"Generally, you get 86'ed because you're a liability": An application of Integrated Threat Theory to frequently witnessed overdoses and social distancing responses
"Generally, you get 86'ed because you're a liability": An application of Integrated Threat Theory to frequently witnessed overdoses and social distancing responses
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DOI：
10.1016/j.socscimed.2020.113190
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发表时间：
2020-09-01
影响因子：
5.4
通讯作者：
Davidson, P. J.
中科院分区：
文献类型：
--
作者：
Bowles, J. M.;Smith, L. R.;Davidson, P. J.
虽然近年来北美阿片类药物过量死亡率呈指数级增长，但大多数过量并不致命，特别是当证人在场并可以干预时。以前的研究发现，一些接受过过量反应训练的药物使用者可能会切断与频繁过量者的社会联系，导致更多的单独使用阿片类药物，如果有人单独过量，则会有死亡风险。为了研究经常过量服用药物的人的社交距离现象，我们使用了在南加州收集的52个深度定性访谈的数据，这些访谈的对象是最近目睹阿片类药物过量服用的PWUD。使用综合威胁理论（ITT）对所观察到的现象进行概念化，对成绩单进行了审查和主题编码。ITT概述了一个群体如何经历现实和象征性的威胁。我们发现，虽然一些参与者承认掺假的街头毒品在过量服用中的作用，但仍然施加了个人责任。对粗心吸毒做法的指控助长了对频繁吸毒者的负面成见。这是由于需要拨打911进行救援，这往往导致警察派遣。警察和PWUDs之间的组间关系是不稳定的，因为警察对PWUDs构成现实的威胁-如监禁，驱逐和过失杀人罪-导致PWUDs对未来过量事件的组内焦虑，并将频繁过量者标记为负债。这些威胁，以及群体内/群体间的冲突，解释了非致命性过量如何以及为什么会导致社交距离事件的一个原因。经常吸毒过量的人也被指控违反了吸毒者偷偷摸摸的规范;这是一种象征性的威胁，由于警方的曝光而危及该群体。社交距离可能会抑制同龄人主导的干预措施的保护作用，如带回家的纳洛酮计划，增加过量死亡的风险。这一现象凸显了群体间的动态是如何推动群体内的进程的。定制公共卫生干预措施的建议进行了讨论。
While rates of opioid overdose deaths in North American have increased exponentially in recent years, most overdoses are not fatal, especially when witnesses are present and can intervene. Previous research has found that some people who use drugs [PWUDs] trained in overdose response might cut social ties with frequent overdosers, leading to more solitary opioid use and risk of death if someone overdoses alone. To examine the phenomenon of social distancing of people who overdose frequently, we used data from fifty-two in-depth qualitative interviews collected in Southern California with PWUDs who had recently witnessed an opioid overdose. Transcripts were reviewed and coded thematically, using the Integrated Threat Theory (ITT) to conceptualize the observed phenomenon. ITT outlines how realistic and symbolic threats are experienced by a group. We found that while some participants acknowledged the role of adulterated street drugs in overdoses, individualized blame was nonetheless imposed. Accusations of careless drug use practices fostered negative stereotyping towards frequent overdosers. This was attributed to the need to summon 911 for rescue, which often resulted in police dispatch. The intergroup relationship between police and PWUDs is precarious as police pose realistic threats onto PWUDs - such as incarceration, eviction, and manslaughter charges - leading to intragroup anxiety among PWUDs about future overdose events, and labelled frequent overdosers as liabilities. These threats, and inter/infra-group conflict, explained one reason how and why non-fatal overdoses led to social distancing events. People who overdose frequently were also accused of breaking the norm of drug user surreptitiousness; a symbolic threat that endangered the group due to police exposure. Social distancing might dampen exposure to the protective effect of peer-led interventions such as take-home naloxone programs, increasing risk of overdose death. This phenomenon highlights how intergroup dynamics are driving intragroup processes. Suggestions for tailoring public health interventions are discussed.