Showing papers in "Journal of Psychoactive Drugs in 1996"

Illicit Use of Ketamine in Scotland

Abstract: Semistructured interviews were carried out with 20 illicit users of ketamine in Scotland. Participants had used a wide range of illegal drugs. Scottish drug agencies reported limited contact with ketamine users; however, subjects were knowledgeable regarding the licit purpose of ketamine, its effects, and its legal status. Ketamine was usually obtained through diversion from legitimate sources. Three participants reported extensive use, indicating the potential for psychological dependence. A standard dose of ketamine was typically 1/8 g, usually taken intranasally. Participants reported the ketamine experience as being extremely intense and dissociative, usually lasting for approximately one hour. All participants reported using ketamine in a carefully preplanned setting, emphasizing comfort, security, and familiarity. Participants identified potential problems arising from using ketamine in a public place, or in unfamiliar surroundings, and also suggested that novice users may encounter problems through lack of knowledge concerning the intense nature of the experience. Accurate information concerning the effects and nature of ketamine as well as the importance of set and setting should be made available. However, publicizing the drug should be avoided as widespread interest could cause greater problems than currently exist.

Sexual abuse, physical abuse, and posttraumatic stress disorder among women participating in outpatient drug abuse treatment

Abstract: Findings from a prospective, longitudinal study of 182 women and 148 men in outpatient drug abuse treatment programs indicate that women are significantly more likely than men to experience sexual and physical abuse Sexual and physical abuse are associated with higher levels of posttraumatic stress disorder (PTSD) symptomatology Moreover, women are more likely than men to possess an array of psychological factors that predict relapse to drug use after treatment, including low self-esteem, depression, anxiety, and suicidal behavior, among others But contrary to expectation, PTSD is not associated with relapse to drug use, nor are women more likely than men to relapse within a six-month posttreatment interval Further analysis indicates that while women have more psychological risk factors associated with relapse, they are more likely than men to engage in the treatment process Engagement in treatment, notably frequent participation in group counseling, appears to mitigate the higher risk of relapse for women

Development of a School-Based Drug Abuse Prevention Curriculum for High-Risk Youths

Abstract: This paper presents the rationale for and description of the empirical curriculum development process in Project Towards No Drug Abuse (Project TND), which is a five-year grant funded by the National Institute on Drug Abuse. First, the target population is described, continuation high-school youths who are at high risk for drug abuse. The rationale for developing a classroom-based curriculum tailored for them is also provided. Second, a brief description is provided of state-of-the-art generic social influences drug abuse prevention programming, which has been found to be the most effective among young adolescents. There is a the need to consider other prevention activities, particularly those that include motivational variables, to maximize prevention efforts among higher-risk youths. Third, five types of curriculum development studies are discussed that led to a curriculum that is being implemented with continuation high-school students at schools in five counties in southern California. Finally, the contents of the final curriculum product is provided, which consists of motivation, skills-training, and decision-making components.

Prevalence of Depression and Alcohol and Other Drug Dependence in Addictions Treatment Populations

Abstract: The diagnosis of depression has been viewed as an important factor in the treatment response for those who have alcohol and other drug dependence. The objective of the study was to examine the prevalence of a lifetime history of major depression in inpatients with a substance use disorder in addictions treatment. An evaluation study of 6,355 patients was conducted in inpatient and outpatient addictions treatment programs from 41 sites. Subjects were required to have a substance use disorder and to be evaluated for a lifetime diagnosis of major depression according to DSM-III-R criteria. The rate of a lifetime diagnosis of major depression was 43.7%. The most common diagnosis was alcohol dependence, followed by cocaine dependence, and cannabis dependence). Depression was associated in significantly greater numbers with diagnoses involving drugs other than alcohol, in females greater than in males, with number and frequency of use, and in inpatient programs more than outpatient programs. The rates for continuous abstinence at one year did not differ between those with and without a lifetime history of depression.

Guilt, Shame, and Depression in Clients in Recovery from Addiction

Abstract: Men and women in recovery from addiction were compared on levels of depression, guilt, and shame. The measurement of guilt included subscales of Survivor Guilt, Separation Guilt, Omnipotent Responsibility Guilt, Trait Guilt, State Guilt, and Adaptive Guilt. The sample included 75 men and 33 women in treatment in a residential treatment community. It was found that women were significantly higher than men in depression. The recovering subjects were compared to nonaddicted subjects and established norms, and it was found that the recovering people were higher on depression, shame, and the subscales of maladaptive guilt. Both men and women in recovery were significantly lower than norms in adaptive guilt.

Abuse of Flunitrazepam (Rohypnol) And Other Benzodiazepines in Austin and South Texas

Abstract: Flunitrazepam (Rohypnol) is a benzodiazepine sedative-hypnotic that has generated significant media attention in the United States because of its abuse and its association with “date rape.” A field...

Background and overview of mental health and substance abuse treatment systems: meeting the needs of women who are pregnant or parenting.

Abstract: Women with a psychiatric disorder who also abuse alcohol or other drugs have historically encountered barriers to integrated treatment for both disorders. Substance abuse treatment services and mental illness treatment services are usually organized independently of each other and few are designed to meet the needs of pregnant and parenting women. This chapter reviews the developmental histories of treatment systems for psychiatric and substance abuse disorders; the structural barriers that impede the delivery of services to individuals with co-occurring psychiatric and substance abuse disorders; the prevalence of dual disorders; issues related to diagnosis and assessment, types of diagnoses and addictions; treatment issues specific to women who are pregnant or parenting; models of service delivery; and initiatives directed at changing treatment systems.

Bufo Toads and Bufotenine: Fact and Fiction Surrounding an Alleged Psychedelic

Abstract: This paper investigates the supposedly psychedelic Bufo toad and the allegedly psychedelic drug bufotenine, which is contained in the skin and glands of this toad. The Bufo toad has held a place in human mythologies and medicines worldwide since archaic times. Used by ancient peoples for a variety of purposes, its most spectacular effects, according to lore, involve magical and shamanic or occult uses for casting spells and for divination. In the Middle Ages, the Bufo toad was celebrated as a panacea and persecuted as a powerful poison. More recently, in the 1960s the Bufo toad was resurrected as a countercultural icon, with people purportedly licking or smoking the secretions to get high. Bufotenine has been at the center of a scientific debate since its discovery in 1893. This paper examines the extensive literature surrounding the Bufo toad and bufotenine, and untangles many of the myths and the misinformation that continue to vex both science and popular reporting. Finally, to promote further...

Treatment as harm reduction, defunding as harm maximization: the case of methadone maintenance.

Abstract: Despite numerous research studies demonstrating the efficacy of methadone maintenance treatment (MMT) in general and the value of retention in particular, the increasing defunding of this modality has compromised its potential. From 1990 to 1995 the lead author conducted a longitudinal research project to determine the impact of the cost of treatment on 233 San Francisco Bay Area study participants seeking, enrolled in, or defunded from MMT. This paper reports on selected findings from that study. Using variables of drug use, crime, gender and HIV risk, qualitative and quantitative results comparing those seeking treatment with those enrolled in treatment indicated that MMT functioned as a harm-reduction tool. When clients were defunded, however, drug use, crime and HIV risk increased and harm was maximized.

Attention deficit disorder in adults and nicotine dependence: psychobiological factors in resistance to recovery?

Abstract: The addictive nature of nicotine appears to depend on a number of psychobiological factors. This study explores the psychoactive effects of nicotine in relationship to the particular dysphoric aspects of Attention Deficit Disorder as a coincident factor in nicotine dependence and resistance to treatment. The psychological and behavioral effects of nicotine directly correspond to reduction in symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) and the neurochemical effects of nicotine are qualitatively similar to stimulant medications used to treat ADHD. Aspects of the treatment of nicotine or other addictions in such comorbid situations are discussed in the context of self-medication.

Gender differences in social and psychological problems of substance abusers: a comparison to nonsubstance abusers

Abstract: This study examines gender differences in 16 social and psychological problems among substance abusers and nonsubstance abusers in a community population to determine whether such differences are simply a reflection of differences between men and women in the general population. Data were gathered from 119 respondents using the Addiction Severity Index. Loglinear analysis suggests that problems typically attributed to “being a female substance abuser” may be due to the effect of gender or substance abuse alone. Only two problems significantly distinguish female substance abusers from the other comparison groups: psychiatric hospitalizations and relatives with substance abuse. However, women in the overall sample were more troubled by family problems, had more parents with psychiatric problems, and received more outpatient psychiatric treatment. Problems associated with substance abuse, not gender, include divorce, problems controlling violence, and parents with substance abuse problems. These fin...

Retention in Methadone Maintenance Treatment Programs, Connecticut and Massachusetts, 1990 – 1993

Abstract: The goal of this study was to identify factors associated with six- and 12-month retention in methadone maintenance treatment programs (MMTPs) in Massachusetts and Connecticut. Data was obtained from 674 participants, clinic records, and clinic staff. Ethnographic and logistic regression analyses were conducted. Overall, 69% and 48% of the clients remained in treatment at six months and 12 months, respectively. The MMTPs were categorized as either a 12-Step, case management, or primary care model. Factors independently associated with retention in treatment at six months were each one-year increase in age of client (OR 1.05), injecting at three months (OR 0.47), and enrollment in the primary care model (OR 2.10). The same factors were associated with 12-month retention in treatment. To retain clients in MMTPs-which should, in turn, help reduce drug use and prevent HIV transmission among IDUs-younger IDUs and clients still injecting at three months after entering drug treatment may need additional services from the staff, or alternative treatment regimens. MMTP directors should consider differences between these programs and, if appropriate, make changes to increase retention in treatment.

Improving detoxification outcomes from methadone maintenance treatment: the interrelationship of affective states and protracted withdrawal.

Abstract: Changing paradigms of health care and increasing knowledge of opioid addiction continue to influence the attitudes of the health profession toward methadone maintenance treatment (MMT) This approach has again reached the forefront of attention because of its significant role in reducing HIV transmission associated with intravenous drug use. In spite of the well-documented benefits of MMT, patients continue to detoxify from methadone for a variety of reasons both overt and covert. Variable outcomes and generally poor long-term abstinence rates result. At present uncertainty still exists surrounding who should attempt detoxification, when or how this should be done, or whether in fact detoxification should be attempted at all. This article describes and examines factors that are positively and negatively associated with detoxification outcome. Evidence for the interrelationship of two notably significant determinants, affective states and protracted withdrawal, are presented and discussed as they r...

The Semantics of Addiction: Moving Beyond Expert Models to Lay Understandings

Abstract: Five expert discourses on addiction purport to explain the phenomenon of the semantics of addiction. An assessment of the burgeoning use of this term by the lay public, however, reveals a plethora of socially contextualized and culturally mediated meanings related to addiction that are generally not considered by expert models. Addiction has meanings that index the loss of self-control and individual responsibility, as well as political and moral meanings and meanings that index social modes of consumption, the range and limits of normative behavior, and the constitution of deviance. The category of addiction interacts with other socially produced categories, including “drugs” and “desires,” and implies an unfolding history linked to specific cultural conventions of what is proper. This paper briefly reviews expert debates over the meanings of addiction and explores the semantics of how this term is used in both popular discourse and among those who use substances associated with physical addicti...

Women offenders and reentry issues

Abstract: Women parallel men in their profile of physical disease, psychosocial configuration, addictive patterns, and criminal deviance. For women offenders in particular, the prison environment reinforces a victim role that originated in childhood and adolescence. In addition, such settings discourage both emotional expression (except for aggression) and responsibility, since basic needs such as food, lodging, and clothing are provided. Incarcerated women have significant treatment issues, including the lack of social and vocational role definition, psychological dependence and psychic craving, poorly developed social skills, and conflicts in social, family, and intimate relationships. This article describes the unique psychoeducational and skills-training needs of women offenders as they adjust to community living, and outlines specific treatment interventions that have proven to effect successful patient outcomes. Case studies are used to illustrate the reentry experiences of three women offenders with distinct backgrounds. One example illustrates how a woman who had been involved in the criminal justice system for 24 years overcame her addiction and self-confidence issues. A second case study profiles an offender with three children who had experienced sexual trauma during her childhood and adult years. A third case reports on an African-American woman whose crack-cocaine addiction resulted in the birth of a drug-exposed son. The treatment model tested in all three cases emphasized the practical and often overlooked treatment issues of incarcerated women.

Challenges in moving from a traditional therapeutic community to a women and children's TC model.

Abstract: With the advent of specialized programs for addicted women and their children, some of the traditional methods used by therapeutic communities have been undergoing significant changes. This article examines the issues that are important for treatment providers to consider as they move from individual client and community orientation to a mother-child/family-centered and community approach. The major adaptations suggested are divided into three categories: structural design issues, including living arrangemcnts and models of childcare; treatment issues, including acting-out behavior by the children; and staff and training issues, including staff composition.

Posttreatment outcomes for substance-abusing probationers mandated to residential treatment.

Abstract: This article presents an initial evaluation of a community-based substance abuse treatment program for probationers described in a previous issue of the Journal of Psychoactive Drugs [27(1): 39-47]. Posttreatment outcomes for 492 probationers remanded to a six-month residential facility were assessed. Based on official state records, 9% of the probationers were rearrested in the six months following discharge from treatment. Those who graduated from the program were significantly less likely to be rearrested during the follow-up interval than were program expulsions and transfers to other programs. Also, program graduates who attended a specialized residential aftercare program were more likely to remain drug-free and be employed after treatment than were those who did not attend the specialized aftercare program. Collectively, results suggest that lower rearrest rates may be associated with the provision of residental treatment to substance-abusing probationers.

Options for recovery: promoting success among women mandated to treatment.

Abstract: In recent years imprisonment has been used increasingly for a wide range of nonviolent and petty offenses committed by women. Among incarcerated women, particularly those who are pregnant or parenting, substance use and its deleterious consequences are often exacerbated by imprisonment. Women who have been identificd as chemical by dependent are also at high risk for losing custody of their children. In California, the Options for Recovery (OFR) treatment program provided an alternative to incarceration or relinquishment of custody of children for chemically dependent pregnant and parenting women. This three-year pilot project offered alcohol and other drug abuse treatment and case management to these women, and included special training and recruitment of foster parents for their children. Findings from a three-year, multimethod evaluation study showed that women who were mandated to OFR treatment programs were more likely to successfully complete treatment than women who had enrolled in OFR vol...

Psychiatric problems among alcohol and other drug dependent women.

Abstract: This article focuses on assessment and treatment of psychiatric disorders within the alcohol and drug treatment and recovery system. Inasmuch as women are represented in all categories of psychiatric disorders, the article begins with a discussion of basic principles of assessment and treatment, examines some of the barriers to good practice, and offers recommendations for reducing them. The article then reviews in grealer detail the psychiatric disorders most frequently found in women seeking help in alcohol and drug treatment settings, adding considerations relevant to those particular disorders. A brief review of key elements to facilitate planning, ongoing monitoring, and evaluation by treatment and recovery service providers is provided.

Access to Substance Abuse Treatment for Homeless Women of Reproductive Age

Abstract: Homeless women in the United States comprise a subpopulation at high risk for substance abuse, with rates of substance use disorder ranging from 16% to 67%. Despite the need for treatment that such high rates imply, relatively few substance-abusing homeless women avail themselves of formal treatment. The fact that they tend not to utilize formal treatment services is especially problematic among homeless women of reproductive age, who are not only themselves at risk of health-related problems but who place their fetuses and children in danger of multiple negative consequences. The imbalance between treatment need and treatment access suggests that homeless, substance-abusing women are facing severe barriers to care. Although identifying barriers to their treatment access is crucial if this imbalance is to be remedied, very little empirical research has been done in this area. This article presents an overview of current knowledge about barriers to substance abuse treatment for women generally and for homeless women specifically, and proposes a comprehensive empirical strategy for redressing the lack of information on homeless women's access to substance abuse treatment.

Drug-abusing homeless clients in California's substance abuse treatment system.

Abstract: As many as one-half to three-fourths of homeless persons have diagnoses of alcohol or other drug dependence. Rates of alcohol and other drug use disorders, and the social costs associated with untreated substance disorder, are higher among homeless than nonhomeless persons. Despite the high level of need for treatment, relatively few substance-abusing homeless individuals receive treatment for their drug problems, suggesting difficulties in accessing treatment. This study addresses access by focusing on the select group of homeless drug users who have overcome barriers to enter the substance abuse treatment system in California and by examining differences between these homeless treatment clients and nonhomeless drug-using clients. Major findings from bivariate and logistic regression analyses performed on 187 homeless and 1,820 nonhomeless treatment clients are that homeless clients were more likely than nonhomeless clients to have a primary drug problem of cocaine/crack and to be injecting methamphetamine and other amphetamines, and that they were no less likely to complete their treatment program. An implication of this study is that homeless persons with primary drug problems appear to have no less commitment to achieving treatment goals than their nonhomeless counterparts.

Involuntary Smoking Cessation: A Treatment Option in Chemical Dependency Programs for Women and Children

Abstract: Recent research has indicated that a relationship exists between nicotine addiction and the abuse of other substances. This relationship, as well as the severe impact of nicotine addiction on the health of women, their children, and the developing fetus, provides the basis of a rationale for developing chemical dependency programs for women where smoking is not allowed. Involuntary smoking cessation (ISC) programs have been tried recently in mixed-gender and male-only programs, and have met with strong resistance from clients. In most published reports this resistance was strong enough to force the programs to eliminate the ISC policy. This article describes the development of an ISC program at a residential substance abuse treatment center for pregnant and postpartum women and their children. It traces the evolution of tactics to defuse resistance and enlist client support for the program. The development of techniques to measure the effectiveness of the program are also presented. Preliminary r...

Newborn renal tubular acidosis associated with prenatal maternal toluene sniffing.

Abstract: Sniffing of volatile organic solvents containing toluene, such as acrylic paints, glues, adhesives, paint thinners, varnishes and shoe polishes, has become increasingly frequent in recent years. Re...

Making Evaluation Work in a Substance Abuse Treatment Program for Women with Children: Olivia's House

Abstract: Olivia's House represents the development and implementation of an innovative substance abuse treatment program for drug-dependant, primarily African-American women with children. This article discusses the prevalence of problems related to women and drug abuse; describes the philosophy and continuum of care of Olivia's House; delineates the program, process, outcome, dissem ination, and training components of the evaluation protocol; presents preliminary evaluation findings as they relate to the overall goals of Olivia's House; and points out the obstacles to the evaluation of a residential drug abuse treatment program for women and children. This article is targeted to substance abuse service providers and evaluators challenged with the effective delivery and accountability of meaningful treatment services to persons with substance use disorders.

The interplay of national, state, and local policy in financing care for drug-affected women and children in California.

Abstract: Recent prevalence studies in California indicate that perinatal alcohol and other drug use remains a serious issue for large numbers of women and their children In response, national, state and local policymakers have taken steps to address the problem, including increasing funding for treatment services To gauge the impact of policy attention to this problem, the Center for the Vulnerable Child at Children's Hospital, Oakland, California, surveyed state and local administrators of programs that serve drug-affected women and children in California Information collected included the scope of program services, indicators of access, and sources of program funding Surveyed programs were funded through federal, state, county, and foundation sources Despite new policy and funding initiatives to serve this population, the study found wide gaps between the kinds of services that are believed to be appropriate for drug-affected women and children and the service system that currently exists Problems in access to care included long waiting times, exclusion of women from programs based on their pregnancy or parenting status, and exclusion of drug-exposed children from programs with medically based eligibility criteria Program funding sources appeared to impede access, as traditional federal, state, and county funding sources do not support programs that are comprehensive, family-centered, and easily accessible to these women and children Analysis of the study data suggests that policymakers consider new approaches to promote access to care for these underserved women and children, particularly now as Congress and the states redesign health and social service funding mechanisms and delivery systems

Family functioning of perinatal substance abusers in treatment.

Abstract: This prospective study examined family characteristics of perinatal substance abusers enrolled in an intensive outpatient treatment program both during and after treatment. Data is provided on family functioning in three areas: current family, family of origin, and love/partner relationship, and at six time points up to 24 months postdischarge. Standard family assessment measures, including the Self-Report Family Inventory (SFI) and Family-of-Origin Scale (FOS) were utilized to measure current family functioning and family of origin health, respectively. A new instrument, the Relationship Assessment Form (RAF), was used to measure the level of unhealthy, codependent behaviors in the subject's love/partner relationship. A mixed models repeated measures ANOVA was used to determine if subjects' family functioning changed over time. Multivariate and univariate methods examined differences between the subjects in the current study and previously reported means for the SFI and FOS. Results were that pe...

Pemoline for the Treatment of Cocaine Dependence in Methadone-Maintained Patients

Abstract: The authors conducted an open-label trial of pemoline, a dopaminergic CNS stimulant, for the treatment of cocaine addiction in methadone-maintained patients. Ten patients who met DSM-III-R criteria for cocaine dependence participated in an eight-week study. Findings showed that 50% of patients were discontinued from the study due to complaints of side-effects. Patients who completed treatment submitted 79% positive urine toxicology screens over the course of the study. Patients who dropped out tended to submit fewer cocaine-positive urine screens than treatment completers. In view of suggestions that dopaminergic agents in the treatment of addictions may be enhanced when combined with serotonergic agents, a single-case study of pemoline plus fenfluramine is also reported. Except for one urine sample, all of this patient's urine screens were positive for cocaine. Although findings from these studies do not support the effectiveness of pemoline for the treatment of cocaine abuse in methadone-maintained patients, conclusions must be qualified by the lack of a control group.

The effects of dual diagnosis on pregnancy and parenting.

Abstract: The desire to give birth and nurture can be significant for women with mental illness and substance-abuse disorders, despite the many internal and external barriers to the effective achievement of these desires. This article provides information on the effect of coexisting mental illness and alcohol or other drug dependency on pregnancy from a medical, obstetric, psychiatric, and psychologic perspective. The article also explores the effect on parenting and highlights the need to assess for parental competency in this population. Treatment planning, including the use of psychotropic medication and the need for collaboration between providers is discussed.

A historically controlled trial of tyrosine for cocaine dependence.

Abstract: Cocaine dependence continues to be a major public health problem and efforts to develop pharmacotherapies have been disappointing. Chronic cocaine use is believed to cause catecholamine depletion and similarities exist between cocaine withdrawal and major depression. Tyrosine is the dietary precursor to catecholamines and has yielded positive results in small trials of its antidepressant efficacy. Tyrosine 2 g every 8 hours was administered on an open-label basis to 49 cocaine-dependent individuals, as an adjunct to intensive outpatient drug abuse counseling. Retention in treatment at 90 days was compared to data from a control group of 80 subjects who had received 10 mg of imipramine per day in an earlier trial. Median retention was 17 days in both groups. No side effects were reported by the subjects receiving tyrosine. These results do not support the utility of tyrosine in the treatment of cocaine dependence.