Drug and Alcohol Dependence

Editorial Board

2010-09-01

Robert Balster resigns as Editor-in-Chief of Drug and Alcohol Dependence

Robert L. Balster — 2010-09-01

Effective June 2010, I resigned as Editor-in-Chief of Drug and Alcohol Dependence (DAD). I did so because I have been serving in this role for over 12 years and felt it was time to move on to some new challenges. Editing this journal has been a significant part of my professional life and one of the most rewarding scholarly activities I have been involved with. Without question, the most interesting part is the correspondence concerning submissions involving authors and reviewers. There is nothing quite so educational about a research field than to read over a good submission, identify experts in those areas of research, and then read over the short essays that reviewers typically write outlining some of the strengths and weaknesses of the research. This is often followed by the author's reply and possibly another round of review. I know that many editors feel that some of the best information in the publishing process is contained in the review correspondence, and I often feel that way too. It is a privilege to be a party to this effort. No editor can be an expert in every area of work in which we receive submissions, and that is especially true for a multidisciplinary journal such as DAD. I am indebted to all of the authors and reviewers who work so hard to make this journal a forum for excellence in the substance abuse field.

Changes at Drug and Alcohol Dependence

Eric C. Strain — 2010-09-01

After over twelve years as Editor in Chief of Drug and Alcohol Dependence (DAD), Dr. Robert Balster has stepped down from his position with the journal. Bob has seen the journal through tremendous changes, including the use of an online submission process, a marked increase in the number of papers reviewed and published, and the establishment of Associate Editors that have helped to manage the journal's growth. He leaves DAD in great shape, and it will be hard to fill his shoes. I want to take this opportunity to publically thank Bob for all of the work he has done to advance the journal, and just as importantly, for how he has advanced the scientific field of addictions research. While transitions such as this can be difficult, he has been very accessible and immense help with ensuring a smooth process through the change in leadership for DAD.

Measuring addiction propensity and severity: The need for a new instrument

2010-09-01

Abstract: Drug addiction research requires but lacks a valid and reliable way to measure both the risk (propensity) to develop addiction and the severity of manifest addiction. This paper argues for a new measurement approach and instrument to quantify propensity to and severity of addiction, based on the testable assumption that these constructs can be mapped onto the same dimension of liability to addiction. The case for this new direction becomes clear from a critical review of empirical data and the current instrumentation. The many assessment instruments in use today have proven utility, reliability, and validity, but they are of limited use for evaluating individual differences in propensity and severity. The conceptual and methodological shortcomings of instruments currently used in research and clinical practice can be overcome through the use of new technologies to develop a reliable, valid, and standardized assessment instrument(s) to measure and distinguish individual variations in expression of the underlying latent trait(s) that comprises propensity to and severity of drug addiction. Such instrumentation would enhance our capacity for drug addiction research on linkages and interactions among familial, genetic, psychosocial, and neurobiological factors associated with variations in propensity and severity. It would lead to new opportunities in substance abuse prevention, treatment, and services research, as well as in interventions and implementation science for drug addiction.

The effectiveness of brief intervention among injured patients with alcohol dependence: Who benefits from brief interventions?

Craig A. Field, Raul Caetano — 2010-09-01

Abstract: Background: Research investigating the differential effectiveness of Brief Motivational Interventions (BMIs) among alcohol-dependent and non-dependent patients in the medical setting is limited. Clinical guidelines suggest that BMI is most appropriate for patients with less severe alcohol problems. As a result, most studies evaluating the effectiveness of BMI have excluded patients with an indication of alcohol dependence.Methods: A randomized controlled trial of brief intervention in the trauma care setting comparing BMI to treatment as usual plus assessment (TAU+) was conducted. Alcohol dependence status was determined for 1336 patients using DSM-IV diagnostic criteria. The differential effectiveness of BMI among alcohol-dependent and non-dependent patients was determined with regard to volume per week, maximum amount consumed, percent days abstinent, alcohol problems at 6 and 12 months follow-up. In addition, the effect of BMI on dependence status at 6 and 12 months was determined.Results: There was a consistent interaction between BMI and alcohol dependence status, which indicated significantly higher reductions in volume per week at 6 and 12 months follow-up (β=−.56, p=.03, β=−.63, p=.02, respectively), maximum amount at 6 months (β=−.31, p=.04), and significant decreases in percent days abstinent at 12 months (β=.11, p=.007) and alcohol problems at 12 months (β=−2.7, p12=.04) among patients with alcohol dependence receiving BMI. In addition, patients with alcohol dependence at baseline that received BMI were .59 (95% CI=.39–.91) times less likely to meet criteria for alcohol dependence at six months.Conclusions: These findings suggest that BMI is more beneficial among patients with alcohol dependence who screen positive for an alcohol-related injury.

The relationship of quality and price of the psychostimulants cocaine and amphetamine with health care outcomes

Tibor M. Brunt, Margriet van Laar, Raymond J.M. Niesink, Wim van den Brink — 2010-09-01

Abstract: A major component of the illicit drug market can be subcategorized as the psychostimulant drug market, with cocaine and amphetamine as popular constituents. In The Netherlands, an increase in both health care outcomes addiction treatment and hospital admissions was noted for both amphetamine and cocaine throughout a period of 17 years (1992–2008). Both cocaine price and quality showed a decrease in The Netherlands during the studied period. We used time-series regression analysis to investigate whether price or quality of the drugs were associated with health care outcomes. Drug seizures were also added to the time-series regressions in order to check for possible effects of drug availability and supply. Price and quality of cocaine were strongly associated with health care outcomes of addiction treatment and hospital admissions. Price of amphetamine also showed a decrease during these 17 years, but was associated with an increase in addiction treatment only. Other amphetamine market variables did not show any relationship with the health care outcomes. It could be stated that following basic market logics does not apply equally to all psychostimulants of abuse. Other factors might play a role, such as the addictiveness or desirability of a specific drug in question. This finding is supportive of the dynamics of the illicit psychostimulant market affecting actual use and thereby health care outcomes.

Dimethyltryptamine (DMT): Subjective effects and patterns of use among Australian recreational users

Vince Cakic, Jacob Potkonyak, Alex Marshall — 2010-09-01

Abstract: Dimethyltryptamine (DMT) is an endogenous hallucinogen with traditional use as a sacrament in the orally active preparation of ayahuasca. Although the religious use of ayahuasca has been examined extensively, very little is known about the recreational use of DMT. In this study, Australian participants (n=121) reporting at least one lifetime use of DMT completed an online questionnaire recording patterns of use, subjective effects and attitudes towards their DMT use. Smoking DMT was by far the most common route of administration (98.3%) with a comparatively smaller proportion reporting use of ayahuasca (30.6%). The reasons for first trying DMT were out of a general interest in hallucinogenic drugs (46.6%) or curiosity about DMT's effects (41.7%), while almost one-third (31.1%) cited possible psychotherapeutic benefits of the drug. An increase in psychospiritual insight was the most commonly reported positive effect of both smoked DMT (75.5%) and ayahuasca (46.7%), a finding that is consistent with other studies examining the ritualised use of ayahuasca in a religious context. Although previous studies of DMT use have examined ayahuasca use exclusively, the present study demonstrates the ubiquity of smoking as the most prevalent route of administration among recreational DMT users.

The role of drinking locations in university student drinking: Findings from a national web-based survey

Kypros Kypri, Mallie J. Paschall, John D. Langley, Joanne Baxter, Beth Bourdeau — 2010-09-01

Abstract: Background: The study examined associations between type of drinking location and alcohol use in a national sample of New Zealand university students.Methods: We conducted a cross-sectional web-based survey with random sampling of 17- to 24-year-old undergraduates from six university campuses in 2005. There were 2548 respondents (response fraction: 63%). Measures included the number of standard drinks (10g ethanol) consumed on each day of the preceding week in pubs/bars/nightclubs, student flats/houses, residential halls, and ‘other’ locations (e.g., restaurants). We used multilevel regression to test for associations between type of drinking location and consumption per episode, adjusting for student- and episode-level covariates.Results: Respondents consumed an average of 7.1 drinks (SD 5.2) per drinking day, including 5.4 drinks (SD 4.5) in pubs/bars/nightclubs, flats/houses, and residential halls, and 3.7 drinks (SD 3.4) in other locations. Overall, men drank more per location (mean 8.4, SD 6.3) than did women (mean 6.2, SD 4.0). Multilevel analyses revealed positive associations between the first three location types and drinks per episode relative to other locations when adjusting for student- and episode-level covariates including duration of episode.Conclusions: Certain drinking locations (i.e., pubs, residential halls, off-campus houses) appear to promote or facilitate heavy alcohol consumption among students. Better enforcement of laws prohibiting service to intoxication should be prioritized to reduce alcohol-related harm among university students. Consideration should be given to strengthening alcohol policies in residential halls and methods for managing heavy drinking in private residences.

Injection of buprenorphine and buprenorphine/naloxone tablets in Malaysia

B. Vicknasingam, M. Mazlan, R.S. Schottenfeld, M.C. Chawarski — 2010-09-01

Abstract: Background: Buprenorphine maintenance is efficacious for treating opioid dependence, but problems with diversion and misuse of buprenorphine (BUP) may limit its acceptability and dissemination. The buprenorphine/naloxone combination tablet (BNX) was developed to reduce potential problems with diversion and abuse. This paper provides data regarding the characteristics of BUP injection drug users in Malaysia and preliminary data regarding the impact of withdrawing BUP and introducing BNX. BUP was introduced in 2002 and subsequently withdrawn from the Malaysian market in 2006. BNX was introduced in 2007.Methods: A two wave survey of BUP IDUs was conducted shortly prior to BUP withdrawal from the Malaysian market (n=276) and six months after BNX was introduced (n=204). Six focus groups with BUP and/or BNX IDUs were also conducted shortly before the second wave.Results: In addition to current BUP or BNX IDU, 96% of first wave participants and 97% second wave participants reported lifetime heroin IDU preceding the onset of their BUP/BNX IDU. Additionally, 58% of first and 64% of second wave survey participants reported current heroin IDU. Benzodiazepine abuse, often injected with BUP, was reported in both the surveys. Focus group participants reported that BNX was not as desirable as BUP, nonetheless, the results of the second wave survey suggest a continuing widespread BNX IDU, at least in Kuala Lumpur.Conclusions: In Malaysia, BUP and BNX IDU occur among heroin IDUs. The introduction of BNX and withdrawal of BUP may have helped to reduce, but did not eliminate the problems with diversion and abuse.

Effectiveness of diacetylmorphine versus methadone for the treatment of opioid dependence in women

2010-09-01

Abstract: Background: There is consistent evidence showing women access treatment with more severe substance-related profiles relative to men; however, treatment outcome evaluation shows inconclusive results regarding gender differences. Furthermore, few studies evaluate response by gender.Methods: The present analyses were performed using data from the NAOMI study, an open-label, phase III randomized controlled trial, carried out between 2005 and 2008 in Vancouver and Montreal, Canada. A total of 226 long-term treatment-refractory opioid dependent individuals were randomized to receive injectable diacetylmorphine or oral methadone for 12 months. Patients in both treatment groups were offered psychosocial and primary care services. Main outcomes were retention in addiction treatment at 12 months. Drug use, health, psychosocial adjustment and health-related quality of life were examined at baseline and during treatment, using the European Addiction Severity Index, Maudsley Addiction Profile, SF-6D and EuroQol EQ-5D.Results: A total of 88 (38.9%) females and 138 (61.1%) males were included in the present analysis. Retention rates among female participants in the diacetylmorphine group were significantly higher than oral methadone (83.3% vs. 47.8%). Males receiving diacetylmorphine improved significantly more than females in physical health, health-related quality of life, and family relations but female participants in the diacetylmorphine group had significantly greater improvements in illicit drug use scores and psychological health compared to females allocated to oral methadone.Conclusions: Among long-term opioid dependent women who have not benefited sufficiently from available treatments, medically prescribed diacetylmorphine is more effective than oral methadone. Men receiving diacetylmorphine showed more improvements than women.

Bringing the real world into the laboratory: Personal smoking and nonsmoking environments

2010-09-01

Abstract: Pictorial representations of specific environments related to smoking can evoke robust craving to smoke, even in the absence of any proximal cues to smoke (e.g., cigarettes, lighters). To evaluate the salience of smoking environment cues, we developed a novel procedure for bringing smokers’ real world smoking and nonsmoking environments into the laboratory to compare them with standard (i.e., not personalized) environments within a cue-reactivity paradigm. Seventy-two smokers used digital cameras to take pictures of the environments in which they do and do not smoke. They then completed a cue-reactivity session during which they viewed and rated pictures of smoking and nonsmoking environments, half personal and half standard, all devoid of proximal smoking cues. As hypothesized, personal environments led to a significantly larger smoking–nonsmoking difference in craving, compared with the standard environments. Personalization also enhanced stimuli vividness, relevance, positive affect, and excitement, as well as heart rate changes from baseline. Implications of these findings for exposure-based research and treatment for addiction, as well as other psychological disorders, are discussed.

Effects of experimental Unemployment, Employment and Punishment analogs on opioid seeking and consumption in heroin-dependent volunteers

Mark K. Greenwald — 2010-09-01

Abstract: This study investigated the extent to which hydromorphone (HYD) choice and behavioral economic demand differed during experimental analogs of Unemployment (Drug Only: HYD and no money alternative), Employment (Drug or Money: HYD and $4 alternative), and Punishment (Drug Only+Money Loss: HYD only and $4 subtracted for each HYD choice), in the context of anticipated high vs. low post-session drug availability (HYD 24mg vs. placebo). Eleven heroin-dependent, buprenorphine-stabilized (8mg/day) volunteers first sampled two HYD doses (0 and 24mg IM in randomized, counterbalanced order, labeled Drug A [session 1] and Drug B [session 2]). In each of the final six sessions, volunteers were given access to a 12-trial choice progressive ratio (PR) task and could work to receive HYD unit doses (2mg each); cumulative dose units earned were administered in a bolus injection after the work session. Before the PR task, volunteers were told which HYD dose (Drug A or B) would be available 3h after the PR-contingent injection. Relative to Unemployment (Drug Only), Employment (Drug or Money) and Punishment (Drug Only+Money Loss) each significantly suppressed HYD seeking (e.g., breakpoints). Employment and Punishment also reduced HYD behavioral economic demand, but via different mechanisms: Employment increased HYD price-elasticity, whereas Punishment decreased HYD demand intensity. Adjusting for the initial level difference (i.e., normalized demand), Employment significantly decreased Pmax (i.e., lower “essential value” of HYD) and Omax (maximum HYD responding) compared to Punishment or Unemployment. These effects were not significantly altered by post-session drug availability.

Prevalence and predictors of transitions to and away from syringe exchange use over time in 3 US cities with varied syringe dispensing policies

2010-09-01

Abstract: Syringe exchange programs (SEPs) can reduce HIV risk among injecting drug users (IDUs) but their use may depend heavily on contextual factors such as local syringe policies. The frequency and predictors of transitioning over time to and from direct, indirect, and non-use of SEPs are unknown. We sought, over one year, to: (1) quantify and characterize transition probabilities of SEP attendance typologies; (2) identify factors associated with (a) change in typology, and (b) becoming and maintaining Direct SEP use; and (3) quantify and characterize transition probabilities of SEP attendance before and after changes in policy designed to increase access. Using data collected from 583 IDUs participating in a three-city cohort study of SEPs, we conducted a latent transition analysis and multinomial regressions. Three typologies were detected: Direct SEP users, Indirect SEP users and Isolated IDUs. Transitions to Direct SEP use were most prevalent. Factors associated with becoming or maintaining Direct SEP use were female sex, Latino ethnicity, fewer injections per syringe, homelessness, recruitment city, injecting speedballs (cocaine and heroin), and police contact involving drug paraphernalia possession. Similar factors influenced transitions in the syringe policy change analysis. Policy change cities experienced an increase in Indirect SEP users (43–51%) with little increased direct use (29–31%). We found that, over time, IDUs tended to become Direct SEP users. Policies improving syringe availability influenced SEP use by increasing secondary syringe exchange. Interactions with police around drug paraphernalia may encourage SEP use for some IDUs and may provide opportunities for other health interventions.

Decisional balance proportion: Quantifying qualitative data to represent motivation to change among treatment-seeking smokers

Susan E. Collins, Sandra Eck, Iris Torchalla, Martina Schröter, Anil Batra — 2010-09-01

Abstract: This study tested a new measure of motivation to change as a predictor of smoking behavior following smoking cessation treatment. Participants were adult, regular smokers (N=191) who took part in a randomized smoking cessation trial in southwestern Germany (). Participants completed smoking and psychological self-report measures before and after a 6-week smoking cessation treatment. Among these measures, the open-ended decisional balance worksheet elicited participant-generated pros and cons of smoking versus abstinence. Counts of the pros and cons were combined into the decisional balance proportion (DBP), which reflected participants’ current balance towards smoking behavior change. Additional smoking assessments were conducted up to the 12-month follow-up. After controlling for group effects and baseline smoking, DBP change scores (posttreatment–pretreatment) reflecting greater movement towards change during treatment predicted time to first smoking lapse as well as abstinence up to the 12-month follow-up. Higher DBP change scores also predicted lower frequency and intensity of smoking lapses during the 12-month follow-up. Findings indicated that participant-generated, qualitative data from a decisional balance worksheet can be quantified to produce a valid measure of motivation to change among smokers. This measure can inform intervention content and may potentially be used to match smokers to appropriate treatments.

The use of administrative data as a substitute for individual screening scores in observational studies related to problematic alcohol or drug use

2010-09-01

Abstract: Administrative data provide a rich resource for improving our understanding of individuals with substance use disorders. The validation of administrative proxies for moderate or high risk alcohol or drug (AOD) use could enhance the ability to carry out rigorous observational research (for example, for use in the construction of comparison groups). This study used receiver operating characteristic (ROC) curve techniques to assess how well AOD-related administrative indicators predicted self-reported AOD use obtained from AUDIT/DAST screening scores. An administrative AOD indicator, derived from a combination of medical encounter and billing data, arrest records, and publicly funded AOD-related services data, demonstrated discrimination in the acceptable range (AUC: 0.72–0.78) for identifying self-reported AOD use consistent with potential need for either (1) any AOD-related intervention, or (2) intensive AOD-related intervention or treatment. These findings held up in two distinct samples: a statewide Medicaid-only sample and a single-site mixed-payer sample that included the uninsured. Our findings suggest that indicators of AOD-related problems derived from administrative data can be useful for identifying moderate or high risk AOD use in a research context. The findings further suggest that proxies for substance use disorders, such as those evaluated here, can enhance future observational studies intended to improve health care for this population.

A placebo-controlled trial of memantine for cocaine dependence with high-value voucher incentives during a pre-randomization lead-in period

2010-09-01

Abstract: Preclinical findings suggest that the inhibition of NMDA glutamatergic neurotransmission may have beneficial effects in the treatment of cocaine dependence. We hypothesized that memantine, a low potency, uncompetitive NMDA receptor antagonist, would be safe and effective in the treatment of cocaine dependence, particularly in preventing relapse to cocaine use in abstinent individuals.Cocaine dependent patients (N=112) were enrolled. The trial began with a 2-week placebo lead-in period during which patients received high-value voucher contingency management to induce abstinence. Participants were then randomized to receive either memantine 20mg bid (N=39) or placebo (N=42) for 12-weeks in combination with individual relapse-prevention therapy. The randomization was stratified by abstinence status during the lead-in period. The primary outcome was the weekly proportion of days of cocaine use.There were no significant differences in cocaine use outcome between the groups treated with memantine versus placebo. Thus, the efficacy of memantine 40mg/d for the treatment of cocaine dependence was not supported. Urine-confirmed abstinence during the lead-in period was achieved by 44% of participants, and was a strong predictor of subsequent cocaine abstinence during the trial. This suggests that this clinical trial design, an intensive behavioral intervention during a lead-in period, resolves cocaine dependent patients into two subgroups, one that rapidly achieves sustained abstinence and may not need a medication, and another that displays persistent cocaine use and would most likely benefit from a medication to help induce abstinence. Targeting the latter subgroup may advance medication development efforts.

A randomized, controlled trial of NRT-aided gradual vs. abrupt cessation in smokers actively trying to quit

2010-09-01

Abstract: Most smoking cessation programs advise abrupt rather than gradual cessation. We conducted a randomized, controlled trial of gradual cessation (n=297) vs. abrupt cessation (n=299) vs. minimal treatment (n=150) among smokers who wanted to quit now and preferred to quit gradually. Participants were recruited via newspaper and radio advertisements. The gradual and abrupt conditions received five phone calls (total=90min) and the minimal treatment condition received two calls (25min total). The gradual condition received nicotine lozenge (via mail) to reduce smoking prior to their quit date. After the quit day, all participants received lozenge. The primary outcome was prolonged abstinence from 2 weeks post-quit day through 6 months. Prior to the quit day, the gradual condition decreased cigarettes/day by 54%, whereas the other two conditions decreased by 1% and 5%. Prolonged abstinence rates (CO<10ppm) did not differ among gradual, abrupt and minimal treatment conditions (4%, 7% and 5%), nor did 7-day point prevalence rates (7%, 11% and 11%). Fewer smokers in the gradual condition (48%) made a quit attempt than in the abrupt (64%) or minimal (60%) conditions (p<.001). In the gradual condition, every week delay to the quit date increased the probability of lapsing by 19% (p<.001). We conclude that among smokers who want to stop gradually in the near future, gradual cessation with nicotine pre-treatment does not produce higher quit rates than abrupt cessation. One liability of gradual reduction may be that it allows smokers to delay their quit date.

The role of alcohol misuse in PTSD outcomes for women in community treatment: A secondary analysis of NIDA's Women and Trauma Study

2010-09-01

Abstract: Background: Individuals with comorbid substance use and posttraumatic stress disorder may differentially benefit from integrated trauma-focused interventions based on specific presenting characteristics such as substance use type and PTSD severity. The current study is a secondary analysis of a NIDA Clinical Trials Network study exploring the effectiveness of two interventions for women with comorbid PTSD and substance use disorders.Method: Generalized estimating equations were used to examine the association of baseline alcohol misuse with PTSD outcome measures over time for all randomized participants.Results: Women entering treatment with baseline alcohol misuse had higher Post Traumatic Stress Disorder Symptom Scale (PSS-SR) total scores (t=2.43, p<.05), cluster C (avoidance/numbing) scores (t=2.63, p<.01), and cluster D (hyper-arousal) scores (t=2.31, p<.05). For women with alcohol misuse, after treatment week 1, PSS-SR scores were significantly lower in the Seeking Safety intervention during treatment (χ2(1)=4.00, p<.05) and follow-up (χ2(1)=4.87, p<.05) compared to those in the health education intervention. Alcohol misusers in the Seeking Safety group who had higher baseline hyper-arousal severity improved more quickly than those with lower baseline hyper-arousal severity during treatment (χ2(1)=4.06, p<.05).Conclusions: These findings suggest that the type of substance abuse at treatment entry may inform treatment selection, predict treatment response among those with co-occurring PTSD and substance use disorders, and indicate a more severe clinical picture.

Cannabis withdrawal symptoms in non-treatment-seeking adult cannabis smokers

2010-09-01

Abstract: Background: Cannabis withdrawal is not recognized in DSM-IV because of doubts about its clinical significance.Objectives: Assess the phenomenon of cannabis withdrawal and its relationship to relapse in non-treatment-seeking adults.Subjects: Convenience sample of 469 adult cannabis smokers who had made a quit attempt while not in a controlled environment.Methods: Subjects completed a 176-item Marijuana Quit Questionnaire collecting information on sociodemographic characteristics, cannabis use history, and their “most difficult” cannabis quit attempt.Results: 42.4% of subjects had experienced a lifetime withdrawal syndrome, of whom 70.4% reported using cannabis in response to withdrawal. During the index quit attempt, 95.5% of subjects reported ≥1 individual withdrawal symptom (mean [SD] 9.5 [6.1], median 9.0); 43.1% reported ≥10. Number of withdrawal symptoms was significantly associated with greater frequency and amount of cannabis use, but symptoms occurred even in those using less than weekly. Symptoms were usually of ≥ moderate intensity and often prompted actions to relieve them. Alcohol (41.5%) and tobacco (48.2%) were used more often than cannabis (33.3%) for this purpose. There was little change during withdrawal in use of other legal or illegal substances.Conclusions: Cannabis withdrawal is a common syndrome among adults not seeking treatment. The intention to relieve withdrawal symptoms can drive relapse during quit attempts, giving cannabis withdrawal clinical significance as a target of treatment.

Adolescents’ expectancies for smoking to regulate affect predict smoking behavior and nicotine dependence over time

Adrienne J. Heinz, Jon D. Kassel, Michael Berbaum, Robin Mermelstein — 2010-09-01

Abstract: Aims: Mounting evidence suggests that individuals smoke, in part, to regulate affective experience (e.g., tension reduction, mood enhancement). Implicit in such motives is the expectancy or belief that smoking will decrease negative affect and increase positive affect. The contribution of cognitively-driven expectancies to the initiation and continuation of smoking during adolescence remains largely uninvestigated. The current study examined the influence of negative affect relief expectancies (NAREs) for smoking on smoking behavior and nicotine dependence using longitudinal data from a study on the emotional and social contexts of youth smoking.Methods: Participants were 568 adolescents with smoking experience (mean age 15.67, 56.7% female). Three separate mixed regression models were estimated to determine the relative contribution of NAREs to smoking behavior and nicotine dependence measured at 4 time points over 2 years.Results: NAREs for smoking influenced all smoking outcomes at baseline and predicted increases in smoking behavior and nicotine dependence over time, even after controlling for anxious and depressive symptoms and baseline nicotine dependence.Conclusions: Outcome expectancies for affect management emerged as an important risk factor for smoking escalation and the development of nicotine dependence during adolescence. The present findings highlight the potential importance of cognitively-driven expectancies as a risk factor for smoking escalation during this critical developmental period.

Socio-behavioral and geographic correlates of prevalent hepatitis C virus infection among young injection drug users in metropolitan Baltimore and Chicago

Basmattee Boodram, Elizabeth T. Golub, Lawrence J. Ouellet — 2010-09-01

Abstract: Background: Hepatitis C virus (HCV) infection prevalence among young injection drug users (IDUs) differs substantially between cities in the United States (U.S.).Methods: Between 2002 and 2004, IDUs aged 15–30 were recruited for the Third Collaborative Injection Drug User Study in five U.S. cities using respondent-driven methods. Our cross-sectional study examined correlates and geographic distribution of prevalent HCV infection (HCV+) from the Baltimore (n=736) and Chicago (n=586) study sites. We evaluated baseline socio-demographic and behavioral data collected from computer-assisted self-interviews and serological antibody testing for human immunodeficiency virus (HIV) and hepatitis A, B, and C.Results: HCV prevalence was 53.0% in Baltimore and 13.7% in Chicago (p<0.0001). Baltimore compared to Chicago participants were significantly (p<0.05) more likely to be older, co-infected with HIV and other hepatitis viruses, reside in an urban area, inject primarily cocaine, inject in public settings, inject with used syringes and paraphernalia, and have been injecting longer; they were less likely to utilize syringe exchange programs. However, after accounting for socio-demographic and behavioral risk factors in multivariable logistic regression, city was the strongest predictor of HCV prevalence (Baltimore versus Chicago adjusted odds ratio=3.5 [95% confidence interval, 2.2–5.6]). Geospatial analyses showed that almost half of all HCV+ participants in Baltimore resided within a 5-mile urban area, while Chicago participants were dispersed across the metropolitan area.Conclusions: The disparate HCV prevalence between the two cities is only partially explained by individual-level factors. Future studies should examine the network configurations and injection partners’ characteristics of young IDUs.

The dimensionality of alcohol use disorders: Results from Israel

2010-09-01

Abstract: Aims: To prepare for DSM-V, the structure of DSM-IV alcohol dependence and abuse criteria and a proposed additional criterion, at-risk drinking, require study in countries with low per-capita consumption, and comparison of current and lifetime results within the same sample. We investigated DSM-IV Alcohol Use Disorder (AUD) criteria in Israel, where per-capita alcohol consumption is low.Methods: Household residents selected from the Israeli population register (N=1338) were interviewed with the AUDADIS. Item response theory analyses were conducted using MPlus, and diagnostic thresholds were examined with the kappa statistic.Results: Dependence and abuse criteria fit a unidimensional model interspersed across the severity continuum, for both current and lifetime timeframes. Legal problems were rare and did not improve model fit. Weekly at-risk drinking reflected greater severity than in U.S. samples. When dependence and abuse criteria were combined, a diagnostic threshold of ≥3 criteria produced the best agreement with DSM-IV diagnoses (kappa>0.80).Conclusion: Consistent with other studies, alcohol dependence and abuse criteria reflected a latent variable representing a single AUD. Results suggested little effect in removing legal problems and little gained by adding weekly at-risk drinking. Results contribute to knowledge about AUD criteria by examining them in a low-consumption country.

In vivo evidence for long-term CNS toxicity, associated with chronic binge use of methamphetamine

2010-09-01

Abstract: Objective: The aim of this study was to examine disturbances in regional cerebral blood flow (rCBF) associated with methamphetamine abuse.Methods: Using Single Photon Emission Computed Tomography (SPECT), rCBF was measured in 20 men who had previously injected methamphetamine intravenously for over 30 months and who were now abstinent for a minimum of 9 months and for an average of 2 years. Values were compared with those in 12 healthy men who had never injected methamphetamine.Results: While rCBF was significantly and disproportionately reduced in subcortical and dorsal cortical brain regions, including the striatum, thalamus, cingulum, mesiodorsal prefrontal cortex, and pons (all t's>8.3 after global normalization, corrected p's<0.001), whole brain CBF was also significantly reduced in the former methamphetamine users. Binge use of methamphetamine is associated with long-term changes in both global and regional blood flows, likely representing severe and enduring neural toxicity of monoaminergic neurotransmitter systems in the brain, producing a pattern of hypoperfusion that resembles patterns reported previously for persons with atypical Parkinson's disease.Conclusions: These findings suggest that methamphetamine abusers may be possibly at increased risk for neurodegenerative diseases later in life.

The effect of motivational status on treatment outcome in the North American Opiate Medication Initiative (NAOMI) study

2010-09-01

Abstract: Dropout and recidivism from addiction treatment has been found to be associated with individuals’ readiness for change. Motivation for treatment among participants entering the North American Opiate Medication Initiative (NAOMI) randomized controlled trial, which compared heroin assisted treatment (HAT) to optimized methadone maintenance treatment (MMT), was assessed. Through multivariate regression, we aimed to determine whether baseline motivational status was predictive of four treatment outcomes: early dropout, 12-month retention, 12-month response to treatment, and time to discontinuation of treatment. Among the 251 out-of-treatment chronic opioid dependent patients recruited in Montreal, Quebec and Vancouver, British Columbia, 52% reported having a high level of motivation for treatment. HAT was statistically significantly more effective than MMT on each of the outcomes assessed. Baseline motivational status did not predict retention or time to discontinuation in either HAT or MMT. However, while patients were retained in HAT regardless of motivational status, motivated patients showed a more favourable response to treatment in terms of decreases in crime and illicit drug use. These results suggest that HAT successfully retains opioid dependent patients who otherwise may not have been attracted into existing treatment options, and may enhance the odds of successful rehabilitation among patients motivated for treatment.

Retention in naltrexone implant treatment for opioid dependence

2010-09-01

Abstract: Background: Naltrexone's usefulness in the treatment of opioid dependence stems from its ability to block the action of heroin and other opioids. However, many patients are ambivalent towards naltrexone and often drop out of treatment with orally administered naltrexone. Sustained release naltrexone seems promising in reducing opioid use, but the extent to which patients remain in treatment beyond the first dosage of naltrexone is not clear.Methods: Patients (n=61) receving treatment with sustained release naltrexone implants were offered a second naltrexone implant after 6 months. Patients who remained in treatment were compared to those who did not, on drug use, mental health, and social problems before and during naltrexone implant treatment. Information was obtained on other treatments sought by patients who discontinued naltrexone. Blood samples were used to verify naltrexone release, and hair samples to confirm opioid intake.Results: Of the patients who received the first naltrexone implant, 51% (n=31) remained in naltrexone implant treatment. Among those who discontinued treatment, 21% expressed a wish to reimplant but failed to attend for reimplantation and 28% declined reimplantation: 6 non-retained patients initiated maintenance or residential treatment. Remaining in naltrexone treatment was related to pre-study length of employment, illicit drug use, and concern for family problems. Higher levels of substance misuse and criminal activity during naltrexone treatment were negatively related to subsequent retention.Conclusion: Rates of retention among opioid-dependent patients receiving naltrexone implant treatment are encouraging and support this as a feasible long-term treatment option.

Substance abusers’ motives for using anabolic androgenic steroids

Anna Petersson, Johanna Bengtsson, Anette Voltaire-Carlsson, Ingemar Thiblin — 2010-09-01

Abstract: Background: The use of anabolic androgenic steroids (AAS) has been associated with the use of illegal drugs. Earlier observations suggested that users of illegal drugs may use AAS for reasons other than increasing muscle strength or size. The aim of the present study was to investigate the motives for AAS use among outpatients at a substance abuse center in Stockholm, Sweden.Methods: All male patients under the age of 50 were asked whether they had used AAS during a 2-month period. An AAS survey was administered to those who reported AAS experiences in the admittance interview.Results: Twenty of the 175 respondents (11%) reported using AAS. The most frequently reported motives were related to anabolic effects (i.e., for a good-looking body, to become stronger, or to perform better in sports). However, some users reported other motives; for example, to conceal concomitant drug use, to alleviate insecurity or low self-esteem, to become brave, or in preparation of committing a crime. Furthermore, many respondents reported side effects that were associated with AAS; most notably, irritability and depression/suicidal ideation.Conclusion: Some users of illicit drugs also use AAS for reasons other than the anabolic properties of these compounds. Therefore, considering that AAS may cause or contribute to diverse morbidity, it is important to ask users of illicit drugs about AAS use, even when obvious external signs of AAS use are lacking.

Determinants of alcohol consumption in HIV-uninfected injection drug users

2010-09-01

Abstract: We assess the association between time fixed and time varying participant characteristics and subsequent alcohol consumption in 1968 injection drug users (median age 37 years, 28% female, 90% African-American) followed semi-annually from 1988 to 2008. Median alcohol consumption was seven drinks per week at study entry (first and third quartile: 1, 26) with 36% reporting binge drinking. Alcohol consumption and binge drinking decreased over follow-up. Older individuals and women reported consuming fewer drinks per week. Higher typical alcohol consumption was reported by those participants who reported in the prior 6 months: non-injection cocaine use, injection drug use, having one or more sex partners, or among men, a same sex partner. Associations were generally similar for drinks per week and binge drinking. This study demonstrates that in a large urban cohort of persons with a history of injection drug use, risky drug use and sexual risk behavior are associated with subsequent alcohol consumption.

Generalizability of clinical trials for cannabis dependence to community samples

2010-09-01

Abstract: There is growing concern that results of tightly controlled clinical trials may not generalize to broader community samples. To assess the proportion of community dwelling adults with cannabis dependence who would have been eligible for a typical cannabis dependence treatment study, we applied a standard set of eligibility criteria commonly used in cannabis outcome studies to a large (N=43,093) representative US adult sample interviewed face-to-face, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Approximately 80% of the community sample of adults with a diagnosis of cannabis dependence (N=133) would be excluded from participating in clinical trials by one or more of the common eligibility criteria. Individual study criteria excluded from 0% to 41.0% of the community sample. Legal problems, other illicit drug use disorders, and current use of fewer than 5 joints/week excluded the largest percentage of individuals. These results extend to cannabis dependence concerns that typical clinical trials likely exclude most community dwelling adults with the disorder. The results also support the notion that clinical trials tend to recruit highly selective samples, rather than adults who are representative of typical patients. Clinical trials should carefully evaluate the effects of eligibility criteria on the generalizability of their results. Even in efficacy trials, stringent exclusionary criteria could limit the representativeness of study results.