Luther Elliott

Opioid and Other Substance Misuse, Overdose Risk, and the Potential for Prevention Among a Sample of OEF/OIF Veterans in New York City

This paper describes veterans’ overdose risks and specific vulnerabilities through an analysis of qualitative data collected from a sample of recently separated, formerly enlisted OEF/OIF veterans in the New York City area. We illustrate how challenges to the civilian readjustment process such as homelessness, unemployment, and posttraumatic stress disorder can render veterans at increased risk for negative health consequences and then present veterans’ perspectives as they outline several innovative solutions to these obstacles. We conclude by discussing several overdose prevention efforts currently underway and how they might be adapted to meet the opioid and substance misuse challenges veterans face.

The Contribution of Game Genre and Other Use Patterns to Problem Video Game Play among Adult Video Gamers

A nationally representative online survey (n = 3,380) was used to assess the contribution of patterns of video game play to problem video game play (PVGP) symptomatology. Game genre, enjoyment, consumer involvement, time spent gaming (gaming days in the past month and hours on days used), and demographic variables were all examined. The study confirms game genre’s contribution to problem use as well as demographic variation in play patterns that underlie problem video game play vulnerability. Identification of a small group of game types positively correlated with problem use suggests new directions for research into the specific design elements and reward mechanics of “addictive” video games. Unique vulnerabilities to problem use among certain groups demonstrate the need for ongoing investigation of health disparities related to contextual dimensions of video game play.

Patterns of and Motivations for Concurrent Use of Video Games and Substances

“Behavioral addictions” share biological mechanisms with substance dependence, and “drug interactions” have been observed between certain substances and self-reinforcing behaviors. This study examines correlates of patterns of and motivations for playing video games while using or feeling the effects of a substance (concurrent use). Data were drawn from a nationally-representative survey of adult Americans who “regularly” or “occasionally” played video games and had played for at least one hour in the past seven days (n = 3,380). Only recent concurrent users’ data were included in analyses (n = 1,196). Independent variables included demographics, substance use frequency and problems, game genre of concurrent use (identified by looking titles up in an industry database), and general game playing variables including problem video game play (PVP), consumer involvement, enjoyment, duration, and frequency of play. Exploratory factor analysis identified the following dimensions underlying patterns of and motivations for concurrent use: pass time or regulate negative emotion, enhance an already enjoyable or positive experience, and use of video games and substances to remediate each other’s undesirable effects. Multivariate regression analyses indicated PVP and hours/day of video game play were associated with most patterns/motivations, as were caffeine, tobacco, alcohol, marijuana, and painkiller use problems. This suggests that concurrent use with some regular situational pattern or effect-seeking motivation is part of the addictive process underlying both PVP and substance dependence. Various demographic, game playing, game genre of concurrent use, and substance use variables were associated with specific motivations/patterns, indicating that all are important in understanding concurrent use.

Playing Video Games While Using or Feeling the Effects of Substances: Associations with Substance Use Problems

This study tested the hypothesis that playing video games while using or feeling the effects of a substance—referred to herein as “concurrent use”—is related to substance use problems after controlling for substance use frequency, video gaming as an enthusiastic hobby, and demographic factors. Data were drawn from a nationally representative online survey of adult video gamers conducted by Knowledge Networks, valid n = 2,885. Problem video game playing behavior was operationalized using Tejeiro Salguero and Bersabé Morán’s 2002 problem video game play (PVP) measure, and measures for substance use problems were taken from the National Survey of Drug Use and Health (NSDUH). Separate structural equation modeling analyses were conducted for users of caffeine, tobacco, alcohol, and marijuana. In all four models, concurrent use was directly associated with substance use problems, but not with PVP. Video gaming as an enthusiastic hobby was associated with substance use problems via two indirect paths: through PVP for all substances, and through concurrent use for caffeine, tobacco, and alcohol only. Results illustrate the potential for “drug interaction” between self-reinforcing behaviors and addictive substances, with implications for the development of problem use.

A multi-method exploratory study of stress, coping, and substance use among high school youth in private schools.

There is growing awareness that students’ experiences of stress may impede academic success, compromise mental health, and promote substance use. We examined these factors in an under-studied population, private/independent high school students, using a multi-method (qualitative and quantitative), iterative data collection and analytic process. We first conducted qualitative interviews with faculty and staff at a number of highly competitive private schools, followed by an anonymous quantitative survey with 128 11th grade students from two of these settings. We then conducted a qualitative exploration of the quantitative results with a subset of students. Next, a set of Expert Panel members participated in qualitative interviews to reflect on and interpret study findings. Overall, we found students experienced high levels of chronic stress, particularly in relation to academic performance and the college admissions process. While students described a range of effective, adaptive coping strategies, they also commonly internalized these serious pressures and turned to alcohol and drugs to cope with chronic stress, although not typically at problematic levels. We discuss study implications for both schools and families derived from the Expert Panel.

Trends in Video Game Play through Childhood, Adolescence, and Emerging Adulthood

This study explored the relationship between video gaming and age during childhood, adolescence, and emerging adulthood. It also examined whether “role incompatibility,” the theory that normative levels of substance use decrease through young adulthood as newly acquired adult roles create competing demands, generalizes to video gaming. Emerging adult video gamers (n = 702) recruited from video gaming contexts in New York City completed a computer-assisted personal interview and life-history calendar. All four video gaming indicators—days/week played, school/work day play, nonschool/work day play, and problem play—had significant curvilinear relationships with age. The “shape” of video gamings relationship with age is, therefore, similar to that of substance use, but video gaming appears to peak earlier in life than substance use, that is, in late adolescence rather than emerging adulthood. Of the four video gaming indicators, role incompatibility only significantly affected school/work day play, the dimension with the clearest potential to interfere with life obligations.

The Opiate Pain Reliever Epidemic among U.S. Arrestees 2000–2010: Regional and Demographic Variations

The increasing rate of opiate pain reliever (OPR) use is a pressing concern in the United States. This article uses a drug epidemics framework to examine OPR use among arrestees surveyed by the Arrestee Drug Abuse Monitoring program. Results demonstrate regional and demographic variation in use across nine focal cities. High rates of OPR use on the West Coast illustrate the expansion of use from its initial epicenter. By 2010, OPR use had plateaued in all focal cities. Findings suggest directions for ongoing research into pathways to use and vectors of diffusion and for regionally specific interventions sensitive to age and ethnic diversity.

PTSD and Cannabis-Related Coping Among Recent Veterans in New York City

This article presents interview and focus group data from veterans of recent conflicts in Iraq and Afghanistan about their use of cannabis as a coping tool for dealing with posttraumatic stress disorder. Veterans’ comparisons of cannabis, alcohol, and psychopharmaceuticals tended to highlight advantages to cannabis use as more effective and less complicated by side effects. Some participants suggested that cannabis can be part of an approach-based coping strategy that aids with introspection and direct confrontation of the sources of personal trauma. Others, however, held that cannabis use was part of a less productive, avoidant coping strategy. Some self-reports suggested the need for more nuanced theorizations of coping behaviors, as they indicated motivations for use that were grounded in symptom alleviation rather than any direct confrontation with (or avoidance of) sources of trauma.

Video Game Addiction: User Perspectives

Purpose – To examine video gamers’ attitudes about and perspectives on the controversial topic of video game “addiction.” Approach – Ethnographic interviews and participant observation with a group of 52 regular video gamers, most also reporting considerable experience with substance use and/or dependence. Findings – Gamers tended to endorse one of two explanations for video game addiction, either arguing that games operate on the same reward centers in the brain as drugs or that gamers who do become addicted are weak, unintelligent, or actively pursue an addictive state. Several rejected the category of addiction as applied to video gaming due to the lack of withdrawal symptomatology or the confusion of pleasure-seeking with pathology. None offered sociostructural explanations for the phenomenon, despite the relative oversampling of poor and minority participants with low degrees of education. Research implications – Future research should attend to ideologies of causality and agency among populations affected by behavioral “addictions.” Practical implications – The perspectives of video gamers themselves are critical to research and advocacy that departs from a position of slightly greater sensitivity, both to the formal dimensions of those games held to be most habit-forming and to the ideological dimensions of video gamers’ thinking about what constitutes “addiction.”

A Genre-Specific Investigation of Video Game Engagement and Problem Play in the Early Life Course

This study explored predictors of engagement with specific video game genres, and degree of problem play experienced by players of specific genres, during the early life course. Video game players ages 18–29 (n = 692) were recruited in and around video game retail outlets, arcades, conventions, and other video game related contexts in New York City. Participants completed a Computer-Assisted Personal Interview (CAPI) of contemporaneous demographic and personality measures and a Life-History Calendar (LHC) measuring video gaming, school/work engagement, and caffeine and sugar consumption for each year of life ages 6 - present. Findings were that likelihood of engagement with most genres rose during childhood, peaked at some point during the second decade of life, and declined through emerging adulthood. Cohorts effects on engagement also emerged which were probably attributable to changes in the availability and popularity of various genres over the 12-year age range of our participants. The relationship between age and problem play of most genres was either negative or non-significant. Sensation-seeking was the only consistent positive predictor of problem play. Relationships between other variables and engagement with and problem play of specific genres are discussed in detail.