Challenges to Opioid Treatment Programs After Hurricane Sandy: Patient and Provider Perspectives on Preparation, Impact, and Recovery.

Over 300,000 patients with an opioid use disorder (OUD) receive methadone maintenance therapy from opioid treatment programs (OTPs) in the United States. Large numbers of these attend OTPs located in New York and New Jersey, areas (largely but not exclusively coastal) impacted by Hurricane Sandy (Sandy) on October 29th, 2012. Disruption of methadone dispensing and other services can have severe consequences to patients (and treatment seekers) such as relapse, dropping out of treatment and resumption or increase in HIV/HCV injection risk behaviors. To facilitate OTP preparedness and response, we developed recommendations for OTPs for future emergencies. Using both qualitative and quantitative measures, we obtained data from OTP directors, staff, patients and out-of-treatment persons to learn how OTPs prepared for the impending hurricane, whether recovery efforts were successful, and what impact the hurricane has had. We observed a wide range of preparation and recovery efforts among participating programs. Director, staff, and patient perspectives on programs' responses and storm impact often differed. Triangulated data suggest that program responses were adequate for a majority of patients. For a sizeable minority of patients, program responses were very successful; for at least 20% of the clinics, program planning and responses were inadequate to meet the needs of patients. Among the recommendations made for sustaining continuity of care in future emergencies are: a focus on improving communication, procuring transportation, guest dosing, and take home provisions.

The long tail of a demon drug: The 'bath salts' risk environment.

Using the case of synthetic cathinones (commonly referred to as 'bath salts' in the US context), this paper analyses structural factors surrounding novel psychoactive substances (NPS) as contributing to the unique risk environment surrounding their use. Drawing on interviews with 39 people who use bath salts from four U.S. cities and analysis of the infrastructural, social, economic, and policy contexts, we document the unique harms related to changing contexts for illicit drug regulation, manufacture, and consumption. Findings suggest that NPS and designer drug markets, which are highly reliant upon the internet, share characteristics of the entertainment industry which has come to rely more heavily upon profits derived from the 'long tail' of myriad lesser-known products and the diminished centrality of 'superstars' and 'hits'. Findings point toward increased theoretical and policy attention to changing drug market structures, more rigorous evaluations of drug 'analogues' legislation and greater involvement with NPS education and testing by harm reduction agencies.

Drug Use and Spatial Dynamics of Household Allocation.

Household space allocation by women who consume drugs in New York and North Florida is depicted to demonstrate the complex character of household space and social relations. Some parents attempt to hide their drug consumption through the allocation space in the household for drug use. Women allocation of space for drug use within their households and the impact of this on the household are relevant issues with implications for therapy and prevention. OBJECTIVE: The use of household space has not been a focus of social scientists. Middle class households have been used by decoration literature to specify space utilization. Modest literature pay attention to the utilization of household space among drug focused households. Analysis herein looks at the lived social relations of drug users to their children through controlling household space. METHODS: Data presented comes from two studies, New York and Florida. The studies involved a total of 158 participants in 72 families from New York and 26 participants in 23 families in North Florida. Both researches used an ethnographic methodology focusing on a variety of behavior patterns and conduct norms occurring within drug abusing households. Repeated interviews and observations took place in households which were visited at different times and days of the week. Florida study was conducted over a 2-year period; New York study took place over a 5-year period. RESULTS: Data suggest parents attempted to conceal their drug use from their offspring by using various strategies. Mental, social, and physical were tied together in space allocation. Household space acquired a different meaning and arose from use practice. CONCLUSION: In urban and rural settings a pattern of household allocation space and drug consumption is emerging. Although drug consumption is still prominent, it is not all consuming or the primary focus in the lives of women who use drugs. These women may have learned to integrate their consumption into their daily household/family life through the reallocation of space in their homes.

Knowledge, Awareness and Behavior: HIV/AIDS and Disasters.

African Americans are the most affected by HIV/AIDS. Both males and females continue to be disproportionately affected by HIV/AIDS. They are often drug users or participate in street/drug subculture. Recent weather disasters have required identification of knowledge, beliefs, conduct norms and behavior patterns that are HIV/AIDS risk factors for disaster survivors. This paper examines patterns of behavior and common practices related to HIV among disaster survivors. STUDY BACKGROUND: Data for this paper come from a three year renewal project which focused upon the processes by which illicit drug markets were reformulated after disasters and practices of risk behaviors for HIV/AIDS. Hurricanes Katrina, Gustav and Ike presented the opportunity to examine the impact of disasters upon risky behavior among illicit drug users and sellers. METHODS: From 2010-2013 ethnographic study was conducted in New Orleans, Louisiana, Houston and Galveston, Texas. Staff completed in-depth interviews with 132 focal respondents of drug users and sellers. There were 57 focus groups with 243 focus group participants; 350 drug using/selling respondents completed a survey protocol (CAPI), organized around their experiences during the hurricanes. RESULTS: In both cities respondents displayed knowledge about HIV, modes of transmission and knew that HIV infection can lead to AIDS. Knowledge about time between exposure and infection was mostly imprecise. Most respondents reported they had been tested for HIV multiple times. A large number of participants reported learning about HIV in school, older respondents (mid-40s to 60) reported their knowledge came from television or the streets. Participants expressed fatalistic attitudes toward HIV, believing the virus was fatal even with medication. CONCLUSION: With the increase of disasters, more attention needs to be placed upon programs focused on drug consumers. Schools, clinics, public information sources, i.e., TV and radio can make understanding HIV/AIDS a priority through taking into consideration specific populations and making sure literature and other forms of information is adjusted to their understanding.

Black Women with Multiple Sex Partners: The Role of Sexual Agency.

Motivations of low-income substance using heterosexual Black women in New York City for having multiple sexual partners are explored in this paper. Analysis of in-depth interviews with 50 study participants demonstrates that their relationships consisted of those who had: (1) a main sex partner and a secondary sex partner; or (2) two or more "casual" partners. Individual-level motivations for extra relational sex fell into four dominant themes: sexual pleasure, partner infidelity, sex exchange and past main partners. Using a Black feminist framework, we describe how participants displayed considerable autonomy by actively forming and withdrawing from sexual relationships with men. However, women described low rates of condom use with main partners and inconsistent use of condoms with more casual sexual partners. This contradiction becomes an important area for sexual health interventions. Women who had sexual relations with only one current mate in the past two years were recruited as a monogamous comparison group.

Cohabitation Duration and Transient Domesticity.

Research finds that many impoverished urban Black adults engage in a pattern of partnering and family formation involving a succession of short cohabitations yielding children, a paradigm referred to as transient domesticity. Researchers have identified socioeconomic status, cultural adaptations, and urbanicity as explanations for aspects of this pattern. We used longitudinal data from the 2001 Survey of Income and Program Participation to analyze variation in cohabitation and marriage duration by race/ethnicity, income, and urban residence. Proportional hazards regression indicated that separation risk is greater among couples that are cohabiting, below 200% of the federal poverty line, and Black but is not greater among urban dwellers. This provides empirical demographic evidence to support the emerging theory of transient domesticity and suggests that both socioeconomic status and race explain this pattern. We discuss the implications of these findings for understanding transient domesticity and make recommendations for using the Survey of Income and Program Participation to further study this family formation paradigm.

Trends in Video Game Play through Childhood, Adolescence, and Emerging Adulthood.

This study explored the relationship between video gaming and age during childhood, adolescence, and emerging adulthood. It also examined whether "role incompatibility," the theory that normative levels of substance use decrease through young adulthood as newly acquired adult roles create competing demands, generalizes to video gaming. Emerging adult video gamers (n = 702) recruited from video gaming contexts in New York City completed a computer-assisted personal interview and life-history calendar. All four video gaming indicators-days/week played, school/work day play, nonschool/work day play, and problem play-had significant curvilinear relationships with age. The "shape" of video gaming's relationship with age is, therefore, similar to that of substance use, but video gaming appears to peak earlier in life than substance use, that is, in late adolescence rather than emerging adulthood. Of the four video gaming indicators, role incompatibility only significantly affected school/work day play, the dimension with the clearest potential to interfere with life obligations.

Recollections of sexual socialisation among marginalised heterosexual black men.

This paper describes the sexual socialisation process of marginalised, drug-using heterosexual black men, focusing primarily on the sources and content of sexual information. Analysing qualitative interview data, we discovered that the men in our sample both learn about sex and become sexually active at an early age. They most often learn about sex from the media and least often learn about sex from family members. The content of sexual information varies in specifics, but overall tends to equate sex with pleasure, encourage sexual activity with multiple partners, and emphasise using protection. Our goal is to use this data to better understand how sexual socialisation contributes to the prevalence of multiple sexual partners and high rates of HIV among heterosexual black men in order to inform future risk-reduction intervention programmes.

A Genre-Specific Investigation of Video Game Engagement and Problem Play in the Early Life Course.

This study explored predictors of engagement with specific video game genres, and degree of problem play experienced by players of specific genres, during the early life course. Video game players ages 18-29 (n = 692) were recruited in and around video game retail outlets, arcades, conventions, and other video game related contexts in New York City. Participants completed a Computer-Assisted Personal Interview (CAPI) of contemporaneous demographic and personality measures and a Life-History Calendar (LHC) measuring video gaming, school/work engagement, and caffeine and sugar consumption for each year of life ages 6 - present. Findings were that likelihood of engagement with most genres rose during childhood, peaked at some point during the second decade of life, and declined through emerging adulthood. Cohorts effects on engagement also emerged which were probably attributable to changes in the availability and popularity of various genres over the 12-year age range of our participants. The relationship between age and problem play of most genres was either negative or non-significant. Sensation-seeking was the only consistent positive predictor of problem play. Relationships between other variables and engagement with and problem play of specific genres are discussed in detail.

Surviving oppression under the rock: the intersection of New York's drug, welfare, and educational polices in the lived experiences of low-income African Americans.

Drawing on standpoint and intersectionality theories, this study explores the degree to which interactions among New York State's Rockefeller Drug Laws and educational and welfare policies have contributed to the maintenance of a culture of surveillance in which the lives of impoverished African Americans are overseen and influenced by oppressive policies and governmental institutions. Qualitative secondary analysis of longitudinal ethnographic data was conducted. Findings demonstrate multiple disadvantages that impoverished African American families struggling with substance use or sale experience. These disadvantages accumulated intergenerationally, in a snowball effect, making it difficult for participants to maintain stable lives. Findings explored the tension between participants' lived experiences and the multiple ways they either assimilated or resisted their oppression. New sensitive policies informed by standpoint, intersectionality, and Afrocentric perspectives must be developed to increase the availability of meaningful employment and strengthening impoverished African American communities.

Stages of drug market change during disaster: Hurricane Katrina and reformulation of the New Orleans drug market.

BACKGROUND: In recent years, numerous weather disasters have crippled many cities and towns across the United States of America. Such disasters present a unique opportunity for analyses of the disintegration and reformulation of drug markets. Disasters present new facts which cannot be "explained" by existing theories. Recent and continuing disasters present a radically different picture from that of police crack downs where market disruptions are carried out on a limited basis (both use and sales). Generally, users and sellers move to other locations and business continues as usual. METHODS: The Katrina Disaster in 2005 offered a larger opportunity to understand the functioning and processes by which drug markets may or may not survive. Utilizing a variety of qualitative data including ethnographic field notes, in-depth interview transcripts, and focus group transcripts, we investigate the operation of the New Orleans drug market before, during, and after Hurricane Katrina. RESULTS: Our data clearly indicate that drug markets go through a series of stages in the wake of disaster in which they disintegrate and then reconstitute themselves. In the case of New Orleans, the post-Katrina drug market was radically different from the pre-Katrina drug market. CONCLUSION: Ultimately this manuscript presents a paradigm which uses stages as a testable concept to scientifically examine the disintegration and reformulation of drug markets during disaster or crisis situations. It describes the specific processes - referred to as stages - which drug markets must go through in order to function and survive during and after a natural disaster.

Video game genre as a predictor of problem use.

This study assessed how problem video game playing (PVP) varies with game type, or "genre," among adult video gamers. Participants (n=3,380) were adults (18+) who reported playing video games for 1 hour or more during the past week and completed a nationally representative online survey. The survey asked about characteristics of video game use, including titles played in the past year and patterns of (problematic) use. Participants self-reported the extent to which characteristics of PVP (e.g., playing longer than intended) described their game play. Five percent of our sample reported moderate to extreme problems. PVP was concentrated among persons who reported playing first-person shooter, action adventure, role-playing, and gambling games most during the past year. The identification of a subset of game types most associated with problem use suggests new directions for research into the specific design elements and reward mechanics of "addictive" video games and those populations at greatest risk of PVP with the ultimate goal of better understanding, preventing, and treating this contemporary mental health problem.

Off the street and into "the cut": deterrence and displacement in NYC's quality of life marijuana policing.

This paper examines the accounts of NYC marijuana smokers about the information and values underlying decisions about where to smoke. We do so to assess the deterrent value of NYC's "quality of life" policing of marijuana in public view. Participants indicated a general awareness of escalated marijuana policing and its attendant risks and almost universally spoke of avoiding public use in high-traffic locations and in the city's cultural and commercial centres. Beyond that, however, the deterrent value of aggressive marijuana policing appears limited. Individuals without access to private space reported outdoor marijuana use as a normalized peer group activity that has increasingly been displaced to marginal and interstitial public spaces that were collectively referred to by participants as "the cut."

The Contribution of Game Genre and other Use Patterns to Problem Video Game Play among Adult Video Gamers.

AIMS: To assess the contribution of patterns of video game play, including game genre, involvement, and time spent gaming, to problem use symptomatology. DESIGN: Nationally representative survey. SETTING: Online. PARTICIPANTS: Large sample (n=3,380) of adult video gamers in the US. MEASUREMENTS: Problem video game play (PVGP) scale, video game genre typology, use patterns (gaming days in the past month and hours on days used), enjoyment, consumer involvement, and background variables. FINDINGS: Study confirms game genre's contribution to problem use as well as demographic variation in play patterns that underlie problem video game play vulnerability. CONCLUSIONS: Identification of a small group of game types positively correlated with problem use suggests new directions for research into the specific design elements and reward mechanics of "addictive" video games. Unique vulnerabilities to problem use among certain groups demonstrate the need for ongoing investigation of health disparities related to contextual dimensions of video game play.

Playing video games while using or feeling the effects of substances: associations with substance use problems.

This study tested the hypothesis that playing video games while using or feeling the effects of a substance--referred to herein as "concurrent use"-is related to substance use problems after controlling for substance use frequency, video gaming as an enthusiastic hobby, and demographic factors. Data were drawn from a nationally representative online survey of adult video gamers conducted by Knowledge Networks, valid n = 2,885. Problem video game playing behavior was operationalized using Tejeiro Salguero and Bersabé Morán's 2002 problem video game play (PVP) measure, and measures for substance use problems were taken from the National Survey of Drug Use and Health (NSDUH). Separate structural equation modeling analyses were conducted for users of caffeine, tobacco, alcohol, and marijuana. In all four models, concurrent use was directly associated with substance use problems, but not with PVP. Video gaming as an enthusiastic hobby was associated with substance use problems via two indirect paths: through PVP for all substances, and through concurrent use for caffeine, tobacco, and alcohol only. Results illustrate the potential for "drug interaction" between self-reinforcing behaviors and addictive substances, with implications for the development of problem use.

Patterns of and motivations for concurrent use of video games and substances.

"Behavioral addictions" share biological mechanisms with substance dependence, and "drug interactions" have been observed between certain substances and self-reinforcing behaviors. This study examines correlates of patterns of and motivations for playing video games while using or feeling the effects of a substance (concurrent use). Data were drawn from a nationally-representative survey of adult Americans who "regularly" or "occasionally" played video games and had played for at least one hour in the past seven days (n = 3,380). Only recent concurrent users' data were included in analyses (n = 1,196). Independent variables included demographics, substance use frequency and problems, game genre of concurrent use (identified by looking titles up in an industry database), and general game playing variables including problem video game play (PVP), consumer involvement, enjoyment, duration, and frequency of play. Exploratory factor analysis identified the following dimensions underlying patterns of and motivations for concurrent use: pass time or regulate negative emotion, enhance an already enjoyable or positive experience, and use of video games and substances to remediate each other's undesirable effects. Multivariate regression analyses indicated PVP and hours/day of video game play were associated with most patterns/motivations, as were caffeine, tobacco, alcohol, marijuana, and painkiller use problems. This suggests that concurrent use with some regular situational pattern or effect-seeking motivation is part of the addictive process underlying both PVP and substance dependence. Various demographic, game playing, game genre of concurrent use, and substance use variables were associated with specific motivations/patterns, indicating that all are important in understanding concurrent use.

Drug markets during the Katrina disaster.

PURPOSE: The purpose of this paper is to examine the experiences of poor drug users and sellers who remained in New Orleans during Hurricane Katrina in 2005 to identify their special needs and the unique challenges they present to disaster management. DESIGN/METHODOLOGY/APPROACH: Semi-structured, open-ended interviews were conducted with 119 poor, predominantly African-American, drug users and sellers. Their stories in their own words provide a mosaic of drug-related experiences from the period immediately preceding the storm through evacuation and reveal the motivations behind their behaviors. FINDINGS: Many drug users placed partying, maintaining their habits, and making money ahead of personal safety and evacuation. Drug use and sales led many not to evacuate before the storm, to use drugs in congregate shelters, to avoid shelters, to roam through flooded debris-strewn streets, to loot stores and homes of drug dealers, and to use violence or the threat of violence to achieve their drug-related aims. ORIGINALITY/VALUE: During a disaster, many poor drug users place risks on themselves, their families, their communities and ultimately on rescue workers. The conclusion presents pragmatic and humanitarian guidelines for successfully addressing this additional challenge. The recommendations are consistent with other suggestions concerning the special needs of indigent populations.

DRUG MARKET RECONSTITUTION AFTER HURRICANE KATRINA: LESSONS FOR LOCAL DRUG ABUSE CONTROL INITIATIVES.

Hurricane Katrina accomplished what no law enforcement initiative could ever achieve: It completely eradicated the New Orleans drug market. However, Katrina did little to eliminate the demand for drugs. This article documents the process of the drug market reconstitution that occurred 2005-2008 based on in-depth interviews and focus groups with predominately low-income drug users and sellers. Before Katrina, the drug market was largely characterized by socially-bonded participants involved with corporate style distribution. After Katrina, a violent freelance market emerged. The conclusion draws recommendations for law enforcement for dealing with drug markets after a major disaster.This article uses New Orleans as a case study to chart the process of drug market reconstitution following an extreme disaster, namely Hurricane Katrina. On August 29, 2005, Hurricane Katrina made landfall and engulfed the New Orleans area, overwhelming levees and causing extensive flooding and destruction across the city. The storm generated 30- to 40-foot waves, which demolished many cities and small towns in Southern Mississippi and Alabama and caused considerable wind damage further inland. Although the hurricane eye missed central New Orleans by about 30 miles, the wave action in Lake Pontchartrain caused several levees to break and flood most of eastern New Orleans, which was under sea level. The storm had an impact on practically all New Orleans residents and almost destroyed New Orleans (Cooper & Block, 2006; Levitt & Whitaker, 2009; Lee, 2006).Our research focused on the impact of this storm on the drug markets in New Orleans. Katrina destroyed the physical environment and organizational structure that sustained the drug trade, yet drug use and sales did not disappear. During and soon after the storm, improvised sales and distribution organizations provided a wide range of illicit drugs to users (see Dunlap, Johnson, Kotarba, & Fackler, 2009; Dunlap & Golub, 2010; Dunlap, Johnson & Morse, 2007). This article examines the next historical period, the continuation of drug use among those returning to New Orleans and the rebuilding of drug market structures. The analysis provides a short review of drug markets before Katrina. Our main focus is the reconstitution process during the three years following the disaster. We pay special attention to street-level dealers and the end users' lived experiences in primarily poorer neighborhoods, illustrating elements of continuity and change as various actors reconstituted New Orleans' drug market.