Alcohol and drug use severity are independently associated with antiretroviral adherence in the current treatment era

Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in adult PWH in care between 2016 and 2020 at 8 sites across the US. PWH completed assessments of alcohol use severity (AUDIT-C), drug use severity (modified ASSIST), and ART adherence (visual analogue scale). Among 9400 PWH, 16% reported current hazardous alcohol use, 31% current marijuana use, and 15% current use of ≥1 illicit drugs. In multivariable analysis, current methamphetamine/crystal use, particularly common among men who had sex with men, was associated with 10.1% lower mean ART adherence (p < 0.001) and 2.6% lower adherence per 5-point higher severity of use (ASSIST score) (p < 0.001). Current and more severe use of alcohol, marijuana, and other illicit drugs were also associated with lower adherence in a dose-dependent manner. In the current HIV treatment era, individualized substance use treatment, especially for methamphetamine/crystal, and ART adherence should be prioritized.

Effect of alcohol consumption on all-cause and liver-related mortality among HIV-infected individuals

OBJECTIVES

The aim of the study was to examine the association between levels of past and current alcohol consumption and all-cause and liver-related mortality among people living with HIV (PLWH).

METHODS

A prospective cohort study of 1855 PLWH in Baltimore, MD was carried out from 2000 to 2013. We ascertained alcohol use by (1) self-report (SR) through a computer-assisted self interview, and (2) medical record abstraction of provider-documented (PD) alcohol use. SR alcohol consumption was categorized as heavy (men: > 4 drinks/day or > 14 drinks/week; women: > 3 drinks/day or > 7 drinks/week), moderate (any alcohol consumption less than heavy), and none. We calculated the cumulative incidence of liver-related mortality and fitted adjusted cause-specific regression models to account for competing risks.

RESULTS

All-cause and liver-related mortality rates (MRs) were 43.0 and 7.2 per 1000 person-years (PY), respectively. All-cause mortality was highest among SR nondrinkers with PD recent (< 6 months) heavy drinking (MR = 85.4 deaths/1000 PY) and lowest among SR moderate drinkers with no PD history of heavy drinking (MR = 23.0 deaths/1000 PY). Compared with SR moderate drinkers with no PD history of heavy drinking, SR nondrinkers and moderate drinkers with PD recent heavy drinking had higher liver-related mortality [hazard ratio (HR) = 7.28 and 3.52, respectively]. However, SR nondrinkers and moderate drinkers with a PD drinking history of > 6 months ago showed similar rates of liver-related mortality (HR = 1.06 and 2.00, respectively).

CONCLUSIONS

Any heavy alcohol consumption was associated with all-cause mortality among HIV-infected individuals, while only recent heavy consumption was associated with liver-related mortality. Because mortality risk among nondrinkers varies substantially by drinking history, current consumption alone is insufficient to assess risk.

Alcohol and drug use disorders, HIV status and drug resistance in a sample of Russian TB patients

SETTING

Alcohol use, tuberculosis (TB) drug resistance and human immunodeficiency virus (HIV) risk behavior are of increasing concern in Russian TB patients.

DESIGN

A prevalence study of alcohol use and HIV risk behavior was conducted in a sample of 200 adult men and women admitted to TB hospitals in St Petersburg and Ivanovo, Russia.

RESULTS

Of the subjects, 72% were men. The mean age was 41. Active TB was diagnosed using a combination of chest X-ray, sputum smears and sputum cultures. Sixty-two per cent met DSM-IV criteria for current alcohol abuse or dependence. Drug use was uncommon, with only two patients reporting recent intravenous heroin use. There was one case of HIV infection. The mean total risk assessment battery score was 3.4. Depression was present in 60% of the sample, with 17% severely depressed. Alcohol abuse/dependence was associated with an eight-fold increase in drug resistance (OR 8.58; 95% CI 2.09-35.32). Patients with relapsing or chronic TB were more likely to meet the criteria for alcohol abuse/dependence (OR 2.56; 95% CI 1.0-6.54).

CONCLUSION

Alcohol use disorders are common in patients being treated for active TB, and are associated with significant morbidity. Additional surveys are needed to examine the relationship between alcohol use disorders and anti-tuberculosis drug resistance.

GABRA6 gene polymorphism and an attenuated stress response

The glucocorticoid component of the stress response has been the subject of intense scientific scrutiny because of the wide ranging pathological consequences resulting from excess glucocorticoid exposure, including mood and anxiety disorders, and cognitive impairment. Exposure to stress activates the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic adrenomedullary system, which are regulated by neuronal pathways, including the inhibitory GABAergic (gamma-aminobutyric acid) system. Approximately 60% of the variance in glucocorticod levels may be attributable to genetic individual differences. In the present study, 56 healthy subjects underwent genotyping to determine the influence of the T1521C single nucleotide polymorphism (SNP) in the GABA(A)alpha6 receptor subunit gene (GABRA6) on the hormonal and autonomic responses to psychological stress induced by the Trier Social Stress Test (TSST). Adrenocorticotropin (ACTH), cortisol, diastolic blood pressure, and mean blood pressure responses to the TSST were significantly greater in subjects homozygous for the T allele or heterozygous compared to subjects homozygous for the C allele. Behavioral data was collected employing the Revised NEO Personality Inventory (NEO PI-R); subjects homozygous for the C allele scored significantly lower on the Extraversion factor compared to subjects homozygous for the T allele or heterozygous. These results suggest that the T1521C polymorphism in the GABRA6 gene is associated with specific personality characteristics as well as a marked attenuation in hormonal and blood pressure responses to psychological stress.

Naltrexone dampens ethanol-induced cardiovascular and hypothalamic- pituitary-adrenal axis activation

Alcohol ingestion activates the autonomic nervous system and the hypothalamic-pituitary-adrenal axis. This study examined naltrexone effects on alcohol-induced increases in physiological responses and their association with alcohol liking. Using a within-subjects design, heavy drinking men (N = 19) were maintained on each of three naltrexone doses (0, 50, and 100 mg, p.o.) over an 8-day inpatient stay. Within each naltrexone dose, subjects had three alcohol challenge sessions (none, moderate, high) in random order. Autonomic, subjective and endocrine measurements were collected regularly prior to and following alcohol administration. High-dose alcohol ingestion increased heart rate, diastolic blood pressure, skin temperature, ACTH, cortisol and liking of drink effects; responses following the moderate alcohol dose were less consistent. Naltrexone significantly dampened alcohol-induced increases in heart rate, diastolic blood pressure, hormone levels and subjective liking of drink effects. This dampening of cardiovascular and hormonal responses may contribute to the therapeutic effectiveness of naltrexone for reducing alcohol liking and decreasing relapse in alcohol-dependent persons.

Confirmation that offspring from families with alcohol-dependent individuals have greater hypothalamic-pituitary-adrenal axis activation induced by naloxone compared with offspring without a family history of alcohol dependence

BACKGROUND

This study was designed to confirm our previous findings that nonalcoholic offspring from families with alcohol-dependent individuals have greater hypothalamic-pituitary-adrenal axis activation induced by opioid blockade compared with nonalcoholic subjects without a family history of alcohol dependence.

METHODS

Sixty-four nonalcoholic subjects aged 18 to 25 years were enrolled in the protocol. Twenty-seven subjects were offspring from families with alcohol dependence and were designated as family history-positive subjects (FHP). Thirty-seven subjects were biological offspring of non-alcohol-dependent parents and were designated as family history-negative subjects (FHN). Subjects received naloxone hydrochloride (0, 50, 125, 375, and 500 microg/kg) in double-blind, randomized order; adrenocorticotropin (ACTH) and cortisol were monitored over 120 min.

RESULTS

No hormone differences at baseline or during placebo administration were identified between FHP and FHN subjects. FHP subjects had greater ACTH and cortisol response to opioid receptor blockade induced by naloxone hydrochloride compared with FHN subjects.

CONCLUSIONS

These observations confirm previous findings that differences in ACTH and cortisol dynamics between FHP and FHN subjects can be unmasked by opioid receptor blockade.

Predictors of outpatient treatment retention: patient versus substance use characteristics

The present study examined predictors of participation and retention for patients treated at an urban, hospital-based outpatient substance abuse treatment clinic. All patients were interviewed using the Addiction Severity Index (ASI) at the time of admission. Based on lifetime diagnostic history of psychoactive substance abuse/dependence, patients (N=268) were classified as: alcohol-only, drug(s)-only, and alcohol+drug(s). Alcohol-only patients were significantly older, more likely to be Caucasian, married, have less than a high school education, and be employed than drug-only or alcohol/drug patients. Using multiple regression analysis, substance use status did not predict treatment participation and retention, whereas race, gender and employment composite score were significant predictors. Specifically, patients attended more sessions and remained in treatment longer if they were Caucasian, male and had a high employment composite score. These findings suggest that type of substance abuse may be overemphasized as a predictor of outpatient drug-free treatment retention, and that greater emphasis should be placed on tailoring treatment to patients' cultural, gender and vocational needs.

Serum 6-beta-naltrexol levels are related to alcohol responses in heavy drinkers

BACKGROUND

There is strong evidence for the role of the endogenous opioid system in alcohol reinforcement and consumption; however, recent human laboratory studies and clinical trials have reported mixed effects of naltrexone (a nonselective opioid antagonist) on alcohol-related behaviors. This paper reports a secondary data analysis of a human laboratory study that examines the relationship between serum levels of 6-beta-naltrexol, the major, biologically active metabolite of naltrexone, and subjective effects of alcohol.

METHODS

The study used a within-subjects design to examine the effects of naltrexone (0, 50, and 100 mg/day) on subjective responses to alcohol (none, moderate, and high dose) in heavy drinkers (n = 23). Each subject received three doses of naltrexone in random order; each naltrexone dose was administered over an 8 day period on an inpatient unit, with a 1 week outpatient washout between doses. After stabilization at each of the naltrexone doses, subjects participated in three alcohol challenge sessions (none, moderate, and high dose) in random order; thus, each subject participated in a total of nine alcohol administration sessions.

RESULTS

Doubling the naltrexone dose (50 vs. 100 mg/day) doubled the mean serum 6-beta-naltrexol levels. At each naltrexone dose, there was a 4-fold range in 6-beta-naltrexol levels across subjects. Before alcohol administration, higher 6-beta-naltrexol levels were associated with higher ratings of sedation. After high-dose alcohol administration, higher 6-beta-naltrexol levels were associated with significantly lower ratings of liking and best effects.

CONCLUSIONS

These findings provide further evidence of the involvement of the opioid system in the modulation of alcohol effects and suggest that serum 6-beta-naltrexol concentrations may be important in predicting therapeutic response to naltrexone.

Plasma adrenocorticotropin responses to opioid blockade with naloxone: generating a dose-response curve in a single session

We examined two methods of generating a dose-response curve to the opioid receptor antagonist naloxone. In 15 healthy male subjects (18-25 years) plasma adrenocorticotropin (ACTH) responses to five doses of naloxone studied over 5 separate days were compared to plasma ACTH responses to five incremental doses of naloxone studied within a single session. There was a statistically significant positive correlation in ACTH responses (area under the curve and peak) between dosing methods. Furthermore, the doses of naloxone that produced half-maximal and maximal ACTH response were similar. The comparability of ACTH responses between the two naloxone dosing techniques, combined with the safety and ease associated with the single-session methodology, underscores the usefulness of the single-session technique for future investigations.

Pregnant, alcohol-abusing women

BACKGROUND

This paper reviews the literature on the identification and treatment of pregnant, alcohol-abusing women, with special emphasis on poor women who have access to treatment through Medicaid.

METHODS

The paper discusses the gaps and controversies in the literature and suggests five priorities for future research.

RESULTS

Studies that attempt to identify pregnant women who drink conclude that heavier drinkers enter prenatal care later than other women, that many health care providers fail to recognize alcohol abuse by pregnant women, and that research on screening techniques is still in the early stages. Treatment research suggests that comprehensive, holistic treatment approaches, as well as brief interventions and case management, have been successful in reducing prenatal alcohol use. Debate continues over whether treatment should be voluntary.

CONCLUSIONS

The five areas identified as priorities for future research include (1) developing reliable and valid measures to identify alcohol abuse in pregnant women, (2) creating training programs for providers, (3) generating programs to reduce barriers to care, (4) determining which treatment programs are most successful, and (5) estimating the costs and benefits of various treatment approaches.

Naltrexone alters subjective and psychomotor responses to alcohol in heavy drinking subjects

Preclinical studies support endogenous opioid system involvement in alcohol reinforcement and consumption; however, recent clinical trials and human laboratory studies have provided mixed findings of the effects of naltrexone (a non-selective opioid antagonist) on alcohol responses. This study used a within-subject design (n = 23) to investigate naltrexone effects (0, 50 and 100 mg qd) on subjective and psychomotor responses to alcohol (none, moderate, high) in heavy drinkers. Before alcohol administration, subjects reported decreased desire to drink alcohol when maintained on 50 mg compared with placebo naltrexone. Following alcohol administration, active naltrexone significantly increased subjective ratings of sedative, and unpleasant/sick effects and decreased ratings of liking, best effects and desire to drink. Naltrexone generally did not alter subjective or objective indicators of drunkenness. Finally, high doses of naltrexone and alcohol interacted to produce the greatest decreases in liking and best effects. Findings support the role of endogenous opioids as determinants of alcohol's effects and suggest that naltrexone may be particularly clinically useful in those treatment patients who continue to drink heavily.

Family history of alcoholism and hypothalamic opioidergic activity

BACKGROUND

This study was designed to assess whether nonalcoholic offspring from families with a high density of alcohol-dependent individuals have altered endogenous central nervous system opioid activity. Naloxone hydrochloride stimulates plasma cortisol by blocking opioidergic input on the corticotropin-releasing factor neuron, thereby providing a noninvasive method for measuring hypothalamic opioid tone.

METHODS

Forty-eight nonalcoholic subjects aged 18 to 25 years were enrolled in a protocol to measure endogenous opioid activity by inducing opioid receptor blockade with the receptor antagonist, naloxone. Twenty-six subjects were offspring from families with a high density of alcohol dependence and were designated as family history-positive subjects. Twenty-two subjects were biological offspring of nonalcohol-dependent parents and designated as family history-negative subjects. Subjects received naloxone hydrochloride (0, 125, and 375 microg/kg) in double-blind, randomized order. Serum cortisol levels were monitored.

RESULTS

Family history-negative subjects had a graded cortisol response to each dose of naloxone. In contrast, family history-positive subjects achieved a maximal cortisol response to the 125-microg/kg dose of naloxone hydrochloride with no further increase in cortisol levels observed following the 375-microg/kg dose. Family history-negative subjects had a diminished cortisol response to the 125-microg/kg dose compared with the family history-positive subjects. Plasma naloxone concentrations did not differ between family history groups.

CONCLUSIONS

Individuals from families with a high density of alcohol dependence are more sensitive to naloxone compared with offspring of nonalcohol-dependent parents. This implies that individuals with a family history of alcohol dependence have diminished endogenous hypothalamic opioid activity.

Substance abuse vulnerability in offspring of alcohol and drug abusers

Epidemiological research has clearly demonstrated the importance of a family history as a determinant of future alcohol and, possibly, drug use in offspring of alcoholics. Laboratory studies have examined a wide range of potential markers both in the presence and absence of alcohol challenge, which may predict those subjects at high risk for the future development of alcoholism. While this body of research has yielded several replicable differences in FHP and FHN subjects, it also has been marked by many discrepancies in outcomes across studies. Future refinements in subject ascertainment and laboratory methodologies may help to bring greater procedural uniformity and consistency in study outcomes.

Cost-effectiveness of treatment for drug-abusing pregnant women

Neonatal intensive care unit (NICU) and drug treatment costs were compared in two groups of pregnant drug abusing women: 100 admissions to a multidisciplinary treatment program and active in care at the time of delivery and 46 controls not entering drug treatment. Clinical measures included urine toxicology at delivery, infant birthweight. Apgar scores and need for and duration of NICU services. Cost measures included drug treatment and NICU costs. Treatment patients showed better clinical outcome at delivery, with less drug use and higher infant estimated gestational age, birthweight and Apgar scores. Infants of treatment patients were also less likely to require NICU services and, for those that did, had a shorter stay. When total cost was examined (including drug treatment), mean net savings for treatment subjects was $4644 per mother/infant pair. The study demonstrates the cost-effectiveness of treatment for pregnant drug abusing women, with savings in NICU costs exceeding costs of drug treatment.

Detecting alcohol problems in drug-dependent women of childbearing age

Alcohol problems frequently go undetected in drug-dependent individuals. In women of childbearing age, the consequences of unrecognized alcohol problems can be severe. Unfortunately, many drug treatment programs lack resources to conduct formal diagnostic interviews with all program admissions. Using the Structured Clinical Interview for DSM-III-R (SCID) as the "gold standard," the present study compared four clinical tools for assessing alcohol problems in a drug-dependent population. Rates of detecting alcohol problems varied widely (15-76%). The Addiction Severity Index (ASI) and the Family Alcohol and Drug Survey (FADS) yielded the highest sensitivities (96% and 83%, respectively) and specificities (94% and 92%, respectively). Since these instruments require less staff training and background education than the SCID, they offer cost-effective alternatives for efficient screening and assessment of alcohol problems in drug-dependent populations.

The use of support groups among pregnant substance abusers: implications for managed care

The Better Chance Program offers a model for coordinating managed care for pregnant substance abusers. Support groups may prove useful for other high-risk segments of society inasmuch as they are enrolled in more restrictive health delivery systems.

Differential expression of guanosine triphosphate binding proteins in men at high and low risk for the future development of alcoholism

We evaluated G-proteins that are components of adenylyl cyclase (AC) signal transduction in erythrocyte and lymphocyte membranes from 26 family history positive (FHP) non-alcoholic and 26 family history negative (FHN) nonalcoholic subjects. Subjects were classified as FHP if their father met criteria for alcohol dependence; as FHN, if there was no history of alcoholism in any first or second degree relatives. Immunoblot analysis indicated that levels of erythrocyte membrane Gs alpha from FHP subjects were greater than levels in FHN subjects (171 +/- 11 vs 100 +/- 6, P < 0.001). To confirm the results of the immunoblot analysis, Gs alpha was quantitated by cholera toxin-dependent [32P]ADP-ribosylation. Levels of erythrocyte [32P]ADP-ribose-Gs alpha from FHP subjects were greater than levels in FHN subjects (236 +/- 28 vs 100 +/- 14, P < 0.001). Gs alpha levels did not correlate with age or alcohol consumption. By contrast to differences in Gs alpha, immunoblot analysis showed similar levels of Gi(2)alpha and Gi(3)alpha in erythrocyte membranes of FHP and FHN subjects. Pertussis toxin-catalyzed [32P]ADP-ribosylation of Gi-like G-proteins confirmed the immunoblot observations. Lastly, compared to FHN subjects, FHP subjects had enhanced Gs alpha expression in lymphocyte membranes as well (138 +/- 11 vs 100 +/- 5.5; P < 0.02). In summary, compared to FHN nonalcoholic men, FHP nonalcoholic men had greater levels of the stimulatory G-protein, Gs alpha, in erythrocyte and lymphocyte membranes. Enhanced expression of Gs alpha may be a marker of increased risk for the future development of alcoholism.

Adrenocorticotropin responses following administration of ethanol and ovine corticotropin-releasing hormone in the sons of alcoholics and control subjects

Alcoholism is a familial disorder with both genetic and environmental determinants. The sons of alcoholic fathers have been documented to have alterations in several neuroendocrine measures. We investigated the ACTH/cortisol response to ovine corticotropin-releasing hormone (oCRH) and ethanol in men with and without a family history of alcoholism. Men were defined as family history positive (FHP) (n = 7) if their father was alcoholic; as family history negative (FHN) (n = 16), if their father was nonalcoholic. Ethanol (0.75 g/kg) or placebo was ingested over 15 min, 1 microgram/kg oCRH was administered, and plasma ACTH/cortisol levels were determined at -20, 0, 15, 30, 60, and 90 min after oCRH. Following placebo, FHP men had lower peak ACTH response to oCRH than did FHN men (12 +/- 2 vs 20 +/- 2 pmol/liter, P = 0.04). In FHN men, plasma ACTH response to oCRH was blunted during the ethanol session compared to the placebo session (13 +/- 1 vs 20 +/- 2 pmol/liter; P = 0.006). In contrast, FHP men had similar ACTH responses to oCRH during ethanol and placebo sessions. Cortisol responses to oCRH were similar in both groups during both sessions. In summary, FHP and FHN nonalcoholic men had different plasma ACTH responses following the administration of oCRH.

Prenatal care and drug use in pregnant women

This case-control study tested the hypothesis that pregnant inner-city women with low utilization of prenatal care are likely to be frequent drug users. Cases registered consecutively for prenatal care at > or = 28 weeks gestation or had < 4 prenatal visits. Controls were matched to cases by date of delivery. 24/81 (30%) cases and 16/128 (12%) controls were frequent drug users (adjusted odds ratio = 2.5; 95% CI, 1.2-5.4). Drug use (P = 0.01) and socioeconomic status (P = 0.001) were significantly correlated with prenatal care utilization. Self-report alone failed to note as many drug users as toxicology screen alone. Both substance use history and toxicology screen are advisable in women with low utilization of prenatal care.

Enhanced expression of the inhibitory protein Gi2 alpha and decreased activity of adenylyl cyclase in lymphocytes of abstinent alcoholics

Ethanol exposure alters signal transduction through the adenylyl cyclase (AC) system. To elucidate the basis for this effect, we investigated the AC system in peripheral lymphocytes from abstinent alcoholic men (n = 22), actively drinking alcoholic men (n = 41), and nonalcoholic control men (n = 16). Immunoblot analysis of lymphocyte membranes from abstinent alcoholics demonstrated a 3.0-fold increase in the level of Gi2 alpha protein (p < 0.05) compared with controls. However, levels of Gs alpha protein were similar in both groups. Abstinent alcoholics had a 2.9-fold increase in Gi2 alpha mRNA (p < 0.001) and a 2.7-fold increase in Gs alpha mRNA (p < 0.03) compared with lymphocytes from control subjects. Actively drinking alcoholics, in contrast, had unaltered Gs alpha protein, Gi2 alpha protein, and Gi2 alpha mRNA levels compared with control subjects, but did have a 1.8-fold increase (p < 0.01) in Gs alpha mRNA. Consistent with enhanced Gi2 alpha expression, lymphocyte membranes from abstinent alcoholics had decreased basal, prostaglandin E1-, guanosine 5'-0-(3-thiotriphosphate)-gamma S-, and forskolin-stimulated AC activity compared with both controls and actively drinking alcoholics (p < 0.05). We conclude that lymphocyte AC is reduced during abstinence from alcohol and enhanced expression of the inhibitory G-protein, Gi2 alpha, may account for this change.

Pregnancy and addiction: outcomes and interventions

Cocaine use by pregnant women has increased dramatically in recent years, resulting in well-documented consequences for mothers and offspring. However, even a once weekly peer-oriented intervention can have a positive impact on pregnancy outcome for drug-using women.

Familial density of alcoholism: effects on psychophysiological responses to ethanol

Recent research findings suggest that the patterning of familial alcoholism may critically determine ethanol sensitivity and severity of alcohol-related problems in the offspring. The present study examined the effects of familial alcoholism density on psychophysiological responses to ethanol administration in college males. Subjects with a positive family history of alcoholism were classified into affected biological father only (LD-FHP) versus both father and at least one second-degree affected relative (HD-FHP), and were compared to family history negative (FHN) subjects. Subjects received 1 g/kg ethanol or placebo in a double-blind procedure. A battery of subjective, physiological and psychomotor measures were collected once prior to and four times following drink administration. HD-FHP subjects showed significantly greater subjective effects, body sway and skin conductance after alcohol ingestion than either FHN or LD-FHP subjects; in contrast, there was no difference on any measure for LD-FHP versus FHN subjects. Our findings of increased ethanol sensitivity as a function of familial density of alcoholism strongly suggest the importance of carefully defining family history characteristics in all studies examining potential markers or risk factors for alcoholism.

Alcohol and secobarbital effects as a function of familial alcoholism: extended intoxication and increased withdrawal effects

Response differences following administration of alcohol between adult males with a positive (FHP) versus negative (FHN) family history of alcoholism have been demonstrated in previous research and are thought to be related to risk for developing alcoholism. If this is so, the pharmacological breadth of addiction risk conferred by a positive family alcoholism history might be studied by determining whether FHP subjects show different responses than FHN to drug classes other than alcohol. We have previously reported on the acute effects of ethanol as compared with secobarbital in FHP and FHN subjects and found that FHP subjects showed greater sensitivity across a variety of subjective measures than FHN subjects for both drug classes. The data reported here are based on an extended data collection period of 3 to 18 hr postingestion, following completion of the acute laboratory portion of the study. Specifically, in the present study, dose-effect timecourse functions for a variety of physiological (heart rate, blood pressure, and breath alcohol level), subjective (analog mood, drug effect, and withdrawal, Subjective High Assessment Scale (SHAS], and psychomotor measures (Digit Symbol Substitution Test and numeric recall) were examined in FHP and FHN college-aged males for secobarbital (0, 100, 200 mg daily) and ethanol (1 g/kg daily). FHP and FHN subjects were matched on light-to-moderate drinking patterns, anthropometric dimensions, age, years of schooling, and drug use. FHP subjects reported more extended intoxication and greater withdrawal effects following both ethanol and the high dose of secobarbital than did FHN subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol and secobarbital effects as a function of familial alcoholism: acute psychophysiological effects

Previous research has demonstrated response differences following administration of alcohol between adult males with a positive (FHP) versus negative (FHN) family history of alcoholism. These response differences are thought to reflect differences in vulnerability to dependence on alcohol. Thus, the role of positive family alcoholism history in increasing risk of addiction to a variety of drug classes might be studied by determining whether FHP subjects show different responses to drug classes other than alcohol. This was done in the present study by determining dose-effect functions for a variety of physiological (heart rate, skin conductance, skin temperature), subjective (analog mood and drug effect, Subjective High Assessment Scale), and psychomotor measures (hand tremor, body sway, Digit Symbol Substitution Test, eye-hand coordination, and numeric recall) in FHP and FHN college-aged males for secobarbital (0, 100, 200 mg by mouth) and ethanol (1 g/kg). FHP and FHN subjects were matched on light-to-moderate drinking patterns, anthropometric dimensions, age, years of schooling, and drug use. At equivalent blood alcohol levels family-history positive subjects reported greater effects of ethanol than did family-history negative subjects on almost all subjective measures. Following the high dose of secobarbital, FHP but not FHN subjects showed elevated subjective effects; these effects were substantially less and were evident in fewer measures than following ethanol. In contrast to effects on the subjective measures, ethanol and secobarbital produced comparable impairment in both groups of subjects for most psychomotor responses. Group differences were not obtained on any physiological measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Alcohol and drug use by college males as a function of family alcoholism history

Family history of alcoholism increases the risk for development of alcoholism in male offspring. The present questionnaire study examined self-reported alcohol and drug use in 744 college males as a function of DSM-IIIR alcohol dependence diagnoses in first- and/or second-degree biological relatives. Substance use was most prevalent and most frequent in students with both first- and second-degree alcohol-dependent family members, was intermediate in students with only first-degree affected relatives, and was least in students with no affected relatives. Students with both first- and second-degree alcohol-dependent relatives reported: more alcohol, marijuana, sedative, and cocaine ingestion; a younger age at first alcohol intoxication and first marijuana use; experience with less commonly used drugs; and more personal substance-related problems as well as more family mental health care. These data have significant prevention implications for targeting at-risk youth.

A comparison of drug use and adjustment in urban adolescent children of substance abusers

Children of alcoholics and other drug abusers are at elevated risk for substance abuse and other related psychosocial problems. Adolescents with a positive family history for drug abuse or alcoholism were compared to a similar group of low-SES, urban youth who were at risk for school failure but did not report any family history of substance abuse. A survey of depression, self-esteem, behavioral competence and dysfunction, and drug/alcohol use found that, overall, adolescents with a positive family history (FHP) for substance abuse exhibited more use of illicit drugs compared to those with a negative family history (FHN). There were also a greater number of FHP cases which fell into the clinical range on the psychosocial measures of behavioral dysfunction and depression compared to FHN youth. There were differential effects for boys versus girls, with FHP girls exhibiting a greater number of problem cases. Implications for substance abuse prevention with urban youth are discussed.

Conditioned opponent responses: effects of placebo challenge in alcoholic subjects

The present study continues a series of studies examining a number of variables that contribute to the demonstration of conditioned responses to alcohol in alcoholics. We pursued here the hypothesis that subjects receiving placebo in an environment previously associated with alcohol ingestion would exhibit conditioned responses as compared with subjects who had only received placebo in the environment. Further, we predicted that these conditioned responses would be opposite in direction to responses obtained during active drink sessions. Twelve subjects received active alcohol during session Days 1 through 4 and a placebo challenge on Day 5; the second group received placebo throughout sessions 1 through 5. On Day 1, heart rate and skin conductance were elevated following active alcohol ingestion as compared with placebo. On Day 5 following the placebo challenge, these physiological responses were significantly lower in the alcohol group as compared with the placebo group; the reversal of effects on Day 5 is suggestive of conditioned compensatory responses. Also, following the placebo on Day 5, desire to drink scores of the alcohol group were greater than those of the placebo group. The present data suggest that subjects exhibit conditioned compensatory responses when the environment signals alcohol availability. Results are consistent with Siegel's model of conditioned compensatory responses to repeated drug administration, and may help to account for some aspects of tolerance development and conditioned withdrawal.

Psychophysiological effects of alcohol-related stimuli: II. Enhancement with alcohol availability

This laboratory study examined methods of enhancing physiological and subjective responses of alcoholics to naturalistic alcohol-related stimuli by repeated exposures to a high-dose alcohol drink. Individual subjects participated in five successive daily sessions consisting of randomized-block presentations of gustatory and visual presentation of alcohol, pepper juice (as a control for stimulus taste intensity), or water stimuli. Following the stimulus trial series, all subjects ingested 1.5 oz of alcohol in a shot glass. Twelve subjects next received a 1.7 g/kg alcohol drink ("high dose alcohol group") on Days 1-4 and placebo on Day 5, and 12 subjects received a placebo drink on all study Days (1-5) ("placebo drink group"). On Day 1, alcohol stimuli generally elicited larger heart rate and skin conductance increases and skin temperature decreases than water or pepper juice stimuli. Alcohol stimuli also elicited greater subjective responses than either pepper juice or water. Alcohol availability within the taste trial markedly increased physiological and subjective reactivity to alcohol-related stimuli, perhaps due to the closer approximation to natural drinking behavior. A comparison with previous data from this laboratory suggests that prestudy deprivation from alcohol, instructions to expect alcohol, a conductive drink setting, and the opportunity to drink alcohol within the session may enhance reactivity to alcohol stimuli in alcoholics.

Psychophysiological effects of alcohol-related stimuli: I. The role of stimulus intensity

The present study extends previous research on conditioning factors in the physiological and subjective responses to naturalistic alcohol-related stimuli. Specifically, the effects of differential alcohol ingestion histories and of stimulus intensity were examined on the occurrence of conditioned responses in the laboratory. Twelve alcoholic subjects and twelve moderate drinkers participated in a single experimental session consisting of randomized presentations of three types of stimulus trials. Each trial included gustatory and visual presentation of alcohol, pepper juice (as a control for stimulus intensity) or water. Both alcohol and pepper juice stimuli significantly increased heart rate and skin conductance responses as compared with water stimuli. In contrast, subjects significantly increased self-report ratings of high and feel different following alcohol stimuli only. Physiological and subjective responses were similar in alcoholics and social drinkers with the exception of significantly higher self-reported craving in alcoholic subjects. These findings suggest that stimulus intensity contributes to the magnitude of physiological but not subjective responses to alcohol-related stimuli.

Psychophysiological effects of oral ethanol in alcoholics and social drinkers

The acute and extended effects of ethanol ingestion were examined in five alcoholic subjects, and five "social" drinkers. Six physiological and four subjective report measures were taken before, during and up to 90 min after the ingestion of ethanol in three doses and placebo. Findings showed that alcohol exerted significant dose-related physiological effects in the initial minutes of ingestion, and in extended analyses of physiological and subjective measures in both groups of drinkers. Alcoholics and social drinkers generally did not differ in their physiological responses to alcohol doses and placebo, while some evidence for tolerance to reported euphoric effects of alcohol in the alcoholic subjects was found. The possibility is raised that early physiological responses observed during ethanol ingestion may arise not only from pharmacological effects of the drink, but may also be evidence for conditional predrink responses.

Pupillary response to methadone challenge in heroin users

The relationship between self-reported illicit heroin use and pupillary response to a low-dose methadone challenge was examined in 28 men beginning methadone therapy for opiate dependence. Pupil diameter was assessed before and 60, 90, and 120 minutes after a 20 mg methadone dose on day 1 of treatment. Self-reports of opiate drug effects were also taken at these times. There was a significant negative correlation (r = -0.53) between pupillary constriction 120 minutes after drug dosing and the average dollar value of subjects' reported heroin use per week. In other words, those who showed the least pupillary constriction generally reported the highest amount of illicit heroin use. Total years since first opiate use was also a significant predictor of pupillary response (r = -0.46). Self-reported amount of heroin use and years since first opiate use together accounted for 60% of the total variance in pupillary response to the challenge (Mult r = 0.77). Pupillary response to a low-dose methadone challenge appears to be a clinically practical and objective method for determining opiate tolerance levels in applicants for methadone therapy.

Chronic opiate use during methadone detoxification: effects of a dose increase treatment

The effects of administering high methadone doses during detoxification treatment were examined on illicit opiate use and treatment retention in chronic opiate supplementors. Twenty-six applicants to a 90-day outpatient detoxification program who delivered 50% or more opiate-positive urine samples during treatment weeks 2 and 3 were randomly assigned to receive a constant 30-mg dose through treatment week 10 or an increase to 60 mg in week 4 with gradual reduction to 30 mg by week 10. Dosage for both groups was reduced to 0 mg during weeks 11-13. Treatment retention was better for experimental (median = 86 days) than for control (median = 41 days) subjects, but the difference was not statistically significant. In the dose increase group, percent opiate-positive urines decreased from 80% to 62% during the first two weeks of dose increase (t = 2.39, P less than 0.05); opiate positive rates for the control group remained above 80%. A 20% between group difference in percent of opiate positive urine tests persisted through study week 10 in subjects (N = 5 control, 7 experimental) who remained in treatment this long. Although the blind dose increase did improve treatment outcome, we concluded that the magnitude of the effect in this population of chronic opiate supplementors was insufficient to judge the procedure clinically useful.

Hydromorphone effects on human conversational speech

The present study provides an objective assessment of the increased talkativeness associated with acute opiate drug administration. Speech of five methadone-maintenance subjects was recorded continuously for 1 h following the injection of 0, 10, 14, or 18 mg hydromorphone. Dose-related increases in subjects' speech were observed, while no systematic changes were seen in speech of an undrugged partner. Dose-related increases were also obtained on an adjective checklist measuring characteristic opiate signs and symptoms. The relationship between behavioral, subjective, and reinforcing drug effects is discussed.

Contingency management interventions: effects on treatment outcome during methadone detoxification

We examined the effectiveness of a contingency management program in preventing relapse to illicit opiate use and increasing treatment retention during outpatient methadone detoxification treatment. Twenty male opiate addicts were randomly assigned to an experimental or control group. Following a 3-week methadone stabilization period, men in both groups received identical gradual methadone dose reductions during Weeks 4 through 9 and were maintained on placebo during Weeks 10 through 13. Beginning in Week 4, control patients received $5.00 for providing a specimen twice weekly. Experimental patients received $10.00 and a take home methadone dose for each opiate-free urine specimen but forfeited the incentives and participated in more intensive clinic procedures when specimens were opiate positive. The contingency management procedure slowed the rate of relapse to illicit opiate use. Experimental patients provided significantly more opiate-free urines during the methadone dose reduction in Weeks 4 through 9 than control patients, although the difference between groups was no longer significant during placebo administration in Weeks 10 through 13. In addition, the contingency management program improved treatment retention and reduced symptom complaints during the detoxification. The usefulness and limitations of contingency management procedures for outpatient methadone detoxification are discussed.

Treatment outcome in methadone detoxification: relationship to initial levels of illicit opiate use

Two groups each of 10 patients enrolled in a 90-day outpatient detoxification program were classified on the basis of high (92.5% of tests) and low (7.5% of tests) rates of opiate-positive urine test results during two weeks of dosage stabilization. Pretreatment demographic variables did not differ between the two groups. Relapse to opiate use during the detoxification occurred in patients who were initially opiate free. By the end of the dose reduction period, opiate-positive rates were 60% and 87% of tests for the low and high opiate use groups, respectively. Sedative use and missed clinic days showed similar trends for both groups during the detoxification, although different patterns of drop-out from treatment were noted. Symptomatology increased during dose reduction for the low- but not for the high-frequency opiate group. In general, treatment outcome appeared equally poor for patients who showed low or high levels of illicit opiate drug use early in detoxification treatment.

Oral methadone self-administration: effects of dose and alternative reinforcers

We examined the efficacy of oral methadone as a reinforcer by offering methadone maintenance patients the chance to self-administer extra doses of methadone occasionally in addition to their regular dose. Seven maintenance patients received twice-weekly choices between methadone doses or money. Doses were 0, 1, 5, 10, 25, or 50 mg methadone; the alternative money option was $1 or $5. Extra methadone doses were reliably self-administered by maintenance patients, and percent of dose choices rose as the size of the dose offered increased. Thus extra methadone doses functioned as reinforcers in this situation. Further, across the entire dose range, more dose choices were selected when $1 was offered than when $5 was offered as an alternative. Thus methadone self-administration was influenced by the alternative reinforcers available for drug refusal. Neither reports of subjective withdrawal symptoms nor reduction of symptoms after extra methadone predicted methadone self-administration, but dose selections were more likely when urinalysis results indicated recent illicit opiate use. The reinforcing effects of oral methadone in methadone-tolerant patients may be an important factor in the popularity of this treatment among drug abusers and in the long-term treatment retention generally observed during methadone maintenance.

Short-term effects of oral methadone in methadone maintenance subjects

In two experiments the physiologic and subjective status of methadone maintenance patients was assessed during the presumed peak (0 to 6 hr postmethadone) and during the presumed nadir of the daily methadone effect (18 to 30 hr postmethadone). In the first experiment physiologic and subjective responses were measured in seven ambulatory subjects at 2, 4, and 6 hr after a regular daily dose of methadone or placebo. In the second, physiologic measures were continuously monitored for 4 hr in six inactive seated subjects. In both studies, pupil diameter decreased after moderate to high methadone doses (35 to 80 mg). In the second experiment, heart rate fell and skin temperature rose significantly after methadone. Responses to the morphine-benzedrine group scale of the Addiction Research Center Inventory were elevated after methadone for most subjects in both studies, although there were individual differences in the magnitude and time course of this effect. Finally, low methadone maintenance doses of 10 and 20 mg/day had little or no effect on physiologic or subjective responses in two subjects. These studies showed that short-term effects of oral methadone can be readily detected during a 24-hr dosing regimen. The changes in function after the regular maintenance dose may result both from short-term opiate effects and relief of mild withdrawal.