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CORK Bibliography: Crack Cocaine

46 citations. January 2010 to present

Prepared: March 2012

Acker CJ. How crack found a niche in the American ghetto: The historical epidemiology of drug-related harm. BioSocieties 5(1, special issue): 70-88, 2010. (63 refs.)

Although neuroscience has produced elegant models of addiction as a brain process, it does not address the incidence and prevalence of conditions like addiction in populations. As incidence and prevalence are the measures of a condition in a society, understanding rates of social problems is critical to controlling them. Nevertheless, not all upsurges in drug use in a population constitute true emergencies. It is useful to distinguish drug eras, new patterns of drug use that emerge in a population and then stabilize or decline from epidemics of drug-related harm. A historical epidemiology of drug-related harm draws from history, science and social science to examine the conditions that produce such epidemics. Compulsive crack use concentrated in American urban neighborhoods characterized by poverty and cultural isolation in the 1980s and the object of lurid media coverage, can be better understood through the lens of the historical epidemiology of drug-related harm. This model holds that serious upsurges in harmful drug use result from the introduction of powerful new drugs or drug forms to populations that lack experience with them and that suffer from multiple dimensions of structural disadvantage.

Copyright 2010, McMillan Ltd

Adimora AA; Schoenbach VJ; Taylor EM; Khan MR; Schwartz RJ. Concurrent partnerships, nonmonogamous partners, and substance use among women in the United States. American Journal of Public Health 101(1): 128-136, 2011. (34 refs.)

Objectives. We determined the prevalence, distribution, and correlates of US women's involvement in concurrent sexual partnerships, a sexual-network pattern that speeds population-wide HIV dissemination. Methods. We used sexual partnership dates reported by 7643 women in the 2002 National Survey of Family Growth to determine prevalence of concurrent sexual partnerships during the preceding 12 months. We examined associations between concurrency and sociodemographic characteristics and risk behaviors. Results. Prevalence of concurrent partnerships was 5.7% based on reported partnerships and 8.3% after adjustment for possible underreporting. Concurrency was associated with younger age (22 to 24 years: prevalence odds ratio [POR]=2.44) versus older age (40 to 44 years); marital status (formerly married: POR=6.56; never married: POR=3.81; vs married); Black race/ethnicity (POR=1.78); younger age at first sexual intercourse (12 to 13 years: POR=2.89) versus 18 years or older); having a nonmonogamous sexual partner (POR=6.96); having intercourse while "high" on drugs or alcohol (POR=1.61); binge drinking (POR=1.70); and crack or cocaine use (POR=2.72). Conclusions. The association of concurrency with nonmonogamous sexual partners and substance use suggests the existence of extensive sexual networks that link people at higher risk for HIV infection with increased opportunities for disseminating infection.

Copyright 2011, American Public Health Association

Booth BM; Curran G; Han X; Wright P; Frith S; Leukefeld C et al. Longitudinal relationship between psychological distress and multiple substance use: Results from a three-year multisite natural-history study of rural stimulant users. Journal of Studies on Alcohol and Drugs 71(2): 258-267, 2010. (44 refs.)

Objective: Substance use is associated with poor mental health, but little is known regarding how use of multiple substances is associated with mental health, particularly longitudinally, in community studies. This article examines this issue in a large (N = 710), natural-history study of rural stimulant (cocaine and/or methamphetamine) users in three states. Method: Respondent-driven sampling recruited recent (past-30-day) stimulant users in three counties each in Arkansas, Kentucky, and Ohio. Participants were interviewed every 6 months for 3 years. Mental health was measured by the Brief Symptom Inventory, and prior 6 months' substance use was measured for 17 possible substances. Data analysis used generalized estimating equations for longitudinal data with the Global Severity Index of the Brief Symptom Inventory as the dependent variable at each interview and substance use as predictor variables measured by number of substances used in the past 6 months and, separately, the 17 individual substances, adjusting for use of substance-use treatment, demographics, and recruitment site. Results: On average, both Global Severity Index score and use of many substances declined over the course of study. Global Severity Index score was significantly associated with (a) greater number of substances used in the past 6 months (p <.0001) and (b) use of crack cocaine, methamphetamine, and nonprescription use of prescription painkillers and tranquilizers. Conclusions: Multiple and specific substances appear to incrementally increase psychological distress. Users of cocaine and methamphetamine are present in rural areas; these associations with poor psychological health raise concerns regarding availability of local treatment services for individuals with mental-health problems, as well as substance abuse.

Copyright 2010, Alcohol Research Documentation

Bowser BP; Lewis D; Dogan D. External influences on drug treatment interventions: East Palo Alto's Free-at-Last. Journal of Addiction Medicine 5(2): 115- 122, 2011. (25 refs.)

External influences on community-based drug treatment program outcomes have not been adequately accounted by either treatment providers or evaluators. In 2001-2003, a cohort of 197 African American and Latino crack cocaine and heroin users was interviewed at intake into the Free-at-Last's treatment program in East Palo Alto, California. Objective: The goal of this research was to identify, and then measure, the impact of a series of theory-based, hypothesized external influences on 3 client treatment outcomes: (1) program completers, (2) dropouts, and (3) referrals to more intensive inpatient treatment. Methods: All program clients were interviewed using the Government Performance and Results Act and the California Alcohol and Drug Data System questionnaires. Supplemental questions hypothesized the external influences and were based on prior research and staff focus groups. Results: There were statistically significant differences in treatment outcomes based on employment status, homelessness, living situation, and jail time. Regression analyses indicated that the strongest outcome predictors were treatment intensity, followed by prior crack use, homelessness, income, and number of illegal drugs used. Path analysis showed that former crack use and time in jail formed a particularly strong cluster of external influences on treatment outcomes. This cluster was the result of court-mandated treatment of arrested crack users who chose treatment over incarceration. If users failed treatment, they went back to jail. In a community such as East Palo Alto, court-mandated referrals had a powerful external influence on treatment and, therefore, need to be considered when evaluating a treatment program.

Copyright 2011, Lippincott, Williams & Wilkins

Bungay V; Johnson JL; Varcoe C; Boyd S. Women's health and use of crack cocaine in context: Structural and 'everyday' violence. International Journal of Drug Policy 21(4): 321-329, 2010. (81 refs.)

Background: There is increasing public health evidence that women who use crack cocaine and are street-involved experience significant health problems and are more isolated with regards to accessing harm reduction and other health-related services. Simultaneously, there is growing acknowledgement that structural and 'everyday' violence are significant factors influencing the health of women who use illegal drugs. Little research has examined how these social processes play out for women who use crack cocaine. Methods: A critical ethnography informed by the theoretical constructs of structural and everyday violence and intersectionality was undertaken to explore women's use of crack cocaine within an inner-city neighbourhood in Western Canada. Data collection included baseline survey (n = 126), participant observation and field notes, informal interviews (n = 53), and in-depth interviews (n = 13). Results: Based on thematic and theoretical analysis two interrelated themes were identified that reflected the interrelationships between women's use of crack, poverty, discrimination, racism, gendered relations of power, and legal policies and practices: (a) the context of health care; and (b) the smoking context. Conclusions: Structural inequities and 'everyday' violence are perilously damaging for women who use crack. Interventions to reduce these inequities are urgently needed if we are to reduce the significant suffering of women who are street-involved and use crack cocaine.

Copyright 2010, Elsevier Science

Carlson RG; Sexton R; Wang JC; Falck R; Leukefeld CG; Booth BM. Predictors of substance abuse treatment entry among rural illicit stimulant users in Ohio, Arkansas, and Kentucky. Substance Abuse 31(1): 1-7, 2010. (23 refs.)

Illicit drug use in the rural United States is increasingly common, yet little is known about drug users' treatment-seeking behaviors. This study identifies predictors of substance abuse treatment entry over 24 months among 710 illicit stimulant users in rural areas of Ohio, Arkansas, and Kentucky. Active users of powdered cocaine, crack cocaine, and/or methamphetamine (MA) were recruited using respondent-driven sampling. Participants completed structured interviews at baseline and follow-up questionnaires every 6 months for 24 months. Data were analyzed using the Cox proportional hazards model. The paper is informed by the Anderson-Newman Model. Overall, 18.7% of the sample entered treatment. Ohio or Kentucky residence, perceived need for substance abuse treatment, higher Addiction Severity Index (ASI) legal problem composite scores, prior substance abuse treatment, and tranquilizer use were positively associated with treatment entry. Nondaily crack cocaine users and marijuana users were less likely to enter treatment. The findings can help inform rural substance abuse treatment program development and outreach.

Copyright 2010, Taylor & Francis

Carrico AW; Johnson MO; Colfax GN; Moskowitz JT. Affective correlates of stimulant use and adherence to anti-retroviral therapy among HIV-positive methamphetamine users. AIDS and Behavior 14(4): 769-777, 2010. (45 refs.)

The use of stimulants has important implications for HIV prevention and care. However, few investigations have examined psychological correlates of substance use and adherence to anti-retroviral therapy (ART) among HIV-positive stimulant users. This cross-sectional investigation examined affective correlates of stimulant use and ART adherence among HIV-positive methamphetamine users. In total, 122 HIV-positive men who have sex with men or transgendered individuals on ART who reported using methamphetamine in the past 30 days were recruited from the community. HIV-specific traumatic stress was consistently and independently associated with more frequent cocaine/crack use (but not with methamphetamine use). Positive affect was independently associated with a decreased likelihood of reporting any injection drug use and an increased likelihood of reporting perfect ART adherence. HIV-specific traumatic stress may be an important determinant of increased cocaine/crack use in this population. Positive affect may increase the likelihood that individuals will refrain from injection drug use and achieve high levels of ART adherence.

Copyright 2010, Springer Press

Chauhan P; Cerda M; Messner SF; Tracy M; Tardiff K; Galea S. Race/ethnic-specific homicide rates in New York City: Evaluating the impact of broken windows policing and crack cocaine markets. Homicide Studies 15(3): 268-290, 2011. (68 refs.)

The current study evaluated a range of social influences including misdemeanor arrests, drug arrests, cocaine consumption, alcohol consumption, firearm availability, and incarceration that may be associated with changes in gun-related homicides by racial/ethnic group in New York City (NYC) from 1990 to 1999. Using police precincts as the unit of analysis, we used cross-sectional, time series data to examine changes in Black, White, and Hispanic homicides, separately. Bayesian hierarchical models with a spatial error term indicated that an increase in cocaine consumption was associated with an increase in Black homicides. An increase in firearm availability was associated with an increase in Hispanic homicides. Last, there were no significant predictors for White homicides. Support was found for the crack cocaine hypotheses but not for the broken windows hypothesis. Examining racially/ethnically disaggregated data can shed light on group-sensitive mechanisms that may explain changes in homicide over time.

Copyright 2011, Sage Publications

Chettiar J; Shannon K; Wood E; Zhang R; Kerr T. Survival sex work involvement among street-involved youth who use drugs in a Canadian setting. Journal of Public Health 32(3): 322-327, 2010. (29 refs.)

Drug users engaged in survival sex work are at heightened risk for drug- and sexual-related harms. We examined factors associated with survival sex work among street-involved youth in Vancouver, Canada. From September 2005 to November 2007, baseline data were collected for the At-Risk Youth Study (ARYS), a prospective cohort of street-recruited youth aged 14-26 who use illicit drugs. Using multiple logistic regression, we compared youth who reported exchanging sex for money, drugs etc. with those who did not. The sample included 560 youth: median age 22; 179 (32%) female; 63 (11%) reporting recent survival sex work. Factors associated with survival sex work in multivariate analyses included non-injection crack use [adjusted odds ratio (AOR) = 3.45, 95% confidence interval (CI): 1.75-6.78], female gender (AOR = 3.02, 95% CI: 1.66-5.46), Aboriginal ethnicity (AOR = 2.35, 95% CI: 1.28-4.29) and crystal methamphetamine use (AOR = 2.02, 95% CI: 1.13-3.62). In subanalyses, the co-use of crack cocaine and methamphetamine was shown to be driving the association between methamphetamine and survival sex work. This study demonstrates a positive interactive effect of dual stimulant use in elevating the odds of survival sex work among street youth who use drugs. Novel approaches to reduce the harms associated with survival sex work among street youth who use stimulants are needed.

Copyright 2010, Oxford University Press

Cunha PJ; Bechara A; de Andrade AG; Nicastri S. Decision-making deficits linked to real-life social dysfunction in crack cocaine-dependent individuals. American Journal on Addictions 20(1): 78-86, 2011. (60 refs.)

Crack cocaine-dependent individuals (CCDI) present abnormalities in both social adjustment and decision making, but few studies have examined this association. This study investigated cognitive and social performance of 30 subjects (CCDI x controls); CCDI were abstinent for 2 weeks. We used the Social Adjustment Scale (SAS), Wisconsin Card Sorting Test (WCST), and Iowa Gambling Task (IGT). Disadvantageous choices on the IGT were associated with higher levels of social dysfunction in CCDI, suggesting the ecological validity of the IGT. Social dysfunction and decision making may be linked to the same underlying prefrontal dysfunction, but the nature of this association should be further investigated.

Copyright 2011, Wiley-Blackwell

DeBeck K; Buxton J; Kerr T; Qi JZ; Montaner J; Wood E. Public crack cocaine smoking and willingness to use a supervised inhalation facility: Implications for street disorder. Substance Abuse Treatment Prevention and Policy 6: article 4, 2011. (44 refs.)

Background: The health risks of crack cocaine smoking in public settings have not been well described. We sought to identify factors associated with public crack smoking, and assess the potential for a supervised inhalation facility to reduce engagement in this behavior, in a setting planning to evaluate a medically supervised crack cocaine smoking facility. Methods: Data for this study were derived from a Canadian prospective cohort of injection drug users. Using multivariate logistic regression we identified factors associated with smoking crack cocaine in public areas. Among public crack smokers we then identified factors associated with willingness to use a supervised inhalation facility. Results: Among our sample of 623 people who reported crack smoking, 61% reported recently using in public locations. In multivariate analysis, factors independently associated with public crack smoking included: daily crack cocaine smoking; daily heroin injection; having encounters with police; and engaging in drug dealing. In sub analysis, 71% of public crack smokers reported willingness to use a supervised inhalation facility. Factors independently associated with willingness include: female gender, engaging in risky pipe sharing; and having encounters with police. Conclusion: We found a high prevalence of public crack smoking locally, and this behavior was independently associated with encounters with police. However, a majority of public crack smokers reported being willing to use a supervised inhalation facility, and individuals who had recent encounters with police were more likely to report willingness. These findings suggest that supervised inhalation facilities offer potential to reduce street-disorder and reduce encounters with police.

Copyright 2011, BioMedical Central

Dias AC; Araujo MR; Dunn J; Sesso RC; de Castro V; Laranjeira R. Mortality rate among crack/cocaine-dependent patients: A 12-year prospective cohort study conducted in Brazil. Journal of Substance Abuse Treatment 41(3): 273-278, 2011. (39 refs.)

Mortality is a significant outcome among Brazilian crack/cocaine-dependent patients yet not well understood and is under investigated. This study examined a range of mortality indicators within a cohort of 131 crack/cocaine-dependent patients admitted into treatment and meeting criteria for dependence of crack (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). After 12 years of treatment discharge, 107 individuals were reassessed and 27 death cases were confirmed by official records, wherein in its majority were caused by homicide (n = 16). In this group, survival rate was 0.77 (95% confidence interval [CI] = 0.74-0.81) and previous history of IV cocaine use was' identified as a predictor of mortality (2.5, 95% CI = 1.08-5.79). High mortality rates among Brazilian crack/cocaine-dependent patients, exposure to violence, and HIV/AIDS were topics discussed in this study. This research highlights the importance of ongoing programs to manage crack/cocaine use along with other treatment features within this population.

Copyright 2011, Elsevier Science

Dickson-Gomez J; Bodnar G; Guevara CE; Rodriguez K; De Mendoza LR; Corbett AM. With God's help I can do it: Crack users' formal and informal recovery experiences in El Salvador. Substance Use & Misuse 46(4): 426-439, 2011. (34 refs.)

Crack use has increased dramatically in El Salvador in the last few decades. As with other developing countries with sudden onsets of drug problems, El Salvador has few medical staff trained in addictions treatment. Little research has examined drug users" attempts to reduce or abstain from drug use in countries where government-regulated formal medical treatment for drug addiction is scarce. This paper uses qualitative and quantitative data gathered from active crack users to explore their formal and informal strategies to reduce or abstain from drugs, and compares these with components of informal and formal treatment in developed countries.

Copyright 2011, Informa Healthcare

Felling T. Cocaine Nation: How the White Trade Took Over the World. New York: Pegasus Books, 2010

The author, a documentary filmmaker, who has done much work in Colombia, turns to the country's main illegal export. (In the opening chapter, we learn about the original 19th-century coca use: The modern-day [Coke] can's red and white livery, taken from the colours of the Peruvian flag, is the only reminder of Coca-Cola's Andean origins. Following the discussion of the cultivation, distribution, and use of cocaine, it counts the drug's dramatic rise in sales and traces traffic from Colombian coca fields to Miami, Kingston, Tijuana, London, and New York. He follows consumers, traders, producers, police officers, doctors, and custom officials. The book is organized in two parts. Part One examines the drug economy. It is cast as a lifeline for plenty of jobless Americans � driving a car loaded with cocaine from El Paso to Chicago can earn the driver $10,000. Crack cocaine, a cheaper form of the drug, became a booming market in the 1980s. By 1989, Jamaican gangs supplied crack to 47 U.S. cities, while the Bloods and the Crips ran West Coast crack houses. Part Two studies suppliers, smugglers, and law enforcement. The conclusing chapters debate drug education, treatment programs, and legalization issues. It is pointed out that over the past 35 years, the U.S. has spent approximately $500 billion on the war on drugs. Yet Americans still consume about 290 metric tons of cocaine a year. Increasingly our neighboring ccountries are suffering too as a result of the drug trade, witness Mexico with its growing drug-related violence and evidence of wide spread corruption among the police and military. The book also endeavors to correct a number of widely held, but inacccurate beliefs about cocaine use. It is pointed out that hard-drug users' wages are actually 20 percent higher than the national average, and cocaine "has become a gesture of extravagance, sophistication and conspicuous consumption, akin to drinking champagne.". A 2007 study found that 80% of cocaine in the U.S. is consumed by whites, but narcotics police have overwhelming focused on poor, inner-city neighbourhoods, typically inhabited by minority populations.

Copyright 2011, Project Cork

Fischer B; Rudzinski K; Ivsins A; Gallupe O; Patra J; Krajden M. Social, health and drug use characteristics of primary crack users in three mid-sized communities in British Columbia, Canada. Drugs: Education, Prevention and Policy 17(4): 333-353, 2010. (100 refs.)

Aims: Despite the increased prevalence of crack use, research on street drug use in Canada currently focusses mainly on injection drug use and/or use in large urban centres. This study's objective was to assess the distinct socio-demographic characteristics, drug-use patterns, health profiles and risk behaviours as well as intervention needs of primary crack users in three mid-sized communities in British Columbia, Canada. Methods: Study participants were recruited with the help of local service agencies and peer recruiters, and assessed between July and November 2008 based on a protocol involving quantitative, qualitative and biological measures. Findings: The majority of the samples: reported unstable housing/homelessness; relied on social benefit payments for income generation; were under current criminal justice supervision; were poly-drug users, using other drugs like alcohol, cannabis or opioids; reported physical and mental health problems; were hepatitis C virus positive; had numerous crack-use episodes per day; frequently shared crack-use paraphernalia; and obtained crack pipe paraphernalia from makeshift items. Conclusions: This study documents crack use as a prevalent street drug use activity associated with extensive social and health risks and harms, which currently are not sufficiently addressed by the existing interventions in the study sites. Concerted attention to, and delivery of, targeted prevention and treatment interventions for the public health problem of crack use in Canada is urgently required.

Copyright 2010, Taylor & Francis

Hadland SE; Marshall BDL; Kerr T; Zhang R; Montaner JS; Wood E. A comparison of drug use and risk behavior profiles among younger and older street youth. Substance Use & Misuse 46(12): 1486-1494, 2011. (48 refs.)

Among 559 street youth recruited between 2005 and 2007 in Vancouver, Canada, young drug users (<21 years of age) were compared with older drug users (>= 21 years) with regard to recent drug use and sexual practices using multiple logistic regression. Older youth were more likely to be male and of Aboriginal ancestry, to have more significant depressive symptoms, to have recently engaged in crack smoking, and to have had a recent history of injection drug use. Young drug users, by contrast, were more likely to have engaged in recent binge alcohol use. Efforts to reduce drug use-related harm among street youth may be improved by considering the highly prevalent use of "harder" drugs and risk for depression among older youth.

Copyright 2011, Informa Healthcare

Hagan H; Perlman DC; Des Jarlais DC. Sexual risk and HIV infection among drug users in New York City: A pilot study. Substance Use & Misuse 46(2-3): 201-207, 2011. (28 refs.)

Measures of sexual health were assessed during 2008-2009 in a New York City sample of 102 injection and noninjection users of heroin, cocaine, or crack. There was considerable overlap and transitioning between crack smoking and injecting. Crack users were also significantly more likely to be gay, lesbian, or bisexual than other drug users. In multivariate analysis, HIV infection was independently associated with crack use and with being gay or bisexual. In New York City, HIV prevention for drug users has focused on syringe access, safe injection, and drug user treatment, but further progress in HIV control will require strategies to address sexual health among people who use drugs. The study's limitations are noted.

Copyright 2011, Informa Healthcare

Hay G; Gannon M; MacDougall J; Eastwood C; Williams K; Millar T. Opiate and crack cocaine use: A new understanding of prevalence. Drugs: Education, Prevention, and Policy 17(2): 135-147, 2010. (41 refs.)

Aims: The aim of this study was to establish prevalence estimates of problem drug use, defined as opiate and/or crack cocaine use by persons aged 15 to 64 years, for England and for each of the 149 administrative areas responsible for commissioning drug interventions. Methods: Indirect estimation techniques, the capture-recapture and multiple indicator methods, were used to obtain estimates. Information on problem drug users presenting to healthcare settings and/or recorded by the criminal justice system, and drug-related indicator data were used in the analyses. Findings: There were an estimated 332,090 problem drug users in England during 2005/06 (95% CI 324,546 to 346,345), equivalent to 9.97 (95% CI 9.74 to 10.40) problem drug users per thousand population aged 15 to 64 years. Prevalence varied by geographic region and age group: the highest rates were observed in London and for those aged 25 to 34 years. Conclusions: This study has produced estimates of the prevalence of problem drug use in England that are more robust, more precise, and suggest a higher prevalence than previous studies. The estimates provide a basis on which to formulate policy, plan services, and measure service performance.

Copyright 2010, Taylor & Francis

Hiestand BC; Smith SW. Cocaine chest pain: Between a (crack) rock and a hard place ... (editorial). Academic Emergency Medicine 18(1): 68-71, 2011. (25 refs.)

Ingersoll KS; Farrell-Carnahan L; Cohen-Filipic J; Heckman CJ; Ceperich SD; Hettema J et al. A pilot randomized clinical trial of two medication adherence and drug use interventions for HIV plus crack cocaine users. Drug and Alcohol Dependence 116(1-3): 177-187, 2011. (60 refs.)

Background: Crack cocaine use undermines adherence to highly active antiretroviral therapy (HAART). This pilot randomized clinical trial tested the feasibility and efficacy of 2 interventions based on the Information-Motivation-Behavioral Skill model to improve HAART adherence and reduce crack cocaine problems. Methods: Participants were 54 adults with crack cocaine use and HIV with <90% HAART adherence. Most participants were African-American (82%) heterosexual (59%), and crack cocaine dependent (92%). Average adherence was 58% in the past 2 weeks. Average viral loads (VL) were detectable (log VL 2.97). The interventions included 6 sessions of Motivational Interviewing plus feedback and skills building (M/+), or Video information plus debriefing (Video+) over 8 weeks. Primary outcomes were adherence by 14day timeline follow-back and Addiction Severity Index (ASI) Drug Composite Scores at 3 and 6 months. Repeated measure ANOVA assessed main effects of the interventions and interactions by condition. Results: Significant increases in adherence and reductions in ASI Drug Composite Scores occurred in both conditions by 3 months and were maintained at 6 months, representing medium effect sizes. No between group differences were observed. No VL changes were observed in either group. Treatment credibility, retention, and satisfaction were high and not different by condition. Conclusions: A counseling and a video intervention both improved adherence and drug problems durably among people with crack cocaine use and poor adherence in this pilot study. The interventions should be tested further among drug users with poor adherence. Video interventions may be feasible and scalable for people with HIV and drug use.

Copyright 2011, Elsevier Science

Ivsins A; Roth E; Nakamura N; Krajden M; Fischer B. Uptake, benefits of and barriers to safer crack use kit (SCUK) distribution programmes in Victoria, Canada-A qualitative exploration. International Journal of Drug Policy 22(4): 292-300, 2011. (75 refs.)

Background: Crack use is prevalent amongst street drug users in Canadian cities, and associated with severe drug use, health and social problems. Whilst few targeted interventions are available for crack use, the common use and sharing of hazardous makeshift paraphernalia are a key concern, as these risks may be associated with oral injury and blood-borne virus (BBV) - e.g., hepatitis C virus (HCV) - transmission amongst users. Recently, distribution programmes of so-called 'safer crack use kits' (SCUMs) have been initiated in select Canadian cities, primarily to reduce the use of unsafe materials and paraphernalia sharing amongst crack users. This study explored uptake and benefits of, barriers to, and possible improvements to two recently implemented SCUK distribution programme in Victoria, Canada. Methods: N=31 regular crack smokers were recruited through community-based efforts between June and August 2010, and assessed via an interviewer-administered protocol involving quantitative and qualitative data items. Descriptive analyses were completed with the quantitative data, and thematic content analyses were conducted with the qualitative data in order to identify and extract prominent themes and issues. Results: The sample indicated high levels of socio-economic marginalization, poly-substance use, health problems, lengthy crack use histories and common crack paraphernalia sharing. Most participants exclusively utilized the SCUK programme including glass-stems in addition to other paraphernalia materials. Participants described: lesser need to share - or to commit property crimes to obtain resources for - crack to paraphernalia, increased health awareness, and increased personal and community safety as benefits experienced from SCUK use. Limitations in SCUK resources and distribution, shortcomings in materials, and police interference were cited as barriers to current SCUK program delivery. Conclusions: SCUM distribution in Victoria appears to result in a variety of individual and community health benefits. These benefits could be solidified by addressing current programme limitations, including better resourcing, expanding geographic distributions and eliminating police interference.

Copyright 2011, Elsevier Science BV

Johnson JE; O'Leary CC; Striley CW; Ben Abdallah A; Bradford S; Cottler LB. Effects of major depression on crack use and arrests among women in drug court. Addiction 106(7): 1279-1286, 2011. (56 refs.)

Aims: We examined whether a current major depressive episode (MDE) at baseline predicted crack use and arrests at follow-up among women enrolled in drug court. Design Primary analyses used zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB) regression analyses to predict both yes/no and number of (i) days of crack use and (ii) arrests at 4-month follow-up from current (30-day) MDE at baseline. Secondary analyses addressed risk conferred by current versus past MDE at baseline. Setting/Participants Participants were 261 women in drug court. Measurements MDE was assessed using the Diagnostic Interview Schedule. Days using crack and number of arrests were assessed using the Washington University Risk Behavior Assessment for Women. Findings Having a current MDE at baseline predicted likelihood of crack use at follow-up, but not days of crack use among those who used. Current MDE at baseline did not predict presence or number of arrests at the 4-month follow-up. Women with current MDE at baseline were more likely to be using crack at follow-up than were those with recent (31+ days to 12 months) but not current MDE (odds ratio = 5.71); past MDE at baseline did not increase risk of crack use. Conclusions Predictors of any versus no crack use or arrests appear to differ from predictors of frequency of these behaviors. Current major depression, but not past major depression, appears to be associated with increased risk of crack use among women attending drug court.

Copyright 2011, Society for the Study of Addiction

Kosman MAH. Falling through the crack: How courts have struggled to apply the crack amendment to "nominal career" and "plea bargain" defendants. Michigan Law Review 109(5): 785- 812, 2011. (9 refs.)

In 2007, after a decade of debate, the U.S. Sentencing Commission instituted an amendment that decreased the sentences of some defendants who had been convicted of crack-cocaine-related offenses. A few months later, the Sentencing Commission passed another amendment that rendered it retroactive. Nearly three years after the passage and retroactive application of the "crack amendment," however, two separate circuit splits have emerged as courts have struggled to uniformly interpret and apply the Sentencing Commission's directives. The first circuit split emerged regarding the eligibility of a subset of "career offenders" to the benefits of the retroactive application of the crack amendment. The second circuit split emerged over the question whether a subset of defendants who pled guilty to crack offenses pursuant to Federal Rule of Criminal Procedure 11(c)(1)(C) prior to the passage of the crack amendment are eligible to receive the benefits of its retroactive application. This Note first argues that the language of the applicable statutes and policy statements and the specific actions taken by the Sentencing Commission indicate that the subset of "career offenders" in the first circuit split are not eligible for a subsequent reduction in the sentence pursuant to the crack amendment. This Note argues, however, that the lack of explicit directives from the Sentencing Commission regarding the "plea bargain" defendants in the second circuit split indicates that these defendants are eligible to receive the benefits of the retroactive application of the amendment. Because the Sentencing Commission instituted and rendered retroactive the crack amendment to decrease the disparity in sentence between defendants convicted of crack and powder cocaine offenses, it would be contrary to the purpose of the amendment to exclude these defendants from its benefits.

Copyright 2011, Michigan Law Review Association

Malchy LA; Bungay V; Johnson JL; Buxton J. Do crack smoking practices change with the introduction of safer crack kits? Canadian Journal of Public Health 102(3): 188-192, 2011. (28 refs.)

Objectives: Crack smoking has increased in Vancouver despite the harms associated with its use. Many people who smoke crack share their equipment, thereby increasing their risk for infectious disease. This project explored the effects of outreach distribution of "safer crack kits" on smoking practices. Methods: Two cross-sectional surveys were conducted, the first prior to kit distribution and the second a year later. Participants were individuals who smoked crack and lived in Vancouver's inner city. Crack smoking practices and use of items in the crack kit were documented. Results: The results of the second survey (i.e., following 12 months of kit distribution) showed an increase in availability and use of safer use items; mouthpieces and condoms provided in the kit were used by 79% and 59% of recipients, respectively. Unsafe practices were reported post distribution: although 42% used brass screens, the majority reported that they usually used Brillo (R); over 40% of respondents reported using syringe plungers to scrape crack resin; and participants reported sharing crack-use paraphernalia. Conclusion: While kit distribution made safer use items more accessible, its impact on safer use practice was limited. Our findings highlight the need for targeted distribution of safer use items. Future research should explore the dynamics of unsafe crack smoking practices and ways to leverage safer use messaging.

Copyright 2011, Canadian Public Health Association

McDermott MJ; Tull MT; Soenke M; Jakupcak M; Gratz KL. Masculine gender role stress and Posttraumatic Stress Sisorder symptom severity among inpatient male crack/cocaine users. Psychology of Men & Masculinity 11(3): 225-232, 2010. (53 refs.)

This study examined the association between masculine gender role stress (MGRS) and posttraumatic stress disorder (PTSD) symptom severity, above and beyond other factors previously found to be associated with PTSD symptoms (e.g., anxiety sensitivity and thought suppression) among 33 crack/cocaine-dependent patients in residential substance abuse treatment. Participants completed a series of questionnaires and were interviewed to determine current PTSD symptom severity. MGRS accounted for a significant amount of additional variance in PTSD symptom severity above and beyond other identified risk factors for PTSD. Results are discussed in terms of their implications for reducing PTSD risk among men following exposure to a potentially traumatic event.

Copyright 2010, Educational Publishing Foundation

Nappo SA; Sanchez Z; De Oliveira LG. Crack, AIDS, and women in Sao Paulo, Brazil. Substance Use & Misuse 46(4): 476-485, 2011. (43 refs.)

Brazil is currently experiencing a growing number of newly recorded cases of HIV infection among women, with transmission mainly occurring by sex. This increase may be associated with the development of sexually risky behavior among female crack users who, according to informal reports, prostitute themselves for drugs or for money to be used for buying drugs. Since epidemiologic studies have not yet addressed this phenomenon, the aim of this study was to investigate this in depth using a qualitative ethnographic approach. An intentional sample was utilized, composed of 75 female crack users in Sao Paulo, who were selected by specific criteria using the snowball strategy and key informants. Fourteen different chains of users were investigated, allowing us to include the largest possible number and variety of users. Each participant was submitted to a semi-structured in-depth interview that was guided by a questionnaire. Verbal information was corroborated and extended using participative observation. These 14-45-year-old women, who had little schooling and no job connections, opted to sell their bodies as a strategy to obtain drugs and to satisfy their compulsive use of crack. The subjects engaged in up to nine acts of sexual intercourse per day, in unsafe locations and with multiple partners who were approached in a besieging way and selected using subjective criteria. These crack users generally exchanged sex under craving for ridiculously low prices and left the use of protection up to the client. Because the users used inadequate pipes to smoke crack, it was common for them to have lesions on their lips and mouths. Since they often provided oral sex, they exposed themselves to considerable risk for infection with STDs including HIV, because of the contact of their partners" semen with their open wounds. These women make up an important risk group with respect to the transmission of STDs including AIDS.

Copyright 2011, Informa Healthcare

Nuijten M; Blanken P; van den Brink W; Hendriks V. Cocaine Addiction Treatments to Improve Control and Reduce Harm (CATCH): New pharmacological treatment options for crack-cocaine dependence in the Netherlands. BMC Psychiatry 11: 135, 2011. (64 refs.)

Background: Cocaine, particularly in its base form ('crack'), has become one of the drugs of most concern in the Netherlands, being associated with a wide range of medical, psychiatric and social problems for the individual, and with significant public order consequences for society. Available treatment options for cocaine dependent users are limited, and a substantial part of the cocaine dependent population is not reached by the addiction treatment system. Psychosocial interventions for cocaine dependence generally show modest results, and there are no registered pharmacological treatments to date, despite the wide range of medications tested for this type of dependence. The present study (Cocaine Addiction Treatments to improve Control and reduce Harm; CATCH) investigates the possibilities and problems associated with new pharmacological treatments for crack dependent patients. Methods/Design: The CATCH-study consists of three separate randomised controlled, open-label, parallel-group feasibility trials, conducted at three separate addiction treatment institutes in the Netherlands. Patients are either new referrals or patients already in treatment. A total of 216 eligible outpatients are randomised using pre-randomisation double-consent design and receive either 12 weeks treatment with oral topiramate (n = 36; Brijder Addiction Treatment, The Hague), oral modafinil (n = 36; Arkin, Amsterdam), or oral dexamphetamine sustained-release (n = 36; Bouman GGZ, Rotterdam) as an add-on to cognitive behavioural therapy (CBT), or receive a 12-week CBT only (controls: n = 3 x 36). Primary outcome in these feasibility trials is retention in the underlying psychosocial treatment (CBT). Secondary outcomes are acceptance and compliance with the study medication, safety, changes in cocaine (and other drug) use, physical and mental health, social functioning, and patient satisfaction. Discussion: To date, the CATCH-study is the first study in the Netherlands that explores new treatment options for crack-cocaine dependence focusing on both abstinence and harm minimisation. It is expected that the study will contribute to the development of new treatments for one of the most problematic substance use disorders.

Copyright 2011, Biomed Central

Nutt DJ; King LA; Phillips LD. Drug harms in the UK: A multicriteria decision analysis. Lancet 376(9752): 1558-1565, 2010. (20 refs.)

Background: Proper assessment of the harms caused by the misuse of drugs can inform policy makers in health, policing, and social care. We aimed to apply multicriteria decision analysis (MCDA) modelling to a range of drug harms in the UK. Method Members of the Independent Scientific Committee on Drugs, including two invited specialists, met in a 1-day interactive workshop to score 20 drugs on 16 criteria: nine related to the harms that a drug produces in the individual and seven to the harms to others. Drugs were scored out of 100 points, and the criteria were weighted to indicate their relative importance. Findings: MCDA modelling showed that heroin, crack cocaine, and metamfetamine were the most harmful drugs to individuals (part scores 34, 37, and 32, respectively), whereas alcohol, heroin, and crack cocaine were the most harmful to others (46, 21, and 17, respectively). Overall, alcohol was the most harmful drug (overall harm score 72), with heroin (55) and crack cocaine (54) in second and third places. Interpretation: These findings lend support to previous work assessing drug harms, and show how the improved scoring and weighting approach of MCDA increases the differentiation between the most and least harmful drugs. However, the findings correlate poorly with present UK drug classification, which is not based simply on considerations of harm.

Copyright 2010, Elsevier Science

Oliveira LG; Ponce JDC; Nappo SA. Crack cocaine use in Barcelona: A reason of worry. Substance Use & Misuse 45(13): 2291-2300, 2010. (41 refs.)

In Spain, crack cocaine use is silently increasing. In Barcelona, an intentional sample was selected to describe the general characteristics of this consumption. Participants were submitted to an interview and data were analyzed through qualitative research procedures. Users are young males and of low socioeconomic status and formal education. The major pattern of use is compulsive. Illegal income activities are the choice for crack cocaine or money acquisition, increasing individual and social health costs. Polydrug use is a matter of concern. Although these findings can not be generalized, they should be considered for the development of public policies to adequately address crack cocaine users' needs.

Copyright 2010, Taylor & Francis

Ompad DC; Friedman SR; Hwahng SJ; Nandi V; Fuller CM; Vlahov D. HIV risk behaviors among young drug using women who have sex with women (WSWs) in New York City. Substance Use & Misuse 46(2-3): 274-284, 2011. (49 refs.)

Previous research has suggested that multiple stressors may work in tandem to affect the health of women who have sex with women (WSWs). WSWshave been a part of the HIV epidemic in New York City since the beginning, making it an ideal setting to further explore these women's risk. Among a sample of 375 heroin, crack and/or cocaine using women recruited from economically disadvantaged communities in New York City, we examined HIV seroprevalence and risk behaviors among WSWs as compared to women who have sex with men only (WSMOs). We also explore differences between WSWs and WSMOs with respect to potential stressors (i.e., decreased access to resources and health care utilization and violence victimization) that might contribute overall HIV risk. The study's limitations are noted.

Copyright 2011, Informa Healthcare

Paquette C; Roy E; Petit G; Boivin JF. Predictors of crack cocaine initiation among Montreal street youth: A first look at the phenomenon. Drug and Alcohol Dependence 110(1-2): 85-91, 2010. (58 refs.)

Background: Crack cocaine use is increasing in Montreal. However, initiation risk factors among street youth are unknown. The goal of this project is to estimate the incidence of first crack cocaine use among these youth and to identify the associated risk factors. Methods: A prospective cohort study of HIV and hepatitis C incidence was conducted among street youth from 2001 to 2005. A questionnaire on sexual and drug use behaviours was administered every 6 months. Incidence was estimated (a) for youth who had never used crack cocaine at recruitment (n=203) and, among them, (b) for those who had snorted cocaine before (n=122). The risk factors for initiation of crack use as well for initiation into a new route of cocaine administration among youth who had snorted cocaine before were determined using Cox regression. Results: Incidence rates for crack cocaine use were (a) 136.6/1000 person-years (p-y) (95% confidence interval [CI]: 104.5-175.5) and (b) 205.8/1000 p-y (95% CI: 150.2-275.3). The number of substance types used recently increased the risk of initiating crack use (adjusted hazard ratio [AHR] = 1.84 per substance type, 95% CI: 1.55-2.18), whereas having a parent with a substance abuse problem decreased that risk (AHR = 0.48, 95% CI: 0.26-0.89). The risk factors were identical among youth who had snorted cocaine before. Conclusions: Our analyses show a high incidence of crack use among street youth. It is important to delve more deeply into the phenomenon of initiation if we wish to develop effective prevention measures for these young people.

Copyright 2010, Elsevier Science

Pope SK; Falck RS; Carlson RG; Leukefeld C; Booth BM. Characteristics of rural crack and powder cocaine use: Gender and other correlates. American Journal of Drug and Alcohol Abuse 37(6): 491-496, 2011. (25 refs.)

Background: Little is known about the relationship of gender with cocaine use in rural areas. This study describes these relationships among stimulant users residing in rural areas of Arkansas, Kentucky, and Ohio. Objectives: Understanding the characteristics of crack and powder cocaine users in rural areas may help inform prevention, education, and treatment efforts to address rural stimulant use. Methods: Participants were 690 stimulant users, including 274 (38.6%) females, residing in nine rural counties. Cocaine use was measured by self-report of cocaine use, frequency of use, age of first use, and cocaine abuse/dependence. Powder cocaine use was reported by 49% of this sample of stimulant users and 59% reported using crack cocaine. Findings: Differing use patterns emerged for female and male cocaine users in this rural sample; females began using alcohol, marijuana, and cocaine at later ages than males but there were no gender differences in current powder cocaine use. Females reported more frequent use of crack cocaine and more cocaine abuse/dependence than males, and in regression analyses, female crack cocaine users had 1.8 times greater odds of reporting frequent crack use than male crack users. Conclusions and Scientific Significance: These findings suggest differing profiles and patterns of cocaine use for male and female users in rural areas, supporting previous findings in urban areas of gender-based vulnerability to negative consequences of cocaine use. Further research on cocaine use in rural areas can provide insights into gender differences that can inform development and refinement of effective interventions in rural communities.

Copyright 2011, Informa Healthcare

Rhoades H; Wenzel SL; Golinelli D; Tucker JS; Kennedy DP; Green HD et al. The social context of homeless men's substance use. Drug and Alcohol Dependence 118(2-3): 320-325, 2011. (55 refs.)

Background: Homeless men may be at particular risk for the negative health effects of substance use. This cross-sectional study investigates the individual and personal network risk factors associated with substance use in this vulnerable population. Methods: Participants were a representative probability sample of 305 heterosexually active homeless men interviewed from meal programs in the Skid Row region of Los Angeles, CA. Interviews assessed individual, personal network, and substance use characteristics. Logistic regression examined individual and personal network predictors of the three most prevalent substances. Results: In the past 6 months, the three most prevalent substances were marijuana (56%), crack (40%), and alcohol to intoxication (38%). The mental health status of homeless men was associated with substance use, with PTSD more common among those who used crack. Riskier networks (comprised of a larger proportion of drug users) were associated with marijuana use, and normative social ties (family, employed and school/work contacts) were associated with a decreased likelihood of crack use. Conclusions: Mental health problems and riskier personal networks are associated with homeless men's substance use. These findings underscore the importance of interventions that focus on improving mental health, mitigating the drug-using norms of personal networks, and helping men to maintain contact with normative, low-risk alters. Mental health care and peer-based, network interventions to reduce substance use should be a priority for heterosexually active homeless men.

Copyright 2011, Elsevier Science

Schaub M; Stevens A; Haug S; Berto D; Hunt N; Kerschl V et al. Predictors of retention in the 'voluntary' and 'quasi-compulsory' treatment of substance dependence in Europe. European Addiction Research 17(2): 97-105, 2011. (41 refs.)

Background: Policies and practices related to the quasi-compulsory treatment (QCT) of substance-dependent offenders are currently implemented in many countries, despite the absence of reliable knowledge about significant predictors of treatment retention. This study aimed to identify such predictors in QCT and voluntary treatment. Methods: Participants were treated in one of 65 institutions in 5 European countries. They were interviewed at intake on substance use, crimes committed, perceived pressure for treatment, self-efficacy, stage of change, employment, and health-related variables. Binary logistic regression models were computed to identify predictors of treatment retention at an 18-month follow-up. Moderator analyses were computed to investigate whether these predictors vary by treatment condition (QCT vs. voluntary). Results: A higher number of working days in the previous month was positively associated with treatment retention, while use of heroin, crack, and multiple drugs, psychiatric problems in the previous month, and lifetime depression were negatively associated with treatment retention. Higher perceived medical pressure resulted in higher treatment retention rates only for participants in QCT. Conclusion: Predictors of substance abuse treatment retention are quite similar across both QCT and voluntary treatments. Perceived medical pressure is of higher relevance than the often-believed legal pressure for treatment retention in QCT.

Copyright 2011, Karger

Seleghim MR; Marangoni SR; Marcon SS; de Oliveira MLF. Family ties of crack cocaine users cared for in a psychiatric emergency department. Revista Latino-Americana de Enfermagem 19(5): 1163-1170, 2011. (24 refs.)

This study characterizes the family ties of crack cocaine users cared for in a psychiatric emergency department in southern Brazil. It is a qualitative study with a series of cases carried out in the city of Maringa, PR, Brazil from April to June 2010. Data were collected through semi-structured interviews, analyzed using content analysis, and organized into two categories: family ties as facilitators in the use of crack cocaine and other drugs; and fragmented family ties of crack users. Loss of relational bonds with family and social milieu was observed among the ten studied users in addition to the presence of drugs and violence in the family sphere. Further studies addressing the use of crack and its interface with the family are encouraged, taking into consideration that families have an essential role in the initiation and continuity of drug use.

Copyright 2011, University of Sao Paulo

Sherman SG; Reuben J; Chapman CS; Lilleston P. Risks associated with crack cocaine smoking among exotic dancers in Baltimore, MD. Drug and Alcohol Dependence 114(2-3): 249- 252, 2011. (20 refs.)

Background: There is a dearth of research focusing on sex work in exotic dance clubs. We conducted a cross-sectional study to examine the prevalence and correlates of crack cocaine smoking among a sample of exotic dancers. Methods: The "block," a historical red-light district in downtown Baltimore, MD, is comprised of 30 adult-entertainment establishments. Between 01/09 and 08/09, we conducted a survey with exotic dancers (N = 98). The survey explored demographic, and drug and sexual/drug risk behaviors. Bivariate and multivariate analysis was conducted using Poisson regression with robust variance estimates to examine correlates of current crack smoking. Results: Crack cocaine smokers compared to non-crack cocaine smokers were significantly more likely to report: older age (29 vs. 23 years, respectively, p < 0.0001); being White (79% vs. 50%, respectively, p = 0.008); having been arrested (93% vs. 67%, respectively, p = 0.008); daily alcohol consumption (36% vs. 17%, p = 0.047); current heroin injection (57% vs. 13%, p < 0.001); and current sex exchange (79% vs. 30%, p < 0.001). In the presence of other variables, crack cocaine smokers compared to non-crack cocaine smokers were significantly older, more likely to report current heroin injection, and more likely to report current sex exchange. Discussion: We found high levels of drug use and sexual risk behaviors as well as a number of risks behaviors associated with crack cocaine smoking among this very under-studied population. Targeted interventions are greatly needed.

Copyright 2011, Elsevier Science

Smith GW; Farrell M; Bunting BP; Houston JE; Shevlin M. Patterns of polydrug use in Great Britain: Findings from a national household population survey. Drug and Alcohol Dependence 113(2-3): 222-228, 2011. (55 refs.)

Background: Polydrug use potentially increases the likelihood of harm. As little is known about polydrug use patterns in the general population, it is difficult to determine patterns associated with highest likelihood. Methods: Latent class analysis was performed on nine illicit substance groups indicating past year use of cannabis, cocaine, amphetamines, ecstasy, LSD, mushrooms, amyl nitrate, tranquillisers and heroin or crack. Analyses were based on data from a large multi-stage probability sample of the population of Great Britain (n=8538) collected in 2000. Multinomial logistic regression was performed highlighting associations between classes, and demographic and mental health variables. Results: A three class solution best described patterns of polydrug use; wide range, moderate range, and no polydrug use. For males and young people, there was a significantly increased chance of being in the wide and moderate range polydrug use groups compared to the no polydrug use class. Hazardous drinking was more likely in the wide and moderate polydrug classes with odds ratios of 9.99 and 2.38 (respectively) compared to the no polydrug use class. Current smokers were more likely to be wide and moderate range polydrug users compared to the no polydrug use class with odds ratios of 4.53 and 5.85 respectively. A range of mental health variables were also related to class membership. Conclusions: Polydrug use in Great Britain can be expressed as three distinct classes. Hazardous alcohol use and tobacco use were strongly associated with illicit polydrug use, polydrug use appeared to be significantly associated with mental health, particularly lifetime suicide attempts.

Copyright 2011, Elsevier Science

Timpson SC; Williams ML; Bowen AM; Atkinson JS; Ross MW. Sexual activity in HIV-positive African American crack cocaine smokers. Archives of Sexual Behavior 39(6): 1353-1358, 2010. (30 refs.)

The AIDS epidemic in the United States continues to disproportionately affect minorities of color, especially African Americans. The purpose of this study was to explore the sexual behaviors of a sample of African American HIV positive crack smokers aware of their serostatus. Participants (100 men, 37 women) were included in this study based on the following criteria: a minimum age of 18 years, HIV positive serostatus, treatment with HIV antiretroviral medications for a minimum of 3 months prior to interview, crack cocaine use at least once in the 7 days prior to being interviewed, willingness to provide a urine sample to confirm recent drug use, and vaginal or anal sex at least once in the past 7 days. The questionnaire was a compilation of other reliable surveys and was designed to collect sociodemographic data, drug use, sexual behavior, condom use intentions and motivators, STD and HIV infection history, HIV medications, and adherence requirements. Participants reported having 1,266 different partners in the 30 days prior to the interview and had traded sex for money or drugs with 68%. A total of 79 participants had multiple partners and accounted for 1,247 partnerships. Rates of consistent condom use across partnerships were low, indicating that more interventions in this at-risk population are needed.

Copyright 2010, Springer

Tobin KE; German D; Spikes P; Patterson J; Latkin C. A comparison of the social and sexual networks of crack-using and non-crack using African American men who have sex with men. Journal of Urban Health 88(6): 1052-1062, 2011. (44 refs.)

The role of crack cocaine in accelerating the HIV epidemic among heterosexual populations has been well documented. Little is known about crack use as an HIV risk factor among African American men who have sex with men (AA MSM), a group disproportionately infected with HIV. We sought to compare the social and sexual network characteristics of crack-using and non-crack using AA MSM in Baltimore, MD, USA and to examine associations of crack use with sexual risk. Participants were recruited using street-based and internet-based outreach, printed advertisements, word of mouth. Inclusion criteria were being aged 18 years or older, African American or of black race/ethnicity, and have self-reported sex with another male in the prior 90 days. Crack use was operationalized as self-report of crack in the prior 90 days. Logistic regression was used to identify variables that were independently associated with crack use. of 230 enrolled AA MSM, 37% (n = 84) reported crack use. The sexual networks of crack-using AA MSM were composed of a greater number of HIV-positive sex partners, exchange partners, and partners who were both sex and drug partners and fewer networks with whom they always use condoms as compared to non-crack using AA MSM. Crack use was independently associated with increased odds of bisexual identity and networks with a greater number of exchange partners, overlap of drug and sex partners, and lesser condom use. Results of this study highlight sexual network characteristics of crack-smoking AA MSM that may promote transmission of HIV. HIV interventions are needed that are tailored to address the social context of crack-smoking AA MSM risk behaviors.

Copyright 2011, Springer

Tolou-Shams M; Ewing SWF; Tarantino N; Brown LK. Crack and cocaine use among adolescents in psychiatric treatment: Associations with HIV risk. Journal of Child & Adolescent Substance Abuse 19(2): 122-134, 2010. (36 refs.)

Crack and cocaine use among adults has been associated with co-occurring psychiatric disorders as well as other drug use and unprotected sex. However, this issue is relatively unstudied in adolescents. This study collected data from 282 adolescents (mean age = 14.9 years) treated in intensive psychiatric treatment settings to understand the relationship between crack/cocaine use and HIV risk. Thirteen percent of youths reported ever using crack or cocaine. Use was not associated with age, gender, race/ethnicity, or SES. After controlling for known factors that influence unprotected sex, the odds that those with a history of crack/cocaine use engaged in inconsistent condom use was six times greater than that for those youths who did not ever use. Thus, crack/cocaine use is prevalent even among younger adolescents with psychiatric disorders who are not in drug treatment. Its use is associated with high rates of sexual and other risk behaviors. A history of use should alert clinicians to a wide variety of possible behavioral risks. These results can also inform future adolescent HIV prevention intervention development.

Copyright 2010, Haworth Press

Tull MT; Gratz KL; Aklin WM; Lejuez CW. A preliminary examination of the relationships between posttraumatic stress symptoms and crack/cocaine, heroin, and alcohol dependence. Journal of Anxiety Disorders 24(1): 55-62, 2010. (65 refs.)

High rates of co-occurrence between posttraumatic stress (PTS) and substance use disorders (SUDs) have led to the suggestion that substance use among individuals experiencing PTS symptoms might serve a self-medication function. However, research is still needed to provide a more comprehensive evaluation of the unique associations between PTS symptom clusters and substances (licit and illicit) with both anxiolytic/depressant and stimulant properties. Consequently, this study examined the relationship between severity of different PTS Symptom Clusters and heroin, crack/cocaine, and alcohol dependence among 48 treatment-seeking SUD patients with a history of traumatic exposure. No evidence was found for a relationship between PTS symptom clusters and crack/cocaine or alcohol dependence: however, results suggested a relationship between hyperarousal and avoidance (inversely related) symptoms and heroin dependence. Results are discussed in terms of their implications for understanding motivations underlying the substance of choice among individuals with PTS symptoms, as well as the development of treatments for co-occurring PTS and SUDs.

Copyright 2010, Elsevier Science

Vaughn MG; Fu QA; Perron BE; Bohnert ASB; Howard MO. Is crack cocaine use associated with greater violence than powdered cocaine use? Results from a national sample. American Journal of Drug and Alcohol Abuse 36(4): 181-186, 2010. (18 refs.)

Background: The question of whether crack cocaine use is associated with increased violence compared to powdered cocaine use has not been adequately explored in large nationally representative general population samples. Methods: This study used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to 1) determine the comparative prevalences of violent behaviors among crack cocaine users and powdered cocaine users, 2) examine these differences while controlling for sociodemographic variables, lifetime psychiatric, alcohol and drug use disorders (a majority of cocaine users use other substances), and levels of crack cocaine and powdered cocaine use. Results: The likelihood of violence associated with crack cocaine users was greater compared to powdered cocaine users at the bivariate level. However, these differences were almost uniformly statistically nonsignificant when demographic, mood and non-cocaine substance use disorders were controlled for. Conclusions: The substantial attenuation of the association of crack cocaine use with violence after adjustment suggests that the sociodemographic characteristics, psychiatric variables, and non-cocaine substance use disorders that make some individuals more likely to use crack cocaine than powder cocaine are responsible for the increased prevalence of violence observed among crack users, rather than crack itself.

Copyright 2010, Taylor & Francis

Vogenthaler NS; Hadley C; Rodriguez AE; Valverde EE; del Rio C; Metsch LR. Depressive symptoms and food insufficiency among HIV-infected crack users in Atlanta and Miami. AIDS and Behavior 15(7): 1520-1526, 2011. (55 refs.)

Depression contributes to worse general and HIV-related clinical outcomes. We examined the prevalence of and factors associated with depressive symptomatology among HIV-infected crack cocaine users recruited for Project HOPE (Hospital Visit is an Opportunity for Prevention and Engagement with HIV-positive Crack Users). We used multiple logistic regression to determine sociodemographic correlates associated with screening in for depression. Among 291 participants, three-quarters (73.5%) were identified as depressed. Higher odds of screening in for depression was associated with food insufficiency and monthly income below $600. Alcohol and crack use were not associated with screening in for depression. Depressive symptomatology is extremely prevalent among HIV-infected crack cocaine users and is associated with food insufficiency and lower income. Screening for depression and food insecurity should be included in HIV prevention and treatment programs. Improved recognition and mitigation of these conditions will help alleviate their contribution to HIV-related adverse health outcomes.

Copyright 2011, Springer

Vogenthaler NS; Hadley C; Lewis SJ; Rodriguez AE; Metsch LR; del Rio C. Food insufficiency among HIV-infected crack-cocaine users in Atlanta and Miami. Public Health Nutrition 13(9): 1478-1484, 2010. (31 refs.)

Objective: To measure the occurrence and correlates of food insufficiency among HIV-infected crack-cocaine users in Atlanta and Miami,. Design: Non-probability cross-sectional sample. Setting: Inner-city hospitals in Atlanta and Miami. Subjects: Two hundred and eighty-seven HIV-infected crack users. Results: One-third (34%) of respondents experienced food insufficiency within 30 d of interview. Increased odds of food insufficiency was associated with current homelessness (adjusted OR = 3.78, 95% CI 1.70, 8.41), living alone (adjusted OR = 2.85, 95% CI 1.36, 5.98), religious service attendance (adjusted OR = 2.34, 95% CI 1.02, 5.38) and presence of health insurance (adjusted OR = 2.41, 95% CI 1.06, 5.54). Monthly income greater than $US 600 (adjusted OR = 0.19, 95% CI 0.06, 0.58) was associated with decreased odds of food insufficiency, and less than weekly crack use was marginally associated with decreased odds of food insufficiency (adjusted OR = 0.39, 95% CI 0.13, 1.08). Conclusions: Food insufficiency is very prevalent among HIV-infected urban crack-cocaine users in Atlanta and Miami. Correlates of food insufficiency confirm the social vulnerability of these individuals. Routine assessment for food insecurity should become a routine component of treatment and prevention programmes in at-risk populations.

Copyright 2010, Cambridge University Press

Wechsberg WM; Novak SP; Zule WA; Browne FA; Kral AH; Ellerson RM et al. Sustainability of intervention effects of an evidence-based HIV prevention intervention for African American women who smoke crack cocaine. Drug and Alcohol Dependence 109(1-3): 205-212, 2010. (45 refs.)

Background: HIV prevention intervention efficacy is often assessed in the short term. Thus, we conducted a long-term (mean 4.4 years) follow-up of a woman-focused HIV intervention for African American crack smokers, for which we had previously observed beneficial short-term gains. Methods: 455 out-of-treatment African American women in central North Carolina participated in a randomized field experiment and were followed up to determine sustainability of intervention effects across three conditions: the woman-focused intervention, a modified NIDA intervention, and a delayed-treatment control condition. We compared these groups in terms of HIV risk behavior at short-term follow-up (STFU; 3-6 months) and long-term follow-up (LTFU; average 4 years). Results: The analyses revealed two distinct groups at STFU: women who either eliminated or greatly reduced their risk behaviors (low-risk class) and women who retained high levels of risk across multiple risk domains (high-risk class). At STFU, women in the woman-focused intervention were more likely to be in the low HIV risk group than the women in control conditions, but this effect was not statistically significant at LTFU. However, low-risk participants at STFU were less likely to be retained at LTFU, and this retention rate was lowest among women in the woman-focused intervention. Conclusions: Short-term intervention effects were not observed over 4 years later, possibly due to differential retention across conditions. The retention of the highest risk women presents an opportunity to extend intervention effects through booster sessions for these women.

Copyright 2010, Elsevier Science

Yang C; German D; Webster D; Latkin C. Experiencing violence as a predictor of drug use relapse among former drug users in Baltimore, Maryland. Journal of Urban Health 88(6): 1044-1051, 2011. (30 refs.)

The purpose of this study was to examine experiencing violence as a predictor of subsequent drug relapse among a sample of former crack, cocaine, and heroin users in Baltimore, MD, USA. The sample consists of 228 former drug users in Baltimore who were recruited through street outreach. Mixed-effects models were used to examine experiencing violence as a predictor of drug relapse at follow-up after adjusting for clustering of responses among participants living in the same census block. Using longitudinal data, we found that experiencing violence in the past year predicted drug relapse at 2-year follow-up among former drug users. Results indicate experiencing violence is a determinant of drug use relapse and highlight the importance of addressing the fundamental issues of violence experienced in inner-city communities. Addressing the extent of recent violence among drug treatment participants, providing coping skills, and reducing community violence are strategies that may address the link between violence and drug relapse.

Copyright 2011, Springer