Predictors of hazardous alcohol consumption among young adult amphetamine-type stimulant users: a population-based prospective study

Background: Very high levels of alcohol consumption have been observed in young adult amphetamine-type stimulant (i.e., ecstasy and methamphetamine) users. The reasons for this association are poorly understood. Objective: To examine predictors of hazardous alcohol consumption in a sample of young adult amphetamine-type stimulant users after 30 months of follow-up, controlling for potential confounders. Method: Analysis of longitudinal data from a population-derived sample of Australian young adult amphetamine-type stimulant users (n = 292). A prediction model of alcohol use at 30 months was developed using generalized linear latent and mixed modeling (GLLAMM). Results: Concurrently using ecstasy (Adjusted Odds Ratio [AOR] = 2.67, 95% Confidence Interval [CI] = [1.41, 5.07]), frequently attending nightclubs (AOR = 2.53, 95% CI = [1.04, 6.16]), high baseline alcohol use patterns (AOR = 2.06, 95% CI = [1.32, 3.20]), and being male (AOR = 3.60, 95% CI = [1.48, 8.78]) were associated with an increased likelihood of hazardous alcohol use at 30 months. Conclusion: Concurrent, but not baseline, ecstasy use was associated with hazardous alcohol use, suggesting that combined use of these substances may have an instrumental role in terms of the social functions of drug use (e.g., increasing capacity to drink). Integration of educational interventions concerning alcohol and stimulants is warranted

The childhood and adult sexual abuse experiences of women who attend a family planning clinic

Background Research suggests that sexual abuse is not an uncommon occurrence. Within the last two decades the research literature on the prevalence and correlates of sexual abuse, particularly abuse that occurs during childhood, has flourished. More recently, research has moved towards the concerns of measuring and classifying sexual abuse and the testing of treatment protocols. Aims The research described in this thesis was designed to provide Family Planning Queensland (FPQ) with information about the sexual abuse experiences of their clients so that service provision and educational services could be targeted and improved within their own service as well as more widely. An important focus of this research was to gauge the extent to which abuse experiences of clients of a (primarily) women's health service were similar to, or different from, women in the general population. This was achieved through the use of interview questions that were comparable to two recent national probability surveys. Further exploration of the data determined the extent and nature of inconsistent reports of sexual abuse over time and the effects of attrition of respondents on longitudinal data. Methods Following a pilot study of 50 women, a longitudinal study of 402 randomly selected female clients aged 18-45 years who attended the Fortitude Valley clinic of FPQ was undertaken between 1996 and 1999. The primary focus of the research was on the collection of quantitative data, but complementary open-ended qualitative questions were included to enable participants to expand upon the context of their experiences and to voice their opinions about the prevention of abuse and the provision of services. Data were collected by face-to-face interviews and self-administered questionnaires which consisted of valid and reliable instruments. Wherever possible, systematic comparisons between the sample and Australian population data were made. Results Prevalence estimates: The prevalence of sexual abuse was high: 55.5 per cent of all respondents had experienced an unwanted sexual experience pnor to the age of 16 years (a considerably higher figure than reported in other Australian and international research) and 74.5 per cent of all respondents had experienced an unwanted sexual experience since the age of 16 years. Overall, 78.4 per cent had experienced some kind of unwanted sexual experience during their lifetime. These experiences ranged from non-physical abuse (such as 'being exposed to') to physical abuse (such as unwelcome touching or fondling), to agreeing to sex but feeling used, and unwanted sexually penetrative experiences. Correlates of sexual abuse: Statistically significant associations were detected between sexual abuse experiences during childhood and as an adult with physical health problems (such as poor health and recent hospitalisation), adverse health behaviours (such as smoking, alcohol dependence and illicit and prescription drug abuse), mental health problems (such as Post Traumatic Stress Disorder, depression, unhappiness and eating disorders), social concerns (such as being on a pension), experiencing other forms of violence (such as domestic violence and sexual re-victimisation) and sexual functioning (such as sexual orientation, number of sexual partners, sexually transmitted infections, having children and sexual dysfunction). Methodological considerations: Twelve months after the initial round of interviews, just over half of the respondents (52.5 per cent) returned for a follow-up interview, which was an exact replica of the first interview. Women who reported penetrative sexual abuse during childhood were significantly more likely to (a) refuse to return for the interview when requested to do so at the time of the first interview, and (b) refuse to be interviewed when requested to do so 12 months after the initial interview, despite agreeing to do so 12 months earlier. Women who refused to be re-interviewed were also significantly more likely to be less than 30 years of age, to report poor or fair health and to have experienced a shocking event (such as a motor vehicle accident or an assault) at some stage in their lives. These findings indicate that, despite being representative of the target population at the initial interview (ie. all female clients of FPQ), the sample at follow-up may not have been representative and may have been biased with regards to the topic of the research. In turn, these sampling issues had a direct impact on prevalence and correlate estimates at follow-up. Furthermore, approximately 20 per cent of the sample were inconsistent in their reports of abusive experiences at the first and follow-up interviews. This could not be accounted for by events that had occurred in the intervening period. This inconsistency was also evident in other topics explored by the research such as ethnicity, sexual orientation and age of first period. No predictors of inconsistency, however, could be determined. The prevention of sexual abuse and the service needs of the abused: Qualitative responses from respondents regarding the prevention of sexual abuse and the service needs of the abused indicated very strong support for: more education and early training in self-esteem (for both boys and girls); opportunities such as self-defence training and the availability of self-protective devices; increased community resources; and changes to the legal system - harsher punishments for offenders, a greater availability of properly trained professionals and more women in these positions, in particular. Conclusion It seems clear that women who attend family planning clinics have higher lifetime rates of sexual abuse than the general population. This includes a considerably higher risk for penetrative abuse during childhood. Indeed it is possible that clinic attendance results in part from such abuse. It is important, therefore, that family planning clinics incorporate screening, counselling and referral options for sexually abused clients. The information provided by this study will be valuable to FPQ, both for the day to day treatment of their clients and for the development of prevention and treatment strategies. The methodological issues explored in this thesis also have significant implications for research. Longitudinal research is seen as the 'gold standard', but causes of attrition and consistency of response over time need to be considered when determining the accuracy of prevalence estimates

Young adults' trajectories of Ecstasy use: A population based study

Young adults' Ecstasy use trajectories have important implications for individual and population-level consequences of Ecstasy use, but little relevant research has been conducted. This study prospectively examines Ecstasy trajectories in a population-based sample. Data are from the Natural History Study of Drug Use, a retrospective/prospective cohort study conducted in Australia. Population screening identified a probability sample of Ecstasy users aged 19-23. years. Complete data for 30. months of follow-up, comprising 4 time intervals, were available for 297 participants (88.4% of sample). Trajectories were derived using cluster analysis based on recent Ecstasy use at each interval. Trajectory predictors were examined using a generalized ordered logit model and included Ecstasy dependence (World Mental Health Composite International Diagnostic Instrument), psychological distress (Hospital Anxiety Depression Scale), aggression (Young Adult Self Report) and contextual factors (e.g. attendance at electronic/dance music events). Three Ecstasy trajectories were identified (low, intermediate and high use). At its peak, the high-use trajectory involved 1-2. days Ecstasy use per week. Decreasing frequency of use was observed for intermediate and high-use trajectories from 12. months, independently of market factors. Intermediate and high-use trajectory membership was predicted by past Ecstasy consumption (>. 70 pills) and attendance at electronic/dance music events. High-use trajectory members were unlikely to have used Ecstasy for more than 3. years and tended to report consistently positive subjective effects at baseline. Given the social context and temporal course of Ecstasy use, Ecstasy trajectories might be better understood in terms of instrumental rather than addictive drug use patterns

Simultaneous use of alcohol with methamphetamine but not ecstasy linked with aggression among young adult stimulant users

Introduction: Illicit stimulants are often combined with alcohol in nightlife entertainment districts, an environment where aggressive behaviour commonly occurs. While alcohol and methamphetamine use are each associated with aggressive behaviour, relatively little is known about the impact of the combined use of alcohol and amphetamine-type stimulants (i.e., ecstasy [MDMA] and methamphetamine) on aggression

Engagement with different nightlife venues and frequent ecstasy use in a young adult population

Aims: Little is known about the possible influence of different social settings on changes in patterns of ecstasy use over time. This study explores the relationship between engagement with different types of nightlife venues and subsequent frequent ecstasy use in an Australian young adult population sample. Methods: Longitudinal data are from a population-derived sample of Australian young adult ecstasy users (n = 265). Attendance at four types of venues (nightclubs, electronic dance music events/music festivals, venues playing live music, and pubs/bars) was measured at 6 months. Frequency of recent ecstasy use (last 12 months) was measured at 12 and 30 months. A prediction model of frequent ecstasy use at 30 months was developed using Poisson regression reporting adjusted relative risk. Findings: Regular attendance at nightclubs (≥monthly, adjusted relative risk 6.21, confidence interval 2.30-16.76) was associated with frequent ecstasy use at 30 months, independently of ecstasy use expectancies, ecstasy availability, ecstasy and methamphetamine dependence, frequent use of methamphetamine and alcohol, and other dimensions of ecstasy involvement (i.e. length of ecstasy use career and lifetime ecstasy consumption). Conclusions: Compared with attendees of other venues, nightclub attendees may be a special priority group for ecstasy harm and demand reduction interventions

Predictors of aggressive behavior while under the influence of illicit drugs among young adult methamphetamine users

Prior research indicates that patterns of combined alcohol and methamphetamine use may be associated with experiencing subjective feelings of aggression or hostility during methamphetamine use episodes.This study examines whether subjective effects of methamphetamine use (i.e., aggression or hostility and paranoia) are associated with aggressive behavior while under the influence of any illicit drugs, controlling for combined alcohol and methamphetamine use and a number of other potential predictors.Data from a population-based sample of Australian young adult methamphetamine users (n = 101) collected in 2010 was analyzed. A prediction model of aggressive behavior under the influence of illicit drugs was developed using penalized maximum likelihood logistic regression.Over one-third (34.7%) of methamphetamine users had engaged in verbal and/or physical aggression under the influence of illicit drugs in the last 12\ua0months. In the prediction model, recurrent feelings of aggression or hostility attributed to methamphetamine use (≥3\ua0times in the last 12\ua0months) were associated with aggressive behavior (adjusted odds ratio 4.95, 95% confidence interval 1.67, 14.69). This association was independent of methamphetamine-attributed paranoia, combined alcohol and methamphetamine use, methamphetamine, ecstasy, cocaine, and cannabis use patterns, heavy episodic drinking, gender, and age. No association was found for combined alcohol and methamphetamine use.These findings indicate a link between methamphetamine-related subjective feelings of aggression or hostility and self-reported aggressive behavior while under the influence of illicit drugs. This suggests that subjective feelings of aggression or hostility may distinguish those who are involved in aggression from other methamphetamine users