Showing papers in "Journal of Psychoactive Drugs in 2002"

Engaging substance abusers after centralized assessment: predictors of treatment entry and dropout.

Abstract: High attrition continues to be an important issue for substance abuse treatment providers. This study examined factors contributing to treatment entry and dropout after referral from centralized assessment. Univariate analysis showed that individuals with a shorter wait after assessment were more likely to attend an initial treatment appointment, while those who reported a history of physical or sexual abuse or were on probation were significantly more likely to drop out of treatment early. Multivariate analysis revealed, first, that persons with a comorbid psychiatric diagnosis and those referred to outpatient rather than residential care were less likely to enter treatment; and, second, that persons on probation and with a history of physical or sexual abuse were more likely to be early treatment dropouts. Findings suggest that decisions to seek help and to accept help are distinct, and that program factors play a substantial role in treatment engagement and retention.

Pathways to Long-Term Recovery: A Preliminary Investigation

Abstract: Recovery from addiction is a lifelong process. While there is a large body of empirical data on the short-term effectiveness (one to two years) of various treatment modalities, very little is known about the processes of recovery over time. This is particularly unfortunate as treatment gains are often short-lived and even multiple treatment episodes do not always succeed in breaking the addiction cycle. Further, treatment represents only one of the paths to recovery. This article reports on a study of individuals in long-term recovery from substance abuse (median = 12 years) and examines the factors they cite as important in establishing and maintaining their recovery status. Key factors reported were social and community support, affiliation with 12-Step organizations and negative consequences of substance use. Implications for clinical practice and future research directions are discussed.

A clinical plan for MDMA (Ecstasy) in the treatment of posttraumatic stress disorder (PTSD): partnering with the FDA.

Abstract: The FDA and the Spanish Ministry of Health have concluded that the risk/benefit ratio is favorable under certain circumstances for clinical studies investigating MDMA-assisted psychotherapy. Both agencies have approved pilot studies in chronic posttraumatic stress disorder (PTSD) patients who have failed to obtain relief from at least one course of conventional treatment. These studies, the only ones in the world into the therapeutic use of MDMA, are being funded by a nonprofit research and educational organization, the Multidisciplinary Association for Psychedelic Studies (MAPS, www.maps.org). A rationale is offered explaining why MAPS chose to focus its limited resources on MDMA, and also on PTSD patients. A Clinical Plan is elaborated for the conduct of the "adequate and well-controlled" trials necessary to evaluate the safety and efficacy of MDMA-assisted psychotherapy for PTSD, with the studies estimated to cost about 5 million dollars and to take about five years. The Clinical Plan has been developed, in part, through analysis of the studies conducted by Pfizer in its successful effort to have Zoloft approved by the FDA for use with PTSD patients, and through review of transcripts of the FDA's Psychopharmacologic Drugs Advisory Committee meeting that recommended approval of Zoloft for PTSD.

MDMA: a review of epidemiologic data.

Abstract: This article reviews recent surveys and reports that provide insight regarding prevalence, frequency, trends, perceptions, and seizures of methylenedioxymethamphetamine (MDMA) or "Ecstasy." An estimated 6.4 million individuals have used MDMA. Among students in the eighth, 10th, and 12th grades, MDMA use has substantially increased from mid-1990 levels to 2001, with sharp increases noted in 2000 and a more gradual increase in 2001. Exposure to MDMA among high school seniors has increased progressively and nearly quadrupled over the past decade, and a substantial proportion of young adults report having friends who use MDMA. Perceived availability has increased dramatically during the 1990s, with sharp increases in 2000 and again in 2001 among high school seniors. MDMA is now one of the most available drugs for youth. Among college students and young adults, MDMA use has increased progressively and substantially throughout the 1990s, and sharply increased in 2000. MDMA-related emergency department visits increased progressively and dramatically during the 1990s, often or nearly doubling from year to year. Most visits were attributed to patients ages 25 years or younger. The motive for their MDMA use tended to be recreation, and their reasons for the emergency department visit tended to be overdose and unexpected reactions. MDMA-related deaths are rare, but the rate is increasing, as are the number of MDMA-related calls at selected poison control centers. The quantity of MDMA seized by U.S. law enforcement has increased dramatically recently, as have the number of MDMA-related arrests. MDMA use is worldwide, and in certain European countries it is the second most frequently used drug following marijuana.

Acute psychological and neurophysiological effects of MDMA in humans.

Abstract: Since the mid 1990s, MDMA has been increasingly used as a recreational drug called "Ecstasy" by young people in Europe and the United States. However, despite the widespread recreational use of Ecstasy, systematic data on the psychological and neurobiological effects of MDMA have been scant. To further our understanding of the mechanism of action of MDMA, the authors conducted several studies in healthy human volunteers in an effort to characterize the psychological, cognitive and behavioral effects of MDMA in healthy human volunteers. Prospective placebo-controlled within-subject study designs and standardized psychometric ratings and neuropsychological tests were used to assess the acute, short-term and prolonged effects of the drug. To elucidate the role of various neurotransmitter and receptor systems involved in the action of MDMA in humans, the blocking effects of specific receptor antagonists on MDMA-induced psychological alterations and measures of sensory information processing were studied. To identify the functional neuroanatomy involved in the action of MDMA, Positron Emission Tomography (PET) was used. The present contribution summarizes the acute effect of MDMA on psychological and cognitive measures, information processing, and regional brain activity in healthy human volunteers.

The prevalence and correlates of depressive symptomatology among a community sample of crack-cocaine smokers.

Abstract: Depression has been identified as a disorder of clinical significance among cocaine users. Even so, its prevalence in cocaine-abusing populations is uncertain. This research employed a cross-sectional design to determine the prevalence of current depressive symptomatology among a sample of 430 not-in-treatment crack-cocaine users. Depression was assessed with the Beck Depression Inventory (BDI). The mean BDI score was 19.1. Overall, 80% of the sample had BDI scores that suggested more than minimal depression, and 55% had symptoms of moderate to severe depression. The results of a cumulative logistic regression analysis showed that men, African-Americans, and individuals with some college education were less likely to be depressed. Individuals with higher Addiction Severity Index composite scores for family/social, medical, legal, and alcohol problems had a greater likelihood of reporting symptoms of depression. Frequency of cocaine use and perceived need for treatment were also positively associated with higher BDI scores. The results suggest that the prevalence of depression among crack users is higher than has been previously reported. Treatment programs should routinely screen crack-cocaine users for depression. The BDI may be a suitable tool for such efforts since it has an acceptable level of internal consistency when employed with crack users (a = 0.89).

Predictors of attrition in a longitudinal study of substance abusers.

Abstract: Previous research has emphasized the importance of minimizing attrition in longitudinal studies. The authors examined the influence of demographic, clinical, and process factors on attrition from a longitudinal study of 286 substance abusers recruited at a central intake unit. Univariate tests showed that those who completed three, six, and 12 month interviews had higher baseline alcohol and drug use and were more likely to provide three or more contacts when recruited, to be female, to have been married, and to have previously received substance abuse or psychiatric treatment. Multivariate logistic regression revealed that complete data participants (those who completed all three ASI interviews) were nearly three times more likely to have previously received psychiatric treatment and twice as likely to have completed an early engagement interview. In addition, they were twice as likely to be female, and nearly twice as likely to be employed, own a residence, have completed high school, and be married. Procedures that may help decrease study attrition are discussed.

Epidemiology and Public Health Consequences of Methamphetamine Use in California's Central Valley

Abstract: Methamphetamine use is an increasingly serious public health problem in California and other parts of the country. Despite sensationalistic media attention, however, very little is known about users of this clandestinely consumed drug. Employing methods known as Rapid Assessment and Response, the authors describe the epidemiology and public health implications of methamphetamine use in California's Central Valley, with a focus on Sacramento, which many social indicators suggest has been more severely affected by methamphetamine than any city in the nation. Data sources for this report include interviews with drug users, statistical reports, epidemiologic studies, and local informed expert opinion. In their social demography, methamphetamine users in the Central Valley are in marked contrast to those of coastal cities such as Seattle and San Francisco, being largely heterosexual, and of mixed racial/ethnic heritage. Three-quarters or more initiate their use of the drug while still in their teens, with more than a quarter beginning use before the age of 15. Many of these rapidly gravitate to regular use, and continue using well into their thirties. Methamphetamine users are at much higher risk of infection with HIV than opiate users, particularly if they inject. Partly because methamphetamine enhances libido, users of the drug typically also have many more sexual partners. Not surprisingly, data indicate that methamphetamine users are more likely than heroin users to be HIV-infected. Methamphetamine appears to be less of a street drug than heroin, complicating efforts at street outreach. However, because it is typically used in social settings, a social or diffusion approach to HIV prevention might be particularly promising.

Hallucinogens and Redemption

Abstract: This article examines drug substitution with regard to hallucinogens (ayahuasca, ibogaine, peyote and LSD) set within the concept of redemption. The model examines both religious and secular approaches to the contemporary use of hallucinogens in drug substitution, both by scientists and in religious settings worldwide. The redemptive model posits that the proper use of one psychoactive substance within a spiritual or clinical context helps to free an individual from the adverse effects of their addiction to another substance and thus restores them as functioning members of their community or group. Data is drawn from the U.S., Brazil, Peru, and West Africa. Two principle mechanisms for this are proposed: the psychological mechanism of suggestibility is examined in terms of the individual reaching abstinence goals from addictive substances such as alcohol and opiates. Neurophysiological and neurochemical mechanisms to understand the efficacy of such substitution are highlighted from ongoing research on hallucinogens. Research by two of the authors with the Unaio do Vegetal (UDV) Church in Brazil is examined in terms of the model.

Denial in addiction: toward an integrated stage and process model--qualitative findings.

Abstract: Focus groups were conducted at five chemical dependency treatment facilities assessing residents' (N = 65) conceptualizations of denial and the role it may have played in the pathogenesis and progression of their substance use disorders. Two of the authors read verbatim transcripts of the focus group proceedings and independently developed models of denial based on those data. The first reader identified a core set of interpersonal and attributional processes that appeared to explain why many participants did not perceive their substance abuse and associated problems as clearly aberrant and/or chose not to self-identify as alcohol or other drug dependent until late in the course of their chemical dependency. The second reader identified five stages that clients appeared to pass through as they progressed from no awareness of their substance use disorder to full awareness. A second set of readers then independently developed an integrated stage and process model of denial that incorporated elements of the models identified earlier. Though obviously exploratory in nature, these findings suggest that denial is a far more complex and dynamic set of intra- and interpersonal processes than is generally recognized.

Negative experiences on Ecstasy: the role of drug, set and setting.

Abstract: Similar to other sociological studies of Ecstasy use, the authors' research suggests that Ecstasy users tend to report positive effects of the drug. However, we also observed that most users experienced at least one adverse psychological outcome while using Ecstasy. The present study examines those negative experiences within the context of drug, set and setting. Data were collected through in-depth interviews with 98 current or former users of Ecstasy. The results indicate that, in general, negative experiences with Ecstasy did not deter people from using the drug again. The findings suggest that most negative experiences with Ecstasy can be attributed to the interaction between two or more factors, nearly always involving set or setting. Although various analyses have shown that the same "brand" of Ecstasy can contain varying degrees of MDMA, other drugs and adulterants, results from the present study suggest that users' expectations of the drug's effects appear to be related to the brand or label of Ecstasy that is consumed. The role of individual disposition in producing negative drug experiences is less clear; it is possible that this factor might interact with user set or friends' set in contributing to the overall drug experience.

Methamphetamine use and HIV risk among substance-abusing offenders in California.

Abstract: Recent epidemiological surveys of illicit substance use show a particularly high prevalence of methamphetamine use in the western and southwestern United States-most notably California. Moreover, in their analysis of 1995 Drug Use Forecasting data, Anglin and colleagues (1998) found that methamphetamine was a preferred substance among California arrestees. The present study uses data from 807 state prison inmates in California (32% of whom reported using methamphetamine prior to incarceration) to examine the associations between methamphetamine use and HIV risk behaviors. Methamphetamine users in this sample were significantly more likely than nonusers to have injected drugs during the six months prior to their current incarceration. Among injectors, however, injection-related risks (such as dirty needles and needle sharing, etc.) were not significantly associated with methamphetamine use. However, past six-month sex-related risks were dramatically higher for methamphetamine users. These patterns persisted even after controlling for background differences between the two groups. The results of this study underscore the importance of addressing the higher sex-related HIV/AIDS risk among methamphetamine users undergoing prison-based drug treatment.

The politics of Ecstasy.

Abstract: Several decades into the monolithic and largely ineffectual War On Drugs, the latest object of media sen­ sationalism and government agency hyperbole has been the phenomenon of Ecstasy use. In spite of a vigorous and lav­ ishly funded propaganda campaign designed to portray Ecstasy as a vehicle for horrific central nervous system damage, its degree of use by vulnerable young people and concomitant risk for serious injury has steadily risen. Un­ fortunately, and not for the first time, a misguided political agenda armed with biased and misleading science has yielded counterproductive results. In order to successfully reduce the risks of harm that young people face in the fu­ ture, it will be necessary to step back from the zealous and disturbed policies that have brought us to our current dis­ tressing state of affairs, and instead create a new foundation based upon common sense and honest interpretation of the scientific process. Mirroring the history of hallucinogen research in the 1 950s and 1960s, when highly promising psychiatric in­ vestigations were precipitously terminated by an increasingly angry and reactive political establish­ ment, attempts in the 1 980s and 1 990s to conduct sanctioned research into the value of the MDMA (3,4methylenedioxymethamphetamine) treatment model were met with a similar fate. Loathe to provide the opportunity to explore such a putative challenge to the multibillion dollar pharmaceutical industry's domination of contemporary psychiatric treatment, government regulatory and funding agencies have resisted the development of research pro­ grams designed to explore alternative models. Regrettably, a potentially valuable dialogue on the relative merits of the MDMA treatment model has been stifled, while sensational

Preventing problems in Ecstasy users: reduce use to reduce harm.

Abstract: Increasing use of 3,4-methylenedioxymethamphetamine (MDMA, "Ecstasy") has been accompanied by concern about acute and possible long-term toxicity. This article discusses acute serious toxicity, chronic toxicity, and common problems associated with Ecstasy use, as well as the implications of these areas for prevention programs targeted at current Ecstasy users. The low incidence of serious adverse events in users creates difficulties for attempts to develop harm reduction recommendations. Many hypothesized risk factors for serious adverse events cannot be confirmed or denied and may not be associated with dramatic elevations in risk. Research on chronic toxicity in users provides strong evidence of neurophysiological changes and suggestive evidence of possible neurocognitive changes. Because these worrisome changes are clinically subtle, users may not be influenced by concerns of neurotoxicity. In contrast, common Ecstasy-related complaints are relatively well documented and have identified risk factors, including factors relating to extent of Ecstasy use (such as "binges"). Common complaints include modest acute and subacute adverse effects,some lasting several days, and problems in life. The apparent willingness of users to modify drug use and other behaviors to decrease these common problems could be used by harm reduction or other prevention programs to encourage users to decrease the extent of Ecstasy use.

Estimating the prevalence of Ecstasy use among juvenile offenders.

Abstract: To date, no studies have examined Ecstasy use among criminal justice populations. Focusing on individuals under criminal justice supervision is useful because “new” illegal drugs will typically takeroot in a criminal population before diffusing to the general population. In the current study, self-report drug use data and urine specimens were collected from 209 juvenile offenders surveyed through Maryland's Offender Population Urinalysis Screening (OPUS) Program. Prevalence estimates are generated and associations between Ecstasy use, demographic characteristics, and alcohol and other drug use are explored. Sixteen percent of the sample reponed using Ecstasy within the past 12 months, an estimate almost three times as high as grade school and high school students surveyed through the Monitoring the Future survey. Compared to nonusers, Ecstasy users were significantly more likely to be female (45% versus 20%, p<0.01), White (82% versus 22%, p<0.001), and out of school (39% versus 20%, p<0.05). Ass...

An exploratory study: the use of paroxetine for methamphetamine craving.

Abstract: Methamphetamine abuse and dependence are growing problems nationally and worldwide. There are currently no effective pharmocologic treatments. Animal studies with SSRI's suggest that serotonergic modulation alters methamphetamine's behavioral effects. This exploratory study is a trial of the effects of the SSRI paroxetine versus placebo (in a double blind design) on craving and use in a population of methamphetamine users. Many subjects dropped out of the study, but those in active treatment who completed the eight week trial had a decrease in methamphetamine craving compared to the placebo treatment as measured by the OCDS modified for use in this population. Statistical analyses were not performed due to the low number of subjects. The preliminary data suggest that serotonergic agents may play a role in the effective treatment of methamphetamine abuse and dependence within the context of other effective behavioral interventions.

Correlates of Ecstasy use among tenth graders surveyed through monitoring the future.

Abstract: Media reports have suggested that the use o f 3,4-methylenedioxymethamphetamine (MDMA or “Ecstasy”) is a prodigious problem among youth in the United States. Unfortunately, little scientific evidence exists to support this contention. In the current study, the drug-using behaviors of 3,376 l0th graders are examined with data collected through the 1999 Monitoring the Future (MTF) project. Prevalence estimates of Ecstasy use are generated and associations between Ecstasy use, demographic characteristics, and alcohol and other drug (AOD) use are explored. Seven percent of the sample reported lifetime Ecstasy use, 5% reported use within the past 12 months, and 2% reported use within the 30 days preceding the interview. Compared to nonusers, 12-month Ecstasy users were significantly more likely to be White, to have less supervision after school, and to have used all other drugs of abuse during the 12 months preceding the interview. Implications for these findings are discussed.

Gender Differences in Dually-Diagnosed Clients Receiving Chemical Dependency Treatment

Abstract: This article considers gender differences among 97 clients with dual diagnoses of severe mental illness and chemical dependency (46 male and 51 female). Comparisons are made at the time of their admission to an inpatient chemical dependency treatment program and at follow-up in cases where data are available. Many of the findings at time of admission are consistent with the few studies that have compared men and women with co-occurring mental and substance use disorders. For example, the women were more likely to have experienced emotional, physical, or sexual abuse, and they reported being charged with fewer types of crimes. Most differences at admission concerned psychiatric problems and family/social relations. Women reported that they were more bothered by their psychiatric symptoms and their family/social relations, but they also reported more happiness and closeness in some relationships. The women also said they had more relatives with alcohol, drug, and especially psychiatric, problems. At follow-up, gender differences in the family/social and psychiatric domains persisted. Findings suggest that men and women with dual diagnoses might benefit from different emphases in treatment programs.

The serotonergic system and mysticism: could LSD and the nondrug-induced mystical experience share common neural mechanisms?

Abstract: This article aims to explore, through established scientific research and documented accounts of personal experience, the similarities between religious mystical experiences and some effects of D-lysergic diethylamide or LSD. LSD predominantly works upon the serotonergic (serotonin-using neurons) diffuse neuromodulatory system, which projects its axons to virtually all areas of the brain including the neocortex. By its normal action it modulates awareness of the environmental surroundings and filters a high proportion of this information before it can be processed, thereby only allowing the amount of information that is necessary for survival. LSD works to open this filter, and so an increased amount of somatosensory data is processed with a corresponding increase in what is deemed important. This article describes the effects and actions of LSD, and due to the similarities with the nondrug-induced mystical experience the author proposes that the two could have common modes of action upon the brain. This could lead to avenues of research into mysticism and a wealth of knowledge on consciousness and how we perceive the universe.

Interaction effects of treatment setting and client characteristics on retention and completion.

Abstract: Client-treatment matching assumes treatment outcome will be improved if characteristics of clients are matched to specific elements of treatment. Few empirical studies, however, have examined matching across different types of treatment settings. The present research examined differences in demographics and substance-related problems in populations admitted to three substance abuse treatment settings--outpatient (n = 1132), intensive outpatient (n = 1190), and residential (n = 149)--and tested whether interactions between client characteristics and type of setting predicted rates of 30-day retention and treatment completion. In addition, three specific hypotheses based on prior theoretical and empirical investigations were tested. Client characteristics included demographic information (e.g., sex, age, race) and Addiction Severity Index (ASI) composite scores. Client-setting interactions were found for both retention and completion. All three hypotheses received at least partial support. Implications for client assignment and future research are discussed.

Ecstasy: America's new "reefer madness"

Abstract: MDMA (3,4-methylenedioxymethamphetamine) was first used as a legal adjunct to psychotherapy in the 1970s. By the early 1980s, "Ecstasy" had become a tiny part of the recreational American drug scene, and was ultimately criminalized in 1986. For a decade use continued, but remained quiet. By the end of the 1990s, increased supply, demand, seizures of pills, arrests of distributors associated with organized crime, adverse reactions, and government reports of problematic brain changes created an Ecstasy media frenzy. The government's reaction led to a public education campaign and proposals for exponential penalties for production, distribution and use of MDMA. This article looks at the history, epidemiology, and politics of Ecstasy, the media's response, and the ways in which media and government reaction will compromise harm reduction and safety.

Looking beyond stereotypes: Exploring variations among crack smokers

Abstract: Since the onset of the crack epidemic in the U.S. in the 1980s, the social and health consequences to the drug's users from their perspective has received limited attention. This exploratory study was designed to explore heterogeneity among crack users. Based on in-depth interviews with 22 active crack users in Atlanta, Georgia, variations among them were explored. Data analysis involved the constant comparison method as part of the grounded theory approach. A typology was derived that describes four subsets of users. The two most salient dimensions of the typology are the level of protective strategies that enable the user to avoid negative consequences and their frequency of crack use. Daily life structure and the extent to which they have access to crack contributed most strongly to use frequency. The typology includes: (1) stable users; (2) tempted users; (3) grappling users; and (4) immersed users. Increased insight into the heterogeneity among crack users is relevant when designing comprehensive prevention and intervention programs.

Snuff synergy: preparation, use and pharmacology of yopo and Banisteriopsis caapi among the Piaroa of southern Venezuela

Abstract: Current understanding of the preparation and use of yopo, a hallucinogenic snuff made from the ground seeds of the Anadenanthera peregrina tree, has departed little from the accounts of scientists and travelers made over a century ago. Schultes and others have made refinements to these early accounts. While several scholars have drawn attention to the fact that little ethnographic work has been conducted to assess the ethnobotanical diversity and cultural framework of the snuff hallucinogen complex, few subsequent studies deal with botanical variations in preparation and use. This article contrasts historical accounts of yopo preparation with ethnographic data I have recently collected among the Piaroa of southern Venezuela to demonstrate one way in which yopo preparation and use deviates from the basic model established by Humboldt, Spruce and Safford. Piaroa shamans include B. caapi cuttings in the preparation of yopo and consume doses of B. caapi prior to snuff inhalation concomitant with the strength of visions desired for particular tasks. I argue that the combined use of yopo and B. caapi by Piaroa shamans is pharmacologically and ethnobotanically significant, and substantiates claims of the use of admixtures in snuff; further ethnographic investigation of the snuff hallucinogen complex is necessary.

Ayahuasca: Human Consciousness and the Spirits of Nature Ayahuasca Reader: Encounters with the Amazon's Sacred Vine

Abstract: Ayahuasca, also known as yage or by any number of other names, is a psychoactive brew concocted of at least two particular plants growing in the rainforest jungles of the Amazonian basin and other similar climes. The primary psychoactive ingredient contained in the vine Banisteriopsis caapi, N,N-dimethyltryptamine (DMT), is usually deacti­ vated by gastrointestinal monoamine oxidase enzymes if taken orally, but brewed in tandem with leaves from an­ other plant which contains MAO inhibitors, a synergistically potent mixture is obtained. Indigenous shamans and other healers have utilized variations on this brew for centuries; more recently, adventurous seekers from other cultures have sought it out in South America and on other continents. Beyond those basic facts, things quickly get murky. After reading these books, it is difficult and seems perhaps beside the point to attempt an \"objective\" perspective on ayahuasca. Perhaps more than any other psychoactive sub­ stance, this one is unavoidably intertwined with \"mystical\" aspects which challenge scientific analysis. And that is of course much of the point. But even viewed as clinically as possible, a few remarkable observations can be made. Here's a couple, of possibly many:

Differences between Ecstasy-using and nonusing methamphetamine users.

Abstract: There have been recent alarming increases in Ecstasy use and growing evidence of possible long-term neurological and cognitive effects. This article considers Ecstasy use within its common polydrug context (specifically with methamphetamine [MA]), examining differences between Ecstasy-using and nonusing subgroups of clients treated for MA use, and exploring the relationship of Ecstasy use to selected treatment outcomes. Multivariate logistic regression showed Ecstasy+MA users differing from MA users who have not used Ecstasy primarily in terms of sociodemographics (higher income, fewer children), substance abuse behaviors and motivators (lifetime history of more types of drugs, more likely to report use of Ecstasy to enhance sex, more drug-related problems), lifestyle (more likely to have had same-sex sex partners), and treatment characteristics (younger at admission, less likely to complete treatment). A lower rate of treatment completion was predicted by Ecstasy use, even when controlling for other Ecstasy-related characteristics; however, time to relapse was not significantly related to Ecstasy use. These results distinguishing subgroups of stimulant users may help guide additional research into specific behavioral causes and correlates of Ecstasy use, which could in turn guide specialization of promising MA-related treatment approaches for Ecstasy users.

Impact of centralized intake on case management services.

Abstract: The Chicago Target Cities demonstration project was designed to improve the effectiveness and accessibility of substance abuse treatment in large metropolitan areas. The primary interventions included centralized intake (CIU), comprehensive standardized assessment procedures, and management of a centralized wait list. A part of this project, the effectiveness of a case management model implemented through the CIU, was tested. Participants were randomly assigned to one of two conditions, case management (CM) or no case management (No-CM). The primary objectives of the CIU case management model were to improve the show rate to treatment, provide referrals to ancillary services, and to support treatment completion. Participants in both groups could also receive other support services provided by staff for the treatment agencies. CM participants were significantly more likely to show to treatment (78.9%) than No-CM participants (71.8%). Case management was found to primarily improve the show rates for younger participants, who without CM were significantly less likely to show for treatment than older participants. CM participants were significantly more likely to receive referrals to non substance abuse treatment services than No-CM participants, although the number of referrals was low in both conditions. No differences were found in the amount or length of substance abuse treatment services received by participants in the two conditions.

Drug-scene roles and HIV risk among Puerto Rican injection drug users in East Harlem, New York and Bayamón, Puerto Rico.

Abstract: This article describes and compares distributions of drug-scene roles, frequency of engaging in role behaviors, and relationships of role-holding to high-risk behaviors and sexual partnerships among Puerto Rican injection drug users in New York and Puerto Rico. For this study 561 street-recruited injection drug users in East Harlem, New York, and 312 in Bayamon, Puerto Rico were asked the number of days (in the last 30) in which they earned money or drugs in each of seven drug-scene roles; and about behaviors and egocentric risk partner characteristics in the last 30 days. East Harlem subjects were more likely to get resources by selling drugs and syringes, and buying drugs for someone else; Bayamon subjects were more likely to be “hit doctors,” buy needles for others, operate a shooting gallery, or escort others to shooting galleries. All roles were part-time except shooting gallery management in East Harlem. About 27% of respondents at each site engaged in two or more roles. Many roles were ass...

Sexual abuse among women entering methadone treatment.

Abstract: Women who enter drug abuse treatment programs are likely to report histories of sexual abuse that may impact psychosocial functioning, retention, and outcomes. This study investigates differences at admission between women with and without sexual abuse histories who entered an outpatient methadone treatment program in Texas. In a sample of 137 women, 39% reported prior sexual abuse. Findings show that women with sexual abuse histories were more likely also to have experienced physical and emotional abuse, to report poorer family-of-origin relationships, and to report more drug-related problems. These clients also reported more depression, anxiety, thoughts of suicide, trouble concentrating, and trouble controlling violent behavior. Results are discussed in terms of the need for adequate assessment of abuse history at intake and the need for targeted outcome studies to better define the impact of past abuse on treatment participation and outcome.

Demystifying the injection drug user: willingness to participate in traditional drug treatment services among participants in a needle exchange program.

Abstract: Injection drug users have been vilified in our culture as being wild-eyed and willing to do anything for the next hit. These individuals are typically seen as being unemployed, uneducated and completely disinterested in making any changes in their lives. Sixty-one participants in a syringe exchange program in Cleveland, Ohio were interviewed using the NIDA Risk Behavior Assessment. Fifty (81%) of the respondents were either in an abstinence-based program or reported a willingness to participate in such a program. Importantly, although the sample consisted of long-term daily users of injection drugs (m=l9.95 years), the majority of the sample was employed (69%) and were high school graduates (51%). The results of this study suggest that injection drug users are willing to make changes in their use-related behaviors, involvement in a needle exchange program does not preclude involvement in abstinence-based programming, and needle exchange services may serve as an important component in a continuum ...

Immigrant and native-born female heroin addicts in Israel.

Abstract: There are an estimated 25,000 heroin addicts in Israel and nearly one out of every five is a woman. Also, about one fourth of the addict population immigrated to Israel from the former Soviet Union (mostly from Russia and the Ukraine) since 1989. In this study, native born and immigrant female addicts were interviewed to develop an understanding of their background characteristics, patterns of drug use, and attitudes based on group status. Results show that the two groups of women are similar in many respects; however, differences do exist. Russian-speaking women tend to be better educated and have a greater concern about their personal health and maintaining custody of their children. Additionally, immigrant women are more inclined to use heroin and other substances while receiving treatment and are more likely to have a father who abuses alcohol. Discussion is given to the study findings as well as issues relevant to the formation of policy regarding services to female addicts in the country.