Variation in youthful risks of progression from alcohol and tobacco to marijuana and to hard drugs across generations.

Objectives: Much research has documented that youthful substance use typically follows a sequence starting with use of alcohol or tobacco or both and potentially proceeding to marijuana and then hard drug use. This study explicitly examined the probabilities of progression through each stage and their covariates.

Methods: A secondary analysis of data from the National Household Survey on Drug Abuse (1979-1997) was conducted with particular sensitivity to the nature of substance use progression, sampling procedures, and reliability of self-report data.

Therapeutic communities. Enhancing retention in treatment using "Senior Professor" staff.

Evaluation research documents a firm relationship between retention and treatment outcomes among substance abusers in therapeutic communities (TCs). However, most admissions leave treatment prematurely, particularly in the first months after admission. This paper reports findings from a controlled study that assessed the efficacy of an intervention to reduce early dropout in a residential TC.

Leaving methadone treatment: lessons learned, lessons forgotten, lessons ignored.

Despite the demonstrated benefits of methadone maintenance, there have been concerns about the ethics, necessity and expense of maintaining addicts on methadone indefinitely. The inability of many patients to achieve normative levels of psychosocial functioning with methadone, combined with widely held attitudes favoring drug abstinence over replacement medication, has led to attempts to promote time-limited methadone treatment. This paper reviews the published research literature on post-discharge outcomes of patients exiting from extended methadone detoxification, "abstinence-oriented" methadone programs, and regular methadone maintenance programs.

An alternative program for methadone maintenance dropouts: description and preliminary data.

Time in drug treatment has been shown to be one of the best predictors of post-treatment success. Since as many as half of the enrollees leave methadone treatment during the first year, the project described in this article was designed to test the effectiveness of an alternative program for individuals who have recently dropped out of methadone maintenance treatment. The goals of this "Alternative Program" are to help participants re-connect with formal drug treatment and other community or medical programs, reduce their HIV risk behavior, decrease or eliminate drug use, join self-help groups, and obtain entitlements.

Measuring client clinical progress in therapeutic community treatment. The therapeutic community Client Assessment Inventory, Client Assessment Summary, and Staff Assessment Summary.

The therapeutic community (TC) Client Assessment Inventory (CAI), Client Assessment Summary (CAS), and Staff Assessment Summary (SAS) are instruments developed from a comprehensive theory of TC treatment and recovery. They measure client self-report and staff evaluation of client progress along 14 domains of behavior, attitude, and cognitive change. The present article reports on the development of the instruments and findings from an analysis of data on 346 clients in TC treatment; including scale properties and cross-sectional client differences by treatment tenure.

Dead tired and bone weary: Grandmothers as caregivers in drug affected inner city households.

At a time of unprecedented growth in the numbers of custodial grandparents, this case study of Emma's household articulates the stresses inherent to the lives of many grandparents whose own children's lives are governed by drug use and addiction. We contrast normative expectations traditionally integral to the culture of extended families with the counternormative demands that drug use imposes on households. This highlights the untenable nature of caregiving for Emma and countless others of her generation.

Equity in the financing of social security for health in Chile.

Real public health spending has more than doubled since 1990, raising concerns about the targeting of public subsidies. This study examined the degree of equity in the financing of FONASA, the public insurer, which in 1995 covered 8.6 million beneficiaries, or 62% of the country's population.

Recovery challenges among dually diagnosed individuals.

Although there is a high prevalence of co-occurring mental and substance abuse disorders, and empirical evidence shows the need to integrate multiple treatment services for dually diagnosed persons, service integration is relatively recent and often poorly implemented. Moreover, service providers and clients often hold divergent views of what constitute appropriate and feasible treatment goals. This paper presents interview data from an urban sample of dually diagnosed members of self-help groups (N = 310) concerning the challenges confronting them in their recovery, and discusses the interrelations of these issues.

On Correcting Biases in Self-Reports of Age at First Substance Use with Repeated Cross-Section Analysis.

Household survey data on age at first use of alcohol, tobacco, marijuana, and hard drugs can be biased due to sample selection and inaccurate recall. One potential concern is attrition, whereby individuals who get involved with substance use at an early age become increasingly less likely to be surveyed in successive years. A comparison of data from the National Household Survey on Drug Abuse (NHSDA) with data from a longitudinal study suggested that attrition might have caused substantially less bias than did "forward telescoping," the inflating of age at first use over time.

Changes in HIV risk behaviors among cocaine-using methadone patients.

Cocaine use among methadone patients has been related to higher prevalence of HIV risk behaviors. HIV risk behaviors for cocaine-using patients in methadone treatment (N = 207) were examined for two time periods, the current month in-treatment and the month previous to treatment admission. All needle-related and sexually-related risk behaviors (except for needle hygiene) significantly and substantially declined over the average two year time interval.

Pre- and in-treatment predictors of retention in methadone treatment using survival analysis.

Aims: To determine the effects of pre- and in-treatment variables on patient retention in methadone treatment.

Design: Retrospective longitudinal study of an admission cohort sample for up to 3 years of treatment or until discharge.

Setting: Six methadone maintenance programs operating 15 clinics in New York City.

Gender differences and other factors associated with HIV testing in a national sample of active drug injectors.

Gender, health, HIV risk, and demographic factors were examined with chi-square and logistic regression analyses to assess which of these factors are most predictive of active injection drug users' (IDUs') getting tested for HIV. Analyses were based on 36,898 IDUs recruited to participate in a nationwide multisite HIV prevention project. Women IDUs were recently tested (prior 6 months) more than men IDUs.