Adolescent immigrant generation and stigmatizing attitudes toward drug addiction

This study examined differences in stigmatizing attitudes toward individuals addicted to drugs among three immigrant generations of youth, and the role of adolescent drug use and friends’ drug use on the association. Data were derived from the 2005 cycle of the Ontario Student Drug Use Survey administered to students in grades 7–12 in the province of Ontario, Canada. A sample of 4078 students completed questionnaires that included a measure of stigma toward drug addiction. Results indicated some immigrant generational differences in negative attitudes toward individuals addicted to drugs, but much of this difference was explained by adolescents’ individual drug use and friendships with individuals who use drugs. The difference between second-generation immigrant youth and their third- and later-generation counterparts was not fully explained. This study highlights the need for greater research on adolescent stigma toward drug addiction given that stigma may reduce drug usage but also may reduce help-seeking among individuals with an addiction.     

Drug use behaviors among Asian drug users in San Francisco

Due to a pervasive bias toward Asian Americans, such as tendency to view Asian Americans as model minorities, drug use behaviors among them are often ignored by health professionals, researchers, and community members, including Asian community members. This study identified patterns of drug use behaviors in relation to cultural factors among Asian drug users in San Francisco, CA. A sample of 92 Asian drug users (35 Chinese, 31 Filipino, 26 Vietnamese) who were not currently enrolled in drug treatment programs were recruited through targeted sampling methods and interviewed using a questionnaire with open-ended questions. The study evaluated responses of the participants and used content analyses. This study clearly revealed that the patterns of drug use among Asian drug users are unique to their ethnicity, gender, immigrant status, and age groups. Also, Asian drug users share cultural constructs related to drug use such as fear of addiction and injecting drugs, and stigma attached to drug users in the community. Therefore, drug abuse prevention programs should address both common factors among Asian drug users, as well as unique factors in specific target groups (e.g., ethnic groups, Asian immigrants, Asian women, refugees, and adolescents).     

Perceived public stigma and stigmatization in explaining lifetime illicit drug use among emerging adults

Illicit drug use is often associated with adverse health and legal consequences, as well as stigma, or social disapproval. Stigma may be enacted as a preventive measure against drug use; however, research was needed to investigate its effects on use in an empirical manner. This cross-sectional study surveyed 1021 emerging adults (age 18–25) throughout Manhattan, New York. We investigated how two forms of stigma – perceived public stigma and personal stigmatization – along with religiosity and exposure to users, explained lifetime use of five drugs: marijuana, powder cocaine, ecstasy, and non-medical use of opioids and amphetamine. Odds ratios for lifetime use of each drug were estimated using age-adjusted stepwise logistic regression models. Results suggest that high levels of exposure to users increased the odds of lifetime use of each drug, and protective effects of religiosity and racial minority status often diminished when controlling for stigma. High levels of stigmatization toward users tended to decrease the odds of use, and perceived public stigma toward users did not explain use of any drug. In conclusion, although individuals who stigmatize users are protected from use, the perception of public stigma does not appear to be valuable in preventing use. Since stigma is associated with adverse psychological and social consequences in users, the efficacy of stigma as a public health tool against drug use is questionable. Public health efforts can deglamorize and discourage use while aiming to reduce stigma toward users by treating use as a health behavior and not a deviant or moral behavior.     

System-level effects of integrating a promising treatment into juvenile drug courts

This study examined the system-level effects of implementing a promising treatment for adolescent substance abuse in juvenile drug courts (JDCs). Six JDCs were randomized to receive training in the experimental intervention (contingency management-family engagement [CM-FAM]) or to continue their usual services (US). Participants were 104 families served by the courts, 51 therapists, and 74 JDC stakeholders (e.g., judges, prosecutors, defense attorneys). Assessments included repeated measurements of CM-FAM implementation by therapists and therapist and stakeholder perceptions of incentive-based interventions and organizational characteristics. Results revealed greater use of CM and family engagement techniques among CM-FAM relative to US therapists. In addition, therapists and stakeholders in the CM-FAM condition reported more favorable attitudes toward the use of incentives and greater improvement on several domains of organizational functioning relative to US counterparts. Taken together, these findings suggest that JDC professionals are amenable to the adoption and implementation of a treatment model that holds promise for improving youth outcomes.     

Transition to and from injecting drug use among regular ecstasy users

There is a scant amount of research investigating injecting drug use among people not selected on the basis of their injecting behaviour, and less attention has been given to stimulant users who may have a different experience with injecting drug use than opioid users who are more commonly studied. The current study aimed to investigate initiation to, and transition from, injecting drug use among a sentinel sample of regular ecstasy users in Australia. Participants were regular ecstasy users recruited across Australia in 2007 who were administered a structured interview that contained questions regarding initiation to injecting, reasons for injecting cessation, and likelihood of future injecting. Among those with a history of injecting drug use, injecting first occurred at a similar age to that of first ecstasy use. The majority did not inject themselves at the first occasion, and two-fifths were under the influence of other drugs at the time. Two-fifths of injectors had not injected in the past 6 months, with many relating this to concerns surrounding stigma. Route of drug administration is clearly not static, and the findings from this study suggest that some who have ceased injecting may still be at risk for future injecting.     

Stigma towards people who use drugs: A case vignette study in methadone maintenance treatment clinics in China

BackgroundDrug use stigma among service providers has been recognized as a barrier to improving the accessibility and outcomes of addiction treatment. This study examined the stigmatizing attitudes towards people who use drugs (PWUD) among service providers in methadone maintenance treatment (MMT) clinics in China and its associated factors.MethodsThe cross-sectional study used the baseline data of a randomized intervention trial conducted in China, and the data were collected from January 2012 to August 2013. A total of 418 MMT service providers were included in the study. Stigma towards PWUD was measured via a 10-item scale embedded in two case vignettes (PWUD and non-PWUD). The Wilcoxon signed-rank test was performed to evaluate the vignette difference for each item of the scale. The linear mixed model was used to identify the adjusted association between drug use stigma and other interested variables including demographics, professional background, and MMT knowledge of the service providers.ResultsThe Wilcoxon signed-rank tests showed that the participants had a higher level of stigmatizing attitudes towards PWUD than non-PWUD (p-value<0.001 for all items of the stigma scale). The linear mixed model identified that the reception of national MMT training was associated with a lower degree of drug use stigma (estimate=−1.79; 95% CI: −3.13, −0.45; p-value = 0.009).ConclusionThe findings of the study provide evidence of the existence of drug use stigma among MMT providers in China. The expansion of national-level training and the development of stigma reduction interventions are needed to address this issue.     

The Prevalence of Sexual Abuse and Its Impact on the Onset of Drug Use Among Adolescents in Therapeutic Community Drug Treatment

ABSTRACT

Assessing the prevalence of sexual abuse among adolescents is problematic because they are generally reluctant to disclose abusive experiences. Often the abuse is ongoing and may involve family members with whom the adolescent lives or with whom there may be strong emotional attachments. Statistics based on self-reports of childhood victimization suggest that issues of childhood abuse are critical factors in the initiation of drug use. The current study describes the prevalence of sexual abuse among a sample of 938 adolescents admitted to residential therapeutic communities for the treatment of substance abuse and related disorders. The data indicate that approximately one-third of the sample reported histories of sexual abuse. Prevalence rates were significantly higher for girls than boys (64% vs. 24%). A history of sexual abuse correlates with several social, behavioral, and psychological characteristics of clients at entry to treatment, including greater drug use, more severe psychopathology, family drug use and more deviant peer associations. Cox regression analyses show that a history of sexual abuse is related to earlier onset of alcohol and illicit drug use. One explanation of the findings is the self-medication hypothesis (Cavailo & Schiff, 1989) which states that drug use functions to ameliorate feelings of depression, and poor self-esteem which often accompany childhood abuse.     

Substance Abuse and Dependence Among Low Income African Americans: Using Data from the National Survey on Drug Use & Health to Demystify Assumptions

ABSTRACT

The media has portrayed African Americans as drug users and criminals. The purpose of this study is to test the assumption that low-income African Americans use more alcohol, nicotine, marijuana, and illicit drugs than other racial groups using data from the 2005 National Survey on Drug Use and Health to compare drug abuse and dependence across low income racial groups (N = 20,172). Most respondents were white, female, and older than 26 years of age. The majority completed high school and reported annual family incomes between $10,000 and $19,000. Few participants reported receiving public assistance. Drug abuse and dependence rates varied across drug type and across race. Drug dependence and abuse were measured using the Nicotine Dependence Syndrome Scale and criteria from the Diagnostic and Statistical Manual of Mental Disorders. Hierarchical regression was conducted to examine the level of association between racial background and drug abuse and dependence after controlling for age and gender. Results reveal that the assumption of high drug and alcohol use and abuse rates among low-income African Americans should be, at best, reexamined. This study has significant implications for both policy and social work practice because it breaks down normalized and biased assumptions of low-income African American drug use.     

Associations with drug use and sexualised drug use among women who have sex with women (WSW) in the UK: Findings from the LGBT Sex and Lifestyles Survey

IntroductionStudies indicate that women who have sex with women (WSW) report greater levels of drug use than heterosexual women, but globally few studies have looked at sexualised drug use among WSW. This study investigated the factors associated with drug use and sexualised drug use (SDU) among WSW.MethodsPotential participants across the UK were invited to take part in a cross-sectional anonymous online survey between April-June 2018. The LGBT Sex and Lifestyles Survey recruited participants through Facebook advertising and social media posts from community organisations. Multivariate logistic regression was used to compare WSW who had engaged in any drug use in the past 12 months with those who had not, and those who engaged in sexualised drug use in the past 12 months with those who engaged in other drug use.Results1501 WSW could be included in the analyses (mean age = 28.9, 97% white ethnicity). Any drug use was reported by 39% of WSW (n = 583), 44% of which (17% of total, n = 258) reported SDU. Factors associated with drug use were identifying as queer (aOR = 1.86, 95%CI 1.08, 3.23), younger age (aOR = 0.96, 95%CI 0.95, 0.98), being born outside the UK (aOR = 1.75, 95%CI 1.15, 2.66), recent sexual assault (aOR = 2.35, 95%CI 1.43, 3.86), > = 5 female sexual partners (aOR = 3.81, 95%CI 1.81, 8.01), and psychological distress (aOR = 1.75, 95%CI 1.15, 2.67). SDU was associated with identifying as bisexual (aOR = 2.55, 95%CI 1.69, 3.86), > = 5 female sexual partners (aOR = 4.50, 95%CI 1.91, 10.59), and highest education achieved at 16 or lower (aOR = 2.46, 95%CI 1.24, 4.90).ConclusionsSome WSW may have negative experiences in relation to drug use and SDU. Harm reduction and health services that provide services for WSW should be aware of potentially compounding factors related to drug use, such as sexual assault and psychological distress, providing a safe and LGBT-friendly environment to discuss these issues.     

Drug Use and Violence Among Adolescents: The Mediation Effect of Attitudes Supporting Violence

The aim of this article is to study the impact of violent attitudes on the drug use/violent delinquency relationship. A total of 1,420 adolescents from the province of Rimini (Italy) completed a questionnaire concerning drug use, violent behaviors, and attitudes toward violence. In general, the results seem to confirm that part of the literature that suggests that people who make frequent use of drugs are also those subjects who are more frequently involved in violent behaviors. However, mediation analyses show that both soft and hard drug use have an indirect effect—mediated by attitudes of violence—on violent behaviors. The results suggest the influence of sociopsychological variables (i.e., attitudes and culture of violence) on the relationship between drug abuse and violent behavior. In planning policies to prevent violent behavior, educational and political institutions should encourage interventions addressed to the promotion of a nonviolent culture.     

Retirement and drug abuse: the conditioning role of age and retirement trajectory

Although recent research on the link between retirement and drinking behavior among older adults suggests that retirement may also serve as a risk factor for drug abuse, the latter association has yet to be subject to rigorous research. We examined this association, as well as the possible conditioning effects of age and retirement trajectory, using a sample of 978 retirement-eligible workers (some having retired, others deferring their retirement) from 3 blue-collar employment sectors: (e.g., construction, manufacturing, and transportation). The findings indicate a weak but significant positive association between retirement and the severity of drug abuse. Age moderated the retirement–drug abuse relationship with — among older workers — higher rates of drug abuse found among those deferring retirement and lower rates among those actually retiring, and the exact opposite pattern found among younger retirement-eligible workers. Also, as hypothesized, the moderating effects of age on the association between retirement and drug abuse were weaker among those opting to return to work post-retirement as opposed to those fully retiring.     

Attitudes Toward Drug Abuse Among Residents* in a Therapeutic Community

In recent years there has been a considerable amount of literature reported about drug abuse and the drug abuser. Generally, the reported evidence pertaining to attitudes toward drug abuse has been concerned with nonusers. Among those, Baker and Isaacs (1970) in a study of visiting nurses, law students, and policemen suggest that these individuals see drug abuse as a physical and mental illness. Pattison (1968) in a study of public attitudes toward narcotic addiction suggests the public sees the addict as less responsible for his behavior. Ferneau and Gertler (in press) studied the first-year psychiatric residents' attitudes toward drug abuse and the drug user and concluded that “this is how we rate these beginners in psychiatry—as more negative than not in the area of drug abuse.” Levitt and his colleagues (1963), in a study of hospital employee attitudes toward the treatment of drug addiction, noted that addicts were perceived as less undesirable among those employees whom they had direct contact with than those with whom they did not have direct contact.

Several investigators have reported on the attitudes of drug users. Recently, Soverow and his coworkers (in press) compared the attitudes of methadone patients ward drug abuse with those of the clinic staff. The report concluded that there was considerable agreement in attitude among the two groups. Grupp (1970) investigated the drug users' attitudes toward the Nalline test and noted that drug users with positive attitudes and expectations are likely to benefit by the test. However, it appears that other than these reports little attention has been given concerning the drug users' attitudes. Grupp (1970) further notes that in the literature there is little consideration given to the attitudes of addicts. Additionally, the New York Academy of Medicine's Committee on Public Health (1963) has eloquently noted the importance of attitudes of drug users:

Among addicts, attitudes toward addiction differ, and individual attitudes may change in time. … It is necessary to recognize these different andvarying attitudes of addicts toward their addiction in order to understand their attitude toward treatment: to seek it or resist it. In short, attitude affects the utilization of treatment and its outcome.

The study reported here was undertaken because of the importance of drug users' attitudes and because of the lack of available literature in this area. This report is an attempt to remedy this deficiency.     

Patterns of regular drug use in Spanish childbearing women: changes elicited by pregnancy

Objective: To determine drug use in Spanish women before pregnancy and from conception to the awareness of pregnancy (early period of pregnancy, EPP), as well as to analyse attitudinal changes when pregnancy was planned or known. Methods: Trained gynaecologists used a structured questionnaire to collect demographic and obstetric characteristics, histories of regular drug taking before pregnancy, attitudes towards drug taking during pregnancy and current drug use in the EPP. Women were interviewed at their first antenatal visit during the first trimester. Results: Two hundred and seventy-two women were included (mean age 29.3 years and 66.3 days of gestation). Before pregnancy, 24% regularly took drugs, 70% of them more than twice a week; a significantly higher frequency was found in those receiving public antenatal care and in those who had had less education. In 39% of women, awareness of pregnancy did not change their attitudes towards regular drug use. Among those who decided to suppress their regular drug intake, 58% did so when their pregnancy was confirmed and 42% when they planned it. In women who planned their pregnancy, 30.1% stopped when they tried to become pregnant. However, 62% of all women took drugs during the EPP. In private antenatal care significantly more drugs were taken per patient. By the 168 women 278 compounds were consumed during the EPP: 40% were analgesics (mainly paracetamol and acetylsalicylic acid) and 25% were digestive and metabolic drugs (mainly antacids and laxatives). Drugs were often used more than twice a week, particularly in women receiving public antenatal care and in those who had had less education. Conclusion: Drug taking is common in Spanish women of childbearing age, and many of those in our study did not decide to stop during the EPP. Few women avoid drugs when planning a pregnancy. Therefore, gynaecologists must advise against drug taking in patients who wish to become pregnant and suggest that unnecessary drug use be avoided when the pregnancy is already diagnosed. Received: 17 February 1998 / Accepted in revised form: 20 May 1998     

Early onset of drug and polysubstance use as predictors of injection drug use among adult drug users

Early onset of alcohol, marijuana, and cigarette use is an indicator of later substance use problems in adulthood such as alcohol or other drug dependence. This paper seeks to address the association between early onset alcohol, marijuana, cigarette, and polysubstance use with injection drug use among recent illicit drug users. The current study used baseline data from the Baltimore site of the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors of HIV, hepatitis A, hepatitis B, and Hepatitis C among both injection and non-injection drug users in Baltimore, Maryland. The present study used a subset (N=651) of the larger parent study that identified as White or Black, and reported any drug use in the past 6 months. In the full sample slightly more than half (52.5%) of study participants were IDUs. IDUs differed from non-IDUs on age of initiation for cigarettes, marijuana, and alcohol, with IDUs initiating the use of all three substances significantly earlier than non-IDUs. IDUs also had significantly greater proportions of early onset of alcohol (χ(2)=19.71, p<.01), cigarette (χ(2)=11.05, p<.01), marijuana (χ(2)=10.83, p<.01), and polysubstance use (χ(2)=23.48, p<.01) than non-IDUs. After adjusting for age, gender, and race/ethnicity, only participants identified as early onset alcohol users (AOR=1.47, 95% CI: 1.00-2.18) and early onset polysubstance users (AOR=1.62, 95% CI: 1.10-2.38) were more likely to have IDU status than those who reported initiating substance use later. IDU status was then stratified by race/ethnicity. After controlling for age and gender, only early polysubstance use was a significant predictor of IDU status for Whites (AOR=2.06, 95% CI: 1.07-3.93). Consistent with literature on early substance initiation and later illicit substance use, early onset of alcohol and polysubstance use is an important risk factor for IDU in adulthood.     

The influence of acculturation on drug and alcohol use in a sample of adolescents

This article reports on the associations between acculturation and substance use among 198 ninth-grade Southern California adolescents (mean age=13.8 years). Substance use measures included 30-day (current) and lifetime use of alcohol and other drugs. Acculturation was measured using the Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA) acculturation scale, a multi-dimensional acculturation scale yielding four acculturation strategy scores. Linear regression analyses evaluated the association between acculturation on alcohol and drug use, adjusting for several covariates. Results revealed that the assimilation acculturation strategy was significantly, but negatively associated with current alcohol use, especially among males. The separation acculturation strategy was significantly and positively associated with current alcohol use, especially among females. Marginalization was associated with greater risk for lifetime alcohol and drug use, especially among males, and a greater risk of current drug use among females. The social influence covariates were predictive of both current and lifetime alcohol and drug use. Future studies should incorporate multidimensional acculturation scales in adolescent substance use to understand how different acculturation strategies impact different populations.     

Stigma and drug use settings as correlates of self-reported,non-fatal overdose among people who use drugs in Baltimore,Maryland

BackgroundFatalities from opioid overdose quadrupled during the last 15 years as illicit opioid use increased. This study assesses how stigma and drug use settings are associated with non-fatal overdose to identify targets for overdose risk reduction interventions and inform overdose education and naloxone distribution programs.MethodsWe surveyed 444 people who used drugs in Baltimore, Maryland, USA, from 2009 to 2013 as part of a randomized clinical trial of a harm reduction intervention. Participants reported demographic characteristics, drug use, overdose history, use of a local syringe services program, involvement in the local drug economy, and whether they experienced discrimination from others (i.e., enacted stigma) or stigmatized themselves (i.e., internalized stigma) related to their drug use. We used multinomial logistic regression models to identify correlates of experiencing a non-fatal overdose within the past year or >1 year ago relative to participants who never experienced an overdose.ResultsStigma was positively associated with experiencing a non-fatal overdose in the past year (adjusted Odds Ratio [aOR]: 1.7, 95% Confidence Interval [CI]: 1.1–2.7) and >1 year ago (aOR [95% CI]: 1.5 [1.1–2.0]) after adjustment for demographic and substance use characteristics. The association of stigma with overdose was stronger for enacted versus internalized stigma. The number of public settings (shooting gallery, crack house, abandoned building, public bathroom, outside) where participants used drugs was also positively associated with experiencing an overdose.ConclusionsStigma related to drug use and using drugs in more settings may increase overdose risk. The effectiveness of overdose prevention and naloxone training may be improved by reducing discrimination against people who use drugs in community and medical settings and diversifying the settings in which overdose prevention trainings are delivered. These efforts may be enhanced by use of peer outreach approaches in which people who use drugs diffuse prevention messages through their social networks and within settings of drug consumption outside the medical setting.     

Drug Use and Abuse: Some Culture-Crossing Questions

Abstract

The relationships between authoritarian ideology and attitudes and beliefs about illegal drugs, the War on Drugs, and prevention strategies were investigated among 353 university faculty, administrators, and students. A confidential mail survey assessed five variables: right-wing authoritarianism, attitude toward drug legalization, attitude toward drug decriminalization, belief regarding the controlled use of illegal drugs, and the tendency to endorse a “just say no” approach to substance abuse prevention. Multivariate analyses revealed that highly authoritarian participants were significantly more opposed to both drug legalization and drug decriminalization than less authoritarian participants. Only nonauthoritarian participants favored decriminalization, though they did not favor legalization. Compared to those scoring lower on authoritarianism, higher-scoring authoritarian participants held significantly more dichotomous beliefs about illegal drugs (i.e., that abstinence or compulsive drug abuse are the only possibilities related to involvement with illegal drugs). They were also less likely to recommend to potential drug users that they consider following guidelines for their use that may potentially function as protective factors against drug abuse, preferring instead to endorse the slogan “just say no to drugs.” Comparisons between groups revealed that students scored significantly higher on authoritari anism and demonstrated significantly greater opposition to drug decriminalization than did faculty and administrators.     

Drinking and smoking as concurrent predictors of illicit drug use and positive drug attitudes in adolescents

The study investigates the relationship between smoking and drinking, and the use of illicit drugs in a cohort of London adolescents. A high prevalence of drug experimentation and positive attitudes to illicit drug use were characteristic of those who both drank alcohol and smoked cigarettes on a regular basis. There was then a clear hierarchy in which lower prevalence of use and more negative attitudes marked those who only smoked, then those who only drank, while non-smokers and non-drinkers (the largest group) had lowest lifetime and recent drug use prevalence and the most negative attitudes about drug use.