Networks of verbal habits for drugs

Opiate addicts (n = 90) were asked to give forced associations to 278 words with options for drugs, users of drugs, places of use of drugs, activities including drug use, and stages of addiction. As expected, a major association network for heroin was found and was comprised of associations to heroin, drugs similar to heroin (morphine, methadone), “junkie” (heroin user), “shooting gallery” (place to inject heroin), “hooked” (stage of addiction), drugs (as an activity), and slang names for heroin. Hooked as a status is closer to the core of the heroin habit than “kicking a habit”. Minor association networks were found for the other drugs evaluated which included Benzedrine, alcohol, “goofball” (barbiturate), and “reefer” (marijuana).     

Knowledge of drug names determines associations to drug names more than habits for the drugs

Verbal habits and knowledge of the names for a large variety of drugs were determined in 76 male heroin addicts by the use of two multiple-choice association tests. Heroin addicts knew more names for heroin and had a greater verbal habit for heroin than for drug names in 12 other categories: alcohol, cigarettes, cocaine, “pep pills” (stimulants), solvents, “goofballs” (barbiturates), minor tranquilizers, major tranquilizers, hallucinogens, blanks, mixed drugs and miscellaneous drugs. The subjects had a greater verbal habit for heroin than marijuana. However, contrary to another study by Haertzen et al. (J. Consult. Clin. Psychol., 47 (1979) 592–594), their knowledge of heroin names did not exceed that of marijuana names. Names for drugs appear to be more specifically learned and partly independent of drug habits, since associations which arise from the knowledge of a drug name generally surpassed those associations based on verbal habits. An exception was found for opiates other than heroin which appeared to be related to certain peculiarities of the opiate response options. Generic drug names (examples, hydromorphone, meperidine, diazepam) were generally less well known than the corresponding trade names (Dilaudid, Demerol, Valium). There are exceptions such as methadone which was more well known than Dolophine. Words referring to a general classification were more frequently known than names of specific drugs within a class, but there are many exceptions such as heroin. The tests designed for this study are presumed to be partial indicators of exposure to specific drug-taking subcultures measured by accurate knowledge of drug names and conditioned verbal drug habits measured by associations of drug-relevant words with drugs. Differential knowledge of drug words has implications for the use of these words in questionnaire studies.     

Reinforcements from the first drug experience can predict later drug habits and/or addiction: Results with coffee,cigarettes, alcohol,barbiturates, minor and major tranquilizers,stimulants, marijuana,hallucinogens, heroin,opiates and cocaine

The relationship between the reinforcing quality of the first drug experiences and eventual habits for a variety of drugs was studied in 42 male drug abusers who were predominantly opiate addicts. These subjects volunteered for drug studies carried out by the Addiction Research Center. The degree of reinforcement they derived from their first drug experience was related to their subsequent habit. This was true for alcohol, barbiturates, minor tranquilizers, cocaine, stimulants, marijuana, glue or solvents, hallucinogens, opiates other than heroin and heroin. Positive but non-significant correlations were found for coffee and major tranquilizers. The correlation for cigarettes was contrary to expectations. Of the components to the index of reinforcement, degree of liking of a drug on the first occasion was most related to the subsequent habit. The greatest initial reinforcement scores were found for heroin, cocaine and opiates other than heroin. Drugs which were not well liked on the first occasion included major tranquilizers, cigarettes, coffee, and glue.     

Altered HPA axis responsivity to metyrapone testing in methadone maintained former heroin addicts with ongoing cocaine addiction.

Metyrapone testing, a provocation of hypothalamic-pituitary-adrenocortical (HPA) axis function, was performed in 39 in-patient subjects: 10 stable methadone-maintained former heroin addicts without ongoing drug or alcohol abuse or dependence (MM), eight methadone- maintained former heroin addicts without ongoing drug or alcohol abuse or dependence other than ongoing cocaine dependence (C-MM), and 21 normal volunteers (NV). Plasma adrenocorticotrophic hormone (ACTH) levels were determined in samples drawn at 9A.M., just before administration of 2.25 g metyrapone orally and 4 and 8 hours afterward. Following metyrapone, C-MM had levels of ACTH that were significantly higher than both MM (p < .05) and NV (p < .01); whereas, MM and NV had levels that were comparable. Area under the plasma ACTH curves yielded similar results. This study documents hyper-responsivity to removal of glucocorticoid negative feedback associated with cocaine addiction, even in the setting of methadone maintenance for heroin addiction, which here and previously has been shown to be associated with normalization of HPA axis function.     

Five Patterns of Darvon Abuse

The “United Kingdom Statistics of Drug Addiction and Criminal Offences Involving Drugs” (published by the Home Office) gives the following data as of 31st December 1969: of the total number of 1466 known drug addicts (namely, addicts to hard drugs), 499 were taking heroin, and more than double that number, namely 1011, were taking methadone (either alone or with other drugs). A footnote explains that “as a result of a deliberate policy adopted by Hospital Clinics in the treatment of heroin addiction, of weaning patients from heroin on to methadone, methadone has supplanted heroin as the drug most commonly used by addicts.” What is meant by the phrase “most commonly used by addicts” is probably, “most commonly prescribed to addicts,” as, of course, the number of abusers or addicts buying “Chinese heroin” or English heroin or methadone on the black market is unknown. There is, in fact, a certain amount of black market dealing in these and other drugs going on.     

Documented poor sleep among methadone-maintained patients is associated with chronic pain and benzodiazepine abuse,but not with methadone dose

Following the findings of perceived poor sleep and of chronic pain among former heroin addicts, current methadone maintenance treatment (MMT) patients, and its possible relation to methadone dose, we studied these patients' objective sleep parameters. Former heroin addicts maintained on “Low” (n = 19, < 80 mg/d) or “High” (n = 25, > 150 mg/d) methadone doses, underwent one-night polysomnography (PSG). Patients filled Pittsburgh Sleep Quality Index (PSQI) and chronic pain questionnaires, and current drug abuse was assessed by urine tests.ResultsOf the 44 patients, 18 (40.9%) had chronic pain, while 24 (54.5%) abused BDZ. “High” vs. “Low” methadone dose groups had more years of opiate abuse and lower % of NREM (non rapid eye movement) deep sleep (stages 3–4) with no other differences between groups. Years of opiate abuse and NREM stages 3–4 inversely correlated (R = − 0.34, p = 0.03). Chronic vs. non-chronic pain patients had lower sleep efficiency and sleep time, and higher wake stage. BDZ abusers vs. no-BDZ abusers had shorter % of NREM stages 3–4, shorter REM % and longer % of NREM light sleep (stage 2). Perceived sleep (as assessed by the PSQI) was worse among the chronic pain group and among the BDZ abusers.ConclusionsPatients with chronic pain or BDZ abuse presented both perceived and objective poorer sleep, regardless of methadone dosage. Sleep evaluation and treatment should address these two prevalent conditions in order to improve MMT patients' quality of sleep (and of life) and overall treatment outcome.     

The Making of the Chronic Addict

Inspired by social problems theory, this article analyzes the “formula story” of harm reduction in a Danish addiction-treatment context. In Denmark, very few opiate addicts are in drug-free therapeutic treatment. Instead, they are offered methadone (often on a permanent basis) accompanied by practical help in tackling the negative social, economic, and health-related consequences of their drug use. The aim of this article is to show how the formula story of harm reduction—and first and foremost the idea that opiate addiction is an incurable condition—tends to work as a self-fulfilling prophesy. Opiate addicts entering the treatment system risk being “made up” as chronic addicts regardless of how they themselves look upon their own addiction problem and notwithstanding that many of them have not given up their hope of becoming drug-free. The article is based on two types of data: (1) file records (gathered in 2007) describing the addiction problems and treatment careers of clients enrolled at outpatient treatment centers in Copenhagen, and (2) qualitative interviews (conducted in 2006) with 30 methadone-program participants at the centers. The analysis is qualitative and the empirical results cannot necessarily be generalized to other methadone-maintenance programs. Yet the theoretical message of the article is applicable to all treatment institutions and social problems work in general. Definitions and categorizations of clients are not innocent, and naming people and their problems is the same as changing them.     

Cocaine abuse among heroin addicts in Spain

Abuse of cocaine is becoming a major problem among heroin addicts in Spain. Between 1987 and 1988, 75% of patients admitted as inpatients for detoxification from opiate dependence had consumed cocaine during the 6 months prior to admission and 25% had abused cocaine daily or several times/week. These cocaine abusers showed more toxicologic and psychopathologic problems than opiate addicts who did not abuse cocaine. The opiate addicts who also abused cocaine had begun using illicit drugs earlier and showed a higher frequency of anti-HIV antibodies. They also had more antisocial personality disorders and persistence of depressive symptoms during opiate detoxification than heroin addicts who did not abuse cocaine. Based on these findings, we insist on the need to develop different treatments for detoxifying patients with this dual addiction.     

Desire Thinking across addictive behaviours: A systematic review and meta-analysis

IntroductionDesire Thinking (DT) is a voluntary cognitive process aimed at orienting to prefigure images, information, and memories about positive target-related experience. It comprises of two components: Imaginal Prefiguration and the Verbal Perseveration. DT has been found to be positively associated with alcohol use, gambling, nicotine use, and problematic Internet use. Despite this, neither qualitative nor quantitative reviews have been undertaken to critically summarize findings about the association between DT and addictive behaviours. The aim of this systematic review and meta-analysis is to evaluate the strength of the association between DT and addictive behaviours.MethodIn accordance to PRISMA criteria, a research was conducted on PubMed and PsycInfo. A manual search of reference lists was also run. Search terms were: “addiction / gambling / alcohol / tobacco / nicotine / drug / cocaine / marijuana / cannabis / opioid / heroin / methadone / internet” AND “Desire Thinking”.ResultsTen studies were included. Both components of DT were found to be associated with addictive behaviours (alcohol use, nicotine use, gambling, problematic Internet use) in both clinical and community samples. The strength of the association between Verbal Perseveration and addictive behaviours appears to be stronger for alcohol and nicotine use than Internet use. The association between DT and addictive behaviours is not moderated by age.ConclusionDT is present across different addictive behaviours. The assessment of DT and tailored interventions aimed to reduce the propensity to engage in DT should be considered in the treatment of addictive behaviours.     

The diagnosis of alcohol, cocaine, and other drug dependence in an inpatient treatment population

The diagnosis of alcohol, cocaine, and other drug dependence in inpatient treatment populations is important to identify for clinical prognosis, treatment, and genetic research. The use of alcohol by cocaine addicts is a common cause for relapse to cocaine. The treatment of cocaine addiction is simplified if alcohol dependence is also present because the same methods can be used for both. In this study, 94% of those patients who qualified for the diagnosis of cocaine dependence were also diagnosed as having alcohol and other drug dependence. The demographic characteristics of these cocaine addicts (n = 413) compared to those patients with the diagnosis of alcohol dependence only (n = 677) and alcohol dependence and drug dependence other than cocaine (n = 453).     

Oxidative stress enzyme status and frequency of micronuclei in heroin addicts in Turkey

Abstract

Heroin is among the most widely used and dangerous addictive opiate. The World Health Organization (WHO) estimated that more than 15 million people are under the influence of opiate addiction. The aim of this study was to investigate copper zinc-superoxide dismutase (Cu,Zn-SOD), catalase (CAT) and selenium-dependent glutathione peroxidase (Se-GPx) antioxidant enzyme activities, malondialdehyde (MDA) levels and the frequency of micronuclei (MN) in addicts using heroin, the most commonly abused opiate in Turkey. Addicts were defined as individuals diagnosed according to “Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)” criteria by the “Alcohol and Substance Abuse Treatment and Education Centre-Ankara (AMATEM)”. The control group had no addiction. In comparisons between the groups, a significant decrease in Cu,Zn-SOD activity and increases in MDA levels and MN frequency were observed in addicts. It can be concluded that opiates may cause oxidative stress and that antioxidant supplementation, in addition to pharmacological and psychiatric approaches, can reduce the toxicological effects of these opiates.     

Onset and pattern of substance use in intravenous drug users of an opiate maintenance program

OBJECTIVES: To assess the initiation of substance use of participants in an opiate maintenance program by a cross-sectional survey. METHOD: Participants (n=184) filled out a questionnaire assessing age at initial substance use and age at onset of regular drug use. RESULTS: Of 15 substances investigated, alcohol, nicotine, analgesics and marijuana were initiated and consumed regularly before the age of 18 years. Barbiturates, benzodiazepines, cocaine, and opiates were begun later. The time gap between initial and regular use varied depending on the substance. Regular use exceeded 50% for alcohol, benzodiazepines, cocaine, heroin, marijuana and nicotine. CONCLUSIONS: Specific knowledge about the age of onset and sequence of substances used by drug addicts may help to prevent substance use more age specifically.     

Integrating the methadone patient in the traditional addiction inpatient rehabilitation program--problems and solutions

Physicians have reported alcoholism and opioid addiction as co-morbid conditions since the 19th century. From the inception of methadone maintenance treatment, heroin addicts with serious alcohol conditions have enrolled in methadone maintenance programs. Programs that treat alcoholism, including the traditional addiction inpatient rehabilitation programs of the Addiction Treatment Centers (ATCs) operated by New York State, have based their treatment regimen on 12-step abstinence models. Methadone maintenance was considered antithetical to this philosophy. It was regarded as simply substituting one drug for another and not a legitimate treatment for opiate dependence. Therefore, methadone patients were often not accepted into alcohol treatment programs, since they were perceived as active addicts taking a mood-altering drug. Alcohol-related conditions among methadone patients are major causes of liver disease and death, and behavior problems associated with excessive drinking are major reasons for discharging patients. To address these issues and the lack of treatment facilities, the administration of the New York State Office of Alcoholism and Substance Abuse Services (OASAS), which licenses both methadone programs and the ATCs in New York State, realized that many of the methadone patients with alcohol problems are in need of the services provided at the ATCs. They instituted, therefore, a rigorous educational effort for the medical and counseling staffs of the ATCs, designed to integrate methadone treatment into the ATC treatment framework. Eighty percent of the 220 methadone patients who entered the ATCs in a demonstration project during the 1997/1998 state fiscal year have been compliant with the treatment regimen. These results have led to acceptance of methadone patients into the ATCs.     

Is Slow-Onset Long-Acting Monoamine Transport Blockade to Cocaine as Methadone is to Heroin? Implication for Anti-Addiction Medications

The success of methadone in treating opiate addiction has suggested that long-acting agonist therapies may be similarly useful for treating cocaine addiction. Here, we examined this hypothesis, using the slow-onset long-acting monoamine reuptake inhibitor 31,345, a trans-aminotetralin analog, in a variety of addiction-related animal models, and compared it with methadone''s effects on heroin''s actions in the same animal models. Systemic administration of 31,345 produced long-lasting enhancement of electrical brain-stimulation reward (BSR) and extracellular nucleus accumbens (NAc) dopamine (DA). Pretreatment with 31,345 augmented cocaine-enhanced BSR, prolonged cocaine-enhanced NAc DA, and produced a long-term (24-48 h) reduction in cocaine self-administration rate without obvious extinction pattern, suggesting an additive effect of 31,345 with cocaine. In contrast, methadone pretreatment not only dose-dependently inhibited heroin self-administration with an extinction pattern but also dose-dependently inhibited heroin-enhanced BSR and NAc DA, suggesting functional antagonism by methadone of heroin''s actions. In addition, 31,345 appears to possess significant abuse liability, as it produces dose-dependent enhancement of BSR and NAc DA, maintains a low rate of self-administration behavior, and dose-dependently reinstates drug-seeking behavior. In contrast, methadone only partially maintains self-administration with an extinction pattern, and fails to induce reinstatement of drug-seeking behavior. These findings suggest that 31,345 is a cocaine-like slow-onset long-acting monoamine transporter inhibitor that may act as an agonist therapy for cocaine addiction. However, its pattern of action appears to be significantly different from that of methadone. Ideal agonist substitutes for cocaine should fully emulate methadone''s actions, that is, functionally antagonizing cocaine''s action while blocking monoamine transporters to augment synaptic DA.     

Cost effectiveness of disulfiram: treating cocaine use in methadone-maintained patients

Converging evidence suggests that disulfiram is a promising treatment for cocaine dependence. We study the cost-effectiveness of providing disulfiram to methadone-maintained opioid addicts in a randomized clinical trial setting. Our economic evaluation is based on a double blind clinical trial in which 67 cocaine-dependent methadone-maintained opioid-dependent subjects were randomized to get the additional treatment of disulfiram or placebo in a 12-week trial. Outcome measures used are the number of days of cocaine use and grams of cocaine per week. Cost measures used are the cost of providing standard methadone treatment and the incremental cost of adding disulfiram to the standard treatment. Cost measures of standard and disulfiram-enhanced treatment were collected retrospectively from the provider. Results from this cost-effectiveness analysis imply that, even though disulfiram increases slightly the cost of methadone treatment, its increase in effectiveness may be important enough to warrant its addition for treating cocaine dependence in methadone-maintained opiate addicts.     

Methadone maintenance reduces heroin- and cocaine-induced relapse without affecting stress-induced relapse in a rodent model of poly-drug use.

Although it is well established that methadone can be an effective treatment for opiate addiction, it is not clear how methadone maintenance affects cocaine use and cravings in individuals who self-administer both opiates and cocaine. In our attempt to explore the effect of methadone maintenance on the effects of cocaine, we first assessed the locomotor stimulatory effects of cocaine in rats maintained on methadone (0, 10, 20, or 30 mg/kg/day, via osmotic minipumps). Chronic methadone elevated baseline locomotion in a dose-dependent manner and did not reduce the direct stimulatory effects of cocaine (5 mg/kg). We then investigated the effects of the highest methadone maintenance dose (30 mg/kg/day) on heroin and cocaine seeking in extinction, and when it was precipitated by exposure to heroin, cocaine, or foot-shock stress in rats trained to self-administer both drugs in the same experimental context (heroin 0.05 mg/kg/inf; cocaine 0.5 mg/kg/inf, eight 3-h sessions each). In tests of reinstatement, rats responded selectively on the appropriate drug-associated lever after priming injections of heroin (0.25 mg/kg) or cocaine (20 mg/kg). Methadone maintenance blocked both cocaine- and heroin-induced reinstatement, but not stress-induced reinstatement, which was not lever selective. These results suggest that although methadone maintenance may not reduce the direct stimulatory effects of cocaine, it has the potential to reduce both spontaneous and cocaine-primed cocaine-seeking behavior.     

Comparison of patient self-reports and urinalysis results obtained under naturalistic methadone treatment conditions

This study examined under naturalistic assessment conditions the validity of self-reported opiate and cocaine use among 175 veterans enrolled in methadone treatment, and factors related to self-report validity, such as stage in treatment and drug of abuse. Veterans were interviewed by clinical staff about past 30-day drug use with the addiction severity index (ASI), and urinalysis results were obtained for the same 30-day interval assessed with the ASI. Analysis revealed that urinalysis generally produced higher rates of substance use than patient self-report, and with the exception of reported opiate use among new patients presenting for treatment, validity of patient self-reported drug use generally was poor with patients under-reporting both opiate and cocaine use. The findings are in marked contrast to those obtained in other studies in which participants are ensured confidentiality regarding their self-reports. Further, the results raise questions about the utility of self-report measures of substance use to assess patient progress or methadone program performance.     

Methadone maintenance counseling: Definition,principles, components

Counseling has been a major service component of methadone maintenance since its inception. Yet, there is no consensus about what methadone counseling is or how it should be practiced. This paper proposes a definition of professional methadone counseling as a specialized modality of addiction therapy and rehabilitation. Five principals of methadone counseling are reviewed: (1) coordination of care, (2) use of the counseling relationship, (3) attention to the stage of recovery, (4) structure and flexibility, and (5) facilitation of patient resourcefulness and social recovery. Fifteen components of methadone counseling are also reviewed. These include interventions focused on (1) the initial phase of treatment, (2) the treatment itself, and (3) the work of rehabilitation. General counseling issues are considered, such as counselor education, the role of the counselor in the program, the methadone controversy, as well as the impact of HIV disease and “crack/ cocaine”. In closing, the advantages of the proposed model are stressed.