Cocaine dependence severity predicts outcome in outpatient detoxification from cocaine and alcohol

This study compared the effects of alcohol and cocaine dependence severity on the outcome of outpatient detoxification from alcohol and cocaine. Subjects included 84 subjects with both alcohol and cocaine dependence admitted for outpatient detoxification. Fifty-three of the 84 subjects (63%) completed detoxification. Baseline cocaine use, cocaine craving, and cocaine withdrawal symptoms predicted detoxification outcome, whereas alcohol use, alcohol craving, and alcohol withdrawal symptoms did not. Among cocaine- and alcohol-dependent subjects, cocaine dependence severity appears to be a more important predictor of detoxification success than alcohol dependence severity.     

Comparison of Demographic Characteristics and MMPI Scores from Alcohol and Poly-Drug Alcohol and Cocaine Abusers

Increasingly, applicants to alcoholism and drug addiction treatment are presenting problems with cocaine abuse along with alcohol abuse. Little is known about the characteristics of these poly-drug abusers or how they compare to alcohol abusers. Applicants to treatment who presented alcohol abuse only were compared to those reporting both alcohol and cocaine abuse problems on their demographic characteristics and MMPI profiles. The abuse of cocaine along with alcohol was associated with lower age single marital status and a more disturbed MMPI profiles. Furthermore, several MMPI scales distinguished between the two groups when age differences were statistically accounted for. Such different psychological and demographic profiles between alcohol abusers and abusers of both alcohol and cocaine should be considered in treatment planning.     

Predictors of Treatment Outcome in Outpatient Cocaine and Alcohol Dependence Treatment

We examined the ability of several baseline variables to predict treatment outcome in a pharmacotherapy trial that included 164 participants who were both cocaine‐ and alcohol‐dependent and were selected for a randomized, double‐blind, placebo‐controlled study. Predictor variables included results from the baseline Addiction Severity Index (ASI), initial Urine Drug Screen results, cocaine and alcohol craving and cocaine and alcohol withdrawal symptoms at the start of treatment. Successful treatment was defined as four continuous weeks of self‐reported cocaine abstinence verified by urine drug screens. In respect to demographic characteristics, there were no significant differences between patients who achieved four weeks of abstinence from cocaine and those who did not. Baseline variables that most consistently predicted cocaine abstinence included initial urine drug screen (UDS) results, the initial Cocaine Selective Severity Assessment (CSSA) scores, and initial self‐reported cocaine use in past 30 days, whereas cocaine craving, cocaine composite scores, alcohol craving, alcohol withdrawal symptoms, and alcohol composite scores did not. The results of this study suggest that cocaine dependence severity in general, and initial UDS results, the CSSA scores and frequency of recent cocaine use in particular, have a significant impact on treatment outcome in the treatment of cocaine‐dependent patients with comorbid alcoholism. Initial UDS results and CSSA scores are very useful predictors of treatment outcome and could be used as stratifying variables in outpatient cocaine and alcohol medication trials.     

The diagnosis of alcohol and cannabis dependence (addiction) in cocaine dependence (addiction)

In two separate studies in 263 inpatients using DSM-III-R criteria for alcohol and drug dependence (addiction) we confirm the clinical experience that cocaine addicts are dependent on other drugs including alcohol. Our study finds a high prevalence of alcohol dependence and cannabis dependence in patients with cocaine dependence. As many as 89% of cocaine addicts diagnosed by DSM-III-R criteria for cocaine dependence (addiction) qualify for other alcohol and drug dependence diagnoses. Previous reports regarding alcohol and other drug use among cocaine addicts are few and inconclusive. The diagnosis of other alcohol and drug dependence in cocaine dependence has important impact on etiology, prognosis, and treatment.     

Crack cocaine, alcohol, and other drug use patterns among homeless persons with other mental disorders

This study examined the co-occurrence of cocaine, alcohol, marijuana, and other drug use among treatment seeking homeless persons to determine whether alcohol use predicted cocaine use differently than marijuana and other drugs predicted cocaine use. Participants were 141 homeless persons with substance use and other nonpsychotic mental disorders seeking drug treatment at a metropolitan health care agency for homeless persons. They were 72.3% male, 27.7% female, 82.7% African American, 17.3% Caucasian, with an average age of 37.7 (SD 7.1) years and had 13.1 (SD 2.4) average years of education. Results supported the assertion that cocaine use was strongly associated with extent of alcohol use and that the association between cocaine and alcohol was stronger than the association between cocaine and other drug use, including marijuana. Participants with cocaine plus alcohol disorders were retained longer in treatment than disorders of cocaine only with no differences in abstinence outcome. The findings should drive further research into the use of alcohol as a trigger or predictor of cocaine use, the deleterious effects of the combined use of cocaine and alcohol, and specialized treatments for polysubstance users.     

CRACK COCAINE,ALCOHOL, AND OTHER DRUG USE PATTERNS AMONG HOMELESS PERSONS WITH OTHER MENTAL DISORDERS

This study examined the co-occurrence of cocaine, alcohol, marijuana, and other drug use among treatment seeking homeless persons to determine whether alcohol use predicted cocaine use differently than marijuana and other drugs predicted cocaine use. Participants were 141 homeless persons with substance use and other nonpsychotic mental disorders seeking drug treatment at a metropolitan health care agency for homeless persons. They were 72.3% male, 27.7% female, 82.7% African American, 17.3% Caucasian, with an average age of 37.7 (SD 7.1) years and had 13.1 (SD 2.4) average years of education. Results supported the assertion that cocaine use was strongly associated with extent of alcohol use and that the association between cocaine and alcohol was stronger than the association between cocaine and other drug use, including marijuana. Participants with cocaine plus alcohol disorders were retained longer in treatment than disorders of cocaine only with no differences in abstinence outcome. The findings should drive further research into the use of alcohol as a trigger or predictor of cocaine use, the deleterious effects of the combined use of cocaine and alcohol, and specialized treatments for polysubstance users.     

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.     

Alcohol, Cocaine, and Brain Stimulation-Reward in C57Bl6/J and DBA2/J Mice

Background: Pleasure and reward are critical features of alcohol drinking that are difficult to measure in animal studies. Intracranial self‐stimulation (ICSS) is a behavioral method for studying the effects of drugs directly on the neural circuitry that underlies brain reward. These experiments had 2 objectives: first, to establish the effects of alcohol on ICSS responding in the C57Bl6/J (C57) and DBA2/J (DBA) mouse strains; and second, to compare these effects to those of the psychostimulant cocaine. Methods: Male C57 and DBA mice were implanted with unipolar stimulating electrodes in the lateral hypothalamus and conditioned to spin a wheel for reinforcement by the delivery of rewarding electrical stimulation (i.e., brain stimulation‐reward or BSR). Using the curve‐shift method, the BSR threshold (θ₀) was determined immediately before and after oral gavage with alcohol (0.3, 0.6, 1.0, 1.7 g/kg) or water. Blood alcohol concentration (BAC) was measured to determine the influence of alcohol metabolism on BSR threshold. Separately, mice were administered cocaine (1.0, 3.0, 10.0, 30.0 mg/kg) or saline intraperitoneally. Results: In C57 mice, the 0.6 g/kg dose of alcohol lowered BSR thresholds by about 20%, during the rising (up to 40 mg/dl), but not falling, phase of BAC. When given to the DBA mice, alcohol lowered BSR thresholds over the entire dose range; the largest reduction was by about 50%. Cocaine lowered BSR thresholds in both strains. However, cocaine was more potent in DBA mice than in C57 mice as revealed by a leftward shift in the cocaine dose–response curve. For both alcohol and cocaine, effects on BSR threshold were dissociable from effects on operant response rates. Conclusions: In C57 and DBA mice, reductions in BSR threshold reflect the ability of alcohol to potentiate the neural mechanisms of brain reward. The DBA mice are more sensitive to the reward‐potentiating effects of both alcohol and cocaine, suggesting that there are mouse strain differences in the neural mechanisms of brain reward that can be measured with the ICSS technique.     

Disulfiram treatment for cocaine dependence in methadone-maintained opioid addicts

Aims: Cocaine use by patients on methadone maintenance treatment is a widespread problem and is associated with a poorer prognosis. Recent studies have evaluated disulfiram as a treatment for individuals with comorbid alcohol and cocaine abuse. We evaluated the efficacy of disulfiram for cocaine dependence, both with and without co-morbid alcohol abuse, in a group of methadone-maintained opioid addicts. Design: Randomized double-blind, placebo-controlled trial. Setting: Urban methadone maintenance clinic. Participants: Sixty-seven cocaine-dependent, methadone-maintained, opioid-dependent subjects (52% female; 51% Caucasian). Intervention: Study medication, either disulfiram or placebo, was placed directly in the methadone to ensure compliance for 12 weeks. Measurements: Primary outcome measures included weekly assessments of the frequency and quantity of drug and alcohol use, weekly urine toxicology screens and breathalyzer readings. Findings: Disulfiram treated subjects decreased the quantity and frequency of cocaine use significantly more than those treated with placebo. Alcohol use was minimal for all subjects regardless of the medication. Conclusions: Disulfiram may be an effective pharmacotherapy for cocaine abuse among methadone-maintained opioid addicts, even in those individuals without co-morbid alcohol abuse. Disulfiram inhibits dopamine beta-hydroxylase resulting in an excess of dopamine and decreased synthesis of norepinephrine. Since cocaine is a potent catecholamine re-uptake inhibitor, disulfiram may blunt cocaine craving or alter the "high", resulting in a decreased desire to use cocaine.     

Neuropeptide Y receptor genes are associated with alcohol dependence, alcohol withdrawal phenotypes, and cocaine dependence

Background: Several lines of evidence in both human and animal studies suggest that variation in neuropeptide Y (NPY) or its receptor genes (NPY1R, NPY2R and NPY5R) is associated with alcohol dependence as well as alcohol withdrawal symptoms. Additional studies suggest that cocaine may affect NPY expression. Methods: A total of 39 single nucleotide polymorphisms (SNPs) were genotyped across NPY and its 3 receptor genes in a sample of 1,923 subjects from 219 multiplex alcoholic families of European American descent recruited as part of the Collaborative Studies on the Genetics of Alcoholism (COGA) study. Family‐based association analysis was performed to test the primary hypothesis that variation in these genes is associated with alcohol dependence. Secondary analyses evaluated whether there was an association of these SNPs with symptoms of alcohol withdrawal, cocaine dependence, or comorbid alcohol and cocaine dependence. Results: Although variations in NPY itself were not associated with these phenotypes, variations in 2 NPY‐receptor genes were. SNPs in NPY2R provided significant evidence of association with alcohol dependence, alcohol withdrawal symptoms, comorbid alcohol and cocaine dependence, and cocaine dependence (all p < 0.03). Haplotype analyses strengthened the evidence for these phenotypes (global 0.0004 < p < 0.005). SNPs in NPY5R demonstrated significant association with alcohol withdrawal characterized by seizures (p < 0.05). Conclusion: These results indicate that sequence variations in NPY receptor genes are associated with alcohol dependence, particularly a severe subtype of alcohol dependence characterized by withdrawal symptoms, comorbid alcohol and cocaine dependence, and cocaine dependence.     

The Diagnosis of Alcohol and Cannabis Dependence in Cocaine Dependents and Alcohol Dependence in their Families

Genetic research in alcoholism has made major advances in recent decades. Twin, adoption, high-risk and familial studies have demonstrated an inheritance factor in alcoholism. Few studies have demonstrated a genetic predisposition to cocaine and cannabis dependence. Two hundred and sixty-three inpatients were given a structured psychiatric interview retrospectively (180) and prospectively (113) to obtain DSM-III-R diagnosis of cocaine, alcohol and cannabis dependence disorders in the inpatients and of alcohol dependence in family members. Our study reveals a large number of cocaine dependents with a positive family history for alcohol dependence. Approximately 50% of cocaine addicts had at least a first or second degree relative with a diagnosis of alcohol dependence when studied by the family history and study methods. As many as 89% of cocaine dependents diagnosed by DSM-III-R criteria for cocaine dependence qualified for other alcohol and drug dependence diagnoses. Our study finds a high prevalence of alcohol (67% and 89%) and cannabis dependence (51% and 46%) in patients with cocaine dependence. Previous reports regarding alcohol and other drug dependence among cocaine dependents and their families are few and inconclusive. The diagnosis of other drug and alcohol dependence in cocaine dependence and in family members of cocaine dependents has important impact on etiology, prognosis and treatment.     

Is there a progression from abuse disorders to dependence disorders?

Background Recent studies suggest that a progression occurs from alcohol abuse to alcohol dependence. Although DSM‐IV criteria for all substance use‐related diagnoses are based largely on the alcohol dependence syndrome, progression from abuse to dependence might not generalize to other substances. Aims This study tested whether a progression from DSM‐IV abuse to dependence occurs related to the use of cannabis, cocaine and opiates. Design Retrospective data from the DSM‐IV Substance Use Disorders Work Group (n = 1226) were reanalysed using McNemar's χ², configural frequency analyses and survival analyses. Participants were men and women who were primarily African‐Americans or Caucasians. Settings Participants were recruited from community and clinical settings. The measure was the Composite International Diagnostic Interview–Substance Abuse Module. Findings For all substances, life‐time dependence in the absence of life‐time abuse was rare. Results were consistent with a progression occurring for alcohol and cannabis, but not for cocaine and opiates. Abuse and dependence occurred in the same year for 66% of the cocaine users who experienced both disorders (57% of users with any cocaine disorder) and 65% of the opiate users who experienced both disorders (46% of users with any opiate disorder). Because cocaine and opiate dependence in the absence of abuse were rare, it is possible that progressions in cocaine and opiate disorders occur more rapidly than cannabis and alcohol. Conclusions Research is needed to clarify the mechanisms that influence progressions of substance use disorders. Potential factors leading to between‐drug variation in rate of progression of disorders are discussed.     

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.     

Coherence of the dependence syndrome in cocaine users

The method of diagnosing drug dependence introduced in DSM-III-R is largely untested for drugs other than alcohol. Cocaine, unlike alcohol, lacks clearly identifiable withdrawal symptoms, yet is also considered highly addictive. Can criteria derived from the dependence syndrome concept be generally applied to treatment seeking cocaine users? To evaluate the coherence of the dependence syndrome elements for cocaine, factor analysis models are applied to the nine dichotomous DSM-III-R drug-dependence criteria derived from structured clinical interviews with 399 cocaine users. A single factor model, in which both the centrality and severity of each criteria were assessed, adequately describes the criteria and supports the coherence of the dependence syndrome concept for cocaine. Pre-occupation was the most central criterion in defining cocaine dependence. However, avoiding withdrawal through the use of other drugs measured the most severe level of drug dependence. Inability to stop using the tolerance were only minimally related to the measurement of cocaine dependence.     

Gender specific associations between types of childhood maltreatment and the onset, escalation and severity of substance use in cocaine dependent adults

We examined associations between types of childhood maltreatment and the onset, escalation, and severity of substance use in cocaine dependent adults. In men (n = 55), emotional abuse was associated with a younger age of first alcohol use and a greater severity of substance abuse. In women (n = 32), sexual abuse, emotional abuse, and overall maltreatment was associated with a younger age of first alcohol use, and emotional abuse, emotional neglect, and overall maltreatment was associated with a greater severity of substance abuse. There was no association between childhood maltreatment and age of nicotine or cocaine use. However, age of first alcohol use predicted age of first cocaine use in both genders. All associations were stronger in women. Findings suggest that early intervention for childhood victims, especially females, may delay or prevent the early onset of alcohol use and reduce the risk for a more severe course of addiction.     

Cognitive impairment among the dually-diagnosed: substance use history and depressive symptom correlates

Abstract The present study examined the effects of substance use history and depressive symptomatology on the cognitive functioning of 149 male and 72 female dually diagnosed inpatients. Logistic regression models examined the effects of life-time alcohol and cocaine use, previous month's alcohol and cocaine use and depression on abstract reasoning as assessed by the Shipley Institute of Living Scale (SILS) and neuropsychological functioning as measured by the Screening Test for the Luria-Nebraska Neuropsychological Battery (STLNNB). Results indicated differential effects of substance use across the two cognitive outcome measures. Specifically, a significant relationship was demonstrated for previous month's alcohol use on Shipley classification. However, after adjusting for possible borderline cases, previous month's alcohol use dropped to non-significance and in its stead an association between Shipley classification and life-time use was demonstrated. No significant effects were demonstrated for cocaine use, recent alcohol use, depressive symptoms or any of the interaction terms. The Luria-Nebraska performance classifications were significantly associated with both educational level and life-time cocaine use. No significant relationships were obtained for previous month's cocaine use, the alcohol use variables, depressive symptoms, or any of the interaction terms. The degree of classification agreement between the two outcome measures was slightly better than chance (k=0.24 for ST-LNNB and traditional or full scale SILS; k="0.35" for ST-LNNB and modified SILS). These kappa coefficients suggest that the SILS and ST-LNNB assess partially independent dimensions of cognitive functioning. The findings are discussed in light of previous research and implications for clinical assessment and treatment are outlined.     

Gender Specific Associations Between Types of Childhood Maltreatment and the Onset,Escalation and Severity of Substance Use in Cocaine Dependent Adults

We examined associations between types of childhood maltreatment and the onset, escalation, and severity of substance use in cocaine dependent adults. In men (n = 55), emotional abuse was associated with a younger age of first alcohol use and a greater severity of substance abuse. In women (n = 32), sexual abuse, emotional abuse, and overall maltreatment was associated with a younger age of first alcohol use, and emotional abuse, emotional neglect, and overall maltreatment was associated with a greater severity of substance abuse. There was no association between childhood maltreatment and age of nicotine or cocaine use. However, age of first alcohol use predicted age of first cocaine use in both genders. All associations were stronger in women. Findings suggest that early intervention for childhood victims, especially females, may delay or prevent the early onset of alcohol use and reduce the risk for a more severe course of addiction.     

Self-reports by alcohol and drug abuse inpatients: factors affecting reliability and validity

The reliability and validity of self-report data regarding substance abuse has often been questioned. To determine how best to enhance the veracity of self-report, three factors which might affect self-report veracity were examined: alcohol status at time of interview; level of cognitive functioning; and method of self-report data collection. Subjects were 234 admissions to an inpatient substance abuse treatment unit. Self-report data were collected via both personal interview on the day of admission and questionnaire within the first week of stay. Self-reports concerned use of alcohol, cocaine, and marijuana in the days preceding admission. Test–retest reliability for the questionnaire data produced reliability coefficients of 0.88, 0.91, and 0.88, for alcohol, cocaine, and marijuana, respectively. Variation in inter-test interval had virtually no effect upon reliability coefficients. Interview data were compared to toxicologic analyses of blood and urine samples collected on admission. Overall, this comparison showed self-reports to be valid, with a 97% agreement between verbal report and laboratory data for alcohol, 93% for cocaine, and 84% for marijuana. The comparison of interview data with questionnaire responses also showed self-reports to be valid: 90% agreement for alcohol, 93% for cocaine, and 81% for marijuana. Level of cognitive function did not influence the validity of self-reports for any of the three substances. Recent consumption of alcohol also had no statistically significant effect on the validity of self-reported marijuana use, regardless of the operational form of validity tested. However, BAC-negative subjects produced a significantly greater validity coefficient for self-reported cocaine use (kappa = 0.87) than did BAC-positive patients (kappa = 0.43), when interview data were compared with toxicologic measures. A similar finding was not uncovered when interview and questionnaire data were compared. An interaction between admission alcohol status and cognitive function was uncovered for cocaine self-reports when interview data was compared with toxicologic measures. The rate of agreement for alcohol-negative subjects is quite high for both cognitively impaired and unimpaired subjects (M = 93% and M = 94%, respectively) as well as for alcohol-positive, cognitively unimpaired subjects (M = 94%), but not for alcohol–positive, cognitively impaired subjects (M = 67%). Results are discussed in terms of threats to the validity of self-report and strategies for the optimization of response accuracy.     

Familial Alcoholism in Cocaine Addicts

The relationship between cocaine addiction and alcoholism has been documented in epidemiological and clinical studies. Approximately 80 to 90% of cocaine addicts are also alcoholic. Moreover, a previous study documented a positive family history of alcoholism to be 5O%, similar to the rate for familial alcoholism among alcoholics. The rate for familial drug addiction has been reported to be somewhat lower at 25%. This study further strengthens the relationship between alcohol and cocaine addiction. Among 63 consecutive admissions to an inpatient alcohol and drug addiction unit, the rate of familial alcoholism among cocaine addicts was between 50 and 80%. The rate of a family history of drug dependence in alcoholics and cocaine addicts was between 23 and 40%. The combination of alcohol and cocaine addiction was between 75 and 89%. Other demographic and alcohol/ drug characteristics are included.