Resident physician substance use, by specialty.

OBJECTIVE: This study compares substance use by medical specialty among resident physicians. METHOD: The authors estimated the prevalence of substance use of 11 medical specialties from a national sample of 1,754 U.S. resident physicians. RESULTS: Emergency medicine and psychiatry residents showed higher rates of substance use than residents in other specialties. Emergency medicine residents reported more current use of cocaine and marijuana, and psychiatry residents reported more current use of benzodiazepines and marijuana. Contrary to recent concerns, anesthesiology residents did not have high rates of substance use. Family/general practice, internal medicine, and obstetrics/gynecology were not among the higher or lower use groups for most substances. Surgeons had lower rates of substance use except for alcohol. Pediatric and pathology residents were least likely to be substance users. CONCLUSIONS: The authors' previous research indicates that residents overall have lower rates of substance use than their age peers in society. Yet resident substance use patterns do differ by specialty. Residents in some specialties are more likely to use specific classes of drugs, to use a greater number of drug classes, and to be daily users of alcohol or cigarettes.

Adolescent drug using groups in Chicago parks.

In a northern Chicago neighborhood, observational and interview data were collected at parks, school lots, and beaches where adolescents congregate to buy, sell, and use nonopiate drugs. These sites were geographically distinct from areas where heroin is regularly distributed. Users at each area generally resided in the immediate neighborhood, were well known to one another, were predominantly male, displayed similar socioeconomic, religious and ethnic backgrounds, and had attended the same grade schools and high schools. These sites were relatively stable during the summer months, although visitors occasionally changed locations in response to police harassment. Attendance fluctuated with weather and time of day. Drug use was generally confined to the daily use of marihuana and weekend use of alcohol and sedative-hypnotics, but availability seemed to determine the type and frequency of drug use to a greater extent than drug perference. This study suggests the potential of a fieldwork model for prevention and intervention activities prior to the onset of more intense and diversified drug use.

PAR Village for chemically dependent women. Philosophy and program elements.

The authors present a description of PAR Village, a demonstration project designed to examine the question of whether mothers in residential treatment accompanied by their children have better outcomes than those who enter treatment without their children. Issues related to the treatment of women in substance abuse programs are discussed as an introduction to the structure and purposes of the program. Details of the setting, client selection process, and program philosophy are provided. The workings of program services and treatment elements are described and illustrated by a case example.

Changes in personality characteristics in women treated in a therapeutic community.

We examined changes in mood and personality characteristics in a sample of cocaine-dependent women being treated in a therapeutic community (TC). Forty-six women completed the Beck Depression Inventory (BDI), the Hamilton Anxiety Scale (HAM-A), and the Millon Clinical Multiaxial Inventory-II (MCMI-II) on admission and 12 months after discharge from the TC. On admission, the group was characterized by clinically significant scores on the BDI, HAM-A, and the MCMI-II Avoidant, Dependent, Antisocial, Passive-aggressive, Self-defeating, and Borderline scales. On follow-up, significant improvement in functioning was suggested by decreases in scale scores on the BDI, HAM-A, and MCMI-II Avoidant, Dependent, Self-Defeating, and Borderline Scales, but not for the MCMI-II Antisocial and Passive-Aggressive scales. These results suggest substantial positive effects of TC treatment on personality characteristics and functioning, but also indicate that TC treatment may not habilitate all critical personality deficits.

Early lymphocyte trapping in malaria infections: a particulate antigen mediated phenomenon.

During the course of rodent malaria a marked decrease in the numbers of circulating lymphocytes within the peripheral blood occurred 2-4 days post-infection. Monocytes and polymorphs did not show the same degree of decline. For both avirulent Plasmodium yoelii and lethal Plasmodium berghei infections lymphocyte numbers returned to control levels by day 6-8 post-infection. While these levels were maintained until clearance of P. yoelii infection, a sustained and abnormal increase occurred during P. berghei infection. Early lymphocyte depletion was also observed following Babesia microti and Plasmodium vinckei petteri infections, and could be induced by freeze-thawed P. yoelii infected blood and its particulate, but not soluble, fraction. Corynebacterium parvum and sheep red blood cells had no depressant effect on peripheral blood lymphocyte counts. Cell trapping experiments indicated that peripheral blood lymphocytes were preferentially recruited to the spleen in the initial stages of infection. Cell surface marker tests showed that the major cell type involved was Thy-1.2+ T-lymphocytes.

Physician substance use by medical specialty.

Self-reported past year use of alcohol, tobacco, marijuana, cocaine, and two controlled prescription substances (opiates, benzodiazepines); and self-reported lifetime substance abuse or dependence was estimated and compared for 12 specialties among 5,426 physicians participating in an anonymous mailed survey. Logistic regression models controlled for demographic and other characteristics that might explain observed specialty differences. Emergency medicine physicians used more illicit drugs. Psychiatrists used more benzodiazepines. Comparatively, pediatricians had overall low rates of use, as did surgeons, except for tobacco smoking. Anesthesiologists had higher use only for major opiates. Self-reported substance abuse and dependence were at highest levels among psychiatrists and emergency physicians, and lowest among surgeons. With evidence from studies such as this one, a specialty can organize prevention programs to address patterns of substance use specific to that specialty, the specialty characteristics of its members, and their unique practice environments that may contribute risk of substance abuse and dependence.

Heroin epidemics revisited.

This paper reviewed heroin use data from the US government's epidemiologic monitoring system for substance abuse. The monitoring system has multiple components, i.e., the Drug Abuse Warning Network of reporting emergency rooms (9), annual surveys of high school and post-high school youth (3, 4), annual National Household Surveys of Substance Abuse (7, 8, 50), Drug Use Forecasting (51), the Community Epidemiology Work Group (52), and law enforcement systems not reviewed here. These monitoring systems should identify any major increase in heroin incidence in this country relatively early. This is important, because the early stages of heroin epidemics are often hidden from society, and the epidemics are already full-blown by the time health and other agencies become aware of the size of the affected population and are required to respond. The hidden or underground nature of heroin epidemics is caused by 1) the need of each user to hide an illegal activity and 2) the delay between the time when heroin is first used and the onset of physical dependence and other adverse consequences, which bring new heroin addicts to the attention of treatment and enforcement systems. Despite an epidemiologic surveillance system which should rapidly identify large-scale heroin spread in this country, our treatment and law enforcement systems are not organized to respond rapidly to contain an epidemic. Substance abuse treatment services are not structured for rapid expansion and contraction based on fluctuating need. Apart from HIV prevention programs, we do not have outreach teams attached to treatment programs that could quickly identify local outbreaks and involve new heroin abusers in treatment (10).(ABSTRACT TRUNCATED AT 250 WORDS)

The dynamics of heroin spread in endemic neighborhoods.

To explore the social dynamics of heroin spread in endemic neighborhoods, a research team conducted interviews with active addicts in two inner-city black neighborhoods in Chicago. Unlike epidemic neighborhoods in which heroin often spreads outward from only a few new users to other members of a friendship group, we found that in these "old dope" neighborhoods there were multiple initiators and multiple, discrete heroin outbreaks not connected with one another. Furthermore, the majority of initiators did not appear to be in the experimental stage but were chronic addicts who ranged in age from their early twenties to middle age. These findings suggest that in endemic neighborhoods, where heroin is continuously available and there are multiple addict initiators, treatment outreach efforts directed only at new, young users would be unlikely to halt further heroin spread. To effectively reduce incidence and prevalence of heroin addiction, it may be necessary to eliminate the entire neighborhood copping area--chronic addicts as well as new addicts--a much more formidable task for a community addiction-control program.

Substance use by surgical residents and students entering surgery.

We studied the use of alcohol, tobacco, and nine unprescribed or illegal substances by surgical residents and medical students accepted into surgical programs. With the exception of alcohol, surgical residents had less lifetime experience and used less than other residents or nonmedical college graduates. Students entering surgery had used these substances more frequently and were more likely to be using them regularly than were residents. Residency directors need to be aware of the change in attitude and use patterns of present residents as compared with those of the past.

Opium use in two communities of Pakistan ---a preliminary comparison of rural and urban patterns.

Interviews were conducted to clarify drug use patterns and characteristics of opium users in two communities. Because of the small number of subjects selected from only two communities, the results are not representative of the country as a whole. Nevertheless, in the city of Rawalpindi 90 users were studied and found to have a mean daily opium consumption of 0.9 grams at a cost of Rs. 1.00 ($US 0.10). Opium was taken by mouth once or twice daily. They were solitary users who first used opium as adults, most often for self-treatment of health disorders. The majority were employed males with no history of criminality. In the rural opium-producing village, 28 users were interviewed. They smoked opium three or four times a day in a social setting and reported a mean daily consumption of 11 grams. They were more likely to use the drug for its social and pleasure effects and to have addicts as close friends. The high dose was associated with adverse effects on work performance and with more severe withdrawal symptoms. The findings suggest different intervention strategies for the two populations.

Resident physician substance use in the United States.

A national survey was conducted to determine patterns of drug use among 3000 American resident physicians. Sixty percent (1785) of the residents surveyed responded. This report evaluates the prevalence of drug use among the respondents, when they initiated drug use, and their reasons for current use. Substance use rates are compared with other studies of resident physicians and with a sample of their nonphysician age peers surveyed the same year. Heavy substance use patterns were not observed among resident physicians. They had significantly lower rates of use for most psychoactive substances than their peers in the general population but did report higher rates of past-month use of alcohol and benzodiazepines. A sizable minority began using benzodiazepines and prescription opiates during their residency years-the stage in physicians' training when they first receive prescribing privileges. Current users of benzodiazepines and opiates used these drugs primarily for self-treatment rather than recreation. These two substances are often associated with impairment at later stages in the physician's career.

Substance use among senior medical students. A survey of 23 medical schools.

Senior students at 23 regionally distributed medical schools received an anonymous questionnaire designed to examine current and prior use of tobacco, alcohol, and nine other drugs. The overall response rate was 67% (N = 2046). Substance use prevalence rates during the 30 days preceding the survey included alcohol, 87.5%; marijuana, 10.0%; cigarettes, 10.0%; cocaine, 2.8%; tranquilizers, 2.3%; opiates other than heroin, 1.1%; psychedelics other than LSD (lysergic acid diethylamide), 0.6%; amphetamines, 0.3%; barbiturates, 0.2%; LSD, 0.1%; and heroin, 0.0%. Compared with national, age-related comparison groups, senior medical students reported less use of all substances during the past 30 days and the past 12 months, except for alcohol, tranquilizers, and psychedelics other than LSD. Substantial new drug use after entry into medical school was reported only for tranquilizers. Seven students (0.2%) admitted to current dependence on a substance other than tobacco, four of these implicating marijuana. Thirty-three students (1.6%) believed that they currently needed help for substance abuse. Only 25.7% were aware of any policy on substance abuse at their own school.