 |
National Institute on Drug Abuse
Women and Sex/Gender Differences Research
Director's Report to Council
Research Findings Excerpts
September, 2001
|
 |
|
Basic Research |
Prenatal Exposure to Methamphetamine Increases the Male Offspring's Vulnerability, When Adults, to Methamphetamine's Neurotoxicity, in Mice
The use of club drugs, such as methamphetamine, by women of childbearing age has become a public health concern. Dr. Alfred Heller and his colleagues at the University of Chicago and Illinois Institute of Technology, modeled this situation in mice. They administered a neurotoxic dose of methamphetamine to pregnant mice during gestational days 7 to 18. Fetal exposure alone did not produce neurotoxicity. The researchers also gave methamphetamine to the offspring after they had become young adults (11 weeks of age), at minimally neurotoxic doses. They observed an enhanced neurotoxicity in the male offspring when they were injected with methamphetamine as adults. The neurotoxicity was evidenced by greater methamphetamine-induced lasting reductions of dopamine and its metabolites in the striatum and of dopamine in the ventral brainstem. Some effects of prenatal methamphetamine exposure were observed in female offspring, but these were much less than those seen in males. The ability of methamphetamine to induce neurotoxicity is associated, in part, with its ability to raise body temperature (hyperthermia). These doses of methamphetamine did not raise the body temperature of the adult female offspring, while the methamphetamine injections did raise the body temperature of the adult males. However, the hyperthermic response to methamphetamine was the same in the adult males whether or not they had been exposed to methamphetamine in utero. These findings raise the concern that male methamphetamine abusers may have an enhanced risk for the neurotoxic effects of the drug if they were previously exposed to it in utero. Furthermore, the mother's methamphetamine abuse may predispose her male offspring to other neuropathological disorders, such as Parkinson's disease. Heller, A., Bubula, N., Lew, R., Heller, B., and Won, L. Gender-Dependent Enhanced Adult Neurotoxic Response to Methamphetamine Following Fetal Exposure to the Drug. J. Pharmacol. Exp. Ther., 298 (2), pp. 1-11, 2001.
|
|
Behavioral Research |
Estrogen Plays a Role in the Acquisition of i.v. Cocaine Self-Administration in Female Rats
Prior research by Drs. Wendy Lynch and Marilyn Carroll of the University of Minnesota showed that female rats acquire i.v. self-administration of cocaine faster than male rats. To assess the role that estrogen might play in this sex difference, these researchers compared i.v. self-administration in female rats for whom estrogen was blocked, either chemically or surgically, with female rats for whom estrogen was not blocked. Four groups of female rats were studied: ovariectomized (OVX) females treated either with estradiol benzoate (OVX-EB) or vehicle (OVX-VEH), and sham-operated (SH) females treated either with the estrogen blocker tamoxifen (SH-TAM) or vehicle (SH-VEH). In the two groups of female rats for which estrogen was not blocked, the SH-VEH and OVX-EB groups, the percentage of females who acquired cocaine self-administration according to the study criterion (a mean of 100 self-administered infusions over five consecutive 6-hr sessions) was 80% and 70%, respectively. In the two groups in which estrogen was either surgically or chemically blocked, the OVX-VEH and the SH-TAM groups, only 30% and 50%, respectively, met the study criterion for cocaine self-administration. In their prior work, these researchers found that 30% of the intact males met acquisition criterion, which is the same percentage as found for the OVX-VEH females in the present study. Taken together, these studies indicate that estrogen plays a role in the acquisition of i.v. cocaine self-administration among females and also in gender differences seen in the acquisition of i.v. cocaine self-administration. Lynch, W.J., Roth, M.E., Mickelberg, J.L. and Carroll, M.E. Role of Estrogen in the Acquisition of Intravenously Self-Administered Cocaine in Female Rats. Pharmacology, Biochemistry and Behavior, 68, pp. 641-646, 2001.
|
|
Treatment Research and Development |
The Therapeutic Workplace is an Efficacious and Self-Sustaining Treatment for Heroin and Cocaine Addicts
Dr. Silverman at Johns Hopkins University School of Medicine conducted a study that integrated abstinence reinforcement into a work setting, using salary that drug abusers earn for work to reinforce drug abstinence. Patients are paid to work, but they must provide drug-free urine samples to gain daily access to the workplace. In Phase 1 of this study, each participant's "job" is to work in a job skills training program where they are paid in vouchers exchangeable for goods and services. Results showed that Phase I effectively promoted long-term abstinence from heroin and cocaine in poor, chronically unemployed pregnant and postpartum women. In Phase 2, successful participants were hired as regular employees of a real income-producing business. Participants must still provide drug-free urine samples to maintain access to the workplace each day, but in this phase they earn regular paychecks instead of vouchers. Findings from Phase 2, suggest that the therapeutic workplace business could be financially feasible and self-sustaining. As well as being utilized for unskilled and chronically unemployed people, the therapeutic workplace intervention could be applied to treat drug-addicted individuals who are skilled and already employed. In addition, the therapeutic workplace could be created around different types of jobs and businesses. Silverman, K., Wong, C.J., Svikis, D., Stitzer, M.L., and Bigelow, G.E. The Therapeutic Workplace: A Promising Treatment for Heroin and Cocaine Addiction among the Chronically Unemployed. In Proceedings of 2001 ONDCP International Technology Symposium: Counterdrug Research and Development: Technologies for the Next Decade.
The Effectiveness of Incentives in Enhancing Treatment Attendance and Drug Abstinence in Methadone-Maintained Pregnant Women
In this study Dr. Hendree Jones and colleagues at Johns Hopkins University examined the effectiveness of short-term contingency management for eliminating cocaine use and increasing full day treatment attendance with pregnant methadone-maintained women randomly assigned to either an escalating voucher incentive schedule (n=44) or non-incentive (n=36) condition. Full day treatment attendance and urine toxicologies for cocaine and heroin were assessed for 14 days. The escalating voucher incentive schedule significantly increased full day treatment attendance and drug abstinence compared to the non-incentive schedule. These findings suggest that reinforcing the co-occurrence of two required behaviors (treatment attendance and abstinence from illicit drug use) is effective, and may be an important adjunct to methadone pharmacotherapy for treating pregnant drug dependent women. Jones, H., Haug, N., Silverman, K., Stitzer, M. and Svikis, D. Drug and Alcohol Dependence, 61, pp. 297-306, 2001.
Clinical and Psychosocial Characteristics of Substance-Dependent Pregnant Women with and without PTSD
This study compared psychiatric and psychosocial functioning in 123 pregnant opiate- and/or cocaine-dependent women with and without a comorbid diagnosis of posttraumatic stress disorder (PTSD). Participants were enrolled in a comprehensive perinatal drug treatment program and completed assessments upon admission. Lifetime diagnostic prevalence of PTSD (Structured Clinical Interview for DSM-IV Disorders (SCID) confirmed) among the sample was 19%. Participants with PTSD (n=24) reported greater need for psychiatric treatment, were more likely to report a previous suicide attempt, and had more previous drug treatments than participants without PTSD (n=99). Women with PTSD were twice as likely to have lifetime Axis I and Axis II disorders and had higher rates of abuse than women without PTSD. Lifetime sexual abuse and ASI family/social composite scores were significant predictors of PTSD. The results suggest that pregnant drug-dependent women with comorbid PTSD may benefit from specialized treatment services for trauma and/or abuse issues. Moylan, P., Jones, H., Haug, N., Kissin, W., and Svikis, D. Addictive Behaviors, 26, pp. 469-474, 2001.
Amygdala Response to both Positively and Negatively Valenced Stimuli
Dr. Hugh Garavan and colleagues at the Medical College of Wisconsin used BOLD fMRI to determine whether the amygdala is differentially tuned to hedonic vs. aversive stimuli. Prior studies have reported activation of the amygdala during drug craving, and so it is important to establish the basic information being processed by the amygdala. The amygdala has long been associated with emotional processing, and a dominant view is that the amygdala responds either exclusively or primarily to negative affective stimuli. In the present study, normal female subjects viewed pictures that varied in emotional content and arousal level selected from a widely used and validated picture set (International Affective Picture System). There was no difference in the amygdala response between negatively and positively valenced pictures, nor were there differences in the laterality of activation. There were differences with respect to interactions with the arousing properties of the pictures. The amygdala response to negatively valenced pictures was influenced by the level of arousal induced, whereas the response to the positive pictures was independent of the level of induced arousal. These results suggest that, at least in female subjects, amygdala activation occurs to both positive and negative emotional stimuli. Garavan et al., Neuroreport, 12, pp. 1-5, 2001.
Psychiatric Comorbidity of Methamphetamine Dependence in a Forensic Sample
The association between psychiatric symptoms and methamphetamine (METH) dependence was examined. A survey was administered to 1,580 arrestees sampled from the 14 most populous counties in California. The survey included items assessing demographic profile, history of substance dependence, and psychiatric symptomatology. METH-dependent individuals (defined as those having used the drug, unsuccessfully tried to decrease use and/or felt addicted within 12 months of the assessment) were significantly more likely to report depressive symptoms and suicidal ideation than individuals denying METH dependence, even after controlling for demographic profile and dependence on other drugs. METH-dependent individuals also were more likely to report a need for psychiatric assistance at the time of the interview. These findings suggest that METH-dependent individuals are at greater risk to experience particular psychiatric symptoms. There was a significant dependence-by-gender effect, with dependent females reporting significantly more overall symptomatology compared to females reporting no dependence; males significantly differed only with respect to depression. Further study to determine the etiology of these symptoms is warranted. Kalechstein, A.D., Newton, T.F., Longshore, D., Anglin, M.D., van Gorp, W.G., and Gawin, F.H. Psychiatric Comorbidity of Methamphetamine Dependence in a Forensic Sample. Journal of Neuropsychiatry & Clinical Neurosciences, 12(4), pp. 480-484, 2000.
Reduced Vasoconstriction in Woman Compared to Men and during Different Phases of the Menstrual Cycle after Cocaine May be a Protective Factor
Dr. Marc Kaufman and colleagues studied cerebral blood flow with dynamic susceptibility contrast magnetic resonance imaging in occasional cocaine users: men and woman at different phases of the menstrual cycle. In men, there was a 20% reduction in blood flow, while there was no reduction during the follicular stage of women and a 10% reduction during the luteal phase. It is conceivable that this difference could account in part to the lesser neuronal injury in women and implies that gonadal steroids or the factors they modulate may be therapeutic agents for reducing cocaine-induced cerebrovascular disorders. Kaufman, M.J., Levin, J.M., Maas, L.C., Kudes, T.J., Villafuerte, R.A., Dostal, K., Lukas, S.E., Mendelson, J.H., Cohen, B.M., and Renshaw, P.F., Biological Psychiatry, 49(9), pp. 774-781, 2001.
|
|
Research on AIDS and Other Medical Consequences of Drug Abuse |
HCV Risk Not Limited to Injection Drug Users
A study in New York City examined the prevalence of hepatitis C (HCV) infection among non-injecting drug users residing in East Harlem and the Lower East Side of Manhattan neighborhoods. As many as 17% percent of the subjects who denied a history of injection drug use were found to be infected, compared to a 2% infection rate in the general population. Among women from one of the study sites in East Harlem who reported use of non-injection heroin, the rate of infection was as high as 26%, compared to 14% among women recruited from the Lower East Side. This discrepancy may be attributed at least in part to differences in age between the two study samples. Older women (>35) were found to have a higher anti-HCV prevalence than do younger women (<35). Rates of anti-HCV prevalence were substantially higher for former injectors than for never injectors and, in contrast to never injectors, former injectors exhibited anti-HCV rates that were quite similar across study locations, non-injecting drug use categories, and gender. The researchers posit that the considerable prevalence of HCV among never injectors could be, in part, from some never injectors misrepresenting past injection histories, although study procedures were designed to minimize underreporting. A particular concern is the possibility that the prevalence of HCV among never injectors is related to non-injecting routes of transmission. A pool of HCV-infected non-injecting drug users may be a residual source for the transmission of HCV to other populations. These findings have relevance for HCV testing and treatment policies, as well as for future research focused on the risk factors for HCV transmission among those with no history of injecting drug use. Tortu, S., Neaigus, A., McMahon, J., and Hagen, D. Hepatitis C Among Non-injecting Drug Users: A Report. Substance Use and Misuse, 36(4), pp. 523-534, 2001.
Gender Differences in Condom Usage Among Rural Crack-Using Men and Women
This study explores gender differences in attitudes and motivations to use condoms within a rural, economically disadvantaged sample. Qualitative data analysis identified recurrent themes regarding condom use and assessed how themes varied among men and women. Analyses showed that men and women exhibit different rationales for condom use, while both reported inconsistencies between their knowledge about safe sex, receptivity to condom use, and applications in practice. The findings suggest that prevention programs should be tailored to increase consistent condom use among main partners of crack smokers at risk for HIV. McCoy, H.V. and Wasserman, A. Women and Health, 33, pp. 1-2, 2001.
Longitudinal Study Identifies Sex Differences in HIV Risks Among Injecting Drug Users
Injection drug use directly or indirectly accounts for nearly half the annual HIV infections in the United States today. The changing dynamic of the HIV/AIDS epidemic has also had a significant impact on women and minorities: in 1999, women accounted for 23% of all reported adult AIDS cases in the U.S. and African American and Hispanic ethnic groups accounted for 55% of the cumulative total number of AIDS cases and 77% of AIDS cases in women and girls. Researchers in Baltimore, MD followed a cohort of 1874 IDUs from 1988 to 1998 to investigate drug-related and sexual risk factors for HIV. Participants were 1447 male (77%) and 427 female (23%) HIV-negative IDUs. The median age at enrollment was 35 years; 91% of the participants were African American. Incidence of HIV was 3.14 per 100 person years (95% CI, 2.78-3.53) and did not significantly differ by sex. Younger age independently predicted HIV seroconversion for both men and women. Among men, less than a high school education, recent needle sharing with multiple partners, daily injection, and shooting-gallery attendance independently predicted HIV seroconversion. HIV incidence was double among men who recently engaged in homosexual activity and cocaine injection. Among women, the incidence of HIV was more than double for those recently reporting sexually transmitted diseases. HIV incidence has remained high among IDUs in Baltimore over the past decade. Risk factors for HIV seroconversion differed markedly by sex, with homosexual activity and needle sharing predominant among men and heterosexual activity predominant among women. These findings underscore the importance of interventions for IDUs that are sex-specific and incorporate sexual risk factors. Strathdee, S.A., Galai, N., Safaiean, M., Celentano, D.D., Vlahov, D., Johnson, L., and Nelson, K.E. Sex Differences in Risk Factors for HIV Seroconversion Among Injection Drug Users. Arch Intern Med, 161, pp. 1281-1288, 2001.
The Search for Congenital Malformations in Newborns With Fetal Cocaine Exposure
Using a prospective longitudinal design, Behnke et al. assessed the association between prenatal cocaine exposure and congenital anomalies in a sample of 272 infants of 154 prenatally identified crack/cocaine users and 154 nonusing matched controls (perinatal deaths and infants not examined within 7 days of birth were not included). Mothers' cocaine use during pregnancy was measured using repeated in-depth histories and urine screens. Measured infant outcomes included 16 anthropometric measurements and a checklist of 180 physical features. In comparison to nonexposed infants, exposed infants were more likely to be born prematurely and to have lower mean birthweights, lengths, and head circumferences. Exposed and nonexposed infants did not differ on remaining anthropometric measurements. Timing and amount of cocaine exposure were not associated with infant outcomes, nor was a consistent pattern of abnormalities associated with prenatal exposure identified. Behnke, M., Eyler, F.D., Garvan, C.W., and Wobie, K. The Search for Congenital Malformations in Newborns with Fetal Cocaine Exposure. Pediatrics, 107, e74, 2001.
Improved Antioxidant Status Among HIV-infected Injecting Drug Users on Potent Antiretroviral Therapy
Tang and her colleagues from Tufts examined serum antioxidant levels (retinal, alpha-and gamma-tocopherols, alpha-and beta-carotenes, lycopene, lutein/zeanthin, and beta-cryptoxanthin) in 175 HIV-positive and 210 HIV-negative IVDUs in Baltimore, MD. Of these patients, 30 were receiving antiretroviral therapy (ART) including a protease inhibitor (PI), 43 ART without a PI, 22 on montherapies, and 80 were not on any ART. Among HIV+ subjects, there were significant differences in antioxidant levels by ART regimen. In multivariate models adjusting for injecting drug use, dietary intake, supplement intake, gender, and alcohol intake, significant overall differences by ART regimen were observed for alpha-tocopherol, beta-carotene, and beta-cryptoxanthin. Serum levels of these three antioxidants were significantly higher in the PI group than in the other three ART groups combined. These data provide indirect evidence of the effectiveness of PIs in lowering oxidative stress levels in HIV+ IDUs. Tang, A. Smit, E., Semba, R., Shah, N., Lyles, C.M., Li, D., and Vlahov, D. JAIDS, 23 (4), pp. 321-326, 2000.
Patterns of Needle Acquisition and Correlates of NEP Attendance in Baltimore
Researchers examined factors associated with obtaining syringes from a needle exchange program (NEP) and other safer sources in Baltimore, Maryland. They conducted a cross-sectional, face-to-face survey of 741 drug injectors recruited by snowball sampling techniques. They also conducted a brief open-ended interview with a subsample of respondents. Most of the participants (85%) obtained needles from street needle sellers. Only 8% obtained their needles exclusively from safer sources (NEPs, pharmacies, hospitals, or patients with diabetes). Cocaine use was associated with obtaining needles from the NE but not from exclusively safer sources. Obtaining needles from only safer sources was associated with being female and less frequent needle sharing and shooting gallery attendance. Among HIV-seropositive participants, those who were diagnosed before the year that the NEP began were more likely to obtain needles from safer sources. Participants who sold needles reported that it was easy to make used needles appear to be unused and some admitted selling used needles as new. Street needle sellers are an important source of needles for drug injectors and few injectors appear to be able to determine whether these needles are clean. Individual sealing of diabetic syringes may reduce the risk of blood-borne infections by enabling drug injectors and patients with diabetes to better judge the sterility of the needles they purchase. Latkin, C.A. and Forman, V.L.. Patterns of Needle Acquisition and Sociobehavioral Correlates of Needle Exchange Program Attendance in Baltimore, Maryland. J Acquir Immune Defic Syndr, 27(4), pp. 398-404, 2001.
Sexual Transmission of HIV-1 Among Injection Drug Users in San Francisco, USA: Risk Factor Analysis
Many new HIV-1 infections in the USA occur in injection drug users (IDUs). HIV-1 seroconversion of IDUs is mainly associated with injection-related risk factors. Harm reduction programs concentrate on injection-risk behavior. The aim of this study was to establish whether injection or sexual risk factors, or both, were associated with HIV-1 antibody seroconversion of street-recruited IDUs in San Francisco, from 1986 to 1998. IDUs were enrolled every 6 months from four community sites. Investigators did a nested case control study comparing 58 respondents who seroconverted between visits with 1134 controls who remained seronegative. Controls were matched with cases by sex and date. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated for men and women by use conditional logistic regression. Men who had sex with men were 8.8 times as likely to seroconvert (95% CI = 3.7, 20.5) as heterosexual men. Women who reported having traded sex for money in the past year were 5.1 times as likely as others to seroconvert (95% CI = 1.9, 13.7). Women younger than 40 years were more likely to seroconvert than those 40 years or older (AOR=2.8; 95% CI=1.05, 7.6), and women who reported having a steady sex partner who injected drugs were less likely to seroconvert than other women (AOR=0.32; 95% CI=0.11, 0.92). HIV-1 seroconversion of street-recruited IDUs in San Francisco is strongly associated with sexual behavior. HIV-1 risk might be reduced by incorporation of innovative sexual-risk reduction strategies into harm-reduction programs. Kral, A.H., Bluthenthal, R.N., Lorvick, J., Gee, L., Bacchetti, P., and Edlin, B.R. Sexual Transmission of HIV-1 Among Injection Drug Users in San Francisco, USA: Risk Factor Analysis. Lancet, 357, pp. 397-401, 2001.
Gender Differences in HIV-related Sexual Risk Behavior among Urban African American Youth: a Multivariate Approach
Alcohol and other drug (AOD) use during sexual encounters, sexual partner's age, perceived HIV risk and perceived condom effectiveness were studied among 388 sexually active African American youth. Cluster analysis of condom use, number of partners, and frequency of sexual intercourse identified four groups: low risk, monogamy strategy, condom strategy, and high risk. Low-risk youth used condoms consistently and had few partners. High-risk youth used condoms inconsistently with many partners. Monogamy strategy youth used condoms inconsistently but had few partners. Condom strategy youth used condoms consistently with a moderate number of partners. The high-risk group included more males and the monogamy group included more females. High-risk males reported more AOD use during sexual activity than all females, and low-risk or condom strategy males. Females had older partners, rated condoms as less effective and perceived lower HIV/AIDS risk than males. Results suggest differential HIV risk mechanisms by gender. Implications for gender-specific HIV prevention are discussed. Newman, P.A., and Zimmerman, M.A. Gender Differences in HIV-related Sexual Risk Behavior among Urban African American Youth: A Multivariate Approach. AIDS Educ Prev,12(4), pp. 308-325, 2000.
Perspectives on Use of Vaginal Microbicides Among Drug-Involved Women
A study was conducted to obtain potential users' perspectives on vaginal microbicides from a population of women at high risk for HIV. Using street outreach sampling techniques, researchers interviewed 743 drug-using women and female sexual partners of male IDUs in Bridgeport, Connecticut, Providence, Rhode Island, and San Juan, Puerto Rico. All of the women were current users of heroin and/or cocaine. Ninety percent of the women said they would be very likely to use micobicides with paying partners (who paid for sex with money or drugs) and 78% with primary partners (p=0.001). Even after potential product characteristics were rated as unacceptable, such as irritation or burning, women expressed a high likelihood of potential use. Latinas had significantly higher predicted likelihood of use with primary (p=0.001) and paying partners (p=0.018) than blacks and whites. Eighty percent of respondents preferred products that provided additional lubrication. More than 80% of respondents said they would want their primary partners to know of their microbicide use and 42% (p=0.001) said that they would want their paying partners to know. Women's concern about a paying partner's violent response to suggested use of risk reduction measures was inversely related to predicted likelihood of microbicide use (p=0.045). Microbicides should be assessed in the context of the potential users' actual relationships and cultures. Achieving broad acceptability among drug-involved women will require a range of products. Hammett, T.M., Norton, G.D., Mason, T.H., Langenbahn, S., Mayer, K.H., Robles, R.R., Feudo, R., and Seage, G. Drug-Involved Women as Potential Users of Vaginal Microbicides for HIV and STD Prevention: A Three-City Survey. Journal of Women's Health and Gender-Based Medicine, 9(10), pp. 1071-1080, 2000.
|
|
Epidemiology, Etiology and Prevention Research |
Replication of a Problem Behavior Model with American Indian, Hispanic, and Caucasian Youth
The replicability of a model of family and peer influences on adolescent problem behavior was evaluated with samples of adolescent boys and girls from three ethnic groups: American Indians, Hispanics, and Caucasians. Participants were 1,450 seventh-grade students from 16 communities. The model included links between three aspects of family functioning and adolescents' association with deviant peers. Those variables were hypothesized predictors of adolescents' problem behavior (antisocial behavior; poor school performance, and frequency of substance use). The resulting cross-sectional model showed good consistency across the three ethnic groups for both genders, but some subgroup differences emerged in the magnitude of relations between monitoring and adolescents' associations with deviant peers and between substance use and the problem behavior construct. With those qualifications, the model was applicable to Hispanic and Native American adolescents in the sample. Barrera, M., Jr., Biglan, A., Ary, D.V., and Li, F. Replication of a Problem Behavior Model with American Indian, Hispanic, and Caucasian Youth. Journal of Early Adolescence, 21 (2), pp. 133-157, 2001.
Further Support for the Developmental Significance of the Quality of the Teacher-Student Relationship
Sociometric nominations and ratings assessed peer's perceptions of supportive and conflicted teacher-student relationships, evaluations of children's positive and negative attributes, and peer-rated liking. Participants were 993 3rd and 4th grade children. Girls obtained higher Teacher Support and lower Teacher Conflict scores, compared to boys. The pattern of correlations between teacher-student relationship scores and other peer evaluations was comparable across genders. Both Teacher Support and Teacher Conflict made independent contributions to peer evaluations of children's competencies and acceptance of children. Teacher Support contributes to the prediction of social preference scores beyond that predicted by peer nominations of aggression. Teacher ratings of aggression were available for a sub-sample of 71 behaviorally at-risk children. For this sub-sample, Teacher Support predicted social preference scores after controlling for both peer nominations of aggression and teacher ratings of aggression. Peer's perceptions of Teacher Support may function as an "affective bias", influencing both perceptions of child competencies and liking for the child. Implications for these findings for classroom-based interventions with peer-rejected children are discussed. Further Support for the Developmental Significance of the Quality of the Teacher-Student Relationship. Hughes, J.N., Cavell, T.A., and Willson, V. Journal of School Psychology, 39(4), pp. 289-301, 2001.
Predicting Regular Cigarette Use Among Continuation High School Students
This article provides a 1-year prospective examination of social, behavioral, intrapersonal and demographic factors that predict transition from experimental to regular cigarette use among continuation (i.e. alternative) high school students. A cohort of 252 students completed baseline and 1-year follow-up questionnaires on health behaviors. Relatively low smoking prevalence estimates, intention to smoke in the next year, violence perpetration, perceived stress, sensation seeking, and male gender predicted the transition to regular use 1 year later. This implies that intrapersonal variables may be relatively important in predicting the progression from experimental to regular smoking. Skara, S., Sussman, S., and Dent, C.W. Predicting Regular Cigarette Use Among Continuation High School Students. American Journal of Health Behavior, 25(2), pp. 147-156, 2001.
From Early to Late Adolescence: Alcohol Use and Anger Relationships
The purpose of this article is to evaluate the longitudinal relationship of alcohol use in early adolescent to anger in late adolescence. Data from 1201 students were collected in Indianapolis, Indiana, from 1987 to 1993 as part of a large drug abuse prevention trial. Subjects were asked four anger-related questions: "When I have a problem, I get mad at people," "When I have a problem, I do bad things or cause trouble," and "I am a hotheaded person." Two additional items asked subjects to report the number of alcoholic drinks consumed and frequency of drunkenness in the past 30 days. Odds ratios were used to assess the predictive relationship of alcohol use in early adolescence to anger in late adolescence. Early use of alcohol increased the odds of later anger. Specifically, alcohol use in the past month in grades 6/7 increased the odds in grades 11/12 of saying or doing nasty things, self-reported hotheadedness, and high anger on a composite anger scale. Drunkenness in the past month in grade 6/7 increased the odds of self-reported hotheadedness and high anger on the anger scale in grade 9/10 and doing something bad to cause trouble in grade 11/12. For subjects in grade 9/10, alcohol use in the past month increased the odds in grade 11/12 of doing something bad to cause trouble, saying or doing nasty things, and self-reported hotheadedness. This study showed that alcohol use in early adolescence was associated with increased anger, both in middle and late adolescence, controlling for gender, age, and socioeconomic status. These findings suggest that alcohol and drug prevention programs delivered in early adolescence may have the capacity to prevent risk for later anger and related violent behavior. Weiner, M.D., Pentz, M.A., Turner, G.E., and Dwyer, J.H. From Early to Late Adolescence: Alcohol Use and Anger Relationships. Journal of Adolescent Health, 28(6), pp. 450-457, 2001.
Influence of Parental Child-rearing Practices and Environment on Adolescent Drug Use
This study examined the relationship between the domains of environmental factors, family illegal drug use, parental child-rearing practices, maternal and adolescent personality attributes, and adolescent illegal drug use. A nonclinical sample of 2,837 Colombian youths and their mothers were interviewed about intrapersonal, interpersonal, and environmental factors in their lives. Results indicated that certain environmental factors (e.g., violence, drug availability, and machismo), family drug use, a distant parent-child relationship, and unconventional behaviors are risk factors for adolescent illegal drug use. As hypothesized, results showed that the adverse effects of family illegal drug use on adolescent drug use can be buffered by protective parental child-rearing practices and environmental factors, leading to less adolescent illegal drug use. Prevention and treatment efforts should incorporate protective environmental, familial, and intrapersonal components in order to reduce adolescent illegal drug use. Brook, J.S., Brook, D.W., De La Rosa, M., Whiteman, M., Johnson, E., and Montoya, I. J. Behav Med, April 24(2), pp. 183-203, 2001.
Genetic and Environmental Influences on Antisocial Personality Disorder in Adoptees
This investigation used data from the Iowa Adoption studies to examine the biological and environmental influences and clinical correlates of adult antisocial behavior, a well-established risk factor for drug abuse. We defined three subgroups: antisocials with conduct disorder (n = 30), antisocials without conduct disorder (n = 25), and controls (n = 142). Results demonstrate that having an antisocial biological parent was a specific risk factor for ASPD. In contrast, fetal alcohol exposure, male gender, and adverse environmental factors were associated with the adult antisocial syndrome, regardless of a history of conduct disorder in childhood. The two antisocial groups were similar with respect to clinical characteristics including sociopathy scores, comoribid disorders, and most individual symptoms. Because the phenotypic expression of the potential genetic-risk for ASPD appears to be manifest before adulthood, findings suggest that a history of conduct disorder may be more relevant to the etiological than clinical understanding of adult antisocial behavior. Langbehn, D.R. and Cadoret, R.J. The Adult Antisocial Syndrome with and without Antecedent Conduct Disorder: Comparisons from an Adoption Study. Comprehensive Psychiatry, 42(4), pp. 272-282, 2001.
The Insidious Course of Alcohol Use Disorders from Adolescence to Adulthood
This study investigated whether alcohol use disorder (AUD) in adolescence is a risk factor for AUD and other forms of psychopathology in young adulthood. Nine hundred forty participants from a large community sample in western Oregon were interviewed twice during adolescence (14-18 years of age the first assessment; between 1987 and 1991) and once at age 24 (1993-1999). Participants were classified into non-problematic drinkers, problem drinkers (symptoms of AUD but no diagnosis), and AUD groups. Both problem drinking and AUD significantly predicted adult AUD, substance use disorder, depression, and antisocial personality disorder symptoms. Compared to the problem drinkers, the AUD group had higher rates of adult AUD, more antisocial personality disorder symptoms, and was at risk of borderline personality disorder. Other findings showed that daily smoking and conduct/oppositional defiant disorders predicted future AUD, after controlling for adolescent AUD and other disorders. Paternal, but not maternal, AUD was associated with greater risk of future AUD. In conclusion, findings indicate that AUD and problem drinking in adolescents are not benign conditions that resolve over time. Assessment, treatment, and prevention recommendations are discussed. Rohde, P., Lewinsohn, P.M., Kahler, C.W., Seeley, J.R., and Brown, R.A. Natural Course of Alcohol Use Disorders from Adolescence to Young Adulthood. Journal of the American Academy of Child and Adolescent Psychiatry, 40(1), pp. 83-90, 2001.
Evaluation of a 6-item Self-Report Screener for Conduct Disorder
This study evaluated the ability of a very brief (6-item) self-report screener, the Oregon Adolescent Depression Project Conduct Disorder Screener (OADP-CDS), to identify adolescents with a lifetime diagnosis of conduct disorder and to examine its ability to predict antisocial personality disorder by age 24. Relevant scales from the Youth Self-Report and the Child Behavior Checklist were examined for comparison purposes. A total of 1,709 high school students completed an initial questionnaire and diagnostic interview assessment (T1); 1,507 participants returned approximately 1 year later for a second assessment (T2). A third (T3) assessment was conducted with selected T2 participants (n = 940) after they had turned 24 years of age. The OADP-CDS demonstrated good internal consistency, test-retest stability, and screening properties. The screening ability of the OADP-CDS did not differ by gender or social desirability, and was as effective as the longer adolescent- and parent-report measures. Perhaps most importantly, the OADP-CDS was able to identify future cases of antisocial personality disorder in young adulthood, thereby underscoring the utility of self-report screening for conduct disorder, a well established risk factor of drug use disorders. Lewinsohn, P.M., Rohde, P., and Farrington, D.P. The OADP-CDS: A Brief Screener for Adolescent Conduct Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 39(7), pp. 888-895, 2000.
Services Needs of Substance Abusing Women in Jail
While women account for only 11% of the U.S. jail population, the population of women in the nation's jails has increased 7% annually since 1990 (compared to a 4.5% rate of growth among males). Since about two-thirds of female arrestees use illicit drugs, there is a need for substance abuse services and other services for females in jail. But historically programs for substance abusers in jail have focused on males and have not considered the special needs of women. This study compared the self-reported service needs of women requesting drug abuse services with those not in need of substance abuse treatment. Interviews were conducted with 165 women incarcerated in an urban county jail in Ohio. The study population was predominantly African-American (72%), aged 30 to 40, and most women were mothers. Women who reported a need for substance abuse treatment were more likely than those not needing drug abuse treatment to report the need for housing, medical care, education, mental health services, family support, and parenting assistance. Housing was the need most frequently mentioned; more than one quarter of drug abuse treatment-seeking women reported that they did not know where they would live when released from jail as compared to 11% of non-treatment seeking women This study suggests that successful drug treatment of women in jail must consider the multidimensional needs of these women in order to break the cycle of drug use and incarceration. Alemagno, S.A. Women in Jail: Is Substance Abuse Treatment Enough? Amer. J. Pub. Health, 91(5), pp. 798-800, 2001.
|
|
Services Research |
The Epidemiology of Physical Attack and Rape Among Crack-Using Women
This prospective study examines the epidemiology of physical attack and rape among a sample of 171 not-in-treatment, crack-cocaine using women. Since initiating crack use, 62% of the women reported suffering a physical attack. The annual rate of victimization by physical attack was 45%. Overall, more than half of the victims sought medical care subsequent to an attack. The prevalence of rape since crack use was initiated was 32%, and the annual rate was 11%. Among those women having been raped since they initiated crack use, 83% reported they were high on crack when the crime occurred as were an estimated 57% of the perpetrators. Logistic regression analyses showed that duration of crack use, arrest for prostitution, and some college education were predictors of having experienced a physical attack. Duration of crack use and a history of prostitution were predictors of suffering a rape. Drug abuse treatment programs must be sensitive to high levels of violence victimization experienced by crack-cocaine using women. Screening women for victimization, and treating the problems that emanate from it, may help make drug abuse treatment more effective. Falck, R.S., Wang, J., Carlson, R.G., and Siegal, H.A. The Epidemiology of Physical Attack and Rape among Crack-Using Women. Violence. Vict.,16(1), pp. 79-89, Feb 2001.
Association of Outpatient Alcohol and Drug Treatment with Health Care Utilization and Cost: Revisiting the Offset Hypothesis
This study examines the hypothesis that treatment reduces medical utilization and costs of patients with substance use problems. Adult patients (N = 1.011; 67% men) entering the outpatient chemical dependency recovery program at Sacramento Kaiser Permanente over a 2-year period were recruited into the study. Medical utilization and costs were examined for 18 months prior and 18 months after intake. To account for overall changes in utilization and cost, an age, gender and length-of-enrollment matched nonpatient control group (N = 4,925) was selected from health-plan members living in the same service area. Multivariate analyses controlling for age and gender were conducted using generalized estimating equation methods, allowing for correlation between repeated measures and nonnormal distributions of the outcome variable. The treatment cohort was less likely to be hospitalized (odds ratio [OR] = 0.59; p < .01) and there was a trend for having spent fewer days (rate ratio [RR] = 0.77; p < .10) in the hospital in the post treatment period compared to pretreatment period. These patients were also less likely to visit the emergency room (ER) (OR = 0.64; p < .01) and had fewer ER visits (RR = 0.81; p < .01) following treatment. Inpatient, ER and total medical costs declined by 35%, 39% and 26%, respectively (p < .01). Reductions in cost were greater for the treatment cohort when compared with the matched sample (p < .05). Among women, there were significant reductions (p < .05) in inpatient, ER and total costs for the study cohort when compared with the matched sample; among men, the reductions in inpatient and ER cost (but not total cost) were significantly larger (p < .05) for the study cohort when compared with the matched sample. For the treatment cohort, the change in medical cost was not significantly different by gender. Changes in cost were significantly different across the various age groups (p < .05) for the study cohort and the matched sample. Among those in the group aged 40-49 years, the decline in cost for study cohort was significantly larger (p < .05) than for the matched sample. For patients with substance use disorders entering treatment, there was a substantial decline in inappropriate utilization and cost (hospital and ER) in the post treatment period. The disaggregated pattern of post treatment decline in utilization and cost is suggestive of long-term reductions that warrant a longer follow-up. Parthasarathy, S.,Weisner, C., Hu, T.W., and Moore, C. Association of Outpatient Alcohol and Drug Treatment with Health Care Utilization and Cost: Revisiting the Offset Hypothesis. J Stud Alcohol., 62(1), pp. 89-97, Jan 2001.
Association of Outpatient Alcohol and Drug Treatment with Health Care Utilization and Cost: Revisiting the Offset Hypothesis
Individuals with alcohol and drug use problems may receive health care from medical, mental health, and substance abuse providers, or a combination of all three. Systems of care are often distinct and separate, and substantial opportunities for benefit to patient, provider, and payer are missed. In this article, the authors outline (1) the possible benefits of linking primary care, mental health, and substance abuse services from the perspective of the major stakeholders-medical and mental health providers, addiction clinicians, patients, and society-and (2) reasons for sub optimal linkage and opportunities for improving linkage within the current health care system. They also review published models of linked medical and substance abuse services. Given the potential benefits of creating tangible systems in which primary care, mental health, and substance abuse services are meaningfully linked, efforts to implement, examine, and measure the real impact should be a high priority. Samet, J.H., Friedmann, P., Saitz, R. Association of Outpatient Alcohol and Drug Treatment with Health Care Utilization and Cost: Revisiting the Offset Hypothesis. Arch Intern Med., 161, pp. 85-91, 2001.
The First Week after Drug Treatment: The Influence of Treatment on Drug Use Among Women Offenders
Over the last decade, there has been a dramatic rise in the number of women arrested for drug offenses, and many have serious drug abuse problems. Increasingly, these women have been mandated to drug treatment, often in community-based settings. This article examines the impact of the treatment programs on the short-term post treatment drug use of women offenders (N = 165) leaving two community-based treatment programs in Portland, Oregon. Women who abstained from drug use during the first week after treatment were more likely than those who used drugs during this time to have remained in treatment longer, received a plan to make a successful transition out of treatment, avoided associations with other drug users after leaving treatment, and obtained encouragement from individuals and groups in support of abstinence. In addition, the research identified the importance of community referrals in the short-term for women to maintain sobriety after leaving treatment. The results suggest that community referrals be provided early in the treatment process since many women offenders do not complete treatment. Strauss, S.M., and Falkin, G.P. The First Week after Drug Treatment: The Influence of Treatment on Drug Use among Women Offenders. Am J Drug Alcohol Abuse, 27(2), pp. 241-264, May 2001.
Diversity in Relapse Prevention Needs: Gender and Race Comparisons among Substance Abuse Treatment Patients
Attempts to address high relapse rates following substance abuse treatment have focused on identifying relapse prevention needs and development of subsequent relapse prevention programs. Few studies have examined whether women and African-Americans have unique relapse prevention needs. Research in this area could provide an initial basis for the development of alternative relapse prevention approaches that could be more appropriate for this population. This study examined gender and race differences in psychosocial concerns among patients recruited from substance abuse treatment as potential indicators of relapse prevention needs. Participants (N = 331) completed several questionnaires during their first month of substance abuse treatment. Assessment packets included measures of coping, self-efficacy, resource needs, cravings, social influences, exposure, and leisure activities. Analyses focused on gender and race differences in these variables before and after controlling for background characteristics (i.e., age, marital status, income, polysubstance use, treatment type, and problem severity). Gender differences found were that men reported poorer coping skills and more negative social influences and exposure to substances than women; these differences remained significant when controlling for background characteristics. Significant race differences were found on all scales except negative social influences. After controlling for background characteristics, African-Americans reported significantly greater coping skills and self-efficacy than did Caucasians; however, African-Americans also reported greater resource needs in comparison to Caucasians. Results highlight the diversity in psychosocial issues among substance abusers in treatment, particularly between Caucasians and African-Americans. Implications for developing alternative relapse prevention approaches to address this diversity are discussed. Walton, M.A., Blow, F.C., and Booth, B.M. Diversity in Relapse Prevention Needs: Gender and Race Comparisons Among Substance Abuse Treatment Patients. Am J Drug Alcohol Abuse., 27(2), pp. 225-240, May 2001.
Factors Affecting the Initiation of Substance Abuse Treatment in Managed Care
A long-standing concern of clinicians in addiction treatment is that a large number of individuals who are admitted to treatment do not return to actually begin the program. Authors of the study identified characteristics that predict treatment initiation. In-person structured interviews were conducted with consecutive admissions to a large outpatient program (N = 1204), and the health plan's automated registration data were used to determine treatment attendance. Those who returned to begin treatment were compared with those who did not. The study was conducted at the Chemical Dependency program of a large group model health maintenance organization (HMO). Study subjects were individuals age 18 or over admitted to the program. Study variables included DSM-IV alcohol and drug dependence and abuse, Addiction Severity Index problem severity, motivation and treatment entry measures. Findings indicate that those who were drug-dependent were less likely to begin treatment than those dependent only on alcohol. Measures of motivation, such as work-place pressures and the patient's perception of the importance of alcohol treatment, predicted starting treatment for individuals who were alcohol-dependent only or alcohol- and drug-dependent. Among patients who were dependent only on alcohol, women were more likely than men to start treatment, and for those who were drug-dependent, being employed and having higher drug severity scores predicted starting treatment. In summary, screening at intake may identify those at risk of not returning after admission to start treatment. Clinicians may consider making additional efforts during the intake process to engage individuals who are unemployed and have drug (as opposed to alcohol) disorders and less motivation. Weisner, C., Mertens, J., Tam, T., and Moore, C. Factors Affecting the Initiation of Substance Abuse Treatment in Managed Care. Addiction., 96(5), pp. 705-716, May 2001.
Gender Differences in Cocaine Craving Among Non-Treatment-Seeking Individuals with Cocaine Dependence
The purpose of this pilot study was to evaluate potential gender differences in cocaine craving among non-treatment seekers with cocaine dependence. Investigators examined 10 female and 11 male individuals matched by demographic characteristics and severity of drug use; we used a multidimensional questionnaire that assesses various aspects of craving: (a) current intensity, (b) projected intensity, (c) resistance to use cocaine, (d) responsiveness to drug-related conditioned stimuli, and (e) imagined likelihood of use if in a setting with access to drugs. Other instruments utilized were the Hamilton Rating Scale for Depression and Addiction Severity Index. Female subjects had higher total craving scores (p < .05), with post hoc tests showing more present desire to use cocaine and responsivity to drug-conditioned stimuli, along with lower scores on the desire not to use cocaine. In exploratory analyses, we found greater depressive symptomatology (p = .02) and severity of family/social problems (p = .02) in females than their males counterparts. These results suggest that gender may influence different aspects of cocaine craving. As estrogen is purported to modulate craving-related dopaminergic systems, further studies will be needed to confirm these observed gender differences and to investigate their possible mechanisms, particularly estrogen-dopamine interactions and their effect on craving and mood. Elman, I., Karlsgodt, K.H., and Gastfriend, D.R. Gender Differences in Cocaine Craving Among Non-Treatment-Seeking Individuals with Cocaine Dependence. Am J Drug Alcohol Abuse, 27(2), pp. 193-202, May 2001.
[Previous Report][Index]
|
