Mortality, suicide, social maladjustment and criminality among male alcoholic parents and men from the general population and their offspring

In a 15-year longitudinal prospective examination of the subsequent life and development of parents and children of 211 male alcoholic inpatients (the probands), we compared them with a simple random sample of 200 men from Greater Stockholm (the controls) and their children. The group of male alcoholic inpatients and the random sample were subdivided with respect to alcohol consumption and use of hepatotoxic drugs: (IA) men from the random sample with low or moderate alcohol consumption and no use of drugs (n= 169); (IB) men from the random sample with low or moderate alcohol consumption with use of drugs (n= 31); (MA) alcoholic inpatients with use of alcohol but no drugs #obn =171); (MB) alcoholic inpatients with use of alcohol and drugs (n =40). Groups IB and IIB had more psychosocial problems than the men of the other groups. They had grown up in families with more abuse of alcohol and drugs, an alcohol-abusing father and mother and had taken up their parents' concomitant drug and alcohol abuse by parental influences. There were differences in social adjustment and health status between the children from alcoholic homes and the control children. Social assistance was required to a greater extent by the proband groups and especially those from group IIB and the control children from group IB, who were registered in the Temperance Register and the Criminal Offenders Register and with the child welfare authorities more often than the control children of group IA. The proband children and the children of group IB were also registerd for sick-leave more often than the control boys and girls of group IA and accounted for a larger number of visits to the wards and outpatient clinics for somatic symptoms and to psychiatric clinics and wards. The two groups IB, from the general population, and MB, from the alcoholic inpatients, were like “twin” groups in that they were equally often involved in crimes with drugs and their children's social maladjustment and health status resembled each other.     

Coping strategies in children of male alcoholic parents and men from the general population

In a 15-year longitudinal-prospective examination of the subsequent life and development of parents and children of 211 male alcoholic inpatients (the probands) we compared them with a simple random sample of 200 men from Greater Stockholm (the controls) and their children. The group probands and the controls were then subdivided with respect to alcohol consumption and use of hepatotoxic drugs: (IA) controls with low or moderate alcohol consumption and no use of drugs (n= 169); (IB) controls with low or moderate alcohol consumption with use of drugs (n=31); (IIA) probands with use of alcohol but no drugs (n=171); (MB) probands with use of alcohol and drugs (n=40). Groups IB and IIB had more psychosocial problems than the men of the other groups. They had grown up in families with more abuse of alcohol and drugs, an alcohol- abusing father and mother and had taken up their parents' concomitant drug and alcohol abuse by parental influences. Coping strategies for one child from each of groups IA, IB, IIA and IIB were followed and described. There were differences in the social adjustment and the health status between the proband's children and the control's children. Social assistance was required to a greater extent by the proband groups and especially those from group IIB and the control children from group IB who were registered in the Temperance Register and the Child welfare authorities more often than the control children of group IA.     

Do daughters of female alcoholics have more problems during childhood and adolescence than sons?

171 female alcoholic inpatients living in Stockholm were examined and found to fulfil the alcoholism criteria of DSM-III-R. They comprised 171 women consecutively admitted to the Karolinska Alcohol Clinic and staying at least one week for treatment. The examination included a general medical examination, a psychiatric and social history, blood tests and ECG. The subjects' and their families' possibilities of creating a good upbringing environment for their children and their own childhood were studied.

The alcoholics and their offspring were followed from the registers of the child welfare committees, temperance boards, social service departments, the Social Insurance Office and the Medical Information System of the Medical Services Board of Stockholm County Council.

The children of the female alcoholics had, during their childhood, often had contact with an educational welfare officer, a psychologist or a physician for various problems and were also registered in the children's welfare committee registers. 29% of the female alcoholics themselves had been fostered by their biological mother alone or by grandparents until 16 years of age. 51% of the women had an alcohol-abusing mother and father during childhood. Signs of social maladjustment and having been under the care of a child welfare committee were recorded in 20% and 12% of the women.

Among the children, we found that the boys were more vulnerable during their adolescence than the girls and that there were also major similarities in the social situation for these children of alcoholic women. The indications were that there is also a vulnerable group among girls who develop high consumption of alcohol and simultaneous drug abuse during their teens. Forty five per cent of the girls and 60% of the boys among the female alcoholics' children had school problems and were also in contact with an educational welfare officer, psychologist or physician for various problems. Scrutiny of the Children's Welfare Committee Register showed 60% of the sons and 40% of the daughters were registered. Forty five per cent of the boys and 30% of the girls were registered by the Temperance Board. Forty per cent of the boys and 25% of the girls were registered in the Criminal Offenders Register. Forty five per cent of the boys and 30% of the girls had had hospital treatment on at least one occasion for underlying physical illness or injury. The most common reason for establishing contact with children's psychiatric outpatient clinics or counselling clinics was recommendation and investigation necessitated by supportive measures and school adjustment problems.

It is concluded that female alcoholics resemble male alcoholics and that these females have a disturbed childhood and often have an alcohol and drug-abusing parent, nervous problems in the parents, attempted suicide by a parent and serious schisms in the family and that especially the boys from these female alcoholics' families are extremely vulnerable and they have a more traumatic childhood than the girls, but both of them fare ill.     

Are children of alcoholic mothers more psychologically damaged compared with children of mothers from the general population?

Matched pairs of 40 women from the general population and 40 female alcoholic inpatients living in Stockholm were examined and found to fulfil the alcoholism criteria of DSM-III-R. They comprised 40 inpatient women consecutively admitted to an Alcohol Clinic and staying at least one week for treatment. The examination included a general medical examination, a psychiatric and social history, blood tests, ECG, computed tomography of the brain and neuropsychological testing.

The aim of the study was to determine if children of alcoholic mothers were more psychologically damaged compared with children of mothers from the general population. The subjects' and their families' possibilities of creating a good upbringing environment and their own childhood were studied.

The female alcoholics and the women from the general population and their offspring were followed from the registers of the child welfare committees, temperance boards, social service departments, the Social Insurance Office and the Medical Information System of the Medical Services Board of Stockholm County Council. The children of the female alcoholics had, during their childhood, more often had contact with an educational welfare officer, a psychologist or a physician for various problems and also had a significantly higher rate of registration in the childrens welfare committee registers than children of women from the general population.

Fourteen per cent of the boys and 6% of the girls in the group from the general population and 35% of the sons and 20% of the daughters of the female alcoholics were registered by the Temperance Board. Eighteen per cent of the boys and 0% of the girls from the general population and 40% of the sons and 25% of the daughters of the female alcoholics were registered in the Criminal Offenders Register. No girl in the group from the general population was registered in the Criminal Offenders Register. Of the girls with an alcoholic home background, 25% were registered and all these had been sentenced to fines. Eight per cent of the children from the general population and 40% of the sons and 25% of the daughters of the female alcoholic inpatients had had hospital treatment on at least one occasion for underlying physical illness or injury. Eight per cent of the children in the general population and 40% of the sons and 25% of the daughters of alcoholic women were registered at children's psychiatric wards and outpatient clinics and counselling clinics. None of the children of the women of the general population, but 30% of the sons and 20% of the daughters of the female alcoholics abused alcohol or drugs. It was concluded that children of female alcoholics have a more psychologically disturbed childhood than children of women from the general population.     

Male offspring of alcoholic parents compared with men from the general population

The probands, 211 male alcoholic inpatients, were compared with their controls, a simple random sample of 200 men, from Greater Stockholm. The group of male alcoholic inpatients and the random sample were subdivided with respect to alcohol consumption and use of hepatotoxic drugs: (IA) men from the random sample with low or moderate alcohol consumption and no use of drugs (n = 169); (IB) men from the random sample with low or moderate alcohol consumption with use of drugs (n = 31); (IIA) alcoholic inpatients with use of alcohol but no drugs (n = 171); (IIB) alcoholic inpatients with use of alcohol and drugs (n = 40). Groups IB and IIB had more psychosocial problems than the men of the other groups. They had grown up in families with more abuse of alcohol and drugs, broken homes, an alcohol-abusing father and mother and had taken up their parents' concomitant drug and alcohol abuse by parental influences. We have here a group of alcohol and drug users (group IB) who resemble the drug users in the alcoholic inpatient group IIB in that they have drunk excessively almost as long, have an early onset, have earlier also used narcotic drugs and have the same type and prevalence of mental symptoms.     

Adolescent alcohol and drug abuse and health

Purpose: To examine the relationship of adolescent alcohol and drug use over a 5-year period to cumulative health problems in late adolescence and young adulthood.

Methods: We prospectively examined self-reported health problems in a sample of adolescents, some of whom received treatment for substance use disorders and had consistently poor substance use outcomes (n = 38), some of whom received treatment for substance use disorders and had positive substance use outcomes (n = 30), and a low alcohol and drug use community comparison group (n = 48). Data regarding health-related problems of these adolescents (mean, 15.9 years; 83% Caucasian; 56.5% female) were collected at 2, 4, and 6 years following initial assessments.

Results: Alcohol and/or drug involvement severe enough to warrant treatment during adolescence was associated with more cumulative health problems and severe health problems for girls and more cumulative health problems for boys. Protracted and continuous abuse of alcohol and drugs was associated with more cumulative and severe health problems for girls and more severe health problems for boys.

Conclusions: These results suggest that significant health problems and concerns are related to both brief and protracted alcohol and drug abuse during adolescence. Health problems will likely become even more evident as early-onset, chronic substance abusers continue to age.     

Heavy drinking is associated with more severe psychosocial dysfunction among girls than boys in Finland.

PURPOSE: To investigate social, psychological, and environmental factors related to heavy drinking by 15-year-old Finnish school pupils. METHODS: Each of 240 pupils completed a questionnaire about alcohol use, smoking, and illicit drug use; an Offer Self-Image Questionnaire; an Inventory of Parent and Peer Attachment; and a Psychosomatic Symptoms Questionnaire. Teachers assessed each pupil according to a Social Skills Rating Scale. Academic achievement was assessed on the basis of report grades. RESULTS: Heavy drinking was associated with smoking, trial of drugs, poor social skills in class, and poor school achievement in both boys and girls. In girls, heavy drinking was associated with psychosomatic symptoms and a negative social self-image. Girls who drank heavily also had more difficulty with concentration and externalizing problems and more problems with teachers than those who were abstinent or consumed alcohol moderately. The self-images of boys who drank heavily were more negative than those of alcohol-abstinent boys. In boys, heavy drinking was associated with higher numbers of peer relationships. CONCLUSIONS: Heavy drinking is associated with more severe psychosocial dysfunction among girls than boys. It may be possible to identify girls at school who drink heavily and guide them toward treatment.     

Substance abuse among sexually abused adolescents and their families

The concurrence of substance abuse and history of sexual abuse among adolescents has prompted this study of substance abuse patterns among families of adolescents who report incest or extrafamilial sexual abuse. A total of 3,179 ninth-grade students in a rural midwestern state completed a survey that included questions about individual and family substance abuse. Adolescents who had been sexually abused were more likely to report substance abuse for themselves as well as for members of their immediate families. They were also more likely to report that they used substances because of family problems, school problems, and because they were sad, lonely, or angry. Adolescents reporting a parent with an alcohol or a drug problem were more likely to use cigarettes, marijuana, alcohol, or “speed.” Adolescents experiencing extrafamilial abuse reported more alcohol abuse and more alcohol-related problems than those who experienced incest. There were similar reports of parental and familial alcohol and drug problems among those experiencing incest and those experiencing extrafamilial abuse. Those with drug-abusing parents, however, were most likely to report some kind of sexual abuse history.     

Surveying teens in school to assess the prevalence of problematic drug use

BACKGROUND: Illicit drug use by school‐aged teens can adversely affect their health and academic achievement. This study used a survey administered in schools to assess the prevalence of problematic drug use among teenagers in a Midwestern community. METHODS: Self‐report data were collected from 11th‐ and 12th‐grade students (N = 3974) in 16 school districts in the Dayton, Ohio, area. Students responded to a drug use survey that also included CRAFFT, a brief substance abuse screening instrument. Binomial and zero‐inflated Poisson regressions were used to examine the association between CRAFFT scores and drug use practices, including abstinence. RESULTS: More than one third of students had CRAFFT scores suggestive of problematic use. Of these, 14.1% had scores suggesting drug dependence. Although alcohol, marijuana, and tobacco were the drugs most commonly used, an array of other drugs including opioids, benzodiazepines, stimulants, hallucinogens, and dextromethorphan were also commonly used. Higher CRAFFT scores were associated with a greater number of drugs used (p < .0001). Proportionately more 12th graders than 11th graders had CRAFFT scores indicating problems (p < .0001). Among 12th graders, boys were more likely than girls to have CRAFFT scores indicating dependence (p = .01). CONCLUSIONS: The results suggest that problematic drug use among high school students is more prevalent than has been recognized previously. CRAFFT can be used easily to assess the prevalence of problematic drug use among teenagers in school settings. CRAFFT results can also inform prevention and intervention activities, particularly if the CRAFFT instrument is paired with a drug use survey.     

Tabak-, Alkohol- und Drogenkonsum von Jugendlichen in Deutschland

Due to its long-lasting effects, the consumption of tobacco, alcohol and drugs is one of the central topics of prevention and health promotion in childhood and adolescence. The data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) show that in Germany today 20.5 % of 11-17-year-old boys and 20.3 % of girls the same age smoke. More than one quarter of adolescents who do not smoke themselves are exposed to cigarette smoke several times a week; around one fifth are even exposed to it almost every day. In the case of alcohol, 64.8 % of boys and 63.8 % of girls have drunk it before. Around one third of boys and one quarter of girls indicated that they currently consumed alcohol at least once a week. In the last 12 months before the survey 9.2 % of the boys and 6.2 % of the girls had taken hashish or marijuana. Other drugs such as Ecstasy, amphetamines or speed had been consumed by less than 1 % of the adolescents. The use of psychoactive substances rises markedly as children get older and is thus the most widespread among 16-17-year-olds. Adolescents of low social status smoke more frequently; in the case of alcohol and drug consumption, however, no significant status-specific differences are observed. There is also a raised prevalence of smoking among boys and girls who attend a secondary school and live in the states of the former GDR. The results emphasise the need for an addiction prevention programme which should include intervention to prevent children taking up substance use, as well as withdrawal treatment.     

Treatment of alcoholism and concomitant drugs of abuse

It has been proposed that concomitant substances of abuse may have additive or synergistic properties such that alcoholics using other substances of abuse concurrently may have a harder time giving up alcohol than alcoholics abusing only alcohol. The present study surveyed 291 alcoholics in an alcohol treatment program and 86 social drinker controls matched on age, education, SES and gender. Alcohol consumption, smoking, coffee intake, other substances of abuse. Beck depression and Spielberger Anxiety (State) were measured. Alcoholics drank significantly more alcohol than did social drinkers per day (350.19 cc versus 28.08 cc, p less than 0.001), consumed more caffeine/day (486.3 mg versus 339.9 mg, p less than 0.002), smoked more cigarettes/day (27.8 versus 12.8, p less than 0.001), were more depressed (16.8 versus 4.4 (Beck), p less than 0.0001), had lower internal locus of control scores (37.6 versus 39.7, p less than 0.005), had higher scores on control by chance (22.7 versus 20.2, p less than 0.03) and were significantly more anxious (52.5 versus 33.9 on Spielberger's State Inventory p less than 0.0001). Some patients used stimulants, tranquilizers, depressants, narcotics or toluene. Only 3/258 abused alcohol without using other drugs. Results support earlier studies showing strong associations between alcohol and smoking and between alcohol and caffeine consumption. The alcoholic abusing only alcohol is very rare. Treatment programs need to pay attention to concomitant drugs of abuse.     

Mental symptoms and disorders in adulthood among offspring of alcoholic parents

211 male alcoholic inpatients (the probands) were compared with a simple random sample of 200 men from Greater Stockholm (the controls). The group of male alcoholic inpatients and the random sample were subdivided with respect to alcohol consumption and use of hepatotoxic drugs: (IA) men from the random sample with low or moderate alcohol consumption and no use of drugs (n = 169); (IB) men from the random sample with low or moderate alcohol consumption with use of drugs (n = 31); (HA) alcoholic inpatients with use of alcohol but no drugs (n = 171); (MB) alcoholic inpatients with use of alcohol and drugs (n = 40). Groups IB and IIB had grown up in families with more abuse of alcohol and drugs, broken homes and an alcohol-abusing father. They showed aggressive behaviour and hostility towards members of their own families when drunk and had even assaulted their partners, wives and children. Groups IB and IIB had been drinking excessively for almost the same time and had an earlier onset, and both had also earlier used narcotic drugs and had the same, type of mental symptoms and mental disorders. They had the same rate of accidents, hospital treatment, poisoning and violence. The alcohol and drug-combining groups in the sample from the general population and from the alcoholic in-patients were equally likely to develop social maladjustment problems, including abuse of alcohol and drugs, while they were growing up.     

青少年网络成瘾与童年期虐待忽视的相关性研究

目的 了解青少年网络成瘾的流行状况,分析青少年网络成瘾与其童年期虐待忽视的关系。方法 整群抽取安徽省阜阳、铜陵、天长3市5 726名初一~高三学生,使用自编“安徽省青少年健康相关行为问卷”调查研究对象一般情况、网络成瘾、童年期虐待忽视等进行调查。结果 男生网络成瘾检出率为5.41%,女生为2.93%,差异有统计学意义(χ²=47.66,P<0.001)。男生躯体虐待、情感虐待、性虐待、躯体忽视检出率均高于女生,差异均有统计学意义(P均<0.01)。童年期情感虐待、性虐待和躯体虐待是青少年轻度网络成瘾的危险因素(P均<0.05),童年期性虐待是青少年重度网络成瘾的危险因素(P<0.05)。结论 青少年网络成瘾与其童年期虐待忽视密切相关,在探讨青少年网络成瘾影响因素的同时,应关注童年期虐待忽视对网络成瘾的影响。     

The Relationship Between Sexual Abuse and Sexual Risk Among High School Students: Findings from the 1997 Massachusetts Youth Risk Behavior Survey

Objective: To assess whether adolescents with a history of sexual abuse were more likely than those with no such history to engage in sexual risk behaviors. Methods: Data for this study were obtained through the 1997 Massachusetts Youth Risk Behavior Survey, a self-report questionnaire administered to a representative sample of 9th through 12th graders (N = 4014) to assess a variety of adolescent risk behaviors. Only sexually experienced adolescents (n = 1610; female = 779, male = 831) were included in the present study. Logistic regression models were constructed to examine the relationship of sexual abuse history to sexual risk behaviors. Adolescents were considered as having a history of sexual abuse if they reported ever having had sexual contact against their will. Results: Almost one- third of sexually experienced adolescent girls (30.2%) and one-tenth (9.3%) of adolescent boys reported a history of sexual abuse. After controlling for related demographics and risk behaviors, sexually abused female students were significantly more likely than those without such a history to have had earlier first coitus (OR = 2.2, 95%CI = 1.46–3.47), to have had three or more sex partners ever (OR = 2.5, 95%CI = 1.71–3.68), and to have been pregnant (OR = 1.9, 95%CI = 1.21–2.92). Sexually abused male students were significantly more likely than those without such a history to have ever had multiple partners (OR = 3.2, 95%CI = 1.56–6.57), to have had multiple sex partners in the past 3 months (OR = 2.9, 95%CI = 1.71–3.68), and to have engaged in sex resulting in pregnancy (OR = 3.4,95%CI = 1.53–7.34). Conclusion: Both adolescent girls and boys with a history of sexual abuse report greater sexual risk-taking than those without such a history. However, although sexual abuse is more prevalent among girls than boys, the impact of sexual abuse on sexual risk appears to be even greater for boys. Programs addressing both sexual abuse and sexual risk must be made available to all adolescents.     

Protecting boys from the risk of sexual abuse

Relatively little is known about the sexual victimisation of male children. Because more girls report sexual abuse than boys, it has been widely assumed that boys are less vulnerable or that their abuse is less damaging than the abuse of girls. As a result, child protection programmes have been directed towards the protection of females. Interviews with 194 adult male survivors of sexual abuse suggest that the victimisation of boys is under-recognised, under-reported and that boys are not adequately protected by parents and current child protection curriculum. Subjects identified their sexual curiosity and ignorance as the primary contributors to their victimisation. Non-incest victims also believed that the lack of physical affection from their fathers contributed to their vulnerability. Strategies to facilitate the recognition and reporting of sexual abuse by boys warrant immediate attention.     

Prevalence of childhood sexual abuse among Mexican adolescents

Background   To determine the characteristics and prevalence of previous child sexual abuse among a group of Mexican junior high school students.
Methods   A total of 1067 adolescents of both genders were selected to fill out a survey about child sexual abuse.
Results   The prevalence of child sexual abuse was 18.7% ( n  = 200). It was more frequent in girls (58%) than in boys (42%). Sexual abuse involved physical contact in 75% of those cases reporting abuse. The aggressors were neighbours (50.3%), relatives (36.8%) and strangers (13.9%). Abuse was committed through deception in 90% of the cases and involved physical mistreatment in 10% of the cases. Of the victims, 14.4% had spoken about the problem and 3.7% had taken legal action. And 9.6% of those surveyed stated that they required psychological counselling.
Conclusions   In the population studied, the prevalency of child sexual abuse was greater than that reported in Mexico City (4.3–8.4%), although it was similar to that found in the Spanish child population (15–23%). The risk of sexual abuse is greater for girls and the principal aggressors are male neighbours, family friends and relatives; the abuse is committed in the home of the aggressor or the victim and very few cases are reported to the authorities.     

Estimating prevalence of alcohol abuse and dependence in one general hospital: an approach to reduce sample selection bias.

Prevalence estimates of alcohol abuse or dependence in general hospitals are often limited to single wards, small data collecting periods or insufficient diagnostic procedures. Therefore, the present study aimed to ascertain alcohol abuse or dependence in one general hospital, to compare prevalence data for all the 11 wards and 6 intake months, to establish if screening is sufficient or if a two-step diagnostic procedure is needed, and to determine whether information for an alcohol diagnosis on suspicion is available. A sample of 1309 medical or surgical in-patients were screened by questionnaires or medication for withdrawal, and, if screening-positive, were interviewed with the alcohol section of a standardized psychiatric interview. In screening-negative patients, a diagnosis on suspicion was given if medication to treat withdrawal had been used, or if there was evidence of single criteria of alcohol dependence, somatic disorders from alcohol drinking, raised laboratory parameters on grounds of alcohol drinking or of self-reported high alcohol consumption. Of the medical and surgical in-patients, 20.7 and 16.0% respectively were alcohol abusers or dependents, with a range of prevalence rates of alcohol abuse or dependence among wards of 11.1-32.9% and among intake months between 11.3 and 28.7%. Of the medical department in-patients, 1.9%, and of the surgical in-patients, 2.1%, were screened as false-positive cases. In addition, 5.5% of the medical and 12.0% of the surgical patients were given a diagnosis on suspicion. It is concluded that all general wards and different intake months should be taken into account when estimating prevalence of alcohol abuse or dependence in a general hospital.     

广州市中小学生精神活性物质滥用现状研究

[目的]了解广州市中小学生精神活性物质滥用的现状．为进行学生健康教育提供参考。[方法]分层随机整群抽取广州市8所小学4-6年级，9所中学初一至高三的8222名学生进行问卷调查。[结果]有23.6%的学生尝试过吸烟,有7.5%的学生是经常性吸烟,有53.2%的学生尝试过饮酒,有过其他药物滥用行为的学生的比例高达7.1%,中学生发生吸烟,饮酒和药物滥用的主要原因是＂好奇＂和＂受周围人影响＂（分别占87.5%,78.7%和87.0%）烟酒及其他药物滥用者中感到身体受到了损害的分别有20.4%,12.3%和52.8%,学生曾因用药后伤人中以喝酒后伤人的学生比例最多占5.2%.[结论]中小学生中发生吸烟,喝酒和其他精神药物滥用的情况已不容忽视,提倡在中小学生中开展个性化健康教育来预防和控制精神活性物质滥用行为.     

Association of Alcohol Abuse and Injection Drug Use with Immunologic and Virologic Responses to HAART in HIV-positive Patients from Urban Community Health Clinics

The purpose of this study is to examine the association of alcohol abuse and injection drug use (IDU) with the immunologic and virologic responses to highly active antiretroviral treatment (HAART) in urban community health clinics. The medical records of 293 HIV-infected adult patients who visited either of two urban health clinics in New Haven, Connecticut, from June 2003 to December 2004 were retrospectively reviewed. Changes in mean CD4 lymphocyte counts and undetectable viral loads were compared before and after the initiation of HAART for patients categorized into one of four substance abuse groups: history of neither alcohol abuse nor IDU, alcohol abuse only, IDU only, or both. Unadjusted mean improvements in CD4 count for the four groups were 136, 97, 20, and 27, respectively. In a linear regression model adjusted for age, gender, and baseline CD4 count, history of IDU only (P = 0.037) and a combination of alcohol abuse and IDU (P = 0.038) were associated with a lesser increase in CD4 count after HAART compared with those with neither alcohol nor IDU. No significant associations were found between substance abuse history and changes in detectable viral load. Our results show that many patients at urban health clinics have a history of either injection drug use or alcohol abuse, and that injection drug use is negatively associated with the immunologic response to HAART in urban HIV-infected individuals. This study highlights the importance for clinicians of understanding the negative associations of substance abuse with the treatment response of HIV-infected patients at urban health centers.