Methods: The data collection involved participant observation in the field, face-to-face interviews and focus groups. Audio-recorded in-depth life histories, drug use histories, and resource needs were collected from 31 suburban women who were former or current users of methamphetamine. The majority was drawn from marginalized communities and highly vulnerable to risk for injury and violence. We provided these women with healthcare and social service information and conducted follow-up interviews to identify barriers to these services.

Results: Barriers included (1) restrictions imposed by the services and (2) limitations inherent in the women's social, economic, or legal situations. We found that the barriers increased the women's risk for further injury, violence and transmission of infectious diseases. Women who could not access needed healthcare and social resources typically used street drugs that were accessible and affordable to self-medicate their untreated emotional and physical pain.

Conclusion: Our findings add to the literature on how healthcare and social services are related to injury prevention. Social service providers in the suburbs were often indifferent to the needs of drug-using women. For these women, health services were accessed primarily at emergency departments (ED). To break the cycle of continued drug use, violence and injury, we suggest that ED staff be trained to perform substance abuse assessments and provide immediate referral to detoxification and treatment facilities.Policy change is needed for EDs to provide the care and linkages to treatment that can prevent future injuries and the spread of infectious diseases.

Award Number: 1R15DA021164-01A1

Principal Investigator: Boeri

Award: $180,900

National Institutes of Health, National Institute of Drug Abuse

Award Number: 1R15DA021164-01A1

Principal Investigator: Boeri

Award: $201,000

National Institutes of Health, National Institute of Drug Abuse

Award Number: 1R21DA025298-01A1

Principal Investigator: Boeri

Award: $367,820

American Recovery and Reinvestment Act

National Institutes of Health, National Institute of Drug Abuse

Although drug use and HIV rates among older drug users are increasing at alarming rates, knowledge on drug use patterns and risk behaviors among this cohort as older adults is limited. National trend data show that adults who are 45 or older comprise the fastest growing age group of drug users as well as new drug treatment admissions and new HIV/AIDS cases. The two-fold goal of this exploratory R21 proposal is to address the lack of current knowledge on older drug users and provide innovative mathematical models that have the potential to inform future research on specific turning points in drug use and related health risks over the life course. In this mixed-methods study we use quantitative methods to identify turning points in drug use and risk behaviors, qualitative methods to explore these turning points more thoroughly, and mathematical analysis to build predictive models on turning points in drug trajectories. The community-based sample will consist of active users (n=50) and former users (n=50) of heroin, cocaine, and methamphetamine age 45 and older. Data are collected using a quantitative matrix on drug history and social roles and a qualitative in-depth interview. The study site is the metropolitan statistical area (MSA) of Atlanta that includes urban, suburban and rural settings. The knowledge gained from an in-depth exploration of this sample will add to our understanding of an aging drug-using population, inform future research on older drug users and provide innovative mathematical models on risk behaviors and drug use to be tested in future large-sample studies. To accomplish this we propose three specific aims: (1) To identify turning points in the onset, continuation, and cessation of drug use throughout the life course of a sample of older users; specifically how social roles, race, gender, age, social contexts, policies and historical events influence turning points in drug use and drug-related HIV risk behaviors; (2) To thoroughly explore these turning points and transitions over the life course, specifically changes in drug availability, risk behaviors, routes of administration, social roles, networks, support, policies, settings, and geographic locations, imbedded in a life course perspective; (3) To build Dynamic Bayesian Networks that best model the static and dynamic aspects found in our quantitative and qualitative data. In so doing we are able to identify not only statistical relationships between the variables but also the influence and progression of these through time. Together these aims provide needed in-depth details on the lives of older drug users as well as trajectory models that can be used to target treatment strategies on the turning points in drug use trajectories. The information and models provided by this study can be used to develop better prevention, intervention and treatment programs by focusing on specific turning points in drug careers. This is a unique and innovative exploration of methodologies that can lead to future studies. The models developed from this R21 exploratory research grant will be used to propose a RO1 grant to extend the predictive value of the models on turning points in drug trajectories throughout the life course.

In this paper, the authors explore the phases in this process. Boeri and Pressley use their own case studies as former members of the Children of God (Family of Love) and the Church of Scientology. These first-person accounts describe their experiences in authoritarian cults and explore the power dynamics of total institutions that constrain members’ creativity. They identify turning points that influenced their decisions to reject or accept the cult’s practices, and their discovery of the emergence of a secret creative self once they were out of the cult. The paper employs interrelated sociological and cultural studies theories to explore the processes involved, including a symbolic interactionist understanding of self.

In conclusion, the authors present their development of the "Hegemonic Communication Model" that illustrates the thought process a cult member may use to cope with power dynamics, hegemony, sovereignty, and the creative self. They hope that a more thorough examination of this process will better help others to detect destructive religious practices and help former members to break free from legalism that suppresses creativity and free thought.