Sex differences in addict careers. 2. Becoming addicted.

Sex differences are examined for the period during which addiction develops after initial narcotics use. About 25% of the 546 heroin addicts studied became addicted within 1 month after initial use. More women than men fell into this category, and, on the average, women took less time to become addicted. For the majority of those studied (whose addiction occurred 1 month or longer after initial use), patterns of narcotic use during this phase of the addiction career were not significantly different by sex within Anglo or Chicano groups. Differences between female and male addicts in interpersonal relationships, other substance use, drug dealing, legal employment, and criminal behaviors parallel traditional sex role expectations.

Long-term follow-up of clients of high- and low-dose methadone programs.

A six- to seven-year follow-up of 1971-1973 admissions to three methadone hydrochloride maintenance programs was conducted. Ninety percent of those alive were interviewed. Two of the programs used a high-dose, long-retention policy, while the third used low doses and a relatively strict policy with respect to involuntary termination for program violations. Retention was much longer for the two high-dose programs, and during the six to seven-year periods from program entry to interview, the clients had significantly less arrest, incarceration, narcotic addiction, and self-reported criminal behavior than did the patients in the low-dose program. These advantages persisted until the time of interview and existed for periods with as well as without methadone. In addition, the overall social costs in the high-dose programs were substantially less than in the low-dose program.

Shutting off methadone. Costs and benefits.

We report the findings of a two-year follow-up of the 99 methadone clients enrolled in the Bakersfield, Calif, clinic when it was closed in September 1976. Because of the remote location, only 11 transferred to another clinic. A sample of 88 were selected from a continuing program for comparison. Ninety-five percent of the combined samples were interviewed. Fifty-four percent of the terminated clients became readdicted to heroin, and the arrest and incarceration rates were approximately double that for the comparison sample. The simultaneous initiation of a special police narcotic task force may have contributed to the arrest rate and limited the percent of time addicted. The net economic costs subsequent to discharge were slightly less than that for the comparison group; however, when the benefits resulting from new admissions are considered, the clinic closing represented an economic loss in addition to the detrimental effects experienced by the clients.

The effect of parole on methadone patient behavior.

A 7-year followup of three male samples of 1971-1973 methadone maintenance admissions was conducted: a random sample of 100; a sample of 136 who had a minimum of 30 months remaining on civil addict parole status at the time of methadone entry; and a matched sample of 136 not on parole. Ninety percent of those not decreased were interviewed. The overall sample spent 58% of the nonincarcerated follow-up interval on methadone. This resulted in a large decline in daily heroin use and associated criminal behavior measures. The addition of parole supervision with urine testing resulted in only marginal improvements in behavior over that attributable to maintenance alone; however, the parole status did significantly reduce the length of intervals of daily heroin use both prior and subsequent to methadone entry.

The Singapore heroin control programme.

In 1975 Singapore experienced a sudden heroin epidemic, and within two years an estimated 3 per cent of the males, 15-24, were involved. In 1977 the Government responded with an all-out enforcement strategy aimed at rapid containment. Demand reduction involved the large scale arrest of suspected users, and the immediate commitment of those with positive urines to Drug Rehabilitation Centres. The primary rehabilitation emphasis is on instilling discipline, social responsibility and sound work habits. Releases are placed on two years of compulsory supervision with a 5-day cycle for reporting and urine specimens. Sixty-three per cent show no detected drug use within the first year of supervision. Supply reduction efforts are equally strong and, while these were not immediately successful in limiting availability, heroin is currently very scarce and expensive. While there is some evidence of the substitution of cannabis, psychotropic drugs and alcohol, the number of new heroin cases is minimal. Overall, the epidemic appears to have been controlled.

Opium use in two communities of Pakistan ---a preliminary comparison of rural and urban patterns.

Interviews were conducted to clarify drug use patterns and characteristics of opium users in two communities. Because of the small number of subjects selected from only two communities, the results are not representative of the country as a whole. Nevertheless, in the city of Rawalpindi 90 users were studied and found to have a mean daily opium consumption of 0.9 grams at a cost of Rs. 1.00 ($US 0.10). Opium was taken by mouth once or twice daily. They were solitary users who first used opium as adults, most often for self-treatment of health disorders. The majority were employed males with no history of criminality. In the rural opium-producing village, 28 users were interviewed. They smoked opium three or four times a day in a social setting and reported a mean daily consumption of 11 grams. They were more likely to use the drug for its social and pleasure effects and to have addicts as close friends. The high dose was associated with adverse effects on work performance and with more severe withdrawal symptoms. The findings suggest different intervention strategies for the two populations.

A follow-up of admissions to the California Civil Addict Program.

A follow-up interview study of early admissions to the California Civil Addict Program found that those continuing in the program performed substantially better during the commitment period than did a comparable group discharged shortly after admission. To a lesser extent, the program also appeared to have had some impact subsequent to discharge. Those program discharges defined as successes tended to do relatively well until the time of interview. Comparisons under the strict (pre-1970) and more lenient regimens showed roughly comparable behavior, but the availability of methadone maintenance was also a significant factor in reducing heroin use during the latter period.