Table of Contents

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Volume 39, Number 1

March 2007

Characteristics and Behaviors of Ketamine Users in France in 2003   —Catherine Reynaud-Maurupt, Ph.D.; Pierre-Yves Bello, M.D.;  Stéphane Akoka, M.A. & Abdalla Toufik, Ph.D.

Single Versus Repeated Sessions of Ketamine-Assisted Psychotherapy for People with Heroin Dependence  — Evgeny M. Krupitsky, M.D., Ph.D.; Andrei M. Burakov, M.D., Ph.D.;  Igor V. Dunaevsky, M.D., Ph.D.; Tatyana N. Romanova, M.S.;  Tatyana Y. Slavina, M.D., Ph.D. & Alexander Y. Grinenko M.D., Ph.D.

Patterns of Ketamine Use Among Young Injection Drug Users —Stephen E. Lankenau, Ph.D. & Bill Sanders, Ph.D.

Is Recreational Ecstasy (MDMA) Use Associated with Higher Levels of Depressive Symptoms?  — Casey Guillot, M.S.

Spiritual/Religious Experiences and In-Treatment Outcome in an Inner-City Program for Heroin and Cocaine Dependence —Adrienne Heinz, B.A.; David H. Epstein, Ph.D. & Kenzie L. Preston, Ph.D.   

Reclaiming Futures: Communities Helping Teens Overcome Drugs, Alcohol and Crime—A New Practice Framework for Juvenile Justice — Laura Burney Nissen, Ph.D., M.S.W.

Client Outcomes from Rural Substance Abuse Treatment — Matthew L. Hiller, Ph.D.; Carl G. Leukefeld, D.S.W.; Thomas F. Garrity, Ph.D.; Theodore Godlaski, M.Div.; Marlies Schoeneberger, Ph.D.;    Michael Townsend, M.S.S.W. & Karyn Hascal, M.S.W

Why the Concept-Based Therapeutic Community Can No Longer Be Called Drug-Free — Fernando B. Perfas, D.S.W. & Suzanne Spross, Ph.D.

Effectiveness of Different Models of Case Management for Substance-Abusing Populations  — Wouter Vanderplasschen, Ph.D.; Judith Wolf, Ph.D.;  Richard C. Rapp, M.S.W. & Eric Broekaert, Ph.D. 

Codeine Cough Syrup Use Among African-American Crack Cocaine Users — Ronald J. Peters, Jr., Dr.P.H.; Mark Williams, Ph.D.; Michael W. Ross, Ph.D.; John Atkinson, M.S. & George S. Yacoubian, Jr., Ph.D. 

COVER ART — The Bay by Mari Aaronsouth (pastel, 22” x 28”; copyrighted, no duplication permitted)

www.mari-aaronsouth.com; 415-388-8462

Abstracts

Characteristics and Behaviors of Ketamine Users in France in 2003 —Catherine Reynaud-Maurupt, Ph.D.; Pierre-Yves Bello, M.D.; Stéphane Akoka, M.A. & Abdalla Toufik, Ph.D.

Abstract—The increase in recreational use of ketamine in France led to the carrying out of a survey aimed at depicting the sociological profiles of French ketamine users, their addictive behaviors, and the characteristics relevant to the use of the substance. This survey is based upon the analysis of 250 questionnaires, 24 semi-directive interviews, and two focus groups. Data was collected between July 2002 and June 2003 among individuals who had used ketamine at least once since January 1, 2001. The respondents were mostly males with a polydrug addiction, aged about 24, with little post-secondary education and no steady job. Ketamine was generally the last substance experimented with throughout their lifetime, as of the age of 22. The article reviews the frequency of ketamine use observed in the population surveyed, as well as the routes of administration, the quantities used, the circumstances of use, the sought-after effects and those experienced, and the risks perceived by the users themselves. The data collected provides working facts to allow for the development and implementation of policies for preventing the use and abuse of ketamine among vulnerable populations.

Keywords—addictive behaviors, ketamine use, risk behaviors, risk perception

Single Versus Repeated Sessions of Ketamine-Assisted Psychotherapy for People with Heroin Dependence — Evgeny M. Krupitsky, M.D., Ph.D.; Andrei M. Burakov, M.D., Ph.D.; Igor V. Dunaevsky, M.D., Ph.D.; Tatyana N. Romanova, M.S.;  Tatyana Y. Slavina, M.D., Ph.D. & Alexander Y. Grinenko M.D., Ph.D.

Abstract— A prior study found that one ketamine-assisted psychotherapy session was significantly more effective than active placebo in promoting abstinence (Krupitsky et al. 2002). In this study of the efficacy of single versus repeated sessions of ketamine-assisted psychotherapy in promoting abstinence in people with heroin dependence, 59 detoxified inpatients with heroin dependence received a ketamine-assisted psychotherapy (KPT) session prior to their discharge from an addiction treatment hospital, and were then randomized into two treatment groups. Participants in the first group received two addiction counseling sessions followed by two KPT sessions, with sessions scheduled on a monthly interval (multiple KPT group). Participants in the second group received two addiction counseling sessions on a monthly interval, but no additional ketamine therapy sessions (single KPT group). At one-year follow-up, survival analysis demonstrated a significantly higher rate of abstinence in the multiple KPT group. Thirteen out of 26 subjects (50%) in the multiple KPT group remained abstinent, compared to 6 out of 27 subjects (22.2%) in the single KPT group (p < 0.05). No differences between groups were found in depression, anxiety, craving for heroin, or their understanding of the meaning of their lives. It was concluded that three sessions of ketamine-assisted psychotherapy are more effective than a single session for the treatment of heroin addiction.

Keywords—hallucinogens, heroin addiction, ketamine, psychedelics, psychotherapy, treatment

Patterns of Ketamine Use Among Young Injection Drug Users —Stephen E. Lankenau, Ph.D. & Bill Sanders, Ph.D.

Abstract—Ketamine is a dissociative anesthetic that has emerged as an increasingly popular choice among young drug users. Recent research indicates the presence of hidden populations of young people who inject ketamine in New York and other U.S. cities. Applying an ethno-epidemiological approach, the authors recruited 40 young injection drug users (IDUs) (< 25 years old) in New York City to explore health risks associated with ketamine use. This analysis looks at the varying patterns and frequencies of ketamine injection by examining personal, social, and cultural aspects of these young people’s lives. We learned that drug-using histories, experiential dimensions, sociocultural characteristics, and associations with other young people help account for the different patterns of injecting ketamine within the sample. In particular, these findings indicate that young people who were more frequent ketamine injectors had the following characteristics: initiated injection drug use with ketamine; enjoyed the effects of ketamine, were stably housed; lived in the vicinity of New York City; and associated with others who also injected ketamine.

Keywords—ethnography, high-risk youth, injection drug use, ketamine

Is Recreational Ecstasy (MDMA) Use Associated with Higher Levels of Depressive Symptoms? — Casey Guillot, M.S.

Abstract— Due to potential serotonergic deficits, 3,4-methylenedioxymethamphetamine (MDMA or Ecstasy) may cause long-term mood disruptions in recreational Ecstasy users. The purpose of this review is to evaluate the evidence for a relationship between recreational Ecstasy use and higher levels of depressive symptoms. Eleven out of twenty-two studies initially have reported significantly higher depression scores in Ecstasy users in comparison to control participants. However, only three studies ultimately have revealed significantly higher depression scores in comparison to cannabis or polydrug controls. Furthermore, most studies have suffered from methodological weaknesses, and the levels of depressive symptoms that have been found in Ecstasy users have not been shown to be much higher than those found in normative groups. The evidence for an association specifically between Ecstasy use and higher levels of depressive symptoms is currently unconvincing, but the frequent concomitant use of Ecstasy and other illicit drugs has been shown to be associated with higher levels of depressive symptoms. Possible causes include polydrug use in general, MDMA-induced serotonergic deficits, individual effects of illicit drugs besides Ecstasy, combined effects of MDMA and other illicit drugs, and preexisting differences in the levels of depressive symptoms in Ecstasy users.

Keywords—3,4-methylenedioxymethamphetamine, 5-HT, depression, Ecstasy, MDMA, serotonin

Spiritual/Religious Experiences and In-Treatment Outcome in an Inner-City Program for Heroin and Cocaine Dependence —Adrienne Heinz, B.A.; David H. Epstein, Ph.D. & Kenzie L. Preston, Ph.D.

Abstract—Although spirituality is an integral component of some of the most popular approaches to substance abuse treatment, there is little empirical evidence for a causal relationship between spirituality and treatment success. In the present study, 169 (121 male) opiate- or cocaine-abusing treatment seekers completed the Index of Spiritual Experience (INSPIRIT), a questionnaire that assesses both spirituality and religiosity. Responses were analyzed in terms of demographic variables and in-treatment outcome, which was determined by treatment retention and drug screens from observed biweekly urine collections. Religious/spiritual beliefs were common in these participants and were associated with in-treatment outcome: total INSPIRIT score was weakly correlated (r = .16, p < .04) with number of subsequent cocaine-negative urines, and participants reporting that they frequently spent time on religious/spiritual activities showed significantly better outcomes in terms of subsequent drug use and treatment retention. Women and African Americans were more likely than men and non-African Americans to report religious and spiritual beliefs or experiences on several individual items, and African Americans had higher INSPIRIT scores than Caucasians. The results suggest that spiritual and religious experience plays a role in substance abuse recovery and that demographic characteristics should be considered in the design of spiritually oriented behavioral interventions for addiction.

Keywords—addiction, religion, spirituality, substance abuse, treatment

Reclaiming Futures: Communities Helping Teens Overcome Drugs, Alcohol and Crime—A New Practice Framework for Juvenile Justice — Laura Burney Nissen, Ph.D., M.S.W.

Abstract—Increasing numbers of youth entering the juvenile justice system on drug-related charges require new practice frameworks for youth advocates. Screening, assessment and intervention capabilities have not kept pace with the youth who need them. This article presents an overview of a new approach, based on the system of care movement, to integrated care service provision for this population. Utilizing the Reclaiming Futures initiative—being piloted in 10 communities in the United States—as a model for change, the article suggests that juvenile justice, in partnership with treatment and other community stakeholders, can have a positive impact on this social problem.

Keywords— alcohol, at-risk youth, drug abuse, juvenile justice, substance abuse

Client Outcomes from Rural Substance Abuse Treatment — Matthew L. Hiller, Ph.D.; Carl G. Leukefeld, D.S.W.; Thomas F. Garrity, Ph.D.; Theodore Godlaski, M.Div.; Marlies Schoeneberger, Ph.D.; Michael Townsend, M.S.S.W. & Karyn Hascal, M.S.W.

Abstract—Several national evaluations have been conducted since the late 1960s that have assessed the effectiveness of publicly-funded substance abuse treatment in the United States. These studies, however, have focused principally on urban-based treatment programs, and it is unclear whether findings from urban programs can be replicated in outcome studies of programs in rural areas. The current study, therefore, examined the treatment outcomes of clients admitted to one of several short-term inpatient or outpatient drug-free treatment agencies in rural Kentucky. Findings showed that treatment was associated with reductions in drug use and criminality during a six-month follow-up interval. Employment status also improved significantly, and health services utilization was reduced. The similarity between the current findings and findings from national outcome studies of urban-based treatment programs is discussed.

Keywords—drug abuse, inpatient, outcomes, outpatient, rural

Why the Concept-Based Therapeutic Community Can No Longer Be Called Drug-Free — Fernando B. Perfas, D.S.W. & Suzanne Spross, Ph.D.

Abstract—In the last two decades, a complex controversy has emerged in therapeutic community (TC) drug treatment programs, many of which are experiencing a marked increase in addicted clients with co-existing mental health disorders. This situation calls into question many theoretical and practical aspects of the TC approach to addiction recovery. Among the central issues: use of psychotropic medications for the increasing cases of comorbidity among substance abuse clients entering the TC, the influx of mental health professionals, and employment of a growing number of mental health interventions or services. The traditional drug-free self-help approach to drug treatment by the TC (with its own set of treatment interventions) and its historic dominance by ex-addicts or recovering persons as key staff are undergoing change. Integrating a biopsychosocial model into the traditional TC treatment modality requires a variety of adjustments that challenge the status quo in these programs. In particular, the use of psychotropic medications and mental health service providers in TC programs has improved the delivery of treatment to clients but at the same time it has created a cultural conflict for paraprofessional staff espousing the drug-free self-help philosophy. The clinical implications and organizational challenges of this predicament are described. Recommendations are provided on how to accept current health care realities without compromising the unique qualities of the TC approach.

Keywords— biopsychosocial model, comorbidity, drug addiction, psychotropic drugs, self-help, therapeutic community

Effectiveness of Different Models of Case Management for Substance-Abusing Populations — Wouter Vanderplasschen, Ph.D.; Judith Wolf, Ph.D.; Richard C. Rapp, M.S.W. & Eric Broekaert, Ph.D.

Abstract—Case management has been implemented in substance abuse treatment to improve (cost-) effectiveness, but controversy exists about its potential to realize this objective. A systematic and comprehensive review of peer-reviewed articles (n = 48) published between 1993 and 2003 is presented, focusing on the effects of different models of case management among various substance-abusing populations. Results show that several studies have reported positive effects, but only some randomized and controlled trials have demonstrated the effectiveness of case management compared with other interventions. Longitudinal effects of this intervention remain unclear. Although no compelling evidence was found for the effectiveness of case management, some evidence is available about the (differential) effectiveness of intensive case management and assertive community treatment for homeless and dually-diagnosed substance abusers. Strengths-based and generalist case management have proven to be relatively effective for substance abusers in general. Most positive effects concern reduced use of inpatient services and increased utilization of community-based services, prolonged treatment retention, improved quality of life, and high client satisfaction. Outcomes concerning drug use and psychosocial functioning are less consistent, but seem to be mediated by retention in treatment and case management. Further research is required to learn more about the extent of the effects of this intervention, how long these are sustained and what specific elements cause particular outcomes.

Keywords—case management, effectiveness, review, substance abuse, treatment

Codeine Cough Syrup Use Among African-American Crack Cocaine Users — Ronald J. Peters, Jr., Dr.P.H.; Mark Williams, Ph.D.; Michael W. Ross, Ph.D.; John Atkinson, M.S. & George S. Yacoubian, Jr., Ph.D.

Abstract—While studies show evidence of a clear problem with the prevalence of crack cocaine and codeine cough syrup use separately, the relationship between these substances of abuse and concurrent polydrug use is unknown. In an attempt to ascertain beyond anecdotal evidence, the authors carried out a cross-sectional study among 482 African-American crack users to investigate the differences between those who were concurrently codeine cough syrup users and those who were not codeine cough syrup users in Houston, Texas. Logistic regression indicated that codeine use was significantly associated with lower participant age, lower education, and lower odds of not having a main sexual partner. In addition, codeine users had significantly higher odds of ever trading sex for money, marijuana use, and fry use. These findings are important in determining the “cultural novelties” relative to crack and codeine use among younger African Americans.

Keywords—codeine, crack, drugs, sex