Women and Sex/Gender Differences Research
Director's Report to Council
Research Findings Excerpts
September, 2000
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Women and Sex/Gender Differences ResearchDirector's Report to Council September, 2000 |
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Basic Research |
Quantitative trait loci (QTL) studies are used to determine the number and chromosomal location of genes involved in complex behaviors that are influenced by more than one gene. Seizures are a well-known but poorly understood consequence of human cocaine abuse, particularly with respect to individual differences in susceptibility. In rodent models, sensitivity to cocaine seizures is strongly influenced by genotype. For example, several studies have reported significant differences between the C57BL/6 (B6) and DBA/2 (D2) inbred mouse strains in their sensitivity to cocaine-induced seizures. These findings prompted Dr. Belknap and his colleagues to undertake a QTL study of cocaine-induced seizures in two populations derived from the C59BL/6 and DBA/2 mouse strains. Three QTLs emerged as significant (P<0.00005): one for clonic seizures on chromosome 9 (distal), and two for tonic seizures on chromosomes 14 (proximal to mid) and 15 (distal). two additional qtls emerged as suggestive (p<0.0015), both associated with clonic seizures on chromosomes 9 (proximal) and 15 (distal). both qtls on chromosome 9 were sex-specific, with much larger effects on the phenotype seen in females than in males. the results suggest that different types of seizures have both common and distinct underlying mechanisms, and that there are a variety of factors that may account for individual differences in seizure sensitivity. some of the qtls were located in regions of the chromosomes that have been identified as qtls for other seizure types such as a mouse model of epilepsy. some of these chromosomal regions are also known to contain nervous system-relevant genes such as those for the dopamine d2 receptor, the serotonin 1b receptor, various glutamate receptors, and ion channel genes. these candidate genes can now be used as the basis of studies on the physiology of cocaine-induced seizures. hain, h.s., crabbe j.c., bergeson, s.e., belknap, j.k. cocaine-induced seizure thresholds: quantitative trait loci detection and mapping in two populations derived from the c59bl/ and dba/ mouse strains. journal of pharmacology and experimental therapeutics, 293, pp. 180-187, 2000.
Stimulation in the Brains of the Offspring When They Are Tested As Adults Dopamine normally inhibits the activity of cholinergic neurons in the striatum, and this inhibition is an important aspect of the control of motor activity. However, the activity of the dopamine-containing neurons is regulated by serotonergic activity at the 5HT3 receptor site, the only serotonin receptor of the 17 identified thus far that is an ion channel. The application of a 5HT3 agonist normally limits the release of acetylcholine in a dose-dependent manner. However, prenatal exposure to cocaine alters this relationship in female, but not in male rats. Denise Jackson and her colleagues treated rat mothers with 20 mg/kg of cocaine or saline solution (the control) twice daily from embryonic days 15 to 21 (day of birth). The rats were tested as adults (postnatal days 80-120). Both males and females (at two times in the estrous cycle) that had been treated with saline in utero showed the expected inhibition of cholinergic activity after graded doses of a 5HT3 agonist were applied to the neurons; however, females in diestrus, a relatively quiescent period during the rodent estrous cycle, were much less sensitive to the lower doses of the agonist. This is important because it demonstrates a functional difference in the brains of females given cocaine prenatally; a difference that is apparent in adulthood. The data also suggest that estrogen may modify the response, as animals in the phase of the cycle when estrogen is high did not display this deficit. This result suggests that persistent modification of the dopaminergic system has occurred as the cholinergic output is altered, and suggests that other parts of the mesocorticolimbic dopamine system may be functionally altered, possibly including regions that control motor activity and the perception of reward. Bolanos, C.A., Trksak, G.H., Glatt, S.J. and Jackson, D. Synapse, 36, pp. 1-11, 2000.
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Behavioral Research |
Researchers at the Yale Child Study Center compared the language abilities at age 24 months of 47 inner-city children exposed prenatally to cocaine with those of 30 inner-city children not exposed prenatally to cocaine. The sample was recruited prenatally. While both groups of children evidenced some delays in language development, the non-cocaine-exposed children produced more complex language, including longer utterances, a richer vocabulary, and more complex grammatical structure than the cocaine-exposed children were able to do. The effect, however, was largely in girls. Malakoff, M.E., Mayes, L.C., Schottenfeld, R., and Howell, S. Language Production in 24 Month Old Inner City Children Exposed In Utero to Cocaine. Journal of Applied Developmental Psychology, 20, pp. 159-180, 2000.
Researchers at the University of Michigan Medical School and at Washington University have shown in rhesus monkeys that cocaine-produced increases in cortisol and ACTH release are greater and more dose-dependent when the cocaine (0.01-, 0.03-, 0.1-, and 0.3-mg/kg/injection) is delivered response-contingently than when it is delivered non-contingently. Under both procedures, the cortisol response was higher in males than in females; there were no sex differences in the ACTH response. A single large dose infusion of cocaine (1 mg/kg) produced a substantially larger ACTH response in males than in females; there were no sex differences in the cortisol response to the large dose. Broadbear, J. H., Winger, W., Cicero, T., and Woods, J.H. Effect of Response Contingent and Non-contingent Cocaine Injection on Hypothalamic-Pituitary-Adrenal Activity in Rhesus Monkeys. Journal of Pharmacology and Experimental Therapeutics, 290, pp. 393-402, 1999.
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Treatment Research and Development |
Dr. Gayle Dakof, University of Miami, investigated gender differences in patterns of co-morbidity and family functioning among a sample of 95 youths (42 girls) referred by juvenile justice (80%), education (10%) and social welfare (10%) for substance abuse treatment. Findings indicate that male and female adolescent substance users (13-17 years) entering treatment do differ. The girls not only used drugs and engaged in externalizing behaviors as extensively as did their male counterparts but they also were distinguished by their higher levels of internalizing symptoms and family dysfunction. Dakof, G. Journal of Psychoactive Drugs, 32(1), pp. 25-32, 2000.
Dr. Elizabeth Whitmore and colleagues, University of Colorado, investigated whether symptoms associated with substance abuse/dependence, conduct disorder and other psychiatric disorders were reduced in adolescents (13-19 years) admitted to a multi-component outpatient drug treatment program. Although the results indicate improvement in three areas (i.e., delinquency and conduct disorder [CD]; attention deficit hyperactivity disorder [ADHD]; educational/vocational status), substance involvement and level of depression did not improve. Unlike results from a concomitant study with boys, no pre-treatment variables predicted post-treatment drug use or conduct outcomes among the girls. And only two post-treatment factors (peer problems and number of ADHD symptoms) were found related to CD and the substance use disorders outcomes. Whitmore, E.A., Mikulich, S.K., Ehlers, K.M. and Crowley, T.J. Drug and Alcohol Dependence, 59, pp. 131-141, 2000.
Dr. Ken Winters and colleagues at the University of Minnesota assessed adolescents with substance use disorders eligible to enroll in a 12-step drug treatment program. Youths were evaluated 6- and 12-month post-treatment in terms of their drug use outcomes. Three groups of adolescents participated in the study: those (n=101) who completed treatment, those (n=39) who did not, and those (n=66) on a waiting list. Among treatment completers, residential and outpatient samples were also compared. Results indicate completing treatment was associated with far superior outcomes compared to those who did not complete treatment or receive any at all. Percentage of treatment completers reporting abstinence one-year post treatment was 23% compared to 2.6% for non-completers and 3.0% for those on the wait-list. No differences were found between residential and outpatient groups or was gender or age a factor. Winters, K.C., Stinchfield, R.D., Opland, E., Weller, C. and Latimer, W.W. Addiction, 95(4), pp. 601-612, 2000.
Since a significant degree of brain development occurs during adolescence, males and females with a history of teenage marijuana use received both positive emission tomography (PET) to assess cerebral blood flow (CBF) and magnetic resonance imaging (MRI) scans to evaluate brain volume. Median age of first marijuana use was the variable used to stratify the volunteers into Early (< age 17) or Late (> age 17) use. Primary findings related to age of first use include: 1) those who were identified as Early users had smaller whole brain and percent cortical gray matter and percent white matter volumes compared to those who started use later, suggesting that the mechanism of this effect has more to do with brain development than with atrophy; 2) functionally, males who began use Early, had significantly higher resting CBF compared to the Late males but was not significantly different from females, supporting additional changes in gonadal and pituitary hormones that alter development; these changes, in turn, are related to global CBF and to reduction in gray matter; 3) both males and females who started using marijuana younger were physically smaller in height and weight, with the effects being greater in males. Since THC suppresses the release of prolactin, growth hormone and gonadotropin and because the adolescent growth period for males starts earlier and lasts longer than for females, starting marijuana use early would expose males longer to the adverse effects of reduced growth hormone release. Overall, these findings suggest that exposure to marijuana (and possibly other drugs) at certain critical periods such as during early adolescence, may alter normal patterns of development. Wilson, W., Mathew, R., Turkington, T., Hawk, T., Coleman, R.E., and Provenzale, J. Brain Morphology Changes and Early Marijuana Use: A Magnetic Resonance and Positron Emission Tomography Study. Journal of Addictive Diseases, 19, pp. 1-22, 2000.
Gary Swan of SRI International conducted a complex segregation analysis in three generation-families to determine the best model for transmission of smoking behavior. This is the first study to date to use three generations for this determination. It was found that the best-fitting model was that of a dominant major gene with low estimated frequency and residual familial correlations. These correlations demonstrate strong influence of mothers (negative) and spouses (positive) toward smoking behavior. However, it should be noted that the sample was selected from those participating in a longitudinal study of aging and health and not selected for smoking behavior per se. Therefore, it is presumed that these results underestimate genetic transmission because heavy-smoking individuals are less likely to volunteer for the study, and many more smokers in the registry may have already died. Nevertheless, these results encourage future linkage studies. Cheng, L.S., Swan, G.E., and Carmelli, D. A Genetic Analysis of Smoking Behavior in Family Members of Older Adult Males. Addiction, 95(3), pp. 427-435, 2000.
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Research on AIDS and Other Medical Consequences of Drug Abuse |
Reductions from lifetime to recent levels of substance use, the time since HIV diagnosis, physical health symptoms, CD4 counts, emotional distress, and social supports were examined among 227 13 to 24 year old (20% female, 80% male) youth living with HIV (YLH). Substance use pervaded the lives of these youth. Male YLH had used more drugs, more often, and for longer periods than female YLH. However, there had been major reductions in use from lifetime to current reports. Being male, having high emotional distress, and having fewer negative social supports were significantly associated with greater reductions in substance use. There was a trend for the length of time that an individual was seropositive being associated with reductions in substance use. The counterintuitive findings suggest that there must be a re-examination of the role of the social support networks of youth living with HIV, as well as the ways in which emotional distress interact with risk behaviors. Rotheram-Borus, M.J., Murphy, D.A., Swendeman, D., Chao, B., Chabon, B., Zhou, S., Birnbaum, J., and O'Hara, P. Substance Use and its Relationship to Depression, Anxiety, and Isolation Among Youth Living with HIV. International Journal of Behavioral Medicine, 6 (4), pp. 293-311, 1999.
Disclosure of serostatus and predictors of disclosure were examined among youth living with HIV (YLH). Disclosure patterns, sociodemographic characteristics, sexual and substance-use risk history, and current health status were examined among 350 youth living with HIV aged 13-23 years (27% African-American, 38% Latino; 72% male). In this group 35 had AIDS, 108 were symptomatic, and 201 were asymptomatic. Most youth disclosed their serostatus to family (87%); unexpectedly, young men (93%) were more likely to disclose to friends than were young women (79%). Being younger at diagnosis was significantly more associated with disclosure to family; young men disclosed more often to friends. Most youth disclosed to all their sexual partners (69%); higher rates of disclosure to sexual partners were associated with having fewer partners and being African-American. Condom use was significantly associated with disclosure for young women, and tended to be related to disclosure for young men. Although many YLH disclosed their serostatus to their partners, condom use was not increased. Interventions are needed to increase condom use among YLH, as well as to encourage disclosure to partners by the 30% of YLH who do not disclose. Lee, M., Rotheram-Borus, M.J., and O'Hara, P. Disclosure of Serostatus Among Youth Living with HIV. AIDS and Behavior, 3 (1), pp. 33-40, 1999.
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Epidemiology, Etiology and Prevention Research |
The 48th biannual meeting of the Community Epidemiology Work Group (CEWG), chaired by Mr. Nicholas J. Kozel, DESPR, was held in Baltimore, Maryland on June 13-16, 2000. The CEWG is composed of researchers from 21 metropolitan areas of the United States who meet semiannually to report on patterns and trends of drug abuse in their respective areas; emerging drugs of abuse; vulnerable populations and factors that may place people at risk of drug use and abuse; and, negative health and social consequences. Reports are based on drug abuse indicator data, such as morbidity and mortality information, treatment data and local and State law enforcement data. Additional sources of information include criminal justice, correctional, medical and community health data, local and State survey information and research findings from ethnographic studies. The following are highlights from the meetings:
Cocaine indicators suggest declining or stable trends in most areas.
Heroin indicators are mixed. Younger populations continue to initiate use in several cities, and some are shifting from snorting to injecting.
Marijuana indicators suggest continued elevated levels, with generally stable or mixed trends in most CEWG sites.
Methamphetamine consequences continue to decline in western and central CEWG sites; indicators remain low in the East but may be trending upward.
"Club drugs," especially GHB, GBL, MDMA, and ketamine, continue to spread across the country. MDMA availability is high and increasing in many CEWG areas, and its quality and content often varies widely.
Cocaine/Crack - Although some indicators increased slightly in a number of CEWG areas during the last reporting period, most cocaine indicators during this reporting period declined or were stable. Cocaine deaths1 were relatively stable, except in Detroit, where they decreased substantially, and Phoenix, where 1999 deaths outnumbered cumulative deaths for 1993-1998. After increasing in many sites during the last 6-month period, cocaine emergency department (ED) mentions2 decreased significantly in seven cities (Atlanta, Dallas, Chicago, New Orleans, New York, San Francisco, and Washington, DC). Nonsignificant ED decreases were reported in the majority of other cities; only two significant increases were noted (in St. Louis and Baltimore). Cocaine is the primary drug of choice for treatment admissions3 in six CEWG sites, excluding Baltimore where heroin and cocaine admissions are evenly distributed. Cocaine treatment and ED admissions tend to involve relatively older people, and the 35-and-older cohort seems to be increasing in many sites. Mixed trends were found in cocaine-positive urinalysis percentages4 among adult male arrestees, with increases at two sites (Dallas and Washington, DC), declines at three (Chicago, Los Angeles, Philadelphia), and stable trends at the rest; the drug is now surpassed by marijuana in all but six cities. By contrast, among female arrestees, cocaine is still the most commonly detected drug in all but one city (San Diego); levels increased in four cities (Chicago, Dallas, Minneapolis/St. Paul, and Phoenix) and declined in Los Angeles and Seattle. Speedball (crack combined with heroin) injections continue to be reported in some cities, including Baltimore, Boston, Denver, Miami, New York City, St. Louis, San Francisco, Seattle, and Washington, DC. High purity and greater availability of cocaine hydrochloride (HCl) may be driving the increase in HCl indicators in some sites, including Denver, Miami (among youth), Minneapolis/St. Paul, and Newark, and the decrease in crack indicators in some cities, such as Boston, Denver, Miami (possibly among youth), and Newark.
Heroin - Heroin indicators show mixed trends. Heroin mortality figures1 were mixed, with deaths increasing notably in three areas (Detroit, Minneapolis/St. Paul, and Phoenix), declining in two (Miami and Seattle), and stable in two. ED indicators2 were also mixed, with 10 cities showing decreases (2 significant-Miami and Baltimore) and 10 cities showing increases (2 significant-San Francisco and Washington, DC). Heroin is the predominant drug of choice among treatment admissions3 in three reporting sites, excluding Baltimore, where cocaine and heroin admissions are evenly distributed, and Seattle, where heroin and marijuana admissions are even distributed. Opiate-positive urinalysis levels4 among adult males remained relatively low (ranging from 3.4 to 20.1 percent-positive) and stable in most cities, except for Atlanta and Washington, DC, where opiate-positive levels increased, and in Philadelphia and Seattle, where levels declined. Conversely, among adult females, opiate-positive levels increased substantially in six cities (Chicago, Minneapolis/St. Paul, New Orleans, Phoenix, San Diego, and Washington, DC); they declined notably in Detroit. Heroin purity5 ranges from 10.7 percent in Miami to 72 percent in Philadelphia. Purity trended mostly upward or remained stable: increases were particularly steep in five cities (Detroit, Los Angeles, Newark, New Orleans, and Phoenix); a decline was notable in Denver (by 22.4 percentage points). Price trends were mixed. A troubling development is the continued reporting of increases of heroin use among young populations in many CEWG cities, including Atlanta (mostly white youth who snort), Baltimore, Boston (mostly young adults who inject and some high school students who snort), Chicago, Denver (youth who primarily snort or smoke), Detroit (suburban youth), Newark, Seattle (young injectors), and Washington, DC. In Boston, Chicago, Denver, Miami, and Washington, DC, snorting seems to be increasing and is often the initial route of administration for many young, new users; conversely, injecting is on an upward trend in Baltimore (among suburban youth), Boston (among youth), Minneapolis/St. Paul, Newark, New York City, and Seattle (among younger users), and many CEWG ethnographers note that heroin snorters often progress to injecting.
This study examined predictors of the quality of the parent-child attachment relationship among a sample of 248 young adults with children. In this longitudinal study, data were collected during early adulthood in 1992 and in 1996/1997 via a structured questionnaire. Using logistic regression and multiple regression analyses, the authors assessed the extent to which participants' personality attributes, substance use, and relationships with their mothers predicted the quality of the parent-child bond. Results showed that participants with certain personality attributes (e.g., high sensitivity), less frequent marijuana use, or a close relationship with their mothers had a greater likelihood of having a close parent-child attachment relationship with their own children at a later time. Analyses also showed that the risk of earlier substance use on the parent-child relationship was offset by protective factors in the parents' personality domain. In addition, protective factors in the various parental domains synergistically interacted with a low frequency of marijuana use, relating to a closer parent-child attachment relationship. The findings suggest that certain parenting styles are transmitted across generations and interventions in the personality and drug use domains can help increase the likelihood that parents will form close attachment relationships with their own children. Brook, J.S., Richter, L., and Whiteman, M. Effects of Parent Personality, Upbringing, and Marijuana Use on the Parent-Child Attachment Relationship. J Am Acad Child Adolesc Psychiatry, 39(2), pp. 240-248, 2000.
This study examined the psychosocial risk and protective factors related to needle-sharing behavior among HIV+ (N = 96) and HIV- (N = 128) female intravenous drug users (IDUs). Participants in this longitudinal study were interviewed individually at two points in time, with a 6-month interval between interviews. The interviewers used a structured questionnaire, which included psychosocial measures and questions about drug and sexual risk behaviors. Data were analyzed using Pearson correlations and hierarchical regression analyses. The findings supported a developmental model in which the psychosocial domains and HIV status predicted T1 (initial) needle-sharing behavior, which in turn was related to T2 (follow-up) needle-sharing behavior. In addition, the relationship between personality and peer risk factors and T2 needle sharing was buffered by family-related protective factors. While HIV-positive status had a direct effect on T1 needle sharing with strangers, its effect was mediated by all of the psychosocial variables in its relation to T1 needle sharing with familiar people. Comparisons of these results were made with a companion study of male IDUs. The results suggest several intervention and treatment approaches that can be implemented at different points in the developmental pathways leading to risky needle-sharing practices among female IDUs. Brook, D.W., Brook, J.S., Richter, L., Masci, J.R., and Roberto, J. Needle Sharing: A Longitudinal Study of Female Injection Drug Users. Am J Drug Alcohol Abuse, 26(2), pp. 263-281, 2000.
To explore the service needs of women in jail, the authors examined three pathways into prostitution: childhood sexual victimization, running away, and drug use. Studies typically have explored only one or two of these pathways, and the relationships among the three points of entry remain unclear. Data on 1,142 female jail detainees were used to examine the effects of childhood sexual victimization, running away, and drug use on entry into prostitution and their differential effects over the life course. Two distinct pathways into prostitution were identified. Running away had a dramatic effect on entry into prostitution in early adolescence, but little effect later in the life course. Childhood sexual victimization, by contrast, nearly doubled the odds of entry into prostitution throughout the lives of women. Although the prevalence of drug use was significantly higher among prostitutes than among non-prostitutes, drug abuse did not explain entry into prostitution. Running away and childhood sexual victimization provide distinct pathways into prostitution. The findings suggest that women wishing to leave prostitution may benefit from different mental health service strategies depending on which pathway to prostitution they experienced. McClanahan, S.F., McClelland, G.M., Abram, K.M., and Teplin, L.A. Pathways into Prostitution Among Female Jail Detainees and their Implications for Mental Health Services. Psychiatr Serv, 50(12), pp. 1606-1613, 1999.
This study examines 5225 out-of-treatment crack users and drug injectors drawn from five different geographic areas to examine selected factors associated with homelessness. Of these crack users, 27% considered themselves undomiciled, and 60% had previously entered some type of drug treatment. Logistic regression found that substance abusers who were married, female, and persons of color were less likely to be without a home when other variables were controlled. Trading sex for money and perceived chance of getting acquired immunodeficiency syndrome (AIDS) were associated positively with homelessness, while participating in methadone detoxification and methadone maintenance programs seemed to offer some protection from homelessness. Royse, D., Leukefeld, C., Logan, T.K., Dennis, M., Wechsberg, W., Hoffman, J., and Cottler, L. Homelessness and Gender In Out-of-Treatment Drug Users. American Journal of Drug and Alcohol Abuse, 26(2) pp. 283-96, 2000.
The purpose of this paper was to compare female crack users who report exchanging sex for drugs and/or money with female crack users who did not report exchanging sex for drugs and/or money. A multi-site sample (n = 4667) of female crack users who participated in the National Institute on Drug Abuse (NIDA) AIDS Cooperative Agreement Project from 20 sites were interviewed. Statistical analysis compared two groups on selected variables of interest: women crack users who reported exchanging sex for drugs and/or money (n = 2658) and women crack users who did not report exchanging sex (n = 2009). Results indicated that both groups of women had frequent unprotected sex. However, women who exchanged sex had more sexual partners, had sex more often, used drugs before and during sex more often, and had a higher rate of STDs than women who did not exchange sex. In addition, African-American women, homeless women, and women who reported past substance abuse treatment were about twice as likely to exchange sex. Regional differences were also examined. Logan, T.K. and Leukefeld, C. Sexual and Drug Use Behaviors among Female Crack Users: A Multi-Site Sample. Drug and Alcohol Dependence, 58(3), pp. 237-45, 2000.
The authors used data from the Mid-Atlantic School Age Twin Study to examine associations between religiousness and substance use. Adolescent religiousness was at least somewhat inversely correlated with drug and alcohol use and with other behavior problems. Religiousness was also related to lower peer conduct problems and drug use, and strongly negatively correlated with sensation seeking, especially in females. From analysis of this twin data, religiousness in adolescents appears to be largely a function of shared environmental factors, with only modest heritability; thus it may prove more important in protecting against initial adolescent use than against more heritable later drug use problems if drugs are initiated. D'Onofrio, B.M., Murrelle, L., Eaves, L.J., McCullough, M.D., Landis, J.L., and Maes, H.H. Adolescent Religiousness and its Influence on Substance Use: Preliminary Findings from the Mid-Atlantic School Age Twin Study. Twin Research, 2, pp. 156-168, 1999.
This study examined relationships among ethnicity, gender, drug use, and resistance to drug offers in a sample of 2,622 African American, Mexican American, and White American seventh graders. Findings included: first, the adolescents did not possess large or sophisticated repertoires of drug resistance strategies. Second, most offers came from acquaintances in contrast to data on older adolescents where offers generally come from intimate friends. Third, ethnicity had significant effects on use and the offer process. Mexican Americans received more offers, used more drugs, and were more likely to be offered drugs by peers, family members and at parties. European Americans were more likely to receive drug offers from acquaintances and at friends' homes and on the street. African Americans were more likely to receive offers from dating partners and parents, and in the park, and were more likely to resist offers of drugs-using explanations. Fourth, gender significantly affected drug offers and types of offers. Males were more at risk for offers and use at a younger age. Offers of drugs to males were more likely to come from parents or other males, while offers to females were more likely to come from other females or dating partners. Males were also more likely to receive drug offers that appealed to their social standing or self-image whereas females received either simple offers or those that minimize effects. Finally, offers of drugs to males were more likely to be made in public, while those to females were more likely to occur in private. Moon, D.G., Hecht M.L., Jackson, K.M., and Spellers R.E. Ethnic and Gender Differences and Similarities in Adolescent Drug Use and Refusals of Drug Offers. Substance.
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Services Research |
Health care use by injection drug users (IDUs) with AIDS were analyzed for methadone maintenance treatment (MMT) patients using AIDS surveillance and Medicaid health care claims data. Consistent participation in MMT was associated with a higher probability of antiretroviral use and, among antiretroviral recipients, more consistent use of antiretrovirals. Consistent MMT was more likely among women, whites, and older subjects. For AIDS-infected IDUs, consistent MMT may lower barriers to receipt of appropriate HIV-related health care and reinforce adherence to medical recommendations. Monthly total expenditures and inpatient expenditures were significantly lower for IDUs in MMT than for IDUs with claims indicative of current drug abuse. Sambamoorthi, U., Warner, L.A., Crystal, S., Walkup, J. Drug Alcohol Depend, 60(1), pp. 77-89, 2000.
Greater improvement in post-treatment outcomes has been shown in programs that tailor frequency and type of services to unique client needs. Using a sample of 635 clients (199 females and 436 males) admitted to three community-based methadone treatment programs, this study examined gender differences in services needed and provided during the first 3 months of treatment. Results revealed that compared to males, women entered treatment with more psychological symptoms and AIDS/HIV-risky behaviors. They also presented with less criminal activity, less alcohol use, and higher motivation. Counselors addressed psychological and crisis issues more frequently with women, and counseling strategies were more often directed toward developing problem-solving and communication skills. Counselors also made more medical referrals and reported having better rapport with females. Attention to employment issues and HIV/AIDS sexual-risk behaviors did not differ by gender, even though women had more needs in these areas. Rowan-Szal, G.A., Chatham, L.R., Joe, G.W., and Simpson, D.D. Journal of Substance Abuse Treatment, 19(1), pp. 7-14, 2000.
The prevalence of major depression was compared in two cohorts of injection drug users in Rhode Island, those enrolled in a methadone maintenance treatment program (MMTP) and those enrolled in a needle exchange program (NEP). Symptomatic and duration criteria for major depression in the last 6 months were identified using the Structured Clinical Interview for DSM-III-R. Among 528 persons interviewed, 54% of those in NEP and 42% of those in MMTP met criteria for major depression. Women (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.7-3.7), persons with alcohol use disorders (OR 1.7, 95% CI 1.1-2.7), and persons without a current partner (OR 1.8, 95% CI 1.2-2.6) were more likely to be depressed. Persons enrolled in MMTP were less likely to be depressed (OR 0.6, 95% CI 0.4-0.8) than NEP. Higher rates of depression were found among NEP attendees than among those enrolled in MMTP. Mental health referrals should be part of the growing number of needle exchanges in the United States. Brienza, R.S., Stein, M.D., Chen, M., Gogineni, A., Sobota, M., Maksad, J., Hu, P., and Clarke, J. J Subst Abuse Treat,18(4), pp. 331-337, 2000.
Although the importance of gender-sensitive programming for women has been acknowledged, few studies have examined outcomes from male-centered interventions in substance abuse treatment programs. Data were collected from 122 male clients in a court-mandated residential treatment program who participated in a study of a psychoeducational group intervention for men. The intervention (Time Out! For Men) addressed communication skills, sexuality, gender socialization, and intimacy. Participation in the training resulted in significant increases in knowledge and social conformity, along with reductions in attitudes that may be associated with rigid socialization and gender-role conflict. The results provide support for the utility of male targeted programming in substance abuse treatment settings. Bartholomew, N.G., Hiller, M.L., Knight, K., Nucatola, D.C., Simpson, D.D. J Subst Abuse Treat,18(3), pp. 217-225, 2000.
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