Drug Abuse Treatment

Research Findings from May, 200 Director's Report

This section lists selected summaries from NIDA funded research projects that investigate the child and adolescent drug abuse treatment. The summaries provided were selected from recent issues of the Director's Report to the National Advisory Council on Drug Abuse. For a more comprehensive listing of NIDA funded projects see the Director's Report.

The Association of Current Stimulant Use with Demographic, Substance Use, Violence-related, Social and Intrapersonal Variables Among High Risk Youth

This article reports the association of current stimulant use with demographic, other substance use, violence-related, social and intrapersonal variables among a large sample of high risk adolescents. A total of 21.4% of the sample reported using stimulants in the last 30 days. In a final, multivariable model, nonredundant concurrent predictors of current stimulant use were reports that friends use stimulants, reports that stimulants were likely to be used again in the next 12 months, use of alcohol, hallucinogens, or cocaine in the last 30 days, use of alcohol or other drugs to feel more safe, and reports of depression in the last week. Being above the median on none to all seven of these correlates predicted from 0% to 85% of those who were above the median on current stimulant use. One may speculate that programming for these stimulant-using youth should include treatment of multiple substances, depression, and correction of social-cognitive misperceptions. Sussman, S., Dent, C.W., and Stacy, A.W. The Association of Current Stimulant Use with Demographic, Substance Use, Violence-related, Social and Intrapersonal Variables Among High Risk Youth. J Addictive Behavior, 24(6), pp. 741-748, 1999.

Survival Sex Among Runaway and Homeless Youth

Investigators at Research Triangle Institute analyzed data on 12-21-year-olds from a nationally representative sample of shelter youths and a multi-city sample of street youths to determine the prevalence and correlates of survival sex. "Survival sex" refers to the selling of sex to meet subsistence needs, including sex to get drugs or money to get drugs. Results indicated that approximately 28 percent of street youths and 10 percent of shelter youths reported having participated in survival sex, which was associated with age, days away from home, victimization, criminal behaviors, substance use, suicide attempts, sexually transmitted disease, and pregnancy. These findings highlight the need to develop services that provide alternatives to the sex trade as a means of meeting economic needs for runaway and homeless youth. It was concluded that intensive and ongoing services are needed to provide resources and residential assistance for these youth. Green, J.M., Ennett, S.T., and Ringwalt, C.L. Prevalence and Correlates of Survival Sex Among Runaway and Homeless Youth. American Journal of Public Health, 89, pp. 1406-1409, 1999.

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.

Victims as Victimizers: Physical Aggression by Persons with a History of Childhood Abuse

Substance abuse has been called the dominant characteristic of families involved in child abuse cases, but the frequency with which childhood victims become adult victimizers is uncertain. This study examines whether a history of childhood sexual or physical abuse is associated with becoming a victimizer (i.e., abusing or assaulting others) as an adult. Interview data from 439 intravenous drug users found a history of sexual or physical abuse before 16 years of age was reported by 51% of women and 31% of men. Seventeen percent of the subjects reported being victimizers. Among childhood victims of physical or sexual abuse, 28% victimized others; among those who denied childhood abuse, 10% victimized others. Two thirds of victimizers reported being under the influence while assaulting others. Controlling for gender, having children, education, race, and history of incarceration, childhood abuse was significantly associated with becoming a victimizer (odds ratio, 3.6). This study confirms a high rate of childhood abuse among intravenous drug users suggesting that treatment programs should both assess and program for treating the adult for past abuse and preventing future victimization. Clarke, J., Stein, M.D., Sobota, M., Marisi, M., and Hanna, L. Arch Intern Med, 159(16), pp. 1920-1924, 1999.

New Directions in Alcohol and Drug Treatment under Managed Care

Studies on managed care and substance abuse were reviewed to explore potential effects of the introduction and expansion of managed care on the financing and organization of public and private alcohol and drug abuse treatment systems. Managed care will continue to have major effects on the organization of service delivery, the workforce, and the provision of services, especially in its impact on links between treatment agencies and the medical community, and other health and social service agencies. The impact of a new emphasis on treatment accountability through the mechanisms of outcomes monitoring and performance indicators has yet to be determined. Weisner, C., McCarty, D., Schmidt, L. Am. J. Manag. Care, 5 Spec No, SP 57-69, 1999.