Starting Drug Use Research Articles

Characteristics of drug users admitted in Lido Rehabilitation Center during 2022

The increasing trend of illicit drug use leaves a huge concern for health and behavioral changes, including in Indonesia. Rehabilitation is a series of treatments designed to help them recover from addiction and its impacts comprehensively. The present study aimed to explore the demographic characteristic and drug use profiles of clients admitted in Lido Rehabilitation Center, the national referral center for drug use treatment in Indonesia, during 2022. A survey study was carried out quantitatively using a 2022 database of client admission in February 2023. Descriptive analysis was performed to present the data as appropriate. The overall total of drug users was 592 clients (569 males, 23 females). The demographic characteristics were dominated by young adults (79.90%), voluntary (74.70%), Muslims (86.80%), high-school-to-higher graduates (74.70%), and employers (61.80%). The drug mostly used was methamphetamines (69.80%) with duration being less than 10 years (75.50%) and addiction level being mild-to-moderate (92.80%). The main reasons for starting drug use were peer/partner pressure (37.18%) and curiosity (29.92%). From this study, we can see that the trend of methamphetamine use in productive ages is still dominating in 2022. Further study is needed to evaluate the outcomes of the treatment they have received during the rehabilitation program.

THE ASSOCIATION BETWEEN SOCIAL CHARACTERISTICS AND PATTERNS OF SUBSTANCE USE DISORDER; A CROSS-SECTIONAL STUDY ON SUDANESE PATIENTS

Objective: This study aimed to examine the association between different social factors and patterns of substance use disorder in Sudan. Methods: Data were collected using a structured interviewer-rated questionnaire designed by the researchers, and distributed to the patients who have drug use disorder at the two main psychiatry teaching hospitals in Khartoum state, Sudan. Results: The total number of participants was 124 and the majority (95.2%) were males, and 54.8% were single. The onset is mostly before the age of 25 years. The most common substance was cannabis followed by alcohol. Only 61 participants (49.1%) had come to the hospital seeking treatment of their own free will, and 41.9% of participants had a family history of substance use which was significantly associated with early-onset. The majority of participants (69.4%) started using psychoactive substances at the age of 15–25 years. Half of the participants use drugs only in a group of friends. Bad relations between parents, and between participants and parents were perceived by participants to have a role in starting drug use. Conclusion: Substance use is more common among males with an early onset. A family history of substance use associates with an earlier onset. The study shed the light on the social aspects of substance use in Sudan and recommended more efforts to restrict the availability of illicit drugs in the country.

Substance use and oral health sensations among substance users residing in rehabilitation centres in an Indian City.

The term substance is usually used to address psychoactive/psychotropic drugs which include both licit and illicit drugs. These substances have varied consequences, including long-term and short-term effects, which include sensations post-consumption. To determine patterns of substance use and short-term oral health effects among substance users. A self-administered questionnaire-based study was conducted on the inmates of drug deaddiction and rehabilitation centres in Bhubaneswar city. All the subjects were males and majority (60.6%) were polydrug users. Alcohol (87.3%) was the most commonly used substance, followed by ganja (57%), bhang (35.3%) and brown sugar (33%). A wide range of oral health sensations like dryness of mouth, taste change, numbness in mouth, feeling like chewing something, loose teeth and stammering/difficulty in speaking were found to be significantly associated with substance use. The age of start of substance use (P < 0.0001), socioeconomic status (P = 0.026) and marital status (P < 0.0001) were significantly associated with the pattern of substance use. About 37.6% of inmates felt that they had very good oral health before starting drug use, while only 15.4% described their oral health as very good at present. Having no oral health problem was the most common reason for not visiting a dentist, followed by ignorant attitude towards oral health. A wide range of oral health sensations were found to be caused due to substance use. Understanding of oral health sensations can aid practitioners detect and report cases of substance use in its early phase.

Substance Abuse among In-School and Out-Of-School Youth in Sokoto, Northwestern Nigeria

The objective of this study was to investigate substance abuse amongst in-school and out-of-school youth in Sokoto, northwestern Nigeria using cross-sectional descriptive survey. In the course of the survey, the commonly use substances, causes, effects, and protection were assessed. The data obtained show that, most of the respondents were males (93%), only few were females (6.7%). All the respondents were Muslims. Most of the out-of-school youth (OSY) were married (80%) and only 6.7% are married among in-school youth (ISY).The respondent’s age was within 18-22 years in most cases. Most (80%) of ISY were at senior secondary classes, 46.7% of OSY left school after primary education, 26.7% never attended school. Most of the respondents have more than 2 kids (93.3%), only 6.7% have about 10 kids. Commonly cited drugs are: cigarette, cannabis, alcohol, inhalants, tranquilizers, opiates, and hallucinogens. Reasons for substance abuse were: social/ peer pressure, rebellion, overwork/learning, shyness, fear, parental influence, fun and lack of role model. It also revealed that ISY started drug use earlier than the OSY. Friends, drug pushers, curiosity introduced youth to drugs. Effects of substance abuse are: bad temper, disturbed sleep, ill-health, depression, anxiety, tiredness, disrespect, failure at workplace/school on individual. At family level the effects include: disgrace, breakdown of relationship, loss of confidence in child, and ill-health. While at friend’s level, the effects include: breakdown of relationship, fear, anxiety. And at community or society levels, the effects listed were: crime, reduced productivity, violence, ill-health, high cost of treatment, accidents. To protect youth from substance abuse diverse efforts by governmentand NGOs and interventions are required.&#x0D; Keywords: Substance abuse, drug, out-of-school youth, in-school youth, key informants, public health

Evaluating drug use relapse event rate and its associated factors using Poisson model

ABSTRACT Background: Drug use is a chronic and recurrent disease, and many individuals return to using drugs a short time after rehabilitation treatment. This study investigated factors involved in increasing the number of times individuals with drug addiction problems relapse. Methods: In this descriptive-analytic study, 700 individuals referred to seven drug rehabilitation centers in Birjand City, Iran were selected based on the date of referral to the center. Checklists and interviews with the patients were used to gather the required information; data were analyzed using Poisson model distributions. Results: Age increases the odds of a higher number of relapses to drug addictions by 1.02 times per year of age (p < .001). Compared to those who smoke cigarettes, the odds of stopping drug use for those with no history of smoking cigarettes decreases by 0.13 with every year of age. Additionally, for every year of delay in age of initiating smoking, the number of drug addiction relapses decreases 0.96 times (p < .001). Modern drugs increase the odds of relapse compared to traditional drugs (p < .05). Individuals with university education undergo a higher number of drug rehabilitations compared to those with only an elementary school education. For every year of age delay in starting the use of drugs, the number of relapses decreases significantly by 0.97 times (p < .001). Conclusion: This study revealed that the current age and the age when first starting drug use, education level, type of substance used, and previous history of smoking cigarettes significantly influence the number of relapses of drug addiction.

Related factors and interaction on high-risk sexual behaviors among patients under the methadone maintenance treatment

To estimate the incidence of high-risk sexual behaviors and to explore the related factors among patients receiving methadone maintenance treatment. Face to face interviews were conducted on 636 patients at 3 methadone maintenance treatment clinics in Guangxi Zhuang Autonomous Region, in China, from September to November, 2014. General demographic characteristics and behavioral factors associated with high-risk sexual behavior of patients were collected through questionnaires. Both univariate and multivariate logistic regression analysis were used to analyze the related factors of high-risk sexual behaviors and the interactions between them. 636 participants were included in this study. Majority of the patients (80.2%) practiced high-risk sexual behaviors in the past three months. Data from the univariate analysis showed that factors as: gender, age, marital status, registered residence, history of hepatitis B (HepB) vaccination, age started drug use and HIV infection etc. might be associated with high-risk sexual behaviors (P<0.05). Data from the multivariate logistic regression analysis showed that factors as: being male, histories with non- or unknown HepB vaccination and free of HIV infection etc., were likely to have high-risk sexual behaviors, with OR (95% CI) as 1.668 (1.021-2.725), 1.730 (1.068-2.801) and 2.880 (1.697-4.888), respectively. Additive interactions were observed between non- or unknown histories of HepB vaccination and free of HIV infection. The incidence rates on high-risk sexual behaviors appeared high in patients under the methadone maintenance treatment. Patients with factors as: being male, histories with non-or unknown HepB vaccination and free of HIV infection were significantly associated with high-risk sexual behaviors. It is necessary to emphasize on behavioral intervention among patients under the methadone maintenance treatment, in order to reduce the occurrence of high-risk sexual behaviors.

Co-infection with Human Immunodeficiency Virus and Hepatitis C Virus among Injecting Drug Users in North-Eastern States of India

Background: Co-infection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) is a significant problem, especially among injection drug users (IDUs). Coinfection with HIV and HCV is a significant global public health problem. The study aims to examine co-infection with human immunodeficiency virus (HIV) and hepatitis C virus (HCV) among injecting drug users (IDUs) in Northeastern states of India. Materials & method: Data were obtained from a crosssectional bio-behavioural survey Integrated behavioural and biological assessment round 2 (2009-2010) among 1650 IDUs in two north-eastern states, Manipur and Nagaland of India. Univariate with Chi-square test and Binary logistic regression were used for analysis. Results: Co-infection with HIV and HCV was found 15.0% of IDUs in the North-East state of India. The HCV prevalence was 93% among HIV positive IDUs and 34.4% among HIVnegative IDUs respectively. The prevalence of HIV in HCV positive and in HCV negative was 34.3% and 1.7%, respectively. Univariate analysis with Chi-Square test found that age, education, marital status, living status, age at first starting drug use, age at first injecting drug use, duration of first drug use and first injecting drug, shared needle/ syringes with partner, injection with prefilled syringe, draw up drug solutions from a common container, cleaning of needle/syringes and being sexually active were significantly associated with coinfection with HIV and HCV. Multivariate logistic regression revealed that divorced/separated/ widowed (2.8 times, p ≤ 0.001), age at starting drug use 26 years and above (2.2 times, p ≤ 0.001), draw up drug solution from a common container (1.8 times, p ≤ 0.10), injection with prefilled syringes (1.3 times, p ≤ 0.002), cleaning of needle/syringes (2.9 times, p ≤ 0.05) and sexually active (0.56 times, p ≤ 0.05) were independently associated with co-infection with HIV and HCV. Conclusion: Study emphasizes that there should be preventive strategies to control hepatitis C infection among IDUs.

The Characteristics of Law-evading Drug Users and Effective Approaches

The increasing number of law-evading drug users in Japan is becoming a serious social problem. Previous studies have shown that law-evading drug users are younger, more educated, and less antisocial than methamphetamine users. They also tend to have some type of psychiatric disorder before starting drug use; therefore one of the reasons that they start using drugs may be to alleviate certain psychiatric symptoms. Furthermore, if drug users are successful in avoiding arrest, they often lack the motivation to stop, which makes treatment difficult. Therapists are required to be non-confrontational, to keep pace with their patients, and to take their patients' other existing disorders into account. Recently, the Matrix Model has shown promise as a new treatment strategy for drug abusers in Japan. The Matrix Model, which was originally developed in response to the 1980s cocaine epidemic in the USA, is an intensive outpatient treatment approach for drug abuse and dependence. The Matrix Model integrates cognitive-behavioral therapy, contingency management, motivational interviewing, 12-step facilitation, family involvement, and so on, with a directive, non-confrontational approach, and this style of therapy seems to fit with law-evading drug users. A Matrix Model-based treatment program was first established in Japan in 2006. The aim of this report is to introduce and assess the benefits of the TAMA Mental Health and Welfare Center Relapse Prevention Program, a Matrix Model-based treatment program established at the Tama Mental Health and Welfare Center in 2007.

Injecting drug users and their health seeking behavior: a cross-sectional study in dhaka, bangladesh.

Introduction and Aim. Injecting drug users (IDUs) are amongst the most vulnerable people to acquisition of HIV/AIDS. This study aims to collect information on IDUs and their health seeking behavior in Bangladesh. Design and Methods. A cross-sectional study was conducted among 120 IDUs attending a drug rehabilitation center in Dhaka, Bangladesh. Data were collected on sociodemographics, drug use, health seeking behavior, knowledge of injecting drugs, and sexual behavior. Results. The mean ± SD and median (IQR) age of the participants were 32.5 ± 21.3 and 33 (27–38) years, respectively, with only 9.2% females. Injection buprenorphine was the drug of choice for 40% of participants, and 58% of the participants first started drug use with smoking cannabis. 73.3% of participants shared needles sometimes and 57.5% were willing to use the needle exchange programs. 60% of the participants had no knowledge about the diseases spread by injection. Condom use during the last intercourse with regular partners was 11.7% and with any partners 15.8%. Conclusion. IDUs in Bangladesh are a high-risk group for HIV/AIDS due to lack of knowledge and risky behaviors. Education and interventions specifically aimed at IDUs are needed, because traditional education may not reach IDUs or influence their behavior.

Addiction: White House Seeks “Third Way”

AS THE US POLICY DEBATE ABOUT drug abuse careens between old approaches that have led to incarceration of many for drug-related crimes and emerging ones that seek to legalize marijuana, the White House has released a new drug control policy (http://1.usa.gov/ZvNdGA) that administration officials describe as a “third way” to address substance abuse. The new strategy emphasizes evidencebased approaches to prevent and treat substance abuse disorders. “It’s very much time for a new approach,” said R. Gil Kerlikowske, director of the Office of National Drug Control Policy (ONDCP) and former police chief of Seattle, during a press briefing in April. Kerlikowske explained that like many in law enforcement, he long believed that drug dependence reflected moral failing and a lack of willpower. But an increasing body of scientific evidence suggests that substance abuse causes changes in the brain that make it difficult for individuals to stop using and that treatment can help curb these behaviors. “Addiction is a disease,” Kerlikowske said. “It can be diagnosed; it can be treated.” Addiction’s economic toll on the country is massive, costing $193 billion in lost productivity, health care, and criminal justice, he said. Given the complexity of the problem, Kerlikowske said, simple “bumper sticker” answers won’t work. “We are not going to solve the problem with legalization or incarceration,” he said. Instead, the new policy suggests a dual approach, emphasizing prevention and treatment for individuals as well as criminal justice efforts to curb the national and international drug trade. The report lays out a strategy that increases funding for programs to prevent youth from starting drug use, supports expansion of drug courts to shift individuals with substance abuse disorders out of the criminal justice system and into treatment, and promotes screening and early intervention for such disorders in primary health care. Additionally, the ONDCP has created the first office dedicated to supporting individuals in recovery from substance abuse disorders and recommends several specific changes to laws that, in their current form, may hamper recovery efforts. “It’s a significant break from the idea that substance abuse is strictly a criminal justice problem,” said A. Thomas McLellan, PhD, chief executive officer and cofounder of the Treatment Research Institute in Philadelphia and a former deputy director of the ONDCP. “It’s trying to strike a balance between public safety and public health.” The new direction is rooted in the emerging evidence based on the neurological underpinnings of addiction and evidence supporting prevention and treatment strategies, according to Kerlikowske. Nora Volkow, MD, director of the National Institute on Drug Abuse, explained at the briefing that until recently, the health care system had distanced itself from addiction because of the stigma associated with the disorder and the misconception that drug dependence was a voluntary behavior and moral failure. But studies of addiction suggest that chronic drug use damages the brain in ways that cause changes in behavior and impair an individual’s self-control. “In order to be able to control your urges, your brain has to work properly,” Volkow said. Additionally, research has suggested that both genetic and social circumstances may con-

Socio-demographic factors, health risks and harms associated with early initiation of injection among people who inject drugs in Tallinn, Estonia: Evidence from cross-sectional surveys

AimTo explore socio-demographic factors, health risks and harms associated with early initiation of injecting (before age 16) among injecting drug users (IDUs) in Tallinn, Estonia. MethodsIDUs were recruited using respondent driven sampling methods for two cross-sectional interviewer-administered surveys (in 2007 and 2009). Bivariate and multivariate logistic regression analysis was used to identify factors associated with early initiation versus later initiation. ResultsA total of 672 current IDUs reported the age when they started to inject drugs; the mean was 18 years, and about a quarter of the sample (n=156) reported early initiation into injecting drugs. Factors significantly associated in multivariate analysis with early initiation were being female, having a lower educational level, being unemployed, shorter time between first drug use and injecting, high-risk injecting (sharing syringes and paraphernalia, injecting more than once a day), involvement in syringe exchange attendance and getting syringes from outreach workers, and two-fold higher risk of HIV seropositivity. ConclusionsOur results document significant adverse health consequences (including higher risk behaviour and HIV seropositivity) associated with early initiation into drug injecting and emphasize the need for comprehensive prevention programs and early intervention efforts targeting youth at risk. Our findings suggest that interventions designed to delay the age of starting drug use, including injecting drug use, can contribute to reducing risk behaviour and HIV prevalence among IDUs.

Initiation to the First Drug Use Among Substance-Dependent Persons in Iran

In the present study, we report the initiation to the first drug in a representative sample of drug dependents in Iran. This is a cross-sectional study with a sample size of 7,743. The participants were characterized as drug dependents according to the Diagnostic and Statistical Manual–Fourth Edition and were sampled from the medical centers, prisons, and streets of the capitals of 29 provinces in the Islamic Republic of Iran. The mean age at first drug use in the sample was 21.1 (6.5), which differed for various first drugs of abuse. Opium was the first drug of use among 46.4% of the sample, and cannabis was the first drug only among 23.5%. The most frequent place of initiation was at a friend's house (n = 2,476, 33.2%). The same-gender friend out of school (the highest rate) was the most frequent person who suggested the first use. A total of 43.5% of the participants started drug use with friends and 18.8% at a friend's party. Policymakers may benefit from considering the information provided here in designing programs with the purpose of prevention.

P03-207 - Gender differences in risks and pattern of drug dependence in Egypt

ObjectiveTo identify possible differences in the ways that women and men are first texposed to drugs, in thier risks of abuse and the pattern of drug dependence.MethodsFour hundreds and fifty seven of drug dependence who attended Outpatient clinic of Neuropsychiatry Department in Tanta University Hospital along the period from june 2006 to june 2009 were classified into two groups according to gender. The two groups (319 males and 138 females) were assessed using DSM IV structured interview and compared together regarding; age, age of starting drug use, duration of abuse, educational level in years, occupation, marital status, first drug used, number of abused drugs, route of use, possible risk factors, causes of asking help, numer of previous treatment trials and comorbid psychiatric disorders.ResultsMales started drug abuse earlier in age than females with longer duration of addiction. Single males are more vunerable to abuse specially in illitrate group. Drug abuse is more common in female students and in male workers. Drugs that are more commonly abused by males are cannabis followed by opiates then alcohol while in females Tramadol ranked first followed by followed by anticholinergics then cannabis. Peer pressure was the most common motivating factor for drug abuse in males contrary to family troubles and sexual abuse in females. Anxiety disorders are more common in females while depressive disorders were common in males.ConclusionGender differences in drug abuse stresses the importance of strategies of treatment, motives for treatment and prevention of drug abuse in females.

A study of fifty drug users in Ankara, Turkey

The purpose of the present article is to explore the relationship between socio-demographic characteristics of a sample of drug users in Ankara, Turkey and their stated reasons for using drugs from the perspective of changes taking place in that country. Interviews were carried out with 50 drug users found by means of snowball sampling. The respondents were all male, young (mean = 21.26 years; SD 4.30), mainly unmarried (64%), their age of starting to use drugs was low (mean = 18.21 and SD 2.30), but their level of education was not low (mean = 10.84 years; SD 2.41). Findings indicate that psychological reasons (concern about future, curiosity, and lack of spiritual values) and socio-psychological reasons (peer pressure) were more powerful than economic reasons for starting drug use. The level of education of the addict and the type of drug used (mostly hashish) appear to be the most important demographic variables. These emerging drug users in Ankara are not unlike those in countries currently in the European Union, although hashish is their drug of choice and they appear to start rather later in life.

Onset of alcohol and tobacco use and transition to other drug use among students from Morelos, Mexico

To estimate the cumulative probability of occurrence of first use of alcohol and tobacco, and the risk of transition to illegal drugs (marijuana, cocaine, and heroine, among others), in adolescents and young adults, in Morelos State, Mexico. A cross-sectional study was conducted during schoolyear 1998-1999, among 13 293 students aged 11-24 years, selected from public schools by probabilistic multistage sampling. Data were collected on sociodemographic, health status, and substance abuse variables, using a validated self-applied questionnaire. Data were restructured to assemble a synthetic cohort for discrete time survival analysis. Associations were assessed with hazard rates and 95% confidence intervals obtained by means of multivariate Cox regression models. Sixty percent of males started drinking alcohol at 17 years of age, and smoking tobacco at 18 years of age, on average. Women started using alcohol and tobacco one year after men. Utilization of illicit drugs occurred at 19 years of age on average in 5% of women and 13% of men. Nine out of every 100 illicit drug users started directly using illicit drugs without previous use of alcohol and/or tobacco. In general, alcohol or tobacco users were at greater risk of starting drug use than nonusers (RR=6.72; 95 % confidence interval [CI]=4.13-10.93). Study findings suggest that interventions to decrease drug abuse should go together with efforts to delay initiation of alcohol and tobacco use. The innovative method used in this study yields epidemiologic evidence relating early use of alcohol and tobacco with initiation of illegal drugs in Mexican students.

Risk factors for drug addiction and its outcome. A follow-up study over 25 years

The aim of the study was to investigate factors related to initiation and abandonment of illegal drugs. A follow-up study on 53 drug addicts originally hospitalized because of parenterally acquired hepatitis was performed using questionnaires. The majority stated that curiosity and peer pressure were the main reasons for starting drug use. Family conflicts, school and mental problems were each reported by about 40% of the subjects. Thirty-nine patients (74%) had abandoned addictive drugs during the approximately 25 years that had elapsed since the hospital stay. All of these thought that own efforts had been most important in this achievement. Other important factors were help and support from family and friends, establishing a family or experiencing acute hepatitis or an overdose.

Violence, Homelessness, and HIV Risk Among Crack-Using African-American Women

This study compares the characteristics of out-of-treatment, homeless, crack-using African-American women with those who are not homeless to determine what risks and protective factors differentiate the two groups. From 1999 to 2001, 683 out-of-treatment, African-American crack-using women (of whom 219 were categorized as homeless) were interviewed and serologically tested. Risk factors that were examined include adverse childhood experiences, psychological distress, physical health, violence and victimization, drug use, and risky sex behaviors. Protective factors that were examined include marital status, education, public assistance, and the responsibility of caring for children. Overall, both groups of women started crack use in their mid-twenties and started drug use with alcohol in their teenage years, though differed significantly on each risk factor examined. Logistic regression analysis found that variables associated with increased odds of being homeless are physical abuse before age 18, crack runs greater than 24 hours, income less than $500 in the last 30 days, depression, and current cigarette smoking. Protective factors found are marital status, living with children under 18, having had a physical in the past year, and receiving money from welfare in the last 30 days. Being sexually assaulted in the past 90 days was marginally associated with homelessness in the model. These findings, specific to crack-using African-American women, suggest that not only do these women overall report painful histories and currently stressful lives, but homeless women are more likely than women who are not homeless to have experienced childhood abuse and are more involved with drug use. Interventions designed for these women need to consider gender, cultural, and contextual issues that not only incorporate aspects of risk reduction related to violence, alcohol use, and comorbid conditions, but also linkages that will address housing issues, education, and skills for independence.

Características de los consumidores de opioides visitados en un servicio de urgencias

Despite of the fact that it was reported for years that emergency rooms are the first health services where drug users attend, there are very few direct studies of this population. In most emergency room studies, the information was obtained from data available in the clinical records, and in very few drug users were interviewed. With the aim of having a deeper knowledge of opiate users who attend the emergency room it was planned to carry out a cross-sectional study interviewing them. The aims of this paper are to describe demographic characteristics, patterns of drug use and to know whether they contact first to an emergency room or to a treatment centre. The sample included all patients detected and referred by the doctor as being current opiate users, defined as any use in the 30 days prior the interview. A descriptive bivariate analysis with simple stratification was carried out. Of the subjects referred by the doctor 383 opiate users were interviewed and 76 were not interviewed. The male/female ratio for the 383 interviewed opiates users was 2. Women were younger than men (25.8 vs 28.3, p (3/4) 0.001). Heroin or cocaine ever injected was reported by 93% and 76% reported injecting in the last 30 days. The mean age at the first use of heroin was higher for those who started use during 1989 or after (21.6) than those who started before 1989 (17.9) (p (3/4) 0.0001). Patients attending the emergency room for organic pathology were older (28.5) than those who attended for withdrawal (26.2) and those who attended for overdose (27.3) (p (3/4) 0.05). Thirty eight percent reported to attend first an emergency room for a drug related problem since they started drug use, and 47% to contact first with a treatment centre for drug dependence. Drug users interviewed seem to be more heavy users than those who started drug treatment in the public centres of Barcelona in 1992. Also, the hypothesis that emergency rooms are for this population the first contact point with health services is not supported by this study.

Enrollment in a drug-free detention program: The prediction of successful behavior change of drug-using inmates

Factors predicting the behavior change of drug-using detainees were investigated in detainees in two penitentiaries in The Netherlands. Subjects attended either a standard program or a Drug-Free Detention Program (DFDP) and were assessed at the beginning of detention, at release/transfer, and at 2 years after the end of detention. Predictors of postprogram contact with treatment agencies and changes in criminal recidivism, substance abuse, and psychosocial functioning were investigated using regression analysis. Detainees who started drug use early, without previous DFDP detention, and who frequently expressed self-esteem and who had many family problems realized meetings with drug treatment agencies more often. Those with a legal source of income showed decreases in addiction severity and in the number of days in which hard drugs were used. Comparison of the normal program and the DFDP showed that only for the normal wing could changes in substance use and psychosocial functioning be predicted. Results show the value of multiple-outcome criteria in criminal recidivism research and call for more studies investigating change processes.

Parent Monitoring and the Incidence of Drug Sampling in Urban Elementary School Children

An epidemiologic study of urban-dwelling children aged 8-10 years in Baltimore, Maryland, was undertaken to test the hypothesis that close monitoring and supervision by parents might signal a reduced risk of drug use in the elementary school years. Drug use, monitoring by parents, peer drug use, and other suspected risk factors for early drug use were first assessed in 1989, identifying 947 children with no prior history of drug use. One year later, 4.2 percent of these children were found to have started using alcohol, tobacco, or other drugs on their own for the first time during the follow-up observation interval. Risk of starting drug use was higher for children with lower levels of parent monitoring (relative risk = 4.39, 95% confidence interval 1.48-13.0). In addition, for children with declining levels of parent monitoring, there was an increased risk of starting to use drugs on their own.