The Structural Determinants of Drug Use: A Primer on Addiction
Edition: 1
Copyright: 2024
Pages: 239
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The Structural Determinants of Drug Use: A Primer on Addiction provides an introductory overview of drug use, addiction, and treatment in America through the lenses of public health, medicine, anthropology, history, public policy, media, academia, and the arts.
Upon completion, readers will gain the ability to apply a critical perspective on these issues in a variety of topics, including:
- Social and structural risk factors that increase vulnerability to addiction
- The racial politics of drug panics and policing of populations
- Treatment modalities, settings, and outcomes
- Comparisons of drug use and addiction treatment policies to other public health issues
- Other historical and contemporary issues
In short, this textbook aims to illuminate the hidden structures that work against someone who uses drugs, as the negative social perceptions around drug use didn't shimmer into existence - it evolved from our history. Grounded in this history and a framework of structure, this publication explores issues such as the War on Drugs and how the federal government evolved to deal with people who use drugs. It uncovers the stirrings of professionals thinking that perhaps the criminal justice approach wasn't quite working...that perhaps addiction needed to be treated as a healthcare issue. The interplay between early childhood trauma, mental health, and drug use is explored as well as drug use and risk behaviors, and the interplay between drug use and infectious disease.
Perhaps most exciting is that this work deviates from traditional undergraduate textbooks by bringing the voices of people who are living the reality of these issues directly to students via ethnography. Healthcare providers share the challenges they experience, humanizing their struggle with structure as they attempt to provide care for people who use drugs. People who use drugs provide a bleak recounting of what it is like to receive healthcare treatment for anything, not just related to the complications of drug use. Other ethnographic offerings include the harm reduction movement, an example of a successful clinical intervention for opioid use disorder, and a discussion of the future of addiction care amongst numerous professionals currently working in the field. Readers will have the opportunity to be in direct conversation with the current perspectives of physicians, peer outreach, infectious disease experts, behavioral health and criminal justice experts, and more.
Foreword by Hansel Tookes, MD, MPH
Introduction
Chapter One: Opium and Alcohol in Early America
Introduction
Tracing the Path of Opium in Early America
Heroin as a Wonder Drug
Government Policy: Harrison Narcotics Tax Act and Anti-Heroin Act
Visual Learning: History of Opioid Use in America
Opioids: Tying it Back to Current Day
Tracing the Path of Alcohol in Early America
Visual Learning: The Roots of Prohibition-PBS
The Temperance Movement
The Temperance Movement and Immigration
The 18th Amendment to the Constitution, and Government Involvement in Prohibition
Alcohol: Tying it Back to Current Day
Conclusion
Chapter Two: Incarceration Nation: A Brief History of the War on Drugs
Introduction
Timeline to the Creation of the Drug Enforcement Agency
December 1915-1970
The DEA Drug Schedule
1971-1975
The War on Drugs: A Fight for the Souls of our Fellow Americans
Mandatory Minimum Sentencing
Discriminatory Drug Policies
A Continuation of Modern Slavery through Mass Incarceration
Public Health Campaigns: Just Say No and DARE
Reaganomics and the Ending of Social Safety Nets
The Crack-Cocaine Epidemic
Pill Mills, Pain Management, and the Rise of the Opioid Epidemic
Introduction of Fentanyl into the Global Drug Supply
Conclusion
Chapter Three: Healing over Handcuffs: Ending the War on Drugs by Embracing a Health-Centered Approach
Introduction
What Exactly is Addiction?
Addiction as it Exists in a Biomedical Worldview
Addiction as it Exists in the Social Collective
Theoretical Models of Addiction
Biological Model
Psychological Model
Social Learning Model
Disease Model
Biopsychosocial Model
Positive Psychology Model
Prisoner to Patient? The Paradigm Shift from Criminal Justice to Healthcare
The Role of the Opioid Epidemic in Recognizing Addiction as a Public Health Crisis
Current Biomedical Therapies Available to Treat Addiction
Medication-Assisted Treatment (MAT)
Nicotine Replacement Therapy (NRT)
Vaccine Therapy
Neurostimulation
Pharmacogenetics
The Absence of Social and Structural Supports to Fully Realize the Disease Model of Addiction in Healthcare
Stigma Associated with Addiction
Lack of Training and Education and Healthcare Provider Attitudes
Logistical and Practical Challenges
Systemic and Structural Barriers
Reimbursement and Regulatory Issues
Lack of Patient Follow-Up and Continuity of Care
Conclusion
Chapter Four: The Significance of Early Childhood Trauma and Mental Health on Drug Use
Introduction
Early Childhood Trauma
Structural Inequality and Trauma
Dual Diagnosis: Co-occurring Mental Illness and Substance Use Disorder
Self-Medication
Improving Access to Quality Healthcare for Individuals with Co-occurring Mental Health, Trauma, and Substance Use Disorders
Conclusion
Chapter Five: Drug Use and Risk: The HIV Epidemic and the Revival of Hepatitis C
Contribution by Bernice McCoy, PhD, MPH and Megan Sarmento, MA
Introduction
Risk Perception and Drug Use
HIV Basics
HCV Basics
Drug Use and HIV/HCV Risk
Contextualizing Risk: The Importance of the Risk Environment
Injection Drug Use in the Age of Fentanyl
The Criminal Justice System
Social Networks
Delaying Treatment
Economic and Healthcare Policy Risk Factors
Reducing Harm by Co-Locating Care
MOUD
Syringe Services Programs (SSPs)
Conclusion
Chapter Six: The Sisyphus Effect: Provider Experiences with Addiction
Introduction
Medical Education and Drug Use
Challenging Healthcare Provider Experiences
A Shared Sense of Helplessness
A Frantic Consult
A Day at Disney World
A Traumatic Overdose
A Routine Process Gone Awry
A Shared Helplessness
The Sisyphus Effect
Conclusion
Chapter Seven: Medical Discrimination, Stigma, and Drug User Health
Introduction
So How Did All This Get Started for You?
Stigma and Drug User Health
The Criminal Justice Lens of Addiction and Healthcare
Conclusion
Chapter Eight: Harm Reduction as Healthcare by People Who Use Drugs for People Who Use Drugs
Introduction
Early Influences and Precursors
The Harm Reduction Movement in the United States
Dr. Alan Marlatt
Needle Exchange Advocates
Harm Reduction Coalition
Drug Policy Alliance
Community-Based Organizations
Researchers and Public Health Advocates
Key Philosophies of Harm Reduction
Harm Reduction Strategies
By Us for Us: The Importance of Lived Experience
Tim Santamour
Conclusion
Chapter Nine: BRIDGE: Building an Ethnographically Informed Treatment Pathway
Introduction
BRIDGE: Building an Ethnographically Informed Treatment Pathway
BRIDGE Pathway Implementation Timeline
September 2017
March 2018
April 2018
April through September 2018
September 13th, 2018
January 2019
June 2019
August 2019
January 2020
June through December 2020
January through September 2021
Conclusion
Chapter Ten: Addiction Reimagined: A Future of Accessible Support and Equitable Treatment
Introduction
Harm Reduction: Tyler Bartholomew, PhD
Peer Advocate: Megan Sarmento, MA
Emergency Medicine: Jason Wilson, MD, PhD
Infectious Disease: Bernice McCoy, PhD, MPH
Behavioral Health and Criminal Justice: Kathleen Moore, PhD; Elzbieta Wiedbusch, BS;
Melissa Carlson, BS
Primary Care: Asa Oxner, MD
Addiction Research and Policy: Bryant Shuey, MD
Conclusion
Appendix A: Person First Language
Appendix B: Where to Go if You Need Help
Heather Henderson, PhD, CAP, CRPS is an Assistant Professor in the Morsani College of Medicine at the University of South Florida, and serves as the Director of Social Emergency Medicine, Population and Global Health in the department of Emergency Medicine, and the Program Director for IDEA Exchange Tampa at Tampa General Hospital. Key accomplishments include establishing and expanding the state of Florida’s largest Emergency Department-based Medication for Opioid Use Disorder (MOUD) treatment and referral pathway and expanding Florida’s Syringe Services Program (SSP) to Hillsborough County—the second legal exchange in the state of Florida.
As a Certified Addiction Professional, Dr. Henderson serves as a subject matter expert on substance use and associated social determinants of health on multiple boards in the Tampa Metropolitan area and supports multiple regions in creating a comprehensive recovery continuum utilizing harm reduction principles. Dr. Henderson is also actively leading multiple research studies as a clinical anthropologist to further expand innovative treatments for substance use disorders.