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The stickup kids
Randol Contreras came of age in the South Bronx during the 1980s, a time when the community was devastated by cuts in social services, a rise in arson and abandonment, and the rise of crack-cocaine. For this riveting book, he returns to the South Bronx with a sociological eye and provides an unprecedented insider's look at the workings of a group of Dominican drug robbers. Known on the streets as \"Stickup Kids,\" these men raided and brutally tortured drug dealers storing large amounts of heroin, cocaine, marijuana, and cash. As a participant observer, Randol Contreras offers both a personal and theoretical account for the rise of the Stickup Kids and their violence. He mainly focuses on the lives of neighborhood friends, who went from being crack dealers to drug robbers once their lucrative crack market opportunities disappeared. The result is a stunning, vivid, on-the-ground ethnographic description of a drug robbery's violence, the drug market high life, the criminal life course, and the eventual pain and suffering experienced by the casualties of the Crack Era. Provocative and eye-opening, The Stickup Kids urges us to explore the ravages of the drug trade through weaving history, biography, social structure, and drug market forces. It offers a revelatory explanation for drug market violence by masterfully uncovering the hidden social forces that produce violent and self-destructive individuals. Part memoir, part penetrating analysis, this book is engaging, personal, deeply informed, and entirely absorbing.
eBook
Multimorbidity and Inpatient Utilization Among Older Adults with Opioid Use Disorder in New York City
BackgroundNationally, there is a sharp increase in older adults with opioid use disorder (OUD). However, we know little of the acute healthcare utilization patterns and medical comorbidities among this population.ObjectiveThis study describes the prevalence of chronic conditions, patterns of inpatient utilization, and correlates of high inpatient utilization among older adults with OUD in New York City (NYC).DesignRetrospective longitudinal cohort study.ParticipantsPatients aged ≥55 with OUD hospitalized in NYC in 2012 identified using data from New York State’s Statewide Planning and Research Cooperative System (SPARCS).Main MeasuresThe prevalence of comorbid substance use diagnoses, chronic medical disease, and mental illness was measured using admission diagnoses from the index hospitalization. We calculated the ICD-Coded Multimorbidity-Weighted Index (MWI-ICD) for each patient to measure multimorbidity. We followed the cohort through September 30, 2015 and the outcome was the number of rehospitalizations for inpatient services in NYC. We compared patient-level factors between patients with the highest use of inpatient services (≥7 rehospitalizations) during the study period to low utilizers. We used multiple logistic regression to examine possible correlates of high inpatient utilization.Key ResultsOf 3669 adults aged ≥55 with OUD with a hospitalization in 2012, 76.4% (n=2803) had a subsequent hospitalization and accounted for a total of 22,801 rehospitalizations during the study period. A total of 24.7% of the cohort (n=906) were considered high utilizers and had a higher prevalence of alcohol and cocaine-related diagnoses, congestive heart failure, diabetes, schizophrenia, and chronic obstructive pulmonary disease. Multivariable predictors of high utilization included being a Medicaid beneficiary (adjusted odds ratio [aOR]=1.70, 95% confidence interval [CI]=1.37–2.11), alcohol-related diagnoses (aOR=1.43, 95% CI: 1.21–1.69), and increasing comorbidity measured by MWI-ICD (highest MWI-ICD quartile: aOR=1.98, 95% CI=1.59–2.48).ConclusionsAmong older adults with OUD admitted to the hospital, multimorbidity is strongly associated with high inpatient utilization.
Journal Article
New York State Health Foundation: Integrating Mental Health and Substance Abuse Care
Roughly half of all people with severe mental disorders also have substance abuse problems. Yet their care is fragmented: They are treated by either the mental health system or the substance abuse system. In New York State only 10 percent of them receive evidence-based treatment for both conditions. Beginning in 2007 the New York State Health Foundation and two state agencies-the Office of Mental Health and the Office of Alcoholism and Substance Abuse Services-began collaborating on ways to integrate the treatment of people with co-occurring disorders. The state agencies removed financial and regulatory barriers to integrated treatment. The foundation provided funding to establish the Center for Excellence in Integrated Care. The center's goal: provide hands-on assistance in implementing best practices to at least half of the state's 1,200 mental health and substance abuse treatment clinics. An evaluation found that the percentage of clinics using best practices doubled after the regulatory and financial changes and the center's intervention. This illustrates the potential that foundations, governments, and nonprofits, working collaboratively, have to improve the care of a neglected and difficult-to-serve population. [PUBLICATION ABSTRACT]
Journal Article
Disciplining Addictions: The Bio-politics of Methadone and Heroin in the United States
Biomedical understanding of methadone as a magic-bullet pharmacological block to the euphoric effects of heroin is inconsistent with epidemiological and clinical data. An ethnographic perspective on the ways street-based heroin addicts experience methadone reveals the quagmire of power relations that shape drug treatment in the United States. The phenomenon of the methadone clinic is an unhappy compromise between competing discourses: A criminalizing morality versus a medicalizing model of addiction-as-a-brain-disease. Treatment in this context becomes a hostile exercise in disciplining the unruly misuses of pleasure and in controlling economically unproductive bodies. Most of the biomedical and epidemiological research literature on methadone obscures these power dynamics by technocratically debating dosage titrations in a social vacuum. A foucaultian critique of the interplay between power and knowledge might dismiss debates over the Swiss experiments with heroin prescription as merely one more version of biopower disciplining unworthy bodies. Foucault's ill-defined concept of the specific intellectual as someone who confronts power relations on a practical technical level, however, suggests there can be a role for political as well as theoretical engagement with debates in the field of applied substance abuse treatment. Meanwhile, too many heroin addicts who are prescribed methadone in the United States suffer negative side effects that range from an accentuated craving for polydrug abuse to a paralyzing sense of impotence and physical and emotional discomfort.
Journal Article
\More drugs, less crime\: why crime dropped in New York City, 1985-2007
The crime drop in New York City has produced a whole academic literature that is unable to explain the decline. This article argues that this literature has ignored the simplest explanation of all: a simultaneous increase in the supply, and decrease in demand for illegal drugs led to a drop in the price of illegal drugs, which in turn led to a drop in crime. We use ethnography to document the drop in demand, secondary literature to document the increase in supply, and econometric analysis to illustrate Granger causality between drug prices and crime rates. While crime dropped across the nation and internationally, our article is focused on New York City.
Journal Article
Historical Disaster and the New Urban Crisis
Conventional studies of urban poverty largely blame African Americans for their impoverished situation and the consequent social difficulties that arise there from. This paper confronts and indicts that perspective. Examining the historic dehumanization process that shaped African America, the present study argues that it served as the framework for how whites justified their racist and violent treatment of slaves and their African American descendants. It was this same racist theory and practice that led to the construction of racialized oppressive urban ghettos that became the economically impoverished domicile for urban black people. Therefore, poor African Americans have been caught in a cauldron of circumstances not of their own making, but with which they have had to cope and struggle.
Journal Article
From beer to crack: developmental patterns of drug involvement
OBJECTIVES. Prior research has identified developmental stages in drug use in adolescence, from substances that are legal for adults to illicit drugs. The position of crack in patterns of drug involvement remains to be established. METHODS. The analyses are based on a sample (n = 1108) representative of 12th graders attending New York State public and private schools. From reported ages of first use of five classes of drugs (alcoholic beverages, cigarettes, marijuana, cocaine but not crack, crack), alternate models of progression were tested for their goodness of fit through log-linear models. RESULTS. The sequence involves at the earliest stage the use of at least one licit drug, alcohol or cigarettes. Subsequent stages involve marijuana and cocaine; crack is the last drug in the sequence. The results confirm the more important role of alcohol among males and cigarettes among females in the progression into various drug classes. Age of first drug use at a lower stage is a strong predictor of further progression. CONCLUSIONS. The developmental pattern of drug involvement identified in the early 1970s still characterizes adolescent pathways of drug involvement in the late 1980s.
Journal Article
Methadone Treatment Protects against HIV Infection: Two Decades of Experience in the Bronx, New York City
Objectives: We undertook a study of the role of methadone maintenance in protecting injecting drug users (IDUs) from human immunodeficiency virus (HIV) infection from the earliest days of the HIV epidemic in New York City to the present. The historical context of the epidemic in the Bronx is discussed. Methods: For close to two decades, we have been tracking changes in injecting drug use and HIV infection levels in a Bronx cohort study of IDUs. An initial sample of 622 IDUs was recruited from a methadone treatment program in 1985, with historical data going back to 1978. Behavioral interviews and HIV testing were performed and methadone treatment program records (urine toxicology and methadone dose history) were reviewed. We examined both prevalent and incident HIV infections. The sample included African Americans (24.3%), Latinos (50.3%), and white non-Latinos (24.4%). The average methadone dose was 64 milligrams (mg) per day with an average time in treatment of five and a half years. Results: We found a very low rate of incident infection of 1.7 per 100 person-years observation since 1986. Because of this low rate of infection, we were unable to determine the association between methadone treatment factors and HIV seroincidence. We found that our prevalence data on the 622 IDUs enrolled from 1985 to 1988 yielded strong findings on the role of methadone maintenance in a period when most infections occurred in this population. HIV seroprevalence was 42.9%. Logistic regression analysis revealed associations of methadone dose ≥80 mg (adjusted odds ratio = 3.07/yr, 95% confidence interval (CI): 1.23-7.68) and last year entered methadone treatment (adjusted odds ratio = 1.22/yr, 95% CI: 1.06-1.41) to HIV infection, independent of year of last cocaine injection, needle sharing in shooting galleries, number of IDU sex partners, low income, and African American or Latino ethnicity. Conclusions: Properly dosed, long-term methadone treatment was found to be a central protective factor in preventing HIV infection from the earliest days of the epidemic in New York City. It is crucial to have high quality drug treatment programs in place before an epidemic draws our attention to the inadequacies through excess and unnecessary morbidity and mortality.
Journal Article
Understanding the Social Needs of Streetwalking Prostitutes
The social dynamics of prostitution render prostitutes unable at times to meet basic human needs, vulnerable to violence, and at risk for sexually transmitted disease. Since April 1989 a mobile van from a private foundation has been contacting prostitutes throughout the five boroughs of New York City to provide HIV testing and counseling and to distribute condoms, bleach kits for cleaning needles, and HIV prevention information. Data collected from 1,963 female prostitutes are discussed in this article. Information is provided on demographics, family and living arrangements, sex and drug practices, HIV status and risk reduction practices, and health history. Methods are discussed for social workers to develop creative ways to provide outreach and develop relationships with a vulnerable population that invests much effort in remaining concealed.
Journal Article