Showing papers in "Journal of Psychoactive Drugs in 1997"

Ketamine Psychedelic Therapy (KPT): A Review of the Results of Ten Years of Research

Abstract: Ketamine is a prescription drug used for general anesthesia. In subanesthetic doses, it induces profound psychedelic experiences and hallucinations. The subanesthetic effect of ketamine was the hypothesized therapeutic mechanism in the authors' use of ketamine-assisted psychotherapy for alcoholism. The results of a controlled clinical trial demonstrated a considerable increase in efficacy of the authors' standard alcoholism treatment when supplemented by ketamine psychedelic therapy (KPT). Total abstinence for more than one year was observed in 73 out of Ill (65.8%) alcoholic patients in the KPT group, compared to 24% (24 out of 100 patients) of the conventional treatment control group (p<0.01). The authors' studies of the underlying psychological mechanisms of KPT have indicated that ketamine-assisted psychedelic therapy of alcoholic patients induces a harmonization of the Minnesota Multiphasic Personality Inventory (MMPI) personality profile, positive transformation of nonverbalized (mostly unc...

Effects of alcohol and other drugs on children.

Abstract: Children are affected by alcohol and other drug use along three primary paths: in utero through the mother's use, environmentally through both family and community influences, and through their own use. Children who are prenatally exposed are put at risk both through physiological insults and through caregiving deficits in their immediate family. The number of cases of Fetal Alcohol Syndrome (FAS) in the western world has been estimated at 0.33 cases per 1,000 live births; 200 babies are born with FAS per year in California. The National Institute on Drug Abuse (NIDA) estimates that 7.62 million babies (18.6%) were exposed to alcohol during gestation. Current prevalence estimates show about 28.6 million children of alcoholics in the United States, while in California it is estimated that about 17.6% of children lived with a parent who used illegal substances during the past year. Although all the prenatal effects of alcohol are not known, it is clear that there is no safe amount of alcohol to be consumed during pregnancy. There is little consensus, however, on long-term effects from in utero exposure alone because of the influence of adverse environmental factors; prenatal exposure is usually not the final influence, but is reinforced by years of neglect, deprivation, negative behavioral models, and other adverse conditions. And although society places most emphasis upon the negative effects of illicit substances, use of alcohol is strongly associated with crime and family violence. The consequences of use of alcohol and tobacco are more costly to society in terms of health care, accidents, days of work lost, and other social costs.

The heroin epidemic in New York City: current status and prognoses.

Abstract: Since 1989, heroin production worldwide has risen; in New York City, as its purity rose and prices fell, street-level markets were restructured and offered heroin in addition to cocaine and crack (which had been popular during the 1980s). While officials estimate that there are between 500,000 and one million hard-core, chronic heroin users nationwide, evidence of supplemental users heralding another heroin era includes: more overdoses and overdose deaths, greater demand for treatment, larger seizures of heroin at all levels of distribution and related arrests, and broader media coverage. In this article, the authors describe the characteristics of populations in which there may have been a percentage increase of new users, such as young middle- or upper-class European-Americans, young Puerto Ricans and recent Haitian and Russian immigrants. The abstinence of young African-Americans is also noted. The article ends with a preliminary needs assessment of the new users in the areas of health (including AIDS), housing, employment, treatment, arrest and imprisonment.

Services for Perinatal Women with Substance Abuse and Mental Health Disorders: The Unmet Need

Abstract: Dual diagnosis refers to the co-occurrence of substance abuse and mental illness, which may take many forms. Women who abuse alcohol or drugs are more likely than men to be diagnosed with a psychiatric disorder, particularly depression or personality disorder. The interaction of pregnancy, addiction, and mental illness creates complex needs that often go unrecognized by treatment providers. Clinical issues concern adequate prenatal care, use of medications while pregnant and/or nursing, maternal bonding, and coordinated treatment planning among medical, addiction, and mental health treatment providers. Barriers to service delivery to perinatal substance-abusing women with a mental illness include the difficulty in diagnosing a dual disorder, child care and custody concerns, lack of health insurance or funds to pay for treatment, and the stigma associated with mental illness and addiction. Services currently available for the dually diagnosed are typically fragmented and uncoordinated and provision of those services is often hampered by philosophical differences, categorical funding, competition for scarce resources, inadequate staff training, and lack of a central administrative authority or mandate. Several models have been suggested that coordinate services for the dually diagnosed. Awareness of the service needs of dually-diagnosed perinatal women must be included within these models and integrated at all levels of the treatment system.

The Minnesota Model.

Abstract: (1997). The Minnesota Model. Journal of Psychoactive Drugs: Vol. 29, PIONEERING TREATMENT AND RECOVERY MODELS, pp. 141-144.

Integration of Treatment and Posttreatment Variables in Predicting Results of Abstinence-Based Outpatient Treatment After One Year

Abstract: A multi-site, longitudinal study of patients undergoing outpatient alcohol and drug dependence treatment was conducted in private outpatient facilities, consisting of 2,029 subjects from 33 independent programs enrolled in a national addiction treatment outcomes registry. Pretreatment demographic and substance variables, treatment utilization variables, and post-treatment continuum of care variables were examined simultaneously in a multivariate prediction context for association with outcome. Upon admission patients provided history information to treatment staff trained in the collection of data for the evaluation efforts. Trained interviewers conducted consecutive structured interviews prospectively for treatment outcome at six- and 12-month follow-up periods. Multivariate analysis with stepwise multiple regression indicated that, relatively speaking, the most powerful predictors of treatment outcome were posttreatment variables: namely, support group attendance and involvement in a continuing care program. Pretreatment and treatment variables contributed proportionately little to the prediction of outcome. Additional sequential-stage analysis showed that the incremental contribution to prediction by posttreatment attendance at Alcoholics Anonymous and involvement in a treatment program following discharge far exceeded the initial predictive validity of the 14 pretreatment and treatment variables examined. Participation in posttreatment continuing care correlated with statistically significant reductions in job absenteeism, inpatient hospitalizations, and arrest rates. Posttreatment more than pretreatment factors may be decisive in influencing risk for relapse.

Set, Setting, and Matrix

Abstract: The future use of psychedelics as an aid to therapeutic change is bound to come. The best source of information on how to use these extraordinary drugs is clearly a detailed description of the successes (and failures) of those researchers who have used these compounds to bring curative, creative and growth-potentiating experiences to their patients. A study of their work is recommended in order to identify those elements that lead to successful sessions. Two known essential elements are “set,” which involves the personality and expectations of the patient, and “setting,” which has to do with the environment of the session. A third element of importance is that of “matrix,” which includes consideration of the environment (1) from which an individual comes, (2) in which the individual lives during the time of the sessions, and (3) to which the individual returns after successful therapy—the everyday living space; these three elements are discussed.

Use of Drugs Among Street Children in Brazil

Abstract: The purpose of this study has been to assess drug consumption among children in five Brazilian state capitals during 1993. The sample was composed of street children who were given assistance in in...

Psychopharmacological treatment of aggression and violence in the substance using population

Abstract: Advances in our knowledge of the neurobiology of aggression and violence has given rise to rational pharmacological treatments for these behaviors. The main biological systems which are known to be involved are the neurotransmitters serotonin, norepinephrine, and gamma-aminobutyric acid (GABA), and electrophysiological activity in the brain. Abnormal functioning of these systems may also be complicated or caused by abuse of various psychoactive substances, particularly alcohol and stimulants. Adding further to this interaction is the high incidence of psychiatric disorders in the substance-using population, providing other behavioral influences and accompanying neurobiological dysregulation. Understanding of the interaction of these components has led to success in the treatment of aggressive and violent behaviors using selective serotonin reuptake inhibitors (SSRI's), lithium carbonate, beta-adrenergic blockers, anticonvulsants, anxiolytics, neuroleptics, and novel agents such as anti-androgens and serenics.

Perspectives of pregnant substance-using women: findings from the California Perinatal Needs Assessment

Abstract: This article reports on selected major findings of a study on alcohol and drug use patterns and problems and unmet service needs, drawing on interview data from a sample of substance-involved pregnant women who were clients at public health, social service, and criminal justice agencies in two California counties. Based on screening rates, a sizable group of pregnant agency clients regularly used alcohol and other drugs, particularly marijuana and cocaine, and most of these users had not been in substance abuse treatment. Reported use of alcohol and other drugs diminished considerably during pregnancy. Negative consequences of alcohol and drug use, problems with family and friends' substance use, neighborhood alcohol and drug problems, and substance-related violence were widely experienced. The greatest service needs include job placement, educational programs and housing. Prenatal health care was widely received, although often inconsistently or late in the pregnancy. Despite high treatment satisfaction among those in recovery programs, relatively few women desired formal treatment. These findings, which are consistent with those of other recent studies, suggest the complexity of problems and needs among substance-involved, low-income pregnant and parenting women.

The Role of Case Management in Substance Abuse Treatment Services for Women and Their Children

Abstract: Given that addiction is a chronic, relapsing disease, ongoing support services are considered a crucial part of preventing relapse and assisting clients in building the foundation for a drug-free life. Building on the substantial history of case management services with other at-risk client populations, drug treatment programs have begun to integrate case management services as an effective, cost-efficient method of delivering coordinated care. This article summarizes what managed care is, describes three conceptual models, discusses the primary functions of case management, and reviews various programs that have used case management for chemically dependent women and their children. Also included is a presentation of the results of a survey of 46 case managers involved in seven pilot sites of California's Options for Recovery (OFR) treatment program, which combines case management and drug treatment. More than 50% of the respondents had worked as case managers previous to joining OFR. Approximat...

Party subculture or dens of doom? An epidemiological study of rave attendance and drug use patterns among adolescent students.

Abstract: Based on 1,853 questionnaires derived from adolescent students participating in the 1995 Ontario Student Drug Use Survey, this article describes the prevalence of rave attendance and the drug-use profile of rave attendees and those participating in similar activities (i.e., bush parties). The results showed that 13% of the sample attended a rave during the 12 months before the survey. Although rates of drug use were higher among rave attendees than nonattendees, differences were more related to participation in other recreational activities. The drug-use pattern for one-third of rave attendees (those who did not attend similar activities, i.e., bush parties) was not dramatically different from those who attended bush parties only. However, for two-thirds of rave attendees, drug use was significantly elevated. Although rave attendance is not prevalent, experienced drug users are attracted to raves, as earlier generations of drug users were attracted to rock concerts. Consequently, although the siz...

Violence, Trauma and Substance Abuse

Abstract: A review of the relevant literature concerning posttraumatic stress disorder, violence, domestic violence suggests that violent behavior, trauma, and substance abuse have a substantial connection; it also suggests that shame is a powerful agent for rage. Shame permeates many levels of society; the individual, the family, institutions and the community. The policies of the criminal justice system are directed towards promoting more shame in a population that has been saturated with shame in the many levels of the culture. Attention is focused on the role of alcohol and other drug use in the cycle of violence. Violent behavior, violent individuals, and victims of violence are deeply affected—emotionally, physically, politically, and spiritually—by drug use. This suggests that any program designed to promote healing violent behavior, for victims and/or perpetrators, should include attention to each of these spheres. This article describes a program that I have developed in the San Francisco City and...

The Incidence and Experience of Rape Among Chemically Dependent Women

Abstract: This descriptive study investigated the incidence and experience of rape among chemically dependent women. Sixty women in a residential treatment facility were interviewed about sexual trauma they had experienced in their lives. In this sample 73% had been raped, and 45% had been raped more than once. The stories of rape were classified in five categories: raped while in the context of using, when too high to resist, while prostituting, by a significant other, and by a family member. Some 35% of the rapists described were friends of the women with whom they were using drugs. Only 20% of the rapes were reported to the police. Clinical implications for treatment of addicted women who are also survivors of violence is discussed.

When is Domestic Violence a Hidden Face of Addiction

Abstract: This article reviews studies that address the comorbidity of domestic violence, addictive disorders, and sexual abuse, and presents a model in which domestic violence parallels the chief features of chemical dependency. Domestic violence and addictive disorders share a number of behavioral features, including loss of control, continuation of behavior despite adverse consequences, preoccupation or obsession, development of tolerance, and family involvement. Domestic violence predisposes the next generation to both domestic violence and addictive disorders. Sexual abuse within the family of origin and/or the couple relationship is a common feature of both domestic violence and substance addiction, and predisposes to both disorders in the next generation. Clinicians encountering patients who are perpetrators or victims of domestic violence or sexual trauma, or have addictive disorders, must assess for the presence of comorbid problems.

Drugs and violence among Ontario students.

Abstract: In this research the links among violence and nonviolent delinquency and the use of alcohol and other drugs were investigated. The data were derived from the 1995 Ontario Student Drug Use Survey, a cross-sectional probability survey of Ontario students in grades seven, nine, 11 and 13 (n = 3,870). Students were classified into four groups: those who reported engaging in no delinquency, those who reported violent delinquency only, those who reported nonviolent delinquency only, and those who reported both violent and nonviolent delinquency. As expected, individuals who reported violent delinquency also reported the most frequent use of cocaine and amphetamine. The association of violent delinquency with alcohol use was not as strong as expected; nonviolent delinquents reported the most frequent use. Language: en

California's Approach to Perinatal Substance Abuse: Toward a Model of Comprehensive Care

Abstract: In the late 1980s and early 1990s there was a growing awareness of the many health, social, psychological, treatment, and recovery needs of pregnant and parenting women and their drug-exposed children. This awareness sensitized policymakers and service providers to the necessity for women-centered programs. Many points of intervention, from primary prevention to treatment of drug dependence, are required to adequately respond to the various needs of this heterogeneous population; a comprehensive women-centered model of care is required that includes health, social. and personal support services. In addition, programs are neededthat are aimed at the prevention and treatment of use, abuse, and addiction to alcohol and tobacco, which are dangerous to women's health and birth outcomes and responsible for more costs to society than are associated with use of illicit drugs. The existing system of social services and health care has been fragmented and uncoordinated in responding to substance-abusing wo...

Methadone maintenance treatment: The first thirty years.

Abstract: (1997). Methadone Maintenance Treatment: The First Thirty Years. Journal of Psychoactive Drugs: Vol. 29, PIONEERING TREATMENT AND RECOVERY MODELS, pp. 149-153.

Prenatal substance abuse in California: findings from the Perinatal Substance Exposure Study.

Abstract: This article reports the overall statewide findings of an epidemiological study that included 29,494 pregnant women who had been admitted for delivery in more than 200 hospitals in California and who were tested for alcohol and other drugs via blind urine toxicology screens. Results were matched to demographic data. The article includes analysis and discussion of four major variables: race/ethnic group differences, acculturation, source of payment for birth, and prenatal care status. Regional results are also discussed. The authors emphasize the high rate of alcohol use and self-reported tobacco use in comparison to relatively low rates of illicit drug use. Alcohol use rates were fairly stable, while use of illicit drugs and tobacco tended to vary according to social and demographic variables. The findings establish the need for both broad-based and targeted prevention and intervention programs to better disseminate the risks involved in drinking alcohol, smoking tobacco, and using drugs during pregnancy.

Integration in Education for Addiction Medicine

Abstract: Addiction to alcohol and other drugs is a serious public health problem that is one of the most common disorders seen in medical practice. Although it is an extremely common disorder, it is poorly diagnosed and treated by physicians. In order to begin to develop an integrated approach to education and addiction, one must define the many roles of the physician working with addicted patients. Training about addictions must begin early in the medical student's career, and continue in a vertically integrated way throughout medical school. The notion of addiction as a disease process must be introduced and integrated into course materials in the preclinical years. Careful attention must be paid to the development of positive views toward working with addicted patients. and students must be indoctrinated early with the idea that physicians have a responsibility to diagnose and manage addicted patients. Students should be given multiple opportunities to learn and use screening interviews for addiction i...

Options for Recovery: California's perinatal projects.

Abstract: In response to the increasing magnitude of problems related to perinatal exposure to alcohol and other drugs, a novel interagency collaboration was formed that involved the California Departments of Alcohol and Drug Programs, Developmental Services. Health Services, and Social Services. This collaboration was named Options for Recovery (OFR). Its mission was to promote the recovery of pregnant, postpartum, and parenting chemically dependent women and the enhancement of the health of their children by providing comprehensive and coordinated alcohol and other drug treatment, case management, and recruitment and training of foster parents and relative caregivers. Seven OFR pilot projects were selected. Findings from the three-year evaluation of the pilot projects showed that the initiative was successful in connecting women with essential services, promoting perinatal recovery and child health, and increasing family reunification of children in foster care. Women who were most likely to complete alcohol and other drug treatment were younger, high school graduates, mandated to treatment, or those who participated in treatment 150 days or more. Participants reported high levels of satisfaction with OFR. The findings indicate that OFR served the unique needs of high-risk perinatal populations. Future efforts should try to reach women early in their pregnancies and should provide a wide array of alcohol and other drug treatment approaches that are responsive to the myriad needs of women and their children.

Temporal patterns of veterans' psychiatric service utilization, disability payments, and cocaine use.

Abstract: This study examined temporal patterns of service utilization, disability benefits, and substance use. Specifically, it investigated whether the first day of the first week of each month (when disability payments are disbursed) was associated with increased emergency room (ER) use and more frequent cocaine use among psychiatric patients. All 1993 psychiatric ER presentations (n=1,448) at a Veterans Administration hospital were reviewed in order by the week of each month in which they occurred. A random subsample of only those admitted to an inpatient psychiatric service (n=143) was further assessed for amount of disability payments received and recent cocaine use. This study found that for the total population of patients utilizing the ER, most ER visits occurred during the first week, followed by weeks two, three, and four respectively. The highest percentage (49%) of patients who used cocaine were those admitted during the first week of the month, followed by week two (39%), week four (28%) and week three (25%). For the subsample of patients admitted to inpatient services, patients hospitalized during the fourth week of the month were those receiving the highest disability payments. This study found that cocaine users have the most ER visits during the first week of the month following receipt of benefits. Current data, if confirmed, would suggest public policy changes, such as payment of entitlement money to cocaine users through a third-party payee and stipulated treatment for psychiatric patients with substance use disorders as a condition of payment. Ethical and political issues, including confidentiality and patient autonomy, would need to be considered in any such policy changes.

The angry patient : An intervention for managing anger in substance abuse treatment

Abstract: Patients who have problems controlling anger and aggression can pose special problems for substance abuse treatment providers. Levels of anger and violence are higher in substance abusers than in the general population. Although anger management treatments have been studied extensively, few treatments have been developed and studied with substance abusers. In this article, we evaluated an anger management treatment based on Novaco's (1983) cognitive-behavioral stress inoculation procedures. The treatment was delivered as individual sessions and evaluated in a study of six substance abuse patients with a single-subject multiple-baseline design. Preliminary findings suggest that the treatment is effective for substance abuse patients and that this mode of treatment should be explored further.

Motivational factors in cocaine pharmacotherapy trials with methadone-maintained patients: problems and paradoxes.

Abstract: Pharmacotherapy trials for cocaine abuse among methadone-maintained patients have typically reported negative findings as well as high rates of cocaine use during the trial. The contribution of motivational factors to these results is a potentially important, underinvestigated area. This article points out that some methadone-maintained patients may enter a trial for cocaine abuse with little desire for treatment, motivated primarily to continue receiving methadone or to avoid program sanctions for continued cocaine use. Participation in clinical trials may constitute a phase delaying discharge in a cyclic pattern of multiple treatment episodes. Testing a pharmacologic agent in a motivationally inappropriate sample may not provide a good estimate of the agent's effectiveness. In view of the important public health role that methadone maintenance programs play in preventing HIV transmission, and the subversion of this role by intravenous cocaine use, solutions to these problems are urgently needed...

The integration of pharmacological therapy for comorbid psychiatric and addictive disorders.

Abstract: The integration of pharmacological therapies for comorbid disorders requires an acceptance of independence and interactions of respective addictive and psychiatric disorders. At the same time, alcohol and other drugs induce psychiatric states that are indistinguishable from psychiatric disorders. On the other hand, while psychiatric disorders do not induce addictive use of alcohol and drugs, they do pose vulnerabilities to the development of addictive disorders. Generally, the treatment of comorbid disorders begins with abstinence and evaluation of the effects of alcohol and other drugs in contributing to the psychiatric picture. In the case of comorbid disorders, stabilization and standard treatments can be employed with certain cautions. namely, to avoid the use of addicting medications such as benzodiazepines and opiates beyond the detoxification stage. High potency neuroleptics and antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) can be used to treat continuing ps...

Addiction medicine and continuing medical education

Abstract: Addictive disorders are one of the most common problems encountered by primary care physicians. In the last decades there has been a significant effort by organizations, universities, and private foundations to increase the teaching of alcohol and drug abuse issues to medical students, residents and practitioners. Still, up to now, the subject has not been presented appropriately at either the undergraduate or graduate medical education level and the majority of physicians in practice have not been adequately instructed in addiction medicine. This article reviews the literature on addictive disorders and medical education, exploring issues concerning continuing medical education (CME) in particular. The authors discuss the problems relative to this subject and the educational techniques and methods most appropriate to changing attitudes and behaviors of physicians. They also design an approach to a CME program on addictive disorders for primary care physicians that incorporates multiple teaching/...

The integration of medical management with recovery.

Abstract: Patients recovering from alcohol and other drug addiction have unique medical and pharmacological needs. Careful selection of medications can decrease the risk of relapse. Angiotensin-converting enzyme inhibitors and calcium channel-blocking medications are excellent choices to treat hypertension. Most gastrointestinal problems resolve with abstinence and can be treated nonpharmacologically. In managing pain, physicians should avoid narcotics and use nonpharmacological treatment whenever possible. Treating recovering patients with HIV can be challenging because of the side effects of many of the antiviral medications. The newer antiviral agents have fewer side effects and contraindications. Commonly used remedies for colds and cough can cause a relapse to drug use. Patients with diabetes mellitus need to be monitored very closely in early recovery to prevent hypoglycemia. Frequently a team approach is helpful in managing the medication needs of patients in recovery.

Visualizing the Firestorms in the Brain: An Inside Look at the Clinical and Physiological Connections Between Drugs and Violence Using Brain SPECT Imaging

Abstract: The connection between drugs and violence has been well documented. Understanding the intricacies of this connection is essential to finding effective interventions. Much has been written about the psychosocial causes of these problems, but there have been few studies exploring the biophysiological interface between drug effects, violent behavior and brain metabolism. Over the past eight years, The Amen Clinic has been extensively involved in the clinical use of brain SPECT imaging to evaluate complicated neuropsychiatric problems, especially related to the issues of both violence and substance abuse. From this work several clinical patterns. as well as brain SPECT imaging patterns, have been recognized that may help further our understanding of these problems. In this article, following a brief review of the literature on drugs, violence and the brain. five clinical examples are explored; the authors show how these support the clinical utility of incorporating SPECT imaging into psychiatric asse...

Alcohol and other drugs: the scope of the problem among pregnant and parenting women in California.

Abstract: This introductory article provides background information on America's experience with the use and abuse of alcohol and other drugs (AODs). Following a brief history, the article presents findings from recent large-scale studies of patterns and consequences of AOD use, including a focus on trends among women and costs of the consequences of AOD use. This article also introduces the subjects to be discussed in later articles of this issue.