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HIV-seropositive opioid-dependent patients maintained on an opiate-agonist who continue to use cocaine and to engage in other high-risk behaviors may benefit from enhanced treatment services; however, there is currently little data to guide the formulation of such services. We report on a preliminary study in which six HIV-seropositive opioid-and cocaine-dependent patients were provided a 12-week comprehensive pharmacologic/psychosocial treatment program developed specifically to meet the treatment needs of HIV-seropositive drug users. This program was comprised of buprenorphine (12 mg/day), bupropion (150 mg/day), and twice weekly manual-guided group therapy. Results showed significant decreases in intravenous cocaine use, cocaine craving, and symptoms of depression. A post-hoc comparison to outcomes of eight HIV-seropositive patients receiving standard methadone-maintenance found no improvements for patients receiving standard care. Controlled investigation of enhanced drug treatment programs for HIV-seropositive patients may be warranted.
J Subst Abuse Treat
PMID:A comprehensive pharmacologic-psychosocial treatment program for HIV-seropositive cocaine- and opioid-dependent patients. Preliminary findings. 963 38

The Dynamic Recovery Project examined relationships between homelessness, substance abuse, and recovery, and investigated the effectiveness of the therapeutic community (TC) treatment model in helping homeless drug users move toward stable, drug-free living. This project compared two short-term TCs that were situated within pre-existing homeless shelters with a clean and sober dormitory. In a separate condition, peer counselors and staff were provided additional training in TC philosophy and practice to reduce program dropout. Dramatic decreases in drug and alcohol use at follow-up were verified by urinalysis. Length of time in treatment rather than specific program accounted for decreased alcohol and drug use. Important decreases in posttreatment criminality for both treatment programs were documented. The comparison group, starting with low criminality, experienced smaller, nonsignificant decreases unrelated to type of program or time in treatment. Major declines in Beck Depression Scores were evident, but were unrelated to groups or time in treatment. Training had no measurable impact on client retention or outcomes and there were no significant differences between TCs and the comparison group on posttreatment drug use, criminality, or depression. This report documents that short-term therapeutic communities can be successfully implemented in public shelters for homeless men.
J Subst Abuse Treat
PMID:Dynamic Recovery: comparative study of therapeutic communities in homeless shelters for men. 975 Sep 98

Risk factors for suicide among active-duty members of the United States Marine Corps were investigated. Three groups were suicide attempters (n = 172), completers (n = 22), and a nonpsychiatric comparison group (n = 384). A series of multiple regression and discriminant analyses were conducted to assess whether any of 137 selected risk-factors differentiated the suicidal group from the comparison group. The following factors differentiated suicide attempters and completers from the comparison group and were associated with increased suicide risk: History of Abuse, Neglect, or Rejection, Lower Performance Evaluation, Symptoms of Depression, No History of Gambling Behavior, Younger Age, History of Alcohol Abuse, and Hopelessness. A discriminant analysis using these seven variables resulted in a 77% accuracy rate. When evaluating variables that could be obtained by a review of military records alone, three variables differentiated the attempters and completers from the comparison group, Lower Performance Evaluation, Younger Age, and a History of Military or Legal Problems. These variables correctly classified 73% of the sample. Implications for suicide-risk assessment for individuals in the Marine Corps are provided.
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PMID:Pilot study of suicide risk factors among personnel in the United States Marine Corps (Pacific Forces). 977 59

Changes over time in posttraumatic stress disorder (PTSD) symptoms during periods when individuals with substance use disorders remain abstinent has not received much attention. PTSD symptomatology over a 36-month period was studied in cocaine-dependent individuals (N = 34) who entered a pharmacologic trial targeting cocaine use and depression, but did not include any treatment for PTSD. All participants reported at least one PTSD Criterion A event, and 17.6% had current PTSD at baseline (Base PTSD+). Significant improvements in PTSD symptoms were observed on global measures of PTSD, but not on the Impact of Events Intrusion subscale. Significant improvement in drug use severity also was observed. Compared with participants who were negative for PTSD at baseline, Base PTSD+ participants were significantly more likely to: (a) meet criteria for current PTSD at follow-up and (b) have been re-victimized over the time period of the study. Careful evaluation of intrusive symptoms may be particularly important when diagnosing PTSD in individuals with SUDs, and repeated assessment of traumatic experiences may be necessary in longitudinal studies.
J Subst Abuse Treat
PMID:Untreated symptoms of PTSD among cocaine-dependent individuals. Changes over time. 984 63

After 12 months of inpatient treatment, 16 opiate-addicted patients were exposed to drug-related stimuli. The results of this study indicate that cue reactivity in opiate-addicted subjects is still present after 12 months of intensive inpatient treatment. After exposing subjects to drug-related stimuli, there is an increase in craving, feelings of depression, and anger. Because posttreatment subjects are likely to be confronted with these stimuli following discharge, a reduction of this reactivity is desirable. In the present study, cue reactivity (feelings of depression, anger, tension, craving, and physical symptoms) reduced after protocolized cue exposure treatment. This effect maintained for at least 6 weeks after the last cue exposure session.
J Subst Abuse Treat 1999 Jan
PMID:Cue reactivity and effects of cue exposure in abstinent posttreatment drug users. 988 25

Abuse liability and acute subjective and psychomotor effects of flunitrazepam were assessed in ten methadone-maintained males with history of benzodiazepine and alcohol use, who voluntarily participated in a double-blind, controlled, cross-over, randomized clinical trial. There were six experimental sessions in which a single oral dose of flunitrazepam 1, 2, and 4 mg; triazolam 0.5 and 0.75 mg; and placebo was given. Evaluations included physiological measures; psychomotor performance tasks (simple reaction time, Digit Symbol Substitution Test, balance task, Maddox-wing device); and self-administered subjective effects questionnaires [Addiction Research Center Inventory (ARCI), Profile of Mood States (POMS), a series of visual analog scales (VAS)]. All drugs but flunitrazepam 1 mg caused an impairment of psychomotor tasks. Effects were more evident with the highest doses of both drugs. Only flunitrazepam 4 mg produced a significant decrease in balance time. Triazolam 0.75 mg induced increases in sedation measured by ARCI-PCAG, depression in POMS, and VAS-drowsiness scores. Flunitrazepam 4mg caused euphoria-related effects as measured by increases in ARCI-MBG and "high" scores in the VAS. Our findings of flunitrazepam-induced euphoria in methadone-maintained subjects together with epidemiological evidence of flunitrazepam abuse by opioid dependents, suggest that it may be included in the group of benzodiazepines with a relatively high abuse potential.
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PMID:Abuse liability of flunitrazepam among methadone-maintained patients. 988 25

We examined changes in mood and personality characteristics in a sample of cocaine-dependent women being treated in a therapeutic community (TC). Forty-six women completed the Beck Depression Inventory (BDI), the Hamilton Anxiety Scale (HAM-A), and the Millon Clinical Multiaxial Inventory-II (MCMI-II) on admission and 12 months after discharge from the TC. On admission, the group was characterized by clinically significant scores on the BDI, HAM-A, and the MCMI-II Avoidant, Dependent, Antisocial, Passive-aggressive, Self-defeating, and Borderline scales. On follow-up, significant improvement in functioning was suggested by decreases in scale scores on the BDI, HAM-A, and MCMI-II Avoidant, Dependent, Self-Defeating, and Borderline Scales, but not for the MCMI-II Antisocial and Passive-Aggressive scales. These results suggest substantial positive effects of TC treatment on personality characteristics and functioning, but also indicate that TC treatment may not habilitate all critical personality deficits.
J Subst Abuse Treat 1999 Mar
PMID:Changes in personality characteristics in women treated in a therapeutic community. 1002 11

The aim of this study was to investigate the prevalence of substance use disorder in young adult patients with borderline personality disorder (BPD) and antisocial personality disorder (APD) and to ascertain the specific substances each of these groups choose to abuse. An additional aim was to assess whether alcohol and drug abuse in the patients related to their psychopathology and hostility. The study subjects were 41 hospitalized patients with BPD and 44 hospitalized patients with APD. The diagnoses of personality disorders and substance use disorders were made using DSM-III criteria. Psychopathology patterns were assessed using the Brief Psychiatric Rating Scale, Hamilton Depression Rating Scale, and State-Trait Anxiety Inventory. Hostility was assessed using the Hostility and Direction of Hostility Questionnaire. Abuse of one or more substances was reported by 76% of BPD patients and 95% of APD patients. There was no difference between the two groups in terms of alcohol abuse, but certain substances (such as benzodiazepines, anticholinergics, cannabis, and opioids) were abused more than twice as often by APD patients versus BPD patients. APD patients were more likely than BPD patients to be multiusers. In BPD patients, the number of substances abused showed a negative association with depression, while in APD patients it was positively related to state anxiety. In both patient groups, there was no correlation of the number of abused substances with the degree of extroverted or introverted hostility.
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PMID:Substance abuse patterns and their association with psychopathology and type of hostility in male patients with borderline and antisocial personality disorder. 1042 87

The present study evaluated 105 clients who were assessed for substance-related problems and a history of domestic violence. A brief survey on family violence examined whether clients were adult victims, childhood victims, and/or perpetrators of physical violence. Results indicated that 37% of the sample reported that they experienced a family history of physical violence. A total of 22% reported being an adult victim of physical violence, 14% reported being a victim of childhood abuse, and 18% reported being a perpetrator of physical violence. There was a significant positive correlation between subtypes of family violence. Substance-using clients who were older reported more incidences of family violence. Results showed that substance-using clients with a history of family violence (SAFV+) tended to have more individual therapy sessions attended than substance-using clients without a history of family violence (SAFV-). The SAFV+ group was different from the SAFV- group in that they had significantly higher scores on the Michigan Alcoholism Screening Test and the Beck Depression Inventory (BDI) scores. The SAFV+ group also had significantly more self-reported and positive urine screens for cocaine use within the 2-month monitoring period. Additionally, substance-using clients with a history of childhood trauma had significantly more individual therapy sessions attended than clients without a history of childhood trauma. The group with a history of childhood trauma had significantly higher scores on the BDI. Findings indicate the importance of assessing family history of violence in substance abusers entering treatment, as this may have significant implications for treatment outcome.
J Subst Abuse Treat 2000 Jan
PMID:Prevalence of family violence in clients entering substance abuse treatment. 1063 3

A study group of 271 registrants had their medical and social history taken by a nurse-interviewer and were requested to take the Substance Abuse Subtle Screening Inventory. If the nurse interviewer felt that the patient needed social service assessment, referral was made, and a social worker completed the the Social Service Review Questionnaire. The patients who were reported as positive for substance abuse did not respond differently from their negative counterparts for issues of demographics, pregnancy, social support, and career. They were highly likely to have had a history of severe depression and/or have been a victim of physical and/or sexual abuse. On the basis of these data we recommend that the prenatal patient who responds positively in her personal history regarding any of these three experiences should be carefully evaluated for problems related to the other two.
J Subst Abuse Treat 2000 Jan
PMID:The triad of substance abuse, violence, and depression are interrelated in pregnancy. 1063 7


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