Affect Drug Use Research Articles

Factors Affecting Drug Use Attitudes among Adolescents in an Urban Area

Factors Affecting Drug Use Attitudes among Adolescents in an Urban Area

Cancer Treatment Before and After Physician-Pharmacy Integration

Integration of pharmacies with physician practices, also known as medically integrated dispensing, is increasing in oncology. However, little is known about how this integration affects drug use, expenditures, medication adherence, or time to treatment initiation. To examine the association of physician-pharmacy integration with oral oncology drug expenditures, use, and patient-centered measures. This cohort study used claims data from a large commercial insurer in the US to analyze changes in outcome measures among patients treated by pharmacy-integrating vs nonintegrating community oncologists in 14 states between January 1, 2011, and December 31, 2019. Commercially insured patients were aged 18 to 64 years with 1 of the following advanced-stage diagnoses: breast cancer, colorectal cancer, kidney cancer, lung cancer, melanoma, or prostate cancer. Data analysis was conducted from May 2023 to March 2024. Treatment by a pharmacy-integrating oncologist, ascertained by the presence of an on-site pharmacy or nonpharmacy dispensing site. Oral, intravenous (IV), total, and out-of-pocket drug expenditures for a 6-month episode of care; share of patients prescribed oral drugs; days' supply of oral drugs; medication adherence measured by proportion of days covered; and time to treatment initiation. The association between an oncologist's pharmacy integration and each outcome of interest was estimated using the difference-in-differences estimator. Between 2012 and 2019, 3159 oncologists (745 females [27.1%], 2002 males [72.9%]) treated 23 968 patients (66.4% female; 53.4% aged 55-64 years). Of the 3159 oncologists, 578 (18.3%) worked in practices that integrated with pharmacies (with a low rate in 2011 of 0% and a high rate in 2019 of 31.5%). In the full sample (including all cancer sites), after physician-pharmacy integration, no significant changes were found in oral drug expenditures, IV drug expenditures, or total drug expenditures. There was, however, an increase in days' supply of oral drugs (5.96 days; 95% CI, 0.64-11.28 days; P = .001). There were no significant changes in out-of-pocket expenditures, medication adherence, or time to treatment initiation of oral drugs. In the breast cancer sample, there was an increase in oral drug expenditures ($244; 95% CI, $41-$446; P = .02) and a decrease in IV drug expenditures (-$4187; 95% CI, -$8293 to -$80; P = .05). Results of this cohort study indicated that the integration of oncology practices with pharmacies was not associated with significant changes in expenditures or clear patient-centered benefits.

Observations on the effects of buprenorphine and methadone on illicit drug use.

To determine if the agonistic effects of buprenorphine and methadone affect drug use. Quantitative examination of urine drug concentrations of patients treated with buprenorphine and methadone. Patients on buprenorphine had less opioid and methamphetamine drug use than those on methadone. Patients on buprenorphine therapy appear to use less illicit drugs.

A mixed methods exploration of injection drug use risk behaviors and place-based norms in Ukraine

IntroductionDespite global reductions in HIV incidence and significant investment in local harm reduction services, Ukraine continues to experience high HIV and HCV prevalence among people who inject drugs (PWID). Place-based factors and social norms affect drug use–related risk factors, but research has paid little attention to the relationship between drug use practices and place in Ukraine, including how these factors may contribute to or protect against HIV/HCV risk. MethodsThis project used a sequential mixed methods design. Between March and August 2018, we interviewed 30 PWID in Dnipro, Ukraine. Participants completed a single in-depth interview in which they described where and with whom they lived; how they generated income; and where, when, how, and with whom they purchased and used drugs. Between May 2019 and March 2020, we recruited 150 PWID in Dnipro to complete a survey that was designed based on interview findings and consisted of three components: an activity space inventory, an egocentric social network inventory, and an HIV risk behavior assessment. ResultsBoth interview and survey respondents reported consistent use of pharmacies to acquire syringes and nearly universal use of new syringes when injecting. Interview participants reflected that while syringe sharing was previously considered a “common practice,” PWID now viewed it as infrequent and unacceptable. However, interview respondents enumerated the contexts in which needle and syringe reuse occurred, including purchasing drugs directly from a dealer and chipping in with other PWID to prepare drugs bought through a stash. ConclusionParticipants described relatively easy access to new needles and syringes through pharmacies and expressed strong social sanctioning against reusing needles or syringes. However, equipment sharing behaviors and norms persisted in certain contexts, creating an opportunity for further harm reduction campaigns that incorporate changing norms in these situations to “close the gap” and further reduce HIV and other infections among PWID.

Factors Affecting Drug Use in the Household Environment During the Covid-19 Pandemic

Background:Inappropriate use of drugs is a big problem all over the world. The COVID-19 pandemic causes people to be easily influenced by information circulating about drugs that are efficacious to ward off COVID-19 so that many people consume excess drugs to protect themselves from COVID-19. The COVID-19 pandemic has also caused people to take health supplements to protect themselves from COVID-19.Objective:The purpose of this study was to determine the factors that influence drug use during the COVID pandemic.Methods:This research was an observational study with a cross sectional design. Sample was 115 respondents chosen by purposive sampling. Bivariate statistical test used was chi-square and multivariate test used was binary logistic regression. Results:Bivariate analysis result showed that age and distance from health care service did not significantly affect the drug use (p value > 0,05). Education, occupation, income, knowledge were significantly influence the drug use (p value < 0,05). In the multivariate analysis, the OR for education was 4,807, OR for occupation was 4,612, OR for income was 0.146. OR for knowledge 3,400.Conclusion:It can be concluded that the factors that significantly affect the use of drugs in the household environment of the Kota Sub-District Kudus Regency during the COVID-19 pandemic are occupation, education, income and knowledge

COVID-19-Related Shifts in Polysubstance Use

Background: Big Events, such as economic crises and natural disasters, affect drug use patterns (e.g. Friedman & Rossi, 2015). The COVID-19 pandemic is a Big Event that led to lockdowns, travel restrictions, protocols on businesses, and rules for social engagements across the globe. Studies primarily in Europe and Oceania show that the pandemic impacted the type and amount of substances used (e.g. Winstock et al., 2020). Objectives: This study examines the impact of COVID-19 on substance use using a sample of 257 individuals across 36 states, who engage in polysubstance use. Results: The sample was recruited via DanceSafe, Inc.’s social media to complete an online survey (April–October 2020) about drug use during the pandemic. The mostly White, heterosexual sample used an average of seven different substances in the past 12 months. Slightly less than half reported increasing use since the onset of the COVID-19 pandemic, with young adults and lesbian, gay, bisexual, pansexual, or queer (LGBPQ) identifying individuals significantly more likely to do so. Relative to other substances, benzodiazepine use increased, and 3,4- methylenedioxymethamphetamine (MDMA) and psychedelic use decreased, while alcohol use stayed the same. Conclusions: The COVID-19 pandemic disproportionately affected those who are young adults, LGBPQ, and use drugs. Their unique needs during the pandemic warrant attention. The swap from leisure (e.g. MDMA) to anti-anxiety (e.g. Xanax) drugs is not surprising. Yet, the rise in novel benzodiazepines (Laing et al., 2021) is a point of concern that suggests drug checking and educational efforts can best reduce potential risks.

Disruption to Australian heroin, methamphetamine, cocaine and ecstasy markets with the COVID-19 pandemic and associated restrictions.

Changes to drug markets can affect drug use and related harms. We aimed to describe market trends of heroin, methamphetamine, cocaine and ecstasy in Australia following the introduction of COVID-19 pandemic-associated restrictions. Australians residing in capital cities who regularly inject drugs (n ∼= 900 each year) or regularly use ecstasy and/or other illicit stimulants (n ∼= 800 each year) participated in annual interviews 2014-2022. We used self-reported market indicators (price, availability, and purity) for heroin, crystal methamphetamine, cocaine, and ecstasy crystal to estimate generalised additive models. Observations from the 2014-2019 surveys were used to establish the pre-pandemic trend; 2020, 2021 and 2022 observations were considered immediate, short-term and longer-term changes since the introduction of pandemic restrictions. Immediate impacts on market indicators were observed for heroin and methamphetamine in 2020 relative to the 2014-2019 trend; price per cap/point increased (β: A$9.69, 95% confidence interval [CI]: 2.25-17.1 and β: A$40.3, 95% CI: 33.1-47.5, respectively), while perceived availability (adjusted odds ratio [aOR] for 'easy'/'very easy' to obtain: 0.38, 95% CI: 0.24-0.59 and aOR: 0.08, 95% CI: 0.03-0.25, respectively) and perceived purity (aOR for 'high' purity: 0.36, 95% CI: 0.23-0.54 and aOR: 0.33, 95% CI: 0.20-0.54, respectively) decreased. There was no longer evidence for change in 2021 or 2022 relative to the 2014-2019 trend. Changes to ecstasy and cocaine markets were most evident in 2022 relative to the pre-pandemic trend: price per gram increased (β: A$92.8, 95% CI: 61.6-124 and β: A$24.3, 95% CI: 7.93-40.6, respectively) and perceived purity decreased (aOR for 'high purity': 0.18, 95% CI: 0.09-0.35 and 0.57, 95% CI: 0.36-0.90, respectively), while ecstasy was also perceived as less easy to obtain (aOR: 0.18, 95% CI: 0.09-0.35). There were distinct disruptions to illicit drug markets in Australia after the COVID-19 pandemic began; the timing and magnitude varied by drug.

Effect of Testosterone on the Extinction Period of Morphine-induced CPP in Male Rats

Background: Sex-related differences in the incidence, prevalence, symptoms, and side effects of drug use, especially narcotics, have been previously shown in animal models and human studies. Objectives: In the presents study, the effects of different doses of testosterone on morphine extinction period were investigated in a rat model. Methods: Forty mature male Wistar rats were randomly allocated to four categories (10 in each group), including control (received intramuscular injection of vehicle) and testosterone (received intramuscular injection of testosterone at 1, 2.5 and 5 mg/kg) during the extinction period. Conditioned place preference (CPP) test was done to assess the psychological phenomena of drug craving and relapse. The CPP score was calculated in four stages, including the baseline (preconditioning), expression (postconditioning), extinction, and reinstatement. Results: Our results demonstrated that testosterone (1, 2.5 and 5 mg/kg) significantly extended morphine extinction duration compared to the control group. Conclution: It has been shown that dopamine neurotransmission in mesocorticolimbic system is affected by testosterone through androgen receptors in adolescence and alteration in testosterone level could affect drug use vulnerability. It seems that normalization of testosterone levels reduces the symptoms of opioid withdrawal syndrome and have important clinical implication for clinicians to understand the effects of testosterone dysregulation on the extinction and withdrawal periods.

Thoughts and attitudes of adults about medicines used for COVID-19; A descriptive study

Aims: With this study; it was aimed to determine the use of various medications or nutritional supplements to support immune system and opinions, usage status and attitudes towards the drugs currently used / recommended for the treatment of COVID-19, and the factors affecting drug use during the COVID-19 pandemic according to the condition of having COVID-19.
 Methods: The descriptive research was conducted in Family Medicine outpatient clinics. Data were collected with a questionnaire prepared by the researchers through the internet (sites on social media) due to the pandemic. The e-questionnaire form was shared on the internet a total of 10 times at 6-day intervals. 
 Results: 1484 people participated, 60.8% were female, 51.5% was a healthcare professional. While 23.3% had a known disease; 19.3% of them had COVID-19 infection, 79% of them received outpatient medication. Although not recommended, it was observed that the most used drugs were Vitamin C and antipyretic drugs, followed by vitamin D and antibiotics. 87.5% who have had COVID-19 infection stated that they used the drugs as suggested/written on to them. The reasons of those who did not use drugs: fear of its side effects, not seeing it necessary, using herbal products and observing and using it if necessary. People who had live a person under the age of 18 living in the same household (p=0.042), who had a chronical disease (p=0.014) and who were regularly drug users (p=0.003) were reported that they used drugs as suggested / written on them.
 Conclusion: Infodemic causes the spread of false information about the disease and its treat-ment both among the public and in scientific circles. The results of our study also support this situation. The healthcare system should be structured in accordance with the pandemic condi-tions in order to explain the importance of the use of medicines.

Evaluation of Drug Use and Its Effective Factors in Elderly

Introduction: The use of medicine as a link in the treatment chain is inevitable, and medical experts believe that proper and regular use of the drug can improve in many cases. One of the population groups that are more likely to take self-medication because of their illnesses is the elderly. Given that older people are at greater risk of misuse and the consequences of drug abuse because of their special status, including loneliness, neglect, and sometimes social isolation, therefore, this study was designed and conducted to evaluate the rate of use and factors affecting drug use in the elderly and to determine its relationship with some variables. This is a cross-sectional descriptive-analytical study that was done on 100 elderly people in Amol city in 2018 selected by multistage sampling. Data were collected using a questionnaire consisting of three sections: demographic characteristics, medication use, and factors affecting drug use. Descriptive statistics and chi-square and variance analysis were used for data analysis. Of the samples, 65% of the elderly were taking medication for three months prior to self-examination. The most important causes were previous drug use and remission and symptoms similar to 20.1%. Self-medication was significantly associated with marital status (P=0.020), education level (P=0.005) and number of children (P=0.003). The mean drug use was 3.04±0.28 pens per day. 65% of the samples observed more than 4 drugs simultaneously. Around 75% of the elderly had self-medication. Cardiovascular drugs were the most common drug group among the 71.2%. Aspirin, Atenolol and Ranitidine were the most commonly used drugs in the elderly. There was a significant relationship between age and age with arbitrary drug use (P<0.020). The mean age of the subjects was 67 years with a standard deviation of 6.89. 73% of the elderly were male. 72% kept the drug at home, the most important reason being caution and 58% storage. Analgesics were the 15% of most home remedies. This study shows that arbitrary drug use among the elderly is lower than the general population, but it is still high compared to developed countries.

Self-medication and its related Factors in Pregnant Women: A Cross-sectional Study

Background & aim: Self-medication as a global challenge for mother and baby is a potential threat and it is common not only in developing countries but also in developed countries. Various factors affect drug use. This study aimed to determine the rate of practicing self-medication and its related factors in pregnant women. Methods: This cross-sectional study was conducted on 598 pregnant women referring to Al-Zahra Teaching Hospital and comprehensive health centers located in Rasht, Iran. The subjects were selected using random sampling method. The data were collected by a self-structured questionnaire on self-medication and analyzed using chi square test, logistic regression. Furthermore, a logistic regression model was applied to determine the factors associated with the rate of self-medication. Results: Practice of self-medication during pregnancy was reported by 8.7% of the mothers. The most commonly used medications were analgesics (50.9%), herbal medicines (24.5%), and cold/ flu medications (17%). The most common causes of self-medication among mothers included availability of medications (67.9%), previous use (60.4%), and treatments (47.2%). The majority of participants had an arbitrary use due to headache (34%), common cold (22.6%), and digestive diseases (22.6%). Also, 86.1% of the mothers had a moderate level of awareness about self-medication, which had no significant relationship with self-medication (P=0.872). The spousal age (OR=0.931, 95% CI=0.87-0.98; P=0.02), gravidity (OR=1.34, 95% CI=1.03-1.74; P=0.028), comorbid diseases, (OR=2.36, 95% CI=1.29-4.32; P=0.005), and uncertainty about the effect of drugs (OR=0.189, 95% CI=0.04-0.805; P=0.024) were found to be the predictors of self-medication. Conclusion: As the findings indicated,the arbitrary use of medications during pregnancy increased with age and gravidity. Therefore, it is recommended that the Ministry of Health consider policies for the education and provision of the necessary information in this regard for the target population.

Associations between perceived illicit fentanyl use and infectious disease risks among people who inject drugs

BackgroundOver the last several years, fentanyl has been introduced into the illicit drug supply in the United States. While the impact of fentanyl on overdose fatalities is clear, the increase in fentanyl use may also be affecting drug use practices with implications for infectious disease transmission. We conducted a cross-sectional survey to explore associations of perceived illicit fentanyl use with opioid use frequency, injection frequency and syringe sharing among people who inject drugs in two California cities. MethodsPeople who inject drugs (PWID) were recruited from community settings in Los Angeles and San Francisco, CA from June 2017 to September 2018. Multivariable logistic regression was used to explore adjusted associations between perceived illicit fentanyl use and high frequency opioid use, high frequency injection and syringe sharing. ResultsAmong the 395 study participants, the median age of participants was 44 years; 74% of participants were cisgender male; 73% reported to be homeless; 61% lived in San Francisco and 39% in Los Angeles. The prevalence of perceived illicit fentanyl use in the past six months was 50.4% (95% confidence interval (CI): 45.4%-55.3%) among PWID. Findings from our adjusted logistic regression models suggested that people reporting perceived illicit fentanyl use had a greater odds of high frequency opioid use (adjusted odds ratio (aOR) = 2.36; 95% CI: 1.43–3.91; p = 0.001), high frequency injection (aOR = 1.84; 95% CI: 1.08–3.13; p = 0.03) and receptive syringe sharing (aOR = 2.16; 95% CI: 1.06–4.36; p = 0.03), as compared to people using heroin and other street drugs but not fentanyl. ConclusionPeople reporting perceived illicit fentanyl use were at increased risk for injection-related infectious disease risks. Actions must be taken to reduce these risks, including improved access to syringe service programs and opioid treatment and consideration of innovative approaches, such as supervised consumption services.

Drug-Using Behaviors of Turkish Armed Forces Service Members: A Social Control Perspective

The present study asked whether and how social-bond factors and self-control factors affect drug use by members of the Turkish armed forces, a key institution in Turkey, where all male citizens complete mandatory military duty. To implement the study’s 2-stage sampling design, first we randomly selected a sample of troops serving in Turkey’s 4 military branches, the army, navy, air force, and gendarmerie. This sample proportionally represented the military’s makeup by the 4 branches. From it, we then chose randomly a subsample from each group, obtaining a final sample of 4,461 men. Each participating service member self-administered a questionnaire approved by the institutional review board of Gulhane Military Medical Academy’s Psychology and War Psychiatry Department located in Istanbul. Data from the Mehmetcik 2015 Field Study survey was subjected to negative binomial regression, and results showed participants’ drug use to be inversely associated, overall, with self-control and social-bond factors. Drug-use behavior also differ by military units being served. An implication of the results is that drug prevention/intervention for service members could usefully target young men prior to conscription and persisting into their first months of military duty, aimed at enhancing their social bonds and self-control.

Drug use among agriculture-related workers in Thailand

Objectives: To examine drug use prevalence and to explore the associations of cluster environment characteristics with drug use among agriculture-related workers in Thailand. Methods: This was a cross-sectional study involving 2936 agriculture-related workers from 10 clusters in 4 regions throughout Thailand. Trained interviewers conducted semi-structured interviews. Additionally, the drug-use patterns and behaviors of 124 current users were structurally observed. A multilevel binary logistic regression model was used to estimate the effects of the cluster environment on drug use. Results: The annual prevalence was 58.73%. Illicit drugs, non-prescription drugs, or over the counter medicines were widely used. Age, sex, and non-prescription behavior were associated with substance use that was statistically significant. Contextual clustering was found to significantly affect drug use among agriculture-related workers. A 1-unit increase in treatment rate predicted 12.7-times higher illicit drug use and 15.3-times higher methamphetamine use. Conclusions: Agricultural work facilitated the spread of drug use The design of the surveillance system should be considered.

Clinical application evaluation and revision suggestions of clinical practice guideline on traditional Chinese medicine therapy alone or combined with antibiotics for community acquired pneumonia

To clarify the clinical application of the group standard (T/CACM 1035-2017) of the Chinese Society of Traditional Chinese Medicine (TCM), the clinical practice guideline on traditional chinese medicine therapy alone or combined with community acquired pneumonia, and to understand the clinical applicability of the Guideline. The clinical workers trained in terms of the Guideline in hospitals at all levels in China were selected as the research objects. A total of 494 questionnaires on application evaluation and 511 questionnaires on applicability evaluation were collected to construct the database of the post-effect evaluation of the Guideline. Excel software was used for statistical analysis. The overall evaluation of the Guideline was 92.31%, 91.06%, 87.45% respectively in efficacy, safety and economy. The Guideline was well used in clinical application, and 99.41% of the patients were willing to follow the recommended scheme. The agreed ratio in rationality evaluation was 97.98%, 92.37%, 94.53% and 92.71% in treatment rules, syndrome differentiation and classification, prevention of complications, and rehabilitation method. The effective rate of the prescriptions recommended in the Guideline was all above 65%. More than 80% of the prescriptions were Tanreqing Injection, Yinqiao Powder, Qingjin Huatan Decoction, Maxing Shigan Decoction, Shengmai San and Shashen Maidong Decoction. Adverse reactions, unknown active components and economy of Chinese patent medicines were the important factors affecting drug use and efficacy, providing a clinical basis for updating and revising the standard.

CONSUMO DE DROGAS E CONHECIMENTO SOBRE SUAS CONSEQUÊNCIAS ENTRE ESTUDANTES DE GRADUAÇÃO EM ENFERMAGEM

RESUMO Objetivo: analisar o padrão de consumo de substâncias psicoativas e o conhecimento das consequências do uso de álcool, maconha e cocaína de estudantes de graduação em enfermagem no primeiro e no último ano do curso. Método: estudo descritivo, transversal, com 141 graduandos de enfermagem de uma universidade pública do interior do Estado de São Paulo. Para coleta dos dados foram utilizados o Questionário para Triagem do Uso de Álcool, Tabaco e outras Substâncias e um questionário sobre o conhecimento das consequências do uso de álcool, maconha e cocaína. Para análise, foram aplicados o teste Exato de Fisher, o Qui-quadrado de Pearson e o Teste t de Student. Resultados: o álcool e a maconha foram as substâncias mais consumidas pelos estudantes. Quanto às consequências do uso de álcool, maconha e cocaína, a maioria alcançou mais de 50% de acertos, considerado um bom conhecimento, sendo que 86,5% obtiveram mais da metade de acertos em relação ao álcool, 68,8% para a maconha e 76,6% para a cocaína. Quanto à média dos escores sobre o conhecimento de tais consequências entre os alunos ingressantes e aqueles do último ano, encontrou-se diferença estatisticamente significativa para o álcool (p=0,026) e a cocaína (p<0,001), sendo que os alunos do último ano atingiram maiores escores. Conclusão: a hipótese de que o conhecimento das consequências do consumo de drogas interfere no uso foi confirmada apenas para a maconha. Os resultados possibilitam repensar a importância da revisão de conteúdos sobre a temática aos alunos de graduação em enfermagem.

Characterizing chronic pain and alcohol use trajectory among treatment-seeking alcoholics.

Accumulating evidence indicates pain may be an important risk factor for development of alcohol use disorder (AUD) and risk of relapse for people recovering from AUD. This study was conducted to characterize the prevalence and severity of significant recurrent pain and various chronic pain conditions in treatment-seeking alcoholics. In addition, we sought to examine associations between alcohol use trajectory and pain presence/severity. Four hundred fifty-one treatment-seeking alcoholics were recruited for this study. Participants completed a battery of assessments, including measures of demographics, affect, alcohol and other drug use, presence/absence of significant recurrent pain, recent pain severity, and chronic pain type. Analyses indicated significant recurrent pain was highly prevalent in the study sample (53.66%), and was significantly more common among women (62.57%) than men (47.35%; p=0.001). Typical drinking prior to treatment did not differ by pain status, but participants with pain were more likely to report current opioid use. Individuals with pain reported greater depression and anxiety than those without (p<0.0008), and pain tended to be more severe among women than men (p=0.035). Both men and women with pain indicated that pain had affected their substance use. In addition, both later age of first treatment and longer transition time from alcohol dependence to treatment were associated with greater pain severity, especially among men. These data suggest chronic pain is highly prevalent among treatment-seeking alcoholics, especially women, and that delays to first treatment are associated with pain presence and intensity. These results highlight the importance of effective pain management for the subset of treatment seekers with pain.

EVALUASI TINGKAT KEPATUHAN PENGGUNAAN OBAT ANTIHIPERTENSI PADA PASIEN PENYAKIT GINJAL KRONIK LANJUT USIA

Chronic Kidney Disease (CKD) is a condition of kidney damage that occurs for 3 months or more in the form of structural or functional abnormalities of the kidney with or without decrease in Glomerular Filtration Rate which manifests as a pathological disorder. Treatment of CKD is closely related to medication adherence that determines a successful treatment, but patient treatment adherence is often low especially in regularity for drug use. This study aims to evaluate the level of adherence to the use of CKD patient drug at the General Hospital of Education Hasanuddin University. The research design is descriptive analysis with Cross Sectional. The data were collected by using questionnaires containing questions that led to patient characteristics, medication adherence, and factors affecting drug use. Measurement of adherence used is Modified Morisky Scale (MMS) which then analyzed using Case Management Adherence Guidelines (CMAG) against 45 subjects. The result of the research is the level of patient compliance based on quadrant level 1 as many as 8 patients (17,78%), quadrant level 2 as many as 8 patient (17,78%), level 3 quadrant 17 patient (37,77%), and quadrant level 4 of 12 patients (26.66%).

Sex as a biological variable: Drug use and abuse

The study of sex as a biological variable is a necessary emphasis across a wide array of endpoints, including basic neuroscience, medicine, mental health, physiology and behavior. The present review summarizes work from clinical and preclinical populations on sex differences in drug use and abuse, ranging from initiation to escalation/dysregulation and from drug cessation/abstinence to relapse. These differences are analyzed in the context of the addiction cycle conceptualization of Koob and his colleagues and address patterns of drug use (binge/intoxication), motivation underlying its use (withdrawal/negative affect) and likelihood and causes of craving and relapse of drug taking (preoccupation/anticipation). Following this overview, an assessment of the basis for the reported sex differences is discussed in the context of the affective (rewarding and aversive) properties of drugs of abuse and how such properties and their balance vary with sex and contribute to drug intake. Finally, the interaction of sex with several experiential (drug history) and subject (age) factors and how these interactions affect reward and aversion are discussed to highlight the importance of understanding such interactions in predicting drug use and abuse. We note that sex as a biological variable remains one of critical evaluation and that such investigations of sex differences in drug use and abuse continue and be expanded to assess all facets of their mediation, including these affective properties, how their balance may be impacted by the multiple conditions under which drugs are taken and how this overall balance affects drug use and addiction vulnerability.

The Effects of Housing Status, Stability and the Social Contexts of Housing on Drug and Sexual Risk Behaviors.

Research on the relationship between housing instability and HIV risk has often focused on two different conceptions of stability. In one conceptualization, housing stability is defined according to physical location with homeless or unstably housed individuals defined as those who reside in places not meant for human habitation or in emergency shelters. The other conceptualization has defined housing stability as individuals' degree of transience, often operationalized as the number of moves or evictions a person has had within a specified amount of time. Less studied has been the social context of living situation, e.g. living with other drug users, conflict over living expenses, or having to have sex in order to stay. This paper uses data from 392 low-income residents in Hartford, CT to explore how people in different housing situations-including those who are housed and homeless-experience housing stability, feelings of security in their homes, and the social context of their housing. We then explore how these varied measures of housing context affect drug use frequency and sexual risk. Results show that participants who are homeless feel more overall housing instability in terms of number of moves and negative reasons for moving. Those who were doubled up with family or friends were more likely to experience conflict over household expenses and more likely to live with drug users. Among homeless and housed, hard drug use was associated with experiencing violence in the place where they lived, perceiving greater housing stability, having moved for a positive reason, doubling up, and longer periods of homelessness, while number of moves and longer prison sentence predicted sexual risk. Among the housed, living with other drug users was associated with more hard drug use, while contributing money toward household expenses was associated with less hard drug use. Two significant interactions were associated with sexual risk among the housed. Those with longer prison sentences who lived with drug users had more sexual partners, and those with longer prison sentences who doubled up had more sex partners. Results of this study indicate that measures of housing status not often considered in the literature such as the social context of housing have significant effects on HIV risk.