Multiple regression analysis of cross-sectional 1985-1986 Ontario county data indicated that the presence of Native Indians on reserves is a significant factor in explaining differences in county alcohol consumption levels. Consumption in counties with reserves was higher than in those without reserves by roughly 1.48 liters of absolute alcohol per adult; consumption increased as the Native reserve population increased (p less than 0.05). When income, employment, household crowding, type of industrial activity, northern isolation, and tourism were included, we could account for over 60% of the variation in alcohol consumption between Ontario counties (p less than 0.01). Every extra $1,000 in income per tax return was associated with a 0.297-liter reduction in absolute alcohol consumption. Efforts to reduce alcohol consumption in the Native population would have their greatest impact when associated with improved economic conditions.
For a 6-year period 30,000 11th graders in Pennsylvania public schools answered questions regarding their situational use of marijuana and the most popularly consumed beverage alcohol, beer. Comparing the item means for the survey responses between 1978 and 1983 supports other national data indicating a significant decline in the use of marijuana by high school students. A new finding is that 11th graders' willingness to drink beer with their friends has declined significantly, beginning in 1982, as has their willingness to drink and drive, beginning in about 1981. These changes may be related historically to the intensive public information and education efforts begun during the same time period.
It is the purpose of this study to report 124 chronic cannabis users in India who smoked the drug in enormous quantities over a period of 6 mth to several years. This group of patients offers an excellent opportunity to demonstrate the association of many medical and psychological effects previously suggested to occur with various preparations of the drug. There are numerous studies suggesting throughout the literature that prolonged smoking of cannabis drugs may cause certain medical as well as psychiatric effects. The most notable are conjunctival congestion, respiratory disorders, including asthma and rhinopharangitis, and diarrheas as physical effects. The psychological manifestations are loss of sense of time and space, confusional states, amnesia, panicky reactions, and a motivational syndrome, which is characterized by apathy, lack of interest, and inability to make decisions.
Responding to the impact of Proposition 13 has become a central concern of several substance abuse programs in California. A discussion of various approaches to the problem of current and anticipated reductions in public finding is presented. Three basic approaches are considered: reducing costs of services, improving program effectiveness, and diversification of the funding base. A greater emphasis on management effectiveness among staff and a shift in policy toward increased early intervention services are suggested as germane to all three approaches.
The psychiatric evaluation of 150 opium addicts in Shiraz, Iran, revealed that (1) the addicts had more psychiatric symptoms than the matched control group, and (2) the most frequent symptom among the addicts was depression. Our findings differ from most Western studies, where anxiety and evidence of antisocial behavior were reported as the most common findings.
Dangerous drinking and driving situations contribute heavily to morbidity and mortality among older adolescents. One hundred ninety-two high school drivers related 662 dangerous driving incidents (430 by males, 232 by females) in which they were involved in the preceding 6 months. Dangerous driving incidents were characterized by reckless intent, driving late at night, riding with other peers involving alcohol and drugs, reporting impaired driving, and distractions in the car. Adolescent drivers are commonly involved in dangerous drinking-driving situations with peers and without significant consequences. There are points along the continuum leading up to, during, and after such events that offer opportunities for significant prevention and intervention. Such strategies are reviewed.
This paper utilizes a longitudinal design to explore the relationship between problem drinking in adolescence and problem drinking in later life. Specifically, the issues investigated include the degree to which there is a continuity or lack of continuity of involvement in a particular pattern of drinking between adolescence and young adulthood, and an assessment of the usefulness of adolescent correlates of drinking for understanding adult patterns of drinking. The results indicate that there is little continuity in drinking behavior across time, and that while an explanatory model using as independent variables the impact of negative peers, family social class, family support, and high school success is successful in predicting alcohol involvement at age 18, this model is of little utility in predicting alcohol involvement at age 31.
A retrospective study was done on the MMPI responses of 120 inpatient drug abusers, comparing the standard MMPI with a short form composed of the first 168 items. Scores "predicted" by the short form were highly correlated with actual scores, and the predicted and actual profile configurations were very similar. Regression equations derived from the data were comparable to those presented by other authors using different diagnostic groups; this suggests a rather stable relationship between the MMPI--168 and the standard MMPI. The use of the short form for drug-abuse patients is encouraged.
This article reviews published 16PF research on drug users. It also compares the 16PF scores of a new sample of nonusers with scores of matched groups of heavy, chronic users of cocaine, amphetamine, opiates, and barbiturates/sedative hypnotics, as well as combined groups of stimulant users, depressant users, and a combined group of users of all substances. No significant differences were found among drug user groups, but the profile of the nonuser group was distinctive. K-Means Cluster Analyses, as well as Cattell's Similarity and Pearson Product Moment Correlation Coefficients, were used to compare profiles of these new samples with the 19 groups described in an earlier meta-analysis of published 16PF studies. Data from the new samples did not cluster with data from other published research, although certain specific similarities appeared in more detailed correlational analyses. Methodological problems are discussed, and it is recommended that in future studies drug user groups be more carefully selected and defined, sample descriptions be more thorough and complete, complete profile information be routinely provided, and efforts be made to explore the utility of the Cattell CAQ in studies of drug users/misusers.
Responses to 65 of the 187 items on Cattell's 16PF test were skewed by 83 members of Alcoholics Anonymous. Seventeen of those items had significantly different distributions when the 18 recidivists were compared to the 8 who had remained clean of all addictive substances and compulsive behaviors during the 2-year period studied. Another 14 items had significantly different distributions when the recidivists were compared to all the others. Comparisons with non-drug-disadvantaged groups and non-AA recovering addicts are suggested in order to isolate empirical predictor items for "addictive" versus "cured" scales.
Meta-analysis of 34 studies on Cattell's 16PF test reveals ragged egos (C-), guilt (O), distrust (L), frustration (Q4), alienation (G-), vague identity (Q3-), alarm (H-), resentment (Q1), quasi-autism (M), scattered intellect (B-), grandiosity (E), autonomy (Q2), infantilism (I), avoidance (A-), and deviousness (N). The aberrant scores on E, G, I, Q1, and Q2 discriminate addicts from suicidals and the chronically ill or unemployed. We found nine types of addicts in our developmental study of 83 members of Alcoholics Anonymous. On the more stable second-order 16PF factors, 43% were highest on Autonomous, 37% on Desperate, 16% on Tough Poise, and 4% on Extravert. Profiles differed more by sexual preference than by gender. Recidivism was highest among homosexual men (38%) and the desperate (25%). Only the Fourth and Fifth Steps of the AA program seem crucial to recovery. Treatment programs based on these and tailored to sexual preference and the second-order personality types seem highly advisable.
This report presents a meta-analysis of a series of published 16PF findings which describe score profiles of nine groups of substance users/abusers, a nonuser comparison group, seven psychiatric groups, a group of criminals, and a group of gang delinquents. Analytical procedures include K Means Clustering, Cattell's rp statistic, and Pearson r. Although drug use was found to be associated with various forms of psychiatric diagnoses, it was not found to be associated with any particular form of psychopathology. The 16PF profiles of groups of users of different substances were not homogeneous within groups. Some similarity, however, was found among profiles of alcoholics. No evidence could be found to support the contention that groups of substance abusers yield the particular profile pattern on the 16PF that was ascribed to them in an earlier meta-analyses. Due to the inadequacies of the 16PF in diagnosing psychiatric conditions, it is suggested that a more fruitful direction of future research might be to use Cattell's Clinical Analysis Questionnaire (CAQ).
Neoalleviase (NA-1700) is a specially formulated unique combination of 14 well-identified species of higher plants whose extracts were obtained through an enzymatic process with macerozymes prior to clinical study. Toxicity and efficacy tests were satisfactorily performed by bioassay with 120 mice under double-blind conditions for 82 days. Straub tests facilitated efficacy proof in mice. Neoalleviase (530 mg capsules q.i.d.) was administered to 268 active heroin addicts under double-blind conditions. The established dosage schedule was utilized over a 35 day drug administration period (maximum) with a follow-up observation at 10 months. Himmelsback's techniques were used to determine withdrawal scores. The results of this study indicated that Neoalleviase (NA-1700) effectively suppressed withdrawal signs and symptoms without undesirable major side effects at the given therapeutic dose level. It appears to be potentially the most promising heroin detoxification agent.
The present paper reports upon the association between alcoholic subtype and treatment response. The subjects participated in an inpatient alcohol treatment program at the Tuscaloosa Veterans Administration Medical Center. Following discharge, the subjects were contacted at 1, 6, 12, and 18 months to evaluate current drinking status and psychosocial outcome. Results indicate that drinking outcome is only moderately associated with alcoholic subtype. However, psychosocial outcome is consistently related to the subtypes. Specifically, Type III (chronic-organic) and Type V (bright-unrealistic) alcoholics do poorly while Type II (impulsive) report few problems. The need to develop better "fits" of treatment and alcoholic is discussed, as are possible adjunctive treatments for the typology presented.
For those drug addicts who do not meet the United States federal government regulations for methadone maintenance, methadone detoxification remains the primary option for treatment. Studies on the effectiveness of 21-day methadone detoxification, however, report low completion rates and high relapse. Revisions to the standard 21-day detoxification are needed. The research literature suggests that offering psychosocial services within an extended 180-day protocol may be an effective mode of treatment for those addicts who do not meet the requirements for entering methadone maintenance, or do not desire maintenance. Methadone Transition Treatment (MTT) is an innovative treatment organized around this strategy. MTT is transitional in that emphasis is place on working with patients to enter longer-term treatment. To aid the development of similar programs at other institutions, we describe the specific procedures of the MTT model and provide an evaluation of the model based on findings from an initial pilot study.
The Civil War (1861-1865) has long been blamed as the catalyst for the spread of drug addiction in America. This paper attempts to examine this hypothesis through an extensive review of pertinent literature, and to clarify misconceptions concerning addiction problems associated with the war.
Despite various attempts by the British authorities to regulate the use of hemp drugs in India, the matter had been left largely in the hands of provincial governments until the end of the 19th century. Laws and practices therefore varied widely from one region to another. In response to questions in the British Parliament, a Commission was set up in 1893 to examine the situation in Bengal, but on the initiative of the Governor General the scope of the inquiry was broadened to include the whole of British India.
A review of various legislative and judicial decisions in the area of alcohol abuse and alcoholism is presented. With heightened awareness of alcoholism as our nation's number one drug problem, the federal government has developed a national institute to coordinate multimodal prevention, treatment, and rehabilitation programs. It is noted that several historical cases promoted the courts and investigating committees to recommend to our states that the crime of public drunkenness be removed. The recently developed Uniform Alcoholism Intoxication Treatment Act is discussed along with some of the intervention techniques being employed to deal with drinking drivers.
An historical viewpoint discloses two potential impediments to effective primary prevention of alcoholism with a communitywide focus: (1) weak evaluation instruments measuring the outcome of primary prevention programs, and (2) the difficulty of creating and maintaining a sufficiently high degree of interorganizational coordination. The origin of the National Council on Alcoholism during the 1940s is used as a focal point for the study. Thie article details the importance, today as well as four decades ago, of designing prevention programs that are well conceived, implemented, and evaluated.
With the introduction of measures restricting the prescribing of heroin or cocaine to narcotic addicts and the virtual withdrawal of supplies of methylamphetamine for intravenous injection in 1968, there have been marked changes in the pattern of narcotic addiction in Britain. In spite of the appearance of illicitly manufactured heroin in London there has been, so far, little evidence of serious narcotic peddling to youngsters, although a recent vogue among narcotic addicts for the intravenous injection of barbiturates has led to serious physical complications. The problem of narcotic addiction in Britain should be viewed seriously but within the context of the problem of drug addiction generally.
Data on Ontario per capita alcohol consumption and alcohol-related cancer mortality rates from 1963 to 1983 generally correlated positively and significantly. Correlations for the period of rising consumption (1963-1974) were similar to those observed for the total period, but during the period of stabilization and decline of alcohol consumption the magnitude of nearly all relationships decreased substantially. The overall positive and significant correlation between per capita alcohol consumption and various cancer site mortality rates may be partly due to lag effects from the period when consumption was on the rise.
Twenty-five publications, conference presentations, and unpublished reports on outcome of therapeutic communities for drug abusers are reviewed for the period 1963 to 1975. A wide variety of methodological limitations are noted, including retrospective designs, unclear definition of outcome variables, low follow-up completion rates, lack of descriptive data on either the treatment processes or the patients, inadequate sampling procedures, lack of comparison control groups, and the absence of data to validate self-reports. Some speculations are offered on the reasons for such methodological inadequacies and a model proposed for future studies.
A set of questions about whether alcohol was served at four selected social situations was included in two general population surveys, one taken in 1964 and one taken in 1984. The results show that there has been a general increase in the frequency of reporting that alcohol was served at these situations. Cross-sectional results tended to support three hypotheses about drinking contexts: that alcohol is more often served among close rather than distant acquaintances; that heavier drinkers tend to socialize with other heavier drinkers, which results in wetter get-togethers for such groups; and that the frequency of serving alcohol reflects the demographic characteristics of the respondent-participants.
University overnight infirmary admissions for drug abuse were reviewed over the 2-year periods 1968--1970 and 1973--1975. Hallucinogen abuse diminished over the years studied while alcohol abuse increased. Marijuana abuse was essentially unchanged. Diazepam overdosage generally replaced barbiturate overdosage, while aspirin remained the most common drug in overdose situations.
Data from two college-student samples, collected through a panel design from 1969 to 1973 and a cross-sectional design in 1976, were analyzed to address three questions regarding initial marijuana use: (1) Which variables, believed associated with marijuana use, are most salient to predicting initial use of the drug? (2) Are variables salient to predicting initial use of marijuana consistent in predicting initial over time? (3) Do any salient variables operate in combination to predict initial marijuana use? Results indicated that salience of the variables to predicting initial marijuana use changed over time. Implications for drug-use prediction are offered based on the findings.
Information concerning types and frequencies of pretreatment drug abuse, obtained by interview from 11,380 patients included in the first two years (June 1969-June 1971) of the NIMH-TCU Drug Abuse Reporting Program, were examined with respect to patterns of usage. Twenty-eight patterns were defined, involving various combinations of drugs used and frequencies of use. The results indicated that the most frequent drug-abuse pattern in this patient sample, accounting for 28% of the entire sample, was the daily or weekly use of heroin with no other drugs. The daily or weekly use of heroin with cocaine, with marihuana, and with both cocaine and marihuana were also frequently observed patterns, and combined with the heroin-only pattern, they characterized the majority of all the patients. The most common patterns reported by the remainder of the patients were of poly-drug use, typically involving marihuana, amphetamines, and barbiturates, as well as heroin and cocaine.
Patient characteristics are described in relation to pretreatment usage combinations of eight classes of illicit drugs for 11,380 drug abusers admitted between 1969 and 1971 to drug treatment centers participating in the NIDA-TCU Drug Abuse Reporting Program. From these data, nine basic patterns of drug use were defined. The most frequent, involving the daily use of heroin or other opioids only, characterized 27% of the patients. Four patterns involving heroin (at least weekly) with various combinations of cocaine, barbiturates, and marijuana accounted for another 29%, two patterns of polydrug use (three or more nonopioid drugs, with and without opioids daily) included 16%, and the remaining 28% of the patients were represented by patterns of a less specific nature. The distribution of patients across drug-use patterns was unrelated to sex, but was associated with race-ethnic background and age.
Between 1970 and 1972 the trend in marihuana use by college students at the University of New Mexico was clearly upward. Not only had an increasing number of these students ever used marihuana, but they had done so at an earlier age and more often in each succeeding year. At the same time, the rate with which marihuana use was growing appeared to be decelerating. That is, the rate of increase in marihuana use had diminished between 1971 and 1972 as compared to the preceding 2-year period. Whether this latter trend signals the onset of a changing interest in marihuana use among our college students or simply reflects the fact that the proportion of college students who have not yet experienced marihuana has been decreasing over the years cannot be definitely determined from the present work.
Study was made of the demographic and drug-using characteristics of new admissions to a narcotic treatment program over the course of a 4-year period. Samples were drawn of 100 new admissions during the month of April in each year from 1970 to 1974. Results indicate that the treatment program under study came to be working with caseloads increasingly court referred, increasingly nonminority, and less frequently prepared to volunteer for methadone maintenance treatment. New admissions claimed to have delayed entrance into treatment based on the geographic inaccessibility of treatment programs or the fact that they did not consider themselves ready for treatment. Implications for the provision of treatment to heroin users are discussed.
The demographics, drug habits, and medical complications of a cohort of 1,129 addicts treated at Lexington in the period 1971-1972 were studied. These patients, admitted from 41 different states, had a mean period of addiction of 5.4 years. Over one-third of the sample had engaged in pimping or prostitution, and there were no differences by gender in terms of involvement. Eight-eight percent had shared injection equipment, and surprisingly, 78% admitted to some effort at sterilizing their "works." Hepatitis was the most common associated medical condition: 87% had serologic markers of hepatitis B virus (HBV) infection, 60% had evidence of hepatitis A virus (HAV) exposure, and 47% had abnormal liver function parameters. Gynecomastia was evident in 2% of male subjects. Thirteen percent of the sample had a reactive VDRL assay, but 64% of these were biologically false positive. Subtle abnormalities of immune function were also observed; 18% of the patients had recent unexplained weight loss, 6% had lymphadenopathy, 8% had leukopenia, and 2% had lymphocytopenia. We conclude that both HBV and HAV were important infectious disease risks in these addicts, and that many evidenced deficiencies in immune function well before AIDS became a major public health concern.
This paper reviews some personal experiences as a researcher at the New York State University drug agency from 1969-70, and from 1973 to 1976, which offer a perspective into its operation and activities. In particular, the evaluation studies in which my staff and I were involved between 1973 and 1976 provide insight into the "misjudgment, mismanagement, and misrepresentation" (Inciardi, 1988, p. 547) that characterized the agency during this period. The agency's neglect to respond in a constructive manner to service delivery problems identified in these evaluation studies exacted a bitter price; and underscores the importance of agency maintenance of integrity in its various activities.
A group of patients (N = 1630) hospitalized in Stockholm County with a diagnosis of substance abuse during 1971-1972 were followed through 1984 as regards mortality: 446 (296 males and 150 females) patients died. The excess mortality in the cohort was 5.3 (males 5.8, females 4.6) compared to the general population in Stockholm County. The highest mortality was found in opiate users, with an excess mortality of 18.3. Fifty-one percent of the causes of death belonged to ICD-8 chapter 17, injury and poisoning, and of these, 69% (155 patients) were definite or probable suicides. Since HIV entered the Stockholm drug addict population by the end of this follow-up, the excess mortality reported here can be even higher in the years to come. To follow and monitor the mortality among patients with substance abuse is an important aspect in the evaluation of programs for prevention and treatment.
In January 1974, the Law Enforcement Assistance Administration, assisted by the Census Bureau, interviewed 10,400 inmates of state correctional facilities. Results from this survey were applicable to 191,400 inmates, which was the estimated population of all state correctional facilities at the time of the survey. Findings showed that an estimated 61% of the 191,400 inmates stated they had used drugs such as heroin, methadone, cocaine, marijuana, amphetamines, or barbiturates at some point in their lives, without a doctor's prescription and outside of a treatment program. A greater percentage of inmates presently convicted of property crimes (61%) had ever used drugs than inmates convicted of violent crimes (56%)--a difference which becomes greater when inmates convicted of robbery are removed from the violent crime category, particularly since seven out of every 10 inmates presently convicted of robbery had ever used drugs. Around one out of every four inmates stated they were using drugs daily, or almost daily, at the time of any of their present offense(s) resulting in imprisonment. Around one in every three inmates presently convicted of robbery was using drugs daily at this time. Classifying inmates according to daily drug use at this time resulted in the finding that a significantly smaller proportion of inmates with daily drug use at this time were presently convicted of "violent crimes" (41%) than inmates with no drug use (57%). In this survey, inmates were asked if they were under the influence of any drugs at the time of any of the offense(s) causing their present imprisonment. Around one in four of all inmates responded affirmatively to this question. Inmates were asked if they had been drinking at the time of any of the offenses resulting in their being in prison at this time. Four out of every 10 stated they had. Taken together with other drugs, six out of every 10 inmates were either under the influence of drugs, or had been drinking, at the time of any of the offenses causing imprisonment now. When the population was asked about enrollment in drug treatment programs, responses were that only 4% of all inmates were enrolled at the time of any of the present offenses resulting in imprisonment, while around 9% had been enrolled in drug treatment prior to the time of their present offenses.
The present paper reports some results from a winter 1974-1975, New York State survey of junior and senior public high school youths' awareness of and attitudes toward the drug prevention efforts their schools had undertaken. The findings indicate that most youths are not aware of community resources available for assistance with a drug problem. Substantial discrepancies were found between student ratings of the effectiveness of prevention programs and the programs which they were most frequently exposed. Finally, the data highlight the peer context and drug culture aspect of the youths' substance taking, emphasizing that the sociocultural backgrounds of students need to be taken into account in prevention program development.
This paper examines trends in rural American rates of marijuana use and drug-related orientations over an 8-year period. The younger rural youths (13-year-olds) in our three surveys (1975, 1979, and 1982) reported significant declines in rates of use and expressed a general trend toward conservatism. The attitudes and orientations of older youths (16-year-olds) changed also, and in the same directions, but those changes were not statistically significant. Use rates for 16-year-olds, on the other hand, increased, but again the changes were not statistically significant. In at least one cohort we studied, attitudes changed prior to shifts in behavior. We also observed that the predictive ability of the selected attitudes and orientations increased considerably from 1975 to 1982. In the midst of a movement toward conservatism on drug issues, liberalness was even more closely linked to marijuana use than in the previous decade. Lastly, we evaluate the implications of these findings for drug prevention policy and future research.
Recent research on urban drug use indicates that the alarming upward trend identified during the late 1960s and early 1970s is stabilizing. However, there is disagreement concerning whether the same pattern holds for rural populations. Early research reported low rates of drug use in nonmetropolitan areas. More recent research findings indicate that drug use in rural areas is much higher than originally thought. This discrepancy results, in part, from our inability to effectively monitor drug use in high-risk groups over time. One effective way of monitoring drug use trends is through the examination of drug arrest statistics by means of time series techniques. This analysis of urban drug arrests confirms that use is leveling off in such areas. No increase was found for the rural population over the 5-year period, however. Rather than finding a difference, it was found that rural-urban drug trends are quite similar.
Drug abuse patterns are examined for 326,611 males and females who abused drugs and were treated at a hospital emergency room or died. The data reveal a marked percentage difference between male and female mentions of heroin, PCP, and diazepam. A significantly larger proportion of females than males indicated their motivation for drug abuse to be a suicide attempt or gesture. Diazepam, alcohol-in-combination, and aspirin are the most frequently mentioned drugs by those whose motivation is suicidal. However, the percentage difference between males and females for these three drugs is less than 6%. The data were collected during the years 1976-1979.
Reviewed are 47 empirical studies. The paper contains sections on results from studies using specific psychometric instruments and measuring specific traits, personality differences in subgroups of heroin addicts, personality changes following treatment, and suggestions for future research. Measuring the presence or absence of a particular trait or characteristic is no longer sufficient. Rather, we need typologies within an interactional framework that systematically relates traits to other variables of interest (i.e., recidivism, treatment retention, and etiology).
Shortages in the supply of marijuana, which became acute around 1981, caused Rastafari marijuana distributors very reluctantly to disregard religious injunctions against the use of any psychoactive substance except marijuana, and to experiment with the use and distribution of cocaine hydrochloride powder for intranasal administration and, later, for smoking (freebase and crack). This experimentation proved ruinous, and many were retired ignominiously from drug distribution. In the crack era they have been succeeded by completely new social, cultural, and economic arrangements.
The results are presented from the analysis of 10,000 urine specimens from Los Angeles County probationers in early 1976 for the following drugs: amphetamine, methamphetamine, allylbarbital, amobarbital, butabarbital, pentobarbital, phenobarbital, secobarbital, morphine, codeine, methadone, primary metabolite of methadone, cocaine, benzoylecgonine, propoxyphene, norpropoxyphene, methaqualone, and phencyclidine. Over 27% of the urine samples analyzed were positive for at least one drug. Opiates were found to be the most widely used drugs, but multiple drug use was also quite common.
The involvement of Caribbean youth in drug distribution (marijuana from the mid-1960s to 1981; cocaine hydrochloride powder and crack from 1981 to 1987, the time of writing) throughout the Circum-Caribbean area and in North America is described. Social, economic, and cultural outcomes of these engagements are highlighted, and the relationship between the underground economy of drugs and the corporate, capitalist economy is explored. Responding to high rates of unemployment and to other problems of migrant adaptation, young Caribbean African males established a multimillion dollar marijuana (ganja) trading network which linked cultivators on the islands with exporters/importers and street-level distributors in North American cities. By 1976, its participants had become Rastafarians, or followers of an ideology of self-reliance and indigenous development. Following its precepts, they reinvested marijuana revenues to revive cottage industry and agriculture. In Caribbean or minority neighborhoods, therefore, marijuana was a "positive vibration" and its distributors were lionized.
A critical review is presented of methods and findings of epidemiological studies on drug use carried out in Brazil. Studies of the first phase (1977-1986) suffered from serious flaws but tended to produce inflated rates, as compared to studies conducted after 1987, which used better case definition criteria and sampling strategies. Prevalence of consumption of legal substances was comparable to industrialized countries but lifetime use of illicit drugs in the country tended to be much lower. In conclusion, there is no support from epidemiologic studies for the hypothesis of an epidemic of drug addiction in Brazil nowadays.
The files of the Casualty Branch of the Military Personnel Center, Europe, Seventh Medical Command, and of the U.S. Army's Tenth Medical Lab were used to examine the epidemiology of "overdose" deaths of U.S. Army soldiers in Europe during the calendar years 1978 and 1979. A total of 91 cases were so identified; i.e., death was the direct result of injection, inhalation, or ingestion of an intoxicant, legal or illegal. Not included were deaths caused by trauma or drowning while intoxicated, deaths from disease secondary to chronic drug or alcohol abuse, and deaths due to chemicals not widely viewed as intoxicants. The monthly distribution of cases showed a spring peak similar to that reported by several studies of U.S. civilian drug deaths. No such similarity was apparent in terms of victim characteristics and circumstances, with soldier victims being nearly always male, equally often White as Black, 20-24 years old, very rarely suicides, and nearly always using heroin and/or alcohol. "Control" data from circumscribed subgroups of nonvictim European soldiers, however, show that victims did not differ markedly from the junior enlisted population from which they came, as least on the variables generally available in personnel and medical records.
On-site investigations involving interviews with spouses, friends, coworkers, supervisors, and commanders were conducted following 37 deaths or near-deaths by drug overdose among U.S. soldiers stationed in Europe. Subjects were all active-duty soldiers put on the seriously ill list at any Army hospital with an initial diagnosis which included suspected drug overdose. Victims were typically single Black males, less than 22, high school graduates in excellent health. They had been in Germany 7-24 months, liked their jobs, and were judged better than average workers by both peers and supervisors. Fifty percent played on a unit sports team, 6 of 10 had German girlfriends, and one-third had prior disciplinary problems. Although nearly half had been previously identified as having a drug or alcohol problem, only two or three could be called addicts in even the broadest sense. Six cases were suicide gestures, and only these six cases did not involve heroin and/or alcohol. The modal case followed a party, with substantial drinking. In only 25% of the cases did the victim collapse upon injection. More often he went to bed, vomited during the night, and choked on or inhaled vomitus. The data suggest reexamination of two common myths: that heroin users comprise a very unique, albeit undesirable, sample of the general population; and that "overdose" deaths are the result of ignorance, incompetence, or indifference.