The Safety,Tolerability, and Subject-Rated Effects of Acute Intranasal Cocaine Administration During Aripiprazole Maintenance II: Increased Aripipirazole Dose and Maintenance Period

Objectives: This experiment determined the safety and tolerability of intranasal cocaine during aripiprazole maintenance. Methods: Six cocaine-dependent human subjects were maintained on aripiprazole (15 mg) and placebo for 10 days in counterbalanced order prior to assessing the physiological and subject-rated effects of intranasal cocaine. Results: Intranasal cocaine produced prototypical stimulant-like effects (e.g., increased blood pressure and heart rate, increased subject ratings of Like Drug and Stimulated), and aripiprazole enhanced these effects on several measures. Conclusions: Aripiprazole (15 mg/day) is safe and tolerable when combined with cocaine; however, the usefulness of aripiprazole as a treatment for cocaine-use disorders remains to be determined.     

Subjective responses to initial experience with cocaine: an exploration of the incentive-sensitization theory of drug abuse

AIMS: This study investigated the relationship between positive and negative subjective responses at the time of initial cocaine use with adult cocaine dependence and life-time use rates. Psychostimulant pre-exposure, regular smoking or stimulant treatment before initiation were examined to explore the incentive sensitization theory of addiction. PARTICIPANTS: A total of 202 adult participants who had tried cocaine on at least one occasion were studied prospectively from childhood into adulthood. The cocaine-initiated group included 89 who met Diagnostic and Statistical Manual version IV (DSM-IV) criteria for attention deficit hyperactive disorder (ADHD) and 113 age-matched controls. DESIGN: Five childhood and three adulthood interviews provided data on ages of initiation into cocaine and life-time use of cocaine from ages 16-40 years. Correlations of each subjective response and analyses of variance (ANOVAs) of cocaine 'liking' and 'wanting' with DSM-III-R cocaine dependence and life-time use provided support for the validity of the measures. ANOVA provided evidence of the effect of psychostimulant pre-exposure on 'liking' and 'wanting'. Logistic regression modeled the prediction of dependence and life-time use with the independent variables of 'liking' and 'wanting', psychostimulant pre-exposure and participant characteristics. RESULTS: When cocaine was first tried, 'liking' and 'wanting' were significant predictors of cocaine dependence and life-time use. Mean 'liking' or 'wanting' responses did not differ by participant characteristics. Those who were pre-exposed by regular smoking or stimulant treatment had higher 'liking' and 'wanting' scores; but participants who were pre-exposed by both stimulant treatment and regular smoking reported the lowest liking and the highest wanting responses, consistent with the incentive sensitization theory. Logistic regression showed that the 'liking' and 'wanting' responses increased significantly the odds of DSM-III-R cocaine dependence and life-time use. CONCLUSION: In this sample, subjective 'liking' and 'wanting' measured risk for cocaine abuse.     

Predictors and Comparisons of Polydrug and Non-Polydrug Cocaine Use in Club Subcultures

Background/Objectives: Club drug users have been shown to tend towards patterns of polydrug use, which has been linked to adverse health outcomes, such as impaired mental health, overdose, dependence, infectious disease exposure, and decreased cognitive functioning. Methods: We analyzed data from the Club Drugs and Health Project, a study designed to examine the patterns and contexts of club drug use among young adults. Four-hundred recent club drug users were recruited through time-space sampling. Results: Among recent cocaine users (n = 361), 61.2% were polydrug users. Male gender was predictive of polydrug cocaine use (OR = 1.66). Gay, lesbian, and bisexual (GLB) sexual orientation, White race, and Non-Latino ethnicity were not. No differences in mental health factors were found between cocaine polydrug users and users of only cocaine. However, polydrug users were significantly more likely to score high on drug-related sensation seeking as well as to use drugs to deal with unpleasant emotions and to have pleasant times with others. Conclusions: Prevention and intervention efforts should account for contextual and motivational factors in attempting to reduce polydrug use and its negative effects.     

Attentional Bias Towards Cocaine-Related Stimuli: Relationship to Treatment-Seeking for Cocaine Dependence

Background: Cocaine-dependent individuals demonstrate attentional bias when measured by Stroop color-naming tasks that have been modified to include cocaine-related words. However, the relationship between attentional bias and the treatment-seeking status of cocaine-dependent individuals has never been explored. The purpose of this study was to compare attentional bias towards cocaine-related verbal stimuli between treatment-seeking and nontreatment-seeking cocaine abusers. Methods: We examined performance on a Stroop task modified to include drug-related words in 17 cocaine-dependent treatment-seeking male participants and 20 cocaine-dependent nontreatment-seeking male participants. Results: Although treatment seekers reported less experience with cocaine than nontreatment seekers, they exhibited increased response latency and made more errors when identifying the colors of cocaine-related words, relative to neutral words (p < .05), whereas nontreatment seekers did not. Conclusions: Factors other than a high frequency of cocaine use may contribute to the difference in attentional bias towards cocaine cues between these subgroups of cocaine users.     

The Safety,Tolerability, and Subject-Rated Effects of Acute Intranasal Cocaine Administration During Aripiprazole Maintenance

Although cocaine dependence remains a significant public health concern, efforts to identify a pharmacotherapy have been unsuccessful. The purpose of this study was to assess the safety, tolerability, and subject-rated effects of intranasal cocaine during maintenance on aripiprazole, a novel antipsychotic with partial agonist activity at monoamine receptors implicated in the effects of cocaine. To this end, eight cocaine dependent subjects were maintained on 10 mg oral aripiprazole and placebo in counterbalanced order prior to assessing the physiological and subject-rated effects of intranasal cocaine (4, 20, 40, and 60 mg). Aripiprazole was generally devoid of effects, but did alter temperature-increasing and subject-rated effects of cocaine as a function of cocaine dose.     

Concurrent Cannabis Use During Treatment for Comorbid ADHD and Cocaine Dependence: Effects on Outcome

Cannabis is the most widely used illicit substance in the United States with especially high prevalence of use among those with psychiatric disorders. Few studies have examined the relationship between concurrent cannabis use and treatment outcome among patients receiving treatment for comorbid substance abuse and psychiatric disorders. This study investigated the effects of cannabis use on treatment retention and abstinence from cocaine among cocaine dependent patients with Attention Deficit Hyperactivity Disorder (ADHD). Cocaine dependent patients diagnosed with current ADHD (DSM-IV, N = 92) aged 25 to 51 participated in a randomized clinical trial of methylphenidate for treatment of ADHD and cocaine dependence in an outpatient setting. The majority of patients (69%) used cannabis during treatment. Results suggest that moderate/intermittent cannabis users had greater retention rates compared to abstainers and consistent users (p = .02). This study is the first to examine concurrent cannabis use in cocaine dependent patients diagnosed with ADHD.     

Characteristics of Rural Crack and Powder Cocaine Use: Gender and Other Correlates

Background: Little is known about the relationship of gender with cocaine use in rural areas. This study describes these relationships among stimulant users residing in rural areas of Arkansas, Kentucky, and Ohio. Objectives: Understanding the characteristics of crack and powder cocaine users in rural areas may help inform prevention, education, and treatment efforts to address rural stimulant use. Methods: Participants were 690 stimulant users, including 274 (38.6%) females, residing in nine rural counties. Cocaine use was measured by self-report of cocaine use, frequency of use, age of first use, and cocaine abuse/dependence. Powder cocaine use was reported by 49% of this sample of stimulant users and 59% reported using crack cocaine. Findings: Differing use patterns emerged for female and male cocaine users in this rural sample; females began using alcohol, marijuana, and cocaine at later ages than males but there were no gender differences in current powder cocaine use. Females reported more frequent use of crack cocaine and more cocaine abuse/dependence than males, and in regression analyses, female crack cocaine users had 1.8 times greater odds of reporting frequent crack use than male crack users. Conclusions and Scientific Significance: These findings suggest differing profiles and patterns of cocaine use for male and female users in rural areas, supporting previous findings in urban areas of gender-based vulnerability to negative consequences of cocaine use. Further research on cocaine use in rural areas can provide insights into gender differences that can inform development and refinement of effective interventions in rural communities.     

Cocaine Dependence and Concurrent Marijuana Use: A Comparison of Clinical Characteristics

Background/Objectives: Marijuana is the most commonly used illicit substance, yet among the least studied in medication development research. Cocaine-dependent individuals frequently also use marijuana; however, little is known about the effect of this combined use on treatment presentation. Methods: Marijuana use was assessed in 1183 individuals seeking outpatient treatment for cocaine dependence. Based on past 30 days of use, the sample was divided into three groups: () patients reporting no recent marijuana use (n = 634); () occasional use (n = 403); () and frequent concurrent marijuana use (n = 146). Differences on baseline measures of substance use, addiction severity (ASI), psychopathology, and sociodemographic characteristics were examined as a function of level of marijuana use. Results: Frequent marijuana users were more likely to be female, Caucasian, and younger than other groups. Cocaine-dependent patients with frequent marijuana use also used more cocaine and alcohol, and reported more medical, legal, and psychiatric problems, including antisocial personality disorder. Conclusion and Scientific Significance: Cocaine-dependent patients with frequent marijuana use present for treatment with more severe impairment. Accounting for this heterogeneity among participants may improve treatment outcome.     

Predictors of Stages of Change for Condom Use in Crack Cocaine Users

This paper addresses the question of whether sexual activity and partner characteristics differentiate people in different stages of change. Factors expected to distinguish people in different stages of change were partner type, drug use during sex, and HIV status. Three discriminant functions emerged. The loading matrix demonstrates that partner type was the strongest predictor that distinguished people in the precontemplation stage from those in the preparation, action, and maintenance stages (first function) (.962). The loadings on the second discriminant function suggest that when controlling for partner type, HIV status (.935) was the best predictor for distinguishing between the people in the maintenance stage and those in the other stages. The loadings on the third function were not significant. The overall classification results indicate that individuals using crack cocaine and engaging in high risk sexual behaviors can be classified into the stages of change for condom use based on these variables.     

Initiating HIV Care: Attitudes and Perceptions of HIV Positive Crack Cocaine Users

There is limited data on the initiation and use of HIV care services by HIV-positive crack cocaine users. We analyzed data from a study of 286 recently infected HIV-positive persons recruited from 4 U.S. cities. Participants completed an Audio Computer Assisted Self Interview (A-CASI) regarding HIV care knowledge, attitudes, beliefs and practices related to the initiation of HIV care. In multiple logistic regression analysis, higher scores on an assessment of knowledge, attitudes and beliefs regarding HIV care, and Hispanic race were positively associated with initiating HIV primary care. Crack cocaine use in the past 30 days and male gender were negatively associated with initiating care. Injection drug use was not associated with initiation of care. Targeted interventions for crack cocaine users, including drug treatment, may be required to provide optimal HIV primary care use in this population.     

Early Life Trauma and Sensitivity to Current Life Stressors in Individuals With and Without Cocaine Dependence

This study investigated the link between exposure to early life trauma, sensitivity to current daily stressors, and cocaine dependence. Individuals with (n = 105) or without (n = 53) cocaine dependence completed the Early Trauma Inventory and the Daily Hassles Scale. In comparison to controls, cocaine-dependent individuals reported almost twice as many daily hassles and perceived those hassles more negatively (p <. 001). For participants with cocaine dependence, a significant relationship between exposure to early life trauma and negative perception of current daily hassles was observed (p <. 01), whereas no such relationship was observed for participants without cocaine dependence. Adverse childhood events may lead to an altered view of the environment that contributes to increased irritability with daily life events among cocaine-dependent individuals.     

Abstinence Self-Efficacy and Substance Use at 2 Years: The Moderating Effects of Residential Treatment Conditions

The relationship between abstinence self-efficacy and substance use at 2 years was examined among a sample (N = 470) of persons with substance use disorders and recent incarceration histories. Participants were assigned to residential (therapeutic community/TC or Oxford House) or nonresidential (usual care) conditions. The authors hypothesized abstinence self-efficacy would predict decreased substance use, and residential treatments would moderate this relationship. A conditional effect was observed, with low levels of abstinence self-efficacy predicting significant increases in substance use in the TC and usual care conditions. Supplemental analyses revealed significant decreases in substance use over time among participants in the Oxford House condition, and a significant conditional effect (gender x treatment condition) in relation to substance use. Findings point to the need for researchers to examine factors that mitigate the relationship between abstinence self-efficacy and substance use outcomes, and for treatment providers to consider the Oxford House model for this population.     

The Relationship between Subjective Cognitive Impairment and Activity Participation: A Systematic Review

ABSTRACT

This systematic review synthesizes current evidence to determine how subjective cognitive impairment (SCI) relates to physical, cognitive, and social activity participation in older adults. Nine peer-reviewed articles were reviewed and appraised for evidence quality. Most were cross-sectional and had high methodological quality. Higher levels of SCI were almost universally associated with lower levels of physical and social activity participation. These findings suggest that older adults who report higher SCI engage in fewer activities. Examining these relationships longitudinally is an important next step to determine whether SCI precedes withdrawing from activities in older adults.     

Maternal Depression and Cognitive Features of 9-Year-Old Children Prenatally-Exposed to Cocaine

This study evaluated cocaine exposure and maternal characteristics as competing predictors of school-age cognitive, achievement, and language performance. One group of 47 exposed 9-year-old children were first studied in an earlier prenatal study. A non-exposed contrast group (n = 46) served as a reference. Maternal measures included: IQ, psychopathology, drugs, demographics, and environment. Child intelligence, language, and achievement scores were inversely related to maternal IQ and depression scores, with cocaine exposure significant secondary or tertiary predictors for many children. Verbal IQ scores of exposed children strongly reflected maternal depression (r = .54) but no such relationship was found among the non-exposed cohort (r = .00).     

Successful Aging: Definitions and Subjective Assessment According to Older Adults

There is no standard method for measuring successful aging or a consensus on its definition. Surveys about successful aging were administered to 53 older adults in New Jersey. Participants defined successful aging as including activity/exercise (56% of responses), physical health (46%), social relationships (41%), and psychological/ cognitive health (33%). Successful aging, as assessed by one question, was positively related to social support, life satisfaction, and subjective health. By understanding more about the concept of aging successfully, researchers can develop interventions to promote successful aging for older adults.     

Frailty,Leisure Activity and Functional Status in Older Adults: Relationship With Subjective Well Being

Older adults generally experience high levels of life satisfaction (e.g., Charles & Carstensen, 2010 Charles, S.T. and Carstensen, L.L. 2010. Social and emotional aspects of aging. Annual Review of Psychology, 61: 383–409. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) and participation in leisure activities may mediate some of their overall well-being. Frailty associated with biological aging may be related to reduced leisure activity engagement and loss of social belonging that may diminish life satisfaction (Charles, 2011). This study examined differences in leisure activity engagement by frailty status, and then tested a model evaluating the link between functional status and subjective well-being in a sample of 95 community-dwelling older adults. Participants completed self-report questionnaires that assessed leisure activity participation, life satisfaction, frailty, and mood. Leisure activities were coded as either social (e.g., taking classes) or solitary (e.g., reading) and summed across to create two composite scores. Results indicated there was a strong relationship between functional status and subjective well-being in older adults. High frailty and low social leisure engagement was associated with reduced subjective well-being. Implications for future research and clinical applications are discussed.     

The Effects of Prenatal Alcohol Use on the Growth of Children at Three Years of Age

In this prospective study of substance use during pregnancy, women were interviewed in their 4th and 7th prenatal months, and women and children were assessed at 24 hr, 8, 18, and 36 months postpartum. Data are presented on the outcome of 519 children at age 3. At 3 years, children who were exposed prenatally to alcohol were smaller in weight, length, and head circumference. They also had an increased number of minor physical anomalies. These effects were found even after controlling for nutritional and environmental factors. The persistence of growth effects at age 3 suggests that children exposed to alcohol prenatally may have a diminished capacity for growth.     

Efficacy of Opiate Maintenance Therapy and Adjunctive Interventions for Opioid Dependence with Comorbid Cocaine Use Disorders: A Systematic Review and Meta-Analysis of Controlled Clinical Trials

Aims: To determine the efficacy of Opiate Maintenance Therapy (OMT) and adjunctive interventions for dual heroin and cocaine dependence by means of a meta-analysis. Method: We searched for and retrieved randomized controlled clinical trials. We used RevMan 5.0 with random effects modeling for statistical analysis and for comparisons of relative risk, effect sizes, and confidence intervals. Subsequent moderator variables and sensitivity analyses were performed. Results: Thirty-seven studies, which have enrolled 3,029 patients, have been included in this meta-analysis. High doses of OMT were more efficacious than lower ones in the achievement of sustained heroin abstinence (RR = 2.24 [1.54, 3.24], p < .0001) but had no effect on cocaine abstinence. At equivalent doses, methadone was more efficacious than buprenorphine on cocaine abstinence (RR = 1.63 [1.20, 2.22], p = .002) and also appeared to be superior on heroin abstinence (RR = 1.39 [1.00, 1.93], p = .05). Several pharmacological and psychological potentiation strategies have been investigated. An improvement on sustained cocaine abstinence was achieved with indirect dopaminergic agonists (RR = 1.44 [1.05, 1.98], p = .03) and with contingency management (CM) focusing on cocaine abstinence (RR = 3.11 [1.80, 5.35], p < .0001). Conclusions: Dual opioid and cocaine dependence can be effectively treated with OMT in combination with adjunctive interventions. Higher OMT doses are preferable to lower ones and methadone to buprenorphine. OMT can be enhanced with indirect dopaminergic drugs and with CM focusing on cocaine abstinence.     

Behavioral and Subjective Effects of Ethanol: Relationship to Cerebral Metabolism Using PET

This study examined the effects of ethanol on regional cerebral metabolic rate using positron emission tomography (PET). The study explored the relationship between the mood-altering effects of ethanol and its effects on regional cerebral glucose utilization (CMRglu) in eight healthy male volunteers. In the first phase of the study, the subjects participated in a behavioral preference procedure conducted in a recreational environment to determine their responses to ethanol (0.5 g/kg) in a naturalistic setting. They then participated in three PET sessions, receiving at three to seven day intervals, in counterbalanced order, placebo, 0.5 g/kg or 0.8 g/kg ethanol. PET scans were conducted using a PETT-VI scanner with F-18-2-fluoro-2-deoxyglucose (FDG) as the tracer. The mood-altering effects of ethanol were measured in both the naturalistic and the PET phases of the study. Ethanol produced comparable effects on mood in the naturalistic and the PET settings (i.e., increases in positive mood). The lower dose of ethanol produced variable effects on whole brain and regional CMRglu across subjects. There was some suggestion that certain regional metabolic changes after ethanol were correlated with subjective responses to the drug. The higher dose of ethanol decreased whole brain CMRglu in most subjects. All regions were affected about equally. It was concluded that the mood-altering effects of ethanol are not related in a simple manner to regional changes in CMRglu.