Showing papers in "American Journal of Drug and Alcohol Abuse in 1999"
TL;DR: It is suggested that weekly or more frequent 12-step participation is associated with drug and alcohol abstinence, and the wisdom of a general policy that recommends weekly orMore frequent participation in a 12- step program as a useful and inexpensive aftercare resource for many clients is pointed to.
Abstract: Although participation in 12-step programs is now widely utilized as a treatment aftercare resource by individuals with drug and alcohol problems, little is known about the effectiveness of such a ...
228 citations
TL;DR: Gender differences in the factors associated with having a history of drug treatment were examined among 7,652 individuals admitted into the Drug Abuse Treatment Outcome Study, suggesting that different strategies for increasing treatment utilization may be appropriate for men and women.
Abstract: Gender differences in the factors associated with having a history of drug treatment were examined among 7,652 individuals admitted into the Drug Abuse Treatment Outcome Study (DATOS), a national m...
214 citations
TL;DR: It is found that male OTIDUs with a history of methamphetamine use had more sex partners and participated in more acts of anal insertive intercourse with casual partners and vaginal intercourse with regular and casual partners than male OTIDs never using methamphetamine.
Abstract: Our primary objective was to examine the relationship between methamphetamine use and sexual risk-taking behaviors—number of sexual partners, frequency of sexual behaviors with regular and casual partners, trading money or drugs for sex, and condom use—among male and female out-of-treatment injection drug users (OTIDUs). As a risk group for human immunodeficiency virus (HIV) transmission, we also investigated injection behaviors by methamphetamine use. Data were collected from 1392 OTIDUs within the California counties of Fresno, Sacramento, and San Diego. Excluded from this cross-sectional survey were male OTIDUs engaging in sex with only or mostly men since 1978. In bivariate analyses, we found that male OTIDUs with a history of methamphetamine use had more sex partners and participated in more acts of anal insertive intercourse with casual partners and vaginal intercourse with regular and casual partners than male OTIDUs never using methamphetamines. In addition, a greater percentage of male OTIDUs usi...
158 citations
TL;DR: Findings suggest that more effective stress management strategies may need to be implemented for military men to reduce the link between stress and heavy alcohol use, illicit drug use, and smoking.
Abstract: This paper examines the relationship between perceived stress (at work, in family or personal life, and from being a woman in the military) and substance use (heavy drinking, illicit drug use, cigarette smoking) among active-duty military women and men. Data were drawn from over 16,000 respondents to the 1995 Department of Defense Survey of Health Related Behaviors Among Military Personnel. Findings indicated substantial substance use and perceived high stress in the armed forces. Further, the relation between substance use and stress varied by gender. Military women reported substantially lower rates of heavy drinking than men, but had similar rates of illicit drug use and cigarette smoking. Both military women and men were more likely to describe their military duties as more stressful than their family or personal lives; for women, the stress associated with being a woman in the military was second to stress at work. Stress at work or in the family was an important predictor of substance use among military men, but not among military women. For military women, stress associated with being a woman in the military was predictive of illicit drug use and cigarette use. These findings suggest that more effective stress management strategies may need to be implemented for military men to reduce the link between stress and heavy alcohol use, illicit drug use, and smoking.
157 citations
TL;DR: It is indicated that ADHD is prevalent in treatment-seeking substance users without difference in prevalence or subtype by drug choice.
Abstract: While there has been much recent interest in the relationship between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs), little has been reported about ADHD diagnostic subtypes, persistence of symptoms from childhood into adulthood, and substance of choice in individuals with substance use disorders (SUD+) and comorbid ADHD. To examine the prevalence and subtypes of ADHD in a group of SUD+ individuals, 136 inpatients with an SUD diagnosis (cocaine vs. alcohol vs. cocaine/alcohol) were administered a structured interview for ADHD. Of the SUD+ individuals, 32% met criteria for ADHD, and 35% of those with a childhood diagnosis of ADHD continued to have clinically significant symptoms into adulthood. There were no significant differences in the percentage of ADHD between the SUD+ groups divided by drug choice. Of ADHD subtypes, subjects with combined and inattentive types were significantly more likely to have symptoms continue into adulthood (p < or = .05) than the hyperactive/impulsive subtype. Patients with cocaine use were more likely to have ADHD in childhood only when compared to the alcohol or cocaine-alcohol groups. The findings of this study indicate that ADHD is prevalent in treatment-seeking substance users without difference in prevalence or subtype by drug choice.
135 citations
TL;DR: The findings suggest that the prevalence of all five childhood traumas was higher than what has been reported in the general population, and that physical neglect of individuals may predict lack of current significant relationships.
Abstract: The purpose of this study was to estimate the prevalence of positive trauma histories in a community sample of intravenous drug using (IVDU) women for five subsets of childhood trauma (emotional ab...
112 citations
TL;DR: The data from this study suggest that network members have potential for social influence on the cessation of drug use and are associated with a lower proportion of personal network members in one's drug network.
Abstract: Few studies have examined recovery from opiate and cocaine dependence without treatment, referred to as "natural recovery," "spontaneous recovery," and "spontaneous remission." The present study examined the relationship between network characteristics and cessation of heroin, cocaine, and crack use in a sample of underclass inner-city injection drug users in Baltimore, Maryland. Participants were enrolled in an experimental human immunodeficiency virus (HIV) preventive intervention. Between the baseline and follow-up interviews, which averaged 5.2 months, 24 (7%) of 335 participants reported ceasing to use heroin, cocaine, and crack. Individuals who had reported cessation of drug use at follow-up had reported at baseline a smaller proportion of their network members with whom they used drugs (p < .02). Using multiple logistic regression analyses and adjusting for baseline drug use, enrollment in drug treatment, and demographic and background variables, cessation of drug use was associated with a lower proportion of personal network members in one's drug network (odds ratio [OR] = 25.4, p < .05). The data from this study suggest that network members have potential for social influence on the cessation of drug use.
112 citations
TL;DR: PTSD and physical assault were assessed in a sample of 91 adults seeking treatment for cocaine dependence, finding women were more likely than men to be physically assaulted by an intimate partner and to report PTSD.
Abstract: Intimate physical assault and post-traumatic stress disorder (PTSD) were assessed in a sample of 91 adults seeking treatment for cocaine dependence. Physical assault included self-report of aggravated assault with a weapon, aggravated assault without a weapon, and simple assault. PTSD was assessed with a structured interview. Overall, 85.7% of the participants reported having been physically assaulted at least once during their lifetime. Slightly less than half of these individuals (46.2%) reported physical assault by an intimate partner. Close to half also met criteria for PTSD at some point in their lives. Women were more likely than men to be physically assaulted by an intimate partner and to report PTSD. Men who experienced physical assault by an intimate were more likely to report PTSD than men assaulted by others. Male victims of intimate violence had higher scores on certain subscales measuring addiction severity than male victims assaulted by others. Findings suggest careful assessment of intimate violence is essential given its high prevalence among cocaine-dependent women and men and its association with PTSD.
93 citations
TL;DR: It is suggested that efforts to promote risk reduction among methamphetamine users be stepped up because this population has been underserved and because less-sweeping behavior changes are needed to reduce needle-related risks to acceptable levels.
Abstract: Drug injection and other practices affecting the risk of human immunodeficiency virus (HIV) infection were studied among 154 heroin users and 45 methamphetamine users in San Antonio, Texas. Amphetamine users were younger, mostly white, and had less-severe drug dependence. Heroin users had significantly higher levels of needle risk, as indicated by frequency of injection, number of persons sharing equipment, and place of injection. Methamphetamine users tended to buy syringes in lots of 10 or more from pharmacies and to use a syringe less than 5 times before discarding it. Heroin users tended to buy 1 needle at a time from an illicit source and to use it more than 20 times. Of methamphetamine users, 71% had more than one sex partner, compared to 39% of heroin users. Partners of methamphetamine users were more likely to be drug injectors than were partners of heroin users. Fewer methamphetamine users reported a behavior change in response to the acquired immunodeficiency syndrome (AIDS) epidemic, and fewer had been contacted by AIDS Education/Outreach. We suggest that efforts to promote risk reduction among methamphetamine users be stepped up because this population has been underserved and because less-sweeping behavior changes are needed to reduce needle-related risks to acceptable levels.
92 citations
TL;DR: Examination of the validity of self-report of drug use in several important high-risk samples by comparing survey answers with urinalysis results showed that a lower degree of underreporting was associated with subjects at jail sites (compared to STD subjects) and those who self-reported lifetime drug dependence.
Abstract: This paper examines the validity of self-report of drug use in several important high-risk samples by comparing survey answers with urinalysis results. The analyses include data obtained from face-to-face interviews with 1536 patients in sexually transmitted disease (STD) clinics, 1564 patients in hospital emergency rooms (ERs), and 2034 recent arrestees in jails. Using urinalysis as the criterion measure, considerable underreporting was observed, particularly among STD and ER subjects using cocaine and opiates. A logistic regression analysis on factors related to the underreporting was conducted for both cocaine and opiates. The results showed that a lower degree of underreporting was associated with subjects at jail sites (compared to STD subjects) and those who self-reported lifetime drug dependence.
88 citations
TL;DR: A questionnaire survey of 285 consecutively recruited adolescents who were adjudicated to juvenile correctional facilities in Virginia was conducted using the Inhalant Use Questionnaire, finding that white youths and youths from other ethnic backgrounds are significantly more likely to report past inhalant use than black youths.
Abstract: A questionnaire survey of 285 consecutively recruited adolescents who were adjudicated to juvenile correctional facilities in Virginia was conducted using the Inhalant Use Questionnaire . White you...
TL;DR: A significant synergistic effect of depressive symptoms and drug network on needle sharing after cleaning with bleach and needle sharing without cleaning was observed and implications for preventing needle-sharing behavior by reducing depressive symptoms are discussed.
Abstract: In this study, we examined the relationship between depressive symptoms and needle-sharing behavior in a community sample of intravenous drug users (N = 499) in Baltimore, Maryland. Based on the polytomous logistic regression, higher depressive symptoms were positively associated both with needle sharing after cleaning with bleach and with needle sharing without first cleaning with bleach at the bivariate analyses. This relationship remained significant (OR = 1.66) even after adjusting for demographic characteristics, life events, drug use patterns, and social and drug networks. A significant synergistic effect of depressive symptoms and drug network on needle sharing after cleaning with bleach and needle sharing without cleaning was observed. More depressed intravenous drug users who also had a larger drug network were found to be at higher risk of needle sharing after cleaning with bleach, as well as needle sharing without cleaning (OR = 2.59). Depression status is discussed as a predisposing factor and drug network size as a precipitating factor for needle-sharing behavior. Implications for preventing needle-sharing behavior by reducing depressive symptoms are discussed.
TL;DR: The results showed that distress, self-esteem, psychotic thoughts, attempted suicide, alcohol problems, drug problems, dual substance problems, and dual disorders varied significantly among the eight clusters, suggesting the need for differential programming.
Abstract: Based on a cluster analysis of 211 street youths aged 13–24 years interviewed in 1992 in Toronto, Ontario, Canada, we describe the configuration of mental health and substance use outcomes. Eight clusters were suggested: Entrepreneurs (n = 19) were frequently involved in delinquent activity and were highly entrenched in the street lifestyle; Drifters (n = 35) had infrequent social contact, displayed lower than average family dysfunction, and were not highly entrenched in the street lifestyle; Partiers (n = 40) were distinguished by their recreational motivation for alcohol and drug use and their below average entrenchment in the street lifestyle; Retreatists (n = 32) were distinguished by their high coping motivation for substance use; Fringers (n = 48) were involved marginally in the street lifestyle and showed lower than average family dysfunction; Transcenders (n = 21), despite above average physical and sexual abuse, reported below average mental health or substance use problems; Vulnerables (n = 12) ...
TL;DR: Results from random effects regression analyses indicate that treatment practices concerning methadone dose levels, client influence in dose decisions, and treatment duration improved significantly between 1988 and 1995.
Abstract: Results from several studies conducted in the late 1980s and early 1990s showed that the majority of the nation's methadone treatment units did not use effective treatment practices. Since then, however, many efforts have been made to improve critical treatment practices. This paper examines the extent to which key methadone treatment practices (dose levels, treatment duration, client influence in dose decisions) changed from 1988 to 1995 in a panel sample of methadone maintenance units. We also examine factors that may account for variation in methadone treatment practices. We use panel data from a national random sample of 172 units in 1988 (82% response rate), 140 units in 1990 (87% response rate), and 116 units in 1995 (89% response rate). Unit directors and clinical supervisors provided phone survey data on clients influence on doses, upper limits on doses, average dose levels, unit emphasis on decreasing doses, time when clients are encouraged to detoxify, and average length of treatment. Results fr...
TL;DR: This paper presented background and pretreatment characteristics of adolescent substance abuse treatment clients, and provided a mechanism for describing perhaps the largest research sample of adolescents who were in drug treatment in this decade, including 3382 subjects who presented for treatment from 1993 to 1995 in 37 programs in Pittsburgh, Pennsylvania, Miami, Florida, Minneapolis, Minnesota, Chicago, Illinois, Portland, Maine, and New York City, New York.
Abstract: Objectives: The present study presents background and pretreatment characteristics of adolescent substance abuse treatment clients, and it provides a mechanism for describing perhaps the largest research sample of adolescents who were in drug treatment in this decade. Methods: The sample was 3382 subjects who presented for treatment from 1993 to 1995 in 37 programs in Pittsburgh, Pennsylvania; Miami, Florida; Minneapolis, Minnesota; Chicago, Illinois; Portland, Maine; and New York City, New York. Informed permission for the youth to participate was obtained from the subject's custodial parent/guardian, and both the youth and the youth's parents or guardians provided informed assent if they agreed to participate as subjects. Adolescents then were interviewed privately and confidentially by a trained professional interviewer who was independent of the treatment programs. The interviews queried subjects about their background, including education and employment; physical and mental health; use of tobacco, al...
TL;DR: Sexual risk factors differed across different types of drug use, with crack-smoking injectors being placed at greatest potential risk for exposure to heterosexually transmitted HIV, followed by injecting drug users, crack smokers, and then other drug users.
Abstract: The large concentration of female illicit drug users in state correctional facilities prompted an examination of the associations among different types of drug use and sexual risk factors related to human immunodeficiency virus (HIV) among women inmates. A consecutive sample of 805 women felons admitted to the North Carolina Correctional Institution for Women between July 1991 and November 1992 was interviewed. Of these inmates, 651 had complete information on relevant characteristics. Of the women inmates, 73% had used drugs prior to incarceration; most women were crack smokers only (33%), followed by non-drug users (27%), other drug users (19%), crack-smoking injecting drug users (15%), and injecting drug users only (6%). Inconsistent condom use with multiple sex partners, a history of a diagnosed sexually transmitted disease (STD), a drug-injecting sex partner, or exchanging sex for money or drugs prior to incarceration were reported by 55% of the women. Sexual risk factors differed across different types of drug users, with crack-smoking injectors being placed at greatest potential risk for exposure to heterosexually transmitted HIV, followed by injecting drug users, crack smokers, and then other drug users. Given the differential associations between sexual risk factors and types of drug use, prison-based sexual-risk reduction strategies should be tailored to specific types of drug users. In times of limited resources, special attention should be given to crack smokers and/or drug injectors.
TL;DR: Some support was found for all of the major elements of Ames and Janes' framework: normative regulation of drinking, quality and organization of work, workplace factors, and drinking subcultures.
Abstract: Ames and Janes provide a theoretical framework that explains alcohol and/or drug problems among workers. Existing studies of occupational risk factors for alcohol and drug problems across multiple occupations and industries provide mixed findings with respect to Ames and Janes' framework. In a preliminary study, the relationships between occupational characteristics and measures of alcohol and drug problems were investigated among a sample of workers from a variety of occupations and industry settings. Some support was found for all of the major elements of Ames and Janes' framework: normative regulation of drinking, quality and organization of work, workplace factors, and drinking subcultures.
TL;DR: Underage drinking was prevalent at all time points, and underage drinkers reported drinking in a range of on- and off-campus situations and drug use in combination with drinking was associated with more problematic patterns of drinking and more negative consequences.
Abstract: This study examined substance use patterns and consequences in college students over a three year period. Students were surveyed at a large, southwestern university, allowing for a diverse sample that included a large percentage of minority respondents. Students (total N = 2710) in 1994, 1995, and 1996 responded anonymously to the Core Survey of Alcohol and Drugs. Over 80% of students at each time point were current drinkers, and over one-third at each time period reported binge drinking. Binge drinking was associated with greater weekly drinking and with a range of negative consequences. Underage drinking was prevalent at all time points, and underage drinkers reported drinking in a range of on- and off-campus situations. Hispanic students reported higher rates of binge drinking than other ethnic groups. Nonwhite, non-Hispanic students reported greater rates of abstinence than other students. Although other drug use was much less prevalent, drug use in combination with drinking was associated with more problematic patterns of drinking and more negative consequences. Results are discussed in terms of implications for interventions with college students.
TL;DR: Clinically, the data in both studies suggest that both drug dependence and associated psychopathology should be assessed and treated in opiate addicts with young offspring, and the offspring should be monitored for the development of conduct and mood disorders and substance use.
Abstract: There are few systematic studies of the school-aged offspring of drug-dependent patients, although this information is useful for planning evidence-based prevention programs. We have completed such a study, which we compare to a similar study independently conducted in 1998. In both studies, both the parent and offspring were assessed blindly and independently by direct diagnostic interviews, and parental assessment of offspring was also obtained. The similarity in design and methods between studies provided an opportunity for replication by reanalysis of data. The major findings are a replication in two independently conducted studies of school-aged offspring of opiate- and/or cocaine-addicted mothers of the high rates of any psychiatric disorder (60% in both studies), major depression (20%, 26%), oppositional defiant disorder (ODD) (18%, 23%), conduct disorder (17%, 9%), attention-deficit/hyperactivity disorder (ADHD) (13%, 8%), and substance abuse (5%, 10%) among offspring. Both studies also found high...
TL;DR: Analysis of data from a consecutive sample of approximately 700 prenatal patients showed that violence victims were more likely than nonvictims to use cigarettes, alcohol, and illicit drugs, and victims of both physical and sexual violence were most likely to use each type of substance.
Abstract: Using data from a consecutive sample of approximately 700 prenatal patients aged 12 to 19, the extent of violence and substance use in the lives of these women was examined, as were associations between violence and substance use. The findings show that 29% of the study participants had been victims of violence, with 15% experiencing physical violence only, 5% sexual violence only, and 9% both physical and sexual violence. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) from logistic regression analyses showed that, after controlling for confounding factors, victims were more likely than nonvictims to use cigarettes, alcohol, and illicit drugs, with victims of both physical and sexual violence being the most likely to use each type of substance. Ordinal logistic regression analysis found that, compared to nonvictims, violence victims were more likely to have more severe patterns of substance use (use multiple types of substances), with victims of both physical and sexual violence being the m...
TL;DR: Why male partners of female drug users in treatment generally were resistant to active participation in family-oriented treatment is discussed: the men's active drug use, their desire to maintain the status quo in the relationship, possible focus on their own recovery, divergent views about treatment goals, and the desire to minimize stigma by association.
Abstract: Despite evidence for the importance of significant others in the recovery process, little is known about male partners of female substance abusers. This paper presents a qualitative exploratory study conducted to learn more about male partners of crack/cocaine-addicted women and specifically examines the men's influence on the treatment and recovery process of their female partners. Subjects were found to have an extensive history of substance abuse and some experience with treatment; three-quarters were active crack/cocaine users. Although their attitude toward women's substance abuse was negative and their opinion of treatment for women positive, men's behavioral support for their partners was usually passive and inconsistent. Reasons are discussed why male partners of female drug users in treatment generally were resistant to active participation in family-oriented treatment: the men's active drug use, their desire to maintain the status quo in the relationship, possible focus on their own recovery, di...
TL;DR: For children incarcerated in a juvenile detention facility in this community, inhalant abuse is associated with the later use of other substances of abuse, which underscores the need for effective preventive strategies.
Abstract: Aims: To examine the relationship between inhalant abuse and other substances of abuse. Design: Survey using a structured interview administered by a single trained interviewer. Setting: A juvenile detention facility. Participants: 209 children incarcerated at the facility over a 3-month period. Selection Procedure: Consecutive sample. Interventions: None. Measurements/Findings: The structured interview was adapted from the American Drug and Alcohol Survey, which has been extensively used to obtain substance abuse epidemiologic data. We collected information on inhalants, alcohol, marijuana, downers, pep pills, lysergic acid diethylamide (LSD), cocaine, designer drugs, phencyclidine (PCP), Talwin and Ritalin, speed, and narcotics. The chi-square or Fisher exact test were used when appropriate. Mean ages of initial experimentation were as follows: inhalants, 9.7 years; marijuana, 11.9 years; alcohol (inebriated), 12.0 years; cigarettes, 11.2 years; for the remaining substances of abuse, the mean age was 13...
TL;DR: It is suggested that withdrawn cocaine-dependent patients have more neuropsychological impairment than normal controls.
Abstract: Previous research suggests that cocaine abuse may result in neuropsychological deficits. To examine this further, we compared cocaine-withdrawn patients (N = 35) to normal controls (N = 17) on tasks of attention, concentration, perceptual-motor speed, and cognitive flexibility. The withdrawn cocaine patients performed significantly worse on Arithmetic, Grooved Peg Board Dominant and Non-Dominant, and Trails B tests. These findings suggest that withdrawn cocaine-dependent patients have more neuropsychological impairment than normal controls.
TL;DR: The findings revealed that early deviance, assessed by self-report measures of both severity and variety, is related to current adolescent drug and alcohol use, association with deviant peers, a negative view of home atmosphere, and psychological symptomatology.
Abstract: This descriptive study examines the self-reported behaviors of 285 male and female adolescent children (ages 12-17) of narcotic addicts participating in methadone maintenance programs. These children responded to an extensive 2.5-hour interview questionnaire focusing on current and past activities, including criminal activities prior to age 12. The findings revealed that early deviance, assessed by self-report measures of both severity and variety, is related to current adolescent drug and alcohol use, association with deviant peers, a negative view of home atmosphere, and psychological symptomatology. These results are contrasted with the retrospective reports of adolescent behavior obtained from adult male narcotic addicts in a prior study of vulnerability to addiction. The comparability of study results is discussed in the context of developmental risk factors, prevention and treatment strategies, and other considerations specifically related to the development of children of narcotic addicts.
TL;DR: Current problem drinking is associated with worse self-perceived health among elderly patients in the year following presentation to an emergency department, and Elderly former problem drinkers suffer from more severe mental health problems over that same period.
Abstract: Objective: To examine the effect of alcohol abuse on the subsequent health status of elderly patients seen in an emergency department (ED). Patients and methods: A sample of 966 patients aged 65 or older who presented to one urban academic ED between the hours of 8 a.m. and 12 midnight was followed for 1 year. A personal interview was administered during the ED visit. Current problem drinkers had a score of 1 or greater on the CAGE questionnaire at ED presentation and drank within the prior 6 months; former problem drinkers had a score of 1 or greater on the CAGE questionnaire at ED presentation and a last drink more than 6 months previously. We used 13 items from the Medical Outcomes Study short form adapted to the ED setting and 6 items from the Index of Activities of Daily Living (ADL) to measure health status. Results: In multivariate models for repeated-measures controlling for potential confounding factors, current problem drinkers had worse overall health (parameter estimate β −3.6; 95% CI −7.1 to ...
TL;DR: This model of drug treatment for pregnant and postpartum women seems to improve mothers' lives, fetal drug exposure, and birth outcome significantly, and a strong positive correlation was found between total length of stay and low rate of positive urine drug tests (UDTs).
Abstract: In the 1980s, there was virtually no drug treatment for pregnant women in New York City, especially women who used crack cocaine. The purpose of the Parent and Child Enrichment (PACE) demonstration project was to assess the effectiveness of the one-stop shopping model of drug treatment for this population. Among PACE clients, 88% were primarily users of crack cocaine. The mean total length of stay was 100.0 days (median 55.5 days). Client retention 42 days after intake was 54.3%. This paper describes the essential components of this program model. “Long-stay” and “short-stay” clients were compared using urine toxicology tests and activity logs. In addition, the birth outcomes of clients were compared to two similar populations. A strong positive correlation was found between total length of stay and low rate of positive urine drug tests (UDTs). Infants of PACE long-stay clients had greater mean birth weight, less low birth weight, and less intrauterine growth retardation than the infants of the comparison...
TL;DR: Very few statistically significant associations were found between childhood trauma and current human immunodeficiency virus (HIV) risk behaviors of 181 active illicit-drug-using women in San Antonio, Texas.
Abstract: A cross-sectional study was conducted to examine the association between childhood trauma and current human immunodeficiency virus (HIV) risk behaviors of 181 active illicit-drug-using women in San Antonio, Texas. We found very few statistically significant associations, which could be explained by (a) childhood trauma subtypes not being mutually exclusive, (b) clustering of mild-to-severe forms of abuse, and (c) childhood trauma having an indirect, rather than direct, effect on HIV risk behavior. Public health implications from this study are that prevention programs need to consider past and current individual and environmental factors that influence HIV sexual risk behaviors in women drug users.
TL;DR: Findings indicate that, even among those admitted to residential treatment for substance abuse, homeless MICA clients are not homogeneous; rather, subgroup differences emerge among the indices of homelessness, mental illness, and substance abuse.
Abstract: This paper is one of a series reporting on a clinical field trial evaluating the efficacy of the modified therapeutic community (TC) approach for the treatment of homeless mentally ill chemical abusers (MICAs). The social and psychological characteristics of the treatment sample were described in an earlier paper; the purpose of the present report was to categorize subtypes of homeless MICA clients to predict with greater accuracy their treatability in modified TCs. An index that consistently correlated with treatment-relevant variables was identified for each of three dimensions; Homelessness (residential instability), Mental Illness (current severity), and Substance Abuse (current substance abuse/dependence diagnosis). These indices yielded distributions that captured the variability in the sample with respect to a number of variables, including drug use, criminality, human immunodeficiency virus (HIV) risk (sexual behavior), psychological status, and motivation. Bivariate and multivariate analyses show...
TL;DR: Lower levels of risk are found among HIV+ men, particularly those with more progressed HIV illness, Nevertheless, a substantial amount of sexual risk behavior remained in this cohort, indicating the continued need for education and intervention.
Abstract: Injecting drug users (IDUs) play a prominent role in the transmission of human immunodeficiency virus (HIV), particularly in urban areas such as New York City, where they comprise nearly half of all adult acquired immunodeficiency syndrome (AIDS) cases. Intervention studies have demonstrated that IDUs are responsive to safer sex messages, but sexual behavior appears to be more resistant to change than drug use behavior. This multidisciplinary study (without an intervention component) assesses changes in sexual risk behavior as a function of time, HIV status, and disease progression in a cohort of HIV+ and HIV− male IDUs (N = 144) for 4 years. Results: For HIV+ and HIV− men, there were increases in abstinence and monogamy, with decreases in the frequency of unprotected vaginal/anal sex and sexual risk index scores. With the exception of monogamy, HIV+ men reported lower levels of risk. Although there was also a decline in substance use, this accounted for only some of the decline in sexual risk behavior. A...
TL;DR: Treatment costs in an ongoing study in which 102 opioid-addicted patients were randomly assigned to either 180-day methadone detoxification or the same treatment enhanced with contingency contracting were examined, with individuals participating in the enhanced condition more likely to provide continuously drug-free urine samples and alcohol-free breath samples during the final month of treatment.
Abstract: We examined treatment costs in an ongoing study in which 102 opioid-addicted patients had been randomly assigned to either 180-day methadone detoxification or the same treatment enhanced with contingency contracting. In the latter condition, study participants received regular reinforcers contingent on negative urine toxicology screens and breath analyses for a range of drugs and alcohol. Both conditions involved psychosocial treatment, and all participants were stabilized to a daily methadone dose of approximately 80 mg during the first 4 months, followed by a 2-month taper. Individuals participating in the enhanced condition were more likely to provide continuously drug-free urine samples and alcohol-free breath samples during the final month of treatment than were participants in the control condition. Cost of treatment was calculated individually for each participant based on actual services received. First, unit cost for each service was determined, including adjusted staff salaries for direct treatment and opportunity cost of facilities utilized during service delivery. Next, we valued each patient's use of services during the first 120 days of the study and then added the cost of methadone, laboratory work, and contingent reinforcers. A subsample (n = 45) also provided data on health care utilization during treatment, which we valued using standard Medicare unit costs. The marginal cost of enhancing the standard treatment with contingency contracting was approximately 8%. An incremental cost of $17.27 produced an additional 1% increase in the number of participants providing continuously substance-free urine and breath samples during month 4 of the study. For every additional dollar spent on treatment, a $4.87 health care cost offset was realized; however, this difference was statistically insignificant due to extreme variances and small subsample size.