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There is a noticeable lack of targeted treatment options for marijuana dependence, in particular pharmacologic approaches. This is the first study evaluating a targeted pharmacologic approach for marijuana dependence. The goals of the study were to determine if such patients would seek pharmacologic treatment, whether these patients could be retained in treatment using a design previously developed for cocaine-dependent patients, and especially whether divalproex sodium showed promise as a treatment agent for marijuana dependence. We found that marijuana-dependent patients will seek treatment, and such patients can be adequately maintained in a pharmacologic trial. Regardless of treatment group, patients reported a significant reduction in their frequency and amount of marijuana use as well as a reduction in irritability. Given the lack of proven effective treatments for marijuana dependence, pharmacotherapies should be sought. The design of a preliminary clinical trial should include a psychosocial/behavioral intervention emphasizing motivation and medication compliance and a placebo control group.

This paper describes the Physicians in Residence Program (PIR), a program developed to train medical housestaff, at the Hazelden Fellowship Club, a halfway house in Manhattan. The housestaff (n = 31), who were trained at different times, heard two daily lectures by experienced physicians on diverse topics. They received training and practice in interviewing, assessment, and treatment planning. They participated in halfway house resident support groups and spent informal time interacting with Hazelden residents. Evaluation included (a) pre- and postprogram self-reports, (b) daily significant event sheets, and (c) overall program evaluation. Using paired mean t tests, the housestaff reported improvements (P < 0.001) in their interviewing and referral skills, knowledge, attitudes, and role confidence. All components of the program received ratings of “good” to “excellent” and were viewed as helpful. The highest ratings were those that included observation, practice of skills, and interactions with Hazelden residents.

The authors systematically evaluated the frequency patterns of cocaine use in 85 cocaine-dependent outpatients and found four patterns of use: continuous (27%), intermittent patterned (35%), intermittent nonpatterned (25%), and occasional (1.3%)- Few subjects reported consistent cycling between binges and crashes. There were no significant differences in patterns of use associated with gender, race, educational level, route of administration, or recency of heroin use. Continuous users and occasional users were older than intermittent users. Because different contingencies may control patterned vs. nonpatterned cocaine use, pattern of use may have implications for treatment, even in individuals reporting similar amounts of cocaine use.

Cigarette smoking increases the risk of myocardial infarction and sudden death (Ball and Turner 1974; Miettinen et al 1976; Rosengren et al 1988). Several mechanisms have been offered for this increased incidence. Cryer et al (1976) attributed the changes in blood pressure and heart rate with cigarett~ smoking to norepinephrine (NE) release fron, adrenergic nerves. NE release has also been shown to lower the ventricular fibrillation threshold (Verrier et al 1974, 1975). Thus, it is possible that the increased incidence of acute myocardial infarction and sudden death i,n smokers may be due to excessive sympathetic tone. It is also possible, however, that a decrease in parasympathetic tone, causing a relative excess of sympathetic tone, would create a similar condition. Given the high rate of cigarette smoking in psychiatric patients (Hughes et al 1986), it is important to determine the physiological effects of this addiction. Spectral analysis provides an estimate of the contribution of sympathetic and parasympathetic tone on heart rate variability (Hyndman and Gregory 1975; Rompelman 1977; Porges 1983). Therefore, the purpose of this

Diagnosing attention-deficit/hyperactivity disorder (ADHD) in adults can be complicated by several factors including the inability to meet appropriate developmental criteria as listed in the DSM-IV. The stringent DSM-IV criteria for ADHD may make diagnosing ADHD in adults difficult, which may lead to an underdiagnosis of ADHD in the adult population. Clinicians must rely on the diagnosis of ADHD not otherwise specified for adults with ADHD symptomatology, but this category does not provide clear delineations for patients whose symptoms vary within this category. Further complications arise due to high rates of comorbid psychiatric disorders, especially substance use disorders, in individuals with ADHD. Comorbid substance use disorders in individuals with ADHD can have a negative impact on the course of illness and quality of life. Further, cognitive deficits associated with substance abuse can hinder the ability to recall ADHD symptoms for appropriate diagnostic purposes. On the other hand, symptoms associated with intoxication or withdrawal may mimic ADHD symptoms, which can lead to an overdiagnosis of ADHD in the substance use disorder population. Another factor that can lead to the overdiagnosis of ADHD in the substance use disorder population is that patients may feign ADHD symptoms in order to obtain stimulant medication. If proper attention is paid to age-appropriate symptoms of ADHD, and careful longitudinal data are obtained from patients presenting with ADHD or substance use disorders, proper treatment can be given to patients with these comorbid disorders.

There is a belief among methadone patients that triple therapy for HIV reduces methadone potency. This cross-sectional study compared the rate of methadone metabolism (peak-trough blood levels) in two groups of methadone-maintained patients, AIDS patients receiving triple therapy (N = 17), and HIV patients without triple therapy (N = 19). These preliminary findings suggest that triple therapy may increase the rate of methadone metabolism, though further studies are warranted.

Many pharmacologic regimens have been recommended as supplemental treatment strategies for cocaine abuse. Using the technique of meta-analysis, we compared and combined the data from six studies to examine the efficacy of desipramine as an adjunctive treatment approach for cocaine addiction. These studies were randomized, placebo-controlled clinical trials of desipramine and involved a total of 200 cocaine-addicted patients. We found that desipramine is no better than placebo in retaining patients in treatment. However, while patients are in treatment, desipramine is helpful in promoting abstinence (p less than 0.001). There were several compromises made to use meta-analysis for these studies. These included comparing patient populations with different psychiatric and substance use diagnoses, comparing studies that used varying amounts of psychotherapy, and comparing studies that defined certain outcome variables in diverse ways. There are other limitations in the use of meta-analysis that were not specific to the studies we compared. These include such issues as statistical bias and publication bias. The purpose of this paper is to suggest the use of meta-analysis as one way to help the clinician evaluate the literature and to point out the areas of difficulty when assessing the literature.