Childhood Sexual Abuse,Post-Traumatic Stress Disorder,and Use of Heroin Among Female Clients in Israeli Methadone Maintenance Treatment Programs (MMTPs)

This study investigated association between post-traumatic stress disorder (PTSD) and a 1-year follow-up heroin use among female clients in methadone clinics in Israel. Participants were 104 Israeli female clients from four methadone clinics (Mean age = 39.09, SD = 8.61) who reported victimization to childhood sexual abuse. We tested traces in urine of these female clients for heroin a year preceding and a year following the assessment of their PTSD. Results show that 54.2% reported symptoms that accedes the DSM-IV criteria for PTSD. We found that among childhood victimized women PTSD is associated with more frequent use of heroin at a 1-year follow-up even after controlling for duration of the stay at the clinic, background, other traumatic experiences and heroin use a year prior the assessment of their PTSD. This study shows the potential long-run negative consequences of childhood sexual abuse. Not only are these sexually abused women trapped into drug dependence and addiction, they cannot break the vicious cycle of continuing the use of illicit drugs even when treated for their addiction. One major practice implication is that treatment for PTSD proven efficacious will be provided in the methadone and other drug treatment services.     

贵州省美沙酮维持治疗门诊海洛因成瘾者偷吸海洛因现状及其影响因素

目的 调查贵州省美沙酮维持治疗门诊海洛因成瘾者偷吸海洛因的情况及其影响因素.方法 从贵州省的8个美沙酮门诊招募了1003名新人组的海洛因成瘾者,进行14个月随访.在随访期间对每个招募的海洛因成瘾者在不同的时间进行尿检.将美沙酮门诊、性别、婚姻情况、工作情况、民族、宗教信仰、使用海洛因的方法、是否强制戒毒过、年龄、美沙酮日平均服药剂量、受教育时间和使用毒品的年限作为自变量代入广义估计方程(GEE)进行分析.结果 1003名海洛因成瘾者平均年龄为(33.3±6.1)岁,平均使用毒品的时间为(8.0±4.0)年,平均日美沙酮剂量为(38.0±16.6)mg.1003名海洛因成瘾者中女性成瘾者占26.0%;15.5%离异;35.8%有全职工作.在治疗不足10个月的海洛因成瘾者中尿检阳性率在30%左右,治疗超过10个月后尿检阳性率开始下降.美沙酮门诊、美沙酮日平均剂量(RR=0.98,P=0.003)、维持治疗时间(RR=0.95,P=0.029)和受教育时间(RR=0.94,P=0.014)是影响海洛因成瘾者偷吸海洛因的因素.结论 在贵州省的8个美沙酮门诊受治者中偷吸海洛因现象比较普遍,应考虑提高美沙酮剂量和维持治疗时间以减少患者偷吸海洛因的情况.     

汉川市美沙酮门诊海洛因成瘾者基本情况调查

目的了解汉川市美沙酮维持治疗门诊海洛因成瘾者的人口学及行为学特征,为制定干预措施提供依据。方法对自愿接受美沙酮维持治疗的230名海洛因成瘾者采用社区药物维持治疗评估基线调查。结果海洛因成瘾者中男性占79.57%,40岁及以下者占73.48%,未婚和离异者占55.66%,初中及以下文化程度者占70.87%,无业或待业者占80.87%。毒资花费每天50～1 500元,平均(380.78±268.14)元;过去1个月内76.52%的成瘾者有注射吸毒行为,13.91%的成瘾者共用过注射器。161人(70.00%)有过性行为,多性伴比例占13.66%,21.74%在最近1次性行为时使用了安全套。丙型肝炎病毒(HCV)阳性率62.17%,艾滋病病毒(HIV)阳性率6.52%。过去3个月内37.83%的成瘾者因为吸毒而有过偷、抢、骗等行为,71.74%与家人居住,51.31%自我感觉与家人关系较差。结论进入美沙酮门诊接受治疗的吸毒者为艾滋病的高危人群,应开展积极的健康教育和有效的行为干预措施,阻断艾滋病经吸毒传播。     

Methadone dosing, heroin affordability, and the severity of addiction

OBJECTIVES: This study sought to track changes in US heroin prices from 1988 to 1995 and to determine whether changes in the affordability of heroin were associated with changes in the use of heroin by users seeking methadone treatment, as indexed by methadone dose levels. METHODS: Data on the price of heroin were from the Drug Enforcement Administration; data on methadone doses were from surveys conducted in 1988, 1990, and 1995 of 100 methadone maintenance centers. Multivariable models that controlled for time and city effects were used to ascertain whether clinics in cities where heroin was less expensive had patients receiving higher doses of methadone, which would suggest that these patients had relatively higher physiological levels of opiate addiction owing to increased heroin use. RESULTS: The amount of pure heroin contained in a $100 (US) purchase has increased on average 3-fold between 1988 and 1995. The average dose of methadone in clinics was positively associated with the affordability of local heroin (P < .01). CONCLUSIONS: When heroin prices fall, heroin addicts require more methadone (a heroin substitute) to stabilize their addiction--evidence that they are consuming more heroin.     

四川省美沙酮维持治疗患者脱失现状及其影响因素

目的 了解四川省美沙酮维持治疗患者的脱失现状,分析患者脱失的影响因素,为降低美沙酮维持治疗的脱失率提供理论依据。方法 多阶段整群随机法,通过面对面问卷调查,对四川省5家美沙酮美沙酮维持治疗门诊点的581名海洛因成瘾者的脱失情况进行调查, 使用卡方检验和logistic回归分析,探究美沙酮患者脱失的影响因素。结果 logistic回归分析发现,调查对象过去6个月的脱失情况与其对美沙酮维持治疗的认知有关(P＜0.05)。首次服用美沙酮剂量＞50ml的患者不易发生脱失(OR=0.568,95%CI:0.333~0.969);与家人现阶段关系非常好或较好的患者不易发生脱失(OR=0.509,95%CI:0.264~0.982)。偷吸海洛因的患者容易发生服药脱失(OR=2.542,95%CI=1.879-4.299) 。结论 MMT门诊应对美沙酮患者进行适当的健康教育,普及正确的美沙酮维持治疗知识,帮助恢复其家庭及社会功能、克服毒瘾,减少患者的脱失。     

中国九城市1301名社区美沙酮维持治疗门诊患者偷吸海洛因及影响因素分析

目的 了解社区美沙酮维持治疗患者治疗期间偷吸海洛因的情况及其影响因素.方法 在江苏、安徽、云南3省9个城市社区美沙酮维持治疗门诊中抽取1301名符合条件的患者进行问卷调查与随机尿吗啡定性检测.收集一般人口学、艾滋病/毒品滥用相关高危行为、参加美沙酮维持治疗情况、抑郁与焦虑及偷吸海洛因等信息.结果 1301名调查对象中男性居多(76.2%),年龄(34.6±6.5)岁,受教育程度以初中及以下为主(71.7%).平均维持治疗剂量(48.1±29.4)mg/d,目前治疗剂量自我满意度平均得分为8.6,尿吗啡检测阳性率为27.7%.有抑郁和焦虑症状者比例分别为38.3%和18.4%,抑郁合并焦虑症状的比例为14.2%.婚姻状况、治疗时间的长短、目前治疗剂量自我满意度及是否曾退出治疗对偷吸海洛因影响的差异有统计学意义,而性别、教育程度及治疗剂量对偷吸海洛因的影响差异无统计学意义.不同省份间影响偷吸海洛因的因素有所不同,但对当前剂量自我满意度是共同的影响因素.结论 提高门诊服务质量及服药依从性、延长参加治疗的时间、提高患者对治疗剂量的满意度及避免脱失对减少治疗期间偷吸海洛因有重要意义.     

Drug czar seeks new emphasis on methadone treatment

Barry McCaffrey, the White House drug policy director, called for improved methadone maintenance treatment programs for heroin addicts. McCaffrey referred to the incarceration of heroin addicts as a failed social policy. Speaking at a heroin addiction conference sponsored by the National Institute of Drug Abuse, McCaffrey told participants that heroin addicts who are not enrolled in methadone treatment programs are exposed to HIV infection through shared drug needles and unprotected sexual relations.     

HIV阳性美沙酮维持治疗者新型毒品使用情况及其影响因素分析

目的 了解HIV阳性美沙酮维持治疗（MMT）者新型毒品使用情况及其影响因素。 方法 在云南省瑞丽、芒市、文山、蒙自、个旧5个MMT门诊选取612名HIV阳性服药人员进行尿液吗啡、甲基苯丙胺、亚甲二氧基甲基苯丙胺、丁丙诺啡、苯二氮卓类检测和问卷调查,收集一般情况、新型毒品使用情况等信息。 结果 612名调查对象平均年龄（38.9±6.3）岁,78.9%为男性,平均受教育年限（8.0±3.4）年,60.5%与家人关系好,25.0%自报近一年使用过新型毒品。尿检结果显示：吗啡阳性率为14.4%,新型毒品阳性率为26.6%。所在地区、有无临时性伴、是否脱失过MMT、是否偷吸海洛因对新型毒品使用和尿检结果的影响均有统计学意义（P<0.05）。结论 HIV阳性MMT者中使用新型毒品的现象普遍。应加强新型毒品使用的监督、检测及相关高危行为干预。     

The experience of hospitalization and restraint of women who have a history of childhood sexual abuse

Within psychiatric settings, many female clients report experiences of childhood sexual abuse (CSA). In this paper we explore the experience of 10 women who were hospitalized in psychiatric settings, restrained, and given forced medication (FM). All the women have histories that included CSA. Some authors have suggested that the experience of psychiatric hospitalization may represent an event that reenacts the experience of trauma. The results suggest that from the perspective of these women, the experience of restraint engendered traumatic emotional reactions such as fear, anxiety, and rage, and in no way was viewed as therapeutic even years later. Women felt powerless and unheard. The women wanted nurses who were empathic and responsive to their human needs as clients, but they felt nurses did not want to hear about the abuse or their internal distress. We hope that the perspective of these women will help in the consideration of alternatives and modifications to the use of restraint in psychiatric settings.     

Longitudinal Effects of LAAM and Methadone Maintenance on Heroin Addict Behavior

Levo-alpha-acetylmethadol maintenance (LAAM) was compared to methadone maintenance (MM) on the behavioral performance of 315 heroin addicts before, during, and after 12 months of fully subsidized treatment. Assessments of drug use, criminal behavior, HIV risk behaviors, and employment and residential status were obtained at treatment intake and at 6, 12, and 18 months after admission. Treatment retention and in-treatment suppression of heroin use were significantly better for the LAAM group than for the MM group. Improvements were also noted during treatment in criminal behavior, criminal justice involvement, and employment status, and there were reductions in injection HIV risk and number of sexual partners. Most significant effects were primarily related to active participation in maintenance treatment. Under subsidized treatment, retention rates were two to four times that of similar clients in local community programs during the same period. LAAM was a useful and a potentially important addition to treatment options for opiate addiction, conferring greater retention and opiate suppression benefits. Its removal from application provides a historical lesson concerning the introduction of new medications into addiction health services. Douglas Longshore died December 2005.     

A randomized trial of an interim methadone maintenance clinic.

BACKGROUND. Interim methadone maintenance has been proposed as a method of providing clinically effective services to heroin addicts waiting for treatment in standard comprehensive methadone maintenance programs. METHODS. A clinic that provided initial medical evaluation, methadone medication, and AIDS education, but did not include formal drug abuse counseling or other social support services was established in New York City. A sample of 301 volunteer subjects recruited from the waiting list for treatment in the Beth Israel methadone program were randomly assigned to immediate entry into the interim clinic or a control group. RESULTS. There were no differences in initial levels of illicit drug use across the experimental and control groups. One-month urinalysis follow-up data showed a significant reduction in heroin use in the experimental group (from 63% positive at intake to 29% positive) with no change in the control group (62% to 60% positive). No significant change was observed in cocaine urinalyses (approximately 70% positive for both groups at intake and follow-up). A higher percentage of the experimental group were in treatment at 16-month follow-up (72% vs 56%). CONCLUSIONS. Limited services interim methadone maintenance can reduce heroin use among persons awaiting entry into comprehensive treatment and increase the percentage entering treatment.     

Childhood physical and sexual abuse experiences associated with post-traumatic stress disorder among pregnant women

PurposeWe sought to evaluate the extent to which childhood physical and/or sexual abuse history is associated with post-traumatic stress disorder (PTSD) during early pregnancy and to explore the extent to which the childhood abuse-PTSD association is mediated through, or modified by, adult experiences of intimate partner violence (IPV).MethodsIn-person interviews collected information regarding history of childhood abuse and IPV from 2,928 women aged 18-49 years old prior to 16 weeks of gestation. PTSD was assessed using the PTSD Checklist-Civilian Version. Multivariate logistic regressions were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).ResultsCompared to women with no childhood abuse, the odds of PTSD were increased 4.31-fold for those who reported physical abuse only (95% CI, 2.18–8.49), 5.33-fold for sexual abuse only (95% CI, 2.38–11.98), and 8.03-fold for those who reported physical and sexual abuse (95% CI, 4.10–15.74). Mediation analysis showed 13% of the childhood abuse-PTSD association was mediated by IPV. Furthermore, high odds of PTSD were noted among women with histories of childhood abuse and IPV compared with women who were not exposed to either (OR = 20.20; 95% CI, 8.18–49.85).ConclusionsChildhood abuse is associated with increased odds of PTSD during early pregnancy. The odds of PTSD were particularly elevated among women with a history of childhood abuse and IPV. Efforts should be made to prevent childhood abuse and mitigate its effects on women's mental health.     

An Exploratory Study of Inhalers and Injectors Who Used Black Tar Heroin

AIMS: To undertake an exploratory study to examine the characteristics of patients in narcotic treatment programs who started their use of black tar heroin either as inhalers or as injectors and to compare them with those who started as inhalers but shifted to injecting. Other studies in this area have used subjects using other forms of heroin more amenable to inhaling. PARTICIPANTS, DESIGN, AND MEASUREMENT: A purposive sample of 199 patients in 6 methadone programs in Texas were interviewed in 2002-2003 using a structured instrument. FINDINGS: At admission to treatment, those who were heroin inhalers were more likely to be African American, to live with their families, to have income from wages, and to report fewer days of problems on most of the ASI measures. Those who shifted from inhaling to injecting were more likely to be Hispanic and to have had mental health problems that interfered with their lives and to have had less nurturing while growing up. Injectors were older at this treatment admission, had more treatment episodes and more times in jail, and were more likely to have hepatitis C, AIDS, or gonorrhea. There were high levels of physical and mental problems and histories of traumatization as children and adults for almost all the respondents. Males were as likely as females to have been sexually abused as children or as adults. CONCLUSIONS: The high rates of mental and physical problems among all the clients interviewed showed the need for comprehensive services to be delivered within the substance abuse treatment programs. Histories of trauma and sexual abuse should be addressed for both male and female clients.     

Childhood abuse and its association with mid-aged women's sexual functioning

The aim of this study was to investigate the association of recalled childhood sexual and physical abuse with current sexual functioning in mid-life. The sample was participants in the longitudinal population-based cohort of mid-aged women, The Melbourne Women's Midlife Health Project. Three hundred sixty two of the women (92% of the available cohort) were administered the Violence Questionnaire in the sixth year of follow-up. This included questions on physical abuse and sexual abuse experienced in childhood. We used the Short Personal Experiences Questionnaire (Dennerstein, Anderson-Hunt, & Dudley, 2002) to assess current sexual functioning. Forty eight percent of the women had no experience of childhood sexual abuse, 42% had experienced noncontact sexual abuse, 36% had experienced contact sexual abuse, and 7% had experienced penetrative sexual abuse. Nine percent of the women had experienced physical abuse in childhood. Women who had experienced penetrative childhood sexual abuse were significantly more likely to have fewer children (median 2) than women who had not experienced penetrative childhood sexual abuse (median 3) (P < 0.05). The only area of sexual or relational functioning significantly affected by childhood sexual abuse was that of feelings for partner (P < 0.05). Those who experienced penetrative childhood sexual abuse had, on average, significantly shorter current relationships (P < 0.05). Women who had experienced both childhood sexual and physical abuse reported a lower frequency of current sexual activities (P < 0.05). This study of mid-aged women found that the major impact of childhood sexual abuse is on the quality of relationship with the partner.     

1173名强制隔离戒毒者童年期虐待及毒品使用行为调查

目的 探讨甲基苯丙胺(methamphetamine,MA)使用障碍戒毒者各类型童年期虐待的检出率及其与毒品使用行为的关系.方法 采用横断面调查法在安徽省7所成人强制隔离戒毒所招募MA使用障碍戒毒者1 173人.采用一般情况和毒品使用行为调查表、儿童期虐待问卷简版(Childhood Trauma Questionna...     

Treatment retention and evolution of clientele in a low threshold methadone substitution treatment program in Montreal

OBJECTIVES: To evaluate client treatment retention and evolution in terms of living conditions, at-risk behaviours, and the use of psychoactive substances (PAS) over a one-year period, following admission into a low-threshold methadone program in Montreal. METHOD: Individual interviews were administered to 114 clients from Relais-Méthadone (RM) at admission and one year after treatment initiation. Participants reported on PAS consumption and unsafe practices of drug use and sexual behaviours at high risk for transmission of HIV, sexually transmitted infections (STI) and other blood-borne viruses (BBV). Services utilized by clients were documented from Relais-Méthadone files. Bivariate analyses were used to compare data recorded at admission and one-year follow-up. RESULTS: The treatment retention rate after one year at RM was 64%. However, by taking into account those clients who were transferred to a regular program during the study period, as well as those who voluntarily tapered their methadone treatment (16.7%), the status of 80.7% of clients demonstrated improvement one year after admission into treatment. Furthermore, the clients who remained in treatment for a year for whom information was available (n = 60) showed a tendency towards more stable living conditions. They also demonstrated a significant decrease in both the number of PAS injections and in risky behaviours related to drug consumption. A statistically significant decrease in the frequency of heroine and cocaine use was also observed. By contrast, however, two thirds of the individuals in treatment after a year (n = 42) maintained or increased their daily consumption of other PAS. DISCUSSION: The treatment retention rate is comparable to other low or regular threshold substitution programs. The results support previous studies showing that the methadone substitution treatment reduces heroine and cocaine consumption, and decreases the number of unsafe behaviours that could potentially transmit HIV, STI and BBV for the majority of clients who remained in treatment. Future research could focus attention on people who abandon treatment and those who present at-risk behaviours during treatment.     

浙江省台州市美沙酮维持治疗就诊者性行为及其网络特征研究

目的　了解浙江省台州市美沙酮维持治疗(MMT)就诊者性行为和性网络特征,探讨其危险性行为的影响因素.方法 采用横断面研究,通过问卷和全国MMT信息系统收集数据,采集尿液快速检测海洛因、冰毒、摇头丸、K粉,采集血液检测HIV、丙型肝炎病毒(HCV)和梅毒.结果 共调查362人,以男性(88.7％)、31～岁组(54.5％)、已婚(61.6％),初中(56.6％)为主;共308人(85.1％)参加尿检,其中82人(26.6％)吗啡阳性,21人(6.8％)冰毒阳性,19人(6.2％)摇头丸阳性,未发现K粉检测阳性者;共279人(77.1％)参加血液检测,HIV、HCV、梅毒阳性率分别为1.1％、36.7％和3.6％;过去6个月内有性行为的MMT就诊者多性伴发生率为19.5％(56/287),与亲人一起居住为其保护因素(aOR=0.30,95％CI:0.13～0.71),新型毒品尿检结果阳性为其危险因素(aOR=5.92,95％CI:1.12～31.34),差异有统计学意义(P＜0.05);该人群的性网络多数呈双元、线性、非循环,性网络与吸毒网络重叠交叉.结论 台州市MMT就诊者仍存在一定的偷吸毒品行为和HIV/性传播疾病(STD)相关危险性行为,性网络与吸毒网络有所交叉,存在一定的HIV/STD疾病传播风险,应加大关注并采取相关措施进行有效防控.     

HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth.

In this article, we present data obtained with the psychosocial interview instrument, HEADSS (Home, Education, Activities, Drug use and abuse, Sexual behavior, Suicidality and depression) that was administered to High Risk Youth Clinic clients at their initial visits during a 1-year period. Of the 1,015 new patients, 63% were homeless/runaway youths and 37% were living with their families. Utilizing the HEADSS interview instrument, we compared homeless/runaway youths to nonhomeless youths in a number of areas, including risks for human immunodeficiency virus (HIV) infection. Our results showed that homeless teens tended to be younger, female, and white compared to their nonhomeless counterparts. They were more likely to have dropped out of school and were far more likely to be depressed and actively suicidal. They demonstrated all forms of drug abuse. They engaged in first sexual intercourse at an earlier age, and experienced a higher incidence of sexual abuse and prostitution. They were 6 times more likely to be at risk for HIV infection.     

武汉市吸毒人群HIV、HCV和 梅毒螺旋体抗体检测分析

摘要:目的　探讨武汉市美沙酮门诊吸毒患者的社会学特征及其人类免疫缺陷病毒（HIV）、丙型肝炎病毒（HCV）和梅毒螺旋体的感染情况,为有效防治毒品引起的相关传染性疾病提供科学依据。方法　对美沙酮门诊的143位接受美沙酮替代治疗的吸毒患者问卷调查,并取其静脉血检测血清中的HIV、HCV和梅毒螺旋体抗体。结果　（1）HIV抗体检测结果均为阴性;HCV抗体检测阳性率为75.52%（108/143）;梅毒螺旋体抗体检测阳性率为6.29%（9/143）,毒品种类以海洛因为主。（2）吸毒人群HCV阳性率性别差异无统计学意义（P＞0.05）;女性梅毒阳性率高于男性,差异有统计学意义（P＜0.05）。（3）青少年吸毒现象较突出:初次接触毒品在18 岁以下者占15.39%（22/143）。（4）无业或待业人员占84.62%（121/143）,初中及以下文化程度占66.43%（95/143）,文化程度低是对毒品及相关疾病认知差的主要原因。（5）未婚或离异人员占60.84%（87/143）,情感、婚姻问题是吸毒主要诱因之一。结论　针对武汉市美沙酮门诊吸毒人群特点,应重点做好以下工作:（1）在青少年和低文化程度人群中加强对毒品及相关疾病的宣教,强调毒品相关疾病的传播途径,提高易感人群对毒品及相关疾病的认识;（2）应重点关注吸毒人群严重的HCV感染状况,积极研究危险因素及防治手段,在宣教时正确引导,使患者克服恐惧心理,正确认识丙型肝炎,及时监测肝功能;（3）在开展艾滋病相关知识的宣教、咨询等活动时,积极推荐吸毒人员进行梅毒螺旋体检测,并在开展行为干预时更多关注女性患者;（4）加强社区和家庭宣教,充分发挥社区和家庭亲情的积极作用,帮助吸毒患者远离毒品,重树对生活的希望。