Social Factors Associated with Pharmacists' Unauthorized Use of Mind-Altering Prescription Medications

A “medical model” ideology dominates the study of drug abuse among health care professionals. This perspective defines and approaches drug abuse as a disease. While this disease is said to have bio-psycho-social origins, scholars have principally focused on possible biological and psychological factors that produce a “predisposition” to drug abuse. Pertinent social factors have been largely overlooked. Drawing upon the membership list (N=50,000+) of the American Pharmaceutical Association, a random sample of 2,036 practicing pharmacists were queried to investigate the relationship between pharmacists' educational, occupational, and professional socialization and their involvement in illicit prescription drug use. A total of 1,016 (50.2%) questionnaires were returned. The data show that 40.1% of the respondents self-reported illegally using some form of potentially addictive, mind-altering prescription drug. Further, 21% reported 5 or more lifetime use episodes and 6.6% reported more than 10. Multivariate analysis reveals significant relationships between numerous social factors and pharmacists' levels of self reported drug use. The existence of these relationships raises the possibility that certain aspects of the professional socialization process may also play a role in the etiology of pharmacists' drug abuse. We conclude that there exists a need to revisit current theoretical and policy approaches to this social problem.

Prevalence and predictors of problematic alcohol use, risky sexual practices and other negative consequences associated with alcohol use among safety and security employees in the Western Cape, South Africa

Introduction

Harmful alcohol use can compromise worker health and productivity. Persons employed in safety-sensitive occupations are particularly vulnerable to hazardous alcohol use and its associated risks. This study describes the patterns of harmful alcohol use, related HIV risks and risk factors for the harmful use of alcohol among a sample of employees in South Africa working in the safety and security sector.

Methods

A cross-sectional study that formed the baseline for a clustered randomized control trial was undertaken in 2011. A random sample of 325 employees employed within a safety and security sector of a local municipality in the Western Cape Province of South Africa participated in the study. Data were collected by means of an 18-page self-administered structured questionnaire and analyzed using SAS/STAT software version 9.2. For all significance testing, the F-statistic and p-values are reported.

Results

Three hundred and twenty-five employees were surveyed. Findings suggest that more than half (76.1%) of the 78.9% of participants who consumed alcohol engaged in binge drinking, with close to a quarter reporting a CAGE score greater than the cut-off of 2, indicating potentially hazardous drinking patterns. The study further found that employees who use alcohol are more likely to engage in risky sexual practices when under the influence. A favorable drinking climate (p < 0.001) and poor levels of group cohesion (p = 0.009) were significantly correlated to binge drinking.

Conclusion

This study identifies alcohol-related behaviors and associated risks in the context of safety-sensitive occupations at the workplace. It suggests that persons employed within such positions are at high risk for developing alcohol-related disorders and for contracting HIV. This study highlights the need for testing a comprehensive package of services designed to prevent hazardous alcohol use among safety and security employees.

Self-Esteem and “At Risk” Women: Determinants and Relevance to Sexual and HIV-Related Risk Behaviors

In this study, we describe the relationship between self-esteem and HIV-related risk behaviors, and explore what factors predict self-esteem levels of "at risk" women. Interviews were conducted with 250 (predominantly African American) women living in the Atlanta, Georgia metropolitan area between August 1997 and August 2000. A community identification process was used to identify potential study participants, with further expansion of the sample via targeted and theoretical sampling and ethnographic mapping procedures. Self-esteem was related to the number of times having oral sex, the number of times having sex with paying partners, the frequency of sexual risk-taking (all during the 90 days prior to interview), the number of different HIV risk behaviors practiced during the previous year, and condom use attitudes and self-efficacy. Greater involvement HIV risk behaviors was associated with lower self-esteem. Multivariate analyses revealed five significant predictors of women's self-esteem levels: race, religiosity, childhood experiences with emotional neglect, the number of money-related problems experienced, and the number of drug-related problems experienced. The findings indicate that self-esteem is highly relevant to "at risk" women's HIV risk behavior practices, and this has important implications for HIV intervention programs.

Job risk and employee substance use: the influence of personal background and work environment factors

Previous studies have noted that employees who work in jobs with physical risk report more substance use than employees working in nonrisky jobs. This study examined the extent to which this relationship could be explained by personal background, specifically general deviance or psychosocial functioning, or work characteristics, including job stressors, organizational bonding, or work group drinking climate. Results from two worksites (ns = 943, 923) indicated that the relationship of job risk and alcohol problems could be fully explained by personal characteristics, particularly deviant behavior styles. Interaction effects were also found. Employees with more deviance indicators were particularly susceptible to recent drug use and problem drinking when they worked in drinking climates or exposed to co-worker drinking. These results suggest the joint influence of personal and job factors and support prevention programs that target the workplace social environment.

General and job-related alcohol use and correlates in a municipal workforce

We examined the prevalence and correlates of both general and workplace-related drinking measures using data from a telephone survey of 673 workers in a large municipal bureaucracy and tested the hypothesis that observed differences across job categories can be explained by compositional difference in terms of demographic variables known to be related to drinking behavior. Results suggest such factors account for much of the variation in general drinking measures (prior-28-day quantity, CAGE score, indicating risk for dependence), but that significant variation in a workplace-related drinking measure (times ever drank before, during, or just after work) remains even after such factors are controlled. Implications of these findings for existing theories of workplace effects on drinking are discussed, along with a consideration of appropriate levels of analysis for future studies.

Onset of illegal use of mind-altering or potentially addictive prescription drugs among pharmacists

OBJECTIVES

To determine the temporal and descriptive aspects of pharmacists' decision-making processes regarding illegal use of mind-altering or potentially addictive prescription drugs (PAPDs) and to measure the effects of social factors associated with being and becoming a pharmacist on pharmacists' decisions to use PAPDs illegally.

DESIGN

One-time, written, mailed survey.

SETTING

United States.

PARTICIPANTS

Random sample of licensed practicing pharmacists who were members of the American Pharmaceutical Association in fall 1996.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Responses to items on the survey.

RESULTS

Nearly 40% of respondents indicated that they had used a form of PAPD without first obtaining a physician's authorizing prescription. A significant portion of the sample showed signs of repeated use-20% of the respondents reported 5 or more lifetime PAPD-use episodes, and 6% reported more than 10 such episodes. Almost 6% of the respondents identified themselves as being drug abusers at some point during their pharmacy careers. Moreover, a full 88% of these pharmacists began such illegal PAPD use after entering college, 51% used more than one type or class of PAPD, and 69% directly violated their professional code of ethics and state and/or federal laws by either stealing PAPDs from their place of employment (61%) or forging prescriptions (8%) to obtain them.

CONCLUSION

A considerable percentage (40%) of the pharmacists surveyed had, on at least one occasion, used some form of PAPD without first obtaining a physician's authorizing prescription, and about one-fifth of respondents reported repeated use. The onset of such illegal PAPD use by pharmacists almost always occurred after the individuals had entered college. Interpersonal factors, such as positive reinforcement of self-medication practices from peers and increased levels of one's own approval for self-medication, appear to increase the likelihood that a pharmacist will engage in such illegal PAPD use.

Prospective relationships between drug problems and work adjustment in a community sample of adults

The prospective relationships between drug problems and work adjustment (e.g., job instability, job satisfaction) were examined in a community sample of 470 adults. Polydrug problems (alcohol, marijuana, and cocaine problem drug use) were both predictors and consequences of work adjustment. In partial support of the impaired functioning theory, polydrug problems predicted reduced job satisfaction 4 years later. Supporting the work-related strain theory, early job instability predicted polydrug problems 4 years later. In support of the theory of general deviance, low social conformity predicted later job instability. Finally, supporting social support theory, early support for drug problems reduced polydrug problems and increased job satisfaction 4 years later.

Job strain and non-medical drug use

In this study, the Karasek demand/control formulation of job strain, initially used in research on cardiovascular health, has been extended to drug use. Full-time nurses (n = 2375), all participants in a national anonymous mailed survey, were an estimated 1.5 times more likely to be a recent non-medical drug user if they had a high strain job as compared to nurses in low strain jobs. The psychosocial work environment might influence whether nurses become and remain non-medical drug users, over and above the risk-modifying functions related to nurses' individual vulnerabilities and their greater access to controlled substances.

Occupational risk factors associated with alcohol and drug problems

Ames and Janes provide a theoretical framework that explains alcohol and/or drug problems among workers. Existing studies of occupational risk factors for alcohol and drug problems across multiple occupations and industries provide mixed findings with respect to Ames and Janes' framework. In a preliminary study, the relationships between occupational characteristics and measures of alcohol and drug problems were investigated among a sample of workers from a variety of occupations and industry settings. Some support was found for all of the major elements of Ames and Janes' framework: normative regulation of drinking, quality and organization of work, workplace factors, and drinking subcultures.