Characterizing longitudinal health state transitions among heroin, cocaine, and methamphetamine users

AIMS: Characterize longitudinal patterns of drug use careers and identify determinants of drug use frequency across cohorts of primary heroin, methamphetamine (MA) and cocaine users. DESIGN: Pooled analysis of prospective cohort studies. SETTINGS: Illicit drug users recruited from community, criminal justice and drug treatment settings in California, USA. PARTICIPANTS: We used longitudinal data on from five observational cohort studies featuring primary users of heroin (N=629), cocaine (N=694) and methamphetamine (N=474). The mean duration of follow-up was 20.9 years. MEASUREMENTS: Monthly longitudinal data was arranged according to five health states (incarceration, drug treatment, abstinence, non-daily and daily use). We fitted proportional hazards (PH) frailty models to determine independent differences in successive episode durations. We then executed multi-state Markov (MSM) models to estimate probabilities of transitioning between health states, and the determinants of these transitions. FINDINGS: Across primary drug use types, PH frailty models demonstrated durations of daily use diminished in successive episodes over time. MSM models revealed primary stimulant users had more erratic longitudinal patterns of drug use, transitioning more rapidly between periods of treatment, abstinence, non-daily and daily use. MA users exhibited relatively longer durations of high-frequency use. Criminal engagement had a destabilizing effect on health state durations across drug types. Longer incarceration histories were associated with delayed transitions towards cessation. CONCLUSIONS: PH frailty and MSM modeling techniques provided complementary information on longitudinal patterns of drug abuse. This information can inform clinical practice and policy, and otherwise be used in health economic simulation models, designed to inform resource allocation decisions

Engagement of men in group treatment programs

The goal of this paper is to arrive at a better understanding of the process of men’s engagement in treatment groups. Given the low perseverance rate of men in such groups, engagement is crucial to program continuance and results. A number of treatment factors and strategies that can influence engagement in group therapy programs are drawn from a review of the literature. To gain a better understanding of the factors and how they interrelate, the literature was reviewed from the perspective of Bronfenbrenner’s (1979) ecological model. The studies reviewed show that engagement is influenced by various factors associated with the characteristics of the participants, their family environment, treatment program, and cultural and social values. Current knowledge is discussed to highlight the main research and practice issues concerning men’s engagement in treatment groups. The review underscores the importance of exploring the influence of male socialization on men’s engagement, given that some traditional norms may curb their involvement and willingness to invest in group programs