Criminal involvement of cocaine users enrolled in a methadone treatment program

Comparison between Heroin and Heroin-Cocaine Polyabusers: A Psychopathological Study

The concomitant use of cocaine by heroin-dependent subjects, or by patients on methadone maintenance treatment, is a relevant phenomenon that determines the negative consequences on health, social adjustment, and outcome of opioid addiction treatment. Little is known about the patterns of co-use of these two substances and the pathophysiological alterations following this condition. Only a few studies have evaluated the neurochemical effects in subjects carrying this specific pattern of abuse. Similarly, the impact of cocaine abuse on psychiatric and social function in subjects already affected by opioid addiction is still poorly understood and further studies are necessary to investigate this specific area that could profoundly affect methadone maintenance treatment. The aim of this article is to investigate the psychopathological symptoms of heroin-cocaine abuse in a group of heroin addicts applying for treatment. Results show a direct relationship between cocaine abuse and a higher rate of psychiatric disorders, but a negative correlation with the severity of self-rated psychopathology.

Temporal patterns of heroin and cocaine use among methadone patients

A sample of 1,038 patients newly admitted to 15 methadone clinics in New York City were studied for up to three years in treatment or until discharge. Cluster analysis identified distinct patient groups with very different heroin and cocaine usage patterns during treatment. About 80% either started in or transitioned to a low heroin use group and 50% either started in or transitioned to a low cocaine use group during treatment. One-third of patients used cocaine extensively during treatment. Other "high risk" groups, such as those not recently employed, younger, or involved with criminal justice, could benefit from special interventions very early in treatment.

The impact of a treatment process for substance users as a function of their degree of exposure to treatment

The objective of this research is to evaluate the outcomes of a treatment for addicts. 248 subjects were tested before and 5 months after treatment with the Addiction Severity Index (ASI). Exposure to treatment was based on the number of clients' contact hours with a therapist. The sample was divided into three groups according to number of hours spent in treatment. The data were analyzed using MANOVA on the seven scales of the ASI for the three groups and the two time periods. Results showed that the severity of addiction problems decreased after treatment, and decreased more for subjects who underwent treatment for a longer period of time.

Predictors of Treatment Retention in Enhanced and Standard Methadone Maintenance Treatment for HIV Risk Reduction

Survival analysis was used to determine the predictors of discharge from a methadone maintenance treatment program for heroin addicts at high-risk for HIV infection and/or transmission. A consistent set of predictors was identified that was associated with treatment discharge at 90 days, 12 months, 18 months, and 24 months. Individuals who, at intake, were HIV seropositive, were younger, used cocaine, drank alcohol daily, and scored high on measures of depression and interpersonal problems were at a higher risk for discharge. Receipt of enhanced methadone treatment, which included case management services, group participation, psychiatric services, contingency-based reinforcers, and transportation assistance, was associated with a higher probability of retention, particularly in the first 90 days. These findings can be used to target individuals who are vulnerable to early discharge from treatment and to provide adjunctive services that may improve retention. Several of these predictors, particularly cocaine use and psychological problems, have also been associated with HIV risk among methadone clients. Increasing retention in methadone treatment will not only improve treatment efficacy but will also address the public health imperative to limit the transmission of HIV.

Patterns and predictors of cocaine and crack use by clients in standard and enhanced methadone maintenance treatment

This paper reports on the patterns of cocaine use among subjects (N = 427) admitted to a methadone maintenance treatment demonstration project designed to reduce risk for HIV. Assessments were conducted at intake and at approximately 18-24 months after treatment admission. Self-reported data on cocaine use was compared with results of urinalysis tests at both intake and follow-up; 29 subjects who falsely reported no use were recorded as users. Over one-third used some form of cocaine at both intake and follow-up, while approximately 30% abstained at both points. Approximately 20% ceased as well as initiated cocaine use between intake and follow-up. Use of powder cocaine, either alone or combined with heroin in "speedballs," decreased at follow-up, whereas crack use increased. Discriminant function analyses were performed to determine the predictors of the different patterns of cocaine use by type. Receipt of enhanced methadone treatment compared with standard methadone treatment, treatment duration, or average duration of counselor contact appeared unrelated to cocaine use. Cocaine use at follow-up was associated with polydrug and alcohol use, illegal activity, a negative emotional state, and sex work. Crack users were more likely to be African American than nonusers; continuous users of powder cocaine were more likely to also be using heroin than were nonusers; and continuous speedball users were more likely to be women sex workers with high levels of depression. This analysis demonstrated that cessation or continuation of cocaine use after entry into methadone maintenance treatment is not uniform across different types of cocaine.

Preliminary study of effect of the Iraqi invasion on addictive behaviour in Kuwait

During the Iraqi invasion, Kuwait was flooded with alcoholic substances and drugs which, if used, could induce harmful radical changes in the personality and behaviour of Kuwait citizens (not Islam prohibits alcohol). After liberation aggressive behaviour prevailed among some Kuwait citizen groups, including addicts, as the government of Kuwait had not yet reestablished discipline and control over the citizens. Forensic cases of addicts referred to Kuwait Psychiatric Hospital before and after the invasion were examined. Marked differences were observed concerning age, education, occupation, marital status, addictive behaviour, crime committed, and place of referral and discharge.

What happens when a demonstration project ends. Consequences for a clinic and its clients

The Los Angeles Enhanced Methadone Maintenance Project was a 5-year research demonstration project funded by the National Institute on Drug Abuse with the goal of reducing high-risk behavior for human immunodeficiency virus (HIV) among heroin users. A clinic was established for the purposes of the study and 500 clients with high-risk profiles were recruited into treatment. Follow-up assessments demonstrated that clients had reduced their drug use, criminal behavior, and HIV-risk behaviors after entering treatment. At the end of the project clients were given the option of continuing treatment at the clinic on a fee-for-service basis, transferring to another treatment provider, or undergoing detoxification. Clients who were eligible for Medicaid were likely to continue receiving methadone treatment, but those without Medicaid funding were not. The implications of terminating treatment among a high-risk population recruited into a research demonstration project are discussed.

Cocaine and crack use and HIV risk behaviors among high-risk methadone maintenance clients

A discriminant function analysis was performed with data from 409 high-risk heroin addicts at intake into a methadone maintenance treatment program to determine the characteristics of cocaine users. Cocaine users presented a higher-risk profile for human immunodeficiency virus (HIV), engaged in a wider variety of criminal activities, were more likely to be African-American, reported more alcohol use, and showed more signs of psychological disturbance. A second discriminant function analysis determined that crack smokers differed from non-crack cocaine users in ethnicity, alcohol use, criminal activity, needle use, and marital status. Heroin addicts who use cocaine, in particular crack, represent a sub-group at higher risk and in need of targeted treatment planning and monitoring.