Comparison of Behavioral Treatment Conditions in Buprenorphine Maintenanceby Walter Ling, Maureen Hillhouse, Alfonso Ang, Jessica Jenkins, Jacqueline Fahey
Abstract
Background and aims
The Controlled Substances Act requires physicians in the United States to provide or refer to behavioral treatment when treating opioid-dependent individuals with buprenorphine; however no research has examined the combination of buprenorphine with different types of behavioral treatments. This randomized controlled trial compared the effectiveness of 4 behavioral treatment conditions provided with buprenorphine and medical management (MM) for the treatment of opioid dependence.
Design
After a 2-week buprenorphine induction/stabilization phase, participants were randomized to 1 of 4 behavioral treatment conditions provided for 16 weeks: Cognitive Behavioral Therapy (CBT=53); Contingency Management (CM=49); both CBT and CM (CBT+CM=49); and no additional behavioral treatment (NT=51).
Setting
Study activities occurred at an outpatient clinical research center in Los Angeles, California, USA.
Participants
Included were 202 male and female opioid-dependent participants.
Measurements
Primary outcome was opioid use, measured as a proportion of opioid-negative urine results over the number of tests possible. Secondary outcomes include retention, withdrawal symptoms, craving, other drug use, and adverse events.
Findings
No group differences in opioid use were found for the behavioral treatment phase (Chi-square=1.25, p=0.75), for a second medication-only treatment phase, or at weeks 40 and 52 follow-ups. Analyses revealed no differences across groups for any secondary outcome.
Conclusion
There remains no clear evidence that cognitive behavioural therapy and contingency management reduce opiate use when added to buprenorphine and medical management in opiates users seeking treatment.
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Gambling and problem gambling in the Netherlandsby Anna E. Goudriaan
Abstract
Aims
To provide an overview of gambling in the Netherlands, focusing on historical background, policy, legislation, prevalence of problem gambling, availability of treatment options and research base.
Methods
Literature review.
Results
Contradictions between gambling policy and practice have been present in the past 15–20 years, and have led to an increasingly stricter gambling regulation to retain the government policy to restrict gambling within a national monopoly. Conversely, political efforts have been made to legalize internet gambling, but have not yet been approved. Compared to other European countries, slot machine gambling and casino gambling are relatively popular, whereas betting is relatively unpopular. Last-year problem gambling prevalence (South Oaks Gambling Screen score > 5) is estimated at 0.22–0.15% (2005, 2011). Treatment for problem gambling is covered by health insurance under the same conditions as substance dependence, but only a small proportion of Dutch problem gamblers seeks help at addiction treatment centres.
Conclusions
Gambling policy in the Netherlands has become stricter during recent last years in order to maintain the Dutch gambling monopoly. Problem gambling in the Netherlands is relatively stable. Dutch research on problem gambling has a lack of longitudinal studies. Most of the epidemiological gambling studies are reported in non-peer-reviewed research reports, which diminishes control by independent peers on the methodology and interpretation of results. Recent efforts to enhance consistency in research methods between gambling studies over time could enhance knowledge on changes in (problem) gambling in the Netherlands.
Homeless Women and Hazardous Drinking: Screening Results in a Primary Health Care Settingby Carole C. Upshur, Linda Weinreb, Monica Bharel
Background and Objectives
Screening for alcohol use in primary care is underutilized, especially for women. The current study implemented systematic women's alcohol use screening in a health care for the homeless primary care program.
Methods
All women (n= 541) seeking care over 12 months were screened.
Results
Of the 541 screening forms returned, 80 women refused to answer the alcohol use questions. Of 461 completed screens, over 40% reported no alcohol use, while 43.8% reported hazardous drinking. Hazardous drinking was significantly associated with younger age, African American race, and living on the street or in a shelter.
Discussion and Conclusions
High rates of drinking were identified among women in different housing situations and use of systematic screening was beneficial to providers.
Scientific Significance and Future Directions
Health care settings are important sites to identify hazardous drinking as well as alcohol disorders among women with unstable housing histories. The growing integration of behavioral health care into primary care, and the medical home concept, both provide opportunities for brief interventions for at-risk drinkers, as well as treatment options for those with alcohol use disorders that may be particularly appealing to women. Findings support further investigation of the relationship of housing stability to drinking, and suggest African American women may need special attention. (Am J Addict 2013;XX:000–000)
Posttraumatic Stress Symptoms and Alcohol Problems: Self-Medication or Trait Vulnerability?by Jennifer P. Read, Jennifer E. Merrill, Melissa J. Griffin, Rachel L. Bachrach, Saba N. Khan
Background and Objectives
Posttraumatic stress symptoms (PTSD) and problem alcohol use (ALC) commonly co-occur, but the nature of this co-occurrence is unclear. Self-medication explanations have been forwarded, yet traits such as tendency toward negative emotionality and behavioral disconstraint also have been implicated. In this study we test three competing models (Self-Medication, Trait Vulnerability, Combined Dual Pathway) of PTSD–ALC prospectively in a college sample.
Method
Participants (N= 659; 73% female, M age = 18) provided data at college matriculation (Time 1) and 1 year later (Time 2).
Results
Structural equation models showed disconstraint to meditate the path from PTSD symptoms to alcohol problems, supporting a trait vulnerability conceptualization. Findings regarding negative emotionality and self-medication were more mixed. Negative emotionality played a stronger role in cross-sectional than in prospective analyses, suggesting the importance of temporal proximity.
Conclusions and Scientific Significance
Self-regulation skills may be an important focus for clinicians treating PTSD symptoms and alcohol misuse disorders concurrently. (Am J Addict 2013;XX:000–000)
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What We Talk About When We Talk About Drugsby Dirk Hanson (noreply@blogger.com)
Some number crunching at bluelight.ru.
A fantastic set of interactive graphics tracking conversational trends in drugs at the chat board bluelight.ru reveals some surprises, to the delight of data journalists everywhere. Virostatiq, a software package authored by Marko Plahuta, was put to the task of analyzing traffic at the drug discussion site. Various kinds of plots are available, with endless variables to permutate. Bear in mind that the data that got crunched dealt with the subject of messages, and cannot be directly correlated with drug use, trends, distributions, etc. But it is a fascinating glimpse at what illegal drug users are talking about, and from that, some inferences can be hazarded.
Plahuta writes:
I thought it would be nice to visualize these drug groups based on what users of harm-reduction forums say, so I analyzed around 1.2 million posts on bluelight.ru and constructed a simple diagram that tells a lot…. My whole database contains posts from 2010 until March 2013. Here’s an analytical tool to better understand what’s going on in the recreational drug community. Time is on horizontal axis, while the proportion of posts mentioning specific drug relative to all posts in that month is on the vertical axis. Play around with interactive chart to discover emerging trends, or simply to behold the wax and wane of specific chemicals as they compete for users’ neurological apparatuses, while their manufacturers are temporarily evading ever stricter analog laws.
The chart above represents a graphic created for Addiction Inbox using the visual data provided by Virostatiq. I have singled out six drugs of abuse for discussion. Bear in mind that the trend lines for common drugs like LSD, Ecstasy, marijuana, and methamphetamine all show much higher usage than the ones I have chosen to chart.
—Mephedrone, arguably the most common “bath salt” stimulant, was mentioned at bluelight.ru a lot during 2010, when it came to the U.S. in a major way. But comments have been tailing off pretty steeply ever since. This suggests that mephedrone was sampled and found wanting by those who knew what drug they were taking. Or it could simply be old news by now, and less of a topic for discussion. But if the graph is suggestive of interest levels in the drug-using community, mephedrone seems to have a PR problem.
—Surprisingly, at least to me, a hallucinogen name 2c-e was one of the most talked-about designer drugs of all. 2c-e is a research chemical similar to mescaline but with a spotty track record. Linked to deaths and hospitalizations in Oklahoma and Minnesota, it isn’t known for certain whether the medical problems were due to the pure drug or contaminants. 2c-e is one of the drugs to come out of Alexander Shulgin’s infamous laboratories, and has been around for 20 years. As Tony O’Neill wrote at The Fix: “All in all, it doesn’t sound like the best bet for a recreational Saturday night at the dance club.” As with mephedrone, 2c-e was less talked bout in the last year of the graph.
—Kratom retained a steady popularity over the full 3-year period. Kratom has always been hovering in the background of the opiate family, but seems to have undergone an unprecedented surge in underground popularity of late. From a tree native to Southeast Asia, and often used as a tea, Kratom is powered by an active ingredient called mitragynine—a substance capable of partially activating the mu- and delta-opioid receptors. Kratom serves as a weak opium, and some opiate enthusiasts swear by it for use as a withdrawal aid.
—One of the popular synthetic cannabis products to come out of the Huffman labs at Clemson University, jwh-018 seems to have pretty much cratered as a topic of discussion among drug cognoscenti. Perhaps some of the news about synthetic cannabis and correlations with serious liver problems has taken the shine off that apple. Or simply the fact that, over the few years that synthetic cannabis has been available, users have learned that they prefer the real thing, drug tests notwithstanding.
—Hydrocodone, otherwise known as Vicodin, may have lost some popularity lately due to the popularity of oxycontin and other new synthetic opiate formulations. This is the drug that may have cost Rush Limbaugh his hearing. As a legitimate pain drug, it suffers in comparison with oxycontin, aka Percodan.
—Ketamine is a major topic of discussion, which makes sense. Lately it has rebounded as a party drug, and also scored highly in clinical testing of its efficacy as a short-acting treatment for depression. Unfortunately, use of the drug has been linked to bladder problems lately.
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Seven Questions About Marijuana Legalizationby Dirk Hanson (noreply@blogger.com)
RAND researcher nails it neatly.
I’ve been meaning to offer up the key points from an excellent column on marijuana legalization that appeared in April in USA Today. Beau Kilmer, a senior policy researcher at the RAND Corporation, lists the “new and tricky issues” that Colorado and Washington forgot to consider in depth before passing broad legalization statutes.
Both states are works in progress. What they have passed so far will undoubtedly be revisited. Without further ado, here are Kilmer’s “Seven Ps,” as I call them:
Production. Who gets to grow it, where do they get to grow it, and how much do they get to grow? Will the business model be Starbucks, Jack Daniels, or your local organic family farm? Will it be legal on large commercial operations, indoor growing rooms, backyard gardens? All of this matters economically, since it’s likely that legalization will force down the price of marijuana, as growers will be able to operate in the open, and middlemen won’t have to worry about arrest. Implicit in this category are things like product testing and product safety.
Profit. If the history of cigarette and alcohol regulation have any bearing on the matter (and they do), it’s likely that marijuana marketers will want to concentrate promotional efforts on the heaviest smokers. States might decide to limit production to mom-and-pop home producers—or try to, at least. Or they could throw the door open to marijuana in the free market, and attempt to regulate the for-profit corporations that flock to the new opportunity. Monopolistic practices, collusion, price-fixing, bribes, payoffs to government officials—the whole panoply of corporate malpractice would be available to Big Pot if things go that way.
Promotion. The California medical marijuana movement got itself in hot water straightaway by hiring sign pointers to stand on Los Angeles street corners and advertise the cheapest Ozs in the neighborhood. Not smart. States that legalize will likely need to pursue some form of restriction on advertising for institutions or storefronts selling marijuana. However, as the cigarette industry has shown in its successful effort to block mandatory graphic warnings on packaging, companies are availing themselves of 1st Amendment defenses as a way of demolishing attempts to restrict advertising and promotional activities. Since corporations are now officially people, it looks, so far, like a winning strategy in court.
Prevention. States will obviously enact some age restrictions, which haven’t been terribly effect with cigarettes and alcohol. In addition, the decades-old message to America’s schoolchildren about staying “chemical-free,” starting with the evil weed, will have to be revisited and revised. The pioneering states have expended much time and verbiage on the subject of how much to tax marijuana sales, and a good deal less time on whether any of that tax money will go for prevention efforts, or for addiction treatment. Yes, pot is addictive for some people, and pot smokers who are lucky enough not to have this problem cannot seem to summon much sympathy for those who do. This will have to change, as marijuana addiction and withdrawal enter the public sphere with legalization.
Potency. If you count butane hash oil, or “dabbing,” the potency of modern seedless marijuana ranges from about 15 per cent to as high as 90 per cent THC. Yes, that’s quite a bit higher than the shoebox full of Mexican from the good old days. Arguments rage in the research community over the effect of strong pot, and whether it increases cognitive deficits, general anxiety, panic attacks, and even mental illnesses. Beer, wine and alcohol have mandated strength levels, printed right there on the bottle. Something similar will likely have to be crafted for marijuana.
Price. How elastic is the price of pot? Could heavy taxation push the whole game back underground? What’s a fair market price for a quarter of Train Wreck? “Retail prices will largely be a function of consumer demand, production costs and tax rates,” writes Kilmer. “The way taxes are set will also have an effect on what’s purchased and consumed—that is, whether pot is taxed by value, total weight, THC content, or other chemical properties.”
Permanency. With legalization, we are likely to see a pioneer penalty: “The first jurisdictions to legalize pot will probably suffer growing pains and want to make changes later on,” Kilmer believes. He envisions a powerful lobbying organization putting the arm on legislators on behalf of a newly legal and seriously profitable line of business. It would be best if legislation comes with maximum flexibility to make future changes, so states can adapt their operations as the thing plays out on the ground for the first time.
I personally understand and sympathize with the drive for legalization. I also think that Colorado and Washington have jumped first, and plan to think later, sorting it all out in freefall. That seems like a possible recipe for disasters large and small. Moving a popular drug across the legal/illegal line is a bit like getting molecules through the blood-brain barrier: It can be done, but it had better be done with sufficient care and forethought.
Graphics Credit: http://thebottomline.as.ucsb.edu/
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 YNN, Your News Now |
A family approach to conquering addiction
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