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National Institute on Drug Abuse
Women and Sex/Gender Differences Research
Director's Report to Council
Research Findings Excerpts
February, 2004
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Basic Research |
Marijuana and Pregnancy
Earlier studies from Dr. S.K. Dey's laboratory has shown that in a mouse model, anandamide, an endogenous cannabinoid ligand, and its receptors play an important regulatory role in the establishment of normal pregnancy and these effects are dose and stage-specific as lower levels of endocannabinoids and CB receptors were found to be beneficial for implantation while higher concentrations were detrimental to this process. In a recent paper, they demonstrate that anandamide within a very narrow range regulates blastocyst function and implantation by differentially modulating mitogen-activated protein kinase (MAPK) signaling and Ca++ channel activity via CB1 receptors. Anandamide at a low concentration induces extracellular regulated kinase (ERK) phosphorylation and nuclear translocation in trophectoderm cells without influencing Ca++ channels, and renders the blastocyst competent for implantation in the receptive uterus. In contrast, anandamide at a higher concentration inhibits Ca++ channel activity and blastocyst competency for implantation without influencing MAPK signaling. These studies utilized genetic, pharmacological and physiological approaches to uncovering a potentially important regulatory mechanism for synchronizing blastocyst and uterine competency to implantation. This observation in addition to advancing our basic knowledge has high clinical relevance as elevated levels of anandamide could induce spontaneous early pregnancy losses in women who smoke marijuana. Wang, H., Matsumoto, H., Guo, Y., Paria, B.C., Roberts, R.L. and Dey, S.K. Differential G-protein Coupled Cannabinoid Receptor Signaling by Anandamide Directs Blastocyst Activation for Implantation. Proc Natl Acad Sci., pp. 14914-14919, 2003.
Sex Differences in the Subjective and Reinforcing Effects of Cigarette Nicotine Dose
Sex differences in the subjective and reinforcing effects of smoking were examined as a function of two cigarette nicotine "dose" levels (moderate - subjects' preferred brand, ³0.7 mg yield; low - Carlton "ultralight" 0.1 mg yield). Male and female smokers (n=30) participated in three sessions: the first two involving independent assessment (only one brand available), and the third involving concurrent assessment (both brands available), of subjective ratings (e.g. "liking") and reinforcement for the two cigarette brands. Subjects were blind to the brand of each cigarette, and subjects abstained overnight prior to each session. Reinforcement was determined by responses on a computer task to earn single puffs on the designated cigarette. As expected, subjective ratings differed between the low versus moderate cigarette nicotine dose under both independent and concurrent assessment conditions with the dose difference smaller in women than in men (i.e. significant sex by dose interactions). The dose effect on smoke reinforcement also was smaller in women than men, but only under the independent and not concurrent assessment condition. These results indicate that cigarette nicotine dose is a less important influence on the subjective and, under some conditions, reinforcing effects of smoking in women than in men. Perkins, K.A., Jacobs. L., Sanders, M. and Caggiula, A.R. Psychopharmacology 163, pp.194-201, 2002.
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Behavioral Research |
Altered Value of Carbohydrates for Females Withdrawn From Nicotine
Discontinuing nicotine intake usually results in weight gain partially due to heightened energy intake from between-meat snacks. This experiment tested the hypothesis that the reinforcing value of palatable carbohydrate-rich snacks increases for female smokers during nicotine deprivation. Eighteen smokers and 18 nonsmokers completed a concurrent-schedules operant computer task on two separate days. Smokers were bioverified abstinent at the second testing. The operant task allowed participants to earn points redeemable for either carbohydrate snacks or money on concurrent variable-ratio schedules of reinforcement. There were five different probabilities of earning points redeemable for snacks (8%, 16%, 25%, 50%, 75%), while the probability of earning points redeemable for money remained fixed at 25%. Reward value of snacks was measured by switch point: the reinforcement ratio at which the effort required to earn snacks exceeded their value to the respondent, as signified by a shift to working for money. Results showed that smokers undergoing nicotine deprivation persisted in working for snacks into leaner reinforcement schedules than nonsmokers (p=.026). Furthermore, nicotine deprivation increased smokers' allocation of effort to earn snack foods relative to their own behavior when smoking (p=.006). Variation in palatability or hunger did not explain these differences in snack reward value. Findings indicate that nicotine deprivation is associated with a heightened reward value of appealing snack foods for female smokers. Spring, B., Pagoto, S., McChargue, D., Hedeker, D. and Werth, J. Altered Reward Value of Carbohydrate Snacks for Female Smokers Withdrawn From Nicotine. Pharmacology, Biochemistry and Behavior, 76(2), pp. 351-360, 2003.
Nicotine Self-Administration In Adolescent and Adult Female Rats
A rat model was used to determine the impact of the age of onset on nicotine self-administration. In Exp. 1, nicotine self-administration of female Sprague-Dawley rats over a range of acute doses (0.01-0.08 mg/kg per infusion) was determined in adolescent (beginning at 54-62 days) versus adult (beginning at 84-90 days). In Exp. 2, chronic nicotine self-administration over 4 weeks from adolescence into adulthood was compared with the chronic self-administration beginning in adulthood. In Exp. 3, adolescent-adult differences in nicotine effects on body temperature and locomotor responses were determined. Adolescent-onset rats showed increased nicotine intake compared with adult-onset rats in an eight-fold range of acute unit doses/infusion. Significant age differences were also seen in the chronic level of nicotine self-administration. Over 4 weeks, the adolescent-onset group had nearly double the rate of nicotine self-administration of the benchmark nicotine dose (0.03 mg/kg per infusion) compared to the adult-onset group. This increased nicotine intake persisted into adulthood. Adolescent rats had significantly greater response than adults to the hypothermic effects of nicotine, but had significantly less response than adults to the reduction in locomotor activity seen after nicotine. Thus, adolescent-onset nicotine self-administration in female rats was associated with significantly higher levels of nicotine self-administration versus rats that began nicotine self-administration in adulthood. This greater self-administration persists into adulthood and may underlie greater propensity of adolescents to nicotine addiction. Levin, E.D., Rezvani, A.H., Montoya, D., Rose, J.E. and Swartzwelder, H.S. Adolescent-Onset Nicotine Self-Administration Modeled In Female Rats. Psychopharmacology, 169(2), pp.141-149, 2003.
Adolescent Sensitivity to Nicotine and Cross-sensitization to Cocaine Effects in Adulthood
In 2002, Dr. Sari Izenwasser reported that peri-adolescent rats were less sensitive to the development of behavioral sensitization with repeated cocaine administration than their adult counterparts. This was an important observation, as sensitization is believed to reflect an underlying change in the neurobiological substrate for reinforcing effects of drugs of abuse, and therefore may be involved in the addiction process. More recently, she has examined the behavioral and neurochemical effects of repeated nicotine treatments in this model. The study of nicotine mechanisms in adolescence is also an important area of investigation, since it has been reported that adolescents show a more rapid progression to dependence on smoking than do adults. Moreover, girls may show an even more precipitous course. In this study, adult and peri-adolescent rats (postnatal day 28 to 40) received 0.4mg/kg of nicotine/day via intra-peritoneal administration for 7 days. Matched age and sex control groups received vehicle instead. After each injection, locomotor activity was measured for one hour. On day 8, all rats where challenged with a cumulative dosing regimen of i.p. cocaine and their locomotor activity tested for 10-min after each injection to probe for cross-sensitization. This portion of the study design addresses concerns that smoking or nicotine exposure may "prime" subsequent illicit drug abuse (e.g., 52% of youth from a 2001 NHSDA report also report using illicit drugs). Both developmental and gender differences were observed in acute effects of nicotine and in the development of sensitization to locomotor stimulation: The young male group had a higher activity count (and greater stereotypy) after the first nicotine injection than all other groups, and did not show a behavioral sensitization. All other groups (female adolescent, and both adult groups) sensitized to nicotine's behavioral activating and stereotypy effects. However, female adolescents showed a significant sensitized response after only one nicotine exposure (versus adults, who showed significant sensitization on day five for both behavioral measures). Unlike their response on locomotor measures, male adolescents did show a sensitized stereotypy that emerged on the fourth nicotine injection. When all groups were challenged with cocaine on day 8, adolescent males - who had not shown locomotor sensitization to repeated nicotine - were sensitized to all doses of cocaine tested (i.e., had higher activity counts than males repeated treated with vehicle) and in fact showed greater cross-sensitization than their adult counterparts. By contrast, neither female group showed any greater response than their chronic vehicle controls after cocaine. These findings, in conjunction with previous reports of gender differences in rats treated acutely, or chronically, with behaviorally active doses of nicotine, highlight potential neurobiological differences in the substrates for addictive processes in adolescence. Thus, although methodological differences between these various studies must be considered (e.g., varied routes of administration and schedules), male adolescents may be initially more behaviorally responsive to nicotine, whereas females may show a more rapid neuroadaptation that gives rise to changing behavioral profiles. Collins, S.L. and Izenwasser, S. Chronic Nicotine Differentially Alters Cocaine-induced Locomotor Activity in Adolescent vs. Adult male and Female rats. Neuropharmacology, Available online December 10, 2003.
A Non-drug Reinforcer, Saccharin, Reduces Oral Self-administration of Phencyclidine (PCP) in Male and Female Rhesus Monkeys
Prior research with non-human primates and rats has clearly established that under a wide variety of conditions the availability of non-drug reinforcers can reduce the acquisition and/or maintenance of drug self-administration. Dr. Carroll has previously demonstrated the suppressive effects of concurrent saccharin on PCP oral self-administration in male monkeys and in a recent study sought to directly compare such effects in males and females. Seven male and seven female subjects responded for oral PCP under fixed-ratio (FR) schedules of 4, 8, 16, 32, 64 and 128 during concurrent availability of either saccharin or water. In both males and females, saccharin availability suppressed the number of operant responses for PCP and the number of PCP deliveries at low to intermediate FR values. Suppression in the number of deliveries was greater for females than males at FR values of 4, 8, 16, and 32. Saccharin produced suppression in the mg/kg consumption of PCP in both males and females with a sex difference in the degree of suppression occurring at FR 32, wherein the suppression seen was greater in females. These data extend to females the prior finding that saccharin can suppress PCP consumption, and further suggest that at certain parameters, suppression may be greater in females. These sex differences are of interest in view of prior work from Dr. Carroll's lab reporting that availability of wheel-running suppressed i.v. cocaine self-administration only in female rats (Cosgrove et al. 2002), and that females exhibited more suppression of i.v. cocaine self-administration than males in response to baclofen (Campbell et al., 2002) and to ketaconazole (Carroll et al, 2001). Such differences point to the need for both animal and human research to continue to examine to sex differences in studies aimed at strategies to reduce drug intake. Cosgrove, K.P. and Carroll, M.E. Effects of a Non-drug Reinforcer, Saccharin, on Oral Self-administration of Phencyclidine in Male and Female Rhesus Monkeys. Psychopharmacology, 170, pp. 9-16, 2003.
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Treatment Research and Development |
Nicotine Withdrawal and Depressive Symptomatology During Short-Term Smoking Abstinence: A Comparison of Postmenopausal Women Using and Not Using Hormone Replacement Therapy
This study investigated whether taking medications for transdermal hormone replacement therapy (HRT) influenced smoking-cessation variables in postmenopausal women undergoing short-term abstinence from cigarettes. Women were recruited into two groups according to their pre-enrollment medication status--those currently on HRT (n = 17) or those not on HRT (n = 13). The HRT group had their previous medication replaced with a standard 0.1 mg estradiol transdermal system and 2.5 mg of Cycrin daily. After 2 weeks of medication adjustment, participants continued smoking as usual for 1 week, at which time baseline measurements were taken. Participants were then instructed to quit smoking for the remaining 2 weeks. They were provided with smoking-cessation counseling and monitored for abstinence. Data were collected during five clinic visits on all dependent measures: Minnesota Nicotine Withdrawal Scale, Beck Depression Inventory (BDI) scale, Profile of Mood States, Motor Speed Tasks, and Reaction Time Test. Contrary to the hypothesis, the exogenous hormone use did not have a differential effect on most of the dependent variables during the first 2 weeks of smoking abstinence. One exception was depressive symptomatology: the BDI change scores (week 2 - baseline) differed significantly for the HRT and non-HRT groups (p = .045), with women in the HRT group experiencing an increase in depressive symptomatology. This finding, though preliminary, may have clinical implications for postmenopausal women who attempt to quit smoking while on HRT, particularly since depressed mood following abstinence is associated with a relapse to smoking. Allen, S.S., Hatsukami, D.K. and Christianson, D. Nicotine Tob Res., 5(1) pp. 49-59, 2003.
Limbic Activation by Procaine in Female Cocaine-addicted Subjects Produces a Different Pattern of rCBF than Males
In a study in which procaineÑa limbic system activatorÑwas administered to female cocaine patients, there was a muted activation response in comparison to a matched comparison group. While this was unexpected because it was hypothesized that the limbic system would be sensitized in cocaine-addicted subjects, this result was nevertheless similar to that found with males. But other patterns of activation, and inactivation, did not follow the pattern of male addicted subjects. In particular, there were differences in the orbitofrontal cortex where females showed little change compared to controls following either saline or procaine while males did show changes. Specifically decreased activation following saline was seen in males but not in females. Conversely, increased activation in this same region was seen in males following procaine but there was no increase in females relative to controls. Other sex pattern differences were observed suggesting that cocaine had differential effect on the neuronal structures between men and women. Since the hypothesized activation due to sensitization did not occur in either male or female addicted subjects, it is now suggested that these findings reflect changes in the cholinergic and/or the serotonergic 3 receptors. Adinoff, B., Devous, M.D., Sr, Best, S.E., Harris, T.S., Chandler, P., Frock, S.D., and Williams, M.J. Regional Cerebral Blood Flow in Female Cocaine-Addicted Subjects Following Limbic Activation. Drug and Alcohol Dependence, 71, pp. 255-268, 2003.
Sex Differences in the Effects of Stressful Life Events on Changes in Smoking Status
Dr. Sherry McKee and colleagues associated with the Yale TTURC examined stressful life events associated with substance use to determine if there are sex-specific responses to stress resulting in changes in smoking status. A community-based sample of ever smokers from the Americans' Changing Lives study was used to examine the interactive effects of sex and stressful life events on the likelihood of two outcomes; relapse among former smokers and failure to quit among current smokers. Results indicated that stressful life events appear to have a greater deleterious effect on continued abstinence and the ability to quit smoking for women when compared to men. In particular, health and financial events are important risk factors for women and tobacco use. McKee, S.A., Maciejewski, P.K., Falba, T., and Mazure, C.M. Addiction, 98, pp. 847-855, 2003.
New Treatment for Incarcerated Women with Post-Traumatic Stress Disorder (PTSD) and Substance Use Disorders (SUDs)
Dr. Caron Zlotnick and colleagues at Brown University and Harvard Medical School piloted a cognitive behavioral therapy, Seeking Safety with 17 incarcerated women with PTSD and SUDs as an adjunct to usual treatment provided by the prison. Of those receiving the treatment 53% no longer met criteria for PTSD at the end of treatment and 3 months following treatment 46% still no longer met criteria for PTSD. Although 35% reporting the use of illicit substances within three months of release from prison, overall results show a significant decrease in drug use from baseline. Measures of client satisfaction suggest the treatment is appealing to women and has the potential to be beneficial especially for PTSD symptoms. These results must be considered preliminary given the uncontrolled nature of the trial and the small number of participants. Zlotnick, C., Najavits, L.M., Rohsenow, D.J. and Johnson, D.M. Journal of Substance Abuse Treatment, 25(2), pp.99-105, September, 2003.
Maternal Vaccination Against Nicotine Reduces Nicotine Distribution to Fetal Brain in Rats
Vaccination of adult male rats against nicotine has been shown to reduce nicotine distribution to the brain. The current study examined whether vaccination of female rats before pregnancy would reduce the distribution to fetal brain of a single nicotine dose administered during gestation. Female rats immunized with a nicotine conjugate vaccine received a single dose of nicotine 0.03 mg/kg i.v. on gestational day 16 to 22. Five minutes later, vaccinated rats had substantially higher bound and lower unbound serum nicotine concentration and lower brain nicotine concentration than controls. Fetal brain nicotine concentration was reduced by 43% in vaccinated rats, comparable to the reduction in the maternal brain nicotine concentration. The whole-fetus nicotine concentration was not altered by vaccination. A similar experiment was performed in which pregnant rats were passively immunized with rabbit nicotine-specific IgG 7 or 21 mg/kg just before nicotine dosing. The effects of passive immunization on nicotine distribution in the mother were IgG dose-related and the higher dose reduced nicotine distribution to fetal brain by 60%. These data suggest that vaccine effects on nicotine distribution to serum and brain are similar in pregnant female rats to those previously reported in adult males. Vaccination of female rats before pregnancy, or passive immunization during pregnancy, can reduce the exposure of fetal brain to a single dose of maternally administered nicotine. Keyler, D.E., Shoeman, D., LeSage, M.G., Calvin, A.D. and Pentel, P.R. J Pharmacol Exp Ther., 305(2) pp. 587-592, 2003.
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Research on AIDS and Other Medical Consequences of Drug Abuse |
AIDS Research
Boundary-Crossing and Drug Use Among Young Adults in a Low-Income, Minority, Urban Neighborhood
In this paper, researchers examine the relationship between boundary-crossing sexual partnerships (i.e., those between partners who are 5 or more years older, of a different race or ethnicity, or live in a different neighborhood or borough) and use of crack or injected drugs among young adults in Bushwick, Brooklyn. Women who smoked crack or injected drugs were more likely to have a sexual partner who was older, of a different race/ethnicity, or from a different borough than were women who did not use these drugs; men who used these drugs were more likely to have older sex partners than men who did not. Young people who use these drugs are known to be at higher risk of having HIV and a number of other sexually-transmittable infections such as hepatitis B, genital herpes, and syphilis. These results imply that this risk may be even higher for people who cross these boundaries. In addition, if these young people become infected, they may be particularly likely to serve as a gateway for spreading infection to other social groups. Flom, P., Friedman, S., Neaigus, A. and Sandoval, M. Boundary-Crossing and Drug Use Among Young Adults in a Low-Income, Minority, Urban Neighborhood. Connections, 25 (2), pp. 77-87, 2003.
HIV 1 Pharmacogenomics in Clinical Practice: Relevance of HIV-1 Drug Resistance Testing
Throughout most of the past century, physicians could offer patients no treatments for infections caused by viruses. The experience with treatment of infection by human immunodeficiency virus (HIV) has changed the way healthcare workers deal with viral infections and has triggered a growing rate of discovery and use of antiviral agents, the first fruits of the expanding genomics revolution. HIV treatment also provides an informative paradigm for pharmacogenomics because control of infection and its consequences is limited by the development of viral drug resistance and by host factors. This report summarizes studies published to date on the significance of testing of HIV-1 resistance to antiretroviral drugs. The only Food and Drug Administration-approved kit is commercially available through Visible Genetics, Inc., for HIV drug resistance testing by genotypic sequencing. Genotyping sequencing alone is most likely an adequate test to assist in the therapeutic decision-making process in cases of previous regimen failure, treatment-naive patients in areas of high prevalence of transmitted resistant virus, and pregnant women. However, in exceptional cases of highly complex mutation patterns and extensive cross-resistance, it may be useful to obtain a phenotype test, because that result may more easily identify drugs to which the virus is least resistant. There are no published clinical trial results on the usefulness of the so-called virtual phenotype over genotypic sequencing alone. The paradigm of viral pharmacogenomics in the form of HIV genotypic sequencing has been not only useful to the treatment of other viral diseases but also important to the real-life implementation of the growing discipline of genomics or molecular medicine. The application of this paradigm to the thousands of potential therapeutic targets that have become available through the various human genome projects will likely change the landscape of diagnosis and management of many diseases, including cancer. Patarca, R., Isava, A., Campo, R., Rodriguez, N.J., Nunez, E., Alter, M., Marchette, M., et al. HIV Pharmacogenomics in Clinical Practice: Relevance of HIV-1 Drug Resistance Testing (Part 2). J Environ Pathology Toxic Oncolo. 22(4), pp. 235-279, 2003.
Iron-deficiency Anemia and the Cycle of Poverty Among Human Immunodeficiency Virus-Infected Women in the Inner City
The prevalence of iron-deficiency anemia appears to be extremely high among female injection drug users in the inner city who have HIV and/or HCV infections. Iron deficiency and its associated anemia may contribute to reduced energetic efficiency, lower aerobic capacity, decreased endurance, and fatigue. In practical terms, the functional limitations of iron deficiency and iron-deficiency anemia may affect the ability of women to participate in work, school, social, and family activities. Iron deficiency may contribute to the cycle of poverty in the inner city by limiting the ability of women to work, earn money, and afford iron-rich sources of food. Although iron supplementation may prevent or treat iron deficiency, the use of iron supplements needs to be approached with caution in women with HIV and HCV infections. Semba, R. Iron-Deficiency Anemia and the Cycle of Poverty Among Human Immunodeficiency Virus-Infected Women in the Inner City. Clin Infect Dis.,37 Suppl 2: S105-111, 2003.
Prevalence of Mental Disorders, Psychological Distress, and Mental Health Services Use Among Lesbian, Gay and Bisexual Adults in the United States
Recent estimates of mental health morbidity among adults reporting same-gender sexual partners suggest that lesbians, gay men, and bisexual individuals may experience excess risk for some mental disorders as compared with heterosexual individuals. However, sexual orientation has not been measured directly. Using data from a nationally representative survey of 2,917 midlife adults, the authors examined possible sexual orientation-related differences in morbidity, distress, and mental health services use. Results indicate that gay-bisexual men evidenced higher prevalence of depression, panic attacks, and psychological distress than heterosexual men. Lesbian-bisexual women showed greater prevalence of generalized anxiety disorder than heterosexual women. Services use was more frequent among those of minority sexual orientation. Findings support the existence of sexual orientation differences in patterns of morbidity and treatment use. Cochran, S.D., Sullivan, J.G. and Mays, V.M. Prevalence of Mental Disorders, Psychological Distress, and Mental Health Services Use among Lesbian, Gay, and Bisexual Adults in the United States.J Consulting Clinical Psych., 71(1), pp. 53-61, 2003.
Women's Drug Injection Practices in the High-Risk Community of East Harlem
This study examined the most recent injection events of injection-drug-using women, determined the prevalence of HIV, hepatitis B (HBV), and hepatitis C (HCV), and identified significant predictors of injection-related risk behaviors. After validation of drug use, 185 street-recruited women participated in structured interviews and were offered HIV, HBV, and HCV testing and counseling. Interview topics included (1) demographic characteristics, (2) characteristics of injection partners (IPs), and (3) relevant situation-specific factors. Prevalence was 28% for HIV infection, 80% for HBV, and 70% for HCV. Injection events were either solitary (n=110) or social (n=75). Most were safe, and 75% of syringes used were obtained from a syringe exchange. Inferential analyses identified two variables that independently predicted unsafe events: (1) respondent had injected previously with her IP, and (2) her IP was her spouse or primary heterosexual partner. Two trends were identified: Injection events in which women felt "very close" to their IP or reported lack of control over injection practices tended to be unsafe. Although most events were safe, safe practices were not adhered to with spouses or primary partners. These findings suggest that syringe exchanges should be supported and may be an ideal setting for interventions targeted to drug-injecting couples. Tortu, S., McMahon, J., Hamid, R. and Neaigus, A. Women's Drug Injection Practices in East Harlem: An Event Analysis in a High-Risk Community. AIDS and Behavior, 7(3), pp. 317-328, 2003.
Contextual Factors and Other Correlates of Sexual Risk of HIV Among African-American Crack-Abusing Women
This study examined differences in contextual factors, substance use, sexual risk behaviors, and comorbid histories between African-American, out-of-treatment, crack-abusing women who had either a single sexual partner or multiple partners. Bivariate analysis indicated that women with multiple partners were more likely than women with a single partner to be homeless, financially dependent, and to have histories of sexual, physical, and emotional abuse. Women with multiple partners reported higher levels of depression, anxiety, and more symptoms of posttraumatic stress disorder (PTSD). In multiple logistic regression analysis, being unemployed, difficult childhood, and number of days of crack use in the previous 30 days, longer crack runs, and more frequent unprotected fellatio were associated with increased odds of having multiple sexual partners. Being married or living as married was associated with decreased odds of having multiple sexual partners. The importance of assessing contextual and historical factors and implications for future research is discussed. Roberts, A.C., Wechsberg, W.M., Zule, W. and Burroughs, A.R. Addictive Behaviors, 28, pp. 523-536, 2003.
Predictors of Sharing Drugs Among IDUs in the S. Bronx: Implications for HIV Transmission
HIV may be transmitted in the process of sharing injected drugs, even if all participants have their own syringes. In an effort to gain understanding of the extent and predictors of drug sharing, data were obtained via personal interviews with 1,024 injection drug users from four neighborhoods in the South Bronx. The relationship between drug-sharing and demographic, sexual, and drug-related variables was first examined in a bivariate analysis, and then via multiple logistic regression. Individuals who split drugs were more likely to be female, have had sex with a casual partner, exchanged sex for drugs or other needs, recently smoked crack cocaine, and shared needles. They were less likely to live or inject at their own home or have used a new needle the last time they injected. In a final logistic model, correlates of drug sharing included trading sex, injecting outside one's home, and using borrowed, rented or shared needles. Despite the lack of significance for gender in the final logistic model, females were at high risk of drug sharing because they constituted the great majority of those who exchanged sex. Continuing research is needed to understand how drug-sharing contributes to the spread of HIV and other infections, as are studies of approaches to reducing drug sharing. Prevention strategists and outreach organizations should be aware of the HIV risks inherent in the widespread practice of drug sharing. Fernando, D., Schilling, R.F., Fontdevila, J., El-Bassel, N. Predictors of Sharing Drugs Among Injection Drug Users in the South Bronx: Implications for HIV Transmission. J Psychoactive Drugs, 35(2), pp. 227-236, April-June 2003.
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Research on AIDS and Other Medical Consequences of Drug Abuse |
Non-AIDS Research
Drug-Exposed Infants, Early Home Intervention, and Developmental Outcomes
Researchers at the University of Maryland have reported on effects of a home intervention program for prenatally drug-exposed infants and their families. Biological mother-infant dyads were randomly assigned to a control (n=54) or intervention (n=54) group at 2 weeks postpartum. Control families received brief monthly tracking visits. Intervention families received a developmentally-oriented home intervention, weekly through 6 months, and bi-weekly from 6 to 18 months. Developmental assessments were carried out at 6, 12, and 18 months of age, as were assessments of ongoing maternal drug use. During the 18-month period under study, there were no significant group differences in entry into drug treatment, or in reported ongoing use of cocaine and/or heroin, alcohol, or marijuana. Ongoing cocaine and/or heroin use was associated with lower infant mental development scores, and infant mental scores declined over the first 18 months post partum in this inner-city, low socioeconomic status sample. Nonetheless, infants in the intervention group had higher mental and motor development scores than did control infants. The investigators note the importance of including a drug treatment component in future interventions. Schuler, M.E., Nair, P., and Kettinger, L. Drug-Exposed Infants and Developmental Outcome. Archives of Pediatric and Adolescent Medicine, 157, pp. 133-138, 2003.
Cumulative Risk and Parenting Stress for Mothers of Drug-Exposed Infants
This study examined the relationship between cumulative environmental risks, parenting attitudes (parenting stress and potential for child abuse and neglect), and child development in a subgroup of 161 mothers and their drug-exposed infants who were part of a randomized longitudinal study of a home-based early intervention. Mothers with five or more environmental risk factors reported higher parenting stress than women with four or fewer risks and greater potential for child abuse and neglect than women with two or fewer risks at 6 and 18-month visits. Risks included depression, domestic violence, non-domestic violence, family size, homelessness, incarceration, absence of significant other in home, negative life events, psychiatric symptoms, and severity of drug use. Amount of risk was not related to children's mental, motor, or language development at 6, 12, or 18 months of age. Nair, P., Schuler, M.E., Black, M.M., Kettinger, L., and Harrington, D. Cumulative Environmental Risk in Substance Abusing Women: Early Intervention, Parenting Stress, Child Abuse Potential and Child Development. Child Abuse and Neglect, 27, pp. 997-1017, 2003.
Chronic Drug Use and Reproductive Health Care among Low Income Women in Miami, Florida: A Comparative Study of Access, Need and Utilization
Interviews of low-income women in Miami, FL, addressed reproductive health issues in a stratified, network-referred sample of chronic drug users (CDUs) and socially and ethnically similar women who were not CDUs. Women who were not CDUs were significantly more likely to report a regular source of health care than CDUs. About one third of each group reported experiencing reproductive health problems (other than pregnancy) in the 12 months preceding their interview. Chronic drug users were twice as likely to report that these problems remained untreated. Measures of use of preventive services (physical exam, breast exam, pelvic exam, family planning visit) consistently showed lower use by CDUs. A higher proportion of women who were not CDUs reported pregnancies in the 12 months preceding interview. The 32 pregnant CDUs were much less likely to have received prenatal care than the 42 pregnant women who were not CDUs. For women who reported a pregnancy in the year preceding interview, logistic regression analysis showed a strong and robust negative effect of being a CDU on receiving prenatal care even when the effects of having a usual source of care and having third-party coverage were controlled. Crandall, L.A., Metsch, L.R., McCoy, C.B., Chitwood, D.D. and Tobias, H. Chronic Drug Use and Reproductive Health Care among Low Income Women in Miami, Florida: A Comparative Study of Access, Need and Utilization. J Behav Health Serv and Res., 30(3), pp. 321-331, 2003.
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Epidemiology, Etiology and Prevention Research |
Genetic and Environmental Risk Factors in Men and Women
The authors used data on psychiatric syndromes from interviews with 5600 male-male and female-female twin pairs from a population-based registry to study patterns of comorbidity. They sought to gain better understanding of the contributions of genetic and environmental risk factors to etiology of internalizing and externalizing disorders, and to test for gender differences in these patterns and contributions. Model-fitting identified two genetic factors, one for externalizing disorders (alcohol and drug dependence, antisocial and conduct disorders) and one for internalizing disorders (major depression, generalized anxiety disorder, and phobia). Among internalizing disorders, one genetic factor loaded heavily for major depression and generalized anxiety, the other for phobia. Of the ten syndromes studied, alcohol dependence and drug abuse/dependence appear to be influenced by specific genes. Shared environmental factors were strongest for conduct disorder and antisocial behavior. Of note, all of the models showed no sex differences. Thus, genetic factors appear to underlie the tendency toward psychiatric comorbidity, and development of specific disorders may be related to individual experiences; however, for the drug use disorders, there appear to be specific genes as well, and the strongest psychiatric risk factors (conduct and antisocial disorders) are the most influenced by shared environmental influences. These findings support both genetic and environmental approaches to understanding and intervening with drug abuse vulnerability. Kendler, K.S., Prescott, C.A., Myers, J. and Neale, M. The Structure of Genetic and Environmental Risk Factors for Common Psychiatric and Substance Use Disorders in Men and Women. Arch Gen Psychiatry, 60, pp. 929-937, 2003.
Marijuana Use Affects Completion of High School
Cross-sectional research has shown a link between adolescent substance use and educational motivation. The purpose of the current study was to examine this link in a longitudinal sample of African American youth. The study examined the interrelationships between alcohol and both marijuana use and school motivation over the high school years and their effect on graduation in 681 African American adolescents (50.8% female). School motivation was shown to relate to subsequent alcohol use throughout high school and marijuana use early in high school. School motivation did not affect graduation status, but alcohol and marijuana use were related to a lower likelihood of graduating from high school. Some gender differences and differences among those who had tried alcohol or marijuana at the first wave as opposed to those who had not tried each substance were found. The findings support a systems model where school experiences can affect substance use, which, in turn, can affect the completion of high school. Zimmerman, M.A., Schmeelk-Cone, K.H. A Longitudinal Analysis of Adolescent Substance Use and School Motivation Among African American Youth. J Res Adolesc, 13(2), pp. 185-210, 2003.
Stress Exposure Among Young Adults
Life events checklists have been the predominant method for estimating variations in stress exposure. It is unknown, however, whether such inventories are equally meaningful for estimating differences in exposure between men and women, African-Americans and Whites, and those in lower and higher SES categories. In this paper, we employ a wider range of measures of stress - recent life events, chronic stressors, lifetime major events and discrimination stress - to examine the extent to which these dimensions collectively yield conclusions about status variations in stress exposure that are similar to or different from estimates based only on a life events checklist. Our analyses of data collected from 899 young men and women of African American and non-Hispanic White ancestry suggest that status differences in exposure to stress vary considerably by the measure of stress that is employed. Although women are more exposed to recent life events than men, males report more major events and discrimination stress than females. Our results also reveal that life event measures tend to substantially under-estimate differences between African-Americans and non-Hispanic Whites in exposure to stress. A similar pattern also holds for SES. When stress is more comprehensively estimated, level of exposure profoundly affects ethnic differences in depressive symptomatology, accounts for almost half of the difference by SES but contributes little to the explanation of the gender difference in distress. The implications of these findings for the debate over the relative mental health significance of exposure and vulnerability to stress are discussed. Turner, R.J. and Avison, W.R. Status Variations in Stress Exposure Among Young Adults: Implications for the Interpretation of Prior Research. Journal of Health and Social Behavior, VOLUME, PAGES, 2003.
Co-Occurrence of Alcohol, Drug, and Psychiatric Disorders Among U.S. Residents of Mexican Origin
This study examined comorbidity in Mexican immigrants and US-born Mexican-Americans, an ethnic group who comprise 66% of the Latino population of the US. Subjects were selected from urban and rural areas of Fresno County, CA; and the weighted sample was composed of 60% immigrants and 40% US-born and had 46.6% females and 53.4% males. Comorbidity refers to co-occurrence of any two diagnoses; whereas the term dual diagnoses refers to co-occurrence of a substance abuse disorder (alcohol or drug) and non-substance use psychiatric disorder. The dominant pattern observed was dual diagnoses of a non-substance use psychiatric disorder with alcohol abuse or dependence. Co-occurring lifetime rates of alcohol or other drug disorders with non-substance use psychiatric disorders, or both, were 8.3% for men and 5.5% for women and were 12.3% for the US born and 3.5% for immigrants. Alcohol abuse or dependence with co-occurring psychiatric disorders is a primary disorder among Mexican-origin adult males (7.5% lifetime prevalence). Mexican-origin females have negligible rates of alcohol or drug abuse and dependence disorders. US-born men and women are almost equally likely to have co-occurring disorders involving substances. Among all sex and nativity subgroups, individuals with drug abuse or dependence disorders have very high comorbidity rates. Comorbidity is expected to increase in the Mexican-origin population owing to acculturation effects; therefore, early preventive interventions and culturally competent treatment services for low-income youth and adults are needed. Vega, W.A., Sribney, W.M. and Achara-Abrahams, I. Co-Occurring Alcohol, Drug, and Other Psychiatric Disorders Among Mexican-Origin People in the United States. Am J Public Health, 93(7), pp.1057-1064, 2003.
Perceived Temptation to Use Drugs and Actual Drug Use Among Women
Perceived level of temptation to use drugs under specified circumstances has received little or no attention. Data from this study of 125 adult women drug users residing in the Atlanta, Georgia metropolitan area are derived from Project FAST - an intergenerational study of drug use among 250 women conducted between 1997 and 2000 that examined substance use, psychological and psychosocial functioning, and a variety of HIV-related risk behaviors among women and their adult daughters. Four dyad groups were identified with approximately equal numbers of women being recruited for each dyad group: (1) drug-using mothers who had drug-using daughters; (2) drug-using mothers with non-using daughters; (3) drug-using daughters with non-using mothers; and (4) non-using mothers who had non-using daughters. The study described here examined 16 specific items assessing temptations to use drugs and compared perceptions to actual drug use behaviors. Marital status was the only statistically significant predictor of women's drug use. Women's age, race, educational attainment, childhood maltreatment history, psychosocial profiles, exposure to substance abusers, and interpersonal relationships had no significant impact upon the amount of drugs used, once the effects of their levels of temptation to use drugs and marital status were known and taken into account. It may be that the effects of women's temptations to use drugs under specified circumstances may be related more closely to the actual contexts in which they find themselves having to make decisions about whether or not to use drugs than other variables that could also affect such decisions. Items assessing their temptation level are more salient to their drug use process than whether or not they belonged to a particular racial/ethnic group and whether or not they have strong interpersonal support networks. Five key findings have specific implications for substance abuse prevention and treatment programs: (1) women who were married or living as married reported nearly twice the amount of drug use than women whose marital status was other-than-married; (2) greater drug use was reported by people who said that they would be tempted to use drugs if they were hanging around in their neighborhood; (3) greater drug use was reported by women who said that they would be tempted to use drugs when they were celebrating and feeling happy; (4) women who said that they would be tempted to use drugs when they were waking up and facing a difficult day reported more drug use than those who said that they would not be tempted to use drugs under such a circumstance; and (5) the greatest drug use was reported by women who felt that they would be tempted to use drugs if they found themselves in a place where everyone else was using drugs. These findings suggest that there is a close relationship between temptations to use drugs in specific circumstances and actual drug usage. Women who reported the greatest amounts of drug use tended to have the greatest need for training/education to help them to acquire the skills to avoid using drugs in various situations. Klein, H., Elifson, K.W., and Sterk, C.E. Perceived Temptation to Use Drugs and Actual Drug Use Among Women, J Drug Issues, Winter, pp. 161-191, 2003.
Role Models and Psychosocial Outcomes Among African American Adolescents
The authors examined who 679 African American ninth-graders (aged 14-17 yrs) from urban environments look up to and how their role model choices relate to substance use, delinquency, academic engagement, and psychological well-being. Male adolescents without male role models and females identifying brothers as role models reported the most problem behavior. Adolescents with paternal male role models had the most positive school outcomes, no differences were found in psychological well-being among adolescents in terms of their male role models. The presence of female role models, in contrast, was associated with psychological well-being such that adolescents with maternal role models reported the least distress. Adolescents without female role models had the lowest grades and most negative school attitudes. These findings remained when parental support, family conflict, and father presence in the household were controlled, suggesting role model effects are separate from parenting effects. Findings support and expand on the notion that having someone to look up to is critical for African American youths' development. Bryant, A.L. and Zimmerman, M.A. Role Models and Psychosocial Outcomes Among African American Adolescents. J Adolesc Res., 18(1), pp. 36-67, 2003.
Comorbid Substance Use and Psychiatric Disorders Among Juvenile Detainees
To estimate the prevalence of comorbid psychiatric disorders in the past 6 months, the Diagnostic Interview Schedule for Children Version 2.3 was administered to 1,829 randomly selected detainees (1172 males, 657 females, aged 10-18) in the Cook County Juvenile Temporary Detention Center. Overall, more than 10 percent of males and almost 14 percent of females had a substance abuse disorder and a major mental disorder, such as psychosis, manic episode, or major depressive episode. Approximately 600 of these 1,829 young people had substance abuse disorders and behavioral disorders. In the subset of 305 youth with major mental disorders, more than 50 percent of females and nearly 75 percent of males also reported a substance abuse disorder. When the subset of 874 youth with substance abuse disorders was examined, 30 percent of the females and 21.4 percent of the males were found to also have a major mental disorder. About 25 percent of juvenile justice system detainees with major mental disorders reported that their psychiatric problem preceded their substance abuse disorder by more than 1 year. Almost 67 percent of females and more than 54 percent of males developed their mental and drug abuse disorders within the same year. Overall, these findings point to the need for assessment and treatment of juvenile detainees with comorbid substance abuse and mental health disorders. Abram, K.M., Teplin, L.A., McClelland, G.M. and Dulcan, M.K. Comorbid Psychiatric Disorders in Youth in Juvenile Detention. Arch Gen Psychiatry, 60(11), pp. 1097-1108, 2003.
Executive Functioning and Temperament in Adolescent Females with Substance Use Disorders
This study was designed to assess the role of temperament in the association between executive functioning (EF) and adolescent females substance use disorders (SUD). The sample included 340 drug using females between 14 and 18 years of age. This included 240 adolescent females with SUD diagnoses. Results suggest that temperament mediates the association between EF and adolescent females' drug use. Furthermore, EF and temperament interact to account for unique variance in drug use involvement, above and beyond the main effects of age, EF, and temperament. Interestingly, the investigators found that low EF was only significantly related to increased drug use involvement for participants with a "good" temperament and not for those with a difficult temperament. Participants with a difficult temperament exhibited significantly greater drug use involvement than those with a good temperament. In conclusion, these findings suggest that a difficult temperament may be a more important risk factor for adolescent females' drug use than low EF. Giancola, P.R. and Mezzich, A.C. Executive Functioning, Temperament, and Drug Use Involvement in Adolescent Females with a Substance Use Disorder. J Child Psychol Psychiatry, 44(6), pp. 857-866, 2003.
Prevalence and Development of Psychiatric and Substance Use Disorders in Childhood and Adolescence
The authors used longitudinal data from a representative community sample of 1420 nine through sixteen year olds, to describe the prevalence and continuity of psychiatric disorders over time. Several significant findings were reported. By age 16, over a third (36.7%) of subjects met DSM-IV criteria for one or more disorders, and those with one disorder were 3 times more likely to have the same or another diagnosis at later waves. Rates of comorbidity were high, with one quarter (25.5%) diagnosed with 2 or more disorders at one time. Almost all disorders showed significant rates of continuity over time. Continuity from one diagnosis to another was significant between anxiety and depressive disorders, and from anxiety and conduct disorder to substance abuse, in girls. Substance use disorders increased with age and were more prevalent in boys than girls. The sample, while representative, does not represent the American population, but prevalence rates were comparable to those in several other studies. The notable points from this study relate particularly to the findings regarding continuity: that in a representative sample, only anxiety and conduct disorders predicted substance use disorders, and only in girls. This has important implications for improving our understanding of the etiology of adolescent drug abuse, for identifying those children at particular risk, and for developing and testing effective childhood interventions to prevent later drug abuse. Costello, E.J., Mustillo, S., Erkanli, A., Keeler, G., and Angold, A. Prevalence and Development of Psychiatric Disorders in Childhood and Adolescence. Arch Gen Psychiatry, 60, pp. 837-844, 2003.
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Prevention Research |
Sensation Seeking Mediates the Relationship Between Pubertal Development and Drug Use in Adolescence
Sensation seeking is a trait characterized by seeking varied, novel, complex, and intense sensations and experiences and it often involves a willingness to take physical, social, legal and financial risks for the sake of experience. This trait also has been found to be associated with earlier age of drug use and abuse and with an increased presence of male and female sex hormones. The present study looked at sensation seeking, pubertal development, and drug use among 208 early and mid-adolescents between ages 11 and 14 who were recruited from psychiatric and pediatric clinics. Consistent with prior research, sensation-seeking scores were higher on average among males compared to females, and sensation seeking was highly associated with cigarette, alcohol, and marijuana use. In addition, sensation seeking partially or fully mediated the relationship of pubertal development to drug use in both adolescent males and females. Monitoring of pubertal development and sensation seeking, even by self-report, may assist in identifying youth at increased risk for nicotine, alcohol, and marijuana use. Martin, C.A., Kelly, T.H., Rayens, M.K., Brogli, B.R., Brenzel, A., Smith, W.J., and Omar, H.A. Sensation Seeking, Puberty, and Nicotine, Alcohol, and Marijuana Use in Adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 41(12), pp. 1495-1502, 2002.
Substance Abuse Among Very Young Juvenile Offenders
Although the relationship between delinquency and substance use in adolescence is well documented, less is known about substance-use initiation in childhood for juvenile delinquent populations. This study examined early substance initiation in childhood as reported by adolescents who were incarcerated for juvenile offenses (93 males, 96 females; 58% African American, 42% European American). Youth were individually interviewed using an adapted version of substance-related questions from the National Household Survey on Drug Abuse. Juvenile justice system records were reviewed to characterize offense histories. A majority of males and females reported using at least one substance (other than cigarettes) such as alcohol, marijuana, or inhalants by age 13. Alcohol use reportedly occurred by age 10 for 17% of the youth. For a substantial portion, early initiation turned into frequent early use. For example, 32% of the males and 39% of the females reported drinking alcoholic beverages at a frequency of at least several times per month by age 13. Limited evidence related early substance initiation with subsequent substance abuse. Offense status is related to early substance initiation for females but not males. Early substance use is a significant problem among youth who end up in the juvenile justice system. Prinz, R.J., and Kerns, S.E.U. Early Substance Use by Juvenile Offenders. Child Psychiatry and Human Development, 33(4), pp. 263-277, 2003.
Longitudinal Relations Among Depression, Stress, And Coping in High Risk Youth
The structural relationships among risk and protective factors were examined in a sample of 646 continuation high school students. Depression predicted more perceived stress but was not a unique predictor of anger coping, seeking social support, or substance use. Perceived stress increased seeking social support, which subsequently decreased the use of anger coping. This suggests that social support may be a means of prevention for adolescents. Anger coping behaviors were significant in sustaining depression and perceived stress, and in increasing hard drug use over time. Analyses of moderators of this effect indicated that there was no difference in the stress-coping depression relationship between Latinos and Caucasians. However, the relationship among perceived stress, anger coping, and depression was stronger for female than for male adolescents. Galaif, E.R., Sussman, S., Chou, C.P., and Wills, T.A., Longitudinal Relations Among Depression, Stress, and Coping in High Risk Youth. Journal of Youth and Adolescence, 32(4), pp. 243-258. 2003.
Predictors of Smoking Among Rural Adolescents
This study investigated a model of social and cognitive cross-sectional predictors of smoking, with a focus on rural adolescents. Gender-specific differences in etiology were examined by testing the same model separately for boys and girls. Seventh graders (N=1,673) residing in northeastern Iowa self-reported smoking, peer smoking norms, adult smoking norms, drug refusal assertiveness, drug refusal techniques, life skills, prosmoking attitudes, risk-taking tendency, and family management practices. Data were collected during a class period in 36 junior high schools. Peer smoking norms, adult smoking norms, drug refusal assertiveness, drug refusal techniques, prosmoking attitudes, and risk-taking tendency were associated with smoking. Notably, family management skills and life skills were associated with current smoking for girls only. Based on the results of the present study and on previous research, smoking prevention programs for rural adolescents should incorporate normative education, drug refusal training, parent skills training, and competence enhancement skills training, strategies that have been successful with urban and suburban populations. Epstein, J.A., Botvin, G.J., and Spoth, R. Predicting Smoking among Rural Adolescents: Social and Cognitive Processes. Nicotine and Tobacco Research, 5, pp. 485-491, 2003.
The Role of Assertiveness and Decision Making in Early Adolescent Substance Initiation
This study examined the mediating processes linking individual rights assertiveness and decision-making to early adolescent substance initiation, along with the moderating effect of gender on those processes. Individual rights assertiveness was defined as learned, goal-oriented behavior that increases the likelihood that personal needs will be met. Decision-making skills were defined as active strategies to gather information, with pros and cons and choose appropriate actions. Self-report measures were collected from a non-treatment cohort of rural, young adolescents participating in a prevention trial (N=357). Analyses were conducted to test mediational models across three waves of data collected over a period of 18 months. Results indicated that individual rights assertiveness and decision-making had indirect effects on substance initiation through effects on negative outcome expectancies and refusal intentions. Gender differences were found in both the average level and the pattern of relationships among the variables. For girls, refusal intentions were negatively associated with later substance initiation. For boys, early levels of substance initiation were negatively associated with later levels of negative expectancies and refusal intentions. Trudeau, L., Lillehoj, C., Spoth, R., and Redmond, C. The Role of Assertiveness and Decision Making in Early Adolescent Substance Initiation: Mediating Processes. Journal of Research on Adolescence, 13(3), pp. 301-328, 2003.
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Services Research |
Posttreatment Victimization and Violence Among Adolescents Following Residential Drug Treatment
This article examines the relationships among experiences of childhood abuse, psychiatric disorders, self-reported victimization, and violent behavior, with a focus on gender differences. Data were obtained from interviews at treatment entry and 5-year post-treatment for 446 adolescent clients in therapeutic community (TC) drug treatment programs throughout the United States and Canada. Fifty-eight percent of the sample indicated that they engaged in serious violent behaviors (e.g., beatings, threatening or using weapons against other people, or violent crimes such as assaults, rapes, murders) in the 5 years following their separation from TC treatment. Multivariate logistic regression analyses revealed that victimization in the posttreatment period was the most significant factor associated with violent behavior, and pretreatment childhood abuse experiences and psychiatric disorders were not significantly related to the odds of violent behavior. There were significant gender differences in self-reported victimization and violent behavior. The findings suggest that violence in young adulthood for males is related to increasing involvement in violent lifestyles that include drug trafficking, while violence among females is associated with the social and psychological consequences of drug involvement and victimization. High rates of violent involvement and victimization among former adolescent clients suggests the utility of incorporating interventions such as safety-oriented strategies for females or interventions that address involvement in the drug use lifestyles (i.e., use and dealing) for both males and females into residential treatment to reduce the likelihood of future violence. Hawke, J.M., Jainchill, N. and De Leon, G. Posttreatment Victimization and Violence Among Adolescents Following Residential Drug Treatment. Child Maltreatment, 8(1), pp. 58-71, 2003.
Comorbid Psychiatric Disorders in Youth in Juvenile Detention
This epidemiological study seeks to estimate 6-month prevalence of comorbid psychiatric disorders among juvenile detainees by demographic subgroups including gender, race/ethnicity, and age. Participants in this longitudinal study include 1829 youth (age 10-18 years) initially arrested and detained between 1995 and 1998 at the Cook County Juvenile Temporary Detention Center in Chicago, IL. Subjects were randomly selected to participate in the study. Results indicate significantly more females (57%) than males (46%) met the criteria for 2 or more mental health disorders represented in the DSM-III-R. Nearly 14% of the girls and 11% of the boys had both a major mental disorder (psychosis, manic episode, or major depressive episode) and a substance use disorder. Nearly 30% of the girls and 20% of the boys with substance use disorders had major mental health disorders. Rates of comorbidity were higher among non-Hispanic whites and older adolescents. Abram, K.M., Teplin, L.A., McClelland, G.M., and Dulcan, M.K. Comorbid Psychiatric Disorders in Youth in Juvenile Detention. Archives of General Psychiatry, 60, pp. 1097-1108, YEAR.
Cost of Residential Addiction Treatment in Public Housing
The cost of providing addiction treatment services in a variety of settings is useful information for program administrators, policy makers, and researchers. This study estimates the economic costs of providing substance abuse treatment services at Safeport, a three-phase residential treatment program serving addicted women living in public housing. Economic (opportunity) costs are estimated for each phase separately and for the complete program. Results indicate that the total cost of providing treatment services at Safeport in 2001 was $1,325,235. This total cost comprises $549,737 for stabilization or early abstinence (Phase I), $400,098 for relapse prevention and self-sufficiency (Phase II), and $375,400 for independent living preparation and long-term recovery (Phase III). Average daily census (number of clients/families on a typical day) was just over 11 clients/families in each phase or 34 clients/families for the entire program. The average length of stay was 12 weeks for Phase I, 20 weeks for Phase II, 18 weeks for Phase III, and 50 weeks overall. The average weekly cost per client amounted to $930 for Phase I, $677 for Phase II, $635 for Phase III, and $748 over the full program. The average cost per treatment episode amounted to $11,163 for Phase I, $13,541 for Phase II, $11,435 for Phase III, and $36,136 for the complete program. Future research should compare these cost estimates with corresponding outcome data from Safeport to perform a comprehensive economic evaluation. Alexandre, P.K., Roebuck, M.C., French, M.T., Barry, M. The Cost of Residential Addiction Treatment in Public Housing. Journal of Substance Abuse Treatment, 24(4), pp. 285-290, 2003.
Lower Levels of Educational Attainment Predict Shorter Time to Relapse Among Alcohol-Dependent Men and Women
This study investigated the relationship between educational attainment and drinking outcomes after discharge from inpatient treatment for alcohol dependence. Researchers consecutively recruited 41 women and 60 men hospitalized for alcohol dependence between 1993 and 1996 and followed them up monthly for 1 year. Structured interviews were conducted during hospitalization and at monthly intervals after discharge for 1 year to provide data to examine the relationship between educational attainment before treatment and postdischarge drinking outcomes, including time to relapse. After covariate adjustment, educational level was a significant predictor of drinking outcomes. Lower levels of educational attainment before entry into treatment predicted shorter times to first drink and relapse in both women and men. The association of educational attainment and treatment outcome for alcohol dependence warrants further investigation. Greenfield, S.F., Sugarman, D.E., Muenz, L.R., Patterson, M.D., He, D.Y., and Weiss, R.D. The Relationship Between Educational Attainment and Relapse Among Alcohol-Dependent Men and Women: A Prospective Study. Alcoholism: Clinical and Experimental Research, 27(8), pp. 1278-1285, 2003.
Gender Differences and Treatment Outcomes Among Methadone Patients in the Drug Abuse Treatment Outcome Study
This study examined gender differences among 727 individuals in 21 methadone treatment programs. At treatment entry, a greater proportion of men abused alcohol, lived with their parents, were under legal supervision, and were employed; a greater proportion of women received public assistance, were depressed, had a substance abusing spouse, and engaged in high-risk sexual behavior. Cocaine use was associated with continued heroin use for both men and women, regardless of treatment participation. Using alcohol, living with one's parents, and having a negative reference group were associated with poorer treatment outcomes among women who received methadone treatment during the follow-up period; criminal justice pressure was associated with abstinence for men who were not in treatment. Grella, C.E., Joshi, V. and Anglin, M.D. Gender Differences and Treatment Outcomes Among Methadone Patients in the Drug Abuse Treatment Outcome Study. Journal of Maintenance in the Addictions, 2(1/2), pp. 103-128, 2003.
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