Substance abuse detection--current medical perspectives.
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Alcoholism↗
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Potential substance abuse. Detection among adolescent patients. Using the Drug and Alcohol Problem (DAP) Quick Screen, a 30-item questionnaire.
The authors administered an abbreviated revision of a previously field-tested, self-administered, brief screening test (the 30-item Drug and Alcohol Problem Quick Screen) to 355 consecutive middle-class adolescent patients seen at a five-pediatrician group practice setting. Ninety-six percent (341) of the subjects completed the 30-item screening questionnaire. Eighty-nine percent of the 341 responders wrote in their names in the space provided for that purpose. Fifty-two patients (approximately 15%) of the 341 responded "yes" to six or more items in the current study. Based on a previous study comparing scores from 200 adolescents from the same pediatric practice with answers from 100 identified adolescent drug abusers at a drug abuse treatment facility, those patients with a score of 6 or more were considered high risk for "red flag" behaviors, particularly drug or alcohol abuse. Forty (77%) of those patients who scored six or greater identified themselves by name. Four key items on the questionnaire accounted for 70 percent of the variation between those at high and those at low risk for drug or alcohol abuse. These four most important items encompassed 1) use of tobacco products; 2) accusation by others of having a drinking or drug problem; 3) school suspension; and 4) riding in a motor vehicle with a driver who drank too much. The DAP Quick Screen appears to be practical as a screening tool in physician's offices for detection of serious problems during adolescence.
Adolescent↗
The use of the MacAndrew Alcoholism Scale in detecting substance abuse and antisocial personality.
We evaluated the hypothesis that characterological factors, particularly antisocial personality, influence scores on the MacAndrew Alcoholism Scale (MAC). Using the Washington University research criteria to establish diagnoses, the following subgroups were defined: subjects who received no psychiatric diagnoses; subjects who received diagnoses other than alcoholism, drug dependence, or antisocial personality; and subjects who received a diagnosis of alcoholism, drug dependence, and/or antisocial personality, alone or in combination with other psychiatric diagnoses. The highest MAC scores were obtained by subjects diagnosed as having antisocial personality without alcoholism or drug dependence and subjects diagnosed with antisocial personality, drug dependence, and alcoholism. Alcoholics without antisocial personality or drug dependence, and subjects with other psychiatric diagnoses scored lowest. Although higher MAC scores were obtained by males, MAC scores greater than 24 correctly classified the greatest number of males and females as alcoholic, drug dependent and/or antisocial. These findings are interpreted as consistent with MacAndrew's reinterpretation of the scale as assessing a dimension of personality, rather than solely a tendency to addiction.
Adult↗
Amantadine may facilitate detoxification of cocaine addicts.
The effectiveness of amantadine hydrochloride was evaluated in a double-blind placebo controlled drug trial. The subjects were 42 cocaine dependent men enrolled in a day hospital program. Twenty-one patients were prescribed 100 mg/bid of amantadine to be taken over 10.5 days and 21 were prescribed an equivalent amount of placebo. The primary outcome measures were the Addiction Severity Index at 1 month after study entry and urines during the drug trial (end of weeks 1 and 2) and 1 month after study entry. Urines obtained at the end of the drug trial (2 weeks) indicated that the subjects receiving amantadine (93%) were more likely (P = 0.040) to be free of cocaine than the placebo (60%) subjects. Urine toxicology data at 1-month follow-up again indicated that more of the amantadine subjects (83%) were free of cocaine than the placebo (53%) subjects (p = 0.049); although no differences were found in self-reports of cocaine or other substance use in the past 30 days. The urine findings provided preliminary indication that amantadine may have some effectiveness in reducing cocaine use in cocaine dependent patients.
Adult↗
Validity of patients' self-reported drug use as a function of treatment status.
Recent reviews conclude that there is some evidence that drug abusers' self-reports are reliable and valid. However, there are wide variations among studies depending upon the samples and procedures used to obtain the data. The current study was conducted to extend the findings in this area. An examination of the intake interviews and same day urinalyses on 150 patients enrolling for outpatient opioid detoxification or maintenance revealed a fairly high agreement between drug use self-reports and urinalyses. A second study (N = 70) looking at the validity of self-reported drug use at intake and at 4 weeks follow-up revealed some noticeable changes in validity measures, suggesting that contingencies on positive urine results influence self reported drug use of addicts.
Adult↗
Methadone dose and urine morphine.
When methadone maintenance was introduced in 1965, daily doses of approximately 100 mg were advocated and used; later, doses under 50 mg became common; recently, doses between 50 and 100 mg have been recommended. In a historical study and a cross-section study in one program the authors found no relationship between methadone dose and urine morphine. Patients on methadone doses under 50 mg had nearly the same percentage of urine tests positive for morphine as did those on doses of 50 mg and more. Gender, ethnic background, and age were also unrelated to urine morphine. Time on methadone was inversely related to urine morphine. Patients maintained on methadone for 3 years or longer showed a marked decrease in urine tests positive for morphine. Increased urine morphine during one decade was associated with program and community changes that could have prompted increased heroin use. These findings suggest that variables other than methadone dose affect heroin use.
Adult↗
Crack cocaine use in a cohort of methadone maintenance patients.
We examined crack use in a cohort of methadone patients originally enrolled in 1984-86. Crack use questions were added to the study in 1987. Of the 494 methadone patients originally enrolled, 228 subjects remained in methadone and were re-interviewed in 1987-88, and 234 remained in methadone and were re-interviewed in 1988-89. Approximately one-quarter of the subjects were using crack at each of the 1987-88 and 1988-89 data collection points, and only 3% of the subjects were using crack at daily or greater frequencies at each of the 1987-88 and 1988-89 interviews. Concurrent crack use was associated with (a) the number of noninjected drugs being used; (b) the number of IV drug-using sexual partners; (c) drug injection; and (d) the use of nonheroin opiates. Persistent crack use, defined as use in both 1987-88 and 1988-89, was associated with previous noninjected drug use and previous suicide attempts. While the potential problem of crack use among methadone patients should not be minimized, it appears that, compared to illicit drug injectors not in treatment, being in methadone maintenance may offer a protective effect against crack use.
Adult↗
The Norwegian injection mark study.
By examining persons arrested in Oslo during a certain period, we will try to obtain a better picture of intravenous drug abuse in Oslo. A pilot project was organized for 3 months during the autumn of 1987. In addition to having their arms examined, the arrestees were asked some questions about their abuse and HIV-testing. The paper presents some data from the pilot period: 35% of the arrestees had marks from intravenous drug abuse (almost 2/3 of the females and slightly less than 1/3 of the males); 78% of them were men, 22% were women; the majority were in the age range 21-35 years; 53% stated that they injected opiates, 35% that they injected stimulants and 12% that they injected both types. Nearly 80% stated that they had been HIV-tested. A larger proportion of users of opiates (88%) stated that they had been tested than users of stimulants (66%). The prevalence of HIV-seropositive cases among the arrested intravenous abusers was 13.8%. In the paper we also discuss methodological aspects of the study.
Adolescent↗
The effect of a needle and syringe exchange on a methadone maintenance unit.
In November 1986, a pilot needle and syringe exchange was established in Sydney adjacent to a methadone maintenance unit. A retrospective study was carried out to determine the effect of increasing the availability of sterile needles and syringes on the treatment outcome of the methadone maintenance unit. In this study, an increase in availability of sterile needles and syringes was not found to be associated with an increase in the presence of illicit injectable drugs in the urine specimens of clients of the methadone programme compared to a control methadone unit where there was no known change in needle and syringe availability. This study suggests that an increase in the availability of sterile needles and syringes does not appear to lead to an increase in the frequency of intravenous drug use. The possibility of drug and alcohol treatment centres acting as needle and syringe exchange or distribution outlets therefore requires consideration.
Australia↗
Lost opportunity to combat AIDS: drug abusers in the criminal justice system.
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Acquired Immunodeficiency Syndrome↗
Drug screening, AIDS in work place among prominent issues at 1990 AOHC.
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Acquired Immunodeficiency Syndrome↗
The prevalence of substance abuse in patients with suspected preterm labor.
Premature labor is a recognized complication of substance abuse in pregnancy. However, the prevalence of substance abuse in patients first seen with symptoms of preterm labor and who deny use of illicit drugs is unknown. Between July 1, 1988, and December 15, 1988, 141 patients first seen at Northwestern Memorial Hospital in suspected preterm labor and a comparison group of 108 uncomplicated laboring term patients had urine toxicology screening performed to detect substance abuse. Positive urine toxicology screenings were found in 24 of 141 (17.0%) patients with suspected preterm labor and in 3 of 108 (2.8%) patients in the comparison group. The most common substance identified was cocaine (14/24 and 1/3, respectively). Of those patients in suspected preterm labor, 22 of 86 (25.6%) clinic patients had positive urine toxicology screenings as did 2 of 55 (3.6%) private patients. On the basis of our observations, we recommend that patients admitted in possible preterm labor be encouraged to submit to screening for substance abuse so that appropriate counseling and prenatal and neonatal care become available for these high-risk patients.
Adolescent↗
Advisability of substance abuse testing in parents who severely maltreat their children: the issue of drug testing before the juvenile/family courts.
The authors discuss the advisability of juvenile courts requiring urine testing for parents who severely maltreat (abuse and/or neglect) their children. While urine testing for substance abuse is not sufficient to ensure adequate treatment, it is important as part of the overall substance abuse treatment in a selected group of parents. An objective of this article is to offer specific urine testing guidelines in the context of child maltreatment cases in which the court considers removing children from parental custody to state custody. Although potentially useful, urinalysis to detect abused substances has limitations and is appropriate only in well-defined situations. Effective treatment of the substance-abusing, child-maltreating parent must be multimodal, with treatment of substance abuse as the first and most important step.
Adult↗
Nasal administration of naloxone for detection of opiate dependence.
In clinical trials, nasally applied naloxone was used to identify opiate dependence in humans for the first time. Withdrawal distress was recorded, and pupillary response, pulse rate and blood pressure measured. A significant increase in withdrawal distress and pupillary dilation was observed after nasal administration of 1mg (1mg/400 microliters) naloxone in all subjects who also showed opiate-positive urine samples. In control subjects, no reaction to naloxone was observed. It may be concluded that the nasal route for naloxone administration is as effective as the parenteral route. This test is sensitive enough to identify the physically-dependent opiate user and might have a role in emergency medicine and withdrawal treatment.
Administration, Intranasal↗
A randomized double-blind study of neuroelectric therapy in opiate and cocaine detoxification.
Prior research on the use of transcranial neuroelectric stimulation suggested that the application of low-amperage, low-frequency alternating current via surface electrodes placed in the mastoid region could relieve the physiological signs and subjective symptoms of withdrawal and craving during opiate detoxification. These effects were reported without gradual tapering of the opiate or the addition of other medications. To test the efficacy of one particular form of neuroelectric therapy (NET), a double-blind, randomized, placebo-controlled study was conducted comparing active NET and placebo NET in the treatment of withdrawal and stabilization of 18 opiate-dependent and 25 cocaine-dependent subjects. Scores on scales for measuring substance withdrawal and craving for each abused substance, as well as the multiple dimensions of mood, were compared for degree of difference across the 10 days of treatment. There was an overall completion rate of 88%, with both cocaine and opiate groups reporting a comfortable detoxification and substantial improvement over the course of a 12-day hospitalization. There was no significant difference between the active or placebo groups, suggesting that placebo was as effective as active NET in reducing drug withdrawal or craving during cocaine and opiate detoxification. However, all placebo patients received 0.2 mA of current, which may have provided a degree of active current. Suggestions are offered for future research.
Adult↗
Bromocriptine and cocaine cue reactivity in cocaine-dependent patients.
Based on previous reports that bromocriptine, a postsynaptic dopamine agonist, reduced cocaine craving and prevented relapse in cocaine-dependent subjects, effects of the drug were evaluated in 20 cocaine-dependent males in an inpatient drug rehabilitation programme. The subjective and physiologic effects of exposure to both cocaine-associated and neutral stimuli, presented using videotapes, were measured at one-week intervals. Between laboratory sessions subjects received either bromocriptine (1.25 mg bid) or a matched placebo, administered in double-blind fashion. Compared with the neutral videotape, the cocaine videotape elicited both a greater desire to use cocaine and more symptoms associated with cocaine self-administration. These results support an appetitive conditioning model of cocaine effects. Bromocriptine, however, had no effect on the cocaine-cue-associated reactivity, which declined over the 1-week interval in both treatment groups. Methodological differences among studies that have examined the effects of bromocriptine in cocaine-dependent subjects may explain the variable findings observed.
Adolescent↗
Plasma methadone measurements and their role in methadone detoxification programs.
We monitored eight patients who were receiving a decreasing dose of methadone for treatment for opioid addiction (detoxification). Patients with plasma concentrations of methadone less than 0.05 mg/L experienced withdrawal symptoms, relapsed, and re-abused illicit drugs. Four patients took extra methadone (illicitly obtained) during detoxification. None of the eight patients in our study were successfully weaned off methadone: all left the methadone detoxification program before the completion of treatment. Two patients subsequently returned to a fixed methadone program elsewhere, and four relapsed and returned to illicit drug misuse. Plasma measurements may help clinicians assess patients during methadone detoxification.
Adult↗
Detection of adolescent substance abuse in a pediatric outpatient department: a double-blind study.
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Adolescent↗