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Drug abuse persists as one of the most costly and contentious problems on the nation's agenda. Pathways of Addiction meets the need for a clear and thoughtful national research agenda that will yield the greatest benefit from today's limited resources. The committee makes its recommendations within the public health framework and incorporates diverse fields of inquiry and a range of policy positions. It examines both the demand and supply aspects of drug abuse. Pathways of Addiction offers a fact-filled, highly readable examination of drug abuse issues in the United States, describing findings and outlining research needs in the areas of behavioral and neurobiological foundations of drug abuse. The book covers the epidemiology and etiology of drug abuse and discusses several of its most troubling health and social consequences, including HIV, violence, and harm to children. Pathways of Addiction looks at the efficacy of different prevention interventions and the many advances that have been made in treatment research in the past 20 years. The book also examines drug treatment in the criminal justice setting and the effectiveness of drug treatment under managed care. The committee advocates systematic study of the laws by which the nation attempts to control drug use and identifies the research questions most germane to public policy. Pathways of Addiction provides a strategic outline for wise investment of the nation's research resources in drug abuse. This comprehensive and accessible volume will have widespread relevance-to policymakers, researchers, research administrators, foundation decisionmakers, healthcare professionals, faculty and students, and concerned individuals.

\"Erudite and wide-ranging, perceptive and provocative, lively and up-to-date - Shane Blackman has produced a book with something to offer to just about anyone interested in drugs in contemporary society. Blackman uncovers hidden histories, points out the contradictions running through media, popular culture and official policy and highlights the challenges facing us.Chilling Outis a book that will be a boon to students and a valuable resource for both teachers and researchers.\"Nigel South, Professor, Department of Sociology and Research Professor, Department of Health and Human Sciences, University of Essex. How are drug war politics, drug prevention, popular culture and drug consumption interconnected? What are the major contradictions, assumptions and silences within the moral arguments of drug policy makers? What are the implications for the viability of drugs policy? This book critically examines the assumptions underlying drug prohibition and explores the contradictions of drug prevention policies. For the first time in this field, it combines a wide-ranging exploration of the global political and historical context with a detailed focus on youth culture, on the basis that young people are the primary target of drug prevention policies.Chilling Out provides a critical map of drugs, bringing together work on drugs as a source of political state repression and regulation of morality through medical discourse, work on drugs as cultural commodities in film, popular music, advertising and tourism, work on 'drug normalisation', subcultural deviance and the politics of drug education.This clear and enlightening text for sociology, health and media and cultural studies courses argues for an holistic and a critical understanding of drugs in society, which can be the basis for a more coherent approach to drug control. Practitioners and policy makers will find it a thought-provoking and informative source.

01 02 In the 1980s, after a period of peaceful co-existence, a bitter conflict arose between National Health Service psychiatrists and private doctors treating drug addiction. Continuing into the twenty-first century, the battle ended with most private addiction doctors being struck from the medical register. This book examines how the conflict played out and what weapons were used by each side. The contrasting organizational structures of the private and public doctors and the changing policy context help to explain why one side triumphed and the other succumbed to extensive medical discipline. Personalities also played an important part: senior civil servants took a major role in shaping British policy to their own privately held beliefs and turnover in these posts significantly affected attempts to regulate private doctors. Based on 55 oral history interviews with key players and private prescribers as well as previously undisclosed documents, The Politics of Addiction gives a detached, historical analysis of this polarised debate. 19 02 Based on meticulous research, including 55 interviews with key players, doctors and patients and access to previously undisclosed documents An important source of reference for agencies involved in current policy-making and regulation, the voluntary sector and patient interest groups A balanced historical analysis which illuminates the polarized debate between public and private drug treatment 31 02 A history of the bitter conflict between private and NHS doctors over the treatment of addiction from the 1960s to the present 04 02 List of Tables List of Figures Acknowledgements Glossary List of Abbreviations Introduction 1965-2010: A Background Sketch Prescribing and Proscribing: The Treatment and Rehabilitation Report Defining 'Good Clinical Practice' Ambiguous Justice: The General Medical Council and Dr Ann Dally 'Friendly' visits and 'Evil Men': The Home Office Drugs Inspectorate Unifying Hierarchs and Fragmenting Individualists: Three Professional Groups Guidelines and the Licensing Question Conclusion Appendix Bibliography Index 02 02 The Politics of Addiction examines power and policy-making in the context of a bitter conflict between private and publicly employed doctors treating addiction. Regulation was used by both the profession and the state to shape the treatment of addiction and who could provide it, with the media feeding into the process. 13 02 SARAH MARS is the Qualitative Project Director, Heroin Price and Purity Outcomes Study, at the University of San Francisco, California. She read history at Emmanuel College, Cambridge, UK, and received a PhD from the University of London. Since contributing to various drug policy reports, she has worked on the history of drugs, alcohol and tobacco at the University of California, San Francisco and London School of Hygiene and Tropical Medicine.

Of the some sixty thousand vacant properties in Philadelphia, half of them are abandoned row houses. Taken as a whole, these derelict homes symbolize the city’s plight in the wake of industrial decline. But a closer look reveals a remarkable new phenomenon—street-level entrepreneurs repurposing hundreds of these empty houses as facilities for recovering addicts and alcoholics. How It Works is a compelling study of this recovery house movement and its place in the new urban order wrought by welfare reform. To find out what life is like in these recovery houses, Robert P. Fairbanks II goes inside one particular home in the Kensington neighborhood. Operating without a license and unregulated by any government office, the recovery house provides food, shelter, company, and a bracing self-help philosophy to addicts in an area saturated with drugs and devastated by poverty. From this starkly vivid close-up, Fairbanks widens his lens to reveal the intricate relationships the recovery houses have forged with public welfare, the formal drug treatment sector, criminal justice institutions, and the local government.

Objectives. To estimate the association of state policies that define prenatal substance use as child abuse and mandate that health care professionals report prenatal substance use to child protective services with congenital syphilis case rates. Methods. We used 2018 to 2022 US data on congenital syphilis case notifications to the National Notifiable Diseases Surveillance System. We conducted linear regression with a generalized estimating equation approach to compare congenital syphilis case rates in states with a child abuse policy only, a mandated reporting policy only, and both polices to rates in states with neither policy. Results. After adjustment for confounders, the rate of congenital syphilis cases was, on average, 23.5 (95% confidence interval = 2.2, 44.8) cases per 100 000 live births higher in states with both a child abuse policy and a mandated reporting policy for prenatal substance use than in states with neither policy. Rates were similar in states with a child abuse policy only and a mandated reporting policy only compared to states with neither policy. Conclusions. The combination of state child abuse policies and mandated reporting policies for prenatal substance use potentially contributes to higher congenital syphilis case rates. ( Am J Public Health. 2025;115(4):566–574. https://doi.org/10.2105/AJPH.2024.307951 )

We examine the effect of Medicaid expansion under the Affordable Care Act (ACA) on substance use disorder (SUD) treatment utilization and financing. We combine data on admissions to specialty facilities and Medicaid-reimbursed prescriptions for medications commonly used to treat SUDs in nonspecialty outpatient settings with an event-study design. Several findings emerge from our study. First, among patients receiving specialty care, Medicaid coverage and payments increased. Second, the share of patients who were uninsured and who had treatment paid for by state and local government payments declined. Third, private insurance coverage and payments increased. Fourth, expansion also increased prescriptions for SUD medications reimbursed by Medicaid. Fifth, we find suggestive evidence that admissions to specialty treatment may have increased one or more years post-expansion. However, this finding is sensitive to specification and we observe differential pretrends between the treatment and comparison groups. Thus, our finding for admissions should be interpreted with caution.

Despite the significant cost of prescription (Rx) drug abuse and calls from policymakers for effective interventions, there is limited research on the effects of policies intended to limit such abuse. This study estimates the effects of prescription drug monitoring (PDMP) programs, which constitute a key policy targeting access to non-medical use of Rx drugs. Based on objective indicators of abuse as measured by substance abuse treatment admissions and mortality related to Rx drugs, estimates do not suggest any substantial effects of instituting an operational PDMP. We find, however, that mandatory-access provisions, which raised PDMP utilization rates by actually requiring providers to query the PDMP prior to prescribing a controlled drug, are significantly associated with a reduction in Rx drug abuse. The effects are driven primarily by a reduction in opioid abuse, generally strongest among young adults (ages 18 to 24), and underscore important dynamics in the policy response. Robustness checks are consistent with a causal interpretation of these effects. We also assess potential spillovers of mandatory PDMPs on the use of other illicit drugs and find a complementary reduction in admissions related to cocaine and marijuana abuse.

Public substance abuse treatment services have largely operated as an independent part of the overall health care system, with unique methods of administration, funding, and service delivery. The Affordable Care Act of 2010 and other recent health care reforms, coupled with declines in state general revenue spending, will change this. Overall funding for these substance abuse services should increase, and they should be better integrated into the mainstream of general health care. Reform provisions are also likely to expand the variety of substance abuse treatment providers and shift services away from residential and stand-alone programs toward outpatient programs and more integrated programs or care systems. As a result, patients should have better access to care that is more medically based and person-centered. Adapted from the source document.

Medication treatment (MT) is one of the few evidence-based strategies proposed to combat the current opioid epidemic. We examined national trends and correlates of offering MT in substance use treatment facilities in the United States. According to data from national surveys, the proportion of these facilities that offered any MT increased from 20.0 percent in 2007 to 36.1 percent in 2016-mainly the result of increases in offering buprenorphine and extended-release naltrexone. Only 6.1 percent of facilities offered all three MT medications in 2016. Facilities in states with higher opioid overdose death rates, facilities that accepted health insurance overall (and, more specifically, those that accepted Medicaid in states that opted to expand eligibility for Medicaid), and facilities in states with more comprehensive coverage of MT under their Medicaid plans had higher odds of offering MT. The findings highlight the persistent unmet need for MT nationally and the role of expansion of health insurance in the dissemination of these treatments.