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Context: Although the nonmedical use of stimulant drugs such as cocaine and methamphetamine is increasingly common in many rural areas of the United States, little is known about the health beliefs of people who use these drugs. Purpose: This research describes illicit stimulant drug users' views on health and health-related concepts that may affect their utilization of health care services. Methods: A respondent-driven sampling plan was used to recruit 249 not-in-treatment, nonmedical stimulant drug users who were residing in 3 rural counties in west central Ohio. A structured questionnaire administered by trained interviewers was used to collect information on a range of topics, including current drug use, self-reported health status, perceived need for substance abuse treatment, and beliefs about health and health services. Findings: Participants reported using a wide variety of drugs nonmedically, some by injection. Alcohol and marijuana were the most commonly used drugs in the 30 days prior to the interview. Powder cocaine was used by 72.3% of the sample, crack by 68.3%, and methamphetamine by 29.7%. Fair or poor health status was reported by 41.3% of the participants. Only 20.9% of the sample felt they needed drug abuse treatment. Less than one third of the sample reported that they would feel comfortable talking to a physician about their drug use, and 65.1% said they preferred taking care of their problems without getting professional help. Conclusions: Stimulant drug users in rural Ohio are involved with a range of substances and hold health beliefs that may impede health services utilization.

The Ohio Substance Abuse Monitoring Network (OSAM) is designed to provide accurate, timely, qualitatively-oriented epidemiologic descriptions of substance abuse trends and emerging problems in the state's major urban and rural areas. Use of qualitative methods in identifying and assessing substance abuse practices in local communities is one of the main assets of OSAM Network. Qualitative methods are sensitive to local contextual variability, flexible enough to capture emergent trends, and can be implemented with limited financial resources. This paper describes how qualitative epidemiologic methods, like those used by the OSAM Network, could be applied to inform substance abuse prevention activities, particularly those directed at adolescents.

Examines the role of motivation in substance abusers' acceptance of treatment and its relation to treatment outcomes. Better motivation was consistently associated with severity of substance use. Motivation was not related to alcohol and drug use severity six months later. Severity associated with motivation at entry was not related to clients' success six months later. (Contains 26 references.) (BF)

Used nine different confirmatory factor analysis models to test the factorial structure of Rosenberg's (M. Rosenberg, 1965) self-esteem scale with a sample of 430 crack-cocaine users. Results partly support earlier research to show a single global self-esteem factor underlying responses to the Rosenberg scale, method effects associated with item wording, and method effects associated with positively worded items. (SLD)

Demonstrates how the latent growth model can be applied to the evaluation of programs targeting HIV risk behavior among drug users. Multigroup piecewise latent growth models were fit to longitudinal data with three repeated response measures. Participants were 430 drug users and their sex partners. (SLD)

The objective of this study was to determine the frequency, principal diagnoses, and correlates of emergency department (ED) visits made by persons with a history of crack-cocaine use (n = 333) over a 3-year period. Data were collected from participant self-reports and hospital records. During the study a total of 643 ED visits were made by 211 people, ranging from 53.5 to 76.7/100 persons/year. Injury and poisoning accounted for the largest single category of ED visits (29.5%). Men had lower odds of visiting the ED (OR = 0.79, 95% CI = 0.62-0.99), as did participants with higher levels of education (OR = 0.83, 95% CI = 0.73-0.94). Number of times in drug abuse treatment (OR=1.04, 95% CI = 1.01-1.09), having a chronic disease (OR = 1.46, 95% CI = 1.06-1.99), and higher Addiction Severity Index composite medical scores (OR = 1.62, 95% CI = 1.15-2.29) increased the odds of an ED visit. Factors in addition to drug use are likely to affect ED utilization rates among crack-cocaine smokers. Keywords: Cocaine, crack, substance abuse, emergency department utilization, ASI, INTRODUCTION The use of cocaine hydrochloride and its smokeable base form, crack, continues to be a serious public health concern in the United States. Epidemiological data show about 28 million [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2005.04.017 Byline: Russel S. Falck, Jichuan Wang, Robert G. Carlson, Harvey A. Siegal Keywords: MDMA; Depression; Substance abuse; BDI-II; Epidemiology Abstract: Research suggests that MDMA can cause serotonin depletion as well as serotonergic neurodegradation that may result in depression among users of the drug. Several small-scale studies have used various editions of the Beck Depression Inventory (BDI) to quantify depressive symptomatology among MDMA users. This study represents the largest application of the BDI to date to explore symptoms of current depression among a community sample of young adult MDMA users (n =402). Internal consistency testing of the BDI-II with this sample revealed Cronbach's [alpha] =.92. Results show a mean BDI-II score of 9.8, suggesting low levels of depressive symptomatology among study participants. Two-thirds of the sample had scores that placed them in the non-depressed/minimal depression category, while 4.7% had scores indicative of severe depression. Logistic regression analysis revealed that men were significantly less likely than women and people who used opioids were significantly more likely than non-users to have higher levels of depressive symptomatology. Higher lifetime occasions of MDMA use were marginally related to symptoms of serious depression. Author Affiliation: Center for Interventions, Treatment and Addictions Research, Wright State University School of Medicine, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA

This study describes the drug-use practices and treatment histories of 249 not-in-treatment, drug-using individuals living in small towns in rural Ohio. Respondent-driven sampling was used to recruit participants who answered questionnaires administered by interviewers. Descriptive statistics and latent class analysis (LCA) were used to examine the data. The illicit drugs most commonly used in the 6 months before entering the study were marijuana (89.6%), cocaine hydrochloride (80.3%), and crack cocaine (76.3%). Injection drug use was not uncommon. About a third of the sample experienced drunkenness frequently. Less than 14% had been in substance abuse treatment recently. LCA revealed two groups: (1) heavy users of virtually all drug classes and (2) moderate-to-light users of fewer drug classes. White and younger people were more likely to be classified in the heavy user group. The results suggest that comprehensive substance abuse prevention and treatment programs are needed in rural communities. Keywords: Substance abuse; Rural; Cocaine; Oxycodone; Epidemiology

This article describes the process of recruiting research subjects for a natural history study of illicit stimulant use in rural Ohio using respondent-driven sampling and ethnographic methods. Participant observation, qualitative interviews, and focus groups were used to establish the project and to evaluate and modify the sampling process as it unfolded. We outline the steps taken in several different rural counties, using ethnographic data to illustrate local differences and obstacles that were faced. The article concludes that respondent-driven sampling is a promising method for identifying and recruiting members of hidden populations in rural areas. However, adequate time must be allotted to establish ethnographic footholds and to reach various networks in separate communities.

Substance use by adolescents continues to present a problem schools must address. Data from survey research can prove useful in helping schools determine the nature and extent of youth drug use. This study identified variations in drug use prevalence among ninth grade students in different school districts in the same locale in Ohio. Possible explanations for the differences were explored. Students (n = 3,016) from 12 suburban high schools anonymously completed self-report drug use questionnaires. School and community-level data were collected from other sources. Cluster analysis was used to group the school districts. ANOVA revealed statistically significant differences (P ≤ 0.001) in levels of drug use by cluster. The cluster with significantly lower levels of drug use consisted of districts with at least one fulltime drug abuse prevention coordinator, higher economic levels, and the highest per pupil expenditures. Drug use among youth is influenced, at least in part, by local contextual factors. Local survey data can inform local policy and programs. These findings have practical implications for policymakers, program developers, and school districts in other areas of the country. (J Sch Health. 2002;72(7):288-293), Drug use by young people continues to constitute a major public health concern. (1) It is the precursor to substance abuse which, according to some policy analysts, represents this nation's [...]

This article discusses the relationship between drug treatment utilization and future drug use outcomes. An analysis of patient adjustment, post-treatment care, and abstinence patterns is presented.

This article discusses the relationship between crack use and sexual assault. Topics include drug abuse, prostitution and violence.

A new study examines the link between health status and drug use in a population of crack-cocaine smokers who are not receiving treatment. An assessment of the reliability of the Medical Outcomes Short Form 36 among drug users is assessed.

A study assessed the effectiveness of prison-based therapeutic communities (TCs) for prisoners with drug abuse histories. Results indicate that inmates with longer TC exposure were less likely to be rearrested/charged with drug-related or violent crimes.

Objective: The purpose of the study described here is to extend our understanding of needle transfer behaviors among injection drug users (IDUs) by combining both micro and macro variables in a multilevel model. Methods: A sample of 8,404 IDUs interviewed at 18 sites of the National Institute on Drug Abuse (NIDA) Cooperative Agreement for AIDS Community-Based Outreach/Intervention Program (COOP) was used for the study. A multilevel model was employed to deal with intraclass correlation in the sample and to evaluate the impact of micro and macro variables on needle transfer among IDUs. Results: A significant intraclass correlation was detected in the sample. Needle transfer was associated with both the individual characteristics and the features of the social setting in which they were embedded. Some of the micro slopes were fixed, while some varied from site to site, depending on the values of macro variables. The micro intercept and the micro slope of ethnicity vary randomly across social settings, while they are partially determined by macro variables. Conclusion: Considering the intraclass correlation in the data and the effects of contextual features on individual behaviors, multilevel analysis of HIV risk behaviors should be considered when combining data from micro and macro levels (e.g., individual and project site levels)., INTRODUCTION The prevalence of HIV among injection drug users (IDUs) is often attributed to using syringes and needles previously used by someone else. Although some studies suggest that IDUs have [...]

Research focusing on active users of crack cocaine and how they interact with the health care system - drug abuse treatment in particular - is a new area of inquiry. Much of what is known about the problems associated with the use of crack comes from short-term studies. This article describes implementation and methodological issues related to conducting health services research with a natural history orientation among a population of active crack cocaine users (n = 444) in Dayton and Montgomery counties in Ohio. Data from this study can help define what addiction to crack really means as well as ways to prevent and treat it., A Case Study From the Midwest In the early 1980s, crack cocaine appeared simultaneously on the east and west coasts of the United States (Inciardi, 1987). By the mid-1980s, the [...]

The positive relationship between time spent in substance-abuse treatment and improved outcomes has led to a significant interest in interventions that encourage substance abusers to remain in treatment. Case management has been tested for its role in both encouraging continued participation and directly affecting desired outcomes. This article reports findings from an ongoing longitudinal study that randomly assigned over 600 substance abusers entering treatment to one of two groups, either: (1) usual primary and aftercare drug treatment services or (2) usual services and an enhancement of strengths-based case management. A cluster analytic technique was used to identify patterns of participation in post-primary treatment, i.e., aftercare and case management, among those substance abusers in the enhanced group. Three distinct clusters emerge that suggest a prominent role for this model of case management as either an adjunct or an alternative to conventional treatment.

This article examines the effectiveness of strengths-based case management in assisting persons with substance abuse problems improve employment-related functioning. In a study of 632 veterans seeking treatments for substance abuse problems, Wright State University's Enhanced Treatment Project found that veterans in substance abuse treatment had improved in several areas of employment functioning, including number of days employed. Among clients who expressed interest in receiving assistance with employment-related issues, those who received strengths-based case management demonstrated additional improvement in employment functioning including more days employed, fewer employment problems and being less troubled about their employment situation. Correlations between improved employment functioning and improved functioning in other life areas further support the value of case management. The implications of these findings for the inclusion of case management services in substance abuse treatment programs will be discussed. Keywords - case management; drug abuse; employment.

This study used the Addiction Severity Index (ASI) to identify the various problems substance abuse clients present when seeking treatment at a Department of Veterans Affairs Medical Center. The sample was 98% male and 73% African-American, with a mean age of 37 years. Cluster analysis was used to identify commonalities and divergences in self-reported employment, legal, family, substance abuse, psychological, and medical problems. Four distinct clusters emerged, each of which could be characterized by a dysfunctional pattern. The utility of this approach in designing treatment regimens, addressing client problems in addition to their substance abuse, increasing client satisfaction with service provided, and decreasing treatment attrition is discussed., Key words. ASI; Cluster analysis; Presenting problems; Treatment retention INTRODUCTION Dropping out of treatment is a continuing source of concern for substance abuse practitioners. A decade and a half ago, [...]

Estimates of the number of people addicted to heroin and cocaine run into the millions. How these drug abusers interact with the social services system is not well understood. To gain insight into the nature and extent of such interactions, an exploratory study was conducted to gather information on the perceptions and utilization of human services by 44 drug abusers not in treatment. Twenty-nine injection drug users and 15 crack-cocaine users participated in focus group sessions and structured interviews. Participants were recruited by indigenous outreach workers in Dayton and Columbus, Ohio. Findings revealed a very high rate of service use by the drug users. The results raise questions about the role and efficacy of the social services system in identifying drug users and addressing their needs. In addition, the findings raise perplexing questions regarding the effectiveness of acquired immune deficiency syndrome risk-reduction efforts among injection drug users and crack-cocaine users., Human services organizations are designed to help people move toward and maintain optimum levels of physical and psychosocial health. In practice, the specialized and fragmented nature of the social services [...]

Recruiting large samples from 'hidden populations' of injection drug and crack-cocaine users who are not in drug treatment has been a troubling methodological problem that has increased in significance in the face of the AIDS pandemic. This article describes a sampling strategy developed for AIDS prevention research in Montgomery County (Dayton) Ohio that combines targeted sampling with the systematic derivation of proportional sampling quotas. The ethnographic mapping of drug use indicators by outreach workers plays a key rol in the sampling design. The triangulation of independent drug use indicators enables us to estimate the relative density of drug users throughout the county and generate proportional sampling quotas for three sampling zones. The samplin strategy has a range of potential applications.

This case involves the examination of an ethically problematic event that arose while we were conducting an outreach/early intervention research demonstration project targeted at women who exchange sex for drugs. Subjects were drug abusers--primarily crack-cocaine smokers--recruited by outreach workers on 'the street' and in jail. Participants were offered counseling, HIV and syphilis screening, and risk-reduction education. A woman who was a jail inmate tested positive for HIV. In order to obtain medical and other assistance, she would have to reveal her serostatus to jail officials. This could result in isolation and the possibility of harm from others in the jail once the information about her circulated. The case highlights the problems inherent in HIV testing of incarcerated drug abusers, especially in low HIV seroprevalence areas. We recommend that a community empanel a committee composed of substance abuse treatment and medical professionals, civil rights advocates, criminal justice personnel, and ethicists to formulate humane and effective policy in light of its drug abuse and HIV problems and its resources., An annotated case ofan unexpectedly HIV-positive drug abuser prison inmate who voluntarily participated in an HIV outreach and research program is presented. The case emphasizes on the problems inherent in HIV testing of incarcerated drug abusers. It is suggested that humane and effective policy on drug abuse, HIV problems and research be formulated by a community panel consisting of substance abuse treatment and medical professionals, civil rights groups, criminal justice personnel and ethicists.

The innovative, successful and widely replicated Weekend Intervention Program (WIP) has been highly effective in identifying and intervening with persons charged with alcohol (and other drug) related driving offenses. WIP's model approach allows a high degree of specificity in assigning individuals to the most appropriate treatment setting and successfully prepares the offender for the substance abuse services to be received, therefore, addressing a major impediment to successful treatment - early drop out. Expanded utilization of a program such as WIP can greatly enhance the therapeutic and cost effectiveness of criminal justice system treatment efforts and help establish a viable productive partnership between the criminal justice system and the substance abuse treatment community. In this article the authors describe WIP, its clinical approach and evaluation, and comment upon the benefits of its wider use.

In a study examining the correspondence between self-reported drug use and drug urinalysis, 128 injection drug users (IDUs), who were subjects in an AIDS prevention research project, were asked to provide urine samples, which would be tested for the presence of the metabolites of opiates and cocaine. Ninety-five IDUs provided samples for testing. Of these, twenty IDUs (21.1%) who reported abstinence from opiates and cocaine for the six months prior to the completion of a follow-up questionnaire had their claims contradicted by urinalysis results. Logit regression analyses revealed that IDUs whose primary drug of choice was both crack and injected cocaine and those who were black were significantly more likely to have misrepresented their current drug use status than other groups. The implications of these findings are discussed.