Flunitrazepam and Its Involvement in Date or Acquaintance Rape

An estimated 1 in 4 women in the United States will be raped in their lifetimes. Approximately 75% of all rapes are date or acquaintance rapes. Recently the illegal use of flunitrazepam (Rohypnol), a benzodiazepine, as a prelude to the assault has been reported. Flunitrazepam readily dissolves, and once in solution, is colorless, odorless, and tasteless. The predominant clinical manifestations are drowsiness, impaired motor skills, and anterograde amnesia. Due to the amnestic effects of flunitrazepam, historical clues of the rape event are difficult to obtain. Patients with a complaint of sexual assault who appear intoxicated or have anterograde amnesia should be suspected of unknowingly ingesting flunitrazepam. In addition to adhering to standard rape protocols, a urine specimen should be analyzed for flunitrazepam metabolites using gas chromatography/mass spectrometry. If the hospital, local, or forensic laboratory is unable to analyze for flunitrazepam, Hoffmann-La Roche Inc., the manufacturer of Rohypnol, should be contacted. Hoffmann—La Roche has a mechanism for definitive testing for flunitrazepam, at no cost, for health care providers, rape treatment centers, and law enforcement agencies. A network of organizations is attempting to reduce the abuse of flunitrazepam in association with date rape.     

Intracranial Hemorrhage Associated with Tangential Gunshot Wounds to the Head

Abstract. Tangential gunshot wounds (TGSWs) to the head are gunshot wounds in which the bullet or bullet fragments do not penetrate the inner table of the skull. Objectives: To determine the occurrence of intracranial hemorrhage (ICH) associated with TGSW to the head and to assess the ability of selected clinical criteria to predict ICH in this patient population. Methods : A retrospective chart review of patients diagnosed as having TGSWs to the head presenting to the ED of Los Angeles County + University of Southern California Medical Center from October 1, 1993, to May 31, 1996. Results : Four hundred twenty patients with gunshot wounds to the head presented to the ED. CT confirmed the diagnosis of TGSWs in 154 patients (36.7%). Head CT of patients with TGSWs revealed 25 (16.2%) skull fractures and 37 (24.0%) ICHs. Fourteen (56.0%) skull fractures were depressed. Of patients with a CT-doc-umented TGSW to the head, 23 (16.1%) had a history of a loss of consciousness (LOC), 129 (84.3%) had a normal neurologic examination in the ED, 17 (11.1%) had a Glasgow Coma Scale score (GCS) < 15, and 75 (48.7%) had retained extracranial bullets or bullet fragments. Of all patients with TGSWs to the head, 113 had a GCS of 15 with no LOC and a normal neurologic examination, with 17 of these 113 patients (15.0%) having ICH. One patient died while hospitalized. Fifty-six (36.6%) patients were released home directly from the ED. Five clinical criteria (history of LOC, GCS < 15 on ED presentation, skull fracture, location of TGSW on the skull, and presence of extra-cranial bullet fragments) were examined to determine their ability to predict ICH. None of these criteria either alone or in combination were adequately predictive of ICH. Conclusion : In this series, 1 in 4 patients with a TGSW to the head had an ICH. All patients with TGSWs to the head should undergo head CT to rule out depressed skull fractures and ICH.     

Meir Gottesmann: An Ambassador for Residential Education and Care

In order to introduce readers to the work and writings of Meir Gottesmann, a selection of his ideas and excerpts from several of his books are presented. Two of the major foci of Meir's attention were the role and functioning of the madrich (housefather/child and youth care worker) in residential education and care, and the trend discernible internationally to move away from residential programs that are considered to be outmoded, misguided, excessively costly and necessarily damaging to children and youth. Meir's mission was to challenge these perspectives by offering an understanding of the important successes and lessons of Youth Aliyah, the Israeli immigrant youth organization, to which he devoted most of his working life.     

Drug treatment careers A conceptual framework and existing research findings

While outcomes for any single intervention are important to determine, the long-term evaluation of multiple, sequential interventions is at least equally important. One strategy for examining this process is that of the treatment career. A treatment careers perspective applies a longitudinal dynamic approach to identify and understand key factors influencing the development of, and transitions in the course of, drug dependence and its treatment.

After presenting an overview of the treatment careers perspective, this paper reviews and discusses relevant research issues and findings on treatment seeking, utilization and resistance, entry and reentry, engagement and retention, client treatment matching, and outcomes. Key findings include high resistance to entering treatment by many drug users, late development of treatment careers relative to addiction and criminal careers, short durations of most treatment episodes, cumulative and facilitative effects of treatment experiences, and beneficial effects of matching clients to treatment. The treatment careers perspective provides a useful framework within which findings on drug treatment can be better integrated and critical issues can be identified for further research, leading to a better understanding of drug dependence and its treatment.     

Rites of Passage: A Conversation on Becoming Adult

A renewed focus on rites of passage and particularly on the “coming of age” of adolescents is noticeable both within North America and beyond. In this article, three experienced youth workers engage in a conversation on a range of professional and research issues related to rites of passage and in the process try to come to grips with the meaning and significance of current youth and community trends. A dominant theme of the discussion is the need for adults to truly become and act as adults in order to assist young people to make a successful transition from childhood to adulthood.     

The epidemiology of alcohol consumption in Spain

This paper is a comprehensive review of the available information about alcohol consumption in Spain. Alcohol use is the most severe drug problem among both young people and adults; almost half the Spanish population drink daily, and more than a fourth drink a quantity of alcohol sufficient to cause health problems in the long term. The consumption of alcohol may be considered to be culturally rooted when compared with other drug use which follows a more recent epidemic pattern. For those who use other drugs, for example cannabis and cocaine, alcohol is commonly used in conjunction. Clearly the level of alcohol use and abuse is high in Spain and constitutes a severe public health and socioeconomic problem.     

A 12-year follow-up of a treated cocaine-dependent sample

The study examined long-term outcomes (mortality, substance use, mental health, employment, criminal involvement) among a cocaine-dependent sample. This 12-year follow-up study, conducted in 2002-2003, updates information obtained at intake and two face-to-face interviews conducted in 1990-1991 and 1991-1992 among 321 male cocaine-dependent veterans admitted to drug treatment in 1988-1989. At the 2002-2003 follow-up, 28 had died and 266 were interviewed. A mixed model examining the longitudinal relationships demonstrated that treatment was associated with lower levels of cocaine use over the 12-year follow-up period after entry into the index treatment and more stable recovery (i.e., continuously abstinent from cocaine for at least 5 years). Few measures at intake predicted stable recovery at follow-up: only being White (vs. being African American) and having greater confidence in ability to avoid cocaine use in high-risk situations. Individuals achieving stable recovery reported less psychiatric symptoms, criminal involvement, and unemployment during the year prior to the interview. Adverse outcomes were apparent for a significant number of cocaine-dependent users who continued to use cocaine for a long period.