Lee Hoffer
Case Western Reserve University, Anthropology, Faculty Member
- Anthropology, Medical Anthropology, Drugs And Addiction, Drug Addiction, Drugs and drug culture, Economic Sociology, and 20 moreEconomic Anthropology, Gift Giving (Economic Anthropology), Illegal Drug Markets, Neuroeconomics, War on Drugs, Computational Sociology, Computational Social Science, Alcohol and drug treatment, Social Sciences, Sociology, Psychology, Economics, Research Methodology, Social Psychology, Cognitive Science, Cognitive Psychology, Health Sciences, Social and Cultural Anthropology, Social Theory, and Mental Healthedit
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Drug epidemics have enormous individual and societal costs that often persist years after the epidemic has declined. Drug use and addiction produce mental and physical health problems, as well as broad societal challenges such as loss of... more
Drug epidemics have enormous individual and societal costs that often persist years after the epidemic has declined. Drug use and addiction produce mental and physical health problems, as well as broad societal challenges such as loss of child custody, potential overdose death, crime, and incarceration. Drug epidemics have features of infectious diseases (e.g., contagion-like spread of use initiation) and chronic diseases (e.g., long-term changes in neurobiology). Understanding and responding to these epidemics requires systems approach that considers multiple connected and interacting components and outcomes. The chapter emphasizes adaptive connectivity between brain neurobiology, behavioral economics, environmental, cultural, and legal factors that impact the course of drug epidemics. The authors illustrate how agent-based models can simultaneously address and capture this interconnectivity. They provide examples of model-based policy evaluations and discuss challenges that modeli...
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: Recognizing the need to develop a portfolio of research to better understand the influence of social and organizational factors on the behavior of individuals and small units, the U.S. Army Research Institute (ARI) requested the... more
: Recognizing the need to develop a portfolio of research to better understand the influence of social and organizational factors on the behavior of individuals and small units, the U.S. Army Research Institute (ARI) requested the National Research Council's Board on Behavioral, Cognitive, and Sensory Sciences to outline a productive and innovative collection of future basic science research projects to improve Amy mission performance for immediate implementation and lasting over the next 10-20 years. This report presents recommendations for a program of basic scientific research on the roles of social and organizational contextual factors, such as organizational institutions, culture, and norms, as determinants and moderators of the performance of individual soldiers and small units. The Context of Military Environments: Basic Research Opportunities on Social and Organizational Factors synthesizes and assesses basic research opportunities in the behavioral and social sciences r...
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In rural areas availability, price, and legal consequences can force some drug users to switch between primary drugs of choice. For example, as a consequence of stricter law enforcement policy in rural Ohio we observed a shift from... more
In rural areas availability, price, and legal consequences can force some drug users to switch between primary drugs of choice. For example, as a consequence of stricter law enforcement policy in rural Ohio we observed a shift from methamphetamine use to heroin and prescription opiate use. We propose a polydrug agent-based model that describes drug users interconnected in a network. Behavior rules are based on our ethnographic research. The drug selection mechanisms are dictated by drug liking, drug availability, drug cost, perception of health and other life consequences, perception of potential punishment and pressure from the peers. The model produces time series of users' choices of one or concurrent drugs. Modeling and ethnographic data collection are interlinked i.e. model results lead to the improvements in quantitative measurements, which in turn improve the model. Polydrug trends are of particular interest to policy makers because short-term interventions can lead to lo...
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In rural areas availability, price, and legal consequences can force some drug users to switch be tw en primary drugs of choice. For example, as a conseque nce of stricter law enforcement policy in rural Ohio we observed a shift from... more
In rural areas availability, price, and legal consequences can force some drug users to switch be tw en primary drugs of choice. For example, as a conseque nce of stricter law enforcement policy in rural Ohio we observed a shift from methamphetamine use to heroin and prescr iption opiate use. We propose a polydrug agent-based model that describes drug users interconnected in a network. B ehavior rules are based on our ethnographic research. The d rug selection mechanisms are dictated by drug liking, d rug availability, drug cost, perception of health and other life consequences, perception of potential punishment an d pressure from the peers. The model produces time series of u sers’ choices of one or concurrent drugs. Modeling and ethnographic data collection are interlinked i.e. model results lead to the improvements in quantitative measuremen ts, which in turn improve the model. Polydrug trends are of particular interest to policy makers because short-term interv entions can lead...
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Like many applied anthropologists who have worked for 20 or so years in public health and drug addiction research, I have sat in more than my fair share of overly quantitative presentations on the "behaviors" of drug users that... more
Like many applied anthropologists who have worked for 20 or so years in public health and drug addiction research, I have sat in more than my fair share of overly quantitative presentations on the "behaviors" of drug users that dominate conferences in the field. Like my peers in these circumstances, I am often frustrated not because the models, tables, graphs, figures, correlations, p-values, or odds ratios presented are difficult to understand or because I have an aversion to basic science, epidemiology, or survey research. Rather, it is because the numbers rarely reflect the histories, concepts, relationships, interactions, and other nuances that have shaped my fieldwork experience. The highly personal narratives of participants framed by equally complex social environments are not visible in the numbers. To epidemiologists and other like-minded health researchers, the numbers are the narrative and all that is required for informing and evaluating theories, models, inter...
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Understanding the social dynamics of local methamphetamine markets is critical to improving community health and reducing social costs associated with illicit drug use. We examine a local drug market in Summit County, Ohio, wherein... more
Understanding the social dynamics of local methamphetamine markets is critical to improving community health and reducing social costs associated with illicit drug use. We examine a local drug market in Summit County, Ohio, wherein methamphetamine users ascribe themselves different ethnic identities from those long associated with the drug elsewhere in the United States. Qualitative interviews with 52 study participants demonstrate that very poor and homeless White males and females are now using methamphetamine; however, even more surprising is that 31 of the participants identified themselves as poor or homeless, male or female African, Native, biracial, or multiracial Americans. The drug use trajectory of these 31 participants in particular involved a transition from a historical preference for crack to a present one for methamphetamine and, in some cases, a preference for concurrent use of methamphetamine and heroin. Many of these methamphetamine users also emphasized their ethn...
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ABSTRACT Thesis (Ph. D.)--University of Colorado at Denver, 2002. Includes bibliographical references (leaves 491-509).
ABSTRACT Background: This paper reports the findings from focus groups with younger adults, conducted as part of a large NIDA funded Prescription Drug Misuse and Abuse study in St. Louis, designed to elucidate factors predictive of... more
ABSTRACT Background: This paper reports the findings from focus groups with younger adults, conducted as part of a large NIDA funded Prescription Drug Misuse and Abuse study in St. Louis, designed to elucidate factors predictive of prescription drug misuse, abuse, and dependence. Methods: Seven focus groups using a semi-structured interview guide were conducted with 20 young adults, aged 18-25 years, living in the city of St. Louis to explore: patterns, reasons and perceptions of misuse, and perceptions of dependence. The audio tapes were transcribed and analyzed using the qualitative software Atlas ti™. Results: Participants, especially college students, reported widespread prescription drug misuse. Adderall, mentioned as a “study drug”, was reported as the most commonly misused prescription drug along with Xanax, Vicodin, Valium, Percocet, Klonopin and Oxycontin. Reasons for misuse were “to stay focused while studying”, “to keep awake”, “to feel good” and “to feel the ‘high’ faster” with a minimal number of alcoholic drinks while partying. Participants viewed prescription drugs as less harmful and stigmatizing compared to other illegal drugs. Several mentioned experiencing withdrawal symptoms such as anxiety, palpitations, craving or feeling down while not using prescription drugs. A pattern of substituting prescription drugs with other illegal drugs was reported when prescription drugs were not available. Conclusions: Findings indicate an alarming trend of increased acceptance and reduced stigma of prescription drug misuse among younger adults. The study also provided specific reasons that encourage young adults to initiate misuse which could be used to develop interventions focusing young adults, especially college students.
ABSTRACT This study illustrates how the social structure of the heroin market can impact the physiology of heroin addiction and how heterogeneity of addiction patterns can be shaped by market dynamics. We use a novel agent-based modeling... more
ABSTRACT This study illustrates how the social structure of the heroin market can impact the physiology of heroin addiction and how heterogeneity of addiction patterns can be shaped by market dynamics. We use a novel agent-based modeling (ABM) approach to simulate possible neurophysiologic functions based on the collective self-organizing behavior of market agents. The conceptual model is based on three components: biological, behavioral, and social. Biological components are informed by mechanistic animal studies, behavioral component relies on studies of real-life human experiences with addiction, and social aspects are based on market research that describes the transactional and decision-making processes associated with the distribution of drugs within local drug markets. Using ABM, this paper unifies these three components to simulate how heroin addiction patterns are generated and shaped through heroin markets. The market model is based on data from an ethnographic study of a local heroin market and includes customers (users), street and private dealers, street brokers, police, and other potential market actors. Behavioral data is based on converting narrative descriptions and fieldwork observations into formal states and transitions, and a simple model of addiction process for the drug users is based on published peer-reviewed literature. Analysis of model-based simulations reveals “binge/crash,” “stepped,” and “stable” patterns in customer addiction levels.
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ABSTRACT High performance liquid chromatography coupled to electrochemical array detectors (HPLC-EA) was used to separate and identify heroin, morphine, codeine and cocaine in drug cottons obtained from injection drug users... more
ABSTRACT High performance liquid chromatography coupled to electrochemical array detectors (HPLC-EA) was used to separate and identify heroin, morphine, codeine and cocaine in drug cottons obtained from injection drug users (IDU's). Drug cottons are drug paraphernalia that are used by IDU's to filter the dissolved or cooked drug prior to injection. A simple extraction procedure was developed that allows for the extraction of drugs and adulterants from drug cottons. The total assay time was 50 minutes per sample, including re-equilibration of the HPLC column. The detection limits of the HPLC-EA assay ranged from a low of 4pg/μL for morphine to 576pg/μL for cocaine, which rival or exceed current assays for the detection of these drugs. This novel street drug sampling procedure may provide information for monitoring the content and quality of drugs used by IDU's, and in developing harm reduction programs aimed at IDU's.
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Thesis (Ph. D.)--University of Colorado at Denver, 2002. Includes bibliographical references (leaves 491-509).
Background: This paper reports the findings from focus groups with younger adults, conducted as part of a large NIDA funded Prescription Drug Misuse and Abuse study in St. Louis, designed to elucidate factors predictive of prescription... more
Background: This paper reports the findings from focus groups with younger adults, conducted as part of a large NIDA funded Prescription Drug Misuse and Abuse study in St. Louis, designed to elucidate factors predictive of prescription drug misuse, abuse, and dependence. Methods: Seven focus groups using a semi-structured interview guide were conducted with 20 young adults, aged 18-25 years, living in the city of St. Louis to explore: patterns, reasons and perceptions of misuse, and perceptions of dependence. The audio tapes were transcribed and analyzed using the qualitative software Atlas ti™. Results: Participants, especially college students, reported widespread prescription drug misuse. Adderall, mentioned as a “study drug”, was reported as the most commonly misused prescription drug along with Xanax, Vicodin, Valium, Percocet, Klonopin and Oxycontin. Reasons for misuse were “to stay focused while studying”, “to keep awake”, “to feel good” and “to feel the ‘high’ faster” with a...
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Human behavior is dynamic, which means that it changes and adapts. Health sciences, however, often consider static risk factors measured once in a cross-sectional survey. Population or group outcomes are then linked to these static risk... more
Human behavior is dynamic, which means that it changes and adapts. Health sciences, however, often consider static risk factors measured once in a cross-sectional survey. Population or group outcomes are then linked to these static risk factors. In this paper, we show how the use of agent-based models allow one to consider risks in a dynamic sense, i.e., to estimate how risk factors affect future outcomes through behavior. We illustrate the issue of dynamic risks using the examples of the heroin market and HIV transmission on sexual and drug-using networks. We show how the social hierarchy among drug users impacts the order of injection and thus the probability of HIV-free survival. We also illustrate the role of street brokers in the functioning of the heroin market. Although the results do not have the same validity as the data obtained from a longitudinal study, they often provide good insight into underlying social mechanisms without the need for conducting expensive and often unfeasible longitudinal studies.
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This project applies agent-based modeling (ABM) techniques to better understand the operation, organization, and structure of a local heroin market. The simulation detailed was developed using data from an 18-month ethnographic case... more
This project applies agent-based modeling (ABM) techniques to better understand the operation, organization, and structure of a local heroin market. The simulation detailed was developed using data from an 18-month ethnographic case study. The original research, collected in Denver, CO during the 1990s, represents the historic account of users and dealers who operated in the Larimer area heroin market. Working together, the authors studied the behaviors of customers, private dealers, street-sellers, brokers, and the police, reflecting the core elements pertaining to how the market operated. After evaluating the logical consistency between the data and agent behaviors, simulations scaled-up interactions to observe their aggregated outcomes. While the concept and findings from this study remain experimental, these methods represent a novel way in which to understand illicit drug markets and the dynamic adaptations and outcomes they generate. Extensions of this research perspective, as well as its strengths and limitations, are discussed.
Research Interests: Psychology, Medical Anthropology, Community-Based Mental Health Services, Cultural Anthropology, Social Simulation, and 13 moreComplex Adaptive Systems, Commerce, Computational Social Science, Humans, Case Study, Dynamic Software Adaptation, Heroin Dependence, Scaling up, Complex Adaptive System, Illicit Drugs, Street Drugs, Agent Based Model, and Heroin
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The documented prevalence of alcohol use among individuals with HIV is higher than reported among the general public. Little is known about how populations with HIV perceive the risks of alcohol use and what they consider to be safe... more
The documented prevalence of alcohol use among individuals with HIV is higher than reported among the general public. Little is known about how populations with HIV perceive the risks of alcohol use and what they consider to be safe levels of consumption. This qualitative study was conducted to increase understanding of the situations and environments in which alcohol is consumed and to explore the perceptions of risks among individuals with HIV, who were engaged in medical care and using alcohol regularly. Nineteen qualitative semi-structured individual interviews were conducted. The major themes that arose from these analyses were patterns of alcohol use, perceptions of risk based on the type of alcohol used, and the impact alcohol had on health. Findings suggest that alcohol is used regularly with little perception of risk; alcohol is perceived to have little effect on health and HIV progression; and providers rarely discuss alcohol use with patients. Future research includes assessment of alcohol use and the delivery of brief interventions to improve general health and HIV-related outcomes.
Research Interests: Psychology, Primary Care, Primary Health Care, Risk assessment, Humans, and 14 moreFemale, Alcohol Drinking, Male, Qualitative Study, Medical Care, General Health, Middle Aged, Adult, Public health systems and services research, Risk Assessment, Alcohol Use, Brief Intervention, AIDS care, and attitude to health
Research Interests: Psychology, Focus Groups, Adolescent, Ethnicity, Humans, and 19 moreChinese, Taiwan, Female, Male, Focus Group, Magnetic Resonance, Ketamine, Young Adult, Data Collection, Health Professionals, Hallucinogens, Adult, Public health systems and services research, Street Drugs, Club Drugs, Substance-Related Disorders, Health Personnel, Marijuana abuse, and Magnetic resonance image
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ABSTRACT High performance liquid chromatography coupled to electrochemical array detectors (HPLC-EA) was used to separate and identify heroin, morphine, codeine and cocaine in drug cottons obtained from injection drug users... more
ABSTRACT High performance liquid chromatography coupled to electrochemical array detectors (HPLC-EA) was used to separate and identify heroin, morphine, codeine and cocaine in drug cottons obtained from injection drug users (IDU's). Drug cottons are drug paraphernalia that are used by IDU's to filter the dissolved or cooked drug prior to injection. A simple extraction procedure was developed that allows for the extraction of drugs and adulterants from drug cottons. The total assay time was 50 minutes per sample, including re-equilibration of the HPLC column. The detection limits of the HPLC-EA assay ranged from a low of 4pg/μL for morphine to 576pg/μL for cocaine, which rival or exceed current assays for the detection of these drugs. This novel street drug sampling procedure may provide information for monitoring the content and quality of drugs used by IDU's, and in developing harm reduction programs aimed at IDU's.
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Research Interests: Psychiatry, Auditory Perception, Schizophrenia, Cognition, Logistic Regression, and 16 moreInformation Processing, Classical Conditioning, Habituation, Humans, Female, Male, Reliability, Normalization, Young Adult, Event Related Potentials, Outpatients, Adult, Gating, Auditory evoked Potentials, Inpatients, and Initial Condition
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Because many schizophrenic patients are heavy smokers, it has been suggested that nicotine normalizes some neuronal deficit involved in their illness. Schizophrenic subjects have various difficulties with maintenance of attention and... more
Because many schizophrenic patients are heavy smokers, it has been suggested that nicotine normalizes some neuronal deficit involved in their illness. Schizophrenic subjects have various difficulties with maintenance of attention and selective processing of sensory information. One defect in sensory gating in schizophrenia has been characterized by recording auditory evoked potentials. Most normal subjects have a decrease in the evoked response to the second of two closely paired stimuli, whereas most schizophrenic subjects do not. The aim of this study was to determine whether smoking normalizes this deficit in auditory sensory gating in schizophrenia. Changes in auditory sensory gating in response to smoking cigarettes were studied in 10 smokers without psychiatric illness and 10 schizophrenic smokers. Both groups were asked to abstain from smoking from 11:00 p.m. until 8:00 a.m. the next morning, when their auditory evoked responses to pairs of clicks were recorded. The ability to gate sensory information is reflected in a decrease in the P50 wave amplitude in response to the second of the two stimuli. After baseline recordings, the subjects smoked as much as they wished, and then two postsmoking recordings were performed. The schizophrenic patients had a marked but brief improvement in P50 auditory gating immediately after smoking, whereas P50 gating for the normal smokers was slightly impaired. This study suggests that cigarette smoking can transiently normalize the impairment of auditory sensory gating in schizophrenic patients.
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Inhibitory gating of response to repeated stimuli is demonstrated by several event-related potentials, including the auditory P50 wave. The present study examined the effects of variation in sound intensity on this phenomenon in... more
Inhibitory gating of response to repeated stimuli is demonstrated by several event-related potentials, including the auditory P50 wave. The present study examined the effects of variation in sound intensity on this phenomenon in schizophrenics and normal subjects. Paired clicks, 500 ms apart, were presented 50 dB above threshold to 10 normal subjects and 10 schizophrenics. The normal subjects demonstrated significantly more decrement of response to the second stimulus than did the schizophrenics. When the sounds were noticeably louder(70 dB above threshold), no such difference was observed. Rather, both groups had similarly diminished gating of response. A significant difference between schizophrenics and normal subjects was also observed when the sounds were 30 dB above threshold, but the difference was smaller than that at 50 dB. At any stimulus intensity, concomitant eye movements led to loss of gating of P50 in the normal subjects.