The visibility of illicit drugs: implications for community-based drug control strategies.

OBJECTIVES: This study examined differences between the visibility of drugs and drug use in more than 2100 neighborhoods, challenging an assumption about drug use in poor, minority, and urban communities. METHODS: A telephone survey assessed substance use and attitudes across 41 communities in an evaluation of a national community-based demand reduction program. Three waves of data were collected from more than 42 000 respondents. RESULTS: Measures of neighborhood disadvantage, population density, and proportion of minority residents explained more than 57% of the variance between census tracts in visibility of drug sales but less than 10% of tract-to-tract variance in drug use. Visible drug sales were 6.3 times more likely to be reported in the most disadvantaged neighborhoods than in the least disadvantaged, while illicit drug use was only 1.3 times more likely. CONCLUSIONS: The most disadvantaged neighborhoods have the most visible drug problems, but drug use is nearly equally distributed across all communities. Thus, efforts to address drug-related problems in poorer areas need to take into account the broader drug market served by these neighborhoods.

Polygraph testing and sexual abuse: the lure of the magic lasso.

Polygraph tests to assess veracity are widely promoted for application in sexual abuse matters. The use of polygraph tests is advocated despite substantial differences in professional and scientific opinion about the validity of such techniques. Polygraph diagnoses of an individual's deception are inferences made by an examiner who compares physiological reactions to a set of questions. The test situation, however, is also used to induce examinees to admit crimes. In addition to their use in investigations, polygraph tests are used by defendants seeking exculpatory evidence and by treatment and probation programs to assess and monitor sexual offenders. Although there are dissenters, most knowledgeable scientists consider polygraph testing as unvalidated. Professionals need to access the literature on polygraph testing, evaluate the efficacy and ethics of polygraph tests in their community, and further develop standards for their use.

Survey estimates of drug-use trends in urban communities: general principles and cautionary examples.

Surveys to depict substance abuse rates and monitor trends in specific areas have become increasingly important policy tools. Yet, as illustrated by two national multiwave surveys, using small sample survey data and making longitudinal comparisons is fraught with interpretative problems. In the case of the metropolitan area "oversample" of the National Household Survey on Drug Abuse, for example, interpreting apparent declines in drug use has to take account of the devastating effects of Hurricane Andrew in the Miami Metropolitan area. In the case of a 41-community survey sponsored by the Robert Wood Johnson Foundation to evaluate substance abuse prevention, the difficulty is how to interpret small differences in drug use, which seem to follow no reasonable pattern with respect to treatment or comparison sites. Inferences from such surveys are confounded with statistical anomalies and unforeseen events. They are limited by the sample size. In part, the solution to these problems is to use other survey and nonsurvey data to validate their conclusions and to note their limitations.

The substance use system: social and neighborhood environments associated with substance use and misuse.

Substance use theory and practice have traditionally focused on individuals who misuse substances or who are at risk for substance misuse, but this emphasis is shifting. The present study views both substance use and misuse systematically, assessing the relationships between the physical and social environments and substance use and misuse in dynamic interplay. This substance use system was examined through a survey of approximately 10,000 persons, aged 22-44, from primarily inner-city neighborhoods in the United States. Individual indicators such as race, sex, age, socioeconomic status, education, and religious service attendance relate to both the physical and interpersonal environments, even when each is controlled for the others. Qualities of both environments are strongly associated with substance dependency, even after individual indicators are controlled. These findings suggest the difficulty of bringing about change in drug and alcohol use without fundamental change in the environments where use takes place.

Zero effects in substance abuse programs. Avoiding false positives and false negatives in the evaluation of community-based programs.

The evaluation of community-based programs poses special design and analysis problems. The present article focuses on two major types of errors that can occur in such evaluations: false positive--incorrectly declaring a program to be effective--and false negatives--incorrectly declaring a program to be ineffective. The evaluation of a national demonstration of community-based programs to reduce substance abuse, Fighting Back, is used to illustrate several approaches to reduce the probability of errors. Both those errors that are affected by the design and those by analytic approaches are considered. Ways to assess multiple outcomes and to match the complexity of the program with design and analytic strategies are proposed. Community trials are complex interventions, and, although they can provide very useful information, their outcomes have to be understood in terms of the constructs they test and the contexts within which they are carried out.

Evaluating systems of care for children: utility of the clinical case conference.

A clinical assessment of the Mental Health Services Program for Youth, a national initiative to integrate systems and coordinate care for severely emotionally disturbed children, was designed to augment and enrich the larger evaluation of program structure. Case conferences were used as a method of examining the effects of collaborative systems of care on vulnerable individuals and of generating clinical insight and understanding. Case vignettes are presented and discussed in terms of the contributions and shortcomings of current system-of-care efforts.

The dependence potential of short half-life benzodiazepines: a meta-analysis.

OBJECTIVES: The dependence potential of benzodiazepine medications is now widely recognized, but uncertainty exists as to whether use of short half-life vs long half-life drugs results in greater dependence. The present study reports a meta-analysis of the extant research to evaluate the dependence potential of different types of benzodiazepines. METHOD: Seven studies were found that specifically compared long half-life and short half-life benzodiazepines and allowed statistical comparison by their homogeneous dependent variables. Drugs in these studies were used as daytime sedatives. RESULTS: Substantial evidence was found for differential effects of short vs long half-life drugs at withdrawal. In all studies, dropouts were higher among short half-life subjects. In the random-assignment short-term use studies, Hamilton Anxiety Scale scores showed higher incidence of rebound among subjects who used the short half-life drugs. CONCLUSIONS: The present meta-analysis confirms clinical impressions of the greater dependence potential of short vs long half-life benzodiazepines. Doctors, patients, and policymakers need to be informed so as to avoid harm to the public health through unintended drug dependence.

Homelessness as psychological trauma. Broadening perspectives.

Most mental health literature on homelessness has focused on characteristics that may be risk factors for homelessness. The authors of this article argue that homelessness itself is a risk factor for emotional disorder and use the construct of psychological trauma--focusing on social disaffiliation and learned helplessness--to understand the potential effects of homelessness. Psychological trauma is likely among homeless individuals and families for three reasons. (a) The sudden or gradual loss of one's home can be a stressor of sufficient severity to produce symptoms of psychological trauma. (b) The conditions of shelter life may produce trauma symptoms. (c) Many homeless people--particularly women--become homeless after experiencing physical and sexual abuse and consequent psychological trauma. Research suggests that negative psychological responses to traumatic events can be prevented or mitigated by a supportive and empowering posttrauma environment. The implications of trauma theory for improving the psychosocial conditions of homeless people are discussed.

Science and the CQT polygraph. A theoretical critique.

Despite substantial contrary scientific evidence, polygraph tests to detect deception continue to be employed in the United States. It is argued that polygraph tests (in particular, the Control Question Technique) lack construct validity. Polygraph tests do not assess deceptiveness, but rather are situations designed to elicit and assess fear. Correct decisions may be obtained when subjects fear detection; however, because there is no way to determine the cause of a subject's fear or anxiety, validation is impossible. The paper also considers other physiological detection paradigms and concludes that because of the nature of honesty their use to detect deception is unlikely.

Goal directed informal sessions: their impact on an adolescent unit.

Goal Directed Informal Sessions ( GDIS ) were utilized on an inpatient adolescent unit in an attempt to facilitate communication between adolescents and their parents, to neutralize partially the almost universal fantasy that adolescents know more than their respective parents on any given topic, and to maximize the impact of the therapeutic milieu in other ways. The vehicle for the GDIS was discussions of various aspects of human sexuality. Thirty-four adolescents (average age 14.8), their parents, and staff were asked to respond to a questionnaire relating to human sexuality prior to the onset of GDIS . Adolescents speculated that their parents would perform least well. The average test scores for the adolescents, their parents, and staff respectively were: 65 percent, 79 percent and 81 percent. There was no significant difference between the scores of staff and parents. The difference between adolescents' scores and those of the parents and staff was significant (p less than 0.05). Framework for the GDIS is outlined, and illustrative vignettes are offered. Based on one year's experience, GDIS are recommended for other adolescent facilities.

The action of colicin E2 on supercoiled lambda DNA. I. Experiments in vivo.

A lambda DNA supercoil system has been developed to study the effects of colicin E2 on DNA in vivo. Colicin E2, a protein antibiotic synthesized by strains of coliform bacteria that carry the Col E2 plasmid, had as its most conspicious effect damage to the DNA of sensitive strains. Colicine E2 attacks the supercoiled molecul formed by labeled lambda DNA in superinfected cells as well as it attacks the bacterial DNA. The rate and extent of acid solubilization of the lambda supercoils and of host bacterial DNA induced by E2 treatment are nearly identical. Treatment of superinfected cells with colicin E2 results in the progressive conversion of lambda DNA supercoils to open circles and/or linear full lenght molecules, and subsequently to fragments less than full lambda in size. The first endonucleolytic reactions are single-strand and or double-strand breaks. The rate of supercoil breakdown as well as the final percent supercoils remaining unconverted, the size of the final lambda fragments, and the extent of solubilization are dependent on the multiplicity of colicin used. Additions of trypsin to E2-treated superinfected cells results in a cessation of further breakdown of the lambda molecules, presumably as a result of digestion of accessible colicin molecules. Energy is essential for an early event in colicin E2 action. The host enzymes, endonuclease I and Rec BC, may be instrumental in the nucleolytic process caused by colicin E2: endonuclease I in reaction preceding cell killing and Rec BC in a secondary degradation of the bacterial DNA.

The action of colicin E2 on supercoiled lambda DNA.II. Experiments in vitro.

An in vitro system has been developed to test whether colicin E2 possesses DNase activity. Purified colicin E2 preparations introduced one single-strand scission in supercoiled lambda phage DNA. Glycerol gradient fractionation of colicin E2 supports the association of in vitro action with in vivo cell-killing activity. Colicin E2 preparations also attacked superhelical SV40 DNA yielding open circles and fragments and single-stranded fd DNA molecules causing one or more endonucleolytic breaks. The possible role of contaminating nucleases in the activity of colicin E2 preparations is discussed.