Alcohol effects on inhibitory and activational response strategies in the acquisition of alcohol and other reinforcers: priming the motivation to drink.

OBJECTIVE: Low doses of alcohol can increase (i.e., prime) operant responding for alcohol in social drinkers. The present study tested the degree to which alcohol increased subjects' responding for the drug by biasing their reward-acquisition strategies in favor of response activation, and away from inhibitory responding. METHOD: Thirty-two social drinkers received either a priming dose of alcohol (0.55 g/kg) or a placebo, prior to performing a stop-signal task to earn their choice of alcoholic drinks or alternative monetary reinforcers. RESULTS: When alternative monetary reinforcement was of low value, alcohol was chosen more often by subjects who received the priming dose versus those who received the placebo. The priming dose also affected reward-acquisition strategies. Subjects who received the priming dose obtained reinforcers by increased response activation and reduced response inhibition. By contrast, those who received the placebo obtained reinforcers via a combination of activational and inhibitory responding. CONCLUSIONS: The results of this study show that alcohol might affect cognitive processes involved in drug reinforcement. By combining traditional operant measures of drug reinforcement with tasks that assess cognitive processes, this research offers a promising new strategy to study the role of cognitive processes in the abuse potential of a wide range of drugs.     

Contingency contracting with monetary reinforcers for abstinence from multiple drugs in a methadone program

Positive monetary contingencies for treating opioid dependence complicated by other drug use were examined. Participants (N = 102) entered 6-month methadone transition treatment (MTT) and were randomized into experimental conditions: 51 entered MTT with contingency contracts using monetary reinforcers and targeting abstinence from illicit drug and alcohol use, and 51 entered MTT without contingency contracts targeting abstinence. Outcomes were evaluated by random urinalysis and breath analysis. After 4 months of treatment, individuals in the contingency condition had longer periods of continuous abstinence (p<.005) and more drug-free tests overall (p<.04). Effects were limited, however, to the contracting period. The authors conclude that contingency contracting using monetary reinforcers may be a useful adjunct for achieving abstinence from multiple drugs of abuse during MTT.     

Monetary alternative reinforcers more effectively decrease intranasal cocaine choice than food alternative reinforcers

Cocaine dependence continues to be a significant public health concern. Contingency management, wherein alternative reinforcers are made available upon cocaine abstinence, has shown promise for decreasing cocaine use. Other research has modeled this effect and demonstrated that alternative reinforcers also reduce cocaine self-administration in the laboratory. Results from both clinical and laboratory studies suggest that the type and value of alternative reinforcers influences their ability to decrease drug choice. The purpose of the present experiment was to determine the effect of money or food alternative reinforcers, valued at $0.01, 0.25, 0.50 and 1.00, on intranasal cocaine (4 [placebo] and 30 mg) choice. Cocaine was chosen to a greater extent than placebo across alternative reinforcer types and values, but the monetary alternative reinforcer suppressed drug choice to a greater degree than the food reinforcer. These results are concordant with previous findings and suggest that money may be a more effective alternative reinforcer for decreasing cocaine use. Future research should determine the sensitivity of this model to specific behavioral aspects of contingency management and whether food could compete with drugs as reinforcers in humans under laboratory conditions.     

An exploratory qualitative study of polydrug use histories among recently initiated injection drug users in San Juan, Puerto Rico

It is well documented that drug users often modulate the effects of their primary drugs of use (e.g., cocaine) by using other drugs (e.g., alcohol), yet the effect of modulating and primary drug interactions on transitions from one class of drugs to another and from noninjected drugs to injected drugs is not clear. This issue, which is critical for understanding polydrug abuse,1 is explored in formative research based on in-depth qualitative interviews conducted during 2003-2004 with 25 recently initiated drug injectors residing in San Juan, Puerto Rico. This study suggests that increased use of a primary drug (e.g., cocaine) was influenced by enhancing or attenuating drugs, which were used in a particular order (e.g., alcohol, heroin) reflecting effectiveness in modulating primary drugs at different use intensities, as well as by participants' perceptions of the relative dangers associated with different drugs. Neither availability nor access appeared to affect the order in which participants used modulating drugs.     

Herbal Therapy in the Treatment of Drug Use

The use of herbs in the treatment of substance abuse is a relatively new phenomenon, although the practice of herbalism goes back to the dawn of humanity. Herbs are natural botanical substances which have noticeable effects on the human organism. Throughout history man has used herbs for nutritional and healing purposes as well as for getting highMost current treatment programs for substance abusers take into account only a small portion of the healing spectrum (e.g., psychological counseling, methadone, self-help, therapeutic community). There is a growing awareness of and concern to develop programs for substance abusers which utilize a holistic approach to deal with the mental, physical, emotional, and spiritual problems accompanying substance abuse. The purpose of this article is to review the use of herbal therapy in the treatment of drug abusers. An annotated bibliography is provided.     

An Exploratory Qualitative Study of Polydrug Use Histories Among Recently Initiated Injection Drug Users in San Juan,Puerto Rico

It is well documented that drug users often modulate the effects of their primary drugs of use (e.g., cocaine) by using other drugs (e.g., alcohol), yet the effect of modulating and primary drug interactions on transitions from one class of drugs to another and from noninjected drugs to injected drugs is not clear. This issue, which is critical for understanding polydrug abuse, is explored in formative research based on in-depth qualitative interviews conducted during 2003–2004 with 25 recently initiated drug injectors residing in San Juan, Puerto Rico. This study suggests that increased use of a primary drug (e.g., cocaine) was influenced by enhancing or attenuating drugs, which were used in a particular order (e.g., alcohol, heroin) reflecting effectiveness in modulating primary drugs at different use intensities, as well as by participants’ perceptions of the relative dangers associated with different drugs. Neither availability nor access appeared to affect the order in which participants used modulating drugs.     

A comparison between low-magnitude voucher and buprenorphine medication contingencies in promoting abstinence from opioids and cocaine

This study compared the relative efficacy of low-magnitude, contingent monetary vouchers, contingent buprenorphine medication, and standard counseling in promoting abstinence from illicit opioids and cocaine among opioid-dependent adults. Following an 8-week baseline period during which participants received buprenorphine maintenance treatment with no contingencies in place, 60 participants were randomly assigned to one of 3 treatment groups for 12 weeks: (a) Participants in the voucher group earned vouchers for each opioid- and cocaine-negative urine sample, in accordance with an escalating schedule. Continuous abstinence resulted in voucher earnings equivalent to a total of 269 US dollars, which participants could exchange for material reinforcers of their choice. (b) Participants in the medication contingency group received half their scheduled buprenorphine dose for clinic attendance and the other half for remaining abstinent from opiates and cocaine. Thus, they received only half of their scheduled dose on submission of an opioid- and/or cocaine-positive urine sample. (c) Participants in standard treatment did not receive programmed consequences contingent on urinalysis results. All participants were maintained with buprenorphine according to a 3-times-per-week dosing regimen and participated in behavioral drug counseling. Retention rate did not significantly differ across the groups; however, participants in the medication contingency group achieved significantly more weeks of continuous abstinence from opiates and cocaine compared with participants in the voucher group (Ms = 5.95 and 2.90, respectively). Results suggest that the use of medication-based contingencies in combination with behavioral therapy in promoting drug abstinence may have clinical utility. Limitations of the study are discussed.     

强制隔离戒毒人员吸食新型毒品相关情况调查分析与对策

目的:了解强制隔离戒毒人员对吸食新型毒品问题的相关态度,并就相关管理和矫治提出对策。方法:采用自制的《强制隔离戒毒人员基本情况》、《对毒品危害的认识》、《应不应该戒毒》、《戒毒信心》问卷,对强制隔离戒毒人员进行问卷调查。结果:在被调查的200名强制隔离戒毒人员中,吸食新型毒品人员占53%。吸食新型毒品人员中认识到毒品对躯体有害者占18%,对精神有害者占8%,认为必须戒断者占8%;在自信心方面,认为能够戒断和一定能够戒断者占73%。新型毒品和传统毒品吸食者在人口学特征、吸毒史、对毒品危害性的认识和态度上存在显著性差异(P<0.01)。结论:强制隔离戒毒人员中吸食新型毒品人数比例很高;与吸食传统毒品者比,新型毒品滥用者的年龄较低,对毒品危害认识不足。建议对吸食新型毒品的强制隔离戒毒人员集中管理,矫治教育方式应有所创新。     

Treatment of Adolescent Drug Abusers

Adolescent drug abuse is acknowledged to be a major national problem, yet little is known about adolescent drug treatment programs and their effectiveness. There is, however, a growing body of knowledge on the correlates of adolescent drug use and the kinds of problems presented by adolescents entering treatment. The problems are complex (e.g., involved family situations, multiple drug use patterns, psychological and socioeconomic factors, and the challenge of the adolescent phase of development), and the resources are scarce. Some modest attempts have been made to analyze existing data sets and to evaluate promising treatment approaches and models directed to adolescent drug abusers, and the findings are encouraging. More needs to be done in terms of developing, testing, and evaluating treatment approaches for adolescent substance abusers.     

Multiple-choice procedure: an efficient approach for investigating drug reinforcement in humans

Two experiments demonstrated the efficiency of assessing drug reinforcement in humans by using a novel multiple-choice procedure. The distinguishing characteristic of the procedure is that it arranges intermittent reinforcement for choices between pairs of potential reinforcers. The procedure has three key operations: (1) a subject is exposed to the potential reinforcers; (2) a subject then makes two or more choices on a questionnaire; for each choice, the subject is required to choose one of two potential reinforcers (e.g. drug vs. drug choices and/or drug vs. money choices); and (3) subsequently only one of the choices, randomly selected, is reinforced. In the present experiments, two variations of the multiple-choice procedure were evaluated in twelve male drug abusers. Both experiments assessed the reinforcing effects of three drug conditions (200 and 400) mg/70kg pentobarbital and placebo) which were presented no more often than every to other day. The experiments demonstrated dose-related choice of pentobarbital over money as well as choice of a higher dose of pentobarbital over a lower dose or placebo. Orderly data were generated with a single-session exposure to each drug condition. Multiple-choice procedures should have applicability, not only to the investigation of drug reinforcement, but also to the study of non-drug reinforcement in humans.     

吸毒者中纹身情况调查与康复治疗

目的··:调查吸毒者中的纹身情况 ,寻求有效康复治疗方法。方法··:采用自行设计《药物滥用调查表》对716例住院强制戒毒者进行调查 ,并进行心理康复治疗。结果··:716例吸毒者中纹身者127例 ,占17.74 % ,其中男100例 ,女27例 ,年龄最小16a ,最大43a ,有纹身时间1 -25a ,平均8.8a±s5.75a。三位一体方式 (集体心理治疗、认知行为治疗、行为治疗 )的康复治疗有一定效果 ;有35例 (27.56% )表示出所后要手术除掉纹身。结论··:吸毒者中有纹身的比例很高 ,这与社会适应问题有一定相关性 ,康复治疗有助于他们摆脱困境     

甲基苯丙胺滥用者对新型毒品的认知、态度以及滥用倾向

目的獉獉:本研究调查了138名甲基苯丙胺滥用者,旨在了解他们对新型毒品的认知、态度、滥用倾向以及对未来的看法。方法獉獉:采用结合文献自行设计的调查问卷,内容包括被调查者的社会人口学特征、对新型毒品的认知、对待新型毒品的态度、滥用新型毒品的倾向以及对未来的看法。结果獉獉:研究结果显示42.8%的甲基苯丙胺滥用者认为吸食新型毒品不会成瘾,认为吸食新型毒品是可以自己控制的高达80.4%,认为新型毒品对身体的危害远远小于海洛因等传统毒品的占68.1%。在对待新型毒品的态度方面,47.1%的认为吸食新型毒品可以消除烦恼,42.8%的认为吸食新型毒品显得有个性、与众不同,42.0%的认为吸食新型毒品是一种身份地位的象征,32.6%的认为吸食新型毒品很新潮、时尚。研究显示有超过一半的研究对象在假定的情景下选择有可能会吸食新型毒品。另外超过1/3的滥用者认为未来毫无希望或对未来不确定。结论獉獉:本研究提示应探寻有效的健康教育、心理咨询和治疗用来纠正甲基苯丙胺滥用者错误的认识,改变他们对待新型毒品以及治疗的态度,帮助他们树立对未来积极的看法以及信心从而帮助甲基苯丙胺滥用者彻底摆脱毒品。     

Drug users' participation in addiction care: different groups do different things

This study allocated 201 (nearly) daily users of heroin and/or crack into four groups, depending on their addiction care participation. Earlier studies have compared treatment groups and nontreatment groups. In this study the treatment group is divided into three categories: (1) drug users in contact with only treatment agencies--i.e., methadone maintenance, clinical and ambulant drug treatment; (2) drugs users in contact with only care agencies--i.e., day and night shelters and drug consumption rooms, which have no explicit aims to change patterns of drug use; and (3) drug users in contact with both treatment and care agencies. This allocation intro three different groups fits the notion of harm reduction, one of the policy aims in The Netherlands. The fourth group consists of drug users in contact with neither treatment nor care agencies. The results show that it is useful to distinguish these four categories, instead of two. The four groups are different from each other with respect to some of their characteristics (e.g. debt situation, prostitution, homelessness) and their drug use (e.g. drug use in public, use of crack, and use of other drugs). A much clearer distinction can be made between the "care" group and the "treatment and care" group. Treatment and care agencies can thus better match their services to their clients or patients.     

Drug dependence: Myth or motive?

The acceptability of nonmedical use for a particular drug is a function of diverse social needs. Drug dependence is due less to intrinsic effects than to the situation in which drug taking occurs. An addictive level of drug self-administration is a symptom of behavioral troubles rather than a definition of the trouble itself. The intrinsic effects of drugs do not in themselves produce either misuse or evoke specific kinds of behavior such as sexual or aggressive activities. Drugs can, however, come to function as discriminative stimuli for socially sanctioned behavior that would not under other circumstances be tolerated. The intrinsic reinforcing potential of an agent evolves in and dominates situations in which other reinforcing opportunities are either absent or remain unavailable who is unprepared to exploit them. While certain intrinsic properties of a drug contribute to its potential as a reinforcer (e.g., rapid onset and brief duration of action), reinforcing efficacy is notoriously malleable. It is a function of historic and currently-acting factors, particularly social reinforcers. The importance of physical dependence in the maintenance of drug seeking and taking is mainly unproven and probably overrated. Situations under which important reinforcers are available only in small portions intermittently can induce various excessive activities, including an untoward concern with obtaining and using drugs. Drug dependence prevention as a species of environmental dependence can be best effected by either alterations in the intermittent reinforcement situations inducing excessive behavior or by providing opportunities and training with respect to reinforcing alternatives other than drugs.     

The effects of housing costs on polydrug abuse patterns: a comparison of heroin, cocaine, and alcohol abusers

This study evaluated how price of housing affects hypothetical purchasing decisions. Participants (26 heroin, 28 cocaine, and 15 alcohol abusers, and 25 controls) were exposed to 4 conditions in which they "purchased" drugs, food, housing, and entertainment. Whereas income remained constant, housing prices varied across conditions. Except for 23% of heroin abusers, participants purchased housing regardless of cost, so that income increased as housing cost decreased. Demand for food was income inelastic, whereas demand for entertainment was income elastic. Each group showed income elastic demand for their drug of choice. Hypothetical choices were reliable; drug choices were correlated with urinalysis results, and willingness to forgo housing in the simulation was correlated with time spent homeless in real life. This study shows that changes in housing prices may affect choices for drug and nondrug reinforcers.     

Multiple Drug Abuse Involving Nonopiate,Nonalcoholic Substances. II. Physical Damage,Long-Term Psychological Effects and Treatment Approaches and Success

A review of the literature of multiple drug abuse involving two or more drug categories where at least one is a nonopiate, nonalcoholic substance (MDA-NONA) suggested the possibility that sedative-hypnotics were the culpable agent for neuropsychological deficits in this group. Individually, amphetamines and hallucinogens, primarily LSD, have been associated with long-term psychological disturbance. While many abusers of these drugs who develop psychoses have been documented to be emotionally disturbed prior to drug usage, indicating that the drug exacerbated a prepsychotic condition, other abusers have no such history, indicating a drug-induced psychosis. Current treatment approaches appear to be ineffective for MDA-NONA abusers, as indicated by poor retention rates and relapse to drug use.     

Hallucinogenic Mushrooms in Guatemala

Abstract

This study allocated 201 (nearly) daily users of heroin and/or crack into four groups, depending on their addiction care participation. Earlier studies have compared treatment groups and nontreatment groups. In this study the treatment group is divided into three categories: (1) drug users in contact with only treatment agencies—i.e., methadone maintenance, clinical and ambulant drug treatment; (2) drugs users in contact with only care agencies—i.e., day and night shelters and drug consumption rooms, which have no explicit aims to change patterns of drug use; and (3) drug users in contact with both treatment and care agencies. This allocation intro three different groups fits the notion of harm reduction, one of the policy aims in the Netherlands. The fourth group consists of drug users in contact with neither treatment nor care agencies. The results show that it is useful to distinguish these four categories, instead of two. The four groups are different from each other with respect to some of their characteristics (e.g. debt situation, prostitution. homelessness) and their drug use (e.g. drug use in public, use of crack, and use of other drugs). A much clearer distinction can be made between the “care” group and the “treatment and care” group. Treatment and care agencies can thus better match their services to their clients or patients.     

Reinforcement by orally delivered methadone, cocaine, and methadone-cocaine combinations in rhesus monkeys: are the combinations better reinforcers?

RATIONALE: Polydrug abuse is a problem that has been infrequently examined. In the present study, drug self-administration procedures were used to investigate the reinforcing effects of drug combinations. OBJECTIVES: To determine the absolute and relative response rates maintained by orally delivered methadone, cocaine, and their combinations under sequential and concurrent access. Choice between drug combinations containing different concentrations of cocaine was also determined. METHODS: Oral intake of methadone, cocaine, and their combinations was studied with rhesus monkeys during daily 3-h sessions. Lip contact (the operant response) was reinforced by delivery of liquid contingent upon completion of a fixed-ratio schedule. In one series, the drugs and drug combinations were studied sequentially with the water vehicle concurrently available. In the next series, the drugs and drug combinations were concurrently available. In the third series, pairs of drug combinations containing different concentrations of cocaine were also concurrently available. RESULTS: Methadone, cocaine and their combinations functioned as reinforcers. Under sequential access, response rates for the drug combinations and the component drugs were often similar. However, under concurrent access, response rates for the drug combinations were greater than response rates for the component drugs at the highest FR size for each condition. Also, drug combinations containing higher cocaine concentrations were preferred to combinations containing lower cocaine concentrations. CONCLUSIONS: Combinations of methadone and cocaine have relatively greater reinforcing effects than the component drugs, and these greater reinforcing effects are better detected with concurrent measures than with sequential measures.     

Patterns of Drug Abuse

A great deal of interest and debate has focused on the tendency of drug abusers to progress from one drug to another (e.g., the relationship between marijuana and heroin abuse). This paper presents methods and results from three types of analysis: (1) correlation between pairs of drugs, without regard for order of abuse; (2) measurement of the order in which pairs of drugs are abused; and (3) determination of what holistic patterns or sequences of drugs tend to be followed. Results indicate that patterns of abuse are not random, and that distinctions should be made between drugs on nonpharmacological grounds. The suggestion is made that the pattern of abuse may be useful in generating typologies of drug abusers.