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Director's Report to the National Advisory Council on Drug Abuse - May, 2006

Research Findings - Services Research

Pathways in the Relapse, Treatment, Recovery Cycle

For many individuals, substance use leads to a chronic cycle of relapse, treatment reentry, and recovery, often lasting for decades. This study replicates earlier work, documents the transition patterns within the cycle during a 3-year period, and identifies variables that predict these transitions. Data are from 1,326 adults recruited from sequential admissions to 12 substance abuse treatment facilities in Chicago, IL, between 1996 and 1998. Participants were predominantly female (60%) and African American (88%) adults. Participants were interviewed at intake, and at 6, 24, and 36 months post-intake. Follow-up rates ranged from 94% to 98% per wave. At each observation, participants' current status in the cycle was classified as (1) in the community using, (2) incarcerated, (3) in treatment, or (4) in the community not using. The transitional probabilities and correlates of pathways between these states were estimated. Over 83% of the participants transitioned from one point in the cycle to another during the 3 years (including 36% two times, 14% three times). For the people in the community, about half remained in the same status (either using or abstinent) and just under half transitioned to incarceration or treatment. The majority of people whose beginning status was incarceration or in-treatment also transitioned to in the community by the end of the observation period. While there was some overlap, predictors typically varied by pathway and direction (e.g., using to not using vs. not using to using). These results help demonstrate the need to adopt a chronic vs. acute care model for substance use. While exploratory and observational, several of the predictors are time-dependent and identify promising targets for interventions designed to shorten the cycle and increase the long-term effectiveness of treatment. Scott, C., Foss, M. and Dennis, M. Pathways in the Relapse--Treatment--Recovery Cycle Over 3 Years. J Subst Abuse Treat, 28(1), pp. S63-S72, 2005


Matching Offenders to Treatment and Services

This study examined the effectiveness of matching offenders with substance abuse problems to levels of treatment, services, and criminal justice supervision based on risk for recidivism and need. Building on the "risk, need, and responsivity" principle from criminology literature and the treatment matching concept from services research literature, this randomized clinical trial investigated the extent to which providing offenders identified as "high" risk (n=144) with more intense treatment and services than those identified as "moderate" risk (n=128) improved outcomes including drug use and criminal activity. Using a blocked random assignment procedure offenders were assessed for risk and treatment need and randomly assigned to receive either an enhanced regiment of treatment and supervision (seamless system) or standard probation services. The enhanced system consisted of intensive drug treatment, drug testing on a routine basis, use of graduated sanctions, and ensuring offenders participated in treatment for at least 6 months. Study results found that the seamless system model improved treatment participation, with greater gains experienced by offenders with high risk. However no main effects were observed for drug use or criminal behavior outcomes, although effect sizes illustrated that small effects were observed for high risk offenders. Investigators hypothesize failure to observe main effects may be attributable to instrumentation problems and the fact that substance abusers in the study reported low-severity substance abuse problems. They suggest that measurement of risk and need factors for offenders with substance abuse factors might benefit from a life course perspective regarding issues of onset and persistence of drug abuse and criminal activity. They state the importance of considering static (past) and dynamic (variable, temporal) risk and need factors when matching offenders to treatment, services, and criminal justice supervision. Taxman, F.S. and Thanner, M. Risk, Need, and Responsivity (RNR): It All Depends. Crime & Delinquency, 52(1), pp. 28-51, 2006.

HIV Intervention for Indigent Women Substance Abusers in the US Virgin Islands

As the HIV/AIDS epidemic continues to expand and penetrate new communities around the globe, risk reduction intervention initiatives must continue to evolve and adapt to new challenges and populations. This is especially true in the Caribbean Basin, where the feminization of the HIV epidemic is tied to a cultural milieu characterized by pervasive gender inequality. HIV intervention programs in the Caribbean must treat women's risks as a function of the social context, standards, and meanings of sexual behaviors and practices in the local community. As such, this article describes an initiative to develop an HIV prevention-intervention protocol for the cultural context of substance abusing women in the US Virgin Islands. Through street-based survey research combined with focus groups and in-depth interviews with such "cultural insiders" as members of the substance-abusing target population, members of the local public health and social services system, and community leaders, a culturally sensitive HIV/AIDS protocol was developed which addresses the supports and barriers to risk reduction faced by substance abusing women in the Virgin Islands. The intervention, which is delivered in three sessions, was pilot tested with 20 active or former substance abusing women. Results from the pilot test revealed that the women were engaged and found the material relevant to their lifestyles and concerns. Surratt, H., and Inciardi, J. Developing an HIV Intervention for Indigent Women Substance Abusers in the United States Virgin Islands. J Urban Health, 82(3-4), pp. iv74-iv83, 2005.

Substance Use, Sexual Risk, and Violence: HIV Prevention Intervention with Sex Workers in Pretoria

This paper describes an HIV prevention intervention designed in the US that was adapted and implemented in South Africa. Using an experimental design, 93 women who reported recent substance use and sex trading were randomly assigned to a modified Standard HIV intervention or to a Woman-Focused HIV prevention intervention. Eighty women completed the one-month follow-up interview. Participants reported high rates of sexual risk and violence at baseline. At follow-up, findings showed decreases in the proportion of women reporting unprotected sex and the daily use of alcohol and cocaine. Daily alcohol and cocaine use decreased more for women receiving the Woman-Focused intervention. Although violence continued to be a problem, at follow-up Woman-Focused participants reported being victimized less often than women receiving the Standard intervention. This study demonstrates the feasibility of implementing cross-cultural behavioral HIV prevention interventions, and supports the need for future studies of women's contextual issues and the effectiveness of targeted interventions. Wechsberg, W.M., Luseno, W.K., Lam, W.K., Parry, C.D. and Morojele, N.K. Substance Use, Sexual Risk, and Violence: HIV Prevention Intervention with Sex Workers in Pretoria. AIDS & Behavior, pp. 1-5, 2006.

The Effects of Providing Housing to Homeless Substance Abusers in Treatment

Housing typically is not provided to homeless persons during drug abuse treatment. This study examined how treatment outcomes were affected under three different housing provision conditions to which the sample was randomly assigned. One hundred and ninety six (196) cocaine-dependent participants received day treatment and no housing (NH), housing contingent on drug abstinence (ACH), or housing not contingent on abstinence (NACH). Drug use was monitored with urine testing. The ACH group had a higher prevalence of drug abstinence than the NACH group (after control for treatment attendance), which in turn had a higher prevalence than the NH group. All 3 groups showed significant improvement in maintaining employment and housing. The results of this and previous trials indicate that providing abstinence-contingent housing to homeless substance abusers in treatment is an efficacious, effective, and practical intervention. Programs to provide such housing should be considered in policy initiatives. Milby, J.B., Schumacher, J.E., Wallace, D., Freedman, M.J., and Vuchinich, R.E. To House or Not to House: The Effects of Providing Housing to Homeless Substance Abusers in Treatment. Am J Public Health, 95(7), pp. 1259-1265, 2005.

Trial of Interim Methadone Maintenance

Effective alternatives to long waiting lists for entry into methadone hydrochloride maintenance treatment are needed to reduce the complications of continuing heroin dependence and to increase methadone treatment entry. The researchers compare the effectiveness of interim methadone maintenance with that of the usual waiting list condition in facilitating methadone treatment entry and reducing heroin and cocaine use and criminal behavior. The researchers followed 319 patients who participated in a randomized, controlled, clinical trial using 2 conditions, with treatment assignment on a 3:2 basis to interim maintenance-waiting list control within a methadone treatment program in Baltimore. The intervention consisted of Interim methadone maintenance, consisting of an individually determined methadone dose and emergency counseling only for up to 120 days, or the comparison control referral to community-based methadone treatment programs. Significantly more participants assigned to the interim methadone maintenance condition entered comprehensive methadone maintenance treatment by the 120th day from baseline (75.9%) than those assigned to the waiting list control condition (20.8%) (P<.001). Overall, in the past 30 days at follow-up, interim participants reported significantly fewer days of heroin use (P<.001), had a significant reduction in heroin-positive drug test results (P<.001), reported spending less money on drugs (P<.001), and received less illegal income (P<.02) than the waiting list participants. Thus, according to this study's findings, interim methadone maintenance results in a substantial increase in the likelihood of entry into comprehensive treatment, and is an effective means of reducing heroin use and criminal behavior among opioid-dependent individuals awaiting entry into a comprehensive methadone treatment program. Schwartz, R., Highfield, D., Jaffe, J., Brady, J., Butler, C., Rouse, C., Callaman, J., O 'Grady, K. and Battjes, R. Trial of Interim Methadone Maintenance. Arch Gen Psychiatry, 63(1), pp. 102-109, 2006.

Trends of HIV Risk Behaviors in a Cohort of Injecting Drug Users and Their Sex Partners

A cohort of 111 injection drug users (IDUs) and their sex partners was assessed in 1988 concerning risk behaviors for HIV and knowledge of HIV/AIDS. Ten years later, in 1998, the cohort was reassessed using the same instrument. All who were HIV negative in 1988 were retested by blood draw for antibodies to HIV. A paired analysis was utilized to determine individual changes in risk behaviors for three serostatus groups--those who remained HIV negative (long-term HIV negatives), seroconverters, and those positive in 1988 (long-term HIV positives). Incidence was twice as high for sex partners (37.5%) as for IDUs (18.0%). Drug and needle use risk behaviors, except crack use, showed decreases; sexual risk behaviors were less amenable to change. Knowledge significantly increased among the long-term HIV negatives and seroconverters but not among those HIV positive in 1988. This analysis demonstrates the need for continued intervention among IDUs and their sex partners. McCoy, C., Metsch, L., Comerford, M., Zhao, W., Coltes, A., and Messiah, S. Trends of HIV Risk Behaviors in a Cohort of Injecting Drug Users and Their Sex Partners in Miami, Florida, 1988-1998. AIDS Behav, 9(2), pp. 187-199, 2005.

Psychosocial and Behavioral Differences Among Drug Injectors Who Use and Do Not Use Syringe Exchange Programs

Most research on the benefits of syringe exchange programs (SEPs) has focused on assessing program effectiveness and identifying risk profiles of SEP customers. To the researchers' knowledge, no empirical studies have considered the psychosocial characteristics of IDUs who do and do not use SEPs. To determine whether IDUs who do and do not use SEPs differ along demographic, psychosocial, and HIV risk characteristics and behaviors, data were analyzed from a three-city (Chicago, IL; Hartford, CT; Oakland, CA) observational study of how HIV prevention messages and supplies diffuse from SEPs. The study sample consisted of 350 participants with no reported history of HIV, hepatitis B or C virus infection. Self-efficacy was the only psychosocial factor to differentiate SEP customers from all non-customers groups; injecting others and pre-injection cleaning of the injection site differentiated some non-customers from customers. Implications for Future Interventions are discussed. Grau, L., Bluthenthal, R., Marshall, P., Singer, M., and Heimer, R. Psychosocial and Behavioral Differences Among Drug Injectors Who Use and Do Not Use Syringe Exchange Programs. AIDS Behav, 9(4), pp. 495-504, 2005.

Assessing Criminal Thinking as part of Drug Abuse Treatment for Offenders

Risk assessments used by the criminal justice system have focused on recidivism and generally relied on actuarial measures of criminal history. The research described in this paper seeks to expand measures of risk for offenders with substance abuse problems and measure dynamic factors of risk that may change as a result of intervention and participation in drug treatment. The instrument developed by this group of researchers, TCU Criminal Thinking Scales (TCU CTS), is intended to measure criminal thinking, a dynamic type of cognitive risk that has been correlated with static risk factors such as prior incarceration. Criminal thinking constructs, including antisocial attitudes, can be the target of intervention for treatment programs, including drug abuse treatment, seeking to change behavior and improve outcomes for offenders. The TCU CTS was developed in an effort to provide criminal justice treatment providers with a brief and cost-effective criminal thinking instrument. This instrument was designed initially to be used in a prison-based residential drug abuse treatment program using a cognitive-based curriculum targeting drug use and criminal activity. The 37-item instrument includes scales to measure Entitlement, Justification, Personal Irresponsibility, Power Orientation, Cold Heartedness, and Criminal Rationalization. For each scale, items are rated using a 5-poing Likert-type scale (1=disagree strongly, 2=disagree, 3=uncertain, 4=agree, 5=agree strongly). Five research centers, funded as part of NIDA' s Criminal Justice Drug Abuse Treatment Studies Research Cooperative participated in the study. Data was collected from a cross-sectional sample of 3,266 offenders participating in 26 prison-based drug treatment programs across the country. Results indicate that the TCU CTS has good psychometric properties and offers the correctional treatment field a quick and reliable self-report assessment of criminal thinking. All 6 criminal thinking scales had sound factor structures and respectable response distributions. All maintained acceptable reliability and goodness-of-fit coefficients across the split-half samples. The investigators suggest that this instrument could be used as part of a larger measurement system designed to examine treatment progress and program effectiveness. When repeatedly administered over the course of treatment, the instrument provides programs with a method to document the impact of interventions and change in offender thinking and attitudes that have been associated with drug use and criminal activity. Knight, K., Garner, B.R., Simpson, D.D., Morey, J.T., and Flynn, P.M. An Assessment for Criminal Thinking. Crime & Delinquency, 52(1), pp. 159-177, 2006.

HIV and HCV Testing for Young Drug Users in Rhode Island

Young injection drug users (IDU) are at risk for both human immunonodeficiency virus (HIV) and Hepatitis C infections (HCV). Rates of HIV testing have been widely documented, but limited information exists regarding HCV screening rates. Among a community sample of 86 IDUs, aged 18-25 years in Rhode Island, 87.2% reported having ever been tested for HIV, versus 51.2% for HCV (p < .001). Young IDUs were under-screened for HCV compared with the far less prevalent HIV infection. Pugatch, D., Anderson, B., O'Connell, J., Elson, L., and Stein, M. HIV and HCV Testing for Young Drug Users in Rhode Island. J Adolesc Health, 38(3), pp. 302-304, 2006.

Mechanisms that Link Addiction Treatment Patients to Primary Care Influence Subsequent Utilization of Emergency and Hospital Care

Patients with drug use disorders are heavy users of emergency department (ED) and inpatient hospital care. This study examines whether formal mechanisms to link addiction treatment patients to primary medical care, either directly on site, or by off-site referral-when compared with an absence of these mechanisms-might reduce these patients use of ED and hospital services after substance abuse treatment. The authors used longitudinal data from 6 methadone maintenance programs with 232 patients, 24 outpatient nonmethadone programs with 1202 patients, and 14 long-term residential programs with 679 patients in the National Treatment Improvement Evaluation Study. Multivariate logistic models controlling for health status and medical service utilization before treatment examined whether provision of medical services on- or off-site during treatment linkage led to reduced use of ED and hospital services in the year after treatment compared with no such provision. This study shows that the on-site delivery of primary care reduced subsequent ED and hospital use among patients in methadone maintenance and long-term residential compared with the non-linkage condition but not in outpatient nonmethadone programs. Off-site referral for medical care reduced subsequent ED visits but not hospitalizations in long-term residential programs. These findings suggest that for some treatment modalities, stronger primary care linkage mechanisms decrease subsequent utilization of expensive ED and hospital services. Future study should examine the cost implications of these strong linkage mechanisms and ways to strengthen linkages to off-site medical care. Friedmann, P., Hendrickson, J., Gerstein, D., Zhang, Z., and Stein, M. Do Mechanisms that Link Addiction Treatment Patients to Primary Care Influence Subsequent Utilization of Emergency and Hospital Care? Med Care, 44(1), pp. 8-15, 2006.

A Risk-Taking Among Adolescents with Serious Conduct and Substance Problems

Adolescent patients' conduct disorder and substance use disorder symptoms are "risky behaviors" with unpredictable rewards and punishments. The authors studied whether such youths also take excessive risks in new situations without prior learning, peer pressure, or intoxication. Subjects were 20 adolescent patients in a program treating conduct disorder and substance use disorder and 20 controls. All were substance free > or =7 days; underwent substance-related, psychological, and social assessments; and performed the Balloon Analogue Risk Task: mouse presses inflated a computerized "balloon" image, each press earning 1 cent. The 30 balloons "popped" at unpredictable sizes; earnings from popped balloons were lost. A "Collect" response saved current earnings and advanced to the next balloon. It was found that the mean number of inflating presses was 1021in patients, and 705 (p = .001) in controls, group differences were stable from the task's beginning. Mean inflating presses before a "collect" response: was 38.6 in patients, and 24.0 (p = .0005) in controls, Mean balloons popped were 9.8 in patients, and 6.3 (p = .001) in controls. Patients (versus controls) reported more aggressiveness and substance use and perceived less risk from substances. Patients' responses were significantly slower than those of controls. This study shows that from the beginning of this novel task, conduct disorder and substance use disorder patients (compared with controls) took more risks, indicating an initial risk-taking propensity, although patients' slower responses argued against "impulsive, thoughtless" behavior. Crowley, T., Raymond, K., Mikulich-Gilbertson, S., Thompson, L., and Lejuez, C. A Risk-Taking "Set" in a Novel Task Among Adolescents with Serious Conduct and Substance Problems. J Am Acad Child Adolesc Psychiatry, 45(2), pp. 175-183, 2006.

Medicaid Eligibility and Access to Mental Health Services Among Adolescents in Substance Abuse Treatment

The co-occurrence of a mental disorder is common among adolescents who present for substance abuse treatment. This study was conducted to determine whether Medicaid eligibility was associated with greater use of mental health services. The study used administrative data for 25,813 adolescents in Oregon. Propensity score analysis was used to assess the likelihood that the adolescents would use mental health services, with group differences and mental health needs as control variables. The study found that Medicaid-eligible youths were nearly five times as likely to receive mental health services in the year they entered substance abuse treatment compared with non-Medicaid-eligible youths. In both groups, there was evidence of racial disparities as well as factors such as foster care that may facilitate access. The fact that Medicaid-eligible youths have greater access to mental health services should be considered in both policy and research design. Funding bodies considering ways to better serve adolescents with co-occurring disorders should consider examining ways to promote Medicaid enrollment or expand eligibility. Deck, D., and Ley, K. Medicaid Eligibility and Access to Mental Health Services Among Adolescents in Substance Abuse Treatment. Psychiatr Serv, 57(2), pp. 263-265, 2006.

Associations Between Phenylthiocarbamide Gene Polymorphisms (Bitter Taste Sensation) and Cigarette Smoking

Phenotypic evidence indicates that the ability to taste the bitter compounds phenylthiocarbamide (PTC) and 6-n-propylthiouracil (PROP) may protect against cigarette smoking. In this study, PTC gene haplotypes were found to be associated with both the odds of being a smoker and the importance of cigarette taste as a smoking motive. Smokers (n = 384) and nonsmokers (n = 183) were genotyped for polymorphisms that affect taste sensitivity to PTC and PROP. The "taster" PAV haplotype, relative to the "nontaster" AVI haplotype, was predicted to be associated with reduced odds of being a smoker and lower taste motivation as measured by the Wisconsin Inventory of Smoking Dependence Motives-68 taste/sensory processes scale. The results did not support the predicted association between the PAV and AVI haplotypes and smoker odds, but the AAV haplotype, which confers intermediate PTC/PROP taste sensitivity, was associated with reduced smoker prevalence (49% vs. 70%), chi(2)(1, N = 567) = 10.392, p = .001. The predicted relationship between PAV and AVI and taste motivation was found, F (2, 348) = 3.303, p = .038. The results encourage further exploration of the role of taste/sensory processes in tobacco dependence, and their role in specific smoking cessation treatments. Cannon, D., Baker, T., Piper, M., Scholand, M., Lawrence, D., Drayna, D., McMahon, W., Villegas, G., Caton, T., Coon, H., and Leppert, M. Associations Between Phenylthiocarbamide Gene Polymorphisms and Cigarette Smoking. Nicotine Tob Res, 7(6), pp. 853-858, 2005.

Matching Judicial Supervision to Client Risk in Drug Courts

This article reports outcomes from a program of experimental research evaluating the risk principle in drug courts which posits that the level of criminal justice supervision and services should match the level of risk an individual poses to the community. Prior studies revealed that participants who were determined to be high risk and had (a) antisocial personality disorder or (b) a prior history of drug abuse treatment performed better in drug court when scheduled to attend biweekly judicial status hearings in court. In contrast, participants who were low risk performed equivalently regardless of the court hearings schedule. This study prospectively matches drug court clients (n=274) to the optimal schedule of court hearings based on an assessment of their risk status and compares outcomes to clients randomly assigned to the standard hearings schedule. Results confirmed that participants who were high risk and matched to biweekly hearings had better during-treatment outcomes than participants assigned to status hearings as usual. These findings provide confirmation of the risk principle in drug courts and yield practical information for enhancing the efficacy and cost-efficiency of drug courts. Marlowe, D.B., Festinger, D.S., Lee, P.A., Dugosh, K.L., and Benasutti, K.M. Matching Judicial Supervision to Clients' Risk Status in Drug Court. Crime & Delinquency, 52(1), pp. 52-76, 2006.

Secondary Prevention Services in Drug Court: A Conceptual Model

This article presents a conceptual framework for developing and administering secondary prevention services in drug courts and proposes a platform of prevention techniques that can be tailored in a clinically relevant manner for the sizeable population of drug court clients who are low risk. The drug court model assumes that most drug offenders are addicts, and that drug use fuels other criminal activity. As a result, drug court clients must satisfy an intensive regimen of treatment and supervisory obligations. However, research suggests that roughly one third of drug court clients do not have a clinically significant substance use disorder. For these clients, standard drug court services may be ineffective or even contraindicated. Instead, these clients may be best suited for a secondary prevention approach directed at interrupting the acquisition of addictive behaviors. DeMatteo, D.S., Marlowe, D.B., and Festinger, D.S. Secondary Prevention Services for Clients who are Low Risk in Drug Court: A Conceptual Model. Crime & Delinquency, 52(1), pp. 114-134, 2006.

The Role of Health Insurance in Getting a Physical Exam

One component of social work' s endeavors on behalf of drug users and other populations- at-risk has been advocating for increased access to health care. This article examines the role that having health insurance plays in obtaining the most basic of all health care-getting a physical examination. Featuring a sample of 1,271 chronic and injecting street drug users and comparison group non-users, the analysis demonstrates that having health insurance enhances access and utilization of health care among this at-risk population. Subjects who had health insurance for even one month of the past twelve were twice as likely to participate in basic health care by having a physical exam. McBride, D., Drumm, R., Terry-McElrath, Y. and Chitwood, D. Back to Basics: The Role of Health Insurance in Getting a Physical Exam. Soc Work Health Care, 42(51), pp. 93-106, 2005.

Sexual Risk Behavior and Substance Use Among a Sample of Asian Pacific Islander Transgendered Women

This study examined the prevalence and correlates of HIV-related sexual risk and substance use behaviors among Asian Pacific Islander (API) male-to-female (MTF) transgendered individuals, referred to here as API transgendered women. As part of a larger study on HIV risk among transgendered women of color (Nemoto, Operario, Keatley, Han, & Soma, 2004), a sample of 110 API transgendered women in San Francisco completed individual interviews, of which 13% reported being HIV-positive. In the past 30 days, one fifth of the sample engaged in unprotected receptive anal intercourse (URAI) with any male partner, nearly one half had sex while under the influence of substances, and over half used illicit drugs. In multivariate models, URAI was associated with commercial sex work (odds ratio [OR] = 4.23, 95% confidence interval [CI] = 1.10, 16.25) and previous attempted suicide (OR = 5.83, 95% CI = 1.02, 33.44). Sex under the influence of substances was associated with commercial sex work (OR = 3.35, 95% CI = 1.11, 10.13) and having a college degree (OR = 5.32, 95% CI = 1.34, 21.18). Illicit drug use was associated with commercial sex work (OR = 7.15, 95% = 2.26, 22.63). Findings suggest that API MTF transgenders are on the front line of HIV risk for the API community, and provide insight into factors within this group that might contribute to unsafe sex and substance use. Operario, D., and Nemoto, T. Sexual Risk Behavior and Substance Use Among a Sample of Asian Pacific Islander Transgendered Women. AIDS Educ Prev, 17(5), pp. 430-443, 2005.

Addiction Treatment Utilization among Homeless and Housed

Research on addiction treatment utilization in indigent samples mainly has been retrospective, without the measures of three factors: addictive consequences, social network influences, and motivation. In this prospective study, the researchers focus upon these three factors as they are associated with utilization of addiction treatment and mutual help groups among substance-dependent persons with high rates of homelessness. Patients detoxified from alcohol or drugs at baseline were followed for 2 years in a randomized clinical trial of linkage to primary care (n = 274). Outcomes included utilization of Inpatient/Residential, Outpatient, Any Treatment, and Mutual Help Groups. Predictor variables in longitudinal regression analyses came from the literature and clinical experience, organized according to theoretical categories of Need, and non-Need (e.g., Predisposing and Enabling). Many subjects used Inpatient/Residential (72%), Outpatient (62%), Any Treatment (88%) or Mutual Help Groups (93%) at least once. In multivariable analyses, addictive consequences (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.12-1.71), motivation (OR 1.32, 95% CI 1.09-1.60), and female gender (OR 1.80, 95% CI 1.13-2.86) were associated with most treatment types. Homelessness was associated with Residential/Inpatient (for Chronically Homeless vs. Housed, OR 1.75, 95% CI 1.04-2.94). Living with one's children (OR 0.51, 95% CI 0.31-0.84) and substance-abusing social environment (OR 0.65, 95% CI 0.43-0.98) were negatively associated with Any Treatment. Addictive consequences, social network variables, and motivation were associated with treatment utilization in this sample. Non-need factors, including living with one's children and gender, also were found to be significant influences on treatment utilization. Kertesz, S., Larson, M., Cheng, D., Tucker, J., Winter, M., Mullins, A., Saitz, R., and Samet, J. Need and Non-Need Factors Associated with Addiction Treatment Utilization in a Cohort of Homeless and Housed Urban Poor. Med Care, 44(3), pp. 225-233, 2006.

Club Drug Use and Risky Sexual Practices Among Hispanic MSM

This study measured use of club drugs among 262 Hispanic men who have sex with men (MSM) recruited at community venues in Miami-Dade County, Florida in 2001. More than 50% of men used club drugs, and 36% used them in the last 3 months. Lifetime and 3-month rates were: ecstasy (36% and 20%), cocaine (34% and 12%), amyl nitrates (28% and 9%), and crystal methamphetamine (20% and 15%). Thirty-six percent had used two or more drugs (polydrug use) in their lifetime and 20% reported polydrug use in the last 3 months. Club drug users had significantly more sex partners in the last 12 months than nonclub drug users. High rates (35%) of unprotected anal sex in the last 3 months were reported by both groups. Men who reported polydrug use in the last 3 months were significantly more likely than men who used a single club drug to have had sex under the influence of club drugs (83% vs. 57%; X2=7.4, p=0.006). At the multivariate level, a significant association between preference for use of English and lifetime club drug use emerged. Effective interventions to reduce club drug use and risky sex for Hispanic MSM are needed. Fernández, M., Bowen, G., Varga, L., Collazo, J., Hernandez, N., Perrino, T., and Rehbein, A. High Rates of Club Drug Use and Risky Sexual Practices Among Hispanic Men Who Have Sex With Men in Miami, Florida. Subst Use Misuse, 40(9-10), pp. 1347-1362, 2005.

Sexual Minoirites Seeking Substance Abuse Treatment Show Relatively Higher Symptom Severity

Previous research has suggested that lesbian, gay, bisexual, and transgender (LGBT) individuals enter treatment for substance abuse with more severe problems than heterosexual individuals. However, methodological difficulties, particularly the difficulty of obtaining a representative sample, have limited the ability to draw conclusions. This study examined a representative sample of openly LGBT clients receiving publicly funded substance abuse treatment by using data gathered by treatment providers in Washington State. Baseline differences between 610 openly LGBT and 15,705 heterosexual clients admitted for treatment at any of 212 agencies during an 18-month period ending in 2002, were compared in a variety of domains. Results demonstrated that openly LGBT clients enter treatment with more severe substance abuse problems, greater psychopathology, and greater medical service utilization when compared with heterosexual clients. Cochran, B.N. and Cauce, A. Characteristics of Lesbian, Gay, Bisexual, and Transgender Individuals Entering Substance Abuse Treatment. J Subst Abuse Treat, 30, pp. 135-146, 2006.

Gender Differences in the Prediction of Condom use Among Incarcerated Juveniles

This research study applied the Information-Motivation-Behavioral skills (IMB) model in predicting condom-protected vaginal intercourse among incarcerated youth. The IMB model is a three-factor conceptualization of HIV preventive behavior. According to the IMB Model, there are three fundamental determinants of AIDS risk reduction including: information on HIV/AIDS transmission and information on specific prevention methods, motivation to act on the knowledge and change risky behavior, and behavioral skills in performing the specific prevention acts. Self-report measures of AIDS knowledge, pro-condom peer influence, risk perception, condom attitudes, condom use self-efficacy, frequency of vaginal intercourse, and frequency of condom-protected vaginal intercourse were collected from predominately African-American adolescent juvenile detainees (N=523). Study results found that for males and females combined condom use was significantly predicted by being male, peer influence, positive condom attitudes, and condom self-efficacy. In separate gender analyses, condom use among adolescent males was predicted by peer influence and positive condom attitudes, whereas condom use among females was predicted by peer influence, self-efficacy, and influence, higher perceived risk for infection, more positive condom attitudes, and more self-efficacy, but females also reported less condom use. The investigators conclude that girls may find it more difficult to consistently use condoms despite awareness of their efficacy. Power imbalances or other dynamics operating in their relationships with boys need further exploration. Robertson, A.A., Stein, J.A., and Baird-Thomas, C. Gender Differences in the Prediction of Condom Use Among Incarcerated Juvenile Offenders: Testing the Information-Motivation-Behaviors Skills (IMB) Model. Journal of Adolescent Health, 38, pp. 18-25, 2006.

Motivational Interviewing for Improving Adherence to Antiretroviral Medications

Many interventions have been developed to address barriers to antiretroviral medication adherence, but few have focused on motivation, a fundamental component of behavior change. Research on other health behavior changes and a few pilot studies investigating motivational interviewing (MI) for adherence to antiretroviral medication suggests that MI may be highly beneficial by helping to motivate patients with HIV to adhere to their medications. Existing research, although limited, suggests that MI combined with other interventions is feasible and efficacious for improving adherence to antiretroviral medications. With continued development and refinement of antiretroviral adherence interventions that incorporate MI, more persons with HIV infection can be expected to choose to make the difficult changes necessary for them to benefit from antiretroviral therapy. Cooperman, N., and Arnsten, J. Motivational Interviewing for Improving Adherence to Antiretroviral Medications. Curr HIV/AIDS Rep, 2(4), pp. 159-164, 2005.

Stakeholders in Recovery: Demands, Expectations, and Research Opportunities

A broad array of agencies, institutions, and individuals interact with community-based substance abuse treatment programs, providing resources or services and asserting demands and expectations in return. These relationships shape the environment in which treatment and community-based research take place, and themselves raise issues worthy of research attention. This article enumerates the stakeholders in one well-established program and describes the scope of the program's efforts to accommodate these stakeholders, along with some of the complications and difficulties programs confront in their attempts to satisfy stakeholders, especially when their demands are unrealistic or their interests conflict. The article concludes by identifying research areas that could facilitate these relationships, enhancing their benefits for patients. McCarty, D., Zammarelli, L., Wylie, H., and Greenlick, M.R. NIDA Science & Practice Perspectives, 3(1), pp. 34-37, 2005.


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