"I Always Kept a Job": Income Generation, Heroin Use and Economic Uncertainty in 21st Century Detroit.

This qualitative study, based on a series of 30 in-depth interviews and 109 economic surveys conducted with active heroin users residing in and around Detroit, Michigan, describes reported patterns of heroin use and income generation activities. In spite of lack of access to regular, legal employment, we found that many participants displayed a dedication to regular daily routine and a sense of risk management or control. These findings are discussed relative to past research on heroin addiction as well as recent research on the changing nature of employment. We argue that this sample fits somewhere in between the controlled or working addict, and the "junkie" or "righteous dope fiend" of urban lore. We draw a connection between these stable patterns of addiction and income generation and the demands of informal and insecure labor markets. Finally, we discuss the implications of these findings for further research, interventions, and public policy.

A hell of a life: addiction and marginality in post-industrial Detroit.

Drawing on concepts from Foucault and Agamben, we maintain that the lives of daily heroin users provide a prime illustration of bare life in the zone of indistinction that is contemporary Detroit. First, we consider the case of Detroit as a stigmatized and racially segregated city, with concrete consequences for its residents. We then present evidence from in-depth ethnographic and economic interviews to illustrate the various spaces of confinement-that of addiction, that of economic marginality, and that of gender-occupied by these men and women, as well as the indeterminacy of their daily lives, captured through their descriptions of daily routines and interactions. We examine their expressions of worth as expressed in economic, emotional and moral terms. Finally, we draw connections between the sustained marginality of these individuals, as a contemporary category of homo sacer, and the policies and powers that both despise and depend upon them. Heroin, we contend, helps to fill and numb this social void, making bare life bearable, but also cementing one's marginality into semi-permanence.

Change in the scenery: an ethnographic exploration of crack cocaine use in rural Ohio.

Though still largely perceived as an "inner city" drug, crack cocaine has become increasingly available in many areas of the United States. However, little research has been conducted on the phenomenon of crack cocaine use outside of urban areas. This paper draws on qualitative interviews with 50 recent and former crack-cocaine users to explore patterns of use and distribution in three counties in rural Ohio. The findings show that variable patterns of crack use previously documented among urban crack users are evident in rural areas as well, though these are modified by the context of the rural small town. It is postulated that local social networks are the primary means by which these patterns are both transmitted and translated. Implications of these exploratory findings and possible directions for future research are discussed.

Needles in the haystacks: the social context of initiation to heroin injection in rural Ohio.

Although there has been much research on the social context of heroin injection, little has been reported outside of major urban areas. This article examines contextual factors associated with initiation to heroin injection in rural Ohio, based on semistructured qualitative interviews and focus groups involving 25 recent heroin injectors (12 women, 13 men) recruited from three contiguous counties between June 2002 and February 2004. Curiosity about the drug's effects, the growing pressures of drug dependence and economic need, and the influence of intimate and group relations were all identified as factors that offset fears commonly associated with injection. This study complements other research on the social ecology of heroin injection and may contribute to improved services for injection drug users in rural areas and small communities.

Perspectives on health among adult users of illicit stimulant drugs in rural Ohio.

CONTEXT: Although the nonmedical use of stimulant drugs such as cocaine and methamphetamine is increasingly common in many rural areas of the United States, little is known about the health beliefs of people who use these drugs. PURPOSE: This research describes illicit stimulant drug users' views on health and health-related concepts that may affect their utilization of health care services. METHODS: A respondent-driven sampling plan was used to recruit 249 not-in-treatment, nonmedical stimulant drug users who were residing in 3 rural counties in west central Ohio. A structured questionnaire administered by trained interviewers was used to collect information on a range of topics, including current drug use, self-reported health status, perceived need for substance abuse treatment, and beliefs about health and health services. FINDINGS: Participants reported using a wide variety of drugs nonmedically, some by injection. Alcohol and marijuana were the most commonly used drugs in the 30 days prior to the interview. Powder cocaine was used by 72.3% of the sample, crack by 68.3%, and methamphetamine by 29.7%. Fair or poor health status was reported by 41.3% of the participants. Only 20.9% of the sample felt they needed drug abuse treatment. Less than one third of the sample reported that they would feel comfortable talking to a physician about their drug use, and 65.1% said they preferred taking care of their problems without getting professional help. CONCLUSIONS: Stimulant drug users in rural Ohio are involved with a range of substances and hold health beliefs that may impede health services utilization.

Nonmedical drug use among stimulant-using adults in small towns in rural Ohio.

This study describes the drug-use practices and treatment histories of 249 not-in-treatment, drug-using individuals living in small towns in rural Ohio. Respondent-driven sampling was used to recruit participants who answered questionnaires administered by interviewers. Descriptive statistics and latent class analysis (LCA) were used to examine the data. The illicit drugs most commonly used in the 6 months before entering the study were marijuana (89.6%), cocaine hydrochloride (80.3%), and crack cocaine (76.3%). Injection drug use was not uncommon. About a third of the sample experienced drunkenness frequently. Less than 14% had been in substance abuse treatment recently. LCA revealed two groups: (1) heavy users of virtually all drug classes and (2) moderate-to-light users of fewer drug classes. White and younger people were more likely to be classified in the heavy user group. The results suggest that comprehensive substance abuse prevention and treatment programs are needed in rural communities.