Cultural-Level Influences on Substance Use & Misuse

This presentation discusses potential associations between dimensions of culture and patterns of substance use. Several well-known frameworks for organizing cultural values and orientations are presented. As an illustration, one framework () is examined for its relevance in understanding national-level variations in patterns of alcohol and illicit drug use. Two of four cultural dimensions examined, individualism-collectivism and uncertainty avoidance, are found to be independently associated with one or more substance use measures in a diverse sample of 64 nations. Future multi-level analyses that integrate cultural values and orientations into empirical studies will enable more systematic assessments of the role of socio-cultural contexts in substance use epidemiology.     

Prevention of Substance Use Problems: Models,Factors, and Processes

The use of substances for medical or nonmedical reasons occurs in most cultures. Regardless of the reason for use, however, most types of substance use (or drug-taking behaviors) have their associated problem states. The prevention of substance use problems is an important issue and need in every society. In this review we present and discuss various models and factors that purport to describe and predict patterns of drug use, and we discuss various strategies to prevent the occurrence of substance use problems.     

Hispanic Substance Use:

No abstract available for this article.     

Alcohol Use and Misuse among Hispanic Women: Selected Factors,Processes, and Studies

Two perspectives have dominated the study of social problems: the objec-tivist and the constructionist. The objectivist approach defines social problems by the concrete, scientifically-measurable damage conditions cause, or the objective dangers they pose, to human life. The constructionist approach defines social problems by the public concern that conditions or issues generate. Constructionists often exaggerate the discrepancies that exist between the objective and the subjective dimensions-that is, for specific conditions, they argue that objectively damaging conditions may generate little or no concern, or that public concern erupts over a condition that may be stable or actually declining in objective seriousness. The American drug crisis or panic of the 1980s is used as a specific issue or condition to illuminate the viability of these two approaches. Some constructionists have minimized the objective harm caused or threat posed by drug misuse during this period, and argue that it actually diminished during the course of the 1980s, while public concern erupted. Using concrete indicators, I show that, although public concern did indeed increase dramatically, in fact, key indicators point to a concomitant increase in drug misuse during this decade, even though use indicators are actually down. While not minimizing the importance of the construction of social problems, I suggest that something of a synthesis of the objective and the subjective approaches may be necessary to understanding social problems.     

SUBULEX: Substance Use Lexicon

In spite of declared intentions to maintain control of drinking, we have cues that during the symposium enough wine was ingested to get intoxicated. Hence, it was widely debated how much wine could be safety drunk, and the conclusion was that it was a matter of individual endurance. Apparently, elders were less prone to wine-induced loss of rationality and control. In conclusion, the Ancients were aware of potential dangers of wine and that its consumption needed rules, but apparently these rules existed for being broken.     

The Association of Selected Sociodemographic Factors and Differences in Patterns of Substance Use: A Pilot Study in Selected Areas of Northeast India

Emergence of new addictive substances and progressive increase of “drug abuse” has become a serious problem in many countries. Despite legal restriction and administrative control, the use of illicit drugs (like opium, heroin, proxyvan, etc.) has increased considerably in many parts of Northeast India. A sample of 1831 people (age 10 years and above) were interviewed during 1997–1998 about their drug use habits, if any, and types of substance used, in Meghalaya and upper Assam. Prevalence of substance use was 29.4% tobacco (20.5% chewers and 12.7% smokers), 12.5% alcohol, and 4.9% opium. In Meghalaya, prevalence of tobacco use was high (41.7%), which was mainly due to the large number of female chewers and male smokers. Opium and cannabis users were mainly confined in Assam close to the Arunachal Pradesh border, indicating a regional influence. Wide differences were observed in the prevalence pattern of tobacco and alcohol use across location, sex, age, education, and occupation. An association of sociodemographic factors with substance use was documented. Religion and ethnic group have significant association with tobacco use patterns but are insignificant with regard to alcohol use. Use of multiple substances and use of cannabis as a substitute for opium are the major problems indicating drug dependence. Mean ages for substance use initiation were: 18.5 years for tobacco, 21.8 years for alcohol, and 25.8 years for opium. Not with-standing the study's limitations, these findings are useful for planned prevention efforts and formulation of a specific program considering the importance of regional and sociodemographic factors.     

Traditional and Other Drug Use(r) Intervention: Necessary Critical Parameters

The presentation consisted of a number of pages listing major area topic headings and subheadings, some of which were further delineated. Its purpose was to serve as a framework and a guide for the exhibit's planning in order to help the visitor to actively consider:

• The complexity and multi-dimensionality of substance use and its interventions, past, present and future (both more immediate and more distant) in terms of areas, processes, models, stakeholders, and unresolved critical issues.

• That the traditional view that considering and understanding (a) types of drugs and their actions, (b) types of users and their focused-on characteristics and behaviors (and not their actual as well as potential strengths and limitations), and (c) some of the semantics of the field are sufficient for effective intervention, has resulted and will continue to result in built-in failures and unnecessary frustrations for a range of individuals (substance users and non-users) and systems.

• The dimensions of what is being focused on, their “demands,” and the critical necessary conditions (endogenous and exogenous) for a posited concept, process, model, policy, etc., to operate (begin, continue, become integrated and anchored, change as realities change, etc.) or not to operate.

• What interests and whose interests have been served and which need to be served with and through substance use(r) intervention and/or non-intervention; who and what are the facilitators-promoters; barriers-preventers, as well as irrelevant foci that can and do use up limited intervention resources (human and non-human resources).

Participants were invited to critically analyze the “list”; to delete, change, and add.     

The Substance Use System: Social and Neighborhood Environments Associated with Substance Use and Misuse

Substance use theory and practice have traditionally focused on individuals who misuse substances or who are at risk for substance misuse, but this emphasis is shifting. The present study views both substance use and misuse systematically, assessing the relationships between the physical and social environments and substance use and misuse in dynamic interplay. This substance use system was examined through a survey of approximately 10,000 persons, aged 22–44, from primarily inner-city neighborhoods in the United States. Individual indicators such as race, sex, age, socioeconomic status, education, and religious service attendance relate to both the physical and interpersonal environments, even when each is controlled for the others. Qualities of both environments are strongly associated with substance dependency, even after individual indicators are controlled. These findings suggest the difficulty of bringing about change in drug and alcohol use without hndamental change in the environments where use takes place.     

Diachronic Substance Use Assessment and the Emergence of Substance Use Disorders

SUMMARY

Substance use is a complex phenomenon that changes during the natural history of consumption. Relevant parameters encompass age of initiation, type and amount of drug consumed per episode, and problems resulting from substance consumption. Comprehensive developmental assessment of substance involvement is thus a prerequisite for conducting rigorous research designed to advance understanding of the progression of substance use behavior to a substance use disorder (SUD). At the Center for Education and Drug Abuse Research, a protocol has been developed for detailed temporal assessment of substance involvement. This article describes the evaluation procedures. The diachronic assessment protocol described herein has yielded several important findings pertaining to substance use behavior and SUD.     

Substance Use and Multiculturalism

This paper reviews intercultural variability of substance use behaviors, including availability of international statistics on consumption of alcohol and other drugs, as well as the use of drugs available locally only. Within a conceptual framework of intercultural relations, it considers the history of transcultural spread of substance use behaviors and possible reactions to the introduction of new drugs within a culture or jurisdiction, including illustrations of the “law of alien poisons.” Although intercultural views of substance use have generally concentrated on majority groups’ views of substance use in minority groups, minority and non-Western views of substance use need to be considered in the context of increasing international and intercultural communications that increase the rate at which substance use behaviors spread. Both Western and non-Western experiences with substance use and misuse must be taken into account so that better interventions can be developed to deal with addictions and other substance-related problems. [Translations are provided in the International Abstracts Section of this issue.]     

Ethnographic Lessons on Substance Use and Substance Abusers

Abstract

The primary purpose of this article is to introduce broadly comparative ethnographic studies on the role of psychoactive substance use. Examples are cited from case studies across Africa, Asia, Australia, Europe, North, and South America. These varied studies are synthesized to provide the basis for a brief analysis of meaning and function on the integration of use, including ritual and the public nature of use. There is also discussion on the cultural construction of intoxication and of the abuser, along with some thoughts regarding humanizing the drug user and avoiding stereotypes.     

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.     

Depression and Substance Use: A Temporal-Ordered Model

Background and Objectives: This study sought empirical evidence for the self-medication hypothesis. It asked whether diagnosis of depression, together with the use of mental-health care, leads to substance use. Methods: Data came from the 5-wave, longitudinal Fragile Families and Child Wellbeing (FFCW) Study, an investigation of a cohort of nearly 5,000 births, which oversampled non-marital births. FFCW examined newborns’ biological mothers and fathers, all of whom lived in the United States. The adults were initially interviewed between 1998 and 2000 (the period of the cohort's births); they were then re-interviewed for four times over 10 years. FFCW measured mental health-related variables, level of drug use, and social structural and demographic factors, all of which are also measured by the present study. Respondents in our study's two final subsamples had responded to every FFCW interview item we would use in constructing our final model's variables. Our subsample of mothers totaled 3,477 women, from whom 5,987 person-waves were derived. Our subsample of fathers totaled 2,096 men, yielding 3,543 person-waves. Results: We used STATA generalized estimating equations for panel data, and found some evidence to support the self-medication hypothesis. In addition, our results indicated that the relationship of substance use to the use of mental-health care was gender-specific. Conclusions/Importance: Empirical evidence from this study only partially supported the self-medication hypothesis; the co-occurrence of depression and substance abuse in our sample was also reflective of social structural and demographic variables and of prior substance use variables.     

Failures in Substance Use Surveys

This paper reviews some of the potential sources of failure in surveys concerned with substance use. These failures are both conceptual and methodological in nature. Conceptual failures include nonuse and misuse of survey data, the inability of these data to detect emerging substance use trends and problems, and relevant ethical concerns. Methodological failures include sampling, coverage, nonresponse, and measurement and processing errors, which are indigenous at some level to all epidemiologic surveys. Consideration of these is necessary if survey data are to be appropriately used for their intended purposes.     

Substance Use and Sexual Assault

The charts of 234 consecutive sexual assault victims age 12 years or greater were reviewed. Substance use by victims and assailants is prevalent. Victims reported substance use immediately preassault in 51 % of cases, and substance use by their assailants in 44%. Victim substance use was associated with a trend toward impaired memory for key elements of the assault. Victim knowledge of assailant substance use was associated with acquaintance assaults. Adult and adolescent substance use rates were not significantly different. Adolescents had a higher rate of acquaintance assaults and nongenital injury. Adults had increased rates of memory impairment and weapon involvement.     

Intergenerational Continuity of Substance Use

Guided by rigorous methodology and a life-course perspective, the goal of this research is to address a gap in current knowledge on whether, when, and how strongly intergenerational continuity of substance use exists when examining age-equivalent and developmentally specific stages of the life course. Annual self-reported substance use measures were analyzed from a prospective, longitudinal, and nationally representative sample that originally consisted of 1,725 respondents and their families, who were then interviewed over a 27-year period from 1977 to 2004. Findings from multilevel random-intercept regression models provide support for intergenerational continuity when substance use occurs in emerging adulthood but not when limited to adolescence. Implications, limitations, and future research directions are discussed.     

Addiction Diagnostic Update: DSM-III-R Psychoactive Substance Use Disorders

Abstract

This article reviews the Community Reinforcement Approach (CRA) in the treatment of opioid dependence. It covers the use of CRA with both methadone maintenance patients and patients withdrawing from opioids. The data reviewed in the use of CRA in combination with methadone maintenance shows improvement in a number of areas. These include the reduction of opioid use, as well as other drugs of abuse, improved legal status, less psychiatric symptoms, and improved vocational and social functioning. CRA coupled with vouchers can assist in retaining patients in treatment long enough to improve opioid detoxification rates from buprenorphine and coupled with naltrexone may sustain abstinence. Further, the use of a standardized computerized format may extend the utility of CRA.