Drug and Alcohol Dependence

Drug and Alcohol Dependence
Volume 80, Number 1, October 2005
(Updated 11/26/2005)

Home Page

Ty A. Ridenour, Mildred Maldonado-Molina, Wilson M. Compton, Edward L. Spitznagel, and Linda B. Cottler. Factors associated with the transition from abuse to dependence among substance abusers: Implications for a measure of addictive liability. Drug and Alcohol Dependence 80(1):1-14, October 2005.

Address correspondence to Ty A. Ridenour, Pennsylvania State University, Prevention Research Center, 135 East Nittany Avenue, Suite 402, State College, PA 16801, USA. Tel: 814-865-4122; Fax: 814-865-6004.

Summary:
The objective was to test the validity of a potential measure for bridging research on the addictive liability of drugs and research on individual addiction liability. It was hypothesized that shorter length of time between abuse onset and dependence (LOTAD) is an indicator of greater addictive liability. Hypotheses were based on animal studies and human studies. Retrospective data from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Substance Use Disorders Work Group were reanalyzed using configural frequency analysis, survival curves, bivariate Kendall's tau associations, and linear regression. Participants in the study were recruited from community and clinical settings. The measure was the Composite International Diagnostic Interview–Substance Abuse Module (CIDI–SAM). The shortest LOTADs were observed for disorders related to use of cocaine and opiates, followed by cannabis, then ethanol, regardless of the subsample that was analyzed. As hypothesized, females and early initiators of drug use had shorter LOTADs compared to men and other initiators of drug use; no consistent differences in LOTAD were observed between African-Americans and Caucasians. None of the LOTAD variance associated with differences between drugs could be accounted for by gender, early use of the drug, or ethnicity. Specific areas of research where LOTAD might be useful and ways it might be improved are discussed.

NIAAA Glossary Terms: addiction, AOD dependence, AOD abuse, validation study, individual as study subject, hypothesis testing, disease onset, early AOD onset, diagnosis, diagnostic criteria, disease course, statistical estimation, regression analysis, cocaine, opiates, marijuana in any form, alcoholic beverage, gender differences, ethnic differences, racial differences, human study

Cuneyt Evren and Bilge Evren. Self-mutilation in substance-dependent patients and relationship with childhood abuse and neglect, alexithymia and temperament and character dimensions of personality. Drug and Alcohol Dependence 80(1):15-22, October 2005.

Address correspondence to Cuneyt Evren, AMATEM, Bakirkoy State Hospital for Psychiatric and Neurological Disorders, 34747 Bakirkoy, Istanbul, Turkey.

Summary:
The authors evaluated the prevalence of self-mutilation in Turkish male substance-dependent patients and investigated the relationship of self-mutilation with childhood abuse and neglect, alexithymia, and temperament and character dimensions of personality. Consecutively admitted males with substance dependence (N = 136; 96 alcohol and 40 drug) participated. Substance dependence was diagnosed with the Structured Clinical Interview (SCID-I) for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Turkish version. Patients were investigated with the Childhood Abuse and Neglect Questionnaire, Toronto Alexithymia Scale (TAS-20), and Temperament and Character Inventory (TCI). Among substance-dependent patients 34.6% were considered to be self-mutilators. Rates of being single and unemployed, histories of physical and sexual abuse, and suicide attempts were higher in the self-mutilation group. Current age, age at first substance use, and age at regular substance use were lower in the self-mutilation group. Mean of TAS-20 and "Difficulty in Identifying Feelings" (DIF) and "Difficulty in Describing Feelings" (DDF) subscales of TAS-20 were higher in the self-mutilation group. No significant differences were found between groups in terms of TCI subscales. Age, childhood physical abuse, and suicide attempt history predicted self-mutilation in logistic regression. Young substance users with childhood physical abuse histories could be the target population to prevent self-mutilating behavior. The findings also suggests that whenever self-mutilating behavior is present, the possibility of childhood abuse, alexithymia, and suicide attempts must be evaluated.

NIAAA Glossary Terms: prevalence, self-destructive behavior, Turkey, AOD abuse, AOD dependence, abused as child, alexithymia, personality trait, variable, characteristic, factor, marital status, employment status, unemployed, patient history, sexual abuse, physical abuse, victim of abuse, suicidal behavior, age of AODU onset, AOD use pattern, regression analysis, human study

Joan S. Tucker, Elizabeth J. D’Amico, Suzanne L. Wenzel, Daniela Golinelli, Marc N. Elliott, and Stephanie Williamson. A prospective study of risk and protective factors for substance use among impoverished women living in temporary shelter settings in Los Angeles County. Drug and Alcohol Dependence 80(1):35-43, October 2005.

Address correspondence to RAND Corporation, Health, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA. Tel: 310-393-0411 x7519; Fax: 310-260-8159.

Summary:
Few prospective studies have examined risk and protective factors for substance use among homeless women, although alcohol and drug use are significant problems in this population. This 6-month prospective study identified psychosocial, behavioral, and economic predictors of drinking to intoxication, crack cocaine use, and marijuana use in a probability sample of women (N = 402) living in temporary shelters in Los Angeles County, California. Sexual risk behavior and depressive symptoms were risk factors for more frequent intoxication, marijuana use, and crack use. Drinking to intoxication was additionally predicted by perceived human immunodeficiency virus (HIV), lower social support, more avoidant and less active coping, and lower self-esteem. Additional predictors of marijuana use included partner alcohol misuse and less social support, whereas more frequent crack use was additionally predicted by partner alcohol misuse, lack of economic resources, and more avoidant and less active coping. The findings suggest that effective substance use programs may need an integrative approach that addresses other types of risk behaviors, assists women in strengthening their support networks and learning effective coping skills, and provides access to basic services such as housing and health care. For women in relationships, there may be a further need to address issues of partner substance use.

NIAAA Glossary Terms: homeless, homelessness, female, alcoholic beverage, AOD use for intoxication, predictive factor, risk factors, psychosocial environment, behavior, economic aspects of AOD and AOD use, human immunodeficiency virus, disease susceptibility, social support, emotional and psychiatric depression, coping, loss of self-esteem, crack cocaine, marijuana in any form, poverty, coping skills, housing, health care availability and access, spouse or significant other, human study

Miriam Bottlender and Michael Soyka. Outpatient alcoholism treatment: Predictors of outcome after 3 years. Drug and Alcohol Dependence 80(1):83-89, October 2005.

Address correspondence to Miriam Bottlender, Department of Psychiatry, Ludwig-Maximilians University, Munich, Nussbaumstr. 7, 80336 Munich, Germany. Tel: +49-89-5160-2777; Fax: +49-89-5160-5748.

Summary:
Predictors of relapse after completion of an intensive outpatient treatment program for alcoholism were investigated in a 3-year prospective study of consecutively recruited participants (N = 103). Since previous studies mainly revealed that alcohol dependence severity and comorbid psychopathology were predictive of subsequent relapses, the impact of these and other pre-treatment variables on the 36-month outcome was evaluated using logistic regression analysis. Variables were assessed using a structured interview. Patients were personally interviewed at entry to, and the end of, an outpatient treatment program and 6, 12, 24, and 36 months after treatment completion. The treatment program was completed by 74 patients. At the 36-month follow-up, 2 patients had died (after heavy alcohol relapse) and 88 (88%) of the remaining patients were located and personally re-interviewed. Forty-four (43%) patients were abstinent, 46 (45%) had relapsed, and 12 (12%) were classified as improved for the total follow-up period. Logistic regression analysis revealed that significant predictors of relapse were treatment drop-outs, female sex, and sum of positive life events prior to treatment (relapsers had significantly fewer positive life events). In contrast to previous studies, this study could not confirm the importance of risk factors for relapse such as dependence severity. Treatment drop-out was the strongest predictor for post-treatment relapse. Since women were at an increased risk for relapse, gender-specific treatment approaches should be considered. In summary, the effectiveness of this intensive outpatient treatment program is favorable, although selection criteria of must be taken into account.

NIAAA Glossary Terms: AODD relapse, predictive factor, AOD dependence, disease severity, comorbidity, predictive factors, risk factors, evaluation study, regression analysis, outpatient care, treatment outcome, follow-up study, interview, program dropout, gender differences, life circumstances, life events, human study

Andrew Rosenblum, Stephen Magura, Deborah J. Kayman, and Chunki Fong. Motivationally enhanced group counseling for substance users in a soup kitchen: A randomized clinical trial. Drug and Alcohol Dependence 80(1):91-103, October 2005.

Address correspondence to Andrew Rosenblum, National Development and Research Institutes, Inc., 71 West 23rd Street, 8th Floor, New York, NY 10010, USA. Tel: 212-845-4528; Fax: 917-438-0894.

Summary:
Soup kitchens tend to serve residentially unstable adults with a high prevalence of substance abuse. In this study, soup kitchen guests (N = 289) who reported drug or alcohol problems were randomly assigned to information and referral (I&R) plus peer advocacy (peers encouraging subjects to participate in other services) (n = 139) or to an experimental 12-session motivational group (three sessions a week for 4 weeks) followed by a 36-session cognitive-behavioral group (three sessions a week for 12 weeks), plus I&R and peer advocacy. The mean age was 42; 82% were male; 68% were African-American; 81% had unstable residence; and 14% were positive for human immunodeficiency virus. Intervention subjects were significantly more likely than controls to have increased their participation in some type of substance abuse intervention during follow-up and were also significantly more likely than controls to have reduced both drinking and heavy drinking at follow-up (the groups did not differ in reduction of cocaine use). Interaction analysis indicated that the experimental intervention was more effective for participants with higher rather than lower substance abuse severity at baseline. The results support the concept that motivationally enhanced group counseling, provided as a low-threshold outreach intervention, can help increase participation in formal treatment and 12-step groups and reduce substance abuse, particularly for those starting with high severity of use.

NIAAA Glossary Terms: AOD abuse, homelessness, group therapy, peer counseling, advocacy, intervention referral, motivation, HIV infection, controlled study, follow-up study, treatment outcome, AOD intake per occasion, AOD consumption, heavy AOD use, disease severity, human study

Frederick S. Stinson, Bridget F. Grant, Deborah A. Dawson, W. June Ruan, Boji Huang, and Tulshi Saha. Comorbidity between DSM-IV alcohol and specific drug use disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug and Alcohol Dependence 80(1):105-116, October 2005.

Address correspondence to Frederick S. Stinson, Laboratory of Epidemiology and Biometry, Room 3075, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, M.S. 9304, 5635 Fishers Lane, Bethesda, MD 20892-9304, USA. Tel: 301-443-4898; Fax: 301-443-1400.

Summary:
This study investigated the prevalence and comorbidity of alcohol and specific drug use disorders and identified sociodemographic and psychopathologic correlates and treatment seeking among three groups of respondents: those with alcohol use disorders only, those with drug use disorders only, and those with comorbid alcohol and drug use disorders. Information on 12-month alcohol and specific drug use disorders in the United States was obtained in personal interviews in the National Institute on Alcohol Abuse and Alcoholism's (NIAAA) 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC: N = 43,093). Prevalences were: alcohol use disorder only, 7.35%; drug use disorder only, 0.90%; and comorbid alcohol and drug use disorder, 1,10%. of these The three groups differed in sociodemographic and psychopathologic correlates, with the drug use disorder and comorbid groups significantly more likely to be young, male, never married, and of lower socioeconomic status than the alcohol use disorder only group. Associations between current alcohol use disorders and 25 specific drug use disorders were generally positive and statistically significant. The 12-month prevalence of treatment seeking significantly increased from 6.06% for those with an alcohol use disorder only, to 15.63% for those with a drug use disorder only, and to 21.76% for those with comorbid alcohol and drug use disorders. The study provides detailed data on the homotypic comorbidity of alcohol use disorders and 25 different drug use disorders and confirms the high levels of association seen in previous studies based on lifetime measures. Implications are discussed in terms of integrating alcohol and drug treatment services and refining prevention and intervention efforts.

NIAAA Glossary Terms: prevalence, comorbidity, AOD abuse, AOD dependence, alcohol use disorder classification, interview, survey, demographic characteristics, psychopathology, statistical association, help-seeking behavior, co-treatment, AOD prevention, intervention (persuasion to treatment), human study

Deborah S. Hasin, Mark Hatzenbueler, Sharon Smith, and Bridget F. Grant. Co-occurring DSM-IV drug abuse in DSM-IV drug dependence: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug and Alcohol Dependence 80(1):117-123, October 2005.

Address correspondence to Bridget F. Grant, Laboratory of Epidemiology and Biometry, Room 3077, Division of Clinical and Biological Intramural Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, M.S. 9304, 5635 Fishers Lane, Bethesda, MD 20893-7003, USA. Tel: 301-443-7370; fax: 301-443-1400.

Summary:
A potential exists for underestimation and biased estimates in surveys that rely on abuse as a screening method for drug dependence, making it important to determine the extent to which dependence occurs with or without abuse. This study estimated the prevalence of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) drug dependence with and without drug abuse in a nationally representative sample, as well as in subgroups defined by sex, age, and race or ethnicity. Among all drug-dependent respondents, 22.0% (19.5% of males and 27.8% of females) did not additionally meet criteria for abuse. Current drug dependence without abuse was especially common among females aged 45–64 years (52.6% of all cases). Among those with lifetime diagnoses of drug dependence, a small proportion overall, 5.0% had no symptoms of abuse, with the highest proportion again found among females 45–64 years old (19.5% of all cases). It was concluded that choosing drug abuse as a screening method for drug dependence in large epidemiologic studies will differentially underestimate the prevalence of dependence by subgroup, affecting many types of research. Dependence with and without abuse may represent heterogeneous phenotypes for genetic and gene-environment research, which should be explored.

NIAAA Glossary Terms: AOD abuse, AOD dependence, AODR behavioral markers, identification and screening for AODD, diagnostic criteria, gender differences, prevalence, statistical estimation, epidemiology, epidemiological indicators, phenotype, genetic trait, gene-environment interaction, research issue, human study

Home Page

Drug and Alcohol Dependence
Volume 79, Number 3, September 2005
(Updated 10/21/2005)

Home Page

Héctor M. Manrique, Marta Miquel, and Carlos M.G. Aragon. Brain catalase mediates potentiation of social recognition memory produced by ethanol in mice. Drug and Alcohol Dependence 79(3):343-350, September 2005.

Address correspondence to Carlos M.G. Aragon, Area de Psicobiologia, Universitat Jaume I, Campus de Riu Sec, 12071 Castelló, Spain. Tel.: +34 964 729835; fax: +34 964 729267, e-mail: aragon@psb.uji.es.

Summary:
This study used the social recognition test (SRT) to evaluate ethanol's effects on memory and the mediating role of catalase. In the SRT, the reduction in investigation time of a juvenile of the same species, when this social stimulus is presented for the second time, is considered a reliable index of memory. The recognition capacity of mice was evaluated by calculating exploration ratios (ER). Ethanol (0.0, 0.5, 1.0, or 1.5 g/kg) was administered intraperitoneally immediately after the first juvenile presentation, and 2 hours later the juvenile was re-exposed to the adult. Additionally, adult mice received the catalase inhibitor aminotriazole (AT) 5 hours before juvenile presentation or sodium azide 30 minutes before juvenile presentation. Ethanol (1.0 and 1.5 g/kg) reduced ER, indicating improved memory. The improvement was prevented by pretreatment with either AT or sodium azide. Neither AT nor sodium azide attenuated the memory-enhancing capacity of N-methyl-_D- aspartate or nicotine, which suggests a specific interaction between catalase inhibitors and ethanol in their effects on memory. These results suggest that brain catalase activity can mediate the memory-enhancing capacity of ethanol and add further support to the idea that this enzyme mediates some of ethanol's psychopharmacological effects.

NIAAA Glossary Terms: ethanol, intraperitoneal administration, memory, catalase, enzyme inhibitors, azide, N methyl D aspartate, nicotine, brain, laboratory mice, animal study

G. Bischof, S. Reinhardt, J. Grothuesa, I. Dybek, C. Meyer, U. Hapke, U. John, and H.-J. Rumpf. Effects of item sequence on the performance of the AUDIT in general practices. Drug and Alcohol Dependence 79(3):373-377, September 2005.

Address correspondence to G. Bischof, Department of Psychiatry and Psychotherapy, Research Group Substance Abuse: Treatment, Epidemiology and Prevention (S:TEP), University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany. Tel.: +49 451 500 4860; fax: +49 451 500 3480, e-mail: gallus.bischof@ukl.uni-luebeck.de.

Summary:
The effects of item sequence on the performance of the Alcohol Use Disorders Identification Test (AUDIT) in general practices were evaluated by comparing two randomly applied versions of the AUDIT with different item sequence. The participants were recruited from general practices in two northern German cities and divided into two groups. One group received the original version of the AUDIT, which starts with three items addressing frequency and quantity of alcohol use (AUDIT1). The other group received a version of the AUDIT in which these items were put at the end of the questionnaire (AUDIT2). In total, 10.803 screenings were conducted (refusal rate: 5%). Alcohol use disorders were diagnosed using the Munich-Composite International Diagnostic Interview (M-CIDI). Logistic regression analysis revealed that AUDIT1 subjects had higher scores in the consumption items of the AUDIT, whereas AUDIT2 subjects scored higher on items focusing on symptoms of alcohol dependence or abuse. Thus the sequence of AUDIT items does influence the report of drinking patterns and symptoms of alcohol use disorders in general practice patients.

NIAAA Glossary Terms: alcohol use test, questionnaire, evaluation study, comparative study, AOD use frequency, AOD consumption, AOD intake per occasion, AOD abuse, symptom, regression analysis, alcohol use disorder classification, primary health care, general practitioner, human study

Bradley T. Conner, Ernest P. Noble, Steven M. Berman, Tulin Ozkaragoz, Terry Ritchie, Tim Antolin, and Courtney Sheen. DRD2 genotypes and substance use in adolescent children of alcoholics. Drug and Alcohol Dependence 79(3):379-387, September 2005.

Address correspondence to Ernest P. Noble, Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90024, USA. Tel.: +1 310 825 1891; fax: +1 310 206 7309, e-mail: epnoble@ucla.edu.

Summary:
Children of alcoholics (COAs) are a population at increased risk for developing substance use problems. Genetic studies support the A1 allele of the D2 dopamine receptor gene (DRD2) as a marker of risk for alcoholism and substance use disorders. This study assessed substance use in adolescent sons of alcoholics (N = 48) with the DRDR A1+ allele (A1A1/A1A2 genotypes) or the A1− allele (A2A2 genotype). The results showed that boys with the A1+ allele tried (p = 0.0001) and got intoxicated on alcohol more often (p = 0.009) than boys with the A1− allele. A1+ allele tried more (p = 0.004) and used more substances overall (p = 0.008) than boys with the A1− allele. Boys with the A1+ allele became habitual tobacco users more often (p = 0.03) and experienced marijuana high at an earlier age (p = 0.001) than boys with the A1− allele. The best predictors of substance use severity in boys with the A1+ allele were Psychoticism (p = 0.01) and Negative Affect (p = 0.04). The results support the DRD2 A1 allele as a marker identifying a subgroup of COAs at high risk for developing substance use problems.

NIAAA Glossary Terms: children of alcoholics, AOD effects and AODR problems, familial alcoholism, risk factors, predictive factor, AOD intoxication, multiple drug use, tobacco in any form, problem severity, dopaminergic receptors, allele, genetic markers, genotype, adolescent, male, mood and affect disturbance, human study

Evelien A.P. Poelen, Ron H.J. Scholte, Rutger C.M.E. Engels, Dorret I. Boomsma, and Gonneke Willemsen. Prevalence and trends of alcohol use and misuse among adolescents and young adults in the Netherlands from 1993 to 2000. Drug and Alcohol Dependence79(3):413-421, September 2005.

Address correspondence to Evelien A.P. Poelen, Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, 6500 HE Nijmegen, The Netherlands. Tel.: +31 24 361 57 67; fax: +31 24 361 27 76; e-mail: e.poelen@pwo.ru.nl.

Summary:
An overview of Dutch studies on the prevalence of alcohol use is presented, with added findings from the authors' own study on the prevalence of drinking among adolescents and young adults aged 12–30 years in the Netherlands. Data were collected as part of a longitudinal study by the Netherlands Twin Register in 1993 (n = 3,885), 1995 (n = 4,814), 1997 (n = 3,772), and 2000 (n = 4,090). Lifetime alcohol use, drinking frequency, drinking quantity, lifetime drunkenness, frequency of drunkenness, and problem drinking were measured. The main findings were: (1) alcohol use increased with age until age 25 years, then decreased; (2) males exceeded females on all aspects of alcohol use, except for the youngest age group and lifetime alcohol use; (3) time trends indicated an increase in frequency and quantity of drinking among 12–15-year-old adolescents during the 1990s; and (4) 21–25-year-old females drank more frequently, consumed more drinks a week, had more experience with lifetime drunkenness, and were intoxicated more often in 2000 than in 1993. Among 21–25-year-old males, there was an increase of drunkenness and problem drinking during the 1990s.

NIAAA Glossary Terms: underage drinking, adolescent, young adult, prevalence, Netherlands, AOD use, AOD use frequency, AOD consumption, AOD intake per occasion, AOD intoxication, AOD effects and AODR problems, gender differences, trend, human study

Home Page

Drug and Alcohol Dependence
Volume 79, Number 2, August 2005
(Updated 8/27/2005)

Home Page

Hendree E. Jones, Conrad J. Wong, Michelle Tuten, and Maxine L. Stitzer. Reinforcement-based therapy: 12-month evaluation of an outpatient drug-free treatment for heroin abusers. Drug and Alcohol Dependence 79(2):119-128, August 2005.

Address correspondence to Hendree E. Jones, Cornerstone Treatment Research Clinic, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Cornerstone D-3-E, 4940 Eastern Avenue, Baltimore, MD 21224, USA. hendreejones@yahoo.com

Summary:
A controlled study of opioid-dependent patients was carried out to assess the efficacy of reinforcement-based therapy (RBT) in producing enhanced abstinence outcomes. After a brief residential detoxification and completion of medically managed taper, patients were randomly assigned to RBT (n = 66) or to usual care (n = 64) in community treatment programs. The 6-month RBT program offered an array of abstinence-based incentives including rent payment for recovery housing, program-led recreational activities, and skills training for getting employment. Compared to usual care, RBT produced significantly higher abstinence rates (self-reported and urinalysis-confirmed) from opioids and cocaine at 1 month (42% versus 15%) and 3 months (38% versus 17%) during treatment, but not at 6 or 12 months after enrollment. The RBT group also showed significant increases in the number of days worked and the amount of legal income earned at 3, 6, and 12 months. The results suggest that an intensive reinforcement-based therapy that includes abstinence-based recovery housing is a promising approach, but further research is needed to determine the role of treatment intensity and the specific efficacy of RBT's components.

NIAAA Glossary Terms: AOD dependence, reinforcement, psychosocial treatment method, treatment outcome, AOD abstinence, community-based treatment, controlled study, comparative study, self report, urinalysis, opioids, opiates, cocaine, employment, income, human study

Louisa Degenhardt, Elizabeth Conroy, Carolyn Day, Stuart Gilmour, and Wayne Hall. The impact of a reduction in drug supply on demand for and compliance with treatment for drug dependence. Drug and Alcohol Dependence 79(2):129-135, August 2005.

Address correspondence to Louisa Degenhardt, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia. l.degenhardt@unsw.edu.au

Summary:
In early 2001, Australia experienced a sudden, dramatic and sustained decrease in heroin availability that was accompanied by sharp increases in price and decreases in street level purity. Because these unprecedented changes occurred in a context of widespread treatment availability, this study was able to examine, for the first time, the impact of a sharp reduction in heroin supply in New South Wales (NSW) on entry to and adherence with treatment for heroin dependence. Since there is evidence of drug substitution by some users, the study also examined the effects of the shortage on entry to treatment for other forms of drug dependence. Interrupted time-series analysis was used to examine the number of persons entering opioid pharmacotherapy and other treatment modalities in NSW for heroin dependence and for treatment of other types of drug dependence. The heroin shortage was associated with a reduction in the number of younger persons entering opioid pharmacotherapy, the number of persons entering heroin withdrawal or “assessment only” treatment episodes decreased dramatically, and there appeared to have been small improvements in adherence to and retention in heroin treatment after the reduction in heroin supply. Relatively small increases occurred in numbers being treated for cocaine dependence. In the context of good treatment provision, a reduction in heroin supply appeared to produce modest improvements in intermediate outcomes. Supply and demand reduction measures, when both are implemented successfully, may be complementary.

NIAAA Glossary Terms: heroin, opioids, opiates, AOD dependence, AOD availability, help-seeking behavior, treatment factors, treatment method, treatment outcome, patient compliance, patient retention, drug therapy, cocaine, human study

Jürgen Rehm, Ulrich Frick, Christina Hartwig, Felix Gutzwiller, Patrick Gschwend, and Ambros Uchtenhagen. Mortality in heroin-assisted treatment in Switzerland 1994–2000. Drug and Alcohol Dependence 79(2):137-143, August 2005.

Address correspondence to Jürgen Rehm, Addiction Research Institute, Konradstr. 32, CH 8031 Zurich, Switzerland. jtrehm@aol.com

Summary:
Mortality of participants in heroin-assisted treatment in Switzerland over a 7-year period (1994 to 2000) was assessed and compared to reported mortality in the general population and other populations of opioid users. Methods used included estimation of person-years under heroin-assisted treatment based on the complete case registry of heroin-assisted treatment in Switzerland, and estimation of standardized mortality ratios comparing the population in treatment to the Swiss population (standardized to the year 2000). Over the 7-year period, the crude death rate of patients in heroin-assisted treatment, and including 1 month after discharge from treatment, was 1% per year. The standardized mortality ratio (SMR) for the entire observation period was 9.7 (95% confidence interval [CI], 7.3–12.8), with females having higher SMRs than males (17.2 versus 8.4). There was no clear temporal trend. Mortality in heroin-assisted treatment was low compared to the estimated mortality of Swiss opioid users in the 1990s (2.5% to 3%). It was also low compared to mortality rates of opioid users in other maintenance treatments in other countries as reported in the literature. The SMR was also lower than that reported in the only meta-analysis in the literature: 13.2 (95% CI, 12.3–14.1). The low mortality rate is all the more noteworthy as heroin-assisted treatment in Switzerland included only refractory opioid addicts with existing severe somatic or mental problems.

NIAAA Glossary Terms: mortality, heroin, AOD dependence, addiction, treatment method, drug therapy, risk analysis, relative risk, gender differences, human study

Douglas B. Marlowe, David S. Festinger, Karen L. Dugosh, and Patricia A. Lee. Are judicial status hearings a “key component” of drug court? Drug and Alcohol Dependence 79(2):145-155, August 2005.

Address correspondence to Douglas B. Marlowe, Treatment Research Institute at the University of Pennsylvania School of Medicine, 600 Public Ledger Building, 150 South Independence Mall West, Philadelphia, PA 19106-3475, USA. Marlowe@Tresearch.org

Summary:
The superiority of drug courts to traditional probation programs for enhancing treatment retention and reducing substance use and crime among drug offenders is supported by substantial evidence. Few studies have isolated the effects of the hypothesized critical components of drug courts to determine their contributions to outcomes. This study assessed outcomes at 6 and 12 months post-admission for misdemeanor drug court clients who were randomly assigned to different dosages of judicial status hearings. Although earlier work (Festinger, D.S. et al. Drug and Alcohol Dependence 68:151–157, 2002) revealed superior effects during treatment for high-risk participants who were assigned to more frequent bi-weekly hearings, those effects did not extend beyond treatment. The results did reveal significant pre-to-post improvements for participants, as a whole, in self-reported drug use, alcohol use, and criminal recidivism; however, without a no-drug court control condition, it is not possible to determine the magnitude of the drug court program's effect. Approximately half of the participants resumed drug or alcohol use within 12 months of admission to drug court, and approximately 10%–15% resumed illegal activities. These findings lend credence to the potential effectiveness of drug courts, but continuing-care strategies are needed to extend the effects of drug courts beyond the initial active phases of the program.

NIAAA Glossary Terms: drug court, illicit drug, alcoholic beverage, AOD use, patient retention, crime, treatment factors, treatment outcome, randomized controlled trial, self report, aftercare, human study

Alison Oliveto, James Poling, Kevin A. Sevarino, Kishorchandra R. Gonsai, Elinore F. McCance-Katz, Susan M. Stine, and Thomas R. Kosten. Efficacy of dose and contingency management procedures in LAAM-maintained cocaine-dependent patients. Drug and Alcohol Dependence 79(2):157-165, August 2005.

Address correspondence to Alison Oliveto, Department of Psychiatry, Yale School of Medicine and the VA CT Healthcare System, West Haven, CT, USA. olivetoalison@uams.edu

Summary:
A 12-week clinical trial was conducted to examine the efficacy of maintenance drug dose and contingency management (CM) procedures in opioid- and cocaine-dependent patients maintained on levo-alph-acetyl-methadol (LAAM). Opioid- and cocaine-dependent participants (N = 140) were randomly assigned to one of the following treatment conditions: LAAM (30, 30, 39 mg/MWF) with CM procedures (LC group); LAAM (30, 30, 39 mg/MWF) without CM (LY group); LAAM (100, 100, 130 mg/MWF) with CM (HC group); LAAM (100, 100, 130 mg/MWF) without CM (HY group). Urine samples were collected three times a week. In CM, each urine negative for both opioids and cocaine resulted in a voucher worth a certain monetary value that increased for consecutively drug-free urines. Subjects not assigned to CM received vouchers according to a yoked schedule. Vouchers were exchanged for mutually agreed upon goods and services. Groups generally did not differ on retention and baseline characteristics. Overall opioid use was lowest in the HC and HY groups; opioid use decreased most rapidly over time in the HC group relative to the HY, LC and LY groups. Overall cocaine use was lowest in the HC group relative to the HY, LC, and LY groups; cocaine use decreased over time most rapidly in the HC and LY groups. Abstinence from both was greatest in the HC group. Opioid withdrawal symptoms decreased fastest in the high-dose groups relative to the low-dose groups. These results suggest that an efficacious maintenance dose is necessary for contingencies to be effective in facilitating both opioid and cocaine abstinence.

NIAAA Glossary Terms: LAAM, drug therapy, contingency management, treatment and maintenance, AOD dependence, opioids, opiates, cocaine, urinalysis, comparative study, AOD withdrawal syndrome, dose-response relationship, human study

Robert G. Carlson, Jichuan Wang, Russel S. Falck, and Harvey A. Siegal. Drug use practices among MDMA/ecstasy users in Ohio: a latent class analysis. Drug and Alcohol Dependence 79(2):167-179, August 2005.

Address correspondence to Robert G. Carlson, Center for Interventions, Treatment and Addictions Research, Wright State University School of Medicine, 143 Biological Sciences Building, 3640 Colonel Glenn Highway, Dayton, OH 45435, USA. robert.carlson@wright.edu

Summary:
This study describes the drug use practices among recent users (N = 402) of 3,4-methelyenedioxymethamphetamine (MDMA; "ecstasy") recruited in Ohio using respondent-driven sampling. Of the participants, ~64% were men and 81.6% were white; the mean age was 20.9 years. Latent class analysis was used to identify subgroups of MDMA users, with classification based on use of cocaine, opioids, amphetamines, tranquilizers, inhalants, marijuana, and hallucinogens during the previous 6 months, and days of alcohol intoxication in the past 30. A three-class model was preferable and reflected "Limited range" (Class 1), "Moderate range" (Class 2), and "Wide range" (Class 3) drug use patterns. For example, the conditional probability of using opioids during the previous 6 months was 0.07 in Class 1, 0.59 in Class 2, and 0.88 in Class 3. Other substances followed similar patterns. Predictors of class membership were examined in a multinomial logit model in which Class 1 ("Limited range") was treated as the reference group. Participants who were white, younger, and who reported more than 10 occasions of MDMA use were more likely to be in the “Wide range” drug use class (Class 3). Latent class analysis is a useful method to help describe and understand variability in multiple-drug use patterns.

NIAAA Glossary Terms: MDMA, cocaine, opioids, opiates, amphetamines, tranquilizers, inhaled substance, marijuana in any form, hallucinogens, alcoholic beverage, multiple drug use, AOD intoxication, AOD use pattern, predictive factor, comparative study, racial differences, age differences, human study

Melissa Tracy, Tinka Markham Piper, Danielle Ompad, Angela Bucciarelli, Phillip O. Coffin, David Vlahov, and Sandro Galea. Circumstances of witnessed drug overdose in New York City: implications for intervention. Drug and Alcohol Dependence 79(2):181-190, August 2005.

Address correspondence to Sandro Galea, Center for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, New York, NY 10029, USA. sgalea@nyam.org

Summary:
Drug users frequently witness the nonfatal and fatal drug overdoses of their peers, but often fail to intervene effectively to reduce morbidity and mortality. This study assessed the circumstances of witnessed heroin-related overdoses in New York City among a predominantly minority population of drug users. Heroin, crack, and cocaine users (N = 1,184) were interviewed between Nov. 2001 and Feb. 2004. Witnessing at least one nonfatal or fatal heroin-related overdose was reported by 672 (56.8%) respondents. Of those, 444 (67.7%) reported that they or someone else present called for medical help for the overdose victim at the last witnessed overdose. In multivariable models, the likelihood of calling for medical help was associated with the respondent never having experienced an overdose personally and the witnessed overdose occurring in a public place. The most commonly cited reason for not calling for help or delaying before doing so was fear of police response (52.2%). Attempts to revive the overdose victim through physical stimulation (e.g., applying ice, causing pain) were reported by 59.7% of respondents, while first aid measures were attempted in only 11.9% of events. Efforts to equip drug users to manage overdoses effectively, including training in first aid and the provision of naloxone, and the reduction of police involvement at overdose events may have a substantial impact on overdose-related morbidity and mortality.

NIAAA Glossary Terms: AOD overdose mortality, AOD poisoning, morbidity, heroin, crack cocaine, cocaine, interview, self report, minority group, multivariate analysis, help-seeking behavior, medically necessary care, law enforcement worker, naloxone, human study

Anna Maria Bargagli, Patrizia Schifano, Marina Davoli, Fabrizio Faggiano, Carlo A. Perucci, and The VEdeTTE Study Group. Determinants of methadone treatment assignment among heroin addicts on first admission to public treatment centres in Italy. Drug and Alcohol Dependence 79(2):191-199, August 2005.

Address correspondence to Anna Maria Bargagli, Department of Epidemiology, ASL Rome E, Via di S. Costanza 53, 00198 Rome, Italy. bargagli@asplazio.it

Summary:
The aims were to identify factors associated with entering any methadone treatment at first admission at a treatment center in Italy and to investigate determinants of receiving detoxification or maintenance methadone treatments.
Data were analyzed from heroin addicts (N = 565) who entered for the first time one of 90 National Health Service (NHS) treatment centers in 12 Italian regions between September 1998 and March 2001. Subjects were interviewed at admission by the center's staff and followed-up for 18 months. Details on treatments provided were recorded using a standardized form. Random effects logistic regression analysis was applied. Factors positively associated with any methadone treatment assignment were being younger than 25 years and using heroin more than twice a day, having been recently incarcerated, and living with a partner. Independent predictors of admission to methadone maintenance were injecting heroin, having sex without a condom in the previous 6 months, being human immunodeficiency virus-positive, and having been enrolled at a NHS treatment center where a psychiatrist was present. Using heroin once a day or more and using cocaine were factors associated with enrolment into detoxification treatment. A significant heterogeneity between centers was observed. These results provide an insight into the different profiles of patients who are enrolled in methadone treatments. The observed heterogeneity between centers indicates the need to develop and implement common guidelines for the access of heroin addicts to substitution treatment.

NIAAA Glossary Terms: methadone, Italy, treatment and maintenance, interview, follow-up study, regression analysis, treatment factors, age differences, heroin, AOD use frequency, intravenous injection, HIV infection, cocaine, detoxification, AODD treatment unit, recommendations or guidelines, human study

Alecia D. Schweinsburg, Brian C. Schweinsburg, Erick H. Cheung, Gregory G. Brown, Sandra A. Brown, and Susan F. Tapert. fMRI response to spatial working memory in adolescents with comorbid marijuana and alcohol use disorders. Drug and Alcohol Dependence 79(2):201-210, August 2005.

Address correspondence to Susan F. Tapert, University of California San Diego Department of Psychiatry, 9500 Gilman Dr., La Jolla, CA 92037-0603, USA. stapert@ucsd.edu

Summary:
Although alcohol and marijuana use are prevalent in adolescence, the neural impact of their combined use remains unclear. The authors previously demonstrated functional magnetic resonance imaging (fMRI) response to spatial working memory (SWM) among adolescents with alcohol use disorders (AUD) compared to controls, and predicted that adolescents with marijuana and alcohol use disorders would show additional abnormalities. Their present study tested that prediction. Three groups of adolescents (15–17 years old) participated: non-abusing controls (n = 19), AUD with limited exposure to drugs (n = 15), and comorbid marijuana and alcohol use disorders (MAUD) and minimal other drug experience (n = 15). After >2 days’ abstinence, participants performed a SWM task during fMRI acquisition. fMRI brain response patterns differed between groups, despite similar performance on the task. MAUD youths showed less activation in inferior frontal and temporal regions than controls, and more response in other prefrontal regions. Compared to AUD adolescencts, MAUD youths also showed less inferior frontal and temporal activation, but more medial frontal response. Overall, MAUD youths showed different brain response abnormalities than those with AUD alone, despite relatively short histories of substance involvement. This pattern could suggest compensation for marijuana-related attention and working memory deficits. However, relatively recent use and premorbid features may influence results, and should be examined in future studies.

NIAAA Glossary Terms: marijuana in any form, illicit drug, underage drinking, adolescence, magnetic resonance imaging, brain imaging, alcohol use disorder classification, comorbidity, multiple drug use, controlled study, comparative study, cerebral cortex, frontal cortex, attention,memory, human study

David M. Penetar, Elena M. Kouri, Michelle M. Gross, Elissa M. McCarthy, Christina K. Rhee, Erica N. Peters, and Scott E. Lukas. Transdermal nicotine alters some of marihuana's effects in male and female volunteers. Drug and Alcohol Dependence 79(2):211-223, August 2005.

Address correspondence to David M. Penetar, Behavioral Psychopharmacology Research Laboratory, McLean Hospital/Harvard Medical School, 115 Mill Street, Belmont, MA 02478, USA. dpenetar@mclean.harvard.edu

Summary:
The effects of nicotine on marijuana-induced intoxication were investigated in a double blind, crossover study using nicotine transdermal patches. The participants (10 males and 10 females) received either placebo or a 21-mg transdermal nicotine patch 4 hours before smoking one of two marijuana cigarettes (1.99% or 3.51% delta-9-tetrahydrocannabinol content). Measurements of physiological activity -- heart rate, blood pressure, and skin temperature -- and subjective effects -- self-reports of drug effects on visual analog scales (VAS) and the Addiction Research Center Inventory (ARCI) -- were made periodically before and for 3 hours after smoking. Nicotine pretreatment enhanced several responses to marijuana, in particular, heart rate, reports of "stimulated" on the visual analog scales, and scores on the Amphetamine scale of the ARCI. Compared to female participants, male participants reported a more pronounced and longer-lasting effect of marijuana. Compared to the male participants, female participants experienced an attenuated response to marijuana and were less affected by the drug combination. The results of this study show that nicotine can have an important influence on the subjective and physiological effects of smoked marijuana. These effects have safety and efficacy implications for marijuana smokers who use the nicotine transdermal patch to manage their tobacco dependence.

NIAAA Glossary Terms: nicotine, marijuana in any form, smoking, AOD intoxication, multiple drug use, heart rate, blood pressure, temperature, gender differences, controlled study, human study

Ilsemarie Kurzthaler, Markus Wambacher, Karl Golser, Gernot Sperner, Barbara Sperner-Unterweger, Alexander Haidekker, Marion Pavlic, Georg Kemmler, and W. Wolfgang Fleischhacker. Alcohol and benzodiazepines in falls: An epidemiological view. Drug and Alcohol Dependence 79(2):225-230, August 2005.

Address correspondence to Ilsemarie Kurzthaler, Department of Biological Psychiatry, Medical University Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. ilsemarie.kurzthaler@uibk.ac.at

Summary:
Concentrations of blood alcohol (BAC) and benzodiazepines (BZD) were studied in patients attending an emergency department because of a fall over a 1-year period. Of the 615 patients tested, 22% were positive for alcohol, 55% were positive for BZD, and 1.5% were positive for both alcohol and BZD. A significantly larger proportion of males tested positive for alcohol than females (40.2% versus 7.6%). Both in males and females the percentage as well as the extent of blood alcohol levels decreased significantly with age. Benzodiazepines were also consumed more frequently in males (8.5%) than in females (3.2%, p = 0.007). There was no difference in BAC between males and females (1.75 ± 0.81 g/l versus 1.66 ± 0.91 g/l). In patients older than 70 years the BAC (1.30 ± 0.80 g/l) was lower compared to younger patients. All BZD-positive blood samples could be traced back to diazepam consumption. A high number of young and middle aged patients using alcohol was found (49.7% of males, 18.9% of females); a lower but still relevant number of benzodiazepine users was also found (9.5% of males, 2.4% of females). The study shows that alcohol plays a more important role in fall-related accidents in patients up to 70 years old when compared to accidents from other causes.

NIAAA Glossary Terms: accidental fall, injury, BAC, benzodiazepines, diazepam, emergency care, multiple drug use, prevalence, gender differences, age differences, human study

Fabian Termorshuizen, Anneke Krol, Maria Prins, Ronald Geskus, Wim van den Brink, and Erik J.C. van Ameijden. Prediction of relapse to frequent heroin use and the role of methadone prescription: An analysis of the Amsterdam Cohort Study among drug users. Drug and Alcohol Dependence 79(2):231-240, August 2005.

Address correspondence to Fabian Termorshuizen, Municipal Health Service, Amsterdam, Cluster Infectious Diseases, Department of HIV & STI Research, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands. ftermorshuizen@gggd.amsterdam.nl

Summary:
The risk of relapse into frequent heroin use was studied among participants (N = 732) in the Amsterdam Cohort Study (ACS) on human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) among drug users, who experienced an episode of abstinence from or occasional use of heroin. The participants were recruited mainly from easy access ("low-threshold") methadone programs. The duration of abstinence/occasional use and relative risks (RR) of relapse were estimated by survival analysis of 1,577 episodes, using patient's characteristics and methadone treatment as covariates. The majority of episodes (85.8%) were followed by relapse within 5 years. Less education, intense use of heroin prior to the episode of abstinence or well-controlled use, occasional use of heroin and intense use of cocaine during the episode, and having a drug-using partner or having no partner were significantly associated with higher risk of relapse. Among frequent attendees of a "low-threshold" methadone program, relapse was associated with the daily dose of methadone: RR for dosages <40 and 40–60 mg, compared with doses of >100 mg, were 1.45 (p < 0.01) and 1.59 (p < 0.01) respectively. There was no evidence of a beneficial influence of methadone dosage or program attendance per se on the risk of relapse into cocaine. High doses of methadone in a harm-reduction setting extend the duration of an episode of no or occasional use of heroin. Other factors, such as no occasional use of heroin during the episode, no use of cocaine, and having a non-using partner, seem to be equally important.

NIAAA Glossary Terms: heroin, AOD user, AOD dependence, AOD use pattern, AOD abstinence, methadone, AODD relapse, HIV infection, acquired immunodeficiency syndrome, risk factors, risk analysis, relative risk, cocaine, human study

Tracy L. Simpson, Daniel R. Kivlahan, Kristen R. Bush, and Miles E. McFall. Telephone self-monitoring among alcohol use disorder patients in early recovery: A randomized study of feasibility and measurement reactivity. Drug and Alcohol Dependence 79(2):241-250, August 2005.

Address correspondence to Tracy L. Simpson, VA Puget Sound Health Care System, Seattle, WA 98108, USA. tracy.simpson@med.va.gov

Summary:
This pilot study with patients in early recovery from an alcohol use disorder evaluated compliance with two Interactive Voice Response (IVR) monitoring protocols, subjective experiences with monitoring, and change in symptoms associated with monitoring (i.e., measurement reactivity). Participants (n = 98) were randomly assigned to call an IVR system daily for 28 days, once per week for 4 weeks, or only to complete 28-day follow-up assessment including retrospective drinking reports. Monitoring calls assessed alcohol craving, substance use, emotional well-being, and post-traumatic stress disorder (PTSD) symptoms. Most monitoring participants completed calls on at least 75% of scheduled days (72.2% and 59.2% for daily and weekly respectively). Including reconstructed data from follow-up of missed calls yielded 77.8% and 74.1% of maximum data points respectively. Most monitoring participants indicated the protocol was manageable and reported positive or no effects of monitoring on urges to use alcohol, actual drinking, and PTSD symptoms. Analyses of measurement reactivity based on assessment 1 month after randomization found no significant group differences on drinking, craving for alcohol, or PTSD-related symptoms. The results suggest that IVR technology is feasible and appropriate for telephone symptom monitoring in similar clinical samples.

NIAAA Glossary Terms: AOD abuse, AOD dependence, pilot study, patient compliance, patient monitoring, patient assessment, AOD craving, AOD use, emotional adjustment, posttraumatic stress disorder, human study

Evgeny M. Krupitsky, Nicholas J. Horton, Emily C. Williams, Dmitri Lioznov, Maria Kuznetsova, Edwin Zvartau, and Jeffrey H. Samet. Alcohol use and HIV risk behaviors among HIV-infected hospitalized patients in St. Petersburg, Russia. Drug and Alcohol Dependence 79(2):251-256, August 2005.

Address correspondence to Jeffrey H. Samet, Department of Social and Behavioral Sciences, Boston University School of Public Health, 91 East Concord Street, Suite 200, Boston, MA 02118, USA. jsamet@bu.edu

Summary:
Although Russia has high per capita alcohol consumption and an epidemic of human immunodeficiency virus (HIV) infection driven by injection drug use, the role of alcohol in the spread of HIV in the country is largely unexplored. This study assessed recent alcohol use and associated HIV risk behaviors among HIV-infected persons in St. Petersburg, Russia. HIV-infected hospitalized patients were recruited from an infectious disease hospital between June 2001 and March 2002. Interviewers assessed alcohol and drug use, and lifetime abuse or dependence diagnoses for alcohol and drugs were established by a physician with addiction medicine training. Among the subjects (N = 201), diagnoses of abuse or dependence (Ab/Dep) were common: 9% had only alcohol Ab/Dep; 39% had alcohol and drug Ab/Dep; 47% had only drug Ab/Dep; and 4% had no diagnosis of alcohol or drug Ab/Dep. Sex- and drug-risk behaviors varied significantly by substance use diagnosis. Subjects with any alcohol Ab/Dep had higher sex-risk scores than those with drug only Ab/Dep (6.1 versus 3.9, p < .0001). Among subjects with any diagnosis of drug Ab/Dep, having in addition an alcohol diagnosis was associated with unclean needle use in the last 6 months (33% versus 21%, p = 0.08). In conclusion, lifetime alcohol diagnoses of abuse or dependence were present in nearly -half of hospitalized HIV-infected patients in St. Petersburg and were associated with significantly higher sex-risk behaviors and borderline significantly higher drug-risk behaviors. As HIV infection spreads rapidly in Russia and Eastern Europe, these data support the need for HIV risk-reduction interventions in alcohol abusing populations and raise the potential of benefit by addressing alcohol use in HIV-infected populations.

NIAAA Glossary Terms: Russia, AOD consumption, AOD abuse, AOD dependence, HIV infection, risk-taking behavior, sexual behavior, intravenous injection, patient assessment, prevalence, human study

Suzanne K. Vosburg, Carl L. Hart, Margaret Haney, and Richard W. Foltin. An evaluation of the reinforcing effects of memantine in cocaine-dependent humans. Drug and Alcohol Dependence 79(2):257-260, August 2005.

Address correspondence to Suzanne K. Vosburg, College of Physicians and Surgeons of Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA. skv2001@columbia.edu

Summary:
The reinforcing and subjective effects of the uncompetitive N-methyl-D-aspartate (NMDA) antagonist memantine was evaluated in a double-blind, outpatient study of cocaine-dependent individuals (N = 8; 2 females, 6 males). The study consisted of three blocks of seven sessions, with each block testing a different dose of memantine. During the first two sessions of each block, participants "sampled" the memantine capsule (10, 20, or 30 mg) and the placebo capsule that were available for the next five sessions. During the five subsequent sessions, participants had an opportunity to self-administer either the active or placebo capsule. Memantine was not reinforcing and subjective-effects ratings were not altered as a function of dose. The results suggest that these doses of memantine do not have abuse liability in cocaine-dependent individuals.

NIAAA Glossary Terms: antagonists, N methyl D aspartate, reinforcement, subjective variables, double-blind study, controlled study, cocaine, AOD dependence, AOD abuse potential, human study

Brice M.R. Appenzeller, Serge Schneider, Armand Maul, and Robert Wennig. Relationship between blood alcohol concentration and carbohydrate-deficient transferrin among drivers. Drug and Alcohol Dependence 79(2):261-265, August 2005.

Address correspondence to Brice M.R. Appenzeller, Centre de Recherche Public de la Santé, Laboratoire National de Santé, Division de Toxicologie, Université du Luxembourg, Campus Limpertsberg, 162a, avenue de la Faïencerie, L-1511 Luxembourg. brice.appenzeller@cu.lu

Summary:
Carbohydrate-deficient transferrin (CDT) was measured in 408 blood specimens, randomly selected from drivers (N = 1,260) apprehended and submitted to blood alcohol concentration (BAC) determination. The first step of the study was to observe whether a BAC-based pre-evaluation was relevant for deciding to test drivers for chronic alcohol abuse. For this purpose, the diagnosis of chronic alcohol abuse was verified by CDT determination, with a high positive cut-off selected at 3% for high specificity. The results showed a significant increase in the part of chronic alcohol abusers with respect to increasing BAC: a few alcohol abusers were present in the BAC category below 0.5 g/L, and their frequency increased to 47% when BAC was between 3 and 3.5 g/L and 67% when BAC was above 3.5 g/L. Secondly, the usefulness of the biomarker CDT in the traffic safety context was investigated by observing whether drivers with abnormally increased CDT value had also higher BAC. The average BAC was 1.32 g/L in drivers with CDT below 1%, and increased to 2.28 g/L in drivers with CDT above 3%. Statistical analysis showed evidence of a monotonic increasing link between BAC and CDT (p < 0.0001). The results confirm the relevance of BAC-based pre-evaluation before testing chronic alcohol abuse among drivers, and demonstrate that CDT is a suitable biomarker in the context of traffic safety, as drivers with increased CDT had significantly higher BAC.

NIAAA Glossary Terms: carbohydrate-deficient transferrin, BAC level, chronic AODE, prevalence, AODR biological markers, highway safety, statistical association, human study

Marilyn W. Lewis and Nancy M. Petry. Contingency management treatments that reinforce completion of goal-related activities: Participation in family activities and its association with outcomes. Drug and Alcohol Dependence 79(2):267-271, August 2005.

Address correspondence to Nancy M. Petry, School of Medicine, Department of Psychiatry, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-3944, USA. petry@psychiatry.uchc.edu

Summary:
Although contingency management (CM) techniques that reinforce completion of nondrug related activities may be effective in treating substance dependence, no studies have evaluated whether involvement in particular kinds of activities reduces problems associated with those activities. In this study, cocaine-abusing adults (N = 159) who had been randomized to a CM intervention were classsified according to whether they engaged (n = 29) or did not engage (n = 130) in three or more family-related activities during the 12-week treatment period. The groups were evaluated for differences in treatment retention, length of continuous abstinence, and changes from baseline to the end of the intervention in Addiction Severity Index-family scores and days of family conflict. Participants who engaged in family activities remained in treatment longer, were abstinent for more weeks, and reported greater reduction in family conflict compared to participants who did not engage in family activities. The results suggest that participants who elect to complete family related activities during CM treatments may have improved outcomes and reduced family conflict.

NIAAA Glossary Terms: contingency management, AOD abuse, cocaine, patient retention, AOD abstinence, psychiatric status rating scales, family relations, family conflict, human study

John R. Monterosso, Adam R. Aron, Xochitl Cordova, Jiansong Xu, and Edythe D. London. Deficits in response inhibition associated with chronic methamphetamine abuse. Drug and Alcohol Dependence 79(2):273-277, August 2005.

Address correspondence to John R. Monterosso, Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90024-1759, USA. jmont@ucla.edu

Summary:
Chronic methamphetamine abuse is associated with cerebral deficits involving frontal/basal-ganglia regions that are important for inhibitory control. Using the Stop-Signal Task, this study measured response inhibition in 11 methamphetamine abusers (5–7 days abstinent) and two groups of control subjects who did not use methamphetamine (14 tobacco smokers and 29 non-smokers). Stop-signal reaction time (SSRT), which indicates the latency to inhibit an initiated motor response, was significantly longer for methamphetamine abusers than for either control group (p values < 0.01). In contrast, the methamphetamine abusers did not differ from either group on Go trial reaction time (RT), which reflects motor speed, or number of discrimination errors, which reflects decision-processes. Methamphetamine abuse was therefore associated with a specific deficit in inhibiting a pre-potent response. The authors suggest that future research could examine whether SSRT is different for methamphetamine abusers who respond to treatment compared to those who do not. If such differences are established, response inhibition may serve as a marker for investigating methamphetamine abuse in basic research and clinical trials.

NIAAA Glossary Terms: methamphetamine, AOD abuse, cerebrum, inhibition, disinhibition, reaction time, decision making, AODR behavioral markers, human study

Home Page

Drug and Alcohol Dependence
Volume 79, Number 1, July 2005
(Updated 6/29/2005)

Home Page

Hendree E. Jones, Rolley E. Johnson, Donald R. Jasinski, Kevin E. O’Grady, Christian A. Chisholm, Robin E. Choo, Michael Crocetti, Robert Dudas, Cheryl Harrow, Marilyn A. Huestis, Lauren M. Jansson, Michael Lantz, Barry M. Lester, and Lorraine Milio. Buprenorphine versus methadone in the treatment of pregnant opioid-dependent patients: Effects on the neonatal abstinence syndrome. Drug and Alcohol Dependence 79(1):1-10, July 2005.

Summary:
The neonatal abstinence syndrome (NAS) was compared in neonates of opioid-dependent women maintained on methadone or buprenorphine during pregnancy. The study was a randomized, double-blind, double-dummy, flexible dosing, parallel-group controlled trial conducted in a comprehensive drug-treatment facility that included residential and ambulatory care. Preliminary safety and efficacy data were also obtained for a larger multi-center trial. Treatment involved daily flexible dosing with either sublingual buprenorphine (4–24 mg) or oral methadone (20–100 mg). Primary outcome measures were: (1) number of neonates treated for NAS; (2) amount of opioid agonist medication used to treat NAS; (3) length of neonatal hospitalization; and (4) peak NAS score. Two of 10 (20%) buprenorphine-exposed and 5 of 11 (45.5%) methadone-exposed neonates were treated for NAS (p = 0.23). Methadone-exposed neonates required three times more total opioid-agonist medication to treat their NAS than buprenorphine-exposed neonates (93.1 versus 23.6; p = 0.13). Length of hospitalization was shorter for buprenorphine-exposed than for methadone-exposed neonates (p = 0.021). The two groups did not differ significantly in peak NAS total scores (p = 0.25). These findings suggest that buprenorphine is not inferior to methadone on outcome measures assessing NAS and maternal and neonatal safety when administered starting in the second trimester of pregnancy.

NIAAA Glossary Terms: AODR neonatal disorder, AOD withdrawal syndrome, AOD dependence, buprenorphine, mother, prenatal chemical exposure, prenatal care, drug therapy, methadone, buprenorphine, opioids, addiction, clinical study, controlled study, comparative study, agonists, hospital, length of stay, second trimester, human study

Chuan-Yu Chen, Megan S. O’Brien, and James C. Anthony. Who becomes cannabis dependent soon after onset of use? Epidemiological evidence from the United States: 2000–2001. Drug and Alcohol Dependence 79(1):11-22, July 2005.

Summary:
The aims were to estimate the risk of becoming cannabis dependent within 24 months after first use of cannabis and to examine subgroup variation in this risk. The estimates were based on the National Household Survey on Drug Abuse conducted during 2000–2001 with a representative sample of U.S. residents ages 12 and older (N = 114,241). First-time use of cannabis within the 24 months prior to assessment was found in 3,352 respondents. An estimated 3.9% of these recent-onset users developed a cannabis dependence syndrome during the interval since first use. Excess risk of cannabis dependence was found for those with cannabis onset before late adolescence, those with family income under US$ 20,000, and those who had used three or more drugs before the first use of cannabis (i.e., tobacco, alcohol, and other drugs). While these findings generally support previous results, the study's focus on recent-onset users, thus removing the influence of users with long-sustained or persistent cannabis dependence developed years ago, more closely approximates prospective and longitudinal research on the risk of becoming cannabis dependent soon after onset of cannabis use.

NIAAA Glossary Terms: AOD dependence, risk analysis, risk factors, marijuana in any form, household survey, recent onset of AOD use, early AODU onset, adolescence, income effect, multiple drug use, human study

Elizabeth R. Disney, Michael Kidorf, Van L. King, Karin Neufeld, Ken Kolodner, and Robert K. Brooner. Prevalence and correlates of cocaine physical dependence subtypes using the DSM-IV in outpatients receiving opioid agonist medication. Drug and Alcohol Dependence 79(1):23-32, July 2005.

Summary:
The relationship between endorsement of physiological dependence to cocaine and lifetime and current problem severity was examined in a cross-sectional study of opioid and cocaine dependent individuals newly admitted to a treatment program based on opioid-agonist medication. All participants (N = 719) completed the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (SCID-IV) and the Addiction Severity Index (ASI). Participants were first classified into physiological (n = 549) versus non-physiological (n = 170) cocaine dependence groups for one set of analyses and then categorized into one of four groups for further analyses: (1) tolerance only (n = 215), (2) tolerance plus withdrawal (n = 279), (3) withdrawal only (n = 55), or (4) no physiological dependence (n = 170). The participants who endorsed physiological dependence reported higher rates of lifetime psychiatric and substance use disorders, higher rates of current drug use, and more current problems. The four-group analyses showed that endorsement of withdrawal, with or without tolerance, was associated with the most severe problems. The results suggest that physiological dependence to cocaine (particularly th