Psychopathology in substance abusers: diagnosis and treatment.
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Blood Platelets↗
Biomedical subjects
R D Weiss
Publications and source records attributed to R D Weiss.
Decreased single breath carbon monoxide diffusing capacity in cocaine freebase smokers.
The authors performed pulmonary function tests on 10 chronic cocaine freebase smokers. Testing occurred at least 2 weeks after stopping cocaine use. Mean single breath carbon monoxide diffusing capacity (DLCOSB) was significantly reduced (P less than 0.05) in the cocaine smokers when compared with a control group of non-smokers and non-drug users. All other parameters of lung function were normal. Since most of the cocaine smokers also smoked tobacco, the observed abnormality may have been due to an additive effect of the 2 substances. The authors conclude that smoking cocaine may damage the gas exchange surface of the lung.
Adult↗
The use of the Diagnostic Interview Schedule in drug-dependent patients.
In an attempt to diagnose other psychiatric disorders in substance abusers, some clinicians and investigators have utilized the NIMH Diagnostic Interview Schedule (DIS). This study assessed the validity of the DIS in a drug-dependent population by comparing DIS diagnoses with clinical diagnoses in 124 hospitalized drug abusers. Every attempt was made to establish the validity of the clinical diagnoses; these represented a consensus of two independent psychiatrists, based on repeated clinical interviews, observation of ward behavior, and information obtained from relatives regarding patient and family history. Concordance between clinical and DIS diagnoses (represented by the kappa statistic and percent agreement) was only moderate for DSM-III Axis I disorders other than substance abuse. In addition, the DIS diagnosed alcoholism less often and antisocial personality disorder more often than the clinicians. Factors contributing to the discrepancy between clinical and DIS diagnoses in this specific population include (a) drug abuse effects, whereby distinguishing between drug effects and primary psychiatric symptoms may be difficult; and (b) the effect of the treatment process itself, whereby patients are encouraged to rethink the role drugs have played in causing some of their difficulties. Patients' reports of the chronology of their symptoms may thus change according to what they have learned in treatment. The authors conclude that the DIS, like any single diagnostic interview, may have limited utility early in the treatment of drug-dependent patients, since their recollection of their previous symptoms may change dramatically as a result of treatment efforts.
Adult↗
Psychopathology in chronic cocaine abusers.
A group of 30 hospitalized cocaine abusers were studied, along with 124 hospitalized patients who were dependent upon opiates or central nervous system depressants. DSM-III diagnoses, family history data, demographic characteristics, and measures of current depressive symptomatology were compared in the two groups. Nineteen (63%) of the cocaine abusers met criteria for an Axis I diagnosis other than substance abuse; sixteen (53%) had affective disorder. These figures reflected a significantly higher prevalence rate of affective disorder among the cocaine abusers than among the opiate and depressant abusers. In addition, a significantly higher rate of affective disorder was found in the first degree relatives of the cocaine abusers when compared to the other group. Since these findings suggest that a substantial number of cocaine abusers may be suffering from other psychiatric disorders, careful diagnostic evaluation is indicated in this population.
Adult↗
Affective illness in substance abusers.
The evaluation and treatment of substance abusers are complicated tasks, requiring a multifaceted approach. In addition to the patient's substance abuse problems, a substantial minority appear to be suffering from concurrent, nondrug-related psychiatric disorders. The early identification of such individuals allows for the development of specific treatment strategies that address both the substance abuse and the associated nondrug psychopathology. On the other hand, attention to nondrug psychopathology should not preclude our simultaneously addressing the patient's substance abuse problem. Thus, manic depressive patients who are also alcoholic may need a treatment program that includes alcoholism counseling. Alcoholics Anonymous, and chronic administration of disulfiram in addition to lithium carbonate and a supportive psychotherapeutic relationship. As in other areas of medicine, attention to the "whole patient" is the sine qua non of good treatment.
Central Nervous System Depressants↗
Subtypes of cocaine abusers.
We have characterized five subtypes of cocaine abusers on the basis of clinical presentation, family history data, and response to specific treatment interventions. These include depressed patients who value the euphorigenic effects of the drug, patients with bipolar or cyclothymic disorder who use cocaine to augment manic or hypomanic symptoms or to alleviate depression, adults with ADD, residual type, who find that cocaine has a paradoxical effect of increasing attention span and decreasing motor restlessness, patients with narcissistic and borderline personality disorders who use cocaine for its social prestige and because it bolsters self-esteem, and patients with antisocial personality disorder who use cocaine as part of an overall pattern of antisocial behavior. Although not all cocaine abusers fit neatly into these categories, careful psychiatric evaluation and subtyping is essential in designing a specific treatment program for these patients. As the prevalence rate of cocaine abuse increases, studies that examine the efficacy of various treatment approaches for specific subtypes of cocaine abusers will be essential. It is hoped that our work will be a step in that direction.
Adult↗
Treatment of chronic cocaine abuse and attention deficit disorder, residual type, with magnesium pemoline.
Research suggests that attention deficit disorder (ADD) may persist into adulthood, perhaps predisposing certain individuals to stimulant abuse. The authors describe two adults with chronic cocaine abuse and apparent residual ADD. After failing to respond to conventional treatment modalities, these patients were administered magnesium pemoline. Both displayed a sustained reduction in their cocaine use, without abusing pemoline. This finding suggests that the diagnostic assessment of cocaine abusers should include a search for a history of ADD. A carefully selected subgroup of this population may benefit from treatment with other stimulant medications.
Adult↗
Substance abuse as an attempt at self-medication.
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Alcoholism↗
Pulmonary dysfunction in cocaine smokers.
The authors report another complication of freebase cocaine smoking. They found a significant reduction in the carbon monoxide diffusing capacity in the lungs of two patients. This suggests that inhalation of the freebase of cocaine may damage the pulmonary gas exchange surface.
Adult↗
Psychopathology in drug abusers and their families.
Demographic, clinical, and family pedigree data obtained on 350 hospitalized drug-dependent patients showed that 52% also met DSM-III criteria for alcohol abuse or dependence, while 37% met DSM-III criteria for a concurrent axis I psychiatric disorder other than substance abuse. Cyclothymic disorder was significantly more common among cocaine abusers, while generalized anxiety disorder and panic disorder were more common among sedative-hypnotic abusers. Data on 1,478 first-degree relatives revealed that the prevalence of alcoholism and affective disorder was highly correlated with the occurrence of similar psychopathology in the probands. These findings suggest a relationship between drug of choice and comorbid psychopathology, a role for familial factors in the transmission of these disorders, and the importance of diagnostic subtypes in the evaluation and treatment of substance abusers.
Adult↗
Personality disorders in cocaine dependence.
To assess the relationship between cocaine dependence and personality disorders, we administered the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) to 50 patients who were hospitalized for cocaine dependence. We modified the SCID-II so that patients were asked to indicate whether personality traits (if present) occurred during periods of drug use, abstinence, or both. Thirty-seven patients (74%) received at least one axis II diagnosis; 69% of these diagnoses were present both during periods of drug use and abstinence. Only one patient received a diagnosis during periods of drug use alone. These findings suggest that personality disorder diagnoses in cocaine-dependent patients remain relatively stable regardless of current drug use patterns. These data support clinicians' addressing these maladaptive personality traits as part of treatment for cocaine dependence.
Adult↗
Group cognitive-behavioral therapy for women with PTSD and substance use disorder.
This paper describes a model of group cognitive-behavioral therapy (CBT) for women with posttraumatic stress disorder (PTSD) and substance use disorder (SUD). The need for specialized treatment derives from the high incidence of these comorbid disorders among women as well as from their particular clinical presentation and treatment needs. The treatment educates patients about the two disorders, promotes self-control skills to manage overwhelming affects, teaches functional behaviors that may have deteriorated as a result of the disorders, and provides relapse prevention training. The program draws on educational principles to make it accessible for this population: visual aids, education for the patient role, teaching for generalization, emphasis on structured treatment, testing of acquired knowledge of CBT, affectively engaging themes and materials, and memory enhancement devices.
Cognitive Behavioral Therapy↗
Brain ventricular size in female alcoholics: an MRI study.
The brains of ten alcohol-dependent women between the ages of 21 and 65 were studied with Magnetic Resonance Imaging (MRI) techniques. All women had MRI scans twice during the withdrawal period. Only one of the ten women had abnormally enlarged ventricles. At the time of the second scan there were no significant changes in ventricular size from the first scan. No correlations were found between age and ventricular size, or years of alcohol abuse and ventricular size.
Adult↗
Twelve-month test-retest reliability of the structured clinical interview for DSM-III-R personality disorders in cocaine-dependent patients.
This study examined 12-month test-retest reliability of the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) in cocaine-dependent patients. Thirty-one patients completed the SCID-II during the second week of hospitalization for cocaine dependence, and again 12 months later. In both interviews, patients were asked to answer questions about their personality during the several years preceding admission to the hospital. Test-retest reliability, as measured by kappa, was relatively poor at .46. However, reliability of negative diagnoses (the absence of a disorder at both time points) was higher than reliability of positive diagnoses (the presence of a disorder at both time points). Reasons for the difficulty in attaining long-term test-retest reliability of axis II diagnoses in cocaine-dependent patients are discussed.
Adult↗
Bacteriocin-like substance of Aeromonas hydrophila.
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Aeromonas hydrophila↗
The role of psychotherapy in the treatment of substance-use disorders.
Psychotherapies for substance-use disorders are reviewed, with particular attention to modifications of standard treatments necessary to make them effective for patients with disorders. Treatments reviewed include cognitive-behavioral therapies (Relapse Prevention, Cognitive Therapy, Contingency Contracting, Behavioral Treatment, Cue Exposure, Network Therapy, and Aversion Therapy) and psychodynamic/interpersonal methods (Supportive-Expressive Therapy, Interpersonal Therapy, Motivational Interviewing, and Modified Psychoanalytic Therapy). The psychotherapies selected are individual, verbally based treatments for substance-use disorders; except for modified psychoanalytic therapy, all have been presented in treatment manuals and empirically studied. Research shows that these forms of psychotherapy can be effective, with some treatments providing more benefit than others for specific subpopulations, but no one treatment is consistently more effective than any other. General guidelines consistent across psychotherapies for substance-use disorders are discussed, with emphasis on phases of treatment, the importance of a compassionate stance by the therapist, the difficulty of engaging substance abusers in treatment, the need for urine and breath-alcohol testing, assessment of comorbid disorders, countertransference problems, the need for multiple treatment modalities, evaluation of the therapist's effectiveness, adjusting the amount of treatment, and appropriate termination. Directions for future research are also discussed.
Humans↗
The effect of comorbid substance use disorders on the course of bipolar disorder: a review.
Population-based studies have documented that among all patients with major psychiatric disorders, those with bipolar disorder have the highest prevalence of comorbid substance abuse and dependence. The cause of this high comorbidity rate has not been clearly established, and the relationship is probably bidirectional. Articles published in English from 1980 through 1997 containing the terms comorbidity, mania, outcome, and substance use were identified by searching Medline and then the bibliographies of the articles identified in this search. The literature review showed several risk factors to be associated with comorbid substance use disorders in bipolar disorder patients: early age of onset, gender, family history of substance use disorders, and presence of mixed mania. Methodological enhancements that have helped to advance understanding in this area include distinguishing between primary and secondary disorders, between the different subtypes of bipolar disorder, and between first and subsequent episodes of illness. In order to determine the temporal sequence of onset, longitudinal studies initiated at the onset of either illness need to be pursued. Increased understanding of the association between bipolar disorder and comorbid substance use disorder will facilitate improved detection and intervention, as well as more-effective preventive measures that could improve outcome for patients with bipolar disorder.
Adolescent↗