Client demographics and outcome in outpatient cocaine treatment.

A number of studies have begun to investigate the characteristics of cocaine abusers who are admitted to outpatient cocaine treatment programs. One study has published success rates for such treatment. A review of this literature indicates that much of what is known is based on clinical experience with what may be nonrepresentative samples of upper-middle socioeconomic status Caucasians. More systematic study and more representative samples are needed; the current study attempts to address these issues by sampling 81 clients admitted to a comprehensive outpatient cocaine program in a public agency, assessing demographics and treatment success. The results indicate that this sample is indeed different from those in most recent studies in race, marital status, income, employment, and other demographic variables. For example, the sample in this study included higher percentages of clients who were non-Caucasians, single, blue-collar or unemployed, and had relatively lower annual incomes. Fewer demographic variables than expected correlated with treatment success. Among factors that did correlate with such measures of treatment outcome as continuing in treatment (vs dropping out), percent of sessions attended, and alcohol- and drug-free were educational level, length of abstinence from cocaine prior to beginning treatment, number of previous treatments, secondary substance currently used, and quality of current living situation. Retention in treatment is similar to other published data but indicates that cocaine abusers are indeed difficult to engage and keep in treatment long enough to make a significant impact on their drug use.

Naltrexone: lack of effect on hepatic enzymes.

A number of studies have established the clinical efficacy of naltrexone in the treatment of opiate addiction. However, questions have been raised regarding its hepatotoxic potential and warnings have been given prominence in the package insert regarding its use for those with even less severe liver disease. The current study monitored 53 male patients receiving naltrexone 350 mg weekly for 12 weeks. The lactic acid dehydrogenase (LDH) and serum glutamic oxalacetic transaminase (SGOT) levels were determined at pretreatment and at monthly intervals thereafter for three months. LDH and SGOT were found to drop significantly from baseline over this three-month period. This decrease appeared most notable for those with pretreatment hepatic enzyme levels exceeding the normal range. Moreover, changes in hepatic enzyme levels were not consistently correlated with the patients use of illicit drugs such as opioids, benzodiazepines, cocaine, barbiturates, and amphetamines. Based on these data, we have concluded that contrary to cautions implied in the naltrexone package insert, the benefit of admitting patients with the sole problem of elevated hepatic enzymes generally exceeds the risk.

Retention and outcome in a narcotic antagonist treatment program.

Investigations of outpatient narcotic antagonist programs have found high attribution rates when compared to such modalities as methadone. Moreover, outcome studies generally are lacking. The present study followed 50 patients through their course of treatment at an outpatient clinic of the Nassau County Department of Drug and Alcohol Addiction. Retention was found to average 69.22 days. This was slightly higher than the average found by other investigators. Patients in the present study who remained longer were similar demographically to those who dropped out early, but were found to enter treatment with more stable employment records and less recent opiate use. They also appeared more successful at termination, with better vocational stability, less extraneous drug use, and greater acceptance of referrals to other treatment. Identification of the needs of individuals at greater risk for premature termination can serve as a basis for refining treatment efforts.

Naltrexone treatment in a jail work-release program.

Inmates with a history of opiate addiction have traditionally been excluded from jail work-release programs because of their high likelihood of returning to drug use. In 1972, a new jail work-release program was begun in the Nassau County (New York) Jail, to which addicted inmates, who had formerly been excluded automatically, could request admission if they took the opiate blocking agent naltrexone. Inmates received naltrexone twice a week and had routine urine checks for drugs of abuse and an alcohol breath test when indicated. Psychological and vocational testing and weekly psychotherapy sessions were provided. For those no longer incarcerated, the adjacent hospital outpatient clinic was available for naltrexone treatment. Naltrexone has proved to be a completely effective opiate blocking agent with no major side effects in 691 patients over a 10-year period.

Controlled clinical study of naltrexone side effects comparing first-day doses and maintenance regimens.

In a controlled double-blind clinical study, 42 patients reported side effects and severity of side effects to naltrexone on three different first-day doses and maintenance dosage regimens. Initiating doses of 25, 100, and 150 mg were administered. The maintenance regimens involved 350 mg of naltrexone per week for 4 weeks with drug administration in Group A, five times weekly; in Group B, three times weekly; and in Group C, twice weekly. All three groups received identical doses for the last dosage administered each week. The first-day doses produced no significant quantitative difference in side effects. Overall, the three groups reported little difference in side effects. Nonetheless, the regimen with the least number of patients reporting side effects daily was that of Group B. In no case, regardless of dose or dosage regimen, did any patient have side effects of such a nature as to require termination of their participation in the study.

Naltrexone and cyclazocine. A controlled treatment study.

The induction side effects of cyclazocine and naltrexone were compared in double-blind placebo-controlled studies involving 40 patients (20 for each drug). These studies were carried out with a twice-a-day dosage regimen. Naltrexone produced fewer side effects than cyclazocine. Naltrexone side effects fell to levels indistinguishable from those of placebo in the "induction after placebo" phase. In contrast, cyclazocine "induction after placebo" produced an even higher level of side effects than found in its induction. In no case was naltrexone discontinued because of side effects. On the other hand, three of 20 cyclazocine-treated patients discontinued the drug because of distressing side effects. No toxicity was noted with either agent. The controlled data reported supports the clinical impression that naltrexone produces fewer induction side effects than cyclazocine.

Personality factors and drug effects in a controlled study of cyclazocine.

This paper investigated the relationship between measurable personality factors and level of effects shown to cyclazocine and placebo in a controlled study. An attempt also was made through case analysis to examine the association between dynamic aspects of personality and adverse drug effect. Hysteria scores on the MMPI were found to be related significantly to self-reported effects under both the drug and placebo conditions. Clinical observations were examined retrospectively for three cases with adverse reactions and cited to support a dynamic theory that associated drug reactivity to personality factors.