This article 1 provides an overview of the relevant literature on the concept of turning points from the life course and developmental criminology perspectives, 2 reviews literature on turning points in substance use, 3 discusses methodological considerations, and 4 suggests areas for future research on turning points in drug use. The influence of life course concepts related to drug use trajectories and turning points including, for example, timing and sequencing of life events, individual characteristics, human agency, and social and historical context offers a potentially fruitful area of investigation that may increase our understanding of why and how drug users stop and resume using over the long-term.
Further research on turning points may be particularly valuable in unpacking the multifaceted and complex underlying mechanisms and factors involved in lasting changes in drug use.
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Illicit drug use continues to be a topic of public concern, directly or indirectly affecting individuals, families, and communities, with detrimental effects that may persist across generations. As such, focus has increasingly turned toward embracing long-term care and continuity of care models for understanding and treating drug addiction [ 2 — 4 ]. It naturally follows that drug abuse research must also involve a longer-term perspective. Further, most drug abusers have frequent and repeated encounters with social, health service, and criminal justice systems.
Thus, a life course perspective using a more holistic, integrated, or systems approach to studying substance abuse, which takes into account varied and multiple factors that might contribute toward abstinence, persistence, or relapse, may be helpful given the complex nature of drug abuse and its dynamic interplay with various social systems [ 2 ]. The approach complements the shift in the treatment and research paradigms from short-term or episodic substance use and treatment to longer-term developmental patterns of behavior and outcomes over time, and takes into consideration factors that may shape or be shaped by these pathways.
Turning point, a key concept in the life course approach may be particularly beneficial in the study of changes in drug use behaviors within varying contexts e. How and why do individuals stop and resume using drugs, particularly when such changes result in the redirection of a pathway or a persistent trajectory? Answers to these questions will have important implications for treatment and relapse prevention strategies.
The purpose of this article is to 1 provide an overview of the relevant literature on the concept of turning points from the life course and developmental criminology perspectives, including definitions of terms and a description of factors contributing to turning points e. We are interested in understanding turning points that redirect trajectories, not simply temporary detours from life pathways [ 7 ].
Turning points often involve particular events, experiences, or awareness that result in changes in the direction of a pattern or trajectory over the long term. Understanding turning points may be particularly valuable in providing insight into the complicated underlying processes involved in long-term changes in drug use and reveal why, for instance, the same life event e. Turning points is a key concept in the life course approach, which emphasizes long-term developmental patterns of continuity and change in relation to transitions in terms of social roles e.
The developmental life course perspective has roots in the social sciences and evolved more recently as developmental criminologists became increasingly interested in using the approach to study criminal careers [ 9 ]. Focusing on developmental stages and patterns of behavior across the life span and taking into account individual and environmental factors that may shape these patterns are instrumental in understanding persistence as well as changes in behavior. Key life course concepts involve developmental trajectories, transitions and turning points, and their relationships to one another.
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Elder [ 10 ] defines the life course as the interconnected trajectories as people age. Trajectories are interdependent sequences of events in different life domains e. In the developmental criminology literature, which offers parallels to drug abuse in terms of focusing on patterns of delinquent behaviors e. Transitions are changes in stages or roles e.
Some, but not all, transitions lead to turning points that produce long-term behavioral change. The term, turning point, has typically been used in association with life events [ 6 ], but not all of these events or experiences lead to changes in life trajectories. Marriage, employment, and military service are often cited in the literature as representing turning points in the life course [ 6 , 11 — 15 ]. Further, although some of these events e.
Thus, it is only in hindsight that turning points emerge [ 7 , 16 ]. Life events and experiences may have cumulative and long-range effects, opening up or shutting down future opportunities [ 7 , 17 , 19 ]. For example, having a satisfying job was found to have a positive influence on criminal careers [ 15 , 20 — 22 ].
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Laub and Sampson [ 22 ] suggest that upon becoming married, spouses of criminal justice offenders may exert direct social control, structure, a new sense of identity and meaning in life, and provide social and emotional support, which may put offenders on the path toward desistence.
Similarly, turning points may also involve both positive and negative results, and may concern events over which a person has some, little, or no control or choice [ 19 ]. While a wide range of experiences and life events e. Given the variety of turning point events and evidence that different people have varied responses to the same event, contextual factors and individual characteristics described in the life course literature concerning turning points are particularly important in understanding such marked changes in awareness and behavior. According to life course theory [ 10 ], the timing and sequence of developmental transitions across the life span are of consequence because age and social norms are associated with particular age groups e.
The subjective meaning of an experience and the associated implications e. Individuals are influenced by different things at varied stages in the life course [ 9 , 28 ], especially as they age and their roles change e. For example, military service during the World War II period has been reported as a turning point for men transitioning into young adulthood with respect to their occupation, employment status, job stability, and economic status, regardless of differences in childhood characteristics and socioeconomic background [ 11 ].
Moreover, in interviewing 60 women in three age cohorts first interviewed in their early 40s, 50s, and 60s, and then five years later about their turning points, Leonard and Burns [ 29 ] found that overall, the nature of the turning points changed around midlife, and that role transition-related turning points decreased with age, whereas personal growth ones increased.
With regard to employment, findings suggest that work is a turning point for older but not younger offenders [ 15 , 20 ]. Whether a life event, experience, or new awareness serves as a turning point may also depend, in part, on contextual factors, which are often unpredictable.
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One of the key notions of the life course approach is the importance of understanding lives within their larger dynamic and complex environment, particularly social, cultural and historical contexts [ 28 , 30 ]. How turning points are interpreted may also be shaped by culture, as norms e.
Hareven and Masaoka [ 31 ] found cultural differences among American and Japanese cohorts in — in the timing of life transitions and relevant perceptions over the life course. Social capital can similarly influence a life pathway because personal change does not happen in a vacuum, but is situated within a larger social context e. Laub and Sampson [ 30 ] theorize that these social linkages or informal social controls e. Individual attributes or background characteristics such a human agency and gender, is yet another area that has been reported as influencing turning points in the life course.
The amount of personal choice and control over decision making individuals feel they have shapes their perceptions and the outcomes of life events and transitions [ 6 , 34 ], and may contribute to the differential effects that the same life event may have on different people. Human agency is a key concept in that overall, people appreciate being able to plan and make choices among the options presented in any given situation that affect their lives [ 26 , 28 , 34 ].
Gender-based differences have been noted in the life course literature. The concept of turning points in the developmental life course has been an area of growing interest among substance abuse researchers [ 2 , 35 ], although earlier inquiries into major events or other reasons for quitting substance use may not have been framed from a life course perspective and have not explored the underlying processes and mechanisms contributing to decisions to abstain.
Turning points in substance use has evolved to become a separate area of empirical study. Further, with more recent empirical findings uncovering the heterogeneity of life course drug use patterns and frequent interplay with multiple service systems e. A number of studies examining turning points in substance use were found in the literature.
For example, with respect to alcohol use, Kaskutas [ 36 ] describes self-reported turning points e. It was noted that on average, it took respondents four years to become sober. Further, Cloud and Granfield [ 35 ] reported that among a sample of 46 individuals who overcame their drug and alcohol addiction without treatment, turning points were typically related to experiences involving other people e. While studies have investigated turning points and life events that have contributed to changes in drug use over the long term, research is limited that delves into how contextual factors e.
The literature includes various methodological approaches to the study of turning points. Qualitative methods, such as the life history narrative approach, have typically been employed to investigate self-perceived turning points [ 23 , 22 , 35 , 45 — 49 ].
For example, with regard to drug use research, in an exploratory qualitative study involving interviews with 18 ex-heroin users, Bammer and Weeks [ 50 ] concluded that for many of them, multiple factors were involved in stopping dependent heroin use and that the process is complex. They concluded that the turning point that prompted behavior change was not the specific life event, but the self-appraisal process that followed.
Through the use of qualitative methods, the intricate patterns, sequencing of events and interconnectedness of different life trajectories embedded in social and historical contexts can be unpacked and explored [ 22 ]. While a growing knowledge base exists, the samples are typically modest and the work largely exploratory. We have limited knowledge of the mechanisms and processes that underlie turning points in drug use, which would be useful in developing intervention or other strategies to help facilitate positive turning points and to maintain downward trends in drug use.
In addition to qualitative methods, advanced statistical methods involving examination of repeated measures associated with changes in developmental trajectories over time have been used to examine drug use trajectories within which turning points are embedded. With the advent of recent advances in statistical analysis methods applied to longitudinal data e.
For example, Hser et al. However, although research on drug use trajectories over the life course is increasing, it is still unclear what influences these pathways, and more importantly, the turning points that bring about enduring changes in substance use. However, quantitative methods may not fully capture the underlying mechanisms and processes influencing turning points.
At present, use of such methods is not able to explain what marked the turning point, which may be different for individuals even with similar trajectories. Another option that integrates qualitative and quantitative methods is to prospectively, concurrently, and repeatedly collect and analyze both quantitative and qualitative data to examine turning points and related factors as well as the underlying processes over the long-term among cohorts of drug users.
Statistical analyses conducted to identify drug use and related trajectories e.
Complementary qualitative data could shed light on the underlying mechanisms and processes associated with the turning points. However, integrating qualitative and quantitative approaches, and data, would most likely be extremely resource and time intensive. Several additional methodological issues related to empirically investigating turning points in many studies have been raised because of the subjective and retrospective process involved in identifying them [ 31 ].
Whether a critical life event is perceived as a turning point at one point in time may differ at another point in time, for example, several decades later. However, the particular life event is not as consequential -- because individuals respond to the same event in different ways -- but understanding the mechanisms and processes that underlie the turning point is, and may be crucial to developing effective prevention strategies and interventions at critical junctures over the life span.
As investigation of turning points in life course drug use trajectories appears to still be in the exploratory stage, more comprehensive methods are needed in collecting and analyzing data on the wide range and complexity of turning point experiences. This understanding can help in guiding the development of theory and a set of hypotheses that can be tested using statistical methods. Research on drug use trajectories from a developmental life course perspective is currently limited and studies on turning points in drug use pathways, specifically, are scarcer.
We know that individuals are able to identify and describe events and experiences that represent turning points in their drug use.
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These turning points are not temporary fluctuations in behavior, but are long-lasting. As indicated earlier, the concept of turning points is intuitive, but has been difficult to operationalize; yet the concept is useful as a marker for long-term behavioral changes. The literature suggests that substance abuse researchers must not only identify possible turning point events and experiences, but more importantly, the developmental processes and underlying mechanisms involved in shaping the redirection [ 2 , 16 , 19 , 22 , 37 , 60 , 62 ] in drug use trajectories. Based on the brief literature review of turning points using a life course perspective, we propose a conceptual framework, illustrated in Fig.
The figure includes key domains and concepts for exploring drug use trajectories and turning points. The framework 1 situates individual drug use trajectories within the context of the larger environment and historical times, 2 takes into consideration that personal characteristics e. For example, whereas drug use persists over the lifespan for some, for others it may decelerate gradually or dramatically, and then may cease entirely, or it may exhibit a recurring pattern of repeated acceleration and deceleration with periods of abstinence.
For some drug offenders, a certain event or experience e. Understanding why this is so is important. Specifically, there is a need to better understand the underlying factors indicated by the arrows in regular font , mechanisms and processes involved in turning points.
Although changes in drug use trajectories and their interplay with pathways in other domains e. Qualitative methods in particular, but also qualitative and quantitative methods used in an integrated manner, are needed as research on turning points in drug use trajectories is still at the exploratory stage, and we need to first understand, for example: The concept of turning points in the life course as applied in the social sciences and more recently in the area of developmental criminal careers has increased our understanding of events and processes that may trigger a redirection of a life pathway over time e.
The developmental life course perspective alerts investigators to the importance of considering the multifaceted and ever-changing influences that shape interdependent drug use and other trajectories over the life span. Longitudinal research and sophisticated statistical methods developed to analyze such data complements the widely held view of drug addiction as a chronic and relapsing condition that may persist over the adult life span. Turning points in a life course perspective is an important evolving area of investigation in the substance abuse field.
The influence of related life course concepts, including timing and sequencing of life events, individual characteristics, human agency, and social and historical context on drug use trajectories and turning points offers a potentially fruitful area of investigation that may increase our understanding of why and how drug users stop using over the long-term. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.
National Center for Biotechnology Information , U. Curr Drug Abuse Rev. Author manuscript; available in PMC Dec Cheryl Teruya , Ph. Author information Copyright and License information Disclaimer. The publisher's final edited version of this article is available at Curr Drug Abuse Rev.
See other articles in PMC that cite the published article. Abstract Turning point, a key concept in the developmental life course approach, is currently understudied in the field of substance abuse, but merits further research. Life Events and Experiences The term, turning point, has typically been used in association with life events [ 6 ], but not all of these events or experiences lead to changes in life trajectories.
Developmental Stages According to life course theory [ 10 ], the timing and sequence of developmental transitions across the life span are of consequence because age and social norms are associated with particular age groups e. Environmental Context—Historical, Cultural, Social Whether a life event, experience, or new awareness serves as a turning point may also depend, in part, on contextual factors, which are often unpredictable.
Individual Factors Individual attributes or background characteristics such a human agency and gender, is yet another area that has been reported as influencing turning points in the life course. Human Agency The amount of personal choice and control over decision making individuals feel they have shapes their perceptions and the outcomes of life events and transitions [ 6 , 34 ], and may contribute to the differential effects that the same life event may have on different people.
Gender Gender-based differences have been noted in the life course literature. Conceptual Framework Based on the brief literature review of turning points using a life course perspective, we propose a conceptual framework, illustrated in Fig. Upload your resume Sign in. Turning Points For Children jobs Filter results by: Full-time Part-time 28 Temporary 12 Contract 6 Internship 6. Enter your zip code in the "where" box to show results in your area. Upload your resume - Let employers find you. Reviewing current model with an eye for optimizing, turning requests into conversions, building a library of templates, keeping the team on point and increasing Asheville, North Carolina - Uplevel You.
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