetime depression among illicit drug users in New York City enrolled in the "Social Ties Associated With Risk of Transition" study. Population average models accounted for clustering of individuals within census tracts. Discrimination based on prior incarceration explained Hispanic/White differences in depression and was independently associated with depression after accounting for neighborhood characteristics. Neighborhood poverty was only marginally related to lifetime depression. These data provide evidence supporting the influence of discrimination on depression among drug users. Research is needed to confirm these findings and highlight specific mechanisms through which discrimination and neighborhood socioeconomic status may operate to influence mental health.
Because of the lack of any in-depth research on the workings of the cocaine industry in the processing regions and on social changes of the drug trade, scholarly writings on the cocaine industry are full of assumptions and speculation. This article, on the contrary, tries to capture how the illegal cocaine industry and its related violence became integrated into the daily lives of the local residents of the Upper Huallaga, one of Peru’s largest cocaine enclaves. It is argued that for those drug smugglers lower on the economic scale, involvement in an illegal industry involves an ongoing sense of economic and physical vulnerability. Moreover, it is described that higher echelons involved lived under a constant threat of violence.
Decision making in the face of risk from law enforcement is considered from the perspective provided by theoretical models of interdependent decisions of potential drug smugglers regarding entry and the use of violence following entry. Implications of three different models of decision making under risk are examined: expected value, expected utility, and prospect theory. The theoretical results help explain many observed characteristics of drug-smuggling operations and allow clarification of some implications drawn from studies of smuggling behavior that were not considered in the context of such models.
The United States recently focused on the methamphetamine "epidemic," but little research has examined policies resulting from this increased attention. This study explores influences of state-level methamphetamine legislation during 2000-2007, with the goals of understanding themes of legislative responses, and assessing political, social, and media-related predictors on legislation. Nine themes of methamphetamine legislation were identified through a legal database: pharmacy precursor regulations, precursor sentencing, manufacturing/trafficking, possession, research/task force, prevention or treatment, law enforcement, environmental cleanup, and child protection. Logistic regression results largely support the moral panic literature by finding media’s influence and methamphetamine manufacturing on legislation. Findings also suggest that law enforcement agencies participate in constructing the drug problem, which then drives legislation. Moreover, the drug problem is defined in terms of methamphetamine manufacturing rather than use and treatment, which are largely nonsignificant. Surprisingly, conservative political ideology predicted decreased legislation, suggesting that liberal candidates also raise concerns over methamphetamine.
Nonprescription stimulant use is a high-risk behavior prevalent in the college population. To date, research on this substance use behavior lacks a comprehensive theoretical lens as well as geographical diversity. Guided by the Theory of Triadic Influence (TTI), multilevel (i.e., students within schools) modeling was used to analyze survey data from the Spring 2009 American College Health Association–National College Health Assessment II. We hypothesized that the behavior would be associated with ultimate underlying causes, distal predisposing influences, proximal immediate predictors, and immediate precursors found in the TTI’s three streams of influence (i.e., intrapersonal, social situation/context, and sociocultural environment). In our sample (N = 10,220 students; 18 schools), the mean prevalence of past-year use of prescription stimulants without a prescription was 10.70% (range across schools, 0.33%-20.04%). Our hypothesis regarding the multifaceted nature of the predictors of the behavior was supported. Implications for prevention efforts, limitations, and future research directions are discussed.
A parallel-process latent growth curve model was used to model alcohol and marijuana use (vs. nonuse). Participation in team sports and gender were considered to be time-invariant covariates. The sample consisted of 8,179 youth from the National Survey of Parents and Youth. Data were collected over four yearly rounds. Analysis revealed that being part of a competitive sports team was related to a lower probability of marijuana initiation, but to increased rates of alcohol use over time. Males had significantly higher levels of marijuana initiation and decreases in rates of alcohol use over time; females had significantly greater rate of increase in alcohol use over time. Analysis suggests that youth involved in sports are less likely to use marijuana over time. This information may help to uncover other predictors of use over time and to inform policy making as well design as effective prevention.
Nonmedical use of prescription drugs has become the fastest growing drug problem in the United States, particularly among young adults. This study examines the reasons young polydrug users misuse prescription drugs, and explores how young users employ risk reduction strategies to minimize adverse consequences. The sample was recruited during 2008 and 2009 in Los Angeles and New York, and comprised 45 nonmedical users of prescription drugs, aged 16 to 25. Data from a semistructured interview were analyzed quantitatively and qualitatively. Participants reported nonmedical use of prescription drugs to change mood, to facilitate activity, and to monitor the intake of other substances. Commonly employed risk reduction strategies included calculating pill timing, dosage, and access, and monitoring frequency of use, particularly when combining different substances. Most study participants often planned drug use to occur within socially acceptable parameters, such that prescription drug misuse was a normalized feature of their everyday lives.
Little is known about detoxification (detox) history as a risk factor for poor treatment outcomes among dually diagnosed (substance use and other mental health disorders) patients. We compared patients with a detox history with those who had never received detox on baseline characteristics, subsequent treatment and mutual-help group participation, and substance use and related outcomes at 6-month, 1-year, and 2-year follow-ups. Having a detox history was associated with poorer status at treatment intake, but detoxed patients were functioning as well as never-detoxed patients on alcohol and drug use severity 2 years later. However, having a detox history at baseline was associated with poorer psychological and legal functioning at follow-ups. Assessing detox history in mental health programs would be feasible to implement routinely. Targeting more comprehensive mental health, case management, and 12-step facilitation services to dually diagnosed patients with a history of detox may improve mental health and criminal involvement status.
To assess key characteristics of the retail crack market and the role of users as buyers and sellers, data from a survey inside and outside institutional setting among 1,039 crack users in the three largest Dutch cities were analyzed to explore their role in the crack market as buyers and sellers. Of the total number of users, 42.3% bought crack in public places, 39.6% through home delivery, and 13.9% at dealer’s addresses. Near one-third reported participating in selling drugs, defining themselves as "go-betweens" (21.4%) or "dealers" (9.2%). User-sellers and nonselling users did not differ with regard to gender and ethnicity. Cluster analysis resulted in three distinct types of user-sellers (freelancers, assistants, and amateurs), each characterized by time spent selling drugs, type of drugs sold, and earnings. Amateurs seem quite similar to what scholars have labeled "social dealers" in recreational drugs markets. This study suggests the need for a more differentiated law enforcement policy toward drug-selling users.
There is substantial literature on the patterns and correlates of substance use across minority youth populations, but comparatively little attention has been directed to substance use among adults. This is particularly the case for adult American Indians, generally due to sampling challenges. This article provides multivariate analyses of the correlates of substance use across five racial/ethnic groups and highlights analyses focused on American Indian adults. In addition to marijuana use and binge drinking, our analyses consider hard drug use, which remains understudied in the literature, and include a first consideration of "bender drinking," a form of alcohol consumption that is most likely to lead to health, social, and legal problems. Our results indicate that although American Indians report higher levels of substance use and abuse than do those from other racial/ethnic groups, these differences are attenuated when sociodemographic and individual-level/risk protective factors are taken into account.
This study describes the extent to which methamphetamine users perceive that their methamphetamine use has resulted in violent behavior, and describes the level of self-reported prevalence of specific violent criminal behaviors irrespective of methamphetamine use. Predictors of these two violence-related indicators, in terms of potential correlates from substance use history, criminal history, and health risk domains, are examined. Data were collected from extensive interviews of 350 methamphetamine users who received substance use treatment in a large California county. A majority (56%) perceived that their methamphetamine use resulted in violent behavior; 59% reported specific violent criminal behaviors. For more than half of those reporting violent criminal behavior, this behavior pattern began before methamphetamine initiation. Thus, for a subsample of methamphetamine users, violence may be related to factors other than methamphetamine use. Users’ perceptions that their methamphetamine use resulted in violence appears strongest for those with the most severe methamphetamine-related problems, particularly paranoia.
The problem of adolescent drug use places a huge toll on society and a heavy burden on the criminal justice system. Despite the ability of therapeutic communities (TCs) to lower drug relapse, a great deal remains unknown in terms of how the process of treatment actually works for adolescents. Using data collected as part of the Drug Abuse Treatment Outcomes Studies–Adolescents, this study examines the direct and indirect relationship between therapeutic engagement and posttreatment substance use. Though there are few direct effects of therapeutic engagement on substance use, findings suggest that those more engaged in treatment are more likely to complete treatment and, therefore, less likely to use substances. This suggests that instruments that evaluate therapeutic engagement are important in assessing involvement in treatment, and that programming designed to engage the adolescents in TC treatment should be utilized to reduce the risk of posttreatment relapse.
This study qualitatively examines the religious and spiritual dimensions of cutting down and stopping cocaine use among African Americans in rural and urban areas of Arkansas. The analyses compare and contrast the narrative data of 28 current cocaine users living in communities where the Black church plays a fundamental role in the social and cultural lives of many African Americans, highlighting the ways that participants used religious symbols, idiomatic expression, and Biblical scriptures to interpret and make sense of their substance-use experiences. Participants drew on diverse religious and spiritual beliefs and practices, including participation in organized religion, reliance on a personal relationship with God, and God’s will to cut down and stop cocaine use. Our findings suggest that culturally sensitive interventions addressing the influence of religion and spirituality in substance use are needed to reduce cocaine use and promote recovery in this at-risk, minority population.
Few analyses of basic elements of the synthetic drug market have been conducted, particularly in regard to its structural features. Synthetic drug’s relatively recent classification as an illicit substance, coupled with its distinct clandestine characteristics, has hindered the development of reliable assessments of the market’s structural features. Using information derived from 365 seized synthetic drugs, this study aims to reliably examine the structural attributes of Quebec’s synthetic drug market by merging two approaches: drug composition and economic analysis. Findings for the drug composition analysis indicate that the market is composed of a high number of small structures, indicating a competitive and decentralized market. Providing complementary information, the economic analysis revealed that differential production costs and relations between traffickers influence price variations, depending on the region. These results emphasize the need to design policies that account for regional differences as well as reflect the competitive nature of the market.
This secondary analysis compared outcomes in African American adults newly admitted to buprenorphine treatment and who were on parole and probation with outcomes in patients who were not under criminal justice (CJ) supervision. Buprenorphine patients (N = 300) were randomly assigned to receive either intensive outpatient (IOP) treatment or standard outpatient (OP) treatment and were assessed at baseline, and 3 and 6 months. There were no differences between groups in treatment retention. Among probationers/parolees, IOP treatment was associated with lower 3-month treatment retention compared with OP treatment, but among participants not on probation/parole, the relationship was reversed (p = .004). Both conditions showed significant declines in heroin and cocaine use, illegal activity, and in meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria for opioid and cocaine dependence. Probationers/parolees reported a lower frequency of illegal activities at 3 months compared with nonprobationers/nonparolees (p = .007). Buprenorphine treatment should be made more widely available to individuals on parole/probation as they respond as well to treatment as patients not supervised by the CJ system.
It has been suggested that self-forgiveness plays an important role in the process of recovery from addiction, especially for women, but this issue has been largely overlooked in the research. This study explored self-forgiveness from the perspective of 25 recovering drug-addicted mothers associated with the same therapeutic community, either as current residents in the course of recovery or as past residents who maintained recovery. The participants were interviewed in a dual-research design (35 interviews) that enabled comparative-longitudinal examination of the self-forgiveness process. Qualitative methods were used to identify the emotional, cognitive, and offense-related factors associated with self-forgiveness regarding mothering patterns during addiction. The results indicated that self-forgiveness involves cognitive flexibility by using the disease model, creating new constructions of motherhood, and changing mothering patterns. Furthermore, self-forgiveness is accompanied by diminishment of guilt and enables construction of a new shame-free identity. The findings may inform self-forgiveness interventions in the addiction field.
Research on substance use, health-, and risk-seeking behavior has focused on various control mechanisms, which are either embedded in the person (self-control) or in the social environment (social control), that prevent individuals from engaging in unhealthy behavior. The present article examines the role of both types of control with respect to alcohol consumption. Whereas most previous research into the interdependence of the two control types has focused on indirect concepts of social control, the present study targets direct social control exerted through social interaction with network persons. The study’s findings indicate that both control types have a mutually independent influence as well as an interdependent influence on drinking behavior. The results show that the effect of one control instance is attenuated when the control level of the other instance is high. The results are discussed with respect to the life-course interdependence model, the cumulative control model, and action-theoretical perspectives of health-related social interventions.
Seeking to fill a substantial gap in analytical infrastructure, this article lays out a summary of a newly developed framework for systematically assessing the harms of criminal activities and presents findings from an initial application to cocaine trafficking in Belgium. The application is based on a substantial data collection, which included an analysis of records in the Organized Crime Database of the Belgian Federal Police, 52 criminal proceedings, and interviews with 18 experts, and 12 convicted traffickers. First, we construct a business model for cocaine trafficking in Belgium to characterize the key operational phases and "accompanying" and "enabled" activities. On this basis, we identify the possible harms associated with cocaine trafficking and related activities, evaluate the severity and incidence of those harms, prioritize the harms, and establish their causality. The application demonstrates the merits of the approach and the conceptual and technical challenges confronting it.
This study works at the intersection of the social construction of drug problems and the social construction of numbers. While others have looked at how the media use numbers and other discursive resources to construct drug problems, this study looks at how researchers select a few numbers from large studies to present to the media in press releases. It focuses on Monitoring the Future, an annual study of drug use among American teens. It examines specifically the choices the principal investigators of the study made about what numbers to publicize during the Crack Scare of late 1985 and 1986, a time when the media were intensely interested in numbers documenting a purported vast increase in cocaine use. It then compares these choices with those the researchers made at other times between 1978 and 2011. Comparisons over time allow us to determine whether the choices about what numbers to publicize in the mid-1980s were unique to that time (and hence reflected the immediate political context) or were similar to choices made at other times as well (and hence reflected routine practices).
This article reports on an empirical study into a group of drug dealers supplying cannabis, ecstasy, cocaine, ketamine, and other drugs in and around a small English city. It reveals a market that is not overly structured or hierarchically controlled, and certainly not dominated by organized crime or characterized by violence. Dealers involved had often drifted into "real" dealing from backgrounds in "social supply." However, despite an increase of their dealing activity (and of their profits), they still maintained the "social supply" values of friendship and trust as the key elements to relationships with suppliers and customers. Escalation of drug dealing did not seem to be accompanied by any wider escalation in criminality or involvement with organized crime.