The relationship between self-reported cocaine withdrawal symptoms and history of depression

This study examined the relationship between cocaine withdrawal and lifetime history of depression (major depression, dysthymia). Participants with a history of regular cocaine use (n = 146) were administered the Structured Clinical Interview for the DSM-IV (SCID) and were asked to recall whether they experienced any of the six DSM-IV cocaine withdrawal symptoms. Results of bivariate analyses demonstrated that those meeting criteria for the cocaine withdrawal syndrome (dysphoria plus two or more other symptoms), in comparison to those who did not, were significantly (P<.001) more likely to have a lifetime history of depression. Lifetime history of depression was also more common in those individuals reporting the withdrawal symptoms of "dysphoria" (P<.001), "insomnia/hypersomnia" (P<.05), "vivid unpleasant dreams" (P<.01), and "psychomotor agitation/retardation" (P<.01). These relationships remained significant after controlling for demographics, severity of addiction, and the presence of opiate, alcohol and cannabis dependence or abuse. The withdrawal symptoms of "fatigue" and "increased appetite" were not associated with mood history. Results suggest that lifetime history of depression is strongly related to whether or not a cocaine abuser self-reports withdrawal symptoms. Several competing hypotheses regarding the nature of this relationship are discussed.

Subjective and discriminative stimulus effects of two de-nicotinized cigarettes with different tar yields

The role of tar yield in the subjective and discriminative stimulus effects of cigarette smoking was examined. Current smokers (n=18) smoked two non-nicotine cigarettes with FTC yields of 0.06 mg nicotine and 12.4 mg (low tar) or 17.9 mg tar (high tar). Physiological measures and visual analog scales were completed over a 30-min period. Dosing order was determined randomly and counterbalanced. After sampling both cigarettes, volunteers smoked a third, test cigarette. Half of the volunteers received the low-tar cigarette and half the high-tar cigarette. Volunteers identified the test cigarette (i.e., A or B) at 5, 30, 60, 300, and 900 s after the first puff. Eight of the eighteen participants correctly identified the test cigarette on 4/5 of trials. No significant changes in visual analog scale scores were found among the non-discriminators. However, among discriminators, the low-tar cigarette produced significant positive effects including good drug effects and stimulation relative to the high-tar cigarette. Relative to the low-tar cigarette, the high-tar cigarette produced negative effects including harshness, heaviness, and intensity of flavor. Average tar yield of these participants' usual cigarettes was 9.75 mg, lower than that of the low-tar cigarette used here, possibly accounting for their greater liking of the low-tar cigarette. No changes in blood pressure or heart rate were observed and both cigarettes produced similar carbon monoxide increases, indicating similar depth of inhalation when smoking each. Results suggest cigarette tar yields may play a role in cigarette smoking preferences. Further research is needed to verify whether preferences are maintained after associations with nicotine delivery are extinguished.

Novelty seeking as a predictor of treatment retention for heroin dependent cocaine users

This study examined the relationship between novelty seeking between treatment retention and among heroin dependent cocaine users. Participants were treated with buprenorphine maintenance and contingency management. The Tridimensional Personality Questionnaire's (TPQ) Novelty Seeking scale was administered to 68 participants prior to buprenorphine induction. Demographics, mood and anxiety disorders, antisocial personality disorder, and substance use were also assessed. Variables with significant relationships with overall retention were entered into a logistic regression analysis. In addition, using a survival analysis, all variables with significant relationships with time to drop-out were entered into a multivariate proportional hazards regression with time dependent covariates. Results demonstrated that although high novelty seekers, in comparison to low novelty seekers, were more likely to drop-out by the end of treatment, they had higher retention rates during the early phases of treatment. It is suggested that buprenorphine and contingency management were viewed by participants as novel treatment components and thus facilitated high novelty seekers' success early in treatment. If replicated, results suggest that inclusion of novel treatment components might facilitate retention among this at-risk group.

Impulsivity and voucher versus money preference in polydrug-dependent participants enrolled in a contingency-management-based substance abuse treatment program

Thirty-four polydrug-dependent participants enrolled in a voucher-based substance abuse treatment program were given choices between hypothetical amounts of money and hypothetical amounts of vouchers, which are traded for goods and services, to determine their preferences for the two payment modalities. It was hypothesized that the majority of participants would prefer money to voucher because under the circumstances of the treatment program, the delay associated with money exchange is shorter than the delay associated with voucher exchange. It was further hypothesized that those participants who selected money over voucher also would have greater levels of impulsivity as assessed by the Barratt Impulsiveness Rating Scale (BIS) (Barratt, 1965). The results show large individual differences in money/voucher preference with approximately half of the participants preferring money to voucher when the two amounts are equivalent. In addition, as the magnitude of the money/voucher comparisons increased from 0.50 dollars to 32.00 dollars, the percentage of participants that preferred money increased. No correlations were found between money/voucher preference and impulsivity scores.

Contingency management for accurate predictions of urinalysis test results and lack of correspondence with self-reported drug use among polydrug abusers

Contingency management procedures have proven effective in the treatment of drug-dependent patients. These procedures, however, often require frequent urine testing, which is too costly for community treatment programs. To make urine-testing procedures more cost effective, the feasibility of reinforcing accurate predictions of urine drug screen (UDS) results was evaluated. Participants made extremely accurate UDS predictions, particularly when they made drug-positive predictions, regardless of whether predictions were reinforced. However, self-reports of recent drug use had poor correspondence with predictions of UDS results. Results suggested that if programs only tested samples predicted to be drug free, considerable cost savings could be incurred. Further research is needed to determine if validity would be enhanced by using a proportion of costs saved to provide nominal reinforcement when samples were verified to be drug free.

Effects of menstrual phase and smoking abstinence in smokers with and without a history of major depressive disorder

Although considerable progress has been made towards understanding the role of menstrual cycle phase in smoking, little is known about the possible effects of menstrual phase upon nicotine intake, withdrawal symptomatology, and craving in women with psychiatric cofactors. Fourteen women with and without a history of Major Depressive Disorder (MDD) were studied during five biologically-confirmed phases over the course of one menstrual cycle: smoking logs, salivary cotinine, and ratings of craving and withdrawal were collected daily. During a second cycle, subjects remained abstinent for 3 consecutive days during the postmenses and premenstrual phases. Although a significant omnibus F-test emerged for cigarettes per day across phases during ad libitum smoking, only trends were observed post hoc and supported midcycle rather than premenstrual elevations. There were no significant phase differences for cotinine. Withdrawal symptomatology was markedly elevated during smoking abstinence and in women with a history of depression. but showed no evidence of phase effects. Thus, the hypothesis that depressed individuals would be differentially affected by phase and abstinence was not strongly supported by our results, though overall elevations emphasize the need for special attention to withdrawal severity in this population. Craving was significantly elevated during smoking abstinence and was significantly higher during postmenses, consistent with the midcycle elevation in smoking rate, but showed no group differences. Our findings overall lend little support for the need to control for menstrual phase under conditions of ad libitum smoking. The strong association of self-reported menstrually related dysphoria during abstinence with both craving and withdrawal symptoms, however, is consistent with an exacerbation of smoking abstinence effects in women with severe menstrual symptomatology.

Treatment of heroin-dependent poly-drug abusers with contingency management and buprenorphine maintenance

This study targeted poly-drug (cocaine plus heroin) abstinence among buprenorphine-maintained participants with a 12-week voucher-based reinforcement therapy (VBRT) phase versus a yoked control condition. Baseline levels of cocaine and heroin use were significant predictors of treatment outcome, regardless of treatment assignment. Overall, there were no significant group differences on treatment outcome. However, among the subsample that produced one or more poly-drug-free urine results, VBRT participants had significantly increased cocaine-but not heroin and poly-drug-abstinence, although all results were in the predicted direction. Results suggest that for those who achieve poly-drug abstinence, VBRT may enhance treatment outcome. However, improved interventions, perhaps targeting single-drug abstinence, increasing reinforcement magnitude, or both, may be necessary to promote initial poly-drug abstinence in this population.

Contingency management for accurate predictions of urinalysis test results and lack of correspondence with self-reported drug use among polydrug abusers

Contingency management procedures have proven effective in the treatment of drug-dependent patients. These procedures, however, often require frequent urine testing, which is too costly for community treatment programs. To make urine-testing procedures more cost effective, the feasibility of reinforcing accurate predictions of urine drug screen (UDS) results was evaluated. Participants made extremely accurate UDS predictions, particularly when they made drug-positive predictions, regardless of whether predictions were reinforced. However, self-reports of recent drug use had poor correspondence with predictions of UDS results. Results suggested that if programs only tested samples predicted to be drug free, considerable cost savings could be incurred. Further research is needed to determine if validity would be enhanced by using a proportion of costs saved to provide nominal reinforcement when samples were verified to be drug free.

The effect of a restricted smoking policy on motivation to quit smoking in psychiatric patients

As dissatisfaction with unrestricted smoking in institutional settings has grown, a number of psychiatric facilities have banned smoking. A compromise, restricted smoking, was recently introduced on an inpatient psychiatric unit at a University of Michigan Hospital. The subsequent rescission of the restricted smoking policy enabled us to compare the effects of restricted smoking vs. ad lib smoking on motivation to quit smoking.

METHOD

Current smokers admitted to an inpatient psychiatry unit were asked to participate in this study. As soon as possible after intake, the patient completed a smoking history questionnaire, depression and anxiety scales, and a stage of change measure. The stage of change measure was readministered upon discharge from the unit.

RESULTS

Repeated measures ANOVA revealed an interaction for Condition (Restricted vs. Ad Lib) by Time (Admission vs. Discharge) for the Action scale, which assesses current level of activity in smoking cessation efforts. Restricted smokers decreased while ad lib smokers increased in motivation over time.

CONCLUSIONS

Results suggest that the restricted smoking policy does not have beneficial motivational effects. Alternative strategies for controlling smoking on an inpatient psychiatric unit are suggested.

Adult attention deficit hyperactivity disorder: psychological test profiles in a clinical population

Compared to attention deficit hyperactivity disorder (ADHD) in children, relatively little is known about the clinical characteristics of adults with persistent ADHD. We elected to use established tests with age-corrected norms to compare the battery of psychological and neuropsychological tests conducted on outpatients admitted to our Adult ADHD clinic. ADHD patients scored significantly higher than norms on the TPQ novelty seeking and harm avoidance scales and MMPI-2 scales F, 2, 4, 7, and 8. Further, these patients were impaired on the California verbal learning test, the attentional capacity test, and the omissions and variability subtests of the test of variables of attention. Adult ADHD had high comorbidity with current depressive disorder, antisocial personality disorder, and alcohol and drug abuse/dependence. High correlations were found between patients' and independent observers' reports of ADHD symptom severity. Implications for further research are discussed.

Personality differences related to smoking and adult attention deficit hyperactivity disorder

Tridimensional Personality Questionnaire (TPQ) scores are compared for three groups of adults: (a) current smokers with Attention Deficit Hyperactivity Disorder (ADHDSmk, n = 14); (b) current smokers without ADHD (NonADHDSmk, n = 21); and (c) ADHD never smokers (ADHDNevSmk, n = 17). The ADHASmk participants started smoking at a significantly younger age than NonADHDSmk participants. On the TPQ Novelty Seeking (NS) scale, all groups scored more than a standard deviation above the norm, and ADHDSmk participants scored significantly higher than NonADHDSmk participants. The earlier onset of smoking in ADHD adults suggests that smoking prevention efforts may be particularly important for ADHD children. Previous studies have reported that both smokers and ADHD patients have elevated NS scores; this study suggests an additive effect for smokers with ADHD. This exaggerated tendency towards thrill seeking in ADHDSmk participants may complicate smoking-cessation treatment in this population, because the health consequences of smoking may be of less concern to ADHD smokers.

Cigarette smoking in adult patients diagnosed with attention deficit hyperactivity disorder

Previous work has shown that adolescent hyperactivity patients are significantly more likely to smoke than controls. To determine whether this pattern persists in adults, we studied a series of 71 patients (55 males, 16 females; mean age +/- SD: 33.9 +/- 11.4 years) diagnosed with ADHD. Of the males, 23 (42%) were current smokers, 7 (13%) were ex-smokers, and 25 (45%) were never smokers. Comparable figures for males in the general population in 1991, unselected for ADHD, were 28.1%, 29.1%, and 42.1%, respectively. Of the females, 6 (38%) were current smokers, 5 (31%) were ex-smokers, and 5 (31%) had never smoked, as compared with 23.5%, 19.0%, and 57.6%, respectively, in the general population. Quit ratio (percentage of ever-smokers who were ex-smokers) was 29% for ADHD patients, compared with 48.5% in the general population. The discrepancy was accounted for by the males, whose quit ratio was 23%, compared with 51.6% in the general population; the figure for ADHD females (45%) was similar to that in the general population (44.7%). Smokers recalled experiencing a significantly higher number of ADHD symptoms (11.5 +/- 1.7) as children than never smokers (9.9 +/- 2.3; p < .01) and scored significantly higher on several indices of childhood and adult comorbidity. Our findings suggest that ADHD patients overinclude smokers, and that these smokers find it extremely difficult to quit. For ADHD smokers, smoking may have begun as an attempt to manage deficits in attention and concentration, as suggested by greater childhood symptomatology in these patients.