Improving understandings of trauma and alcohol and other drug-related problems: A social research agenda.

Trauma is increasingly understood to shape a range of alcohol and other drug (AOD)-related problems, including addiction, relapse, mental illness and overdose. However, the merits of understanding AOD-related problems as the effect of trauma are uncertain with the nature and implications of such linkages requiring closer scrutiny. Where trauma is linked to AOD-related problems, this relationship is typically treated as self-evident, obscuring the uncertainties in knowledge surrounding the notion of trauma itself. Informed by insights from critical drugs and trauma scholarship that challenge deterministic notions of AOD 'problems' and trauma, this essay identifies key issues for social research in this area that warrant further consideration. We argue that there is a pressing need to acknowledge variation and diversity in the relationship between trauma and AOD-related problems, and the gendered and sexual dynamics shaping the expansion of the trauma paradigm. We then outline how critical Indigenist interdisciplinary work can inform culturally specific knowledge on trauma and AOD-related problems, and also suggest targeted research on the delivery and experience of trauma-informed approaches in the AOD context. To this end, we present several recommendations for a social research agenda underpinned by critical, qualitative research into how people experience and manage trauma and AOD-related problems in their everyday lives.

A novel predictive algorithm to personalize autologous T-cell harvest for chimeric antigen receptor T-cell manufacture.

BACKGROUND AIMS: The most widely accepted starting materials for chimeric antigen receptor T-cell manufacture are autologous CD3+ T cells obtained via the process of leukapheresis, also known as T-cell harvest. As this treatment modality gains momentum and apheresis units struggle to meet demand for harvest slots, strategies to streamline this critical step are warranted. METHODS: This retrospective review of 262 T-cell harvests, with a control cohort of healthy donors, analyzed the parameters impacting CD3+ T-cell yield in adults with B-cell malignancies. The overall aim was to design a novel predictive algorithm to guide the required processed blood volume (PBV) (L) on the apheresis machine to achieve a specific CD3+ target yield. RESULTS: Factors associated with CD3+ T-cell yield on multivariate analysis included peripheral blood CD3+ count (natural log, ×109/L), hematocrit (HCT) and PBV with coefficients of 0.86 (95% confidence interval [CI], 0.80-0.92, P < 0.001), 1.30 (95% CI, 0.51-2.08, P = 0.001) and 0.09 (95% CI, 0.07-0.11, P < 0.001), respectively. The authors' model, incorporating CD3+ cell count, HCT and PBV (L), with an adjusted R2 of 0.87 and root-mean-square error of 0.26 in the training dataset, was highly predictive of CD3+ cell yield in the testing dataset. An online application to estimate PBV using this algorithm can be accessed at https://cd3yield.shinyapps.io/cd3yield/. CONCLUSIONS: The authors propose a transferrable model that incorporates clinical and laboratory variables accessible pre-harvest for use across the field of T-cell therapy. Pending further validation, such a model may be used to generate an individual leukapheresis plan and streamline the process of cell harvest, a well-recognized bottleneck in the industry.

The hammer and the nail: The triple lock of methods, realities and institutional contexts in Australian research on nightlife violence.

There is considerable public and policy debate in Australia about measures to reduce violence associated with alcohol and young people in the night-time economy. Though overrepresented in violence, the role of men and masculinities is rarely explicitly addressed in policy responses to such violence, which rest on a narrow range of mainly quantitative research and recommendations favouring blanket alcohol restrictions. Drawing on John Law and colleagues' account of the 'double social life of methods' (2011), we analyse interviews conducted with Australian quantitative researchers about the role of gender in such violence. According to Law et al., methods inhabit and reproduce particular ecologies and reflect the concerns of those who advocate them. From this 'triple lock' of methods, realities, and institutional advocacies and contexts emerges particular modes of knowing. Participants described a research ecology in which the authority of quantitative research methods emerged in relation to an imperative to respond in a 'timely' and 'pragmatic' fashion to public policy debates, and prevailing governmental and policy priorities and public framings of violence. Though participants frequently acknowledged the role of men in violence, these arrangements sustain taken-for-granted assumptions about the properties and effects of alcohol while displacing men and masculinities from policy attention. The political consequences of these arrangements demand the development of innovative policy responses and new modes of knowing that make visible the gendering of violence.

Noticed and then Forgotten: Gender in Alcohol Policy Stakeholder Responses to Alcohol and Violence.

In this article, we analyse interview data on how alcohol policy stakeholders in Australia, Canada and Sweden understand the relationship between men, masculinities, alcohol and violence. Using influential feminist scholarship on public policy and liberal political theory to analyse interviews with 42 alcohol policy stakeholders, we argue that while these stakeholders view men's violence as a key issue for intervention, masculinities are backgrounded in proposed responses and men positioned as unamenable to intervention. Instead, policy stakeholders prioritise generic interventions understood to protect all from the harms of men's drinking and violence without marking men for special attention. Shared across the data is a prioritisation of interventions that focus on harms recognised as relating to men's drinking but apply equally to all people and, as such, avoid naming men and masculinities as central to alcohol-related violence. We argue that this process works to background the role of masculinities in violence, leaving men unmarked and many possible targeted responses unthinkable.

Recommendations for procurement of starting materials by apheresis for advanced therapy medicinal products.

Activities involved in the production of certain advanced therapy medicinal products (ATMPs) require standardized approaches to mononuclear cell procurement to ensure the highest product quality, safety and process efficiency. These aims must be achieved while meeting regulatory and accreditation requirements for the procurement of mononuclear cells as starting materials. Mononuclear cells constitute the starting materials for many ATMPs, and this article sets out recommendations for procurement by clinical apheresis, addressing the variation among existing working practices and different manufacturers' requirements that currently poses a challenge when managing multiple different protocols.

Gendering practices in quantitative research on alcohol and violence: Comparing research from Australia, Canada and Sweden.

In this article, we analyse the treatment of gender in Canadian and Swedish quantitative research on alcohol and violence and compare it with the treatment of gender in similar Australian research. In previously published work, we argued that Australian research on 'alcohol-related presentations' to emergency departments, and on alcohol and violence among young people participating in the night-time economy, tends to overlook the stark gendering of violence in its analyses and policy recommendations. It does this via a series of 'gendering practices' (Bacchi, 2017): omitting gender from consideration; overlooking clearly gendered data when making gender-neutral policy recommendations; rendering gender invisible via methodological considerations; displacing men and masculinities via a focus on environmental, geographical and temporal factors; and addressing gender in limited ways. We identify a similar set of gendering practices at work in Canadian and Swedish quantitative research on alcohol and violence, as well as a key difference. This key difference emerges in relation to the practice of addressing gender. Here, we see a bifurcation in the Canadian studies: between one group of articles in which gender is central to the analyses and ensuing policy recommendations, and a second group containing only one example in which gender is partially addressed. We draw attention to the differing realities of gender, alcohol and violence iterated by these contrasting knowledge practices, and offer two possible explanations for this difference. We close by asking how future research analyses and policy recommendations might differ if gender-sensitive quantitative tools were developed, gender considerations were systematically integrated, and gendered effects were taken into account when alcohol policy choices are made.

A normalised future of addiction.

This essay speculates about the possibility of a normalised future of addiction, where dependence on substances is no longer attached to a disease category or disordered identity. It draws on critical sociological literature addressing expectation and the moral economy of anticipation, as well as adopting a utopian perspective inspired by feminist and queer theory. It questions dominant discourses of technologised innovation in the addiction field, and instead sees openings towards a better future in the spaces and practices of harm reduction.

Enacting alcohol realities: gendering practices in Australian studies on 'alcohol-related presentations' to emergency departments.

'Alcohol-fuelled violence' and its prevention has been the subject of recent intense policy debate in Australia, with the content of this debate informed by a surprisingly narrow range of research resources. In particular, given the well-established relationship between masculinities and violence, the meagre attention paid to the role of gender in alcohol research and policy recommendations stands out as a critical issue. In this article, which draws on recent work in feminist science studies and science and technology studies, we focus on the treatment of gender, alcohol and violence in Australian research on 'alcohol-related presentations' to emergency departments (EDs), analysing this type of research because of its prominence in policy debates. We focus on four types of 'gendering practice' through which research genders 'alcohol-related presentations' to EDs: omitting gender from consideration, ignoring clearly gendered data when making gender-neutral policy recommendations, methodologically designing out gender and addressing gender in terms of risk and vulnerability. We argue that ED research practices and their policy recommendations reproduce normative understandings of alcohol's effects and of the operations of gender in social arrangements, thereby contributing to the 'evidence base' supporting unfair policy responses.

Vapers' perspectives on electronic cigarette regulation in Australia.

BACKGROUND: The use of electronic cigarettes (e-cigarettes), also known as personal vaporisers (PVs), has increased rapidly in Australia despite legal barriers to the sale, possession and use of nicotine for non-therapeutic purposes. Australia is one of many countries in the process of developing regulations for these devices yet knowledge of consumers' views on e-cigarette regulation is lacking. METHODS: An online survey was completed by 705 e-cigarette users recruited online. Participants answered questions about their smoking history, e-cigarette use, as well as their opinions on appropriate regulation of e-cigarettes. RESULTS: Most participants were male (71%), employed (72%), and highly educated (68% held post-school qualification). They tended to be former heavy smokers who had stopped smoking entirely and were currently vaping. Participants generally agreed that the government should enforce minimum labelling and packaging standards and there was majority support for minimum quality standards. Most supported making e-cigarettes available for sale to anyone over the age of 18, but expressed concern about the government's motivation for regulating e-cigarettes. There was strong opposition to restricting sales to a medicines framework (prescription only or pharmacy only sales). CONCLUSION: E-cigarette users in Australia are in favour of e-cigarettes being regulated as long as those regulations do not impede their ability to obtain devices and refill solutions, which they view as important for them to remain smoke free. These views align with some aspects of appropriate policy designed to maximise the public health potential of e-cigarettes in society, but conflict with some of the proposed regulatory models. Governments should consider how future regulation of e-cigarettes will affect current consumers while helping to maximise the number of smokers who switch to e-cigarettes and minimise the possibility of non-smokers becoming addicted to nicotine.

All gates lead to smoking: the 'gateway theory', e-cigarettes and the remaking of nicotine.

The idea that drug use in 'softer' forms leads to 'harder' drug use lies at the heart of the gateway theory, one of the most influential models of drug use of the twentieth century. Although hotly contested, the notion of the 'gateway drug' continues to rear its head in discussions of drug use--most recently in the context of electronic cigarettes. Based on a critical reading of a range of texts, including scholarly literature and media reports, we explore the history and gestation of the gateway theory, highlighting the ways in which intersections between academic, media and popular accounts actively produced the concept. Arguing that the theory has been critical in maintaining the distinction between 'soft' and 'hard' drugs, we turn to its distinctive iteration in the context of debates about e-cigarettes. We show that the notion of the 'gateway' has been transformed from a descriptive to a predictive model, one in which nicotine is constituted as simultaneously 'soft' and 'hard'--as both relatively innocuous and incontrovertibly harmful.

Categorising methadone: Addiction and analgesia.

While methadone was first developed as an analgesic, and used for this purpose before it was adopted as a therapy for drug dependence, it is this latter use which has saturated its identity. Most of the literature and commentary on methadone discusses it in the context of methadone maintenance therapy (MMT). But one of the effects of the liberalization of opiate prescription for chronic pain which took place in the 1990s was the re-emergence of methadone as a painkiller. This article examines the relationship between methadone the painkiller and methadone the addiction treatment as it is constituted in recent medical research literature and treatment guidelines. It highlights the way medical discourse separates methadone into two substances with different effects depending on the problem that is being treated. Central to this separation is the classification of patients into addicts and non-addicts; and pain sufferers and non-pain sufferers. The article argues that despite this work of making and maintaining distinctions, the similarities in the way methadone is used and acts in these different medical contexts complicates these categories. The difficulties of keeping the 'two methadones' separate becomes most apparent in cases of MMT patients also being treated for chronic pain.

Making smokers different with nicotine: NRT and quitting.

This article applies the insights of Actor Network Theory to analyse some of the actions performed by Nicotine Replacement Therapy (NRT), a technology which separates nicotine physically and conceptually from the harms of tobacco and enhances its capacities to act against rather than for smoking. The article argues that NRT puts into action a medicalised logic of substitution in which dependence on nicotine becomes a route to health as well as a disorder to be treated. NRT thereby enables different performances of the substance nicotine, the identity smoker and the practice of quitting. The article draws on a range of smoking cessation and tobacco control literature, including medical and public health research, government-sponsored stop smoking websites and clinical guidelines to trace the changes produced by the shifting status of most forms of NRT from prescription medication to consumer health product. It also examines less conventional uses of NRT which produce varied practices of quitting and thus support the possibility of tobacco harm reduction based on the circulation of 'good nicotine'.

Nicotine control: E-cigarettes, smoking and addiction.

BACKGROUND: Over the past year or so, electronic cigarettes, more commonly known as 'e-cigarettes', have achieved widespread visibility and growing popularity. These products, which deliver nicotine via an inhaled mist, have caused no small amount of controversy in public health circles, and their rise has been accompanied by energetic debate about their potential harms and benefits. METHODS: Interspersed with an analysis of current media coverage on e-cigarettes and the response of mainstream tobacco control and public health to these devices, this article examines the emergence of nicotine as both as an 'addiction' and a treatment for addiction. RESULTS: We argue that by delivering nicotine in way that resembles the visual spectacle and bodily pleasures of smoking, but without the harms of combustible tobacco, e-cigarettes highlight the complex status of nicotine as both a poison and remedy in contemporary public health and tobacco control. CONCLUSION: In consequence, e-cigarettes jeopardize the carefully drawn distinctions between 'good' and 'bad' forms of nicotine.

Foucault on methadone: beyond biopower.

This essay reviews four texts which critically analyse methadone maintenance therapy using Foucault as a key theoretical framework: [Friedman, J., & Alicea, M. (2001). Surviving heroin: Interviews with women in methadone clinics. Florida: University Press of Florida], [Bourgois, P. (2000). Disciplining addictions: The bio-politics of methadone and heroin in the United States. Culture Medicine and Psychiatry, 24, 165-195], [Bull, M. (2008). Governing the heroin trade: From treaties to treatment. Ashgate: Aldershot], and [Fraser, S., & valentine, k. (2008). Substance & substitution: Methadone subjects in liberal societies. New York: Palgrave Macmillan]. Taken together these works demonstrate one trajectory in the development of critical drug studies over the past decade. While all four view MMT as a regulatory technology which aims to create productive and obedient subjects, their understandings of the power relations of the clinic are quite distinct. The first two texts emphasise the social control of drug users, the third, issues of governmentality and liberal political practice, while the fourth engages with ontological questions about substances themselves. Thus while Foucauldian analysis has become familiar in social studies of drugs and alcohol, new uses for its conceptual tools continue to emerge.