PRIMARY PREVENTIVE HEALTH CARE AMONG INJECTION DRUG USERS,OTHER SUSTAINED DRUG USERS,AND NON-USERS

The primary objective of this paper is to investigate the relationship between sustained illicit drug use and the utilization of primary preventive health care. Data from 1254 African-American, Hispanic/Latino, and non-Hispanic/Latino white men and women collected in 1996–1997 were analyzed to determine independent risk factors for the utilization of primary preventive health care that was not received as a result of seeking treatment for a specific health condition. When several demographic, health, and drug use variables were assessed in a logistic regression model, gender, ethnicity, health insurance status, drug use, and alcohol use were independently associated with primary preventive care. Women, Hispanic/Latinos, and persons who had health insurance were more likely to have received primary preventive health care while injection drug users, other sustained drug users, and “heavy” alcohol users were less likely to have used primary preventive health care services in the past year. [Translations are provided in the International Abstracts Section of this issue.]     

ALCOHOL AND DRUG ABUSERS' PERCEIVED REASONS FOR SELF-CHANGE IN CANADA AND SWITZERLAND: COMPUTER-ASSISTED CONTENT ANALYSIS

Although many people recover from substance-use associated problems on their own, little is known about this phenomenon. The paper had two objectives: to use a new research method, computer-assisted content analysis, to understand alcohol and drug abusers' perceived reasons for self-change and to undertake a comparative evaluation across substances and cultures to validate previous findings about subjective appraisal processes. Three studies of natural recoveries of alcohol and drug abusers in two countries conducted tape-recorded interviews with 216 respondents. The taped responses were coded based on a content analytic dictionary approach using a computerized content analysis program. All three studies found several processes mediating the decision to change substance use. The computer content analysis confirmed a cognitive appraisal process regardless of the cultural setting or substance. The findings suggest that several procedures might have benefit in clinical interventions. [Translations are provided in the International Abstracts section of this issue.]     

A COMPARISON OF HIV RISK BEHAVIORS BETWEEN NEW AND LONG-TERM INJECTION DRUG USERS

The purpose of this study was to characterize the injection and sexual risk behaviors of a cohort of active drug injectors who have initiated injection within the past 4 years and to compare their behaviors with the risk behaviors of long-term injectors who have been injecting drugs since 1984. A stratified, network-based sample was used to recruit injection drug users from the streets in Miami-Dade, Florida. After screening for eligibility, which included a urine test to confirm current drug use, participants were administered a structured questionnaire that included basic demographic information, drug-use history, and HIV risk behavior practices. Both injector groups displayed a high level of HIV injection risk behavior. Although new initiates into injection demonstrated lower risk behavior than long-term injectors at the first injection episode, the current risk behavior between new and long-term injectors is similar. [Translations are provided in the International Abstracts Section of this issue.]     

ASSESSMENT OF BENZODIAZEPINE DEPENDENCE IN ALCOHOL AND DRUG DEPENDENT OUTPATIENTS: A RESEARCH REPORT

In this study on 99 outpatients who were being treated for alcohol and/or drug dependence and also using benzodiazepines (BZDs), prevalence rates of DSM-III-R and ICD-10 substance dependence diagnoses were ascertained and scalability, reliability and validity of the scales of the Benzodiazepine Dependence Self-Report Questionnaire (Bendep-SRQ) were assessed.The latter properties were investigated by Rasch analyses, discriminability coefficients, test–retest coefficients and factor analyses. BZD dependence was found to be a prevalent additional diagnosis. The psychometric findings appear to support the use of the Bendep-SRQ at outpatient addiction centers, which could contribute to a more differentiated treatment for poly-substance dependence.     

BRIDGE TO SERVICES: DRUG INJECTORS' AWARENESS AND UTILIZATION OF DRUG USER TREATMENT AND SOCIAL SERVICE REFERRALS,MEDICAL CARE,AND HIV TESTING PROVIDED BY NEEDLE EXCHANGE PROGRAMS

Using qualitative interviews conducted in 1999, we examine awareness and use of drug user treatment and social service referrals, medical care, and HIV testing provided by needle exchange programs (NEPs) among injectors who use NEPs (N = 26) and injectors who get their syringes from other sources (N = 20). A four-category typology of NEP service knowledge and use emerges from these interviews: “Active involvement”—use of services; “Steppingstone”—no use of services but knowledge that specific services are available; “Vague awareness”—nonspecific knowledge of service availability; and “Unaware:—no awareness of the service provision function of NEPs. We describe patterns of distribution of respondents among these categories and suggest policy implications.     

THE LANGTON CLINIC CLIENTELE: SOCIAL & DEMOGRAPHIC CHARACTERISTICS OF ALCOHOL AND DRUG DEPENDENT PATIENTS

One year's experience of patients admitted to the Langton Clinic for the first time in 1980–81 is reviewed. Alcohol was the principal or only drug abused by 388 patients, and was abused conjointly with other drugs by 58 patients; 188 patients abused other drugs, but not alcohol. Various sub-cultural groups were suspected from the distribution of drug used, sex, age, religion and country of birth. Patients were characterized by social, marital and employment difficulties rather than physical and psychiatric morbidity.     

CLINICIAN BELIEFS AND PRACTICES RELATED TO INCREASING RESPONSIVITY TO THE NEEDS OF MAORI WITH ALCOHOL AND DRUG PROBLEMS

Culturally responsive treatments are often cited as essential for successfully addressing substance use-associated problems in indigenous and other ethnicgroups. However, there has been little investigation of the support for this assertion among alcohol and drug-user treatment workers, or how it might translate into clinical practice. The current paper reports on the results of a survey of the New Zealand alcohol and drug-user treatment field, which canvassed these issues. Eighty-six percent of respondents advocated adjustment of clinical practice when working with Maori. Two key strategies were referral to specialist Maori groups or individuals and/or contacting/meeting with whanau (family). Comparisons were made between respondents who referred clients on and those who provided intervention themselves. Implications of results, limitations and future research are discussed.     

NORMAL DRUG USE: ETHNOGRAPHIC FIELDWORK AMONG AN ADULT NETWORK OF RECREATIONAL DRUG USERS IN INNER LONDON

A key debate in late 1990s Britain is the “normalization” of illicit drug use among young people. This qualitative research study explores recreational drug use (mainly cannabis and cocaine) among an adult friendship network in an inner London neighborhood. It finds that the use of these drugs is accepted as a normal and routine aspect of daily life. In addition to patterns of drug consumption and drug dealing, some aspects of risk perception are also described. Adults are neglected in current UK drug policy debates. “Normal” adult recreational drug use poses the need for a new public health policy agenda for the new century. [Translations are provided in the International Abstracts Section of this issue.]     

一种新的异氰酸酯类手性衍生化试剂用于药物对映体高效液相色谱拆分性能的研究

A new chiral derivatizing reagent (s) -α-methoxybenzyl isocyanate (MIB) was prepared from (s)-(+)-mandelic acid with a practical method, and its ability of liquid chromatographic rasolution for drug enantiomers by pre-column chiral derivatization was evaluated with racemic amphetamine and mexiletine as well as phenylpropanol. The operation is simple and rapid. Separation is good for the amine isomers, but poor for alcohols and extensive work remains to be done. The solution of derivatization was directly injected into the chromatograph. Conventional silica gel column was used with light petroleum as the mobile phase.     

一种新的异氰酸酯类手性衍生化试剂用于药物对映体高效液相色谱拆分性能的研究

在已报道的四十多种手性衍生化试剂中,异氰酸酯是应用研究最活跃的一类。目前,这类试剂只有(R)-(-)或(S)-( )-naphthylethyl isocyanate(NEIC)和(R)-( )或(S)-(-)-phenylethyl isocyanate(PEIC)两种。它们均由相应的手性伯胺化合物,经光气或氯甲基硅烷作用得到的。但光气是毒性极大的气体,在一般实验室条件下难以得到     

AFRICAN-AMERICAN INJECTION DRUG USERS: TENSIONS AND BARRIERS IN HIV/AIDS PREVENTION

This exploratory study utilized a focus group methodology to explore tensions and barriers in HIV/AIDS prevention among African-American injection drug users. Participants discussed HIV infection risks, national/community HIV prevention effectiveness, prevention barriers, ideas on barrier removal, and the tensions which exist between users and the larger African-American community. Recognizing the inevitability of continued drug use for many injectors, participants requested basic harm-reduction supplies including condoms, needle exchange programs, additional drug user treatment services, and the use of culturally- and gender-matched peer-led prevention and treatment outreach. Preliminary recommendations are made for consideration in HIV/AIDS prevention among African-American IDUs. [Translations are provided in the International Abstracts Section of this issue.]     

DRUG USER TREATMENT REFERRALS AND ENTRY AMONG PARTICIPANTS OF A NEEDLE EXCHANGE PROGRAM

Objective. To compare characteristics of needle exchange program (NEP) participants who requested methadone treatment to those who did not, compare participants who subsequently enrolled into treatment to those who did not enroll, and suggest possible barriers to treatment among NEP participants. Methods and Materials. Between 8/94 and 2/97, data pertaining to demographics and drug use were collected from Baltimore NEP participants upon registration. Participants were made aware that referrals to off-site methadone maintenance were available upon request. Odds ratios and multiple logistic regression models were used to compare those who requested treatment to those who did not and those who entered treatment to those who did not enter. Results. Among 2659 NEP participants, 86% were African-American, 28% were female, 9% were employed, and the median age was 38 years. Requesting a drug user treatment referral was associated with female gender [Adjusted Odds Ratio (AOR) = 2.02], age >38 years (AOR = 1.96), use of speedballs during the past 6 months (AOR = 3.38), and age >20 years at time of first injection (AOR = 1.59). Among 139 individuals who requested treatment, males were twice as likely as females to enter treatment (OR = 2.45). In an open-ended survey, health insurance (p =. 02) and not living with children (p =. 01) were associated with drug user treatment entry. Conclusions. Even though female NEP participants were more likely to request methadone treatment, they were less likely than males to enter treatment. Although NEPs can be a bridge to drug user treatment, these data suggest that barriers to utilizing treatment referrals are important issues to resolve, especially for women who use community needle exchange programs.     

DRUG AND ALCOHOL OFFENDERS COERCED INTO TREATMENT: A REVIEW OF MODALITIES AND SUGGESTIONS FOR RESEARCH ON SOCIAL MODEL PROGRAMS

Outcome studies on drug and alcohol offenders coerced into treatment by the criminal justice system were reviewed. Positive outcomes were found for therapeutic community, methadone maintenance, and unspecified residential and outpatient programs. No outcome studies were found for court-mandated clients coerced into social model recovery programs. When developing studies, researchers should consider how clients perceive legal mandates and whether they are receiving pressures to enter treatment from other sources, such as family members, employers, friends or the welfare system. Use of the Social Model Philosophy Scale (SMPS) is suggested to correlate program characteristics and processes with outcome.     

ALCOHOL AND HYPERTENSION

1. Regular alcohol consumption is a significant contributor to the prevalence of hypertension in drinking communities. 2. The effect is additive to that of obesity and is partly reversible over 2–4 weeks with moderation of ethanol intake. 3. In heavy drinkers acute alcohol withdrawal may lead to more blood pressure elevation following an initial depressor response. 4. Heavy drinking is also associated with an increased risk of haemorrhagic stroke and cardiomyopatby. 5. Lighter drinking habits appear to offer significant protection against ischaemic heart deaths and ischaemic strokes. 6. Antihypertensive drug treatment for alcohol related hypertension may mask some of the adverse cardiovascular effects of alcohol. 7. Arguments as to whether alcohol is a cause of essential hypertension are tautological, given the many reversible lifestyle factors now known to contribute to the rise in blood pressure with ageing.     

RESOLVING PROBLEMS ASSOCIATED WITH ALCOHOL AND DRUG MISUSE: UNDERSTANDING RELATIONS BETWEEN ADDICTIVE BEHAVIOR CHANGE AND THE USE OF SERVICES

“Natural resolutions” highlight how influences on addictive behavior change may differ from and interact with influences on the use of substance-related services. These distinct literatures are summarized and implicate extra-therapeutic environmental variables in both processes. Whether assisted by interventions or not, stable resolutions are surrounded by environmental contexts characterized by improved circumstances across several years that bracket cessation of substance misuse. Psychosocial problems associated with substance use increase help-seeking, and interventions enhance improvements that typically follow initial resolution. Implications for promoting help-seeking and behavior change and necessary revisions in conventional views about relations between the processes are discussed. [Translations are provided in the International Abstracts section of this issue.]     

OUTCOMES OF AN ECOLOGICAL AND PARTICIPATORY APPROACH TO PREVENT ALCOHOL AND OTHER DRUG “ABUSE”* AMONG MULTIETHNIC ADOLESCENTS†

This study presents outcomes related to adolescents' alcohol use from an evaluation study testing the effectiveness of The Coalition for Youth Quality of Life Project (Le Regroupement pour la qualité de vie des jeunes). This project is an ecological and participatory approach developed to prevent alcohol and other drug use and misuse among multiethnic youth. The intervention was implemented through four channels of program delivery: families, schools, community organizations, and local government. The study involved 411 sixth graders from eight elementary schools and 380 eighth graders from two junior high schools, in two school districts of the Island of Montreal (province of Quebec, Canada). All students were enrolled in regular classes. Follow-up data were collected 18 months and 30 months after pre-test using a school survey. The findings indicated that the program had no significant impact on alcohol use. The program was, however, capable of producing a significant effect on several hypothesized mediating variables. At first follow-up, the sixth graders showed a higher self-esteem, better peer pressure resistance skills, and a more positive relationship with their father than the controls. The eighth graders were also more inclined to get involved in community activities related to substance abuse prevention and to choose more alternatives to “substance abuse” in their leisure time than the controls. The results are discussed by examining attrition effects and also reasons for program failure. Issues are raised about the evaluation of an ecological and participatory approach. [Translations are provided in the International Abstracts Section of this issue.]