Department of Sociology, Purdue University, 700 W State St, West Lafayette, IN, 47907, USA.
Department of Sociology, The Ohio State University, 238 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH 43210, USA.
Int J Drug Policy. 2021 Aug;94:103182. doi: 10.1016/j.drugpo.2021.103182. Epub 2021 Mar 6.
Past approaches to policy and practice for substance use have focused heavily on young people, but recent trends indicate this approach may not be where the future lies. The crises with escalating overdose mortality in several countries, particularly overdoses related to opioids, have drawn attention to life course shifts in the burdens of substance use. Overdose mortality rates for individuals in midlife have considerably outpaced those of adolescents and individuals in early adulthood. These diverging life course trends are occurring not only in the United States, but in other countries with growing overdose problems as well. The future of effective policy and practice depend upon evidence and analyses that adapt to emerging data on shifting life course trends in drug related mortality. Within this manuscript, we consider a range of theoretical possibilities on the divergence of midlife drug mortality trends from those of young people for the purpose of outlining an agenda for future research and practice. Specifically, we consider the following theoretical approaches to move research forward in this area: Changes in Medical Context hypothesis; Emergent Comorbidities hypothesis; Cohort hypothesis; Generational Forgetting hypothesis; Legal Regulation hypothesis; Strength of Life Course Bonds hypothesis; Deepening Inequality hypothesis; Measurement Reliability hypothesis. These theoretical frameworks attend specifically to the overdose crisis but extend to other aspects of substance use. Beyond setting an agenda for research by providing empirically verifiable hypotheses, this manuscript also identifies future directions in policy and practice that are attentive to life course trends.
过去针对物质使用的政策和实践方法主要集中在年轻人身上，但最近的趋势表明，这种方法可能不符合未来的发展方向。一些国家的过量死亡率不断上升的危机，特别是与阿片类药物有关的过量死亡率，引起了人们对物质使用负担在生命过程中转移的关注。中年人因药物过量而死亡的比率远远超过青少年和成年早期人群。这种不同的生命过程趋势不仅在美国，而且在其他存在过量问题的国家也在发生。有效的政策和实践的未来取决于证据和分析，这些证据和分析需要适应有关药物相关死亡率的生命过程趋势转变的新兴数据。在本文中，我们考虑了一系列关于中年人群药物死亡率趋势与年轻人的死亡率趋势分歧的理论可能性，旨在为未来的研究和实践制定一个议程。具体而言，我们考虑了以下几种理论方法来推动该领域的研究进展：医学背景变化假设；新兴合并症假设；队列假设；代际遗忘假设；法律监管假设；生命过程关系强度假设；不断加深的不平等假设；测量可靠性假设。这些理论框架特别关注过量危机，但也扩展到物质使用的其他方面。除了通过提供可经验验证的假设为研究制定议程外，本文还确定了关注生命过程趋势的政策和实践的未来方向。
