Recent Dissertation Abstracts: Substance Use Around the World

Editor’s Note: Periodically the Points blog posts selections from University of Pittsburgh History of Medicine Librarian Jonathon Erlen‘s running bibliography of dissertation titles relevant to our interests. Today’s post surveys some recent work in the varieties of drug experiences and their management in different cultural contexts. Contact Erlen at erlen@pitt.edu. 

Fathering and Substance Use in Northern Uganda: An Ethnographic Study

Author: Mehus, Christopher J.

Abstract: Parents are the most proximal influence in children’s lives and parenting practices can moderate the relationship between risk-laden contexts and child outcomes. The present study is part of a broader project supporting parents in Northern Uganda and adds to the small but growing literature focused on the impact of fathers in children’s lives. In this study, I utilized ethnographic in-depth interviews with 19 fathers, focus groups, informal conversations with community members, and field observations to learn about the roles of fathers in Northern Uganda and the perceived impact of alcohol use on those roles and their relationships. Findings that emerged from the data show that fathers have three primary roles: to provide for their children, to educate their children, and to provide a stable and peaceful home. Each of these roles is seen as being negatively impacted by “over-drinking”. These roles are all future oriented and occur within broader systems including partner relationships, extended family, and a societal context characterized in part by a defined social hierarchy, recovery from war, and a developing economy. Findings provide directions for future research with fathers and will support this research team’s inclusion of fathers in future parent education programs.

Subject: Cultural anthropology; Individual & family studies; Sub Saharan Africa Studies

Publication year: 2015

Advisor: Wieling, Elizabeth

University/institution: University of Minnesota

 

Choosing Methadone: Managing Addiction and the Body Politic in Ukraine

Author: Carroll, Jennifer J.

Abstract: This dissertation explores the lived experience of opiate substitution therapy (OST) patients in Ukraine. To complete this research, I conducted fourteen months of ethnographic research in OST programs across Ukraine between 2012 and 2014. I conducted extensive clinical observations and collected more than fifty interviews with patients and clinicians. The first chapter, the introduction, describes the historical and contemporary landscape of harm reduction and drug treatment services in Ukraine. The second chapter positions this research as a ‘neurochemical ethnography,’ which taps into critical medical anthropology, phenomenology, and science studies to explore human-chemical relationships. The third chapter reveals that, in Ukraine, scientific utterances are also political utterances. This complicates the interpretation of evidence and destabilizes the epistemological foundation of ‘evidence-based’ practice. The fourth chapter shows that patients and clinicians in OST programs espouse conflicting explanatory models of addiction. This causes antagonism over the utility of OST drugs and the definition of treatment success. The fifth chapter analyses the semiotics of OST drugs and patients’ active resistance to the clinical distinction between ‘street drugs’ and ‘medicine.’ The sixth chapter demonstrates that treatment-seeking decisions are motivated by patients’ desire to embody normative social roles. They hope to achieve this goal by simplifying the logistics of their chemical self-management. In the seventh chapter, the conclusion, I outline practical recommendations for improving OST programs in Ukraine and elsewhere. In sum, this dissertation argues that clinical cultures and treatment-seeking behaviors are shaped by a ‘somatic ethic,’ which not only governs discourses on drug use and addiction but also places social integration and acceptable personhood at odds with the practicalities of treatment.

Subject: Cultural anthropology; East European Studies; Public health; Epidemiology

Publication year: 2015

Advisor: Bilaniuk, Laada

University/institution: University of Washington

Department: Anthropology

 

Alcohol Use in Mexican-Americans by Nativity: The Role of Ethnic Identity, Acculturation, and Acculturative Stress

Author: Vallejo, Leticia G.

Abstract: The present study examined alcohol use disorder symptoms among Mexican-Americans. Participants consisted of a community-based sample of 237 Mexican-American adults living in the Midwest United States. The role of nativity status and cultural variables in alcohol use disorder symptoms was explored. Specifically, ethnic identity, acculturation, and acculturative stress were used to predict membership into high and low alcohol use disorder symptom groups among U.S.-and foreign-born Mexican-Americans. Additionally, gender, ethnic identity, and acculturative stress were tested as moderators in the relationship between acculturation and alcohol use disorder symptoms. Among U.S.-born participants, only ethnic identity was found to be predictive of alcohol use disorder symptoms, such that higher ethnic identity was related to fewer alcohol use disorder symptoms. Among foreign-born participants, ethnic identity was also predictive of few alcohol use disorder symptoms. Additionally, increased pressure against acculturation was predictive of higher alcohol use disorder symptoms for foreign-born participants. Among the sample as a whole, those with low Latino Orientation and high pressure against acculturation reported more alcohol use disorder symptoms. These results highlight the protective effect of ethnic identity and the need for further research that examines nativity status, acculturation, and specific acculturative stressors in regard to alcohol use disorder symptoms among Mexican-Americans.

Subject: Clinical psychology; Hispanic American studies

Publication year: 2013

Advisor: Torres, Lucas

University/institution: Marquette University

Department: Clinical Psychology

 

Discrimination, substance use, and cultural buffers among Native American college students

Author: Greenfield, Brenna L.

Abstract: The negative effects of racial discrimination and microaggressions on health have been consistently documented, but only a handful of studies have examined this topic among Native Americans. The goal of this study was to test the Indigenist Stress-Coping Model (Walters, Simoni, & Evans-Campbell, 2002) among Native American college students attending two post-secondary institutions in the Southwestern United States. It was hypothesized that microaggressions would be positively related to substance use, and that cultural factors would attenuate the strength of this relationship. A total of 347 participants (65% female) completed a one-time online survey that included the Microaggressions Scale, the Actualization subscale of the Urban American Indian Identity Attitudes Scale (a measure of cultural identity), and measures of past-month and lifetime substance use. In the past month, only 43% of participants drank alcohol and only 27% binge drank – figures much lower than national averages for college students. Thirteen percent were current smokers and 20% had used illicit drugs in the past month. Almost all (94%) had experienced a microaggression in the past year. In regression models, microaggressions were positively related to using an illicit drug more than 100 times and to lifetime CAGE-AID score when controlling for gender, age, income, and cultural identity. However, microaggressions were unrelated to past-month substance use variables. While stronger Native American cultural identity was related to less past-month substance use, cultural identity did not moderate the relationship between discrimination and substance use. A subgroup of participants (n = 61) from the larger study completed a 21-day daily diary measuring substance use, discrimination, and cultural involvement. The goal was to examine the prospective influence of daytime experiences of racial discrimination on evening substance use, as well as the moderating effects of cultural identity, positive and negative interpersonal interactions, and alcohol expectancies. Using multi-level modeling, daytime discrimination did not predict evening substance use, and moderators could not be tested because of statistical convergence issues. These findings highlight cultural strengths and comparatively low rates of tobacco and alcohol use among Native American college students despite substantial experiences of lifetime discrimination; implications for future research and intervention are discussed.

Subject: Public health; Clinical psychology; Native American studies

Publication year: 2015

Advisor: Venner, Kamilla

University/institution: The University of New Mexico

Department: Psychology

 

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