Substance Abuse In Population Research Articles

DIAGNOSING ANTISOCIAL PERSONALITY DISORDER AMONG SUBSTANCE ABUSERS: THE SCID VERSUS THE MCMI-II

There is much controversy among social scientists and clinicians over the proper measurement of antisocial personality disorder (ASPD). The degree to which various diagnostic measures differ in their assessment of ASPD among substance abusers is not known. This study assessed the degree of agreement between a semistructured clinical interview and a self-report inventory on a diagnosis of ASPD among substance abusers. The Structured Clinical Interview for DSM-III-R (SCID-II), a clinically generated instrument, and the Millon Clinical Multiaxial Inventory (MCMI-II), a self-report inventory, were administered to 275 clients randomly assigned to two therapeutic communities (TCs). Based on the limited existing literature, it was hypothesized that there would be minimal agreement between the diagnosis of ASPD by the two scales. This hypothesis was supported. The kappa statistic indicated low agreement between the scales (κ = 0.27), with the MCMI-II diagnosing ASPD more often than the SCID-II. The low agreement on a diagnosis of ASPD may be due to the different types of information collected by the two scales. The SCID-II emphasizes observable behavioral criteria, while the MCMI-II emphasizes pathological personality traits. The focus of the MCMI-II on pathological personality traits may more accurately diagnose ASPD in substance-abusing populations in which the majority of the clients have extensive criminal histories. Definite conclusions regarding the proper measurement of ASPD in substance-abusing samples is difficult without additional empirical evidence.

Determinants of Graduation from a Day Treatment Drug Court in California: A Preliminary Study

This paper focuses on an evaluation of the Riverside County (California) Drug Court Program, a post conviction program that operates much like most drug courts in the country. Riverside County has a large population of drug abusers. A recent study (Sechrest and Josi, 1996) showed that about 40% of the prison commitments from this county were for drug offenses (this figure did not include commitments for other crimes with drug involvement). The “Inland Empire,” comprising Riverside County and San Bernardino counties, is known as one of the highest, if not the highest, producers of methamphetamine in the nation.

Prevalence of sexually transmitted infections and associated risk factors among populations of drug abusers.

A cross-sectional survey was conducted of sexually transmitted diseases (STDs) and risky behaviors among 407 drug abusers in treatment facilities in 1998. Infections with human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), herpes simplex virus type 2 (HSV-2), and syphilis were detected by testing serum antibody levels; chlamydia and gonorrhea were detected by testing nucleic acid levels in urine. Logistic regression analysis was performed to measure associations. Prevalences of antibodies were as follows: to HSV-2, 44.4%; to HCV, 35.1%; to HBV, 29.5%; to HIV, 2.7%. The prevalence of syphilis was 3.4%; of chlamydia, 3.7%; and of gonorrhea, 1.7%. Of the 407 subjects, approximately 62% had markers for 1 of the STDs. HIV infection was associated with African American race, use of smokable freebase (crack) cocaine, and STD history. HBV infection was associated with age >30 years, injecting drugs, needle sharing, a history of treatment for drug abuse, and African American race. HCV infection was associated with an age >30 years, injecting drugs, and needle sharing, and HSV-2 infection with an age >30 years, female sex, and African American race. Syphilis was associated with a history of STDs. High prevalences of STDs among drug abusers indicate the need for integration of STD screening and treatment into drug treatment programs.

Effects of increasing income on polydrug use: a comparison of heroin, cocaine and alcohol abusers.

To assess how income affects hypothetical drug and non-drug purchasing decisions. Ninety-four subjects (26 heroin abusers, 28 cocaine abusers, 15 alcohol abusers and 25 non-drug using controls) were recruited from advertisements. Subjects were exposed to six conditions in which they "purchased" drugs as well as food, housing, and entertainment as income rose from $30 to $560 per day. Heroin abusers selected significantly more hypothetical heroin and cocaine as income rose and demand for these two drugs was income elastic, with purchases rising in greater proportion than income. Cocaine abusers significantly increased purchases of, and showed income elastic demand for, cocaine and alcohol. Among alcohol abusers, significant increases in purchases and income elastic demand were found for alcohol and cigarettes, but not for other drugs. Across all four groups, demand for rent and food were income inelastic, such that purchases did not rise in proportion to the changes in income, while demand for entertainment was income elastic. Hypothetical choices were reliable between and within subjects, and drug choices were correlated with urinalysis results and life-time years of drug use. Income is an important variable in understanding choices for drug and non-drug commodities across a variety of substance-abusing populations.

Suicide risk in substance-abusing populations

Objectives: To review the association between substance abuse and risk of suicide and self-harm.Methods: Based on a review of the relevant literature, a consideration is made of the relevance of psychiatric diagnosis, personality, and the role of substance-induced disinhibition in the production of self-harming behaviour in these populations. The relative importance of biological and social-cultural factors and the importance of substance abuse as a risk factor for self-harm are emphasized. Data is also presented from a study conducted by the author on a cohort of individuals admitted to a Sydney inpatient detox unit.Results: The literature indicates the powerful relationship which exists between substance abuse and self-harm. This appears to be mediated largely by comorbid psychiatric illness and/or by impul-sivity, possibly exacerbated by the direct pharmacological effects of the substances. In the study cohort a high rate of self-harm history is noted, and this appears to be associated with clearly rec...

Recent advances in the biology of addiction.

Recent research into the biologic basis of drug addiction continues to offer considerable promise for understanding how neurochemistry, pharmacology, and molecular biology relate to the reinforcing effects of abused drugs. One area of research is the development and pharmacologic and neurochemical characterization of cocaine and opiate polydrug abuse, a growing subset of the drug abuse population. Considerable advances have also been made in understanding how chronic and persistent drug use induces biochemical and molecular biologic adaptations in brain regions related to drug reinforcement.

A postmarketing surveillance program to monitor Ultram® (tramadol hydrochloride) abuse in the United States

Tramadol HCl, marketed as Ultram® in the USA, was introduced as a non-scheduled drug in April 1995 based on the assumption that the risk of abuse was sufficiently low to warrant a non-scheduled status. However, approval was contingent upon the development of an innovative proactive surveillance program, to be overseen by an independent steering committee, which would detect unexpectedly high levels of abuse. The postmarketing surveillance program consisted of systematic collection and scientific evaluation of reports of suspected abuse in high-risk populations surveyed through an extensive key informant network of drug abuse specialists and all spontaneous reports of abuse received through the FDA MedWatch system. Methods to estimate the number of patients prescribed tramadol were also developed. Monthly rates of abuse were calculated as an index of the risk–benefit ratio (i.e., abuse cases per 100 000 patients prescribed the drug). The data for the 3 years since the drug was introduced show that the reported rate of abuse has been low. Although a period of experimentation seemed to occur in the first 18 months after its introduction—which reached a peak rate of approximately two cases per 100 000 patients exposed—during the 2 year period prior to June 1998, the reported rate of abuse has significantly ( P=0.011) declined, reaching levels of less than one case per 100 000 patients in the last 18 months. The overwhelming majority of abuse cases (97%) have been found to occur among individuals with a history of substance abuse and the abuse has been confined to isolated pockets around the country—notably none of which have significant populations of street drug abusers. Thus, the data support the decision not to schedule tramadol and, furthermore, suggest that a proactive post-marketing surveillance program can be successfully developed to effectively monitor abuse of new medications.

Dissociation as a Function of Child Abuse and Fantasy Proneness in a Substance Abuse Population

To our knowledge, no research has empirically assessed the relationships among dissociation, child abuse, and fantasy proneness in a single study. The present study assessed 1229 male substance abuse patients at a VA Medical Center on dissociation (measured by the Dissociative Experiences Scale, DES), child abuse (measured by the Child Abuse and Trauma scale, CAT), and fantasy proneness (assessed by the Inventory of Childhood Memories and Imaginings, ICMI). A regression analysis was used to predict dissociation with the five CAT subscales and fantasy proneness. The five CAT subscales accounted for 12 percent of the variance when predicting the DES from only the five CAT subscales. However, 22 percent of the variance was accounted for when using both the ICMI and the CAT subscales. Cross-validation regression analysis yielded very similar results. Regression analyses suggested that fantasy proneness is as important as sexual abuse in predicting dissociation. These results may shed light on the recent controversy concerning “repressed memories,” as well as understanding the development of dissociative disorders and differences between borderline personality disorder and the dissociative disorders.

A Survey of Adult Recreational Drug Use Via the World Wide Web: The DRUGNET Study

DRUGNET was a cross-sectional survey of adult recreational drug users (i.e., not abusers) via the World Wide Web of the Internet. The purpose of this survey was to provide a unique, broad description of nondeviant adult recreational drug users. The survey instrument had four divisions: demographic and lifestyle indices, drug use history, legal history and attitudes about drug issues, and the General Well-being Schedule (GWBS). Responses were received from 1,473 self-identified drug users. Of these, 567 completed only the first section, leaving 906 respondents who completed the entire survey. The typical respondent was a White male who was well educated, employed full-time, a participant in recreational and community activities, and who described his physical health status as good. Their mental health, as measured by the GWBS, was similar to the general adult U.S. population. Their drug-taking behavior appeared to be well-controlled, at mild to moderate levels in both frequency of use and degree of intoxication. These findings have major implications for drug policy and indicate the need for further research on the majority of drug users, who may be expected to resemble this sample more than they do clinical populations of drug abusers.

Myers-Briggs Type Indicator Correlations with Enneatype-6 Alcohol or Other Drug Clients in Clinical Settings in Southeastern Wisconsin

ABSTRACT Research indicates that type six from the typology system of the Enneagram overrepresents the population of drug and alcohol abusers. Type six drug and alcohol abusers are correlated with the Myers-Briggs Type Indicator in a clinical setting in Wisconsin to reveal a “universal” nature of type six. Susceptibility toward addiction and depression are also revealed by the MBTI within this characterological structure.

Substance abuse and sexual trauma in a female veteran population.

An increasing number of researchers have explored connections between substance abuse, posttraumatic stress disorder (PTSD), and sexual assault histories in civilian women. Despite literature suggesting the prevalence of substance abuse and sexual assault for female veterans, few studies have investigated these variables in a female veteran population. Thus, this paper was designed to provide preliminary information about this group of women. The results of this preliminary study suggest a high incidence of PTSD related to sexual trauma in a substance-abusing population of female veterans and a high incidence of substance abuse among female veterans who presented requesting help for sexual trauma. Suggestions for future study include examination of comparison samples of female veterans with and without PTSD and substance abuse across a variety of dimensions, including psychiatric symptoms, substance use, treatment utilization, and impact of treatment. Implications for assessment are highlighted.

Flunitrazepam a Benzodiazepine Most used among Drug Abusers

Flunitrazepam (FZ) is a sedative/hypnotic nitro-benzodiazepine. This drug has been accepted by both patients and physicians and in the last 20 years flunitrazepam has been included and studied in many clinical trials so, in many countries, flunitrazepam is one of the most prescribed hypnotic. Since 1980 it has been found that FZ began to be a popular drug among drug abusers all over the word. However, little is known about the difference between Fz and other Benzodiazepines in capacity to produce physiologic dependence or in ability to produce drug taking or drug seeking behaviour. Flunitrazepam has little risk of abuse by the vast majority of patients; however when the drug is taken i. v. or intranasally, its effect is much faster and risk of abuse is much greater. In this report we examine the reasons why some populations of drug abusers prefer flunitrazepam over the other benzodiazepines.

Dissociative Identity Disorder and Substance Abuse: The Forgotten Relationship

The treatment and research of dissociative disorders, particularly dissociative ide ntity disorder (DID), are hampered by professional skepticism and diagnostic uncertainties. Almost always associated with severe and sustained childhood trauma, its chief manifestations are at least two distinct and separate identities which have an independent manner of exis ting in the world. It is also associated with a high degree of psychiatric comorbidity. Among the most frequent diagnoses found in patients with DID are substance use and dependence. For a variety of reasons there has been little dialogue among the disciplines that study patients with trauma and those that study and treat substance abuse. Clinicians dealing with a primarily substance-abusing population are likely to encounter but not recognize these patients. The authors present several representative cases illustrative of features of patients with DID. The epidemiology, phenomenology and presentation of DID, as well as its relation to posttraumatic stress disorder are discussed. Little systematic investigation exists on the treatment of DID in general, and substance abuse in DID in particular. The authors draw upon the existing literature, and their experience to discuss treatment strategies aimed at treating patients with both diagnoses. Ignoring either diagnosis is likely to be detrimental to patients: both disorders and their coexistence need to be addressed.

Moving Substance-Abusing Women from Welfare to Work

Substance abuse and welfare reform are among the nation's highest priorities, and research that examines linkages between the two is of extreme importance to both government policy and the community. Welfare reform will have serious implications for substance abusers as well as for the various professionals who treat them and work to move their clients into functional recovery and self-sufficiency. Within the context of welfare reform and the special needs of substance-abusing populations, the present study examines current welfare status, work status, and barriers and facilitators to gaining and maintaining employment among 100 low income women who participated in a long-term residential substance-abuse treatment program in Miami, Florida. Participants completed a face-to-face interview to assess a detailed employment history and current sources of income as well as the Addiction Severity Index. Results indicate that completers of the treatment program were more likely to be working post-discharge than non-completers. Similarly, the longer the length of stay in the program, the more likely the client was to be working post-discharge. Multivariate analysis indicates a high-school education, participation in the treatment center's aftercare program, and treatment duration of more than one year were independently related to work status. These data suggest that as welfare reform becomes a reality, continuing support of various types, particularly drug treatment, is needed to assist substance-abusing women in gaining and maintaining employment.

History of alcohol or drug problems, current use of alcohol or marijuana, and success in quitting smoking

Previous research suggests higher rates of smoking, and smoking cessation failure, in alcohol- and drug-abusing populations. The present study examined the relationship of alcohol/drug treatment history and current alcohol and marijuana consumption with success in smoking cessation treatment in a smoking clinic population. Participants were 199 smokers; 23% reported a history of alcohol/drug problems, 12.6% reported a history of drug treatment, 78.7% reported alcohol use, and 21.3% reported marijuana use during treatment. Results indicate no significant differences in abstinence rates based on history of alcohol/drug problem or treatment. Differences were found for any current alcohol use but not for marijuana use. Both alcohol use at baseline and any alcohol use during treatment predicted smoking at all follow-up points. Alcohol users had significantly lower quit rates than did participants reporting no use. Neither use of marijuana at baseline nor during treatment predicted outcome. These findings suggest that even low to moderate levels of alcohol consumption during smoking cessation may decrease treatment success.

Cultural differences on three measures of dissociation in a substance abuse population.

Scores on three measures of dissociation were compared between 48 African American and 48 Caucasian men being treated for substance abuse at a VA Medical Center. The three assessment instruments included the Dissociative Experience Scale, the Questionnaire of Experiences of Dissociation, and the North Carolina Index of Dissociation. Groups were matched with respect to age, education, marital status, number of previous treatments, IQ, employment status, history of childhood abuse, and psychological discomfort. In each case, the African-American group scored higher, with statistical significance being achieved on two of the three instruments. Potential implications of these findings were discussed and future research was suggested.

Cultural differences on three measures of dissociation in a substance abuse population

Scores on three measures of dissociation were compared between 48 African American and 48 Caucasian men being treated for substance abuse at a VA Medical Center. The three assessment instruments included the Dissociative Experience Scale, the Questionnaire of Experiences of Dissociation, and the North Carolina Index of Dissociation. Groups were matched with respect to age, education, marital status, number of previous treatments, IQ, employment status, history of childhood abuse, and psychological discomfort. In each case, the African-American group scored higher, with statistical significance being achieved on two of the three instruments. Potential implications of these findings were discussed and future research was suggested. © 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 1109–1116, 1998.

AIDS and Injecting Drug Use in Later Life

Despite substantial progress in slowing the epidemic among substance-abusing populations, new cases of HIV increasingly can be attributed directly to injecting drug use through contaminated needles or indirectly through sexual transmission. While many studies examine factors related to drug use practices and AIDS among young and middle-aged substance abusers, few studies have considered how HIV is contracted or experienced among older addicts. This article reviews what is known about HIV and older substance abusers with special emphasis on the age-related factors that shape the experience of AIDS for this population. Next, drawing on findings from the Partners in Community Health Project, the analysis explores factors that underlie older injectors' and other substance abusers' risk for HIV. Next, issues related to treatment of older HIV-positive injecting drug users are explored. Finally, priorities for future research are identified.

Predicting personality pathology among adult patients with substance use disorders: Effects of childhood maltreatment

The purpose of this study was to examine predictive relationships between types of childhood maltreatment and personality disorders in a substance-abusing population. Three hundred thirty-nine drug- or alcohol-dependent patients completed a reliable and valid retrospective measure of childhood trauma, the CTQ, and a self-report inventory that assesses the entire range of DSM-III-R personality disorders, the PDQ-R. As a preliminary step, factor analyses were used to group personality disorders into the three DSM-III-R Axis II clusters (Clusters A, B, and C), although some diagnostic subclusters were also found. Structural equation modeling analyses revealed several significant paths between types of maltreatment and personality disorder clusters (and subclusters). Physical abuse and physical neglect were related to a subcluster of “psychopathic” personality disorders consisting of childhood and adult antisocial personality traits and sadistic traits. Emotional abuse emerged as a broad risk factor for personality disorders in Clusters A, B, and C. Emotional neglect was related to the traits of schizoid personality disorder, which formed its own subcluster. Finally, sexual abuse, which had been expected to predict borderline personality disorder traits, was unrelated to any personality disorder cluster. These findings support the view that child maltreatment contributes to the high prevalence of co-morbid personality disorders in addicted populations.

HIV Prevention Protocols: Adaptation to Evolving Trends in Drug Use

Applied research in HIV prevention with out-of-treatment substance abusers takes place in a constantly changing environment. Researchers must be able to identify changes in drug use and sexual risk patterns, develop and evaluate appropriate interventions to respond to those changes, and find ways to make effective use of new technologies as they are developed. An example of this process is the collaborative revision made to NIDA's Standard Intervention for HIV prevention by the final six study sites funded under the NIDA Cooperative Agreements for AIDS Community-Based Outreach and Intervention Research. To illustrate the process of responding to changes in the substance abuse environment, to advances in knowledge about risk, and to newer technologies, this article provides an overview of the history of two federally funded HIV-prevention programs for out-oftreatment substance abusers and reviews recent changes made to the Standard Intervention protocol. The rationale for the changes is discussed, and the substance abuse population in the study is described.