Table of Contents

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Volume 41, Number 2

June 2009

Reactivity to Cannabis Cues in Virtual Reality Environments — Patrick S. Bordnick, M.S.W., M.P.H., Ph.D.; Hilary L. Copp, M.S.W.; Amy Traylor, M.S.W., Ph.D.; Ken M. Graap, M.Ed.; Brian L. Carter, MS, Ph.D.; Alicia Walton, M.D. & Mirtha Ferrer

Young Adult Ecstasy Users’ Enhancement of the Effects of Their Ecstasy Use — Hugh Klein, Ph.D.; Kirk W. Elifson, Ph.D. & Claire E. Sterk, Ph.D.

Changes in Spirituality Among Ayahuasca Ceremony Novice Participants — Stephen Trichter, Psy.D.; Jon Klimo, Ph.D. & Stanley Krippner, Ph.D.

Nitrite Inhalant Abuse in Antisocial Youth: Prevalence, Patterns, and Predictors — Martin T. Hall, Ph.D. & Matthew O. Howard, Ph.D.

Incarceration and Opioid Withdrawal: The Experiences of Methadone Patients and Out-of-Treatment Heroin Users — Shannon Gwin Mitchell, Ph.D.; Sharon M. Kelly, Ph.D.; Barry S. Brown, Ph.D.; Heather Schacht Reisinger, Ph.D.; James A. Peterson, Ed.D.; Adrienne Ruhf;        Michael H. Agar, Ph.D. & Robert P. Schwartz, M.D.

A Model for Sober Housing During Outpatient Treatment — Douglas L. Polcin, Ed.D., M.F.T.

Engaging Minority Men at HIV Risk in Integrated Mental Health and Drug Treatment  —Jean Oggins, Ph.D.

Predictors of Drug Treatment Completion Among Parole Violators — David A. Zanis, Ph.D.; Donna. M. Coviello, Ph.D.; Jacqueline J. Lloyd, Ph.D. & Barry L. Nazar, Ph.D.

Visual Representation Tools for Improving Addiction Treatment Outcomes — Michael Czuchry, Ph.D.; Dianna Newbern-McFarland, Ph.D. & Donald F. Dansereau, Ph.D.

SHORT COMMUNICATIONS

An Integrated Drug Counseling and Employment Intervention for Methadone Clients — Donna M. Coviello, Ph.D.; Dave A. Zanis, Ph.D.; Susan A. Wesnoski, M.S.W., L.S.W. & Sarah W. Domis, M.S.

Narcotherapy in the Treatment of Post-Traumatic Stress Disorders: A Report of Two Cases  — Raymond Denson, MSc (Saskatchewan), MDCM (McGill), FRCPC MRCPsych.

Movement Disorders and MDMA Abuse — James Allen Wilcox, D.O., Ph.D. & Aidee Herrera Wilcox, B.A.

COVER ART — The Rites of Spring by Pat Preble (www.patpreble.com)

ABSTRACTS

Reactivity to Cannabis Cues in Virtual Reality Environments — Patrick S. Bordnick, M.S.W., M.P.H., Ph.D.; Hilary L. Copp, M.S.W.; Amy Traylor, M.S.W., Ph.D.; Ken M. Graap, M.Ed.; Brian L. Carter, MS, Ph.D.; Alicia Walton, M.D. & Mirtha Ferrer..

Abstract—Virtual reality (VR) cue environments have been developed and successfully tested in nicotine, cocaine, and alcohol abusers. Aims in the current article include the development and testing of a novel VR cannabis cue reactivity assessment system. It was hypothesized that subjective craving levels and attention to cannabis cues would be higher in VR environments with cannabis cues compared to VR neutral environments. Twenty nontreatment-seeking current cannabis smokers participated in the VR cue trial. During the VR cue trial, participants were exposed to four virtual environments that contained audio, visual, olfactory, and vibrotactile sensory stimuli. Two VR environments contained cannabis cues that consisted of a party room in which people were smoking cannabis and a room containing cannabis paraphernalia without people. Two VR neutral rooms without cannabis cues consisted of a digital art gallery with nature videos. Subjective craving and attention to cues were significantly higher in the VR cannabis environments compared to the VR neutral environments. These findings indicate that VR cannabis cue reactivity may offer a new technology-based method to advance addiction research and treatment.

Keywords—cannabis, craving, cue reactivity, olfactory cues, marijuana, virtual reality

Young Adult Ecstasy Users’ Enhancement of the Effects of Their Ecstasy Use — Hugh Klein, Ph.D.; Kirk W. Elifson, Ph.D. & Claire E. Sterk, Ph.D.

Abstract—This study examines drug effect-enhancing behaviors practiced by young adult users of the drug, Ecstasy. Between August 2002 and August 2004, 283 face-to-face interviews were conducted with active Ecstasy users. Study participants were recruited in the Atlanta, Georgia metropolitan area using a targeted sampling approach. The large majority of study participants (87%) engaged in at least one behavior specifically designed to bolster the effects of their Ecstasy use, with 61% of the study participants reporting having engaged in at least three such behaviors during the past 30 days. Taking steps to boost one’s Ecstasy-related high was associated with binging on Ecstasy and a variety of adverse outcomes, such as experiencing a greater number of negative consequences resulting from Ecstasy use and experiencing more Ecstasy-related drug dependency symptoms. Multivariate analysis revealed several factors associated with greater involvement in effects-boosting behaviors, including race (not being African American), spending time with other drug users, using Ecstasy for its touch-enhancing qualities, enjoyment of the music-and-Ecstasy-use experience, and childhood maltreatment experiences. The implications of these findings for treatment, prevention, and intervention for drug problems among Ecstasy users are discussed.

Keywords—Ecstasy use, enhancing drug effects, MDMA, young adults

Changes in Spirituality Among Ayahuasca Ceremony Novice Participants — Stephen Trichter, Psy.D.; Jon Klimo, Ph.D. & Stanley Krippner, Ph.D.

Abstract—Ayahuasca, a hallucinogenic plant brew from the Amazon basin used as part of healing ceremonies by the local indigenous people of the region for centuries, is now being consumed by growing numbers of people throughout the world. Anecdotal evidence and previous research suggest that there are spiritual effects experienced among participants who take part in ayahuasca ceremonies. The current study examined whether novice participants’ spirituality was affected through participation in an ayahuasca ceremony, and if so, how. A mixed-design method was used, comparing those participating in an ayahuasca ceremony to those who did not participate. This investigation used the Peak Experience Profile, the Spiritual Well-being Scale, and the Mysticism Scale as quantitative measures. Participant interviews and written accounts of ceremony experiences were analyzed. Results showed that neither the SWB score nor the M-Scale score increased significantly after participating in an ayahuasca ceremony. However, it was found that the higher the PEP score, the greater the positive change in SWB and M-Scale scores. Qualitative data revealed common spiritual themes in many of the participants’ interviews and written accounts. Experiential differences were displayed within the ayahuasca ceremony group, warranting continued investigation into, and identification of, various confounding variables that prompt reported changes in spirituality within some participants while not in others.

Keywords—ayahuasca, entheogen, mysticism, spirituality

Nitrite Inhalant Abuse in Antisocial Youth: Prevalence, Patterns, and Predictors — Martin T. Hall, Ph.D. & Matthew O. Howard, Ph.D.

Abstract—The purpose of this study was to examine the prevalence, patterns, and predictors of nitrite inhalant use in antisocial adolescents. Face-to-face interviews were conducted with 723 Missouri youth (M_age = 15.5, SD = 1.2) in residential care for antisocial behavior. The lifetime prevalence of nitrite inhalant use was 1.7% (1.3% for boys; 4.3% for girls, p = .06), a figure somewhat higher than comparable estimates from the MTF and NSDUH national surveys. Most lifetime users reported nitrite use in the prior year (92%) and experienced intoxication (83%) during periods of nitrite inhalation. Nitrite users had significantly higher scores on measures of somatization, obsessive-compulsive traits, interpersonal sensitivity, impulsivity, fearlessness, suicidality, and polydrug use and were significantly more likely to have suffered a serious head injury and to be White than their non-nitrite-using counterparts. Nitrite users also reported significantly higher levels of current psychiatric distress related to periods of faintness or dizziness, hot or cold spells, difficulty making decisions, and their “mind going blank” than did non-nitrite users. Antisocial adolescent nitrite users are at substantially elevated risk for serious functional impairments given their high rates of lifetime head injury, comparatively more varied and intensive levels of involvement with psychoactive drugs, and symptom reports suggestive of psychiatric and cognitive dysfunction.

Keywords—adolescents, amyl nitrite, antisocial, butyl nitrite, delinquents, poppers

Incarceration and Opioid Withdrawal: The Experiences of Methadone Patients and Out-of-Treatment Heroin Users — Shannon Gwin Mitchell, Ph.D.; Sharon M. Kelly, Ph.D.; Barry S. Brown, Ph.D.; Heather Schacht Reisinger, Ph.D.; James A. Peterson, Ed.D.; Adrienne Ruhf;        Michael H. Agar, Ph.D. & Robert P. Schwartz, M.D.

Abstract—Both heroin-addicted individuals and methadone maintenance patients are likely to face untreated opioid withdrawal while incarcerated. Limited research exists concerning the withdrawal experiences of addicted inmates and their impact on individuals’ attitudes and plans concerning drug abuse treatment. In the present study, 53 opioid dependent adults (32 in methadone treatment and 21 out of treatment) were interviewed in an ethnographic investigation of withdrawal experiences during incarceration. When treatment for opioid withdrawal was unavailable, detoxification experiences were usually described as negative and were often associated with a variety of unhealthy behaviors designed to relieve withdrawal symptoms. Negative methadone withdrawal experiences also negatively influenced participants’ receptivity to seeking methadone treatment upon release. A minority of participants took a positive view of their withdrawal experience and saw it as an opportunity to detox from heroin or discontinue methadone. Findings support the importance of providing appropriate opioid detoxification and/or maintenance therapy to opioid-dependent inmates.

Keywords—ethnography, incarceration, methadone, opioid addiction, withdrawal

A Model for Sober Housing During Outpatient Treatment — Douglas L. Polcin, Ed.D., M.F.T.

Abstract—Finding a living environment that supports recovery is a major challenge for many clients attending outpatient treatment. Yet it is important because family, friends, and roommates who encourage substance use or discourage recovery can undermine the progress made in treatment. Destructive living environments are most problematic for clients who have limited incomes and reside in urban areas where housing markets are tight. Individuals who are homeless face constant threats to their sobriety and often lack the stability necessary to attend treatment consistently. Options Recovery Services is an outpatient program in Berkeley, California that uses sober living houses (SLHs) to provide an alcohol- and drug-free living environment to clients while they attend the outpatient program. This article describes the structure and processes of the houses along with six month outcome data on 46 residents. Improvements were seen in the number of months using substances, maximum number of days of substance use per month, arrests, and employment. Seventy six percent of the residents remained in the house at least five months and 39% reported being employed at some point during the past 30 days. Outpatient programs should consider establishing SLHs for clients who lack a living environment supportive of sobriety.

Keywords—drug-free housing, outpatient, recovery, sober living houses

Engaging Minority Men at HIV Risk in Integrated Mental Health and Drug Treatment —Jean Oggins, Ph.D.

Abstract—This article describes Walden House’s Enhanced Planetree Intervention Component (EPIC), enhanced substance abuse treatment services that offered minority men mental health services integrated with services for substance abuse and HIV. Of clients entering EPIC in a one-year period, 93% successfully completed treatment, compared to a significantly lower 65% for a group in mainstream treatment that did not receive EPIC services two years before. Interviews with EPIC clients and staff indicated that despite client ambivalence about entering a program for people at HIV risk or minorities, skilled minority therapists helped make EPIC more attractive than standard treatment and contributed to important gains in insight, including insight about sexuality and about cultural expectations. The therapy was perceived to help reduce risk behaviors and helped some stay in treatment. The combination of individual therapy and nonconfrontational small groups appeared culturally sensitive and flexible in meeting varied needs. Although clients who relapsed or left early could continue in EPIC outpatient treatment, the agency’s general emphasis on abstinence deterred some. Issues in implementing counseling programs for minority men are discussed.

Keywords—AIDS, harm reduction, HIV, mental health, minority, substance use treatment

Predictors of Drug Treatment Completion Among Parole Violators — David A. Zanis, Ph.D.; Donna. M. Coviello, Ph.D.; Jacqueline J. Lloyd, Ph.D. & Barry L. Nazar, Ph.D.

Abstract—This study examined the predictors of treatment completion among 380 state parole violators consecutively admitted to a comprehensive 12-month drug treatment program in lieu of reincarceration. Offenders were placed on intensive parole supervision throughout the 12-month treatment protocol and received three months of residential substance abuse treatment followed by nine months of outpatient counseling. Overall 123 (32.4%) of the offenders completed the 12-month treatment protocol. The primary reason for noncompletion was a positive drug screen. Bivariate analyses were performed to determine independent predictors of program completion. Four variables (age, past 30-day heroin use, total months incarcerated, and significant problems with mother) from the baseline Addiction Severity Index were found to be correlated with treatment completion (p < .10). These factors and other demographics (race, marital status, education) and variables found predictive of program completion in previous studies were entered into a multiple logistic regression model. Overall the final model found that only two factors—older age (p < .03) and no heroin use in the past 30 days (p < .02) significantly predicted treatment completion. These findings suggest that among parolees with moderate to extensive criminal justice histories younger individuals and those with recent heroin use respond less favorably to comprehensive substance abuse treatment services and intensive parole supervision.

Keywords—drug treatment, parole, recidivism, rehabilitation, substance abuse

Visual Representation Tools for Improving Addiction Treatment Outcomes — Michael Czuchry, Ph.D.; Dianna Newbern-McFarland, Ph.D. & Donald F. Dansereau, Ph.D.

Abstract—To examine the effectiveness of two visual representation counseling techniques for reducing illicit drug use, participants were randomly assigned to receive standard treatment “as usual” or standard treatment supplemented with free mapping or free plus guide mapping. Each counselor delivered all types of treatment to participants to control for differences in counselor characteristics (e.g., experience, empathy). Eighty-two participants who had received one year of methadone maintenance treatment and had urinalysis and self-report data for illicit drug use six months after treatment were examined. Compared to participants receiving standard treatment, participants randomly assigned to the free plus guide mapping condition had significantly lower opiate use based on urinalysis and self-report data. These results support the use of the free plus guide visual representation strategy and provide evidence for the concurrent validity of self-report measures of illicit drug use.

Keywords—counseling, mapping, methadone, self-report, urinalysis

SHORT COMMUNICATIONS

An Integrated Drug Counseling and Employment Intervention for Methadone Clients — Donna M. Coviello, Ph.D.; Dave A. Zanis, Ph.D.; Susan A. Wesnoski, M.S.W., L.S.W. & Sarah W. Domis, M.S.

Abstract—After drug use stabilization, employment has long been considered an important goal for clients enrolled in Methadone Maintenance Treatment Programs (MMTPs). The integrated counseling and employment intervention described here is a manualized treatment based on interpersonal cognitive problem solving (ICPS) theory. The six-month intervention utilized a problem-solving framework to help methadone clients obtain a job and manage employment within the context of drug treatment. In this pilot study, 23 subjects were randomly assigned to either integrated ICPS drug and employment counseling (n = 12) or to an ICPS drug counseling control condition (n = 11). While there were no differences between the integrated and control conditions, both groups showed a significant improvement in employment outcomes and reduction in HIV risk behaviors at the six-month follow-up. Although there may be concerns regarding the generalizability of the findings, overall, the problem solving framework may be an improvement over standard methadone counseling. The intervention may be beneficial when implemented with a larger group of motivated ex-offenders who are mandated to drug treatment as a condition of their parole.

Keywords—cognitive problem solving, employment, methadone, treatment

Narcotherapy in the Treatment of Post-Traumatic Stress Disorders: A Report of Two Cases — Raymond Denson, MSc (Saskatchewan), MDCM (McGill), FRCPC MRCPsych.

Abstract—The history of narcotherapy is outlined and reasons are given for its current obsolescence. A modified procedure and two cases in which it has been employed successfully are described. The rationale of narcotherapy and its application to the treatment of post-traumatic stress disorders are discussed and elucidated.

Keywords—drug-induced abreaction, emotional catharsis, modified narcotherapy, PTSD treatment, sodium amytal interviews

Movement Disorders and MDMA Abuse — James Allen Wilcox, D.O., Ph.D. & Aidee Herrera Wilcox, B.A.

Abstract—This article present the cases of two young men with chronic MDMA abuse who later developed movement disorders typical of the Parkinson’s syndrome. It is worth noting that both men bought the presumed MDMA from the same illicit source. Potential risks of MDMA use and movement disorders are discussed. The risks inherent from contaminants and similar factors associated with illegal drug manufacture are discussed. The authors conclude that as long as nonpharmaceutical-grade MDMA is illicitly produced, health risks will be associated with its use.

Keywords—MDMA, movement, Parkinsonism, toxicity