Psychiatric Comorbidity in Cocaine Dependence:Diverging Trends, Axis II Spectrum, and Gender Differentials

Screening for antisocial personality disorder in drug users--a qualitative exploratory study on feasibility

Knowledge about co-occurring personality disorders in drug users is important for planning therapy and prevention. The objective of this study was to assess whether the SCID-II (Structured Clinical Interview for DSM-III-R) Screen for antisocial personality disorder was feasible and acceptable in a population of opioid users. A qualitative study on veridicality and emotional quality in responses to SCID-II Screen was carried out by personal interview in a multifunctional addiction centre. The subjects were 10 outpatient participants (six female, four male) in methadone substitution treatment. The SCID-II Screen triggered a high level of emotions. Some questions were mainly interpreted from a victim's perspective, even though the intention was the perpetrator's view. Questions were seen as sex-biased. Provision of support to deal with potential emotional problems should be supplied. Potential revision should be considered to include the female perspective in the screen.

Voluntary intoxication and criminal responsibility

This paper reviews the law related to voluntary intoxication and criminal responsibility in the 50 United States, the District of Columbia, the US Virgin islands, and Puerto Rico. Statutory and case law citations are provided which govern the use of intoxication evidence in each jurisdiction to negate mens rea (i.e., to establish diminished capacity), to support an insanity defense, and to mitigate criminal sentencing. Factors that courts typically focus on when deciding whether to admit this evidence in a particular case are discussed, and these factors are related to clinically relevant criteria.

Predictors of dropout from psychosocial treatment of cocaine dependence

The current study assessed demographic, drug and psychiatric predictors of dropout in the pilot/training phase of a large, multi-site psychotherapy outcome study for patients with cocaine dependence. The different predictors of dropout were assessed throughout the phases of the study: screening, intake, stabilization and assessment phase, and following randomization to treatment. Results showed that (1) younger patients were less likely to keep their intake appointment. (2) Of the patients who had an intake visit, those who did not complete high school and with more days of cocaine use in the previous month were less likely to complete an initial stabilization and assessment phase requiring 1 week of abstinence from all drugs. A survival analysis was used to examine time to dropout for the 286 patients randomized to individual treatment. (3) Again, younger age was associated with dropout after randomization. (4) Drug use variables did not predict time to dropout. (5) Presence of any current Axis I disorder was associated with later dropout from treatment. Minority treatment information seekers and treatment initiators were less likely to go on to complete the full treatment program.

Congruence of the MCMI-II and MCMI-III in cocaine dependence

This study compared the MCMI-II and MCMI-III among 40 urban, poor, cocaine abusers in outpatient treatment. The mean group profiles had strikingly similar relative elevations on the Antisocial, Narcissistic, Aggressive-Sadistic, Alcohol Dependence, and Drug Dependence scales. However, the MCMI-III group profile was significantly lower in magnitude compared with the MCMI-II. Interval and rank-order correlations were moderate to low for most scales, and 90% of participants produced discrepant 2-point codetypes between the 2 tests. These results suggest that clinicians working in substance abuse settings should perhaps adjust MCMI-III profile elevations upward on most scales (particularly on the personality disorder scales) when comparing results to extant normative data and should use caution when referencing MCMI/MCMI-II interpretive manuals for descriptive correlates of MCMI-III scales and codetypes.

Cocaine in Britain: Prevalence, Problems, and Treatment Responses

Cocaine now occupies an established place in the British illicit drug scene. The available data point to London and several other metropolitan areas as core centers of the problem. Smokable cocaine (crack) represents a notable and worrying new feature of cocaine use in the 1990s. There remain substantial gaps in knowledge about the natural history of cocaine problems in Britain. This review addresses the prevalence and problems associated with cocaine in Britain and includes a brief summary of the effects of the drug and the development and distribution of illicit cocaine products in Britain. Following discussion of the prevalence of cocaine use and associated problems, the orientation of existing services toward cocaine users is described and future challenges for responding effectively to cocaine users in need of treatment services are identified.

Behavioral Treatments of Cocaine Addiction: Assessing Patient Needs and Improving Treatment Entry and Outcome

Our studies have evaluated behavioral interventions for cocaine dependence among low-income, minority, inner city clients. These clients have multiple treatment needs, and like other populations of cocaine-addicted individuals, it can be difficult to entice them to enter treatment, stay in treatment, and effect positive treatment outcomes. Our research has three foci: (1) gaining better awareness of what types of problems we encounter in this population and the best ways of assessing these patient needs, (2) finding ways to increase rates of treatment entry, and (3) improving treatment outcomes. The purpose of this review is to summarize some of our findings in the first two areas, and to present some preliminary data regarding a procedure that appears to be promising for assisting patients in initiating cocaine abstinence and maintaining treatment gains.

Resting hand tremor in abstinent cocaine-dependent, alcohol-dependent, and polydrug-dependent patients

Laboratory studies of cocaine-exposed rodents, and positron emission tomographic studies of human cocaine abusers have suggested that chronic cocaine abuse downregulates dopaminergic function in the basal ganglia. The present study sought to provide behavioral evidence for this phenomenon by demonstrating enhanced levels of resting hand tremor among patients with previous histories of cocaine dependence. to determine the specificity of the phenomenon, patients with previous histories of alcohol dependence, cocaine/alcohol codependence, and cocaine/opiate codependence were also evaluated. Patients were assigned to one of four groups according to DSM-IIIR diagnostic criteria: (1) cocaine dependent (n = 19); (2) cocaine and alcohol dependent (n = 12); (3) cocaine and opiate dependent (n = 7); (4) alcohol dependent (n = 9). All were abstinent from their primary drug of abuse for a period of 1 to 5 months. The three patient groups with histories of cocaine dependence exhibited significantly more resting hand tremor than the alcohol-dependent and normal control groups. Furthermore, hand tremor in the former three groups was positively related to the number of self-reported uses of cocaine and negatively related to the number of months of cocaine abstinence.