Trauma, drugs and violence among juvenile offenders.

Trauma typically occurs when one experiences a situation where life has been threatened or lost. If the trauma is not resolved, negative residual effects may result in alcohol and drug use, involvement in violent activities as well as the development of mental health problems such as posttraumatic stress disorder (PTSD). Findings from a National Institute on Drug Abuse-funded study examining the link between trauma, drug use and violence among youth are presented. Results from interviews with 414 juveniles remanded to the Office of Children and Family Services (formerly New York State Division For Youth) for assault, sexual assault, robbery or homicide, document the trauma experienced by these youth, as well as how it correlated with their drug usage and participation in violent, illegal activities. Discussion of these findings, their implications for understanding and intervening, and recommendations for future research are highlighted.

Pathological gambling and substance misuse: a review of the literature.

This paper reviews research conducted on the link between pathological gambling and substance misuse. We first examine the phenomenon of "pathological gambling," including similarities between pathological gambling and substance misuse, instruments used to measure pathological gambling, and the prevalence of pathological gambling in the United States and internationally. We then examine research on substance misuse among pathological gamblers, pathological gambling among substance misusers, and the treatment of the pathological gambler-substance misuser. We conclude with a discussion of future research needs.

Alcohol-related homicides committed by women.

In this paper we use data derived from interviews with female homicide offenders either incarcerated or on parole in New York to examine those cases (N=35) that the respondents believed were related to their use of alcohol at the time of the homicide. We found four basic types of these homicides based on victim-offender relationships and the circumstances of the incidents. Women who committed each type of alcohol-related homicide reported a variety of motives for committing these acts. We also found that there were similarities and differences between the types, not only in terms of the kinds of motives reported but also in terms of the extent to which planning was involved. Likewise, there were similarities and differences between the different types of homicides regarding the type and amount of alcohol and other drugs used by respondents on the day of the incident, and regarding respondents' perceptions of the alcohol-relatedness of the events. The implications of our findings are discussed.

An interactive videodisc program for low back pain patients.

Decisions about back pain treatment are often made in the presence of both physician and patient uncertainty. Therefore, we developed a computerized, interactive video program to help patients make informed decisions about undergoing low back surgery. Program development was guided by the shared decision-making model, a comprehensive literature synthesis, information from administrative databases, and focus groups of patients and physicians. Core segments are tailored to each patient's age and diagnosis; and include a narrative, excerpts from patient interviews, animated graphics illustrating spinal anatomy, and tabular summaries of the benefits and risks of both surgical and non-surgical treatment. As part of a multifocal information dissemination effort, interactive videodiscs were placed in five medical facilities in two Washington State counties. Patients (N = 239) who viewed the video program completed short evaluation forms. The majority rated the video's understandability (84%) and interest (64%) as very good or excellent. Most patients felt the amount of information provided was appropriate (75%) and over half (56%) believed the discussion of surgical versus non-surgical treatment was completely balanced. Fewer patients (17%) remained undecided about therapy after watching the program than before (29%). We conclude that interactive videodisc technology offers substantial promise as a means of involving patients in their own medical decision making.

Drugs and homicide by women.

In this paper we use data derived from interviews with 215 female homicide offenders incarcerated or on parole in New York to examine their drug use prior to and at the time of the homicide, their victims' drug use, and their perceptions as to the drug-relatedness of the homicides. We found that about 7 out of 10 respondents had been regular users of some drug at some point in their lives prior to their incarceration, while over half had been addicted to a substance. Over one-third of the respondents who were present at the scene were "high" on a drug at the time, while about half of the victims of these homicides used drugs before the homicide. Almost two-thirds of the homicides committed by respondents who were present at the scene were perceived to be drug-related. Alcohol, crack, and powdered cocaine were the drugs most likely to be related to these homicides. The implications of our findings are discussed.

Pathological gamblers in methadone treatment: A comparison between men and women.

This article uses data from interviews with 462 individuals enrolled in methadone treatment programs in New York City to compare the gambling and gambling-related drug use and criminal activities of those males (N=72) and females (N=27) found to be pathological gamblers. Both the male and female pathological gamblers were and continue to be actively involved in various forms of gambling. A greater proportion of males had engaged in almost all specific types of gambling, although differences between males and females were not all statistically significant. Males and females were very similar in terms of their patterns of drug and alcohol use and the substances they used when gambling. Males and females shared some reasons but also had separate reasons as to why they used heroin when they gambled. Males especially may participate in a variety of criminal and hustling activities to have the money to be able to gamble or to pay gambling debts. The implications of this research are discussed.

Substance involvement among juvenile murderers: comparisons with older offenders based on interviews with prison inmates.

We evaluated substance involvement among incarcerated juvenile offenders convicted of murder of manslaughter. Patterns of substance involvement among juvenile offenders were compared with patterns found in older offenders. Irrespective of age group, close to one-third of all homicide perpetrators reported that they were affected by alcohol prior to the offense. In every age group, alcohol was the substance showing the highest rate of "regular" lifetime use and the highest rate of ingestion in the week preceding the homicide. In many respects, the reported substance use patterns in the 16-17-year-old age group were closer to the patterns demonstrated by the oldest (36+) age group than they were to the adjacent 18-20-year-old group. Juvenile offenders were generally less substance involved than all but the oldest group of offenders. Almost all of the juveniles who were substance involved prior to the homicide attributed the homicide to the effects of those substances. Narrative accounts suggest that substances (almost always alcohol) escalated impulsive, spontaneous violent outbursts. Implications for the interpretation of self-reports about substance use provided by murderers are also discussed.

Gambling among methadone patients.

In this paper we assess participation in various forms of gambling activities and establish the prevalence of pathological gambling in a sample of patients (N = 117) enrolled in a large methadone maintenance treatment program in New York City. Respondents were interviewed with a protocol that incorporates the South Oaks Gambling Screen. We found that gambling was a common part of the regular activities of many patients, that 15% of the patients had some problem with gambling, and that an additional 16% were probable pathological gamblers. The implications of our findings are discussed.

Drug use by homicide offenders.

This article uses data derived from interviews with 268 homicide offenders incarcerated in New York State correctional facilities to examine their drug use prior to and at the time of the homicide, and their perceptions as to whether and how the homicides were related to their drug use. Most respondents who used a drug were not hard-core users of that drug. About one in five of the respondents could be considered polydrug abusers. Thirty percent of the sample believed that the homicide was related to their drug use. Alcohol was the drug most likely to be implicated in these homicides. The implications of this research are discussed.

Low back pain hospitalization in Washington State: recent trends and geographic variations.

For several years, interest in clinical practice patterns has increased due to concerns about the costs and quality of health care. Our objectives were to examine recent trends and geographic variations in low back pain hospitalization. We analyzed data from a Washington State automated database for 1987-1992. Low back surgery rates in Washington changed little during the study years. In contrast, nonsurgical hospitalization rates fell from 15.5 to 5.1 per 10,000. The proportion of operations involving fusion decreased from 15.8% in 1987 to 11.7% in 1990, and then remained stable. During 1990, important county-to-county variations were observed in surgery rates, nonsurgical hospitalization rates, the proportion of operations involving fusion, and the percentage of surgical patients undergoing reoperation within 3 years. Wide county variations suggest that there may be overutilization or underutilization of low back pain treatments in some geographic areas. A more consistent approach to the management of back problems may benefit patients.

The role of marijuana in homicide.

In this paper we examine the relationship between marijuana use and homicide. Data derive from interviews with 268 individuals incarcerated in New York State correctional facilities for homicides that occurred in 1984. We found that in terms of lifetime use, marijuana was the most commonly used illicit drug in this sample; that about one-third of respondents who had ever used marijuana used the drug in the 24-hour period before the homicide; and that almost three-quarters of those respondents were experiencing some type of effect from the drug when the homicide occurred. A total of 18 respondents (7% of the total sample) said that the homicide was related to their marijuana use. We examine the reasons these respondents gave for this relationship and the other substances they reported using at the time of the homicide. We also demonstrate that from the perspective of a conceptual framework that specifies the ways that drugs and violence may be linked, there are various nuances in the ways that marijuana and homicide are related. We discuss the implications and limitations of using self-report data from perpetrators of violence for our understanding of the drugs-violence connection.

The link between identity and crime for the heroin addict in methadone treatment.

In this paper we examine the relationship between identity and involvement in crime for the heroin addict enrolled in methadone treatment. We hypothesize that crime during treatment is related to the maintenance of an identity appropriate to the role of the active street hustler. Data derive from interviews with addicts in methadone treatment in the New York City area. The major finding is that addicts in methadone treatment who had street-oriented identities were more likely than those with model patient-based identities to be involved in crime, particularly property crime. The limitations and implications of this research are discussed.

Race/ethnicity and gender differences in the drugs-violence relationship.

This article examines the drug relatedness of violent events reported by White, Black, and Hispanic male and female street drug users from New York City. The primary purpose is to determine if the drugs-violence relationship varies for these different populations of drug abusers. Drug relatedness is assessed according to a tripartite conceptual model of the general relationship between drugs and violence. Significant race/ethnicity and gender differences were found in regard to the number of violent events manifesting specific drug-related dimensions of violence, the drugs associated with these violent events, and the primary reasons for the occurrence of these events. The implications of these findings are discussed.

Ethnographic field stations.

Ethnographic field stations are not a substitute for traditional ethnography, because they provide an "unnatural" setting for research interaction and observation to take place. However, they do provide perhaps the optimal setting for qualitative and quantitative methodologies to be undertaken in a single research effort. In this sense, they are critically important for advancing our knowledge about drug abusers and their behaviors.

Drug relationships in violence among methadone maintenance treatment clients.

In this paper the nature, scope, and drug relatedness of violent events reported by a sample of methadone maintenance treatment clients is examined and compared with events reported by a sample of drug abusers not in treatment. The drug relatedness of events is ascertained according to a tripartite model of the drugs-violence relationship. Data derive from a study of the drugs-violence nexus among male drug users and distributors who lived in or frequented the lower east side of Manhattan. Among the major findings were that while events reported by the treatment group were less likely than those reported by the not-in-treatment group to be related to heroin, total alcohol and cocaine related dimensions of violence were similar for the two groups. There was no difference between these groups in terms of the proportion of events that were drug related or the proportion of drug related events that could be attributed to each of the three posited models of drug relatedness. The implications of our findings are discussed.

Patient-staff governance in methadone maintenance treatment: a study in participative decision making.

To help counteract some methadone patients' unfavorable attitudes to treatment and consequent antitherapeutic behaviors, a participative decision-making model was implemented in two methadone maintenance programs. Team building was used to initiate collaboration between patients and staff, resulting in the establishment of joint patient-staff governance committees. Outcomes as measured by the Client Attitudes Toward Methadone Programs (CAMP) Scale (a new instrument developed for the study) and by patients' supplementary drug use showed no statistically significant changes. The process evaluation, however, indicated that the committees had positive results in increasing communication and understanding between patients and staff, and in improving the efficiency of certain clinic procedures. The study analyzes the organizational dilemmas encountered in implementing participative decision making in drug treatment programs and gives recommendations for promoting future work in this area.

The costly bonus: cocaine related crime among methadone treatment clients.

This paper examines the relationship between the use of cocaine and criminal activity among 368 current methadone maintenance clients and 142 narcotics users not in treatment. Findings include an increase of cocaine use among methadone clients in the last ten years and the indication that cocaine plays an increasingly important role in the criminal activity of both methadone clients and users not in treatment. We find a direct relationship between escalating use of cocaine and increasing involvement in crime. The relationship is related to properties of the drug itself, its costs and the lifestyle associated with cocaine use.

"It takes your heart": the image of methadone maintenance in the addict world and its effect on recruitment into treatment.

Using data gathered on 368 current methadone clients and 142 narcotics users not in treatment in structured interviews and through ethnographic fieldwork, the study examines the image of methadone maintenance treatment in the drug-using community and discusses the effect of that image on recruitment of addicts into methadone treatment. The results indicate that the image of the methadone client as a "loser," fear of the long-term effects of methadone, and the perception of treatment as an intrusion in the user's daily life make addicts often difficult to recruit and, once in treatment, ambivalent about their participation. The image of methadone is based on both misinformation about treatment and the user's contrasting of a treatment status with the stereotypic ideal of the "righteous dope fiend." Policy implications and suggestions derived from the data are discussed.

Patterns of cocaine use among methadone clients.

This paper presents data on cocaine use and its consequences among 368 methadone-maintained clients. Data come from the Tristate Ethnographic Project (TRISEP), a study of methadone maintenance at four treatment programs in three states. Cocaine is a part of the drug use and social life of clients in methadone treatment; it is found not only among a handful of deviant clients but also among one-fifth of clients otherwise compliant with program rules. Cocaine is reported to be a high-status drug among clients, but one with potentially dangerous consequences. Cocaine is associated with increased criminal activity and exposure to violence and the addict life-style. It is reported to be a substitute high, an economic drain on the client user, and a possible route back into the life-style of addiction. Cocaine use, and the consequences stemming from that use, may affect the success or failure of treatment and, therefore, is of critical importance to the treatment community.