Context Of Drug Use Research Articles

Taking Control by Loosing Control?: Patterns of heroin addiction in Estonia

Similarly to other countries in Eastern and Central Europe, Estonia has a relatively short experience of problems related to the use of illicit substances. In the previously “Real Socialist” countries in general, the increase in drug use among youth did not take place until the 1990s. This paper focuses on opiate users in Estonia. Unlike some other drugs, heroin does not have a trendy status, but is strongly rejected by the recreational drug users of the party scene. On the contrary, opiate users tend to be heavily marginalized. Relying on open-ended interviews with opiate users, this paper focuses on relationships between addiction and the cultural context of drug use. The majority of opiate users belong to the Russian-speaking minority, whose relative social status has considerably weakened after the restoration of Estonia's independence in 1991, and who have limited opportunities in the educational and labour markets. Young people started to use drugs from a desire to experience action, but the absence of other meaningful roles besides that of a drug user quickly led them towards addiction. However, the addicts were able to develop and maintain new competencies for living with heroin. It can be argued that addiction does not lead to a complete loss of control over their lives, but is rather an escape route from mainstream society. Heroin users do not become addicted to the drug alone but to the whole way of life centred on it.

In a class of its own: Introducing a new tool for understanding adolescents' perceptions of the world of drugs

Objective To describe the use of (draw, describe and write', a tool for exploring how adolescents perceive and explain their understanding of the world of drugs, as used in the development of the Blueprint project. Design A cross-sectional study using a specifically designed research tool, including drawing and open-ended questions, used with young people aged 11-13 years to record their understanding of drug use. Setting Eight secondary schools in four areas of England. Method Open-ended questionnaire: 'Draw, describe and write' is an illuminative method based on constructivist/interpretivist approaches. Respondents were invited to'describe or draw' a young person who uses drugs. Further open-ended questions explored the drugs used, the context of drug use and the risks and benefits to the young person and the respondent. Results A response rate of 85 per cent was achieved. A random sample were analysed. The results provide a valuable insight into how 11-13 year olds perceive and understand drug use by young people. The method is acceptable to young people and their teachers and is strongly inclusive. This tool will be useful in curriculum development and in evaluation of drug education intervention studies for pupils of secondary school age range. Conclusion The method could be used in further studies where it is important to understand young people's perceptions of the complex context of the drug using world in which they are growing up.

'Up for it, mad for it? Women, drug use and participation in club scenes'

In this paper the meanings that participating in contemporary club scenes have for women are analysed in terms of risk and pleasure. The notion that club spaces provide an equal environment where women are free to participate without encountering sexual harassment from men is questioned, as is the assumption that all club spaces are the same. The differences between club spaces are discussed in terms of mainstreams and undergrounds and the implications that these different spaces have an impact on the women who choose a clubbing lifestyle. Previous accounts of women's sexual behaviour have focused on risk and danger. This extended analysis, by putting this behaviour into the context of drug use, risk and pleasure allows for a different reading of women's experiences. An ethnographic study using in-depth interviews, focus groups and participant observations was carried out to ascertain how women viewed their own participation on club scenes. The data suggests that women feel more comfortable in underground club spaces as they encounter less sexual harassment there, and that factors such as alcohol use and self esteem are crucial in determining risk taking behaviour. The use of ecstasy itself was not seen as a precursor to risk taking behaviour. The negotiation of femininity and sexuality in club spaces is highlighted as problematic for the women concerned. In constructing identities within club spaces however, a positive femininity can be produced in opposition to traditional, passive images of femininity and sexuality.

Social context of HIV risk behaviours among male-to-female transgenders of colour

To explore the social context of drug use and sexual behaviours that put male-to-female (MTF) transgenders at risk for HIV, focus groups were conducted consisting of African American, Latina and Asian and Pacific Islander MTF transgenders (N=48) who reside or work in San Francisco, California. Participants were likely to report having unprotected sex with primary partners to signify love and emotional connection, as well as to receive gender validation from their partners. In contrast, viewing sex work with customers as a business encouraged intentious to use condoms. Safer sex intentions with customers were frequently undermined by urgent financial needs, which stemmed from transphobia, employment discrimination and costly procedures associated with gender transition. Participants reported using drugs as a way to cope with or escape life stresses associated with relationships, sex work, transphobia and financial hardship. Interventions with at-risk MTF transgenders should address the interpersonal and social context of unsafe sex and drug use, particularly the unique roles of relationship issues with male partners, stigma, discrimination and community norms regarding sex work and drug use.

Drug Use within the Finnish Club Culture as Marks of Distinction

Drug use in the context of dance clubs and “raves” has established a permanent position in Western youth cultures during the past two decades. Although the phenomenon is global, the prevalence and local cultural forms vary significantly among countries. In this article we analyze how the Finnish drug users in the context of club culture distinguish themselves from other night-life subcultures and from mainstream popular culture. We also try to categorize the distinctions of this group into more general discursive structures that define their group identity. Drug use in the club cultural context is analyzed as modern symbolically significant consumption as a way to create and maintain social categories and distinctions. We conclude that Finnish club culture is quite a hidden context. Club cultural distinctions differ greatly from values of Finnish society. Even though the club culture expanded and interlocked with mainstream popular culture in the late 1990s, club culture and related drug use are still quite a marginal phenomenon.

Beyond “Subculture” in the Ethnography of Illicit Drug Use

“Subculture” has been an important conceptual and methodological tool in the ethnographic study of drug use and drug-related harm, particularly heavy drug use among marginalized populations. When researching those whose drug use is less all-consuming, however, this concept does not serve us so well. What term or terms might provide a better framework for the investigation of more intermittent drug use? I explore this question through attention to material gathered during three years of ethnographic research with drug users in Perth, Western Australia. I characterize my units of analysis as social “scenes” oriented around sets of practices. These scenes are located on urban “pathways.” Drug ethnographers need to reorient themselves, no longer seeking to describe and analyze normative subcultural values, beliefs and behaviors but rather focusing on the diverse nature of some drug scenes and their constitutive practices. It may be time to retire “subculture” in the study of certain contexts of drug use.

Exploring the context of drug use: a problem-based learning course in pharmacoepidemiology for undergraduate science students.

The teaching of pharmacoepidemiology has been largely confined to health care professionals and graduate students. This paper reports an attempt to use problem-based learning (PBL) to teach the elements of that discipline to undergraduate science students. Carefully sequenced problems led students to consider the following issues: the terms used in epidemiology, merits and demerits of different epidemiological study designs, pharmacovigilance, the nature of evidence in law and science, economic evaluation of drugs and the use of drugs in different cultures. The 12-week course was taken by students in their final term prior to graduation. Multiple evaluation procedures were used: specific forms for assessing tutorial participation, individual explorations assessed usually by written essays and problem-solving exercises. The course has received high ratings from the students. The observations over a 10-year period suggest that PBL is a feasible approach to teach the social dimensions of drug use.

News and Notes

News and Notes

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.

Male Condom Use by Type of Relationship following an HIV Intervention among Women Who Use Illegal Drugs

Predictors of increased male condom use are investigated following a recent, gender-specific HIV intervention among African-American women. Data were analyzed from 138 women (aged 18 to 59), recruited from inner-city Atlanta (Georgia, U.S.) neighborhoods. Predictors of condom use with steady and casual paying partners were examined separately. Increased condom use with steady partners was associated with drug-using status, intervention assignment, sexual relationship characteristics, age at first condom use, and HIV testing history. Condom use with casual paying partners was associated with having sex while high and the frequency of crack cocaine use. Personalized norms regarding condom use were not salient factors in predicting increased rates of condom use with either partner type. Findings indicate the continued need to consider sex in the context of drug use, and reveal the importance of measuring such influences and all antecedents of condom use separately for steady versus casual sexual relationships.

The Socio‐Cultural Context of Drug Use and Implications for Drug Policy

Cultural diversity in India has nurtured the use of mind‐altering substances over centuries, with‐out causing any great alarm about drug abuse. This paper, using research conducted by the authors and other secondary data, attempts to present socio‐cultural‐religious, functional patterns of drug use in the country and examines some of the factors responsible for the drastic changes that have occurred since the 1980s. Specifically, it points out that the Narcotics Drugs and Psychotropic Substances (NDPS) Act, 1985, took the responsibility of drug abuse control away from the community to the near‐defunct legal establishment; that by criminalising socio‐religious‐cultural‐recreational use of opium and cannabis, it has promoted the pro‐liferation of alcohol, heroin, and other moreharmful pharmaceutical drugs; that it has given a new lease of life to organised crime syndicates; and that denial of access to low cost, accessible health care at the hands of traditional healers is an unintended consequence needing immediate rectification. It makes certain policy recommendations to the UN bodies, their member states and to policy makers in India in particular.

Social context of risk behaviours

The global incidence of HIV and other blood-borne viral infections in injecting drug users continues, in varying degrees and at different rates. Yet a problem with the epidemiological characterisation of route of transmission as 'injecting drug use' as a single homogenous category is that it tends to hide major cultural and contextual differences, as these following studies, from Switzerland, France, Brazil, Vietnam, India and Scotland, demonstrate effectively. Thus, whilst Somaini et al. in Zurich can posit a relationship between the provision of harm reduction programmes and reduced HIV incidence, and certainly the protective effects of such programmes on younger drug users, it is unclear why the impact on Hepatits B and C is much less marked. In France, on the other hand, Reynaud-Maurupt et al . indicate that the use of drug maintenance treatment had little impact on risk reduction, and look to other characteristics of IDUs to understand continued risk exposure. This is also evident in Dunn and Laranjeira's account of risk behaviour among IDUs and non-IDUs in Sao Paulo, Brazil. Here, cocaine and multi-drug use in older users was associated with HIV positivity and, as so often with such studies, non-injectors are on a trajectory to greater harm if interventions are not addressed to their needs. In Ho Chi Minh City, Vietnam, Hien et al. find the classic combination of extremely high risk factors (including sharing of needles and syringes in shooting galleries) facilitating HIV transmission not only among drug users, but in relation to their partners and sex workers in the city. In Manipur, India, Eicher et al. demonstrate how quickly new epicentres of HIV can be established when the risk behaviours for HIV are present, with most infections occurring in their study population within two years of commencement of drug injecting. The key to all of these papers is the social context of drug use, and this is explicated by MacRae and Aalto's paper from Scotland, which focuses on the impact of women's sexual relationships on their risk exposure. This finds that male partners injected their female partners, as part of what the women considered to be a loving relationship. Whilst parenteral transmission of HIV can be reduced to its most basic level - in the case of these papers, as a function of the sharing of injecting equipment - it is clear that effective interventions to prevent transmission will not be possible unless the diversity of drug use, the range of people involved and the varied contexts in which it occurs, are placed at the heart of our efforts to stop the spread of HIV and AIDS.

Attitudes toward marijuana use and drug-free experience: Relationships with behavior

Attitude toward drug-free experience is conceptualized as a psychological context for drug use that influences the evaluation of perceived consequences of marijuana use. Two studies examined the moderating effect of attitude toward drug-free experience on relationships between attitudes toward marijuana and drug use. In Study 1 ( N = 316), attitude toward drug-free experience emerged as a significant moderator. Participants with positive attitudes toward marijuana use and relatively low attitudes toward drug-free experience used marijuana at the highest rates. Study 2 ( N = 308) provided a partial replication and extension. In a second sample, a quadratic relationship emerged between drug-free experience and marijuana use. The interaction between the two attitudes approached significance. Among the 47 participants who had used marijuana more than 100 times in their lifetime, attitude toward drug-free experience moderated the relationship between attitude toward marijuana and marijuana-related problems.

Drug Use Patterns of Substance Abusing Women: Gender and Ethnic Differences in an AIDS Prevention Program

SUMMARY The social context of drug use defines women's experiences of addiction and their patterns of use. Gender relations and roles, ethnic identity, poverty, and local circumstances, including drug-related epidemics such as the human immunodeficiency virus (HIV) and sexually transmitted diseases (STDs), constitute powerful social forces that create a unique set of risky conditions for women drug users. This paper presents findings from a community-based AIDS prevention research project for 1,022 out-of-treatment drug users recruited through street outreach and targeted sampling. Data from a baseline risk behavior assessment and in-depth interviews on contexts of women's drug use show different patterns of use when comparing women to men, and among women comparing African Americans, Puerto Ricans, and Whites. Related differences in prevalence of HIV, STDs, and other consequences of drug use and addiction also are presented. Implications of these findings are discussed in terms of the development of drug...

Drug Use Among Prisoners Before, During and After Custody

This study examines the use of drugs in a Welsh prison within the context of drug use in the community as a whole. It involves a survey of custodial and non-custodial drug use among male inmates in...

People and Places: Behavioral Settings and Personal Network Characteristics as Correlates of Needle Sharing

Sharing of contaminated needles constitutes one of the primary modes of HIV transmission in the U.S. This study examined social and environmental factors as possible correlates of needle sharing in a sample of inner-city drug users in Baltimore, Maryland. Drug users' social context was assessed through an analysis of personal networks, and the environmental context of drug use was assessed through a delineation of injection settings. The 330 respondents participating in an HIV prevention study were administered two surveys an average of 5.2 months apart. An examination of the association of network characteristics at baseline and needle sharing at followup revealed that the factors of higher total network density, larger drug network size, and injecting at friends' residences were positively associated with reports of sharing needles that had been cleaned with bleach. Sharing of needles that had not been disinfected with bleach was positively associated with reports of injecting in semipublic areas (streets, rooftops, parks, cars, public bathrooms, and abandoned buildings). These data support ecological and resource models of needle sharing and suggest the potential utility of network-oriented strategies for reducing needle sharing among injecting drug users.

Effect of training on the clinical management of malaria by medical assistants in Ghana

Malaria accounts for over 40% of all outpatient consultations in Ghana. A common drug use problem associated with its treatment with chloroquine is over- and under-dosage and a preference for the intramuscular route of administration. Inadequate treatment is an important factor in the selection of resistant strains of malaria parasites. To ensure the proper management of diseases at health centres the Ministry of Health instituted an in-service training programme for medical assistants in 1987. We evaluated the effect of this training on the clinical management of malaria using a quasi-experimental design. Three methods of data collection were used; prescription survey, assessment questionnaires and focus group discussions. Our findings revealed that gains in knowledge following the training had deteriorated within a year. There was also a discrepancy between knowledge and practice of malaria treatment. This was shown by over- and under-dosing of chloroquine in children and adults respectively. There was also overwhelming preference (85% of all cases) for injections and a high tendency towards polypharmacy (average of five drugs per visit). The motivating reasons for these were mainly socio-cultural and included patient demand and attitudes, prescriber self interests and stereotypes and the daily practical challenges of the community. While paying greater attention to supervision of clinical work at health posts, consideration must be given to socio-cultural context of drug use in any such future training programmes if rational use of drugs is to be achieved.

Reliability of interview responses of injecting drug users.

We compared 23 injecting drug users (IDUs) who were part of a larger study at retest periods of less than or greater than one month for test-retest reliability of their responses to a detailed questionnaire covering demographics, drug use, HIV risk behavior and attitudes and knowledge about HIV. Data indicated that there was high test-retest reliability for demographic characteristics, and for the social context of drug use for the shorter retest duration.

Abstracts from USP DI

To evaluate the consistency of the relationship between early drug use in adolescence and illegal drug use in adulthood as proposed in the “gateway theory” and to determine whether pre-existing depressive symptoms modifies this relationship. We used contractual data from the National Longitudinal Study of Adolescent to Adult health data spanning a 14 year period. We assessed the relationship between gateway drugs at baseline (age 11–20 years) and drug use in adulthood using generalized estimating equation (GEE) regression models. Gateways drugs used in early adolescence were significantly associated with marijuana use, illegal drugs and cocaine in older adolescence, but over time these relationships were not consistent in adulthood. Changes in the pattern of psychoactive drug use were important predictors of drug use in adulthood. A history of higher depressive symptoms was associated with higher frequencies of psychoactive drug use over time. Users of mental health services in adolescence were less likely to use drugs in older adolescence and in adulthood. Relationships between early drug use and later drug use in adulthood cannot be solely explained by the gateway hypothesis. Collectively, adolescent drug prevention and treatment programs should apply theory-based and evidence-proven multisectoral intervention strategies rather than providing a brief counseling on individual's behaviors. This evidence should include understanding that changes in behavior should involve broader analyses of the underlying social context for drug use and in particular the role of the community social norms in driving a group's behaviors.

Substance Misuse and the Physical Environment: The Early Action on a Newly Completed Field

Transactions between individuals and their physical settings involving consciousness-altering drugs are examined. Research has gradually expanded outward from the individual and the drug to include the social and, finally, the physical context of drug use and misuse. Similarly, theory has evolved from simple unidirectional causal tenets to complex multidirectional contextual tenets. Research to date is sparse and does not live up to the ambitious vision of current theoretical views, but some results are striking and provocative. The review is framed in terms of physical scale (macro-, meso-, and microenvironments) and specificity (from molecular features of a setting to molar environmental characteristics such as stimulation level). Three temporal phases are considered: the development, maintenance, and cessation of substance misuse. The paucity of empirical research combined with the potential importance of environmental factors means that many challenging questions remain for a new generation of researchers.