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PubMed1991

[Human immunodeficiency virus (HIV) and drug dependence].

A research has been carried out at several centers for the treatment of drug abusers in Argentina, during the year 1989. Questions related to HIV infection were included among the topics under study. A questionnaire was filled out by 659 patients from both State-run, and private rehabilitation centers. 13.7% of the patients informed that they were HIV-infected, a percentage that reached 21% among shot injected drug abusers. An inquiry about prevention and care strategies (if any) these abusers resorted to, as far as the avoidance of HIV transmission to other people was concerned, revealed a tremendous lack of information. Thus, the major differences between HIV-infected, or non-infected substance abusers referred only to the kind of abused substance, and addiction consequences. Infected patients feature a higher cocaine consumption, higher overdose problems, accidents, and police taking them into custody.

Female↗
PubMed1986

AIDS health education for intravenous drug users.

Intravenous (IV) drug users are the second largest risk group for AIDS and the main source of infection for heterosexual partner and pediatric AIDS cases. IV drug users have an addiction and a subculture that make risk reduction difficult; for example, to refuse to share needles can endanger personal relationships, and carrying clean works (rather than renting them in a shooting gallery) risks arrest. In New York City, at least, knowledge about AIDS transmission is widespread among IV drug users, and most drug injectors report having changed their drug use practices to reduce their risks. The main functions of health education in areas where IV drug users have this level of knowledge are to disseminate news of new discoveries; reach those drug users who have not yet learned AIDS basics; reinforce what is already known; and provide information about new programs to help drug users deal with AIDS-related problems. To encourage behavior change requires going beyond simple education, however; it entails trying to change IV drug user subculture. Drug user groups in the Netherlands and in New York City are attempting to do this from within the subculture. Outside intervention requires repeated messages from multiple sources; face-to-face, interactive communication; and perhaps the use of ex-addicts as health educators.

Acquired Immunodeficiency Syndrome↗
PubMed1977

Heroin addicts with a history of glue sniffing: a deviant group within a deviant group.

Sociodemographic, drug-taking history and psychological test data were collected from 133 male heroin addicts in treatment programs. Those addicts who had ever sniffed glue (26.4%) were characterized by a unique orientation toward death. Not only were they significantly more likely to have attempted suicide, but also they more often fantasized about death both while on heroin and when clean, and they acknowledged less fear of the pain/deterioration involved in dying as measured by the Collett-Lester Scales. In addition, they had on the average abused more than twice as many different substances as addicts without a glue use history.

Adult↗
PubMed1997

A substance abuse consultation service. Enhancing the care of hospitalized substance abusers and providing training in addiction psychiatry.

The authors review the literature on the high prevalence but underrecognition of substance abuse among hospitalized patients and the general unavailability of hospital-based substance abuse consultation services. They describe the development, clinical operations, staffing, and teaching activities of a large substance abuse consultation service in one urban academic medical center and detail the service's growth and changing utilization patterns over an 8-year period, reporting the clinical characteristics of 1,819 patients seen over a 1-year period. Differences in patient demographics, patterns of substance use, and diagnoses were highly significant from one referring service to another. The authors discuss the implications of such a service for patient care and teaching.

Adult↗
PubMedDate not supplied

Psychological study in children addicted to inhalation of volatile substances.

Deliberate inhalation of volatile substances is a common and harmful practice among young persons around the world. Psychological studies were performed in 40 children habituated to inhalation of volatile agents, with the aim to define the psychological profile of inhalers, particularly their reactions against frustration. A significant difference in the extrapunitive attitude (p less than 0.001) and in the reaction of ego-defense (p less than 0.02) was found in sniffers as compared with controls. Addicted children also showed inadequate handling of frustration, aggressive and defensive behaviours, and passive and irresponsible attitude when confronted with problems.

Administration, Inhalation↗
PubMed1994

The prevalence of HIV infection among mentally ill offenders in Thailand.

The study was made at Nitichitawej Hospital in 1988 to find the prevalence among mentally ill offenders whom had detained there. The total of 325 cases were investigated by gel agglutination and confirmed by W-B analysis. A total of 81.5 per cent were mentally ill and the 1.85 per cent of these were HIV infected. Among the seropositive HIV, the two cases were Schizophrenia and the four cases were drug addicted.

Adult↗
PubMed1990

Seropositivity to Chlamydia trachomatis in prostitutes: relationship to other sexually transmitted diseases (STDs).

The prevalence of Chlamydia trachomatis and its relationship with other sexually transmitted diseases (STDs) was investigated by serological determinations in a group of 45 women working as prostitutes in Santos, State of São Paulo. Seropositivity to HIV-1 was demonstrated in 4 (9%) of the cases and to HIV-2 in one case. Syphilis and hepatitis B were detected in 29% and 43% of the 45 women, respectively. Specific antibodies to C. trachomatis were found in all subjects. The high seroprevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), syphilis and C. trachomatis in this population was related to predisposing factors such as number of sexual contacts, sexual practices, drug use and episodes of sexually transmitted diseases (STDs).

Adolescent↗
PubMed1991

Outcomes of an AIDS prevention program for methadone patients.

Methadone maintenance patients are at risk of contracting or transmitting HIV through intravenous drug use and/or unsafe sexual practices. An outcome evaluation of a voluntary AIDS prevention program for methadone patients in three clinics (two experimental, one control) is reported. The prevention program included three components: didactic AIDS education, HIV antibody counseling/testing, and facilitated peer support groups. Participation in AIDS education was associated with increased knowledge of AIDS risks and with improved attitudes toward condoms. Peer group participation was associated with improved attitudes toward the use of condoms and with increased use of condoms. Learning of HIV seronegativity was related to increased self-efficacy and decreased intravenous drug use risk behaviors. Rates of participation in the prevention program were disappointing, but the program seemed beneficial for those patients who did become involved.

Acquired Immunodeficiency Syndrome↗
PubMed1991

AIDS knowledge, attitudes, and behavior among inner city, junior high school students.

To gain information about AIDS knowledge, attitudes, and behavior of junior high school students, 1,967 students in three junior high schools in an inner city school district were surveyed. Ages of the participants ranged from 11-16 years, and 48% were male. Ethnically, 33% were Asian, 31% African-American, 24% Latino, and 5% white. African-American students had greater AIDS general knowledge than Asians and similar general knowledge to Latinos and whites. Most students wanted to be taught about AIDS in school. Misconceptions about casual contagion of AIDS were common. Students with these misconceptions were more likely to believe that students with AIDS should not be allowed to attend school. A high proportion of students had engaged in high-risk behavior including sexual intercourse, drinking alcoholic beverages, and using street drugs. More boys than girls reported each of these activities. Of individuals having had sexual intercourse, a positive association was found between the belief that condoms are effective in preventing HIV infection and use of condoms. These findings support the possibility that improving knowledge about HIV transmission would result in more tolerance toward students with HIV infection and would result in less high-risk behavior.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Recommendations and guidelines regarding the preferred research protocol for investigating the impact of an optimal healing environment on patients with substance abuse.

The addictive disorders affect every aspect of a person's life, and thus the most effective interventions are those that address many or all of these issues. Although the initial evaluation and intake process for addiction assessment is lengthy, this process does give the practitioner an opportunity to provide what can be considered an optimal healing environment (OHE) in treating the addictive disorders. In addition to our traditional medical treatment modalities of pharmacotherapy and psychotherapy, many complementary and alternative treatment modalities address and provide additional support for the holistic approach to treatment and recovery. The important role of spirituality in obtaining and maintaining recovery and sobriety has been recognized for many years. Because one specific treatment is not effective for all people and for all of the addictive disorders, using a holistic approach and individualizing the treatment regimen is the recommended approach to disease intervention and establishing an OHE. There are instruments available for measuring the facility, the staff, and the patient in their contributions to providing an OHE for substance abuse treatment. This paper suggests study design considerations for investigating the impact of an OHE on the results of treatment and specific instruments designed for use in patients with addictive disorders.

Clinical Protocols↗
PubMed2002

Brief treatment for young substance abusers: a pilot study in an addiction treatment setting.

The present study evaluated a motivationally based, 4-session outpatient intervention for young substance abusers presenting for addiction treatment. Follow-up interviews were conducted 6 months after assessment on (a) clients who sought additional help (n = 22) and (b) clients who did not seek additional help (n = 28). Results indicated that (a) participating in an assessment and brief intervention was associated with reduced use and consequences and increased confidence in high-risk situations up to 6 months after entry into the program, and (b) clients who participated in additional treatment showed less of a decrease in substance-related consequences. These findings suggest that brief interventions can serve as either a stand-alone intervention for individuals who need short-term assistance or a first-step intervention for those with more specialized or long-term needs.

Adolescent↗
PubMed2001

[A case of primary zopiclone dependence].

MEDICAL HISTORY: A 59-year-old female patient reported an increasing intake of up to 20 pills of zopiclone per day (150 mg) during the past 3 years. The dose increase was associated with euphoria and subjectively improved fitness. The patient suffered from anxiety and inner restlessness when trying to discontinue the medication, as well as from fatigue and forgetfulness when on medication. The medical history was free of psychiatric disorders and abuse of psychoactive substances. CLINICAL FINDINGS: Apart from mild attention and concentration deficits with a mildly depressed mood the psychiatric findings were normal. COURSE AND TREATMENT: Consistent with the preliminary diagnosis of a primary non-benzodiazepine dependence (zopiclone), after withdrawal of zopiclone the patient suffered from inner restlessness and psychomotor agitation, vague abdominal pain, and hypertension. The symptoms subsided after administration and subsequent gradual discontinuation of diazepam. CONCLUSION: Zopiclone dependence has repeatedly been reported in patients with pre-existing substance-related addictions, and in patients with other psychiatric disorders. Primary zopiclone dependence may be regarded as rare. Despite the low dependence potential of non-benzodiazepine hypnotics, the indication of prescription should be thoroughly considered.

Anti-Anxiety Agents↗
PubMed1997

An initial evaluation of the psychosocial dimensions of the American Society of Addiction Medicine criteria for inpatient versus intensive outpatient substance abuse rehabilitation.

OBJECTIVE: The American Society of Addiction Medicine (ASAM) criteria were developed as guidelines for the placement of substance abuse patients in appropriate levels of care. Although the ASAM criteria are widely used, little is known about their validity. In this study, we evaluated the predictive validity of the psychosocial dimensions of the ASAM criteria for inpatient versus intensive outpatient rehabilitation. METHOD: The psychosocial dimensions of the ASAM criteria were first operationalized with instruments with proven reliability and validity. The criteria were then used to determine whether cocaine (n = 159) and alcohol (n = 133) dependent male patients in inpatient and intensive outpatient rehabilitation programs were correctly "matched" to the level of care they received. The patients were followed up at 3, 6 and 12 months postrehabilitation, and outcomes of "matched" and "mismatched" patients were compared in a number of ways. RESULTS: Alcohol and cocaine patients who were correctly matched to treatment according to ASAM did not have significantly better outcomes than those who were mismatched. Furthermore, a more focused analysis generated no evidence that alcohol patients who met ASAM criteria for inpatient care had better outcomes in that setting than in intensive outpatient treatment. Among cocaine patients who met ASAM inpatient criteria, inpatient care produced marginally better short-term outcomes on most measures, although these results did not reach statistical significance. CONCLUSIONS: These results suggest that the psychosocial dimensions of the ASAM criteria for inpatient treatment are probably too broad and are therefore in need of further refinement, particularly for alcohol patients. However, all patients were male veterans without acute medical problems serious enough to warrant inpatient care or histories of psychosis, and the majority were of lower socioeconomic status. It is not clear to what extent the results would generalize to substance abusers with other characteristics.

Adult↗
PubMed1992

Sexual issues of women with spinal cord injuries.

The need for research addressing problems unique to women with spinal cord injuries is well documented. Consequently, 231 such women, ages 18 to 45, were surveyed. Demographic characteristics and data relating to physician usage, female hygiene, pregnancy, contraception and sexuality were collected. Analysis revealed that 60% of the respondents had post injury amenorrhea; the average time until menses resumption was 5 months. The group's post injury pregnancy rate was one-third its pre injury rate, but women with incomplete paraplegia had significantly more pregnancies than those with complete quadriplegia. Of 47 women who did carry babies to delivery, one-half had vaginal deliveries; 49% used no anesthesia. Problems during pregnancy included autonomic hyperreflexia, decubitus ulcers, urinary tract infections, water retention, bladder and bowel problems, anemia, spotting, fatigue, cardiac irregularity and toxemia. Many of these problems plagued the women during labor and delivery and in the post partum period as well. Sixty-nine percent of the women were satisfied with their post injury sexual experiences, although self confidence, spasticity, and lack of spontaneity were issues. Although satisfied with care received from physicians, many women were not content with the information provided during rehabilitation, and felt a need for more literature, counselling, and peer support.

Adolescent↗
PubMed1991

Risk of health care professionals acquiring HIV infection in Latin America.

This study describes the professional risk of acquiring HIV infection while caring for AIDS patients at a teaching hospital in Brazil. Since 1985 we have tested health care professionals (HCP) for HIV-1 antibody after accidents with blood and body fluids from AIDS patients. The blood samples were tested twice using an ELISA FDA approved test and, if positive, we performed Western blot. Two hundred and forty seven health care professionals reported 338 accidents (50% were percutaneous and 22% were mucous membrane exposures to blood). A further 404 HCPs reported no occupational exposure but wanted to be tested. From 247 HCPs with at least one accident, we analyzed 115 with more than 6 months of follow up. None were HIV antibody positive. Nobody received zidovudine as a prophylaxis. Of the 404 HCPs with no accident, 6 (1.5%) were positive and had confirmed risk factors for HIV. Our results support other studies that report a low occupational risk (about 0.4%) of acquiring HIV infection.

Accidents, Occupational↗
PubMed1989

HIV and HTLV-I infections in the Americas: a regional perspective.

With over 143,000 cases of AIDS reported to the World Health Organization from 145 countries and with an estimated 5 to 10 million people worldwide infected with HIV, AIDS has become firmly established as a global pandemic. In the region of the Americas over 100,862 cases of AIDS have been reported with indigenous transmission documented in 45 to 46 countries. While North America has the highest annual number of AIDS cases per population, with 72 cases/million, the Caribbean subregion has a disproportionately high number of cases, with annual rates as high as 200 to 300 cases/million population for some countries. Despite differences in absolute number of cases, there has been a remarkable similarity in the temporal rate of increase of AIDS in the countries of the Americas, reflecting delayed introduction of the virus to some areas with an early exponential increase similar to that observed initially in the United States. Although the modes of transmission of HIV are the same throughout the region, evidence of increasing bisexual and heterosexual transmission, particularly in the Caribbean subregion, has resulted in a lower male-to-female ratio of AIDS cases and increased perinatal transmission. Clinically, a resurgence of diarrheal diseases, respiratory infections, and tuberculosis has been documented in association with HIV infection in many tropical countries of the Americas. With relatively high rates of HTLV-I infection already established in the Caribbean subregion, the overall public health problems of the Americas will be markedly potentiated by further spread of these 2 human retroviruses. If HIV infection continues to penetrate the poor and less advantaged populations in Latin America and the Caribbean, the potential exists for a massive epidemic in the Americas that may rapidly parallel the situation in Africa.

Acquired Immunodeficiency Syndrome↗