The Psychodynamics of Opiate Dependence: A New Look

This study examined the drug use patterns of pregnant women in two inner city sites, selected to overrepresent cocaine users. Women who used cocaine were much more likely to have used some combination of cigarettes, alcohol, and marijuana in addition to cocaine during pregnancy. There was little difference in the patterns of drug use in the two study sites, Trenton, New Jersey, and northwestern Philadelphia. A number of demographic and lifestyle variables of cocaine users, soft drug users (cigarettes, alcohol, and/or marijuana), and abstainers were compared. The cocaine-using group was significantly older and had more children, had less stable and more isolated living situations, was less likely to be employed and more likely to be receiving public assistance during pregnancy, and was more likely to have a higher drug- and alcohol-using social environment and family history than soft drug users or abstainers. Of significance was that many of the high-risk lifestyle factors exhibited by cocaine users were also seen, albeit to a lesser extent, among the soft drug users. These findings have implications for the timing of intervention strategies that would be most effective.     

Marijuana use is associated with risky sexual behaviors in treatment-seeking polysubstance abusers

Abstract

Background: Multiple types of substance use are associated with HIV risk behaviors, but relatively little research has examined the association between marijuana use and risky sexual activities in treatment-seeking polysubstance abusing patients. Objectives: This study evaluated the relationship between marijuana use and sexual behaviors in 239 patients with cocaine, opioid or alcohol use disorders who were initiating outpatient substance use treatment. Methods: Participants completed the HIV Risk Behavior Scale and were classified into one of three groups based on their marijuana use histories: never (n?=?66), past but not current use (n?=?124) or current use (n?=?49). Results: Compared to never marijuana users, current and former marijuana users had a greater likelihood of having more than 50 lifetime sexual partners (odds ratio [OR] and 95% confidence interval [CI]?=?3.9 [1.0–15.7] and 5.2 [1.6–17.3], respectively). Former marijuana users had increased risk of low frequency condom use with casual partners relative to never users (OR [95% CI]?=?2.9 [1.1–7.6]). Moreover, current marijuana users were more likely than never users to have had more than two recent sexual partners (OR [95% CI]?=?8.1 [1.94–33.44]). Conclusion: Treatment-seeking polysubstance abusers with current or past marijuana use histories may be at greater risk of HIV infection than their counterparts who do not use marijuana. These data underscore the importance of increasing awareness about the potential association between marijuana use and increased high-risk sexual behavior among polysubstance abusing patients.     

Assessing the risk of marijuana use disorder among adolescents and adults who use marijuana

Background: The changing political and social climate surrounding marijuana use, coupled with the fact that available estimates of marijuana use disorder prevalence are outdated and do not adequately represent adolescents, underscore the need for up-to-date and comprehensive prevalence estimates of marijuana use disorder. Objectives: To provide recent national estimates of marijuana use disorder as a function of usage patterns, age, and other sociodemographic, substance use, and mental health variables. Methods: Analyses of data from the 2014 National Survey on Drug Use and Health examined the prevalence of marijuana use disorder among respondents (N = 55,271) with various sociodemographic, substance use, and mental health characteristics. Logistic and multinomial regression analyses examined the correlates of marijuana use disorder as a function of these variables, with a special focus on age. Results: In 2014, 3.49% of lifetime, 11.62% of past-year, and 15.32% of past-30-day marijuana users met DSM-IV criteria for a marijuana use disorder; rates among youth generally were at least double those of adults across reported time frame and intensity of use. Regression analyses indicated that young age, black race/ethnicity, greater intensity of use, current tobacco/nicotine use, and alcohol and other drug use disorders were associated with increased odds of a marijuana use disorder. Conclusions: A significant proportion of marijuana users, especially youth, are at risk for having a marijuana use disorder, even at relatively low levels of use.     

Longitudinal patterns of cocaine use among adolescents

Developmental patterns of cocaine use were examined in a longitudinal sample of 1,308 male and female adolescents. The data indicate that substantial increases in use occurred between 15 and 18 and between 18 and 21 years old. Although there were developmental changes, there were no significant increases over time for same aged individuals. Gender differences within age groups were not statistically significant, although some differences were apparent. Examinations of intraindividual changes in cocaine use among continuous users indicate significant individual increases in all measures of cocaine use over a 3-year period. While continuous users increased their use of cocaine, they experienced decreases in their frequency of use of alcohol, marijuana, and other drugs. Analyses also suggest that those individuals who initiated cocaine use between T1 and T2 were already different from their age peers in terms of their cigarette, alcohol, and marijuana use at T1. Overall, the findings suggest that patterns of cocaine use may be more dependent upon the number of years of use rather than on the age of the user.     

CRACK COCAINE,ALCOHOL, AND OTHER DRUG USE PATTERNS AMONG HOMELESS PERSONS WITH OTHER MENTAL DISORDERS

This study examined the co-occurrence of cocaine, alcohol, marijuana, and other drug use among treatment seeking homeless persons to determine whether alcohol use predicted cocaine use differently than marijuana and other drugs predicted cocaine use. Participants were 141 homeless persons with substance use and other nonpsychotic mental disorders seeking drug treatment at a metropolitan health care agency for homeless persons. They were 72.3% male, 27.7% female, 82.7% African American, 17.3% Caucasian, with an average age of 37.7 (SD 7.1) years and had 13.1 (SD 2.4) average years of education. Results supported the assertion that cocaine use was strongly associated with extent of alcohol use and that the association between cocaine and alcohol was stronger than the association between cocaine and other drug use, including marijuana. Participants with cocaine plus alcohol disorders were retained longer in treatment than disorders of cocaine only with no differences in abstinence outcome. The findings should drive further research into the use of alcohol as a trigger or predictor of cocaine use, the deleterious effects of the combined use of cocaine and alcohol, and specialized treatments for polysubstance users.     

Crack cocaine, alcohol, and other drug use patterns among homeless persons with other mental disorders

This study examined the co-occurrence of cocaine, alcohol, marijuana, and other drug use among treatment seeking homeless persons to determine whether alcohol use predicted cocaine use differently than marijuana and other drugs predicted cocaine use. Participants were 141 homeless persons with substance use and other nonpsychotic mental disorders seeking drug treatment at a metropolitan health care agency for homeless persons. They were 72.3% male, 27.7% female, 82.7% African American, 17.3% Caucasian, with an average age of 37.7 (SD 7.1) years and had 13.1 (SD 2.4) average years of education. Results supported the assertion that cocaine use was strongly associated with extent of alcohol use and that the association between cocaine and alcohol was stronger than the association between cocaine and other drug use, including marijuana. Participants with cocaine plus alcohol disorders were retained longer in treatment than disorders of cocaine only with no differences in abstinence outcome. The findings should drive further research into the use of alcohol as a trigger or predictor of cocaine use, the deleterious effects of the combined use of cocaine and alcohol, and specialized treatments for polysubstance users.     

Trajectory of substance use after an HIV risk reduction intervention

Background: Research assessments can confound the results of treatment outcome studies and can be themselves an intervention or form of aftercare. Objective: To determine the trajectory of substance use and substance severity in a sample of African American cocaine users participating in a community-based sexual risk reduction trial. Methods: Out-of-treatment participants were recruited using Respondent-Driven Sampling in two African American majority counties in rural Arkansas. They participated in either the sexual risk reduction condition or an active control focused on access to social services. They were interviewed at baseline, post-intervention, and 6 and 12 months post-intervention. Substance use outcome measures were use of crack cocaine, powder cocaine, marijuana, alcohol, and the Addiction Severity Index Alcohol and Drug Severity composites. A random sample of participants completed qualitative interviews post-12-month interview. Results: 251 were enrolled. Substance use outcomes did not differ among the two conditions at any point in the study. Use of measured substances and the ASI composites significantly decreased between baseline and post-intervention (p?<?0.01), decreases that persisted at the 12-month assessment period compared to baseline. Qualitative findings suggested that many participants identified increased awareness of their drug use and need to control it through the programs. Participants also noted strong bonding with interviewers. Conclusion: Clinical trials may have positive unexpected outcomes in terms of reduced substance use even though the trial is not substance use focused. Behavioral interventions for drug users that are not focused specifically on reducing drug use may nonetheless have unanticipated positive associations with reductions in drug use.     

Neural correlates of verbal learning in adolescent alcohol and marijuana users

Aims Alcohol and marijuana are the most widely used intoxicants among adolescents, yet their potential unique and interactive influences on the developing brain are not well established. Brain regions subserving learning and memory undergo continued maturation during adolescence, and may be particularly susceptible to substance‐related neurotoxic damage. In this study, we characterize brain response during verbal learning among adolescent users of alcohol and marijuana. Design Participants performed a verbal paired associates encoding task during functional magnetic resonance imaging (fMRI) scanning. Setting Adolescent subjects were recruited from local public schools and imaged at a university‐based fMRI center. Participants Participants were 74 16–18‐year‐olds, divided into four groups: (i) 22 controls with limited alcohol and marijuana experience, (ii) 16 binge drinkers, (iii) eight marijuana users and (iv) 28 binge drinking marijuana users. Measurements Diagnostic interview ensured that all teens were free from neurological or psychiatric disorders; urine toxicology and breathalyzer verified abstinence for 22–28 days before scanning; a verbal paired associates task was administered during fMRI. Findings Groups demonstrated no differences in performance on the verbal encoding task, yet exhibited different brain response patterns. A main effect of drinking pointed to decreased inferior frontal but increased dorsal frontal and parietal fMRI response among binge drinkers (corrected P < 0.05). There was no main effect of marijuana use. Binge drinking × marijuana interactions were found in bilateral frontal regions (corrected P < 0.05), where users of either alcohol or marijuana showed greater response than non‐users, but users of both substances resembled non‐users. Conclusions Adolescent substance users demonstrated altered fMRI response relative to non‐using controls, yet binge drinking appeared to be associated with more differences in activation than marijuana use. Alcohol and marijuana may have interactive effects that alter these differences, particularly in prefrontal brain regions.     

Anomie and drug use in high school students.

The use of alcohol, tobacco, and drugs as it relates to anomie was studied in 11th grade students. A questionnaire was administered to 1,314 11th grade students which included Srole's Anomie Scale as well as items pertaining to the usage of alcohol, tobacco, marijuana, cocaine, LSD, heroin, amphetamines, barbiturates, and methaqualone. The name of each drug was given along with the colloquial terms typically used to identify each drug. Substance users showed significantly higher anomie scores than nonusers on alcohol, tobacco, marijuana, LSD, amphetamines, and barbiturates. Although the results were not statistically significant for cocaine, heroin, or methaqualone, the differences between substance users and nonusers were all in the predicted direction.     

Initiation and Progression of Alcohol,Marijuana, and Cocaine Use Among Adolescent Abusers

Adolescent alcohol and drug use are associated with many negative consequences. Understanding factors in initiation and patterns of use could aid in treatment and prevention. Sixty-four adolescents calling a cocaine hotline received structured telephone interviews. Mean age was 16.7 years. Two-thirds of the adolescents were young men. Sixty-six percent used alcohol; 60.9%, marijuana; 60.9%, cocaine; mean onset was at 13.57, 13.28, and 14.64 years, respectively. Daily use of alcohol was reported by 25.8%; marijuana, 36.9%; and cocaine, 41.3%. Eighty-four percent tried drugs because of peer pressure. Multiple alcohol/drug use commonly started in early adolescence. Peer use and pressure were major reasons for initiation. Early interventions can incorporate and make use of these factors.     

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.     

Drug Network Characteristics as a Predictor of Cessation of Drug Use Among Adult Injection Drug Users: A Prospective Study

Few studies have examined recovery from opiate and cocaine dependence without treatment, referred to as “natural recovery,” “spontaneous recovery,” and “spontaneous remission.” The present study examined the relationship between network characteristics and cessation of heroin, cocaine, and crack use in a sample of underclass inner-city injection drug users in Baltimore, Maryland. Participants were enrolled in an experimental human immunodeficiency virus (HIV) preventive intervention. Between the baseline and follow-up interviews, which averaged 5.2 months, 24 (7%) of 335 participants reported ceasing to use heroin, cocaine, and crack. Individuals who had reported cessation of drug use at follow-up had reported at baseline a smaller proportion of their network members with whom they used drugs (p <. 02). Using multiple logistic regression analyses and adjusting for baseline drug use, enrollment in drug treatment, and demographic and background variables, cessation of drug use was associated with a lower proportion of personal network members in one's drug network (odds ratio [OR] = 25.4, p. 05). The data from this study suggest that network members have potential for social influence on the cessation of drug use.     

A Comparison of Male Users and Nonusers of Marijuana on the Perceived Harmfulness of Drugs

Subjects (n = 108) who volunteered to participate in a study in which they expected to smoke marijuana were asked, as part of a screening procedure, to rate the harmfulness of a number of illicit drugs including marijuana. Subjects were separated into three groups according to their reported history of use of marijuana. The three groups were: (1) naive users (at least 1 but no more than 25 incidences of use in a lifetime), (2) light users (1 to 3 incidences of use per week), and (3) heavy users (at least 5 incidences of use per week). Groups did not differ in terms of their perceived harmfulness of any of the drugs. Cluster analyses of the results for each group and for the total group indicated three distinct clusters: the drugs perceived to be the most harmful were heroin, morphine, and LSD; drugs perceived to be less harmful were cocaine, amphetamines, barbiturates, and nicotine; and the drugs perceived to be the least harmful were caffeine and marijuana, with marijuana being judged the least harmful of all the drugs.     

Violent victimization and drug involvement among Mexican middle school students

Aims To answer the following research questions: (a) is there an association between violent victimization and exposure to opportunities to use marijuana, inhalants and cocaine and (b) is there an association between violent victimization and actual drug use among youth with drug‐using opportunities? Design Cross‐sectional survey. Setting Two middle schools located in the Historic Downtown area of Mexico City. Participants The entire body of students (n = 767; mean age 13.8 years, 52% males). Measurements Qualitative research was used to develop questions on drug exposure opportunities and violent victimization. Standardized questions on life‐time alcohol, tobacco, marijuana, inhalant drugs and cocaine use were also included, as well as questions on violent victimization and other covariates. Findings One‐quarter (25%) of students had an opportunity to try marijuana, inhalant drugs or cocaine; 35% who had an opportunity actually used at least one drug. In this sample, 59% had been victimized violently. Youth who had been victimized had greater odds of opportunities to use drugs compared to those who had not been victimized [adjusted odds ratio (OR) = 3.8; 95% confidence interval (CI), 2.4, 6.1]. Once exposure opportunity is taken into consideration, no association was evident between violent victimization and actual drug use (adjusted OR = 0.9; 95% CI, 0.4, 2.1). Conclusions It is possible to trace back the association between violent victimization and drug use to differences in exposure to opportunities. Limitations considered, this study suggests interventions to improve micro and macro contexts, such as families, schools and communities, so young people can have better places to live and develop.     

Is there a progression from abuse disorders to dependence disorders?

Background Recent studies suggest that a progression occurs from alcohol abuse to alcohol dependence. Although DSM‐IV criteria for all substance use‐related diagnoses are based largely on the alcohol dependence syndrome, progression from abuse to dependence might not generalize to other substances. Aims This study tested whether a progression from DSM‐IV abuse to dependence occurs related to the use of cannabis, cocaine and opiates. Design Retrospective data from the DSM‐IV Substance Use Disorders Work Group (n = 1226) were reanalysed using McNemar's χ², configural frequency analyses and survival analyses. Participants were men and women who were primarily African‐Americans or Caucasians. Settings Participants were recruited from community and clinical settings. The measure was the Composite International Diagnostic Interview–Substance Abuse Module. Findings For all substances, life‐time dependence in the absence of life‐time abuse was rare. Results were consistent with a progression occurring for alcohol and cannabis, but not for cocaine and opiates. Abuse and dependence occurred in the same year for 66% of the cocaine users who experienced both disorders (57% of users with any cocaine disorder) and 65% of the opiate users who experienced both disorders (46% of users with any opiate disorder). Because cocaine and opiate dependence in the absence of abuse were rare, it is possible that progressions in cocaine and opiate disorders occur more rapidly than cannabis and alcohol. Conclusions Research is needed to clarify the mechanisms that influence progressions of substance use disorders. Potential factors leading to between‐drug variation in rate of progression of disorders are discussed.     

Neurocognitive,psychological and behavioral correlates of binge drinking and use of alcohol with caffeinated beverages in college-aged adults

Background: We examined event-related potential (ERP), behavioral and psychological correlates of binge drinking and the use of alcohol mixed with caffeinated beverages (AmCBs) in college-aged (18–26 years) adults. Objective: Our objective was to delineate the neurocognitive correlates of different patterns of risky alcohol use in this population. Methods: We collected ERP data while an initial sample of 60 participants completed visual oddball and go/no-go tasks. We also collected self-report data measuring levels of sensation seeking, impulsivity, and drinking-induced disinhibition. In our primary analyses between binge drinker (N?=?17) and comparison participants (N?=?29), we used analysis of covariance (ANCOVA) to control for monthly marijuana usage and excluded participants who reported using other illicit drugs. As separate, exploratory analyses, we compared participants who reported using AmCBs (n?=?14) and those who did not (n?=?46), co-varying for monthly marijuana and recreational drug use. Results: We found that binge drinkers and AmCB users reported significantly higher levels of sensation seeking and drinking-induced disinhibition. In addition, we found that binge drinkers exhibited greater P3a/b amplitudes in the oddball task. In contrast, AmCB users exhibited significantly attenuated P3a amplitudes to distracter stimuli in the oddball task. However, we found no statistically significant differences in the amplitudes of P2(00) or N2(00) components between binge drinkers and comparison participants or between AmCB users and nonusers. Conclusions: Overall, these data suggest that binge drinking and AmCB use are associated with P3 alterations, but the specific effects may differ for individuals with different patterns of risky alcohol use.     

Cultural patterns and causal processes in adolescent drug use: the case of Greeks versus Americans

Patterns of adolescent drug use in Greece (N = 174) and the United States (N = 2,610) are compared. The rates of self-reported lifetime alcohol and cigarette use are rather similar. For other drugs (marijuana, amphetamines, depressants, cocaine, LSD, PCP, and heroin) there is much more drug use in the United States. A causal model employing variables from social control and social learning theories is applied to drug use in both samples. We conclude that American theories of adolescent deviance assume certain cultural conditions, and therefore may need revision before they can be fruitfully applied to the behavior of young people in other cultures.     

Alcohol and marijuana consumption among undergraduate polydrug users

Of 365 undergraduates surveyed, 42% admitted to polydrug use. The rank order of drugs used was: alcohol, marijuana, tobacco, hallucinogens, barbiturates, amphetamines, cocaine, opiates, and inhalants. Forty-four percent used one drug combination, 25% used 2 to 3 combinations, 17% used 4 to 7 combinations, with 14% using 8 to 14 combinations. Nealry 85% used alcohol plus marijuana, with nearly one-third combining alcohol or marijuana with barbiturates, hallucinogens, or amphetamines. Alcohol appeared to be first drug used; however, it was not abandoned when marijuana use began-both drugs simply used concurrently, and new drugs were incorporated into the existing patterns of drug use. Interpretations of polydrug use are limited by difficulties in assessing drug use, as well as inconsistencies in the chemical composition of illicit drugs.