Immigrants from Russia, Ukraine and the Caucasus Region: Differential Drug Use, Infectious Disease, and Related Outcomes

This study examined drug use patterns, HIV/AIDS, and related outcomes among former Soviet Union (FSU) immigrants from Russia, Ukraine and the Caucasus mountain region in Israel who reported heroin use. A total of 253 FSU heroin users were interviewed from 2002 to 2007 as part of a large drug use surveillance study in Israel. Individuals were sampled at drug treatment facilities in an urban population center of the Negev region of Israel. Participants were assessed using the Addiction Severity Index, fifth edition. First, immigrants from Russia and Ukraine were compared; then, as a group, compared to those from the Caucasus region. Overall, ASI composite scores suggested comparable levels of addiction severity between the Russian and Ukrainian groups. However, Kavkaz immigrants are older, less likely to be employed, and have more severe scores on many of the drug use measures as compared to the other two nationalities. This study shows different drug use patterns exist among FSU immigrants. Such differences may be, in part, due to socioeconomic, geographic and other sociodemographic factors. Injection drug use, regardless of country/region of origin is a critical public health problem, especially given the link between injection drug use and infectious disease.     

Mental symptoms,psychotropic drug use and alcohol consumption in immigrated middle-aged women. The Women's Health in Lund Area (WHILA) Study

This study aims to analyse mental symptoms, psychotropic drug use and alcohol consumption, in immigrant women born in Finland, the other Nordic countries, Eastern Europe, Western Europe and countries outside Europe, compared with Swedish-born women, and furthermore, to study if age at immigration may have an influence. All women (n=10,766) aged 50–59?years and living in the Lund area of southern Sweden received a postal invitation to a health survey named the Women's Health in Lund Area; 64.2% (n=6917) participated. The participants answered a questionnaire including prevalence of mental symptoms during the past 3?months, regular use of psychotropic drugs, alcohol consumption during an average week, country of birth and age at immigration. Severe mental symptoms were more common among most immigrant groups compared with native Swedes, but the association to country of birth was not significant after adjustment for possible confounders. Regular use of hypnotics was more common among Nordic immigrants only (odds ration, OR?=?4.4). East European and non-European immigrants less often were alcohol consumers (OR?=?1.6 and OR?=?3.8). Heavy drinking was more common among non-Nordic immigrants who immigrated at a younger age than at an older age. Furthermore, it was found that although East European and non-European immigrants had a higher educational level, they were less often gainfully employed compared with native Swedes. In middle-aged women, country of birth as well as age at immigration are important factors to consider in relation to alcohol consumption, but these factors may be of less importance considering mental health.     

Mental symptoms, psychotropic drug use and alcohol consumption in immigrated middle-aged women. The Women's Health in Lund Area (WHILA) Study

This study aims to analyse mental symptoms, psychotropic drug use and alcohol consumption, in immigrant women born in Finland, the other Nordic countries, Eastern Europe, Western Europe and countries outside Europe, compared with Swedish-born women, and furthermore, to study if age at immigration may have an influence. All women (n=10,766) aged 50-59 years and living in the Lund area of southern Sweden received a postal invitation to a health survey named the Women's Health in Lund Area; 64.2% (n=6917) participated. The participants answered a questionnaire including prevalence of mental symptoms during the past 3 months, regular use of psychotropic drugs, alcohol consumption during an average week, country of birth and age at immigration. Severe mental symptoms were more common among most immigrant groups compared with native Swedes, but the association to country of birth was not significant after adjustment for possible confounders. Regular use of hypnotics was more common among Nordic immigrants only (odds ration, OR = 4.4). East European and non-European immigrants less often were alcohol consumers (OR = 1.6 and OR = 3.8). Heavy drinking was more common among non-Nordic immigrants who immigrated at a younger age than at an older age. Furthermore, it was found that although East European and non-European immigrants had a higher educational level, they were less often gainfully employed compared with native Swedes. In middle-aged women, country of birth as well as age at immigration are important factors to consider in relation to alcohol consumption, but these factors may be of less importance considering mental health.     

Depression prevalence in disadvantaged young black women

Abstract Background Research with Mexican Americans suggests that immigrants have lower rates of mental disorders than U. S.-born Mexican Americans. We examine the prevalence of depression, somatization, alcohol use and drug use among black American women, comparing rates of disorders among U. S.-born, Caribbean-born, and African-born subsamples. Methods Women in Women, Infants and Children (WIC) programs, county-run Title X family planning clinics, and low-income pediatric clinics were interviewed using the PRIME-MD. In total, 9,151 black women were interviewed; 7,965 were born in the U. S., 913 were born in Africa, and 273 were born in the Caribbean. Results Controlling for other predictors, U.S.-born black women had odds of probable depression that were 2.94 times greater than the African-born women (p<0.0001, 95% CI: 2.07, 4.18) and 2.49 times greater than Caribbean-born women (p<0.0016, 95% CI: 1.41, 4.39). Likelihood of somatization did not differ among women who were U. S. born, African born, or Caribbean born. Rates of alcohol and drug problems were exceedingly low among all three groups, with less than 1% of the women reporting either alcohol or drug problems. Conclusions These results mirror similar findings for Mexican immigrant as compared with American-born Mexican Americans. The findings suggest that living in the U. S. might increase depression among poor black women receiving services in county entitlement clinics. Further research with ethnically validated instruments is needed to identify protective and risk factors associated with depression in immigrant and U. S.-born poor black women.     

Heroin use among adolescents in treatment for substance use disorders

OBJECTIVE: To clarify prevalence rates and describe patterns of adolescent heroin users who are in treatment for substance use disorders. METHOD: The Treatment Episode Data Set (TEDS) was examined for trends in the number of adolescents admitted to substance abuse treatment centers and for changes in the routes of heroin administration. Thirteen adolescents who used heroin from one treatment program were compared with 536 adolescents who did not. RESULTS: Between 1992 and 1996, heroin-using youths represented 2.0% of youths in treatment and in 1997 they represented 2.6%. Heroin-using youths represented 56% of those using injection drugs. Heroin-using youths from one treatment program had significantly more polysubstance dependence in comparison with adolescents who did not use heroin. CONCLUSIONS: Nationally, there has been an increasing number, but not percentage, of heroin-using youths in treatment between 1992 and 1996. In 1997 there was an increase in both the number and percentage of heroin-using youths in treatment. Heroin-using adolescents have the highest rate of injection drug use when compared with youths using other substances. Because of their greater risk of contracting human immunodeficiency virus through injection drug use, treatment trials for these adolescents are needed.     

Substance abuse among psychiatric inpatients.

The drug use history was obtained for all patients admitted to the inpatient service of a large municipal hospital during a 1-month period. A total of 104 patients were evaluated. An inverse relationship was found between the frequency of drug use and the diagnosis of schizophrenia. Approximately one third of the patients were found to be polydrug users, that is, individuals who used at least two types of drugs weekly (e.g., alcohol plus cocaine, heroin plus cocaine, etc.) during the 3 months prior to hospitalization. Most of the polydrug users were males. Patients who scored high in drug use tended to be younger, had more seclusions while on the ward, and had less of a history of drug or alcohol treatment. The drug having the highest frequency of daily use was found to be cocaine. It appears that drug use in general and polydrug use in particular is increasing among psychiatric patients.     

Negative attributions towards people with substance use disorders in South Africa: Variation across substances and by gender

ABSTRACT: BACKGROUND: Little research has examined attitudes towards people who use substances in low and middle income countries (LMIC). Therefore, the present study examined the attributions made by the general South African population about people who use substances and whether these attributions differ by the type of substance being used, the gender of the person using the substance, or the characteristics of the person making the attribution. Method: A convenience sample of 868 members of the general public was obtained through street-intercept methods. One of 8 vignettes portraying alcohol, cannabis, methamphetamine or heroin, with either a male or female as the protagonist was presented to each respondent. Respondents' attitudes towards the specific cases were investigated. Results: Respondents held equally negative views of the presented substances, with the exception of the cannabis vignette which was considered significantly less "dangerous" than the alcohol vignette. Respondents were more likely to offer "help" to women who use alcohol, but more likely to suggest "coercion into treatment" for men. Individuals who scored higher on the ASSIST were more likely to hold negative attitudes towards substance users and black African respondents were more likely to offer help to individuals who use substances. Conclusion: The stigma associated with substance use in South Africa is high and not necessarily dependent on the drug of choice. However, a range of factors, including gender of the substance user, and ethnicity of the rater, may impact on stigma. Interventions designed to strengthen mental health literacy and gender-focused anti-stigma campaigns may have the potential to increase treatment seeking behaviour.     

Inter-group and intra-group assertiveness: adolescents' social skills following cultural transition

The goals of this study were to examine intra-group and inter-group assertiveness among adolescents, and to compare these two domains of assertiveness between cultural groups in Israel. Measures of intra-group and inter-group assertiveness were developed, and questionnaires were administrated to 441 immigrants from the Former Soviet Union (FSU), 242 immigrants from Ethiopia and 333 non-immigrants. Compared to non-immigrants, FSU and Ethiopian immigrants' inter-group assertiveness was lower. Girls reported higher levels of inter-group assertiveness than boys. Each of the immigrant groups rates itself as equally assertive as the non-immigrant group and more assertive than the other immigrant group. Also, a difference between inter-group and intra-group assertiveness was found among the FSU immigrants. It is argued that adolescents' assertiveness following cultural transition is associated with socio-cultural context, and the implications of this conclusion are discussed.     

Heroin and cocaine co-use in a group of injection drug users in Montréal

OBJECTIVE: To describe the pattern of co-use of heroin and cocaine in individuals who were not receiving methadone maintenance treatment. DESIGN: Structured interviews. SETTING: Community hospital. PARTICIPANTS: Individuals (n = 1111) selected from a cohort of out-of-treatment injection drug users in Montréal, Que. OUTCOME MEASURE: Frequency (injections per day) and quantity (number of days of use) of heroin, cocaine and speedball (the simultaneous administration of heroin and cocaine) use reported in the month preceding the interview. RESULTS: About 50% of the sample reported using only cocaine intravenously (C group), about 8% reported using only heroin (H group) intravenously and about 15% reported using both heroin and cocaine (HC group) intravenously. Reported cocaine consumption was similar in the HC and C groups. Heroin was used on fewer days by the HC than by the H group, but the number of injections per day was similar. Speedball use, which was quantified independently from heroin and cocaine use, was reported almost exclusively by the HC group, and speedball was used less often than either heroin or cocaine alone. Finally, a similar proportion of individuals in the C and the HC groups consumed alcohol in the 24 hours preceding the interview, but a larger proportion of individuals in the HC group reported the use of marijuana. CONCLUSION: In a cohort of injection drug users in Montréal, cocaine was the most prevalent illicit drug. Furthermore, about 70% of the heroin users also injected cocaine, but not in the form of speedball. Thus, the sequential co-use of heroin and cocaine is highly prevalent in Montréal and deserves particular clinical attention.     

Lifetime use of mental health and substance abuse treatment services by incarcerated women felons

OBJECTIVE: This study examined the lifetime use of alcohol, drug, and mental health treatment services by recently incarcerated women prison inmates. METHODS: A total of 805 women entering a North Carolina prison for new felony charges in 1991 and 1992 were interviewed in person shortly after incarceration. The women were assessed for psychiatric disorders and lifetime use of substance abuse and mental health treatment services. Rates of service use were analyzed by inmate characteristics and were compared with rates for a sample of women in the community in North Carolina. RESULTS: The majority of women inmates reported a history of using substance abuse services or mental health services or both. Those with psychiatric disorders and prison recidivists were the most likely to have used such services. Rates of service use were substantially higher for the inmates than for the women in the community, even when the effects of having a psychiatric or substance use disorder were controlled for. CONCLUSIONS: Many of the incarcerated women in the study met lifetime criteria for alcohol, drug, and mental health disorders that were significantly related to their use of substance abuse and mental health treatment services. The majority of the inmates met criteria for a current disorder despite past treatment. Further research is needed to help in developing programs to reduce women inmates' alcohol, drug, and mental health problems.     

Referral and screening for substance abuse treatment in jails

As jails and prisons have become filled to capacity with inmates arrested and convicted for drug-related offenses, efforts have intensified to reduce subsequent drug use, drug-related crime, and recidivism among this population. Faced with the drug abuse epidemic; treatment resources in the community have expanded more quickly than in detention and corrections facilities. Many large jails and prisons do not presently have a substance abuse treatment program despite clear evidence of widespread drug and alcohol dependence problems among inmate populations. Where substance abuse treatment resources are available, administrators face difficult choices in determining which inmates will receive services. This paper provides a discussion of issues related to referral and screening procedures for in-jail substance abuse treatment programs. Referral and screening systems implemented in several jails across the country are reviewed.     

Psychiatric comorbidity and gender difference among treatment-seeking heroin abusers in Taiwan

The objectives of the present study were to estimate the psychiatric comorbidity of Taiwanese heroin users seeking treatment and to identify the gender differences in psychiatric comorbidity and drug use behavior. Subjects were interviewed using a structured questionnaire on drug use behavior and the Mini International Neuropsychiatric Interview for psychiatric disorders. Of the subjects, 58.5% of the male and 62.5% of the female subjects had at least one non-substance-use axis I psychiatric disorder or antisocial personality disorder. Compared to male subjects, female subjects were younger, were less educated, had higher rates of unemployment and had earlier onset of illicit drug use. Female subjects were 11-fold more likely than male subjects to exhibit suicidal behavior. Among heroin abusers in the present study, female subjects were more widely exposed to unfavorable social factors and had substantially higher incidence of suicidal behavior than male subjects. Drug treatment centers should be aware of these gender differences and pay particular attention to comorbid depressive disorders and suicidal behavior of female heroin abusers.     

Contingency management in opioid substitution treatment

The majority of opiate-dependent patients in substitution treatment show additional substance-related disorders. Concomitant use of heroin, alcohol, benzodiazepines or cocaine compromises treatment success. Concomitant drug use may be treated by using contingency management (CM) which is based on learning theory. In CM, abstinence from drugs, as verified by drug screenings, is reinforced directly and contingently. Reinforcers used in CM studies with substituted patients were, amongst others, vouchers and take-home privileges. Studies in the USA show a medium average effect of CM on drug consumption rates and abstinence. The effects decrease markedly after the end of the intervention. We discuss whether CM is applicable within the German substitution treatment system and how it can be combined with other interventions such as selective detoxification treatments or cognitive-behavioural programmes.     

A 33-year follow-up of narcotics addicts

BACKGROUND: This study examined longitudinal patterns of heroin use, other substance use, health, mental health, employment, criminal involvement, and mortality among heroin addicts. METHODS: The sample was composed of 581 male heroin addicts admitted to the California Civil Addict Program (CAP) during the years 1962 through 1964; CAP was a compulsory drug treatment program for heroin-dependent criminal offenders. This 33-year follow-up study updates information previously obtained from admission records and 2 face-to-face interviews conducted in 1974-1975 and 1985-1986; in 1996-1997, at the latest follow-up, 284 were dead and 242 were interviewed. RESULTS: In 1996-1997, the mean age of the 242 interviewed subjects was 57.4 years. Age, disability, years since first heroin use, and heavy alcohol use were significant correlates of mortality. Of the 242 interviewed subjects, 20.7% tested positive for heroin (with additional 9.5% urine refusal and 14.0% incarceration, for whom urinalyses were unavailable), 66.9% reported tobacco use, 22.1% were daily alcohol drinkers, and many reported illicit drug use (eg, past-year heroin use was 40.5%; marijuana, 35.5%; cocaine, 19.4%; crack, 10.3%; amphetamine, 11.6%). The group also reported high rates of health problems, mental health problems, and criminal justice system involvement. Long-term heroin abstinence was associated with less criminality, morbidity, psychological distress, and higher employment. CONCLUSIONS: While the number of deaths increased steadily over time, heroin use patterns were remarkably stable for the group as a whole. For some, heroin addiction has been a lifelong condition associated with severe health and social consequences.     

Heroin Abuse and Collective Identity: Correlates and Consequences of Geographical Place

Ethnographic and qualitative research were utilized to examine how the effects of geographic place can be related to heroin abuse and collective identity in non-metropolitan areas (NMAs) in the mid-Hudson region of New York State, U.S. The socio-geographic consequences of this interrelationship are explored. In-depth interviews were conducted with 237 recent admissions to drug treatment at 28 facilities in the seven mid-Hudson region counties. The effects of geographic place and collective identity emerged in interviews through narratives relating to heroin experimentation, subsequent dependence, and the lure of New York City. Heroin experimentation and the New York City lifestyle are collectively constructed by many respondents as ??cool.?? They are both oriented toward city life and in conflict with what respondents believe to be a lack of community and caring among city dwellers and the dehumanizing effects of the city. The idea that heroin use is cool serves as tacit permission to experiment with heroin.     

Differences between men and women in the course of opiate dependence: is there a telescoping effect?

According to the so-called telescoping effect, there is a gender-specific course of alcohol dependence with women starting alcohol use later than men and having a faster development of harmful consequences. There are inconsistent data regarding a telescoping effect in opiate dependence. In each of six European centres, 100 opiate addicts were investigated by a structured interview (mainly the EuropASI and CIDI) at admission to various kinds of treatment (TREAT project). In a secondary analysis of the TREAT data, women and men were compared regarding age at onset of heroin use and the current severity of addiction. In addition, a comparison of female (n = 140) and male (n = 140) addicts matched for age and study centre were carried out. Eventually, multiple logistic and linear regressions were done with the interaction term of gender and time of regular consumption as predictor for the severity of dependence, besides, other sociodemographic variables. There was no difference between genders regarding the age at onset of regular heroin consumption. Up to 4 years of regular consumption, there are gender-specific differences in the course of opiate dependence, e.g. a faster progression of legal problems in men and social problems in women. There were no differences in the severity of dependence other than more economic problems for women. A telescoping effect could only partially be observed in this large sample of opiate addicts. A gender-specific course was limited to the first years of consumption, and included domains with a faster progression for men. It has to be assumed that opiate dependence is a rapidly developing disorder with early chronification. Afterwards, only individual courses with influences of the national treatment system were observed.     

Prevalence and comorbidity of major depressive disorder in young black and white women

OBJECTIVE: This study reports the prevalence and comorbidity of depression in two large samples of black and white young adult women. METHOD: Clinical interviews of participants in a follow-up study of the National Heart, Lung, and Blood Institute Growth and Health Study (NGHS-Wave II; N=378) were contrasted with a subsample of the National Comorbidity Survey (NCS; N=3749) to examine the rates and comorbidity of lifetime major depressive disorder in black and white women using methodology described by . The sequencing of disorders was also examined to determine which disorder was primary. Comorbidity and sequencing were examined for alcohol and drug use disorder, panic disorder, specific phobia, social phobia, and post-traumatic stress disorder. RESULTS: Prevalence estimates for depression, alcohol use disorder, and drug use disorder were higher for white women than for black women in both NGHS-Wave II and NCS. Over half of depressed participants in both samples had at least one comorbid disorder and depression was associated with an increased probability of all the investigated disorders. Only one ethnic difference was found in comorbidity, indicating that black women were more likely to have comorbid panic disorder than white women were. Depression was primary to alcohol and substance use disorders, whereas it was secondary to specific phobia and PTSD. CONCLUSIONS: High rates of comorbidity were found for both black and white women, though few ethnic differences in comorbidity were found. Preventive and treatment interventions are needed to address multiple disorders in young adult women.     

Mental Health Problems in Recently Incarcerated Male Adult Drug Users in Taiwan: Patterns,Rates, and Implications for Treatment

This study aimed to explore the extent of association between the classes and patterns (single vs. multiple) of drug use and the psychiatric disorders among recently incarcerated male drug users to help formulate drug policies for correctional facilities and provide adequate treatment for incarcerated drug users. Data were recruited from 414 male first-time incarcerated illicit drug users in one detention center in Taiwan. Their lifetime historical profiles of illicit drug use were then assessed and their associations with current psychiatric disorders were compared with 257 community controls. Heroin and meth/amphetamine were the most commonly used drugs among single and combined users. Heroin users were more likely to exhibit major depression and social phobia; meth/amphetamine users showed more psychotic disorder and antisocial personality disorder than community controls. Multiple drug users were associated with two-thirds of the psychiatric disorders. This study suggests that heroin and meth/amphetamine users require specific treatments, which may effectively address associated psychopathologic conditions. Interventions for mental disorders for some detainees are also recommended.