Presenting problems of substance abusers in treatment: implications for service delivery and attrition.

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.

High-risk behaviors for transmission of syphilis and human immunodeficiency virus among crack cocaine-using women. A case study from the Midwest.

This study examines the drug use patterns, sexual practices, condom use, knowledge and attitudes toward sexually transmitted diseases (STD)s and AIDS, and seroprevalence of human immunodeficiency virus (HIV) and syphilis among women who use crack in Dayton, Ohio. In 1990, two indigenous outreach workers recruited 150 participants who were not in drug treatment programs, who were 18 years of age or older, and had used crack in the previous 3 months. Structured interviews revealed that 90% of the sample were black, 78% used crack "daily," 93% had multiple sexual partners, and 49% had 10 or more male sexual partners in the last 3 months. A majority (67%) of the women felt they were in need of drug treatment. No reactive syphilis serologies were detected in 138 serum samples; 2 women (1.4%) were HIV seropositive. This case study provides insight into the high-risk sexual behaviors of crack users in a medium-sized, midwestern city. The study demonstrates the value of indigenous outreach prevention and STD screening initiatives in reaching this segment of our society, which has a high risk of acquiring STDs.

Exchanging sex for crack-cocaine: a comparison of women from rural and urban communities.

Studies of the HIV risks of crack-cocaine using women have focused on those living in the inner city, urban areas of the country. However, reports indicate that the rates of syphilis and HIV infection have shown greater increases in rural areas than in urban ones. This paper reports the findings of a comparative study of 60 female crack-cocaine users, 25 from rural southeast Georgia and 35 from Miami, Florida, to determine their drug using and sexual practices, as well as their knowledge about AIDS and HIV transmission. Their patterns of initial and continuous drug use were similar, as were their sexual practices. However, the Miami women were more likely to have had a greater number of sexual partners than the Georgia women. Both groups were knowledgeable about AIDS and the transmission of HIV, yet all participated in activities that put them at high risk for HIV infection and transmission. Some 12 percent of the 60 respondents reported testing positive for HIV. The study suggests that at least within these populations, there are few differences between rural and urban crack using women in terms of their crack use, sexual practices, and potential for HIV infection and transmission.

HIV infection and risk behaviors among intravenous drug users in low seroprevalence areas in the Midwest.

We studied behavioral factors that place intravenous drug users at risk for the acquisition and transmission of the human immunodeficiency virus (HIV) in a sample of 855 individuals not in drug treatment, living in central and southwestern Ohio. The HIV seropositivity rate for the sample was 1.5%. Three factors were significantly related to HIV infection: homeless shelter residence (odds ratio [OR] = 7.7, 95% confidence interval (CI) = 3.0-20.0), travel to northeastern HIV hyperendemic areas (OR = 5.2, 95% CI = 1.8-15.4), and recent male homosexual or bisexual behavior (OR = 11.2, 95% CI = 2.9-43.9).

Predictor variables of adolescent drinking.

A survey was conducted to determine which socio-cultural and psychosocial variables had the ability to discriminate adolescent drinking behavior at four different age groups. A total of 3,017 sixth, eighth, tenth, and twelfth grade students in the Southeast participated in the study. Those students who were classified as moderate to heavy drinkers were more likely to be White, male, had higher scores on an alcohol knowledge test, were more liberal in their attitudes toward alcohol use, drank at an earlier age, and had friends who drank. When all predictor variables were considered as a group, the two most predominant characteristics for explaining student drinking behavior were peer behavior and attitudes toward alcohol. Parental drinking behaviors were significant for the younger students, but compared to the peer and attitude variables, their contributions to group separation were minor. Efforts to curb moderate or heavy drinking among adolescents should focus on the peer influences of adolescent drinking and related risk factors associated with problem drinking.

Profile of an adolescent problem drinker.

A study was conducted to determine what sociocultural and demographic variables can be used to identify potential problem drinkers among adolescents in middle school and high school. Three thousand seventeen students were administered an in-depth questionnaire regarding their knowledge, attitudes, and behavior toward the use of alcohol. Twenty schools in six school districts in the two-state area of Georgia and South Carolina participated in the study. A number of analyses indicated that the student heavy drinker was most typically male, white, and between the ages of 14 and 15 years with an above average knowledge about alcohol and liberal attitudes toward alcohol use. The adolescent heavy drinker is more likely to have parents and best friends who are heavy drinkers, to have had his first encounter with alcohol at an early age, to drink with friends his own age, and to feel that almost all of his friends drink. Results of this study can be used by family physicians in the management of potential alcohol abusers. Early recognition and intervention by the family physician may help to reduce the alarming number of adolescents who are struggling with problems related to alcohol.

A profile and prediction study of problem drinking among first-year medical students.

A study was conducted to determine to what extent first-year medical students are engaged in alcohol use and if specific sociocultural and self-reported behavior characteristics can be used to develop a profile and to predict potential problem drinkers. Four geographically distinct medical schools participated in the study, with a total of 341 students completing a questionnaire regarding current alcohol use and other risk-taking behaviors. Chi-square analyses, analyses of variance, and a discriminant analysis indicated that there is a high occurrence of frequent and heavy drinking among first-year medical students. Potential problem drinkers appear to be White males whose fathers are heavy drinkers. They seem prone to a nonpassive life-style and attend church infrequently. Prevention/intervention programs in medical school can utilize these results to identify high-risk individuals early in their medical career and target them for counseling.

Alcohol and adolescents. Knowledge, attitudes, and behavior.

Students (n = 3017) from the 6th, 8th, 10th, and 12th grades in six school districts throughout Georgia and South Carolina completed a questionnaire to determine their knowledge, attitudes, and behavior regarding alcohol use. Results suggest that knowledge, attitudes, and behavior are significantly correlated. Two distinct attitudes were discovered: acceptable use of alcohol and unacceptable uses of alcohol, and these interacted with knowledge and behavior in different ways. Students who reported school as their major source of information about alcohol were more knowledgeable and had the most conservative attitudes toward unacceptable use of alcohol (p less than 0.001). White students scored higher on the knowledge test and had more liberal attitudes than minority students (p less than 0.001). Females were more conservative than males (p 0.001), and older students had more liberal attitudes (p less than 0.001). Our results suggest that efforts to educate youth about alcohol should incorporate acceptable uses as well as the negative aspects of drinking.