The Ethnographic Accessing,Sampling and Screening of Hidden Populations: Heroin Sniffers in New York City

This article discusses various ways in which ethnographic methods were employed in a cohort study of HIV risk and transitions to injecting among non-injecting heroin users (NIUs), or ‘sniffers’, in New York City. In preparation for and in conjunction with an epidemiologic questionnaire survey and biological specimen collection, ethnographic methods were used to explore the meaning of non-injecting and injecting routes of heroin administration for NIUs, how non-injecting heroin use was imbedded in the everyday life of the user, and the relationship of users to the retail markets for heroin. The study utilised different ethnographic techniques to access, sample, and screen heroin ‘sniffers’ for the epidemiologic survey. These techniques included ethnographic accessing, targeted canvassing, and interactive screening. The article concludes that ethnographic methods can be fruitfully integrated with epidemiologic survey research and are necessary for conducting research among non-institutionalised, ‘hidden’ populations of drug users.     

The structure of positive alcohol expectancies in alcohol-dependent inpatients

Alcohol expectancies, i.e. the immediate effects of alcohol anticipated by an individual, have been shown to predict initiation of drinking during adolescence as well as transition from nonproblem to problem drinking. Moreover, cross-sectional studies have revealed that alcohol expectancies are related to both frequency and quantity of alcohol use. However, research has focused almost exclusively on nonclinical samples. While numerous studies have examined alcohol expectancies in college samples, little is known about the expectancies of alcohol-dependent individuals. The present study aimed to expand the research on alcohol expectancies by establishing the factor structure of the Alcohol Expectancy Questionnaire (AEQ), the most frequently used expectancy scale, in a large sample of alcoholism treatment clients (N = 685). Furthermore, gender differences and the relationship between expectancies and alcohol consumption were examined. Exploratory factor analysis identified two dimensions of alcohol expectancies. Factor one represented alcohol expectancies regarding social assertiveness, self-confidence, and mood management. With two exceptions all items loading on the second factor described alcohol-induced enhancement of sexual feelings. Comparing the findings of the present study with the results of previous expectancy research based on the responses of college students and other nonclinical samples revealed that these factors appear to be relatively uniform across studies. However, item statistics suggested that the structure derived from factor analysis may have been influenced by rate of endorsement. Women scored lower on factor one and the total score than men. Inclusion of the total score in regression analysis added to the prediction of alcohol consumption. The present results suggest that the findings of previous research should be interpreted with caution, since AEQ scores are not comparable across groups.     

Excessive Exercise as an Addiction: A Review

Theories regarding how exercise can become addictive, and studies of withdrawal from exercise are reviewed. Several phsiological mechanisms, including endogenous opioids, catecholamines, and dopamine pathways, have been implicated in exercise dependence. The higher levels of endogenous opioids found following strenuous exercise, has prompted researchers to suggest that a form of auto-addiction to these hormones might be responsible for continued excessive exercising in humans. As well, investigators have suggested that, exericise dependence could be the result of a dependence on the exercise stimulated release of catecholamines, resulting in an over-arousal of the sympathetic nervous system. Moreover, the increased stimulation of dopaminergic brain structures by exercise, and the likely involvement of these structures in behavioural and pharmacological addictions, could provide another explanation for exercise-dependent behaviour. Finally, reports of withdrawal symptoms following cessation of regular exercise, has led investigators to propose that exercise can, like pharmacological and other behavioural stimuli, become addictive.     

"Crack,Cocaine and Heroin: Drug Eras in Williamsburg,Brooklyn, 1960-2000"

This article traces the development of crack markets in Williamsburg, Brooklyn in the period 1980-2000. It seeks to explain why crack appeared so late on the scene there and why, when it did, its markets were different from those found in many other neighborhoods. The article is based upon more than 20 years of ethnographic observations in Williamsburg and adjacent neighborhoods, and upon in-depth interviews with drug distributors, users and neighborhood residents. While other areas had their own patterns, the crack scene in Williamsburg was especially affected by the heroin-and-cocaine era that preceded it. A full understanding of both of these eras - the heroin-and-cocaine era of the 1970s and early 1980s and the crack era of the late 1980s and early 1990s - requires an accounting of how local, regional, national and international forces intersect to produce different market structures and different drug "epidemics" and outcomes. This work demonstrates how local-level changes in consumer demand for a variety of drugs, evolving patterns of use, and the locally specific community structure affect the social organization of drug distribution and have a historical dynamic that both precedes and determines the story of any single drug in any locale.     

Accidental Fatalities Among Heroin Users in South Australia, 1994-1997: Toxicological Findings and Circumstances of Death

A total of 101 accidental deaths were identified among heroin users in South Australia for the period 1994-1997. Mean age at death was 29.9 years. Cases typically involved a single, unemployed, Caucasian male in his late twenties with a history of heroin and other drug use. Two or more drug types were detected in 80% of cases. The total number of substance types identified increased significantly with age. In comparison to younger fatalities, alcohol and benzodiazepines were identified in more of those 27 years of age and over. Thirteen deaths occurred within four weeks of release from prison and in nine cases tricyclic anti-depressants were found. The majority of deaths occurred in a private home and in the presence (or near proximity) of others. Identified risk factors included: being male; being a long-term heroin user; recent release from prison; use of tricyclic antidepressants and/or other central nervous system depressants.     

海洛因依赖者血清中辅助性T细胞因子的表达水平及其临床意义

目的研究海洛因依赖者血清中辅助性T细胞1（Th1）／Th2类细胞因子的表达水平,进而对海洛因依赖者的免疫状况进行评价。方法选择2012年7月至2013年6月于温州市三蝉强制隔离戒毒所收容的50例海洛因依赖者作为海洛因依赖组,选择同期于我院行健康体检的50例正常人作为正常对照组。采取放射免疫法检测2组受试对象血清中白细胞介素2（IL-2）、γ干扰素（IFN-γ）、肿瘤坏死因子α（TNF-α）、TNF-β、IL-4、IL-6、IL-8、IL-10和IL-17的表达水平。结果海洛因依赖组血清中Thl细胞因子IL-2、IFN-γTNF—α和TNF-β水平均明显低于正常对照组[分别为（1184-38）ng／L比（249±76）ng/L、（2634±78）ng/L比（492±154）ng／L、（103±22）ng/L比（121±23）ng／L、（72±26）ng／L比（118±34）ng／L],差异均有统计学意义（t=3．154,t=4．518,t=2．459,t=3．089,均P〈0．05）;Th2细胞因子IL-4、IL-6、IL-8、IL-10和IL—17的表达水平均明显高于正常对照组[分别为（252±72）ng/L比（124±32）ng／L、（4．4±1．6）ng/L比（2．8士1．0）ng／L、（409±112）ng／L比（214±67）ng／L、（12．14±3．4）ng／L比（8．2±2．0）ng/L、（1644±50）ng／L比（954-28）ng／L],差异均有统计学意义（t=3．157,f=2．589,t=3．872,t=2．711,t=3．255,均P〈0．05）。结论海洛因依赖者血清中Th1／Th2类细胞因子水平较正常对照严重失衡,提示其免疫功能较差,易获得外界感染,需给予足够重视。     

Heroin Maintenance: The Issues

Abstract

This article aims to assess the influence of the need to inject and drug withdrawal on drug injectors' perceptions of human immunodeficiency virus (HIV) risk behavior inside and outside prison. Complementary qualitative research methods were used with 24 drug injectors in England. It was found that when sterile injecting equipment was unavailable the need to inject and drug withdrawal were important factors on the reported readiness to share injecting equipment. This finding was broadly consistent both outside and inside prison. However, different patterns of responses between these two environments were influenced by the social context in which HIV risk was considered. These perceptions of HIV risk are situationally specific, but the influence of the need for a drug injection and drug withdrawal on HIV risk behavior transcends social settings. Thus, HIV risk reduction strategies should be consistent outside and inside prison.     

A Case of Treating Cathinone Dependence and Comorbid Depression Using Bupropion

Abstract

Cathinone is a potent CNS stimulant found in khat leaves. Cathinone and synthetic cathinone-derivatives have become popular recreational drugs in recent years, commonly marketed as “legal highs.” In addition to acute physical and psychiatric adverse effects, dependence on these substances is a concern. The following case reports describes a young man with cathinone dependence and depression that was treated using bupropion. Bupropion is a cathinone-derivative with a dual dopamine-norepinephrine reuptake inhibiting mechanism, which is approved for the treatment of depression and smoking cessation. Clinical awareness to the addictive potential of cathinone and cathinone-derivatives is important. Research regarding the potential effectiveness of bupropion in these cases is needed.