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Stoops WW, Strickland JC, Hatton KW, Hays LR, Rayapati AO, Lile JA, Rush CR. Suvorexant maintenance enhances the reinforcing but not subjective and physiological effects of intravenous cocaine in humans. Pharmacol Biochem Behav 2022; 220:173466. [PMID: 36152876 PMCID: PMC9588557 DOI: 10.1016/j.pbb.2022.173466] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 10/14/2022]
Abstract
Preclinical research has sought to understand the role of the orexin system in cocaine addiction given the connection between orexin producing cells in the lateral hypothalamus and brain limbic areas. Exogenous administration of orexin peptides increased cocaine self-administration whereas selective orexin-1 receptor antagonists reduced cocaine self-administration in non-human animals. The first clinically available orexin antagonist, suvorexant (a dual orexin-1 and orexin-2 receptor antagonist), attenuated motivation for cocaine and cocaine conditioned place preference, as well as cocaine-associated impulsive responding, in rodents. This study aimed to translate those preclinical findings and determine whether suvorexant maintenance altered the pharmacodynamic effects of cocaine in humans. Seven non-treatment seeking subjects with cocaine use disorder completed this within-subject human laboratory study, and a partial data set was obtained from one additional subject. Subjects were maintained for at least three days on 0, 5, 10 and 20 mg oral suvorexant administered at 2230 h daily in random order. Subjects completed experimental sessions in which cocaine self-administration of 0, 10 and 30 mg/70 kg of intravenous cocaine was evaluated on a concurrent progressive ratio drug versus money choice task. Subjective and physiological effects of cocaine were also determined. Cocaine functioned as a reinforcer and produced prototypic dose-related subjective and physiological effects (e.g., increased ratings of "Stimulated" and heart rate). Suvorexant (10, 20 mg) increased self-administration of 10 mg/70 kg cocaine and decreased oral temperature but did not significantly alter any other effects of cocaine. Future research may seek to evaluate the effects of orexin-1 selective antagonists in combination with cocaine.
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Affiliation(s)
- William W Stoops
- Department of Behavioral Science, University of Kentucky College of Medicine, 1100 Veterans Drive, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA; Department of Psychiatry, University of Kentucky College of Medicine, 245 Fountain Court, Lexington, KY 40509-1810, USA; Department of Psychology, University of Kentucky College of Arts and Sciences, 171 Funkhouser Drive, Lexington, KY 40506-0044, USA; Center on Drug and Alcohol Research, University of Kentucky College of Medicine, 845 Angliana Avenue, Lexington, KY 40508, USA.
| | - Justin C Strickland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Kevin W Hatton
- Department of Anesthesiology, University of Kentucky College of Medicine, 800 Rose Street, Lexington, KY 40536, USA
| | - Lon R Hays
- Department of Psychiatry, University of Kentucky College of Medicine, 245 Fountain Court, Lexington, KY 40509-1810, USA
| | - Abner O Rayapati
- Department of Psychiatry, University of Kentucky College of Medicine, 245 Fountain Court, Lexington, KY 40509-1810, USA
| | - Joshua A Lile
- Department of Behavioral Science, University of Kentucky College of Medicine, 1100 Veterans Drive, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA; Department of Psychiatry, University of Kentucky College of Medicine, 245 Fountain Court, Lexington, KY 40509-1810, USA; Department of Psychology, University of Kentucky College of Arts and Sciences, 171 Funkhouser Drive, Lexington, KY 40506-0044, USA
| | - Craig R Rush
- Department of Behavioral Science, University of Kentucky College of Medicine, 1100 Veterans Drive, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA; Department of Psychiatry, University of Kentucky College of Medicine, 245 Fountain Court, Lexington, KY 40509-1810, USA; Department of Psychology, University of Kentucky College of Arts and Sciences, 171 Funkhouser Drive, Lexington, KY 40506-0044, USA
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2
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Stoops WW. A Brief Introduction to Human Behavioral Pharmacology: Methods, Design Considerations and Ethics. Perspect Behav Sci 2022; 45:361-381. [PMID: 35719875 PMCID: PMC9163231 DOI: 10.1007/s40614-022-00330-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 11/25/2022] Open
Abstract
Human behavioral pharmacology methods have been used to rigorously evaluate the effects of a range of centrally acting drugs in humans under controlled conditions for decades. Methods like drug self-administration and drug discrimination have been adapted from nonhuman laboratory animal models. Because humans have the capacity to communicate verbally, self-report methods are also commonly used to understand drug effects. This perspective article provides an overview of these traditional human behavioral pharmacology methods and introduces some novel methodologies that have more recently been adapted for use in the field. Design (e.g., using placebo controls, testing multiple doses) and ethical (e.g., avoiding enrollment of individuals seeking treatment, determining capacity to consent) considerations that must be addressed when conducting these types of studies are also described.
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Affiliation(s)
- William W. Stoops
- University of Kentucky, 1100 Veterans Drive, Medical Behavioral Science Building Room 140, Lexington, KY 40536-0086 USA
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3
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Abstract
Objectives Measurement of electronic cigarette (ECIG) puff topography provides an understanding of how product characteristics and user behavior affect nicotine delivery. However, mouthpiece-based topography devices may affect natural puffing behavior. This study was designed to compare ECIG topography measured by mouthpiece-based eTop computerized device and mouthpiece-free video recordings. Methods ECiG-naïve cigarette smokers (N = 18) and ECIG-experienced users (N = 25) puffed on a standardized ECIG via eTop or conventionally; both sessions were videotaped. Following overnight abstinence, participants experienced one directed (10 puffs, 30 sec IPI) and 2 ad libitum puffing bouts. Heart rate and subjective response were measured throughout sessions. Results No statistically significant differences between methods were observed for topography, heart rate, or abstinence-related subjective effects, and both methods were accurate and reliable. Use of a mouthpiece was perceived to alter aspects of ECIG puffing (eg, "reduce enjoyment). Conclusions The mouthpiece-based eTop measures ECIG topography precisely as when no mouthpiece is used, and interferes minimally with subjective ECIG experience. Reliable and valid ECIG topography measurement methods are an important regulatory tool, as they can be used to understand the interplay between product design and user behavior to predict toxicant exposure.
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Wang YG, Shen ZH, Wu XC. Detection of patients with methamphetamine dependence with cue-elicited heart rate variability in a virtual social environment. Psychiatry Res 2018; 270:382-388. [PMID: 30300868 DOI: 10.1016/j.psychres.2018.10.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 09/24/2018] [Accepted: 10/01/2018] [Indexed: 01/05/2023]
Abstract
In the present study, we developed a methamphetamine (METH)-related virtual social environment to elicit subjective craving and physiological reactivity. Sixty-one male patients who were abstinent from METH use and 45 age-matched healthy males (i.e., normal controls) were recruited. The physiological electrocardiogram (ECG) signals were recorded before (resting-state condition) and during viewing of a METH-cue video in the virtual environment (cue-induced condition). The cue-induced subjective craving was measured with a visual analogue scale (VAS) for patients with METH dependence. The results indicated that the cue-induced condition elicited significant differences in heart rate variability (HRV) between patients with METH dependence and normal controls. The changes of HRV indexes on time domain and non-linear domain from the resting-state condition to the cue-induced condition were positively correlated with the score on VAS of METH craving. Using a supervised machine learning algorithm with the features extracted from HRV changes, our results showed that the discriminant model provided a high predictive power for distinguishing patients with METH dependence from normal controls. Our findings support that immersing subjects with METH dependence in a METH-related virtual social environment can successfully induce physiological reactivity, and cue-induced physiological signal changes may have a potential implication in clinical practice.
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Affiliation(s)
- Yong-Guang Wang
- Department of Brain Functioning Research, The Seventh Hospital of Hangzhou, 305 Tianmushan Road, Hangzhou, Zhejiang Province 310013, China; Clinical Institute of Mental Health in Hangzhou, Anhui Medical University, Hangzhou, Zhejiang Province, China; Zhejiang provincial Institute of Detoxification Research, Hangzhou, Zhejiang Province, China.
| | - Zhi-Hua Shen
- Department of Brain Functioning Research, The Seventh Hospital of Hangzhou, 305 Tianmushan Road, Hangzhou, Zhejiang Province 310013, China; Clinical Institute of Mental Health in Hangzhou, Anhui Medical University, Hangzhou, Zhejiang Province, China; Zhejiang provincial Institute of Detoxification Research, Hangzhou, Zhejiang Province, China
| | - Xuan-Chen Wu
- Hangzhou Seventh Science and Technology Co., Ltd, Hangzhou, Zhejiang Province, China
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5
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Pike E, Marks KR, Stoops WW, Rush CR. Influence of Cocaine-Related Images and Alcohol Administration on Inhibitory Control in Cocaine Users. Alcohol Clin Exp Res 2017; 41:2140-2150. [PMID: 28921654 PMCID: PMC5711585 DOI: 10.1111/acer.13500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 09/08/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alcohol use and impulsivity, including decreased inhibitory control, predict poor treatment outcomes for individuals with cocaine use disorders. This study sought to determine the effects of alcohol administration on inhibitory control following cocaine-related and neutral cues on the Attentional Bias-Behavioral Activation (ABBA) task in cocaine users. We hypothesized that the proportion of inhibitory failures would increase following cocaine, compared to neutral, cues. We further hypothesized that there would be an interaction between alcohol administration and task version, such that alcohol would impair inhibitory control following cocaine, but not neutral cues. METHODS Fifty current cocaine users completed this mixed-model, double-blind, placebo-controlled, crossover study over 2 experimental sessions. The ABBA task was completed following alcohol administration (0.0 and 0.65 g/kg). Subject-rated drug effect and physiological measures were collected prior to and after alcohol administration. RESULTS Proportion of inhibitory failures was increased following cocaine-related cues compared to neutral cues independent of alcohol dose. Alcohol administration also produced prototypical subject-rated drug effects. CONCLUSIONS A better understanding of the relationship between alcohol consumption and inhibitory control in cocaine users could direct the development of interventions to decrease the risk of relapse in individuals who drink and display impaired inhibitory control.
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Affiliation(s)
- Erika Pike
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA
| | - Katherine R. Marks
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA
| | - William W. Stoops
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA
- Department of Psychology, University of Kentucky Arts and Sciences, Kastle Hall Lexington, KY 40506-0044, USA
- Department of Psychiatry, University of Kentucky College of Medicine, 245 Fountain Court, Lexington, KY 40509, USA
| | - Craig R. Rush
- Department of Behavioral Science, University of Kentucky College of Medicine, Medical Behavioral Science Building, Lexington, KY 40536-0086, USA
- Department of Psychology, University of Kentucky Arts and Sciences, Kastle Hall Lexington, KY 40506-0044, USA
- Department of Psychiatry, University of Kentucky College of Medicine, 245 Fountain Court, Lexington, KY 40509, USA
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Temple JL. Behavioral sensitization of the reinforcing value of food: What food and drugs have in common. Prev Med 2016; 92:90-99. [PMID: 27346758 DOI: 10.1016/j.ypmed.2016.06.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 06/14/2016] [Accepted: 06/21/2016] [Indexed: 12/14/2022]
Abstract
Sensitization is a basic property of the nervous system whereby repeated exposure to a stimulus results in an increase in responding to that stimulus. This increase in responding contributes to difficulty with treatment of drug abuse, as stimuli associated with substance use become signals or triggers for drug craving and relapse. Our work over the past decade has applied the theoretical framework of incentive sensitization to overeating. We have shown, in several studies, that lean adults do not commonly demonstrate behavioral sensitization after repeated exposure to snack food, but a subset of obese adults reliably does. This review will discuss this change in behavioral response to repeated consumption of snack food in obese individuals and apply the theoretical framework of incentive sensitization to drugs of abuse to high fat/high sugar snack foods. We will also show data that suggest that behavioral sensitization to repeated administration of snack food is predictive of weight gain, which may enhance its utility as a diagnostic tool for identifying at-risk individuals for obesity. Finally, we will discuss the future directions of this line of research, including studying the phenomenon in children and adolescents and determining if similar principles can be used to increase motivation to eat healthier food. A combination of reductions in unhealthy food intake and increases and healthy food intake is necessary to reduce obesity rates and improve health.
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Affiliation(s)
- Jennifer L Temple
- Departments of Exercise and Nutrition Sciences and Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States.
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7
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Marks KR, Pike E, Stoops WW, Rush CR. Alcohol Administration Increases Cocaine Craving But Not Cocaine Cue Attentional Bias. Alcohol Clin Exp Res 2016; 39:1823-31. [PMID: 26331880 DOI: 10.1111/acer.12824] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 06/23/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alcohol consumption is a known antecedent to cocaine relapse. Through associative conditioning, it is hypothesized that alcohol increases incentive motivation for cocaine and thus the salience of cocaine-related cues, which are important in maintaining drug-taking behavior. Cocaine-using individuals display a robust cocaine cue attentional bias as measured by fixation time during the visual probe task. The purpose of this study was to evaluate the influence of alcohol administration on cocaine cue attentional bias using eye-tracking technology to directly measure attentional allocation. METHODS Twenty current cocaine users completed a double-blind, placebo-controlled, within-subjects study that tested the effect of 3 doses of alcohol (0.00, 0.325, and 0.65 g/kg) on cocaine cue attentional bias using the visual probe task with eye-tracking technology. The participant-rated and physiological effects of alcohol were also assessed. RESULTS Participants displayed a robust cocaine cue attentional bias following both placebo and alcohol administration as measured by fixation time, but not response time. Alcohol administration did not influence cocaine cue attentional bias, but increased craving for cocaine in a dose-dependent manner. Alcohol produced prototypic psychomotor and participant-rated effects. CONCLUSIONS Alcohol administration increases cocaine craving but not cocaine cue attentional bias. Alcohol-induced cocaine craving suggests that alcohol increases incentive motivation for cocaine but not the salience of cocaine-related cues.
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Affiliation(s)
- Katherine R Marks
- Department of Psychology, University of Kentucky College of Arts and Sciences, Lexington, Kentucky.,Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Erika Pike
- Department of Psychology, University of Kentucky College of Arts and Sciences, Lexington, Kentucky.,Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky
| | - William W Stoops
- Department of Psychology, University of Kentucky College of Arts and Sciences, Lexington, Kentucky.,Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky.,Department of Psychiatry, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Craig R Rush
- Department of Psychology, University of Kentucky College of Arts and Sciences, Lexington, Kentucky.,Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky.,Department of Psychiatry, University of Kentucky College of Medicine, Lexington, Kentucky
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Le Strat Y, Dubertret C. [The role of genetic factors on the link between stress and alcohol use: the example of CRH-R1]. Presse Med 2011; 41:32-6. [PMID: 21752573 DOI: 10.1016/j.lpm.2011.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 05/02/2011] [Accepted: 05/10/2011] [Indexed: 11/18/2022] Open
Abstract
There are no straightforward relationships between stressful life events, genetic factors and alcohol use. Human and animal-based studies suggest that stress exposure increase the risk of alcohol use and relapse among alcohol-dependent subjects. The physiological mechanisms underlying these links remain unknown. Alcohol dependence heritability ranges between 50% and 70%. Of the potentially involved genes, CRH-R1 appears as a plausible candidate in the literature. The present review emphasizes the relationship between variations of genes coding for proteins involved in physiological answer to stress and alcohol use, within the hypothesis of a gene x environment interaction.
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Affiliation(s)
- Yann Le Strat
- Assistance publique-Hôpitaux de Paris, hôpital Louis-Mourier, service de psychiatrie du Professeur Adès, Colombes, France.
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Minocycline attenuates subjective rewarding effects of dextroamphetamine in humans. Psychopharmacology (Berl) 2011; 213:61-8. [PMID: 20838775 PMCID: PMC3014439 DOI: 10.1007/s00213-010-2014-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 08/24/2010] [Indexed: 12/13/2022]
Abstract
RATIONALE Minocycline, a tetracycline antibiotic, interacts with brain glutamate and dopamine neurotransmission. In preclinical studies, minocycline attenuated amphetamine-induced acute dopamine release and subsequent behavioral sensitization. The goal of this study was to determine minocycline's effects on the acute physiological, behavioral, and subjective responses to dextroamphetamine (DAMP) in healthy volunteers. METHODS Ten healthy volunteers participated in an outpatient double-blind, placebo-controlled, crossover study. Subjects had a 5-day treatment period with either minocycline (200 mg/day) or placebo and then were crossed over for 5 days of the other treatment. After 2 days of taking the study medication, on days 3 and 4, subjects were randomly assigned to double-blind acute challenge with either 20 mg/70 kg DAMP or placebo DAMP (randomly labeled as drug A or B) and then crossed over to the other challenge. On day 5 (experimental session 3), subjects had the opportunity to self-administer either placebo or DAMP capsules by working on a progressive ratio computer task. RESULTS Minocycline attenuated DAMP-induced subjective rewarding effects but did not change DAMP choice behavior. Minocycline treatment speeded reaction times on a Go No-Go task and reduced plasma cortisol levels. CONCLUSIONS These findings warrant further studies examining the potential use of minocycline for stimulant addiction.
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Culbertson C, Nicolas S, Zaharovits I, London ED, De La Garza R, Brody AL, Newton TF. Methamphetamine craving induced in an online virtual reality environment. Pharmacol Biochem Behav 2010; 96:454-60. [PMID: 20643158 DOI: 10.1016/j.pbb.2010.07.005] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Revised: 06/21/2010] [Accepted: 07/05/2010] [Indexed: 11/29/2022]
Abstract
The main aim of this study was to assess self-reported craving and physiological reactivity in a methamphetamine virtual reality (METH-VR) cue model created using Second Life, a freely available online gaming platform. Seventeen, non-treatment seeking, individuals that abuse methamphetamine (METH) completed this 1-day, outpatient, within-subjects study. Participants completed four test sessions: 1) METH-VR, 2) neutral-VR, 3) METH-video, and 4) neutral-video in a counterbalanced (Latin square) fashion. The participants provided subjective ratings of urges to use METH, mood, and physical state throughout each cue presentation. Measures of physiological reactivity (heart rate variability) were also collected during each cue presentation and at rest. The METH-VR condition elicited the greatest change in subjective reports of "crave METH", "desire METH", and "want METH" at all time points. The "high craving" participants displayed more high frequency cardiovascular activity while the "low craving" participants displayed more low frequency cardiovascular activity during the cue conditions, with the greatest difference seen during the METH-VR and METH-video cues. These findings reveal a physiological divergence between high and low craving METH abusers using heart rate variability, and demonstrate the usefulness of VR cues for eliciting subjective craving in METH abusers, as well as the effectiveness of a novel VR drug cue model created within an online virtual world.
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Abstract
The results of preclinical laboratory experiments and clinical trials indicate that agonist replacements such as d-amphetamine may be a viable option for managing cocaine dependence. This study determined the effects of d-amphetamine maintenance on cocaine choice behavior in human participants. We predicted that d-amphetamine maintenance would reduce cocaine choice. Nine cocaine-dependent participants completed the study. Two d-amphetamine maintenance conditions were completed in a counterbalanced order (0 and 40 mg/d). After 3 to 5 days of placebo or d-amphetamine maintenance, the participants completed 5 experimental sessions. During these sessions, the participants first sampled the placebo (ie, 4 mg of intranasal cocaine) identified as drug A. The participants then sampled a second intranasal drug dose (4, 10, 20, or 30 mg of cocaine) identified as drug B. The participants then made 6 discrete choices between drugs A and B. Drug choices were separated by 45 minutes. The primary outcome measure was the number of cocaine choices. All doses of cocaine were chosen significantly more than placebo during both maintenance conditions (ie, placebo and d-amphetamine). Choice of the 20-mg dose of cocaine was significantly lower during d-amphetamine maintenance relative to when this cocaine dose was tested during placebo-d-amphetamine maintenance. Cocaine produced prototypical subject-rated drug effects (eg, good effects, like drug, willing to take again). These effects were not altered to a significant degree by d-amphetamine maintenance. Cocaine was well tolerated during D-amphetamine maintenance, and no unexpected or serious adverse events occurred. These results are concordant with those of previous preclinical experiments, human laboratory studies, and clinical trials that suggest that agonist replacement therapy may be a viable strategy for managing cocaine dependence.
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Poling J, Kosten TR, Sofuoglu M. Treatment Outcome Predictors for Cocaine Dependence. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 33:191-206. [PMID: 17497542 DOI: 10.1080/00952990701199416] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Over the past decade, a large number of potential medications have been examined in clinical trials for cocaine dependence. Unfortunately, no effective pharmacotherapies for cocaine dependence have been found to date. Although effective treatments for cocaine dependence are still being investigated, a few variables have been found to significantly predict cocaine treatment response. These variables include cocaine use variables, such as days of cocaine use in the month before treatment, baseline urine cocaine results, and cocaine withdrawal symptoms. Comorbid depression and alcohol use have also been shown to be risk factors for relapse. Among personality variables, impulsivity and similar personality traits may predict treatment response. Initial promising findings with genetic polymorphism, brain activation, and stress response have also been found and need to be replicated in future studies.
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Affiliation(s)
- James Poling
- Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System. West Haven, CT 06516, USA.
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Stoops WW, Lile JA, Lofwall MR, Rush CR. The Safety, Tolerability, and Subject-Rated Effects of Acute Intranasal Cocaine Administration During Aripiprazole Maintenance. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 33:769-76. [DOI: 10.1080/00952990701651556] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rush CR, Stoops WW, Hays LR. Cocaine effects during D-amphetamine maintenance: a human laboratory analysis of safety, tolerability and efficacy. Drug Alcohol Depend 2009; 99:261-71. [PMID: 18926645 PMCID: PMC2663379 DOI: 10.1016/j.drugalcdep.2008.08.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 08/20/2008] [Accepted: 08/21/2008] [Indexed: 11/24/2022]
Abstract
Agonist replacement therapies are effective for managing substance abuse disorders including nicotine and opioid dependence. The results of preclinical laboratory studies and clinical trials indicate that agonist replacements like D-amphetamine may be a viable option for managing cocaine dependence. This experiment determined the physiological and behavioral effects of cocaine during D-amphetamine maintenance in seven cocaine-dependent participants. We predicted cocaine would be well tolerated during D-amphetamine maintenance. We also predicted D-amphetamine would attenuate the behavioral effects of cocaine. After 3-5 days of D-amphetamine maintenance (0, 15, and 30 mg/day), volunteers were administered ascending doses of cocaine (4, 30, 60 mg, i.n.) within a single session. Cocaine doses were separated by 90 min. Cocaine produced prototypical physiological (e.g., increased heart rate, blood pressure, and body temperature) and subject-rated (e.g., increased ratings of Good Effects) effects. During maintenance on the highest D-amphetamine dose, the heart rate increasing effects of cocaine were larger than observed during placebo maintenance. These effects were not clinically significant and no unexpected or serious adverse events were observed. D-amphetamine attenuated some of the subject-rated effects of cocaine. These results are concordant with those of previous preclinical studies, human laboratory experiments and clinical trials, further suggesting that agonist replacement therapy may be a viable strategy for managing cocaine abuse. Additional research in humans is needed to determine whether D-amphetamine attenuates the effects of cocaine under different experimental conditions (e.g., higher cocaine doses) and behavioral arrangements (e.g., drug self-administration or discrimination).
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Affiliation(s)
- Craig R. Rush
- Department of Behavioral Science, University of Kentucky College of Medicine, College of Medicine Office Building, Lexington, KY 40536-0086, U.S.A., Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Parkway, Lexington, KY 40509-1810, U.S.A., Department of Psychology, University of Kentucky College of Arts and Sciences, Kastle Hall, Lexington, KY 40506-0044, U.S.A., To whom correspondence should be addressed: Department of Behavioral Science, University of Kentucky Medical Center, Lexington, KY 40536-0086. Telephone: +1 (859) 323-6130. Facsimile: +1 (859) 257-7684. E-Mail:
| | - William W. Stoops
- Department of Behavioral Science, University of Kentucky College of Medicine, College of Medicine Office Building, Lexington, KY 40536-0086, U.S.A
| | - Lon R. Hays
- Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Parkway, Lexington, KY 40509-1810, U.S.A
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Abstract
The objective of this review is to describe self-administration procedures for modeling addiction to cocaine, cannabis and heroin in the human laboratory, the benefits and pitfalls of the approach, and the methodological issues unique to each drug. In addition, the predictive validity of the model for testing treatment medications will be addressed. The results show that all three drugs of abuse are reliably and robustly self-administered by non-treatment-seeking research volunteers. In terms of pharmacotherapies, cocaine use is extraordinarily difficult to disrupt either in the laboratory or in the clinic. A range of medications has been shown to significantly decrease cocaine's subjective effects and craving without decreasing either cocaine self-administration or cocaine abuse by patients. These negative data combined with recent positive findings with modafinil suggest that self-administration procedures are an important intermediary step between pre-clinical and clinical studies. In terms of cannabis, a recent study suggests that medications that improve sleep and mood during cannabis withdrawal decrease the resumption of marijuana self-administration in abstinent volunteers. Clinical data on patients seeking treatment for their marijuana use are needed to validate these laboratory findings. Finally, in contrast to cannabis or cocaine dependence, there are three efficacious Food and Drug Administration-approved medications to treat opioid dependence, all of which decrease both heroin self-administration and subjective effects in the human laboratory. In summary, self-administration procedures provide meaningful behavioral data in a small number of individuals. These studies contribute to our understanding of the variables maintaining cocaine, marijuana and heroin intake, and are important in guiding the development of more effective drug treatment programs.
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Affiliation(s)
- Margaret Haney
- College of Physicians and Surgeons of Columbia University and the New York State Psychiatric Institute, Department of Psychiatry, New York, 10032, USA.
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Lile JA, Stoops WW, Hays LR, Rush CR. The safety, tolerability, and subject-rated effects of acute intranasal cocaine administration during aripiprazole maintenance II: increased aripipirazole dose and maintenance period. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2008; 34:721-9. [PMID: 18855244 DOI: 10.1080/00952990802308262] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This experiment determined the safety and tolerability of intranasal cocaine during aripiprazole maintenance. METHODS Six cocaine-dependent human subjects were maintained on aripiprazole (15 mg) and placebo for 10 days in counterbalanced order prior to assessing the physiological and subject-rated effects of intranasal cocaine. RESULTS Intranasal cocaine produced prototypical stimulant-like effects (e.g., increased blood pressure and heart rate, increased subject ratings of Like Drug and Stimulated), and aripiprazole enhanced these effects on several measures. CONCLUSIONS Aripiprazole (15 mg/day) is safe and tolerable when combined with cocaine; however, the usefulness of aripiprazole as a treatment for cocaine-use disorders remains to be determined.
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Affiliation(s)
- Joshua A Lile
- Department of Behavioral Science, University of Kentucky Medical Center, Lexington, Kentucky, USA
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Redish AD, Jensen S, Johnson A. A unified framework for addiction: vulnerabilities in the decision process. Behav Brain Sci 2008; 31:415-37; discussion 437-87. [PMID: 18662461 PMCID: PMC3774323 DOI: 10.1017/s0140525x0800472x] [Citation(s) in RCA: 293] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The understanding of decision-making systems has come together in recent years to form a unified theory of decision-making in the mammalian brain as arising from multiple, interacting systems (a planning system, a habit system, and a situation-recognition system). This unified decision-making system has multiple potential access points through which it can be driven to make maladaptive choices, particularly choices that entail seeking of certain drugs or behaviors. We identify 10 key vulnerabilities in the system: (1) moving away from homeostasis, (2) changing allostatic set points, (3) euphorigenic "reward-like" signals, (4) overvaluation in the planning system, (5) incorrect search of situation-action-outcome relationships, (6) misclassification of situations, (7) overvaluation in the habit system, (8) a mismatch in the balance of the two decision systems, (9) over-fast discounting processes, and (10) changed learning rates. These vulnerabilities provide a taxonomy of potential problems with decision-making systems. Although each vulnerability can drive an agent to return to the addictive choice, each vulnerability also implies a characteristic symptomology. Different drugs, different behaviors, and different individuals are likely to access different vulnerabilities. This has implications for an individual's susceptibility to addiction and the transition to addiction, for the potential for relapse, and for the potential for treatment.
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Affiliation(s)
- A. David Redish
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, , http://umn.edu/~redish/
| | - Steve Jensen
- Graduate Program in Computer Science, University of Minnesota, Minneapolis, MN 55455,
| | - Adam Johnson
- Graduate Program in Neuroscience and Center for Cognitive Sciences, University of Minnesota, Minneapolis, MN 55455,
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Haney M, Spealman R. Controversies in translational research: drug self-administration. Psychopharmacology (Berl) 2008; 199:403-19. [PMID: 18283437 PMCID: PMC2731701 DOI: 10.1007/s00213-008-1079-x] [Citation(s) in RCA: 224] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2007] [Accepted: 01/11/2008] [Indexed: 11/26/2022]
Abstract
RATIONALE Laboratory animal and human models of drug self-administration are used to evaluate potential pharmacotherapies for drug abuse, yet the utility of these models in predicting clinically useful medications is variable. OBJECTIVE The objective of this study was to track how antagonist, agonist, and partial agonist medication approaches influence heroin and cocaine self-administration by rodents, non-human primates, and humans and to compare these results to clinical outcomes. RESULTS Across species, heroin self-administration was decreased by all three medication approaches, paralleling their demonstrated clinical utility. The heroin data emphasize the importance of assessing a medication's abuse liability preclinically to predict medication abuse and compliance and of considering subject characteristics (e.g., opioid dependence) when interpreting medication effects. For cocaine, the effects of ecopipam, modafinil, and aripiprazole were consistent in the laboratory and clinic, provided that the medications were administered repeatedly before self-administration sessions. Modafinil attenuated cocaine's reinforcing effects in the human laboratory and improved treatment outcome, while ecopipam and aripiprazole increased the reinforcing effects of cocaine and do not appear promising in the clinic. CONCLUSIONS The self-administration model has reliably identified medications to treat opioid dependence, and the recent data with modafinil suggest that the human laboratory model also identifies medications to treat cocaine dependence. There have been numerous false positives when subjective effects are the primary outcome measure, but not when self-administration is the outcome. Factors relevant to the predictive validity of self-administration procedures include medication maintenance and the concurrent assessment of a range of behaviors to determine abuse liability and the specificity of effect.
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Affiliation(s)
- Margaret Haney
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University and the New York State Psychiatric Institute, 1051 Riverside Dr., Unit 120, New York, NY 10032, USA.
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Stoops WW, Blackburn JW, Hudson DA, Hays LR, Rush CR. Safety, tolerability and subject-rated effects of acute intranasal cocaine administration during atomoxetine maintenance. Drug Alcohol Depend 2008; 92:282-5. [PMID: 17719727 PMCID: PMC2213369 DOI: 10.1016/j.drugalcdep.2007.07.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2007] [Revised: 06/28/2007] [Accepted: 07/03/2007] [Indexed: 12/18/2022]
Abstract
The results of recent research indicate that agonist replacement may be a viable option in the treatment of cocaine dependence. For example, d-amphetamine and modafinil have shown promise in managing cocaine dependence in preliminary clinical trials. The aim of this study was to determine the physiological and subject-rated effects of acute intranasal cocaine doses during chronic atomoxetine treatment. Atomoxetine was chosen because it produces pharmacological and subject-rated effects similar to those of prototypical stimulants and thus may also be a viable agonist replacement therapy. To this end, seven cocaine-dependent subjects were maintained on doses of atomoxetine (0mg [lead in], 5, 10, 20 and 0mg [washout], four times daily) for 3-5 days prior to completing experimental sessions in which ascending doses of intranasal cocaine (4, 20, 40 and 60 mg) were administered. Cocaine produced prototypical cardiovascular and subject-rated effects. Atomoxetine attenuated the systolic pressure increasing effects and enhanced the heart rate increasing effects of cocaine, but was otherwise devoid of effects. These results indicate that cocaine is well tolerated during atomoxetine maintenance. Further research is needed to better determine the effects of atomoxetine and cocaine combinations.
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Affiliation(s)
- William W Stoops
- Department of Behavioral Science, University of Kentucky College of Medicine, College of Medicine Office Building, Lexington, KY 40536-0086, USA
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20
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Galloway GP, Singleton EG, Anglin MD, Rawson RA, Patricia MC, Joseph B, Richard B, Alison Hamilton B, Cynthia B, Darrell C, Judith C, Florentina C, Alice D, Melissa D, Yvonne F, Freese TE, Cheryl G, Galloway GP, Vikas G, James H, Kathryn H, Alice H, Iguchi MY, Lord RH, McCann MJ, Sam M, Pat M, Jeanne O, Susan P, Chris R, Norman R, Janice S, Stalcup PA, Stamper ES, Janice S, Sarah Turcotte M, Denna V, Ahndrea W, Kathryn W, Joan Z. How Long Does Craving Predict Use of Methamphetamine? Assessment of Use One to Seven Weeks after the Assessment of Craving. SUBSTANCE ABUSE: RESEARCH AND TREATMENT 2008. [DOI: 10.4137/sart.s775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims This study lays the foundation for a clinical prediction model based on methamphetamine craving intensity and its ability to predict the presence or absence of within-treatment methamphetamine use. Design We used a random effects logistic approach for estimating repeated-measures, generalized linear mixed models (GLMM) using craving as the sole predictor of methamphetamine. A multivariate GLMM included craving, length of treatment, treatment assignment, and methamphetamine use the previous week as covariates to control for potential confounds. We performed receiver operating characteristic (ROC) analyses to evaluate predictive accuracy. We investigated further whether methamphetamine craving predicted subsequent use more accurately at intervals more proximal to versus those more distal to assessment, examining one-week periods ending one to seven weeks after assessment of craving. Setting The study was part of the Center for Substance Abuse Treatment (CSAT) Methamphetamine Treatment Project (MTP). Subjects Analyses were based on data from 691 methamphetamine dependent outpatients enrolled in the MTP. Measurements Craving was assessed by self-report on a 0–100 scale. Self-reported methamphetamine use was toxicologically verified. Craving and drug use were assessed weekly for 8 weeks. Findings In the univariate analysis craving predicted methamphetamine use in the week immediately following the craving report (p < 0.0001), with subject-specific use increasing 0.38% for each one-point increase in craving on a 0–100 scale. In the multivariate analysis the probability of use decreased by 2.45% for each week in treatment increased by 33.11% for previous methamphetamine use, and the probability of methamphetamine use still increased with craving, rising 0.28% for each one-point increase in craving score (all p < 0.0001). Predictive accuracy was strongest at the one-week time-lag and declined in magnitude the more distal the assessment period. Conclusions Craving is a predictor of within-treatment methamphetamine use. Intensity of craving is appropriate for use as a surrogate marker in methamphetamine dependence.
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Affiliation(s)
- Gantt P. Galloway
- Addiction Pharmacology Research Laboratory, St. Lukes Hospital, 7th floor, 3555 Cesar Chavez Street, San Francisco, CA 94110
| | - Edward G. Singleton
- The MayaTech Corporation, 1100 Wayne Avenue, Suite 900, Silver Spring, MD 20910
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21
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Yamamoto RT, Karlsgodt KH, Rott D, Lukas SE, Elman I. Effects of perceived cocaine availability on subjective and objective responses to the drug. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2007; 2:30. [PMID: 17931408 PMCID: PMC2173892 DOI: 10.1186/1747-597x-2-30] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 10/11/2007] [Indexed: 11/10/2022]
Abstract
RATIONALE Several lines of evidence suggest that cocaine expectancy and craving are two related phenomena. The present study assessed this potential link by contrasting reactions to varying degrees of the drug's perceived availability. METHOD Non-treatment seeking individuals with cocaine dependence were administered an intravenous bolus of cocaine (0.2 mg/kg) under 100% ('unblinded'; N = 33) and 33% ('blinded'; N = 12) probability conditions for the delivery of drug. Subjective ratings of craving, high, rush and low along with heart rate and blood pressure measurements were collected at baseline and every minute for 20 minutes following the infusions. RESULTS Compared to the 'blinded' subjects, their 'unblinded' counterparts had similar craving scores on a multidimensional assessment several hours before the infusion, but reported higher craving levels on a more proximal evaluation, immediately prior to the receipt of cocaine. Furthermore, the 'unblinded' subjects displayed a more rapid onset of high and rush cocaine responses along with significantly higher cocaine-induced heart rate elevations. CONCLUSION These results support the hypothesis that cocaine expectancy modulates subjective and objective responses to the drug. Provided the important public health policy implications of heavy cocaine use, health policy makers and clinicians alike may favor cocaine craving assessments performed in the settings with access to the drug rather than in more neutral environments as a more meaningful marker of disease staging and assignment to the proper level of care.
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Affiliation(s)
- Rinah T Yamamoto
- Behavioral Psychopharmacology Research Laboratory, McLean Hospital/Harvard Medical School, 115 Mill St,, Belmont, MA, USA.
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22
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Donny EC, Bigelow GE, Walsh SL. Comparing the physiological and subjective effects of self-administered vs yoked cocaine in humans. Psychopharmacology (Berl) 2006; 186:544-52. [PMID: 16552557 DOI: 10.1007/s00213-006-0312-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Accepted: 12/07/2005] [Indexed: 10/24/2022]
Abstract
RATIONALE Studies with laboratory animals demonstrating different effects of self- vs experimenter-administered drug suggest that the ability to control or predict drug delivery may be an important determinant of drug action. OBJECTIVE This study assessed whether self-administered and yoked cocaine injections produce different effects in humans. METHODS Ten inpatient volunteers with experience in using cocaine participated in a double-blind, yoked design during which four experimental test sessions were conducted. During two sessions, participants controlled if and when up to six 40 mg/70 kg i.v. cocaine injections were given. During two sessions, participants received noncontingent exposure to the same pattern of injections given during the preceding session (i.e., yoked) under blind conditions. Sessions followed a fixed-order, ABAB design. Measures of subjective and physiological response to cocaine were taken throughout each session. RESULTS Cardiovascular safety parameters were exceeded in some individuals after yoked, but not self-administered, cocaine resulting in some scheduled injections being delayed or withheld. Mean systolic and diastolic blood pressures were higher following yoked compared to self-administered cocaine. In contrast, analysis of the subjective effects revealed only small and generally nonsignificant differences in the effects of self-administered vs yoked cocaine. CONCLUSIONS These results suggest that under the laboratory methods employed, control over the schedule of drug delivery may not alter the subjective effects of cocaine in humans. In contrast, the cardiovascular effects of cocaine appear to be greater when the drug is administered noncontingently.
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Affiliation(s)
- Eric C Donny
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
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23
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Newton TF, Kalechstein AD, De La Garza R, Cutting DJ, Ling W. Apathy predicts hedonic but not craving response to cocaine. Pharmacol Biochem Behav 2005; 82:236-40. [PMID: 16181666 DOI: 10.1016/j.pbb.2005.08.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Revised: 08/19/2005] [Accepted: 08/24/2005] [Indexed: 10/25/2022]
Abstract
Cocaine-induced craving has been implicated in the maintenance of ongoing cocaine use and is presumed to be mediated by enhanced synaptic availability of monoamines, including dopamine. Apathy is a neuropsychiatric syndrome that is associated with hypodopaminergic functioning and is neurobiologically distinct from depression. Apathy has been observed to be prevalent during the initial phases of abstinence in cocaine-dependent individuals. In the current report, we sought to investigate the relationship between apathy, depression, and craving in response to an acute intravenous administration of cocaine. To this end, sixteen non-treatment seeking volunteers were evaluated. Following acute administration of cocaine (40 mg, IV), patients with low apathy scores exhibited increased craving, whereas patients with high apathy scores exhibited decreased craving. In addition, patients with high apathy scores exhibited increased ratings of the subjective measure of "High", suggesting that high apathy predicts a greater hedonic response in dependence. Self-reported ratings of depression did not account for the observed differences. The data reveal that cocaine-induced craving is not ubiquitous, and may not play a critical role in the maintenance of cocaine dependence. Overall, the findings suggest that apathy predicts hedonic but not craving response to cocaine.
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Affiliation(s)
- Thomas F Newton
- David Geffen School of Medicine at the University of California Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA 90024, USA
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24
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Ikegami A, Duvauchelle CL. Dopamine Mechanisms and Cocaine Reward. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2004; 62:45-94. [PMID: 15530568 DOI: 10.1016/s0074-7742(04)62002-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Aiko Ikegami
- Division of Pharmacology/Toxicology, College of Pharmacy, The University of Texas at Austin, Austin, Texas 78712, USA
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25
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Abstract
Given the heterogeneous nature of substance abuse, it is notable that several predictors of response are independent of the primary drug of abuse or the treatment setting [208]. Although the strength of the relationship of predictor to outcome varies, the following factors have been identified consistently: severity of dependence or withdrawal; psychiatric comorbidity; substance-related problems; motivation (abstinence commitment); length of treatment; negative affective states; cognitive factors; personality traits and disorders; coping skills; multiple substance abuse; contingency contracting or coercion; genetic factors; sleep architecture; urges and craving; self-efficacy; and economic and social factors. Although it is well known that severity of dependence (including polysubstance abuse), serious psychiatric comorbidity, and social problems are associated with poor treatment response, only recently has research examined the efficacy of intervention strategies that specifically address these problems. Adequate treatment of psychiatric comorbidity and improvement in social, economic, and family functioning lead to better treatment outcomes. The development of specific techniques to enhance self-efficacy, motivation, coping skills, and functioning in the community are concrete examples of how the identification of factors associated with positive outcomes has led to the development of new treatments. Despite significant accomplishments, the field is left with many unanswered questions. Although several biologic markers, such as neuroendocrine response and sleep architecture, show promise as outcome predictors, it is not known whether these are critical factors in the initiation of substance use or its progression to dependence. Determining whether biologic markers are epiphenomena reflecting the amount and duration of substance abuse or are fundamental to the pathophysiology of dependence is a matter of urgent concern. With some exceptions, identification of biologic predictors has not led to innovative therapies. One of these exceptions is the development of naltrexone for the treatment of alcoholism, which was based in a solid theoretical rationale and followed by hypothesis-driven experiments. Similar opportunities should emerge from current basic science and clinical research. The application of pharmacogenetic techniques to the field of addiction also holds great promise. As future studies are undertaken, researchers and clinicians must be mindful that differences in outcome predictors across drugs of abuse and treatments may emerge as subgroups of individuals with addictive disorders and new therapies are identified. There is already evidence that early onset alcoholism is associated with poor response under some circumstances, yet may be a predictor of response to targeted pharmacotherapy with ondansetron [64, 112]. As the ability to subtype disorders based on meaningful biologic differences grows, it is anticipated that several relevant outcome predictors that are specific for pharmacotherapy will emerge.
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Affiliation(s)
- Domenic A Ciraulo
- Division of Psychiatry, Boston University School of Medicine, Doctor's Office Building, 720 Harrison Avenue, Suite 914, Boston, MA 02118, USA.
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26
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Donny EC, Bigelow GE, Walsh SL. Choosing to take cocaine in the human laboratory: effects of cocaine dose, inter-choice interval, and magnitude of alternative reinforcement. Drug Alcohol Depend 2003; 69:289-301. [PMID: 12633915 DOI: 10.1016/s0376-8716(02)00327-7] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cocaine abuse involves a variety of behaviors including the initiation of cocaine-seeking, the self-selected patterning of cocaine administrations, and the cessation of cocaine-taking. To date, most human laboratory models of cocaine self-administration have only assessed the amount of cocaine consumed under a fixed set of conditions. This double-blind, randomized, within-subject, inpatient study evaluated a novel model of human cocaine self-administration that aimed to quantify the reinforcing value of cocaine after cocaine-taking was initiated. Cocaine-dependent volunteers (n=8) sampled cocaine (12.5, 25 or 50 mg per 70 kg i.v.) or placebo and were subsequently allowed to choose between another injection of the same dose or money over six trials during 12 experimental sessions. The value of the monetary alternative increased with each trial from US dollars 1 to 16. Each cocaine dose was assessed under three inter-choice intervals: 15 min, 30 min, and an interval selected by the volunteer. Injection choices increased dose dependently; however, there was little relationship between the value of the alternative reinforcer and the choice to take cocaine. Most volunteers exclusively chose injections when active cocaine was available and money when placebo was available. Inter-choice interval did not affect cocaine choices. These results illustrate the persistence of cocaine self-administration once cocaine-taking has been initiated.
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Affiliation(s)
- Eric C Donny
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, 5510 Nathan Shock Drive, Baltimore, MD 21224, USA.
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27
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A Comparison of Single-Item Visual Analog Scales With a Multiitem Likert-Type Scale for Assessment of Cocaine Craving in Persons With Bipolar Disorder. ADDICTIVE DISORDERS & THEIR TREATMENT 2002. [DOI: 10.1097/00132576-200211000-00005] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hartz DT, Frederick-Osborne SL, Galloway GP. Craving predicts use during treatment for methamphetamine dependence: a prospective, repeated-measures, within-subject analysis. Drug Alcohol Depend 2001; 63:269-76. [PMID: 11418231 DOI: 10.1016/s0376-8716(00)00217-9] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Clinical lore dictates that craving drives the compulsive use of drugs and alcohol - the core feature of substance dependence. Yet limited research has yielded mixed results, suggesting that craving is neither necessary nor sufficient for continued use or relapse to addictive substances. To investigate the role of craving in compulsive methamphetamine use, 31 men and women in treatment for methamphetamine dependence were asked to indicate, once each week for 12 weeks, the severity of craving that they had experienced during the previous 24 h, using a 100-mm visual analog scale. In a prospective, repeated-measures, within-subject analysis, craving intensity significantly predicted methamphetamine use in the week immediately following each craving report. Craving remained a highly significant predictor in multivariate models controlling for pharmacological intervention, and for methamphetamine use during the prior week. Craving scores that preceded use were 2.7 times higher than scores that preceded abstinence. Risk of subsequent use was 2.5 times greater for scores in the upper half of the scale relative to scores in the lower half. The results obtained demonstrate that, while craving alone may be neither necessary nor sufficient to explain substance addiction, when measured prospectively in a carefully-designed study craving emerges as a salient predictive factor in continued methamphetamine use for patients in treatment for methamphetamine dependence.
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Affiliation(s)
- D T Hartz
- Haight Ashbury Free Clinics, Inc., 603 Clayton Street, San Francisco, CA 94117, USA
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29
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Duvauchelle CL, Ikegami A, Castaneda E. Conditioned increases in behavioral activity and accumbens dopamine levels produced by intravenous cocaine. Behav Neurosci 2000; 114:1156-66. [PMID: 11142647 DOI: 10.1037/0735-7044.114.6.1156] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In vivo microdialysis, behavioral activity assessments, and a conditioned place preference (CPP) test were used to investigate dopaminergic correlates of cocaine-conditioned behaviors. Over 12 days, rats were given either intravenous cocaine (4.2 mg/kg) or saline (6 cocaine and 6 saline infusions) daily in distinctively different environments. The following day, rats were tested in the cocaine- and saline-paired environments; 48 hr later, CPP was determined. The cocaine-associated environment elicited greater nucleus accumbens dopamine (NAcc DA) levels, hyperactivity, and place preference, though the emergence of DA increases was not in synchrony with peak behavioral activation. Although conditioned behavioral effects after repeated cocaine are well documented, direct evidence of increased NAcc DA in response to a cocaine-paired environment has not been previously reported. Discrepancies with previous work are attributed to a number of methodological differences.
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Affiliation(s)
- C L Duvauchelle
- Division of Pharmacology/Toxicology, University of Texas at Austin, 78712-1074, USA.
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30
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Sofuoglu M, Nelson D, Dudish-Poulsen S, Lexau B, Pentel PR, Hatsukami DK. Predictors of cardiovascular response to smoked cocaine in humans. Drug Alcohol Depend 2000; 57:239-45. [PMID: 10661674 DOI: 10.1016/s0376-8716(99)00055-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to examine the predictors of heart rate and blood pressure changes following cocaine administration. Sixty-two smoked cocaine users received a single 0.4 mg/kg dose of smoked cocaine. Male sex, African American race, higher body weight and current marijuana use predicted a greater cardiovascular response to cocaine. In contrast, higher baseline blood pressure, heart rate, amount and frequency of current cocaine use and presence of current cocaine snorting predicted a diminished cardiovascular response to cocaine. Whether these predictors of the cardiovascular response to smoked cocaine in the laboratory also predict cardiovascular complications from long-term cocaine use needs to be studied further.
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Affiliation(s)
- M Sofuoglu
- Department of Psychiatry and Pharmacology, Health Science Center, University of Minnesota, Minneapolis 55415, USA.
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31
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Rush CR, Baker RW, Wright K. Acute physiological and behavioral effects of oral cocaine in humans: a dose-response analysis. Drug Alcohol Depend 1999; 55:1-12. [PMID: 10402144 DOI: 10.1016/s0376-8716(98)00164-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The present study was designed to assess the acute physiological and behavioral effects of a wide range of doses of oral cocaine HCL (placebo, 50, 100, 200, and 300 mg). Nine volunteers (eight males and one female) with recent histories of cocaine use resided on a general inpatient psychiatry unit while they participated. Drug doses were administered in a double-blind fashion under medical supervision, but for safety purposes, they were administered in ascending order. The physiological, subject-rated, and performance effects of oral cocaine HCL were assessed before drug administration and periodically afterwards for 5 h. Oral cocaine HCL increased heart rate and blood pressure as a graded function of dose, but the magnitude of these effects were not clinically significant. Oral cocaine HCL produced positive subject-rated drug effects (e.g. increased ratings of good effects, like drug, and willing to take again), but did not affect performance. Consistent with the pharmacokinetics of oral cocaine HCL, drug effects were generally discernible from placebo 0.5-1 h after administration, peaked approximately 1 h after administration, and progressively abated during the remainder of the experimental session. The results of this experiment demonstrate that across a six-fold range of doses oral cocaine HCL is well tolerated by individuals with recent histories of cocaine use and can be safely administered under controlled laboratory and medical conditions.
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Affiliation(s)
- C R Rush
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson 39216, USA.
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32
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Wang GJ, Volkow ND, Fowler JS, Cervany P, Hitzemann RJ, Pappas NR, Wong CT, Felder C. Regional brain metabolic activation during craving elicited by recall of previous drug experiences. Life Sci 1999; 64:775-84. [PMID: 10075110 DOI: 10.1016/s0024-3205(98)00619-5] [Citation(s) in RCA: 245] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cocaine cues elicit craving and physiological responses. The cerebral circuits involved in these are poorly understood. The purpose of this study was to assess the relation between regional brain activation and cocaine cue elicited responses. Thirteen right-handed cocaine abusers were scanned with positron emission tomography (PET) and [F-18] fluorodeoxyglucose (FDG) twice; during an interactive interview about neutral themes and during an interactive interview about cocaine themes designed to elicit cocaine craving. In parallel the behavioral (rated from 0: felt nothing to 10: felt extreme) and cardiovascular responses were recorded. During the cocaine theme interview subjects reported higher self reports for cocaine craving (+2.5+/-3.3, p < or = 0.02) and had higher heart rates (+4.7+/-7.2%, p < or = 0.001), systolic (+4+/-4%, p < or = 0.0001), and diastolic blood pressures (+2.6+/-3.8%, p < or = 0.003) than during the neutral interview. Absolute and relative metabolic values in the orbitofrontal (+16.4+/-17.1%, p < or = 0.005; +11.3+/-14.3%, p < or = 0.008) and left insular cortex (+21.6+/-19.6%, p < or = 0.002; +16.7+/-19.7%, p < or = 0.01) and relative values in cerebellum (+17.9+/-14.8%, p < or = 0.0008) were higher during the cocaine theme than during the neutral theme interview. Relative metabolic values in the right insular region (p < or = 0.0008) were significantly correlated with self reports of cocaine craving. Activation of the temporal insula, a brain region involved with autonomic control, and of the orbitofrontal cortex, a brain region involved with expectancy and reinforcing salience of stimuli, during the cocaine theme support their involvement with craving in cocaine addicted subjects.
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Affiliation(s)
- G J Wang
- Medical Department, Brookhaven National Laboratory, Upton, NY 11973, USA.
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