bluuebunny/crossref_metadata_2025 huggingface dataset:
An Overview of Nicotine Use Disorders for Alcohol/Drug Abuse Clinicians
Authors: Hughes John R.
Published: February 2010

Alcohol and drug abuse clinicians often fail to intervene in nicotine dependence because of unfounded beliefs or inadequate knowledge of the topic. This overview 1) describes the epidemiology, initiating factors, consequences, pharmacology, behavioral effects, and dependence syndrome associated with nicotine use; 2) describes how nicotine use and withdrawal interfere with the diagnosis and treatment of other drug dependencies; and 3) provides a simple, concrete algorithm for treating nicotine dependence. (American Journal on Addictions 1996; 5:262–274)
Screening for Mental Illness With the Addiction Severity Index
Authors: Dixon Lisa , Myers Patrick , Johnson Jeanette , Corty Eric
Published: February 2010

The authors assessed the relationship of the psychological composite score (PCS) of the Addiction Severity Index (ASI) to the presence of current DSM‐III‐R depressive, anxiety, psychotic, and somatoform disorders. A total of 365 patients in two inner‐city psychiatric units received the Structured Clinical Interview for DSM‐III‐R (SCID) and the ASI. The presence of a current DSM‐III‐R psychiatric diagnosis was significantly correlated with the PCS (P < 0.001). Controlling for substance abuse, affective (P < 0.01) and anxiety (P < 0.02) disorders significantly contributed to the ASI PCS. Individual PCS items were associated with the different types of mental disorders. The ASI PCS was significantly related to the presence of current DSM‐III‐R psychiatric diagnoses, especially depressive and anxiety disorders. Clusters of ASI PCS items may have utility in screening for patients in the substance abuse treatment setting who need psychiatric services. (American Journal on Addictions 1996; 5:301–307)
Predictors of Antidepressant Response in Depressed Alcoholic Patients
Authors: Nunes Edward V. , McGrath Patrick J. , Quitkin Frederic M. , Stewart Jonathan W. , Goehl Leslie , Ocepek‐Welikson Katja
Published: February 2010

Sixty alcoholic patients with depressive disorders completed a 12‐week, open‐label trial of imipramine; 27 (45%) had a favorable response, defined as substantial improvement in both mood and sobriety. The authors examine demographic and clinical predictors of response. Responders were less likely to be minorities, bad lower Hamilton Rating Scale for Depression scores, fewer maximum drinks per day at baseline, and were somewhat more likely to have panic disorder. The authors discuss implications for the selection of alcoholic patients for antidepressant treatment. (American Journal on Addictions 1996; 5:308–312)
AMPT Effects on Cue‐Induced Craving for Cocaine
Authors: Petrakis Ismene L. , Satel Sally L. , Stine Susan , Kosten Thomas R. , Namanworth Sheila N. , Charney Dennis S. , Krystal John H.
Published: February 2010

The authors evaluated the effect of an acute reduction in catecholamine synthesis, produced by alpha methyl para tyrosine (AMPT), on cue‐induced craving for cocaine in cocaine‐dependent patients. AMPT and diphenhydramine were administered under double‐blind conditions in a randomized, crossover design. Two cue exposure sessions were conducted 1 week apart. Self‐reported assessments of cocaine craving were administered before and after cue exposure. AMPT, but not diphenhydramine, significantly decreased plasma levels of the dopamine metabolite, homovanillic acid and the norepinephrine metabolite, 3‐methoxy‐4‐hydroxy phenylethylene glycol. However, AMPT's effects on cue‐induced craving interacted with the test‐day order in a complex manner. (American Journal on Addictions 1996; 5:313–320)
Cardiovascular Interactions of Desipramine, Fluoxetine, and Cocaine in Cocaine‐Dependent Outpatients
Authors: Nelson Richard A. , Gorelick David A. , Keenan Robert M. , Carmona Gilberto N. , Covi Lino
Published: February 2010

The authors investigated the subacute cardiovascular effects of cocaine use alone and with antidepressants. At study entry, 55 cocaine‐dependent (DSM‐III‐R) patients with cocaine‐positive urines had slightly higher resting heart rates and blood pressures than 36 patients with cocaine‐negative urines, which achieved significance (P < 0.05) for three of eleven parameters. A repeated‐measures analysis of medication‐compliant patients found no significant cardiovascular differences between cocaine‐positive and cocaine‐negative urine conditions for either desipramine (n = 10) or fluoxetine (n = 20). Cocaine use appears to produce minimal subacute cardiovascular effects, which are not accentuated by desipramine or fluoxetine, in physically healthy cocaine‐dependent patients. (American Journal on Addictions 1996; 5:321–326)
Diazepam Loading for Alcohol Detoxification
Authors: Hyatt Mark , Cheever Todd , Eldot Rosalyn
Published: February 2010

Fifty male alcoholic patients were detoxified by means of a modified diazepam loading technique, where diazepam dosing was linked to the degree of diazepam‐induced intoxication and not to the presence of alcohol withdrawal symptoms. The average period of diazepam loading from onset of alcohol withdrawal was 8.7 ± 2.7 hours. The average amount of diazepam administered was 147 ± 46 mg. There were no diazepam intoxication‐ or alcohol withdrawal‐related complications noted with this method. Orthostatic hypotension, as well as tremor, diaphoresis, tachycardia, and restlessness, were frequently found during alcohol withdrawal. (American Journal on Addictions 1996; 5:354–358)
The General Internist
Authors: O'Connor Patrick C.
Published: February 2010

Although general internists recognize the medical complications arising from alcohol abuse, they may be less familiar with its social and psychological consequences or with methods for its treatment. Because internists are the only physicians some patients see, they must be prepared to diagnose and take part in the treatment of alcohol problems.
The Pediatrician
Authors: Adger Hoover , Werner Mark J.
Published: February 2010

Alcohol consumption by pediatric patients and their parents can have a significant impact on the health and development of the children and adolescents. The pediatrician can help prevent or reduce alcohol‐induced impairments by providing education and guidance about the responsible use of alcohol and by initiating early intervention if necessary.
Coping With AIDS
Authors: Brook Judith S. , Brook David W. , Win Pe T. , Whiteman Martin , Masci Joseph R. , Catalogne Jacques de , Roberto Josephine , Amundsen Frances
Published: February 2010

The goals of this longitudinal, prospective study were to 1) examine coping strategies of HIV‐positive (HIV+) and HIV‐negative (HIV‐) injecting drug users; 2) study the relationship of earlier social support to later coping in HIV+ men; and 3) examine the effects of earlier coping strategies on later psychosocial function. The authors studied 287 men given a structured questionnaire at two points in time. HIV+ subjects scored higher than HIV‐ subjects on measures of AIDS‐related adaptive coping (social support) and AIDS‐related maladaptive coping (aggression), but not on general coping. General coping was not specifically AIDS‐related, but was correlated positively with adaptive coping and negatively with maladaptive coping. These results suggest that earlier general coping is related to the later avoidance of maladaptive coping, and they have specific implications for teaching preventive strategies. AIDS‐related adaptive or maladaptive coping techniques may be used simultaneously, and coping behavior may change over time. Earlier social support is related positively to aspects of later coping in HIV+ men.
High‐Dose Naltrexone and Liver Function Safety
Authors: Marrazzi Mary Ann , Wroblewski Jill M. , Kinzie Joseph , Luby Elliot D.
Published: February 2010

Studies have found naltrexone useful in the treatment of diseases other than opiate addiction in which endogenous opioids presumably play a role, such as alcoholism and eating disorders. Some of these studies involve high doses (100–200 mg bid). Because investigational studies with high doses (300 mg/day) reported clinically significant increases in liver enzyme levels, the authors measured a spectrum of liver function parameters in response to high doses of naltrexone in a double‐blind, crossover trial (100 mg bid) followed by an open‐label period (200 mg bid). They observed no adverse clinical or laboratory changes in liver function in association with high‐dose naltrexone therapy in eating disorders.
Outcome of Trauma Patients After Brief Intervention by a Substance Abuse Consultation Service
Authors: Greber Roberta A. , Allen Karen M. , Soeken Karen L. , Solounias Bernadette L.
Published: February 2010

The Substance Abuse Consultation Service (SACS) at the University of Maryland Medical System (UMMS) conducts assessments and brief interventions for patients at the University Hospital and the Shock Trauma Center of the UMMS. This project examined a 10‐week sample of trauma patients (N = 30) seen by the SACS, for whom consultations and recommendations (including participation in formal treatment programs as well as 12‐step meetings) were provided. The authors used medical record reviews for background information and telephone interviews for follow‐up. Of 22 subjects reached by telephone, 6 reported that they had followed the SACS recommendations completely or partially, and 16 subjects reported they had not. Of the latter group, a majority reported self‐imposed abstinence or decreased use. No relationships existed between demographic characteristics or patterns of substance abuse and whether or not subjects acted upon SACS recommendations.
Craving for Cocaine in Addicted Users
Authors: Buydens‐Branchey Laure , Branchey Marc , Fergeson Paul , Hudson Jeffrey , McKernin Craig
Published: February 2010

Very few studies have examined the role of serotonin (5‐HT) in the modulation of craving for cocaine in cocaine‐addicted persons. The authors evaluated whether the acute increase in serotonergic neurotransmission after the administration of a challenging dose of the 5‐HT partial agonist meta‐chlorophenylpiperazine (m‐CPP) had an effect on spontaneous cocaine craving. Male inpatients (N = 31) who met DSM‐III‐R criteria for cocaine dependence completed 2 days of testing (separated by 48 hours) that involved the oral administration of m‐CPP (0.5 mg/kg of body weight) or placebo in random order and under double‐blind conditions. Patients' craving for cocaine was found to decrease significantly after the administration of m‐CPP. These data could provide evidence for a modulation of cocaine craving by 5‐HT systems.
A Measure of Readiness for Substance Abuse Treatment
Authors: Najavits Lisa M. , Gastfriend David R. , Nakayama Emilie Y. , Barber Jacques P. , Blaine Jack , Frank Arlene , Muenz Larry R. , Thase Michael
Published: February 2010

The Recovery Attitude and Treatment Evaluator‐Research (RAATE‐R) scale is a structured interview that assesses readiness for substance abuse treatment in five subscales: resistance to treatment, resistance to continuing care, biomedical acuity, psychological acuity, and environmental/social problems. Psychometric properties, based on an inter‐rater reliability analysis of 23 raters and administration of the scale to 116 cocaine‐dependent outpatients, included high interrater reliability, high internal consistency, independence of subscales, and a factor structure that partially supports the scale's original design. The authors discuss limitations of these conclusions and the lack of concurrent validity with a self‐report measure of therapy readiness.
Cost of Comorbid Alcohol and Drug Problems
Authors: Pirzada Sarmad R. , Ries Richard , LoGerfo James P.
Published: February 2010

The authors measured the comorbid effect of alcohol and other drug (AOD) problems on medical, surgical, and psychiatric inpatient charges and length of stay (LOS) in an urban hospital by use of retrospective study of hospital clinical computer data comparing AOD‐affected patients with non‐AOD‐affected patients in terms of cost, diagnostic, demographic, and utilization variables (N = 14,768). Patients were men and women with and without comorbid history of AOD problems, admitted for medical, surgical, and psychiatric reasons. For 10 of the 20 most frequent Diagnosis‐Related Groups (DRGs), total hospital charges and LOS were significantly lower in patients with comorbid AOD problems (P < 0.001). Overall, for the most frequent 20 DRGs, total charges and LOS remained significantly lower for the AOD group. Most physicians believed that AOD‐affected patients were often less ill than non‐AOD patients within the same DRG. Alcohol/drug‐affected patients had robustly lower costs and LOS. Fragmentation of psychosocial costs and addiction treatment from general health care and the fee‐for‐service DRG system appear to financially reward acute‐care hospitals to repeatedly treat secondary AOD sequelae without providing any apparent incentives for the treatment of the primary alcohol/drug condition itself.
Outpatient Non‐Opioid Detoxification for Opioid Withdrawal
Authors: McCann Michael J. , Miotto Karen , Rawson Richard A. , Huber Alice , Shoptaw Steven , Ling Walter
Published: February 2010

The authors examined characteristics of successful completers of an outpatient clonidine/oxazepam detoxification procedure for opioid dependence. Of 215 initial applicants, 167 received medication, and 65 successfully completed by taking a dose of naltrexone. Those who completed were more likely to have last used an opioid other than heroin, to be heroin smokers, rather than intravenous users, to have used benzodiazepines in the 30 days before treatment, and to have abstained from opioids for a longer time before presenting for treatment. New users (for less than 2 years) did no better than those using longer than 2 years. These findings may help in the continued refinement of patient placement criteria.
Predictors of Successful vs. Unsuccessful Outcome of a 12‐Step Inpatient Alcohol Rehabilitation Program
Authors: Craig Thomas J. , Krishna Gollivelli , Poniarski Richard
Published: February 2010

Comparison of successful vs. unsuccessful outcome at 1‐year follow‐up for 101 patients treated in a VAMC inpatient alcohol rehabilitation unit, which used a combined 12‐step facilitation/relapse prevention treatment model, revealed remarkably few predictors of outcome. However, one variable (self‐reported absence of a mainstream Christian religious preference) strongly predicted poor outcome, whereas absence of a family history of alcoholism or a positive history of combat experience predicted a successful outcome. These results are among the first to examine the characteristics of patients who do well or poorly in this type of program and may, if replicated, begin to provide a basis on which to develop clinical algorithms for patient‐treatment matching.
Characteristics of Smoked Drug Use Among Cocaine Smokers
Authors: Gorelick David A. , Simmons Michael S. , Carriero Nicholas , Tashkin Donald P.
Published: February 2010

The authors collected data by structured interview from a convenience sample of 228 physically healthy, largely (82%) treatment‐seeking, cocaine smokers with minimal histories of other smoked (other than tobacco and marijuana) or injection drug use. The vast majority of subjects also smoked either marijuana only (17.5%), tobacco only (17%), or both (61%), with onset of such smoking almost always (97%) preceding the initiation of regular cocaine smoking. There were few significant differences in sociodemographic or cocaine use characteristics among the subgroups of subjects smoking either cocaine only or cocaine and marijuana and/or tobacco. More than one‐third of marijuana smokers quit (45%) or decreased (38%) their use after starting regular cocaine smoking, whereas only 5% of tobacco smokers did so. These findings suggest that marijuana smoking is more influenced by regular cocaine smoking than is tobacco smoking.
The Relationship of Methadone Dose and Other Variables to Outcomes of Methadone Maintenance
Authors: Maddux James F. , Prihoda Thomas J. , Vogtsberger Kenneth N.
Published: February 2010

The authors evaluated the relationship of methadone dose to retention in treatment and to urine tests for morphine and cocaine in a cohort of 610 opioid users admitted to methadone maintenance and followed for 1 year. Methadone dosing was flexible, with patient participation in dose decisions. The maximum dose during treatment ranged from 10 mg to 110 mg, with a mean of 52 mg. Higher doses were associated with increased retention through the dose range of 60 mg‐69 mg. Dose was not related to the likelihood of a positive morphine test but was related to the likelihood of a positive cocaine test. In this study, with flexible dosing and patient participation in dose decisions, patients were retained on methadone about as well as was reported in a previous study with patients on a fixed dose of 80 mg.
Tolerability of Naltrexone in Treating Older, Alcohol‐Dependent Patients
Authors: Oslin David , Liberto Joseph C. , O'Brien John , Krois Stacy
Published: February 2010

The authors conducted an interim analysis of the tolerability of naltrexone among older, alcohol‐dependent adults. Thirty‐six subjects over 50 years old were enrolled in a 12‐week, double blind, placebo‐controlled efficacy study of naltrexone. Sixteen subjects received naltrexone and were compared with the placebo group for the development of adverse effects. Self‐reported adverse effects did not differ in frequency or duration between the placebo and naltrexone groups. There were no significant differences in laboratory values between the two groups. Naltrexone was well tolerated with no clinically significant adverse effects. However, the efficacy of naltrexone has yet to be determined in this age group.
Course and Severity of Substance Abuse Among Patients With Comorbid Major Depression
Authors: Westermeyer Joseph , Kopka Stacy , Nugent Sean
Published: February 2010

The authors assessed the course and severity of substance‐related disorder (SRD) among patients with comorbid major depressive disorder (MDD) by means of both retrospective and concurrent data. A total of 642 patients were assessed. Data on course included lifetime use, age at first use, years of use, use in the last year, periods of abstinence, and current diagnosis. Data on severity included two measures of SRD‐associated problems, substance abuse vs. dependence, self‐help activities, and number of substances being abused. SRD‐MDD patients tended to manifest lower levels of cannabis, opiate, and cocaine use, and more SRD‐only patients were abusing three or more substances. Men with SRD‐MDD demonstrated longer mean durations of abstinence compared with men with SRD‐only, whereas SRD‐MDD women demonstrated shorter mean durations of abstinence, compared with women with SRD‐only. MDD‐SRD patients showed slightly less substance abuse, but SRD severity was comparable with SRD‐only patients.
Social Phobia in Cocaine‐Dependent Individuals.
Authors: Myrick Hugh , Brady Kathleen T.
Published: February 2010

The authors explored the relationship between social phobia and cocaine dependence in 158 individuals entering a pharmacologic treatment trial for cocaine dependence. Twenty‐two patients met DSM‐III‐R criteria for social phobia. The social phobia group was compared with 22 age‐ and sex‐matched cocaine‐dependent control subjects. Those with social phobia and cocaine dependence were more likely to have additional psychiatric diagnoses and greater symptom severity, more likely to be polysubstance users, and more likely to have developed alcohol dependence at an early age. The authors discuss treatment implications of these data.
A Protocol to Switch High‐Dose, Methadone‐Maintained Subjects to Buprenorphine
Authors: Levin Frances Rudnick , Fischman Marian W. , Connerney Ingrid , Foltin Richard W.
Published: February 2010

Buprenorphine (BUP) is an alternative to methadone (METH) maintenance. However, there are few studies on the switching of patients from METH to BUP. Eighteen volunteers who had been maintained on METH for 1–19 years were recruited for a residential cocaine self‐administration study. All subjects were maintained on 60 mg METH for up to 1 1/2 weeks before the 7‐day changeover (60, 40, 30, 30, 0 mg METH; 4, 8 mg BUP). Fifteen subjects successfully completed the transfer from METH to BUP, experiencing moderate withdrawal symptoms, as measured by the Subjective Opiate Withdrawal Scale (SOWS). Withdrawal symptoms were the highest during the first assessment of the day, at the time of BUP administration. SOWS scores returned to baseline 4 days after the switchover. This study demonstrates that within a supportive inpatient setting, research volunteers can be rapidly switched from high‐maintenance doses of METH to BUP with an acceptable degree of tolerability.
Pergolide Mesylate:Adverse Events Occurring in the Treatment of Cocaine Dependence
Authors: Malcolm Robert , Moore Juliann W. , Kajdasz Daniel K. , Cochrane Carolyn E.
Published: February 2010

In this preliminary report from a placebo‐controlled, double‐blind, dose‐response study on the use of pergolide mesylate for cocaine dependence in outpatients, 8 out of 235 subjects noted adverse events requiring breaking of the blind. Events occurred at or within 7 days of receiving the first dose of medication and included side effects (four cardiovascular, one psychiatric); drug‐drug interactions (one); and clinical exclusions (two pregnancies). Two anecdotes of illicit abuse are reported. Although efficacy is unestablished, pergolide appears to be safe in the early treatment of cocaine dependence except where there are relative contraindications.
Recovery Rates After Treatment for Alcohol/Drug Dependence:Tobacco Users vs. Non‐Tobacco Users
Authors: Stuyt Elizabeth B.
Published: February 2010

Because it bas been seen repeatedly that using another addictive drug frequently leads to relapse to using the initial drug of choice, most chemical‐dependence treatment specialists recognize the necessity of addressing all drugs of abuse in the same treatment setting. This treatment philosophy, however, does not appear to apply to the drug nicotine. Although a significant number of persons with alcohol/drug dependence use tobacco on a regular basis, there do not appear to have been any studies conducted on the effect of nicotine use on outcome after treatment for alcohol/drug dependence. In a prospective study, the authors compared 12‐month recovery rates after inpatient treatment for alcohol/drug dependence in tobacco users and non‐tobacco users. Significantly better recovery rates were discovered for non‐tobacco users than tobacco users, especially if the drug of choice was a sedative, such as alcohol or narcotics. Data presented here support the theory that continued nicotine use may be a relapse factor for resuming alcohol use.
Can Cocaine Abuse Cause Parkinsonism?
Authors: Dhopesh Vasant P. , Yagnik Pratap M. , Weddington William W.
Published: February 2010

Dopamine deficiency is found in both chronic cocaine abusers and Parkinson's disease. The authors sought to determine whether parkinsonian signs occur in chronic cocaine abusers. Fifty male patients with a history of chronic heavy cocaine abuse were examined on the Unified Parkinson Disease Scale (UPDS) and compared with 20 non‐cocaine‐abusing age‐ and sex‐matched control subjects. UPDS scores of cocaine abusers ranged from 0 to 1 (mean: 0.08 ± 0.28) and, in control subjects, from 0 to 3 (mean: 0.15 ± 0.49; P = 0.5, NS). This study suggests that chronic heavy cocaine abuse does not cause parkinsonism.
Prevalence and Risk Factors of Illicit Drug Use by People With Disabilities
Authors: Moore Dennis , Li Li
Published: February 2010

The authors examined patterns and risk factors of illicit drug use among people with disabilities by use of a random sample of 1,876 persons actively involved in vocational rehabilitation services in three Midwestern states. Compared with regional drug use data from the general population, respondents with disabilities reported higher rates of illicit drug use for nearly every drug category. Factors significantly associated with illicit drug use included level of disability acceptance, best friends' drug use, attitude of disability entitlement, self‐esteem, and risk‐taking. These findings provide additional insight into illicit drug use among people with disabilities. The authors discuss implications from these findings for rehabilitation and disability policy. (Am J Addict 1998; 7:93–102)
Psychosocial Risk and Protective Factors for Condom Use Among Female Injection Drug Users
Authors: Brook David W. , Brook Judith S. , Whiteman Martin , Win Pe Thet , Masci Joseph R. , Roberto Josephine , Catalogne Jacques de , Amundsen Frances
Published: February 2010

The authors examined the influences of domains of psychosocial risk and protective factors on male‐partner condom use in a cohort of 209 female HIV‐positive (HIV+) and HIV‐negative (HIV‐) injection drug users (IDUs) by use of a cross‐sectional, retrospective design. Information collected from a structured questionnaire included data on psychosocial risk and protective factors in the personality, family, and peer domains; HIV status; and condom use. Among HIV+ IDUs, personality risk factors (e.g., unconventionality), family (e.g., low maternal identification), and peer factors were related to less male‐partner condom use. Resources and condom availability were associated with greater male condom use with both HIV+ and HIV‐ IDUs. The psychosocial domains affected male condom use with both HIV+ and HIV‐ female IDU patients via two different mediational models. The findings suggest the need to use specific psychosocial interventions for risky sexual behavior among HIV+ and HIV‐ female IDUs. (Am J Addict 1998; 7:115–127)
Posttraumatic Stress Disorder and Cocaine Dependence: Order of Onset
Authors: Brady Kathleen T. , Dansky Bonnie S. , Sonne Susan C. , Saladin Michael E.
Published: February 2010

To investigate differences between patients whose posttraumatic stress disorder (PTSD) preceded their cocaine dependence and vice versa, 33 patients with comorbid PTSD and cocaine dependence were divided into two groups: one in which the trauma and PTSD occurred before onset of cocaine dependence (primary PTSD) and one in which the PTSD occurred after cocaine dependence was established (primary cocaine). In the primary‐PTSD group, the trauma was generally childhood abuse. In the primary‐cocaine group, the trauma was generally associated with the procurement and use of cocaine. In the primary‐PTSD group, there were significantly more women, more other Axis I diagnoses, more Cluster B and C Axis II diagnoses, and more benzodiazepine and opiate use. In the primary‐Cocaine group, there was a trend toward more cocaine use in the previous month. Significant clinical differences between these two groups may warrant different types of treatment or differing treatment emphasis. (Am J Addict 1998; 7:128–135)
Effect of Fenfluramine Challenge on Cocaine Craving in Addicted Male Users
Authors: Buydens‐Branchey Laure , Branchey Marc , Hudson Jeffrey , Rothman Michael , Fergeson Paul , McKernin Craig
Published: February 2010

The authors studied the effects of a challenging dose of the serotonin (5‐HT)‐releaser/reuptake inhibitor d,l‐fenfluramine (FEN) on spontaneous cocaine craving in a group of cocaine‐addicted users in order to evaluate the involvement of serotonergic pathways in the modulation of craving for cocaine. Nineteen cocaine‐dependent male inpatients received 60 mg of FEN or placebo (double‐blind). Data were compared with those obtained in a previous study of another serotonergic probe, the partial postsynaptic agonist meta‐chlorophenyl‐piperazine (m‐CPP). FEN significantly reduced cocaine craving and increased cortisol and prolactin when compared with placebo. When the responses to the two drugs were compared, there were no differences in the cortisol and prolactin rises, but m‐CPP was a more potent inhibitor of cocaine craving than FEN. These data suggest that 5‐HT releasers/reuptake inhibitors and serotonergic agents with greater postsynaptic activity should be further examined. (Am J Addict 1998; 7:142–155)
Use of Anticonvulsants in Benzodiazepine Withdrawal
Authors: Pages Kenneth P. , Ries Richard K.
Published: February 2010

The problem of dependence on benzodiazepines has been aggravated by iatrogenic physiologic dependence on these medications and by polysubstance abusing patients using them in addition to other agents. A safe, rapid, and effective way to detoxify patients from benzodiazepines is of prime importance to facilitate further treatment of their psychiatric or substance use disorder. Patients withdrawing from these agents may experience physiologic withdrawal, rebound, and recurrence. In this paper the authors review the typical syndrome associated with withdrawal from benzodiazepines and discuss treatment of benzodiazepine withdrawal using carbamazepine and valproate.
Comparing IV and Non‐IV Cocaine Users: Characteristics of a Sample of Cocaine Users Seeking to Participate in Research
Authors: Lexau Benjamin J. , Nelson David , Hatsukami Dorothy K.
Published: February 2010

The authors examined differences between current intravenous (IV), past IV, and no IV cocaine use among a sample of cocaine users on measures of drug use, medical history, psychiatric history, and criminal history. Past IV cocaine users were older than non‐IV cocaine users. The current IV cocaine‐using group included more white participants, and the non‐IV group included more African Americans. Those with past or current IV use had more extensive drug use histories than non‐IV users. Also, more current and past IV cocaine‐using groups reported having been tested for HIV and reported testing positive for hepatitis. Former IV cocaine users reported more emergency room visits for complications stemming from cocaine use. They also reported more treatment for substance abuse and were convicted of more crimes. These results suggest that the route of administration is important in studying the characteristics of drug users.
Effect of LAAM Dose on Opiate Use in Opioid‐Dependent Patients:A Pilot Study
Authors: Oliveto Alison H. , Farren Conor , Kosten Thomas R.
Published: February 2010

The authors conducted a 16‐week study with nine opioid‐dependent individuals (six male; four white/two African American/three Hispanic; age 36.8±2.2 years). Participants were assigned to either a low‐dose (165 mg/week; n = 5) or high‐dose (330 mg/week; n = 4) Levo‐alpha‐acetylmethadol (LAAM) condition according to a randomized, double‐blind, within‐subjects crossover design, such that they were inducted onto one maintenance dose for 4 weeks and then were crossed over to receive the converse for 4 weeks. Subsequently, individuals underwent detoxification from LAAM. Eight of nine participants completed the study protocol. The proportion of urine samples positive for opiates was 0.22 ± 0.08 and 0.53 ± 0.12, under the high‐ and low‐dose conditions, respectively (F = 11.8; P = 0.01). These results show that LAAM dose regimen affects the degree of abstinence from opioids.
A Pilot Study Comparing Severely and Persistently Mentally III Opiate‐Addicted Patients in Dual‐Diagnosis Treatment With Patients in Methadone Maintenance
Authors: Jaffe Craig , Comtois Katherine Anne , Calsyn Donald A. , Saxon Andrew J.
Published: February 2010

The authors describe a severely and persistently mentally ill (SPMI) opiate‐addicted (OA) patient sample (n = 43) in a dual‐diagnosis outpatient treatment program by demographic, clinical, and treatment characteristics and compare these with other dually diagnosed SPMI patients in the same treatment center (n = 297). Also, those SPMI/OA patients with physiological dependence (n = 20) were compared with a matched sample of OA patients in traditional methadone maintenance (n = 20). The authors then present a clinical evaluation of treatment course and outcome for the SPMI/OA patients (n = 43) and discuss implications from these pilot data.
Treatment of Depressed Methadone Maintenance Patients With Nefazodone: A Case Series
Authors: Hamilton Steven P. , Klimchak Carol , Nunes Edward V.
Published: February 2010

The authors presented four consecutive case studies in which depressed methadone‐maintained patients previously treated with other drugs, such as sertraline, risperidone, and bupropion, and who did not respond and/or suffered various side effects, responded well to nefazodone.
Further Validation of the Obsessive‐Compulsive Drinking Scale (OCDS)
Authors: Moak Darlene H. , Anton Raymond F. , Latham Patricia K.
Published: February 2010

The authors administered the Obsessive‐Compulsive Drinking Scale (OCDS), a self‐rated questionnaire that quantifies some cognitive and behavioral dimensions of “craving” for alcohol, to 124 alcohol‐dependent subjects in three pharmacological treatment studies. The OCDS total scores had significant correlations with both the Alcohol Dependence Scale (r = 0.42; P<0.0001) and the alcohol subscale of the Addiction Severity Index (r = 0.44; P<0.0001). Previous alcoholism treatment was associated with higher OCDS Total and Obsessive subscale scores. These data support the congruent validity of the OCDS with previously well established measures of alcohol dependence severity and suggest that this measurement of craving may help in formulating appropriate treatment plans for alcoholic patients.
Anger and Depressive States Among Treatment‐Seeking Drug Abusers: Testing the Psychopharmacological Specificity Hypothesis
Authors: Aharonovich Efrat , Nguyen Hueco T. , Nunes Edward V.
Published: February 2010

The aim of this study was to examine the self‐medication hypothesis (SMH) of substance abuse. The SMH suggests that drug abuse is driven by an attempt to alleviate specific psychological distress. One prediction from the SMH hypothesis is that drugs of abuse, because of their different pharmacological properties, attract specific patient subgroups. Specifically, this study tested the hypothesis1 that opiate abusers experience difficulty managing aggression and that cocaine abusers suffer from distress associated mostly with depression. The State‐Trait Anger Expression Inventory (STAXI) and the Beck Depression Inventory II were used to examine levels of anger and depression among three groups of substance abusers (opiates, cocaine, cannabis), defined by their primary drug of abuse. Anger and depression scores were elevated, but contrary to Khantzian's hypothesis, there were few differences between groups, and if anything, opiate addicts were more depressed and the cocaine abusers were angrier on several subscales. Data are discussed in terms of diagnosis and clinical treatment implications.
Abuse and Violence History of Men and Women in Treatment for Methamphetamine Dependence
Authors: Cohen Judith B. , Dickow Alice , Horner Kathryn , Zweben Joan E. , Balabis Joseph , Vandersloot Denna , Reiber Chris ,   The Methamphetamine Treatment Project
Published: February 2010

The Methamphetamine Treatment Project offers the opportunity to examine the history of abuse and violence in a sample of 1016 methamphetamine users participating in a multisite study between 1999–2001. Reporting of abuse and violence was extensive, with 80% of women reporting abuse or violence from a partner. Men were more likely to report experiencing violence from friends and others. A high percentage of study participants reported a variety of threatening or coercive experiences with their partners. Past and current interpersonal violence is a characteristic of the lifestyles of the majority entering treatment for methamphetamine dependence.
Looking Back on Cocaine Dependence: Reasons for Recovery
Authors: Flynn Patrick M. , Joe George W. , Broome Kirk M. , Simpson D. Dwayne , Brown Barry S.
Published: February 2010

Factors that contributed to long‐term recovery from cocaine dependence were examined as part of a 5‐year national follow‐up study of 708 patients from 45 treatment programs in eight U.S. cities. Outcomes from 33% of the sample were highly favorable at follow‐up, including no drugs detected in urine or hair specimens, no self‐reported use of any drugs, less than daily alcohol use, and no illegal activity or arrests during the past year. Major reasons cited for these improvements were motivations to change, positive influences of family, strength from religion and spirituality, and help from drug treatment. “Recovery” was viewed as a continuous process and one that benefits from lessons learned in treatment. These retrospective attributions affirm many of the same findings from prospective outcome studies and contribute to a conceptual framework for treatment process and recovery.
Gender Differences in Individuals with Comorbid Alcohol Dependence and Post‐traumatic Stress Disorder
Authors: Sonne Susan C. , Back Sudie E. , Zuniga Claudia Diaz , Randall Carrie L. , Brady Kathleen T.
Published: February 2010

This study investigated gender differences in a sample of outpatient, treatment‐seeking individuals (N = 84) with comorbid alcohol dependence and post‐traumatic stress disorder (PTSD). Assessments included substance use severity, trauma history, PTSD symptomatology, and comorbid psychiatric disorders. Men reported an earlier age of onset of alcohol dependence, greater alcohol use intensity and craving, and more severe legal problems due to alcohol use. Women reported greater exposure to sexually related traumas, greater frequency and intensity of avoidance of trauma‐related thoughts and feelings, and greater social impairment due to PTSD. Women were more likely than men to demonstrate higher rates of other anxiety disorders and test positive for cocaine at treatment entry. PTSD more often preceded alcohol dependence in women than in men. The results illustrate a number of gender differences that may shed light on etiologic models of comorbid alcohol dependence and PTSD.
A Comparison of the Patterns of Drug Use among Patients with and without Severe Mental Illness
Authors: Gandhi Devang H. , Bogrov Moira U. , Osher Fred C. , Myers C. Patrick
Published: February 2010

We compared the patterns of substance use among patients with severe mental illness (SMI) served by three community treatment teams, substance users with non‐severe mental illness (NSMI), and substance abusers without mental illness (no mental illness: NMI). There were highly significant differences in substance use patterns among the groups: among patients with SMI, the order of drug preference was alcohol, cocaine, cannabis, and then heroin; in the NMI group, it was cocaine, alcohol, heroin, and then cannabis; while in the NSMI group, it was alcohol, cocaine, heroin, and then cannabis. The data suggest that the choice of drugs by individuals with SMI may be determined by factors related to their illness, in addition to the price and availability of the particular drug.
Pharmacological Mechanisms of Naltrexone and Acamprosate in the Prevention of Relapse in Alcohol Dependence
Authors: Littleton John , Zieglgänsberger Walter
Published: February 2010

Naltrexone and acamprosate may ultimately prove to be useful additions to pharmacotherapy for alcoholism by reducing relapse. Naltrexone is a relatively selective competitive antagonist at mu‐opioid receptors, and this activity may explain its anti‐relapse action either because endogenous opioids are involved in the positively reinforcing effects of alcohol and/or because these same transmitters are involved in the conditioned anticipation of these effects. In contrast, the pharmacology of acamprosate is still poorly understood. This is not surprising because it is a small flexible molecule with similarities to several neuro‐active amino acids and is used in high doses. All these factors suggest that it may have multiple actions. Currently, the best explanation for the effects of acamprosate seems to be that it inhibits the glutamatergic transmitter system involved in both the negative reinforcing effects of alcohol and the conditioned “pseudo‐withdrawal” that may be important in cue‐induced relapse.
Alcohol Use Disorders: Screening and Diagnosis
Authors: Maisto Stephen A. , Saitz Richard
Published: February 2010

The purpose of this article is to provide an overview of empirically supported, primarily self‐report methods of screening and diagnosis related to alcohol use disorders (AUDs). The discussion of screening instruments focuses on the primary care setting, and the diagnosis instruments discussion centers on the alcohol (and other drug) treatment setting. The literature shows that the AUDIT and the CA GE are the most widely validated methods of screening for AUDs in primary care and may be applied readily in that context. Similarly, a number of instruments designed to derive DSM‐IV (and ICD‐10) AUD diagnoses, as well as constructs related to how AUDs are defined, are available and can meet a variety of clinical needs. Future research priorities include further development of brief methods to identify hazardous drinkers or individuals who have an AUD, as well as refinement of diagnosis instruments to increase their application across treatment settings and subpopulations.
Dual Diagnosis: Alcoholism and Co‐Morbid Psychiatric Disorders
Authors: Kranzler Henry R. , Rosenthal Richard N.
Published: February 2010

Although alcohol use disorders are commonly associated with co‐morbid drug use and psychiatric disorders, such co‐morbidity is frequently underdiagnosed and inadequately treated. This paper reviews the epidemiological, diagnostic, and treatment literature on the co‐morbidity of alcoholism, with a focus on the most common co‐morbid disorders: drug abuse, mood disorders, anxiety disorders, and antisocial personality disorder. The paper goes on to describe a number of promising approaches to the treatment of these common co‐morbid disorders in alcoholics. Despite the difficulties inherent in treating dual diagnosis patients, the clinician must recognize that it is possible to derive valid diagnoses and deliver efficacious treatment to such patients.
What General Psychiatrists Ask Addiction Psychiatrists: A Review of 381 Substance Abuse Consultations in a Psychiatric Hospital
Authors: Greenfield Shelly F. , Hennessy Grace , Sugarman Dawn E. , Weiss Roger D.
Published: February 2010

We reviewed the records of 381 consecutive substance abuse consultations completed by the Substance Abuse Consultation Service (SACS) of McLean Hospital to ascertain 1) the most frequent reasons why general psychiatrists consulted the SACS, and 2) the clinical characteristics of these patients. The most frequent reasons for consultation were to make aftercare recommendations (66.1%) or to make (19.7%) or clarify (6.3%) a substance use disorder (SUD) diagnosis. Mood disorders were the most prevalent co‐occurring psychiatric disorder; alcohol use disorders were the most prevalent SUDs. The findings indicate the potential utility of a substance abuse consultation service in a psychiatric hospital.
Coping Styles and Response to High versus Low‐Structure Individual Counseling for Substance Abuse
Authors: Thornton Charles , Gottheil Edward , Attar Ash win , Einstein Stephen
Published: February 2010

We compared outcomes during and after treatment for mixed substance dependent patients (N = 143) randomly assigned to a high‐structure, behavior ally‐oriented (FSB) or a low‐structure, facilitate (LSF) individual counseling style. We hypothesized that patients with different coping characteristics would respond differently to the two styles of counseling. Patients were treated in once‐weekly individual FSB or LSF counseling for up to 12 weeks. Outcome measures included patient and counselor ratings of benefit, retention, symptom reduction, and negative urines; follow‐up assessments included control of substance use and psychosocial adjustment. While no differences in outcomes during or after treatment were found for the FSB and LSF patients, both groups did improve equally. Contrary to our hypothesis, our coping measures did not predict different outcomes for patients treated in the LSF and FSB styles. Post‐hoc analyses, however, revealed that outcomes could be predicted in each style from patterns of pretreatment characteristics, which included measures of coping strategies, psychological characteristics, and treatment readiness. Moreover, the patterns associated with positive outcomes were different for the FSB and LSF patients: high treatment readiness was most important for success in FSB counseling, while low psychiatric severity and positive coping styles were important for the LSF clients. The finding of no FSB‐ASF outcome differences calls into question the exclusive emphasis on behavioral treatment approaches by the present‐day managed care industry. Also, the traditional approach to matching studies, ie, employing one patient characteristic at a time to predict differential outcomes for particular treatments, may be simplistic. An alternative approach employing multivariate statistical procedures to predict outcomes from several patient characteristics may hold more promise.
Changing Trends in Heroin‐Related Deaths in Sydney, Australia‐1995 to 1999
Authors: Sheedy Donna L. , Garrick Therese M. , Fortis Andrew H. , Harper Clive G.
Published: February 2010

This 1997–1999 study replicates an earlier one (1995–1997) in which coronial cases were reviewed at the Department of Forensic Medicine in Australia. Ten percent of the 2945 cases were considered accidental illicit drug deaths, compared to 4% in the previous study. Heroin was associated with 90% of the deaths, but in only 17% of these cases as a single drug. Concomitant drug use, in particular alcohol, benzodiazepines, and antidepressants, has increased considerably. The combined effects of these substances might play a role in the disturbingly large increase in heroin (morphine) related deaths during this period.
Relationship of Tobacco Use to Depressive Disorders and Suicidality Among Patients Treated for Alcohol Dependence
Authors: Patten Christi A. , Hurt Richard D. , Offord Kenneth P. , Croghan Ivana T. , Gomez‐Dahl Leigh C. , Kottke Thomas E. , Morse Robert M. , Melton L. Joseph
Published: February 2010

This population‐based, retrospective cohort study examined the association of tobacco use and diagnosis of a depressive disorder (DD) and suicide attempts (SA) before and after discharge from an inpatient addiction program (IAP). All 813 Olmsted County, Minnesota residents (537 males, 276 females) admitted for the first time to the IAP for treatment of alcoholism during the period 1972–1983 were studied. Tobacco use status at admission was classified as ever (current or former use) (85.5%), never (8.6%), or missing (5.9%). Subjects were followed through 1994. Current or former use of tobacco was markedly lower among those with a prior diagnosis of DD than those without this diagnosis (73.6% vs. 89.3%>,p< 0.001). Although females were more likely to have a diagnosis of DD and were less likely to have ever used tobacco than males, gender did not explain the relationship between tobacco use and DD. Tobacco use status was unrelated to a DD diagnosis after discharge from the IAP and was not associated with SA.
The Effectiveness of Combined Naloxone/Lofexidine in Opiate Detoxification: Results from a Double‐blind Randomized and Placebo‐controlled Trial
Authors: Beswick Tracy , Best David , Bearn Jenny , Gossop Michael , Rees Sian , Strang John
Published: February 2010

The efficacy of lofexidine/naloxone was compared with lofexidine/placebo in a double‐blind, randomized, placebo‐controlled trial in 89 opiate‐dependent patients. There were no significant differences between the two groups in the proportion of patients completing detoxification or in the length of stay. Patients in the active naloxone group demonstrated gradual reductions in levels of withdrawal and craving over the detoxification period. At completion of detoxification, patients who received naloxone maintained a level of withdrawal consistently lower than that in the placebo group; however, naloxone did not substantially accelerate the resolution of the withdrawal syndrome. Implications for future research are discussed.