Background
This study aims to review the literature regarding the barriers to sampling, recruitment, participation, and retention of members of socioeconomically disadvantaged groups in health research and strategies for increasing the amount of health research conducted with socially disadvantaged groups.

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Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups

The study of craving and lapse during attempts to quit smoking has been quietly revolutionized by the use of handheld data-collection devices that enable study participants to report, in real time, their activities and moods in their daily environments1. This methodology is referred to as experience sampling2 or Ecological Momentary Assessment (EMA)3. A PDA (Personal Digital Assistant or PalmPilot) configured for use in EMA is referred to as an Electronic Diary (ED). EMA comprises two complementary types of data collection. The first type occurs through random prompts, enabling assessment of the base rates of exposure to putative craving/lapse triggers such as stressors and drug-associated cues4. The second type of data collection is participant-initiated; participants are typically instructed to initiate an EMA entry immediately after each episode of craving or use. These event-driven data provide near-real-time self-report of such episodes.

EMA data collected through random prompts enable a truly prospective approach to the question of what events preceded a specific episode of use. For example, Shiffman and Waters5 use such data to show that lapses to cigarette smoking were preceded by increases in negative affect over a time course of hours, but not days—in other words, over a time frame that could not have been captured if participants had merely made daily visits to a laboratory for assessment.

EMA studies of illicit-drug use are far more rare. For example, to determine whether stress predicts relapse to cocaine or heroin use, there is only a small body of non-EMA prospective studies whose time frames were not sensitive to episodes of acute stress. The general finding from such studies has been that prospective measures of stress can predict relapse only when aggregated over time frames of three to twelve months, not week by week6–8. The effects of more rapid increases in stress cannot be determined without EMA data. The near-absence of EMA studies presumably reflects reluctance to entrust handheld electronic devices to individuals from the relevant populations, along with concern that meaningful real-time reports cannot be collected during use of intoxicating drugs. However, some studies have shown that EMA is possible in users of illicit drugs, providing new insights into the natural history of Ecstasy use9 and demonstrating that cannabis smokers10 and homeless users of crack cocaine11 will use and return cellphones issued for EMA recording. Larger datasets would help to resolve longstanding theoretical questions about the precipitants and process of drug craving and use, and may also lead to better outcome measurement in clinical trials12 and even to new forms of tailored, on-the-spot treatment interventions (see Comment).

In this study, we used EMA to monitor craving for, and use of, cocaine and heroin in a large sample of methadone-maintained outpatients. (Methadone maintenance, though highly effective, does not entirely eliminate heroin use in all patients.) Here we present data on the time course of mood and cue exposure in the hours before self-reported episodes of craving and drug use.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/482933/yoa80074_88_94.pdf

Real-time electronic-diary reports of cue exposure and mood in the hours before cocaine and heroin craving and use

This article reports outcomes from a program of experimental research evaluating the risk principle in drug courts. Prior studies revealed that participants who were high risk and had (a) antisocial personality disorder or (b) a prior history of drug abuse treatment performed better in drug court when scheduled to attend biweekly judicial status hearings in court. In contrast, participants who were low risk performed equivalently regardless of the court hearings schedule. This study prospectively matches drug court clients to the optimal schedule of court hearings based on an assessment of their risk status and compares outcomes to clients randomly assigned to the standard hearings schedule. Results confirmed that participants who were high risk and matched to biweekly hearings had better during-treatment outcomes than participants assigned to status hearings as usual. These findings provide confirmation of the risk principle in drug courts and yield practical information for enhancing the efficacy and cost-efficiency of drug courts.

/pdf/matching-judicial-supervision-to-clients-risk-status-in-drug-1tv26yb698.pdf

Matching Judicial Supervision to Clients’ Risk Status in Drug Court

Contingency management (CM) based interventions that reinforce adherence to prescribed medications have shown promise in a variety of disadvantaged populations. Fifty-six participants with histories of illicit substance use who were prescribed antiretroviral medication but evidenced suboptimal adherence during a baseline assessment were randomly assigned to 16 weeks of weekly CM-based counseling or supportive counseling, followed by 16 additional weeks of data collection and adherence feedback to providers. The CM intervention involved review of data generated by electronic pill-bottle caps that record bottle opening (MEMS) and brief substance abuse counseling. CM participants were reinforced for MEMS-measured adherence with drawings from a bowl for prizes and bonus drawings for consecutive weeks of perfect adherence. Potential total earnings averaged $800. Mean MEMS-measured adherence to the reinforced medication increased from 61% at baseline to 76% during the 16-week treatment phase and was significant...

Improved Adherence with Contingency Management

Background“Legal highs” are becoming increasingly common features of the recreational drug market. The Internet has emerged as an important resource for technical and pharmacological knowledge in the absence of evidence-based literature, and for identifying emerging trends. Self-established drug-related Internet forums have emerged as particularly useful sources of information.AimsIt was the aim of this study to explore the key features of drug-related Internet forums and the drug forum communities.MethodsWithin the framework of the larger Psychonaut Web Mapping project, eight English-language drug forums were assessed, and key features, categories, themes and attributions were identified.ResultsThe results are reported taking into account ethical issues, such as anonymity and confidentiality, associated with research in online communities.ConclusionsThis study identified strong, unified and unique communities of recreational drug users that can provide an insight into the growing market in new drugs and ...

e-Psychonauts: Conducting research in online drug forum communities

Do research payments precipitate drug use or coerce participation

According to perceived-deterrence theory, the likelihood that an offender will engage in drug use or illegal activity is influenced by the perceived certainty of being detected for infractions or recognized for accomplishments, the perceived certainty of receiving sanctions for infractions or rewards for accomplishments, and the anticipated magnitude of the sanctions and rewards. This study evaluated drug court participants' perceived deterrence at monthly intervals during their enrollment in drug court. Exploratory cluster analysis (N=255) on the longitudinal scores yielded five subtypes of drug offenders characterized either by consistently elevated perceived-deterrence scores, consistently moderate scores, consistently low scores, increasing scores, or decreasing scores. The best outcomes were associated with consistently elevated scores, whereas the worst outcomes were associated with scores that declined over time as the participants became accustomed to the program. The clusters also differed in predicted directions on demographic variables. The correlational design does not permit inferences of causality; however, the results lend credence to perceived deterrence as a potential explanatory mechanism for the effects of drug courts.

Perceived deterrence and outcomes in drug court.

Internet access to Salvia divinorum: Implications for policy, prevention, and treatment

THE “WAR ON DRUGS” that began in the 1980s contributed to an unprecedented expansion in the U.S. inmate population. Prison and jail admissions more than tripled in the ensuing years (Harrison & Karberg, 2003), with drug violations accounting for approximately 60 percent of the increase in the federal inmate population and one-third of the increase in the state inmate population (Belenko & Peugh, 1998; Harrison & Beck, 2002). As of 2001, drug offenders comprised more than half (57 percent) of federal prison inmates and over 20 percent of state prison inmates in this country (Harrison & Beck, 2002).

Amenability to Treatment of Drug Offenders

This study evaluated the degree to which anabolic-androgenic steroids are proffered for sale over the Internet and how they are characterized on popular Web sites. Searches for specific steroid product labels (e.g., Dianabol) between March 2006 and June 2006 revealed that approximately half of the Web sites advocated their "safe" use, and roughly one third offered to sell them without prescriptions. The Web sites frequently presented misinformation about steroids and minimized their dangers. Less than 5% of the Web sites presented accurate health risk information about steroids or provided information to abusers seeking to discontinue their steroid use. Implications for education, prevention, treatment, and policy are discussed.

Nicholas S. Patapis

Papers

Do research payments precipitate drug use or coerce participation

Perceived deterrence and outcomes in drug court.

Internet access to Salvia divinorum: Implications for policy, prevention, and treatment

Amenability to Treatment of Drug Offenders

Nonprescription steroids on the Internet.