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PubMed2005

Differential effects of MDMA, cocaine, and cannabis use severity on distinctive components of the executive functions in polysubstance users: a multiple regression analysis.

Executive functioning impairments have been demonstrated following consumption of drugs of abuse. These executive impairments could play an important role on the development of the addictive process and rehabilitation of substance abusers. Recent neuropsychological models of executive functioning assume a multicomponent organization of these processes, suggesting different functions could contribute differentially to performance on executive tasks. The aim of this study was to analyze the relationship between severity of consumption of different drugs and neuropsychological performance on tasks sensitive to impairment in the executive subprocesses of working memory, response inhibition, cognitive flexibility, and abstract reasoning. Instruments sensitive to impairment in these four components were administered to 38 polysubstance abusers along with a severity of drug consumption interview. Multiple regression analyses were used. Results showed a differential impact of severity of MDMA abuse on working memory and abstract reasoning indices, of cocaine severity on an inhibitory control index and of cannabis on a cognitive flexibility index. Metabolic reorganization of monoamine frontal-subcortical pathways after drug exposure are proposed as possible explanations for these impairments.

Adult↗
PubMed2005

"Painting a picture of the client": implementing the Addiction Severity Index in community treatment programs.

This article discusses the implementation of the Drug Evaluation Network System (DENS) version of the Addiction Severity Index (ASI) among substance abuse treatment providers in Los Angeles County. Thirty-two trained and certified treatment professionals from 14 programs participated in focus group interviews about their use of and experiences with the ASI. All 14 programs were currently administering the ASI at the time of the study. Qualitative interviews revealed variation among the programs in terms of when staff administered the ASI and how they used it in clinical care. Although the ASI creates a comprehensive picture of substance-abusing patients and their functioning, the timing of its administration seems to significantly affect the usefulness of the information. The findings illustrate the importance of practicality, flexibility, and ongoing training for the successful implementation of evidence-based practices.

Adult↗
PubMed2000

Consistency of self-administered and interview-based Addiction Severity Index composite scores.

AIMS: This study assesses the viability of a self-administered version of the Addiction Severity Index for monitoring substance abuse patients' functioning. DESIGN AND MEASUREMENTS: Patients completed the ASI interview and a self-administered questionnaire containing ASI composite items an average of 4 days apart. Composite scores from both formats were compared using correlations and mean differences. PARTICIPANTS AND SETTING: Participants were 316 veterans entering substance abuse treatment in a US Department of Veterans Affairs medical center. FINDINGS: Composite scores for alcohol, drug, psychiatric, family, legal and employment problems correlated 0.59-0.87 across formats. Patients endorsed more drug use and psychiatric symptoms by questionnaire than by interview. Medical composite scores correlated only 0.47 across formats. CONCLUSIONS: This study and previous research suggest that a self-administered questionnaire can be a feasible alternative to ASI interviews for monitoring substance abuse patients' treatment outcomes.

Female↗
PubMedDate not supplied

The Clinical Opiate Withdrawal Scale (COWS).

The clinical opiate withdrawal scale (COWS) is a clinician-administered, pen and paper instrument that rates eleven common opiate withdrawal signs or symptoms. The summed score of the eleven items can be used to assess a patient's level of opiate withdrawal and to make inferences about their level of physical dependence on opioids. With increasing use of opioids for treatment of pain and the availability of sublingual buprenorphine in the United States for treatment of opioid dependence, clinical assessment of opiate withdrawal intensity has received renewed interest. Buprenorphine, a partial opiate agonist at the mu receptor, can precipitate opiate withdrawal in patients with a high level of opioid dependence who are not experiencing opioid withdrawal. Since development of the first opiate withdrawal scale in the mid-1930s, many different opioid withdrawal scales have been used in clinical and research settings. This article reviews the history of opiate withdrawal scales and the context of their initial use. A template version of the COWS that can be copied and used clinically is appended. PDF formatted versions of the COWS are also available from the websites of the American Society of Addiction Medicine, the California Society of Addiction Medicine, the UCLA Integrated Substance Abuse Programs, and AlcoholMD.com.

Humans↗
PubMed1999

Predicting outcome of inpatient detoxification of substance abusers.

OBJECTIVE: Variables that have been identified as predictors of outcome of substance abuse treatment--coping style, addiction severity and addiction-related problems, psychopathology, and treatment motivation--were examined as predictors of outcome of inpatient detoxification. METHODS: A cohort of 175 drug abuse patients consecutively admitted to an inpatient detoxification clinic in the Netherlands were assessed. Baseline data were obtained on psychopathology using the Symptom Checklist-90, on severity and addiction-related problems using the Addiction Severity Index (ASI), on personal coping style using the Utrecht Coping List, on motivation using the CMRS scales, and on sociodemographic background. Positive detoxification outcome was defined as transfer to inpatient rehabilitation treatment. RESULTS: Of the 175 admissions, 81 (46 percent) had a positive outcome, and 94 (54 percent) had a negative outcome. Severe drug use and severe medical problems, as measured by the ASI, were the best predictors of a negative outcome of detoxification. Self-rated suitability of postdetoxification treatment was also a predictor of positive outcome, although to a lesser degree than the ASI variables. Established predictors of residential drug abuse treatment outcome, such as psychopathology, coping style, and sociodemographic variables, did not predict outcome of detoxification. CONCLUSIONS: Caution is necessary when applying results of inpatient treatment outcome studies to inpatient detoxification programs. Different factors may play a role in the outcome of detoxification. To improve the rate at which patients in detoxification programs are transferred to longer-term rehabilitation, more attention should be paid to medical conditions and to the direct consequences of drug use, such as withdrawal symptoms and craving during detoxification.

Adaptation, Psychological↗
PubMed2004

Influence of genetic variations of ethanol-metabolizing enzymes on phenotypes of alcohol-related disorders.

Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase-2 (ALDH2) play central roles in the metabolism of ethanol and its metabolite, acetaldehyde, in the liver. In ADH2, one nucleotide replacement causes either a super-active beta 2 subunit encoded by the ADH2*2 allele or a less active beta 1 subunit (ADH2*1 allele). In the same way, a G/A replacement at codon 487 of the ALDH2 gene produces an inactive form of the enzyme. Because the geno-types of these genes may explain individual differences in concentration and elimination of ethanol and acetaldehyde in the blood after drinking, they could be used as models to elucidate the contribution of these substances to the development of addiction and various types of organ damage. We have examined the influence of genetic variations of these enzymes on alcohol-related disorders in the Japanese. The results revealed that (1) the less active allele of the ADH2 gene (ADH2*1) is associated with an increased risk for alcohol dependence, alcohol-induced persistent amnestic disorder, alcohol withdrawal syndrome, and cancer of the upper GI tract; (2) the inactive allele of the ALDH2 gene (ALDH2*2) is associated with a decreased risk for alcohol dependence, and an increased risk for alcoholic polyneuropathy and cancer in the same region; and (3) these genetic variations modify clinical features of alcohol dependence. Possible mechanisms of altered risk for these disorders are discussed.

Alcohol Dehydrogenase↗
PubMed1999

Verbal ability predicts abstinence from drugs and alcohol in a residential treatment population.

Measures of cognitive ability, depression, anxiety, antisocial personality, as well as length, type and severity of addiction were obtained from 122 substance abusers enrolled in residential treatment programs. Over a subsequent 6-mo. monitoring period, relapse to substance use was detected in 46 subjects. 17 subjects withdrew from treatment for other reasons and their relapse status was unknown. The remaining 59 maintained abstinence from alcohol or drug use throughout the monitoring period. The only variables to differentiate the groups significantly on outcome were IQ and the Verbal subtest from the Shipley Institute of Living Scale. Stepwise discriminant function analysis indicated that the Verbal component alone correctly identified 64.4% of patients who would successfully remain abstinent.

Adult↗
PubMed1987

Sex differences in addict careers. 2. Becoming addicted.

Sex differences are examined for the period during which addiction develops after initial narcotics use. About 25% of the 546 heroin addicts studied became addicted within 1 month after initial use. More women than men fell into this category, and, on the average, women took less time to become addicted. For the majority of those studied (whose addiction occurred 1 month or longer after initial use), patterns of narcotic use during this phase of the addiction career were not significantly different by sex within Anglo or Chicano groups. Differences between female and male addicts in interpersonal relationships, other substance use, drug dealing, legal employment, and criminal behaviors parallel traditional sex role expectations.

Adult↗
PubMed1995

[Treatment of drug dependent patients in a psychiatric department].

The authors report their three years experience with treating addicts (both alcoholics and users of prescription and illegal drugs) in a specialized unit employing a low-threshold admission policy. Difficulties as well as advantages of the concept are discussed. For the common treatment of patients addicted to different groups of substances on the same ward to be successful certain prerequisites probably have to be met: A clearly structured daily routine respectively therapy-program and close professional cooperation within a multifunctional therapeutic team harbouring a basic attitude of acceptance towards their patients.

Adult↗
PubMed2006

C/EBPbeta couples dopamine signalling to substance P precursor gene expression in striatal neurones.

Dopamine-induced changes in striatal gene expression are thought to play an important role in drug addiction and compulsive behaviour. In this study we report that dopamine induces the expression of the transcription factor CCAAT/Enhancer Binding Protein beta (C/EBP)-beta in primary cultures of striatal neurones. We identified the preprotachykinin-A (PPT-A) gene coding for substance P and neurokinin-A as a potential target gene of C/EBPbeta. We demonstrated that C/EBPbeta physically interacts with an element of the PPT-A promoter, thereby facilitating substance P precursor gene transcription. The regulation of PPT-A gene by C/EBPbeta could subserve many important physiological processes involving substance P, such as nociception, neurogenic inflammation and addiction. Given that substance P is known to increase dopamine signalling in the striatum and, in turn, dopamine increases substance P expression in medium spiny neurones, our results implicate C/EBPbeta in a positive feedback loop, changes of which might contribute to the development of drug addiction.

2,3,4,5-Tetrahydro-7,8-dihydroxy-1-phenyl-1H-3-ben↗
PubMed1988

Cox v. Court of Common Pleas, 13 December 1988.

The plaintiff, a pregnant woman, sought an order prohibiting the juvenile court from exercising jurisdiction over her in a dependency and neglect action with respect to her unborn child. The Ohio Court of Appeals held that the juvenile court had no jurisdiction to compel a pregnant woman to act for the alleged benefit of an unborn child. On 7 October 1988, in "Matter of Fletcher," the Family Court, City of New York, held that a mother's drug use during pregnancy could not alone serve as the basis for finding child neglect; facts had to be alleged with respect to the mother's neglect after the birth of the child (533 N.Y.S.2d 241).

Americas↗