Journal of Psychoactive Drugs

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Volume 40, Number 2

June 2008

Predicting Positive and Negative Treatment Responses to Stimulants with Brain SPECT Imaging — Daniel G. Amen, M.D.; Chris Hanks, Ph.D. & Jill Prunella

Preliminary Evidence Differentiating ADHD Using Brain SPECT Imaging in Older Patients — Daniel G. Amen, M.D.; Chris Hanks, Ph.D. & Jill Prunella.

Characteristics of Injection Drug Users Who Participate in Drug Dealing: Implications for Drug Policy —Thomas Kerr, Ph.D.; William Small, M.A.; Caitlin Johnston, B.A.; Kathy Li, Ph.D.; Julio S. G. Montaner, M.D. & Evan Wood, M.D., Ph.D.

A Clean and Sober Place to Live: Philosophy, Structure, and Purported Therapeutic Factors in Sober Living Houses — Douglas L. Polcin, Ed.D., M.F.T. & Diane McAllister Henderson, B.A.

The Link Between Recent Sexual Abuse and Drug Use Among African American Male College Students: It’s Not Just a Female Problem in and around Campus — Charles Amos, Ph.D.; Ronald J. Peters, Jr., Dr.PH.; Lena Williams, M.P.H.; Regina Jones Johnson, Dr.PH., R.N.; Queen Martin, Dr.PH. & George S. Yacoubian, Jr Ph.D.

Listening to Our Clients: The Prevention of Relapse — Michael S. Levy, Ph.D.

Enhancing Adolescent Substance Abuse Treatment Engagement - Paula T. McWhirter, Ph.D.

Legally High? Legal Considerations of Salvia divinorum — O. Hayden Griffin, III, J.D., M.A.; Bryan Lee Miller, M.S. & David N. Khey, M.S., M.A.

The “Vine of the Soul” vs. The Controlled Substances Act: Implications of the Hoasca Case — Ronald K. Bullis, Ph.D., J.D., M.Div.

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SHORT COMMUNICATIONS

Substance Use Problems Reported by Historically Black College Students: Combined Marijuana and Alcohol Use Versus Alcohol Alone — Warren A. Rhodes, Ph.D.; Ronald J. Peters Jr. Dr.P.H.; Carrol S. Perrino, Ph.D. & Sharronne Bryant, M.A., M.S..

Neuropsychological Effects of Formaldehyde Use — Janice C. Marceaux, M.A.; Lawrence S. Dilks, Ph.D. & Sheila Hixson, M.A.

Chloroquine Psychosis Masquerading as PCP: A Case Report — Gregory B. Collins, M.D. & Mark S. McAllister, M.D.

A Case Report of Propofol Dependence in a Physician — Udo Bonnet, M.D.; Jörg Harkener, M.D. & Norbert Scherbaum, M.D.

Ecstasy Analogues Found in Cacti — Jan G. Bruhn, Ph.D.; Hesham R. El-Seedi, Ph.D.; Nikolai Stephanson, Ph.D.; Olof Beck, Ph.D. & Alexander T. Shulgin, Ph.D.

COVER ART — Yosemite by Chuck Whelon (www.whelon.com)

Abstracts

Barriers to Formal Drug Abuse Treatment in the Rural South: A Preliminary Ethnographic Assessment — Rocky L. Sexton, Ph.D.; Robert G. Carlson, Ph.D.; Carl G. Leukefeld, Ph.D. & Brenda M. Booth, Ph.D
Abstract—This article describes barriers to obtaining drug abuse treatment in the rural South using qualitative interviews conducted with 86 illicit stimulant users recruited in rural Arkansas and Kentucky between 2003 and 2005. Fifty-nine (69.0%) of the interviewees had never entered drug abuse treatment. Sixteen (19.0%) participants reported current perceived need for treatment, while seven (8%) were ambivalent about seeking it. Interview data suggest five interrelated categories of barriers to accessing drug abuse treatment: (1) geographical, (2) organizational, (3) economic, (4) social, and (5) psychological. The study findings can inform further examination of rural treatment barriers and have important implications for developing strategies to overcome these obstacles.
Keywords—barriers to drug abuse treatment, ethnography, rural South

Predicting Positive and Negative Treatment Responses to Stimulants with Brain SPECT Imaging — Daniel G. Amen, M.D.; Chris Hanks, Ph.D. & Jill Prunella

Abstract—The goal of this study was to test whether clinician-rated regional cerebral blood flow (rCBF) as rendered by SPECT imaging is a meaningful predictor of patient response to CNS stimulants. Chart reviews were used to identify patients who reported prior significant positive and negative responses to CNS stimulants. Each patient in the study had received resting and concentration SPECT scans using Tc99m exametazime. Differences in cerebral blood flow for frontal regions of interest were assessed in three conditions (resting, concentration, and their difference, or “delta”) using ANCOVAs and age-matched ANOVAs. Prefrontal pole deltas were found to be highly sensitive and specific predictors of response to CNS stimulants, with pole activation predicting adverse responses and pole deactivation predicting good responses. Positive and negative predictive values were greater than .75 for both poles. We conclude that SPECT renderings of rCBF, particularly in the prefrontal cortex, are a potentially powerful clinical tool for anticipating response to stimulant medications, both positive and adverse.

Keywords—ADHD, CNS stimulant, neuroimaging, SPECT, treatment response

Preliminary Evidence Differentiating ADHD Using Brain SPECT Imaging in Older Patients — Daniel G. Amen, M.D.; Chris Hanks, Ph.D. & Jill Prunella.

Abstract—The objective of this study was to differentiate ADHD patients from a healthy comparison

group using high resolution brain SPECT imaging in older patients. Using extensive chart reviews of structured interviews, DSM-IV criteria, and psychiatrist-given diagnoses, we identified 27 patients over age 50 with ADHD, either combined or inattentive types. Patients were compared to an age-matched group of healthy subjects with brain SPECT imaging at rest and during concentration using semiquantitative visual readings. Significantly lower cortical activity is noted in the ADHD group, particularly in the prefrontal poles, orbits, and parietal lobes. Older ADHD patients can be discerned from healthy subjects using brain SPECT. The results support the executive dysfunction model of ADHD.

Keywords—ADHD, attention, executive function, prefrontal cortex, SPECT

Abstract—So-called “balanced” drug policy couples enforcement initiatives targeting drug dealers with health-focused interventions serving addicted individuals. There are few evaluations of this approach, and little is known about how these two populations may overlap. We evaluated factors associated with drug dealing among injection drug users (IDUs) in Vancouver, Canada, and examined self-reported drug-dealing roles and reasons for dealing. Among 412 IDUs seen from March through December 2005, 68 (17%) had dealt drugs during the previous six months. Variables independently associated with drug dealing included: recent incarceration (adjusted odds ratio [AOR] = 2.9; 95%CI: 1.4 – 6.0); frequent heroin injection (AOR = 2.5; 95%CI: 1.4 – 4.6); frequent cocaine injection (AOR = 2.0; 95%CI: 1.1 – 3.8); and recent overdose (AOR = 2.7; 95%CI: 1.0 – 7.3). The most common drug-dealing roles were direct selling (82%), middling (35%), and steering (19%), while the most common reasons for dealing included obtaining drugs (49%) and money (36%). Drug dealing among IDUs was predicted by several markers of higher intensity addiction, and drug-dealing IDUs tended to occupy the most dangerous positions in the drug-dealing hierarchy. These findings suggest that elements of “balanced” drug policies may undermine each other and indicate the need for alternative interventions.

Keywords—drug dealing, drug policy, injection drug use, Vancouver

A Clean and Sober Place to Live: Philosophy, Structure, and Purported Therapeutic Factors in Sober Living Houses — Douglas L. Polcin, Ed.D., M.F.T. & Diane McAllister Henderson, B.A.

Abstract—The call for evidence-based practices (EBPs) in addiction treatment is nearly universal. It is a noteworthy movement in the field because treatment innovations have not always been implemented in community programs. However, other types of community-based services that may be essential to sustained recovery have received less attention. This article suggests that sober living houses (SLHs) are a good example of services that have been neglected in the addiction literature that might help individuals who need an alcohol- and drug-free living environment to succeed in their recovery. It begins with an overview of the history and philosophy of this modality and then describes our five-year longitudinal study titled, “An Analysis of Sober Living Houses.” Particular attention is paid to the structure and philosophy of SLHs and purported therapeutic factors. It ends with the presentation of baseline data describing the residents who enter SLHs and six-month outcomes on 130 residents.

Keywords—housing, recovery house, sober living house, social model recovery

Abstract—This study examined the relationship between sexual abuse in or around campus and drug use among young African-American males in college. It offers cross-sectional analysis of data collected from the Alcohol and Substance Abuse Awareness and Use Study (ASAAUS). Data collection took place in October 2004 via a self-administered survey among 181 African-American male students. Males who reported past sexual abuse in or around campus were significantly more likely than nonsexually-abused males to have used tobacco (41% v.19%, p < .05), alcohol (82% v. 49%, p < .05), marijuana (59% v. 30%, p < .05), and cocaine (18% v. 2%, p < .05) in the 30 day preceding the interview. Logistic regression analyses indicated that sexual abuse history in or around campus was significantly associated with past year (OR = 9.8, p ≤ 0.001) and past 30 day (OR = 5.0, p ≤ 0.001) drug use.

Keywords—abuse, college, drugs, males, sex, students

Listening to Our Clients: The Prevention of Relapse — Michael S. Levy, Ph.D.

Abstract—A survey to assess the most common reasons for relapse was developed and administered to 335 individuals who were current clients in various levels of care in a large substance abuse treatment program in order to better understand what factors were most relevant for relapse among these clients. Several reasons for relapse were chosen significantly more often than others. Common reasons for relapse for both men and women were the following: feeling bored, feeling anxious or stressed, wanting to use and get high, believing that use could occur without getting readdicted, and relationship problems and break up. In addition, men also commonly reported anger, having too much money, and no longer attending meetings as significant reasons for relapse. Among female clients, depression, loneliness, and the pain of withdrawal were among their top reasons for relapse. As a result of this survey, specific groups were developed and implemented in an effort to better address the unique reasons for relapse that our clients most commonly reported. It is hoped that the addition of these groups will help to improve overall treatment outcome of the clients who are served by the agency.

Keywords—relapse, relapse prevention, treatment planning

Enhancing Adolescent Substance Abuse Treatment Engagement - Paula T. McWhirter, Ph.D.

Abstract—Trends in adolescent drug use are encouraging and suggest the importance of preventative programs for youth. Yet, among those who become involved with illicit substances and seek treatment, only a fraction report positive outcomes. This article describes an approach to enhance adolescent participation in substance abuse treatment. Aspects of the transtheoretical model are integrated into a treatment program designed to meet the unique developmental needs of adolescent alcohol and marijuana abusers. The result is a treatment that better engages adolescents in participation, thereby increasing the likelihood for treatment success.

Keywords—adolescent, treatment engagement, transtheoretical

Legally High? Legal Considerations of Salvia divinorum — O. Hayden Griffin, III, J.D., M.A.; Bryan Lee Miller, M.S. & David N. Khey, M.S., M.A.

Abstract—The legal status of the hallucinogenic plant Salvia divinorum has been rapidly changing. Legal prohibitions on this plant native to Oaxaca, Mexico have emerged at the state level, a phenomenon that has not occurred since the passage of the Controlled Substances Act (CSA). Included will be a brief description of the plant that has only recently crept into the popular American consciousness, and a review of the different legal mechanisms through which states have controlled the plant and the pending legislation proposing controls. Lastly, the implications of various state laws are discussed.

Keywords—controlled substances, drug policy, drugs, hallucinogens, Salvia divinorum

The “Vine of the Soul” vs. The Controlled Substances Act: Implications of the Hoasca Case — Ronald K. Bullis, Ph.D., J.D., M.Div

Abstract—In 2006, the Supreme Court paved the way for the sacramental use of a hallucinogen, hoasca, to be imported, distributed and ingested by a religious group. This case has broad implications for religious freedom for using sacramental psychotropics and how such cases might be decided in the future. This article outlines the arguments used both by the church and by the government. It lists the facts of the cases, explains and analyzes the decision, evaluates the likelihood of expansions of religion-based exceptions for entheogen use in light of the Supreme Court’s decision and offers a profile for those groups most likely to receive such an exemption.

Keywords—controlled substances, entheogens, First Amendment, hoasca, sacramental drugs, spirtuality

SHORT COMMUNICATIONS

Abstract—Using secondary data analysis, this study compares alcohol and other drug (AOD) problems experienced by African-American students attending a historically Black university who use alcohol only versus those who use alcohol plus marijuana. Results indicate that students who used marijuana plus alcohol experienced more AOD problems than their counterparts who used alcohol only. The current findings are similar to previous research with a majority White college student population.

Keywords—alcohol, binge drinking, marijuana

Neuropsychological Effects of Formaldehyde Use — Janice C. Marceaux, M.A.; Lawrence S. Dilks, Ph.D. & Sheila Hixson, M.A.

Abstract—This study compared five individuals who intentionally ingested formaldehyde (possibly laced with PCP) in marijuana cigarettes to a control group on measures of cognitive ability. Formaldehyde, a major component in embalming fluid, is legal to purchase and possess and has become popular due to its euphoric properties. In significant doses, the chemical is a neurotoxin. The effects of inadvertent exposure are fairly well known, but the effects of intentional ingestion have only recently been investigated. In addition, there has been little research on the effects of formaldehyde use specific to intellectual ability and cognitive intactness. The results of this study indicate intentional ingestion may cause a decline in neuropsychological intactness, as measured by performance on the Shipley Institute of Living Scale.

Keywords—brain damage, cognitive, formaldehyde, fry, neuropsychology, PCP

Chloroquine Psychosis Masquerading as PCP: A Case Report — Gregory B. Collins, M.D. & Mark S. McAllister, M.D.

Abstract—Chloroquine and its derivatives have been drugs of choice in the prophylaxis and treatment of malaria for over 50 years. These drugs are also frequently used in the treatment of various rheumatologic disorders. Because many Americans now travel abroad and may require chloroquine prophylaxis, as well as the fact that such medications are readily available through Internet-based supply houses, clinicians should be aware of the potential toxicity associated with the use of these agents. We present the case of an adolescent female who presented with acute, chloroquine-induced toxic psychosis resembling that induced by phencyclidine (PCP) in clinical presentation and laboratory findings. In the acute setting, the differentiation between chloroquine toxic psychosis and PCP psychosis may be difficult. Therefore, the syndrome of chloroquine-induced psychosis is reviewed and its differentiation from PCP psychosis highlighted as it relates to important aspects of this case.

Keywords—chloroquine, phencyclidine, psychosis

A Case Report of Propofol Dependence in a Physician — Udo Bonnet, M.D.; Jörg Harkener, M.D. & Norbert Scherbaum, M.D.

Abstract—Propofol is a widely used general anaesthetic with multisite mechanisms and especially ultrashort activation of certain central GABA-A receptors. Since its introduction into the market in the mid 1980s this is the seventh report on propofol dependence in the literature. The present case shows for the first time that craving for propofol can be quite intense and able to induce addictive behaviour.

Keywords—dependence, propofol, sedatives

Ecstasy Analogues Found in Cacti — Jan G. Bruhn, Ph.D.; Hesham R. El-Seedi, Ph.D.; Nikolai Stephanson, Ph.D.; Olof Beck, Ph.D. & Alexander T. Shulgin, Ph.D

Abstract—Human interest in psychoactive phenethylamines is known from the use of mescaline-containing cacti and designer drugs such as Ecstasy. From the alkaloid composition of cacti we hypothesized that substances resembling Ecstasy might occur naturally. In this article we show that lophophine, homopiperonylamine and lobivine are new minor constituents of two cactus species, Lophophora williamsii (peyote) and Trichocereus pachanoi (San Pedro). This is the first report of putatively psychoactive phenethylamines besides mescaline in these cacti. A search for further biosynthetic analogues may provide new insights into the structure-activity relationships of mescaline. An intriguing question is whether the new natural compounds can be called “designer drugs.”

Keywords— Ecstasy, homopiperonylamine, lophophine, lobivine, peyote, San Pedro

Vol. 40 (2)

June 2008

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