Behavior analysts have had much success in affecting behavior change with individuals diagnosed with intellectual disabilities as well as those who would be considered typically developing with a variety of intervention strategies; most of which involve affecting direct acting contingencies. However, the realm of language-based psychopathology has just begun to be addressed within the field through language based, or indirect acting strategies. Acceptance and Commitment Therapy (ACT) is based on the concept of derived stimulus relations and allows for a behavior analytic treatment of language-based psychopathology. The current study was intended to test the efficacy of a brief protocol-delivered ACT intervention with individuals who smoke marijuana. Oral swab drug screens were the primary dependent variable, along with the Acceptance and Action Questionnaire II (AAQ-II). All six ACT components were taught to each subject using a set list of metaphors and exercises and was assessed using a concurrent/non-concurrent multiple baseline across participants design. Results indicate that the brief protocol impacted levels of marijuana consumption with all three participants and that their self-reported levels of struggle (via the AAQ-II) lessened over the course of the training.

Does Nimbin have a drug problem? This tiny village in north-eastern NSW has an international reputation for its alternative community and its street drug market. Ever since the Aquarius Festival thirty years ago Nimbin has fascinated the media, and recurrent headlines about the village's (undefined) 'drug problem' suggested my research topic. My research aim was to investigate the meaning/s of Nimbin's 'drug problem' in the context of Nimbin's 'alternative' culture. Because the topic of illicit drugs is both ethically challenging and highly sensitive, my research design was strongly participant-focused, with an emphasis on confidentiality balanced by a mixed methodology to cross-validate results. My methods included an anonymous household (door-to-door) survey based on a national household survey; an anonymous mailed-back survey of Nimbin and Lismore drug injectors; taped interviews with health and legal professionals, cannabis activists and drug dealers; semi-structured interviews with 'professional' cannabis crop growers; and participant observation over several years. I found the multi-method research design to be particularly effective for investigating illegal drug marketing and use, and the design provided me with multiple perspectives on a complex issue. Superficially, there appeared to be two drug 'problems' in Nimbin — one was the (largely cannabis) street market, and the other revolved around heroin users, and included complaints about scruffy-looking people hanging around the main street, or overdosing in the public toilet. However, my research suggested that these issues, while immediately comprehensible as 'drug problems', obscured more complex issues. For example, the village's street drug market was intertwined with the local economy and with the alternative community's values and drug use, while close to half of the drug injectors lacked secure housing (which creates problems that are not related to heroin), and all heroin users were blamed for the actions of few. Many factors influence the creation and maintenance of what we might call 'problems', and drugs are frequently blamed for broader social problems. What is Nimbin’s drug problem? The answer depends, in part, on the drug of interest, but more importantly it depends on your definition of a ‘problem’. Some useful and meaningful perspectives on this important social issue include quantified indicators such as death, injury, arrest rates, the economics of black markets, the demographics of drug use, and estimates of ‘social costs’. Qualitative perspectives include people’s opinions about drugs, media-generated moral panics, the effects of social marginalisation, and the role of drug cultures. A number of ‘drug problems’ arise as a direct result of drug illegality. They include black markets, corruption, drug-related violence, theft, stronger forms of the drug, and more dangerous using practices (with the risk drug overdoses and HIV/AIDS), as well as public nuisance issues. Government policy, judicial sentencing and public opinion are moving towards the social reintegration of illicit drug users, but this is almost invariably counter-balanced by a toughening of legal sanctions against supply of the same drug. Most discussions about illicit drugs fail to consider the long-term implications of harsh penalties for, and elaborate and punitive police operations (such as occurred throughout my Nimbin research) against, small-scale independent growers and dealers. The only way to directly engage with drug markets and all the attendant problems, is to legitimise and regulate the supply of recreational drugs. I discuss several examples of the important role of the drug culture in mitigating problems caused by illegality. One example is the influence of Nimbin's alternative community on the style of the drug market. The village drug scene more closely resembles the many north coast village craft markets, than it does Kings Cross, Cabramatta or New York's Bronx. Buyers are north coast locals, along with national and international tourists (the small village is known to cannabis users world-wide, both through media attention and word-of-mouth). Nimbin offers a 'safe' village market ambience and competitive prices to a mainly cannabis using clientele. I suggest that there are two major underlying influences on the experience of a ‘drug problem’, regardless of the drug or the place. They are: 1. Political influences — specifically the effects of government policy on black markets, law enforcement practices, and access to services and resources; 2. Cultural influences — particularly the beneficial effects of norms and functional role models for the safe use of a drug, cultural effects on the drug market, and the role/s of the drug in the day-to-day life of the culture. These influences can operate with, or despite, each other, and can create or ameliorate many ‘drug problems’. In the case of Nimbin’s alternative culture, government policy has created a number of drug problems and the counter-culture has worked to minimise them. In my research into Nimbin’s ‘drug problem’ I have clarified some issues and raised a number of others. I have examined the notion of a ‘drug problem’ from several perspectives using a range of research tools, and discussed some key influences on the problem associated with drug use. Drawing from the Nimbin research and my reading, I suggest legalising the recreational drugs to bring them under the dual controls of supply legislation and social norms. In conclusion, I suggest that we need to be very clear about what ‘drug problem’ it is that we are talking about, and indeed, whether the problem is really about drugs at all.

The consequences of drug use and benefits of methadone maintenance therapy (MMT) were investigated in a random sample of Maori and non- Maori injecting drug users in Christchurch, Aotearoa New Zealand. Eighty- five injecting drug users (IDUs) who had been on MMT for a mean time of 57 months were interviewed and followed up over an average 18 month period. Markov models were used to model cohorts of IDUs, changes in their health states and the effects of MMT and anti-viral therapy on morbidity and mortality. The savings in life from reductions in drug overdoses were used as the main outcome measure in cost-effectiveness analysis. Cost-utility and cost-benefit analysis were also used to provide additional information on the costs and outcomes of treatment. Comparisons were made between: (a) MMT alone; (b) MMT provided with conventional combination therapy for hepatitis C virus (HCV); and (c) MMT provided with anti-viral therapy with pegylated interferon. The monetary costs of drug use and benefits of MMT were similar for Maori and non-Maori. However, Markov modelling indicated that MMT is associated with greater savings in life for Maori than for non-Maori. Further, Maori IDUs identified the main personal costs of drug use as being loss of their children and loss of marriage or partners. Large reductions in use of opioids and benzodiazipines were reported at interview, compared with before starting MMT. The participants also reported large reductions in crime and stabilisation of their lifestyles. Improvements in the general health of IDUs om MMT were reported. However, 89% were positive for HCV infection, which was identified as the major physical health problem affecting IDUs in New Zealand. Few IDUs had received anti-viral therapy for HCV infections, despite having stabilised on MMT. This study investigated the benefits of providing anti-viral therapy for HCV to all patients meeting treatment criteria. The cost-effectiveness of MMT alone was estimated at $25,397 per life year saved (LYS) for non- Maori men and $25,035 for non-Maori women IDUs (costs and benefits discounted at 3%). The incremental effects of providing anti-viral therapy for HCV to all eligible patients were to save extra years of life, as well as to involve additional costs. The net effect was that anti-viral therapy could be provided, at a similar level of cost-effectiveness, to all patients who meet HCV treatment criteria. Cost-effectiveness could be improved if IDUs could be stabilised on MMT five years earlier at an average age of 26 instead of the current age of 31 years. The cost-effectiveness of treatment with pegylated interferon was similar to that for conventional combination therapy because there were incremental savings in life as well as increased treatment costs. Costs per LYS were estimated to be lower for Maori than for non-Maori, reflecting ethnic differences in mortality. Sensitivity analysis revealed that provision of MMT with anti-viral treatment remained cost-effective under varying assumptions of mortality, disease progression and compliance with treatment. the main problems that were not improved during MMT were continuing use of tobacco and cannabis, low participation in paid employment, only three participants had received specific treatment for their HCV infections. Cost-benefit analysis using a conservative approach showed a ratio of the benefits to the costs of MMT of 8:1. Benefits were demonstrated in terms of large reductions in crime. Benefit to cost ratios were similar for the different policy examined, as well as for both Maori and non-Maori IDUs.

<p>Between April 1997 and November 1999, I followed eight socially excluded female drug users in an attempt to describe their lives and living conditions. The study employs an ethnographic approach with the focus being directed at the specific woman and her life in relation to the social context where this life is lived.</p><p>The study’s objective has been to describe the lives and living conditions of the eight drug-using women, as well as the extent of the opportunities available to them, as being determined by mechanisms of social exclusion. Their lives are understood on the basis of a feminist and social constructionist perspective where perceptions of ‘the drug-abusing woman’ are regarded as the result of constructions of gender and deviance. The theoretical perspectives proceeds from the idea that one is not born a woman but rather becomes one. The fundamental idea is that women become women by means of processes of femininisation, in the context of which certain ways of interpreting and presenting oneself as a woman are regarded as good and others as bad. Our images of ‘the female drug addict’ are based on how we define and interpret deviance and on the cultural and social thought and behaviour patterns we ascribe to people on the basis of bodily differences. It is images of ‘the good woman’ that defines what we regard as characteristic of ‘the bad woman’ and vice versa.</p><p>The findings are organised into three main topics: femininity, living conditions and social control. The main findings are: The women described themselves as women by relating to normative messages about how women “are and should be”, and their drug use constituted a means of coping with life from their social position. Their life revolved to a large extent around money via a constant struggle to find enough to cover the rent, food and other basic necessities. And finally, how the women’s relations to societal institutions were formed by their social position as ‘female drug addicts’ and how the asymmetry of these relations produced certain fixed patterns of action for the parties involved.</p>

Background: Aboriginals are overrepresented in Canada’s HIV epidemic and are more likely to be infected with HIV through injection drug use (IDU) than non-Aboriginals. However, little research has investigated the outcomes of combination antiretroviral therapy (cART) among Aboriginal HIV-patients or compared outcomes between Aboriginal and non-Aboriginal HIV-patients. Objectives: The primary objectives of this research were to 1) compare all-cause and HIV-related mortality rates between Aboriginal and non-Aboriginal HIV-patients after they start cART, 2) determine if Aboriginal patients were less likely to achieve virological suppression and more likely to experience subsequent treatment failure after starting cART; 3) describe and compare the health-related quality of life (HRQL) of Aboriginal and non-Aboriginal HIV-patients; and 4) describe the life stability of Aboriginal and IDU HIV-patients treated with cART and explore associations between life stability, clinical status, and HRQL. Methods: This research was conducted in northern Alberta, Canada using a clinical database, vital statistics data, and data collected through interview and a self-administered HRQL questionnaire. Data analyses included multivariable Cox proportional hazards models and multiple linear and logistic regression models. Results: After starting cART, Aboriginals suffer higher rates of all-cause and HIV-related mortality than non-Aboriginals. Furthermore, Aboriginals are less likely to achieve virological suppression after starting cART and, among those who achieve suppression, Aboriginals experience higher rates of virological failure ≥1 year after suppression. Aboriginal IDUs, Aboriginal non-IDUs, and non-Aboriginal IDUs reported similarly worse physical HRQL compared to non-Aboriginals non-IDUs. Among Aboriginals and IDUs, factors significantly associated with poor clinical status were unemployment, lower income, not completing high school, homelessness, and perceiving that one’s current life was not much better compared to before starting cART. Similarly, factors significantly associated with lower HRQL in this group were unemployment, perceiving that one’s current health or one’s current life was not much better compared to before starting cART, and having a current CD4 cell count ≤350 cells/μL. Conclusions: Overall, after starting cART, Aboriginal HIV-patients suffer worse outcomes than non-Aboriginal HIV-patients. Future research should investigate adherence among Aboriginals and IDUs treated with cART and explore their treatment experiences to develop interventions to improve the prognosis of these vulnerable populations.

Between April 1997 and November 1999, I followed eight socially excluded female drug users in an attempt to describe their lives and living conditions. The study employs an ethnographic approach with the focus being directed at the specific woman and her life in relation to the social context where this life is lived. The study’s objective has been to describe the lives and living conditions of the eight drug-using women, as well as the extent of the opportunities available to them, as being determined by mechanisms of social exclusion. Their lives are understood on the basis of a feminist and social constructionist perspective where perceptions of ‘the drug-abusing woman’ are regarded as the result of constructions of gender and deviance. The theoretical perspectives proceeds from the idea that one is not born a woman but rather becomes one. The fundamental idea is that women become women by means of processes of femininisation, in the context of which certain ways of interpreting and presenting oneself as a woman are regarded as good and others as bad. Our images of ‘the female drug addict’ are based on how we define and interpret deviance and on the cultural and social thought and behaviour patterns we ascribe to people on the basis of bodily differences. It is images of ‘the good woman’ that defines what we regard as characteristic of ‘the bad woman’ and vice versa. The findings are organised into three main topics: femininity, living conditions and social control. The main findings are: The women described themselves as women by relating to normative messages about how women “are and should be”, and their drug use constituted a means of coping with life from their social position. Their life revolved to a large extent around money via a constant struggle to find enough to cover the rent, food and other basic necessities. And finally, how the women’s relations to societal institutions were formed by their social position as ‘female drug addicts’ and how the asymmetry of these relations produced certain fixed patterns of action for the parties involved.

Context & Rationale: Individuals with similar CD4 cell counts and RNA levels can vary considerably with regards to clinical progression. This variation is likely the result of a complex interplay between viral, host and environmental factors. This study aimed to characterize and identify predictors associated with disease progression to AIDS or death in Saskatoon, Saskatchewan. Methods: This is a retrospective cohort study of 343 seroprevalent HIV positive patients diagnosed from Jan 2005 to Dec 2010. Of these, 73 had an estimated seroconversion date. Data was extracted from medical charts at two clinics specialized in HIV/AIDS care. Disease progression was measured as time from HIV diagnosis (or seroconversion) to immunological AIDS and death. The Cox hazard model was used. Results: The 3-year and 5-year immunological AIDS free probability was 53% and 33%, respectively. The 3-year and 5-year survival probability was 89% and 77%, respectively. Among the seroconversion cohort, the 3-year immunological AIDS free probability was 76%. Due to multicollinearity, separate models were built for IDU, hepatitis C and ethnicity. A history of IDU (HR, 3.0; 95%CI, 1.2-7.1), hepatitis C coinfection (HR, 2.9; 95%CI, 1.2-6.9), baseline CD4 counts (HR, 0.95; 95%CI, 0.92-0.98, per ever 10 unit increase), ever on ART, and year of diagnosis were significant predictors of progression to immunological AIDS among the seroprevalent cohort. Age at diagnosis, sex and ethnicity were not. For survival, only treatment use was a significant predictor (HR, 0.34; 95%CI, 0.1-0.8). Hepatitis C coinfection was marginally significant (p=0.067), while a history of IDU, ethnicity, gender, age at diagnosis, and year of diagnosis were not. Among the seroconversion cohort, no predictors of progression to immunological AIDS were identified. Ethnicity, hepatitis C coinfection and history of IDU could not be assessed. Conclusion: Our study found that IDU, HCV coinfections, baseline CD4 counts, and ART use were significant predictors of disease progression. This highlights the need for increased testing and early detection and for targeted interventions for these particularly vulnerable populations to slow disease progression.

The purpose of this study was to compare the delinquent behavior, psychological health, and emotional wellbeing of maltreated and nonmaltreated adolescents in a chemical dependency treatment program. Data were collected over a seven year period from intake interviews and Minnesota Multiphasic Personality Inventory (MMPI) scores of 522 adolescent patients at a chemical dependency treatment program in a Northwest city of about 100,000. The subjects consisted of 220 females and 302 males. Maltreatment was selfreported by 43% of the females and 17% of the males. Results indicated that maltreated, drugaddicted adolescents engaged in significantly more delinquent behavior, including arrests and drugrelated arrests, suicide attempts, runaway behavior and illicit drug use than nonmaltreated adolescents in the program. Results of the MMPI scores revealed that maltreated adolescents scored significantly higher than nonmaltreated adolescents on eight of the ten clinical scales, indicating that maltreated adolescents entered the drug treatment program with higher levels of psychological and emotional distress than did their peers. Analyses run separately for males and females revealed that differences between maltreated and nonmaltreated patients could be accounted for, in large part, by differences between maltreated and nonmaltreated females. Maltreated females, but not males, scored significantly higher on total drug use, and on the Hypochondriasis (Hs), Hysteria (Hy), Psychasthenia (Pt), and Schizophrenia (Sc) scales of the MMPI. The unique needs of maltreated adolescents, in particular maltreated females, in drug treatment programs are discussed. / Graduation date: 1992

Context & Rationale: Individuals with similar CD4 cell counts and RNA levels can vary considerably with regards to clinical progression. This variation is likely the result of a complex interplay between viral, host and environmental factors. This study aimed to characterize and identify predictors associated with disease progression to AIDS or death in Saskatoon, Saskatchewan. Methods: This is a retrospective cohort study of 343 seroprevalent HIV positive patients diagnosed from Jan 2005 to Dec 2010. Of these, 73 had an estimated seroconversion date. Data was extracted from medical charts at two clinics specialized in HIV/AIDS care. Disease progression was measured as time from HIV diagnosis (or seroconversion) to immunological AIDS and death. The Cox hazard model was used. Results: The 3-year and 5-year immunological AIDS free probability was 53% and 33%, respectively. The 3-year and 5-year survival probability was 89% and 77%, respectively. Among the seroconversion cohort, the 3-year immunological AIDS free probability was 76%. Due to multicollinearity, separate models were built for IDU, hepatitis C and ethnicity. A history of IDU (HR, 3.0; 95%CI, 1.2-7.1), hepatitis C coinfection (HR, 2.9; 95%CI, 1.2-6.9), baseline CD4 counts (HR, 0.95; 95%CI, 0.92-0.98, per ever 10 unit increase), ever on ART, and year of diagnosis were significant predictors of progression to immunological AIDS among the seroprevalent cohort. Age at diagnosis, sex and ethnicity were not. For survival, only treatment use was a significant predictor (HR, 0.34; 95%CI, 0.1-0.8). Hepatitis C coinfection was marginally significant (p=0.067), while a history of IDU, ethnicity, gender, age at diagnosis, and year of diagnosis were not. Among the seroconversion cohort, no predictors of progression to immunological AIDS were identified. Ethnicity, hepatitis C coinfection and history of IDU could not be assessed. Conclusion: Our study found that IDU, HCV coinfections, baseline CD4 counts, and ART use were significant predictors of disease progression. This highlights the need for increased testing and early detection and for targeted interventions for these particularly vulnerable populations to slow disease progression.

Research has documented that Episodic Heavy Drinking (EHD), defined as consuming four or more and five or more alcoholic drinks per drinking episode among females and males, respectively, is a prevalent risk behavior among undergraduate college students throughout the United States. Moreover, studies have shown that EHD is the leading cause of preventable morbidity and mortality among college students as unintentional injuries, sexual assaults, and unsafe sexual behaviors among this population have been linked to this risk behavior. Illicit substance use, although often portrayed as a separate risk behavior, is also associated with EHD. Nationally, the most frequently used illicit substance among college students is marijuana. Research suggests that college students who engage in EHD are several times more likely to be current marijuana users or to have used marijuana during their lifetime. Furthermore, EHD has been identified as a predictor of marijuana use and other substances, illicit or otherwise. With regard to this particular investigation, three specific risk behaviors among undergraduate students at Western Kentucky University (WKU) were the primary foci: 1) the prevalence of alcohol use and episodic heavy drinking (EHD), 2) the prevalence of illicit substance use, particularly marijuana use, and 3) concomitant EHD and marijuana use. In addition, WKU students' personal characteristics and certain behaviors were examined to determine their association with alcohol and marijuana use. This study was a secondary analysis of data gathered through the Western Kentucky Student Health Assessment (WKU-SHA 2002)administered during the fall semester of 2002. The WKU-SHA 2002 utilized the American College Health Association's (ACHA) National College Health Assessment (NCHA) survey instrument to investigate overall health status and health risk behaviors of WKU undergraduate students. It used a cross- ectional, random cluster sampling of 100, 200, 300 and 400 level undergraduate classes held on WKU's main campus. Results of this investigation were similar to findings reported in current literature. Seventy-three percent of respondents reported consuming alcohol during the last 30 days. Fortysix percent reported engaging in episodic heavy drinking the last time they "partied" and approximately 20% reported using marijuana during the last 30 days. Episodic heavy drinkers were more likely to report 30-day marijuana use than students who did not engage in EHD. Significant associations were reported between risk behaviors and respondents' characteristics. It is anticipated that the information provided through this investigation may be particularly useful to the planning of future health programs and services designed to address EHD and marijuana use among WKU undergraduate college students.