Prevalence and implications of perinatal substance use in Missouri

A study was conducted to determine the prevalence of perinatal substance use in Missouri. The population sample studied was selected according to a multi-stage probability-proportional-to-size sampling. The weighted prevalence for perinatal exposure to alcohol, tobacco or illicit substances was 31.9%, 10.8% for illicit substances, 21.9% for tobacco use, and 7.9% for self-reported alcohol use. In 1993, an estimated 23,925 perinatal exposures to licit and illicit substances occurred.     

Laparoscopic management of adnexal masses in premenopausal and postmenopausal women

OBJECTIVE: Caffeine is by far the most commonly consumed psychoactive substance. The use and abuse of most other licit and illicit psychoactive drugs have been shown to be substantially heritable. However, the impact of genetic factors on caffeine consumption, heavy use, intoxication, tolerance, and withdrawal is largely unknown. METHOD: Caffeine consumption, in the form of brewed coffee, instant coffee, tea, and caffeinated soft drinks, as well as caffeine intoxication, tolerance, and withdrawal, were assessed by personal interviews of 1,934 individual twins from female-female pairs ascertained from the population-based Virginia Twin Registry. The sample included both members of 486 monozygotic and 335 dizygotic pairs. Twin resemblance was assessed by probandwise concordance, odds ratios, and tetrachoric correlations. Biometrical model fitting was also performed. RESULTS: The resemblance in twin pairs for total caffeine consumption, heavy caffeine use, caffeine intoxication, caffeine tolerance, and caffeine withdrawal was substantially greater in monozygotic than in dizygotic twin pairs. Model fitting suggested that twin resemblance for these measures could be ascribed solely to genetic factors, with estimated broad heritabilities of between 35% and 77%. CONCLUSIONS: Caffeine is an addictive psychoactive substance. Similar to previous findings with other licit and illicit psychoactive drugs, individual differences in caffeine use, intoxication, tolerance, and withdrawal are substantially influenced by genetic factors.     

Initial drug abuse: A review of predisposing social psychological factors.

Reviews the literature and states that appropriate research describing initial use of illicit drugs suggests that disruption of normal child-parent relationships, lack of involvement in organized groups, and few effective peer relationships may have been predisposing factors in some individuals initiating use of illicit drugs. Research also suggests that socialization to nontraditional norms, parental modeling of licit and illicit drug use, involvement with drug-using peers, and positive experiences with drugs may have been important factors in initial use for other individuals. It is concluded that both theory and research need a clear distinction between the several paths leading to initial drug abuse, particularly since separate statistical analyses may be necessary for people in each path. (3 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Modeling population heterogeneity in appearance- and performance-enhancing drug (APED) use: Applications of mixture modeling in 400 regular APED users.

Appearance- and performance-enhancing drugs (APEDs) constitute a wide range of substances, including anabolic-androgenic steroids, nonsteroidal anabolics, and licit and illicit ergo/thermogenics. A great deal of heterogeneity exists in APED use patterns among weight-lifting men, and, consequently, little is known about how these patterns are related to side effect profiles or risk potential. In the current study, a sample of 400 adult men who were regular APED users completed an interactive Web-based instrument detailing information about APED use, side effects, and related indicators of risk. To explore the heterogeneity of APED use patterns, the authors subjected data on use patterns to (a) latent class analysis (LCA), (b) latent trait analysis (LTA), and (c) factor mixture analysis to determine the best model of APED use. Results indicated that a 4-class factor mixture model provided a better fit than LCA and LTA models. The authors also found that severity and latent class were uniquely associated with negative outcomes. Each of the 4 classes was associated with unique side effects, motivations, and participant use patterns. Implications for identifying pathological forms of APED use are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age of first use: its reliability and predictive utility

OBJECTIVE: The purpose of this study was: (1) to assess the utility of age of first licit use and age of first illicit use as predictors of alcohol and drug use at ages 20 and 30; and (2) to examine the reliability of retrospectively recalled ages of onset of use. METHOD: Subjects (N = 839) from the Rutgers Health and Human Development Project provided four waves of longitudinal data spanning the age range from 15 to 31. RESULTS: Retrospective recall of age of onset revealed a fair degree of relative agreement but a lack of absolute agreement because of an upward shift in recalled ages as individuals became older. Repeated measures ANOVAS revealed normative declines in alcohol and drug use from 20 to 30 even though individual differences in use remained quite stable across time. Regression analyses indicated that: (1) age of first licit use as recalled at age 18 did not predict alcohol or drug use at age 20; (2) age of first illicit use was a weak predictor of alcohol use at 20 but a fairly strong predictor of drug use at 20; and (3) neither age predicted use or use consequences at age 30. CONCLUSIONS: In the general population, illicit drug use and heavier alcohol use are, regardless of age of onset, adolescence-limited phenomena for most individuals. Findings suggest that intervention efforts need to be aimed simultaneously at delaying the onset of illicit use and reducing use levels among young adult users.     

A preliminary analysis of the perceived risks of misusing multiple substances, trait anxiety, and approval motivation

In a sample of college undergraduates, perceptions of the risks associated with the misuse of substances such as alcohol, cigarettes, and marijuana were evaluated, and the correlations of risk ratings with trait anxiety and approval motivation were examined. The results indicated (a) a temporally stable, hierarchical ordering of risk means that ranged from illicit to licit substance pairs; (b) a string negative correlation between perceived risk means and corresponding standard deviations, suggesting that greater variability was associated with lower perceived risk; (c) small to small/moderate correlations between high risk ratings and trait anxiety; and (d) small to small/moderate correlations between risk ratings and approval motivation. These findings provide a first approximation of young adults' perceptions of the possible risks involved in the misuse of multiple substances and suggest that such perceptions are not confounded by dispositional anxiety of by social desirability response bias. The results discussed in light of their implications for alcohol and drug education.     

Effect of ageing on pancreatic hyperplasia after 90% proximal small bowel resection

PURPOSE: A longitudinal study to ascertain the attitudes toward, and habits of, substance use among a single class of medical students. METHOD: A single class from a northeastern medical school was surveyed in both its first year (February 1991, 176 students) and its third year (May 1993, 170 students). The students were asked to report how frequently during the prior year they had used drugs or alcohol, and whether their use of each substance had increased, decreased, or remained the same since entering medical school; to identify any family members with histories of alcohol or drug problems; and to report any incidence during the prior year of ten behaviors associated with substance dependence. The students were also asked to indicate their agreement or disagreement with 11 attitudinal statements. Additional attitudinal items asked the students to identify three major deterrents to the abuse of drugs and alcohol, and what they had done if they had become aware of a classmate with a drug or alcohol problem. Chi-square analysis and two-tailed t-tests were used to compare data from the two surveys. RESULTS: The response rates in the first and second surveys were 96.9% and 81.8%, respectively. Use of licit and illicit substances was comparable to that of chronological peers and prior national studies of medical trainees. Most of the students admitted to using alcohol at least once in the prior year (91.8% and 95%, respectively). In both years marijuana was the illicit drug used most often. Although there was a slight increase over time in the use of benzodiazepines (2.4% to 5.8%) and a decrease in the use of marijuana (29.4% to 21.7%), these changes were not significant. Few of the students in their third year reported using any substance other than alcohol more than once a month. In general, a greater percentage of the students reported a decrease rather than an increase in the use of a substance since entering medical school; the primary exception was for wine. As they progressed in their training, the students became less concerned about the effect of substance use on their performance and more likely to be embarrassed about admitting to an addiction. Although in each year a few of the students appeared to be at risk for substance dependence (8.9% and 3.5%, respectively), no student came to the attention of the administration because of problems related to substance use. While most of the students were unaware of any classmate who had a problem, half of those who were aware had done nothing, and the balance had rarely sought assistance from the faculty or administration. CONCLUSION: Although there was no evidence that substance use was a major problem, a few of the students appeared to be at risk for drug or alcohol dependence. Appropriate intervention, support, and referral systems should be identified for the few who may be at risk, and increased educational efforts are needed to help all students address this issue with their peers and, ultimately, with their patients.     

Substance use and abuse among children and teenagers.

During the past several years, there has been a renewed national concern about drug abuse, culminating in the current "war on drugs." In this review, we emphasize that even though child or teenage drug use is an individual behavior, it is embedded in a sociocultural context that strongly determines its character and manifestations. Our focus is on psychoactive substances both licit (cigarettes and alcohol) and illicit (e.g., cannabis and cocaine). We feel that it is critical to draw a distinction between use and abuse of drugs and to do so from a multidimensional perspective that includes aspects of the stimulus (drug), organism (individual), response, and consequences. Our selective review of substance use and abuse among children and adolescents covers epidemiology (patterns and extent of drug use), etiology (what generates substance use), prevention (how to limit drug use), treatment (interventions with drug users), and consequences (effects and outcomes of youthful drug use). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

CD5 B cells and B-cell malignancies

Evidence from both animal, and human, studies suggests that repeated administration of 3,4-methylenedioxymethamphetamine (MDMA: "ecstasy") produces lasting decreases in serotonergic activity. Serotonin is believed to play a modulatory role in a variety of psychological processes, including learning and memory. There are recent reports that polydrug users, who have used ecstasy recreationally, exhibit selective impairments in memory. However, these studies did not compare ecstasy users with polydrug users who had not taken ecstasy, leaving open the possibility that the memory deficits may be associated with a history of use of other illicit drugs. The present study used the Rivermead Behavioural Memory test to investigate immediate and delayed recall in: 25 polydrug-users who had taken more than 20 tablets of ecstasy (MDMA group), 22 participants (polydrug controls) who had never taken ecstasy, but, otherwise has personal characteristics (e.g. age, gender, education, height, weight), and illicit drug use histories, that were generally not significantly different from those of the MDMA group, and 19 participants who had not used illicit drugs but who also had similar personal characteristics (non-drug controls). Participants in the MDMA group recalled significantly fewer ideas (approximately 75% of the number of ideas recalled by participants in either of the other two groups), in both immediate and delayed recall conditions. The two illicit drug-using groups did differ in their estimated IQ scores and their duration of use of LSD, but only the latter proved to be a statistically significant covariate, and the difference in recall performance between the MDMA and polydrug controls groups remained statistically significant when this variable was treated as a covariate. The present findings provide the first evidence that deficits in memory performance in recreational ecstasy users are primarily associated with past exposure to ecstasy, rather than with the other legal and illicit drugs consumed by these individuals, and are consistent with reduced serotonergic modulation of mnemonic function as a result of long-term neurotoxic effects of MDMA in humans.     

Personality factors in student drug use.

Interviewed a random sample of 160 male and female undergraduates concerning illicit psychotropic drug use and administered the Personality Research Form. Univariate and multivariate analyses strongly supported the hypothesis that nonusers, moderate users, and heavy users of illicit drugs differ in personality characteristics. Dramatic sex differences were observed in the personality characteristics associated with illicit drug use, suggesting that sex and personality interact in a crucial way to influence drug use. The relationships between illicit drug use and GPA, satisfaction with academic performance, aptitude, and other relevant variables were also investigated. The data are interpreted as suggesting that both male and female heavy users may have rejected their stereotypic sex roles. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multidimensional locus of control and drug use among high school students.

Examined the relationship between D. W. Reid and E. E. Ware's multidimensional measure of internal–external (I–E) locus of control and licit and illicit drug use among 920 high school students over a 2-yr period. Results based on 1-way ANOVAs indicate that dimensions of I–E control are differentially related to drug use. Greater externality on the dimension of fatalism was significantly related to the use of a number of drugs, while externality on the dimensions of self-control and sociopolitical control was not consistently related to drug use. Certain interpretations regarding the relationship between fatalism and drug use were tested. Since the I–E subscales appear to have a different validity, it is concluded that older unidimensional scales may obscure the relationship between I–E and drug use. The use of multidimensional measures is suggested since these offer more precise measurement of particular expectancy domains. (French summary) (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical use of recreational drugs by AIDS patients

A survey of 72 patients at an AIDS clinic regarding self-medication with recreational drugs for medical or psychological conditions related to their illness disclosed that marijuana was the primary drug used. The perceived benefit was for gastrointestinal conditions such as nausea, vomiting, indigestion and appetite improvement. Use of other "recreational" drugs as self-medication was reported to usually be ineffective or to worsen the condition they sought to help. Fifty-eight percent of patients reported some attempt to self-medicate. Thirty-two percent were currently using marijuana, and most admitted to pre-AIDS marijuana use. Fifty-seven percent of the sample reported some pre-AIDS drug use, primarily alcohol and marijuana. Results are discussed in terms of potential clinical problems arising from continued recreational drug use among AIDS patients.     

Power spectral analysis of EEG in a multiple-bedroom, multiple-polygraph sleep laboratory

Although scientific and policy statements regarding drugs often suggest that there are grave problems of drug use within America's inner cities, the evidence that supports these statements is often based on anecdotal or incomplete data. This study of African-American adults from the Woodlawn study followed longitudinally partially fills that gap, at least for learning more about those who spend some or all of their childhood within an inner city neighborhood. We found few differences between the lifetime prevalence of drug use and a national representative sample of adults of the same age range. Furthermore, a national household survey of African-Americans of similar age living in six central cities also reported low lifetime rates of illicit drug use. Nevertheless, those from the Woodlawn cohort had higher rates of use of illicit drugs in the past year than the national sample, especially those still living in areas with high rates of poverty. Additionally, reports of heavy drug trafficking were much greater in the inner city areas than in the suburbs.     

Contracting for treatment termination to reduce illicit drug use among methadone maintenance treatment failures.

Evaluated the effectiveness of a contingency contracting intervention on reducing illicit drug use by 21 25–60 yr old male methadone maintenance patients selected on the basis of positive urinalysis results during a 60-day baseline. The intervention consisted of a 30-day contract, which stated that Ss would continue to receive a specified dosage of methadone, would not be asked to leave the program or detoxify, and would not use illicit drugs during the contract period. Illicit drug use was significantly reduced during the 30-day intervention and remained below baseline levels during a 60-day follow-up. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prescribing drug of choice to illicit heroin users: the experience of a U.K. community drug team

Functioning across several life domains, in the first cohort of illicit heroin users to be prescribed injectable diamorphine (pharmaceutical heroin) as an adjunct to treatment within a community drugs service, was assessed in a cross-sectional study with a 6-month follow-up. Case-control matching procedures were employed to compare outcomes in this group with an oral methadone-prescribed sample, attending different clinics within the same community service and geographical locale. The Heroin Prescribed (HP) group manifested lower levels of psychopathology and showed greater retention in treatment. Although reduced, illicit heroin misuse was not eliminated; the use of other illicit substances was comparable between groups but significantly more of the HP group were using illicit cocaine. Although no differences in current physical health were apparent, the sharing of used injecting equipment was reported only in the MP group. Criminal activity appeared significantly reduced, but not eliminated, in the HP group. Implications for prescribing practice are discussed.     

Prevalence of illicit drugs detected in the urine of women of childbearing age in Alabama public health clinics

Each year, it is estimated that from 350,000 to 739,000 U.S. infants are exposed in utero to one or more illicit drugs. To estimate the prevalence of and risk factors for illicit drug use by women of childbearing age in Alabama, during 2 months in 1991 the authors collected patient-reported histories, clinical histories, and urine specimens from 6,195 women statewide attending public health maternity clinics, family planning clinics, and a high-risk referral obstetrical clinic. Blind drug screening of urine specimens for marijuana, cocaine, opiates, barbiturates, and amphetamines was performed with the use of a fluorescent polarization immunoassay. The overall prevalence of positive results for drugs tested was 10.1 percent, including 8.4 percent of the 3,554 pregnant and 12.3 percent of the 2,571 nonpregnant women screened. The drugs most frequently detected were marijuana and cocaine. Characteristics of the subjects associated with a higher prevalence of positive results for any drug tested or for marijuana included white race, older age, being divorced, non student occupation, having 12 or less years of education, attending a clinic located in a suburban county, self-reported substance use, increased risk for human immunodeficiency virus infection, and reproductive history. Characteristics of women with positive screening for cocaine results were similar to those who tested positive for any drug, except that the prevalence of cocaine was higher among black women and those attending urban county clinics and did not vary by years of education. Patient-reported histories of drug use were insensitive in identifying women who had positive drug screening results (sensitivity, 6.3 percent; specificity, 98.2 percent). Thus, in this study,the use of illicit drugs among women of childbearing age attending public clinics in Alabama was common and emphasizes the need for targeted drug education and interventions to reduce the impact of drug use on this high-risk population.     

Development of substance use and psychiatric comorbidity in an epidemiologic study of white and American Indian young adolescents the Great Smoky Mountains Study

The progression of substance use and the patterns of comorbidity of substance use and psychiatric disorders are explored prospectively in young adolescents enrolled in the Great Smoky Mountains Study. This study is an epidemiologic study of white and American Indian youths living in rural Southern Appalachia. Results from this study indicate that alcohol use without permission predicts subsequent use of illicit drugs and regular tobacco use. Use of tobacco was not associated with either later alcohol or drug use. Patterns of comorbidity showed strong cross-sectional relationships between substance use and behavioral disorders, but not emotional disorders. Use of alcohol was also associated with psychiatric diagnosis at a later interview. There were some differences between white and American Indian youths in the pattern of comorbidity of tobacco use and psychiatric disorder and the relationship between prior psychiatric disorder and later alcohol use. These findings suggest that alcohol use without permission may be an important marker for youths who are at risk for illicit drug use and/or psychiatric diagnoses.     

Prison inmate characteristics and suicide attempt lethality: An exploratory study.

Working with suicidal inmates is among the most demanding elements of clinical practice in corrections, yet few studies regarding the characteristics of prison inmate suicide attempters or their attempts exist. This represents a significant gap as the method of attempt, the prison context, and the resulting lethality of these incidents may be different from attempts made outside of prison. This exploratory study is the first to apply a continuous scale rating of suicide attempt lethality to incidents where an inmate survived a suicide attempt. It describes the attempt incident dynamics and resulting range of lethality scores found within the study sample. It also examines the inmate adjustment and mental health characteristics that were associated with the lethality rating. Preliminary findings suggest that increases in suicide attempt lethality are associated with the presence of Axis II disorders, favorable staff interactions, and the decreased use of drugs other than marijuana, alcohol, cocaine, or depressants. A call for research to extend this exploration through replication is made and recommendations for clinical practice are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strategies for the monitoring of drugs in body fluids by micellar electrokinetic capillary chromatography

Electrokinetic capillary techniques can exploit numerous separation principles, making them flexible and easily applicable to a variety of separation problems. In recent publications, this emerging technology has been shown to be well suited for monitoring drugs and metabolites in body fluids, including serum, saliva and urine. Most attention has been focused on micellar electrokinetic capillary chromatography (MECC) because it permits the separation and determination of drugs with discrimination being largely based on differences in hydrophobicity. An overview of literature data on the MECC of drugs in body fluids and recent data obtained with antiepileptics in serum and saliva, with model mixtures of illicit drugs, and with extracts from urine specimens that tested positively for opiates and cocaine metabolites are presented. Emphasis is focused on buffer selection and simple sample preparation procedures, including direct injection of body fluids, ultrafiltration and solid-phase extraction.     

A practical technique for assessing electromagnetic interference in the clinical setting: ad hoc testing

Many homeless youth may also be considered "thrownaway" in that they have specifically been told to leave home. In this study, thrownaway experiences among homeless youth are examined in two national samples: (a) a nationally representative sample of youth residing in youth shelters, and (b) a purposive sample of street youth in 10 cities. Prevalence of thrownaway experiences for the total samples and for demographic subgroups is provided, along with comparisons of the familial backgrounds and high-risk behaviors of youth with and without such experiences. In both samples, youth with thrownaway experiences (who constituted nearly half of each sample) were more likely than youth without such experiences to report (a) that they had attempted suicide, used marijuana and other drugs (excluding cocaine), and had been involved in the drug trade and carried hidden weapons; (b) that other family members had used illicit drugs during the 30 days before the youth left home; and (c) that they had spent at least 1 night away from home due to physical and/or emotional abuse or neglect, familial conflict, and familial substance use. Thrownaway youth constitute a particularly vulnerable subpopulation of homeless youth. A greater recognition and understanding of such youth will facilitate design of services that better address their needs.