Showing papers in "Journal of Psychoactive Drugs in 1992"
TL;DR: Implications for smoking cessation treatment are discussed in the areas of the use of pharmacologic agents in the reduction of nicotine withdrawal symptoms; (2) nicotine replacement therapy; and (3) skills-training approaches to smoking cessation and relapse prevention.
Abstract: Numerous investigators have examined the role of negative affective states and affect regulation in the initiation and development of cigarette smoking behavior, smoking cessation, and relapse prevention. Affect regulation refers to any attempt to alleviate negative mood states by means of pharmacologic-, cognitive-, behavioral- or environmental-change methods. The psychological construct/process of affect regulation is examined in relation to (1) the initiation, development, and maintenance of the cigarette smoking habit; (2) the process of quitting smoking; and (3) the long-term maintenance of smoking abstinence versus relapse. Various psychosocial factors and physiological mechanisms are explored that have been hypothesized to be links between negative mood states, nicotine addiction, and smoking cessation. Implications for smoking cessation treatment are discussed in the areas of (1) the use of pharmacologic agents, such as clonidine, in the reduction of nicotine withdrawal symptoms; (2) nicotine replacement therapy; and (3) skills-training approaches to smoking cessation and relapse prevention.
206 citations
TL;DR: The cocaine-smoking epidemic of 1981-1991 (which included crack) afforded the opportunity to research it in its entirety, and the cyclical nature of drug epidemics, as well as their progression through regular stages, was again affirmed.
Abstract: Although Americans have experienced many drug epidemics, the majority of which have ended within ten years of onset, they nevertheless believed that the use of smokable cocaine, which took the popular form of crack cocaine in 1984, would grow exponentially throughout the 1990s unless it was vigorously combated. However, in 1991 it appears that crack use is in decline even in the inner-city neighborhoods where it had been most entrenched, and that the decline is due more to natural controls than to the War on Drugs. The cyclical nature of drug epidemics, as well as their progression through regular stages, was again affirmed. The cocaine-smoking epidemic of 1981-1991 (which included crack) afforded the opportunity to research it in its entirety. In this article, the advantages of recognizing the developmental cycles of drug epidemics are outlined, the most important of which concerns the future. In the terminal stage of the developmental cycle of a drug epidemic, remaining abusers play a pivotal role. If humanely treated, they may serve as deterrents to future drug use: frustrated in current drug use, however, yet insensitively treated by the wider society, they may author the next epidemic.
115 citations
TL;DR: Overall, crack smokers, whether injectors or not, engaged in higher-risk sexual behaviors than nonsmokers, reported greater numbers of sex partners than nons mokers, and were more likely than nonsMokers to have exchanged sex for money or drugs or to have had an STD.
Abstract: Since crack cocaine appeared in urban areas in the United States in the mid-1980s, reports have suggested that crack smokers may be at increased risk of sexually transmitted diseases (STDs), including infection with HIV, because they have multiple sex partners, trade sex for money or drugs, and rarely use condoms. A cross-sectional survey is being conducted in urban neighborhoods in Miami, New York and San Francisco--where crack use is common--to explore these issues. Indigenous street outreach workers are recruiting men and women who are either current regular crack smokers or who have never smoked crack; each group is further stratified according to whether participants had ever injected drugs. Participants were interviewed about their sexual and drug-use practices. Overall, crack smokers, whether injectors or not, engaged in higher-risk sexual behaviors than nonsmokers, reported greater numbers of sex partners than nonsmokers, and were more likely than nonsmokers to have exchanged sex for money or drugs or to have had an STD. Differences between crack smokers and nonsmokers were generally greater among non-injectors than among injectors, and generally greater among women than among men. Condom use, although somewhat more common with paying than nonpaying partners, was infrequent overall. Most of the subjects had not been in substance abuse treatment in the preceding 12 months, and a majority had never been in substance abuse treatment. Education and prevention programs specifically targeted at crack smokers not currently in substance abuse treatment are needed to reach these high-risk persons.
114 citations
TL;DR: The experience of using and quitting drugs is described in this paper, where the authors discuss the effects of using drugs on the user's experience. But they focus on the negative effects.
Abstract: (1992). Cocaine Changes: The Experience of Using and Quitting. Journal of Psychoactive Drugs: Vol. 24, No. 1, pp. 71-71.
110 citations
TL;DR: Crack use was associated with increased sexual activity, trading sex for money or drugs, and sex with multiple partners, and neither traders nor nontraders reported rates of condom use sufficient to substantially reduce the transmission of sexually transmitted diseases and HIV infection.
Abstract: Data are analyzed from the Multicenter Study of Crack Cocaine and HIV Infection in Miami, Florida, examining interrelationships among use of crack cocaine, use of other drugs, sexual activity, and exchange of sex for money and drugs. This study was designed to recruit two groups of approximately equal size: persons who reported current use of crack cocaine three or more times per week, and those who had never used crack. Participants (N = 641) were recruited in Miami. Participants' median age for first use of crack cocaine was higher than for use of alcohol, marijuana or powdered cocaine. It was also higher than participants' ages at first sexual activity, and somewhat higher than the median age for reporting initiation of trading sex for money or drugs. The median age of first crack use was lower among younger participants, suggesting that crack use in older participants followed quickly upon availability of the drug. Crack users reported reduced desire for sex and diminished ability to have sex after smoking crack. However, crack use was associated with increased sexual activity, trading sex for money or drugs, and sex with multiple partners. Participants who traded sex for money or drugs (traders) reported higher rates of condom use than nontraders; however, neither traders nor nontraders reported rates of condom use sufficient to substantially reduce the transmission of sexually transmitted diseases and HIV infection.
102 citations
TL;DR: A review of the literature is consistent with the hypothesis that the 5-HT1A and the5-HT2 receptor subtypes play a facilitatory role in human sexual behavior, and suggests that drugs that act as agonists on these receptor sites enhance sexual functioning in the human, while those that acts as antagonists inhibit sexual functioning.
Abstract: A wide range of both prescription and nonprescription drugs has been reported to affect human sexual functioning. While the sexual side effects resulting from drug use have often been attributed to adrenergic, anticholinergic or dopaminergic activity, the present review considers the potential role of serotonin. Based on animal studies, serotonin has been shown to either facilitate or inhibit sexual activity depending on which serotonin receptor subtype is activated. However, few studies have been done in the human that assess the effects of drugs that bind selectively to serotonin receptors. Consequently, little is known about the role of serotonin in human sexual functioning. In this review, a wide range of drugs that affect both brain serotonergic systems and human sexual behavior is examined in an effort to determine the possible role of serotonin in human sexual behavior. A review of the literature is consistent with the hypothesis that the 5-HT1A and the 5-HT2 receptor subtypes play a facilitatory role in human sexual behavior. The evidence suggests that drugs that act as agonists on these receptor sites enhance sexual functioning in the human, while those that act as antagonists inhibit sexual functioning.
99 citations
TL;DR: It was found that engaging IDUs in peer-group-directed prevention efforts is both feasible and promising and that this approach extended the reach of the program to a great degree and that it was well received in the IDU community.
Abstract: Needle exchange is a practical and important part of the Dutch prevention strategy to check the spread of HIV among injecting drug users (IDUs). However, needle-exchange programs are often tied to drug treatment programs that only reach a limited number of IDUs. To overcome this limitation, alternative designs are considered and initiated. This article describes a community-based approach to needle exchange that is built on empowerment of, and intense participation by, known IDUs to target unknown IDUs for delivery of clean needles. The needle-exchange patterns of the IDUs participating in this collective scheme are compared to those of other users who exchanged needles on an individual basis. It was found that this approach extended the reach of the program to a great degree and that it was well received in the IDU community. However, the results were negatively influenced by police activities aimed at closing down places where drugs were used and sold. It is concluded that engaging IDUs in peer-group-directed prevention efforts is both feasible and promising.
89 citations
TL;DR: An overview of the social history leading up to the crack era, especially 1960 to the present, is provided, exemplified in this article by one inner-city household having an extensive family history exhibiting the chronic impacts of these macro forces and their micro consequences.
Abstract: This article provides an overview of the social history leading up to the crack era, especially 1960 to the present. The central theme holds that several major macro social forces (e.g., economic decline, job loss, ghettoization, housing abandonment, homelessness) have disproportionately impacted on the inner-city economy. These forces have created micro consequences that have impacted directly on many inner-city residents and have increased levels of distress experienced by households, families, and individuals. Economic marginality has generated high levels of alcohol and other drug abuse as well as criminality, which are exemplified in this article by one inner-city household having an extensive family history exhibiting the chronic impacts of these macro forces and their micro consequences.
80 citations
TL;DR: The consequences of this persistent stigma, which necessitates the need for secrecy, the adaptations made in order to successfully "pass as normal," and the contexts in which methadone-maintained individuals decide to disclose their stigmatized status are explored.
Abstract: This article focuses on the management of stigma by methadone maintenance patients. It explores (1) the consequences of this persistent stigma, which necessitates the need for secrecy, (2) the adaptations made in order to successfully "pass as normal," and (3) the contexts in which methadone-maintained individuals decide to disclose their stigmatized status. The data reported and analyzed were gathered between 1980 and 1989 during a series of studies funded by the National Institute on Drug Abuse. The three studies--"Women on Methadone," "Getting Off Methadone," and "Alameda County Methadone Study"--utilized qualitative, in-depth interviews and ethnographic sampling techniques, primarily chain referral sampling. After ten years of interviewing women and men in various stages of their methadone maintenance careers, recurring themes emerged, one of which was that being a methadone patient is a marginal identity; not quite junkie, not quite conventional. Clients' efforts to manage this stigmatized identity were often shrouded in anguish and secrecy. Methadone patients were in a kind of identity limbo; a holding pattern between two extremely different social worlds. They were trying to effect an identity transformation; however, in many circumstances they were still associated with and defined by their "dirty secret."
75 citations
TL;DR: Analysis of the decision-making process of IDUs indicates that the party in the dominant role may choose not to disinfect a syringe for a variety of reasons, which suggests that education alone may be insufficient to produce behavior changes necessary to eliminate risk of HIV infection.
Abstract: Injecting practices of illicit drug users in San Antonio, Texas, were studied by means of informal field interviews and participant observation. The methods injection drug users (IDUs) employed to obtain drugs seemed to affect their HIV risk behaviors. Many of the methods involve reciprocal exchanges between a person who has drugs and a person who wants drugs. The exchanges frequently occur in the context of asymmetrical social interactions. The person with the drugs usually occupies the dominant role in the interaction and determines the needle hygiene for both parties. Analysis of the decision-making process of IDUs indicates that the party in the dominant role may choose not to disinfect a syringe for a variety of reasons. An understanding of the subcultural rules that govern these interactions may provide valuable clues to researchers or educators who are designing interventions aimed at reducing HIV risk behaviors among IDUs. This research suggests that for IDUs in subordinate roles, education alone may be insufficient to produce behavior changes necessary to eliminate risk of HIV infection.
74 citations
TL;DR: The data suggest that in this population of heroin users, crack is not a substitute for heroin but rather is a part of a drug-use pattern that includes an increased use of other drugs and increased high-risk behaviors for contracting HIV.
Abstract: Traditionally, researchers and clinicians have viewed street heroin users as representing an end point in a drug-using career. It is toward this population that major national treatment efforts have been directed. Concomitant with the historical national concern about heroin use has been concern about the increase in crack cocaine use. There has been speculation that crack use may have become a substitute for the higher risk of heroin injection. This article examines the impact of crack use in a national population of heroin users. It was consistently found that there was a correlation between the frequency of crack use and the frequency of speedballing as well as the use of other forms of cocaine, amphetamines, and marijuana. There was also a positive relationship between frequency of crack use and such HIV risk behaviors as renting needles and having a large number of sex partners. The data suggest that in this population of heroin users, crack is not a substitute for heroin but rather is a par...
TL;DR: Cocaethylene is a psychoactive homologue of cocaine, and is formed exclusively during the coadministration of cocaine and alcohol, resulting in euphoria, reinforcement, and self-administration as mentioned in this paper.
Abstract: Cocaethylene is a psychoactive ethyl homologue of cocaine, and is formed exclusively during the coadministration of cocaine and alcohol. Not a natural alkaloid of the coca leaf, cocaethylene can be identified in the urine, blood, hair, and neurological and liver tissue samples of individuals who have consumed both cocaine and alcohol. With a pharmacologic profile similar to cocaine, it can block the dopamine transporter on dopaminergic presynaptic nerve terminals in the brain. It increases dopamine synaptic content, provoking enhanced postsynaptic receptor stimulation, resulting in euphoria, reinforcement, and self-administration. Equipotent to cocaine with regard to dopamine transporter affinity, cocaethylene appears to be far less potent than cocaine with regard to serotonin transporter binding. Lacking the serotonergic-related inhibitory mechanism, cocaethylene appears to be more euphorigenic and rewarding than cocaine. Synthesized and administered cocaethylene has a behavioral stimulation profile similar to cocaine. Cocaethylene has been shown to be less potent and equipotent to cocaine, and alcohol plus cocaine produces more stimulatory locomotor behavior in mice than either drug alone. Equipotent to cocaine with regard to primate reinforcement and self-administration, cocaethylene can substitute for cocaine in drug discrimination studies, and can produce stimulation of operant conditioning in rats. With regard to lethality, cocaethylene has been shown to be more potent than cocaine in mice and rats. The combination of cocaine and alcohol appears to exert more cardiovascular toxicity than either drug alone in humans. Alcohol appears to potentiate cocaine hepatotoxicity in both humans and mice.
TL;DR: Findings suggest that the arrival of crack cocaine has directly and indirectly affected the drugs-prostitution nexus by lowering the price of sex for street prostitutes, altering the social status of cocaine, and increasing the level of social disorganization in illicit street activities, including prostitution.
Abstract: There are many ways that women support their use of crack cocaine, including sex-for-crack bartering and other forms of prostitution. Empirical studies conducted in the mid-1970s and in the mid-1980s in New York City, and in Chicago in the late 1980s to early 1990s are compared, analyzing similarities and differences between the contemporary crack-prostitution scene and previous prostitution scenes. Findings suggest that the arrival of crack cocaine has directly and indirectly affected the drugs-prostitution nexus by lowering the price of sex for street prostitutes, altering the social status of cocaine, and increasing the level of social disorganization in illicit street activities, including prostitution. Barterers are shown to be the heaviest drug users, using the greatest variety of drugs, using larger amounts of drugs, and using more frequently.
TL;DR: Findings are presented from a 1988-1990 study of a purposive but demographically diverse sample of 699 crack and other cocaine users in Miami, 349 of them interviewed in residential treatment and 350 interviewed on the street.
Abstract: The question of how cocaine overdoses are related to preferred routes of cocaine administration and other aspects of cocaine use patterns is sufficiently complex that very little information is available on it. Even the most extensive information on cocaine overdoses, that of the Drug Abuse Warning Network, is severely limited for purposes of examining this topic. Findings are presented from a 1988-1990 study of a purposive but demographically diverse sample of 699 crack and other cocaine users in Miami, 349 of them interviewed in residential treatment and 350 interviewed on the street. Among these respondents: a history of cocaine overdose is extremely common; overdose episodes do not commonly motivate treatment entry and in some populations are relatively unlikely to result in an emergency room visit; cocaine overdose is less associated with crack smoking than with snorting or intravenous (IV) use, whereas IV use is especially likely to result in overdose; and the street and treatment samples are strikingly different in regard to drug use patterns, overdose history, changes some users made to use patterns as a result of overdose experiences, and reasons given by other users for not making such changes.
TL;DR: The Phenethylamines I Have Known and Loved (1992) as mentioned in this paper ) is a collection of poems written by a woman about her relationship with a Phenethylimine.
Abstract: (1992). Phenethylamines I Have Known and Loved. Journal of Psychoactive Drugs: Vol. 24, No. 1, pp. 77-78.
TL;DR: The self-reported health status of the study population was good, but men perceived their health in a more positive light than did women, and HIV-seronegative men were most likely to report excellent or good health and seropositive women reported the greatest incidence of poor health, regardless of the amount of crack use.
Abstract: This study examines a population of inner-city crack cocaine users in Miami, Florida. Many study participants were also injection drug users; others were the sexual partners of injection drug users. In general, the self-reported health status of the study population was good, but men perceived their health in a more positive light than did women. HIV-seronegative men were most likely to report excellent or good health, and seropositive women reported the greatest incidence of poor health, regardless of the amount of crack use. Serostatus was statistically significant for women but not for men. Pneumonia was reported more frequently by women, while hepatitis and tuberculosis were reported more frequently by men. There was a significant gender difference in reported endocarditis among light users of crack, with more women that men reporting a history of endocarditis. Among sexually transmitted diseases, men reported more gonorrhea and women reported more syphilis. These gender differences were stat...
TL;DR: The methodological strategies and underlying paradigms informing the recruitment of hard-to-reach and ill-defined subpopulations of crack abusers and noncrack drug abusers are addressed and utility and external comparability of the recruitment techniques are supported.
Abstract: This study attempts to better understand a limited segment of the drug-abusing population, especially individuals who repeatedly use crack and other drugs. This article addresses the methodological strategies and underlying paradigms informing the recruitment of hard-to-reach and ill-defined subpopulations of crack abusers and noncrack drug abusers. Subjects were recruited from diverse social contexts: streets or communities where most drug users do their business, arrested persons who were released, jail inmates, probationers and parolees, prison inmates, and treatment settings. A systematic comparison of subject attributes across recruitment locales and with other, similar target groups is presented. The utility and external comparability of the recruitment techniques are supported by the findings.
TL;DR: The argument presented in this article is that it is not simply substance use that frames the experiences of women who use cocaine too much, but the social class mediated by gender and race.
Abstract: Monique (an African-American 19-year-old) and Becky (a white 21-year-old) were interviewed as part of a NIDA-funded study of women and cocaine. Although they were not necessarily typical, they do illustrate some of the differences among women who use cocaine. Despite the fact that they were close in age and both used cocaine, their scenarios and outcomes were very different, as one was a white middle-class woman and the other was an underclass woman of Color. The argument presented in this article is that it is not simply substance use that frames the experiences of women who use cocaine too much, but the social class mediated by gender and race. Through these life histories, the lives of these women are examined prior to cocaine use. Then the differential processes of initiation into and continuation of cocaine are described and analyzed, followed by a discussion of their lives after cocaine use.
TL;DR: Results from a systematic study of a large sample of cocaine users suggest that the respiratory consequences of alkaloidal cocaine are most likely attributable to the inhaled cocaine itself, rather than to variable characteristics of usage.
Abstract: This article offers a perspective on the use of volatilized alkaloidal cocaine in its freebase and crack forms and on the pulmonary consequences of such use. The inhalational route of administration of freebase and crack cocaine exposes the lung to their combustion products, raising concern about possible adverse pulmonary effects. A brief historical review of cocaine and its methods of use precedes the presentation of data concerning current modes and patterns of use and some pulmonary complications of crack and freebase use. Results from a systematic study of a large sample of cocaine users document a high frequency of occurrence of acute respiratory symptoms in temporal association with cocaine smoking. No relationship was detected between the prevalence of acute pulmonary symptoms and identifiable aspects of techniques of cocaine administration. These results suggest that the respiratory consequences of alkaloidal cocaine are most likely attributable to the inhaled cocaine itself, rather than to variable characteristics of usage.
TL;DR: The characteristics and clinical features of the patients with both a B-cluster personality disorder and substance abuse as well as a model for understanding some of the motivating principles behind the patient's conduct, feelings, thoughts are presented.
Abstract: The patient population that presents with both a B-cluster personality disorder and substance abuse is a challenge to professionals in both the mental health and substance abuse treatment fields. The coexistence of both disorders is not uncommon and is frequently encountered in substance abuse treatment, social welfare, and mental health settings. The complexity of the clinical picture for these patients and their greater resistance to treatment severely taxes the practitioner's skills. Even without a clear understanding of the primary causative pathology, effective treatment modes based on a recognition of the interactive and interdependent nature of the two disorders can be developed. Part I of this two-part article presents the characteristics and clinical features of the population as well as a model for understanding some of the motivating principles behind the patient's conduct, feelings, thoughts. This is followed by guidelines for the clinician's attitude, desired characteristics, and rol...
TL;DR: The characteristics and clinical features of the patient population that presents with both a B-cluster personality disorder and substance abuse and further recommendations for the treatment of this population are presented, taking into account how the combination of these disorders manifests itself.
Abstract: Part I of this two-part article described the characteristics and clinical features of the patient population that presents with both a B-cluster personality disorder and substance abuse. It also included guidelines for the clinician. Part II presents further recommendations for the treatment of this population, taking into account how the combination of these disorders manifests itself. The treatment approach should be kept simple and easy for patients to understand and should promote their ability to think rationally about the effect of their emotions on their behavior and its outcomes. A firm structure is critical to compensate for the lack of internal control of these patients and to prevent the manipulation that results from their view of the instrumentality of others. Denial, resistance, countertransference, and relapse to addictive behaviors are all potential barriers that are often encountered when attempting to treat this population. Group therapy with this population presents unique challenges to the clinician. As with individual therapy, a firm structure is imperative, with the clinician in charge of process and content.
TL;DR: In this paper, retrospective reports of Psychiatric Symptoms Before, During, and After Drug Use in a Recovering Population are presented, with a focus on the effects of drug use on mental health.
Abstract: (1992). Retrospective Reports of Psychiatric Symptoms Before, During, and After Drug Use in a Recovering Population. Journal of Psychoactive Drugs: Vol. 24, No. 1, pp. 65-68.
TL;DR: The resurgence of the use of LSD by a young, inexperienced population increases the likelihood of the occurrence of adverse psychedelic reactions, and nonjudgmental talkdown, intramuscular lorazepam and haloperidol offer invaluable and specific adjuncts to care.
Abstract: The resurgence of the use of LSD by a young, inexperienced population increases the likelihood of the occurrence of adverse psychedelic reactions. While the treatment of choice remains supportive, nonjudgmental talkdown, intramuscular lorazepam and haloperidol offer invaluable and specific adjuncts to care.
TL;DR: In this article, the impact of methadone maintenance treatment on staff and patients is discussed, and the effect of its politics on patients and staff is discussed. Journal of Psychoactive Drugs: Vol. 24, No. 3, pp. 281-283.
Abstract: (1992). Methadone Maintenance Treatment: Impact of Its Politics on Staff and Patients. Journal of Psychoactive Drugs: Vol. 24, No. 3, pp. 281-283.
TL;DR: Odyssey House has conducted an annual marathon therapy group for women who are rape survivors, and this article summarizes the program's experience with the marathon and reports on its therapeutic accomplishments.
Abstract: Odyssey House is a therapeutic community (TC) in New York City that treats a wide range of drug abusers. For over 20 years. Odyssey House has conducted an annual marathon therapy group for women who are rape survivors. This article summarizes the program's experience with the marathon and reports on its therapeutic accomplishments.
TL;DR: It is argued that recovery can occur either by abstinence or through moderating drinking, which leaves the clinician in a quandary about how best to treat an individual who experiences a drinking problem.
Abstract: This article discusses conducting psychotherapy with alcoholics in light of the controversy about whether alcoholism is a disease. The belief that alcoholism is a disease forces many clinicians to offer abstinence from alcohol as the only option for alcoholics who seek treatment. From this perspective, the alcoholic must be helped to accept the idea that he or she has a disease and that to recover from this problem, drinking must stop. Others maintain that alcoholism may not be a disease and view alcoholic drinking as maladaptive behavior. From this vantage point, helping the patient to control or to moderate drinking might be considered. These two distinct paradigms lead to divergent treatment goals, which leaves the clinician in a quandary about how best to treat an individual who experiences a drinking problem. To resolve this dilemma, it is suggested that the clinician who works with alcoholics entertain a multiplicity of perspectives and should not be blinded by any one paradigm. While control of alcohol intake must take place if such patients are to improve their functioning, the author argues that recovery can occur either by abstinence or through moderating drinking.