OBJECTIVES:To elaborate a state-of-the-art list of alcohol-related fatal medical conditions for future social-cost studies in Western societies.METHODS:Three major social-cost studies were compared with regard to their respective section on fatal health effects attributable to long-term as well as short-term use of alcohol. On discordant conditions, a systematic literature search was conducted in the Medline and ETOH databases.RESULTS:There is no consensus between social-cost studies with respect to alcohol-related causes of mortality. Based on the recent epidemiological evidence on alcohol and health, this paper suggests an up-to-date list of fatal medical conditions for which the causal relationship has been established with sufficient scientific evidence. A further investigation is needed, however, to reestimate relative risks by meta-analysis.CONCLUSIONS:Evaluating new epidemiological evidence regularly is necessary for the purpose of up-to-date social-cost studies.
Peer pressure is consistently implicated in the excessive drinking of college students. However, both theory and empirical findings suggest that peer pressure is a combination of three distinct influences: overt offers of alcohol, modeling, and social norms. Overt offers of alcohol can range from polite gestures to intense goading or commands to drink. Modeling occurs when the student's behavior corresponds to another student's concurrent drinking behavior. Perceived social norms can serve to make excessive alcohol use appear common and acceptable to the student. This review critically examines the literature on each form of peer influence and provides suggestions for future research.
We examined substance use in relationship to transmission risk behavior (unprotected insertive, UIAI, or receptive anal intercourse, URAI) between HIV-positive men who have sex with men (MSM) and their HIV-negative or unknown serostatus partners. Men who engaged in transmission risk behavior with casual partners were more likely than men who did not engage in such behavior to have used various substances. Users of certain drugs were specifically less likely to use condoms with HIV-negative or unknown status partners than users. Of men who drank alcohol, those who drank more frequently before or during sex engaged in significantly more UIAI with casual partners. Of men who used drugs, those who used more frequently before or during sex were more likely to engage in URAI with casual partners. In multivariate analyses, use of inhalants as well as drinking before or during sex predicted UIAI, while use of inhalants as well as noninjection drug use before or during sex predicted URAI. HIV prevention programs for HIV-positive MSM should focus on decreasing substance use and use specifically before or during sex. Developing prevention programs for substance-using MSM is critical to improve community health and decrease HIV transmissions.
Purpose: We examined the population demographics and club drugs used in gay circuit parties and estimated the reported unsafe sexual behavior associated with each drug, the reasons for attending circuit parties, and the unsafe sex associated with different reasons. Methods: A brief questionnaire was provided to a nonrandom sample of party attendees covering demographics, drugs used, sexual activity, and reasons for attending gay circuit parties at three major North American parties in 1998–1999. A total of 1169 usable questionnaires were obtained. Odds ratios for unsafe sex for the drugs surveyed [alcohol, marijuana, methylenedioxymethamphetamine (Ecstasy), ketamine (Special K), crystal methamphetamine (crystal meth), cocaine, volatile nitrites (poppers), and γ-hydroxybutyrate (GHB)] were calculated, as was significance of unsafe sex for the 10 major reasons for attending parties. Results: 12-month party drug use was high: >50% reported using alcohol, Ecstasy, and Special K. Frequent (rather than occasional) use of Ecstasy, Special K, and poppers had an association with unsafe sex at parties. Poppers also showed a statistically significant association with unsafe sex in 12 months (not necessarily at parties) while crystal meth and GHB showed a trend. Attending circuit parties "to look and feel good," "to have sex," and "to be uninhibited and wild" were associated with higher levels of unsafe sex in 12 months. Implications: In this sample, circuit party attendees are well educated and financially secure. Party drug use is high. It appears that use of poppers, Ecstasy, Special K, crystal meth, and GHB are associated with various measures of unsafe sex. More comprehensive research on club drug use in gay men is required.
Purpose: To examine heroin use and associated morbidity in young adults undergoing drug detoxification. Methods: A retrospective chart review of all persons (ages 18–25) admitted to either of the two state-funded detoxification facilities in Rhode Island was conducted between June 1998 and June 1999. Only those reporting heroin as a primary drug were included in this study (N=201). Results: Clients were largely male (64%), and white (79%), with a mean age of 22. Of those that reported heroin as their primary drug, 62% used primarily by injection. Mean age of initiation for heroin use was 18.3 years. Twenty-two percent reported a psychiatric diagnosis, and 80% reported a substance-abusing family member. Injection, previous overdose, and a mother with a history of substance use were associated with early initiation of heroin use. Conclusions: The majority of young adults with heroin addiction undergoing detoxification began using heroin during late adolescence. Cooccurrence of psychiatric and medical diagnoses with heroin addiction was common, and may contribute to the severity of drug use. Efforts to identify risk factors for heroin and other injection drug use in adolescents and young adults will be critical for the design of effective interventions to prevent injection drug use and its associated morbidities.
Purpose: A common criticism of designated driver programs (DDPs) is that they promote excessive drinking among companions of the designated driver (DD). Methods: Data were collected from two representative samples of drinkers using computer-assisted telephone interviews (CATIs), and questionnaires administered to customers in barrooms. Results: Most respondents drank moderately—had usual estimated blood alcohol concentrations (BACs) of less than 0.10 when they used DDs. Differences between respondents' estimated BACs when they used a DD and when they drank outside their homes were very small: 0.017 in both samples. Additional analyses examined shifts between lower and higher categories of risk defined as a BAC of less than 0.10 and a BAC of 0.10 or greater. A minority, 15% of CATI and 30% of barroom respondents, switched to the higher risk category when using a DD. These CATI and barroom respondents increased their BACs by an average of 0.089 and 0.11, respectively. Risk associated with this increase was mitigated, however, by respondents' infrequent use of DDs. Implications: Use of DDs was not generally associated with excessive alcohol consumption. Since a minority of respondents did drink heavily when using a DD, programs promoting DD use should caution drinkers that the availability of a DD is not an excuse for excessive consumption, and remind hosts and servers that they should not overserve their guests or customers even when they have a DD.
PURPOSE:We examined rural-urban differences in cumulative risk for youth substance use. A recent report [National Center on Addiction and Substance Abuse (CASA) 2000] found that the rural-urban distribution of substance use and known risk factors for substance use differed; in many cases rural youth showed higher levels of use, as well as higher levels of risk factors. The current investigation, while not directly examining substance use, further examined rural-urban differences in the distribution of risk factors for youth substance use, based on information from parent reports. METHOD:Study 1 data were collected from a random sample of Midwestern parents (n = 339) with a young adolescent between the ages of 11 and 13 years. Study 2 data were collected from a second sample of Midwestern parents (n = 593). RESULTS:Analyses of rural-urban comparisons demonstrated higher levels of cumulative risk among rural youth. An evaluation of the sensitivity of the analysis to rural-urban classification schemes indicated that the findings were robust, but that there was some minor variation in rural-urban differences by classification scheme. IMPLICATIONS:Results contribute to an explanation of findings from earlier reports of rural-urban differences in substance use, and suggest directions for future research on rural-urban distributions of youth risk factors.
Purpose: This cross-sectional study investigated the predictors for and patterns of health care utilization among young adult injection drug users (IDUs). Methods: The subjects were 206 IDUs, ages 18-29, who were street-recruited from Harlem, New York. Participants were interviewed about their drug use, health conditions, and use of services such as health care, needle exchange programs (NEPs), and drug treatment in the preceding 6 months. Data were analyzed using logistic regression. Results: Health insurance was associated with use of health care both among NEP users [AOR (adjusted odds ratio) 10.66] and non-NEP users (AOR 2.45). Use of health care was independently associated with drug treatment (AOR 2.58), being gay/bisexual (AOR 3.86), and negatively associated with injecting cocaine (AOR 0.56). Half the participants (49%) had used health care in the previous 6 months: 48% were uninsured. Many participants who did not use health services reported a condition that would have warranted medical care. Implications: Health insurance was strongly associated with use of health care, particularly among those who attend NEPs. Young adult IDUs may benefit from increased efforts to help them arrange and maintain health insurance coverage, potentially at NEPs. NEPs may be connecting young IDUs with health insurance to medical care through referrals. (C) 2001 Elsevier Science Inc. All rights reserved.
PURPOSE:The Columbia University HIV Mental Health Training Project, created to improve the mental health workforce's AIDS preparedness in New York and neighboring states, sought to compare the perceived HIV-related needs and capacities of mental health care providers in settings where clients with substance use disorders predominated versus those where clients with substance use disorders were the minority of the agencies' caseload.METHODS:The first consecutive 67 mental health care agencies that requested HIV/AIDS training between March 2000 and January 2001 completed a written needs assessment describing their HIV-related services and training needs.RESULTS:Agencies with higher substance abuse caseloads were significantly more likely than others to have large HIV/AIDS caseloads, to be currently providing condoms to clients, and to rate staff comfort with sexual identity issues as well as drug-related issues as good. Overall, agencies that had received previous training in specific topic areas (e.g., HIV risk assessment) were significantly more likely than others to provide those services. Even so, in all settings, significant gaps in service provision were found.IMPLICATIONS:Two decades into the AIDS epidemic, mental health care agencies, especially those treating smaller caseloads of patients with substance use disorders, may not be providing sufficient services to meet their clients' HIV-related needs.
Purpose: The purpose of this study was to examine the degree to which psychosocial functioning and social relationships changed during the first 3 months of treatment among women in a residential substance abuse program that emphasizes the importance of developing healthy relationships. Methods: Participants included 77 female clients admitted to the Salvation Army First Choice (FC) Program in Fort Worth, TX. Assessments of psychological functioning, family relations, and peer relations were administered at treatment entry and again after 3 months. Relationships with clients in treatment and friends outside treatment were measured separately. Results: Repeated-measures analyses of variance (ANOVA) indicated that interpersonal relationships improved. Family networks increased, family cohesion increased, and family conflict decreased. Peer networks changed as well, due in part to new relationships with other clients in treatment. The number of drug-using friends decreased, peer deviance and negative influence decreased, and social conformity among friends increased. There was a corresponding improvement in psychosocial functioning. Implications: Results suggested that relationship-centered treatment for women was effective. Clients reestablished connections with family members, disassociated from drug-using peers, and improved the quality of relationships with family members and friends. Further research is needed in order to examine the influence of specific treatment components and the potential long-term effects of changes in women's relationships.
Purpose: To investigate among children of opiate addicts a potential protective effect of religiousness (broadly defined in the literature to include religious beliefs, practice, and tradition) against onset of substance use. Methods: Subjects were 161 opiate-addicted biological parents recruited from methadone maintenance programs in the New York metropolitan area, their 279 children, and 63 non-opiate-addicted parents with whom the child had daily contact. Childhood onset of substance use was assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (K-SADS); parental DSM-III-R diagnosis of opiate addiction was assessed using the SADS-Lifetime Version (SADS-L). Results: Religiousness in children of opiate addicts was associated with a substantially decreased likelihood of onset of substance use. Parent-child concordance of religiousness showed additional protective qualities with respect to religious denomination in opiate-addicted parent and with respect to the personal importance of religion and frequent attendance of religious services in non-opiate-addicted parents. Conclusion: Religiousness protects against substance use among children of opiate addicts. (C) 2001 Elsevier Science Inc. All rights reserved.
PurposeWe assessed the use of HIV care among HIV-seropositive crack cocaine smokers and other active drug users in Miami-Dade County, FL. Methods Personal interviews were conducted with 327 adults recruited from inner city neighborhoods. Cross-tabulations and logistic modeling were used to analyze the relationship between selected variables and use of HIV care. Results One-third of respondents had not seen a provider for HIV-related health care in the past 12 months. Among those who had seen a provider, only 33.8% were receiving highly active antiretroviral therapy (HAART). Factors associated with utilization of HIV-related health care were age, race, having a usual source of care, health insurance, time elapsed since time of diagnosis, and reports of moderate to extreme interference of pain with daily activities. Implications These findings suggest the need to develop, implement, and evaluate intervention strategies to improve use of HIV medical care among active drug users.
OBJECTIVE:We sought to identify risk factors for needle sharing and HIV infection among injecting drug users (IDUs) in Ho Chi Minh City (HCMC), Vietnam.METHODS:Three cross-sectional surveys among IDUs, both on the street (in 11 urban districts) and in the rehabilitation center for IDUs in HCMC, were carried out in April of 1995, 1997, and 1998. Outreach workers interviewed IDUs about socio-demographic characteristics, drug use and sexual practices, and HIV knowledge and perceptions. The IDUs were also tested for seropositivity to HIV. Independent predictors for HIV positivity and needle sharing were determined by univariate and multivariate logistic regression for the study sample within the rehabilitation center in 1997 and for that on the street in 1998.RESULTS:The HIV prevalence in 1998 among IDUs was 44% for those on the street and 38.5% for those in the rehabilitation center. Independent predictors for HIV infection in IDUs were being injected by drug dealers (for the 1997 sample), injecting on the street, and sharing the drug pots (for the 1998 sample). The reported rate of needle sharing was low and decreased significantly from 20% in 1995 to 12% in 1998 for the sample of IDUs at the street. In the multivariate analysis, predictors for needle sharing for both study samples were injecting on the street, injecting at shooting galleries, and having shared needles in the past. Adequate and easy access to sterile needles and syringes, and a supportive environment of behavior change, especially in street and shooting gallery could reduce risks of virus transmission in the Vietnamese IDU community.
Purpose: The purpose of this study was to examine the relationship between age at drinking onset and the development of DSM-IV alcohol abuse and dependence in a 12-year prospective study of youth in the United States. Methods: Logistic regression analyses were used to quantify the relationship between age at drinking onset and the development of alcohol abuse and dependence controlling for sociodemographic factors and problem indicators. Results: The odds of alcohol dependence decreased by 5% in 1989 and 9.0% in 1994 for each year drinking onset was delayed. In 1994, the odds of alcohol abuse increased by 7.0% with each decreasing year of age at drinking onset, while age at drinking onset was not related to alcohol abuse in 1989. Several other risk factors were found to be strong and consistent predictors of abuse and dependence in 1989 and 1994, including being male, divorced, separated or never married, younger, and having an early history antisocial behaviors and marijuana use. Implications: Implications of the results of this study are discussed in terms of other factors that may impact on the onset-abuse and onset-dependence relationship and the need to focus future prevention efforts.
Purpose: This study examined the role of impression management in cigarette smoking by linking the constructs of self-monitoring, perceived success in impression management, self-esteem and social anxiety among nonsmokers (NS), occasional smokers (OS), and frequent smokers (FS). Methods: High school students (N = 243) in years 8-12 completed a questionnaire assessing the above-mentioned variables. Multivariate discriminant function analysis and a priori contrasts were used to analyze the data. Results: In comparison to OS, ITS and NS had the lowest levels of self-monitoring, perceived success in impression management and self-esteem, while having the highest levels of social anxiety. Implications: Cigarette use may serve an impression management function during adolescence and subsequently influences OS' level of smoking. Intervention programs need to give greater consideration to providing adolescents with alternative strategies for both social acceptance and the acquisition and maintenance of self-esteem. (C) 2001 Elsevier Science Inc. All rights reserved.
Purpose: In this paper, we develop and test a model for predicting sexual risk for HIV and other STDs. Methods: Researchers interviewed 528 women and men with a history of substance abuse about their past experiences of physical and sexual abuse, symptoms, and sexual risk behavior (number of partners, trading sex for drugs or money, unprotected intercourse, and sexual orientation). The model explores direct and indirect associations of physical abuse and sexual abuse with sexual risk. Results: Depression and severity of problems with drugs and alcohol were expected to mediate associations between abuse and sexual risk. However, analyses did not substantiate any indirect effects. Being female, more severe drug problems and, among men, past sexual abuse were significant predictors of sexual risk. Conclusion: Prevention interventions would do well to address not only drug addiction, but also past sexual abuse in men and depression in women.
Purpose: To explore the associations between violent and other crimes, and alcohol intoxication and recent use of cocaine, marijuana, and other drugs among men and women arrestees and examine gender differences in these relationships. Methods: We conducted a secondary analysis of 1998 using Arrestee Drug Abuse Monitoring (ADAM) system data using a sample of 9242 male and 2594 women arrested for violent and property offenses in 35 cities. Logistic regression was used to predict arrest for a violent offense (rather than a property crime) from drug- and alcohol-related, and other variables. Results: Both gender and alcohol intoxication are significantly related to arrest for a violent offense. However, the intoxication effects (in the absence of cocaine) are more than three times as great for female (Exp(beta) = 5.59) as male arrestees (Exp(beta) = 1.74), while the combined effects of alcohol and cocaine predict a property offense for women but are insignificant for men. Implications: To achieve further reductions in violent crime, intervention strategies need to focus on reducing alcohol intoxication as well as illicit drug use. Research on the role of alcohol on women's aggression and violence also is suggested. (C) 2001 Elsevier Science Inc. All rights reserved.
Purpose: Recently we found that the early onset of regular tobacco use is as predictive of lifetime drug use and depressive disorders as it is of alcohol use disorders [Alcohol.: Clin. Exp. Res. 23 (1999) 513.]. This finding, which paralleled findings regarding early onset of alcohol use [J. Subst. Abuse 10 (1998) 59.], suggested that early regular use of any drug might simply be an indicator of risk for a constellation of problem behaviors. The purpose of the present study is to test this hypothesis as well as to study the strength and patterns of associations among these problem behaviors already present among youth. The results will permit description of more precise profiles to identify groups of children at risk. Methods: Using data for respondents aged 12-16 from the Third National Health and Nutrition Examination Survey (NHANES III), descriptive statistics were calculated and logistic regression models were estimated. Results: Descriptive analyses indicated that in comparison with those who never smoked, or who simply experimented, early-onset regular smokers, both those who began at age 13 or younger and those who did so between 14 and 16, were those most likely to use alcohol and other drugs as well as have school problems and early sexual experiences culminating in pregnancy. Multivariate logistic regression analyses were conducted to assess the associations among these high-risk behaviors. Implications: These results support the hypothesis that early onset of smoking is but an indicator of a syndrome of problem behaviors already in place during childhood. They also suggest that the significance of an age onset variable may differ depending on the age of the sample used. As follow-up data are collected, we expect to learn much about the natural course of the distinct risk groups identified in the analyses by studying longitudinally this nationally representative group of early adolescents. (C) 2001 Elsevier Science Inc. All rights reserved.
PURPOSE:This study describes the course of alcohol abuse among a nationally representative sample of young adults over a 5-year time period for the purpose of examining the validity of the DSM-IV alcohol abuse category.METHODS:DSM-IV diagnoses of alcohol abuse at baseline and follow-up were examined using logistic regression analyses.RESULTS:Alcohol abuse and dependence were shown to have different courses. Very few abusers at Time 1 became dependent at Time 2, suggesting that abuse is not merely prodromal to dependence. Females, Blacks, and high school dropouts were less likely to receive an abuse diagnosis at baseline. Marital status, family history, earlier onset of drinking, and heavy drinking were also related to abuse at baseline. Alcohol abuse at baseline, in addition to gender, marital status, family history, early onset drinking, and heavy drinking, predicted abuse at follow-up. Exclusion of the hazardous criterion item "driving after drinking too much" from the abuse diagnosis yielded similar results.DISCUSSION:The DSM-IV alcohol abuse category was shown to have some diagnostic utility.
Purpose: While many youths residing at homeless shelters will return home, many are placed in group or foster homes. Few researchers have examined the experiences of adolescents with a history of these out-of-home placements. This study examined shelter residents and compared the experiences of system and non-system youth. Methods: Information regarding youths' family functioning, substance use, depression and related problem behaviors was obtained from substance abusing system (n=62) and non-system (n=82) adolescents staying at local runaway shelters. Results: System males engaged in significantly more delinquent behaviors than did non-system males and system females. Alcohol and drug problem consequences were positively associated with longevity in the system, while having ever attempted suicide was negatively associated with system longevity. System youth reported: 1) taking more prescribed psychotropic medications 2) experiencing more sexual abuse, and 3) less parental overprotection, as compared to non-system youth. Gender differences were found in which females reported more conflictual problem solving interactions with their parents than did males, as well as more comorbid diagnoses. Implications: Although longitudinal research is needed, findings argue that without intervention efforts targeted at identified problem behaviors, youth are at risk to continue their system involvement into adulthood.
