Table of Contents

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Volume 41, Number 1

March 2009

Khat Use: Lifestyle or Addiction? — Rita Annoni Manghi, M.D.; Barbara Broers, M.D.; Riaz Khan, M.D.; Djamel Benguettat, M.D. Yasser Khazaal, M.D. & Daniele Fabio Zullino, M.D. 

Initiation into Methamphetamine Use: Qualitative Findings from an Exploration of First Time Use Among a Group of New Zealand Users — Janie Sheridan, Ph.D.; MRPharmS RegPharmNZ; Rachael Butler, PGDipPH, B.A.  & Amanda Wheeler, B.Sc., BPharm PGDipPsychPharm

Mediating MDMA-Related Harm: Preloading and Post-loading Among Ecstasy-Using Youth  — Brian C. Kelly, Ph.D.

What’s in a Label? Ecstasy Sellers’ Perceptions of Pill Brands — Micheline Duterte, B.A.; Camille Jacinto, B.A.; Paloma Sales, Ph.Dc. & Sheigla Murphy, Ph.D.

Controlled Release: A Cultural Analysis of Collegiate Polydrug Use — Gilbert Quintero, Ph.D.

Pharmacological Research on Addictions: A Framework for Ethical and Policy Considerations —Cynthia Geppert, M.D., Ph.D., M.P.H. & Michael P. Bogenschutz, M.D.

Relationship between Anxiety and Addiction to a Depressant Drug — James F. Scorzelli, Ph.D. & Saleha Z. Chaudhry, B.A.

Thunder Among the Pines: Defining a Pan-Asian Soma — Frederick Dannaway 

SHORT COMMUNICATIONS

Childhood Abuse and Neglect as a Risk Factor for Alexithymia in Adult Male Substance Dependent Inpatients — Cuneyt Evren, M.D.; Bilge Evren, M.D.; Ercan Dalbudak, M.D.;  Basak Ozcelik, M.D. & Fatih Oncu, M.D.

Reliability of the Lifetime Inventory of Drug Use Consequences (Induc) in Methadone Maintenance Patients — Kenneth R. Conner, Psy.D., M.P.H.; Mary Ellen Ross, R.N.C.; Gloria Baciewicz, M.D.; Luke M. Sworts, B.A. & Sean C. Meldrum, M.S.

Relationship of Unemployment Rate and Rate of Opiate Exposure in Kentucky — Diana J. Gascon, M.D., M.P.H. & Henry A. Spiller, M.S. D.A.B.A.T.

LETTERS TO THE EDITOR — Steve Heilig M.P.H. & Donald Wesson, M.D.

COVER ART — Ice Wave by Michael Zimmerman

Abstracts

Khat Use: Lifestyle or Addiction? — Rita Annoni Manghi, M.D.; Barbara Broers, M.D.; Riaz Khan, M.D.; Djamel Benguettat, M.D. Yasser Khazaal, M.D. & Daniele Fabio Zullino, M.D. 

Abstract—The khat plant contains psychoactive alkaloids with psychostimulant properties, and has been used for centuries as a recreational and religious drug, mainly in some African and Middle Eastern countries. With changing migration patterns, epidemiological and clinical outcomes may have changed. The aim of this article is to review current knowledge on pharmacological, epidemiological and clinical aspects of khat use. Khat use is still highly prevalent in the countries mentioned, and in African and Yemeni emigrant groups. Preclinical and clinical data confirm its addictive potential as well as possible psychological, psychiatric and medical consequences related to stimulant use; however, existing epidemiological studies do not focus on the prevalence of problematic use or dependence. There are no indications of high prevalence of khat use in other cultural and ethnic groups. Data are lacking on possible increased psychotogenic risks when khat is used outside of the original cultural context. As with alcohol use in many countries, khat use can be considered as a lifestyle in some specific countries, covering the spectrum from nonproblematic use to problematic use and dependence. Khat dependence is associated with high morbidity and societal and economical costs.
Keywords—clinical epidemiology, khat, pharmacology, psychoactive alkaloids

Initiation into Methamphetamine Use: Qualitative Findings from an Exploration of First   Time Use Among a Group of New Zealand Users — Janie Sheridan, Ph.D.; MRPharmS RegPharmNZ; Rachael Butler, PGDipPH, B.A.  & Amanda Wheeler, B.Sc., BPharm PGDipPsychPharm

Abstract—Methamphetamine use has risen in many countries around the world in recent years, and New Zealand is no exception, with the substance having become well-established in the illicit drug market. While there is much published on the individual and social harms of this drug, limited data are available on methamphetamine use initiation. Understanding early patterns of behavior is important, given the potential risks involved at this stage of use. This article presents findings from a qualitative study which was undertaken with methamphetamine users, most of whom were in treatment at the time of the research. While the research primarily sought to investigate patterns of methamphetamine use and associated harms, a key issue explored was the way in which respondents came to use the drug. Findings revealed that most were experienced users of other substances when trying the drug for the first time, but lacked specific knowledge of methamphetamine. The majority were introduced to methamphetamine in a social situation by a friend or partner, who also played a key role in preparing the drug for administration. Several reported risk-taking behaviors on the first occasion of use. The findings have important implications for potential interventions and harm reduction strategies at first use.
Keywords—drug use initiation, methamphetamine, qualitative

Mediating MDMA-Related Harm: Preloading and Post-loading Among Ecstasy-Using Youth  — Brian C. Kelly, Ph.D.

Abstract—Ecstasy use remains a key concern for professionals working in fields related to youth and drug use. At the forefront of these concerns are issues related to neurological dysfunction and depression—both acute and long-term—associated with MDMA use. Ecstasy users have been shown to assess Ecstasy related harms and to engage in a variety of practices to manage these risks. To contend with risk related to neurological dysfunction and depression, some youth have turned to “pre-loading” and “post-loading”: the practice of consuming other substances to mitigate the negative effects of Ecstasy. Drawing upon data from an ethnographic study of club drug use among youth, the author provides a descriptive profile of the practices of pre-loading and post-loading as well as the motivations underlying these behaviors among New York City area youth. Youth utilize a range of pre-loading and post-loading practices, yet do not universally share similar practices, attitudes, and knowledge. It is critical to link clinical and behavioral sciences research to further study both the efficacy and safety of these practices.
Keywords—club drugs, Ecstasy, harm reduction, pre-loading, post-loading, youth

What’s in a Label? Ecstasy Sellers’ Perceptions of Pill Brands — Micheline Duterte, B.A.; Camille Jacinto, B.A.; Paloma Sales, Ph.Dc. & Sheigla Murphy, Ph.D.

Abstract—This article presents selected findings from a qualitative study of Ecstasy sellers and their sales practices, knowledge of distribution networks, buyer-seller relationships, and self-reported drug use. In-depth interviews were conducted with 80 men and women who had sold five or more hits of Ecstasy five or more times in the six months prior to the interview. Study participants described their perceptions of the various types of Ecstasy they had distributed or used themselves. The participants had experience with a variety of Ecstasy labels, from the popular “Blue Dolphin” tablets to the powdered form called “Molly.” We tracked pill brand mentions on Ecstasy-related websites to compare with interviewees’ descriptions of Ecstasy brands. This study examines Ecstasy sellers’ ideas about the role of brand names in Ecstasy markets and their relationship to their beliefs about different types of Ecstasy’s purity and quality. We demonstrate that considering Ecstasy branding increases our understanding of buyer and seller relationships.
Keywords—brands, buyer-seller relationships, drug distribution, Ecstasy

Controlled Release: A Cultural Analysis of Collegiate Polydrug Use — Gilbert Quintero, Ph.D.

Abstract—Social science research on polydrug use among young adult college students is scant, adopts definitions of this practice that are often devoid of sociocultural context, and emphasizes a very narrow range of use patterns. This article, based on ethnographic interviews from a study of collegiate prescription drug misuse, expands this focus by offering a cultural analysis of polydrug use. Two specific types of collegiate polydrug use, simultaneous interaction and sequential management, are examined within a cultural framework that relates these practices to the expression of two complementary values—control and release. The college experience provides young people with a culturally sanctioned “time-out” period that affords freedom from many of the roles, responsibilities, and other constraints that come to structure later adult life. At the same time, college students are expected to meet academic and social demands that require organization, initiative, and direction. Specific types of polydrug use provide young adults with a means to navigate these competing prescriptions that are characteristic of contemporary college life.
Keywords—college, culture, polydrug use

Pharmacological Research on Addictions: A Framework for Ethical and Policy Considerations —Cynthia Geppert, M.D., Ph.D., M.P.H. & Michael P. Bogenschutz, M.D.

Abstract—Findings from neuroscience research hold promise for improved treatments for and prevention of substance use disorders (SUD), but ethical concerns about psychopharmacological research involving SUD may potentially undermine scientific progress. This article reviews the literature pertaining to seven ethical requirements that elucidate a coherent framework for evaluating the ethics of clinical SUD research protocols. Those requirements are social or scientific value, scientific validity, fair subject selection, favorable risk-benefit ratio, independent review, informed consent, and respect for potential or enrolled subjects. An evidence-based analysis suggests that sound pharmacological research in SUD can safeguard the welfare of research participants while collecting valuable scientific data and benefiting society.
Keywords—ethics, policy, psychopharmacology, research, substance use disorders

Relationship between Anxiety and Addiction to a Depressant Drug — James F. Scorzelli, Ph.D. & Saleha Z. Chaudhry, B.A.

Abstract—A systematic random sample of 267 patients who were involved in outpatient detoxification was surveyed. Their records were evaluated, and the demographics, psychiatric diagnoses, and type(s) of substance of abuse of each patient were recorded. The results indicated that there was a significant relationship between an anxiety disorder and whether the patient was addicted to an opioid. A follow-up was conducted on 79 patients who were addicted to an opioid, and had an anxiety diagnosis. Of this group, 54 (70%) responded, of which only 22 (40%) said that they were receiving some type of treatment for their disorder. All of these patients reported that they were sober and that their anxiety disorder significantly decreased.
Keywords—addiction, anxiety, co-occurring disorder, depressive drug, relationship

Thunder Among the Pines: Defining a Pan-Asian Soma — Frederick Dannaway 

Abstract—Many ancient cultures and religions engaged in various techniques and used various substances to instigate religious experience and to alter perception. These techniques of psycho-sexual drug yoga reached an unparalleled level of sophistication that arose and was often cloaked in practical terms of alchemy and metallurgy. The Vedic tradition describes this plant-based ritualism as soma, which has been identified by Gordon Wasson as the mushroom Amanita muscaria. This article traces these soma-influenced sects of esoteric Buddhism that exerted influences from India, China and Tibet to Japan. Some of the key components, practices and symbolism are retained despite numerous cultural filters. Japan’s tradition of esoteric Buddhism can thus be seen to have preserved and incorporated the soma/amrita mushroom lore into its own traditions of mountain ascetic mystics.
Keywords—Amanita muscaria, esoteric Buddhism/Tantra, Japanese ethnomycology, soma

SHORT COMMUNICATIONS

Childhood Abuse and Neglect as a Risk Factor for Alexithymia in Adult Male Substance Dependent Inpatients — Cuneyt Evren, M.D.; Bilge Evren, M.D.; Ercan Dalbudak, M.D.;  Basak Ozcelik, M.D. & Fatih Oncu, M.D.

Abstract—The prevalence of childhood abuse and neglect (CAN) histories and their associations with alexithymia among male substance-dependent inpatients were studied. Participants were 159 consecutively admitted male substance dependents (115 alcohol and 44 other drugs). Substance dependence was diagnosed by means of the Structured Clinical Interview for DSM-IV (SCID-I), Turkish version. Patients were investigated with the Toronto Alexithymia Scale (TAS-20) and Childhood Abuse and Neglect Questionnaire. Among substance-dependent patients, 57.0% had at least one type of CAN and 45.3% were considered as alexithymic since they had a score greater than 60 on the TAS-20. Rate of unemployment, low educational status, emotional abuse and history of suicide attempts were higher in alexithymic substance dependent patients. Those who had histories of two or more types of childhood abuse or neglect had also higher mean score on TAS-20, particularly on the item “difficulty in identifying feelings-DIF.” Also, the number of childhood trauma types was positively correlated with TAS-20 and DIF and the “difficulty in describing feelings-DDF” items of TAS-20. History of childhood emotional abuse was the only determinant for alexithymia. Childhood emotional abuse might be a risk factor for alexithymia among inpatient substance dependents.
Keywords—alexithymia, childhood abuse, childhood neglect, substance abuse

Reliability of the Lifetime Inventory of Drug Use Consequences (Induc) in Methadone Maintenance Patients — Kenneth R. Conner, Psy.D., M.P.H.; Mary Ellen Ross, R.N.C.; Gloria Baciewicz, M.D.; Luke M. Sworts, B.A. & Sean C. Meldrum, M.S.

Abstract—One hundred twenty one opiate-dependent individuals in methadone maintenance treatment at an urban university medical center in the U.S. were administered the Inventory of Drug Use Consequences (InDUC), and 68 subjects provided follow-up assessments at two to six weeks. The sample included 61 (50.4%) women; 86 (71.1%) of the subjects reported that they were White, 29 (24.0%) Black, and six (5.0%) other race. The mean age was 41.9 (SD = 9.7) years. Ninety-nine (81.8%) of participants had used opiates intravenously. INDUC total scores and a short form showed high internal consistency (α) and test-retest reliability (ICC) across gender, race, ethnicity, and education, supporting their use as global measures of drug use consequences. The interpersonal scale was also reliable across strata whereas the physical and intrapersonal scales were not reliable. The impulse control and social responsibility scales were stable but not internally consistent.
Keywords—instrumentation, opioid-related disorders, psychometrics, substance abuse

Relationship of Unemployment Rate and Rate of Opiate Exposure in Kentucky — Diana J. Gascon, M.D., M.P.H. & Henry A. Spiller, M.S. D.A.B.A.T.

Abstract—There are conflicting reports regarding the relationship of labor supply and substance abuse. Opioid analgesic abuse, particularly with Oxycontin and hydrocodone, has increased in the past years. Kentucky is one of the states with the highest abuse rate for these substances. The purpose of this trend study is to determine if there is a relationship between unemployment rate and rate of opiate exposure in Kentucky. The time period analyzed was year 2000 to year 2005. Data were obtained from the United States Census Bureau, United States Department of Labor and the Kentucky Regional Poison Center. Three of the six years (2000, 2002, 2003) showed a significant positive correlation between higher unemployment rate and higher rate of opiate exposure. The largest negative correlation was noted in 2004, which was also the period wherein the unemployment rate decreased statewide. Correlations for the remaining two years (2001 and 2005) approached statistical significance.
Keywords—Kentucky, rate of opiate exposure, trend study, unemployment rate, USA