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Drug injection and other practices affecting the risk of human immunodeficiency virus (HIV) infection were studied among 154 heroin users and 45 methamphetamine users in San Antonio, Texas. Amphetamine users were younger, mostly white, and had less-severe drug dependence. Heroin users had significantly higher levels of needle risk, as indicated by frequency of injection, number of persons sharing equipment, and place of injection. Methamphetamine users tended to buy syringes in lots of 10 or more from pharmacies and to use a syringe less than 5 times before discarding it. Heroin users tended to buy 1 needle at a time from an illicit source and to use it more than 20 times. Of methamphetamine users, 71% had more than one sex partner, compared to 39% of heroin users. Partners of methamphetamine users were more likely to be drug injectors than were partners of heroin users. Fewer methamphetamine users reported a behavior change in response to the acquired immunodeficiency syndrome (AIDS) epidemic, and fewer had been contacted by AIDS Education/Outreach. We suggest that efforts to promote risk reduction among methamphetamine users be stepped up because this population has been underserved and because less-sweeping behavior changes are needed to reduce needle-related risks to acceptable levels.

Treatment outcomes of 296 subjects admitted to methadone maintenance while on probation or parole are compared to those of 314 subjects admitted without such compulsory supervision. Equivalent treatment services were offered to both groups. The pretreatment differences between groups were small except for time incarcerated. All subjects were followed for one year. The compulsory supervision group had worse outcomes with respect to retention, productive activity, and incarceration. The differences were small except for incarceration. The mean number of months incarcerated was 2.1 for the compulsory supervision group and 0.7 for the voluntary group. Of subjects discharged from treatment, a higher percentage of the compulsory supervision group was discharged because of incarceration, but a higher percentage of the voluntary group was discharged for noncompliance with program requirements. The findings do not support a policy of exclusion of opioid users from methadone maintenance because they are on probation or parole.

In three Texas cities illicit drug injectors not in treatment were located by outreach and interviewed with a standard questionnaire. In all the cities the drug injectors were predominantly undereducated and unemployed young men from minority groups. In Dallas and Houston most were Black, while in San Antonio most were Hispanic. The most frequently reported primary drug in Houston was cocaine, but in Dallas and San Antonio it was heroin. The high needle risk for AIDS and the low rates of positive HIV antibody tests in these samples present a special window of opportunity for prevention of AIDS.

While maintained on methadone, heroin users reduce their heroin use and related criminal activity and increase their legitimate employment. These benefits are obtained at the cost of continued opioid dependence. Furthermore, as a consequence of neural adaptation and conditioning, methadone maintenance may impede eventual recovery from opioid dependence. The authors attempt to assess such a possible effect by comparing long-term outcomes after methadone maintenance with those after drug-free treatment. In five long-term follow-up studies of methadone maintenance, the percentages found voluntarily abstinent ranged from 9 to 21. In six long-term follow-up studies of drug-free treatment, the percentages found voluntarily abstinent ranged from 10 to 19. These rates seem remarkably similar. They do not suggest that methadone maintenance impedes eventual recovery from opioid dependence, but they do not clearly exclude such an effect.

When methadone maintenance was introduced in 1965, daily doses of approximately 100 mg were advocated and used; later, doses under 50 mg became common; recently, doses between 50 and 100 mg have been recommended. In a historical study and a cross-section study in one program the authors found no relationship between methadone dose and urine morphine. Patients on methadone doses under 50 mg had nearly the same percentage of urine tests positive for morphine as did those on doses of 50 mg and more. Gender, ethnic background, and age were also unrelated to urine morphine. Time on methadone was inversely related to urine morphine. Patients maintained on methadone for 3 years or longer showed a marked decrease in urine tests positive for morphine. Increased urine morphine during one decade was associated with program and community changes that could have prompted increased heroin use. These findings suggest that variables other than methadone dose affect heroin use.

Next to Blacks, Mexican-Americans are the largest ethnic minority group among the visible opioid addict population in the United States. Although commonly grouped together with Puerto Ricans and other Spanish-speaking peoples under the rubric "Hispanic," Mexican-Americans have a unique culture and ethnohistory. In this report we review the clinical and research literature and present new data from studies of Mexican-American opioid users in San Antonio. Mexican-American addicts tend to use fewer classes of illicit drugs and are less likely to use stimulants and psychedelics than Whites or Blacks. Onset of daily opioid use occurs at an early age, typically around 20, yet first voluntary admission to treatment usually occurs later than it does for other ethnic groups. Mexican-American addicts tend to be arrested more frequently and spend significantly more years in correctional institutions, but there is also evidence that they spend more time voluntarily abstinent and employed during their careers. The duration of the career is prolonged, however, and typically exceeds 20 years. Mexican-Americans prefer individual to group treatment, and are especially unlikely to participate in traditional therapeutic communities and group psychotherapies. The Mexican-American client is the least likely to complete treatment without adverse termination. The literature seems unanimous in calling for more treatment of Mexican-American addicts by Mexican-American therapists, but we found little empirical outcome data which demonstrated that ethnic matching of therapist and client brings better results.

Religion is often overlooked as a factor in recovery from chronic opioid dependence. Research on the effectiveness of religious programs is scanty, but three reports in the literature suggest that programs of the Pentecostal type may be particularly effective among Hispanic drug users. In this paper we review the literature and report our own observations of religious program participation among 248 San Antonio addicts, 87% of whom are Hispanic (Mexican-American). In a 12-year period, 11% of the 248 entered religious programs. Although there were only 33 admissions, the percent followed by a year or more of abstinence (44%) markedly exceeded that following conventional treatment or correctional interventions. We conclude that the ability of religious programs to attract large numbers of clients is limited, but that major changes in attitudes and life-style occur among some participants. Successful participation seems to depend upon a special motivational state at admission. Religious programs may be conceived as sociotherapy, and are similar to traditional therapeutic communities and other self-help programs in many ways. We suggest some psychodynamic and sociocultural mechanisms which may explain how religion promotes recovery from chronic drug dependence among Hispanic heroin users.

The outcome of outpatient methadone withdrawal reported in 20 published studies during the 1970s varied widely: none to 62% of the patients completed withdrawal, none to 35% became abstinent at termination of withdrawal, and none to 38% were abstinent at follow-up. Although somewhat ambiguous, the results indicated that outpatient withdrawal did not lead to prolonged abstinence in most heroin users. In two studies in San Antonio we attempted to compare opioid use and other behavior during 1 year before and 1 year after outpatient withdrawal. In the first study the before and after comparison of opioid use was unsatisfactory because of follow-up attrition. The frequency of arrest, based on police records and not affected by the follow-up attrition, changed only slightly. In the second study the follow-up attrition was small (8%), and satisfactory comparison could be made. Months abstinent did not increase, but months maintained on methadone increased significantly. The follow-up results did not differ notably from those in inpatient withdrawal. Outpatient withdrawal limited to 21 days has the disadvantage that many persons are prematurely withdrawn and consequently resume heroin use.

In San Antonio serious reported crime increased every year from 1965 through 1969. Then, in 1970, coincident with a marked increase of heroin users in treatment, the crime rate decreased. In three succeeding years while the treatment rate increased, crime decreased. Then in 1974, due to loss of program funds, the treatment rate decreased and the crime rate increased. The changes in the crime rate were due primarily to changes in the theft rate. For the years 1970-1974, treatment and theft had a significant negative correlation. We tentatively attribute part of the changes in the theft rate to changes in the treatment rate.

Childhood and adult life experiences of 50 heroin addicts are compared with those of their nonaddicted brothers. The sibling pairs came from large families with a median of six children; 45 pairs came from Mexican-American families. The median age of both addicts and brothers was 39. One-third of both addicts and brothers lost a parent before age 16. The addicts showed early deviant behavior preceding heroin use in contrast to the socially conforming behavior of the brothers. Noteworthy discrepancies appeared in the retrospective explanations offered by the addicts and the brothers of conditions leading to addiction in one and abstinence in the other. The addicts attributed the addiction versus abstinence primarily to association with different peer groups; the brothers cited this difference, but also frequently cited personality differences and other differences, thus giving more complex explanations. As adults the addicts showed gross social impairment on dimensions of employment, criminal record, marital adjustment, and other life activities. The brothers, in contrast, seemed socially competent, but they nonetheless showed evidence of some impairment: 40% were arrested one or more times, and 50% had histories of alcohol abuse. Apparently the brothers did not entirely escape the adverse early environments which shaped the careers of the addicts.