THE BULLETIN BOARD

No abstract available for this article.     

RESEARCH REPORT The early course of change in methadone maintenance

Abstract Aims. This study examined the functional and substance use status of methadone maintenance (MM) patients at treatment entry and 2 and 7 months later. Design. Two groups of subjects were identified for longitudinal follow-up, those in continuous MM treatment and those who left treatment. Setting. The study was conducted at the Philadelphia Veterans Affairs Medical Center MM Program. Participants. Subjects were 157 men admitted to treatment. Measurements. Change was evaluated using the Addiction Severity Index and urinalysis results. Findings. Both groups of subjects reported significant reductions in drug use and increases in psychosocial functioning from admission to month 2, but demonstrated no significant changes from months 2 to 7. Subjects who left treatment, however, had more heroin use and criminal activity at all evaluation points than subjects who remained in treatment. Urinalysis data also suggested that subjects who left treatment were using drugs more frequently while in treatment than were those subjects who remained continuously enrolled in MM. Finally, subjects who left treatment spent more time in restricted environments (e.g. inpatient treatment, jail) at follow-up. Conclusions. Services may need to be enhanced to foster continuing progress in patients who remain in MM treatment and to retain those patients with more severe problems who leave treatment early.     

我国首次发现乡土旋毛虫的研究报告

目的 :对我国两株旋毛虫进行虫种归属鉴定。方法 :通过生物学特性的比较研究。结果 :单对虫体杂交试验 ,表明河南猪株与黑龙江犬株存在生殖隔离现象 ;冷冻耐力试验 ,在 - 15℃下 ,前者 9d即死亡 ,后者可存活 1年以上 ;在 4℃ ,前者肌肉期幼虫呈圆盘状卷曲 ,后者呈螺旋状卷曲 ;生殖力指数 ( RCI)在小鼠试验分别为 195.7和 6.2 ( P<0 .0 1) ,在大鼠分别为 191.3和 14.4 ( P<0 .0 1) ;前者对家猪易感 ,后者不易感 ;随机扩增多态性 DNA指纹分析其扩增后产物的 DNA片段电泳带型 ,河南猪株旋毛虫与 T.spiralis基本相同 ,黑龙江犬株旋毛虫与 T.nativa一致。结论 :我国至少存在上述两种旋毛虫 ,即 :河南猪株旋毛虫系 T.spiralis,黑龙江犬株旋毛虫系 T.nativa。     

RESEARCH REPORT Male drinking and violence-related injury in the emergency room

Abstract Aims. To present epidemiological measures of associations between violence-related injuries (assaults and fights), alcohol consumption prior to the event, and drinking patterns among males attending hospital emergency rooms (ERs) in Mexico City. Design. All patients were interviewed and breath tested for alcohol consumption. The data were analyzed using a case-control design. Setting. Eight ERs in Mexico City that were representative of the types of emergency care systems available in that city (from public, private and social security systems hospitals). Participants. Cases were males patients ( n= 445) admitted to the ER because of a fight or an assault. The control group was comprised of patients ( n= 320) admitted to the ER because of accidents that are less frequently reported as alcohol-related (i.e. work-place accidents, animal bites or recreational accidents excluding near drowning). Measurements. A breath sample to estimate BAC, as well as an interviewer-administered questionnaire were used. Findings. Alcohol consumption prior to injury was found to be a more important risk factor than usual drinking for injuries resulting from violence, while quantity of usual alcohol consumption was more predictive of violence-related injuries than frequency of drinking. Conclusions. These data suggest the importance of using more appropriate control groups when estimating associations of alcohol and violence-related injuries so that associations will not be underestimated. More research is needed to establish unbiased estimates of alcohol-related violence.     

RESEARCH REPORT Clinical significance of Cloninger's classification in a sample of alcoholic Spanish men

Abstract Aims. To evaluate Cloninger's classification in a sample of alcoholic Spanish men. Design. A crosssectional study was carried out on subjects diagnosed as alcoholics. Setting. Out-patient units specializing in the treatment of alcoholics and the psychiatry unit of a general hospital. Participants. One hundred and ninety-eight males diagnosed as alcoholics. The mean age was 44.4 11.6 years and 98% were from urban areas. Measurements. Participants were interviewed using the Structured Clinical Interview for DSMIII-R(SCID). They were classified using type 1 and type 2 criteria of Cloninger's classification. Findings. Only one-third of our sample could be classified by Cloninger's type 1 and type 2 criteria. Patients classified as belonging to type 2 had an earlier onset of regular drinking compared to type 1 patients. Type 2 subjects presented a higher percentage of alcohol-related problems as well as problems related to drugs other than alcohol and they also presented a higher percentage of antisocial personality disorder. No differences in alcoholism family history were found between the groups. Criteria showing the poorest discriminative ability between both groups were "failure to keep abstinent" and "benders lasting at least two days". Conclusions. Our results do not support Cloninger's etiological hypotheses for alcoholism. Cultural differences may be responsible for the different drinking patterns observed.     

RESEARCH REPORT Pre- and in-treatment predictors of retention in methadone treatment using survival analysis

Abstract Aims. To determine the effects of pre- and in-treatment variables on patient retention in methadone treatment. Design. Retrospective longitudinal study of an admission cohort sample for up to 3 years of treatment or until discharge. Setting. Six methadone maintenance programs operating 15 clinics in New York City. Participants. A sample of 1206 admissions to these clinics during 1989-90. Measurements. Data were abstracted from patients' medical charts. Time in treatment for up to 3 years was the dependent variable, analyzed as a survival function. Pretreatment variables were: gender, race/ethnicity, age at admission, employment, education, marital status, living arrangements, child care responsibility, criminal justice status, life-time arrests, referral source, age at first heroin use, polydrug use, route of drug administration, mental health status and methadone treatment history. In-treatment variables were: patient problems during treatment, clinic response to patient problems, patient treatment strengths, methadone dosage, heroin use and cocaine use. Findings. The estimated median treatment duration was 23 months. Cox proportional hazards modeling determined that two pretreatment variables (older age and no criminal justice involvement) were associated with longer retention in treatment. Among in-treatment variables, constructive clinic responses to patient problems, higher methadone dosage, more patient treatment strengths and less heroin and cocaine use during treatment were associated with longer retention. Conclusions. Events during treatment are crucial for patient retention in methadone treatment. Only two of 16 pretreatment variables, compared with five of six during-treatment variables, had significant effects on length of stay in a multivariate model.