Showing papers in "American Journal of Drug and Alcohol Abuse in 2000"
TL;DR: These data confirm earlier reports of a shorter course, less deviant drug usage, and—if married—a substance-abusing spouse and lower rates of lifetime admissions, treatment days, and total cost of substance abuse treatment.
Abstract: Objective: To assess the course and severity of substance-related disorder (SRD) in relation to gender. Design: Retrospective data on course were obtained for several indices of substance use, abus...
180 citations
TL;DR: Results suggested that the longer residential treatment program had a particularly beneficial impact on women, and completion of treatment is the key predictor of treatment outcomes for both men and women.
Abstract: This study compared factors that predict treatment outcomes in men and women randomly assigned to two therapeutic communities differing primarily in length of inpatient and outpatient treatment. Based on the prior research literature comparing treatment outcomes of men and women, we formulated the following research question: Do factors that predict drug use at follow-up, postdischarge arrest, and employment at follow-up differ for men and women? Self-reports and objective measures of criminal activity and substance abuse were collected at pre- and posttreatment interviews. Separate regression analyses were conducted for men and women for each of the three outcome variables. The results showed that the predictors of outcome for men and women were similar. Clients who completed the 12-month treatment programs had better outcomes regardless of gender. Men and women who completed treatment were characterized at follow-up by substantial reductions in drug use and arrests and by increased employment. Results further suggested that the longer residential treatment program had a particularly beneficial impact on women. Number of prior arrests was also associated with postdischarge outcomes for women. Women with more arrests at admission were more likely to have a postdischarge arrest and less likely to be employed at follow-up. This finding provides invaluable information about which women may be at greater risk for relapse and in need of additional services. We conclude that completion of treatment is the key predictor of treatment outcomes for both men and women.
152 citations
TL;DR: Results of stepwise multiple logistic regressions indicate that drinking with friends and events with food available protect against alcohol problems, while drinking events in which illicit drugs are available present higher risk for problems.
Abstract: This paper examines the contextual characteristics common to binge drinking occasions reported by college students. In addition, the study examines the influence of such contextual characteristics on alcohol-related problems experienced by students. Using random sampling and telephone interview methodology, 401 college students attending a large southern California university were surveyed by trained research staff. The interview protocol was based on the Core Survey and included context of use questions from the College Risk Assessment Guide. Results of stepwise multiple logistic regressions indicate that drinking with friends and events with food available protect against alcohol problems, while drinking events in which illicit drugs are available present higher risk for problems. Implications for future research and prevention are discussed.
136 citations
TL;DR: Significant relationships were obtained between initial motivation, Circumstances, Motivation, Readiness, retention, aftercare, and outcomes in a sample of substance abusers treated in a prison-based TC program.
Abstract: Current research concludes that participation in postprison aftercare is critical to the effectiveness of prison-based therapeutic community (TC) treatment. This conclusion makes it imperative to understand the client determinants of retention in prison treatment, particularly continuance in postprison aftercare. Currently, however, little data exist as to client predictors of seeking and remaining in prison-based TCs or entering postrelease aftercare. In the present study, significant relationships were obtained between initial motivation (i.e., Circumstances, Motivation, Readiness [CMR] scores), retention, aftercare, and outcomes in a sample of substance abusers treated in a prison-based TC program. Implications are discussed for theory, research, and treatment policy.
134 citations
TL;DR: Levels of nonadherence were comparable to estimates from other chronic diseases, but this finding has important implications for patients receiving highly active antiretroviral therapy.
Abstract: Methadone maintenance patients infected with human immunodeficiency virus (HIV) currently receiving antiretroviral therapy had HIV RNA testing and were surveyed regarding their adherence to their t...
109 citations
TL;DR: The present findings support the effectiveness and longer term stability of effects of a modified TC program for treating homeless MICA clients.
Abstract: This study compared homeless mentally ill chemical abuser (MICA) clients (n = 342), male and female, sequentially assigned to either of two modified therapeutic community programs (TC1 and TC2) and to a treatment-as-usual (TAU) control group. Follow-up interviews were obtained at 12 months postbaseline and at time F (on average more than 2 years postbaseline) on a retrieved sample of 232 (68%) clients and 281 (82%) clients, respectively. Outcome measures assessed five domains: drug use, crime, HIV risk behavior, psychological symptoms, and employment. Individuals in both modified TC groups showed significantly greater behavioral improvement than TAU at 12 months and time F, and the modified TC2, with lower demands and more staff guidance, was superior to modified TC1. Completers of both TC programs showed significantly greater improvement than dropouts and a subgroup of TAU clients with high exposure (i.e., more than 8 months) to other treatment protocols. The present findings support the effectiveness and longer term stability of effects of a modified TC program for treating homeless MICA clients.
108 citations
TL;DR: The findings further emphasize the impact of substance use on outcome in schizophrenia and the need for more research on the nature and treatment of the patient with a dual diagnosis.
Abstract: Objective: Although the clinical reality of substance dependence and/or abuse among schizophrenia patients is widely acknowledged, the interaction of these diagnoses is not well understood. Perhaps the largest study documenting the comorbidity of substance abuse is the Epidemiologic Catchment Area (ECA) study, which found the rate to be 47% in schizophrenia patients . The present study examined substance use and compared the broad categories of substance users versus nonusers vis-a-vis schizophrenic symptomatology, hospitalizations, compliance, and demographic variables. We further examined the two subcategories of alcohol versus other substances of abuse (hereafter called “drugs”) to determine differences. Methods: Data were collected by the same person retrospectively from the charts of schizophrenia outpatients in a public inner city mental health center. Patients must have had at least 10 outpatient visits within a 2-year period for data to be used. Results: Data were compiled from 262 charts. Of the ...
100 citations
TL;DR: Of the factors cited by self-remitters as important in facilitating their desistance from substances, the present review found that health concerns, pressure from friends and family, and extraordinary events were instrumental in initiating spontaneous remission, while social support, non-drug-using friendships, willpower, and identity transformation were pivotal in maintaining change.
Abstract: A quantitative review of the substance abuse literature revealed a mean general prevalence of spontaneous remission from alcohol, tobacco, and other drugs abuse of 262% when a broad definition of remission was employed and 182% when a narrow definition was implemented From the results of this review, it was concluded that few meaningful differences exist between spontaneous remitters and persons who either continue misusing substances or remit through treatment on pre-remission measures of prior drug involvement Of the factors cited by self-remitters as important in facilitating their desistance from substances, the present review found that health concerns, pressure from friends and family, and extraordinary events were instrumental in initiating spontaneous remission, while social support, non-drug-using friendships, willpower, and identity transformation were pivotal in maintaining change Evidence is presented to indicate that spontaneous remission from alcohol and illicit drugs and spontaneous remission from tobacco smoking may differ in several key respects
90 citations
TL;DR: This paper uses data from the National Household Surveys on Drug Abuse to estimate simple descriptive statistics and analysis of variance (ANOVA) models of the relationship between symptoms of dependence and labor market outcomes for alcohol, cigarettes, marijuana, and other illicit drugs.
Abstract: The prevalence and costs of alcohol and drug disorders pose a serious social concern for policymakers. In this paper, we use data from the National Household Surveys on Drug Abuse (NHSDA) to estimate simple descriptive statistics and analysis of variance (ANOVA) models of the relationship between symptoms of dependence and labor market outcomes for alcohol, cigarettes, marijuana, and other illicit drugs. For men, we find that substance use with symptoms of dependence is associated with both lower employment rates and fewer hours of work. For women, we find that substance use with symptoms of dependence is associated with lower employment rates, but we find no consistent evidence of a relationship between symptoms of dependence and the number of hours worked. Finally, all of our point estimates are smaller in magnitude when we control for multiple substance use, suggesting that comorbidities play a critical role in the relationship between substance use and labor market outcomes. Our results suggest that policymakers and researchers should consider the full spectrum of substance use and dependence rather than focusing on the simple use of a single substance.
82 citations
TL;DR: Multivariate analyses indicate that mothers in the high-risk group had significantly worse scores on parenting attitude scales, and which factors besides maternal substance abuse place these mothers at risk for poor parenting.
Abstract: This study examined the amount of exposure to negative environmental risks and their association with parenting attitudes among a group of inner city substance-abusing women. Mothers (N = 198) were...
80 citations
TL;DR: The study found that individuals currentlydependent on cocaine or opiates perceived that they had a need for drug treatment, while those currently dependent on marijuana did not share this perception.
Abstract: An interview study was conducted among a group of incoming prisoners in a county jail in Ohio during the summers of 1997 and 1998 to assess their current drug treatment needs. "Incoming prisoners" refers to individuals who were being transferred from this county jail to the state prison system. Marijuana and cocaine were the most commonly tried illegal drugs among the subjects as well as the drugs of choice during the month prior to imprisonment. The Diagnostic Interview Schedule, combined with questions employed in the Drug Use Forecasting (DUF) project, was used to construct the questionnaire for this study. Based on the criteria of DSM-IV diagnoses, 57.5% of those interviewed had exhibited drug dependency at some point in their lives, and 51% were currently dependent on some substance. Thus, more than half of the incoming prisoners were in need of treatment for use of at least one substance. Cocaine dependence was the greatest problem facing this group of inmates, with an especially notable problem among the older females. Younger males were more likely to have current marijuana dependence. The study found that individuals currently dependent on cocaine or opiates perceived that they had a need for drug treatment, while those currently dependent on marijuana did not share this perception.
TL;DR: The results of this study suggest that clients with this profile have increased likelihood of being retained in intensive outpatient substance abuse treatment programs.
Abstract: The purpose of this research was to expand knowledge in the current literature regarding treatment retention in intensive outpatient substance abuse treatment programs. The sample in this study participated in a hospital-based program accredited by the Joint Commission on Accreditation for Health Organizations (JCAHO) that utilized the Minnesota model. Specifically, this inquiry investigated whether treatment retention would be predicted by gender, age, employment status, number of problems on the treatment plan, whether the referral was related to driving while intoxicated (DWI), marital status, race, and whether each of the following substance problems was listed as the client's primary DSM-IV diagnosis: alcohol dependence, cocaine dependence, polysubstance dependence, opioid dependence, sedative/hypnotic dependence, cannabis dependence, other (or unknown) dependence, alcohol abuse, cannabis abuse, amphetamine abuse, and caffeine intoxication. Findings indicated that those retained in treatment, when compared to those who dropped out, had significantly more problems on their treatment plans, were more likely to be alcoholics, were less often cocaine addicts, and were more likely to be employed. The results of this study suggest that clients with this profile have increased likelihood of being retained in intensive outpatient substance abuse treatment programs.
TL;DR: Analysis of a subset of data from a reproductive history survey that included a nonparametric self-assessment of past substance abuse distributed to a random sample of American women showed that a report of substance abuse following a first pregnancy was associated significantly with abortion for all women, abortion for adolescents, and abortion for women over 19 years of age.
Abstract: A statistical association between a history of substance abuse and a history of abortion has been identified in several studies, but this association has not yet been thoroughly analyzed. This study draws on a subset of data from a reproductive history survey that included a nonparametric self-assessment of past substance abuse distributed to a random sample of American women. Analysis of this substance abuse variable showed that a report of substance abuse following a first pregnancy was associated significantly with (a) abortion for all women, (b) abortion for adolescents, and (c) abortion for women over 19 years of age. Women who aborted a first pregnancy were five times more likely to report subsequent substance abuse than women who carried to term, and they were four times more likely to report substance abuse compared to those who suffered a natural loss of their first pregnancy (i.e., due to miscarriage, ectopic pregnancy, or stillbirth). Women with a history of abortion or a history of substance abuse were significantly more likely to feel discomfort in responding to the survey. The findings of this study have important implications for the design of future studies examining substance abuse, adolescents, and women. These findings may also have clinical and counseling implications.
TL;DR: The findings suggest that, although there may be a need for gender-specific targeted interventions, treatment providers must also recognize that the impact of abuse seems to transcend gender within this population of homeless men and women.
Abstract: Substance abuse and severe mental illness are factors that have been linked to homelessness, and the rates of mental illness have been reported to be higher among homeless women than men. Only rece...
TL;DR: The results suggest that the relative degree of distraction by alcohol versus other personally relevant stimuli holds promise for understanding the cognitive and motivational processes underlying alcohol abuse.
Abstract: Alcohol abusers' and nonabusers' attentional distraction for neutral, alcohol-related, and concern-related (personally relevant) words was assessed with a word-word color-naming task. Abusers, unlike nonabusers, showed greater attentional distraction for alcohol-related than concern-related words. Exploratory analyses indicated that abusers who were more distracted by alcohol-related than concern-related stimuli (i.e., "alcohol distracted") responded more slowly to neutral words than "concern-distracted" participants. The results suggest that the relative degree of distraction by alcohol versus other personally relevant stimuli holds promise for understanding the cognitive and motivational processes underlying alcohol abuse.
TL;DR: Preliminary findings demonstrate the need for a randomized clinical trial to test the efficacy of the anger management group treatment in men and women with a diagnosis of cocaine dependence.
Abstract: Cocaine abusers who fail to manage anger appropriately may have greater difficulty achieving and maintaining abstinence. We conducted a pilot study to examine an anger management group treatment in a sample of 59 men and 32 women with a diagnosis of cocaine dependence. Participants attended a 12-week anger management group treatment and background substance abuse treatment. Levels of anger, negative affect, and anger control were measured at baseline, weekly during treatment, and at 3-month posttreatment follow-up. Levels of anger decreased and anger control increased between baseline and the end of treatment. End-of-treatment changes were maintained at follow-up. These findings were not moderated by gender, age, or psychiatric medication use. In the absence of a randomized control group, we cannot make conclusive statements regarding the effectiveness of the anger management group treatment. However, these preliminary findings demonstrate the need for a randomized clinical trial to test the efficacy of the anger management group treatment.
TL;DR: A prospective study of 823 injecting drug users was made to identify baseline variables differentiating those who entered treatment during the study from those who did not enter and level of injection-related risk for HIV infection.
Abstract: A prospective study of 823 injecting drug users (IDUs) was made to identify baseline variables differentiating those who entered treatment during the study from those who did not enter. Variables independently associated with entering treatment in a multiple logistic regression model included (a) expressed desire for treatment, (b) being eligible for methadone maintenance, (c) two or more previous treatment admissions, (d) frequency of injection, (e) heroin use in the past 30 days, (e) being human immunodeficiency virus (HIV) positive, (f) giving money or drugs for sex, and (g) level of injection-related risk for HIV infection.
TL;DR: The results of this small study indicate that venlafaxine may be a safe, well-tolerated, rapidly acting, and effective treatment for patients with a dual diagnosis of depression and cocaine dependence.
Abstract: Objective: There appears to be a link between depression and cocaine that is both complex and elusive. The purpose of this study was to examine the effect of venlafaxine, a broad spectrum antidepressant, in the treatment of 13 patients who were diagnosed with cocaine dependence and comorbid major depressive disorder (MDD). Method: The majority of the patients in the study were part of a larger double-blind trial using desipramine. This subgroup consisted of people who had failed to respond to desipramine or could not tolerate its side effects. Thirteen patients were enrolled, 10 men and 3 women. Of the patients, 11 completed the 12-week study. All of the patients had a Hamilton Depression (HAM-D) score greater than 14 at baseline, and each had used at least $20 worth of cocaine per week in the 4 weeks prior to entering the study. In addition, all of the patients received weekly relapse prevention therapy throughout the study. The median dose of venlafaxine was 150 mg/day. Results: The 11 patients who comp...
TL;DR: The survey on this unit revealed that 80% of injection drug users (IDUs) had hepatitis B core antibody (HBcAB), and 90% had hepatitis C virus antibody (HCVAB) and the need to focus on education, especially about transmission of hepatitis B and C infection in drug addicts, particularly IDUs.
Abstract: The survey on our unit revealed that 80% of injection drug users (IDUs) had hepatitis B core antibody (HBcAB), and 90% had hepatitis C virus antibody (HCVAB). Less than half of each group did not know or were unsure of the mode of transmission and spread of HCV. These findings emphasize the need to focus on education, especially about transmission of hepatitis B and C infection in drug addicts, particularly IDUs.
TL;DR: It was found that substance abusers who were married, female, and persons of color were less likely to be without a home when other variables were controlled, and trading sex for money and perceived chance of getting acquired immunodeficiency syndrome (AIDS) were associated positively with homelessness.
Abstract: This study examines 5225 out-of-treatment crack users and drug injectors drawn from five different geographic areas to examine selected factors associated with homelessness. Of these crack users, 27% considered themselves undomiciled, and 60% had previously entered some type of drug treatment. Logistic regression found that substance abusers who were married, female, and persons of color were less likely to be without a home when other variables were controlled. Trading sex for money and perceived chance of getting acquired immunodeficiency syndrome (AIDS) were associated positively with homelessness, while participating in methadone detoxification and methadone maintenance programs seemed to offer some protection from homelessness.
TL;DR: It was found that, in most treatment settings, for-profit programs were smaller and more likely to specialize in providing treatment in a single setting, but public programs differed from public programs operated by state and local governments.
Abstract: Objective: This study describes differences between public and private substance abuse treatment programs. Method: Data from the National Drug and Alcoholism Treatment Unit Survey (NDATUS) were analyzed with regression models that evaluated the association between ownership and program characteristics. Results: Programs operated by state and local government and nonprofit agencies had more staff, but federal and for-profit programs employed more psychologists and medical doctors. We found that, in most treatment settings, for-profit programs were smaller and more likely to specialize in providing treatment in a single setting. Methadone maintenance programs were larger when operated under for-profit ownership, however. For-profit programs received more funding from private insurance and client fees. Conclusions: We found substantial differences between public and private programs, but this division was not strictly dichotomous. Federal programs differed from public programs operated by state and local gov...
TL;DR: This preliminary study supports further investigation of divalproex in the treatment of alcohol withdrawal and supports the use of lorazepam in patients with uncomplicated alcohol withdrawal syndrome.
Abstract: The present study represents an open-label clinical trial comparing treatment with a benzodiazepine (lorazepam) to divalproex in 11 inpatients with uncomplicated alcohol withdrawal syndrome. The tr...
TL;DR: It is suggested that the treatment readiness training is having its intended impact on probationers, and the usefulness of a newly developed measure in evaluating treatment effectiveness is supported.
Abstract: This study examined the impact of a treatment readiness program on probationers receiving drug abuse treatment in a modified therapeutic community (TC). The program we developed was designed to inc...
TL;DR: While standard screening instruments appear to work reasonably well in both samples for alcohol dependence and harmful drinking/abuse, variation across gender, injury, and acculturation subgroups suggests attention should be given to choosing the “best” instrument.
Abstract: The performance of standard screening instruments and alternate measures against ICD-10 (International Classification of Diseases, 10th revision) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th revision) criteria for alcohol dependence and separately for harmful drinking/abuse were compared between probability samples of 1511 emergency room (ER) patients from three hospitals in Pachuca, Mexico, and 586 Mexican-American ER patients in Santa Clara County, California. Sensitivity was highest for the Alcohol Use Disorders Identification Test (AUDIT), TWEAK, and Rapid Alcohol Problems Screen (RAPS) for alcohol dependence; sensitivity was highest for holding five or more drinks for harmful drinking/abuse in both samples. All instruments performed better for alcohol dependence than for abuse/harmful drinking. Arrests for drinking and driving performed better in Santa Clara than in Pachuca, while a positive Breathalyzer reading and reporting drinking prior to the event performed better in Pachuca; both were significantly more sensitive among the injured compared to the noninjured in Pachuca. The data suggest that instrument performance may be similar between those in Pachuca and those in the low acculturation group in Santa Clara, relative to those scoring higher on acculturation. While standard screening instruments appear to work reasonably well in both samples for alcohol dependence, variation across gender, injury, and acculturation subgroups suggests attention should be given to choosing the "best" instrument.
TL;DR: Assessment of coping and depression in 307 methadone-maintained patients found a reliance on avoidant coping strategies, most notably by depressed patients, and drug use at the 6-month follow-up was related to gains made during treatment.
Abstract: Use of illicit drugs by opioid-dependent patients maintained on methadone undermines the benefits of methadone maintenance treatment. Because supplemental pharmacologic approaches have met with limited success, it is important to identify psychological mechanisms associated with drug use that potentially could contribute to the development of more effective treatments. To investigate this issue, the current study assessed coping and depression in 307 methadone-maintained patients and found a reliance on avoidant coping strategies, most notably by depressed patients. Patients who achieved abstinence following a 12-week coping skills training intervention decreased the use of avoidant coping strategies. Drug use at the 6-month follow-up was related to gains made during treatment, specifically reduced cognitive avoidance, reduced depression, and number of drug-free weeks during treatment.
TL;DR: There was an overall decrease in MCMI scores, indicating less psychopathology between initial assessment and follow-up, and inspection of individual MCMI scales supported the hypothesis; there were decreases on scales measuring affective disturbance, anxiety, and social isolation, but not on scalesasuring antisocial and narcissistic traits.
Abstract: The Millon Clinical Multiaxial Inventory (MCMI) was administered to 144 men and 86 women within 1 month of admission to methadone maintenance treatment and was readministered 18 months following admission. Based on prior research, we hypothesized there would be significant decreases on scales measuring affective disturbance, anxiety, and social isolation and little change in scales measuring antisocial and narcissistic traits. In addition, it was hypothesized that changes on the MCMI would be related to retention in treatment and illicit drug use during the interim between initial assessment and follow-up. Data were analyzed using a multivariate analysis of variance (MANOVA) for repeated measures. There was an overall decrease in MCMI scores, indicating less psychopathology between initial assessment and follow-up. MCMI scales did not change as a function of retention status, but decreases in MCMI scale scores were greater for subjects who were light drug users in the 6 months prior to the follow-up compared to heavy users. Inspection of individual MCMI scales supported our hypothesis; there were decreases on scales measuring affective disturbance, anxiety, and social isolation, but not on scales measuring antisocial and narcissistic traits.
TL;DR: It is found that social workers trained in substance abuse had more substance abuse cases, with and without additional diagnoses, and rated themselves higher on two of six competency measures: in intervening with clients when all diagnoses were combined and in intervening when substance abuse only diagnoses were Combined.
Abstract: Past research and reports from the field have described social workers as having a host of negative responses to alcohol- and drug-abusing clients. Some found that substance abuse training increased social workers' sense of security and legitimacy in the therapeutic role with such clients. We report on 23 master's level social workers (MSWs) who completed an intensive 9-month substance abuse training program (trainees) and 22 MSW comparison subjects (comparisons). Both trainees and comparisons completed caseload forms identifying their clients by diagnosis and self-rated their competence to assess and treat each client. We predicted that workers trained in substance abuse, when compared with workers who lacked such intensive training, would (a) assess and treat more substance-abusing clients, (b) work with more complex substance-abusing clients (i.e., dually diagnosed clients), and (c) perceive themselves to be more competent to assess and treat substance-abusing clients. No significant differences were f...
TL;DR: This paper presents a method for mobilizing and collaborating with families and extended the support system toward working with resistance and getting the substance abuser into treatment.
Abstract: The model described in this paper takes into consideration two key findings: (a) In a given year, the vast majority (90-95%) of active substance abusers do not enter treatment or self-help groups, and (b) substance abusers have frequent contact with their families (60-80% either live with a parent or are in daily contact). This paper presents a method for mobilizing and collaborating with families and extended the support system toward working with resistance and getting the substance abuser into treatment. Principles and techniques are provided for convening and structuring intervention network meetings toward that end. This intervention network approach can be used either alone or as part of an overall model, ARISE (A Relational Intervention Sequence for Engagement). The ARISE model addresses both clinical and programmatic issues in treatment engagement for substance abusers.
TL;DR: Findings revealed that 7 of 14 factors were significant predictors of tobacco use and some factors predicted smoking only, ST only, and conjoint use; however, the pattern of predictors varied for these three categories.
Abstract: Purpose: To identify and compare the determinants of different types of tobacco use among rural youths and discuss the implication of these differences for youth tobacco use cessation. Methods: Ninth grade participants (n = 883) were 95% white, between 13 and 19 years old with a mean age of 14.6 years. Students were classified into four exclusive groups: non–tobacco use, smoking only, smokeless tobacco (ST) use only, and conjoint smoking and ST use. The influences of 14 specific risk factors on tobacco use were investigated for each group using separate multiple logistic regression analyses. Results: Among participants, 20% were smokers only, 6% were ST users only, and 10% were conjoint users. Students who had more friends (odds ratio [OR] =] 2.75) and siblings (OR = 1.96) who smoke, family problems (OR = 1.70), and favorable attitudes toward tobacco use (OR = 1.12) were more likely to smoke than were other students. Among students who used only ST, gender was a primary determinant (95% were male). Exclud...
TL;DR: Both forms of combinational use of alcohol and marijuana together increased in the 1990s more among younger adolescents than among older ones, and controlling for rates of use suggest that these forms of Combinational use are incidental to the use of the individual substances, rather than uniquely sought “highs.”
Abstract: Combinational use of substances refers to taking two or more substances together so that they affect the person at the same time. This pattern of substance use presents unique health and safety risks. Trends in combinational use of alcohol and marijuana or alcohol and cocaine were determined using data from three large comparable samples of students in grades 7–12 in New York State, from surveys conducted in 1983, 1990, and 1994. Each of the three samples was demographically diverse, permitting detailed analysis of trends in various adolescent subgroups according to gender, grade level (age), and race/ethnicity. These two forms of adolescent combinational use of alcohol and illicit drugs dropped sharply from 1983 to 1990, but increased or remained stable from 1990 to 1994. Use of alcohol and marijuana together increased sharply from 1990 to 1994, much more for blacks and Hispanics than for whites, while use of alcohol and crack or cocaine together remained stable at a low level in the 1990s. Both forms of...