Search

Street "doctory" is a form of peer-based medical care performed in street settings among a group of heroin addicts in Yamuna Bazaar, New Delhi. Using participant observation and semi-structured interviews, this study describes three components of the practice, and suggests that each contained peer learning processes. First, participants conducted procedures such as injections and wound care that involved apprenticeship relationships in which "novices" learned through observation and participation with "experts". Second, addicts participated in illness discussions in which they co-constructed meanings about the causes, symptoms and remedies of prevalent diseases. Third, individuals engaged in health consultancy for peers who were sick which involved synthesising, interpreting and communicating concepts and experiences through meaningful units of advice. Analysis suggests that these practices may be theorised as instances of situated learning involving legitimate peripheral participation, meaning negotiation and learning through teaching. These learning patterns represent opportunities for developing culturally tuned health education interventions that engage and impact the participants.

This study builds on existing research investigating the stigma-reducing strategies specific to rehabilitation service providers by comparing differences in education levels and degree of contact among rehabilitation service providers. Rehabilitation service providers with master's level and bachelor level education showed significant differences in their stigmatizing tendencies on subscales of controllability and stability for different categories of disabilities. Specifically, service providers with a master's degree had more stigmatizing beliefs for psychosis and cocaine addiction, compared with service providers with a bachelor's degree. Service providers with either a bachelor's degree or master's degree reported lower levels of stigma overall for five of the six categories of disability compared with their community college student counterparts. No differences were found for length of time working with persons with psychiatric disabilities.

While most school districts utilize a drug abuse resistance curriculum, as science teachers, it is our responsibility to understand the science behind drug addiction in order to most effectively educate our students against drug abuse. In the last two decades, increases in scientific technology have permitted significant discoveries surrounding the neurobiology, genetic components, and treatment of drug addition. This article addresses the latest scientific knowledge about drug addition and treatment with information that can be used in the middle school setting, focusing on cocaine addiction to illustrate the points discussed. (Contains 2 online resources.)

Parenting women emerging from prison on parole face numerous challenges to their successful reentry into the community. Along with finding housing, employment, and satisfying the conditions of their supervision, parenting women must also reassume their roles as mothers. This article adds to the literature on reentry by placing women's maternal concerns at the forefront of this process. Combining quantitative explorations of women's parole case files (203) with in-depth interviews (25), this research demonstrates that reentering mothers confront many of the same problems that mediated their incarceration: poverty, lack of education, unstable housing, lack of access to social services, underemployment, and addiction. While the maternal role may constitute a conventional identity "script" for these ex-inmates and motivate their success on parole, the challenges they face that impact their childrearing before prison make reassuming their maternal roles a precarious enterprise. Recommendations for gender-responsive policies and programs are provided. (Contains 2 tables and 5 notes.)

This article highlights the problem of substance use and abuse among adolescents and discusses the important role of school leaders in addressing this problem. Drug and alcohol use among adolescents is a significant and serious problem. In fact, an alarmingly high number of students report that they have used drugs or alcohol. Substance use and abuse is societal problem that schools alone cannot fix, but they can play an important role in education, prevention, and intervention. School leaders can help students, parents, and staff members be aware of the risks associated with substance use and abuse, the ways of preventing students from using and abusing substances, and the treatment resources that are available for students who may need help. Principals also can collaborate with community service providers to ensure that school policies and programs are supported by community services. Their commitment to addressing substance use and abuse is integral to creating safe and productive learning environments for all students. Principals will be most effective if they take a proactive approach to drinking and substance use, empower faculty and staff members to implement evidence-based programs, and provide the resources necessary to support such programs.

Background: Etiological hypotheses of eating disorders, anorexia nervosa and bulimia nervosa have not produced informative research for predictably effective treatment. Methods: The rationale for applying a model of allostasis, a dysregulation of reward circuits with activation of brain and hormonal stress responses to maintain apparent stability, is developed for eating disorders. Results: The neurotransmitter systems involved in the allostatic state of a reward system in anorexia nervosa and bulimia nervosa may be similar to those present in drug addiction. Conclusion: The biological vulnerabilities underlying the unique features of eating disorders should be intensively investigated with the advancing techniques in genetics and neuroimaging. Preventing chronicity with early diagnosis and adequate treatment before age 18 is necessary.

Adults in a therapeutic workplace working on a computerized keyboarding training program earned vouchers for typing correct characters. Typing technique was evaluated on review steps. Participants could pass the review and earn a bonus, or skip the review and proceed with no bonus. Alternatively, participants could continue practicing on the same step. Participants persistently repeated the same step, which halted progress through the program but allowed them to increase their rate of responding and, as a result, their earnings. Blocking the initiation of practice on review steps and removing payment for practice initiated after prompts (extinction) both produced rapid progress through the program. These results underscore the importance of careful arrangement of the contingencies in adult education programs. (Contains 4 figures and 2 tables.)

The authors examined the effectiveness of motivational interviewing (MI) on club drug use and risky sex in non-treatment-seeking men who have sex with men (MSM). MSM (N = 150) were assessed and randomly assigned to 4 sessions of MI or an educational control intervention. Follow-up occurred at quarterly intervals for 1 year. Primary outcomes were days of any club drug use and number of unsafe sex acts. On average, club drug use declined during follow-up. A significant interaction effect showed that MI was associated with less club drug use during follow-up compared with education but only among participants with lower severity of drug dependence (p less than 0.02; small to medium effect size). MI did not result in a significant reduction in risky sex relative to education. The results support the use of MI targeting club drug use in at-risk or mildly dependent users not seeking treatment but not in more severely dependent users. MI does not appear effective in reducing risky sexual behavior in this population. (Contains 1 footnote, 2 tables and 2 figures.)

Using a grant from the National Institute on Drug Abuse, The Missouri Institute of Mental Health produced a series of media tools designed to teach fourth-, fifth-, and sixth-grade children from African-American churches about the science of drug addiction. Beginning with a core curriculum, we created two separate interventions. In the "SpaceScouts" version of the program, the content is embedded within a narrative storyline delivered via an interactive DVD. In the "LockerTalk" version of the program, content is delivered in a more didactic form via an interactive CD-ROM. Youths from a dozen churches were randomly assigned to one of these two conditions or to a wait-list control. We conducted pretest, posttest, and four- and eight-month follow-up evaluations. We ran an additional sample of youths through our programs during a summer camp. Analyses of our programs revealed that students who received our interventions demonstrated some modest gains in knowledge. Specifically, students who viewed "SpaceScouts" demonstrated improvements from baseline on one of the three sub-modules at post-test. Students who viewed "LockerTalk," however, showed greater overall mastery of the content as compared to the students who viewed "SpaceScouts" or were in the wait-list control condition. (Contains 4 figures.)

The incarceration binge between 1980 and 2000 resulted in a rate of incarceration of 100 to over 500 people per 100,000 (Irwin, 2005). Specifically, from 1980 to 1997, the number of drug offenders increased 1,040% (Petersilia, 2003). Not only is the number of drug offending inmates an issue, so is the cost of drug addiction, prompting a need for an evidence-based evaluation of several international corrections-based substance treatment programs. According to Pollock (2004), drug addiction costs the states' governments approximately $81 billion a year; however, only $3.4 billion is spent on its prevention or treatment--but do these programs work?

Fifty-three adolescent girls residing in community-based group-living child welfare programs were administered a standardized measure (SASS-2) in order to assess probability of a substance use/dependency disorder in this highly vulnerable population. Findings revealed that one third of the sample, and one half of the nonpregnant/parenting girls, met the diagnostic criteria for a substance use/dependency disorder. Probability of such a disorder was associated with aspects of the group living milieu including access to peers who also use drugs and lack of perceived pressure from staff to abstain from using drugs and alcohol. Results support the need for broad-based screening of group home youth, intensive interventions to address existing substance use problems, and staff training in prevention and identification of youth who use substances. Findings also suggest that pregnancy and parenthood represent a window of opportunity for changing the trajectory of substance use in adolescent teens in the child welfare system. (Contains 1 table.)

The climate of domestic drug policy in the United States as it pertains to both women and men at the beginning of the 21st century is the criminalization mode of regulation--a mode that is based on the model of addiction as a crime and one that is used to prohibit the use of illegal drugs. In Canada, drug policy is based mainly on the harm reduction model, a policy or program directed towards decreasing the adverse health, social, and economic consequences of drug abuse without requiring abstinence from such use. Using a comparative perspective, several issues are examined in this article: the prevalence of substance abuse between the two countries, the significance of gender and substance abuse, drug costs relative to both countries, the prevalence of crime and substance abuse, and domestic drug control policies.

Schools have been identified as one of the appropriate settings for addiction prevention since this is the place where pupils may come into contact with drugs for the first time and experiment with them, with the possibility of becoming addicted. To be effective, school-based drug education must be firmly based on knowledge of oneself and knowledge of the effects of various addictive substances. Biology education is then an essential part of school-based drug education. The aim of this work was to compare the approach taken towards addictive substances in textbooks within 16 countries involved in the European project BIOHEAD-CITIZEN. We used a specific part of the project grid for substance abuse (alcohol, tobacco and other drugs) and focussed on three major indicators: physical effects, psychological effects and social effects. Generally, in all 16 countries, the educative approaches taken in their textbooks include the three dimensions. Textbooks mainly employ text rather than visual images, and some countries' textbooks have only text. Moroccan and Mozambican textbooks do not mention tobacco and other drugs, respectively. The comparative analyses highlighted that the Finnish textbook is the most comprehensive; the only one, in the study, to have a specific Health Education teaching module. (Contains 3 figures.)

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.)

There may have been a time when we in Kenya considered the use or abuse of drugs as a problem relating only to Western world. Today it has become an African problem to the extent that a month hardly passes without media reports on large quantities of drugs having been intercepted in a number of African cities and towns. The results of the study indicated that students abused drugs for varied reasons and the commonly abused drugs were alcohol, bhang, miraa, tobacco and kuber. The study recommended that guidance and counseling in schools be enforced and that strict disciplinary measures be enforced by teachers to curb the vice. Policy makers should also focus their efforts on addressing administrative disparities of principal's leadership capacities across urban, suburban and rural setting.

One of the alluring aspects of examining chromatin modifications in the role of modulating transcription required for long-term memory processes is that these modifications may provide transient and potentially stable epigenetic marks in the service of activating and/or maintaining transcriptional processes. These, in turn, may ultimately participate in the molecular mechanisms required for neuronal changes subserving long-lasting changes in behavior. As an epigenetic mechanism of transcriptional control, chromatin modification has been shown to participate in maintaining cellular memory (e.g., cell fate) and may underlie the strengthening and maintenance of synaptic connections required for long-term changes in behavior. Epigenetics has become central to several fields of neurobiology, where researchers have found that regulation of chromatin modification has a significant role in epilepsy, drug addiction, depression, neurodegenerative diseases, and memory. In this review, we will discuss the role of chromatin modifying enzymes in memory processes, as well as how recent studies in yeast genetics and cancer biology may impact the way we think about how chromatin modification and chromatin remodeling regulate neuronal function.

There is an increasing demand for social work students to be prepared to work with a wide range of involuntary groups including the more traditional court-ordered programs in domestic abuse and chemical dependency, as well as groups in mental health and schools that provide outreach to high-risk client populations. This paper introduces three innovative frameworks including Reactance theory, Stages of Change model and Motivational Interviewing. Classroom guidelines and exercises are presented that help students integrate these interventions as they develop their group work skills. Strategies for involving students in moving these innovations towards best practices with involuntary groups are discussed. (Contains 1 table.)

We have investigated the neurochemical mechanisms of memory reconsolidation and, in particular, the functional requirement for intracellular mechanisms initiated by [beta]-adrenergic signaling. We show that propranolol, given in conjunction with a memory reactivation session, can specifically disrupt the conditioned reinforcing properties of a previously appetitively reinforced conditioned stimulus (CS), whether the stimulus had been associated with self-administered cocaine or with sucrose. These data show that memories for both drug and nondrug CS-US associations are dependent on [beta]-adrenergic receptor-mediated signaling for their reconsolidation, with implications for the potential development of a novel treatment for drug addiction and some forms of obesity.

The chronic and relapsing nature of substance abuse points to the need for continuing care after a primary phase of treatment. This article reviews the economic studies of continuing care, discusses research gaps, highlights some of the challenges of conducting rigorous economic evaluations of continuing care, and offers research guidelines and recommendations for future economic studies in this emerging field. Rigorous economic evaluations are needed by health care providers and policy makers to justify the allocation of scarce resources to continuing care interventions. The adoption of cost-effective continuing care services can reduce long-term consequences of addiction, thereby potentially increasing overall social welfare. (Contains 2 tables.)

The advantages of active learning methodologies have been suggested and empirically shown by a number of IS educators. Case studies are one such teaching technique that offers students the ability to think analytically, apply material learned, and solve a real-world problem. This paper presents a case study designed to be used in a database design and development course. The case is about the Recovery Care and Treatment Center System, a real-world organization with names changed. The case is challenging, presents a real-world exercise, and allows students to apply a number of the skills they discuss and learn in class. The case provides sufficient information to be demanding and thought-provoking, but not so much that the case becomes overwhelming in terms of its challenges. The project may be structured as a group or individual project. Additionally, the structure of assigned work from the case can be an overall project, multiple deliverables, or even singular assignments if aspects of the database are separated. Suggested deliverables include relational schema, normalized relational schema, design of entity-relationship diagrams, data dictionary, SQL queries, forms and reports, and other system documentations.

Two experimental conditions, a manualized cognitive-behavioral anger-control treatment incorporating empowerment strategies and a relapse-prevention treatment without the anger-control component, were compared to assess their impact on levels of trait anger and attributional styles of women recovering from alcohol and drug addiction. Participants were predominantly African American, low-socioeconomic-level women living in a residential facility in a major Midwestern city. Although significant changes were found for the anger-control group participants, sample size (anger control n = 8, relapse prevention n = 5) and participant characteristics call for caution when interpreting the results and limit the generalizability of the intervention. As a preliminary study, the findings are encouraging. Recommendations for future research and implications for social work practice are discussed. (Contains 5 tables.)

This study analyzed the viability of financing a voucher program for cocaine addicts in Spain through public and private donations. Of the 136 companies contacted, 52 (38%) provided donations. The difference between the benefits (15,670[euros]/$20,371) and the costs (3,734[euros]/$4,854) was 11,936[euros]/$15,517. The type of reinforcer a company can offer, the size of the company, and the time elapsed before responding may be determining variables in a company's decision whether to collaborate. (Contains 1 table.)

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.

Methamphetamine dependence is an emerging epidemic confronting physicians. In an effort to improve understanding of its impact, the authors presented an educational workshop at a national meeting for general internists featuring small group discussions with patients in recovery (PIR) from methamphetamine dependence. Participants rated the workshop highly, stating it would lead to concrete change in their teaching, research, or patient care practices and they would invite the workshop to their institution for presentation. Direct interaction with PIR was the most valued aspect of the workshop. Lessons learned included patient's fear of being "turned in" limits disclosure of methamphetamine use to physicians; active users have little insight into methamphetamine-related changes in physical appearance; and a sense of productivity reinforces ongoing methamphetamine use. Workshops that include small group discussions between physicians and PIR are an innovative, practical, and acceptable method to teach physicians about their role in helping patients with substance dependence. (Contains 2 tables.)

Marijuana is the number one illicit drug of abuse worldwide and a major public health problem, especially in the younger population. The objective of this article is to update and review the state of the science and treatments available for marijuana dependence based on a pre-meeting workshop that was presented at ISAM 2006. At the workshop, several papers were presented addressing the neurobiology and pharmacology of marijuana and treatment approaches, both psychotherapy and medications, for marijuana withdrawal. Medicolegal and ethical issues concerning marijuana medical use were also discussed. Concise summaries of these presentations are incorporated in this article, which is meant to be an updated review of the state of the science. Major advances have been made in understanding the underpinning of marijuana dependence and the role of the CNS cannabinoid system, which is a major area for targeting medications to treat marijuana withdrawal and dependence, as well as other addictions. Behavioral therapies are efficacious for facilitating abstinence from marijuana. Nefazadone, Marinol, and buspirone are showing early positive signals for efficacy in ameliorating marijuana withdrawal symptoms. Effective psychotherapeutic approaches are available and promising medications studies need to be confirmed in outpatient trials. The next few years look promising for translational research efforts to make treatment widely accessible to patients with marijuana dependence.

This investigation examined how personal, environmental and substance use factors predicted psychosocial functioning for youth with alcohol and drug problems. Four hundred twenty-four adolescents (M = 15.9, SD = 1.3) completed comprehensive assessments, including personal characteristics (e.g., Axis I diagnosis, motivation, self-esteem), environmental factors (e.g., family history, social supports) and substance use, at study intake and throughout the year following inpatient treatment. Treatment outcomes were assessed by measures of academic functioning, family relations, social functioning as well as health status and mental health treatment at one year. Aspects of the proposed model significantly predicted all treatment outcome domains, except family functioning, in the year following treatment. Psychosocial functioning at one year was predicted by age, gender, SES, comorbid psychopathology, family influence and nonusing social supports prior to treatment and relapse status after treatment. The utility of variables associated with substance use treatment outcomes in predicting psychosocial outcomes is considered. (Contains 1 table.)

This paper examines the association of psychosocial factors and long-term drug use behaviors (year-5.5) among adolescents with a substance dependence disorder. One group received treatment with a 12-Step approach (n = 159) and one group was on a waiting list (n = 62). Four psychosocial factors (deviant behavior, peer drug environment, psychological disturbance and family estrangement), as measured by a standardized self-report questionnaire, were examined as predictors across three time points (year-1, year-4 and year-5.5). Improved outcome across time was significantly associated with decreases in deviant behavior, peer drug environment and family estrangement. However, psychological disturbance was not associated with outcome. Also, we did not find an effect on outcome as a function of age, gender and race. Youth that received treatment, as opposed to the waiting list youth, generally revealed a more favorable outcome across time. Treatment implications of the study findings are discussed. (Contains 4 tables and 2 figures.)

Four successive randomized clinical trials studying contingency management (CM), involving various treatment arms of drug-abstinent housing and work therapy and day treatment (DT) with a behavioral component, were compared on common drug abstinence outcomes at 2 treatment completion points (2 and 6 months). The clinical trials were conducted from 1990 to 2006 in Birmingham, Alabama, with a total of 644 homeless persons with primary crack cocaine addiction. The meta-analysis utilized the weighted least squares approach to integrate data encompassing 9 different treatment arms to assess the effects of CM and DT (neither, DT only, CM only, and CM = DT) on a common estimate of prevalence of drug abstinence. Taken together, the results show much stronger benefits from CM = DT and from CM only than for DT alone. Throughout all of the Birmingham Homeless Cocaine Studies, the CM = DT consistently produced higher abstinence prevalence than did no CM.

A previous randomized trial with 224 alcohol and/or cocaine addicts who had completed an initial phase of treatment indicated that 12 weeks of telephone-based continuing care yielded higher abstinence rates over 24 months than did group counseling continuing care. The current study examined mediators of this treatment effect. Results suggested that self-help involvement during treatment and self-efficacy and commitment to abstinence 3 months after treatment mediated subsequent abstinence outcomes. These analyses controlled for substance use prior to the assessment of mediators. Conversely, there was no evidence that self-help beliefs or social support mediated the treatment effect. These results are consistent with a model in which treatment effects are first accounted for by changes in behavior, followed by changes in self-efficacy and in commitment to abstinence.

Hurricane Katrina's impact on the operations of the largest residential, addiction treatment organization in New Orleans is described. Pre- and post-Katrina experiences are discussed and augmented with organizational performance data. Suggestions for future research are provided. (Contains 4 figures.)

The purpose of this study was to determine the relationship between Minnesota Multiphasic Personality Inventory-2 (E. S. Neukrug & R. C. Fawcett, 2006) profiles and employment status for clients who are opiate dependent. A discriminant function analysis indicated that employment was a predictor in maintaining sobriety after 6 months. (Contains 4 tables.)

Nonfatal heroin overdoses and suicide attempts are both common among heroin addicts, but there is limited knowledge about the association between them. The sample in the present study consisted of 149 regular heroin users in Malmo, Sweden. Out of these 98 had taken an unintentional heroin overdose at some time and 51 had made at least one attempt to commit suicide (but not using heroin). Suicide attempts were significantly more common among those who had taken unintentional overdoses as compared with those who had never taken any overdose (p less than 0.01). The more overdoses, the greater the risk of suicide attempt.

"The Doubles," funded by the National Institute on Drug Abuse, is a seven-episode series of media tools designed to teach third- and fourth-grade students about the science of drug addiction. The program's curriculum was delivered through a set of DVDs, interactive CD-ROMs, workbooks, or an Internet Site. Results indicate that although the interventions were successful in teaching students about the biological bases of substance abuse, they had little effect on student attitudes. Implications for future studies are discussed.

This paper proposes that an organism's integrated repertoire of operant behavior has the status of a biological system, similar to other biological systems, like the nervous, cardiovascular, or immune systems. Evidence from a number of sources indicates that the distinctions between biological and behavioral events is often misleading, engendering counterproductive explanatory controversy. A good deal of what is viewed as biological (often thought to be inaccessible or hypothetical) can become publicly measurable variables using currently available and developing technologies. Moreover, such endogenous variables can serve as establishing operations, discriminative stimuli, conjoint mediating events, and maintaining consequences within a functional analysis of behavior and need not lead to reductionistic explanation. I suggest that explanatory misunderstandings often arise from conflating different levels of analysis and that behavior analysis can extend its reach by identifying variables operating within a functional analysis that also serve functions in other biological systems. (Contains 1 figure.)

Drug addicts make poor decisions. These decision-making deficits have been modeled in addicts and laboratory animals using reversal-learning tasks. However, persistent reversal-learning impairments have been shown in rats and monkeys only after noncontingent cocaine injections. Current thinking holds that to represent the human condition effectively, animal models of addiction must utilize self-administration procedures in which drug is earned contingently; thus, it remains unclear whether reversal-learning deficits caused by noncontingent cocaine exposure are relevant to addiction. To test whether reversal learning deficits are caused by contingent cocaine exposure, we trained rats to self-administer cocaine, assessed cue-induced cocaine seeking in extinction tests after 1 and 30 d of withdrawal, and then tested for reversal learning more than a month later. We found robust time-dependent increases in cue-induced cocaine seeking in the two extinction tests (incubation of craving) and severe reversal-learning impairments.

Smoking is highly prevalent across most anxiety disorders. Tobacco use increases risk for the later development of certain anxiety disorders, and smokers with anxiety disorders have more severe withdrawal symptoms during smoking cessation than smokers without anxiety disorders. The authors critically examined the relationships among anxiety, anxiety disorders, tobacco use, and nicotine dependence and reviewed the existing empirical literature. Future research is needed to better understand the interrelationships among these variables, including predictors, moderators, and mechanisms of action. Increased knowledge in these areas should inform prevention efforts as well as the development and improvement of smoking cessation programs for those with anxiety and other psychiatric disorders.

The study was a randomized placebo-controlled trial testing whether fluoxetine selectively enhances cessation for smokers with a history of depression. Euthymic smokers with (H+, n = 109) or without (H-, n = 138) a history of major depression received 60 mg fluoxetine or placebo plus group behavioral quit-smoking treatment for 12 weeks. Fluoxetine initially enhanced cessation for H+ smokers (p = 0.02) but subsequently impaired cessation regardless of depressive history. Six months after quit date, fluoxetine-treated participants were 3.3 times more likely to be smoking (p = 0.02). Further research is warranted to determine why high-dose fluoxetine produces continuing effects that oppose tobacco abstinence.

This study provides new evidence regarding the relation of coerced care to posttreatment substance use and addiction severity while controlling for two important factors: readiness to change and addiction severity at admission to treatment. The initial study sample consisted of 289 people who agreed to participate in a prospective study of substance abuse treatment outcomes in five large outpatient programs in Ohio. The findings reported here are based on analyses for the 141 (48.8 percent of the original sample) individuals who completed a six-month follow-up interview using the short form of the Addiction Severity Index. These data indicate that legally coerced participants were more likely than noncoerced participants to report abstaining from alcohol and other drugs in the 30 days before their follow-up interview. They were also more likely to demonstrate reduced addiction severity at follow-up. Readiness to change at admission showed no relation to treatment outcomes.

While the epidemiologic trends concerning alprazolam (Xanax[R]) are unknown, the use of benzodiazepines, in general, has increased in popularity among youth within recent years. To shed light on the drug problem, the current pilot study used a qualitative approach to investigate relevant beliefs, norms, and perceived addiction associated with alprazolam initiation among 46 youth who were attending an inpatient drug treatment program during the spring of 2004. Overwhelmingly, most participants stated that addiction to alprazolam occurs as early as initial consumption. Most youth in the study stated that their friends felt it was normal to use alprazolam. In addition, their control beliefs revealed that if someone wanted to stop it would be difficult because of the widespread use in their communities and family social reinforcement involved with its use. In this study, a majority of students stated that medical professionals such as doctors and pharmacists were the greatest facilitator of alprazolam acquisition. Implications for these results are discussed. (Contains 2 tables.)

Rates of return to active substance use after addiction treatment tend to be high; participation in 12-step fellowships (e.g., Alcoholics Anonymous) reduces relapse rates but many clients do not attend or attend for a short period only. This quasi-experimental study uses repeated measurement to explore the role of presence/absence of on-site 12-step meetings during treatment on post-treatment outcomes. Polysubstance-dependent clients (N = 219) recruited at a program with and one without 12-step on-site, were followed for one year post-treatment. On-site 12-step enhanced 12-step attendance, especially during treatment, and predicted continuous abstinence for the post-treatment year. Holding 12-step meetings on-site is a low-cost strategy that programs should consider to foster post-treatment remission maintenance. (Contains 3 tables.)

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.)

Using data from 1,162 people entering treatment and followed up (greater than 94%) for 8 years, this article examines the relationship between the duration of abstinence (1 month to 5 or more years) and other aspects of recovery (e.g., health, mental health, coping responses, legal involvement, vocational involvement, housing, peers, social and spiritual support), including the trend and at what point changes occur. It also examines how the duration of abstinence at a given point is related to the odds of sustaining abstinence in the subsequent year. The findings demonstrate the rich patterns of change associated with the course of long-term recovery. (Contains 5 tables and 1 figure.)

This article discusses the life course perspective on drug use, including conceptual and analytic issues involved in developing the life course framework to explain how drug use trajectories develop during an individual's lifetime and how this knowledge can guide new research and approaches to management of drug dependence. Central concepts include trajectories marked by transitions and social capital and turning points influencing changes. The life course perspective offers an organizing framework for classifying varying drug use trajectories, identifying critical events and factors contributing to the persistence or change in drug use, analytically ordering events that occur during the life span, and determining contributory relationships. (Contains 2 figures.)

The authors review the article "Prescription Drug Use and Abuse: Risk Factors, Red Flags, and Prevention Strategies" (J. H. Isaacson, J. A. Hopper, D. P. Alford, & T. Parran, 2005), which provides an overview of the recent increase in prescription opioid abuse and dependence from the physician's perspective. In the present article, the authors discuss the counselor's role in identifying issues related to client misuse and abuse of prescription opioids. Associated terminology, common drug acquisition strategies, and signs of problematic use are provided and discussed.

Employment counselors have been resistant to working with persons in recovery from addiction except under the strictest of criteria. This article examines the relationship between this resistance and the concepts of addiction and addict. Following this is an examination of substance abuse recovery and practical suggestions on incorporating recovery knowledge into career counseling. The goals of the article are twofold: (a) to present a framework that highlights the necessity of employment counseling for the recovery process from substance misuse and (b) to affirm that many employment counselors have the skills needed to assist clients who have been labeled as addicts.

This study, initiated and funded by The Israel Anti-Drug Authority, investigated adolescents' reactions to professionally produced anti-drug plays, performed in 27 schools across Israel. The study included observations and the analyses of 20 professionally produced anti-drug plays performed during the school year and interviews with theatre personnel. The analysis of the plays' narratives revealed that most plays had a melodramatic narrative based on a "true story" and most depicted the downfall of a protagonist who became addicted to drugs. By the very choice of a closed, melodramatic structure, that precludes alternatives and a deep discussion of issues, these plays created an undivided hero, devoid of conflicts and ambivalence, who has no personal responsibility for his actions and the people around him and moves in a narrow private world that does not relate to the values and norms surrounding the issue of drugs.