Attitudes toward narcotic addiction

In an effort to isolate the major dimensions of attitude and expectation regarding narcotic addiction and its treatment and to compare different groups of addict/clients and agency staff on these factors, a comprehensive questionnaire was administered to 900 addict/clients and 237 agency personnel in 25 drug treatment clinics in six states. Results of a factor analysis, which used questionnaire data from all of the 1137 subjects so that direct group comparisons could be made, indicated the presence of 10 major dimensions of attitude and expectation. Results also suggested considerable variation, particularly by status (client vs. staff) and ethnic group, on these dimensions. An additional analysis of staff attitudes and expectations revealed correlations with years of education, ex-addict status, and years of work experience. Such findings suggest the need to consider client/staff characteristics and attitudes in the planning of treatment services for narcotic addicts. An abbreviated (53-item) attitude and expectation questionnaire was developed for this purpose.     

Propoxyphene form maintenance treatment of narcotic addiction

Two studies compared propoxyphene napsylate (Darvon-N) with methadone hydrochloride as maintenance treatment for narcotic addicts. Most measures indicated that methadone was more effective than propoxyphene as a maintenance drug. Patients receiving propoxyphene reported more withdrawal-related symptoms early in treatment, tended to drop out sooner than patients receiving methadone, and were more likely to abuse heroin. Nevertheless, follow-up interviews at one and six months after treatment indicated no between-group differences in adjustment.     

Differences among treatment clinic types in attitudes toward narcotic addiction

Factor analysis of data from a general survey of attitudes and opinions concerning narcotic addiction and its treatment revealed 10 major dimensions, five of which were likely to have significant implications for drug abuse intervention strategies. For these latter dimensions, differences were determined among clients and staff according to type of treatment clinic (three types involving the provision of methadone maintenance in various combinations with other treatments and one involving the use of abstinence only). The most pronounced differences were between the methadone clinics and those offering abstinence only. Both the clients and staff of abstinence clinics were more skeptical concerning treatment effectiveness, were more negative regarding the use of narcotic drugs, and were more disposed to the use of ex-addict counselors and group procedures in treatment.     

Therapeutic usefulness of amitriptyline in spastic colon syndrome

The therapeutic efficacy of amitriptyline in irritable bowel was studied in a cross-over double-blind trial, employing fourteen patients whose symptoms were rated as Class II or worse on an arbitrarily-defined interval scale and who had not benefited from previous trials of anticholinergics, anticholinergic-sedative combinations, and bulk-forming agents. During the study, patients rated their own symptoms and the interviewer rated their symptoms using the same scale. Average scores for the patients while on drug showed significant improvement compared to pre-test level. No placebo or drug carry-over effects could be demonstrated. Inasmuch as amitriptyline is effective in this context at dosages subtherapeutic with regard to depression, the authors suggest that a central (perhaps anticholinergic) mechanism of action is responsible.     

Treatment of narcotic addiction by inhibition of craving: Contending with a cherished habit

The indefinitely repeated occurrence of powerful impulses to take drugs is the essence of drug addiction. These impulses are correlated with activity of the automatic nervous system. As early as 1941, Himmelsbach noted that the morphine abstinence syndrome (or craving) was “a disturbance affecting the autonomic division of the nervous system.”¹ The syndrome that results from repeated doses of narcotics has the features of a learned habit. Although narcotic habits always include motor acts that may have socially motivated components, treatment that concentrates on motor acts without attention to autonomic events inevitably misses the crux of the problem. The substantial failure of attempts to modify drug-taking behavior by measures directed at motor behaviors is exactly what was to have been expected.The evocations of the autonomic responses comprising the abstinence syndrome must be in response to some antecedent stimulus or stimuli. Lawrence Kolb, one of the earliest observers of addiction patterns stated: “… When we say a man relapses to drugs because he has a periodic craving …, we have stated only an end result and have left the primary cause of the craving undisclosed.”² Antecedent stimuli to craving may be in the external environment (exteroceptive),^2–11 or in a specific internal state (interoceptive).^2,5,6,12 In many cases, both external and internal antecedents can be identified.In this article we report our experiences in an experiment designed to weaken abstinence responses by systematically inhibiting them through the competition of aversive responses. The abstinence responses were induced by intravenous injections of naloxone and the aversive responses by electrical stimulation of the forearm. Our efforts achieved some success, but were largely thwarted by the subjects' almost universal disinterest in working towards change.     

Human pharmacology and abuse potential of the analgesic buprenorphine: a potential agent for treating narcotic addiction.

Buprenorphine was evaluated for its abuse potential and utility in treating narcotic addiction. The drug was morphine-like but was 25 to 50 times more potent than morphine and was longer-acting. Little if any physical dependence of clinical significance was produced by buprenorphine. The effects of morphine to 120-mg doses were blocked by buprenorphine, a blockade that persisted for 29 1/2 hours. In man, buprenorphine has less intrinsic activity than morphine, and as such, as a low abuse potential. Moreover, the drug has potential for treating narcotic addiction since it is acceptable to addicts, is long-acting, produces a low level of physical dependence such that patients may be easily detoxified, is less toxic than drugs used for maintenance therapy, and blocks the effects of narcotics.     

Three therapeutic communities. A prospective controlled study of narcotic addiction treatment: process and two-year follow-up results

The efficacy of three different residential therapeutic communities for male veterans addicted to heroin was studied, comparing 181 subjects who were randomly assigned to one of the communities with 166 subjects briefly hospitalized only for the treatment of withdrawal symptoms. At two-year follow-up, subjects from both a professionally staffed community and a peer confrontation community were found significantly more likely than the withdrawal-only group to be working or attending school and less likely to have been convicted of a crime. An eclectic program employing both professionals and paraprofessionals was not found to exceed the withdrawal-only group on any of the major outcome variables. The two relatively successful communities, although different in structure and style, were both perceived by their residents to have greater program clarity, order, staff control, and orientation to personal problems than the unsuccessful program.     

A controlled trial of propoxyphene and naltrexone in patients with Tourette's syndrome.

To investigate the effect of drugs acting on the endogenous opioid system, we studied 10 adults with Tourette's syndrome who received propoxyphene hydrochloride (260 mg/day), naltrexone hydrochloride (50 mg/day), and placebo in a double-blinded, randomized clinical trial. Using a self-report scale (Tourette's Syndrome Symptom List), subjects noted a significant (p less than 0.04) lessening of tics after treatment with naltrexone when compared with placebo. An improvement in performance on the Trail Making B test, a measure of attention and visuomotor sequencing and planning, occurred after receiving naltrexone when compared with placebo (p less than 0.08) or propoxyphene (p less than 0.02). The Trail Making B test best discriminated the treatments (p less than 0.02, analysis of variance). No other treatment effects were observed for several other measures of tic severity, attentional ability, or obsessive-compulsive symptoms. Our findings indicate that pharmacological manipulation of the endogenous opioid system does influence symptoms of Tourette's syndrome.