海洛因戒治者对疼痛线索的选择性注意加工偏向

研究采用点探测范式,以疼痛线索(感觉疼痛词、情感疼痛词和健康灾难词)和中性线索(中性词)为实验材料,考察接受美沙酮维持治疗的海洛因戒治者对疼痛线索的视觉选择性注意偏向。结果表明:海洛因戒治者对疼痛线索的注意偏向具有普遍性,即对感觉疼痛词、情感疼痛词和健康灾难词等三类疼痛线索均存在注意回避偏向,尤其对健康灾难词的注意回避程度最高;海洛因戒治者还对感觉疼痛词和情感疼痛词存在注意脱离易化倾向。本研究对于有针对性的开展注意偏向矫正以干预疼痛,从而辅助美沙酮的治疗效果、维持患者的戒断状态、降低其复吸风险具有重要意义。     

Development and validation of a Client Problem Profile and Index for drug treatment

The development of the Client Problem Profile and Index are described, and initial concurrent and predictive validity data are presented for a sample of 547 patients in outpatient methadone treatment. Derived from the TCU Brief Intake for drug treatment admissions, the profile covers 14 problem areas related to drug use (particularly cocaine, heroin/opiate, marijuana, other illegal drugs, and multiple drug use), HIV risks, psychosocial-functioning, health, employment, and criminality. Analyses of predictive validity show the profile and its index (number of problem areas) were significantly related to therapeutic engagement, during-treatment performance, and posttreatment follow-up outcomes. Low moderate to high moderate effect sizes were observed in analyses of the index's discrimination.     

Understanding public stigma toward substance dependence

This study examined the mechanisms of stigma toward individuals diagnosed with substance‐related disorders. The applicability of a mental health model of stigma extended to substance dependence was tested. Undergraduates completed a modified version of stigma questionnaires previously used to measure mental health stigma models. Questionnaires captured familiarity, perceived dangerousness, fear, and desired social distance toward individuals dependent to alcohol, marijuana, and heroin. Path analysis assessed the direct and indirect effects within this theoretical model for each substance. For marijuana and heroin, path models suggested that familiarity indirectly predicted desired social distance through perceived dangerousness and fear. For alcohol, familiarity did not indirectly or directly predict desired social distance. Implications for applying mental health models to substance disorder stigma are discussed.     

Using Acceptance and Commitment Therapy During Methadone Dose Reduction: Rationale,Treatment Description,and a Case Report

Many clients who undergo methadone maintenance (MM) treatment for heroin and other opiate dependence prefer abstinence from methadone. Attempts at methadone detoxification are often unsuccessful, however, due to distressing physical as well as psychological symptoms. Outcomes from an MM client who voluntarily participated in an Acceptance and Commitment Therapy (ACT)–based methadone detoxification program are presented. The program consisted of a 1-month stabilization and 5-month gradual methadone dose reduction period, combined with weekly individual ACT sessions. Urine samples were collected twice weekly to assess for use of illicit drugs. The participant successfully completed the program and had favorable drug use outcomes during the course of treatment, and at the 1-month and 1-year follow-ups. Innovative behavior therapies, such as ACT, that focus on acceptance of the inevitable distress associated with opiate withdrawal may improve methadone detoxification outcomes.     

The association between heroin use and anxiety sensitivity among inner-city individuals in residential drug use treatment

The current study represents an initial investigation of the association between heroin use and anxiety sensitivity (AS). Within a sample of 172 inner-city treatment seeking drug users, AS was compared across past year (1) heroin users with no crack/cocaine use (n=12); (2) crack/cocaine users with no heroin use (n=66); (3) users of both heroin and crack/cocaine (n=45); and (4) individuals with no use of heroin or crack/cocaine (n=49). Consistent with expectations, primary heroin users evidenced higher levels of AS than all other groups, with these differences also evidenced for the physical and social subscales. Differences in AS total score and physical subscale score persisted after controlling for demographic variables, depressive symptoms, and primary use of drugs other than heroin and crack/cocaine including alcohol, nicotine, marijuana, and hallucinogens. Findings suggest a unique relationship between AS and heroin, and set the stage for future work explicating the direction of the observed association.     

A behavioural-pharmacological treatment of dually addicted patients

maintenance appears to be an effective means of treating narcotic addiction both because it blocks the effects of heroin and because patients are willing to accept methadone treatment. However, alcoholism has been found commonly to complicate methadone maintenance and to result in treatment failure. The regular ingestion of disulfiram, a drug which blocks ethanol metabolism, could provide a solution to this problem, but alcoholics tend not to persist in taking this drug, because unlike methadone it possesses no reinforcing properties. This paper describes a novel technique whereby the reinforcing action of methadone has been employed to maintain disulfiram-taking, and thus to arrest alcohol abuse and consequent treatment failure.     

Specious causal attributions in the social sciences: the reformulated stepping-stone theory of heroin use as exemplar

The claims based on causal models employing either statistical or experimental controls are examined and found to be excessive when applied to social or behavioral science data. An exemplary case, in which strong causal claims are made on the basis of a weak version of the regularity model of cause, is critiqued. O'Donnell and Clayton claim that in order to establish that marijuana use is a cause of heroin use (their "reformulated stepping-stone" hypothesis), it is necessary and sufficient to demonstrate that marijuana use precedes heroin use and that the statistically significant association between the two does not vanish when the effects of other variables deemed to be prior to both of them are removed. I argue that O'Donnell and Clayton's version of the regularity model is not sufficient to establish cause and that the planning of social interventions both presumes and requires a generative rather than a regularity causal model. Causal modeling using statistical controls is of value when it compels the investigator to make explicit and to justify a causal explanation but not when it is offered as a substitute for a generative analysis of causal connection.     

The Poly-Drug User: Examining Associations between Drugs Used by Adolescents

Based on data from the 2014 Communities that Care Youth Survey, the authors examine the associations between drug use frequencies among 11 drugs. This research represents a step in determining what leads to the use of dangerous drugs like heroin, other opioids, and other not so dangerous substances. Findings indicate the highest association is between marijuana and alcohol use. Most drugs show at least a low to medium association with all other drugs. Findings indicate the difficulty in making gateway assumptions and that poly-drug use determined by peer associations is a better explanation.     

The effectiveness of drug treatment programs in reducing criminal behavior: a meta-analysis

The main aim of this paper is to assess the effectiveness of drug treatment programs in reducing criminal behavior. The research is based on a systematic review and meta-analysis of evaluations of drug treatment programs. The research investigated various drug treatment programs including methadone treatment, therapeutic communities, post-release supervision for drug-misusing offenders, and drug courts, and focused on drug treatment programs that were primarily concerned with heroin, crack and cocaine misuse. The main outcome variable analyzed was reoffending following treatment as measured by self-reports or official records. The study was based on a meta-analysis of 28 evaluations of drug treatment programs. The meta-analysis involved calculating individual effect sizes for each study and weighted mean effect sizes for groups of studies. The mean odds of offending following treatment were significantly lower among clients of the drug treatment programs than among the comparison groups. However, the results varied by type of program, type of evaluation methods used, and characteristics of clients.     

Three perspectives on addiction

Three perspectives on addiction promulgated during the 1990s are reviewed, along with many earlier contributions to the understanding of addictive illness. It is suggested that these distinct yet overlapping formulations of the dynamics of addiction form a hierarchy for each patient suffering from an addiction. Assessment of a patient's ego strength, and of the relative importance of addictive behaviors in overall character structure, allows referral to various types of treatment, including psychoanalytic therapy. Case examples are presented, including material from the psychoanalysis of a woman addicted to heroin, methadone, cocaine, amphetamines, nicotine, alcohol, and shopping.     

Treatment Populations,Services, and Outcomes for Cocaine and Crack-Cocaine Dependence

This paper analyzes demographic and other pretreatment characteristics, measures of treatment services received, and treatment outcomes of participantsin the National Treatment Improvement Evaluation Study (NTIES), a large-scale longitudinal study of substance abuse treatment (D. R. Gerstein et al., 1997; R. A. Johnson & D. R. Gerstein, 2000). The focus here is those treated primarily for cocaine powder or crack-cocaine dependence, compared with those in treatment for other substances, particularly heroin. Crack-dependent users tend to be female and black, older than primary marijuana or alcohol users but younger than those in treatment for heroin. Primary cocaine powder or crack users are likely to have entered treatment under pressure from the criminal justice system. After treatment there are substantial reductions in use of cocaine powder and crack, especially among participants with fewer prior treatment episodes and lower pretreatment intensity of use. Longer duration and intensity of treatment result in greater reductions in cocaine and crack use.     

EFFECT OF REINFORCEMENT PROBABILITY AND PRIZE SIZE ON COCAINE AND HEROIN ABSTINENCE IN PRIZE‐BASED CONTINGENCY MANAGEMENT

Although treatment outcome in prize‐based contingency management has been shown to depend on reinforcement schedule, the optimal schedule is still unknown. Therefore, we conducted a retrospective analysis of data from a randomized clinical trial (Ghitza et al., 2007) to determine the effects of the probability of winning a prize (low vs. high) and the size of the prize won (small, large, or jumbo) on likelihood of abstinence until the next urine‐collection day for heroin and cocaine users (N = 116) in methadone maintenance. Higher probability of winning, but not the size of individual prizes, was associated with a greater percentage of cocaine‐negative, but not opiate‐negative, urines.     

Pain-related anxiety and marijuana use motives: a pilot test among active marijuana-using young adults

The present investigation examined pain-related anxiety in regard to marijuana use motives among a sample of young adult marijuana users (N = 180; 45% women; M(age) = 21.11 years, SD = 6.41). Hierarchical multiple regression analyses were used to determine the relations between pain-related anxiety and marijuana use motives. After controlling for current marijuana use frequency (past 30 days), daily cigarette smoking rate, current rate of alcohol consumption, level of bodily pain (current), and other marijuana use motives, pain-related anxiety was significantly and uniquely associated with coping and conformity motives for marijuana use. Pain-related anxiety was not significantly related to other marijuana use motives. These results offer novel empirical insight pertaining to a relation between pain-related anxiety and coping as well as conformity motives for marijuana use among active users.     

A Cross‐National Comparison of Suicide Attempts,Drug Use,and Depressed Mood Among Dominican Youth

We compared suicide attempts, depressed mood, and drug use of 1,710 Dominican public high school students in New York City (NYC) and 9,573 in the Dominican Republic (DR) in 2009. Compared to DR Dominicans, NYC Dominicans were more likely to have reported lifetime marijuana use (27.6% vs. 1.5%), lifetime inhalant use (11.0% vs. 7.6%), lifetime other drug use (9.9% vs. 3.0%), depressed mood (31.3% vs. 27.2%), and suicide attempt (13.8% vs. 8.8%). The results of this study supported the hypothesis that substantial increases in illicit drug use, especially cocaine, heroin, ecstasy, and methamphetamines, among NYC Dominican youth account for their increased risk for suicide attempts compared to their DR Dominican counterparts. It also identified suicide attempts as a public health problem among NYC Dominicans, the largest NYC Latino immigrant population.     

Medication-assisted treatment research with criminal justice populations: challenges of implementation

Creating, implementing and evaluating substance abuse interventions, especially medication-assisted treatments, for prisoners, parolees, and probationers with histories of heroin addiction is an especially challenging endeavor because of the difficulty in coordinating and achieving cooperation among diverse criminal justice, substance abuse treatment, research, and social service agencies, each with its own priorities and agenda. In addition, there are special rules that must be followed when conducting research with criminal justice-involved populations, particularly prisoners. The following case studies will explore the authors' experience of over 10 years conducting pharmacotherapy research using methadone, buprenorphine, and naltrexone with criminal justice populations. The major obstacles and how they were overcome are presented. Finally, recommendations are provided with regard to implementing and conducting research with criminal justice populations. Copyright © 2011 John Wiley & Sons, Ltd.     

Comparing measures of cognitive bias relating to eating behaviour

Consumption of and/or abstinence from substances with a high reward value (e.g. heroin, marijuana, alcohol, nicotine, certain foods) are associated with cognitive biases for information related to the substance. Such cognitive biases are important since they may contribute to difficulties in controlling intake of the substance. We examine cognitive biases for stimuli related to food. For the first time, we concurrently employ and compare five conceptually distinct measures of cognitive bias (dot probe, emotional Stroop, recognition, EAST, explicit attitudes). Contrary to expectations from current theory, the relation between the cognitive measures was weak and evident only in certain subsets of the population sample, as defined by gender and emotional‐, restrained‐ and external‐eating characteristics of our participants. We discuss some methodological implications of our findings. Copyright © 2008 John Wiley & Sons, Ltd.     

Pain-Related Anxiety and Marijuana Use Motives: A Pilot Test Among Active Marijuana-Using Young Adults

The present investigation examined pain-related anxiety in regard to marijuana use motives among a sample of young adult marijuana users (N = 180; 45% women; M _age = 21.11 years, SD = 6.41). Hierarchical multiple regression analyses were used to determine the relations between pain-related anxiety and marijuana use motives. After controlling for current marijuana use frequency (past 30 days), daily cigarette smoking rate, current rate of alcohol consumption, level of bodily pain (current), and other marijuana use motives, pain-related anxiety was significantly and uniquely associated with coping and conformity motives for marijuana use. Pain-related anxiety was not significantly related to other marijuana use motives. These results offer novel empirical insight pertaining to a relation between pain-related anxiety and coping as well as conformity motives for marijuana use among active users.     

Personality characteristics of adolescent marijuana users

A group of high school students from middle- to upper-middle-class backgrounds was studied to investigate the relationship between marijuana use, marijuana misuse, and personality. The California Personality Inventory and a version of the Adolescent Alcohol Involvement Scale (adapted for the assessment of marijuana involvement) were the primary instruments used. Analysis of variance and regression analysis were performed on the data. Results indicated a relationship between the personality characteristics of adolescents who are involved in marijuana use and misuse and adolescents who are not; there are discernible differences in the personalities of the adolescents who are involved with marijuana. The intervention and prevention implications of these results are discussed.     

Interaction of methadone, reinforcement history, and variable-interval performance.

In the present study, we examined how a reinforcement schedule history that generated high or low rates of responding influenced the effects of acute (Experiment 1) and chronic (Experiment 2) methadone administration. Initially, key-peck responses of pigeons were maintained under a variable-interval 90-s schedule of food presentation, and a methadone dose-response curve was determined with doses of 0.6, 1.2, and 2.4 mg/kg. The pigeons were then exposed, for at least 40 sessions, to either a fixed-ratio 50 schedule or a differential-reinforcement-of-low-rate 10-s schedule, or were given continued exposure to the variable-interval schedule. The methadone dose-response curve was redetermined after all pigeons again were responding under the variable-interval schedule. The effects of two different daily methadone doses (9.0 and 12.0 mg/kg/day) and withdrawal precipitated by naloxone also were assessed. Experience with a fixed-ratio or differential reinforcement of low rate schedule did not result in significantly different response rates under the variable-interval schedule and, in general, the acute effects of methadone did not have differential effects correlated with schedule history. However, for 2 of 4 subjects the rate-decreasing effects of methadone on rates of key pecking were greater following a history of low-rate responding, suggesting a possible interaction between schedule history and effects of methadone. Daily methadone administration under the variable-interval schedule revealed that pigeons with experience under the differential reinforcement of low rate schedule developed more rapid and complete tolerance to the rate-decreasing effects of methadone. Three of the 4 subjects in this group showed rate increases above drug-free baselines during chronic methadone dosing. Pigeons with a history of fixed-ratio responding also developed tolerance to the rate-decreasing effects of methadone but without the subsequent rate increases seen by subjects with low-rate histories. No subjects with variable-interval histories showed complete recovery of drug-free baselines, suggesting that interpolated training under other schedules may attenuate the rate-altering effects of chronically administered drugs. Naloxone (1.0 mg/kg), administered during the chronic methadone phase, resulted in greater disruption of responding by pigeons with a history of low-rate responding, as compared to subjects in the other two groups.(ABSTRACT TRUNCATED AT 400 WORDS)     

The Adjustment of Drug Addicts as Measured by the Sentence Completion Test

The Rotter Incomplete Sentences Blank was administered to fifty out-patients at a rehabilitation center for narcotic addicts. There were twenty male heroin users, twenty male pill users, and ten female heroin users. Interscorer, intrascorer, and split-half reliabilities were all high. It was found that a cutting score of adjustment of 135 correctly identified 80 per cent of the male heroin users, 90 per cent of the male pill users, and 100 per cent of the female heroin users.