Research targeting the chemically dependent woman has received little attention, even though the research indicates a convergence of male and female drinking norms. Research centered on the special issues of the chemically dependent woman also needs to be extended beyond the scope of actual alcohol and drug abuse and resulting treatment to include information on what issues women face in their recovery process. The findings would help treatment providers design more successful interventions for this population. This study used qualitative methods to investigate issues that 12 chemically dependent women, ranging in actual time in recovery from first to third year post inpatient treatment, discussed as part of a 16 week therapy group. Their recorded responses were transcribed and analyzed, using Glaser and Strauss' methods of comparative analysis, comparing the women between three groups desiginated by the divisions of first, second, and third year post inpatient treatment. The findings indicate that all share many of the same issues, however there are marked differences between the groups. All the women had difficulties with intra- and interrelationships, finding it difficult to maintain a healthy recovery in spite of the problems they confronted in experiencing reality without mind-altering substances. Many issues were influenced by the subjects' family of origin history and sex-role orientation. Conflicts in role obligations resulting in work, family, parenting, and relationship problems surfaced. All the women were aware of additional substance and compulsive dependencies that they would like to eliminate; however, avoiding relapse of their alcohol/drug addiction was the major concern for most. The findings reveal that the longer women spent time actively undertaking a concerted program of recovery, the more they experienced integration into the rest of society, and that the acquisition of life skills and resolution of the past were important factors to the success of this integration. The categories and theme issues that emerged from the analysis have implications for social work practice, policy, and further research. / Arts, Faculty of / Social Work, School of / Graduate

長久以來，社會科學家在西方社會及香港曾作出多項與濫藥有關的研究，從不同層面，就不同犯罪學理論展開探討。然而，很少的研究會聚焦濫藥行為中男女的差異。正如一直存在的爭議，圍繞在近年的濫藥行為上，性別的差異是否減少了，是的話，原因何在。很多學者都提出關注，女性濫藥情況加劇，可能歸咎於女權開放、更大壓力、青年人的次文化或現今社會執法者的偏見。 / 這研究有系統地探究及解釋過去二十四年香港女性濫藥的趨勢及性別差距，是否女性濫藥加劇情況比男性快。我查看了香港警隊的拘捕記錄、藥物濫用資料中央檔案室記錄及禁毒處六次對學生服用藥物情況調查。再用「單根檢定法」分析數據，確認有關數據在反映性別差距的可靠性。 / 有些學者及傳媒都留意到近年女性濫藥增加趨勢比男性快，但原因仍待討論，因為此現象可能由警方加強打擊導致。當今有兩個相爭的說法，「規範性方法」相信增加是事實的，其中的「自由女權主義」相信性別平等會導致女性獲得更大自由和機會，所以濫藥也增多，「社會女性主義」提出現今女性要兼顧工作與家庭，壓力大時需要濫藥減壓。更有學者相信近年濫藥是娛樂活動的一部份，故被「正常化」。「社會建構方法」提出罪案率的上升並非真實，只是刑事司法體制制度化所致，因為當警隊加強執法，對輕微案件都不放過時，更多人會被拘捕。我今次的研究，運用了時間序列迴歸的分析法驗証這兩個相爭說法。 / 根據警方及藥物濫用資料中央檔案室的記錄，我發覺女性濫藥確有上升，性别差距亦收窄。雖然男女在吸食精神毒品的增加步伐相同，但女性吸用海洛英的下降比男性慢。警方記錄的濫用藥物性別差距，沒有像對學生服用藥物情況所發現的收窄。這顯示警方的拘捕行動，可能受多個因素影響。 / 理論上，我的研究沒有發現強烈証據支持男女平等會增加女性濫藥。反之，我發現女性承受的社會壓力愈大，濫藥愈多。我的研究亦間接上支持「正常化」的論點，因為青少年濫用精神科藥物確屬一個次文化。另外，我亦發現當刑事司法體制愈制度化，濫藥的性別差異相應減少。 / 這是在香港首個用量性研究方法進行的相關研究，當中使用高等定量時間序列迴歸方法分析，集中研究女性濫藥情況及性別差距，測試西方的「規範性方法」及「社會建構方法」在不同文化的套用性，結果指出這兩個相爭的說法事實上是相輔相成。實際上，我提出了當今女性面對的問題，她們的需要及應該得到的支持。最後我亦討論了此研究的不足之處，主要我全依賴官方數字，未有實地研究。日後的研究，應結合質性研究，加強對個別濫藥者的了解，包括他們的個人背景及濫藥的原因。 / Drug use is of longstanding research interest in sociology. Many studies of the subject have been conducted in Western contexts and in Hong Kong from social and economic perspectives, at the macro and micro levels, and in connection with numerous criminological theories. However, relatively few studies of drug use have focused on gender differences or on the changing patterns of abuse in relation to gender over time. There is ongoing debate over the issue, including the question of whether the gender gap in drug use has changed over time and, if so, in what ways and why. Currently, there is increased concern about the behavior of female drug users, with many scholars arguing that female drug use may increase or become more visible in modern societies due to women's liberation, heightened strain, the spread of youth subcultures, and/or biased law enforcement. / This study systematically examines and explains the trends in female drug use, and the gender gap in that use, in Hong Kong in the past two and a half decades to determine whether drug use among female has increased at a faster pace than that among male, meaning the gender gap is narrowing, or whether the two groups are undergoing parallel trends, meaning the gender gap is stable. The study's methods were as follows. I reviewed and compared Hong Kong Police (Police) arrest records, the records maintained by the Central Registry of Drug Abuse (CRDA), and the results of six self-report surveys. I then used the Augmented Dickey-Fuller Test, a time series technique, to test the statistical reliability of the patterns identified in the gender gap in drug use. / Some scholars and the media in Hong Kong have noticed that drug use among females is on the rise and that the rate of the increase in their drug use has exceeded that of males in recent decades. However, the question of whether there has been a real change in the rate of female drug use needs to be addressed, as the figures they cite may reflect the more proactive policing of minor offences. Two competing approaches offer different views. The "normative approach" posits that there has been a real increase in female drug use. Liberal Feminism sees this rise as resulting from greater gender equality, as females now enjoy greater freedom and more opportunities. Socialist Feminism takes the view that more females are now using drugs to cope with the social strain and stress they suffer from the need to both work and take care of their families. Furthermore, some scholars posit that drug use is a result of "normalization," that is, it is now more accepted as part of leisure and recreation. The "social constructionist" approach posits that changes in crime rates do not reflect real rises in crime, but are the result of the formalization of the criminal justice system. In the case of female drug use, this approach suggests that the police are now less tolerant toward female drug use, and increased enforcement renders their drug use more visible. In this study, I employed advanced quantitative time series regressions to test these competing theoretical explanations. / The Police and CRDA records indicate that female drug use has been increasing, with females now taking more psychotropic drugs. The gender gap in drug use appears to be narrowing. Both males and females have seen an increase in psychotropic drug use, but female use of heroin has not declined as much as male. The self-report surveys show that girls' use of psychotropic drugs has increased two times more than boys', but the gender gap trend shows instability. The Police and CRDA records show girl drug use to be increasing at a faster rate than the self-report survey data do, but the Police records do not show the gender gap in drug use to be narrowing to the extent that the self-report survey data do, suggesting that arrests may be guided by different policing factors and priorities. / With regard to theoretical explanations, my analysis does not produce strong support for the view that greater gender equality has caused the rise in female drug use. Rather, I find strong support for the theory that increased social strain and stress may be the main factor in this rise. To some extent, this study also offers indirect support for the normalization thesis, revealing that young people's use of psychotropic drugs is more related to youth subculture, in which psychotropic drug use is prevalent and acceptable. I also find the greater formalization of the criminal justice system to have contributed to the narrowing of the gender gap in drug use. / The findings of this study have important theoretical implications, as this is the first quantitative research conducted in Hong Kong using advanced times series analysis and focusing on female drug use and the gender gap in drug use to test the competing normative and social constructionist perspectives, thereby extending these Western theories to another culture. The findings illustrate that these perspectives are not actually mutually exclusive, but can be complementary. Practically, the findings shed light on the need to better understand female drug use and to determine what can be done to support them. Finally, the study does have a number of limitations, which are recognized and discussed. Its main limitation is that I relied fully on official data and self-report surveys without conducting field research. Future research incorporating a qualitative approach would enhance our understanding of individual drug users, such as their personal background and reasons of taking drugs. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Ng, Ka Sing David. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 227-237). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / ABSTRACT --- p.i / ACKNOWLEDGEMENTS --- p.ii / LIST OF TABLES --- p.ii / LIST OF FIGURES --- p.ii / Chapter CHAPTER ONE --- THE RESEARCH PROBLEM --- p.17 / Chapter 1.1 --- Introduction --- p.17 / Chapter 1.2 --- Background of the Study in the Western Societies --- p.18 / Chapter 1.3 --- Background of the Study in Hong Kong --- p.21 / Chapter 1.4 --- Research Objectives and Significance of Study --- p.25 / Chapter 1.5 --- Organization of the Thesis --- p.31 / Chapter CHAPTER TWO --- LITERATURE REVIEW AND HYPOTHESES --- p.34 / Chapter 2.1 --- A Theoretical Overview of the Convergence Hypothesis --- p.34 / Chapter 2.2 --- Explaining Convergence: The Normative Perspective --- p.38 / Chapter 2.3 --- A Competing Explanation of Convergence: The Social Constructionist Perspective --- p.58 / Chapter CHAPTER THREE --- RESEARCH DESIGN AND METHODOLOGY --- p.66 / Chapter 3.1 --- Hypotheses --- p.66 / Chapter 3.2 --- Sources of Data --- p.68 / Chapter 3.3 --- Measures--The Dependent Variables and Independent Variables --- p.79 / Chapter 3.4 --- Analytic Strategies --- p.87 / Chapter CHAPTER FOUR --- FINDINGS (HYPOTHESES 1 TO 6) --- p.97 / Chapter 4.1 --- Hypothesis 1: The rate of female drug use has been rising according to official data. --- p.97 / Chapter 4.2 --- Hypothesis 2: The gender gap in the rate of drug use has been narrowing according to official data. --- p.104 / Chapter 4.3 --- Hypothesis 3: The rate of female drug use has been increasing according to self-report survey data. --- p.115 / Chapter 4.4 --- Hypothesis 4: The gender gap in the rate of drug use has been narrowing according to self-report survey data. --- p.116 / Chapter 4.5 --- Hypothesis 5: The rate of female drug use has been increasing faster in official data than in self-report survey data. --- p.117 / Chapter 4.6 --- Hypothesis 6: The gender gap in the rate of drug use has been narrowing faster in official data than in self-report survey data. --- p.118 / Chapter CHAPTER FIVE --- FINDINGS (HYPOTHESES 7 TO 9) --- p.135 / Chapter 5.1 --- Descriptive Statistics Regarding Hypotheses 7-9 --- p.135 / Chapter 5.2 --- Regression Results for Hypothesis 7-9 --- p.141 / Chapter 5.3 --- Summary of Findings --- p.151 / Chapter CHAPTER SIX --- PSYCHOTROPIC DRUG USE AMONG GIRLS AND BOYS --- p.163 / Chapter 6.1 --- Descriptive Statistics --- p.164 / Chapter 6.2 --- Evidence from a Time-series Regression Analysis --- p.167 / Chapter 6.3 --- Summary of Findings --- p.169 / Chapter CHAPTER SEVEN --- SUMMARY AND DISCUSSION --- p.173 / Chapter 7.1 --- The Study --- p.176 / Chapter 7.2 --- Summary of Descriptive Findings --- p.178 / Chapter 7.3 --- Summary of the Findings Relating to the Theoretical Explanations --- p.184 / Chapter 7.4 --- Theoretical Implications --- p.190 / Chapter 7.5 --- Practical Implications --- p.195 / Chapter 7.6 --- Limitations of the Study and Suggestions for Future Research --- p.198 / APPENDIX I --- p.202 / References --- p.227

Many studies have reported that women consume approximately twice the amount of psychotropic drugs as men. In an attempt to explain this ratio, a conceptual model of psychotropic drug was developed, focusing on questions of initial problem recognition and definition; problem-solving ability; and the perception of control. These factors were explored with 179 women chosen to reflect varying frequencies of drug use. In addition, patient-physician interaction was evaluated by psychiatrists' diagnostic and prescriptive reactions to differing patient attributes. / Multidimensional scaling interpretations across drug frequency groups indicated that external causal attribution and lack of control were concomitants of drug use. Deficient problem-solving, particularly at the definitional stage, accounted for 21% of drug use variance, discriminating 73% of drug users. Physicians were found to prescribe according to factors additional to diagnosis and symptomatology. This research was seen as providing theoretical coherence to the increasingly complex gestalt of drug use.

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published_or_final_version / Social Work / Master / Master of Social Work

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Background: Despite substantial global progress against the HIV/AIDS epidemic, the Eastern Europe and Central Asian region has experienced a 43% increase in HIV incidence. The HIV epidemic in Kazakhstan has outpaced that of the region, with the incidence of new infections growing by 73% since 2010. Key populations of people who inject drugs (PWID), female sex workers (FSW) and their sexual partners account for the majority of new infections, where drug policies continue to undermine HIV prevention and control efforts. Kazakhstan has made insufficient progress towards 95-95-95 HIV epidemic control targets, with 78% of people living with HIV (PLWH) knowing their HIV status, of which 57% receive ART, and 48% of those receiving ART achieve viral suppression. Laws, policies and their enforcement can shape social and structural determinants of health, and it is fundamental to understand how punitive legal environments shape the HIV epidemic in Kazakhstan. This dissertation seeks to identify patterns of police violence victimization among FSW who use drugs and examine how police violence is associated with the HIV risk environment. Given the insufficient progress towards 95-95-95 HIV epidemic control targets, this dissertation also seeks to identify how patterns of injection and sexual HIV transmission risk behaviors vary among men and women who inject drugs and examine how criminal-legal involvement is associated with patterns of HIV transmission risk behaviors. Methods: Data on police violence victimization among FSW who use drugs were drawn from Project Nova, a cluster-randomized control trial that evaluated the efficacy of a combination HIV risk reduction and microfinance intervention. A community-based sample of 255 FSW who use drugs were recruited and enrolled between February 2015 and May 2017 in Almaty, Kazakhstan. Latent class analysis (LCA) was used to characterize women into distinct subgroups (i.e., classes) of police violence victimization. Next, multinomial logistic regression was used to examine how police violence victimization subgroups are associated with the physical, social, economic and policy HIV risk environment. Data on injection and sexual HIV transmission risk behaviors were drawn from Bridge, an implementation science study that evaluated the effectiveness of HIV service integration into needle/syringe programs on retention in care and viral suppression for PWID living with HIV in Kazakhstan. A random sample of 450 men and 166 women who inject drugs were recruited and enrolled in Almaty, Shymkent, and Temirtau/ Karaganda between February 2017 and June 2019. Similarly, LCA was used to characterize distinct subgroups of HIV transmission risk behaviors among men and women who inject drugs. Multinomial logistic regression was then used to identify associations between criminal-legal involvement and patterns of HIV transmission risk. Results: Three subgroups of police violence victimization among FSW who use drugs emerged. Just over half were characterized as experiencing low violence victimization (“Low Violence;” 51%); over one-third were characterized as experiencing all forms of police violence victimization (Poly-Victimization; 34%), and 15% were characterized as experiencing primarily discrimination and extortion from the police. Relative to Low Violence, factors associated with Poly-Victimization included being positive for HIV and/or sexually-transmitted infections (STI) (aOR= 1.78 (95% CI: 1.01, 3.14)), prior tuberculosis diagnosis (aOR= 2.73 (1.15, 6.50)), injection drug use (IDU) (aOR= 2.00 (1.12, 3.58)), greater number of unsafe injection behaviors (aOR= 1.21 (1.08, 1.35)), homelessness (aOR= 1.92 (1.06, 3.48)), greater drug use stigma (aOR= 1.22 (1.07, 1.39)) and sex work stigma (aOR= 1.23 (1.06, 1.43)), greater number of sex work clients (aOR= 2.40 (1.33, 4.31)), working for a boss/pimp (aOR= 2.74 (1.16, 6.50)), client violence (aOR= 2.99 (1.65, 5.42)), economic incentives for condomless sex (aOR= 2.77 (1.42, 5.41)), accessing needle/syringe exchange programs (aOR= 3.47 (1.42, 8.50)), recent arrest (aOR= 2.99 (1.36, 6.55)) and detention (aOR= 2.93 (1.62, 5.30)), and negative police perceptions (aOR= 8.28 (4.20, 16.3)). Compared to Low Violence, Discrimination and Extortion was associated with lower odds of experiencing intimate partner violence (aOR= 0.26 (0.12, 0.59)), but no other significant associations with the risk environment upon adjusting for socio-demographic characteristics. Distinct patterns of HIV transmission risk behaviors emerged among men and women, in which men were characterized as having Low Sexual Risk (41.8%), Injection & Sexual Risk (36.4%), and High Injection Risk (21.8%) behaviors. Class membership in the Injection & Sexual Risk and High Injection Risk class was associated with greater criminal-legal involvement, compared to the Low Sexual Risk class. This is demonstrated by higher odds of multiple detentions ((aORInjection & Sexual Risk = 1.28 (1.10, 1.49); aORHigh Injection Risk = 1.25 (1.06, 1.46)) and drug court participation (aORHigh Injection Risk = 5.29 (1.03, 27.20) in the past six months, committing crimes while under the influence of alcohol or drugs (aORInjection & Sexual Risk = 2.79 (1.53, 5.11); aORHigh Injection Risk = 2.76 (1.34, 5.65), and perceived police discrimination (aORHigh Injection Risk = 1.79 (1.01, 3.19). Women who inject drugs were characterized as having Low Injection & Sexual Risk (60.7%), Sex Work Behaviors (8.4%), High Injection Risk (30.7%) behaviors. Class membership in the Sex Work Behaviors and High Injection Risk class was associated with greater odds of being detained (aORSex Work Behaviors= 4.59 (1.27, 16.53) and experiencing verbal police harassment (aORSex Work Behaviors= 3.31 (1.20, 9.15); aORHigh Injection Risk = 2.91 (1.32, 6.40), compared to the Low Injection & Sexual Risk class. Conclusion: Results from this dissertation show that police violence against FSW who use drugs is pervasive in Kazakhstan. Patterns of police violence victimization among FSW who use drugs vary, with multiple forms of police violence victimization being associated with greater HIV susceptibility. This dissertation also demonstrates that men and women who inject drugs and are living with HIV have a high prevalence of injection and sexual HIV transmission risk behaviors, despite low viral suppression, and that patterns of HIV transmission risk behaviors vary by gender. Moreover, criminal-legal involvement is associated with injection and sexual HIV transmission risk, particularly among men who inject drugs. Collectively, these results support drug policy reforms and suggest that decriminalization of drug use and possession may promote enabling environments that support harm reduction, and subsequently reduce HIV transmission through injection and sexual networks of PWID in Kazakhstan.