Factors associated with the initiation of cocaine and heroin among problem drug users: reflections on interventions

Peer Influence in Initiation to Heroin Use

Much research on heroin initiation shows that most people use heroin initially with friends or family. However, there is little research examining why those who use heroin would initiate others to its use, and conversely, whether and why one might try to prevent initial heroin use in others. Following recent work on peer influence on crime and delinquency, we test the hypothesis that those with higher levels of self-control are less likely to initiate others to heroin use and are more likely to try to prevent others from using for the first time. The sample included 370 persons entering an opioid withdrawal program. We find that those with low self-control are more likely to initiate others, but there is no relationship between self-control and trying to prevent initiation. We further investigate self-reported motives for initiating others, and find a mix of self-interested and more altruistic motives for initiating others.

"Not for Human Consumption": A Descriptive Investigation into User Characteristics, Motives, and Consequences Associated with Bath Salt Use

Synthetic cathinones, commonly referred to as "bath salts," are recreational designer drugs that recently emerged as a drug of abuse. However, little is known about bath salt users, particularly in the United States (US). This descriptive study aims to better characterize users and user behavior, including common motives for and consequences of use. Individuals with a lifetime history of bath salt use (BSU; n = 110) completed an Internet survey. Participants (50.9% male) were aged 18 to 58 (M = 31.21, SD = 10.25) years and were from 32 US states. Most participants reported past-year BSU, via intranasal use, obtained from a friend or acquaintance. Recreational motives (e.g., to get high, experimentation) were commonly reported, as was use due to drug availability. Participants reported experiencing an average of 5.50 consequences, with both physical (e.g., rapid heartbeat) and psychological (e.g., anxiety) negative outcomes commonly reported. This descriptive information on BSU from a small but diverse sample of users may inform efforts to reduce use and negative consequences, such as eliminating riskier routes of administration (e.g., injection) and targeting specific motives for use (e.g., providing alternative methods for mood expansion).

Onset of cocaine use: associated alcohol intoxication and psychosocial characteristics among adolescents in substance abuse treatment

OBJECTIVES

Cocaine abuse is widespread in Europe, and Ireland ranks among the leading countries for prevalence of cocaine use among adolescents. This study aimed to examine demographic and substance use correlates of lifetime cocaine use among adolescents with substance use disorder, and to explore the relationship between alcohol intoxication and cocaine initiation.

METHODS

Data from a cross-sectional study of 171 adolescents presenting to an outpatient substance abuse treatment program in the Dublin metropolitan area were analyzed. Bivariate and multivariate analyses were conducted.

RESULTS

Approximately 64% of the participants reported ever used cocaine: 70% reported the first use of cocaine was while alcohol intoxicated and 96% reported the onset of cocaine use was preceded by cannabis use. Later age at treatment entry, unstable accommodation, non engagement in educational/vocational functions, and greater frequency of alcohol and cannabis use had robust associations with lifetime cocaine use. Male gender was significantly associated with first use of cocaine while alcohol intoxicated.

CONCLUSIONS

Alcohol frequently plays a central role in cocaine initiation in Irish adolescents. Efforts to delay, avoid, or reduce adolescent drinking may yield benefits in terms of reducing cocaine use initiation in this population.

Methamphetamine use among Iranian heroin kerack-dependent women: implications for treatment

Background

Co-use of heroin kerack with methamphetamine (MA) is a new epidemic health concern among Iranian female drug users. Yet, little is known about this issue because of stigma.

Objectives

The current study aimed to investigate the reasons associated with initial and continued co-use of heroin kerack with MA among two groups of regular and recreational female co-users, their motivations associated with treatment entry and to compare their general characteristics at a drop in center (DIC) in Tehran.

Materials and Methods

82 clients were randomly recruited. A researcher-designed questionnaire was used to collect data. Data was analyzed by performing descriptive statistics, the Chi-square test and t-test.

Results

The mean age of the participants were 31 (SD = 8) years. Reducing negative affect (55%), addicted family and social networks (50%), curiosity (48%), and the lack of knowledge on addictive effects of co-use of heroin kerack with MA (32%) were the most frequently reported reasons at initiation. Drug dependence (71%) and drug availability (56%) were reasons of continued co-use. Restoring health (61%), fear from becoming MA abuser only (33%), and fear from making a transition from heroin kerack and MA smoking to injection (15%) were important motivations for treatment entry. Regular co-users were more likely to be single (41.7% vs. 14.7%, P < 0.001), jobless (45.8% vs. 38.2, P < 0.05), homemaker (50% vs. 35.3%, P < 0.01), recently incarcerated (16.7% vs. 11.7%, P < 0.01), and were less likely to be enrolled in opioid replacement programs (33.5% vs. 41%, P < 0.01). Regular co-users were younger (30.6 vs. 32.1 years, P < 0.05), less educated (9.6 vs. 10.8 years, P < 0.05) and had a longer duration of drug dependence (9.6 vs. 8 years, P < 0.05).

Conclusions

Reasons associated with initial and continued co-use of heroin kerack with MA, factors associated with treatment entry and the differences between regular and recreational co-users should be specifically considered in designing and tailoring drug use treatment programs for this group.

Respondent-driven sampling in a syringe exchange setting

Aims: Respondent-driven sampling is a research technique, new to the Scandinavian setting, used in hard-to-reach populations, such as subjects at risk for HIV, including drug users. This study aimed to evaluate the use of respondent-driven sampling originating from syringe exchange clients, as a method to identify ‘hidden’ drug users without treatment or social service contact. Methods: Nine heroin and amphetamine injectors were recruited as ‘seeds’ and instructed to recruit up to three heavy drug users in a chain-referral process. Recruited clients were interviewed about drug use, social conditions and contacts with treatment, syringe exchange and other authorities. In order to estimate whether the recruitment managed to evolve into groups of ‘hidden’ drug users, clients included beyond the fourth wave of chain-referral were compared with seeds (wave 0) and clients recruited in waves 1–3. Results: Five seeds were generative, and in total, 66 clients were assessed. Except for one of the 35 variables studied, clients in waves 4–9 did not differ from clients in waves 0–3, and were no less likely to have contacts with authorities. All clients except one were injectors and syringe exchangers, and clients recruited later in the chain-referral even tended to attend the syringe exchange more frequently. Conclusions: Respondent-driven sampling originating from syringe exchange clients may have difficulty reaching beyond the population of injectors and syringe exchangers. The technique, new to this geographical setting, has potential for future studies, but particular efforts may be necessary to study out-of-treatment heavy drug users unknown to the syringe exchange program.

Cocaine Dependence and Anxiety Sensitivity Among Patients Presenting for Residential Drug Use Treatment

Cocaine use and dependence remains an important public health concern. Thus, the identification of individual difference factors that may maintain cocaine use remains an important goal. The goal of the current study is to test whether the cognitive vulnerability of anxiety sensitivity (AS), an identified risk factor for anxiolytic use and use-related disorders, is related to cocaine dependence diagnosis (n = 168) among a sample of drug users currently enrolled in residential treatment (N = 304). Results demonstrated that AS was significantly related to cocaine dependence and remained significant after controlling for sex, age, alcohol dependence, hallucinogen dependence, major depressive disorder, panic disorder, and posttraumatic stress disorder. Taken together, these data suggest that AS may have a specific relation to cocaine dependence, calling into question the notion that AS is positively related only to drugs with anxiolytic properties.

Initiation into methamphetamine use: qualitative findings from an exploration of first time use among a group of New Zealand users

Methamphetamine use has risen in many countries around the world in recent years, and New Zealand is no exception, with the substance having become well-established in the illicit drug market. While there is much published on the individual and social harms of this drug, limited data are available on methamphetamine use initiation. Understanding early patterns of behavior is important, given the potential risks involved at this stage of use. This article presents findings from a qualitative study which was undertaken with methamphetamine users, most of whom were in treatment at the time of the research. While the research primarily sought to investigate patterns of methamphetamine use and associated harms, a key issue explored was the way in which respondents came to use the drug. Findings revealed that most were experienced users of other substances when trying the drug for the first time, but lacked specific knowledge of methamphetamine. The majority were introduced to methamphetamine in a social situation by a friend or partner, who also played a key role in preparing the drug for administration. Several reported risk-taking behaviors on the first occasion of use. The findings have important implications for potential interventions and harm reduction strategies at first use.