Thesis advisor: Marius Stan / This thesis explores America's Opioid addiction crisis through a philosophical lens, arguing for a need to adopt a national mandatory rehabilitative approach for the sake of maintaining our country's cultural ethos grounded in freedom and the subsequent capacity to flourish as a human being. It proceeds in four chapters: the development of our cultural ethos through an analysis of John Locke and J.S. Mill, the history of the opioid addiction crisis and development of the two dominant addiction theories, America's current measures to tackling the crisis, and the proposal of a new approach that recovers addicts' freedom and ability to flourish. The work concludes by arguing for the importance of using philosophical principles and interpretations to guide problem solving and tackling current crises. / Thesis (BA) — Boston College, 2023. / Submitted to: Boston College. College of Arts and Sciences. / Discipline: Departmental Honors. / Discipline: Philosophy.

This study sought to investigate fatal overdoses in Orange County, Florida during the years of 2019, 2020, and 2021. Data for this project was provided by the Orange County Medical Examiner's office. Each overdose death was coded for age, sex, race, and cause of death. The purpose of the study is to identify trends to inform policy reform. The results reveal that fentanyl overdose deaths are continuing to rise as heroin overdose deaths decrease. Additionally, there is greater upward trends in polysubstance opioid overdose deaths as compared to non-opioid polysubstance overdose deaths. Ultimately, a specific type of overdose death cannot be predicted by race or sex. The implications of this study are that awareness campaigns and treatment opportunities should highlight that an overdose death can happen to anyone.

While there is a substantial body of placed-based evaluations of drug enforcement strategies, little is known about the nature and effectiveness of the routine tactics used by local police to target individual drug offenders. This study used a mixed-method approach to build on existing research on the efficacy of drug enforcement by documenting the nature and consequences of street-level drug enforcement at the local level. First, a focus group of drug enforcement experts was conducted to identify the tactics used to generate arrests and various types of evidence believed to strengthen drug cases. Next, official data in the form of police reports and court records were coded from one year of proactive felony drug arrests in a large, urban police department. The relationship between offender-focused drug enforcement tactics and various court outcomes (e.g., felony prosecution, formal conviction, and incarceration) were examined through logistic regression analyses. Results indicate traffic stops were the most frequently used tactic to generate felony drug arrests. However, buy-walks were more effective than traffic stops at receiving felony prosecutions. In contrast, search warrants were significantly less likely to result in prosecution. Implications for research and policy are discussed.

付記する学位プログラム名: グローバル生存学大学院連携プログラム / 京都大学 / 新制・課程博士 / 博士(医学) / 甲第24510号 / 医博第4952号 / 新制||医||1064(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 小杉 眞司, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Substance use and substance use disorders (SUDs) pose a significant health and economic concern in the United States. Conditions and comorbidities exist that are associated with substance use onset, continuation, and outcomes. In the theory of Reinforcer Pathology, we can categorize these conditions into vulnerabilities, or factors that may be associated with susceptibility to substance use onset and poorer outcomes in substance use recovery. The theory of vulnerabilities and reinforcer pathology is tested through three investigations. The first investigation sought to establish the relationship between cumulative vulnerabilities and adolescent substance use in a cross-sectional analysis. The second investigation evaluates the temporal relationship of cumulative vulnerabilities and substance use among adolescents. The final investigation establishes the relationship of cumulative vulnerabilities and substance use among individuals in recovery from Opioid Use Disorder. Collectively, these reports suggest that the intersection and cumulation of vulnerabilities to substance use and substance use disorders are directly related to substance use outcomes. Future research and reports in the substance use domain should consider these constructs, their accumulation, and their co-occurrence patterns. / Doctor of Philosophy / Substance use and substance use disorders are a great health and economic concern in the United States. Conditions that are related to trying substances, using substances, and outcomes of this substance use. In the theory of Reinforcer Pathology, we can call these conditions vulnerabilities, or conditions that may be associated with the likelihood of starting to use substances and having poorer substance use outcomes in the long-term. Three studies investigate the theory of vulnerabilities and Reinforcer Pathology. First, the relationship between cumulative vulnerabilities and substance use among adolescents is assessed cross-sectionally or simultaneously. The second study examines the relationship between cumulative vulnerabilities and adolescent substance use over time. The third study examines the relationship between cumulative vulnerabilities and substance use among individuals in recovery from Opioid Use Disorder. Collectively, the studies in this report suggest that the overlap and cumulation of vulnerabilities to substance use and substance use disorders is related to substance use outcomes. Future research and other reports in the substance use domain should consider these constructs, their accumulation, and their co-occurrence patterns.

No description available.

This thesis attempts to document and illuminate the growing issue of prescription drug abuse among the elderly population. The average elder in the U.S. takes at least one prescription drug per day, depending upon their health status. Likewise, elders that suffer from multiple chronic conditions are more likely to take multiple prescription drugs. As the lifespan of humankind grows well into their 90's and older, even more elders will be placed on prescription drugs. As part of this study, a narrative literature review was conducted to summarize the topic of prescription drug abuse amongst the elderly. The findings suggest that elderly white women over the age of 80 years old are more likely to take prescription drugs that lead to a higher risk of bodily injuries and death. This study is critically important and essential since the current generation that meets the age requirement to be considered elderly is the "Baby Boomer" generation. The "Baby Boomer" generation, defined as individuals born between 1946 and 1964, is considered one of the largest generations recorded in modern times. This study will be useful for practitioners, residential care facilities, policymakers, and family members to have better oversight and communication with elders suffering from chronic conditions that take prescription drugs to cure their illnesses.

Alcohol-use disorders affect 15 million people nationwide, 4% of which are adolescents (12-17). Clinical data indicate that adolescents who binge drink greatly increase their likelihood of developing an alcohol-use disorder later in life. Moreover, research indicates that binge-drinking during adolescence produces long-lasting alterations in brain circuitry that underlie the processing of rewarding stimuli. The current study sought to determine the effect of adolescent exposure to chronic intermittent ethanol (AIE) on the consumption of, and motivation to obtain, sucrose solution in adulthood. Alcohol naïve, male Wistar rats arrived at the laboratory on post-natal day (PND) 25 and were randomly divided into two exposure groups (AIE and Air). Animals were provided 3 days to allow for acclimation to the animal colony, prior to the start or experimental procedure (PND 28). The AIE procedure involves inducing alcohol dependence by placing rats, in their home cage, into an alcohol vapor chamber for 14 consecutive days, with each exposure day consisting of 12 hrs of exposure in the chambers (8 am to 8 pm) and 12 hrs out of the chambers. The control rats (Air) are treated the same as AIE rats but without exposure to ethanol vapors. Following the AIE paradigm, all rats remained in their home-cage until adulthood (>PND 70) at which time they started operant training/testing in standard operant chambers equipped with two sipper tubes connected via tubing to liquid delivery solenoids. When the response requirement (# of licks) was met, animals received a delivery of 0.1 ml of 5% sucrose solution. All animals were instrumented to the operant procedure on a fixed-ratio (FR) 2 schedule which increased to an FR4 then FR8. Finally, all rats underwent a progressive ratio test in which response requirement increased exponentially for each liquid delivery. On lower schedules (FR2 and FR4) animals did not exhibit a significant difference in licks or reinforcers earned. However, for higher schedules (FR8 and PR) animals in the Air group exhibited a significantly higher level of behavior (licks) and received a significantly greater number of reinforcers than the AIE group. Overall, the data suggest that exposure to AIE, which approximates binge-like EtOH intake and dependence, differentially affects consumatory and appetitive behavior in response to a non-drug reward in adulthood.

This thesis examines the possibilities of living an authentic life for an alcoholic, both in and out of Alcoholics Anonymous. Authenticity is explored using the existential models put forth by Jean-Paul Sartre and Soren Kierkegaard. Alcoholics Anonymous figures prominently in this analysis. It is suggested that A.A. acts inauthentically in its claims that it is not a religious organization. A.A. creates special problems for female alcoholics because of the sexist and masculinist nature of its primary literature. While A.A. claims that its message is the only way by which an alcoholic can recover, other treatment methods exist. Suggestions are made that A.A. revise its main texts, and two alternative organizations to A.A. are briefly discussed.

Pregnant women with substance use issues are a doubly at-risk group in desperate need of support. Using open-ended interviews, participant-observation, and media analysis, I examine the support provided by the Department of Children and Families (DCF) in Massachusetts for pregnant women who seek treatment at Project Empowerment. Project Empowerment provides prenatal care, maintenance therapy, and other services to expectant mothers who struggle with substance use issues. Drawing upon Foucault’s (1975) notion of surveillance, I explore how pregnant women with substance use issues are surveilled by agencies, and how these surveillance agencies structure their care and policies through their definitions of what it means to be a “good mother.” I argue that through the Department of Children and Families definition of the “good mother,” DCF produces an unintended paradox of support for pregnant women with substance use issues in Massachusetts.