Showing papers in "Journal of Psychoactive Drugs in 1993"

Women and Crack-Cocaine

Abstract: (1993). Women and Crack-Cocaine. Journal of Psychoactive Drugs: Vol. 25, No. 4, pp. 347-349.

Against Excess: Drug Policy for Results

Abstract: (1993). Against Excess: Drug Policy for Results. Journal of Psychoactive Drugs: Vol. 25, Culturally Relevant Substance Abuse Treatment, pp. 175-176.

Substance abuse treatment: cultural barriers in the Asian-American community.

Abstract: Asians constitute the largest growing minority in the United States. However, inaccurate perceptions and stereotypes continue to mask a full understanding of the state of knowledge regarding their alcohol and other drug abuse. Much of the existing research has continued this trend by categorizing Asians as "others" or persisting in its attempts to explain low incidence rates by investigating metabolic phenomena. More recent community-based studies have shown alarming incidence rates of specific substance abuse among different Asian ethnic groups. Asian heterogeneity and cultural barriers have also contributed to the lack of knowledge regarding substance abuse prevalence rates. Issues related to taboo, denial, and loss of face further mask understanding of the extent of the problem. Institutional barriers and the lack of community infrastructure make treatment efforts difficult in serving a myriad of Asian groups. For most Asians undergoing treatment, cultural factors need to be considered, including the involvement of the family as well as the risk related to its transition under immigration and the following acculturation patterns. An example of a specific treatment program and activity is discussed in relationship to the cultural factors indicated above. Finally, recommendations are specified for future treatment policy, research, and services.

"Stage of change" by drug problem in concurrent opioid, cocaine, and cigarette users.

Abstract: Within the field of addiction, the majority of work regarding "stages and processes of change" has focused on single drug problems, such as cigarette smoking or alcohol use. However, the majority of the substance abuse treatment population present with more than one substance use disorder. This article reports the results of the internal consistency and test-retest reliability of the University of Rhode Island Change Assessment (URICA) in a sample of 41 methadone-maintained, opioid-dependent male veterans who had concurrent problems of cigarette and cocaine dependence. These volunteers were given a URICA for each of their three drug problems, followed by a repeated administration three to five days later. All the stage-of-change scale scores showed excellent internal consistency and stability across the three- to five-day interval for all three drug problems, thus confirming the reliability of the measure in this population. URICA scores were lowest on the precontemplation stage, with higher and approximately equivalent scores on the other three stage measures. Most surprising was that these profile scores were almost identical across the three drugs tested, suggesting limits to the validity of this measure with this population.

Entangled epidemics: cocaine use and HIV disease

Abstract: Over the past decade, two epidemics have had a severe impact on public health in this country. These health problems involve cocaine abuse and AJDS (or HIV disease). The processes of these two conditions are clearly not independent of each other and may be quite complex. Understanding of this relationship has been hampered by a myriad of social, biological and behavioral variables that are entangled with the basic cocaine-HIV association. This article presents a paradigm for discussion of the interaction between cocaine exposure and HIV disease based on three mechanisms: the relationship between cocaine exposure and increased opportunity for HIV exposure, the direct role that cocaine plays in altering susceptibility to HIV infection, and the influence that cocaine usc has on the progression of HIV disease. The goal of this structured approach is to enhance conceptual understanding of the cocaine-HIV relationship while recognizing the complexity of the issue and the limitations of current research...

Is the Therapeutic Community Culturally Relevant? Findings on Race/Ethnic Differences in Retention in Treatment

Abstract: The therapeutic community (TC) views cultural diversity as an essential ingredient in its treatment approach. However, based on clinical observation and some research, questions persist concerning the relevance of TC programing for numerical race/ethnic minorities. This article briefly reviews pertinent research and presents findings from recent studies on race/ethnic differences in readine ss and suitability for, and retention in, TC treatment. A framework is outlined for the empirical study of cultural relevance issues in TCs.

African-centered drug treatment: an alternative conceptual paradigm for drug counseling with African-American clients

Abstract: An alternative conceptual framework is presented for understanding the culturally normative behavior of African-Americans in drug abuse treatment and recovery, based on an appreciation of core African-centered beliefs. Key ontological and epistemological assumptions of traditional clinical and counseling interventions are presented that highlight the differences between traditional goals and theories and the proposed alternative conceptual system and treatment strategies. Implications for African-centered treatment and future research on the course of addiction and recovery among African-Americans are discussed.

Gender differences among African-American substance abusers.

Abstract: The purpose of this investigation was to determine if there were gender differences in 80 medical records (37 African-American men and 43 African-American women) from one drug treatment facility located in a midwestern city. Using independent t-tests and chi square analyses to determine group differences, there were significant gender differences relative to childhood sexual abuse experiences and maternal alcohol and other drug abuse; however, there were no gender differences relative to most drug-related behaviors and to paternal alcohol or other drug abuse. Implications for further study are discussed.

Stigma or Legitimation? A Historical Examination of the Social Potentials of Addiction Disease Models

Abstract: This article presents a historical discussion of disease models of opiate addiction in the United States in the twentieth century. First, several approaches to defining disease are discussed. Then, the shifts in formulations of opiate addiction as a disease in the twentieth century in the U.S. are analysed in light of the preceding theoretical discussion. The period before 1920 is described as heterodox, as researchers attempted to develop scientific models of opiate addiction, while various medically legitimate and quasi-legitimate treatment approaches flourished in an unregulated marketplace. After 1920, a stigmatizing disease model of opiate addiction was based on a psychiatric formulation that linked chronic addiction with psychoneurotic deficits in certain individuals. After 1940, this model dominated medical and scientific thinking about opiate addiction for several decades. After 1970, enormous changes in the demographics of drug use forced changes to the prevailing model of addiction. A new focus on behavioral aspects of addiction allowed the creation of a nonstigmatizing Parsonian disease model.

Cultural points of resistance to the 12-Step recovery process

Abstract: This article addresses some of the key issues in developing culturally relevant approaches to drug abuse treatment and recovery, using the HAFC/Glide African-American Extended Family Program as a positive example of effective cultural adaptability within recovery. Cultural points of resistance to the recovery process are also addressed, including the perception that 12-Step fellowships are exclusive and confused with religion, confusion over surrender versus powerlessness, and concerns about low self-esteem, dysfunctional family structure, communication difficulties, and institutionalized and internalized racism. The authors also focus on professional resistance in other countries, where different treatment approaches and philosophies block the acceptance of a recovery concept in general and the 12-Step process in particular. In explicating these issues, addiction is presented as a multicultural problem in need of multicultural solutions. The challenge is to adapt the process of recovery to all cultures and races, to counter stereotypes on all sides, and to eliminate the perception that recovery only works for addicts from the White mainstream.

Strategies for Increasing Retention in Methadone Programs

Abstract: Data from the nationwide Treatment Outcome Prospective Study were analyzed to develop strategies for increasing patient retention in methadone programs. The sample comprised 351 daily or weekly heroin users who were admitted to 17 publicly funded methadone programs and completed intake, one month in treatment, and one-year follow-up questionnaires. The analysis suggests three strategies for increasing patient retention: providing more highquality social services, making programs more easily accessible, and individualizing treatment. The analysis also identifies characteristics of patients and programs to which these strategies should be targeted to increase patient retention in methadone programs.

Issues to Consider When Predicting Retention in Therapeutic Communities

Abstract: Many studies have focused on retention in therapeutic communities (TCs) because research shows that retention is an important predictor of client outcomes from these programs. A comparison of the three largest studies found there was little overlap between predictors of retention in TCs. Treatment Outcome Prospective Study data were analyzed to assess whether these findings may have been due to differences in times when the data were collected, measures oflength of stay, and domains of variables used to predict retention. While the results suggest that each of these factors contributed to some differences between predictors of retention, the predictors still were unable to explain more than a small amount of the variance in retention. Research indicates that other variables need to be taken into account if future studies are to be more successful in predicting retention in TCs.

Sociodemographic and attitudinal correlates of alcohol and other drug use among children and adolescents: analysis of a large-scale attitude tracking study.

Abstract: Data from the Partnership Attitude Tracking Study are analyzed to provide a greater understanding of the contributing factors to alcohol and other drug use among children and adolescents. The data were collected from children (ages 9 to 12) and teenagers (ages 13 to 17) in central locations (usually shopping malls) located in 100 primary sampling units across the United States. The analysis, which primarily employed stepwise multiple regression for model estimation, reinforced the importance of friends use, perceived risk, and tobacco and alcohol use in predicting marijuana use. An exposure model, which included antidrug advertisements, was a particularly powerful model. Implications of the findings are discussed.

Lesbians and alcohol: patterns and paradoxes in medical notions and Lesbians' beliefs

Abstract: There is growing awareness in the lesbian community about the prevalence of alcohol problems, and the meanings and values attached to alcohol use are currently undergoing change. Little research has focused on lesbians' life experiences and alcohol use practices, although in earlier decades a number of medical theories linked lesbianism with alcohol problems as copathologies. More recent theories from the social sciences also linked lesbianism with alcohol problems, but on the basis of sociocultural dynamics and consequent negative self-images. This article compares and contrasts medical theories about lesbians and alcohol with lesbians' own ideas about alcohol use and alcohol problems. Mutually reinforcing themes in medical views and lesbians' experiences are identified. The analysis clarifies what is at stake in the current debates about alcohol, alcohol problems and recovery experiences in the lesbian community, and offers suggestions for research, theory, and practice regarding this significant health issue.

Cultural issues in an outpatient program for stimulant abusers

Abstract: Cocaine abuse has created widespread problems, especially in poor urban ethnic minority communities. This article discusses the cultural issues in delivering a cocaine treatment program to a predominantly minority patient population. The Stimulant Treatment Outpatient Program (STOP) of San Francisco General Hospital's Substance Abuse Services was established in 1990 as a public service clinic. Many program elements apply equally well to various cultural groups, including individual and group counseling, limited time in treatment, and crisis intervention. Culturally linked clinical issues include provision of a supportive infrastructure, role models in leadership positions, understanding the cultural influences in patients' lives, and establishing communication links with clients. Cultural themes are discussed as they apply to treating African-Americans, Latinos, AsianAmericans, Native Americans, and clients of different genders. Programmatic outcome indicators, including program attrition, sugges...

Priorities for Alcohol Treatment Research Among U.S. Hispanics

Abstract: This article reviews the clinical research conducted with U.S. Hispanics and discusses priorities for alcohol treatment research in this ethnic group. Specific areas in which research is needed include epidemiological descriptions of client characteristics, access and utilization of alcohol treatment, the structure of alcohol programs, pathways to treatment, alcohol dependence and treatment effectiveness, and treatment matching in alcohol treatment. Methodological requirements, research funding strategies, and professional training needed for implementing the research needs identified in the article are also discussed. A concerted effort by funding institutions is needed to emphasize the importance of this research, and an increased commitment of funds for research and professional training is necessary. Such funds should be earmarked for research with minorities and training for minority professionals.

Types of benzodiazepines abused by chemically dependent inpatients.

Abstract: Records of inpatients (N=1,483) ove r a three-year period at an addiction treatment center were evaluated for the presence of benzodiazepine (BZ) dependence (N=136). The preferred BZ for 43% of the subjects was diazepam, and alprazolam for 14% of subjects. Chlordiazepoxide, lorazepam, and clorazepatc were each the preferred bZ for 4% of patients. Cocaine and opioid abusers were six times more likely to abuse diazepam than any other BZ. Alprazolampatients required asignificantly longer period of detoxification than diazepam patients. Four percent of BZ-dependent patients (N=6) abused BZs only and had no other substance abuse history.

Decline in HIV-1 seroprevalence and low seroconversion rate among injecting drug users at a methadone maintenance program in New York City.

Abstract: To monitor the trend of HIV-1 seroprevalence, 2,194 newly admitted injecting drug users (IDUs) in a methadone maintenance program in New York City were tested from June 1988 through June 1992. This was a blinded study and unlabeled blood specimens were collected during the required physical examination. There was a significant linear trend (p=.01) toward decline in HIV-1 seropositivity by year of admission as follows: 4 7.0% in 1988, 43.4% in 1989, 43.2% in 1990, 39.8% in 1991, and 39.1% in 1992. From January 1988 through December 1992, admissions data that included the newly admitted IDUs showed a significant decrease (p<.0002) in self-reported current needle sharing from 11.3% to 5.4%. These two data sources suggest that a continued decline in HIV-1 seroprevalence among new admissions may be related to decreased needle sharing. A volunteer cohort of 235 HIV-1 seronegative IDUs was also enrolled from April 1990 through June 1991 in a study of HIV-1 seroconversion. Follow-up data were available o...

Individual psychotherapy for addicted clients: an application of control mastery theory.

Abstract: This article presents an overview of Control Mastery Theory, developed by Joseph Weiss, and applies this theory to the treatment of alcohol- and other drug-addicted clients. The article proposes that individual psychotherapy, in conjunction with self-help and other chemical dependency treatment programs, may be a significant component of the treatment of addicted clients. According to Weiss's theory, addicted clients are suffering not only from the direct effects of addictive disease but are also often suffering from unconscious pathogenic beliefs acquired from childhood experiences. Pathogenic beliefs result in shame, guilt, fear, and inhibitions that predate the development of addiction. Adicted clients are highly motivated unconsciously to recover from their addiction and to pursue normal goals. They are hindered by their pathogenic beliefs and by the effects of their addiction. They enter treatment with an unconscious plan to stop using drugs and to disprove their pathogenic beliefs. They tes...

A Neurochemical Basis for Alcohol and Other Drug Addiction

Abstract: There are major clinical observations in alcohol and other drug addicts and neurochemical studies in animals and humans that support the hypothesis for a common neurochemical basis for alcohol and other drug addiction. The common occurrence of concurrent alcohol and multiple drug dependence in clinical and general populations, family history and genetic studies, and basic and clinical research in the neurochemistry of addictive behavior provide evidence for a common genealogical vulnerability to combined alcohol and other drug addiction. Clinical neurochemical models for addictive behaviors can be derived from neurochemical pathways for the initiation and sustenance of addictive disorders. The role of tolerance and dependence is not specific to addiction but indicates a homeostatic response of the brain to the presence of a foreign substance. Animal and human studies are analyzed for clinical synthesis of a neurochemical basis for addictive disorders.

Training of Residents and Medical Students in the Diagnosis and Treatment of Dual Diagnosis Patients

Abstract: Treatment of dual diagnosis patients requires simultaneous treatment of the addictive and the mental disorders. Available data suggest that this does not happen often. In a survey of several psychiatric services, the unit chiefs reported that dual diagnoses were underreported, no plans were present for combined treatment, families were infrequently involved, and few referrals were made for combined treatment. There is a need for competent, experienced clinician teachers who have had positive experience with the treatment of dual disorders. The training of addiction and mental health professionals must include cooperation, understanding, and respect for each other. Cross-training is needed in chemotherapy, psychotherapy, abstinence from alcohol and other addictive drugs, 12-Step programs, spiritual issues, and milieu therapy. Negative attitudes and ignorance must be overcome for this training to take place. Faculty Fellow training programs have provided a beginning in this direction, but have so f...

Enrollment of Drug Abusers in HIV Clinical Trials: A Public Health Imperative for Communities of Color

Abstract: There is an increasing appreciation of the impact of drug abuse on AIDS in the United States because of the pivotal role of injecting drug use in the prevalence of total AIDS cases and case reporting among ethnic/racial minorities, women, and children. While the participation of injecting drug users (IDUs) in HIV clinical trails has increased steadily, the IDU accrual rate lags unacceptably behind the IDU proportion of AIDS cases. The stigma of drug abuse, issues related to poverty, and the underrepresentation of communities of color are the major obstacles to IDU participation in HIV clinical research. It is critical to overcome these obstacles as the spectrum of HIV disease in IDUs requires the development of an IDU-relevant scientific agenda for HIV clinical trials. This, in turn, is crucial to the development of effective therapies for the treatment of HIV disease in IDUs. To the extent that these endeavors are successful, more relevant therapies to communities of color will be developed, as injecting drug use is disproportionately more prevalent in these communities.

Addressing treatment needs of Southeast Asian Mien opium users in California.

Abstract: This report describes efforts in progress to meet the needs of opium smoking Mien immigrants in Oakland, California. Translating concepts of addiction and recovery into terms that are culturally relevant constitutes the basis for efforts to assist the Mien to adjust to an opium-free lifestyle. The acceptability and utility of clonidine, acupuncture, methadone, counseling, support groups, and other medical services are discussed.

At war in the fields of play: current perspectives on the nature and treatment of adolescent chemical dependency.

Abstract: While the numbers of adolescents entering drug abuse treatment are not increasing dramatically, those entering treatment are getting sicker, according to clinical reports. Adolescents are entering treatment with multiple problems, including severe learning disorders, borderline personality disorders, multiple diagnoses of addiction, mental health and physical problems (including HIV/AIDS), and issues arising from child abuse and incest. A case study in client-therapist interaction is presented, highlighting the concept of the wounded healer. The disease model of addiction is discussed as it applies to adolescents, as is their need for habilitation, not rehabilitation. Current abuse trends and the drugs involved are also discussed. Multiple diagnoses, physiologic disorders, HIV testing and counseling, surgical problems, and maternal/neonatal complications are reviewed.

Cross-cultural counseling with the chemically dependent: preparing for service delivery within a culture of violence

Abstract: This article prepares the clinician delivering chemical dependency treatment for more effective work in therapeutic dyads where there are racial, ethnic, or other "differences" between client and therapist. The objective is to prepare clinicians for service delivery within the present culture of violence and for the receipt of additional training in cross-cultural counseling and trauma-resolution psychotherapy. Social learning and unconscious processes are reviewed in order to explain how this culture of violence operates and impacts treatment. The way in which chemically dependent clients of color--especially African-Americans, Native Americans, and Latinos--have been impacted by both personal and cultural trauma is illustrated by a case example. The resolution of clients' personal trauma by properly trained clinicians is presented as relapse prevention and the clients' best defense against becoming a victim of violence and racism. The article ends with a brief description of the recommended clinical technique for this kind of work, and a statement of needed research.