Drug misuse and diversion in adults prescribed anxiolytics and sedatives.

STUDY OBJECTIVE: To identify patterns of misuse and diversion of anxiolytic and sedative drugs among a sample of adults prescribed these drugs. DESIGN: Cross-sectional study. SETTING: University research center in Canada. PARTICIPANTS: Sixty-seven adults (aged 19-61 yrs) who had current prescriptions for anxiolytic or sedative drugs. INTERVENTION: Face-to-face interviews and questionnaires were used to gather information on demographics as well as variables relating to drug misuse and diversion such as personality dimensions, psychiatric symptoms, and other substance use. MEASUREMENTS AND MAIN RESULTS: Of the 67 participants, 36 (54%) reported misusing their drugs on at least one occasion, and 35 (52%) reported diverting their drugs at least once. A variety of forms of anxiolytic or sedative misuse were reported, including exceeding the recommended dosage (28 participants [42%]), deliberately using the drug with alcohol or another drug (27 [40%]), or taking it by an alternate route of administration (5 [7%]). Misuse and diversion were associated with a history of substance use and substance-related problems, as well as personality characteristics relating to impulsivity and hopelessness. Diversion was also associated with an increased likelihood of having taken any psychoactive prescription drug without having a valid prescription for it. CONCLUSION: A variety of forms of drug misuse and diversion occurred among this population of adults who were prescribed anxiolytics or sedatives. Likelihood of engaging in misuse or diversion was associated with other substance use, substance use disorders, and personality characteristics. Despite the modest sample size and cross-sectional design, this study identified substantial heterogeneity in prescription anxiolytic and sedative misuse, suggesting that the use of clearly defined operational criteria will be essential in future efforts to further characterize this phenomenon.

Visual P3 amplitude and self-reported psychopathic personality traits: frontal reduction is associated with self-centered impulsivity.

Past studies have examined P3 amplitude as an index of cognitive function related to psychopathy with mixed results. Psychopathy is a heterogeneous set of dissociable traits, and no previous study has examined relationships between P3 and specific traits. A Two Process Theory (TPT) of psychopathy has recently been advanced predicting that P3 reductions are related to only one dimension. We evaluated the relationship between P3 and the two factors of the Psychopathic Personality Inventory (PPI) in 96 undergraduates who performed a visual task. One factor of the PPI, Self-Centered Impulsivity, is related to the dimension of the TPT predicted to underlie P3 reduction. Frontal amplitude reduction was uniquely and inversely related to this trait. The other PPI factor, Fearless Dominance, was associated with faster reaction times. Future work on psychopathic personality and P3 should evaluate whether relationships are unique to one personality dimension.

P300 amplitude, externalizing psychopathology, and earlier- versus later-onset substance-use disorder.

P300 amplitude predicts substance use or disorder by age 21. Earlier- versus later-onset substance disorders may reflect different levels of an externalizing psychopathology dimension. P300 in adolescence may not be as strongly related to later-onset substance problems as it is to earlier-onset ones. In the present study, visual P300 amplitude was measured at age 17 in a community-representative sample of young men. Substance and externalizing disorders were assessed at approximately ages 17, 20, and 24. Earlier-onset (by age 20) substance disorder was associated with higher rates of externalizing disorders than were later-onset problems. P300 amplitude was reduced in subjects with earlier-onset substance disorders, relative to later-onset and disorder-free subjects. Amplitude was also reduced in subjects with an externalizing disorder but no substance disorder. Earlier-onset subjects had reduced P300, even in the absence of an externalizing disorder. The results could not be attributed to a concurrent disorder or to recent substance use at the time of the P300 recording. The findings are consistent with P300 indexing an externalizing spectrum. Earlier-onset substance disorders are more strongly related to P300 and externalizing than are later-onset problems.