Unconscious emotional reasoning and the therapeutic misconception.

The "therapeutic misconception" describes a process whereby research volunteers misinterpret the intentions of researchers and the nature of clinical research. This misinterpretation leads research volunteers to falsely attribute a therapeutic potential to clinical research, and compromises informed decision making, therefore compromising the ethical integrity of a clinical experiment. We review recent evidence from the neurobiology of social cognition to provide a novel framework for thinking about the therapeutic misconception. We argue that the neurobiology of social cognition should be considered in any ethical analysis of how people make decisions about participating in clinical trials. The neurobiology of social cognition also suggests how the complicated dynamics of the doctor-patient relationship may unavoidably interfere with the process of obtaining informed consent. Following this argument we suggest new ways to prevent or at least mitigate the therapeutic misconception.

Alcohol use and sexual risk taking among hazardously drinking drug injectors who attend needle exchange.

BACKGROUND: To determine if sex-risk days are also alcohol use days for active injection drug users. METHODS: Cross-sectional interview of 187 active injection drug users who scored positively (> or =8) on the Alcohol Use Disorders Identification Test who were recruited between February 1998 and October 1999 from a needle exchange program in Providence, Rhode Island. A sex-risk day was defined as "vaginal sex, anal sex or oral sex without a condom," measured by using a 30 day timeline follow-back procedure. RESULTS: The sample was 64% male and 87% white, and 85% met DSM-IV criteria for alcohol abuse/dependence. Of the total days analyzed (n = 5610), 19% were sex-risk days; on 52% of these days drinking also occurred. By using a generalized estimating equation model to cluster by subject, alcohol use was associated with sex-risk days (odds ratio, 1.76; 95% confidence interval, 1.35-2.29; p < 0.001), when we controlled for gender, age, race, education, cocaine use, injection frequency, exchanging sex for money or drugs, number of sexual partners, and perceived sexual risk of acquiring human immunodeficiency virus from partners. CONCLUSIONS: Alcohol use is associated with sex risk-taking behavior among injection drug users. A substantial majority of participants reported using alcohol before or during sexual relations, which temporally links alcohol use with human immunodeficiency virus injection risk.

Adverse drinking consequences among alcohol abusing intravenous drug users.

BACKGROUND: Heavy alcohol use is common among out-of-treatment injection drug users (IDUs); however, the relationship between alcohol and drug use behaviors in codependent populations is not well understood. Our specific objectives were (1) to describe the psychometric properties of the Drinker Inventory of Consequences (DrInC) in a sample of active IDUs, and (2) to compare DrInC scores of active IDUs with those reported for the alcohol treatment seeking sample on which the instrument was developed. METHODS: Interview data were collected from 187 active IDUs who scored positively (> or = 8) on the Alcohol Use Disorders Identification Test, who were recruited from a Providence, RI, needle exchange program (1998-1999). DrInC total and subscale scores for the 159 (85%) participants who met DSM-IV criteria for alcohol abuse/dependence were analyzed. Six-month follow-up data were used to estimate test-retest reliability. RESULTS: The DrInC total scale exhibited high internal consistency and test-retest reliability. With the exception of adverse physical consequences, reliability estimates for DrInC subscales were good to very good. These data indicate higher subscale redundancy than reported for the development sample. Active IDUs had significantly higher adverse impulse control consequences than the alcohol treatment seeking population on which the instrument was developed. CONCLUSIONS: The DrInC exhibits desirable psychometric properties for assessing adverse drinking consequences in active IDU populations. IDUs who met DSM-IV criteria for alcohol abuse/dependence reported overall levels of adverse drinking consequences comparable with non-IDU alcohol treatment populations but were more likely to exhibit adverse impulse control consequences.

Hepatitis B vaccination practices in state and federal prisons.

OBJECTIVE: Incarcerated populations are a group at high risk for hepatitis B. About 30% of people experiencing acute hepatitis B virus infection (HBV) have a history of incarceration. Offering routine HBV vaccinations to incarcerated individuals could have a significant effect on public health. The objective of this study is to identify current vaccine practices and the perceived feasibility of routine vaccinations for hepatitis B within correctional settings. METHOD: The authors surveyed the medical directors of state correctional facilities in all 50 states and the federal prison system regarding current HBV vaccine practices. Surveys were faxed or mailed between July 1 and September 1, 2000. RESULTS: Thirty-five states and the federal system responded (response rate = 70.6%). These systems account for 77% of all inmates in federal or state prisons and jails. Two states give hepatitis B vaccine routinely, nine states offer no hepatitis B vaccine, and 26 states and the Federal Bureau of Prisons offer hepatitis vaccine to some inmates. Most states do not spend enough money to vaccinate even those prisoners at highest risk. Under the Vaccine for Children program, 19,520 youths could receive vaccine immediately. According to the respondents, if vaccine were available at no-cost, 25 states and the Federal Bureau of Prisons would routinely offer vaccination to all inmates. CONCLUSIONS: Most correctional systems do not routinely offer vaccine to their incarcerated populations, but would if funds were available. There exists now a unique public health opportunity to prevent a significant proportion of new hepatitis B infections.

Risk factors for syphilis among incarcerated women in Rhode Island.

Syphilis remains a significant problem in the United States. The prison environment is an ideal location to identify and treat syphilis. We undertook this study to describe the correlates and risk factors for syphilis among incarcerated women in Rhode Island. The study design was a review of all cases of syphilis identified through routine screening in the state prison and a case control study. Between 1992 and 1998, among 6,249 incarcerated women, 86 were found to have syphilis; of these, 29 were primary and secondary cases representing 49% of infectious cases of syphilis in women in the state. The prison environment offers a unique opportunity for the diagnosis and treatment of syphilis.