Showing papers in "Journal of Psychoactive Drugs in 2003"

The Clinical Opiate Withdrawal Scale (COWS)

Abstract: The clinical opiate withdrawal scale (COWS) is a clinician-administered, pen and paper instrument that rates eleven common opiate withdrawal signs or symptoms. The summed score of the eleven items can be used to assess a patient's level of opiate withdrawal and to make inferences about their level of physical dependence on opioids. With increasing use of opioids for treatment of pain and the availability of sublingual buprenorphine in the United States for treatment of opioid dependence, clinical assessment of opiate withdrawal intensity has received renewed interest. Buprenorphine, a partial opiate agonist at the mu receptor, can precipitate opiate withdrawal in patients with a high level of opioid dependence who are not experiencing opioid withdrawal. Since development of the first opiate withdrawal scale in the mid-1930s, many different opioid withdrawal scales have been used in clinical and research settings. This article reviews the history of opiate withdrawal scales and the context of their initial use. A template version of the COWS that can be copied and used clinically is appended. PDF formatted versions of the COWS are also available from the websites of the American Society of Addiction Medicine, the California Society of Addiction Medicine, the UCLA Integrated Substance Abuse Programs, and AlcoholMD.com.

The historical trauma response among natives and its relationship with substance abuse: a Lakota illustration.

Abstract: Historical trauma (HT) is cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma experiences; the historical trauma response (HTR) is the constellation of features in reaction to this trauma The HTR often includes depression, self-destructive behavior, suicidal thoughts and gestures, anxiety, low self-esteem, anger, and difficulty recognizing and expressing emotions It may include substance abuse, often an attempt to avoid painful feelings through self-medication Historical unresolved grief is the associated affect that accompanies HTR; this grief may be considered fixated, impaired, delayed, and/or disenfranchised This article will explain HT theory and the HTR, delineate the features of the HTR and its grounding in the literature, offer specific Native examples of HT and HTR, and will suggest ways to incorporate HT theory in treatment, research and evaluation The article will conclude with implications for all massively traumatized populations

Psychiatric and substance dependence comorbidities, sexually transmitted diseases, and risk behaviors among methamphetamine-dependent gay and bisexual men seeking outpatient drug abuse treatment.

Abstract: This article describes psychiatric and substance dependence comorbidities, lifetime rates of infectious disease, and reported high-risk sexual behaviors for methamphetamine-dependent, gay and bisexual men at entry to outpatient drug abuse treatment in Los Angeles. Participants' self-reports of high-risk sexual and drug use behaviors and of history of infectious disease status were correlated with diagnostic information from 155 Structured Clinical Interviews for the DSM-IV (SCID). A total of 82 participants met criteria for lifetime depressive disorders; 44 participants met criteria for lifetime anxiety disorders. Compared to those without psychiatric diagnoses, significant differences were observed in lifetime prevalence of sexually transmitted infections among those who have generalized anxiety disorder (higher rates of genital gonorrhea), specific phobia and major depressive disorder (higher rates of oral gonorrhea), social phobia (higher rates of syphilis) and bipolar disorder, type I (higher rates of HIV). Differences in infectious disease prevalence did not correspond to significantly different rates of high-risk sexual behaviors. Findings indicate that gay and bisexual men seeking outpatient treatment for methamphetamine dependence are likely to experience psychiatric comorbidity and to have high rates of infectious disease, including HIV, syphilis and gonorrhea.

Co-occurring psychiatric symptoms and drug dependence or heavy drinking among HIV-positive people.

Abstract: This study sought to establish population-based estimates of the prevalence of co-occurring psychiatric symptoms and either or both drug dependence symptoms or heavy drinking among individuals who test positive for the human immunodeficiency virus (HIV) and to identify the factors associated with such comorbidity. Data from the HIV Cost and Services Utilization Study (HCSUS), a nationally representative sample of HIV-infected adults receiving medical care in the U.S. in 1996 (N = 2,864), were used to estimate the prevalence of comorbidity. Logistic regression was used to identify the independent influences of sociodemographic and HIV-related variables on comorbidity. The authors estimate that 13% of people with HIV receiving care in the U.S. in 1996 had co-occurring psychiatric symptoms and either or both drug dependence symptoms or heavy drinking. The odds of having a comorbid condition were higher for males, heterosexuals, and people with more HIV-related symptoms. The odds were lower for people living with AIDS, African Americans, people who were gay or sexually abstinent, those living with a spouse, those aged 50 years or older, and those with private insurance. Sixty-nine percent of those with a substance-related condition also had psychiatric symptoms; 27% of those with psychiatric symptoms also had a substance-related condition.

Evidence-Based Prevention: Characteristics, Impact, and Future Direction

Abstract: Drug use has been gradually declining among early and mid-adolescents since 1997. The timing of the decline roughly matches the introduction and diffusion (spread) of evidence-based prevention to middle schools in the United States. Evidence-based prevention refers to prevention programs, strategies, and policies that have been rigorously tested under research conditions and found to be effective in changing adolescent drug use behavior and attitudes. Federal and state funding for prevention is increasingly tied to community and school commitments to use only evidence-based strategies. However, local interpretation of what constitutes evidence-based prevention is highly variable, and subject to lack of knowledge about characteristics of evidence-based prevention, local politics and preferences for the status quo, and attempts to change parameters of evidence-based programs to fit perceived local needs. The current article reviews and synthesizes the characteristics and impact of evidence-based prevention, including the use of theoretical, process, and structural models; content guided by risk and protective factors for drug use; and settings and components of prevention delivery. Issues of adoption, implementation, and diffusion of evidence-based prevention are discussed. Gaps in knowledge of how to move the U.S. from research to practice are presented in terms of future researchable questions. Finally, the changing nature of prevention research is discussed as "action research," involving the negotiated partnership of the researcher and the community, and feedback of research results to communities to use as a planning tool for prevention.

Community Readiness: The Journey to Community Healing

Abstract: Community readiness is a research-based theory that provides a basic understanding of the intervention process in communities. This theory allows us to accurately describe the developmental level of a community relative to a specific issue or problem. In order to move the community toward implementing and maintaining efforts that are effective and sustainable, community mobilization must be based on involvement of multiple systems and utilization of within-community resources and strengths. Successful local prevention and intervention efforts must be conceived from models that are community-specific, culturally relevant, and consistent with the level of readiness of the community to implement an intervention. The community readiness model is an innovative method for assessing the level of readiness of a community to develop and implement prevention programming. It can be used as both a research tool to assess distribution of levels of readiness across a group of communities or as a tool to guide prevention efforts at the individual level. This tool has proven useful in addressing a gamut of problems ranging from health and nutritional issues to environmental and social issues. The model identifies specific characteristics related to different levels of problem awareness and readiness for change.

A potential hidden source of hepatitis C infection among noninjecting drug users

Abstract: Hepatitis C virus (HCV) is a major cause of chronic liver disease in the United States and worldwide. It is primarily transmitted through blood-to-blood contact with an infected individual. HCV is hyperendemic among injection drug users (IDUs), who contract the virus through contaminated syringes and drug preparation equipment shared with other IDUs. The prevalence of HCV is also high, to a lesser degree, among noninjection drug users, many of whom report no identifiable HCV risk exposures. This article reviews the epidemiological and virological evidence bearing on a potential hidden source of HCV infection among noninjection drug users: namely, the oral or intranasal transmission of HCV through the sharing of noninjection drug-use implements such as pipes or straws. While there is some epidemiological evidence supporting both oral and intranasal HCV transmission, most studies are hampered by methodological limitations. Thus, there is a need for prospective studies designed specifically to examine these potential routes of transmission. Current biological evidence does not refute either oral or intranasal transmission as possible sources of HCV infection, although more research is needed in the areas of oronasal HCV pathogenesis and the detection of HCV RNA in the nasal mucosa of intranasal drug users.

Acute physiologic and chronic histologic changes in rats and mice exposed to the unique hallucinogen salvinorin A.

Abstract: Salvinorin A is a unique hallucinogen that is seeing increased use in humans. It is not currently a controlled substance and is used as a legal alternative to controlled substances. Usually smoked or buccally absorbed by chewing, doses of approximately 200 mcg can produce profound hallucinogenic effects of short duration. The mechanism of action of salvinorin A is at the kappa-opioid receptor. Little data is available on the medical effects of this substance so animal studies were undertaken to explore the acute toxic effects of this substance in rats and the chronic effects in mice. Rats were anesthetized and administered salvinorin A at 1600 mcg/kg or vehicle. Recordings were made of galvanic skin response, EKG, temperature, and pulse pressure for 100 minutes. Mice were chronically exposed to vehicle or 400, 800, 1600, 3200, or 6400 mcg/kg of salvinorin A for two weeks. After exposure the animals were sacrificed and brain, heart, kidney, bone marrow, blood and spleen were removed, fixed, sectioned, stained and examined by light microscopy. No effects were seen on cardiac conduction, temperature, or galvanic skin response. A nonsignificant rise was seen in pulse pressure. Histologic studies of spleen, blood, brain, liver, kidney, and bone marrow did not find any significant histologic changes at any of the doses examined. These data suggests that the toxicity of salvinorin A is relatively low, even at doses many times greater than what humans are exposed to. However, further studies should be done on blood pressure effects. The psychological impact of this potent hallucinogen should also be investigated.

HIV/AIDS Among Probationers: An Assessment of Risk and Results from a Brief Intervention

Abstract: A number of studies have examined HIV risk behaviors in prisoner populations, but relatively few have examined such behaviors in probationer populations. Since probationers have more opportunities to engage in risk behaviors than do prisoners, the potential importance of HIV interventions with probationers becomes readily apparent. This article examines a sample representative of the supervised probationer population in Delaware. The sample respondents received a baseline interview, then were randomly selected to receive either an enhanced version of NIDA standard HIV Intervention or a Focused Intervention based on a cognitive thought-mapping model. Intervention boosters were offered at two follow-up intervals in the following three months, and respondents were reinterviewed at six months. The data at baseline suggest that probationers in Delaware have levels of injection drug use, other serious drug use, and rates of risky sexual behaviors that approach those observed in prison populations. The interventions' effectiveness in changing attitudes and behaviors at the six-month interview was then examined. The data support the conclusion that brief interventions can significantly impact both drug use and sexual risk behaviors among probationers. However, there do not appear to be significant improvements for those receiving the more intensive Focused Intervention, as compared to those who receive the enhanced Standard Intervention. Further work will consider what components in programs and characteristics in clients should be considered in selecting the most appropriate interventions for probationers.

Head Injury Among Drug Abusers: An Indicator of Co-Occurring Problems

Abstract: Alcohol and other drug use has been associated with traumatic brain injury both as a contributing factor to the injury and as a complicating factor for rehabilitation. Brain injury is associated with an increase in mental health and other problems that may be related to drug and alcohol abuse and that may influence recovery. This study examined self-reports of 661 drug-abusing inmates with self-reported head injury, health problems and mental health problems. Three groups were examined for this study: those having no head injury, one head injury, and two or more head injuries. Results indicate that inmates with head injuries had a significantly greater number of health problems, higher levels of alcohol and marijuana use, and significantly more mental health problems including depression, anxiety, suicidal thinking, and difficulties in concentrating and controlling violent behavior. This study suggests that questions regarding head injuries during assessment may identify drug abusers who need a treatment approach that accommodates their co-occurring problems and difficulties with processing and complying with treatment interventions.

Prevalence and risk factors for HIV among sniffers, short-term injectors, and long-term injectors of heroin.

Abstract: The prevalence of HIV and associated risk behaviors were assessed among three groups of heroin users: long term injection drug users (LTIDUs). new injection drug users (NIDUs), and heroin sniffers (HSs) with no history of injection. HIV seroprevalence was similar among NIDUs (13.3%) and HSs (12.7%). LTIDUs had almost twice as high a level of HIV infection (24.7%). A fter including drug use and sex behavior variables in logistic regression models, both drug and sexual risk factors remained in the models. Attributable risk percent (APR) from injection for HIV infection among injection drug users was estimated to be 55.7% for LTIDUs and 5.8% for NIDUs. High-risk sex behavior plays an important role in the prevalence of HIV among drug users and accounts for nearly all the infection among NIDUs. Both injection and sexual risk behaviors need to be stressed in HIV prevention and intervention programs aimed at drug users.

Effects of gender and diagnosis on addiction history, treatment utilization, and psychosocial functioning among a dually-diagnosed sample in drug treatment.

Abstract: There has been increased recognition of the clinical treatment needs of patients with co-occurring mental and substance use disorders and the heterogeneity of this group with regard to types of substances used and mental disorders. This article examines differences between men and women diagnosed with mood or psychotic disorders at admission to residential drug treatment, specifically regarding their addiction history, treatment history, perceived service needs, and psychosocial functioning. Males initiated drug use at a younger age and had higher levels of dependence on alcohol, cannabis, and opioids. There were no differences among groups in treatment history, motivation, or initiation. Males had higher rates of being under legal supervision and engaging in property crime, whereas females had higher rates of prostitution. Females had greater needs for family- and trauma-related services, and females with psychotic disorders had the highest needs for basic services. There were no differences among groups in barriers to treatment, quality of life, self-efficacy, or family support. Individuals with psychotic disorders had more symptoms of psychological distress; females had higher rates of posttraumatic stress disorder. Differences among dually-diagnosed individuals related to gender and diagnosis need to be considered in treatment planning and in matching services to patient needs.

Measurement of adolescent drug use.

Abstract: There is widespread agreement that estimates of adolescent drug use prevalence from the National Household Survey of Drug Abuse (NHSDA) and Monitoring the Future (MTF) are subject to considerable measurement error. Nevertheless, some have suggested that trends over time in these prevalence estimates probably reflect true trends in drug use, since underreporting may be assumed to be constant over time. A recent National Research Council report criticizes this assumption on logical grounds. The present study examines adolescent drug use responses on the NHSDA and MTF for evidence of "drug omission," "jargon confusion" and "conceptual confusion," three types of misreporting expected to vary in magnitude with changes in drug use practices and changes in survey items. Results demonstrate that adolescent drug users are significantly more likely than adults to report use of drugs not listed in the NHSDA. Among adolescents who wrote in the "other" drugs they used, 66% and 86% of hallucinogen and inhalant responses showed confusion over the meaning of the pharmacological terms used in the NHSDA. Almost 20% of MTF respondents who report lifetime use of Rohypnol or ecstasy, when specifically queried about these drugs, deny lifetime use of any substances in the drug classes intended to assess use of Rohypnol and ecstasy. MTF respondents reporting lifetime use of PCP underreport use of hallucinogens at rates that vary substantially over time, from a high of 45% (in 1986), to a low of just 8% (in 1998). The implications of these findings for adolescent drug use prevalence estimation and survey design are discussed.

Drug Injectors and Dealers in Odessa, Ukraine

Abstract: This article reports on the results observed in a series of focus groups and in-depth interviews with injection drug users (IDUs) and drug dealers in Odessa, Ukraine. Ukraine has the highest rate of HIV infection in Eastern as well as Western Europe, and Odessa ranks among the cities in that country with the highest seroprevalence. The epidemic is largely concentrated among IDUs, although heterosexual transmission is increasing. The purpose of this study was to further understand the context in which HIV-related risk behaviors occur in order to recommend intervention strategies that might reduce the rate of new infections. The drug users who participated in the research were impoverished and severely addicted. Findings revealed that there were two sources for drugs in Odessa: either from gypsies in preloaded syringes, or from drug dealers also in a liquid form. The most common drug injected was liquid poppy straw, a weak opiate known as “hernia.” Results showed widespread victimization of drug us...

Towards the integration of treatment systems for substance abusers: report on the second International Symposium on Substance Abuse Treatment and Special Target Groups.

Abstract: The central ideas of this article are the result of intensive discussions during a symposium that was organized following structural changes in European substance abuse treatment. Therapeutic communities were concerned about their approach being replaced by other treatment modalities. Participants focused on the question of whether the emerging harm reduction paradigm could be combined with the principle of recovery and how its integration in a comprehensive treatment system could be beneficial or detrimental to therapeutic communities. This article defines integrated treatment systems for substance abusers from a conceptual, etymological, ethical and ideological point of view. In addition, it focuses on old but ongoing contradictions and discussions between drug-free, methadone-maintenance and harm reduction approaches. Several prerequisites for the integration of treatment systems are discussed, and parallels and discrepancies between the American and European situation are explored. An integrated and comprehensive system of treatment services is put forward as an alternative to the present-day gap between conventional abstinence-oriented programs and harm reduction initiatives. Participants maintain that collaboration between these apparently incompatible treatment paradigms will depend on mutual respect, the introduction of a common language and a thorough analysis of clients' treatment demands.

"The rock always comes first": drug users' accounts about using formal health care.

Abstract: Illicit drug use remains a significant public health threat. The issues surrounding drug use are recognized by public health professionals as important for several reasons. The incidence and prevalence of drug use persists in spite of the extensive societal, interpersonal, and individual consequences. In addition, the chronic health issues and health care costs associated with drug use continue to spiral. A wide variety of quantitative studies have examined the extent of health care problems, access, cost, and health care satisfaction among illicit drug users. While these studies offer important information through survey formats, fewer studies focus on subjective constructions of health care management from the users' perspective. This article examines the elements of the decision-making process involved in accessing formal health care among chronic and injecting street drug users. Twenty-eight in-depth interviews provide the data for this analysis, which is part of a large quantitative study of 1,479 injecting and chronic drug users and nondrug users in Miami, Florida. By exploring the elements of health care access through the eyes of the drug users, researchers and treatment professionals may gain insights into new ways to improve health care access for this at-risk population.

The use of the Puerto Rican Biculturality Scale with Puerto Rican drug users in New York and Puerto Rico.

Abstract: This study examines the psychometric properties of an acculturation scale specifically developed for Puerto Ricans with a sample of substance abusers residing in Puerto Rico and New York. In line with current conceptual models of acculturation, this instrument departs from a mutually exclusive or zero-sum conceptualization of acculturation by assessing involvement in both American and Puerto Rican cultures independently of each other. Findings from this study permitted comparisons of acculturation as experienced by Puerto Rican injection drug users in Puerto Rico and New York. Results supported the notion of independence of individuals' involvement in American and Puerto Rican cultures, thus confirming the complex nature of biculturalism. This article also examines the relevance of the study of acculturation scales that can assist in identifying the influences of the cultures of origin and destination on substance abuse and HIV risk behaviors.

Sweat lodge ceremonies for jail-based treatment

Abstract: Sweat lodge ceremonies (SLCs) have been an integral part of Navajo culture for hundreds of years. The Dine' Center for Substance Abuse Treatment staff utilized SLCs as a modality for jailbased treatment. Data were collected from the Spring of 1996 through the Spring of 1999 from 190 men ranging in age from 18 to 64. These inmate/patients (IPs) provided information at intake on a broad range of questions which were important in understanding the problems these men were having with alcohol and other drugs. Experiential data were collected from 123 IPs after each SLC. Several cultural variables showed improvement in the IP's world view following the SLCs. Even though there were few areas where data were statistically significant. several drinking measures changed in a positive direction. For example, among those subjects who were followed-up, analysis revealed a decrease in the number of drinks consumed in drinking sessions from a mean of 6.7 drinks at intake to a mean of 5.3 drinks. This article ex...

A Dual Diagnosis Demonstration Project: Treatment Outcomes and Cost Analysis

Abstract: This article presents findings from an outpatient dual diagnosis demonstration project that investigated whether integrated treatment services for severely and persistently ill patients with co-occurring mental health and substance abuse disorders could result in improved outcomes and reduction of criminal justice and health care costs. Integrated treatment was defined as a simultaneous focus on both disorders through the provision of psychosocial rehabilitation, psychotherapeutic and psychopharmacologic treatment, and substance abuse recovery and relapse prevention by cross-trained staff. One hundred twenty six (126) patients with multiple DSM-IV Axis I and Axis II disorders were assessed on a variety of mental health, substance abuse, and quality of life measures at baseline and at six-month intervals up to three years post entry into treatment. Criminal justice and health care costs obtained from state and local databases were compared two years before and two years after initiation of treatment to determine cost differences. The study found statistically significant improvements in psychiatric symptoms, substance abuse, and quality of life outcomes. There were also decreases in criminal justice and acute and sub-acute mental health and alcohol and other drug (AOD) costs and increases in outpatient mental health and physical health care costs.

Intervening effectively with drug abusers infected with HIV: taking into account the potential for cognitive impairment

Abstract: HIV-positive drug users play a significant role in the transmission of HIV infection. Substance abuse treatment programs can potentially reduce transmission by providing HIV preventive interventions to these individuals. However, there is growing evidence suggesting that, due to a variety of factors, a substantial proportion of HIV-positive drug users may enter addiction treatment with some degree of cognitive impairment in domains that could impede their ability to learn, retain, and execute HIV preventive behaviors. Hence, in order to optimize the effectiveness of these interventions, the client's level of cognitive functioning may need to be considered. In this article an Information-Motivation-Behavioral Skills model of HIV preventive behavior is used to illustrate ways in which impairment in cognitive functioning could impede HIV preventive efforts, and present several practical strategies that front-line substance abuse counseling staff and other treatment providers can incorporate into interventions delivered to HIV-positive clients.

A Holistic System of Care for Native Americans in an Urban Environment

Abstract: The Native American Health Center has implemented a holistic system of care in the San Francisco Bay Area as a result of a multiyear strategic planning process that included a needs assessment based on the community-readiness model. The strategic plan links substance abuse, mental health, HIV/AIDS, and social services in a holistic approach congruent with Native American values and traditions. The plan also links prevention with treatment in a continuum of care. Based on a collaboration of Native American nonprofit community-based organizations and public agencies, the plan has resulted in bringing significant resources to the community.

Family-focused substance abuse treatment: a program evaluation.

Abstract: Until recently, few programs were available for children whose mothers are in recovery. A refinement of the gender-specific model of substance abuse treatment, the “family-focused” approach, has placed increased emphasis on the needs of children and other family members. However, because these programs are relatively new, little is known about the effectiveness of this type of treatment for either the mother or her children. This article presents findings from a three-year evaluation of a family-focused residential treatment program for women and their children. Longitudinal assessment of the mothers indicated that their psychosocial status and parenting attitudes improved over time. Additionally, the mothers remained in treatment longer. At intake, as a group, the children who were birth to three years of age did not exhibit developmental delay. However, developmental concerns were identified for some children in the areas of motor and/or language development. The results reported here provide b...

Comparing the Validity of Self-Reported Recent Drug Use Between Adult and Juvenile Arrestees

Abstract: A large body of literature has explored the validity of self-reported drug use among criminal populations. These works have typically revealed strong underreporting of recent illicit drug use. To date, however, no studies have compared the validity of self-reported drug-using behaviors between adult and juvenile offenders. The authors overcome this limitation by assessing the validity of self-reported recent drug use with data collected from 1,425 adult and 551 juvenile Los Angeles arrestees surveyed through the Arrestee Drug Abuse Monitoring (ADAM) Program in 1997. Kappa statistics were computed and tests for specificity and sensitivity were conducted utilizing urinalysis as the reference standard. Results suggest that adult arrestees are more inclined to underreport their recent use of illicit drugs. Implications for drug use research are assessed in light of the current findings.

Healthy Nations: Reducing Substance Abuse in American Indian and Alaska Native Communities

Abstract: Since 1993, 14 American Indian and Alaska Native (AIAN) communities have worked diligently to reduce the harm due to substance abuse in their communities. Funded by the Robert Wood Johnson Foundation's Healthy Nations Initiative I, these communities implemented creative strategies that span the continuum from community-wide prevention, early identification and treatment to aftercare. Drawing upon the unique strengths of their own cultural traditions to find solutions to local substance abuse problems, these efforts have identified important and useful lessons for not only other AIAN communities, but also for sponsors of substance abuse programming in Indian country and elsewhere. Described here are successful strategies for developing and sustaining substance abuse programs in AIAN communities and an assessment of their impacts and accomplishments.

An holistic approach to substance abuse treatment.

Abstract: The purpose of this article is to describe a model outpatient substance abuse treatment program. This program is designed to provide patients with not only traditional modalities of treatment such as individual, group, and family therapy, but also to provide an opportunity for patients to express thoughts and feelings through holistic modalities. These modalities include dance/movement therapy, Tai Chi, art therapy, leisure and recreational skills, spiritual growth and development, cultural awareness and appreciation, vocational services, psychiatric care and physical health. The authors describe features of this program that they believe to be unique and that focus on ways to help patients develop a stronger sense of self-identity, self-esteem and self-confidence.

Cultural connection and transformation: substance abuse treatment at Friendship House

Abstract: This research investigates the transformational experiences o f Native Americans during the course of their retraditionalization and treatment for drug and alcohol dependence Twelve graduates of the residential treatment program at Friendship House in San Francisco were interviewed about the kind and quality of their healing experiences in this particular program, which provides a comprehensive matrix of Native American medicine as well as Western models of psychological treatment The purpose of this study was to understand and document the experience of substance abuse recovery from the perspective of the Native Americans in treatment Twelve themes emerged from the data analysis: feeling cared for; spiritual experience; insight; making a commitment; empowerment/self-esteem; releasing emotional pain; remorse; reconnecting to traditional values; forgiveness; relief; safety; and gratitude

Treatment Readiness Among Out-of-Treatment African-American Crack Users

Abstract: Crack cocaine use is linked to high rates of HIV and other sexually transmitted infections, as well as violence and criminal activity. Substance abuse treatment can play an important role in reducing drug use and related problems. However, many crack users do not want treatment, and those who do often encounter significant obstacles to access. This study compares 216 out-of-treatment African-American crack users who reported wanting to enter treatment with 129 who did not want treatment. In bivariate analyses, participants wanting treatment in the next 30 days were more likely to report needing help with medical care, daily crack use, physical abuse, transportation issues, and legal pressure to enter treatment. Predictors of treatment readiness in multiple logistic regression analysis included gender, daily crack use, legal pressure, depression, and problem recognition. Fear of physical abuse and previous treatment admissions were associated with decreased odds of wanting treatment. The many unmet needs reported by crack users motivated for treatment suggest that treatment entry and retention could be facilitated by pretreatment and more comprehensive and ancillary treatment services.

Beliefs about drinking behavior predict drinking consequences.

Abstract: Cognitions about drinking, such as positive expectancies and self-efficacy, have been found to profoundly influence drinking behavior. Although the relationship of self-efficacy and positive expectancies with drinking consumption has been established, the relationship of self-efficacy and alcohol expectancies with the number of reported drinking related consequences has not been examined. One hundred thirteen participants who met criteria for alcohol abuse or dependence were administered the Situational Confidence Questionnaire, the Alcohol Expectancies Questionnaire, the Drinker Inventory of Consequences-Recent, and the Losses of Significance Self-report Questionnaire-Revised. As predicted, lower self-efficacy and greater positive alcohol expectancies predicted greater recent drinking consequences beyond those accounted for by alcohol consumption alone. Greater numbers of positive alcohol expectancies also predicted greater numbers of recent important alcohol related losses. Correcting errant assumptions about alcohol expectancies and strategies designed to increase self-efficacy may reduce harmful drinking consequences even if a client is unwilling to reduce consumption.

Current physical health problems and their predictors among a community sample of crack-cocaine smokers in Ohio.

Abstract: The harmful effects of nonmedical cocaine use are well documented, but the overall health of people involved with crack is less well understood. This cross-sectional study describes the nature and extent of current health problems in a community sample of 430 crack smokers in Dayton, Ohio. Two-thirds of the sample reported one or more current physical health problems. The estimated annualized incidence of acute health problems was 152.6 conditions/100 persons/year. The estimated prevalence of chronic problems ranged from a low of 30.2 conditions/1000 persons for diabetes to a high of 223.2 conditions/1000 persons for anemias. Cardiovascular problems were common. Even though the results cannot prove a cause and effect relationship between crack use and health problems, they do suggest that crack users experienced higher than usual rates of problems, when compared with data from the National Health Interview Survey. The results of a cumulative logistic regression analysis suggest that men were significantly less likely, and older users more likely, to have health problems. Neither duration of crack use nor frequency of use of any drug predicted health problems. Incorporating assessments of physical problems as well as a mechanism for their treatment into the regimen of drug abuse treatment programs should be considered.

Rural and urban similarities and differences in private substance abuse treatment centers.

Abstract: Although previous research has considered the unique treatment needs of rural residents, little research has investigated the potential differences in the availability of treatment services in rural and urban areas. Using three waves of longitudinal data from a nationally representative sample of privately-funded substance abuse treatment centers, this research compared rural and urban treatment centers with regard to the availability of clinical levels of care, the offering of specialty treatment tracks, the adoption of treatment innovations, and the average costs of care. Results indicate that rural and urban centers were similar in their increasing provision of inpatient psychiatric levels of care and their decreasing offering of more intensive levels of chemical dependency services between 1995 and 2001. Rural and urban centers were increasingly likely to offer specialty treatment tracks for women, adolescents, clients with HIV/AIDS, and relapsing clients over time, but rural centers were les...