Substance abuse history predicts depression and relapse status among cocaine abusers

This study examined the relationships between lifetime years of cocaine, alcohol, and marijuana use prior to entry into residential treatment for primary cocaine dependence and (a) intake depression levels, and (b) levels of cocaine use in the six months after completing treatment. Years of education, age, and lifetime years of cocaine and alcohol use contributed significantly to predicting depression levels. Lifetime years of alcohol use alone predicted cocaine use during the six months post-treatment.     

Drug abuse and alcohol problems among cocaine abusers in an assessment/referral service

This paper reports the social, demographic and drug abuse backgrounds of cocaine abusers seen at an alcohol and drug abuse assessment centre in Kitchener, Ontario. It compares cocaine abusers to cannabis users and alcoholics of the same age at the same centre. Cocaine and cannabis abusers are mainly young, single males while alcohol abusers are much older. The cocaine and cannabis abusers are both heavy drinkers but the cocaine group contained more high-risk drinkers, more drug injectors and had a higher alcohol consumption. Cocaine abusers are young poly-drug users for whom drinking is also a major problem. Treatment plans should take these problems into account.     

Sexual dysfunction in abusers of cocaine and alcohol

Sexual dysfunction is not uncommon in alcoholics and in cocaine addicts. Alcohol abuse frequently develops along with cocaine dependence and the reverse is also common. We examined the sexual history of this common dually-addicted population. Sexual dysfunction was found in 62% (N = 50) of male cocaine and alcohol abusers consecutively admitted to a substance disorder treatment unit. The influence of cocaine and alcohol on commonly studied neurotransmitters and hormones along with their influence on sexual function are discussed.     

Injury risk among medically identified alcohol and drug abusers

BACKGROUND: Although nonfatal injury prevalence is higher among substance abusers than in the general population, few studies have estimated the injury risk for clinically recognized substance abusers. The extant studies, moreover, analyze rates of visits for injury treatment rather than rates of injury events. This study estimates the excess risk of medically treated and hospitalized nonoccupational injury for people under age 65 with medically identified substance abuse problems and private health care coverage. METHOD: We conducted a retrospective cohort study by using medical claims data from Medstat Systems, Inc., with a longitudinal database of health care claims for 1.5 million people with health care coverage from 70 large corporations. Claims histories for anyone who had an alcohol-related or drug-related primary or secondary diagnosis during 1987 to 1989 were analyzed. A random sample was selected from the remaining people without a substance abuse diagnosis in their medical records. Injury rates were compared among groups. We used logistic regression to estimate odds of medically treated and hospitalized injury, controlling for demographics. RESULTS: Medically identified substance abusers had an elevated risk of injury in a 3-year period; alcohol and drug abusers had the highest risk (58%), followed by drug-only abusers (49%), alcohol-only abusers (46%), and controls (38%). Alcohol and drug abusers were almost four times as likely to be hospitalized for an injury in a 3-year period when compared with controls. Injury risks were elevated substantially more for female then male substance abusers. CONCLUSIONS: This study greatly improves on available information about the risk of injury for drug and multiple-substance abusers. Medically identified substance abusers, especially adult women, have a higher probability of injury, more hospitalized injuries, and more injury episodes per person injured than nonabusers. More aggressive identification and subsequent treatment of female substance abusers appear warranted.     

Withdrawal and dependency symptoms among adolescent alcohol and drug abusers

Due to differences in duration, intensity and topography of alcohol and drug use patterns, the withdrawal and dependency symptoms of adolescent substance abusers may differ from those of adult substance abusers. To explore these potential differences, 166 adolescents recruited from inpatient alcohol and drug treatment programs in the USA were assessed for alcohol and other drug withdrawal and dependency symptoms. Teens were administered the Customary Drinking and Drug Use Record following 2 weeks of abstinence and evaluated for recent (< 3 months) DSM-III-R psychoactive substance withdrawl and dependency symptoms. Adolescents were all multiple substance users with a life-time average of 4.27 drugs used in addition to alcohol. Amphetamines were the most frequently used drug (50% of sample) and the most prevalent withdrawal symptoms were those associated with central stimulant use. However, the number of different withdrawal symptoms (M= 11.27) was greater than expected for uncomplicated stimulant withdrawal or withdrawal from any single substance. On average, participants reported dependency symptoms more than DSM-III-R criteria for the diagnosis of alcohol dependency (M = 3.30), as well as dependency on their two most frequently used drugs. Heavy alcohol and cigarette use were found to exacerbate withdrawal symptoms of other drugs. These findings highlight the importance of assessing adolescent substance abusers for withdrawal from and dependency on multiple substances.     

Individual and family characteristics of middle class adolescents hospitalized for alcohol and other drug abuse

The frequency of alcohol and drug use, abuse and severity of dependence, and personality and family characteristics in 280 female and male hospitalized adolescents in treatment for chemical dependence and 120 middle class adolescents were examined. A MANOVA showed that parents' drug and alcohol use was a main effect, increasing frequency of use and severity of dependence upon alcohol and drugs in both groups of adolescents. Sexual and physical abuse studied in the patient group also functioned as a main effect. Patients reported significantly less family interests, and participation in intellectual, cultural and social activities, but more control than the comparison group. It was concluded that adolescent alcohol and other drug abuse is part of a biopsychosocial syndrome of problem behavior, which includes the problem behavior of parents and the interacting family unit.     

Psychopathology in chronic cocaine abusers

A group of 30 hospitalized cocaine abusers were studied, along with 124 hospitalized patients who were dependent upon opiates or central nervous system depressants. DSM-III diagnoses, family history data, demographic characteristics, and measures of current depressive symptomatology were compared in the two groups. Nineteen (63%) of the cocaine abusers met criteria for an Axis I diagnosis other than substance abuse; sixteen (53%) had affective disorder. These figures reflected a significantly higher prevalence rate of affective disorder among the cocaine abusers than among the opiate and depressant abusers. In addition, a significantly higher rate of affective disorder was found in the first degree relatives of the cocaine abusers when compared to the other group. Since these findings suggest that a substantial number of cocaine abusers may be suffering from other psychiatric disorders, careful diagnostic evaluation is indicated in this population.     

The impact of contingency management on quality of life among cocaine abusers with and without alcohol dependence

The use of quality of life (QOL) measures in substance abuse treatment research is important because it may lead to a broader understanding of patients’ health status and effects of interventions. Despite the high rates of comorbid cocaine and alcohol use disorders, little is known about the QOL of this population, and even less about the impact of an efficacious behavioral treatment, contingency management (CM), on QOL. In this study, data from three clinical trials were retrospectively analyzed to examine QOL in outpatient cocaine abusers with and without alcohol dependence (AD) and the impact of CM on QOL over time as a function of AD status. Patients were randomized to standard care (n = 115) or standard care plus CM (n = 278) for 12 weeks. QOL was assessed at baseline and Months 1, 3, 6, and 9. At treatment initiation, AD patients had lower QOL total scores and they scored lower on several subscale scores than those without AD. CM treatment was associated with improvement in QOL regardless of AD status. These data suggest that CM produces benefits that go beyond substance abuse outcomes, and they support the use of QOL indexes to capture information related to treatment outcomes. (Am J Addict 2011;21:47–54)     

Meta-analyses in alcohol and other drug abuse treatment research

Meta-analysis is a quantitative method of synthesizing empirical evidence across a collection of related studies and addresses many of the weaknesses of traditional narrative forms of reviewing. This paper describes the basic methods for conducting a state-of-the-art meta-analysis and criticizes 11 extant meta-analyses of alcohol and other drug abuse treatment programs. Eight of these 11 meta-analyses used questionable methods and contributed little to our understanding of the effects of these programs. The paper concludes with a proposal for an archive of alcohol and other drug services research to facilitate and improve the quality of future meta-analyses.     

Subtyping male alcoholics by family history of alcohol abuse and co-occurring psychiatric disorder: a bi-dimensional model

Six studies of 568 alcoholics in treatment are summonsed to illustrate the interactive effects of familial alcoholism, other forms of family psychopathology and the lifetime prevalence of additional psychiatric disorder on the onset and course of male alcoholism. A family history of alcoholism as well as additional co-occurring psychiatric syndromes were associated with (1) earlier onsets of problem drinking, (2) a more virulent course and (3) greater heterogeneity of psychopathology among first degree relatives. A bi-dimensional method of classifying male alcoholics is proposed which combines a family history of abusive drinking and the presence or absence of co-morbid psychiatric disorders. Implications for the clinical researcher and practitioner are briefly discussed.     

Reason for medical hospitalization among adult alcohol and drug abusers.

This study attempts to identify the associations between types of substance use and particular medical problems as causes of acute hospital admission on an inpatient substance abuse consultation service. Records of all consultations performed from 1994 to 1998 were analyzed. A total of 4,526 complete records were available. Cocaine (p < .01), heroin (p < .001), and injection drug (p < .001) users were more likely to be admitted to the hospital for infection. Both alcohol (p < .001) and marijuana (p < .001) users were more likely to be hospitalized for trauma related injuries. Individuals that used alcohol were also more likely to be admitted for the treatment of gastrointestinal disorders (p < .001). Clinicians who treat patients with these diagnoses should have a high index of suspicion of co-morbid substance use disorders. Effective treatment of substance use disorders can lead to a decrease in medical morbidity, improved outcomes for individual patients, and decreased costs for the health care system.     

Stroke in 19 year-old man with drug and alcohol abuse

We report a case of a 19 year-old man with stroke, who was taking cocaine, marihuana and alcohol for a few days before hospitalisation. Diagnostic tests showed protein C insufficiency and patent foramen ovale (PFO). As a result of the therapy neurological symptoms have regressed.     

Network therapy for cocaine abuse: use of family and peer supports

Cocaine-dependent subjects were treated by psychiatric residents in a 24-week sequence of Network Therapy. This approach, developed for practitioners in solo practice, employs a cognitive-behavioral orientation in sessions with family and peers as well as in individual sessions. Of 47 subjects, 73% of all observed weekly urines were negative for cocaine, and 20 (45%) of the subjects had negative toxicologies in the last 3 scheduled samples. A positive outcome was associated with the number of network (but not individual) sessions attended and completion of the full treatment sequence. Results suggest the utility of Network Therapy, even in the hands of relatively naive therapists.     

Neuropsychological impairment in chronic cocaine abusers.

Twenty chronic cocaine abusers were compared with age and education matched controls using standardized neuropsychological assessment procedures to determine whether the cocaine abusers were impaired. Fifty percent of the cocaine abusers in contrast to 15% of the controls scored in the impaired range on the summary index of the Neuropsychological Screening Exam. The cocaine abusers also performed more poorly on the Halstead Category Test, the Symbol Digit Modalities Test, the WAIS-R Arithmetic Test, and a test of verbal memory (forgetting). In the cocaine abuser sample, neuropsychological performance was related to the amount and recency of cocaine use, suggesting a direct role of cocaine on cognitive functioning.