bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of the Teen Addiction Severity Index (T‐ASI)
Authors: Kaminer Yifrah , Wagner Eric , Plummer Barry , Seifer Ronald
Published: February 2010

The Teen Addiction Severity Index (T‐ASI) is a semistructured interview that was developed to fill the need for a reliable, valid, and standardized instrument for periodic evaluation of adolescent substance abuse. A preliminary study indicated good clinical utility and satisfactory interrater reliability. This study had three objectives: 1) to determine whether the T‐ASI discriminated between hospitalized psychiatric patients with and without comorbid psychoactive substance use disorders (PSUD); 2) to determine whether T‐ASI scores were related to other indices of problem behavior; and, 3) to determine whether there was any specificity in the ratings of different domains of the instrument when compared with other criteria. The results of the study provide support for the good psychometric properties of the T‐ASI.
A Placebo‐Controlled Elimination Study to Identify Potential Treatment Agents for Cocaine Detoxification
Authors: Tennant Forest , Sagherian Anita Tarver Artin , Loveland David B.
Published: February 2010

This open‐label study was done to determine which of several recommended agents and rationales may be effective for outpatient detoxification of cocaine dependence. A total of 324 cocaine‐dependent persons were sequentially assigned to subgroups of 8–23 subjects and detoxified with 20 different treatment agents. Subjects who received each treatment agent were compared to a control group of 18 subjects who received only placebo and amino acids. Fourteen of the 20 agents (70%) appeared inappropriate for outpatient cocaine detoxification because they demonstrated intolerable side effects, a first‐week drop‐out rate over 40%, or failed to reduce urine cocaine metabolite concentrations. Cocaine use appeared to increase with bromocriptine mesylate, levodopa, and phenmetrazine hydrochloride, since mean cocaine urine concentration increased during treatment. Although no agent was statistically superior in performance to the placebo (control) group on any evaluation criterion, amantadine hydrochloride, bupropion hydrochloride, mazindol, nifedipine, pentoxifylline, and prazosin hydrochloride did not demonstrate any obvious liabilities and warrant further study as outpatient cocaine detoxification agents.
Psychiatric Disorders Among American Indian vs. Other Patients With Psychoactive Substance Use Disorders
Authors: Westermeyer Joe
Published: February 2010

In this study 100 American Indian (AI) patients and 200 non‐AI patients with a psychoactive substance use disorder (PSUD) were studied with special reference to associated psychiatric disorders. Current Axis I diagnoses, previous psychiatric treatment, and family history of psychiatric disorder were compared among these two groups. AI patients from a university hospital clinical population had excess numbers of organic mental disorder (OMD), including both acute OMD (i.e., delirium tremens and alcoholic hallucinosis) and chronic OMD (i.e., alcohol amnestic disorder, alcohol dementia, and trauma‐induced OMD). Overall, “dual diagnosis” was more frequent among the AI patients, due primarily to the excess incidence of OMD. The rate of other psychiatric diagnoses was comparable between the two groups. Within the non‐OMD psychiatric diagnoses, a few differences did occur. AI patients manifested increased anxiety disorders, whereas non‐AI patients had increased eating disorders. Previous psychiatric treatment and family history of psychiatric disorder did not differ between AI and non‐AI patients. Treatment implications are based on these data combined with reports from the literature.
Smoking and Schizophrenic Psychopathology
Authors: Chiles John A. , Cohen Seth , Maiuro Roland , Wright Robert
Published: February 2010

Individuals with schizophrenia use cigarettes at a rate significantly above that of the general population. A variety of explanations for this phenomenon are available, with none taking precedence. In this study the authors examined 80 schizophrenic individuals in an intensive community support program. Eighty‐eight percent are current smokers and smoking is significantly associated with overall psychopathology. When demographic variables are controlled, smoking does not contribute to medication use or tardive dsykinesia as inferred from the Abnormal Involuntary Movement Scale. These results, although confirming some findings in the literature, underscore the importance of controlling for demographic variables, especially age, when analyzing for possible effects of smoking on schizophrenia.
Problems in Implementing an AIDS Prevention Program for Injecting Drug Users
Authors: Vogtsberger Kenneth N. , Desmond David P. , Maddux James F.
Published: February 2010

The authors present the design and implementation of an AIDS prevention program of information and counseling for injecting drug users (IDUs). Outreach worker attrition has been a major problem. IDUs tend to drop out of the intervention; they do not seek HIV antibody test results and reject drug treatment referrals.
The Use of Clonazepam for Alprazolam Withdrawal: Clinical Observations of Six Methadone‐Maintained Patients
Authors: Wilens Timothy E. , Herzog Laura , Renner John A.
Published: February 2010

Alprazolam (Xanax) is commonly abused by patients in methadone maintenance treatment. The authors describe six alprazolam‐dependent patients receiving methadone (mean ± SD, dose = 8.2 ± 3.7 mg/day) who were safely detoxified as inpatients using a clonazepam (Klonopin) substitution and taper. After a 3‐day stabilization period, patients were tapered at a rate of 1.0 mg/day of clonazepam for an average duration of 8.3 ± 1.5 days. There were no subjective or objective withdrawal symptoms throughout this period. This preliminary report indicates that the use of clonazepam for alprazolam detoxification may be a safe and effective method for patients receiving methadone and therefore warrants further investigation.
The Nosology of Adolescent Substance Abuse
Authors: Bukstein Oscar , Kaminer Yifrah
Published: February 2010

Despite a consensus view that we are experiencing an epidemic of drug and alcohol abuse in adolescents, there is little agreement about the definition of adolescent substance abuse disorders. This review explores past and current efforts at defining psychoactive substance use problems and the relevance of these efforts to adolescents. Current diagnostic classifications and criteria for substance abuse and dependence are often inadequate in describing the clinically relevant patterns of substance use in adolescents. A discussion of future directions in the nosology of adolescent substance abuse focuses on the need for the development of a valid, meaningful classification system for substance use problems, using data from studies of prevalence, natural history, genetics, and treatment outcome among youth.
Cocaine Use in Buprenorphine‐ vs. Methadone‐Maintained Patients
Authors: Oliveto Alison H. , Kosten Thomas R. , Schottenfeld Richard , Ziedonis Douglas , Falcioni Jean
Published: February 2010

The authors examined cocaine use in 110 opioid‐dependent cocaine users during a 24‐week, randomized, double‐blind clinical trial in which patients were maintained daily on one of the following: 2 mg of buprenorphine, 6 mg of buprenorphine, 35 mg of methadone, or 65 mg of methadone. During the 24‐week trial, cocaine use, as measured by urinalysis and self‐reports, did not differ across medication groups, although opiate use decreased significantly in the methadone groups relative to the buprenorphine groups. These results suggest that buprenorphine, at doses up to 6 mg/day, is not more effective than methadone in decreasing cocaine use in opioid‐dependent cocaine users. (American Journal on Addictions 1994; 3:43–48)
Photic Driving of EEG Alpha Activity in Recovering Cocaine‐Dependent and Alcohol‐Dependent Patients
Authors: Bauer Lance O.
Published: February 2010

Electroencephalographic (EEG) activity was evaluated in nine cocaine‐dependent and five alcohol‐dependent patients after 1, 3, and 12 weeks of verified abstinence. A group of 15 non‐drug‐dependent control subjects were evaluated after comparable intervals. The EEG was recorded from posterior lead sites during an eyes‐open resting condition and during square‐wave photic stimulation delivered at two different intensities. The stimulation rate was set relative to each subject's dominant alpha frequency at rest. Analyses revealed no significant group differences in resting EEG activity in the standard frequency bands. However analyses of power at the dominant alpha frequency revealed a reliable increase as stimulus intensity was increased, but only in the control group. The cocaine‐dependent and alcohol‐dependent groups exhibited no evidence of a photic driving response at any of the three time points. (American Journal on Addictions 1994; 3:49–57)
Cannabis Psychotic Disorder
Authors: Gruber Amanda J. , Pope Harrison G.
Published: February 2010

Although “cannabis‐induced delusional disorder” is recognized in DSM‐III‐R and appears as “cannabis psychotic disorder” in the draft criteria for DSM‐IV, little information on this entity is available. The authors reviewed available studies of psychiatric syndromes attributed to cannabis use and then surveyed 9,432 admissions at two psychiatric centers, seeking cases of cannabis‐induced disorders. The literature review found inadequate evidence to be certain that cannabis alone can produce a psychotic syndrome in previously asymptomatic individuals. The chart review produced no convincing cases of a cannabis‐induced psychotic syndrome. The authors conclude that further research is needed to validate the diagnosis of cannabis psychosis.
Reliability of Admission History in Predicting HIV Infection Among Alcoholic Inpatients
Authors: Mahler John , Stebinger Allan , Yi Donna , Bingham Julia , Sacks Michael , Dermatis Helen , Perry Samuel
Published: February 2010

The authors evaluated the reliability of admission history for assessing risk for HIV infection in alcoholic inpatients. Discard blood specimens were used and correlated with risk factors for HIV obtained from the admission record. Of 300 admissions, 31 (10.4%) tested seropositive for HIV. Of these 31 HIV‐infected inpatients, 11 (35–5%) had no documented risk factors. Although history of injection drug use was associated with HIV infection (adjusted odds ratio = 506; P< 0.0001), history of male sex with males, crack‐cocaine use, and heterosexual risk behaviors did not predict HIV seropositivity. Admission history was not reliable for assessing risk for HIV infection among inpatients on our alcohol rehabilitation unit.
A Survey of Posthospitalization Treatment Needs and Preferences in Cocaine Abusers
Authors: Schmitz Joy M. , Oswald Lynn M. , Baldwin Laurie , Grabowski John
Published: February 2010

In an effort to lower recidivism, most inpatient drug treatment programs offer a variety of aftercare options. There is a lack of empirically based knowledge needed to make decisions about posthospital treatment development and its implementation. The authors used a survey method to evaluate outpatient treatment needs and preferences of hospitalized cocaine‐dependent patients (N = 40). Stronger preferences were expressed for 12‐step programs, behavioral relapse prevention, and employment counseling than for psychotherapy, medical treatment, and legal assistance. Most subjects viewed cocaine addiction as a disease (93%) rather than a learned habit (7%). Group therapy was preferred over individual therapy (66% vs. 34%). For each problem area on the Addiction Severity Index (ASI), patient severity ratings were strongly correlated with perceived aftercare treatment needs, whereas interviewer ratings and composite scores on the ASI were not. The authors discuss implications of client preferences in posthospital treatment.
Suicide and Psychopathology in 1,537 Patients Dependent on Prescribed Psychoactive Medications: Stockholm, Sweden
Authors: Allgulander Christer , Brandt Lena , Allebeck Peter
Published: February 2010

The risk of suicide among patients hospitalized because of dependence on prescribed psychoactive medications was estimated among all 1,537 such patients in Stockholm, Sweden, over an 8‐year period. The suicide standardized mortality ratio was 41.0 among the women and 45.6 among the men who were dependent on such medications alone. It was of a similar magnitude (50.4 and 30.6) among women and men with concurrent alcohol/street‐drug abuse. Among all deaths, 38% were suicides. Primary and secondary psychiatric disorders were common. To reduce the suicide risk, professional treatment intervention should entail thorough diagnostic assessment, behavioral/cognitive therapy, and a judicious use of psychoactive medications for anxiety, affective, and personality disorders.
Test‐Retest Reliability of the Addiction Severity Index Composite Scores Among Clients in Residential Treatment
Authors: McCusker Jane , Bigelow Carol , Servigon Charmaine , Zorn Martha
Published: February 2010

The authors investigated the test‐retest reliability of the Addiction Severity Index (ASI) composite scores and the use of “free‐living vs. institutionalized” reporting periods among 112 patients admitted to either of two residential, drug‐free treatment programs in New England. Alcohol and drug scores were substantially lower for institutionalized vs. free‐living reporting periods. Intraclass correlation coefficients were high (> 0.80) for the alcohol, drug, employment, and legal scores, but lower (0.50–0.59) for the psychiatric and medical scores and did not differ substantially by type of reporting period or by lag period between end of the reporting period and the interview. The use of free‐living reporting periods yields more valid ASI scores for drugs and alcohol, in particular, and yields comparable reliability.
Gender Differences in the Pattern and Progression of Substance Use in Conduct‐Disordered Adolescents
Authors: Mezzich Ada Castillo , Moss Howard , Tarter Ralph E. , Wolfenstein Miriam , Hsieh Ya‐Chen , Mauss Renne
Published: February 2010

Female adolescents (n = 40) and male adolescents (n = 42) with conjoint conduct disorder and substance abuse were compared to elucidate differential substance use and abuse patterns and to determine the probability and rate of transition from alcohol and drug use to a DSM‐III‐R diagnosis of abuse/dependence. It was found that young women were more likely to have experimented with nonprescription diet pills and caffeine. Young men, on the other hand, were more likely to have experimented with snuff or chewing tobacco. Women more frequently had a diagnosis of nicotine dependence and were at greater risk than men to qualify for that diagnosis. Women started drinking alcohol at a later age than men, although the age at which they qualified for a diagnosis of alcohol abuse/dependence did not differ. The interval between alcohol use and a diagnosis of alcohol abuse/dependence was shorter for women than men. Furthermore, compared to the men, the women exhibited a shorter interval between cannabis use and a diagnosis of cannabis abuse/dependence.
Dual Diagnosis in a State Psychiatric Facility: Risk Factors, Correlates, and Phenomenology of Use
Authors: Alexander Mary Jane , Craig Thomas J. , MacDonald Jack , Haugland Gary
Published: February 2010

Patients admitted to a state psychiatric facility were interviewed to ascertain the co‐occurrence of mental illness and chemical abuse (MI/CA), lifetime substance use, childhood experiences, current living conditions, and use of mental health services. Of the sample, 49% currently had MI/CA, and 20% more had used multiple substances. MI/CA patients were more likely to have been exposed to multiple early risk factors for substance use, including familial substance abuse, mental illness, and physical abuse. They were also younger, male, and experienced more adult homelessness, legal trouble, and family conflict. These results demonstrate the continuing need to develop MI/CA programs.
Early Teenage Substance Use as a Predictor of Educational‐Vocational Failure
Authors: Friedman Alfred S. , Bransfield Shirley , Kreisher Cheryl
Published: February 2010

The authors report on the relationship of early adolescent substance use (up to the time of the 16th birthday) to educational‐vocational performance in the early adulthood of 612 African‐American urban subjects. Voluminous prospective data were available on the behavior, test performance, and families of 612 urban African‐American subjects, from birth up to 7 years of age. Scarcer prospective data were available for school performance during later years of school. Control variables were derived from these data to determine the amount of variance in each dependent educational‐vocational outcome variable that was accounted for, independently of the amount of variance accounted for by early substance use. (American Journal on Addictions 1994; 3:325–336)
Psychosocial Risk Factors and Condom Use in Intravenous Drug Abusers
Authors: Brook David W. , Brook Judith S. , Whiteman Martin , Roberto Josephine , Masci Joseph R. , Catalogne Jacques de , Amundsen Frances , Wynn Pe Shein
Published: February 2010

The authors studied psychosocial risk and protective factors in HIV transmission in a population of intravenous drug abusers (IVDAs), with a focus on needle‐sharing. The authors examined high‐risk sexual behavior in the same population by looking at factors affecting the individual IVDA's condom use. The volunteer sample was 300 male IVDAs who were patients at AIDS or methadone clinics in a large city hospital. All subjects were individually interviewed regarding condom use for vaginal intercourse, with a structured questionnaire analyzed by means of multiple hierarchical regressions and Pearson correlation coefficients. Parental and peer factors and coping measures were associated with more condom use. The findings supported a mediational model for condom use. Family factors were associated with good coping and with the selection of friends who support condom use. These factors in turn were associated with planning to use and actually using condoms.
A Comparison of Pergolide and Bromocriptine in the Initial Rehabilitation of Cocaine Dependence
Authors: Malcolm Robert , Phillips Joem D. , Brady Kathleen T. , Roberts John R.
Published: February 2010

Numerous pharmacologic agents have been used in an attempt to improve treatment outcome for cocaine‐dependent individuals. In this study, 41 men and women newly admitted to a 30‐day inpatient treatment program for cocaine dependence were randomized to open treatment with pergolide or bromocriptine (two dopamine agonists) or a no‐medication group. Treatment groups were compared for mean length of stay in the hospital (MLS), number of discharges against medical advice (AMA), and on a self‐report visual analog craving scale prior to treatment and again between Day 7 and Day 10. The pergolide and bromocriptine groups both had an MLS of 25 days, with one AMA discharge (6%). The no‐medication treatment group had an MLS of 16.2 days and four (36%) AMA discharges. Mean decrease in the craving scores in the pergolide group was 31.8, in the bromocriptine group, 24.0, and in the no‐medication group, 7.9.
Axis I and Axis II Comorbidity Among Alcohol‐Disordered Men in a Sample of Vietnam‐Era Veterans
Authors: Scheidt Douglas M. , Windle Michael
Published: February 2010

The authors examine the scope of alcoholic comorbidity by evaluating the full range of coexisting Axis II personality disorders (PDs) in conjunction with selected Axis I disorders. Prevalence data are reported for a large sample of male, Vietnam‐era military veterans. Higher rates of PD were found among alcohol‐disordered individuals and those with Axis I disorders when compared with no‐diagnosis and other Axis I‐diagnosed control groups. The significance of PD among alcohol‐disordered subjects was demonstrated further by a pattern of decrements in measures of adaptive functioning related to alcoholism, other Axis I, and Axis II diagnoses. Less than one‐third of the alcohol‐disordered subjects in this sample were without a coexisting Axis I or Axis II disorder.
Alcohol Withdrawal and Limbic Kindling:A Hypothesis of Relapse
Authors: Adinoff Bryon , O'Neill H. Katherine , Ballenger James C.
Published: February 2010

In this concept paper, the authors review the arguments and evidence for the hypothesized link between the alcohol withdrawal syndrome and the anxiety and craving that occurs during abstinence in alcohol‐dependent patients. This hypothetical construct suggests that the repeated experience of alcohol withdrawal and its associated limbic‐neuronal discharge induces a permanent state of limbic hyperexcitability. This phenomenon has been referred to as “kindling.” Subsequent episodes of limbic discharge may then be precipitated during abstinence by alcohol‐related cues or may even occur spontaneously. Subjectively experienced as anxiety or craving, such a neuronal discharge could provoke relapse to drinking in vulnerable subjects. The clinical, neurochemical, and electrophysiologic rationale for this hypothesis will be presented, along with implications for treatment and suggested future studies.
Patient‐Regulated Methadone Dose and Optional Counseling in Methadone Maintenance
Authors: Maddux James F. , Desmond David P. , Vogtsberger Kenneth N.
Published: February 2010

The authors evaluated the effects on retention and other outcomes of three approaches in a methadone maintenance program. At the time of admission, 300 chronic opioid users were randomly assigned to standard treatment, patient‐regulated dose, or optional counseling. Retention of the optional counseling group exceeded that of the other two groups, but the difference was only of borderline significance. Allowing patients to regulate their methadone dose did not lead to a general escalation of dose. Subjects in optional counseling saw their counselors less than half as often as those in the standard treatment with two mandatory sessions per month. Illicit drug use and social performance in the twelfth month did not differ significantly among the three subgroups that remained in treatment. The findings support patient participation in decisions about methadone dose and the frequency of counseling.
Substance Abuse and Psychiatric Illness: Psychosocial Correlates
Authors: Sloan Kevin L. , Rowe Gail
Published: February 2010

The authors examined the psychosocial correlates of 1) having a history of any type of psychiatric treatment and 2) being staff‐identified as a suitable candidate for treatment from an outpatient dual‐diagnosis program. They reviewed 1,303 consecutive patients in a 16‐month period who applied for substance abuse and/or dual‐diagnosis treatment at a Veterans Administration hospital. The sample included 665 individuals describing a history of prior psychiatric treatment, 126 of whom were referred for outpatient dual‐diagnosis treatment. Data were collected at the time of treatment application and included demographics, employment and treatment histories, and recent substance use. Even the broadest definition of dual diagnosis (having a history of any type of psychiatric treatment) was associated with higher rates of homelessness, disconnection from social support systems, unemployment and vocational disability, and treatment chronicity; a narrower definition selected for even greater impairment. Substance abuse programs should anticipate significant case management needs in addition to psychiatric support when treatment programs are expanded to include services to patients with comorbid psychiatric illness.
Psychiatric Comorbidity in Cocaine Dependence: Diverging Trends, Axis II Spectrum, and Gender Differentials
Authors: Marlowe Douglas B. , Husband Stephen D. , Lamb R.J. , Kirby Kimberly C. , Iguchi Martin Y. , Platt Jerome J.
Published: February 2010

One hundred consecutive admissions to an intensive outpatient cocaine treatment clinic in Camden, NJ, were assigned DSM‐III‐R Axis I and II psychiatric diagnoses by means of the SCID. Prevalence rates for non‐substance‐use Axis I disorders were equivalent to expected population base rates. By far the most common diagnoses were on Axis II (73% of subjects), with over one‐third of subjects receiving more than one personality disorder diagnosis, frequently crossing DSM‐III‐R “clusters.” In the distribution of psychopathology, certain gender differences were noted. The authors discuss implications for the clinical management and treatment of cocaine‐addicted individuals in urban environments.
Chemical Dependence and Substance Abuse on a Geropsychiatric Unit: A Preliminary Study
Authors: Pourian Kristin R. , Finkel Sanford I. , Lyons John S.
Published: February 2010

Medical records of 125 geropsychiatric inpatients were reviewed for a pilot study of the prevalence and medical and psychosocial correlates of chemical dependence and/or abuse. Patients were studied in three groups, each corresponding to the phased implementation of a program to enhance staff awareness of these problems. In contrast to patients without chemical dependence/abuse diagnoses, patients with these diagnoses had shorter lengths of stay, a greater number of psychiatric diagnoses, and were more likely to show personality disorder. Inception and implementation of the staff awareness program was associated with finding a significantly greater number of patients with chemical dependence/abuse diagnoses.
Psychiatric Implications of Alcoholism and Traumatic Brain Injury
Authors: Weinstein David D. , Martin Peter R.
Published: February 2010

The authors examined the synergism between pathologic patterns of alcohol consumption and traumatic brain injury (TBI) and its implications for psychiatric practice. The information that forms the basis of this review was identified by a computer‐assisted search of the English‐language literature for appropriate articles. The literature suggests that alcohol abuse/dependence can precipitate behavior resulting in head trauma and that chronic alcohol abuse potentiates the mechanical and neurochemical processes involved in TBI, often resulting in a subsequent dual diagnosis of alcohol dependence and organic mental disorder. The magnitude of clinical morbidity, as documented by a broad range of epidemiologic studies associated with this topic, is considerable, and the authors hope it may be significantly reduced with increased education of health care professionals and with the education and psychiatric treatment of patients who are at risk for this condition.
Personality Disorder and Assault History in Substance‐Dependent Individuals
Authors: Brady Kathleen T. , Dustan Lorraine R. , Grice Dorothy E. , Danksy Bonnie S. , Kilpatrick Dean
Published: February 2010

The authors explored the relationship between assault, substance use disorders, and personality disorders by interviewing 82 substance‐dependent inpatients with a structured interview concerning physical and sexual assault as well as the Structured Clinical Interview for DSM‐III‐R, parts I and II. Sixty percent of subjects met criteria for a personality disorder. Individuals who had experienced assault (n = 43) were more likely to have all types of personality disorder diagnoses (P ≤ 0.001). Those who reported childhood assault were more likely to have Cluster B personality disorders and to meet criteria for more than two personality disorder diagnoses (P ≤ 0.05) compared with those who reported adult assault only. Personality disorders were commonly diagnosed in this group of treatment‐seeking, substance‐dependent individuals. The effect of substance abuse as well as assault on the development and presentation of personality disorders is likely to be substantial.
Evaluating Craving in Crack‐Cocaine Abusers
Authors: Ollo Christine , Alim Tanya N. , Rosse Richard B. , Cunningham Stacey , Gillis Tama , Khan Mushtari , Green Thomas , Ricci Judy , Deutsch Stephen I.
Published: February 2010

The authors evaluated the psychometric properties of a 33‐item Likert‐scale questionnaire assessing subcomponents of craving in 77 crack‐cocaine abusers. Split‐half and test‐retest correlations were moderate to strong, indicating good internal reliability. High correlations with traditional visual analog scale measures of drug thoughts and cravings (but not other symptoms) support the questionnaire's validity as a measure of subjective craving. An exploratory factor analysis indicated that craving in these treatment‐seeking crack‐cocaine abusers is motivated both by the positive reinforcing properties of cocaine and by seeking relief from negative symptoms. A previous study using a similar questionnaire found that craving in non‐treatment‐seeking drug users was motivated primarily by the desire and intention to use cocaine. The results support the notion that subcomponents of craving exist and may vary with motivational state (i.e., those in treatment vs. non‐treatment‐seekers).
Recovering Physicians in Addiction Psychiatry Fellowships
Authors: Willenbring Mark L. , Specker Sheila M.
Published: February 2010

In this report, the authors describe the characteristics and experiences of recovering fellows in a university addiction subspecialty fellowship. Four stages of adjustment were identified: 1) initial adjustment, 2) role conflict, 3) role integration, and 4) graduation. From a faculty viewpoint, it is particularly important to separate clinical from educational responsibilities in dealing with recovering fellows. Despite some continuing conflict about treatment models, most fellows achieved their training goals and were able to successfully adapt to post‐training practice. However, some fellows were unable to integrate personal recovery and professional roles.
Urinary Dopamine Metabolites During Cocaine Abstinence
Authors: Wyatt Richard Jed , Angrist Burt , Karoum Farouk
Published: February 2010

The authors compared catecholamine concentrations measured on 2‐hour urine collections of recently hospitalized cocaine abusers (CAs; n = 17) with those of detoxified alcoholic patients (APs; n = 10) and staff normal‐control subjects (NCs; n = 13). CAs had been abstinent for 6–8 days; APs had been abstinent for 9–53 days. Compared with NCs, the recently abstinent CAs had a decrease in the dopamine metabolite, 3,4‐dihydroxyphenylacetic acid (DOPAC), and a decrease in Sum dopamine/Sum norepinephrine (the molar sum of dopamine and its metabolites/the molar sum of norepinephrine and its metabolites). The dopamine metabolite, 3‐methoxytyramine (3‐MT) was increased. The detoxified APs had increases in the norepinephrine metabolites normetanephrine and 3‐methoxy‐4‐hydroxyphenylglycol in addition to elevated 3‐MT. Sum dopamine/Sum norepinephrine was decreased in APs compared with NCs. The authors discuss differences in light of other findings related to recent abstinence after cocaine and alcohol abuse.
A Meta‐Analysis of Multiple Longitudinal Studies From the Collaborative Alcohol‐Related Longitudinal Project
Authors: Leino E. Victor , Ager Catherine R. , Fillmore Kaye Middleton , Johnstone Bryan M.
Published: February 2010

The authors used individual and group‐level variables within age and sex to predict drinking patterns over time among individuals. Eight longitudinal samples of persons age 21–30 years were analyzed separately. Drinking patterns at final measurement were regressed simultaneously on both individual and group‐level variables. The first model tested for marital and drinking status along with group‐level mean change in drinking. The second model tested for marital and drinking status along with group‐percent married. The third model tested for marital and drinking status along with percent newly married. Using meta‐analysis, the authors demonstrated significant and homogeneous effects for the three models tested and for grouplevel mean differences in the first model.
A Comparison of Male and Female Physicians Treated for Substance Use and Psychiatric Disorders
Authors: Nace Edgar P. , Davis Carlos W. , Hunter Judy
Published: February 2010

The authors compared physicians admitted for psychiatric or substance use disorders on demographic, clinical, and gender variables. The records of 92 physicians admitted to a private psychiatric hospital over a 6‐year period were reviewed to compare characteristics of those admitted for psychiatric disorders with those admitted for substance abuse problems, and to compare female and male physician‐patients. Of physicians who presented for substance abuse treatment, 58% had an additional Axis I psychiatric disorder, whereas 22% of physicians admitted for psychiatric treatment had substance use disorder; 59% of this sample of physicians received a personality disorder diagnosis. “Dual disorder” is a common clinical presentation in physicians. Male (n= 76) and female (n= 16) physicians were similar on compared variables except that they showed differing patterns of substance abuse. Compared with previous studies of treated physicians, the percentage of female physicians and the overall percentage of physicians with substance abuse diagnoses are increasing.
Paresthesia During Naltrexone Treatment
Authors: Vannucchi T. , Manfredi A. , Vigliotti A. , Schifano F. , Miconi L. , Villani G.
Published: February 2010

Naltrexone (NTX) is an antagonist of morphine‐like substances; it is orally active and blocks the pharmacological effects of opiates. The authors describe the treatment of a 28‐year‐old woman intravenous heroin user who developed paresthesia of the arms and legs after a standard 50‐mg dose. When the dosage was reduced to 25 mg, this side effect was of shorter duration and finally disappeared after 10 days of dosage at this level. At the 60th day, the dosage was brought back up to 50 mg daily, and no paresthesia was observed.
Acute Hepatitis After Clozapine Administration
Authors: Contoreggi Carlo , Cheskin Lawrence J. , Lange W. Robert
Published: February 2010

The authors present a case report of a cocaine abuser who developed acute hepatitis and an extrapyramidal reaction after administration of clozapine, a novel dopamine antagonist. Previous clinical experience with clozapine is reviewed. Both clozapine and cocaine undergo hepatic metabolism, increasing the potential for hepatotoxicity in selected patients. The authors also review hepatic metabolism of biogenic amines, their central nervous system effects, and the pharmacologic effects of clozapine and other abused substances on bioamine metabolism. Substance abusers' high susceptibility to hepatotoxicity highlights the need for careful monitoring for this form of liver dysfunction when administering clozapine.
Treatment Retention, Occupational Role, and Cocaine Use in Methadone Maintenance
Authors: Lamb R.J. , Kirby Kimberly C. , Platt Jerome J.
Published: February 2010

The authors interviewed methadone maintenance patients (N = 264) reporting cocaine use in the previous year to examine the relationship between treatment retention, occupational role, and continued cocaine use. Treatment retention was positively correlated with reduced cocaine use. Patients who had been in treatment longer than 6 months were less likely to have used cocaine in the previous month than patients who had been in treatment 6 months or less. Patients who were employed full‐time, were full‐time home‐makers, or full‐time students were less likely to have used cocaine in the previous month than those who were unemployed or employed only part‐time or occasionally. The effects of occupational role and treatment retention were additive.
Substance Disorder Among Persons With Mild Mental Retardation
Authors: Westermeyer Joseph. , Kemp Kenneth , Nugent Sean.
Published: February 2010

The authors compared the nature and severity of substance disorder (SD) in patients with mental retardation (MR) compared with SD in non‐MR patients. Subjects were patients sequentially admitted to alcoholism/addiction programs in two university medical centers (MR+SD = 40; SD‐only = 308). Data were collected on demographic characteristics, substance use history, SD duration and severity, and family history of SD. Subjects with MR+SD began substance use at a later age, used fewer substances during their lifetime (especially illicit substances), used less frequently in the past year, had lower severity scores on measures of substance abuse severity, and demonstrated milder and briefer substance use histories. It appears that less substance abuse is required in MR than in non‐MR persons to precipitate psychosocial crises and health problems associated with psychoactive substances.
Alexithymia in Substance Abusers
Authors: Pinard Louis , Negrete Juan Carlos , Annable Lawrence. , Audet Nathalie.
Published: February 2010

The authors investigated the effects of detoxification on alexithymia scores in a sample of psychoactive substance‐dependent patients. At baseline, 48 subjects were administered the 20‐item Toronto Alexithymia Scale (TAS–20); a second measurement was carried out 4–6 weeks later. The mean TAS–20 total score of these subjects at baseline (55.5 ± 12.0) was higher than healthy population norms (46.5 ± 10.3), and no significant change in totals was elicited after detoxification. The results suggest that, in substance abusers, alexithymia tends to be a stable trait and is not significantly altered as a result of abstinence.
Comparison of Clinical and Research Diagnoses of Substance Use Disorders in a First‐Admission Psychotic Sample
Authors: Fennig Shmuel , Naisberg‐Fennig Silvana , Craig Thomas J. , Tanenberg‐Karant Marsha , Bromet Evelyn J.
Published: February 2010

In a sample of 294 first‐admission psychotic subjects participating in an epidemiologic study, a diagnosis of comorbid psychoactive substance use disorder (PSUD) was made less frequently by clinicians at the treating facilities (17.7%) than by the research diagnosticians (28.9%). The level of agreement was moderate (kappa = 0.49), and the clinical diagnoses showed high specificity (0.95) but low sensitivity (0.48). Concordance between clinical and research diagnosis of PSUD was not significantly associated with demographic or clinical characteristics; the major reason for the discordance was criterion variance.
A Review of Pharmacotherapies for Substance Abuse
Authors: Kosten Thomas R. , McCance Elinore.
Published: February 2010

New pharmacotherapies have been developed for acute withdrawal and maintenance treatments of alcohol and opioid dependence but not for cocaine dependence. High‐dose, long‐acting benzodiazepines, beta‐blockers, and two antiseizure agents—carbamazepine and valproate—are being used for alcohol withdrawal. For maintenance treatment, opioid antagonists and various serotonergic agents, such as fluoxetine and ondansetron, show promise. For opioid dependence, clonidine‐naltrexone detoxification appears quite cost‐effective, and buprenorpbine and LAAM (levo‐alpha‐acetylmethadol) show promise for both detoxification and maintenance. More work is needed, however, to discover an effective agent for target populations of cocaine abusers.
False Positives in Urine Monitoring of Substance Abusers
Authors: Dilts Stephen L. , Gendel Michael H. , Williams Michael
Published: February 2010

The authors provide two examples of formerly substance‐abusing physicians who had false‐positive urine tests while being monitored for addictive substances. Urine tests are not infallible and can return both false‐positive and false‐negative results that must be addressed. The role of urine monitoring in assessing the recovery of patients from substance abuse is discussed with emphasis on the need to include multiple sources of clinical input in assessing the patient.
Lithium Treatment of Aggressive Behaviorin Depressed, Drug‐Dependent Patients
Authors: Deliyannides Deborah A. , Nunes Edward V. , Quitkin Frederic M. , Brady Ronald
Published: February 2010

Four non‐bipolar I methadone‐maintenance patients with irritability and aggressiveness were treated with lithium. Three had met criteria for childhood conduct disorder and all four had adult antisocial features. In each case there was a noticeable reduction in aggression and an improvement in functioning. This finding suggests that there is a treatable subgroup of drug‐dependent patients with antisocial behavior.
Alcoholism in Irish American Catholics
Authors: O'Connor Garrett
Published: February 2010

Alcoholism has been a major public health problem among Irish Catholics for centuries. Until recently, however, the etiology of this phenomenon has been poorly understood. This article attempts to 1) explore the political and socio‐historical roots of Irish American Catholic attitudes toward alcohol; 2) describe how patterns of heavy drinking among Irish Catholics have been handed down through generations; and 3) examine the role of cultural stereotyping in promoting and maintaining pathological drinking behavior among Irish Catholics from the middle of the 19th century until the present day. The author considers implications for psychotherapy with this population.
Alcohol Abuse in Asian Americans
Authors: Varma Satish C. , Siris Samuel G.
Published: February 2010

Asian Americans are proportionately the fastest growing minority in the United States. Once considered a model minority, recent studies have suggested that Asians have a fairly high prevalence of alcoholism. The authors present epidemiological data from the few available surveys involving the Asian American community. An important consideration is that the term “Asian American” does not represent a homogenous group. It comprises people from many countries, several major religious groups, various socioeconomic levels, and different lengths of time and levels of acculturation in the United States. The presence of aldehyde dehydrogenase (ALDH2) deficiency also represents a relevant biological difference in some subgroups. This heterogeneity makes it difficult to encompass all relevant parameters in any one study, but each of these factors clearly affects the rates and expressions of alcohol use, and they all represent important considerations for treatment. Culturally sensitive and/or bicultural programs are indicated for the proper treatment of this population.
The Effects of Major Depression on Alcoholism
Authors: Hasin Deborah S. , Tsai Wei‐Yuan , Endicott Jean. , Mueller Timothy I. , Coryell William , Keller Martin
Published: February 2010

Some patients come into treatment with clear cases of both major depression (MDD) and alcoholism. Although assumptions are often made about the relationships of these two conditions, little empirical information exists on the effects of changes in MDD on the course of alcoholism in patients presenting at psychiatric facilities. The authors used survival analysis with time‐dependent covariates to investigate the effects of remissions and relapses of MDD on the 5‐year course of alcoholism in 127 dual diagnosis patients. Changes in the status of MDD bad strong, significant effects on the course of alcoholism. Improvement in MDD status increased the chances of remission in alcoholism and reduced the chances of alcoholism relapse. The status of MDD appears to have an effect on the course of alcoholism in patients with severe affective disorders.
Women, Their Significant Others, and Crack Cocaine
Authors: Boyd Carol J. , Guthrie Barbara.
Published: February 2010

The 1993 National Household Survey showed that 54,000 African American women bad smoked crack cocaine at least once in the previous month; for the first time, a larger percentage of African American women are using illicit drugs than their Euro‐American counterparts. To better understand the interpersonal and family context in which African American women who smoke crack came to use drugs, the authors aimed to characterize the drug and alcohol abuse of parents, siblings, and spouses of such women. A total of 161 women who reported smoking at least $100/week of crack cocaine were recruited into this study. At the time of data collection, 110 women were in treatment, and 48 were still using. Sixty‐five percent of the participants reported at least one parent with a drug or alcohol problem, and sibling use was equally high. These data are consistent with previous research with female heroin users.
Phenobarbital vs. Clonazepam in the Outpatient Sedative Detoxification of Methadone‐Maintained Patients
Authors: DeMaria Peter A. , Gottheil Edward. , Serota Ronald , Sterling Robert C.
Published: February 2010

The authors used either phenobarbital or clonazepam to detoxify 25 sedative‐dependent patients enrolled in an outpatient metbadone‐maintenance treatment program. Sedatives abused by patients included glutetbimide, diazepam, alprazolam, and lorazepam. There were no reported seizures. Urine drug screening results indicated that only a minority of the patients were able to “detox” and stay off sedatives. The authors report on patient demographics, sedative abuse history, detoxification agent, dosage, and tapering schedules.
Treatment Program Progress
Authors: Goubert Debrin , McKay James R. , Burke Maureen. , McLellan A. Thomas , Randall Mary. , Alterman Arthur I.
Published: February 2010

In this study, the authors evaluated the psychometric properties of the Treatment Program Progress (TPP) rating scale, a brief instrument that assesses counselor ratings of patient response to 12‐step–oriented substance abuse treatment interventions. In both 3‐ and 5‐day‐per‐week outpatient programs, the TPP bad good internal consistency reliability. However the TPP demonstrated good interrater reliability and strong predictive validity only in the 5‐day program. These preliminary results suggest that the TPP may be used to identify outpatients who are at heightened risk for early dropout, but only when raters have frequent opportunities to observe the patients (i.e., more than 3 times per week).
Needle‐Sharing: A Longitudinal Study of Psychosocial Risk and Protective Factors
Authors: Brook David W. , Brook Judith S. , Whiteman Martin , Wynn S. , Masci Joseph R. , Roberto Josephine , Catalogne Jacques de , Amundsen Frances
Published: February 2010

The authors examined the psychosocial correlates of needle‐sharing behavior at two points in time (T1 and T2) by use of a prospective longitudinal design. Subjects were 278 male intravenous drug users, 111 of whom were HIV‐positive. All subjects were given structured questionnaires by trained, ethnically matched interviewers. Pearson correlation coefficients (rs) and hierarchical regression analyses were done to examine interrelationships among T1 psychosocial domains, T1 needle‐sharing, and T2 needle‐sharing. T1 psychosocial/personality factors predicting T2 needle‐sharing included unconventionality, poor emotional control, and poor intrapsychic functioning. The relationship of T1 needle‐sharing to T2 needle‐sharing was buffered by the T1 psychosocial protective factors. The findings supported a mediational model, in which personality and peer factors predicted T1 needle‐sharing, which served as the mediator for T2 needle‐sharing. (American Journal on Addictions 1996; 5:209–219)
Ethnicity and the Course of Opiate Addiction: Native‐Born Americans vs. Hmong in Minnesota
Authors: Westermeyer Joseph , Chitasombat Panupong
Published: February 2010

The authors studied the course of opiate dependence among two ethnic groups in Minnesota, one of whom used heroin by injection and one of whom used opium by smoking. Subjects were 57 Hmong (Laotian) immigrants and 80 native‐born Americans. American subjects were more likely to be employed, had more education, younger age at onset of opiate use, higher addiction scores, more legal problems, spent about 50 times more money per day on drugs, had used more treatment, and more self‐help methods. Hmong subjects were more men, more married and living with family, had longer periods of abstinence, and more of certain psychological symptoms. Differences were related to culture, type of opiate, and immigrant/refugee status. Similarities (e.g., types and severity of certain drug‐related problems, family history of substance abuse) suggested that certain core features of opiate dependence persist despite differences in ethnicity and type of opiate used. (American Journal on Addictions 1996; 5:231–240)