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This study examines perceived neighborhood characteristics associated with successful outcome among mothers 10 years after being treated for substance use disorders. Data were obtained from 713 mothers first studied at admission to drug treatment in California in 2000-2002 and followed up in 2009-2011. At follow-up, 53.6% of mothers had a successful outcome (i.e., no use of illicit drugs and not involved with the criminal justice system). Perceived neighborhood safety almost doubled the odds of success. Perceived neighborhood safety interacted with social involvement, decreasing the odds of success among mothers who reported more versus less neighborhood social involvement. Perceived neighborhood climate is associated with long-term outcomes among mothers with substance use disorders independent of individual-level characteristics, underscoring the need for further efforts to understand its interaction with recovery capital in ways that promote and impede health.

Asian Americans and Pacific Islanders (AAPIs) are often portrayed as a healthy group with minor substance use problems. Using data from two studies of patients treated in 44 community-based substance use treatment sites located in three states, 298 AAPIs and a matched comparison group of 298 non-AAPI patients were compared on demographic characteristics, treatment experiences, and 1-year outcomes. At treatment entry, more AAPIs reported recent drug use and fewer injected drugs, AAPIs had less severe medical and alcohol problems, and AAPIs reported worse general health but less desire for medical and alcohol services. After controlling for baseline problem severity, there were no differences in treatment retention, completion, or outcomes. Contrary to the model minority stereotype, AAPIs have mostly similar treatment needs, experiences, and outcomes as other racial/ethnic groups in drug treatment.

In this article, we directly questioned the common practice in growth mixture model (GMM) applications that exclusively rely on the fitting model without covariates for GMM class enumeration. We provided theoretical and simulation evidence to demonstrate that exclusion of covariates from GMM class enumeration could be problematic in many cases. Based on our findings, we provided recommendations for examining the class enumeration by the fitting model without covariates and discussed the potential of covariate inclusion as a remedy for the weakness of GMM class enumeration without including covariates. A real example on the development of children's cumulative exposure to risk factors for adolescent substance use was provided to illustrate our methodological developments.

This article considers a Bayesian approach for analyzing a longitudinal 2-level nonlinear structural equation model with covariates, and mixed continuous and ordered categorical variables. The first-level model is formulated for measures taken at each time point nested within individuals for investigating their characteristics that are dynamically changed over time. The second level is defined for individuals for assessing their characteristics that are invariant with time. The proposed longitudinal structural equation model also accommodates missing data. A Bayesian approach is developed for estimation of parameters and model comparison. The newly developed methodologies are applied to a longitudinal study concerning cocaine use.

Limited information is known with regard to substance abuse treatment outcomes among AI/ANs. Data retrieved from the Treatment System Impact (TSI) project and Methamphetamine Treatment Project (MTP) were used to compare treatment measures between a sample of AI/ANs and a matched comparison group. Our results revealed no significant differences between AI/ANs and the matched comparison group in treatment outcomes at 12-months post-treatment based on legal, employment, medical, and psychiatric measures. AI/ANs also received more family-related services (29.9% vs. 17.1%) and abuse-related services (21.3% vs. 7.6%). Addressing barriers to receiving substance abuse treatment and enhancing screening methods for AI/ANs are suggested.

Current literature has shown that heroin addiction is characterized by long periods of regular use persisting over the life course, whereas the course of stimulant use is less understood. The current study examined long-term trajectories of drug use for primary heroin, cocaine (crack/powder cocaine), and methamphetamine (meth) users. The analyses used data from five studies that collected longitudinal information using the Natural History Instrument, including 629 primary heroin users, 694 cocaine users, and 474 meth users. Drug use trajectories over the 10 years since initiation demonstrated the persistence of use over time for all three drugs, with heroin use at the highest level (13 to 18 days per month), cocaine at the lowest level (8 to 11 days), and meth in between (approximately 12 days per month). Application of growth mixture models revealed five distinctive groups: Consistently High Use (n = 545), Increasing Use (n = 260), Decreasing Use (n = 254), Moderate Use (n = 638), and Low Use (n = 100). Heroin users were disproportionately overrepresented in the Consistently High Use group and underrepresented in the Low Use group; cocaine and meth users were mostly in the Moderate Use group. Users in the High Use group also had earlier onsets of drug use and crime, longer incarceration durations, and were the least employed. Clinical/service policy and practice need to recognize and adapt to the specific patterns and needs of users of different drugs while being mindful of the stage drug users are at in their life course.

This study examined longitudinal treatment effects among cocaine users. The study examined a sample of 371 cocaine users screened from arrestees in jails and from patients in sexually transmitted disease clinics and emergency rooms-all in Los Angeles County during 1992-1994. Of the 371 subjects, 121 had never been in treatment and 250 reported a history of participation in drug user treatment (145 subjects' first treatment was for cocaine use and 105 were in treatment for a drug other than cocaine). Data were collected during face-to-face interviews using a natural history interview instrument. We applied a series of growth curve models to investigate treatment effects on cocaine use. For those who had been in treatment for cocaine use, use of cocaine decreased from approximately 70% before treatment to 12% after treatment entry, while no such changes were observed among those who had never been in treatment or those in treatment for other drugs. Relative to nontreated users, cocaine-treated participants showed a greater likelihood of pretreatment use for both initial status (OR = 3.58) and growth rate (OR = 1.05). After treatment entry, cocaine-treated participants as compared to nontreated participants had a lower likelihood of use (OR = 0.27), although their cocaine use after the initial status increased at a greater rate (OR = 1.03). Treated users were five times less likely to use when they were in treatment than when they were out of treatment. Longer treatment retention was related to initially reduced use but not to later rates of change in cocaine use. The study findings support that treatment for cocaine use is effective in reducing cocaine use. Longitudinal models provide opportunities to demonstrate the dynamic relationships between treatment and outcome.

Most studies of parents in drug treatment have focused exclusively on mothers, and few studies have examined the effects of parents' level of involvement with their children on the parents' drug use and psychological functioning, either before or after treatment. This study examined mothers and fathers (n = 331) who were parents of children under the age of 18; participants were sampled from 19 drug treatment programs across four types of treatment modalities in Los Angeles County. A majority of each group (57% of 214 mothers and 51% of 117 fathers) were classified as being highly involved with their children. At the baseline assessment, higher parental involvement was related to lower levels of addiction severity, psychological severity, and symptoms of psychological distress, and to higher levels of self-esteem and perception of parenting skills. In general, fathers had higher levels of alcohol and drug-use severity than did mothers, but fathers who were more involved with their children showed lower levels of addiction severity than fathers who were less involved. Parental involvement at baseline was unrelated to drug use at the 12-month follow-up, although parents who were less involved with their children reported experiencing more stressors. Given the association of parental involvement with lower levels of addiction severity and psychological distress at baseline, treatment protocols should build upon the positive relationships of parents with their children, and seek to improve those of less-involved parents.

Research on adolescent drug treatment engagement is scarce; however, such research on adults suggests that successful engagement in treatment increases the likelihood of positive treatment outcomes. Compliance during drug treatment reflects treatment engagement. We examined self-assessed compliance (agreement with treatment goals, meeting treatment staff expectations, and following treatment staff instructions), behavioral compliance (staying for the duration of planned treatment), and their influences, among adolescents in treatment. Stepwise logistic regression showed that desire for help was significantly (p < 05) related to more compliance. Compared with those in residential treatment, those in inpatient treatment were more likely to agree with treatment goals, to follow instructions, and to stay for the planned duration of treatment; those in outpatient treatment were more likely to meet treatment expectations. Psychological maladjustment was related to less self-perceived compliance. We dis...

Does tobacco use in polydrug users relate to future daily functioning (SF-36) and disability? To answer this question, community-living polydrug users (n = 254) were interviewed at baseline, 1-year and 2-year follow-up. Measures included: smoking status and self-reported disability at each assessment, and SF-36 measures collected at the final assessment. Urine samples permitted validation of reported drug use status. Results revealed that baseline disability rates were high but fell nearly 50% over two years. Disabilities named were similar to those reported in the general population. Change in smoking status was associated with decreased disability and improvements in general health and vitality. Respondents reporting disability reported lower daily functioning (SF-36). Stable everyday smoking was strongly associated with increased probability of positive urine tests for illicit drug use. Illicit drug use did not affect SF-36 ratings. Findings suggest that tobacco use by polydrug users is related to disability rates, to illicit drug use and to variations in daily functioning.

This paper examines the validity of self-report of drug use in several important high-risk samples by comparing survey answers with urinalysis results. The analyses include data obtained from face-to-face interviews with 1536 patients in sexually transmitted disease (STD) clinics, 1564 patients in hospital emergency rooms (ERs), and 2034 recent arrestees in jails. Using urinalysis as the criterion measure, considerable underreporting was observed, particularly among STD and ER subjects using cocaine and opiates. A logistic regression analysis on factors related to the underreporting was conducted for both cocaine and opiates. The results showed that a lower degree of underreporting was associated with subjects at jail sites (compared to STD subjects) and those who self-reported lifetime drug dependence.

This paper discusses the results of a comprehensive survey of one of the largest drug-user treatment systems in the United States--the system in Los Angeles County, California, which contains more than 300 programs, covers over 4,000 square miles, and serves clients from a notably heterogeneous population of almost nine million people. The survey reported on here was distinct from similar surveys in that it provided simultaneously comprehensive and in-depth descriptions of formal treatment programs in a defined local area. The authors believe that this survey is the first local drug-user treatment program survey of its scope and magnitude in the United States.

This paper applied a hierarchical linear modeling approach to explore the interaction effects of treatment program and client characteristics on client retention in treatment for drug users. Program characteristics included services provision, funding sources, and staff-client gender congruence, and client characteristics included gender, age at admission, and drug use level prior to admission. The same model was applied separately to three modalities: residential, methadone maintenance, and outpatient drug-free programs. Data were obtained from 59 treatment programs and 3,764 of their clients who had discharge records. The most noteworthy significant interaction effect detected was program's funding source and client's gender on treatment retention in the outpatient drug-free modality. For example, female clients remained less time in the programs that accepted only public funding than in the programs that accepted both public and private funding. Male clients remained in the treatment an average of 25.3 fewer days than female clients in drug-free programs that only accepted public fund, but stayed about the same time as females if the programs received mixed funding.

Pattern reliability, or the invariance of relationships among variables, was investigated in this study. The consistency of theoretical constructs reflected by measures taken at two separate occasions can be tested using confirmatory factor analysis. Self-report data were obtained from 323 narcotics addicts in two face-to-face interviews conducted in 1974/75 and 1985/86. The two interviews overlapped approximately 4 years between 1970 and 1974/75. Through the testing of the invariance of measurement and structural models, pattern reliability was confirmed in one of the models developed. Explication of pattern reliability offers an alternative means of assessing validity of self-report data.

This study applies multiple-capture models to drug treatment data and the synthetic estimation method to arrestee data to provide estimates of the number of IVDUs in Los Angeles County in 1989. Based on the 5% HIV-prevalence rate currently found in IVDUs in Los Angeles, it is estimated that there could be as many as 9,500 HIV-infected IVDUs. The estimates of IVDUs are generally higher than those obtained by back-calculation methods which often undercount IVDU-related AIDS cases and do not consider deaths for causes other than HIV infection.

Log-linear modeling, structural equation modeling, repeated measures analysis of variance, and time series analysis are discussed for their utility in evaluating the temporal effects of social interventions. Methods are illustrated by applications examining the independent and joint temporal effects of methadone maintenance treatment and legal supervision on narcotics use and property crime among narcotics addicts. Convergent results from a multimethod assessment of the issue show that methadone maintenance has long-term and short-term suppressive effects on narcotics use and property crime. More complicated but complementary findings have been found in evaluating the effectiveness of legal supervision. [Translations are provided in the International Abstracts section of this issue.]

Sex differences are examined for the period during which addiction develops after initial narcotics use. About 25% of the 546 heroin addicts studied became addicted within 1 month after initial use. More women than men fell into this category, and, on the average, women took less time to become addicted. For the majority of those studied (whose addiction occurred 1 month or longer after initial use), patterns of narcotic use during this phase of the addiction career were not significantly different by sex within Anglo or Chicano groups. Differences between female and male addicts in interpersonal relationships, other substance use, drug dealing, legal employment, and criminal behaviors parallel traditional sex role expectations.

Part I of this series compared characteristics of 546 Chicanos and Anglo men and women methadone maintenance (MM) clients. In Part II, specific differences between Chicanos and Anglos are analyzed, by sex, for each of five stages in the addiction career: preexperimentation, experimentation addiction, initial MM treatment, and posttreatment. The analysis examines narcotic and other drug use, arrest, incarceration and legal supervision histories, criminal involvement, employment, interpersonal relationships, and treatment history. Whereas preaddiction differences between addicts parallel ethnic differences found in the general population, after addiction occurs the similarities are greater than the dissimilarities between ethnic groups, except for Chicanas. Chicanos appear to continue to function as part of their community after addiction, but Chicanas appear to risk becoming marginal. Treatment outcomes for Chicanos were, in general, less successful than for Anglos.

Comparisons of behaviors during treatment were made between a sample of women and a sample of men methadone maintenance clients. Women in this study exhibited high motivation for treatment. Overall, however, small differences were found between the sexes with respect to treatment process and outcome measures. The observed differences that were significant included use of substances other than heroin, interpersonal relationships, drug dealing, employment, and criminal behaviors. The differences seemed to be in accordance with traditional sex role expectations. The distinctive behavior pattern of Chicanas demonstrated in this study demands special attention. It is suggested that treatment programs should incorporate more services to meet women-specific needs.

The learning effects due to test and study trials after the initial presentation were examined in a paired‐associate learning paradigm. In Experiment 1 both the spacing and retention intervals were systematically varied. The results showed advantages of spacing for both test and study trials. However, the spacing function of test trials interacted significantly with the retention interval. At a short retention interval, the second recall was a decreasing function of spacing and paralleled closely the initial recall. As the retention interval increased, the spacing‐of‐test function assumed an inverted U‐shape. Performance after repeated studies was on the average better than after test trials. Experiment 2 confirmed that when an initial presentation was followed by two test trials, an increasing spacing interval between each successive test trial produced optimal long‐term performance. In the case where a second study trial was coupled with a test trial, a pattern with equal interval length was better than...

The process and correlates of addiction prior to treatment are examined for a sample of 546 women and men methadone maintenance clients. Narcotic addiction careers for women (defined both as from first daily use to first treatment intervention, and from first daily use to last daily use of heroin) were shorter than those for men, and women entered treatment earlier. However, the narcotic drug use patterns for women were not substantially different from those for men (including mean percentage of time using, number of times abstinent, number of relapses, and so forth). Narcotics use for many women was influenced by a spouse or partner, but some also reported increased use for hedonistic reasons. Criminal behaviors increased for both women and men after addiction, and the major sex difference was the type of crime committed. Differences for women and men for employment, welfare, and interpersonal relationships reflected patterns found in the larger society.