Objective: To determine the characteristics associated with health care and drug treatment utilization among a distinctly high-risk sub-population of injectors participating in a needle exchange program (NEP). Methods: Between June 1998 and May 1999, study staff collected demographic and health services utilization data on participants of the Baltimore NEP. Odds ratios and logistic regression were used to identify the participant characteristics associateds with utilizing primary health care and drug treatment during the prior 3 years. Results: Among 269 participants, 81% were African–American and 66% were male. Over half (56%) had not graduated from high school, 89% were unemployed, 70% did not have health insurance, and the median age was 39 years. Fifty-eight percent of the participants reported utilizing primary care (i.e., visited a physician or other health care provider) and 44% had utilized drug treatment during the prior 3 years. Primary care utilization was associated with age≥39 [adjusted odds ...

background

Heroin addiction: Theory, research, and treatment, (2nd ed.): Jerome J. Platt Malabar, FL: Robert E. Krieger Publishing Company, 1986, 372 pages.

Health services utilization by injection drug users participating in a needle exchange program.

Introduction - Chapter 1. Diversity: Theory and Meaning - Chapter 2. Substance Abuse and Dependence: Definition, Causation, Epidemiology, and Sequelae - Chapter 3. The Development of Drug Policy - Chapter 4. Considering the Historical and Cultural Context: Race and Ethnicity - Chapter 5. Considering the Historical and Cultural Context: Sex and Sexual Orientation - Chapter 6. Diversity Issues in Treatment - Chapter 7. Diversity Issues in Addiction and Treatment Research - References - Index

Diversity Issues in Substance Abuse Treatment and Research

textThe etiology of addiction has a long history of clinical and scientific
interest, which is characterized by differences in conceptual approach, conflicting
data and public controversy. There have been numerous attempts to describe the
antecedents and consequences of addiction in theoretical models and by
classifying addicts on the basis of personal, pathological and environmental
characteristics (Lettieri, Sayers, & Pearson, 1980). Despite these considerable
efforts, the insights that emerged from theory and empirical research have not
led to a clear understanding of the etiology and the course of addiction. Perhaps
evenly important, the limited clinical applicability of theory and research has led
practitioners in the addiction field to rely on their private theories about the
nature of addiction and the significance of co-existent problems in the treatment
of addiction. Complicating the issue, addiction is subject to considerable moral
debate, which includes opposing views on the types of drugs that are considered
acceptable, the acceptability of drug use in general, law enforcement strategies,
and treatment methods.
Perhaps the most important trend that emerges from the past decades of
model-development and research in the addiction field, is that scientist of
various disciplines now agree that addiction is a heterogeneous concept in terms
of its antecedents, concomitants, and consequences. Simply acknowledging the
multifaceted complexity of addiction however, does itself not necessarily lead to
a better understanding of the phenomenon, nor does it provide a guidance for
clinical decisions. To expand our views on addiction, it has become extremely
important to examine the interactions between the various components of the full
addiction complex in detaiL Of particular importance is the question whether
addiction constitutes a complex of highly interdependent problem areas that
together form one underlying "addiction-dimension", or whether separate
dimensions exist that are relatively independent from each other. Perhaps the
most intriguing issue in this question is the relationship between substance abuse
and psychopathology, as psychiatric disorders are often assumed to antedate and
precipitate the onset and continuation of substance abuse. Clearly, the issue of
dimensionality and the specific role of psychopathology in addiction is not only important from a theoretical point of view, but also bears relevance to the treatment of addiction. While the unidimensional concept of the full addiction complex would argue for a treatment approach that primarily focuses on reduction of the actual substance use, under the assumption that this will more
or less automatically lead to reduction of addiction-related problems in other
 areas, the multidimensional concept of addiction would argue for focused
attention on each of the specific problem areas, including psychiatric
symptomatology, independently.
This introductory chapter describes the context and perspective of the
dissertation. First, the major models and research findings in the general field of
addiction are briefly summarized as background of the study. Second, issues
associated with dimensionality conceptualizations of addiction are discussed.
Third, the relationship between psychopathology and addiction is examined.
Fourth, the significance of psychopathology in the treatment of addiction is
discussed. At the end of the chapter, the methodology and research questions on
which this dissertation is based are described.

background or result

Addiction and psychopathology: a multidimensional approach to clinical practice

A new conditional reasoning measure was developed to evaluate the role of implicit biases in perpetuating addictive behavior. Data (N = 669) were collected in 2005 from two samples in a suburban area: individuals with a known history of chemical dependency and individuals from the general population. Results indicated a strong correlation between overall test scores and group membership (rpb = .48), which increased when the groups’ demographic characteristics were equalized (rpb = .65). Overall, findings suggest that addiction-prone individuals rely on a distinct set of cognitive biases that rationalize self-destructive behavior. The study's limitations are noted and implications and directions for future research are discussed.

The cognitive underpinnings of addiction.

Historically, conceptualizations of substance abuse and the psychopathology associated with addictive behaviors have varied depending on the sociopolitical climate (Sutker & Allain, 1988). As drug-taking behaviors unfold within the societal Zeitgeist, patterns of substance abuse shift to parallel contemporary fashions, moods, and sanctions. Over the past several decades, drugs of choice have included psychedelics in the early 1960s, cannabis in the middle to late 1960s, heroin in the early to mid 1970s, and cocaine in the late 1970s and 1980s (Zinberg, 1987). Abuse of cocaine in its new, more potent forms continues to escalate in the 1990s. Currently, cocaine accounts for the majority of drug treatment referrals (Kleber, 1988) and drug abuse-related emergency room admissions (National Institute on Drug Abuse [NIDA], 1988). A gradual resurgence in popularity of opioids also has been reported (NIDA, 1989b), prompting researchers to speculate that the cocaine epidemic will be followed by a resurgence of opioid abuse (Arif, 1987; Pinkney, 1989). In addition, Pollack, Brotman, and Rosenbaum (1989) have described a steady increase in “speedball” abuse (ingestion of a mixture of cocaine and heroin). The purpose of this chapter is to describe the psychopathology associated with use of the two most prevalent and addictive types of illicit substances: the opioids and cocaine in its several popular forms.

Heroin addiction: Theory, research, and treatment, (2nd ed.): Jerome J. Platt Malabar, FL: Robert E. Krieger Publishing Company, 1986, 372 pages.

Citations

Health services utilization by injection drug users participating in a needle exchange program.

Diversity Issues in Substance Abuse Treatment and Research

Addiction and psychopathology: a multidimensional approach to clinical practice

The cognitive underpinnings of addiction.

Opioid and Cocaine Abuse and Dependence Disorders