Changes in Withdrawal and Craving Scores in Participants Undergoing Opioid Detoxification Utilizing Ibogaine

Opioid use disorder (OUD) is currently an epidemic in the United States (US) and ibogaine is reported to have the ability to interrupt opioid addiction by simultaneously mitigating withdrawal and craving symptoms. This study examined opioid withdrawal and drug craving scores in 50 participants with OUD undergoing a week-long detoxification treatment protocol with ibogaine. The Addiction Severity Index (ASI) was used for baseline characterization of participants’ OUD. Clinical Opioid Withdrawal Scale (COWS), Subjective Opioid Withdrawal Scale (SOWS), and Brief Substance Craving Scale (BSCS) scores were collected at 48 and 24 hours prior to ibogaine administration, as well as 24 and 48 hours after ibogaine administration. At 48 hours following ibogaine administration, withdrawal and craving scores were significantly lowered in comparison to baseline: 78% of patients did not exhibit objective clinical signs of opioid withdrawal, 79% reported minimal cravings for opioids, and 68% reported subjective withdrawal symptoms in the mild range. Ibogaine appears to facilitate opioid detoxification by reducing opioid withdrawal and craving in participants with OUD. These results warrant further research using rigorous controlled trials.     

A Gratuitous Grace: The Influence of Religious Set and Intent on the Psychedelic Experience

ABSTRACT

Psychedelic drugs, or entheogens, have been used for religious purposes among various cultures for thousands of years. Recently, these substances have caught the attention of Westerners for many reasons, including their propensity to induce mystical experiences. This study examined the relationship between religion and having mystical experiences. A total of 119 participants were drawn from psychedelic-related websites and asked to complete an anonymous online questionnaire containing items regarding history of psychedelic use, set and setting for psychedelic use, and a measure for mystical experiences. A majority of respondents were White males who displayed at least some level of post-secondary education. The findings indicated that respondents who used psychedelics for specifically religious purposes, as well as those who identified with a religion, were more likely to score higher on the Mysticism Scale than those who did not.     

On Addiction,Complexity, and Freedom: Toward a Liberation-Focused Addiction Treatment

This article outlines a liberation-focused model of addiction treatment. Drawing on the Latin root word "addictus", addiction is seen as slavery and freedom, rather than the cessation of drug and alcohol use, is proposed as a viable, alternative treatment goal. Freedom is defined as: (1) the capacity to create a life of social and internal complexity and multiplicity; (2) the ability to make choices from an array of options; and (3) the possibility of engaging in long-term, goal-directed behavior. This vision of personal liberation is then embedded within a biopsychosocial model of care and treatment. Examples of how biomedical, psychological, and social interventions can each serve to promote the goal and experience of freedom and liberation are provided. Engaging in identity projects and using harm reduction interventions and philosophies are also seen as key to this transformative journey.     

Effects of a High-Dose,Fast Tapering Buprenorphine Detoxification Program on Symptom Relief and Treatment Retention

Abstract

A large number of patients with heroin dependency fail to enter a treatment program because of dropping out during or immediately after detoxification. This article presents an open study of symptom relief of 10 patients withdrawing from heroin with a high-dose rapid tapering buprenorphine detoxification protocol. It also presents a pseudo-experimental comparison between 208 patients treated with a clonidine/dextropropoxiphene detoxification protocol and 246 patients treated with the high-dose rapid tapering buprenorphine detoxification protocol to evaluate differences in patients' ability to continue in treatment of addiction immediately after detoxification. The results indicate that 24 mg of sublingually administered buprenorphine beginning when the patient judges himself to be in a withdrawal state followed by another three days of daily administered and rapidly decreased doses resulted in a significant reduction of withdrawal symptoms. Also, when the clonidine/dextropropoxiphene protocol was replaced with this buprenorphine protocol the number of patients continuing in treatment immediately after discharge from the detoxification ward increased from 41.3% to 58.1%. Buprenorphine given in high doses with rapid tapering when withdrawal symptoms occur seems to offer an effective symptom-alleviating treatment, probably also decreasing the number of drop-outs after detoxification.     

Users' Experiences of Heroin and Methadone Treatment

The present study, conducted in 2003, Melbourne, Australia, examined and compared how different personal and social resources related to participants' use of both heroin and methadone, as well as their experiences of stigma and program regulation, and their evaluation of methadone treatment. In-depth interviews were conducted with 10 participants (five men, five women) aged between 25 and 42. Participants who had diverse personal and social circumstances were purposefully sought. Findings showed that users with “non-addict” or “functional” self-concepts had more resources and supportive social relationships that assisted them to develop realistic treatment expectations, avoid the stigma associated with methadone, and focus on the benefits of the treatment. Conversely, “conflicted” users with limited resources, few social connections, and negative self-concept saw methadone as an addiction, and as a highly stigmatizing and disempowering intervention. Social policies that differentiate users and address ways of improving users' personal and social resources are now needed.     

Medicaid Coverage,Methadone Maintenance,and Felony Arrests: Outcomes of Opiate Treatment in Two States

ABSTRACT

A modest number of clinics in Oregon and Washington provide MMT maintenance treatment (MMT) services. More than 10,000 clients in each state were followed for 3 years after an initial admission for opiate use between 1993 and 2000. Medicaid clients in both states had far greater access to MMT than their non-Medicaid counterparts, controlling for differences in client characteristics using propensity scores. Months in MMT were associated with much lower arrest rates than time not in treatment, but unexpectedly this was only true for clients participating in MMT for many months. Despite differences in the treatment systems for opiate addiction in these two states observed in previous studies, the current findings generalized across both states.     

Voice of the Psychonauts: Coping,Life Purpose,and Spirituality in Psychedelic Drug Users

Abstract

Psychoactive drug use shows great diversity, but due to a disproportionate focus on problematic drug use, predominant nonproblematic drug use remains an understudied phenomenon. Historic and anecdotal evidence shows that natural sources of “psychedelic” drugs (e.g., mescaline and psilocybin) have been used in religious and spiritual settings for centuries, as well as for psychological self-enhancement purposes. Our study assessed a total of 667 psychedelic drug users, other drug users, and drug nonusers by online questionnaires. Coping, life purpose, and spirituality were measured with the Psychological Immune Competence Inventory, the Purpose in Life test, and the Intrinsic Spirituality Scale, respectively. Results indicate that the use of psychedelic drugs with a purpose to enhance self-knowledge is less associated with problems, and correlates positively with coping and spirituality. Albeit the meaning of “spirituality” may be ambiguous, it seems that a spiritually-inclined attitude in drug use may act as a protective factor against drug-related problems. The autognostic use of psychedelic drugs may be thus hypothesized as a “training situation” that promotes self-enhancement by rehearsing personal coping strategies and by gaining self-knowledge. However, to assess the actual efficiency and the speculated long-term benefits of these deliberately provoked exceptional experiences, further qualitative investigations are needed.     

Quality of Life Profiles and Changes in the Course of Maintenance Treatment Among 1,015 Patients With Severe Opioid Dependence

Introduction: Studies indicate that different areas of mental, physical, social and daily life functioning need to be considered in order to improve intervention outcomes in substance user patients. The aim of the study was to assess health-related quality of life (HRQOL) in patients diagnosed with opioid dependence as compared to healthy controls and patients diagnosed with depression and schizophrenia. Methods: A total of 1,015 outpatients diagnosed with opioid dependence were investigated during 12 months of maintenance treatment. HRQOL (MSQoL), addiction (EUROP-ASI), and sociodemographic characteristics were assessed. Results: HRQOL in opioid dependence improved significantly (p < .001), but was lower as compared to that of healthy controls and patients diagnosed with schizophrenia. HRQOL in opioid dependence comprises addiction-specific aspects, most importantly low material satisfaction, physical health, and social stability. Conclusions: HRQOL measurement provides valuable information for course and outcome in opioid dependence treatment.     

Exercise as an Adjunct Treatment for Opiate Agonist Treatment: Review of the Current Research and Implementation Strategies

ABSTRACT

Opiate dependence is a significant public health concern linked to poor quality of life, comorbid psychiatric disorders, and high costs to society. Current opiate agonist treatments are an effective but limited intervention. Adjunctive interventions could improve and augment opiate agonist treatment outcomes, including drug abstinence, quality of life, and physical health. This article reviews exercise as an adjunctive intervention for opiate agonist treatment, especially in regards to improving mood and overall quality of life, while reducing other substance use. Poor adherence and dropout frequently prevent many individuals from garnering the many physical and mental health benefits of exercise. Strategies for implementing an exercise intervention, including safety considerations, are discussed.     

The association between cocaine use and short-term outcomes for the treatment of heroin dependence: findings from the Australian Treatment Outcome Study (ATOS)

The aim of this study was to determine the prevalence of cocaine use among individuals presenting for treatment for heroin dependence, describe the clinical profile of heroin users who also use cocaine and to establish the effects of cocaine use on short term outcomes for the treatment for heroin dependence. A longitudinal follow-up of 549 heroin users recruited in Sydney for the Australian Treatment Outcome Study was conducted at 3-month post-baseline interview. At baseline, current cocaine use was common (39%) and was associated with increased drug use, needle risk taking and criminality. The 3-month prevalence of cocaine use declined significantly to 19%. Thirty-five per cent of those who had used cocaine at baseline continued to use at 3 months, while 9% of the sample had commenced cocaine use. Those who entered residential rehabilitation at baseline were less likely than other treatment entrants and the non-treatment group to have used cocaine at follow-up. Treatment retention was not affected by baseline cocaine use status; however, baseline cocaine users (CU) displayed higher levels of heroin use, polydrug use and drug-related problems. A poorer outcome was associated with the commencement or continuation of cocaine use, while cessation of cocaine use resulted in significant improvements on these measures. Cocaine use was common among individuals seeking treatment for heroin dependence and was an important moderator of treatment outcome. It appears that cocaine use has a strong negative effect on treatment outcome over and above that caused by polydrug use generally. [Williamson A, Darke S, Ross J, Teesson M. The association between cocaine use and short-term outcomes for the treatment of heroin dependence: findings from the Australian Treatment Outcome Study (ATOS). Drug Alcohol Rev 2006;25:141 - 148]     

A Comparison of Clonidine and Buprenorphine in the Outpatient Treatment of Opiate Withdrawal

The opiate withdrawal syndrome, although not life threatening, is a major obstacle in the treatment of opiate dependence. Over a 12 week period, 124 patients (63% female, 66% African American and mean age 32.6 years) underwent 5 day treatment for opiate withdrawal. Patients treated in the first 6 weeks (n = 69) received clonidine based treatment (0.1 mg every 6 h with one dose received on-site each day and the others taken home), while patients treated in the latter 6 weeks (n = 65) received buprenorphine 0.3 mg IM daily. Both groups received supportive medications for diarrhea, cramps, aches, and nausea, had clonidine patches placed on day 4, and were offered naltrexone upon completion. Based on age, gender, and race the two treatment groups were similar. The completion rate was 75.4% for buprenorphine group and 47.5% for the clonidine group, (p = .001). In conclusion, buprenorphine was superior to clonidine in enabling opiate dependent patients to successfully complete an outpatient detoxification program.     

The Use of Psychedelic Drugs in the Treatment of Severely Disturbed Children: A Review

Abstract

Recent health care reform legislation has prompted greater efforts to divert substance abusers to addiction treatment facilities. A major component of reform has been the acknowledgement that mental health and addiction issues must be treated on a par with medical issues. The merger of the Haight Ashbury Free Clinics and Walden House offers a model for the medicalization of therapeutic communities to provide a medical home for previously underserved, marginalized populations.     

Outcomes for Substance User Treatment in Women: Results from the Baltimore Drug and Alcohol Treatment Outcomes Study

The Baltimore Drug and Alcohol Treatment Outcomes Study is a large study focusing on a single city. Over 1000 adult male and female substance users entering treatment in 16 publicly funded substance use treatment programs in the City of Baltimore between 1998 and 1999 were evaluated at four time periods (intake, 30 days after treatment, 6 month, and 12 month follow-ups). A comprehensive psychological battery was administered at each assessment interval. In this article, we report on the seven domains (alcohol, drug, medical, legal, employment, family, and psychological) of the addiction severity index (ASI) with the 459 women who participated in the study. Overall, statistically significant differences across time showed improvement as a result of substance user treatment were found in six of the seven ASI domains; no statistically significant effects for time were found for the medical composite scores. Drug and alcohol use among the participants was significantly reduced as early as 30 days after treatment. We discuss these findings in relation to the specific treatment needs of women who are addicted.     

An 18-Year Follow-Up of Patients Admitted to Methadone Treatment for the First Time

ABSTRACT

An 18-year addiction career, 1985-2003, for 157 heroin dependent subjects (73% men; 49% human immunodeficiency virus seropositive) admitted for the first time to Stockholm's Methadone Maintenance Treatment program during 1989 to 1991 was analyzed with data from seven official registers and patient records. Regression analyses and incidence rates for various outcomes were calculated for subjects in first methadone maintenance treatment at the end of the observation period, discharged from first methadone maintenance treatment, in second methadone maintenance treatment, and discharged from second methadone maintenance treatment. Being human immunodeficiency virus positive (HR = 3.8), lodging (HR = 1.9) and prison sentence (HR = 1.7) predicted mortality for the 45% deceased. Approximately 70% of living subjects participated in methadone maintenance treatment at some period each year. Subjects in first or second methadone maintenance treatment had less criminality and had spent more time in methadone maintenance treatment (70% to 100%) than those discharged from first or from second methadone maintenance treatment (50%). Efforts and interventions should be intensified to increase time in treatment also for those with high problem severity.     

Assessing self-determined motivation for addiction treatment: validity of the Treatment Entry Questionnaire

Although legal, formal, and informal social controls are frequently used to pressure individuals to enter treatment, motivational consequences of using these tactics have been neglected. Self-determination theory (SDT) provides a useful perspective for understanding client experiences of social controls and highlights the importance of self-determined motivation for long-term behavior change. This study assessed the construct validity of the Treatment Entry Questionnaire (TEQ), a brief scale derived from SDT to measure identified, introjected, and external treatment motivation. Two independent samples of clients entering Canadian residential and outpatient treatment completed TEQ items (ns = 529 and 623). Exploratory and confirmatory factor analyses supported a 9-item version of the scale, with 3 factors aligning with SDT motivational subtypes. Subscales showed high internal consistency and correlated as expected with social controls and perceived coercion at treatment entry. The TEQ-9 is a valid option for assessing self-determined motivation in clinical practice and evaluating coerced addiction treatment.     

Drug Treatment Experiences: Rural and Urban Comparisons

This study sought to investigate treatment-seeking behaviors among drug users in rural populations and how they compare to their urban counterparts. Data for this analysis were drawn from the Miami and Immokalee sites of the National Institute on Drug Abuse's Cooperative Agreement Program for AIDS outreachhtervention research study targeting high-risk out-of-treatment injection drug users and crack smokers. Findings indicate that Miami subjects were 2.57 times more likely to have been in drug treatment compared to their rural counterparts. This differential may be explained in terms of the availability, accessibility, and acceptability of health care services. [Translations are provided in the International Abstracts Section of this issue.]     

Meeting the needs of prisoners with a drug or alcohol problem: No mean feat

The case for providing prisoners with a drug or alcohol problem with access to effective treatment and support services is long standing and beyond question. Previous research has shown that rates of re-offending and other adverse outcomes can be reduced to the extent that such treatment services are provided to prisoners. However, as obvious as the importance of providing treatment may be this is not the same thing as ensuring that the types and range of services provided to prisoners are commensurate with the evident need. In this paper we describe the characteristics of prisoners engaged in enhanced drug and alcohol treatment within Drug Recovery Wings in prisons in England and Wales. This study which has involved structured interviews with 322 prisoners beginning enhanced drug recovery wing treatment has demonstrated the wide ranging needs of prisoners both in terms of their substance use, their mental health, their attitudes towards criminality and their motivations for treatment. On the basis of the data presented here it is essential that the support provided to prisoners with a drug or alcohol problem extends well beyond the focus on drug treatment itself to address major long standing and deep rooted areas of difficulty in the prisoners’ lives.