Effect of incentives on retention in an outpatient treatment for cocaine addicts

The high drop-out rate in treatment programs is one of the most important problems in the area of drug addictions. This study evaluated the effect of the use of incentives on retention in an outpatient program for cocaine addicts. The effect of individual variables on program drop-out was also analysed. Participants were 66 subjects who were randomly assigned to one of three treatment groups: standard treatment, treatment with incentives I, and treatment with incentives II. The patients of these two groups received incentives contingent on cocaine abstinence with two different magnitudes. Retention rate at six months was 35% in the standard treatment, 78.6% in the treatment with incentives I, and 53.3% in the treatment with incentives II. The global prognostic capacity of the individual variables (sociodemographic, history and consumption pattern, psychopathological variables, and EuropASI scores) was 85.7%, with the psychopathological variables being more closely related to retention. These results suggest that the use of incentives may be an effective strategy to improve retention in outpatient treatments for cocaine addiction.     

Cocaine use and post partum psychiatric symptoms.

The association of mental health symptoms with cocaine use was studied among post partum women. Gestational cocaine use was determined by confidential interview or urine assay. A structured Psychiatric Symptom Index was used to measure mental health symptoms. Among 155 women, 24 (15%) used cocaine. Cocaine-using women had less education, higher parity, less weight gain during pregnancy, and used more cigarettes, marijuana, and opiates in pregnancy than nonusers. High frequency of symptoms (standardized Psychiatric Symptom Index score greater than or equal to 20) was found in 71% of women for the Total Index score, 81% on depression, 61% on anxiety, 36% on cognitive disturbance, and 75% on anger. No differences in Psychiatric Symptom Index Total or factor scores were associated with cocaine use.     

Psychosocial predictors of relapse in cocaine-dependent patients in treatment

Relapses in cocaine abusers in treatment are an important problem. The majority of patients are incapable of sustaining abstinence over any length of time. To identify the factors associated to relapses risk in the cocaine use can be an optimal choice to improve the treatment strategies. The aim of this study was to analyze relapse-risk factors in cocaine-dependent patients on treatment. Participants were 102 patients who had begun outpatient treatment at a public health center in Spain. Some functional areas and cocaine use are evaluated for a period of six months. A structural equations model was used to identify possible predictive variables. The results show that social-family environment and economic-employment situation were associated with greater risk of relapse. Likewise, the social-family environment was related to severity of addiction. It is concluded that the incorporation of family intervention strategies and vocational/employment counseling may help to reduce relapse rates in cocaine addicts receiving treatment.     

A randomized trial of employment-based reinforcement of cocaine abstinence in injection drug users

High-magnitude and long-duration abstinence reinforcement can promote drug abstinence but can be difficult to finance. Employment may be a vehicle for arranging high-magnitude and long-duration abstinence reinforcement. This study determined if employment-based abstinence reinforcement could increase cocaine abstinence in adults who inject drugs and use cocaine during methadone treatment. Participants could work 4 hr every weekday in a workplace where they could earn about $10.00 per hour in vouchers; they were required to provide routine urine samples. Participants who attended the workplace and provided cocaine-positive urine samples during the initial 4 weeks were invited to work 26 weeks and were randomly assigned to an abstinence-and-work (n = 28) or work-only (n = 28) group. Abstinence-and-work participants had to provide urine samples showing cocaine abstinence to work and maintain maximum pay. Work-only participants could work independent of their urinalysis results. Abstinence-and-work participants provided more (p = .004; OR = 5.80, 95% CI = 2.03-16.56) cocaine-negative urine samples (29%) than did work-only participants (10%). Employment-based abstinence reinforcement can increase cocaine abstinence.     

CONTINGENT REINFORCEMENT OF ABSTINENCE WITH INDIVIDUALS ABUSING COCAINE AND MARIJUANA

Two males diagnosed with cocaine dependence received a behavioral intervention comprised of contingency management and the community reinforcement approach. During the initial phase of treatment, reinforcement was delivered contingent on submitting cocaine-free urine specimens. The community reinforcement approach involved two behavior therapy sessions each week. Almost complete cocaine abstinence was achieved, but regular marijuana use continued. During a second phase, reinforcement magnitude was reduced, but remained contingent on submitting cocaine-free specimens. Behavior therapy was reduced to once per week. Cocaine abstinence and regular marijuana use continued. Next, reinforcement was delivered contingent on submitting cocaine- and marijuana-free specimens. This modified contingency resulted in an abrupt increase in marijuana abstinence and maintenance of cocaine abstinence. One- and 5-month follow-ups indicated that cocaine abstinence continued, but marijuana smoking resumed. These results indicate that the behavioral intervention was efficacious in achieving abstinence from cocaine and marijuana; maintenance, however, was achieved for cocaine only.     

Antipsychotic medication adherence, cocaine use, and recidivism among a parolee sample

This study examined the independent and interactive associations between cocaine use and antipsychotic medication adherence in predicting 12 month criminal recidivism among a sample of mentally ill parolees (N = 200). Consistent with prior research, cocaine use (based on hair assays) was associated with more than a threefold increase (relative to non-cocaine users) in the likelihood of a parolee being returned to custody during the follow-up period. Although medication adherence (based on urine specimens) was not independently associated with a significant reduction in recidivism risk, the interaction between cocaine use and medication adherence was significant, revealing a disproportionate impact of medication adherence specific to cocaine users. Prediction models of recidivism based on self-reported measures of medication adherence and cocaine use revealed only marginally significant trends for cocaine use, no effect for adherence, and no significant interaction between these two predictors.     

Examining Adolescent Cocaine Use with Social Learning and Self-Control Theories

An estimated 1.6 million adolescents use cocaine on a regular basis. Social learning theory and self-control theory are regularly used to explain adolescent substance use, but few studies have examined Hirschi’s (2004) revised self-control theory. This study examines the efficacy of these three theories in explaining adolescent cocaine use using data from the 2011 Monitoring the Future survey. The study finds that Hirschi’s (2004) revised theory and peer hard drug use predicted the probability of adolescent cocaine use in the previous 30 days. When examining cocaine use in the prior year, all three theoretical perspectives were significant predictor of cocaine use. The implications of the findings are discussed.     

Development of the brief Spanish Cocaine Craving Questionnaire-General

Combining two different samples of cocaine users (N = 183), we tested the factor structure of a brief (12-item), Spanish version of the Cocaine Craving Questionnaire-General using confirmatory factor analysis. The four-factor model provided excellent fit to the measure. Moreover, the measure significantly differentiated between recent cocaine users and abstainers, as well as between participants with different levels of severity of drug-use history. Factor 1 expresses highly intense and overwhelming desires, Factor 2 expresses lack of self-control over cocaine use, Factor 3 items express lack of positive reinforcement expectancies, and Factor 4 expresses stimulating expectancies for cocaine use. The results revealed the validity of the CCQ-General brief as an instrument to assess cocaine craving in Spanish and supported the conceptualization of cocaine craving as a multifaceted construct.     

Depression and decision-making among intravenous drug users

Two short scales, the TCU Depression Scale and the TCU Decision-making Scale, were psychometrically evaluated in a sample of 145 intravenous drug users. Coefficient alpha reliabilities were .78 for the 6-item TCU Depression Scale and .77 for the 9-item TCU Decision-making Scale. Concurrent validity of the former scale was assessed by correlating scores with those on the Beck Depression Inventory, r = .75. Based on the Beck Depression Inventory Clinical cutoff scores, 83% of the sample showed some depression, with 23% severely depressed, 39% moderately depressed, and 21% mildly depressed. Individuals scoring higher on depression on both tests tended to score lower on decision-making. Significant demographic associations of age, gender, education, and race-ethnicity were found for the depression and decision-making scales. More depression was noted for women, those younger, white, and having less education. Older and more educated intravenous drug users tended to score higher on decision-making. Validity for the depression and decision-making scales was assessed by examining correlations with behaviors. Significant positive correlations were found between depression scores and intravenous use of cocaine only, heroin and cocaine combined, and heroin only. Also, intravenous use of cocaine only and of cocaine and heroin combined were negatively related to decision-making. AIDS sex-risky behavior was positively correlated with depression and negatively correlated with decision-making.     

PRENATAL COCAINE EXPOSURE AND NEONATAL CONDITION

Infants who are prenatally exposed to cocaine have an increased risk of suffering neonatal medical complications. We hypothesized that this effect is mediated by the relation between cocaine use and prenatal medical risk of the mother, birth weight, and intrapartum risk, that would lead to increased neonatal complications. This study used structural equation modeling to assess the direct and indirect effects of prenatal cocaine exposure on neonatal medical risk in a sample of 337 neonates. Prenatal cocaine exposure had a significant indirect, but not direct effect on neonatal medical risk. Several paths contributed to this indirect effect. The strongest was via cocaine's impact on birth weight, and birth weight's effect on neonatal medical risk. The paths through prenatal risk and intrapartum risk also contributed to the total indirect effect. These results suggest that the observed relation between prenatal cocaine exposure and neonatal medical complications is mediated by prenatal and intrapartum risk factors.     

Identifying g: A review of current factor analytic practices in the science of mental abilities

Factor analysis is arguably one of the most important tools in the science of mental abilities. While many studies have been conducted to make recommendations regarding “best practices” concerning its use, it is unknown the degree to which contemporary ability researchers abide by those standards. The current study sought to evaluate the typical practices of contemporary ability researchers. We analyzed articles reporting factor analyses of cognitive ability tests administered to adult samples over a 12 year period. Results suggest that, in aggregate, the science of mental abilities seems to be doing well with respect to the issues of sample size, number of indicators (relative to number of factors) and breadth of indicators. Further, our results suggest that the majority of ability researchers are using methods of factor analysis that allow for the identification of a g factor. However, 14.57% failed to use a method that allowed a common factor to emerge. These results provide insights regarding the methodological quality of the science of mental abilities, and will hopefully encourage further “introspective” research into the science of mental abilities.     

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.     

Maternal substance use and mother–infant feeding interactions

The purpose of this study was to examine the impact of maternal polydrug cocaine use during pregnancy and associated risk factors such as maternal psychopathology and negative infant temperament on the quality of mother–infant feeding interactions at 2 months of infant age. Participants were 45 mother–infant dyads (19 cocaine‐exposed and 26 nonexposed) who were recruited at birth and assessed again 2 months of infant age. Mother–infant interactions during feeding were videotaped and coded with regard to dyadic reciprocity, maternal noncontingency, and dyadic conflict. Results indicated that maternal cocaine use was associated with higher dyadic conflict. Moreover, cocaine‐using mothers were also more likely to use marijuana and alcohol, and use of such substances was associated with lower dyadic reciprocity and higher maternal noncontingency during interactions. Results also suggested that one pathway to higher dyadic conflict during interactions among cocaine‐using mothers was through the impact of cocaine on infant risk conditions like lower gestational age and negative temperament (e.g., higher distress to novelty). Interventions focusing on promoting the quality of mother–infant interactions in combination with substance abuse treatment may be especially promising for this population. ©2001 Michigan Association for Infant Mental Health.     

Recent research on the relationship between illicit drug use and crime

This article reviews research on the relationship between illicit drug use and crime conducted since 1980. Significant advances are noted in studies of the crime of known drug abusers and in studies of the drug use of individuals processed by the criminal justice system. Major conclusions supported by the results of studies of the criminal activity of narcotic abusers are that both a higher prevalence and higher rates of crime are associated with more frequent use of heroin and/or cocaine, although addicts vary with regard to the type, amount, and severity of crime they commit. Rates of lifetime and recent illicit drug use, particularly the use of cocaine, among prisoners, parolees, probationers, and arrestees are high compared to the general population. Issues discussed include the etiology of drug abuse, the effects of treatment and criminal justice interventions on drug use and crime, and drug-related violence.     

A Puzzle about Consent in Research and in Practice

In this paper, I will examine a puzzling discrepancy between the way clinicians are allowed to treat their patients and the way researchers are allowed to treat their subjects: in certain cases, researchers are legally required to disclose quite a bit more information when obtaining consent from prospective subjects than clinicians are when obtaining consent from prospective patients. I will argue that the proper resolution of this puzzling discrepancy must appeal to a pragmatic criterion of disclosure for informed consent: that what needs to be disclosed in order for consent to be valid depends on what the patient/subject needs to know in order to make a decision. I will then use this pragmatic criterion of disclosure to argue that when obtaining consent researchers should be permitted to omit the same information clinicians are, given certain qualifications. I will also examine how this puzzle forces us to confront some perhaps surprising truths about valid consent. My broader aim in this paper is to examine, not so much the puzzle itself, but rather what this particular puzzle can teach us about more theoretical issues surrounding informed consent.     

Suicide Attempts within 12 Months of Treatment for Substance Use Disorders

There are limited prospective data on suicide attempts (SA) during the months following treatment for substance use disorders (SUD), a period of high risk. In an analysis of the Drug Abuse Treatment Outcomes Study, a longitudinal naturalistic multisite study of treated SUDs, variables associated with SA in the 12 months following SUD treatment were examined. Participants included 2,966 patients with one or more SUDs. By 12 months, 77 (2.6%) subjects had attempted suicide. Multivariate logistic regression analyses were used to identify variables associated with SA. Variables collected at baseline that were associated with SA included lifetime histories of SA, suicidal ideation (SI), depression, cocaine as primary substance of use, outpatient methadone treatment, and short‐term inpatient treatment. Male sex, older age, and minority race or ethnicity were associated with lower likelihood of SA. After controlling for baseline predictors, variables assessed at 12 months associated with SA included SI during follow‐up and daily or more use of cocaine. The data contribute to a small but growing literature of prospective studies of SA among treated SUDs, and suggest that SUDs with cocaine use disorders in particular should be a focus of prevention efforts.     

Who owns this data? using dialogic reflection to examine an ethically important moment

There has been growing use of reflective practice as a means for examining ethically important moments that occur during research. Reflective practice enables researchers to be alert to the unfolding of these ethically important moments and to consider how they will respond to them. In this paper, we use dialogic reflection to explore an ethically important moment that occurred during one of our research projects. We present our dialogic reflective conversation as a means of exploring the ethical issues associated with data ownership. We draw on this conversation to describe a framework for dialogic reflection that provides researchers with a process for engaging in reflection on their practice as ethical researchers.     

Role of matrix metalloproteinases in the acquisition and reconsolidation of cocaine-induced conditioned place preference

Persistent drug seeking/taking behavior involves the consolidation of memory. With each drug use, the memory may be reactivated and reconsolidated to maintain the original memory. During reactivation, the memory may become labile and susceptible to disruption; thus, molecules involved in plasticity should influence acquisition and/or reconsolidation. Recently, matrix metalloproteinases (MMPs) have been shown to influence neuronal plasticity, presumably by their regulation of extracellular matrix (ECM) molecules involved in synaptic reorganization during learning. We hypothesized that inhibition of MMP activity would impair the acquisition and/or reconsolidation of cocaine-conditioned place preference (CPP) in rats. Intracerebral ventricular (i.c.v.) microinjection of a broad spectrum MMP inhibitor, FN-439, prior to cocaine training suppressed acquisition of CPP and attenuated cocaine-primed reinstatement in extinguished animals. In a separate experiment, the cocaine memory was reactivated on two consecutive days with a cocaine priming injection. On these two days, artificial cerebral spinal fluid (aCSF) or FN-439 was administered either 30 min prior to or 1 min after cocaine-primed reinstatement sessions. Infusion of FN-439 partially impaired retrieval of the cocaine-associated context when given 30 min prior to cocaine. In both groups, however, FN-439 suppressed reinstatement compared with controls on the third consecutive test for cocaine-primed reinstatement, when no FN-439 was given. Control experiments demonstrated that two injections of FN-439 + cocaine given in the home cage, or of FN-439 + saline priming injections in the CPP chambers did not disrupt subsequent cocaine-primed reinstatement. These results show for the first time that (1) MMPs play a critical role in acquisition and reconsolidation of cocaine-induced CPP, and (2) rats demonstrate apparent disruption of reconsolidation by an MMP inhibitor after extinction and while they are under the influence of cocaine during reinstatement.     

Individual characteristics and response to Contingency Management treatment for cocaine addiction

Voucher-based contingency management (CM) research has demonstrated efficacy for treating cocaine addiction, but few studies have examined associations between individual baseline characteristics and response to CM treatments. The aim of this study, involving 50 cocaine outpatients receiving CM for cocaine addiction, was to assess the impact of baseline characteristics on abstinence outcomes after six months of treatment. Patients who were abstinent after six months of treatment accounted for 58% of the sample. Patients with higher scores on the Alcohol area of the EuropASI and patients that were non-abstinent during the first month of treatment were less likely to achieve abstinence. These outcome predictors have implications both for treatment research and for clinical practice. Patients who do not respond early to treatment may need a more intensive intervention, and concomitant problematic alcohol use should be detected and treated. The remaining baseline variables examined were not statistically significant predictors of abstinence. This finding is important for the generalizability of CM across the range of individual characteristics of treatment-seeking cocaine abusers.