Les communautés thérapeutiques en milieu carcéral

The author focuses on therapeutic communities, particularly the KEY and CREST programs, applied in the state of Delaware since 1988. There programs are aimed at substance users living either in correctional settings (KEY) or on probation (CREST). This research tries to evaluate both programs according to the subject's relapse rate after 6 months. Based on the results, it has been determined that the subjects who participated in these programs successively had better chances of never using drugs again than those who had been in only one of the two programs, or neither. Other American experiments of the same kind have shown similar results

Crystal Meth, Gay Men, and Circuit Parties

Excerpt Over the three decades since the advent of the gay civil rights movement, gay male subcultures in large cities have frequently maintained—as an integral and celebrated element of “gay ghetto” life—an intimate connection between recreational drug use, all-night dance parties, and sexual freedom (Browning, 1993; Kramer, 1978; Rotello, 1997; Shilts, 1987). Writing about 1970s New York, Levine (1998) called these cultural elements the “four Ds: disco, drugs, ‘dish’ and ‘dick’.” Although the onslaught of the AIDS epidemic in the 1980s forced a broad-based retrenchment in the more libertine aspects of these subcultures, a number of social forces in the 1990s brought the drug/ sex/dance scenes back with vigor. The most visible facet of this renewed revelry has been the circuit party, which, paradoxically, emerged from AIDS fundraising efforts initiated by the gay community in the early days of the epidemic (Kurtz, 1999; Signorile, 1997)

Criminal Activity Among Young Adults in the Club Scene

Excerpt The modern all-night dance club culture has its most recent roots in the adolescent rave and gay male circuit party subcultures that emerged in the late 1980s, with more distant connections to the earlier New York nightclub scene epitomized by Studio 54 (Fritz, 1999; Kurtz, Inciardi, Surratt, & Cottler, 2005; Silcott, 1999; Thornton, 1996). This type of night life is found in almost every large city but is especially prevalent in major tourist destinations where people tend to be looking for an escape from their routines. This concept is represented in such slogans as “What Happens in Vegas Stays in Vegas® .” Miami, historically a major tourist destination and since the early 1970s a national center for cocaine importation, distribution, and use (Didion, 1987; Portes & Stepick, 1993), is also a major player in the U.S. club culture

HIV, HBV, and HCV Infections among Drug-Involved, Inner-City, Street Sex Workers in Miami, Florida

This study describes the rates of HIV, HBV, and HCV seropositivity among drug-involved, female street sex workers in low-income, inner-city sections of Miami, Florida; further, their sociodemographic characteristics, drug use, and sexual risk behaviors were assessed; and predictors of infection were reported. A sample of 586 sex workers was recruited through targeted sampling methods, interviewed, and counseled and tested for the presence of antibody to HIV, HBV, and HCV. Respondents\u27 median age was 38 years, median time in sex work was 14 years, all were heavily involved in the use of alcohol and drugs, and 42% were homeless. More than half (51.0%) had engaged in unprotected vaginal sex in the past month. Prevalences were HIV, 22.4%; HBV, 53.4%; HCV, 29.7%. A multidimensional public health program must address not only issues related to unsafe sex, but also the problems of drug abuse, homelessness, and other lifestyle factors that contribute to risk behaviors

Prescription Opioid Abuse among Drug-Involved Street-Based Sex Workers

National population surveys and individual studies over the past decade have documented the escalating abuse of a variety of prescription medications, particularly prescription opioids. Although surveillance data provide important information for estimating the prevalence of prescription opioid abuse in the general population, studies documenting the patterns of prescription drug abuse among chronic street-drug-using populations are extremely rare. This paper examines the abuse of prescription opioids among drug-involved street-based sex workers in Miami, Florida. The data for this study were drawn from an ongoing HIV intervention trial initiated in 2001, designed to test the relative effectiveness of two alternative HIV prevention protocols for this population. Participants in the study were recruited through traditional targeted sampling strategies, and complete data are available on 588 street-based sex workers. In terms of prescription drug abuse, 12.2 percent of the sample reported using at least one opioid analgesic in the past 90 days without having a legitimate prescription. Logistic regression analyses were conducted to examine the associations between prescription opioid abuse and its predictors. In the multivariate model, factors positively associated with prescription opioid abuse included: Caucasian race (OR = 2.53; 95 percent CI 1.30 to 4.91), current powder cocaine use (OR = 2.28; 95 percent CI 1.28 to 4.08), current heroin use (OR = 2.08; 95 percent CI 1.10 to 3.92), 90-day physical abuse/victimization (OR = 2.07; 95percent CI 1.18 to 3.61), and shorter sex-work involvement (OR = 1.98; 95 percent CI 1.13 to 3.48). In contrast, daily crack smoking was negatively associated with prescription opioid abuse (OR = 0.61; 95 percent CI 0.33 to 1.10). This study provides some of the first empirical evidence to indicate that prescription opioid abuse is emerging in a heretofore unstudied community of marginalized drug-using sex workers. In addition, data on this population\u27s mechanisms of access to prescription opioids clearly suggest that there is an active black market for these drugs. These findings warrant intensive study to determine the relative contribution of each mechanism of diversion to the illicit market

Prescription Drug Abuse among Ecstasy Users in Miami

This study examines the nature, extent and consequences of prescription drug abuse among 143 ecstasy users in Miami. Participants were recruited through nightclub and college campus outreach, and through respondent referrals. Instrumentation included the Risk Behavior Assessment, Substance Abuse Module and Center for Epidemiological Studies Depression Scale. Median age was 23, 42% were female and 50% Hispanic. An arrest history was reported by 44%, and 33% reported prior drug/alcohol treatment. Prescription drug abuse was reported by 87%; alprazolam (57%), oxycodone (36%), hydrocodone (32%) and diazepam (30%) were cited most often. Prescription drug abusers were more likely to report polydrug use, drug treatment histories, risky drug use behaviors, and symptoms of depression. They also reported numerous physical, psychological and social consequences of prescription drug abuse. Additional studies among larger samples are needed to understand the processes of prescription drug access and the extent of integration in club drug using cultures

Correlates of Heterosexual Anal Intercourse among Substance-Using Club-Goers

Anal sexual intercourse represents the highest transmission risk for infection with the human immunodeficiency virus (HIV), yet much of what we know about anal sex is based on men who have sex with men (MSM). Less is known about heterosexual adults who practice anal sex, especially those who may be at risk for HIV such as substance users. The present study examined the demographic, sexual behaviors, substance use, and psychosocial correlates of recent anal intercourse among a heterosexual young adult sample of nightclub goers who also use substances. Data were drawn from an on-going natural history study of participants (n = 597) in Miami\u27s club scene who use club drugs, use prescription medications for non-medical reasons, and were regular attendees of nightclubs. Participants who reported anal sex (n = 118) were more likely to be male, of moderate income, Latino, trade sex, have unprotected sex, and report victimization. Event-based and qualitative studies are needed to better understand the context in which anal sex occurs. Interventions that target heterosexual populations should include discussion about the risks of anal sex

Sex Work and Drug Use in a Subculture of Violence

This article examines the subculture of violence thesis as it relates to female street sex workers in Miami. Interview and focus group methods were used to study the intersections of childhood trauma, drug use, and violent victimization among 325 women. Using targeted sampling, crack- and heroin-using sex workers were recruited through street outreach into an HIV-prevention research program. Interviews used standard instrumentation and focused on drug-related and sexual risk for HIV, sex work, violence, childhood trauma, and health status. Nearly half of the respondents reported physical (44.9%) and/ or sexual (50.5%) abuse as children, and over 40% experienced violence from clients in the prior year: 24.9% were beaten, 12.9% were raped, and 13.8% were threatened with weapons. Consistent relationships between historical and current victimization suggest that female sex workers experience a continuing cycle of violence throughout their lives. The policy and research implications of these findings are discussed

Mechanisms of Prescription Drug Diversion among Drug-Involved Club and Street-Based Populations

OBJECTIVE: Prescription drug diversion involves the unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace, and can occur along all points in the drug delivery process, from the original manufacturing site to the wholesale distributor, the physician\u27s office, the retail pharmacy, or the patient. However, empirical data on diversion are limited. METHOD: In an attempt to develop a better understanding of how specific drug-using populations are diverting prescription opioids and other medications, or obtaining controlled drugs that have already been diverted, qualitative interviews and focus group data were collected on four separate populations of prescription drug abusers in Miami, Florida--club drug users, street-based illicit drug users, methadone maintenance patients, and HIV positive individuals who abuse and/or divert drugs. RESULTS: Sources of abused prescription drugs cited by focus group participants were extremely diverse, including their physicians and pharmacists; parents and relatives; doctor shopping ; leftover supplies following an illness or injury; personal visits to Mexico, South America and the Caribbean; prescriptions intended for the treatment of mental illness; direct sales on the street and in nightclubs; pharmacy and hospital theft; through friends or acquaintances; under-the-door apartment flyers advertising telephone numbers to call; and stealing from grandma\u27s medicine cabinet. CONCLUSION: While doctor shoppers, physicians and the Internet receive much of the attention regarding diversion, the data reported in this paper suggest that there are numerous active street markets involving patients, Medicaid recipients and pharmacies as well. In addition, there are other data which suggest that the contributions of residential burglaries, pharmacy robberies and thefts, and sneak thefts to the diversion problem may be understated