Entangled identities and psychotropic substance use

This paper reports the findings of a grounded theory study investigating drug users' concerns and experiences of their oral health. The aim of this paper is to demonstrate how the findings relate to various strands of literature which focus on processes and discourses of recovery from problematic drug use (biographical reconstruction), the chronic illness literature (biographical disruption), public/private discourses and the myth of addiction. Data were collected from four focus groups containing a total of 25 participants, and 15 in-depth interviews. Participants were recruited from drug detoxification programmes (27), recovery units following detoxification (9) and a drug rehabilitation unit (4). Data analysis revealed that the core concern of drug users' was talking about the 'entangled' nature of their identity whilst they were on drugs. Such 'entangled identities' emerged through what appeared to be a gradual sedimentation process of drug-using habits and routines that replaced those of the everyday self. Other concerns were distancing one's self from the drug using self (involving expressions of disgust) and recovery processes (disentangling). The paper discusses each of these core problems in the light of the literature on the recovery from drug use, the chronic illness literature and the myth of addiction. It concludes by briefly reflecting on problematic psychotropic substance use as another form of biographical disruption formed on the basis of a dialectic between private discourses of the entangled self and public discourses of addiction. It suggests that further work should be conducted in these areas.

Individual and environmental factors related to quitting heroin injection

This study examines the relationship between individual-level and the certain neighborhood characteristics with drug use cessation among a sample of long-term inner-city heroin injectors in Baltimore, Maryland. The data were derived from baseline and first follow-up visits of SHIELD, a larger HIV prevention intervention study targeting members of the drug-using community. The survey instrument was interviewer-administered and ascertained sociodemographics, drug use history, and sexual and drug risk behaviors. The data were collected between August 1997 and March 1999. The current study was limited to participants with a median age of 41 years old. 27.5% (n=53) reported quitting drug use at follow-up. Compared with those who quit, participants who continued (n=147) were close to five times as likely to buy drugs in the neighborhoods in which they lived, 80% less likely to have used drugs in a shooting gallery in the past 6 months, and close to five times more likely to have used drugs in outside places. Controlling for other factors, enrollment in drug user treatment programs or attending self-help groups were not significantly associated with drug use cessation. This study points to the importance of examining specific environmental factors in relation to quitting drug use. Research is needed to further articulate the types and characteristics of physical environments that are related to and could be intervened in promoting sustainable drug cessation.

A replicable model for achieving over 90% follow-up rates in longitudinal studies of substance abusers

The goals of this paper were to: (a) discuss the interface between dominant behavioral patterns of substance users and the development of a follow-up management model, (b) describe the components of the model, (c) present data regarding its effectiveness, (d) estimate the number of contacts for various follow-up rates, (e) explore the generalizability of the model across sub samples, and (f) present client outcome data that underscore the potential negative impact of low follow-up rates. The model has been used to follow-up over 12,000 research participants yielding over a 95% follow-up rate across seven studies (with over 90% completed within +/-14 days of their anniversary date). Using data from two of these studies (n = 2010, n = 632), 22 contacts or less captured 70% of the participants while 33 or 38 contacts or less captured 90% in the first and second studies, respectively. When outcome variables were compared based on 70% versus 90% follow-up, the results varied by study and within study. An examination of the effect of attrition on validity in these two samples demonstrated that even the traditionally acceptable 30% level of attrition can result in significant bias and that the nature of the bias is unpredictable.

The moral relevance of addiction

I attempt to understand and assess the widespread belief that addiction is relevant to morality. I examine several accounts of how addiction might be significant from a moral point of view. Although I briefly discuss theories of virtue, I focus on three possible ways addiction might be relevant to moral blame. First, blame might be imposed for the act of using addictive drugs. Second, blame might be imposed for the condition of being addicted. Third, blame might be imposed for further risks persons are likely to undertake once they have become addicts. I conclude that each of these accounts has some plausibility, but none is entirely unproblematic. Addiction probably is relevant to morality, although its degree of importance is not as great as some commentators appear to believe. The moral relevance of addiction does not appear to rise to whatever level would justify a punitive response to addictive drug users.

Gambling and related mental disorders: a public health analysis

This article reviews the prevalence of gambling and related mental disorders from a public health perspective. It traces the expansion of gambling in North America and the psychological, economic, and social consequences for the public's health, and then considers both the costs and benefits of gambling and the history of gambling prevalence research. A public health approach is applied to understanding the epidemiology of gambling-related problems. International prevalence rates are provided and the prevalence of mental disorders that often are comorbid with gambling problems is reviewed. Analysis includes an examination of groups vulnerable to gambling-related disorders and the methodological and conceptual matters that might influence epidemiological research and prevalence rates related to gambling. The major public health problems associated with gambling are considered and recommendations made for public health policy, practice, and research. The enduring value of a public health perspective is that it applies different 'lenses' for understanding gambling behaviour, analysing its benefits and costs, as well as identifying strategies for action. Harvey A. Skinner (160, p. 286)

Resolving problems associated with alcohol and drug misuse: understanding relations between addictive behavior change and the use of services

"Natural resolutions" highlight how influences on addictive behavior change may differ from and interact with influences on the use of substance-related services. These distinct literatures are summarized and implicate extra-therapeutic environmental variables in both processes. Whether assisted by interventions or not, stable resolutions are surrounded by environmental contexts characterized by improved circumstances across several years that bracket cessation of substance misuse. Psychosocial problems associated with substance use increase help-seeking, and interventions enhance improvements that typically follow initial resolution. Implications for promoting help-seeking and behavior change and necessary revisions in conventional views about relations between the processes are discussed.

Social context and "natural recovery": the role of social capital in the resolution of drug-associated problems

This paper explores the social context of "natural recovery" from problems associated with the misuse of intoxicants. Using data collected from in-depth interviews with 46 former alcohol- and drug-dependent persons, this paper examines how the social capital that these respondents had accumulated prior to their addiction and maintained during it aided in their recovery without treatment. We specifically explore how the relations within their lives and the actual and virtual resources available to subjects through their social capital aided in our respondents' "natural recovery" from drug-use related problems. We conclude with a discussion of the implications an analysis of social capital has for the treatment of drug-associated problems as well as for drug policy.

Illicit drug use in one's social network and in one's neighborhood predicts individual heroin and cocaine use

PURPOSE

The nature of competing social environmental factors' influence on substance abuse is unclear. A longitudinal study was undertaken to determine the relative power of social network and neighborhood characteristics to predict continuing illicit drug use.

METHODS

Three hundred forty-two inner-city adults with a history of injection drug use were followed for 1 year; their heroin and cocaine use were assessed semiannually. Multiple logistic regression models were fit to determine the degree to which social network and neighborhood characteristics, assessed at baseline, predicted continuing heroin and/or cocaine use throughout the study period.

RESULTS

Two hundred thirty-six (69%) participants reported continuing heroin and/or cocaine use. Drug use by members of the social network was a stronger predictor of participants' continuing drug use (OR = 4.31, 95% CI 2.51 to 7.40) than was a high level of drug-related arrests in the participant's neighborhood (OR = 2.41, 95% CI 1.24 to 4.71), after adjusting for drug treatment and demographic variables. Both seemed to have independent effects on study participants' drug use.

CONCLUSIONS

These findings reiterate the importance of breaking ties with drug-using associates, even for those who reside in high-risk environments. Further work is needed to develop interventions that increase drug users' success in altering social network composition or also treat drug-using network members.

The Addicted-Self Model: An Explanation of “Natural” Recovery?

This investigation examines whether the Addicted-Self Model of cessation of alcohol and drug dependent behavior (Fiorentine & Hillhouse, 2000b; in press) is able to predict unassisted or “natural” recovery. Four hypotheses are tested using a prospective investigation of individuals who drop out in the First week of outpatient treatment, do not re-enter any type of treatment or aftercare, and attend no Twelve-step meetings during the study period (n =78). Consistent with the assumptions of the model, acknowledgement of loss of control over alcohol and drug use, or low controlled use self-efficacy, predicts greater acceptance of the need for life-long abstinence. A decrease in controlled use self-efficacy is associated with an increase in abstinence acceptance. High and increasing abstinence acceptance predicts higher levels of alcohol and drug abstinence. Consistent with the Addicted-Self Model, but contrary to the Relapse Prevention Approach (Marlatt & Gordon, 1980,1985), high controlled use self-efficacy does not predict less severe relapse or lower levels of alcohol and drug use for those who continue to use these substances. Clinical implications and directions for future research are discussed.

Spontaneous remission from alcohol, tobacco, and other drug abuse: seeking quantitative answers to qualitative questions

A quantitative review of the substance abuse literature revealed a mean general prevalence of spontaneous remission from alcohol, tobacco, and other drugs abuse of 26.2% when a broad definition of remission was employed and 18.2% when a narrow definition was implemented. From the results of this review, it was concluded that few meaningful differences exist between spontaneous remitters and persons who either continue misusing substances or remit through treatment on pre-remission measures of prior drug involvement. Of the factors cited by self-remitters as important in facilitating their desistance from substances, the present review found that health concerns, pressure from friends and family, and extraordinary events were instrumental in initiating spontaneous remission, while social support, non-drug-using friendships, willpower, and identity transformation were pivotal in maintaining change. Evidence is presented to indicate that spontaneous remission from alcohol and illicit drugs and spontaneous remission from tobacco smoking may differ in several key respects.

Addicts' narratives of recovery from drug use: constructing a non-addict identity

Sociological accounts of the process of recovery from dependent drug use have emphasised the importance of the individual constructing a non-addict identity for themselves. Following Giddens we identify the process of providing a narrative of their recovery as one of the mechanisms by which addicts may seek to achieve this. The narratives of recovery which are the subject of this paper were elicited in the course of semi-structured interviews with a sample of 70 recovering addicts. There were three key areas in which the addicts' narratives of recovery could be seen to be constructing a non-addict identity for the individual; firstly, in relation to the reinterpretation of aspects of their drug using lifestyle; secondly, in relation to the reconstruction of their sense of self and thirdly, in relation to the provision of convincing explanations for their recovery. In certain respects, the addicts' narratives of recovery are similar to the accounts of recovery provided by drug workers and addictions researchers. The paper argues that the correspondence between addicts' own accounts of their recovery and those of professional drug workers may be not so much the result of the intrinsic nature of the recovery process as a product of the socially constructed nature of the narratives and the fact that the latter may have been developed in conjunction with those working in the drug treatment industry.

Exploring the additive effects of drug misuse treatment and Twelve-Step involvement: does Twelve-Step ideology matter?

Previous research revealed an additive effect of recovery activities in that those who attended Twelve-Step meetings on a weekly basis during and after outpatient drug-user treatment had higher rates of abstinence compared to those who participated in either treatment or Twelve-Step programs alone. The current investigation extends the previous research by examining the possible effects of Twelve-Step ideology on participation in Twelve-Step programs and abstinence from drug use. The findings from this treatment outcomes study indicate that the acceptance of Twelve-Step ideology, particularly strong agreement with the need for frequent, lifelong attendance at Twelve-Step meetings, and the need to surrender to a "higher power" are significant predictors of weekly or more frequent attendance at Twelve-Step meetings independent from other potentially mediating variables. Twelve-Step ideology, specifically the notion that controlled or nonproblematic drug use is not possible, predicted abstinence independent from Twelve-Step participation and other potentially mediating variables. These findings often a number of implications concerning group process and recovery from drug misuse which are addressed in the Discussion section under the following topics: 1) spirituality and group cohesion, 2) spiritual transcendence, social transcendence, and recovery; 3) spirituality and the obstruction of recovery; 4) Twelve-Step ideology and learning; 5) perceived control of drug use, self-efficacy theory, and recovery; and 7) perceived control of drug use and optimistic illusions. Directions for future research are discussed.

Drug network characteristics as a predictor of cessation of drug use among adult injection drug users: a prospective study

Few studies have examined recovery from opiate and cocaine dependence without treatment, referred to as "natural recovery," "spontaneous recovery," and "spontaneous remission." The present study examined the relationship between network characteristics and cessation of heroin, cocaine, and crack use in a sample of underclass inner-city injection drug users in Baltimore, Maryland. Participants were enrolled in an experimental human immunodeficiency virus (HIV) preventive intervention. Between the baseline and follow-up interviews, which averaged 5.2 months, 24 (7%) of 335 participants reported ceasing to use heroin, cocaine, and crack. Individuals who had reported cessation of drug use at follow-up had reported at baseline a smaller proportion of their network members with whom they used drugs (p < .02). Using multiple logistic regression analyses and adjusting for baseline drug use, enrollment in drug treatment, and demographic and background variables, cessation of drug use was associated with a lower proportion of personal network members in one's drug network (odds ratio [OR] = 25.4, p < .05). The data from this study suggest that network members have potential for social influence on the cessation of drug use.

Treated and untreated recovery from alcohol misuse: environmental influences and perceived reasons for change

This Swedish study compared assisted and unassisted subjects with different long-term drinking outcomes with regard to drinking patterns, significant life events, and attributions as to what initiated and maintained recovery. It was found that both recovery, independent of help-seeking status, and help-seeking, independent of long-term outcome, were preceded by prolonged harmful drinking consequences and increasing negative stress. Initial attempts to solve the drinking problem were followed by a significant reduction in life stress, but stable recovery was uniquely associated with stability and/or major improvements in the life context. Unassisted recovery was more often gradual in character and/ or motivated by positive incentives than assisted recovery. Possible clinical and social-political implications are discussed.

Investigation of Cigarette Smokers Who Quit without Treatment

This study investigates the phenomenon of spontaneous recovery through qualitative methodology. The Development Research Model, as introduced by James Spradley (1979) was employed with a sample of people who quit smoking without the aid of formal treatment. This technique examines the language used by informants to describe the experience of quitting. The results report that many of the informants used multiple techniques. Also of importance is the finding that the majority of the informants had relapsed and used the experience as motivation to continue trying to quite smoking. It was also found that many individuals experienced vivid dreams about smoking while undergoing the cessation process. Several important factors about the decision to quit are discussed as well as the treatment implications.

Drug-Related Identity Change: Theoretical Development and Empirical Assessment

Our study targets an understanding of the drug-related identity change process, which may offer important sociological insights into the etiology of drug abuse. Our work is grounded in symbolic interactionism, cultural studies, and an extant drug-identity model (Anderson 1994). We use a quantitative survey instrument and retrospective accounts to test our model with a representative sample of white and black females and males seeking treatment for drug abuse in mid-Michigan.

Our data show that for many drug-related identity change began in childhood and early adolescence with marginalizing experiences that helped create ego identity discomfort and lost control in defining an identitybefore drug use. Identification with a drug subculture offered alternative identities to resolve such predicaments. Additionally, we found that identification with a drug subculture significantly reduced ego identity discomfortduringdrug use, which, thereby, substantiates the claim that subcultures can act as solutions to individual problems and predicaments.

The challenge of sobriety: natural recovery without treatment and self-help groups

Natural recovery is a phenomenon that is not understood and largely challenged by self-help group members and professionals working in the field of substance abuse. So strong is the supposition of the process of recovering as a life-long condition that requires treatment and/or a self-help group for on-going support and rehabilitation that recovery on one's own is given little credence. Yet there is growing empirical evidence that natural recovery not only exists, but may be more prominent than is currently recognized. This article presents a study of natural recoverers from alcoholism and problem drinking, reporting their subjective motivating factors and strategies of recovery, while examining an issue of which there is still limited data--the perceived changes since abstaining, i.e., how their lives have been altered by pursuing abstinence on their own. It concentrates on rich narrative data to explore the meaning of the change experience that can be applied to various addictions, for the purpose of illuminating novel approaches that have the potential for expanding practice techniques and forums, thereby enhancing its effectiveness.

A selected bibliography on the drug use(r) "career"

This paper provides a brief discussion of the issues in examining "heavy" drug use in terms of a "career." This is an old paradigm in drug user research, and one that has produced some of the richest descriptions in the literature. It draws on the analytic approach developed to study other criminal activity in terms of "criminal careers" as well as the literature describing the variety of career "patterns" for substance users. Research into drug user careers is focused on the most serious, chronic substance users and examines the predictors of transition from lower level involvement to higher levels of involvement. Their use differs from that of experimental or social-recreational use in terms of its frequency and its significance in the user's life. The bibliography is divided into two general headings: research which described drug use careers and methodological issues in studying drug use careers. It ranges from classic narratives of the lives of drug users to discussions of the problems of trying to characterize accurately or to follow complex lives over time.

Paths to recovery from substance misuse: change of lifestyle and the role of treatment

Controlled outcome studies have, on the whole, failed to demonstrate more than rather weak and short-lived effects of substance misuser treatment. There is, at the same time, growing evidence that people often recover from substance misuse problems without the help of formal treatment. This state of affairs has, not least in times of economic recession, been taken as an argument for cutting fundings of treatment facilities and other forms of formal help. This article questions that present knowledge necessarily justifies such conclusions. We do know that even severe misusers are sometimes capable of changing their way of life. We do not, however, know very much about the circumstances and situations-planned or not and designated as "treatment" or something else-that contribute to such change processes. A closer integration of two research areas-outcome research and research on "spontaneous recovery"-is proposed as a way of learning more about the possible interplay between "real life" events, various formal interventions, and change of life style.

The Natural History of Substance Misuse in an Incarcerated Criminal Population

The natural history of substance misuse was explored in 343 medium security federal inmates. Of the subjects surveyed, 144 (42.0%) acknowledged a prior history of substance misuse, minimally defined as weekly ingestion of a psychoactive substance for a period of 3 or more months. Whereas the majority of subjects reported that they were abstinent due only to incarceration (57.4%), a quarter of the sample (24.8%) affirmed that they stopped using drugs on their own without treatment (spontaneous remission). Differences were observed between subjects who continued using or desisted only because of incarceration and subjects who displayed spontaneous remission. Several interpretations of this finding are possible, one being that subjects in the spontaneous remission group perceived themselves as having experienced significantly fewer problems as a consequence of drug use than subjects in the continued use and incarceration groups.

Social identities and response to treatment for alcohol and cocaine abuse

This study examined the relationship between social identities and response to treatment for alcohol and/or cocaine abuse. Individuals who reported more valued (i.e., positive and important) social identities were expected to have better treatment outcomes. Forty-five participants were interviewed at treatment entry and at 3 and 6 months after starting treatment. The number of valued identities increased between treatment entry and 3 months. Participants with a greater number of valued identities at treatment entry were more likely to be abstinent at 3 months. Participants who reported more interference between substance use and valued identities were also more likely to be abstinent at 3 months, suggesting a possible motivational mechanism for the link between identities and response to treatment. Neither number of valued identities nor conflict between substance use and identities predicted abstinence between 3 and 6 months. Interaction effects, specific identities, and protective and motivational functions of social identities are discussed.

Retention in methadone maintenance treatment programs, Connecticut and Massachusetts, 1990-1993

The goal of this study was to identify factors associated with six- and 12-month retention in methadone maintenance treatment programs (MMTPs) in Massachusetts and Connecticut. Data was obtained from 674 participants, clinic records, and clinic staff. Ethnographic and logistic regression analyses were conducted. Overall, 69% and 48% of the clients remained in treatment at six months and 12 months, respectively. The MMTPs were categorized as either a 12-Step, case management, or primary care model. Factors independently associated with retention in treatment at six months were each one-year increase in age of client (OR 1.05), injecting at three months (OR 0.47), and enrollment in the primary care model (OR 2.10). The same factors were associated with 12-month retention in treatment. To retain clients in MMTPs-which should, in turn, help reduce drug use and prevent HIV transmission among IDUs-younger IDUs and clients still injecting at three months after entering drug treatment may need additional services from the staff, or alternative treatment regimens. MMTP directors should consider differences between these programs and, if appropriate, make changes to increase retention in treatment.

Situational analysis of coping in substance-abusing patients

A recently revised version of the Situational Competency Test (SCTDR), a tape-recorded role-play assessment procedure, was used to evaluate situational specificity of coping in hospitalized substance-abusing patients (N = 24). Responses to six types of high-risk situations were scored according to coping method used (active cognitive, active behavioral, avoidance, help-seeking) and objective response parameters (latency, duration, specification, compliance). Additionally, patterns of past drug use and self-efficacy were evaluated for situational variability and association with coping response measures. Findings revealed that the situational profiles for each of the four coping methods were distinct, and that each coping method was used differentially across high-risk situations. Objective scoring dimensions demonstrated patterns of situational specificity, for example, subjects' responses in situations involving unpleasant emotions were more delayed, shorter, and less specific than in other types of high-risk situations. Heavy past drug use and low self-efficacy were significantly related to latency in responding. These findings are consistent with previous studies in which substance abusers' coping was shown to be at least partially dependent on situational parameters.

Public health care policies for drug addicts in Amsterdam

Recognizing that drug addiction is a chronic health problem for which, in the majority of cases, no curative, effective treatment exists, Amsterdam developed a coherent system of public health measures. Data on the course of the local drug epidemic, including medical complications such as AIDS, tuberculosis and mortality, are presented.

Relapse prevention: an emerging technology for promoting long-term drug abstinence

This article reviews relapse prevention strategies that can be applied after primary drug treatment. To sustain their own recovery, ex-addicts must learn a program of self-management to cope with drug cravings and social pressures to use drugs, become integrated into a new social network, learn to find pleasure in drug-free activities, and find new ways of responding to emotional stress and physical pain. While additional research is needed to identify the very best methods, there is now sufficient evaluation data to argue that practitioners should incorporate this approach as an integral part of their treatment services.

A comparison study of treated and untreated pregnant and postpartum cocaine-abusing women

The purpose of this study was to determine whether untreated pregnant and recently post-partum cocaine-abusing women could be differentiated from women who enrolled in drug treatment programs. The experimental sample was selected from women referred to the Georgia Addiction, Pregnancy, and Parenting Project, an intervention program for pregnant and postpartum addicted women, between January 1987 and January 1988 (n = 45). The comparison group was randomly selected from women who were admitted to two (2) day treatment programs during the same time period (n = 50). Groups were compared using the Addiction Severity Index (ASI) and the Psychiatric Symptom Checklist-90 (SCL-90). Results indicated that untreated women were less impaired socially and exhibited fewer symptoms of psychiatric distress. These findings confirm the commonly held belief that the severity of psychosocial distress may be an important motivating factor in the decision to enter drug treatment. Alternatively, the lack of gender-sensitive program components, such as childcare, and the social stigma attached to drug use in pregnancy may also account for the reluctance of pregnant and post-partum mothers to seek drug treatment. Implications for the development of intervention and treatment programs for women are discussed.

Abstinence, reasons for not drinking, and life satisfaction

This study examines the reasons given for not drinking by abstinent alcoholics with varying lengths of sobriety. A Reasons for Not Drinking Scale is tested, as well as the Purpose in Life Questionnaire and Life Satisfaction Scale. Subjects are 60 males from a VA population. Results show that subjects with less education and those treated in a detoxification setting are more likely to endorse negative reasons for not drinking. Individuals with short and long abstinence have a higher level of life "dissatisfaction" than those with moderate periods of abstinence. The study suggests that purpose in life, life satisfaction, and reasons for not drinking are important measures of progress in treatment and movement through phases of recovery.

Evaluation of the effectiveness of adolescent drug abuse treatment, assessment of risks for relapse, and promising approaches for relapse prevention

A review of controlled evaluations of adolescent and other drug abuse treatment programs concludes that some treatment is better than no treatment, that few comparisons of treatment method have consistently demonstrated the superiority of one method over another, that posttreatment relapse rates are high, and that more controlled studies of adolescent treatment which allow evaluation of the elements of treatment are needed. In the absence of the clear superiority of specific treatment techniques, it is suggested that examination of factors related to relapse can provide an empirical base for identifying effective treatment approaches. Pretreatment, during-treatment, and posttreatment factors related to relapse are reviewed from existing studies of adolescent treatment. Program components are suggested which have been associated with or hold promise for reducing factors associated with higher relapse rates and increasing factors associated with lower relapse rates.

Relapse and recovery in drug abuse: research and practice

Relapse and recovery are two related areas which are central to drug abuse treatment research and practice. The view of drug addiction and dependence as a chronic, relapsing disease is supported by both research and clinical experience. Recent research shows that many drug abusers have relatively short "addiction careers" and suggests that a better understanding of relapse (and its prevention) may assist treatment providers in more effectively moving clients toward recovery.

A Moral Vision of Addiction: How People's Values Determine Whether They Become and Remain Addicts

Contemporary theories of addiction of all stripes rule out faulty values as a cause of addiction. Yet evidence from cross-cultural, ethnic, and social-class research, laboratory study of addictive behavior, and natural history and field investigations of addiction indicate the importance of value orientations in the development and expression of addictive behaviors, including drug and alcohol addiction, smoking, and compulsive eating. Furthermore, the rejection of moral considerations in addiction deprives us of our most powerful weapons against addiction and contributes to our current addiction binge. The disease myth of addiction in particular attacks the assumption of essential moral responsibility for people's drug use and related behavior, an assumption that we instead ought to be encouraging.

The Disease and Adaptive Models of Addiction: A Framework Evaluation

Underlying a vast proliferation of theory, there are two fundamentally different views of addiction. The first conceptualizes addiction as an illness (disease model) and the second as a way of coping (adaptive model). From the vantage point of the modern history and philosophy of science, both models are better evaluated as “frameworks” than as empirically testable hypotheses. A “framework evaluation” reveals that both models provide a comprehensive, coherent analysis of addiction and both can claim some empirical support, but that they differ sharply in their utility for formulating promising and humane policy. The disease model provides a major part of the justification for excessive, ineffective drug control policies and supports values that are repellent outside the drug field. The adaptive model, on the other hand, implies more humane and potentially more effective policy. This article argues the necessity of a framework evaluation and the superiority of the adaptive model over the disease model and over combinations of the two models.

Delinquency cessation and adolescent development: preliminary data

Recent research on juvenile criminal careers has documented a consistent drop in the prevalence of delinquent activity during late adolescence, but there are only a few limited investigations of the processes underlying this occurrence. The present report of retrospective interviews with a sample of recently "reformed" 15-20-year-old white males suggests directions for larger-scale and more rigorous research.

Addiction Careers: Etiology, Treatment, and 12-Year Follow-up Outcomes

Follow-up interviews were conducted with 405 black and white male opioid addicts 12 years after admission to drug abuse treatments in the Drug Abuse Reporting Program. Outcomes over time in this longitudinal data system showed that the behavioral improvements observed throughout the first 6-year posttreatment follow-up period (compared with pretreatment baselines) tended to stabilize between Years 6 and 12. About one-fourth of the sample still used opioid drugs daily in Year 12. Demographic and background measures generally failed to predict Year 12 outcomes, although Year 6 outcomes were related to those in Year 12. Reasons for starting, continuing, and terminating opioid addiction were also examined, as well as the importance of treatment during addiction careers.

Spontaneous remission from the problematic use of substances: an inductive model derived from a comparative analysis of the alcohol, opiate, tobacco, and food/obesity literatures

Despite obvious theoretical and treatment implications, the study of how individuals end the "compulsive" use of substances without formal treatment ("spontaneous remission") remains a relatively neglected topic. This paper reviews the literature germane to spontaneous remission from four substances (opiates, alcohol, food/obesity, and tobacco) selected for their widely variant meanings within the mainstream North American culture. Common processes important to spontaneous remission from these four substances are identified and form the basis of an inductively derived model of spontaneous remission behavior. This model, relevant to interactionist theory, is offered for further, empirical testing.

Dealing with drugs: heroin abuse as a social problem

Reported here are attitudes and perceptions regarding heroin control, prevention, and treatment obtained in a survey of community leaders in four high drug traffic and drug use neighborhoods in New York City. Studies in the past have focused on the causes and consequences of heroin use primarily from the standpoint of the drug user. Operationalizing the tenet that heroin abuse is a social problem, this study develops an ecological paradigm for analyzing the effects on neighborhoods of illicit drugs and of prevention, intervention, and treatment policies. The research was undertaken in 1981 for the New York State Heroin and Alcohol Study Commission. It demonstrates the importance of including community perspectives in policy decisions and the usefulness of a study group of community leaders as a reliable source of this information.