The purpose of this mixed methods study was to identify demographic and psychosocial correlates of illicit drug use among pregnant women and to explore the life experiences and circumstances that contribute to women’s use of illicit drugs during pregnancy. A sequential explanatory mixed-methods design consisting of quantitative and qualitative components was used. The results of the quantitative component found that women who are depressed, of First Nations ethnicity, drink alcohol during pregnancy, smoke during pregnancy, and have low self-esteem are more likely to use illicit drugs during pregnancy. The qualitative component of the study identified four themes that impacted women’s use of illicit drugs during pregnancy. These included: (1) living a chaotic life as a child, (2) complicated life circumstances, (3) social support system, and (4) the road to recovery. The information gathered during this study will inform practice and policy and may guide future research in this area.

The purpose of this mixed methods study was to identify demographic and psychosocial correlates of illicit drug use among pregnant women and to explore the life experiences and circumstances that contribute to women’s use of illicit drugs during pregnancy. A sequential explanatory mixed-methods design consisting of quantitative and qualitative components was used. The results of the quantitative component found that women who are depressed, of First Nations ethnicity, drink alcohol during pregnancy, smoke during pregnancy, and have low self-esteem are more likely to use illicit drugs during pregnancy. The qualitative component of the study identified four themes that impacted women’s use of illicit drugs during pregnancy. These included: (1) living a chaotic life as a child, (2) complicated life circumstances, (3) social support system, and (4) the road to recovery. The information gathered during this study will inform practice and policy and may guide future research in this area.

Marijuana has been found to be the sole substance used by 57.3 percent of illicit drug users in the United States (NSDUH 2008). Taking this statistic into mind, it makes sense that individuals currently wed, divorced, cohabitating, or in some form of committed, romantic relationship would also be affected by the use of marijuana. While in today’s society the process of mate selection and relationship formation is considered to be a rather private and personal affair, some aspects of relationships still have consequences for the greater society. The effects of failed pairings on the individuals involved can have numerous repercussions; such ramifications are only multiplied when children are present within the relationship. The purpose of this project was to gain an understanding of the interplay between marijuana use and relationships and to better understand the means and methods by which relationships and marijuana use change over time. The influence of one’s personal, committed relationships on the increase, decrease, initiation, or cessation of marijuana use is examined in this study. Through the use of qualitative, in-depth interviews with 19-seven current and former users of marijuana, the underlying processes and events associated with the use of marijuana within relationships are better understood. According to the current research, marijuana can have both positive and negative repercussion on the romantic relationships of users. However, the most negative impacts on relationships tend to be seen when partners are unequally matched on their usage of the substance.

Does Nimbin have a drug problem? This tiny village in north-eastern NSW has an international reputation for its alternative community and its street drug market. Ever since the Aquarius Festival thirty years ago Nimbin has fascinated the media, and recurrent headlines about the village's (undefined) 'drug problem' suggested my research topic. My research aim was to investigate the meaning/s of Nimbin's 'drug problem' in the context of Nimbin's 'alternative' culture. Because the topic of illicit drugs is both ethically challenging and highly sensitive, my research design was strongly participant-focused, with an emphasis on confidentiality balanced by a mixed methodology to cross-validate results. My methods included an anonymous household (door-to-door) survey based on a national household survey; an anonymous mailed-back survey of Nimbin and Lismore drug injectors; taped interviews with health and legal professionals, cannabis activists and drug dealers; semi-structured interviews with 'professional' cannabis crop growers; and participant observation over several years. I found the multi-method research design to be particularly effective for investigating illegal drug marketing and use, and the design provided me with multiple perspectives on a complex issue. Superficially, there appeared to be two drug 'problems' in Nimbin — one was the (largely cannabis) street market, and the other revolved around heroin users, and included complaints about scruffy-looking people hanging around the main street, or overdosing in the public toilet. However, my research suggested that these issues, while immediately comprehensible as 'drug problems', obscured more complex issues. For example, the village's street drug market was intertwined with the local economy and with the alternative community's values and drug use, while close to half of the drug injectors lacked secure housing (which creates problems that are not related to heroin), and all heroin users were blamed for the actions of few. Many factors influence the creation and maintenance of what we might call 'problems', and drugs are frequently blamed for broader social problems. What is Nimbin’s drug problem? The answer depends, in part, on the drug of interest, but more importantly it depends on your definition of a ‘problem’. Some useful and meaningful perspectives on this important social issue include quantified indicators such as death, injury, arrest rates, the economics of black markets, the demographics of drug use, and estimates of ‘social costs’. Qualitative perspectives include people’s opinions about drugs, media-generated moral panics, the effects of social marginalisation, and the role of drug cultures. A number of ‘drug problems’ arise as a direct result of drug illegality. They include black markets, corruption, drug-related violence, theft, stronger forms of the drug, and more dangerous using practices (with the risk drug overdoses and HIV/AIDS), as well as public nuisance issues. Government policy, judicial sentencing and public opinion are moving towards the social reintegration of illicit drug users, but this is almost invariably counter-balanced by a toughening of legal sanctions against supply of the same drug. Most discussions about illicit drugs fail to consider the long-term implications of harsh penalties for, and elaborate and punitive police operations (such as occurred throughout my Nimbin research) against, small-scale independent growers and dealers. The only way to directly engage with drug markets and all the attendant problems, is to legitimise and regulate the supply of recreational drugs. I discuss several examples of the important role of the drug culture in mitigating problems caused by illegality. One example is the influence of Nimbin's alternative community on the style of the drug market. The village drug scene more closely resembles the many north coast village craft markets, than it does Kings Cross, Cabramatta or New York's Bronx. Buyers are north coast locals, along with national and international tourists (the small village is known to cannabis users world-wide, both through media attention and word-of-mouth). Nimbin offers a 'safe' village market ambience and competitive prices to a mainly cannabis using clientele. I suggest that there are two major underlying influences on the experience of a ‘drug problem’, regardless of the drug or the place. They are: 1. Political influences — specifically the effects of government policy on black markets, law enforcement practices, and access to services and resources; 2. Cultural influences — particularly the beneficial effects of norms and functional role models for the safe use of a drug, cultural effects on the drug market, and the role/s of the drug in the day-to-day life of the culture. These influences can operate with, or despite, each other, and can create or ameliorate many ‘drug problems’. In the case of Nimbin’s alternative culture, government policy has created a number of drug problems and the counter-culture has worked to minimise them. In my research into Nimbin’s ‘drug problem’ I have clarified some issues and raised a number of others. I have examined the notion of a ‘drug problem’ from several perspectives using a range of research tools, and discussed some key influences on the problem associated with drug use. Drawing from the Nimbin research and my reading, I suggest legalising the recreational drugs to bring them under the dual controls of supply legislation and social norms. In conclusion, I suggest that we need to be very clear about what ‘drug problem’ it is that we are talking about, and indeed, whether the problem is really about drugs at all.

Doctor of Philiosophy (PhD) / Since 1998 anti-doping policy has undergone massive change. The level of world-wide cooperation involved in establishing an international anti-doping system is unprecedented in the history of the regulation of performance enhancing substances in sport. Such cooperation and the unipartite nature of public doping discourse give the impression that anti-doping policy is clear, unproblematic and universally acceptable. However, scratching the harmonious surface of modern anti-doping approaches reveals fundamental problems and inconsistencies, the two most basic of which go to the very core of the policy. Basic issues — what constitutes doping and the reasons why we prohibit it — are still unsettled, lack clarity and give rise to many significant operational issues. For instance, the definition of ‘doping’ in doping discourse is quite different from the definition in the World Anti-Doping Code: what is thought of as ‘doping’ is very different from what is punished as ‘doping.’ Moreover, the commonly suggested anti-doping rationales do not adequately explain the present prohibition on the use of performance enhancing substances in sport. In light of this uncertainty, two questions arise: why is there so much confusion and why do we prohibit doping in sport? Desmond Manderson, in his study of the origins of illicit drug laws, has wrestled with a similar question; his conclusions are that drugs have been prohibited more for what they symbolise than their pharmacological properties. This thesis argues that, in a similar way to illicit drug policy, the symbolism of performance enhancing substances in sport has played a major role in the development of anti-doping policy. To demonstrate the influence of such symbolism, three significant time periods in anti-doping history are considered in the thesis: the 1920s, the 1960s and the 1970s. The most formative aspect of symbolism in the 1920s, when anti-doping rules were first passed, was the association between doping and illicit drug taking. The stigma attached to stereotypical images of illicit drug-users contributed to ‘doping’ being viewed as contrary to the amateur ethos and the adoption of a regulatory system modelled on illicit drug policy approaches. In the 1960s, when anti-doping policy began in earnest, illicit drug symbolism was also extremely influential. Concerns regarding drug addiction in sport fuelled fears about the health of the athlete which were prominent in doping discourse at this time. Combined with a strong belief in the power of drugs in general, illicit drug symbolism led to the expansion of the illicit drug model of regulation to include illicit drug style testing. Doping changed in the 1970s with the emergence of training drugs such as anabolic steroids. Steroids became strongly associated with ‘communist’ athletes and were viewed as extremely powerful transforming drugs. A kind of steroid hysteria was thereby created in doping discourse. Simultaneously, the continuing influence of illicit drug symbolism meant that the previously adopted illicit drug model was also applied to steroids. The conclusion of the thesis is that anti-doping policy is not fundamentally a rational system: instead it has been driven much more by emotional factors such as public opinion than rational argument. Such a basis is bound to create confusion and explains many of the problems of current anti-doping policy. The way in which symbolism has led to the regulatory decisions in anti-doping history is summarised as constituting the ‘reactive regulation model’ in the concluding section of the thesis. This pattern of regulation has produced a number of important operational difficulties in current anti-doping law, the prime example being the ‘fallacy’ of in-competition drug testing to deal with the issue of training drugs such as steroids. Finally, it is argued that in light of the reactive nature of anti-doping policy, it is unlikely that recent challenges, such as gene doping and the use of non-analytical evidence, will be treated any differently to past challenges. Anti-doping policy has always been largely driven by reactions to symbolism; there is no reason to suspect this type of approach will change.

Does Nimbin have a drug problem? This tiny village in north-eastern NSW has an international reputation for its alternative community and its street drug market. Ever since the Aquarius Festival thirty years ago Nimbin has fascinated the media, and recurrent headlines about the village's (undefined) 'drug problem' suggested my research topic. My research aim was to investigate the meaning/s of Nimbin's 'drug problem' in the context of Nimbin's 'alternative' culture. Because the topic of illicit drugs is both ethically challenging and highly sensitive, my research design was strongly participant-focused, with an emphasis on confidentiality balanced by a mixed methodology to cross-validate results. My methods included an anonymous household (door-to-door) survey based on a national household survey; an anonymous mailed-back survey of Nimbin and Lismore drug injectors; taped interviews with health and legal professionals, cannabis activists and drug dealers; semi-structured interviews with 'professional' cannabis crop growers; and participant observation over several years. I found the multi-method research design to be particularly effective for investigating illegal drug marketing and use, and the design provided me with multiple perspectives on a complex issue. Superficially, there appeared to be two drug 'problems' in Nimbin — one was the (largely cannabis) street market, and the other revolved around heroin users, and included complaints about scruffy-looking people hanging around the main street, or overdosing in the public toilet. However, my research suggested that these issues, while immediately comprehensible as 'drug problems', obscured more complex issues. For example, the village's street drug market was intertwined with the local economy and with the alternative community's values and drug use, while close to half of the drug injectors lacked secure housing (which creates problems that are not related to heroin), and all heroin users were blamed for the actions of few. Many factors influence the creation and maintenance of what we might call 'problems', and drugs are frequently blamed for broader social problems. What is Nimbin’s drug problem? The answer depends, in part, on the drug of interest, but more importantly it depends on your definition of a ‘problem’. Some useful and meaningful perspectives on this important social issue include quantified indicators such as death, injury, arrest rates, the economics of black markets, the demographics of drug use, and estimates of ‘social costs’. Qualitative perspectives include people’s opinions about drugs, media-generated moral panics, the effects of social marginalisation, and the role of drug cultures. A number of ‘drug problems’ arise as a direct result of drug illegality. They include black markets, corruption, drug-related violence, theft, stronger forms of the drug, and more dangerous using practices (with the risk drug overdoses and HIV/AIDS), as well as public nuisance issues. Government policy, judicial sentencing and public opinion are moving towards the social reintegration of illicit drug users, but this is almost invariably counter-balanced by a toughening of legal sanctions against supply of the same drug. Most discussions about illicit drugs fail to consider the long-term implications of harsh penalties for, and elaborate and punitive police operations (such as occurred throughout my Nimbin research) against, small-scale independent growers and dealers. The only way to directly engage with drug markets and all the attendant problems, is to legitimise and regulate the supply of recreational drugs. I discuss several examples of the important role of the drug culture in mitigating problems caused by illegality. One example is the influence of Nimbin's alternative community on the style of the drug market. The village drug scene more closely resembles the many north coast village craft markets, than it does Kings Cross, Cabramatta or New York's Bronx. Buyers are north coast locals, along with national and international tourists (the small village is known to cannabis users world-wide, both through media attention and word-of-mouth). Nimbin offers a 'safe' village market ambience and competitive prices to a mainly cannabis using clientele. I suggest that there are two major underlying influences on the experience of a ‘drug problem’, regardless of the drug or the place. They are: 1. Political influences — specifically the effects of government policy on black markets, law enforcement practices, and access to services and resources; 2. Cultural influences — particularly the beneficial effects of norms and functional role models for the safe use of a drug, cultural effects on the drug market, and the role/s of the drug in the day-to-day life of the culture. These influences can operate with, or despite, each other, and can create or ameliorate many ‘drug problems’. In the case of Nimbin’s alternative culture, government policy has created a number of drug problems and the counter-culture has worked to minimise them. In my research into Nimbin’s ‘drug problem’ I have clarified some issues and raised a number of others. I have examined the notion of a ‘drug problem’ from several perspectives using a range of research tools, and discussed some key influences on the problem associated with drug use. Drawing from the Nimbin research and my reading, I suggest legalising the recreational drugs to bring them under the dual controls of supply legislation and social norms. In conclusion, I suggest that we need to be very clear about what ‘drug problem’ it is that we are talking about, and indeed, whether the problem is really about drugs at all.

Does Nimbin have a drug problem? This tiny village in north-eastern NSW has an international reputation for its alternative community and its street drug market. Ever since the Aquarius Festival thirty years ago Nimbin has fascinated the media, and recurrent headlines about the village's (undefined) 'drug problem' suggested my research topic. My research aim was to investigate the meaning/s of Nimbin's 'drug problem' in the context of Nimbin's 'alternative' culture. Because the topic of illicit drugs is both ethically challenging and highly sensitive, my research design was strongly participant-focused, with an emphasis on confidentiality balanced by a mixed methodology to cross-validate results. My methods included an anonymous household (door-to-door) survey based on a national household survey; an anonymous mailed-back survey of Nimbin and Lismore drug injectors; taped interviews with health and legal professionals, cannabis activists and drug dealers; semi-structured interviews with 'professional' cannabis crop growers; and participant observation over several years. I found the multi-method research design to be particularly effective for investigating illegal drug marketing and use, and the design provided me with multiple perspectives on a complex issue. Superficially, there appeared to be two drug 'problems' in Nimbin — one was the (largely cannabis) street market, and the other revolved around heroin users, and included complaints about scruffy-looking people hanging around the main street, or overdosing in the public toilet. However, my research suggested that these issues, while immediately comprehensible as 'drug problems', obscured more complex issues. For example, the village's street drug market was intertwined with the local economy and with the alternative community's values and drug use, while close to half of the drug injectors lacked secure housing (which creates problems that are not related to heroin), and all heroin users were blamed for the actions of few. Many factors influence the creation and maintenance of what we might call 'problems', and drugs are frequently blamed for broader social problems. What is Nimbin’s drug problem? The answer depends, in part, on the drug of interest, but more importantly it depends on your definition of a ‘problem’. Some useful and meaningful perspectives on this important social issue include quantified indicators such as death, injury, arrest rates, the economics of black markets, the demographics of drug use, and estimates of ‘social costs’. Qualitative perspectives include people’s opinions about drugs, media-generated moral panics, the effects of social marginalisation, and the role of drug cultures. A number of ‘drug problems’ arise as a direct result of drug illegality. They include black markets, corruption, drug-related violence, theft, stronger forms of the drug, and more dangerous using practices (with the risk drug overdoses and HIV/AIDS), as well as public nuisance issues. Government policy, judicial sentencing and public opinion are moving towards the social reintegration of illicit drug users, but this is almost invariably counter-balanced by a toughening of legal sanctions against supply of the same drug. Most discussions about illicit drugs fail to consider the long-term implications of harsh penalties for, and elaborate and punitive police operations (such as occurred throughout my Nimbin research) against, small-scale independent growers and dealers. The only way to directly engage with drug markets and all the attendant problems, is to legitimise and regulate the supply of recreational drugs. I discuss several examples of the important role of the drug culture in mitigating problems caused by illegality. One example is the influence of Nimbin's alternative community on the style of the drug market. The village drug scene more closely resembles the many north coast village craft markets, than it does Kings Cross, Cabramatta or New York's Bronx. Buyers are north coast locals, along with national and international tourists (the small village is known to cannabis users world-wide, both through media attention and word-of-mouth). Nimbin offers a 'safe' village market ambience and competitive prices to a mainly cannabis using clientele. I suggest that there are two major underlying influences on the experience of a ‘drug problem’, regardless of the drug or the place. They are: 1. Political influences — specifically the effects of government policy on black markets, law enforcement practices, and access to services and resources; 2. Cultural influences — particularly the beneficial effects of norms and functional role models for the safe use of a drug, cultural effects on the drug market, and the role/s of the drug in the day-to-day life of the culture. These influences can operate with, or despite, each other, and can create or ameliorate many ‘drug problems’. In the case of Nimbin’s alternative culture, government policy has created a number of drug problems and the counter-culture has worked to minimise them. In my research into Nimbin’s ‘drug problem’ I have clarified some issues and raised a number of others. I have examined the notion of a ‘drug problem’ from several perspectives using a range of research tools, and discussed some key influences on the problem associated with drug use. Drawing from the Nimbin research and my reading, I suggest legalising the recreational drugs to bring them under the dual controls of supply legislation and social norms. In conclusion, I suggest that we need to be very clear about what ‘drug problem’ it is that we are talking about, and indeed, whether the problem is really about drugs at all.

Doctor of Philiosophy (PhD) / Since 1998 anti-doping policy has undergone massive change. The level of world-wide cooperation involved in establishing an international anti-doping system is unprecedented in the history of the regulation of performance enhancing substances in sport. Such cooperation and the unipartite nature of public doping discourse give the impression that anti-doping policy is clear, unproblematic and universally acceptable. However, scratching the harmonious surface of modern anti-doping approaches reveals fundamental problems and inconsistencies, the two most basic of which go to the very core of the policy. Basic issues — what constitutes doping and the reasons why we prohibit it — are still unsettled, lack clarity and give rise to many significant operational issues. For instance, the definition of ‘doping’ in doping discourse is quite different from the definition in the World Anti-Doping Code: what is thought of as ‘doping’ is very different from what is punished as ‘doping.’ Moreover, the commonly suggested anti-doping rationales do not adequately explain the present prohibition on the use of performance enhancing substances in sport. In light of this uncertainty, two questions arise: why is there so much confusion and why do we prohibit doping in sport? Desmond Manderson, in his study of the origins of illicit drug laws, has wrestled with a similar question; his conclusions are that drugs have been prohibited more for what they symbolise than their pharmacological properties. This thesis argues that, in a similar way to illicit drug policy, the symbolism of performance enhancing substances in sport has played a major role in the development of anti-doping policy. To demonstrate the influence of such symbolism, three significant time periods in anti-doping history are considered in the thesis: the 1920s, the 1960s and the 1970s. The most formative aspect of symbolism in the 1920s, when anti-doping rules were first passed, was the association between doping and illicit drug taking. The stigma attached to stereotypical images of illicit drug-users contributed to ‘doping’ being viewed as contrary to the amateur ethos and the adoption of a regulatory system modelled on illicit drug policy approaches. In the 1960s, when anti-doping policy began in earnest, illicit drug symbolism was also extremely influential. Concerns regarding drug addiction in sport fuelled fears about the health of the athlete which were prominent in doping discourse at this time. Combined with a strong belief in the power of drugs in general, illicit drug symbolism led to the expansion of the illicit drug model of regulation to include illicit drug style testing. Doping changed in the 1970s with the emergence of training drugs such as anabolic steroids. Steroids became strongly associated with ‘communist’ athletes and were viewed as extremely powerful transforming drugs. A kind of steroid hysteria was thereby created in doping discourse. Simultaneously, the continuing influence of illicit drug symbolism meant that the previously adopted illicit drug model was also applied to steroids. The conclusion of the thesis is that anti-doping policy is not fundamentally a rational system: instead it has been driven much more by emotional factors such as public opinion than rational argument. Such a basis is bound to create confusion and explains many of the problems of current anti-doping policy. The way in which symbolism has led to the regulatory decisions in anti-doping history is summarised as constituting the ‘reactive regulation model’ in the concluding section of the thesis. This pattern of regulation has produced a number of important operational difficulties in current anti-doping law, the prime example being the ‘fallacy’ of in-competition drug testing to deal with the issue of training drugs such as steroids. Finally, it is argued that in light of the reactive nature of anti-doping policy, it is unlikely that recent challenges, such as gene doping and the use of non-analytical evidence, will be treated any differently to past challenges. Anti-doping policy has always been largely driven by reactions to symbolism; there is no reason to suspect this type of approach will change.

Opioids are scheduled by the propensity for misuse and abuse with a high rate of dependency and risk of fatal overdose. Opioids can be divided into different classes, including, natural, synthetic, and semi-synthetic. Opiates are naturally occurring and come directly from the opium poppy plant; whereas the semi synthetics opioids are chemical modifications of the poppy plant. Synthetic opioids attach to the opioid receptor but contain no part of the poppy plant. The increased variety and frequency in opioid prescriptions contributed to an opioid epidemic in the United States which is still on going. According to the CDC, the opioid epidemic has occurred in three waves. The first wave of the epidemic began in the 1990’s with the increase in opioid prescription pain medication overdoses. The second wave began around 2010 when heroin overdoses became more prevalent. This was followed by a sharp uptick in fentanyl deaths beginning around the year 2013, indicating the start of the third wave. The opioid epidemic has had a huge cost to society, not just due to deaths but also because of lost productivity, medical expenses and judicial system costs (Florence, Zhou, Luo, & Xu, 2016). To best design and implement strategies to combat this issue, an understanding of the population effected is needed. Since many public health policies are implemented at the regional level, knowing the characteristics and demographics of the epidemic at the local level is important. This study evaluates trends in drug related death cases in the Florida District 6 Medical Examiner Office (MEO) from the calendar years 2011 through 2016. Specifically, it focuses on opioids and the role of fentanyl in overdose related mortality. Additional attention is given to fentanyl and fentanyl analog related deaths. Fentanyl analogs present challenges from an analytical toxicology perspective. Fentanyl analogs can be difficult to detect. Two sets of data from each calendar year were obtained from the MEO. This data was collated, standardized and then statistically analyzed. It was determined that there was not a significant difference in month of the year or the day of the week that drug related fatalities occurred. The time of day was statistically significant with more drug related mortalities occurring during the hours of 8:00am and 4:00pm. When assessing mortality rates, Pinellas and Pasco county demonstrated differences. Pasco county has higher overall mortality for opioid related deaths. Pinellas county has almost twice the number of the opioid, fentanyl, related overdose fatalities. Racial demographics, divided into White, Black, and Asian populations, demonstrated that the White population is disproportionally affected by fentanyl drug related mortality. Binary logistic regression showed that fentanyl and heroin tend to co-occur, and that ethanol, hydrocodone, methadone, morphine, and oxycodone do not usually co-occur with fentanyl in drug related fatalities. These data help elucidate trends in the opioid epidemic at a regional level. There are differences between Pinellas and Pasco county; with the former having more fentanyl related drug deaths and the latter having more opioid related drug deaths over the six years analyzed. An interesting result is derived from the binary logistic regression. It is shown here that fentanyl and heroin tend to co-occur together. It is also shown that ethanol, hydrocodone, morphine, oxycodone, and methadone do not co-occur with fentanyl related overdose cases. Notably, methadone has the strongest negative association with fentanyl related overdoses.

Peer influence is a well-studied and established phenomenon in the social sciences with much research focusing on peers influencing one another in negative ways. However, peers have also been shown to provide a positive influence. Research on substance treatment programs indicates that one's social network can influence one to enter treatment as well as help maintain abstinence following the completion of the program. However, little is known about the influence that peer's drug treatment can have on the substance levels of an individual. I use the peer nomination data and Waves 1 and 2 of the National Longitudinal Study of Adolescent to Adult Health to study this instance of peer influence. Results indicate that having a higher proportion of peers who attend drug treatment is not associated with lower levels of respondent illicit drug, alcohol use, and binge drinking behaviors. Consistent with past findings, having a higher proportion of one's peers who reported drug use is associated with higher levels of respondent substance use. Implications for clinicians and other treatment providers are discussed with an emphasis on the role that strong parental attachment can play in offsetting negative peer influence.