James A. Hall

Effects of frequent marijuana use on brain tissue volume and composition

To investigate CNS effects of frequent marijuana use, brain tissue volume and composition were measured using magnetic resonance imaging (MRI) in 18 current, frequent, young adult marijuana users and 13 comparable, non-using controls. Automated image analysis techniques were used to measure global and regional brain volumes, including, for most regions, separate measures of gray and white matter. The marijuana users showed no evidence of cerebral atrophy or global or regional changes in tissue volumes. Volumes of ventricular CSF were not higher in marijuana users than controls, but were, in fact, lower. There were no clinically significant abnormalities in any subjects MRI. Sex differences were detected in several global volume measures.

Treatment of methamphetamine abuse: research findings and clinical directions

Over the past few years, methamphetamine has appeared in mass quantities, in part, because of the ease and cost efficiency of manufacturing. With this increase in availability, the use of methamphetamine has increased significantly. The purpose of this article is to describe the existing treatment options for methamphetamine abuse and provide recommendations for practitioners and researchers. Methamphetamine abuse adversely impacts physical functioning, brain functioning and cognition, social support and social networks, and behavioral functioning. Negative consequences have also been documented to the environment and communities. In the studies reviewed on effective treatments, interventions consisted of aversion therapy, medication, psychosocial treatment, and case management. Each specific treatment is described as connected with an overall drug treatment program. If methamphetamine abuse continues to increase and the consequences continue to be so devastating, researchers and clinicians could advance the field by particular focus on the treatment of this type of drug use.

Effects of frequent marijuana use on memory-related regional cerebral blood flow.

It is uncertain whether frequent marijuana use adversely affects human brain function. Using positron emission tomography (PET), memory-related regional cerebral blood flow was compared in frequent marijuana users and nonusing control subjects after 26+ h of monitored abstention. Memory-related blood flow in marijuana users, relative to control subjects, showed decreases in prefrontal cortex, increases in memory-relevant regions of cerebellum, and altered lateralization in hippocampus. Marijuana users differed most in brain activity related to episodic memory encoding. In learning a word list to criterion over multiple trials, marijuana users, relative to control subjects, required means of 2.7 more presentations during initial learning and 3.1 more presentations during subsequent relearning. In single-trial recall, marijuana users appeared to rely more on short-term memory, recalling 23% more than control subjects from the end of a list, but 19% less from the middle. These findings indicate altered memory-related brain function in marijuana users.

Extramammary pacet's disease of the vulva: A clinicopathologic study of 13 cases

The clinicopathologic findings of 13 patients having extramammary Pagets disease of the vulva are discussed with emphasis on its histogenesis and biological behavior. For the purpose of study and assessment of prognosis, these cases were divided into two groups, those with an underlying invasive cutaneous adnexal adenocarcinoma, and those lacking an underlying invasive lesion. Four cases contained invasive cutaneous adnexal adenocarcinoma; in one of these the invasion was superficial. Three of the cases with an invasive lesion and three other cases showed in situ adenocarcinoma of sweat glands. Surgical treatment is mandatory for both groups of patients. The prognosis was excellent for the patients having Pagets disease without an underlying invasive carcinoma. From the literature, the prognosis of those with an underlying invasive carcinoma of the vulva appears to be less favorable. Multiple surgical excisions may be required to control the recurrences and metastases. A frequent association with other internal malignancy was observed. In four cases, second malignancies were found. Of special interest was the demonstration in one case of columns of neoplastic cells extending from involved sweat glands to the surface epithelium via the intradermal sweat duct. Our study leads us to support the concept that the Pagets cells, in a number of cases, are derived from an underlying carcinoma in situ of sweat gland origin.

Cerebellar hypoactivity in frequent marijuana users

It is uncertain whether frequent marijuana use adversely affects human brain function. Using PET, regional cerebral blood flow was compared in frequent marijuana users and comparable, non-using controls after at least 26 h of monitored abstention by all subjects. Marijuana users showed substantially lower brain blood flow than controls in a large region of posterior cerebellum, indicating altered brain function in frequent marijuana users. A cerebellar locus of some chronic and acute effects of marijuana is plausible, e.g. the cerebellum has been linked to an internal timing system, and alterations of time sense are common following marijuana smoking.

The family relations, peer relations, and criminal activities of Caucasian and Hispanic-American gang members

Juvenile gang members present serious problems to society, yet few empirical studies have examined their criminal activity, family relations, and peer relations in comparison with other highly antisocial youths. In a 2 (Gang Membership) × 2 (Ethnicity: Hispanic-American vs. Caucasian) design, 131 incarcerated male juvenile offenders were administered a battery assessing criminal activity, family relations, and peer relations. Results demonstrated (a) higher rates of criminal behavior (i.e., general delinquency, index offenses, school delinquency) among gang members than among offenders who did not belong to gangs, (b) higher rates of general delinquency and home delinquency among Caucasian offenders than among Hispanic-American offenders, and (c) greater aggression and less social maturity in the peer relations of gang members than in the peer relations of offenders who did not belong to gangs. In addition, gang membership mediated sociocultural differences in hard drug use. Findings are integrated with the extant literature.

Evaluating the impact of case management dosage.

BackgroundBecause of the broad range of activities involved and high variance in clients’ needs, it is challenging to measure the actual dose of case management in order to assess quality and manage outcomes. ObjectiveThe purpose of this research is to evaluate the impact of intervention dosage on client outcomes in different case management models within substance abuse treatment. MethodA descriptive and repeated measures analysis from a clinical trials data set measured the dosage of case management and evaluated impact on client outcomes. A sample of 598 clients from a substance abuse treatment facility was randomized into one of four groups, assessed at intake and then followed for 1 year. Three groups received a form of case management as an intervention (n = 437), and all clients received drug treatment. ResultsClients who engaged (actively participated) in case management were less likely to have legal and family issues but more likely to have a chronic medical condition at baseline. Dosage factors differed significantly across treatment conditions. In general, dose was significantly related to outcomes in the legal and family domains. ConclusionsAlthough complex, case management intervention dosage can be measured using the model presented. Dosage determination aids cost-effective initiatives. Further research is needed to specify intervention protocols.

Comparative Efficacy of Family and Group Treatment for Adolescent Substance Abuse

Due to the continuing prevalence of adolescent substance abuse, promising treatment models need to be developed and evaluated. Thus, the purpose of this study was to evaluate the efficacy of two promising models, Strengths Oriented Family Therapy (SOFT) and The Seven Challenges(R) (7C). Adolescents who qualified for outpatient treatment and agreed to participate in our study were randomly assigned to one of the two treatments and assessed at 3 and 6-months following baseline. Using a two-part, random-effects model, we examined the odds of achieving abstinence or full symptom remission between treatments and over time. For those not achieving full abstinence or full problem remission, we investigated whether frequency of use or symptom severity were reduced at follow-up. Participants in both SOFT and 7C demonstrated significant reductions in substance use and related problems, but treatments did not differ at 3 and 6 months following baseline. Overall, treatment services were delivered as planned. Both SOFT and 7C were efficacious with adolescents who abuse substances, as participants in both conditions were significantly more likely to be in symptom remission or abstinent at follow-up interviews versus at baseline. Replication studies are needed that address this studys limitations.

Participation and retention in drug abuse treatment services research.

We examined potential bias in treatment effectiveness research by studying client characteristics associated with initial participation and subsequent retention in research assessments among clients in substance abuse treatment receiving case management. Six hundred thirty-four residential and 429 outpatient clients were invited to participate. Participants were randomly assigned to one of four conditions. Logistic regression examined the relation between client characteristics and initial participation and retention in follow-up assessments. Females and clients with significant others were more likely to participate and remain in the study. Older persons and criminal justice-referred clients were less likely to participate. Older clients and urban outpatient clients were more likely, and criminal justice-referred clients were less likely, to be retained. Two case management conditions were associated with decreased retention. Client characteristics are important factors in participation and retention in treatment services research. Further, client characteristics may bias estimates of effectiveness generally, or for specific populations.

Telephone management in substance abuse treatment

The purpose of this article is to describe the results of a clinical trial in which telephonic case management was evaluated as a supplement to substance abuse treatment. An interactive voice response system (IVR) was developed by the research team for use in the case management of randomly assigned participants in a clinical trial research project. The features of the software program facilitated a double caseload for the case manager as well as real-time data capture. At intake, no significant differences were found between participants in the telecommunication condition and the general project. Thus, the effectiveness of random assignment was supported. An IVR was useful for case management services, was less costly, and showed acceptability to clients. A reduction in time expenditure by using telecommunication occurred within three activity areas. Telecommunication facilitated client interaction and the use of case management, and it reduced provider time expenditure. As an alternative strategy, telecommunication case management can enhance cost effectiveness improvements.