Relationship of depression to smoking outcomes in a methadone-maintained population.

The association of depression and successful smoking cessation efforts is inconsistent. We test the hypothesis that higher levels of depression complicate efforts to quit smoking in a methadone-maintained (MM) population offered nicotine replacement and a brief behavioral intervention. We recruited 383 participants from 2/02 to 5/04; 340 (88.8%) were assessed at follow- up. Current depressive symptoms were measured using the Psychiatric Diagnostic Screening Questionnaire (PDSQ). Participants were 53% male, 78% Caucasian, with a mean MM duration of 153 weeks. Twenty-seven percent met PDSQ screening criteria for Major Depressive Disorder (MDD). Participants with higher levels of depressive symptoms were significantly less likely to set a quit date (p = .02) but depression was not associated significantly with motivation to quit smoking at baseline, time to first cigarette, or any behavioral indicator of smoking during the follow-up period. Depressive symptoms have little influence on smoking cessation outcomes in this population.

A smoking cessation intervention for the methadone-maintained.

AIM: To test, in combination with the nicotine patch, the incremental efficacy of a maximal, tailored behavioral treatment over a minimal treatment for smoking cessation. DESIGN: Randomized clinical trial with 6-month follow-up. SETTING: Five methadone maintenance treatment centers in Rhode Island. PARTICIPANTS: Three hundred and eighty-three methadone-maintained smokers. INTERVENTION: Participants were assigned randomly to nicotine patch (8-12 weeks) plus either (1) a baseline tailored brief motivational intervention, a quit date behavioral skills counseling session and a relapse prevention follow-up session (Max) or (2) brief advice using the National Cancer Institute's 4 As model (Min). An intent-to-treat analysis with those lost to follow-up assumed to smoke was used. MEASUREMENTS: Carbon monoxide (CO)-confirmed 7-day point smoking cessation prevalence at 3 and 6 months, and self-reported numbers of cigarettes smoked per day. FINDINGS: Participants had a mean age of 40 years, were 53% male, 78% Caucasian, smoked 26.7 (+/- 12.2) cigarettes/day and had a mean methadone dose of 95.5 mg. At 3 months, 317 (83%) were re-interviewed; at 6 months, 312 (82%) were re-interviewed. The intent-to-treat, 7-day point prevalence estimate of cessation was 5.2% in the Max group and 4.7% in the Min group (P=0.81) at 6 months. In logistic models with treatment condition, age, gender, race, Fagerström Test for Nicotine Dependence and cigarettes per day as covariates, males were more likely to be abstinent at 3 months (OR 4.67; P=0.003) and 6 months (OR 4.01; P=0.015). CONCLUSION: A tailored behavioral intervention did not increase quit rates over patch and minimal treatment. Smoking cessation rates in methadone-maintained smokers are low, with men having greater success.

Persistence of antidepressant treatment effects in a pharmacotherapy plus psychotherapy trial for active injection drug users.

The objective of this study was to determine if combined psychotherapy and pharmacotherapy reduces reported depressive symptoms compared to an assessment only condition for active drug injectors over nine months. Using a randomized controlled trial at an outpatient academic research office, the researchers applied psychotherapy (eight sessions of cognitive behavioral therapy) plus pharmacotherapy (citalopram) to active injection drug users with a DSM-IV diagnosis of major depression, dysthymia, substance-induced mood disorder with symptoms persisting for at least three months, or major depression plus dysthymia, and a Modified Hamilton Rating Scale for Depression (MHRSD) score greater than 13. The MHRSD scale scores were then assessed at the completion of three, six, and nine months. Participants (n = 109) were 64% male and 82% Caucasian, with a mean baseline MHRSD score of 20.7. Depression subtypes included major depression only (63%), substance-induced depression (17%), and double-depression (17%). Study retention at nine months was 89%. At the completion of three months of acute treatment, 26% of combined treatment patients (n = 53), compared to 12% of control patients (n = 56), were in remission (p = .047). At both six and nine months, the between-group differences in remission rates and mean MHRSD scores were insignificant, although the overall mean MHRSD score decreased from baseline (p < .01). At all follow-up assessments, depression remission was significantly associated with lower heroin use. Among active drug injectors diagnosed with depression, symptoms decline over time. Combined treatment is superior to an assessment-only condition in depression remission rates at the end-of-treatment, but this difference does not persist.

Anion effects on gas solubility in ionic liquids.

This work presents the results of solubility measurements for a series of gases in 1-n-butyl-3-methyl imidazolium tetrafluoroborate and 1-n-butyl-3-methyl imidazolium bis(trifluoromethylsulfonyl) imide. The gases considered include benzene, carbon dioxide, nitrous oxide, ethylene, ethane, oxygen, and carbon monoxide. Carbon dioxide and oxygen solubilities are also reported in methyl-tributylammonium bis(trifluoromethylsulfonyl) imide, butyl-methyl pyrrolidinium bis(trifluoromethylsulfonyl) imide, and tri-isobutyl-methyl phosphonium p-toluenesulfonate. We report the associated Henry's constants and enthalpies and entropies of absorption. In general, benzene, followed by carbon dioxide and nitrous oxide, have the highest solubilities and strongest interactions with the ionic liquids, followed by ethylene and ethane. Oxygen had very low solubilities and weak interactions. Carbon monoxide had a solubility below the detection limit of our apparatus. Ionic liquids with the bis(trifluoromethylsulfonyl) imide anion had the largest affinity for CO(2), regardless of whether the cation was imidazolium, pyrrolidinium, or tetraalkylammonium. These results suggest that the nature of the anion has the most significant influence on the gas solubilities.

Correlates of motivation to quit smoking in methadone-maintained smokers enrolled in a smoking cessation trial.

Cigarette smoking is a clear problem among methadone-maintained persons, yet little is known about factors that may be associated with their motivation to quit smoking. A sample of 255 smokers, enrolled in a smoking cessation research protocol, completed measures of their smoking motivation, smoking habit, quitting history, and intent to quit in the future. Both zero-order correlational and multivariate linear regression analyses indicated that only number of cigarettes smoked per day and expectancies for success with smoking cessation were associated significantly with motivation to quit smoking. These results have implications for understanding motivational processes among methadone-maintained smokers and may help in the design of interventions that will assist this population with quitting smoking.

Why Is CO2 so soluble in imidazolium-based ionic liquids?

Experimental and molecular modeling studies are conducted to investigate the underlying mechanisms for the high solubility of CO2 in imidazolium-based ionic liquids. CO2 absorption isotherms at 10, 25, and 50 degrees C are reported for six different ionic liquids formed by pairing three different anions with two cations that differ only in the nature of the "acidic" site at the 2-position on the imidazolium ring. Molecular dynamics simulations of these two cations paired with hexafluorophosphate in the pure state and mixed with CO2 are also described. Both the experimental and the simulation results indicate that the anion has the greatest impact on the solubility of CO2. Experimentally, it is found that the bis(trifluoromethylsulfonyl)imide anion has the greatest affinity for CO2, while there is little difference in CO2 solubility between ionic liquids having the tetrafluoroborate or hexafluorophosphate anion. The simulations show strong organization of CO2 about hexafluorophosphate anions, but only small differences in CO2 structure about the different cations. This is consistent with the experimental finding that, for a given anion, there are only small differences in CO2 solubility for the two cations. Computed and measured densities, partial molar volumes, and thermal expansion coefficients are also reported.

Adherence to treatment of depression in active injection drug users: the minerva study.

The impact of depression on drug users is extensive, serving as a trigger for high-risk injection practices and continued drug use. Yet the ability to retain active drug users in mental health treatment has never been tested clinically. We recruited injection drug users (IDU) for a randomized study of combined psychotherapy and pharmacotherapy for the treatment of depression. Among the 53 SCID-diagnosed depressed subjects assigned to the combined treatment group, 43.4% were "fully adherent" to treatment (75% or greater attendance at cognitive-behavioral therapy (CBT) sessions or 75% or greater adherence to the pharmacotherapy regimen). The correlation of CBT attendance and pharmacotherapy use was high (r(s) =.74). Persons with double depression (major depression plus dysthymia) were most likely to be fully adherent (p =.01); frequency of heroin use was inversely associated with adherence. Developing public health treatment interventions to engage out-of-treatment, dually-diagnosed IDUs is possible.

Pharmacotherapy plus psychotherapy for treatment of depression in active injection drug users.

CONTEXT: Depressive disorders are common among opiate abusers and are associated with detrimental behavioral effects. However, there is little precedent for offering active drug users complex treatments for depression. OBJECTIVE: To determine whether combined psychotherapy and pharmacotherapy treatment reduces reported depressive symptoms compared with an assessment-only condition among out-of-treatment drug injectors. DESIGN: Randomized controlled trial. SETTING: Research office located at an academic medical center. PATIENTS: Active injection drug users with a DSM-IV diagnosis of major depression, dysthymia, substance-induced mood disorder with symptoms persisting for at least 3 months, or major depression plus dysthymia, and a Modified Hamilton Rating Scale for Depression (HAM-D) score greater than 13. INTERVENTION: Combined psychotherapy (8 sessions of cognitive behavior therapy) plus pharmacotherapy (citalopram). MAIN OUTCOME MEASURES: Modified HAM-D scale scores at the end of 3 months of combined treatment. RESULTS: The 109 study subjects were 64% male and had a mean age of 36.7 years and a mean baseline HAM-D score of 20.7. Depression subtypes included major depression only (63%), substance-induced depression (17%), and major depression plus dysthymia (17%). In the intent-to-treat analysis, participants in treatment averaged 2.11 HAM-D points greater improvement than control subjects (P=.08), and 26.1% of combined treatment patients (n=53) compared with 12.5% of control patients (n=56) were in remission (P=.047). Nearly 40% of fully adherent subjects (receiving >75% of either psychotherapy or pharmacotherapy) were in remission at follow-up (odds ratio, 3.6; P=.04). CONCLUSIONS: Combined treatment for depression is significantly superior to a control condition (assessment only) in proportion of patients in remission, but not in HAM-D improvement among drug injectors. Full adherence to treatment is associated with the largest treatment effects. Our findings demonstrate that active drug users with dual diagnoses are able to participate in conventional treatment.