The International journal of the addictions最新文献

The AIDS Risk Reduction Model is a theory-based representation of sequential psychosocial processes by which people may attempt to change their HIV risk behavior. These processes are said to occur in three stages: 1) labeling one's risk behavior as problematic, 2) forming an intention to change behavior, and 3) taking action to accomplish change. Cognitive and perceptual factors are said to influence progress across stages. This study tests the degree to which hypothesized relationships among factors at Stages 1 and 2 are consistent with cross-sectional data collected from a sample of HIV-negative injection drug users who reported recent sharing of drug injection paraphernalia ("works"). Findings indicate that intentions to share works less often in the future may be influenced directly by drug users' perceived risk of infection, which in turn is influenced by their level of HIV knowledge, perceived susceptibility to HIV, and perceived peer norms regarding drug-related risk reduction.

This paper reexamines data from two previous surveys. It looks at self-reported alcohol, tobacco, and illicit drug use and sexual risk-taking among three subgroups of young adults. All subjects (N = 1,387) were aged 20-30. The samples consisted of nurses in the Lothian Region, and residents in Muirhouse (Edinburgh) and Easterhouse (Glasgow). Factor analysis revealed that risk-taking behavior was neither entirely general nor entirely specific. Although there was some tendency for a risk-taker in one area to be a risk-taker in others, five fairly distinct types of risk-taking could be distinguished. These included sexual risk-taking, illicit use of drugs, and excessive alcohol consumption. The samples differed in the extent to which they indulged in the different types of risk-taking, and various other predictors of these behaviors were found. Different patterns of association emerged in relation to specific subgroups of respondents.

To study the effects of illicit drug use during pregnancy on maternal health, we reviewed the records of women who delivered at the University of Texas Medical Branch between June 1, 1989, and February 28, 1990, for peripartum history and results from drug urinalysis screens. After controlling for age at delivery, gravidity, race/ethnicity, and use of alcohol or tobacco, elevated relative risk estimates were observed among women who had positive urinalysis for syphilis, gonorrhea, pregnancy-induced hypertension, chorioamnionitis, asthma, and postpartum hemorrhage. These findings confirm that pregnant women who use illicit drugs are at increased risk for serious health complications.

A comprehensive program for the prevention of fetal alcohol syndrome (FAS) and alcohol-related birth defects (ARBD) must consider multiple approaches and utilize knowledge from a variety of academic disciplines. Issues related to culture, society, behavior, belief systems, and medicine must all be considered for both etiology and solutions. A broad paradigm such as a public health model integrates various elements of approach. Because FAS and other levels of ARBD form a spectrum, from severe to negligible damage, a variety of drinking patterns with various characteristics and etiologies have to be addressed. This paper describes a multiple-level, comprehensive program with primary, secondary, and tertiary prevention components. Practical recommendations are proposed for addressing ARBD in a variety of arenas. While secondary and tertiary prevention hold promise for short-term reduction of FAS and ARBD prevalence, comprehensive prevention serves both short- and long-term effects. Multiple level prevention efforts are well served by clear and compelling vision and mission statements, and require careful evaluation.

The influence of religious values and religious affiliation on alcohol and drug use among American college students living in Germany is examined. Religious affiliation differentiates among Protestant, Catholic, and nonaffiliated groups for reported high school alcohol use but not for collegiate alcohol consumption. Groups defined by the importance of religious values differ on reported high school and college alcohol and drug use. Implications for prevention and future research are discussed.

A brief summary of the literature to evaluate for whom Alcoholics Anonymous (A.A.) is or is not likely to be effective is provided. A description of A.A. is presented. Next, support and criticisms of A.A., details of who A.A. seems to help and does not seem to help, and alternatives to A.A. are discussed. Finally, recommendations regarding matching clients to supportive treatments are made.

HIV among injecting drug users (IDUs) has now been documented in over 60 countries in the world, and there are an additional 40 countries where injecting drug use has been reported including widespread epidemics in Southeast and southern Asia and in Latin America. At present HIV infection is almost always fatal, and there is no promise that a preventive vaccine will become available soon. Given the enormity of the HIV epidemic among IDUs and the critical need to reduce the spread of HIV transmission to and from IDUs, prevention efforts are essential. Syringe-exchange programs have become a major component of HIV prevention strategies in most developed countries and work within the philosophy of harm reduction. Increasing access to sterile syringes has been met with considerable controversy. Opponents of syringe exchange have generally argued that increasing access to sterile syringes would simultaneously increase the number of injecting drug users, increase the frequency of injection for already active IDUs, and appear to "condone" an illegal behavior. To date many research studies and four major reviews of syringe exchange literature have been conducted. All studies thus far have shown no increase in illicit drug injection associated with syringe exchanges, and significant decrease in drug risk behaviors.

In response to a high incidence of AIDS among injecting drug users in Barcelona, Spain, the city established a program in four geographically distinct centers for assistance and surveillance. The centers provided testing, counseling, and monitoring of infectious diseases. In 1991-92, HIV rates were 33% in the northwest center, 39% in the western center, 39% in the east, and 71% in the south. Differences between the rates in the southern center when compared with those in the other centers were very significant (P < or = .001). These data show geographic variation of HIV infection within one city and substantiate the need to provide expanded medical care in the drug misuse treatment setting.

An eighteen-item Addiction Belief Scale (ABS) was developed to assess strength of belief in the disease versus free-will model of addiction (alpha = .91). Factor analysis of the ABS revealed three dimensions to the disease-model controversy of addiction. These include beliefs regarding personal power (subscale alpha = .91, n = 274), dichotomous thinking (subscale alpha = .83, n = 285), and addiction as a way of coping with life (subscale alpha = .47, n = 286). A discussion of scale analysis and suggestions for application of the ABS as a clinical and research instrument are presented.

Failures to implement substance use prevention programs preclude success in program effectiveness and sustantation. Failures to initiate substance use prevention programs can result from the failure of program managers to meet the challenges which occur in the creation and management of program organizations. Attention to the program organization from a variety of frameworks is useful in the implementation process. Based on divergent organizational theories, four approaches utilized in the implementation of a substance use prevention program are presented.