Showing papers in "Addiction in 1996"
TL;DR: Research findings on friend selection and projection are reviewed to suggest that the magnitude of friend influence may be overestimated, and social network analysis is identified as a promising method for measuring peer groups.
Abstract: Peer influence is generally believed to be a major cause of adolescent drug behavior. This paper reviews research findings on friend selection and projection to suggest that the magnitude of friend influence may be overestimated. This paper also observes that, although adolescent drug use is assumed to begin in response to peer group influence, peer groups have rarely been measured in studies of drug behavior. Social network analysis is identified as a promising method for measuring peer groups. The implications of this review for research and programs are considered.
554 citations
TL;DR: The advent of highly potent analogs and a specific antagonist may make possible the development of compounds that lack undesirable side effects, thus limiting therapeutic usefulness of cannabinoid-derived drugs on the market today.
Abstract: Cannabis is one of the most widely used drugs throughout the world. The psychoactive constituent of cannabis, delta 9-tetrahydrocannabinol (delta 9-THC), produces a myriad of pharmacological effects in animals and humans. For many decades, the mechanism of action of cannabinoids, compounds which are structurally similar to delta 9-THC, was unknown. Tremendous progress has been made recently in characterizing cannabinoid receptors both centrally and peripherally and in studying the role of second messenger systems at the cellular level. Furthermore, an endogenous ligand, anandamide, for the cannabinoid receptor has been identified. Anandamide is a fatty-acid derived compound that possesses pharmacological properties similar to delta 9-THC. The production of complex behavioral events by cannabinoids is probably mediated by specific cannabinoid receptors and interactions with other neurochemical systems. Cannabis also has great therapeutic potential and has been used for centuries for medicinal purposes. However, cannabinoid-derived drugs on the market today lack specificity and produce many unpleasant side effects, thus limiting therapeutic usefulness. The advent of highly potent analogs and a specific antagonist may make possible the development of compounds that lack undesirable side effects. The advancements in the field of cannabinoid pharmacology should facilitate our understanding of the physiological role of endogenous cannabinoids.
528 citations
TL;DR: It is concluded that the term overdose is, in many cases, a misleading term, since it implies the same mechanism of death in all cases, an implication that is neither clinically useful nor consistent with published data.
Abstract: The current paper examines critically the literature on deaths attributed to heroin overdose, and examines the characteristics and circumstances of such deaths. In particular, the dominance of the widely held belief that heroin-related fatalities are a consequence of overdose is challenged. Deaths attributed to overdose represented in the literature are typically older, heroin-dependent males not in drug treatment at the time of death. Fatalities involving only heroin appear to form a minority of overdose occasions, the presence of other drugs (primarily central nervous system depressants such as alcohol and benzodiazepines) being commonly detected at autopsy. Furthermore, deaths attributed to overdose are likely to have morphine levels no higher than those who survive, or heroin users who die from other causes. It is concluded that the term overdose is, in many cases, a misleading term, since it implies the same mechanism of death in all cases, an implication that is neither clinically useful nor consistent with published data. Implications for the prevention of heroin-related deaths are discussed.
420 citations
TL;DR: This review applies some new experimental findings and theoretical ideas about how reinforcers act on the neural mechanisms of learning and memory to the problem of how addictive drugs affect behaviour, suggesting that no single factor is likely to explain either addictive behaviour in general or self-administration in particular.
Abstract: This review applies some new experimental findings and theoretical ideas about how reinforcers act on the neural mechanisms of learning and memory to the problem of how addictive drugs affect behaviour A basic assumption of this analysis is that all changes in behaviour, including those involved in drug addiction and the initiation of drug self-administration, require the storage of new information in the nervous system Animal studies suggest that such information is processed in several (this review deals with three) more or less independent learning and memory systems in the mammalian brain Reinforcers can interact with these systems in three ways: they activate neural substrates of observable approach or escape responses, they produce unobservable internal states that can be perceived as rewarding or aversive, and they modulate or enhance the information stored in each of the memory systems It is suggested that each addictive drug maintains its own self-administration by mimicking some subset of these actions Evidence supporting the notion of multiple memory systems and data on the actions of several drugs (amphetamine, cocaine, nicotine, alcohol and morphine) on these systems are briefly reviewed The utility of the concept of "reward" for understanding the effects of drugs on behaviour is discussed Evidence demonstrating actions of drugs on multiple neural substrates of reinforcement suggests that no single factor is likely to explain either addictive behaviour in general or self-administration in particular Some of the findings on the development and maintenance of self-administration by animals of the five exemplar drugs are discussed in the context of these ideas
407 citations
TL;DR: Logistic regression analyses indicated three independent factors associated with having overdosed: longer heroin using careers, greater heroin dependence and higher levels of alcohol consumption.
Abstract: A sample of 329 heroin users were interviewed regarding their personal experience of non-fatal heroin overdose. Experience of overdose was widespread, with two-thirds of subjects (68%) reporting having overdosed. The median number of life-time overdoses was three, with males and females equally likely to have overdosed. The majority (62%) of most recent heroin overdoses occurred in conjunction with the consumption of other central nervous system depressants (alcohol, benzodiazepines and other opioids). Logistic regression analyses indicated three independent factors associated with having overdosed: longer heroin using careers, greater heroin dependence and higher levels of alcohol consumption. Implications for the reduction in the prevalence and frequency of overdose are discussed.
338 citations
TL;DR: A prospective test supported Marlatt's developmental model of relapse, pointing to two client factors as optimally predictive of resumed drinking: lack of coping skills and belief in the disease model of alcoholism.
Abstract: Predictors of relapse to drinking were examined in a clinical sample of 122 individuals seeking outpatient treatment for alcohol problems. Drinking status and a variety of predictor variables were measured every two months for one year following presentation for treatment. In addition to pretreatment characteristics, potential antecedents of relapse were assessed at each point within five domains: (1) the occurrence of negative life events; (2) cognitive appraisal variables including self-efficacy, alcohol expectancies, and motivation for change; (3) client coping resources; (4) craving experiences; and (5) affective/mood status. Although the occurrence of adverse life events did not predict 6-month relapse, all other domains singly accounted for significant variance in drinking outcomes. Proximal antecedents (from the prior 2-month interval) significantly and substantially improved predictive power over that achieved from pretreatment characteristics alone. When analyzed jointly, these predictors accounted for a majority of variance in 6-month relapse status. A prospective test supported Marlatt's developmental model of relapse, pointing to two client factors as optimally predictive of resumed drinking: lack of coping skills and belief in the disease model of alcoholism.
329 citations
TL;DR: This article provided an overview of the development of the taxonomy of high-risk situations for relapse in patients receiving abstinence-based treatment for alcoholism, with an emphasis on social learning theory and its implications for cognitive-behavioral interventions for relapse prevention.
Abstract: The purpose of this paper is to provide an historical overview of the development of the taxonomy of high-risk situations for relapse in patients receiving abstinence-based treatment for alcoholism. Research conducted during the 1970s on determinants of relapse is briefly reviewed, beginning with a preliminary analysis of relapse patterns in alcoholics treated with aversion therapy. Theoretical foundations underlying the development of the taxonomy are then discussed with an emphasis on social-learning theory and its implications for cognitive-behavioral interventions for relapse prevention. Findings supporting the efficacy of coping-skills training for high-risk relapse situations, based on a prospective treatment outcome study for inpatient alcoholics, are also presented in support of the clinical validity of the relapse model. The paper concludes with a description of the refined and extended taxonomy of high-risk situations and the associated cognitive-behavioral model of relapse described in the Marlatt & Gordon (1985) text on relapse prevention.
276 citations
TL;DR: Prospective data from the California Tobacco Surveys were used to perform a critical test of the Prochaska et al. (1991) stages of change model and found that smokers in preparation at baseline were more likely to be in cessation at follow-up than smokers in pre-contemplation at baseline.
Abstract: Prospective data from the California Tobacco Surveys (n = 2066) were used to perform a critical test of the Prochaska et al. (1991) stages of change model. When the stages of change model was used as a stand alone predictor, smokers in preparation at baseline were more likely to be in cessation at follow-up than smokers in pre-contemplation at baseline (ORadj = 1.9). When stage membership was combined with baseline measures of addiction including smoking behaviors and quitting history, it was not a significant predictor of future cessation. A prediction equation that combined daily vs. occasional smoking, cigarettes per day smoked, life-time quits of at least a year, and quits of more than 5 days in the previous year discriminated smokers in cessation at follow-up of 1 to 2 years better than did the stages of change model. The area under the ROC curve for the equation based on addiction measures was 69.3% vs. 55.1% for the stages of change. Cessation rates ranged from 7.7% to 35.7% for the four-category addiction equation compared with 15.1% to 24.9% for stages of change model.
254 citations
TL;DR: The validity of current and life-time substance use diagnoses obtained by a research technician using the SCID was good; it was moderate for antisocial personality disorder and major depression and poor for anxiety disorders.
Abstract: Structured or semi-structured interviews, including the Structured Clinical Interview for DSM-III-R (SCID), are used widely to maximize the reliability and validity of psychiatric diagnoses. Although the reliability of such interviews appears adequate, there has been little effort to evaluate their validity. In a sample of 100 substance abuse patients, we evaluated the concurrent, discriminant and predictive validity of SCID substance use diagnoses, as well as co-morbid disorders that occur commonly among these patients. The validity of current and life-time substance use diagnoses obtained by a research technician using the SCID was good; it was moderate for antisocial personality disorder and major depression and poor for anxiety disorders. Although accurate diagnosis of substance use disorders in substance abuse patients can be accomplished by a research technician, the diagnosis of co-morbid psychiatric disorders requires either additional expertise or the use of a diagnostic instrument specially designed for that purpose.
236 citations
TL;DR: Recommendations for research in the area based on the presentations and discussions of the first "International Conference on Social and Health Effects of Different Drinking Patterns" held in Toronto in November 1995 are presented.
Abstract: Recent epidemiological and social studies have increasingly pointed to the importance of drinking patterns in explaining consequences of alcohol consumption This paper presents recommendations for research in the area based on the presentations and discussions of the first "International Conference on Social and Health Effects of Different Drinking Patterns" held in Toronto in November 1995 In particular, the social dimension in pattern research, and the relationship between patterns of drinking and casualties as well as social harm, are stressed The paper also argues for better theories, incorporating knowledge from related basic disciplines In addition, we emphasize the need for improved methodologies and standardized methods for assessing drinking patterns Finally, implications of research on drinking patterns for policy and programme development are discussed
213 citations
TL;DR: Modelling injecting as a communicable phenomenon, where appropriate, may help estimate population dynamics among IDUs and peer education programmes are likely to be the most effective harm reduction approach among new injectors.
Abstract: Initiation into injecting is a crucial event for continued reproduction of an injecting drug using (IDU) population and for exposure to blood-borne viruses, but little is known about how this happens. Three hundred young injectors were interviewed in Melbourne by peer workers within the first few years of beginning to inject, about the circumstances surrounding their initiation. Most had indications of social disruption, including having left school early, unemployment, family disruption, homelessness and incarceration. First drug injected was most often amphetamines (average age 16 years), most having already used amphetamines by a different route of administration, but with a steady movement thereafter to heroin as the drug of choice. The most common scenario was one in which injecting was unplanned but the person was active in bringing about the initiation. Most identified a significant other who initiated them (few of whom were dealers), and over half had subsequently initiated others into injecting, on average 0.6 per year; after 5 years 237 young injectors had initiated at least 420 others. Those who initiated multiple others were more likely to be unemployed, to inject multiple drugs and to have dealt. Modelling injecting as a communicable phenomenon, where appropriate, may help estimate population dynamics among IDUs. Peer education programmes are likely to be the most effective harm reduction approach among new injectors.
TL;DR: When inpatient treatment was found to be more effective, outpatients did not receive a respite in the form of inpatient detoxification and the studies were slightly less likely to have social stability inclusion criteria and to use random assignment to treatment settings.
Abstract: Previous reviews have concluded that there was no evidence for the superiority of inpatient over outpatient treatment of alcohol abuse, although particular types of patients might be more effectively treated in inpatient settings. In this review, we first consider the conceptual rationales that have been offered to support inpatient and outpatient treatment. Following that, the results of the relevant research on setting effects are presented. Five studies had significant setting effects favoring inpatient treatment, two studies found day hospital to be significantly more effective than inpatient treatment, and seven studies yielded no significant differences on drinking-related outcome variables. In all but one instance in which a significant effect emerged, patients in the 'superior' setting received more intensive treatment and patients were not 'preselected' for their willingness to accept random assignment to treatment in either setting. Studies finding significant setting effects also conducted more treatment contrasts (18.6 vs. 4.9), on average, and had a mean statistical power level of 0.71 (median 0.79) to detect a medium-sized effect, whereas studies with no significant findings had an average power level of 0.55 (median 0.57). When inpatient treatment was found to be more effective, outpatients did not receive a respite in the form of inpatient detoxification and the studies were slightly less likely to have social stability inclusion criteria and to use random assignment to treatment settings. We consider the implications of our findings for future research, especially the need to examine the conceptual rationales put forward by proponents of inpatient and outpatient treatment, i.e. mediators and moderators of setting effects.
TL;DR: Heroin users were reluctant to seek medical attention, with an ambulance being called on only half (56%) of the most recent overdose occasions, and males reported taking significantly longer than females to call an ambulance.
Abstract: A sample of 329 heroin users were interviewed about their experiences at other peoples' heroin overdoses. The overwhelming majority (86%) had witnessed a heroin overdose, on a median of six occasions. Heroin users were reluctant to seek medical attention, with an ambulance being called on only half (56%) of the most recent overdose occasions. At only 17% of most recent overdoses was calling an ambulance the first action taken. Males reported taking significantly longer than females to call an ambulance. Nearly half (44%) of subjects reported that there were factors that had delayed or stopped them seeking medical assistance, the most common impediment being a fear of police involvement. The importance of interventions to encourage help-seeking at overdoses are discussed.
TL;DR: Findings underscore the importance of examining risk (physical and social) at lower levels of drinking and for using both overall volume and heavier quantity per occasion drinking measures when assessing risk for any alcohol-related problem.
Abstract: To assess the relationship of alcohol use and three types of alcohol-related problems (ICD-10 dependence syndrome, work problems and drunk driving), risk curves were developed for average number of drinks per day during last year (volume) and number of days drinking five or more drinks during one day (5+). Using data from the 1988 National Health Interview Alcohol Supplement, risk curves were derived from data on 22,102 current drinkers who consumed at least 12 drinks in the last year. The emphasis in this analysis was on the proportion of drinkers at lower levels reporting different types of problems. The results indicate that even at lower levels of drinking (volume averaging one or fewer drinks/day) there is considerable risk for drunk driving and less risk for work problems and alcohol dependence. The risk for all types of problems at lower and moderate levels of drinking was significantly higher for respondents who had five or more drinks during one day in the last year. These findings underscore the importance of examining risk (physical and social) at lower levels of drinking and for using both overall volume and heavier quantity per occasion drinking measures when assessing risk for any alcohol-related problem. Language: en
TL;DR: It is indicated that the more often drinking takes place in public drinking places, the less is the impact of intoxication on the probability of getting into a fight.
Abstract: The impact of alcohol consumption, drinking pattern and drinking context on involvement in alcohol-related violence was assessed in a survey of 2711 Norwegian adults. Having taken pan in a fight while influenced by alcohol and halting been injured by an intoxicated person during the past year was reported by 3% and 2.4% of the respondents, respectively. Involvement in alcohol-related violence was most often reported among younger people, among single people, and it was positively associated with alcohol consumption, frequency of intoxication and frequency of visiting public drinking places. Both frequency of intoxication and overall alcohol consumption were positively associated with the probability of having been in a fight while intoxicated. Frequency of visits to public drinking places was significantly associated with the risk of being injured by an intoxicated person, also when own drinking pattern was controlled for. The results also indicated that the more often drinking takes place in public drinking places, the less is the impact of intoxication on the probability of getting into a fight.
TL;DR: An assessment of the prevalence of smoking and quitting among adolescents approaching adulthood found a dramatic increase in number of daily smokers, and in a climate of expected decreases in smoking, a history of never smoking to age 15 years was not as protective against future smoking as anticipated.
Abstract: A follow-up of smoking behaviour to age 18 in a longitudinal study of a birth cohort enabled an assessment of the prevalence of smoking and quitting among adolescents approaching adulthood. There was a dramatic increase in number of daily smokers (15% at age 15 years to 31% at age 18 years), and in a climate of expected decreases in smoking, a history of never smoking to age 15 years was not as protective against future smoking as anticipated. Among 15-year-olds who had experimented with smoking, only 11% per year stopped by age 18 years. Cessation rates for adolescent daily smokers were low (3% had not smoked in the last year at age 18 years), and previously have not been widely reported. We also examined some methodological issues related to self-reported prevalence rates, in particular reliability, validity and sources of bias, finding confirmation of the accuracy of information from prospective longitudinal studies and supporting the conclusion that adolescents' recall for information beyond a 1-year period is inconsistent.
TL;DR: The unexplained association between alcohol misuse and violent offending may suggest the presence of a direct cause and effect association in which adolescent alcohol misuse is associated with increased risks of violent offending.
Abstract: The associations between alcohol misuse and juvenile offending during the period from 15 to 16 years of age were studied in a birth cohort of New Zealand adolescents. This analysis showed that young people who misused alcohol had significantly (p <0.001) higher rates of both violent and property offences. These associations were similar for males and females. Further analysis suggested that a substantial component of the association between alcohol misuse and juvenile offending arose from shared risk factors that were common to both outcomes. These risk factors included measures of family social background, family and parental characteristics, individual characteristics and adolescent peer affiliations. After adjustment for antecedent risk factors there was no significant association between alcohol misuse and odds of property offences. However, young people who abused alcohol had odds of violent offending that were 3.2 times (p< 0.001) the odds of those offences for young people who did not misuse alcohol. It is concluded: (a) that a large component of the association between alcohol misuse and juvenile offending arises because of the effects of shared risk factors that are associated with both outcomes; (b) none the less, the unexplained association between alcohol misuse and violent offending may suggest the presence of a direct cause and effect association in which adolescent alcohol misuse is associated with increased risks of violent offending.
TL;DR: The paper concludes with a description of the refined and extended taxonomy of high-risk situations and the associated cognitive-behavioral model of relapse described in the Marlatt & Gordon (1985) text on relapse prevention.
Abstract: The purpose of this paper is to provide an historical overview of the development of the taxonomy of high-risk situations for relapse in patients receiving abstinence-based treatment for alcoholism. Research conducted during the 1970s on determinants of relapse is briefly reviewed, beginning with a preliminary analysis of relapse patterns in alcoholics treated with aversion therapy. Theoretical foundations underlying the development of the taxonomy are then discussed with an emphasis on social-learning theory and its implications for cognitive-behavioral interventions for relapse prevention. Findings supporting the efficacy of coping-skills training for high-risk relapse situations, based on a prospective treatment outcome study for inpatient alcoholics, are also presented in support of the clinical validity of the relapse model. The paper concludes with a description of the refined and extended taxonomy of high-risk situations and the associated cognitive-behavioral model of relapse described in the Marlatt & Gordon (1985) text on relapse prevention.
TL;DR: The most commonly reported symptoms subsequent to the onset of amphetamine use were depression (79%), anxiety (76%), paranoia (52%), hallucinations (46%), and violent behaviour (44%).
Abstract: A sample of 301 amphetamine users were interviewed about their experiences of psychological symptoms prior to, and subsequent to, their initiation of amphetamine use. Psychological morbidity was common, with 44% scoring greater than a conservative cut-off of 8 on the General Health Questionnaire. The most commonly reported symptoms subsequent to the onset of amphetamine use were depression (79%), anxiety (76%), paranoia (52%), hallucinations (46%) and violent behaviour (44%). All these symptoms increased in prevalence after the onset of amphetamine use. Route and frequency of amphetamine administration were significant independent predictors of overall psychological morbidity, while route of administration was related to the experience of hallucinations, violent behaviour and paranoia. The avoidance of injection as a route of administration and the use of amphetamines less than weekly are recommended as steps that users can take to reduce the psychological sequelae of amphetamine use.
TL;DR: In most cultures, clinicians were more likely to make a diagnosis of drug dependence than of alcohol dependence although behavioural signs were equivalent, and criteria were sometimes not readily differentiated from one another.
Abstract: The cross-cultural applicability of criteria for the diagnosis of substance use disorders and of instruments used for their assessment were studied in nine cultures. The qualitative and quantitative methods used in the study are described. Equivalents for English terms and concepts were found for all instrument items, diagnostic criteria, diagnoses and concepts, although often there was no single term equivalent to the English in the languages studied. Items assuming self-consciousness about feelings, and imputing causal relations, posed difficulties in several cultures. Single equivalent terms were lacking for some diagnostic criteria, and criteria were sometimes not readily differentiated from one another. Several criteria--narrowing of the drinking repertoire, time spent obtaining and using the drug, and tolerance for the drug--were less easy to use in cultures other than the United States. Thresholds for diagnosis used by clinicians often differed. In most cultures, clinicians were more likely to make a diagnosis of drug dependence than of alcohol dependence although behavioural signs were equivalent. The attitudes of societies to alcohol and drug use affects the use of criteria and the making of diagnoses.
TL;DR: Data were presented describing the current understanding of the structure and function of neuronal nicotinic acetylcholine receptors, by which nicotine exerts most, if not all, of its effects in the brain.
Abstract: The proceedings of the inaugural scientific meeting of the Society for Research on Nicotine and Tobacco (SRNT) are summarized. The primary objective of the meeting was to foster the exchange of information on the effects of nicotine and tobacco use, as well as factors which influence their use, drawing from biological, behavioral and social sciences. Much of this research can be viewed as a tale of "two" drugs--nicotine as a key to an important public health problem, and nicotine as a classical tool of physiological and pharmacological research. A historical overview of research on "both" drugs is provided first. Public policy alternatives for reducing the prevalence of tobacco use have been derived in part from basic and clinical research results and are briefly outlined. Evidence for genetic determinants on nicotine use and effects is presented using data from twin studies and from molecular genetic research with humans and animals. Consistent with this research, there is evidence of individual differences in pharmacokinetics and effects of nicotine, which could account for differences in smoking behavior and nicotine dependence. Finally, recent developments in the therapeutic uses of nicotine and novel nicotinic agonists with schizophrenia, Alzheimer's disease, Parkinson's disease, Tourette's syndrome and ulcerative colitis are presented. Overall, the research presented at the meeting demonstrated the vast diversity of areas of study involving nicotine and tobacco, as well as the rich opportunities for cross-communication among researchers from different disciplines.
TL;DR: Heroin users at entry to the methadone maintenance programme had significantly worse physical and psychological health than the general population, and alcohol and marijuana use were associated with better social and physical health.
Abstract: This study used the SF-36 general health questionnaire to measure the health status of heroin users at entry to a public methadone maintenance programme. Their results were compared to those from the general population and from three clinical groups: patients with minor medical, major medical and psychiatric problems. One hundred consecutive clients were interviewed in the first week on the programme using the SF-36 health questionnaire. Data were also gathered on their drug use, use of medical services and HIV risk behaviour. The results showed that heroin users at entry to the methadone maintenance programme had significantly worse physical and psychological health than the general population. Their scores were most similar to the psychiatrically depressed patients, although they had worse physical health than this comparison group. The greater the amount of heroin used by clients before entering the programme, the more pain they reported. Alcohol and marijuana use were associated with better social and physical health. The relationship between general health status and amount or frequency of drug use is not a clear one. Heroin users experience severe emotional and physical problems at the time of entering methadone maintenance treatment.
TL;DR: It is suggested that dance drug users are polydrug users who use drugs in a setting specific fashion and it would be wrong to classify such users solely on the grounds of their very visible behaviour in the public arena (at dance events).
Abstract: Interviews were conducted with 135 participants in the Glasgow dance (rave) scene. Drug use in this group was varied and not merely restricted to drugs associated with dance events, such as MDMA (Ecstasy). The setting in which each drug was used varied greatly. Amphetamine, nitrites and Ecstasy were the drugs most commonly used at dance events. Pharmaceuticals were least likely to be used in such settings. However, some drugs, such as Temazepam, were sometimes used prior to or after attending rave events. It is suggested that dance drug users are polydrug users who use drugs in a setting specific fashion. As such it would be wrong to classify such users solely on the grounds of their very visible behaviour in the public arena (at dance events). Other forms of substance use engaged in by this group may have a greater potential for harm than that seen at raves. The implications of these findings are discussed.
TL;DR: The Relapse Replication and Extension Project (RREP) was a multisite study to replicate and extend Marlatt's taxonomy of relapse precipitants, which showed little predictive validity in analyses that used pretreatment relapse data to predict post-treatment relapse, but there are important unresolved issues.
Abstract: The Relapse Replication and Extension Project (RREP) was a multisite study to replicate and extend Marlatt's taxonomy of relapse precipitants. In addition to replicating Marlatt's original taxonomic system, three independent research teams utilized prospective designs to identify additional predictors of relapse and developed and evaluated two alternative systems for assessing high risk relapse situations. This overview describes the replication methodology, summarizes seven RREP studies completed by the three research groups, and discusses five cross-cutting conclusions emerging from the studies. These conclusions are: (1) reliability of Marlatt's taxonomic system was variable both within and across the three research sites; (2) Marlatt's taxonomic system showed little predictive validity in analyses that used pretreatment relapse data to predict post-treatment relapse, but there are important unresolved issues; (3) an alternative taxonomy provided little more predictive validity than the original taxonomy even though it measured more dimensions of relapse situations and provided greater analytic flexibility; (4) the Reasons for Drinking Questionnaire appeared to be a successful psychometric transformation of Marlatt's taxonomy, one which did demonstrate predictive validity; and (5) Marlatt's taxonomy was based on a time-intensive model of relapse prediction whereas RREP prospective analyses represented time-extensive models of relapse prediction. Coping responses are noted to be effective predictors of relapse under both models.
TL;DR: While subject variables over which treatment providers have little control were, thus, related to outcome, type of treatment provided and methadone dose also influenced outcome.
Abstract: Predictors of methadone maintenance treatment outcome have not been extensively studied as they relate to variations in program philosophy, nor have such predictors received much examination among recently treated, older cohorts of opioid addicts for whom drug use patterns have changed. Predictors of outcome were examined at 18 months post-treatment entry for 353 admissions to methadone maintenance who received random assignment to one of three counseling conditions: (1) medication only, (2) standard counseling and (3) enhanced services; and one of two contingency conditions: (1) no contingencies, and (2) contingency contracting in a six-cell 3 x 2 design. Subjects in contingency contracting conditions were placed on contingency contracts for positive urine toxicology results and ultimately discharged for unremitting drug use. All subjects completed the Addiction Severity Index (ASI) and provided weekly urine specimens. Predictors of urinalysis results and treatment retention were determined using bivariate and multivariate techniques. Interactions between subject characteristics by experimental condition assignment were also examined as predictors. Higher rates of total positive urine specimens were predicted by younger age, greater pre-treatment frequency of smoking cocaine, lower ASI psychiatric composite scores, and higher ASI legal composite scores. Higher rates of opiate positive specimens were predicted by younger age, lower pre-treatment frequency of alcohol intoxication, higher ASI legal and lower ASI employment and psychiatric composite scores, and assignment to medication only/no contingencies condition. Higher rates of cocaine positives were predicted by younger age, black race, lower ASI psychiatric composite score, greater pre-treatment frequency of intravenous and smoked cocaine use, less pre-treatment frequency of marijuana use, and lower methadone dose level. Assignment to enhanced/contingency contracting predicted lower rates of cocaine positives. Treatment retention was predicted by older age, non-black race, lower ASI legal composite score, higher methadone dose level and assignment to non-contingent conditions. While subject variables over which treatment providers have little control were, thus, related to outcome, type of treatment provided and methadone dose also influenced outcome.
TL;DR: While Group 4 subjects were more likely to have developed dependence on most types of drugs, even when alcohol and drug use patterns were statistically taken into account, marijuana use was still significantly related to a self-report of a history of marijuana withdrawal.
Abstract: Case reports and laboratory research indicate the existence of a cannabis withdrawal syndrome. However, the data tell us little about the prevalence and clinical characteristics of a marijuana withdrawal syndrome in people who have used the drug but who did not enter treatment for cannabis dependence. Face-to-face semi-structured interviews applying standard diagnostic criteria were used in the present study to gather data from 5611 men and women, recruited between 1991 and 1995 through the Collaborative Study of the Genetics of Alcoholism (COGA). Almost 41% of the sample had no history of marijuana use (Group 1), 28% had consumed this drug less than 21 times in any single year (Group 2), and 31% used it at least that frequently (Groups 3 and 4). Almost 16% of the more frequent marijuana users related a history of a marijuana withdrawal syndrome, and these Group 4 subjects had used the drug almost daily for an average of almost 70 months. The typical withdrawal symptoms included "nervous, tense, restlessness", "sleep disturbance" and "appetite change". While Group 4 subjects were more likely to have developed dependence on most types of drugs, even when alcohol and drug use patterns were statistically taken into account, marijuana use was still significantly related to a self-report of a history of marijuana withdrawal.
TL;DR: The inhaler is clearly useful for short-term smoking cessation with potential for long-term efficacy and extended access to the inhaler and relapse prevention training could improve success rates.
Abstract: A non-combustible nicotine inhaler, administered orally, has been developed for treatment of smokers. The inhaler allows weaning from nicotine while maintaining partial reinforcement of the ritual/sensory phenomena of smoking. Subjects were randomly assigned to active (n = 112) and placebo (n = 111) groups. Some behavioral intervention occurred as a function of participation. Strict abstinence (primary outcome criterion) was defined by CO < or = 8 ppm with no slips allowed at any time and cotinine values < or = 14 at 1 year. Survival analysis showed active inhaler was superior to placebo (p < 0.01). Active vs. placebo success rates were: 63% vs. 47% (day 3), 46% vs. 28% (week 1), 36% vs. 19% (week 2), 33% vs. 16% (week 3), 29% vs. 14% (week 6), 24% vs. 10% (3 months), 17% vs. 9% (6 months) and 13% vs. 8% (1 year). chi 2 analyses were significant through 3 months but not at 6 months (p < 0.08) or 1 year. Craving was relieved with active inhalers at day 3 and week 1. Subjects averaged six inhalers/day. Cotinine levels were 57-61% of smoking levels. Common side effects included throat/mouth irritation and coughing. Failure was predicted by early slips. The inhaler is clearly useful for short-term smoking cessation with potential for long-term efficacy. Extended access to the inhaler and relapse prevention training could improve success rates. Another promising approach would be to combine the inhaler with a nicotine patch.
TL;DR: It may be useful in research and clinical practice to abandon the notion of "relapse" and focus instead on terminology that better describes the normal resolution process for addictive behaviors.
Abstract: Binary thinking has often guided research and practice in the addiction field. For example, emphasis has been given to identifying whether an individual is "alcoholic" or not, and the dichotomous judgement that a client is either drinking or abstinent has been used to judge treatment effectiveness. Research on the nature of alcohol problems, however, indicates that they lie along several modestly interrelated continuous dimensions of severity, rather than occurring as a single syndrome qualitatively distinct from normality. Similarly, changes in addictive behaviors in general, and treatment outcomes in particular, are complex phenomena not readily captured by dichotomous classification. The term "relapse" is itself seriously problematic in various ways, and its definition elusive. It represents a somewhat arbitrary binary judgement imposed on the flow of behavior, and carries negative evaluative overtones. A potentially detrimental abstinence violation effect is implicit in the very use of the term "relapse", which thereby may become a self-fulfilling prophecy. Further, it implicitly pathologizes what is in fact a rather common event in the course of behavior change, and embodies an unrealistic and inaccurate conception of how successful change occurs over time. For these reasons, it may be useful in research and clinical practice to abandon the notion of "relapse" and focus instead on terminology that better describes the normal resolution process for addictive behaviors.
TL;DR: The results of the analysis showed that physical availability was unrelated to self-reports of driving after drinking and driving while intoxicated and significantly related to rates of single vehicle night-time crashes.
Abstract: This paper reports on an analysis of geographically based data from four communities conducted to evaluate relationships between measures of the physical availability of alcohol and rates of driving after drinking. From a review of the literature, it was expected that rates of driving after drinking would be directly related to the availability of alcohol at on-premise establishments. Based on theoretical arguments regarding the life activities which underlie drinking and driving it was expected that the effects of availability upon these outcomes would extend significantly beyond the local areas of outlets. Taking into account the geographic variations in environmental characteristics (road network density, traffic flow, population density), and socioeconomic (age, gender, race, marital status, income, employment) and drinking characteristics (rates of abstention, frequency and quantity of use) of resident populations, a spatial analysis of drinking driving and alcohol-related crashes was conducted. The results of the analysis showed that physical availability was unrelated to self-reports of driving after drinking and driving while intoxicated and significantly related to rates of single vehicle night-time crashes. In the latter case, physical availability affected both local and adjacent area rates of crashing.