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BACKGROUND: U.S. military veterans face many biopsychosocial (BPS) challenges post-service that may elevate risk for opioid-related overdose including physical pain, mental health concerns and social stressors. Some veterans use opioids to manage pain and cope with social readjustment. This study assessed associations between BPS factors and recent engagement in overdose risk behavior in a community sample of post-9/11 veterans who used opioids in New York City. METHODS: Participants (n=218) were recruited through convenience sampling and completed a baseline assessment including a validated Opioid Risk Behavior Scale (ORBS) that measured past-30-day engagement in 22 opioid-related overdose risk behaviors. Analyses examined associations between ORBS scores and hypothesized demographic, biological/physical, psychological and social predictors. Incident rate ratios estimated the expected relative difference in ORBS score associated with each predictor. RESULTS: Participants reported an average of 4.72 overdose risk behaviors in the past 30 days. Significant independent predictors of higher ORBS score, after adjustment for demographics and current prescription medications, were past-30-day: depression symptoms; unsheltered or living in a homeless shelter (vs. private housing); history of mental health treatment; experiencing stressful life events; average pain severity; and pain interference. CONCLUSION: Veterans face myriad BPS challenges and, while drug-related overdose risks are well understood, findings suggest that other factors—including mental health, pain and stressful life events—may also be associated with overdose risk among opioid-using veterans. The larger challenges veterans face should be considered in the context of BPS forms of pain management when tailoring and delivering overdose prevention interventions.

An innovative employment counseling model, Customized Employment Supports, was developed for methadone‐treatment patients, a population with historically low employment rates. The effectiveness of a key component of the model, "vocational fieldwork," the delivery of services in the community rather than only within the clinic, was assessed through a quasi‐experimental study of the first 55 patients receiving the model in 2 clinics. Employment outcomes after 6 months were compared between patients who received vocational fieldwork (n = 18) and those who did not (n = 37). Logistic regression analysis demonstrated that patients receiving vocational fieldwork had significantly better outcomes for competitive work, informal work, and any paid work.

Frontmatter -- Contents -- Acknowledgments -- Preface -- Introduction -- Part one. Becoming an Ethnographer -- 1. Going Native with Evil -- 2. Lost in the Park: Learning to Navigate the Unpredictability of Fieldwork -- 3. Unearthing Aggressive Advocacy: Challenges and Strategies in Social Service Ethnography -- 4. Going into the Gray: Conducting Fieldwork on Corporate Misconduct -- Part two. team ethnography -- 5. Hide-and-Seek: Challenges in the Ethnography of Street Drug Users -- 6. Into the Epistemic Void: Using Rapid Assessment to Investigate the Opioid Crisis -- 7. Conducting International Reflexive Ethnography: Theoretical and Methodological Struggles -- Part three. navigating the unusual -- 8. Hidden: Accessing Narratives of Parental Drug Dealing and Misuse -- 9. Navigating Stigma: Researching Opioid and Injection Drug Use among Young Immigrants from the Former Soviet Union in New York City -- Part four. the emotional impact of doing ethnography -- 10. Dangerous Liaisons: Reflections on a Serial Ethnography -- 11. The Emotional Labor of Fieldwork with People Who Use Methamphetamine -- 12. Ethnography of Injustice: Death at a County Jail -- Conclusion: Looking Back, Moving Forward -- List of Contributors -- Index