Journal of substance abuse最新文献

Purpose: We examined the population demographics and club drugs used in gay circuit parties and estimated the reported unsafe sexual behavior associated with each drug, the reasons for attending circuit parties, and the unsafe sex associated with different reasons. Methods: A brief questionnaire was provided to a nonrandom sample of party attendees covering demographics, drugs used, sexual activity, and reasons for attending gay circuit parties at three major North American parties in 1998–1999. A total of 1169 usable questionnaires were obtained. Odds ratios for unsafe sex for the drugs surveyed [alcohol, marijuana, methylenedioxymethamphetamine (Ecstasy), ketamine (Special K), crystal methamphetamine (crystal meth), cocaine, volatile nitrites (poppers), and γ-hydroxybutyrate (GHB)] were calculated, as was significance of unsafe sex for the 10 major reasons for attending parties. Results: 12-month party drug use was high: >50% reported using alcohol, Ecstasy, and Special K. Frequent (rather than occasional) use of Ecstasy, Special K, and poppers had an association with unsafe sex at parties. Poppers also showed a statistically significant association with unsafe sex in 12 months (not necessarily at parties) while crystal meth and GHB showed a trend. Attending circuit parties “to look and feel good,” “to have sex,” and “to be uninhibited and wild” were associated with higher levels of unsafe sex in 12 months. Implications: In this sample, circuit party attendees are well educated and financially secure. Party drug use is high. It appears that use of poppers, Ecstasy, Special K, crystal meth, and GHB are associated with various measures of unsafe sex. More comprehensive research on club drug use in gay men is required.

PurposeWe assessed the use of HIV care among HIV-seropositive crack cocaine smokers and other active drug users in Miami-Dade County, FL. Methods Personal interviews were conducted with 327 adults recruited from inner city neighborhoods. Cross-tabulations and logistic modeling were used to analyze the relationship between selected variables and use of HIV care. Results One-third of respondents had not seen a provider for HIV-related health care in the past 12 months. Among those who had seen a provider, only 33.8% were receiving highly active antiretroviral therapy (HAART). Factors associated with utilization of HIV-related health care were age, race, having a usual source of care, health insurance, time elapsed since time of diagnosis, and reports of moderate to extreme interference of pain with daily activities. Implications These findings suggest the need to develop, implement, and evaluate intervention strategies to improve use of HIV medical care among active drug users.

Purpose: In this paper, we develop and test a model for predicting sexual risk for HIV and other STDs. Methods: Researchers interviewed 528 women and men with a history of substance abuse about their past experiences of physical and sexual abuse, symptoms, and sexual risk behavior (number of partners, trading sex for drugs or money, unprotected intercourse, and sexual orientation). The model explores direct and indirect associations of physical abuse and sexual abuse with sexual risk. Results: Depression and severity of problems with drugs and alcohol were expected to mediate associations between abuse and sexual risk. However, analyses did not substantiate any indirect effects. Being female, more severe drug problems and, among men, past sexual abuse were significant predictors of sexual risk. Conclusion: Prevention interventions would do well to address not only drug addiction, but also past sexual abuse in men and depression in women.

Types of drugs used and routes of administration were assessed, and correlations to social affiliation, HIV status, and lifestyle stability were explored among 672 street-recruited drug users in Baltimore. Participants reported 63 patterns of drug use, which were categorized into five groups: (1) only sniff heroin; (2) smoke crack and may snort cocaine; (3) sniff heroin and smoke crack; (4) inject heroin and cocaine; and (5) inject heroin and cocaine, smoke crack, and may snort heroin. Social network analysis revealed that heroin sniffers and crack smokers both tended to associate with those with similar drug use patterns. High symptoms of drug dependence were observed among heroin users irrespective of mode of administration. Injectors reported higher rates of hospitalization compared to noninjectors even after adjusting for HIV status. Implications to HIV prevention and drug use transitions are discussed.

Purpose: This article describes 12 HIV Outreach Demonstration Projects funded by the Center for Substance Abuse Treatment in 1995, and the clients these projects served. The article also summarizes the findings of multivariate statistical analyses aimed at identifying important project and client characteristics that influenced project success in achieving two key outcomes: persuading at-risk clients to obtain HIV tests, and facilitating entry by substance-abusing clients into structured substance abuse treatment (SAT). Methods: Hierarchical linear modeling (HLM) analysis was used to conduct the analyses. Results: The findings support the hypothesis that HIV Outreach, as an integrated approach to addressing the multiple problems clients have due to substance abuse and related problems, can be an effective model for reaching clients who have not been reached through traditional means. Implications: By implementing a complement of comprehensive HIV Outreach interventions, many of the HIV Outreach projects were successful in addressing the various needs of their clients. However, as detailed in this article, some services and service delivery procedures, were more effective than others in achieving project objectives.

We examined substance use in relationship to transmission risk behavior (unprotected insertive, UIAI, or receptive anal intercourse, URAI) between HIV-positive men who have sex with men (MSM) and their HIV-negative or unknown serostatus partners. Men who engaged in transmission risk behavior with casual partners were more likely than men who did not engage in such behavior to have used various substances. Users of certain drugs were specifically less likely to use condoms with HIV-negative or unknown status partners than users. Of men who drank alcohol, those who drank more frequently before or during sex engaged in significantly more UIAI with casual partners. Of men who used drugs, those who used more frequently before or during sex were more likely to engage in URAI with casual partners. In multivariate analyses, use of inhalants as well as drinking before or during sex predicted UIAI, while use of inhalants as well as noninjection drug use before or during sex predicted URAI. HIV prevention programs for HIV-positive MSM should focus on decreasing substance use and use specifically before or during sex. Developing prevention programs for substance-using MSM is critical to improve community health and decrease HIV transmissions.

Purpose: Substance use by pregnant women is socially stigmatized and may be legally punishable. This societal condemnation raises concerns about underascertainment of prenatal substance exposure of offspring if mothers are asked specifically about their behavior during gestation, versus their life histories without reference to gestational dates. This study assessed agreement between life history-focused and pregnancy-focused assessments of prenatal exposure, and percentages of offspring classified as exposed to a range of substances by each measure, in a sample of school-aged children of methadone-maintained, opioid-dependent parents.

Methods: Prenatal exposure was assessed in 172 offspring of 109 mothers by: (a) questionnaires administered to mothers about substance use during pregnancy; and (b) best-estimate (BE) diagnoses of substance use disorders in mothers overlapping with pregnancy dates. BE diagnoses were based on interviews with the Schedule for Affective Disorders and Schizophrenia-Lifetime Version, conducted by trained mental health professionals with mothers about their life histories of psychiatric and substance use disorders, as well as mothers' medical records. Chance-corrected agreement between the measures was examined using κ statistics. Percentages of offspring classified as exposed by each method were compared using McNemar χ² tests.

Results: Except for cigarettes, agreement between the measures was poor. Except for alcohol, diagnosed episodes of substance use disorders in mothers with dates overlapping pregnancy classified more offspring as exposed than mothers' responses to the questionnaire focusing on behavior while pregnant, though the differences in proportions identified as exposed were not always large or statistically significant.

Implications: When retrospective ascertainment of prenatal exposure is necessary, asking mothers for their own life histories, without reference to pregnancy dates, may be the preferred approach.

Purpose: The data from the National Maternal and Infant Health Survey (NMIHS) and its 3-year follow-up offer a unique opportunity to study the effects of substance (alcohol, marijuana, and tobacco) use during gestation on development at age three in a nationally representative sample. Using this data, the relationship of development (language, gross motor, fine motor, and adaptive behavior) and specific behaviors (eating problems, length of play, activity level, difficulty of management, level of happiness, fearfulness, ability to get along with peers, tantrums, eating nonfood) and maternal drinking, marijuana use, and cigarette smoking was studied in a sample of live births who had been followed up at age three. Methods: The data were analyzed using a cumulative logit model of ordinal responses. Results: Higher activity level, greater difficulty of management, tantrums, eating problems, and eating nonfood were related to maternal drinking during pregnancy. Increased fearfulness, poorer motor skills, and shorter length of play were associated with maternal marijuana use during pregnancy. Less well developed language, higher activity level, greater difficulty of management, fearfulness, decreased ability to get along with peers, and increased tantrums were associated with maternal cigarette smoking during pregnancy. The preponderance of significant effects involved the behaviors studied rather than the developmental indices. Implications: It may be that the effects of substance use during pregnancy, especially more subtle ones, show up in behavior before they can be measured by developmental scales.

Purpose: To assess preference for different psychoactive substances and time trends in Kuwait. Methods: Analysis of urine and blood samples of specimens sent by attending physicians to the only public health reference laboratory for toxicological screening in the country. Results: A total of 28,548 tests were performed on 3781 samples. Cannabinoids were positive in 40% of the tested samples, opiates in 24%, ethanol in 10%, and amphetamines in 5%. Elevated concentrations of methadone, cocaine, and phencyclidine did not exceed 0.1%. About 40% of samples was positive for benzodiazepines, but their therapeutic use obscures the informativeness of this finding. There was a significant increase in the proportion of positive results for ethanol, amphetamines, and benzodiazepines. Implications: It is high time to implement a modern and comprehensive preventive and control program. The tendency to blame the Iraqi invasion for drug addiction has hampered efforts to recognise and address the problem in its entirety.