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National Institute on Drug Abuse
Women and Sex/Gender Differences Research
Director's Report to Council
Research Findings Excerpts
September, 2003
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Behavioral Research |
Perinatal Lead Exposure and Relapse to Drug-Seeking Behavior in the Rat: A Cocaine Reinstatement Study
Prior work published by Dr. Jack Nation and his colleagues at Texas A&M University has shown that perinatal lead exposure enhances cocaine-induced locomotor sensitization. He now reports that perinatal lead exposure enhances cocaine reinstatement, measured in a paradigm that is regarded to be a preclinical model of drug-seeking and relapse. Female rats were gavaged with either 0 or 16 mg lead prior to mating and this exposure procedure was continued through gestation and postnatal day 21. At postnatal day 120, male offspring were trained to self-administer cocaine. Following acquisition of steady-state responding, cocaine restatement was assessed over a 5-hour session in which cocaine self-administration occurred during the first hour, extinction via replacement of cocaine with saline occurred in hours 2-4, followed by a priming i.p. injection of either 0.00, 5.00, 10.00, or 20.00 mg/kg cocaine with assessment of drug-induced reinstatement in hour 5. During hour 5, both the lead-exposed and non-lead-exposed rats exhibited a dose-related increase in saline responding, indicative of "drug-seeking" behavior elicited by environmental cues previously paired with drug reward. The lead-exposed group, however, exhibited more saline responding than the non-lead-exposed group following priming doses of 5.00 and 10.00 mg/kg. These results indicate that low levels of lead exposure during gestation and lactation are associated with enhanced vulnerability to cocaine relapse in response to reintroduction of the drug cue. In the same paper, Dr. Nation cites unpublished data from his research program showing that adult rats with a history of perinatal lead exposure self-administer more low-dose cocaine than non-lead-exposed rats. The mechanism underlying perinatal lead exposure's effects on cocaine sensitivity and vulnerability in adulthood is not known, but Dr. Nation suggests that it could be mediated by lead's direct effects on maternal behavior or by lead's direct effects on the pups which then modulate maternal behavior. Such early pup/dam behavioral interactions could alter motivational circuits expressed in adulthood as enhanced cocaine vulnerability. In view of human data indicating that lead exposure during pregnancy and lactation can produce significant developmental and neurological abnormalities, the present data are particularly important, especially given that 1999 survey data shows approximately 70% of inner-city children have "unsafe" blood lead levels and that this percentage is even higher for urban minority children. Nation, J.R., Cardon, A.L., Heard, H.M., Valles, R., and Bratton, G.R. Perinatal Lead Exposure and Relapse to Drug-Seeking Behavior in the Rat: A Cocaine Reinstatement Study. Psychopharmacology, 168, pp. 236-243, 2003.
The Effects of Alprazolam and Buspirone in Light and Moderate Female Social Drinkers
Benzodiazepines are prescribed to women almost twice as often as men. Additionally, women are more likely than men to become dependent on sedatives. Ongoing laboratory-based research by Dr. Suzette Evans and her colleagues at Columbia University is investigating sub-populations of women who may be at risk for anxiolytic abuse. One such population is moderate social drinkers. Several laboratory-based studies have shown a relationship between the positive reactions to the anxiolytic diazepam (a benzodiazepine) and degree of alcohol use. Those studies, however, did not examine data separately for females nor did they control for a family history of alcoholism. In the present study, Dr. Evans and her colleagues compared the subjective and cognitive/motor performance reactions to the anxiolytic benzodiazepine alprazolam (0.25, 0.50, 0.75 mg) in 14 female light social drinkers who consumed four drinks per month and 14 female moderate social drinkers who consumed 36 drinks per month. All subjects were non-drug abusing, without substance abuse problems, and had no first- or second-degree family history of alcoholism. Buspirone (5, 10, 15 mg), a non-benzodiazepine anxiolytic of low abuse liability and minimal performance effects, was studied as a comparison drug. The researchers found that the two anxiolytics produced similar cognitive/motor impairment. The impairment was dose-related for alprazolam, but not buspirone. Both anxiolytics produced greater "Drug Liking" and "Good Drug Effect" in moderate drinkers than in light drinkers. The moderate drinkers, but not the light drinkers, however, also reported more positive reactions to the placebo. These data suggest that female social drinkers may be more likely have enhanced psychoactive drug expectancies and to report positive subjective reactions that can contribute to vulnerability for addiction. Evans, S.M. and Levin, F.R. The Effects of Alprazolam and Buspirone in Light and Moderate Female Social Drinkers. Behavioural Pharmacology, 13, pp. 427-439, 2002.
Effects of THC on Behavioral Measures of Impulsivity in Humans
Drugs of abuse have been associated with poorly controlled, maladaptive behaviors that have been described as impulsive. Research on the effects of drugs of abuse on impulsive behavior has been hampered, in part, because there is no universally accepted measure of impulsivity. The purpose of the present study was to examine the effects of THC on four behavioral measures of impulsivity in male and female recreational marijuana users. The four tasks were: The Stop task, which measures the ability to inhibit a prepotent motor response; a Go/No-Go task, which involves reward/punishment conflict and the ability to inhibit a punished response; a Delay Discounting task, which measure the value of delayed or uncertain reinforcers; and a Time Estimation task, which measures alterations in time perception. Subjects also completed mood questionnaires and general measures of performance. Results indicated that THC produced increases in euphoria and responses on the marijuana scales of the ARCI (Addiction Research Center Inventory). In addition, THC increased impulsive responding on the Stop task, but had no effect on the Go/No-Go task or the Delay Discounting task. THC decreased patterns of impulsive responding on the Time Estimation task. There were no effects of gender alone or in interaction with the four tasks. There were no significant correlations among the four measures of impulsivity, suggesting that multiple processes underlie impulsive behavior, and that THC affects some, but not all, of these processes. These findings emphasize the importance of using multiple measures when investigating impulsive behavior. To say that drugs of abuse affect impulsivity, without specifying how impulsivity is measured, may not give an accurate or meaningful description of the drug's effects. Mcdonald, J., Schleifer, L., Richards, J.B., and deWit, H. Effects of THC on Behavioral Measures of Impulsivity in Humans. Neuropsychopharmacology, 28, pp. 1356-1365, 2003.
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Treatment Research and Development |
Comparative Profiles of Women with PTSD and Comorbid Cocaine or Alcohol Dependence
Drs. Back, Sonne, Killeen, Dansky, and Brady, at the Medical University of South Carolina examined the differences in substance abuse severity, trauma history, posttraumatic stress disorder (PTSD) symptomatology and psychiatric comorbidity among treatment-seeking women (N=74) with PTSD and either comorbid cocaine or alcohol dependence. Women in the cocaine/PTSD group, compared with the alcohol/PTSD group, demonstrated greater occupational impairment (e.g., greater severity on the employment subscale of the Addiction Severity Index, less monthly income, fewer days worked in the past month), more legal problems (e.g., greater number of months incarcerated and arrests for prostitution), and greater social impairment (e.g., fewer number of close friends, less likely to be married). Women in the alcohol/PTSD group evidenced higher rates of exposure to traffic accidents, other situations involving serious injury, and other stressful life events. Rates of major depression and social phobia were higher among the alcohol/PTSD group than the cocaine/PTSD group. Women in the alcohol/PTSD group scored higher on the CAPS avoidance, hyperarousal, and total subscale scores. These findings enhance our understanding of the substance-specific profiles of women with PTSD and comorbid substance use disorders, and may have important implications for the design of treatment interventions for substance abusing women with co-occurring psychiatric disorders. Back, S.E., Sonne, S.C., Killeen, T., Dansky, B.S., and Brady, K.T. American Journal of Drug and Alcohol Dependence, 29(1), pp. 169-189, 2003.
Pregnant Women With Drug-Using Partners Have Poorer Treatment Outcomes
Hendree Jones and a colleague at Johns Hopkins University School of Medicine surveyed pregnant women enrolled in a comprehensive treatment program for addiction regarding their male partners and found that 50% of their partners used drugs. Additionally, results showed that male drug-using partners had more unemployment, current legal involvement and less education than drug-free partners. Additionally, male drug-using partners were less likely to be supportive of the pregnant woman's recovery efforts and more likely to give them money to buy drugs. Treatment retention data indicated that women with drug-using partners are retained in treatment for a shorter time. Findings suggest treatments that target the drug-using male partners may improve treatment outcomes for women with such partners. Tuten, M. and Jones H.E. A Partner's Drug-Using Status Impacts Women's Drug Treatment Outcome. Drug and Alcohol Dependence, 70 (1), pp. 327-330, 2003.
Wives of Substance-Abusing Men are at Risk of Exposure to HIV
Dr. Fals-Stewart and colleagues at the Research Institute on Addictions and the San Diego VA Medical Center assessed the HIV risk behaviors of 144 men in treatment for substance abuse and their wives. Almost all wives (96%) reported having sexual intercourse with their husbands during the year before treatment, and of these, 78% reported not regularly using condoms during intercourse. Of all husbands in the study, 40% reported engaging in risky behaviors, including having unprotected sex with a partner other than their wives, and/or engaging in risky needle practices. Almost three-fourths of wives (71%) reported they were not aware of their husbands' risky behaviors, and so unknowingly were at indirect risk for HIV. These results suggest the need for effective HIV risk reduction strategies for married couples in which husbands abuse drugs. Fals-Stewart, W., Birchler, G.R., Hoebbel, C., Kashdan, T.B., Golden, J., and Parks, K. An Examination of Indirect Risk of Exposure to HIV among Wives of Substance-abusing Men. Drug and Alcohol Dependence, 70, pp. 65-76, 2003.
Gambling Behavior in Adolescent Substance Abusers
Dr. Kaminer and colleagues from the University of Connecticut assessed the gambling behavior of 97 adolescents receiving outpatient treatment for substance use disorders. In this sample, 34% had never gambled, 57% were classified as non-pathological gamblers, 8% were identified as "in transition" gamblers, and 1% met criteria for pathological gambling. Adolescent boys were more likely to gamble than girls, and younger age of onset of gambling behavior was associated with being female, history of suicide attempts, more symptoms of Cluster B personality disorders, and other factors. Importantly, none of the gambling adolescents had ever been referred for treatment. While these findings suggest that the prevalence of gambling behavior among substance abusing adolescents is similar to a non-substance abusing population, they also suggest that identification and treatment of problematic gambling behavior is not being adequately addressed for this population. Kaminer, Y., Burleson, J.A.and Jadamec, A. Gambling Behavior in Adolescent Substance Abusers. Substance Abuse, 23, pp. 191-198, 2002.
Depression is Not Necessarily Counter-Indicative for Smoking Cessation
Dr. Hitsman and colleagues at Brown University completed a meta-analysis study to determine if smokers with a lifetime history of depression are less likely to be successfully treated to quit smoking than those who have no history of depression. Fifteen studies of 2,984 smokers published between 1966-2000 included assessments of both history of depression and smoking cessation outcome. Only two of thirteen studies showed a significant association between history of depression and abstinence of three months or less; only one of twelve showed that history of depression was associated with abstinence of six months or more. In addition, the depression-abstinence association did not differ between females and males at either time point. Hitsman, B., Borelli, B., McCargue, D.E., Spring, B., and Niaura, R. Journal of Consulting and Clinical Psychology, 71(4), pp. 657-663, 2003.
Sex Differences were Found in Limbic Responsiveness Using a Procaine Challenge and Assessed by SPECT
Dr. Adinoff and colleagues at University of Texas Southwestern Medical Center administered procaine by slow intravenous infusion to healthy female and male volunteers (controls for other studies) and compared the resultant stimulation to saline infusion. In between group comparisons of the relative increases in regional cerebral blood flow, females had a significantly greater increase in the left amygdala while males had a significantly greater increase in the left insula and marginally greater increase in the right insula. In both instances, the significant increase was relative since both males and females had significant increases following procaine relative to saline for females the increase was considerable greater in the amygdala while in males it was in the insula. Subjective differences to the procaine were assessed but were not found to be different between the sexes. This study is among the first to demonstrate differential limbic responsiveness to pharmacological challenge. It remains to be demonstrated whether this reflects the differential emotional responses often reported in the literature. Adinoff, B., Devous, M.D., Sr., Best, S.E., Chadler, P., Alexander, D., Payne, K., Harris, T.S., and Williams, M.J. NeuroImage,18, pp. 697-706, 2003.
Nicotine Withdrawal and Depressive Symptomatology during Short-Term Smoking Abstinence: A Comparison of Postmenopausal Women Using and Not Using Hormone Replacement Therapy
This study investigated whether taking medications for transdermal hormone replacement therapy (HRT) influenced smoking-cessation variables in postmenopausal women undergoing short-term abstinence from cigarettes. Women were recruited into two groups according to their pre-enrollment medication status--those currently on HRT (n = 17) or those not on HRT (n = 13). The HRT group had their previous medication replaced with a standard 0.1 mg estradiol transdermal system and 2.5 mg of Cycrin daily. After 2 weeks of medication adjustment, participants continued smoking as usual for 1 week, at which time baseline measurements were taken. Participants were then instructed to quit smoking for the remaining 2 weeks. They were provided with smoking-cessation counseling and monitored for abstinence. Data were collected during five clinic visits on all dependent measures: Minnesota Nicotine Withdrawal Scale, Beck Depression Inventory (BDI) scale, Profile of Mood States, Motor Speed Tasks, and Reaction Time Test. Contrary to our hypothesis, the exogenous hormone use did not have a differential effect on most of the dependent variables during the first 2 weeks of smoking abstinence. One exception was depressive symptomatology: the BDI change scores (week 2 - baseline) differed significantly for the HRT and non-HRT groups (p = .045), with women in the HRT group experiencing an increase in depressive symptomatology. This finding, though preliminary, may have clinical implications for postmenopausal women who attempt to quit smoking while on HRT, particularly since depressed mood following abstinence is associated with a relapse to smoking. Allen, S.S., Hatsukami, D.K. and Christianson, D. Nicotine Withdrawal and Depressive Symptomatology During Short-Term Smoking Abstinence: A Comparison of Postmenopausal Women Using and Not Using Hormone Replacement Therapy. Nicotine. Tob. Res., 5, pp. 49-59, 2003.
Effect of Maternal Smoking on Fetal Catecholamine Concentrations at Birth
Pregnant women who were self-identified as smokers (>/=10 cigarettes per day throughout pregnancy) or nonsmokers were recruited for study participation. Maternal blood was collected for cotinine concentrations. Umbilical artery cord blood was collected at delivery for arterial pH and catecholamine concentrations. Cord blood was obtained from 51 subjects, including 21 smokers and 30 nonsmokers. Median epinephrine concentrations [304 pg/mL versus 597 pg/mL (Mann-Whitney U = 170; p = 0.006)] and median norepinephrine concentrations [3148 pg/mL versus 6558 pg/mL (Mann-Whitney U = 191; p = 0.006)] were significantly lower in smokers compared with nonsmokers, respectively. After controlling for gestational age, route of delivery, and arterial pH, log-transformed epinephrine concentrations between smokers and nonsmokers were statistically significant (p = 0.03), with a similar trend for log-transformed norepinephrine concentrations (p = 0.07). Analyses of the data using cotinine <20 ng/mL to classify nonsmokers also showed differences in epinephrine concentrations between groups (p = 0.02). These results are consistent with results from animal studies showing that catecholamine concentrations may be affected by prenatal nicotine exposure. Further studies are needed to validate these findings and to examine the specific mechanism by which these differences may arise. Oncken, C.A., Henry, K.M., Campbell, W.A. et al. Effect of Maternal Smoking on Fetal Catecholamine Concentrations at Birth. Pediatr. Res., 53, pp. 119-124, 2003.
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Research on AIDS and Other Medical Consequences of Drug Abuse |
AIDS Research
Prevalence of and Risk Factors for Viral Infections Among Human Immunodeficiency Virus (HIV)-Infected and High-Risk HIV-Uninfected Women
Viruses that can persist in the host are of special concern in immunocompromised populations. Among 871 human immunodeficiency virus (HIV)-infected and 439 high-risk HIV-uninfected women, seroprevalences of cytomegalovirus, hepatitis B virus, hepatitis C virus, and herpes simplex virus types 1 and 2 and prevalence of human papillomavirus DNA in cervicovaginal lavage fluids were all >50% and were 2-30 times higher than prevalences in the general population. Prevalences were highest among HIV-infected women, of whom 44.2% had >or=5 other infections, and were relatively high even among the youngest women (age 16-25 years). In multivariate analyses, viral infections were independently associated not only with behaviors such as injection drug use and commercial sex but also with low income, low levels of education, and black race. Disadvantaged women and women who engage in high-risk behaviors are more likely to be coinfected with HIV and other viruses and, thus, may be at high risk of serious disease sequelae. Stover, C.T., Smith, D.K., Schmid, D.S., Pellett, P.E., Stewart, J.A., Klein,,R.S., Mayer, K., Vlahov, D., Schuman, P. and Cannon, M.J. HIV Epidemiology Research Study Group. J Infect Dis., 187(9), pp. 1388-1396, May 1, 2003. Epub April 15, 2003.
Clinical and Immunologic Progression in HIV-Infected US Women Before and After the Introduction of Highly Active Antiretroviral Therapy
The objective of this study was to examine factors associated with clinical and immunologic HIV disease progression in a cohort of US women. Data from a prospective, longitudinal, case-control study of HIV-infected women followed every 6 months for 7 years in four urban clinical centers in the United States were analyzed. Participants were 648 HIV-infected women who did not have AIDS at time of entry into the study. Structured clinical and behavioral interviews, protocol-directed physical examinations, CD4 lymphocyte counts, plasma HIV RNA, and infectious pathogen serologies were performed. With 2304 women-years of follow-up, 46.1% of the women developed AIDS; however, 93.3% of the diagnoses were based on CD4 counts dropping to <200 cells/mm3. Only 10.6% of the women with CD4 counts <200 cells/mm3 developed an opportunistic infection. Baseline CD4 count was the strongest predictor of subsequent clinical progression. Illicit substance use, multiple pregnancies, demographic variables, and other infections were not associated with progression. Among women with CD4 counts >500 cells/mm3 at baseline, those who were anemic or had hepatitis C were more likely to progress to AIDS. By the end of the study, only 52% of the participants were on highly active antiretroviral therapy (HAART). Despite underutilization of HAART in this multicenter cohort of urban women, opportunistic infections were uncommon, despite CD4 declines. Mayer, K.H., Hogan, J.W., Smith, D., Klein, R.S., Schuman, P., Margolick, J.B., Korkontzelou, C., Farzedegan, H., Vlahov, D. and Carpenter, C.C. HIV Epidemiology Research Study (HERS) Group. J Acquir Immune Defic Syndr. 33(5), pp. 614-624, August 15, 2003.
Home Intervention for Mothers and their Drug-Exposed Infants
This longitudinal randomized cohort study assessed the effects of a home intervention and ongoing maternal drug use on developmental outcomes of drug-exposed infants. Participants included 108 low-income, inner-city, drug-exposed children and their biological mothers (control, 54; intervention, 54). Results suggest that, compared to control infants, intervention infants had significantly higher Bayley Scales of Infant Development (BSID) Mental Development Index (MDI), and BSID Psychomotor Developmental Index (PDI) scores during the first 18 months post partum. Furthermore, ongoing maternal drug use was associated with worse developmental outcomes for both groups. Schuler, M.E., Nair, P., and Kettinger, L. Drug Exposed Infants and Developmental Outcome: Effects of a Home Intervention and Ongoing Maternal Drug Use. Archives of Pediatrics & Adolescent Medicine, 157, pp. 133-138, 2003.
Intervention Response Rates Among Drug-using Women
Injection drug users (IDUs) who also smoke crack may be at greatest risk for infection with HIV as well as other blood-borne and sexually transmitted infections and in most need of positive behavioral changes. In this study, researchers randomly assigned 333 women (aged 18-59 years) to one of two enhanced gender- and culturally specific HIV intervention conditions or to the NIDA standard condition. Of primary interest were baseline risk and intervention response rates among three groups of drug users--IDUs who did not smoke crack, IDUs who did smoke crack, and crack smokers who did not inject. Using univariate and multivariate methods, including generalized estimating equations, the study found that the intervention produced positive behavioral changes over time, but that response rates varied according to drug-using group. Women in the crack smoking IDU group were found to be less responsive to the intervention than women in the other drug-using groups, and participants in the crack smoking only group were less responsive than those in the IDU only group. These findings indicate that there is a continuing need to develop and target improved, effective interventions to particular subgroups of high-risk individuals who may be most resistant to change. Sterk, C., Theall, K. and Elifson, K. Who's Getting The Message? Intervention Response Rates Among Women Who Inject Drugs and/or Smoke Crack Cocaine. Prev Med., 37(2), pp. 119-128, August 2003.
HIV Prevalence, Risk Behaviors, and High-Risk Sexual and Injection Networks Among Young Women Injectors Who Have Sex With Women
Women who inject drugs and have sex with women constitute 20% to 30% of American women IDUs. Compared with other women IDUs, this group has higher prevalence and incidence of HIV, and a greater likelihood of engaging in high-risk injection and sexual practices with men. In this study, researchers examined HIV risk among women who inject drugs and have sex with women, and compared their social situations, injection and social networks, and behaviors with those of other young women IDUs. A sample of 803 women IDUs was recruited from 5 U.S. cities between July 1997 and March 1999, of which 274 reported having had sex with a woman in the past 6 months or identifying as lesbian or bisexual. Compared to the other women IDUs, those who had sex with women were more likely to have been recently homeless, to have ever been institutionalized in a mental health facility, and to have been incarcerated. They were more likely to receive most of their income from selling sex than from other sources. Women who inject drugs and have sex with women were more likely to have injected drugs with a person who was HIV positive, and to be positive for hepatitis B and HIV (but not hepatitis C, chlamydia, or gonorrhea), in high prevalence but not low prevalence sites. They were also more likely to have engaged in receptive syringe sharing, and to have shared rinse water. These differences cannot be accounted for by their greater involvement in sex work. The findings show that sexual identity and sex between women are important in studies of women drug users, and may help explain variations in homelessness, institutionalization, behavior, networks, and infection rates. Friedman, S.R., Ompad, D., Maslow, C., Young, R., Case, P., Hudson, S., Diaz, T., Morse, E., Bailey, S., Des Jarlais, D., Perlis, T., Hollibaugh, A. and Garfein, R. HIV Prevalence, Risk Behaviors, and High-Risk Sexual and Injection Networks Among Young Women Injectors Who Have Sex With Women. Amer J Public Health, 93, pp. 902-906, 2003.
Violence, Homelessness, and HIV Risk Among Crack-Using African-American Women
This study compares the characteristics of out-of-treatment, homeless, crack-using African-American women with those who are not homeless to determine what risks and protective factors differentiate the two groups. From 1999 to 2001, researchers interviewed and serologically tested 683 out-of-treatment, African-American crack-using women (of whom 219 were categorized as homeless). They examined risk factors (adverse childhood experiences, psychological distress, physical health, violence and victimization, drug use, and risky sex behaviors) as well as protective factors (marital status, education, public assistance, and the responsibility of caring for children). Overall, both groups of women started crack use in their mid-twenties and started drug use with alcohol in their teenage years, though differed significantly on each risk factor examined. Logistic regression analysis found that variables associated with increased odds of being homeless are physical abuse before age 18, crack runs greater than 24 hours, income less than 500 dollars in the last 30 days, depression, and current cigarette smoking. Protective factors found are marital status, living with children under 18, having had a physical in the past year, and receiving money from welfare in the last 30 days. Being sexually assaulted in the past 90 days was marginally associated with homelessness in the model. These findings, specific to crack-using African-American women, suggest that not only do these women overall report painful histories and currently stressful lives, but homeless women are more likely than women who are not homeless to have experienced childhood abuse and are more involved with drug use. Interventions designed for these women need to consider gender, cultural, and contextual issues that not only incorporate aspects of risk reduction related to violence, alcohol use, and comorbid conditions, but also linkages that will address housing issues, education, and skills for independence. Wechsberg, W., Lam, W., Zule, W., Hall, G., Middlesteadt, R. and Edwards, J. Violence, Homelessness, and HIV Risk Among Crack-Using African-American Women. Subst Use Misuse, 38(3-6), pp. 669-700, February-May 2003.
HIV Risk Behaviors Among Older American Drug Users
Despite increasing numbers of Americans older than 50 years of age, little is known about the impact of HIV/AIDS on aging drug users. The current study assesses the drug-related and sex-related HIV risk behaviors of older and younger injection drug users and crack smokers. Structured interview responses from 1508 out-of-treatment active drug users older than 50 years of age were compared with those of 1515 out-of-treatment active drug users who were 50 years old or younger. Comparisons were also made within the older cohort to examine differences in risk behaviors between crack smokers and nonsmokers, men and women, and users older than 60 years of age and those in their 50s. Results indicated that although older drug users (older than 50 years of age) were less likely to have had sex in the prior month, those who did were as risky as their younger counterparts with regard to sex-related risk behaviors. They were, however, significantly less risky in their needle sharing practices than those 50 years old or younger. Among the older cohort, those who smoked crack were extremely risky. Men older than 50 years of age were riskier than women older than 50 years of age; however, users older than 60 years of age were no less risky than those in their 50s. The findings show that interventions designed for older drug users should focus on sex risk behaviors, especially among those who smoke crack. Kwiatkowski, C. and Booth, R. HIV Risk Behaviors Among Older American Drug Users. JAIDS, 33 (Supplement 2), S131-S137, June 1, 2003.
Safer Sex by Type of Relationship Following an HIV Intervention Among Women
Predictors of increased male condom use were investigated following a recent, gender-specific HIV intervention among African-American women. Data were analyzed from 138 women (aged 18 to 59), recruited from inner-city Atlanta neighborhoods. Predictors of condom use with steady and casual paying partners were examined separately. Increased condom use with steady partners was associated with drug-using status, intervention assignment, sexual relationship characteristics, age at first condom use, and HIV testing history. An increased ability to communicate openly and honestly with one's sex partner was another partner-specific factor that predicted increased condom use over time. Condom use with casual paying partners was associated with having sex while high and the frequency of crack cocaine use. Personalized norms regarding condom use were not salient factors in predicting increased rates of condom use with either partner type. These findings indicate the continued need to consider sex in the context of drug use, and reveal the importance of measuring such influences and all antecedents of condom use separately for steady vs. casual sexual relationships. Theall, K., Sterk, C. and Elifson, K. Male Condom Use by Type of Relationship Following an HIV Intervention Among Women Who Use Illegal Drugs. J Drug Issues, pp. 1-28, 2003.
Religiosity and HIV Risk Behavior Among "At Risk" Women
During the past decade, increased attention has been given to the role that religious and faith-based organizations can play in enhancing health behaviors. In this study, researchers examined the role that religiosity plays in women's involvement in HIV risk behaviors. They analyzed data from an intergenerational drug use study with 250 mother/daughter dyads, collected from August 1997 to August 2000 in Atlanta, Georgia. Three measures of religiosity were used: frequency of attending worship services, belief in the role of religion in influencing personal behavior, and an interaction term that combined these 2 variables. They found that religiosity was a strong predictor of women's involvement in HIV-related risky behaviors, even when the effects of other demographic/background variables, childhood maltreatment experiences, psychosocial measures, experiences and relationships with other persons, exposure to substance abusers, and condom related beliefs and attitudes were considered. The more frequently women attended worship services and the more influential they perceived their religion to be on their behaviors, the less involved they tended to be in HIV-related risky behaviors. Elifson, K., Klein, H., and Sterk, C. Religiosity and HIV Risk Behavior Involvement Among At Risk' Women. J Religion and Health, 42(1), pp. 47-65, Spring 2003.
Perceived Temptation To Use Drugs And Actual Drug Use Among Women
Much research has been conducted to examine the relationship between various psychological and psychosocial factors and substance use/abuse. Where as such topics as depression, bipolar disorder, anxiety, self-esteem, optimism/pessimism, coping, and stress/tension have been studied fairly extensively others have received much less attention. One such understudied psychosocial factor is perceived level of temptation to use drugs under specified circumstances. This research is based on a study of 125 adult women drug users residing in the Atlanta, Georgia metropolitan area, interviewed between August l997 and August 2000. Street outreach efforts were used to identify potential study participants, with further expansion of the sample done via targeted sampling and ethnographic mapping procedures. The present study examines 16 specific items assessing temptations to use drugs. After describing which circumstances people think will be most likely to bring about greater illegal drug usage, the authors compare perceptions to actual drug use behaviors. Multivariate analyses are conducted to examine the role that perceived temptations to use drugs play in predicting actual drug use when the effects of demographic variables, background experiences, childhood maltreatment experiences, other psychosocial measures, and exposure to substance abusers are taken into account. A multivariate model explaining nearly one-half of the variance in actual drug abuse is derived, and retained several of the temptations-to-use-drugs items. Klein, H., Elifson, K.W. and Sterk, C.E Journal of Drug Issues, pp. 161-192, 2003.
Effectiveness Of A Risk Reduction Intervention Among African American Women Who Use Crack Cocaine
The primary objective of this study was to evaluate the effectiveness of an HIV intervention for African American women who use crack cocaine. Two hundred sixty-five women (aged 18-59 years) were randomly assigned to one of two enhanced intervention conditions or to the national institute on drug abuse standard condition. A substantial proportion of women reported no past 30-day crack use at 6-month follow-up (100%-61%, p <.001). Significant (p < .05) decreases in the frequency of crack use; the number of paying partners; the number of times vaginal, oral, or anal sex was had with a paying partner; and sexual risks, such as trading sex for drugs, were reported over time. Significant (p < .05) increases in male condom use with sex partners were observed, as well as decreases in casual partners' refusal of condoms. Findings suggest that combined components of our culturally appropriate, gender-tailored intervention may be most effective at enhancing preventive behavior among similar populations. Sterk, C.E., Theall, K.P. and Elifson, K.W. AIDS Education and Prevention, 15(1), pp. 15-32, 2003.
HIV Risk Reduction Among African-American Women
Who Inject Drugs: A Randomized Controlled Trial A community-based HIV intervention for African-American women who are active injection drug users (IDUs) was evaluated. Seventy-one women (aged 20-54 years) were randomly assigned to one of two enhanced gender- and culturally specific intervention conditions or to the NIDA standard condition. Substantial decreases (p < .001) were found in the frequency of drug use and the frequency of drug injection as well as in the sharing of injection works or water and the number of injections. Trading sex for drugs or money, having sex while high, as well as other sexual risk behaviors were also reduced significantly. Furthermore, women in both enhanced intervention conditions were more likely to reduce their drug-using and sexual risk behaviors than were women in the standard condition. Results indicate the value of including additional components in interventions designed to reduce the risk of infection with HIV among women who inject drugs. Sterk, C.E., Theall, K.P., Elifson, K.W., and Kidder, D., AIDS and Behavior, 7(1), pp. 73-85, March 2003.
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Research on AIDS and Other Medical Consequences of Drug Abuse |
Non-AIDS Research
Welfare and Work Outcomes after Substance Abuse Treatment
Employment and welfare outcomes are investigated for women who received both welfare and substance abuse treatment in Florida from 1994 to 1999. By linking information from three statewide administrative databases, the authors identify 4,236 women who meet both criteria. Over the study period, there was a significant increase in the proportion of women moving from welfare to work. Predictors of post treatment employment include demographic characteristics, treatment related characteristics, and working during the month of admission. Both completion of treatment and length of time in treatment are associated with employment. Metsch, L.R., Pereyra, M., Miles, C. and McCoy, C.B. Social Service Review, 77(2), pp. 2003.
Chronic Drug Use and Reproductive Health Care among Low-Income Women in Miami
In this study, researchers interviewed a stratified, network-referred sample of chronic drug-using women (CDUs) and socially and ethnically similar women who were not CDUs about reproductive health issues. Women who were not CDUs were significantly more likely to report a regular source of health care than CDUs. About one third of each group reported experiencing reproductive health problems (other than pregnancy) in the 12 months preceding their interview. Chronic drug users were twice as likely to report that these problems remained untreated. Measures of use of preventive services (physical exam, breast exam, pelvic exam, family planning visit) consistently showed lower use by CDUs. A higher proportion of women who were not CDUs reported pregnancies in the 12 months preceding interview. The 32 pregnant CDUs were much less likely to have received prenatal care than the 42 pregnant women who were not CDUs. For women who reported a pregnancy in the year preceding interview, logistic regression analysis showed a strong and robust negative effect of being a CDU on receiving prenatal care even when the effects of having a usual source of care and having third-party coverage were controlled. Crandall, L., Metsch, L., McCoy, C., Chitwood, D. and Tobias, H. Chronic Drug Use and Reproductive Health Care among Low-Income Women in Miami, Florida: A Comparative Study of Access, Need, and Utilization, J Behav Health Serv Res., 30(3), pp. 321-331, July-September 2003.
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Epidemiology, Etiology and Prevention Research |
HIV and AIDS Risk Behaviors in Juvenile Detainees
Detained youth may be at especially high risk for contracting HIV and AIDS. This study reports on the rates of HIV and AIDS sexual and drug risk behaviors among a group of juvenile detainees participating in the Northwestern Juvenile Project. Participants in this longitudinal study included 1829 youth (age 10-18) initially arrested and detained between 1995 and 1998 at the Cook County Juvenile Temporary Detention Center in Chicago, Ill. The random sample was stratified by gender, race/ethnicity, age, and charge severity. Information related to HIV and AIDS risk behavior was collected on 800 participants from the larger study. Results indicate 95% of the detained youth report engaging in 3 or more sexual and drug risk behaviors, and 65% report engaging in 10 or more risk behaviors. More than 90% of the males were sexually active; 61% had more than one sexual partner in the last three months. Significantly more males than females report engaging in the sexual risk behaviors examined in this study. No significant gender differences were found in the self-report data related to drug risk behaviors. Regarding race/ethnicity: African American males report engaging in significantly more sexual risk behaviors, although non-Hispanic Whites and Hispanics report participating in more drug risk behaviors. Among females, significantly more non-Hispanic Whites than African Americans or Hispanics report engaging in sexual risk behaviors, while Non-Hispanic Whites and Hispanics report participating in more drug risk behaviors. Over 50% of juveniles age 10-13 report engaging in both sexual and drug risk behaviors. These findings highlight the importance of developing effective sexual and drug-related HIV/AIDS risk reduction interventions for youth in the juvenile justice system. Teplin, L.A., Mericle, A.M., McCelland, G.M., and Abram, K.M. HIV and AIDS Risk Behaviors in Juvenile Detainees: Implications for Public Health Policy. American Journal of Public Health, 93(6), pp. 906-912, 2003.
Race/Ethnic Differences in the Effects of Cumulative Adversity on Drug Dependence in Young Adults
This study assesses the effects of cumulative exposure to stressors as a risk factor for drug dependence, and evaluates whether race/ethnic differences in exposure to stressful events contributes to race/ethnic differences in prevalence of drug dependence. Data were analyzed cross-sectionally from a community survey of lifetime adverse experiences and substance and psychiatric disorders among young adults. Data were collected between 1997-2000 in Miami-Dade County, Florida. The sample size is 1,803 former Miami-Dade Public School students, 93% of whom were between ages 19 and 21 when interviewed. Males and females of Cuban origin, other Caribbean basin Hispanics, African-Americans, and non-Hispanic Whites are equally represented. Drug dependence disorder was assessed by DSM-IV criteria using the Composite International Diagnostic Interview, and a 41-item checklist of lifetime exposure to major and potentially traumatic experiences were used to measure cumulative adversity. Both measures include age at time of first occurrence. The lifetime rate of drug dependence disorder (total 14.3%) did not vary significantly (p>.05) by socioeconomic group. The rate for males (17.6%) was significantly greater than female rate (10.9%). The African-American rate (6.5%) was dramatically lower than non-Hispanic White (17.0%), Cuban (18.1%) and non-Cuban Hispanic (16.0%) rates despite their dramatically higher exposure to adversity. Twenty eight of 33 individual adversities were associated with the subsequent onset of drug dependence (p<.05). Cumulative lifetime exposure was greatest for males and for African-Americans, and was inversely associated with socioeconomic level. Multivariate discrete-time event history analysis revealed significant independent effects of distal (>1 year earlier) and proximal (previous year) exposure to adverse events (p<.05), controlling for childhood conduct disorder, ADHD, and prior psychiatric disorder. Lifetime cumulative exposure to distant as well as more recent adversity predicts risk of subsequent drug dependence, though it does not explain ethnic group differences in risk. Implications are that distal and proximal stressful events should both be included when measuring stress exposure. Turner, R.J. and Lloyd, D. Cumulative Adversity and Drug Dependence in Young Adults: Racial/Ethnic Contrasts. Addiction, 98, pp. 305-315, 2003.
Antisocial Behavior Impairs Emotion Regulation among Cocaine-Using Women
This study examined the relation between deficits in affect regulation and adult antisocial behavior (ASB) in a sample of 80 inner-city crack/cocaine-using women. Retrospective narrative early memories were coded for two components of affect regulation, affect tolerance and affect expression, using the Epigenetic Assessment Rating Scale. Analyses compared the affect regulation measures among primary crack/cocaine-using women with and without ASB, as measured by the adult criteria of antisocial personality disorder. Findings revealed that women with ASB had significantly poorer capacity for affect tolerance and affect expression than women without ASB. Litt, L.C., Hien, D.A.and Levin, D. Psychology of Women Quarterly, 27(2), pp. 143-152, 2003.
Emotion-Focused Coping as a Mediator of Maternal Cocaine Abuse and Antisocial Behavior
This study examined the links between maternal drug use and antisocial behavior in a case-control study of 279 inner-city mothers in 3 comparison groups: drug abusers, (n = 112), depressed mothers (n = 73), and nonsubstance abusing controls (n = 94). Using hierarchical regression techniques and mediational analyses controlling for ethnicity, current depression, and family history of substance abuse, support was provided for an emotion-focused coping style as a link between addictive and antisocial behavior. These results highlight the importance of focusing on emotion regulation models in the prevention and treatment of violence in drug-abusing women. Hien, D.A. and Miele, G.M. Emotion-Focused Coping as a Mediator of Maternal Cocaine Abuse and Antisocial Behavior. Psychology of Addictive Behaviors, 17(1), pp. 49-55, 2003.
Maternal Correlates of Toddler Insecure and Dependent Behavior
The present study was designed to examine the relationship between characteristics of mothers' and toddlers' insecure and dependent behavior. Two hundred fifty-four 2-year-old toddlers and their mothers were studied using a structured questionnaire administered to the mothers in their homes. The extent to which insecure and dependent behavior is related to the domains of maternal personality traits, maternal drug use, maternal child rearing, and parental marital relations was assessed. Using Pearson correlations and hierarchical multiple regression analyses, the maternal child-rearing and maternal personality domains were found to have a direct effect on the toddlers' insecure and dependent behavior. The maternal child-rearing domain also served as a mediator for the domains of the parents marital/partner relations, maternal personality attributes, and maternal drug use. There was also evidence suggesting an indirect effect of maternal personality attributes on the toddlers insecure and dependent behavior, which is mediated by the domain of maternal child-rearing practices. Implications for the prevention of insecure and dependent behavior in toddlers are discussed. Brook, J.S., Brook, D.W., and Whiteman, M. Maternal Correlates of Toddler Insecure and Dependent Behavior. Journal of Genetic Psychology, 164(1), pp.72-87, 2003.
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Prevention Research |
Father Absence and Risk for Early Sexual Activity and Teenage Pregnancy
The impact of father absence on early sexual activity and teenage pregnancy was investigated in longitudinal studies in the United States and New Zealand. In both studies girls were studied prospectively from age 5 until age 18. Results from both datasets revealed that greater exposure to father absence was strongly associated with elevated risk for early sexual activity and adolescent pregnancy. After controlling for important covariates, there was a stronger and more consistent relationship between father absence and early sexual activity and teenage pregnancy than on other behavioral and mental health problems or academic achievement. Ellis, B.J., Bates, J.E., Dodge, K.A., Fergusson, D.M., Horwood, L.J., Pettit, G.S. and Woodward, L. Does Father Absence Place Daughters at Special Risk for Early Sexual Activity and Teenage Pregnancy? Child Development, 74, pp. 801-821, 2003.
Life Skills Training Program Outcomes in a Rural, Midwest Youth Population
The purpose of this study is to extend earlier research by evaluating the effect of the Life Skills Training (LST) school-based preventive intervention on substance initiation and two related constructs, expectancies and refusal intentions, in a rural, Midwestern sample. The 15-session LST program (which is based on social cognitive/learning theory and problem behavior theory) was implemented during classroom periods by trained teachers using interactive teaching techniques. All seventh-grade students in 24 participating schools were recruited for participation in the study, and a total of 847 students were included in the growth curve analysis. The pretest, posttest, and follow-up assessments were conducted during the fall of the seventh grade, the spring of seventh grade, and the spring of eighth grade, respectively. The intervention significantly slowed the rate of increase in substance initiation and significantly slowed the rate of decrease in refusal intentions in both males and females. Notably, a stronger intervention effect was detected for females with regard to the rate of decrease in refusal intentions. Trudeau, L., Spoth, R., Lillehoj, C., Redmond, C., and Wickrama, K.A.S. Effects of a Preventive Intervention on Adolescent Substance Initiation, Expectancies, and Refusal Intentions. Prevention Science, 4(2), pp. 109-122, 2003.
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Services Research |
Gender Identity, Ethnicity, Acculturation, and Drug Use Among Adolescents in the Southwest
This article presents the findings of a survey completed by 1,351 predominantly Mexican-American middle school students residing in a large urban center in the U.S. Southwest. The study explored associations between drug use attitudes and behaviors and biological sex, gender identity, ethnicity and acculturation status. Based on the concepts of machismo and marianismo that have been used to describe Mexican populations, four dimensions of gender identity were measured: aggressive masculinity, assertive masculinity, affective femininity and submissive femininity. In explaining a variety of indicators of drug use behaviors and anti-drug norms, biological sex alone had limited explanatory power, while gender identityoften regardless of biological sexwas a better predictor. Aggressive masculinity was generally associated with higher risk of drug use, while the other three gender identity measures had selected protective effects. However, the impact of gender identity was strongly mediated by acculturation. Less acculturated Mexican-American students reported lower aggressive masculinity scores than non-Latinos. Less acculturated Mexican-American girls reported both the lowest aggressive masculinity scores and the highest submissive femininity scores. More acculturated Mexican-American students, along with the less acculturated Mexican-American boys, did not appear to be following a polarized approach to gender identity (machismo and marianismo), as was expected. The findings suggest that some aspects of culturally prescribed gender roles can have a protective effect against drug use behaviors and attitudes, possibly for both girls and boys. Kulis, S. Marsiglia, F.F., and Hurdle, D. Gender Identity, Ethnicity, Acculturation and Drug Use: Exploring Differences among Adolescents in the Southwest. Journal of Community Psychology, 31(2), pp. 167-188, 2003.
Effects of Ethnic Pride and Biculturalism on Drug Use Norms of Urban American Indian Adolescents
This study examined how strength of ethnic identity, multiethnic identity, and other indicators of biculturalism relate to the drug use norms of urban American Indian middle school students. Following the focus theory of norms, different categories of norms that may impact drug use are distinguished. Regression analysis of self-reports by 434 American Indian 7th graders attending middle schools in a large southwestern U.S. city show that those with a more intense sense of ethnic pride adhere more strongly to certain anti-drug norms, while those with negative feelings toward their ethnic or racial heritage have more permissive norms toward drug use. Compared to multi-ethnic American Indian students, those claiming only an American Indian identity report less certainty that they would refuse potential drug offers. Those who speak a language other than English with family and friends at least occasionally report that fewer of their friends are drug users. While American Indian students with better grades in school hold consistently stronger anti-drug norms, there are few differences by gender, socioeconomic status, or age. Kulis, S., Napoli, M. and Marsiglia, F.F. Ethnic Pride, Biculturalism, and Drug Use Norms of Urban American Indian Adolescents in the Southwest. Social Work Research, 26(2), pp. 101-112, 2002.
The Role of Chronic Drug Use in Serious Injuries and Trauma
The authors estimated the differential risks of serious injury or trauma for a community-based sample of 926 chronic drug users (CDU) and a matched comparison group of 553 nondrug users (NDUs). The authors also estimated whether CDUs and NDUs differed in their utilization of health care services for serious injury or trauma. Data were collected in 1996 and 1997 through community outreach activities in Miami-Dade County, Florida. Analyses estimated the effects of drug use on (1) any lifetime serious injury or trauma, (2) any serious injury or trauma during the past 12 months, and (3) utilization of health care services for serious injury or trauma. All analyses were gender specific and the models were estimated with a measure of problematic alcohol use in addition to CDU. Female CDUs experienced significantly more serious injury, trauma, or both (both lifetime and past year) than nonusers, but drug use status did not predict serious injury or trauma (lifetime and past year) for males. Regardless of gender, conditional on experiencing any serious injury or trauma during the past year, CDUs and NDUs did not differ in their utilization of health care services. The elevated risk for serious injury or trauma for female CDUs renders these individuals vulnerable to severe medical problems. Specific training in substance abuse issues may be necessary if health care providers are to identify, engage, knowledgeably serve, and refer CDUs for appropriate services. Zavala, S.K., and French, M.T. Dangerous to Your Health - The Role of Chronic Drug Use in Serious Injuries and Trauma. Medical Care, 41(2), pp. 309-322, 2003.
Psychological Distress, Employment, and Drug Use among Female Welfare Recipients
In this study, the authors examined the relationship over time among work experience, psychological distress, and illegal substance use in a sample of 534 women receiving Temporary Assistance for Needy Families. Study participants were interviewed at intake and at 4-month intervals for a period of 2 years. Each interview recorded the number of hours worked in the previous 4 months and the use of powder cocaine, crack cocaine, heroin, or methamphetamines during the same period. To measure the extent of psychological distress, participants completed the personal adjustment problems subscales of the Multidimensional Addictions and Personality Profile at intake and at 1-year intervals. A path model was analyzed to assess the temporal effects of employment, drug use, and emotional and psychological distress. Results suggest a cycle in which employment at one time period can reduce the likelihood of drug use in the following period, which, in turn, can lead to improvement in levels of distress. This improvement can lead to an increase in the number of hours worked and further improvement in distress levels. Atkinson, J.S., Montoya, I.D., Whitsett, D.D., Bell, D.C. and Nagy, C.W. The Relationship Among Psychological Distress, Employment, and Drug Use Over Time in a Sample of Female Welfare Recipients. Journal Of Community Psychology, 31(3), pp. 223-234, 2003.
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Intramural Research |
Effects of Opioid Detoxification on Withdrawal and Pain in Hospitalized Heroin-Dependent AIDS Patients
With the growing role of intravenous drug use in the transmission of HIV infection, HIV-infected patients frequently present with comorbid opioid dependence. Yet, few empirical evaluations of the efficacy and consequences of opioid detoxification medications in medically ill HIV-infected patients have been reported. In a randomized, double blind clinical trial, IRP scientists evaluated the impact of three medications on the signs and symptoms of withdrawal and on pain severity in heroin-dependent HIV-infected patients (N=55) hospitalized for medical reasons on an inpatient AIDS service. Patients received a 3-day pharmacologic taper with intramuscular buprenorphine (n=21), oral clonidine (n=16), or oral methadone (n=18). Observer- and subject-rated opiate withdrawal scores decreased significantly following the first dose of medication and overall during treatment. Among all 55 subjects, self-reported and observer-reported pain decreased after treatment (on average OOWS scores declined 5.6 units and SOWS declined 4.77 units p<0.001 for both) with no indication of increased pain during medication taper. There were no significant differences of pain decline and other measures of withdrawal between the 3 treatment groups. Supplemental morphine was administered as medically indicated for pain to 45% of the patients; only 34% of men versus 62% of women received morphine (p< .05). These findings suggest buprenorphine, clonidine, and methadone regimens each decrease opioid withdrawal in medically ill HIV-infected patients. No differences between effectiveness of these treatment regimens were detected. Umbricht, A., Leslie, J.M., Tucker, M.J., Hoover, D.R., Chaisson, R.E. and Preston, K.L. Drug and Alcohol Dependence, 69, pp. 263-272, 2003.
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