National Institute on Drug Abuse Women and Sex/Gender Differences Research Director's Report to Council Research Findings Excerpts May, 2000

Behavioral Research

Menstrual Cycle Phase Affects the Subjective Effect of d-Amphetamine

Research from the laboratory of Dr. Harriet de Wit at the University of Chicago shows that menstrual cycle phase is a factor in the subjective response to acute d-amphetamine. Sixteen healthy women received oral d-amphetamine during the follicular and mid-luteal phases of the menstrual cycle. Under d-amphetamine, subjective effects were greater during the follicular phase than the luteal. Subjects reported a greater feeling of "high," euphoria (ARCI MBG), and energy and intellectual efficiency (ARCI BG) during the follicular than the luteal phase, and more liking and wanting of the drug. During the follicular phase (when estrogen levels are high and progesterone levels are low), higher estrogen levels were associated with feeling energetic and intellectually efficient. During the luteal phase, when levels of both estrogen and progesterone are relatively high, the response to d-amphetamine was unrelated to estrogen level. Justice, A.J.H. and de Wit, H. Acute Effects of d-Amphetamine During the Follicular and Luteal Phases of the Menstrual Cycle in Women. Psychopharmacology, 145, pp. 67-75, 1999.

Menstrual Cycle Phase Affects Smoking Withdrawal Symptoms and Depressive Symptomatology

Dr. Kenneth Perkins and colleagues at the University of Pittsburgh found that in women who attempt to quit, phase of the menstrual cycle affects withdrawal symptoms. In a study of 78 women enrolled in a smoking cessation trial, women who quit during the luteal phase of their cycle had significantly more withdrawal symptoms and more depressive symptomatology during the week after quitting than women who quit during their follicular phase. These data suggest that women seeking to quit smoking may reduce the adverse effects of cessation by choosing to quit during the follicular phase. Perkins, K.A., Levine, M., and Marcus, M. Tobacco Withdrawal in Women and Menstrual Cycle Phase. Journal of Consulting and Clinical Psychology, 68, pp. 176-180, 2000.

Treatment Research and Development

A Clinical Profile of Women with PTSD and Substance Dependence

This paper compared the clinical characteristics of two groups of women (those with Post Traumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD) and those with PTSD only) to better understand why some women with PTSD also develop SUD, while others do not. The dual diagnosis women consistently had a more severe clinical profile, including worse life conditions, greater criminal behavior, higher number of lifetime suicide attempts, etc. One discrepant finding, however, was their lower rate of major depression. Interestingly, the two groups did not differ in number or type of lifetime traumas, PTSD onset or severity, family history of substance use, coping style, functioning level, psychiatric symptoms, or sociodemographic characteristics. Najavits, L.M., Weiss, R.D., and Shaw, S.R. Psychology of Addictive Behaviors, 13, pp. 98-104, 1999.

Gender Differences in Hostility of Opioid-Dependent Outpatients: Role in Early Treatment Termination

In this study, Dr. Nancy Petry and Dr. Warren Bickel evaluated gender differences in hostility and the role of hostility in predicting early treatment termination of opioid-dependent patients. Subjects were 104 patients (68 males and 36 females) in a buprenorphine- maintenance treatment program. Opioid-dependent females scored significantly higher on the Buss-Durkee Hostility Scale, compared to males. Early treatment termination was defined as remaining in treatment less than 30 days, and 13% of males and 25% of females were classified as early terminators. Severity of legal and employment problems and the interaction between hostility and gender were predictors of early treatment termination. Patients with less severe legal problems and patients with greater employment problems were more likely to terminate early from treatment. Higher levels of hostility predicted early treatment termination of female patients, but hostility levels were not associated with treatment termination in male patients. Results from this study show that female heroin addicts have high levels of hostility and suggest that hostility may be an important predictor of premature termination of treatment, especially among opioid-dependent women. These data suggest that hostility should be assessed early in treatment and that increased effort may be needed to enhance participation of hostile women in treatment programs. Petry, N. and Bickel, W. Drug and Alcohol Dependence, 58, pp. 27-33, 2000.

Hormone Fluctuations Appear to Affect Cocaine Metabolism and Behavioral Response in Rat

In the Biology of Addictive Disease Laboratory (Rockefeller University) of Dr. Mary Jeanne Kreek, "binge" administration of cocaine increased plasma levels of the cocaine metabolite, benzoylecgonine, more during metestrus-diestrus than during estrus and proestrus. Stereotypic behavior and locomotion were also greater during the same period. QuiÐones-Jenab, V., Ho, A., Schlussman, S.D., Franck, J. and Kreek, M.J. Estrous Cycle Differences in Cocaine-Induced Stereotypic and Locomotor Behaviors in Fischer Rats. Behavioural Brain Research, 101, pp. 15-20, 1999.

Research on AIDS and Other Medical Consequences of Drug Abuse

Elicitation Study Focuses on the Sexual Risk Practices of African American Crack Users

A descriptive elicitation research study was conducted in Washington, D.C. to better understand the attitudes, beliefs, and barriers that affect the adoption and maintenance of condom use to prevent sexual transmission of HIV. An ethnographer recruited 64 adults for participation in the study. Participants were interviewed using semi-structured interview guides that were developed as cognitive maps for interviewing, rather than as questionnaires. The data were coded and analyzed according to condom use outcome expectancies, normative beliefs about condom use, and contextual facilitators and barriers of condom use. Participants described few positive condom use outcome expectancies, while detailing several negative expectations. Participants described few contextual barriers to condom use, although situational barriers, including crack addiction, were identified. Unlike other studies, this project did not find that cultural or social factors inhibited women from introducing condoms into sexual relationships, other than those related to intimate sexual relationships or to the special situation of sex and crack. Culturally determined sexual scripts may be important in determining condom use: Normative beliefs were weakly related to condom use with casual partners, but strongly influenced condom use with intimate partners. Williams, M., Bowen, A., Elwood, W., McCoy, C., McCoy, V., et al. Determinants of Condom Use Among African Americans Who Smoke Crack Cocaine. Culture, Health, and Sexuality. 2(1), pp. 15-32, 2000.

Perceptions of Tuberculosis and Treatment Adherence for Adolescents and Adults with HIV

HIV-infected individuals are a population at very high risk for and often among the least able to afford health care resources. In this study of adolescents and adults infected with HIV, interviews were completed to assess perceptions of tuberculosis (TB) infection rates and physician TB behavior, and patient knowledge of TB transmission and treatment adherence. The sample consisted of HIV-infected youth (N = 199) from adolescent clinical care sites in three cities and HIV-infected adults (N = 133) in New York. Adolescents reported they were significantly less likely to be tested for TB; however, testing rates were high for both samples. Results indicated that approximately 9% of both samples reported infection with TB; the majority reported receiving medication (97%), and consistent medication adherence (93%). The overall mean knowledge score regarding TB was 66% and there were significant age differences, with adolescents less knowledgeable than adults, and young males tending to be less knowledgeable than young females. Age, gender and experience with TB (self-perception of TB, testing history and clinic choice) significantly predicted accuracy of knowledge about TB. Results suggest that education and support from their community health care sources may substantially reduce chances of contracting and spreading TB. Murphy, D.A., Rotheram-Borus, M.J., and Joshi, V. HIV-Infected Adolescent and Adult Perceptions of Tuberculosis Testing, Knowledge and Medication Adherence in the USA. AIDS Care-Psychological and Socio-Medical Aspects of AIDS/HIV, 12(1), pp. 59-63, 2000.

A Prospective Study of HIV Disease Progression in Female and Male Drug Users

Disease progression and mortality was assessed in a cohort of drug users attending a methadone maintenance program with on-site primary care. CD4 cell decline and distribution of AIDS-defining illnesses were studied in a cohort of 222 HIV-infected women and 302 HIV-infected men. Rates of CD4 cell decline, the distribution of first AIDS-defining illnesses, and the time to clinical AIDS did not differ by sex. Mortality rates for women and men were similar (8.71/100 person yrs. vs. 9.85/100 person yrs). However, CD4 cell count, two or more HIV-related symptoms, and crack-cocaine use were associated with an AIDS outcome. Webber, M.P., Schoenbaum, E.E., Gourevitch, M.N. et al., AIDS, 13, pp. 257-262, 1999.

Epidemiology, Etiology and Prevention Research

Monitoring the Future (MTF) Study

Results from the 1999 MTF were released on December 17, 1999. The major findings are summarized below. For more information, go to http://www.nida.nih.gov. The study findings are also available in a NIDA-published report: Johnston, L.D., O'Malley, P.M., & Bachman, J.G. (2000). Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings, 1999. NIH publication 00-4690. Rockville, MD: National Institute on Drug Abuse. This report is available on the internet at http://monitoringthefuture.org/.

Results from the 1999 MTF suggest that, with a few exceptions, use of marijuana and most other illicit drugs remained unchanged from 1998 to 1999 among 8th, 10th, and 12th graders. There were however, notable increases in the use of MDMA (ecstasy) among 12th graders and steroids among 8th and 10th graders. With a few exceptions, use of alcohol, and cigarettes also generally remained unchanged. In addition, for a third year in a row, attitudes toward use of illicit drugs, alcohol, and cigarettes generally remained unchanged or improved in all three grades, although attitudes about steroid use eroded somewhat among high school seniors.

Illicit Drug Use

• Data from the 1999 MTF indicate the rates of illicit drug use remained largely unchanged in 1998 and 1999. Illicit drug use had increased between 1991 and 1996, and slowed between 1996 and 1997. Many differences between 1998 and 1999 were not statistically significant. However, there were notable increases in MDMA and steroids.

• Lifetime, past year, and past month use of any illicit drug did not change from 1998 to 1999 in any of the three grades. However, among 8th graders the 1999 past month rate of 12.2 percent, represented a statistically significant decrease from the high mark of 14.6 percent reached in 1996. Similar results were found for lifetime and past year any illicit use statistics between 1996 and 1999.
• Lifetime, past year, and past month use of marijuana/hashish did not change in any grade between 1998 and 1999. In 1999, lifetime rates of marijuana/hashish were 49.7, 40.9, and 22.0 percent for 12th, 10th, and 8th graders respectively.
• In 1998, lifetime and past year use of crack increased among 8th graders to its highest levels since 1991, the first year data were available for students in this grade. In 1999, past year use of crack declined to 1.8 percent (down from 2.1 percent in 1998). When examining subgroups, declines in past year use occurred among 8th graders residing in the South and West census regions (2.5% and 2.6% in 1998 to 1.9% and 1.8% in 1999 respectively).
• There were no statistically significant differences in inhalant use between 1998 and 1999. During the 9 years for which data are available for 8th graders, lifetime, past year, and past month inhalant use appears to have peaked in 1995. Inhalant use continues to be generally more prevalent among 8th graders than the two higher grades.
• Increases in the use of MDMA (ecstasy) were observed for the first time since 1996, when collection of data on this drug was initiated. Lifetime, past year, and past month use increased between 1998 and 1999 among 12th graders. Lifetime: from 5.8 percent to 8.0 percent; past year: from 3.6 percent to 5.6 percent; past month: from 1.5 percent to 2.5 percent. The increase in past year use among 12th graders occurred among females (2.7% to 5.6%), those residing in the Northeast (3.7% to 9.4%), and those residing in large metropolitan statistical areas (MSAs) (3.2% to 6.1%).
• Past year use among 10th graders also increased (from 3.3 percent in 1998 to 4.4 percent in 1999). The increase in past year use among 10th graders occurred among females (2.9% to 4.2%), those residing in the Northeast (3.8% to 7.0%), and those residing in large metropolitan statistical areas (2.5% to 5.2%).
• Past year use of Rohypnol among 8th graders decreased from 0.8 percent in 1998 to 0.5 percent in 1999. A survey question about Rohypnol, sometimes referred to as the "date rape" drug, was first asked in 1996. While a statistically significant change occurred for 8th graders, it should be kept in mind that these rates are quite small. The 1999 rate for both 10th and 12th graders was 1.0 percent, which was not a statistically significant change from the 1998 rates.
• Use of ice (crystal methamphetamine) in the past year decreased to 1.9 percent among 12th graders in 1999 (it was 3.0 percent in 1998).
• Past year, and past month use of use of steroids increased among 8th and 10th graders. Past year use increased from 1.2 percent in 1998 to 1.7 percent in 1999 for both 8th and 10th graders. Past month use remains under one percent in 8th and 10th grades in spite of increases in 1999 (e.g., 0.5 percent in 1998 to 0.7 percent in 1999 among 8th graders). Also, lifetime use of steroids increased among 10th graders (from 2.0 percent in 1998 to 2.7 percent in 1999). Increases in past year steroid use among 8th graders occurred among males (1.6% to 2.5%) and whites (1.1% to 1.5%). The increase in past year use among 10th graders occurred among males (1.9% to 2.8%).
• Use of marijuana, cocaine, other cocaine, inhalants, heroin, other narcotics, hallucinogens, LSD, PCP, amphetamines, barbiturates, and tranquilizers remained stable for all three grades and all recency-of-use categories (lifetime, past year, past month, and daily use where measured).

Alcohol Use

• Alcohol use has generally remained stable in the past few years among 8th and 10th graders, and more recently among 12th graders, though at levels which most people would find unacceptably high.
• Daily alcohol use decreased for 12th graders. Use among these students decreased from 3.9 percent in 1998 to 3.4 percent in 1999.
• After decreasing to 38.3 percent in 1998, the proportion of 10th graders reporting having been drunk sometime during the past year increased to 40.9 percent in 1999.
• Also more 8th graders in 1999 had 5 or more drinks in a row during the past two weeks (from 13.7 percent in 1998 to 15.2 percent in 1999). An increase also occurred among males (from 14.4% to 16.4%).

Cigarettes and Smokeless Tobacco

• Use of cigarettes during the past month among 8th graders decreased 1.6 percentage points to 17.5 percent in 1999.
• Between 1997 and 1998, 10th graders' lifetime, past month, and daily use of cigarettes in the past month decreased from 60.2%, 29.8%, and 18.0% in 1997 to 57.7%, 27.6%, and 15.8% in 1998 respectively. Between 1998 and 1999, these rates did not change statistically (the 1999 rates were 57.6%, 25.7%, and 15.9%). However, past month use, decreased among 8th graders (from 19.1% in 1998 to 17.5% in 1999).
• In 1997, daily cigarette use in the past month among seniors was at its highest level since 1979 (24.6% in 1997 vs. 25.4% in 1979). In 1998, seniors' daily smoking decreased to 22.4% and smoking a half-pack or more cigarettes per day decreased from 14.3% to 12.6%. In 1999 seniors' rate of smoking did not change statistically (daily smoking=23.1% and 1/2 pack +/day=13.2%).
• African American students continue to have the lowest rates of smoking. Past month smoking among 8th, 10th, and 12th grade whites and Hispanics is around double or more the rate among their African American peers. For example, in 1999, 14.9 percent of African American seniors report current smoking compared to 40.1 percent of white and 27.3 percent of Hispanic seniors.

Perceived Harm, Disapproval, and Perceived Availability

• Among 8th and 10th graders, there were several changes in the perceived risk and disapproval that were in the favorable direction. Notable changes in perceived availability among 12th graders were found, all favorable. The one notable exception was steroids.
• The perceived harm in trying crack once or twice decreased among 12th graders, declining to 48.2 percent in 1999 from 52.2 percent in 1998.
• Disapproval of using smokeless tobacco regularly increased among 8th and 10th graders. Perceived availability of cigarettes decreased among 8th graders.
• Perceived harmfulness of taking steroids decreased 6 percentage points among 12th graders to 62.1 percent in 1999 (down from 68.1 in 1998). This drop marks the largest attitudinal change ever observed in the MTF.
• In the 1999 survey, more 8th and 10th graders reported personal disapproval of people taking inhalants once or twice. (8th graders: from 83.0 to 85.2 percent; 10th graders: from 85.6 to 88.4 percent).
• Perceived availability of several drugs decreased among seniors; perception of "fairly easy" or "very easy" access decreased for cocaine, LSD, PCP, other psychedelics, amyl/butyl nitrites, heroin, and tranquilizers. The only increase in perceived availability occurred for steroids among 10th graders (from 33.0 percent in 1998 to 35.9 percent in 1999).

Trends (1991-1999)

• For many drugs, there have been significant increases between 1991 and 1997. The most dramatic case was the change in marijuana use from 1991 to 1997. For 8th graders, past year use of this substance has nearly tripled, from 6.2% in 1991 to 17.7% in 1997. However, between 1996 and 1999, use rates declined for students in this grade. Among sophomores, past year use has more than doubled from 15.2 percent in 1992 to 34.8 percent in 1997, with a statistically significant decrease occurring in 1998 (31.1 percent) and remaining unchanged in 1999. Past year use among seniors has almost doubled from 21.9 percent in 1992 to 38.5 percent in 1997, and remained unchanged in 1998 and 1999 at 37.5 percent and 37.8 percent respectively.
• Between 1991 and 1996, all three grade levels reported increased use of cigarettes. So far, the high mark for cigarette use (lifetime, past month, daily, and _ pack or more per day) appears to have occurred in 1996 for 8th and 10th graders only. Between 1997 and 1998, statistically significant decreases were observed for 10th graders and 12th graders, while estimates among 8th graders did not change. In 1999, past month use decreases among 8th graders (from 19.1 percent in 1998 to 17.5 percent in 1999). All other differences were not statistically significant.

Long-Term Trends (seniors only)

• After more than a decade of declining use (1980-1992), marijuana use rose from 1993 to 1995, remained level from 1995 to 1996, increased again from 1996 to 1997, and remained unchanged in 1998 and 1999. For past year prevalence, self-reported marijuana use by seniors peaked at 50.8 percent in 1979 and then declined to a low of 21.9 percent in 1992. Past year marijuana use then increased steadily to 38.5 percent in 1997 with no change in the 1998 and 1999 rate (37.5 percent in 1998, 37.8 percent in 1999).
• Among seniors in the class of 1997, daily cigarette smoking reached 24.6 percent, its highest level since 1979, when 25.4 percent of seniors reported daily cigarette use. Daily smoking decreased between 1979 and 1980 (21.3 percent) and then remained basically level for many years. During the early 1990's increases were observed, followed by a decrease in 1998 to 22.4 percent. In 1999 the daily rate was 23.1 percent, which is statistically unchanged from the 1998 rate.

Methodological Note: In 1998, Monitoring the Future questionnaires were changed from confidential (i.e., with some identifying information being gathered) to anonymous for half of the 8th and 10th grade samples. Assuming higher rates of self-reporting of drug use when questionnaires are anonymous, this change may have resulted in some overestimation of increases and underestimation of decreases. For example, results from the matched half-sample of 8th graders receiving the anonymous questionnaires in both 1998 and 1999, showed a 1.4 percentage point decline in past year marijuana use while the full sample showed a decline of 0.4 percentage points. However, the change was not statistically significant in either case

The 47th biannual meeting of the Community Epidemiology Work Group (CEWG), was held in Los Angeles, California on December 14-17, 1999. 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 data, local and State survey information and research findings from ethnographic studies. The following are highlights from the meeting:

In the past 6 months...

Following several reporting periods of stable or declining trends, some indicators of cocaine abuse show slight rebounds in many cities; increases among younger age groups in some indicators warrant watching. Some indicators, however, continue to suggest declining or stable trends.

Heroin indicators are mixed. Younger populations continue to initiate use in several cities, and some are shifting from snorting to injecting.

Marijuana indicators suggest generally stable or increasing trends in most CEWG sites.

Declines in methamphetamine consequences are reported in most CEWG sites, especially as reflected in ED data.

"Club drugs," especially GHB, GBL, and MDMA, continue to spread across the country.

Cocaine - Following several reporting periods of stable or declining cocaine trends, mortality, emergency department (ED), and female arrestee urinalysis indicators suggest slight increases in many cities. Based on partial-1999 data, cocaine-related mortality(i) appears to be increasing in three cities (Philadelphia, Phoenix and Seattle) and declining or stable in four (Honolulu, Miami, Minneapolis/St. Paul and San Diego). Cocaine ED mentions(ii) increased significantly in five cities (Dallas, Los Angeles, Philadelphia, Phoenix, and Washington, DC), with the largest shift a 45-percent increase in Dallas. Nonsignificant ED increases were reported in the majority of the other cities; no significant declines were noted. Disturbingly, cocaine ED mentions per 100,000 population in the 12-17 age group increased sharply in four cities (Baltimore, Boston, Dallas, and Denver). By contrast, treatment admission figures(3) show generally declining or stable trends. Generally declining or stable trends were also found in cocaine-positive urinalysis percentages(4) among adult male arrestees, except in Miami and Washington, DC, where levels increased; the drug is now surpassed by marijuana in all but six cities. By contrast, among female arrestees, cocaine is still the most commonly detected drug in all but one city (San Diego); levels increased in six cities (Dallas, Detroit, Minneapolis, Philadelphia, Phoenix, and San Diego) and declined only in Los Angeles. Crack injection continues to be reported in some cities, including Boston, New York, and Washington, DC. Increased availability of cocaine hydrochloride (HCl) is reported in some cities, including Boston, Dallas, Denver, Philadelphia, and Phoenix.

Heroin - Heroin indicators show mixed trends. Mortality figures(1) declined slightly in 5 cities (Honolulu, Minneapolis/St. Paul, Philadelphia, San Diego, and Seattle) and increased only in Phoenix. Heroin ED mentions(2) declined significantly in only one city (San Francisco) and increased significantly in four (Miami, New Orleans, Newark, and Washington, D.C.). Heroin is the predominant drug of choice among treatment admissions(3) (excluding alcohol-only, but including alcohol-in-combination) in 6 of 18 reporting sites. Opiate-positive urinalysis levels(4) among adult males remained relatively low and stable in most cities, excluding Washington, D.C., where opiate-positive levels among adult males more than doubled. Similarly, among adult females, opiate-positive levels remained relatively stable, except in Chicago (where they declined notably) and in Minneapolis and New Orleans (where levels more than doubled). Heroin purity(5) remained stable or declined in most cities; prices fluctuated. Purity declines were particularly steep in three western cities (Denver, Los Angeles, and San Francisco); conversely, purity more than doubled in Miami. Younger populations are increasingly initiating heroin use in many CEWG cities, including Atlanta, Baltimore (especially among suburbanites), Boston (where ethnographic sources report high school students snorting heroin), Denver (where ethnographic sources report college students increasingly using heroin and street youth switching from methamphetamine to heroin use), Philadelphia (where new users are often adolescents), St. Louis, San Diego, San Francisco, and Seattle (where young injectors are increasing). In Atlanta, Baltimore, Chicago, Denver, and New York, the proportion of treatment clients who snort is increasing; conversely, in Newark and Seattle (among younger users), injecting is on an upward trend. In Boston and Miami, new and younger users are reportedly progressing from snorting to injecting. On Chicago's South Side, reports of heroin/cocaine combinations ("speedballs" or "John Belushi") increased, and the proportion of treatment admissions who reported snorting rose dramatically. In Washington, DC, a variant of heroin, nicknamed "bag delight," dissolves without heat.

Marijuana - Marijuana ED mentions(2) increased significantly in 3 cities (Dallas, Philadelphia, and San Diego) and nonsignificantly in 10 others; they remained level in 4 cities; and they declined significantly in only 1 city (New Orleans) and nonsignificantly in 2 cities. Marijuana is the predominant primary drug treatment problem3 in four cities (Denver, Minneapolis/St. Paul, New Orleans, and Seattle). Treatment percentages increased (5-9 percentage points) in three cities (Denver, Philadelphia, and San Diego) and remained relatively stable elsewhere. Among adult male arrestees(4), marijuana has now surpassed cocaine as the most commonly detected drug in the majority of CEWG cities; positive findings increased sharply in four cities (Atlanta, Los Angeles, Miami, and Washington, DC) and remained relatively stable elsewhere. Levels also remained relatively stable among female arrestees, except for notable increases in four cities (Chicago, Denver, Minneapolis, and New Orleans) and a decline in Seattle. Juvenile arrestee levels also remained relatively stable, but they exceeded adult marijuana-positive levels at all four sites where juveniles were tested. In some cities, such as Denver, increased potency resulting from genetic plant manipulation may have contributed to increased consequences, especially among older users who had started smoking marijuana in their teens and have recently resumed use. Marijuana is increasingly used as a delivery medium for other psychoactive drugs. For example, in Chicago, blunts are often laced with either crack or PCP ("3750s"). Marijuana/crack combinations are also reported in Boston, Minneapolis/St. Paul ("fireweed"), and parts of Texas; and marijuana/PCP combinations are also reported in Minneapolis/St. Paul ("happy stick"), Philadelphia ("loveboat" or "wet"), and New York. In Philadelphia, blunts are also laced with cocaine HCl ("turbo"). Marijuana/embalming fluid combinations are reported in Minneapolis/St. Paul ("wets" or "amp"), New York ("duck foot," which also includes the pesticide DDT), and parts of Texas (where this combination also includes PCP). In Texas, joints are also dipped in codeine cough syrup.

Stimulants - Methamphetamine ("crystal meth, "ice") remains concentrated in the West and, to a lesser extent, in some rural areas elsewhere. In the West, recent indicators suggest declines, possibly related to national and community prevention programs, stricter precursor laws, increased clandestine lab seizures, and declining methamphetamine potency. In the East, methamphetamine indicators remain low, but ethnographic and law enforcement evidence indicates a slight increase in availability, especially in rural areas and among whites. Mortality figures(1) show methamphetamine-related deaths remained relatively stable, except in Minneapolis/St. Paul and San Diego where they declined, and in Honolulu and Phoenix where they increased. Methamphetamine ED mentions(2) declined in six cities (Denver, Los Angeles, Phoenix, San Diego, San Francisco, and Seattle) and increased significantly only in Dallas. Methamphetamine remains the number-one primary drug problem among treatment admissions in Honolulu and San Diego(3), although in San Diego most methamphetamine indicators declined. Methamphetamine-positive percentages among adult male arrestees(4) increased notably in only two cities (San Diego and Seattle); percentages among adult female arrestees decreased notably in Phoenix. Methamphetamine users are heterogeneous, consisting of many small subgroups, as suggested by ethnographic data in Atlanta, where methamphetamine indicators appeared for the first time among arrestees. In Minneapolis/St. Paul, "snow," methamphetamine that allegedly contains extra lithium and produces hallucinations, is available. In Phoenix, where lab seizures recently increased dramatically, 2-phenethylamine is present in seizures, and ephedra, an herb, is used as a precursor.

Methylenedioxymethamphetamine (MDMA) ("ecstasy," "E," "Florida dove," "Mitsubishi," "red devils," "white dove," "XTC"), used primarily as a club drug at raves, dance clubs, and college scenes, seems to be increasing in Boston, Miami, New Orleans, New York, and parts of Texas; it is also reportedly available in Atlanta, Chicago, Minneapolis/St. Paul, New Jersey, Phoenix, St. Louis, Seattle, and Washington, DC. In Boston, it seems to be spreading outside the club scene. In Minneapolis/St. Paul, respirator masks rubbed with menthol-based cold ointments are worn after taking MDMA, a practice believed to heighten the drug's effect. In Atlanta, the content of what is sold as MDMA may vary widely. In Miami, Washington, DC, and parts of Texas, LSD and MDMA are combined in a pill form called "nexus," and in Chicago, homemade MDMA is sold as "wigits." Methylphenidate (Ritalin) is abused by young adults in Minneapolis/St. Paul and in middle- and upper-class communities in Boston; African-Americans in Chicago sometimes inject it with heroin or heroin and cocaine. White IDUs in Chicago inject Phenmetrazine (Preludin).

Depressants - Problems associated with "rave" and "club drugs" have dramatically risen in 1999. Gamma-hydroxybutyrate (GHB, a central nervous system depressant) and two of its precursors, gamma butyrolactone (GBL) and 1,4 butanediol (1,4 BDL, also called tetramethylene) have been increasingly involved in poisonings, overdoses, drug rapes, other criminal behaviors, and fatalities in nearly every CEWG city and their surrounding suburban and rural areas. These products, obtainable over the Internet and sometimes still sold in health food stores, are also available at gyms, nightclubs, raves, gay male party venues, on college campuses, or on the street. They are commonly mixed with alcohol, have a short duration of action, and are not easily detectible on routine hospital toxicology screens. GBL is available in commercial products such as Blue Nitro, Renew-Trient, and Revivarent G, while 1,4 butanediol is sold in products such as Enliven, Weight Belt Cleaner, and Revitalize Plus. New esters and analogs continue to appear as Federal and State laws remove the sale of these drugs. The tranquilizer ketamine ("Special K" or "vitamin K"), also common in the club, rave, and party scene, is reported in numerous cities, including Baltimore (where users are predominantly suburban white youth from middle- and upper-socioeconomic backgrounds), Boston (where some white middle-class youth inject it, it is also used as a heroin adulterant, and it may have been involved in some overdose deaths), Minneapolis/St. Paul (where small amounts appear in crime labs), New York (where it is available on the street, it is either snorted or injected, and it is sometimes mistaken for cocaine HCl), Newark, and Phoenix. Clonazepam (Klonopin or Rivotril) and alprazolam (Xanax, or "sticks") use, in various combinations and with alcohol, has recently increased in Boston, where diverted prescription drug seizures have increased sharply after a recent rash of pharmacy break-ins. Those two drugs have replaced flunitrazepam (Rohypnol) among adolescents in Miami; similarly, in parts of Texas, clonazepam continues to replace flunitrazepam, especially in combination with beer. Flunitrazepam continues to be a problem among treatment admissions in Texas, particularly among young Hispanic males along the Mexican border, and it has been involved in numerous poison control calls. Seizures of that drug have increased during the past year in New Orleans, where it remains common among white upper-class high school and college students. It is also widely available in Atlanta, where it arrives via couriers from Mexico or by mail through Florida from South America. Diazepam remains the most readily available and frequently used pharmaceutical depressant in Chicago; in New York, however, it is now second to alprazolam as the leading psychoactive prescription drug. Recent deaths in Seattle have involved concomitant injection of heroin and a depressant, typically diazepam.

Hallucinogens - Despite relatively low numbers in traditional data sources, qualitative data suggest that hallucinogen use is not uncommon among adolescents and young adults. Emergency department mentions generally declined for both lysergic acid diethylamide (LSD) (significantly in Baltimore, New Orleans, and San Francisco) and phencyclidine (PCP) (significantly in seven cities: Denver, Detroit, Miami, Minneapolis/St. Paul, New York, San Francisco, and Washington, DC); however, PCP mentions increased significantly in Dallas and New Orleans. Among arrestees, PCP-positive findings remained generally stable, except for a slight increase in Dallas and, following a decade of marked decline, a marked upturn in Washington, DC. The recent increases in the Dallas PCP indicators may reflect the use of marijuana cigarettes dipped in embalming fluid containing PCP. PCP is often smoked with marijuana, as continues to be reported in Chicago ("wicky stick" or "donk"), New York, and St. Louis. Some medical emergencies in south Florida have involved LSD abused with "rolls" (MDMA and cocaine). In parts of Texas, LSD is sometimes mixed with other drugs such as MDMA, diazepam, and Demenex (a diet pill from Mexico), and it is sometimes sold with methamphetamine. LSD in Dallas is becoming more available in the young adult nightclub scene. In Seattle, LSD and mushrooms turn up frequently at local concerts or raves. Psilocybin mushrooms ("shrooms") and mescaline are common among adolescents and young adults in Boston. In New York, the term "eaters" refers to teenagers and young adults who use locally grown mushrooms, which are sometimes dipped in or treated with PCP, LSD, or methamphetamine. Peyote is readily available in Phoenix.

Other drugs - A substance with mild hallucinogenic effects, called "red rock opium," "red run," and "red stuff," is smoked in Baltimore in combination with marijuana. It contains dracorhodin, a compound found in the plant Daemonorops draco ("dragon's blood"), used in varnishes and stains, as an herbal medicine, and to make incense. Teenagers in south Florida occasionally abuse two local anticholinergic plants, "devil's trumpet" and "angel's trumpet," by various routes (orally or via smoking), for their hallucinogenic properties. The plants' toxic effects have led to at least three medical emergencies. Jimson weed was involved in one recent death and several poison center calls per month in Phoenix. Cough medicines with dextromethorphan (DXM) are commonly abused by teens in Boston and Minneapolis/St. Paul ("robo tripping"). "Huffing" of toluene and other solvents continues among youth in Philadelphia. Three of four recent inhalant deaths in Phoenix involved toluene. Inhalant deaths also continue to be reported in Texas. Sildenafil citrate (Viagra) is reportedly used as a recreational drug in Boston. Needle exchange personnel in areas surrounding Boston report steroid injection among young male body builders. In Atlanta, law enforcement sources note the potential for abuse of the anabolic steroid clenbuterol (Spiropent) by weight lifters.

(1) Mortality figures are for 1998 versus 1999 projections (based on first-half-year 1999 data) and were available in six reporting areas.

(2) Emergency department mentions are for 20 CEWG cities in the Drug Abuse Warning Network (DAWN) of SAMHSA's Office of Applied Studies; comparisons are for 1997 versus 1998 estimates, except for age group comparisons, which are for 1996 versus 1998; changes are noted only when statistically significant at pÐ0.05.

(3) Treatment admission figures are primary drug of abuse as a percentage of total admissions; total admissions exclude alcohol-only but include alcohol-in-combination. Comparisons generally are for first-half-1998 versus first-half-1999 data.

(4) Arrestee urinalysis data are for the 18 CEWG cities in the National Institute of Justice's Arrestee Drug Abuse Monitoring (ADAM) program; comparisons are for 1998 versus first-half-1999; first-half-1999 data are preliminary; changes are noted only when they are _5 percentage points.

(5) Heroin price and purity information are for 19 CEWG cities in the Drug Enforcement Administration (DEA) Domestic Monitor Program (DMP); comparisons are for 1998 versus first-half-1998.

Tobacco Smoking and Other Suspected Antecedents of Nonmedical Psychostimulant Use in the United States, 1995

This study investigates the extent to which tobacco smoking is associated with the nonmedical use of psychostimulants and the temporal order of the age of first use for tobacco and psychostimulants within a nationally representative sample of United States household residents. At the same time, alcohol use and other suspected determinants of psychostimulant use are investigated and held constant, using multiple regression models. Data were taken from public use files of the 1995 National Household Survey on Drug Abuse. Conditional logistic regression analyses were performed to derive estimated relative odds of using stimulants for tobacco smokers versus nonsmokers, holding constant other potentially distorting influences. The study found an independent association between tobacco smoking and nonmedical use of stimulant drugs, with and without adjustment for suspected confounding variables. Additional variables identified as being associated with lifetime stimulant use included lifetime alcohol use, being male, being 18-24 years of age, and not being married. This study provides recent evidence on tobacco smoking as one of the potentially malleable risk factors for the nonmedical use of stimulant drugs. Wu, L.T. and Anthony, J.C. Tobacco Smoking and Other Suspected Antecedents of Nonmedical Psychostimulant Use in the United States, 1995. Substance Use & Misuse, 34(9), pp. 1243-1259, 1999.

Tobacco Smoking and Other Suspected Antecedents of Nonmedical Psychostimulant Use in the United States, 1995

This study investigates the extent to which tobacco smoking is associated with the nonmedical use of psychostimulants and the temporal order of the age of first use for tobacco and psychostimulants within a nationally representative sample of United States household residents. At the same time, alcohol use and other suspected determinants of psychostimulant use are investigated and held constant, using multiple regression models. Data were taken from public use files of the 1995 National Household Survey on Drug Abuse. Conditional logistic regression analyses were performed to derive estimated relative odds of using stimulants for tobacco smokers versus nonsmokers, holding constant other potentially distorting influences. The study found an independent association between tobacco smoking and nonmedical use of stimulant drugs, with and without adjustment for suspected confounding variables. Additional variables identified as being associated with lifetime stimulant use included lifetime alcohol use, being male, being 18-24 years of age, and not being married. This study provides recent evidence on tobacco smoking as one of the potentially malleable risk factors for the nonmedical use of stimulant drugs. Wu, L.T. and Anthony, J.C. Tobacco Smoking and Other Suspected Antecedents of Nonmedical Psychostimulant Use in the United States, 1995. Substance Use & Misuse, 34(9), pp. 1243-1259, 1999.

Childhood Peer Rejection and Aggression Predicting Delinquency in Adolescence

In this study sociometric surveys were completed at third grade for a predominantly low-socioeconomic status, urban sample of African American boys and girls, and youth reports of delinquency were gathered at grades 6, 8, and 10. Results showed that patterns of association between childhood peer rejection and aggression and delinquency severity varied by gender. For boys, the additive effect of childhood peer rejection and aggression was a strong predictor of more serious delinquency, whereas for girls only aggression predicted more serious delinquency. For boys, the combination of peer rejection and aggression was associated with felony assaults, and aggression was associated with a wide variety of offenses during adolescence, whereas for girls only peer rejection predicted involvement in minor assault. Results of the study were discussed in terms of the early starter pathway of antisocial behavior as it relates to peer rejection and aggression for boys, differing predictive patterns for girls, and implications for intervention with children with emotional and behavioral disorders. Miller-Johnson, S., Coie, J.D., Maumary-Gremaud, A., Lochman, J., and Terry, R. Relationship Between Childhood Peer Rejection and Aggression and Adolescent Delinquency Severity and Type Among African American Youth. Journal of Emotional and Behavioral Disorders, 7 (3), pp. 137-146, 1999.

Dynamics of Alcohol and Marijuana Initiation

The Seattle Social Development Project has followed the initiation of alcohol and marijuana prospectively in 808 subjects beginning in fifth grade (10 1/2 years old) and continuing through age 18. A large portion of the participants were from low-income households; half of the subjects participated in the school free-lunch program. The sample was gender balanced and the ethnic composition was 46% Caucasian, 24% African American, 21% Asian American, and 3% from other ethnic groups. The social development model provided the framework for examining etiology, and this analysis focused on individual, family, and peer constructs. At age 10 1/2, 25% of the sample had tried alcohol and 3% had tried marijuana. Alcohol initiation rose relatively quickly to about age 13, by which time the cumulative initiation rate was 64%. From age 13 to 18 the rate of initiation slowed. In contrast, marijuana initiation remained relatively flat through age 13, and then the rate of initiation increased over the next 5 years until by age 18, 50% of the sample had initiated marijuana use. Asian American ethnicity reduced the likelihood of alcohol use, as did strong parental norms about teen alcohol use, while alcohol use by peers and associates increased the likelihood of initiation. For marijuana, African Americans and Native Americans were more likely to initiate use and Asian Americans were less likely to initiate use than Caucasians. Males were more likely to initiate use, as were those who had previously initiated alcohol use. Parents' proactive family management inhibited initiation as did teens' own norms against marijuana use, but marijuana use by acquaintances and siblings was a strong predictor of initiation. This study suggests that prevention efforts should span the entire adolescent period, with alcohol prevention efforts directed toward preteen years and marijuana prevention efforts focused on later teen years. Prevention efforts should encourage clear family standards and proactive management as well as address the influence of peers, siblings, and other acquaintances who use drugs and alcohol. Kosterman, R., Hawkins, J.D., Guo, J., Catalano R.F., and Abbott, R.D. The Dynamics of Alcohol and Marijuana Initiation: Patterns and Predictors of First Use in Adolescence. American Journal of Public Health, 90, pp. 360-366, 2000.

Parent-Child Conversations About Tobacco Use

In this study parents engaged their 6th- and 8th-grade daughters in a conversation about tobacco, using a pamphlet designed to encourage effective family communication about tobacco. Results indicated that parent-daughter conversations about tobacco use were successfully carried out in a nonaversive manner. The conversations were perceived to have gone well, with very little conflict reported. The daughters reported that the parental advice was helpful and they did not resist receiving such advice. The pamphlet topics most frequently discussed included: consequences of smoking as experienced by friends and relatives, difficulty of quitting, promotional tactics of tobacco companies, making rules about tobacco use, and deciding on the consequences of rules adherence or violation. Ary, D.V., James, L., and Biglan, A. Parent-Daughter Discussions to Discourage Tobacco Use: Feasibility and Content. Adolescence, 34 (134), pp. 275-282, 1999.

A Social Stress Model for Substance Abuse in Immigrant Hispanic Women

The authors used cross-sectional interview-administered surveys of 60 low-income predominantly Mexican-American women to examine the independent variables of stress, social support and influences, personal competencies and community resource utilization patterns in relation to the outcome variable of alcohol and drug use (alcohol, cigarettes, marijuana, cocaine and opiates). Their findings suggested that the levels of drug use in this study sample were lower than in the general USA population regardless of pregnancy status. Results of bivariate correlations indicated that women with higher drug use indices had more lenient attitudes regarding drug use and were more likely to have family and friends that used alcohol and drugs. Women who used alcohol themselves and whose partners used alcohol and drugs reported significantly higher levels of stress, weaker social support and lower levels of self-esteem. Lindenberg, C.S., Strickland, O., Solorzano, R., Galvis, C., Dreher, M., and Darrow, V.C. Correlates of Alcohol and Drug use Among Low-Income Hispanic Immigrant Childbearing Women Living in the USA. International Journal of Nursing Studies, 36 (1), pp. 3-11, 1999.

Psychosocial Predictors of Current Drug Use, Drug Problems, and Physical Drug Dependence in Homeless Women

Risk and protective factors associated with three qualitatively different drug use constructs describing a continuum of drug use were studied among a sample of 1,179 homeless women. Relationships among positive and negative sources of social support, positive and negative coping strategies, depression, and the drug constructs of current drug use, drug problems, and physical drug dependence were assessed using structural equation models with latent variables. Current drug use was predicted by more negative social support (from drug-using family/friends), depression, and less positive coping. Drug problems were predicted by more negative coping, depression, and less positive coping. Physical drug dependence was predicted by more negative social support and depression and less positive social support. Results highlighted the importance of investigating both the positive and negative dimensions of psychosocial functioning, while suggesting that empowering homeless women and offering tangible resources for coping with the stress of being homeless may be beneficial to them. Galaif, E.R., Nyamathi, A.M., and Stein, J.A. Psychosocial Predictors of Current Drug Use, Drug Problems, and Physical Drug Dependence in Homeless Women. Addictive Behaviors, 24(6), pp. 801-814, 1999.

Parentification and its Impact on Adolescent Children of Parents with AIDS

Parentification refers to children or adolescents assuming adult roles before they are emotionally or developmentally ready to manage those roles successfully. An assessment of the predictors and outcomes of parentification was made among adolescent children of Parents with AIDS (PWAs) in two phases. In Phase 1, relationships among parental AIDS-related illness, parent drug use, parent and adolescent demographics, and parentification indicators (parental, spousal, or adult role-taking) were assessed among 183 adolescent-parent pairs (adolescents: 11 to 18 years, M = 14.8 years, 54 percent female; parents: 80 percent female). Adult role-taking was associated with maternal PWAs, female adolescents, and greater parent drug use. Greater parental AIDS-related illness predicted more spousal and parental role-taking. Parent drug use predicted more parental role-taking. In Phase 2, the impact of parentification on later adolescent psychological adjustment was examined (N = 152 adolescents). Adult role-taking predicted more internalized emotional distress; parental role-taking predicted externalized problem behaviors, sexual behavior, alcohol and marijuana use, and conduct problems. Given these dysfunctional outcomes, interventions to mitigate parentification among children of PWAs are discussed. Stein, J.A., Riedel, M., Rotheram-Borus, M.J. Parentification and Its Impact on Adolescent Children of Parents with AIDS. Family Process, 38(2), pp. 193-208, 1999.

Prevention of Post-Rape Psychopathology

The authors developed an acute time-frame hospital-based video intervention to minimize anxiety during forensic rape exams, and prevent post-rape posttraumatic stress disorder (PTSD), panic, and anxiety. Results of preliminary data indicated that psychological distress at the time of the exam was strongly related to PTSD symptomatology 6 weeks post-rape, and the video intervention successfully reduced distress during forensic exams. Resnick, H., Acierno, R., Holmes, M., Kilpatrick, D.G., and Jager, N. Prevention of Post-Rape Psychopathology: Preliminary Findings of a Controlled Acute Rape Treatment Study. Journal of Anxiety Disorders, 13 (4), pp. 359-370, 1999.

Limited Prosocial Information Exchange And Substance Use

This study assessed attitudes, drug use, and mental health status in pregnant, inner-city residents. Structured interviews revealed that the 38 substance users were more likely to report favorable attitudes toward drugs and polysubstance use, disengagement coping, depressive symptoms, negative affect, and antisocial behavior than were 45 nonusers. During videotaped interviews, trained observers coded less warmth and less prosocial information exchange (e.g., self-disclosure, question asking) among users. Factor analysis of measures of coping and its concomitants yielded a three-factor (prosocial, antisocial, asocial) solution, with substance users more likely to use asocial and antisocial coping. These results suggest that coping has emotional, social, and cognitive elements. This study is the first to demonstrate an association between a substance-using lifestyle and limited prosocial information exchange. Blechman, E.A., Lowell, E.S., Garrett, J. Prosocial Coping and Substance Use During Pregnancy. Addictive Behaviors, 24, pp. 99-109, 1999.

Health Correlates of Sexual Violence in Homeless Women

Researchers at RAND and UCLA documented the association of rape with specific health and substance use/abuse characteristics in a probability sample of 974 homeless women in Los Angeles County. Structured interviews were administered to women aged 15-44 who had spent at least one of the past 30 nights in non-traditional housing. Thirteen percent of the women reported being raped in the past year, and half of these women had been raped at least twice in the past year. Women reporting recent rape fared worse on every physical and mental health measure and were more likely to have a lifetime history of drug abuse or dependence and reports of recent drug use than other homeless women. These data indicate that sexual violence is a major problem confronting homeless women and that all homeless women who present with serious mental, physical, or substance abuse problems should be screened for violent experiences. Wenzel, S.L., Leake, B.D., and Gelberg, L., Health of Homeless women with Recent Experience of Rape. Journal of General Internal Medicine 15(4), 2000.

Women Who Use Crack Cocaine

FAST (Female Atlanta Study, N=149 women), a 4-year ethnographic study to develop a clearer understanding of the lives of female crack cocaine users, is presented in a way that captures how these women arrived at their use; how they survive under their current circumstances, such as the constant threat of HIV/AIDS and violence; how they develop and maintain intimate relationships; how they combine the multiple social roles of mother and drug user; and how--as they share their aspirations and expectations for the future--their stories underscore the effects of poverty, sexism, and racism on their lives. Many of the women recognize their own responsibility for ensuring positive change. Dr. Sterk includes an argument for a harm reduction approach and reminds the reader that the strength and courage of these women may be futile without social policies that are realistic and appropriate for women. Sterk, C. Women Who Use Crack Cocaine. Philadelphia, PA: Temple University Press, pp. 242, 1999.

Services Research

Drug Abuse Treatment Outcome Study of Adolescents: A Comparison of Client Characteristics and Pretreatment Behaviors in Three Treatment Modalities

The sample was 3382 adolescent subjects who presented for treatment from 1993 to 1995 in 37 programs in Pittsburgh, Pennsylvania; Miami, Florida; Minneapolis, Minnesota; Chicago, Illinois; Portland, Maine; and New York City, New York. Interviewers queried subjects about their background, including education and employment; physical and mental health; use of tobacco, alcohol, and other drugs; sexual experiences; legal problems: religious beliefs; and treatment experience. The findings indicate that the long-term residential treatment modality was the least gender balanced and had the most African-American and Hispanic clients. This modality was also distinguished by the proportion of clients who were referred to treatment by the juvenile or criminal justice system. Compared with other modalities, short-term inpatient clients were more likely to be female and white and to report more indicators of psychiatric impairment. Outpatient clients were slightly younger than clients in the other modalities, had higher levels of school attendance at the time of admission to treatment, had the least criminally involved lifestyles, and the lowest rates of (regular daily or weekly) drug use were also the lowest of the three modalities for all drugs assessed, and they had the least drug treatment experience. The findings suggest that there is a need for more community-based adolescent substance abuse treatment programs and more training in substance abuse treatment programs to serve the specific needs of incarcerated youth and youth under criminal justice supervision. Finally, the researchers recommended that programs be designed to address such specialized issues as comorbid substance abuse and psychiatric problems, family dysfunction, physical and sexual abuse, gender and ethnic differences, and academic performance. Rounds-Bryant, J.L., Kristiansen, P.L., and Hubbard, R.L. Am J Drug Alcohol Abuse, 25(4), pp. 573-591, 1999.

Substance Abuse Treatment Cost Offsets Vary with Gender, Age, and Abstinence

Likelihood The cost-offset effect has been promoted as a way for substance abuse treatment to pay for itself by generating reductions in health care utilization in other areas. Clients (n = 5,434) that were abstinent for 24 months following substance abuse treatment had lower post-treatment utilization than clients that had relapsed. An examination of cost offsets revealed a complex interplay between gender, age, and type of utilization (medical versus psychiatric). Cost offsets were larger for women over 40 years old. Zywiak, W.H., Hoffmann, N.G., Stout, R.L., Hagberg, S., Floyd, A.S., and DeHart, S.S. J Health Care Finance, 26(1), pp. 33-39, 1999.

Client Engagement in Drug Treatment

This study investigates why some clients are more likely to engage in treatment. Findings indicate that the predictors of treatment engagement are generally confined to current treatment experiences. For both women and men, the perceived utility of treatment, ancillary services, and the client-counselor relationship are the strongest predictors of client engagement in treatment. Client characteristics are generally not strong predictors of treatment engagement. Concerning the client-counselor relationship, the findings suggest that women may respond more favorably to an empathic counseling style, whereas men may respond to a more utilitarian style. The findings contradict popular stereotypes about the treatment-receptive client, identify possible directions for treatment improvement, and highlight the need for more research examining the treatment experience of the client. Fiorentine, R., Nakashima, J., and Anglin, M.D. Journal of Substance Abuse Treatment, 17(3), pp. 199-206, 1999.

Drug Treatment Effectiveness and Client-Counselor Empathy. Exploring the Effects of Gender and Ethnic Congruency

This study examined the effects of gender and ethnic congruency between patients and counselors on perceived counselor empathy, client engagement in treatment, and abstinence during and after outpatient drug treatment. The findings indicate that client-counselor gender and ethnic congruence were significantly associated with higher levels of perceived counselor empathy for all gender, ethnic, and age groups. However, client-counselor gender and ethnic congruence were not consistently associated with higher levels of treatment engagement and abstinence for all gender, ethnic, and age groups. The findings support a recommendation of paying closer attention to matching clients to counselors. This may be especially important for women, Latinos, and clients 35 years or older. With some female patients it may also be important to match with respect to ethnicity. Also with Latino clients, routinely matching a client to an empathic counselor regardless of gender or ethnicity of the counselor would lead to more favorable treatment outcomes than matching clients solely to gender and ethnically-congruent counselors. Fiorentine, R., Hillhouse, M.P. Journal of Drug Issues, 29(1), pp. 59-74, 1999.

Biopsychosocial Characteristics and Treatment Outcomes of Pregnant Cocaine-dependent Women in Residential and Outpatient Substance Abuse Treatment

This study compared treatment outcomes of pregnant cocaine-dependent women and their infants enrolled in residential (N=32) and outpatient (N=32) treatments. No significant differences between treatment programs were found in retention or infant birth outcomes, but abstinence and patterns of attrition showed differences favoring residential treatment. Comfort, M., Kaltenbach, K.A. J. Psychoactive Drugs, 31(3), pp. 279-289, 1999.

Crack-Cocaine Users as Victims of Physical Attack

A retrospective and prospective natural history design was used to study correlates of physical attack among 440 not-in-treatment crack-cocaine users in Dayton, Ohio. Physical attack was found to be widespread among these crack cocaine users. Between baseline and 12-month follow-up, the odds of men being attacked were significantly less than those for women. The findings did not vary by ethnicity. Injuries often resulted in the need for medical care. These findings point to the need for accessible and effective drug abuse treatment to diminish harm to this population. Siegal, H.A., Falck, R.S., Wang, J., and Carlson, R. J National Medical Association, 92, pp. 76-82, 2000.

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