AIM: Failure to disclose cocaine use can have a negative impact on medical care and research validity. This study was performed to identify predictors of cocaine non-disclosure among individuals who self-reported heroin use during a medical care encounter. DESIGN: A prospective comparison of self-report of cocaine use among heroin users and hair analysis for cocaine. SETTING: Four health-care clinics at an academic, inner-city hospital. PARTICIPANTS: Patients presenting for a health-care visit who were willing to self-report use of heroin and were not engaged in any form of drug treatment. MEASUREMENTS: (1) Self-report using standardized instruments: the Drug Addiction Severity Test (DAST), the Addiction Severity Index (ASI) and quantity/frequency questions for heroin and cocaine use. (2) Biochemical evidence: analysis of hair by radioimmunoassay (RIA) for cocaine and opiate levels. FINDINGS: Among 336 heroin users who tested positive for cocaine in hair, 34.2% did not report their recent cocaine use. The mean cocaine level for discordant individuals was significantly lower than for concordant individuals (109.6 ng/10 mg versus 470.57 ng/10 mg; P < 0.0001). Multivariate predictors of disclosure included opiate and cocaine levels in hair and the ASI drug severity subscore. CONCLUSIONS: Although self-report has been validated for treatment system patients, almost a third of the out-of-treatment heroin users in this medical clinic study failed to disclose concomitant cocaine use. The likelihood of non-disclosure was greatest for heavy users of heroin and light users of cocaine. Confirmation of self-report with biochemical analysis in the medical setting may be necessary to improve both clinical care and research validity.
AIM: Failure to disclose cocaine use can have a negative impact on medical care and research validity. This study was performed to identify predictors of cocaine non-disclosure among individuals who self-reported heroin use during a medical care encounter. DESIGN: A prospective comparison of self-report of cocaine use among heroin users and hair analysis for cocaine. SETTING: Four health-care clinics at an academic, inner-city hospital. PARTICIPANTS: Patients presenting for a health-care visit who were willing to self-report use of heroin and were not engaged in any form of drug treatment. MEASUREMENTS: (1) Self-report using standardized instruments: the Drug Addiction Severity Test (DAST), the Addiction Severity Index (ASI) and quantity/frequency questions for heroin and cocaine use. (2) Biochemical evidence: analysis of hair by radioimmunoassay (RIA) for cocaine and opiate levels. FINDINGS: Among 336 heroin users who tested positive for cocaine in hair, 34.2% did not report their recent cocaine use. The mean cocaine level for discordant individuals was significantly lower than for concordant individuals (109.6 ng/10 mg versus 470.57 ng/10 mg; P < 0.0001). Multivariate predictors of disclosure included opiate and cocaine levels in hair and the ASI drug severity subscore. CONCLUSIONS: Although self-report has been validated for treatment system patients, almost a third of the out-of-treatment heroin users in this medical clinic study failed to disclose concomitant cocaine use. The likelihood of non-disclosure was greatest for heavy users of heroin and light users of cocaine. Confirmation of self-report with biochemical analysis in the medical setting may be necessary to improve both clinical care and research validity.
Authors: M J Reinhard; C H Hinkin; T R Barclay; A J Levine; S Marion; S A Castellon; D Longshore; T Newton; R S Durvasula; M N Lam; H Myers Journal: Addict Behav Date: 2007-04-14 Impact factor: 3.913
Authors: Elin Lehrmann; Zoan R Afanador; Amy Deep-Soboslay; Gloria Gallegos; William D Darwin; Ross H Lowe; Allan J Barnes; Marilyn A Huestis; Jean L Cadet; Mary M Herman; Thomas M Hyde; Joel E Kleinman; William J Freed Journal: Addict Biol Date: 2008-01-14 Impact factor: 4.280
Authors: Charles H Hinkin; Terry R Barclay; Steven A Castellon; Andrew J Levine; Ramani S Durvasula; Sarah D Marion; Hector F Myers; Douglas Longshore Journal: AIDS Behav Date: 2007-03
Authors: Jose Carlo Hojilla; Derek D Satre; David V Glidden; Vanessa M McMahan; Monica Gandhi; Patricia Defechereux; Juan V Guanira; Megha Mehrotra; Robert M Grant; Adam W Carrico Journal: J Acquir Immune Defic Syndr Date: 2019-05-01 Impact factor: 3.731
Authors: Jan Gryczynski; Robert P Schwartz; Shannon Gwin Mitchell; Kevin E O'Grady; Steven J Ondersma Journal: Drug Alcohol Depend Date: 2014-05-17 Impact factor: 4.492
Authors: David M Ledgerwood; Bruce A Goldberger; Nathan K Risk; Collins E Lewis; Rumi Kato Price Journal: Addict Behav Date: 2008-05-08 Impact factor: 3.913