Consequences of Prenatal Exposure to Methadone: Chicago, 1978-1984

Investigators: Sydney L. Hans

This longitudinal study assessed the effects of prenatal methadone exposure on a cohort of children who were followed from birth to two years of age. The purpose of the study was to examine teratogenic effects of methadone as well as to determine how other non-teratogenic risk factors might be related to the behavior of drug-exposed children. The study was designed to replicate prior research and clinical observations which identified a variety of behaviors and medical conditions that might appear soon after birth for methadone-exposed infants. These included tremulousness, hypertonicity, irritability, incessant high-pitched crying, sleep disturbances, hyperactive reflexes, frantic but weak sucking, regurgitation, yawning, sneezing, nasal congestion, sweating, fever, and convulsions. These behaviors, termed neonatal narcotics abstinence syndrome, bore a close resemblance to withdrawal symptoms observed in adult narcotics addicts, and their presence during the neonatal period had usually been attributed to generalized hyperirritability of the central nervous system caused by withdrawal from opioid drugs following in utero exposure. However, methadone exposure often co-occurred with other factors such as perinatal complications, which might be affecting the neonatal behaviors assumed to be caused by withdrawal from opioids. The study comprised 42 infants delivered by 36 pregnant opioid-using women between the ages of 18 and 35 who were recruited at prenatal clinics at Chicago Lying-In Hospital between 1978 and 1982. All of the women were involved in low-dose methadone-maintenance programs for the treatment of chronic heroin addiction, and the majority occasionally used other drugs, most commonly alcohol, marijuana, heroin, cocaine, Valium, or Talwin. All of the women were black, came from low-income inner-city neighborhoods, and received good quality prenatal care. Infants' behavior was assessed at one day and at four weeks of age using the Neonatal Behavioral Assessment Scale with Kansas Supplements (NBAS-K). The children were assessed again at 4, 8, 12, 18 and 24 months of age using the Bayley Scales of Infant Development. Children's heights, weights, and head circumferences were measured at each of the assessments. The study assessed a total of 436 variables across 79 cases.

Demographic, Behavioral & Health Characteristics of Injection Drug Users in San Francisco 1985-86

Investigators: John K. Watters

The study, Demographic, Behavioral, and Health Characteristics of Injection Drug Users in San Francisco, 1985- 86, was conducted in late 1985 and early 1986 as part of a larger investigation of health characteristics and risk factors for HIV transmission in intravenous drug users. The purpose of the study was to obtain data on demographic characteristics, sexual and other risk behavior, and general health characteristics from a group of intravenous drug users (IVDUs) in San Francisco. The San Francisco research team first conducted a two-pronged approach among the city's IVDUs during late 1985 and early 1986. The first element consisted of intensive ethnographic study in the two San Francisco neighborhoods with the highest concentrations of IVDUs.The other direction of research, which proceeded simultaneously with the ethnographic study, consisted of lengthy interviews with 438 IVDUs.

Holistic Health Recovery Program for Injection Drug Users (HHRP)

Investigators: S. Kelly Avants, PhD, Arthur Margolin, PhD, Mary Helen Usubiaga, MD, Cheryl Doebrick, PhD

HOLISTIC HEALTH RECOVERY PROGRAM FOR INJECTION DRUG USERS is a 12-session, manual-guided, group therapy intervention delivered over six weeks. This risk reduction and health promotion intervention is appropriate for use with drug users in a substance abuse treatment program, and it was designed to specifically address the special needs of HIV-negative and status unknown injection drug users (IDUs). HHRP is based on the Information-Motivation-Behavioral Skills (IMB) model of HIV prevention through behavioral change and uses cognitive remediation components to facilitate learning and retention of IMB treatment components. The primary goals of this intervention are harm reduction, health promotion, and improved quality of life. More specific objectives include abstinence from illicit drug use or from sexual risk behaviors, reduced drug use, reduced risk of HIV infection, and improved medical, psychological, and social functioning. The HHRP program includes session topics such as: reaching your goals; health care participation; reducing the harm of injection drug use; harm reduction with latex; negotiating harm reduction with partners; preventing relapse to risky behavior; healthy lifestyle choices; introduction to the 12-steps; overcoming stigma; motivation for change; emotional and spiritual healing; and healthy social relationships and activities. Click here to view more detailed information on this program.

Holistic Health Recovery Program for Injection Drug Users Living with HIV (HHRP+)

Investigators: S. Kelly Avants, PhD, Arthur Margolin, PhD, Lara A. Warburton, PhD, Keith A. Hawkins, PsyD, Julia Shi, MD

HOLISTIC HEALTH RECOVERY PROGRAM FOR INJECTION DRUG USERS LIVING WITH HIV is a 12-session, manual-guided, group therapy intervention delivered over six weeks. This risk reduction and health promotion intervention is appropriate for use with drug users in a substance abuse treatment program, and it was designed to specifically address the special needs of HIV-positive injection drug users (IDUs). HHRP+ is based on the Information-Motivation-Behavioral Skills (IMB) model of HIV prevention through behavioral change and uses cognitive remediation components to facilitate learning and retention of IMB treatment components. The primary goals of this intervention are harm reduction, health promotion, and improved quality of life. More specific objectives include abstinence from illicit drug use or from sexual risk behaviors, reduced risk for HIV transmission, reduced drug use, and improved medical, psychological, and social functioning. The HHRP+ program includes session topics such as: reaching your goals; health care participation; reducing the harm of injection drug use; harm reduction with latex; negotiating harm reduction with partners; preventing relapse to risky behavior; healthy lifestyle choices; introduction to the 12-steps; overcoming stigma; motivation for change; moving beyond grief; and healthy social relationships and activities. Click here to view more detailed information on this program.

Honoring Ancient Wisdom and Knowledge: Prevention and Cessation (HAWK)

Investigators: Shobana Raghupathy, April Lea Go Forth

American Indians and Alaskan Natives (AI/ANs) have some of the highest rates of substance use compared to other ethnic groups. The problem is particularly acute among Indian youth in reservations and remote rural areas and has been attributed to factors such as poverty, low cost and easy availability. The HAWK2 intervention is a multimedia, computer-based drug prevention program for Native youth in upper elementary and middle schools. The intervention uses engaging features such as games, animations, and video clips to impart substance abuse prevention knowledge and skills training. The development of this intervention was a collaborative process involving the participation of community experts, research scientists, school teachers and practitioners as well as Native youth. The intervention was sponsored by the National Institute of Drug Abuse. HAWK2 consists of seven lessons of 25-30 minutes each, with a total exposure time of 3.5 hours. Teachers have the flexibility to integrate the lessons into an existing health curriculum or to implement them as separate units over several weeks. Each session includes video segments that demonstrated refusal skills, conflict resolution, negotiation skills, coping skills, assertive communication, and relaxation techniques. Problem solving exercises allow participants to walk through different scenarios, identify problems, consider alternative responses, practice behavioral responses, and solve problems. Animations were used to convey Native American tales and legends that illustrate the positive impact of empowerment. Interactive quizzes, polls, and learning exercises were developed to reinforce prevention program content during and at the end of each lesson. The program is distributed on USB drive. A student (or a group of students) can view the program content on any computer and can self-administer the intervention. To run the program you will need computer with a USB drive and Speakers or Headphones (for privacy).

National Household Survey on Drug Abuse, 1990

Investigators: Joseph Gfroerer, Joseph Gustin, Thomas Virag, Ralph Folsom & J. Valley Rachal

The 1990 National Household Survey on Drug Abuse (NHSDA) is the tenth in a series of cross-sectional studies, which began in 1971, designed to measure the prevalence and correlates of drug use in the United States household population aged 12 and over. The 1990 NHSDA was sponsored by the National Institute of Drug Abuse (NIDA). Researchers from the Research Triangle Institute in Research Triangle Park, North Carolina, directed the 1990 study. The basic sample design involved several selection stages; these were the selection of Primary Sampling Units (PSUs, e.g. counties), area segments (e.g., blocks or enumeration districts) within these PSUs, sample households within area segments, one or two (if any) age group domains within sample households, and a person within selected age group domains. Interviewers administered questionnaires in-person. All samples were done using probability methods. Topics covered in the 1990 NHSDA include tobacco, alcohol, and illicit drug use; consequences of various drugs; health condition; and general demographic information.

National Household Survey on Drug Abuse, 1991

Investigators: Joseph Gfroerer, Joseph Gustin, Thomas Virag, Ralph Folsom & J. Valley Rachal

The NHSDA is the only study that produces estimates of drug use among members of the household population the United States. The survey is appropriate for estimating prevalence rates for different drugs, since much drug use would not ordinarily come to the attention of administrative, medical, or correctional authorities and therefore would not be included in official statistics. In-person interviews with a large national probability sample seem to be the best way to estimate drug use in virtually the entire population of the United States. Topics covered in the 1991 NHSDA include tobacco, alcohol, and illicit drug use; consequences of various drugs; health condition; treatment for drug use; illegal activities; and use of anabolic steroids. Also, sets of questions regarding insurance and personal and family income sources and amounts were expanded in comparison to previous surveys. The 1991 survey includes 1,283 variables. The content of the NHSDA changes slightly from year to year. Changes made over the course of the 1990 and 1991 surveys include changes regarding sampling methods, sample populations, and the deletion and addition of variables. The 1991 NHSDA is the first NHSDA to sample from Alaska and Hawaii in addition to the contiguous states. Furthermore, unlike previous surveys, residents of non-institutional group quarters (e.g., college dormitories, group homes, civilians dwelling on military installations) and persons with no permanent residence (homeless people and residents of single rooms in hotels) were sampled in the 1991 NHSDA.

National Survey on Drug Use and Health (NSDUH) 2015

Investigators: Substance Abuse and Mental Health Services Administration (SAMHSA)

The National Survey on Drug Use and Health (NSDUH) series (formerly titled National Household Survey on Drug Abuse) primarily measures the prevalence and correlates of drug use in the United States. The surveys are designed to provide quarterly, as well as annual estimates. Information is provided on the use of illicit drugs, alcohol, and tobacco among members of United States households aged 12 and older. Questions included age at first use as well as lifetime, annual, and past-month usage for the following drug classes: marijuana, cocaine (and crack), hallucinogens, heroin, inhalants, alcohol, tobacco, and nonmedical use of prescription drugs, including pain relievers, tranquilizers, stimulants, and sedatives. The survey covered substance abuse treatment history and perceived need for treatment, and included questions from the Diagnostic and Statistical Manual (DSM) of Mental Disorders that allow diagnostic criteria to be applied. The survey included questions concerning treatment for both substance abuse and mental health-related disorders. Respondents were also asked about personal and family income sources and amounts, health care access and coverage, illegal activities and arrest record, problems resulting from the use of drugs, and needle-sharing. Questions introduced in previous administrations were retained in the 2015 survey, including questions asked only of respondents aged 12 to 17. These "youth experiences" items covered a variety of topics, such as neighborhood environment, illegal activities, drug use by friends, social support, extracurricular activities, exposure to substance abuse prevention and education programs, and perceived adult attitudes toward drug use and activities such as school work. Several measures focused on prevention-related themes in this section. Also retained were questions on mental health and access to care, perceived risk of using drugs, perceived availability of drugs, driving and personal behavior, and cigar smoking. Questions on the tobacco brand used most often were introduced with the 1999 survey. For the 2008 survey, adult mental health questions were added to measure symptoms of psychological distress in the worst period of distress that a person experienced in the past 30 days and suicidal ideation. In 2008, a split-sample design also was included to administer separate sets of questions (WHODAS vs. SDS) to assess impairment due to mental health problems. Beginning with the 2009 NSDUH, however, all of the adults in the sample received only the WHODAS questions. Background information includes gender, race, age, ethnicity, marital status, educational level, job status, veteran status, and current household composition.

Neonatal Costs of Maternal Cocaine Use: Harlem Hospital, 1985-1986

Investigators: Ciaran S. Phibbs, David A. Bateman and Rachel M.Schwartz

Investigators compared all cocaine-exposed infants born in a large, publicly funded inner-city hospital (n=355) with a random sample of non-exposed infants born in the same hospital (n=199) to examine the added neonatal cost and length of hospital stay associated with fetal cocaine exposure. Between September 1, 1985 and August 31, 1986, all newborn infants were screened by urine test for illicit substances, and medical records were reviewed for maternal histories of substance abuse. The cocaine-exposed group consisted of all single live births who were identified by either maternal history or infant urine assay. The control group was comprised of single live births for whom no drug use history was indicated by either maternal history or infant urine test. Investigators assessed a total of 129 variables. Outcome measures included the cost and length of stay for each infant until medically cleared for hospital discharge, as well as the cost and length of stay for each infant until actual discharge from the hospital. The present study examines the added newborn cost and length of hospital stay associated with prenatal exposure to cocaine. Newborn costs for cocaine-exposed infants were compared to those of a random sample of unexposed infants delivered in the same hospital during the same time period. National estimates of diagnosis related group (DRG) per diem costs of care for newborns were used to generate estimates of the costs of hospital care. Costs and lengths of stay were subdivided into those that were medically necessary and those generated by "boarder babies" (infants who are medically cleared for discharge but who remain in the hospital while awaiting social evaluation or placement in the foster care system). Data were gathered on related variables such as prenatal care, maternal smoking and alcohol use, race, gravidity, maternal age, gender of the infant, crack exposure and exposure to multiple illicit substances.

Physical and Social Development in Children Exposed Prenatally to Download/PCP and Cocaine

Investigators: Judy Howard, Leila Beckwith, Michael Espinosa and Carol Rodning

The purpose of this study was fourfold: to compare PCP-exposed infants to a comparison group of non-drug-exposed infants as to attention regulation, social interaction, motor patterns, and cognitive development; to test the effectiveness of an intervention program in ameliorating early neurobehavioral problems by comparing the development of PCP-exposed infants whose caregivers received intervention to PCP-exposed infants without intervention; to compare the development of PCP-exposed infants reared in foster homes to PCP exposed infants reared by biological parents; and to assess the influence of multiple significant biologic and environmental factors on development. Additionally, caretaker-child interactions and attachment issues were also studied. The study is a prospective, longitudinal investigation of 46 full-term infants who had positive urine toxicology screens for phencyclidine (PCP) and other drugs at birth and 39 non-drug-exposed control infants. Infants were followed from birth to 15 months of age. This study examined fetal growth impairment, as shown by subnormal head size and/or intrauterine growth retardation (IUGR) (i.e., birth weight below the tenth percentile), and later behavioral development in the groups of drug-exposed and non-drug-exposed infants. In order to access the range of possible causes of poorer developmental outcome, the investigators examined 89 variables such as maternal parity, maternal nicotine and alcohol use, caregiver education, and child placement outside of the biological home.