Naltrexone for alcohol-dependent patients.

BACKGROUND: Clinical trials have shown that naltrexone 50 mg/day reduces alcohol consumption and relapse rates in alcohol dependents. AIM: To investigate the efficacy of 50mg/day dose of naltrexone in the maintenance of alcohol-dependent subjects over a 36-week treatment period. METHODS: Subjects were randomised into two equal groups, consisting of 116 male alcohol-dependent patients who met the DSM-IV criteria for alcohol dependence and were seeking treatment. The participants received naltrexone or placebo at a dose of 50 mg/day and were treated in an outpatient clinic, offering a weekly 0.5-hour individual counselling session. Days retained in treatment were measured. RESULTS: Forty-one participants (35.3%) completed the 36-week study. Completion rates by group were 44.8% for the 50 mg naltrexone group and 25.9% for the placebo group (chi2=4.56, DF=1, 2-sided significance=0.033). CONCLUSION: The results support the efficacy and safety of naltrexone for outpatient treatment of alcohol-dependent individuals in Iran.

Cocaine withdrawal symptoms and initial urine toxicology results predict treatment attrition in outpatient cocaine dependence treatment.

This study evaluated the ability of cocaine withdrawal symptoms, measured by the Cocaine Selective Severity Assessment (CSSA) and initial urine toxicology results, to predict treatment attrition among 128 cocaine dependent veterans participating in a 4-week day hospital treatment program. The CSSA was administered and a urine toxicology screen was obtained at intake and at the start of the day hospital (about 1 week later). The combination of a positive urine toxicology screen and a high CSSA score at intake predicted failure to complete treatment. Urine toxicology results at the start of the day hospital, but not at intake, predicted failure to complete treatment. Among participants without other psychiatric illness, high CSSA scores at intake predicted failure to complete treatment. The presence of cocaine withdrawal symptoms and a positive urine toxicology screen are clinically useful predictors of treatment attrition.

A randomized, double-blind, placebo-controlled study of ritanserin pharmacotherapy for cocaine dependence.

Eighty cocaine-dependent individuals enrolled in outpatient treatment took part in a randomized, double-blind, placebo-controlled trial of ritanserin, a 5-HT(2) antagonist, as an adjunct therapy. Participants attended an outpatient day hospital therapy program each day and received tablets containing placebo or 10 mg ritanserin for a 4-week period. Primary outcome measures included retention in treatment, urine drug tests, and self-reports of craving. Secondary outcome measures were depression scores on the Beck and Hamilton inventories, negative mood as measured by the Profile of Mood States, and life functioning as measured by the Addiction Severity Index. Although participants showed improvement over the 4 weeks, there were no group differences on any of the measures. These results fail to support the use of ritanserin as a complement to outpatient psychosocial therapy for cocaine dependence.

A cocaine-positive baseline urine predicts outpatient treatment attrition and failure to attain initial abstinence.

The primary study objective was to ascertain whether a prior finding that the baseline cocaine urine toxicology predicted treatment dropout for cocaine dependent outpatients could be extended to three additional cocaine dependent outpatient treatment samples and whether the urine toxicology also predicted attainment of initial abstinence for the four samples. A secondary objective was to ascertain the extent to which other baseline variables accounted for additional outcome variance over and above that afforded by urine toxicology. To evaluate the first objective, the relationships between the baseline cocaine urine and each of two measures of within treatment response--the completion of treatment or the attainment of initial abstinence--were determined for each of the treatment samples. The second objective was evaluated by a stepwise, hierarchical logistic regression analysis, with the urine toxicology entered in the first step, baseline Addiction Severity Index (ASI) variables in the second step, and achievement of initial abstinence as the outcome. In all four samples, patients with a urine indicative of recent cocaine use were less than half as likely to complete treatment or achieve initial abstinence. Individual ASI baseline variables did not contribute statistically significant variance over and above that predicted by the cocaine urine toxicology. The findings confirm the utility of the initial cocaine urine as a predictor of unfavorable outpatient treatment response.

Absence of parkinsonism among patients in long-term neuroleptic therapy who abuse cocaine.

The study used the United Parkinson's Disease Scale to compare parkinsonian signs and symptoms among 19 patients in long-term neuroleptic therapy who had a history of cocaine abuse with those among 24 similar patients with no history of cocaine use. There was no significant difference between the two groups' scores. The results suggest that chronic cocaine abuse is not a risk factor for parkinsonism among subjects in long-term neuroleptic therapy.

Carbamazepine treatment for cocaine dependence.

We report on a double-blind, placebo-controlled study of carbamazepine (CBZ) treatment for cocaine dependence. A previously reported uncontrolled study found CBZ to be a beneficial pharmacotherapy for cocaine dependence. Statistical analyses were performed on data from 82 subjects who were randomized to 10 weeks' treatment with either CBZ, titrated to 4-12 micrograms/ml, (n = 37) or placebo (n = 45). The two treatment groups did not differ for primary outcome measures of retention time in treatment, urine samples positive for cocaine metabolite, subject reported desire for cocaine or for subject reported side-effects. CBZ was not an effective treatment in this study.

Reducing waiting time for substance abuse treatment does not reduce attrition.

Attrition rates from substance abuse treatment are high. In an attempt to cut down on the attrition rate in our clinic we instituted an "Orientation Group" to cut down on the time patients spent waiting to enter treatment. An evaluation of the results of this intervention reveals that contrary to the impressions of the clinical staff, the attrition rate was not reduced.

The relationship of cocaine to headache in polysubstance abusers.

In a questionnaire survey of inpatient polysubstance abusers it was found that cocaine relieved migraine-type headaches much more often in chronic headache sufferers than in those with only occasional headaches (p less than .05). However, cocaine could also bring on headaches after several hours, both in chronic headache sufferers and in those not subject to headaches. The facts that cocaine may relieve headache immediately, and also may precipitate headaches several hours after use, suggests that the well-known vasoconstrictive actions of cocaine may be responsible. Migraineurs seem more susceptible to some of these effects of cocaine than are people without chronic headaches.

Effect of cocaine on thyroid functions.

Results of routine thyroid function tests in heavy cocaine abusers at the time of treatment admission were not statistically different from normal values for our laboratory or from a similar group of other substance abuse patients in treatment. This suggests that heavy cocaine use per se does not affect thyroid function. Therefore, if the thyroid function tests are abnormal in a cocaine abuser, then a true thyroid dysfunction should be considered and completely evaluated. In addition, nonspecific alterations in thyroid function tests in nonthyroidal illnesses should be kept in mind.

Prolonged presence of metabolite in urine after compulsive cocaine use.

The authors studied the pattern of benzoylecgonine excretion in 35 male veterans who had recently used large amounts of cocaine. Following admission to a drug-free environment, the veterans completed a short structured interview and gave daily urine samples for benzoylecgonine analysis. Eleven (31.4%) patients excreted benzoylecgonine at levels of 300 ng/mL or above for 120 hours or longer after admission. Eight (22.9%) patients whose enzyme-multiplied immunoassay test results were negative subsequently tested positive. These findings corroborate recent case reports of prolonged presence of benzoylecgonine in the urine and have important implications for drug treatment programs.

Detoxification with phenobarbital of alprazolam-dependent polysubstance abusers.

Alprazolam appears to have an abuse liability among opiate addicts, and detoxification can be prolonged. The authors describe experience with five methadone maintenance patients who were polysubstance abusers and were admitted specifically for detoxification from alprazolam dependence. Phenobarbital in tapering doses adequately suppressed withdrawal symptoms and shortened hospitalization.