Table of Contents

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Volume 38, Number 3

September 2006

Comparing Treatments of Alcoholism on Craving and Biochemical Measures of Alcohol Consumptions  — Felice Nava, M.D., Ph.D.; Stefania Premi, M.D.; Ezio Manzato, M.D. & Alfio Lucchini, M.D.

Differences in Drug Treatment Services Based on Profit Status — Isaac D. Montoya, Ph.D., CMC, CLS    

Knowledge, Attitudes and Practices of Pharmacists Concerning Prescription Drug Abuse —Lynn Lafferty, Pharm.D., M.B.A.; Tracy S. Hunter, R.Ph., Ph.D.  &  Wallace A. Marsh, Ph.D., M.B.A.

Staff Perspectives on Facilitating the Implementation of Hepatitis C Services at Drug Treatment Programs — Corrine E. Munoz-Plaza, M.P.H.;  Shiela M. Strauss, PH.D.; Janetta M. Astone-Twerwll, Ph.D.;  Don C. Des Jarlais, Ph.D. & Holly Hagan, Ph.D.

Variations in Drug Users’ Accounts of the Connection Between Drug Misuse and Crime —Professor Trevor Bennett & Dr. Katy Holloway

Life Stress, Coping and Comorbid Youth: An Examination of the Stress-Vulnerability Model for Substance Relapse — Kristen G. Anderson, M.Ed., Ph.D.; Danielle E. Ramo, M.S. & Sandra A. Brown, Ph.D.

Integrated Residential Treatment for Persons with Severe and Persistent Mental Illness: Lessons in Recovery —Kristin E. Davis, Ph.D.; Timothy Devitt, M.S., C.A.D.C.; Angela Rollins, Ph.D.; Sheila O’Neill, L.C.S.W.; Debra Pavick, M.S.W., L.C.S.W. & Brian Harding, M.A.

An Extended Nondrug MDMA-Like Experience Evoked Through Posthypnotic Suggestion —Arthur Hastings, Ph.D.

A Comparison of Plants Utilized in Ritual Healing by Two Brazilian Cultures: Quilombolas and Krahô Indians — Eliana Rodrigues & E. A. Carlini, M.Sc., M.D.

Juvenile Offences Among Hospitalized Adolescent Inhalant Users in Istanbul: A Comparison Regarding Place of Residence — Kültegin Ögel, M.D.; Sevil Taner, M.A.;  Musa Tosun, M.D.;  Olcay Liman, B.A. & Turkay Demir, M.D.

SHORT COMMUNICATION

Changing Patterns of Cocaine Use and HIV Risks in the South of Brazil — James A. Inciardi, Ph.D.; Hilary L. Surratt, Ph.D.; Flavio Pechansky, M.D., Ph.D.;  Felix Kessler, M.D., M.Sc.; Lisia von Diemen, M.D.; Elisabeth Meyer da Silva, B.A., M.Sc. & Steven S. Martin, M.Sc., M.A.

Good and Bad Times for Treating Cigarette Smoking in Drug Treatment —Kimber P. Richter, Ph.D., M.P.H.

BOOK REVIEW - Ecstasy: In and About Altered States — Reviewed by Marlene Dobkin De Rios, Ph.D.

COVER ART — QuickSilverLight by Frank Pietronigro (www.pietronigro.com)

Abstracts

Comparing Treatments of Alcoholism on Craving and Biochemical Measures of Alcohol Consumptions —Felice Nava, M.D., Ph.D.; Stefania Premi, M.D.; Ezio Manzato, M.D. & Alfio Lucchini, M.D.
Abstract—An open randomized study was conducted to compare different treatments of alcoholism on ethanol intake, craving, and on biochemical measures of alcohol consumptions. Eighty-six alcoholics were abstinent for a mean of two weeks prior to random assignment to g-hydroxybutyrate (GHB, 50 mg/kg of body weight t.i.d), naltrexone (NTX, 50 mg/day) or disulfiram (DSF, 200 mg/day) treatment for 12 months. All treatments were equally effective in reducing alcohol intake and in maintaining abstinence. In all patients, the treatments were able to reduce both craving and the altered biological markers of alcohol abuse. The maximum effects were observed in GHB-treated patients. The results of the present study suggest that GHB might act both as anticraving and cellular protector agent.
Keywords—alcohol craving, biological markers of alcohol abuse, disulfiram, g-hydroxybutyrate, naltrexone

Knowledge, Attitudes and Practices of Pharmacists Concerning Prescription Drug Abuse —Lynn Lafferty, Pharm.D., M.B.A.; Tracy S. Hunter, R.Ph., Ph.D. & Wallace A. Marsh, Ph.D., M.B.A.
Abstract—This study assessed the knowledge, attitudes, and professional practices of pharmacists regarding addiction and patient use of controlled medications. This research project explored the relationship between pharmacy education, perceived and actual knowledge, and professional interactions as it pertains to problems surrounding dependency and addiction. A questionnaire of 25 items was administered at three separate continuing education programs in Florida in 2005. A total of 484 surveys were completed. Pharmacists (67.5%) reported participating in two hours or less of addiction/substance abuse education in pharmacy school. Of particular concern was that 29.2% reported having received no addiction education. Pharmacists who had greater amounts of addiction-specific education had a higher likelihood of correctly answering questions relating to the science of addiction and substance abuse counseling. In addition, pharmacists who reported more education counseled patients more frequently and felt more confident about counseling. A majority of respondents (53.7%) reported that they had never referred a patient to drug treatment in their career. These findings suggest that the neurobiological basis for addictive diseases, standards of care, and pain management guidelines were not widely understood by the sample. More research should be undertaken to determine the educational needs of practicing pharmacists to enable them to assume a leadership role in detecting, preventing, and treating prescription drug abuse.
Keywords—addiction, education, pharmacist, prescription drug abuse

Staff Perspectives on Facilitating the Implementation of Hepatitis C Services at Drug Treatment Programs — Corrine E. Munoz-Plaza, M.P.H.; Shiela M. Strauss, PH.D.; Janetta M. Astone-Twerwll, Ph.D.; Don C. Des Jarlais, Ph.D. & Holly Hagan, Ph.D.
Abstract—Drug users are at risk of acquiring the hepatitis C virus (HCV). Although ancillary services available to clients at drug treatment programs are often limited, some of these programs are providing HCV services. Presenting qualitative data, the authors describe the HCV education and/or support services available at four drug treatment programs and examine staff and client perspectives on factors that facilitated the implementation of these services. Major findings include participants’ perceptions that their programs had: (1) at least one change agent on staff who promoted the innovation and delivery of HCV services; (2) at least one administrator or director who encouraged and supported the adoption of these services; and (3) a treatment team that tended to collectively “buy into” and value the HCV service. Ultimately, we found that some drug treatment programs are finding creative and nonresource-intensive ways of delivering HCV services despite the existence of significant barriers. While programs need more funding and resources to overcome these barriers, these findings may prove helpful to other drug treatment programs that would like to offer HCV services to at least some of their clients.
Keywords—drug treatment programs, education, hepatitis C

Variations in Drug Users’ Accounts of the Connection Between Drug Misuse and Crime —Professor Trevor Bennett & Dr. Katy Holloway
Abstract—A great deal of progress has been made in identifying explanations for the links between drug use and crime. However, less progress has been made in the application of these explanations. In particular, less is known about whether some explanations are more common than others, whether some are linked to certain conditions, whether some apply only to certain individuals, and whether some apply only to certain kinds of drug use and crime. In this article, we investigate the extent to which explanations for the connection between drug misuse and crime vary by type of drug user, type of drug use and type of crime by looking at users’ own accounts of the connection. The research is based on data collected as part of the New English and Welsh Arrestee Drug Abuse Monitoring (NEW-ADAM) program conducted in 16 custody suites in England and Wales. The analysis investigates the proportion of drug users who believe that there is a connection and looks at variations in accounts of the connection by individual and behavioral factors. The implications for government policy designed to reduce drug-related crime are discussed.
Keywords—arrestees, connection, crack, crime, drugs, explanations, heroin

Life Stress, Coping and Comorbid Youth: An Examination of the Stress-Vulnerability Model for Substance Relapse — Kristen G. Anderson, M.Ed., Ph.D.; Danielle E. Ramo, M.S. & Sandra A. Brown, Ph.D.

Abstract—The stress-vulnerability model of addiction relapse states that the impact of life stress on alcohol and other drug use is influenced by several types of psychosocial risk and protective factors. Coping skills have been shown to be protective against alcohol or other drug use in adolescents and adults. To date, the influence of life stress and coping on addiction relapse has not been investigated among substance use disordered youth with comorbid Axis I psychopathology. In the present study, 80 adolescents, ages 13 to 17, were followed six months after treatment for substance use and Axis I disorders. Participants completed measures of psychopathology, substance use, life stressors and coping during treatment and at three and six months following treatment. Coping ability best predicted youth substance use at six months. Negative life events moderated the relation between coping and frequency of substance use. These results suggest that coping is a protective factor for return to substance involvement post-treatment, particularly for comorbid youth who have experienced high levels of life stress.
Keywords—adolescents, comorbidity, relapse, substance use

Integrated Residential Treatment for Persons with Severe and Persistent Mental Illness: Lessons in Recovery —Kristin E. Davis, Ph.D.; Timothy Devitt, M.S., C.A.D.C.; Angela Rollins, Ph.D.; Sheila O’Neill, L.C.S.W.; Debra Pavick, M.S.W., L.C.S.W. & Brian Harding, M.A.
Abstract—The stress-vulnerability model of addiction relapse states that the impact of life stress on alcohol and other drug use is influenced by several types of psychosocial risk and protective factors. Coping skills have been shown to be protective against alcohol or other drug use in adolescents and adults. To date, the influence of life stress and coping on addiction relapse has not been investigated among substance use disordered youth with comorbid Axis I psychopathology. In the present study, 80 adolescents, ages 13 to 17, were followed six months after treatment for substance use and Axis I disorders. Participants completed measures of psychopathology, substance use, life stressors and coping during treatment and at three and six months following treatment. Coping ability best predicted youth substance use at six months. Negative life events moderated the relation between coping and frequency of substance use. These results suggest that coping is a protective factor for return to substance involvement post-treatment, particularly for comorbid youth who have experienced high levels of life stress.
Keywords—adolescents, comorbidity, relapse, substance use

An Extended Nondrug MDMA-Like Experience Evoked Through Posthypnotic Suggestion —Arthur Hastings, Ph.D.
Abstract—This research explored whether hypnotic suggestion could produce a subjective mind-body condition similar to that produced by the psychoactive drug methylenedioxy methamphetamine (MDMA, Ecstasy). Twelve participants received posthypnotic instructions to re-experience an MDMA-like state posthypnotically, similar to one in their prior experience, for one hour. Three separate self report measures and qualitative self reports showed that the posthypnotic condition effectively mimicked an MDMA-like experience, lasting an hour at a stable level. Participant ratings in real time and in retrospect ranged from 36% to 100% similarity to a drug-induced experience. The qualitative reports and rating scales enabled a phenomenological description of the subjective experience. Scores on the Tellegen Absorption Scale correlated significantly with the strength of the posthypnotic condition (Spearman rho .87, p = .0003). The participants successfully carried out various intentional activities during this time (e.g., self reflection, talking with partners about relationships, artwork, walking in nature). Applications for this technique as an adjunct to therapy and health treatments are discussed.
Keywords—altered states of consciousness, consciousness, Ecstasy, hypnosis, MDMA, subjective drug effects

A Comparison of Plants Utilized in Ritual Healing by Two Brazilian Cultures: Quilombolas and Krahô Indians — Eliana Rodrigues & E. A. Carlini, M.Sc., M.D.
Abstract—The present study deals with two ethnobotanical surveys carried out in two different segments of the Brazilian population: the first among the Krahô Indians living in Tocantins State, a Cerrado region, and the second one among the descendants of former black slaves, the Quilombolas, living in Mato Grosso State. Both populations use plants which may have effects on the central nervous system (CNS) in their ritual healing ceremonies. Field work was performed during two years by one of the authors (E. Rodrigues) utilizing methods from botany and anthropology. Information was obtained on a total of 169 plants which were utilized in the preparation of 345 prescriptions for 68 ailments seemingly of the CNS, classified as tonics, analgesics, anorectics, hallucinogens, and anxiolytics. The taxonomic families of plants used, the more common therapeutic indications and types of healing rituals are discussed.
Keywords—Brazilian folk healers, ethnopharmacology, healing ceremony ,psychoactive plants, shaman, shamanism

Juvenile Offences Among Hospitalized Adolescent Inhalant Users in Istanbul: A Comparison Regarding Place of Residence — Kültegin Ögel, M.D.; Sevil Taner, M.A.; Musa Tosun, M.D.; Olcay Liman, B.A. & Turkay Demir, M.D.
Abstract—In this research, juvenile offenses and associated behaviors among adolescent inhalant users in Istanbul were investigated and inhalant users living in the street were compared to inhalant users living with their families. An interview questionnaire developed by the researchers was administered to 200 male adolescent inhalant users who were hospitalized during 2002-2003. More than half of the sample had committed juvenile offenses at least once in their lifetime, 16.3% had entered a house of corrections, 91.5% had friends who committed juvenile offenses, and the majority had been taken to a police station at least once in their lifetime. The rates for juvenile offenses, being taken to the police station, committing crimes to obtain money to buy drugs, and obtaining income through illegal activities were higher among adolescents living in the street than adolescents living with their families. Although the juvenile offense rate was higher among adolescents living in the street, it can be suggested that both groups live in subcultures that have a tendency towards crime, and inhalant use is part of these subcultures. Juvenile offense interventions can be useful for all inhalant users.
Keywords—addiction, crime, homeless youth, inhalant use, juvenile offense, street children

SHORT COMMUNICATION

Changing Patterns of Cocaine Use and HIV Risks in the South of Brazil — James A. Inciardi, Ph.D.; Hilary L. Surratt, Ph.D.; Flavio Pechansky, M.D., Ph.D.; Felix Kessler, M.D., M.Sc.; Lisia von Diemen, M.D.; Elisabeth Meyer da Silva, B.A., M.Sc. & Steven S. Martin, M.Sc., M.A.
Abstract—For well over a decade, researchers in Porto Alegre, Brazil, have been documenting the extent of the AIDS epidemic in the region, with a specific focus on the linkages between drug use and HIV seropositivity. Virtually all of the studies conducted during those years found injection drug use (IDU) to be the major vector for HIV seropositivity in this population. However, recent research found that the number of IDUs had declined significantly. Qualitative interviews and focus groups suggested many reasons for this decline: (1) many had died, because they had never heard of AIDS or HIV, and were unaware of how HIV is transmitted. As a result, they had become infected through the sharing of injection paraphernalia. (2) The quality of street cocaine had declined, making injection difficult. (3) Because of a fear of AIDS, some shifted to the smoking of crack, which had become a newly availability commodity in the street culture. Within this context, this article describes the qualitative data describing the decline of cocaine injecting and the corresponding emergence of crack use in Porto Alegre, Brazil, and related HIV risks.
Keywords—Brazil, crack, cocaine, drug users, HIV, injection

Good and Bad Times for Treating Cigarette Smoking in Drug Treatment —Kimber P. Richter, Ph.D., M.P.H.
Abstract—Most substance abuse treatment facilities do not routinely treat cigarette smoking even though most of their clients smoke and many will die from tobacco-related illness. This study is a secondary analysis of a national survey of the prevalence and type of tobacco treatment services available in methadone maintenance treatment. It presents qualitative and quantitative information on provider attitudes regarding tobacco treatment in drug treatment. One clinic leader (either a medical director, head nurse, or clinic director) from all 697 U.S. facilities was invited to participate in the study. Most (38%) clinic leaders thought the best time to treat patients for nicotine dependence was whenever the patient wanted treatment. One in four clinic leaders reported they or one of their staff had advised patients to delay quitting smoking cigarettes. Fewer (14%) believed that patients in some way benefited from cigarette smoking; these benefits included managing mood disturbances (calming, reducing anxiety, depression, stress, anger) and substituting for illicit drug abuse. This suggests that some providers might rely on cigarettes in lieu of psychotherapy or prescription medications to address patients’ mood disorders such as depression, anger, and anxiety. One tactic for disseminating tobacco treatment in drug treatment might involve identifying the purported benefits of tobacco and training providers in alternative methods for delivering these benefits.
Keywords—comorbidity, health services, smoking cessation, substance abuse, treatment