Employed men and women substance abusers: job troubles and treatment outcomes

The majority of U.S. adults with substance abuse or dependence are gainfully employed. However, little is known about outcomes among stably employed people in treatment for substance dependence. Participants (N = 212) entering a residential treatment program completed the Addiction Severity Index (ASI) at intake and 6 and 12 months follow-up. Significant improvements were seen in absenteeism, number of employment problem days, and whether their job was in jeopardy 12 months later. Overall, 65% were retained by their original employer. ASI composite alcohol, drug, legal, family, and psychiatric scores also improved significantly. Continuous abstinence was achieved by 65% and 51% at 6 and 12 months, respectively. Although less likely to be referred to treatment by their employer, women responded to treatment as well as men, reporting similar abstinence rates and overall quality of life during the year following discharge from treatment.     

Sexual HIV risk among gay and bisexual male methamphetamine abusers

The current report examined HIV-related high risk sexual behaviors among a small sample of gay and bisexual male methamphetamine abusers in Los Angeles. Participants were 16 methamphetamine-abusing or -dependent gay or bisexual males who participated in a treatment demonstration project between 1989 and 1993. All participants completed the NIDA/WAVE survey, a detailed inventory of HIV-related risk behaviors. Findings indicate a strong connection between methamphetamine abuse and highrisk sexual behavior. For the 12 months prior to treatment 62.5% of participants reported having anal insertive sex without a condom, and 56.3% reported having sex with someone who had HIV. Drug use before or during sex, measured on a 5-point Likert scale, was frequent (M = 4.27, SD = 0.7). Implications for treatment of gay and bisexual male methamphetamine abusers and prevention of HIV among this population are discussed.     

HIV prevalence and risk among heterosexual methamphetamine injectors in California

This study funded by Centers for Disease Control compares HIV prevalence and risk behavior among heterosexual methamphetamine (n = 428) and nonmethamphetamine (n = 878) injectors in California, USA, during 2001-2003. While HIV was not highly prevalent among methamphetamine injectors (3%), sexual and injection risk behaviors were highly prevalent (ranging from 21% to 72%). In multivariate analyses, methamphetamine injectors had higher odds than nonmethamphetamine injectors of unprotected vaginal intercourse and sex with five or more sexual partners in the past 6 months and of distributive and receptive syringe sharing in the past 30 days. There was no significant difference in HIV sero-status by methamphetamine use. Suggestions are made for designing HIV prevention programs. The study's limitations are noted.     

Neuropsychological deficits in adolescent methamphetamine abusers

Background  

Methamphetamine (METH) is a widely abused psychostimulant that is associated with neurotoxicity and neurocognitive impairments in adults. However, the effects of METH use on neurocognitive performance of adolescents are unclear.     

Effectiveness of pretreatment interim support group attendance in facilitating treatment enrollment among methamphetamine abusers

Decreasing state and federal budgets have led to shortages in public health funding for treatment programs to aid long-term users in recovery from methamphetamine abuse. These shortages have led to client "waiting lists" for government-subsidized treatment. Many of these "waiting list" individuals fail to show up for treatment when it is scheduled. The current study investigates the efficacy of "interim support groups" as a means of encouraging methamphetamine abusers to begin treatment programs (defined as attendance on the first day of treatment). A logistic regression revealed that interim group attendance predicted whether a methamphetamine abuser would show up for treatment. These results are discussed in terms of both the value of interim groups in facilitating treatment adherence and the role pretreatment support groups can play in facilitating a methamphetamine abuser's determination to engage in treatment.     

Cognitive function and nigrostriatal markers in abstinent methamphetamine abusers

Objective Preclinical investigations have established that methamphetamine (MA) produces long-term changes in dopamine (DA) neurons in the striatum. Human studies have suggested similar effects and correlated motor and cognitive deficits. The present study was designed to further our understanding of changes in brain function in humans that might result from chronic high dose use of MA after at least 3 months of abstinence.Method Brain function in abstinent users was compared to controls using neuroimaging of monoamine transporters and cognitive assessment. Striatal levels of DA transporter (DAT) and vesicular monoamine transporter type-2 (VMAT2) were determined using [¹¹C]methylphenidate and [¹¹C]dihydrotetrabenazine positron emission tomography, respectively. Cognitive function was evaluated using tests of motor function, memory, learning, attention, and executive function.Results Striatal DAT was approximately 15% lower and VMAT2 was 10% lower in MA abusers across striatal subregions. The MA abusers performed within the normal range but performed more poorly compared to controls on three of the 12 tasks.Conclusions Failure to find more substantial changes in transporter levels and neurocognitive function may be attributed to the length of time that MA users were abstinent (ranging from 3 months to more than 10 years, mean 3 years), although there were no correlations with length of abstinence. Persistent VMAT2 reductions support the animal literature indicating a toxic effect of MA on nigrostriatal nerve terminals. However, the magnitude of the MA effects on nigrostriatal projection integrity is sufficiently small that it is questionable whether clinical signs of DA deficiency are likely to develop.An erratum to this article can be found at     

Decreased frontal white-matter integrity in abstinent methamphetamine abusers

This study explored differences in frontal white-matter (WM) integrity between methamphetamine (MA) abusers and healthy comparison subjects using diffusion tensor imaging (DTI). Fractional anisotropy (FA) values, which indicate WM integrity, were calculated for regions-of-interest in frontal WM on diffusion tensor images of 32 MA abusers and 30 healthy comparison subjects. Frontal executive functions were also assessed by the Wisconsin Card Sorting test (WCST). MA abusers had significantly lower FA values in bilateral frontal WM at the anterior commissure-posterior commissure (AC-PC) plane and the right frontal WM 5 mm above the AC-PC plane relative to healthy comparison subjects. MA abusers had more total, perseveration and non-perseveration errors in the WCST relative to healthy comparison subjects. FA values of the right frontal WM 5 mm above the AC-PC plane negatively correlated with the number of total and non-perseveration errors in the WCST in MA abusers. In the sub-analysis for gender differences, lower FA values in frontal WM and more errors in the WCST were found only in male MA abusers, not in female MA abusers, relative to comparison subjects of the respective gender. We report that frontal WM integrity of MA abusers is compromised. This finding may also be related to impairment in frontal executive function. In addition, the neurotoxic effect of MA on frontal WM may be less prominent in women than in men, possibly due to oestrogen's neuroprotective effect.     

Increased white matter hyperintensities in male methamphetamine abusers

BACKGROUND: The current study was conducted to compare the prevalence, severity, and location of white matter signal hyperintensities (WMH) on brain magnetic resonance (MR) imaging in methamphetamine (MA) abusers. METHODS: Thirty-three MA abusers and 32 age- and gender-matched healthy comparison subjects were studied. Axial T-2 weighted images and fluid attenuated inversion recovery axial images were obtained using 3.0 T MR scanner. The severity of WMH was assessed separately for deep and periventricular WMH. Ordinal logistic regression models were used to assess the odds ratio for WMH. RESULTS: MA abusers had greater severity of WMH than the healthy comparison subjects (odds ratio: 7.06, 8.46, and 4.56 for all, deep, and periventricular WMH, respectively). Severity of deep WMH correlated with total cumulative dose of MA (p = 0.027). Male MA abusers had greater severity of WMH than female MA abusers (odds ratio = 10.00). While male MA abusers had greater severity of WMH than male comparison subjects (odds ratio = 18.86), there was no significant difference in WMH severity between female MA abusers and female comparison subjects. CONCLUSIONS: The current study reports increased WMH in MA abusers, which may be related to MA-induced cerebral perfusion deficits. In addition, female MA abusers had less severe WMH than male MA abusers, possibly due to estrogen's protective effect against ischemic or neurotoxic effects of MA.     

Cognitive performance of current methamphetamine and cocaine abusers

Forty currently using methamphetamine (MA) abusers, 40 currently using cocaine (COC) abusers, and 80 comparison participants who did not use psychostimulants received a cognitive battery and questionnaires covering medical history and stimulant use patterns. Forty comparison participants were matched to the 40 MA users on age, education, ethnicity, and gender. The other 40 comparison participants were matched to the cocaine users on the same variables. This design was chosen because there were significant differences in age and ethnicity between COC and MA users that precluded a direct comparison between the groups. The COC group was older and predominantly African American compared to the predominantly Caucasian MA group. When compared to their matched non-using control groups, both MA and COC abusers were impaired on cognitive measures, but the type and degree of impairments were somewhat different.     

Prefrontal grey-matter changes in short-term and long-term abstinent methamphetamine abusers

Authors explored grey-matter density in 29 methamphetamine abusers and 20 healthy comparison subjects using voxel-based morphometry. Grey-matter density changes and performances on the Wisconsin Card Sorting test (WCST) were also compared between 11 short-term (<6 months) and 18 long-term (>or=6 months) abstinent methamphetamine abusers. Methamphetamine abusers had lower grey-matter density in the right middle frontal cortex (corrected p<0.05) and more total errors in the WCST (p<0.01) relative to healthy comparison subjects. Grey-matter density decrease in the right middle frontal cortex correlated with total errors in the WCST in methamphetamine abusers (r=-0.45). Long-term abstinent abusers had significantly less right middle frontal grey-matter density decrease (p<0.01) and total errors in the WCST (p<0.01) than short-term abstinent abusers, but more than the healthy comparison subjects. We report that methamphetamine abusers have prefrontal grey-matter deficit, which may, in part, recover with long-term abstinence.     

Antisocial personality disorder predicts methamphetamine treatment outcomes in homeless,substance-dependent men who have sex with men

One-hundred-thirty-one homeless, substance-dependent MSM were enrolled in a randomized controlled trial to assess the efficacy of a contingency management (CM) intervention for reducing substance use and increasing healthy behavior. Participants were randomized into conditions that either provided additional rewards for substance abstinence and/or health-promoting/prosocial behaviors (“CM-full”; n = 64) or for study compliance and attendance only (“CM-lite”; n = 67). The purpose of this secondary analysis was to determine the affect of ASPD status on two primary study outcomes: methamphetamine abstinence, and engagement in prosocial/health-promoting behavior. Analyses revealed that individuals with ASPD provided more methamphetamine-negative urine samples (37.5%) than participants without ASPD (30.6%). When controlling for participant sociodemographics and condition assignment, the magnitude of this predicted difference increases to 10% and reached statistical significance (p < .05). On average, participants with ASPD earned fewer vouchers for health-promoting/prosocial behaviors than participants without ASPD ($10.21 [SD = $7.02] versus $18.38 [SD = $13.60]; p < .01). Participants with ASPD displayed superior methamphetamine abstinence outcomes regardless of CM schedule; even with potentially unlimited positive reinforcement, individuals with ASPD displayed suboptimal outcomes in achieving health-promoting/prosocial behaviors.     

Explanations for methamphetamine use among gay and bisexual men in New York City

Qualitative interview data from Project Tina, a formative investigation of methamphetamine use among gay and bisexual men in New York City, were used to explore the reasons men use methamphetamine. Interviews were conducted with 48 active methamphetamine users, and coding revealed that a majority of the men used the substance to enhance sexual experiences. However, usage was also related to physical needs, emotional needs, and socialization. Differential explanations were noted across participant HIV serostatus, age, and race/ethnicity. HIV seropositive men indicated significantly greater use of methamphetamine for sexual reasons, as did older respondents. HIV seronegative participants reported significantly greater use of the drug for social reasons, as did younger men. White participants were significantly more likely to use the drug for physical reasons compared to other men. These data suggest that methamphetamine use is multifaceted. Treatment programs should consider individual differences and motivations for drug use in tailoring programs.     

Motivations associated with methamphetamine use among HIV+ men who have sex with men

Previous research has documented an association between methamphetamine (meth) use and high-risk sex among HIV- men who have sex with men (MSM); however, little is known about the sexual risk behaviors of HIV+ meth-using MSM. The purpose of this study was to explore personal motivators of meth use among HIV+ MSM, and to elaborate upon the interaction between meth use and risky sex. Thematic analysis of qualitative data from 25 HIV+ MSM revealed meth use was associated with high rates of anal sex, low rates of condom use, multiple sex partners, sexual marathons, and anonymous sex. Personal motivations associated with meth use included: sexual enhancement; and self-medication of negative affect associated with HIV+ serostatus. A variety of treatment approaches are used to describe how client insights into motivations can be used by clinicians to promote change in drug use and sexual risk behavior.     

纳曲酮治疗男同性恋甲基苯丙胺依赖患者的效果

目的:探讨纳曲酮治疗男同性恋甲基苯丙胺依赖患者的效果。方法:2013年8月-2018年6月北京高新医獉獉獉獉院戒毒医疗科50例男同性恋甲基苯丙胺依赖患者作为研究对象,用盐酸纳曲酮(50 mg·d-1)进行治疗。治疗第4、8、12周时检测甲基苯丙胺尿检阳性率;评价性风险行为(自我报告过去4周内情况),包括男伴数量、使用冰毒男伴数量和无套肛交次数等;采用依赖严重程度量表(Severity of Dependence Scale,SDS)和视觉模拟量表(Visual Analog Scale,VAS)评价甲基苯丙胺依赖程度;用汉密尔顿抑郁量表(24-item Hamilton Depression Rating Scale for Depression,HAMD-24)评价抑郁情绪的严重程度。结果:基线时甲基苯丙胺尿检阳性率为100%,治疗第4周为獉獉86. 96%(40/46)、第8周为72. 50%(29/40)、第12周为61. 54%(24/39)。与基线时比较,第12周时患者的尿检阳性率明显下降,差异有统计学意义(P <0. 05)。治疗后患者的男伴数量、使用冰毒的男伴数量和无套肛交次数均逐渐减少,与基线时比较,第4周时、第8周、第12周患者的上述三种性风险行为均明显下降,差异有统计学意义(P<0. 05)。治疗后患者SDS量表、VAS量表和HAMD-24量表评分均明显改善,与基线时比较,治疗第12周时SDS量表、VAS量表和HAMD-24量表评分明显降低,差异有统计学意义(P <0. 05)。结论:纳曲酮可减少男性同性恋獉獉患者对甲基苯丙胺使用,进而改善性风险行为。     

Assortative mating among men and women alcoholics

The contention that assortative mating for alcoholism is higher among women probands than among men probands is discussed. Theoretical and statistical explanations for observed differences in assortative mating as a function of proband sex are provided. Empirical studies of relevance to this issue are reviewed and various methodological variations and deficiencies that help explain the differences in assortative mating that are reported are noted.     

Methadone-maintenance outcomes for Hispanic and African-American men and women

Six-month methadone-maintenance response and outcome were examined for African-American and Hispanic men and women in a large urban sample. A consistent pattern of improvement was indicated for both races and genders on the addiction severity index (ASI). There were virtually no statistically significant differences in ASI outcomes between Hispanics and African-Americans and men and women using conventional analysis of variance (ANOVA) procedures. Results from an additional equivalence analysis, however, indicated that baseline to 6-month changes for the different groups were generally not similar enough to consider them equivalent. Urine toxicologies obtained during the 6-month treatment period were also not statistically equivalent by race and gender. Evaluating outcomes by gender and race are discussed, as are the implications of using equivalence tests when examining group differences.     

The effect of relapse on cognition in abstinent methamphetamine abusers

Data from 75 participants in a longitudinal study of methamphetamine (MA) abuse were used to differentiate the cognitive performance of those who remained abstinent, relapsed, or continued to use during treatment. Participants were divided into three groups: continuous abstinence, initial abstinence but relapse, and continuous use. Groups did not differ on age, education, gender or ethnicity. Participants in the longitudinal study completed a battery of cognitive tests within 7 days of their last use of MA, then were re-tested monthly for up to 6 months (average time for this analysis was 92 days). For episodic memory, the relapse groups performance was worse than the abstinent and significantly worse than that of the continued use group who had the best performance on all measures. Relapse to methamphetamine use may affect episodic memory differently than it affects the other cognitive functions measured.     

全球糖尿病治疗药物研发及市场态势

糖尿病是常见慢性代谢性疾病,随着我国人口老龄化与生活方式的变化,糖尿病从少见病变成一个流行病,糖尿病患病率从1980年的0.67%飙升至2017年的10.9%,当前,糖尿病具有患病率高、病情不可逆和后期并发症多的特点。除了生活方式干预疗法,包括饮食和锻炼计划外,药物治疗仍是糖尿病治疗的重要方法之一。尽管目前已有多种不同机制的降糖药物,但是63%的2型糖尿病患者仍然得不到有效的治疗,因此开发糖尿病治疗创新药物仍是当务之急。综述了全球糖尿病治疗药物的数量、研发阶段、药物靶点及作用机制、研发机构和销售等情况,展望糖尿病药物研发前景。