Table of Contents

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Volume 39, Number 3

September 2007

Methadone Maintenance Therapy in Residential Therapeutic Community Settings: Challenges and Promise — Brian Greenberg, Ph.D.; Danny H. Hall, Ph.D. & James L. Sorensen, Ph.D. 

Methamphetamine Use in Dayton, Ohio: Preliminary Findings from the Ohio Substance Abuse Monitoring Network — Raminta Daniulaityte, Ph.D.; Robert G. Carlson, Ph.D. & Deric R. Kenne, M.S. 

Examining the Decay of HIV Risk Reduction Outcomes Following a Community-Friendly Intervention Targeting Injection Drug Users in Treatment — Michael M. Copenhaver, Ph.D. & I-Ching Lee, M.S. 

Implementing an Evidence-Based Practice: Seeking Safety Group — Vivian B. Brown, Ph.D.; Lisa M. Najavits, Ph.D.; Sharon Cadiz, Ed.D.; Norma Finkelstein, Ph.D.; Jennifer P. Heckman, Ph.D. & Elke Rechberger, Ph.D. 

Understanding the Working Alliance Between Persons with Substance Abuse Problems and Strengths-Based Case Managers —Cristina Redko, Ph.D.; Richard C. Rapp, M.S.W.; Cindy Elms, M.S.W.;  Mindy Snyder, M.A. & Robert G. Carlson, Ph.D. 

Substance Abuse Treatment Staff Perceptions of Intimate Partner Victimization Among Female Clients — Hillary Kunins, M.D., M.P.H., M.S.; Louisa Gilbert, M.S.W.;  Antonette Whyte, M.S.W.; Paul Meissner, M.S.P.H. & Mary Zachary, M.D. 

Adolescents’ Participation in Alcoholics Anonymous and Narcotics Anonymous: Review, Implications and Future Directions   —John F. Kelly, Ph.D. & Mark G. Myers, Ph.D. 

An Exploratory Study of OxyContin Use Among Individuals with Substance Use Disorders —Michael S. Levy, Ph.D. 

Beliefs and Social Norms about Codeine and Promethazine Hydrochloride Cough Syrup (CPHCS) Use and Addiction Among Multi-Ethnic College Students  — Ronald Peters, Jr., Dr.P.H., M.S.; George S. Yacoubian, Jr., Ph.D.; Warren Rhodes, Ph.D.; Karry J. Forsythe, B.A.; Kameko S. Bowers, B.S.; Valencia M. Eulian, B.S.; Clemmie A. Mangum, B.S.;   Jamie D. O’Neal, B.S.; Queen Martin, Dr.P.H.  & E. James Essien, M.D., Dr.P.H. 

The Creativity of Crumb:Research on the Effects of Psychedelic Drugs on the Comic Art of Robert Crumb — Matthew T. Jones, M.A.  

SHORT COMMUNICATIONS

Gamma-Hydroxybutyric Acid (GHB) Withdrawal: A Case Report — W. R. Murray Bennett, M.D., FRCPC; Lawrence G. Wilson, M.D. & Peter P. Roy-Byrne M.D. 

Abuse of Olanzapine by Substance Abusers — Roy R. Reeves, D.O., Ph.D. 

Death by Drug Overdose: Impact on Families — Eroy Aparecida da Silva, B.Sc.; Ana Regina Noto, Ph.D. & Maria Lucia O. S. Formigoni, Ph.D. 

BOOK REVIEW

The Brotherhood of Eternal Love—From Flower Power to Hippie Mafia: The Story of LSD Counterculture — Reviewed by Steve Heilig, M.P.H.

COVER ART - Winds of Change by Rori Ranch Productions

Abstracts

Methadone Maintenance Therapy in Residential Therapeutic Community Settings:  Challenges and Promise — Brian Greenberg, Ph.D.; Danny H. Hall, Ph.D. & James L. Sorensen, Ph.D.

Abstract—The therapeutic community (TC) and methadone maintenance treatment (MMT) have individually demonstrated consistent positive outcomes yet rarely have been combined. This article describes how a well-established residential therapeutic community integrated methadone maintenance treatment into its activities. Practical recommendations regarding how to incorporate MMT in a residential program are provided including topics for staff (training, coordination with the methadone service provider agency), patients (education, confronting stigma about methadone maintenance), and potential therapeutic activities (methadone group therapy). The implementation of these staff, patient, and therapeutic adaptations can assist residential substance abuse treatment programs in integrating these two addiction treatment modalities.

Keywords—drug abuse, methadone, opioid replacement therapy, residential treatment, therapeutic community

Methamphetamine Use in Dayton, Ohio: Preliminary Findings from the Ohio Substance Abuse Monitoring Network — Raminta Daniulaityte, Ph.D.; Robert G. Carlson, Ph.D. & Deric R. Kenne, M.S.

Abstract—Since the 1990s, methamphetamine manufacturing and use have been spreading into midwestern and southern United States. However, most research on methamphetamine use has been conducted in the western United States. This exploratory study is based on qualitative interviews with 26 people recruited in Dayton, Ohio, for the Ohio Substance Abuse Monitoring Network, a statewide epidemiological surveillance system. Participants ranged in age from 21 to 57 years. The majority were White and male. The participants reported increases in methamphetamine availability and identified powder-type locally manufactured methamphetamine as the most commonly seen form of the drug. The participants reported extensive drug use histories, and were introduced to methamphetamine in the context of their involvement with pharmaceutical stimulants, crack, powder cocaine, and/or club drug scene. A large proportion of the participants continued to use crack or powder cocaine in addition to methamphetamine. Many primary methamphetamine users felt they were able to moderate methamphetamine use and fulfill their daily responsibilities related to work and family life. Ranking results and consensus analysis revealed that participants shared high agreement about drug-related risks, and perceived methamphetamine as a serious drug, although not as risky as heroin, crack or OxyContin®. Implications for treatment and prevention are discussed.

Keywords—cultural consensus model, methamphetamine, Midwest, OSAM Network, qualitative methods

Examining the Decay of HIV Risk Reduction Outcomes Following a Community-Friendly Intervention Targeting Injection Drug Users in Treatment — Michael M. Copenhaver, Ph.D. & I-Ching Lee, M.S.

Abstract—It has become crucial for risk reduction interventions targeting injection drug users (IDUs) in treatment to be “community-friendly” and potent over time so that limited resources may be optimally utilized. This study examined (1) the extent to which observed post-intervention effects—including enhanced HIV-related knowledge, motivation, behavioral skills, and drug- and sex-risk reduction behavior—decayed over time and (2) whether repeating the intervention at follow-up provided additional benefit. Approximately 10 months after completing an adapted, substantially shortened, version of an evidence-based intervention, participants completed a follow-up assessment and then repeated the intervention. No evidence of decay was found. Even so, after repeating the intervention, a trend toward additional sex-risk reduction was observed for participants at higher risk for HIV. Findings point to the potential for an adapted evidence-based intervention for IDUs to be both community-friendly and potent over time within community-based treatment settings.

Keywords—community-friendly interventions, HIV risk reduction, injection drug use, outcome durability, substance abuse treatment

Implementing an Evidence-Based Practice: Seeking Safety Group — Vivian B. Brown, Ph.D.; Lisa M. Najavits, Ph.D.; Sharon Cadiz, Ed.D.; Norma Finkelstein, Ph.D.; Jennifer P. Heckman, Ph.D. & Elke Rechberger, Ph.D.

Abstract—This article presents findings from a multisite study on adopting and implementing an evidence-based practice, Seeking Safety, for women with co-occurring disorders and experiences of physical and sexual abuse. It focuses on what implementation decisions different sites made to optimize the compatibility of Seeking Safety with the site’s needs and experiences and on issues posed by Rogers (1995) as relevant to successful diffusion of an innovative practice. A total of 157 clients and 32 clinicians reported on satisfaction with various aspects of the model. Cross-site differences are also examined. Results show that Seeking Safety appears to be an intervention that clinicians perceive as highly relevant to their practice, and one that adds value. Clients perceive the treatment as uniquely touching on their needs in a way that previous treatments had not.

Keywords—adoption of innovation, group interventions, mental health, substance use/abuse, trauma

Understanding the Working Alliance Between Persons with Substance Abuse Problems and Strengths-Based Case Managers —Cristina Redko, Ph.D.; Richard C. Rapp, M.S.W.; Cindy Elms, M.S.W.; Mindy Snyder, M.A. & Robert G. Carlson, Ph.D

Abstract—A substantial body of literature has examined the importance of the working alliance in psychotherapy; few works have examined it in the context of case management. Qualitative methods were used to examine how 26 persons with substance abuse problems perceived the working alliance with case managers who practice from the strengths perspective. Clients’ narratives emphasized the personal qualities of the case manager and the nature of the client-case manager relationship. Their narratives also reflected two guiding principles of strengths-based case management: personal control over goal-setting, and an emphasis on strengths. Most clients concluded that a positive working alliance helped them to build trust, self-worth, and self-esteem.

Keywords—case management, qualitative research, strengths perspective, substance abuse treatment, working alliance

Substance Abuse Treatment Staff Perceptions of Intimate Partner Victimization Among Female Clients — Hillary Kunins, M.D., M.P.H., M.S.; Louisa Gilbert, M.S.W.; Antonette Whyte, M.S.W.; Paul Meissner, M.S.P.H. & Mary Zachary, M.D.
Abstract—Providing intimate partner violence (IPV)-related services to women enrolled in substance abuse treatment programs has the potential to reach a population disproportionately affected by IPV. Integrating basic IPV services into substance abuse treatment, however, poses challenges to organizations and staff. Using focus groups, the authors examined the experiences and attitudes of substance abuse treatment staff towards clients with IPV victimization experiences in order to elucidate factors that might affect the implementation of IPV services within substance abuse treatment. Seven focus groups were conducted with staff members from substance abuse treatment programs in New York City. Although participants believed that IPV is common and negatively affects client recovery, they felt competing time demands, complex confidentiality issues, insufficient training and lack of agency leadership would impede their provision of IPV-services. The study suggests that system-level assessment and change is needed to provide IPV-related services in substance abuse treatment settings.
Keywords—domestic violence, staff, substance abuse

Adolescents’ Participation in Alcoholics Anonymous and Narcotics Anonymous:  Review, Implications and Future Directions —John F. Kelly, Ph.D. & Mark G. Myers, Ph.D.

Abstract—Youth treatment programs frequently employ 12-Step concepts and encourage participation in Alcoholics Anonymous (AA) and Narcotics Anonymous (NA). Since AA/NA groups are easily accessible at no charge and provide flexible support at times of high relapse risk they hold promise as a treatment adjunct in an increasingly cost-constricting economic climate. Yet, due to concerns related to adolescents’ developmental status, skepticism exists regarding the utility of AA/NA for youth. This review evaluates the empirical evidence in this regard, identifies and discusses knowledge gaps, and recommends areas for future research. Searches were conducted in PsychINFO, Medline, relevant literature and by personal correspondence. Findings suggest youth may benefit from AA/NA participation following treatment, but conclusions are limited by four important factors: (1) a small number of studies; (2) no studies with outpatients; (3) existing evidence is solely observational; and ( 4) only partial measurement of the 12-Step construct. While surveys of adolescent SUD treatment programs indicate widespread clinical interest and application of adult-derived 12-Step approaches this level of enthusiasm has not been reflected in the research community. Qualitative research is needed to improve our understanding of youth-specific AA/NA barriers, and efficacy, comparative effectiveness, and process studies are still needed to inform clinical practice guidelines for youth providers.

Keywords—12-Step, Alcoholics Anonymous, Narcotics Anonymous, groups, adolescent,  self-help

Beliefs and Social Norms about Codeine and Promethazine Hydrochloride Cough Syrup (CPHCS) Use and Addiction Among Multi-Ethnic College Students — Ronald Peters, Jr., Dr.P.H., M.S.; George S. Yacoubian, Jr., Ph.D.; Warren Rhodes, Ph.D.;  Karry J. Forsythe, B.A.; Kameko S. Bowers, B.S.; Valencia M. Eulian, B.S.; Clemmie A. Mangum, B.S.; Jamie D. O’Neal, B.S.; Queen Martin, Dr.P.H.  & E. James Essien, M.D., Dr.P.H.

Abstract—In this study a qualitative approach is used to investigate relevant beliefs and norms concerning the consumption, initiation, and perceived addiction of codeine and promethazine hydrochloride cough syrup (CPHCS) among 61 college-age students who identified themselves as current CPHCS users. In general, a majority of students stated that doctors and pharmacists were the greatest facilitators of CPHCS acquisition. A majority of students believed that their friends felt codeine promethazine use was “normal” and “cool” among college students their age, and that reinforcing factors, such as peer pressure and curiosity, contributed to initial CPHCS use.

Keywords—beliefs, codeine initiation, cough syrup, social norms, students

The Creativity of Crumb: Research on the Effects of Psychedelic Drugs on the Comic Art of Robert Crumb — Matthew T. Jones, M.A.
Abstract—This article investigates the influence of perception that is altered by psychedelic drugs on processes of creativity through a case study of the work of well-known comic artist Robert Crumb. Samples of Crumb’s work before, during, and after the period of his use of psychedelic drugs are content analyzed and compared according to the categorization offered by Janiger and Dobkin de Rios (1989). The results of the comparison indicate that Robert Crumb’s drug use significantly altered the stylistic approach of his artwork not only during the period of his drug use, but long after he had stopped using drugs.
Keywords—content analysis, comic art, creativity, perception, psychedelic drugs, Robert Crumb

SHORT COMMUNICATIONS

Gamma-Hydroxybutyric Acid (GHB) Withdrawal: A Case Report— W. R. Murray Bennett, M.D., FRCPC; Lawrence G. Wilson, M.D. & Peter P. Roy-Byrne M.D.
Abstract—GHB is an increasingly popular drug of abuse that can be associated in select cases with growing dependence and a severe withdrawal syndrome. While benzodiazepines are recommended for treatment of the withdrawal syndrome, some cases have been described as benzodiazepine-resistant. The authors describe treatment of such a case, which was unsuccessfully treated initially with benzodiazepines, then successfully treated with adjuvant atypical neuroleptics, and offer a possible neurochemical explanation for why such agents may be theoretically more effective than benzodiazepines in treating GHB withdrawal.
Keywords—abuse, delerium, dependence, Gamma-hydroxybutyric acid (GHB), withdrawal

Abuse of Olanzapine by Substance Abusers — Roy R. Reeves, D.O., Ph.D.

Abstract—Olanzapine has been used for over a decade for treatment of schizophrenia and bipolar disorder. The drug may have sedative properties for some patients, especially in large doses. The case reported here involves a 25-year-old male who abused olanzapine, both by itself and in combination with other drugs. Also described are the patient’s reports of abuse of olanzapine by several of his acquaintances. The potential for abuse of olanzapine by substance abusers is discussed.

Keywords—drug abuse, olanzapine

Death by Drug Overdose: Impact on Families — Eroy Aparecida da Silva, B.Sc.; Ana Regina Noto, Ph.D. & Maria Lucia O. S. Formigoni, Ph.D.
Abstract—Death by overdose is loaded with social/moral stigmas, in addition to strong feelings of anger, helplessness, guilt and shame in the families. The objective of this study was to analyze the impact of these feelings on families facing death by overdose. Qualitative methodology was used to study six families with a history of death by overdose of one of their members. The interview was open, and guided by the question “What did you feel with the death of your family member by overdose and what was the impact of this death on your family as a whole?” The families were grouped into two categories: families who knew about the drug use of their family member, and families who were not aware of it. The reports show that secrecy regarding drug use followed by death by overdose arouses feelings of anger, guilt, helplessness, and deprives the family members of information that could allow them to take action. As regards families that were aware of the drug use, there seems to be a “veiled preparation” for a possible death by overdose, bringing about ambivalent situations of grief and relief. The report stresses how disturbing it is to lose a family member by overdose, and points to the need for psychological support for those families.
Keywords— death, drug dependence, family, overdose, qualitative family research