Contemporary Drug Problems

The growing importance of local communities as sites for preventive alcohol-related initiatives has generated interest in the role of research associated with community action. To date, however, this has not led to a theoretically informed account because of a failure to account reflexively for researchers' own practices and the use of conceptually inadequate models of “community.” This paper proposes an analytical framework, derived from the author's association with alcohol initiatives in several northern Australian towns and drawing on Bourdieu's concept of the social field. It is argued that the initiation of local action generates a complex social field in which stakeholders pursue their interests by mobilizing forms of capital: economic, social, political, and symbolic. Research, as well as the conveyance of valued information, is imbued with symbolic and political capital. The analysis concludes with four propositions relating to how, by whom, and with what consequences research is likely to be utilized in these settings.

This article examines mental health and substance abuse treatment providers' attitudes and beliefs regarding the relative values of academic knowledge and experiential knowledge. These two forms of “knowing” increasingly come into conflict as providers from the two service systems work together to provide services to individuals with co-occurring disorders. Data to address this issue were obtained from seven focus groups conducted with 48 substance abuse and mental health treatment providers and stakeholders in Los Angeles County. Findings suggest the tenuous role of experience-based knowledge within the emergent framework of dual diagnosis treatment and its emphasis on the professionalization of providers. The article raises concerns as to how differing, and often competing, treatment approaches affect the provision of care for this population and questions how these tensions will be resolved within efforts to increase collaboration between the two systems in providing services to dually diagnosed patients.

Interest in improving low-income, drug-using women's access to and utilization of care services tends to focus on remedies to personal, structural and gendered barriers to care. In contrast, this exploratory, qualitative study of women's perspectives illustrates how institutional rules, both within and across agencies, and informal provider practices can constrain women's use of health and social services. This paper draws attention to the ways in which low-income, drug-using women respond to obstacles and interpersonal tensions they experience in service settings. As a means of pursuing their material and social well-being, the women employ forms of resistance that are both protective and potentially harmful. This paper underscores the need to recognize how service institutions are implicated in drug users' everyday struggles for well-being.

Alcoholics Anonymous has greatly informed the individual, social, and political landscape of the contemporary self-help or mutual-aid movement. There has emerged, in turn, a vast, though largely uncritical, body of research examining AA and its 12-step recovery model. A close look inside a virtual AA community, however, reveals that not all AA members embrace formal AA discourse. Through an examination of dialogue and discourse on a public Usenet newsgroup, this study demonstrates that in contrast to research that depicts AA program practices as necessarily harmonious, members' experiences of program wisdom are frequently negotiated and reassessed outside larger AA dicta. The data examined show that what becomes constituted as members' practice can be fraught with questions, tensions, and separations from conventional or ideal AA.

The 40-year follow-up of a subset of men (N=41) from the Lundby Community Cohort indicated that the development of alcohol use disorders was related to different problem areas, including work situations. The present study examines the life stories of the 23 subjects who had been interviewed 3 times before and were alive at the follow-up. It is the accounts of (mostly former) problem drinkers about how their work and their drinking fitted together. It also illuminates how work alienation is related to social class and to alcohol-use disorders and recovery. It shows that the life course perspective can lead to a fuller understanding of the subjective experience. The alienation model might also give some clues for treatment and prevention.

The association between average volume of drinking and coronary heart disease (CHD) morbidity and mortality in African Americans compared with whites was explored, based on a representative US sample. A prospective cohort study with interview follow-up after 10 years and outcome follow-up over about 15 years was used. The sample consisted of 1,158 African Americans and 6,607 whites, all 40 years of age and older with no history of heart disease at baseline. Alcohol intake was measured with a quantity-frequency measure. Incidence of CHD was the sum of non-fatal and fatal events as determined from hospital records and death certificates. The event with the earliest date was defined as the incident event. With respect to CHD, African Americans showed markedly higher risks and significantly fewer protective effects compared with whites. Thus the cardioprotective effects of alcohol were not present in a representative sample of African Americans. On the contrary: Moderate to high average volume of alcohol was associated with increased risk of CHD in African Americans. Patterns of drinking as a potential cause for this finding are discussed.

Utilizing an ethnically diverse snowball sample of 31 current or former marijuana smokers, this paper uses recent data to update and expand Howard S. Becker's (J953) theory of using marijuana for pleasure. Although the main tenets of Becker's social-process-based theory of marijuana use have survived the test of time amazingly well, the data suggest that some significant aspects of the theory need to be updated. Most users become intoxicated the first time they smoke marijuana, many no longer have to learn that they are intoxicated through social interaction with other users, and most immediately find the experience pleasurable. Historical changes in marijuana “scenes,” rather than fundamental weaknesses, necessitate revisions in Becker's theory.