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National Institute on Drug Abuse
Women and Sex/Gender Differences Research
Director's Report to Council
Research Findings Excerpts
February, 1998
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Basic Research |
Females and Anabolic Steroid Use
Research findings, soon to be published, report that three commonly used anabolic-androgenic steroid (AAS), stanozolol, oxymetholone, or testosterone cypionate, produce alterations in the reproductive behavior and physiology of female rats. Dr. Ann Clark and her associates found AAS-induced disruptions in the cyclical display of vaginal estrus following acute or 14 days paradigm; however, their effects on sexual receptivity were different. Studies in ovariectomized rats also showed a time course variation with respect to sexual receptivity. For example, methyltestosterone, methandrostenolone and stanozolol interfered with the display of sexual receptivity on Day 14, whereas oxymetholone and testosterone cypionate had no effect. These findings illustrate that short-term administration of AAS compounds do elicit measurable and distinct effects on the estrous cycle as well as on female sexual behavior. Blasberg, M.E., Langan, C.J. & Clark, A.S. Physiology & Behavior, In Press; Clark, A.S., et al. Hormone & Behavior, In Press.
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AIDS Research |
HIV Seroprevalence Rates Among Homicide Victims in New York City: 1991-1993
Tardiff and his team (Cornell) assessed HIV seroprevalence in homicide victims killed in New York City in 1991-1993, using data from the Office of Chief Medical Examiner. Among 5,852 homicide victims, there were 344 (5.9%) victims who were HIV+. Females were just as likely as males to be HIV+. For females, the rates were 11.7% and 12.6% in the 25-34 and 35-44 year age group, respectively. The highest rates of HIV infection for homicide victims were among those using both opiates and cocaine (males:23.0%; females:27.3%). The rate of HIV infection among women using cocaine was 18.4%. In comparison, the victims not using these drugs had rates of HIV infection around 2%. According to the investigators, the high risk of HIV among homicide victims may be due to the use of cocaine and associated risky use of needles and risky sex practices. Tardiff, K., Marzuk, P.M., Leon, A.C., Hirsch, C.S., Stajic, M., Portera, L., Hartwell, N. J Forensic Sci., 42(6), pp. 1070-1073, 1997.
HIV Infection Among Victims of Accidental Fatal Drug Overdoses in New York City
Tardiff and his colleagues at Cornell determined the factors associated with HIV seroprevalence rates for victims (n=2,159; over 15 years of age) of drug overdoses in New York City (population 7,322,564) in 1991-1993, using data from the Office of Chief Medical Examiner. There were 646 (29.9%) victims who were HIV positive. Women (37.5%) were more likely than men (27.9%) to be HIV+. African-Americans (39.4%) had a higher rate of HIV infection than Latinos (27.5%), whites (19.2%) or Asians (8.3%). The rates of HIV positive seroprevalence were 38.8%, 33.7% and 20.4% among victims aged 35-44, 45-54, and 25-34, respectively. Dying from opiates overdose was associated with a 24 times increase in the likelihood of being HIV positive. Women who died of drug overdoses were more likely than men to be HIV positive. The authors stated that this may be related to risky sex practices as well as sharing needles (Inciardi et al.1993 and Beveer et al. 1995). They suggest that harm reduction programs should address risky sex as well as needle programs. Tardiff, K., Marzuk, P.M., Leon, A.C., Hirsch, C.S., Portera, L., Hartwell, N. Addiction, 92(8), pp. 1017-1022, 1997.
Impact of AIDS Prevention Intervention on Risky Behaviors and Drug Use
This study examined the impact on specific risky behaviors of two randomly assigned cognitive-behavioral community-based AIDS interventions for high-risk impoverished African-American (N = 353) and Latina (N = 31) women residing in homeless shelters or drug treatment facilities. The study participants were contrasted with untreated, newly recruited controls. An in-depth Specialized program provided AIDS information, and psychosocial and behavioral skill enhancement; a shorter Traditional program provided basic AIDS information. Both treatment groups received information about community resources. At follow-up, women exposed to either program reported significant decreases from their baseline scores in unprotected sexual activity, illegal activities (providing sex for drugs or money), cocaine use, heroin use, and high risk drug-related behaviors such as sex with injection drug users and needle-sharing. After controlling for pre-existing differences between the groups and whether they were in drug treatment, the Specialized group reported less cocaine use and fewer illegal activities. Further comparisons with the untreated newly-recruited control group supported findings of improvement across the two years for both treatment groups. Community-based AIDS health education efforts are discussed. Stein. J.A., Nyamathi, A., and Kington, R. Journal of Community Psychology, 25, pp. 519-533, 1997.
Adolescent Conduct Disorder Predictive of HIV Risk Taking Behaviors
A study was conducted to assess the prevalence of conduct disorder among runaway and homeless adolescents and to investigate associations between conduct disorder and HIV risk behaviors. The Diagnostic Interview Schedule for Children and a standardized HIV risk assessment questionnaire were administered to 219 runaway and homeless adolescents recruited from a drop-in center serving high risk youth. One half of the males and 60% of the females were diagnosed with conduct disorder. In multivariate analyses, conduct disorder was the strongest predictor of lifetime use of heroin and/or cocaine and exchanging sex for money, drugs, food or shelter, as well as the number of drugs used and the number of sex partners in the last 3 months. The high rate of conduct disorder in this population, and the association between conduct disorder and both drug and sex-related HIV risk behaviors, indicate a need for interventions that consider the influence of psychiatric diagnosis on high risk behaviors. Booth, R.E. and Zhang, Y. Conduct Disorder and HIV Risk Behaviors among Runaway and Homeless Adolescents. Drug and Alcohol Dependence, 48: pp. 69-76, 1997.
Psychosocial Risk Factors for HIV Transmission in Female Drug Abusers
This cross- sectional study examined the influences of domains of psychosocial risk factors on needle-sharing with familiar people and with strangers in a cohort of female injecting drug users (IDUs). Subjects were 119 female IDUs, 46% of whom were HIV+. Subjects were given individually administered questionnaire interviews. Using Pearson correlation coefficients and multiple hierarchical regression analyses, personality, family, and peer attributes related to needle-sharing in women were similar to those found in men, with certain exceptions. Specifically, in males, the family was more distal in its effect on needle-sharing behavior. The role of the family, particularly the significant other, was more important and proximal in its effect on needle-sharing behavior in women than in men. The data suggest that women's resilience and resistance to self-destructive behavior are closely related to ties with others. There was a main effect as well as mediating effects of protective family factors in women, buffering the risk factors leading to needle-sharing. Brook, D.W., Brook, J.S., Whiteman, M., Win, P.T., Gordon-Maloul, C., Roberto, J., Amundsen, F., Masci, J.R., de Catalogne, J. Psychosocial Risk Factors for HIV Transmission in Female Drug Abusers. The American Journal on Addictions, 6 (2), pp. 1-12, 1997.
HIV-Risk Behaviors and Mental Health Characteristics Among Homeless or Drug Recovering Women and their Supportive Person
This paper describes risky drug and sexual behavior and mental health characteristics in a sample of 240 homeless or drug-recovering women and their most immediate source of social support. Women and their closest support sources both reported a great deal of recent non-injection drug use (56% and 52%, respectively) and lesser, though similar, amounts of recent injection drug use (12% and 14%, respectively). Over a third of both groups reported a history of STD and sexual activity with multiple partners. Fifty-one percent of the women and 31% of their companions had CES-D scores of 27 or greater, suggesting a high level of depressive disorders in both samples. Similarly, 76% of the women and 59% of their friends had psychological well-being scores below a standard clinical cutpoint. These data suggest that homeless and impoverished women are turning to individuals who are themselves at high risk for emotional distress and risky behaviors as their main source of support. Implications relating to the importance of integrating the dyad in interventions and introducing alternate sources of support are discussed. Nyamathi, A., Flaskerud, J., and Leake, B. Nursing Research, 46 (3), pp. 133-137, 1997.
Relative Impact of Two AIDS Education Programs among High-Risk Women on Cognitive, Behavioral, and Psychosocial Variables
Changes in cognitive, psychological, and risky behavior latent variables after traditional or specialized AIDS education were assessed using structural equation modeling in a sample of impoverished at-risk African American women (N = 300). The traditional group watched an AIDS videotape and received a 1-hour basic AIDS education program. In addition to the videotape, the specialized group received a 2-hour program in which they received a demonstration of risk-reducing behaviors, discussion of problem-focused coping, and techniques to enhance self-esteem. Also, they received individualized responses to their concerns such as referrals to drug rehabilitation programs or shelters. Both groups reported significant improvement at two years in their self-esteem and social resources. They also reported less threat perception, avoidant coping, emotional disturbance, HIV risk behavior, and drug use behavior. Also, when compared with the traditional group at two years, women in the specialized group reported more social resources, more reduced emotional distress, less use of an avoidant coping style, and less drug use. The advantages of culturally sensitive HIV risk reduction programs and the importance of connecting women with social services available in their communities are discussed. Nyamathi, A.M. and Stein, J.A. AIDS Education and Prevention, 9, pp. 253-273, 1997.
Behavioral Change in HIV+ Adolescents
This study examined whether HIV+ adolescents (N=102) linked to care then change risk and health-related behaviors subsequent to learning their HIV serostatus, and to document the stability of their current behavior patterns over a 6-month period. Over their lifetime, youths engaged in unprotected sexual acts with multiple partners (M=284; median=44; consistent condom protection, 5%) and substance use (21% injecting drug use; 68% hard drugs). When current risk behaviors were assessed twice over two consecutive 3-month periods, almost one third had been sexually abstinent. Among youths who were currently sexually active, most had multiple sexual partners (M=5.7, time 1; 4.9, time 2) and used condoms (72-77% sexual acts protected); most of the youths (63-64%) always used condoms. Use of alcohol (63%), marijuana (41%), hard drugs (36%), and injecting drugs (12%) was substantial. There were gender difference among sexual behavior (females had fewer sexual partners) and substance use behavior (fewer females injected drugs or shared needles). Youths were relatively healthy (M T cells=521.4; 14% T cells < 200; 1.9 diseases and 3.7 physical symptoms in the previous 3 months). There was an exceptionally high rate of adherence, about 66% for appointment over 3-6 months. Rotheram-Borus M.J., Murphy D.A., Coleman C.L., Kennedy M., Reid H.M., Cline T.R., Birnbaum J.M., Futterman D., Levin L., Schneir A., Chabon B., O'Keefe Z., & Kipke M. Risk Acts, Health Care, and Medical Adherence among HIV+ Youths in Care Over Time. AIDS and Behavior, 1, pp. 43-51, 1997.
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Clinical and Services Research |
Psychosocial Predictors of Drug Abuse Among Drug Clinic-Referred Youths
In a study that examined 2582 adolescents referred to drug treatment facilities nationwide and in Ontario, Canada, who met criteria for DSM-III-Revised drug abuse or dependence of at least one psychoactive substance, Winters, Latimer and Stinchfield found the strongest predictors of drug use severity at the time of referral, as measured by the Personal Experience Inventory, to be use of illicit drugs by peers and by siblings. Less predictive were psychological distress (emotional disturbance; social isolation), declaration of nonconventional values (e.g., rejecting conventional values; absence of goals; spiritual isolation), and family distress (e.g., parent drug use; parent dysfunction; family estrangement). Results were similar for all racial/ethnic, gender, and age subgroups represented in the study sample. Journal of Pediatric Psychology. In Press.
Influences on Adolescent Substance Dependence: Conduct Disorder, Depression, Attention Deficit Hyperactivity Disorder, and Gender
Whitmore and his colleagues from the University of Colorado conducted a study to determine if prevalence and severity of conduct disorder (CD), major depression and ADHD would differ by gender, and that these conditions would associate differentially with severity of substance disorder (SD) in males and females. The subjects were 285 male and 82 female adolescents referred for treatment for comorbid CD and SD. The investigators found that males and females did not differ significantly in severity of substance involvement, major depression, or ADHD, but males had more severe CD. Major depression was the only variable significantly associated with SD severity for females, while for males, severity of CD combined with major depression and ADHD was significantly associated with SD severity. The authors concluded that among referred adolescents, CD, major depression, and ADHD may all be important concomitants of SD in males, while in females, depression may be the primary variable related to SD. Whitmore, E.A., Mikulich, S.K., Thompson, L.L., Riggs, P.D., Aarons, G.A., and Crowley, T.J., Drug and Alcohol Dependence, 47, pp. 87-97, 1997.
Risk Factors for Disruption of Primary Caregiving of Substance-Abusing Mothers
Researchers at the University of Maryland School of Medicine have identified perinatal factors (i.e., postpartum hospital stay and 2-week visit) that are predictive of disruption of primary infant caregiving among high-risk, substance-abusing mothers. Disruption of primary caregiving was defined as the infant receiving substitute care during the first 18 months of life because of the mother's inability to care for her infant due to neglect/abuse, incarceration, continued drug abuse, or homelessness (includes voluntary placement with a relative as well as protective service referral). All women in the study were at high risk for disruption based on histories of drug abuse, poverty, limited education, and other social problems. All had a history of heroin and/or cocaine use during pregnancy. Analyses were based on 152 mother-infant dyads from a larger, ongoing longitudinal study. Forty-three percent of the sample had disruption in primary caregiving. Bivariate analyses compared the disruptive care group with the non-disruptive care group on maternal and neonatal factors. Results of a multiple logistic regression showed that younger maternal age, two or more other children, positive heroin tox at delivery, and reported depressive symptoms were significantly associated with disruption of caregiving. The investigators discuss possible processes underlying these relationships, and implications of the findings for screening and service delivery. Nair, P., Black, M.M., Schuler, M., et al. Child Abuse & Neglect, 21, pp. 1039-1051, 1997.
Demographic, Drug Use, and Psychosocial Characteristics of Rural Pregnant Cocaine Users
Data from a University of Florida project following the development of children exposed to cocaine in utero provide important new information on the demographics, drug use patterns, and psychosocial factors of a sample of women rarely characterized in the scientific literature, i.e., women from a generally rural population with minimal access to drug treatment, and with varying amounts of crack cocaine use during pregnancy, but with little other illicit drug use during pregnancy. The study involved 154 women in the cocaine use group, and 154 in the non-cocaine comparison group, matched on race, parity, socioeconomic status, and level of prenatal risk. Based on information collected at the time of study enrollment (i.e., the earliest contact possible after the first trimester of pregnancy) for the demographic and drug use factors, and at the time of delivery for the psychosocial variables, cocaine users were found more likely to be older, to use other drugs, to begin their drug use at an earlier age, to have more depressive symptoms, to have an external locus of control, to have lower self-esteem, to have a more simplistic understanding of child development, and to have higher positive life event impact scores. There were also similarities between the two groups, such as level of education completed (average of 11th grade for both groups) and marital status (69% never married in each group). Both groups exhibited a very low level of reading skills, a finding that led to reading the interviews and measures to each participant, and that has implications for healthcare and drug treatment programs. Behnke, M., Eyler, F.D., Woods, N.S., et al. Journal of Drug Issues, 27, pp. 501-524, 1997.
Modeling Missing Data
In a paper presented at the American Society of Criminology, in November, 1997, Strauss and Falkin discussed early findings of a new methodological approach to examine non-ignorable nonresponse in a sample of (approx. 330) women offenders in drug treatment in New York City. In their sample, about 17 percent self-reported HIV infection. An analysis taking missing data into account increased the upper bound estimate of seroprevalence to 35 percent. Strauss, S. & Falkin, G. Modeling the Missing Data Mechanism: An Exploration into the Unknown, Presented at the Annual Meeting of the American Society of Criminology, San Diego, November 1997.
A Bi-Costal Comparison of Criminal Activity and Drug Use
In November 1997, Falkin and Strauss presented findings from Project WORTH (Women's Options for Recovery Treatment and Health), a large scale evaluation of treatment programs that serve women mandated into treatment in New York City and Portland, Oregon. They found that three-quarters of the women in New York City used crack, while methamphetamine was the most commonly used drug in the Portland sample (reported by over 50% of women). Over three quarters of the women in both cities reported use of stimulants, including cocaine, crack, methamphetamine, and other amphetamines. Injection drug use was more prevalent in the Portland sample. Falkin, G. & Strauss, S., East Coast Meets West Coast: A Comparison of Criminal Activity and Drug Use Among Women in New York City and Portland, Oregon. Presented at the Annual Meeting of the American Society of Criminology, San Diego, November 1997.
Health Needs of Women in Drug Treatment
In a study of 500 women who entered drug treatment programs through the criminal justice system in New York, Falkin and Strauss found that nearly half rated their health as only fair or poor. This is an unfavorable comparison with women in the general population. The most frequently cited health problems were lung problems, gynecological problems, excessive undesired weight loss, night sweats, and HIV/AIDS. Almost one third of the women perceived no connection between their drug use and physical health, and only 20% recognized a close connection between their drug use and health. Health status was poorest among long-time drug users. Falkin, G. and Strauss, S., Emotional and Physical Health Problems and Needs of Women in Drug Treatment, paper presented at the American Public Health Association, Indianapolis, November 1997.
Potential for Child Abuse
Falkin and Strauss found average scores on the Child Abuse Potential Inventory (CAP) among women substance-abusing offenders with minor children (N=300) were in the same range as scores for individuals convicted of child abuse. These scores were significantly higher for women with psychological problems and those who had experienced physical abuse as children. The children of these women may be at high risk for abuse if the women do not receive appropriate interventions after treatment. Falkin, G. and Strauss, S., The Potential for Child Abuse Among Women Offenders Who Abuse Substances, paper presented at the 7th International Conference on Family Violence, Durham, New Hampshire, June 1997.
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Epidemiology, Etiology, and Prevention Research |
Community Epidemiology Work Group (CEWG)
The 43rd biannual meeting of the CEWG was held in Phoenix, Arizona on December 9-12, 1997. 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: Crack cocaine continues to dominate as the Nation's primary illicit drug problem, but indicator data show a leveling off in many urban areas: cocaine-related deaths were stable or up slightly in 6 of the 8 areas where such information was reported; emergency department (ED) mentions increased* in only 3 of the 20 CEWG cities in the Drug Abuse Warning Network (DAWN); the percentage of treatment admissions for primary cocaine problems declined slightly or remained stable in 13 of the 15 areas where data were available; and prices remained stable or declined slightly in most areas. Supplies remain abundant in nearly every city. Cocaine continues to be frequently used in combination with other drugs in some cities, including heroin and marijuana in Atlanta and Philadelphia, and methamphetamine in Denver. Demographic data continue to show most cocaine users as older, inner-city crack addicts; only in Miami were any new using populations reported this period. [* DAWN comparisons are for 1994 versus 1996; they are included only when they are reliable at p< 0.05.]
- Heroin: Heroin overshadows cocaine in some indicators: it was the top-ranking ED mention in three cities, and it was the most common primary drug of abuse among treatment admissions in six areas. The rate of ED mentions per 100,000 increased significantly* in eight cities. Mortality, treatment, arrestee urinalysis, and price/purity figures were mixed, with increases in some cities, declines in others, and stable trends in others. In six CEWG cities, noteworthy percentages (>10 percent) of arrestees, both male and female, tested heroin-positive in the Alcohol and Drug Abuse Monitoring (ADAM) program.
Injecting remains the most common route of heroin administration--particularly in the West, but also in some eastern and midwestern cities. However, it is declining sharply in some cities. Snorting predominates in several eastern and midwestern cities. Smoking is increasing among treatment admissions in Hawaii, San Diego, San Francisco, Atlanta, and Denver. Younger heroin users tend to snort or smoke the drug. Overall, heroin users tend to be males, older than 35, but in some cities, qualitative and quantitative data--including mortality figures in Miami--indicate increases among those age 18-25. Those age 17 and younger still account for relatively few ED mentions or treatment admissions, but even the low numbers, in areas such as Dallas, Minneapolis/St. Paul, San Francisco, and Texas, are a cause for serious concern.
- Marijuana: Continuing the upward trend in many cities since 1992, marijuana ED rates increased significantly* in 9 CEWG cities and primary marijuana abuse as a percentage of treatment admissions increased slightly to moderately in at least 10 reporting areas since the previous reporting period. Marijuana is now the top-ranking primary drug in at least four areas, and it accounts for substantial proportions (>20 percent) of nonalcohol admissions in at least three others. Among adult male arrestees, marijuana now exceeds cocaine as the most frequently detected drug in eight of the CEWG cities in ADAM; moreover, in each of the seven CEWG cities where ADAM tests juvenile males, the percentage of positive urinalyses is much higher for juveniles than for adults. Treatment demographics have similarly become increasingly youth dominated: the <17 age group now accounts for the largest percentages of marijuana admissions in at least eight areas. That age group also accounted for 20 percent or more of marijuana ED mentions in seven of the CEWG cities in 1996. All age groups, however, are substantially represented in all indicators, both qualitative and quantitative. Youth often consume marijuana with malt liquor. In some cities, joints or blunts are also dipped in PCP, codeine cough syrup, or embalming fluid; sometimes they contain crack or cocaine HCl, or they are laced with heroin.
- Stimulants: Except for ED mentions, methamphetamine indicators--mortality, treatment, and arrestee urinalysis--and ethnographic research show increases in the West, where the problem has been historically centered. Recent ADAM data show increases** in all the western CEWG cities. San Diego mortality figures also show increases, as do treatment figures in Denver, Los Angeles, and San Francisco. Methamphetamine is the most common primary drug among treatment admissions in San Diego and Hawaii, and it equals heroin as the number-one drug in Arizona. By contrast, ED rates declined significantly by 30-40 percent* throughout the West. They also declined* in Philadelphia, but the numbers are much lower there. The only city with a significant increase* was Minneapolis/St. Paul, but, again, the numbers are sharply lower than in the West. Smoking has recently overtaken inhalation as the primary route of administration in San Diego and Los Angeles. "Ice" smoking also predominates in Hawaii, and it is increasing in Denver and San Francisco. Injecting, however, still predominates in Denver, San Francisco, and Texas. In San Francisco, methamphetamine remains widespread among the gay and club scenes. Denver drug dealers sometimes cut crack or heroin with methamphetamine. Elsewhere in the country, methamphetamine appears in indicators in Minneapolis/St. Paul and in the rural areas surrounding St. Louis; availability is reported in Atlanta and New Orleans; and it is associated with the club or rave scenes in Boston, Baltimore, Miami, and New York City. [**ADAM comparisons are for first half of 1996 versus first half of 1997.]
- Methylenedioxymethamphetamine (MDMA or "ecstasy") availability is reported in 12 CEWG areas, primarily as a club drug at raves and dance parties. Increases are reported in Boston and Miami. Ephedrine-based products remain a major concern, with products such as "herbal ecstasy" widely available at convenience stores and truck stops in many CEWG areas, including Minneapolis/St. Paul and Arizona. Methylphenidate (Ritalin) abuse is reported among school-aged adolescents in Boston and Washington, DC, and it is the drug of choice for some stimulant users in Chicago. Seizures of khat, a flowering evergreen shrub also known as "qat" or "Somali tea," continue in Minneapolis/St. Paul.
- Depressants: Gamma-hydroxybutyrate (GHB) has been involved in poison control cases in Boston, Miami, and Texas, and is suspected in deaths in Miami; it is also part of the club scene (but not reported as a significant problem) in Baltimore, Honolulu, New York City, and areas of New Jersey; in Atlanta, it has become common as a synthetic steroid. Another club drug, ketamine ("Special K" or "Vitamin K"), is available in Boston (where youth both smoke and inject it), Honolulu, Miami, Minneapolis/St. Paul (where adolescents and young adults snort it and sometimes sprinkle it on tobacco or marijuana), New York City (where recent legislation has classified it as a controlled substance), and Washington, DC. Flunetrazepam (Rohypnol) availability has been sharply curtailed in Miami since State and Federal legislative measures were enacted. In Texas, however, it continues to be reported by treatment admissions, especially youth, in border areas. It continues to be reported in "date rape" incidents in Atlanta, Minnesota (where large quantities have been seized), and the Washington, DC, area; and it is used as a club drug in Atlanta and Honolulu. It has received media attention in some cities, such as San Diego and Seattle, but is not a widespread problem there. Clonazepam (marketed as Klonopin in the United States and Rivotril in Mexico), is sold and abused as flunetrazepam in Miami; on the Texas-Mexico border, juveniles widely use it in combination with beer, just as they had used flunetrazepam before the import ban. Opiate addicts use it to enhance the effects of methadone in Atlanta, Boston, and Minneapolis/St. Paul (where availability has declined).
- Hallucinogens: Lysergic acid diethylamide (LSD) is reportedly available in many CEWG cities and prices have become somewhat lower. However, indicators are declining in most areas. Rates of LSD-related ED mentions declined* in every CEWG area with the exception of San Diego and New Orleans. Similarly, phencyclidine (PCP)-related ED mentions declined* in six CEWG cities, but rose slightly in three. Primary hallucinogen users generally continue to constitute small percentages of total treatment admissions. Most hallucinogen users are young, suburban and middle class. In numerous areas, such as Chicago, Philadelphia, St. Louis and Texas, PCP is frequently used in combination with other drugs, primarily marijuana. In Boston and Seattle, LSD and other hallucinogens are often regarded as club drugs and used in the rave scene. treatment figures in Denver, Los Angeles, and San Francisco. Methamphetamine is the most common primary drug among treatment admissions in San Diego and Hawaii, and it equals heroin as the number-one drug in Arizona. By contrast, ED rates declined significantly by 30-40 percent* throughout the West. They also declined* in Philadelphia, but the numbers are much lower there. The only city with a significant increase* was Minneapolis/St. Paul, but, again, the numbers are sharply lower than in the West. Smoking has recently overtaken inhalation as the primary route of administration in San Diego and Los Angeles. "Ice" smoking also predominates in Hawaii, and it is increasing in Denver and San Francisco. Injecting, however, still predominates in Denver, San Francisco, and Texas. In San Francisco, methamphetamine remains widespread among the gay and club scenes. Denver drug dealers sometimes cut crack or heroin with methamphetamine. Elsewhere in the country, methamphetamine appears in indicators in Minneapolis/St. Paul and in the rural areas surrounding St. Louis; availability is reported in Atlanta and New Orleans; and it is associated with the club or rave scenes in Boston, Baltimore, Miami, and New York City. [**ADAM comparisons are for first half of 1996 versus first half of 1997.]
High Prevalence of Sexual and Drug Use Risks Found in Drug-Using Women Who Have Sex With Women
Researchers analyzed the HIV-related risks of women IDUs and crack cocaine users who have sex with women. Between 1992-1994, 3,856 women were recruited from street settings in 19 U.S. cities participating as sites in NIDA's Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program. This analysis focused on data from 231 women who reported female sex partners in the 30 days before interview. In the 30 days before interview, 53% of the women had shared syringes and 66% had shared injection supplies. Only 11 women (6%) always used barrier protection while giving oral sex to women and 5 (3%) while receiving oral sex from women in the 30 days before interview. Fifty percent of the women reported sex with men as well as women in the previous 30 days, but only 26%-30% of the women who had sex with men used barrier methods to protect themselves from acquiring or transmitting HIV or other STDs. Having sex with men was predicted by commercial sex work, but not by self-identifying as a "lesbian." Differences in risk perception were significant between women who reported varying sexual risks, but not significant between women who reported varying injection-related risks. There is a high prevalence of risky sex and drug behaviors among drug using women who have sex with women, indicating a need to increase prevention efforts aimed toward this risk group. Kral, A.H., Lorvick, J., Bluthenthal, R., and Watters, J. HIV Risk Profile of Drug-Using Women Who Have Sex With Women in 19 U.S. Cities. J. AIDS, 16: pp. 211-217, 1997.
Associations Between Attention Deficit Hyperactivity Disorder (ADHD) and Psychoactive Substance Use Disorders (PSUD)
In a sample of siblings of ADHD and non-ADHD probands, ADHD, conduct disorder, anxiety disorders, and male gender in the sibling were associated with higher rates of PSUD. There was also a statistical interaction between ADHD and conduct disorder in which nearly all siblings with both disorders had PSUD and a particularly early onset of that disorder. Using DSM-III-R structured diagnostic interviews and blind raters, a four-year follow-up of siblings from ADHD (N=152) and control families (N=117) was conducted. The mean age of the siblings was 17.3 (range 9 to 41) and roughly half were males. Information on PSUD was obtained in a standardized manner blind to the proband's clinical status. Cox proportional hazards models evaluated baseline diagnoses of ADHD and other psychiatric disorders (conduct, anxiety, and mood) as potential predictors of PSUD. These Cox analyses simultaneously controlled for confounding variables such as age, gender, intactness of family, and SES. These findings linking ADHD and PSUD could have significant public health significance. Since ADHD is a prevalent, childhood-onset disorder that is often characterized by impulsive behavior, it could represent a large group of youth at high risk for illicit drug use. Considering that the earliest age at onset of PSUD in our sample was 12 years and that the latest age at onset of ADHD is 7 years, there may be a window of several years where prevention and early intervention efforts could be targeted. Milberger, S., Biederman, J., Faraone, S.V., Wilens, T., and Chu, M.P. American Journal on Addictions, 6, pp. 318-329, 1997.
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Intramural Research |
Brain Imaging Section
Sex Difference in Up-regulation of Nicotinic Acetylcholine Receptors in Rat Brain
Male and female rats exhibit different neurochemical and pharmacologic responses to chronic nicotine. Recent declines in tobacco smoking have been less pronounced in women than in men and prompted an evaluation of sex differences in the effects of chronic nicotine administration and withdrawal on nicotinic acetylcholine receptor (nAChR) binding in the rat. Rats received nicotine or saline once a day for 15 days, and were killed either 1 or 20 days after discontinuing the chronic treatment. Male but not female rats receiving chronic nicotine had higher receptor densities than corresponding control groups; up-regulation of nAChRs was not seen 20 days after withdrawal. Further, in groups showing no up-regulation (controls and rats withdrawn for 20 days), nAChR densities were higher in female rats than males. The findings underscore the importance of sex differences in pharmacological responses as well as in basal neurochemical parameters. Koylu, E., Demirgoren, S., London, E.D., and Pogun, S. Life Sci., 61, pp. 185-190, 1997.
Functional Interactions Between Sex and Brain Development May Contribute to Attention-Deficit /Hyperactivity Disorder (ADHD) Pathophysiology
Using positron emission tomography and [18F]fluorodeoxyglucose (FDG), glucose cerebral metabolic rates (CMRglc) were compared between 10 Attention-Deficit/Hyperactivity Disorder (ADHD) (14.10_1.91 years) and 11 normal girls (14.3_1.70 years). Lateralization of normalized CMRglc differed significantly between ADHD and control girls in parietal and subcortical regions. The sylvian area of the parietal region and the anterior putamen of the subcortical region were the main contributors to this effect. Normalized CMRglc of the hippocampus was higher in ADHD than in control girls. Sexual maturation correlated negatively with global CMRglc. This study suggested that (1) functional interactions between sex and brain development may contribute to ADHD pathophysiology, and that (2) sexual maturation should be controlled in future CMRglc studies of adolescent girls. Ernst, M., Cohen, R.M., Liebenauer, L.L., Jons, P.H., and Zametkin, A.J. Cerebral Glucose Metabolism In Adolescent Girls With Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 36, pp. 1399-1406, 1997.
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