Hair analysis versus conventional methods of drug testing in substance abusers seeking organ transplantation.

As substance abusers need to demonstrate abstinence prior to transplant, valid/reliable drug tests are needed. Patients may deny use, fearing surgery will be delayed. Breath, blood and urine tests have brief detection windows that allow patients to evade detection. Routine laboratory tests do not include all substances of abuse. Hair analysis overcomes these barriers, increasing the likelihood that active users will be identified. This study compared results for alcohol, opioids and cocaine based on 445 self-report, breath, urine and hair samples from 42 patients who had been denied a transplant due to recent substance abuse. Compared to hair toxicology, sensitivity for conventional drug tests was moderate for cocaine and opioids, but poor for alcohol. Of positive hair tests, only half were corroborated through other tests. In contrast, specificity was high across tests and substances, with positive findings from conventional tests confirmed through hair toxicology. Based on a 90-day detection window for hair analysis, two negative tests suggest 6 months of continuous abstinence. Hair testing should be considered as an alternative approach for monitoring substance use in the transplant population, either as a routine procedure or when the veracity of findings from conventional tests is in doubt.

Psychosocial assessment of living organ donors: clinical and ethical considerations.

This article outlines psychosocial and ethical issues to be considered when evaluating potential living organ donors. Six types of living donors are described: genetically related, emotionally related, "Good Samaritan" (both directed and nondirected), vendors, and organ exchangers. The primary domains to be assessed in the psychosocial evaluation are informed consent, motivation for donating and the decision-making process, adequacy of support (financial and social), behavioral and psychological health, and the donor-recipient relationship. Obstacles to the evaluation process include impression management, overt deception, minimization of behavioral risk factors, and cultural and language differences between the donor and the evaluator. Ethical concerns, such as the right to donate, donor autonomy, freedom from coercion, nonmaleficence and beneficence in donor selection, conflicts of interest, "reasonable" risks to donors, and recipient decision making are also explored. To fully evaluate living organ donation, studying psychosocial as well as medical outcomes is crucial.

Perinatal substance abusers: factors influencing treatment retention.

This study investigated the association between two demographic and two psychological variables and treatment retention for 65 perinatal substance abusers. Subjects who lived in the community while attending day treatment were 6.125 times more likely to drp out than subjects who lived in a program-operated shelter (p < .0001). An interaction was found for pregnancy status and antisocial personality disorder (p < .0478). Subjects who were both pregnant and antisocial were 4.876 times more likely to remain in treatment than those who were neither pregnant nor antisocial. Degree of "treatment resistance," measured by the MMPI Negative Treatment Indicators (TRT) Scale, did not predict dropout. These findings indicate that supportive housing can play an important role in preventing dropout for perinatal substance abusers. Additionally, pregnancy may present a "window" of opportunity for treating a hard to reach population, drug abusing women with comorbid ASP.

Relapse prevention treatment for liver transplant patients.

This paper explores the utility of relapse prevention therapy (RPT) for transplant candidates with substance use disorders. Similarities and differences between this population and the general substance abuse patient population are discussed and suggestions are made for modifying the RPT treatment protocol. Major issues include the source and intensity of motivation for treatment, the nature of the therapeutic relationship, the type and severity of psychosocial consequences that may have been experienced as a result of substance use, and the patient's perception of the problem (addiction versus liver disease). Recommendations are made to provide empathy and support around medical concerns, motivate them for sobriety, and work to build collaborative relationships between team members and patients. Patients need to see the RP therapists as working to help them maintain sobriety and obtain a transplant, not as policing their drug use.

Predictors of in-treatment relapse in perinatal substance abusers and impact on treatment retention: a prospective study.

This prospective study investigated in-treatment relapse in a sample of perinatal substance abusers in intensive outpatient treatment. Sixty-four female first-time admissions to a perinatal treatment program completed comprehensive psychological and psychosocial assessment before beginning treatment. Relapse was detected by urine toxicology screening and self-report. A regression analysis resulted in variable reduction, then survival analysis identified the impact of in-treatment relapse and other predictors on treatment length. Fifty-five percent of the subjects were classified as relapsers. Two risk factors for and six protective factors from in-treatment relapse were identified. The survival curves for relapsers and nonrelapsers did not differ until covariates were considered. Subjects with more severe consequences of drug use and less social exposure to drug use during treatment tended not to relapse during treatment, perhaps in order to prevent deterioration such as loss of children or incarceration. Relapse alone did not result in fewer treatment days. Few addiction characteristics were related to either in-treatment relapse or length of treatment. Rather, personality and demographic variables were more salient in both the regression and survival models. Treatment staff may need to reconsider their views of the meaning of relapse and should develop enhanced engagement and retention strategies for women at greater risk of relapse.

Perinatal substance abusers. Psychological and social characteristics.

Forty perinatal substance abusers were administered multiple psychosocial, addiction, and psychological measures before beginning treatment. Results indicate that these patients are limited intellectually, educationally, financially, and emotionally. Psychiatric comorbidity was high, with 45% having non-substance abuse axis I diagnoses and 75% having confirmed (by two or more tests) axis II pathology. The most frequently identified axis I disorders were depression and anxiety. The most frequently detected personality disorders were antisocial, borderline, paranoid, and dependent. The average IQ was 87 (low average range) and nearly one third of the sample were found to be somewhat impaired intellectually. These data suggest that treatment programs must take psychological characteristics into account if they are going to succeed in helping these women achieve and maintain abstinence.

Repair of injured skeletal muscle: a molecular approach.

We review cellular and molecular processes involved in injury and repair of skeletal muscle with regard to the amount and location of damage produced. Discussion is based on advances made by use of newer techniques, including immunochemistry, in situ hybridization, molecular biology, ultrastructural analysis, and cell culture. Damage and repair processes after eccentric work, stretch, overload, chronic stimulation, cold injury, and other models are discussed for cellular and molecular components. Hypertrophy or hyperplasia can occur under certain conditions. After injury, satellite cells are activated by growth factors. These cells can also be activated during fiber-type transformation, probably to provide necessary DNA content rather than to supply cells of a new lineage. Emphasis is given to myosin mRNA studied by in situ hybridization to localize subcellular distribution. Increases in mRNA concentration are found near nuclei in damaged regions and at the subcellular sites being repaired in the middle of skeletal muscle fibers or near the myotendon junction. The activation of genes for muscle regulatory factors during development is compared with their activation in regeneration and response to injury.

Now I lay me down for keeps: a study of adolescent suicide attempts.

From a nationwide study of 830 white, emotionally disturbed adolescents, ages 12 to 18, three samples were selected for study. One consisted of all boys (N = 31) and girls (N = 67) referred for treatment after suicide attempts. The second included those boys (N = 7) and girls (N = 22) referred for suicidal thoughts and threats, as well as suicide attempts. The third was comprised of those boys (N = 13) and girls (N = 12) referred for suicidal thoughts and threats, but who had made no known suicide attempts. Both self- and psychotherapist ratings on 1,250 variables were examined by comparing the endorsement rates for boys and girls in each criterion group separately with those of the remaining sample of distrubed adolescents who had not been referred for suicidal behavior. Our results confirm some past findings and introduce a large number of new correlates of adolescent suicidal behavior. They indicate that there is little difference between teenagers who attempt suicide and those who think about it or threaten it. The findings also highlight the necessity of studying the sexes separately.