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This study examined how science teachers' knowledge of research methods, neuroscience and drug addiction changed through their participation in a 5-day summer science institute. The data for this study evolved from a four-year NIH funded science education project called Addiction Research and Investigation for Science Educators (ARISE). Findings were based on pre- and post-test evaluation data from three annual cohorts in June 2010, 2011 and 2012. Researchers found significant improvement in teacher knowledge overall and on all subscales. Teachers with lower pre-test scores showed the greatest gain in post-test scores. What made this in-service unique was that the 5E pedagogical model was used to teach the teachers and demonstrate 5E instruction in the science classroom. Through the use of the 5E teaching method, we found that teachers in our cohorts with the least skill had higher rates of gain. A strategy that has been used extensively to teach science to children, this model moves away from didactic methods of in-service pedagogy. These findings suggest that the 5E model could be an effective way to teach teachers as well as students, particularly new and/or less skilled teachers, who often tend to have high numbers of English Learner (EL) students in their classes.

Substance use is highly prevalent among homeless, street-involved young people. Societal estrangement is often associated with substance use, particularly among this population. The current study sought to identify four domains of social estrangement (disaffiliation, human capital, identification with homeless culture, and psychological dysfunction) in relation to alcohol and drug addiction. Homeless young adults were recruited from three disparate urban areas: Los Angeles, CA (n = 50), Austin, TX (n = 50) and St. Louis, MO (n = 46) using comparable research methods and measurement instruments. Findings demonstrated that variables measuring psychological dysfunction and homeless culture predicted alcohol addiction, while institutional disaffiliation and homeless culture predicted drug addiction. Findings affirm distinct patterns of estrangement related to alcohol compared to drug addiction. Understanding these features and the heterogeneity of this population has strong potential for assisting development of programs targeting substance use among this underserved population. (Contains 4 tables.)

The purpose of the study was to explore the potential effectiveness of service learning as a pedagogical technique for providing substance abuse education to human services/social work students. Using a quasi-experimental design, the authors assigned 38 human services undergraduate students to experimental and comparison groups on the basis of their availability to attend a service-learning project in substance abuse. The service learning consisted of a 30-min educational presentation followed by a visit to a residential substance abuse treatment facility for women. Results indicated that service learning in substance abuse had a positive effect on the general knowledge, perceptions, and attitudes of human services students toward substance-dependent mothers and their children. The findings from this exploratory study support future research in this area. (Contains 2 tables.)

This article discusses recovery high schools which are designed specifically to serve students who have been through a professional substance abuse treatment program and are working to stay away from drugs and alcohol. The schools typically serve multiple districts and are funded from both the per-pupil state funds that follow a student and what districts raise themselves. Nationwide, recovery high schools are operated as charter schools, schools within a school, schools that share a building, and stand-alone schools. In a school within a school, recovering students are in some or all classes together but remain students of the public high school with the same administration. In a shared building several schools operate, but each has its own classes and principal. What they have in common is a commitment to providing a safe haven and support for students learning to deal with addiction.

This article reports the characteristics of Latino day laborers who have sex with female commercial sex workers (CSWs). A sample of 450 day laborers in Los Angeles was used. Multivariate logistic regression was used to determine the association of independent variables with the likelihood of having sex with a CSW. Overall, 26% of the 450 day laborers reported having had sex with a CSW in the previous 12 months. A lower likelihood of having sex with a CSW was found for those with more than 6 years of education and for those who were married and living with their spouses. A higher likelihood of having sex with a CSW was found for those who met the criteria for harmful drinking or drug dependence. Commercial sex work has been associated with sexually transmitted infections and other problems among clients of CSWs and warrants further attention by providers working with day laborers. (Contains 2 tables.)

In October 2006, the California Men's Colony (CMC) in San Luis Obispo, faced with staff recruitment and retention difficulties, took an innovative step to utilize long-term sentenced inmates as peer mentors and primary counselors to lead their prison-based therapeutic community (TC) program. The program was designed, developed, and implemented through the collaborative efforts of CMC's Our House program, the California Department of Corrections and Rehabilitation (CDCR), the University of California, San Diego (UCSD), Center for Criminality and Addiction Research, Training and Application (CCARTA), and the Orange County Department of Education (OCDE). The program is designed to be a peer mentor-driven 24-hour TC built to uphold the fundamental TC principles that have been lost in many treatment programs. UCSD CCARTA was instrumental in training the long-term residents who served as peer mentors in substance abuse treatment principles and strategies, equivalent to the training received by state-funded providers for the nationally accredited Forensic Addictions Corrections Treatment certification program, and the OCDE joined the program to support the community's structural and educational needs. Since the implementation of the peer-driven Our House program, the peer mentors have demonstrated exceptional command of a TC environment and have yielded a postrelease aftercare attendance of approximately 81%, a number much higher than that of most treatment programs in CDCR. Thus, the peer-mentor-driven treatment model may be a much needed solution for the improvement of program quality and effectiveness, especially in rural and other hard-to-hire regions with constant staff retention problems.

This study investigates trajectories of heroin use and subsequent consequences in a sample of 471 male heroin addicts who were admitted to the California Civil Addict Program in 1964-1965 and followed over 33 years. Applying a two-part growth mixture modeling strategy to heroin use level during the first 16 years of the addiction careers since first heroin use, the authors identified three groups with distinctive profiles: stably high-level heroin users (n = 278), late decelerated users (n = 149), and early quitters (n = 44). Study findings empirically demonstrate the chronic nature of heroin addiction and subsequent adverse consequences including mortality, mental health, and employment. (Contains 4 tables and 1 figure.)

Objective: Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and a leading cause of death and disability. The authors examined the extent to which psychiatry residents are prepared to treat nicotine dependence in clinical practice. Methods: Residents from five psychiatry residency programs in northern California completed an anonymous survey of their knowledge, attitudes, and behaviors regarding treating nicotine dependence among their patients. Results: Respondents (N = 105, 60% female) represented all 4 years of residency training. Residents' smoking status was 11% current, 17% former, and 72% never. Knowledge scores averaged 54% correct. Confidence ratings averaged 3 (SD = 0.6) on a 5-point scale. Seventy six percent rated their overall ability to help patients quit using tobacco as fair or poor. The percent reporting often or always engaging in the National Cancer Institute's 5-A intervention for smoking cessation was: 58% ask; 29% advise; 17% assess; 18% assist; and 13% arrange follow up. Most residents reported none or inadequate tobacco cessation training during medical school (74%) or residency (79%), and nearly all (94%) reported moderate to high interest in learning more about helping patients quit smoking. Conclusion: Psychiatry residents appear unprepared to treat nicotine dependence, but report considerable interest in this area. The findings demonstrate the need for and interest in tobacco cessation curricula in psychiatry residency training.

Regarded as the nation's gang violence capital, Los Angeles' politicians and law enforcement and school administrators are using knowledge from lost battles to win the war. Solutions include targeting younger children, teaching self-esteem and communication skills, as well as organizing group graffiti cleanups. (SI)

Little research has examined mechanisms driving cannabis use disparities among sexual minority (SM; versus heterosexual) young adults (YAs). Participants were US YA women (N  = 1345; 24.8% bisexual, 6.1% lesbian) and men (N  = 998: 8.9% bisexual, 13.8% gay). Bivariate analyses examined associations between sexual orientation (heterosexual, gay/lesbian, bisexual) and cannabis use outcomes (past 30-day [current] use, use frequency, cannabis-tobacco dual use, use intentions), perceived risks (harm, addictiveness) and social norms (social acceptability, peer use). Regressions examined sexual orientation, perceived risks and social norms as correlates of cannabis outcomes. Bisexual and lesbian (versus heterosexual) women reported lower cannabis-related perceived risks, greater social norms and higher odds of current use. Bisexual (versus heterosexual) women reported more days of use, higher odds of cannabis-tobacco dual use and greater use intentions. Gay (versus heterosexual) men reported lower perceived addictiveness, greater social norms and higher odds of current use. Lower perceived risks and greater social norms predicted greater use outcomes for women and men. Bisexual women displayed higher odds of several cannabis use outcomes, whereas lesbian women and gay men displayed higher odds of current cannabis use only. Cannabis-related perceptions and social norms may be important targets for public health messaging for SMYAs. [ABSTRACT FROM AUTHOR]

Background: Diagnostic and Statistical Manual (DSM) alcohol use disorder (AUD) criteria are written in broad enough terms to apply to diverse populations. The current analyses evaluate whether the endorsement of criteria changes with increasing age in individuals with persistent AUDs. Methods: Data regarding AUDs persisting across 3 timepoints between average ages of 31 and 43 were gathered about every 5 years from 318 interviews for 106 San Diego Prospective Study (SDPS) AUD male probands. Similar data regarding persistent AUDs across 2 timepoints were obtained from 136 interviews with 68 SDPS AUD offspring between average ages of 21 and 27. Changes in the endorsement of each AUD criterion were evaluated using Cochran's Q test. Results: For AUD probands across time, significant decreases were observed in the proportions endorsing 4 criteria (tolerance, withdrawal, failure to fulfill obligations, and using alcohol in hazardous situations). Increased rates of endorsement were documented for 3 criteria (drinking alcohol in higher amounts or for longer periods of time, spending a great deal of time regarding alcohol, and continued use despite social or interpersonal problems). Significant increases in rates of endorsements for offspring were seen for spending a great deal of time regarding alcohol and giving up or reducing important activities in order to drink. Conclusions: These data indicate that the salience of many DSM AUD criterion items changed significantly with age in both SDPS generations among individuals with persistent AUDs. The current results support the need for additional systematic research to determine whether specific criterion items might need to be weighted differently in evaluating older and younger individuals with persistent AUDs. [ABSTRACT FROM AUTHOR]

Background: As the coronavirus pandemic public health emergency begins to ebb in the United States, policymakers and providers need to evaluate how the addiction treatment system functioned during the public health emergency and draw lessons for future emergencies. One important question is whether the pandemic curtailed the use of addiction treatment and the extent to which telehealth was able to mitigate access barriers. Methods: To begin to answer this question, we conducted a survey of specialty addiction treatment providers in California from June 2020 through July 2020. The survey focused specifically on provider organizations that served Medicaid beneficiaries. Results: Of the 133 respondents, 50% reported a decrease in patients since the stay-at-home order in March 2020, with the largest decline among new patients, and 58% said more patients were relapsing. Eighty-one percent of providers said that telemedicine use had increased since the stay-at-home order. Most said that telemedicine had moderately (48%) or completely (30%) addressed access barriers. Conclusion: More efforts are needed to ensure that patients, and in particular new patients, receive addiction treatment during public health emergencies. [ABSTRACT FROM AUTHOR]

Aims: To estimate associations between both current‐ and prior‐year medical cannabis dispensary densities and hospitalizations for cannabis use disorder in California, USA between 2013 and 2016. Design Spatial analysis of ZIP code‐level hospitalization discharge data using Bayesian Poisson hierarchical space–time models over 4 years. Setting and cases: California, USA from 2013 to 2016 (6832 space–time ZIP code units). Measurements We assessed associations of annual hospitalizations for cannabis use disorder [assignment of a primary or secondary code for cannabis abuse and/or dependence using ICD‐9‐CM or ICD‐10‐CM (outcome)] with the total number of medical cannabis dispensaries per square mile in a ZIP code as well as dispensary temporal and spatial lags (primary exposures). Other exposure covariates included alcohol outlet densities, manual labor and retail sales densities and ZIP code‐level economic and demographic conditions. Findings One additional dispensary per square mile was associated with a median risk ratio of 1.021 (95% credible interval 1.001, 1.041). Prior‐year dispensary density did not appear to be associated with hospitalizations (median risk ratio = 1.006, 95% CrI = 0.986, 1.026). Higher median household income, higher unemployment, greater off‐premises alcohol outlet density and lower on‐premises alcohol outlet density and poverty were all associated with decreased ZIP code‐level risk of cannabis abuse/dependence hospitalizations. Conclusions: In California, USA, the increasing density of medical cannabis dispensaries appears to be positively associated with same‐year but not next‐year hospitalizations for cannabis use disorder. [ABSTRACT FROM AUTHOR]

The present study investigated the prevalence and co-occurrence of addictions to tobacco, alcohol, other drugs, food/eating, the internet, texting, video games, shopping, love, sex, exercise, work, and gambling among American Indian (AI) youth in California. As with previous work in other cultural groups, the most prevalent addictions were love, internet, and exercise, though prevalence and co-occurrence of these addictions were relatively high among AI youth. A negative life events measure was associated with all the addictions, suggesting that life stressors are associated with high rates of multiple types of addictions among AI youth. There is a need for more research to better understand the relations of life stressors with multiple addictions among AI youth as well as how to remediate these behaviors. [ABSTRACT FROM AUTHOR]

Frailty is a deficit accumulation in physical, psychological and social domains. Correlates of frailty were explored among formerly incarcerated, homeless women (N = 130, Mage = 38.9). Significant correlates of physical frailty were age, years homeless, prior violence, witnessing less violence, drug dependence, PTSD symptoms and tangible support. Significant correlates of psychological frailty were age, years homeless, witnessed violence, jail time, divorced less, drug use/dependence, prison time, methamphetamine use, and bodily pain. Significant correlates of social frailty were drug use, emotional regulation, and daily alcohol use. Reentry interventions are needed for formerly incarcerated, homeless women who experience physical, psychological and social frailty. [ABSTRACT FROM AUTHOR]

Background: The field of addiction studies (AS) has grown in the last several decades. However, little is known about the structure and conditions of current academic programs. Only two studies have examined AS programs in the U.S., and both were conducted almost 15 years ago. The current study was designed to identify AS programs existing in the U.S. universities. Methods: We conducted an Internet search to identify university-based programs according to defined key words. The university program websites were then subjected to content analysis. Results: A total of 333 U.S. universities were identified that offered 392 different academic programs in AS of which 302 were degree programs. Out of these, 161 (53%) programs were offered at the associate degree level, 48 (15,9%) at the bachelor’s level, 55 (18.2%) at the master’s level, and 5 (1.6%) at the doctorate level. The largest number of programs was in California. Two states in the U.S. had no identifiable programs. Only one university located in the state of New York offered comprehensive academic programs across the educational spectrum. Many of the academic programs offered certificates. The most common phrases used in program titles were “substance abuse”, “addiction studies/counseling”, and “chemical dependency”. Conclusions: There is a wide range of academic AS programs in the U.S., although their focus is mostly on clinical training rather than on research or drug policy. Future surveys such as this one would benefit from greater attention to issues related to certification, licensing, and academic curricula. [ABSTRACT FROM AUTHOR]

Background: Although there are an increasing number of states exploring the legalization of medical and/or recreational cannabis, little research has explored whether and how people are medically using cannabis along with the broader implications of this potential change in policy. Objectives: This study seeks to explore reasons for use and experience with use among users of a medical cannabis delivery service. Methods: In this cross-sectional study, a convenience sample of users (n = 21) of a medical cannabis delivery service were recruited and interviewed. Semi-structured interviews were used to gather qualitative data for thematic analysis. Results: Five themes for cannabis use emerged from our research: distrust for the medical field, side effects of prescription drugs, clinical failure, addiction treatment, and cannabis as a prescription drug substitution. Conclusion: People are seeking cannabis to be delivered to them as an alternative to receiving traditional medical treatments, including as a substitute for opioids in treatment for chronic pain. Findings from this formative research suggest future research should be conducted on whether and how cannabis is being used as a substitute for medical treatments along with the implications of this effect on future healthcare and health policy. [ABSTRACT FROM AUTHOR]

The article offers medical science news briefs on topics including the Constitutional Court of the country of Georgia rule for abolishing of criminal sanctions for cannabis use in November 2017, tobacco and nicotine regulation by US Food and Drug Administration (FDA), and cannabis legalization legislation by the Canadian senate in June, 2018.

Abstract: Background and aims: Methamphetamine use is increasingly prevalent and associated with HIV transmission. Early‐phase human studies suggested naltrexone reduced amphetamine use among dependent individuals. We tested if extended‐release naltrexone (XRNTX) reduces methamphetamine use and associated sexual risk behaviors among high‐risk methamphetamine‐dependent men who have sex with men (MSM). Design: Double‐blind, placebo‐controlled, randomized trial of XRTNX versus placebo over 12 weeks from 2012 to 2015. Setting: San Francisco Department of Public Health, California, USA. Participants: One hundred community‐recruited, sexually‐active, actively‐using methamphetamine‐dependent MSM. Mean age was 43.2 years; 96% were male, 3% transfemale, and 1% transmale; 55.0% were white, 19.0% African American, and 18.0% Latino. Interventions: XRNTX 380 mg (n = 50) or matched placebo (n = 50) administered by gluteal injection at 4‐week intervals. Measurements: Regression estimated average level and change in level of positive urines during the period 2–12 weeks (primary outcomes) and sexual risk behaviors (secondary outcome). Findings: Ninety per cent of visits were completed. By intent‐to‐treat, participants assigned to XRNTX had similar differences during 2–12 weeks in methamphetamine‐positive urines as participants assigned to placebo [incidence rate ratio (IRR) = 0.95, 95% confidence interval (CI) = 0.76–1.20; Bayes factor < 0.3]. Observed urine positivity declined from 78 to 70% in the XRNTX arm and 74 to 64% in the placebo arm. Adherence to injections was 96.7% in the XRNTX arm and 91.3% in the placebo arm. Sexual risk behaviors declined similarly among participants in both arms (all P > 0.05). There were no serious adverse events related to study drug and no differences in frequency of adverse events by treatment arm. Conclusions: Notwithstanding very high medication adherence for this study, extended‐release naltrexone does not appear to reduce methamphetamine use or sexual risk behaviors among methamphetamine‐dependent men who have sex with men compared with placebo. [ABSTRACT FROM AUTHOR]

The article presents addiction-related news briefs on topics such as the establishment of the President's Commission on Combating Drug Addiction and the Opioid Crisis in the U.S., and it previews several conferences and events such as the 9th International AIDS Society (IAS) Conference on HIV Science in Paris, France on July 23-26, 2017. The legalisation of electronic cigarettes (e-cigarettes) in New Zealand is examined, along with a cigarette tax increase in California.

Background and Aims High rates of loss to follow-up represent a significant challenge to clinical trials of pharmacological treatments for methamphetamine (MA) use disorder. We aimed to estimate and test the relationship between achieving and maintaining abstinence in the initial weeks of study participation and subsequent retention in such trials, hypothesizing that participants able to achieve early abstinence would be less likely to drop out. Design Data from four randomized controlled trials (RCTs) of pharmacological treatments for MA use disorder were pooled and analyzed using a random-effects approach. Setting All trials were conducted in the greater Los Angeles, CA, USA area. Participants A total of 440 participants were included; trials were conducted between 2004 and 2014. Measurements Participants' ability to achieve a brief period of initial abstinence was measured as the number of MA-negative urine screens completed in the first 2 weeks of the trials. Outcomes were the likelihood of dropout, i.e. missing two consecutive weeks of scheduled urine drug screens, and the number of days participants were retained in the trials. Findings Study participants achieved an average of three (of six possible) negative urine screens during the first 2 weeks of the trials, 51% dropped out and the average number of days retained was 60 (of 90 maximum). Each additional negative urine screen achieved during the first 2 weeks of the study reduced multiplicatively the odds of dropout by 41% [odds ratio (OR) = 0.59, 95% confidence interval (CI) = 0.53, 0.66]. Abstinence was also a significant predictor of retention time; the hazard ratio for non-completion was 0.75 per additional negative urine screen (95% CI = 0.71, 0.80). Conclusions Participants in randomized controlled trials of pharmacological treatments for methamphetamine use disorder who are able to achieve a brief period of early abstinence are retained longer in the trials and are less likely to drop out overall. [ABSTRACT FROM AUTHOR]

To understand health, research needs to move outside of controlled research settings into the environments where health activities occur—homes, streets, and neighborhoods. I offer the docent method as a qualitative place-based approach for exploring health in a participant-driven, structured, and flexible way. The docent method is a participant-led, audiotaped, and photographed walking interview through broad “sites of interest” (SOIs). It is rooted in grounded theory and influenced by community-based participatory research and walking interviews. The three stages of the docent method involve: (a) a warm-up interview focusing on positionality, participant background, and mapping/planning SOIs; (b) a participant-led, photographed walking interview to and around the SOI; and (c) a wind-down interview in the community. I describe the methodological influences, development, and procedures of the docent method drawing from my own experiences conducting it with formerly homeless women living in permenant supportive housing in the Tenderloin neighborhood of San Francisco. [ABSTRACT FROM AUTHOR]

Background Alcohol and nicotine dependence frequently co-occur, and quitting smoking might enhance long-term alcohol abstinence. Topiramate appears to help non-alcohol-dependent individuals quit smoking, and our pilot work suggested efficacy only in men. It also prevents relapse to alcohol in recently detoxified alcoholics. We evaluated topiramate in abstinent alcohol-dependent men to assess whether this medication (i) promotes smoking cessation and (ii) prevents alcohol and other drug relapse in the context of smoking cessation treatment. Methods One hundred and twenty-nine alcohol-abstinent (mean ~6 months) alcohol-dependent male smokers (80% with other substance use disorders) participated in this 12-week randomized, double blind, parallel group comparison of topiramate (up to 200 mg/d) and placebo with a 24-week nontreatment follow-up period. The study was carried out sequentially at 2 academic centers in the Midwest and Southern California between March 23, 2009 and November 20, 2014. All participants received manual-guided smoking cessation counseling combined with medication-focused compliance enhancement therapy. Randomization was block designed by the research pharmacist in a 1:1 ratio. Participants, investigators, and research personnel were masked to treatment assignment. The primary smoking end point was biochemically confirmed 4-week continuous abstinence from smoking during weeks 9 to 12, while the secondary end point was relapse to any drinking or drug use during the entire 36-week evaluation period. Logistic regression was used to determine the effects of topiramate on quitting smoking and alcohol relapse, controlling for relevant covariates. The trial is registered at ClinicalTrials.gov (number NCT00802412) and is now closed. Results Only a small proportion (7.9%) of topiramate-treated participants were able to quit smoking, and this cessation rate was similar to placebo (10.6%; odds ratio = 1.60; 95% confidence interval 0.4, 6.5; p = 0.51). Roughly 30% of the sample had a documented relapse to drinking or drug use during the study, and these rates were similar in the topiramate (20/63; 31.8%) and placebo groups (18/66; 27.3%; p = 0.58). Results of a longitudinal logistic regression model examining time to any alcohol relapse revealed no medication effect. Conclusions Topiramate at a daily dosage of up to 200 mg per day, combined with smoking cessation and medication adherence counseling, had no effects on smoking cessation or the prevention of alcohol or drug relapse in male smokers who were in early or sustained full remission from alcohol and motivated to make a quit attempt. Alternative approaches for treating this high-risk, dually dependent population are needed. [ABSTRACT FROM AUTHOR]

Overdose deaths have increased during the Covid-19 pandemic, likely attributed to fentanyl, a synthetic opioid. Naloxone is a harm reduction strategy, and similar to a fire extinguisher, to be used in emergencies. If administered in time, naloxone can reverse an opioid overdose. A hospital-wide survey of multidisciplinary oncology healthcare providers evaluating experiences and knowledge related to opioid use disorders (OUDs) was distributed via email over a 4 week time period in early 2020. This abstract focuses on naloxone administration and nurses, including Advanced Practice Providers (APPs). The total possible sample was ~1560 participants (~360 APPs and ~1200 nurses). The final sample included 180 APPs and 518 nurses (n = 698). The response rates were 50% for APPs and 43% for nurses. The mean age for nurses was 38.4 (SD 11.4) and 40.2 (SD 10) for APPs. A greater percentage of participants were female (n = 641, 91.8%) and White (n = 631, 90.4%). Overall, 49.7% of nurses (n =257) and 62.3% of APPs (n = 112) had worked in oncology for > 5 years. Participants were asked to respond to the following statement: "I feel comfortable administering naloxone in the community". A greater percentage of APPs (39.4%, n = 69) compared to nurses (29.1%, n = 145) answered no. Overall, the majority of nurses (n = 201, 40.4%) and APPs (n = 71, 40.6%) answered "Yes- I would feel comfortable with training". Nurses (n = 309, 64.2%) and APPs (n = 104, 60.1%) were interested in attending a naloxone training class. Many oncology nurses and APPs would feel comfortable administering naloxone in the community with training, and the majority are interested in attending a naloxone training course. This represents an opportunity for oncology nurses and APPs to positively impact the opioid epidemic, for not only patients affected by cancer, but there may be a positive trickle-down effect on families and communities. Incorporating naloxone training as a continuing education opportunity for oncology nurses and APPs, and may increase knowledge, decrease addiction stigma, and ultimately save lives. [ABSTRACT FROM AUTHOR]

Using ethnographic data from Los Angeles, this article examines how two distinctive faith-based programs--Homeboy Industries and Victory Outreach--drew upon masculine bodily displays and practices to facilitate recovery from gang life. First, recovery's body projects negotiated masculine bodily displays from gang member to "family man" or "man of God" by reshaping malleable facets of men's embodiment. Second, leaders protected reformed gang embodiment from the risk of being interpreted as a failed masculinity by emasculating active gang embodiment. Lastly, because some subjects had difficulty overcoming rigid facets of masculine gang embodiment--such as drug addiction--recovery provided bodily practices for reshaping and redirecting rigid facets of embodiment. Whereas emerging research on gang exit has built upon functionalist-oriented life-course and role-exit perspectives of crime desistance, this article suggests that embodied, masculine contests are fundamental to the phenomenological realities of gang recovery. Recovering gang members deepen commitment to exit from gang life not by being passively legitimated as "family men" or "men of God," but by actively using bodily displays and practices to construct new, masculine moral universes. [ABSTRACT FROM AUTHOR]

Aims To examine the safety and effectiveness of buprenorphine + naloxone sublingual tablets (BUP, as Suboxone®) provided after administration of extended-release injectable naltrexone (XR-NTX, as Vivitrol®) to reduce cocaine use in participants who met DSM-IV criteria for cocaine dependence and past or current opioid dependence or abuse. Methods This multi-centered, double-blind, placebo-controlled study, conducted under the auspices of the National Drug Abuse Treatment Clinical Trials Network, randomly assigned 302 participants at sites in California, Oregon, Washington, Colorado, Texas, Georgia, Ohio, New York and Washington DC, USA to one of three conditions provided with XR-NTX: 4 mg/day BUP (BUP4, n = 100), 16 mg/day BUP (BUP16, n = 100, or no buprenorphine (placebo; PLB, n = 102). Participants received pharmacotherapy for 8 weeks, with three clinic visits per week. Cognitive behavioral therapy was provided weekly. Follow-up assessments occurred at 1 and 3 months post-intervention. The planned primary outcome was urine drug screen (UDS)-corrected, self-reported cocaine use during the last 4 weeks of treatment. Planned secondary analyses assessed cocaine use by UDS, medication adherence, retention and adverse events. Results No group differences were found between groups for the primary outcome (BUP4 versus PLB, P = 0.262; BUP16 versus PLB, P = 0.185). Longitudinal analysis of UDS data during the evaluation period using generalized linear mixed equations found a statistically significant difference between BUP16 and PLB [ P = 0.022, odds ratio (OR) = 1.71] but not for BUP4 ( P = 0.105, OR = 1.05). No secondary outcome differences across groups were found for adherence, retention or adverse events. Conclusions Buprenorphine + naloxone, used in combination with naltrexone, may be associated with reductions in cocaine use among people who meet DSM-IV criteria for cocaine dependence and past or current opioid dependence or abuse. [ABSTRACT FROM AUTHOR]

Background: Despite the existence of evidence-based guidelines, different prescriber practices around buprenorphine maintenance treatment (BMT) of opiate dependence exist. Moreover, certain prescriber beliefs may influence their practice patterns.Objective: To understand community BMT practice patterns and discern their relationship to practitioner beliefs.Method: Survey of 30 local BMT prescribers about aspects of BMT, and analysis of correlations between practices and practitioner beliefs.Results: Practitioners generally followed standard treatment guidelines, though the most-common maintenances dosages of BMT (4–12 mg) were lower than recommended by some studies. Endorsement of belief in a “spiritual basis” of addiction correlated with lower average BMT doses and less frequent endorsement of the belief that BMT-treated patients are “in recovery.”Conclusions/Importance: These data suggest that relatively standardized, longer-term BMT of opiate dependence is accepted among the majority of surveyed prescribers, and certain provider beliefs about addiction may influence prescribing habits and attitudes. Future studies should: (1) assess these findings in larger samples; (2) examine how prescriber beliefs about addiction and BMT compare with those of other addiction treatment providers; and (3) ascertain whether individual prescriber beliefs influence patient outcomes. [ABSTRACT FROM PUBLISHER]

Heroin overdose, more accurately termed ‘heroin-related overdose’ due to the frequent involvement of other drugs, is the leading cause of mortality among regular heroin users. (Degenhardt et al., 2010) Heroin injectors are at greater risk of hospital admission for heroin-related overdose (HOD) in the eastern United States where Colombian-sourced powder heroin is sold than in the western US where black ‘tar’ heroin predominates. (Unick et al., 2014) This paper examines under-researched influences on HOD, both fatal and non-fatal, using data from a qualitative study of injecting drug users of black tar heroin in San Francisco and powder heroin in Philadelphia Data were collected through in-depth, semi-structured interviews carried out in 2012 that were conducted against a background of longer-term participant-observation, ethnographic studies of drug users and dealers in Philadelphia (2007–12) and of users in San Francisco (1994–2007, 2012). Our findings suggest three types of previously unconsidered influences on overdose risk that arise both from structural socio-economic factors and from the physical properties of the heroin source-types: 1) retail market structure including information flow between users; 2) marketing techniques such as branding, free samples and pricing and 3) differences in the physical characteristics of the two major heroin source forms and how they affect injecting techniques and vascular health. Although chosen for their contrasting source-forms, we found that the two cities have contrasting dominant models of drug retailing: San Francisco respondents tended to buy through private dealers and Philadelphia respondents frequented an open-air street market where heroin is branded and free samples are distributed, although each city included both types of drug sales. These market structures and marketing techniques shape the availability of information regarding heroin potency and its dissemination among users who tend to seek out the strongest heroin available on a given day. The physical characteristics of these two source-types, the way they are prepared for injecting and their effects on vein health also differ markedly. The purpose of this paper is to examine some of the unexplored factors that may lead to heroin-related overdose in the United States and to generate hypotheses for further study. [ABSTRACT FROM AUTHOR]

Background and aims Individuals with methamphetamine dependence ( MD) exhibit dysfunction in brain regions involved in goal maintenance and reward processing when compared with healthy individuals. We examined whether these characteristics also reflect relapse vulnerability within a sample of MD patients. Design Longitudinal, with functional magnetic resonance imaging ( fMRI) and clinical interview data collected at baseline and relapse status collected at 1-year follow-up interview. Setting Keck Imaging Center, University of California San Diego, USA. Participants MD patients ( n = 60) enrolled into an in-patient drug treatment program at baseline. MD participants remaining abstinent at 1-year follow-up (abstinent MD group; n = 42) were compared with MD participants who relapsed within this period (relapsed MD group; n = 18). Measurements Behavioral and neural responses to a reinforcement learning (paper-scissors-rock) paradigm recorded during an fMRI session at time of treatment. Findings The relapsed MD group exhibited greater bilateral inferior frontal gyrus ( IFG) and right striatal activation than the abstinent MD group during the learning of reward contingencies ( Cohen's d range: 0.60-0.83). In contrast, the relapsed MD group displayed lower bilateral striatum, bilateral insula, left IFG and left anterior cingulate activation than the abstinent MD group ( Cohen's d range: 0.90-1.23) in response to winning, tying and losing feedback. Conclusions Methamphetamine-dependent individuals who achieve abstinence and then relapse show greater inferior frontal gyrus activation during learning, and relatively attenuated striatal, insular and frontal activation in response to feedback, compared with methamphetamine-dependent people who remain abstinent. [ABSTRACT FROM AUTHOR]

We conducted a longitudinal study of a community-based cohort of HIV-infected indigent adults to examine smoking behaviors and factors associated with quitting. We assessed 'hardcore' smoking behaviors associated with a low probability of quitting. Of the 296 participants, 218 were current smokers (73.6 %). The prevalence of 'hardcore' smoking was high: 59.6 % smoked ≥15 cigarettes per day, and 67.3 % were daily smokers. During the study interval, 20.6 % made at least one quit attempt. Of these, 53.3 % were abstinent at 6 months. The successful quit rate over 2 years was 4.6 %. Illegal substance use (adjusted odds ratio, AOR 0.2, 95 % CI 0.1-0.6) and smoking within 30 min of waking (AOR 0.2, 95 % CI 0.1-0.7) were associated with lower likelihood of making a quit attempt. Interventions that reduce nicotine dependence prior to smoking cessation and those that are integrated with substance use treatment may be effective for this population. [ABSTRACT FROM AUTHOR]

Aims To determine if methamphetamine-dependent ( MD) individuals exhibit behavioral or neural processing differences in risk-taking relative to healthy comparison participants ( CTL). Design This was a cross-sectional study comparing two groups' behavior on a risk-taking task and neural processing as assessed using functional magnetic resonance imaging ( fMRI). Settings The study was conducted in an in-patient treatment center and a research fMRI facility in the United States. Participants Sixty-eight recently abstinent MD individuals recruited from a treatment program and 40 CTL recruited from the community completed the study. Measurements The study assessed risk-taking behavior (overall and post-loss) using the Risky Gains Task ( RGT), sensation-seeking, impulsivity and blood-oxygenation-level-dependent activation in the brain during the decision phase of the RGT. Findings Relative to CTL, MD displayed decreased activation in the bilateral rostral anterior cingulate cortex ( ACC) and greater activation in the left insula across risky and safe decisions ( P < 0.05). Right mid-insula activation among CTL did not vary between risky and safe decisions, but among MD it was higher during risky relative to safe decisions ( P < 0.05). Among MD, lower activation in the right rostral ACC ( r = −0.39, P < 0.01) and higher activation in the right mid-insula ( r = 0.35, P < 0.01) during risky decisions were linked to a higher likelihood of choosing a risky option following a loss. Conclusions Methamphetamine-dependent individuals show disrupted risk-related processing in both anterior cingulate and insula, brain areas that have been implicated in cognitive control and interoceptive processing. Attenuated neural processing of risky options may lead to risk-taking despite experiencing negative consequences. [ABSTRACT FROM AUTHOR]

Background and aims The Controlled Substances Act requires physicians in the United States to provide or refer to behavioral treatment when treating opioid-dependent individuals with buprenorphine; however, no research has examined the combination of buprenorphine with different types of behavioral treatments. This randomized controlled trial compared the effectiveness of four behavioral treatment conditions provided with buprenorphine and medical management ( MM) for the treatment of opioid dependence. Design After a 2-week buprenorphine induction/stabilization phase, participants were randomized to one of four behavioral treatment conditions provided for 16 weeks: cognitive behavioral therapy ( CBT = 53); contingency management ( CM = 49); both CBT and CM ( CBT + CM = 49); and no additional behavioral treatment ( NT = 51). Setting Study activities occurred at an out-patient clinical research center in Los Angeles, California, USA. Participants Included were 202 male and female opioid-dependent participants. Measurements Primary outcome was opioid use, measured as a proportion of opioid-negative urine results over the number of tests possible. Secondary outcomes include retention, withdrawal symptoms, craving, other drug use and adverse events. Findings No group differences in opioid use were found for the behavioral treatment phase (χ2 = 1.25, P = 0.75), for a second medication-only treatment phase, or at weeks 40 and 52 follow-ups. Analyses revealed no differences across groups for any secondary outcome. Conclusion There remains no clear evidence that cognitive behavioural therapy and contingency management reduce opiate use when added to buprenorphine and medical management in opiate users seeking treatment. [ABSTRACT FROM AUTHOR]

Aims To test aripiprazole for efficacy in decreasing use in methamphetamine-dependent adults, compared to placebo. Design Participants were randomized to receive 12 weeks of aripiprazole or placebo, with a 3-month follow-up and a platform of weekly 30-minute substance abuse counseling. Setting The trial was conducted from January 2009 to March 2012 at the San Francisco Department of Public Health. Participants Ninety actively using, methamphetamine-dependent, sexually active adults were recruited from community venues. Measurements The primary outcome was regression estimated reductions in weekly methamphetamine-positive urines. Secondary outcomes were study medication adherence [by self-report and medication event monitoring systems ( MEMS)], sexual risk behavior and abstinence from methamphetamine. Findings Participant mean age was 38.7 years, 87.8% were male, 50.0% white, 18.9% African American, and 16.7% Latino. Eighty-three per cent of follow-up visits and final visits were completed. By intent-to-treat, participants assigned to aripiprazole had similar reductions in methamphetamine-positive urines as participants assigned to placebo [risk ratio ( RR) 0.88, 95% confidence interval ( CI): 0.66-1.19, P = 0.41]. Urine positivity declined from 73% (33 of 45 participants) to 45% (18 of 40) in the placebo arm and from 77% (34 of 44) to 44% (20 of 35) in the aripiprazole arm. Adherence by MEMS and self-report was 42 and 74%, respectively, with no significant difference between arms ( MEMS P = 0.31; self-report P = 0.17). Most sexual risk behaviors declined similarly among participants in both arms (all P > 0.05). There were no serious adverse events related to study drug, although participants randomized to aripiprazole reported more akathisia, fatigue and drowsiness ( P < 0.05). Conclusion Compared with placebo, aripiprazole did not reduce methamphetamine use significantly among actively using, dependent adults. [ABSTRACT FROM AUTHOR]

In accordance with the chronic disease model of opioid dependence, cessation is often observed as a longitudinal process rather than a discrete endpoint. We aimed to characterize and identify predictors of periods of heroin abstinence in the natural history of recovery from opioid dependence. Data were collected on participants from California who were enrolled in the Civil Addict Program from 1962 onward by use of a natural history interview. Multivariate regression using proportional hazards frailty models was applied to identify independent predictors and correlates of repeated abstinence episode durations. Among 471 heroin-dependent males, 387 (82.2%) reported 932 abstinence episodes, 60.3% of which lasted at least 1 year. Multivariate analysis revealed several important findings. First, demographic factors such as age and ethnicity did not explain variation in durations of abstinence episodes. However, employment and lower drug use severity predicted longer episodes. Second, abstinence durations were longer following sustained treatment versus incarceration. Third, individuals with multiple abstinence episodes remained abstinent for longer durations in successive episodes. Finally, abstinence episodes initiated >10 and ≤20 years after first use lasted longer than others. Public policy facilitating engagement of opioid-dependent individuals in maintenance-oriented drug treatment and employment is recommended to achieve and sustain opioid abstinence. [ABSTRACT FROM AUTHOR]

Abstract: Research with injection drug users (IDUs) benefits from interdisciplinary theoretical and methodological innovation because drug use is illegal, socially sanctioned and often hidden. Despite the increasing visibility of interdisciplinary, mixed methods research projects with IDUs, qualitative components are often subordinated to quantitative approaches and page restrictions in top addiction journals limit detailed reports of complex data collection and analysis logistics, thus minimizing the fuller scientific potential of genuine mixed methods. We present the methodological logistics and conceptual approaches of four mixed-methods research projects that our interdisciplinary team conducted in San Francisco with IDUs over the past two decades. These projects include combinations of participant-observation ethnography, in-depth qualitative interviewing, epidemiological surveys, photo-documentation, and geographic mapping. We adapted Greene et al.’s framework for combining methods in a single research project through: data triangulation, methodological complementarity, methodological initiation, and methodological expansion. We argue that: (1) flexible and self-reflexive methodological procedures allowed us to seize strategic opportunities to document unexpected and sometimes contradictory findings as they emerged to generate new research questions, (2) iteratively mixing methods increased the scope, reliability, and generalizability of our data, and (3) interdisciplinary collaboration contributed to a scientific “value added” that allowed for more robust theoretical and practical findings about drug use and risk-taking. [Copyright &y& Elsevier]