Factors associated with frequency of 12-Step attendance by drug abuse clients.

Comparison was made of treatment clients attending Narcotics Anonymous and/or Alcoholics Anonymous meetings less than weekly (n = 41) with treatment clients attending meetings at least three times a week (n = 30). The frequent attenders (attending an average of 30.6 meetings monthly) differed from non- and infrequent attenders (attending an average of 0.4 meetings monthly) in terms of histories of greater lifetime drug use, more arrests and treatment experiences, and an earlier age of first use of alcohol. Although the frequent attender was also older, age was not found to influence the differences found between groups. Measures of religiosity, use of community services, and support from others for recovery and psychological functioning, other than ratings of the helpfulness of 12-Step, were not differentiated among groups. The findings suggest that 12-Step groups are more likely to be selected by clients with more severe histories of drug use and criminal activity, i.e., those most in need of the support to behavior change those groups provide. The role of treatment programs in facilitating the use of 12-Step groups is discussed.

Factors associated with frequent and infrequent HIV testing.

Drug user treatment clients with 5 or more HIV tests (frequent testees N=43) and 0-2 HIV tests (infrequent testees-N = 56) were compared on demographic characteristics, risk behaviors, perceived risk of HIV infection to self, involvement with family members, and psychological functioning. Extreme groups of HIV testees did not differ on any variables other than an index of perceived vulnerability to HIV infection (e.g., " You think that you really could get AIDS"). That measure of felt vulnerability was not correlated significantly with needle or sexual risk behaviors, family involvement, psychological functioning or other measures of perceived risk. It was reasoned that, in a community in which both dangers and protective behaviors are widely understood, frequent testees experience a generalized and heightened concern unrelated to specific behaviors or characteristics.

Effectiveness of a stand-alone aftercare program for drug-involved offenders.

A study was made of the effectiveness of an aftercare program operating in conjunction with area outpatient drug free treatment programs while organizationally independent of those programs. Parolees and probationers mandated to treatment were assigned to aftercare on the basis of residence in the catchment areas in which aftercare facilities were located (n = 32) and randomly to aftercare (n = 62) and control (n = 51) when not a resident in a catchment area. No outcome differences were found between aftercare groups based on proximity to facility. At 6 months postbaseline the combined aftercare group showed significantly lower levels of criminal activity and frequent drug use as compared to controls. At 12 months postbaseline there was an attenuation of group differences with only tendencies toward significance obtained for lower levels of frequent drug use by the aftercare group. The findings are discussed in terms of the relevance of community variables for programming and for understanding long-term treatment outcomes.

A complementary perspective to primary socialization theory.

Primary socialization theory as formulated by Oetting and his associates emphasizes the transmission of societal norms during childhood and adolescence within society's three major socializing agencies: family, school, and small, intimate peer groups. The norms thus transmitted may be prosocial or deviant, with prosocial norms more likely to be transmitted through strong bonds to healthy families or schools. Personality traits and other personal characteristics influence negative outcomes, such as deviance or drug use, only to the extent that they interfere with socialization to family or school. Our own research does not address primary socialization theory directly in that we have not focused on the transmission of norms per se as central. Nevertheless, we have studied social factors, personality factors, and various psychopathologies as etiological for deviance and substance use. By and large our research has supported the hypotheses of primary socialization theory, even extending them in specific areas, such as the importance of family influences as etiological. Our work has also emphasized the significance of rebelliousness and impulse control in this regard. Like all large-scale theories which necessarily abstract from the totality and diversity of human behavior, primary socialization theory leaves some gaps requiring further elucidation. Among these is its ethnocentric and temporocentric perspective, but even within this perspective it understates the difficulties for adolescents in making a successful transition to adult social roles (Kingley Davis) and in establishing a unique identity independent of parents (Erik H. Erikson). Also, it generally ignores the salience of the youth culture as rebellious against the older generation, a particularly important characteristic of modern society. And finally, it should cover the process of "maturing out" of deviance, which perhaps results in a reaffirmation of the legitimacy of norms transmitted earlier, and it should also cover gender differences in their transmission and legitimization. Nevertheless, despite these caveats and especially because of this theory's insightfulness and path-breaking character, its hypotheses should be tested in carefully designed, large-scale studies. These studies should allow, among other factors, measurement of the effects of genetic factors on the early emergence of deviant personality attributes and of their impact on the transmission of prosocial norms. [Translations are provided in the International Abstracts Section of this issue.]

Early deviance and related risk factors in the children of narcotic addicts.

This descriptive study examines the self-reported behaviors of 285 male and female adolescent children (ages 12-17) of narcotic addicts participating in methadone maintenance programs. These children responded to an extensive 2.5-hour interview questionnaire focusing on current and past activities, including criminal activities prior to age 12. The findings revealed that early deviance, assessed by self-report measures of both severity and variety, is related to current adolescent drug and alcohol use, association with deviant peers, a negative view of home atmosphere, and psychological symptomatology. These results are contrasted with the retrospective reports of adolescent behavior obtained from adult male narcotic addicts in a prior study of vulnerability to addiction. The comparability of study results is discussed in the context of developmental risk factors, prevention and treatment strategies, and other considerations specifically related to the development of children of narcotic addicts.

Differential contributions of family and peer factors to the etiology of narcotic addiction.

This retrospective study investigated relationships among early family circumstances, peer associations, and narcotic addiction in a sample of 601 urban males. Results of logistic regression analyses indicated that the extent of deviant behavior among close friends at ages 12-14 and disruption in family structure (parental divorce/separation) prior to age 11 were significantly associated with narcotic addiction. Additional regression analyses indicated that deviant behavior among family members, as well as family disruption, experienced prior to age 11, also increased the probability of association with deviant peers and a negative home atmosphere at ages 12-14. Implications of these findings for preventive interventions and for future research are presented.

A long-term program of research on drug use and crime.

This paper describes the major findings emanating from a long-term research program conducted in Baltimore, Maryland, on the drugs-crime relationship. It is the compilation of experiences, studies, and findings related to the research career of David N. Nurco, D.S.W., and his colleagues. Covering a period of over 30 years, the program of research, described in the report from the personal perspective of Dr. Nurco, has moved from the study of the nature and correlates of narcotic drug use to the development of data-based interventions. Topics investigated involve many aspects of narcotic addiction, including the relationship between addiction status and crime rates; changes in addict behavior over time; individual variation among addicts in the type, frequency, and severity of crime; and an examination of the early adolescent behavior of males who eventually become narcotic addicts in contrast to that of their never-addicted peers. It concludes with a description of the program's ongoing research, principally dealing with community-based interventions.

The family experiences of narcotic addicts and their subsequent parenting practices.

This survey study of male and female narcotic addicts participating in methadone maintenance programs examined self-reported retrospective data on parental behavior experienced by addicts during their adolescent years. These findings were contrasted with the addicts' self-report of their current parenting practices with their own adolescent children. Results showed addicts as perceiving their mothers as significantly more functional in their parenting practices than their fathers on indices of parental involvement, attachment, and responsibility. Significant parenting differences between addicts and their parents were reported for the three indices mentioned, as well as for parent discipline and punitive actions, with the addicts rating their current parenting practices as more effective than those of their parents. Reported parenting practices were further analyzed in the context of how the ratings of parental functioning were related to problems of drug and alcohol abuse exhibited in the home. Findings are discussed in terms of the implications for prevention and treatment approaches for addicts and their children.

The early emergence of narcotic addict types.

Providing retrospective self-reports of their activities, perceptions, and experiences during their early adolescent years (ages 12 to 14), 255 narcotic addicts were classified into four distinct types on the basis of a clustering technique applied to risk factor information derived from five major descriptive domains: family; peer deviance; personal deviance; psychological status; and protective factors. Differentiations among the types largely involved the extent of early drug and other behavioral deviance and family dysfunction. The predictive utility of the typology was examined in terms of outcome over the first ten years of the addiction career, including age at first narcotic addiction, amount of time incarcerated, and percentage of time addicted while in the community. The implications of the typology for both substance abuse prevention and treatment are discussed.

Early family adversity as a precursor to narcotic addiction.

This retrospective study examined differences among three groups of urban males in the prevalence of various family risk factors occurring before age 11 and their independent contributions to subsequent deviance. The groups included: narcotic addicts; never-addicted peer controls who were associates of the addicts at age 11; and never-addicted community controls not associated with the addicts. Sixty-four percent of the addicts, compared to slightly under 40% of both control groups, reportedly experienced one or more family risk factors involving deviant behavior among family members and family disruption before age 11. While community controls differed from addicts on both family deviance and disruption in family structure, peer controls differed from addicts only on disruption of family structure. For the total sample, both family deviance and family disruption experienced before age 11 were significantly associated with crime severity level at age 11. Implications of these findings for future substance abuse research and intervention are discussed.

Perceptions of social pathology in the neighborhood and the etiology of narcotic addiction. A retrospective study.

In this study, we examined whether differential perceptions of poor urban neighborhoods may contribute to narcotic addiction in individuals who grow up in these neighborhoods. Three groups of adult males provided retrospective perceptions of the neighborhoods where they lived at ages 12 to 14. The groups, matched on neighborhood, age, and race, were: narcotic addicts, peer controls--a never-addicted control sample of age-11 associates of the addicts, and community controls--a never-addicted control sample of age-11 peers who did not associate with the addicts. Results suggested clear group differences in perceptions of neighborhood deviance, with addicts perceiving the greatest and community controls the least amount of deviance. However, within groups, subjects who lived in more socially deviant areas, as determined by official records, tended to view their neighborhoods as more deviant than did subjects who lived in less deviant neighborhoods.

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.

Drug abuse treatment in the context of correctional surveillance.

Evaluating drug abuse treatment within a correctional framework presents unique issues and challenges. Given their respective emphases on rehabilitation and incapacitation, treatment and corrections approaches to incarcerated drug abusers often differ in methods aimed at reducing deviant behavior. Although this results in problems in planning integrative drug abuse intervention strategies, the two approaches are not always incompatible. Corrections can help identify those individuals in need of treatment, and for some of these, treatment can lessen the need for incapacitation. Understandably, gaining a drug-abusing offender's cooperation in monitoring routines and engendering trust in the confidentiality of treatment conducted in criminal justice systems settings, while still ensuring public safety, are not easy tasks. Nevertheless, there are decided advantages, in terms of compliance and retention, to the increased surveillance exercised by the criminal justice system in community-based treatment efforts. In these efforts, therapy coupled with urine monitoring appears particularly promising. Along with the presentation of descriptive and preliminary outcome information, this report provides a discussion of treatment/corrections issues within the framework of an ongoing treatment evaluation study involving drug-abusing parolees in Baltimore City.

The nature and status of drug abuse treatment.

This article focuses on the effectiveness of the major drug abuse treatment modalities (methadone maintenance, therapeutic communities, outpatient drug-free programs, and short-term detoxification) in the United States. It includes findings specific to individual clients and to particular modalities. Methadone maintenance, therapeutic communities, and outpatient drug-free treatment are generally effective in reducing illicit narcotic use and the criminal activity that often accompanies narcotic addiction. These effects are usually short-term, however, and more than one treatment episode is often required for long-term recovery. Longer time in treatment, pretreatment employment, and lack of pretreatment criminality are generally associated with favorable outcome regardless of modality. Issues needing further study, such as treatment for nonnarcotic (mainly cocaine) use, matching clients to treatments, and evaluating the cumulative effects of multiple treatment episodes, are discussed, along with the authors' research on the relationship between drug abuse, crime, and treatment in Maryland.

Aftercare/relapse prevention and the self-help movement.

This paper presents the background and initial experiences of a treatment evaluation involving self-help techniques and principles as a means of providing aftercare services for stabilized methadone maintenance patients. It describes the Clinically Guided Self-Help (CGSH) model, which focuses on community reintegration and places emphasis on social network components following a period of primary treatment and demonstrated client stability. From our experiences, we have identified needs and issues that are of concern to stabilized clients, and we have distilled a paradigm for responding to these in a self-help group format. The model permits clients to establish their own agenda of interests and, guided by staff, to engage in a process geared toward maximum participation of their part. The model is clinically based in that staff and participants are engaged in working on present adjustment concerns. The overall goal of the investigators is to generate the prerequisite skills for successful adaptation of self-help concepts and techniques to the particular needs and interests of individual methadone maintenance programs and clients.

Trends in criminal activity and drug use over an addiction career.

The present study, involving 132 narcotic addicts with multiple periods of addiction, examines trends in criminal activity and drug use over successive periods of addiction and successive periods of nonaddiction during an average 15-year addiction career. Significant decreases over successive addiction periods were found for four (of five) categories of crime: theft, violence, drug distribution, and "other" crime (primarily gambling). These results appear to be accounted for by a disproportionately high level of crime during the first addiction period. Criminal activity, most notably theft and violence, decreased over successive periods of nonaddiction, though not significantly. Although more evidence is needed, a particularly large addiction vs nonaddiction disparity in crime rates for Hispanic addicts revealing a low propensity for crime when not addicted suggests that crime reduction may be a reasonable objective in the treatment of these individuals. With regard to drug use over the addiction career, the most dramatic increases over time were found for illicit methadone and cocaine. Rates of heroin and marijuana use declined. Generally, nonnarcotic drug use, other than use of cocaine and Valium, tended to decrease progressively over time regardless of addiction status. These results, along with findings relevant to the "maturing out of addiction," are discussed.

The consistency of types of criminal behavior over preaddiction, addiction, and nonaddiction status periods.

Using self-report information provided by 250 male admissions to methadone maintenance/detoxification clinics in Baltimore and New York City, separate criminal typologies were derived for prior periods of addiction and nonaddiction in the community. Although far more crime was committed during periods of addiction, comparison of the typologies indicated highly consistent individual patterns regarding the kinds of crime that were committed over periods of addiction and nonaddiction. The association between early deviant behavior and later criminal involvement over an addiction career was determined by relating preaddiction characteristics to both the addiction and nonaddiction typologies. It was found that crime patterns established before addiction, although intensified by addiction, tended to persist throughout the addiction career. Correspondence between the present typology results and those found in an earlier Baltimore sample of 354 addicts was high with respect to both the number and descriptive characteristics of the types derived. Implications of this research with regard to the early identification of the most criminally prone individuals are discussed.