Showing papers in "American Journal of Drug and Alcohol Abuse in 1990"
TL;DR: A procedure for systematically evaluating and treating adolescents with known or suspected substance abuse with the opportunity to comprehensively characterize the adolescent's problems and to quantitatively monitor treatment progress and outcome is described.
Abstract: A procedure for systematically evaluating and treating adolescents with known or suspected substance abuse is described. Integrating assessment with intervention affords the opportunity to comprehensively characterize the adolescent's problems and to quantitatively monitor treatment progress and outcome.
283 citations
TL;DR: Data suggest that single-parent and intact families may not be skilled at resolving issues and coping with life's difficulties whether or not they are drug-related, and showed that aversive affective behavior was more likely to be displayed by substance-using adolescents,Whether or not the issue was drug- related.
Abstract: This study reports on the social problem-solving interactions of young adolescents in single-parent and intact families on substance-specific and nonsubstance-related issues. Although research has shown die impact of families on adolescent substance use, all of die previous results have been based on questionnaire or interview data. A sample of 128 families was selected from a larger sample of 763 within a longitudinal study of adolescent substance use. Parent(s) and one adolescent, aged 11–15, participated in interactions which were videotaped for later coding. In three standard scenarios, the families discussed fictional assignments from a health class teacher about the use of cigarettes, alcohol, and marijuana. In addition, they discussed an issue salient to diem that was the source of recent conflict. Results showed that aversive affective behavior was more likely to be displayed by substance-using adolescents, whether or not die issue was drug-related. Mothers' and fathers' alcohol use was also shown...
136 citations
TL;DR: This paper touches upon several important issues in the current understanding of alcohol and other drug use and abuse by women, including societal attitudes as both protective and destructive forces.
Abstract: This paper touches upon several important issues in our current understanding of alcohol and other drug use and abuse by women. Societal attitudes as both protective and destructive forces are discussed. Recent findings relating to physiology and psychopathology are also discussed in relation to casefinding and treatment. Finally, a number of current prevention and policy considerations are mentioned.
133 citations
TL;DR: Differences among three racial groups in exposure to three risk factors for drug use (availability of drugs, acceptability of drug use, and peer alcohol use), and the relationship of these factors to drug use initiation in a sample of preadolescent urban youths are examined.
Abstract: This paper examines differences among three racial groups in exposure to three risk factors for drug use (availability of drugs, acceptability of drug use, and peer alcohol use), and the relationship of these factors to drug use initiation in a sample of preadolescent urban youths. Tobacco and alcohol initiation rates were highest among Whites, lower among Blacks, and lowest among Asian-Americans. Paralleling these differences, White youths reported the greatest access to marijuana, greatest parental tolerance of substance use, and greatest intentions to use drugs as adults. Blacks somewhat less, and Asian-Americans the least. No racial differences appear in the proportion who reported that their peers used alcohol. Marijuana availability and peer use predicted substance initiation for all three racial groups. However, intentions to use substances as an adult and perceived parental tolerance of substance use predicted drug use only for White and Asian-American youths, while the expectation of punishment for drug use predicted lower drug use only among Black youths. Implications for prevention are discussed.
124 citations
TL;DR: Test the effectiveness of attrition prevention procedures at the time of the client's first phone contact with the clinic, and how mental health professionals can find cost effective interventions that prevent drug abuse treatment dropout is discussed.
Abstract: The problem of early attrition from treatment is pervasive throughout community mental health and is particularly high for substance-abusing clients. In spite of the severity of this problem and the potential for successful interventions, there have not been many studies that attempt to reduce the dropout rate of drug abusers. The purpose of this research was to test the effectiveness of attrition prevention procedures at the time of the client's first phone contact with the clinic. Callers were either given an appointment or told to come to the clinic the same day. A second variable was the presence or absence of an experimenter-initiated dialogue designed to help subjects predict possible obstacles to attendance and to generate potential solutions to those barriers. Subjects in the same day conditions showed at a higher rate than those given appointments, but the addition of the dialogue had no effect on client behavior. The results are discussed in terms of how mental health professionals can find cost effective interventions that prevent drug abuse treatment dropout.
94 citations
TL;DR: A particularly large addiction vs nonaddiction disparity in crime rates for Hispanic addicts revealing a low propensity for crime when not addicted suggests that crime reduction may be a reasonable objective in the treatment of these individuals.
Abstract: The present study, involving 132 narcotic addicts with multiple periods of addiction, examines trends in criminal activity and drug use over successive periods of addiction and successive periods o...
88 citations
TL;DR: It is concluded that chronic use of alcohol by mental patients undergoing pharmacotherapy with neuroleptics enhances the vulnerability of these patients to tardive dyskinesia.
Abstract: The authors report on the incidence of tardive dyskinesia (TD) in a sample of 284 psychiatric patients who chronically abused street drugs; 82.4% had received neuroleptic treatment for the length of their illness (10.5 +/- 5.8 years). The incidence of TD was 15.9%. The incidence of TD was significantly higher in groups of patients in which alcohol alone (25.4%) or in combination with cannabis (26.7%) was the drug of abuse than in those groups in which alcohol was either absent or used in combination with sedatives, opioids, or stimulants. Tardive dyskinesia was absent in patients not treated with neuroleptics and in a control group of drug abusers free of mental disorders. The anatomical distribution was similar to that reported in other psychiatric samples. Mean severity was mild and incapacitation and distress were minimal. Polydrug abuse was dominant in both patients and controls, and alcohol abuse was more frequent among TD patients. It is concluded that chronic use of alcohol by mental patients undergoing pharmacotherapy with neuroleptics enhances the vulnerability of these patients to TD.
63 citations
TL;DR: Infants exposed to PCP in utero, like those exposed to cocaine, had a high incidence of intrauterine growth retardation and were more likely to have meconium-stained amniotic fluid and less likely to be born prematurely as cocaine-exposed infants.
Abstract: Phencyclidine (PCP) remains a widely used illicit drug, especially among adolescents and young adults. The pharmacologic effects of PCP are similar to those of cocaine; therefore, in this retrospective study 37 PCP-intoxicated parturients were matched for ethnicity, tobacco use, age, gravidity, and degree of prenatal care with 37 cocaine-intoxicated parturients. Infants exposed to PCP in utero like those exposed to cocaine, had a high incidence of intrauterine growth retardation (32 vs 19%, N.S.), precipitate labor (43 vs 27%, N.S.), symptoms of neonatal drug withdrawal/intoxication, and prolonged neonatal hospitalizations. Moreover, they were more likely to have meconium-stained amniotic fluid (30 vs 19%, p =. 05) and less likely to be born prematurely as cocaine-exposed infants. The comparison between the long-term developmental outcome of these groups awaits further study.
40 citations
TL;DR: The AIDS epidemic has forced investigators to turn their attention to the histories of high risk sexual behaviors and drug-using patterns among their respondents, but mainly studies have been initiated on needle-sharing, homosexual, and other high risk samples, which limits the generalizability of such findings.
Abstract: IntroductionThe proportion of reported AIDS cases is currently low among heterosexuals without any reported risk factors. Further spread of HIV into this population will certainly depend on their sexual contact with drug users [1-4]. The AIDS epidemic has forced investigators to turn their attention to the histories of high risk sexual behaviors and drug-using patterns among their respondents. Primarily studies have been initiated on needle-sharing, homosexual, and other high risk samples, which limits the generalizability of such findings.
39 citations
TL;DR: Seizures occurred 1) as acute provoked convulsions in patients known to have epilepsy, 2) spontaneously in otherwise normal individuals after acute snorting or "crack smoking," and 3) agonally with massive ingestion.
Abstract: Cocaine abuse is associated with a variety of severe acute neurologic complications. These include ischemic stroke, subarachnoid and intraparenchymal hemorrhage, syncope, seizures, and death. Eleven adult patients with cocaine-related seizures are reported. All were seen during the 1987 calendar year at the King/Drew Medical Center and Urban Comprehensive Epilepsy Program of Los Angeles. Three apparent clinical circumstances with defined methods of intake and time course after usage were identified in our cases. Seizures occurred 1) as acute provoked convulsions in patients known to have epilepsy, 2) spontaneously in otherwise normal individuals after acute snorting or "crack smoking," and 3) agonally with massive ingestion.
37 citations
TL;DR: Males, in the main, engaged in more dangerous driving and risk taking in simulated driving conditions than females and drove increasingly faster and made more mistakes than subjects in the against drinking driving condition when under the influence of alcohol.
Abstract: This study presents an investigation of the effects of peer attitude, gender, and blood alcohol level on driving performance using a driving simulator. The subjects were 18 male and 18 female social drinkers from the general population, aged 18-25, and holding a current drivers' licence. Subjects were randomly assigned to pro or against drinking driving conditions and tested at different blood alcohol levels. The results revealed that subjects in the for drinking driving condition perceived themselves to be more capable than they actually were and drove increasingly faster and made more mistakes than subjects in the against drinking driving condition when under the influence of alcohol. Significant sex differences were observed only for performance on the driving simulator. Males, in the main, engaged in more dangerous driving and risk taking in simulated driving conditions than females.
TL;DR: Although the underlying mechanism cannot be determined from these plasma studies, possible reduced hydroxylation of DMI in methadone patients suggests the need for DMI plasma monitoring.
Abstract: Plasma concentrations of desipramine (DMI) and its 2-hydroxy metabolite (OHDMI) were compared among 72 patients being treated with desipramine for either depression (n = 39) or cocaine abuse (n = 33). Eleven cocaine abusers who were concurrently maintained on methadone had a significantly lower ratio of DMI dose to plasma concentration (0.9) than the depressives (2.2) or nonmethadone cocaine abusers (2.0). Their OHDMI/DMI ratios were significantly lower (0.19) than for either the other 22 cocaine abusers (0.39) or the depressed (0.50) patients. This difference was not due to DMI dosage. Although the underlying mechanism cannot be determined from these plasma studies, possible reduced hydroxylation of DMI in methadone patients suggests the need for DMI plasma monitoring.
TL;DR: A dramatic continuous increase in PCP abuse from 1984 through 1986 was demonstrated by drug abuse indicator data: treatment admissions, emergency room episodes, police exhibits, and driving under the influence of PCP arrests.
Abstract: A survey of 104 deaths involving phencyclidine (PCP) occurring from 1981 through 1986 in metropolitan St. Louis, Missouri, is presented. Four black males (22-33 yr) died from fatal PCP intoxication. PCP was detected in an additional 100 deaths: 81 homicides, 13 suicides, and 6 accidental deaths. Seventy-five of these deaths were homicides of Black males (mean age 27 years) typically dying from gunshot wounds, 64 cases. In 50% of deaths where PCP was detected, other drugs were co-administered: ethanol (35%) and cocaine (20%) being the most common mixtures. A dramatic continuous increase in PCP abuse from 1984 through 1986 was demonstrated by drug abuse indicator data: treatment admissions, emergency room episodes, police exhibits, and driving under the influence of PCP arrests. Increased abuse of PCP in St. Louis has been associated with increased medical emergencies and violence against persons.
TL;DR: A significant lack of parental awareness of teen drinking and a denial of their own teen's involvement in it is indicated.
Abstract: A random telephone survey was conducted in a suburban community in the Washington, D.C. metropolitan area to assess the perceptions of parents about teenage drinking and driving. A total of 807 completed interviews were conducted. The results indicated that while most parents viewed teen drinking (69%) and drinking and driving (65%) to be a prevalent, relatively few seem to be engaging in behaviors likely to influence this. Thirty-two percent said they never discuss drinking and driving with their children, and over 65% said they never talk to other parents about how to talk to their children about drinking and driving, nor have any interest in doing so. Although slightly more than half said they had family policies concerning drinking, less than 20% said there were penalties for violating these policies. Over 70% expressed their willingness to watch a special show on TV about how parents can talk to their children about alcohol. Parents of teenagers appear to be far more likely to think that their teen's friends drink and drive (36%) than they are to think that their teen drinks and drives (10%). The results of this survey indicate a significant lack of parental awareness of teen drinking and a denial of their own teen's involvement in it.
TL;DR: It is demonstrated that the amino acids, L-tryptophan and L-tyrosine, do not significantly reduce most symptoms of cocaine craving and withdrawal when used alone.
Abstract: In a six-month double-blind study in an inpatient chemical dependency facility, 29 cocaine-dependent subjects were studied to determine if the amino acids, L-tryptophan and L-tyrosine, would decrease cocaine craving and withdrawal symptoms. Those subjects receiving placebo were shown to have a statistically significant increase in only one physical symptom category. The drug craving and other major physical and subjective symptoms were not shown to be significant. This study is consistent with a literature review in demonstrating that the amino acids do not significantly reduce most symptoms of cocaine craving and withdrawal when used alone.
TL;DR: The effectiveness of drug testing in identifying and preventing drug use was assessed by a study of intercollegiate athletes required to participate in a urine testing program, showing that some drug-using athletes avoided detection.
Abstract: The effectiveness of drug testing in identifying and preventing drug use was assessed by a study of intercollegiate athletes required to participate in a urine testing program. Five hundred athletes who underwent testing were contrasted with a comparison group of 124 athletes not tested. Results show that some drug-using athletes avoided detection. Although many reduced their drug usage, some continued in the same pattern as before; a few actually increased drug usage.
TL;DR: It is suggested that an increased awareness of substance use history, by the use of a standardized questionnaire, is an effective means of increasing the diagnostic yield of substance-induced disorders in the psychiatric emergency room.
Abstract: The tendency of emergency psychiatrists to make alcohol- and drug-related diagnoses was examined before and after the addition of a standardized psychoactive substance use questionnaire. The addition of the questionnaire resulted in a significant increase in the number of psychoactive-substance-induced organic mental disorder (substance-induced disorder) diagnoses. The questionnaire selectively increased the recognition of nonalcoholic substance-induced disorders while not significantly increasing the diagnoses of alcohol-induced disorders when alcohol was used alone. This suggests that nonalcoholic substance-induced disorders are underdiagnosed in emergency psychiatry. With the increase in the diagnoses of substance-induced disorders, there was a significant decrease in the frequency of psychotic disorder diagnoses and a significant increase in the frequency of adjustment disorder diagnoses. The clinical impact of underdiagnosing and misdiagnosing substance-induced disorders is discussed. Overall, the findings suggest that an increased awareness of substance use history, by the use of a standardized questionnaire, is an effective means of increasing the diagnostic yield of substance-induced disorders in the psychiatric emergency room. Follow-up studies using urine drug screening are recommended.
TL;DR: Patients who came to the clinic via coerced referral from a public assistance agency were as likely to remain in treatment for at least nine sessions as self-referred patients.
Abstract: In order to ascertain the relative impact of coercion by a welfare program on retention in an ambulatory alcoholism program, records of 178 consecutive admissions to an inner-city alcoholism clinic were reviewed. Patients who came to the clinic via coerced referral from a public assistance agency were as likely to remain in treatment for at least nine sessions as self-referred patients.
TL;DR: The frequency of inpatient hospital care for three years before and three years after alcoholism treatment was evaluated for a group of 255 patients of predominantly lower socioeconomic status treated for alcoholism at a rural midwestern medical center in 1983.
Abstract: The frequency of inpatient hospital care for three years before and three years after alcoholism treatment was evaluated for a group of 255 patients of predominantly lower socioeconomic status treated for alcoholism at a rural midwestern medical center in 1983. Subjects were interviewed while in treatment to obtain information regarding alcoholism history and demographics. Hospital care was ascertained from an electronic data file of discharges from 172 acute care hospitals throughout the United States and Puerto Rico. One-third of the sample was never hospitalized for an alcohol-related condition in the years prior to or after alcoholism treatment, and 23% of the sample experienced no hospitalizations at all other than the treatment episode when interviewed. The majority of hospital stays before and after treatment were attributed to alcohol abuse. The frequency and total hospital length of stay for alcohol-related admissions increased yearly before treatment, peaked in the year after treatment, and then...
TL;DR: The author underscores the importance of understanding the three most common epidemiological methods, each of which has different histories, advantages, liabilities, inherent value sets, and disparate-but-overlapping purposes.
Abstract: Epidemiological research on psychoactive substance use disorders can and sometimes does lead to conclusions that are mutually conflicting. A current example is the apparent drop in substance use among adolescents in schools, with continuing high levels of substance-associated adolescent suicide, hospitalization, and crime. In an effort to clarify such differences, the author underscores the importance of understanding the three most common epidemiological methods. Each has different histories, advantages, liabilities, inherent value sets, and disparate-but-overlapping purposes.
TL;DR: A surprisingly high number of patients who had received disulfiram drank ethanol while taking or within 1 week of stopping disulforam and experienced a disulfIRam ethanol reaction.
Abstract: We studied 345 alcoholic inpatients utilizing a 43-item questionnaire designed to assess these patients' attitudes toward and experiences with disulfiram. A surprisingly high number of patients who had received disulfiram drank ethanol while taking or within 1 week of stopping disulfiram and experienced a disulfiram ethanol reaction. This finding and others derived from the questionnaire are reported, and the potential implications of the findings are discussed.
TL;DR: In a subpopulation of alcoholics, pharmacotherapy for panic may be indicated and not lead to anxiolytic abuse, and three patients with alcoholism in whom diagnosis of panic was facilitated by intravenous lactate infusion, and whose symptoms were alleviated by clonazepam.
Abstract: It has been postulated that many alcoholics use alcohol to "self-mediate" symptoms of anxiety or panic. Early diagnosis and treatment in this population are both complicated by symptoms of alcohol withdrawal and controversial because of the belief that alcoholics will abuse anxiolytics. The authors present three patients with alcoholism in whom diagnosis of panic was facilitated by intravenous lactate infusion, and whose symptoms were alleviated by clonazepam. All three patients were able to maintain sobriety during treatment. The authors conclude that in a subpopulation of alcoholics, pharmacotherapy for panic may be indicated and not lead to anxiolytic abuse.
TL;DR: Findings suggest that judges may perceive of and sentence repeat offenders differently than first-time offenders, regardless of the level of intoxication at arrest.
Abstract: This study examined the impact of 1) a DUI offender's blood alcohol level at the time of arrest and 2) the number of prior drunken driving convictions on judges' sentencing patterns. These variables were manipulated using vignettes that were presented to all judges who sentence drunken drivers in Colorado. Judges were asked to determine appropriate amounts of jail time, fines, public service hours, and alcohol education course work. Results indicated that they gave more severe sentences to offenders with prior records and to those with higher blood alcohol levels. The effects were generally stronger for the first variable, prior record. These findings suggest that judges may perceive of and sentence repeat offenders differently than first-time offenders, regardless of the level of intoxication at arrest.
TL;DR: Overall, elements of the bond explain less variance in amphetamines than in cigarettes, alcohol, and marijuana, and combining drug progression with social bonding theory substantially increases the explained variance of Amphetamines.
Abstract: Social bonding theory explains less serious drug use better than use of hard drugs. The difference in prediction may be due to the omission of intervening variables between the bond and serious drug use, such as experience with minor drugs. In this study the impact of the social bond on amphetamine use is examined among a national sample of high school senior women. Included in the model is the notion of drug progression, in which individuals first use minor drugs and progress to illicit drugs. To ascertain whether the bond is mediated through use of less serious drugs, cigarettes, alcohol, and marijuana are utilized in the analysis. Among the bonding variables, religious commitment has the only significant direct effect on amphetamines. Overall, elements of the bond explain less variance in amphetamines than in cigarettes, alcohol, and marijuana. Combining drug progression with social bonding theory substantially increases the explained variance of amphetamines.
TL;DR: This paper presents data on mortality by drug dependence among Puerto Rican residents aged 15-44 of New York City and investigates gender roles as they influence patterns of drug use and types of chronic use: regular and intermittent.
Abstract: This paper presents data on mortality by drug dependence among Puerto Rican residents aged 15-44 of New York City. While men show death rates for drug dependence several times those of women, when deaths by drug dependence are calculated as a proportion of all deaths, the ratios are nearly the same for both sexes. Factors relevant to analyzing mortality statistics on drug dependence in this population are an undercount of Puerto Rican males and competing causes of death, particularly homicide among men. Factors influencing deaths by drugs are gender roles as they influence patterns of drug use and types of chronic use: regular and intermittent.