Hilary James Liberty

Supporting the habit: income generation activities of frequent crack users compared with frequent users of other hard drugs.

US Federal sentencing guidelines punish possession of crack cocaine very differently from powder cocaine, based partially upon the assumption that crack users engage more frequently in criminal behavior to pay for their habit. This article analyzed frequent users (those who have used at least 15 of the last 30 days) of crack with subgroups of less frequent hard drug users in terms of various income generation activities reported during the past 30 days. The sample consists of 602 African-Americans who were current (in past 30 days) users or sellers of cocaine powder, crack, and heroin. They were carefully recruited from randomly selected blocks in the Central Harlem area of New York City and interviewed extensively in 1998-1999. Their IGAs were classified into six categories. Compared with not-frequent (less than 15 days) hard drug users, frequent crack and multiple hard drug users were equally likely to be involved in drug distribution activities, but were significantly less likely to have full-time jobs, part-time jobs, aid to families with dependent children or welfare support. They had much higher odds ratios for non-drug related illegal (theft mainly) income generation activities and sex work among women. Often, gender and birth cohort variables had higher odds ratios with specific income generation activities than the frequent use of the primary drug(s). This evidence suggests that very frequent crack users have been stigmatized by, are largely excluded from, and perform very marginal economic roles in the legal economic system (jobs and welfare), the illegal economic system, and even in the hard drug distribution system.

Drug Use by Homicide Offenders

This article uses data derived from interviews with 268 homicide offenders incarcerated in New York State correctional facilities to examine their drug use prior to and at the time of the homicide, and their perceptions as to whether and how the homicides were related to their drug use. Most respondents who used a drug were not hard-core users of that drug. About one in five of the respondents could be considered polydrug abusers. Thirty percent of the sample believed that the homicide was related to their drug use. Alcohol was the drug most likely to be implicated in these homicides. The implications of this research are discussed.

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.

Unmet Need for Treatment of Substance Use Disorders and Serious Psychological Distress Among Veterans: A Nationwide Analysis Using the NSDUH

Many veterans returning from Afghanistan and Iraq experience serious mental health (MH) concerns including substance use disorders (SUD), post-traumatic stress disorder, traumatic brain injury, depression, or serious psychological distress (SPD). This article uses data from the 2004 to 2010 National Survey on Drug Use and Health to examine the prevalence of unmet MH needs among veterans aged 21 to 34 in the general population. The prevalence of untreated SUD among veterans (16%) was twice as high as untreated SPD (8%), a nonspecific diagnosis of serious MH concerns. Surprisingly, similar rates of untreated SUD and SPD were found among a nonveteran comparison sample matched on gender and age. These findings suggest that reducing unmet need for MH treatment for veterans in the general population may require improving outreach to all Americans and creating greater acceptance for MH treatment. The need for further analyses of reasons for not obtaining treatment is discussed.

Dynamic Recovery: Comparative Study of Therapeutic Communities in Homeless Shelters for Men

The Dynamic Recovery Project examined relationships between homelessness, substance abuse, and recovery, and investigated the effectiveness of the therapeutic community (TC) treatment model in helping homeless drug users move toward stable, drug-free living. This project compared two short-term TCs that were situated within pre-existing homeless shelters with a clean and sober dormitory. In a separate condition, peer counselors and staff were provided additional training in TC philosophy and practice to reduce program dropout. Dramatic decreases in drug and alcohol use at follow-up were verified by urinalysis. Length of time in treatment rather than specific program accounted for decreased alcohol and drug use. Important decreases in posttreatment criminality for both treatment programs were documented. The comparison group, starting with low criminality, experienced smaller, nonsignificant decreases unrelated to type of program or time in treatment. Major declines in Beck Depression Scores were evident, but were unrelated to groups or time in treatment. Training had no measurable impact on client retention or outcomes and there were no significant differences between TCs and the comparison group on posttreatment drug use, criminality, or depression. This report documents that short-term therapeutic communities can be successfully implemented in public shelters for homeless men.

Detecting crack and other cocaine use with fastpatches

A continuing social problem is presented by the large number of individuals who use crack cocaine. Recent research has identified unique pyrolysis products of crack or burned cocaine as anhydroecgonine methylester (AEME) and ecgonidine (ECD) through gas chromatography/mass spectrometry (GC/MS) that allow for the detection of crack use distinct from other cocaine use. However, there have been no large‐scale studies to document the presence and prevalence of these substances in sweat. A new sweat‐testing appliance called a fastpatch was developed for this study. Through mild heating and a slightly larger collection pad than a standard Pharmchek ™ sweat patch, this product shows the promise of shorter required wear periods than standard sweat patches, and possibly longer time‐periods of detected use. One hundred and eighty subjects wore 360 fastpatch prototypes (one per hand). However, subsequent analysis determined that only one patch per subject was needed to obtain sufficient sweat eluate for GC/MS. Cocaine use was detected in sweat of 92% of subjects through GC/MS, comparing favorably with 91% with EMIT urinalysis. Crack metabolites were detected in 54% of subjects. The predominant analyte detected was AEME. There were no significant differences in detection rates between 15‐, 20‐ and 30‐minute wear periods. All wear periods detected both cocaine use in general and crack use successfully. These results suggest that crack use as distinct from other cocaine use can be detected in sweat and that fastpatches are a promising new way to detect drugs of abuse.

The Variation in Arrestees' Disclosure of Recent Drug Use across Locations, Drugs, and Demographic Characteristics

This study provides a comprehensive multivariate analysis of drug use disclosure among arrestees interviewed between 2000 and 2001 at 37 sites across the U.S. served by the Arrestee Drug Abuse Monitoring (ADAM) Program. Rates varied widely by drug and across sites. The marijuana disclosure rate varied from 68% in Fort Lauderdale to 93% in Spokane. The cocaine/crack disclosure rate varied from 28% in Chicago to 70% in Kansas City. Moreover, covariates of disclosure differed across drugs. This wide variation in disclosure suggests extreme caution be used when comparing self-reports of prevalence across drugs, locations, and individual characteristics – certainly at least for arrestees.

Risks for HIV infection among users and sellers of crack, powder cocaine and heroin in central Harlem: Implications for interventions

Abstract This article investigates behaviours that may be associated HIV infection among users and sellers of crack, powder cocaine and heroin in central Harlem. Chain referral sampling and other strategies were combined to acquire a sample of 637 (Users = 546; Sellers = 91) who provided urine specimens that were tested for the presence of drugs and HIV. Nearly a quarter (23.9%) of all respondents were HIV positive. Drug injectors were more than 2.5 times more likely to have HIV infections than other respondents (OR = 2.66; 95% CI 1.66–4.26). Those involved in frauds/cons were almost as likely to be HIV positive (OR = 2.58; 95% CI 1.64–4.06). Those with a marital status of being separated, divorced or widowed were twice as likely to be HIV infected (OR 2.16; 95% CI 1.43–3.25). Respondents currently having multiple partner sex (OR = 1.66; 95% CI 1.1–2.51) or who were female (OR = 1.66; 95% CI 1.12–2.45) were more than 1.5 times more likely to be HIV positive. Thus, controlling for lifetime drug injection and current multiple partner sex, other factors, such as participating in frauds/cons, as well as relationship status and being female, were also associated with HIV infection.

Inaccuracies in Self-Reports and Urinalysis Tests: Impacts on Monitoring Marijuana Use Trends among Arrestees

Measured trends in drug use can potentially reflect changes in drug use, changes in the accuracy of the measurement instrument, or both. This paper compares marijuana use trends from 1987 to 2001 using self-report and urinalysis data from arrestees interviewed at 23 sites served by the Arrestee Drug Abuse Monitoring (ADAM) Program. Overall, 60% of the variation in reported use reflected changes in detected use. Most notably, reported and detected use suggested different dynamics to the increase in marijuana use during the 1990s. The growth in detected use started later, increased more, and lasted longer. Several factors appear to have clearly contributed to this divergence between the measures: the percentage of marijuana users that disclosed their activity changed over time, the accuracy of ADAMs urinalysis test increased with time, and the percentage of infrequent users changed over time (urinalysis tests are less likely to detect infrequent users). The paper concludes with recommendations for the careful analysis of marijuana use trends using self-report data, biological data, or both. Trends in cocaine, crack, heroin, and methamphetamine are also considered.

Characteristics of Hidden Status among Users of Crack, Powder Cocaine, and Heroin in Central Harlem

This article analyzes hidden status among crack, powder cocaine, and heroin users and sellers, in contrast to more accessible users/sellers. Several sampling strategies acquired 657 users (N=559) and sellers (N=98). Indicators of hidden status were those who (1) paid rent in full in the last 30 days, (2) used nonstreet drug procurement, (3) had legal jobs, and (4) earned