Club drug use and dependence among young adults recruited through time-space sampling

Racial/Ethnic Disparities in Club Drug Use, Situational Club Drug Use during Sex, and Sexual Risk Behaviors among Alcohol-Using Men Who Have Sex with Men (MSM) in San Francisco

BACKGROUND

Club drug use-including 3,4-Methylenedioxymethamphetamine, ketamine, crack/cocaine, hallucinogens, gamma hydroxybutyrate, volatile nitrites, and methamphetamine-has been linked to sexual risk behaviors among MSM. Few studies examine how the use of club drugs and the association between club drug use during sex and sexual risk may differ by race/ethnicity.

METHODS

Using data from a cross-sectional study among alcohol-using MSM in San Francisco (n = 252), we examined the associations between the interaction of race/ethnicity and club drug use during sex, and the following behavioral outcomes: any condomless anal intercourse (CAI), insertive CAI, receptive CAI, and any serodiscordant sex in the past six months. All models controlled for income, HIV status, relationship status, age, and current use of a biomedical HIV prevention tool (i.e., Pre-Exposure Prophylaxis [PrEP] or antiretroviral therapy).

RESULTS

There were significant racial differences in club drug use (p < 0.001) and club drug use during sex (p = 0.01). Asian/Pacific Islander (API) and Latino participants reported using club drugs the most at 78.8% and 79%, respectively. Among users of club drugs, club drug use during sex was most common among Black (100%), and Latino MSM (93%). Significant interactions between race/ethnicity and club drug use during sex were observed for CAI (p = 0.02), insertive CAI (p = 0.01), and receptive CAI (p = 0.01). API participants who used club drug during sex had higher odds of reporting CAI (aOR = 15.27, CI = 1.50-155.34), insertive CAI (aOR = 21.11, CI = 2.04-218.10), and receptive CAI (aOR = 21.11, CI = 2.04-218.10).

CONCLUSIONS

Given the differing rates of club drug use during sex by race/ethnicity and the role race/ethnicity plays in modifying the relationships between club drug use during sex and sexual risk behaviors, culturally-tailored interventions may be needed to address the needs of ethnically-diverse, club drug-using MSM.

Substance Use and Attendance Motives of Electronic Dance Music (EDM) Event Attendees: A Survey Study

EDM event attendees are a high-risk population for substance use and associated adverse effects. The aim of this study was to examine substance use at EDM events, focusing on associations between attendance motives and substance use. Sociodemographic characteristics, event specifics, past-year use, and attendance motives were assessed through an online survey. Participants were 1345 Belgian EDM event attendees (69.44% male, M_age = 22.63, SD_age = 4.03). Ecstasy/MDMA/Molly (52.28%), other synthetic hallucinogens (53.68%), ketamine (42.13%), amphetamines (40.45%), and alkyl nitrites (poppers) (32.76%) were most frequently used at festivals/outdoor parties/raves. In nightclubs, cocaine (32.29%) was shown to be prevalent as well, while other synthetic hallucinogens (15.79%) were less often consumed. At events with a more private character, cannabis (68.88%) and magic mushrooms (66.44%) were most frequently used. Aside from alcohol (47.76%), substance use in pubs/bars was negligible. Overall enjoyment was demonstrated to be the key attendance motive, which was succeeded by those relating to music and socialization. A wide range of motives proved to be more important to users (e.g., dance, exploration, escapism, excitement, alcohol, drugs) than non-users, while some were associated with the use of particular substances. The prevalence of substance use was shown to be dependent on the specifics of the setting. Moreover, the idea of a three-dimensional classification of the most principal motives for music event attendance was supported. Finally, correlations were estimated between attendance motives and substance use as well as specific substances. Results could enable more tailored approaches in prevention and harm reduction efforts as well as event management strategies.

Pilot Randomized Trial of an Expressive Writing Intervention to Reduce Sexual HIV-Transmission Risk and Substance Use Among Emerging Adult Gay and Bisexual Men

This pilot randomized controlled trial evaluated the feasibility, acceptability, and preliminary efficacy of expressive writing to reduce HIV-related sexual risk taking and symptoms of drug dependence among emerging adult gay and bisexual men (EAGBM) through linguistic mechanisms involving use of words associated with cognitive processing (e.g., think, cause), positive emotion (e.g., love, nice), and negative emotion (e.g., hurt, shame). Between 2014 and 2015, EAGBM (n = 78; aged 18-29) completed a baseline survey and were randomized to complete three 15-min expressive writing or equivalent control-group writing sessions and follow-up assessments 2 months post-baseline. EAGBM in the expressive writing condition utilized significantly more positive emotion, negative emotion, and cognitive processing words. Path model results indicated the intervention condition resulted in significant reductions in symptoms of drug dependence and frequency of condomless anal sex (CAS) through paths mediated by positive emotion words, and significant increases in CAS through a path mediated by negative emotion words.

Illicit Drug Use and Associated Problems in the Nightlife Scene: A Potential Setting for Prevention

Illicit drug use is prevalent in the nightlife scene, especially at electronic dance music (EDM) events. The aim of the present study was to investigate illicit drug use patterns and consequences of drug use among frequent visitors of EDM events. Young adults (18-34 years old) who had visited at least six EDM events in Sweden during the past year participated in a web-based survey on drug use patterns and its consequences. Fifty-nine percent of participants had used illicit drugs during the past year, most often cannabis followed by ecstasy, cocaine, and amphetamine. Nightlife venues were identified as the main setting for the use of central stimulants, while cannabis was mostly used at home. Frequent alcohol and tobacco use was associated with illicit drug use. The most prevalent negative consequences of drug use were related to mental health, such as impairments in mood, sleep, and memory problems, but physical manifestations were also reported, such as palpitations and collapsing. These findings confirm that drug use is prevalent and associated with negative health effects among EDM nightlife attendees. The nightlife scene is a setting with promising potential to reach a high-risk target group with illicit drug use prevention interventions.

The Epidemiology of Cocaine Use Among Hispanic Individuals: Findings From the 2015-2018 National Survey of Drug Use and Health

Cocaine use disproportionately affects several social groups, including ethnic and sexual minorities. The present study sought to identify the epidemiology of cocaine use among a national sample of Hispanic young adults using pooled data from the 2015-2018 National Survey of Drug Use and Health. Weighted analyses were used to identify correlates to past-year cocaine use. Results revealed that 4.11% (n = 729) of individuals used cocaine in the past year. Individuals who identified as gay/lesbian or bisexual, who drove under the influence of alcohol in the past year, and who reported prior drug use were at risk of cocaine use. Of concern, nearly 10% of gay/lesbian Hispanic individuals report having used cocaine in the past year. Furthermore, cocaine use was associated with other risky behaviors; 41.1% of LSD (Lysergic acid diethylamide) users also reported cocaine use, and 18.2% of cocaine users reported having driven under the influence of alcohol within the past year. Findings from the present study may inform harm reduction efforts and health prevention messages.

"Am I gonna get in trouble for acknowledging my will to be safe?": Identifying the experiences of young sexual minority men and substance use in the context of an opioid overdose crisis

BACKGROUND

North America and other parts of the globe are in the midst of a public health emergency related to opioid overdoses and a highly contaminated illicit drug supply. Unfortunately, there is a substantial gap in our understandings about how this crisis affects key populations not conventionally identified within overdose-related surveillance data. This gap is particularly pronounced for gay, bisexual, and other men who have sex with men (sexual minority men)-a population that experiences substance use-related inequities across adolescence and young adulthood.

METHODS

We draw on in-depth semi-structured interviews conducted in 2018 with a diverse sample (N = 50) of sexual minority men ages 15-30 who use substances and live in Vancouver, Canada, to identify how patterns and contexts of substance use are occurring in the context of the opioid overdose crisis.

RESULTS

Our analysis revealed three themes: awareness, perceptions, and experiences of risk; strategies to mitigate risk; and barriers to safer substance use. First, participants described how they are deeply impacted by the contaminated illicit drug supply, and how there is growing apprehension that fatal and non-fatal overdose risk is high and rising. Second, participants described how procuring substances from "trustworthy" drug suppliers and other harm reduction strategies (e.g., drug checking technologies, Naloxone kits, not using alone) could reduce overdose risk. Third, participants described how interpersonal, service-related, and socio-structural barriers (e.g., drug criminalization and the lack of a regulated drug supply) limit opportunities for safer substance use.

CONCLUSIONS

Equity-oriented policies and programming that can facilitate opportunities for safer substance use among young sexual minority men are critically needed, including community- and peer-led initiatives, access to low-barrier harm reduction services within commonly frequented social spaces (e.g., Pride, night clubs, bathhouses), nonjudgmental and inclusive substance use-related health services, the decriminalization of drug use, and the provision of a safe drug supply.

Illicit Drugs in the Nightlife Setting: Changes in Employee Perceptions and Drug Use over a Fifteen-Year Period

Illicit drug use is common in nightlife settings and associated with various public health-related problems, making this an important arena for prevention. Purpose/objectives: To assess perceived prevalence of illicit drug use in the Stockholm nightlife setting, use of and attitudes toward illicit drugs among employees at licensed premises. Also, to make comparisons with two identical measurements from 2001 and 2007/08, and to explore potential differences related to own drug use, type of licensed premise, age or gender. Methods: Cross-sectional surveys were conducted at three time-points: 2001, 2007/08, and 2016/17, comprising employees at licensed premises in Stockholm participating in STAD's Responsible Beverage Service training program. A total of 665 persons (mean age 28 years, 53% women) were included in the 2016/2017 measurement. Results: A majority of the respondents reported having observed patrons intoxicated by illicit drugs in the last six months, and agreed that patrons intoxicated by illicit drugs should be asked to leave licensed premises. The belief that one had observed patrons intoxicated by illicit drugs was more common among respondents who had themselves been using illicit drugs during the last year, and also among employees at nightclubs. Furthermore, comparisons with previous time-points showed a significant increase in the proportion of employees using illicit drugs. Almost half of the respondents in the youngest age group (18-24 years) reported illicit drug use during the last year. Conclusions/importance: Observation and use of illicit drugs are common among employees in the Stockholm nightlife setting and has increased significantly during the past decade.

Clinic-Based Delivery of the Young Men's Health Project (YMHP) Targeting HIV Risk Reduction and Substance Use Among Young Men Who Have Sex with Men: Protocol for a Type 2, Hybrid Implementation-Effectiveness Trial

BACKGROUND

Young men who have sex with men (YMSM) are disproportionately at risk for HIV and sexually transmitted infections. Adapting and testing the effectiveness of the Young Men's Health Project (YMHP), an efficacious intervention designed to reduce substance use and condomless anal sex (CAS) among YMSM, at clinics in Miami, Detroit, and Philadelphia has the potential to reduce HIV and STI disparities among urban YMSM.

OBJECTIVE

This study (Adolescent Medicine Trials Network for HIV/AIDS Interventions [ATN] 145 YMHP) aims to adapt YMHP for clinic and remote delivery by existing clinic staff and compare their effectiveness in real-world adolescent HIV clinics. This protocol is part of the ATN Scale It Up program described in a recently published article by Naar et al.

METHODS

This is a comparative effectiveness hybrid type-2 trial of the YMHP intervention with 2 delivery formats-clinic-based versus remote delivery-offered following HIV counseling and testing. Phase 1 includes conducting focus groups with youth to obtain implementation feedback about the delivery of the YMHP intervention and intervention components to ensure culturally competent, feasible, and scalable implementation. Phase 2 includes recruitment and enrollment of 270 YMSM, aged 15 to 24 years, 90 at each of the 3 sites. Enrollment will be limited to HIV-negative YMSM who report recent substance use and either CAS or a positive STI test result. Participants will be randomized to receive the YMHP intervention either in person or by remote delivery. Both conditions involve completion of the 4 YMHP sessions and the delivery of pre-exposure prophylaxis information and navigation services. A minimum of 2 community health workers (CHWs) will be trained to deliver the intervention sessions at each site. Sessions will be audio-recorded for Motivational Interviewing Treatment Integrity (MITI) fidelity coding, and CHWs and supervisors will be given implementation support throughout the study period.

RESULTS

Phase 1 focus groups were completed in July 2017 (n=25). Feedback from these focus groups at the 3 sites informed adaptations to the YMHP intervention manual, implementation of the intervention, and recruitment plans for phase 2. Baseline enrollment for phase 2 began in November 2018, and assessments will be at immediate posttest (IP)-, 3-, 6-, 9-, and 12-months after the intervention. Upon collection of both baseline and follow-up data, we will compare the effectiveness and cost-effectiveness of clinic-based versus remote delivery of YMHP in the context of health care access.

CONCLUSIONS

We are conducting YMHP in 3 cities with high rates of YMSM at risk for HIV and STIs. When adapted for real-world clinics, this study will help substance-using YMSM at risk for HIV and STIs and allow us to examine differences in effectiveness and cost by the method of delivery.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03488914; https://clinicaltrials.gov/ct2/show/NCT03488914 (Archived by WebCite at http://www.webcitation.org/770WaWWfi).

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/11184.

Determining the Roles that Club Drugs, Marijuana, and Heavy Drinking Play in PrEP Medication Adherence Among Gay and Bisexual Men: Implications for Treatment and Research

Researchers have established that substance use interferes with anti-retroviral medication adherence among gay and bisexual men (GBM) living with HIV. There is limited parallel examination of pre-exposure prophylaxis (PrEP) adherence among HIV-negative GBM. We conducted retrospective 30-day timeline follow-back interviews and prospective semi-weekly diary data for 10 weeks with 104 PrEP-using GBM, half of whom engaged in club drug use (ketamine, ecstasy, GHB, cocaine, or methamphetamine)-generating 9532 days of data. Participants reported their day-by-day PrEP, club drug, marijuana, and heavy alcohol use (5 + drinks in one sitting). On average, club drug users were no more likely to miss a dose of PrEP than non-club drug users (M = 1.6 doses, SD = 3.0, past 30 days). However, we found that club drug use (at the event level) increased the odds of missing a dose on the same day by 55% and the next day (e.g., a "carryover effect") by 60%. Further, missing a dose on one day increased the odds of missing a dose the following day by eightfold. We did not identify an event-level effect of marijuana use or heavy drinking on PrEP adherence. Our data suggest club drug users could have greater protective effects from daily oral or long-acting injectable PrEP compared to a time-driven PrEP regimen because of the concurrence of club drug use and PrEP non-adherence.

Drug Use and HIV Prevention With Young Gay and Bisexual Men: Partnered Status Predicts Intervention Response

The Young Men's Health Project (YMHP) has shown efficacy in reducing drug use and condomless anal sex (CAS) with casual partners among young gay, bisexual and other men who have sex with men (YGBMSM). The study examined whether relationship status at the time of intervention predicted response to YMHP by comparing baseline (pre-intervention) and follow-up (3, 6, 9, and 12 months post-intervention) data from the original trial. A group of 13 partnered YGBMSM who received YMHP was compared to a matched subsample of single YGBMSM. Among single men, drug use declined significantly at all follow-ups. Among partnered men, drug use was largely stable. While significant reductions were observed at 9 month assessment, 3, 6, and 12 month use did not differ significantly from baseline. Regardless of relationship status, CAS with casual partners declined significantly at 12 month follow-up. Results suggest the incorporation of components which address relationship factors, particularly those associated with drug use, may enhance benefits of YMHP for partnered YGBMSM.

A three-city comparison of drug use and drug use before sex among young men who have sex with men in the United States

High rates of drug use have been documented among young men who have sex with men (YMSM). However, updated prevalence data are needed to understand current trends, especially for drug use before sex. We used baseline data from an HIV prevention trial to examine demographic differences in drug use (in general and before sex) among YMSM in Atlanta, Chicago, and NYC. Marijuana was the most commonly used drug, but alkyl nitrites ("poppers"), cocaine, and Ecstasy were also common. Drug use was more prevalent among older and White YMSM, and it was similar between cities, except use of poppers was higher in NYC. Our data generally support national prevention efforts.

A randomized trial of brief assessment interventions for young adults who use drugs in the club scene

BACKGROUND

Efficacious interventions to reduce drug use and its consequences for club drug using populations are not apparent in the literature. We tested interviewer- (CAPI) and self-administered (ACASI) comprehensive health and social risk assessments as distinct interventions compared to waitlist control.

METHODS

750 men and women ages 18-39 with multidrug use and heterosexual behavior were randomized in equal proportions to the three conditions. Instrumentation included well-tested measures of drug use, risky sex, mental distress and substance dependence.

RESULTS

The sample was 56% male; mean age=25. Reported risk behaviors and health consequences did not differ by assessment modality. Adjusted HLM analyses showed a significant main effect of assigned condition on all outcomes. CAPI participants had greater reductions in drug use, risky sex, mental distress and substance dependence symptoms, and greater increases in abstinence, compared to ACASI intervention or control participants at 12months, except that the CAPI and ACASI conditions had similar efficacy for reductions in drug use. Effect sizes for CAPI versus ACASI participants were d=0.2-0.3, and between CAPI and controls d=0.2-0.4. Effect sizes for improved outcomes between ACASI compared to controls were small to non-significant.

CONCLUSIONS

The study established the therapeutic benefit of interviewer interaction in reducing risky behavior among this young drug using population. The study demonstrated the efficacy and acceptability of a low threshold intervention in reducing drug use, sexual risk and related co-morbidities among a not-in-treatment young adult population that exhibits severe and complex levels of drug use, but that is also highly resistant to intervention.

GHB-involved crimes among intoxicated patients

INTRODUCTION

In recent years, the involvement of GHB in drug facilitated sexual assaults has been one of the most frequently studied aspects of GHB in both clinical and non-clinical settings. GHB-involved acquisitory crimes, however, can be mentioned as understudied research topics, as well as the poisoning severity properties of GHB.

MEASURES

The medical reports of Péterfy Sándor Street Hospital Clinic and Casualty Centre's 408 GHB-intoxication cases (352 patients) were reviewed and registered. Analyzed data consisted of epicrisis, serum and urine concentration of various substances (including GHB), scores of Glasgow Coma Scale and Poisoning Severity Score.

RESULTS

Majority of the patients were males, in their twenties. GHB was detected in 34.1% and it was solely consumed in 27.7% of all the cases. Ethanol was found to be the most frequently co-ingested substance. A higher rate of severe poisonings was observed among males. We found significant difference in the frequency of enduring sexual assaults and acquisitory crimes between intentional and unintentional GHB intake cases. Among unintentional GHB intake cases, 6.5% endured GHB-involved sexual assaults, whereas 21.7% endured an acquisitory crime. Among recurrent GHB intoxication cases generated by the same patients, voluntary and sole GHB consumptions were more frequently observed, however, enduring any crime was less characteristic.

DISCUSSION

Our results regarding demographic and substance use characteristics and the frequency of GHB-facilitated sexual assaults are in line with former findings. Enduring acquisitory crimes due to unintentional GHB intake was found to be more inherent than enduring sexual assaults. Authors emphasise that the victims of these acquisitory crimes were typically males.

CONCLUSION

GHB's role in drug facilitated acquisitory crimes seems to be significant, although the decrease in GHB's popularity is observed among intoxicated patients as well. The need for further research on GHB's impact on cognitive impairment and on sexual correlates of intentional GHB use is addressed by the authors.

Prescription Drug Misuse and Sexual Behavior Among Young Adults

Though research indicates a complex link between substance use and sexual risk behavior, there is limited research on the association between sexual risk behavior and prescription drug misuse. In light of alarming increases in prescription drug misuse and the role of demographic characteristics in sexual risk behavior and outcomes, the current study examined demographic differences (gender, sexual identity, age, relationship status, parental class background, and race/ethnicity) in sexual risk behavior, sexual behavior under the influence of prescription drugs, and sexual risk behavior under the influence of prescription drugs in a sample of 402 young adults (ages 18 to 29) who misused prescription drugs. Nearly half of the sexually active young adult prescription drug misusers in this sample reported recent sex under the influence of prescription drugs; more than three-quarters reported recent sex without a condom; and more than one-third reported recent sex without a condom after using prescription drugs. Zero-inflated Poisson regression models indicated that White race, younger age, higher parental class, and being a heterosexual man were all associated with sexual risk behavior, sex under the influence of prescription drugs, and sexual risk under the influence of prescription drugs. Findings have implications for the targeting of prevention and intervention efforts.

Drug use and sexual arrangements among gay couples: frequency, interdependence, and associations with sexual risk

Rates of drug use among gay men are higher than their heterosexual counterparts and drug use is a prominent risk factor for HIV transmission. Studies using heterosexual samples have found that being partnered reduces the risk of drug use and individuals in a relationship tend to have similar use patterns. Studies among gay men suggest that sexual agreements may be an important predictor of drug use. Data from 322 partnered gay men were collected and the 161 matched couples were categorized as monogamous (52.8 %), monogamish (14.9 %), open (13.0 %), and discrepant (19.3 %). Patterns of significance and significant trends suggested that monogamous men reported lower rates of marijuana and other drug use compared to open and monogamish men. Men in discrepant relationships did not differ from any other group. Partners' marijuana and other drug use was significantly interdependent in the overall sample; however, substantial variation in the magnitude and significance of interdependence was observed across sexual arrangement categories. Sexual arrangement and the use of drugs during sex both contributed to the prediction of UAI with casual partners among non-monogamous men. Implications for substance use treatment and HIV prevention are discussed.

Methamphetamine use in club subcultures

In recent decades, methamphetamine developed a peculiar geographic distribution in the United States, with limited diffusion in the Northeast. While use within gay clubs received attention, methamphetamine in club subcultures more broadly remains less clear. Using quantitative and qualitative data, we provide a descriptive assessment of methamphetamine use in club subcultures. Methamphetamine use in club subcultures often has instrumental purposes. The context of initiation into methamphetamine use and its close connection to cocaine shape later patterns of use. Viewing meth solely as a gay party drug misses a significant part of the population and may misguide public health strategies to reduce methamphetamine use in the Northeast.

Circumstances of initiation into new-type drug use among adults in Shanghai: are there differences by types of first new-type drug used?

BACKGROUND

This study investigated circumstances of initiating new-type drug use among adult new-type drug users and differences among those who first used methamphetamine, ecstasy and ketamine.

METHODS

A total of 276 participants were recruited, using respondent-driven sampling (RDS) from nine seeds recruited through NGOs, social workers and outreach workers in Shanghai, China.

RESULTS

Methamphetamine was the most frequently reported first new-type drug used (37.1%), followed by ecstasy (35.6%) and ketamine (20.0%). 38.7% of participants initiated new-type drug use before the age of 21 years. 47.8% knew at initiation that club drugs can be harmful. Most were introduced to new-type drug use by friends, spouses or boy/girlfriends. The three most common reasons for initiation were curiosity, peer influence, and wishing to dull one's emotions. Those first using methamphetamine were more likely to be female, have a monthly individual income less than 3000 Yuan (approx. $476), initiate use at 21 years or older and at private setting than those first using ecstasy and ketamine.

CONCLUSIONS

There is an urgent need for drug education efforts in China to raise awareness of the harms of new-type drugs, as well as to increase knowledge about the paradox of new-type drug effects. Drug prevention and intervention programs should be tailore to target populations and their social context.

Acute effects of three club drugs on the striatum of rats: evaluation by quantitative autoradiography with [18F]FDOPA

In this work, we used quantitative autoradiography to study the acute effect of cocaine, methamphetamine, and ketamine on the uptake of [(18)F]FDOPA in the striatum of rats. Drugs were treated 0.5 h before (pre-treated), and 1.5 h after (post-treated) [(18)F]FDOPA injections, rats were then sacrificed at 2 h post [(18)F]FDOPA injections to determine the striatum/frontal cortex binding ratios in the striatum. The ratios were lower in the post-treated groups than those of the pre-treated groups, suggesting a net effect of inhibition of trapping of the tracer. The order of uptake inhibition is: ketamine>methamphetamine>cocaine.

Recruiting drug using men who have sex with men in behavioral intervention trials: a comparison of internet and field-based strategies

Although online and field-based samples of men who have sex with men (MSM) have been compared on a variety of markers, differences in drug use have not been well examined. In addition, generalization from studies comparing recruitment methods is often limited by a focus on either HIV seropositive or seronegative MSM. We compared two New York City-based samples of MSM recruited simultaneously between July 2009 and January 2010-one sample recruited in the field (n = 2,402) and one sample recruited via the Internet (n = 694). All recruitment efforts targeted men without restriction on age or self-reported HIV status. Our results show marked differences in drug and alcohol use between online and field-based samples of MSM. Specifically, men surveyed online were significantly more likely to have tried a variety of drugs, including methamphetamine, cocaine, and ecstasy. Men recruited online were also more likely to report older age, HIV positive serostatus, and "never" using condoms. Internet-based recruitment was found to be more cost-effective in terms of recruitment yield than was field-based recruitment.

Interview as intervention: the case of young adult multidrug users in the club scene

This paper reports on changes in substance use and substance dependence symptoms-without intervention-among young adult multidrug users in the club scene, ages 18-29, (N = 444) who participated in a natural history study. Computer-assisted personal interviews at baseline and 6-, 12-, and 18-month follow-ups included well-tested measures of substance use and dependence. Changes in substance dependence symptoms and drug use frequencies were calculated using Cohen's d statistic. Mean age was 22; 40% were female; 58% were Hispanic, 17% White, and 21% Black. At 18-month follow-up assessment, participants reported significantly fewer days of cocaine (d = -.85 at 18 months), ecstasy (d = -.93), benzodiazepine (d = -.82), and prescription opioid (d = -.81) use, as well as reduced substance dependence symptoms (d = -.42). These results, together with data from focus groups with completers, suggest that comprehensive health and social risk assessments may have quite strong intervention effects among young adult multidrug users.

Binge drinking and psychoactive drug use in a cohort of European youths

Background

TEN-D by Night is an international, multicentre, cross-sectional portal survey conducted on a large sample of young people in six European countries. This paper aims to investigate the alcohol and psychoactive drug consumption of this sample, with a focus on the prevalence of binge drinking and the poly-drug habits of the TEN-D cohort.

Design and Methods

The study population consisted of 4695 young people attending recreational sites on weekend nights. The intervention included two questionnaires and two psychoactive substance detection tests performed at the entry and exit of the recreational sites. A multivariate logistic regression model was used to predict the probability of binge drinking.

Results

Binge drinking was reported by 20% of the males and 13% of the females (P=0.001) before entry into the recreational sites and by 18% of the males and 11% of the females before entry into the clubs (P<0.001). Poly-drug use was reported by 71% of the males and 66% of the females. Living with a parent (OR 1.57; P=0.01), seeking employment (OR 1.66; P=0.005) and cannabis consumption (several times per month and several times per week, OR 1.94 and 3.66, respectively, P<0.05) were associated with binge drinking.

Conclusions

Our survey showed that it is possible to identify individuals and groups at higher risk of binge drinking. This identification would allow for a focus on specific targets and would facilitate the redesign of prevention programmes. The increased use of psychoactive substances among youths should be studied extensively to promote successful prevention campaigns.

HIV in young men who have sex with men: a review of epidemiology, risk and protective factors, and interventions

Epidemiological studies have found that young men who have sex with men (YMSM) represent the majority of young people infected with HIV annually in the United States. Further, they are one of the few risk groups to show an increase in the rate of infections in recent years. In addition to these disparities in prevalence and infection rates, there is an inequity in prevention and intervention research on this population. The purpose of this article is to review the existing YMSM literature on HIV epidemiology, correlates of risk, and intervention research. The article concludes that promising future directions for basic research include a focus on multiple clustering health issues, processes that promote resiliency, the role of family influences, and the development of parsimonious models of risk. In terms of intervention research, the article suggests that promising future directions include Internet-based intervention delivery, integration of biomedical and behavioral approaches, and interventions that go beyond the individual level to address partnership, structural, community, and network factors.

The problem of "just for fun": patterns of use situations among active club drug users

Existing research has demonstrated the significance of situational antecedents to substance use. The current study used a cluster analytic approach to identify groups of club drug users who report using substances in similar situations (assessed by the Inventory of Drug Taking Situations) with longitudinal data from 400 active drug users. A three-cluster solution emerged in baseline data and was replicated in 12-month follow-up data. Groups were identified as Situationally Restricted, Pleasure Driven, and Situationally Broad users. Group differences were observed on measures of mental health, attitudes towards substance use, amount of substance use, and rates of substance dependence. Cluster membership predicted substance dependence after controlling for past dependence, current use, and current depression/anxiety.

A European study on alcohol and drug use among young drivers: the TEND by Night study design and methodology

Background

Young individuals are the age group with the highest risk of car accidents. One of main explanations relies on the use of psychoactive substances (alcohol, illegal and medicinal drugs), which are known to be major risk factors of road accidents, and whose consumption is almost universally more common among younger drivers. Although the correlation between psychoactive substances use and decrease in driving performance has been established in controlled experimental or laboratory settings, few studies were conducted in naturalistic circumstances. The TEND by Night project has been designed to evaluate the relationship between driving performance and psychoactive substances assumption in young drivers enrolled at typical places of consumption.

Methods/Design

The TEND by Night project, endorsed by the European Commission, is a multidisciplinary, multi-centric, cross-sectional study conducted in six European countries (Italy, Belgium/Netherlands, Bulgaria, Spain, Poland and Latvia). The study population consists of 5000 young drivers aged 16-34 years, attending recreational sites during weekend nights. The intervention is based on the portal survey technique and includes several steps at the entrance and exit of selected sites, including the administration of semi-structured questionnaires, breath alcohol test, several drug assumption test, and measurement of the reaction time using a driving simulator. The main outcome is the difference in reaction time between the entrance and exit of the recreation site, and its correlation with psychoactive substances use. As a secondary outcome it will be explored the relationship between reaction time difference and the amount of consumption of each substance. All analyses will be multivariate.

Discussion

The project methodology should provide some relevant advantages over traditional survey systems. The main strengths of the study include the large and multicentric sample, the objective measurement of substance assumption (which is typically self-reported), the application of a portal survey technique and the simultaneous evaluation of several psychoactive substances.

Typology of club drug use among young adults recruited using time-space sampling

The present study examined patterns of recent club drug use among 400 young adults (18-29) recruited using time-space sampling in NYC. Subjects had used at least one of six club drugs (methylenedioxymethamphetamine (MDMA), ketamine, gamma-hydroxybutyrate (GHB), cocaine, methamphetamine, and D-lysergic acid diethylamide (LSD)) within the prior 3 months. We used latent class analysis (LCA) to estimate latent groups based on patterns of recent club drug use and examined differences in demographic and psychological variables by class. A 3-class model fit the data best. Patterns were: Primary cocaine users (42% of sample), Mainstream users (44% of sample), and Wide-range users (14% of sample). Those most likely to be Primary cocaine users were significantly less likely to be heterosexual males and had higher educational attainment than the other two classes. Those most likely to be Wide-range users were less likely to be heterosexual females, more likely to be gay/bisexual males, dependent on club drugs, had significantly greater drug and sexual sensation seeking, and were more likely to use when experiencing physical discomfort or pleasant times with others compared to the other two groups. Findings highlight the utility of using person-centered approaches to understand patterns of substance use, as well as highlight several patterns of club drug use among young adults.

Is ecstasy a drug of dependence?

This paper examines the evidence for an MDMA or "ecstasy" dependence syndrome. Animal evidence suggests that MDMA may be a less potent reinforcer than other drugs, but that it does have dependence potential. This suggests that (a) ecstasy dependence might be less likely than dependence upon other drugs; and (b) factors related to the behavioural and psychological aspects of reward and dependence may make a relatively greater contribution for ecstasy than for other drugs, where physically centred (and better understood) features of dependence may be more salient. Human evidence supports this proposition. Some people report problems with their use, but the literature suggests that physical features play a more limited role than psychological ones. Tolerance is apparent, and withdrawal is self-reported, but it is unclear whether these reports distinguish sub-acute effects of ecstasy intoxication from symptoms reflective of neuroadaptive processes underlying a "true" withdrawal syndrome. Studies examining the structure of dependence upon ecstasy suggest it may be different from drugs such as alcohol, methamphetamine and opioids. Consistent with studies of hallucinogens, a two-factor structure has been identified with factors suggestive of "compulsive use" and "escalating use". Regardless of the nature of any dependence syndrome, however, there is evidence to suggest that a minority of ecstasy users become concerned about their use and seek treatment. Further controlled studies are required to investigate this phenomenon.

Polydrug use among club-going young adults recruited through time-space sampling

The Club Drugs and Health Project was supported by a grant from the National Institute on Drug Abuse (R01-DA014925-02, Jeffrey T. Parsons, Principal Investigator). Christian Grov was supported as a postdoctoral fellow in the Behavioral Sciences training in drug abuse research program sponsored by Public Health Solutions and the National Development and Research Institutes, Inc. (NDRI) with funding from the National Institute on Drug Abuse (T32 DA07233). The authors recognize the contributions of the Club Drug and Health Project team-Michael Adams, Virginia Andersen, Anthony Bamonte, Jessica Colon, Armando Fuentes, Sarit A. Golub, Chris Hietikko, Eda Inan, Juline Koken, Jose E. Nanin, Anthony Surace, Julia Tomassilli, Jon Weiser, Brooke E. Wells, and the recruitment team. An earlier version of this paper was presented at the 2008 meeting of the College on Problems of Drug Dependence (CPDD). Though some researchers have indicated club drug users are more likely to be polydrug users, there remains little known about the prevalence and specific combinations of the substances they use. Between 2004 and 2006, and using time-space sampling, a stratified sample of 400, 18-29-year-old New York City club-going, drug-using young adults were recruited into the Club Drugs and Health Project. Most participants (91.7%) had engaged in polydrug usage and 1,670 combinations of drugs were reported. Ecstasy (86.6% of users) and cocaine (85.7% of users) were the two most-frequently reported club drugs used in combination with other substances. In terms of poly-club drug combinations, ecstasy appeared to be the "universal compliment" as this drug was most often cited in combinations with other club drugs (specifically ecstasy + ketamine, ecstasy + cocaine, ecstasy + gamma hydroxybutyrate or GHB). Other frequently cited drug combinations included cocaine and marijuana, ecstasy and marijuana, LSD and marijuana, and cocaine and alcohol. These data highlight the need to develop drug health-education and prevention messages targeted at polydrug usage.