Decrease In Drug Use Research Articles

Addiction medicine

Debate has intensified this year in political, media, and scientific circles regarding the success or failure of the "War on Drugs." Surgeon General Elders' call to study the matter this year has met with swift response. Two recent opinion articles, from an addiction medicine perspective, highlight the pros and cons of changing existing drug use laws.^1,2 Recent optimism regarding decreasing drug use in high school students has been tempered by a closer examination of the data and recent trends. According to the American Drug and Alcohol Survey, after a 5-year drop in drug use by high school students, there are early indications of a rise in the percentage of eighth graders who have tried marijuana and inhalants.³This survey echoes the National Survey of Secondary School Students, which also found statistically significant increases in the use of drugs in eighth graders.⁴These statistics do not include the

Compliance with tubercolosis treatment in methadone-maintained patients: Behavioral interventions

Tubercolosis has increased dramatically in the United States. Noncompliance with treatment is high. The purpose of this investigation was to achieve compliance with prophylactic TB treatment and simultaneously decrease drug use in a high-risk group of intravenous drug users. Two studies were conducted. Study 1: Subjects were 9 chronic opiate users who tested positive for tubercolosis and were placed on isoniazid (INH) and methadone. Methadone was dispensed contingent upon INH ingestion throughout. A within-subject, A-B design with contingency management interventions on drug use was implemented. Results: Compliance with INH was 100% in 8 patients. Cocaine use remained high. Study 2: Two patients, meeting same criteria as Study 1, participated in a within-subject A-B multiple baseline design. Methadone was dispensed contingent upon INH ingestion throughout. Successive decreases in cocaine use were reinforced in the contingent phase. Results: Compliance with INH was high. During contingency, both patients had over 40% cocaine-free urine samples compared with 0% at baseline. This investigation serves as a model for achieving compliance with TB treatment in opiate users.

Drug abuse prevention for high-risk African American children and their families: a review and model program.

In this article we are specifically concerned with the familial and socioeconomic factors that contribute to the exceedingly high prevalence rates of drug abuse in African-American children. In addition to detailing the impact of drug abuse in African-American children and their families, we consider how this critical health problem can be prevented using existing knowledge and strategies known to mental health professionals. A model program entitled Project for a Substance Abuse-Free Environment (SAFE) is outlined. Its objectives are to implement: (a) a broad-spectrum family intervention to empower disadvantaged and high-risk families in their communities: (b) a competency-based skills intervention to increase resilience and decrease drug use and other maladaptive behaviors in at-risk children; (c) alternative activities that will promote self-efficacy, achievement, and self-esteem; (d) a culturally-relevant evaluation plan that includes both formative (process) and summative (outcome) evaluation; (e) a comprehensive approach for assessing project impact; (e) systematic procedures for enhancing the maintenance and generalization of gains in participating children and families.

Recreational drugs and sexual behavior in the Chicago MACS/CCS cohort of homosexually active men

Since initial reports emerged of an association between recreational drug use and high-risk sexual behaviors in gay men, there has been interest in studying this relationship for its relevance to behavioral interventions. Reported here are the longitudinal patterns of alcohol and recreational drug use in the Chicago Multicenter AIDS Cohort Study (MACS)/Coping and Change Study (CCS) of gay men. A pattern of decreasing drug use over 6 years was observed that paralleled a decline in high-risk sexual behavior (i.e., unprotected anal intercourse). In contrast, alcohol consumption tended to be more stable over time, and to show no relationship to sexual behavior change. Men who combined volatile nitrite (popper) use with other recreational drugs were at highest risk both behaviorally and in terms of human immunodeficiency virus-1 (HIV) seroconversion throughout the study. Popper use also was associated independently with lapse from safer sexual behaviors (failure to use a condom during receptive anal sex). Use of other recreational substances showed no relationship to sexual behavior change patterns, and stopping popper use was unrelated to improvement in safer sexual behavior. When popper use and lapse from safer sex were reanalyzed, controlling for primary relationship status, popper use was associated with failure to use condoms during receptive anal sex among nonmonogamous men only. These findings suggest an association between popper use and high-risk sexual behavior among members of the Chicago MACS/CCS cohort that has relevance to HIV prevention intervention efforts.

Progress Toward Eliminating Drug and Alcohol Abuse among U.S. Military Personnel

Since 1970, the Department of Defense has set forth a series of policies and programs to combat drug and alcohol abuse among military personnel. The goal of the current policy is one of zero tolerance toward drug and alcohol abuse. Programmatic areas to help attain this goal are assessment, deterrence and detection, treatment and rehabilitation, and education and training. Progress toward eliminating drug and alcohol abuse among military personnel is traced by examining efforts in each of these programmatic areas. The authors conclude that the dramatic decreases in drug use and more stable patterns of alcohol use since 1980 indicate that military policy and programs to eliminate drug abuse have been highly successful, but that military efforts to eliminate alcohol abuse should be intensified.

Drug prevention programs can work: research findings.

This paper reports findings of a subset of 91 programs, which included drug use measures, from the data base previously reported in the author's meta-analysis of 143 adolescent drug prevention programs. Treatment components of strategies successful in decreasing drug use by adolescents are discussed with regard to both the developmental stages of adolescents and the current etiology of drug abuse. Meta-analysis is briefly discussed. The focus is on issues rather than the actual research. Questions for future programming address theoretical assumptions and practical issues. Is attitude change a prerequisite for decreased drug use? This meta-analysis questions the validity of using knowledge and attitude measures as the only outcome measures. Successful program strategies require innovative planning and close attention to implementation factors. Answers to implementation questions require continued quality research. Implications for future planning may lie in the public policy arena.

Etiologies and consequences of adolescent drug use: implications for prevention.

This paper reviews recent results and work in progress from a longitudinal study of drug use etiologies and consequences. Early- and mid-adolescent drug use patterns, personality, and behavioral correlates were studied in a large sample of normal youth beginning in the mid-1970's. To determine the correlates and consequences of adolescent drug use, controlling for related tendencies such as lack of social conformity and deviant friendship networks, 654 youngsters were followed into young adulthood and their behaviors and lifestyles evaluated. Teenage drug use was found to disrupt many critical developmental tasks of adolescence and young adulthood. Tendencies to use many different drugs as an adolescent led in young adulthood to increased drug crime involvement, decreased college involvement, increased job instability, income, psychoticism, and stealing episodes. Intervention efforts should be directed not only towards decreasing drug use, but also towards improving personal maturity, social skills, and economic opportunities.

The unofficial history of drug use: a study in a Brazilian sample

Interviews were conducted with 59 former intensive users of illicit drugs with no evidence of current social or behavioural dysfunction. Data were gathered by in-depth standardized interviews through which, past and current psychoactive substance use (including alcohol, tobacco and tranquillizers) were assessed. Special attention was given to the subjects' attributions as to what had caused the change in the drug use pattern. Events attributed for ending or substantially decreasing drug use were categorized as follows: 'physical-mental problems/disliked side effects' (27.1% of respondents), 'developmental/maturational/existential reasons' (27.1%), 'formal or informal drug treatment system' (11.8%), 'interpersonal reasons' (10.2%), 'job or school/performance lowering' (10.2%), 'religious/spiritual involvement' (6.8%), and 'legal/financial problems' (6.8%). The major finding was that only 7 out of the 59 respondents (11.8%) reported having ever been in any formal or informal drug treatment system.

Urinary testing for drugs of abuse in the military

AbstractThe military has tested urine for drugs of abuse since 1971.Testing followed the evidence of heroin use in Vietnam. The program was limited, by technical constraints, to a few drugs and in 1974by a decision that precluded the use of information gained by urinalysis in disciplinary actions. In 1980, testing expanded enormously due in part to the availability of immunoassays for cannabis metabolites. The period of 1981‐1983was marked by deficiencies in military laboratories; faulty testing, inadequate personnel, and the inability to document challenged results. As many as 50,000 discharges were subject to review and revision. The 1983Einsel Commission, a toxicology panel, submitted recommendations that reformed the testing systems. This experience affects current nonmilitary testing programs. Many give the program credit for decreasing drug use and improving performance. The empirical proof of this is not obvious and the cost effectiveness of the program can still be criticized.

Decreasing Adolescent Drug Use and School Failure:

Behavioral analyses of 3 adolescents show that 3 months of targeted family problem-solving training can decrease drug use and school failure by the end of a 1 1/4 year follow-up while control behaviors remain stable. Some findings, however, reflected incomplete understanding of the controlling variables: (a) lengthy delays before behavioral improvement, (b) recurrences of the problem behavior and subsequent recoveries during follow-up, and (c) correlated changes in the home and school environments. It is suggested that systematic study of relevant variables in the intervention could reduce behavioral variability and further increase understanding of adolescent drug use.

Borderline personality disorder and alcoholism treatment: a one-year follow-up study.

One year following treatment, alcoholic patients with a documented borderline personality disorder were compared with alcoholic patients who did not show borderline personality features. Both groups of alcoholic patients showed significant and comparable decreases in alcohol use through the follow-up year. Nonborderline alcoholics showed significant decreases in drug use through the follow-up. Borderline alcoholics showed a significant decrease in drug use for the first 6 months of follow-up, with uncertain results thereafter. Borderline alcoholics also showed significant improvements in their ratings of satisfaction with family, decreased hospitalizations and greater leisure satisfaction. There were also trends toward improvements in their relations with children and self-ratings of health and a decrease in accidents. The study documents that alcoholic patients with severe character pathology can significantly benefit from treatment in a short-term psychiatrically oriented alcoholism treatment program.

Back to fundamentalism

Our management of the problems created by drug use is demonstrably deficient; in most areas it is probably not too much to claim that it is totally ineffective or, even worse, counter-productive. What we do effectively is confined to approaches that have been used from time immemorial. In degree we achieve less today than some communities have managed in the distant past. No community has done better than the ancient Hebrews and Chinese and few fare as well today. This fact alone suggests that our understanding of the problems has advanced no further than the insights expressed in the Bible or on ancient Chinese bronzes. Perhaps we have to wait for the original thinker who will break the bonds of our preconceptions and introduce the brilliant light of a totally new way to visualise the problem. Our past history suggests that this will not be until most of us are on the very brink of that same discovery, else the innovative inspiration will pass unheeded or positively spurned. That being the case, what comfort or hope can we obtain from the events of the past decade reflected in the pages of Drug and Alcohol Dependence. History provides some clue to the future, but history received little attention in the past decade, perhaps because we have been so intent on repeating the errors of the past with monotonous regularity. The cyclic fluctuations in drug use over the ages served as the model to explain the gradual decrease in drug use among men attending a Drug Rehabilitation Centre [ 11. Interesting and plausible, but not the explanation advanced by others who came across similar data. A reduction in drug use over time among addicts prescribed heroin at London clinics was attributed to the ‘impact made by the advent of the clinics’ [ 21. Sadly, the ‘improvement’ was not reflected in any change in their employment record. In another study, a similar improvement among amphetamine abusers led to the argument that they were a different species to the opiate abusers, who had become worse [ 31. The improvement in another series of injectors of heroin, given treatment within the community as part of a management policy that eschewed narcotis, was compared invidiously with a group of addicts who became worse when maintained on narcotics away from the local environment [4]. Not strictly comparable, but leading to an opposite conclusion, another study used the improvement observed among addicts on a methadone main

Follow-up of former clients of a large multimodality drug treatment program.

A follow-up study was conducted of a sample of 360 former clients of the Narcotics Treatment Administration program in Washington, D.C. Ninety-five percent of the persons sampled were located, and interviews were successfully completed with 81 percent of the total sample. Interviews were conducted 1 to 3 years following treatment. Findings indicate that a general decrease in drug use has occurred between the period immediately preceding treatment and time of the interview. Improvements were also realized in arrests and in employment and other prosocial activities.

Large group influence for decreased drug use: findings from two contemporary religious sects.

This paper reports on studies designed to clarify the role of large cohesive groups in effecting diminished drug use among their members. Subjects were drawn from two contemporary religious sects and data were obtained by administering self-report questionnaires under controlled conditions, in cooperation with the sects' leadership. Data which bear directly on changes in drug use are reported here. Members of the Divine Light Mission (DLM), many of whom had been involved in the "counterculture" of the early 1970s, reported incidence of drug use prior to joining which was much above that of a nonmember comparison group. Reported levels were considerably lower after joining, and the decline was maintained over an average membership of 2 years. Unification Church (UC) members showed a similar pattern but their drug use began at a somewhat lower level and declined further still; this reflects a stricter stance toward illicit intoxicants in the UC, and relatively less openness to transcendental altered consciousness, which is an integral part of DLM meditation. Data from persons registered for UC recruitment workshops corroborated retrospective reports of the long-standing members. Changes in the consumption of tranquilizers were also considered. Data on caffeine consumption reflected less strict commitment to controls over this agent. The decline in drug use was considered in relation to feelings of social cohesiveness toward fellow group members, which was a significant predictor of change in drug use in multiple regression analysis. The findings are examined in relation to the interplay between behavioral norms in a close-knit subculture and the role of its beliefs and values in determining levels of drug use.

The "relief effect": a sociobiological model for neurotic distress and large-group therapy.

The author discusses the new discipline of sociobiology. He develops the hypothesis that relief of neurotic distress may be associated with experiencing social affiliation and presents data that demonstrate a decline in neurotic symptom intensity in individuals who joined a cohesive religious sect. Anthropological and ethological evidence for the adaptive value of this "relief effect" provides a basis for the evolution of this trait. The author proposes a corresponding model for psychotherapy in large groups.

Pharmacist impact on drug use in an institution for the mentally retarded

Pharmacist involvement on a team developed to monitor drug use in an institution for the mentally retarded is described, and the results of the team's efforts are reported. The behavioral review committee consisted of a physician, pharmacist(s), nurses, psychologists, sociologists and therapists. The pharmacists reviewed the patients' charts and pharmacy records to compile a complete drug history on a special "drug calender" form. The pharmacist visited the patient to determine current problems, the effectiveness of therapy and the presence of adverse drug reactions. Recommendations were than made to the committee. During the two-year study period, the use of antipsychotic drugs was reduced 18%; antianxiety-antidepressant drugs, 50%; sedative-hypnotics, 58%; and miscellaneous agents, 65%. The net savings in drug expenditures was more than $10,000 per year, Maladaptive behaviorial test results implied that the decreased drug use did not change behavior significantly. The study shows that the pharmacist, through a team approach, can help reduce the overuse of medications in institutions for the mentally retarded.

Indirect modification of adolescent drug abuse using contingency contracting

Contingency contracting was used to modify the relationship between a poly-drug abusing adolescent and his family. Concomitant with improvement in the family relationship there was a marked decrease in drug use. Implications for the indirect modification of drug abuse and the importance of negotiation in contingency contracting are discussed.

A National Follow-up Study to Evaluate the Effectiveness of Drug Abuse Treatment: A Report on Cohort 1 of the DARP Five Years Later

Preliminary findings for the first cohort of a national follow-up study of drug users admitted to treatment in the Drug Abuse Reporting Program (DARP) during 1969-1971 are reported. From a sample of 1,853 selected for follow-up, 87% were located and interviews were completed for 77%. Gross tabulations are shown comparing several outcome measures based on pre-DARP treatment, the posttreatment period, and for the 2 months before interview. Sixty-one percent of all patients returned to treatment at some time after DARP termination. Decreases in drug use, expecially of opioids, were substantial and were generally accompanied by improvements in other outcome measures as well. Plans for more detailed and informative analysis of these and related DARP data are addressed.

Meditation and the prevention of alcohol abuse

The authors surveyed the frequency of alcohol use in individuals identified as practitioners of Transcendental Meditation (N equals 126) and a matched control group (N equals 90). No control subjects reported discontinuation of beer and wine use; 40 percent of subjects who had meditated for more than 2 years reported discontinuation within the first 6 months. After 25-39 months of meditation, this figure increased to 60 percent. In addition, 54 percent of this group, versus 1 percent of the control group, had stopped drinking hard liquor. The authors suggest that meditation could be an effective preventive tool in the area of alcohol abuse.

Dental Corps Orders from War Department

This study tested a sequential mediation model that emotion-oriented coping and motivation for change mediate the relations between anxiety and depressive symptoms and the change in substance use. Data included 183 substance using women, randomly assigned to family therapy (N = 123) or individual therapy (N = 60). They reported their baseline anxiety and depressive symptoms, emotion-oriented coping, as well as motivation for change throughout treatment, and substance use over a time period of 1.5 years. Latent growth curve modeling showed that increased baseline motivation was associated with a faster decline in alcohol and drug use. Moreover, higher baseline anxiety and depressive symptoms were associated with a faster decrease in drug use through higher emotion-oriented coping and higher baseline motivation. This study underscores the importance of emotion-oriented coping in increasing clients' motivation and reducing their drug use.