Theories of Addiction: Methamphetamine Users' Explanations for Continuing Drug Use and Relapse

A variety of preclinical models have been constructed to emphasize unique aspects of addiction‐like behavior. These include Negative Reinforcement (“Pain Avoidance”), Positive Reinforcement (“Pleasure Seeking”), Incentive Salience (“Craving”), Stimulus Response Learning (“Habits”), and Inhibitory Control Dysfunction (“Impulsivity”). We used a survey to better understand why methamphetamine‐dependent research volunteers (N = 73) continue to use methamphetamine, or relapse to methamphetamine use after a period of cessation of use. All participants met DSM‐IV criteria for methamphetamine abuse or dependence, and did not meet criteria for other current Axis I psychiatric disorders or dependence on other drugs of abuse, other than nicotine. The questionnaire consisted of a series of face‐valid questions regarding drug use, which in this case referred to methamphetamine use. Examples of questions include: “Do you use drugs mostly to make bad feelings like boredom, loneliness, or apathy go away?”, “Do you use drugs mostly because you want to get high?”, “Do you use drugs mostly because of cravings?”, “Do you find yourself getting ready to take drugs without thinking about it?”, and “Do you impulsively take drugs?”. The scale was anchored at 1 (not at all) and 7 (very much). For each question, the numbers of participants rating each question negatively (1 or 2), neither negatively or affirmatively (3–5), and affirmatively (6 or 7) were tabulated. The greatest number of respondents (56%) affirmed that they used drugs due to “pleasure seeking.” The next highest categories selected were “impulsivity” (27%) and “habits”(25%). Surprisingly, many participants reported that “pain avoidance” (30%) and “craving” (30%) were not important for their drug use. Results from this study support the contention that methamphetamine users (and probably other drug users as well) are more heterogeneous than is often appreciated, and imply that treatment development might be more successful if treatments targeted subtypes of patients, though a range of limitations to the approach used are acknowledged.     

Cardiac problems in a Station Hospital

The picture that I have given of cardiac problems at the Station Hospital at Fort Devens is probably the same for all hospitals serving troops young in their Army career or in noncombatant branches. As the training program becomes more severe, most cardiacs (organic or functional) fall by the wayside.The situation could be called ideal if we had only cases of rheumatic fever and degenerative diseases to report. The presence of the large number of soldiers with neurocirculatory asthenia is a challenge to the examining physicians at induction stations.     

Surgery for pharyngeal pouch

Diverticulectomy for pharyngeal pouch requires several days in hospital and carries a risk of postoperative fistula formation. Small to moderate sized pouches can be inverted easily. Experience with this technique has been encouraging and results are reported here. Large pouches of long standing probably should be excised rather than inverted.