Medicalizing the drug war

Recent findings in the field of psychopharmacology pertain to the abuse of drugs and alcohol among criminal offenders and have implications for new management techniques. Drugs of abuse exert their effects on areas of the brain responsible for pleasure, providing a powerful reinforcement for drug usage. Furthermore, there is a prevalence of psychological, psychiatric and social dysfunctions that antedate drug use which are identifiable at an early age. It is suggested that drugs of abuse differentially influence users via these biological, psychological and social mechanisms, reinforcing the development of serious and chronic abuse in a vulnerable subgroup. Studies of drug abuse specially indicate that within this subgroup, antisocial behavior precedes and exacerbates drug abuse, and multiple risk factors contribute to the concomitant development of criminality and drug abuse. Early detection and comprehensive treatment of underlying disorders that may both precipitate and result from drug abuse promise to improve possibilities for prevention and reducing relapse rates. Furthermore, the inclusion of pharmacologic treatments may further enhance the success of conventional drug treatments. This article proposes that incorporating scientific data and medicalizing our approach to drug abuse is essential to win the war against drugs.     

The Effect of Stress on Spontaneous Nest Leaving Behavior in the Mouse: An Improved Model of Stress-Induced Behavioral Pathology

The present experiments were conducted to develop a more sensitive and reliable model of stress-induced behavioral pathology in the mouse. Male mice were housed singly in nest cages connected to either a circular tunnel, a recreational cage or a large box with food foraging apparatus. Spontaneous nocturnal out of nest activity or food foraging behavior in these environments was continuously monitored for a two week period during which time the effects of stress were examined. It was found that both repeated restraint and aggression stress markedly and persistently reduced out of nest nocturnal activity or food foraging behavior in all 3 environments but did not alter activity in a novel open field or plus maze or food or saccharin intake in the nest cage. In a preliminary experiment the reduction in out of nest activity by stress was attenuated by prior chronic treatment with the antidepressant, desmethylimipramine. Plasma corticosterone was elevated immediately after aggression stress but reduced 5 hr after chronic aggression stress. The reduction in activity did not appear the result of increased anxiety as measured by spontaneous risk assessment behavior in the nest. It is concluded that the decrease in out of nest activity after stress in the present studies models a withdrawn behavioral state and may be due to either or both a decrease in appetitive motivation to leave the nest or an increased aversion to the external environment which does not apparently involve anxiety.     

Open-field and avoidance behavior after neostriatal lesions in male and female rats.

The behavioral effects of lesions of the anterodorsal or posteroventral parts of the caudate-putamen were studied in adult male and femle rats that were gonadectomized or left untreated prior to brain surgery. Anterodorsal (ADC) lesions consistently impaired acquistion of one-way avoidance behavior and tended to interfere with the development of a two-way avoidance response; comparable effects were observed in gonadectomized and intact animals of both sexes. By contrast, ADC lesions increased activity in the open field only in intact females and increased rearing only in ovariectomized females. Posteroventral caudate (PVC) lesions caused transient aphagia and adipsia in both sexes but did not consistently affect open-field activity or the acquistion of one-way avoidance responses by either sex. These lesions profoundly impaired acquistion of shuttle box avoidance responses by intact males. By contrast, castrated males and intact and ovariectomized females with PVC lesions avoided normally in the shuttle box. The present results suggest that localization of behavioral functions within the striatum differs with the sex of the subject, in part because of activational effects of gonadal hormones.     

Clinical Implications and Methodological Challenges in the Study of the Neuropsychological Correlates of Cannabis,Stimulant, and Opioid Abuse

Chronic consumption of several drugs of abuse (cannabis, stimulants, opioids) has been associated with the presence of neuropsychological impairments in a broad range of functions. Nevertheless, in recent years neuropsychological research on substance abuse has focused on the study of impairments in the executive functions linked to the prefrontal cortex and their influence on the personality, cognitions, and behaviors of the substance abusers. The aim of our review is, first, to summarize the main neuropsychological impairments shown by classic studies, as well as these new discoveries in executive functioning; second, to consider the mediating role of neuropsychological status on treatment outcomes and analyze the impact of these impairments in clinical practice with drug addicts; and third, to review the principal methodological challenges associated with research in the field of the neuropsychology of substance abuse. We also highlight the convenience of intervening in those functions most relevant to the abusers' persistence in consumption and risk of relapse.     

CNTF对应激大鼠行为障碍和海马CA1神经元损害的作用

实验采用 ｏｐｅｎ ｆｉｅｌｄ测定、 Ｎｉｓｓｌ染色、 Ｂｉｅｌｓｃｈｏｗｓｋｙ－Ｇｒｏｓ－Ｌａｗｒｅｎｔｊｅｗ染色和常规透射电镜技术,观察急性和慢性足底电击应激大鼠的ｏｐｅｎ ｆｉｅｌｄ行为和海马ＣＡ１神经元形态的变化,及双侧海马注射睫状神经营养因子（ＣＮＴＦ）对它的影响。结果表明,急性应激大鼠ｏｐｅｎ ｆｉｅｌｄ行为活动增加,海马ＣＡ１神经元形态无明显变化;慢性应激大鼠ｏｐｅｎ ｆｉｅｌｄ行为活动减少,海马ＣＡ１神经元出现明显的损伤性形态变化;睫状神经营养因子对对照组大鼠和急性应激大鼠的ｏｐｅｎ ｆｉｅｌｄ行为和海马ＣＡ１神经元形态均无明显作用,但可显著减轻慢性应激大鼠海马ＣＡ１神经元损伤程度,改善其行为障碍。实验结果提示睫状神经营养因子可能通过保护海马神经元从而改善慢性应激大鼠的行为障碍。     

Influence of anabolic steroid on anxiety levels in sedentary male rats

The aim of this study was to evaluate the influence of nandrolone decanoate on anxiety levels in rats. Male Wistar rats were treated with nandrolone decanoate (5mg/kg, two times per week, i.m.) or vehicle (propylene glycol--0.2 ml/kg, two times per week, IM) for 6 weeks. Control rats were subject only to procedures related to their routine husbandry. By the end of 6 weeks, all groups (24-29 rats/group) were submitted to the elevated plus maze test in order to evaluate their anxiety level. Some of these animals (12-14/group) were treated with diazepam (1 mg/kg i.p.) 30 min before the elevated plus maze test. Nandrolone decanoate significantly decreased the percentage of time spent in the open arms (1.46+/-0.49%) compared with control (3.80+/-0.97%) and vehicle (3.96+/-0.85%) groups, with no difference between control and vehicle treatments. The percentage of open arm entries was also reduced in the group treated with nandrolone decanoate in comparison with the vehicle and control. No changes in the number of closed arm entries were detected. Diazepam abolished the effects of nandrolone decanoate on the percentage of time in, and entries into the open arms. The present study showed that chronic treatment with a high dose of nandrolone decanoate increased the anxiety level in male rats.     

Suicidality in a Sample of Arctic Households

We investigated the association of suicidal ideation and behavior with depression, anxiety, and alcohol abuse in a Canadian Arctic Inuit community. Inuit (N = 111) from a random sample of households completed assessments of anxiety and depression, alcohol abuse, and suicidality. High rates of suicidal ideation within the past week (43.6%), and suicide attempts within last 6 months (30%), were reported. Ideation was more frequent among younger persons, whereas those favoring local native language were less likely to report a wish to die. Higher overall suicidality scores were associated with higher anxiety, and alcohol abuse, but not with depression or gender. Implications for future research are discussed.     

Bayesian Diagnostics of Hidden Markov Structural Equation Models with Missing Data

Cocaine is a type of drug that functions to increase the availability of the neurotransmitter dopamine in the brain. However, cocaine dependence or abuse is highly related to an increased risk of psychiatric disorders and deficits in cognitive performance, attention, and decision-making abilities. Given the chronic and persistent features of drug addiction, the progression of abstaining from cocaine often evolves across several states, such as addiction to, moderate dependence on, and swearing off cocaine. Hidden Markov models (HMMs) are well suited to the characterization of longitudinal data in terms of a set of unobservable states, and have increasingly been used to uncover the dynamic heterogeneity in progressive diseases or activities. However, the existence of outliers or influential points may misidentify the hidden states and distort the associated inference. In this study, we develop a Bayesian local influence procedure for HMMs with latent variables in the presence of missing data. The proposed model enables us to investigate the dynamic heterogeneity of multivariate longitudinal data, reveal how the interrelationships among latent variables change from one state to another, and simultaneously conduct statistical diagnosis for the given data, model assumptions, and prior inputs. We apply the proposed procedure to analyze a dataset collected by the UCLA center for advancing longitudinal drug abuse research. Several outliers or influential points that seriously influence estimation results are identified and removed. The proposed procedure also discovers the effects of treatment and individuals’ psychological problems on cocaine use behavior and delineates their dynamic changes across the cocaine-addiction states.     

Effects of caffeine on performance of low intensity tasks

31 college age men and women who consume less than three caffeinated beverages per week agreed to participate as subjects in research on the effects of acute caffeine intake on low intensity task performance. All subjects performed two randomly administered test conditions: (1) caffeine (5 mg/kg) and (2) placebo on separate visits following an initial 1-hr. orientation visit. Subjects were administered the beverage 30 min. prior to performing 12 separate tests assessing basic mathematics, simple response, logical reasoning, hand-eye coordination, and spatial and assembly skills. The Spielberger State Anxiety test was administered immediately after consuming the test beverage and once again at posttest. Analysis showed that caffeine did not significantly affect performance on all tests with the exception of the peripheral awareness (hand-eye coordination) test on which performance was higher after ingesting caffeine. The placebo treatment produced no effect on state anxiety, which contrasted with a significant rise in anxiety after caffeine consumption. State anxiety values were significantly greater after caffeine treatment relative to the placebo at pretest, and this difference persisted at posttest. These results demonstrated that the dose of caffeine increased scores on state anxiety for individuals who consumed less than three caffeinated beverages weekly but had very little effect on performance of low intensity tasks, except for a hand-eye coordination test involving peripheral awareness. Perhaps longer continuous performance of more demanding tasks would be more sensitive.     

Safety Behaviors in Adults With Social Anxiety: Review and Future Directions

Safety behaviors are considered an important factor in the maintenance of social anxiety disorder (SAD). Safety behaviors are typically employed by socially anxious individuals to reduce anxiety in feared social situations. However, by preventing individuals with social anxiety from gathering evidence that would disconfirm their maladaptive beliefs about social situations, the use of safety behaviors ultimately maintains social anxiety over time. Twenty years ago, Wells and colleagues (1995) demonstrated that use of safety behaviors diminishes the efficacy of exposure treatment for SAD, suggesting that reduction in the use of safety behaviors during exposure can enhance treatment response. Research on safety behaviors has expanded considerably since Wells et al.’s seminal publication, and our understanding of the role safety behaviors may play in the maintenance of social anxiety has grown in breadth and depth. In this paper, we present a detailed review of the published research on safety behaviors relevant to social anxiety and social-anxiety-related processes. Finally, we evaluate the impact of safety behaviors on the outcome of treatment for SAD, and we look to the literature on safety behaviors in other anxiety disorders to inform our understanding of use of safety behaviors during exposure and to facilitate future research in SAD.     

Role of the Leader in Therapy Groups Conducted With Illicit Drug Abusers: How Directive Does the Leader Have to Be?

A 17-hour marathon group was conducted in a residential treatment center established for inmates in a correctional setting in the southeastern United States. The Hill Interaction Matrix (HIM-G; Hill, 1965) was used to measure the types of leader activity and the types of member activity during portions of each hour of the group activity. It was found that when the group was most therapeutic, there was a relationship between the therapists' actions and behaviors and the types of issues that were discussed in the group. The results that were found do not agree with some of the established drug and alcohol abuse literature.     

Childhood Abuse Types and Physical Health at the Age of 24: Testing Health Risk Behaviors and Psychological Distress as Mediators

This study examines whether adult psychological distress and health risk behaviors mediate the relationship between childhood abuse and physical health in adulthood. A randomly selected population-based sample, with oversampling to include a one-third subgroup of former child protection cases, completed a structured interview. Questions pertained to childhood exposure to abuse, adult psychological distress, physical health, and health risk behaviors. Previous research using this sample had identified three abuse typologies: emotional abuse, sexual abuse, and polyvictimization (physical abuse, emotional abuse, and neglect). All three typologies were significantly associated with poorer self-reported physical health. Psychological distress and health risk behaviors partially mediated the relationship between nonabuse, sexual abuse, polyvictimization, and physical health, and fully mediated the relationship between emotional abuse and physical health. The results of this study indicate that health risk behaviors and symptoms of psychological distress could contribute to some of the long-lasting consequences of childhood abuse on adult physical health.     

DRUG ABUSE AND THE FAMILY

The Family and Drug Abuse Symposium held on July 10–12, 1975, brought together individuals who possess clinical and/or research expertise in the area of family research and substance abuse. The purpose of the symposium was directed toward assessing the current state of knowledge in the field and delineating directions for future work. The role of family interaction in causing or maintaining a drug abuse problem has only recently become the focus of research and innovative treatment efforts. This special section is intended to acquaint therapists and researchers with recent work in the field; the papers are revised versions of materials originally prepared for the symposium. This first paper offers a brief overview of the symposium and summarizes issues that arose from each of the four workshops: I. Psychosocial Research; II. Clinical Observations; III. Clinical Programs; and IV. Recommendations Made to the National Institute on Drug Abuse. The next paper is a review of recent studies in research and treatment that have approached substance abuse from a family viewpoint. Other research methods that appear relevant to the study of families with a drug-abusing member are discussed. Three commentaries on this review follow. The last paper describes an extensive effort to implement and evaluate family therapy within an existing drug treatment facility.     

The effects of urine on aggressive responses by male golden hamsters

Twenty adult male golden hamsters were isolated into individual cages for a period of six weeks, at the end of which time they had introduced into their home cages, on three occasions, a castrated male intruder. On each occasion the castrated intruder was daubed on the anogenital region with urine from one of three sources: (1) intact females, (2) other castrated males, and (3) intact males. Urine from a different source was applied to the castrated intruder on each of the three tests. Resident males consistently showed more aggression, sniffing, and following and less defensive behavior than the intruders. However, aggression by the resident males showed a significant variance over the three urine treatments given to the intruder. It is concluded that like male mouse urine, male hamster urine contains attack-provoking cues, but that unlike that of the mouse, female urine does not appear to be attack-inhibiting in this species.     

Introduction to The Special Issue on The Behavior Analysis and Treatment of Drug Addiction

Extensive evidence from the laboratory and the clinic suggests that drug addiction can be viewed as operant behavior and effectively treated through the application of principles of operant conditioning. Contingency management interventions that arrange for the direct reinforcement of drug abstinence or of other therapeutically important target behaviors (e.g., regular use of drug abuse treatment medications) are among the most studied type of operant treatments. Behavior analysts have contributed to the substantial and rapidly growing literature on operant treatments for drug addiction, but the publications of this work usually appear in medical, clinical psychology, or drug abuse journals. This special issue of the Journal of Applied Behavior Analysis represents an effort to bring this important work to the attention of the behavior-analytic community. The articles in this special issue illustrate both the enormous potential of contingency management interventions to address the serious and seemingly intractable problem of drug addiction as well as the real challenges involved in attempting to develop and disseminate treatments that will produce substantial and lasting changes in the lives of individuals plagued by the chronic problem of drug addiction.     

A Regional Study of Risk Factors for Drug Abuse and Delinquency: Sex and Racial Differences

Many juveniles are at high risk for delinquency and drug abuse by virtue of the characteristics of their neighborhoods, which are often economically impoverished, socially unstable, physically neglected, and rife with crime, drug use, and drug selling. However, a significant proportion of these youth do not engage in deviant behavior, while others participate to varying degrees. This study examined what factors discriminate between high-risk youth who do and who do not exhibit deviant behavior. Self-reported measures of several attitudes and behaviors known to correlate with drug abuse and delinquency were assessed in relation to reports of property offenses, person offenses, drug use, and drug selling. Additional analyses were conducted to distinguish between sex and racial groups to further qualify the relationships between deviant behaviors and attitudes. The most notable finding was that types of deviance that primarily involve material and monetary gain may be largely influenced by relationships with significant others, while deviance with potentially harmful consequences to both self and others are influenced largely by personal attitudes. Examination of individual variables showed that negative peer influences and positive attitudes toward fighting significantly increased the likelihood of reporting involvement in three of the four deviance measures, and that positive relationship with the father and prosocial values were inversely related to two of the behavioral deviance measures. There were very few differences in significant predictors of deviance for males versus females. Several self-reported attitudes and behaviors distinguished African Americans from Hispanics and Whites, even though Whites were reportedly responsible for a higher incidence of deviant behaviors.     

Connections Between Childhood Abuse and HIV Infection

This study examined the incidence of childhood sexual and physical abuse in 52 human immuno-deficiency virus (HIV) infected adults. Behaviors and dynamics associated with unresolved childhood abuse (revictimization, sexual compulsivity, chronic depression, and alcohol and other drug abuse) are discussed in light of those behaviors and dynamics that increase a person's risk of exposure to the virus causing Acquired Immune Deficiency Syndrome (AIDS). lnterview results showed that 65% of those infected reported physical or sexual abuse in childhood. The prevalence of adult survivor characteristics was also examined, and responses were compared based on HIV transmission modes. Recommendations for counselors working with HIV-infected clients are also provided.     

Comparing Students From Substance Abusing and Dysfunctional Families: Implications for Counseling

This research compared family role dysfunction, college adjustment, chemical dependence, and family functioning among a sample of 245 college students from three groups: homes in which significant alcohol or other chemical abuse or dependence dysfunction existed; dysfunctional homes in which substance abuse was not a significant problem; and nonabusing, nondysfunctional homes. The results suggest that chemical abuse or dependence in families is associated with slowed adult role assimilation and increased risk for alcohol and other drug abuse among children.     

Compulsive buying disorder: a review of the evidence

Compulsive buying disorder is characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding shopping and spending that lead to subjective distress or impaired functioning. Compulsive buying disorder is estimated to have a lifetime prevalence of 5.8% in the United States general adult population. In clinical settings, most individuals with compulsive buying disorder are women (approximately 80%). This gender difference may be artifactual. Compulsive buying disorder is typically chronic or intermittent, with an age of onset in the late teens or early 20s. Comorbid mood and anxiety disorders, substance use disorders, eating disorders, and other disorders of impulse control are common, as are Axis II disorders. The disorder occurs worldwide, mainly in developed countries with market-based economies, and it tends to run in families with mood disorders and substance abuse. There is no standard treatment for compulsive buying disorder, but group cognitive-behavioral models seem promising, and psychopharmacologic treatments are being actively studied. Other treatment options include simplicity circles, 12-step programs, financial counseling, bibliotherapy, marital therapy, and financial counseling. Directions for future research are discussed.