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Many of the papers in this theme issue originated as presentations at a conference entitled "Reflections on 40 Years of Drug Abuse Research." At the conference, leaders in the drug abuse field presented their work, as well as their visions and concerns for the future of drug abuse research, and many of those presentations are included as papers in this issue of the Journal of Drug Issues. At the end of the conference, and after hearing presentations from senior researchers in the field, several mid-career investigators were invited to reflect on the conference and on the field of drug abuse research at this time in its history. This brief article offers reactions to the conference, in terms of its meaning for the future of drug abuse research.

Since the first drug court in Miami in 1989, the drug court movement has spread throughout the United States, influencing how drug-involved offenders are treated in the criminal justice system. This paper reports on an outcome evaluation of a drug court in San Mateo County, California. Arrest rates were compared for drug court participants (N=618) and nonparticipants (N=75), and for graduates (N=257) and nongraduates (N=361). Factors associated with rearrest were assessed for participants in both groups. During a two-year follow-up period, there were no significant differences in rearrest rates between the participant and non-participant groups. Comparisons between graduates and nongraduates showed lower rearrest rates for graduates (19% vs. 53%, χ2(1)=73.5, p< 0.01). In a model including participants and nonparticipants, only a prior history of conviction predicted an increased likelihood of rearrest whereas being female and older decreased the likelihood of rearrest. In addition, among drug court participants only, graduating decreased the likelihood of rearrest.

This paper presents a cohort study of injection drug users (n=229) who did and did not use syringe exchange in San Francisco in 1993. Participants were interviewed at baseline, six months (49%), and 12 months (57%). At baseline, exchangers were less likely than nonexchangers to share syringes (21% vs. 37%), have multiple sharing partners (7% vs. 19%), and reuse their syringes (73% vs. 90%). These differences persisted in multivariate analysis adjusting for gender, age, race, education, and injection frequency. For the subset of participants who provided data at all three time points (n=101), rates of syringe sharing, syringe reuse, and indirect sharing decreased over time for both exchangers and nonexchangers. Nonetheless, levels of indirect sharing remained high among exchangers in this study (>45%) and decreased significantly less than nonexchanger levels over time. The implications of these Findings for syringe exchange programs and research are discussed.

This report describes the development and measurement characteristics of a new measure of smoking knowledge, attitudes, and practices (S-KAP) among treatment providers. Data are based on survey responses from 336 paid staff working in one of three drug abuse treatment or HIV care settings. Exploratory factor analysis, used to examine the factor structure, pointed towards five underlying factors: a single "knowledge" factor, three "attitude" factors ('treatment barriers,' 'counselor self-efficacy,' and 'counselor attitudes') and a single "practices" factor. The Knowledge scale had a standardized Cronbach's alpha coefficient of .85. The coefficients for Barriers, Self-Efficacy, and Attitudes were .81, .72, and .74, respectively. The Practice scale had a standardized Cronbach's alpha coefficient of .91. These results indicate that the proposed scales have reasonably good psychometric characteristics and will allow researchers to quantify staff knowledge, attitudes, and practices regarding smoking cessation treatments and issues.

This study investigated whether organizational changes occurred when nicotine treatments were tested in specialty care clinics. Two intervention clinics (one drug treatment and one HIV-care) participated in clinical trials for nicotine treatment. Three clinics (two drug and one HIV-care) were control clinics. Staff in the intervention clinics (n=57) and in the control clinics (n=62) were surveyed at baseline and 18 months later. Staff surveys concerned nicotine-related knowledge, beliefs about treating smoking, self-efficacy in delivering such treatment, nicotine related practices, and barriers to providing nicotine treatment. Mean scale scores at 18 months were no different in clinics participating in the clinical trials from the control group for any of the five scales (knowledge, practices, barriers, efficacy and beliefs). The presence of a smoking cessation clinical trial did not influence staff knowledge, attitudes, or practices related to smoking in these clinics. More specific organizational intervention may influence staff practices related to addressing smoking among clients in drug treatment and HIV-care clinics.

This paper describes the demographic and drug use characteristics, and levels of HIV-related risk behavior, for a sample of injection drug users (N=50) participating in the San Francisco needle exchange program. Exchange patrons were recruited as they approached the street-based exchange program, and were interviewed immediately to minimize drop-out. Clients reported high levels of satisfaction with exchange services, and many reported decreasing HIV risk behavior since participating in the exchange. Regular participation in the exchange was associated with lower levels of HIV risk behavior, but number of months since first visiting the exchange was not. Participation in needle exchange may negatively impact drug use behavior for a small minority of clients, and this issue warrants further study.

The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) was established in 1999 to determine effectiveness of drug abuse treatment interventions among diverse client populations and settings. To address dissemination of research findings, the CTN also has as its mission the transfer of research findings to treatment providers. In a qualitative study of adoption of evidence-based practice in the context of two CTN clinical trials, we interviewed 29 participants from seven organizational levels of the multisite study organization about post-trial adoption, their role in the clinical trial, and interactions between the research initiative and clinic staff and setting. Analysis of interview data revealed a range of opinion among participants on the place of adoption within the CTN. Innovation within the CTN to support adoption and further observational research on dynamics of adoption within the CTN can increase dissemination of evidence-based drug abuse treatment interventions in the future.

We compared overall treatment satisfaction and helpfulness of treatment components for 216 clients randomly assigned to day versus residential treatment. Baseline interviews were conducted near admission using the Addiction Severity Index, Beck Depression Inventory, Symptom Check-list-90-R, and a social support measure. Follow-up interviews occurred 6 months later with these instruments plus a client satisfaction measure. Clients in both day and residential treatment were highly satisfied with overall services and most treatment components. Satisfaction scores were high and did not differ between modalities; however, mental health services were less helpful to day treatment clients, and more day treatment clients indicated not receiving certain treatment components. Client satisfaction correlated with treatment retention and several baseline and 6-month severity outcomes. These findings indicate day treatment may be as satisfying to clients as residential treatment, and give credence to the idea that client satisfaction assessment should be routine in outcome evaluations of drug abuse treatment.

Graphic warning labels (GWLs) on cigarette packs have been tested among diverse groups at high risk for tobacco use. However, little is known about the effectiveness of GWL interventions for persons with substance use disorders, whose smoking prevalence is 3 to 4 times that of the general population. After a experimental study which exposed clients in residential addiction treatment to GWLs for 30 days, we conducted five focus groups with trial participants ( N = 33) to explore how exposure to the labels may have impacted their readiness to quit smoking. Focus group interviews were analyzed thematically. Interviewees reported that GWLs were more effective than text-based warnings for increasing quit intentions due to greater cognitive and emotional impact. Male and female interviewees expressed gender-specific reactions to the labels. Addiction treatment programs are a strategic site for GWL and other tobacco interventions due to the tobacco-vulnerable populations they serve.

ObjectiveThe aim of this study is to assess the level of protection of secondhand smoke in outdoor locations among countries belonging to the WHO European Region.MethodThis cross-sectional study measures the level of protection provided by laws in outdoor locations. A protocol to evaluate the outdoor smoke-free legislation was developed according to the recommendations provided by the WHO Guidelines for implementing smoke-free outdoor places. For each law 6 main sectors and 28 outdoor locations were evaluated.Results68 laws from 48 countries were reviewed, totally assessing 1758 locations. Overall 3.1% of the locations specified 100% smoke-free outdoor regulation without exceptions, 2.5% permitted smoking in designated outdoor areas, 37.5% allowed smoking everywhere, and 56.9% did not provide information about how to deal with smoking in outdoor places. In the Education sector 17.8% of the laws specified smoke-free outdoor regulation, mainly in the primary and secondary schools. Three pioneering laws from recreational locations and two from general health facilities specified 100% outdoor smoke-free regulation.ConclusionOutdoor smoke-free policies among countries belonging to the WHO European Region are limited and mainly have been passed in the primary and secondary schools, which protect minors from the hazards of secondhand smoke in educational settings.

This study examined smoking-related knowledge, beliefs, self-efficacy, smoking cessation practices, and barriers to providing smoking cessation services in a workforce sample. The 11 participating clinics (N=335 staff) included substance abuse treatment and HIV care clinics categorized into three types: Veterans Affairs Medical Center (VAMC) clinics, hospital-based clinics, and community-based clinics. Staff in both VAMC and hospital-based settings shared characteristics that may predict smoking-related knowledge, beliefs, and practices (higher education level, low smoking rates, fewer staff in recovery, and location in hospital-affiliated environments where there was greater emphasis on physical health). However, staff in VAMC settings outperformed those in both hospital-based and community-based clinic settings on measures of smoking-related knowledge, beliefs, self-efficacy, and practices. Well-developed procedures to support VAMC clinicians in addressing smoking may account for these findings. Findings suggest that both reductions in staff smoking, and development and implementation of smoking policy are needed to support staff in better addressing nicotine dependence in community-based treatment settings.

The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) is intended to test promising drug abuse treatment models in multisite clinical trials and to support adoption of new interventions into clinical practice. Using qualitative research methods we asked the following question: how might the technology of multisite clinical trials be modified to better support adoption of tested interventions? A total of 42 participants, representing eight organizational levels ranging from clinic staff to clinical trial leaders, were interviewed about their role in the clinical trial, its interactions with clinics, and intervention adoption. Among eight clinics participating in the clinical trial, we found adoption of the tested intervention in one clinic only. Analysis of interview data revealed four conceptual themes likely to affect adoption and may be informative in future multisite clinical trials. Planning for adoption in the early stages of protocol development will better serve the aim of integrating new interventions into practice.