Participants’ views on the strengths and limitations of drug court: Recommendations to enhance assessment and treatment of mental illnesses

ABSTRACT

Since 1989, drug courts have provided an alternative to incarceration for arrestees who have a substance use disorder. Previous research has suggested that participants who graduate from the program are less likely to recidivate than those who are terminated from the program. The majority of research on drug courts is quantitative; therefore, the benefits of qualitative methods are not fully seen in the literature. This qualitative study developed an in-depth understanding of participants’ (n = 42) views on the strengths and limitations of a Midwestern drug court. Two themes emerged from the data. First, participants felt that the drug court promoted camaraderie, which enhanced their motivation for change and supported them in graduating from the program. Second, participants felt that the drug court did not adequately treat their mental illnesses, which for some resulted in relapse and was perceived as a barrier to graduating from the program. Recommendations for drug court practice are discussed.     

Vilazodone: another novel atypical antidepressant drug

This article reviews the novel atypical antidepressant drug vilazodone (Viibryd(?)), which was approved by the U.S. Food and Drug Administration in January 2011 for the treatment of major depression. Vilazodone is a dual-acting antidepressant drug, with a primary mechanism of action of blocking the serotonin reuptake transporter together with acting as a 5-HT1A receptor partial agonist. The antidepressant efficacy of vilazodone was established in two 8-week placebo-controlled studies. One long-term (52-week) open-label study has been conducted. The most common side effects are diarrhea, nausea, and headache. The drug has not been studied in pediatric patients or well studied in patients older than 65. Vilazodone is efficacious, safe, and well tolerated, but does not appear to have major efficacy advantages compared with other antidepressant drugs. However, because of its unique pharmacology and relatively benign tolerability profile, it may be a more effective alternative for patients who do not respond to or cannot tolerate currently available antidepressant drugs.     

Longitudinal HIV risk behavior among the Drug Abuse Treatment Outcome Studies (DATOS) adult sample

Longitudinal trajectories for HIV risk were examined over 5 years following treatment among 1,393 patients who participated in the nationwide Drug Abuse Treatment Outcome Studies. Both injection drug use and sexual risk behavior declined over time, with most of the decline occurring between intake and the first-year follow-up. However, results of the application of growth mixture models for both sets of trajectories indicated that a subgroup of individuals reverted to a high-risk behavior over time, with a higher level of risk at the 5-year follow-up than their original risk level at intake. Of clients who were engaged in regular injection drug use at intake, 76% continued to inject drug at a moderate-stable or increased rate during the 5-year follow-up.     

Factors associated with phosphodiesterase type 5 inhibitor treatment satisfactions: results of patient interrogation

Introduction. Phosphodiesterase type 5 (PDE5) inhibitor therapy is an efficacious means of treatment for erectile dysfunction (ED). PDE5 inhibitors supply penile erection by inhibiting the hydrolysis of cGMP and therefore relaxing the corpus cavernosum. In this study, retrospective evaluation of those patients who were admitted to our clinic with the complaint of ED and who were recommended on PDE5 inhibitor treatment in terms of follow-up results and patient satisfaction were aimed.

Method. The patients were called by phone and after informing about the study and taking the informed consent, patient satisfaction with the treatment, purposes of withdrawal, treatment alterations and partner satisfaction were investigated.

Results. Interviews were made with 345 patients, who accepted to enroll in the study and the mean patient age was 56 ± 11.2 years. Of the patients 66.4% were learned to be satisfied with the treatment. It was determined that 10.7% of the patients have never used the medication and 50% could not continue because of high drug cost. It was recognised that 50.2% of the patients who are not satisfied with the treatment tried another PDE5 inhibitor. The success rate of the treatment was found to be higher in the followed-up group than those losses to follow-up.

Conclusion. Therapy with PDE5 inhibitors is an effective means of ED treatment. The importance of doctor-patient communication should be considered, and the patient should be advised for adaptation to follow-up program. High drug cost is a significant predictor of patient compliance to treatment continuation.     

Impact of a classroom behavior management intervention on teacher risk ratings for student behavior

Classroom behavior management interventions have been used successfully with drug prevention programs to prevent subsequent antisocial behavior and substance use among youth. This article presents results from implementation of the All Stars Challenge, a classroom-based behavior management component to a drug prevention program for fifth graders. Risk ratings for shyness and lack of awareness of social norms among high-risk students who received the All Stars Challenge were reduced compared with fifth graders who did not receive the intervention. In contrast, physical and social aggressivity among low-risk students who received the program increased when compared to similar control students.     

CBD may help prevent relapse in abstinent heroin addicts

Cannabidiol (CBD) has the potential to reduce craving and anxiety in people with opioid use disorder who have been opioid‐free for at least a week, a recent study using Epidiolex, the Food and Drug Administration–approved form of the marijuana‐derived drug, has found. The study compared CBD to placebo in subjects who were exposed to drug‐related and non‐drug‐related‐cues, and measured craving and anxiety. CBD administration was short‐term (three days), but beneficial effects lasted seven days afterward. There were no effects on cognition and no adverse effects.     

Mental Health Consultation on the College Campus

Abstract

“Mild Hypertension: When and How to Treat,” NORMAN M. KAPLAN. “Early and aggressive” drug therapy for mild hypertension, now widely prescribed in the United States, may be inappropriate for many of the 30 million patients with this condition. Although all of these patients are at greater risks of premature cardiovascular disease, the risks are manifested neither quickly nor uniformly. Drug therapy has not proved beneficial for patients with a diastolic (D) BP reading below 100 mm Hg, particularly those patients who are otherwise at low risk. Those antihypertensive drugs that are available now carry risks along with their benefits. Therefore, persons with mild hypertension who are at low risk should be encouraged to use nondrug therapies for at least six to 12 monts. If their DBP remains below 100 mm Hg, they may be better off than if they were given drugs. The drug used in initial therapy has usually been a diuretic. For many patients, however, an adrenergic inhibitor may be a more appropriate choice.     

Dietary intake and the risk of hyperuricemia,gout and chronic kidney disease in elderly Taiwanese men

Introduction.?This study was conducted to examine the relationship between dietary intake and the risk of chronic kidney disease (CKD), treated hyperuricemia (or gout) without CKD, and untreated hyperuricemia without CKD in elderly men.

Methods.?The study population comprised 752 men aged 65 or older who had been included in the Elderly Nutrition and Health Survey (1999–2000) (Elderly NAHSIT).

Results.?Statistical analysis using a polychotomous logistic regression model revealed that compared with the individuals in the normouricemic group, the individuals in the other groups exhibited a significant association between a higher prevalence of CKD and the following factors: advanced age, drug use for hypertension, egg and shellfish consumption and consumption of poultry with the skin and meat with fat. The significant risk factors for the patients who did not have CKD and were undergoing treatment for hyperuricemia were as follows: BMI?≥?25 kg/m²; drug use for hypertension; intake of poultry with skin; increased daily consumption of shellfish, fried food, sugar and juice.

Conclusions.?Men who use anti-hypertensive drugs and who consume fewer soy products and more shellfish may be at a higher risk of developing hyperuricemia or CKD.     

Agomelatine: a novel atypical antidepressant

This article reviews the novel atypical antidepressant drug agomelatine (Valdoxan), which is currently being actively investigated in the United States for the treatment of depression but is not yet approved by the U.S. Food and Drug Administration. Agomelatine is a synthetic analog of the hormone melatonin and has unique pharmacological properties that distinguish it from other currently available antidepressant drugs. Agomelatine is efficacious, safe, and well tolerated but does not appear to have major efficacy advantages compared with other antidepressant drugs. Because of its unique pharmacology and relatively benign tolerability profile, however, it may be a more effective alternative for patients who do not respond to or cannot tolerate currently available antidepressant drugs.     

Ethnic pride, biculturalism, and drug use norms of urban American Indian adolescents

This study examines how strength of ethnic identity, multiethnic identity, and other indicators of biculturalism relate to the drug use norms of urban American Indian middle school students. The article distinguishes categories of norms that may affect drug use. Regression analysis of self-reports by 434 American Indian seventh graders attending middle schools in a large southwestern U.S. city indicated that students who had a more intense sense of ethnic pride adhered more strongly to certain antidrug norms than those who did not. Whereas American Indian students with better grades in school held consistently stronger antidrug norms, there were few differences by gender, socioeconomic status, or age. These results have implications in social work practice for better understanding and strengthening the protective aspects of American Indian culture in drug prevention efforts.     

Age at Entry into Prostitution: Relationship to Drug Use,Race, Suicide,Education Level,Childhood Abuse,and Family Experiences

This study seeks to explore factors related to age at entry into prostitution. Participants were 389 women arrested for prostitution who had attended a diversion program. Women who entered prostitution as minors were found to be more likely to be African-American; report having a family member with a substance use problem; have a history of attempted suicide; and not have completed middle or high school. The age at first drug use was found to significantly impact the reported age at entry. Key areas for intervention should include improving school connectedness and preventing adolescent substance abuse, specifically for African-Americans.     

Informal Care Intensity and Caregiver Drug Utilization

Providing informal care has negative health consequences for informal caregivers. If these health consequences increase drug utilization among caregivers, estimates of health care savings from informal care—mainly realized through reductions in utilization among care recipients—should consider the increased drug costs incurred by informal caregivers. This paper evaluates whether more intensive informal caregivers have higher drug utilization than less intensive caregivers, controlling for initial health status and other factors. We find that informal care intensity is associated with higher drug consumption. An increase of 10% of total informal care per day is associated with a 0.7% increase in drugs. The small magnitudes indicate that, in this application, it is not important to consider caregiver drug utilization when quantifying the net savings to the health care system of informal care. For individual caregivers, such as those who take multiple drugs per month and/or have no drug coverage, the increase in drug utilization associated with intensive caregiving is likely to be costly.     

A three-city comparison of drug use and drug use before sex among young men who have sex with men in the United States

High rates of drug use have been documented among young men who have sex with men (YMSM). However, updated prevalence data are needed to understand current trends, especially for drug use before sex. We used baseline data from an HIV prevention trial to examine demographic differences in drug use and drug use before sex among YMSM in Atlanta, Chicago, and New York City. Marijuana was the most commonly used drug, but alkyl nitrites (“poppers”), cocaine, and Ecstasy were also commonly used. Drug use was more prevalent among older and White YMSM, and it was similar across cities, although use of poppers and polydrug use were more common in New York City. Our data generally support national prevention efforts.     

Drugs, delinquency and "nerds": are loners deviant?

Many studies have focused on the influence of peers on delinquency and drug use. But what about adolescents who are not part of the peer culture--the loners, or nerds? This study focuses on drug use, delinquency and lifestyle correlates of LONERS and SOCIALS. Data for a nine-year period (1976 through 1984) from the Monitoring the Future data set of high school seniors across the United States are analyzed. The lack of peer influence on the LONERS seems to contribute to less delinquency and drug use and more conventional lifestyle activities than is found among SOCIALS.     

Predicting continued use of marijuana among adolescents: the relative influence of drug-specific and social context factors.

Most research on the determinants of adolescent drug use has focused on predictors of either initiation or current use. Little attention has been given to the determinants of continued use of drugs after initiation, even though some researchers have found that the consequences of continued use are more serious than those associated with experimental or occasional use. In this study, a longitudinal sample of 456 secondary and high school students who had already tried marijuana was used to examine the determinants of continued use of marijuana. Nearly 38 percent of those who had tried marijuana continued using, according to the definition operationalized in this study. Potential predictor measures were grouped in a drug-specific domain and a social context domain, and their effects on continued use, controlling for background characteristics, were examined in logistic regression models. Results showed that only the drug-specific domain had a statistically significant effect on the likelihood of continued use. Students who felt that the adverse physical and psychological effects of marijuana were not very important reasons for discontinuing use and those who had gotten stoned during their experimental stage of use were the most likely to continue use after initiation. The results suggest that the perceived physical and psychological effects of the drug are more important determinants of continued use than are social factors or benefits related to use. Any relationships between social factors and continued use are mediated by the perceived effects and risks of the drug.     

Exploring the prevalence and correlates of methamphetamine use: findings from Sacramento's ADAM program

Anecdotal reports have suggested that the use and abuse of methamphetamine is increasing in the United States. To date, however, few scholarly works have explored the prevalence and correlates of methamphetamine use in the United States. To address this limitation, a secondary analysis was undertaken with data collected through the Arrestee Drug Abuse Monitoring (ADAM) Program. An examination of methamphetamine-positive rates among ADAM arrestees interviewed between 1991 and 2001 identified that its use is concentrated within the Western part of the United States. Supplementary analyses of Sacramento arrestees indicated that 71% were diagnosed as needing some form of alcohol or other drug treatment. Compared to those arrestees who were detected methamphetamine-negative, methamphetamine-positive arrestees in Sacramento were three times as likely to be white and to have been diagnosed in need of drug treatment. Implications for drug control policy are discussed.     

A critical evaluation of the cardiac toxicity of citalopram: part 2

In August 2011, the U.S. Food and Drug Administration issued a drug safety communication that the antidepressant drug citalopram (Celexa?) should not be used at dosages greater than 40 mg per day (or greater than 20 mg per day for patients 60 and older) because higher doses have been associated with abnormal heart rhythms. Clinical studies using citalopram in patients with cardiac disease and in older patients do not confirm such a risk. The major metabolite of citalopram is demethylcitalopram, which is subsequently metabolized to the minor metabolite didemethylcitalopram (DDCT). High DDCT concentrations have been associated with QT interval prolongation in beagle dogs. Therapeutic drug monitoring study data suggest that routine or even high oral doses of citalopram are unlikely to result in cardiotoxic concentrations of the DDCT metabolite. Based on evidence taken from a wide variety of studies, the citalopram dose limitations described in the safety announcement do not have strong clinical justification.