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We present analyses based on selected findings from a NIDA-funded project entitled, "An Exploratory Study of Ecstasy Distribution" (2003–2006). We conducted in-depth interviews with 120 men and women in the San Francisco Bay area who had sold five or more doses five or more times in the six months prior to the interview. The research focused on the motivations and circumstances surrounding the decision to initiate sales, sales settings, the characteristics of both sellers and buyers and their relationships. It also focused on negotiated order and social identities. We describe the ways in which a sample of educated, housed, and employed Ecstasy dealers' attitudes and practices compared with more marginalized groups from other drug market studies. These findings suggest attention to social class, that is, the social characteristics of sellers and the availability of types of sales settings (public vs. private) is critical to developing a sociological understanding of drug markets.

In this exploratory study of pregnant drug users who have experienced one or more violent events (physical/sexual or emotional) while pregnant, the authors detail how drug use is both a survival strategy and a source of vulnerability to violence. Using a qualitative methodology, 126 women were interviewed who were or had recently been pregnant (within six months postpartum) and had used marijuana, crack, cocaine, or heroin singly or in combination (including alcohol with one or more of the above). Data concerning demographics, family, relationships, reproductive, drug use and violence histories were collected with a structured questionnaire. Of the 126 interviewees, 79% (100) were selected on the basis of their violent experiences during pregnancy for an in-depth interview that focused on their drug use and violence histories. The authors detail the ways in which women's drug use was a form of recreation, as well as a coping and survival strategy. Drug use also caused them serious problems. Women were demonized for using drugs while pregnant but not given feasible or reasonable alternatives.

This is a report of a qualitative study of the perceived risks and criminal justice pressures experienced by middle class cocaine suppliers. In-depth interviews with eighty ex-sellers indicate that most feel that they can avoid arrest by controlling the networks of buyers they sell to and do not believe that the police, police investigations, RICO laws and the activities of the IRS are any real threat. In general, they were much more concerned about informants, disgruntled customers and robberies than the police. Very often the sellers own drug abuse was a regular unanticipated risk that caused them to give up drug sales more than criminal justice pressures.

Getting off maintenance is problematic for methadone clients. This paper, based on data from qualitative/ethnographic data from 100 depth interviews with women on methadone, attempts to document and analyze this problem. We begin with a discussion of women's conceptions of readiness to detoxify from methadone, the components of this state and the illusions which are operative. Next is a discussion of obstacles to detachment from methadone: models of failure so visible in the clinic setting; being a success in the eyes of clinic staff and clients; and ever-present and intensive fears of clients about this process. We examine the actual detoxification process: the clinic's role, methadone withdrawal, and aids and accessories in this endeavor. Finally we look at the failure to complete a detoxification or remain abstinent upon getting off methadone, the meaning this has for the addict, and its implications.

In this article, we present findings from a qualitative National Institute on Drug Abuse-funded study of nonmedical prescription drug users in the San Francisco Bay Area. We interviewed young adults between the ages of 18 and 25 years, who used prescription drugs nonmedically at least 12 times in the 6 months prior to the interview. Employing Aker's Social Learning Theory and Zinberg's Drug, Set, and Setting, we explore the factors that contributed to participants' choices to begin using prescription drugs nonmedically. Social Learning Theory provides the framework for understanding how deviant behaviors are learned and imitated, while set and setting emphasizes the psychological and social contexts of initiation and the ways in which the set and setting of the initiating user were influenced by exposure, motivation, access, and setting. Together, social learning, and set and setting allow us to understand the interaction of individual and social factors contributing to nonmedical prescription drug use initiation.

Fluctuations in the use of many drugs at one time or another have been characterized as drug epidemics. The depiction of drug use as an epidemic, as in the recent cases of methamphetamine and crack use, is a proven mechanism for communicating that a problem exists, but such depictions are not without risk. When the public characterization of drug use as an epidemic represents more than its epidemiological meaning of "unusually elevated occurrence," panic is often substituted for reasoned action. Such declarations are likely to truncate objective investigation, generate fear rather than understanding, and stimulate reactive measures that exacerbate drug misuse. This article discusses the epidemiological origin and meaning of epidemic, documents how media headlines have sensationally depicted methamphetamine use, and recommends that alternative strategies for describing an increase in the incidence and prevalence of use may be more successful in directing researchers and policy makers toward effective strategies for reducing misuse.

The authors examine the organizational transformation of Prevention Point, the San Francisco-based syringe exchange program. Their purposes are to explore the processes of organizational change, focus on the impact of formalization on members and organizational goals, and contextualize these in light of belonging to an underground organization. They highlight the volunteers' motivation and commitment, and their responses to the organizational changes. Drawing on qualitative interviews with 56 service providers, conducted from 1993 to 1995, the authors document the changes in the organization and the members' perceptions of it as it moved from an illegal, deviant group to a socially sanctioned service organization. This transition is shown to have ultimately undermined much of the basis for volunteer commitment, reinforcing the shift in responsibility from the membership to a new management structure. These findings have implications for the larger problem of maintaining volunteer engagement in volunteer work.

From a process evaluation, participants in San Francisco's syringe exchange program (SEP) are described. Three groups, primary, secondary, and nonexchangers, were interviewed for a total of 244 study participants recruited from eight needle exchange sessions. Fifty percent of all primary exchangers exchanged for one or more injecting drug user(s) (IDUs). Three general routes of syringe distribution were identified between primary and secondary exchangers: between close friends and lovers; for people who lived in close proximity to them; and with customers who bought drugs from them. Focusing on why some go to SEPs and why some rely on others to go for them, findings are summarized primarily as the barriers for not attending SEPs, including exposure, legal status, illness, drug lifestyle, and conflicts with service provision. The secondary exchangers had similar risk reduction profiles to the SEP users that overall were better than the nonexchangers. For example, they shared syringes and cookers significantly fewer times than nonexchangers. The results demonstrate that these client-provided exchanges enable the SEP to overcome injection drug users' obstacles to program attendance, thereby reaching even hard to access members of IDU populations. We found the effects of these client-provided services to be positive for the larger IDU population.

We present findings from a qualitative study of 80 women and men who sold Ecstasy in private settings. In this paper we explore Ecstasy sellers' identity processes and pathways to dealing. Interviewees believed "real dealers" sold in public settings to people they did not know and relied on drug sales as their main source of income. We found that 76% of the sample resisted the dealer identity due to the stigma associated with dealing, Ecstasy's benign reputation, selling in private settings, and customer bases that comprised mainly friends. The majority of the sample "drifted" into dealing and did not consciously decide to sell. Additionally, most interviewees did not implement precautionary sales strategies that characterize drug dealing operations described in our own and other investigators' research on drug markets. Ecstasy sellers created new, more positive identity constructions for themselves, which is also an important focus of this paper.

The research discussed here explores the sexual behavior of two hundred and twenty-eight heavy users of cocaine. Intensive, face-to-face, tape-recorded interviews with each user uncovered some interesting differences in sexuality among various user groups. Far example, male users were found to have greater levels of sexual enhancement from cocaine, than were female users. Another finding was that freebasers and snorters of the drug had similar levels of sexual impairment, while injectors experienced far worse levels of sexual dysfunction. The widespread mythology that cocaine is always a sexual aphrodisiac was certainly not confirmed by this research effort. It was found that there were a myriad of responses to the same dosage level of cocaine, depending, in part, upon the setting of the usage, as well as the background experiences of the user.