Which Relapse Criteria Best Predict the Mortality Risk of Treated Alcoholics?

We examined which relapse criteria best predict the mortality risk of treated male alcoholics. The subjects were 172 male alcoholics who had previously been hospitalized. Using three criteria which defined relapse as failure to maintain abstinence from alcohol, alcohol abuse, or dependence, the relapse of each subject had been evaluated during a previous 3-year outcome study. Relative mortality risks in the next 3 years classified by the three relapse criteria were compared. The follow-up rate was 93.6% and 31 subjects died. The age-corrected relative mortality risk for subjects failing to maintain abstinence compared with abstainers was 5.32, while the relative mortality risks for the group abusing alcohol and for the group suffering alcohol dependence were 2.23 and 2.56, respectively. These results suggest that relapse defined as failure to maintain abstinence predicts a higher relative mortality risk than do criteria defining in terms of alcohol abuse and alcohol dependence.     

Six-Month Follow-Up of Short-Term Pharmacotherapy for Cocaine Dependence

This 6-month follow-up study of 43 of 72 patients who entered a 6-week randomized clinical trial of pharmacotherapy for cocaine dependence found that self-reported cocaine abstinence during the 6 months was significantly greater in patients treated with desipramine (44%) than in those treated with lithium (19%) or placebo (27%). The placebo group had more occurrences of depression (36% vs. 6%) and daily alcohol abuse (36% vs. 15%) than the medicated groups. The ability to abstain from cocaine use during the clinical trial was the strongest predictor of continued abstinence during the follow-up, which showed that 53% remained abstinent after 6 months.     

Follow-up of 180 alcoholic patients for up to 7 years after outpatient treatment: impact of alcohol deterrents on outcome

OBJECTIVE: (1) To perform a 9-year study of abstinence, lapse, and relapse in 180 chronic alcoholic patients, participants of the Outpatient Longterm Intensive Therapy for Alcoholics (OLITA); (2) To investigate the role of supervised alcohol deterrents (AD) in relapse prevention and as an adjunct for maintenance of long-term abstinence. METHOD: This prospective open treatment study evaluates the long-term course of drinking outcomes and AD use of 180 chronic alcoholics consecutively admitted from 1993 to 2002. Subsamples are compared for (1) sham-AD versus verum-AD (disulfiram/calcium carbimide), (2) coped lapses versus finally detrimental lapses versus malignant relapses, and (3) AD use for 13 to 20 versus >20 months. RESULTS: In this 9-year study, the cumulative probability of not having relapsed was 0.52, and that of not having consumed any alcohol was 0.26. Despite long-term use, disulfiram/calcium carbimide was well tolerated. Patients on sham-AD (due to contraindications to verum-AD) showed higher cumulative abstinence probability than patients on verum (S = 0.86 vs. S = 0.49, p = 0.03). Detrimental lapses and malignant relapses occurred earlier than successfully coped lapses (p < 0.001); patients with detrimental lapse and with malignant relapse had fewer days of AD intake and less subsequent days without AD than patients with coped lapse (p < 0.001). The cumulative abstinence probability was S = 0.75 for patients with long-term intake compared with S = 0.50 for patients who stopped AD between months 13 and 20 (p < 0.001). CONCLUSIONS: An abstinence rate of >50% in this 9-year study strongly supports the concept of comprehensive, long-term outpatient treatment of alcoholics. Supervised, guided intake of AD, also over extended periods, can be used as a predominantly psychologically acting ingredient of successful alcoholism therapy.     

The Short-Term Psychological Health of Alcoholic and Non-Alcoholic Liver Transplant Recipients

In response to limited resources and overwhelming clinical need, we previously developed an approach to alcoholic patient selection for liver transplant based on factors reported to predict short- and long-term sobriety in prospective studies of alcoholics. The present study reports follow-up data comparing alcohol dependent (n = 22, DSM-3-R criteria) and non-dependent (n = 39) subjects followed from 6 months to 3 years post-transplant. Nine percent of the alcoholics had returned to symptomatic drinking with 14% reporting some exposure to ethyl alcohol. Nearly half (46%) of the non-alcoholic group reported occasional social alcohol use. The alcoholic patients were less likely to be in their first marriage and more likely to be asked about alcohol use at follow-up clinic visits. In most other respects the two groups resembled each other more often than they differed. The alcoholic group reported continued high rates of prognostic factors associated with long-term abstinence although the content of these shifted noticeably between pre- and postoperative assessment. Members of both groups reported high frequencies of medication side effects, of missed doses of medications, and of depressive symptoms. Most felt the transplant had improved their lives but had brought on significant financial burden. There were no differences in subjective appraisals of either psychological or physical health between the two groups. These follow-up data suggest that carefully selected alcohol dependent patients will do as well as non-dependent patients after liver transplant.     

Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: post-intervention outcomes

Aims Due to the chronicity of cocaine dependence, practical and effective maintenance interventions are needed to sustain long‐term abstinence. We sought to assess the effects of long‐term employment‐based reinforcement of cocaine abstinence after discontinuation of the intervention. Design Participants who initiated sustained opiate and cocaine abstinence during a 6‐month abstinence reinforcement and training program worked as data entry operators and were randomly assigned to a group that could work independently of drug use (control, n = 24), or an abstinence‐contingent employment (n = 27) group that was required to provide cocaine‐ and opiate‐negative urine samples to work and maintain maximum rate of pay. Setting A non‐profit data entry business. Participants Unemployed welfare recipients who persistently used cocaine while in methadone treatment. Measurements Urine samples and self‐reports were collected every 6 months for 30 months. Findings During the employment year, abstinence‐contingent employment participants provided significantly more cocaine‐negative samples than controls (82.7% and 54.2%; P = 0.01, OR = 4.61). During the follow‐up year, the groups had similar rates of cocaine‐negative samples (44.2% and 50.0%; P = 0.93) and human immunodeficiency virus risk behaviors. Participants' social, employment, economic and legal conditions were similar in the two groups across all phases of the study. Conclusions Employment‐based reinforcement effectively maintains long‐term cocaine abstinence, but many patients relapse to use when the abstinence contingency is discontinued, even after a year of abstinence‐contingent employment. Relapse could be prevented in many patients by leaving employment‐based abstinence reinforcement in place indefinitely, which could be facilitated by integrating it into typical workplaces.     

A Placebo-Controlled, Double-Blind Study of Fluoxetine in Severe Alcohol Dependence: Adjunctive Pharmacotherapy During and After Inpatient Treatment

Twenty-eight male patients with severe alcohol dependence (mean pretreatment consumption of 18.6 standard drinks per day) completed a placebo-controlled, double-blind clinical trial of fluoxetine (60 mg/day). They were assigned to medication group in the second of 4 weeks on a voluntary inpatient chemical dependency ward and continued medication during a 12-week follow-up phase. Fluoxetine did not reduce clinically significant relapse rates: only 8 of 15 (53%) of fluoxetine subjects remained sober at 12 weeks, compared with 9 of 13 (69%) of the placebo group (Fisher's exact test, p = 0.46). Subjects with comorbid cocaine dependence relapsed more than twice as often (3 of 4, 75%) as those with alcohol dependence alone (8 of 24, 33%), although this trend did not reach statistical significance because of the small number of dually dependent subjects (Mann Whitney U test = 68, p = 0.13). Supportive living arrangements after hospital discharge did reduce relapse rates: 8 of 9 subjects (89%) discharged to a Veterans Affairs domiciliary were sober at 12 weeks, compared with 9 of 19 (47%) subjects discharged back to the community (Mann-Whitney U test = 125, p = 0.02). Fluoxetine-treated subjects who remained sober at 12 weeks reported a significant decrease in mean subjective alcohol craving scores from 2.9 to 0.7 on a 10-point scale ( t = 2.828, p = 0.02). In summary, fluoxetine did not reduce clinical relapse rates in this sample of male severe alcoholics without other axis I disorders who completed 4 weeks of in-patient alcoholism treatment.     

A 2-Year Follow-Up of 120 Swedish Female Alcoholics Treated Early in Their Drinking Career: Prediction of Drinking Outcome

BACKGROUND: One hundred twenty women alcoholics recruited to a treatment program called EWA (Early Treatment for Women With Alcohol Addiction) were studied. The selected women were not previously treated for alcohol abuse. METHODS: The women were followed up by use of a structured personal interview, biomarkers sensitive for alcohol abuse (i.e., glutamyl transpeptidase), and questionnaires, by using defined criteria for abstinence, social drinking, satisfactory drinking outcome, and unsatisfactory drinking outcome. RESULTS: Drinking outcome was good (i.e., total abstinence, social drinking, or satisfactory drinking outcome) for 67% of the women during the total follow-up time, by use of strict criteria for relapse. The results were corroborated by the biomarkers. Similar results were reported from two previously studied groups of women from the same department. However, the frequency of abstinence was higher and social drinking was significantly lower among this sample of women. Daily drinking, the use of sedatives, and a long duration of pretreatment alcohol abuse predicted an unfavorable outcome. However, a long duration of outpatient treatment predicted a good outcome, whereas treatment dropout was related to an unsatisfactory drinking outcome. A majority of the women (96%) rated the treatment experience and the treatment program favorably. The overall good results might reflect the selection of the subjects studied. CONCLUSIONS: Improving treatment program adherence would probably improve outcome for the women with an unsatisfactory drinking outcome.     

Resting Hand Tremor in Abstinent Cocaine-Dependent, Alcohol-Dependent, and Polydrug-Dependent Patients

Laboratory studies of cocaine-exposed rodents, and positron emission tomographic studies of human cocaine abusers have suggested that chronic cocaine abuse downregulates dopaminergic function in the basal ganglia. The present study sought to provide behavioral evidence for this phenomenon by demonstrating enhanced levels of resting hand tremor among patients with previous histories of cocaine dependence. To determine the specificity of the phenomenon, patients with previous histories of alcohol dependence, cocaine/alcohol codependence, and cocaine/opiate codependence were also evaluated. Patients were assigned to one of four groups according to DSM-IIIR diagnostic criteria: (1) cocaine dependent (n = 19); (2) cocaine and alcohol dependent (n = 12); (3) cocaine and opiate dependent (n = 7); (4) alcohol dependent (n = 9). All were abstinent from their primary drug of abuse for a period of 1 to 5 months. The three patient groups with histories of cocaine dependence exhibited significantly more resting hand tremor than the alcohol-dependent and normal control groups. Furthermore, hand tremor in the former three groups was positively related to the number of self-reported uses of cocaine and negatively related to the number of months of cocaine abstinence.     

Comparative Evaluation of the Clinical Utility of Three Markers of Ethanol Intake: The Effect of Gender

We evaluated three markers of ethanol intake [whole blood associated acetaldehyde (WBAA), serum β -hexosaminidase, and γ -glutamyl transpeptidase (GGT)] in four groups of subjects: teetotalers ( n = 104), random insurance applicants or "normals"( n = 1,010), subjects enrolling in an alcohol treatment program or "alcoholics"( n = 31), and subjects attending outpatient drug/alcohol treatment follow-up clinics ( n = 128). Significant differences ( p < 0.004 for each assay and each comparison) were found in the mean values between teetotalers and normals and normals and alcoholics. Male teetotalers and normals had significantly ( p < 0.002) higher levels of WBAA than females of the same group. Male normals had significantly higher levels of GGT than females ( p < 0.001). GGT increased with age in the normal population into the fifth decade and decreased thereafter. WBAA was the most sensitive assay with 97% of alcoholics having values above the 99th percentile for the teetotaler population (vs. 66% for serum β -hexosaminidase and 70% for GGT). None of the alcoholic subjects had values for all three assays below the 99th percentile for teetotalers compared with 21% of those in follow-up and 72% of normals. We conclude that WBAA appears to be the best of the three markers studied and that measurement of multiple markers for ethanol use appears clinically useful and incremental.     

Serum sialic acid levels are increased during relapse to alcohol drinking: a pilot study

BACKGROUND: Sialic acid has been suggested to be a potential marker for alcohol abuse. A previous study showed that sialic acid levels were significantly higher in serum among alcoholics as compared with social drinkers. In addition, serum sialic acid concentrations decreased after a treatment program aiming at abstinence. In this study, sialic acid was investigated as a possible marker for relapse to alcohol drinking. METHODS: Serum from alcohol-dependent patients in outpatient treatment ( n = 8) was analyzed for sialic acid by a colorimetric assay. A baseline sample was taken when the subject had been abstinent for longer than 4 weeks. A second sample was taken after relapse within 3 days after cessation of drinking. A relapse was defined as two or more days with daily drinking of more than 60 g of pure alcohol. RESULTS: The sialic acid levels were significantly increased by 21% (median; range, 6-33%; < 0.01; n = 8) after a relapse as compared with the level after 4 weeks or longer of abstinence. CONCLUSIONS: This study suggests that serum sialic acid levels are significantly increased even after a short period of heavy drinking and may be a potential marker for relapse.     

Long-acting injectable bromocriptine does not reduce relapse in alcoholics

Abstract Dopamine is one of several neurotransmitters that may mediate alcohol intake and dependence. A randomized, double-blind, placebo-controlled international, multicentre study was conducted to assess the effects of a long-acting injectable preparation of bromocriptine, a dopamine agonist, (Parlodel-LAR ) in reducing relapse in 366 moderately/severely dependent alcoholics (DSM-III-R), drinking approximately 200 g alcohol (14.5 standard drinks) per day. After detoxification they were randomized to receive six monthly injections of bromocriptine 25 mg ( n= 120), bromocriptine 50 mg ( n= 124), or placebo ( n= 122). Brief psychosocial treatment was allowed. At 6 months there were no significant differences between treatment groups in rates of relapse to any drinking or to drinking 5 days per month and 3 drinks per day. Pre-treatment alcohol intake did not determine response. Efficacy ratings by subjects and investigators and adverse events, reported by 51% of subjects, did not differ between treatments. The results of this large study, in which compliance was enhanced by Parlodel-LAR , do not indicate that bromocriptine is efficacious in the maintenance of abstinence or reduced drinking. Possible reasons for the discrepancy between these conclusions and those of some previous clinical trials, in which bromocriptine was reported to reduce symptoms of alcohol withdrawal and dependence, are discussed.     

Motivational enhancement and coping skills training for cocaine abusers: effects on substance use outcomes

AIMS: This clinical trial investigated effects of motivational enhancement treatment (MET) and group coping-skills training (CST) tailored for cocaine dependence. Effects of MET were hypothesized to be greater with CST and for less motivated patients. DESIGN AND INTERVENTIONS: A 2 x 2 design investigated two individual sessions of MET compared to meditation-relaxation (MRT), followed by four group sessions of CST versus drug education (ED), as daily adjuncts to intensive treatment. SETTING: The substance abuse program provided full-day treatment with a learning-theory and 12-Step orientation. PARTICIPANTS: Cocaine-dependent patients were recruited. MEASUREMENTS: Assessment included treatment retention; change in cocaine-related urge, self-efficacy, pros and cons, and motivation; substance use and problems during 12-month follow-up. Findings Of 165 patients, follow-up status is known for 90% (n = 149). Patients in MET with low initial motivation to change reported less cocaine and alcohol relapse and use days and fewer alcohol problems than MET patients with higher initial motivation. MET produced more employment improvement than MRT, with no other significant benefit for MET. Patients with higher motivation had more cocaine use and alcohol problems after MET than MRT. Group CST reduced cocaine and alcohol use during follow-up for women only and reduced alcohol relapse for men and women. CONCLUSIONS: MET is more beneficial for patients with lower initial motivation than for patients with high initial motivation. CST reduced cocaine and alcohol use for women only and reduced alcohol relapses, in contrast to results with lengthier individual CST.     

Variation in Alcoholism Treatment Orientation: Differential Impact upon Specific Subpopulations

Treatment programs across the State of New York were studied to determine the differential impact of treatment orientations upon various types of alcoholism clients. 1340 patients from 17 alcoholism treatment programs were treated and followed up 3 and 8 months after treatment. The majority of the clients were categorized as either Behaviorally Impaired Drinkers (n=205) or Alcoholics (n = 814). Each of the treatment programs were classified according to either Peer Group, Rehabilitation Professional, or Medical Orientations. Three different outcome measures were examined: abstinence, amount of alcohol consumed at follow-up, and improvement (life and drinking) at follow-up. The generalizable conclusions were that females had significantly better outcome (78% abstinent) when treated according to a medical orientation. Male Behaviorally Impaired Drinkers had better outcomes when treated in Rehabilitation Professional Orientation (74% abstinent) and male alcoholics had the best outcome in Peer Group (60% abstinent), although male alcoholics achieved similar abstinence rates in Medical (59.5%) and Rehabilitation (55%) orientations.     

Effectiveness of naltrexone in a community treatment program

OBJECTIVE: In several large, well-designed, randomized, double-blind studies, the opiate antagonist naltrexone demonstrated efficacy in the treatment of alcohol dependence. Specifically, when combined with certain psychosocial therapies, naltrexone reduces the number of drinking days, heavy drinking, and time to relapse to alcohol use in alcohol-dependent individuals. Whether this efficacy can be generalized to individuals who have alcohol use disorders and present for treatment at front-line community treatment programs has not been well established. METHODS: A total of 145 patients who presented for treatment at a rural community substance abuse treatment center were randomized to receive naltrexone 50 mg daily plus usual program treatment (n = 54), placebo plus usual treatment (n = 43), or usual treatment alone (n = 48) for 12 week. A total of 133 participants had at least one follow-up visit. Primary outcome measures included percent days drinking, average drinks per drinking day, average drinks per day, heavy drinking days (four or more for women and six or more for men), and time to first heavy drinking day. Secondary measures included changes in serum biological markers (alkaline phosphatase, alanine transaminase, aspartate transaminase, and gamma-glutamyltransferase), craving, and psychosocial functioning. RESULTS: In the intention-to-treat analysis, there were no between-group differences for any of the primary drinking outcomes at 12 weeks. In post hoc exploratory analyses, the entire sample of participants was divided into two new groups: (1) people who drank during the 2 weeks before the start of medication (entry drinkers) and (2) people who did not drink during this interval (entry abstainers). Entry abstainers were at an advantage at study entry in that they were significantly more likely to have an inpatient hospitalization immediately before entry into outpatient treatment. Mixed-model analysis of variance revealed a main effect for entry group at the 12-week treatment endpoint on the primary outcome measures of percent days drinking, average drinks per drinking day, average drinks per day, heavy drinking days, and time to first heavy drinking day. Participants in any of the randomized groups who were entry abstainers had significantly better improvement on all of the primary outcome measures. The abstainer groups that were randomized to placebo and usual treatment had significantly better outcomes than the entry drinkers in those perspective groups. However, for the naltrexone-treated group, entry drinkers and entry abstainers had similar improvement in drinking-related outcomes. CONCLUSIONS: These data suggest that naltrexone may offer particular benefit to patients who continue to drink during the early stages of the trial as compared with those who have achieved abstinence before treatment entry.     

Subject-Collateral Reports of Drinking in Inpatient Alcoholics with Comorbid Mental Disorders

Verbal self-report continues to be the primary method by which clinicians and researchers obtain measurements of a person's past drinking. In addition, collateral reports are an important second measure of an individual's drinking behavior. Although there is considerable confidence in the use of collateral reports as a measure of drinking in individuals with only a diagnosis of alcohol abuse or dependence, information about subject-collateral reports for alcoholics with a comorbid mental disorder is lacking. Given both that symptoms of mental illness can negatively impact cognitive processes relevant to the recall of information, and that such symptoms can be influenced by alcohol consumption, it is important to be confident in the reports of alcohol use in dually diagnosed individuals. This study examined subject-collateral reports of alcohol use in two groups of inpatient alcoholics: those meeting DSM-Ill-R criteria for an alcohol use disorder and a current mental disorder ( n = 91) and those meeting criteria for an alcohol use disorder only ( n = 93). Overall, the results show that the self-reports of alcoholics with comorbid mental disorders are generally valid. In addition, subject-collateral agreement was found to be similar for both groups, with no consistent tendency to overreport or underreport alcohol or drug use in either group. Importantly, psychological symptom severity and cognitive functioning were not related to subject-collateral agreement. However, less frequent contact between subject and collateral had a more negative impact on subject-collateral agreement for the dual diagnosis group, compared with the alcohol-only group. Recommendations for enhancing the accuracy of self-reports of drinking in a dual diagnosis population are discussed.     

Relapse Prevention in Alcohol Aftercare: effects on drinking outcome, change process, and aftercare attendance

Aftercare contributes to improved drinking outcome, yet maintenance has been overlooked as a point for intervention. This project evaluated the effect of cognitive-behavioural relapse prevention (RP) and interpersonal process (IP) aftercare groups for recently hospitalized alcoholics, consisting of eight weekly 90 min sessions delivered by three co-therapy teams conducting one group in each condition. Six cohorts of patients were assigned to conditions (N=39) and assessed at pretreatment, post-treatment, and 6 month follow-up. RP and IP resulted in comparable improvement/outcome on alcohol consumption, alcohol-related impairment, cognitive coping, drinking days, time to first drink, abstinence, and aftercare attendance. In secondary analyses, improvement on temptation was attributed to RP, on behavioural coping to IP, and effects on self-efficacy appeared marginally related to greater short term improvement for RP. The lack of differential outcome is discussed with respect to inadequate power, possible ceiling effects in outcome, the brevity of the follow-up period, and the possibility that treatments may have been more similar in implementation than intended. Suggestions for improving aftercare and relapse prevention research are presented.     

Clinical Characteristics of Alcoholism in Alcohol-Dependent Subjects With and Without a History of Alcohol Treatment

BACKGROUND: Most clinical alcohol research is carried out on alcoholics who are in treatment, usually inpatients. However, most alcohol-dependent men and women never enter treatment, and even fewer ever receive inpatient care. Thus, some generally accepted data on the clinical course of alcoholism, derived from treatment samples, might not generalize to the entire population of alcohol-dependent individuals. This article characterizes the clinical characteristics of alcohol dependence in three groups of alcoholics, based on their histories of treatment for alcohol problems: those without prior rehabilitation; those with only outpatient approaches or Alcoholics Anonymous (AA); and subjects with an inpatient experience. METHODS: Semistructured interviews were administered to 3572 DSM-III-R-defined alcohol-dependent subjects from the Collaborative Study on the Genetics of Alcoholism. The clinical patterns were compared across the three groups of alcoholics: Group 1, never-treated (n = 1582; 44%); Group 2, histories of outpatient or AA only (n = 399; 11%); and Group 3, at least one inpatient experience (n = 1591; 45%). RESULTS: A progression was shown from Groups 1 to 3 for more general life problems (e.g., unemployment, marital instability); higher rates of additional drug dependencies and psychiatric disorders; and more alcohol-related adverse events. Logistic regression analyses revealed that those with no prior treatment were more likely to be women, Caucasian, and employed, and to report a lower rate of divorce/separation, lower levels of alcohol intake, and fewer alcohol problems. Among those who received help, inpatient care was predicted by an opposite profile. CONCLUSIONS: These results indicate that studies using data from inpatient populations may give a skewed picture of the clinical characteristics of alcohol dependence.     

Subject-collateral reports of drinking in inpatient alcoholics with comorbid cocaine dependence.

Greater substance abuse severity has been associated with less reliable self-reports of drinking in individuals with only an alcohol use disorder. In addition, individuals with multiple substance use disorders often report greater substance abuse severity. Therefore, it is important to be confident in the self-reports of substance use in individuals with multiple substance use disorders. Although there is considerable confidence in the use of collateral reports as a measure of drinking in individuals with only a diagnosis of alcohol abuse or dependence, information about subject-collateral agreement for individuals who meet the criteria for more than one substance use disorder is lacking. In this study, we examined subject-collateral reports of substance abuse in individuals presenting for alcohol treatment who met DSM-III-R criteria for alcohol and cocaine use disorder (n = 85). We then compared subject-collateral reports of those individuals to subject-collateral reports for individuals with only a diagnosis of alcohol abuse or dependence (n = 99). Overall, the results demonstrate that self-reports of individuals with alcohol and cocaine use disorders are generally valid. The results revealed no significant differences between groups on measures of subject-collateral consistency for several alcohol use variables. However, a significant difference was found for the number of days of drug use, with subject-collateral agreement being greater for individuals with an alcohol and cocaine use disorder. Additional analyses revealed that subject-collateral discrepancy scores were positively related to the participants' severity of alcohol and drug dependence. Recommendations for enhancing the accuracy of self-reports of drinking and drug use in alcoholics with comorbid cocaine use disorders are discussed.     

The Tridimensional Personality Questionnaire as a predictor of relapse in detoxified alcohol dependents. The European Fluvoxamine in Alcoholism Study Group

Personality traits have been found as strong predictors for treatment response in different psychiatric disorders. We administered the Tridimensional Personality Questionnaire, which measures the three personality dimensions: novelty seeking, harm avoidance (HA), and reward dependence, as introduced by Cloninger in a multicenter study (11 centers in the United Kingdom, Eire, Switzerland, and Austria) with detoxified alcohol-dependent patients (n = 521). The objective of this study was to evaluate a possible predictive value of these three dimensions on relapse over 1 -year follow up. A logistic regression analysis showed that novelty seeking is a strong predictor for relapse in detoxified male alcoholics (p = 0.0007; p values adjusted for treatment), but not in females. In both sexes, HA and reward dependence were of no predictive value. However, we found a trend for significance of HA for predicting "early" relapse (4 weeks) in females (p = 0.074). Our results show that Tridimensional Personality Questionnaire personality traits have direct clinical applications for prediction of relapse in detoxified alcohol dependents and indicate the necessity of additional therapeutic treatment in risk groups.     

Heroin and cocaine abusers have higher discount rates for delayed rewards than alcoholics or non-drug-using controls

AIMS: To test a prediction of the discounting model of impulsiveness that discount rates would be positively associated with addiction. The delay-discount rate refers to the rate of reduction in the present value of a future reward as the delay to that reward increases. DESIGN AND MEASUREMENTS: We estimated participants' discount rates on the basis of their pattern of choices between smaller immediate rewards ($11-80) and larger, delayed rewards ($25-85; at delays from 1 week to 6 months) in a questionnaire format. Participants had a one-in-six chance of winning a reward that they chose on one randomly selected trial. PARTICIPANTS AND SETTING: Heroin (n = 27), cocaine (n = 41) and alcohol (n = 33) abusers and non-drug-using controls (n = 44) were recruited from advertisements. They were tested in a drug abuse research clinic at a medical school. FINDINGS: On average, the cocaine and heroin groups had higher rates than controls (both P < 0.001), but alcoholics did not (P = 0.44). Abstinence was associated with lower rates for heroin abusers (P = 0.03), but not for cocaine or alcohol abusers (both P > 0.50). CONCLUSIONS: These data suggest that discount rates vary with the preferred drug of abuse, and that high discount rates should be considered in the development of substance abuse prevention and treatment efforts.