bluuebunny/crossref_metadata_2025 huggingface dataset:
Barriers to Engaging and Retaining African- American Post-Partum Women in Drug Treatment
Authors: Roberts Amelia C. , Nishimoto Robert
Published: March 2012

Little is known about barriers to engaging and retaining African-American women in drug treatment. This descriptive study addressed three questions regarding barriers to substance abuse treatment for African-American women: What barriers made it difficult for women to participate in treatment? Did identified barriers differ by program modality? To what degree were barriers related to treatment retention? Findings revealed that barriers considered to be internal in nature, i.e., “drug severity,” “did not feel like going,” and “felt I could manage on my own,” were most frequently reported. Only a few program-related barriers were found to be related to length of time in treatment and both internal and programmatic barriers had an effect on treatment completion. Implications for policy decisions, future research, and clinical competence in addressing barriers to treatment for African-American women are discussed.
Evaluation of the Breaking the Cycle Demonstration Project: Jacksonville, FL and Tacoma, WA
Authors: Mitchell Ojmarrh , Harrell Adele
Published: March 2012

This research presents the results of the evaluation of the Breaking the Cycle (BTC) demonstration project in Jacksonville, FL and Tacoma, WA. The BTC demonstration project tested the feasibility and impact of system-wide intervention designed to reduce drug use among offenders. Specifically, the BTC model was designed to identify drug using felony defendants and then apply a combination of drug testing linked to graduated sanctions and drug treatment to promote abstinence among these defendants. The evaluation of BTC revealed that certain elements of the intervention might not be feasible. However, the results of the quasi-experimental impact evaluation discovered that, in spite of partial program implementation, participation in BTC was associated with reductions in criminal behavior.
Marijuana Markets: Inferences from Reports by the Household Population
Authors: Caulkins Jonathan P. , Pacula Rosalie Liccardo
Published: March 2012

Generally more is known about drug use and demand than about markets and supply, in large part because population survey data are available while market data are not. Although the household population represents a relatively small proportion of users of hard drugs, it represents a large proportion of the population using marijuana and participating in marijuana markets. This paper provides a description of marijuana market and acquisition patterns as reported by participants in the 2001 National Household Survey on Drug Abuse. We find that most respondents obtain marijuana indoors (87%), from a friend or relative (89%), and for free (58%). Retail marijuana distribution appears to be embedded in social networks rather than being dominated by “professional” sellers. Despite these contrasts with stereotypical street markets for cocaine and heroin, there are also similarities, such as evidence of quantity discounts and a minority of users accounting for the majority of purchases. We estimate that there are on the order of 400 million retail marijuana purchases in the U.S. each year and that the average purchase size is small, about six or seven joints.
Research Note: Patterns of Alcohol-Related Mortality in Russia
Authors: Pridemore William Alex , Kim Sang-Weon
Published: March 2012

The level of alcohol consumption in Russia is among the highest in the world and is often associated with a variety of problems in the country. Until recently, however, it was impossible to examine the health and social burdens associated with consumption in Russia due to Soviet secrecy surrounding vital statistics and health data related to alcohol and other topics. This study employed newly available mortality data to describe the demographic, temporal, and spatial patterns of mortality resulting directly from chronic and acute alcohol consumption in the country. The data reveal that in spite of high overall rates of alcohol-related mortality in Russia, levels of mortality vary considerably along these dimensions. Although descriptive in nature, the patterns of alcohol-related mortality in Russia presented here should provide initial observations with which to generate and test hypotheses concerning the causes and consequences of these patterns.
Overview of the Evaluation of “Fighting Back” and Introduction to This Issue
Authors: Winick Charles
Published: March 2012

During the last few decades, community coalitions have increasingly emerged as program vehicles for coping with alcohol and other drug problems. The Robert Wood Johnson Foundation supported “Fighting Back,” a community coalition program between 1992 and 2002 that was developed at each community and operated at 15 sites in 11 states. The program's goal was the reduction of alcohol abuse and illegal drug use through coalitions. An outside interdisciplinary evaluation of the Fighting Back and matched comparison sites concluded that the program had no significant effect on substance abuse. Various aspects of the evaluation are discussed. For the last 15 years, the federal government has supported hundreds of anti-substance abuse coalitions. In the articles that follow, different features of the evaluation dealing with results, treatment of substance abusers, community structure, correlative factors, research methodology, bibliography, and a funder's perspective are set forth.
Changes in the Number of Methadone Maintenance Slots as Measures of “Fighting Back” Program Effectiveness
Authors: Livert David , Winick Charles
Published: March 2012

This study examined trends in the number of available methadone maintenance treatment (MMT) slots to evaluate a community-based drug prevention program. In the 1990s, the “Fighting Back” (FB) initiative sought to reduce substance use and harm through community-based coalitions in 14 sites across the U.S. Nine state agencies provided MMT data for 28 FB and control communities for a 10-year period prior to and during the program. Opioid use data from a general population survey conducted in the same communities by the national evaluation team were also examined. Counter to expectation, implementation of the FB program was associated with significantly less expansion of MMT slots when compared to control communities. This trend was not attributable to opioid use in those communities, which did not change during the same period. The implication of the findings as well as the historical context of methadone maintenance treatment since the 1990s is also discussed.
“Everything Here is so Political. …” Separating the Organizationally Normal from the Political in Communities of Organizations
Authors: Ryan Dan
Published: March 2012

The rhetoric of “community” is common in talk of social programs. With it comes imagery of common interests, overcoming turf battles, working together, and getting along. When programs fail to achieve goals or turn into outright fiascos, personal, organizational, and community pathology, or simply “politics” are common explanations. Problems are assumed to be endemic and intractable or remediable only by gifted leadership or transcendence of business as usual. This article argues that such thinking is rooted in a false assumption. “Community” needs to be reconceptualized as a community of organizations, not people, and organizations as constrained actors not analogous to individuals. Organizations interact in peculiar, but analyzable ways, giving rise to unanticipated outcomes that could be labeled pathology or mere politics. Community alcohol and other drug AOD programs might be more successful if their logic models were based on realistic concepts of community that can distinguish the actually political from the organizationally normal.
Varieties of Substance use and Visible Drug Problems: Individual and Neighborhood Factors
Authors: Ford Julie M. , Beveridge Andrew A.
Published: March 2012

This paper examines whether the individual and neighborhood factors associated with visible drug problems are also related to drug use. It also looks at how the relationship between individual and neighborhood characteristics and substance use may vary depending upon type of substance under consideration (e.g., marijuana versus cocaine). Using data from the evaluation of the “Fighting Back” national demonstration program, our findings indicate that while neighborhood disadvantage, minority concentration, and density are strongly related to increased levels of visible drug problems, these characteristics are not significantly related to drug use. One implication of these findings is that law enforcement tactics aimed at reducing drug-related “incivilities” in a neighborhood are unlikely to have a substantial impact on residents' rates of drug use. The results also suggest that intervention programs targeting demand reduction among residents in a given neighborhood are likely to have little impact on visible drug problems in that area.
Neighborhood Crime Victimization, Drug use and Drug Sales: Results from the “Fighting Back” Evaluation
Authors: Ford Julie M. , Beveridge Andrew A.
Published: March 2012

A fundamental premise of the “Fighting Back” program was the existence of a direct causal relationship between drug use and crime. Using data from the evaluation of the program and spatial hierarchical models, we examine whether drug use and the presence of visible drug sales lead to elevated levels of three types of crime: assault, burglary, and theft. Our analysis controls for neighborhood disadvantage, racial and Hispanic concentration, percent renter occupied, and population density. For crime victimization rates by neighborhood, we find that for burglary, neighborhood disadvantage, the presence of visible drug sales, and drug use are related to victimization. None of the control variables demonstrate a significant impact on burglary victimization. For assault, only neighborhood disadvantage and visible drug sales are statistically significant, and for theft, only visible drug sales influence the rate of criminal activity. Considering the Fighting Back intervention, there are no differences in changing crime patterns of reported burglary, assault, and theft from 1983 through 1995 and no differences in the pattern of changing crime victimization rates for 1997 to 1999 between the Fighting Back and comparison sites. Possible reasons for the lack of effects of drug use prevention programs in crime reduction and possible alternative strategies are also discussed.
Scale-Up Methods as Applied to Estimates of Heroin use
Authors: Kadushin Charles , Killworth Peter D. , Bernard H. Russell , Beveridge Andrew A.
Published: March 2012

The feasibility of using the network scale-up method to estimate heroin use is described. A random sample was asked “How many people do you personally know” who use heroin, and how many in other subpopulations – robbery, assault, burglary, auto-theft victims, binge drinkers, and marijuana users – whose size is more accurately known. A model estimated the overall number of persons each respondent knew and the size of each subpopulation. Estimates of the subpopulation are compared with known subpopulation sizes to assess the plausibility of the model. Data came from the 1999 survey evaluating the “Fighting Back” substance prevention program. Fourteen sites with clear political boundaries were used (n = 5892). Heroin use varied from city to city. Rates estimated for heroin use correlated .832 with the level of respondents' sense of “crime in their neighborhood.” The average ratio between the known populations and the estimates is .943. Members of each subpopulation, especially drug users, tended to know more people within their own subpopulation.
Heavy Alcohol use in the “Fighting Back” Survey Sample: Separating Individual and Community Level Influences using Multilevel Latent Class Analysis
Authors: Rindskopf David
Published: March 2012

In this article, multilevel latent class analysis is used to examine the structure of heavy alcohol use. A model with three latent classes (types) of people fits the data well: those who seldom suffer major consequences from heavy drinking, those who typically suffer only a small number of major consequences, and those who suffer serious consequences in a large number of areas of their lives. Individuals in the first class tend to be older, female, with domestic partners, more highly educated, employed, and either Catholic, Muslim, or Baptist.
Social Risks for At-Risk Drinking in Young Workers: Application of Work-Life Border Theory
Authors: Bennett Joel B. , Patterson Camille R. , Wiitala Wyndy L. , Woo Ada
Published: March 2012

The current study evaluated work-life risks uniquely associated with at-risk drinking for younger (aged 18 to 30) versus two samples of older workers (31 to 40, and 41 or older). Measures were selected according to theories of alcohol culture (e.g., drinking norms at work) and work-life conflict. Following “work-life border” theory (Clark, 2000), an exploratory model examined relationships of these measures with at-risk drinking (ARD) and job-related hangovers (JRH) across the three age groups within a large municipality (n=587) and a sample of small businesses (n=736). Survey results showed life-to-work conflict uniquely predicted ARD for younger workers. In small businesses, younger workers reporting JRH perceived the most permissive drinking norms. Findings suggest risks differ between the small business and municipal samples, and the importance of distinguishing ARD and JRH when assessing outcomes. Results are interpreted with border theory, and discussion focuses on suggestions for prevention programming for young workers.
Adolescent Predictors of Generalized Health Risk in Young Adulthood: A 10-Year Longitudinal Assessment
Authors: Bogart Laura M. , Collins Rebecca L. , Ellickson Phyllis L. , Klein David J.
Published: March 2012

We conducted a prospective examination of multiple adolescent predictors of generalized health risk in early adulthood. Data were used from 3,392 members of a longitudinal cohort surveyed at ages 13 and 23. A measure of generalized risk was constructed using confirmatory factor analysis to represent shared variance among substance use, sexual risk, and victimization. Multiple regression analysis indicated several robust sociodemographic, behavioral, and environmental early predictors of generalized adult risk, including gender, age, race, not coming from a nuclear family, engaging in smoking and deviant behavior as an adolescent, having poor grades in high school, alcohol and cigarette use by an adult important to the adolescent, and being offered substances as an adolescent. Results support the existence of an underlying risk construct in early adulthood, the importance of early adolescent deviance and substance use exposure in predicting risk, and the use of early comprehensive interventions that prevent several risks simultaneously.
Cross-National Differences in Drugs and Violence among Adolescents: Preliminary Findings of the DAVI Study
Authors: Adlaf Edward M. , Korf Dirk J. , Harrison Lana , Erickson Patricia
Published: March 2012

The purpose of this paper is to describe cross-national differences in drug use and violence among three sites that vary in social and political culture and drug use policies—Philadelphia, Toronto, and Amsterdam. The DAVI (Drugs, Alcohol and Violence International) study is based on personal interviews with 1,120 adolescents aged 14 to 17 years from three sites and two samples (550 detainees and 570 dropouts). Seven drug use outcomes and three violence outcomes were compared across sites. We found that site differences were dominant. Only two of 10 outcomes (cannabis onset and relative drug-related violence) were not significantly related to site as a main effect or through an interaction. The most common site differences showed that the Toronto samples reported higher rates of drug use than Philadelphia and Amsterdam. Our findings indicate that drug taking behavior transcends geopolitical boundaries and that there is no clear evidence that rates of drug use are related to policy climate.
Street-Level Drug Market Activity in Sydney's Primary Heroin Markets: Organization, Adulteration Practices, Pricing, Marketing and Violence
Authors: Coomber Ross , Maher Lisa
Published: March 2012

This study is a qualitative exploration of two distinctive high-profile street drug markets in Sydney, Australia. Semi-structured interviews were conducted with 32 street-level heroin dealers about their experiences of selling drugs in these areas, market organization, drug adulteration and quality assessment practices, and the extent and impact of violence associated with these markets. Most dealers operated independently, working for themselves or in loosely defined groups of two or three with little or no hierarchy while others acted as “runners,” selling for others for a percentage of sales. A range of “folk” or nonscientific methods were employed for testing the quality of drugs, and adulteration or “cutting” of drugs was rare. Moreover, this research suggests that even during periods of heroin scarcity, increased adulteration is not an inevitable outcome. In contrast to popular perceptions, dealers in both areas cooperated with each other, and little intimidatory rivalry was reported or observed. Indeed, most participants considered violence to be fairly rare, largely avoidable, and not an inevitable consequence of their involvement in the market. Numerous popular drug market and drug dealer stereotypes about the two locations were not supported by the findings.
Effects of Mass Communication on Attitudes toward Anabolic Steroids: An Analysis of High School Seniors
Authors: Denham Bryan E.
Published: March 2012

Drawing on a national probability sample of high school seniors (n = 2,560), this research explores relationships between exposure to four types of mass communication—magazines, movies, newspapers, and television—and attitudes toward anabolic steroids, operationalized along three dependent measures. Logistic regression analyses revealed statistically significant relationships among (a) magazine exposure and estimates of drug use in professional sports, (b) newspaper and television exposure and disapproval of steroid use, (c) newspaper exposure and estimates of self-inflicted harm caused by steroid use, and (d) exposure to anti-drug spots and each of the three dependent variables. Theoretical and methodological implications and suggestions for future research are discussed.
Patterns of Illicit Methamphetamine Production ("Cooking") and Associated Risks in the Rural South: An Ethnographic Exploration
Authors: Sexton Rocky L. , Carlson Robert G. , Leukefeld Carl G. , Booth Brenda M.
Published: March 2012

This article describes rural methamphetamine (MA) production (‘cooking”) and associated risks in Kentucky and Arkansas. It is based on qualitative interviews with 36 active MA users and one former user, a population that included 10 MA “cookers.” Participants reported that various forms of the Birch cooking method have become widespread locally over the past decade. There is an underground market in MA ingredients like pseudoephedrine pills and anhydrous ammonia and innovative methods to overcome restrictions on obtaining them. MA production is hazardous. Explosions, chemical spills, and injuries are associated with acquiring anhydrous ammonia. MA cooking is often undertaken by the inexperienced, those “high” on MA, or people who rush production because of fear of discovery or craving for the drug. Consequently, accidents and injuries sometimes occur. Lab waste is also a potential danger. Our preliminary findings can inform future research and the development of educational programs that address MA cooking and associated problems.
A Pilot Study of Reunification following Drug Abuse Treatment: Recovering the Mother Role
Authors: Carlson Bonnie E. , Matto Holly , Smith Carolyn A. , Eversman Michael
Published: March 2012

This qualitative study explored the experiences of women in recovery from drug abuse who had resumed parenting their children after child placement. Six mothers and 11 service providers from substance abuse treatment and child welfare agencies were interviewed about their perceptions of the experience of being reunified with one's children following substance abuse treatment. Findings revealed that mothers have intense emotional reactions to having children placed, which can motivate recovery but also be a source of stress. A variety of supports were identified as necessary to prepare mothers for resuming care of children beyond substance abuse treatment including counseling, child care, financial support, and parenting education. Reunification, however desirable, was described as overwhelming and fraught with parenting challenges, such as effective limit setting with children. Numerous challenges and barriers to successful reunification were identified, such as stigmatization in the child welfare system. Implications for service delivery and research are discussed.
An Exploratory Study of Socio-Cultural Factors Contributing to Prescription Drug Misuse among College Students
Authors: Quintero Gilbert , Peterson Jeffery , Young Bonnie
Published: March 2012

Although recent increases in collegiate prescription drug misuse have generated a great deal of concern, there are few analyses available that examine the socio-cultural factors influencing these trends. This article attempts to address this gap in knowledge by providing an analysis of several socio-cultural factors influencing pharmaceutical misuse by college students. Prescription drugs are put to a number of different purposes in the collegiate setting, including self-medication, socio-recreation, and academic functioning. Such misuse is acceptable in a social context where individuals deliberately attempt to experiment with drugs. Widespread knowledge regarding effects, dosages, and compatibilities with other drugs, coupled with the extensive availability of pharmaceuticals in collegiate social circles, makes this class of drugs an attractive alternative to other psychoactive substances. These factors underscore several implications for substance abuse prevention efforts on college campuses and suggest a number of important issues for further research.
Trust and other Characteristics Associated with Health Care Utilization by Injection Drug Users
Authors: Ostertag Stephen , Wright Bradley R. E. , Broadhead Robert S. , Altice Frederick L.
Published: March 2012

This article examines health care utilization among injection drug users. Based on previous health care models, we identify various attitudes and personal characteristics that have been found to affect health care utilization in the general population, and we examine their effect with this at-risk group. They include trust in physicians, self-esteem, self-efficacy, social isolation, and depression. We examined survey data collected from 374 injection drug users in New Haven, Connecticut. Our findings indicated that trust in physicians significantly increased health care utilization, and depression decreased it. We also found that HIV+ respondents as well as those with health insurance utilized health care more often. These findings broaden the generalizability of existing health care utilization models, and they inform efforts to increase health care among vulnerable populations such as injection drug users.
Family Structure, Family Tension, and Self-Reported Marijuana Use: A Research Finding of Risky Behavior among Youths
Authors: Hollist Dusten R. , McBroom William H.
Published: March 2012

This article examines the role of family structure in the self-reported lifetime and past month use of marijuana within a sample of American children. The research makes comparisons between youths living in two parent homes where both the biological father and mother are present and those who live in single parent, stepparent, or nonparent families. The results show that youths living in two parent families are far less likely to report ever having used marijuana, associate with marijuana using friends, or have siblings who use marijuana. Youths from two parent families, even those typified by high levels of tension in the household, are shown to report less use of marijuana than youths from low or high conflict homes where one or both of the biological parents are absent. The findings are similar for both males and females. Implications of the results as well as directions for future research are presented.
Research Note: Factors Associated with Skin Cleaning Prior to Injection among Drug Users
Authors: Varga Leah M. , Chitwood Dale D. , Fernandez M. Isabel
Published: March 2012

Injection drug users are at risk for a variety of infections when hygienic injection practices are not performed. Disinfecting the injection site prior to injecting reduces the risk of bacterial infections but has been overlooked in many prevention efforts. Using what is known about factors associated with risk-reduction behaviors of disinfecting equipment, we evaluated a model to determine whether those factors are associated with disinfection of the injection site. Sociodemographic and behavioral data were collected in interviews with 600 injection drug users. The majority of injection drug users do not clean the injection site prior to injecting. Results indicate that gender, ethnicity, and frequency of injection were significantly related to whether or not an injector cleaned the injection site. Failure to clean the injection site prior to injecting is a common practice and constitutes a health risk among injection drug users, particularly in a population prone to other infections. Prevention efforts need to incorporate all levels of sterilization procedures when working with these high risk populations.
Changing Patterns of Drug Use in the Czech Republic during the Post-Communist Era: A Qualitative Study
Authors: Miovský Michal
Published: March 2012

The author carried out a reconstruction of the development of the Czech Republic's drug scene on the basis of the results of key research studies that made use of qualitative methods; he also utilized a multilayer timeline according to target groups and socio-historical perspectives. The last decade of the 20th century was a period in which the Czech drug scene underwent a radical transformation, both in problem drug use (see the definition in the editorial) and recreational use of illicit drugs. The original “hard core” groups were usually comprised of individuals who shared close personal relationships. A system of home production and self-supply dominated the market, and this system was not very organized or hierarchical. The entire drug scene opened up in the course of the 1990s and started to “move” and communicate markedly, both internally and externally. A stabilization of prices, purity, and availability of drugs, as well as the relationships and rules of the black market, was characteristic of the second half of the 1990s. The field of recreational use (of cannabis and the so-called “recreational” drugs in particular) went through a different development during this period, when other changes that deepened the commercial nature of the market took place.
Mortality of Hospitalized Drug Users in the Czech Republic
Authors: Lejčková Pavla , Mravčík Viktor
Published: March 2012

Drug users are generally thought to experience higher mortality rates than those found among the general population. This study analyzes mortality rates among different subgroups of drug users in the Czech Republic. For this project, a retrospective cohort mortality study was conducted. A cohort of 12,207 persons aged 15 to 49 who had been hospitalized for drug related behavioral disorders was followed from 1997 to 2002. The study findings indicate that direct standardized mortality for the cohort of drug users was 16.78 per 1000 person-years (PY); 22.38 for men and 11.18 per 1000 PY for women. After reaching a peak in 1998, mortality rates began to decrease and stabilized around 14 per 1,000 PY from 2000 to 2002. When compared to the rates found in the general population, drug user mortality is eight times higher than nonuser rates (SMR = 8.15; 8.13 for men and 8.22 for women). These mortality rates are highest among polyvalent drug and opiate users and lowest among stimulant users. The authors conclude that the overall mortality of opiate users in the Czech Republic is relatively low when compared with those reported in similar European and non-European studies. There were few overdoses found in the cohort, and in sharp contrast to other available studies, no AIDS related cases were observed.
Regional Comparison of Drug Use in the Czech Republic in 2002: Situation Analysis in Wider Demographic and Socioeconomic Contexts
Authors: Lejčková Pavla , Mravčík Viktor , Radimecký Josef
Published: March 2012

This paper describes regional differences in the extent of drug use within the Czech Republic, especially in regard to wider demographic, socioeconomic, and institutional contexts. It documents the relationship that exists between the presence of environmental risk factors and the extent of related risk behaviors (e.g., criminal behavior or problematic use of psychotropic substances). Available sociodemographic and economic indicators collected from 14 regions were assessed in light of the data on the extent of criminality, distribution and funding of services for drug users, and the extent of drug use. Further on, correlation, factor and cluster analyses were made to closely observe the relationship of individual indicators and to assess the similarities within the regions. The analysis reveals that within the Czech Republic (its geographic size is similar to that of the state of South Carolina), substantial differences exist in terms of risk behaviors and drug use. The analysis illustrates that regions exhibiting the highest number of environmental risk factors also experience higher levels of personal risk taking. That is, both high drug use prevalence and negative indicators of drug use consequences are concentrated in regions experiencing extensive social problems. These findings can facilitate better targeting of the scarce resources that are designated every year for drug policy by directing them in the future to the neediest locales experiencing most severe drug-related problems. Existing regional differences should also be considered when formulating and implementing health, social, and drug policies at the national and regional levels.
Methamphetamine in the Czech Republic
Authors: Zábranský Tomáš
Published: March 2012

The Czech Republic has a relatively long tradition in the addictive and problem use of methamphetamine, which is called “pervitin” locally. This paper attempts to provide as complex a picture of this phenomenon as possible by analyzing what is known about the Czech methamphetamine situation through scientific monitoring and research. It begins with a brief historical overview and then utilizes five key indicators (surveys, treatment demand, problem drug use estimates, blood borne diseases, and mortality) and some of the core indicators (namely, drug related crime, price and purity data, and estimates of market value) of drug epidemiology that were developed by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). By summarizing and carefully interpreting this data, the specifics of the Czech pervitin scene are described and future research directions are identified.
Developing the System of Drug Services in the Czech Republic
Authors: Kalina Kamil
Published: March 2012

This paper begins with a brief overview of the status of Czech services for alcohol and drug users as they existed before 1990 (during the communist era). Particular attention is directed to the prominent figure of Jaroslav Skála and the treatment and training systems he pioneered. The second section of the paper concentrates on how the system of services evolved during the 1990s, after the fall of communism, and identifies the main factors affecting this development (the ongoing reform of health care, formation of the nongovernmental nonprofit sector, emergence of a national drug policy, and the reform of social services). The paper also describes characteristics of the current system of services for legal and illegal drug users. Included here are descriptions of the types of care available (low threshold services, ambulatory and hospital care, therapeutic communities, aftercare, and substitution programs), and an overview of their utilization. Specific features and weak points in the present system are addressed in broad terms. Financing and costs are addressed, with particular attention being paid to public grants at governmental, regional, and municipal levels. The paper also pays attention to the infrastructure of the system of services (coordination, training and education, quality assurance, etc.) as well as to research needs, training and quality assurance, and the effectiveness and efficiency of services based on sound financing, in order to promote innovative programs of care and to adjust existing services to the actual needs of the target population.
What's Love Got to Do with It? Substance Use and Social Integration for Young People Categorized by Same-Sex Experience and Attractions
Authors: Hegna Kristinn , Rossow Ingeborg
Published: March 2012

The aim of the study was to assess whether social integration and substance use differed between three groups of adolescents that were categorized by a combination of sexual experience and attractions: (a) heterosexual orientation and attraction only, (b) same-sex experiences without same-sex attraction, and (c) same-sex attraction. A school based sample of 5,500 Norwegian 16 to 19 year olds (92% response rate) with good population representativity was analyzed. Same-sex experiences included “necking”/“making out,” petting, intercourse, and oral sex. Compared to heterosexual young people, young people reporting same-sex sexual experiences only were more socially integrated into their peer group and consumed more alcohol. Young people reporting same-sex attraction reported poorer social integration into peer networks and good social support, but a stronger sense of loneliness. Use of illegal drugs other than marijuana was more than three times as prevalent compared to that of heterosexual youths, and the gender differences in substance use were small or the opposite of what was expected.
Drug Users' Experiences of Prescribed Injectable Methadone: The Impact on Drug Use and Perceptions of Stability
Authors: Day Ed , Best David , George Sanju , Copello Alex
Published: March 2012

Twenty of the 24 drug users receiving prescribed injectable methadone from a city-wide drug treatment service agreed to participate in a semi-structured interview about their drug use and treatment. Participants reported that they were originally prescribed injectable methadone to replace street purchases because they could not tolerate oral methadone or because of an inability to stop injecting. The experience of injectable methadone was reported as having led to significant improvements in drug use and life stability and reductions in risk behavior, but several participants compared injectable methadone unfavorably to injectable heroin, either in the form of street heroin or prescribed diamorphine. Although a number of the respondents reported sufficient stability to contemplate employment and relationships, few spoke about abstinence as a viable goal in the short-term and many participants reported considerable ambivalence about the experience of receiving injectable methadone prescriptions.
Factors That Influence Women's Disclosures of Substance Use during Pregnancy: A Qualitative Study of Ten Midwives and Ten Pregnant Women
Authors: Phillips Diane , Thomas Kristina , Cox Helen , Ricciardelli Lina A. , Ogle Jan , Love Veronica , Steele Angela
Published: March 2012

The present study was designed to examine the factors that motivate or act as barriers to disclosure of substance use by pregnant women. Participants included 10 midwives and 10 pregnant women who attended two ante-natal clinics at an Australian maternity hospital. One clinic specialized in women who were substance users and one clinic was specifically for young women (under 19 years of age). Midwives and pregnant women were interviewed in-depth about disclosure of substance use. Interview transcripts were analyzed, and the results revealed six main themes: practice style, assessment of substance use, practice environment and privacy, child protection issues, health of the baby, and continuity of care. The findings are discussed in relation to recommendations for best practice in midwifery care when working with pregnant women who use substances.
English and American Drug Clients' Views of the Acceptability, Advantages, and Disadvantages of Treatment and Harm Reduction Interventions
Authors: Phillips Kristina T. , Rosenberg Harold , Sanikop Ajat
Published: March 2012

Although drug abusers present to clinics and drop-in centers requesting various treatments and harm reduction interventions, clinicians and administrators have little direct empirical evidence of the degree to which clients find various therapies acceptable or the perceived advantages and disadvantages of specific interventions. A structured interview was administered to 48 male and female outpatient or detoxification ward clients in Nottingham, England, and 40 female residential treatment program clients in Northwest Ohio, to assess the acceptability of and related attitudes regarding a broad range of interventions. Large proportions of respondents in both samples, and especially in the English sample, reported somewhat or complete acceptance of various abstinence-oriented treatments and harm reduction interventions for those still taking drugs. Respondents also discriminated among these interventions, as evidenced by differing levels of acceptance of many and outright rejection of other interventions. Although there were differences in acceptance and experience of the specific interventions between the two samples, respondents in both countries provided balanced appraisals of the advantages and disadvantages of each intervention.
The Impact of Marijuana Law Enforcement in an Economic Model of Crime
Authors: Shepard Edward M. , Blackley Paul R.
Published: March 2012

U.S. law enforcement against the sale and possession of marijuana has been estimated to cost close to $8 billion a year in criminal justice resources. Current enforcement is justified if it provides net benefits greater than alternatives such as a legal, regulated market for marijuana. Prior research suggests that current levels of drug enforcement may increase nondrug crime and hard drug use. Here, local rates of property crime, homicide, and nonmarijuana drug possession are estimated as a function of economic conditions, enforcement effectiveness, and arrests for possession or sale of marijuana. The data consists of a pooled sample of over 1300 U.S. counties (1994–2001). The results suggest that marijuana arrests are associated with increases in homicides, burglaries, motor vehicle thefts, and larcenies along with subsequent increases in hard drug arrests. These results raise significant questions about the merits of policies that focus on criminal justice approaches to marijuana control.
Crack Use Sites and HIV Risk in El Salvador
Authors: Dickson-Gomez Julia , Bodnar Gloria , Guevara Aradenia , Rodriguez Karla , Gaborit Mauricio
Published: March 2012

“The Social Context of Crack Use and Related Sexual Risk in El Salvador” study was designed to increase knowledge of the locations where drugs are consumed in urban San Salvador, the social dynamics within such sites, and their implications for HIV risk and prevention efforts. In-depth interviews with crack smokers reveal several different types of sites where drugs are consumed and risky sex may occur including trances (generally houses where crack is sold and consumed), brothels, motels, drug users' own homes, abandoned buildings, the street, parks, or cantinas. These range from private sites, where site “gatekeepers” strictly control access, to public sites where access is more open. However, even in more public sites there is considerable social interaction, rules regarding site usage, and in some cases gatekeeper control of the site. Social dynamics already normative at drug use sites may support a site-based, peer-led intervention approach.
Alcohol, Drugs, Sex, and HIV Risk Behaviors among a Community Sample of Black and Coloured South Africans
Authors: Wong Frank Y. , Thompson Estina E. , Huang Z. Jennifer , Park Royce J. , DiGangi Julia , De Leon Jordana M.
Published: March 2012

The objective of this study was to examine substance use and HIV risk behaviors among a community sample of Black and Coloured South Africans. Eligible participants aged 18 and above were recruited from one historically Black and one historically Coloured township in Cape Town. Blacks and Coloureds were about equally as likely to use at least one soft drug (e.g., cannabis). Coloureds were more likely to use at least one hard drug, with methamphetamines being most common. Alcohol before sex was the primary “driver” of having unprotected sex and served as a mediator of other risk factors such as drug use before sex and problem drinking. Furthermore, hard drug users were much more likely to use soft drugs than vice versa. The independent and mediating role of soft drugs suggest that soft drug (vs. hard drug) use should not be overlooked at least in the context of HIV prevention.
What Does the Community Say: Key Informant Perceptions of Rural Prescription Drug Use
Authors: Leukefeld Carl , Walker Robert , Havens Jennifer , Leedham Cynthia A. , Tolbert Valarie
Published: March 2012

This article presents data from four groups of rural Key Informants—Community leaders, educators, health care providers and justice/law enforcement officials—to understand the nonmedical use and misuse of prescription drugs. Seventy key informants were purposively selected from two counties in Appalachian Kentucky. Key informants indicated that the nonmedical use of prescription drugs is complex and has historical roots. Two pathways, or entry points, into the nonmedical use and misuse of prescription drugs were identified: physical pain and recreational use. Data show trends with regard to drug use patterns, drug use education, involvement with the criminal justice system and the role of economics in the prescription drug use problem. Key Informants underscored a common theme that the rural prescription drug problem was fueled by a cultural acceptance of drug misuse. Recommendations are presented for services and research.
Retirement, Social Support, and Drinking Behavior: A Cohort Analysis of Males with a Baseline History of Problem Drinking
Authors: Bacharach Samuel B. , Bamberger Peter A. , Cohen Ayala , Doveh Etti
Published: March 2012

Although previous research examining drinking behaviors among older adults suggests that significant life events are likely to have their strongest alcohol-related effects among those with a history of heavy or problematic drinking, to date researchers have not directly examined the association between such events and the drinking behavior of such individuals. Consequently, using longitudinal data, we examine the link between retirement as a significant life event and the severity of problem drinking behavior of retirement-eligible males employed in blue-collar occupations and having a history of problem drinking. We find that while retirement had no significant impact on the problem drinking behavior of a control sample of 236 retirement-eligible blue-collar males with no history of problem drinking, retirement was associated with a net decline in the severity of drinking problems among those 71 retirement-eligible blue-collar males with a history of problem drinking. Much of this effect is explained by the consolidation of the latters' retirement-related social networks, suggesting that for those with a problem drinking history, retirement may provide a kind of “relief” from permissive drinking environments potentially encouraging problem drinking behaviors.
Drug Use and Job Quits: A Longitudinal Analysis
Authors: Hoffmann John P. , Dufur Mikaela , Huang Lynn
Published: March 2012

Voluntary job separation, or quitting, occurs for a variety of reasons. Although it is often a positive move, it may also lead to periods of unemployment. Studies suggest that one factor that may be implicated in the likelihood of quitting is illicit drug use: Adult drug users may not only quit more frequently but also have a heightened probability of unemployment following a quit. Yet, prior research has not taken a sufficient longitudinal perspective, considered contemporary research on job mobility, nor examined gender differences. We assessed the association using longitudinal data on 8,512 individuals followed from 1984 to 1995. The results indicated that marijuana and cocaine use were associated with a higher probability of quitting. Moreover, marijuana use among males, but not females, was associated with a higher likelihood of experiencing periods of unemployment following a quit. We discuss the implications of these results for understanding gender-distinct patterns of drug use and occupational trajectories.
Pathways of Substance Users Linking (or Not) with Treatment
Authors: Redko Cristina , Rapp Richard C. , Carlson Robert G.
Published: March 2012

This qualitative paper describes different pathways substance users experience as they decide whether to link to treatment or not after being assessed in a centralized intake unit in a Midwestern city. The narratives of 16 participants who did not link with treatment were compared with the narratives of 20 participants who did. Narratives from both groups described similar themes that were experienced differently. Nonlinkers were characterized by pretreatment abstinence, a negative experience with previous treatment, little previous engagement in a treatment career, and meaningful social support coming from AA. Linkers were more likely to continue using drugs before treatment entry, yet they described more readiness for treatment and were more engaged in a treatment career. The treatment careers approach provides a broader framework for understanding linkage versus nonlinkage to treatment.
The Effect of Drug Use, Drug Treatment Participation, and Treatment Completion on Probationer Recidivism
Authors: Huebner Beth M. , Cobbina Jennifer
Published: March 2012

The prevalence of drug use among probationers, and the entire offender population, has been well documented. Numerous drug treatment modalities have been shown to reduce recidivism among this population; however, analyses of programmatic success are often based on a subset of offenders who complete treatment. Less is known about individuals who fail to complete treatment. The goal of the current study is to consider the interaction of drug use, drug treatment provision, and treatment completion on recidivism using data from the 2000 Illinois Probation Outcome Study. Findings from a series of proportional hazard models indicate that probationers who failed to complete treatment were more likely to be rearrested in the four years following discharge from probation, even when compared to individuals who needed treatment but did not enroll. Moreover, probationers who failed to complete treatment had more serious criminal histories and fewer ties to society. The research has important implications for the measurement of treatment provision in studies of recidivism, in specific, and more generally for the need to engage and retain probationers in drug treatment.