"Heavy users," "controlled users," and "quitters": understanding patterns of crack use among women in a midwestern city.

Over the past two decades, the use of crack cocaine has become an enduring part of the social ecology of many cities across the United States. The purpose of this exploratory study is to describe patterns of crack use drawing on life history interviews conducted with 18 women in Dayton, Ohio, between 1998 and 2000. Ten of the women were African American, and eight were white. Age ranged between 23 and 47. The women were at very different stages of their crack-cocaine careers. We focus on understanding the social factors, life history, and everyday circumstances that participants related to their current patterns and levels of crack use. Implications for intervention are discussed.

Psychiatric disorders and their correlates among young adult MDMA users in Ohio.

This study describes the lifetime prevalence, correlates, and age of onset of selected psychiatric disorders among a community sample of MDMA users (n = 402), aged 18 to 30, in Ohio. Participants responded to interviewer-administered questionnaires, including sections of the computerized Diagnostic Interview Schedule for DSM-IV. Fifty-five percent of the sample had at least one lifetime disorder, with major depression (35.3%) and antisocial personality disorder (ASPD) (25.4%) the most common. Proportionately more women were diagnosed with depression, generalized anxiety disorder, and posttraumatic stress disorder (PTSD), while proportionately more men were diagnosed with ASPD. Proportionately more non-White participants had attention deficit/hyperactivity disorder (AD/HD). Higher levels of education were associated with proportionately less PTSD, ASPD, and AD/HD. Higher frequencies of MDMA use were associated with proportionately more ASPD and AD/HD. Comparing the age of first MDMA use with the age of onset for selected psychiatric disorders revealed that for most participants disorders preceded use. Multivariate analysis revealed participants with more than a high school education were less likely to have experienced a lifetime disorder, while those who had used MDMA more than 50 times were more likely. Variations in the prevalence of psychiatric disorders have practical implications for drug abuse prevention and treatment programs.

Perspectives on health among adult users of illicit stimulant drugs in rural Ohio.

CONTEXT: Although the nonmedical use of stimulant drugs such as cocaine and methamphetamine is increasingly common in many rural areas of the United States, little is known about the health beliefs of people who use these drugs. PURPOSE: This research describes illicit stimulant drug users' views on health and health-related concepts that may affect their utilization of health care services. METHODS: A respondent-driven sampling plan was used to recruit 249 not-in-treatment, nonmedical stimulant drug users who were residing in 3 rural counties in west central Ohio. A structured questionnaire administered by trained interviewers was used to collect information on a range of topics, including current drug use, self-reported health status, perceived need for substance abuse treatment, and beliefs about health and health services. FINDINGS: Participants reported using a wide variety of drugs nonmedically, some by injection. Alcohol and marijuana were the most commonly used drugs in the 30 days prior to the interview. Powder cocaine was used by 72.3% of the sample, crack by 68.3%, and methamphetamine by 29.7%. Fair or poor health status was reported by 41.3% of the participants. Only 20.9% of the sample felt they needed drug abuse treatment. Less than one third of the sample reported that they would feel comfortable talking to a physician about their drug use, and 65.1% said they preferred taking care of their problems without getting professional help. CONCLUSIONS: Stimulant drug users in rural Ohio are involved with a range of substances and hold health beliefs that may impede health services utilization.

The role of African-American clergy in providing informal services to drug users in the rural South: preliminary ethnographic findings.

To date, no ethnographic studies of the role of African-American clergy in providing informal services to drug users in the rural South have been reported. We use qualitative interviews with 15 African-American ministers and 26 African-American drug users in Arkansas' Mississippi River Delta region to explore this issue. All drug users reported significant religiosity, and 9 had discussed drug problems with clergy. Every minister had provided assistance to at least one drug user or their family during the previous year, including: direct counseling; referrals to treatment programs; aiding negotiations with formal institutions; and providing for basic needs. Ministers stated that clergy are not well-prepared to address drug problems, and most acknowledged a need for professional training. They also discussed barriers to education. The findings contribute to understanding rural informal drug treatment resources. They suggest that professional treatment providers should investigate the potential benefits of improving outreach efforts to assist African-American ministers engaged in drug abuse issues.

Emergency department utilization by crack-cocaine smokers in Dayton, Ohio.

The objective of this study was to determine the frequency, principal diagnoses, and correlates of emergency department (ED) visits made by persons with a history of crack-cocaine use (n = 333) over a 3-year period. Data were collected from participant self-reports and hospital records. During the study a total of 643 ED visits were made by 211 people, ranging from 53.5 to 76.7/100 persons/year. Injury and poisoning accounted for the largest single category of ED visits (29.5%). Men had lower odds of visiting the ED (OR=0.79, 95%CI=0.62-0.99), as did participants with higher levels of education (OR=0.83, 95%CI=0.73-0.94). Number of times in drug abuse treatment (OR=1.04, 95%CI=1.01-1.09), having a chronic disease (OR=1.46, 95%CI=1.06-1.99), and higher Addiction Severity Index composite medical scores (OR=1.62, 95%CI=1.15-2.29) increased the odds of an ED visit. Factors in addition to drug use are likely to affect ED utilization rates among crack-cocaine smokers.

Prevalence and correlates of current depressive symptomatology among a community sample of MDMA users in Ohio.

Research suggests that MDMA can cause serotonin depletion as well as serotonergic neurodegradation that may result in depression among users of the drug. Several small-scale studies have used various editions of the Beck Depression Inventory (BDI) to quantify depressive symptomatology among MDMA users. This study represents the largest application of the BDI to date to explore symptoms of current depression among a community sample of young adult MDMA users (n = 402). Internal consistency testing of the BDI-II with this sample revealed Cronbach's alpha = .92. Results show a mean BDI-II score of 9.8, suggesting low levels of depressive symptomatology among study participants. Two-thirds of the sample had scores that placed them in the non-depressed/minimal depression category, while 4.7% had scores indicative of severe depression. Logistic regression analysis revealed that men were significantly less likely than women and people who used opioids were significantly more likely than non-users to have higher levels of depressive symptomatology. Higher lifetime occasions of MDMA use were marginally related to symptoms of serious depression.

From "Candy Kids" to "Chemi-Kids": a typology of young adults who attend raves in the midwestern United States.

Although young people attending raves have been most visibly associated with the use of ecstasy and other "club drugs" in the United States, there is reason to believe that they are not a homogenous group in terms of their drug use practices. The purpose of this article is to begin developing a typology of young adult ecstasy users involved in the rave subculture--known as Ravers or Party Kids. The study is based on focus groups and qualitative interviews conducted between November 2001 and September 2003 with 36 current and former ecstasy users, aged 19-31, in central Ohio, as well as participant observation conducted in raves, clubs, and bars where "club drugs" are often used. Findings suggest the existence of five main subgroups in attendance at raves--Chemi-Kids, Candy Kids, non-affiliated Party Kids, Junglists, and Old School Ravers. These groups differ in regard to musical taste, philosophy, style of clothing worn, amount of time in the rave subculture, and most importantly, patterns of drug use. For example, while the use of ecstasy appears most common among Candy Kids, Junglists tend to be more involved with the use of ketamine and methamphetamine. The use of alcohol, cocaine, marijuana, and hallucinogens is also widespread in the rave subculture. The typology can aid in the development of communication strategies necessary for successful prevention activities among some categories of ecstasy users.

Drug use practices among MDMA/ecstasy users in Ohio: a latent class analysis.

This study describes the drug use practices among 402 recent MDMA (3,4-methelyenedioxymethamphetamine) users recruited in Ohio using respondent-driven sampling. About 64% of the participants were men, 81.6% were white, and the mean age was 20.9 years. Latent class analysis was used to identify subgroups of MDMA users. Use of cocaine, opioids, amphetamines, tranquilizers, inhalants, marijuana, and hallucinogens during the previous 6 months, and days of "drunkenness" in the past 30, were used for classification. A three-class model was preferable and reflected "Limited range," "Moderate range," and "Wide range" drug use patterns. For example, the conditional probability of using opioids during the previous 6 months was .07 in Class 1, .59 in Class 2, and .88 in Class 3. Other substances followed similar patterns. Predictors of class membership were examined in a multinomial logit model in which the "Limited range" Class was treated as the reference group. Participants who were white, younger, and who reported more than 10 occasions of MDMA use were more likely to be in the "Wide range" drug use Class. Latent class analysis is a useful method to help describe and understand variability in polydrug use patterns.

Nonmedical drug use among stimulant-using adults in small towns in rural Ohio.

This study describes the drug-use practices and treatment histories of 249 not-in-treatment, drug-using individuals living in small towns in rural Ohio. Respondent-driven sampling was used to recruit participants who answered questionnaires administered by interviewers. Descriptive statistics and latent class analysis (LCA) were used to examine the data. The illicit drugs most commonly used in the 6 months before entering the study were marijuana (89.6%), cocaine hydrochloride (80.3%), and crack cocaine (76.3%). Injection drug use was not uncommon. About a third of the sample experienced drunkenness frequently. Less than 14% had been in substance abuse treatment recently. LCA revealed two groups: (1) heavy users of virtually all drug classes and (2) moderate-to-light users of fewer drug classes. White and younger people were more likely to be classified in the heavy user group. The results suggest that comprehensive substance abuse prevention and treatment programs are needed in rural communities.

Respondent-driven sampling to recruit MDMA users: a methodological assessment.

Recruiting samples that are more representative of illicit drug users is an on-going challenge in substance abuse research. Respondent-driven sampling (RDS), a new form of chain-referral sampling, is designed to eliminate the bias caused by the non-random selection of the initial recruits and reduce other sources of bias (e.g. bias due to volunteerism and masking) that are usually associated with regular chain-referral sampling. This study provides a methodological assessment of the application of RDS among young adult MDMA/ecstasy users in Ohio. The results show that the sample compositions converged to equilibrium within a limited number of recruitment waves, independent of the characteristics of the initial recruits (i.e. seeds). The sample compositions approximated the theoretical equilibrium compositions, and were not significantly different from the estimated population compositions-with the exception that White respondents were over-sampled and Black respondents were under-sampled. The effect of volunteerism and masking on the sampling process was found not to be significant. Though identifying productive seeds and improving the referral rate are significant challenges when implementing RDS, the findings demonstrate that RDS is a flexible and robust sampling method. RDS has the potential to be widely employed in studies of illicit drug-using populations.

Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care.

OBJECTIVE: The Antiretroviral Treatment Access Study (ARTAS) assessed a case management intervention to improve linkage to care for persons recently receiving an HIV diagnosis. METHODS: Participants were recently diagnosed HIV-infected persons in Atlanta, Baltimore, Los Angeles and Miami. They were randomized to either standard of care (SOC) passive referral or case management (CM) for linkage to nearby HIV clinics. The SOC arm received information about HIV and local care resources; the CM intervention arm included up to five contacts with a case manager over a 90-day period. The outcome measure was self-reported attendance at an HIV care clinic at least twice over a 12-month period. RESULTS: A higher proportion of the 136 case-managed participants than the 137 SOC participants visited an HIV clinician at least once within 6 months [78 versus 60%; adjusted relative risk (RR(adj)), 1.36; P = 0.0005) and at least twice within 12 months (64 versus 49%; RR(adj), 1.41; P = 0.006). Individuals older than 40 years, Hispanic participants, individuals enrolled within 6 months of an HIV-seropositive test result and participants without recent crack cocaine use were all significantly more likely to have made two visits to an HIV care provider. We estimate the cost of such case management to be 600-1200 US dollars per client. CONCLUSION: A brief intervention by a case manager was associated with a significantly higher rate of successful linkage to HIV care. Brief case management is an affordable and effective resource that can be offered to HIV-infected clients soon after their HIV diagnosis.

Barriers and pathways to diffusion of methamphetamine use among African Americans in the rural South: preliminary ethnographic findings.

There are no studies of African Americans methamphetamine use in the South where it is widespread among whites. We describe factors that inhibit or facilitate the diffusion of methamphetamine use among African Americans based on qualitative interviews with 86 drug users in rural Arkansas and Kentucky. Results suggest low prevalence of methamphetamine use among African Americans, and interviewees cited several barriers to its diffusion which were linked to the drug's ingredients, psychoactive and physiological effects, difficulty in accessing distribution networks, and established African-American preference for cocaine. Fourteen African Americans reported methamphetamine use and discussed pathways to it. Possible increases in African- American methamphetamine use merits further investigation.

MDMA/Ecstasy use among young people in Ohio: perceived risk and barriers to intervention.

In the past several years, the use of MDMA (Ecstasy) has increased substantially in the United States and in many countries around the world. Although this increase has been associated with the dance club and rave scenes, Ecstasy use has expanded into new settings. At the same time, the diversity of people using the drug has also grown. Given the increasing, although unclear, evidence that MDMA has the potential to cause neurotoxicity and various psychological problems under certain conditions among humans, understanding how active users perceive the risks associated with Ecstasy use can help to inform prevention and intervention approaches. Based on audiotaped focus groups and individual interviews conducted with 30 Ecstasy users in Dayton and Columbus, Ohio, this article explores these and other issues. Results demonstrate that beyond the risk of obtaining something potentially deadly instead of MDMA, most users do not associate risks of neurotoxicity or psychological problems with Ecstasy use. Active users look to harm-reduction approaches for answers to using Ecstasy safely; prevention messages like, "just say no to drugs" are largely ignored. Because Ecstasy is commonly used among small groups of friends, peer leader or other social network intervention approaches may be promising.

The prevalence of psychiatric disorder among a community sample of crack cocaine users: an exploratory study with practical implications.

The Diagnostic Interview Schedule for DSM-IV was used to assess the lifetime prevalence of psychiatric disorder among not-in-treatment crack cocaine users (N = 313). The most common dependencies involved cocaine (59.7%), alcohol (37.7%), and cannabis (12.1%). The most common nondependency disorders were antisocial personality disorder (ASPD; 24%), depression (17.8%), and posttraumatic stress disorder (PTSD; 11.8%). Comorbidity was present in 36.4% of the sample. Proportionately more white than black users were dependent on cocaine, alcohol, amphetamine, and sedative-hypnotics. More white than black users experienced ASPD, depression, PTSD, and attention deficit disorder. Proportionately fewer black users suffered comorbid disorders. Proportionately more men had ASPD, whereas more women had PTSD and phobias. Multinominal modeling revealed that black users and users with a high school education were less likely to have comorbid disorders; married users were less likely to have nondependency disorders. White crack users were more likely to have comorbidity, complicating their treatment.

Sources of information about MDMA (3,4-methylenedioxymethamphetamine): perceived accuracy, importance, and implications for prevention among young adult users.

The goal of this cross-sectional study was to assess the perceived accuracy and the importance of various sources of information about MDMA/ecstasy among young adult users. A respondent driven sampling plan was used to recruit a community sample of recent ecstasy users (n = 304), aged 18-30, in Ohio, who responded to structured interviews. Friends, drug abuse treatment programs, and physicians were perceived to be the most accurate sources of information about ecstasy by 45.7, 37.2, and 30.3% of the sample, respectively. Friends were considered the most important source of information about ecstasy (40.2%), followed by web sites like DanceSafe (16.2%), and MTV/VH1 television specials (6.9%). About half the sample used the Internet to obtain information about ecstasy, with younger and more educated participants significantly more likely to do so. Educated users were also significantly more likely to consider the Internet to be an important source of information. Web sites like DanceSafe were visited by four times as many users as government-sponsored web sites. Findings support the development of peer-oriented, network strategies to reach ecstasy users with prevention messages. Efforts to make prevention web sites more attractive should be considered.

Demographic and clinical correlates of client motivation among substance abusers.

Understanding the role of motivation in substance abusers' acceptance of treatment is critically important to improving treatment outcomes. To examine this phenomenon a cohort of substance abuse treatment clients was recruited from two treatment programs whose services are funded by a state managed care system. Motivation at treatment entry was examined. Better motivation was consistently associated with severity of substance use. Neither the coercion that accompanies legal system involvement nor self-referral was significantly related to measured levels of motivation. Motivation was not related to alcohol and drug use severity six months later. The severity associated with motivation at treatment entry was, for the most part, not related to clients' success six months later. Implications for social work practice with substance abusers are discussed.

Current physical health problems and their predictors among a community sample of crack-cocaine smokers in Ohio.

The harmful effects of nonmedical cocaine use are well documented, but the overall health of people involved with crack is less well understood. This cross-sectional study describes the nature and extent of current health problems in a community sample of 430 crack smokers in Dayton, Ohio. Two-thirds of the sample reported one or more current physical health problems. The estimated annualized incidence of acute health problems was 152.6 conditions/100 persons/year. The estimated prevalence of chronic problems ranged from a low of 30.2 conditions/1000 persons for diabetes to a high of 223.2 conditions/1000 persons for anemias. Cardiovascular problems were common. Even though the results cannot prove a cause and effect relationship between crack use and health problems, they do suggest that crack users experienced higher than usual rates of problems, when compared with data from the National Health Interview Survey. The results of a cumulative logistic regression analysis suggest that men were significantly less likely, and older users more likely, to have health problems. Neither duration of crack use nor frequency of use of any drug predicted health problems. Incorporating assessments of physical problems as well as a mechanism for their treatment into the regimen of drug abuse treatment programs should be considered.

The prevalence and correlates of depressive symptomatology among a community sample of crack-cocaine smokers.

Depression has been identified as a disorder of clinical significance among cocaine users. Even so, its prevalence in cocaine-abusing populations is uncertain. This research employed a cross-sectional design to determine the prevalence of current depressive symptomatology among a sample of 430 not-in-treatment crack-cocaine users. Depression was assessed with the Beck Depression Inventory (BDI). The mean BDI score was 19.1. Overall, 80% of the sample had BDI scores that suggested more than minimal depression, and 55% had symptoms of moderate to severe depression. The results of a cumulative logistic regression analysis showed that men, African-Americans, and individuals with some college education were less likely to be depressed. Individuals with higher Addiction Severity Index composite scores for family/social, medical, legal, and alcohol problems had a greater likelihood of reporting symptoms of depression. Frequency of cocaine use and perceived need for treatment were also positively associated with higher BDI scores. The results suggest that the prevalence of depression among crack users is higher than has been previously reported. Treatment programs should routinely screen crack-cocaine users for depression. The BDI may be a suitable tool for such efforts since it has an acceptable level of internal consistency when employed with crack users (a = 0.89).

Variability in drug use prevalence across school districts in the same locale in Ohio.

Substance use by adolescents continues to present a problem schools must address. Data from survey research can prove useful in helping schools determine the nature and extent of youth drug use. This study identified variations in drug use prevalence among ninth grade students in different school districts in the same locale in Ohio. Possible explanations for the differences were explored. Students (n = 3,016) from 12 suburban high schools anonymously completed self-report drug use questionnaires. School and community-level data were collected from other sources. Cluster analysis was used to group the school districts. ANOVA revealed statistically significant differences (P < or = 0.001) in levels of drug use by cluster. The cluster with significantly lower levels of drug use consisted of districts with at least one full-time drug abuse prevention coordinator, higher economic levels, and the highest per pupil expenditures. Drug use among youth is influenced, at least in part, by local contextual factors. Local survey data can inform local policy and programs. These findings have practical implications for policymakers, program developers, and school districts in other areas of the country.