Innovative alcohol- and drug-user treatment of inmates in New Zealand prisons

The Kowhai Alcohol and Drug Treatment Unit at Rolleston Prison offers an innovative treatment approach for New Zealand inmates. The development of the program has involved local staff from Public Prisons, Psychological Services, and the Community Probation Service (CPS). This presentation outlines the author's impression of this bold innovation. The primary aim of the program is to reduce recidivism. This is achieved by assisting inmates to recognize the thoughts, emotions, and behaviours that are present in the period preceding and/or during the commission of criminal activity--particularly those that are precipitated and/or maintained by alcohol and drug use. This insight, coupled with the learning of specific coping skills and intensive lifestyle and reintegration planning, leads naturally to the follow-up phase that is conducted in the community. The functional relationship between offending and substance use is far more explicitly addressed in this new program compared with past programs that focused more on substance use.

Prevention of HIV among drug users

The relationship between injection drug use and HIV was established early in the HIV epidemic, and injection drug use has continued to be an important risk factor for HIV throughout the world. This panel included 4 papers related to HIV prevention among drug users, focusing on effective prevention strategies, the importance of organizing the AIDS-affected community, the impact of knowledge of serostatus on risk behaviors, and developing interventions for drug-using homosexual and bisexual men. These papers, addressing various aspects of the epidemic and methods to enhance prevention efforts, all indicate that although extensive knowledge regarding how to reduce HIV risks among drug users has accumulated, many areas for further research and intervention development remain.

Migration, acculturation, displacement: migratory workers and "substance abuse"

The following essays represent the topics and issues raised by the panel presenters. A diverse group of researchers came together to compare and contrast the substance use and "abuse" practices and patterns of marginalized groups in their region of the world. The panelists included researchers discussing: the hill people of Burma, Mäori in New Zealand, Algerians in France, Mexican-Americans in the United States and predominantly African-American homeless males in New York. We found many common themes. In particular, we found that each of the marginal populations increased their use of substances with increased time in the host society/culture. It was agreed that substance use is not only a process of adaptation but also a coping mechanism in, for the most part, hostile and unwelcoming environments. We also agreed that "abuse" of substances is not common to traditional cultures. Migration to a more modern society was accompanied by initiation and/or increase in substance use. When used at all, indigenous people tend to use substances in the controlled form of ritual and ceremony. The use of substances as a method of desensitizing to day-to-day stressors was adopted with exposure to the practises of their new surroundings. We found that there are more commonalities in the processes we examined than differences independent of location and race/ethnicity.

A brief overview and introduction to artificial neural networks

This article is designed to acquaint professionals working in the field of substance use intervention with a range of artificial intelligence nonlinear, powerful tools, artificial neural networks, concepts, and paradigms. The family of ANNs, when appropriately selected and used, permits the maximization of what can be derived from available data as well as our studying and understanding the many people, processes, and phenomena which comprise substance use and its intervention. The latter represent complex, dynamic, multidimensional phenomena which are unpredictable and uncontrollable in the traditional "cause and effect" sense. As such they are likely to be nonlinear in their very essence. Using linear-based paradigms for planned intervention with nonlinear phenomena brooks the all-too-common possibility of using inappropriate intervention paradigms and/or drawing misleading conclusions about what is and/or has happened.

Harnessing expertise: involving peer interviewers in qualitative research with hard-to-reach populations

The use of peer interviewers with privileged access to a particular population group, which is difficult to reach via more conventional methods, has been acknowledged in recent research. This paper explores a number of key issues relating to the employment of peer interviewers by reflecting on a project designed to explore the views and experiences of parents who use illegal drugs. The project presented the research team with a number of challenges. These included the need to provide on-going support for the interviewers, a sense of distance felt by the researchers from the raw data they collected, and the difficulties of gaining from the skills and experiences of peer interviewers without exploiting their labour. The paper also explores the advantages of involving peer interviewers closely in research work and reflects on the nature and boundaries of expert knowledge that can become evident in such collaborations. The need for a certain amount of flexibility over the roles and domains of control that lay experts and researchers traditionally inhabit is suggested. In conclusion, it is argued that the involvement of peer interviewers in research can be a valuable means of enhancing our knowledge and understanding of a variety of population groups who tend to live beyond the gaze of more orthodox researchers.

Pathological gambling and substance misuse

This paper first discusses the ways in which pathological gambling (a disorder of impulse control) and substance misuse are similar. It then examines research focusing on substance misuse among pathological gambles, and research on pathological gambling among substance misusers, focusing on a study examining gambling among 462 methadone patients from New York City. That study found that 21% of the sample were probable pathological gamblers, while an additional 9% were problem gamblers, i.e., they had some problem related to their gambling. The treatment implications of these findings and future research directions are also discussed.

Use of illicit substances in a psychosis incidence cohort: a comparison among different ethnic groups in the Netherlands

OBJECTIVE

Use of illicit substances has been suggested as an explanation for the increased incidence of psychosis among some immigrant groups. The aim of the present study is to compare the rates of illicit substance use among immigrants with a first psychosis with that among non-migrants.

METHOD

A population-based, first-contact incidence study in the Netherlands. Patients and key informants were interviewed about drug use in the preceding year.

RESULT

One hundred and eighty-one subjects were examined. Proportions of patients who misused any illicit substance were 23% for Dutch, 17% for Moroccans, 27% for Surinamese, 30% for Turkish subjects, and 33% for other immigrants. Logistic regression analysis, controlling for age and sex, showed that ethnicity did not significantly contribute to the prediction of substance misuse.

CONCLUSION

A higher rate of drug misuse is an unlikely explanation for the increased incidence of psychotic disorders among Moroccan and Surinamese immigrants to the Netherlands.

Re-enculturation: culturally congruent interventions for Mäori with alcohol- and drug-use-associated problems in New Zealand

Generally, the relationship between culture and substance use has been explored in two ways. Firstly, high rates of substance use and related problems amongst indigenous and migrant populations generated interest in genetics and cultural susceptibility. Acculturation-strain type theories suggested the stress of culture-change increased the risk of substance use and related harm. Secondly, there has been an increasing emphasis on taking account of the diversity of social, psychological, and cultural factors in the assessment and treatment of alcohol- and drug-use-associated problems. Utilization of ethnocultural factors as a means to promote recovery from alcohol- and drug-use-associated problems is a feature of culturally congruent interventions. Mäori are the indigenous people of New Zealand, and this paper outlines the background to the increasing inclusion of customary Mäori values, beliefs, and practices in interventions in the development of culturally congruent programs.

Smoking cessation among persons in recovery

The literature on smoking cessation for those in recovery from other drug use is reviewed. Reasons for engaging in this work, arguments against treatment of smoking along with another drug, characteristics of drug users who smoke, and treatment content implications are reviewed. Outcomes of 24 studies are presented. It is concluded that the future of research and practice in this arena should include facilitating smoking cessation among those early in recovery.

An outcome evaluation of prison-based treatment programming for substance users

This paper briefly documents the results of a broad-based implementation of substance user treatment programs within the Federal correctional system in Canada.

A discussion of the concept of technology transfer of research-based drug "abuse" prevention and treatment interventions

With the availability of both drug user prevention and treatment interventions that have demonstrated effectiveness under rigorous experimental design, new avenues of research have opened up to bring these strategies to scale. Of major importance is adapting evidence-based prevention and treatment programs to community specifications without diluting their power. A number of researchers have examined this issue from a variety of perspectives. This brief discussion is an attempt to bring those perspectives together within a conceptual framework that integrates them around research issues and questions. Several theoretical perspectives that have not been brought into the technology transfer discussion are mentioned, others need to be reviewed for their potential to guide further research in this area.

A comparison of alcohol-positive and alcohol-negative trauma patients

OBJECTIVE

Hospital admission for an alcohol-related traumatic injury may offer a "teachable moment" to address a patient's alcohol problem. Although trauma teams provide a number of other health-related services, there may be characteristics of alcohol-positive victims that act as barriers toward providing alcohol counseling. The purpose of this study was to compare the characteristics and hospital outcomes of trauma patients who tested positive for alcohol at the time of hospital admission with those who did not. This information is useful for planning interventions and referrals for treatment.

METHOD

The study was a retrospective comparison of alcohol-positive and alcohol-negative patients who were admitted for at least 48 hours to a Level-I trauma center. Data from 1,049 trauma victims (736 male, 742 alcohol-negative) were abstracted from clinical records.

RESULTS

Several characteristics were found to be associated with alcohol-related injuries: being male, aged 40 years or less, having a toxicology screen positive for illicit drugs, lacking health insurance, being indigent and sustaining an injury related to violence. Alcohol-positive patients were also found to spend fewer days in a critical care unit, to be less likely to die and to be less likely to be transferred to another hospital than alcohol-negative patients, despite having similar injury severity.

CONCLUSIONS

Patient characteristics suggest that there are obstacles to providing interventions and referrals by healthcare professionals for victims of alcohol-related injuries. Less expensive options that consider the demographic features of this patient population need to be developed as an alternative to expensive, professional interventions.

Relationship of treatment orientation and continuing care to remission among substance abuse patients

OBJECTIVES

The authors examined whether continuing outpatient mental health care, the orientation of the treatment program (12-step, cognitive-behavioral, or eclectic), and involvement in self-help groups were linked to substance abuse patients' remission status two years after discharge.

METHODS

The data were from a cohort of 2,805 male patients who were treated through one of 15 Department of Veterans Affairs substance abuse programs. Remission was defined as abstinence from illicit drug use and abstinence from or nonproblem use of alcohol during the previous three months. The relationships of the three variables to remission were tested with regression models that controlled for baseline characteristics.

RESULTS

About a quarter of the study participants (28 percent) were in remission two years after discharge. Intake characteristics that predicted remission at two years included less severe substance use and psychiatric problems, lower expected disadvantages and costs of discontinuing substance use, and having abstinence as a treatment goal. No significant relationship emerged between treatment orientation and remission status two years later. Involvement in outpatient mental health care during the first follow-up year and participation in self-help groups during the last three months of that year were associated with a greater likelihood of remission at the two-year follow-up.

CONCLUSIONS

The results extend previously published one-year outcome findings showing that cognitive-behavioral and 12-step treatment programs result in similar remission rates. Patients who enter intensive substance abuse treatment with polysubstance use, psychiatric symptoms, or significant emotional distress have more difficulty achieving remission. Routinely engaging patients in continuing outpatient care is likely to yield better outcomes. The duration of such care is probably more important than the number of sessions.

Prescription medication use among an aboriginal population accessing addiction treatment

OBJECTIVES

Inappropriate prescription medication use can have significant consequences. Although it is suspected that Aboriginal populations within Canada have high rates of inappropriate use, published information is lacking. To better understand this issue, we studied an Aboriginal population seeking addiction treatment.

METHODS

We surveyed Aboriginal clients who accessed addiction treatment in Calgary, Alberta, for prescription medication use in the previous year, frequency of medication use, and medication source(s), if inappropriately used.

RESULTS

Sixty-nine percent of the clients completed the survey (n = 144). Most respondents were aged 31 to 50 years (56%), and 52% were male. Of the respondents, 48% reported that they used prescription medication inappropriately, 8% indicated appropriate use, and the rest indicated no medication use. Sedatives or relaxants were most frequently used inappropriately. Among those who inappropriately used medication, 47% used medication more than 10 times in the previous year. Common sources for those who used medication inappropriately included medication given by a friend or a stranger (52%), medication bought on the street (45%), and medication prescribed by a physician (41%). Age greater than or equal to 30 years was associated with inappropriate use. Sex, residence, and Aboriginal status were not found to be associated with inappropriate use.

CONCLUSION

Inappropriate prescription medication use was a significant problem among an Aboriginal population that sought addiction treatment, and many of these individuals accessed medication from a prescribing physician.

Use of illegal drugs among mothers across racial/ethnic groups in the United States: a multi-level analysis of individual and community level influences

OBJECTIVE

To obtain adjusted one-year prevalence estimates and compare multi-level correlates of marijuana, cocaine, crack, or heroin use among 4,678 mothers of minor children in the United States across racial/ethnic populations.

METHODS

The study used publicly available data from the 1997 National Household Survey on Drug Abuse. Hierarchical generalized linear modeling (HGLM) procedures were used to test drug use variation among non-Hispanic White, non-Hispanic Black, and Hispanic mothers across US neighborhoods.

RESULTS

Black mothers were 40% less likely to use illegal drugs than were White mothers, and Hispanic mothers were 72% less likely than were White mothers to use drugs, after adjusting for demographic and community covariates. Drug use was found to vary across neighborhoods for all racial/ethnic groups. This study identified a positive association between the likelihood of mothers using illegal drugs and their living in neighborhoods with a higher occurrence of drug use.

CONCLUSION

To compare drug use across racial/ethnic groups, it is necessary to account for the confounding effects of covariates. Additional research is needed to determine whether non-drug using mothers chose to live in neighborhoods with a lower concentration of drug use, whether residence in these neighborhoods decreases the likelihood of mothers using drugs, or if a reciprocal relationship exists. The mechanisms that link individual drug use and neighborhood characteristics merit further investigation.

Evidence-based analysis of the worldwide abuse of licit and illicit drugs

In order to place the issues of drug abuse in a proper perspective and to allow rational, evidence-based decision-making, an analysis of the international data on the use of illicit drugs and the misuse of legally prescribed psychotropic drugs was undertaken. The data show that by far the most widely abused drug is cannabis, followed, according to region, by amphetamine-type stimulants or cocaine. While opiate abuse is far less widespread, it accounts for a disproportionately large proportion of medical and social problems. The illicit use of licit medicines is a very small, and declining, problem. The implications of these data for physicians, politicians, regulators and administrators are discussed.

High-risk behaviors associated with transition from illicit non-injection to injection drug use among adolescent and young adult drug users: a case-control study

OBJECTIVE

The goal of our study was to elucidate characteristics of persons likely to transition into injection drug use so that an identifiable group with high-risk for blood-borne infection may be targeted for interventions.

METHODS

An age-matched case-control analysis was performed from a cohort study in Baltimore, 1997-1999, of street-recruited non-injection and injection drug users (IDUs), aged 15-30. Cases were IDUs injecting < or = 2 years and controls were age-matched persons who used non-injection heroin, cocaine or crack. At baseline, all were interviewed about prior year-by-year behaviors; analysis using conditional logistic regression was based on information for the year prior to injection onset for the case and the same calendar time for the controls as well as recent behaviors for both groups.

RESULTS

Of 270 participants, most were African American (78%), female (61%), and HIV seroprevalence was 7% at baseline. IDUs were significantly more likely than controls to be non-African American (adjusted odds ratio (AOR)=0.09) and report high school dropout (AOR=2.32), early sex-trading (AOR=2.72), and recent violence victimization (AOR=9.28).

CONCLUSION

Given that new injectors are at high-risk for HIV and hepatitis yet difficult to reach for prevention efforts, our data suggest some categories to use to target non-injectors who are likely to transition into injection use.

The injection of methadone and benzodiazepines among Sydney injecting drug users 1996-2000: 5-year monitoring of trends from the Illicit Drug Reporting System

Trends in the injection of methadone and benzodiazepines by injecting drug users (IDU) recruited in Sydney for the Illicit Drug Reporting System over the period 1996-2000 were examined. A total of 788 IDU were interviewed over the 5-year period. The proportion of IDU reporting recent methadone injecting declined significantly over the study period, from a peak of 31% in 1997 to 13% in 2000. Unlike the injection of methadone, there was no significant difference between the proportions of IDU reporting recent benzodiazepine injecting over the study period, which ranged between 10% and 16%. A consistent minority (range 5-7%) of IDU reported having injected both methadone and benzodiazepines in all years of the study. There were no differences in the proportions of males and females reporting recent methadone or benzodiazepine injecting in any individual year. Both methadone and benzodiazepine injecting were independently associated with higher levels of injection-related health problems. Given the substantial harms associated with these practices, continued monitoring of their prevalence is warranted.

Young adults with attention deficit hyperactivity disorder: subtype differences in comorbidity, educational, and clinical history

The present study sought to examine subtype differences in comorbidity and in antisocial, educational, and treatment histories among young adults (ages 17-27) with attention deficit hyperactivity disorder (ADHD). Comparisons were made between ADHD Combined Type (ADHD-C; N = 60) and Predominantly Inattentive Type (ADHD-I; N = 36) relative to each other and to a community control group of 64 adults. Both ADHD groups had significantly less education, were less likely to have graduated from college, and were more likely to have received special educational placement in high school. Both groups also presented with a greater likelihood of dysthymia, alcohol dependence/abuse, cannabis dependence/abuse, and learning disorders, as well as greater psychological distress on all scales of the SCL-90-R than the control group. Both ADHD groups were more likely to have received psychiatric medication and other mental health services than control adults. In comparison with ADHD-I, adults with ADHD-C differed in only a few respects. The C-type adults were more likely to have oppositional defiant disorder, to experience interpersonal hostility and paranoia, to have attempted suicide, and to have been arrested than the ADHD-I adults. These results are generally consistent with previous studies of ADHD in children, extend these findings to adults with ADHD, and suggest that the greater impulsivity associated with the ADHD-C subtype may predispose toward greater antisocial behavior and its consequences than does ADHD-I type in adults.

Content based information retrieval in forensic image databases

This paper gives an overview of the various available image databases and ways of searching these databases on image contents. The developments in research groups of searching in image databases is evaluated and compared with the forensic databases that exist. Forensic image databases of fingerprints, faces, shoeprints, handwriting, cartridge cases, drugs tablets, and tool marks are described. The developments in these fields appear to be valuable for forensic databases, especially that of the framework in MPEG-7, where the searching in image databases is standardized. In the future, the combination of the databases (also DNA-databases) and possibilities to combine these can result in stronger forensic evidence.

Body packers: grading of risk as a guide to management and intervention

The dual aims of management of the drug smuggler are for low morbidity and mortality combined with a low operation rate. In our experience, presented in this paper, adherence to the principle of identifying the high-risk patient by symptoms and signs combines safety with low rates of intervention.