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					                                                           Characteristics of Primary Alcohol Users with Secondary Use
                                                                     of Powder Cocaine, Crack, or Marijuana
                                                                                            Laurel Mangrum & Richard Spence
                                                                                   University of Texas at Austin, Addiction Research Institute


     Introduction                                                            Client and Treatment Characteristics                           Results and Conclusions

   Past research has revealed a substantial prevalence of                 Demographic                            Race/Ethnicity             On demographic variables, crack users were more likely to be older,
   drug use in primary alcohol dependents, with incidence                                                                                   female, and Black, whereas powder cocaine users were more often
   rates ranging from 20-50%. Other studies focusing on                                                                                     Hispanic and marijuana users were White. Crack users had higher
   primary drug dependent individuals have found                                                                                            rates of unemployment and homelessness, but had the lowest rates of
   comorbid alcohol dependence rates from 40-90%. The                                                                                       legal involvement. No differences were found in education level
   high frequency of polysubstance use in treatment-                                                                                        among the groups. At admission, analyses indicated that the crack
   seeking individuals poses important considerations for
                                                                                                                                            user group had the highest incidence of prior detox and non-detox
   determining interventions that will address the
                                                                                                                                            substance abuse treatment, emergency room visits, history of IV drug
   multifaceted issues presented by these clients.
                                                                                                                                            use, and daily use of both alcohol and secondary substance in the 30
   Research is needed targeting particular drug-using
                                                                                                                                            days prior to admission. Crack users also reported more problem
   subgroups of primary alcohol dependents that may
   identify unique characteristics and treatment responses.                                                                                 days related to employment, family, social, psychological, and
   Findings of this nature could assist in guiding treatment                                                                                substance use issues during the month prior to admission, and had the
   decisions based on clients’ presenting issues and                                                                                        highest ASI clinician severity ratings in the areas of substance use,
   increase knowledge regarding the prognosis of different                                                                                  psychiatric, family, and medical problems. The predominant treatment
   types of substance users. The current study compares                                                                                     placements for crack users were detox and intensive residential,
   demographic, admission, discharge, and follow-up                                                                                         whereas powder cocaine and marijuana users were more frequently
   characteristics of primary alcohol users with secondary                                                                                  placed in outpatient services. At discharge, crack users had the
   substance use of powder cocaine, crack, or marijuana to                                                                                  highest completion rates, were more likely to be abstinent and to have
   assess for potential group contrasts in these areas.                                                                                     attended AA in the 30 days prior to discharge, although they had the
                                                                                                                                            shortest length of stay. Crack users also more frequently received the
                                                                       Admission Features                                                   specialized services of acupuncture, anti-craving medication,
                                                                                                               ASI Severity Ratings in      antidepressants, and anti-anxiety medication. Follow-up data were
                                                                                                            Considerable to Extreme Range   available for approximately 30% of each of the groups. At 60-day
     Sample and Method                                                                                                                      follow-up, crack users continued to have the highest unemployment,
                                                                                                                                            homelessness rates, and problem days related to substance use, but
                                                                                                                                            at substantially lower levels than reported at admission. Crack users
                                                                                                                                            were also more likely to have attended AA in the past month and
   The sample consisted of 6,173 primary alcohol users
                                                                                                                                            continued to have the lowest rates of legal involvement. Marijuana
   with secondary substance use who received substance
                                                                                                                                            users had the highest abstinence rates and reported the least problem
   abuse treatment in state-funded programs during the
                                                                                                                                            days related to employment, family, and social issues.
   Texas 2004 fiscal year. The sample was divided into
   three groups for analysis based on the category of
   secondary substance: powder cocaine (N = 1,796),                                                                                         Findings indicate that, in this sample of primary alcoholics with
   crack (N = 2,206), and marijuana (N = 2,171). The                                                                                        secondary substance use, the crack user subgroup was more likely to
   study examined data from BHIPS, the mandatory data                                                                                       present for treatment with greater substance use severity and higher
   collection and outcomes monitoring system for state-                                                                                     levels of psychosocial problems relative to clients using powder
   funded substance abuse treatment programs in Texas.                                                                                      cocaine or marijuana as secondary substances; however, despite
   The three groups were compared on demographic,                                                                                           heightened symptom severity, a large proportion of these crack clients
   admission, treatment, discharge, and 60-day follow-up                                                                                    completed treatment and demonstrated reduction in substance use
   characteristics. Continuous variables were analyzed                                                                                      and related problems at follow-up.
   using analysis of variance and Tukey’s Studentized
   Range Test to contrast groups with significant
   differences. Chi-square analyses were used to
   examine categorical variables.
                                                               Treatment and Discharge Features                   Level of Treatment                               60-Day Follow-Up

   Acknowledgements

   The authors acknowledge the Texas Department of
   State Health Services (TDSHS), Mental Health and
   Substance Abuse Treatment Division for their
   assistance in providing data for this study.
   The findings and conclusions of this in this
   presentation are the opinions of the authors and do
   not necessarily reflect the official position of
   TDSHS.




Presented at the Research Society on Alcoholism, Santa Barbara, California, June 28, 2005

				
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