Behavioral Therapy Development and Psychological Science: Reinforcing the Bond

An abundance of research from diverse areas of psychological science is potentially relevant to behavioral therapy development research The National Institute on Drug Abuse of the National Institutes of Health convened a workshop to reinforce the connection between basic behavioral and therapy development research The articles in this Special Section are the product of this workshop Several lines of basic behavioral research are described, and implications for the development of behavioral therapies are discussed This Special Section highlights the notion that strengthening the bond between behavioral therapy development research and basic behavioral science will accelerate the advancement of knowledge about behavior, behavioral change and therapeutic interventions

Treatment outcomes in opioid dependent patients with different buprenorphine/naloxone induction dosing patterns and trajectories

BACKGROUND AND OBJECTIVES

Induction is a crucial period of opioid addiction treatment. This study aimed to identify buprenorphine/naloxone (BUP) induction patterns and examine their association with outcomes (opioid use, retention, and related adverse events [AEs]).

METHODS

The secondary analysis of a study of opioid-dependent adults seeking treatment in eight treatment settings included 740 participants inducted on BUP with flexible dosing.

RESULTS

Latent class analysis models detected six distinctive induction trajectories: bup1-started and remained on low; bup2-started low, shifted slowly to moderate; bup3-started low, shifted quickly to moderate; bup4-started high, shifted to low; bup5-started and remained on moderate; bup6-started moderate, shifted to high dose (Fig. 1). Baseline characteristics, including Clinical Opioid Withdrawal Scale (COWS), were important predictors of retention. When controlled for the baseline characteristics, bup6 participants were three times less likely to drop out the first 7 days than bup1 participants (adjusted hazard ratio (aHR) = .28, p = .03). Opioid use and AEs were similar across trajectories. Participants on ≥16 mg BUP compared to those on <16 mg at Day 28 were less likely to drop out (aHR = .013, p = .001) and less likely to have AEs during the first 28 days (aOR = .57, p = .03).

DISCUSSION AND CONCLUSIONS

BUP induction dosing was guided by an objective measure of opioid withdrawal. Participants with higher baseline COWS whose BUP doses were raised more quickly were less likely to drop out in the first 7 days than those whose doses were raised slower.

SCIENTIFIC SIGNIFICANCE

This study supports the use of an objective measure of opioid withdrawal (COWS) during BUP induction to improve retention early in treatment.

The construct and measurement equivalence of cocaine and opioid dependences: a National Drug Abuse Treatment Clinical Trials Network (CTN) study

INTRODUCTION

Although DSM-IV criteria are widely used in making diagnoses of substance use disorders, gaps exist regarding diagnosis classification, use of dependence criteria, and effects of measurement bias on diagnosis assessment. We examined the construct and measurement equivalence of diagnostic criteria for cocaine and opioid dependences, including whether each criterion maps onto the dependence construct, how well each criterion performs, how much information each contributes to a diagnosis, and whether symptom-endorsing is equivalent between demographic groups.

METHODS

Item response theory (IRT) and multiple indicators-multiple causes (MIMIC) modeling were performed on a sample of stimulant-using methadone maintenance patients enrolled in a multisite study of the National Drug Abuse Treatment Clinical Trials Network (CTN) (N=383). Participants were recruited from six community-based methadone maintenance treatment programs associated with the CTN and major U.S. providers. Cocaine and opioid dependences were assessed by DSM-IV Checklist.

RESULTS

IRT modeling showed that symptoms of cocaine and opioid dependences, respectively, were arrayed along a continuum of severity. All symptoms had moderate to high discrimination in distinguishing drug users between severity levels. "Withdrawal" identified the most severe symptom of the cocaine dependence continuum. MIMIC modeling revealed some support for measurement equivalence.

CONCLUSIONS

Study results suggest that self-reported symptoms of cocaine and opioid dependences and their underlying constructs can be measured appropriately among treatment-seeking polysubstance users.

An item response theory modeling of alcohol and marijuana dependences: a National Drug Abuse Treatment Clinical Trials Network study

OBJECTIVE

The aim of this study was to examine psychometric properties of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), diagnostics criteria for alcohol and marijuana dependences among 462 alcohol users and 311 marijuana users enrolled in two multisite trials of the National Drug Abuse Treatment Clinical Trials Network.

METHOD

Diagnostic questions were assessed by the DSM-IV checklist. Data were analyzed by the item response theory and the multiple indicators-multiple causes method procedures.

RESULTS

Criterion symptoms of alcohol and marijuana dependences exhibited a high level of internal consistency. All individual symptoms showed good discrimination in distinguishing alcohol or marijuana users between high and low severity levels of the continuum. In both groups, "withdrawal" appeared to measure the most severe symptom of the dependence continuum. There was little evidence of measurement nonequivalence in assessing symptoms of dependence by gender, age, race/ethnicity, and educational level.

CONCLUSIONS

These findings highlight the clinical utility of the DSM-IV checklist in assessing alcohol- and marijuana dependence syndromes among treatment-seeking substance users.

Infrequent illicit methadone use among stimulant-using patients in methadone maintenance treatment programs: a national drug abuse treatment clinical trials network study

We sought to determine the prevalence, patterns, and correlates of past-month illicit methadone use and history of regular illicit use among stimulant-using methadone maintenance treatment patients. We obtained self-reported information on illicit methadone use from 383 participants recruited from six community-based methadone maintenance programs. Overall, 1.6% of participants reported illicit use in the past month, and 4.7% reported a history of regular use. Younger age and history of outpatient psychological treatment were associated with increased odds of past-month illicit use. Illicit methadone use among patients in maintenance programs is infrequent; however, a number of factors may increase risk of illicit use.

Acupuncture treatment for drug abuse: a technical review

Conflicting opinions exist regarding the efficacy of acupuncture for the treatment of substance abuse. On October 23, 1991, the National Institute on Drug Abuse (NIDA) sponsored a technical review to discuss this issue. The purpose of the meeting was to review the current status of research regarding acupuncture treatment for drug abuse and to propose directions for future studies. This report represents a summary of the meeting which consisted of presentations by individuals currently involved in acupuncture treatment and discussions by a panel of experts in the field of substance abuse treatment research.

Use of ECT in the United States in 1975 and 1980

The authors examined data from the National Institute of Mental Health regarding the use of ECT in the United States in 1975 and 1980. A total of 33,384 hospitalized patients were treated with ECT in 1980, representing 2.4% of all patients hospitalized in psychiatric facilities. The use of ECT decreased by 46% between 1975 and 1980. Of the type of facilities surveyed, only public general hospitals did not decrease their use of ECT. Patients with affective disorders received 69.8% of the ECT given, and patients with schizophrenia received 16.6%. Although more women than men received ECT, diagnosis and age were more important factors than sex.

Antidepressant drug therapy: the role of the new antidepressants

Three new antidepressants have been marketed in the United States since 1980, and about two dozen more are being evaluated. In a 1983 workshop convened by the National Institute of Mental Health, participants examined the claims made for the newer antidepressants in relation to clinical efficacy, speed of onset, cardiovascular effects, and other adverse reactions. In this summary report of the workshop, primarily covering amoxapine, maprotiline, trazodone, and the investigational drug bupropion, the authors note that none of the new antidepressants demonstrate greater effectiveness than standard tricyclics, although some produce a different profile of side effects. The main benefit of the newer drugs is that they offer new options for the treatment of patients who cannot tolerate side effects of the traditional drugs or have responded unsatisfactorily to them.

The role of antidepressants in the treatment of affective disorders

The paper reviews studies of the effectiveness of antidepressants in acute depression and variables accounting for nonresponsiveness. Data supporting continuation and maintenance therapy are presented. The authors discuss nonspecific psychotherapeutic components of drug management and also review studies of the usefulness of antidepressant and psychotherapy, alone and in combination.

Compulsive heroin use and interpersonal orientation

This research attempt to clarify and quantify the ways in which heroin addicts deal with interpersonal relations. A sample of heroin addicts on a methadone maintenance program were given the Fundamental Interpersonal Relations Orientation-Behavior (FIRO-B) scale. An accidental sample consisted of 35, approximately one-half, of the clinic's population. A mean interpersonal orientation profile is established and interpreted. An analysis of variance was performed for each of the six FIRO-B scores. Patients needs based on FIRO-B scores are discussed with regard to the descriptions of addicts life-styles as described in the literature. The possible etiological basis for these interpersoanl orientations is also discussed. Several therapeutic approaches, as indicated by FIRO-B scores, are explored.

Marijuana effects on simulated flying ability

The authors studied the effects of marijuana intoxication on the ability of 10 certified airplane pilots to operate a flight simulator. They used a randomized double-blind crossover design to compare the effect of active versus placebo marijuana. They found that all 10 pilots showed a significant decrease in measurements of flying performance 30 minutes after smoking active marijuana. For a group of 6 pilots tested sequentially for 6 hours, a nonsignificant decrease in flying performance continued for 2 hours after smoking the active drug. The authors conclude that the effects of marijuana on flying performance may represent a sensitive indicator of the drug's psychomotor effects.

Simulated flying performance after marihuana intoxication

Ten pilots smoked, in counterbalanced order on a double blind basis, a social dose of marihuana (.09 mg/kg delta-9-tetrahydrocannabinol) and a matched placebo after being trained to fly a specific flight sequence on an ATC-510 flight simulator. In contrast to placebo, marihuana caused a gross decrement in flying performance, with increased prevalence of major errors, minor errors, altitude deviations, heading deviations, and radio navigation errors. These effects of active marihuana persisted for at least 2 hr and generally had disappeared by 4 to 6 hr after marihuana administration.