Margaret S. Kelley

Treatment as harm reduction, defunding as harm maximization: The case of methadone maintenance

Despite numerous research studies demonstrating the efficacy of methadone maintenance treatment (MMT) in general and the value of retention in particular, the increasing defunding of this modality has compromised its potential. From 1990 to 1995 the lead author conducted a longitudinal research project to determine the impact of the cost of treatment on 233 San Francisco Bay Area study participants seeking, enrolled in, or defunded from MMT. This paper reports on selected findings from that study. Using variables of drug use, crime, gender and HIV risk, qualitative and quantitative results comparing those seeking treatment with those enrolled in treatment indicated that MMT functioned as a harm-reduction tool. When clients were defunded, however, drug use, crime and HIV risk increased and harm was maximized.

Doing syringe exchange: Organizational transformation and volunteer commitment

The authors examine the organizational transformation of Prevention Point, the San Francisco-based syringe exchange program. Their purposes are to explore the processes of organizational change, focus on the impact of formalization on members and organizational goals, and contextualize these in light of belonging to an underground organization. They highlight the volunteers’ motivation and commitment, and their responses to the organizational changes. Drawing on qualitative interviews with 56 service providers, conducted from 1993 to 1995, the authors document the changes in the organization and the members’ perceptions of it as it moved from an illegal, deviant group to a socially sanctioned service organization. This transition is shown to have ultimately undermined much of the basis for volunteer commitment, reinforcing the shift in responsibility from the membership to a new management structure. These findings have implications for the larger problem of maintaining volunteer engagement in volunteer work.

RE-EXAMINING THE RELATIONSHIP BETWEEN INTERSCHOLASTIC SPORT PARTICIPATION AND DELINQUENCY: TYPE OF SPORT MATTERS*

Abstract For years it has been commonly held by the public and by policy makers that youth sport participation can serve as an agent of social control. At the school level, this relationship has been examined in terms of numerous psychosocial and behavioral outcomes. Research on one such outcome - delinquency - has resulted in mixed findings. To better understand this association and perhaps arrive at more conclusive findings, the present study utilizes nationally representative data (NELS: 88) to conduct a more in-depth analysis of the relationship between school sport participation and delinquency. We present findings from a systematic analysis of engagement in delinquency that 1) controls for race, gender, and SES, 2) takes into account important factors representing components of Hirschis (1969) social control theory found both inherent in sport participation and external to it, and 3) compares different delinquency outcomes for different types of sport. Results confirm the complexity of the sports—delinquency relationship, as both the direct and mediating effects of social control vary by type of sport.

A Cultural Impact of Needle Exchange: The Role of Safer-Injection Mentors

We examine one way in which needle-exchange services in the San Francisco Bay Area have affected needle-sharing and sexual-risk behaviors for injection drug users. We interviewed, qualitatively and quantitatively, 244 participants. Our analysis focuses on comparisons in HIV/AIDS-risk behaviors for a subcategory of “new” injectors: those initiating after the introduction of needle-exchange services in 1988 (n=57). We found that some new injectors benefited from the presence of “safer-injection mentors.” That is, those with someone to teach them harm reduction from their initiation of injection drug use were somewhat more likely to report safer injection practices at the time of interview. We also found that the mentoring process included sharing of information about needle-exchange services. Our results point to evidence of the effectiveness of needle-exchange services in contributing to a culture of harm reduction for injection drug users.

Examining participation in school sports and patterns of delinquency using the national longitudinal study of adolescent health

Abstract This project seeks to identify what factors can account for patterns of delinquency, with special attention given to the role of organized sports. We used The National Longitudinal Study of Adolescent Health (Add Health), a school-based sample of adolescents collected for the purpose of measuring the impact of social environment on adolescent health and social behaviors. The framework for this study rests on the social bond theory of delinquent behavior and social psychology of sports research. We hypothesize that organized sports participation, as a measure of involvement, mitigates youthful delinquent outcomes, as do attachment to parents and friends. Our findings indicate that social bond theory is not sufficient to explain the relationship between sports and delinquency, and social psychological approaches provide some context for understanding outcomes and conceptualizing sport as a complex domain for both exerting and experiencing social control. Although some involvement with sports does not produce an increase in delinquency, being a highly involved athlete is generally associated with higher levels of delinquency. In important ways, family attachment buffers the relationship. These results have important policy implications for schools and families.

Investigating How Decisions to Use Marijuana Change Over Time

This article examines illicit drug use from a decision-making perspective using data collected during 2000–2002 from 51 current and ex-users of marijuana in a large urban city in the central/southwest United States. A qualitative inductive approach based on grounded theory guided the analyses. We find that prior to experimentation and use, decision-making processes are general and nonspecific. In the later stages of drug involvement, decision-making processes become drug-specific. Individuals consider a number of different types of factors when making decisions about illicit drug use involvement. The studys implications and limitations are discussed and future research suggested.

Defunding the Poor: The Impact of Lost access to Subsidized Methadone Maintenance Treatment on Women Injection Drug Users:

Qualitative data from women defunded from a subsidized methadone maintenance treatment (MMT) program were analyzed to determine the impact of defunding on the women and their dependents. Women attested to the efficacy of MMT in creating a stable environment in which their illicit drug use was eliminated or controlled; they were able to decrease their participation in illicit activities and pursue further employment and educational goals. When defunding occurred women employed a variety of strategies including family borrowing, welfare funds, and illicit activities to remain on private MMT programs. The result of these payment strategies was often a premature detoxification from MMT due to unpaid clinic bills. Many women returned to heroin use to alleviate withdrawal symptoms from methadone detoxification. This return to heroin use was also accompanied by increased illicit activities. Defunded women reported severe emotional and financial destabilization as a result of lost access to subsidized methadone maintenance treatment.

Deterrence theory and the role of shame in projected offending of college students against a ban on alcohol.

In the present study we advance previous research in deterrence theory by examining the perceived deterrent effects of a newly instituted dry policy on a college campus. A survey of 500 full-time undergraduate students between the ages of 18 and 26 was conducted 3 months following the ban on alcohol. Hypotheses are derived from deterrence theory and focus on both formal and informal sanctions as they predict projected offending. Findings indicate that perceived severity of the sanction does not predict deterrence against future policy violations. However, the informal deterrent of shame does lower projected offending. While these results suggest that a formal dry policy is not likely to deter future problem drinking behaviors among these college students, reductions may be achieved with the use of informal sanctions and the incorporation of principles from reintegrative shaming theory.

Involuntary versus voluntary detoxification from methadone maintenance treatment: The importance of choice

The authors report on a subset of data from a three-year qualitative and quantitative study of 233 injection drug users (IDUs) in and out of methadone maintenance treatment (MMT) programs in the San Francisco Bay Area. We analyzed data from ten study participants detoxified from their MMT programs voluntarily and thirty involuntarily detoxified due to the defunding of their subsidized MMT slots. All of the study participants reported benefits from MMT program participation including decreased drug use or abstinence; decreased illicit activity; increased ability to maintain or initiate conventional employment; and increased ability to respond to parenting and family obligations. Those who were involuntarily detoxified from MMT programs experienced severe destabilization. Many were financially unstable and dependent on subsidized drug treatment prior to defunding. Several defunded participants were detoxified because they could not afford private fees (

Toward an understanding of responses to methadone maintenance treatment organizational style

225-300/month); others reverted to illicit activities ...