Association of MDMA/ecstasy and other substance use with self-reported sexually transmitted diseases among college-aged adults: a national study.

OBJECTIVES: MDMA/ecstasy use among college students has increased and reportedly leads to risky sexual behaviours. However, little is known about its association with sexually transmitted diseases (STDs). To evaluate this public health concern, this study examined the association between substance use (particularly MDMA) and self-reported STDs (chlamydia, gonorrhoea, herpes and syphilis) among college students and non-students aged 18-22 years (n=20,858). STUDY DESIGN: A cross-sectional data analysis of a national survey. METHODS: Data were drawn from the 2005-2006 National Surveys on Drug Use and Health; a nationally representative survey of non-institutionalized Americans. Self-reported STDs and substance use were assessed by the audio computer-assisted self-interviewing method. The association between MDMA use and STDs was determined while taking into account young adults' use of other substances, healthcare utilization and sociodemographic characteristics. RESULTS: Overall, 2.1% of college students and 2.5% of non-students reported contracting an STD in the past year. MDMA use in the past year was not associated with STDs. Among non-students, onset of MDMA use before 18 years of age increased the odds of past-year STDs. In both groups, alcohol use, marijuana use, female gender and African American race increased the odds of both past-year and lifetime STDs. Additional analyses indicated that, regardless of college-attending status, greater odds of past-year STDs were noted among users of alcohol and drugs, and users of alcohol alone, but not among users of drugs alone. CONCLUSIONS: Alcohol use is a robust correlate of STDs. Irrespective of college-attending status, young women and African Americans have a higher rate of STDs than young men and Whites.

HTLV-III exposure among drug users.

The Centers for Disease Control hierarchical classification of those at risk for acquired immunodeficiency syndrome (AIDS) underestimates the number of cases in which illicit drug use may play a role in the exposure to human T-cell leukemia virus type III. The immunosuppressive effects of nitrite inhalants are not sufficiently documented to elucidate their role as a cofactor in the development of AIDS. The currently available data on the immunosuppressive effects of self-administered parenteral drugs and their diluents indicate an associated elevation of immunoglobulin M, depressed helper/suppression T-cell ratios, and even damage to DNA. Illicit psychoactive drugs and their diluents may influence the virulence of the virus among parenteral drug users. An association between parenteral drug use and prostitution is not unexpected. Female prostitutes who use parenteral drugs may be at high risk for exposure to the virus and thus may transmit this infectious agent to their clients and their families.

A national evaluation of treatment outcomes for cocaine dependence.

BACKGROUND: This national study focused on posttreatment outcomes of community treatments of cocaine dependence. Relapse to weekly (or more frequent) cocaine use in the first year after discharge from 3 major treatment modalities was examined in relation to patient problem severity at admission to the treatment program and length of stay. METHODS: We studied 1605 cocaine-dependent patients from 11 cities located throughout the United States using a naturalistic, nonexperimental evaluation design. They were sequentially admitted from November 1991 to December 1993 to 55 community-based treatment programs in the national Drug Abuse Treatment Outcome Studies. Included were 542 patients admitted to 19 long-term residential programs, 458 patients admitted to 24 outpatient drug-free programs, and 605 patients admitted to 12 short-term inpatient programs. RESULTS: Of 1605 patients, 377 (23.5%) reported weekly cocaine use in the year following treatment (dropping from 73.1% in the year before admission). An additional 18.0% had returned to another drug treatment program. Higher severity of patient problems at program intake and shorter stays in treatment (<90 days) were related to higher cocaine relapse rates. CONCLUSIONS: Patients with the most severe problems were more likely to enter long-term residential programs, and better outcomes were reported by those treated 90 days or longer. Dimensions of psychosocial problem severity and length of stay are, therefore, important considerations in the treatment of cocaine dependence. Cocaine relapse rates for patients with few problems at program intake were most favorable across all treatment conditions, but better outcomes for patients with medium- to high-level problems were dependent on longer treatment stays.

An evaluation of drug treatments for adolescents in 4 US cities.

BACKGROUND: Little is known about outcomes of community-based treatment programs for adolescents with drug problems. METHODS: We studied 1167 adolescents (age range, 11-18 years; 368 females, 799 males) from 4 US cities (Pittsburgh, Pa; Minneapolis, Minn; Chicago, Ill; and Portland, Ore) using a naturalistic, nonexperimental evaluation design. These adolescents were consecutive admissions during the period from 1993 to 1995 at 23 community-based treatment programs in the Drug Abuse Treatment Outcome Studies for Adolescents. Included were 418 admissions to 8 residential programs, 292 admissions to 9 outpatient drug-free programs, and 457 admissions to 6 short-term inpatient programs. RESULTS: Adolescents in treatment typically had multiple problems (eg, 58.4% of them were involved in the legal system, and 63.0% met diagnostic criteria for a mental disorder). Nevertheless, less than half (43.8%) of all patients reported weekly marijuana use in the year following treatment (dropping from 80.4% in the year before admission). Similarly, there were decreases in heavy drinking (dropping from 33.8% to 20.3%), use of other illicit drugs (dropping from 48.0% to 42.2%), and criminal involvement (dropping from 75.6% to 52.8%). Additionally, patients reported better psychological adjustment and school performance after treatment. Longer stays in treatment were positively associated with several favorable outcomes, although length of time in treatment was generally short. CONCLUSIONS: Substance abuse treatment for adolescents is effective in achieving many important behavioral and psychological improvements. Strategies specific to adolescents to improve their treatment retention and completion are needed to maximize the therapeutic benefits of drug treatment.

Patterns of alcohol and drug abuse in drug treatment clients from different ethnic backgrounds.

In this paper we have sought to identify differences in alcohol consumption patterns and problems among young adult males from white, black, and Hispanic ethnic groups entering drug treatment programs. In overall consumption patterns we found results similar to those obtained in general population studies. However, about one-third of the clients in all ethnic groups could be classified as heavier drinkers (drinking at least once a week and 4 or more drinks per drinking occasion) in the period immediately prior to treatment. About one-fourth of the clients in each ethnic group consumed a daily average of 2.5 ounces of absolute alcohol. Compared with the other ethnic groups, blacks were the most likely to be abstainers and reported regular alcohol use and drunkenness at later ages. Regardless of the pattern of development, similar proportions of the clients in all ethnic groups reported heavier drinking levels by age 21-30. Consistent with the current hypotheses in the literature, whites reported much higher levels of alcohol-related problems and prior treatment. Despite having similar levels of drinking, black and Hispanic ethnic groups did not appear to recognize alcohol as a problem or to report alcohol-related problems to the extent that whites did. Examination of drug-use patterns showed great variation in the nature and extent of drug use among the three ethnic groups. Whites were distributed among the seven patterns of use. Heroin use with cocaine, marijuana, and alcohol was the predominant pattern for blacks and Hispanics. Although the patterns of drug use differed greatly, these patterns were not differentially related to alcohol consumption or alcohol-related problems within ethnic groups. On the contrary, the drug-use patterns appeared to be a stronger predictor than ethnicity of use and problems. Multiple-nonnarcotic-users reported the highest levels of alcohol consumption and the greatest numbers of alcohol-related problems. This group typically reported the highest number of alcohol-related problems. Expression of a current need for treatment and a history of prior alcohol treatment were highest for black multiple-nonnarcotic-users. Our examination of the influences of family and friends was based on a limited number of questions available in the data. Heavier drinking was reported by clients who lived with friends, had family or friends who drank regularly, or had extensive involvement in the drug-use network, including drug sales. No ethnic differences were found.(ABSTRACT TRUNCATED AT 400 WORDS)

The relationship of counseling and self-help participation to patient outcomes in DATOS.

Using a sample of 927 cocaine patients enrolled in programs in three modalities included in the national Drug Abuse Treatment Outcome Studies (DATOS), this investigation examined the relationship of three dimensions of treatment process on after-treatment cocaine and heavy alcohol use and predatory illegal activity. Logistic regression revealed significant reductions in all three outcomes and strong effects of treatment duration and after-treatment self-help, conditional on the modality. Results did not support the hypothesized relationship between treatment outcomes and amounts of counseling and during-treatment self-help. Findings support the robustness of duration effects and after-treatment self-help and contribute to the measurement methodology for calibrating treatment intensity. The strong after-treatment self-help effect in the two residential and inpatient modalities suggests these programs can improve treatment outcomes by making referral to after-treatment self-help participation a standard practice and installing mechanisms to increase the likelihood of attendance at least twice weekly during the year after treatment.

Costs and benefits of treatment for cocaine addiction in DATOS.

Our objective was to examine the cost of long-term residential (LTR) and outpatient drug-free (ODF) treatments for cocaine-dependent patients participating in the Drug Abuse Treatment Outcome Studies (DATOS), calculate the tangible cost of crime to society, and determine treatment benefits. Subjects were 502 cocaine-dependent patients selected from a national and naturalistic nonexperimental evaluation of community-based treatment. Financial data were available for programs from 10 US cities where the subjects received treatment between 1991 and 1993. Treatment costs were estimated from the 1992 National Drug Abuse Treatment Unit Survey (NDATUS), and tangible costs of crime were estimated from reports of illegal acts committed before, during, and after treatment. Sensitivity analyses examined results for three methods of estimating the costs of crime and cost-benefit ratios. Results showed that cocaine-dependent patients treated in both LTR and ODF programs had reductions in costs of crime from before to after treatment. LTR patients had the highest levels and costs of crime before treatment, had the greatest amount of crime cost reductions in the year after treatment, and yielded the greatest net benefits. Cost-benefit ratios for both treatment modalities provided evidence of significant returns on treatment investments for cocaine addiction.

Relationship between time spent in treatment and client outcomes from therapeutic communities.

Research found that therapeutic communities and other types of residential programs are effective in reducing drug use, unemployment, and criminal behavior and that length of time spent in treatment is an important predictor of client outcomes from programs. Studies vary considerably, however, in terms of the amount of time they found clients need to stay in treatment to produce those outcomes. Data collected for the Treatment Outcome Prospective Study (TOPS) were analyzed to explore the relationship between time spent in treatment and client outcomes from therapeutic communities and other types of residential drug treatment programs. The analysis took into account client characteristics and whether clients received drug treatment during the follow-up year. The results indicate there is a stronger relationship between time spent in treatment and client outcomes from therapeutic communities than was suggested in earlier analysis of TOPS data.

Reproducibility and accuracy of angle measurements obtained under static conditions with the Motion Analysis video system.

The development of computerized and semi-automated motion analysis systems has made the study of human motion more widely available in research and clinical settings. Although many of these systems are currently used by physical therapists, the accuracy and reproducibility of some of these systems in estimating joint angles have not been reported. In this study, the accuracy and reproducibility of angle measurements obtained by use of the Motion Analysis video system were evaluated under static conditions using a standard goniometer. Reflective markers placed on a goniometer were recorded by two video cameras at 17 angles, from 20 to 180 degrees, in 10-degree increments. Recordings of the goniometer were made at three locations within the field of view of the cameras. The intraclass correlation coefficient for each location tested was .99. Average within-trial variability was less than 0.4 degree at all locations. A linear regression of the system-calculated angles and reference angles for all locations had slopes near unity (ie, 1) and intercepts that were not statistically different from zero. A preliminary evaluation of the system under dynamic conditions revealed that distances were slightly underestimated, regardless of where the movement occurred within the calibration cube.

Training and employment programs in methadone treatment: client needs and desires.

Training and employment programs (TEP) in methadone treatment have declined in recent years. Yet heroin abusers who enter methadone treatment have historically high unemployment and low earnings compared to the general population and other treatment modalities. This paper reports on the first phase of a multiyear project to develop and evaluate TEPs for methadone treatment clients. Preliminary findings from the treatment intake survey of the pilot study are used to identify client needs and desires. Specifically, we report descriptive statistics for clients' (a) demographics, (b) education and training, (c) employment status, (d) income and expenditures, (e) interest in a TEP, and (f) labor market expectations thereafter. We conclude with a presentation of our proposed future analyses and a discussion of the policy implications of the project. Our main finding is that most addicts have a strong interest in training and employment services, but their expectations about the impact of such services is often unrealistic.

Individual Assessment Profile (IAP). Standardizing the assessment of substance abusers.

The Individual Assessment Profile (IAP), a structured intake assessment interview instrument in the public domain, was designed for use with substance-abusing populations in several large-scale and community-based drug abuse treatment projects underway in the United States. Background information is presented, including the content-based item-selection process used during the pretests and pilot testing. Validity and test-retest reliability data are also presented, along with descriptions of studies using the IAP for clinical, research, and management information purposes. Concordance between biological measures and self-reports of recent drug use, measures of internal consistency, and test-retest reliability coefficients were generally good. A computer-assisted personal interview version of the IAP and an automated reporting system were subsequently developed for clinical and management reporting purposes and used in a large-scale research demonstration project. An intreatment version of the IAP has also been developed to collect information on treatment services provided and to assess changes in behaviors after 3, 6, and 12 months of treatment. These instruments (the IAP intake and intreatment interviews) provide a comprehensive system to assess substance-abusing populations.

Developmental variation in the context of marijuana initiation among adolescents.

A longitudinal sample of 3,454 secondary school students is used to examine the variations in the contexts of marijuana initiation which may be attributable to developmental changes during adolescence. Concepts representing the context of initiation include attachments to parents and peers, exposures to drug-related attitudes of parents and peers and behaviors of peers, and the decision-making process, which involves the weighing of expected costs and benefits of use. Measures representing these concepts are included in logistic regression models predicting initiation. Regression parameters are compared for students in the sixth, seventh, and eighth grades. Results show that only parental attachment measures influence initiation for the youngest group; a mix of parental and peer attachment and peer exposure measures affects initiation for the middle group; and only measures of peer attachment and exposure and of the relative importance of the costs of use predict initiation for the oldest group. The results suggest that developmental factors do influence the context of marijuana initiation.

Comparative cocaine abuse treatment strategies: enhancing client retention and treatment exposure.

The current investigation explores the clinical utility in providing a series of enhanced clinical services to a sample of 303 cocaine-abusing clients (primarily crack smokers) relative to a standard group therapy treatment program. In addition to examining the comparative impact of six varying psychosocial treatment approaches for cocaine abuse on client retention and treatment exposure rates, an additional emphasis has been to examine the ability of fixed and dynamic client variables in predicting client outcome in this regard. No fixed (e.g., sex, income, marital status, income level, or employment status) or dynamic (e.g., recent alcohol use, antisocial personality disorder diagnoses, or motivational variables) client characteristics were useful in predicting client retention or treatment exposure rates. Program characteristics, however, or the frequency, intensity, and/or type of treatment services offered, were related to client retention and treatment exposure. Treatment exposure and retention were significantly enhanced by providing clients with more frequent and intensive group therapy, or by adding individual treatment services to a standard group therapy treatment regimen. With a population such as cocaine abusers, who typically have an extremely high treatment dropout rate, an obvious strategy is to focus efforts on engaging and retaining clients in treatment, and maximizing levels of treatment exposure. The current findings suggest that one successful approach towards enhancing psychosocial treatments for cocaine abuse is to increase the frequency, intensity, and/or types of treatment services offered.

Treating combined alcohol and drug abuse in community-based programs.

The key issues in effective treatment of combined alcohol and drug abuse are identified as comprehensive diagnosis, effective services, and long-term recovery. Empirical data from community-based alcohol and drug treatment studies are presented, illustrating the extent of combined abuse, the lack of treatment for combined abuse, and the negative effects of combined abuse on treatment outcomes. Reconsideration is given to issues such as the concentration of diagnosis on a primary pattern of abuse, the orientation toward concurrent treatment of combined abuse, the requirement of immediate abstinence vs. gradual reduction of combined abuse patterns, and the role of relapse in recovery from combined abuse.

Drug abuse treatment process: a review of the literature.

The literature on drug abuse treatment is reviewed in two sections. The first of these briefly describes the three major treatment modalities (outpatient methadone, residential, and outpatient drug-free). The objectives and approaches of each modality are outlined, and a number of issues surrounding each modality are sketched. The second section of the review covers general studies of drug abuse treatment. In particular, studies of retention, counselor characteristics, program policies and goals, the nature and extent of services received by clients, the context in which treatment is administered, methadone dosage levels, and other such variables are reviewed. Various typologies of treatment are presented and discussed. Conclusions and implications for future research are also discussed.

Developmental changes in peer factors and the influence on marijuana initiation among secondary school students.

A longitudinal sample of 3454 secondary school students in Wake County, North Carolina, was used to examine developmental changes in peer factors and their influence on marijuana initiation. Research hypotheses and questions focused on the issues of the relative influence of different types of peer factors, the causal order of peer attitudes and behaviors and respondents' behavior, and the influence of developmental changes on these relationships. Results showed that respondents perceived greater levels of use among students generally and adolescents in their neighborhoods than among their friends, but when friends' use was perceived, it was strongly related to respondents' own use. The causal order of these variables, however, was not necessarily friends influencing respondents but was probably reciprocal. Friends' drug-related behaviors, rather than attitudes, were more strongly related to respondents' likelihood of initiation. This relationship was strongest for the youngest respondents, those in the sixth grade. The strength of the relationship diminished as adolescents grew older.

Conceptualizing and assessing treatment structure and process in community-based drug dependency treatment programs.

Having established the effectiveness of drug dependency treatment, the next generation of research will necessitate a focus on treatment structure and process and the systems within which programs operate. As a foundation for a process conceptualization, we constructed a grounded theory definition of treatment consisting of core elements and related comprehensive services. We then presented the multilevel conceptual framework that guided the Drug Abuse Treatment Outcome Study (DATOS) treatment structure and process study design and instrumentation, anchored by supporting empirical literature. The framework emphasizes seven critical levels of process measurement that future research should consider in order to avoid potential spurious findings.

Quality of alcohol use histories collected at intake to substance user treatment.

Many survey questions on alcohol require complex cognitive tasks, such as long-term recall, shifting reference periods, and numeric calculation. Moreover, alcohol-related impairment is known to affect cognitive ability. To assess the quality of data on self-reported alcohol use, internal consistency analyses were conducted as part of a comprehensive multisite prospective study of drug user treatment outcome undertaken in 11 cities throughout the United States (DATOS). Contrary to expectation, analyses found high levels of internal consistency. For questions on age of initiation of different types of alcohol use, over 99% of respondents (N = 2,842) reported consistent answers for each pair of logically related questions. Reports of being drunk and of quantity of alcohol consumed were similarly consistent.

Treatment predictors of tenure in methadone maintenance.

Tenure in methadone maintenance treatment was analyzed in terms of treatment process factors using a survival curve regression analysis. The treatment process framework included client variables at entry, program characteristics, treatment events, and client attitudes and satisfaction. The sample consisted of 606 methadone maintenance clients from 21 different clinics. Significant predictors included professional classifications of the diagnosing and treatment-planning staff members, measures of early treatment services, client attitudes and satisfaction, methadone dosage level, and frequency of urine monitoring. The results showed higher tenure rates when specialized professionals diagnosed problems and defined treatment plans, when service needs were addressed, when client attitudes and satisfaction were high, and when methadone dose was higher. Lower tenure rates were found among blacks and clients with lower sociodemographic status. Lower tenure also occurred among those who perceived the program as less accessible or less structured in its procedures.