Drug use and dependence in cocaine dependent subjects, community-based individuals, and their siblings.

BACKGROUND: The purpose of this study was to examine substance use and dependence among cocaine dependent subjects and their siblings compared to individuals recruited from the same neighborhood and their siblings in order to better understand family and neighborhood contributions to the development of dependence. METHODS: Cocaine dependent subjects were recruited through treatment centers. Community-based subjects were matched to cocaine dependent index cases on age, ethnicity, gender, and zip code. One full sibling for each case and community-based subject participated. RESULTS: Cocaine dependent subjects were significantly more likely than community-based subjects to use all substances studied and were 2-10 times more likely to be dependent on alcohol and other illicit drugs. Dependence only on cocaine was uncommon (<10%). The siblings of cocaine dependent subjects had higher rates of substance use and were 1.3-3 times more likely to have a diagnosis of substance dependence compared siblings of community-based subjects. However, when analyses focused only on those who ever used a specific substance, the siblings of cocaine dependent cases were at a similar or modestly elevated risk (1.5 times) of developing dependence. CONCLUSIONS: Cocaine dependence is characterized by polysubstance use and dependence. In addition, the prevalence of substance dependence in the community subjects was higher than reported for the general population, indicating that cocaine dependent cases live in high-risk communities with elevated prevalence of substance dependence. A potential intervention to decrease the family clustering of dependence is to reduce the initiation of drug use in relatives at risk.

Exposure to trauma: a comparison of cocaine-dependent cases and a community-matched sample.

BACKGROUND: The purpose of this study was to examine rates of traumatic events and PTSD in cocaine-dependent cases and a community comparison sample. METHODS: Participants were interviewed as part of the Family Study of Cocaine Dependence. A cross-sectional case-cohort design assessed a total of 918 participants: 459 cocaine-dependent cases recruited from chemical dependency treatment and 459 community-based participants. Community-based comparison participants were matched to cocaine-dependent cases on year of birth (within 1 year), ethnicity, gender, and neighborhood (zip code). Participants completed a personal interview modeled after the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA). RESULTS: Compared to community-based individuals, cocaine-dependent cases recruited from treatment experienced higher rates of assaultive events including rape or sexual assault in women (58% vs. 33%) and threatened with a weapon in men (75% vs. 52%). Cocaine-dependent cases endured significantly more types of trauma than the community-based participants (4.64 vs. 3.08) and PTSD (22.4% and 12.2%). The number of traumatic exposures, witnessing trauma to others, experiencing violent trauma, and being female were predictive of conditional risk of PTSD, even after controlling for cocaine dependence and other demographic factors. CONCLUSIONS: Cocaine dependence is strongly associated with an increased risk of exposure to traumatic events and PTSD, and experiencing multiple, violent traumas increases the risk of PTSD, regardless of cocaine dependence. The high prevalence of trauma seen in our community-based participants emphasizes the role of violence in the neighborhood and the connection between drug dependence, trauma exposure, and PTSD.

Risky sexual behaviors and sexually transmitted diseases: a comparison study of cocaine-dependent individuals in treatment versus a community-matched sample.

Cocaine users routinely engage in high-risk sexual behaviors that place them at an elevated risk of contracting HIV and other blood-borne infections. The purpose of the present study was to compare trading sex for drugs and/or money, having 10 or more sexual partners in 1 year, and sexually transmitted diseases (STDs) of cocaine-dependent individuals in treatment for their dependence across race and gender and against participants who live in their community. Cocaine-dependent individuals (n = 459) were identified through nine publicly and privately funded inpatient and outpatient chemical dependency treatment centers in the St. Louis area during 2001-2006. Community-based participants (n = 459) were matched to cocaine-dependent participants on age, ethnicity, gender, and zip code of residence. Mean age of the sample was 36 years old, 50% were Caucasians, 50% were African American, and 47% were male. Nearly half of cocaine-dependent participants in treatment had traded sex for drugs and/or money and over one-third had more than 10 sexual partners in 1 year with a risk concentrated among African Americans even after controlling for income and educational attainment. Participants recruited from the community with some exposure to cocaine reported similar rates of high risk sexual behaviors as the cocaine dependent subjects from treatment settings. It is important for clinicians to recognize that once released from treatment, cocaine-dependent individuals may be returning to high-risk environments where sexual risk behaviors are occurring in the context of cocaine use.