SUBSTANCE USE AMONGST FEMALE SURVIVORS OF DOMESTIC VIOLENCE SURVIVORS RESIDING AT SHELTERS

Purpose:  This study examined substance use problems among women residing at a domestic violence shelter in Austin, TX. Prior studies have examined substance abuse among survivors of intimate partner abuse who were in substance abuse treatment programs. There is a shortage of studies on substance abusing women in domestic violence shelters.
Methods:  Data were collected during structured interviews with eligible women residing at a domestic violence shelter in Austin, Texas. A total of 101 women were interviewed and included in this analysis. Convenience sampling was used to identify women willing to participate in the study. Participants were recruited through their caseworkers at the shelter as well as flyers and posters describing the study. Each participant received a $20 grocery store gift card as compensation for their time. Women were eligible to participate if they were over 18 years of age, understood and spoke English and reported substance use based on their responses to the CAGE-AID. One positive response to a CAGE-AID question qualified the woman to participate in this study.
Findings:  Preliminary results show high rates of substance abuse and dependence. Nearly 60% of the women interviewed were alcohol dependent and 55% were drug dependent. Marital status, race and age were found to be predictors of alcohol and drug use. Additional analysis showed that the victims' substance use was not related to the severity or extent of physical and non-physical violence.
Conclusions:  These results reveal a strong need for substance abuse intervention for women who enter domestic violence shelters.     

Alcohol Abuse or Dependence Among Mexican American Women Who Report Violence

BACKGROUND: Violence against women has been linked to alcohol disorders in various populations. Few studies have assessed alcohol disorders among assaulted women in a general population of Mexican Americans. This study examined alcohol disorders among Mexican American women who reported physical or sexual assault. METHODS: Participants were women (n = 1516, ages 18-59) living in Fresno County, California, who were enrolled in a population-based, randomized household survey of Mexican-origin men and women. Crude and adjusted odds ratios (ORs) were calculated for alcohol dependence/abuse (ADA) and physical or sexual assault by a current partner or someone other than a current partner. RESULTS: Women who reported lifetime physical or sexual assault were significantly more likely to meet criteria for ADA (OR = 8.2; 95% confidence interval [CI], 4.4-15.4). After we adjusted for birthplace, age, income, and parental problem drinking, assaulted women were still 4.7 times more likely to meet criteria for ADA (CI, 2.1-10.4). Physical or sexual assault by someone other than a partner was more strongly associated with ADA (OR = 8.7; CI, 4.5-16.9) than assault by a current partner (OR = 3.2; CI, 1.3-7.6). Both physical (OR = 9.0; CI, 4.7-17.0) and sexual assault (OR = 4.7; CI, 2.2-10.0) by either type of perpetrator were associated with ADA. CONCLUSION: There is a strong association between reporting violence and having a lifetime history of ADA. Although temporal order could not be established, these findings highlight the importance of screening for physical and sexual assault in settings that treat alcohol disorders as well as screening for alcohol disorders among women who seek services related to previous or current violence.     

Factors associated with alcohol use, depression, and their co-occurrence during pregnancy

Background:  Alcohol use and depression each adversely affect birth outcomes, but the impact of their co-occurrence among pregnant women is not well understood. In this study, we examined factors associated with alcohol use, depression, and their co-occurrence during pregnancy.
Methods:  We analyzed datasets from 2 longitudinal studies conducted nearly 20 years apart in the same outpatient prenatal clinic of an urban women's hospital. Participants included 278 women recruited from 1982 to 1985 for the Maternal Health Practices and Child Development (MHPCD) Study and 209 women recruited from 2000 to 2002 for the Health Outcomes from Prenatal Education (HOPE) Study. Both studies selected women on the basis of their level of alcohol use early in pregnancy. We used multinomial logistic regression models to test multiclassification prediction of alcohol use, depression, and their co-occurrence during pregnancy.
Results:  In the second and third trimesters, more MHPCD participants than HOPE participants consumed alcohol (67% vs. 20%), experienced depression (85% vs. 34%), and had co-occurring drinking and depression (56% vs. 10%) ( p  < 0.001 for each). For the MHPCD cohort, smoking predicted alcohol use. There were no significant predictors for depression alone or the co-occurrence. For the HOPE cohort, older age and smoking were predictors of alcohol use, smoking and less education were predictors of depression, and illicit drug use was a predictor of the co-occurrence of alcohol use and depression ( p  < 0.05 for all relationships).
Conclusions:  Smoking, older age, lower education, and illicit substance use predicted alcohol and/or probable depression in the second and third trimesters among women who drank in the first trimester.     

Violence and illegal drug use among adolescents: evidence from the U.S. National Adolescent Student Health Survey.

The relationships between violence, drug use, and victimization were examined in a representative sample of American adolescents. The commonly used illegal drugs (marijuana, amyl/butyl nitrites, psychedelics, amphetamines, and cocaine) and alcohol were considered. Drug users, compared to nonusers, fought more, took more risks which predisposed them to assault, and were assaulted more both at school and outside school supervision. Adolescents who were victims at school were also more likely to be victimized outside of school supervision. This study clearly demonstrates that the aggressor may also be the victim, and that illegal drug/alcohol use is related to victimization.     

Substance Use Before and During Pregnancy: Links to Intimate Partner Violence

Although some research has found links between women's experiences of intimate partner violence and their use of substances, little research has examined how this potential relationship changes when women become pregnant. Furthermore, most of the past research examining women's experiences of intimate partner violence and their use of substances has focused on only one type of violence, typically, physical assault. Thus less is known concerning how other important forms of violence, such as psychological aggression and sexual coercion, may be related to women's substance use and substance abuse disorders. This research studies 85 prenatal care patients to describe the women's use of alcohol and illicit drugs, both before and during pregnancy, in relation to their experiences of various types of intimate partner violence before and during pregnancy (including psychological aggression, physical abuse, and sexual coercion). The Conflict Tactics Scales 2 was used to assess the women's experiences of intimate partner violence. The women were asked about their frequency of alcohol use, and alcohol using women were administered a short version of the Michigan Alcohol Screening Test to assess the women for symptoms of alcohol disorder. The women's use of illicit drugs was assessed by asking the women about their frequencies of various types of drug use and drug using women were administered the Drug Abuse Screening Test to assess the women for symptoms of drug disorder. The results showed that before pregnancy, women who were physically assaulted by their partners were somewhat more likely to drink alcohol and use illicit drugs compared with women who did not experience such violence, even though these differences did not reach the traditional level of statistical significance; however, among the substance‐using women, those who experienced each type of violence were more likely to be frequent users of substances compared with the non‐victims, and they evidenced a greater number of substance disorder symptoms compared with the non‐victims. After the women became pregnant, the links between women's experiences of intimate partner violence and their use of substances became stronger, with the women who experienced each type of partner violence being more likely to use both alcohol and illicit drugs. Furthermore, among the substance using women, those who were psychologically and physically abused had somewhat elevated levels of substance disorder symptoms during pregnancy compared with women who did not suffer such victimization. These findings underscore the importance of providing routine screening for various types of violent victimization and substance use within the context of many types of women's health care settings, including substance abuse treatment programs, domestic violence programs, and prenatal care services.     

The impact of depressive symptoms on alcohol and cigarette consumption following treatment for alcohol and nicotine dependence

Background:  Although depression is common among alcohol and tobacco dependent patients, its impact on treatment outcomes is not well established. The purpose of this study was to examine the impact of depressive symptoms on abstinence from tobacco and alcohol after treatment for alcohol dependence and nicotine dependence.
Methods:  The Timing of Alcohol and Smoking Cessation Study (TASC) randomized adults receiving intensive alcohol dependence treatment, who were also smokers, to concurrent or delayed smoking cessation treatment. The sample consisted of 462 adults who completed depression and substance use (alcohol and smoking) assessments at treatment entry and 6, 12, and 18 months posttreatment. Longitudinal regression models were used to examine the relationships between depression and subsequent abstinence from alcohol and tobacco after baseline characteristics, including alcohol and smoking histories, were considered.
Results:  Depressive symptoms were prospectively related to nonabstinence from alcohol. Depressive symptoms at the previous assessment increased the odds of drinking at the subsequent time point by a factor of 1.67 (95% CI 1.14, 2.43), p  < 0.01. Depressive symptoms were not significantly related to subsequent abstinence from cigarettes.
Conclusions:  Depression is an important negative predictor of the ability to maintain abstinence from alcohol within the context of intensive alcoholism and smoking treatment. It may be important to include depression-specific interventions for alcohol and tobacco dependent individuals to facilitate successful drinking treatment outcomes.     

Substance use before and during pregnancy: links to intimate partner violence

Although some research has found links between women's experiences of intimate partner violence and their use of substances, little research has examined how this potential relationship changes when women become pregnant. Furthermore, most of the past research examining women's experiences of intimate partner violence and their use of substances has focused on only one type of violence, typically, physical assault. Thus less is known concerning how other important forms of violence, such as psychological aggression and sexual coercion, may be related to women's substance use and substance abuse disorders. This research studies 85 prenatal care patients to describe the women's use of alcohol and illicit drugs, both before and during pregnancy, in relation to their experiences of various types of intimate partner violence before and during pregnancy (including psychological aggression, physical abuse, and sexual coercion). The Conflict Tactics Scales 2 was used to assess the women's experiences of intimate partner violence. The women were asked about their frequency of alcohol use, and alcohol using women were administered a short version of the Michigan Alcohol Screening Test to assess the women for symptoms of alcohol disorder. The women's use of illicit drugs was assessed by asking the women about their frequencies of various types of drug use and drug using women were administered the Drug Abuse Screening Test to assess the women for symptoms of drug disorder. The results showed that before pregnancy, women who were physically assaulted by their partners were somewhat more likely to drink alcohol and use illicit drugs compared with women who did not experience such violence, even though these differences did not reach the traditional level of statistical significance; however, among the substance using women, those who experienced each type of violence were more likely to be frequent users of substances compared with the non-victims, and they evidenced a greater number of substance disorder symptoms compared with the non-victims. After the women became pregnant, the links between women's experiences of intimate partner violence and their use of substances became stronger, with the women who experienced each type of partner violence being more likely to use both alcohol and illicit drugs. Furthermore, among the substance-using women, those who were psychologically and physically abused had somewhat elevated levels of substance disorder symptoms during pregnancy compared with women who did not suffer such victimization. These findings underscore the importance of providing routine screening for various types of violent victimization and substance use within the context of many types of women's health care settings, including substance abuse treatment programs, domestic violence programs, and prenatal care services.     

Characteristics of non-respondents in a US national longitudinal survey on drinking and intimate partner violence

Aims   To identify non-respondents' characteristics in a longitudinal household survey of intimate partner violence and drinking among United States couples.
Design   Multistage probability sampling procedure with over-samples from black and Hispanic populations. A total of 1635 couples 18 years of age or older were interviewed at baseline (1995) for a response rate of 85%. Five years later, 1392 respondents were re-interviewed, with a response rate of 72%.
Measurements   Sociodemographic variables, drinking volume and pattern, drug use, intimate partner violence, exposure to parental violence and childhood physical abuse.
Findings   Among men, those who are younger, those who did not graduate from high school, those who are unemployed and those who are drinkers are more likely to be among the non-respondents. Among women, those who are 40–49 years of age are two times more likely than those aged 50 years or older to be among non-respondents. Also, women who reported experiencing abuse during their childhood are less likely to be among non-respondents compared with those who were not victimized. Gender-specific regression models accounted for only 5% of the variance in the response status variable, even after the inclusion of a comprehensive range of predictors in the model.
Conclusions   A low proportion of the variance in survey participation was explained by the variables included in the analysis, suggesting that sociodemographic, drinking-related and violence-related variables might not be the main factors determining participation in the survey.     

Prefrontal cortex volumes in adolescents with alcohol use disorders: unique gender effects

Background:  Adolescents with alcohol use disorders (AUD) have shown smaller prefrontal cortex (PFC) volumes compared with healthy controls; however, differences may have been due to comorbid disorders. This study examined PFC volumes in male and female adolescents with AUD who did not meet criteria for comorbid mood or attention disorders.
Methods:  Participants were adolescents aged 15 to 17 who met criteria for AUD ( n  = 14), and demographically similar healthy controls ( n  = 17). Exclusions included any history of a psychiatric or neurologic disorder other than AUD or conduct disorder. Magnetic resonance imaging scans occurred after at least 5 days of abstinence from alcohol or drugs. Overall PFC volumes and white matter PFC volumes were compared between groups.
Results:  After controlling for conduct disorder, gender, and intracranial volume, AUD teens demonstrated marginally smaller anterior ventral PFC volumes ( p  = 0.09) than controls, and significant interactions between group and gender were observed ( p  < 0.001 to p  < 0.03). Compared with same-gender controls, females with AUD demonstrated smaller PFC volumes, while males with AUD had larger PFC volumes. The same pattern was observed for PFC white matter volumes.
Conclusions:  Consistent with adult literature, alcohol use during adolescence is associated with prefrontal volume abnormalities, including white matter differences. However, adolescents with AUD demonstrated gender-specific morphometric patterns. Thus, it is possible that gender may moderate the impact of adolescent alcohol use on prefrontal neurodevelopment, and the neurodevelopmental trajectories of heavy drinking boys and girls should be evaluated separately in longitudinal studies.     

Alcohol consumption in homicide victims in the city of São Paulo

Aims   To assess the association between alcohol use and victimization by homicide in individuals autopsied at the Institute of Legal Medicine in São Paulo, Brazil.
Design   Cross-sectional study.
Setting   Excessive consumption of alcohol is a serious public health issue and a major factor in triggering violent situations, which suggests a strong association between alcohol ingestion and becoming a victim of homicide.
Participants   Data from 2042 victims of homicides in 2005 were obtained from medical examiner reports.
Measurements   The victim's gender, age, ethnicity and blood alcohol concentration (BAC) were collected. The method of death and homicide circumstances, as well as the date, time and place of death were also studied.
Findings   Alcohol was detected in blood samples of 43% of the victims, and mean BAC levels were 1.55 ± 0.86 g/l. The prevalence of positive BAC levels was higher among men (44.1%) than women (26.6%), P  < 0.01. Firearms caused most of the deaths (78.6%), and alcohol consumption was greater among victims of homicide by sharp weapons ( P  < 0.01). A greater proportion of victims with positive BAC were killed at weekends compared to weekdays (56.4 and 38.5%, respectively; P  < 0.01), and the correlation between homicide rates and the average BAC for the central area of the city was positive ( r _s = 0.90; P  < 0.01).
Conclusions   These results highlight alcohol as a contributing factor for homicide victimization in the greatest urban center in South America, supporting public strategies and future research aiming to prevent homicides and violence related to alcohol consumption.     

Sexual assault and coincident alcohol use in attendees at a genitourinary medicine clinic in the south of England

To investigate the relationship between alcohol consumption and the experience of sexual assault, either as victim or perpetrator, among genitourinary (GU) medicine department attendees in Portsmouth, UK, we carried out a cross-sectional survey of consecutive patients attending the walk-in service when a researcher was available. Self-completed questionnaires were used and anonymized data were collected from 1186 participants (response rate 34%). Responses showed that 15.6% of female and 3.7% of male participants had ever being sexually assaulted. Women who reported sexual assault drank more on a heavy night out than those who did not report sexual assault (mean 21.3 versus 17.0 units, P = 0.041). Over half of the victims had been drinking prior to the relevant assault. Twenty-seven participants (2.3%) admitted to having sex with a person who was not fully willing. Of these, 59% had been drinking prior to the assault, and the majority believed alcohol had contributed to the assault. Any strategies aiming to reduce the incidence of sexual assault must address hazardous drinking as a high priority.     

The association between caffeinated alcoholic beverages and the perpetration of intimate partner violence

Background: Problematic alcohol use is a recognized risk factor for intimate partner violence (IPV) perpetration.Objective: The use of caffeinated alcoholic beverages (CAB) appears to be associated with high-risk drinking behavior but the relationship between CAB use and IPV has yet to be explored.Methods: Sixty male and 40 female married or dating participants responded to an online survey including measures of past-year alcohol use and partner violence.Results: Logistic regression analyses revealed that CAB users were significantly more likely to perpetrate physical assault and partner injury after controlling for age, sex, ethnicity, income, and heavy alcohol use. The relationship between CAB use and perpetration of sexual coercion was better accounted for by heavy alcohol use.Conclusion: Results from the current study suggest that there exists an independent link between CAB use and partner violence perpetration.     

Is Pregnancy the Time to Change Alcohol Consumption Habits in France?

Background:  Although it is well known that France has a cultural history of alcohol use, no recent French data on alcohol consumption during pregnancy in a large sample are available.
Methods:  To determine the alcohol consumption patterns among pregnant women in France, we analyzed data from a 1-year multicenter self-survey. Sociodemographic profile, obstetrical history, neonatal data, and a self-report for assessing drinking patterns during pregnancy including AUDIT were recorded from women who delivered recently. Cases of fetal alcohol syndrome (FAS) were also reported.
Results:  A total of 837 pregnant women have described all parameters. The mean age at delivery of our sample was 29.7 years (SD = 4.8 years). A total of 52.2% of women indicated that they had consumed alcohol at least once during their pregnancy, and among abstainers 54.5% had a positive AUDIT score. Of the pregnant women who consumed alcohol, 13.7% reported at least one binge drinking episode (5 or more drinks on 1 occasion) during pregnancy. Binge drinking is significantly more frequent than regular alcohol consumption (at least 1 drink more than 1 time per week) during pregnancy. A prevalence rate of FAS of 1.8 per 1,000 live births was observed.
Conclusions:  There is a large population of women who still drink alcohol during pregnancy, particularly in binge drinking episodes. This underlines the need to clearly inform women of childbearing age about the dangers of alcohol during pregnancy as related to all types of consumption. Moreover, acting to prevent alcohol consumption prior to pregnancy may also greatly influence prenatal drinking.     

Effects of MAOA-Genotype, Alcohol Consumption, and Aging on Violent Behavior

Background:  Environmental factors appear to interact with a functional polymorphism ( MAOA-LPR ) in the promoter region of the monoamine oxidase A gene ( MAOA ) in determining some forms of antisocial behavior. However, how MAOA - LPR modulates the effects of other factors such as alcohol consumption related to antisocial behavior is not completely understood.
Methods:  This study examines the conjunct effect of MAOA-LPR , alcohol consumption, and aging on the risk for violent behavior. Recidivism in severe impulsive violent behavior was assessed after 7 to 15 years in a sample of 174 Finnish alcoholic offenders, the majority of whom exhibited antisocial or borderline personality disorder or both, and featured impulsive temperament traits.
Results:  The risk for committing new acts of violence increased by 2.3% for each kilogram of increase in yearly mean alcohol consumption ( p =  0.004) and decreased by 7.3% for every year among offenders carrying the high activity MAOA genotype. In contrast, alcohol consumption and aging failed to affect violent behavior in the low activity MAOA genotyped offenders. MAOA-LPR showed no main effect on the risk for recidivistic violence.
Conclusions:  Violent offenders carrying the high activity MAOA genotype differ in several ways from carriers with the low activity MAOA risk allele previously associated with antisocial behavior. Finnish high activity MAOA genotyped risk alcoholics exhibiting antisocial behavior, high alcohol consumption, and abnormal alcohol-related impulsive and uncontrolled violence might represent an etiologically distinct alcohol dependence subtype.     

Sexuelle Viktimisierung im Alter

A study on the underresearched topic of elderly sexual victimization combined multiple data sources: German police crime statistics, 122 public prosecutor files on sexual victimization of people above age 60, survey data from 76 institutions assisting victims of sexual violence/domestic violence, in-depth interviews with 22 practitioners who had worked with sexually victimized elderly.The study shows that few cases of sexual victimization in old age are known to law enforcement agencies or victim services. Offences dealt with by the criminal justice system differ significantly from those known to battered women's shelters and victim services. The majority of incidents prosecuted by the criminal justice system are hands-off offences; hands-on offences are typically single incidents committed by strangers or loose acquaintances of the victim. Battered women's shelters and institutions of victim assistance are confronted with severe forms of sexual violence in intimate relationships, the prototypical case being an older woman who is repeatedly victimized by her husband over a considerable period of time and within a relationship characterized by a comprehensive system of violence, humiliation, and control (corresponding to Johnson's concept of intimate terrorism).The study demonstrates how small numbers of recorded cases of sexual violence in old age may reflect age-specific detection rates. It provides evidence on older victims' help-seeking behavior and on ways to improve victim services.     

Sexual assault history and risks for sexually transmitted infections among women in an African township in Cape Town, South Africa

Sexual violence is associated with women's risks for HIV infection. The current study investigated factors related to risks for sexually transmitted infections (STIs), including HIV, among South African women with a history of sexual assault. An anonymous street intercept survey of women (N = 272) living in an African township in the Western Cape, South Africa assessed demographic characteristics, history of sexual assault, HIV risk behaviours, substance use and non-sexual relationship abuse. Surveys were completed by 90% of women approached. Forty-four per cent (N = 119) of women reported a history of sexual assault. Multiple logistic regressions, controlling for participant age, education, marital status and survey venue, showed that women who had been sexually assaulted were significantly more likely to have shared injection drug equipment, exchanged sex to meet survival needs, and used alcohol compared to women who had not been sexually assaulted. Women with a history of sexual assault were also significantly more likely to have multiple male sex partners, greater rates of unprotected vaginal intercourse, lower rates of condom protected anal intercourse, more sexual contacts involving blood, more STIs and genital ulcers. Finally, women who had been sexually assaulted were more likely to have been non-sexually abused by relationship partners and were more likely to fear asking partners to use condoms. There is a close connection between sexual assault and women's risks for STIs and HIV. Structural and behavioural interventions are needed to simultaneously reduce the prevalence of sexual assault against women and prevent the transmission of HIV.     

Impulsivity, age of first alcohol use and substance use disorders among male adolescents: a population based case–control study

Aims   To evaluate the association between impulsivity, age of first alcohol consumption (AFD) and substance use disorders (SUD) in a non-clinical sample of adolescents.
Design and setting   Population-based case–control study of male adolescents between 15 and 20 years of age nested in a community survey in southern Brazil.
Participants   Cases were drug or alcohol abusers/dependents defined according to DSM-IV abuse/dependence criteria ( n  = 63). Individuals who had experienced alcohol use but where non-abusers served as controls ( n  = 355). Cases and controls completed a structured face-to-face interview.
Measurements   The Mini International Neuropsychiatric Interview (MINI) was completed during the original survey and used to identify cases and controls. Impulsivity was measured by means of the Barratt Impulsivity Scale (BIS 11). Self-reported AFD and socio-demographic data were collected and analyzed through logistic regression according to a hierarchical model.
Findings   Impulsivity and AFD were significantly associated with SUD. Both higher impulsivity [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.4–7.8] and earlier AFD (OR 1.2, 95% CI 1.0–1.3) remained associated with SUD after model adjustments.
Conclusions   The findings from this population-based case–control study suggest that impulsivity and age of first alcoholic drink are associated strongly with alcohol and drug problems. Additionally, impulsivity seems to contribute to a premature exposure to alcohol by hastening the AFD. If the temporal effect of these associations is confirmed in longitudinal designs including broader population groups, our findings may contribute to the development of clinical and policy interventions aiming at reducing the incidence and morbidity associated with substance-related problems among adolescents.     

The prosecution of sexual assault cases: correlation with forensic evidence.

STUDY OBJECTIVE: We sought to determine the association between historical and physical evidence with judicial outcome in sexual assault cases. METHODS: A population-based, retrospective review of forensic evidence was conducted for all sexual assault cases reported in Duval County, FL, during a 2-year period. Variables examined included age, race of victim, evidence of trauma (body, genital, or both), presence of spermatozoa at the time of the forensic examination, weapon use, and whether the victim knew the assailant. In cases in which an arrest was made, logistic regression was used to estimate the strength of association with the outcome of conviction in sexual assault cases. RESULTS: During the study period, 821 sexual assaults were reported, and 801 forensic examinations were performed. The victims were predominantly female (776; 97%), with 409 (51%) being black, 376 (47%) white, and 16 (2%) other minorities. A suspect was identified in 355 (44%) of the 801 cases for which a sexual assault forensic examination was conducted. No suspect was identified in 446 (56%) of these cases. There were 271 arrests made. The police did not have enough evidence to arrest a suspect after detention in 84 cases. For those cases in which a suspect was arrested, 153 had charges dropped, 89 were found guilty, 2 were found not guilty, and 27 cases were still pending or the files were sealed and unavailable for review. There was evidence of trauma in 202 (57%) of the examinations, and spermatozoa were found at the time of the forensic examination in 110 (31%) of the cases in which a suspect was identified. Logistic regression found that victims aged younger than 18 years, the presence of trauma, and the use of a weapon by the assailant were significantly associated with successful prosecution. There was a trend toward conviction if the victim was white. CONCLUSION: Emergency physicians have an obligation to provide care for victims of sexual assault cases. This care includes a possible legal defense. To that end, emergency physicians should be vigilant in the documentation of the history of the event (eg, weapon use) and in the documentation of traumatic injuries because these factors can assist in a successful prosecution.     

A randomized double-blind pilot trial of gabapentin versus placebo to treat alcohol dependence and comorbid insomnia

Background:  Insomnia and other sleep disturbances are common, persistent, and associated with relapse in alcohol-dependent patients. The purpose of this pilot study was to compare gabapentin versus placebo for the treatment of insomnia and prevention of relapse in alcohol-dependent patients.
Methods:  Twenty-one subjects, including 10 women who met study criteria for alcohol dependence and insomnia and expressed a desire to abstain from alcohol, were recruited to the study. During a 1 to 2 week placebo lead-in and screening phase, a complete medical history, physical exam, blood tests, urine drug test, and structured interviews were performed to determine eligibility and patterns of alcohol use and sleep. Insomnia due to intoxication or acute withdrawal, psychiatric or medical illness, medications, and other sleep disorders were ruled out. Subjects were then randomized to either placebo ( n  = 11) or gabapentin ( n  = 10) for 6 weeks and titrated over a 10-day period to 1,500 mg or 5 pills at bedtime. After a 4-day taper, subjects were reassessed 6 weeks after ending treatment.
Results:  Gabapentin significantly delayed the onset to heavy drinking, an effect which persisted for 6 weeks after treatment ended. Insomnia improved in both treatment groups during the medication phase, but gabapentin had no differential effects on sleep as measured by either subjective report or polysomnography.
Conclusion:  Because gabapentin is a short-acting medication that was taken only at nighttime in this study, it may possibly exert a nocturnal effect that prevents relapse to heavy drinking by a physiological mechanism not measured in this pilot study.     

The Mexican migration to the United States and substance use in northern Mexico

Aims   To examine the impact of migration to the United States on substance use and substance use disorders in three urban areas of northern Mexico.
Design   Cross-sectional survey of immigration-related experiences and life-time and past-year alcohol and drug use, in a representative sample of respondents aged 12–65 years.
Setting   Interviews were conducted in the cities of Tijuana, Ciudad Juarez and Monterrey during 2005. Respondents were classified into three groups: (i) 'return migrants', (ii) 'relatives of migrants' and (iii) 'others in the general population'.
Findings   A total of 1630 completed interviews were obtained for a response rate of 70.5%. 'Return migrants' were more likely to have used alcohol, marijuana or cocaine at least once in their life-time and in the last 12 months, more likely to develop a substance use disorder and more likely to have a 12-month substance use disorder compared with 'others in the general population'. Among 'return migrants', longer length of time in the United States and type of work performed as an immigrant were related to higher prevalence of substance use. Among 'relatives of migrants', migration experiences were not associated with increased prevalence of substance use compared with 'others in the general population'.
Conclusion   This study found a link between migration to the United States and the transformation of substance use norms and pathology in Mexico. Future research on pre-migration involvement in substance use and data on the timing of events among return migrants is needed. Public health measures are likely to require cross-border coordination of research and service development.