Alcohol and other drug abuse (AOD) treatment is a major means of HIV/AIDS prevention, yet clients of street outreach programs (SOP) who are injection drug users (IDU), and outreach workers and staff as well, report various obstacles to enrolling clients in AOD programs. This study assessed the barriers to AOD enrollment facing high risk street outreach clients and obtained suggestions for reducing them. Data were obtained from semistructured field interviews with: 1) IDU outreach clients (N = 144) of the six SOPs in New York City (NYC) and northern suburbs supported by the Office of Alcoholism and Substance Abuse Services (OASAS), the single state agency in New York State for AOD prevention and treatment, 2) outreach workers and staff of the six SOPs (N = 55), 3) staff of detox and AOD treatment programs in major modalities treating IDUs (N = 71), and 4) officials and administrators (N = 11) in OASAS, the AIDS Institute of the Department of Health (addresses all aspects of the HIV/AIDS epidemic in New York State), and the agency for public assistance in New York City, the Human Resources Administration (HRA). Principal barriers for street outreach clients included personal-family issues, lack of insurance/Medicaid, ignorance, suspicion, and/or aversion to AOD treatment (methadone maintenance especially), "hassles" with Medicaid, lack of personal ID, lack of "slots," limited access to intake, homelessness, childcare-child custody issues. Further, about 18% had no desire for AOD services, reported no barriers, or were too enmeshed in addiction to enroll. Outreach staff cited prospective client's lack of ID and lack of Medicaid, lack of "slots," and stakeholder agency bureaucracy. Treatment staff cited lack of client readiness, "hassles" posed by welfare reform, AOD programs' own "red tape," waiting lists, and near exclusionary preference for the Medicaid-eligible. Finally, agency managers cited client factors, inadequate funding and lack of appropriate programs, treatment program requirements, and societal stigmatization of addicts. Proposed remedies included dropping ID and insurance requirements for admission, major increases in resources, funding the transporting of outreach client treatment candidates to AOD services sites, education and training initiatives, increased inter-agency cooperation, and the need for stakeholder agencies, OASAS especially, to more effectively integrate abstinence-oriented AOD services with harm reduction and the public health aspects of AOD problems.

The Housing First approach used by Pathways to Housing, Inc., was used to enhance residential independence and treatment retention of homeless, seriously mentally ill methadone patients. The Keeping Home project first secured scattered-site apartments and assertive community treatment services and then addressed patients' service needs. Three years post-implementation, methadone treatment retention for 31 Keeping Home patients versus 30 comparison participants (drawn from an administrative database) was 51.6% vs. 20% (p < .02); apartment/independent housing retention was 67.7% vs. 3% or 13% (both p's < .01). Although results firmly support Keeping Home, future research needs to address study's possible database limitations.

No abstract

The Sensation-Seeking Scale and the State-Trait Anxiety Inventory were administered to 30 white, 30 black, and 30 Hispanic male narcotic drug abusers in residential treatment. Individual drug abuse histories were assessed in semistructured interviews. The results indicate that (a) white subjects scored significantly higher on the five Sensation-Seeking subscales than did either black or Hispanic subjects. No significant differences were obtained between ethnic groups on state or trait anxiety, (b) Even though the prevalence of the use of alcohol, cannabis, street methodone, and cocaine was similar in the three ethnic groups, significantly more white subjects had used amphetamines, barbiturates, tranquilizers, methaqualone, inhalants, and psychedelics. (c) Measures of sensation seeking and anxiety correlated significantly with the number of different drugs used by whites, although the measures were virtually unrelated to drug use among nonwhites. The frequency of use of stimulant, depressant, or hallucinogenic drugs was unrelated to the user's level of sensation seeking or anxiety. Among individuals with extensive histories of drug abuse, ethnicity appeared to be more closely related to drug-use patterns than motivational variables such as sensation seeking and anxiety.

Sustained attention was examined in chronic, high-dose (70-120 mg) methadone patients with a modified Continuous Performance Test (Rosvold et al., 1956) 45 min in duration. Working and nonworking patient groups, and drug-free ex-addict and opiate-naive comparison groups were tested at high, moderate, and low signal rates. Groups did not differ overall in accuracy, response latencies, or commission errors. The working patients, however, performed better at the high than at the lower signal rates, and had poorer accuracy and longer latencies at the low rate than the comparison groups. The nonworking patients had different results; they made more commission errors at the high signal rate than the other three groups.