摘要:

This study of all accidental fatal drug overdoses (N= 1,986) in New York City from 1990 to 1992, using medical examiner data, found that cocaine, often with opiates and ethanol, caused almost three-fourths of deaths, while opiates without cocaine caused roughly one-fourth of fatal overdoses. Only 5% of accidental drug fatalities were caused by drugs other than cocaine or opiates. This is a marked departure from the results of studies in the early 1980s when opiates prevailed as a cause of accidental fatal overdoses.In this study the highest cocaine overdose rates were found among males, African-Americans, and Latinos. Rates of opiate overdose without cocaine did not differ in regard to race/ethnicity except for low rates among Asians and other ethnic groups. There was a marked increase in the rate of combined cocaine and opiate overdoses from 1990 to 1992 and a more gradual but steady increase of overdoses due to opiates without cocaine during that time period. Overdoses due to drugs other than cocaine or opiates showed no increase during that time period.

ISSN:0095-2990    

DOI:10.3109/00952999609001650

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Research on familial factors in illicit drug abuse has been approached from the perspectives of psychiatric epidemiology, which aims to assess familial clustering of disorders, and clinical psychiatry, which focuses on intrafamilial dynamics. To date, however, these two research traditions have existed in relative isolation from each other, and there has been little consideration given to enhancing the understanding of familial factors in drug abuse by combining these approaches. The intention of this article is to critically review the literature in these two areas and to offer suggestions as to how the strengths from each could be applied in a comprehensive research approach.

ISSN:0095-2990    

DOI:10.3109/00952999609001651

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

This study was undertaken to compare cocaine-dependent patients with and without an opioid use disorder, in an effort to identify important clinical similarities and differences between the two groups. Ninety patients hospitalized for cocaine dependence were divided according to whether or not they had a coexisting opioid use disorder; 32 patients (35.6%) had an opioid diagnosis and 58 (64.4%) did not. The groups were compared on substance use histories, psychopathology, severity of drug-related problems, and 3-month cocaine use outcome. Patients with an opioid diagnosis had more current major depression, antisocial personality disorder, and other substance use disorders. They also had higher medical and drug scores on the Addiction Severity Index, and longer cocaine use histories. Nonetheless, 3-month cocaine use outcome was similar for both groups. Interestingly, patients with an opioid diagnosis engaged in more treatment during the follow-up period. Cocaine-dependent patients with a coexisting opioid use disorder may thus constitute a subgroup with worse prognostic characteristics, for whom differential treatments may improve outcome.

ISSN:0095-2990    

DOI:10.3109/00952999609001652

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Treatment outcome was evaluated for perinatal cocaine addicts admitted to a hospitalbased day treatment clinic, organized as a modified therapeutic community (TC) modality. The perinatal program consisted of a specialized track for women embedded within this larger coed day treatment clinic. A total of 87 perinatal women (28 pregnant at intake, the remaining 59 postpartum) were compared with cohorts of nonperinatal women (N= 63) and men (N= 158) admitted during the period of evaluation (September 1989 through December 1993).In logistic regression analysis, successful discharge urine status (last three urines prior to discharge drug-free) was associated with current child custody involvement (odds ratio = 2.80, 95% C.I. = 1.16–6.72), entering treatment when not postpartum (odds ratio = 0.15, 95% C.I. = 0.05–0.42), and taking psychiatric medication (odds ratio = 2.04, 95% C.I. = 1.11–3.72). Both pregnant and postpartum perinatal women showed a similar pattern of shorter treatment as compared with nonperinatal women and male clients, averaging 2 months of treatment as compared with 4 months for nonperinatal clients. Factoring out pregnancy and postpartum status, the women in treatment fared as well as men with respect to both retention and discharge urine standings. This finding indicates that programmatic modifications need to address specific perinatal issues and not gender issues per se. Also, a differential pattern in discharge urine status of women who enter treatment while pregnant vs. those who enter when postpartum suggests that outreach and recruitment be targeted, but not limited, to pregnant women.

ISSN:0095-2990    

DOI:10.3109/00952999609001653

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Injection drug use is a major risk factor for human immunodeficiency virus (HIV) infection and drug treatment is widely recognized as a core component of the public health effort to limit the spread of HIV. The assumption is frequently made that lack of immediate access to treatment is a significant barrier to the success of this effort. However, little empirical data exist to support this belief. We conducted a trial of no-cost outpatient drug-free treatment made available on demand to a cohort of out-of-treatment injection drug users (IDUs) in Portland, Oregon, through a coupon program. Of 824 IDUs, 272 (33%) expressed an interest in treatment, 225 (27%) accepted a coupon, 66 (8%) redeemed a coupon, and 9 (1%) remained in treatment for 6 months. These numbers indicate that simply enhancing access is not adequate. Additional strategies to increase motivation to enter and remain in treatment are needed if drug treatment is to play an important role in reducing the spread of HIV among injection drug users, their sexual partners, and their infants.

ISSN:0095-2990    

DOI:10.3109/00952999609001654

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Alcohol and other drugs of abuse (AODA) are of great medical and social concern. Patients with physical injury requiring rehabilitation may be at particular risk of AODA due to pain, physical handicaps, mood disturbances, vocational difficulties, and problems of self-image. Their access to AODA, however, is often temporarily or permanently limited. In this literature review, we have explored various aspects of AODA in physically disabled patients. Frequently, AODA are involved in the cause of physical injuries. The average use and abuse of alcohol prior to injury was high. Postinjury alcohol use and abuse frequently declined or remained unchanged. Some non-alcohol drug use and problems increased postinjury, particularly during initial periods. Postinjury abuse of AODA is particularly important with regard to the disruption of the rehabilitation process. Use of adequate control groups and analysis at multiple postinjury time points is recommended in future investigations.

ISSN:0095-2990    

DOI:10.3109/00952999609001655

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

The Johnson Intervention is a therapeutic technique in which members of the person's social network confront him or her about the damage the drinking or drug use has caused and the action they will take if treatment is refused. It is highly effective in engaging and retaining clients in inpatient treatment, but, since initial evaluations, two trends have emerged in the field. First, there has been an increase in the use of outpatient treatment and, second, a number of variations of the Johnson Intervention have been developed. The purpose of this study was to compare the effectiveness of the Johnson Intervention with four other methods of referral to outpatient treatment. The other methods included two naturally occurring types of referral (coerced and non-coerced) and two less intense and less costly variations of the Intervention (Unrehearsed and Unsupervised). Effectiveness was determined by both entry into and completion of treatment. A retrospective study was conducted on a sample of 331 cases drawn from an alcohol and other drug treatment agency. Those who had undergone the Johnson Intervention were more likely to enter treatment than those in any of the four other groups. Of those that entered treatment, the Johnson Intervention and the coerced referral groups were equally likely to complete treatment, and both groups were more likely to complete treatment than those in the other three types of referral. Although the Johnson Intervention was the most effective, the variations did show some measure of success and can be viewed as part of an Intervention continuum.

ISSN:0095-2990    

DOI:10.3109/00952999609001656

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

ISSN:0095-2990    

DOI:10.3109/00952999609001657

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Women for Sobriety represents a self-help option oriented toward positive thinking and behavior modification. Formed in 1975, there are now approximately 125 active WFS groups holding weekly meetings in the United States and Canada. Using data collected from a 1991 membership survey (n= 600, response rate = 73%), this paper chronicles WFS members' pathways to recovery. We describe turning points in seeking help, things women tried at first to contain their drinking, exposure to other treatment approaches, and referrals to WFS from formal treatment programs. Only 15% of the respondents sought treatment because they had been confronted about their drinking, while physical symptoms or emotional problems represented the turning point for over half the women. Another fifth said their life had gotten out of control, and these were the ones to achieve sobriety most quickly. Almost all WFS members had sought professional help for their drinking, and three-fourths have undergone individual therapy—suggesting that WFS members are fairly open to a psychological approach such as WFS offers. WFS philosophy is based on the belief that behavior is predicated on thoughts, so the program teaches members that maintaining sobriety must involve the realization that negative emotions are destructive—and that members can control how much they allow problems to bother them. Goals of membership include abstinence, improved self-esteem, and spiritual and emotional growth. About a third of the respondents currently attend AA, and no differences in length of sobriety associated with current AA attendance were found within the WFS membership. However, women who sought professional help in response to the turning point experience but who also attended AA that year were most likely to have achieved sobriety within a year of the turning point.

ISSN:0095-2990    

DOI:10.3109/00952999609001658

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor

摘要:

Self-help groups have assisted many in their recovery from alcohol use disorders. Although Alcoholics Anonymous (AA) is the largest self-help organization for addressing alcohol problems, no single organization can be suited to the needs of all alcohol abusers. For example, some alcoholics have chosen not to affiliate with AA because of objections to religious or spiritual references in the 12 steps of AA. It was largely for this reason that a secular self-help organization–Secular Organizations for Sobriety (SOS)–was established. This article provides an overview of SOS. Also described are the results of a survey of SOS participants. These data provide a preliminary picture of SOS members and will, we hope, stimulate further research on this organization and its effectiveness.

ISSN:0095-2990    

DOI:10.3109/00952999609001659

出版商:Taylor&Francis    

年代:1996

数据来源: Taylor