Is counseling ‘required’ with medications to treat opioid use disorder?

In “No Strings Attached: More Opioid Addicts Get Meds Without Talk Therapy,” an article by Beth Schwartzapfel of the Marshall Project published in USA Today May 9 ( https://www.usatoday.com/story/news/investigations/2019/05/09/opioid‐crisis‐drugs‐no‐therapy/1131110001/ ), both sides were excellently reported. Kenneth B. Stoller, M.D., longtime methadone researcher from Johns Hopkins, was quoted as saying that medications without any talking is “selling patients short.” Some Twitter participants immediately charged that Stoller was kicking patients off medication if they weren't participating in counseling (which he doesn't do and the article doesn't say he does), and a protracted debate on Mother's Day led us to ask Stoller himself — who does not tweet — to respond. We copied and pasted the comments so he could see them. His response is below. (To see the Twitter thread, go to https://twitter.com/ADAWnews/status/1127175604959436800 .)     

A comparison of “black” and “white” integration attitudes on a deep‐south campus: A research note

A survey of “racial” attitudes on a deep‐South university campus indicates that both “black” and “white” students strongly support desegregation—equality of political and economic rights including access to public facilities. Although “blacks” are receptive to integration also, the majority of “whites” reject “blacks” socially.     

Dominican‐American Etbnic/Racial Identities and United States Social Categories

The majority of Dominicans have sub‐Saharan African ancestry, ¹ 1 In the 1980 Dominican census, 16 percent of the population were classified as blanco (‘white’), 73 percent were classified as indio (‘indian‐colored’), a term used to refer to the phenotype of individuals who match stereotypes of combined African and European ancestry and 11 percent were classified as negro [‘black’] (Haggerty, 1991). These categories are social constructions, rather than objective reflections of phenotypes. The positive social connotations of “whiteness,” for example, lead many Caribbean Hispanics to identify themselves as white for the public record regardless of their precise phenotype (Dominguez, 1978:9). Judgments of color in the Dominican Republic also depend in part upon social attributes of an individual, as they do elsewhere in Latin America. Money, education and power, for example, “whiten” an individual, so that the color attributed to a higher class individual is often lighter than the color that would be attributed to an individual of the same phenotype of a lower class (Rout, 1976:287).
which would make them “black” by historical United States ‘one‐drop’ rules. Second generation Dominican high school students in Providence, Rhode Island do not identity their race in terms of black or white, but rather in terms of ethnolinguistic identity, as Dominican/Spanish/Hispanic. The distinctiveness of Dominican‐American understandings of race is highlighted by comparing them with those of non‐Hispanic, African descent second generation immigrants and with historical Dominican notions of social identity. Dominican second generation resistance to phenotype‐racialization as black or white makes visible ethnic/racial formation processes that are often veiled, particularly in the construction of the category African‐American. This resistance to black/white racialization suggests the transformative effects that post‐1965 immigrants and their descendants are having on United States ethnic/racial categories.     

Dancing with discrimination: managing stigma and identity

Fans are a group that are stigmatized and discredited, at least to some degree, by their “deviant” and common form of symbolic consumption. At stake in the process of stigmatization is the very identity of the individual fan, and their symbolic and emotional well‐being. This paper reports on an empirical study of one particular group of fans—Star Trek fans (or “Trekkies”)—and explores the complex identity issues articulated by them as they “manage” their problematic public identity. Drawing upon interviews conducted with 18 Trekkies, the article describes how this stigmatic identity is organized within a disciplinary matrix that operates at a micro level through two key processes: humour and self‐surveillance. In particular, we highlight their struggle with the dilemmas of exposing their private “fandom” in a public context, and the highly ambivalent manner in which they seek to escape stigmatization.     

“I Try Not to Depend on Anyone but Me”: Welfare‐Reliant Women's Perspectives on Self‐Sufficiency,Work, and Marriage*

Welfare reformers sought to reduce “dependency,” or reliance on state‐supported cash benefits and deployed a discourse of “self‐sufficiency” to promote the legitimacy of efforts to remove welfare recipients from publicly funded cash assistance through either wage labor or marriage. We use longitudinal, qualitative interview data collected from 38 initially welfare‐reliant women to examine what self‐sufficiency means to them and their perspectives on how work and marriage affect their ability to be self‐sufficient. Grounded theory analysis revealed that for these women, self‐sufficiency means formal independence from both the state (i.e., Temporary Assistance to Needy Families [TANF]) and men (i.e., marriage). Although they value marriage as an institution and would ideally marry, they do not consider marriage to be a likely route to self‐sufficiency given the pool of men available to them. Rather, they embrace their own market‐based wage labor as the means by which they can attain some measure of independence. Taking our lead from the women in this study, we challenge the emphasis on marriage in current welfare policy. We argue that employment training that results in better jobs for women and men and work supports that make low‐wage work pay are clearly the appropriate direction for policy aimed at the welfare‐reliant and working poor.     

Briefly Noted

The biennial International Drug Policy Reform Conference, sponsored by the Drug Policy Alliance and held Nov. 7–9 in St. Louis, Missouri, was full of varying sessions on harm reduction and reform — 45 of them in all. An article by Filter editor Will Godfrey summed up his perspective — he was the only print reporter so far to have covered the entire conference. We asked him what his feeling was about the prospects for treatment and harm reduction working together, as they have in the past. “There's plenty of friction, but there can and should be rapprochement between the harm‐reduction and traditional treatment communities,” he told ADAW. “Many people in the harm‐reduction movement pursue traditional recovery, and there are treatment folks who support harm reduction. All should be trying to save lives and empower people. Harm reductionists' legitimate concerns about mainstream treatment include its coercive or controlling deployment, its frequent eschewal of evidence‐based practices and its promotion of abstinence at the expense of stigmatizing people who use drugs. Treatment advocates often overlook that most people who use drugs are fine. And in any case, everyone must be free to choose their own path.” But the fact that two approaches — one more radical than the other — coexist still is bound to make some treatment providers uncomfortable. After all, some of the speakers said that even supervised consumption sites are unfair to drug users, who have no need to be “supervised,” and instead should be free to use drugs. All viewpoints were there. “There's constant debate in the harm‐reduction movement about working to change systems that inflict harm from the inside, versus calling for radical reforms from the outside,” said Godfrey. “I think both approaches are simultaneously necessary.” Not everyone saw the conflict. “I have to say that I didn't see an anti‐public health movement there at all,” Maia Szalavitz, who is writing a history of harm reduction and is respected in both harm reduction and some, at least, treatment camps, told ADAW. “There has always, of course, been tension between activists and researchers and between people who want to fight within the system and those who want to tear it all down.” For the Filter article, go to https://filtermag.org/drug‐policy‐reform‐movement/ .     

Smartphone and social media addiction: Exploring the perceptions and experiences of Canadian teenagers

“Addiction” to internet‐connected technology continues to dominate media discourses of young people. Researchers have identified negative outcomes, including decreased mental health, resulting from anxieties related to technology, e.g., a fear of missing out and social connectivity related to online technologies. Not enough is known, however, regarding young people's own responses to these ideas. This paper highlights discussions with teenagers around the idea of internet addiction, exploring their experiences and perceptions regarding the idea that “kids today” are addicted to their devices, especially smartphones and the social network sites they often access from them. Thirty‐five focus group discussions with 115 Canadian teenagers (aged 13–19 years old) center on their use of information communication technologies, especially contemporary social network sites such as Snapchat, Instagram and Facebook. Our discussions reveal (1) that teens are actively embracing the label of addiction; (2) their ironic positioning occurs despite a felt sense of debased agency in relation to the power of the algorithms and affordances of the technologies mediating their use; and (3) rather than a stark divide between adults as “digital immigrants” versus young people as “digital natives,” our teens positioned themselves in contrast to both their parents and younger siblings, both of whom are criticized as addicted themselves. A consistent theme is the influence of peer groups who socially compel addictive behaviours, including the fear of missing out, rather than the technologies per se. Wider implications for thinking beyond solely young people as suffering from online addiction are considered.     

INVESTMENT CHOICE ARCHITECTURE IN TRUST GAMES: WHEN “ALL‐IN” IS NOT ENOUGH

While many economic interactions feature “All‐or‐Nothing” options nudging investors towards going “all‐in,” such designs may unintentionally affect reciprocity. We manipulate the investor's action space in two versions of the “trust game.” In one version investors can invest either “all” their endowment or “nothing.” In the other version, they can invest any amount of the endowment. Consistent with our intentions‐based model, we show that “all‐or‐nothing” designs coax more investment but limit investors' demonstrability of intended trust. As a result, “all‐in” investors are less generously reciprocated than when they can invest any amount, where full investments are a clearer signal of trustworthiness. (JEL C72, C90, C91, D63, D64, L51)     

Early Word Recognition in Sentence Context: French and English 24‐Month‐Olds' Sensitivity to Sentence‐Medial Mispronunciations and Assimilations

Recent work has shown that young children can use fine phonetic detail during the recognition of isolated and sentence‐final words from early in lexical development. The present study investigates 24‐month‐olds' word recognition in sentence‐medial position in two experiments using an Intermodal Preferential Looking paradigm. In Experiment 1, French toddlers detect word‐final voicing mispronunciations (e.g., bu z [by z ] for bu s [by s ] “bus”), and they compensate for native voicing assimilations (e.g., bu z d evant toi [bu zd ?vɑ?twa] “bus in front of you”) in the middle of sentences. Similarly, English toddlers detect word‐final voicing mispronunciations (e.g., shee b for shee p ) in Experiment 2, but they do not compensate for illicit voicing assimilations (e.g., shee b th ere). Thus, French and English 24‐month‐olds can take into account fine phonetic detail even if words are presented in the middle of sentences, and French toddlers show language‐specific compensation abilities for pronunciation variation caused by native voicing assimilation.     

Analysis: The so‐called ‘Freedom Model’ of addiction treatment

The below comments were originally posted, in shortened form, on the Facebook Broken No More page. We asked the author to revise for ADAW, and he did. He refers to the article “Widespread Use of Medically Assisted Treatment (MAT) Has Not Resulted in Less Overdoses” (and we resisted the almost overwhelming temptation to change “less” to “fewer”). For the article, go to https://www.thefreedommodel.org/suboxone‐has‐not‐reduced‐deaths‐in‐the‐us/ .     

“Us” versus “Them”: communication barriers in post‐socialist Russia

The paper addresses the general socio‐cultural consequences of economic and political globalisation. With regard to the dispute between “universalists” and “culturalists” it holds the view that—contrary to expectations of cultural convergence and the emergence of universal values and institutions‐‐the “universal grip” of globalisation has produced a mirror effect of “localisation”; it has strengthened old boundaries and created new ones between religions, ethnic groups, regions or nations. This is the background against which the present communication between East and West Europeans is explored in the paper.

For Europe, globalisation has some additional effects, such as the collapse of the Soviet system in Eastern Europe. There, (a) globalisation coincides with the painful process of political and economic transformation and (b) revitalises the pre‐socialist context of the West‐East dichotomy. It shows that the East European variety of the opposition global‐local acquires additional drama due to being superceded by the opposition West‐East: the defensive reactions against globalisation are sharper and more powerful—and they are largely perceived and experienced as an East‐West controversy.

The paper explores the new mental barriers between West and East, the “wall in the heads”, and presents them as a major obstacle to the effective interpersonal communication in post‐socialist Europe. It is based on field research in Russia and Germany and uses the concept of “otherness” (Fremdheit) and the related ingroup‐outgroup category as key instruments for the interpretation and understanding of intercultural situations. The strengthening of the “us vs. them” boundary largely determines the communication process: it creates potential for conflict and has a negative effect on the motivation for cross‐cultural learning. Some implications for cross‐cultural educators and trainers are pointed out.     

Predictors of female nocturnal orgasms: A multivariate analysis

Variables predicting the reported occurrence and frequency of nocturnal orgasms among women are reported. Undergraduate and graduate women (N = 245) from a large midwestern university volunteered to complete nine self‐report scales and inventories. Thirty‐seven percent of the sample reported they had experienced nocturnal orgasm, and 30% reported having had the experience in the past year. The predictors accounted for a statistically significant amount of variation in each of the dependent variables: 33% of “ever experienced nocturnal orgasm,” 44% of “experienced nocturnal orgasm in the past year,” and 27% in the case of “frequency of nocturnal orgasm in the past year.” Positive attitudes toward and knowledge of nocturnal orgasms, sexual liberalism, and waking sexually excited from sleep (without experiencing orgasm) were the most important predictors of nocturnal orgasm experience. The reported incidence of nocturnal orgasms in this sample is higher than in comparative samples of previous studies.     

The aesthetic and practical fields of excrementality of L’boulevard festival

The revolutionary aspect of performance is given ample room in this article. “Conflict” deserves a renewed importance, because it places the term “transgression” in relation to festivals as sites for the embodiment of social struggles. We will hone in on L’boulevard festival, which not only participates in a dialogue with social conflicts, but also epitomises them through an ambivalent theatricality that merges the real with the unreal. As festival agents identify their marginal place in relation to the body of the system – generally present in the festival through panoptical surveillance, badges, barriers and an entire discourse of social categorisation, and as they are cognisant of the festival as possibly an empowering threshold, a place for no system other than that chosen by the theatres of roleplaying, they activate their excrementality, a mentality which, in its ideological framing, creates and innovates, inspired by excrement, its functionality and symbolism. Excreta-mental types would perform the very khsoriya (vulgarity) expected of them, by performing their marginality (their becoming central), among other things, through art.     

Toward A Renewed Sociological Jurisprudence: From Roscoe Pound to Herbert Blumer and Beyond

This article, based on the Distinguished Lecture presented on August 21, 2001, at the annual meeting of the Society for the Study of Symbolic Interaction in Anaheim, California, proposes a synthesis of Herbert Blumer's macrosociological perspective on the race question with Roscoe Pound's philosophy and science of law (i.e., his so‐called sociological jurisprudence), Joseph Tussman's and Jacobus tenBroek's juridical methodology, and Philip Selznick's sociology of responsive law. The compound so produced will help to establish a foundation for a praxiological sociology of American constitutional law. The article focuses on the problem of legislative‐made “classifications” and their relations to the legitimate public purposes entailed in the enactment of statutes, laws, and decrees. Such classifications become problematic when they are said to be “underinclusive,” “over‐inclusive,” or both in seeking to effect their aims. Strategic research sites for this issue are racial and ethnic classifications that single out one or a limited cluster of racial or ethnic groups for special benefits (“affirmative action”) or restitution (“reparations”). Calling for a reinvigoration of Pound's pragmatic approach to sociological jurisprudence, I show how Blumer's analysis of the “color line”—when seen in relation to the original intent of the makers of the Thirteenth, Fourteenth, and Fifteenth post‐Civil War Amendments to the U.S. Constitution and, using Tussman's and tenBroek's showing of how such categorizations might be both methodically evaluated and applied to the challenged classifications—provides grounds for reconsidering whether the latter are instances of “reverse discrimination” and, hence, violations of the constitutional requirement of “equal protection of the law.” The science of law is a science of social engineering having to do with that part of the whole field which may be achieved by the ordering of human relations through the action of politically organized society. —Roscoe Pound, Justice According to Law We did not hold it necessary to wait for nature to put a canal across the Isthmus of Panama, and we shall not much longer hold it necessary to wait for nature to dig the legal canals that will give security to neglected human interests which clamor for recognition and protection. —Roscoe Pound, “Juristic Problems of National Progress”     

Examining the Association between Hazardous Waste Facilities and Rural “Brain Drain”*

Abstract Rural communities are increasingly being faced with the prospect of accepting facilities characterized as “opportunity‐threat,” such as facilities that generate, treat, store, or otherwise dispose of hazardous wastes. Such facilities may offer economic gains through jobs and tax revenue, although they may also act as environmental “disamenities.” This analysis examines the possibility that the presence of such facilities equates with lower loss of rural human capital, a question as yet unexamined on a national scale within the academic literature. Making use of secondary data from several different sources, we examine the association between age‐ and education‐specific outmigration and 1) the number of hazardous waste facilities, 2) the number of large quantity hazardous waste generators, and 3) the number of hazardous waste landfills and incinerators across rural counties within the 48 contiguous states. Our findings suggest that the presence of hazardous waste facilities does not clearly equate with reductions in rural “brain drain.”     

Single Mothers “Do” Family

This paper explores how single mothers both incorporate others into family life (e.g., when they ask others to care for their children) and simultaneously “do families” in a manner that holds out a vision of a “traditional” family structure. Drawing on research with White, rural single mothers, the author explores the manner in which these women both endorse their children’s attachment to other caregivers and maintain boundaries around issues of discipline and attachment vis‐à‐vis these others. The author demonstrates that single mothers are willing to share this protected realm of family life with a new man (a fiancé or cohabiting boyfriend) as they pursue the goal of what has been called the “Standard North American Family.”     

Facing Facts: An Analysis of the Early “Nude Self-Portraits” by Robert Giard

Early in his career, photographer Robert Giard took on an elemental aesthetic “chore”: the self-portrait. The project was an amalgam; it was the self-portrait in the sense that he was the model, and it was the nude in the sense that he was naked. But in his handling of these 2 genres, Giard broke with these categories as they are typically understood. Grouping his “self-portraits” under 3 rubrics—“candid,” “headless,” and “neoclassical”—Giard appeared to toy with standard definitions. Words and images suggest tensions held in balance: disclosure vs. concealment; confession vs. secrecy; present vs. retrospective; identification vs. obfuscation; personal vs. impersonal. Indeed, these “self-portraits,” in which the subject concealed his face, encourage us, aware that Giard was a gay man, to wonder if these pictures are not an obvious metaphor for the status of homosexuals at the period in which they were made.     

The Dramaturgical Model of Behavior: Its Strengths and Weaknesses*

By means of the dramaturgical model we freshly illuminate social behavior as role-like “performances” in which persons manage the impressions that others get of them. This impression management involves the concealment of data in a “dramatic” struggle with those others who wish to penetrate one's “mask.” But the chief limitations of the dramaturgical model are that it excites the invalid inferences that offstage “roles” are more like stage actors' roles than they really are, and that the person is nothing but these “roles.” The differences between onstage and offstage behavior are kept in view when the metaphorical concept of “role playing” is re-connected to its source in role playing onstage. Through an analysis of theatre and the concepts of appearance and time we conclude that while we must appear to others in a “role-like” way offstage in order to be ourselves, we are nevertheless involved in world-time offstage in a way that fundamentally distinguishes our “role-playing” from an actor's role playing. We are our “roles”, but not just our “roles.”