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1.
J Subst Abuse Treat ; 42(1): 87-94, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21831562

RESUMO

Very little is known about the impact of age and gender on drug abuse treatment needs. To examine this, we recruited 2,573 opioid-dependent patients, aged from 18 to 75 years, entering treatment across the country from 2008 to 2010 to complete a self-administered survey examining drug use histories and the extent of comorbid psychiatric and physical disorders. Moderate to very severe pain and psychiatric disorders, including polysubstance abuse, were present in a significant fraction of 18- to 24-year-olds, but their severity grew exponentially as a function of age: 75% of those older than 45 years had debilitating pain and psychiatric problems. Women had more pain than men and much worse psychiatric issues in all age groups. Our results indicate that a "one-size-fits-all" approach to prevention, intervention, and treatment of opioid abuse that ignores the shifting needs of opioid-abusing men and women as they age is destined to fail.


Assuntos
Transtornos Mentais/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Dor/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Comorbidade , Coleta de Dados , Feminino , Humanos , Masculino , Transtornos Mentais/fisiopatologia , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Fatores Sexuais , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/fisiopatologia , Adulto Jovem
2.
J Drug Issues ; 41(2): 283-304, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22287798

RESUMO

Numerous national surveys and surveillance programs have shown a substantial rise in the abuse of prescription opioids over the past 15 years. Accessibility of these drugs to non-patients is the result of their unlawful channeling from legal sources to the illicit marketplace (diversion). Empirical data on diversion remain absent from the literature. This paper examines abusers' sources of diverted drugs from two large studies: 1) a national sample of opioid treatment clients (N=1983), and 2) a South Florida study targeting diverse populations of opioid abusers (N=782). The most common sources of diverted medications were dealers, sharing/trading, legitimate medical practice (e.g., unknowing medical providers), illegitimate medical practice (e.g., pill mills), and theft, in that order. Sources varied by users' age, gender, ethnicity, risk-aversiveness, primary opioid of abuse, injection drug use, physical health, drug dependence, and either access to health insurance or relative financial wealth. Implications for prescription drug control policy are discussed.

3.
J Prev Interv Community ; 38(2): 118-31, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20391059

RESUMO

Female sex workers are especially vulnerable to HIV infection, particularly those who use drugs and engage in street-based sex exchange. This study examines the risk behaviors and HIV serostatus of 806 drug-using female sex workers in Miami and assesses the relative impact of two HIV and hepatitis prevention interventions on changes in risk behavior. Drug-using sex workers were recruited using targeted sampling strategies and were randomly assigned to the NIDA Standard Intervention or an innovative Sex Worker Focused (SWF) Intervention. Outcome analyses indicate that both groups benefited from participation in the intervention trial. However, the SWF Intervention was found to be more efficacious in regard to reductions in unprotected oral sex and sexual violence.


Assuntos
Infecções por HIV/prevenção & controle , Trabalho Sexual , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Aconselhamento , Feminino , Florida , Promoção da Saúde/métodos , Humanos , Pessoa de Meia-Idade , Grupo Associado , Adulto Jovem
4.
Drug Alcohol Depend ; 110(1-2): 21-9, 2010 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-20227199

RESUMO

Although prescription drugs are readily available on the Internet, little is known about the prevalence of Internet use for the purchase of medications without a legitimate prescription, and the characteristics of those that obtain non-prescribed drugs through online sources. The scientific literature on this topic is limited to anecdotal reports or studies plagued by small sample sizes. Within this context, the focus of this paper is an examination of five national data sets from the U.S. with the purpose of estimating: (1) how common obtaining prescription medications from the Internet actually is, (2) who are the typical populations of "end users" of these non-prescribed medications, and (3) which drugs are being purchased without a prescription. Three of the data sets are drawn from the RADARS (Researched Abuse Diversion and Addiction-Related Surveillance) System, a comprehensive series of studies designed to collect timely and geographically specific data on the abuse and diversion of a number of prescription stimulants and opioid analgesics. The remaining data sets include the National Survey on Drug Use and Health (NSDUH) and the Monitoring the Future (MTF) survey. Our analysis yielded uniformly low rates of prescription drug acquisition from online sources across all five data systems we examined. The consistency of this finding across very diverse populations suggests that the Internet is a relatively minor source for illicit purchases of prescription medications by the individual end-users of these drugs.


Assuntos
Internet/estatística & dados numéricos , Medicamentos sob Prescrição/economia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Anfetaminas , Estimulantes do Sistema Nervoso Central , Coleta de Dados , Humanos , Hipnóticos e Sedativos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Centros de Controle de Intoxicações/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Inquéritos e Questionários , Tranquilizantes , Estados Unidos/epidemiologia , Universidades
5.
Arch Sex Behav ; 39(4): 959-67, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20217224

RESUMO

Anal sexual intercourse represents the highest transmission risk for infection with the human immunodeficiency virus (HIV), yet much of what we know about anal sex is based on men who have sex with men (MSM). Less is known about heterosexual adults who practice anal sex, especially those who may be at risk for HIV such as substance users. The present study examined the demographic, sexual behaviors, substance use, and psychosocial correlates of recent anal intercourse among a heterosexual young adult sample of nightclub goers who also use substances. Data were drawn from an on-going natural history study of participants (n = 597) in Miami's club scene who use club drugs, use prescription medications for non-medical reasons, and were regular attendees of nightclubs. Participants who reported anal sex (n = 118) were more likely to be male, of moderate income, Latino, trade sex, have unprotected sex, and report victimization. Event-based and qualitative studies are needed to better understand the context in which anal sex occurs. Interventions that target heterosexual populations should include discussion about the risks of anal sex.


Assuntos
Heterossexualidade/psicologia , Comportamento Sexual/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Feminino , Florida , Humanos , Entrevistas como Assunto , Masculino , Americanos Mexicanos/psicologia , Recreação , Assunção de Riscos , Sexo Seguro/psicologia , Caracteres Sexuais , Fatores Socioeconômicos , Violência/psicologia
6.
J Drug Issues ; 40(3): 681-702, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-21278927

RESUMO

The goal of this research is to better understand the role that South Florida pain management clinics may be playing in the abuse and diversion of prescription drugs. This study explores 1) the characteristics and practices of pain clinics that may be facilitating the drug-seeking endeavors of prescription drug abusers and 2) the drug-seeking behaviors of prescription drug abusers who use pain clinics as a primary source for drugs. Thirty in-depth interviews were conducted with prescription drug abusers in South Florida. Interviews were transcribed verbatim and codes were generated based on thematic analyses of the data. Using grounded theory strategies, the analysis revealed six main themes: "pill mills", on-site pharmacies, liberal prescribing habits, "sponsoring" drug diversion, pain doctor/pharmacy shopping, and faking symptoms/documentation. These findings should provide insights for law enforcement, regulatory agencies, and industry as they attempt to develop appropriate policy initiatives and recommendations for best practices.

7.
J Opioid Manag ; 5(2): 81-7, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19507804

RESUMO

Generic drugs account for half of all prescription drug purchases in the United States. Although they are bioequivalent to their branded counterparts, they are typically sold at substantial discounts from the branded price. Given this, the purpose of this analysis is to examine the impact of the introduction of generic forms of selected opioids on their diversion to the illicit marketplace. The analgesics in this analysis include oxycodone ER (extended release), and the fentanyl transdermal patch. The data were collected through a post-marketing surveillance initiative supported by the Researched Abuse Diversion and Addiction-Related Surveillance (RADARS) System risk management program, gathered on a quarterly basis from a national sample of police and regulatory agencies. The results indicate that with oxycodone ER and the fentanyl transdermal patch, the diversion of their generic formulations occurs less often than that of the branded products, and that the introduction of the generic formulations did not significantly increase the overall levels of diversion during the period covered by this analysis. Although diversion did not increase in the short-term, the need for longer term monitoring appears warranted.


Assuntos
Analgésicos Opioides/efeitos adversos , Aprovação de Drogas , Medicamentos Genéricos/efeitos adversos , Fentanila/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Oxicodona/efeitos adversos , Medicamentos sob Prescrição/efeitos adversos , United States Food and Drug Administration/legislação & jurisprudência , Administração Cutânea , Analgésicos Opioides/administração & dosagem , Preparações de Ação Retardada , Medicamentos Genéricos/administração & dosagem , Fentanila/administração & dosagem , Humanos , Oxicodona/administração & dosagem , Medicamentos sob Prescrição/administração & dosagem , Vigilância de Produtos Comercializados , Fatores de Tempo , Estados Unidos/epidemiologia
8.
Pharmacoepidemiol Drug Saf ; 18(9): 778-90, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19536784

RESUMO

PURPOSE: Integrate statewide rankings of abuse across different drugs and/or signal detection systems to summarize prescription drug abuse in each state in 2007. METHODS: Four signal detection systems (Opioid Treatment Programs, Key Informants, Drug Diversion, and Poison Centers) that covered heterogeneous populations collected data on the abuse of nine opioids: hydrocodone, immediate-release oxycodone, tramadol, extended-release [ER] oxycodone, fentanyl, morphine, methadone, hydromorphone, and buprenorphine). We introduce here linearized maps which integrate nine drugs within each system; four systems for each drug; or all drugs and systems. RESULTS: When rankings were integrated across drugs, Rhode Island, New Hampshire, Maine, West Virginia, and Michigan were in the highest tertile of abuse in three systems. When rankings were integrated across signal detection systems, there was a geographic clustering of states with the highest rates for ER oxycodone (in Tennessee, Mississippi, Kentucky, Ohio, Indiana, Michigan, and in Massachusetts, New Hampshire, Maine, and Vermont) and methadone (Massachusetts, Rhode Island, New Hampshire, Maine, Vermont, Connecticut, and New Jersey). When rankings were integrated across both drugs and signal detection systems, states with 3-digit ZIP codes below 269 (i.e., from Massachusetts to West Virginia): Massachusetts, New Hampshire, Maine, Vermont, Washington DC, Virginia, and West Virginia were in the highest tertile and only Delaware was in the lowest tertile. CONCLUSIONS: We have presented methods to integrate data on prescription opioid abuse collected by signal detection systems covering different populations. Linearized maps are effective graphical summaries that depict differences in the level of prescription opioid abuse at the state level.


Assuntos
Analgésicos Opioides , Medicamentos sob Prescrição , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Coleta de Dados , Humanos , Medição de Risco , Gestão de Riscos , Estados Unidos/epidemiologia
9.
Pain Med ; 10(3): 537-48, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19416440

RESUMO

OBJECTIVE: Prescription-drug diversion is a topic about which comparatively little is known, and systematic information garnered from prescription-drug abusers and dealers on the specific mechanisms of diversion is extremely limited. DESIGN: A pilot ultrarapid assessment was carried out in Wilmington, Delaware, during December 2006 to better understand the scope and dynamics of prescription-drug abuse and diversion. This involved focus groups with prescription-drug abusers and key informant interviews with police, regulatory officials, prescription-drug dealers, and pill brokers. SETTING AND PATIENTS: The research team recruited focus group participants from the two residential substance abuse treatment programs in Wilmington reporting the highest proportions of prescription drug abusing clients. A total of six focus groups were conducted with 32 patients in these two programs. Dealers were recruited from the same treatment facilities, and three in-depth interviews were completed. In-depth interviews were also conducted with two prescription pill brokers recruited through the authors' existing contacts in the drug abusing community. Six in-depth interviews were conducted with representatives from a number of Delaware agencies-the Attorney General's Office, the Department of Professional Regulation, the State Police; the Wilmington Police Department, and the Newark Police Department. MEASURES: In-depth interview and focus group guides were developed for each of the target populations. The in-depth interviews with police and regulatory officials focused on the extent of prescription drug abuse and diversion in the community, the types of drugs most commonly diverted, and mechanisms being used to channel the drugs to the illicit market. The focus group areas of inquiry with prescription drug abusers included general perceptions of the prescription drug problem in Delaware, sources and mechanisms of access to prescription drugs, popularity and prices of prescription medications on the street, as well as the initiation and progression of prescription and illicit drug abuse. RESULTS: The primary sources of prescription drugs on the street were the elderly, patients with pain, and doctor shoppers, as well as pill brokers and dealers who work with all of the former. The popularity of prescription drugs in the street market was rooted in the abusers' perceptions of these drugs as 1) less stigmatizing; 2) less dangerous; and, 3) less subject to legal consequences than illicit drugs. For many, the abuse of prescription opioids also appeared to serve as a gateway to heroin use. CONCLUSION: The diversion of prescription opioids might be reduced through physician education focusing on 1) recognizing that a patient is misusing and/or diverting prescribed medications; 2) considering a patient's risk for opioid misuse before initiating opioid therapy; and 3) understanding the variation in the abuse potential of different opioid medications currently on the market. Patient education also appears appropriate in the areas of safeguarding medications, disposal of unused medications, and understanding the consequences of manipulating physicians and selling their medications.


Assuntos
Analgésicos Opioides , Programas de Rastreamento/métodos , Medicamentos sob Prescrição , Transtornos Relacionados ao Uso de Substâncias , População Urbana , Adulto , Idoso , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino
10.
J Exp Criminol ; 5(3): 245-272, 2009 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-20090928

RESUMO

The purpose of this study was to examine the implementation, adherence and protocol fidelity for the Reducing Risky Relationships for HIV (RRR-HIV) study. The RRR-HIV study is a phase III trial of a randomized intervention to reduce human immunodeficiency virus (HIV) risk behaviors among incarcerated women in four US states: Connecticut, Delaware, Kentucky and Rhode Island. The intervention consists of five interventionist-led prison-based group sessions and a sixth individual community-based session. Data on adherence, implementation, acceptability and fidelity of the intervention were obtained from forms completed after the five prison-based sessions by both the interventionist and participant. Data from the sixth session were collected by the interventionist. Of the 363 women recruited to date, 173 (47.6%) have been randomly allocated to the experimental RRR intervention, of which implementation measures were available for 162 (93.6%). Almost three-quarters of women attended all five sessions, each of which lasted a median of 90 minutes, indicating successful implementation of the protocol across multiple study sites. Interventionists and participants alike reported that all of the topics for each session were discussed, suggesting adherence to the protocol. In addition, protocol interventionists indicated that more than 95% of the women were engaged/involved, interested, and understood the materials presented, indicating high levels of acceptability among the participants and fidelity to the intervention protocols. The majority of participants also answered all of the post-test questions correctly, which is another strong indicator of the fidelity to the intervention. Results suggest that the RRR-HIV study has been successfully implemented across multiple study sites. Adherence to the protocol, as well as protocol fidelity and acceptability, were also strong, which is essential to establish prior to examining outcome data.

12.
J Addict Dis ; 28(4): 332-47, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20155603

RESUMO

A variety of surveys and studies are examined in an effort to better understand the scope of prescription drug diversion and to determine whether there are consistent patterns of diversion among various populations of prescription drug abusers. Data are drawn from the RADARS System, the National Survey of Drug Use and Health, the Delaware School Survey, and a series of quantitative and qualitative studies conducted in Miami, Florida. The data suggest that the major sources of diversion include drug dealers, friends and relatives, smugglers, pain patients, and the elderly, but these vary by the population being targeted. In all of the studies examined, the use of the Internet as a source for prescription drugs is insignificant. Little is known about where drug dealers are obtaining their supplies, and as such, prescription drug diversion is a "black box" requiring concentrated, systematic study.


Assuntos
Analgésicos Opioides , Prescrições de Medicamentos , Fraude , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Medicamentos sob Prescrição , Bases de Dados Factuais , Indústria Farmacêutica/legislação & jurisprudência , Prescrições de Medicamentos/estatística & dados numéricos , Família , Amigos , Humanos , Hidrocodona , Internet/estatística & dados numéricos , Farmácia , Médicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia
13.
Drug Alcohol Depend ; 98(3): 249-63, 2008 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-18674872

RESUMO

This study used latent class analysis to examine distinctive subtypes of Ecstasy users based on 24 abuse and dependence symptoms underlying standard DSM-IV criteria. Data came from a three site, population-based, epidemiological study to examine diagnostic nosology for Ecstasy use. Subject inclusion criteria included lifetime Ecstasy use exceeding five times and once in the past year, with participants ranging in age between 16 and 47 years of age from St. Louis, Miami, U.S. and Sydney, Australia. A satisfactory model typified four latent classes representing clearly differentiated diagnostic clusters including: (1) a group of sub-threshold users endorsing few abuse and dependence symptoms (negatives), (2) a group of 'diagnostic orphans' who had characteristic features of dependence for a select group of symptoms (mild dependent), (3) a 'transitional group' mimicking the orphans with regard to their profile of dependence also but reporting some abuse symptoms (moderate dependent), and (4) a 'severe dependent' group with a distinct profile of abuse and dependence symptoms. A multinomial logistic regression model indicated that certain latent classes showed unique associations with external non-diagnostic markers. Controlling for demographic characteristics and lifetime quantity of Ecstasy pill use, criminal behavior and motivational cues for Ecstasy use were the most efficient predictors of cluster membership. This study reinforces the heuristic utility of DSM-IV criteria applied to Ecstasy but with a different collage of symptoms that produced four distinct classes of Ecstasy users.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/epidemiologia , Alucinógenos , N-Metil-3,4-Metilenodioxianfetamina , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/psicologia , Depressão/epidemiologia , Depressão/psicologia , Família , Feminino , Humanos , Modelos Logísticos , Masculino , Modelos Estatísticos , Escalas de Graduação Psiquiátrica , Religião , Medição de Risco , Apoio Social , Fatores Socioeconômicos , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto Jovem
14.
Pain ; 139(1): 127-35, 2008 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-18455314

RESUMO

The purpose of this study was to identify co-morbidity in a national sample (N=1408) of males and females entering treatment for opioid abuse. Our sample was primarily white, lived in small urban, suburban or rural locations (80%), and was well-educated. Chronic pain was a symptomatic feature in over 60% of all subjects. Furthermore, 79% of male and 85% of female prescription opioid abusers indicated that their first exposure to an opioid was a legitimate prescription for pain which subsequently led 60-70% to misuse to get high. Our data also indicate that the use of prescription opioids to get high represents the end stage on a continuum of substance abuse, beginning at a very early age. The age of first alcohol use, getting drunk, smoking, use of marijuana, stimulants and other non-opioid prescription or illicit drugs occurred very early (13-19) in prescription opioid misusers/abusers, whose first use of opioids did not occur, on average, until age 22. Finally, most of the sample had sought treatment 3 or more times for substance abuse prior to the treatment admission in which the survey was completed. Physical and mental health were very poor in both male and female prescription opioid abusers, but females were more ill and dysfunctional than males in all physical and particularly emotional domains. Our results suggest that a small number of "at risk" opioid naive pain patients, who might abuse their therapeutically appropriate opioid analgesics, can be identified by assessing pre- and co-morbid substance abuse and significant psychopathology.


Assuntos
Analgésicos Opioides , Dor/epidemiologia , Dor/psicologia , Admissão do Paciente , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Analgésicos Opioides/uso terapêutico , Comorbidade , Feminino , Humanos , Masculino , Dor/tratamento farmacológico , Admissão do Paciente/estatística & dados numéricos , Psicopatologia , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Inquéritos e Questionários
16.
J Psychoactive Drugs ; 40(4): 427-36, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19283947

RESUMO

Brief interventions to reduce harmful or problem behaviors have become increasingly popular in a variety of health fields, including HIV and hepatitis risk reduction. A central issue in intervention research involves the evaluation of what constitutes an effective "dose" of an intervention. This research examines the relative effectiveness of three alternative brief interventions of varying intensity designed to change the risk behaviors of inmates who are reentering society: a DVD-based, peer delivered intervention; the NIDA Standard HIV Intervention; and a standard practice condition (HIV educational video). All participants randomly received one of the interventions and were tested for HIV and HCV prior to release from custody. Thirty and ninety-day follow-ups examined changes in high-risk behaviors. Results reported here for 343 subjects who have completed the 90-day follow up indicate significant reductions in reported sexual risk behaviors for those participating the DVD intervention, compared to the other two brief interventions. This study is among the first to report any positive impacts on sexual behaviors among a population of inmates returning to the community.


Assuntos
Infecções por HIV/prevenção & controle , Educação em Saúde/métodos , Hepatite C/prevenção & controle , Prisioneiros/psicologia , Adulto , Idoso , Delaware , Feminino , Seguimentos , Infecções por HIV/transmissão , Hepatite C/transmissão , Humanos , Kentucky , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Comportamento de Redução do Risco , Assunção de Riscos , Comportamento Sexual/psicologia , Gravação de Videoteipe , Virginia , Adulto Jovem
17.
J Psychoactive Drugs ; 40(4): 471-81, 2008 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19283951

RESUMO

The HIV infection rate is increasing among women in general and for female inmates specifically (Maruschak 2004), which makes understanding the correlates of risky sexual behaviors critical for this population. Partner relationships, particularly the extent to which women perceive they have power within the relationship, may be important in modeling risk behaviors. Few studies have considered the association between relationship power and HIV risk behaviors among women offenders. This study examines women's perceptions of their relationships using the Sexual Relationship Power Scale (Pulerwitz, Gortmaker, & DeJong 2000) and NIDA's HIV Risk Behavior Assessment (NIDA 1995). Data were collected from female inmates in four prisons as part of the Reducing Risky Relationships for HIV protocol being conducted through the NIDA's Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement. Women reported whether they had engaged in five types of unprotected sex in the month prior to incarceration. Logistic regression models of the associations between relationship power and five types of unprotected sex revealed some support for the importance of power as a protective factor in reducing the odds of unprotected sexual behaviors. Implications and findings are presented to add to understanding of partner relationships and HIV risk behaviors.


Assuntos
Infecções por HIV/transmissão , Relações Interpessoais , Prisioneiros/psicologia , Sexo sem Proteção/psicologia , Adulto , Coleta de Dados , Feminino , Humanos , Modelos Logísticos , Psicometria , Comportamento de Redução do Risco , Assunção de Riscos , Comportamento Sexual/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Estados Unidos
18.
Subst Use Misuse ; 42(11): 1651-84, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17934989

RESUMO

Becker and Murphy's (1988) theory of rational behavior suggests that economic factors play an influential role in the decision leading to drug consumption and possibly dependence. Psychological models, on the other hand, emphasize internal regulatory cues that motivate drug use and play a contributory role in dependence. Until now, the confluence of both economic and psychological models has not been tested empirically. The present study used latent-variable structural equation modeling (SEM) to examine the influence of both economic (social anomie, unit price, and time spent acquiring drugs) and psychological risk factors (motivation, depression, and sexual risk behaviors) on self-reported ecstasy use. Data were obtained from 612 recreational ecstasy users in the United States and Australia participating in a NIDA-funded epidemiological study examining trends in ecstasy use. The sample was mainly white (61%), male (58%), and young (mean age = 23 yrs [5.25]). All of the hypothesized latent constructs were statistically reliable and correlated in the expected direction. A saturated SEM indicated that monetary and opportunity cost, but not income, significantly predicted ecstasy use. Among the psychological measures, motivational cues were the strongest predictor of both use and dependence. Inclusion of gender, age, race, education, and site variables did not appreciably alter the final model parameters. The implications of incorporating the role of economic factors in shaping a more refined understanding of addiction are discussed. Suggestions for future research and study limitations are also noted.


Assuntos
N-Metil-3,4-Metilenodioxianfetamina , Psicologia , Classe Social , Adulto , Austrália/epidemiologia , Análise Fatorial , Feminino , Humanos , Entrevistas como Assunto , Masculino , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologia
19.
Rev. bras. psiquiatr ; 29(3): 233-240, set. 2007. tab
Artigo em Inglês | LILACS | ID: lil-461510

RESUMO

OBJECTIVES: To compare changes in AIDS knowledge and risk behaviors among Brazilian cocaine users in an intervention trial. METHOD: 119 participants were randomly assigned to either a standard or a standard plus "thought mapping" intervention, and re-interviewed 2 and 8 weeks after intake using standardized data collection instruments. Intervention effects were examined using generalized estimated equation model. RESULTS: Significant increases in AIDS knowledge and condom use were observed in the experimental group, as well as significant changes in the subscores for sexual and drug risks. The experimental intervention was less successful in decreasing mean days of cocaine use when compared to the standard. CONCLUSION: Although not robust, the findings nevertheless suggest that components of the experimental thought-mapping model might be useful in combination with other approaches.


OBJETIVOS: Comparar as mudanças em conhecimento sobre AIDS e comportamentos de risco em usuários de cocaína brasileiros submetidos a uma intervenção experimental. MÉTODO: 119 sujeitos foram aleatoriamente designados para uma intervenção padrão ou uma intervenção padrão adicionada a um "mapa cognitivo", e re-entrevistados duas e oito semanas após admissão no estudo, utilizando-se instrumentos de coleta padronizados. Os efeitos da intervenção foram examinados utilizando modelo de equações de estimação generalizadas. RESULTADOS: Foram observados aumentos significativos no conhecimento sobre AIDS e uso de preservativos no grupo experimental, bem como modificações significativas nos subescores para risco sexual e uso de drogas. A intervenção experimental teve menos sucesso em diminuir dias de uso de cocaína quando comparada com a intervenção padrão. CONCLUSÃO: Apesar de não serem robustos, os achados sugerem que os componentes do modelo de mapa cognitivo experimentados poderiam ser úteis em combinação com outras abordagens.


Assuntos
Adulto , Humanos , Masculino , Cocaína Crack , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Infecções por HIV/prevenção & controle , Assunção de Riscos , Comportamento Sexual , Abuso de Substâncias por Via Intravenosa/epidemiologia , Brasil/epidemiologia , Estudos de Casos e Controles , Redes Comunitárias , Transtornos Relacionados ao Uso de Cocaína/psicologia , Transtornos Relacionados ao Uso de Cocaína/terapia , Preservativos , Infecções por HIV/transmissão , Educação Sexual , Parceiros Sexuais , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/psicologia , Abuso de Substâncias por Via Intravenosa/terapia
20.
Braz J Psychiatry ; 29(3): 233-40, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17713693

RESUMO

OBJECTIVES: To compare changes in AIDS knowledge and risk behaviors among Brazilian cocaine users in an intervention trial. METHOD: 119 participants were randomly assigned to either a standard or a standard plus "thought mapping" intervention, and re-interviewed 2 and 8 weeks after intake using standardized data collection instruments. Intervention effects were examined using generalized estimated equation model. RESULTS: Significant increases in AIDS knowledge and condom use were observed in the experimental group, as well as significant changes in the subscores for sexual and drug risks. The experimental intervention was less successful in decreasing mean days of cocaine use when compared to the standard. CONCLUSION: Although not robust, the findings nevertheless suggest that components of the experimental thought-mapping model might be useful in combination with other approaches.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Cocaína Crack , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Assunção de Riscos , Comportamento Sexual , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Brasil/epidemiologia , Estudos de Casos e Controles , Transtornos Relacionados ao Uso de Cocaína/psicologia , Transtornos Relacionados ao Uso de Cocaína/terapia , Redes Comunitárias , Preservativos/estatística & dados numéricos , Infecções por HIV/transmissão , Humanos , Masculino , Educação Sexual , Parceiros Sexuais , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/psicologia , Abuso de Substâncias por Via Intravenosa/terapia
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