Drug dependence scale in the Millon Clinical Multiaxial inventory.

The Million Clinical Multiaxial Inventory (MCMI versions I, II, and III) includes a scale to assess drug use problems, Scale T-Drug Dependence. Detailed drug use data from a sample of 659 known drug users along with MCMI-II results were examined to determine the operating characteristics of the MCMI-II drug dependence scale. Operating characteristics, sensitivity, specificity, positive predictive power, negative predictive power, and overall diagnostic power were calculated for base rate cutoffs and for the number of prototypic items endorsed to determine the diagnostic efficiency of Scale T-Drug Dependence in identifying regular drug users. Prototypic item cutoffs provided higher levels of diagnostic and positive predictive power than did the standard base rate cutoffs.

Profiles of clients in government-funded drug user treatment settings.

This report describes profiles of 535 clients who participated in a federally-funded drug user treatment research demonstration program in Washington, D.C. The majority of clients were African-Americans (92%) and single (60%). These profiles were created to determine which types of clients were enrolled in which modalities and whether there were differences between clients placed in outpatient or residential programs after stratification by primary drug problem: heroin or cocaine. Localities which are involved in developing client placement criteria and/or managed care guidelines for treatment programs may find these profiles helpful in planning to address the multiple needs of drug users.

Psychosocial treatments for cocaine abuse. 12-month treatment outcomes.

The 12-month posttreatment outcome results for a randomized clinical trial that tested the effectiveness of various combinations of 4-month psychosocial treatment interventions are reported for 184 clients who used cocaine. Clients primarily used crack (93%), and the majority were African American (95%). Overall, clients exhibited substantial pre-post treatment gains: reduced regular cocaine use, reduced other drug use, reduced regular alcohol use, and reduced involvement in illegal activities. Logistic regression models produced significant odds ratios showing that those who used cocaine regularly during the year after treatment were more likely to have attended fewer treatment sessions, to be female, to be less educated, to have been regular cocaine users prior to treatment, and to have spent fewer days incarcerated during the 12-months after treatment. It was concluded that treatment positively impacted posttreatment gains, and it was suggested that selective tailoring of additional treatment services may produce additional treatment gains.

Relationship between drug preference and indicators of psychiatric impairment.

This study was conducted to investigate the relationship between the indicators of psychiatric disorders of individuals and their choice of either cocaine or heroin, drugs that differ markedly in their pharmacological effects. Cocaine acts as an intense stimulant, and heroin has profound sedative effects. This investigation examined the relationship between preference for heroin or cocaine and indicators of psychiatric impairment. Data from 282 subjects were grouped according to drug of choice and analyzed. Ninety-three percent of these subjects were African-American, 32% were female, and the average age was 34. Univariate and multivariate statistical analyses, such as discriminant analyses, were used to determine group differences. The results are evaluated and interpreted in relation to both the current empirical findings and to the hypotheses and theories postulated as a result of earlier clinical observations on drug of choice and psychopathology. Discriminant analysis yielded an overall correct classification rate of 75%. The discriminant function suggests that members in the cocaine drug of choice group as contrasted with members in the heroin preference group can be characterized as more socially inhibited and more self-defeating after adjusting for differences in age, duration of use of illicit substances, and marital status. Those who favored cocaine as contrasted with those who favored heroin were more likely to have never married, be younger, and have used illicit substances for a shorter period of time.

Individual Assessment Profile (IAP). Standardizing the assessment of substance abusers.

The Individual Assessment Profile (IAP), a structured intake assessment interview instrument in the public domain, was designed for use with substance-abusing populations in several large-scale and community-based drug abuse treatment projects underway in the United States. Background information is presented, including the content-based item-selection process used during the pretests and pilot testing. Validity and test-retest reliability data are also presented, along with descriptions of studies using the IAP for clinical, research, and management information purposes. Concordance between biological measures and self-reports of recent drug use, measures of internal consistency, and test-retest reliability coefficients were generally good. A computer-assisted personal interview version of the IAP and an automated reporting system were subsequently developed for clinical and management reporting purposes and used in a large-scale research demonstration project. An intreatment version of the IAP has also been developed to collect information on treatment services provided and to assess changes in behaviors after 3, 6, and 12 months of treatment. These instruments (the IAP intake and intreatment interviews) provide a comprehensive system to assess substance-abusing populations.

Comparative cocaine abuse treatment strategies: enhancing client retention and treatment exposure.

The current investigation explores the clinical utility in providing a series of enhanced clinical services to a sample of 303 cocaine-abusing clients (primarily crack smokers) relative to a standard group therapy treatment program. In addition to examining the comparative impact of six varying psychosocial treatment approaches for cocaine abuse on client retention and treatment exposure rates, an additional emphasis has been to examine the ability of fixed and dynamic client variables in predicting client outcome in this regard. No fixed (e.g., sex, income, marital status, income level, or employment status) or dynamic (e.g., recent alcohol use, antisocial personality disorder diagnoses, or motivational variables) client characteristics were useful in predicting client retention or treatment exposure rates. Program characteristics, however, or the frequency, intensity, and/or type of treatment services offered, were related to client retention and treatment exposure. Treatment exposure and retention were significantly enhanced by providing clients with more frequent and intensive group therapy, or by adding individual treatment services to a standard group therapy treatment regimen. With a population such as cocaine abusers, who typically have an extremely high treatment dropout rate, an obvious strategy is to focus efforts on engaging and retaining clients in treatment, and maximizing levels of treatment exposure. The current findings suggest that one successful approach towards enhancing psychosocial treatments for cocaine abuse is to increase the frequency, intensity, and/or types of treatment services offered.

Sex differences in self-report of physical health by injection drug users.

Through heterosexual contact, injection drug users (IDUs) put others at risk of contracting Human Immunodeficiency Virus (HIV) disease. Self-report of health was compared among IDUs in Laredo, Texas, San Diego, California, and San Juan, Puerto Rico, and in a subsample which contained HIV positive subjects from these cities. These data were compared with similar National Opinion Research Center data and indicated that IDUs do not report their health to be different from that of the general public. Previous research has reported sex differences in morbidity and mortality in the non-IDU population. This study found sex differences in perception of health by IDUs in Laredo and San Diego.

Sexual risk behavior among injection drug-using human immunodeficiency virus positive clients.

This study examined sexual risk behavior of 154 seropositive Hispanic injection drug-using clients who were a subsample of a larger study. The results revealed that while nearly 71% followed safe sex practices at a 6-month follow-up, the other 29% were following risky sexual behaviors. Among males who were 25 years of age or younger, slightly over 58% were practicing unsafe sex. Among females, those in the 31-35 age group were all following risky sexual behaviors. Generally, those who lived with their sexual partners, females, and younger clients tended to follow risky sexual behaviors. These findings are very significant in the light of the heterosexual transmission of Human Immunodeficiency Virus (HIV). Educational and case management programs are needed to provide such clients with an understanding of the possibility of HIV transmission to their sexual partners and to their children in case of pregnancies.

Findings from the Horizontes Acquired Immune Deficiency Syndrome Education project: the impact of indigenous outreach workers as change agents for injection drug users.

A human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) intervention using indigenous outreach workers was implemented with Hispanic injection drug users (IDUs) and their sexual partners in three locations: Laredo, Texas; San Diego, California; and San Juan, Puerto Rico. A total of 2,169 subjects were contacted, given health education, HIV antibody testing, and follow-up counseling. This article reports on the 1,616 IDUs (75%) who completed the initial and follow-up interviews. The results indicated significant increases in health knowledge on AIDS, decreases in needle risk drug taking behaviors, some decreases in sex risk behaviors, and more realistic perceptions of personal AIDS risk. Using multivariate analyses, gender (male) and increasing age (older than age 25 years) were the strongest predictors of behavior change. Surprisingly, the identification of a positive HIV serostatus was not a significant predictor of behavior change. Although intended as a comparison study between contrasting levels of intervention, logistical and administrative problems undermined the use of a true quasi-experimental design. Nonetheless, the results from this research suggest that the use of indigenous outreach workers is an effective means of combatting the spread of HIV in this difficult to reach population. Some programmatic recommendations are provided for future efforts of this kind, particularly in relation to role conflicts experienced by outreach workers.

An inventory to measure contact with medical health care professionals.

The Koman Contact With Medical Health Care Professionals Inventory is described. It was devised to measure total contact including office visits and telephone calls with medical health care professionals as one component of self-report health-related questions. Use of this inventory indicated that women utilize medical health care professionals more than men.