Showing papers in "Journal of Psychoactive Drugs in 1998"

A Method of Conducting Therapeutic Sessions with MDMA

Abstract: A method for preparing clients and conducting therapeutic sessions with 3,4-methylenedioxymethamphetamine (MDMA) is described, with emphasis on the need for careful attention to the mental set of therapists and clients and the setting of the session. The therapists' belief was that MDMA inhibited the fear response to a perceived emotional threat, allowing the client to place the emotional sequelae of past experiences into a more realistic perspective in their current emotional lives and relationships. Clients were carefully screened and prepared until they had a clear purpose for the session, including a willingness to experience and to learn from anything that might happen. Sympathomimetic effects of MDMA determined the medical contraindications, and clients with histories of serious functional psychiatric impairments were excluded. Total doses of 75-150 mg, plus 50 mg if requested later, were administered, followed by clients lying down and listening to music with eyeshades and headphones during the peak MDMA effect. Screening and follow-up questionnaires were utilized. Two case histories are presented: a man achieving relief of pain from multiple myeloma, and a woman finding relief from problems as the daughter of Holocaust survivors. Use of consciousness-altering drugs in other contexts is discussed.

Ayahuasca preparations and serotonin reuptake inhibitors: a potential combination for severe adverse interactions.

Abstract: The Amazonian psychoactive plant beverage ayahuasca has attracted increasing interest in recent years. Little attention has been given, however, to potentially dangerous interactions with other drugs. In particular, the interaction between the potent monoamine oxidase-inhibiting harmala alkaloids in ayahuasca and the selective serotonin reuptake inhibitor (SSRI) class of antidepressants may induce a serotonin syndrome with potentially grave outcome. Caution is advised when combining ayahuasca with certain pharmaceutical drugs.

The Use of Cannabis as a Mood Stabilizer in Bipolar Disorder: Anecdotal Evidence and the Need for Clinical Research

Abstract: The authors present case histories indicating that a number of patients find cannabis (marihuana) useful in the treatment of their bipolar disorder. Some used it to treat mania, depression, or both. They stated that it was more effective than conventional drugs, or helped relieve the side effects of those drugs. One woman found that cannabis curbed her manic rages; she and her husband have worked to make it legally available as a medicine. Others described the use of cannabis as a supplement to lithium (allowing reduced consumption) or for relief of lithium's side effects. Another case illustrates the fact that medical cannabis users are in danger of arrest, especially when children are encouraged to inform on parents by some drug prevention programs. An analogy is drawn between the status of cannabis today and that of lithium in the early 1950s, when its effect on mania had been discovered but there were no controlled studies. In the case of cannabis, the law has made such studies almost impossi...

Hallucinogenic Drugs and Plants in Psychotherapy and Shamanism

Abstract: Western psychotherapy and indigenous shamanic healing systems have both used psychoactive drugs or plants for healing and obtaining knowledge (called "diagnosis" or "divination" respectively). While there are superficial similarities between psychedelic-assisted psychotherapy and shamanic healing with hallucinogenic plants, there are profound differences in the underlying worldview and conceptions of reality. Four paradigms are reviewed: (1) psychedelic psychotherapy within the standard Western paradigm—here the drug is used to amplify and intensify the processes of internal self-analysis and self-understanding; (2) shamanic rituals of healing and divination, which involve primarily the shaman or healer taking the medicine in order to be able to "see" the causes of illness and know what kind of remedy to apply; (3) syncretic folk religious ceremonies, in which the focus seems to be a kind of community bonding and celebratory worship; and (4) the "hybrid shamanic therapeutic rituals," which incorporate some features of the first two traditions. There are two points in which the worldview of the shamanic and hybrid shamanic ceremonies differs radically from the accepted Western worldview: (1) the belief and assumption (really, perception) that there are multiple realities ("worlds") that can be explored in expanded states of consciousness; and (2) the belief that "spirits," the beings one encounters in dreams and visions, are just as real as the physical organism.

Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence

Abstract: (1998). Marijuana Myths, Marijuana Facts: A Review of the Scientific Evidence. Journal of Psychoactive Drugs: Vol. 30, Marijuana at the Millenium: Medical and Social Implications, pp. 223-224.

Abuse Potential of Dronabinol (Marinol

Abstract: Dronabinol is an oral form of delta-9-tetrahydrocannabinol indicated for treatment of anorexia associated with weight loss in individuals with AIDS, and nausea and vomiting associated with cancer chemotherapy. The authors reviewed the literature and conducted surveys and interviews among addiction medicine specialists, oncologists, researchers in cancer and HIV treatment, and law enforcement personnel to determine the abuse liability of dronabinol. There is no evidence of abuse or diversion of dronabinol. Available prescription tracking data indicates that use remains within the therapeutic dosage range over time. Healthcare professionals have detected no indication of "scrip-chasing" or "doctor-shopping" among the patients for whom they have prescribed dronabinol. Cannabis-dependent populations, such as those treated in our Clinic and seen by the addiction medicine specialists we interviewed, have demonstrated no interest in abuse of dronabinol. There is no street market for dronabinol, and no evidence of any diversion of dronabinol for sale as a street drug. Furthermore, dronabinol does not provide effects that are considered desirable in a drug of abuse. The onset of action is slow and gradual, it is at most only weakly reinforcing, and the overwhelming majority of reports of users indicate that its effects are dysphoric and unappealing. This profile of effects gives dronabinol a very low abuse potential.

Treatment of alcoholism using psychedelic drugs: a review of the program of research.

Abstract: Following Albert Hofmann's discovery of LSD's psychoactive properties in 1943, and previous to their scheduling as controlled substances, the psychedelic drugs were widely studied—six international conferences and hundreds of papers discussed their potential therapeutic usefulness. The observation that the frightening experience of delirium tremens sometimes led alcoholics to moderate their alcohol intake suggested to early psychedelic researchers that the “psychotomimetic” experience thought to be produced by LSD could be used to treat alcoholism. A number of hypothesis-generating studies employing a variety of research designs to examine this premise were completed, but relatively few controlled trials attempted hypothesis testing. After twenty-five years of study, a combination of flawed methodology, uneven results and social reprehension led to the abandonment of research on the therapeutic use of psychedelic drugs, leaving many avenues of inquiry unexplored and many questions unanswered. Tod...

Hallucinogens, Serotonin and Obsessive-Compulsive Disorder

Abstract: The serotonin (5-HT) neurotransmitter system has been implicated in the pathophysiology of several neuropsychiatric disorders, especially obsessive-compulsive disorder (OCD). Blockade of 5-HT reuptake appears to be an important initial neurobiological event in the therapeutic mechanism of action of antiobsessional drugs. However, for reasons that continue to be poorly understood, clinical improvement following initiation of treatment with 5-HT reuptake inhibitors can take up to eight to 12 weeks, and most patients do not fully improve. Recent data suggest that activation of 5-HT2A and/or 5-HT2C receptors may be important for the improvement of OCD symptoms. Most psychedelic drugs are potent agonists at 5-HT2A and 5-HT2C receptors and their binding potency to these receptors is strongly correlated with their human potency as hallucinogens. This article will briefly review the relevant clinical and preclinical studies relating to the effects of hallucinogens on OCD. These data suggest that activation of 5-HT2 receptors by hallucinogens may lead to acute reduction of, as well as possible longer-lasting beneficial effects on, the symptoms of OCD. Evidence for and against involvement of 5-HT2A and/or 5-HT2C receptors in the therapeutic effects of drug therapies for OCD are reviewed. Issues related to the pharmacological properties and safety of psychedelic drugs, when considered as potential treatments for patients with OCD, are summarized. The authors suggest that controlled trials of potent 5-HT2 agonists in people suffering from OCD are warranted.

High Resolution Brain SPECT Imaging of Marijuana Smokers with AD/HD

Abstract: Marijuana abuse is common among young Americans and even more common among teenagers and adults with attention deficit/hyperactivity disorder (AD/HD). Many teenagers and young adults believe that marijuana is a safe substance to use despite a number of studies demonstrating cognitive impairment with chronic or heavy usage. Brain single photon emission computer tomography (SPECT) imaging is being used increasingly in psychiatry to study underlying functional brain problems, including AD/HD. SPECT provides information on cerebral blood flow and metabolic function. Brain SPECT studies were performed on 30 heavy marijuana users (who had used on at least a weekly basis for a minimum of one year) with AD/HD from an outpatient psychiatric clinic and 10 AD/HD control group subjects matched for age and sex who had never used drugs. The three-dimensional surface images were used in the analysis of the scans, and were blindly interpreted without knowledge of the clinical data. Decreased perfusion in the prefrontal cortex was the only abnormality seen in the AD/HD control group (80%). In the marijuana group, there was a similar decrease in the perfusion of the prefrontal cortex while performing the same concentration task (83%). However, the marijuana group also demonstrated marked decreased activity in the right and left temporal lobes. The severe and moderate ratings were found in the heaviest users, but not necessarily the longest users. This study demonstrates decreased cerebral perfusion in the temporal lobe regions of the brain on SPECT imaging from chronic marijuana usage.

Effectiveness of HIV risk reduction initiatives among out-of-treatment non-injection drug users.

Abstract: While attention has been paid recently to the effectiveness of HIV/AIDS interventions among injection drug users, less focus has been given to out-of-treatment noninjecting drug users. This study examines the the NIDA Cooperative Agreement standard intervention versus an enhanced intervention for HIV/AIDS risk among noninjecting drug users. Data come from five sites of the NIDA-funded Cooperative Agreement on HIV risk behaviors. The sample is comprised of those who never injected drugs or reported not injecting in the 12 months prior to the interview; and who completed a three-month follow-up assessment. Three risk behaviors in the prior 30 days were analyzed; frequency of crack/cocaine use, number of sex partners, and frequency of condom use. The levels of both baseline and follow-up risk were analyzed. Individuals remaining at low risk or decreasing risk behaviors were classified as “improved.” Those increasing risk behavior or remaining at moderate or high levels were classified as “worsened.”...

Psychosocial histories, social environment, and HIV risk behaviors of injection and noninjection drug using homeless youths.

Abstract: Injection drug use is a common risk behavior for HIV infection among homeless, runaway and street youths. However, the psychosocial histories and current social environment of these youths are not well understood. The authors recruited 186 homeless, runaway and street youths using systematic street-based sampling methods, and assessed psychosocial histories, current daily activities, and sexual and drug-related risk behaviors using qualitative and quantitative techniques. Youths reported high lifetime rates of injection drug use (45%), recent drug and alcohol use (100%), and current homelessness (84%). Injection drug using youths were more likely than noninjection drug using youths to report traumatic psychosocial histories, including parental substance use and forced institutionalization, use of alcohol and other noninjection drugs, a history of survival sex, and the use of squats or abandoned buildings as shelter. These findings underscore the need for multifaceted service and prevention programs to address the varied needs of these high-risk youths.

Medicinal Marijuana: A Comprehensive Review

Abstract: Considerable controversy exists regarding the role of marijuana as a therapeutic agent; however, many practitioners are taught very little about existing marijuana data. The authors therefore undertook a comprehensive literature review of the topic. References were identified using textbooks, review and opinion articles, and a primary literature review in MEDLINE. Sources were included in this review based primarily on the quality of the data. Some data exists that lends credence to many of the claims about marijuana's properties. In general, however, the body of literature about marijuana is extremely poor in quality. Marijuana and/or its components may help alleviate suffering in patients with a variety of serious illnesses. Health care providers can best minimize short term adverse consequences and drug interactions for terminally ill patients by having a thorough understanding of the pharmacology of marijuana, potential adverse reactions, infection risks, and drug interactions (along with on-going monitoring of the patient). For chronic conditions, the significance and risk of short and long term adverse effects must be weighed against the desired benefit. Patients who are best suited to medicinal marijuana will be those who will gain substantial benefit to offset these risks, and who have failed a well-documented, compliant and comprehensive approach to standard therapies.

Psychoactive plants and ethnopsychiatric medicines of the Matsigenka.

Abstract: For the Matsigenka of the Peruvian Amazon, health and well-being in daily life depend upon harmonious relationships within the social group and with the spirit world. Psychoactive plants play a crucial role in curing disrupted social relationships while giving humans access to the otherwise remote, parallel world of spirits. Different species and cultivars of psychoactive plants, as well as varying admixtures and doses, are used to obtain different intensities and qualities of psychoactive experience, depending upon the individual's goals. Strongly psychoactive plants are used by shamans to travel to the realm of spirits. A number of mild to strongly psychoactive plants are used by male hunters to purify their souls and improve their aim. Mildly psychoactive plants are used to improve women's concentration for spinning and weaving cotton, to control negative emotions such as grief and anger, to manipulate the content of dreams, and to pacifysick or frightened children. A majority of such remedies...

Drug use and HIV risks among African-American, Mexican-American, and Puerto Rican drug injectors.

Abstract: This article documents the prevalence of injection-related HIV risk behaviors among a sample of 758 Mexican-American. Puerto Rican, and African-American drug injectors derived from the National Institute on Drug Abuse Cooperative Agreement database. The results show that the two Hispanic subgroups had higher injection-related risks than the African-American group. Further, among Hispanics, Puerto Ricans had higher rates of drug injection than Mexican-Americans, but Mexican-Americans had higher rates of sharing injection paraphernalia than Puerto Ricans. The research suggests that more aggressive HIV/AIDS intervention efforts be targeted to minority injection drug users, especially those that are contextualized by the racial/ethnic group targeted.

Effectiveness of HIV/AIDS Interventions on Drug Use and Needle Risk Behaviors for Out-of-Treatment Injection Drug Users

Abstract: -This study presents an evaluation of the effectiveness of the AIDS Community-Based Outreach/Intervention projects implemented as part of the National Institute on Drug Abuse (NIDA) Cooperative Agreement (CA), which began in 1990 and is currently ongoing. Participants in the CA were randomly assigned to one of two interventions: a NIDA/CA-developed standard intervention (SI); or the SI plus a site-specific enhanced intervention (EI). Analyses of drug use and needle-related risk behaviors were conducted among injection drug users (IDUs) in eight participating cities where follow-up rates of at least 60% were obtained (N=3,743). Results indicated that IDUs significantly reduced their needle-related risk behaviors following delivery of the interventions and that a substantial portion entered substance abuse treatment. However, there was relatively little to support the effectiveness of more expensive and involved enhanced interventions. A number of factors associated with increasing or maintaining high risk behaviors, including an HIV negative serostatus and a greater perceived chance of acquiring AIDS, were also observed. Continued outreach to drug injectors is recommended, as well as the development of new and creative interventions targeting individuals who are HIV negative and those who are aware of their high risk status but have not changed their behaviors in response to risk-reduction interventions.

Attitudes toward methadone maintenance: implications for HIV prevention

Abstract: Attitudes of opioid users toward methadone maintenance were studied using semistructured field interviews. One hundred and sixty-one heroin and speedball users in San Antonio, Texas, were interviewed between 1989 and 1992. Users were classified according to whether or not they had ever been on methadone maintenance. Opioid users who had never been on methadone maintenance were more likely to express a negative attitude toward methadone maintenance than users who had been on it (50% versus 30%). Sources of negative attitudes fell into the following categories: (1) general societal disapproval of addictive drugs, including methadone; (2) prior experience with 12 Step groups or abstinence-based treatment programs; (3) previous forced rapid detoxification from methadone in jail; and (4) observation of methadone maintained peers who continued to use drugs. Very few respondents reported adverse effects from methadone itself as a source of negative attitudes. Sources of positive attitudes included: (1) ...

Medical Marijuana: Tribulations and Trials

Abstract: Widespread use of smoked marijuana in the San Francisco Bay Area as a treatment for HIV-related anorexia and weight loss, as well as nausea related to prescribed therapy, prompted the design of a clinical trial to evaluate the safety and effectiveness of this controlled substance. The Community Consortium--the Bay Area's community-based HIV clinical trials organization--designed a first pilot evaluation of smoked marijuana compared to oral tetrahydrocannabinol (THC, synthesized as dronabinol or Marinol) in 1993. A legal source of marijuana could not be identified. Two subsequent applications to the National Institutes of Health were submitted in 1996 and 1997. During the intervening period, increasing numbers of people with HIV infection were obtaining marijuana for "medicinal use" from local Cannabis Buyer's Clubs. In November 1996, California voters endorsed the medical use of marijuana by approving Proposition 215. The federal government's attempt to oppose the voters' mandate led to public outrage. Organized medicine demanded more studies into marijuana's potential use as medicine. The consortium's 1997 proposal to evaluate the potential interaction between THC and widely-prescribed protease inhibitors was positively received. Funding and study-required marijuana cigarettes have been obtained from the National Institute of Drug Abuse, and the first subjects are being enrolled in the trial. When politically sensitive research proposals include sound science, they can prevail if investigators are willing to persist.

Providing Medical Marijuana: The Importance of Cannabis Clubs

Abstract: In 1996, shortly after the San Francisco Cannabis Club was raided and (temporarily) closed by state authorities, the authors conducted an ethnographic study by interviewing selected former members to ascertain how they had benefited from the use of medical marijuana and how they had utilized the clubs. Interviews were augmented by participant observation techniques. Respondents reported highly positive health benefits from marijuana itself, and underscored even greater benefits from the social aspects of the clubs, which they described as providing important emotional supports. As such, cannabis clubs serve as crucial support mechanisms/groups for people with a wide variety of serious illnesses and conditions. The authors concluded that of the various methods so far proposed, the cannabis clubs afford the best therapeutic setting for providing medical cannabis and for offering a healing environment composed of like-minded, sympathetic friends.

Male Drug Abuse, Criminality and Subcultural Affiliation in a Career Perspective

Abstract: Degree of connection to the criminal underworld was the basis for typologic research on 698 male drug abusers; interviews as well as official records were used. Four types were distinguished: The addicted criminals seemed to resemble the groups dominant in Sweden from the 1950s to the 1970s. An early crime debut and criminal offenses in youthful years characterized their deviant careers. Drugs and criminal activities coexisted with an often very high intake of alcohol and the most difficult childhood and adolescence conditions compared to the other types. The criminal addicts had fewer recorded acts of juvenile delinquency. Their drug abuse was severe and occurred later in life, as criminality did, but tended to accelerate very rapidly. Their subcultural affiliation was probably as strong as that of the addicted criminals. A large group called low-crime addicts had a weak subgroup affiliation. The "normal" abuse pattern, with cannabis as the first substance used and a gradual shift to more severe opioid and CNS stimulant abuse, was most true of this type. Probably the drug abuse played a role in the development of the criminal pattern. Emotionally unstable addicts with little or no criminality had the best education, job situation and social relations. Multiple drug abuse and abuse of legal drugs were common. Mental ill-health was characteristic for this group. The results show that drug abusers in Sweden cannot be seen as a homogeneous group of individuals, that they do not commit crimes only in order to finance their habit, and that the history of narcotics use in Sweden, with its strong connection to a criminal subculture, is highly relevant to this sample.

Dr. Leary's Concord prison experiment : A 34-year follow-up study

Abstract: This study is a long-term follow-up to the Concord Prison Experiment, one of the best-known studies in the psychedelic psychotherapy literature The Concord Prison Experiment was conducted from 1961 to 1963 by a team of researchers at Harvard University under the direction of Timothy Leary The original study involved the administration of psilocybin-assisted group psychotherapy to 32 prisoners in an effort to reduce recidivism rates This follow-up study involved a search through the state and federal criminal justice system records of 21 of the original 32 subjects, as well as personal interviews with two of the subjects and three of the researchers: Timothy Leary, Ralph Metzner and Gunther Weil The results of the follow-up study indicate that published claims of a treatment effect were erroneous This follow-up study supports the emphasis in the original reports on the necessity of embedding psilocybin-assisted psychotherapy with inmates within a comprehensive treatment plan that includes pos

HIV serostatus and risk behaviors in a multisite sample of drug users

Abstract: In developing HIV prevention efforts, it is critical to determine whether interventions are effective in achieving declines in risk behavior among both HIV-positive and HIV-negative individuals. Based on a multisite intervention study of injection drug users (IDUs) and crack smokers, 488 seropositive IDUs and 364 seropositive crack users were compared with randomly selected matched samples of seronegatives (with matching based on recruitment site, gender, age group and ethnicity) at baseline and six-month follow-up to compare changes in risk behaviors by serostatus. Results indicated that overall, risk behaviors declined substantially over time; significant interaction effects indicated that seropositives reported a greater decline in sex risk behaviors than seronegatives. These data support the utility of HIV testing for high-risk drug users, and indicate that interventions have produced red uctions in risk behaviors of both seropositives and seronegatives. Further research on the impact of site...

Human nature and the nature of reality : Conceptual challenges from consciousness research

Abstract: Holotropic states (a large special subgroup of nonordinary states of consciousness) have been the focus of many fields of modern research, such as experiential psychotherapy, clinical and laboratory work with psychedelic substances, field anthropology, thanatology, and therapy with individuals undergoing psychospiritual crises ("spiritual emergencies"). This research has generated a plethora of extraordinary observations that have undermined some of the most fundamental assumptions of modern psychiatry, psychology, and psychotherapy. Some of these new findings seriously challenge the most basic philosophical tenets of Western science concerning the relationship between matter, life, and consciousness. This article summarizes the most important major revisions that would have to be made in our understanding of consciousness and of the human psyche in health and disease to accommodate these conceptual challenges. These areas of changes include: a new understanding and cartography of the human psyche; the nature and architecture of emotional and psychosomatic disorders; therapeutic mechanisms and the process of healing; the strategy of psychotherapy and self-exploration; the role of spirituality in human life; and the nature of reality.

Embalming fluid-soaked marijuana: new high or new guise for PCP?

Abstract: A growing trend of smoking marijuana soaked in what is purported to be embalming fluid has been reported in the literature since the mid-1980s. This article describes several cases of intoxication, gives regional epidemiological data on this phenomenon, and includes current nomenclature. The authors also analyze a sample of fluid said to be embalming fluid and discover PCP (phencyclidine) and multiple congeners and by-products of PCP manufacture. The implications of this finding are discussed, and the hypothesis that most embalming fluid-soaked marijuana likely contains PCP is considered.

Using peer, self, and counselor ratings to evaluate treatment progress

Abstract: It is generally recognized that the evaluation of treatment progress requires multiple methods of assessment. To provide a basis for supplementing existing measures, the current study investigated the use of a peer rating methodology for evaluating the treatment progress of 381 probationers admitted to a four-month residential drug abuse facility. Self ratings of "working the program" (i.e., conscientiously participating in treatment) were compared with ratings by peers in the program and with ratings by counselors. Peer and counselor ratings were more highly correlated with each other than with client self ratings. Peer as well as self ratings detected differences between enhanced and standard counseling, and were related to individual difference measures known to be associated with treatment progress. In addition, peer midterm ratings of "working the program" were related to both self and counselor ratings of clients' endterm participation, and counselor ratings of the likelihood of remaining clean and sober. These findings support the use of peer ratings as additional indicators of treatment progress.

The Guru Papers: Masks of Authoritarian Power

Abstract: (1998). The Guru Papers: Masks of Authoritarian Power. Journal of Psychoactive Drugs: Vol. 30, No. 1, pp. 105-106.

"Just say know" to teenagers and marijuana.

Abstract: Despite increasing expenditures on prevention, government survey after survey indicates that marijuana use--which comprises 90% of illicit drug use--has not been eradicated among teenagers. Today's adolescents have been exposed to the largest dose of prevention in our history. After three decades of such efforts, one must ask why young people continue to use marijuana, and why drug education has failed to bring about a marijuana-free teenage America. Drug education falls short because it is based on a "no-use" premise, scare tactics and top-down teaching. Such programs do not educate, and may even be counterproductive for those who choose to say "maybe" or "sometimes," or "yes." Moreover, drug education, as has been the case since its advent, is based on politics rather than science--an enormous taxpayer drain with few demonstrative results. A new strategy for drug education requires a pragmatic view that accepts the ability of teenagers, if educated honestly and in ways they trust, to make wise decisions leading, if not to abstinence, to moderate, controlled, and safe use.

Seroconversion Issues Among Out-of-Treatment Injection Drug Users

Abstract: Many risk factors for HIV incidence among drug users have been reported in the literature. However most of these studies have been with local samples, and typically have had limited sample sizes. The National Institute on Drug Abuse (NIDA) funded a Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research (CA) since 1991 that produced a national database. Associations found in the literature were tested to determine whether they were replicated on this national database. The CA national database had complete data, including blood draws six months apart, on 6,970 drqg users who were seronegative at baseline. Sites that had no seroincident cases were excluded from the analysis. Twenty-nine risk factors identified in the literature were tested on the national database on a bivariate basis. There were 56 seroincident cases (those who were HIV-seronegative at baseline and HIV-seropositive at follow-up) out of 3752 person years at risk, for a seroconversion rate of 1.49 (CI 1.05, 1....

Patterns of alcohol use among adolescents living in Porto Alegre, Brazil.

Abstract: A cross-sectional household survey was used to assess patterns of alcohol experimentation and consumption among Brazilian adolescents, stratified by age and sex. Trained interviewers administered a standardized questionnaire to 950 subjects, ages 10 to 18, which examined such things as age of first alcohol use, situational aspects of consumption, amounts ingested and use among peers. Lifetime prevalence of alcohol use was high (71.5%), especially in the older teens (94.4%). The mean age of first use was 10 years, and consumption of all types of alcohol, including hard liquor, was common. Alcohol use typically began in the home, at family celebrations and social occasions, and progressively evolved to street drinking with peers. This pattern was most evident in males, who reported a larger volume of alcohol consumption per episode, when compared to females. The total amount of alcohol consumption reported for all ages is very high and may be due to permissive cultural views of alcohol. Age and gender play an important role in the evolution of drinking, with male adolescents being exposed to higher concentrations of alcohol and at younger ages than females, who seem to have a more conservative attitude toward excessive drinking. Subjects considered these practices normal, with no concern about the illegality of such behaviors. Language: en

Efficacy and effectiveness issues in the NIDA cooperative agreement : Interventions for out-of-treatment drug users

Abstract: This paper examines the Cooperative Agreement (CA) HIV intervention studies for active drug users, sponsored by the National Institute on Drug Abuse, in terms of the constructs of prevention efficacy and effectiveness. A rationale is presented for conservatively interpreting outcome findings of these studies as indicative of intervention efficacy, as opposed to effectiveness. It is argued that the CA studies fall more within the domain of efficacy owing to the high degree of control and optimization that occurred with respect to intervention recruitment, participation, process monitoring, and staff training. Because the interventions were implemented and evaluated in community-based, noninstitutional settings with many real-world constraints, it is suggested that minimal shrinkage of their effects would occur if they were implemented in uncontrolled community settings. The relationship of intervention structure, content, process, dose, and participant characteristics to intervention efficacy is r...

Review of the American Medical Association council on scientific affairs report on medical marijuana

Abstract: (1998). Review of the AMA Council on Scientific Affairs Report on Medical Marijuana. Journal of Psychoactive Drugs: Vol. 30, Marijuana at the Millenium: Medical and Social Implications, pp. 127-136.