Abstinence-contingent reinforcement and engagement in non-drug-related activities among illicit drug abusers.

Methadone-maintained cocaine abusers (N = 78) were randomly assigned to 1 of the following 52-week interventions: (a) usual care only (UC), (b) take-home methadone doses contingent on cocaine- and opiate-negative results (THM), or (c) take-home methadone doses for cocaine- and opiate-negative results and monetary-based vouchers contingent on cocaine-negative urinalysis results (THM + V). Cocaine use was assessed by urinalysis on a thrice-weekly schedule. Frequency and enjoyability of non-drug-related activities were assessed with the Pleasant Events Schedule (PES) at baseline, midtreatment, and end of treatment. The THM + V condition achieved the greatest abstinence from cocaine and opiate use, followed by the THM and UC conditions. The THM + V condition had the highest PES frequency ratings at midtreatment and at the end of treatment, followed by the THM and UC conditions. There were significant differences between the THM + V and UC conditions on 10 of 12 PES-derived subscales. Analyses revealed that abstinence mediated the effects of treatment condition on frequency ratings. There were no significant differences in enjoyability ratings. These results suggest that when contingency-management interventions increase abstinence from drug abuse, they also increase engagement in non-drug-related activities in naturalistic settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some relations between pleasant and unpleasant mood-related events and depression.

Studied (a) the validity of 2 methods of identifying reinforcing and punishing events, (b) their interrelations and dimensional structure, and (c) their relation to depression. A total of 909 Ss who were screened with the MMPI and classified as depressed, nondepressed psychiatric, or normal control rated the frequency and the subjective enjoyability or aversiveness of 320 pleasant (the Pleasant Event Schedule Form III) and 320 unpleasant events (the Unpleasant Events Schedule Form I). Some Ss also monitored the occurrence of pleasant and unpleasant events and rated their mood on a daily basis (Depression Adjective Check List). Correlations between each event and mood were calculated and used to identify 49 pleasant and 35 unpleasant "mood-related events." The proportion of Ss for whom the events correlated with mood and the mean enjoyability and aversiveness of the items were hypothesized to be measures of reinforcing or punishing impact. As predicted, statistically significant correlations between these 2 measures were obtained. The mood-related events also discriminated more strongly between depressed and nondepressed groups than the non-mood-related events did. The intercorrelations between pleasant and unpleasant events yielded separate and orthogonal dimensions of punishment and of reinforcement. (28 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The validity of an alternative five-factor measure of personality in cocaine abusers.

The validity of an alternative 5-factor measure of personality, the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ), was assessed in 450 cocaine abusers seeking outpatient treatment. As predicted, the ZKPQ Impulsive Sensation Seeking (ImpSS), Neuroticism-Anxiety (N-Anx), and Aggression-Hostility (Agg-Hos) scales were associated with greater drug abuse and psychiatric severity and symptoms and worse outcome (p?     

Brief coping skills treatment for cocaine abuse: substance use outcomes at three months

AIMS: Coping skills training, a promising treatment approach for alcoholics, was adapted for use with cocaine abusers and effects on outcome were investigated. DESIGN: A cocaine-specific coping skills training (CST) package was compared to an attention placebo control when both were added to a comprehensive treatment program. SETTING: The sites were two private substance abuse treatment facilities, one residential and rural, and one an urban partial hospital. PARTICIPANTS: Substance abusers in treatment with cocaine abuse or dependence were selected. INTERVENTION: The CST intervention was conducted in individual sessions. It involved functional analysis of high risk situations and coping skills training based on the functional analysis. FINDINGS: Clients who received CST had significantly fewer cocaine use days and the length of their longest binge was significantly shorter during the 3-month follow-up period compared to clients in the control condition. CST did not affect relapse rates or use of other substances. CONCLUSIONS: Results support the notion that cocaine-specific CST is a promising adjunct to treatment for cocaine abusers.     

Cocaine abusers do not show loss of dopamine transporters with age

Cocaine blocks dopamine transporters (DAT) and this effect is crucial to its reinforcing properties. To assess the effects of chronic cocaine on DAT we evaluated 20 current cocaine abusers and 20 age matched controls using PET and [C-11]cocaine as a DAT ligand. Though there were no differences in DAT availability between groups, current cocaine abusers (and 12 detoxified cocaine abusers studied previously) did not show the typical age-related decline in DAT seen in controls. Though further studies are required to rule out sampling effects and to control for confounding variables (i.e. smoking), one could speculate that chronic DAT blockade by cocaine has a protective effect on the loss of DAT with age.     

Review of Cocaine: A clinician's handbook.

Reviews the book, Cocaine: A clinician's handbook edited by Arnold M. Washton and Mark S. Gold (see record 1987-98183-000). Washton and Gold point out that the goal of this text is to provide "clinicians with information that is directly relevant to the treatment of cocaine abusers." I feel they accomplished their goal, by concentrating on various aspects of theory, research, and treatment of cocaine abuse. The book is divided into three major sections: Basic and Biomedical Issues, Treatment Approaches, and Special Topics. Overall, this text examines a range of topics. This book can be extremely valuable to physicians, psychiatrists, psychologists, social workers, counselors in the drug and alcohol fields, and students. The book is comprehensive in what it covers and well organized. Even experienced professionals in this field will be hard pressed to find flaws with this resource. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Concurrent use of cocaine and alcohol is more potent and potentially more toxic than use of either alone--a multiple-dose study

BACKGROUND: Simultaneous abuse of cocaine and alcohol is widespread and increasingly detected in patients seeking emergent care. This double-blind, randomized, within-subjects study used a paradigm more closely approximating practices of drug abusers to better understand the pathogenesis of cocaine-alcohol abuse. METHODS: Subjects meeting DSM-IV criteria for cocaine dependence and alcohol abuse participated in three drug administration sessions: four doses of intranasal cocaine (1 mg/kg every 30 min) with oral alcohol (1 g/kg) administered following the initial cocaine dose and a second dose (120 mg/kg) at 60 min calculated to maintain plasma alcohol concentration at approximately 100 mg/dL during cocaine administration; four doses of cocaine/placebo alcohol; four doses of cocaine placebo/alcohol. Pharmacokinetic, physiological, and behavioral effects were followed over 8 hours. RESULTS: Cocaine-alcohol produced greater euphoria and increased perception of well-being relative to cocaine. Heart rate significantly increased following cocaine-alcohol administration relative to either drug alone. Cocaine concentrations were greater following cocaine-alcohol administration. Cocaethylene had a longer halflife with increasing concentrations relative to cocaine at later time points. CONCLUSIONS: Enhanced psychological effects during cocaine-alcohol abuse may encourage ingestion of larger amounts of these substances over time placing users at heightened risk for greater toxicity than with either drug alone.     

Subtypes of cocaine abusers: Support for a Type A–Type B distinction.

The dysfunction and generalizability of a multidimensional alcoholism typological system was systematically assessed in 399 inpatient, outpatient, and non-treatment-seeking cocaine abusers. Two different cluster-analytic procedures supported the construct, concurrent, and predictive validity of the Type A–Type B distinction in cocaine abusers. Participants classified as Type B (33%) cocaine abusers exhibited higher rates of premorbid risk factors (family history, childhood behavior problems, personality, age of onset), more severe drug and alcohol abuse, more addiction-related psychosocial impairment, more antisocial behavior, and more comorbid psychiatric problems than Type A participants (67%). Multidimensional typological systems have had a major impact on the alcoholism field and may be equally important for the assessment, prevention, treatment, and theoretical understanding of other substance use disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of immunologic nervous system diseases by using anti-adhesion molecule antibodies

In this evaluation of baseline drug use as a predictor of treatment outcome, cocaine use during a 5-week baseline was compared in methadone maintenance patients who had < 5 (n = 10) versus > or = 5 (n = 9) weeks of abstinence during an experimental cocaine abstinence reinforcement treatment. Cocaine use was evaluated at the 1st and last visit and the 1st and last week of baseline and as a mean across the 5-week baseline treatment; response was calculated as a mean across 12 weeks of experimental treatment. Those who had successful outcomes (abstainers) used significantly less cocaine in the 5-week baseline than those with less successful outcomes (nonabstainers). Differences in cocaine use were not evident in the 1st baseline visit or week, but the abstainers used significantly less cocaine in the last visit and week of baseline compared with the nonabstainers. Cocaine use during baseline provided critical predictors of response to the experimental treatment.     

Buprenorphine-induced alterations of cocaine's reinforcing effects in rhesus monkey: a dose-response analysis

Buprenorphine reduces cocaine self-administration by rhesus monkeys, opiate- and cocaine-dependent men and polydrug abusers, but the mechanisms underlying these cocaine-opiate interactions are not well understood. In the present study, the effects of daily placebo or buprenorphine (0.1, 0.3 and 1.0 mg/kg) treatment on cocaine self-administration (0.001-0.3 mg/kg/inject) were examined in five cocaine-experienced rhesus monkeys. Saline and each of six cocaine doses were available in an irregular order. Responding for cocaine (or saline) and food was maintained on a second order FR4 (VR 16:5) schedule of reinforcement. During placebo treatment, the daily number of cocaine injections increased as the unit dose was increased and then decreased at higher doses. Cocaine doses that maintained the highest rates of responding during placebo treatment were more resistant to buprenorphine's effects. The typical increase in response rate during the first five cocaine injections of a session also was attenuated by buprenorphine. The ascending limb of the cocaine dose-response curve was shifted downward and approximately one log unit to the right during low-dose buprenorphine treatment (0.1 mg/kg/day). In contrast, individual response rates for food pellets were unaffected. We conclude that buprenorphine selectively decreases self-administration of some unit doses of cocaine at doses that have minimal effects on food-maintained responding.     

Discriminative and reinforcing stimulus effects of nicotine, cocaine, and cocaine + nicotine combinations in rhesus monkeys.

Concurrent cigarette smoking and cocaine use is well documented. However, the behavioral pharmacology of cocaine and nicotine combinations is poorly understood, and there is a need for animal models to examine this form of polydrug abuse. The purpose of this study was twofold: first to assess the effects of nicotine on the discriminative stimulus effects of cocaine, and second, to study self-administration of nicotine/cocaine combinations in a novel polydrug abuse model. In drug discrimination experiments, nicotine increased the discriminative stimulus effects of low cocaine doses in two of three monkeys, but nicotine did not substitute for cocaine in any monkey. Self-administration of cocaine and nicotine alone, and cocaine + nicotine combinations was studied under a second-order fixed ratio 2, variable ratio 16 (FR2[VR16:S]) schedule of reinforcement. Cocaine and nicotine alone were self-administered in a dose-dependent manner. The combination of marginally reinforcing doses of cocaine and nicotine increased drug self-administration behavior above levels observed with the same dose of either cocaine or nicotine alone. These findings indicate that nicotine may increase cocaine's discriminative stimulus and reinforcing effects in rhesus monkeys, and illustrate the feasibility of combining cocaine and nicotine in a preclinical model of polydrug abuse. Further studies of the behavioral effects of nicotine + cocaine combinations will contribute to our understanding the pharmacology of dual nicotine and cocaine dependence, and will be useful for evaluation of new treatment medications. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cocaine use early in treatment predicts outcome in a behavioral treatment program.

In this evaluation of baseline drug use as a predictor of treatment outcome, cocaine use during a 5-week baseline was compared in methadone maintenance patients who had n?=?10) versus ≥5 (n?=?9) weeks of abstinence during an experimental cocaine abstinence reinforcement treatment. Cocaine use was evaluated at the 1st and last visit and the 1st and last week of baseline and as a mean across the 5-week baseline treatment; response was calculated as a mean across 12 weeks of experimental treatment. Those who had successful outcomes (abstainers) used significantly less cocaine in the 5-week baseline than those with less successful outcomes (nonabstainers). Differences in cocaine use were not evident in the 1st baseline visit or week, but the abstainers used significantly less cocaine in the last visit and week of baseline compared with the nonabstainers. Cocaine use during baseline provided critical predictors of response to the experimental treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pythium insidiosum keratitis

Dopamine deficiency is found in both chronic cocaine abusers and Parkinson's disease. The authors sought to determine whether parkinsonian signs occur in chronic cocaine abusers. Fifty male patients with a history of chronic heavy cocaine abuse were examined on the Unified Parkinson Disease Scale (UPDS) and compared with 20 non-cocaine-abusing, age- and sex-matched control subjects. UPDS scores of cocaine abusers ranged from 0 to 1 (mean: 0.08 +/- 0.28) and, in control subjects, from 0 to 3 (mean: 0.15 +/- 0.49; P = 0.5; NS). This study suggests that chronic heavy cocaine abuse does not cause parkinsonism.     

Single-portal endoscopic treatment of carpal tunnel syndrome. Results of a preliminary series]

The authors assessed social-evaluative anxiety in 50 cocaine abusers attending an outpatient therapeutic-community (TC)-oriented clinic. This group-based modality presumes that the ability of clients to self-disclose is key to recovery. Fully half of the clients tested, some of whom had been attending treatment for a number of months, showed an elevation of social withdrawal and distress. Newcomers with higher social anxiety scores were less likely to drop out of treatment over the first 3 months, and self-reported level of social anxiety decreased over this time interval. These findings suggest that social anxiety may be an important consideration in treatment for cocaine abuse and that the rigors of a modified TC with intense focus on group involvement may reduce social anxiety.     

Cocaine and the nervous system

Cocaine abuse today has reached greater heights than it did during the first cocaine epidemic in the late nineteenth century. It is estimated that one out of every four Americans has used cocaine and some six million people in the US use it regularly. Although cocaine affects all systems in the body, the central nervous system (CNS) is the primary target. Cocaine blocks the reuptake of neurotransmitters in the neuronal synapses. Almost all CNS effects of cocaine can be attributed to this mechanism. Euphoria, pharmacological pleasure and intense cocaine craving share basis in this system. The effects of cocaine on other organ systems, in addition to its effects on the CNS, account for the majority of the complications associated with cocaine abuse. In this paper, the CNS effects following cocaine administration and their treatment are discussed.     

PET study of competition between intravenous cocaine and [11C]raclopride at dopamine receptors in human subjects

OBJECTIVE: Animal data suggest that the strong euphoriant effects of cocaine are related to the drug's enhancement of available dopamine at the synaptic cleft. The authors' goal was to determine whether this mechanism is the same in humans because the development of putative pharmacological agents for treatment of cocaine dependence depends on this knowledge. METHOD: Positron emission tomography with [11C]raclopride was used to examine the effects of the intravenous administration of 48 mg of cocaine (a typical "street" dose) on the occupancy of dopamine 2 receptors in the putamen of 11 self-identified intravenous drug abusers. RESULTS: All 11 subjects reported subjective stimulation and euphoria in response to cocaine administration. Radioligand occupancy at dopamine receptors was decreased significantly after cocaine administration, suggesting that higher dopamine concentrations were competing at the receptor site. CONCLUSIONS: These results support the concept of dopamine system involvement in human cocaine abuse.     

Effects of repeated-dose isradipine on the abuse liability of cocaine.

Despite preclinical studies suggesting that isradipine may antagonize the abuse liability of cocaine, pretreatment with sustained-release isradipine did not reduce euphoric mood in cocaine-using volunteers. This double-blind, within-subject, crossover laboratory study determined whether maximal dose-loading with isradipine could antagonize effects of cocaine in 12 cocaine-dependent research volunteers administered intravenous cocaine doses (0, 0.325, and 0.65 mg/kg) on different days after 5 days of treatment with isradipine or placebo. Isradipine dose was 30 mg sustained release nightly plus 15 mg immediate release 2 hr before cocaine infusion. Cocaine produced dose-related increases in cocaine's subjective effects and a behavioral measure of reinforcement. Isradipine enhanced, rather than antagonized, subjective effects, indicating that isradipine does not antagonize cocaine's abuse liability in dependent research volunteers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contingency management is efficacious for cocaine abusers with prior treatment attempts.

Efforts are underway to detect subgroups who may be more or less responsive to contingency management (CM) substance abuse treatments. This study examined the impact of prior treatment attempts on primary and posttreatment outcomes in a combined sample of cocaine abusers randomized to standard care substance abuse outpatient treatment (SC) or SC plus CM. Participants (N = 393) were categorized according to self-reported prior treatment attempts (0-1, ≥2). Participants with multiple prior treatment attempts were older, had more severe alcohol and cocaine use disorders, and had greater employment-related problems. Participants with 0?1 prior treatment attempts had comparable treatment retention, regardless of treatment condition; however, among participants with multiple prior treatment attempts, retention was greater for CM than SC. A similar, but nonsignificant (p = .08) pattern was evident for longest duration of abstinence (LDA). LDA was a significant predictor of negative (for cocaine, alcohol, and opiates) specimen results at Month 9. The results provide support for CM as an advantageous option for individuals with multiple prior treatment attempts, as well as for substance abuse treatment patients in general. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy for cocaine addiction.

Cocaine abuse continues to be a major public health problem. Drug abuse researchers and practitioners have developed theoretically diverse cocaine-specific psychological treatments, including behavioral and cognitive–behavioral therapies, psychodynamic therapies, and integrative outpatient programs. In 1991, a major literature review identified several promising approaches, but there was little empirical evidence for their efficacy (R. A. Rawson, J. L. Obert, M. J. McCann, F. G. Castro, & W. Ling, 1991). Since then, outpatient psychotherapies for cocaine addiction have increasingly been empirically evaluated. This article summarizes prominent current approaches, with emphasis on empirical studies that have appeared since the Rawson et al. (1991) review, and evaluates progress in the field. Studies of treatment retention and the effect of comorbid psychopathology on treatment response are reviewed, and directions for future research are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differential expression of pathogen-responsive genes encoding two types of glycine-rich proteins in barley

This trial assessed whether behavioral treatment improves outcome during a 26-week outpatient opioid detoxification. Thirty-nine opioid-dependent adults were assigned randomly to a buprenorphine dose-taper combined with either behavioral or standard treatment. Behavioral treatment included (a) a voucher incentive program for providing opioid-free urine samples and engaging in verifiable therapeutic activities and (b) the community reinforcement approach, a multicomponent behavioral treatment. Standard treatment included lifestyle counseling. Fifty-three percent of the patients receiving behavioral treatment completed treatment, versus 20% receiving standard treatment. The percentage of patients achieving 4, 8, 12, and 16 weeks of continuous opioid abstinence were 68, 47, 26, and 11 for the behavioral group and 55, 15, 5, and 0 for the standard group, respectively. Behavioral treatment improved outcomes during outpatient detoxification.