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Director's Report to the National Advisory Council on Drug Abuse - May, 2003

Research Findings - Research on AIDS and Other Medical Consequences of Drug Abuse - Non-AIDS Medical Consequences of Drug Abuse

Family-Based Treatment For Drug Abuse

Dr. Howard Liddle and colleagues at the University of Miami's Center for Treatment Research on Adolescent Drug Abuse (CTRADA) conducted a comprehensive review of the status of family-based treatment for drug abuse in 1995 and concluded that this modality offered a "promising, but not definitive" approach to treating drug abuse among adolescents and adults. Less than a decade later, significant progress can be seen in the treatment of drug abuse problems using family-based approaches, particularly with adolescents. Family-based treatments are currently recognized as among the most effective approaches for adolescent drug abuse. Family-based treatment of adult drug abuse problems has also advanced in important ways with the recent systematic application and testing of engagement techniques and behavioral couples therapy approaches. The current review characterizes and discusses the developmental status of this subspecialty and outlines areas in which continued research attention is needed. Rowe, C.L. and Liddle, H.A. Journal of Marital and Family Therapy, 29(1), pp. 97-120, January 2003.

Consequences and Costs of Closing a Publicly Funded Methadone Maintenance Clinic

Dr. Pierre Alexandre and colleagues examined the economic consequences and related costs of closing the Central Methadone Clinic (CMT), a long-established substance abuse treatment program in Miami, Florida, on May 31, 1997. Economic consequences were determined through comparative analysis of patient status at baseline and one year following treatment cessation for Miami clients, relative to a comparison group in Jacksonville, Florida that had continued access to a publicly funded methadone treatment clinic. Outcome measures included health-care utilization, addiction treatment, employment income, and crime. Bivariate and multivariate analyses were conducted to estimate differences in consequences and related costs. Total cost as well as the cost for each category (except for addiction treatment) was statistically similar for both groups. The researchers concluded that clients at the CMT did not generate significant economic consequences/costs for taxpayers or society in general during the year following closure relative to clients at a comparison clinic. Alexandre, P.K., Salome, H.J., French, M.T., Rivers, J.E. and McCoy, C.B. Social Science Quarterly, 83(2), pp. 519-536, June 2002.

Met and Unmet Need for Dental Services among Active Drug Users in Miami, Florida

Dr. Lisa Metsch and colleagues examined both met and unmet need for dental services among chronic drug users in Miami, Florida, and compared them with non-drug users recruited from the same neighborhoods (N = 1,479). Three primary findings emerged: (1) dental problems are among the most frequently reported health problems, (2) drug use is independently associated with need for dental services, and (3) injection drug use is independently associated with increased odds of unmet need for dental services. These findings suggest that policies that increase access to dental services for drug users and other disadvantaged groups are needed. These services could be integrated into existing behavioral health programs already targeting active drug users. Metsch, L.R., Crandall, L., Wohler-Torres, B., Miles, C.C., Chitwood, D.D. and McCoy, C.B. Journal of Behavioral Health Services Research, 29(2), pp. 176-88, May 2002.

Mass Vaccination for Smallpox More Effective Than Alternatives

With support from NIDA, and in response to requests for assistance from the National Academy of Sciences (NAS) and Fogarty International Center, AIDS modelers embedded a traced vaccination approach in a smallpox disease transmission model to estimate the number of cases and deaths that would result from an attack in a large urban area. They demonstrated that mass vaccination results in both far fewer deaths and much faster epidemic eradication over a wide range of disease and intervention policy parameters, including those believed most likely, and that mass vaccination similarly outperforms starting with traced vaccination and switching to mass vaccination only if required. Kaplan, E., Craft, D., and Wein, L. Emergency Response to a Smallpox Attack: The Case for Mass Vaccination. Proceedings of the National Academy of Sciences, 99, pp. 10395-10440, 2003.

Emergency Response to an Anthrax Attack

NIDA researchers developed a mathematical model that included atmospheric dispersion, age-dependent dose response, disease progression, and queuing systems for antibiotic distribution and hospital care to compare various emergency responses in the event of an airborne anthrax attack. They demonstrated the need for extremely aggressive and timely use of oral antibiotics by all asymptomatics in the exposure region, for the creation of surge capacity for supportive hospital care, and for the use of federal and military resources and nationwide network of medical volunteers. Wein, L.M., Craft, D.L., and Kaplan, E.H. Emergency Response to an Anthrax Attack. Proceedings of the National Academy of Sciences, 100(7), pp. 4346-4351, 2003.

Drugs and Firearms Deaths in New York City

Firearm deaths remain among the leading causes of mortality in the United States. Changing law enforcement activities, incarceration, drug use, and socioeconomic conditions may have played roles in the declining rates of firearm deaths during the 1990s. Using records from the Office of the Chief Medical Examiner, we analyzed the role of drugs in firearm deaths in New York City between 1990 and 1998. Positive drug toxicology was present in over half of all firearm death victims during this time. Cocaine, cannabis, opiates, and alcohol accounted for almost all of these deaths with drug-positive toxicology. There were decreases in cocaine-and alcohol-positive toxicology for firearm deaths in New York City starting in the early 1990s; there was a more gradual decrease in heroin-positive toxicology for firearm deaths. Cannabis-positive toxicology for firearm deaths increased in the early part of the 1990s and then decreased starting in the mid-1990s. Although the disparities between minority and white firearm death rates narrowed during this time, minorities remained about three times more likely to be victims of fatal firearm violence than whites in 1998. The highest firearm death rates were among African American and Latino male decedents, with a larger proportion of Latinos testing cocaine or opiate positive, while a larger proportion of African Americans tested cannabis positive. These results suggest a complex role of drugs in firearm-related deaths, Galea, S., Ahern, J., Tardiff, K., Leon, A.C., and Vlahov, D. Drugs and Firearm Deaths in New York City, 1990-1998. J Urban Health, 79(1), pp. 70-86, March 2002.

Maternal Smoking During Pregnancy

University of Chicago researchers have reported on fluctuations in women's cigarette smoking during pregnancy, with special attention to implications for the design of clinical interventions and for research on the effects of fetal exposure to cigarettes. Data were analyzed from two independent projects, the National Health Interview Survey 1991 Pregnancy and Smoking Supplement (N=1426), and the Family Health and Development Project, the latter a small (N=60), prospective, clinic-based study. A substantial portion of the women in the large study showed a pattern of repeated cessation and relapse. In the smaller sample, fluctuations in smoking intensity were also substantial. While 48% quit or reduced smoking when they learned of their pregnancy, more than half changed smoking intensity multiple times. The investigators conclude that simple measures of smoking during pregnancy may lead to underestimation of possible fetal impact, and that brief smoking cessations early in pregnancy are likely to be inadequate for many women. Pickett, K.E., Wakschlag, L.S., Dai, L., and Leventhal, B.L. Fluctuations of Maternal Smoking During Pregnancy. Obstetrics and Gynecology, 101, pp. 140-147, 2003.


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