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National Institute on Drug Abuse
Women and Sex/Gender Differences Research
Director's Report to Council
Research Findings Excerpts
May, 1999
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Behavioral Research |
Smoked Cocaine Self-Administration in Females and Voucher Incentives for Abstinence
Researchers at New York State Psychiatric Institute and the College of Physicians and Surgeons of Columbia University previously developed and reported on a laboratory model of "binge use" of cocaine that permitted characterization of behavior during the binge and during withdrawal from the binge. These researchers have now attempted to extend their model to a sample of high-use female cocaine abusers. Because of logistical difficulties associated with recruiting females for extended inpatient studies, the investigators used a modified protocol in which the withdrawal phase was conducted on an outpatient basis using a voucher procedure to facilitate abstinence so that withdrawal effects could be assessed. In the initial inpatient 4 to 5-day "binge" phase, ten non-treatment seeking females were permitted to smoke up to 6 doses of 50 mg cocaine base in two daily "binge" sessions for two consecutive days. Cocaine's subjective and cardiovascular effects were consistent with those previously reported in males, with the exceptions of a within-binge decrease in cocaine craving and a within-binge increase in tiredness among females. In the subsequent 2-week out-patient abstinent period, urine samples and questionnaire responses were collected daily and subjects received merchandise vouchers each time their urine sample contained less cocaine metabolite than the prior sample and was negative for all other drugs tested. During the outpatient withdrawal phase, although session attendance was excellent (98%), because only 56% of the urines indicated no new cocaine use, cocaine withdrawal effects could not be assessed. Nevertheless, achievement of 56% daily abstinence in a group of non-treatment seeking, high-use cocaine abusers serendipitously points to the utility of using voucher incentives in this population. Smoked Cocaine Self-Administration in Females and Voucher Incentives for Abstinence. Evans, S.M., Levin, F.R, Fischman, M.W., and Foltin, R. W. Journal of Substance Abuse, 10, pp. 143-162, 1998.
Male Rats Exhibit Greater Morphine Tolerance and Dependence Than Female Rats
Several rodent studies have shown that morphine's antinociceptive effect is greater for males than females. Dr. Rebecca Craft and colleagues have now reported sex differences in tolerance to morphine's antinociceptive effect. In the first experiment, whereas acute single doses of either 3.0, 5.6, or 10 mg/kg morphine produced significantly greater hotplate and tail withdrawal antinociception in males than females, delivery of all three doses spaced one week apart ("repeated dosing") did not produce sex differences; however, in males, morphine's antinociceptive effect was greater under acute dosing that under repeated dosing, whereas in females the effect was the same under the two procedures. In Experiment 2, in which morphine was delivered chronically twice daily, males exhibited significantly greater tolerance to morphine's antinociceptive effect than females and they exhibited greater recovery. During this experiment, 7 of 31 males, but none of the 29 females, died of respiratory depression. Morphine produced a decrease in the number of proestrus and estrus days and an increase in diestrus days. In Experiment 3, when morphine withdrawal was precipitated by naloxone, withdrawal scores were significantly greater for males than females with the greatest sex difference occurring in number of "wet-dog shakes." Craft, R.M., Stratmann, J.A., Bartok, T.I., and King, S.J. Psychopharmacology, 143, pp. 1-7, 1999.
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Clinical and Services Research |
Dynorphin Lowers Dopaminergic Tone Acting through Opioid Receptor Mechanisms
Dr. Mary Jeanne Kreek and associates demonstrated that administration of dynorphin increased prolactin levels suggesting a reduction of dopaminergic tone that modulates that system. It was further demonstrated that this action likely occurred through kappa and possibly mu opioid receptors. Furthermore, females were more responsive than males. These results suggest that a dynorphin-like compound might be useful in managing cocaine addiction. (Kreek, M.J., Schluger, J., Borg, L., Bunduz, M., and Ho, A. The Journal of Pharmacology and Experimental Therapeutics, 288(1), pp. 260-269, 1999) Dynorphin was also administered as a possible treatment for opioid withdrawal. Opiate-dependent subjects who had been stabilized on morphine received a single dose of dynorphin A(1-13) with positive results. There was some reduction in symptomatology at the higher doses (500 micrograms), but these were not dose-dependent. Specker, S., Wananukul, W., Hatsukami, D., Nolin, K., Hooke, L., Kreek, M.J., and Pentel, P.R. Psychopharmacology, 137, pp. 326-332, 1998.
How Are Women Who Enter Substance Abuse Treatment Different than Men?: A Gender Comparison from the Drug Abuse Treatment Outcome Study
Gender differences at admission to treatment were examined in a large sample (N=10,010) of men and women entering four major substance abuse treatment modalities in the Drug Abuse Treatment Outcome Study (DATOS). Women were younger and less educated than men and had been employed less. Although some drug use patterns were similar, men reported more alcohol use while women reported greater daily use of cocaine. Women reported more problems related to health and mental health. In addition, women reported higher levels of past and current physical and sexual abuse. Both men and women who had custody of children showed concern that drug treatment might affect their custody, but most other issues related to children are still primarily women's issues. Wechsberg, W.M., Craddock, S.G., & Hubbard, R.L. Drugs and Society, 13(1/2), pp. 97-115, 1998.
Women in Residential Drug Treatment: Differences by Program Type and Pregnancy Attitudes
This study compared the characteristics of 4,117 women treated in publicly-funded residential drug treatment programs in Los Angeles County between 1987-1994 by pregnancy status and program gender composition, i.e., women-only and mixed gender programs. A logistic regression analysis determined the predictors of program completion. Patients in women-only programs were more likely than women in mixed-gender programs to be pregnant, homeless, on probation, to use methamphetamines, to use alcohol, and to have prior drug treatment. Pregnant women were younger, more likely to be homeless, had fewer years of drug use, were more often referred to treatment by other services providers, and were less likely to have injected drugs or have prior drug treatment than non-pregnant women. Patients in women-only programs spent more time in treatment and were over twice as likely to complete treatment as women in mixed gender programs. Grella, C.E., Journal of Health Care for the Poor and Underserved, 10(2), May 1999.
Substance Use, Mental Disorders, Abuse and Crime: Gender Comparisons Among a National Sample of Adolescent Drug Treatment Clients
This paper describes important gender comparisons in drug and alcohol use, illegal activity, physical and sexual abuse, and mental health problems among a large sample of adolescents (N=3,382) who were treated from 1993 to 1995 in adolescent-oriented drug programs that participated in the Drug Abuse Treatment Outcome Study of Adolescents. Most of the adolescents reported regular use of marijuana and alcohol. Males had higher rates of illegal activity and involvement with the juvenile justice system. Females reported more sexual abuse, while males reported more physical abuse. Males and females had equal rates of conduct disorder and attention deficit hyperactivity disorder. Rounds-Bryant, J. L., Kristiansen, P.L., Fairbank, J.A., & Hubbard, R.L. Journal of Child & Adolescent Substance Abuse, 7(4), pp. 19-34, 1998.
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AIDS Research |
HIV Among Trauma Patients in New York City
The Cornell University Medical College investigators, Tardiff and his colleagues conducted a descriptive survey to determine the HIV seroprevalence rates in relation to the demographic characteristics of victims, cause of death, and toxicology findings in a sample of victims of violence and accidents who presented to emergency departments before death. The survey was conducted in 5 boroughs of New York City (population, 7.3 million). Persons 15 years of age and older injured by intentional violence or accidents (excluding drug overdoses, falls, and suicides) who presented to hospitals, died and were sent to the medical examiner were included. Plasma and sera were analyzed for HIV and cocaine and its metabolites. Logistic regression and other appropriate statistical tests analyzed the data. Among the 1,242 subjects in the sample, 90 (7.2%) had positive findings: male patients (8%) having higher rates of HIV than females (3.4%). Among the various age groups, HIV rates were 20.8%, 9.6% and 8.1% among patients 35-44, 45-54, and 25-34-year age groups, respectively. Further, HIV rates among victims of homicides, accidents, and motor vehicle crashes were 8.2%, 10.5%, and 4%, respectively. Patients with positive results for cocaine (16.3%) were more likely than those with negative results (5.8%) to be HIV positive. Logistic regression analyses found that only age and positive cocaine results, not sex race, were related to increased risk of HIV infection. The investigators concluded that the rate of HIV infection among victims of fatal trauma was significant, especially in those with evidence of cocaine use. The results further emphasize the need for use of universal precautions in the care of trauma patients. Tardiff, K., Marzuk, P., Leon, A.C., Hirsch, C.S., Portera, L., and Hartwell, N. Human Immunodeficiency Virus Among Trauma Patients in New York City. Annals of Emergency Medicine, 32, pp. 151-154, 1998.
Very Recent and New Injectors in NYC Have Very High Risks of Acquiring the HIV Infection
This paper examines HIV risk behavior and HIV infection among new initiates into illicit drug injection in New York City. Cross-sectional surveys were conducted of IDUs recruited from a large detoxification treatment program (n=2489) and a street store-front research site (n=2630) in New York City from 1990 through 1996. The interviews covered demographics, drug use history, and HIV risk behavior; serum samples were also collected for HIV testing. Subjects were categorized into two groups of newer injectors: very recent initiates (just began injecting to 3 years of injecting) and recent initiates (injecting 4 to 6 years); and long-term injectors (injecting more than or at least 7 years). Of the 5119 study subjects, 954 (19%) were newer injectors, all of whom had begun injecting after knowledge about AIDS had become widespread among IDUs in the City. New injectors were more likely to be female and white than long-term injectors, and new injectors were more likely to have begun injecting at an older age (median age at first injection for very recent initiates, 27 years; median age at first injection for recent initiates, 25 years; these compare to the median age at first injection for long-term injectors, 17 years). Newer injectors generally matched long-term injectors in frequencies of HIV risk behavior. No significant differences were found among these groups on four measures of injection risk behavior. HIV infection was substantial among the newer injectors: HIV prevalence was 11% among very recent initiates and 18% among recent initiates. Among new injectors, African Americans, Hispanics, females, and men who had sex with men were more likely to be infected. New injectors appear to have adopted the reduced risk injection practices of long-term injectors in the City. HIV infection among new injectors, however, must still be considered a major public health problem in New York City. Des Jarlais, D.C., Friedman, S.R., Perlis, T., Chapman, T.F., et al. Risk Behavior and HIV Infection Among New Drug Injectors in the Era of AIDS in New York City. J AIDS and Human Retrovirol, 20(1), pp. 67-72, 1999.
Gender Differences in an Impoverished Minority Population
Gender differences among impoverished minority females (n = 205; 87% African-American, 13% Latina) and males (n = 203; 89% African-American, 11% Latino) were examined using associations among latent variables representing stress, self-esteem, avoidant and active coping strategies, and health outcomes of depression, escapist drug use, and sexual risk behaviors. Subjects were selected from individuals participating in a community-based educational AIDS prevention program in 9 homeless shelters and 11 residential drug recovery programs in Los Angeles. Among both men and women, drug use and depression were positively related to each other. A large and significant relationship between stress and sexual risk behaviors among women was not evidenced for men. In multiple group latent means comparison models, women reported significantly more stress, depression, and avoidant coping styles than men. In predictive path models, an avoidant coping style predicted escapist drug use among men whereas greater stress predicted escapist drug use among women. Greater stress, and lower self-esteem predicted depression in both groups. Greater stress and less active coping predicted more sexual risk behaviors for women. No predictor construct in this model was significantly associated with elevated sexual risk behavior among the men. These results suggest gender-specific leverage points for AIDS-risk reduction interventions. Stein, J.A., and Nyamathi, A. Gender Differences in Relationships Among Stress, Coping, and Health Risk Behaviors in Impoverished Populations. Personality and Individual Differences, 26, pp. 145-157, 1999.
Older Substance Abusers, Age-Related Factors, and HIV/AIDS
A study was conducted to examine the role of HIV counseling, testing, and partner notification in the lives of street addicts of all ages, with a subsample of the addicts being older injectors (N=53) ranging between 50 to 86 years. About 75% of the sample were African American and the rest were White or Latino; there were 11 women and 42 men. Ten of the 53 (19%) were positive for HIV. Six of the 10 seropositive IDUs lived alone, compared to only nine of the 43 seronegative IDUs. Heroin was the drug of choice, and one injection a day was the average. All of the IDUs reported polydrug use, with the major drugs used being downers, amphetamines, and cocaine. Six of the seven males who were HIV positive had been crack smokers at one time or another. All but one of the women and half the men reported having had heterosexual sex in the past six months, but nearly 60% said they never used a condom. A lot of time was spent by the IDUs to procure drugs and money to buy drugs, by stealing, engaging in "street hustles," or by assisting drug dealers in supplying their customers. The paper reviews issues related to the illness trajectory for HIV/AIDS in older drug users, social support and social networks, access to old age benefits and public assistance, and the need for age appropriate interventions to facilitate older drug users to adopt strategies of risk reduction and AIDS prevention. Levy, J.A. AIDS and Injecting Drug Use in Later Life. Research on Aging, 20(6), pp. 776-797, 1998.
Unprotected Sex Among Drug-Using Men and Women
Using the AIDS risk reduction model as a conceptual framework, a multivariate prospective test of psychosocial antecedents of unprotected sex was conducted using 155 female and 134 male heterosexual injection drug users. For both women and men, stronger intentions to use condoms predicted subsequent reduction in unprotected sex. For women, but not men, higher perceived self-efficacy also led to reductions in unprotected sex. These results suggest that explicit formation of risk-reduction intentions is an important antecedent to sexual behavior change by drug users of either gender and that change by drug-using women is also influenced by their perceived control over sexual risk-taking. Longshore, D., Stein J.A., Anglin, M.D., and Kowalewski, M.R. Psychosocial Antecedents of Unprotected Sex by Drug-Using Men and Women. AIDS & Behavior, 2, pp. 293-306, 1998.
Correlates of High Risk Sexual Activity Are Identified Among STD Patients Who Use Crack
Crack-smoking sexually transmitted disease (STD) patients are at high-risk for contracting HIV. To examine the effects of cocaine use and other correlates on high-risk sexual behavior among STD clinic patients, a cross-sectional study was conducted. The sample included 1,490 consecutive patients attending three Los Angeles County STD clinics between 1992 and 1994. Logistic regression analysis found high-risk sexual activity was associated with being male and of younger age. Among women, high-risk sexual behavior was associated with crack cocaine use and a perceived need for help. Among men in the study, ethnicity (being black) and having an arrest history were associated with high-risk behavior. Effective intervention strategies should address cocaine use among STD patients and provide them with referrals to drug treatment. Hser, Y.I., Chou, C.P., Hoffman, V., Anglin, M.D. Cocaine Use and High-Risk Sexual Behavior Among STD Clinic Patients. Sex Transm Dis, 26(2), pp. 82-86, 1999.
Building Bridges for Community Involvement in Drug and HIV Research among Minority Populations
This paper proposes methods for developing a community base for drug abuse research with minority populations. Recommendations are based on 6 years of research in communities with a high prevalence of prostitution and/or drug use in New York City and Atlanta. Researchers employed a qualitative methodology that included participant observation, in-depth interviewing, and focus groups. The participant observation involved data collection in the subjects' natural setting. The main stages in participant observation, also referred to as ethnographic mapping, were to gain access, develop a role in the field, identify key respondents, and build trust relationships. The open-ended structured interviews facilitated the development of trust and permitted discovery of the subjects' perspective of his/her own salient issues. Sterk, C.E. Building Bridges: Community Involvement in Drug and HIV Research Among Minority Populations. Drugs & Society 14, 1/2, pp. 107-121, 1999.
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Epidemiology and Prevention Research |
Marijuana Use Among American Indian Adolescents
Researchers at the University of Colorado Health Sciences Center report two studies of marijuana use among American Indian adolescents. The first study examined the characteristics of marijuana (MJ) users in a survey of 1464 9th-12th-grade adolescents from four Indian tribal groups. Forty percent of these American Indian subjects had used MJ at least once in the last month. The prevalence of MJ use varied across the 4 tribes. Low- and high-frequency marijuana use (1-3 times in the past month, and 11 or more times in that period, respectively) were modeled as outcome variables. The factors associated with MJ use varied with the frequency of use and by gender. Males were no more likely than females to use MJ at a low frequency, but were more likely to use at high frequency. In the final multivariate models, low-frequency MJ use among females was associated with reporting that peers encouraged alcohol use as well as use of alcohol and stimulants. Among males, low-frequency use was associated with greater positive alcohol expectancies, lower grades in school, and alcohol use. While high-frequency MJ use was associated with use of alcohol, stimulants and cocaine among females, such use was associated with higher scores on the antisocial behavior scale as well as the use of alcohol, stimulants and cocaine among males. Overall, the strongest associations were with the use of alcohol and other illicit substances. Novins, D.K. and Mitchell, C.M. Factors Associated With Marijuana Use Among American Indian Adolescents. Addiction. 93(11), pp. 1693-1702, Nov 1998. The second study examined the developmental course of marijuana use among 1766 American Indian adolescents 14-20 years old across three cultural groups. Three annual ascertainments of 30-day marijuana use and 5 age cohorts were linked and hierarchical linear modeling was used to assess the trajectory of marijuana use, taking account of gender and community group differences as well. Use of marijuana increased in middle adolescence, peaked in later adolescence, and began to decrease in early adulthood, supporting a non-linear maturational model. Both gender and community differences were observed in the trajectories, with girls and boys similar in frequency of use at age 14 but diverging by age 20; in all three communities, males showed a sharper increase in use. The authors conclude that growth curve analysis provides an additional tool for studying effects of interventions that may not be apparent in traditional evaluation design. Mitchell, C.M., Novins, D.K., and Holmes, T. Marijuana Use Among American Indian Adolescents: A Growth Curve analysis from Ages 14 Through 20 Years. Journal of the American Academy of Child and Adolescent Psychiatry, 38(1), pp. 72-78, 1999.
Stress-Coping Factors in Adolescent Substance Use: Test of Ethnic and Gender Differences in Samples of Urban Adolescents
Addressing the question of whether and how the etiology of drug use differs for adolescents in various ethnic groups, researchers investigated group differences in the relationship between stress-coping variables and substance use with samples of inner-city students in 6th-8th grades (N = 1,289) and metropolitan-area students in 7th-9th grades (N = 1,702). Use of cigarettes, alcohol, and marijuana were considered, and measures of psychosocial predictor domains focused on affect, life events, parental support, and coping patterns. African-American adolescents had the lowest rate of substance use, Hispanics were intermediate, and Whites had the highest rate; there was no gender difference in overall substance use. Multiple regression analysis showed that the strength of predictive relationships for stress-coping variables was lower for African Americans and was greatest for Whites; methodological tests showed that these differences were not attributable to statistical artifacts. Hispanic adolescents showed greater vulnerability than did Whites at younger ages but this effect was reversed at later ages. Implications of the study include the importance of incorporating stress-coping components in the design of prevention programs for all ethnic groups. As affective factors were less predictive of substance use among African-American adolescents, programs should give greater attention to other domains when targeting programs to these adolescents. Earlier prevention efforts (before age 12) are likely to be most critical for Hispanic youth. Vaccaro, D. and Wills, T.A. Journal of Drug Education. Vol. 28(3), pp. 257-280, 1998.
The 45th biannual meeting of the Community Epidemiology Work Group (CEWG) was held in Miami, Florida on December 15-18, 1997. The CEWG is composed of researchers from 21 metropolitan areas of the United States who meet semiannually to report on patterns and trends of drug abuse in their respective areas; emerging drugs of abuse; vulnerable populations and factors that may place people at risk of drug use and abuse; and, negative health and social consequences. Reports are based on drug abuse indicator data, such as morbidity and mortality information, treatment data, and local and State law enforcement data. Additional sources of information include criminal justice, correctional, medical and community health reports, local and State surveys, and research findings from ethnographic studies. The following are highlights from the meeting:
In the Past 6 Months
- Heroin has attracted a growing number of young people, many from the suburbs, some of whom inject.
- Marijuana indicators have continued to escalate across the country.
- Cocaine indicators have generally continued to level or decline, but some increases are reported.
- Methamphetamine has been increasingly involved in medical emergencies across the country, but other indicators are mixed.
- "Club drugs," especially GHB, have increasingly resulted in adverse reactions in several areas.
Cocaine - While most cocaine indicators continue to reflect declines or stability, some increases are still reported. Cocaine mortality figures declined or appeared stable in eight cities but increased in three areas (Detroit, Phoenix, and Texas) where 1997or partial-1998 data were available. Emergency department (ED) mentions declined significantly* in 6 of the 20 CEWG cities in the Drug Abuse Warning Network (DAWN) and increased* in 2 (Chicago and Denver). The percentage of treatment admissions for primary cocaine problems declined or remained stable in 15 of the 16 areas where trend data were available (it increased in Philadelphia). Cocaine-positive urinalysis percentages remained relatively stable (within 4 percentage points) among male adult arrestees in 16 of the 17 CEWG cities in the Arrestee Drug Abuse Monitoring (ADAM) program. Again, an increase** in Philadelphia was the exception. The cocaine-using population generally continues to age; however, younger users are still appearing in local indicators in Dallas (ED mentions), Miami, and Washington, DC (arrestee urinalysis). Austin street outreach workers report a new generation of young African-American crack addicts and an increase in crack users among Hispanic women. Injection of crack (dissolved in lemon juice, orange juice, or vinegar) is reported in Austin, Boston (usually in conjunction with heroin), New York, and Washington, DC (either alone or mixed with heroin). Some slight shifts to cocaine hydrochloride are reported: in Detroit (with increased intranasal use), in cities outside of Boston (possibly in relation to cocaine injection), and in San Francisco. In areas such as Atlanta, the crack scene is shifting to suburban and rural counties.
Heroin - Mortality figures suggest an abatement or plateau following increases: between 1996 and 1997, heroin-related deaths increased in 8 of the 11 cities where such data were available; but partial-1998 data, available in 8 cities, suggest declines or stable levels in 6 of them. DAWN and treatment figures show more mixed trends: ED mentions increased* in four cities (Miami, New Orleans, Chicago, and Washington, DC) and declined* in three (Los Angeles, Baltimore, and New York); and primary heroin treatment percentages increased slightly in four cities (Boston, Detroit, New Orleans, and New York), declined in five (Los Angeles, Philadelphia, San Diego, San Francisco, and Seattle), and remained stable in five (Denver, Atlanta, Minneapolis/St. Paul, St. Louis, and Dallas). ADAM percentages remained generally stable, except for an increase** in Philadelphia.
Researchers caution against complacence about the recent leveling of some indicator data because there is lag time between heroin initiation and its appearance in indicators. National concerns about the lure of "heroin-chic" trends andthe "normalization" of heroin among middle-class youth appear to be borne out in some cities. San Francisco ethnographers report an increase in young middle-class users. Younger populations are also increasingly initiating heroin use in Boston, where needle exchange workers report a recent increase in younger injectors. Atlanta ethnographic reports also continue to indicate an increasing number of recently initiated snorters shifting to injection. An increase in injecting among Newark treatment admissions suggests a possible reversal of the trend toward increased snorting which started in the mid-1980s. A Chicago study identified a high percentage of suburban youth who are injectors. Suburban or rural heroin activity is also reported around the Baltimore and Boston areas. A recent surge in asthmatic reactions among young heroin snorters is under investigation in Chicago.
Marijuana - Marijuana now accounts for more than 10 percent of total ED mentions in six cities, and it is the top-ranking primary drug treatment problem in four cities (Denver, Seattle, New Orleans, and Minneapolis/St. Paul). ED mentions increased* in six cities; no significant declines were noted. Treatment percentages increased in 10 cities and remained stable in 5. Among adult male arrestees, marijuana-positive findings exceeded cocaine-positives in nine ADAM cities; percentages declined in three cities and increased in two**. In each of the eight CEWG cities where ADAM tests juvenile males, the percentage of positive urinalyses was much higher for juveniles than for adults. Focus group findings in Boston revealed teens who, because they had grown bored with or developed tolerance for marijuana, had moved on to other drugs. Marijuana is sometimes combined with crack in Chicago (3750s), Miami (geek joints), and Philadelphia (turbos); with PCP in Chicago (wicky stick or donk), New York (high-powered blunts), Philadelphia (love boat), and St. Louis; with methamphetamine in St. Louis; with embalming fluid in Minneapolis and Seattle; and with embalming fluid laced with PCP in Houston. The World Wide Web has become a substantial source of information, including instructions on indoor growing, user group discussions, announcements about the "legal" sale of marijuana, and advertisements for marijuana seeds.
Stimulants - Indicators of methamphetamine use are mixed. Available partial-1998 mortality figures show methamphetamine-related deaths declined in four cities and increased in two (Phoenix and St. Paul). Methamphetamine ED mentions increased* in nine cities, in all regions of the country: Atlanta, Dallas, Denver, Minneapolis/St. Paul, Philadelphia, Phoenix, San Diego, San Francisco, and Seattle; no significant declines were noted. Methamphetamine remains the number-one primary drug treatment problem in San Diego and Honolulu. Treatment percentages increased in four western cities (Denver, San Diego, San Francisco, and Seattle) and remained stable in four (Dallas, Los Angeles, Minneapolis/St. Paul, and St. Louis). Methamphetamine-positive urinalyses remained generally stable** among adult male arrestees. "Tweaking," or "crystal" use, occurs among a broad array of subcultures, including urban gay men, white working-class, bikers, the dance club scene, adolescent girls, and urban runaway street youth who follow a yearly circuit ranging from New Orleans, the Southwest, California, and the Northwest (including Vancouver, British Columbia).
Methylenedioxymethamphetamine - MDMA (ecstasy, blue lips, blue kisses, and white dove) availability is reported, primarily as a club drug at raves and dance parties, in Atlanta, Baltimore, Boston, Chicago, Miami, New York, St.Louis, Seattle, and Washington, DC. In the Boston area, the prominence of MDMA has increased as reflected in seizure data, in focus group reports by suburban white teens, in reports by needle exchange workers, and in school survey data. MDMA has now become included in Atlanta's weekend-long gay male party circuit. In Seattle, ecstasy is mixed with other drugs, such as LSD (candy flipping), mushrooms (flower flipping), and heroin (H-bomb); a new liquid form of ecstasy in that city is of concern because its purity ranges wildly, it is cut with many different drugs, and users are uncertain of what they are getting. Similarly, in Miami, adulteration is viewed as an opportunity to try something different rather than a ripoff, a phenomenon known as "rolling" because these combinations produce seesaw stimulant and depressant effects.
Methylphenidate (Ritalin) remains readily obtainable by Boston students in middle- and upper-middle-class communities; it is increasingly reported in Phoenix in poison control calls; and a resurgence is reported in Seattle, where it is diverted from prescribed use, especially among younger students
Depressants _ Use of Gamma-hydroxybutyrate (GHB), a central nervous system depressant, continues to spread across the country with recipes for its manufacture easily accessible on the Internet. It has been involved in poisonings, overdoses, date rapes, and even fatalities in Boston, Colorado, Detroit, Miami, New York, Phoenix, Seattle, and Texas. Availability is also reported in Atlanta, Baltimore, and Minneapolis/St. Paul. It is associated with the club scene, raves, gay circuit parties, and fitness centers and gyms. It is frequently consumed with alcohol, and sometimes with marijuana, LSD, or ecstasy. In New Orleans, it is mixed with amphetamine in an alcoholic drink called "max." Only in San Francisco did ethnographers report a decline in 1998. Its names include "grievous bodily harm," "cherry meth," "easy lay," "gamma," "Georgia home boy," "G," "liquid E," "liquid ecstasy," "liquid X," "great hormones at bedtime," "everclear," "g-riffic," and "salty water." In addition, gamma butyrolactone (GBL) is contained in commercial products (Blue Nitro, RenewTrient, and ReVivarin) legally sold as health supplements; it metabolizes into GHB and produces clinical symptoms identical to GHB. Dangerous labeling may cause a critical lag time in seeking help for GBL toxicity.
Another club drug, ketamine ("Special K" or "vitamin K"), is popular in cities such as Atlanta, Boston, Miami, Minneapolis/St. Paul, San Diego, and Seattle. It is usually snorted, but injection is reported among young users in some areas, including Boston and Minneapolis/St. Paul. In the latter city, being under the influence of ketamine is known as being "in the hole" or "in the K hole." The drug has been involved in DUI cases and poison control calls in Miami and in one death in San Diego.
Clonazepam - (Klonopin or Rivotril) has been termed "street drug of the 90s" in Boston. Juveniles in Texas commonly use it in combination with beer. It is sold in Atlanta to enhance the effects of methadone, and it is commonly diverted in Phoenix. Alprazolam (Xanax, or "sticks") is increasingly replacing diazepam on the street in New York; it is also a common street drug in Boston. Diazepam is appearing in Atlanta crack houses. An emerging trend in Seattle involves concomitantly injecting heroin and a depressant, typically diazepam -a longtime practice in Chicago. Flunitrazepam (Rohypnol) reports continue to decline in Miami, but still appear in Minnesota and in Texas treatment and survey data. Use of this "date-rape" drug was suspected in a syphilis outbreak among white, middle-class adolescent girls in Atlanta. Trazodone (Desyrel) has been involved in numerous poisonings and one death in Detroit.
Hallucinogens - Ethnographic, law enforcement, and survey data suggest continued low-level abuse of lysergic acid diethylamide (LSD) and phencyclidine (PCP), despite declining or stable ED and treatment indicators. For example, treatment percentages have been declining in Chicago for more than a decade, but school survey data suggest some increases in LSD. Massachusetts school surveys also show increased hallucinogen use. LSD is reportedly common among teens and young adults - often in suburban and rural settings in a number of cities, including Atlanta, Baltimore, Boston, Detroit, Minneapolis/St. Paul, New York, St. Louis, Seattle, and parts of Texas. It is frequently found at local concerts, parties, and raves. PCP availability continues in several cities, including Baltimore, Minneapolis/St. Paul, New rleans, and New York. Ethnographers in San Francisco note a renewed interest in PCP in one predominately Hispanic neighborhood. In Washington, DC, PCP-positive screens among adult and juvenile arrestees continue their decade-long decline. Use of PCP in combination with marijuana continues to be reported in Chicago, New York, Philadelphia, and St. Louis. PCP/crack combinations are reported in Philadelphia. In Houston, marijuana cigarettes are dipped in embalming fluid containing PCP. Psilocybin mushrooms ("shrooms") are reportedly available in some cities, including Baltimore, Minneapolis/St. Paul, and Seattle.
Other Drugs - Ten Newark teenagers were recently hospitalized for reactions to jimsonweed; the drug is also reportedly abused in Phoenix. Ingesting cough medications in Minneapolis/St. Paul is known as "robo tripping" and adolescents who use it are known as "robo cops." The practice has resulted in adverse reactions. The cough medicine guaiphenesin (Robitussin) is also reportedly abused in Phoenix and by Boston teenagers.
*DAWN comparisons are for first half 1996 versus first half 1997; changes are noted only when statistically significant at p < 0.05.
**ADAM comparisons are for first half 1997 versus first half 1998; changes are noted only when they are >5 percentage points.
Preventing Adolescent Health Risk Behaviors By Strengthening Protection During Childhood
Researchers at the University of Washington examined the long-term effects of an intervention combining teacher training, parent education, and social competence training for children during the elementary grades on health-risk behaviors at age 18 years. The study employed a nonrandomized controlled trial with follow-up six years after intervention. Subjects consisted of 643 students in public elementary schools serving high-crime areas in Seattle, Washington. A full intervention condition (n=156) provided in grades 1 through 6 consisted of 5 days of teacher in-service training each intervention year, developmentally appropriate parenting classes offered to parents when children were in grades 1, 2, 3, 5, and 6, and developmentally adjusted social competence training for children in grades 1 and 6. A late intervention condition (n=267) provided in grades 5 and 6 paralleled the full intervention at these grades. A control condition (n=220) consisted of students in schools assigned to receive no intervention in grades 5 and 6 and who were not in intervention classrooms in grades 1 through 4. The follow-up at age 18, six years after the end of intervention, included 93% of the baseline sample and assessed self-reported substance use, violent and non-violent crime, sexual activity, pregnancy, bonding to school, school achievement, grade repetition and school dropout, suspension and/or expulsion, and school misbehavior. Compared to control students, fewer students receiving the full intervention reported heavy drinking (15.4% vs. 25.6%), violent delinquent acts (48.3% vs. 59.7%), sexual intercourse (72.1% vs. 83.0%), having multiple sex partners (49.7% vs. 61.5%), and pregnancy or causing pregnancy (17.1% vs. 26.4%) by age 18 years. The full-intervention student group reported more commitment and attachment to school, better academic achievement, and less school misbehavior than control students. Late intervention in grades 5 and 6 only did not significantly affect health-risk behaviors in adolescence. These findings suggest that a package of interventions with teachers, parents, and children provided throughout the elementary grades can have enduring effects in reducing heavy drinking, violent behavior, and sexual intercourse at age 18 years among multiethnic urban children. Results support efforts to reduce health-risk behaviors through universal interventions in selected communities or schools serving high-crime neighborhoods. Hawkins, J.D., Catalano, R.F., Kosterman, R., Abbott, R., Hill, K.G. Archives of Pediatrics and Adolescent Medicine, 153, pp. 226-234, 1999.
Children, Particularly Sons, of Opiate Addicts with Major Depression at Increased Risk forConduct Disorder and Global, Social, and Intellectual Impairment
Children (N=114, age 6 to 17 years) of 69 white methadone maintenance patients with (N=30) and without (N=39) major depression were evaluated for DSM-III-R diagnoses by the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic version and best estimate, and by measures of functioning (Children's Global Assessment Scale, Social Adjustment Inventory for Children and Adolescents, WISC, and Peabody Picture Vocabulary Test), and compared with children of historical controls without substance abuse history. Sons of opiate addicts with major depression were at increased risk for conduct disorder and global, social, and intellectual impairment compared with sons of opiate addicts without major depression and/or sons of controls with neither drug dependence nor depression. Sons of opiate addicts without major depression differed little from controls. Daughters of opiate addicts did not differ from controls in rates of disorders but had poorer social adjustment and nonverbal intelligence. Treatment settings such as methadone maintenance might afford an opportunity for primary and secondary prevention, both through early detection of childhood disorders and treatment of parental drug dependence and psychopathology. Nunes, E.V., Weissman, M.M., Goldstein, R.B., McAvay, G., Seracini, A.M., Verdeli, H., Wickramaratne, P.J. Psychopathology in Children of Parents with Opiate Dependence and/or Major Depression. Journal of the American Academy of Child and Adolescent Psychiatry, 37(11), pp. 1142-1151, 1998.
Young Adult Drug Use May Be Reduced by Early Interventions, Stronger Parent-Child Bonds
This study examined young adult drug use stemming from childhood aggression, the parent-child mutual attachment relationship, and the effect of unconventionality. Youngsters and their mothers were interviewed when the youngsters were early adolescents, late adolescents, and young adults. Additional data were collected from the mothers when their youngsters were children. The analysis was conducted on youngsters who had complete data at all 4 points in time. The findings were in accord with the family interactional model; that is, the parent-child mutual attachment relationship affects unconventionality in the youngster, which, in turn, affects young adult drug use. The results indicate that the parent-child mutual attachment relationship does so through the stability of : (a) the attachment relationship from childhood to young adulthood, (b) unconventional personality and behavioral attributes from early adolescence to young adulthood, and (c) drug use from early adolescence to young adulthood. The findings imply that early intervention with respect to aggression, interventions that focus on strengthening the parent-child bond and conventional behavior, and interventions aimed at early drug use should be most effective in reducing young adult drug use. Brook, J.S., Whiteman, M., Finch, S., and Cohen, P. Mutual Attachment, Personality, and Drug Use: Pathways from Childhood to Young Adulthood. Gen Soc Gen Psy Monogr, 124(4), pp. 492-510, 1998.
Effects of Drug Testing High School Athletes
Data from numerous studies have shown that high school athletes initiate hazardous drug use behaviors at rates similar to non-athletic peers, with the added risk of anabolic steroids and other ergogenic drug use. Some investigators have found higher use of alcohol and other high risk behaviors among those engaged in aggressive contact sports. Currently, schools from many states have initiated drug testing of adolescent athletes using urinalysis. The use of drug surveillance as a deterrent was upheld by the US Supreme Court in 1995 and 1998. However, the acceptability of the technique and its impact on future drug use by adolescents have never been studied. To assess the use of alcohol and other drugs in athletes, (n=1506) male high school football players and adolescent females (n=2085) were surveyed. Results included lifetime use of alcohol (76.2% male, 65.3% female), marijuana (29.4% male, 14.8% female) and amphetamines (8.4% male, 7.8% female). Participants were also surveyed by confidential questionnaire (1299 students from 28 high schools) to determine potential deterrent effects and acceptability of drug testing. Of those surveyed, only a small minority (< 9%) said they would use drugs or alcohol (12%) if random drug testing were school policy. Importantly, drug testing received broad student support. Goldberg, L., Elliot, D., Moe, E., Kuehl, K., and Clarke, G. Acceptability and Potential Deterrent Effects of Drug Testing. Medicine and Science in Sports and Exercise, 31(5)S, 1999.
Gender Differences in Use of Prescribed Psychotropic Drugs
Data from the 1989 National Ambulatory Medical Care Survey (NAMCS) was used to examine gender differences in aggregate psychotropic drug use and use of specific therapeutic categories--anxiolytics, sedative-hypnotics, antidepressants, and antipsychotics. Logistic regression analysis was used to estimate the probability of psychotropic drug use in aggregate. For equations where gender was statistically significant, separate logistic regression equations were estimated to determine the explanatory variables that vary by gender. The probability of receiving any psychotropic drug is 55% greater in office visits by women than by men, all else constant. Further, gender is a positive and significant predictor of anxiolytic and antidepressant use. Variables estimating anxiolytic and antidepressant use that differ by gender include diagnosis, physician specialty, and payment source for the office visit. Findings confirm research that has demonstrated that women are more likely than men to receive anxiolytics and antidepressants in office-based care. In addition, there were significant differences in the predictors of drug use for women and men. Simoni-Wastila, L. Gender and Psychotropic Drug Use. Medical Care 36(1), pp. 88-94, 1998.
Executive Cognitive Functioning, Temperament, and Antisocial Behavior in Conduct-Disordered Adolescent Females
Investigators from CEDAR assessed whether low executive cognitive functioning (ECF) and a difficult temperament are related to aggressive and nonaggressive forms of antisocial behavior (ASB) in 249, 14-18-year-old, conduct-disordered females and controls. ECF was measured using neuropsychological tests; temperament was measured using the Dimensions of Temperament Survey--Revised; and ASB was assessed using psychiatric symptom counts for conduct disorder. The conduct-disordered females exhibited lower ECF capacity and greater difficult temperament compared with controls. The combined influence of low ECF and difficult temperament was significantly related to both forms of ASB. In comparison with low ECF, difficult temperament was more strongly related to nonaggressive ASB, whereas in comparison with difficult temperament, low ECF was more strongly related to aggressive ASB. Last, ECF mediated the relation between difficult emperament and aggressive ASB. Giancola, P.R., Mezzich, A.C., and Tarter, R.E. Journal of Abnormal Psychology. 107(4), pp. 629-641, Nov 1998.
The Etiology of Adult and Adolescent Substance Use May Differ--Substance Use Patterns in Milwaukee Gangs
A study of the patterns of substance use by male and female gang members in Milwaukee, Wisconsin, from their teenage years in the 1980s into adulthood indicate that the gangs started out as one form of neighborhood-based drug-using peer groups. Variation existed in drug use but family variables explained little of the variation. Male gang members raised in families with a history of gang involvement and drug use were more likely than other gang members to use cocaine and to use it seriously. On the other hand, severe family distress was not related to onset, duration, nor seriousness of cocaine use in either males or females. Cocaine use for both males and females increased in adulthood. It appears that the etiology of adult and adolescent drug use may differ. Neither social control theory nor differential association theory is well suited to explain the variations in gang drug use by age or gender. Hagedorn, J.M., Torres, J., and Giglio, G. Cocaine, Kicks, and Strain: Patterns of Substance Use in Milwaukee Gangs. Contemporary Drug Problems 25, Spring, pp. 113-145, 1998.
Characteristics of Inconsistent Respondents Who Have "Ever Used" Drugs in a School-Based Sample
Inconsistency of reporting of lifetime drug use has been recognized in numerous longitudinal surveys, and some researchers have coined the term "recanting" to describe denial of ever-use at follow-up when use has been acknowledged at an earlier contact. Investigators at the University of Illinois at Chicago examined the predictors of inconsistent responses from adolescents to questions about whether they ever used alcohol, cigarettes, and marijuana. Male adolescents had significantly higher rates of inconsistent responses than female adolescents. Black and Hispanic adolescents had significantly higher rates of inconsistent responses regarding ever using alcohol and cigarettes (only for Black) than White adolescents. The subjects' living status and academic achievements were significant predictors of inconsistent responses regarding ever using marijuana. Thus, these results are consistent with the notion that inconsistent responses may bias the estimation of the prevalence of ever using drugs in multivariate analyses. Siddiqui, O., Mott, J.A., Anderson, T.L., and Flay, B.R. Measurements, Instruments, Scales, and Tests -- Characteristics of Inconsistent Respondents who have "Ever Used" Drugs in a School-Based Sample. Substance Use & Misuse, 34(2), pp. 269-295, 1999.
Stressful Life Events and Adolescent Substance Use and Depression: Conditional and Gender Differentiated Effects
Stressful life circumstances have myriad influences on human health and behavior. Early research focused on the variable distribution of stress and its effects by socioeconomic status, race, and gender. More recent research indicates that variation by age is also an important consideration. For example, adolescent reactions to stressful life events are often inconsistent with adult reactions to similar life situations and transitions. Moreover, since most studies assess only a single outcome-usually depression-they risk classification bias since analyses exclude other potential stress-related outcomes. This paper assesses the gender distinct effects of stressful life events on two outcomes among adolescents, substance use and depressive symptoms. The results of a second-order regression model indicate that life events affect female, but not male, depressive symptoms, especially when self-esteem is low or mastery is high. Furthermore, life events affect substance use when peer drug use is high, or when parental support is low, but this latter effect is limited to female adolescents. Hoffmann, J.P., and Su, S.S. Substance Use & Misuse 33(11), pp. 2219-2262, 1998.
Prevalence of Homelessness Among Adolescents in the United States
Homeless adolescents represent one of the nation's most vulnerable groups and are believed to be at high risk for drug abuse. This study, conducted by investigators at Research Triangle Institute, reports the 12-month prevalence of homeless episodes among US adolescents. Interviews were conducted in 1992 and 1993 with a representative household sample of 6496 adolescents aged 12 to 17 as part of the Youth Risk Behavior Survey sponsored by the Centers for Disease Control and Prevention. Respondents reported whether they had spent the night in any of a variety of locations other than home during the previous 12 months. Findings indicate 7.6% of the youths questioned reported that they had spent at least 1 night in a youth or adult shelter (3.3%), public place (2.2%), an abandoned building (1.0%), outside (2.2%), underground (0.4%) or with a stranger (1.1%). Boys were much more likely than girls to report having experienced a homeless episode. This study suggests that homelessness among adolescents is not simply an urban problem and that prevention programs targeting homeless youth should be implemented nationwide. Ringwalt, C., Greene, J., Robertson, M., McPheeters, M. American Journal of Public Health, 88(9), pp. 1325-1329, 1998.
Ethnic and Gender Differences in Drug Use and Resistance
A survey was conducted to measure drug use, drug offers and drug resistance and to compare male and female members of different ethnic groups in seventh grade classes in the Phoenix metropolitan area. The survey was administered to over 4,000 students, with usable data obtained from 3,080. Significant ethnic and gender differences were described in drug use and, more importantly, in the drug offer and resistance process. Results indicate younger adolescents (12-13) do not possess large or sophisticated repertoires of strategies to resist drug offers and most offers come from acquaintances while previous studies report offers come from more intimate relationships for older adolescents. Also illustrated was that ethnicity and gender are related to drug use and how drugs are offered and resisted. This suggests that ethnic and gender specific approaches are needed in prevention curricula and refusal and life skills should be stressed. Moon, D.G., Hecht, M.L., Jackson, K.M., & Spellers, R. Ethnic and Gender Differences and Similarities in Adolescent Drug Use and the Drug Resistance Process. Substance Use and Misuse, 34, pp. 1059-1083, 1999.
Females At-Risk for Anabolic Steroid Use
Three national surveys document an increasing prevalence of young women's anabolic steroid (AS) use. Both local survey and national data indicate prevalences of AS use among young women of approximately 1%. Predictors of AS use and the relationship to disordered eating behavior (DEB) have not been defined. This study surveyed 2,090 middle and high school-aged females using a 140-item questionnaire. Tendency toward DEB and physique-altering drug use (including AS) and potential risk factors in the domains of knowledge, beliefs, psychological factors, peer/ environmental effects, demographics, drug use, and deviant behaviors were assessed. One-hundred and eleven (5.3%) subjects indicated a high intent for future AS use. Of those at high risk for DEB (24% total), 12% also were at risk for AS use. Those at risk for both DEB and AS use also indicated greater use of supplements, cocaine, alcohol and diet pills (p <0.005 for each). They also exhibited less belief in AS adverse effects, greater perceived peer AS use, and more sexual partners (p < 0.005 for each). Those at risk for DEB, were also at risk and exhibited more deviant behavior. Because similar predictors are present for DEB and AS use, programs designed to prevent DEB also should address AS use. Elliot, D.L., Moe, E.L., Duncan, T., and Goldberg, L. Who Are the Young Women at Risk for Anabolic Steroid Use? Medicine and Science in Sports and Exercise, 31(5)S, 1999.
Sexual and Physical Abuse at Home Predicts Suicide Attempts by Homeless Street Youth
A study was conducted to examine the relationship between home life risk factors and suicide attempts among homeless and runaway street youth recruited from both shelters and street locations in Denver, New York City, and San Francisco. Street youth (N=775) age 12-19 years old were recruited in 1992 and 1993 by street outreach staff for interview. Cross-sectional, retrospective data were analyzed to examine the relationship between suicide attempts and antecedent home life variables. Suicide attempts were reported by 48% of the females and 27% of the males, with a mean of 6.2 times for females and 5.1 times for males. Among the females, 70% reported sexual abuse and 35% reported physical abuse; among males, 24% reported sexual abuse and 35% reported physical abuse. Sexual and physical abuse before leaving home were independent predictors of suicide attempts for both females and males. Among street youth in this study who were sexually or physically abused, the odds of attempting suicide were 1.9 to 4.3 times the odds of attempting suicide among those not sexually or physically abused. Interventions attempting to reduce risk behaviors in this population must include assessments of suicidal behaviors as well as components for assisting youth in dealing with the behavioral and emotional sequelae of sexual and physical abuse. Molnar, B.E., Shade, S.B., Kral, A., et al. Suicidal Behavior and Sexual/Physical Abuse Among Street Youth. Child Abuse and Neglect, 22 (3): pp. 213-222, 1998.
Tobacco Use and Perception of Harm Among Mexican American Youth
This study sought to understand reasons for an increase in smoking and tobacco-related diseases among the Hispanic population. It examined the relationship between gender, level of cultural identification, migrant status, and grade level and tobacco use and perception of harm among Mexican American youth. Males were more likely to use tobacco than females when grade, cultural identification, and migrant status of parents are held constant. No gender effect was found for lifetime cigarette use. The odds of using cigarettes and smokeless tobacco increased substantially across grades. Effects were found for Mexican American/Spanish and Anglo/White American cultural identification and daily cigarette use. Youths who belonged to nonmigrant families or who identified with a traditional Mexican American or Spanish culture were more likely to consider regular tobacco use as harmful. These and other findings have implications for preventing future use of tobacco among Mexican American youth. Casas, J.M., Bimbela, A., Corral, C.V., et al. Cigarette and Smokeless Tobacco Among Migrant and Nonmigrant Mexican American Youth. Hispanic J Behavioral Sciences, 22 (1), pp. 102-121, 1998.
Pregnancy Among Three National Samples of Runaway and Homeless Youth
Investigators at Research Triangle Institute compared estimates of the prevalence of pregnancy among runaway and homeless youth between the ages of 14 and 17 years in various settings with each other and with youth in the general population. Comparisons used three surveys of youth: (1) the first nationally representative survey of runaway and homeless youth residing in federally and non-federally funded shelter, (2) a multi-city survey of street youth, and (3) a nationally representative household survey of youth with and without recent runaway and homeless experiences. Youth living on the streets had the highest lifetime rates of pregnancy (48%), followed by youth residing in shelters (33%) and household youth (< 10%). The investigators concluded that shelter and street youth were at much greater risk of having ever been pregnant than were youth in households regardless of whether they had recent runaway or homeless experiences. Such youth need comprehensive services, including pregnancy prevention, family planning, and prenatal and parenting services. Greene, J., and Ringwalt, C. Journal of Adolescent Health, 23(6), pp. 370-377, 1998.
The Female Atlanta Study (FAST): Crack Cocaine and Women
Dr. Claire Sterk explores the lives of 259 female drug users based on participant observation, close-ended interviewing, open-ended, in-depth interviewing, ethnographic mapping, and community consultants. In addition to drug copping zones in which drug selling and using were visible, women were recruited in neighborhoods in which drug use was just as prevalent but hidden. The book moves through the woman's initial drug use experimentation, controlled use, and evolution to current regular use. The various patterns of crack cocaine use and income-generating activities are organized into a typology: women who finance their use through involvement in the drug business, through illegal activities other than prostitution, through prostitution including sex for crack exchanges, and women who did not use drugs until they were in their thirties or older as they struggled to survive. Overall, the women's steady relationships with drug users were more mutually rewarding than relationships with non-users. Frequently, the women believed pregnant women should eliminate or reduce drug use; however, many women failed to learn of their pregnancy until the second trimester or later. Once aware of their pregnancy, several women shifted from smoking crack cocaine to drinking alcohol, assuming a legal substance was safer. Criminalization of drug use by pregnant women reduced their seeking prenatal care. Once pregnant, some chose abortion or drug-induced miscarriage; some elected adoption; others chose to become mothers. Many of the women had at least one experience with drug treatment and described motivators and barriers to drug treatment. The majority of the women had heard of HIV/AIDS, but many were misinformed about risk behaviors and risk reduction. Their claims to have made behavioral changes to reduce risk often referred to intentions. Among the women tested, very few felt prepared for the waiting period between test and results. At times, women increased their HIV risk-taking during this waiting period. The women who tested negative for HIV still led lives impacted by the HIV epidemic. They faced a continual challenge to remain HIV negative, basing their actions on the assumption that they or their partner was infected with HIV. Violent encounters were common--childhood and adult--and linked violence to HIV risk-taking. The women's perceptions of the past, present, their aspirations, and impact of the constantly changing drug market on their lives is interlaced with their acknowledgement that societal changes were needed to reduce racism, poverty, and sexism but they also described actions they could take themselves. Sterk, C.E. Fast Lives: Women Who Use Crack Cocaine. Philadelphia: Temple University Press, 1999.
The Lives, Motivations, and Options of Pregnant Drug Abusing Women, Their View
Extensive literature exists about the effects of drugs on the fetus but almost no information exists about the mother herself. Through interviews with 120 pregnant or recently delivered drug-using women, Dr. Sheigla Murphy and Dr. Marsha Rosenbaum examine how pregnant addicts make choices about their drug use, pregnancy, and prenatal care. To combat the stereotype of the negligent and even abusive pregnant drug user, the authors present the feelings and motivations of the women themselves. How do they decide whether to terminate their pregnancy? What options are available to them if they choose to continue the pregnancy but can't kick the drug use? Where do they get information upon which to make their decisions? They tend not to terminate pregnancy. They tend to change from one drug to another based on newspaper stories (if crack is bad, use heroin). The authors address these issues and the policy implications of their findings. Murphy, S. & Rosenbaum, M. Pregnant Women on Drugs: Combating Stereotypes and Stigma. New Brunswick, NJ: Rutgers University Press, 1999.
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Intramural Research |
Clinical Trials Section
Treatment Branch
Occurrence of Cocaine in Urine of Substance Abuse Treatment Patients
As part of ongoing research efforts to improve methods of monitoring drug use in treatment patients, the presence of cocaine in urine specimens was evaluated as a possible marker for recent illicit cocaine use. A total of 2,327 urine specimens collected during a clinical trial of a cocaine abuse treatment study were tested. Cocaine was measured by gas chromatography-mass spectrometry and benzoylecgonine equivalents were determined by fluorescence polarization immunoassay (FPIA). More than one-third of the specimens were positive (>25 ng/mL) for cocaine, and nearly two-thirds were positive (> 300 ng/mL) for cocaine metabolite. Median concentrations of cocaine and benzoylecgonine equivalents were 235 and 14,900 ng/mL and maximum concentrations were 112,025 and 1,101,190 ng/mL in cocaine- or benzoylecgonine-positive specimens, respectively. No significant differences in cocaine or benzoylecgonine concentrations between White and African American or between male and female patients were found. Cocaine was present less frequently and at lower concentrations than benzoylecgonine, but more frequently than expected based on an approximate average half-life of 1 hour. These results suggest that cocaine may exhibit a longer terminal half-life and/or that accumulation of cocaine can occur in chronic, heavy users. Preston, K.L., Goldberger, B.A., and Cone, E.J. Occurrence of Cocaine in Urine of Substance Abuse Treatment Patients. Journal of Analytical Toxicology, 22, pp. 580-586, 1998.
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