Dana E. Hunt

Gambling among Methadone Patients

In this paper we assess participation in various forms of gambling activities and establish the prevalence of pathological gambling in a sample of patients (N = 117) enrolled in a large methadone maintenance treatment program in New York City. Respondents were interviewed with a protocol that incorporates the South Oaks Gambling Screen. We found that gambling was a common part of the regular activities of many patients, that 15% of the patients had some problem with gambling, and that an additional 16% were probable pathological gamblers. The implications of our findings are discussed.

Patterns of Cocaine Use among Methadone Clients

This paper presents data on cocaine use and its consequences among 368 methadone-maintained clients. Data come from the Tristate Ethnographic Project (TRISEP), a study of methadone maintenance at four treatment programs in three states. Cocaine is a part of the drug use and social life of clients in methadone treatment; it is found not only among a handful of deviant clients but also among one-fifth of clients otherwise compliant with program rules. Cocaine is reported to be a high-status drug among clients, but one with potentially dangerous consequences. Cocaine is associated with increased criminal activity and exposure to violence and the addict life-style. It is reported to be a substitute high, an economic drain on the client user, and a possible route back into the life-style of addiction. Cocaine use, and the consequences stemming from that use, may affect the success or failure of treatment and, therefore, is of critical importance to the treatment community.

UNCOPE: A Brief Substance Dependence Screen for Use with Arrestees

A national multi-site monitoring system for determining prevalence of alcohol and drug involvement in arrestees sought to refine the screening for substance dependence among persons arrested and incarcerated in local jails. Fifteen items were selected from the content of existing alcohol and drug abuse screens. These items were evaluated against a detailed diagnostic interview covering criteria of the DSM-IV. A total of 310 prisoners incarcerated within the previous 48 hours were recruited as subjects. Almost 65% of the subjects had a positive diagnosis of dependence for one or more substances. A six-item screen identified by the acronym UNCOPE emerged as the best set of screening items for identifying dependence on alcohol and/or drugs. The UNCOPE had sensitivity of 88% and specificity of 83% for the sample as a whole. It performed similarly irrespective of gender or ethnicity and appears to have potential utility in a wide range of populations.

Patterns of Criminal Activity among Methadone Clients and Current Narcotics Users Not in Treatment

Much prior research has looked at the changes in criminal activity of narcotics addicts when they enter methadone maintenance treatment programs. Because of the special nature of methadone, a drug which produces a cross-tolerance to other opiates in the user making continued heroin use difficult, the methadone treatment population has also been examined for answers to basic questions about the relationship between drug use and crime. This paper draws on interviews and ethnographic data collection with 368 methadone maintenance clients and 142 narcotics users not currently in treatment to explore the relationship between drug use and criminal activity. Results indicate that methadone clients are not only less involved in criminal activity than users not in treatment, but also among those clients who do continue criminal activity, there is less involvement in more serious crimes such as robbery, burglary, or dealing heroin and cocaine. The differences between those in treatment and those not in treatment are not a function of a lower level or criminal activity prior to treatment, but relate to being in treatment. Methadone clients who continue to commit crime are either clients continuing to use heroin and/or cocaine or clients for whom crime is an income or an income supplement.

Alcohol use and abuse: heavy drinking among methadone clients.

This paper discusses alcohol use among methadone maintenance clients and narcotics users not in treatment. The data are derived from the Tri-State Ethnographic Project, a study of four methadone maintenance clinics in three states. Data indicate that methadone clients consume more alcohol than comparable age groups in the general population, but not more alcohol than narcotics users not in treatment. For a portion of the treatment population, however, heavy drinking presents significant problems. Sixteen percent of the treatment sample were found to be abusive pattern drinkers; that is, persons who report not only drinking heavily but also spending a great deal of time hanging out on the street, getting high, and consuming many other additional drugs. These abusive pattern drinkers reflect a pattern of polydrug use which began in their early teens and report multiple unsuccessful treatment attempts.

An Instant Shot of “Aah”: Cocaine Use Among Methadone Clients

†This research was supported by a grant from the National Institute on Drug Abuse (1 H81 DA 02300-01) to Narcotic and Drug Research, Inc., New York, and the Division of Substance Abuse Services, New York State. Opinions expressed in this article do not necessarily reflect the policy of NIDA or the Division of Substance Abuse Services.

Methadone Diversion: A New Look

This paper examines the nature and extent of methadone diversion, drawing on interviews and ethnographic data collection with methadone maintenance clients and current narcotics users not in treatment. We explore the social as well as the economic role of diversion in the drug world and find that it is a more complex phenomenon than the simple monetary transaction it is often portrayed to be. Our data indicate that selling or sharing of methadone by methadone clients, though still uncommon, is the primary source of street methadone. We find that removal of take-home dosages from the client population would have deleterious effects on retaining in treatment many otherwise compliant clients and would have minimal effect on diversion. A flexible and differentiated approach might help to reduce diversion while a singular, punitive administrative approach is unlikely to do more than simply contain the situation on the surface and drive it underground.

Pathological gamblers in methadone treatment: A comparison between men and women.

This article uses data from interviews with 462 individuals enrolled in methadone treatment programs in New York City to compare the gambling and gambling-related drug use and criminal activities of those males (N=72) and females (N=27) found to be pathological gamblers. Both the male and female pathological gamblers were and continue to be actively involved in various forms of gambling. A greater proportion of males had engaged in almost all specific types of gambling, although differences between males and females were not all statistically significant. Males and females were very similar in terms of their patterns of drug and alcohol use and the substances they used when gambling. Males and females shared some reasons but also had separate reasons as to why they used heroin when they gambled. Males especially may participate in a variety of criminal and hustling activities to have the money to be able to gamble or to pay gambling debts. The implications of this research are discussed.

The Connections Between Substance Dependence, Offense Type, and Offense Severity

The link between drug use and crime has been broadly described, but little detail is known about the contributions of alcohol and drug dependence to different types of offending. Data were drawn from the 2010 Arrestee Drug Abuse Monitoring II (ADAM II) program to examine the relationships between dependence, offense type, and severity among recent male arrestees (N = 3,006). A substantial proportion (ranging from 15% to 39%) of arrestees across all offense types and severity levels endorsed drug-dependent items. Smaller proportions (between 5% and 16%) of arrestees endorsed alcohol-dependent items. Drug dependence was associated with higher odds of receiving felony charges and higher probability of being charged with a substance-related offense. Alcohol dependence was associated with lower odds of felony charges, but greater probability of being charged with a violent offense. Assessment and treatment provisions need to be systematically implemented to reduce these types of offenses.

Telling the Truth About Drug Use How Much Does It Matter

The gap between what people admit about their behavior and what is actually true has plagued social scientists and survey methodologists for decades. This gap would not matter if it did not play an important role in estimation of the extent of the consumption of illegal drugs and/or changing trends in illegal use, both data critical for developing public policy and determining the effects of intervention programming and policy changes. The Arrestee Drug Abuse Monitoring (ADAM) survey matches anonymous self-reported interview information to a urine test for nine drugs in a probability-based sample of adult male arrestees conducted within 48 hr of their arrest. Using data from 2000-2003 and 2007-2011 collected in 10 U.S. counties, this article looks at how the gap between the truth and reality in self-report varies by the drug reported, by the region of the country, over time, and by characteristics of the user, and discusses the relevance of these findings to policy.