Showing papers in "Journal of Psychoactive Drugs in 1999"
TL;DR: The 1967 Holmstedt-Lindgren hypothesis of the ayahuasca effect--oral psychoactivity of DMT consequent to monoamine-oxidase (MAO) inhibition from simultaneous ingestion of beta-carbolines--has been confirmed by eight self-experimenters.
Abstract: A summary is presented of human self-experiments or psychonautic bioassays of pharmahuasca--capsules containing crystalline N,N-dimethyltryptamine (DMT) plus harmine, as well as combinations of other psychoactive tryptamines with other beta-carbolines. The 1967 Holmstedt-Lindgren hypothesis of the ayahuasca effect--oral psychoactivity of DMT consequent to monoamine-oxidase (MAO) inhibition from simultaneous ingestion of beta-carbolines--has been confirmed by eight self-experimenters. Results of a total of some 70 bioassays are summarized and the literature on this subject is reviewed (with 66 references and one table).
110 citations
TL;DR: D doses of methadone in excess of 100 mg/d are not only safe but necessary to prevent illicit opiate use, stabilize psychiatric symptoms, and diminish abuse of alcohol and benzodiazepines in many patients.
Abstract: Using signs, symptoms and serum methadone levels to guide evaluation, the authors treated 164 patients in a methadone maintenance program with doses of methadone exceeding 100 mg/d. The mean dose of these higher dose (HD) patients was 211 mg/d (range 110-780 mg/d). A comparison group (C) of 101 patients was randomly selected from the general clinic population (mean dose 65 mg/d). At intake the HD group reported $153/day of heroin use versus $87/day in the C group. The HD group had more patients whose opiate of choice was an oral pharmaceutical (30% versus 2% of the C group). Sixty-three percent of the HD group had comorbid Axis I psychiatric diagnoses compared to 32% of the C group. Response to psychopharmacologic treatment was enhanced by increased methadone dose in HD patients with "refractory" psychiatric disorders. Urine toxicologies described as "before" were collected prior to increase over 100 mg/d in the HD group or at the first routine urine toxicology collection of the calendar year for the C group. These results were compared to the most recent urine toxicologies for both groups ("after"). The percentage of toxicologies positive for illicit drugs in the HD group dropped from 87% "before" to 3% "after". The C group were 54% positive "before" and 37% positive "after". We conclude that doses of methadone in excess of 100 mg/d (range 110-780 mg/d in our sample of 164 patients) are not only safe but necessary to prevent illicit opiate use, stabilize psychiatric symptoms, and diminish abuse of alcohol and benzodiazepines in many patients.
83 citations
TL;DR: It was found that later news stories about crack cocaine were generally less blatant, but overall did not correct for previous exaggerations, and revealed an insidious bias in news coverage through its focus on the inner city, in spite of broader use of crack.
Abstract: Early news coverage of the rapid expansions and horrors associated with use of crack in the mid-1980s led to a great panic. Scholarly research subsequently debunked the various myths emanating from this media scare. This article examines whether this expanded understanding was reflected in the quality of news coverage over time through a comprehensive examination of all articles about crack cocaine appearing in the New York Times, Time, and Newsweek from 1985 through 1995. It was found that later news stories were generally less blatant, but overall did not correct for previous exaggerations. The long-term perspective also revealed an insidious bias in news coverage through its focus on the inner city, in spite of broader use of crack. This misleading view of "the problem" constructed by the media probably helped divert attention from persistent structural problems facing the inner-city. Scholars and activists need to continue their efforts to focus attention on the underlying social problems to counteract the media's propensity to focus on what might more appropriately be termed symptoms, such as the "crack epidemic."
72 citations
TL;DR: This study followed up on 25 male patients aged 16 to 28 who were strongly addicted to crack, as diagnosed through the Composite International Diagnostic Interview (CIDI), according to CID-10 and DSM-IV diagnostic criteria, and found that the use of cannabis reduced their craving symptoms, and produced subjective and concrete changes in their behavior, helping them to overcome crack addiction.
Abstract: This study ensued from clinical observations based on spontaneous accounts by crack abusers undergoing their first psychiatric assessment, where they reported using cannabis in an attempt to ease their own withdrawal symptoms. Throughout a period of nine months, the researchers followed up on 25 male patients aged 16 to 28 who were strongly addicted to crack, as diagnosed through the Composite International Diagnostic Interview (CIDI), according to CID-10 and DSM-IV diagnostic criteria. Most of the subjects (68%, or 17 individuals) ceased to use crack and reported that the use of cannabis had reduced their craving symptoms, and produced subjective and concrete changes in their behavior, helping them to overcome crack addiction. The authors discuss some psychological, pharmacological and cultural aspects of these findings.
68 citations
TL;DR: There is growing evidence that smoking, and in particular heavy smoking, is prevalent in Vietnam combat veterans with posttraumatic stress disorder, but the pathways responsible for development and perpetuation of smoking in this clinical population have been identified.
Abstract: There is growing evidence that smoking, and in particular heavy smoking, is prevalent in Vietnam combat veterans with posttraumatic stress disorder. However, the pathways responsible for development and perpetuation of smoking in this clinical population have not been identified. Relevant smoking, substance abuse, and anxiety disorder research is reviewed. Although an association between smoking and PTSD has not been directly tested, there is evidence that such research is warranted. Suggestions for future research are offered.
61 citations
TL;DR: Examination of issues for women with multiple vulnerabilities in a sample of 577 women participating in a residential substance abuse treatment program found there was an interaction between time in program and severe mental illness such that women with severemental illness who were retained for less than 180 days were more likely to demonstrate negative outcomes.
Abstract: Women diagnosed with severe mental illness and substance abuse may face a variety of associated difficulties that require intervention, including other health-related problems, housing instability or homelessness, and a history of or current physical or sexual abuse. This article expands upon the concept of "level of burden" by specifically examining issues for women with multiple vulnerabilities in a sample of 577 women participating in a residential substance abuse treatment program. Two types of outcomes were examined for the women. In Study 1, the effects of severe mental illness as well as overall level of burden on retention in treatment were examined. Cox regression analyses revealed that severe mental illness was significantly related negatively to retention in treatment; those women diagnosed with severe mental illness tended to stay in treatment less time than those without such a diagnosis. In Study 2, staff ratings of the women's status at departure from residential treatment for a subsample of 311 women were examined with respect to overall retention in treatment and severe mental illness. Ratings of client status at program exit were significantly related to time in program but were not related to having a severe mental illness diagnosis. For a few indicators (e.g., leaving treatment against advice, having scattered or disorganized thoughts, and having no specific plans for life outside of treatment), there was an interaction between time in program and severe mental illness such that women with severe mental illness who were retained for less than 180 days were more likely to demonstrate negative outcomes. Implications for the treatment of multiply-diagnosed women are discussed.
55 citations
TL;DR: Higher general intellectual, executive, and memory functioning were significantly related to greater scores in readiness to change substance abuse in this sample, suggesting cognitive ability may be an important variable to consider in the motivation and treatment of dually-diagnosed patients.
Abstract: Substance abuse has been associated with cognitive dysfunction, such as problems with attention, reasoning, and memory. Certain psychiatric disorders also have been associated with cognitive difficulties, thus placing dually-diagnosed patients at high risk for cognitive impairment that could interfere with successful entry into or completion of therapy. Twenty-two dually-disordered inpatients were administered the Brief Readiness to Change Questionnaire to measure levels of motivation to change substance use, and a neuropsychological test battery that included the Wechsler Adult Intelligence Scale-Revised (WAIS-R), the Halstead Category Test (HCT), and the Wechsler Memory Scale-Revised (WMS-R). Higher general intellectual, executive, and memory functioning were significantly related to greater scores in readiness to change substance abuse in this sample. Cognitive ability may be an important variable to consider in the motivation and treatment of duallydiagnosed patients.
45 citations
TL;DR: The findings indicate few differences between those with and without past histories of such abuse in terms of drug use, drug treatment and 12-Step program participation, criminality, income sources, intimate relationships, family functioning, and psychiatric symptoms.
Abstract: Individuals in drug treatment, particularly women, generally report high levels of past sexual and physical abuse. Although histories of sexual and physical abuse are associated with greater prevalence and severity of depression, anxiety, phobias, and interpersonal difficulties for individuals seeking substance-related treatment, several recent studies failed to show that prior sexual or physical abuse compromised short-term drug treatment outcomes. This study examined the possible effects of sexual and physical abuse on a wide array of behavioral domains over a two-year posttreatment period. The findings indicate few differences bet ween those with and without pasthistories of such abuse in terms of drug use, drug treatment and 12-Step program participation, criminality, income sources, intimatere lationships, family functioning, and psychiatric symptoms. There are specific exceptions, but they apply only to men. Overall, the findings indicate that the impact of sexual and physical abuse histori...
41 citations
TL;DR: This model has now been successfully introduced into mental health, drug treatment, shelter, and correctional settings and makes clear the feasibility of a modified TC model of established effectiveness with a MICA population.
Abstract: This article describes the main features of an innovative therapeutic community (TC) model adapted for use with mentally ill chemical abusers (MICAs). It describes the rationale for use of the modified TC with MICAs, the treatment structure and environment created, the essential components of the modified TC program, staffing, and the process and goals of client change. Details are given regarding issues and strategies for the implementation of the new program in terms of program planning, staff training, and system initiation. Evaluation data from the authors' research is summarized to support the adoption of the modified TC model. The article makes clear the feasibility of a modified TC model of established effectiveness with a MICA population. This model has now been successfully introduced into mental health, drug treatment, shelter, and correctional settings.
37 citations
TL;DR: The influence of education and recovery status on substance abuse treatment counselors' approach to patients was examined and working in residential programs was linked to a wider range of treatment goals and treatment practices.
Abstract: The goal of this study is to examine the influence of education and recovery status on substance abuse treatment counselors' approach to patients. Three hundred forty-four drug abuse and alcoholism treatment counselors were questioned about treatment goals. A subgroup of 197 were also questioned about treatment practices. The influences of education and recovery status on the choice of treatment goals and treatment practices were examined through structural modeling procedures. Level of education influenced neither treatment goals nor techniques. Being in recovery, however, was associated with more varied treatment techniques and a broader range of treatment goals. The other variable related to treatment goals and practices was treatment modality. Working in resi dential programs was linked to a wider range of treatment goals and treatment practices. Implications of these findings for counselor training and the movement to professionalize substance abuse treatment are discussed.
35 citations
TL;DR: The findings of DRUGNET have major implications for drug policy and indicate the need for further research on the majority of drug users, who may be expected to resemble this sample more than they do clinical populations of drug abusers.
Abstract: DRUGNET was a cross-sectional survey of adult recreational drug users (i.e., not abusers) via the World Wide Web of the Internet. The purpose of this survey was to provide a unique, broad description of nondeviant adult recreational drug users. The survey instrument had four divisions: demographic and lifestyle indices, drug use history, legal history and attitudes about drug issues, and the General Well-being Schedule (GWBS). Responses were received from 1,473 self-identified drug users. Of these, 567 completed only the first section, leaving 906 respondents who completed the entire survey. The typical respondent was a White male who was well educated, employed full-time, a participant in recreational and community activities, and who described his physical health status as good. Their mental health, as measured by the GWBS, was similar to the general adult U.S. population. Their drug-taking behavior appeared to be well-controlled, at mild to moderate levels in both frequency of use and degree o...
TL;DR: Findings from initial analyses examining correlates of 90-day dropout suggest a complex interaction among specific problems a woman brings to treatment, her level of dysfunction at treatment entry, how much social support is available to her, and what services she receives.
Abstract: The Salvation Army First Choice Program, located in Fort Worth, Texas, provides comprehensive-as well as gender-specific-treatment for addicted women while providing child care and therapeutic services for children Specific program attributes (including the rapeutic interventions, community linkages, and staffing patterns) are described, and the five-year evaluation initiative, designed to examine relationships between client characteristics, program participation, and client progress is outlined Findings from initial analyses examining correlates of 90-day drop out suggest a complex interaction among specific problems a woman brings to treatment, her level of dysfunction at treatment entry, how much social support is available to her, and what services she receives
TL;DR: The findings reveal that a shift is underway from traditional marijuana abuse to abuse of crack cocaine and heroin in greater Accra, and highlights the social relations that characterize this more dangerous drug setting and enhances the understanding of the psychiatric comorbidity of drug abuse, health, and behavior.
Abstract: This article represents a preliminary effort to describe drug abuse in Tudu, one of a number of neighborhoods in Accra that serve as drug centers. The problems of such neighborhoods reflect the drug problems that currently beset the rest of Ghana and Accra in particular. There is almost no fundamental current research on this issue. The few works cited comprise virtually the entire body of existing literature on this subject, and they fall far short of providing a comprehensive account of the changes that drugs have made in the social structure of the greater Accra region. This article is based on research done in the drug parlors and alleyways where the Tudu drug trade is conducted, and is a preliminary effort to redress the current lack of information by documenting the changing patterns of drug use in greater Accra. The findings reveal that a shift is underway from traditional marijuana abuse to abuse of crack cocaine and heroin. The article highlights the social relations that characterize this more dangerous drug setting and enhances the understanding of the psychiatric comorbidity of drug abuse, health, and behavior. These conclusions are derived from a multifaceted approach to data collection, taken to enhance the validity of research findings.
TL;DR: Mothers completing or still active in FRP had higher rates of abstinence and substantially lower average levels of cocaine in their hair at follow-up than those exiting prematurely, and completing or remaining active in the program were associated with less out-of-home placement at following-up.
Abstract: This article presents an outcome study of the Family Rehabilitation Program (FRP), a unique network of community-based programs in New York City that provides comprehensive services to families with drug-dependent parents, most caring for prenatally cocaine-exposed newborns. An admission sample of 173 mothers in 17 FRP sites was studied for one year; substance use was assessed by hair analysis and self-report. Mean length of retention was 10 months; half the clients were still active in the program at follow-up. Mothers completing or still active in FRP had higher rates of abstinence and substantially lower average levels of cocaine in their hair at follow-up than those exiting prematurely. The percent of families with children out of their homes did not increase significantly between admission and follow-up, and completing or remaining active in the program were associated with less out-of-home placement at follow-up.
TL;DR: A random survey of 1,200 psychologists indicated that most psychologists are to some degree involved in clinical practice with substance abusers, although most have no formal education or training in substance abuse.
Abstract: A random survey of 1,200 psychologists (with a 62% response rate) indicated that most psychologists (91%) are to some degree involved in clinical practice with substance abusers, although most have no formal education (74%) or training (54%) in substance abuse. Relevant recommendations are made.
TL;DR: A modified ACT Team approach to the treatment of individuals who suffer from severe comorbid mental illness and substance abuse is described.
Abstract: The Assertive Community Treatment model of mental health service delivery has been extensively studied and has undergone various modifications over the past twenty years. This article describes a modified ACT Team approach to the treatment of individuals who suffer from severe comorbid mental illness and substance abuse. Demographics of patients who are chosen to receive these intensive services, service utilization patterns, and elements of team treatment are discussed. Comparisons with less severely ill dual diagnosis patients who receive more traditional case management services are reviewed.
TL;DR: Lower socioeconomic clients who are coerced into alcohol treatment from the courts for non-DUI offenses, such as public inebriation, disorderly conduct, trespassing, assault, and theft are examined.
Abstract: An increasing number of individuals are being referred to alcohol treatment programs under coercion from the criminal justice system. While a substantial number of investigations have addressed coercive treatment for illicit drug-related offenses, fewer studies have focused on mandated treatment for alcohol-related problems. This article examines the treatment of two subgroups of clients coerced into alcohol treatment from criminal justice institutions. The article begins with an overview of the literature on clients coerced into treatment as a result of "driving under the influence" (DUI) charges. The characteristics of a subgroup that has received less attention are then described: lower socioeconomic clients who are coerced into alcohol treatment from the courts for non-DUI offenses, such as public inebriation, disorderly conduct, trespassing, assault, and theft. This subgroup of non-DUI coerced-treatment offenders depends primarily upon underfunded public services, although their treatment requires careful assessment and triage for multiple problem areas. The article addresses some potential political and economic roadblocks to comprehensive treatment and closes with questions and recommendations for further research.
TL;DR: A dual diagnosis typology was developed with three subtypes and was found to be reliable and have consensual validity; it increased staff interest in the dual disorder population and improved differential diagnoses and targeted interventions.
Abstract: A dual diagnosis typology was developed with three subtypes. Type I is a primary psychiatric disorder with substance use only when psychiatrically symptomatic (self-medication). Type II is a primary substance use disorder with substance-induced psychiatric symptoms. Type III is psychiatric and substance use disorders of long duration that are co-occurring or present at different times. Type III is considered the “true” dual disorder state. This typology was found to be reliable and have consensual validity. It was used with a standardized interview and clinical interview plus questions designed to determine the subtype with patients in psychiatric and substance abuse outpatient programs and with state hospital inpatient dual disorder patients. The dual disorder subtypes found in the psychiatric outpatient programs were: Type I, 21%; Type II, 9%; and Type III, 70%. In the substance abuse programs were found: Type I, none; Type II, 37%; and Type III, 63%. The subtypes in the state psychiatric patie...
TL;DR: Some of the common problems related to diagnostic decision making and initiation of medication in persons with co-occurring disorders are discussed and an algorithm for guiding these decisions is presented.
Abstract: Persons presenting with concurrent psychiatric and substance problems present unique challenges for diagnosis and for effective and rational treatment planning. This is especially true for psychiatrists attempting to prescribe pharmacologic interventions which will promote recovery from both disorders and improve function. In order to be effective in this endeavor it is important to have a clear understanding of the dynamics of addiction as well as the particular issues and struggles related to mental illness which will affect an individual's attitude toward and use of medication. This article discusses some of the common problems related to diagnostic decision making and initiation of medication in persons with co-occurring disorders. An algorithm for guiding these decisions is presented. Common misconceptions held by these individuals regarding medication, as distinguished from "drugs," are considered. Unique psychodynamic issues that may lead these persons to actively seek medication as a solution to their problems, or which may, conversely, lead them to an outright rejection of medication as a part of their recovery, are discussed. Countertransferential issues influencing the physician's approach to prescribing for this population are also considered. The article concludes with recommendations for pharmacologic approaches to address specific psychiatric syndromes which may present in this population.
TL;DR: The issues relating to the assessment of treatment outcomes for the drug-abusing offender are addressed and several recommendations for future research are provided.
Abstract: The recent increase in drug abusers in the criminal justice system has led to the expansion of corrections-based drug treatment facilities. Although three key evaluations have provided consistent support for the effectiveness of drug treatment within the criminal justice system, direct comparisons of outcomes across these evaluations are limited by variations in their measurement systems and the structure of official records on which they are based. This article addresses some of the issues relating to the assessment of treatment outcomes for the drug-abusing offender and provides several recommendations for future research.
TL;DR: The study shows that drug abuse and criminality are interrelated for certain individuals, but not for others.
Abstract: Criminality among female (n=351) drug abusers is compared to that of men (n=798) as part of a longitudinal study of persons in treatment in Sweden (the SWEDATE project). The extent of criminality was much less among females than among males, and fewer women than men were criminal. The pattern of criminality varied between the sexes. Women's crime debuts occurred later, and they committed less violent crimes and more drug-related crimes. The majority of women supported themselves in other way s than with criminality. Also, women tended to have a more severe pattern of abuse, a more rapid drug career, and more complex psychological problems than men. A subgroup of prostitutes whose drug of choice was heroin often began drug use early with cannabis and went on to amphetamine for their first injection, which often took place in a junkie pad. There was also a criminal group (as there was among men) with a very early and intensive juvenile delinquency pattern, early drug debuts and a rapid transition t...
TL;DR: Comparisons of retention and infant birth outcomes found no significant differences between treatment programs, whereas abstinence and patterns of attrition showed meaningful differences favoring residential treatment.
Abstract: The purpose of this descriptive study was to compare the characteristics and treatment outcomes of pregnant cocaine-dependent women and their infants enrolled in residential (N=32) and outpatient (N=32) treatment settings Biopsychosocial characteristics and issues that influenced the women's multiple treatment outcomes are highlighted Comparisons of retention and infant birth outcomes found no significant differences between treatment programs whereas abstinence and patterns of attrition showed meaningful differences favoring residential treatment Further research is needed to evaluate whether the reported treatment outcomes are markers of improved life functioning that hold promise for the women in treatment, their families and the community
TL;DR: No significant differences were found in craving scores while in treatment, nor in recidivism after treatment, while using naltrexone in an inpatient treatment setting.
Abstract: Naltrexone has been used successfully in outpatient settings as an adjunct to alcoholism treatment. This study examines the efficacy of using naltrexone in an inpatient treatment setting. Sixty-three alcohol-dependent patients who volunteered for a double-blind, placebo-controlled study were followed over the course of their 20 days in treatment and six months follow-up. A comparison group of 59 patients who did not volunteer were also studied over the same period of time. Patients in the study group were randomly assigned to receive naltrexone or placebo. Information was gathered daily on alcohol craving, drug craving and moods on self-reporting forms from the naltrexone and placebo groups, and from the comparison group. Follow-up data was gathered through self-report and through Washington State's TARGET management information system. No significant differences were found in craving scores while in treatment, nor in recidivism after treatment.
TL;DR: There is an urgent need for additional research on the relationship between drug injection and crack smoking as well as improved HIV risk-reduction interventions that include drug abuse treatment components focusing on issues surrounding crack-cocaine addiction.
Abstract: This study compares the drug use and needle risk behaviors among 733 crack-smoking injection drug users (IDUs) and 518 nonsmoking IDUs. Participants were recruited in Dayton and Columbus, Ohio, for the Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program from 1992 to 1996. Crack-smoking IDUs were more likely to be male, African-American, and 30 to 40 years of age, but less likely to be married or living with a sex partner compared to nonsmokers. Daily crack users were less likely to be daily injectors but more likely to use alcohol daily when compared to non-crack users and less-than-daily crack smokers. IDUs who smoked crack less than daily were more likely to have injected with needles and syringes used by others. There is an urgent need for additional research on the relationship between drug injection and crack smoking as well as improved HIV risk-reduction interventions that include drug abuse treatment components focusing on issues surrounding crack-cocaine ...
TL;DR: Three cases of delirium experienced by three young friends after recreational use of "ecstasy" are reported--a syndrome which, to the best of the authors' knowledge, has not been previously observed in MDMA abusers.
Abstract: Three cases of delirium experienced by three young friends after recreational use of “ecstasy” are reported-a syndrome which, to the best of the authors' knowledge, has not been previously observed in MDMA abusers. Special attention is given to the etiological factors and clinical features of the adverse reaction.
TL;DR: Results suggest that more highly motivated individuals seeking relief from substance dependency may be more vulnerable to depression which, in turn, can attenuate treatment effectiveness.
Abstract: This investigation was designed to determine who would benefit most from enhanced motivation, increased awareness of control, and the opportunity to make choices in substance abuse treatment Thirty males and 21 females participated in treatment planning, goal setting, and determining methadone dosage level Subjects were assigned at random to the Choice or Force condition Choice group subjects were allowed to choose the type of treatment and their urin alysis schedule No significant differences between groups on treatment outcome variables were found However, higher motivation at the start of treatment predicted greater depression after 12 weeks Results suggest that more highly motivated individuals seeking relief from substance dependency may bemore vulnerable to depression which, in turn, can attenuate treatment effectiveness
TL;DR: The authors present several representative cases illustrative of features of patients with DID, and draw upon the existing literature, and their experience to discuss treatment strategies aimed at treating patients with both diagnoses.
Abstract: The treatment and research of dissociative disorders, particularly dissociative identity disorder (DID), are hampered by professional skepticism and diagnostic uncertainties. Almost always associated with severe and sustained childhood trauma, its chief manifestations are at least two distinct and separate identities which have an independent manner of existing in the world. It is also associated with a high degree of psychiatric comorbidity. Among the most frequent diagnoses found in patients with DID are substance use and dependence. For a variety of reasons there has been little dialogue among the disciplines that study patients with trauma and those that study and treat substance abuse. Clinicians dealing with a primarily substance-abusing population are likely to encounter but not recognize these patients. The authors present several representative cases illustrative of features of patients with DID. The epidemiology, phenomenology and presentation of DID, as well as its relation to posttraumatic stress disorder are discussed. Little systematic investigation exists on the treatment of DID in general, and substance abuse in DID in particular. The authors draw upon the existing literature, and their experience to discuss treatment strategies aimed at treating patients with both diagnoses. Ignoring either diagnosis is likely to be detrimental to patients; both disorders and their coexistence need to be addressed.
TL;DR: Of the two visual test kits, ONTRAK was the more specific assay, and was lower in cost and simplest to perform, and decision makers could employ similar evaluative methods in selecting drug testing materials.
Abstract: Urine screening is a potentially useful tool for detecting drugs of abuse in treatment, criminal justice, and other human service settings. This article examines the relative accuracy and other features of three drug screening assays sold by commercial laboratories: (1) Abbott Diagnostics ADx machine and reagents; (2) ONTRAK, manufactured by Roche Diagnostics; and (3) EZ-SCREEN, manufactured by Environmental Diagnostics. Urine samples (n=345) were collected from indigent men and women in a work and life skills program, and tested for cocaine and opiates with each of the kits. The ADx fluorescent immunoassay was presumed to be the most sensitive and specific screening method, and comparisons with the two visually-determined test kits supported this assumption. Of the two visual test kits, ONTRAK was the more specific assay, and was lower in cost and simplest to perform. Decision makers could employ similar evaluative methods in selecting drug testing materials.
TL;DR: Amlodipine, a long-acting dihydropyridine-type calcium channel antagonist related to isradipine and nifedipine was administered in open label fashion for 12 weeks to 26 cocaine-dependent patients, and craving significantly declined in subjects expressing cocaine craving.
Abstract: Preclinical studies indicate that dihydropyridine-type calcium channel antagonists modulate dopamine neurotransmitter function and can reduce cocaine-reinforced behaviors. Amlodipine, a long-acting...
TL;DR: The implementation and preliminary evaluation of a dual diagnosis case rate program developed as a collaborative experiment between a public managed Medicaid organization and a specialized integrated dual diagnosis provider with a vertically integrated, managed-care oriented system of care is described.
Abstract: This article describes the implementation and preliminary evaluation of a dual diagnosis case rate program developed as a collaborative experiment between a public managed Medicaid organization (MHMA) and a specialized integrated dual diagnosis provider (Choate) with a vertically integrated, managed-care oriented system of care. The case rate program applied to dually-diagnosed inpatient referrals for a period of 65 days. On admission, 68% of the patients had little insight, motivation and compliance regarding addiction or psychiatric management. Nonetheless, 56% maintained sobriety for 65 days, and 49% of these were still sober at 95-day follow up.