“They Should Have Them All Over the Place”: A Health Program for Children of Illicit Drug Users

A peer-based support and advocacy group for illicit drug users in collaboration with a community nurse developed an innovative program for the children of users. The program provides well-baby checks, immunization monitoring, parenting advice, monitoring of children's safety, a free lunch and education about nutrition, as well as activities for the children and mothers. In addition, it allows mothers to have time out in a friendly, relaxed, safe, and nonjudgmental environment. The program has been running for more than 7 years, costs little, and gives a hard-to-reach population access to valuable health care.     

Chapter 9. Drug User Researchers as Autoethnographers: “Doing Reflexivity” With Women Drug Users

This article explores autoethnography, based upon transcribed, narratives, conversations, and research notes, as a useful method of creating social and cultural insights into the lives of women drug users and their particular kinds of problems and to related issues of reflexivity, reliability, and validity. A critical issue is raised by asking the question “where do we go from here?” contending that we must challenge outdated methodological traditions and canons that deny autoethnographers their voice and close the door to their claims of authenticity.     

Factors Associated with the Initiation of Cocaine and Heroin among Problem Drug Users—Reflections on Interventions

Objective: This study identifies self-reported factors facilitating initiation of cocaine and heroin among young problem users in Amsterdam to enable interventions to be targeted at issues personally relevant for this population. Method: A qualitative study using in-depth interviews to obtain retrospective drug use histories. Recruitment took place both directly (by street outreach, outreach at methadone outposts) and indirectly (by respondent-driven sampling). The study started in the year 2001 and included 50 problem drug users, aged 18–30, of whom 72% were male, 64% were polydrug users, and 36% were homeless. Results: The seven most common self-reported factors facilitating initiation of cocaine and heroin are desire for affect regulation, drug availability, curiosity, desire to be part of a group, misinformation, desire for energy, and starting because it has a depressant effect. Conclusion: Some factors perceived to facilitate initiation of cocaine and/or heroin revealed in this study are hardly addressed by current prevention programs and could inform future initiatives. Programs can be targeted at young people who we identified to be at high risk. Research using quantitative methods is likely to be valuable in determining the relative importance of mentioned factors for different groups of young people. The study's limitations are noted.     

Relationship of “Risk” Factors to Teen Substance Use: A Comparison of Abstainers,Infrequent Users,and Frequent Users

This study was designed for the purpose of investigating the differences between adolescent substance abstainers, infrequent users, and frequent users on risk factors for substance use related to commitment to education, peer influence, family relationships, and intrapersonal factors. Results from analyses comparing the three groups on the risk factor variables showed that teen substance abstainers and infrequent users are more similar to each other than they are similar to frequent substance users. The study provides support for the contention that preventive efforts may be more successful if targeted at clearly identified groups of problem teen substance users.     

“Heavy Users,” “Controlled Users,” and “Quitters”: Understanding Patterns of Crack Use Among Women in a Midwestern City

Over the past two decades, the use of crack cocaine has become an enduring part of the social ecology of many cities across the United States. The purpose of this exploratory study is to describe patterns of crack use drawing on life history interviews conducted with 18 women in Dayton, Ohio, between 1998 and 2000. Ten of the women were African American, and eight were white. Age ranged between 23 and 47. The women were at very different stages of their crack-cocaine careers. We focus on understanding the social factors, life history, and everyday circumstances that participants related to their current patterns and levels of crack use. Implications for intervention are discussed.     

A Cultural Psychology Approach to “Drug Abuse” Prevention

Much research on the etiology of adolescent drug use has focused on posited risk and protective factors at the level of the individual or small group. However, those proximal influences exist within a cultural context that also influences drug use. To prevent drug use in the diverse population of the United States, research is needed on the influence of the cultural context on adolescent drug use, including the effects of immigrating from one cultural or sociodemographic context to another, as well as the effects of living within two different cultural systems simultaneously. Theoretical models and research methods from cultural psychology and cultural sociology are well-suited to examine the cultural context of drug use. We examine causal mechanisms by which acculturation might affect drug use by using two paradigms to conceptualize culture: a stress/coping paradigm and a cultural values paradigm. Implications of cultural risk and protective factors for transdisciplinary research on drug abuse prevention are also discussed.     

A Plan for Estimating the Number of “Hardcore” Drug Users in the United States

The study is based on a systematic random sample from the New York State's Driver License File, which contains 15,032 drivers who were convicted of DWI/DWAI at least once in the period of 1978 to 1988. The analysis reveals (1) the proportion of male offenders 20 and younger continued to decrease through the 1980s, while the proportion of female offenders 21 and older increased; and (2) the female DWI/DWAI recidivism rate began to parallel the male recidivism rate after the mid-1980s. A number of factors may be attributed to the changing DWI/DWAI structure, such as the impact of the 21 alcohol purchase age law, the change of women's roles and lifestyles, and the changing attitudes of the public and the police toward female drinking-driving.     

High Prevalence and Incidence of HIV and HCV Among New Injecting Drug Users With a Large Proportion of Migrants—Is Prevention Failing?

Objectives: The aim of this study was to assess differences in the prevalence of HIV and HCV infection and associated risk factors between new (injecting for ≤5 years) and long-term injectors and to estimate HIV/HCV incidence among new injectors. Methods: Cross-sectional study among people who inject drugs (PWID) who attended harm reduction centers in Catalonia in 2010–11. Anonymous questionnaires and oral fluid samples were collected. Poisson regression models were applied to determine the association between HIV/HCV infection and risk factors. Results: Of the 761 participants, 21.4% were new injectors. New injectors were younger than long-term injectors (mean age = 31.6 vs. 37.8) and were more likely to be immigrants (59.0% vs. 33.4%). HIV and HCV prevalence was 20.6% and 59.4% among new injectors, and estimated HIV and HCV incidence 8.7 and 25.1 /100 person-years, respectively. Among new injectors, HIV infection was associated with homelessness (PR = 3.10) and reporting a previous sexually transmitted infection (PR = 1.79). Reporting front/backloading (PR = 1.33) and daily injection (PR = 1.35) were risk-factors for HCV infection. For long-term injectors, HIV risk factors were: having shared syringes (PR = 1.85), having injected cocaine (PR = 1.38), reporting front/backloading (PR = 1.30) and ever having been in prison (PR = 2.03). Conclusion: A large proportion of PWID in Catalonia are new injectors, a subgroup with a high level of both sexual and parenteral exposure and a high incidence rate of HIV/ HCV infections. It is important to improve early diagnosis of these infections among this group, in particular among migrants. To identify and address risk factors for homelessness PWID should be a priority.     

Impact of a Harm-Reduction Policy on HIV and Hepatitis C Virus Transmission Among Drug Users: Recent French Data—The ANRS-Coquelicot Study

In France a harm-reduction policy was implemented in the late 1980s with the aim of reducing the prevalence of HIV and hepatitis C virus (HCV) infection among drug users. The ANRS-Coquelicot survey was designed to measure the prevalence of HIV and HCV infection among drug users and to examine determinants of at-risk behaviors. In 2002, information was collected from 166 drug users recruited in all types of services specializing in drug use intervention and harm reduction in Marseille, France. Self-reported HIV and HCV serostatus was compared with the results of serological tests done on capillary blood collected on filter paper. The self-reported and biologically documented prevalence rates of HIV infection were identical (22%). In contrast, the self-reported prevalence of HCV infection was 52%, whereas the biologically documented prevalence was 73%. Overall, 30% of HCV-infected drug users were unaware of their status. Forty-four percent of drug users under 30 years of age were HCV seropositive, suggesting that they had been infected early during drug use. The harm-reduction policy seems to have had a marked impact on HIV transmission among drug users but a much more limited impact on HCV transmission. The limitations and implications of the study are discussed.     

The Influence of Social Circumstances on “Risky” Patterns of Alcohol Consumption Among Mothers With Preschool-Aged Children in England

Background: Social factors have been linked to patterns of alcohol use among women. However, conflicting evidence on the ways in which socio-economic circumstances are linked to women's alcohol use impedes our understanding. Interest in women's alcohol use has moved up the policy agenda. Nevertheless, existing research fails to attend to differences among groups of women according to their social circumstances, including whether or not they are mothers. Objectives: This study aims to enhance our understanding of “risky” patterns of alcohol use among mothers in the UK during very early motherhood. Methods: Secondary analyses of 2000/1 data from the Millennium Cohort Study (MCS) was undertaken. Using a broad outcome measure of “risky” alcohol use, patterns of consumption among a sub-set of mothers recruited in England (n = 7048) were explored according to a number of social and domestic variables. Using logistic regression, mutually adjusted analyses that included adjustment for age were undertaken. Odds ratios were calculated for the likelihood of “risky” drinking according to mothers' social circumstances and level of disadvantage. Results: “Risky” alcohol use was more likely with increased levels of disadvantage: disadvantaged childhood circumstances, lower levels of educational attainment, lower household income, younger age at first birth, lone parenthood. Conclusions: Social gradients were evident for “risky” alcohol use among mothers with 9-month-old babies in England who took part in the MCS. These findings emphasize the importance of exploring patterns of alcohol use among sub-groups of the population that are currently under-represented in the research literature.     

Needle Syringe Acquisition and HIV Prevention Among Injecting Drug Users: A Treatise on the “Good” and “Not So Good” Public Health Practices in South Asia

This article describes the prevalence of HIV/AIDS and other bloodborne infections is well established among injection drug user (IDU) populations in South Asia (SA). IDU populations in SA are diverse and display different demographic and socioeconomic profiles. The current provision of sterile injecting equipment as part of public health initiatives is suboptimal. Although some needle and syringe exchange programs (NSEPs) operate in the region, pharmacies and “friends” continue to be a major source of syringe acquisition. It is suggested that the cost of syringes in the region is significantly higher in real terms than in several other countries and negatively impacts on the ability of IDUs to acquire needles and syringes. In addition, existing NSEPs offer poor coverage both at the population and individual level. Their effective functioning is hampered by resource constraints, ambivalent policy positions, little attention to quality, and environmental factors. Secondary syringe exchange is a nascent phenomenon in SA that needs to be adequately documented and evaluated. Urgent attention needs to be given to developing alternative models of needle syringe delivery to scale-up HIV prevention interventions for IDUs. This study was conducted in the first quarter of 2004 and updated in 2006. We used key informants, previously unpublished and published data from research studies, and interventions programs, service statistics, and primary data to inform this study.     

Parental Perceptions of Neighborhood Effects in Latino Comunas: The Script of “the Delinquent” in Understanding Drug Use,Violence, and Social Disorganization

Objectives: To obtain rich information about how adult Latinos living in high-poverty/high-drug use neighborhoods perceive and negotiate their environment. Methods: In 2008, 13 adult caregivers in Santiago, Chile, were interviewed with open-ended questions to ascertain beliefs about neighborhood effects and drug use. Analysis: Inductive analysis was used to develop the codebook/identify trends. Discussion: Residents externalized their understanding of drug use and misuse by invoking the concept of delinquent youth. A typology of their perceptions is offered. Learning more about residents’ circumstances may help focus on needs-based interventions. More research with Latino neighborhoods is needed for culturally competent models of interventions.     

“We as Drug Addicts Need that Program”: Insight from Rural African American Cocaine Users on Designing a Sexual Risk Reduction Intervention for Their Community

This focused ethnographic study examines data collected in 2007 from four gender- and age-specific focus groups (FGs) (N = 31) to inform the development of a sexual risk reduction intervention for African American cocaine users in rural Arkansas. A semi-structured protocol was used to guide audio-recorded FGs. Data were entered into Ethnograph and analyzed using constant comparison and content analysis. Four codes with accompanying factors emerged from the data and revealed recommendations for sexual risk reduction interventions with similar populations. Intervention design implications and challenges, study limitations, and future research are discussed. The study was supported by funds from the National Institute of Nursing Research (P20 NR009006-01) and the National Institute on Drug Abuse (1R01DA024575-01 and F31 DA026286-01).     

Pentazocine - Naloxone: Another “Addiction-Proof Drug of Abuse”

Pentazocine, in combination with the antihistamine tripelennamine, was a popular drug of intravenous abuse in many large cities in the late 1970s and early 1980s. To stem the abuse of pentazocine, naloxane was added to the tablet. This would presumably allow oral activity, but naloxone would block the euphoria if the pills were injected. Abuse of pentazocine appears to have diminished, but we have recently treated three addicts who continued to inject pentazocine, despite its naloxone content. Two patients experienced no overall decrease in the drug-induced euphoria. The third patient became acutely psychotic with each injection. Hypotheses are advanced to explain these findings.