John Henryism Active Coping as a Cultural Correlate of Substance Abuse Treatment Participation among African American Women

The rates of illicit drug use among African American women are increasing, yet African American women are least likely to participate in treatment for substance use disorders when compared to women of other racial groups. 

The current study examined family history of substance use, perceived family support, and John Henryism Active Coping (JHAC) as correlates to seeking treatment for substance abuse. The underlying theoretical frame of JHAC (James et al., 1983) suggests that despite limited resources and psychosocial stressors, African Americans believe that hard work and self-determination are necessary to cope with adversities. 

The current study is a secondary data analyses of 206 drug-using African American women (N=104 urban community women with no criminal justice involvement and N=102 women living in the community on supervised probation) from urban cities in a southern state. It was expected that African American women with a family history of substance abuse, higher levels of perceived family support, and more active coping skills would be more likely to have participated in substance abuse treatment. 

Step-wise logistic regression results reveal that women on probation, had children, and had a family history of substance abuse were significantly more likely to report participating in substance abuse treatment. 

Perceived family support and active coping were significant negative correlates of participating in treatment. Implication of results suggests coping with psychosocial stressors using a self-determined and persistent coping strategy may be problematic for drug-using women with limited resources.

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By:  Stevens-Watkins D1, Knighton JS2, Allen K3, Fisher S2, Crowell C2, Mahaffey C2, Leukefeld C2, Oser C2.

• 1University of Kentucky. Electronic address: d.stevenswatkins@uky.edu.
• 2University of Kentucky.
• 3Florida State University. 
• J Subst Abuse Treat. 2016 Apr;63:54-60. doi: 10.1016/j.jsat.2016.01.004. Epub 2016 Jan 15.

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Drug-Resistance Strategies of Early Adolescents in Mexico: Gender Differences in the Influence of Drug Offers and Relationship to the Offeror

To address increases in substance use among Mexican adolescents, particularly females, US prevention programs are being adapted to the Mexican cultural context. Understanding how responses to substance offers by Mexican adolescents are shaped by gender and relationships to those making offers is an important step in the adaptation process. 

Using data from Guadalajara, Mexico middle schools (N = 431), this pilot study tested for gender differences in the use of several drug resistance strategies commonly taught in US substance abuse prevention interventions. 

Results indicated that the drug-resistance strategies of Mexican early adolescents differ by gender, type of substance offered, and the youth's relationship to the offeror. Contrary to previous research on older Mexican adolescents, in this sample, females received more substance offers from age peers than males did, and employed a wider repertoire of drug-resistance strategies, including active strategies such as direct refusals. Gender differences in use of the strategies persisted after controlling for number of offers received. There were gender differences in the conditional effects of greater exposure to offers. A larger volume of alcohol and cigarette offers predicted females' use of direct strategies more strongly than for males, but less strongly than males for marijuana offers. 

Females' use of drug resistance strategies was more strongly associated with offers from family adults, siblings, and cousins, while males' use of strategies was predicted more strongly by offers from nonfamily adults. Interpretations and prevention implications are discussed in light of changing gender norms in Mexico and gendered patterns of substance use.

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By:  Kulis S1, Booth JM2, Becerra D3.

• 1 Southwest Interdisciplinary Research Center, Arizona State University , Phoenix , Arizona , USA.
• 2 School of Social Work, University of Pittsburgh , Pittsburgh , Pennsylvania , USA.
• 3 School of Social Work, Arizona State University , Phoenix , Arizona , USA.
• Subst Use Misuse. 2016 Feb 23;51(3):370-82. doi: 10.3109/10826084.2015.1110171. Epub 2016 Feb 17. 

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Ecological Momentary Assessment of Illicit Drug Use Compared to Biological and Self-Reported Methods

BACKGROUND:

The use of mHealth methods for capturing illicit drug use and associated behaviors have become more widely used in research settings, yet there is little research as to how valid these methods are compared to known measures of capturing and quantifying drug use.

OBJECTIVE:

We examined the concordance of ecological momentary assessment (EMA) of drug use to previously validated biological and audio-computer assisted self-interview (ACASI) methods.

METHODS:

The Exposure Assessment in Current Time (EXACT) study utilized EMA methods to assess drug use in real-time in participants' natural environments. Utilizing mobile devices, participants self-reported each time they used heroin or cocaine over a 4-week period. Each week, PharmChek sweat patch samples were collected for measurement of heroin and cocaine and participants answered an ACASI-based questionnaire to report behaviors and drug using events during the prior week. Reports of cocaine and heroin use captured through EMA were compared to weekly biological or self-report measures through percent agreement and concordance correlation coefficients to account for repeated measures. Correlates of discordance were obtained from logistic regression models.

RESULTS:

A total of 109 participants were a median of 48.5 years old, 90% African American, and 52% male. During 436 person-weeks of observation, we recorded 212 (49%) cocaine and 103 (24%) heroin sweat patches, 192 (44%) cocaine and 161 (37%) heroin ACASI surveys, and 163 (37%) cocaine and 145 (33%) heroin EMA reports. The percent agreement between EMA and sweat patch methods was 70% for cocaine use and 72% for heroin use, while the percent agreement between EMA and ACASI methods was 77% for cocaine use and 79% for heroin use. Misreporting of drug use by EMA compared to sweat patch and ACASI methods were different by illicit drug type.

CONCLUSIONS:

Our work demonstrates moderate to good agreement of EMA to biological and standard self-report methods in capturing illicit drug use. Limitations occur with each method and accuracy may differ by type of illicit drugs used.

Below:   Reported drug use as assessed by sweat patch (green bars), EMA (orange bars) or ACASI (blue bars) methods

Below:  Figure 2. Percent agreement by drug type and week comparing EMA, sweat patch, and ACASI methods. Panel A: Percent agreement between EMA/Sweat Patch methods (blue bars) and EMA/ACASI methods (green bars) by week for cocaine use. Panel B: Percent agreement between EMA/Sweat Patch methods (orange bars) and EMA/ACASI methods (yellow bars) by week for heroin use.

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By:  Linas BS1, Genz A, Westergaard RP, Chang LW, Bollinger RC, Latkin C, Kirk GD.

• 1Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, USA. Blinas@jhu.edu.
• JMIR Mhealth Uhealth. 2016 Mar 15;4(1):e27. doi: 10.2196/mhealth.4470. 

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Socioeconomic Marginalisation in the Structural Production of Vulnerability to Violence among People Who Use Illicit Drugs

OBJECTIVE:

Many people who use illicit drugs (PWUD) face challenges to their financial stability. Resulting activities that PWUD undertake to generate income may increase their vulnerability to violence. We therefore examined the relationship between income generation and exposure to violence across a wide range of income generating activities among HIV-positive and HIV-negative PWUD living in Vancouver, Canada.

METHODS:

Data were derived from cohorts of HIV-seropositive and HIV-seronegative PWUD (n=1876) between December 2005 and November 2012. We estimated the relationship between different types of income generation and suffering physical or sexual violence using bivariate and multivariate generalised estimating equations, as well as the characteristics of violent interactions.

RESULTS:

Exposure to violence was reported among 977 (52%) study participants over the study period. In multivariate models controlling for sociodemographic characteristics, mental health status, and drug use patterns, violence was independently and positively associated with participation in street-based income generation activities (ie, recycling, squeegeeing and panhandling), sex work, drug dealing, and theft and other acquisitive criminal activity. Engagement in regular, self-employment or temporary employment was not associated with being exposed to violence. Strangers were the most common perpetrators of violence (46.7%) and beatings the most common type of exposure (70.8%).

CONCLUSIONS:

These results suggest that economic activities expose individuals to contexts associated with social and structural vulnerability to violence. The creation of safe economic opportunities which can minimise vulnerability to violence among PWUD is therefore urgently required.

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By:  Richardson LA1, Long C2, DeBeck K3, Nguyen P4, Milloy MJ5, Wood E5, Kerr TH5.

• 1British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Department of Sociology, University of British Columbia, Vancouver, British Columbia, Canada.
• 2British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
• 3British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada School of Public Policy, Simon Fraser University, Burnaby, British Columbia, Canada.
• 4British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada.
• 5British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada Faculty of Medicine (Division of AIDS), University of British Columbia, British Columbia, Canada. 
• J Epidemiol Community Health. 2015 Jul;69(7):686-92. doi: 10.1136/jech-2014-205079. Epub 2015 Feb 17.

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Sexual Dysfunction in Men Diagnosed as Substance Use Disorder

Illicit drugs are often used as aphrodisiacs to enhance sexual performance and/or pleasure; however, the available data suggest that most illicit drugs have adverse effects on erection, sexual desire and ejaculation latency in males and that these effects are not fully understood. 

This study aimed to determine the effect of illicit drug abuse on male sexual function, based on the International Index of Erectile Function (IIEF) score. This descriptive study was conducted at the Alcohol and Substance Research Treatment and Education Center, Ankara, Turkey. Males diagnosed as substance use disorder according to DSM-IV (n = 101) were included as the patient group, and age-matched healthy male volunteers (n = 43) were included as the control group. A 30-item sociodemographic interview form developed by researchers and the 15-item IIEF were administered to all the participants. Data were compared between the patient and control groups. 

Mean IIEF score was 46.7 ± 3.3 in the patients that used alcohol, 23.7 ± 3.3 in the opioid users, 34.1 ± 5.3 in the ecstasy users, 43.5 ± 4.2 in the cannabis users and 55.3 ± 1.6 in the control group. There was not a significant difference between the alcohol and cannabis users' mean IIEF scores and that in the control group, whereas there was a significant difference between the opioid and ecstasy users' mean IIEF scores and that in the control group. All IIEF subscale scores in the opioid users were significantly lower than in the control group. IIEF erectile function, sexual desire and general satisfaction subscale scores were significantly lower in the ecstasy users than in the control group. In the alcohol users only, the IIEF general satisfaction subscale score was lower than in the control group (P < 0.005).

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By:  Kumsar NA1, Kumsar Ş2, Dilbaz N3.

• 1Sakarya University Training and Research Hospital Psychiatry Clinic, Sakarya, Turkey.
• 2Sakarya University Training and Research Hospital Urology Clinic, Sakarya, Turkey.
• 3Üsküdar University NP Hospital, Istanbul, Turkey. 
• Andrologia. 2016 Mar 4. doi: 10.1111/and.12566. 

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Demographics & Post-Mortem Toxicology Findings in Deaths among People Arrested Multiple Times for Use of Illicit Drugs and/or Impaired Driving

BACKGROUND:

Multiple arrests for use of illicit drugs and/or impaired driving strongly suggests the existence of a personality disorder and/or a substance abuse problem.

METHODS:

This retrospective study (1993-2010) used a national forensic toxicology database (TOXBASE), and we identified 3943 individuals with two or more arrests for use of illicit drugs and/or impaired driving. These individuals had subsequently died from a fatal drug poisoning or some other cause of death, such as trauma.

RESULTS:

Of the 3943 repeat offenders 1807 (46%) died from a fatal drug overdose and 2136 (54%) died from other causes (p<0.001). The repeat offenders were predominantly male (90% vs 10%) and mean age of drug poisoning deaths was 5 y younger (mean 35 y) than other causes of death (mean 40 y). Significantly more repeat offenders (46%) died from drug overdose compared with all other forensic autopsies (14%) (p<0.001). Four or more drugs were identified in femoral blood in 44% of deaths from poisoning (drug overdose) compared with 18% of deaths by other causes (p<0.001). The manner of death was considered accidental in 54% of deaths among repeat offenders compared with 28% for other suspicious deaths (p<0.001). The psychoactive substances most commonly identified in autopsy blood from repeat offenders were ethanol, morphine (from heroin), diazepam, amphetamines, cannabis, and various opioids.

CONCLUSIONS:

This study shows that people arrested multiple times for use of illicit drugs and/or impaired driving are more likely to die by accidentally overdosing with drugs. Lives might be saved if repeat offenders were sentenced to treatment and rehabilitation for their drug abuse problem instead of conventional penalties for drug-related crimes

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By:  Ahlner J1, Holmgren A2, Jones AW3.

• 1Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden; Department of Clinical Pharmacology, Faculty of Medicine, Linköping University, Linköping, Sweden.
• 2Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden.
• 3Department of Forensic Genetics and Forensic Toxicology, Swedish National Board of Forensic Medicine, Linköping, Sweden; Department of Clinical Pharmacology, Faculty of Medicine, Linköping University, Linköping, Sweden. Electronic address: wayne.jones@liu.se. 
• Forensic Sci Int. 2016 Feb 3;265:138-143. doi: 10.1016/j.forsciint.2016.01.036.

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Religiosity as a Protective Factor for Hazardous Drinking and Drug Use among Sexual Minority and Heterosexual Women

OBJECTIVE:

Despite research documenting disparities in risk for alcohol-related problems among sexual minority women, few studies explore potential protective factors within this population. This study examines how religiosity may function as a protective or risk factor for alcohol-problems or other substance use among sexual minorities compared to heterosexuals.

METHOD:

Data from 11,169 women who responded to sexual identity and sexual behavior questions from three population-based National Alcohol Survey waves (2000, 2005, 2010) were utilized for analyses of religiosity in relation to lifetime drinking, past year hazardous drinking, and past year drug use.

RESULTS:

Religiosity was significantly greater among exclusively heterosexual women compared to all sexual minority groups (lesbian, bisexual and heterosexual women who report same sex partners). Lesbians reported the lowest rates of affiliation with religions/denominations discouraging alcohol use. Past year hazardous drinking and use of any illicit drugs were significantly lower among exclusively heterosexual women compared to all sexual minority groups. High religiosity was associated with lifetime alcohol abstention and was found to be protective against hazardous drinking and drug use among both sexual minority and heterosexual women. Reporting religious norms unfavorable to drinking was protective against hazardous drinking among exclusively heterosexual women but not sexual minority women.

CONCLUSIONS:

Findings reveal the importance of considering sexual minority status in evaluation of religion or spirituality as protective among women. Future studies should explore religiosity in the context of other individual and environmental factors, such as positive identity development and community-level acceptance, which may be salient to resiliency among sexual minorities.

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By:  Drabble L1, Trocki KF2, Klinger JL3.

• 1San José State University School of Social Work, One Washington Square, San José, CA 95192-0124, United States. Electronic address: laurie.drabble@sjsu.edu.
• 2Alcohol Research Group, Public Health Institute, 6475 Christie Ave. Suite 400, Emeryville, CA 94608, United States. Electronic address: ktrocki@arg.org.
• 3Alcohol Research Group, Public Health Institute, 6475 Christie Ave. Suite 400, Emeryville, CA 94608, United States. Electronic address: jklinger@arg.org. 
• Drug Alcohol Depend. 2016 Feb 2. pii: S0376-8716(16)00050-8. doi: 10.1016/j.drugalcdep.2016.01.022.

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Death by Fentanyl - Video

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The cost of one gram of cocaine on the dark web

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Poly-Drug Trafficking: Estimating the Scale, Trends and Harms at the Australian Border

Highlights

• Poly-drug trafficking occurred in Australia in almost every year from 1999 to 2012.
• This type of drug trafficking was associated with larger quantities of drugs and more assets seized.
• Poly-drug traffickers were more involved in other forms of criminal activity.
• The findings suggest poly-drug trafficking may make traffickers more resilient and profitable.
• Future studies are needed to replicate the analysis in other countries.

Background

International drug law enforcement agencies have identified an apparent rise in high level drug traffickers choosing to deal in multiple different drugs. It is hypothesised that this may be a “deliberate modus operandi” and that the formation of “portfolios of trades” may make such traffickers more profitable, harmful and resilient to changes in drug supply and policing. In this paper we provide the first exploration of the extent, nature and harms of poly-drug trafficking at Australian borders.

Methods

Two different methods were used. First, we used Australian Federal Police (AFP) data on all commercial level seizures at the Australian border from 1999 to 2012 to identify the proportion of seizures that were poly-drug and trends over time. Second, we used unit-record data on a sub-set of 20 drug trafficking cases and linked-cases (defined as the original drug trafficking case and all other criminal cases that were connected via common offenders and/or suspects) to compare the profiles of poly-drug and mono-drug traffickers, including: the total weight and type of drug seized, the value of assets seized, and the level of involvement in other crime (such as money laundering and corruption).

Results

Between 5% and 35% of commercial importations at the Australian border involved poly-drug trafficking. Poly-drug trafficking occurred in almost every year of analysis (1999 to 2012), but it increased only slightly over time. Compared to mono-drug traffickers poly-drug traffickers were characterised by: larger quantities of drugs seized, larger networks, longer criminal histories and more involvement in other types of serious crime.

Conclusion

Some fears about poly-drug traffickers may have been overstated particularly about the inherent escalation of this form of trafficking. Nevertheless, this suggests poly-drug traffickers are likely to pose added risks to governments and law enforcement than mono-drug traffickers. They may necessitate different types of policy responses.

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By:  Dr Caitlin Elizabeth Hughes, Dr Jenny Chalmers, Dr David Anthony Bright, Dr Michael McFadden

Affiliations

Drug Policy Modelling Program, National Drug and Alcohol Research Centre, UNSW Australia, Sydney, NSW, 2052, Australia

Correspondence

Corresponding author. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia, 2052. Tel.: +61 2 9385 0132; fax: +61 2 9385 0222.

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Declining Trends in the Rates of Assisted Illicit Drug Injecting

BACKGROUND:

Assisted injecting has been associated with increased risk of blood-borne infections, overdose, and other harms among people who inject drugs (PWID), particularly women. Given the changing availability of relevant harm reduction interventions in Vancouver, Canada, in recent years, we conducted a gender-based analysis to examine changes in rates and correlates of assisted injecting over time among active PWID.

METHODS:

Using data from a prospective cohort of PWID in Vancouver, we employed gender-stratified multivariable generalized estimating equations to examine trends in assisted injecting and identify the correlates during two periods: June 2006-November 2009 and December 2009-May 2014.

RESULTS:

Among 1119 participants, 376 (33.6 %) were females. Rates of assisted injecting declined between 2006 and 2014 among males (21.9 to 13.8 %) and females (37.0 to 25.6 %). In multivariable analyses, calendar year of interview also remained independently and negatively associated with assisted injecting among males (adjusted odds ratio [AOR] 0.95, 95 % confidence interval [CI] 0.92-0.99) and females (AOR 0.93, 95 % CI 0.89-0.97). Syringe borrowing remained independently associated with assisted injecting throughout the study period among females (AOR 1.53, 95 % CI 1.10-2.11 during 2006-2009; AOR 2.15, 95 % CI 1.24-3.74 during 2009-2014) and during 2009-2014 among males (AOR 1.88, 95 % CI 1.02-3.48).

CONCLUSIONS:

Our findings demonstrate assisted injecting has significantly decreased for both males and females over the past decade. Nevertheless, rates of assisted injecting remain high, especially among women, and are associated with high-risk behavior, indicating a need to provide safer assisted injecting services to these vulnerable sub-populations of PWID.

Below:  Rates of requiring assistance with injecting among PWID by year of interview. PWID people who inject drugs

Full article at:   http://goo.gl/9NBBTM

By:  Pedersen JS1, Dong H2, Small W3,4, Wood E5,6, Nguyen P7, Kerr T8,9, Hayashi K10,11,12.

• 1Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada. jspeders@ucalgary.ca.
• 2British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. hdong@cfenet.ubc.ca.
• 3British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. wsmall@cfenet.ubc.ca.
• 4Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, 15A 1S6, Canada. wsmall@cfenet.ubc.ca.
• 5British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-ew@cfenet.ubc.ca.
• 6Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-ew@cfenet.ubc.ca.
• 7British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. pnguyen@cfenet.ubc.ca.
• 8British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-tk@cfenet.ubc.ca.
• 9Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-tk@cfenet.ubc.ca.
• 10British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. khayashi@cfenet.ubc.ca.
• 11Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. khayashi@cfenet.ubc.ca.
• 12B.C. Centre for Excellence in HIV/AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. khayashi@cfenet.ubc.ca.
• Harm Reduct J. 2016 Jan 27;13(1):2. doi: 10.1186/s12954-016-0092-3. 

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Do Police Arrestees Substitute Legal Highs for Other Drugs?

Background

Some commentators have suggested legal highs (LH) might reduce existing illegal drug use and contribute to lower drug-related harm. However, no studies have specifically investigated substitution between LH and other drugs.

Aims

To explore the extent to which police detainees substitute LH for illegal drugs

Method

A total of 848 detainees at four central police stations were interviewed about their drug and LH use. Detainees were asked what impact their LH use had on their other drug use (i.e., ‘no change’, ‘more’, ‘less’ or ‘stopped’). The detainees were placed into four groups: (i) no LH use; (ii) LH use and ‘no change’ in drug use; (iii) LH use and ‘more’ drug use; (iv) LH use and ‘less’ or ‘stopped’ drug use. Demographics and levels of drug use in the past month were compared between groups.

Results

Ninety-six percent of the LH using detainees had used synthetic cannabinoids (SC), and, of those who reported substituting a drug, 94% had substituted (natural) cannabis. Overall, 54% of the detainee sample had not used SC, 34% had used SC but not changed their cannabis use, 9% had used SC and used ‘less’ or ‘stopped’ cannabis use, and 3% had used SC and used ‘more’ cannabis. The SC users were more likely to have recently been in drug treatment. All those who used SC had higher cannabis consumption regardless of substitution behaviour. The SC users who used ‘more’ cannabis also used more methamphetamine and ecstasy.

Conclusion

Twenty percent of those who used SC and cannabis reported reducing or stopping their cannabis use while 5% increased their cannabis use, suggesting a modest overall reduction in cannabis use. Further research is required to quantify the magnitude of substitution changes, the impact on drug-related harm, and extent to which substitution occurs for other LH and other populations.

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By:  Chris Wilkins, Karl Parker, Jitesh Prasad, Sonie Jawalkar

Corresponding author. SHORE & Whariki Research Centre, College of Health, Massey University, P.O. Box 6137, Wellesley Street, Auckland, New Zealand, +64 9 366 6136. www.shore.ac.nz.

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