Dissertations, Theses, and Capstone Projects

Date of Degree


Document Type


Degree Name



Social Welfare


Alexis Kuerbis

Committee Members

Sarah-Jayne Dodd

Daniel Gardner

Subject Categories

Social Work


Women, Prescription Opioids, Initiation, Substance Use, Heroin, Staten Island


The most recent opioid epidemic in United States history emerged in the late 1980s and continues its destructive impact to this day. It has evolved into a devastating public health crisis with a broad range of medical, social, and economic consequences. This dissertation focuses on the “first wave” of this opioid epidemic characterized largely by the misuse of prescription opioids. The research questions here were focused on developing a greater understanding of the social processes involved in young women’s initiation of prescription opioid misuse (POM) during this first wave. The research methodology consisted of a cross-sectional, exploratory study using qualitative data collection and analytic methods in the grounded theory tradition. An ecosystems perspective was used in the categorization of findings at the individual, interpersonal, and community levels, and a description of the POM initiation trajectory experienced by participants is described. A grounded theory that emerged from these findings is presented, as are key themes that include the importance of an initiation trajectory as a concept replacing the term initiation; the impact of female gender on this particular initiation trajectory; the lack of evidence-based information about addiction across the prevention, treatment, and recovery landscape; key differences between POM and other substance misuse trajectories; the contribution of stigma as a barrier to accessing support for substance misuse; and an examination of the connections between boredom, lack of meaning and substance misuse outcomes. Study findings point to a set of recommendations for interventions at the individual, interpersonal, and community levels that can inform practice, policy, and research moving forward.

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