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Biomedical subjects

D S Lipton

Publications and source records attributed to D S Lipton.

At least 37 records · Page 2Linked to original sources

Patient-staff governance in methadone maintenance treatment: a study in participative decision making.

To help counteract some methadone patients' unfavorable attitudes to treatment and consequent antitherapeutic behaviors, a participative decision-making model was implemented in two methadone maintenance programs. Team building was used to initiate collaboration between patients and staff, resulting in the establishment of joint patient-staff governance committees. Outcomes as measured by the Client Attitudes Toward Methadone Programs (CAMP) Scale (a new instrument developed for the study) and by patients' supplementary drug use showed no statistically significant changes. The process evaluation, however, indicated that the committees had positive results in increasing communication and understanding between patients and staff, and in improving the efficiency of certain clinic procedures. The study analyzes the organizational dilemmas encountered in implementing participative decision making in drug treatment programs and gives recommendations for promoting future work in this area.

Adult↗

Citrate, Malate, and Succinate Concentration in Exudates from P-Sufficient and P-Stressed Medicago sativa L. Seedlings.

Under certain stress conditions roots exude organic molecules, which may facilitate the uptake of nutrients. The objective of this research was to identify and measure the effect of low P upon the exudation of organic acids by roots of alfalfa (Medicago sativa L.) seedlings. Surface-sterilized alfalfa seeds were grown aseptically in sterile sand using an apparatus specially designed for the addition of +/-P nutrient solutions and for the collection of root exudates. Citric, malic, and succinic acids were detected in the root exudates of 24-day-old alfalfa seedlings. Citrate exudation from the roots of P-stressed alfalfa was 182% that of plants receiving a complete nutrient solution. The increased release of citrate may provide a mechanism by which P-stressed plants enhance the availability of P in the rhizosphere.

Journal Article↗

The validity of methadone clients' self-reported drug use.

Drug use self-reports were compared with urinalysis for 248 clients in four methadone treatment programs. The validity of self-reporting based on urinalysis as a criterion depended on the type of drug examined. Opiate reporting was least valid, while benzodiazepine and cocaine reporting were moderately and highly valid, respectively. EMIT urinalysis was far more useful as a criterion of validity than TLC urinalysis. Self-reports helped identify drug users who were missed by urinalysis because of the latter's limited detection period, but urinalysis in turn detected an equal number of drug users missed by the interviews. The age of clients and the type of interviewer directly affected the rate of underreporting. Some respondents systematically denied disvalued behaviors (i.e., drug use and criminality), leading to a spurious correlation between these behaviors. This has important implications for future research.

Humans↗

Estimating illicit drug use through telephone interviews and the randomized response technique.

To determine whether or not telephone interviewing could be a viable alternative to field interviewing as a method for eliciting drug use information, a variation of Warner's randomized response technique (RRT) was developed. Comparisons were made between the telephone responses obtained through use of the RRT and those obtained through direct questioning. Although none of the comparisons showed a statistically significant difference, three out of four favored the RRT. Background characteristics of respondents were examined to identify those individuals who might be most receptive to the RRT. Major implications of the findings are discussed.

Adult↗

Alcohol use and abuse: heavy drinking among methadone clients.

This paper discusses alcohol use among methadone maintenance clients and narcotics users not in treatment. The data are derived from the Tri-State Ethnographic Project, a study of four methadone maintenance clinics in three states. Data indicate that methadone clients consume more alcohol than comparable age groups in the general population, but not more alcohol than narcotics users not in treatment. For a portion of the treatment population, however, heavy drinking presents significant problems. Sixteen percent of the treatment sample were found to be abusive pattern drinkers; that is, persons who report not only drinking heavily but also spending a great deal of time hanging out on the street, getting high, and consuming many other additional drugs. These abusive pattern drinkers reflect a pattern of polydrug use which began in their early teens and report multiple unsuccessful treatment attempts.

Adult↗

Patterns of cocaine use among methadone clients.

This paper presents data on cocaine use and its consequences among 368 methadone-maintained clients. Data come from the Tristate Ethnographic Project (TRISEP), a study of methadone maintenance at four treatment programs in three states. Cocaine is a part of the drug use and social life of clients in methadone treatment; it is found not only among a handful of deviant clients but also among one-fifth of clients otherwise compliant with program rules. Cocaine is reported to be a high-status drug among clients, but one with potentially dangerous consequences. Cocaine is associated with increased criminal activity and exposure to violence and the addict life-style. It is reported to be a substitute high, an economic drain on the client user, and a possible route back into the life-style of addiction. Cocaine use, and the consequences stemming from that use, may affect the success or failure of treatment and, therefore, is of critical importance to the treatment community.

Adult↗

Street pharmacology: uses of cocaine and heroin in the treatment of addiction.

This paper examines a unique finding from a larger research study of methadone maintenance treatment at four treatment programs in three Northeastern states. In looking at methods used by narcotics addicts to withdraw or detoxify from heroin, we found a small group of persons who had successfully detoxified from heroin addiction using a structured injection regimen of gradually decreasing amounts of heroin and gradually increasing amounts of cocaine. While this paper represents the case study of ten cases, the regimen was reported by others as part of 'street pharmacology.' It is a relatively uncommon regimen, reportedly due to the expense of the procedure and the problems associated with cocaine abuse. It is the pharmacological aspects of the procedure which warrant attention. All ten cases reported little or no withdrawal symptoms after the last injection containing small amounts of heroin. It was widely believed that cocaine interacts with heroin in a way which masks withdrawal during the detoxification process, providing a measure of physiological relief. Information from the addict world on that interaction provides clues as to the biochemical properties of drug interactions and may suggest areas for further clinical and pharmacological research.

Adult↗

An overview of substance use among New York State's upper income householders.

A 1981 survey of substance use among household residents in New York State found rates of use consistently higher among the upper income group ($50,000 and over) than among groups with lower incomes. In addition, measures of the seriousness of the problem also revealed higher rates among the upper income group than the other income groups. In terms of preferences for treatment, the upper income group substance user clearly opts for the private professional. The findings generally suggest that there are few qualitative differences in patterns of substance-taking among the income groups, and it might be hypothesized that the availability of disposable income in the upper income group and some situational factors may facilitate that group's substance-using behavior.

Data Collection↗

The State perspective.

Our survey showed that State agencies make use of NIDA materials of all sorts, including NIDA treatment evaluation materials. A majority of the respondents indicated that NIDA treatment evaluation materials were among the most useful of its products; most frequently mentioned was DARP, then Nurco's and Robins' work, and TOPS. That DARP was most frequently mentioned is not a contradiction, since the responses were stated in a general sense, not in terms of a specific report or material. In the past 1 to 2 years, many State drug abuse agency budgets have been substantially reduced due to declines in Federal funding. As a result, treatment evaluation reports and related materials are viewed somewhat differently than they were in the past. The fiscal climate in various States may thus be another factor contributing to the greater familarity and reported use of reports such as DAWN, CODAP, and case management and monitoring manuals published by NIDA. A number of suggestions were made about the kinds of evaluation materials needed by States. It was generally agreed that attempts should be made to produce treatment evaluation findings/new knowledge in a format where it would be more accessible to administrators (e.g., "how-to" manuals, evaluation case studies, dissemination of treatment evaluation bibliographies) and should assist in making existing treatment evaluation results more accessible (divide results for modalities into subtypes, provide data on the effectiveness of specific interventions with specific conditions, diversify the settings of programs in which evaluations are done, etc.). The theme of these various suggestions is to make evaluations more available, usable, and specific, especially now in view of the reduced ability of many States to carry on their own evaluation activities. The general sense of the respondents regarding dissemination was that right now, in view of other problems such as the financial crunch, NIDA's system of distribution cannot be a salient concern. Nevertheless, from a State perspective, NIDA's dissemination of treatment evaluation materials is particularly important in the light of the paucity of resources States have to conduct their own research. Thus, having access to NIDA's usable evaluation data is all the more crucial to improving service delivery and its cost effectiveness. Another factor to bear in mind at the present time is the absence of opportunities to share evaluation results at national conferences which formerly were, of course, major mechanisms for formal dissemination.

Government↗

A survey of students' awareness of and attitudes toward drug abuse prevention programs in New York State, winter 1974/75.

The present paper reports some results from a winter 1974-1975, New York State survey of junior and senior public high school youths' awareness of and attitudes toward the drug prevention efforts their schools had undertaken. The findings indicate that most youths are not aware of community resources available for assistance with a drug problem. Substantial discrepancies were found between student ratings of the effectiveness of prevention programs and the programs which they were most frequently exposed. Finally, the data highlight the peer context and drug culture aspect of the youths' substance taking, emphasizing that the sociocultural backgrounds of students need to be taken into account in prevention program development.

Adolescent↗

Seeking truth in heroin indicators: the case of New York City.

An epidemiological investigation of New York City's indirect indicators of heroin activity from 1970 through 1976 yielded insights about New York City heroin trends. Indirect indicators were gathered from official data sources, such as law enforcement, health, and treatment agencies. Since each indicator had significant limitations inhibiting interpretation, a factor analysis of the indicators was performed, resulting in the reduction of a large number of variables to a small number of factors. The factor analysis demonstrated the way in which New York City indicators cluster or move together--a "street" component, including arrests, hepatitis, price and purity of retail heroin; a "new admissions to methadone treatment" component; and a "readmissions to methadone treatment" component. Furthermore, the analysis revealed the time-lag relationships between components--"new admissions to methadone treatment" lag 1--2 years behind the "street" component; "readmissions to methadone treatment" lag 1--3 years behind the "new admissions" component. Finally, the 1970--1976 factor scores were related to 1970--1974 estimates of narcotic addicts in New York City in regression analysis, and were also projected through 1978, yielding estimates of New York City's heroin addict population from 1975 through 1978.

Crime↗

Drug information source credibility among junior and senior high school youths.

Analysis was made of data gathered in a winter 1974/75 survey of 7th through 12the grade youngsters attending public schools in New York State to learn the credibility of various sources of information on drugs. The results showed important relationships to hold between the youth's involvement with substances and their belief in the media and nonmedia information sources that were probed.

Adolescent↗

A survey of substances use among junior and senior high school students in New York state, Winter 1974-75.

A survey designed to assess drug and alcohol use among the 1,600,000 students in Grades 7 through 12 who attend New York State public schools was administered in 10i schools during the winter of 1974-75. Findings indicate that over 80% of the students have used alcohol and that almost one-third of the students have used marijuana at least once. In addition, 60% of the marijuana users have used no other substance, with the possible exception of alcohol. Also, if a student has used a substance, he is likely to have used it within the last 6 months. Finally, multiple substance use is not predominant among marijuana users, but is predominant among users of other substances.

Adolescent↗

Acupuncture for crack-cocaine detoxification: experimental evaluation of efficacy.

Anecdotal studies have reported acupuncture alleviating the severity of withdrawal symptoms associated with cocaine abuse. The efficacy of auricular (ear) acupuncture in reducing cocaine/crack craving and consumption was examined via a single-blind, placebo experiment. One hundred and fifty individuals seeking treatment for cocaine/crack abuse were randomly assigned to receive either experimental or placebo acupuncture treatments. Treatments were provided in an outpatient setting for a one-month period. Placebo treatments involved acupuncture at ear locations not used for drug treatment. Subjects provided urine specimens for drug content analysis after each acupuncture session. Urinalysis results over the one-month study period favored the experimental group. Experimental subjects in treatment over 2 weeks had significantly lower cocaine metabolite levels relative to placebo subjects in treatment for a comparable period. Treatment retention with both groups was similar. Relative to pretreatment usage, a significant decrease in cocaine consumption was reported by both groups. Self-report outcomes did not indicate significant between-groups differences.

Acupuncture Points↗