Table of Contents

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Volume 38, Number 2

June 2006

The Drugs-Violence Nexus Among Mexican-American Gang Members — Avelardo Valdez, Ph.D.; Charles D. Kaplan, Ph.D. & Alice Cepeda, Ph.D.

Drug Users’ Participation in Addiction Care: Different Groups Do Different Things — Agnes van der Poel, M.A.; Cas Barendregt, M.A. &  Dike van de Mheen, Ph.D.

Are Americans Receptive to Smokefree Bars? —William Feigelman, Ph.D. & Julia A. Lee, Ph.D.

Values and Beliefs of Psychedelic Drug Users: A Cross-Cultural Study —Michael Lerner, B.A. (Honours) & Michael Lyvers, Ph.D.

Suicidal Ideation in Veterans Receiving Treatment for Opiate Dependence — Richard Thompson, Ph.D.; Vincent Kane, L.S.W.; Joan M. Cook, Ph.D.; Robert Greenstein, M.D.; Patricia Walker, B.A. & George Woody, M.D.

Maintaining the Viability and Safety of the Methadone Maintenance Treatment Program — Kathy T. Breslin, Ed.S. & Sandra Malone, Ph.D., R.N.

Street-Level Effects of Local Drug Policy on Marginalization and Hardening: An Ethnographic Study Among Chronic Drug Users — Moniek Coumans, Ph.D.; Ronald A. Knibbe, Ph.D. & Dike van de Mheen, Ph.D.

A Select Annotated Bibliography: Illegal Drug Research in Rural and Suburban Areas —Kirsten Hunt, M.A. & R. Terry Furst, Ph.D.

A Treatment Model for Craving Identification and Management —S. Alex Stalcup, M.D.; Darrell Christian, Ph.D.; Janice Stalcup, M.S.N., Dr.P.H.; Michelle Brown, M.A. & Gantt P. Galloway, Pharm.D.

Case-Control Retrospective Study of Pulmonary Tuberculosis in Heroin-Abusing Patients in China   — Wang Weihua, Ph.D., M.D.; Xiao Hong, M.D. & Lu Lanying, M.D.

SHORT COMMUNICATION 

A Comparison Between Instant and Laboratory Oral Fluid Analysis Among Arrestees — George S. Yacoubian, Jr., Ph.D. & Eric D. Wish, Ph.D.      207

COVER ART — Through the Looking Glass by Rori Ranch Productions

Abstracts

The Drugs-Violence Nexus Among Mexican-American Gang Members — Avelardo Valdez, Ph.D.; Charles D. Kaplan, Ph.D. & Alice Cepeda, Ph.D.
Abstract—This study examines hypotheses and builds models to help clarify the causal connections between drugs and violence outcomes among Mexican-American male gang members. The study uses cross-sectional data of 160 male gang members sampled from 26 gangs in a Southwestern city. A life-history /intensive interview using closed and open-ended questions and a violence risk psychometric test (PFAV) also employed 10 scenario questions to elicit self-produced accounts of the participant’s last fight. Gang member participant’s ages ranged from 14 to 25 years with a mean age of 18.5 years. The study concludes that drug use interacts with an individual gang member’s risk for violence to affect violent behavior outcomes. Furthermore, an important situational variable explaining violent outcomes among respondents scoring high on the violence risk measure was whether the rival was using drugs that resulted in high intoxication levels. The study concludes that drugs have a modulating and mediating influence on violence that is conditioned by situational and individual level variables among members of these adolescent street gangs.
Keywords—drugs-violence nexus, gangs, Mexican American, violence risk

Drug Users’ Participation in Addiction Care: Different Groups Do Different Things — Agnes van der Poel, M.A.; Cas Barendregt, M.A. & Dike van de Mheen, Ph.D.
Abstract—This study allocated 201 (nearly) daily users of heroin and/or crack into four groups, depending on their addiction care participation. Earlier studies have compared treatment groups and nontreatment groups. In this study the treatment group is divided into three categories: (1) drug users in contact with only treatment agencies—i.e., methadone maintenance, clinical and ambulant drug treatment; (2) drugs users in contact with only care agencies—i.e., day and night shelters and drug consumption rooms, which have no explicit aims to change patterns of drug use; and (3) drug users in contact with both treatment and care agencies. This allocation intro three different groups fits the notion of harm reduction, one of the policy aims in the Netherlands. The fourth group consists of drug users in contact with neither treatment nor care agencies. The results show that it is useful to distinguish these four categories, instead of two. The four groups are different from each other with respect to some of their characteristics (e.g. debt situation, prostitution, homelessness) and their drug use (e.g. drug use in public, use of crack, and use of other drugs). A much clearer distinction can be made between the “care” group and the “treatment and care” group. Treatment and care agencies can thus better match their services to their clients or patients.
Keywords—care agencies, dependent drug users, harm reduction, treatment agencies

Are Americans Receptive to Smokefree Bars? —William Feigelman, Ph.D. & Julia A. Lee, Ph.D.
Abstract—It is not known whether the American public accepts smokefree bars and restaurants. Anticipating public displeasure with these ordinances, tobacco, liquor and restaurant industry trade associations have helped to stall efforts to pass laws curbing bar and restaurant smoking in the expectation that diminished patronage would inevitably result. This cross-sectional trend study uses data from the May 1993 and January 1999 Current Population Surveys, Tobacco Use Supplements to compare tobacco-control attitudes among American bar and restaurant workers, all other workers, smokers and nonsmokers (total n = 90,661). It was found that by 1999, smokefree workplaces were widely accepted by two-thirds of adults, with half favoring completely smokefree restaurants. Completely smokefree bars remained less popular, with nearly equal numbers (about 30%) preferring them or favoring unrestricted bar smoking. Even among bar and restaurant industry workers less than 10% favored unrestricted restaurant smoking. Greater acceptances of smokefree bars are now taking hold, especially in places like California, where acceptance rose 15% in six years, and 45% preferred them. Opponents to smokefree bars and restaurants may have underestimated the levels of support and growing acceptance of smokefree living areas now taking hold among the general public.
Keywords—bar and restaurant workers, environmental tobacco smoke exposure, smokefree bars and restaurants, workplace smoking bans

Values and Beliefs of Psychedelic Drug Users: A Cross-Cultural Study —Michael Lerner, B.A. (Honours) & Michael Lyvers, Ph.D.
Abstract—Psychedelic drugs such as LSD and psilocybin are often claimed to be capable of inducing life-changing experiences described as mystical or transcendental, especially if high doses are taken. The present study examined possible enduring effects of such experiences by comparing users of psychedelic drugs (n = 88), users of nonpsychedelic illegal drugs (e.g., marijuana, amphetamines) (n = 29) and non illicit drug-using social drinkers (n = 66) on questionnaire measures of values, beliefs and emotional empathy. Samples were obtained from Israel (n = 110) and Australia (n = 73) in a cross-cultural comparison to see if values associated with psychedelic drug use transcended culture of origin. Psychedelic users scored significantly higher on mystical beliefs (e.g., oneness with God and the universe) and life values of spirituality and concern for others than the other groups, and lower on the value of financial prosperity, irrespective of culture of origin. Users of nonpsychedelic illegal drugs scored significantly lower on a measure of coping ability than both psychedelic users and non illicit drug users. Both groups of illegal drug users scored significantly higher on empathy than non illicit drug users. Results are discussed in the context of earlier findings from Pahnke (1966) and Doblin (1991) of the transformative effect of psychedelic experiences, although the possibility remains that present findings reflect predrug characteristics of those who chose to take psychedelic drugs rather than effects of the drugs themselves.
Keywords—drug use, LSD, psychedelics, spirituality

Suicidal Ideation in Veterans Receiving Treatment for Opiate Dependence —Richard Thompson, Ph.D.; Vincent Kane, L.S.W.; Joan M. Cook, Ph.D.; Robert Greenstein, M.D.; Patricia Walker, B.A. & George Woody, M.D.
Abstract—Persons with opiate use disorders, especially veterans, have a number of both chronic and acute indicators of risk for suicide, but are not typically screened for suicidal ideation on a routine basis, beyond initial evaluations. One hundred one veterans receiving treatment for opiate dependence at an urban VA medical center were screened for suicidal ideation. Over 24% reported some suicidal ideation. Current ideation was associated with severe chronic pain, ongoing problems with street drugs, firearm ownership, and with having recently enrolled in treatment. It was also associated with a variety of recent negative life events and mental health issues, especially depression, recurring troubling thoughts, hallucinations, loss of jobs, and conflicts with family members. Two veterans endorsing suicidal ideation required immediate hospitalization. The implications of these findings are discussed, and frequent screening for suicidal ideation among patients receiving treatment for opiate dependence is recommended.
Keywords—opiate, screening, suicide, veterans

Maintaining the Viability and Safety of the Methadone Maintenance Treatment Program — Kathy T. Breslin, Ed.S. & Sandra Malone, Ph.D., R.N.
Abstract—The purpose of this article is to describe a methadone maintenance treatment (MMT) program and address how such programs can maintain their viability in the community as well as the safety of the clinic environment for patients and staff. The complex nature of the MMT patient is described including social, legal and psychiatric issues. Diversion (selling of methadone) is discussed and examples of how to combat diversion are explored, including monitoring of take-home privileges. The safety of the clinic setting may be ensured through the utilization of toxicology screens and breathalyzers as well as through limit-setting, enforcement of program rules and the maintenance of professional therapeutic boundaries.
Keywords—methadone maintenance treatment, safety

A Select Annotated Bibliography: Illegal Drug Research in Rural and Suburban Areas —Kirsten Hunt, M.A. & R. Terry Furst, Ph.D.
Abstract—As the diffusion of illegal drugs continues to spread to rural and suburban areas, there is a greater need among illegal drug researchers, law enforcement, and policy makers to gain knowledge from previous work done on what is loosely termed as rural substance abuse research. To help serve that need an annotated bibliography is proffered based on three categories and one method of illegal substance abuse research. These are: drug consumption, drug distribution, drug prices, and ethnography. An exhaustive review of the literature was not undertaken, but rather a focus on research that addresses drug consumption and distribution is put forward.
Keywords—drug prices, drug trafficking, illegal substance abuse research, rural drug use

A Treatment Model for Craving Identification and Management —S. Alex Stalcup, M.D.; Darrell Christian, Ph.D.; Janice Stalcup, M.S.N., Dr.P.H.; Michelle Brown, M.A. & Gantt P. Galloway, Pharm.D.
Abstract—This article presents an addiction treatment model based on craving identification and management (CIM). Craving is broadly defined as the desire to use alcohol or other drugs; it increases the likelihood of use of these substances. In the CIM Model treatment interventions are referenced to craving, i.e., helping clients to identify their craving level and equipping them with strategies to avoid use. Four causes of craving are identified: (1) environmental cues (triggers): exposure to people, places, and things associated with prior drug-using experiences may cause immediate and overwhelming craving; (2) stress: addicted persons experience stress as craving; (3) mental illness; and (4) drug withdrawal: symptoms of both mental illness and withdrawal lead to craving if clients associate use with relief of these symptoms. The CIM Model incorporates four service delivery elements: Relapse Prevention Workshop, individual counseling, medical/psychiatric services, and screening for ongoing drug use. At its core, the CIM Model asks clients to be aware of craving, analyze its causes, and, based on those causes, implement specific strategies to prevent and manage craving. The CIM Model combines several treatment components, including control of exposure to environmental cues, establishment of a daily schedule, the use of behaviors that dissipate craving (tools), and treatment (with medications when appropriate) of mental health and withdrawal symptoms. The CIM Model is a client-derived approach to achieving and maintaining sobriety based on a process of analyzing craving and managing it with an individualized program of recovery activities.
Keywords—addiction, cognitive-behavioral, craving, recovery, treatment

Case-Control Retrospective Study of Pulmonary Tuberculosis in Heroin-Abusing Patients in China — Wang Weihua, Ph.D., M.D.; Xiao Hong, M.D. & Lu Lanying, M.D.
Abstract—The objective of this study was to observe the clinical significance of pulmonary tuberculosis in heroin abusers. A case–retrospective study was done to analyze clinical symptoms and severity based on chest X-rays, results of sputum bacterial test and effects of treatment. The clinical symptoms in patients with tuberculosis and heroin addiction were more severe than those in the nonheroin-addicted group. An examination of chest X-rays showed that tuberculosis lesions were involved in two or more lung fields in 80% of the heroin-addicted cases. In 73.3% of the cases, sputum bacterial tests were positive for tuberculosis. After anti-tuberculosis treatment, chest X-rays showed a recovery rate of 46.67%, caves became smaller by 41.7%, and the sputum negative conversion rate was 45.5%. There are significant differences compared with the control group (p < 0.05). The patients with pulmonary tuberculosis combined with heroin addiction had more severe clinical symptoms, more lesion zones found in their chest X-rays, higher sputum tuberculosis positive rates, and poorer treating effects.
Keywords—heroin addiction, lung, tuberculosis

SHORT COMMUNICATION

A Comparison Between Instant and Laboratory Oral Fluid Analysis Among Arrestees — George S. Yacoubian, Jr., Ph.D. & Eric D. Wish, Ph.D.
Abstract—Research studies that collect biological measures of drug use have traditionally utilized laboratory urinalysis. Several recent studies have also documented the utility of laboratory oral fluid (OF) analysis. A new method of drug testing—instant OF technology—may offer a quicker, equally accurate alternative to laboratory OF assays. To date, however, no field studies have compared the two methods. In the current study, an instant OF test (ORALscreen™) was administered to 65 adult arrestees surveyed through Maryland’s Substance Abuse Need for Treatment among Arrestees (SANTA) study. Following a research interview, a second OF sample was collected (ORALconfirm™) and shipped to the manufacturer’s laboratory for analysis. The instant OF test was 96% sensitive and 83% specific for cocaine, 100% sensitive and 75% specific for opiates, and 100% sensitive and 94% specific for marijuana. Kappa statistics were low for all three drugs, suggesting poor agreement between the two tests. Moreover, while the marijuana sensitivity and specificity coefficients in the current study were high, a growing body of research has indicated that OF analysis is not as accurate as the gold standard of urinalysis in detecting recent marijuana use. Implications for these findings are discussed.
Keywords—oral confirm, oral fluid, oral screen, rapid drug screening