The drug-of-choice phenomenon psychological differences among drug users who preferred different drugs

Why Switch? - Motivations for Self-Substitution of Illegal Drugs

Self-substitution is the conscious switch from one drug to another for reasons such as price, availability, desired effect, or perceived benefit of the substitute drug. Purpose/Objectives: This study aimed to describe drug use patterns and motivations associated with substitution. We examined correlates of lifetime substitution among individuals with substance use disorder. Methods: A cross-sectional study of 771 treatment-enrolled individuals. We used self-report for determining the lifetime prevalence, correlates, and motivations for substitution. Results: Of the 771 respondents, 570 (73.9%) reported ever substituting their preferred substance. The main incentives for substitution were availability (23.7%) and curiosity (20.2%). Among heroin or cannabis preferers, improved effects or less adverse effects of the substitute drug, self-medication, and managing withdrawal symptoms were significant substitution incentives. Increased odds for substitution were observed for past 12 months use of cannabis (OR = 1.51, CI = 1.06-4.52), prescription opioids (OR = 2.86, CI = 1.81-4.52), novel psychoactive substances (OR = 2.68, CI = 1.64-4.36), and repeated admission (OR = 1.50, CI = 1.05-2.14). Older age at onset-of-use was negatively associated with substitution (OR = 0.95, CI = 0.93-0.98). Conclusions: Self-substitution of one substance for another is a highly prevalent behavior among treatment-enrolled patients with substance use disorder. Clinicians caring for substance use disorder patients should be aware of substitution patterns involving the use of highly potent substances, which constitutes a risk to patients. Results underscore the benefit of substitution patterns analyses, as they reveal important information on the characteristics of persons who use drugs and their motivations.

Clonidine Increases the Likelihood That Abstinence Can Withstand Unstructured Time in Buprenorphine-maintained Outpatients

OBJECTIVE

In a clinical trial examining daily clonidine as an adjunct to buprenorphine treatment for opioid dependence, we found that clonidine increased opioid abstinence and decoupled stress from craving. From a personalized-medicine perspective, the next step is to identify people for whom clonidine would be beneficial. To that end, using data from the same clinical trial, we examined the associations of daily-life activities with treatment success.

METHODS

Outpatients (N = 118) received clonidine (0.3 mg/d) or placebo during 18 weeks of buprenorphine treatment. Participants carried a smartphone that randomly prompted them 4 times per day to report their moods and activities. Using generalized linear mixed models, we assessed the likelihoods of different types of daily activity as a function of clonidine versus placebo, days of longest continuous opioid abstinence, and their interaction.

RESULTS

Participants in the buprenorphine-only (buprenorphine plus placebo) control group who engaged in more responsibilities (work and child/elder care) had longer streaks of abstinence, whereas those who engaged in more unstructured-time activities had shorter streaks of abstinence. Conversely, for participants in the buprenorphine-plus-clonidine group, longer streaks of abstinence were associated with higher frequencies of activities associated with "unstructured" time.

CONCLUSIONS

The study replicates findings that engaging in responsibilities is related to positive treatment outcomes in standard opioid agonist therapy. The pattern of results also suggests that clonidine helped participants engage in unstructured-time activities with less risk of craving or use than they might otherwise have had.

How do drug market changes affect characteristics of injecting initiation and subsequent patterns of drug use? Findings from a cohort of regular heroin and methamphetamine injectors in Melbourne, Australia

BACKGROUND

Changes in drug market characteristics have been shown to affect drug use patterns but few studies have examined their impacts on injecting initiation experiences and subsequent patterns of injecting drug use (IDU).

METHODS

We collected data on self-reported injecting initiation experiences and past-month patterns of IDU from 688 regular heroin and methamphetamine injectors in Melbourne, Australia, who initiated injecting across three different drug market periods (prior to the Australian heroin shortage ('high heroin')/immediately following the shortage ('low heroin')/'contemporary' markets (fluctuating heroin and methamphetamine availability)). We used univariable and multivariable logistic regression to examine the relationship between period of injecting initiation and first drug injected, and multinomial logistic regression for the relationship between period of injecting initiation and current injecting patterns.

RESULTS

425 participants (62%) reported initiating injecting in the high heroin period, 146 (21%) in the low heroin period, and 117 (17%) in the contemporary period. Participants who initiated injecting during the low heroin period were twice as likely to initiate injecting using a drug other than heroin (AOR: 1.94, 95% CI: 1.27-2.95). The most common patterns of drug use among study participants in the month preceding interview were polydrug use (44%) and primary heroin use (41%). Injecting initiation period was either non-significantly or weakly associated with current drug use pattern, which was more strongly associated with other socio-demographic and drug use characteristics, particularly self-reported drug of choice.

CONCLUSION

The drug market period in which injecting initiation occurred influenced the first drug injected and influenced some aspects of subsequent drug use. In the context of highly dynamic drug markets in which polydrug use is common there is a need for broad harm reduction and drug treatment services which are flexible and responsive to changing patterns of drug use.

Models of co-occurring substance misuse and psychosis: are personality traits the missing link?

Traditional models of co-occurring substance misuse in psychosis, including the vulnerability and coping (self-medication) hypotheses, have tended to focus on state-specific factors, such as the severity of substance misuse or psychotic symptoms. In contrast, more recent personality models posit that co-morbidity is related to individual differences in stable trait-specific personality variables that underlie affective outcomes, coping strategies and subsequent risk for substance use. This paper reviews the current evidence base for these three models, and suggests that future research examine the inter-relationships between trait and state-specific personality, affective and behavioural variables on co-morbidity.

Relationship of personality traits and drug of choice by cocaine addicts and heroin addicts

The link between specific personality profiles and a single psychotropic drug of choice is still unclear and only partially explored. The present study compares three groups of male subjects: 85 patients manifesting heroin dependence (age: 30.07 +/- 2.78), 60 patients manifesting cocaine dependence (age: 31.96 +/- 3.1), and 50 healthy subjects from a random population sample (age: 33.25 +/- 1.45). The patients included in the study showed a long-lasting history of dependence on heroin or cocaine, respectively, 5.2 +/- 2.5 years, 4.6 +/- 2.9 years, and were stabilized in treatment, and abstinent, at least 4 weeks at the time of the diagnostic assessment. Heroin addicts (52.90%) were on methadone maintenance treatment. Cocaine addicts (11.60%) were treated with selective serotonin reuptake inhibitors. Personality traits were measured by the Minnesota Multiphasic Personality Inventory (MMPI-2) and Cloninger's Three-dimensional Personality Questionnaire (TPQ). Character and quantification of aggressiveness were measured by the Buss-Durkee Hostility Inventory (BDHI). Heroin-dependent patients (group A) scored significantly higher on hysteria, masculine-feminine and social introversion subscales of the MMPI, and significantly lower on the harm avoidance (HA) subscale of the TPQ than cocaine addicts. In contrast, scores on the MMPI for hypochondria, psychopathic deviance, and paranoia dimensions were more elevated in cocaine addicts than in heroin-dependent patients. Cocaine addicts scored higher than heroin addicts on the "direct" aggressiveness subscale and on the BDHI total score. Cocaine addicts did not differ from healthy controls on harm avoidance (behavioral control). Although cocaine addicts showed more consistent psychopathic deviance and overt aggressiveness than heroin addicts, higher harm avoidance (behavioral control), hypochondria (or worry about their health), and social extroversion may reduce their proneness to overt antisocial behavior and allow relatively higher levels of social integration. The study's limitations are noted.

Differences in impulsivity and sexual risk behavior among inner-city crack/cocaine users and heroin users

The current study utilized a sample of 123 inner-city drug users in residential treatment, comparing sexual risk behavior (SRB) across primary users of (a) heroin and not crack/cocaine, (b) crack/cocaine and not heroin, and (c) both heroin and crack/cocaine. Additional analyses also examined impulsivity as a mediator of drug choice and SRB. Results indicated that SRB was higher in primary crack/cocaine users than in primary heroin users, with those using both drugs evidencing intermediate levels of SRB. Beyond differences in SRB, a similar pattern across drugs was found for impulsivity. Finally, impulsivity mediated the relationship between drug choice and SRB. Although further research is necessary to establish causal relationships, these results support a relationship between SBR and crack/cocaine, and suggest that disinhibition processes including impulsivity may underlie this relationship.

Personality profile and drug of choice; a multivariate analysis using Cloninger's TCI on heroin addicts, alcoholics, and a random population group

As personality may predispose, precipitate or perpetuate substance abuse and/or dependence, and as it is considered to remain stable across the years in a given subject, potential links with the drug of choice may help screen future patients before drug consumption. The present study compared three groups: 42 patients with heroin dependence (mean age: 31.2; standard deviation (SD): 5.5; 10 females), 37 patients with alcohol dependence (mean age 44.2; SD: 9.1; 9 females) and 83 subjects from a random population sample (mean age: 38.8; SD: 6.9; 20 females). Personality was measured by Cloninger's Temperament and Character Inventory (TCI). Pillai's MANCOVA with age as a covariate and gender as a cofactor was highly significant. Univariate ANOVA analyses using TCI dimensions as dependent variable showed most variables to vary in parallel for the two patient groups in comparison with controls. Post-hoc tests showed heroin patients to score higher in Novelty-Seeking and Self-Directedness than alcohol patients. Sub-dimensions Exploratory Excitability, Fear of the Uncertain, Responsibility, Congruent Second Nature and Transpersonal Identification were also significantly different in the two patient samples. Logistic regression showed Exploratory Excitability to segregate up to 76% of heroin patients from alcohol patients. In conclusion, personality profiles were linked to some preferential choice of drug and personality screening might be tested in preventive strategies.

Relationships Between Personality and Preferred Substance and Motivations for Use Among Adolescent Substance Abusers

This study examined the utility of Cloninger's tridimensional personality theory (1986, 1987a) in predicting preferred substance of abuse and self-reported motivations for use among a sample of 200 adolescent substance abusers and 200 matched community control adolescents. Two primary hypotheses were tested: (1) Cloninger's type II profile is more strongly associated with stimulant use, and his type I profile is more strongly associated with substances having sedative-hypnotic effects; and 2) type II individuals will report motivations for use that focus primarily on obtaining positive rewards, whereas type I individuals will report motivations primarily concerning negative reinforcement or the avoidance of problems and negative life experiences. Our results did not show strong associations between Cloninger's Harm Avoidance and Reward Dependence dimensions and preferred substance or motivations for use. However, in partial support of the hypotheses examined here, we did find that individuals low in novelty seeking (NS) tended to prefer alcohol and marijuana, whereas those high in NS endorsed a wider range of preferred substances. High NS was associated with significantly greater stimulant use and motivations focused on obtaining positive rewards, whereas low NS was associated with greater sedative use and motivations related to avoiding negative emotions or negative life experiences.

Dopamine D4 receptor gene and severity of dependence

Family, twin and adoption studies demonstrate that substance dependence is determined partially by genes. Recent studies in opiate-dependent subjects have found a significant excess of the long-long (LL) allele of the 48bp repeat in the coding sequence of the DRD4 gene. This study examined this association further in a sample of 60 opiate dependent, 51 alcohol-dependent and 64 normal, healthy control subjects. No significant association between the polymorphism at DRD4 and opiate or alcohol abuse was found. However, results yielded a significant main effect on severity of dependence, demonstrating that individuals with the LL allele rated their severity of dependence significantly higher than those who had the short-short (SS) allele :[F(2, 101) = 5.0, p < 0.01]. This study suggests that the DRD4 gene does not directly influence vulnerability to substance dependence, but that possession of the LL genotype significantly increases severity of dependence.

Exploratory and confirmatory factor analyses of the Brief Symptom Inventory among substance abusers

The Brief Symptom Inventory (BSI) is a multidimensional measure of psychological and somatic distress that is used to obtain detailed symptom profiles. The BSI has been questioned regarding its ability to differentiate among its proposed nine dimensions, and the factor structure underlying the BSI has not been confirmed with substance abusers. Exploratory factor analyses were completed on substance abusers (ntotal = 453; nwomen = 121; nmen = 332); nine factors were not identified. Five models were then submitted to confirmatory factor analyses using an independent sample of substance abusers (ntotal = 456; nwomen = 127; nmen = 329). A one-factor model (i.e., global psychological distress) best represented the data. Implications for using the BSI in research and counseling are discussed.

An examination of racial and ethnic differences within a sample of Hispanic, white (non-Hispanic), and African American Medicaid-eligible pregnant substance abusers. The MOTHERS Project

White (n = 213), African American (n = 210), and Hispanic (n = 104) Medicaid-eligible, chemically-dependent, pregnant women were interviewed during their stay in stay in publicly-funded detoxification centers in Massachusetts. Comparisons of demographic, psychosocial, and substance abuse variables revealed significant intergroup differences in almost all instances. There appears to be as much heterogeneity within the treatment population subgroup of pregnant women as there is across different treatment populations. Ramifications of the observed differences for treatment planning and service provision are discussed.

The Sonda Project: prevention, prediction, and psychological disorder

The Sonda Project began in Italy in 1985 and was created by Semeion Research Center of Sciences of Communication. It has been operating in approximately 30 Italian cities, ranging from large to small, since 1986. The aim of the Sonda Project is to undertake primary prevention measures at the level of personality organization disorder. Cognitive and communication disorders are, in the context of the Sonda Project, the common ground for many expressions of cultural disorders labeled drug addiction, alcoholism, violence, etc. From the point of view of the Sonda Project, measures aimed at combating drug-addiction and alcoholism are no more than superficial strategies incapable of dealing with the causes of self and hetero-destruction (of others). Such abuses are the most evident political symptoms. The methodological aim of the Sonda Project, therefore, consists in understanding, predicting, and acting upon the incubation disorder of human beings; a disorder which subsequently transforms itself into more or less recognizable symptoms. In order to attain its aim, the Sonda Project has made use of two instruments: 1) a series of Intelligent Computerized Observatories, able to predict, in each community, the typology of people who are more likely to exhibit forms of destructive suffering; 2) a local team able to use such advanced technology and able to utilize territorial activation techniques. These are designed to reinsert into the arena of the social game those people who are more "at risk" in terms of self and heterodestruction, and who are most exposed to psychological and sociological levels of relational "fatigue."

THE RELATIONSHIP BETWEEN BOREDOM PRONENESS AND INTERNAL AND EXTERNAL WORK VALUES

Undergraduate students (N = 111) completed the Boredom Proneness Scale (BPS) and the Survey of Work Values (SWV) as part of a study examining vocational preferences. The results indicated that individuals with high boredom proneness scores possessed significantly greater external work value scores, whereas those low in boredom proneness had significantly higher internal work values. The results are discussed in terms of their importance for career guidance, selection, and motivation strategies.