An appraisal of chemical aversion (emetic therapy) approaches to alcoholism treatment.

More than 35,000 alcoholics have received chemical aversion (emetic therapy) in at least 75 settings worldwide since the 1930s. This consummatory aversion (CA) treatment, which pairs ethanol ingestion with emetically induced nausea, incorporates the highly efficient variety of learning known as taste aversion (TA) conditioning. The CA literature indicates that emetic therapy should induce conditioned alcohol aversions in many alcoholics. Such aversions have been widely reported by clinicians and have been confirmed by recent psychophysiological evidence. Long standing evidence of treatment effectiveness is found in the results of private hospitals which have consistently produced 1-yr abstinence rates approximating 60%. Diminished alcohol craving is a frequently reported benefit. Few experimental evaluations have been completed, as is generally the case for all alcoholism treatments, but those which used methodologically sound temporal parameters during conditioning have supported the clinical efficacy of emetic therapy. The clear need for more definitive research notwithstanding, there are compelling indications that emetic therapy is a useful component of multimodal treatment within certain alcoholic populations. However, its availability is severely limited. Many alcoholics could probably benefit from expanded treatment availability. The time is ripe for a reevaluation of resistances to the clinical use of emetic therapy alcoholism treatment.     

Conditioned inhibition of craving in drug addiction: A pilot experiment

It seems likely that an important reason for the limited success of aversion treatment of drug addiction has been that the aversion is applied only to extrinsic stimuli associated with the drug. No attempt is ordinarily made to combat the endogenous habit.

In the present experiment a subject with a Demerol (Pethidine) addiction of 3 years' standing was instructed to give himself a severe shock from a portable apparatus whenever he felt a desire for the drug arise endogenously. On three occasions he gave himself 4, 3 and 2 shocks respectively, dispelling the craving. After this the apparatus broke down, but for a period of 12 weeks the patient remained free from any but minor cravings that he could easily control.     

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.     

Substance use/abuse as a predictor to illegal and violent behavior: A review of the relevant literature

The preponderance of the research evidence supports the conclusion that abuse of certain types of illicit drugs, separately from the abuse of alcohol, predisposes to subsequent violent behavior. The relationship of cocaine/crack to violent crime has been established more clearly for users of crack in inner city areas than it has for those who are users of other forms of cocaine in the general population.In regard to any race/ethnic or socioeconomic factors in the relationships between substance use/abuse and violent behavior, most clearly established is that a higher proportion of young Black males, compared to other race/ethnic groups, are actively involved in dealing cocaine/crack in some inner city poverty areas.As for gender differences, the research evidence indicates that alcohol abuse as a predictor to and a precipitant of violent behavior, is more clearly established for males than for females. Drug abuse, as distinct from alcohol abuse, has been found to predict subsequent violent behavior, for females as well as for males. “Co-morbidity,” the combination of substance use with and psychopathology, appears more likely to predict for females to later violent behavior. Psychopathology and mental health problems are less likely to predict occurrence of either violent or criminal behavior in the future than are either alcohol abuse or drug abuse.     

Substance use/abuse as a predictor to illegal and violent behavior: A review of the relevant literature

The preponderance of the research evidence supports the conclusion that abuse of certain types of illicit drugs, separately from the abuse of alcohol, predisposes to subsequent violent behavior. The relationship of cocaine/crack to violent crime has been established more clearly for users of crack in inner city areas than it has for those who are users of other forms of cocaine in the general population.In regard to any race/ethnic or socioeconomic factors in the relationships between substance use/abuse and violent behavior, most clearly established is that a higher proportion of young Black males, compared to other race/ethnic groups, are actively involved in dealing cocaine/crack in some inner city poverty areas.As for gender differences, the research evidence indicates that alcohol abuse as a predictor to and a precipitant of violent behavior, is more clearly established for males than for females. Drug abuse, as distinct from alcohol abuse, has been found to predict subsequent violent behavior, for females as well as for males. “Co-morbidity,” the combination of substance use with and psychopathology, appears more likely to predict for females to later violent behavior. Psychopathology and mental health problems are less likely to predict occurrence of either violent or criminal behavior in the future than are either alcohol abuse or drug abuse.     

Cocaine and crack users compared

Because crack use is such a recent phenomenon, little is known about users of this highly addictive drug, the harmful effects of which have been widely publicized. This study hypothesized that crack users would be more depressed and more alienated from family, friends, and school staff than would cocaine users, and would consider as less important reasons not to use crack and cocaine. The authors compared 411 users of cocaine (but not crack) to 156 crack users, all but 22 of whom had also used cocaine. The sample was derived from a larger random survey of 7th- through 12th-grade students in North Carolina. Results indicated that crack users were younger than cocaine users, made poorer grades, were more depressed, and were more likely to be alienated from family and friends. However, cocaine and crack users were equally unlikely to confide in anyone in their school if they had a drinking or drug problem. Further, crack users were more likely to have talked once to a teacher or counselor in the past year about their problems. The implications of these seemingly inconsistent findings are explored. Crack users appear to be a particularly vulnerable population.     

Women Inmate Substance Abusers’ Reactivity to Visual Alcohol, Cigarette, Marijuana, and Crack-Cocaine Cues: Approach and Avoidance as Separate Dimensions of Reactivity

Despite the growing recognition for multidimensional assessments of cue-elicited craving, few studies have attempted to measure multiple response domains associated with craving. The present study evaluated the Ambivalence Model of Craving (Breiner et al. Alcohol Research and Health 23:197–206, 1999; Stritzke et al. 2007) using a unique cue reactivity methodology designed to capture both the desire to use (approach inclination) and desire to not consume (avoidance inclination) in a clinical sample of incarcerated female substance abusers. Participants were 155 incarcerated women who were participating in or waiting to begin participation in a nine-month drug treatment program. Results indicated that all four substance cue-types (alcohol, cigarette, marijuana, and crack cocaine) had good reliability and showed high specificity. Also, the validity of measuring approach and avoidance as separate dimensions was supported, as demonstrated by meaningful clinical distinctions between groups evincing different reactivity patterns and incremental prediction of avoidance inclinations on measures of stages of change readiness. Taken together, results continue to highlight the importance of measuring both approach and avoidance inclinations in the study of cue-elicited craving.     

Withdrawal from cocaine self-administration produces long-lasting deficits in orbitofrontal-dependent reversal learning in rats

Drug addicts make poor decisions. These decision-making deficits have been modeled in addicts and laboratory animals using reversal-learning tasks. However, persistent reversal-learning impairments have been shown in rats and monkeys only after noncontingent cocaine injections. Current thinking holds that to represent the human condition effectively, animal models of addiction must utilize self-administration procedures in which drug is earned contingently; thus, it remains unclear whether reversal-learning deficits caused by noncontingent cocaine exposure are relevant to addiction. To test whether reversal learning deficits are caused by contingent cocaine exposure, we trained rats to self-administer cocaine, assessed cue-induced cocaine seeking in extinction tests after 1 and 30 d of withdrawal, and then tested for reversal learning more than a month later. We found robust time-dependent increases in cue-induced cocaine seeking in the two extinction tests (incubation of craving) and severe reversal-learning impairments.     

EEG Biofeedback for Addictive Disorders—The State of the Art in 2004

This paper reviews studies of brainwave biofeedback as a therapeutic technique for substance use disorder. This modality is attractive as a medication free, neurophysiologic, and self actualizing treatment for a substance based, brain impaired and self-defeating disorder. Three approaches are described and the literature for each reviewed. Alpha–theta occipital feedback was originally employed to facilitate autosuggestion in hypnagogic states to augment standard therapy approaches in substance abuse treatment programs and appears most suited for chronic treatment resistant alcoholics. Beta augmentation feedback in conjunction with alpha/theta feedback has been employed in mixed substance abuse and stimulant abuse with good results. Individualized brainwave biofeedback based on correcting EEG abnormalities, or based on addressing comorbid conditions is a third approach that has been described, and may be most appropriate where confounding comorbid conditions are present. Although effectiveness in certain hard to treat populations (conventional treatment resistant alcoholics, crack cocaine addicts, cognitively impaired substance abusers) is promising, better-designed controlled studies are needed.     

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.     

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.     

Randomized Trial Comparing Two Treatment Strategies Using Prize-Based Reinforcement of Abstinence in Cocaine and Opiate Users

We compared two strategies of prize-based contingency management (CM) in methadone-maintained outpatients. Urine was tested thrice weekly for 5 weeks pre-CM, 12 weeks CM, and 8 weeks post-CM. Participants were randomly assigned to a cocaine contingency (four prize draws for each cocaine-negative urine, N  =  29) or an opiate-cocaine contingency (one draw for each urine negative for opiates or cocaine, four draws if negative for both, N  =  38). There were no group differences in cocaine abstinence during CM or post-CM and no differences in opiate abstinence during CM. Opiate abstinence was greater in the opiate-cocaine group post-CM, and heroin craving was reduced in this group during and post-CM. Draws earned per cocaine-negative urine (four vs. one) did not affect cocaine use.     

gendered pathways into and experiences within crack cultures outside of the inner city

This study examines the life histories of male and female crack addicts outside of the inner city context, focusing on gendered variation in experiences related to childhood background, pathways into crack cocaine use, income generation strategies, and violence. We offer insight into the nature of crack use and culture outside of the inner city and question the generalizability of previous studies to communities outside of the inner city. Furthermore, the question of women's emancipation and the subsequent impact this has had on their roles and experiences within crack cultures is addressed through comparison of male and female experiences within crack cultures. Lastly, the issue of how race, class, and gender interact to shape the experiences of crack addicts is tentatively explored.     

Activation of amygdaloid PKC pathway is necessary for conditioned cues-provoked cocaine memory performance

Drug-associated cues are critical in reinstating the drug taking behavior even during prolonged abstinence and thus are thought to be a key factor to induce drug craving and to cause relapse. Amygdaloid complex has been known for its physiological function in mediating emotional experience storage and emotional cues-regulated memory retrieval. This study was undertaken to examine the role of basolateral nuclei of amygdala and the intracellular signaling molecule in drug cues-elicited cocaine memory retrieval. Systemic anisomycin treatment prior to the retrieval test abolished the cues-provoked cocaine conditioned place preference (CPP) memory. Likewise, a similar blockade of cues-provoked cocaine CPP performance was achieved by infusion of anisomycin and cycloheximide into the basolateral nuclei of amygdala before the test. Intra-amygdaloid infusion of H89, a protein kinase A inhibitor, or U0126, a MEK inhibitor, did not affect retrieval of the cues-elicited cocaine CPP memory. In contrast, intra-amygdaloid infusion of NPC 15437, a PKC inhibitor, abolished the cues-elicited cocaine CPP expression, while left the memory per se intact. Intra-amygdaloid infusion of NPC 15437 did not seem to affect locomotor activity or exert observable aversive effect. Taken together, our results suggest that activation of PKC signaling pathway and probably downstream de novo protein synthesis in the basolateral nuclei of amygdala is required for the cues-elicited cocaine memory performance. However, temporary inhibition of this signaling pathway does not seem to affect cocaine CPP memory per se.     

A Primer of Covert Sensitization

Covert sensitization is the first of a family of behavior therapy procedures called covert conditioning initially developed by Joseph Cautela in the 1960s and 1970s. The covert conditioning procedures involve the use of visualized imagery and are designed to work according to operant conditioning principles. When working with cooperative clients to treat maladaptive approach behaviors, covert sensitization has been found to be a humane and effective alternative to in vivo aversion therapy procedures that employ aversive stimuli such as chemicals and electric shock. This primer describes covert sensitization, provides examples and notes representative research. Guidelines for use and suggestions for further readings are also included.     

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.     

Olfactory aversion conditioning and overeating: a review and some data

The present study evaluated the efficacy of olfactory aversion conditioning in the management of overeating problems. 42 overweight female subjects were assigned to one of three treatment conditions: olfactory aversion therapy, attention placebo control, and no-contact control. One experimenter administered the 8-wk. treatment phase. The aversion therapy procedure entailed the pairing of selected target foods (CSs) with noxious odors (UCSs). There were 25 pairings of the CS and UCSs during each weekly session. Four noxious odors were employed, one each week, to prevent habituation to the UCS. The attention-placebo control procedure was identical except that "air" was substituted for the putative UCS of the aversion therapy condition. At the end of the treatment period the aversion therapy group had lost 4.7 lb.; the attention placebo controls had lost 3.6 lb. and the no-contact controls 0.5 lb. The difference between the aversion therapy group and the no-contact controls was significant and that between the attention placebo group and the no-contact controls approached significance. At a follow-up 8 wk. after the end of the treatment period the weights of all groups had risen to pretreatment levels and there were no differences between them. These results indicate that olfactory aversion therapy is not an efficient technique in promoting weight-loss.     

Cocaine-but not methamphetamine-associated memory requires de novo protein synthesis

Context-induced drug craving and continuous drug use manifest the critical roles of specific memory episodes associated with the drug use experiences. Drug-induced conditioned place preference (CPP) in C57BL/6J mouse model, in this regard, is an appropriate behavioral paradigm to study such drug use-associated memories. Requirement of protein synthesis in various forms of long-term memory formation and storage has been phylogenetically demonstrated. This study was undertaken to study the requirement of protein synthesis in the learning and memory aspect of the conditioned place preference induced by cocaine and methamphetamine, two abused drugs of choice in local area. Since pCREB has been documented as a candidate substrate for mediating the drug-induced neuroadaptation, the pCREB level in hippocampus, nucleus accumbens, and prefrontal cortex was examined for its potential participation in the formation of CPP caused by these psychostimulants. We found that cocaine (2.5 and 5.0 mg/kg/dose)-induced CPP was abolished by the pretreatment of anisomycin (50 mg/kg/dose), a protein synthesis inhibitor, whereas methamphetamine (0.5 or 1.0 mg/kg/dose)-induced CPP was not affected by the anisomycin pretreatment. Likewise, cocaine-induced CPP was mitigated by another protein synthesis inhibitor, cycloheximide (15 mg/kg/injection) pretreatment, whereas methamphetamine-induced CPP remained intact by such pretreatment. Moreover, anisomycin treatment 2h after each drug-place pairing disrupted the cocaine-induced CPP, whereas the same treatment did not affect methamphetamine-induced CPP. An increase of accumbal pCREB level was found to associate with the learning phase of cocaine, but not with the learning phase of methamphetamine. We further found that intraaccumbal CREB antisense oligodeoxynucleotide infusion diminished cocaine-induced CPP, whereas did not affect the methamphetamine-induced CPP. Taken together, these data suggest that protein synthesis and accumbal CREB phosphorylation are essential for the learning and consolidation of the cocaine-induced CPP, whereas methamphetamine-induced CPP may be unrelated to the synthesis of new proteins.     

Dual-memory processes in crack cocaine dependents: The effects of childhood neglect on recall

Exposure to adversities during sensitive periods of neurodevelopment is associated with the subsequent development of substance dependence and exerts harmful, long-lasting effects upon memory functioning. In this study, we investigated the relationship between childhood neglect (CN) and memory using a dual-process model that quantifies recollective and non-recollective retrieval processes in crack cocaine dependents. Eighty-four female crack cocaine–dependent inpatients who did (N = 32) or did not (N = 52) report a history of CN received multiple opportunities to study and recall a short list composed of familiar and concrete words and then received a delayed-recall test. Crack cocaine dependents with a history of CN showed worse performance on free-recall tests than did dependents without a history of CN; this finding was associated with declines in recollective retrieval (direct access) rather than non-recollective retrieval. In addition, we found no evidence of group differences in forgetting rates between immediate- and delayed-recall tests. The results support developmental models of traumatology and suggest that neglect of crack cocaine dependents in early life disrupts the adult memory processes that support the retrieval of detailed representations of events from the past.