David A. Wasserman

Patterns and Predictors of Alcohol Use in Male and Female Urban Police Officers

In a large sample of urban police officers, 18.1% of males and 15.9% of females reported experiencing adverse consequences from alcohol use and 7.8% of the sample met criteria for lifetime alcohol abuse or dependence. Female officers had patterns of alcohol use similar to male officers and substantially more than females in the general population. Critical incident exposure and posttraumatic stress disorder (PTSD) symptoms were not associated with level of alcohol use. Greater psychiatric symptoms were related to adverse consequences from alcohol use. There was a noteworthy gender by work stress interaction: greater routine work stress related to lower current alcohol use in female officers. 

Detection of Illicit Opioid and Cocaine Use in Methadone Maintenance Treatment

Urine toxicology is the gold standard for estimating the prevalence of illicit drug use in methadone maintenance treatment (MMT). The frequency of urine testing may be crucial for establishing accurate use rates. Infrequent testing may lead programs to undercount active drug users and to target interventions too narrowly. This study compared results from frequent testing (twice per week) versus less frequent testing of 166 patients at four MMT programs. As part of a research study, all patients were tested by research staff for opioid and cocaine use twice per week on a fixed schedule for 10 weeks. During the same period, the four MMT programs tested the patients according to their standard protocols, approximately weekly (one program) or every 3-4 weeks (three programs). The research tests identified approximately 50% more illicit opioid users and 70% more cocaine users than the less frequent program tests. Patients who were drug positive according to the research tests but drug negative according to the program tests tended to be infrequent users. The data suggest that standard urine testing practices in MMT programs may result in underestimates of the prevalence of opioid and cocaine use. More frequent testing, even for time-limited periods, should produce more accurate depictions of drug use prevalence and help indicate the direction of interventions.

Psychometric evaluation of the Quality of Life Interview, Brief Version, in injection drug users.

The authors investigated the psychometric characteristics of the Quality of Life Interview, Brief Version (QOLI-BV; A. F. Lehman, 1995) in 126 injection drug users recruited for a clinical trial. The QOLI-BV assesses global and domain-specific quality of life. Participants completed the instrument at baseline and 3 and 6 months later. Most scales showed acceptable internal consistency. Convergent and discriminant validity were demonstrated through correlations with the SF-36, the Beck Depression Inventory, and demographic variables. Scale means rose over time, suggesting that the QOLI-BV is sensitive to change. Unexpectedly, lower baseline QOLI-BV scores predicted opiate abstinence at follow-up. The QOLI-BV appears to be an acceptable quality-of-life measure for use in clinical trials of opioid dependence treatments.

Relapse to Cocaine Use

Publisher Summary Relapse denotes at least one episode of drug use following a period of no use. Some authors differentiate a lapse from a relapse. Usually, a lapse is defined as a brief episode of drug use quickly followed by a resumption of abstinence. Definitions of relapse are also complicated by emerging definitions of positive cocaine treatment outcomes. Development of definitions of cocaine relapse is hampered by the lack of descriptive data on relapse episodes. There are several models of drug use and relapse, including the conditioning models, many of which have a neurobiological underpinning. Numerous biological, psychological, social, and situational factors may influence relapse to cocaine. Research on most of these factors is still sparse. Epidemiological studies suggest a high prevalence of psychiatric disorders among cocaine patients compared to the general population. This chapter reiterates that most drug abuse treatments, both psychological and pharmacological, strive to help patients achieve abstinence. Relapse Prevention (RP) is a relatively recent technology for promoting abstinence from drugs of abuse as well as cessation of nondrug problematic behaviors.