Predictors of Stages of Change for Condom Use in Crack Cocaine Users

This paper addresses the question of whether sexual activity and partner characteristics differentiate people in different stages of change. Factors expected to distinguish people in different stages of change were partner type, drug use during sex, and HIV status. Three discriminant functions emerged. The loading matrix demonstrates that partner type was the strongest predictor that distinguished people in the precontemplation stage from those in the preparation, action, and maintenance stages (first function) (.962). The loadings on the second discriminant function suggest that when controlling for partner type, HIV status (.935) was the best predictor for distinguishing between the people in the maintenance stage and those in the other stages. The loadings on the third function were not significant. The overall classification results indicate that individuals using crack cocaine and engaging in high risk sexual behaviors can be classified into the stages of change for condom use based on these variables.     

Situational Correlates of Condom Use in a Sample of African-American Drug Users Who Are Primarily Crack Cocaine Users

We studied the situational determinants of condom use for vaginal sex in 151 African-American crack cocaine users in Houston, Texas, using situational presentation (Sitpres) methodology, which uses hypothetical scenarios with randomly generated levels of eight variables across 10~scenarios that may impact the decision to use a condom. Multiple regression showed that variables associated with a high probability of using a condom were older age, how badly the partner wants to use a condom, and how badly the respondent wants vaginal sex. Crack craving or level of intoxication were not correlates. The Sitpres methodology was successfully used by these crack users and data indicated that it was sexual variables, rather than drug-associated variables, that were significantly associated with condom use.     

The Validity of Self-Reported Cocaine Use in a Criminal Justice Treatment Sample

Recent studies comparing self-admitted cocaine use with hair and urine test results have raised concerns about underreporting due to variations across situations and settings. Because of the frequent need for self-report data in conducting treatment evaluations, more information is needed on factors that affect the credibility of this information. the present study examines records of cocaine use collected as part of an evaluation of prison-based treatment (N = 396). Specifically, self-reported cocaine use from 6-month postrelease follow-up interviews, completed with treatment graduates and a comparison sample of parolees who were eligible but not sent to treatment, was examined in relation to urine and hair test results. Overall, cocaine use was underreported when compared to hair test results, but underreporting was lower for program graduates than for the untreated comparison group. Furthermore, program graduates originally admitted to prison on a drug-related arrest were the most likely to underre-port cocaine use, seemingly due to a heightened concern about potential consequences, such as returning to prison on another drug-related charge. Given that the validity of self-report for high-risk individuals varies greatly and is difficult to predict across studies, future research with criminal justice samples should continue to assess the validity of these measures under specific research conditions and for diverse types of individuals.     

Medication Compliance and Satisfaction with Treatment for HIV Disease in a Sample of African-American Crack Cocaine Smokers

The development of treatment regimes for African-American HIV-infected crack cocaine users has often been based on assumptions about compliance with medication regimes rather than evidence. This study sought to obtain baseline information on the adherence to antiretroviral medications by members of this important risk population in Houston, Texas. It was found that for only 5 of a range of 16 antiviral medications was there a significant correlation between levels of compliance reported by respondents and their beliefs as to how effective these medications are. Medication compliance was also found not to be associated with frequency of crack cocaine use in the month prior to interview. Furthermore, irrespective of both gender and their reported extent of medication compliance, the respondents tended to report positive relationships with their treating physician, with higher levels of satisfaction reported by women. These results suggest that the majority of African-American crack cocaine users are able to comply with HIV treatment regimes, with more than half (53%) claiming full compliance for one or more medications, and a further one third (31%) claiming compliance more than half the time. Moreover, these findings suggest that they will continue to take antiretroviral medications even if they have doubts about the effectiveness of these medications.     

Predictors and Comparisons of Polydrug and Non-Polydrug Cocaine Use in Club Subcultures

Background/Objectives: Club drug users have been shown to tend towards patterns of polydrug use, which has been linked to adverse health outcomes, such as impaired mental health, overdose, dependence, infectious disease exposure, and decreased cognitive functioning. Methods: We analyzed data from the Club Drugs and Health Project, a study designed to examine the patterns and contexts of club drug use among young adults. Four-hundred recent club drug users were recruited through time-space sampling. Results: Among recent cocaine users (n = 361), 61.2% were polydrug users. Male gender was predictive of polydrug cocaine use (OR = 1.66). Gay, lesbian, and bisexual (GLB) sexual orientation, White race, and Non-Latino ethnicity were not. No differences in mental health factors were found between cocaine polydrug users and users of only cocaine. However, polydrug users were significantly more likely to score high on drug-related sensation seeking as well as to use drugs to deal with unpleasant emotions and to have pleasant times with others. Conclusions: Prevention and intervention efforts should account for contextual and motivational factors in attempting to reduce polydrug use and its negative effects.     

Social Service Delivery Preferences Among African American Women Who Use Crack Cocaine

Abstract

African American women involved in high-risk, substance use-related behaviors are affected by extremely high rates of HIV infection. While research has demonstrated that HIV is preventable, in order for prevention efforts to be successful in reducing disparities, perceptions of African American women who use crack cocaine need to be taken into account. This qualitative study presents results of eleven focus groups with eighty-nine African American women respondents presenting their perceptions of service needs and preferences for service delivery. The results indicate two important findings for social service providers: the respondents' lack of a perceived need for HIV prevention services as a spontaneously identified need, and respondents' desires for more basic services such as childcare, safe shelter, basic necessities, and especially substance abuse treatment before they could be approached about HIV prevention services. The findings are relevant for developing gender-and culture-specific prevention strategies to reduce the spread of HIV.     

Characteristics of Rural Crack and Powder Cocaine Use: Gender and Other Correlates

Background: Little is known about the relationship of gender with cocaine use in rural areas. This study describes these relationships among stimulant users residing in rural areas of Arkansas, Kentucky, and Ohio. Objectives: Understanding the characteristics of crack and powder cocaine users in rural areas may help inform prevention, education, and treatment efforts to address rural stimulant use. Methods: Participants were 690 stimulant users, including 274 (38.6%) females, residing in nine rural counties. Cocaine use was measured by self-report of cocaine use, frequency of use, age of first use, and cocaine abuse/dependence. Powder cocaine use was reported by 49% of this sample of stimulant users and 59% reported using crack cocaine. Findings: Differing use patterns emerged for female and male cocaine users in this rural sample; females began using alcohol, marijuana, and cocaine at later ages than males but there were no gender differences in current powder cocaine use. Females reported more frequent use of crack cocaine and more cocaine abuse/dependence than males, and in regression analyses, female crack cocaine users had 1.8 times greater odds of reporting frequent crack use than male crack users. Conclusions and Scientific Significance: These findings suggest differing profiles and patterns of cocaine use for male and female users in rural areas, supporting previous findings in urban areas of gender-based vulnerability to negative consequences of cocaine use. Further research on cocaine use in rural areas can provide insights into gender differences that can inform development and refinement of effective interventions in rural communities.     

Binge Use of Crack Cocaine and Sexual Risk Behaviors Among African-American, HIV-Positive Users

This study describes binge use of crack cocaine, binge users, and their sexual risk behaviors in a sample of 303 African-American, HIV-positive users. Recent binge use was defined as, “using as much crack cocaine as you can, until you run out of crack or are unable to use any more” in the last 30 days. Fifty-one percent reported a recent crack binge. The typical crack binge lasted 3.7 days and involved smoking 40 rocks on average. Nearly two-thirds reported their last binge was in their own or another’s home. Seventy-two percent had sex during the last binge, with an average of 3.1 partners. In multivariable logistic regression analyses, recent bingers were more likely than non-bingers to consider themselves homeless, to have any income source, to have used crack longer, and to score higher on risk-taking and need for help with their drug problem. In multivariable ordinal and logistic regression analyses, recent bingers had more sex partners in the last six months and 30 days and were more likely to have never used a condom in the last 30 days. Among male users, recent bingers were more likely to report lifetime and recent exchange of money for sex and drugs for sex. Among both male and female users, recent bingers were more likely to report lifetime trading of sex for drugs. African-American, HIV-positive binge users of crack cocaine appear to be at increased risk for HIV transmission. Further investigations of binge crack use and sexual risk behaviors and interventions targeting and tailored to this group should be considered.     

Comparing IV and Non-IV Cocaine Users: Characteristics of a Sample of Cocaine Users Seeking to Participate in Research

The authors examined differences between current intravenous (IV), past IV, and no IV cocaine use among a sample of cocaine users on measures of drug use, medical history, psychiatric history, and criminal history. Past IV cocaine users were older than non-IV cocaine users. The current IV cocaine-using group included more white participants, and the non-IV group included more African Americans. Those with past or current IV use had more extensive drug use histories than non-IV users. Also, more current and past IV cocaine-using groups reported having been tested for HIV and reported testing positive for hepatitis. Former IV cocaine users reported more emergency room visits for complications stemming from cocaine use. They also reported more treatment for substance abuse and were convicted of more crimes. These results suggest that the route of administration is important in studying the characteristics of drug users.     

Predictors of Asthma Control in a Random Sample of Asthmatic Patients

The purpose of this study was to identify determinants of asthma control. Questionnaires were completed by a random sample of 570 members of a large managed care organization who were ≥35 years of age with utilization suggestive of active asthma. Asthma control was assessed buy the Asthma Control Test (ACT). Independent relationships were found between lower ACT scores and oral corticosteroid use (p < 0.0001), COPD (p < 0.0001), absence of regular specialist care (p = 0.006), higher BMI (p = 0.01), gastroesophageal reflux (p = 0.02), not being Caucasian (p = 0.04), and low income (p = 0.04).     

Gender Differences in Patterns of Cocaine Use

Gender differences in characteristics of substance use disorders may have important implications. To explore this question, the authors compared 27 women and 60 men presenting for treatment of cocaine dependence with regard to demographic and cocaine use patterns. Women had earned less in the previous year (P < 0.01) and were more likely to have been unemployed (P < 0.05). Although women began using cocaine at a later age than men, they attained regular cocaine use at the same age as men and bad fewer years of total cocaine use at the time of presentation for treatment (P < 0.001). Women were more likely to initiate cocaine use with crack cocaine (P < 0.01) and reported shorter duration of abstinent periods since initiating cocaine use (P < 0.05). (American Journal on Addictions 1996; 5:259–261)     

Predictors of Treatment Outcome in Outpatient Cocaine and Alcohol Dependence Treatment

We examined the ability of several baseline variables to predict treatment outcome in a pharmacotherapy trial that included 164 participants who were both cocaine‐ and alcohol‐dependent and were selected for a randomized, double‐blind, placebo‐controlled study. Predictor variables included results from the baseline Addiction Severity Index (ASI), initial Urine Drug Screen results, cocaine and alcohol craving and cocaine and alcohol withdrawal symptoms at the start of treatment. Successful treatment was defined as four continuous weeks of self‐reported cocaine abstinence verified by urine drug screens. In respect to demographic characteristics, there were no significant differences between patients who achieved four weeks of abstinence from cocaine and those who did not. Baseline variables that most consistently predicted cocaine abstinence included initial urine drug screen (UDS) results, the initial Cocaine Selective Severity Assessment (CSSA) scores, and initial self‐reported cocaine use in past 30 days, whereas cocaine craving, cocaine composite scores, alcohol craving, alcohol withdrawal symptoms, and alcohol composite scores did not. The results of this study suggest that cocaine dependence severity in general, and initial UDS results, the CSSA scores and frequency of recent cocaine use in particular, have a significant impact on treatment outcome in the treatment of cocaine‐dependent patients with comorbid alcoholism. Initial UDS results and CSSA scores are very useful predictors of treatment outcome and could be used as stratifying variables in outpatient cocaine and alcohol medication trials.     

Racial Identity and Its Assessment in a Sample of African-American Men in Treatment for Cocaine Dependence

Substance abuse treatment studies frequently include subjects from different ethnic and racial groups, but many investigations limit the examination of race and ethnicity to the use of nominal labels. This approach reveals little about the social or psychological significance of racial and ethnic group membership to the subjects of study or about the potential effects of these factors on substance-involved behaviors. In this study, a principal components analysis (PCA) with varimax rotation was conducted on the 50-item long form of the Racial Identity Attitude Scale (RIAS) in a sample of 294 African-American men in treatment for cocaine dependence. The RIAS was developed to measure attitudes about race and racial status among blacks, but it has not been utilized widely in substance abuse research. Our findings provide evidence for the structural validity of this instrument in this sample of substance abusers. We discuss how recent advances in racial identity theory and its measurement may provide an important avenue for understanding the psychological consequences of racial group membership and for examining the potential effects of these factors on treatment response in studies of substance misuse.     

Use of Salvia divinorum in a Nationally Representative Sample

Background: Salvia divinorum has known hallucinogenic effects and is legal in most parts of the United States. Given that this psychoactive substance has a potential of misuse and abuse, further data regarding the clinical and psychosocial factors associated with use are needed. Objectives: To examine the clinical and psychosocial characteristics associated with use of salvia. Methods: The study uses data from the National Survey on Drug Use and Health, 2008 (N = 55,623). Results: The results of this study suggest that salvia use is most common among young adults aged 18–25 years as well as individuals who had engaged in risk-taking behaviors (selling illicit drugs, stealing) or illicit drug use (especially other hallucinogens/ecstasy). Self-reported depression and anxiety were also associated with salvia use. Conclusions/Scientific Significance: The results provide evidence that salvia use is part of a broader constellation of psychosocial and behavioral problems among youth and young adults. The accessibility, legal status, and psychoactive effects of salvia can be a potentially complicating health risk to young people, especially among those with existing substance use problems.     

Cultural,Economic, and Psychological Predictors of Colonoscopy in a National Sample

Background  

Although colorectal cancer (CRC) is the second leading cause of cancer death among adults in the US and colonoscopy is efficacious in reducing morbidity and mortality from CRC, screening rates are sub-optimal. Understanding the socioeconomic, cultural, and health care context within which decisions about colonoscopy are made allows physicians to address patients’ most salient beliefs and values and other constraints when making screening recommendations.     

Patterns of Cocaine Use Among Cocaine-Dependent Outpatients

The authors systematically evaluated the frequency patterns of cocaine use in 85 cocaine-dependent outpatients and found four patterns of use: continuous (27%), intermittent patterned (35%), intermittent nonpatterned (25%), and occasional (13%). Few subjects reported consistent cycling between binges and crashes. There were no significant differences in patterns of use associated with gender, race, educational level, route of administration, or recency of heroin use. Continuous users and occasional users were older than intermittent users. Because different contingencies may control patterned vs. nonpatterned cocaine use, pattern of use may have implications for treatment, even in individuals reporting similar amounts of cocaine use.     

The Effect of Carbamazepine on Cocaine Use

Thirty-five chronic cocaine users were offered carbamazepine in an open clinical trial as an adjunct to outpatient treatment for cocaine dependence. Nine patients refused ongoing carbamazepine treatment, 13 decreased their cocaine use from 65/100 days pretreatment to 2.8/100 days with treatment (2,562 days at risk), and 13 had a reduction from 78.1/100 days pretreatment to 35.1/100 days with treatment (2,790 total days at risk). The 9 carbamazepine refusers had virtually no change in their cocaine use. The degree of patient compliance with carbamazepine intake correlated directly with decreased cocaine use and with lowered craving intensity, frequency, and duration.