Showing papers in "Journal of Addiction Medicine in 2008"

The Opioid Dependent Mother and Newborn Dyad: Nonpharmacologic Care

Abstract: Opioid dependent pregnant and post-partum women and their infants are a complex and vulnerable population requiring individualized, comprehensive and multidisciplinary treatment. Though methadone maintenance in the setting of comprehensive service provision during pregnancy significantly improves pregnancy outcomes for opioid dependent women, its use has implications for the infant, most notably the Neonatal Abstinence Syndrome (NAS). NAS is comprised of physiologic signs and behaviors that indicate a dysfunctional regulation of the central and autonomic nervous systems, and is variable in its expression in affected infants. The disorganized rather than adaptive behaviors displayed by each infant undergoing the effects of in-utero opioid exposure may impair basic functions such as feeding, sleeping, and the ability to be alert and communicate clear cues to caregivers. Understanding and responding to neurobehavioral dysfunction of the newborn may help to promote the infant's self-organization and self-regulating abilities. However, the substance abusing mother's physical and psychological wellbeing may be debilitated in the perinatal period, and her ability to recognize and respond to the newborn's cues may be limited. A multi-tiered comprehensive assessment and intervention of the methadone-maintained mother, her child, and the mother/infant dyad can improve early maternal nurturing interactions, a crucial component of early infant development, particularly in this vulnerable population. The purpose of this article is to review the contribution of maternal opioid dependency to the difficulties experienced by the mother-infant dyad and their treatment providers in the postnatal period, and the non-pharmacological treatment of the infants with suggestions for practical measures with emphasis on the treatment of the mother and baby as an interactional dyad.

Mindfulness meditation for alcohol relapse prevention: a feasibility pilot study.

Abstract: Objectives:Meditation is a promising treatment for alcohol dependence. This 16-week prospective case series was designed to gather preliminary data about the efficacy of meditation for relapse prevention and to evaluate study methods feasibility.Methods:Nineteen adult alcohol-dependent graduates of

The Case for Chronic Disease Management for Addiction

Abstract: Chronic disease (care) management (CDM) is a patient-centered model of care that involves longitudinal care delivery; integrated, and coordinated primary medical and specialty care; patient and clinician education; explicit evidence-based care plans; and expert care availability. The model, incorporating mental health and specialty addiction care, holds promise for improving care for patients with substance dependence who often receive no care or fragmented ineffective care. We describe a CDM model for substance dependence and discuss a conceptual framework, the extensive current evidence for component elements, and a promising strategy to reorganize primary and specialty health care to facilitate access for people with substance dependence. The CDM model goes beyond integrated case management by a professional, colocation of services, and integrated medical and addiction care-elements that individually can improve outcomes. Supporting evidence is presented that: 1) substance dependence is a chronic disease requiring longitudinal care, although most patients with addictions receive no treatment (eg, detoxification only) or short-term interventions, and 2) for other chronic diseases requiring longitudinal care (eg, diabetes, congestive heart failure), CDM has been proven effective.

Impulsive sensation seeking, parental history of alcohol problems, and current alcohol and tobacco use in adolescents.

Abstract: Objectives This study attempted to evaluate whether impulsive sensation seeking mediated the relationship between parental alcohol problems and offspring alcohol and tobacco use. Methods Participants were Connecticut high school students (n = 2733) completing a survey of high-risk behaviors. Variables of interest included past month alcohol use, past month binge alcohol use, frequency of past month alcohol use, past month tobacco use, having a biological parent with an alcohol problem, and score on the impulsive sensation seeking (ImpSS) scale from the Zuckerman-Kuhlman Personality Questionnaire - Form III. Results ImpSS scores were elevated in past month users of alcohol, binge users of alcohol, users of both tobacco and alcohol, and they increased with increasing frequency of past month alcohol use. Also, parental history of alcohol use increased the likelihood of past month alcohol use, binge use, use of both tobacco and alcohol, and higher levels of past month alcohol use. Mediational analyses did not appear to support the hypothesis that impulsive sensation seeking mediates the relationship between parental history of alcohol problems and alcohol and tobacco use in offspring. Conclusions Impulsive sensation seeking and parental history of alcohol problems appear to be independent factors that contribute to the co-occurrence of alcohol and tobacco use in adolescents. These findings can inform prevention and treatment efforts.

Daily Tobacco Smoking in Treatment-Seeking Pathological Gamblers: Clinical Correlates and Co-occurring Psychiatric Disorders.

Abstract: Objectives Tobacco smoking and pathological gambling (PG) frequently co-occur. Little is known, however, about the clinical correlates and co-occurring psychiatric disorders in treatment-seeking pathological gamblers with and without daily tobacco smoking. Methods Among a sample of 465 consecutive treatment-seeking subjects with current DSM-IV PG, those with daily tobacco smoking were compared to those without daily tobacco smoking on measures of gambling symptom severity (South Oaks Gambling Screen [SOGS] and the Yale Brown Obsessive Compulsive Scale Modified for Pathological Gambling [PG-YBOCS]), types of gambling, social and legal problems, and co-occurring disorders. Results Two hundred and nine (44.9%) of the 465 subjects with PG reported current daily tobacco smoking. Gamblers with daily tobacco smoking as compared to those without had higher SOGS scores, had more severe PG-YBOCS behavior scores, endorsed more DSM-IV PG criteria, lost more money gambling, and were more likely to engage in non-strategic gambling, and were less likely to have a co-occurring mood disorder. Gamblers with daily tobacco smoking and a current substance use disorder reported a greater percentage of income lost to gambling during the past year. Conclusions Daily tobacco smoking in PG is common and associated with multiple important clinical features including more severe gambling and financial problems. These findings suggest that pathological gamblers with daily tobacco smoking might need unique or enhanced treatment strategies.

Management of addiction disorders in pregnancy.

Abstract: In this article, we will review the prevalence of addiction disorders in pregnancy and the impact that it has on perinatal morbidity and mortality. We will then review effective screening techniques and propose a management scheme for achieving short-term abstinence leading to the ultimate goal of long-term recovery. The various medical and obstetric complications unique to this patient population will be discussed as well as the specific adverse effects of substance abuse on placentation and the developing fetus. Finally, medications proven efficacious in the treatment of addiction disorders will be reviewed in the context of their use in the pregnant population.

Counselors' Experiences Treating Methadone-maintained Patients with Chronic Pain: A Needs Assessment Study.

Abstract: PURPOSE: : This study was designed to conduct a needs assessment concerning methadone counselors' experiences working with methadone-maintained patients with chronic pain and measure counselors' interest in receiving specialized training to treat such patients. METHODS: : A survey, developed by the authors, was administered to 25 counselors with a combined caseload of 956 patients at 3 opioid agonist treatment programs. RESULTS: : Patients with chronic pain comprised 27% of counselors' overall caseloads. Counselors believed that, on average, 46% of these patients' pain had a psychologic component and 56% exhibited continued drug use, which patients attributed to ongoing pain. Twenty-three counselors reported an interest in receiving specialized training in treating chronic pain. A variety of management issues, including monitoring the use of pain medications and providing pain management referrals, were reported. CONCLUSIONS: : Findings from this needs assessment study suggest specific targets, which may be important to consider, in prospective specialized methadone maintenance treatment (MMT) counselor training and counseling for MMT patients with chronic pain.

Correlates of prescription drug nonmedical use and problem use by adolescents.

Abstract: Objectives:This study characterizes patterns and correlates of prescription drug nonmedical (PDNM) use and prescription drug problem (PDP) use among U.S. adolescents.Methods:Using the 2003 National Survey on Drug Use and Health (NSDUH), we estimated annual prevalence of PDNM and PDP use. We stratifi

Early Age-of-onset Drinking Predicts Prescription Drug Misuse Among Teenagers and Young Adults: Results from a National Survey.

Abstract: Early age-of-onset drinking is associated with alcohol problems and related, high-risk behaviors. We analyzed data from 18- to 34-year-old respondents from the 2001 to 2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC) to determine to what extent early age-of-onset drinking increased risks for prescription drug misuse (PDM), defined as 1 or more positive responses to: "ever having misused sedatives, tranquilizers, painkillers or stimulants, obtained either as prescriptions or from indirect sources." Lifetime prevalence of PDM was 15.4% among 8306 "drinkers" and 3% among 4652 "nondrinkers." Unadjusted odds for PDM for both men and women increased with each successively younger drinking age-of-onset, reaching a 10-fold risk at <14 years (odds ratio [OR], 10.7; 95% confidence interval [CI], 7.43-15.3) for men and women combined). In adjusted analyses, early age-of-onset marijuana use among drinkers reduced these odds and independently increased the risks for PDM 2-fold (adjusted OR, 2.07; 95% CI, 1.17-3.64). Lifetime alcohol dependence independently predicted PDM (adjusted OR, 2.43; 95% CI, 2-2.96) and obscured the association of early drinking, but not of early marijuana use, with PDM. This finding suggests a specific mediating effect of alcohol dependence between early drinking and PDM. Findings support the need for effective programs to prevent and reduce harm from early-onset drinking and from the associated risk of alcohol dependence and prescription drug misuse.

Screening, brief intervention, and referral to treatment for adolescents.

Abstract: Drug, alcohol, and tobacco use is highly prevalent among high school students in United States, and adolescents, even those without a substance use disorder, are at high risk of morbidity and mortality related to use of these substances. The primary care setting provides access to adolescents, and the health maintenance visit provides a private, confidential setting in which patients expect to discuss health-related behaviors and receive advice. This article reviews guidelines for identifying and managing adolescent substance use in the primary care setting, including screening, brief intervention, and referral to treatment.

Inhalant abuse (typewriter correction fluid) in street children.

Abstract: Background : Inhalant abuse is a growing concern in India among street children. Aim : To describe the sociodemographic and clinical characteristics of 9 street children and adolescents with typewriter correction fluid abuse. Method : Nine street children who presented to the psychiatry department of Dr. Ram Manohar Lohia Hospital, New Delhi for treatment of inhalant abuse were interviewed. Findings : The inhalant abusers were boys of 10 to 17 years, school dropouts who had run away from villages of Bihar and Uttar Pradesh. In two-third of children there was domestic violence and conflict in their family, along with physical abuse by family members; in one-third it was due to alcoholic fathers. They used to "huff" typewriter correction fluid, and abused other substances as well. Conclusion : There is a need to systematically study inhalant abuse in the street children in India.

Acamprosate: Safety and Tolerability in the Treatment of Alcohol Dependence

Abstract: Acamprosate, in conjunction with psychosocial treatment, has demonstrated efficacy in maintaining abstinence in alcohol-dependent patients in multiple clinical trials. Data from 13 short-term (≤26 weeks) and long-term (≥48 weeks) clinical trials were analyzed to assess the safety and tolerability of acamprosate: 4234 patients were randomized to placebo (N = 1962), acamprosate 1332 mg/d (N = 440), 1998 mg/d (N = 1749), or 3000 mg/d (N = 83). Overall incidence of treatment-emergent adverse events (AEs) was 61% for acamprosate and 56% for placebo (P < 0.01). The majority of AEs in all groups were reported as transient and considered "mild" or "moderate" in severity, and discontinuation rates due to AEs were comparable. Most common AEs were diarrhea (16% acamprosate versus 10% placebo, P < 0.01) and flatulence (3% acamprosate versus 2% placebo, P < 0.01). Patients taking concomitant medications commonly used to treat alcohol dependence reported comparable AEs between placebo- and acamprosate-treated groups.Acamprosate was shown to be safe in patients with hepatic impairment. A dose reduction is recommended in patients with renal impairment. No clinically meaningful between-group differences were reported for clinical chemistry tests or vital sign parameters. This ad hoc analysis demonstrates that acamprosate can be used safely in alcohol-dependent patients, including those taking concomitant medications, or having renal or hepatic impairment.

Differences in Treatment Outcomes between Prescription Opioid-Dependent and Heroin-Dependent Adolescents.

Abstract: Objective:This study was designed to examine the extent to which heroin-dependent and prescription opioid-dependent adolescents experienced differential outcomes during a clinical trial designed to evaluate combined behavioral-pharmacological treatment.Methods:Participants were a volunteer sample of

Dosing adjustments in postpartum patients maintained on buprenorphine or methadone.

Abstract: Scant scientific attention has been given to examining the need for agonist medication dose changes in the postpartum period Study objectives were: 1) to determine the need for medication dose adjustments in participants stabilized on buprenorphine or methadone 3 weeks before and 4 weeks after delivery, and 2) to evaluate the need for methadone dose adjustments during the first 7 days in participants transferred from buprenorphine to methadone at 5 weeks postpartum Participants were opioid-dependent pregnant women who had completed a randomized, double-blind, double-dummy, flexible dosing comparison of buprenorphine to methadone Participants received a stable dose of methadone (N = 10) or buprenorphine (N = 8) before and 4 weeks after delivery Buprenorphine-maintained participants were transferred to methadone at 5 weeks postpartum There were no significant differences predelivery and/or postdelivery between the buprenorphine and methadone conditions in the mean ratings of dose adequacy, "liking," "hooked," and "craving" of heroin or cocaine Patient response to the conversion from buprenorphine to methadone seems variable Buprenorphine-maintained participants required dose changes postpartum only after they transferred to methadone Regardless of type of medication, postpartum patients should be monitored for signs of overmedication

A Latent Class Analysis of DSM-III-R Pathological Gambling Criteria in Middle-Aged Men: Association with Psychiatric Disorders.

Abstract: Purpose:This study was designed to empirically derive latent classes based on PG criteria and to assess the association between nongambling psychiatric disorders and specific classes.Methods:A total of 8138 community-based middle-aged men were surveyed, and 2720 were assessed for Diagnostic Intervie

Prediction of abstinence in opioid-dependent patients.

Abstract: Objectives: Opioid detoxification with subsequent naltrexone is found to be an effective method as the first step in an abstinenceoriented approach. The aim of this study is to investigate the predictive value of variables for abstinence in opioid-dependent patients. Methods: Opioid-dependent patients were followed up to 1 month after detoxification. Predictor variables were assessed at baseline, during detoxification, and at discharge. Primary outcome was abstinence assessed by analyzing urine samples and self-reports. Logistic regression was used to identify predictors of abstinence. Results: Of 272 participants, 211 could be rated as abstinent (59.2%) or nonabstinent (40.8%) at 1 month follow-up. Significant baseline predictors were severity score of justice/police (ASI) and physical quality of life (SF-36); discharge predictors were general quality of health (SF-36) and sleeping problems (SCL-90); change in sleeping problems (SCL-90) during detoxification was also a predictor. The explained variance of these predictors was very low and clinical significance was limited. Conclusions: Considering the results it seems not possible to predict who will be abstinent or not 1 month after detoxification. Because rapid detoxification is found to be an effective detoxification method in selected patients, it seems warranted to recommend that patients with similar characteristics (ie, patients motivated for an abstinencebased treatment and low non‐drug-related severity scores on the ASI) should be regarded as eligible for rapid detoxification. (J Addict Med 2008;2: 194‐201)

Associations of substance abuse and sexual risks with self-reported depressive symptoms in young adults in northern Thailand.

Abstract: Depression among young adults is a significant mental health issue worldwide. Withdrawal from amphetamine and chronic alcohol use is associated with significant increases in depressive symptoms. Young adults with depressive symptoms are more likely to engage in sexual risk behaviors than peers who are not depressed. We investigated the association between substance abuse and sexual risk behaviors with recent depressive symptoms (using the Centers for Epidemiologic Studies Depression Scale [CES-D] scale) in a sample of 1189 young adults aged 18 to 25 years in Chiang Mai, Thailand, who were recruited based on recent methamphetamine use or were sex partners of a methamphetamine user. High reports of depressive symptoms, based on CES-D scores ≥22, were seen in 45% of women and 31% of men (P < 0.0001) and were associated with alcohol problems (Cut down, Annoyed, Guilty, Eye-opener [CAGE] score and frequency of drunkenness) and frequent methamphetamine use in men but not women. For women, higher depressive symptoms were associated with greater numbers of reported sexual partners during the past year where condoms were infrequently used. These results point to the importance of identifying substance abuse among young adults in Thailand and its contribution to depressive symptoms and the importance of recognizing depression as a significant public mental health problem in this population.

Do Objective Measures of Blood Alcohol Concentrations Make More Sense than Self-reports in Emergency Department Studies?

Abstract: Purpose: Concerns about self-reports have led to calls for objective measures of blood alcohol concentration (BAC). The present study compared objective measures with self-reports. Methods: BAC from breath or blood samples were obtained from 272 randomly sampled injured patients who were admitted to a Swiss emergency department (ED). Self-reports were compared a) between those providing and refusing a BAC test, and b) to estimated peak BAC (EPBAC) values based on BACs using the Widmark formula. Results: Those providing BACs were significantly (P Conclusions: There is little evidence that patients who provide objective BAC measures deliberately conceal consumption. ED studies must rely on self-reports, eg, take the time period between injury and ED admission into account. Clearly, objective measures are of clinical relevance, eg, to provide optimal treatment in the ED. However, they may be less relevant to establishing effects in an epidemiologic sense, such as estimating risk relationships. In this respect, efforts to increase the validity and reliability of self-reports should be preferred over the collection of additional objective measures.

Naltrexone in the treatment of alcohol dependence.

Abstract: Naltrexone is an opioid receptor antagonist that has been shown to be effective for maintaining abstinence in alcohol-dependent persons. It is particularly effective in a subset of persons who suffer from high craving, as it reduces craving for alcohol. Family history has been shown to be a predictor of treatment response and, indeed, allelic variation in the mu opioid receptor gene predicts treatment response to naltrexone. The therapeutic effects of naltrexone are mediated by blockade of central mu opioid receptors. The site of action is under investigation but evidence supports a role of mu opioid receptors in the central nucleus of the amygdala, nucleus accumbens, and ventral tegmental area in the therapeutic actions of naltrexone for alcohol dependence. This article reviews the role of the endogenous opioid system in addictive diseases, especially alcoholism and discusses the pharmacological basis for the use of naltrexone in the treatment of alcohol dependence.

Buprenorphine-induced Symptomatic Hypogonadism in Men: Case Reports and Discussion.

Abstract: BACKGROUND Sexual dysfunction with decreased serum testosterone concentrations in methadone maintenance patients was first reported in the 1970s.1–4 Subsequently, researchers reported that other sustained-action opiates used to treat noncancer and cancer pain can produce symptomatic hypogonadatrophic hypogonadism with low serum testosterone and suppression of adrenal androgenic steroids in men.5–9 Methadone-induced suppression of testosterone is mediated by the inhibition of hypothalamic gonadotropin releasing hormone production.10 Sustained-action opiates also depress adrenal production of dehydroepiandrosterone sulfate (DHEAS).11 In 2005, Bliesener et al evaluated the effects of sublingual buprenorphine (11.2 4 mg/d) in 17 men; they did not find abnormalities in serum testosterone, follicle-stimulating hormone, luteinizing hormone, estradiol, or prolactin levels.12 To our knowledge, there have been no reports of buprenorphine-induced reduction in serum gonadotropins or testosterone. We report 10 cases of apparent hypogonadism in buprenorphine/naloxone treated men.

Quetiapine versus trazodone in reducing rehospitalization for alcohol dependence: a large data-base study.

Abstract: Clinicians commonly use nonindicated (or "off-label") medications for the treatment of alcoholism, although there is no clear evidence to support this practice. Quetiapine and trazodone are 2 medications frequently used in this manner, especially to treat sleep disturbance associated with alcohol withdrawal. Using national administrative data from the Department of Veterans Affairs, we compared the differences among these medications in time to rehospitalization after discharge from an index hospitalization for alcohol dependence. Our outcome measure was the difference in time (weeks) to rehospitalization for patients given medications in 1 of 4 groups: quetiapine alone (median, 6.1 weeks); trazodone alone (median, 10.1 weeks); quetiapine combined (median, 7.1 weeks); and trazodone combined (median, 10.3 weeks) with other frequently used psychotropic drugs. Differences between groups were examined with Cox's proportional hazards regression using trazodone in combination with other medications as the reference category. Crude hazard ratios were determined first and then adjusted for covariates. There was no difference in the risk of rehospitalization when patients using quetiapine in combination were compared with the reference category (hazard ratio [HR] = 1.08; confidence interval [CI], 0.99-1.17; P < 0.0936). In contrast, when quetiapine was used alone there was a significantly higher risk of rehospitalization (HR = 1.22; CI = 1.06-1.41; P < 0.005). When trazodone was used alone there was no difference in risk in the unadjusted analysis (HR = 1.05; CI = 0.96-1.14; P < 0.3076); however, the HR increased to a significant level after adjusting for covariates (HR, 1.14; CI = 1.05-1.24; P < 0.0029) and for those with 2+ previous discharges (HR = 1.25; CI = 1.14-1.37; P < 0.0001). These findings suggest the need for additional studies to better understand what symptoms of alcoholism benefit from the use of these medications, at what dose levels, and with what other medication combinations.

Assessing health care organizations' ability to implement screening, brief intervention, and referral to treatment.

Abstract: Objectives: To determine if a new measure of organizational readiness for change reflects site and staff role differences when implementing a screening, brief intervention, and referral to treatment (SBIRT) program for alcohol and drug misuse in a healthcare organization. Sample: One hundred forty-one Community Health Program (CHP) and 45 Emergency Center (EC) respondents completed the survey. Methods: Medical and ancillary staff from a Level 1 trauma hospital EC and 3 CHP clinics within a large, urban, publicly funded health-care system were asked to complete the 45-item Medical Organizational Readiness for Change (MORC) survey 5 to 7 months after the start of implementation planning. One-way ANOVAs compared the 4 sites’ responses and independent t tests compared the clinical versus administrative staff responses on 8 MORC scales. Results: There were statistically significant differences between the EC and CHP sites on Need for External Guidance, Pressure to Change, Organizational Readiness to Change, Workgroup Functioning, Work Environment, and Autonomy Support. Clinical and administrative staff differed significantly on Need for External Guidance, Pressure to Change, and Organizational Readiness to Change. When change agents used the MORC data to inform their implementation process, the results were positive. Conclusions: Among CHP sites, there were differences in organizational functioning, which were consistent with CHP implementation outcomes. The MORC scales can help planners and change agents understand their organization’s current readiness to integrate screening, brief intervention, and referral to treatment services into their medical setting.

Patterns of health care utilization for asthma treatment in adults with substance use disorders.

Abstract: OBJECTIVES: : National goals for improving asthma outcomes include decreasing emergency room utilization and increasing adherence to outpatient treatment guidelines. Few studies have examined the impact of substance use disorders on asthma treatment. The objective of this study was to describe correlations between substance use disorders and patterns of healthcare utilization for asthma care. METHODS: : We performed a retrospective analysis of 1999 Medicaid claims for adults with asthma from 5 states. Adjusted odds of receiving asthma treatment in outpatient, inpatient, and emergency settings were calculated for patients with substance use disorder (SUD). RESULTS: : Consistent patterns emerge demonstrating significantly lower odds of utilization of outpatient services for asthma in patients with SUD. A trend toward increased utilization of acute care resources was observed, with odds of emergency care for asthma significantly increased in New Jersey (odds ratio [OR], 1.14; 95% confidence interval [CI], 1-1.31) and Georgia (OR, 1.24; 95% CI, 1.04-1.48), and odds of inpatient care for asthma significantly increased in Georgia (OR, 1.42; 95% CI, 1.03-1.95). CONCLUSIONS: : Substance use disorders are associated with decreased odds of receiving outpatient care and equivalent or increased odds of receiving emergency and inpatient care for asthma. Consequently, outpatient-based strategies to improve asthma care may have a very limited impact for this population. Identifying asthma patients with SUD in acute care settings and enhancing the care they receive in these settings may be necessary to improve adherence to treatment guidelines and decrease utilization in this population.

Screening pregnant young adults for alcohol and drug use: a pilot study.

Abstract: This study ascertained the feasibility of offering a self-report alcohol and drug screen embedded in a general health habits survey to patients attending the Young Adult Reproductive Medicine Clinic and compared those who screened positive for a substance use problem with those who did not An anonymous convenience sample of 100 young adults completed the Health Habits Survey, which included the CRAFFT screening test, designed specifically to identify substance-related problems in adolescent populations and recently recommended as a potential tool to reduce adverse outcomes from prenatal alcohol exposure Eighty of the 100 respondents were pregnant and younger than aged 25 years, and they are the focus of the study With a mean age of 182 years and 235 weeks gestation, most were single (75%) and had a high school education or less (75%) The majority (81%) was CRAFFT screen negative, but 15 answered yes to at least 1 CRAFFT question There were no systematic differences between those with positive or negative CRAFFT screens The CRAFFT, when embedded in a general health habits survey, seems to be a feasible option for pregnant young adults, but further studies to assess reliability, sensitivity, and specificity are recommended

Screening, brief intervention, and referral to treatment for adolescents: companion clinical case.

Abstract: T clinical case presentation which is synthesized from the authors’ clinical experiences, discusses a health maintenance visit for a 16-year-old boy. On routine screening, his pediatrician identifies that he is using marijuana and at times driving after smoking. Two expert clinicians discuss the challenges of managing adolescents and when and how to risk the therapeutic relationship by breaking confidentiality.

A randomized trial of extended buprenorphine detoxification for opioid dependency.

Abstract: Objective:The objective of this study was to determine whether additional “take-home” medication after inpatient opioid detoxification would lead to improved rates of subsequent treatment initiation and abstinence.Methods:We randomly assigned 60 inpatients to a 7-day or 37-day extension of sublingua

Pregnancy complicated by opiate addiction and fetal growth restriction.

Abstract: This case describes recovery of fetal growth restriction in utero after treatment for opiate addiction with the long-acting agent methadone. It is followed by discussions by an addiction medicine specialist followed by a maternal-fetal medicine specialist.

Transdermal nicotine administration and the electroencephalographic activity of substance abusers in treatment.

Abstract: OBJECTIVES It is widely recognized that individuals with alcohol or illicit substance abuse disorders often smoke cigarettes. However, few studies have examined the direct effects of nicotine among substance abuse subgroups. The current study examined patterns of electroencephalographic (EEG) activity in alcohol-dependent (AD), stimulant-dependent (StimD), alcohol- and stimulant-dependent (ASD) participants, as well as community controls (CC). All participants were regular smokers. METHODS After overnight nicotine abstinence, subjects were administered either a high (14 or 21 mg) or low (7mg) dose transdermal nicotine patch. EEG data were collected during a 2 minute eyes open and 5 minute eyes closed baseline recording session, which occurred as part of a larger study of brain electrophysiology. RESULTS The most interesting finding was a differential pattern of nicotine dose effects by group. EEGs of Controls and ASD participants did not distinguish between high and low nicotine doses; whereas, nicotine administration in the AD and StimD groups resulted in opposite findings across a range of spectral bands. CONCLUSIONS Although further research is warranted, these results may have implications for the study of smoking cessation and attentional functioning among substance abusers in treatment. These data suggest that nicotine-related changes in neurophysiology may be associated with specific brain areas and/or specific drug histories and reinforce the need for caution in generalizing among such groups.

A retrospective sibling study of childhood adjustment in adults with substance use disorders.

Abstract: PURPOSE : Research has suggested that people who develop serious substance use disorders have delinquent traits as children before using any illicit drugs. This study was designed to retrospectively identify differences in antisocial and delinquent behavior between siblings discordant for serious substance use disorders. METHODS : A retrospective survey was conducted of 50 pairs of adult siblings who were discordant for serious substance use disorders. The self-report early delinquency scale (SRED) was used to retrospectively assess delinquent traits in childhood and adolescence. RESULTS : The mean SRED 29 (illegal item) score in treatment seeking opiate-dependent people (mean age = 33.5 years) was 19.6 (standard error [SE] = 0.9) compared with 4.8 (SE = 0.6) in same-sex, nonsubstance-dependent siblings (P < 0.0001; paired Wilcoxon test). The mean SRED 58 (norm violation) score in treatment seeking opiate-dependent people was 36.8 (SE = 1.7) compared with 10.5 (SE = 1.4) in same-sex siblings (P < 0.0001; paired Wilcoxon test). Forty percent of patients were expelled from school compared with 12% of siblings (Yates-corrected χ = 8.78; P = 0.003). Ninety-six percent of patients reported problems with the police as adolescence compared with 48% of controls (Yates-corrected χ = 26.24; P < 0.0001). Police problems in substance users predated first use of illicit substances by 5.5 years. CONCLUSIONS : The study used a validated instrument and objective reports to confirm significantly higher rates of delinquent behavior and social dysfunction in childhood for substance users compared with nonsubstance-dependent siblings. The delinquent behaviors usually predated serious substance misuse.