Quantitative EEG findings associated with chronic stimulant and cannabis abuse and ADHD in an adult male substance use disorder population.

QEEG was studied in a population of chronic male PSUD/ADHD (psychoactive substance use disorder/attention deficit hyperactivity disorder) subjects vs. a matched sample of non-ADHD subjects with PSUD. Our first interest in conducting this study was to determine if the Thatcher University of Maryland database and complex demodulation method could replicate the specific QEEG findings reported for cocaine and cannabis using the John-NYU database and Fourier Transform method. The effects of cannabis and stimulants were also studied both separately and together to see if there were interactions and to see if the QEEG changes associated with chronic stimulant dependence were predicted by childhood ADHD status. Eyes-closed QEEGs were obtained and two independent artifacted 60 second samples were compared for reliability. The Thatcher database was used to analyze QEEG data from 56 subjects with mixed substance use disorder. Results showed that the Thatcher database replicates the John database for chronic stimulant dependence findings. Because of confounding variables of alcohol and polysubstance abuse, the findings related to cannabis and stimulant interaction were difficult to assess. Cannabis and stimulant dependence together produced more QEEG changes than either alone. More right temporal abnormalities were observed with stimulant dependence. In the absence of stimulant use, the QEEG effects of cannabis were relatively small; however, sample selection and methods used precluded comparison to previous studies. The persistent QEEG abnormalities associated with chronic stimulant dependence were independent of ADHD status in this sample using the methods of this study. Further research is needed to clarify the relationship of stimulant dependence with QEEG changes and ADHD status, and to clarify the interactions of chronic stimulant and cannabis abuse on QEEG.

Findings of mild traumatic brain injury in combat veterans with PTSD and a history of blast concussion.

Veterans with chronic posttraumatic stress disorder were evaluated for a history of blast concussion, controlling for confounding conditions. Electroencephalograms were analyzed by discriminant function for traumatic brain injury. A difference was found in discriminant scores between veterans with and without blast concussion. More members of the blast group had attentional symptoms and attentional dysfunction. Combat veterans with a remote history of blast injury have persistent electroencephalographic features of traumatic brain injury as well as attentional problems. The authors hypothesize that these constitute a type of chronic postconcussive syndrome that has cognitive and mood symptoms overlapping those of posttraumatic stress disorder.

Efficacy of smoking cessation strategies in a treatment program.

Efficacy of a total smoking ban on an inpatient drug and alcohol rehab program was assessed by urine cotinine levels and indicated a continued smoking rate of 70%. In spite of these results, however, some staff were concerned that removal of the smoking ban would lead to a dramatic increase in patients' smoking. However, other staff were concerned over the apparent dishonesty undermining the objectives of the program. Therefore, a change in policy was initiated. Under this new approach, where smoking was no longer punished, cotinine levels were 60% positive. Although this was not a statistically significant reduction, it was clinically significant. Patients were openly encouraged to discuss their smoking, and therapies were designed to match patients' level of motivation. A significant reduction in number of cigarettes smoked (mean = 26 pretreatment, mean = 17 posttreatment; p < 0.01), increased interest to stop smoking (on a linear scale from 1 to 5, mean = 1.86 pretreatment and mean = 2.61 posttreatment; p < 0.01), and increased patient satisfaction was noted in a subsequent sample. Nonprohibitive counseling approaches were just as effective as prohibition of smoking. Change in smoking behavior and motivation were demonstrable with programming that emphasized behavior change and motivational counseling. Relationships between nicotine dependence, depression and other substance use disorders are discussed.

Clonazepam prescribing patterns and abuse by methadone patients in a medical center setting.

Methadone patients who require inhospital detoxification from self-administered clonazepam (CZM) were interviewed. Patients enrolled in drug dependency (DDTP), combined addiction psychiatry (CAPP) and methadone maintenance (MM) were surveyed. Twenty out of 20 DDTP and 15 out of 30 CAPP patients responded indicating no knowledge of CZM as a drug of abuse. MM patients were reluctant to respond, but the 18 out of 72 who did, indicated knowledge of CZM abuse. Ten identified CZM as a "downer," 11 indicated its use to "get high," 10 knew other people who abused, and 6 believed abuse to be common. Six identified a street value as $1-5 per mg and 5 identified the amount to get high as 2 mg or more. A 90 day monitoring of prescription writing by all physicians at the same institution used a threshold of benzodiazepine potency equivalent to 40 mg diazepam daily with unmonitored refills. Using this arbitrary descriptor of potentially hazardous prescribing, CZM was the most commonly "excessively" prescribed benzodiazepine. (Fifty cases out of 194 prescriptions as compared to 14 cases of all other benzodiazepines combined.) Psychiatrists wrote 68%, neurologists 15% and internists 14%. As a result of this information, physicians are cautioned and prescription monitoring mechanisms are recommended.