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We report a new method for measurement of the isotopic composition of nitrate [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] at the natural-abundance level in both seawater and freshwater. The method is based on the isotopic analysis of nitrous oxide ([N.sub.2]O) generated from nitrate by denitrifying bacteria that lack [N.sub.2]O-reductase activity. The isotopic composition of both nitrogen and oxygen from nitrate are accessible in this way. In this first of two companion manuscripts, we describe the basic protocol and results for the nitrogen isotopes. The precision of the method is better than 0.2 [salinity] (1 SD) at concentrations of nitrate down to 1 [micro]M, and the nitrogen isotopic differences among various standards and samples are accurately reproduced. For samples with 1 [micro]M nitrate or more, the blank of the method is less than 10% of the signal size, and various approaches may reduce it further.

Clinically, the treatment of substance abuse has relied on the Twelve Steps model, which is heavily focused on issues of spirituality. Adolescents may have cognitive and developmental issues that preclude them from taking advantage of the Alcoholics Anonymous (AA) model. To this end, we examined the spiritual orientation and spiritual behaviors among adolescent substance abusers in a drug-free residential therapeutic community (TC). One hundred and eighty-six adolescent clients of a drug-free residential therapeutic community were given a self-report questionnaire about their substance abuse and attitudes toward spirituality. The adolescents had a mean Spiritual Orientation Score of 21.48, reflecting a significantly lower level of spiritual orientation than adults in a similar setting. Also, adolescents who were heavy marijuana users were less spiritual than those adolescents who used marijuana less. Spirituality and affiliation with religious institutions may be considered a protective factor because they represent more conventional beliefs and attitudes and indicate a stronger social bond to conventional society. [ABSTRACT FROM AUTHOR]

This study assesses medical students' use of and attitudes towards club drugs, classified as 'Generation I' (i.e., cocaine and lysergic acid diethylamide), and 'Generation II' (i.e., methylenedioxymethamphetamine [MDMA], ketamine, gamma hydroxybutyrate, methamphetamine, rohypnol, dextromethorphan) club drugs based on their initial widespread use in club settings. An anonymous questionnaire was administered to 340 medical students. The prevalence of any club drug use was 16.8%, with MDMA (11.8%) and cocaine (5.9%) the most commonly used. Results discussed also include the relationship of age and gender to having ever used club drugs and to their attitudes regarding use. Additionally, the study identifies differences in patterns of use and attitudes toward Generation I versus Generation II club drugs based on age, gender, and participants' prior club drug use. Findings are compared to those of earlier studies about medical students and those in a similar age group in the general population. [ABSTRACT FROM AUTHOR]

Medical care has long been associated with religion and spirituality, but in recent years a trend has arisen to introduce diverse spiritually oriented approaches in the context of empirically grounded practice. This article reviews the application of these approaches in contemporary medical practice. It highlights the relative utility of such applications, the use of spiritual assessment of the patient, and the role of the clergy and nursing in introducing spirituality into the clinical setting. It then presents findings from a program developed by the authors to employ spiritual support groups in the general hospital in order to aid patients in coping with illness, and to develop among them a more positive identification with their treatment providers. [ABSTRACT FROM AUTHOR]

Co-occurring mental illness and addiction is very common and results in worse treatment outcomes compared to singly diagnosed addicted individuals. Integrated treatment for co-occurring disorders is associated with better treatment outcomes; however there is a wide range of what is included in integrated treatment. Due to patient and staff interests, integrated treatment often includes complementary and alternative therapies, including music and art therapy. There is a need to study how these approaches effect treatment engagement, retention, and outcome. This study was a prospective naturalistic non-randomized pilot study without a control group that sought to evaluate how participation in a music therapy program affected treatment outcomes for individuals with co-occurring mental illness and addiction. In summary, music therapy appears to be a novel motivational tool in a severely impaired inpatient sample of patients with co-occurring disorders. Future studies of music therapy in integrated co-occurring disorder setting should include a control group. [ABSTRACT FROM AUTHOR]

The present study evaluated a model program at Bellevue Hospital Center incorporating a peer-led self-help (PLSH) approach which can be applied to bring about systems-level change in a variety of settings where persons with dual diagnosis are encountered. A total of 461 consecutive MICA inpatient admissions were evaluated to compare the PLSH unit with two standard psychiatric units. The PLSH program was associated with a higher rate of acceptance of aftercare referral (93% vs. 74%) and aftercare attendance (52% vs. 30%) among patients with no prior psychiatric hospitalizations (N = 111). In addition, the PLSH program appeared to benefit chronically impaired MICA patients (N = 350) or those with a history of prior psychiatric hospitalizations, as they were more likely to accept referral to aftercare treatment than were chronic patients discharged from the standard psychiatric units (96% vs. 81%). Such a program, when more widely applied, could yield decreased recidivism and considerably lower medical, psychiatric, and economic cost. [ABSTRACT FROM AUTHOR]

This study sought to determine which adolescents being treated for substance use in a residential Therapeutic Community (TC) would endorse spirituality and Twelve Step oriented approaches as part of their treatment. By identifying individual difference characteristics associated with preference for spirituality and Twelve Step oriented approaches, integrated substance abuse treatments can be targeted to appropriate subgroups of adolescents. A total of 181 adolescents completed a survey assessing their substance use and attitudes toward spirituality and Twelve Step oriented approaches that was similar to a survey completed by 322 adults in the same residential TC program. In the adolescent sample, three spirituality related characteristics: perceived connectedness to others, frequency of prayer, and spiritual orientation to life were associated with preference for both spirituality and twelve step oriented approaches being featured more in TC treatment. Adolescents were less likely than adults to express a preference that both approaches be featured more in TC treatment. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Alcoholics Anonymous is not yet fully employed by the medical community as a means to enhance patient outcome. The purpose of this study was to evaluate visitors' use of an Internet course on Alcoholics Anonymous, and to compare how various disciplines learned about, gained access to and participated in the course. METHODS: Demographic information was collected from 414 visitors to the course. RESULTS: 64% of the 414 respondents received their last educational degree within the last 10 years, and had an interest in the topic of addiction prior to their accessing the site. 294 (71%) of those who accessed the course completed it, and those who accessed it learned about it from various sources other than print advertisement in professional journals. Within the 230 physician respondents, 143 (62%) were psychiatrists, 82 (78%) of whom learned about the Internet course via professional journal. DISCUSSION: Given the need for further training among physicians in the use of Alcoholics Anonymous, the Internet can be utilized to make information available to a large number of people. Because it allows the user to access information outside the traditional means, the barriers to its use are minimal, and it has the potential to effectively convey useful clinical information. [ABSTRACT FROM AUTHOR]

Although Alcoholics Anonymous and other Twelve-Step interventions are among the most widely utilized self-help options by persons with chemical dependency, little is known concerning whether this approach should be integrated with non-spirituality based self-help approaches. The purpose of this study was to assess the extent to which clients receiving inpatient treatment in a residential therapeutic community (TC) felt that spirituality based interventions should be featured in TC treatment. Three hundred twenty-two members of the Daytop TC completed a survey assessing personal orientation to spirituality and attitudes towards spirituality based treatments. The majority of clients believed that the TC program should feature spirituality more in treatment. Nearly half agreed that the Twelve-Step (AA) approach should be more a part of TC treatment. Preference for Twelve-Step meeting interventions was positively correlated with past attendance at Twelve-Step meetings. Personal spiritual orientation to life was positively correlated with endorsement of spirituality based interventions in TC treatment. These findings highlight the importance of integrating treatment approaches which address the spiritual needs of TC residents. [ABSTRACT FROM AUTHOR]

Pathways to Recovery is a peer-led, 12-step-based, selfhelp group with spiritual underpinnings that was developed to meet the needs of clients in a Methadone Treatment Program (MTP) based in a large municipal hospital. Pathways is facilitated by staff, but groups are patient-run. Pathways was adapted for the MTP population from our original Methadone Anonymous format because of the need for increased structure and to ensure the inclusion of women participating in substance abuse treatment that is predominantly male. A sample of 26 Pathways participants and a comparison group of 26 MTP clients who did not attend Pathways completed a battery of questionnaires to assess demographic characteristics, substance use, depression, anxiety, spiritual orientation, and 12-step beliefs. Preliminary findings on gender differences are presented. [ABSTRACT FROM AUTHOR]

This study examined the characteristics of gay men attending circuit parties and their drug use. In particular, the role of methylenediomethamphetamine (MDMA, ?ecstasy?) was considered in relation to other drug use and sexual behavior. A one-page survey was distributed to 173 men attending a circuit party. Respondents were generally gay men, Caucasian, employed, and well-educated. Twenty-five percent self-identified as HIV-positive. Eighty-six percent reported using at least one substance on the day of the party; polydrug use was frequent. The most common substances were MDMA, ketamine, and methamphetamine. MDMA use was highly associated with ketamine, and methamphetamine. MDMA use was highly associated with ketamine, methamphetamine, and cocaine use. MDMA use was also associated with significantly more receptive anal intercourse. Circuit parties are settings of increased drug use and associated high-risk sexual behavior. A better understanding of these issues is needed to develop interventions aimed at reducing drug use and sexual risk taking among gay men who attend circuit parties. [ABSTRACT FROM AUTHOR]

Fifty-two heroin addicts were inducted onto buprenorphine under the care of psychiatric residents in a setting modeled on office practice. Subjects were maintained on a protocol of six weeks of 16 mg daily dosing, then tapered to zero dose up to week 16, and maintained on placebo through week 18. Of 44 subjects who continued after the first induction dose, 11 terminated during maintenance, 17 during taper; and 16 while on zero dose. Twice weekly urine toxicologies showed significant successive declines in samples positive for heroin use across these three periods: 70%, 41%, and 20%, respectively. Among historical variables, only prior AA attendance distinguished subjects who achieved zero dose from those who did not. A comparison with recent studies suggests that relatively inexperienced office-based physicians can maintain patients on buprenorphine at a level comparable to that reported for research clinic settings, but with comparable rates of heroin abstinence. These findings are discussed in light of potential options for office-based opioid maintenance. [ABSTRACT FROM AUTHOR]

A study was conducted to ascertain correlates of HIV high risk behaviors and attitudes toward HIV. A questionnaire was administered to 103 men living in a modified therapeutic community (TC) for homeless, chemically addicted and mentally ill men. The psychiatric diagnoses of the sample population included psychotic disorders (48%), depressive disorders (36%), and bipolar disorders (16%). Forty-two percent reported that their primary substance of abuse was cocaine and another 40% named alcohol as the substance to which they were most addicted. Two logistic regression analyses were conducted, one with needle sharing as the outcome measure and one with endorsement of the need for lifestyle changes to reduce risk of HIV transmission. Cocaine users were 3.4 times more likely to have shared needles than the rest of the sample. Patients who had a history of sexually transmitted diseases (STDs) were 17 times more likely to endorse the need for lifestyle changes. The level of HIV transmission knowledge was unrelated to HIV risk behaviors or attitudes. [ABSTRACT FROM AUTHOR]

At the conclusion of a 3-year demonstration project in a medical setting in which refusal to accept methadone was an inclusion criterion, 12 subjects were unable to detoxify from buprenorphine and remained adamant in their refusal to enroll in a MMTP. In order to study the feasibility of expanding opportunities for treatment previously unavailable to this under-served population of heroin addicts, these 12 subjects plus an additional 11 subjects (N = 23) were recruited for a 12 months trial of buprenorphine treatment conducted in an office-based setting on a fee-for-service basis. An additional cohort of 40 heroin dependent subjects were entered in a protocol for detoxification only. The findings demonstrate both feasibility and patient acceptance of office based fee-for-service buprenorphine treatment, supporting the need for (1) additional studies of this population and (2) changes in government regulations to reintroduce addiction treatment under physician auspices in private practice settings. [ABSTRACT FROM AUTHOR]

Presents a study designed to assess the impact of cocaine abuse on a general psychiatric service and an obstetrics service in an urban general hospital and to evaluate a program for engaging affected patients in addiction treatment. Method ; Results; Conclusions.