Showing papers in "Substance Use & Misuse in 2000"
TL;DR: Investigation of how sociodemographics, psychosocial health, and perceived support from parents and friends might predict smoking, drinking, and drug use in adolescence found Sociodemographics proved to be the key predictors of substance use.
Abstract: A number of factors influence adolescent substance use. The main goal of this study has been to investigate how sociodemographics, psychosocial health, and perceived support from parents and friends might predict smoking, drinking, and drug use in adolescence. Data were collected using self-administered questionnaires among secondary school students (n = 1,039) in Szeged, Hungary. Sociodemographics (gender, age, and the type of school) proved to be the key predictors of substance use. While neither friend nor mother support appeared to be strong predictors, a low level of perceived father support increased the chance of all types of substance use.
160 citations
TL;DR: Telephone audio computer-assisted self-interviewing (T-ACASI) overcomes this limitation of telephone surveys by allowing respondents to respond to a computer and reported a higher prevalence of drug use and drug-related behaviors than respondents interviewed by human interviewers.
Abstract: Measurements of drug use and other illicit or stigmatized behaviors are subject to nontrivial underreporting biases. During in-person surveys, respondents are more likely to report such behaviors w...
144 citations
TL;DR: The results indicate that experiencing a high number of life events over time is related to a significant “growth” of drug use, even after controlling for “ growth” due to age or peer relations.
Abstract: The purpose of this paper is to describe and examine one pathway by which adolescent drug use increases during early and mid-adolescence. It draws upon recent research on adolescent stress, drug us...
124 citations
TL;DR: Results show that the impact of bystanders during the interview varies according to the identity of the bystander, age of the person interviewed, and the mode of interview.
Abstract: In this study we investigated the influence of bystanders on self-administered interviews asking about the use of alcohol and illicit drugs. Interview participants were adolescents and young adults living in urban and suburban areas of the United States. Participants were assigned randomly to either a computerized or a paper-and-pencil self-administered interview. Results show that the impact of bystanders during the interview varies according to the identity of the bystander, age of the person interviewed, and the mode of interview. When a parent was present during the interview, survey participants were less likely to report the use of alcohol and marijuana. The influence of parents was stronger for adolescents than for young adults. The use of computer-assisted self-administered interviewing, compared to interviews with paper-and-pencil forms, reduced the effects due to the presence of parents during the interview. The presence of siblings during the interview had a small, negative effect on reports of...
121 citations
TL;DR: Results from conditional models demonstrate that the impact of the stress is contingent on age, and that the strong associations between drinking and stress evidenced during the high school years weaken considerably as individuals move into their late teens and early twenties.
Abstract: Despite evidence of a strong association between stress and level of drinking in adolescent populations, the role of stress in accounting for changes in drinking behavior throughout the adolescent ...
110 citations
TL;DR: Survey findings reflect greater acceptance of alcohol and drug misusers in recent years, however, significant minorities of nurses continue to regard substance users as immoral, characterologically defective, and unlikely to recover.
Abstract: Studies of nurses' attitude toward substance misusers, spanning three decades, are reviewed. Survey findings reflect greater acceptance of alcohol and drug misusers in recent years. However, significant minorities of nurses continue to regard substance users as immoral, characterologically defective, and unlikely to recover. Implications of these attitudes for treatment of substance misusers are discussed.
103 citations
TL;DR: In this selective review of literature, a growing body of empirical work on clinicians' impact highlights several key issues that have relevance both to clinical practice and future research.
Abstract: Clinicians' impact on substance use disorder treatment has been much less studied than therapy and patient variables. Yet, in this selective review of literature, a growing body of empirical work on clinicians' impact highlights several key issues that have relevance both to clinical practice and future research. These issues include clinicians' effect on treatment retention and outcome, professional characteristics, recovery status, adherence to protocols, counter-transference, alliance, personality, beliefs about treatment, and professional practice issues. Specific recommendations are offered to help improve the quality of care clinicians provide. In particular, it is suggested that greater accountability for clinicians' performance be balanced with increased support for their very difficult role. Methodological issues in studying clinicians are also addressed.
89 citations
TL;DR: The review considers the impact of the recent stress and coping paradigm on clinical interventions for excessive drinkers and their families, and suggestions are made for future research.
Abstract: There is much debate in the addiction literature about the extent to which excessive drinking affects nondrinking family members. The issue is considered in this review by examining and evaluating research relating to the effects of drinking on children, family systems, and partners of drinkers. The latter group have, historically, been blamed and apologized for their partner's drinking, although more recent theories have adopted a stress and coping paradigm, thus normalizing individuals and their behaviors. Conceptualizations of spouses over the last five decades are described and evaluated in the second part of the review. Finally, the review considers the impact of the recent stress and coping paradigm on clinical interventions for excessive drinkers and their families, and suggestions are made for future research.
79 citations
TL;DR: Program factors found to be significantly correlated with effect size in one or more modalities were decade of treatment, researcher involvement in treatment delivery, maturity of the program, counselor/client ratio, treatment implementation, treatment exposure, and methadone dosage.
Abstract: In comparison with studies of client characteristics and treatment processes, limited research has been conducted on how program features of drug dependence treatment programs may affect client outcomes. Of particular interest are those characteristics of programs that may have a clinically significant impact on outcomes and that are amenable to change within programs. This study examines the impact of various program factors on client outcomes using data from a meta-analysis of drug dependence effectiveness studies (n = 143). Because of heterogeneity among studies, the data are analyzed in terms of type of outcome variable (drug use and crime), type of design (single-group and treatment-comparison group), and type of treatment (methadone maintenance, therapeutic communities, outpatient drug free, and detoxification). For the more valid treatment-comparison group studies, the weighted mean effect size was 0.29 for drug use outcomes and 0.17 for crime outcomes. Program factors found to be significantly correlated with effect size in one or more modalities were decade of treatment, researcher involvement in treatment delivery, maturity of the program, counselor/client ratio, treatment implementation, treatment exposure, and methadone dosage.
76 citations
TL;DR: A typology of existing DIS is offered and what is required are DIS that combine a critical information processing function with the ongoing systematic collection of data from a range of data sources is offered.
Abstract: Drug Information Systems (DIS) are called upon to provide an early warning of emerging trends in drug use. However, little theoretical attention is directed toward exploring conceptual issues in this area. In this paper a typology of existing DIS is offered. Among the features that distinguish DIS are their structure (human network or organization systems) and the range of information sources used. Indicators of drug use can be placed on a continuum of sensitivity ranging from leading edge indicators to lagged indicators. Sensitivity implies volatility as sensitive indicators also react to fluctuations that do not become trends. DIS conventionally are largely reliant upon lagged indicators. What is required are DIS that combine a critical information processing function with the ongoing systematic collection of data from a range of data sources.
74 citations
TL;DR: Developmental theory and research suggest an alternative conceptualization of the linkages between family bonding and adolescent risk behaviors that requires concurrent examination of a range of adolescent competencies as well as consideration of parent and peer contexts.
Abstract: Social-control-based deviance theories highlight parental bonding as a protective factor for problem behaviors in that bonds are viewed as reflecting the adolescent's adoption of conventional societal attitudes and values. Developmental theory and research suggest an alternative conceptualization of the linkages between family bonding and adolescent risk behaviors. This conceptualization requires concurrent examination of a range of adolescent competencies as well as consideration of parent and peer contexts. Support is found for several hypotheses derived from a developmental approach proposing: (a) positive associations between adolescent-parent attachment and adolescent competencies–autonomy, peer relationship competency, and coping; (b) coherence in the pattern of negative associations between attachment/competencies and substance use problems; and (c) a disjunctive pattern of associations with substance use reflected by positive associations with peer competencies but not with parental attachment.
TL;DR: Overall measures of fit generated via structural equation modeling indicate that the IMB model adequately fits the data obtained, and tests of parameter estimates indicate that while information and motivation had direct and reliable associations with safer sexual behavior in this population, behavioral skills did not.
Abstract: The current study represents the application of a health behavior model to account for unsafe sexual behavior (as opposed to unsafe needle use) among heroin addicts in methadone treatment. The Information-Motivation-Behavioral Skills (IMB) model of HIV preventive behavior asserts that HIV prevention information, motivation, and behavioral skills are fundamental determinants of HIV preventive behavior. Participants (N = 156 heroin-addicted individuals in methadone treatment) completed assessments of their levels of HIV prevention information, motivation, behavioral skills, and safer sexual behavior. Overall measures of fit generated via structural equation modeling indicate that the IMB model adequately fits the data obtained. The constructs of the model accounted for a substantial proportion of the variance in safer sexual behavior, and tests of parameter estimates indicate that while information and motivation had direct and reliable associations with safer sexual behavior in this population, behavioral skills did not. Discussion focuses on the primary roles of HIV prevention information and motivation as determinants of safer sexual behavior in this population, on the lack of a significant contribution of HIV prevention behavioral skills, and on the implications for intervention of this pattern of findings.
TL;DR: The findings from this treatment outcomes study indicate that the acceptance of Twelve-Step ideology, particularly strong agreement with the need for frequent, lifelong attendance at Twelve- step meetings, and the need to surrender to a “higher power” are significant predictors of weekly or more frequent attendance at 12-Step meetings independent from other potentially mediating variables.
Abstract: Previous research revealed an additive effect of recovery activities in that those who attended Twelve-Step meetings on a weekly basis during and after outpatient drug-user treatment had higher rates of abstinence compared to those who participated in either treatment or Twelve-Step programs alone. The current investigation extends the previous research by examining the possible effects of Twelve-Step ideology on participation in Twelve-Step programs and abstinence from drug use. The findings from this treatment outcomes study indicate that the acceptance of Twelve-Step ideology, particularly strong agreement with the need for frequent, lifelong attendance at Twelve-Step meetings, and the need to surrender to a “higher power” are significant predictors of weekly or more frequent attendance at Twelve-Step meetings independent from other potentially mediating variables. Twelve-Step ideology, specifically the notion that controlled or nonproblematic drug use is not possible, predicted abstinence independent ...
TL;DR: An integrative model developed previously to predict treatment retention was expanded and applied to post- treatment outcomes and the effects of intervening social support variables as predictors of post-treatment drug and criminality outcomes were expanded.
Abstract: Follow-up studies of drug user treatment generally find significant improvements in client functioning, but information about the therapeutic components associated with client behavioral changes over time is limited. An integrative model developed previously to predict treatment retention was expanded and applied to post- treatment outcomes. This study is based on 321 daily opioid users treated in three methadone treatment clinics. Effects of pretreatment motivation, treatment process measures representing therapeutic relationship, counseling session attendance, and length of treatment are examined in relation to measures of family relations, peer deviancy, return to treatment, drug use, and criminality in the year after treatment. Models were tested in two stages. The first was built on a during-trealment process model for predicting time in treatment to include post-treatment outcomes. The second model was expanded further to include the effects of intervening social support variables as predictors of p...
TL;DR: A standard approach is developed, sampling and attrition rates are broken down, differences in client, program, and methodology factors are discussed, and some methodological recommendations for future follow-up studies of addiction treatment are concluded.
Abstract: Large-scale studies of addiction treatment employ two stages: select providers, then select patients to follow-up. Nonresponse due to noncooperation of providers and problems of locating and recruiting patients may bias the results. We review selection and attrition biases in previous work and in four major United States treatment studies in the 1990s: DATOS (N = 10,100 clients. 96 units), NTIES (N = 6,593/71), SROS (N = 3,047/99), and CALDATA (N = 3,045/86). We develop a standard approach, break down sampling and attrition rates, and discuss differences in client, program, and methodology factors. We conclude with some methodological recommendations for future follow-up studies of addiction treatment. [Translations are provided in the International Abstracts Section of this issue.]
TL;DR: Findings indicate that the observed increased risk of death associated with “alcohol dependence” is not limited to cases severe enough to have been treated but is also present among cases in the household population.
Abstract: Objective: Evidence is provided about the association between “alcohol-use disorders” and the 14-year risk of death in a community sample. Most prior descriptions of this association come from trea...
TL;DR: The aim of this paper is to reflect on the past decade of research and community action on alcohol and especially on some of the presentations given in the three previous international meetings on community action: in Ontario 1989, San Diego 1992, and Greve Florence 1995.
Abstract: The aim of this paper is to reflect on the past decade of research and community action on alcohol and especially on some of the presentations given in the three previous international meetings on community action: in Ontario 1989, San Diego 1992, and Greve Florence 1995. The projects reported on are diverse, reflecting the different cultures represented, but there are also common strands. Among these common strands is the growing consensus that at the heart of successful evaluated community action projects is a process of reciprocal and respectful communication: between different community sectors and also between the community and researchers. While there is increased acknowledgment of the knowledge community sectors bring to planning and implementing community action, there is also an increasing focus on the role of the researcher in providing research-based knowledge to facilitate the development of effective community strategies to reduce alcohol-use-related harm. This is in contrast to a research ro...
TL;DR: Characteristics of successful community action programs that outlived their original funding are identified, including honoring community values and cultural relevance, cultivating key leader support, and utilizing indigenous staff.
Abstract: This article reviews papers from a recent conference on community action research in order to identify factors that contribute to long-term maintenance, sustainability, or institutionalization of c...
TL;DR: Social workers who completed a 9-month substance abuse training program were significantly more likely than comparisons to work with substance-abusing clients, have “substance abuse”-related roles, and obtain high ratings of optimism, confidence, and competence after training.
Abstract: This study examines the influence of substance abuse training on social workers in nonaddiction treatment settings. Eighty-one Masters level social workers who completed a 9-month training program were compared with a matched sample of 78 Masters level social workers who did not enroll, with supervisors as collateral informants. Subjects and supervisors were blind to the purpose of the study. Measures included behavior, clinical skills, and self-rated attitudes. After training, trainees were significantly more likely than comparisons to 1) work with substance-abusing clients, 2) have "substance abuse"-related roles, 3) seek jobs that increased their opportunities to work with substance-abusing clients, 4) assess and intervene with substance abuse, and 5) obtain high ratings of optimism, confidence, and competence.
TL;DR: Frequent cannabis use at the time of the survey was associated with “heavy” drinking and drinking problems, drinking and driving, driving within 2 hours of using cannabis, and the use of other drugs, especially among young males.
Abstract: In a national survey conducted in 1994, 29.3% of all respondents reported that they had used cannabis at least once, 7.3% reported using at least once during the year of the survey, and 2.0% reported using cannabis at least once a week during the year of survey. Nonusers and those with different patterns of cannabis use could be distinguished by age; gender; the use of alcohol, tobacco, and other drugs; and involvement with drug users. Frequent cannabis use at the time of the survey was associated with “heavy” drinking and drinking problems, drinking and driving, driving within 2 hours of using cannabis, and the use of other drugs, especially among young males. The association between regular cannabis use, “heavy” drinking, and other risk behaviors poses challenges to prevention and harm-reduction initiatives.RESUMEEn 1994, un sondage effectue a l'echelle nationale observait que 29,3% des repondants avai consomme du cannabis au moins une fois; 7,3% avaient repondu en avoir consomme au mo une fois au cours...
TL;DR: A grounded theory definition of treatment consisting of core elements and related comprehensive services is constructed and the multilevel conceptual framework that guided the Drug Abuse Treatment Outcome Study (DATOS) treatment structure and process study design and instrumentation is presented.
Abstract: Having established the effectiveness of drug dependency treatment, the next generation of research will necessitate a focus on treatment structure and process and the systems within which programs operate. As a foundation for a process conceptualization, we constructed a grounded theory definition of treatment consisting of core elements and related comprehensive services. We then presented the multilevel conceptual framework that guided the Drug Abuse Treatment Outcome Study (DATOS) treatment structure and process study design and instrumentation, anchored by supporting empirical literature. The framework emphasizes seven critical levels of process measurement that future research should consider in order to avoid potential spurious findings.
TL;DR: Experimental investigations of nurses consistently indicate that a patent labeled as a substance misuser is perceived far more negatively across a range of personal attributes than an identical patient who is not so labeled.
Abstract: Experimental investigations of nurses consistently indicate that a patent labeled as a substance misuser is perceived far more negatively across a range of personal attributes than an identical patient who is not so labeled. Comparative evaluations suggest that nurses are less tolerant of social drinking and drug use and are more morally condemnatory of the chemically dependent than are other health-care professionals.
TL;DR: Using multiple classification models applied to self-report data on initiation of drug use from nine National Household Surveys on Drug Abuse conducted between 1982 and 1995, this paper shows that the directions of change in period and cohort effects were similar for marijuana and alcohol and for males and females.
Abstract: Using multiple classification models applied to self-report data on initiation of drug use from nine National Household Surveys on Drug Abuse conducted between 1982 and 1995, this paper shows that the directions of change in period and cohort effects were similar for marijuana and alcohol and for males and females. Period effects-indicative and societal tolerance or support for drug use during 5-year periods between 1961 and 1990-declined between the early 1970s and late 1980s, while cohort effects-indicative of early experiences of birth cohorts favoring drug use-increased. One interpretation is that trends in incidence were determined by two opposing vectors of social forces: Beginning in the 1970s, changes in social policies, values, and drug markets-as reflected in period effects-increasingly acted to reduce incidence, while changes in conditions of childhood socialization-as reflected in cohort effects-increasingly facilitated or encouraged incidence. Especially for marijuana, the increase in cohort ...
TL;DR: The mental health and drug user treatment literature is surveyed, identifying promising approaches and research issues in the treatment of co-occurring mental illness and substance use disorders and proposing a research agenda focused on relevant emerging treatment issues.
Abstract: This paper surveys the mental health and drug user treatment literature, identifying promising approaches and research issues in the treatment of co-occurring mental illness and substance use disorders. The prevalence and classification of co-occurring disorders are briefly reviewed, and selected treatment models currently in use are described. Three models are cited as representing particularly promising approaches--comprehensive integrated treatment, assertive community treatment, and the modified therapeutic community--and best practices are summarized. This paper proposes a research agenda focused on relevant emerging treatment issues.
TL;DR: Soup kitchens should be prime locations for outreach to cocaine/crack and heroin users in need of treatment, medical care, and interventions to prevent infectious disease transmission.
Abstract: Representative samples of female (N = 119) and male (N = 100) guests were selected at two inner city soup kitchens. In the preceding month, 75% used cocaine/crack and 25% used heroin/opiates as determined by hair analysis. Relatively few guests (25%) were in substance dependency treatment. Infectious disease rates were: HIV (16%), hepatitis B exposure (21%), hepatitis B carrier (6%), syphilis exposure (15%). Years of injecting drug use and homelessness/marginal housing were associated with HIV infection and hepatitis B exposure. Soup kitchens should be prime locations for outreach to cocaine/crack and heroin users in need of treatment, medical care, and interventions to prevent infectious disease transmission.
TL;DR: The temperatures at which drug injectors are likely to store their used syringes will vary according to climate, season, and circumstances faced by the injector, and this may be a factor influencing the syringe-borne transmission of HIV-1.
Abstract: In a previous paper we demonstrated that HIV-1 survival in syringes was strongly associated with the volume of blood remaining and with the duration of storage at room temperature. The current study was performed to determine the effects of storage temperature upon the survival of HIV-1 inside syringes. At 4 degrees C, 50% of all syringes contained viable HIV-1 at 42 days of storage, the longest storage duration tested. At room temperature (20 degrees C), the last day that syringes with 2 microL of infected blood were positive was Day 21, and viable HIV-1 was recovered from 8% of syringes. The last day on which syringes with 20 microL were positive was Day 42, and viable HIV-1 was recovered from 8% of syringes. Above room temperature (27, 32, and 37 degrees C), the likelihood of encountering syringes with viable HIV-1 when periods of storage exceeded 1 week decreased to less than 1%. The temperatures at which drug injectors are likely to store their used syringes will vary according to climate, season, and circumstances faced by the injector. The survival of HIV-1 in contaminated syringes varied over a range of temperatures, and this may be a factor influencing the syringe-borne transmission of HIV-1.
TL;DR: Alcohol use is prevalent among university students and is related to the use of other substances, and being a male as one of the strongest correlates is confirmed.
Abstract: An anonymous questionnaire was administered to a sample of 1,911 students at Sardinia's main university during the fall of 1997. The questionnaire assessed various behaviors relating to alcohol including its use during or outside meals and binge drinking, defined as five or more drinks in a row. A significantly higher number of males reported drinking alcohol outside of meals and binge drinking than females, and males were also more likely to report impaired driving and consequences after drinking alcohol than females. A logistic regression model was used to determine correlates of binge drinking using demographics, health-risk behaviors, and leisure activities. The model confirmed being a male as one of the strongest correlates, but also included first drinking alcohol before age 17, marijuana use, living away from parents, cigarette use, having multiple sex partners, and exercising. The results indicate that alcohol use is prevalent among university students and is related to the use of other substances. Further investigation is warranted with particular attention paid to gender as a determinant of use.
TL;DR: There is a robust relationship between stress and substance use, however, there is a clear need for general population studies to address age, gender, and cultural differences to better assess the specificity and complexity of the stress/substance use relationship.
Abstract: The purpose of this review is to outline and critique studies that have examined the link between stress and substance use. Studies are categorized according to the age of the sample and the type of substance use measure considered. The research is mostly limited to studies that operationalize stress as stressful life events, daily hassles, or subjective stress. This paper concludes that there is a robust relationship between stress and substance use. However, there is a clear need for general population studies to address age, gender, and cultural differences to better assess the specificity and complexity of the stress/substance use relationship.
TL;DR: The authors address the continuing danger of methadone poisoning to children and identify factors contributing to this problem.
Abstract: The prevention of accidental poisoning by prescribed an over-the-counter medication has been successfully addressed by the use of child-resistant containers. Nevertheless, accidental methadone poisoning in children remains a problem. The Office of the Chief Medical Examiner for the State of Maryland has investigated four deaths in children due to methadone poisoning over a 4-year period. Three of the cases occurred within a 3-month period. Two victims accidentally ingested methadone within 3 days of each other. The authors address the continuing danger of methadone poisoning to children and identify factors contributing to this problem.
TL;DR: The findings of this study support the need to investigate the relationship between specific “cultural factors” and other clinical components of effective treatment for Maori.
Abstract: There is an increasing emphasis on taking account of the diversity of social, psychological, and cultural factors in the assessment and treatment of alcohol and drug-use-related problems. In New Zealand the increasing use of customary Maori values, beliefs, and practices in the treatment of Maori with alcohol and drug-use-related problems has also been accompanied by the adaptation and integration of Western approaches to fit contemporary Maori sociocultural needs. This paper reports on an investigation of cultural factors and cultural identity in the alcohol and drug-user treatment of a clinical sample of Maori. The essential finding was a very high endorsement of the importance of cultural factors in treatment--irrespective of age, gender, mood, level of dependence, previous admissions, cultural connectedness, or whether they were treated in a Maori dedicated program or not. A significant number believed that a sense of belonging to an Iwi (tribe), identifying as a Maori and having pride in being Maori were also important in the recovery/healing process. The findings of this study support the need to investigate the relationship between specific "cultural factors" and other clinical components of effective treatment for Maori.