National Institute on Drug Abuse
Director's Report to the National Advisory Council on Drug Abuse
September, 1998
Research Findings
Epidemiology, Etiology and Prevention Research
Community Epidemiology Work Group
In the Past 6 Months
- Heroin indicators have shown increases in many cities, in some cases overshadowing cocaine.
- Marijuana indicators have continued to escalate across the country.
- Cocaine indicators have continued to level or decline, except for some isolated potentially emerging problems (in Miami and Texas).
- Methamphetamine indicators have increased in most western areas, following some declines last year.
- "Club drugs" have continued to proliferate in the drug scene in several areas.
The 44th meeting of the Community Epidemiology Work Group (CEWG) was held in Boston, Massachusetts on June 23-26, 1998.
The CEWG is a network of researchers from 21 U.S. metropolitan areas and selected foreign countries 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. The following are highlights of the meeting:
- Cocaine - While crack cocaine remains the Nation's predominant illicit drug problem, indicator data continue to show leveling off in many urban areas: cocaine-related deaths were down or stable* in 7 of the 8 areas where such information was reported (Philadelphia was the exception); emergency department (ED) mentions increased* in only 3 of the 20 CEWG cities in the Drug Abuse Warning Network (DAWN); the percentage of treatment admissions for primary cocaine problems declined or remained stable* in 14 of the 16 areas where such data were available (Newark and New Orleans had slight increases); cocaine-positive urinalysis percentages declined or remained stable in all 15 CEWG cities in the Arrestee Drug Abuse Monitoring (ADAM) program; and prices and purity remained stable in most areas. Supplies remain abundant in nearly every city. Demographic data continue to show most cocaine users as older, inner-city crack addicts, with two exceptions: in Miami, poison center, school survey, and anecdotal data continue to indicate some adolescents initiating cocaine use in combination with other drugs; and in some Texas communities, white and Hispanic street youth are reportedly using crack as an alternative to poor methamphetamine quality. Cocaine continues to be used in combination with other drugs, such as marijuana in Atlanta, Chicago, Miami, and Philadelphia; heroin in Atlanta, Boston, Philadelphia, St. Louis, and Seattle; and methamphetamine in Denver and parts of Texas. In some areas, such as Boston and Denver, users dissolve crack for injection. Some shifts from crack to cocaine hydrochloride (HCl) are reported: among treatment admissions in Atlanta and Texas; and in street-level sales in New York. Cocaine is reported to be involved in 50 percent of homicides in New Orleans.
- Heroin - Indicators in many cities continue to show increases: heroin-related deaths increased in 6 of the 8 cities where mortality was reported (they remained stable in Honolulu and declined in Seattle); ED mentions increased significantly* in 8 cities; and treatment percentages increased* in 10 of the 16 areas where trend data were available. Heroin now overshadows cocaine in some cities: it ranks first among ED drug mentions in three cities, and it is the primary drug of abuse among treatment admissions in six areas. More than 10 percent of male arrestees tested heroin-positive in six CEWG cities.
Heroin continues to increase among new and young users in a number of cities because of its easy availability, low price, high purity, and favorable reputation compared with crack. Indicator and anecdotal data suggest increases among young adults in Boston, Chicago, Denver, and San Francisco and among both youth and young adults in Baltimore, Miami, Minneapolis/St. Paul, Philadelphia, San Diego, and parts of Texas. The suburbs are increasingly mentioned: in Baltimore, young white professionals, laborers, and high school students from the suburbs are being noted in the inner city buying drugs; in some Texas suburbs, youth and young adults have been involved in overdose deaths; and a recent Chicago study of injecting drug users included a large proportion of suburban residents. Younger heroin users tend to snort the drug. The percentage of snorters among treatment admissions continues to increase in several cities, including Atlanta, Baltimore, Detroit, Minneapolis/St. Paul, Philadelphia, and San Diego. Atlanta ethnographic reports continue to indicate an increasing number of recently initiated snorters shifting to injection; in New York City, by contrast, snorters do not seem to be shifting to injection, except for a population of young immigrants from the former Soviet Union. Smoking remains relatively rare, but it is reported by 7 percent of admissions in both Miami and San Diego. Young adults in Phoenix reportedly use heroin to "come down" from methamphetamine-induced highs. In San Francisco, heroin-marijuana combinations are sold as "canade." In New York City, many crack sellers are switching to heroin sales due to the high profit potential.
*mortality, treatment, and ADAM comparisons are for 1996 versus 1997; DAWN comparisons are for 1995 versus 1996, reliable at p<0.05.
- Marijuana - Marijuana accounted for more than 10 percent of total ED mentions in four cities, and it was the primary drug of abuse among treatment admissions in Denver, Minneapolis, and Seattle. Treatment admissions remained at elevated levels: percentages increased in five cities, remained stable in nine, and decreased in one. Among adult male arrestees, marijuana-positive findings exceeded cocaine-positives in seven ADAM cities. Despite declines in nine cities between 1996 and 1997, marijuana levels in this population were generally higher than in 1995. Marijuana remained readily available in many CEWG areas, although it was expensive and hard to find in San Francisco. Seizures increased in Boston, Detroit, and Hawaii, while marijuana-related arrests increased in New York City and Washington, DC. Qualitative and quantitative data from most CEWG cities indicate widespread marijuana use among youth. For example, among primary marijuana treatment admissions, the average age at first use was 13.9 in Minneapolis and 14 in Denver. In Washington, DC, the number of marijuana treatment admissions in the 12-17 age group increased 70 percent between 1995 and 1997. In each of the seven cities where ADAM tests juvenile males, the percentage of positive urinalyses was much higher for juveniles than for adults. While alcohol remains the most common secondary and tertiary drug among marijuana treatment admissions, other drug combinations continue to be reported. Blunts are combined with cocaine HCl in Atlanta and Philadelphia ("turbo") and with crack in Chicago ("diablito," "primo," or "3750,") and Miami ("geek joint"). Other combinations include phencyclidine (PCP) in Chicago ("wicky stick" or "donk") and Philadelphia ("love boat" or "dust blunt") and embalming fluid in Minneapolis. In Texas, blunts are dipped in embalming fluid laced with PCP ("fry," "amp," or "water-water") or in codeine cough syrup ("candy blunts").
- Stimulants - Indicators of methamphetamine use - mortality, treatment, and arrestee urinalysis-and ethnographic research continue to show increases in the West. After declining in 1996, mortality figures in San Diego, Hawaii, and Phoenix have risen. Similarly, the 1997 ADAM data indicate increases in all the western CEWG cities, returning the rates of arrestees testing positive to 1994-95 levels. Treatment figures show increases in all reporting western cities, except for Seattle, where they have stabilized, and Phoenix, where they have declined since 1994. Methamphetamine remains the most common primary drug among treatment admissions in Hawaii and San Diego. Smoking remains the primary route of administration for methamphetamine in San Diego and for "ice" in Hawaii, and it has become more common in Denver and San Francisco, although injecting still predominates. Inhalation still predominates in Los Angeles. In San Francisco, "speed" use is increasing among blue collar workers, young professionals, and college students. In Denver, where methamphetamine is often used with crack, some former crack users may have crossed over to exclusive methamphetamine use. Elsewhere in the country, methamphetamine appears in indicators in Minneapolis/St. Paul, Philadelphia, and parts of Texas. The number of treatment admissions has increased in Baltimore, Boston, Detroit, New Orleans, and St. Louis. In Missouri, statewide meth-amphetamine admissions began to outnumber heroin admissions in 1996. State police report increased seizures of the drug in and near Boston, and it is associated with the club or rave scenes in Atlanta, Miami, and New York City.
Methylphenidate (Ritalin) abuse is reported, mostly among school-aged adolescents, in Boston, Detroit, Minneapolis/St. Paul, Phoenix, Seattle, Washington, DC, and areas of Texas; in Chicago, it is the drug of choice for some stimulant users or is mixed with heroin as a "speedball." Methylenedioxymethamphetamine (MDMA or "ecstasy") availability is reported in eight CEWG areas, primarily as a club drug at raves and dance parties. Increases are reported in Boston. Ephedrine-based products remain a concern, with products such as "herbal ecstasy" widely available at convenience stores and truck stops in many CEWG areas, including Atlanta, Minneapolis/St. Paul, and Phoenix; in Texas, at least eight deaths have been associated with ephedrine since 1993. Seizures of khat, a flowering evergreen shrub also known as "qat" or "Somali tea," continue in Detroit and Minneapolis/St. Paul. Fenfluramine and phentermine (Fen-Phen) are reportedly brought into Texas via legal prescriptions from Mexico.
- Depressants - Gamma-hydroxy butyrate (GHB), referred to as a "stove-top drug" in Phoenix because of its ease of manufacture, has been involved in poisonings and over-doses in Boston, Detroit, Miami, and New Orleans. It is also part of the club scene in Baltimore, San Francisco, and Texas, and is popular as a synthetic steroid in Atlanta. Another club drug, ketamine ("Special K" or "vitamin K"), was involved in overdose cases in New Orleans. Some ketamine availability was reported in Boston (where police report it is becoming more prevalent), Detroit, Miami (where it was involved in DUI cases along with other drugs), Minneapolis, Seattle, and Washington, DC. Flunitrazepam (Rohypnol) availability and use appears to have decreased substantially in some CEWG areas: Detroit (where hotline inquiries have declined since 1996), Miami (where it has been replaced by GHB combined with alcohol), and Texas (where submissions to the crime laboratory declined 71 percent between 1996 and 1997); however, seizures and anecdotal data in New Orleans indicate that distribution and abuse is increasing. Clonazepam (marketed as Klonopin in the United States and Rivotril in Mexico) is frequently used as a substitute for flunitrazepam in Texas; in Atlanta it is used to enhance the effects of methadone; and police in Boston report it frequently accompanies heroin use. Benzodiazepines such as diazepam are appearing in crack houses in Atlanta and are used by heroin and cocaine abusers in Miami to self-medicate for withdrawal symptoms. Treatment admissions for depressants in Chicago, while remaining small proportionally, have more than doubled recently.
- Hallucinogens - Contrary to declining ED and treatment indicators, ethnographic data indicate increased lysergic acid diethylamide (LSD) use among youth in Atlanta and Boston and increased phencyclidine (PCP) use in Chicago and San Francisco. LSD also remains popular among youth in Detroit, Miami, and Minneapolis. Treatment admissions, however, remain low for all hallucinogens. In Washington, DC, PCP treatment admissions decreased by more than 50 percent between 1995 and 1997 (1.4 percent of all admissions). In addition to LSD and PCP, psilocybin mushrooms were reportedly available in Boston, Minneapolis, and Seattle, while some availability of mescaline was reported in both Baltimore and Boston.
- Viagra - The potency pill sildenafil citrate (Viagra) may be appearing in the club scene. Los Angeles treatment officials describe "Viagra parties" at gay bars and report that three young men have died after combining the drug with "poppers," a recreational nitrate. Researchers are also concerned about two other areas of potential abuse: sale of the drug over the Internet; and a black market for the drug in other countries, such as Japan and the United Kingdom, where the drug is not approved for prescription sale.
Age of First Use: Its Reliability and Predictive Utility
In a study of the early-onset issue, researchers at Rutgers University posed three questions: (1) Is age of first licit use a predictor of differences in alcohol and drug use intensity during the period (age 20) when normative patterns of use reach a peak?, (2) Is age of first licit use a predictor of differences in use intensity in young adulthood (age 30) when most individuals have moderated their use? and (3) How consistent are adolescents in retrospectively recalling age of first use? Subjects (N=839) from the Rutgers Health and Human Development Project provided four waves of longitudinal data spanning the age range from 15 to 31. The vast majority of adolescents exhibited a sequential pattern of drug use initiation consistent with that found in previous studies. Retrospective recall of age of onset revealed a fair degree of relative agreement but a lack of absolute agreement; that is, as adolescents became older, recalled ages on onset exhibited an upward shift approximately equal across most individuals. Age of first licit use as recalled at age 18 did not predict differences in alcohol or drug use intensity at age 20. Age of first illicit use was a fairly strong predictor of drug use at 20 but a weak predictor of alcohol use at that age. Age of first licit use and age of first illicit use did not predict difference in useor use consequences at age 30. Regardless of age of onset, illicit drug use and heavier alcohol use constitute an adolescence-limited phenomenon for most individuals. The findings suggest that intervention efforts need to be aimed not only at delaying the onset of illicit use in adolescence but also at reducing use levels among young adult users by facilitating the maturing out process. Labouvie, E., Bates, M. E., and Pandina, R. J. Age of First Use: Its Reliability and Predictive Utility. Journal of Studies on Alcohol, 58(6), pp. 638-643, 1997.
Repeat Pregnancies Among Adolescent Mothers
Findings from an event history analysis of rapidly repeated pregnancies (i.e., within 18 months) among a sample of 170 adolescents who had experienced a nonmarital birth is presented. Study participants were school-aged adolescents (<18 at enrollment) from lower-to middle-income families who were recruited from social and health service agencies in an urban area of the Northwest. Just over half the sample were persons of color. Respondents were interviewed at five points from pregnancy through 18 months postpartum. The best fitting model included two proximate determinants of pregnancy, contraceptive use and frequency of intercourse, as well as a history of school problems, drug use, fighting, living with parents, length of relationship with boyfriends, best friends experiencing pregnancies, and age at first birth. Gillmore, M., Lewis, S., Lohr, M., Spencer, M., and White, R. Journal of Marriage and the Family, 59, pp. 536-550, 1997.
Gender and Psychotropic Drug Use
Although studies have documented women's greater use of prescribed psychotropic drugs, few have explicitly examined how women and men differ in psychotropic drug use. This study examines gender differences in aggregate psychotropic drug use, as well as use of specific therapeutic categories, and explores how other factors explaining psychotropic drug use vary by gender. Using 1989 National Ambulatory Medical Care Survey (NAMCS) data, logistic regression analysis is used to estimate the probability of psychotropic drug use in aggregate and for four therapeutic categories-anxiolytics, sedative-hypnotics, antidepressants, and antipsychotics. For equations where gender is statistically significant, separate logistic regression equations are estimated to determine the explanatory variables that vary by gender. Results of this study indicated that the probability of receiving any psycho-tropic drug is 55% greater in office visits by women than those 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 any psychotropic drug in office-based care. This gender differential holds only for anxiolytics and antidepressants. In addition, there were significant differences in the predictors of drug use for women and men. Simoni-Wastila.L. Medical Care, 36(1), pp. 88-94. 1998.
Comparative Treatment Effectiveness: Effects of Program Modality and Client Drug Dependence History on Drug Use Reduction This study examined treatment outcome as a function of program modality, clients' lifetime patterns of drug dependence, and their interaction, controlling for current level of drug use at treatment intake. Data were based on almost 3,000 clients who were interviewed at intake and one-year follow-up as part of the national Drug Abuse Treatment Outcome Study (DATOS). Subjects' lifetime patterns of drug dependence were classified into nine groups according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association; 1987) diagnostic criteria and time of onset of drug use career. Outcome measure was the reduction of heroin use or cocaine use. The presence of dependence diagnosis was associated with less improvement when current use level at intake was controlled. Clients dependent on heroin but not currently daily users benefited most from inpatient and residential programs. Methadone programs were also relatively ineffective in reducing cocaine use. Characteristics of the client's drug dependence history, in addition to the current or presenting drug problem, should be assessed to guide treatment planning. The high rate of cocaine dependence among methadone clients, most of whom were dependent on heroin, poses considerable challenge to contemporary opiate substitution treatments. Hser, Y.I., Anglin, M.D., and Fletcher, B. Journal of Substance Abuse Treatment 15(1), pp. 1-11, 1998.
The Impact of Maternal Drinking During and After Pregnancy on the Drinking of Adolescent Offspring
The impact of prenatal maternal drinking on alcohol consumption in adolescent offspring was examined among boys and girls separately. A prospective longitudinal sample of 185 mother-firstborn child dyads was used to examine the impact of maternal self-reported lifetime and current drinking, controlling for potential confounding factors. In this representative general population sample, maternal drinking during pregnancy, particularly continuous moderate to heavy consumption, had a significant positive effect on adolescent daughters' current drinking, but a slight negative effect on sons' lifetime drinking. The sex-specific prenatal effect on current drinking persisted with controls for prenatal maternal cigarette smoking, current maternal drinking, child-rearing practices (i.e. maternal child closeness, monitoring and a rule against drinking) and adolescent's problem behaviors in childhood. Prenatal maternal smoking was also associate with elevated rates of adolescent drinking, particularly current drinking. Of the child-rearing variables, only a rule against drinking decreased adolescent drinking. Thus, selected prenatal factors may constitute risks for alcohol consumption among adolescent daughters. Griesler, P.C., Kandel, D.B. Journal of Studies on Alcohol, 59(3), pp. 292-304, 1998.
Ethnic Identity has Protective Effect on Risks for Drug Use
Five year follow-up data were collected from structured interviews with 555 male and female Puerto Rican adolescents who were originally interviewed in 1990 in New York City. At time of follow-up, the average age of the respondents was 19. The interview data were analyzed to determine the relationship of multiple drug risks, Puerto Rican identity, and drug use. In addition, the risk/protective and protective/protective paradigms for examining interactive effects of ethnic identity and drug risks on drug use were assessed. Each risk and two ethnic variables were related to drug use. Regressions showed that cultural knowledge, being culturally active, group attachment, and identification with Puerto Ricans offset the impact of risks on drug use. Ethnic variables also enhanced the protective effect of other protective factors. The findings substantiate expanding risk-buffering models to include ethnic identity and the protective role of ethnic identity for Puerto Rican Youth. Brook, J.S., Whiteman, M., Balka, et al. Drug Use Among Puerto Ricans: Ethnic Identity as a Protective Factor. Hispanic Journal of Behavioral Sciences, 20(2), pp. 241-254, 1998.
Statistical Methods in Genetic Research on Smoking
A growing body of evidence suggest that genetic factors have an important influence on the onset and course of smoking. Various statistical methods that have been used to test for genetic influences on smoking behavior, with a particular focus on studies of large national twin samples were reviewed. It is shown how many of the hypotheses that have been tests using a genetic model-fitting approach may be reformulated using logistic regression models that are more familiar to epidemiologists. Such an approach is more easily extended to allow for sociocultural, as well as genetic, influences on smoking behavior. Using either approach, data obtained from Scandinavian, Australian, and U.S. adult twins were consistent in indicating that certainly in men, and possibly in women, genetic factors play an important role in predicting which individuals who become cigarette smokers progress to being long-term persistent smokers. Heath, A.C., Madden, P.A.F., and Martin, N.G. Statistical Methods in Medical Research, 7, pp. 165-186, 1998.
Maternal Smoking in Pregnancy, Child Behavior Problems, and Adolescent Smoking
This study used a longitudinal sample of mother-child dyads to examine the role of child behavior problems in explaining the effect of maternal prenatal smoking on adolescent daughter's smoking. Maternal smoking during pregnancy is associated with higher levels of child behavior problems, particularly among girls. Childhood behavior problems increase the likelihood of lifetime smoking among daughters but do not explain the effect of prenatal maternal smoking on their current smoking. Maternal smoking in pregnancy, especially heavy use of a pack or more a day, retains a unique effect on girls' current smoking with controls for current maternal smoking, child behavior problems, and maternal monitoring of the child. The effect of maternal prenatal smoking is suggestive of a biological component, which may have direct or indirect influences on adolescent smoking. The small number of cases in the study calls for the replication of these findings in large samples that would incorporate prospective measures of prenatal nicotine exposure from mother and father and additional biological and psychosocial covariates. Griesler, P.C., Kandel, D.B., Davies, M. Journal of Research on Adolescence, 8(1), pp. 159-185, 1998.
Smoking, Smoking Cessation, and Tooth Loss
Smoking is associated with an increased risk of tooth loss, but it is not known if this risk decreases significantly when individuals quit smoking. The objectives of this study were to describe the rate of tooth loss by smoking status in two populations of medically healthy men and women. Among the men, rates of tooth loss and edentulism in relation to smoking cessation were also evaluated. The subjects were drawn from a group of 584 women (aged 40 to 70) recruited from the Boston, MA, area and a separate population of 1231 male veterans (aged 21 to 75) who participated in the VA Dental Longitudinal Study in Boston. In cross-sectional baseline analyses, current cigarette smokers of either had significantly more missing teeth than never-smokers or former smokers. Former smokers and pipe or cigar smokers tended to have an intermediate number of missing teeth. Current male smokers had more teeth with calculus, but the differences in plaque, tooth mobility, probing depth >2 mm, filled and decayed teeth, and bleeding on probing by smoking history were not significant. Prospective observations of 248 women (mean follow-up time=6.2 years) and 977 men (mean=18.7 years) indicated that individuals who continued to smoke cigarettes had 24-fold (men) to 3.5 fold risk (women) of tooth loss compared with non-smokers. The rates of tooth loss in men were significantly reduced after they quit smoking cigarettes but remained higher than those in non-smokers. Men who smoked cigarettes had a 4.5-fold increase in risk of edentulism, and this risk also decreased upon smoking cessation. These findings indicate that the risk of tooth loss is greater among cigarette smokers than among non-smokers. Smoking cessation significantly benefits an individual's likelihood of tooth retention, but it may take decades for the individual to return to the rate of tooth loss observed in non-smokers. Krall, E.A., Dawson-Hughes, B., Garvey, A.J., and Garcia, R.I. Journal of Dental Research, 76(10), 1997.
Gender Difference In The Outcome Of An Unaided Smoking Cessation Attempt
There is conflicting evidence concerning gender differences in success at quitting smoking. Information is especially lacking regarding gender differences among unaided quitters who make up the vast majority of those attempting to quit. One hundred thirty-five smokers who made an unaided attempt at quitting were interviewed before quitting and were followed for 1 year after cessation. Relapse rates were extremely high both for men and women with 62% of participants returning to regular smoking within 15 days after cessation. Women and men were equally likely to maintain short-term abstinence (through 15 days), but women were more than three times as likely to relapse subsequently. Nine percent of men, but no women, had biochemically verified sustained abstinence throughout the 1-year follow-up-period. For both men and women, any smoking after the quit attempt inevitably led to full-blown relapse. Most participants resumed regular smoking within 24 hours after the first episode of smoking. Gender differences were observed for several variables related to smoking history, demographics, social support, perceived stress, and motivational factors, but these differences did not explain the increased risk of relapse for women. Results clearly indicate that women are less likely than men to maintain long-term smoking abstinence following an unaided quit attempt, but reasons for this gender difference need further exploration. Ward, K., Klesges, R., Zbikowski, S., Bliss, R., and Garvey A. Addicted Behaviors, 22(4), pp. 521-533, 1997.
Hepatitis C Virus Transmission Dynamics in IDUs Challenges Prevention Efforts
Holly Hagan, Ph.D., reviewed published studies on the seroepidemiology of hepatitis C (HCV) in drug injectors in relation to HIV and hepatitis B (HBV) epidemiology, and related HBV, HIV, and HCV infections to a model of infectious disease transmission dynamics. She describes the unique features of HCV that define the epidemiology and natural history of the infection, and shows how HCV may be an important biological indicator of chains of viral transmission in an injection drug-user population. HCV presents several challenges to the development of prevention programs for IDUs. The infection in up to 80% of cases is persistent, and viremic individuals may transmit infection to others. With 65-90% of IDUs anti-HCV positive, a large reservoir of infection exists in most drug injector populations. Studying the genetic variability of HCV infections could permit researchers to reconstruct chains of viral transmission in IDUs. However, the relationship of HCV to HIV epidemiology remains unclear and may depend on whether the proportions of infectious persons in the population are similar for both viruses. Hagan, H. Hepatitis C Virus Transmission Dynamics in Injection Drug Users. Substance Abuse and Misuse, 33(5), pp. 1197-1212, 1998.
Patterns of Noninjecting Heroin Use and Risks for Transitions to Use by Injection
In a recent article, researchers review ethnographic data they have collected and the published literature in describing possible factors linked to an increased prevalence in noninjecting heroin use. Heroin use by noninjecting routes of administration has become more widespread worldwide, to the extent that its prevalence now equals or exceeds heroin use by injection in some cities (e.g., Rotterdam in The Netherlands and London in the United Kingdom). Methods of noninjected heroin use include oral ingestion, intranasal use by sniffing the powdered form, smoking (either by itself or in a mixture with other drugs or substances, such as marijuana or tobacco), and inhaling the vapor after heating the drug on aluminum foil (colloquially known as "chasing the dragon"). Several reasons are discussed to explain why noninjecting heroin use has increased: the supply of high purity heroin is abundant (the worldwide production of opium has nearly doubled since the late 1980s and the purity of street-level heroin is at an all-time high); the wholesale price has fallen, as has the retail price; heroin distribution has become much more efficient, sophisticated, and "high tech" (e.g., use of electronic beepers with special codes, home delivery, more nonstreet sales); and users perceive noninjecting use as protective against HIV (in addition to reporting a fear of AIDS from needles, and anxiety about the use of needles themselves, noninjectors report being socially and morally different from highly stigmatized injectors or "dope fiends"). Another factor is that many heroin noninjectors use crack cocaine and report mixing crack with heroin as a way to modulate crack's stimulant effect and soften its "crash." The risks for transitioning from noninjecting heroin use to heroin injection are complex, and are characterized as falling along a continuum. Some people report using it strictly on social occasions, and not between, to stabilize their use and prevent themselves from developing a dependency. But of 202 new injectors in New York City between 1991 and 1993, 53% had sniffed heroin in the 30 days before their first injection, and 83% reported heroin as the drug they first injected. Factors which appear to predict transitions to injection use are the influence of social network members and those with whom they engage in drug and sexual behaviors, sociodemographic status (especially gender, race/ethnicity), and the extent of social integration within (or marginalized from) social institutions. Neaigus, A., Atillasoy, A., Friedman, S.R., et al. Trends in the Noninjected Use of Heroin and Factors Associated with the Transition to Injecting. In: J. Inciardi and L. Harrison (Eds.). Heroin in the Age of Crack-Cocaine. Thousand Oaks, CA: SAGE Publications, Inc.; Volume 6 of the drugs, health, and social policy series: pp. 131-159, 1998.
Current and Emerging Heroin Use Trends in the Age of Crack-Cocaine
A state-of-the-art volume has just been released which presents articles by experts in the field on current developments and emerging trends, in addition to a historical overview, of heroin use in the United States. The volume fills a void in the current literature on what's known about the "new" heroin users today, and provides an update on the status of aging heroin addicted populations who initiated use of the drug prior to the "age of cocaine." Having moved from the stereotypical "shooting galleries" of back alleys in inner city neighborhoods, heroin addiction continues to rise in mainstream culture and new ways of administration have come into use. A relative abundance of purer Southeast Asian heroin, the rapid rise in popularity of crack-cocaine, treatment controversies, and the realized role that injection drug use plays in the transmission of HIV all suggest increased dimensions of the heroin problem and in their saliency for the 1990s and beyond. Inciardi, J.A. and Harrison, L.D. (Eds.). Heroin in the Age of Crack-Cocaine. Thousand Oaks, CA: SAGE Publications, Inc.; Volume 6 of the drugs, health, and social policy series, 1998.
Heavy Caffeine Use and the Beginning of the Substance Use Onset Process: An Illustration of Latent Transition Analysis
This chapter has two objectives, the introduction of a relatively new methodology, latent transition analysis (LTA) and the demonstration of its usefulness in alcohol prevention research. LTA is an extension of latent class theory that allows the user to estimate and test models of stage-sequential development. Researchers may be more accustomed to thinking in terms of strictly quantitative development, in which change can be characterized by increases and decreases in a particular variable, such as test scores, self-esteem, or amount of alcohol consumed per week. Stage-sequential development is distinguished from quantitative development by the involvement of qualitatively different stages. Individuals develop by passing through these stages. In this study, LTA was used to investigate whether heavy use of caffeine would be a predictor in the early part of the substance use onset process. Heavy use of caffeine was defined in several different ways, in terms of both coffee and cola soft drinks. By all the definitions of heavy caffeine use, those in the high-caffeine-risk latent class were more likely to have initiated the substance use onset process by seventh grade, and those who had not initiated by seventh grade were more likely to do so by eighth grade. The increased risk of onset related to caffeine use was greater for coffee than for cola. For coffee, the probability of onset was greater for the more extreme definitions of caffeine risk. The level of caffeine consumption required to elevate risk was surprisingly low. Increased risk was found for as little caffeine consumption as 6 cups of coffee in one's lifetime and 6 cola drinks in the past week. The results replicated well and consistently across two cross-validation subsamples. In K. Bryant, M. Windle, and S.West
(Eds.), The Science of Prevention: Methodological Advances from Alcohol and Substance Abuse Research (pp. 79-99). Washington, DC: American Psychological Association, 1998.
Problem and Conventional Behaviors Among American Indian Adolescents
Investigators from the National Center for American Indian and Alaska Native Mental Health Research at the University of Colorado Health Sciences Center report two related factor analytic studies that take Problem-Behavior Theory as a starting point. They examined the latent structure of problem and positive behaviors in a sample of 1894 American Indian adolescents (n=1894 in the first study and 2250 in the second study) and found a 2-factor 2nd-order structure in which problem behaviors (alcohol use, drug use, antisocial behavior, risky sexual behavior) and positive behaviors (school success, cultural activities, competencies, community-mindedness) represented two relatively uncorrelated aspects of behavior. The positive behaviors construct contributed significant incremental construct validity in the prediction of psychosocial outcomes (e.g., depression, competencies), relative to the problem behavior construct alone. Factor structures differed across gender primarily for alcohol use and school success. The second-order alcohol use factor was more closely related to "problem drinking" for girls, but for boys it was more closely related to "negative consequences following drinking". "Doing schoolwork carefully" was more closely related to school success for girls than for boys, reflecting others' reports that girls tend to attribute their successes in school to their own hard work whereas boys tend to attribute their school successes to greater intellectual ability. Across four sampled communities, the structures differed only slightly, suggesting commonalities on such dimensions as positive behaviors, possibly from consistent messages adolescents receive about appropriate ways to act. Results highlight the need to include a focus on positive behaviors in prevention/promotion activities, and community members need to understand not only how to circumvent the processes that result in maladaptive outcomes but also how to promote the development of successful adolescents. Mitchell, C.M., and Beals, J. The Structure of Problem and Positive Behavior Among American Indian Adolescents: Gender and Community Differences. American Journal of Community Psychology, 25, pp. 257-288, 1997; and Mitchell, C.M. and O'Nell, T.D. Problem and Conventional Behaviors Among American Indian Adolescents: Structure and Validity. Journal of Research on Adolescence, 8, pp. 97-122, 1997.
Affectivity and Impulsivity: Temperament Risk for Adolescent Alcohol Involvement
Researchers at Arizona State University studied the joint effects of impulsivity, positive affectivity, and negative affectivity on adolescent alcohol use and alcohol-related impairment. Participants were 427 adolescents (aged 12-18, mean age=14.6) from the third wave of an ongoing study of adolescent children of alcoholics and demographically matched controls. Data were gathered using in-person interviews with adolescents and their parents. Results showed that impulsivity moderated the effects of positive affectivity on both alcohol use and alcohol-related impairment. Impulsive adolescents who were also characterized by low levels of positive affectivity showed higher alcohol involvement and more alcohol-related impairment than did either impulsive adolescents with high levels of positive affectivity or non-impulsive adolescents. These results suggest that multiple dimensions of temperament (and their interaction) must be taken into account in trying to predict alcohol involvement, and that positive affectivity is important above and beyond negative affectivity. Practically, the results suggest that positive affectivity is a potentially important target for intervention programs. Although intervention programs often focus on teaching adolescents how to cope with negative affect, less attention has been paid to interventions that increase positive affect, and strategies that target positive affect may be helpful additions to prevention programs. Colder, C.R., and Chassin, L. Psychology of Addictive Behaviors, 11, pp. 83-97, 1997.
Effects of Stress on Delinquency and Drug Use Similar for Males and Females
In a test of Agnew's revised individual-level strain theory, which postulates a mediating role for negative relationships and resulting negative affect (primarily anger) that propels adolescents toward deviant adaptations, investigators at the National Opinion Research Council (NORC) assessed the effects of stressful life events on male and female adolescents' subsequent delinquent and drug-using behaviors. They hypothesized the relationships would vary by sex because of previously observed differences in males' and females' reactions to stress. They used structual equation modeling with two waves of data from 11-to 17-year old adolescents in the High Risk Youth Study (N = 803), a sample that includes heavy representation of offsprings of parents with psychological disorders. Modeling variables reflecting stressful life events, school and family attachment, grades, and indicators of delinquency and substance use, they found that stressful life events have a similar, short-term impact on delinquency and drug use among females and males and that changes in life events were associated with greater delinquency and drug use. The authors presented several possible reasons for the failure to find a sex difference, including the possibility that stress associated with parental psychological disorders may affect males and females similarly. Hoffman, J.P., and Su, S.S. The Conditional Effects of Stress on Delinquency and Drug Use: A Strain Theory Assessment of Sex Differences. Journal of Research in Crime and Delinquency, 34 (1), pp. 46-78, 1997.
Developmental Variations in Factors Related to Initial and Increased Levels of Adolescent Drug Involvement
The impact of maternal and adolescent factors on initial and increased levels of drug use by adolescents was examined in two groups of adolescents: 210 younger adolescents (ages 12-14 at initial assessment) and 199 older adolescents (ages 15-18). The adolescents and their mothers were interviewed at 2 points in time, 3 years apart. The results indicated that adolescent unconventionality is a crucial determinant for both initial and increased levels of drug use for both age groups, but intrapsychic distress is more important for the younger adolescent's initial use. Lack of maternal attachment and poor control techniques were associated with initial levels of drug use for both groups. However, the mother-child relationship and models of the mother's unconventionality had a greater impact on the older than on the younger group's increased involvement. Interactive results suggest that adolescents from both age groups who are well adjusted can offset the potential risks of maternal models of drug use. Brook J.S., Cohen P., and Jaeger, L. The Journal of Genetic Psychology, 159(2), pp. 179-197, 1998.
Drug Use and Parenting in Adolescence This project at the University of Washington conducted longitudinal analyses of 241 adolescent mothers' use of 3 substances -- marijuana, alcohol and tobacco -- from the time of pregnancy through 1 year post-partum. Variables measured for each substance included use, verified with urinalysis; intentions to use; attitudes and perceived norms about using; and specific outcome and normative expectations about use of each substance. Substance use increased dramatically from pregnancy to 6 months post-partum, leveling off between 6 and 12 months post-partum. Consistent with the Theory of Reasoned Action model, as substance use increased after pregnancy, so did intentions to use, favorable attitudes toward use, perceived norms regarding use, and beliefs favorable to use. Changes in specific outcome and normative beliefs were observed and that, over time, the young mothers saw bad outcomes of using substances (such as negative effects on their health) as less likely, and positive outcomes (such as helping them to forget their problems) as more likely. They also perceived less disapproval from their families, friends, and doctors after their babies were born. These findings suggest that young mothers are heeding warnings about the danger to their babies of using substances during pregnancy, but are less convinced that substance use has negative effects on parenting or on their own health. The contrast between the abundance of messages warning about substance use during pregnancy and the very few messages aimed at reduce substance use among parents may unwittingly reinforce a notion that substance use is not very harmful when one is not pregnant. A promising intervention approach for young mothers may be to capitalize on their concerns for their babies' health. Morrison, D.M., Spencer, M.S., and Gillmore, M.R. J. Res. Adoles., 8, pp. 69-95, 1998.
Sibling Antisocial Behavior, Substance Use, and Intra-family Conflict
Conventional covariance structure analysis, such as factor analysis, is often applied to data obtained in a hierarchical fashion, such as siblings observed within families. Multivariate modeling of such data, however, is most frequently done as if the data were obtained as a simple random sample from a single population. An alternative specification is presented that explicitly models the within-level and between-level covariance matrices in family antisocial behavior. Data from the National Youth Survey included 1076 adolescents from 450 households. The age of participants ranged from 11 to 17 years with a mean age of 13.9 years. Antisocial behavior included theft, aggression, vandalism, and minor violations. Predictors of family antisocial behavior included life transitions, parent marital status, and whether the family was receiving public assistance. Results showed homogeneity in antisocial behavior within sibling clusters and heterogeneity across families. Between-family variation in antisocial behavior represented approximately 31% of the total variation in antisocial behavior scores. Families experiencing greater numbers of life transitions had higher family levels of antisocial behavior. Findings highlight potential pitfalls of ignoring issues of dependence and demonstrate the importance of examining family-level clustering of specific problem behaviors, such as antisocial behavior.
Another paper on sibling behavior demonstrates a more appropriate specification which explicitly models the within-level and between-level covariance matrices of sibling substance use and intra family conflict. Participants were 267 target adolescents (mean age=13.11 years) and 318 siblings (mean age=15.03 years). The level of homogeneity within sibling clusters, and heterogeneity among families, was sufficient to conduct a multilevel covariance structure analysis (MCA). Parent and family-level variables consisting of marital status, socioeconomic status, marital discord, parent use and modeling of substances, were used to explain heterogeneity across families. Marital discord predicted intra family conflict, and single-parent families and families with higher levels of parent displayed substance use had higher levels of sibling substance use. Duncan, T.E., Alpert, A., and Duncan, S.C. Multilevel Covariance Structure Analysis of Sibling Antisocial Behavior. Structural Equation Modeling, 5, pp. 211-228, 1998; Duncan, T.E., Alpert, A., Duncan, S.C., and Hops, H. Journal of Psychopathology and Behavioral Assessment, 18, pp. 347-369, 1997.
Social Context Predictors of Adolescent Substance Use Development
This study examined the form of growth in alcohol, cigarette, and marijuana use among adolescents and covariates influencing this growth. Participants were 664 male and female adolescents (ages 14 to 17 years) assessed at three time points. A common trajectory existed across the developmental period with significant increases in all three substances. Second-order multivariate extensions of the basic latent growth modeling framework indicated that associations among the individual differences parameters representing growth in the various substance use behaviors, could be adequately modeled by a higher-order substance use construct. Inept parental monitoring, parent-child conflict, peer deviance, academic failure, gender, and age, were significant predictors of initial levels and the trajectory of substance use. Results indicate considerable similarity in the development of alcohol, cigarettes and marijuana during adolescence, and suggest that it may be possible to reduce the upward trajectory of adolescent substance use if we improve the prevalence of effective parental monitoring, reduce parent-child conflict and associations with deviant peers, and increase academic success. Duncan, S.C., Duncan, T.E., Biglan, A., and Ary, D.V. Contributions of the Social Context to the Development of Adolescent Substance Use: A Multivariate Latent Growth Modeling Approach. Drug and Alcohol Dependence, 50, pp. 57-71, 1998.
Behavioral and Emotional Problems Among Children of Cocaine and Opiate Dependent Parents
Children of cocaine and opiate dependent parents are compared with demographically matched referred and nonreferred children. Cocaine and opiate dependent parents completed the Child Behavior Checklist for 410 children (218 boys, 192 girls) between the ages of 2 and 18 years (mean=7.9 years). Children of drug abusers (CDAs) were matched to referred (RCs) and nonreferred children (NCRs) on age, gender, informant, ethnicity, and SES. RCs scored lower than CDAs and NCRs on all competence scales, and higher than CDAs and NRCs on all problem scales. CDAs scored lower than NRCs on social, school, and total competence, and higher than NRCs on withdrawn, thought problems, delinquent behavior, aggressive behavior, internalizing, externalizing, and total problems. More CDAs than NRCs also scored in the clinical range on school and total competence, withdrawn, anxious/depressed, thought problems, delinquent behavior, aggressive behavior, internalizing, externalizing, and total problems. Preschool CDAs were at risk of both internalizing and externalizing problems, and adolescent CDAs were at greatest risk of externalizing problems. CDAs were at risk of internalizing and externalizing psychopathology relative to demographically matched NRCs, but showed significantly less psychopathology than shown by matched RCs. Stanger, C., Higgins, S.T., Bickel, W.K., Elk, R., Grabowski, J., Schmitz, J., Amass, L., Kirby, K.C., Seracini, A. Journal of the American Academy of Child and Adolescent Psychiatry, 1998.
Alcohol-Related Homicides Committed by Women
In an analysis of data derived from interviews conducted with female homicide offenders as part of the FEMDREIM (Female Drug Relationships in Murder), cases in which respondents believed the offense was related to their use of alcohol at the time of the homicide were examined (N=35). Four basic types of homicides based on victim-offender relationships and the circumstances of the incidents were found. The first and most common type (n=11 or 31% of the alcohol-related homicides) was a non-domestic dispute (i.e., a dispute where the victim was not a spouse, lover, or other family member). The second type (n=7 or 20% of the homicides) was a domestic dispute (i.e., a dispute that was domestic in nature in that the victim was an intimate or family member). The third type (n=7 or 20% of the alcohol-related homicides) occurred during a robbery. The fourth type of alcohol-related homicide (n=4 or 11% of the homicides) was a DWI (driving while intoxicated) case. (Also, there were six alcohol-related homicides (17%) that could not be categorized as one of the four basic types. These involved a variety of other circumstances, including child abuse and neglect, arson, and infanticide.) Women who committed each type of alcohol-related homicide reported a variety of motives for committing these acts. There were also similarities and differences between the types not only in the kinds of motives reported but also in the extent to which planning was involved. Likewise, there were similarities and differences between the different types of homicides regarding the type and amount of alcohol and other drugs used by respondents on the day of the incident, and regarding respondents' perceptions of the alcohol-relatedness of the events. Spunt, B., Brownstein, H., Crimmins, S., Langley, S., Spanjol, K. Journal of Psychoactive Drugs, 30, pp. 33-43, 1998.
Aggression Classification and Treatment Response
This preliminary study investigated whether the aggression subtypes derived from the Aggression Questionnaire (AQ) are related to treatment response. Subjects were 28 aggressive conduct-disordered children (25 males, 3 females), ranging in age from 9.8 to 17.0 years (mean=12.69 years), who participated in a double-blind, placebo-controlled study of lithium as a treatment for reducing aggression. The Predatory-Affective Index of the AQ was used to classify subjects into predatory (planned) or affective (explosive) subtypes of aggression and then related this classification to treatment response. This index did not differentiate placebo baseline responders from non-responders but did significantly differentiate responders and non-responders during the experimental treatment period, regardless of whether they received lithium or placebo. Treatment response was associated with a more affective and less predatory subtype of aggression. Authors report that, to the best of their knowledge, this is the first study in children to show an association between aggression subtype and treatment response. Malone R., Bennett D., Luebbert, J., Rowan, A., Biesecker, K., Blaney, B., Delaney, M. Psychopharm. Bulletin, 34(1), pp. 41-45, 1998.
Using Developmental Processes to Predict Substance Use Outcomes
Latent growth models have been used to describe developmental growth and to identify factors that influence growth in predictable ways. However, there are few examples of research that use characteristics of growth trajectories as predictors of developmental outcomes. This report provides an illustration of this type of study, where the development of ego resiliency (a sequence of stages of functioning across the domains of personal relationships, impulse control, moral develop-ment and cognitive style) over the adolescent years is modeled as a predictor of alcohol and tobacco use in early adulthood. Ego development was assessed six times during a ten year interval in a sample of 123 adolescents. Previous work with these data show that growth in ego development can be described as a curvilinear trajectory over this ten year period. This paper extends prior work to examine the extent to which ego level at three different points along the ten year trajectory (the initial assessment, midway through the study, and the final assessment), the rate of growth at these three points, and the extent to which curvature in ego growth predicted subjects' substance use status in the final year of the study. Results show that steady growth in ego development during early adolescence is associated with nonsmoking status in early adulthood. In addition, youths with steady ego development are more likely than those with delayed development to report moderate drinking habits. Sayer, A.G. and Allison, T.J. Using Developmental Processes to Predict Substance Use Outcomes. The Methodology Center Technical Report Number 98-25, College of Health and Human Development, The Pennsylvania State University, 1998.
Raising Healthy Children
In 1993, ten schools were randomly assigned to program or control conditions resulting in a sample of 562 program and 478 control first and second grade students. Students are currently in grades 5 and 6. Teachers, parents and students have been surveyed annually, teachers are observed twice a year, and school records are collected. The intervention includes teacher staff development, parenting workshops, and individual work with students. After 1.5 years of the intervention, teacher reports indicated academic and behavioral improvements for children in the experimental condition. Recent analyses focused on students in the top tertiles on antisocial behavior and depression. High anti-social students demonstrated higher academic achievement compared with their control group counterparts. Among the depressed children, those in the experimental group maintained their baseline level of social competence, whereas those in the control group decreased. Analyses focused on the hypothesized processes of development revealed significant prediction of family attachment (in year 3) from earlier protective processes (involvement, opportunities, and rewards) and child social, emotional and cognitive skills. Additional analyses examined the long-term effects of parental transitions and family stress on the development of anti-social behavior in children. Results suggest that family bonding partially mediates the effects of parental transitions on antisocial behavior. Haggerty, K.P., Catalano, R.F., Harachi, T.W., and Abbott, R.D. Criminology, 31(1), pp. 25-48, 1998.
Modeling of Longitudinal and Multilevel Alcohol Use Data
Using Multilevel Latent Growth Modeling (LGM), levels of alcohol use and development of alcohol use over four years were examined among individuals (adolescents and parents) nested within families. The sample comprised 435 families (435 target adolescents, 203 siblings and 566 parents) assessed annually for four years. The effects of family status (single-parent, two-parent intact, and stepparent families) and socioeconomic status (SES) on family levels and development of alcohol use were examined. Approximately 29% of the total variation in initial levels of alcohol, and 37% of the developmental trajectories for alcohol use could be explained by family membership. Stepparent families, and less educated and more economically disadvantaged families, had higher family levels of alcohol use and developed in their use of alcohol at a faster rate. Findings suggest that the alcohol use of individuals in the same family is more alike than that of individuals from different families and that family alcohol use may be influenced by family-level variables such as family composition or SES. Duncan, T.E., Duncan, S. and Hops, H. Latent Variable Modeling of Longitudinal and Multilevel Alcohol Use Data. Journal of Studies on Alcohol, 59, pp. 399-408, 1998.
Beliefs About Substance Use Among Pregnant and Parenting Adolescents
Substance use among pregnant and parenting adolescents has health implications for both mother and baby. Utilizing the Theory of Reasoned Action, a social psychological model, this research investigates the cognitive structure underlying substance use, based on longitudinal analyses of data from 3 waves of interviews with a cohort of young mothers who were 17 years old or younger during pregnancy. Use of cigarettes, alcohol, and marijuana were lowest during pregnancy, increased sharply at 6 months postpartum, and remained level at 12 months postpartum. Changes in intentions, attitudes, perceived social norms, outcome beliefs, and normative beliefs followed the same pattern. The content of changing beliefs about substance use is examined and implications for substance use interventions among postpartum adolescent mothers is discussed. Morrison, D., Spencer, M., and Gillmore, M. J. Res. Adoles., 8(1), pp. 69-95, 1998.
An Ecological Model for School-Based Mental Health Services for Urban Low-Income Aggressive Children
An ecological model for school-based mental health services that targets urban low-income aggressive children--a highly vulnerable and underserved population--is presented. The goals of the model are to increase children's and teachers' involvement in the delivery of services and to increase the integration of these services into existing school resources and activities. The model proposes that mental health service providers work in collaboration with teachers to deliver services that (1) can be managed by existing school resources and personnel, (2) are related to empirically based factors associated with reduced aggression and increased social functioning, and (3) are group administered to increase the number of children served and to reduce stigmatization associated with mental health services. The model is individualized and flexible by acknowledging that contexts for aggression differ across classrooms and children by providing services specific to those contexts. Two studies are presented illustrating the application of this model to decrease aggression and increase academic engagement in low-income urban public schools. Atkins, M.S., McKay, M.M., Arvantis, P., London, L., Madison, S., Costigan, C., Haney, P., Zevenbergen, A., Hess, H., Bennett, D., and Webster, D. The J. of Behav. Health Serv. & Res., 5(1), pp. 64-75, 1998.
31P MRS and ERP Investigations of Substance Abuse Liability
Researchers at the University of Pittsburgh report two recent neurobiological studies elucidating components of liability to substance abuse. The first was an exploratory study to determine the heuristic potential of Phosphorus-31 magnetic resonance spectroscopy (MRS) employing chemical shift imaging (CSI), a procedure that reveals the presence of low molecular weight phosphorus containing metabolites critical in the transformation and use of energy by neurons and glia. Four distinct anatomic brain locations (i.e. frontal, occipital, right parietal, left parietal) were imaged in three groups of peripubertal children hypothesized to be at varying levels of familial SUD risk: children with a positive paternal history of SUD and a disruptive behavior disorder (DBD) diagnosis (SUD+/DBD+; n=10), those with a positive paternal SUD history in the absence of other psychopathology (SUD+/DBD-; n=13), and matched control children from normal families (SUD-/DBD-; n=13). In addition, investigators examined subjects' neuro- cognitive test results to determine any associations between cognitive capacities and regional 31P1 MRS spectra. The highest-risk sample (SUD+/DBD+) demonstrated a diminished proportion of phosphodiesters confined to the right parietal voxel. This right parietal phosphodiester proportion correlated only with the Information Scale score on a standard intelligence test for children. This suggested a relationship between general learning ability and motivation for academic achievement and right parietal physiology in the highest-risk sample. Variations in synaptic pruning could account for this observation. Moss, H.B., Talagala, S.L., and Kirisc, I.L. Phosphorus-31 Magnetic Resonance Brain Spectroscopy of Children at Risk for a Substance Use Disorder: Preliminary Results. Psychiatry Research-Neuroimaging, 76(2-3), pp. 101-112, 1997.
The second study examined event-related potentials (ERPs) in preadolescent boys at elevated risk for substance use due to paternal history of substance abuse or dependence. Sons (age 10-12) of fathers with an alcohol-use disorder (ALC, n=29) were matched by age, IQ, education and parental alcohol use with sons of fathers with a polysubstance abuse or dependence diagnosis (POLY, n=37). These two groups were matched with a low-risk comparison group (LOW, n=29) of boys whose fathers had no substance-use disorder diagnosis. No boy in the study met criteria for a substance-use disorder. ERPs were collected from midline (Fz, Ct, Pt) and parietal (P3, P4) electrode leads during an auditory oddball task. ERPs of boys from the ALC and POLY groups showed a slow negative shift prominent at Ct and Pz. This negative shift, evident by 100ms post-stimulus and lasting for the remainder of the 1000-ms recording period, overlapped temporally with N1, N2 and P3 amplitude differences distinguishing the ALC and POLY groups from the LOW group. The ALC and POLY groups differed from each other in N2 amplitude at Ct, which was larger for ALC subjects. These findings offer a possible alternative explanation for previously observed amplitude anomalies noted in children at risk for substance-use disorders and suggest new avenues of inquiry. Brigham, J., Moss, H., Murrelle, E., Kirisci, L., and Spinelli, J. Psychiatry Research, 73(3), pp. 133-146, 1997.
Evaluating the Perceived Quality of Drug Treatment Programs
Key personnel in 294 drug treatment facilities in Los Angeles County were surveyed to provide objective program information and subjective evaluations of various aspects of their treatment programs. These ratings were obtained as part of the UCLA Drug Abuse Research Center Treatment Referral Network Survey which has the goal of matching drug users' treatment needs to appropriate services. Using latent variable models, a subset of the objective measures was used to predict perceived quality of the treatment programs. Perceived quality was indicated by ratings of the effectiveness of counseling services, staff, and overall program. At the latent variable level, significant predictors of greater perceived quality included a programmatic focus (philosophy and emphasis), and program intensity (greater frequency and number of psychological and social services). Group therapy and methadone program (including detoxification and maintenance) had significantly negative effects. Individual therapy had a slightly positive but not statistically significant effect on perceived quality. There were also significant relationships among measured variables: More individual counseling and a skills-building approach predicted higher ratings of overall program, supportive group therapy predicted higher ratings of treatment staff, and a change-oriented emphasis predicted higher ratings of counseling services. Measured variables representing staff turnover ratio, caseloads, and ratio of licensed staff to total staff did not significantly predict quality and did not increase the amount of variance accounted for by the final path model. The variables were, however, significantly correlated with some of the predictors which in turn predicted quality. Hser, Y.I., Stein, J.A., Maglione, M., & Polinsky, M.L. Predicting Perceived Quality of Drug Treatment Programs Using Latent Variable Models. Evaluation and Program Planning, 21, pp. 1-10, 1998.
Information Exposure
A theoretical model of attention to messages has been used to guide an extensive series of laboratory and field experiments involving the mass media and, more recently classroom instruction and health interventions. The model draws on individual differences in need for novelty as a basis both for identifying target audiences most likely to engage in a number of health risk behaviors, such as drug and alcohol abuse and risky sex, and as a guide for designing messages to attract and hold the attention of some individuals who make up the prime target audience for many campaigns. These strategies have been successful in bringing about changes in attitudes and behavioral intentions in experimental studies and in reaching at-risk audience segments in field studies through novel televised public service announcements placed in appropriate television programming. Donohew, L.R., Lorch, E.P., and Palmgreen, P. Applications of a Theoretical Model of Information Exposure to Health Interventions. Health Communication Research, 24(3), pp. 454-468, 1998.
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