Changes in locus-of-control attitudes about drug misuse in a self-help group in a methadone maintenance clinic.

Clients of a methadone-maintenance clinic in Brooklyn, New York participating in a clinically-guided self-help (CGSH) program plus standard treatment (methadone maintenance plus individual counseling) demonstrated statistically significant changes in locus-of-control beliefs, from external to internal causation, about personal responsibility for drug misuse. Members of two control groups--one participating in a didactic lecture program plus standard treatment and the other receiving only standard treatment--failed to demonstrate similar changes. This increase in internal locus of control in the CGSH group suggests the potential efficacy of CGSH as a relapse-prevention therapeutic technique.

Human immunodeficiency virus infection in a cohort of intravenous drug users in New York City. Demographic, behavioral, and clinical features.

In 1985, 454 intravenous drug users were recruited from among patients scheduled for physical examination in methadone treatment clinics in New York City. A questionnaire was administered, and serum was collected for human immunodeficiency virus (HIV) serology. The HIV seroinfection rate was 60.6%, with antibody and antigen detected in 58.4% and 4.3%, respectively, of the population. Nineteen percent of 307 subjects were in Group III or Group IV of the Centers for Disease Control (CDC) classification system for HIV-associated infections. Only behavioral factors (p = 0.001) and clinical indicators (p = 0.003) were found to distinguish the HIV-infected from the non-infected subjects. Frequent use of intravenous drugs (p = 0.016), duration of drug use (p = 0.050), and duration of drug treatment enrollment (p = 0.038) were significantly associated with HIV seroinfection status and CDC stage of HIV disease. These findings strongly support aggressive efforts to reduce parenteral drug use and enroll intravenous drug users into effective drug treatment programs.

Sexual contacts of intravenous drug abusers: implications for the next spread of the AIDS epidemic.

A scarcity of knowledge exists regarding the sexual behavior of intravenous drug abusers (IVDAs) despite their potential role in the heterosexual transmission of acquired immunodeficiency syndrome (AIDS). Using a standardized questionnaire of drug and sexual practices, 96 patients enrolled in methadone maintenance treatment in New York City were interviewed anonymously.Over one half of the 767 sexual contacts reported by this sample were non-IVDAs. Male IVDAs, compared with female IVDAs, reported a significantly greater percentage of heterosexual non-IVDA contacts (P < .001). Participating in needle-sharing behavior or being younger than 35 years of age was also associated with a significant probability (P < .001) of having a non-drug-using sex partner. Female IVDAs, as compared with male IVDAs, were at greater risk for human immunodeficiency virus (HIV) infection from sexual contacts with male IVDAs and their own parenteral drug use. Black and Hispanic IVDAs, in contrast to white IVDAs, reported a statistically insignificant greater percentage of non-IVDA sex partners.These findings suggest that aggressive health education campaigns targeted for IVDAs and sexually active female non-IVDAs are sorely needed to reduce HIV-exposing sexual behaviors, especially in communities where intravenous drug use is prevalent.

Interim report of the Presidential Commission on the Human Immunodeficiency Virus Epidemic: Chairman's recommendations--Part I.

PIP: The Presidential Commission was created in September 1987 with the mandate to advise the White House "on the public health dangers including the medical, legal, ethical, social, and economic impact, from the spread of the HIV and resulting illnesses including AIDS, AIDS related complex, and other related conditions." This paper covers the Commission's interim policy recommendations as of March 15, 1988, in the areas of intravenous drug abuse, patient care, and basic research and drug development. The scope of recommendations in the area of intravenous drug abuse includes provision of treatment services, treatment research, drug abuse prevention, and outreach education. There must be a national policy of "treatment on demand" for drug users. An expanded program of drug treatment research must include research on cocaine as well as heroin addiction treatment. Drug abuse prevention should coordinate efforts at all levels of government as well as community and religious organizations and schools. Outreach education, which is especially difficult with drug users because drug use is illegal, will cost roughly $126.5 million a year over current funding. Outreach programs should train and utilize street outreach workers, including former addicts, and should have special focuses on adolescents, minorities, and women of childbearing age. The scope of recommendations in the area of patient care includes health care provider education, health care systems, psychosocial needs, nursing care, minorities and underserved populations, and information coordination and exchange. AIDS needs to be integrated into the educational curricula of medical and all other health professional schools. In the area of health care systems, the recommendations emphasize the need for integrated community-based services for people with HIV infection. 22 AIDS Service Delivery Demonstration projects are currently being conducted in the US, 13 funded by the US Public Health Service and 9 funded by the Robert Wood Johnson Foundation.^ieng

The AIDS epidemic among blacks and Hispanics.

Social researchers and epidemiologists, as well as their major institutions and the general public, have been slow to address the racial and ethnic aspects of the AIDS epidemic. Whether measured by categories associated with major routes of infection, age level, gender, or by diminished length of survival, blacks and Hispanics are disproportionately affected by AIDS. Education, care, and outreach efforts based upon stereotypes of gay white males will have to yield to greater attention to cultural differences--and potential strengths--within each of the special "communities at risk." Evidence indicates areas of social resistance along with unique possibilities for change.

Drug use patterns: implications for the acquired immunodeficiency syndrome.

The acquired immunodeficiency syndrome (AIDS) represents a major public health concern for society. Intravenous drug users continue to be the second largest risk group. While needle sharing has been demonstrated to play a prominent role in the higher risk experienced by illicit drug users, serious evaluations of the inherent immunologic aberrancies attendant to drug abuse have been limited. Partly responsible are the small study sample sizes and inadequate examinations of the role of particular patterns of drug abuse in the development of immunologic dysfunction. The present study represents the preliminary findings of an ongoing investigation to assess the contribution of an array of behaviors on various indicators of immunologic status.The results in 97 patients investigated demonstrate that route of administration and duration of drug use were the factors most significantly associated with a greater prevalence of immunologic abnormalities. There was also a suggestion that abnormal liver function may contribute to altered immune status.

Metabolic disposition of 2-phenylethylamine and the role of depression in methadone-dependent and detoxified patients.

We have now postulated that differences in the innate capacity of individuals to synthesize, store and utilize biogenic amines may provide the biological basis for human abuse of narcotic and other drugs, and that these drugs are used in an apparent unconscious effort to self-medicate against an inherent affective disorder. In this communication, we attempted a preliminary characterization of the narcotics withdrawal syndrome on biochemical and clinical parameters. Abstinence was found to be characterized by low urinary excretion of 2-phenylethylamine and depression. An indication for use of tricyclic drugs has been discussed.