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Synthetic cannabinoids (SCs) are low-cost substances that have been associated with adverse health outcomes and an increase in emergency department visits over recent years, particularly among people experiencing homelessness. This mixed methods study explored the connection between homelessness, SC use, and readiness to quit in order to inform the development of harm reduction strategies. Individuals (18+) residing in homeless encampments in Houston, TX with experiences of SC use were eligible to participate. Participants (N= 65) completed an interviewer-administered survey about their SC use. Most participants were Black/African American (65.7%), male (82.9%), and most (75.4%) reported using SCs to avoid positive drug tests. Many wanted to quit using SCs (69.2%) and already employed harm reduction strategies while using SCs. Organizations supporting individuals experiencing homelessness who use SCs should focus on reducing barriers to stopping SC use and increasing the availability of housing and supportive services.

Methamphetamine (MA) use is marked by high rates of comorbid tobacco smoking, which is associated with more severe drug use and worse clinical outcomes compared to single use of either drug. Research has shown the combination of naltrexone plus oral bupropion (NTX-BUP) improves smoking cessation outcomes in non-MA-using populations. In the Accelerated Development of Additive Pharmacotherapy Treatment (ADAPT-2) study, NTX-BUP successfully reduced MA use. Our aim in this secondary data analysis was to examine changes in cigarette smoking among the subgroup of participants reporting comorbid tobacco use in the ADAPT-2 trial.

Despite the high prevalence of cocaine use disorder (CUD) in individuals with schizophrenia, current understanding of the effect of cocaine on psychiatric hospital length of stay (LOS) in individuals with schizophrenia is limited. We therefore retrospectively examined the medical records of 5106 hospital admissions due to exacerbation of schizophrenia. Linear regression and t-test were used to compare LOS between individuals with schizophrenia with cocaine-positive urine drug test results and those with negative test results. Individuals with schizophrenia who were also positive for cocaine had shorter LOS from both unadjusted (geometric mean LOS, 8.07 ± 1.92 vs.11.83 ± 1.83 days; p< 0.001) and adjusted (= 0.69; confidence interval, 0.63–0.76; p< 0.001) analyses. Our results suggest that individuals with schizophrenia who also have comorbid CUD may require shorter inpatient treatment during periods of exacerbation of symptoms. Replication of this finding has relevance in treatment planning and resource allocation for the subpopulation of individuals with schizophrenia who also have stimulant use disorders.

Recent studies have suggested that heterogeneity in the level of dopamine activity and function might be useful for identifying a subgroup of cocaine-dependent patients responding better to dopamine-enhancement pharmacotherapy. Here we hypothesized that response to levodopacarbidopa treatment would be greater in patients with genetically determined low levels of the dopamine metabolizing enzyme dopamine -hydroxylase (DH). Seventy-one cocaine-dependent patients who participated in a 12-week randomized double-blind placebo-controlled trial of levodopacarbidopa were genotyped for the DH gene (DBH) polymorphism rs1611115. Our results showed that for patients with the low DH activity genotypes (CTTT) who received levodopa, the odds of having cocaine-positive urine decreased significantly over treatment compared with placebo-treated patients with the CTTT genotypes (P=0.004). Individuals with the normal DH activity genotype (CC) showed no differential response to levodopa. These preliminary results need to be confirmed in a larger sample focusing on the DBHpolymorphism.

Background: Alcohol dependence is extremely common in patients with bipolar disorder and is associated with unfavorable outcomes including treatment nonadherence, violence, increased hospitalization, and decreased quality of life. While naltrexone is a standard treatment for alcohol dependence, no controlled trials have examined its use in patients with co‐morbid bipolar disorder and alcohol dependence. In this pilot study, the efficacy of naltrexone in reducing alcohol use and on mood symptoms was assessed in bipolar disorder and alcohol dependence.

This article concerns methodology for testing the significance of differences in mean rates of change in controlled repeated measurements designs with limited sample sizes, autoregressive error structures, nonlinear patterns of underlying true mean change, dropout rates exceeding 50%, plus other missing data. Each of these is problematic for ordinary repeated measures analysis of variance, and a complex generalized linear mixed model formulation popularly advocated for the ability to deal with autoregressive error structures and missing data is shown to perform poorly in such circumstances. Monte Carlo simulation methods confirm that simple two-stage analyses of dropout-weighted linear slope coefficients provide conservative Type 1 error protection, although adequate power requires the presence of large treatment effects in studies with the limited sample sizes and high proportions of missing data. No other analysis has been documented to provide both conservative Type 1 error protection and competitive power under similarly taxing conditions.

A double-blind, placebo-controlled clinical trial examining the joint action of naltrexone (NTX) in combination with relapse prevention (RP) therapy for the treatment of cocaine dependence was conducted. Eighty-five participants who achieved initial abstinence during the intake evaluation and detoxification phase of the study were randomized into 1 of 4 combined NTX (0 vs. 50 mg) by therapy (RP vs. Drug Counseling) experimental conditions for the 12-week outpatient treatment phase of the study. A random effects regression model to test for group differences on percentage of cocaine-positive urines indicated a significant time by medication by therapy interaction, suggesting less cocaine use over time among subjects receiving RP-50mg than those in the other conditions. No differences were found for retention or time until first cocaine-positive urine. Naltrexone was well tolerated by participants, with acceptable rates of medication compliance observed. Treatment integrity measures confirmed successful manipulation of the psychotherapy. These results are consistent with the notion that substance use in dependent patients can be reduced with a combination of coping skills training and pharmacologic treatments.

A partial blockade of the multiple actions of cocaine is one strategy by which cocaine dependence may be treated. Risperidone, a 5-hydroxytryptamine and dopamine D2antagonist, is an atypical antipsychotic and was a candidate medication for the treatment of cocaine dependence. One hundred ninety-three cocaine-dependent subjects were enrolled in a 12-week, randomized, double-blind, placebo-controlled trial. Subjects initially received either placebo or 4 or 8 mg of risperidone, with a subsequent change to active doses of 2 mg and 4 mg. Subjects attended the clinic twice each week, provided urine samples, obtained medication, and underwent one behavioral therapy session per week. The study was terminated at the interim analysis. Retention was worse for the 4- and 8-mg active medication groups. Side effects were primarily associated with the 8-mg dose, although neither 2 mg nor 4 mg was well accepted by subjects. There was no reduction in cocaine use associated with risperidone. The results suggest that although antagonists might be a useful treatment approach, such as in the treatment of opiate dependence, risperidone is unlikely to find broad acceptance with the treatment-seeking population.

Two experiments examined the effects of methylphenidate in male and female patients enrolled in an outpatient treatment program for primary cocaine dependence. The first study was a component of a double-blind efficacy trial wherein 57 patients were first tested in a human laboratory for their initial responsiveness to medication. Patients were randomly assigned to receive either placebo or methylphenidate treatment and received their first dose in the human laboratory environment before continuing in outpatient treatment. Methylphenidate was given as a 20-mg sustained-release dose (twice daily) plus an additional 5-mg immediate-release dose combined with the morning dose. Methylphenidate increased heart rate and subjective ratings; however, the subjective effects were primarily of a "dysphoric" nature, and significant effects were limited to increases in anxiety, depression, and anger on the Profile of Mood States; shaky/jittery ratings on a visual analog scale; and dysphoria on the lysergic acid diethylamide (LSD) scale of the Addiction Research Center Inventory. Methylphenidate did not increase cocaine craving nor ratings suggesting abuse potential (i.e., Morphine-Benzedrine Group or drug-liking scores, etc.). None of the drug effects observed in the human laboratory was of clinical concern, and no subject was precluded from continuing in the outpatient study. After outpatient treatment completion, 12 patients were brought back into a second double-blind human laboratory study in which three doses (15, 30, and 60 mg) of immediate-release methylphenidate were administered in an ascending series preceded and followed by placebo. Methylphenidate produced dose-related increases in heart rate, subjective ratings of shaky/jittery, and LSD/dysphoria without significantly altering cocaine craving or stimulant euphoria ratings. These results suggest that stimulant substitution-type approaches to the treatment of cocaine dependence are not necessarily contraindicated because of cardiovascular toxicity or medication abuse potential. However, they also suggest that the subjective effects of methylphenidate may not be positive enough for an adequate replacement approach.

A recently revised version of the Situational Competency Test (SCTDR), a tape-recorded role-play assessment procedure, was used to evaluate situational specificity of coping in hospitalized substance-abusing patients (N= 24). Responses to six types of high-risk situations were scored according to coping method used (active cognitive, active behavioral, avoidance, help-seeking) and objective response parameters (latency, duration, specification, compliance). Additionally, patterns of past drug use and self-efficacy were evaluated for situational variability and association with coping response measures. Findings revealed that the situational profiles for each of the four coping methods were distinct, and that each coping method was used differentially across high-risk situations. Objective scoring dimensions demonstrated patterns of situational specificity, for example, subjects' responses in situations involving unpleasant emotions were more delayed, shorter, and less specific than in other types of high-risk situations. Heavy past drug use and low self-efficacy were significantly related to latency in responding. These findings are consistent with previous studies in which substance abusers' coping was shown to be at least partially dependent on situational parameters.

In a retrospective program evaluation analysis, we compared abstinence rates in 78 smokers participating in a 2-, 3-, or 6-week clinic-based behavioral-pharmacological smoking cessation program. The three treatment formats consisted of six sessions that varied in session frequency. Retention and end-of-treatment smoking cessation rates were best in the medium-frequency (3-week) and high-frequency (2-week) treatment session formats. One-year follow-up abstinence rates were highest in the medium-frequency format, and lowest in the high-frequency format. A significant patient—treatment interaction effect was found for pretreatment smoking rate. Individuals with lower pretreatment smoking rates benefited most with respect to end-of-treatment cessation rates from the medium- and high-frequency treatment session format. However, this effect was not significant at the 1-year follow-up. The need for prospective research and patient-to-treatment matching implications in smoking cessation programs are discussed.

Based on Marlatt's relapse model, this study examined the previously unexplored role of cognitive and affective responses that follow successful coping experiences during smoking cessation. Twenty-six smokers completed self-report measures of attribution, efficacy, and affect in response to smoking cessation behaviors during treatment and at 2-, 4-, and 8-week follow-ups. Subjects abstinent at 3-month follow-up were more likely to attribute their successful quitting behaviors to more internal, stable, and controllable factors, and they reported enhanced self-efficacy, compared with smokers. Differences in affective responses to successful coping by quitters and smokers were not significant. Implications of the findings with respect to relapse theory and relapse prevention treatment are discussed.

This study examined the relationship between verbal reports of craving and actual cocaine use across different treatment phases using a longitudinal design. Participants (n= 32) were cocaine-dependent patients who completed an inpatient chemical dependency program and then participated in an 8-week outpatient relapse prevention program. Craving ratings and urine samples were collected during hospitalization, at 12 weekly outpatient treatment sessions, and at 1, 2, 4, 8, 12, and 24-week follow-up. Craving increased significantly from inpatient to outpatient treatment. Cocaine-abstinent participants reported lower craving across outpatient treatment and follow-up compared to moderate and heavy cocaine users. The overall relationship between craving and total proportion of cocaine positive urines was highly significant. Implications of these findings for advancing our theoretical and practical knowledge about craving and cocaine use, are explored.

Psychologic approaches continue to represent the mainstay of treatment for most types of substance abuse problems.As evident in this review of empiric studies published in the past 12 months, the most effective treatments include approaches based on behavioral and cognitive-behavioral theoretical models. Client-to-treatment matching hypotheses have received mixed support. The influence of treatment delivery variables is covered in this review. Curr Opin Psychiatry 11:289-293.

Agonists, or "replacement medications," are useful adjuncts in treatment of opiate and nicotine dependence.They have not been systematically examined in cocaine dependence. Results of early open trials with methylphenidate for treatment of cocaine dependence were equivocal. Twenty-four cocaine-dependent subjects were enrolled in an 11-week double-blind, placebo-controlled study of methylphenidate. Assignment was random. Intake included a 2-day human laboratory procedure in which subjects received initial doses of methylphenidate or placebo. Subjects attended the clinic Monday through Friday and received oral doses of methylphenidate (5 mg plus 20-mg sustained release) or placebo at 8:00 a.m., with afternoon and weekend take-home doses (20 mg sustained-release or placebo) provided in Medication Events Monitoring System bottles to monitor compliance. Clinic visits included therapy sessions, electrocardiograms, self-report measures, and twice-weekly urine screens. The two groups were equivalent in terms of retention (methylphenidate 48% and placebo 42%) and had similar cocaine use outcomes (40% benzoylecgonine-positive urine screens). There were no significant adverse effects. The doses were sufficient to permit detection of psychoactive effects ("stimulant," "more energy") and side effects ("jitteriness," "eating less") without increased "craving." Additional medications with different effects profiles are being studied to further evaluate the replacement model in cocaine dependence. (J Clin Psychopharmacol 1997;17:485-488).