Anthony Tommasello

Effectiveness of outreach to homeless substance abusers

Substance abuse is a frequent and complicating feature of homelessness. Barriers to service access have prevented homeless individuals from receiving substance abuse care. Outreach to homeless persons is a mechanism for identifying homeless substance abusers and engaging them in treatment. This study describes a program of substance abuse treatment conducted by a medical care provider for homeless persons in Baltimore, Maryland and compares characteristics of outreach recipients to those of walk-in clients. The study also examines the differences in drug abuse pathology and selected treatment outcomes among homeless and non-homeless clients and the extent to which homeless persons are unidentified in the drug abuse treatment reporting system of the state. Homelessness is about 5.5 times more prevalent in the clientele of drug abuse treatment programs than is reflected in the statewide substance abuse management information system of Maryland. Composite scores on the Addiction Severity Index for homeless individuals are significantly higher (reflecting more serious problems) on every measure in the interview, compared to non-homeless individuals. Except for residential treatment settings, homeless persons demonstrate a shorter length-of-stay in substance abuse treatment than housed clients. Our outreach effort successfully located its targets. Outreach clients reported significantly higher levels of substance abuse than walk-in clients. In addition 42.3% of outreach contacts became service recipients. These findings indicate that outreach can be a successful method of targeting and engaging a segment of homeless substance abusers who are otherwise difficult to engage in treatment.

Clonidine use and abuse among methadone program applicants and patients

Forty-eight consecutive applicants and 30 known clonidine-abusing methadone patients at three methadone treatment programs were surveyed regarding their use of clonidine. Two distinct patterns of clonidine use emerged. Of 22 applicants who took clonidine illicitly, 15 used it primarily to decrease opioid withdrawal, as well as for its sedating effect. Applicants mostly obtained it from physicians, used an average dose of 0.37 mg at a time, and about one third believed clonidine to be addictive. In contrast, clonidine-using patients took clonidine primarily for its psychoactive effects, including the interaction with methadone, in addition to decreasing opioid withdrawal. Patients obtained clonidine frequently on the street and from family or friends, but less from physicians. The average reported dose for patients was 0.6 mg. The vast majority of these patients felt clonidine was addictive. Our findings, when coupled with the risk inherent in clonidine overdose, suggest that further research into the identification and treatment of clonidine abuse among methadone patients is warranted.

Medical Services Provided to 2,394 Patients at Methadone Programs in Three States

The type and amount of medical services provided to 2,394 patients in methadone maintenance programs in three states was studied. Data were obtained from on-site confidential interviews with the entire treatment staff at seven programs. It was found that there were marked differences in the number and type of medical staff. Thus, there was ten times more coverage by physicians at some programs than others. In general, there were notable differences in the treatment staff available. Comparable variations among the programs were found with respect to the actual provision of medical services. Thus, the number of patients seen by the medical staff on a weekly basis varied from a high of 185 patients to a low of 36 patients. Similarly, the proportion of each programs patients receiving medical treatment per week varied from 53 to 14 percent. Reasons for those variations in medical services are considered.

Outpatient Benzodiazepine Detoxification Procedure for Methadone Patients

Benzodiazepines are used by a substantial minority of opioid addicts on methadone maintenance. Alprazolam, now the most widely prescribed benzodiazepine in the United States, appears to have supplanted diazepam as the benzodiazepine drug of choice in this population. Its greater addiction liability, shorter half-life, and more intense withdrawal symptoms make addiction to alprazolam more likely and its management in methadone patients more complicated. This article describes a slow outpatient tapered reduction procedure that was utilized to detoxify benzodiazepine dependent methadone patients seen over a two-year period. The reduction procedure was offered to 22 opioid addicts on methadone maintenance who were regularly ingesting low to moderate amounts of benzodiazepines, primarily alprazolam. Of the 22 patients, 4 patients refused outpatient detoxification, and 18 were started on a reduction procedure. Twelve patients completed the detoxification procedure which averaged 7.8 weeks. Comparisons are made between completers and non-completers and essential design features of the procedure are discussed.

Psychosocial correlates of drug use among Latino youth leading autonomous lives.

Drug use and psychosocial profile of young Central American immigrants in Washington, D.C., were compared to the National Household Survey of Latinos. The immigrants showed: (1) more exposure to alcohol and illicit drugs; (2) interrelated marijuana, cocaine, PCP, and hallucinogenic drug use; and (3) a positive association between psychosocial competency and ratio of perceived supports/threats. Drug involvement intensity was negatively associated with psychosocial competence and positively with instrumental drug use, CAGE scores, and problems. Crisis scores and drug involvement were related only in the high support/threat group. Supportive environments may be more effective than threats in preventing drug use.

Computer-Automated Reprint Requests

The current explosion of information in the medical sciences makes it difficult and time consuming to keep on top of the literature within ones discipline. Computers can eliminate the drudgery of weekly reviews of Current Contents® and writing out reprint request postcards by hand. Computer-based article retrieval is actually less costly than manual methods. This paper presents a strategy for using existing computer database services to collect citations of interest and automatically generate reprint request postcards. The system developed by the Office of Substance Abuse Studies (OSAS) indexes the citations with user-defined key words, and stores them in a private database for easy location and retrieval. This method requires modem or computer access to a commercial citation database, a word processing program, and a database program. It does not require purchase of any particular software package or preprinted forms of any kind. With an understanding of this method, an article retrieval system can be set up using any full-featured word processing and database programs. Using conservative estimates, the total cost per article of this system was compared with the total cost of photocopying per article at the Universitys library. Library cost per article was

The reduction of intravenous heroin use, non-opiate abuse and crime during methadone maintenance treatment: further findings

1.41, compared to .85 for computer retrieval. An estimated 60% savings rate is achieved using computer-automated reprint requests.