Search

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2009.05.006 Byline: Jiang Yu (a), Lucia Perfetti Clark (a), Lalita Chandra (a), Agnelo Dias (b), Ting-Fun May Lai (c) Keywords: Asian American; Substance abuse; Cultural competency; Early intervention model Abstract: This article addresses the issue of underutilization of treatment services by Asian Americans. Although Asian Americans continue to be the fastest growing ethnic minority in New York City, they are reported to underutilize substance abuse treatment services. However, much of the underutilization may be attributed to cultural and language barriers hindering them from seeking help and support. Past literature indicates that when culturally appropriate services are available, service utilization tends to increase among Asian Americans. This study tested strategies to enhance the continuum of care in the Asian community by adapting a well-documented generic early intervention model in a culture-specific setting. The results of this study indicate that these models may be successfully adapted to culturally specific settings such as Asian American communities. When culturally competent services combined with case management and motivational interviewing are provided, there tends to be an increase in Asian clients' chance of accomplishing treatment goals. Author Affiliation: (a) New York State Office of Alcoholism and Substance Abuse, Albany, NY 12203, USA (b) Asian Outreach Program, Child Center of New York, Elmhurst, NY 11373, USA (c) Behavioral Health Services, Hamilton Madison House, New York, NY 10002, USA Article History: Received 31 December 2008; Revised 21 May 2009; Accepted 21 May 2009

Objective: The aim of this article is twofold: first, to examine the prevalence of being the victim of actual and attempted rape among a large representative sample of Cape Town high school students; and second, to identify the correlates of sexual assault for both boys and girls, including alcohol, tobacco and other drug use, behavioral problems, and suicidality. Method: Data for this study were derived from the 1997 South African Community Epidemiology Network on Drug Use (SACENDU) school survey. A stratified sampling procedure was used to select students in Grades 8 and 11 at non-private high schools in Cape Town. A total of 2,946 students completed a survey consisting of socio-demographic questions and items about substance abuse, sexual activity, and other adolescent health risk behaviors. A subsample of 939 was randomly selected to complete items about sexual violence. Results: The results revealed that 8.4% of respondents were victims of attempted rape, while 5.8% were victims of actual rape. Ordinal logistic regression showed that girls were 3.9 times more likely than boys to have been victims of sexual abuse. Family structure was also significantly related to rape as persons who lived with a single parent (OR = 1.74, CI = 1.00-3.04) and those who resided with one biological parent and one step parent (OR = 2.59, CI = 1.34-5.01) were more likely to have been have been victims of sexual abuse than those living with both biological parents. Alcohol use (OR = 2.0, CI = 1.10-3.62), anti-social behavior (stolen property, caused physical damage to property, bullied others, or been in physical fights) (OR = 1.44, CI = 1.12-1.86), suicidal dialogue (OR = 2.48, CI = 1.19-5.19), and suicidal attempts (OR = 3.2, CI = 1.65-6.30) were also significant predictors of sexual abuse victimization. Racially classified social groups (RCSG), age, drug use, and cigarette smoking were not significant predictors of sexual abuse victimization, while socioeconomic status was found to be marginally significant. Conclusion: This study reinforces the importance of multiple factors including alcohol use, anti-social behavior, suicidal thoughts and actions, and family structure with respect to sexual assault of adolescents in South Africa. Establishing and strengthening intervention programs, school based child protective protocols, professional education of teachers and school personnel, community prevention programs, and initiatives could help prevent adolescent sexual violence and reduce the sequelae associated with this problem. Keywords: Substance abuse; Sexual assault; South Africa

Objective: The aim of this study was to investigate associations between four categories of maltreatment and substance use among adolescents. Method: All 10th through 12th graders (n = 2,187) at six public high schools in a rural Oregon county filled out an anonymous survey that included questions about their experience of emotional, sexual, and physical abuse and their use of a variety of substances. Substance use was subsequently categorized as: (1) tobacco use, (2) alcohol use, and (3) illicit drug use. Experience of maltreatment was subsequently categorized as: (1) no type of maltreatment, (2) emotional abuse, (3) physical abuse, (4) sexual abuse, and (5) sexual and physical abuse. Results: Results showed that all four categories of maltreatment were associated with increased levels of all three categories of substance use. Statistical comparisons of the magnitude effects of different types of maltreatment on substance use indicated a linear trend with the effects of emotional abuse being significantly lower than those of physical or sexual abuse, and the effects of the combination of physical and sexual abuse being significantly higher than the other types. Conclusion: Results suggested that all types of maltreatment, including emotional abuse, are related to significantly higher levels of substance use and should be considered serious risk factors for substance use during adolescence. Results also indicated that the strength of association between maltreatment and substance use varies by type of maltreatment. Youth who have experienced both physical and sexual abuse are at especially high risk of substance use. Keywords: Adolescent; Maltreatment types; Drug use

In this article, we report on our work at St. Ann's Corner of Harm Reduction, a multi-service agency committed to implementing effective public health strategies in disenfranchised communities from a harm reduction perspective. Based on our experiences, we hope to contribute to the ongoing dialogue about the definition of harm reduction, while proposing to integrate harm reduction and abstinence-oriented treatment modalities into a model of comprehensive drug prevention and care. The five components of our harm reduction service provision are discussed, and a vignette is provided. We conclude with a plea for close collaborations between innovative researchers and harm reduction agencies, and a call for the full integration of harm reduction approaches into the substance abuse field at large. Keywords: Harm reduction; Community based addiction treatment

Objective: This study, using latent variable methodology, explores simultaneously the relative effects of childhood abuse and early parental substance abuse on later chronic homelessness, depression, and substance abuse problems in a sample of homeless women. We also examine whether self-esteem and recent violence can serve as mediators between the childhood predictors and the dysfunctional outcomes. Method: The sample consists of 581 homeless women residing in shelters or sober living centers in Los Angeles (54% African-American, 23% Latina, 22% White, mean age = 33.5 years). Multiple-indicator latent variables served as predictors and outcomes in structural models. Childhood abuse was indicated by sexual, physical, and verbal abuse. Results: Childhood abuse directly predicted later physical abuse, chronic homelessness, depression, and less self-esteem. Parent substance use directly predicted later substance use problems among the women. Recent physical abuse predicted chronic homelessness, depression, and substance use problems. Greater self-esteem predicted less depression and fewer substance use problems. Childhood abuse also had significant indirect effects on depression, chronic homelessness, and drug and alcohol problems mediated through later physical abuse and self-esteem. Conclusions: Although there was a strong relationship between childhood abuse and parent drug use, childhood abuse was the more pervasive and devastating predictor of dysfunctional outcomes. Childhood abuse predicted a wider range of problems including lower self-esteem, more victimization, more depression, and chronic homelessness, and indirectly predicted drug and alcohol problems. The mediating roles of recent physical abuse and self-esteem suggest salient leverage points for change through empowerment training and self-esteem enhancement in homeless women. Keywords: Childhood abuse; Substance abuse; Homeless women; Depression

The comorbidity of bulimia and substance abuse is significant. The substance that is abused may vary and the abuse potential for nonillicit substances may be overlooked. This paper presents the first case reported of dextromethorphan abuse and bulimia. It demonstrates the complexity of assessment and treatment of bulimia and substance abuse of over-the-counter medications. Keywords - bulimia; substance abuse; dextromethorphan: over-the-counter medications: adolescent.

The syndrome of factitious disorders with physical symptoms was named 'Munchausen's syndrome' by Richard Asher (1951). The present article contains an interesting case report of a patient who has a history of Munchausen's syndrome, substance abuse, and genuine physical illness. A review of the literature supports a strong association of substance abuse in patients with Munchausen's syndrome. Also important for clinicians to remember is that patients with Munchausen's syndrome often have true physical illnesses which need appropriate treatment. The patient described here has successfully begun treatment with methadone maintenance, but further study will be needed regarding methadone maintenance's role in the management of Munchausen's syndrome.

Clonidine has been used to assist opiate detoxification in the past 10 years. This substance is known to have multiple effects on the central nervous system and to cause withdrawal symptoms when stopped abruptly. The combination of these two effects could result in clonidine having a poten for abuse. Two cases of clonidine abuse/dependence in methadone-maintained patients are presented. Nonmedical use of clonidine in opioid-dependent persons has never been evaluated. Keywords--clonidine; methadone; abuse., The abuse potential of clonidine was evaluated in two case studies. Clonidine has been used to alleviate symptoms of opiate withdrawal. It is claimed to work synergistically with methadone, and is used for its sedative effects. However, clonidine abuse can lead to adverse central nervous system effects aside from its own withdrawal effects such as rebound hypertension. The case profiles presented recommend further studies on the use of clonidine and focus on screening of patients.