Richard T. Spence

Alcohol and Drug Use, Abuse, and Dependence in Urban Areas and Colonias of the Texas-Mexico Border

This study describes the prevalence of alcohol and drug use, abuse, and dependence among adults on the Texas-Mexico border in 2002-2003. The findings are based on survey responses from a random sample of 1,200 adults living in households in three communities: El Paso, a densely populated city in west Texas; the less dense urbanized areas of the lower Rio Grande Valley in south Texas; and rural or semirural colonias—unregulated settlements characterized by lack of basic public services—in south Texas. The findings revealed similarity in drug use across the three sites but higher rates of binge drinking and alcohol dependence in the colonias. Border alcohol and drug use appeared similar or lower than use among residents of Texas as a whole or Hispanics nationwide; however, problems of abuse and dependence appeared somewhat higher on the border.

Drug use and risk of HIV/AIDS on the Mexico-USA border: a comparison of treatment admissions in both countries

This study analyzes trends in treatment admissions and summarizes HIV/AIDS risk factors along the US-Mexican border. Data are presented at the national level and at the state level for states along the border. Client data also are compared for treatment programs located in sister cities on the Texas-Mexico border. These data show that methamphetamine admissions are increasing nationally and methamphetamine use is a major problem in the western states on both sides of the border. Use of Ice (smoked methamphetamine) has increased significantly. Use of crack (smoked cocaine) is a growing problem on the border, and injection is the primary route for using black tar heroin in this area. Each of these drugs is a risk factor, either from drug-influenced risky sexual behaviors or from sharing injection equipment. In addition, the availability of drugs on the border and patterns of risky behaviors among migrants mean that drug users on the border are at risk of HIV/AIDS, and this risk is expected to increase with the spreading methamphetamine epidemic and smoking of crack cocaine. Comparable data on HIV/AIDS are needed for further studies of the relationship of drug use and HIV/AIDS on the border.

Effectiveness of adjunct therapies in crack cocaine treatment

Although intensive outpatient therapy is recommended for treatment of cocaine, psychosocial characteristics associated with crack cocaine abuse are also implicated in attrition from outpatient programs. Acupuncture, medications, and brainwave therapy (biofeedback), have all been used to encourage treatment retention and drug use outcomes. The effectiveness of three adjunct therapies in improving retention and drug use outcomes in intensive outpatient cocaine treatment was tested in a primarily young, indigent African-American sample of crack cocaine users at a community hospital in a low-income, high drug use neighborhood in Houston. Subjects were assigned to receive either neurobehavioral treatment alone or neurobehavioral with one of three adjunct therapies. These included acupuncture, anticraving medication, or brainwave therapy. Comparative results indicated that dosage of any adjunct therapy was associated with days in treatment and standard treatment sessions attended, and that standard treatment sessions attended was associated with negative urinalysis results at follow-up. None of the adjunct therapies were directly associated with drug use outcomes.

Profiles of Club Drug Users in Treatment

There is little in the literature about treatment of persons with problems with “club” or “party” drugs. This paper looks at the characteristics of individuals admitted to treatment for primary, secondary, or tertiary problems with club drugs such as ecstasy, gamma-hydroxybutyrate (GHB), ketamine, flunitrazepam (Rohypnol), methamphetamine, and hallucinogens (e.g., LSD) in programs funded by the Texas Commission on Alcohol and Drug Abuse. Some 38,350 unduplicated records from 1988 through 2003 of persons admitted with problems with club drugs were compared against users of alcohol or other drugs. Club drug users were more impaired on five of six Addiction Severity Index (ASI) indices at admission and they were more likely to use multiple substances more often. They were more likely than users of alcohol or other drugs to complete treatment, but this varied by drug. At follow-up 90 days after discharge, club drug users continued to report more ASI problems. Profiles of these clients show that ecstasy use has spread beyond the club culture, as indicated by the changes in client demographics over time. GHB clients presented a mixed picture of severe problems at admission and good response to treatment. Hallucinogen clients were young and less likely to complete treatment, while Rohypnol users were on the Texas-Mexico border. The methamphetamine epidemic has resulted in increased admissions, and the proportion of “Ice” smokers has increased. However, methamphetamine clients were less likely to complete treatment and their higher level of problems at admission and follow-up are of concern. Of special note are the indications of co-occurring problems and the need for both mental health and substance dependence treatment for some clients.

An experimental test of retention in residential and outpatient programs

Previous studies of residential and outpatient drug treatment programs have found that retention is higher in residential than in outpatient programs. This study attempts to verify previous findings by conducting an experiment that controls for ecological, self-selection, and program content biases. The Houston Recovery Campus is a research-focused, multiple-provider drug treatment facility for the indigent of Harris County, Texas. During the study period, 646 applicants were randomly assigned to two comparable 28-day programs. The first program was a residential program; the second was an outpatient day treatment program. Twenty-eight day retention rates were significantly higher for the residential program (76%) compared to the day treatment program (64%).

Assessing Culturally Competent Chemical Dependence Treatment Services for Mexican Americans

Mexican Americans struggling with chemical dependence are greatly underserved. Barriers to treatment include language, lack of culturally relevant services, lack of trust in programs, uninviting environments, and limited use and linkage with cultural resources in the community. This project aimed to develop a tool for assessing and planning culturally competent/relevant chemical dependence treatment services for Mexican Americans. Focus groups were conducted with experts in Mexican-American culture and chemical dependence from six substance abuse programs serving adult and adolescent Mexican Americans and their families. Sixty-two statements were developed describing characteristics of culturally competent/relevant organizations. Concept mapping was used to produce a conceptual map displaying dimensions of culturally competent/relevant organizations and Cronbach’s alpha was calculated to assess the internal consistency of each dimension. Analysis resulted in seven reliable subscales: Spanish language (α = 0.84), counselor characteristics (α = 0.82), environment (α = 0.88), family (α = 0.84), linkage (α = 0.92), community (α = 0.86), and culture (α = 0.89). The resulting instrument based on these items and dimensions enable agencies to evaluate culturally competent/relevant services, set goals, and identify resources needed to implement desired services for both individual organizations and networks of regional services.

The trajectory of client progress A longitudinal pilot study

Successful nonchemical drug treatment is a transformative experience: client change is the goal of treatment. Two domains in which programs intend to facilitate change are emotional well-being and the therapeutic relationship. Little previous research has addressed the question of what changes clients in drug treatment actually undergo while in treatment. This article presents results from a pilot longitudinal study of clients in two short-term drug treatment programs in Houston, TX. Results showed measurable increases in self-esteem and connection to counselor and decreases in anxiety and depression over the course of treatment for clients who completed treatment. Program graduates and early withdrawals showed distinctly different patterns of progress as measured by emotional and relationship scales.

Systematic Assessment of Culturally Competent Chemical Dependence Treatment Services for African Americans

This project aimed to develop a tool for assessing and planning culturally competent and relevant chemical dependence treatment services for African American clients and their families. Focus groups were conducted with experts in African American culture and chemical dependence in eight substance abuse programs serving adult and adolescent African Americans and their families. Seventy-five statements were developed describing characteristics of culturally competent and relevant organizations. Concept mapping was used to produce a conceptual map displaying dimensions of culturally competent and relevant organizations and Cronbachs alpha was calculated to assess the internal consistency of each dimension. Analysis resulted in six reliable dimensions: Family Involvement (α = .81), Staff and Program Cultural Diversity (α = .98), Counselor Traits (α = .99), Linkage (α = .94), Community/Faith Services (α = .96), and Agency Culture (α = .97). The resulting instrument enables agencies to evaluate culturally competent and relevant services, set goals, and identify resources needed to implement desired services for both individual organizations and within networks of regional service providers.

Counselor and Client Characteristics in Mental Health versus Substance Abuse Treatment Settings Providing Services for Co-Occurring Disorders

The study compares counselor and client characteristics of state-funded co-occurring disorder (COPSD) programs in mental health (MH) versus substance abuse (SA) settings. SA counselors more often had graduate degrees and MH counselors rated their knowledge and skills lower on two of nine COPSD best practice principles. MH clients were more frequently diagnosed with schizophrenia, depression, and bipolar disorder, whereas SA clients displayed evidence of greater substance use severity and had higher rates of treatment completion and abstinence at discharge. Results reveal significant implications for workforce development and potential system changes to enhance COPSD services that are unique to each setting.

Differences in characteristics of heroin inhalers and heroin injectors at admission to treatment: a preliminary study using a large database of client records.

Aims. To compare the characteristics of heroin injectors vs. inhalers at their first admission to publicly funded treatment in Texas. Methods. The sample consisted of 9732 unique clients who entered publicly funded treatment programs in Texas between 1997 and 2001 and who had a primary problem with either injected or inhaled heroin, which they had used in the past 30 days. The records were analyzed using a generalized linear model of logistic regression with the outcomes modeled as binomial and multinomial distribution and a hierarchical linear model for continuous outcomes to compare heroin inhalers and injectors. Findings. There were large statistically significant differences between injectors and inhalers. Inhalers were more likely to be older at first use of heroin, to have entered treatment sooner, to have minor children at home, to have higher annual incomes, to be first admissions to treatment, and to have a secondary drug problem with crack cocaine. They were also more likely to be Hispanic [odds ratio (OR) = 1.74] or African-American (OR = 12.32). Conclusions. Even though the race/ethnic differences in the Texas population and the type of heroin available for use in Texas differs from that studied elsewhere, many of the characteristics of heroin users are similar. Inhalers have more strengths in many areas, and these findings raise the possibility that there are factors, particularly among African-American participants in Texas, that lessen the risk of injecting heroin. Efforts should be directed to providing therapeutic interventions to discourage the transition to injecting and to encourage inhalers to enter treatment earlier rather than progressing on to injecting. This analysis is the first part of a larger study of heroin users in public and private treatment.