Ethnic differences in narcotics addiction. I. Characteristics of Chicano and Anglo methadone maintenance clients

Pathways through opiate use and offending: A systematic review

BACKGROUND

Although evidence points to a strong link between illicit drug use and crime, robust evidence for temporal order in the relationship is scant. We carried out a systematic review to assess the evidence for pathways through opiate/crack cocaine use and offending to determine temporal order.

METHODS

A systematic review sourced five databases, three online sources, bibliographies and citation mapping. Inclusion criteria were: focus on opiate/crack use, and offending; pre-drug use information; longitudinal design; corroborative official crime records. Rate ratios (RR) of post-drug use initiation to pre-drug use initiation were pooled using random effects meta-analysis.

RESULTS

20 studies were included; UK (9) and US (11). All were of opiate use. Mean age at (recorded) offending onset (16.7yrs) preceded mean age at opiate-use onset (19.6yrs). Substantial heterogeneity (over 80%: unexplained by meta-regression) meant that RRs were not pooled. The RR for total (recorded) offending ranged from 0.71 to 25.7 (10 studies; 22 subsamples: positive association, 4: equivocal, 1: negative association). Positive associations were observed in 14/15 independent samples; unlikely to be a chance finding (sign test p=0.001). Individual offence types were examined: theft (RR 0.63-8.3, 13 subsamples: positive, 9: equivocal, 1 negative); burglary (RR 0.74-50.0, 9 subsamples: positive, 13: equivocal); violence (RR 0.39-16.0, 6 subsamples: positive, 15: equivocal); and robbery (RR 0.50-5.0, 5 subsamples: positive, 15: equivocal).

CONCLUSIONS

Available evidence suggests that onset-opiate use accelerates already-existing offending, particularly for theft. However, evidence is out of date, with studies characterised by heterogeneity and failure to use a matched non-opiate-user comparison group to better-establish whether onset-opiate use is associated with additional crime.

Drug Treatment Needs of Hispanic Drug Users in Long Beach, California

The objective of this study is to investigate differences between Hispanic and non-Hispanic drug users in Long Beach, CA, with respect to drug use, HIV risk behaviors, and drug treatment experience and to explore the dissimilarities between Hispanic drug users who identify their family origin as Mexican American compared to those who identify their family origin as Mexican. We recruited 1,728 drug users into an HIV risk reduction intervention; of these, 404 were Hispanic. The Risk Behavior Assessment (RBA) was used to collect information on demographics, drug and sex risk behaviors, and drug treatment experience. Hispanic drug users are significantly more likely to inject drugs than non-Hispanic drug users and were found to have a higher mean number of injections in the last 30 days. Hispanic drug users were more likely to have taken part in drug treatment programs, specifically methadone detoxification and maintenance programs. Self-identified Mexican drug users were less likely to have ever attended a drug treatment program than were Mexican-American drug users. Greater availability of drug treatment programs for monolingual and bilingual Hispanic injectors is needed.

Racial and ethnic differences in substance abuse service needs, utilization, and outcomes in California

OBJECTIVE

This study examined differences in service needs and treatment utilization, retention, and outcomes between African-American, Hispanic, and white substance abusers in community-based treatment programs.

METHODS

Data were collected from 2,401 African Americans, 3,222 Hispanics, and 7,980 whites who were admitted to 43 drug treatment programs across California from 2000 to 2001. The Addiction Severity Index (ASI) was administered at intake to assess clients' problem severity in a number of domains (alcohol use, drug use, employment, family and social relationships, legal, medical, and psychological), and treatment retention and arrest data were obtained from administrative records. A subsample was followed up at three months to assess service utilization (N=2,145) and again at nine months to readminister the ASI (N=2,566).

RESULTS

All three groups had similar severity levels of drug and legal problems upon treatment entry. Upon entry to treatment, white clients had the highest severity levels of alcohol, family, and psychiatric problems and African Americans had the highest severity levels of employment problems compared with the other two groups. Treatment retention did not differ between the three groups, but whites received a greater number of alcohol treatment services than did African Americans or Hispanics, and African Americans received a greater number of employment services than did Hispanic and white clients. All three groups showed significant improvement in all outcome domains except for medical outcomes. At the nine-month follow-up, whites had worse outcomes in the alcohol domain compared with the other two groups, and whites had worse outcomes in the legal domain compared with Hispanics. Compared with whites, African Americans were significantly less likely to be charged with driving under the influence in the year after treatment admission.

CONCLUSIONS

All three groups improved after treatment, although benefits from treatment can be further enhanced if services underscore different facets of the psychosocial problems of each racial and ethnic group.

Drug and Alcohol Use Among Homeless Older Adults

Using data from the National Survey of Homeless Assistance Providers and Clients (NSHAPC), predictors of current alcohol and drug misuse problems among homeless, previously homeless, and marginally housed older adults are identified. Childhood sexual assault, victimization, and neglect, being male, being younger, being homeless or previously homeless, being a minority, and having income below US$499 per month increased the odds of reporting a drug problem. Being male, being younger, being homeless, having mental illness increased the odds of reporting an alcohol problem. Reporting any type of substance use problem increased the odds of reporting the other.

Trajectories of heroin addiction: growth mixture modeling results based on a 33-year follow-up study

This study investigates trajectories of heroin use and subsequent consequences in a sample of 471 male heroin addicts who were admitted to the California Civil Addict Program in 1964-1965 and followed over 33 years. Applying a two-part growth mixture modeling strategy to heroin use level during the first 16 years of the addiction careers since first heroin use, the authors identified three groups with distinctive profiles: stably high-level heroin users (n = 278), late decelerated users (n = 149), and early quitters (n = 44). Study findings empirically demonstrate the chronic nature of heroin addiction and subsequent adverse consequences including mortality, mental health, and employment.

Predictors of reported current and lifetime substance abuse problems among a national sample of U.S. homeless

Using the National Survey of Homeless Assistance Providers and Clients (NSHAPC), this study examined predictors of alcohol and drug problems among a national probability sample of homeless and previously homeless adults in the United States. Consistent with research, about one third and one quarter of the respondents reported a current alcohol and drug problem, respectively. A larger proportion reported lifetime substance abuse problems. As hypothesized, males, younger respondents, veterans, and those with mental and physical health problems were at greater risk. Results reveal that substance abuse treatment and prevention programs for the homeless should take into consideration these characteristics to maximize effectiveness.

Drug treatment service utilization and outcomes for Hispanic and white methamphetamine abusers

OBJECTIVE

To examine differences in drug treatment service needs, utilization, satisfaction, and outcomes between Hispanic and white methamphetamine (meth) abusers.

DATA SOURCES

Intake assessments and follow-up interviews of 128 Hispanic and 371 non-Hispanic white meth abusers admitted during 2000-2001 to 43 drug treatment programs in 13 counties across California.

STUDY DESIGN

A prospective longitudinal study comparing ethnic differences in problem severity during pre- and posttreatment periods, as well as in services received during treatment.

DATA COLLECTION/EXTRACTION METHODS

The Addiction Severity Index (ASI) was administered at both intake and the 9-month follow-up to assess clients' problem severity in a number of domains. Service utilization and satisfaction were assessed 3 months following treatment admission.

PRINCIPAL FINDINGS

Hispanics were less educated and reported more employment difficulties than whites. Whites were more likely to be treated in residential programs than Hispanics despite similar severity in drug and alcohol use, legal, medical and family/social problems, and psychiatric status. Significantly more whites than Hispanics received psychiatric services, likely because more of them were treated in residential programs. Whites also reported receiving greater numbers of total services and services addressing alcohol and psychiatric problems. While no ethnic differences were found in treatment satisfaction and several other outcomes, Hispanics demonstrated better family and social outcomes than whites.

CONCLUSIONS

Both Hispanic and white meth abusers improved after treatment, although benefits from treatment can be further enhanced if services underscore different facets of their psychosocial problems.

Victimization and Substance Abuse among Women: Contributing Factors, Interventions, and Implications

Although the literature indicates that there is an association of victimization with substance abuse, there has been limited research focused on understanding and synthesizing the factors that have been identified as contributing to victimization and substance abuse and on interventions designed to address these contributing factors. The purposes of this article are to (a) review the literature on factors related to victimization and substance abuse, (b) review interventions and outcomes, and (c) discuss clinical implications for interventions and research. Results suggest that there is a high rate of co-occurrence of victimization and substance abuse among women, that the factors contributing to victimization and substance abuse are complex, and that there is a lack of treatment models addressing victimization and substance abuse.

Women, sex, and HIV: social and contextual factors, meta-analysis of published interventions, and implications for practice and research

This article is focused on examining social and contextual factors related to HIV-risk behavior for women. Specifically, this article has three main purposes: to review the literature on selected social and contextual factors that contribute to the risk for the heterosexual transmission of HIV and AIDS, to review and conduct a meta-analysis of HIV-prevention interventions targeting adult heterosexual populations, and to suggest future directions for HIV-prevention intervention research and practice. Results suggest that the HIV-prevention interventions reviewed for this article had little impact on sexual risk behavior, that social and contextual factors are often minimally addressed, and that there was a large gap between research and the practice of HIV-prevention intervention.

Women in treatment: within-gender differences in the clinical presentation of opioid-dependent women

Despite consistent evidence of gender differences in the nature of drug dependence, there has been little consideration of within-gender differences in the clinical presentation of drug-abusing women. In this study, cluster analysis and standardized ratings obtained from 153 women seeking methadone maintenance treatment were used to define four groups of women with different profiles of problem severity. The four clusters were characterized as Unemployed, Medically Ill, Psychiatrically Distressed, and Higher Functioning. When the validity of this four-cluster solution was examined, there were significant differences in the ethnic composition of the four groups, and the four clusters differed in terms of a) psychiatric status, b) medical status, c) vocational-educational history, d) lifetime history of maltreatment, and e) perception of social support available from friends and family. The findings suggest that, although understanding of gender differences cannot be ignored, understanding of ways women differ from one another may be as important in the development of gender-sensitive treatment programs.

Ethnic Differences in Longitudinal Patterns and Consequences of Narcotics Addiction

The purpose of this paper is to examine differences in patterns and consequences of narcotics use among Hispanic and white addicts over time. Data were gathered from admission records and from interviews conducted in 1974–75 and 1985–86 from 323 Hispanic and 212 white narcotics addicts admitted to the California Civil Addict Program in 1962 to 1964. Analyses compared the two groups on narcotics use, incarceration, mortality, and other characteristics at each follow-up point and in terms of drug-use status. Compared with white addicts, Hispanic addicts showed a progression of more persistent and severe narcotics addiction. At each interview point, Hispanics were more likely than whites to be using opiates or to be incarcerated. Comparisons of opiate use at the two interview points showed that Hispanics were less likely than whites to remain abstinent and were more likely to relapse to opiate use. Overall, Hispanics also had greater involvement in the criminal justice system, higher rates of cocaine use, and a higher proportion of deaths due to violence and accidents.

A differential assessment of the cumulative versus stabilizing effect of methadone maintenance treatment

Differential response effectiveness is examined for patients during multiple episodes of methadone maintenance (MM) treatment. Subjects were 251 narcotics addicts who were divided into three groups based on their daily narcotics use pattern during their first two MM treatment periods: (1) a "stabilizing group"--showing no daily use for both periods, (2) a "cumulative group"--showing a lower level of daily use during the second period compared to the first, and (3) a "deteriorating group"--showing higher daily use during the second period. Behavioral measures for various narcotics-related variables were plotted over 4 time periods (pre-MM, during first MM, between first and second episodes, and during second MM) were compared. Results indicated several individual differences related to patients' response to multiple episodes of MM. Clinical, research, and policy implications are discussed.

Gender relations in addiction and recovery

This article adds to the growing but still limited literature on the role of gender relations in women's addiction and recovery. In-depth interviews were conducted with 35 women randomly drawn from a large study of drug-abusing pregnant women who were recruited into an HIV/AIDS prevention program. These interviews explored conditions surrounding initiation and continuation of drug use, past and current sexual/love relationships, and experiences in the HIV/AIDS prevention program. Throughout the interviews, the women participants consistently voiced feelings stressing the importance of relationships in their lives. At the same time, they expressed a sense of disconnection and deprivation in those relationships. Four areas in which relationships with male partners ran counter to women's needs for connection are discussed in this article: initiation into drug use and supply of drugs, disappointment in men for failure to be providers, experience of violence, and opposition to treatment. The implications of these findings for substance abuse treatment are discussed.

AIDS and the health crisis of the U.S. urban poor; the perspective of critical medical anthropology

The social identity of HIV/AIDS in the U.S. has been shaped, for the most part, by two factors, the prevailing configuration of social relations across class, racial, gender, and sexual orientation, on the one hand, and the prevailing array of public health, especially epidemiological, categories of disease transmission, on the other. Focusing on the AIDS epidemic among inner city people of color, this paper challenges the distortions wrought in our understanding from both of these factors and instead develops an alternative perspective for AIDS research among medical anthropologists and health social scientists generally.

Alcohol and heroin use patterns of narcotics addicts: gender and ethnic differences

Data on lifetime alcohol and heroin use by 443 White and Chicano addicts of both genders were obtained from a sample of admissions to several Southern California methadone maintenance programs. Patterns of alcohol and heroin use were examined with respect to gender and ethnic differences. Repeated-measures MANOVA established an inverse pattern of alcohol and heroin use for all four groups, confirming and extending the findings of a previous study by the authors. With this additional evidence, the authors propose a compensatory model that explains the obtained inverse pattern of alcohol and heroin use and that may be suitable in examining concurrent or sequential use of other psychoactive substances in addition to alcohol. Significantly higher levels of heavy alcohol use were reported by Chicano than by White addicts. Overall findings indicate that after heroin addiction occurs, there is a convergence in patterns of substance use by both genders, although variations related to ethnicity persist, particularly for alcohol use.

Addiction Severity Index scores of four racial/ethnic and gender groups of methadone maintenance patients

This report compares the findings for four racial/ethnic and gender groups of methadone maintenance (MM) patients--African-American men (n = 153), African-American women (n = 107), Hispanic men (n = 138), and Hispanic women (n = 70)--administered the Addiction Severity Index (ASI). African-American men had a history of more arrests and incarcerations than Hispanic men. African-Americans had a longer history of drug and alcohol abuse problems than Hispanics and more current alcohol problems. Women reported more medical, psychiatric, family-social, and employment problems than men. Men reported more legal and alcohol-related problems than women. With several exceptions, the study findings were consistent with those based on other instruments. Given the relatively large sample sizes, the data may provide a characteristic ASI profile of the racial/ethnic and gender groups studied. The implications of differential group problem levels for substance abuse treatment efforts are discussed.

Social intervention against AIDS among injecting drug users

Many drug injectors continue to engage in behaviors that lead them to become infected with HIV in spite of a wide variety of public health programs. In addition, many persons have begun to inject drugs in spite of knowing the risks of AIDS. The inadequacy of current efforts to prevent these behaviors suggests that additional forms of intervention should be attempted. We suggest that social interventions be tried to complement current programs (almost all of which have an individual focus). Evidence that social factors such as peer pressure and the social relations of race affect risk behavior is presented. Social interventions that are discussed include organizing drug injectors against AIDS in ways analogous to those in which gays organized against the epidemic, and finding ways to change large-scale social relationships that predispose people to inject drugs.

Ethnicity and alcohol/drug use revisited: a framework for future research

Despite the large pool of research findings pertaining to ethnic and racial variations in the use of drugs (including alcohol), the relationship between ethnicity and drug use has not been thoroughly examined. This paper describes some of the major findings regarding ethnic and racial variations in drug use, and examines the methodological limitations of such studies. Moreover, this paper addresses the problem of shortage of theoretical explanations for ethnic variations in drug use. It is argued that the variable of ethnicity has not been properly conceptualized and measured in most studies. Cultural and structural aspects of ethnicity at both the individual and collective levels are examined, and their possible contributions to more rigorous research on the relationship between ethnicity and drug use are discussed.

Hispanics and illicit drug use: a review of recent findings

This manuscript presents a comprehensive assessment of the current illegal drug use problem among Hispanics by analyzing the recent findings on this subject. Information is provided on the prevalence of illegal drug use by drug type, age, and specific Hispanic group, and on the accessibility and availability of drug treatment facilities to Hispanics. The consequences of illegal drug use upon the well-being of Hispanics are discussed. Recommendations on additional research are made.

Conditional factors of maturing out: legal supervision and treatment

This study is third in a series exploring the conditional nature of the process of maturing out of narcotics addiction over time. Hypotheses are tested about the relationship of two selected social interventions, legal supervision and methadone maintenance treatment, on maturing out. The technique of log linear modeling is used on long-term follow-up data from 375 admissions to the California Civil Addict Program. Results suggest that maturing out may be conditional on methadone treatment participation, which reduces addicted use to a greater extent for older addicts, but does not seem to be related to legal supervision, which is equally effective regardless of age.