Two short scales, the TCU Depression Scale and the TCU Decision-making Scale, were psychometrically evaluated in a sample of 145 intravenous drug users. Coefficient alpha reliabilities were .78 for the 6-item TCU Depression Scale and .77 for the 9-item TCU Decision-making Scale. Concurrent validity of the former scale was assessed by correlating scores with those on the Beck Depression Inventory, r = .75. Based on the Beck Depression Inventory Clinical cutoff scores, 83% of the sample showed some depression, with 23% severely depressed, 39% moderately depressed, and 21% mildly depressed. Individuals scoring higher on depression on both tests tended to score lower on decision-making. Significant demographic associations of age, gender, education, and race-ethnicity were found for the depression and decision-making scales. More depression was noted for women, those younger, white, and having less education. Older and more educated intravenous drug users tended to score higher on decision-making. Validity for the depression and decision-making scales was assessed by examining correlations with behaviors. Significant positive correlations were found between depression scores and intravenous use of cocaine only, heroin and cocaine combined, and heroin only. Also, intravenous use of cocaine only and of cocaine and heroin combined were negatively related to decision-making. AIDS sex-risky behavior was positively correlated with depression and negatively correlated with decision-making.
Although the number of females served in United States treatment programs for substance use has increased over the last decade, women continue to be underrepresented. This suggests that the prevalent treatment models, which tend to be male-oriented, may not provide appropriate strategies to meet women's needs. Substance use problems in women appear to be multideterminded phenomena in which genetics, familial history, psychosocial issues, and other environmental factors play contributing roles. Working from a relational theoretical model of female psychosocial development, a continuum of expanded services addressing the entire context of women's lives is discussed.
The addicted prostitute faces a risk of AIDS from both her sexual practices and intravenous drug use. While the sexual practices of these women have been studied, much less is known about their needle-using practices. We suggest women in the sex industry are more enmeshed in the drug-using scene and occupy a more constricted set of social roles than other women. They will therefore lack the resources and have fewer opportunities to engage in safer behaviors compared to women who support themselves by other means. The analysis is based on 9,055 addicted women not in treatment. Women who trade sex for money and/or drugs are less likely to use new needles on any consistent basis or to clean old needles. They are more likely to share needles with others compared to women who support themselves by other means. Three identifiable patterns of needle-using practices emerge: indiscriminate sharing, monogamous sharing with a sexual partner, and exclusive use of new needles. To reach those engaged in promiscuous sharing, needle-swapping programs must be particularly "user friendly." Where needle-using behaviors reflect an intimate relationship, the spouse/sex partner must be engaged if change is to take place. Finally, policymakers and practitioners should capitalize on the strengths and strategies of those who report they consistently use sterile needles.
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In three Texas cities illicit drug injectors not in treatment were located by outreach and interviewed with a standard questionnaire. In all the cities the drug injectors were predominantly undereducated and unemployed young men from minority groups. In Dallas and Houston most were Black, while in San Antonio most were Hispanic. The most frequently reported primary drug in Houston was cocaine, but in Dallas and San Antonio it was heroin. The high needle risk for AIDS and the low rates of positive HIV antibody tests in these samples present a special window of opportunity for prevention of AIDS.
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