Addicting
Marital Histories and Heavy Alcohol Use among Older Adults
Corinne Reczek et al.
Journal of Health and Social Behavior, March 2016, Pages 77-96
Abstract:
We develop a gendered marital biography approach — which emphasizes the accumulating gendered experiences of singlehood, marriage, marital dissolution, and remarriage — to examine the relationship between marital statuses and transitions and heavy alcohol use. We test this approach using individual-level (n = 10,457) and couple-level (n = 2,170) longitudinal data from the Health and Retirement Study, and individual-level (n = 46) and couple-level (n = 42) in-depth interview data. Quantitative results show that marriage, including remarriage, reduces men’s but increases women’s drinking relative to being never married and previously married, whereas divorce increases men’s but decreases women’s drinking, with some variation by age. Our qualitative findings reveal that social control and convergence processes underlie quantitative results. We call attention to how men’s and women’s heavy drinking trajectories stop, start, and change direction as individuals move through their distinctive marital biography.
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Predictors of alcohol consumption on dates and sense of intimacy
Sonia Ip & Bernd Heubeck
Personal Relationships, March 2016, Pages 124–140
Abstract:
The drinking culture in Western societies infiltrates many aspects of life, including early romantic relationships. This study investigated factors that predict drinking on dates and the impact of date drinking on feelings of intimacy. Regression analyses of questionnaire data revealed that expectancies, general drinking tendencies, and partner's drinking as well as their interactions with gender and ethnicity contributed to explaining alcohol consumption on dates. Intimacy was significantly predicted by alcohol usage on dates, but the effects of drinking by self and partner varied by gender. Women's own drinking positively predicted their sense of intimacy, but their partner's drinking was linked to decreased intimacy. Men's reports showed significant effects but in the opposite direction. The Discussion section considers implications for dating and future research.
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The War on Drugs: Estimating the Effect of Prescription Drug Supply-Side Interventions
Angelica Meinhofer
Brown University Working Paper, February 2016
Abstract:
Prescription drug abuse is America’s fastest-growing drug problem, with overdose deaths from opioid pain relievers increasing by 313% from 1999 to 2010. This paper estimates the effect of supply-side interventions on prescription drug availability, abuse, public health, and crime. The study is based in Florida, the epicenter of the prescription drug abuse epidemic in the late-2000s, where physicians prescribing and dispensing oxycodone from pain clinics were the main source of drug diversion. In mid-2010, government officials initiated a sweeping crackdown on Florida’s pain clinic suppliers, reducing the number of pain clinic licenses by 59%. Using novel online and administrative data and exploiting the timing and geographic location of the crackdown, I find that enforced regulation of pharmaceuticals’ legal supply chain can reduce prescription drug abuse substantially and sustainably. Between 2008-12, oxycodone street prices increased by 238% and average supply decreased by 59%. In turn, indicators of oxycodone consumption decreased significantly. There is no evidence of an oxycodone price, supply, or consumption recovery. There is substitution to heroin, but this offsetting effect is small relative to substantial public health gains from decreases in oxycodone deaths and hospitalizations. In addition, there is weak evidence of a decrease in drug arrests and index crimes.
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David Simon
American Economic Journal: Applied Economics, forthcoming
Abstract:
Evidence suggests that excise taxes on tobacco improve fetal health. However, it remains unknown if smoke exposure in early life causes lasting harm to children. I find that in-utero exposure to a dollar increase in the state cigarette tax causes a 10% decrease in sick days from school and a 4.7% decrease in having two or more doctor visits. I present additional evidence for decreases in hospitalizations and asthma. This supports the hypothesis that exposure to cigarette smoke in utero and infancy carries significant medium-term costs, and that excise taxes can lead to lasting intergenerational improvements in wellbeing.
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Assessing the Impact of Twenty Underage Drinking Laws
James Fell et al.
Journal of Studies on Alcohol and Drugs, March 2016, Pages 249–260
Method: We updated the effective dates of the 20 MLDA-21 laws examined in this study and used scores of each law’s strengths and weaknesses. Our structural equation model included the 20 MLDA-21 laws, impaired driving laws, seat belt safety laws, economic strength, driving exposure, beer consumption, and fatal crash ratios of drinking-to-nondrinking drivers under age 21.
Results: Nine MLDA-21 laws were associated with significant decreases in fatal crash ratios of underage drinking drivers: possession of alcohol (-7.7%), purchase of alcohol (-4.2%), use alcohol and lose your license (-7.9%), zero tolerance .02 blood alcohol concentration limit for under-age drivers (-2.9%), age of bartender ≥21 (-4.1%), state responsible beverage service program (-3.8%), fake identification support provisions for retailers (-11.9%), dram shop liability (-2.5%), and social host civil liability (-1.7%). Two laws were associated with significant increases in the fatal crash ratios of underage drinking drivers: prohibition of furnishing alcohol to minors (+7.2%) and registration of beer kegs (+9.6%).
Conclusions: The nine effective MLDA-21 laws are estimated to be currently saving approximately 1,135 lives annually, yet only five states have enacted all nine laws. If all states adopted these nine effective MLDA-21 laws, it is estimated that an additional 210 lives could be saved every year.
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Sabriya Linton et al.
Drug and Alcohol Dependence, March 2016, Pages 30–41
Methods: This longitudinal study analyzed 7 waves of data (2009–2014) from a predominantly substance-using cohort of 172 African American adults relocated from public housing complexes in Atlanta, GA, to determine whether post-relocation changes in exposure to neighborhood conditions were associated with four network characteristics related to substance use: number of social network members who used illicit drugs or alcohol in excess in the past six months (“drug/alcohol network”), drug/alcohol network stability, and turnover into and out of drug/alcohol networks. Individual- and network-level characteristics were captured via survey and administrative data were used to describe census tracts where participants lived. Multilevel models were used to assess relationships of census tract-level characteristics to network outcomes over time.
Results: On average, participants relocated to census tracts that had less economic disadvantage, social disorder, and renter-occupied housing. Post-relocation reductions in exposure to economic disadvantage were associated with fewer drug/alcohol network members and less turnover into drug/alcohol networks. Post-relocation improvements in exposure to multiple census tract-level social conditions and reductions in perceived community violence were associated with fewer drug/alcohol network members, less turnover into drug/alcohol networks, less drug/alcohol network stability, and more turnover out of drug/alcohol networks.
Conclusion: Relocating to neighborhoods with less economic disadvantage and better social conditions may weaken relationships with substance-using individuals.
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Economic Conditions, Illicit Drug Use, and Substance Use Disorders in the United States
Christopher Carpenter, Chandler McClellan & Daniel Rees
NBER Working Paper, February 2016
Abstract:
We provide the first analysis of the relationship between economic conditions and the use of illicit drugs other than marijuana. Drawing on US data from 2002-2013, we find mixed evidence with regard to the cyclicality of illicit drug use. However, there is strong evidence that economic downturns lead to increases in substance use disorders involving hallucinogens and prescription pain relievers. These effects are robust to a variety of specification choices and are concentrated among prime-age white males with low educational attainment. We conclude that the returns to spending on the treatment of substance use disorders are particularly high during economic downturns.
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Gender balance and its impact on male and female smoking rates in Chinese cities
Tingzhong Yang et al.
Social Science & Medicine, April 2016, Pages 9–17
Objective: Although gender differences in smoking have received much attention, few studies have explored the importance of contextual effects on male and female smoking rates. The aim of this study is to examine the association between variations in city-level sex ratios and gender differences in smoking in China.
Methods: Participants included 16,866 urban residents, who were identified through multi-stage sampling conducted in 21 Chinese cities.
Results: The study found that, independent of personal characteristics, cities with more males had higher male smoking rates and lower female rates.
Conclusions: Our research underscores the importance of city-level contextual effects in understanding gender differences in smoking in China.
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Adam Sacarny et al.
Health Affairs, March 2016, Pages 471-479
Abstract:
Inappropriate prescribing is a rising threat to the health of Medicare beneficiaries and a drain on Medicare’s finances. In this study we used a randomized controlled trial approach to evaluate a low-cost, light-touch intervention aimed at reducing the inappropriate provision of Schedule II controlled substances in the Medicare Part D program. Potential overprescribers were sent a letter explaining that their practice patterns were highly unlike those of their peers. Using rich administrative data, we were unable to detect an effect of these letters on prescribing. We describe ongoing efforts to build on this null result with alternative interventions. Learning about the potential of light-touch interventions, both effective and ineffective, will help produce a better toolkit for policy makers to improve the value and safety of health care.
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Addiction History Associates with the Propensity to Form Habits
Theresa McKim, Daniel Bauer & Charlotte Boettiger
Journal of Cognitive Neuroscience, forthcoming
Abstract:
Learned habitual responses to environmental stimuli allow efficient interaction with the environment, freeing cognitive resources for more demanding tasks. However, when the outcome of such actions is no longer a desired goal, established stimulus–response (S-R) associations or habits must be overcome. Among people with substance use disorders (SUDs), difficulty in overcoming habitual responses to stimuli associated with their addiction in favor of new, goal-directed behaviors contributes to relapse. Animal models of habit learning demonstrate that chronic self-administration of drugs of abuse promotes habitual responding beyond the domain of compulsive drug seeking. However, whether a similar propensity toward domain-general habitual responding occurs in humans with SUDs has remained unclear. To address this question, we used a visuomotor S-R learning and relearning task, the Hidden Association between Images Task, which employs abstract visual stimuli and manual responses. This task allows us to measure new S-R association learning and well-learned S-R association execution and includes a response contingency change manipulation to quantify the degree to which responding is habit based, rather than goal directed. We find that people with SUDs learn new S-R associations as well as healthy control participants do. Moreover, people with an SUD history slightly outperform controls in S-R execution. In contrast, people with SUDs are specifically impaired in overcoming well-learned S-R associations; those with SUDs make a significantly greater proportion of perseverative errors during well-learned S-R replacement, indicating the more habitual nature of their responses. Thus, with equivalent training and practice, people with SUDs appear to show enhanced domain-general habit formation.
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Marijuana on Main Street? Estimating Demand in Markets with Limited Access
Liana Jacobi & Michelle Sovinsky
American Economic Review, forthcoming
Abstract:
Marijuana is the most common illicit drug with vocal advocates for legalization. Among other things, legalization would increase access and remove the stigma of illegality. Our model disentangles the role of access from preferences and shows that selection into access is not random. We find that traditional demand estimates are biased resulting in incorrect policy conclusions. If marijuana were legalized those under 30 would see modest increases in use of 28 percent, while on average use would increase by 48 percent (to 19.4 percent). Tax policies are effective at curbing use, where Australia could raise a billion (and the US $12 billion).
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Nancy Nicosia, Beau Kilmer & Paul Heaton
Lancet Psychiatry, March 2016, Pages 226–232
Background: In the UK and USA, various jurisdictions have launched new approaches for managing alcohol-involved offenders that might have public health implications. These programmes require participants to abstain from alcohol and submit to frequent alcohol testing with swift, certain, and modest sanctions for violations, with the aim to reduce crime and keep alcohol-involved offenders in the community. In this study we examine whether the 24/7 Sobriety programme in South Dakota, USA—the largest such programme to date—is associated with reductions in mortality.
Methods: With a differences-in-differences design, we used variation in the timing of 24/7 Sobriety implementation across South Dakota counties between 2005 and 2011 to estimate the association between programme introduction and county-level mortality. We used monthly, county-level, aggregate counts for mortality from January, 2000, to June, 2011. We assessed total deaths, and deaths due to external injuries, circulatory disorders, digestive disorders, and cancer (as a potential placebo).
Findings: Between January, 2005, and June, 2011, 16 932 people (about 3% of the adult population) participated in the 24/7 Sobriety programme. The analysis was based on a sample size of 9 108 county-month observations (ie, 66 counties × 12 months × 11•5 years). Implementation of 24/7 Sobriety was associated with a 4•2% (95% CI 1•5–6•9) reduction in all-cause adult mortality, with the largest associations among women (8•0%, 95% CI 3•9–11•8) and individuals older than 40 years (4•3%, 95% CI 1•4–7•0). Associations were most evident among circulatory disorders.
Interpretation: 24/7 Sobriety might have public health benefits, which could extend beyond individuals directly enrolled in the programme. However, further research, including randomised controlled trials and analyses of individual-level data, is needed to corroborate the finding, reassess the size of these associations, and gain insight into causal mechanisms. Should a negative association be replicated, it might represent a substantial advance in our understanding of how criminal justice interventions could help shape public health.
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Arthur Robin Williams et al.
Health Affairs, March 2016, Pages 480-488
Abstract:
Twenty-three states and the District of Columbia have passed laws implementing medical marijuana programs. The nineteen programs that were in operation as of October 2014 collectively had over one million participants. All states (including D.C.) with medical marijuana laws require physicians directly or indirectly to authorize the use of marijuana at their discretion, yet little is known about how medical marijuana programs vary regarding adherence to basic principles of medical practice and associated rates of enrollment. To explore this, we analyzed marijuana programs according to seven components of traditional medical care and pharmaceutical regulation. We then examined enrollment rates, while controlling for potentially confounding state characteristics. We found that fourteen of the twenty-four programs were nonmedical and collectively enrolled 99.4 percent of participants nationwide, with enrollment rates twenty times greater than programs deemed to be “medicalized.” Policy makers implementing or amending medical marijuana programs should consider the powerful relationship between less regulation and greater enrollment. Researchers should consider variations across programs when assessing programs’ population-level effects.