Both COC and CE show equipotent affinity for specific dopamine transporter sites and inhibition of dopamine reuptake. Each leads to high dopamine concentration in the nucleus accumbens, an area of the limbic system of the brain involved with reinforcement of behaviors (through euphoric emotion) as well as with positive symptoms of schizophrenia (delusions, hallucinations).6 Both have been associated with acute cardiac problems and death, matters of concern for even casual or first time users.7 Each substantially increases blood pressure and heart rate, probably through interfering with action potential of cardiac cells through blocking sodium channels. However, CE's effect is even more pronounced. Studies in dogs comparing cardiac functions altered by CE vs. COC found decreased cardiac output (34% vs. 26%) with even faster heart rate (85 beats/min vs. 56 beats/min).8 The danger for cardiac problems is compounded.

Other problems arise with concurrent use. Alcohol plus COC seems to be more destructive on the immune system than COC alone9 and more than ten times as damaging to liver cells.10 In animals, the lethal dose of CE when administered with ETOH was about half the necessary amount for lethality as when CE was administered alone11. In mice, the concurrent use has been found to produce 2- to 4-fold increases of benzoylecgonine (BE), another COC metabolite which is more potent than COC in producing seizures.12 This metabolite (BE) was also shown to cause retraction of cell processes in laboratory cultured cells (which model neuronal and glial cells of the brain) in as little as 15-30 minutes and produced cell death in six hours with concentrations near what has been measured in fetal blood and brain tissue after maternal use of COC.13 The fact that CE leads to decreased cerebral blood flow (26%), and thus slower clearing from the tissue as well as decreased cerebral oxygen metabolism (26%), puts the developing fetus at great risk for hypoxia as well as prolonged exposure to these substances.14

In summary, it appears that cocaine plus alcohol produces a metabolite (cocaethylene) that is significantly more toxic than COC on the heart, liver, and brain. It has been found to bring an 18- to 25-fold increase over COC alone in risk for immediate death15 and poses a significant threat to life, even though it is associated with prolonged and enhanced euphoria by drug users.

Paul Andrews, Ph.D.
Clinical Psychologist
Tyler, Texas

1. McCance E, Price L, Kosten T, Jatlow P. Cocaethylene: pharmacology, physiology and behavioral effects in humans. J Pharmacol Exp Ther. 1995; 274:215-223.
2. Jatlow P. Cocaethylene: pharmacologic activity and clinical significance. The Drug Monit. 1993; 15:533-536.
3. Schechter M. Cocaethylene produces discriminative stimulus properties in the rat: effect of cocaine and ethanol coadministration. Pharmacol Biochem Behav. 1994; 51:285-289.
4. Lewis MJ, June HL. Synergistic effects of ethanol and cocaine on brain stimulation reward. J Exp Anal Behav. 1994; 61:223-229.
5. Pirwitz M, Willard J, Landau C, Lange R, Glamann B, Kessler D, Foerster E, Todd E, Hillis D. Influence of cocaine, ethanol, or their combinations on epicardial coronary arterial dimensions in humans. Arch Intern Med. 1995; 155:1186-1191.
6. McCane E, Price L, Kosten T, Jatlow P. Cocaethylene: pharmacology, physiology and behavioral effects in humans. J. Pharmacol Exp Ther. 1995; 274:215-223.
7. Farre M, de la Torre R, Llorente M, Lamas X, Ugenda B, Segura J, Cami J. Alcohol and cocaine interactions in humans. J Pharmacol Exp Ther. 1993; 266:1364-1373. Perwitz M, Willard J, Landau C, Lange R, Glamann B, Kessler D, Foerster E, Todd E, Hillis D. Influence of cocaine, ethanol, or their combinations on epicardial coronary arterial dimensions in humans. Arch Intern Med. 1995; 155:1186-1191.
8. Henning R, Wilson L, Glauser J, Lavins E, Sebrosky G, Sutheimer C. Cocaine plus ethanol is more cardiotoxic than cocaine or ethanol alone. Crit Care Med. 1994; 22:1896-1906.
9. Pirozhkov SV, Watson RR, Chen GJ. Ethanol enhances immunosuppression induced by cocaine. Alcohol. 1993; 2:75-82.
10. Landry M. An overview of cocaethylene, an alcohol-derived, psychoactive, cocaine metabolite. J Psychoactive Drugs. 1992; 24:273-276.
11. Meehan S, Schechter M. Cocaethylene-induced lethality in mice is potentiated by alcohol. Alcohol. 1995; 12:383-385.
12. Roberts S, Phillips D, Tebbett I. Increased blood and brain cocaine concentrations with ethanol cotreatment in mice. Drug Metab Dispos Biol Fate Chem. 1995; 23:664-666.
13. Lin Y, Leskawa K. Cytotoxicity of the cocaine metabolite benzoylecgonine. Brain Res. 1994; 643:108-114.
14. Albuquerque M, Kurth CD, Monitto C, Shaw L, Anday E. Ethanol, morphine and barbiturate alter the hemodynamic and cerebral response to cocaine in newborn pigs. Biol Neonate. 1995; 67:432-440.
15. Xu Y-Q, Crumb W, Clarkson C. Cocaethylene, a metabolite of cocaine and ethanol, is a potent blocker of cardiac sodium channels. J Pharmacol Exp Ther. 1994; 271:319-325

Gleaned from the existing research, most studies of incarcerated populations have found lower levels of drinking for women than men, but more similar levels of drug use.2 For example, in a 1991 survey of state prison inmates, daily drinking was higher for men (29%) than women (19%) during the year before their current offense.3 A 1989 survey of jail inmates found that 44% of the men, but only 21% of the women, reported being under the influence of alcohol at the time of their current offense.4 In contrast, a slightly higher proportion of women than men committed their offense under the influence of drugs. In the 1991 survey of state prison inmates, 31% of the men and 36% of the women reported being under the influence of drugs at the time of their current offense-an increased relationship from 1986 when more men (36%) than women (34%) used drugs when committing offenses.5 Similarly, drug use in the month before the offense was higher for women (54%) than men (50%) in prison- also a change from 1986 where more men (56%) than women (50%) used drugs in the month before the offense. Despite the fact that these differences are not well understood, women have not been a focus of research.

Several reasons may account for the lack of emphasis on women, including sample selection. Women committing criminal offenses, particularly violent offenses, is a rare phenomenon in the general population; thus general population samples are costly and not practical to collect. Instead, data on prison populations are most often used, but such samples are over-represented by individuals with the most serious crimes or the longest criminal histories. Women are not as well represented by such crimes and are also less likely than men to go to prison. Therefore, women represented only 5% of the national inmate population in 1991. This investigation of women and crime, with particular attention to violence, took another approach; one that is more narrow than a general population frame but more inclusive than a prison population. The focus here is on individuals whose behavior has come to the attention of the criminal justice system-those who have been arrested and are been booked in a county jail. This study examines differences between men and women in the relationship between sociodemographic characteristics, alcohol use, drug use, and criminal behavior, with an emphasis on violence.

Source of Data

This data was derived from the Alcohol Research Group Community Epidemiology Laboratory (CEL). The CEL consists of probability samples of health and social service agencies and the general population in a northern California county. In this sample, individuals were consecutively sampled at the point of booking at the county jail over a period of 15 weeks between January and May 1989. There were 7,603 bookings recorded in the jail log during the study period. Fieldwork was carried out 24 hours a day, 7 days a week, during the study period.

1. The sampling procedure grouped booking into violent and non-violent categories, using offense categories entered on the official booking log.
2. Of the 1,594 eligible intakes, 72% of the interviews were completed (n=1,147). The response rate for both strata were similar, i.e., 72.4% for the violent and 71.9% for the non-violent.
3. The interviews consisted of a one hour structured survey instrument administered in a jail by trained interviewers, not affiliated with the criminal justice system.

Drinking measures were based on quantity-frequency of drinking over the previous 12 months. Drug use in the past year was measured by any use of drugs not medically prescribed.

Results

1. Differences noted in this sample of arrestees between men and women in demographic, drinking patterns, and criminal behavior measurements revealed that women were older, more often separated or divorced, unemployed, and had lower income than men.
2. Surprisingly, there were no significant gender differences in drug use. A high proportion of women in the sample report drug use related to the offense for which they were arrested, compared to the men.
3. While the arrested men had higher rates of problem drinking than men in the general population, the differences for women are even more striking.
4. When violent offenses were analyzed, more men than women were charged with a violent offense or reported being violent in the course of the event leading to arrest. However, when other demographic characteristics, frequent heavy drinking, and weekly drug use were controlled, gender was not significant. These findings suggest that the relationship between drinking and violence is stronger than gender differences.

Maria Nunes-Dinis, MSW, Ph.D.
Assistant Professor Department of Social Work
Augsburg College
Minneapolis, MN

Editor's Note: For more complete analysis of this report, please see "Gender Differences in the Relationship of Alcohol and Drug Use to Criminal Behavior in a Sample of Arrestees," American Journal of Drug Alcohol Abuse. 1997; 21(1):129-141.

1. US Department of Justice. Uniform Crime Report (1988) in the United States. Federal Bureau of Investigation, US Government Printing Office, Washington, DC, 1989.
2. Bureau of Justice Statistics. Criminal Victimization in the United States, 1988: A National Crime Survey Report. US Department of Justice, Washington, DC, 1990.
3. Steffenmeier, D.J. Sex differences in patterns of adult crime; 1965-77: a review and assessment. Social Forces. 1980; 58(4):1080-1108.
4. Bureau of Justice Statistics. Special Report: Women in Jail: 1989. US Department of Justice, Washington, DC, 1992. Bureau of Justice. Drugs and Jail Inmates, 1989. US Department of Justice, Washington, DC, 1991.
5. Rozien, J. Alcohol and violence: an evaluation from epidemiological research. IN The Working Group on Alcohol-Related Violence: Fostering Interdisciplinary Perspectives. National Institute on Alcohol Abuse and Alcoholism, Washington, DC, May 14-15, 1992.

Balancing emerged as the core concept, a process that explained how women successfully integrated the recovery and motherhood processes into their recovery. The women used strategies learned in the process of alcohol/drug recovery to balance between alcohol/drug recovery and motherhood. A part of balancing was the use of the protecting strategy in unique ways during pregnancy and early parenting to safeguard both recovery and motherhood. The transitions of pregnancy, child birth through 3 months, and 4 to 11 months were pivotal points for mothers. During these three time periods, women were identified using different aspects of the protecting strategy. Understanding concepts and processes associated with the concurrent experience of recovery and parenthood will be useful to all disciplines that seek to improve the health of mothers, infants and families.

This study demonstrates the complexity of the women's experiences and the unique needs of women making the transition to motherhood while in alcohol/drug recovery. Results indicated that the unique needs of women need careful consideration or program planning, policy, clinical practice, and research. Future studies may investigate how women cope with starting an alcohol/drug recovery program during pregnancy and early parenting as well as further refine relapse prevention for this population.

Ingrid Brudenell, R.N., Ph.D.
Department of Nursing Boise State University
Boise, Idaho

Editor's Note: A complete research report of this study may be found in "A Grounded Theory of Protecting Recovery during Transition to Motherhood," American Journal of Drug and Alcohol Abuse. 1997; 23(3):453-466.

Dr. Lohr is a native North Carolinian who completed his undergraduate medical education at the University of North Carolina at Chapel Hill. Following his pediatric residency training at the University of Virginia, he remained in Charlottesville as a faculty member in the Department of Pediatrics.

At UVA, Dr. Lohr became Associate Chairman of Pediatrics and published extensively in the field of primary care. He was also involved in the Aid to Impaired Medical Student Program (AIMS) and principal investigator on a NIDA grant to develop a generalist substance abuse curricula for medical students. In 1990, he received a NIAAA/NIDA Faculty Development Grant, but before the grant could begin he returned to the University of North Carolina at Chapel Hill.

Since 1990, Dr. Lohr has been Professor and Vice Chair of the Department of Pediatrics at University of North Carolina School of Medicine. Because of his substance abuse curriculum experience at UVA, Dr. Lohr was selected to head the Governor's Institute Kate B. Reynolds Health Care Trust grant which resulted in the integration of addiction medicine curricula into the state's four medical schools and the UNC School of Dentistry.

One of the major challenges of the Institute in the coming years is finding new ways to encourage health practitioners throughout the state to become involved in the early diagnosis and intervention in addictive diseases. The Institute anticipates that managed care's emphasis on prevention might open the door for regular screening during periodic physical examinations for smoking, problem drinking and drug abuse. Our new Executive Director is well positioned to lead this effort.

Michael F. Durfee, M.D., M.P.H.
North Carolina State University
Chair, Board of Directors Search Committee

Dr. Hoban has a doctorate in education from Indiana University. He is an Associate Professor of Medical Education at the Wake Forest University School of Medicine serving as the Director of the Office of Educational Research and Services since 1978. He was a Faculty Fellow for the Governor's Institute Kate B. Reynolds Curriculum Project from 1992-1996 and Co-Investigator, of the Bowman Gray Medical Center's NIAAA/NIDA Faculty Development Fellowship in Substance Abuse from 1990-1995. He is currently president-elect of the North Carolina Association for Research in Education. He has published extensively on educational research and evaluation.

With the addition of a director of research, the Institute will be able to better integrate its student and young faculty development research awards programs with the activities of faculty at our universities, research institutes and state agencies.

Mary E. Powell, M.H.A.
Associate Director, Governor's Institute

The North Carolina Addiction Technology Transfer Center page is dedicated to the relationship between the substance abuse field and higher education. It's mission is to provide information and resources for learners, educators, institutions and other interested individuals.

The North Carolina Initiative to Reduce Underage Drinking web page designed by Anthony McLeod now features a monthly web-zine, with updates about statewide activities and national news stories about underage drinking. The page is accessible via national search engines such as Alta Vista and Yahoo.

North Carolina Initiative to Reduce Underage Drinking
After a nine-month strategic planning process last year, Initiative coalition members are promoting two policy solutions in 1998 that they believe will reduce underage drinking: development of a keg registration program to reduce youth access to beer kegs, and closure of the legal loop hole that makes the penalty for purchasing beer more lenient for 19- and 20-year-olds than for younger teens. Several state legislators have stepped forward to promote these policy solutions in the General Assembly this year.

SAFE Prevention Coalition Conference
Substance Abuse-Free Families and Environments (SAFE) Prevention Coalition, funded by the Center for Substance Abuse Prevention (CSAP), is hosting a conference on April 30, 1998 at the North Raleigh Hilton. The goal of the conference is to raise the awareness in Wake County about the importance of coordinating a plan among community agencies to prevent, intervene, refer or treat alcohol, tobacco and other drug problems of youth and their families.

Public Policy Scholars Forum
The Public Policy Scholars Forum will be May 26 from 5:00-7:00 p.m. at the North Carolina Museum of History in Raleigh. During the 1997-1998 academic year, five graduate students were given public policy research awards to conduct individual substance abuse projects. At the Forum, these scholars will relate their findings and associated policy recommendations.

lst Annual N.C. Substance Abuse Research Symposium
The North Carolina Research Consortium and the Governor's Institute will be sponsoring a research symposium on June 2, 1998 from 10-3 p.m. The program will feature 1997 Young Investigator Award recipients and other researchers from across the state will be presenting papers describing their work. To get more information, call 919-990-9559.

2nd Annual Mid-Atlantic ATTC Educators Conference
The Mid-Atlantic Addiction Technology Transfer Center Addiction Educators Conference is a forum in which substance abuse educators from Maryland, North Carolina and Virginia can learn about current issues and resources in addiction education. It is an opportunity to learn about creating or improving addiction education programs and network with colleagues from across the tri-state region. The program is scheduled for September 24-25, 1998 at the Hyatt Brookfield in Richmond, Virginia.

New Statewide Conference Date
The Governor's Institute statewide conference is scheduled for February 25-26, 1999 in Greensboro. The program will continue the focus on advancing substance abuse treatment by applying current research.

The Prevention For The 90s Conference: The Next Step for Youth
May 5-8
1998 Adam's Mark Hotel
Winston-Salem, N.C.
Sponsored by the Step One, Inc.

Alcohol, tobacco, and the drug (ATOD) prevention programming is currently seen as an integral component within the continuum of care specific to substance abuse issues. It has been proven that sound, scientifically based prevention programming works to reduce the use and abuse of substances. The 1998 "Prevention For The 90s" Conference is an excellent opportunity for both professionals and lay people to research new and proven programming and to share it with local communities. This conference is supported by the N.C. Deptartment of Health and Human Services, Division of MD/DD/SAS and the N.C. Department of Public Instruction, Safe and Drug-Free Schools Section. For registration information, contact Sandy Smith, (336) 725-8389. For any other general information contact Jilma Shackleford (919) 733-0696.

Narcotic Use, Addiction and Treatment: Trends of the 1990s and Implications for the New Millennium June 15-16
1998 Sheraton Imperial Hotel and Conference Center
Research Triangle Park, N.C.
Sponsored by North Carolina Department of Health and Human Services, Substance Abuse Services Section, in conjunction with the University of North Carolina at Chapel Hill School of Public Health Office of Continuing Education and Dorothea Dix Hospital. For more information call (919)966-4032 or e-mail: oce@unc.edu

The idea behind the proposal was to bring researchers together from pharmacology, psychiatry, cell biology and anatomy and medicine to try to understand the key steps in alcohol-related disease. Researchers will be using modern molecular techniques, gene delivery and imaging to attack all of the pathologies of alcoholism.

The grant will fund six research projects. Researchers will identify common cellular patterns using techniques developed in fields such as psychiatry, pharmacology, physiology and anatomy.

Three projects will focus on different aspects of the brain, particularly what is involved in the development, progression and sustaining aspects of alcohol dependence. Researchers will use gene delivery to test what causes alcohol dependence studying what parts of the brain are important for the negative consequences of drinking, and determining the mechanism of tolerance of alcohol.

In addition, two research teams will study the genes involved in alcohol-related liver disease. Since it takes about 15 years for cirrhosis of the liver to develop in humans, scientists believe that in the future, gene delivery may effectively prevent it.

The sixth project will center on fetal alcohol syndrome, a group of birth defects that include slow growth before and after birth, deficient intellectual and social performance often associated with juvenile delinquency, and a consistent pattern of minor facial abnormalities. The studies will use modern molecular approaches.

Faculty members who will work on the new federal grant include Drs. George R. Breese, David A. Brenner, Fulton Crews, John J. Lemasters, A. Leslie Morrow, David H. Overstreet, Richard A. Rippe, Richard Jude Samulski, Kathleen K. Sulik and Ronald G. Thurman.

The Bowles Center for Alcohol Studies was established in 1970 by the North Carolina General Assembly. The center's mandate is to conduct, coordinate and promote basic and clinical research on the cause, prevention and treatment of alcoholism and alcohol abuse.

Fulton Crews, Ph.D.
Director, Bowles Center for Alcohol Studies
University of North Carolina-Chapel Hill
Chapel Hill, North Carolina