MEDICAL HISTORY AND ETHICS

  • Claire D. Clark and Emily Dufton, "Peter Bourne's Drug Policy and the Perils of a Public Health Ethic, 1976-1978" American Journal of Public Health 105, no. 2 (2015): 283-292 [Winner, Paper of the Year Award, American Public Health Association]

    As President Jimmy Carter’s advisor for health issues, Peter Bourne promoted a rational and comprehensive drug strategy that combined new supply-side efforts to prevent drug use with previously established demand-side addiction treatment programs. Using a public health ethic that allowed the impact of substances on overall population health to guide drug control, Bourne advocated for marijuana decriminalization as well as increased regulations for barbiturates. A hostile political climate, a series of rumors, and pressure from both drug legalizers and prohibitionists caused Bourne to resign in disgrace in 1978. We argue that Bourne’s critics used his own public health framework to challenge him, describe the health critiques that contributed to Bourne’s resignation, and present the story of his departure as a cautionary tale for today’s drug policy reformers

  • Claire Clark,"Chemistry is the New Hope: Therapeutic Communities and Methadone Maintenance, 1965- 1971"Social History of Alcohol and Drugs: An Interdisciplinary Journal 26, no. 2 (2012): 192-216.

    Historians generally agree that the “classic era” of narcotics control, a period of punitive drug policies and limited treatment options,came to an end in the early 1960s along with, among other things, the emergence of methadone maintenance treatment for heroin addiction. But methadone was not the only treatment model competing to replace the punitive system; throughout the 1960s therapeutic communities also competed for funding and political legitimacy. A close examination of the debate between promoters of these different approaches complicates the progressive narrative of addiction policy moving seamlessly from punitive and conservative to sympathetic and liberal approaches. A compromised treatment infrastructure that combined methadone, therapeutic communities, and criminal justice approaches to addiction ultimately emerged from the conflict – a compromise that retained key elements of the carceral approach while minimizing the boldest challenges to it, thus laying the groundwork for the drug wars that followed.

BEHAVIORAL SCIENCE AND HEALTH EDUCATION

  • Claire Clark,"Doctoring Undercover: Updating the Educational Tradition of Shadowing" Medical Education Online, 22, no. 1 (2017): 1-8.

    Background: Premedical students are educated in basic biological and health sciences. As a complement to traditional premedical coursework, medical school applicants are encouraged to shadow practitioners, with the hope that observation will introduce students to the culture and practice of healthcare. Yet the shadowing experience varies widely across practitioners and institutions; resources that guide students’ critical reflection and structure the experience are scarce. Development: A pilot experiential learning course, Doctoring Undercover: Shadowing and the Culture of Medicine, was developed to fill this gap. The course consisted of three parts: an introduction to medical culture through the disciplines of medical sociology, history, anthropology, and bioethics; a site placement in which students applied these fields’ analytical techniques to the study of medical culture and practice; and the development of an online activity guide that other premedical students may adapt to their shadowing circumstances. Implementation: Students reported that they were exposed to new disciplinary perspectives and interprofessional environments that they would not traditionally encounter. Students’ contributions to the shadowing guide encouraged active learning and reflection on the dynamics of effective patient-provider relationships and shadowing experiences. Future Directions: Locally, the class may be scaled for a larger group of premedical students and incorporated into a formal pathway program for premedical students; the content will also be integrated into the clinical medicine course for first-year medical students. Online, the guide will be promoted for use by other institutions and by individuals planning extracurricular shadowing experiences; feedback will be solicited. Tools for evaluating the short- and long-term impact of the course and guide will be developed and validated. Observational and experimental studies of the course’s impact should be conducted.

  • CD Clark, S Langkjaer, S Chinikamwala, H Joseph, S Semaan, J Clement, R Marshall, E Pevzner, BI Truman, K Kroeger "Providers' Perspectives on Program Collaboration and Service Integration for Persons Who Use Drugs" Journal of Behavioral Health Services Research (2016): E-pub before print. DOI: 10.1007/s11414-016-9506-y

    Government and private initiatives encourage program collaboration and service integration (PCSI) in providing prevention and treatment services for substance abuse, mental disorders, and infectious diseases. The authors conducted 25 semi-structured interviews with healthcare providers serving persons who use drugs in Atlanta, GA in 2012. HIV testing was the most frequently provided integrated service and access to sterile drug preparation equipment was least frequently integrated into substance abuse centers and HIV clinical settings. Almost half the collaborations were strong, as defined by participants' perceptions of long-standing partnerships and active referral of patients. Policies, resources, and treatment philosophies influenced integration in both favorable and unfavorable ways. Infectious disease screening services required by law or organizational mission were more likely to be integrated. Providers had positive views of PCSI, viewed effective collaboration as essential to meeting the needs of persons who use drugs, and described how local organizations implement PCSI for this population

  • Hannah LF Cooper, Claire Clark, Terrika Barham, Venita Embry, Bethany Caruso, and Megan Comfort "'He Was the Story of My Drug Use Life': A Longitudinal Qualitative Study of the Impact of Partner Incarceration on Substance Misuse Patterns Among African American Women" Substance Use and Misuse 49, no. 1-2 (2014): 176-188.

    This NIH-funded longitudinal qualitative study explored pathways through which partner incarceration affected substance misuse among African American women. Four waves of semi-structured interviews were conducted with 17 substance-misusing African American women whose partners had recently been incarcerated. Data were collected in Atlanta, Georgia, during 2010–2011. Transcripts were analyzed using grounded theory methods. Analyses suggest that partner incarceration initially precipitated multiple crises in women's lives (e.g., homelessness); over time, and with formal and informal support, women got their lives “back on track.” Substance misuse declined over time, though spiked for some women during the crisis period. We discuss implications for research and interventions.