bluuebunny/crossref_metadata_2025 huggingface dataset:
Data Sources: Problems and Issues
Authors: Hser Yih-Ing
Published: November 2015

Several nationwide data systems have been specifically designed to assemble data on prevalence of drug use. Additional information is available from other systems that are oriented to different purposes, but also collect drug-related data. National prevalence estimation efforts are variously based on one or more of these prominent data sources, which are briefly reviewed in this article. Also discussed is the utility of these existing data in terms of sampling and coverage, nature and validity of measures, methods of enumeration, and consistency of data collection over time and across systems. To determine the nature of drug use at the local level, local data should be examined. Regardless of their geographic scope, all data systems should improve sampling and coverage of high-risk groups and results should be assessed by occasional small-scale validity studies. Most important, comparability among data systems using comparable measures is needed to enable integration of information, leading to more comprehensive and accurate estimates of the prevalence of drug use.
Detecting Prenatal Substance Exposure: An Exploratory Analysis and Policy Discussion
Authors: Zellman Gail L. , Jacobson Peter D. , DuPlessis Helen , DiMatteo M. Robin
Published: November 2015

Despite considerable public and media concern, little attention has been devoted to prevention or early detection of substance use during pregnancy. A limited literature suggests that this lack of attention stems from a lack of policies or procedures for systematically identifying substance-using pregnant women and substance-exposed neonates in health care institutions. This study was designed to generate exploratory data about health care provider response to prenatal substance exposure and to examine current substance detection policies and practices in health care institutions. Based on interviews in local hospitals, study data reveal many disincentives to detecting substance exposure. For the most part, detection policies are not being developed or implemented, although hospitals serving poor communities are more likely to have such policies. Policy implications are discussed, including the appropriateness of mandated detection policies and whether such policies should be developed at the state or federal level.
Happy Hour and Social Lubrication: Evidence on Mood-Setting Rituals of Drinking Time
Authors: Orcutt James D.
Published: November 2015

This study employs a combination of questionnaire and diary data to examine positive emotional changes that a sample of 328 students experienced during routine episodes of social drinking. Quasi-experimental comparisons of participants versus nonparticipants in weekday or weekend evening drinking events reveal two basic patterns of change in drinkers' ratings of situational affect. Participants in weekday drinking events — in contrast to weekend drinkers — show a transitional pattern of reduction in stress from a predrinking baseline period to the subsequent period when they began to drink. Increases in sociable affect emerge within the context of both weekday and weekend drinking events, but this contextual pattern of mood enhancement is especially prominent at certain times among drinkers who score relatively high on a dispositional measure of sociability. These results support theoretical analyses of the cultural regulation and mood-setting functions of social drinking rituals.
Beyond Equity in the Delivery of Alcohol and Drug Abuse Treatment Services
Authors: Fiorentine Robert
Published: November 2015

Equity in service utilization has become an important policy goal of federally-, state-, and locally-funded alcohol and drug treatment programs. A number of conceptual and methodological issues surrounding equity, including its strengths and limitations as a policy goal, are addressed. Among the many issues discussed is the observation that inequity in service utilization carries evaluative connotations in that a service system is likely to be judged as unsatisfactory, inadequate, or inappropriate when the inequity is modest, and as morally reprehensible when the inequity is significant. Violation of the norm of equity is a prescription for institutional reform and political action. On the other hand, policies that would increase the equity in service utilization may be incompatible with the goal of “service on demand” and they may have no consequent effect of increasing service efficacy. Moreover, there are some arrangements in which maintaining or even increasing inequity would be cost-effective. Other methodological, conceptual and policy-related issues are addressed.
The Drug-Testing Controversy
Authors: West Louis Jolyon , Ackerman Deborah L.
Published: November 2015

Professional and societal debate regarding drug taking and drug-use problems occurs in cycles. In recent years a number of contentious issues have developed about the testing of urine, blood, saliva, and breath for evidence of drug use. Substances evaluated include alcohol, steroids, stimulants, sedatives, opiates, hallucinogens, and a variety of other chemicals both legal and illegal. Legal issues have been raised concerning the validity of testing procedures used and the reliability of evidence obtained, especially with preemployment drug screening. Other controversies center on the right to privacy versus the needs of society, and a variety of related topics. These issues and suggestions for maximizing the effectiveness of drug testing programs while minimizing legal challenges are discussed.
A Content Analysis of the Drug Legalization Debate
Authors: MacCoun Robert J. , Kahan James P. , Gillespie James , Rhee Jeeyang
Published: November 2015

We analyzed two convenience samples of opinion essays from U.S. newspapers to examine differences in the content and complexity of argumentation in the drug legalization debate. The first sample was of fifty-one New York Times essays over a twenty-year span of the 1970s and 1980s. The second sample was of 133 essays from twenty-seven newspapers across the country in 1989 and 1990. Content analyses suggest that the debate has shifted over time from decriminalization of marijuana, based on the civil rights of users, to legalization of cocaine and heroin, based on the perceived need to disrupt the connection between drugs and crime. Proponents of legalization provided significantly more complex arguments than proponents of continued prohibition.
Alcohol and Drug Use among Abused Women Who Kill, Abused Women Who Don't, and Their Abusers
Authors: Blount William R. , Silverman Ira J. , Sellers Christine S. , Seese Robin A.
Published: November 2015

Interviews were conducted with forty-two women with extensive abuse histories who had killed their intimates and fifty-nine women with similar abuse histories who were in shelters for battered women. Controlling for demographic and other differences, analyses indicated that alcohol and other drug use ably distinguished between the two groups of women (correctly classifying 89% of the cases), and that alcohol use was more salient than other drug use. The partner's alcohol use and the respondent's alcohol use were significantly higher among the intimate homicide group, suggesting an association between intimate homicide and alcohol use. Alcohol counseling should, therefore, be a significant part of programs for both battered women and for men who batter.
Progress in Prison Substance Abuse Treatment: A Five Year Report
Authors: Wexler Harry K.
Published: November 2015

Within the recent years there has been a paradigmatic shift in the direction of correctional policy — a movement away from an exclusive concern with security and control toward a more comprehensive approach that includes rehabilitation and treatment. Looking for ways to reduce recidivism and to control overcrowding (and recognizing the close connection between substance abuse and crime), correctional authorities have begun expanding prison-based drug treatment programs. This movement toward a corrections-treatment perspective has been based upon a growing body of research that has indicated that intensive prison-based drug treatment programs are an effective means of controlling recidivism. Progress in prison substance abuse treatment that has transpired over the last five years is described, along with a brief description of correctional substance abuse treatment approaches. Recommendations for the future of correctional drug treatment and some critical cautions are presented as well.
Gender Differences in the Determinants of Smoking
Authors: DeFronzo James , Pawlak Rebecca
Published: November 2015

The authors analyzed factors affecting tobacco smoking in a national sample. Interaction tests revealed that the social bond of commitment inhibited only male smoking, while the bond of religiousity deterred only female smoking. Age negatively affected smoking only among women, while having been the victim of childhood violence promoted smoking only among men. The findings suggest that anti-smoking campaigns might be more effective if tailored to gender-specific determinants of smoking.
Aids-Related Knowledge, Beliefs and Risk Behaviors in a Sample of Crack Addicts
Authors: Khalsa M.E. , Kowalewski M.R. , Lunn R. , Anglin M.D. , Miller K.A.
Published: November 2015

This longitudinal study examines male veterans with a history of cocaine dependence and treatment, focusing on the relationship between levels of crack use and HIV-related knowledge, beliefs and risk behaviors. Over half the subjects were African-American and the majority were heterosexual. A survey instrument was administered at one and two years after initiating treatment. HIV serotesting was conducted at each interview which showed the rate of seropositivity to be low at both points. Knowledge about HIV transmission increased significantly over time for the sample, but no differences were significantly related to level of crack use. Few subjects report the use of condoms on a consistent basis, regardless of crack use level. However, both the number of sex partners reported and beliefs about personal susceptibility to HIV infection increased as the level of crack use increased. Our crack-using subjects had not fully internalized their risk of HIV infection or were fatalistic about their ability to change HIV-related risk behaviors. Either of these possibilities presents a significant challenge to education and prevention efforts targeted to crack users. AIDS education efforts in drug treatment programs may need to more strongly emphasize the sexual transmission routes of HIV infection and highlight the effects of cocaine use on sexual practices.
Changes in HIV Risk Behaviors among Counseled Injecting Drug Users
Authors: Mandell Wallace , Vlahov David , Latkin Carl A. , Carran Deborah , Oziemkowska Maria J. , Reedt Louis
Published: November 2015

A community sample of ninety-one HIV seronegative IDUs were randomly assigned to either a one-hour, one-on-one, intensive educational intervention or a fifteen-minute “standard” educational session. Risk behaviors for the prior six months were assessed by interview before the intervention and six months later. Self-reported injecting drug use decreased from 100% to 70% at the six-month follow-up and the proportion injecting daily dropped from 42% to 18%. The proportion who used someone else's injection equipment dropped from 65% to 34%. Nearly all IDUs who continued to inject reported using bleach to clean their equipment. There was no significant additional benefit from the intensive intervention. Variables hypothesized to mediate reduction in HIV risk behavior (personal distress, perceived personal risk, and intention to reduce risky behavior) were not associated with reduction of activities with high-risk for HIV infection. These data suggest that individualized, short-term educational interventions probably have limited impact on lowering frequency of risky behaviors.
Women at High Risk for HIV: Pregnancy and Risk Behaviors
Authors: Deren Sherry , Davis W. Rees , Tortu Stephanie , Beardsley Mark , Ahluwalia Indu ,   National AIDS Research Consortium
Published: November 2015

Pregnancy may provide an opportunity for behavior change among women at high risk for HIV. Baseline and six-month follow-up data were collected from a national sample of female injection drug users (IDUs) and sexual partners of injection drug users (SPs). Repeated measures analyses were conducted separately for three groups of IDUs (pregnant at baseline, became pregnant between baseline and follow-up, and not pregnant during the study) and three similar groups of SPs. Results indicated that both pregnant and not pregnant high risk women reported significant levels of risk reductions at follow-up. IDUs who were pregnant or became pregnant reported greater reductions in drug injection rates, were more likely to report entering drug treatment and reported the greatest reduction in sex risks compared to IDUs who were not pregnant. Results suggest that the period of pregnancy provides an opportunity for changes in risk behaviors. Innovative outreach efforts and increases in treatment options are needed.
Drug Control as a National Project: The Case of Sweden
Authors: Tham Henrik
Published: November 2015

During the 1980s, the slogan a “drug-free society” became the catchword of the official narcotics policy in Sweden. An analysis based on platforms of the political parties, parliamentary bills, and the debate in national newspapers and journals tries to explain why the reactions against drugs have become so strong despite data showing that the problem is limited and not increasing. The interpretation is made that one reason why reactions against drugs have become so strong and so widespread in Sweden is that they serve the function of strengthening a threatened national identity in a situation where the traditional “Swedish Model” has come under increasingly hard attack from both inside and outside the country.
Sensation-Seeking and Delinquent Substance Use: An Extension of Learning Theory
Authors: Wood Peter B. , Cochran John K. , Pfefferbaum Betty , Arneklev Bruce J.
Published: November 2015

The paper allows an explicit test of a sensation-seeking perspective to help account for substance use (legal and illegal) among a sample of nearly 1,600 high school students responding to a survey conducted in 1991. We present analyses specific to drinking alcohol, getting drunk, tobacco use, use of marijuana or hash, and use of harder drugs to determine if factors common to a sensation-seeking perspective help explain both the prevalence and frequency of substance use among adolescents. Findings provide strong support for considering sensation-seeking variables like thrillseeking, immediate gratification, and impulsivity to help explain self-reported substance use. Our results show that for each of the five substance delinquencies examined, sensation-seeking factors generate statistically significant influences. Results point toward intrinsic rewards that initially promote and subsequently reinforce substance use, and which center on the fun, thrills, and excitement of risky, illegal substance use, and the physiological high generated by drug or alcohol use. Finally, the relevance of a sensation-seeking approach to social learning theory is explored.
To Report or Not to Report: Nurses' Attitudes toward Reporting Co-Workers Suspected of Substance Abuse
Authors: Hood Jane C. , Duphorne Patsy L.
Published: November 2015

Using survey data from a stratified, random sample of New Mexico nurses ( N=498), this study helps to explain why some nurses choose informal rather than formal reporting strategies when confronted with substance-abusing co-workers. The researchers mailed a questionnaire to male and female RNs and LPNs in 1989, two years after New Mexico established its diversion program for substance-abusing nurses. Using a combination of OLS and logistic regressions, the authors test the diffusion model predicting that program knowledge leads to program acceptance and implementation. Finding little evidence of a link between program knowledge and implementation, the authors then offer two alternatives. The vulnerability model predicts that workers in the least secure positions will be most likely to avoid making formal reports, whereas the occupational hegemony model argues that administrators will avoid formal reporting to maintain control over their own work settings. Because their results offer most support for the latter two models, the authors reject the diffusion model and conclude that occupational culture and organizational politics are the most important social forces intervening between program diffusion and implementation.
The Social Context of Needle Exchange and User Self-Organization in San Francisco: Possibilities and Pitfalls
Authors: Moore Lisa D. , Wenger Lynn D.
Published: November 2015

In order to halt the spread of human immunodeficiency virus (HIV) among injection drug users (IDUs), innovative intervention programs such as Prevention Point Needle Exchange have been established. As a means toward understanding the possibility of establishing User Self-Organizations, we reviewed pertinent literature and analyzed qualitative data that we collected at two syringe exchange sites in San Francisco. Based on our analysis, we discovered that IDUs in San Francisco are committed to working with the needle exchange program and with other IDUs to help decrease the transmission of HIV. We also discovered that the political and social context in the United States may not as easily foster user organizations as in Europe and Australia. We believe that in order to foster user organizations and broaden its harm-reduction approach, Prevention Point will have to confront internal and external contradictions to serve as a conduit for necessary social and political change.
A History of Peer-Based Drug-User Groups in Australia
Authors: Crofts Nick , Herkt David
Published: November 2015

The active involvement of at-risk communities has been the hallmark of Australia's response to the AIDS epidemic, including community groups often supported by government funding. Organizations of injecting drug users (IDUs) at state and national levels have been key in providing input to policy, program development, and delivery, but their important contributions have so far been inadequately documented. We review here available information about the histories and impact of user groups, and report that their mere existence has had a profound effect on the nature of the response to HIV among IDUs, and their activities on the prevention of an epidemic among most sectors of the IDU community. After checkered careers and different evolutions, the greatest challenge now facing user groups is to sustain a relevant role in an atmosphere of developing complacency—that the epidemic is over—and that user groups are no longer useful to governments. The history of IDU organizations in Australia is not over, but their future is yet to be defined.
A Procedure for Assessing the Validity of Self-Report Data on High-Risk Sex Behaviors from Heroin Addicts Entering Free Methadone Treatment
Authors: Grella Christine E. , Chaiken Shama , Anglin M. Douglas
Published: November 2015

A procedure is described for determining the validity of self-reported high-risk sex behaviors obtained from heroin addicts entering a research demonstration project providing free methadone maintenance. The procedure included: classifying subjects with inconsistencies in self-reported data provided at eligibility screening and later interviews as “falsifiers;” comparing admitted or suspected falsifiers with others on a range of background variables; and comparing the rate of inconsistency between self-reported drug use and urinalysis results for falsifiers and non-falsifiers. Falsifiers were more likely to be older and male and to fail to report cocaine use at treatment entry; non-falsifiers were more likely to underreport benzodiazepine use at follow-up. Falsifiers did not differ in their personality characteristics, and thus were probably responding to perceived situational consequences. Researchers offering free treatment need to use a variety of means for obtaining information to validate self-reported risk behavior.
Problems Related to Alcohol Consumption by Adolescents Living in the City of Porto Alegre, Brazil
Authors: Pechansky Flavio , Barros Fernando Celso
Published: November 2015

A cross-sectional household survey was conducted in a randomized sample of 575 households of the city of Porto Alegre, Brazil, providing a weighted N of 950 adolescents, their ages ranging from 10 to 18. Subjects were submitted to individualized interviewing, using a structured instrument, about their normal and abusive patterns of alcohol drinking. Alcohol use is frequent (71%), with no sex differences. Overall, males reported more problems with drinking than females (36.8% vs. 28.9%), its prevalence increasing in the older subjects. Seventy percent of the problems (both sexes) were physical complaints. Normal, excessive, and intoxicating levels of use were recorded, with higher patterns reported by males. Lifetime intoxications were common (more than 50%) after the age of 17, and more frequently reported by males. The implications for prevention programs and strategies to cope with adolescent alcohol abuse are discussed.
Toward a Drug Abuse Treatment System
Authors: Wellisch Jean , Prendergast Michael L. , Anglin M. Douglas
Published: November 2015

Drug treatment in the United States has been fragmented, underfunded, less than comprehensive, and poorly planned and integrated. To bring about a significant improvement in the number of drug abusers who receive treatment and in the effectiveness of the treatment they receive, the current fragmented approach needs to be replaced with an integrated, coherent system of drug treatment. This paper discusses the characteristics of a drug treatment system and focuses on two elements of such a system: the use of the health care and criminal justice systems as locations to identify persons in need of drug treatment, and matching clients with appropriate services to improve treatment effectiveness. The paper also discusses several issues that will need to be addressed in developing a drug treatment system, offers examples at the federal, state, and local levels indicative of trends in the direction of a systems approach to drug treatment, and emphasizes the importance of federal leadership in systems development.
Drinking Contexts, Alcohol Beliefs, and Patterns of Alcohol Consumption: Evidence for a Comprehensive Model of Problem Drinking
Authors: Holyfield Lori , Ducharme Lori J. , Martin Jack K.
Published: November 2015

The social contexts in which individuals drink and the expected outcomes of that drinking (i.e., individual beliefs about the effects of drinking beverage alcohol) have recently been found to represent conceptually distinct models of alcohol consumption patterns. This paper examines the relationships between contexts, beliefs, and a variety of problem drinking patterns, and reestimates these relationships in a large national probability sample of 2,100 adults (U.S. National Alcohol Survey [National 7], Alcohol Research Group 1984: Berkeley, Calif). Regression analyses indicate that the interrelationship of drinking contexts and drinking beliefs, and their impact on drinking behavior, is more complex than previously described. Consistent with earlier research, when simple frequency of drinking is the focus, social contexts for drinking emerge as the more important independent influences. When several indicators of maladaptive drinking are considered, however, beliefs regarding the effects of drinking, particularly beliefs regarding drinking as a means to modify affect, are found to be more influential. Logic is developed for a comprehensive model of the sources of problem drinking that incorporates both classes of explanatory variables.
Hidden Populations and the Gaze of Power
Authors: Fitzgerald John L.
Published: November 2015

The “hidden population” of illicit drug users has recently attracted increased attention from public health research organizations. This article explores the ways in which the term hidden population is constructed using Foucault's metaphor of the gaze of power. I argue that the construction of the hidden population through the gaze of power is sustained through the rituals and rhetorics of examination of the hidden population. The rituals of examination include quantitative methods that aim to enumerate the hidden population, as well as qualitative methods that aim to provide a realist language for that which has previously been hidden. The rhetoric of examination is the language used to justify exposure of the hidden population. The political implications of this analysis are discussed in terms of a resistance to examination. The “agency” or “capacity for choice” on the part of the researchers and the researched to not take part in the gaze of power, or at least to have more control of their participation, is also discussed, with recent examples from the literature.
The Influence of Alcohol and Drug Use on the Subsistence Adaptation of Homeless Mentally Ill Persons
Authors: Cohen Alex , Koegel Paul
Published: November 2015

While epidemiological research has offered much valuable information about substance use among homeless persons in general and homeless mentally ill persons in particular it has lacked information about the context in which substance use occurs, patterns of use, how use influences subsistence adaptation, and factors that mediate its effects. The Adaptation of the Homeless Mentally Ill (AHMI) research was able to address these gaps in our knowledge through long-term ethnographic field work with 50 homeless mentally ill individuals in the Skid Row area of Los Angeles. Most importantly, we found variation in the extent to which alcohol and drug use dominated the lives of sample members. Where some individuals organized their lives completely around the pursuit and use of drugs and alcohol, others were able to precariously balance their substance use with the tasks of meeting their basic needs. We then examine several of the possible factors that shape the relationship between substance use and subsistence adaptation, looking specifically at: (1) Skid Row; (2) psychopathology; (3) institutional affiliations; (4) values and beliefs, and; (5) the role of eventfulness. We conclude by summarizing our findings and their implications for social policy.
Empirical Validation of the Applicability of an Integrative Theory of Deviant Behavior to the Study of Drug Use
Authors: Kaplan Howard B.
Published: November 2015

The outline of an integrative theory of deviant behavior is described and evaluated with reference to (1) the compatibility of the theory with findings from a systematic program of a research using longitudinal data designed to test the theory, and (2) the congruence of empirical findings from studies guided by other theoretical frameworks or using no theoretical frameworks with the integrative theory. The systematic estimation of theoretically informed models using panel data suggests that the basic theoretical framework is sound. At the same time certain findings, while compatible with the theory, suggest the need to elaborate the model further through the specification of other mediating and moderating variables. Findings from the general literature on deviance and drug use are congruent with the general theory, and indicate that the integrative model is a useful framework for organizing the empirical literature as well as for providing a valid foundation for constructing an explanation of drug use and other deviant adaptations.
Reciprocal Causal Relationships among Drug Use, Peers, and Beliefs: A Five-Wave Panel Model
Authors: Krohn Marvin D. , Lizotte Alan J. , Thornberry Terence P. , Smith Carolyn , McDowall David
Published: November 2015

Interactional theory posits a reciprocal relationship among drug use, association with drug using peers, and beliefs about drug use. Using five waves of data from a panel study of high-risk adolescents, two models are estimated to examine these assumptions. The results support the main hypotheses from interactional theory. Drug use and peer drug use are involved in a reciprocal causal relationship with the effect from drug use to peer drug use being slightly larger. Beliefs about drug use and drug use are also reciprocally related although the effect of beliefs on drug use is relatively weak. The effect of peer drug use on beliefs is stronger in later waves as compared to earlier waves, supporting interactional theory's assumptions about the importance of taking into account developmental stages of drug use. The importance of these findings for both theoretical development and intervention strategies is discussed.
Are We Reaching and Enrolling at-Risk Drug Users for Prevention Studies?
Authors: Cunningham Renee M. , Cottler Linda B. , Compton Wilson M.
Published: November 2015

The St. Louis EachOneTeachOne (EOTO) project is a National Institute on Drug Abuse (NIDA)-funded cooperative agreement aimed at examining rates of HIV risk behaviors and studying HIV risk reduction interventions among out-of-treatment injection and crack cocaine drug users. This paper uses data collected during the first year of recruitment and enrollment to document the effect of street outreach on HIV risk behavior involvement. The major findings are that: (1) men reported more HIV risk behaviors than did women, but the results failed to show striking racial or ethnic differences; (2) we successfully enrolled women in spite of the fact that our women street contacts were largely ineligible to enroll in EOTO; and (3) actual EOTO enrollees, compared with all street contacts and eligible street contacts, engaged in fewer HIV risk behaviors. These results imply that strategies in addition to street outreach may be needed to enlist more individuals, particularly whites and women who are engaging in the highest risk drug and sexual behaviors.
Effects of Intervention Attrition and Research Attrition on the Evaluation of an HIV Prevention Program
Authors: Lauby Jennifer , Kotranski Lynne , Feighan Kelly , Collier Karyn , Semaan Salaam , Halbert Joan
Published: November 2015

Attrition impacts the effectiveness of preventive interventions as well as the external validity of efficacy analyses. This paper examines attrition from the intervention and from the research data collection in an HIV prevention program for out-of-treatment drug users. Of the 1,115 respondents, 87% completed the two-session HIV prevention intervention and of these 69% completed the 6-month data collection. Factors related to completing the intervention were different from those related to completing the 6-month interview. Completing the intervention was associated with HIV risk behaviors and with having a negative result on the project's HIV test, whereas research completion was related to indicators of a stable lifestyle. Individuals at highest risk were less likely to complete the data collection and so were under-represented in the assessment of intervention efficacy. These results have implications for program planners and evaluators.
Marijuana Use: Current Issues and New Research Directions
Authors: Sussman Steve , Stacy Alan W. , Dent Clyde W. , Simon Thomas R. , Johnson C. Anderson
Published: November 2015

Due to recent evidence of the increasing frequency of marijuana use among adolescents and young adults, and due to the many remaining research issues regarding this drug, it is appropriate to summarize some of the important data about marijuana and to suggest some directions for research and service. This article first provides a review of the history, botany, active ingredients, effects, and negative consequences of marijuana use. Next, prevention and cessation of marijuana use are discussed. Finally, this paper provides a selective examination of current issues in marijuana research. Several salient issues are highlighted including its preference among certain subgroups (high risk youth and ethnic differences), its relations with illegal behavior (marijuana use and driving, current marijuana-related legislation, and marijuana use and violence), and its recent portrayal in the media.
Injection Drug Users' Reactions to Guidelines for Bleach Disinfection of Needles and Syringes: Implications for HIV Prevention
Authors: Gleghorn Alice A. , Corby Nancy H.
Published: November 2015

The objective was to determine injection drug users' (IDUs) reactions to and willingness to adopt new National Institute on Drug Abuse, Center for Substance Abuse Treatment, and Centers for Disease Control provisional guidelines for bleach disinfection of needles and syringes (NS). In 1993, 154 IDUs participated in 17 focus groups in 8 U.S. cities. Process evaluations of transcriptions were completed utilizing qualitative techniques. Active IDUs expressed willingness to adopt most new recommendations. Syringe agitation and use of full strength bleach were acceptable. Pre-bleach water rinse, complete filling of the NS, post-bleach rinsing with fresh water, and longer bleach contact times were possible under favorable injection conditions. Cleaning both before and after injection and disassembling the NS for cleaning were unlikely to be adopted. Multiple barriers to consistent bleach use were identified. IDUs were willing to attempt new guidelines, but many circumstances interfere with adequate bleach disinfection. To avoid HIV exposure, increased access to sterile NS is necessary. Implications for HIV prevention are discussed.
HIV Infection and Drug Use in the Netherlands: The Course of the Epidemic
Authors: van Haastrecht Harry J.A.
Published: November 2015

The introduction of human immunodeficiency virus (HIV) among injecting drug users (IDUs) in the Netherlands has been traced back to 1982, whereas the first case of the acquired immunodeficiency syndrome (AIDS) in an IDU was diagnosed in 1985. By the end of December 1995, 438 AIDS cases among IDUs had been reported to the surveillance system, 53% of whom were Amsterdam residents, making the capital the epicenter of the national HIV epidemic. After a rapid spread of HIV during the first half of the 1980s, HIV prevalence stabilized at about 30% during the second half of that decade in Amsterdam. Since 1984, a variety of preventive measures have been implemented, including needle and syringe exchange programs. These measures have contributed to large reductions in HIV risk behavior. However, an important residual of HIV risk behavior remains and new infections of HIV continue to occur. In recent years, new HIV infections have been outnumbered by the increasing number of deaths occurring among HIV-infected IDUs. A large fraction of these deaths have occurred without an AIDS diagnosis. By 1994, an estimated 1,400 HIV-infected IDUs remained in the country who were still alive and AIDS-free and this number is expected to decrease further in the near future.
Predictors of Treatment Retention in Enhanced and Standard Methadone Maintenance Treatment for HIV Risk Reduction
Authors: Grella Christine E. , Wugalter Stuart E. , Anglin M. Douglas
Published: November 2015

Survival analysis was used to determine the predictors of discharge from a methadone maintenance treatment program for heroin addicts at high-risk for HIV infection and/or transmission. A consistent set of predictors was identified that was associated with treatment discharge at 90 days, 12 months, 18 months, and 24 months. Individuals who, at intake, were HIV seropositive, were younger, used cocaine, drank alcohol daily, and scored high on measures of depression and interpersonal problems were at a higher risk for discharge. Receipt of enhanced methadone treatment, which included case management services, group participation, psychiatric services, contingency-based reinforcers, and transportation assistance, was associated with a higher probability of retention, particularly in the first 90 days. These findings can be used to target individuals who are vulnerable to early discharge from treatment and to provide adjunctive services that may improve retention. Several of these predictors, particularly cocaine use and psychological problems, have also been associated with HIV risk among methadone clients. Increasing retention in methadone treatment will not only improve treatment efficacy but will also address the public health imperative to limit the transmission of HIV.
Passages: A Therapeutic Community Oriented Day Treatment Model for Methadone Maintained Clients
Authors: De Leon George , Staines Graham , Sacks Stanley
Published: November 2015

Passages is a day treatment model based on therapeutic community (TC) methods adapted for methadone maintained clients. The goal of the program is to reduce cocaine use and injection, other drug use, and high-risk sexual behavior. The Passages approach is grounded in a recovery-oriented perspective in which methadone is a prescribed medicine that can facilitate a self help, recovery process. Preliminary evaluation findings on over 500 research participants indicate greater differential improvement in drug-risk behavior and psychological status for the Passages clients who remained 6 months in the program compared to non-Passages clients. Though awaiting controlled studies, the present study demonstrated the feasibility of integrating methadone maintenance and TC-oriented day treatment in methadone clinics; and provided evidence for the effectiveness of the Passages program in reducing risk behavior and improving psychological functioning among seriously dysfunctional substance abusers.
Changes in HIV/AIDS Risk Behaviors in Drug Users in St. Louis: Applications of Random Regression Models
Authors: Gallagher Timothy J. , Cottler Linda B. , Compton Wilson M. , Spitznagel Edward
Published: November 2015

A National Institute on Drug Abuse demonstration project in AIDS prevention among drug users was conducted in St. Louis during the years 1990 through 1994. The main objective was to reduce the spread of HIV by counseling drug users and by improving drug-treatment programs in the area. A second objective was to examine the correlates of risk behavior. A structured interview was administered six times over an 18-month period. Of those persons assessed at baseline (n = 475), 95.0% (n = 451) were also reinterviewed in the last interview at 18 months. Both group and individual level changes in risk behavior were assessed using random regression models. We report on three potential risk behaviors for HIV/AIDS: (1) number of sexual partners, (2) frequency of condom use, and (3) injection drug use. For each risk behavior a separate statistical model was estimated. The results of the random regression models showed significant reductions in number of sexual partners and injection drug use. Additionally, a number of variables, such as perceived risk for AIDS and knowledge of HIV/AIDS, were statistically significant covariates of risk behavior.
Frequency of Prenatal Drug Abuse: Assessment, Obstacles, and Policy Implications
Authors: Norton-Hawk Maureen A.
Published: November 2015

The scope of interventions into social problems is based on an accurate assessment of the nature of that problem. An accurate, biased or ambiguous analysis has serious consequences for the efficacy of social interventions. This may indeed be the case with studies on the prevalence of prenatal drug use. This paper examines 23 studies conducted since 1980 and finds that the data have a number of serious methodological issues that compromise their utility in determining the breadth and characteristics of the problem.
Women and Children in Residential Treatment: Outcomes for Mothers and Their Infants
Authors: Wobie Kathleen , Eyler Fonda Davis , Conlon Michael , Clarke Leslie , Behnke Marylou
Published: November 2015

This paper examines the relationship between the living arrangement of mother and baby in a residential treatment center and measures of self-esteem, depression and parenting sense of competence and a woman's length of stay and completion or non-completion of treatment. Scores on the Bayley Scales of Infant Development (Bayley 1969) are also examined by the amount of time the baby spent with mother, an arrangement that affords the opportunity for the child to participate in the facility's therapeutic child care center. Findings suggest that the earlier a mother's infant resides with her in the treatment setting, the longer her length of stay will be, with an increased opportunity for program completion. In addition, measures of depression were lower and measures of self-esteem were higher for women with their babies than for clients who did not have their infant in the treatment facility. Scores on the Bayley Scales of Infant Development were within normal limits for all infants living with their mothers in treatment.
Criminalizing Women's Behavior
Authors: Gustavsson Nora S. , MacEachron Ann E.
Published: November 2015

Legal precedent for criminalizing the behavior of pregnant women has been established in an attempt to protect the fetus. Elevating fetal rights over maternal rights is based on questionable assumptions and inconclusive medical evidence. These criminalization policies are sexist and serve to victimize poor, pregnant women. This paper examines the evidence and policies and suggests an alternative policy approach to dealing with families with parental drug use issues.
Needlework: The Lifestyle of Female Drug Injectors
Authors: Taylor Avril
Published: November 2015

Participant observation was used to study the lifestyles of female drug injectors in Glasgow. Twenty-six women were interviewed in-depth at the end of the observation period. The results reveal how women become involved in drug use, the ways in which they finance their drug use, and their relationships with friends, partners and children. The efforts the women made to give up their use of drugs is discussed along with the difficulties involved in their attempts to do so. Overall, the findings refute the stereotypical view of women drug users as inadequate individuals. The evidence provided indicates that the lifestyle which evolves from the use of drugs offers an arena in which the women are able to find a degree of independence and purpose otherwise missing from their lives and which makes their drug-using lifestyle attractive even when disadvantages become apparent.
Illicit Drug Use in Ireland: An Overview of the Problem and Policy Responses
Authors: O'Gorman Aileen
Published: November 2015

Problematic drug use, mainly regarding the use of opiates, has been identified as a major social problem in Ireland. Such problematic drug use has been found to be concentrated in Dublin's inner city areas and outer estates where poverty, multi-generational unemployment, high population density (particularly of young adults), and poor facilities are the norm. Policy responses, although acknowledging the environmental context of the drug problem, have tended to focus on the medical treatment of the individual, rather than tackling the wider social and economic issues.
Cocaine in Britain: Prevalence, Problems, and Treatment Responses
Authors: Marsden John , Griffiths Paul , Farrell Michael , Gossop Michael , Strang John
Published: November 2015

Cocaine now occupies an established place in the British illicit drug scene. The available data point to London and several other metropolitan areas as core centers of the problem. Smokable cocaine (crack) represents a notable and worrying new feature of cocaine use in the 1990s. There remain substantial gaps in knowledge about the natural history of cocaine problems in Britain. This review addresses the prevalence and problems associated with cocaine in Britain and includes a brief summary of the effects of the drug and the development and distribution of illicit cocaine products in Britain. Following discussion of the prevalence of cocaine use and associated problems, the orientation of existing services toward cocaine users is described and future challenges for responding effectively to cocaine users in need of treatment services are identified.
The Validity of Self-Reported Opiate and Cocaine Use by Out-of-Treatment Drug Users
Authors: Nelson Deborah Brooks , Kotranski Lynne , Semaan Salaam , Collier Karyn , Lauby Jennifer , Feighan Kelly , Halbert Joan
Published: November 2015

The objective of this study was (1) to assess the validity of self-report measures of opiate and cocaine use for a sample of out-of-treatment drug users by comparing self-reports to urinalysis results, and (2) to examine the correlates of valid self-reports. Baseline data were collected from 1,015 out-of-treatment drug users in Philadelphia as part of an HIV risk reduction intervention project funded by the National Institute on Drug Abuse. Agreement rates, sensitivity, and specificity measurements were high, and kappa values were good indicating that out-of-treatment drug users provided moderately valid self-reported drug use. The multivariate analysis revealed that women and younger persons were more likely to validly report opiate use and those who were younger and more educated were more likely to give valid reports of cocaine use. Additional research is needed to better understand differences in the validity of self-reports of opiate and cocaine use and the role that urinalysis plays in influencing the validity of self-reported data.
The Impact of Crack Enforcement on Police Budgets
Authors: Bumgarner Mary , Sjoquist David L.
Published: November 2015

During the 1980s, many urban areas in the United States experienced a widespread expansion in the use of drugs in general and crack cocaine in particular. This expansion of crack use is thought to have resulted in various behavioral changes, e.g., an increase in crime and an increase in expenditures to reduce drug use. This paper examines how local police spending responded to the spread of crack cocaine. We use a pooled cross-section, time series data set consisting of 18 cities over the period 1982 through 1989 to estimate the impact of crack cocaine use on police spending, and find that police expenditures increased significantly as crack cocaine use rose.
Skin Test Anergy among Injection Drug Users Recruited from Community Settings
Authors: Lifson Alan R. , Thompson Suzanne , Grant Suzanne , Hilk Rose , Lorvick Jennifer
Published: November 2015

Five hundred ninety-two drug users (IDUs) from community settings in San Francisco and Oakland, California, were screened for tuberculosis using the tuberculin skin test, as well as for skin test anergy using two controls: mumps antigen and either tetanus toxoid or Candida. Those nonresponsive to one skin test were more likely to be nonresponsive to another, even after stratifying by HIV status. Skin test anergy (defined as nonresponse to the tuberculin skin test and to both controls) occurred in 37% of HIV-positive and 11% of HIV-negative IDUs (p<0.001). Among HIV-negative IDUs, anergy was associated with city of residence (p<0.001), use of cocaine by any route in the last 30 days (p=0.026) and use of speedballs (heroin and cocaine) by any route in the last 30 days (p=0.053). Skin test anergy in this population of IDUs may reflect more generalized defects in the delayed hypersensitivity response. Other exposures besides HIV which occur in IDUs may result in impaired cellular immunity.
Alcohol is Not the Gateway to Hard Drug Abuse
Authors: Golub Andrew Lang , Johnson Bruce D.
Published: November 2015

Much prior research has found that alcohol and/or tobacco use in early adolescence typically precedes marijuana use which typically precedes any hard drug use and abuse. This finding has been often misinterpreted as suggesting that use of alcohol somehow “causes” subsequent hard drug abuse. This perspective has lead to the simplistic policy position that preventing alcohol use among youths will eventually solve the broader problem of substance abuse. This paper reviews the ample evidence which refutes this claim and encourages those involved with policy development not to oversimplify the challenges and problems facing youths.