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Biomedical subjects

William E Schlenger

Publications and source records attributed to William E Schlenger.

17 recordsLinked to original sources
PubMed2006

Concurrent use of methamphetamine, MDMA, LSD, ketamine, GHB, and flunitrazepam among American youths.

BACKGROUND: The magnitude and the characteristics of the use of methamphetamine, MDMA (Ecstasy), LSD (d-lysergic acid diethylamide), ketamine, GHB (gamma-hydroxybutyrate), and flunitrazepam (Rohypnol) were examined in a probability sample of the U.S. civilian population that included multiethnic urban, suburban, and rural youths aged 16-23 (N=19,084). METHODS: Data were drawn from the National Survey on Drug Use and Health (NSDUH). Logistic regression analyses were conducted to identify the characteristics associated with the use of each of these drugs and of multiple drugs. RESULTS: Approximately 20% of youths aged 16-23 reported having ever used one or more of these drugs. Less than 1% of club drug users used club drugs only, and 82% of them had ever used three or more drug classes. Females were more likely than males to report using multiple club drugs. Recent users of methamphetamine were most likely to be females and adolescents aged 16 or 17. Recent users of MDMA tended to be young adults aged 18-21 and residents of metropolitan areas. Most recent users of LSD were adolescents aged 16-19 and those in low-income families. Ketamine users were primarily employed youths. Staying in school and getting married were associated with decreased odds of club drug use. Club drug use was highly associated with the presence of criminal behaviors and recent alcohol abuse or dependence. CONCLUSIONS: Adolescents are more likely than young adults to use multiple drugs. The clustering of multidrug use and alcohol use disorder is a cause of concern.

Adolescent↗
PubMed2006

Web-based methods in terrorism and disaster research.

This article provides an overview of the use of the Internet for conducting studies after terrorist attacks and other large-scale disasters. We begin with a brief summary of the scientific and logistical challenges of conducting such research, followed by a description of some of the most important design features that are required to produce valid findings. We then describe one approach to Internet surveys that, although not perfect, addresses many of the challenges well. We close with some thoughts about how the Internet-based methods available today are likely to develop further in coming years.

Data Collection↗
PubMed2005

"Islands of Risk": subgroups of adolescents at risk for HIV.

OBJECTIVE: To use cluster analysis to determine profiles of adolescents at risk for HIV. METHODS: Adolescents 15-21 years old (N = 1153) with a history of unprotected sex were assessed in five domains of risk (unprotected sex, alcohol/marijuana use, other drug use, mental health crises, and arrest/school dropout) as well as demographic, contextual, and behavioral variables. RESULTS: Cluster analysis revealed separate three-cluster solutions for males and females. Among males, clusters were characterized by (a) mental health crises and unprotected sex, (b) alcohol/marijuana use and unprotected sex, and (c) lower risk. Among females, clusters were distinguished by (a) unprotected sex, (b) substance use and mental health crises, and (c) lower risk. Cluster membership was associated with secondary variables related to sexual risk. CONCLUSIONS: Even within populations of high-risk adolescents, subgroups exist for which specific risk factors co-occur, particularly unprotected sex, mental health crises, and substance use. These patterns suggest that effective HIV prevention interventions may need to target the association between mental health and/or substance abuse with sexual risk for some adolescents.

Adolescent↗
PubMed2005

High prevalence of substance use disorders among adolescents who use marijuana and inhalants.

BACKGROUND: We examined the association between the use of inhalants, marijuana, and other drugs and recent DSM-IV substance use disorders among adolescents aged 12-17 years. METHODS: Data were drawn from 2000 to 2001 National Household Surveys on Drug Abuse. Adolescents aged 12-17 years who reported having ever used an illicit drug in their lifetime were categorized into four mutually exclusive groups: inhalant users (16%), marijuana users (53%), inhalant and marijuana users (16%), and other drug users (15%). Logistic regression models were used to estimate associations with recent substance use diagnoses among lifetime adolescent drug users (N=10,180). RESULTS: We found that 31% of lifetime drug users reported having never used marijuana. One half of these atypical drug users were predominantly nonmedical users of pain relievers. Adolescents who used inhalants or other drugs but not marijuana were least likely to report multidrug use. Adolescents who reported using both inhalants and marijuana were most likely to use three or more classes of drugs (73%) and to receive a diagnosis of past year alcohol (35%) and drug (39%) abuse or dependence. CONCLUSIONS: Our study findings suggest that among lifetime adolescent drug users, those who use both inhalants and marijuana are at very high risk for alcohol and drug use disorders.

Administration, Inhalation↗
PubMed2005

Use of nitrite inhalants ("poppers") among American youth.

PURPOSE: We examined the patterns and correlates of nitrite inhalant use among adolescents aged 12 to 17 years. METHODS: Study data were drawn from the 2000 and 2001 National Household Surveys on Drug Abuse. Logistic regression was used to identify the characteristics associated with nitrite inhalant use. RESULTS: Among adolescents aged 12 to 17 years, 1.5% reported any lifetime use of nitrite inhalants. The prevalence of lifetime nitrite inhalant use increased to 12% and 14% among adolescents who were dependent on alcohol and any drug in the past year, respectively. Many nitrite inhalant users used at least three other types of inhalants (68%) and also met the criteria for alcohol (33%) and drug (35%) abuse or dependence. Increased odds of nitrite inhalant use were associated with residing in nonmetropolitan areas, recent utilization of mental health services, delinquent behaviors, past year alcohol and drug abuse and dependence, and multi-drug use. CONCLUSIONS: Adolescents who had used nitrite inhalants at least once in their lifetime tend to engage in delinquent activities and report co-occurring multiple drug abuse and mental health problems in the past year.

Administration, Inhalation↗
PubMed2004

Effects of diversion on adults with co-occurring mental illness and substance use: outcomes from a national multi-site study.

This quasi-experimental non-equivalent comparison group study examines outcomes for participants in eight programs conducting criminal justice diversion for people with co-occurring serious mental illness and substance use disorders compared with jail detainees eligible for diversion, but who were processed through standard criminal justice methods without diversion. Nearly 2000 participants were interviewed at baseline, and 1500 at 3 month and 1300 at 12 month follow-up to baseline. In these interviews, outcome measures of re-arrest, mental health functioning, substance abuse, quality of life, and service utilization were obtained. Those diverted were more likely to have received mental health counseling, mental health medication, and mental health hospitalization than those not enrolled in a diversion program, but were equally likely to have received substance abuse counseling. Overall, the differences in proportions receiving services between the two groups were small, even when these differences were statistically significant. The effect associated with diversion differed somewhat across the individual sites. However, overall cross-site pooled analyses revealed no outcome differences between groups on measures of mental health symptoms, substance use, criminal justice recidivism, or quality of life. Although the immediate benefit of diversion as an access mechanism to community treatment is indicated in pooled cross-site results, such access was driven by more coercive (pre-booking and court) models and results suggest that effecting substantially greater access to services or services use did not occur. The findings also suggest that mental health, substance abuse, and criminal justice outcomes remain dependent on the treatment intervention received, perhaps moderated by type of diversion intervention, rather than on a generic and initial diversion event.

Adult↗
PubMed2004

Injection drug use among stimulant users in a national sample.

OBJECTIVE: This study examined the correlates of injection drug use (IDU) in a community sample of psychostimulant users. Factors related to the cessation of illicit drug use and substance abuse service utilization were also determined among a subsample of stimulant users who reported IDU. METHOD: The study sample consisted of 3408 lifetime psychostimulant users from the National Household Survey on Drug Abuse. Logistic regression procedures were used to estimate independent associations of correlates of IDU. RESULTS: Approximately one in seven lifetime stimulant users reported IDU in their lifetime. Stimulant users with a lifetime history of IDU were more likely than those who did not inject to be African-American, not have received a high school diploma, have a history of multiple drug use, and report an onset of stimulant use before age 18. Among recent stimulant users, being aged 26 or older, using stimulants at least weekly, and getting drunk in the past year were associated with increased odds of recent IDU. Only one-half of all injection drug users reported having ever used substance abuse services. Cessation of illicit drug use among injectors with a history of stimulant use is common (44%). CONCLUSIONS: Further studies should clarify the natural history of IDU among stimulant users, including the cessation of drug use without participating in substance abuse treatment services.

Adolescent↗
PubMed2004

Inhalant abuse and dependence among adolescents in the United States.

OBJECTIVE: To examine the patterns of inhalant use and correlates of the progression from inhalant use to abuse and dependence among adolescents aged 12 to 17. METHOD: Study data were drawn from the 2000 and 2001 National Household Surveys on Drug Abuse. Multinominal logistic regression was used to identify the characteristics associated with progression to inhalant abuse and dependence. RESULTS: Inhalant use was common among the studied adolescents. Among adolescents aged 12 to 17, 0.4% met DSM-IV inhalant abuse or dependence criteria in the past year. Inhalant abuse and dependence affected adolescents regardless of gender, age, race/ethnicity, and family income. The progression from inhalant use to abuse or dependence was related to early first use, use of multiple inhalants, and weekly inhalant use. Adolescents with inhalant use disorders reported coexisting multiple drug abuse and dependence, mental health treatment, and delinquent behaviors. CONCLUSIONS: Adolescents with an inhalant use disorder may represent a subgroup of highly troubled youths with multiple vulnerabilities. Because early use is associated with progression to abuse and dependence, prevention programs should target elementary school-age children.

Administration, Inhalation↗
PubMed2004

Private health insurance coverage for substance abuse and mental health services, 1995 to 1998.

Four years of data from the National Household Survey on Drug Abuse were combined to examine the characteristics of underinsurance in a sample of privately insured Americans aged 18 to 64. Among these adults, 38 percent (45 million) reported not having behavioral health coverage or not knowing their coverage. Young adults aged 18 to 25, Hispanics, Asians, adults in the lowest income level, and less educated adults were more likely to be underinsured. Untreated addictive and psychiatric problems are costly to society. Underinsurance among socially disadvantaged subgroups deserves greater attention from researchers and policy makers.

Adult↗
PubMed2003

The relationship between employment and substance use among students aged 12 to 17.

PURPOSE: To examine the association between employment status and substance use among students aged 12 to 17 years. METHODS: Secondary analysis of data from the 1995 and 1996 National Household Surveys on Drug Abuse was conducted. The survey is a primary source of data on licit and illicit drug use among noninstitutionalized Americans aged 12 years or older. Participants are interviewed at their places of residence. Multiple logistic regression procedures yielded estimated associations. RESULTS: About one in six adolescents reported both going to school and holding a job. Approximately one-fourth of students smoked cigarettes, and one-third consumed alcohol in the past year. An estimated 1.6% of students were current heavy cigarette smokers, and 2.6% were current heavy alcohol users. One-year prevalence estimates of any illicit drug use and heavy illicit drug use were 16.7% and 1.8%, respectively. Among students employed full time, prevalence estimates increased to 9.7% for heavy cigarette smoking, 13.1% for heavy alcohol use, 38.1% for any illicit drug use, and 5.0% for heavy illicit drug use. Logistic regression analyses supported relatively high rates of cigarette use, alcohol use, illicit drug use, and heavy substance use among working students. Mental health problems, especially externalizing behavioral syndromes, were found to coexist with the use and heavy use of substances. The observed associations varied somewhat by gender. CONCLUSIONS: The workplace may be an appropriate venue for establishing substance use prevention and early intervention programs focused on younger workers, including adolescents who work part time.

Adolescent↗
PubMed2003

Psychostimulant dependence in a community sample.

OBJECTIVE: To examine the prevalence of psychostimulant dependence and the characteristics associated with nonmedical users' development of dependence. METHODS: The study sample was drawn from the 1995 to 1998 National Household Surveys on Drug Abuse. Statistical analysis was conducted on a total of 1047 individuals aged 12 or older who reported nonmedical use of stimulants in the past year. Multiple multinomial logistic regression identified factors related to stimulant dependence and dependence problems. RESULTS: Among all past year stimulant users, 19% met criteria for stimulant dependence in the past year, and an additional 16% reported having one to two dependence problems. Adjusting for demographics and drug use characteristics, female stimulant users were an estimated 2.6 times more likely than male users to develop dependence. Not only did the Western region of the United States have more recent stimulant users than other regions, its users also were more likely to meet criteria for dependence or experience dependence problems. Stimulant users who had increased odds of progressing into dependence were characterized by an early onset of stimulant use, coexisting multiple illicit drug use, and an onset of daily cigarette smoking between the ages of 13 and 17 years. CONCLUSIONS: Gender differences in initial stimulant use and progression to dependence require further investigation, including contextual, cultural, or perceptual factors related specifically to the choice of drugs by females.

Adolescent↗
PubMed2003

Substance use, dependence, and service utilization among the US uninsured nonelderly population.

OBJECTIVES: We examined the prevalence and correlates of substance use, dependence, and service utilization among uninsured persons aged 12 to 64 years. METHODS: We drew study data from the 1998 National Household Survey on Drug Abuse. RESULTS: An estimated 80% of uninsured nonelderly persons reported being uninsured for more than 6 months in the prior year. Only 9% of these uninsured persons who were dependent on alcohol or drugs had received any substance abuse service in the past year. Non-Hispanic Whites were an estimated 3 times more likely than Blacks to receive substance abuse services. CONCLUSIONS: Compared with the privately insured, uninsured persons had increased odds of having alcohol/drug dependence and appeared to face substantial barriers to health services for substance use problems.

Adolescent↗
PubMed2003

Mental health issues in disasters and terrorist attacks.

Recent events make clear that those living in the United States are at risk of exposure to a variety of potentially traumatic events, ranging from sniper and terrorist attacks to a variety of natural disasters. This paper provides a broad overview of the most common psychological reactions that can be expected in the aftermath of such events, how primary care practitioners can identify such reactions in their patients, and actions those practitioners might take.

Disasters↗
PubMed2002

Psychological reactions to terrorist attacks: findings from the National Study of Americans' Reactions to September 11.

CONTEXT: The terrorist attacks of September 11, 2001, represent an unprecedented exposure to trauma in the United States. OBJECTIVES: To assess psychological symptom levels in the United States following the events of September 11 and to examine the association between postattack symptoms and a variety of indices of exposure to the events. DESIGN: Web-based epidemiological survey of a nationally representative cross-sectional sample using the Posttraumatic Stress Disorder (PTSD) Checklist and the Brief Symptom Inventory, administered 1 to 2 months following the attacks. SETTING AND PARTICIPANTS: Sample of 2273 adults, including oversamples of the New York, NY, and Washington, DC, metropolitan areas. MAIN OUTCOME MEASURES: Self-reports of the symptoms of PTSD and of clinically significant nonspecific psychological distress; adult reports of symptoms of distress among children living in their households. RESULTS: The prevalence of probable PTSD was significantly higher in the New York City metropolitan area (11.2%) than in Washington, DC (2.7%), other major metropolitan areas (3.6%), and the rest of the country (4.0%). A broader measure of clinically significant psychological distress suggests that overall distress levels across the country, however, were within expected ranges for a general community sample. In multivariate models, sex, age, direct exposure to the attacks, and the amount of time spent viewing TV coverage of the attacks on September 11 and the few days afterward were associated with PTSD symptom levels; sex, the number of hours of television coverage viewed, and an index of the content of that coverage were associated with the broader distress measure. More than 60% of adults in New York City households with children reported that 1 or more children were upset by the attacks. CONCLUSIONS: One to 2 months following the events of September 11, probable PTSD was associated with direct exposure to the terrorist attacks among adults, and the prevalence in the New York City metropolitan area was substantially higher than elsewhere in the country. However, overall distress levels in the country were within normal ranges. Further research should document the course of symptoms and recovery among adults following exposure to the events of September 11 and further specify the types and severity of distress in children.

Adolescent↗
PubMed2002

The prevalence of posttraumatic stress disorder among American Indian Vietnam veterans: disparities and context.

This study employed data from two Congressionally mandated efforts (the American Indian Vietnam Veterans Project and the National Vietnam Veterans Readjustment Study) to examine differential prevalence of posttraumatic stress disorder (PTSD) among 5 ethnically defined samples of male Vietnam theater veterans. Lay interviews assessed individual experiences before, during, and after the war from 1,798 male Vietnam theater veterans. Clinical reinterviews using the SCID were conducted with subsamples (N = 487). The prevalence of both 1-month and lifetime PTSD was higher for the 2 American Indian samples than for Whites. Once logistic regressions controlled for differential exposure to war-zone stress, ethnicity was no longer a significant predictor of PTSD.

Age Factors↗
PubMed2002

Lifetime use of mental health and substance abuse treatment services by incarcerated women felons.

OBJECTIVE: This study examined the lifetime use of alcohol, drug, and mental health treatment services by recently incarcerated women prison inmates. METHODS: A total of 805 women entering a North Carolina prison for new felony charges in 1991 and 1992 were interviewed in person shortly after incarceration. The women were assessed for psychiatric disorders and lifetime use of substance abuse and mental health treatment services. Rates of service use were analyzed by inmate characteristics and were compared with rates for a sample of women in the community in North Carolina. RESULTS: The majority of women inmates reported a history of using substance abuse services or mental health services or both. Those with psychiatric disorders and prison recidivists were the most likely to have used such services. Rates of service use were substantially higher for the inmates than for the women in the community, even when the effects of having a psychiatric or substance use disorder were controlled for. CONCLUSIONS: Many of the incarcerated women in the study met lifetime criteria for alcohol, drug, and mental health disorders that were significantly related to their use of substance abuse and mental health treatment services. The majority of the inmates met criteria for a current disorder despite past treatment. Further research is needed to help in developing programs to reduce women inmates' alcohol, drug, and mental health problems.

Adult↗