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Hirchak KA, Lyons AJ, Herron JL, Kordas G, Shaw JL, Jansen K, Avey JP, McPherson SM, Donovan D, Roll J, Buchwald D, Ries R, McDonell MG. Contingency management for alcohol use disorder reduces cannabis use among American Indian and Alaska Native adults. J Subst Abuse Treat 2022; 137:108693. [PMID: 34952747 PMCID: PMC9086134 DOI: 10.1016/j.jsat.2021.108693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 10/29/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Determine whether a culturally tailored contingency management (CM) intervention targeting alcohol abstinence resulted in secondary effects on cannabis use among American Indian and Alaska Native (AI/AN) adults. METHODS The research team conducted this secondary data analysis to examine cannabis abstinence using data from a randomized control trial of CM for alcohol use among three AI/AN-serving organizations. One hundred and fifty-eight adults met the randomization criteria (i.e., submission of 50% or more urine samples and one alcohol-positive urine test during a 4-week, pre-randomization, observation period). For 12 weeks after randomization, participants received incentives for submitting a urine test negative for ethyl glucuronide (EtG < 150 ng/mL, CM group) or incentives for submitting a urine sample regardless of abstinence (Non-contingent [NC] Control group). Generalized linear mixed effects models assessed group differences in cannabis abstinence during the intervention, verified by urine tetrahydrocannabinol negative tests (11-nor-delta-9-tetrahydrocannabinol-9-carboxylic acid <50 ng/mL). RESULTS At baseline, 42.2% (n = 35) of participants in the NC group and 40.0% (n = 30) of those in the CM group had a cannabis positive urine test. An overall intervention by time interaction was detected for a cannabis negative urine test (χ2 = 13.40, p = 0.001). Compared to the NC group, the CM group had 3.92 (95% CI:1.23-12.46) times higher odds of having a cannabis negative urine test during the intervention period and 5.13 (95% CI:1.57-16.76) times higher odds of having a negative cannabis test at the end of intervention period. CONCLUSION CM addressing alcohol misuse may be an effective strategy for decreasing cannabis use among AI/AN adults. TRIAL REGISTRATION ClinicalTrials.gov number, Identifier: NCT02174315.
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Affiliation(s)
- Katherine A Hirchak
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Abram J Lyons
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA; School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Jalene L Herron
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, NM, USA; Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Gordon Kordas
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | | | - Kelley Jansen
- Southcentral Foundation, Anchorage, AK, USA; Department of Psychology, University of Montana, Missoula, MT, USA
| | | | - Sterling M McPherson
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA; Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - Dennis Donovan
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - John Roll
- Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Dedra Buchwald
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA
| | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Michael G McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA; Institute for Research and Education to Advance Community Health, Washington State University, Spokane, WA, USA.
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Schlagal CR, Wu P. Alcohol and Cocaine Combined Substance Use on Adult Hypothalamic Neural Stem Cells and Neurogenesis. Brain Plast 2020; 6:41-46. [PMID: 33680845 PMCID: PMC7903003 DOI: 10.3233/bpl-190091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Many advancements have been made over the years looking at the individual and combined effects of drugs of abuse on the brain, with one key area of research focusing on the effects on neurogenesis. An integral part of fetal brain development and, later, maintenance in the adult brain, neurogenesis occurs in three main regions: subventricularzone of the lateral ventricles (SVZ), subgranularzone of the dentate gyrus (SGZ), and the tanycyte layer in the hypothalamus (TL). We will review current literature on combined drugs of abuse and their effect on adult neurogenesis. More specifically, this review will focus on the effect of combining cocaine and alcohol. Additionally, the tanycyte layer will be explored in more depth and probed to look at the neurogenic properties of tanycytes and their role in neurogenesis.
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Affiliation(s)
- Caitlin R Schlagal
- Neuroscience, Cell Biology and Anatomy, University of Texas Medical Branch, Galveston, TX, USA
| | - Ping Wu
- Neuroscience, Cell Biology and Anatomy, University of Texas Medical Branch, Galveston, TX, USA
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Hammad AM, Sari Y. Effects of Cocaine Exposure on Astrocytic Glutamate Transporters and Relapse-Like Ethanol-Drinking Behavior in Male Alcohol-Preferring Rats. Alcohol Alcohol 2020; 55:254-263. [PMID: 32099993 PMCID: PMC7171926 DOI: 10.1093/alcalc/agaa010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 12/14/2022] Open
Abstract
AIM Glutamate has been considered as neurotransmitter that is critical in triggering relapse to drugs of abuse, including ethanol and cocaine. Extracellular glutamate concentrations are tightly regulated by several mechanisms, including reuptake through glutamate transporters. Glutamate transporter type 1 (GLT-1) is responsible for clearing the majority of extracellular glutamate. The astrocytic cystine/glutamate antiporter (xCT) regulates also glutamate homeostasis. In this study, we investigated the effects of cocaine exposure and ampicillin/sulbactam (AMP/SUL), a β-lactam antibiotic known to upregulate GLT-1 and xCT, on relapse-like ethanol intake and the expression of astrocytic glutamate transporters in mesocorticolimbic brain regions. METHODS Male alcohol-preferring (P) rats had free access to ethanol for 5 weeks. On Week 6, rats were exposed to either cocaine (20 mg/kg, i.p.) or saline for 12 consecutive days. Ethanol bottles were then removed for 7 days; during the last 5 days, either AMP/SUL (100 or 200 mg/kg, i.p.) or saline was administered to the P rats. Ethanol bottles were reintroduced, and ethanol intake was measured for 4 days. RESULTS Cocaine exposure induced an alcohol deprivation effect (ADE), which was associated in part by a decrease in the expression of GLT-1 and xCT in the nucleus accumbens (NAc) core. AMP/SUL (100 mg/kg, i.p.) attenuated the ADE, while AMP/SUL (200 mg/kg, i.p.) reduced ethanol intake during 4 days of ethanol re-exposure and upregulated GLT-1 and xCT expression in the NAc core, NAc shell and dorsomedial prefrontal cortex (dmPFC). CONCLUSION This study suggests that these astrocytic glutamate transporters might be considered as potential targets for the treatment of polysubstance abuse.
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Affiliation(s)
- Alaa M Hammad
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, 3000 Arlington Ave, Toledo, OH, USA
- Department of Pharmacy, College of Pharmacy, Al-Zaytoonah University of Jordan, P.O. Box 130 Amman, 11733, Jordan
| | - Youssef Sari
- Department of Pharmacology and Experimental Therapeutics, College of Pharmacy and Pharmaceutical Sciences, University of Toledo, 3000 Arlington Ave, Toledo, OH, USA
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McGrath EL, Schlagal CR, Cortez I, Dunn TJ, Gao J, Fox RG, Stutz SJ, Kuo YF, Hommel JD, Dineley KT, Cunningham KA, Kaphalia BS, Wu P. Chronic poly-drug administration damages adult mouse brain neural stem cells. Brain Res 2019; 1723:146425. [DOI: 10.1016/j.brainres.2019.146425] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 12/29/2022]
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Liu Y, Williamson V, Setlow B, Cottler LB, Knackstedt LA. The importance of considering polysubstance use: lessons from cocaine research. Drug Alcohol Depend 2018; 192:16-28. [PMID: 30195242 PMCID: PMC7450360 DOI: 10.1016/j.drugalcdep.2018.07.025] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Polysubstance use (PSU) is prevalent among individuals with substance use disorders, but the vast majority of preclinical substance use research has focused on individual substances in isolation. Cocaine has been prevalent in the repertoire of persons who use more than one illicit substance. METHODS We conducted a meta-analysis combining results from literature searches and secondary data analyses to estimate the prevalence of simultaneous and concurrent cocaine + alcohol and cocaine + cannabis use among cocaine users. We next summarized the small body of literature on behavioral, cognitive and neurobiological consequences of cocaine PSU across species, with a focus on alcohol and cannabis. Finally, we used systematic literature searches to assess the extent to which human and animal studies on the neurobiological consequences of cocaine include PSU subjects. RESULTS The estimated prevalence of simultaneous and concurrent alcohol use among human cocaine users was 74% and 77%, respectively. The estimated prevalence of simultaneous and concurrent cannabis use among cocaine users was 38% and 64%, respectively. Consumption of alcohol or cannabis with cocaine enhances subjective responses to cocaine, concomitant with changes in cocaine metabolism that increase blood cocaine levels, and, in the case of alcohol, produce the psychoactive metabolite cocaethylene. There is also consistent evidence for neurobiological effects of cocaine + alcohol combinations. However, animal PSU research with cocaine lags behind human research. CONCLUSION Based on the prevalence and known consequences of PSU, consideration of PSU in both human and animal research is vital for understanding patterns of substance use.
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Affiliation(s)
- Yiyang Liu
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, 2004 Mowry Road, PO Box 100231, USA
| | - Victoria Williamson
- Department of Psychology, University of Florida, 945 Center Dr., P.O. Box 112250, Gainesville, FL 32611, USA
| | - Barry Setlow
- Department of Psychology, University of Florida, 945 Center Dr., P.O. Box 112250, Gainesville, FL 32611, USA,Department of Psychiatry, University of Florida College of Medicine, PO Box 100256, Gainesville, FL 32610-0256, USA,Department of Neuroscience, 1149 Newell Drive, Room L1-100, Gainesville, FL 32611, USA,Center for Addiction Research and Education, Gainesville, FL 32611, USA
| | - Linda B. Cottler
- Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, 2004 Mowry Road, PO Box 100231, USA,Center for Addiction Research and Education, Gainesville, FL 32611, USA
| | - Lori A. Knackstedt
- Department of Psychology, University of Florida, 945 Center Dr., P.O. Box 112250, Gainesville, FL 32611, USA,Center for Addiction Research and Education, Gainesville, FL 32611, USA,Corresponding author at: Department of Psychology, University of Florida, 945 Center Dr., Room Psy 114, Gainesville, FL 32611, USA. (L.A. Knackstedt)
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John WS, Nader MA. Effects of ethanol on cocaine self-administration in monkeys responding under a second-order schedule of reinforcement. Drug Alcohol Depend 2017; 170:112-119. [PMID: 27886524 PMCID: PMC5744897 DOI: 10.1016/j.drugalcdep.2016.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 11/03/2016] [Accepted: 11/03/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Concurrent alcohol use among cocaine abusers is common but the behavioral variables that promote co-abuse are not well understood. The present study examined the effects of intragastric (i.g.) ethanol (EtOH) administration in monkeys responding under a schedule of cocaine reinforcement in which extensive drug seeking was maintained by conditioned stimuli. METHODS Four adult male cynomolgus monkeys (Macaca fascicularis) were trained to respond under a second-order fixed-interval (FI) 600s (fixed-ratio (FR) 30:S) schedule of cocaine (0.003-0.56mg/kg/injection) presentation. Sessions ended after 5 injections or 90min had elapsed. Different EtOH doses (0.5-2.0g/kg, i.g.) were administered 30min before the session, typically on Tuesdays and Fridays. Blood ethanol concentrations (BECs) were also assessed. Pattern of FI responding was assessed by determining quarter-life (QL) values. RESULTS Cocaine self-administration was characterized as an inverted U-shaped function of dose; QL values increased monotonically with dose. EtOH pretreatments dose-dependently decreased self-administration at several cocaine doses in 3 of 4 monkeys. In one animal, EtOH increased low-dose cocaine-maintained responding. For all monkeys, QL values were increased by EtOH when low- and high-cocaine doses were self-administered, suggesting additive effects of EtOH and cocaine. Furthermore, BECs were not altered following cocaine self-administration. CONCLUSIONS The reductions in cocaine self-administration and the increases in QL values following EtOH, suggest that EtOH was enhancing cocaine-related conditioned reinforcement. A better understanding of the behavioral mechanisms that mediate the co-abuse of alcohol and cocaine will lead to improved treatments for both drugs.
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Carroll KM, Nich C, Shi JM, Eagan D, Ball SA. Efficacy of disulfiram and Twelve Step Facilitation in cocaine-dependent individuals maintained on methadone: a randomized placebo-controlled trial. Drug Alcohol Depend 2012; 126:224-31. [PMID: 22695473 PMCID: PMC3461119 DOI: 10.1016/j.drugalcdep.2012.05.019] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2012] [Revised: 05/16/2012] [Accepted: 05/17/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cocaine use remains a major problem within methadone maintenance programs. Disulfiram's efficacy in reducing cocaine use has been demonstrated in several trials, but its relative efficacy among individuals who use versus abstain from alcohol remains unclear. Treatment approaches which seek to enhance substance users' involvement in self-help activities (Twelve Step Facilitation, TSF) have been associated with better outcomes among alcohol and cocaine users, but have rarely been evaluated among methadone-maintained cocaine-opioid users. METHODS We conducted a randomized, placebo-controlled, double blind (for medication condition), factorial (2×2) trial with 4 treatment conditions: Disulfiram plus TSF, disulfiram plus standard counseling only, placebo plus TSF, and placebo plus standard counseling in the context of a community-based methadone maintenance program. Participants (N=112) received either disulfiram (250 mg/d) or placebo in conjunction with daily methadone maintenance. RESULTS Assignment to TSF was associated with less cocaine use throughout treatment and a higher number of cocaine-negative urines. While there were no significant main effects of disulfiram versus placebo, individuals without an alcohol use disorder demonstrated greater reductions in cocaine use over time when assigned to disulfiram. CONCLUSIONS TSF appears feasible in this methadone maintenance program and was associated with modest reductions in cocaine use, an often intractable problem in this setting. Support for the efficacy of disulfiram was weaker, as it appeared effective only for those without a current alcohol use disorder for this sample.
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Affiliation(s)
- Kathleen M. Carroll
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Charla Nich
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Julia M. Shi
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516,The APT Foundation, New Haven Connecticut, 1 Long Wharf, New Haven CT 06511
| | - Dorothy Eagan
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516
| | - Samuel A. Ball
- Department of Psychiatry, Yale University School of Medicine, 950 Campbell Avenue, 151D, West Haven, CT 06516,The APT Foundation, New Haven Connecticut, 1 Long Wharf, New Haven CT 06511
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Manuel JK, Austin JL, Miller WR, McCrady BS, Tonigan JS, Meyers RJ, Smith JE, Bogenschutz MP. Community Reinforcement and Family Training: a pilot comparison of group and self-directed delivery. J Subst Abuse Treat 2012; 43:129-36. [PMID: 22154038 PMCID: PMC3331969 DOI: 10.1016/j.jsat.2011.10.020] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 10/06/2011] [Accepted: 10/19/2011] [Indexed: 11/24/2022]
Abstract
In a randomized clinical pilot study, 40 concerned significant others (CSOs) of treatment-refusing alcohol- and drug-using individuals were randomized to either Community Reinforcement and Family Training (CRAFT) conducted in a group format (Group CRAFT) or a Self-Directed CRAFT condition. Although results indicated no significant between-group difference in engaging treatment-refusing substance-using individuals (referred to as identified patients or IPs) into treatment, the engagement rate in Group CRAFT was similar to rates previously reported with individual CRAFT. For the intent-to-treat analysis, 60% of Group CRAFT CSOs engaged their loved one into treatment, as compared with 40% in Self-Directed CRAFT. Of CSOs in the Group condition who received at least one session of group therapy, 71% engaged their IP into treatment. CSOs in both conditions reported improvements in family cohesion and conflict at the 3- and 6-month follow-up, replicating prior CRAFT findings.
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Affiliation(s)
- Jennifer K Manuel
- Department of Psychiatry, University of California, San Francisco, CA 94110, USA.
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Teesson M, Farrugia P, Mills K, Hall W, Baillie A. Alcohol, tobacco, and prescription drugs: the relationship with illicit drugs in the treatment of substance users. Subst Use Misuse 2012; 47:963-71. [PMID: 22676566 DOI: 10.3109/10826084.2012.663283] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Alcohol, tobacco, prescription drug, and illicit drug use frequently co-occur. This paper reviews the extent of this co-occurrence in both general population samples and clinical samples, and its impact on treatment outcome. We argue that the research base for understanding comorbidity among tobacco, alcohol, prescription, and illicit drugs needs to be broadened. We specifically advocate for: (1) more epidemiological studies of relationships among alcohol, tobacco, and other illicit drug use; and (2) increased research on treatment options that address the problematic use of all of these drugs.
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Affiliation(s)
- Maree Teesson
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.
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Andrade LF, Alessi SM, Petry NM. The impact of contingency management on quality of life among cocaine abusers with and without alcohol dependence. Am J Addict 2011; 21:47-54. [PMID: 22211346 DOI: 10.1111/j.1521-0391.2011.00185.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The use of quality of life (QOL) measures in substance abuse treatment research is important because it may lead to a broader understanding of patients' health status and effects of interventions. Despite the high rates of comorbid cocaine and alcohol use disorders, little is known about the QOL of this population, and even less about the impact of an efficacious behavioral treatment, contingency management (CM), on QOL. In this study, data from three clinical trials were retrospectively analyzed to examine QOL in outpatient cocaine abusers with and without alcohol dependence (AD) and the impact of CM on QOL over time as a function of AD status. Patients were randomized to standard care (n = 115) or standard care plus CM (n = 278) for 12 weeks. QOL was assessed at baseline and Months 1, 3, 6, and 9. At treatment initiation, AD patients had lower QOL total scores and they scored lower on several subscale scores than those without AD. CM treatment was associated with improvement in QOL regardless of AD status. These data suggest that CM produces benefits that go beyond substance abuse outcomes, and they support the use of QOL indexes to capture information related to treatment outcomes.
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Affiliation(s)
- Leonardo F Andrade
- Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030-3944, USA
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Morales-Manrique CC, Palepu A, Castellano-Gomez M, Aleixandre-Benavent R, Valderrama-Zurián JC. Quality of life, needs, and interest among cocaine users: differences by cocaine use intensity and lifetime severity of addiction to cocaine. Subst Use Misuse 2011; 46:390-7. [PMID: 20735213 DOI: 10.3109/10826084.2010.501675] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We examined the quality of life (QoL) of 149 patients who were recruited in 2005 at outpatient treatment centers for cocaine dependence in Spain. Important life areas and life areas with potential need and interest to change in order to improve the QoL were analyzed in terms of patients? cocaine use intensity within the previous six months and lifetime severity addiction to cocaine. The Spanish versions of the Drug User Quality of Life Scale and the Lifetime Severity Index for Cocaine were used to measure QoL, needs and interest, and severity addiction to cocaine. The data analysis employed t-tests, linear regression, Mann?Whitney U tests, multivariate regression, and chi-square tests. Tailoring treatment programs to address the life areas that are considered relevant to cocaine users considering their intensity of consumption and lifetime severity addiction to cocaine may improve retention and treatment outcomes. Further research needs to consider patients of different ethnic backgrounds and cultural contexts. The study's limitations are noted.
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Affiliation(s)
- C C Morales-Manrique
- Unidad de Información e Investigación Social y Sanitaria (UISYS) (Universitat de València-CSIC), Valencia, Spain
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Hambley J, Arbour S, Sivagnanasundaram L. Comparing outcomes for alcohol and drug abuse clients: A 6-month follow-up of clients who completed a residential treatment programme. JOURNAL OF SUBSTANCE USE 2010. [DOI: 10.3109/14659890903075066] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Wan L, Baldridge RM, Colby AM, Stanford MS. Association of P3 amplitude to treatment completion in substance dependent individuals. Psychiatry Res 2010; 177:223-7. [PMID: 20381882 DOI: 10.1016/j.psychres.2009.01.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 01/27/2009] [Accepted: 01/28/2009] [Indexed: 11/19/2022]
Abstract
Individuals with substance use disorders typically show reduced amplitudes of the P3 component of the evoked potential and high scores on impulsivity and aggression measures. The present study investigated the usefulness of P3 amplitude, addiction severity and impulsivity as predictors of treatment completion in substance dependence. Forty-four participants (8 women), between the ages of 19 and 61 years old, who met DSM-IV-TR Axis I substance/alcohol dependence criteria were recruited for the present study. All participants were currently residents at a local substance abuse facility receiving treatment and had been free of all drug toxicity for a minimum of 21 days. The P3 was evoked using a standard rotated-heads oddball paradigm. Significantly reduced P3 amplitude at Pz was found in patients who did not complete treatment compared to those who did. P3 amplitude at Pz elicited by target stimuli correctly identified 76.2% of those who did complete the treatment and 46.7% of those who did not.
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Affiliation(s)
- Li Wan
- Department of Psychology and Neuroscience, Baylor University, Waco, TX 76798, USA.
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Magruder KM, Bichun Ouyang, Miller S, Tilley BC. Retention of under-represented minorities in drug abuse treatment studies. Clin Trials 2009; 6:252-60. [PMID: 19528134 DOI: 10.1177/1740774509105224] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Differential attrition by minority participants can be as limiting to interpreting final results as poor initial recruitment of minority participants. This is especially important in drug abuse treatment studies, as minorities are over-represented in substance abuse clinical treatment programs. PURPOSE The specific aims of this secondary data analysis were to: (1) determine if there are differences in study retention rates by race/ethnicity and age, and (2) explore other client characteristics, as well as protocol and treatment program factors, that could account for differential retention rates. METHODS We conducted a secondary analysis using data from 1737 participants in the first six clinical trials whose databases were locked in the NIDA Clinical Trials Network. Protocol level characteristics were also abstracted from these studies, and we used data from a study which assessed characteristics of community treatment programs that participated in these studies. Logistic regression was used to study the effect on retention of: client, protocol, and program characteristics. RESULTS In the model of client characteristics, a significant age by race/ethnicity interaction term was detected based on a threshold of 0.1, with younger African Americans having the lowest odds of retention. Primary drug of abuse was also a significant factor in determining study retention, with heroin, methadone, and opiate users having the greatest odds of retention and polydrug users the lowest. Similar analyses testing treatment program characteristics found that only the presence of HIV risk screening and decreasing levels of female admissions (as a percent of total admissions) were related to study retention. In our final model, there was an effect of age, but not race/ethnicity, with younger participants having lower odds of retention. A multivariable model including protocol variables could not be developed due to the high correlation among protocol variables. LIMITATIONS We excluded those of multi-race/ethnicity and those from minority groups other than Hispanic or African American due to small numbers. Additionally, only three therapy types were represented among the six studies. Some potential variables that would influence retention, such as client housing, and client comorbidities, the race/ethnicity and gender of the staff who conducted study follow-up assessments, and reasons for loss to follow-up, were not collected by the CTN. CONCLUSIONS Although in our client model older African Americans and Caucasians had the greatest odds of retention and younger African Americans the lowest, in our final model, only age was significantly related to study retention. Additionally, primary drug of abuse, having HIV risk screening as a program benefit, and lower percentages of female admissions were significantly related to study retention. Efforts should be made to increase the study retention of younger participants to improve the validity and generalizability of drug abuse treatment study results.
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Affiliation(s)
- Kathryn M Magruder
- Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.
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Schmitz JM, Lindsay JA, Green CE, Herin DV, Stotts AL, Moeller FG. High-dose naltrexone therapy for cocaine-alcohol dependence. Am J Addict 2009; 18:356-62. [PMID: 19874153 PMCID: PMC2907651 DOI: 10.3109/10550490903077929] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
This randomized, double-blind, placebo-controlled study compared the effects of high-dose (100 mg/d) naltrexone versus placebo in a sample of 87 randomized subjects with both cocaine and alcohol dependence. Medication conditions were crossed with two behavioral therapy platforms that examined whether adding contingency management (CM) that targeted cocaine abstinence would enhance naltrexone effects compared to cognitive behavioral therapy (CBT) without CM. Primary outcome measures for cocaine (urine screens) and alcohol use (timeline followback) were collected thrice-weekly during 12 weeks of treatment. Retention in treatment and medication compliance rates were low. Rates of cocaine use and drinks per day did not differ between treatment groups; however naltrexone did reduce frequency of heavy drinking days, as did CBT without CM. Notably, adding CM to CBT did not enhance treatment outcomes. These weak findings suggest that pharmacological and behavioral interventions that have shown efficacy in the treatment of a single drug dependence disorder may not provide the coverage needed when targeting dual drug dependence.
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Affiliation(s)
- Joy M Schmitz
- Department of Psychiatry and Behavioral Sciences, University of Texas, Houston, Texas, USA.
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Jackson KR, Booth PG, McGuire J, Salmon P. Predictors of starting and remaining in treatment at a specialist alcohol clinic. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890500143614] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lyne J, O'Donoghue B, Clancy M, Kinsella A, O'Gara C. Concurrent cocaine and alcohol use in individuals presenting to an addiction treatment program. Ir J Med Sci 2009; 179:233-7. [PMID: 19597917 DOI: 10.1007/s11845-009-0385-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 06/22/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND National population surveys and information from the National Drug Treatment Reporting System indicate cocaine use is increasing. There is a paucity of studies focusing on comorbid cocaine and alcohol use in Ireland. AIMS The aims of the study are to examine comorbid cocaine and alcohol use patterns in those under 45 years, presenting to a national addiction treatment unit for alcohol and drug dependence. METHODS A retrospective review of the substance misuse behavior of 465 individuals participating in an addiction rehabilitation programme for alcohol dependence. RESULTS Cocaine use among this population rose significantly between 1995 (8%) and 2006 (37.9%). There was a significant association between lifetime reported cocaine use and both psychotic disorders and deliberate self harm. Overall, the use was highest among younger age group and this declined steadily with age. CONCLUSIONS Cocaine use among the alcohol-dependent population is an increasing problem in the Republic of Ireland, and poses a problem of higher toxicity associated with concurrent cocaine and alcohol use.
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Affiliation(s)
- J Lyne
- Addiction Department, St John of God Hospital, Stillorgan, Co Dublin, Ireland.
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Poling J, Kosten TR, Sofuoglu M. Treatment Outcome Predictors for Cocaine Dependence. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 33:191-206. [PMID: 17497542 DOI: 10.1080/00952990701199416] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Over the past decade, a large number of potential medications have been examined in clinical trials for cocaine dependence. Unfortunately, no effective pharmacotherapies for cocaine dependence have been found to date. Although effective treatments for cocaine dependence are still being investigated, a few variables have been found to significantly predict cocaine treatment response. These variables include cocaine use variables, such as days of cocaine use in the month before treatment, baseline urine cocaine results, and cocaine withdrawal symptoms. Comorbid depression and alcohol use have also been shown to be risk factors for relapse. Among personality variables, impulsivity and similar personality traits may predict treatment response. Initial promising findings with genetic polymorphism, brain activation, and stress response have also been found and need to be replicated in future studies.
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Affiliation(s)
- James Poling
- Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System. West Haven, CT 06516, USA.
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Mateyoke-Scrivner A, Webster JM, Staton M, Leukefeld C. Treatment Retention Predictors of Drug Court Participants in a Rural State. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 30:605-25. [PMID: 15540496 DOI: 10.1081/ada-200032304] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Factors distinguishing clients who complete drug court treatment from those who do not complete drug court have been documented, but differences between urban and rural drug court participants have not been examined. The present study focuses on examining mental health, drug use, criminal activity, and education/employment as factors that are associated with treatment retention, which is measured by graduation from a rural and urban drug court. Study findings indicate that for the urban drug court, marital status, employment, drug use, and criminal activity predicted graduation. For the rural drug court, however, graduation was only predicted by age and juvenile incarceration. Findings from this study suggest there are different factors associated with drug court retention/graduation between urban and rural drug court settings. It is suggested that drug court administrators and other could use this information to better assess potential participants and to target services.
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Rash CJ, Alessi SM, Petry NM. Cocaine abusers with and without alcohol dependence respond equally well to contingency management treatments. Exp Clin Psychopharmacol 2008; 16:275-81. [PMID: 18729681 PMCID: PMC2730966 DOI: 10.1037/a0012787] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Contingency management (CM) treatments are efficacious in treating cocaine abuse. Despite high prevalence rates of alcohol dependence (AD) among individuals with cocaine use disorders, relatively little data are available regarding whether comorbid AD is associated with poorer treatment outcomes in general, or in response to CM in particular. Using data from 3 randomized trials of CM for cocaine abuse, we compared cocaine abusers (N = 393) with and without AD in terms of abstinence and psychosocial problems during treatment and follow-up. Alcohol dependent participants had more lifetime years of cocaine and alcohol use and greater severity of alcohol and psychiatric problems. CM was positively and significantly associated with longer durations of abstinence, regardless of AD status. Although not significantly associated with abstinence, the presence of AD was related to improvement in medical and alcohol-related problems during treatment, and these gains were maintained posttreatment. The results suggest that cocaine abusers benefit equally well from CM treatments, regardless of AD status. Further, alcohol dependent participants are able to offset greater baseline severity in psychosocial functioning and maintain these improvements with CM.
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Affiliation(s)
- Carla J Rash
- Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06033, USA
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Stein MD, Herman DS, Anderson BJ. A motivational intervention trial to reduce cocaine use. J Subst Abuse Treat 2008; 36:118-25. [PMID: 18657938 DOI: 10.1016/j.jsat.2008.05.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 04/11/2008] [Accepted: 05/05/2008] [Indexed: 11/26/2022]
Abstract
The aim of this study was to test if a motivational intervention would reduce cocaine use. We performed a randomized trial with 6-month follow-up for 198 persons who used cocaine at least weekly. Participants were randomly assigned to a four-session motivational intervention or an assessment control group. We performed an intent-to-treat analysis of past 30-day self-reported cocaine use at 6 months, with those lost to follow-up assumed to use cocaine at their baseline level. Participants were 62% male, 40% Caucasian, and used cocaine an average of 13.8 days over the past month. In the full cohort, there were no significant intervention effects on mean change in cocaine use days (p = .21), past 30-day abstinence (33% vs. 26%, p = .26), or >50% reduction in cocaine use days from baseline (55.7% vs. 46.5%, p = .20). However, among those using cocaine on 15 or more of the 30 days prior to baseline, motivational interviewing participants had a significantly larger mean reduction in cocaine use days (p = .023). There were also no significant group differences in days of employment, quality of life, or substance abuse treatment entry. We conclude that this motivational intervention was more effective than assessment alone at reducing cocaine days among the heaviest community-based users. Both study conditions induced positive effects on cocaine use.
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Affiliation(s)
- Michael D Stein
- Rhode Island Hospital, Division of General Internal Medicine, Providence, RI 02903, USA.
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Colpaert K, Vanderplasschen W, Van Hal G, Broekaert E, Schuyten G. Dual Substance Abusers Seeking Treatment: Demographic, Substance-Related, and Treatment Utilization Characteristics. JOURNAL OF DRUG ISSUES 2008. [DOI: 10.1177/002204260803800209] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
High comorbidity exists between alcohol and drug-related disorders. However, little information is available on characteristics of clients abusing both alcohol and illicit drugs (so-called dual substance abusers). The proportion of dual substance abusers and their characteristics are examined in a sample of 1,626 clients seeking treatment in one of the 16 participating centers in the province of Antwerp (Belgium). More than a quarter of all clients were identified as dual substance abusers. Their characteristics correspond better to those of drug abusers than to those of alcohol abusers, but compared to the former, they are younger, more often male, use more types of illicit substances and more often use stimulating substances. Alcohol is often underestimated in substance use patterns. Thorough alcohol assessment, early intervention, and preventive actions are needed within the drug treatment system, and closer collaboration with the alcohol treatment system is absolutely essential.
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Abstract
The US FDA has approved a limited number of treatments for alcohol, nicotine and opioid dependence; however, no treatments for other abused drugs such as marijuana, cocaine or methamphetamine are approved. This review focuses on research into drug pharmacotherapies, particularly single-drug therapies, for substance abuse and dependence contributing to the most important dual substance use disorders (SUDs). Given the implications of poly-substance abuse, it is essential that clinicians and researchers be aware of potential pharmacotherapies for the treatment of dual SUDs.A substantial number of patients abuse more than one drug concurrently, complicating the treatment of SUD and leaving clinicians with few FDA-approved drug options for their patients. In this era of evidence-based medicine, such patients are typically treated with therapeutically proven medications, but in ways that are outside the scope of a drug's original indication by the FDA. Such 'off-label' prescribing has become an important therapeutic strategy for practitioners seeking treatments for other diseases in subpopulations such as paediatrics and gerontology or for medical conditions such as oncology or mental illness. Similarly, the information that most clinicians use to make their decisions for treating patients abusing multiple drugs stems from trials treating a single SUD, anecdotal experiences from their own practice or that of their colleagues, or single-case studies reported in the literature. The existing evidence suggests there are few treatments for SUDs that confer significant reductions in substance use across a broad patient population. Moreover, even fewer clinical efficacy trials have been conducted that provide evidence of therapeutic benefit for these drugs. Recognising the difficulty in making the proper drug choice for facilitating maximum treatment success, this review highlights the single drugs or drug combinations that show some potential for treating dual SUDs. This review finds strongest support for the use of disulfiram for treatment of alcohol and cocaine dependence (with or without concomitant methadone maintenance), baclofen for alcohol and cocaine dependence (but not opioid-dependent cocaine users), tiagabine for cocaine dependence in methadone-maintained patients, and topiramate for alcohol, nicotine and cocaine dependence. While ondansetron and olanzapine show some efficacy in treating alcohol and cocaine dependence, more research is needed to better delineate the subpopulation in which these drugs may provide their maximum effect.
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Affiliation(s)
- George A Kenna
- Department of Community Health, Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA.
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Patkar AA, Thornton CC, Mannelli P, Hill KP, Gottheil E, Vergare MJ, Weinstein SP. Comparison of pretreatment characteristics and treatment outcomes for alcohol-, cocaine-, and multisubstance-dependent patients. J Addict Dis 2004; 23:93-109. [PMID: 15077843 DOI: 10.1300/j069v23n01_08] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We investigated whether pretreatment characteristics and measures of outcome differed for alcohol-, cocaine-, and multisubstance-dependent patients receiving outpatient substance abuse treatment. One hundred and forty substance dependent individuals (32 alcohol, 76 cocaine, and 32 multisubstance) enrolled in a 12-week outpatient treatment program were compared across measures of addiction severity, personality, and treatment-readiness at admission. In-treatment, end-of-treatment and 9-month follow-up assessments of treatment outcome were then compared across the three groups. Outcome measures included reduction in problem severity, abstinence, retention, number of sessions attended, dropout, and counselor and patient ratings of treatment benefit. At admission, the multisubstance group had a higher proportion of positive urines, reported more severe drug, alcohol and psychiatric problems, and displayed higher impulsivity and anxiety scores than one or both of the other groups. However, multisubstance patients were more treatment ready in terms of adopting a total abstinence orientation than alcohol or cocaine patients. While a significant reduction in symptoms occurred for the total sample during treatment as well as at follow-up, comparisons of outcomes did not consistently favor any particular group. The three groups had equivalent improvements in eleven of fourteen during-treatment and five of seven follow-up measures. Despite pretreatment differences, in severity and treatment-readiness, outcomes were more similar than different for alcohol-, cocaine-, and multisubstance-dependent patients. Clinicians should be cautious about forecasting treatment-outcomes for addicted patients based on their primary substances of abuse.
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Affiliation(s)
- Ashwin A Patkar
- Division of Substance Abuse Programs, Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Carroll KM, Fenton LR, Ball SA, Nich C, Frankforter TL, Shi J, Rounsaville BJ. Efficacy of disulfiram and cognitive behavior therapy in cocaine-dependent outpatients: a randomized placebo-controlled trial. ACTA ACUST UNITED AC 2004; 61:264-72. [PMID: 14993114 PMCID: PMC3675448 DOI: 10.1001/archpsyc.61.3.264] [Citation(s) in RCA: 282] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Disulfiram has emerged as a promising treatment for cocaine dependence, but it has not yet been evaluated in general populations of cocaine users. OBJECTIVES To compare the effectiveness of disulfiram therapy with that of a placebo condition in reducing cocaine use and to compare the effectiveness of 2 active behavioral therapies-cognitive behavior therapy (CBT) and interpersonal psychotherapy (IPT)-in reducing cocaine use. DESIGN Randomized, placebo-controlled, double-masked (for medication condition), factorial (2 x 2) trial with 4 treatment conditions: disulfiram plus CBT, disulfiram plus IPT, placebo plus CBT, and placebo plus IPT. SETTING A community-based outpatient substance abuse treatment program. PATIENTS A total of 121 individuals meeting the criteria for current cocaine dependence. INTERVENTIONS Patients received either disulfiram (250 mg/d) or placebo in identical capsules. Medication compliance was monitored using a riboflavin marker procedure. Both behavioral therapies (CBT and IPT) were manual guided and were delivered in individual sessions for 12 weeks. MAIN OUTCOME MEASURES Random regression analyses of self-reported frequency of cocaine use and results of urine toxicology screens. RESULTS Participants assigned to disulfiram reduced their cocaine use significantly more than those assigned to placebo, and those assigned to CBT reduced their cocaine use significantly more than those assigned to IPT (P<.01 for both). Findings were consistent across all study samples (eg, intention to treat, treatment initiators, and treatment completers). Benefits of disulfiram use and CBT were most pronounced for participants who were not alcohol dependent at baseline or who fully abstained from drinking alcohol during treatment. Adverse effects experienced by participants who received disulfiram were mild and were not considerably different from those experienced by participants who received placebo. CONCLUSIONS Disulfiram and CBT are effective therapies for general populations of cocaine-dependent individuals. Disulfiram seems to exert a direct effect on cocaine use rather than through reducing concurrent alcohol use.
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Affiliation(s)
- Kathleen M Carroll
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06516, USA.
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Abstract
Given the heterogeneous nature of substance abuse, it is notable that several predictors of response are independent of the primary drug of abuse or the treatment setting [208]. Although the strength of the relationship of predictor to outcome varies, the following factors have been identified consistently: severity of dependence or withdrawal; psychiatric comorbidity; substance-related problems; motivation (abstinence commitment); length of treatment; negative affective states; cognitive factors; personality traits and disorders; coping skills; multiple substance abuse; contingency contracting or coercion; genetic factors; sleep architecture; urges and craving; self-efficacy; and economic and social factors. Although it is well known that severity of dependence (including polysubstance abuse), serious psychiatric comorbidity, and social problems are associated with poor treatment response, only recently has research examined the efficacy of intervention strategies that specifically address these problems. Adequate treatment of psychiatric comorbidity and improvement in social, economic, and family functioning lead to better treatment outcomes. The development of specific techniques to enhance self-efficacy, motivation, coping skills, and functioning in the community are concrete examples of how the identification of factors associated with positive outcomes has led to the development of new treatments. Despite significant accomplishments, the field is left with many unanswered questions. Although several biologic markers, such as neuroendocrine response and sleep architecture, show promise as outcome predictors, it is not known whether these are critical factors in the initiation of substance use or its progression to dependence. Determining whether biologic markers are epiphenomena reflecting the amount and duration of substance abuse or are fundamental to the pathophysiology of dependence is a matter of urgent concern. With some exceptions, identification of biologic predictors has not led to innovative therapies. One of these exceptions is the development of naltrexone for the treatment of alcoholism, which was based in a solid theoretical rationale and followed by hypothesis-driven experiments. Similar opportunities should emerge from current basic science and clinical research. The application of pharmacogenetic techniques to the field of addiction also holds great promise. As future studies are undertaken, researchers and clinicians must be mindful that differences in outcome predictors across drugs of abuse and treatments may emerge as subgroups of individuals with addictive disorders and new therapies are identified. There is already evidence that early onset alcoholism is associated with poor response under some circumstances, yet may be a predictor of response to targeted pharmacotherapy with ondansetron [64, 112]. As the ability to subtype disorders based on meaningful biologic differences grows, it is anticipated that several relevant outcome predictors that are specific for pharmacotherapy will emerge.
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Affiliation(s)
- Domenic A Ciraulo
- Division of Psychiatry, Boston University School of Medicine, Doctor's Office Building, 720 Harrison Avenue, Suite 914, Boston, MA 02118, USA.
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Zule WA, Flannery BA, Wechsberg WM, Lam WK. Alcohol use among out-of-treatment crack using African-American women. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2003; 28:525-44. [PMID: 12211364 DOI: 10.1081/ada-120006740] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The purpose of this study was to categorize the quantity and frequency of alcohol use among African-American women who were abusing crack cocaine and to explore relationships between categories of alcohol use and demographic variables, cocaine use, comorbidity, and risky sexual behaviors. METHOD Data were collected from 635 out-of-treatment crack cocaine-abusing African-American women in the Raleigh/Durham area of North Carolina. The women were categorized as light (n = 272), moderate (n = 216), or heavy drinkers (n = 147). RESULTS Women classified as heavy drinkers were demographically similar to light and moderate drinkers. Heavy drinkers used more crack cocaine and were more likely to engage in sexual risk behaviors than were the other two drinking groups. The heavy drinkers also reported greater psychological distress, and they were more likely to report histories of physical, sexual, and emotional abuse. CONCLUSIONS Heavy alcohol use among crack-abusing African-American women may be a marker for a host of underlying problems that require special attention. The HIV prevention programs and substance abuse treatment programs that provide services to crack-abusing women should screen for heavy drinking. Women identified as heavy drinkers should undergo more in-depth assessments and receive additional referrals as appropriate.
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Affiliation(s)
- William A Zule
- Research Triangle Institute, Research Triangle Park, NC 27709-2194, USA.
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Shoptaw S, Rotheram-Fuller E, Yang X, Frosch D, Nahom D, Jarvik ME, Rawson RA, Ling W. Smoking cessation in methadone maintenance. Addiction 2002; 97:1317-28; discussion 1325. [PMID: 12359036 DOI: 10.1046/j.1360-0443.2002.00221.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To evaluate relapse prevention (relapse prevention) and contingency management (contingency management) for optimizing smoking cessation outcomes using nicotine replacement therapy for methadone-maintained tobacco smokers. DESIGN Experimental, 2 (relapse prevention)x2 (contingency management) repeated measures design using a platform of nicotine replacement therapy featuring a 2-week baseline period, followed by randomization to 12 weeks of treatment, and 6- and 12-month follow-up visits. SETTING Three narcotic treatment centers in Los Angeles. PARTICIPANTS One hundred and seventy-five participants who met all inclusion and no exclusion criteria. INTERVENTION Participants received 12 weeks of nicotine replacement therapy and assignment to one of four conditions: patch-only, relapse prevention + patch, contingency management + patch and relapse prevention + contingency management + patch. MEASUREMENTS Thrice weekly samples of breath (analyzed for carbon monoxide) and urine (analyzed for metabolites of opiates and cocaine) and weekly self-reported numbers of cigarettes smoked. FINDINGS Participants (73.1%) completed 12 weeks of treatment. During treatment, those assigned to receive contingency management showed statistically higher rates of smoking abstinence than those not assigned to receive contingencies (F3,4680=6.3, P=0.0003), with no similar effect observed for relapse prevention. At follow-up evaluations, there were no significant differences between conditions. Participants provided more opiate and cocaine-free urines during weeks when they met criteria for smoking abstinence than during weeks when they did not meet these criteria (F1,2054=14.38, P=0.0002; F1,2419=16.52, P<0.0001). CONCLUSIONS Contingency management optimized outcomes using nicotine replacement therapy for reducing cigarette smoking during treatment for opiate dependence, although long-term effects are not generally maintained. Findings document strong associations between reductions in cigarette smoking and reductions in illicit substance use during treatment.
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Affiliation(s)
- Steve Shoptaw
- Friends Research Institute, Los Angeles, CA, UCLA, Department of Psychiatry, Los Angeles, CA 90025, USA.
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Sayre SL, Schmitz JM, Stotts AL, Averill PM, Rhoades HM, Grabowski JJ. Determining predictors of attrition in an outpatient substance abuse program. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2002; 28:55-72. [PMID: 11853135 DOI: 10.1081/ada-120001281] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Determining pre-treatment variables that predict attrition in an outpatient cocaine abuse program is critically important in efforts to enhance retention and ultimately improve client outcome. Potential predictors have been identified, such as treatment history, deviant behaviors, and level of drug use; however there is not widespread agreement on their applicability across treatments and populations. This study examines the relationship of demographic, drug use severity, and psychosocial factors with treatment attrition and the time of dropout. One hundred and sixty-five individuals from the Houston area, seeking treatment for cocaine dependence, completed a pre-treatment assessment battery prior to starting 12 weeks of outpatient treatment. A series of regression analyses showed that treatment dropouts were more likely to be separated from their spouses, have poorer family/social functioning, have fewer years of education, and to be female. Those participants with higher education levels and those with poorer psychiatric functioning tended to remain in treatment longer. The implications of these findings are discussed.
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Affiliation(s)
- Shelly L Sayre
- Department of Psychiatry and Behavioral Medicine, Substance Abuse-Medications Development Research Center, The University of Texas-Houston Medical School, 77030, USA
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Coviello DM, Alterman AI, Rutherford MJ, Cacciola JS, McKay JR, Zanis DA. The effectiveness of two intensities of psychosocial treatment for cocaine dependence. Drug Alcohol Depend 2001; 61:145-54. [PMID: 11137279 DOI: 10.1016/s0376-8716(00)00136-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Structured treatments for cocaine dependence have been shown to be effective despite high attrition rates. What is unclear is what level of treatment intensity is needed to improve and sustain patient outcomes, especially among low SES urban residents. This study evaluated whether there were differences between two levels of treatment intensities for cocaine dependence in reducing substance use and improving health and social indicators. Ninety-four cocaine dependent predominantly African-American male veterans were randomly assigned to either a 12 h/week day hospital program (DH12) or a 6 h/week outpatient program (OP6) and were evaluated at baseline, during treatment and at 4 and 7 months post-treatment. Both treatments stressed abstinence, behavior change and prosocial adjustment and only differed in level of treatment intensity. During treatment measures included urine toxicologies, program attendance, treatment completion and aftercare attendance. Participants reported a 52% reduction in days of cocaine use and experienced significant improvements in employment and psychiatric functioning at seven months post-treatment. However, there was no significant difference between the DH12 and OP6 programs in terms of abstinence during treatment, treatment completion, treatment or aftercare attendance or any Addiction Severity Index (ASI)-related variable assessing level of functioning at 4 and 7 months. While future research with a larger community-based sample that includes female clients is necessary, the current findings demonstrate that a 6 h/week program is just as effective and thus has a significant cost savings compared to a 12 h/week treatment modality for cocaine dependence.
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Affiliation(s)
- D M Coviello
- University of Pennsylvania School of Medicine and VA Medical Center, 3900 Chestnut Street, Philadelphia, PA 19104, USA.
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Smith TL, Volpe FR, Hashima JN, Schuckit MA. Impact of a Stimulant-Focused Enhanced Program on the Outcome of Alcohol- and/or Stimulant-Dependent Men. Alcohol Clin Exp Res 1999. [DOI: 10.1111/j.1530-0277.1999.tb04072.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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