Exploring Proposition 36 as a Turning Point in Life Course Drug Use Trajectories

摘要基于生命历程理论，转折点的概念被用来解释和描述药物使用轨迹的主要变化（Hser et al., 2007b）。发展转变（例如，进入青春期或成年期）和关键的生活事件（例如，就业、婚姻、服兵役）是被引用为转折点的几个例子，它们改变了生活轨迹并重新定向了道路。然而，同样的生活事件可能会触发一些人的转折点，而不是其他人，关于药物使用轨迹转折点的发育过程和潜在机制的知识是有限的。申请人提议探索加州36号提案（或36号提案，又称物质滥用和犯罪预防法案）是否以及如何成为改变参与者吸毒轨迹的转折点。这项相对较新的法律为非暴力持有毒品犯罪的成年人提供了选择社区戒毒治疗的机会，而不是在没有治疗的情况下被监禁或缓刑。虽然全州范围内的评估总体上显示了36号提案客户的积极治疗效果，但从长远来看，36号提案是否以及如何影响个人的药物使用轨迹却鲜为人知。通过对另一项nida支持的研究中选择的36号提案参与者进行深入的定性访谈（n = 80），研究对象是参加治疗的客户的结果（其中一些人自根据36号提案进入治疗后一直保持禁欲，而另一些人则没有），拟议的研究将探讨36号提案是否已成为这些人的转折点，并描述相关的主观经验。虽然我们对第36号提案在参与者吸毒中可能发挥的作用特别感兴趣，但我们试图揭示哪些其他经历、事件和过程也可能导致吸毒轨迹的变化或缺乏变化。我们这项探索性研究的目标是推导出可能解释药物使用生命过程中转折点的潜在机制和发展过程的理论组成部分，并通过R01资助机制产生假设，以便在未来的研究中进行测试。这一系列研究的最终目标是制定和测试干预措施和策略，以改善药物使用者的结果。从这项探索性研究中获得的知识和信息将通过推导理论来解释药物使用生命过程转折点的潜在机制和发展过程，并通过R01资助机制产生假设，以在未来的研究中进行检验，从而用于改善公共卫生。这一系列研究的最终目标是制定和测试干预措施和策略，以改善药物使用者的结果。

DESCRIPTION (provided by applicant): Exploring Proposition 36 as a Turning Point in Life Course Drug Use Trajectories Abstract Rooted in the life course theory, the idea of turning points has been used to explain and characterize major changes in drug use trajectories (Hser et al., 2007b). Developmental transitions (e.g., into adolescence, or adulthood) and critical life events (e.g., employment, marriage, military service) are a few examples that have been cited as turning points, which modify life trajectories and redirect pathways. Yet, the same life event may trigger a turning point for some individuals, but not for others, and knowledge about the developmental processes and underlying mechanisms involved in turning points of drug use trajectories is limited. The applicants propose to explore whether and how California's Proposition 36 (or Prop 36, aka the Substance Abuse and Crime Prevention Act) served as a turning point redirecting participants' drug use trajectories. This relatively new law offers adults convicted of nonviolent drug possession offenses the opportunity to choose drug treatment in the community in lieu of incarceration or probation without treatment. While the statewide evaluation has generally shown positive treatment outcomes among Prop 36 clients, little is known about whether and how Prop 36 has impacted individuals' drug use trajectories in the long run. By conducting in-depth qualitative interviews (n = 80) with selected Prop 36 participants from another NIDA-supported study of outcomes among clients enrolled in treatment (some of whom have sustained abstinence since entering treatment under Prop 36 and others who have not), the proposed study will explore if Prop 36 has served as a turning point for these individuals and describe related subjective experiences. While we are particularly interested in what role Prop 36 may have played in participants' drug use, we seek to uncover what other experiences, events, and processes may also have contributed to the change or lack of change in drug use trajectories. Our goal for this exploratory study is to derive theory components that may account for the underlying mechanisms and developmental processes involved in turning points within the life course of drug use and to generate hypotheses to test in future research studies via the R01 grant mechanism. The ultimate objective of this series of studies is to develop and test interventions and strategies to improve outcomes for substance users. PUBLIC HEALTH RELEVANCE: Exploring Proposition 36 as a Turning Point in Life Course Drug Use Trajectories Project Narrative The knowledge and information gained from this exploratory study will be used to improve public health by deriving theory to account for the underlying mechanisms and developmental processes involved in turning points of the life course of drug use and to generate hypotheses to test in future research studies via the R01 grant mechanism. The ultimate objective of this series of studies is to develop and test interventions and strategies to improve outcomes for substance users.