Table of Contents

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Volume 38, Number 1

March 2006

Sexual Assault): A Consideration of the Issues  — Karl L.R. Jansen, M.B.Ch.B, M.Med.Sci, D.Phil (Oxon), M.R.C.Psych & Lynn Theron, M.D., F.A.C.E.M.

A Profile of Ecstasy (MDMA) Use in São Paulo, Brazil: An Ethnographic Study — Murilo Campos Battisti, M.Sc.; Ana Regina Noto, Ph.D.; Solange Nappo, Ph.D. & Elisaldo de Araújo Carlini, M.D., Ph.D.

Psychiatric Disorders and Their Correlates Among Young Adult MDMA Users in Ohio — Russel S. Falck, M.A.; Robert G. Carlson, Ph.D.;  Jichuan Wang, Ph.D. & Harvey A. Siegal, Ph.D.

Exploring the Validity of Self-Reported Ecstasy Use Among Club Rave Attendees —George S. Yacoubian, Jr., Ph.D. & Eric D. Wish, Ph.D.

Alcohol, Drugs, and Substance Use Among Asian-American College Students —Dominicus W. So, Ph.D. & Frank Y. Wong, Ph.D.

Medical Use, Illicit Use and Diversion of Prescription Stimulant Medication — Sean Esteban McCabe, Ph.D., M.S.W.; Christian J. Teter, Pharm.D., B.C.P.P. & Carol J. Boyd, Ph.D., R.N.

Axis I Psychiatric Comorbidity Among Adult Inhalant Dependents Seeking Treatment— Cuneyt Evren, M.D.; Tuncay Barut, M.D.; Omer Saatcioglu M.D. & Duran Cakmak, M.D.

An Exploratory Investigation of Marijuana and Other Drug Careers— Michael Hallstone, Ph.D.

The Rise of the Mobile Phone in the Hard Drug Scene of Rotterdam — Cas Barendregt, M.A.; Agnes van der Poel, M.A. & Dike van de Mheen, Ph.D.

Dissemination and Feasibility of a Cognitive-Behavioral Treatment for Substance Use Disorders and Posttraumatic Stress Disorder in the Veterans Administration — Joan M. Cook, Ph.D.; Robyn D. Walser, Ph.D.; Vincent Kane, L.S.W.;  Josef I. Ruzek, Ph.D. & George Woody, M.D.

Predicting Treatment Retention with a Brief “Opinions About Methadone” Scale — Deborah J. Kayman, C.S.W., Ph.D.; Marjorie F. Goldstein, Ph.D.;  Sherry Deren, Ph.D. & Andrew Rosenblum, Ph.D.

Obviation of Opioid Withdrawal Syndrome by Concomitant Administration of Naltrexone in Microgram Doses: Two Psychonautic Bioassays  — Jonathan Ott

SHORT COMMUNICATION

Heroin Addicts Show Impairment of Information Processing at the Iconic Level  — Kripa S. Pathak, Ph.D.; Manas. K. Mandal, Ph.D.; Hari O. Sharma, Ph.D.  & Shusheela Rai, Ph.D.

COVER ART — Kosmos by Frank Pietronigro (www.pietronigro.com)

Abstracts

Sexual Assault): A Consideration of the Issues — Karl L.R. Jansen, M.B.Ch.B, M.Med.Sci, D.Phil (Oxon), M.R.C.Psych & Lynn Theron, M.D., F.A.C.E.M.
Abstract—The term “date rape drug” has traditionally been applied by the media to powerful sedatives, such as gamma hydroxybutyrate (GHB) and flunitrazepam (Rohypnol), which can render a person unconscious and hence unable to resist and/or recall an assault. However, some law enforcement agents and others have recently obtained convictions by arguing that the empathy-generating and sensual effects of MDMA, and an occasional increase in disinhibition and sexual desire linked with methamphetamine use, remove a person’s ability to give a reasoned consent, turning the person into “a helpless slave” to their own sexual desires and those of the alleged perpetrator. The argument holds that the victim becomes part of the assault because they may appear to be cooperating and colluding with activity which they would not have consented to without taking these drugs. This interpretation of the term “date rape” has been fed by data that sometimes finds MDMA and amphetamines in samples taken from sexual assault victims, and hence these prosecutions sometimes rely on expert testimony from toxicologists, pathologists and police officers rather than psychologists and psychiatrists who are expert in the human effects of these drugs. Some of those in the latter group have dismissed claims that MDMA is an aphrodisiac or a date rape drug as myths propagated by the media. In this article, these arguments and their respective strengths and weaknesses will be examined to assist professionals and others who may become involved in these cases.
Keywords—date rape, drug-facilitated sexual assault, GHB (gamma hydroxybutyrate), ketamine, MDMA (methylenedioxymethamphetamine), methamphetamine

A Profile of Ecstasy (MDMA) Use in São Paulo, Brazil: An Ethnographic Study — Murilo Campos Battisti, M.Sc.; Ana Regina Noto, Ph.D.; Solange Nappo, Ph.D. & Elisaldo de Araújo Carlini, M.D., Ph.D.
Abstract—The use of Ecstasy in Brazil has gained visibility in recent years. Nevertheless, scientific data on this issue remain scarce. The present study focused on clarifying this phenomenon by means of qualitative and ethnographic research. Observational studies (N = 8), information obtained from key informants (N = 14) and interviews with Ecstasy users (N = 32) from the city of São Paulo were part of this study. The results pointed to night clubs and rave parties where electronic music is played as the main context of use. Interviews with users revealed a sample of young adult members of the highest layers of society, with a good educational background and access to the labor market. Furthermore, polydrug use was manifested. Users’ typology was established regarding the pattern of drug use, showing two profiles of users: the “Rave Generation,” consisting of more recent users who initiated this use with the arrival of the large-sized rave parties at the end of the 1990s. The second profile, the “Sons of the Hell’s Club,” consisted of more experienced users (beginning in the early 1990s) and showed a richer history of use. Neither profile group had sought help regarding their Ecstasy use, and both showed positive beliefs related to the safety of use.
Keywords—drug use, Ecstasy, ethnography, MDMA, qualitative research

Psychiatric Disorders and Their Correlates Among Young Adult MDMA Users in Ohio — Russel S. Falck, M.A.; Robert G. Carlson, Ph.D.; Jichuan Wang, Ph.D. & Harvey A. Siegal, Ph.D.
Abstract—This study describes the lifetime prevalence, correlates, and age of onset of selected psychiatric disorders among a community sample of MDMA users (n = 402), aged 18 to 30, in Ohio. Participants responded to interviewer-administered questionnaires, including sections of the computerized Diagnostic Interview Schedule for DSM-IV. Fifty-five percent of the sample had at least one lifetime disorder, with major depression (35.3%) and antisocial personality disorder (ASPD) (25.4%) the most common. Proportionately more women were diagnosed with depression, generalized anxiety disorder, and posttraumatic stress disorder (PTSD), while proportionately more men were diagnosed with ASPD. Proportionately more non-White participants had attention deficit/hyperactivity disorder (AD/HD). Higher levels of education were associated with proportionately less PTSD, ASPD, and AD/HD. Higher frequencies of MDMA use were associated with proportionately more ASPD and AD/HD. Comparing the age of first MDMA use with the age of onset for selected psychiatric disorders revealed that for most participants disorders preceded use. Multivariate analysis revealed participants with more than a high school education were less likely to have experienced a lifetime disorder, while those who had used MDMA more than 50 times were more likely. Variations in the prevalence of psychiatric disorders have practical implications for drug abuse prevention and treatment programs.
Keywords—depression, epidemiology, MDMA, mental disorders, psychopathology, temporality

Exploring the Validity of Self-Reported Ecstasy Use Among Club Rave Attendees —George S. Yacoubian, Jr., Ph.D. & Eric D. Wish, Ph.D.
Abstract—While several empirical studies have focused on Ecstasy use among rave attendees, only one study has explored the validity of self-reported Ecstasy use within this population. To address this limitation, the authors collected self-report drug use information and oral fluid (OF) specimens from 96 club rave attendees within the Baltimore-Washington corridor between August and October 2000. The Kappa statistic is 0.59, suggesting a moderate relationship between the self-report and OF measures. Such accurate reporting bodes well for researchers interested in eliciting sensitive information from this population.
Keywords—concordance, MDMA, oral fluid, self-report, toxicology

Alcohol, Drugs, and Substance Use Among Asian-American College Students —Dominicus W. So, Ph.D. & Frank Y. Wong, Ph.D.
Abstract—Two hundred and forty eight self-identified Asian-American college students participated in this study that examined the prevalence rates and sociodemographic factors of substance use among Asian Americans in college. Using a Basic Demographic Questionnaire, Family of Origin Measure, Acculturation Lifestyle Survey, and Substance Use Checklist (all instruments were in English), prevalence rates were found to be comparable to or higher than a national sample: 94.5% lifetime prevalence and 78.6% current prevalence (past 30 days) of alcohol use; and higher current prevalence (past 30 days) of illicit drug use (9.5%) and of cigarette use (22.8%) than other Asians aged 12 and older (3.5% for illicit drugs and 17.7% for cigarettes) in a national survey. Male students and those who were employed were more likely to be current users (past 30 days) of drugs in general (15%) and marijuana (13.2%), and users of wine coolers (76.0%) and cigarettes (61.1%) in their lifetime. Being born overseas, years in the U.S., and preference for American TV/movies are associated with substance use. Asian Americans are not immune from substance use (or abuse) while in college. Culture-specific prevention is necessary.
Keywords—alcohol, Asian Americans, cigarettes, college students, drug, substance

Medical Use, Illicit Use and Diversion of Prescription Stimulant Medication — Sean Esteban McCabe, Ph.D., M.S.W.; Christian J. Teter, Pharm.D., B.C.P.P. & Carol J. Boyd, Ph.D., R.N.
Abstract—The objective of this study was to examine the prevalence and factors associated with the illicit use of prescription stimulants and to assess the relationship between the medical and illicit use of prescription stimulants among undergraduate college students. A Web survey was self-administered by a random sample of 9,161 undergraduate students attending a large public midwestern university in the spring of 2003. A total of 8.1% reported lifetime illicit use of prescription stimulants and 5.4% reported past year illicit use. The number of undergraduate students who reported illicit use of prescription stimulants exceeded the number of students who reported medical use of prescription stimulants for ADHD. The leading sources of prescription stimulants for illicit use were friends and peers. Multivariate logistic regression analyses revealed several risk factors for illicit use of prescription stimulants such as being male, White, member of a social fraternity or sorority, Jewish religious affiliation, and lower grade point average. All of these characteristics were also related to medically prescribed use of prescription stimulants. Those who initiated medically prescribed use of prescription stimulants for ADHD in elementary school were generally not at increased risk for illicit use of prescription stimulants or other drugs during college as compared to those who were never prescribed stimulant medication. The present study provides evidence that the illicit use of prescription stimulants is a problem among undergraduate college students, and certain subgroups appear to be at heightened risk.
Keywords—college students, epidemiology, prescription drug abuse, stimulant medication for ADHD, substance use

Axis I Psychiatric Comorbidity Among Adult Inhalant Dependents Seeking Treatment — Cuneyt Evren, M.D.; Tuncay Barut, M.D.; Omer Saatcioglu M.D. & Duran Cakmak, M.D.
Abstract—The present study aimed to investigate the prevalence of Axis I disorders in adult inhalant-dependent patients in comparison to other substance-dependent patients and subjects without substance use disorders. The inhalant-dependent group consisted of 83 male inpatient and outpatient adults diagnosed according to DSM-IV criteria. This group was compared with 74 other substance-dependent patients and with 70 subjects without alcohol and substance use disorder diagnoses. Ninety-three percent of the inhalant dependents had a lifetime history of at least one type of comorbid Axis I disorder, while 77% of the same subjects had at least one type of any affective disorder and 75.9% of them had at least one type of anxiety disorder. Prevalence of Axis I disorders among inhalant dependents was 72.3% for lifetime major depression, 41% for major depression during the past month, 24% for dysthymic disorder, 20.5% for inhalant-induced depressive disorder, 27.7% for panic disorder, 30% for PTSD, 36.1% for social phobia and 20.5% for generalized anxiety disorder. The rate of lifetime axis I disorders was higher in patients with inhalant dependency in comparison to the other two groups. This finding suggests that inhalant-dependent adults have high rates of comorbid psychiatric problems, and that it is important to determine Axis I disorder comorbidity in this population before making an inpatient or outpatient treatment plan.
Keywords—abuse, anxiety, comorbidity, depression, inhalant

An Exploratory Investigation of Marijuana and Other Drug Careers — Michael Hallstone, Ph.D.
Abstract—In-depth interviews and a qualitative methodology are used to examine the drug careers of a nonrandom sample of 31 current or former marijuana smokers. Three user typologies were developed to describe the complex development of marijuana careers over time: Druggies, Weekend Warriors, and Grown-ups. Druggies and Weekend Warriors tend to use marijuana (and alcohol) fairly heavily during the early phases of their careers; Druggies pass this stage quickly and eventually move on to harder drugs and periods of chronic substance abuse. Gradual assumption of adult identities and roles allow Weekend Warriors to moderate their marijuana (and other drug use), which steadily declines throughout the remainder of their careers. Grown-ups tend to use marijuana and all drugs moderately during the beginning phases of their careers, eschew experimentation with harder drugs, and generally progress to very controlled use of marijuana and other intoxicants (or abstinence) in the later stages of their careers. The social process of using marijuana teaches the majority of users to quit or how to integrate its use into a lifestyle that can reasonably be described as normal or conventional. Lastly, two future directions for drug career research are suggested.
Keywords—cannabis careers, cannabis use, drug careers, illicit drug use, marijuana careers, marijuana use

The Rise of the Mobile Phone in the Hard Drug Scene of Rotterdam — Cas Barendregt, M.A.; Agnes van der Poel, M.A. & Dike van de Mheen, Ph.D.
Abstract—The rise of mobile phone dealing in the retail market of heroin and cocaine in the city of Rotterdam is described. Multiple methods were used for the study, including analysis of street survey data (1998, 2000, 2003), qualitative and quantitative analysis of fieldwork data, and semi-open interviews with drug users and key informants. In 2000, 70% of the respondents to a street survey bought drugs from a mobile dealer. Qualitative data showed that the majority of mobile dealers have an ethnic Moroccan background; the reasons for this may include the ambiguous attitude of the Moroccan community towards drug crime, and repressive legislation causing the market to find alternatives for basic street dealing. The rise of mobile dealing is discussed as a form of reshaping of the drug market under prohibition.
Keywords—drug dealing, drug enforcement, drug markets, local drug policy, Moroccans, public nuisance

Dissemination and Feasibility of a Cognitive-Behavioral Treatment for Substance Use Disorders and Posttraumatic Stress Disorder in the Veterans Administration — Joan M. Cook, Ph.D.; Robyn D. Walser, Ph.D.; Vincent Kane, L.S.W.; Josef I. Ruzek, Ph.D. & George Woody, M.D.
Abstract—This article describes a small dissemination effort and provides initial efficacy data for use of Seeking Safety, a cognitive-behavioral treatment for comorbid substance use disorders (SUD) and posttraumatic stress disorder (PTSD), in a VA setting. After providing a daylong interactive training in Seeking Safety to front-line clinicians, a cotherapist group practice model was implemented. Following 14 months of clinician training and an uncontrolled pilot study of four groups with 18 veterans, initial efficacy data indicate significant symptom reduction for patients and acceptability to clinicians. Findings are encouraging in that Seeking Safety treatment appears to have the potential to be beneficial for veterans with SUD-PTSD and also appeal to clinicians. Dissemination of Seeking Safety is feasible in the VA, yet there are likely barriers to sustaining it as a routine treatment. Recommendations for future dissemination are proposed, including ways VA administration can facilitate this process.
Keywords—posttraumatic stress disorder, PTSD, substance-related disorders, therapy, trauma

Predicting Treatment Retention with a Brief “Opinions About Methadone” Scale — Deborah J. Kayman, C.S.W., Ph.D.; Marjorie F. Goldstein, Ph.D.; Sherry Deren, Ph.D. & Andrew Rosenblum, Ph.D.
Abstract—It is important to identify social conditions, program factors, and client characteristics that predict retention because time in substance abuse treatment is associated with improved health, mood, and social functioning. Treatment dropouts also are at high risk for serious harms, including relapse. Most opioid-dependent persons require long-term stabilization in methadone maintenance treatment (MMT) to normalize brain function and control withdrawal symptoms. The purpose of this study was to determine whether a client characteristic, namely, attitude toward methadone, was related to retention. Analysis of 14 opinion statements about methadone identified a reliable five-item scale with factorial validity. This scale (Opinions About Methadone; OAM-5) also predicted retention in MMT. Of 338 clients followed for one year after MMT enrollment, 48% dropped out of treatment; those who were more likely to remain had more favorable opinions. A supplementary qualitative study with MMT counselors demonstrated face validity for the OAM-5; counselors found the items easy to interpret and relevant to client attitudes towards MMT. The findings suggest that it would be worthwhile for MMT staff to assess client attitudes at intake, using the OAM-5. This would help them to identify and intervene promptly with those in greatest need of support for remaining in treatment.
Keywords—assessment, client opinions, methadone, opioid dependence, predictors, retention

Obviation of Opioid Withdrawal Syndrome by Concomitant Administration of Naltrexone in Microgram Doses: Two Psychonautic Bioassays — Jonathan Ott
Abstract—Two psychonautic bioassays (self-experiments) in stepwise and abrupt cessation of long-term daily oral ingestion habits of 800 mg of codeine phosphate are presented. Concomitant administration of minute doses (about 0.5 mcg) of the opioid antagonist naltrexone with each dose of codeine was found in both cases to obviate the expected opioid withdrawal syndrome, resulting in asymptomatic and uneventful transitions from physical opioid dependency states to exogenous opioid-free metabolism. These experiments are analyzed in the context of a conjectured, rapid, iterative reduction and complete elimination of opioid tolerance, once acquired. It was found that coadministration of naltrexone with codeine phosphate obviated the development of both tolerance and physical dependency over several months of four daily oral doses of 200 mg, allowing abrupt (“cold turkey”), asymptomatic and uneventful withdrawal. This points the way to the biochemical substrate of opioid tolerance itself, and shows that this can easily and inexpensively be blocked, even over months of iterative oral administration of substantial doses of opioid analgesics. Finally, it suggests the opioid withdrawal syndrome is directly related to the physiology of opioid tolerance, and can be prevented by blocking tolerance itself. Even when tolerance has been acquired, this can be reduced stepwise over a matter of days, with no symptoms of opioid withdrawal syndrome.
Keywords—addiction, codeine, naltrexone, opioids, tolerance, withdrawal

SHORT COMMUNICATION

Heroin Addicts Show Impairment of Information Processing at the Iconic Level — Kripa S. Pathak, Ph.D.; Manas. K. Mandal, Ph.D.; Hari O. Sharma, Ph.D. & Shusheela Rai, Ph.D.
Abstract—Heroin addicts (n = 100) and healthy controls (n = 100) were examined for their information processing ability at iconic (100 ms, 125 ms) as well as relatively deeper (250 ms, 500 ms) levels. Subjects were asked to identify briefly exposed photographs of familiar objects through an electronic tachistoscope. Addicts showed significant impairment of visual information processing at iconic but not at deeper levels.
Keywords— addiction, heroin, iconic, impairment, memory