Improving Adherence to Post-Cervical Biopsy Sexual Abstinence in Kenyan Female Sex Workers

PROBLEM:

Cervical biopsies offer a unique opportunity for studying local immune response. To investigate hormonally induced immune fluctuations in cervical tissues of Kenyan female sex workers, we improved biopsy sampling protocol safety. Here, we report on steps taken to minimize exposure to HIV following two cervical biopsies.

METHODS OF STUDY:

Women were asked to abstain from vaginal intercourse to limit HIV exposure during wound healing with financial compensation. A comprehension tool for informed consent, on-site detection of prostate-specific antigens indicating unprotected intercourse within 48 hr, and bi-weekly text message reminders were implemented.

RESULTS:

The implemented methods improved compliance with post-procedure abstinence by two times (P = 0.013). Fourteen days following a cervical biopsy, no sign of genital inflammation or change in HIV T-cell target proportion were observed.

CONCLUSIONS:

This study provides new tools for limiting HIV exposure in studies requiring biopsy sampling among women at risk of acquiring HIV.

Below:  Schematic representation of the study visits

Below:  PSA-semiquant cassette test serial dilutions to indicate PSA concentrations

Below:  Proportion of cervical HIV T-cell targets in HIV-uninfected and HIV-infected FSWs before and after biopsy sampling

Full article at:   http://goo.gl/tX6M5j

By: Lajoie J1,2,3, Boily-Larouche G1, Doering K1, Cheruiyot J4, Oyugi J1,3,4, Broliden K5, Kimani J1,3,4, Fowke KR1,2,3.

• 1Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada.
• 2Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
• 3Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya.
• 4Kenya AIDS Control Program, Nairobi, Kenya.
• 5Department of Medicine Solna, Center for Molecular Medicine, Clinic of Infectious Diseases, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
• Am J Reprod Immunol. 2016 May 24. doi: 10.1111/aji.12520. 

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The Role of Social Capital in African Americans' Attempts to Reduce and Quit Cocaine Use

BACKGROUND:

Research examining substance users' recovery has focused on individual-level outcomes while paying limited attention to the contexts within which individuals are embedded, and the social processes involved in recovery.

OBJECTIVES:

This paper examines factors underlying African American cocaine users' decisions to reduce or quit cocaine use and uses practice theory to understand how lifestyle changes and shifts in social networks facilitate access to the capital needed to change cocaine use patterns.

METHODS:

The study, an in-depth analysis of substance-use life history interviews carried out from 2010 to 2012, included 51 currently not-in-treatment African American cocaine users in the Arkansas Mississippi Delta region. A blended inductive and deductive approach to data analysis was used to examine the socio-cultural and economic processes shaping cocaine use and recovery.

RESULTS:

The majority of participants reported at least one lifetime attempt to reduce or quit cocaine use; motivations to reduce use or quit included desires to meet social role expectations, being tired of using, and incarceration. Abstinence-supporting networks, participation in conventional activities, and religious and spiritual practices afforded access to capital, facilitating cocaine use reduction and sobriety.

CONCLUSIONS:

Interventions designed to increase connection to and support from nondrug using family and friends with access to recovery capital (e.g., employment, faith community, and education) might be ideal methods to reduce substance use among minorities in low-income, resource-poor communities.

Purchase full article at:   http://goo.gl/tu8pcE

By:  Cheney AM¹, Booth BM², Borders TF³, Curran GM⁴.

¹ Center for Healthy Communities , University of California Riverside , Riverside , California , USA.

² Division of Health Services Research , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.

³ Department of Health Management and Policy , University of Kentucky , Lexington , Kentucky , USA.

⁴ Department of Pharmacy Practice , University of Arkansas for Medical Sciences , Little Rock , Arkansas , USA.

Subst Use Misuse. 2016 Apr 20:1-11.

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Has Virginity Lost Its Virtue? Relationship Stigma Associated with Being a Sexually Inexperienced Adult

While virginity prior to marriage has been historically valued, changing sociosexual scripts in the United States have made premarital sexual activity the norm for young adults, with sexual debut generally occurring in late adolescence. 

In the current research, we examined the impact of being developmentally off-time with first coitus (i.e., not yet engaging in coitus when most same-aged peers have done so). Specifically, we investigated stigma toward sexually inexperienced adults and discrimination regarding romantic relationship formation. 

Across three methodologically diverse studies we observed that sexually inexperienced adults perceived themselves to be stigmatized due to their inexperience and that sexually inexperienced adults were not highly desired as relationship partners. 

Even sexually inexperienced adults themselves did not find other inexperienced adults to be attractive relationship partners. 

Although abstaining from sexual activity may bestow some health advantages, our studies show that being a sexual "late bloomer" may result in negative interpersonal consequences such as limited opportunities for romantic relationships.

Below:  Target’s attractiveness as a function of age of target and participant.

Below:  Target’s attractiveness as a function of sexual experience of target and participant

Full article at:  http://goo.gl/lN9B5d

By:  Gesselman AN1, Webster GD2, Garcia JR3.

• 1 The Kinsey Institute , Indiana University , Bloomington.
• 2 Department of Psychology , University of Florida.
• 3 The Kinsey Institute and Department of Gender Studies , Indiana University , Bloomington.
• J Sex Res. 2016 Mar 16:1-12 

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Neurocognitive & Psychiatric Dimensions of Hot, But Not Cool, Impulsivity Predict HIV Sexual Risk Behaviors among Drug Users in Protracted Abstinence

BACKGROUND:

Impulsivity is an important risk factor for HIV risky drug and sexual behaviors. Research identifies hot (i.e. affectively-mediated, reward-based) and cool (motoric, attentional, independent of context) neurocognitive and psychiatric dimensions of impulsivity, though the impact of specific drugs of abuse on these varieties of impulsivity remains an open question.

OBJECTIVES:

The present study examined the associations of neurocognitive and psychiatric varieties of hot and cool impulsivity with measures of lifetime and recent sexual risk behaviors among users of different classes of drugs.

METHODS:

The study sample was comprised of drug users in protracted (> 1 year) abstinence: heroin mono-dependent (n = 61), amphetamine mono-dependent (n = 44), and polysubstance dependent (n = 73). Hot impulsivity was operationalized via neurocognitive tasks of reward-based decision-making and symptoms of psychopathy. Cool impulsivity was operationalized via neurocognitive tasks of response inhibition and symptoms of attention deficit/hyperactivity disorder (ADHD).

RESULTS:

Hot impulsivity was associated with sexual risk behaviors among heroin and amphetamine users in protracted abstinence, whereas cool impulsivity was not associated with sexual risk behaviors among any drug-using group. Neurocognitive hot impulsivity was associated with recent (past 30-day) sexual risk behaviors, whereas psychopathy was associated with sexual risk behaviors during more remote time-periods (past 6 month and lifetime) and mediated the association between heroin dependence and past 6-month sexual risk behaviors.

CONCLUSION:

Assessments and interventions aimed at reducing sexual risk behaviors among drug users should focus on hot neurocognitive and psychiatric dimensions of impulsivity, such as decision-making and psychopathy. Cool dimensions of impulsivity such as response inhibition and ADHD were not related to sexual risk behaviors among drug users in protracted abstinence.

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By:  Wilson MJ1, Vassileva J2.

• 1 Department of Psychology , University of Illinois at Chicago , Chicago , IL , USA.
• 2 Department of Psychiatry , Institute for Drug and Alcohol Studies, Virginia Commonwealth University School of Medicine , Richmond , VA , USA.
• Am J Drug Alcohol Abuse. 2016 Feb 2:1-11.  

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Patterns of Abstinence or Continued Drug Use among Methadone Maintenance Patients & Their Relation to Treatment Retention

The efficacy and effectiveness of methadone maintenance treatment (MMT) in the medical management of opioid addiction has been well-established, but treatment outcomes are compromised by the continued use of licit and illicit drugs during MMT. 

The present study examined the relationship between in-treatment illicit drug use and retention and dropout of 604 MMT patients in Washington, D.C. Sixty-eight percent of patients did not test positive for an unprescribed drug during the study period. 

Of patients who tested positive for an illicit drug during the baseline period, 55% tested positive for cocaine, 44% for opiates, 23% for THC, 20% for benzodiazepines, 7% for PCP, and 4% for amphetamines. Those testing positive were three times more likely to leave treatment than those who did not test positive. Testing positive for one drug doubled the rate of attrition; testing positive for multiple drugs quadrupled the risk of attrition. Non-prescribed opioid or benzodiazepine use was a predictor of MMT dropout, but prescribed opioid or benzodiazepine use was not. 

Continued illicit drug use poses significant risk for subsequent premature termination of MMT. Assertive clinical management of continued illicit drug use could provide mechanisms to enhance MMT retention and long-term recovery outcomes.

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By:   White WL1, Campbell MD, Spencer RD, Hoffman HA, Crissman B, DuPont RL.

• 1a Emeritus Senior Research Consultant, Chestnut Health Systems , Punta Gorda , FL. 

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Sexual Abstinence & Other Behaviours Immediately Following a New STI Diagnosis among STI Clinic Patients: Findings from The Safe in the City Triala

BACKGROUND:

Few studies have assessed patients' sexual behaviours during the period immediately following a new diagnosis of a curable sexually transmitted infection (STI).

METHODS:

Data were analysed from a behavioural study nested within the Safe in the City trial, which evaluated a video-based STI/HIV prevention intervention in three urban STI clinics. We studied 450 patients who reported having received a new STI diagnosis, or STI treatment, 3 months earlier. Participants reported on whether they seriously considered, attempted and succeeded in adopting seven sex-related behaviours in the interval following the diagnostic visit. We used multivariable logistic regression to identify, among men, correlates of two behaviours related to immediately reducing reinfection risk and preventing further STI transmission: sexual abstinence until participants were adequately treated and abstinence until their partners were tested for STIs.

RESULTS:

Most participants reported successfully abstaining from sex until they were adequately treated for their baseline infection (89%-90%) and from sex with potentially exposed partners until their partners were tested for HIV and other STIs (66%-70%). Among men who intended to be abstinent until they were adequately treated, those who did not discuss the risks with a partner who was possibly exposed were more likely not to be abstinent (OR, 3.7; 95% CI 1.5 to 9.0) than those who had this discussion. Similarly, among men who intended to abstain from sex with any potentially exposed partner until the partner was tested for HIV and other STIs, those who reported not discussing the risks of infecting each other with HIV/STIs were more likely to be sexually active during this period (OR, 3.5; 95% CI 1.6 to 8.1) than were those who reported this communication.

CONCLUSIONS:

Improved partner communication could facilitate an important role in the adoption of protective behaviours in the interval immediately after receiving a new STI diagnosis.

Purchase full article at:   http://goo.gl/0QbLTy

By:   Gallo MF1, Margolis AD2, Malotte CK3, Rietmeijer CA4, Klausner JD5, O'Donnell L6, Warner L7; Safe in the City Study Group.

• 1Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
• 2Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
• 3Center for Health Equity Research, California State University, Long Beach, California, USA.
• 4Rietmeijer Consulting, LLC, Denver, Colorado, USA.
• 5David Geffen School of Medicine and Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California, USA.
• 6Health and Human Development, EDC, Waltham, Massachusetts, USA.
• 7Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 

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Premarital First Births: The Influence of the Timing of Sexual Onset Versus Post-Onset Risks in the United States

Motivated by long-standing debates between abstinence proponents and sceptics, we examine how socio-economic factors influence premarital first births via: (i) age at first sexual intercourse and (ii) the risk of a premarital first birth following the onset of sexual activity. Factors associated with an earlier age at first intercourse will imply more premarital first births owing to increased exposure to risk, but many of these same factors will also be associated with higher risks of a premarital first birth following onset. Our analyses confirm previous findings that women from disadvantaged backgrounds are younger at first intercourse and have higher premarital first-birth risks than women from more advantaged backgrounds. However, differences in onset timing have a strikingly smaller influence on premarital first-birth probabilities than do differences in post-onset risks. Our findings thus suggest that premarital first births result primarily from differences in post-onset risk behaviours as opposed to differences in onset timing...

Our empirical results confirm previous findings that women from disadvantaged backgrounds initiate sexual activity earlier and have more premarital first births than those from more advantaged backgrounds. Our hazard regressions reveal strikingly different effects of covariate for the transitions to sexual activity and to a premarital first birth following onset. A standard set of sociodemographic variables have large and statistically significant associations with premarital first birth risks following onset. These same variables have smaller associations with onset risk, and only a subset are statistically significant. These findings provide empirical hints that some aspects of these two processes may be behaviorally distinct. Results from decompositions comparing median onset timing for disadvantaged and advantaged groups show that, net of controls, differences in exposure to risk have only a small influence on the probability of a premarital first birth, but that group differences in post-onset risks have a sizeable influence on the probability of a premarital first birth. This pattern—small effects of differential exposure to risk but sizeable differences in post-onset risks—holds for all the variables we examine.

Why might this be? Some insight can be gleaned by contrasting what is characteristic of sexual onset vs. a premarital first birth. A higher risk of an event usually implies more individuals experiencing the event, and our results show that this holds for premarital first births. Thus, we find that sizeable and statistically significant group differences in post-onset premarital first birth risks imply equally sizeable group differences in the probability of such births. Sexual onset is different. Premarital sexual activity was both close to universal and highly compressed in this birth cohort of women, with estimated group differences in median ages at onset of 0.7 to 9.0 months after conditioning on background controls. Taken together, near universality and compression mean that even sizeable and statistically significant group differences in onset risks imply only modest group differences in onset timing.

These results also speak, in part, to policies such as the abstinence provisions in the 1996 Personal Responsibility and Work Opportunity Reconciliation Act by providing answers to “what if” questions such as “What might be the expected consequence for premarital first births were a policy to delay onset by an amount equal to that for women from intact vs. nonintact families?” Our results suggest that for premarital first births, onset timing plays a quite minor role relative to post-onset risks. This negative finding—that onset timing plays only a minor role—is, we believe, likely to be robust against factors not observed in our data in that the class of unobservables needed to reverse this finding will be far smaller than usual.

Our results thus suggest that policies seeking to influence post-onset behaviors may be far more effective than those seeking to delay sexual onset. But our findings do not distinguish between a variety of post-onset factors, including the frequency of post-onset sexual activity; contraceptive use, knowledge, and consistency; whether pregnancies are planned or unplanned; abortion availability and utilization; and how such options are weighed when individuals confront different sets of circumstances. Our results thus speak to the question of when policies to reduce premarital first births might be most effective, but say little about which post-onset behaviors might be most effectively targeted.

Further caution is warranted in that the outcomes we analyze have been evolving rapidly. In the United States, there have been sharp declines in teen fertility and steady increases in nonmarital fertility, but only modest increases in women’s age at first sexual intercourse, with premarital sexual activity remaining nearly universal. These trends reinforce our belief that our central finding—that for the probability of a premarital first birth, onset timing plays a quite minor role relative to post-onset risks—will likely hold for more recent birth cohorts of women. What has undoubtedly changed are factors influencing post-onset risks—post-onset contraception has improved among sexually active teens and young adults, and there have been sharp increases in births to cohabiting couples. This study thus provides only a first step towards examining these and other proximate determinants, but our findings also suggest that future research on such factors may hold substantial promise for better understanding the behavioral subprocesses underlying nonmarital fertility...

Full article at:  http://goo.gl/Vu9OTZ

By:  Lawrence L. Wu, Steven P. Martin, 

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Effect of Savings-Led Economic Empowerment on HIV Preventive Practices among Orphaned Adolescents in Rural Uganda: Results from the Suubi-Maka Randomized Experiment

Improving economic resources of impoverished youth may alter intentions to engage in sexual risk behaviors by motivating positive future planning to avoid HIV risk and by altering economic contexts contributing to HIV risk. Yet, few studies have examined the effect of economic-strengthening on economic and sexual behaviors of orphaned youth, despite high poverty and high HIV infection in this population. 

Hierarchal longitudinal regressions were used to examine the effect of a savings-led economic empowerment intervention, the Suubi-Maka Project, on changes in orphaned adolescents' cash savings and attitudes toward savings and HIV-preventive practices over time. We randomized 346 Ugandan adolescents, aged 10-17 years, to either the control group receiving usual orphan care plus mentoring (n = 167) or the intervention group receiving usual orphan care plus mentoring, financial education, and matched savings accounts (n = 179). Assessments were conducted at baseline, 12, and 24 months. 

Results indicated that intervention adolescents significantly increased their cash savings over time (b = $US 12.32, ±1.12) compared to adolescents in the control group. At 24 months post-baseline, 92% of intervention adolescents had accumulated savings compared to 43% in the control group. The largest changes in savings goals were the proportion of intervention adolescents valuing saving for money to buy a home, pursue vocational training, and start a business. Intervention adolescents also had a significant relative increase over time in HIV-preventive attitudinal scores, most commonly toward perceived risk of HIV (95.8%), sexual abstinence or postponement (91.6%), and consistent condom use (93.4%). In addition, intervention adolescents had 2.017 significantly greater odds of a maximum HIV-prevention score. 

To minimize HIV risk throughout the adolescent and young adult periods, long-term strategies are needed to integrate youth economic development, including savings and income generation, with age-appropriate combination prevention interventions.

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By:  Jennings L1, Ssewamala FM2, Nabunya P3.

• 1 Department of International Health, Social and Behavioral Interventions Program , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
• 2 International Center for Child Health and Asset Development , Columbia University School of Social Work , New York , NY , USA.
• 3 School of Social Service Administration , University of Chicago , Chicago , IL , USA.

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Virgin College Students' Reasons for and Reactions to Their Abstinence from Sex: Results from a 23-Year Study at a Midwestern U.S. University

Sexual activity is normative in college. Thus, college students who are virgins are a minority; they are also an understudied group. This study extended a prior investigation (Sprecher & Regan, 1996 ) that focused on U.S. college virgins' reported reasons for and reactions to virginity. 

Data were collected from the same university over an additional 18 years and from more than 700 additional virgin students. We found differences between male and female virgins that showed that men are more reluctant virgins. For example, the only reason for being a virgin that male virgins endorsed to a greater degree than did female virgins was "my partner was not willing." Men also had more negative affective reactions to being avirgin than did women. We also found some variation in reasons for and reactions to virginity based on sociodemographic variables such as religiosity and ethnicity. A temporal analysis revealed that reasons for being a virgin that referred to a fear (e.g., fear of AIDS and other sexually transmitted infections) became less important over the 23-year period. 

We discuss our findings in the frameworks of evolutionary and social exchange theories.

Full article at: http://goo.gl/qTbNpd

By: Sprecher S1, Treger S2.

• 1a Department of Sociology and Anthropology , Illinois State University.
• 2b Department of Psychology , DePaul University. 

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Caregiver Involvement in Sexual Risk Reduction with Substance Using Juvenile Delinquents: Overview and Preliminary Outcomes of a Randomized Trial

Substance using juvenile offenders have some of the highest rates for engaging in risky sexual behaviors compared to other adolescent subgroups.

An overview of the literature on sexual risk behaviors among these youth is provided, including the empirical support for including caregivers/parents as critical partners in sexual risk reduction efforts with this population. In particular, there is (a) evidence that family factors contribute to adolescent sexual risk, (b) emerging support for caregiver focused interventions that target adolescent sexual risk, and (c) established support for caregiver focused interventions that target other complex adolescent behavior problems. In addition, this paper presents preliminary results from a randomized controlled trial evaluating a family-based intervention for substance using juvenile delinquents that combines contingency management (CM) for adolescent substance use with a novel sexual risk reduction (SRR) protocol. Results through six months post-baseline (corresponding with the end of treatment) are presented for intervention fidelity and outcomes including number of intercourse acts (Sex Acts), use of condoms or abstinence (Safe Sex), and obtaining HIV testing (Testing).

In comparison to youth focused group substance abuse treatment, the CM-SRR intervention was associated with significantly greater therapist use of SRR techniques and greater caregiver involvement in treatment sessions (supporting treatment fidelity) and significantly lower increases in Sex Acts (supporting treatment efficacy). There were also higher odds for Safe Sex and for Testing, although these results failed to reach statistical significance. Findings add to the growing literature supporting the feasibility and efficacy of caregiver focused interventions targeting sexual risk behaviors among high-risk adolescent populations.

Full article at: http://goo.gl/3ylvEF

By: Elizabeth J. Letourneau,1,* Michael R. McCart,2 Kammarauche Asuzu,1 Pia M. Mauro,1 and Ashli J. Sheidow2

²

1Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University

2Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC

1Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University

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Craving Is Associated with Amygdala Volumes in Adolescent Marijuana Users During Abstinence

Amygdala volume abnormalities have been reported in relation to craving in substance-dependent adults, but it remains unclear if these effects are seen in adolescent marijuana (MJ) users, particularly following abstinence.

The aim of this study was to examine the relationship between amygdala volume and craving during 28 days of abstinence in adolescent MJ users.

MJ-using adolescents (n = 22) aged 16–19 were recruited as part of a larger study on brain function in teen drug users. Craving measures were collected twice per week throughout a 28-day abstinence period. High-resolution anatomical magnetic resonance imaging data were collected at the end of the 28 days of confirmed abstinence. Left and right amygdala volumes were traced by hand (ICC>0.86). Composite scores for self-reported craving and withdrawal symptoms throughout the 28-day abstinence period were calculated to provide four composite measures of total craving, mood, sleep, and somatic complaints.

Results revealed that greater craving during abstinence was significantly associated with smaller left and right amygdala volumes, after controlling for age and gender. Other measures of withdrawal, including mood, somatic complaints and sleep problems, were not related to amygdala morphometry.

These results are consistent with previous findings in adult alcohol-and cocaine-dependent individuals, who demonstrated a relationship between reduced amygdala volumes and increased craving. 

Future studies are needed to determine if these brain-behavior relationships are attributable to MJ use or predate the onset of substance use.

Below:  Scatterplot of craving symptom scores predicting right and left amygdala to intracranial volume ratios in 22 abstinent adolescent marijuana users

Below:  Average craving rating for chronic marijuana users across nine time-points collected over 28 days of abstinence

Read more at: http://ht.ly/SshDS 

By: Claudia B. Padula, PhD,1 Tim McQueeny, MA,2 Krista M. Lisdahl, PhD,3 Jenessa S. Price, PhD,4 and Susan F. Tapert, PhD5

1Veterans Affairs Palo Alto Health Care System, Sierra Pacific Mental Illness Research Education and Clinical Center and Stanford University, Department of Psychiatry and Behavioral Sciences, Palo Alto, CA

2University of Cincinnati, Department of Psychology, Cincinnati, OH

3University of Wisconsin-Milwaukee, Department of Psychology, Milwaukee, WI

4McLean Hospital – Harvard Medical School, Department of Psychiatry, Belmont, MA

5Veterans Affairs San Diego Healthcare System and University of California, San Diego, Department of Psychiatry, La Jolla, CA

Measuring Outcome in the Treatment of Cocaine Dependence

Below:  Patterns of Cocaine Use from Baseline to Month 18 Among Patients Identified as “Continued Users” (N=215) During Months 1 to 4 of Active Treatment. Note: The proportion of patients who used cocaine at each assessment is evaluated on a compositive cocaine use measure that combined information from self-report, urines, and the Addiction Severity Index cocaine use item.

Below:  Patterns of Cocaine Use from Baseline to Month 18 Among Patients Identified as “Slower Improvers” (N=90) During Months 1 to 4 of Active Treatment

Below: Patterns of Cocaine Use from Baseline to Month 18 Among Patients Identified as “Immediate Abstainers” (N=125) During Months 1 to 4 of Active Treatment

Measures of during-treatment reduction in use were moderately correlated with drug and cocaine use measures 12 months, but showed non-significant or small correlations with measures of functioning at 12 months. Highest correlations were evident for abstinence measures (maximum consecutive days abstinence and completely abstinent) during treatment in relation to sustained (3 month) abstinence at 12 months. Latent class analysis of patterns of change over time revealed that most patients initially (months 1 to 4 of treatment) either became abstinent immediately or continued to use every month. Over the couse of follow-up, patients either maintained abstinence or used regularly – intermittent use was less common.

There were generally small associations between various measures of cocaine use and longer-term clinical benefits, other than abstinence was associated with continued abstinence. No one method of measuring outcome of treatment of cocaine dependence appears superior to others.

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By: Paul Crits-Christoph,a Robert Gallop,b Mary Beth Connolly Gibbons,a Jaclyn S. Sadicario,a and George Woodya

^b

^b

aDepartment of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA
bApplied Statistics Program, Department of Mathematics, West Chester University, 25 University Avenue, West Chester, PA 19383, USA

aDepartment of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA

aDepartment of Psychiatry, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA