Drugs as instruments: a new framework for non-addictive psychoactive drug use

Most people who are regular consumers of psychoactive drugs are not drug addicts, nor will they ever become addicts. In neurobiological theories, non-addictive drug consumption is acknowledged only as a "necessary" prerequisite for addiction, but not as a stable and widespread behavior in its own right. This target article proposes a new neurobiological framework theory for non-addictive psychoactive drug consumption, introducing the concept of "drug instrumentalization." Psychoactive drugs are consumed for their effects on mental states. Humans are able to learn that mental states can be changed on purpose by drugs, in order to facilitate other, non-drug-related behaviors. We discuss specific "instrumentalization goals" and outline neurobiological mechanisms of how major classes of psychoactive drugs change mental states and serve non-drug-related behaviors. We argue that drug instrumentalization behavior may provide a functional adaptation to modern environments based on a historical selection for learning mechanisms that allow the dynamic modification of consummatory behavior. It is assumed that in order to effectively instrumentalize psychoactive drugs, the establishment of and retrieval from a drug memory is required. Here, we propose a new classification of different drug memory subtypes and discuss how they interact during drug instrumentalization learning and retrieval. Understanding the everyday utility and the learning mechanisms of non-addictive psychotropic drug use may help to prevent abuse and the transition to drug addiction in the future.     

Self-image bias in drug use attributions

The aim was to examine the degree to which people's personal drug use affects how they perceive other drug users, with a view to investigating the possibility that drug use attributions are a function of self-image bias. University students (n = 60), categorized post hoc as drug users or nonusers, completed questionnaires assessing locus, control, and stability attributions about their own personal drug use or imagined drug use. Attributions pertaining to presented vignettes of light and heavy drug use by others were also assessed. Heavy drug use elicited the most "addicted" attributions (dispositional locus, low control, and high stability) and drug-using participants made more addicted attributions about their own personal drug use than did nonusing participants about their imagined use. Additionally, attributions made by non-drug users regarding their imagined personal drug use were similar to those they made for the light drug use described in presented vignettes. Conversely, drug users made attributions which were similar for their personal drug use and for the heavy drug-use vignette. These data lend support to conceptualizing addiction as a product of the functional attribution process-"addict" attributions being applied mainly where drug use is more problematic (heavy) and thus in need of explanation. The data also lend support to the notion that a self-image bias is operating in drug use attributions when people can identify with the behavior of others.     

Family-Based Therapy for Adolescent Drug Abuse: Knowns and Unknowns

Family-based therapy is one of the most thoroughly studied treatments for adolescent drug abuse. Considerable empirical support exists for the efficacy of family-based therapy in curtailing adolescent drug use and cooccurring behavior problems. This article extends knowledge of the effects of family-based therapy for adolescent drug abuse by reviewing 16 controlled trials and 4 therapy process studies from a treatment development perspective. We articulate knowns and unknowns regarding the outcomes of treatment as well as the components, processes, mechanisms, moderators, and boundaries of effective family-based therapy for adolescent drug abuse. The review highlights areas of progress and future research needs within the specialty of family-based therapy for adolescent drug abuse.     

Drug use and its relation to high school students' activities

In a high school in a suburb of Detroit, students' attitudes toward, use of, and money spent on drugs, as well as possible alternative activities, were investigated. The sample included 42 enrolled in alternative education designed for students at risk for drug abuse, pregnancy, etc., who might attend college if guided carefully, and 65 regular students who were a mix of college and noncollege bound. The two groups did not differ in actual drug use, most likely because those who recommended students to the alternative education program used low grade point average and not drug use as criterion. Very few "hard" drugs were used. Most frequently used were readily available drugs such as alcohol. Use of a drug, spending money on it, or believing that it is all right for adolescents to use the drug did not automatically indicate frequent use of the drug. Contrary to adults' expectations, "hangin' out" with peers decreased use of "soft" drugs. Family activities for some involved the use of hard drugs together or the condoning of use. To create effective drug-prevention programs, the effects of different activities need to be explored further, and admission criteria need to be well delineated.     

Discriminative stimulus properties of drugs: a brief history and a selective review

A brief history of the background of drug discrimination research is given, focusing on the concepts of "drug dissociation" or state-dependent learning; an alternative explanation to the state dependency concept is to view the drug as a discriminative stimulus. In drug discrimination learning both a qualitative and a quantitative dimension is identified as governing the discrimination, examples of which are provided in the text. Examples of how drug discrimination techniques may assist in future research are outlined.     

Repeated acquisition of response sequences: stimulus control and drugs.

Pigeons obtained food by making four responses on three keys in a specified sequence, e.g., left, right, center, right. Under the "tandem-learning" condition, all three keys were the same color throughout the response sequence, and the sequence was changed from session to session. After total errors per session (overall accuracy) and within-session error reduction (learning) had stabilized, the effects of varying doses phenobarbital and chlordiazepoxide were assessed. For comparison, the drug tests were also conducted under a "tandem-performance" condition, in which the response sequence was the same from session to session, and under corresponding "chain-learning" and "chain-performance" conditions, where different colored keylights were associated with the response sequence. Under all four baseline conditions, the largest dose of each drug impaired overall accuracy. Under the two learning conditions, the error rate decreased across trials within each session, but the degree of negative acceleration was less in the drug sessions than in the control sessions. In contrast, under the two performance conditions, the error rate was relatively constant across trials, but was higher in the drug sessions than in the control sessions. Of the four baselines, the chain-learning condition was the most sensitive to the drug effects.     

Social learning and teenage drug use: an analysis of family dyads

This analysis of drug use in family dyads draws upon data from a series of nationwide studies in which interviews were conducted separately with teenagers and with older members of their families, i.e., their mothers, fathers, and older siblings. The interview schedule for these studies examines each individual's personal experience with a broad range of psychoactive substances. Thus, to the extent that behavioral similarities do occur in family dyads, "same drug links" can be compared to "cross drug links," providing a basis for differentiating evidence of direct imitation from less specific patterns of behavioral similarity. The theoretical implications of these findings are discussed.     

Parental and family risk factors for substance use in inner-city African-American children and adolescents

The purpose of this study was to develop and test a multidimensional model of parental and family influences on risk for substance use in inner-city African-American primary grade children and their adolescent siblings. The risk factors investigated were conceptually grouped into three broad domains of family influences and the respective indices computed: parental risk attributes, family risk attributes, and parenting styles. Parenting styles were captured as indicators of a latent construct, poor parenting. In study 1, we hypothesized that the parental and family risk variables would be mediated through parenting styles to predict intentions to use drugs, actual drug use, positive drug attitudes, and negative drug attitudes in a sample of 455 inner-city African-American families and their primary-grade children. In study 2, the substance use risk model was tested on a sample of 59 adolescent sibilings to determine whether the pattern of parental and family factors that contributed to early high-risk attitudes and behaviors in children would predict drug attitudes and behaviors in teen siblings. The results confirmed our expectations that parental and family risks were important predictors of childrens' negative drug attitudes and intentions to use drugs in the future and that positive parental and family characteristics would protect against future risk by enhancing negative drug attitudes. Also, substance use attitudes and behaviors in the teen siblings were predicted primarily by family risk characteristics. The family risk index also predicted frequency of use of hard drugs, but only when mediated through poor parenting. The implications of these results for future research are discussed.     

Conditioning of a discriminative drug stimulus: Overshadowing and blocking like procedures

Interactions between a drug discriminative stimulus ( D , 17.5 mg/kg of pentobarbital vs. N , saline) and exteroceptive stimulus conditions (light vs. dark) were examined in a T-maze, shock-escape task using conditioning procedures pertaining to the phenomena of "overshadowing" and "blocking". From an operational point of view, in the "overshadowing" procedure the stimulus compound is introduced from the outset of the training, whereas in the "blocking" procedure the stimuli components are introduced sequentially. When the compound discriminations were established, dose-generalization tests with various doses of pentobarbital (range 5.6–17.5 mg/kg) as well as saline (1 ml/kg) were carried out under both elements (light and dark) of the exteroceptive stimulus dimension. Prior training with drug ( D vs. N ) neutralized the potential influence of the exteroceptive dimension (light vs. dark); conversely training with the exteroceptive stimuli prior to the drug training accentuated the control over behavior by the visual stimuli. Dose-generalization results intermediate to those described above were observed in the group trained to discriminate the stimulus compound ( D plus light vs. N plus dark) from the outset of training. It may therefore be concluded that exteroceptive stimuli can compete with interoceptive drug stimuli for associative strength in the procedure used. Thus, the formal similarities between drug discriminative stimuli and more conventionally studied exteroceptive, sensory signals are furthered by the data.     

Governing drug use through neurobiological subject construction: The sad loss of the sociocultural

Based on their "drugs as instruments" framework, Müller & Schumann (M&S) propose a staged drug policy that matches well the neoliberal governance scheme. To mend the sad loss of the sociocultural dimension in their model, I propose three such considerations: first, sociocultural interactions with the brain; second, sociocultural context and justice of drug use; and third, sociocultural preparedness for implementing their drug policy.     

Drug consumption and perception among Latin American immigrants

The aim of this study is to obtain information about drug consumption, leisure activities and knowledge of community services among Spanish-speaking immigrants to prevent drug abuse in this population. Quantitative methodology was used. The field work of this study has two phases: in the first stage (2003), a survey of social perception of drugs was administered to 147 subjects. During the second stage (2004), 610 surveys were administered. Data were analysed by bivariate analysis. Usual consumption of alcohol was 40.1%, usual consumption of tobacco was 31.3%, and usual consumption of cannabis was 3.4%. Drug users considered that the main reason for drug consumption was "to have fun" (p<.03). There is a relationship between leisure time and drug use. Family plays an important role in drug abuse prevention and preventive drug abuse programs must be adapted to this population.     

A follow-up program for suicide attempters: evaluation of effectiveness.

Suicide attempters are a high-risk group in relation to ultimately completing suicide and are usually "treated and released" with little or no follow-up care. A 4-month follow-up outreach program for suicide attempters seen in the emergency room was developed with an emphasis on continuity and quantity of "treatment" received. Suicide attempters were randomly assigned to the "follow-up outreach" or "normal" treatment programs. Measures for the evaluation of effectiveness were (a) incidence of suicide reattempts and purposive accidents and (b) prevalence of drug misuse and excessive use of alcohol. The experimental group showed a statistically significant reduction in suicide reattempts and excessive use of alcohol, while the reduction of drug abuse, although not statistically significant, did conform to a trend indicating improvement. Purposive accidents occured at a relatively equal rate among both groups.     

Increased generalization between drug-related interoceptive stimuli with delayed testing.

Although the flattening of generalization gradients over time has been widely investigated using exteroceptive stimuli, little attention has been given to generalization involving interoceptive stimuli. To investigate generalization between internal states, Sprague-Dawley rats were given either 0.835 ml/kg chloropent or 15 mg/kg sodium pentobarbital. Both drugs produced asymmetrical state-dependent retention of a passive avoidance response, that is, good retention in the "same state" conditions (i.e., the drug-drug and no drug-no drug conditions) as well as in the no drug-drug conditions but poor retention in the drug-no drug conditions, at both 1- and 7-day retention intervals. Furthermore, subjects trained in one drug state (pentobarbital or chloropent) demonstrated disrupted performance when tested 1 day later in another drug state, but good performance when tested 7 days later in the other drug state, indicating a decrement in the discriminability of the two drug states after 7 days. This outcome demonstrates that generalization gradients between drug states flatten over time. Moreover, these results suggest that memory for attributes of internal stimuli undergoes changes similar to those found for exteroceptive stimuli. Implications for contextual cues models of forgetting are considered.     

A Dual-Process Discrete-Time Survival Analysis Model: Application to the Gateway Drug Hypothesis

The gateway drug model is a popular conceptualization of a progression most substance-users are hypothesized to follow as they try different legal and illegal drugs. Most forms of the gateway hypothesis are that "softer" drugs lead to "harder," illicit drugs. However, the gateway hypothesis has been notably difficult to directly test - i.e., to test as competing hypotheses in a single model that licit drug use might lead to illicit drug use or the reverse. This article presents a novel statistical technique, dual-process discrete-time survival analysis, which enables this comparison. This method uses mixture-modeling software to estimate two concurrent time-to-event processes and their effects on each other. Using this method, support for the gateway hypothesis in the National Longitudinal Survey of Youth 1997 was weak. However, this paper was not designed as a strong test of causal direction but more as a technical demonstration, and suffered from certain technological limitations. Both these limitations and future directions are discussed.     

Oral self-administration of pentobarbital by rhesus monkeys: relative reinforcing effects under concurrent fixed-ratio schedules.

During daily 3-hr sessions, orally delivered pentobarbital solutions and water, or two separate pentobarbital solutions, were concurrently available to rhesus monkeys according to fixed-ratio schedules of mouth contacts with a spout. First water, and then each of four "comparison-concentration" pentobarbital solutions (0.0625, 0.25, 1, and 4 mg/mL), was successively available from one spout for a block of sessions under a fixed-ratio-64 (three monkeys) or fixed-ratio-16 (one monkey) schedule. Under an identically sized fixed-ratio schedule, deliveries of a "standard-concentration" pentobarbital solution were concurrently available from a second spout. The concentration of the standard solution remained unchanged throughout testing of the series of comparison solutions. Each of three pentobarbital concentrations (4, 1, and 0.25 mg/mL) in turn served as the standard concentration. Within each pair of concurrently available solutions, the higher drug concentration maintained more behavior than the lower concentration. Thus when monkeys were provided with concurrent access to different pentobarbital concentrations, relative reinforcing effects were directly related to drug concentration. Further, the amount of behavior maintained by a particular drug concentration was dependent on the concentration of the concurrently available drug solution. Thus, the relative effectiveness of a reinforcer in maintaining behavior is a function of both the reinforcer's magnitude and the availability of alternative reinforcers in the environment.     

A procedure for studying the within-session onset of human drug discrimination.

The purpose of the present study was to develop a procedure for measuring the within-session onset of human drug discrimination. During daily sessions, under double-blind conditions, caffeine-abstinent adults ingested a letter-coded capsule containing 178 mg caffeine or placebo. Trials were presented at 30-s intervals, beginning immediately after drug ingestion and continuing for 60 min. On each trial, subjects could guess which of their two letter-coded drugs they had received by pressing a left button (for one drug) or right button (for the other drug); subjects could also press a center "no guess" button instead of guessing. Each trial ended after one button press. After each session, subjects were told which drug they had received. Subjects earned one point (worth $0.10 per point) for each correct guess. Subjects lost either 0, 1, or 10 points for each incorrect guess; the point-loss contingencies were varied in random order across sessions. Discrimination earnings accumulated across all sessions. The point-loss contingencies decreased random responding and delayed the discrimination time course. Overall, this procedure provided an orderly and relatively continuous measure of the within-session onset of drug discrimination and should have a range of applications in understanding the human behavioral pharmacology of drugs.     

Psychopharmacology and conditional reflexes

Drugs may be used in several ways to investigate their role in behavior. (1) The placebo effect is usually connected with the relation of the person to the drug. (2) Using the drug as an unconditional stimulus, its action may help to analyze the role of peripheral vs. central stimuli in the formation of conditional reflexes; our work has shown that the effect of drugs which act solely at the peripheral nerve endings without the involvement of the central nervous system cannot become conditioned. (3) The action of drugs on the conditional reflex (CR) compared with their action on the unconditional reflex (UR) explains some of their behavioral effects. (4) Schizokinesis is often prominent in the action of drugs. Although a drug may increase the level of the heart rate, for example, it can, on the other hand, diminish the reactivity shown in the CR. Meprobamate and mescaline affect differently the cardiac and the motor components of the CR, illustrating a schizokinesis. (5) The type of individual is an important factor in the action of drugs; the same drug may have opposite effects on different individuals. This leads to the conclusion that a drug should fit the individual as well as the disease. (6) Autokinesis is often seen in drug action. Therefore a single dose of some drugs, such as acetylcholine, epinephrine or LSD, may permanently change the relationships between excitation and inhibition, in the direction of improvement or deterioration (positive or negative autokinesis).     

Psychological treatment of hypnotic-dependent insomnia in a primarily older adult sample

Objective

This study tested cognitive behavior therapy (CBT) in hypnotic-dependent, late middle-age and older adults with insomnia.

Method

Seventy volunteers age 50 and older were randomized to CBT plus drug withdrawal, placebo biofeedback (PL) plus drug withdrawal, or drug withdrawal (MED) only. The CBT and PL groups received eight, 45 min weekly treatment sessions. The drug withdrawal protocol comprised slow tapering monitored with about six biweekly, 30 min sessions. Assessment including polysomnography (PSG), sleep diaries, hypnotic consumption, daytime functioning questionnaires, and drug screens collected at baseline, posttreatment, and 1-year follow-up.

Results

Only the CBT group showed significant sleep diary improvement, sleep onset latency significantly decreased at posttreatment. For all sleep diary measures for all groups, including MED, sleep trended to improvement from baseline to follow-up. Most PSG sleep variables did not significantly change. There were no significant between group differences in medication reduction. Compared to baseline, the three groups decreased hypnotic use at posttreatment, down 84%, and follow-up, down 66%. There was no evidence of withdrawal side-effects. Daytime functioning, including anxiety and depression, improved by posttreatment. Rigorous methodological features, including documentation of strong treatment implementation and the presence of a credible placebo, elevated the confidence due these findings.

Conclusions

Gradual drug withdrawal was associated with substantial hypnotic reduction at posttreatment and follow-up, and withdrawal side-effects were absent. When supplemented with CBT, participants accrued incremental self-reported, but not PSG, sleep benefits.     

Working memory capacity moderates the predictive effects of drug-related associations on substance use

Some theories suggest that spontaneously activated, drug-related associations in memory may have a "freer reign" in predicting drug use among individuals with lower working memory capacity. This study evaluated this hypothesis among 145 at-risk youth attending continuation high schools (CHS). This is the 1st study to evaluate this type of dual-process interaction in the prediction of drug use among a sample of at-risk adolescents. The CHS students completed assessments of drug-related memory associations, working memory capacity, and drug use. Control variables included age, gender, ethnicity, and acculturation. Robust multiple regression using least trimmed squares estimation indicated that there was a significant linear by linear interaction between working memory capacity (assessed with the self-ordered pointing task) and drug-related associations (assessed with verb generation and cue-behavior association tasks) in the prediction of alcohol and cigarette use. Consistent with dual-process cognitive theories, drug-related associations in memory predicted drug use more strongly in students with lower levels of working memory capacity. These findings add to the literature implicating the influence of dual cognitive processes in adolescent risk behaviors.     

Human d-amphetamine drug discrimination: methamphetamine and hydromorphone.

Standard measures of subjective and discriminative effects of drugs were compared in 5 human volunteers. Subjects responded on a second-order color-tracking procedure, where 30 mg of d-amphetamine served as a discriminative stimulus for one response and its absence as the discriminative stimulus for another response. Self-reported subjective effects were assessed concurrently using the single-dose questionnaire, subscales of the Addiction Research Center Inventory, and several analogue rating scales. On different days following discrimination acquisition, varying doses of d-amphetamine, methamphetamine, and hydromorphone were administered. In these test sessions, either response was reinforced. Methamphetamine and d-amphetamine occasioned dose-related increases in d-amphetamine appropriate responding; hydromorphone did not. Methamphetamine and d-amphetamine occasioned dose-related increases in reports of the drug received being most like "speed"; hydromorphone occasioned dose-related increases in reports of the drug received being most like "dope." All three drugs occasioned dose-related increases in reports of drug liking, and increases in the morphine-benzedrine group, amphetamine, and benzedrine group scales of the Addiction Research Center Inventory. This experiment demonstrated that although explicit discriminative control of behavior by a drug may covary with drug identification, it does not necessarily covary with other self-reported subjective effects. Thus, the complementary nature of the data provided by drug discrimination and standard subjective-effects measures provides quantitative and qualitative data useful in studying both relatively novel compounds and the behavioral biology of psychoactive drugs in general.