Differences in psychological need hierarchies between black and white drug addicts

A total of 109 Black and White heroin and cocaine addicts in treatment for drug abuse were compared on the Adjective Checklist (ACL). We found that the White addict had a significantly different pattern of needs than did the Black addict, characterized by more psychological dependence, distress, and maladjustment. Consistent with the MMPI literature in this area, the ACL provides an accurate evaluation of personality dimensions among drug addicts, and White addicts are more psychologically maladjusted than Black addicts.     

MCMI comparisons of cocaine abusers and heroin addicts

Cocaine addicts (N = 107) and opiate addicts (N = 86) in treatment for drug abuse were compared on the MCMI. Univariate analyses revealed that cocaine abusers showed more traits of the antisocial personality style, whereas heroin addicts evinced more problems with anxiety and somatic distress, probably related to residual problems of withdrawal, and alcohol abuse. Multivariate analyses revealed four distinct clusters (MCMI patterns 456', 865', 56', and 8') that aligned by underlying personality style and clinical syndrome expression rather than by drug of choice. Ideographic analyses further demonstrated consistencies in prevalence rates of DSM-III-R personality disorders. Results do not support the pharmacodynamic theory of drug abuse. It was concluded that the similarities in personality between these two groups are greater than their differences.     

海洛因依赖者复吸相关因素的前瞻性研究

目的：了解海洛因依赖者戒毒后的转归,分析复吸相关因素。方法：随访178名劳教的海洛因依赖者出所后6个月的情况,比较复吸者和戒断者的一般人口学科、临床特征、成瘾严重程度、伴发的精神疾病等方面的差异。结果：随访到的149（83．7％）的资料显示,22．8％保持戒断,46．3％复吸,29．5％正在强制戒毒、劳教或自愿戒毒,1．3％死亡。复吸与家庭中有其他吸毒者、无强烈戒毒愿望、伴有反社会人格障碍、示参加康复治疗和入教前ASI中海洛因滥用、家庭社会关系、违法犯罪三个因子分、静脉使用毒品等有关。结论：海洛因依赖者劳教后的复吸率较高,复吸与家庭生活环境、戒毒愿望、既往海洛因依赖程度、反社会人格障碍等有关,据此制定预防复吸治疗具有重要意义。     

212例海洛因依赖者回避型人格调查

目的 调查回避型人格在海洛因依赖者群体中的发病率.方法 采用自行设计的<回避型人格诊断调查问卷>对我院212例海洛因依赖者进行调查.结果 回避型人格在海洛因依赖人群中发病率80.18%,形成的原因为自卑心理、受毒友影响及就业困难等.结论 海洛因依赖者群体中具有回避型人格的比例较高.戒毒中给予充分的重视和治疗将有助于成功戒毒,降低复吸率,解决就业问题也应引起有关部门的注意.     

甲卡西酮成瘾者的心理特点及其对戒毒的启示

目的:通过调查分析强制隔离戒毒人员中甲卡西酮成瘾者的心理特点,为开展有针对性的分类矫治提供理论依据。方法:通过问卷收集甲卡西酮组(177人)、冰毒组(153人)和海洛因组(64人)的人口学信息、毒品滥用史和人格特点,比较不同组心理特点的异同。结果:3组成瘾者在年龄、受教育程度、首次吸毒年龄、强戒次数和吸毒使用时间上均存在显著差异(F=14.24,5.34,20.93,119.74,189.85;P0.01)。甲卡西酮组的冲动性和感觉寻求显著低于冰毒组和海洛因组(F=4.53,13.13;P0.01),自我控制显著高于冰毒组和海洛因组(F=9.99,P0.01),只有冰毒组的身体攻击得分显著高于甲卡西酮组(F=5.03,P0.01)。成瘾者的首次吸毒年龄与冲动性、感觉寻求呈显著负相关,与自我控制呈显著正相关(r=-0.227,-0.312,0.217;P0.001)。结论:不同毒品成瘾者具有不同的人格特点,应根据成瘾者的心理和行为特点进行有针对性的矫治。     

Cocaine abuse and the bipolar spectrum in 1090 heroin addicts: clinical observations and a proposed pathophysiologic model

BACKGROUND: Several studies indicate a specific relationship between bipolar disorder and stimulant use and abuse. It has generally been assumed that cocaine use represents self-enhancement or attempts to optimize one's level of hypomania, cyclothymia or hyperthymia. This topic required further examination among heroin abusers because cocaine abuse is commonly comorbid with heroin abuse. METHODS: Cocaine abuse by bipolar subjects was investigated in a group of 1090 treatment-seeking heroin addicts enrolled between 1994 and 2005. We collected data with 1) the Drug Addiction History Rating Scale; and 2) the Semi-structured Interview for Depression, which inquires systematically among others, about hypomania, cyclothymia, hyperthymia and depressive temperament. Subjects were aged 29+/-6 years, and predominantly male (76.2%). RESULTS: Univariate and multivariate analyses provided correlations in favour of a link between current cocaine abuse and double diagnosis, with special relevance to the bipolar spectrum, as well as psychotic disorders (p<0.0001). LIMITATION: The modality of access to cocaine in different communities and the difficulty to distinguish cocaine use from abuse by the rating scale administered may have limited the interpretation of results. CONCLUSIONS: If cocaine abuse precedes that of heroin or is concomitant, heroin may hypothetically serve as a "mood balancer" which transiently dampens subthreshold excitatory states and mood swings. Our data further suggest the need for a more complex model linking cocaine and bipolarity: subthreshold bipolarity, including hyperthymic and cyclothymic temperaments, seems to predispose to heroin addiction, but craving for the suppressed hypomania in turn could lead to cocaine abuse, which eventually unmasks a frank bipolar disorder - in some cases leading to mixed state, severe mania, as well as psychosis beyond mania. Prospective observations would shed further insight on this complex interface of major clinical and public health importance.     

Confirmation of an excess of the high enzyme activity COMT val allele in heroin addicts in a family-based haplotype relative risk study

A previous case control study by Vandenbergh et al. [1997: Am J Med Genet 74:439-442] showed an association between the high activity catechol O-methyltransferase (COMT) polymorphism and polysubstance abuse in a group of North American subjects. In the current study we confirm these results by genotyping 38 Israeli heroin addicts and both parents using a robust family-based haplotype relative risk (HRR) strategy. There is an excess of the val COMT allele (likelihood ratio = 4.48, P = 0.03) and a trend for an excess of the val/val COMT genotype (likelihood ratio = 4.97, P = 0.08, 2 df) in the heroin addicts compared to the HRR control group. We also genotyped an additional 101 nonrelated heroin addicts and 126 control subjects using a case control design and found no significant difference in COMT val allele frequency (25.4% vs. 29.7%, likelihood ratio = 1.04, P = 0.31). A significant difference is observed in COMT allele frequency among the three principal Israeli ethnic groups (Ashkenazi Jewish, non-Ashkenazi Jewish, and Palestinian Arab) in a large group of control subjects we have so far examined (chi-square = 7.9, P = 0.019, df = 2, n = 1,422 alleles) suggesting that population stratification is responsible for our failure to observe an excess of the COMT val allele when using the case-control design.     

Disparities in the Patterns and Determinants of HIV Risk Behaviors among Adolescents Entering Substance Abuse Treatment Programs

Opinions expressed in this paper are those of the authors and do not represent official positions of the government, the grantees or the individuals above.Background:Black youth are disproportionately affected by the HIV/AIDS epidemic. This study examined disparities in patterns and determinants of sexual risk behaviors among black and white adolescents in substance abuse treatment programs.Methods:We used pooled clinical data collected from 4,565 sexually active 12-17-year-old black (29.7%) and white (70.3%) adolescents entering outpatient and residential substance abuse treatment programs nationally. Multivariate logistic regression analyses were used to examine racial differences in patterns of sexual risk behaviors and the associations of these behaviors with demographic, socioenvironmental and psychosocial risk factors, including substance use and abuse, symptoms of mental disorders and criminal behaviors.Results:Blacks were significantly more likely than whites to have had sex with multiple partners, purchased or traded sex and used substances to enhance their sexual experiences, even after adjusting for demographic, socioenvironmental and psychosocial risk factors. Substance use and abuse, internalizing symptoms and drug-related crimes were significantly associated with engaging in ≥ 2 sexual risk behaviors in both groups. Disparities in determinants of HIV risk were also found. For instance, male gender, single-parent custody and history of criminal justice involvement were associated with having had sex with multiple partners among blacks but not among whites. Demographic, socioenvironmental and psychosocial risk factors accounted for up to 30% of the variance in sexual risk in both groups.Conclusions:Black adolescents with substance use problems are at greater risk for HIV infection than their white peers because of their higher rates of sexual risk behaviors.Differences in co-occurring psychosocial problems did not fully explain racial disparities in sexual risk behaviors. HIV prevention programs for black adolescents in treatment should consider both individual and broader contextual factors that co-occur with sexual risk behaviors.     

青少年吸毒者免疫细胞、细胞因子和生长激素的改变

目的：通过测定青少年吸食海洛因者外周血中T细胞亚群、Th1／1112细胞因子和血清中的生长激素，从分子水平探讨吸食海洛因对青少年免疫功能和生长发育的影响。方法：用微量全血直接免疫荧光染色，用流式细胞术检测外周血中T细胞亚群；流式细胞（Cytometric bead array，CBA）技术测定Th1／Th2细胞因子；化学发光法测定生长激素。结果：青少年吸食海洛因组（n=20）CD3^＋、CD3^＋＋CIM^＋、CD3^＋＋CIM^＋／CD3^＋＋CD8^＋、Th1细胞因子（IL-2，TNF-α和IFN-γ）和Th2细胞因子（IL-4，IL-10）低于健康组（n=23）（P〈0．01或0．05）；且Th1细胞因子下降程度大于Th2细胞因子（P〈0．05）；血清生长激素显著高于健康组（P〈0．01）。结论：海洛因降低青少年机体免疫功能，对细胞免疫的损伤大于体液免疫；海洛因能升高青少年血清生长激素，机制需进一步探讨。     

Genetic variants associated with addictive behavior in Colombian addicted and non-addicted to heroin or cocaine

Objective:

Determine the prevalence and compare some genetic markers involved in addictive behavior in a group of addicts to derivative of coca (cocaine/crack) or heroin and a control group of non-addicted people matched for gender, age and ethnicity.

Methods:

A 120 addicts and 120 non-addicts Colombian male were surveyed and genotyped for 18 polymorphism of the OPRM1, DRD2, DRD4, SLC6A3, SLC6A4, ABCB1, DβH and CYP2B6 genes. For the identification of alleles markers were used mini-sequencing and fragment multiplex PCR techniques; ethnicity of cases and controls was analyzed with 61 AIMs.

Results:

The age of onset use of heroin or coca derivatives (cocaine/crack) was 16.5±6 years and 99.2% of them consume several illicit drugs. It showed that controls and addicts belong to the same ethnic group. Significant differences between addicts and controls in relation to schooling, marital status, social security family history of substance abuse (p <0.001), Int8-VNTR SLC6A3 gene (p= 0.015) and SNP 3435C>T ABCB1 gene (p= 0.001) were found.

Conclusion:

The present results indicate that the VNTR- 6R polymorphism of the gene SLC6A3 and the genotype 3435CC in the ABCB1 gene, are both associated with addictive behavior to heroin or cocaine.     

Allelic association analysis of the dopamine D2, D3, 5-HT2A, and GABA(A)gamma2 receptors and serotonin transporter genes with heroin abuse in Chinese subjects

Five candidate genes, the receptors DRD2, DRD3, HTR2A and GABA(A)gamma2, and the serotonin transporter (5-HTT) were analyzed for association with heroin abuse. We examined three polymorphisms (promoter - 141DeltaC, Ser311Cys, and TaqI) in the DRD2 gene, one polymorphism (Ser9Gly) in the DRD3 gene, two polymorphisms (promoter - 1438G/A and T102C) in the HTR2A gene, two polymorphisms (VNTR and Del/Ins) in 5-HTT gene, and one polymorphism (G3145A) in GABA(A)gamma2 gene in 121 Chinese heroin addicts and 194 controls. None of the polymorphisms differed significantly for allele, genotype, or haplotype frequencies, except for the DRD2 promoter polymorphism - 141DeltaC (genotype-wise and allele-wise, P = 0.05, uncorrected). An additional 344 subjects with heroin abuse and 104 controls were investigated for the - 141DeltaC polymorphism. In the second sample, there were no significant difference of genotype or allele frequencies between subjects with heroin abuse and normal controls. When we divided the sample by route of administration into nasal inhalers and IM or IV injectors, however, it produced a significant difference between inhalers of heroin and controls (genotype-wise, P = 0.006, allele-wise, P = 0.016) but not for injectors of heroin (genotype-wise, P = 0.81, allele-wise, P = 0.69). We also found that LD between all polymorphisms we examined in the gene was weak, possibly explaining why we see association of this polymorphism with heroin abuse but not with other markers in the gene. Overall our results indicates that the HTR2A, 5-HTT, DRD3 and GABA(A)gamma2 genes are not likely to be a major genetic risk factor for heroin abuse in this population, with the exception of possible association between nasal inhalation and DRD2 promoter - 141DeltaC polymorphism.     

Coordinate and independent effects of heroin, cocaine, and alcohol abuse on T-cell E-rosette formation and antigenic marker expression

Simultaneous and independent use of cocaine and alcohol by heroin addicts was shown to variably modulate the ability of their T cells to form E-rosettes with sheep erythrocytes (E). As reported previously, the percentages of E-rosette-forming T cells of both active and total types were depressed in association with heroin addiction. We show here that the kinetic curve of the rate of E-rosette formation is also depressed by heroin use and that the use of cocaine but not alcohol by heroin addicts reverses depression of E-rosette formation by heroin. The percentages of E-rosette-forming T cells from the bloods of heroin addicts who used both alcohol and cocaine, as well as the kinetic rate curves of E-rosette formation, were intermediate between the essentially normal levels found for heroin addicts who used cocaine and the severely depressed levels evident for users of heroin alone or heroin plus alcohol. Modulation of the levels of E-rosette formation by alcohol used in conjunction with cocaine and/or heroin was variably dose dependent. Polydrug effects evident by analyses of E-rosette formation were not seen when the percentages of lymphocytes reactive with LYT-3 (anti-E-receptor, 9.6 epitope) and OKT-3 (anti-total T cell) monoclonal antibodies were assessed cytofluorometrically, although the data suggested that subnormal percentages of LYT-3+ T cells were present when heroin addicts also used cocaine. These findings are relevant to basic understanding of T-cell physiology from a neuroimmunological perspective and also suggest ways that addictive drugs may modulate the immunocompetence of drug addicts.     

海洛因依赖者血清中TGF-β1水平的研究

通过检测TGF-β1在海洛因依赖者血清中水平的变化,为进一步认识海洛因对机体免疫功能的影响提供依据。将99例海洛因依赖者按吸食海洛因时间长短均分为三组(2年以内、5~10年、10年以上),33例正常人血清作为对照组,用双抗体夹心酶联免疫吸附试验(ELISA)检测各组血清TGF-β1水平。结果显示,各组海洛因依赖者血清TGF-β1较正常对照组降低(P<0.05);从2年以内组到5~10年组到10年以上组,TGF-β1水平逐渐降低(99.92±38.35 pg/ml、91.72±67.78pg/ml、53.51±27.32 pg/ml)。TGF-β1在海洛因依赖者血清中水平改变明显,吸食海洛因可抑制机体TGF-β1的水平表达。     

丁丙诺啡舌下片合并东莨菪碱、异丙嗪药物依赖者脑灰质密度的研究

目的:观察盐酸丁丙诺啡舌下片(sublingual buprenorphine)合并东莨菪碱(scopolamine)、异丙嗪(promet鄄hazine)药物依赖者(简称BSP依赖者)脑灰质密度的变化,并比较其与海洛因依赖者脑结构损害的异同。方法:采用基于像素的形态学测量(voxel-based morphometry,VBM)方法对16例BSP依赖者、20例海洛因依赖者停药第3天、第2个月的脑灰质密度进行了组间以及组内自身前后对比研究,并设立18例正常对照者。结果:与正常对照组相比,BSP滥用可导致成瘾者大脑广泛性脑结构损害,表现为灰质密度下降,涉及额叶、顶叶、颞叶、枕叶、岛叶、纹状体等脑区;与海洛因依赖组相比,停药3天BSP依赖组脑区灰质受损程度重于海洛因依赖组,且随着停药时间的延长,BSP依赖者灰质恢复进程慢于海洛因依赖者。结论:BSP滥用可造成依赖者广泛性、严重的脑皮质结构异常,主要集中在额叶等与成瘾关系密切的脑区。BSP滥用较海洛因更易损伤大脑皮质神经元,且大脑灰质恢复进程慢于海洛因依赖组,这提示BSP滥用对大脑皮质神经元的损害在短时间难以恢复。     

Changes in health insurance coverage and health status by race and ethnicity, 1997-2002

Recent years have seen shifts in health insurance coverage associated with economic fluctuations and changes in health policy. The analysis presented here uses data from the National Survey of America's Families to examine changes in health insurance coverage and respondent-reported health status by race and ethnicity. The data indicate that public coverage increased for black, Hispanic and white children between 1997 and 2002. Uninsurance rates fell among children in low-income black, Hispanic and white families, remained constant among black and white children in higher-income families, and increased among higher-income Hispanic children. The health status of children was stable for blacks, Hispanics and whites except for a decline in health among higher-income Hispanic children. Black and white adults saw increases in public health insurance coverage but not in overall coverage. The uninsurance rate of Hispanic adults increased, despite expanded public coverage of higher-income Hispanic adults. None of these developments altered racial and ethnic disparities in health. Hispanics fared worse than blacks in both health status and insurance coverage, and blacks fared worse than whites. Given the anticipated growth of minority populations in the United States, the nation's health will deteriorate if policymakers allow current disparities to continue.     

海洛因依赖者环境诱发渴求感的相关因素研究

目的：研究海洛因依赖者环境诱发渴求感的相关因素。方法：对87名男性劳教患者进行环境诱发实验，比较诱发成功组（n=25）与诱发失败组（n=62）在人口学资料、吸毒相关特征、戒毒相关资料等方面的差异。结果：诱发成功组的毒品依赖程度强于诱发失败组，平均戒断时间短于诱发失败组。父母有烟酒嗜好以及首次吸毒有“飘”感的戒毒者，更容易诱发渴求感。结论：海洛因依赖者对于环境诱发刺激具有不同的易感性。对于预防复吸具有指导意义。     

海洛因依赖患者的MMPI与ERP电位研究

目的:探讨明尼苏达多项人格调查量表(MMPI)及事件相关电位(ERP)在海洛因依赖患者中的临床应用价值。方法:对44例海洛因依赖患者和43例正常健康者分别进行了MMPI及ERP测定,并将两组的结果加以比较。结果:海洛因依赖患者中MMPI测定异常率为63.64%(28/44),其量表中Hs(疑病),D(抑郁),Pd(心理变态)、Pa(偏执)、Pt(精神衰弱),Ma(轻躁狂)分显著高于对照组(P<0.01)。海洛因依赖患者ERP测定异常率为52.27%(23/44),其中N2波及P3波(即P300)潜伏期较对照组明显延长,波幅也降低,两组间比较差异有显著意义(P<0.01)。结论:MMPI及ERP电位对海洛因依赖患者临床诊治及预后判断有较高的价值。     

海洛因依赖者一级亲属心理状况测查

吸毒不仅危害个人 ,而且危害社会和家庭。一个家庭有成员吸毒 ,必然对家庭中其他成员的身心健康产生不良的影响 ,为了解吸毒人员对其家庭成员心理健康状况的影响情况 ,本研究对 32 0名吸毒者的一级亲属作了心理健康的调查 ,结果报告如下 :1　资料和方法从 1999年 7月至 8月在广州地区 8家自愿戒毒所进行自愿戒毒的戒毒人员中 ,随机抽取其一级亲属 32 0名 ,既往有心理障碍史的除外。其中男 16 5名 ,女 155名 ;年龄 19～ 58岁 ,平均 37.2± 6 .7岁 ,吸毒 5年以下和 5年以上的戒毒者的一级亲属分别为152名、16 8名。吸毒 5年以下和 5年以上的两…     

海洛因依赖者脱毒后症状自评量表结果分析

目的：研究海洛因依赖者脱毒后的心理卫生问题。方法：对309例海洛因依赖者在脱毒后作症状自评量表（SCL-90）测评。结果：海洛因依赖者脱毒后各因子分，总分及阳性症状均分均显著高于国内常模，尤以躯体化、抑郁、焦虑、精神病性项目评分为著。其中女性海洛因依赖者的敌对性评分高于男性，而男性海洛因依赖者的精神病性评分高于女性。海洛因依赖者初中文化组在强迫、人际关系、抑郁、焦虑、偏执高于小学文化组，在恐怖分上高于高中文化组。结论：海洛因依赖者脱毒后存在躯体稽延症状，并且可能与焦虑、抑郁情绪有关，需使用有关药物并进行心理社会干预以防复吸。