Robert J. Battjes

Factors that predict adolescent motivation for substance abuse treatment

Many adolescent substance abusers enter treatment because of external pressures and thus lack motivation to change their behavior and engage in treatment. Because an understanding of adolescent motivation may contribute to improved treatment, an investigation of factors that predict motivation was undertaken with youth admitted to an adolescent outpatient substance abuse treatment program (N=196). At admission, these subjects received a comprehensive biopsychosocial assessment. Using multiple regression analysis, factors considered to potentially predict motivation were assessed. Of the factors examined, those that involved experiencing various negative consequences of substance use emerged as important predictors of motivation, whereas severity of substance use did not. Diminished awareness of negative consequences of use was consonant with lower motivation, suggesting the importance of interventions to help youth recognize negative consequences of their substance use. Interventions to enhance motivation are likely to become more important as the juvenile justice system increasingly refers troubled youth to treatment.

Prevention of Adolescent Drug Abuse

The prevention of drug abuse has been of public concern since the mid-1960s. Research efforts to document program effectiveness have met with relatively little success. Past research efforts are reviewed. Research on social pressures and social skills training approaches to smoking prevention is reviewed in detail because of the promise these approaches hold for the prevention of drug abuse. Future research needs are identified.

Smoking as an issue in alcohol and drug abuse treatment

Little attention has been given to the role of tobacco dependence within alcohol and drug abuse treatment. Yet, smoking behavior appears to be interrelated with the use of alcohol and other drugs. This interrelationship is explored, and the role of smoking cessation within alcohol and drug abuse treatment is considered. Areas for future research on this topic are identified. Addictive disorders are generally thought to include alcohol abuse, drug abuse, smoking, overeating, and, sometimes, gambling and caffeine dependence. While some attention has been paid to the common etiological roots of various addictive disorders, relatively little systematic attention has been paid to commonalities in their treatment and especially to the treatment of multiple disorders in the same individuals. The one significant exception is alcohol abuse and drug abuse. Of the other addictive disorders, tobacco dependence has been most closely interrelated with alcohol and drug abuse. Yet, little attention has been given to tobacco dependence within alcohol and drug abuse treatment. This paper will focus on smoking in relationship with alcohol and drug abuse, and will consider the possible role of smoking cessation treatment within the context of alcohol and drug abuse treatment. First, background regarding the interrelationship of alcohol and drug abuse is explored. Then, the relationship of smoking with other substance use is considered, followed by a review of special concerns related to smoking among alcohol and drug abuse clients. Next, the current status of smoking cessation within alcohol and drug abuse treatment is addressed. Finally, implications are considered.

Correlates of Early Substance Use and Crime Among Adolescents Entering Outpatient Substance Abuse Treatment

Although many studies have examined the relationship between early deviant behavior and subsequent life problems among adolescents drawn from the general population, such relationships have not been examined for youth attending substance abuse treatment. Based on in‐depth psychosocial assessments conducted with adolescents entering an outpatient substance abuse treatment program (N = 193), the current study examines individual characteristics, life circumstances, and other behavioral and psychological characteristics that are correlated with the age at which these youth initiated substance use and criminal activity. Early onset of substance use was associated with greater levels of family deviance and a variety of problems including school adjustment, drug use, criminal involvement, bullying and cruelty to people and animals, and involvement in risky sexual activities. In contrast, early onset of crime was related only to male gender, early onset of substance use, and cruelty to people. Findings suggest that treatment providers may need to consider the ages at which their adolescent clients initiated substance use given its association with illegal activity, other deviant behavior, and precocious and high‐risk sexual behaviors.

Cause-specific mortality associated with Hiv and Htlv-ii infections among injecting drug users in the Usa

BackgroundHuman T-lymphotropic virus type II (HTLV-II) is widespread among injecting drug users (IDU) and may contribute to the risk of leukemia/lymphoma, neurodegenerative disease, and perhaps pneumonia, especially with HIV co-infection. MethodsIn 1987–1991, 6570 IDU were tested for HIV and HTLV-II antibodies. In 1998, they were matched to the National Death Index. Numbers of observed deaths of each cause were compared by standardized mortality ratios with the numbers expected, using sex-, race-, age-, and year-specific rates in the general population. Relative risk (RR) associated with each virus, compared to uninfected drug users, was estimated by Poisson modeling. ResultsThere were 1351 deaths, including 683 (15%) of 4604 participants who enrolled seronegative for both viruses; 328 (47%) of 701 who had HIV but not HTLV-II infection; 220 (21%) of 1033 who had HTLV-II but not HIV infection; and 120 (52%) of 232 who were infected by both viruses. Compared to the general population, mortality for participants with neither virus was increased 4.3-fold [95% confidence interval (CI), 4.0–4.7] and was significantly elevated for virtually every cause of death. With HIV, mortality from medical causes, but not external causes, was increased 3.7-fold (95% CI, 3.3–4.2), particularly with AIDS and related conditions. With HTLV-II, all-cause mortality was reduced (RR, 0.8; 95% CI, 0.7–0.9), with no statistically significant reduction or elevation for any specific cause. A non-significant excess of tuberculosis deaths (RR, 4.6; 95% CI, 0.8–25.2) was noted with HTLV-II, but there was no excess mortality from leukemia/lymphoma, other malignancies, or neurodegenerative disease. ConclusionsWithout HIV or HTLV-II, IDU had profoundly increased mortality from medical and external causes. HIV was specifically associated with death due to AIDS and related conditions. HTLV-II infection was not significantly associated with mortality from any cause, suggesting that it is not a significant human pathogen, even when present with HIV infection.

HIV infection and AIDS risk behaviors among injecting drug users entering methadone treatment: an update.

Trends in HIV infection and AIDS risk behaviors among injecting drug users (IDUs) were assessed through a series of nonblinded point-prevalence surveys conducted between 1987 and 1991 with admissions to methadone treatment in eight areas, including New York City; Asbury Park and Trenton, New Jersey; Philadelphia; Baltimore; Chicago; San Antonio, Texas; and Los Angeles County. Over the 5-year period, significant changes in HIV seropositivity were found in two of the eight cities, with seroprevalence decreasing in Asbury Park from 43.1 to 21.2% and increasing from 10.1 to 17.6% in Chicago. Initially high levels of injection-related risk behaviors decreased substantially across cohorts in most cities, except for San Antonio and Los Angeles, where risk levels remained high. Sexual risk behaviors continued at high levels in all cities, suggesting relatively little sexual risk reduction during the course of the study.

A novel opioid maintenance program for prisoners: preliminary findings.

Effective postincarceration treatment for individuals with preincarceration heroin dependence is urgently needed because relapse typically follows release. This article presents first-year findings from a unique 2-year pilot study of opioid agonist maintenance treatment initiated in prison and continued in the community. Incarcerated males with preincarceration heroin dependence were randomly assigned to Levo-alpha-acetylmethadol (LAAM) maintenance or control conditions 3 months before release. Approximately 92% of eligible inmates volunteered to participate; 36 of 58 subjects who were eligible and randomly assigned to LAAM maintenance successfully initiated treatment. Twenty-eight of these continued on LAAM until release; 22 (78.6%) entered community-based maintenance treatment; and 11 (50%) remained in treatment at least 6 months postrelease. Changes in LAAMs labeling because of its association with cardiac arrhythmias now makes it a second-line treatment for heroin dependence, unsuitable for treatment initiation. Nonetheless, study findings may also be applicable to methadone maintenance treatment, suggesting such treatment may be a promising means of engaging prisoners with preincarceration heroin dependence into continuing treatment.

A Novel Opioid Maintenance Program for Prisoners: Report of Post-Release Outcomes

Because prisoners with preincarceration heroin dependence typically relapse following release, a pilot study examined a novel opioid agonist maintenance program whereby consenting males initiated levo-alpha-acetylmethadol (LAAM) treatment shortly before release from prison with opportunity to continue maintenance in the community. Treated prisoners (experimental group) were compared with controls who received community treatment referral information only and prisoners who withdrew from treatment prior to medication regarding treatment participation and community adjustment during nine months post-release. Nineteen of 20 (95%) prisoners who initiated maintenance in prison entered community treatment, compared with 3 of 31 (10%) controls, and 1 of 13 (8%) who withdrew. Moreover, 53% of experimental participants remained in community treatment at least six months, while no other participants did so. Differences in heroin use and criminal involvement between experimental participants and each of the other two groups, while not consistently statistically significant, uniformly favored the experimental group. Despite study limitations, robust findings regarding treatment attendance suggest that this intervention is highly promising.

Factors associated with treatment outcomes in an aftercare population.

This study examined six-month outcomes for 194 criminal justice clients exiting outpatient drug-free treatment and assigned to aftercare or standard treatment. It compared sub-samples of those achieving positive (n=111) and negative outcomes (n=59), as defined by drug and alcohol use and arrests. Psychological variables and attendance at religious services distinguished significantly between groups. Predictor variables developed from that comparison were employed in logistic regression analyses making use of the full sample. Aftercare was found to be particularly significant for reduction in drug use, with optimism/pessimism about ones future and religious observance also significant predictors for substance use.

Hepatitis C virus load and survival among injection drug users in the United States

Persons chronically infected with hepatitis C virus (HCV), some of whom may be coinfected with HIV and human T‐lymphotropic virus type II (HTLV‐II), are at high risk for end‐stage liver disease (ESLD). We evaluated whether ESLD death was associated with premorbid HCV RNA level or specific HCV protein antibodies among persons with or without HIV/HTLV‐II coinfection in a cohort of 6,570 injection drug users who enrolled in 9 US cities between 1987 and 1991. We compared 84 ESLD descendents and 305 randomly selected cohort participants with detectable HCV RNA, stratified by sex, race, HIV, and HTLV‐II strata. Relative hazard (RH) of ESLD death was derived from the proportional hazard model. Risk of ESLD death was unrelated to the intensity of antibodies against the HCV c‐22(p), c‐33(p), c‐100(p), and NS5 proteins, individually or combined, but it increased with HCV RNA level (RHadj= 2.26 per log10 IU/mL, 95% CI: 1.45‐5.92). The association between HCV RNA level and ESLD death remained significant after adjustment for alcohol consumption (RHadj= 2.57 per log10 IU/mL, 95% CI: 1.50‐8.10). Deaths from AIDS (n = 45) and other causes (n = 43) were unrelated to HCV RNA (RHadj= 1.14 and 1.29 per log10 IU/mL, respectively). HIV infection was not associated with ESLD risk in multivariate analyses adjusted for HCV RNA. Men had an increased risk of ESLD death in unadjusted analyses (RH = 1.92, 95% CI: 1.15‐3.56) but not in multivariate analysis (RHadj= 0.98, 95% CI: 0.48‐2.88). Non‐black patients were at increased risk for ESLD death (RHadj= 2.76, 95% CI: 1.49‐10.09). In conclusion, HCV RNA level is a predictor of ESLD death among persons with chronic HCV infection. (HEPATOLOGY 2005.)