Rita Hindin

Radioimmunoassay of hair for determination of cocaine, heroin, and marijuana exposure : comparison with self-report

Radioimmunoassay of hair (RIAH) was compared with self-report for cocaine, heroin, and marijuana in two populations: 109 persons entering residential drug user treatment and 86 at follow-up posttreatment. Among treatment entrants, 89% of 87 RIAH cocaine-positives and 96% of 45 RIAH heroin-positives were confirmed by self-report. However, among those followed-up posttreatment, only 51% of 43 RIAH cocaine-positives and 67% of 18 RIAH heroin-positives were so confirmed. Whereas 95% of 104 self-reports of cocaine use in the combined population were confirmed by RIAH, only 69% of 80 self-reports of heroin use were. Self-report and RIAH for marijuana were weakly associated.

The effectiveness of alternative planned durations of residential drug abuse treatment.

Randomized controlled trials were conducted at two residential drug abuse treatment facilities to compare programs that differed in planned duration. One trial compared a 6-month and a 12-month therapeutic community program (n = 184), and the second compared a 3-month and a 6-month relapse prevention program (n = 444). Retention rates over comparable time periods differed minimally by planned treatment duration, and the longer programs had lower completion rates. There was no effect in either trial of planned treatment duration on changes in psychosocial variables between admission and exit or on rates or patterns of drug use at follow-up between 2 and 6 months after exit.

Changes in HIV risk behavior following alternative residential programs of drug abuse treatment and AIDS education

We compared the effectiveness in changing human immunodeficiency virus (HIV) risk behavior of two different approaches to acquired immunodeficiency syndrome (AIDS) education given by residential drug abuse treatment programs differing in their planned duration. Two randomized controlled trials compared (a) a 6-month with a 12-month therapeutic community (TC) program, and (b) a 6-month with a 3-month relapse prevention (RP) program. Three composite variables assessing HIV risk (a) drug injection, (b) sexual partners, and (c) condom use-were measured for the 3 months prior to admission and follow-up. The TC program comprised a four-part AIDS information intervention. The RP program comprised a 21- or 42-session small-group program in the principles of RP, 5 skills-building AIDS education sessions, and 6 other health education sessions. Four hundred ninety-five clients were enrolled in the study and completed a follow-up interview within 6 months of exit (79% of those enrolled). Clients in the RP program reduced their drug injection and condom use risk. Female clients in the TC program reduced their condom use risk. There were no differential effects on risk behavior change of either planned duration (randomization assignment) or program type (RP versus TC). Thus, differences in the treatment programs, including AIDS education components, had no apparent effect on HIV risk behavior change. The contribution of residential drug abuse treatment programs to AIDS prevention remains unproved.

The effects of planned duration of residential drug abuse treatment on recovery and HIV risk behavior

OBJECTIVE This study assessed the effects of planned duration of residential drug abuse treatment on recovery from drug use and on human immunodeficiency virus (HIV) risk behaviors. METHODS Two concurrent randomized controlled trials of programs differing in planned duration were conducted: 6-month vs 12-month versions of a traditional therapeutic community program, and 3-month vs 6-month versions of a modified therapeutic community incorporating a relapse prevention and health education program. Outcomes, measured at least 16.5 months after admission, included time from admission to first drug use; severity of drug, alcohol, legal, and employment problems; and risky drug injection and sexual behaviors. RESULTS Among 539 clients (86% of those enrolled), there were no significant effects of planned duration of treatment upon Addiction Severity Index scores or HIV risk behavior. In the relapse prevention program, clients randomized to the 6-month program had a longer time to first drug use than those in the 3-month program (hazard ratio = 0.74; 95% confidence interval = 0.58, 0.93). Employment problems at follow-up were significantly less severe among clients treated in the therapeutic community than among those in the relapse prevention program. CONCLUSIONS No overall benefit of extending treatment beyond 6 months was found.

The relationships of HIV status and HIV risky behavior with readiness for treatment.

We investigated the associations of self-reported HIV status and risky injection practices with dependent variables measuring readiness and motivation for treatment and depression among 550 clients at two residential drug abuse treatment programs. The results suggest that a positive HIV status may be associated with motivation for treatment independently of and more strongly than risky behavior. In multivariable analyses, HIV status was associated with a scale measuring cons of drug use (P = 0.006). Risky behavior was associated with the dependent variables only in univariate analyses. The univariate association between risky behavior and depression was confounded by social desirability bias. Further research is needed to determine whether HIV-related variables predict retention or outcome of treatment.

Strategies for follow-up of drug users: field research guidelines.

The timely follow-up of clients who exited from two residential treatment programs was achieved by the consistent application of the described strategies. The enrollment and treatment phases of the study provided the environment for the use of standard follow-up and enhanced outreach methods. The applicability of the strategies to a variety of settings makes the prioritization of the follow-up methods presented a meaningful one. The role of the researcher in the reevaluation of follow-up protocols within an ethical context is discussed.

Data for empowerment! The application of small area analysis in community health education and evaluation.

This article describes the use of Small Area Analysis (SAA) techniques in public health education planning and evaluation efforts. An array of health and social indicators for a mid-size metropolitan city (150,000+) were collected as part of the evaluation of a Center for Substance Abuse Prevention (CSAP) community partnership grant for alcohol and other drug prevention. Data sources included the state public health department, school system, hospitals, census bureau, police department, and the city administration. Germane health and social indicators were then calculated for each of the citys socio-historical neighborhoods or zip code area. The process of gaining access to these diverse data and how they were used for planning and evaluation purposes are detailed and typical problems encountered in utilizing SAA techniques are enumerated. Finally, the potential for SAA as a community organizing tool for galvanizing community responses is discussed.