Journal of substance abuse最新文献

Purpose: Studies investigating temperament traits of drug abusers and their biological correlates have disclosed high rates of novelty seeking (NS) in opiate addicts, possibly based on dysfunctions of the dopaminergic (DA) system. The aims of the present study were to see whether or not the monoamine functions were impaired in detoxified addicts and whether or not these alterations were correlated with temperament traits, given the possibility that impairment of the biological and temperament parameters might be responsible for the development of addiction. Methods: We have investigated the DA, serotonergic (5-HT), and noradrenergic (NE) functions in 22 abstinent heroin addicts and 22 healthy controls by challenging the monoamine systems with the DA agonist bromocriptine (brom), the 5-HT agonist d-fenfluramine (d-fen), and the NE agonist clonidine (clon), respectively. We examined the temperament traits by measuring NS, harm avoidance (HA), and reward dependence (RD) using the “Three-Dimensional Personality Questionnaire” (TPQ). Results: Addicts showed higher than normal NS scores at TPQ, blunted 5-HT function, and normal DA and NE activities, in response to the neuroendocrine challenges. NS correlated negatively with the DA function in both addicts and controls, and negatively with the 5-HT function only in addicts. HA correlated positively with 5-HT function in controls but not in addicts. Implications: The impairment in 5-HT function observed in heroin addicts and the changes in the biological correlates of temperamental traits could increase the proneness to addiction and possible comorbid psychiatric disorders.

Purpose: To explore the association between substance use in conjunction with sex and unprotected anal sex among Colombian, Dominican, Mexican, and Puerto Rican men who have sex with men (MSM), considering ethnicity, acculturation, and mediating variables.

Methods: A New York City convenience sample of 307 men provided information on past year's sexual behavior, substance use, acculturation, attendance at bars, discos, and parties, self-worth, machismo, and sensation seeking.

Results: Alcohol use and drug use were positively associated with unprotected anal sex, particularly with casual partners. Different rates of substance use among the four ethnic groups were found, but were not significant when adjusting for acculturation. Among men who engaged in both unprotected and protected anal sex, substance use was not more common on unprotected occasions than on protected occasions. Attendance at bars, clubs, etc. was not associated with unprotected anal sex. Sensation seeking, self-worth, and machismo were related to substance use and unprotected anal sex. In multivariate analyses, the substance use/unprotected sex association remained when adjusting for ethnicity, acculturation, partner type, attendance at bars, and personality variables.

Implications: Substance use and unprotected sex are associated among these Latino MSM. However, there does not appear to be a simple causal relationship between the variables. Several other variables co-vary with these factors but did not statistically explain their association.

Increases in the use of illicit opiates have refocused attention on these drugs. One outgrowth of this attention has been the increased consideration of pharmacotherapies to provide alternatives to methadone maintenance. Buprenorphine is one new tool used in the attenuation of illicit opiate use. Like methadone, buprenorphine produces cross-tolerance to other opiates. However, it may have advantages over methadone including a longer duration, limited withdrawal syndrome, and increased safety. Buprenorphine's ability to serve as a replacement drug for illicit opiate use is well documented, and efforts have recently been made to compare the drug with methadone. The purpose of this study was to provide a meta-analysis of all available research reporting a controlled comparison of buprenorphine and methadone. This analysis provided a rating of the comparative efficacy of each drug, thus giving clinicians an additional guide when selecting an appropriate course of treatment. Findings suggest a relative equality in the efficacy of buprenorphine and methadone, although patients receiving methadone were less likely to test positive for illicit opiate use. Past experience with methadone maintenance acted as a moderating variable, however, such that those receiving buprenorphine were more likely to stay drug-free in studies that included patients with prior methadone experience.

Purpose: Alcohol use is commonly present in sexual assault incidents, but the nature of its role in these offenses remains unclear. Researchers have argued that the propensity to abuse alcohol generally and the use of alcohol prior to assault by offenders and victims may be associated with increased severity of sexual abuse and physical injury to sexual assault victims. In particular, there is speculation that offender drinking may facilitate offenders' use of greater physical aggression against victims in their attacks, resulting in more serious injuries to victims.

Methods: The role of alcohol in sexual assault incidents (n=163) identified from a national sample of women was studied.

Results: In the present sample, offender pre-assault drinking and offender aggression used in the offense were each strong predictors of victim physical injury. Victim heavy episodic drinking did not predict victim injury controlling for other assault characteristics, victim and offender drinking prior to assault, and victim demographic characteristics. Drinking by offenders and victims was more common in assaults where victims were less well acquainted with their assailants prior to attack. Higher levels of offender aggression and victim injury were also associated with stranger attacks. Implications: Implications of the results for the study of alcohol and sexual assault are discussed.

The present study examined 1-year prospective predictors of self-reported substance abuse and dependence among a sample of 702 youths at high risk for drug abuse from 21 southern California continuation high schools. Triadic influence theory was used as a theoretical guide. Predictors were selected as measures of triadic influence theory. Among 13 predictors, a drug use and intention index, and concern that one is or will become an addict or alcoholic, were consistently predictive of self-reported substance abuse or substance dependence 1 year later, controlling for baseline abuse or dependence status. In addition, baseline substance abuse, White ethnicity, and relatively poor prosocial coping predicted later substance dependence. Apparently, adolescents can predict their future use, and abuse or dependence status. Also, instruction in prosocial coping (e.g., seeking social support) may help inhibit the transition from substance abuse to substance dependence.

Purpose: The attitudes of substance abuse counselors can have significant effects on their client's recovery. This study examined the attitudes and knowledge of substance abuse counselors regarding lesbian, gay, bisexual, and transgendered (LGBT) clients. Methods: 242 substance abuse counselors in Iowa completed mail-in questionnaires. Results: The counselors reported very little formal education regarding the needs of these clients, and nearly half had negative or ambivalent attitudes. Respondents had the greatest negativity regarding transgendered clients and reported knowing the least about this group. Counselors frequently lacked knowledge about the legal issues of these clients, the concepts of domestic partnership and internalized homophobia, and family issues. Implications: Substance abuse counselors require more education about LGBT clients.

Purpose: This study examined the objective demand characteristics of treatment programs in which substance abuse patients, or psychiatric patients, were residing. It also examined associations of objective demand with substance abuse patients' perceived expectations for functioning during treatment and patients' in-program participation. Methods: A total of 994 patients living in 79 programs took part. Results: When patients had a substance abuse rather than a psychiatric problem, objective demand was higher: program policies had higher requirements for functioning and more resident control; programs offered fewer health-treatment services; and the physical design provided fewer safety features and social–recreational aids. Compared to substance abuse patients in low-demand programs, patients in high-demand programs perceived the program to have higher expectations, in that the treatment climate exerted more press to develop relationships, set goals, and be organized. Patients in high-demand programs engaged more in self-initiated activities and participated more in treatment services and program-organized events. Substance abuse patients' activity and participation levels were determined jointly by the level of demand and by the expectations for patients' expressiveness and self-understanding of their personal problems. Implications: The findings illustrate the importance of considering objective indices of demand in conjunction with perceived expectations to improve patients' treatment outcomes.

Purpose: This study examined activity, daily living, health, support, and outlook in HIV + drug users. Methods: Using the physician-administered Spitzer Index, the study assessed 75 HIV-1 seropositive men (n=51) and women (n=24) enrolled in the Miami HIV-1 Infected Drug Abusers Study (MIDAS). Results: Total composite scores were significantly lower in the HIV-1 infected women than the men (p=.03). Significant gender differences were observed in activity assessment, independent of disease status, with women six times as likely to have lower activity scores (p=.0038). Most women (45%) in this category were homeless or marginally housed, compared to 11 percent of the men. Additionally, women with low activity scores had less social support than women with high activity scores. Cocaine use was significantly related to reports of normal activity, and varied across genders; more men used cocaine than women (p=.03). Compared to non-AIDS participants, AIDS patients were more likely to have lower scores in health (p=.009) and poorer outlook (p=.03). Implications: These findings reveal specific deficits in areas of psychosocial capacity, particularly in HIV-1 infected women who abuse drugs, that may need to be strengthened in order to enhance function and adherence to treatment, as well as well-being.