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Cocaine use and dependence in young adults: associated psychiatric disorders and personality traits
Abstract
Current and lifetime prevalence of substance use and psychiatric disorders was determined by administering the NIMH-DIS, revised to cover DSM-III-R diagnoses, to a sample of 1007 young adults. Personality and affectivity were measured also. Increased rate of any Substance Use Disorder was related to use of cocaine more than 5 times over the lifetime regardless of whether or not criteria for Cocaine Dependence were met. Increased rate of any Affective Disorder was related to dependence in those who used cocaine more than 5 times. Cocaine use was associated with increased neuroticism, psychoticism and negative affect.
... Lifetime nicotine dependence is associated with higher levels of neuroticism (Brcslau, Kilbey, & Andreski, 1994) as are alcohol-use disorders (Martin & Sher. 1994), and lifetime cocaine dependence is related to higher levels of psychoticism and negative affect (Kilbey, Breslau, & Andreski, 1992). The relationship of these variables to changes in alcohol dependence status is not known. ...
The relationship of alcohol outcome expectancies and other risk factors: demographic, personality, and affectivity, to alcohol dependence status was examined over a 3.5-year interval in 1,007 young adults. Lifetime prevalence of alcohol dependence was 18.1% at baseline. Of persons classified as current alcohol dependent at baseline, 66.9% experienced remission at the 3.5-year follow-up. Of persons classified as remitted alcohol dependent at baseline, 11.3% were current alcohol dependent at the 3.5-year follow-up. At follow-up, 5% of persons with no history of alcohol dependence at baseline met criteria for current alcohol dependence. Male gender, higher extraversion, and lower positive affect scores predicted emergent current alcohol dependence at the 3.5-year interval. Persistent current alcohol dependence was predicted by the expectation of improved social and sexual experiences following alcohol use. The findings suggest that positive expectancies may be an important factor in persistence of alcohol dependence and that their modification may enhance treatment of alcohol dependence in young adults.
... In the medical utility of cocaine, it can be used as a local numbing agent to help with painful procedures [96]. However, excessive and repeated cocaine consumption is also associated with an increased risk of a range of somatic, psychological and social problems, such as psychosis and aggression [97][98][99]. An estimated 20 million people used cocaine in 2019, corresponding to 0.4 per cent of the global population [3]. ...
Psychoactive substances are a class of chemical substances which could cause public health threats. Cognitive disorders are a category of mental health disorders that primarily affect cognitive abilities. Tau protein could maintain neuronal cytoskeleton stabilization. Post-translational modification of tau, especially phosphorylation, is an important way to regulate the structure and function of tau and phosphorylated tau is closely related to cognitive function. Lots of studies have reported the phenomenon that psychoactive substances can cause cognitive function impairment. We reviewed recent related studies and discussed them by drug classification. We mainly focused on cognitive disorders caused by acute or chronic exposure of each drugs, animal experiments and the mechanisms associated with tau phosphorylation, then compared the similarities and differences among them, trying to find out the common rules. The results suggested that tau phosphorylation is involved in psychoactive substance-induced cognitive disorder and different psychoactive substances may act by affecting amount or activity of different kinases and phosphatases in the metabolic pathway of tau. We demonstrated that tau protein is a potential target for psychoactive substances induced cognitive disorder treatments.
... It is also hypothesized that working memory deficits prior to drug exposure increase vulnerability to drug addiction. Consistent with this hypothesis, individuals suffering from psychiatric disorders with significant learning and memory deficits such as depression and schizophrenia have high rates of stimulant addiction (14,15,64,65). Also, a recent study reported that adolescents with weak working memory were more vulnerable to get addicted to drugs of abuse (66). ...
Addiction to psychostimulants like cocaine, methamphetamine, and nicotine poses a continuing medical and social challenge both in the United States and all over the world. Despite a desire to quit drug use, return to drug use after a period of abstinence is a common problem among individuals dependent on psychostimulants. Recovery for psychostimulant drug-dependent individuals is particularly challenging because psychostimulant drugs induce significant changes in brain regions associated with cognitive functions leading to cognitive deficits. These cognitive deficits include impairments in learning/memory, poor decision making, and impaired control of behavioral output. Importantly, these drug-induced cognitive deficits often impact adherence to addiction treatment programs and predispose abstinent addicts to drug use relapse. Additionally, these cognitive deficits impact effective social and professional rehabilitation of abstinent addicts. The goal of this paper is to review neural substrates based on animal studies that could be pharmacologically targeted to reverse psychostimulant-induced cognitive deficits such as impulsivity and impairment in learning and memory. Further, the review will discuss neural substrates that could be used to facilitate extinction learning and thus reduce emotional and behavioral responses to drug-associated cues. Moreover, the review will discuss some non-pharmacological approaches that could be used either alone or in combination with pharmacological compounds to treat the above-mentioned cognitive deficits. Psychostimulant addiction treatment, which includes treatment for cognitive deficits, will help promote abstinence and allow for better rehabilitation and integration of abstinent individuals into society.
... It is characterized by emotional instability, self-consciousness, anxiety, negative affect, and sensitivity to negative environmental stimuli (Izard et al., 1993;Larsen and Ketelaar, 1991;Rusting and Larsen, 1997). Disorders commonly associated with high neuroticism include depression, anxiety, eating disorders, substance abuse, schizophrenia, and Alzheimer's Disease (AD) (Clark et al., 1994;Davis, 1997;Jylhä and Isometsä, 2006;Kilbey et al., 1992;Ormel et al., 2004;Prescott et al., 1997;Van Os and Jones, 2001;Wilson et al., 2006). ...
Neuroticism is associated with greater reactivity to stress and lifetime psychopathology. In the present study we examined the association between neuroticism and regional and total cortical thickness (CT) across the lifespan, accounting for gender. We also assessed interactions among these factors. 450 subjects between 19 and 80 years were included. Participants completed the International Personality Item Pool and a structural MRI scan. Total CT and the mean values of CT in five regions of interest were examined. We also investigated the interaction effect among age, gender and neuroticism on CT. There was no significant association between neuroticism and regional/total CT. A significant interaction between neuroticism, age, and gender on the thickness of the anterior cingulate was found. Women high in neuroticism showed a thinner anterior cingulate cortex than women low in neuroticism, with increasing age. In contrast, men high in neuroticism had a thicker anterior cingulate cortex compared to men low in neuroticism, with increasing age. Overall, high neuroticism was associated with differential cortical thickness in the anterior cingulate among men and women with increasing age.
... Previous studies have used a variety of measures and timeframes for correlating affect and drug use. Young adults with cocaine dependence reported greater NA scores (N ¼ 34, M ¼ 21.38) on the PANAS 3 compared with non-dependent cocaine users (N ¼ 90, M ¼ 19.94) and with "non-users" (N ¼ 883, M ¼ 18.29), but the groups did not differ on PA. 11 However, higher PA on the modified Differential Emotions Scale 12 was indirectly associated with lower stimulant use among 88 treatment-seeking men. 13 Higher PA on the Ryman mood questionnaire 14 was correlated with lower cocaine relapse likelihood in the next week in retrospective reports among 104 adults. ...
Background
Cognitive‐behavior therapy (CBT) for substance use disorder is empirically supported, and may be associated with change in affect over time.
Objectives
Understanding the role of affect in cocaine use disorder could help to improve CBT outcomes.
Methods
This secondary analysis included 140 adults with cocaine use disorder, 57.9% female, drawn from two randomized controlled studies of web‐based cognitive‐behavior therapy who completed the Positive and Negative Affect Scale (PANAS) before and during treatment.
Results
In mixed‐effects regression models, baseline negative affect (NA) scores were not associated with self‐reported cocaine use during treatment, but baseline PA scores were associated with less frequent cocaine use (β = −0.04, p = .02). During treatment, NA scores reduced over time in CBT and treatment as usual (β = −0.27, p < .01), although PA scores did not change. Higher weekly NA scores were associated with weekly cocaine use (β = .02, SE = .01, t(746.15) = 2.37, p = .02), although weekly PANAS PA scores were not associated with weekly cocaine use.
Discussion and Conclusions
Results indicated that individuals with higher baseline PA were more likely to abstain from cocaine use during treatment, even when controlling for baseline cocaine use frequency. Although baseline NA was not associated with cocaine use, NA during treatment was associated with greater cocaine use.
Scientific Significance
PA at baseline and NA during treatment were associated with cocaine use. If findings are replicated, treatment developers may wish to include treatment interventions to boost early PA and reduce NA throughout treatment. (Am J Addict 2018;XX:1–8)
... Other conditions may additionally predispose them to substance abuse, such as mood disorders. Thus, it is not surprising that the concept of ' negative emotionality ' has been invoked as a risk factor for problems with substances, and has found empirical support by some (Kilbey et al. 1992 ;Sher et al. 2000 ) but not others (Teichman et al. 1989 ). In addition to familial risk, young people with affective disturbance, conduct problems, and neurotic or disinhibited personalities appear to be at risk for escalating substance abuse once initiated 71 . ...
This article has no abstract.
... -Marihuana: un metaanálisis [17] que categorizó los rasgos en afecto negativo (como depresión, ansiedad), emocionalidad (extroversión, desinhibición social) e inconvencionalidad (tolerancia a las desviaciones, irreligiosidad), los cuales podrían coincidir con neuroticismo, extroversión y apertura, respectivamente, sugirió que el uso de marihuana se relacionaba con altos niveles de inconvencionalidad y sólo débilmente con emocionalidad y afecto negativo. -Cocaína: los consumidores se caracterizarían por altos niveles de rasgos relacionados con el neuroticismo, tales como depresión e impulsividad, así como psicoticismo, un rasgo relacionado con baja conformidad y baja autotrascendencia [18,19]. -Heroína: los estudios los dibujan repetidamente como con alto neuroticismo [20]. ...
... 1996; Manschreck et al., 1990;Rogers and Robbins, 2001). In terms of affective dysfunction, cocaine users have a high incidence of depressive disorders, attention deficit disorder, and other psychopathologies (Carroll et al., 1994;Clure et al., 1999;Kilbey et al., 1992;Levin et al., in press). Paralleling these alterations in affect and cognition, there are widespread structural and functional brain abnormalities associated with chronic cocaine use. ...
... Cocaine has been used at least once in a lifetime by 4.3% of the general population (EMCDDA, 2011). Cocaine use is associated with an increased risk of a range of somatic, psychological, and social problems, such as cardiac toxicity, psychosis, mood and anxiety disorders, aggression and crime (Gawin and Kleber, 1986;Kilbey et al., 1992;Kloner and Hale, 1993;Maraj et al., 2010) and a considerable risk of transition to addiction (Dhossche and Rubinstein, 1997;Gawin, 1991;Licata et al., 1993). Establishing cognitive alterations associated with cocaine use may lead to a better understanding of mechanisms associated with this transition. ...
... Similarly, of the 20% of substance users found to have an anxiety disorder, 60% had the anxiety disorder prior to substance use. Thus, it is not surprising that the concept of 'negative emotionality' has been invoked as a risk factor for problems with substances, and has found empirical support by some (Kilbey et al., 1992; Sher et al., 2000) but not others (Teichman et al., 1989). Several studies have shown an increased association between drug abuse or dependence and anxiety disorders (Merikangas et al., 1998), and individuals with substance use disorders have signifi cantly elevated anxiety and anger scores (Walfi sh et al., 1990). ...
... Such findings may reflect the ability of alcohol to reduce negative affect (Gilman et al., 2008). Negative affect has also been associated with cocaine use, with higher levels of associated with cocaine use in a community-based sample of young adults (Kilbey et al., 1992) and depression in adolescents predicted higher cocaine use the following year (Newcomb and Bentler, 1986). These findings are contrary to the hypothesis that negative affect traits selectively confer enhanced risk of opiate and anxiolytic abuse. ...
Substance dependence is complex and multifactorial, with many distinct pathways involved in both the development and subsequent maintenance of addictive behaviors. Various cognitive mechanisms have been implicated, including impulsivity, compulsivity, and impaired decision-making. These mechanisms are modulated by emotional processes, resulting in increased likelihood of initial drug use, sustained substance dependence, and increased relapse during periods of abstinence. Emotional traits, such as sensation-seeking, are risk factors for substance use, and chronic drug use can result in further emotional dysregulation via effects on reward, motivation, and stress systems. We will explore theories of hyper and hypo sensitivity of the brain reward systems that may underpin motivational abnormalities and anhedonia. Disturbances in these systems contribute to the biasing of emotional processing toward cues related to drug use at the expense of natural rewards, which serves to maintain addictive behavior, via enhanced drug craving. We will additionally focus on the sensitization of the brain stress systems that result in negative affect states that continue into protracted abstinence that is may lead to compulsive drug-taking. We will explore how these emotional dysregulations impact upon decision-making controlled by goal-directed and habitual action selections systems, and, in combination with a failure of prefrontal inhibitory control, mediate maladaptive decision-making observed in substance dependent individuals such that they continue drug use in spite of negative consequences. An understanding of the emotional impacts on cognition in substance dependent individuals may guide the development of more effective therapeutic interventions.
... The significant association between methamphetamine use and depressive symptoms is consistent with data from other studies of stimulant users. For example, the literature on cocaine and depressive disorders suggests that higher frequency of problematic cocaine use is associated with higher levels of depressive symptoms (Falck, Wang, Carlson, Eddy, & Siegal, 2002;Grant, 1995;Kilbey, Breslau, & Andreski, 1992). The mechanisms through which methamphetamine use leads to depressive symptoms remain unclear. ...
This study investigated the relationship between intensity of methamphetamine use and depressive symptoms in a sample of 182 heterosexually identified methamphetamine users. Perceived stigma and social and health problems were hypothesized as potential mediators of the relationship between methamphetamine use and depressive symptoms. Forty per cent of the sample met criteria for moderate to severe depression. As hypothesized, the greater the intensity of methamphetamine use, the higher the levels of depressive symptoms. Results of the mediation analyses failed to identify mediating effects for stigma, social problems or health problems. However, perceived stigma had a significant positive direct effect on depressive symptoms. Gender, age and marital status also predicted higher levels of depression. This research suggests the need for drug treatment programmes to: (1) identify and treat depressive symptoms among methamphetamine users; and (2) address social and psychological issues, such as perceived stigma, in an effort to decrease depressive symptomatology and ultimately enhance programme effectiveness.
... High rates of depression in cocaine abusers were first reported over 20 years ago (Weiss et al., 1986), and experience in drug abuse clinics has continued to support an association between psychiatric disorders and substance abuse (Kilbey et al., 1992). In general, cocaine abuse and dependence are associated with increased risk for depression, with lifetime rates of major depression ranging from 25%-61% in cocaine abusers versus ~10% for community control populations (Rounsaville, 2004). ...
Depression and psychostimulant addiction are co-morbid conditions; depression is a significant risk factor for psychostimulant abuse, and the rate of depression in drug addicts is higher than in the general population. Despite the prevalence of this comorbidity, there are few animal models examining psychostimulant abuse behaviors in depression. We have shown previously that while rats selectively bred for depression-like phenotypes (SwLo) have blunted mesolimbic dopamine (DA) signaling and locomotor responses to dopaminergic drugs, they voluntarily administer excessive amounts of psychostimulants compared to normal or depression-resistant (SwHi) rats in oral consumption paradigms. To determine whether this increased drug intake by depression-sensitive rats extends to operant self-administration, we assessed fixed ratio-1, progressive ratio, extinction, and reinstatement responding for cocaine and amphetamine in SwLo and SwHi rats. Contrary to the oral consumption results, we found that the SwHi rats generally responded more for both cocaine and amphetamine than the SwLo rats in several instances, most notably in the progressive ratio and reinstatement tests. Food-primed reinstatement of food seeking was also elevated in SwHi rats. These results provide further insight into the neurobiology of depression and addiction comorbidity and caution that oral and operant psychostimulant self-administration paradigms can yield different, and this case, opposite results.
... The items primarily tap antisocial, impulsive, non-conforming, callous and sadistic traits and secondarily tap paranoid ideation and anhedonia, and so it is not surprising that many investigators have found that antisocial and non-conforming persons have elevated scores on the scale. The number of demonstrations of this point is too large to review here, but in 1991 and 1992 alone, researchers have reported that the P-Scale is related to antisocial behavior (Farrell, 1992); criminality (Rahman, 1992; Gudjonsson, Petursson, Sigurdardottir, & Skulason, 1991); drug use (Nagoshi, Walter, Mutaner & Haertzen, 1992; Bentler, 1992; Kilbey, Breslau, & Andreski, 1992); delinquency (Fumham & Thompson, 1991); violent behavior (Cookson, Rushton, & Thornton, 1991); a preference for graphic violence in movies (Weaver, 1991), unsafe sexual practices (McCown, 1991), sadomasochistic sexual practices (Gosselin, Wilson, &Barrett, 1991), suicidal ideation and behavior (Lolas, Gomez & Suarez, 199 1; de Leo, Predieri, Melodia, Vella, Forza & De Bertolini, 199 1) and poor study habits (McCown & Johnson, 1991). The literature on psychosis is much smaller, but schizophrenics and other psychotics are usually found to score lower than antisocial Ss, although higher than most normal control Ss (Eysenck & Eysenck, 1976; Eysenck, 1992). ...
534 college students were selected by their scores on several scales of psychosis proneness, were interviewed, and were given the Eysenck and Eysenck (1975) Psychoticism Scale (P-Scale). After 10 yr, 508 subjects were reinterviewed. Subjects identified by initial deviantly high scores on the P-Scale (N = 26) did not differ from control subjects (N = 310) on the rate of subjects who developed psychotic disorders or in reports of psychotic relatives. However, High P subjects exceeded controls on ratings of psychoticlike experiences and on symptoms of schizotypal and paranoid personality disorder. The findings indicate that high scorers on the P-Scale are psychoticlike but are not at heightened risk for psychosis.
... In the broadly clinical domain alone there is a huge variety of phenomena found to be associated with raised neuroticism. N correlates positively with susceptibility to most sources of pain (Bru, Myletun & Svebak, 1993; Costa, 1987); all manner of psychosomatic complaints (Kentle, 1989; Sainsbury, 1960; Yadav, Jain, Bahre & Gupta,1990); the symptoms of manifestly physical illness, such as the common cold (Carr, 1981); the premenstrual syndrome (van den Akker, Eves, Stein & Murray, 1995); eating disorders of both the bulimic and anorectic type (Davis, 1997); the predisposition to (Saklofske, Kelly & Janzen, 1995), and failure to recover from (Duggan, Lee & Murray, 1990), depression; suicidality (Statham et al., 1998); and with the abuse of drugs as dierent as nicotine (Breslau, Kilbey & Andreski, 1993), alcohol (Prescott, Neale, Corey & Kendler, 1997), and cocaine (Kilbey Breslau & Andreski, 1992). Increased N is found, predictably, not only in`dysthymicin`dysthymic' reactions such as anxiety neurosis (Claridge, 1967; Eysenck & Eysenck, 1975) and obsessive-compulsive disorder (Slade, 1974), but also in most personality disorders (Trull, 1992), as well as in acute schizophrenia (Claridge, 1967; McGuire, Mowbray & Vallance, 1963 ). ...
In this paper we examine two aspects of neuroticism (N): its status as a personality descriptor and its role in the personality dynamics of abnormal states. We first suggest that high N is such a universal accompaniment of abnormal functioning (both psychological and biological) that by itself it has little descriptive or explanatory value. Then, acknowledging that N has more utility when used alongside other personality variables, we argue that here the most informative are disorder-specific characteristics that have unique variance, while also correlating with N. We propose that N's role in aetiology is that of a moderator variable, influencing the expression of these disorder-specific characteristics to produce (or not) the clinical conditions to which they relate. By way of illustration, examples are taken from our joint studies of the eating disorders and of schizotypy and schizophrenia.
... Cocaine users often experience depression (Brienza et al., 2000; Kidorf et al., 2004; Kilbey et al., 1992; Falck et al., 2002; Wild et al., 2005). Specifically, 25–61% of individuals in treatment for cocaine abuse or dependence (Rounsaville et al., 1991) are diagnosed with mood disorders, including specifically major depressive disorder. ...
Much effort has been devoted to research focused on pharmacotherapies for cocaine dependence yet there are no FDA-approved medications for this brain disease. Preclinical models have been essential to defining the central and peripheral effects produced by cocaine. Recent evidence suggests that cocaine exerts its reinforcing effects by acting on multiple neurotransmitter systems within mesocorticolimibic circuitry. Imaging studies in cocaine-dependent individuals have identified deficiencies in dopaminergic signaling primarily localized to corticolimbic areas. In addition to dysregulated striatal dopamine, norepinephrine and glutamate are also altered in cocaine dependence. In this review, we present these brain abnormalities as therapeutic targets for the treatment of cocaine dependence. We then survey promising medications that exert their therapeutic effects by presumably ameliorating these brain deficiencies. Correcting neurochemical deficits in cocaine-dependent individuals improves memory and impulse control, and reduces drug craving that may decrease cocaine use. We hypothesize that using medications aimed at reversing known neurochemical imbalances is likely to be more productive than current approaches. This view is also consistent with treatment paradigms used in neuropsychiatry and general medicine.
... Depressive symptoms are common among cocaine abusers [7][8][9][10][11][12][13] and have been associated with greater severity of cocaine dependence and impairment [13][14][15][16][17] as well as poor treatment outcome. [18][19][20][21] In addition, a lifetime history of depression is associated with greater self-reported cocaine withdrawal. ...
Whether the selective serotonin re-uptake inhibitor sertraline at 200 mg/day delays relapse in recently abstinent cocaine-dependent individuals.
The study involved a 12-week, double-blind, placebo-controlled clinical trial with 2-week residential stay followed by 10-week out-patient participation.
Veterans Affairs residential unit and out-patient treatment research program.
Cocaine-dependent volunteers (n = 86) with depressive symptoms (Hamilton score > 15), but otherwise no major psychiatric or medical disorder or contraindication to sertraline.
Participants were housed on a drug-free residential unit (weeks 1-2) and randomized to receive sertraline or placebo. Participants then participated on an out-patient basis during weeks 3-12 while continuing to receive study medication. Patients participated in a day substance abuse/day treatment program during weeks 1-3 and underwent weekly cognitive behavioral therapy during weeks 4-12. The primary outcome measure was thrice-weekly urine results and the secondary measure was Hamilton Depression scores.
Pre-hoc analyses were performed on those who participated beyond week 2. Generally, no group differences in retention or baseline characteristics occurred. Sertraline patients showed a trend towards longer time before their first cocaine-positive urine ('lapse', χ(2) = 3.67, P = 0.056), went significantly longer before having two consecutive urine samples positive for cocaine ('relapse', χ(2) = 4.03, P = 0.04) and showed significantly more days to lapse (26.1 ± 16.7 versus 13.2 ± 10.5; Z = 2.89, P = 0.004) and relapse (21.3 ± 10.8 versus 32.3 ± 14.9; Z = 2.25, P = 0.02). Depression scores decreased over time (F = 43.43, P < 0.0001), but did not differ between groups (F = 0.09, P = 0.77).
Sertraline delays time to relapse relative to placebo in cocaine-dependent patients who initially achieve at least 2 weeks of abstinence.
... Other temperament characteristics that are frequently studied in humans are high impulsivity, psychoticism, negative affect, and neurosis; these characteristics also correlate with substance abuse (Dalley et al., , 2008 Kabbaj et al., 2004b; Kilbey et al., 1992; Miczek et al., 2004; Moeller et al., 2001b). Some of these characteristics are more difficult to study in animals generally due to an inability to obtain self-reported data which is widely used in clinical studies and lack of uniformly accepted definitions and measuring paradigms (Evenden, 1999a; Moeller et al., 2001a; Patton et al., 1995). ...
Socially housed monkeys have been used as a model to study human diseases. The present study examined behavioral, physiological and neurochemical measures as predictors of social rank in 16 experimentally naïve, individually housed female cynomolgus monkeys (Macaca fascicularis). The two behavioral measures examined were novel object reactivity (NOR), as determined by latency to touch an opaque acrylic box placed in the home cage, and locomotor activity assessed in a novel open-field apparatus. Serum cortisol concentrations were evaluated three times per week for four consecutive weeks, and stress reactivity was assessed on one occasion by evaluating the cortisol response to adrenocorticotropic hormone (ACTH) following dexamethasone suppression. Measures of serotonin (5-HT) function included whole blood 5-HT (WBS) concentrations, cerebrospinal fluid (CSF) concentrations of the 5-HT metabolite 5-hydroxyindoleacetic acid (5-HIAA) and brain 5-HT transporter (SERT) availability obtained using positron emission tomography (PET). After baseline measures were obtained, monkeys were assigned to four social groups of four monkeys per group. The two measures that correlated with eventual social rank were CSF 5-HIAA concentrations, which were significantly higher in the animals who eventually became subordinate, and latency to touch the novel object, which was significantly lower in eventual subordinate monkeys. Measures of 5-HT function did not change as a consequence of social rank. These data suggest that levels of central 5-HIAA and measures of novel object reactivity may be trait markers that influence eventual social rank in female macaques.
... ]interestingly, some of the major symptoms observed during: withdrawal from chronic cocaine intoxication can also include severe anxiety as well as restlessness, agitation and depression [16]. In fact, some chronic cocaine users may actually be self-medicating to regulate painful feelings and psychiatric symptoms via their drug use [14,29,31], especially since increased rates of affective disorders and anxiety are observed in these individuals [3,30,48]. Since environmental events can also influence the onset and/or duration of anxiety and depression [4,35,36], changes in the amount, severity or perception of environmental stress may actually predispose sensitive individuals to engage in compulsive drug use. ...
Previous research has suggested the potential involvement of the hypothalamic-pituitary-adrenal (HPA) axis in psychostimulant reinforcement. In particular, we have found significant correlations between electric footshock-induced increases in plasma corticosterone and the acquisition, or lack thereof, of intravenous cocaine self-administration in rats. The experiments presented here were designed to further determine the role for corticosterone in cocaine reinforcement in rats by decreasing plasma levels of the hormone with surgical and pharmacological adrenalectomies. Bilateral adrenalectomy completely abolished the acquisition of intravenous cocaine self-administration over a wide range of doses (0.03125 to 1.0 mg/kg/infusion) without affecting food maintained responding. This suppression of self-administration was partially reversed by adding corticosterone (100 micrograms/ml) to the rats' drinking water. In another group of rats, pretreatment with metyrapone, which blocks the synthesis of corticosterone, resulted in dose-related decreases in ongoing cocaine self-administration. These data suggest that corticosterone is not only important, but may also be necessary for both the acquisition and maintenance of cocaine reinforcement in rats.
... Behaviorally, cocaine use in humans has been reported to produce profound subjective feelings of well being and a decrease in anxiety (Gawin andEllinwood 1988, 1989). In fact, a subpopulation of chronic cocaine users may actually be self-medicating to regulate "painful feelings" and psychiatric symptoms via their drug use (Kleber and Gawin, 1984;Khantzian, 1985;Gawin, 1986), especially since increased rates of affective disorders and anxiety are observed in these individuals (Rounsaville et al., 1991;Brady and Lydiard, 1992;Kilbey et al., 1992). However, cocaine use, itself, has actually been reported to precipitate episodes of panic attack in some individuals (Anthony et al., 1989;Aronson and Craig, 1986;Washton and Gold, 1984). ...
Cocaine stimulates the secretion of corticosterone and ACTH, probably through a CRF-related mechanism, indicating that the drug activates the HPA axis. Indeed, cocaine has been reported to produce anxiety and to precipitate episodes of panic attack during chronic use and withdrawal in humans and to induce anxiogenic behavior in animals. Cocaine also alters benzodiazepine receptor binding in discrete regions of the rat brain. Some of these changes in binding are obviously related to the convulsions and seizures which are often observed in an acute cocaine overdose. However, data from behavioral studies have suggested that some of these effects may be related directly to cocaine reinforcement since receptor changes also were observed when binding in the brains of rats that self-administered cocaine was compared with that from animals that had received identical yoked, but non-contingent infusions of the drug. In this regard, pretreatment with the benzodiazepine receptor agonists chlordiazepoxide and alprazolam decreased cocaine self-administration without decreasing food-reinforced responding, suggesting that these effects were specific for cocaine. Since this attenuation of self-administration was reversed by increasing the unit dose of cocaine, it is likely that these drugs were decreasing cocaine reinforcement. In contrast, exposure to stress increases vulnerability to self-administer psychostimulants. In these experiments, low-dose cocaine self-administration was related directly to stress-induced increases in plasma corticosterone, such that plasma corticosterone was always greater than 150 ng/ml for rats which subsequently self-administered cocaine at doses of 0.125 mg/kg/infusion or lower, suggesting a threshold for the hormone in cocaine reinforcement. In other experiments, bilateral adrenalectomy completely abolished the acquisition of intravenous cocaine self-administration in naive rats, while metyrapone decreased ongoing self-administration. In addition, ketoconazole pretreatment resulted in patterns of self-administration that were virtually indistinguishable from that observed during saline extinction, suggesting that plasma corticosterone is not only important, but may even be necessary for cocaine reinforcement. The mechanisms through which adrenocorticosteroids alter cocaine reinforcement remain to be determined, but there is increasing evidence that the mesocorticolimbic dopaminergic system is involved. In particular, the medial prefrontal cortex appears to be at least one brain region where dopamine and adrenocorticosteroids may interact to affect cocaine reinforcement.
... Investigations of psychiatric comorbidity among cocaine abusers have indicated high levels of psychopathology, particularly for depressive disorders (5). Lifetime prevalences of DSM-III-R depressive disorders among cocaine abusers in treatment range from about 20% to 47% (5-7), and 28%-53% of cocaine abusers are diagnosed with concurrent major depressive disorders (6,8). ...
The authors investigated the theoretical and clinical role of depression among cocaine abusers in treatment.
Eighty-nine cocaine-abusing patients underwent 2 weeks of substance abuse treatment. Posttreatment major depressive disorder, depressive symptoms before and after substance abuse treatment, and alcohol diagnoses were assessed and their relation to pretreatment substance use, cravings in high-risk situations, and 3-month follow-up status was examined.
High rates of major depressive disorder were found but were unrelated to pretreatment substance use. The decrease in depressive symptoms during treatment was independent of major depressive disorder or alcohol diagnoses and predicted treatment attrition. Higher levels of depressive symptoms during treatment were associated with greater urge to use cocaine, alcohol, and other drugs in high-risk situations. Concurrent major depressive disorder and depressive symptoms did not predict cocaine use at follow-up. However, patients who had an alcohol relapse episode experienced more depressive symptoms during treatment than did those who abstained.
The results highlight the relationship of depression to alcohol use among cocaine abusers and suggest a need for further studies of the association between depression and substance use disorders.
... Interestingly, some of the major symptoms observed during withdrawal from chronic cocaine intoxication can also include severe anxiety as well as restlessness, agitation, and depression (Gawin and Ellinwood 1989). In fact, a subpopulation of chronic cocaine users may actually be selfmedicating to regulate painful feelings and psychiatric symptoms via their drug use (Gawin 1986; Khantzian 1985; Kleber and Gawin 1984), especially since increased rates of affective disorders and anxiety are observed in these individuals (Brady and Lydiard 1992; Kilbey et al. 1992; Rounsaville et al. 1991). Cocaine has even been reported to precipitate episodes of panic attack in some individuals (Anthony et al. 1989; Aronson and Craig 1986; Washton and Gold 1984). ...
In nonlaboratory settings, social users of cocaine are sometimes able to control their drug intake so their patterns of use do not escalate to levels that would increase their risk of dependency and toxicity (Siegel 1984). This suggests that there may be factors in addition to the primary reinforcing properties of cocaine that determine why some individuals can remain casual recreational users while others progress to compulsive drug use. Individual reactivity to anxiety or stress, either mitigated or induced by cocaine, may represent one such factor that could influence the awareness or perception of the reinforcing efficacy of the drug. Clinical evidence supports the concept that anxiety may be involved in the etiology of cocaine use and/or withdrawal. For example, initial cocaine use produces profound
... Additional careful analysis of the co-occurrence of tobacco and other substance use at age 17 and 18 and in adulthood provided some intriguing findings supporting the role of tobacco smoking as a risk factor in cocaine and stimulant dependence in early adulthood (Davidson, Lambert, Hartsough & Schenk, 1996). Breslau and colleagues (Breslau, Kilbey & Andreski, 1991; Kilbey, Breslau & Andreski, 1992) also have reported a much lower rate for cocaine dependence than for alcohol dependence among adults who were not tobacco dependent. ...
This study focused on an audience at high risk for heavy use of licit and illicit substances: young adults who as children had attention-deficit/hyperactivity disorder (ADHD). The participants in this study were part of a longitudinal study of the life histories of 492 children, one third of whom were identified as hyperactive in 1974 and whose childhood symptom ratings and medical histories were used to establish Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; DSM-III-R) ADHD diagnoses (American Psychiatric Association, 1987). The objectives of the study centered on describing (a) developmental history of tobacco use among ADHD and non-ADHD participants in a longitudinal sample, (b) the characteristic adult patterns of tobacco use from early adolescence through early adulthood, and (c) the relationship between ADHD status and tobacco and substance dependence outcomes. Adult data were obtained for 81% of the original 492 participants (77% of the ADHD and 86% of the controls). Lifetime and current tobacco use were assessed from child, adolescent, and adult data, yielding eight measures of smoking status. The study showed that participants with and without ADHD did not differ in age of initiation to smoking, but there was a significant difference in the age they began smoking regularly. By age 17, 46% of all participants with ADHD, as contrasted with 24% of the age-mate controls, reported smoking cigarettes daily. In adulthood, the proportion of participants with ADHD who were current smokers (42%) continued to exceed that of the age-mate controls (26%). Among current adult smokers, 35% with ADHD smoked daily as compared to 16% of the age-mate controls. There were significantly different lifetime tobacco dependence rates--40% compared to 19% for age-mate controls. The rates for cocaine dependence were 21% for participants with ADHD and 10% for age-mate controls. We reported a significant difference in rates of daily smoking and tobacco dependence for those with ADHD who had used stimulant medication in childhood in contrast to controls. Results were interpreted to support a possible link between ADHD treatment histories and levels of tobacco smoking and tobacco dependence in adulthood.
... Behaviorally, cocaine use in humans has been reported to produce profound subjective feelings of well being and a decrease in anxiety (Gawin and Ellinwood 1988, 1989 ). In fact, a subpopulation of chronic cocaine users may actually be self-medicating to regulate " painful feelings " and psychiatric symptoms via their drug use (Kleber and Gawin, 1984; Khantzian, 1985; Gawin, 1986), especially since increased rates of affective disorders and anxiety are observed in these individuals (Rounsaville et al., 1991; Brady and Lydiard, 1992; Kilbey et al., 1992). However, cocaine use, itself, has actually been reported to precipitate episodes of panic attack in some individuals (Anthony et al., 1989; Aronson and Craig, 1986; Washton and Gold, 1984). ...
Scientists have been aware of the existence of a complex relationship between stress and the subsequent activation of the hypothalamic-pituitary-adrenal (HPA) axis and the endocrine and neurobehavioral effects of cocaine for many years now. Our research program has focused on the involvement of HPA axis activation in cocaine reinforcement using the intravenous self-administration model. Behaviorally, there are at least three general phases in the etiology of drug self-administration to consider: acquisition, maintenance and reinstatement. We have investigated the role for the HPA axis during each of these three phases. Corticosterone is necessary during acquisition; self-administration does not occur unless this stress-related hormone is increased above a threshold critical for reward. Sensitivity to low doses of cocaine falling on the ascending limb of the acquisition dose-response curve can be augmented by increasing circulating levels of corticosterone, but similar treatments do not affect responding maintained by higher doses. In a similar vein, ongoing, low-dose cocaine self-administration is decreased by drugs affecting the synthesis and/or secretion of corticosterone. When higher doses falling on the descending limb of the cocaine dose-response curve are self-administered, plasma corticosterone can still reach this hypothetical reward threshold even when synthesis is inhibited, and drug intake is not affected. On the other hand, the self-administration of doses falling on both the ascending and descending limbs of the cocaine dose-response curve can each be attenuated by drugs that block central corticotropin-releasing hormone (CRH) receptors. Finally, corticosterone and CRH are also critical for the stress- and cue-induced reinstatement of extinguished cocaine-seeking behavior, demonstrating an involvement of the HPA axis in the relapse to cocaine use as well. Continued investigations into how stress and the subsequent activation of the HPA axis affect cocaine self-administration will likely result in the identification of more effective and efficient treatment for cocaine addiction.
... These findings cannot be attributed to the control topic because the control prime in each study has been varied and Goldenberg et al. used a neutral rather than aversive control condition. Although we do not have a definitive explanation for this tendency, we are not alone in our findings; for example, Eysenck found that neurotics, although more conflicted about sex, actually have a greater sex drive than do people low in neuroticism (Eysenck, 1971), and other research has found high neurotics to be more inclined to abuse drugs and alcohol (e.g., Kilbey, Breslau, & Andreski, 1992). Perhaps neurotic individuals' difficulties with meaning, value, and anxiety may make them especially attracted to that which is pleasurable or intense, such as a foot massage or a piece of jazz music, as long as its association with the creaturely nature of the human body is relatively weak. ...
Based on terror management theory, the authors suggest that ambivalent reactions to the human body are partially rooted in the association of the physical body with inescapable death and that individuals high in neuroticism are particularly vulnerable to such difficulties. Three experiments demonstrated that priming thoughts about one's death leads individuals high in neuroticism to flee from physical sensations, including pleasurable ones. In response to mortality salience, highly neurotic individuals spent less time submerging their arm in ice-cold water and using an electric foot massager but did not avoid stimulation in nontactile modalities (i.e., listening to music). The discussion highlights the role of existentially motivated self-repression in inhibitions surrounding the body.
... Both major depressive disorder (MDD) and attention-deficit/hyperactivity disorder (ADHD) are common psychiatric disorders in cocaine-dependent individuals seeking treatment (Rounsaville and Carroll 1991; Levin, Evans and Kleber 1998; Clure et al. 1999). The lifetime prevalence rates of major depression in the general population are notable, with rates ranging from 13–16% (Kessler et al. 2003; Hasin et al. 2005), while the rates of major depression in treatment-seeking cocaine abusers are higher, with rates ranging from 15–30% (Rounsaville and Carroll 1991; Kilbey, Breslau and Andreski 1992; Charney et al. 2005; McLean et al. 1999). Similarly, Kessler et al. (2006) found that the rate of adult ADHD in the U.S. population is 4.4%, whereas recent prevalence studies in substance dependent samples seeking treatment have obtained rates ranging from 15–24% (Levin, Evans and Kleber 1998; King et al. 1999; Schubiner et al. 2000), suggesting that these disorders merit clinical attention in substance abuse treatment settings. ...
Co-occurring psychiatric disorders have been associated with poor prognosis among substance-dependent patients, but few studies have examined this association among patients with cocaine dependence (CD). We compared baseline characteristics and treatment outcome between cocaine-dependent patients with major depressive disorder (MDD; n = 66), those with attention-deficit/hyperactivity disorder (ADHD; n = 53), and those with CD without comorbid disorders (CD alone; n = 48) who had been randomized to the placebo arms of clinical trials with venlafaxine, methylphenidate, and gabapentin, respectively. The three groups differed significantly in racial makeup, with more Caucasians and Hispanics among patients with MDD and those with ADHD but more African Americans among those with CD alone. The groups did not differ significantly in treatment retention, with retention rates ranging from 42% to 47%; neither did they differ in the rates of achieving 2 consecutive weeks of urinalysis-confirmed abstinence, with rates ranging from 40% to 50%. Using logistic regression for repeated measures with general estimating equations, modeling the likelihood of a cocaine-positive week over time in treatment, we found the diagnostic group to interact with the baseline level of cocaine use and time. Among cocaine-dependent patients who achieved abstinence at baseline, those with MDD and those with ADHD had better outcome over time as compared with patients with CD alone. However, among patients with cocaine-positive urine specimens at baseline, those with MDD and those with ADHD were associated with poor outcome as compared with patients with CD alone. The findings suggest that diagnosis and treatment of co-occurring disorders such as depression and ADHD may be important components of treatment planning for CD and that the baseline level of cocaine use should be included as a covariate in studies evaluating the impact of such treatment.
... Prog Neuropsychopharmacol Biol Psychiatry. Author manuscript; available in PMC 2008 November 15. depressive disorders, attention deficit disorder, and other psychopathologies (Carroll et al., 1994; Clure et al., 1999; Kilbey et al., 1992; Levin et al., 2007). Paralleling these alterations in affect and cognition, there are widespread structural and functional brain abnormalities associated with chronic cocaine use. ...
Repeated exposure to psychostimulant drugs such as cocaine has been shown in numerous studies to produce significant neuroadaptations in both structure and function throughout the brain. Nonhuman primate models provide a way to systematically evaluate these adaptations engendered by cocaine self-administration and simulate the progressive nature of cocaine addiction in humans. Functional activity, measured using the 2-[14C]deoxyglucose method, was evaluated at selected critical time points over the course of chronic cocaine self-administration in rhesus monkeys. The effects of cocaine exposure in the initial stages of self-administration resulted in changes in functional activity in a highly restricted network of interconnected brain regions when compared to activity in food-reinforced controls. This pattern of changes was confined mainly to ventromedial prefrontal cortex and ventral striatum. Following chronic exposure to cocaine self-administration, however, the spatial extent and intensity of significant alterations in functional activity expanded considerably. The shift in topography of these changes was orderly, originating ventromedially in the prefrontal cortical-ventral striatal network and expanding dorsally to encompass the dorsal striatum. A strikingly similar progression occurred within the cortical areas that project to each of these striatal regions. Preliminary studies suggest that this pattern is maintained despite periods of abstinence from cocaine. The shifting patterns of cerebral metabolic function that accompany longer durations of cocaine self-administration may underlie many of the characteristics of chronic drug exposure, and may provide transitional mechanisms to more compulsive cocaine use.
Background
Although drug trafficking is one of the most prevalent crimes around the world, drug dealers used to be a hard-to-reach population far away from attention by public health programmes. Decisions to participate in such instrumental crimes, however, are based on external and internal factors that could be investigated and perhaps modified.
Aim
To identify drug use problems and personality factors consistently related to the drug trafficking recidivism among incarcerated drug dealers.
Method
Data were from 179 men serving a sentence for drug trafficking in two Brazilian penitentiaries who were asked to complete mainly self-ratings of alcohol and drug use, impulsiveness, personality and criminological features. Data were analysed using descriptive statistics and structured equation modelling.
Results
Incarcerated recidivist drug dealers are younger, more likely to be non-white, have more frequently used illicit drugs before the penalty and have higher alcohol use-severity than non-recidivists. Neuroticism, extraversion, severity of alcohol use and drug use before the penalty were each positively correlated with recidivism. Openness to experience was not associated with a history of recidivism but, rather, positively correlated with better school achievement. One third of the men took up the offer of feedback from the research assessment.
Conclusions
Our study showed that social, drug-related and personality style variables come together to allow likely recidivist drug dealers to be distinguished from those unlikely to resume dealing after imprisonment. Given scarce resources for constructive intervention, this is important. We were impressed by the men's willingness to co-operate with the study, despite their reputation for being in thrall to the drug trade hierarchy, and by their curiosity about themselves. This bodes well for further investigation of relevant psychological indicators and consequently informed intervention.
Introduction:
Major depressive disorder (MDD) and cocaine use disorder (CUD) are prevalent and frequently co-occur. When co-occurring, the presence of one disorder typically negatively impacts the prognosis for the other. Given the clinical relevance, we sought to examine pharmacotherapies for co-occurring CUD and MDD. While multiple treatment options have been examined in the treatment of each condition individually, studies exploring pharmacological options for their comorbidity are fewer and not conclusive.
Areas Covered
For this review, the authors searched the literature in PubMed using clinical query options for therapies and keywords relating to each condition. Then, they described potentially promising pharmacologic therapeutic options based on shared mechanisms between the two conditions and/or results from individual clinical trials conducted to date.
Expert opinion
Medications like stimulants, dopamine (D3) receptors partial agonists or antagonists, antagonists of kappa opioid receptors, topiramate, and ketamine could be promising as there is significant overlap relating to reward deficiency models, anti-reward pathways, and altered glutamatergic systems. However, the available clinical literature on any one of these types of agents is mixed. Additionally, for some agents there is possible concern related to abuse potential (e.g., ketamine and stimulants).
Anxiety, depression and stress are exceedingly common in patients with cardiovascular disease (CVD). They increase the risk of cardiac events and are associated with much worse outcomes. A causal relationships exists between anxiety/depression and adverse cardiac events such as acute myocardial infarction and sudden cardiac death. Various treatments, including psychological therapies and pharmacotherapy, can used to treat patients with these disorders. This review discusses the epidemiology, pathogenesis and treatment options for patients with CVD who suffer from these conditions, and argues that they should be treated as concomitant risk factors for CVD.
Vorbemerkung: Die Zusammenfassung verschiedener Wirkstoffe unter diesem, von lat. stimulus (Stachel, Antrieb, Reiz) abgeleiteten Begriff stellt auf die charakteristische anregende und leistungssteigernde Wirkungskomponente dieser Gruppe von Rauschdrogen ab (engl. CNS Stimulants). Synonym wird der ältere, von Lewin geprägte, heute weniger gebräuchliche Begriff „Excitantia“ verwandt.
Vorbemerkung: Die Zusammenfassung verschiedener Wirkstoffe unter diesem, von lat. stimulus (Stachel, Antrieb, Reiz) abgeleiteten Begriff stellt auf die charakteristische anregende und leistungssteigernde Wirkungskomponente dieser Gruppe von Rauschdrogen ab (engl. CNS Stimulants). Synonym wird der ältere, von Lewin geprägte, heute weniger gebräuchliche Begriff „Excitantia“ verwandt.
Vorbemerkung: Die Zusammenfassung verschiedener Wirkstoffe unter diesem, von lat. stimulus (Stachel, Antrieb, Reiz) abgeleiteten Begriff stellt auf die charakteristische anregende und leistungssteigernde Wirkungskomponente dieser Gruppe von Rauschdrogen ab (engl. CNS Stimulants). Synonym wird der ältere, von Lewin geprägte, heute weniger gebräuchliche Begriff „Excitantia“ verwandt.
Depressive disorder rates in stimulant-dependent individuals are substantially higher than community rates. Further, depressive symptoms are considered a major component of stimulant withdrawal. The comorbidity of these disorders may reflect shared neurochemical alterations in the function of serotonin, dopamine, and peptide systems, such as corticotropin releasing factor (CRF) and neuropeptide Y (NPY). These alterations are observed in patients, and in animal models of depression and stimulant dependence, particularly in limbic brain structures. This shared neurobiology does not seem to result from significant shared heritability or genetic linkage; stimulants may induce changes in neurobiology that are similar to those found in depression, and these changes might provide a therapeutic target. Stimulant-dependent patients with a depressive disorder may be a specific subpopulation for antidepressant trials, and they might reduce their stimulant abuse when treated with antidepressants. Nevertheless, concomitant dependence on alcohol or opioids may influence this response, and antidepressants appear to be more effective for depression in combined stimulant and opioid dependence than in combined stimulant and alcohol dependence.
Although scientists have been investigating the neurobiology of psychomotor stimulant reward for many decades, there is still no FDA-approved treatment for cocaine or methamphetamine abuse. Research in our laboratory has focused on the relationship between stress, the subsequent activation of the hypothalamic-pituitary-adrenal (HPA) axis, and psychomotor stimulant reinforcement for almost 30 years. This research has led to the development of a combination of low doses of the cortisol synthesis inhibitor, metyrapone, and the benzodiazepine, oxazepam, as a potential pharmacological treatment for cocaine and other substance use disorders. In fact, we have conducted a pilot clinical trial that demonstrated that this combination can reduce cocaine craving and cocaine use. Our initial hypothesis underlying this effect was that the combination of metyrapone and oxazepam reduced cocaine seeking and taking by decreasing activity within the HPA axis. Even so, doses of the metyrapone and oxazepam combination that consistently reduced cocaine taking and seeking did not reliably alter plasma corticosterone (or cortisol in the pilot clinical trial). Furthermore, subsequent research has demonstrated that this drug combination is effective in adrenalectomized rats, suggesting that these effects must be mediated above the level of the adrenal gland. Our evolving hypothesis is that the combination of metyrapone and oxazepam produces its effects by increasing the levels of neuroactive steroids, most notably tetrahydrodeoxycorticosterone, in the medial prefrontal cortex and amygdala. Additional research will be necessary to confirm this hypothesis and may lead to the development of improved and specific pharmacotherapies for the treatment of psychomotor stimulant use.
We examined basic coping styles, mental absorption, sensation seeking, use of alcohol, contacts with the health care system and the level of social activity and physical exercise in two drug groups, a hashish/marihuana group (n = 46) and a heroin etc. group (n = 19), and a comparison group (n = 46) with no drug use. Compared to the comparison group, the drug groups had elevated scores on Tellegen’s Absorption Scale and on the novelty subscale of the Arnett Inventory of Sensation Seeking. The hashish/marihuana group had elevated scores on the Millon Behavioral Health Inventory (MBHI) sociable, confident and forceful style. The heroin etc. group had elevated scores on the inhibited coping style. The heroin etc. group also had elevated anxiety scores on the MBHI psychogenic attitude scales. This group drank almost 5 times more alcohol than the comparison group. The hashish/marihuana group drank almost twice as much as the comparison group. There were also differences between the groups in beverage preferences. There were no differences between the drug users and the comparison group in frequency of contacts with the health care system and no differences in level of social activity and physical exercise or participation in sports.
Chest pain is the most frequent cocaine-related medical event for which patients seek treatment in inner-city emergency departments (EDs). Given that depression increases risk for poor substance use and cardiac outcomes, knowledge of correlates of depressive symptoms among these out-of-treatment cocaine users is crucial to developing interventions for these inner-city populations that frequently present to the ED. A total of 219 individuals presenting to an inner-city ED with chest pain and recent cocaine use were divided into 2 groups based on scoring positive (42%) for moderate-to-severe depression on the Patient Health Questionnaire (PHQ-9). The depression symptoms group reported a significantly greater number of standard drinks per drinking occasion (7.1 versus 4.6) and a greater number of heavy drinking days (9 versus 5). A significant 3-way interaction effect found males and non-white females reporting a greater number of heavy drinking days were more likely to be in the depression symptoms group, whereas white females with a greater number of heavy drinking days were more likely to be in the nondepression symptoms group. Depression is clearly a problem among not-in-treatment cocaine users presenting to an inner-city ED; heavy drinking in concert with cocaine use increases the risk for depression, with important interactions by race and gender.
We argue that existential concerns underlie discomfort with the physicality of the body and that activities likely to make individuals aware of their physical body (e.g., sex, dancing) may be inhibited and cause guilt. Further, individuals high in neuroticism may be especially vulnerable to such difficulties. To test this, individuals high and low in neuroticism were primed with thoughts about their mortality or a control topic and then engaged in an exercise designed to promote body awareness before self-reporting guilt. A comparison group engaged in non-body-oriented behavior. The results revealed that high neuroticism participants inhibited their body-oriented behavior when mortality was salient and that they experienced a marginal increase in guilt after performing the behavior in conjunction with mortality salience. Discussion focuses on the relationship between neuroticism, mortality salience, inhibition surrounding the body, and guilt.
The experiments described below were designed to investigate whether contingent versus non-contingent electric footshock would affect the acquisition of intravenous cocaine self-administration in rats. During the first component of a multiple schedule, triads of rats were trained to respond under a discrete-trial, fixed-ratio 10 schedule of food reinforcement. Random footshock presentation (0.6 mA) for the first and second rats from each triad was yoked to food lever responding by the rats in the first group only, while the third group of rats was never shocked. When stable baselines of food-reinforced responding were obtained, all three rats from each triad were allowed to self-administer increasing doses of cocaine (0.031-0.5 mg/kg per infusion) during the second component. Rats from the second group, receiving non-contingent footshock presentation, self-administered cocaine (0.125 mg/kg per infusion) at higher rates and at one-half the dose which maintained responding in rats from the other two treatment groups. Plasma corticosterone, measured before the acquisition of cocaine self-administration, was highly correlated with drug intake at this concentration for all three groups of rats. These data demonstrate that non-contingent experimental stress facilities the acquisition of intravenous cocaine self-administration in rats.
The role of corticosterone in cocaine reinforcement was investigated in rats exposed to either response-contingent electric footshock, noncontingent shock or no shock prior to the initiation of testing for intravenous cocaine self-administration. Although rats from the two shock groups were consistently more sensitive to cocaine, plasma corticosterone was always significantly higher in all rats that subsequently self-administered low doses of cocaine compared to the rats that did not, regardless of the treatment condition. In fact, plasma corticosterone was always greater than approximately 150 ng/ml for rats that self-administered low doses of cocaine, suggesting that this stress hormone must be increased above a critical threshold for stable low-dose cocaine self-administration to subsequently occur. Plasma corticosterone was also measured following exposure to cocaine and was significantly elevated in rats from all three treatment groups during cocaine self-administration, provided that doses of cocaine that would maintain responding were tested. When the dose would not maintain self-administration, plasma corticosterone was markedly lower, suggesting that at higher concentrations, the cocaine injections alone were sufficient to increase plasma corticosterone above a critical threshold, even for rats which had low precocaine levels of the hormone. These data suggest a significant role for corticosterone in both the acquisition and maintenance of cocaine reinforcement in rats.
Depressive disorder rates in stimulant-dependent individuals are substantially higher than community rates. Further, depressive symptoms are considered a major component of stimulant withdrawal. The comorbidity of these disorders may reflect shared neurochemical alterations in the function of serotonin, dopamine, and peptide systems, such as corticotropin releasing factor (CRF) and neuropeptide Y (NPY). These alterations are observed in patients, and in animal models of depression and stimulant dependence, particularly in limbic brain structures. This shared neurobiology does not seem to result from significant shared heritability or genetic linkage; stimulants may induce changes in neurobiology that are similar to those found in depression, and these changes might provide a therapeutic target. Stimulant-dependent patients with a depressive disorder may be a specific subpopulation for antidepressant trials, and they might reduce their stimulant abuse when treated with antidepressants. Nevertheless, concomitant dependence on alcohol or opioids may influence this response, and antidepressants appear to be more effective for depression in combined stimulant and opioid dependence than in combined stimulant and alcohol dependence.
This paper presents a model developed to advance the understanding of the relationship between sexual abuse and HIV risk among women. It is proposed that the relationship is mediated by many of the long-term sequelae of sexual abuse. The process of mediation is believed to occur through various causal pathways propelled by specific underlying mechanisms that increase the likelihood of HIV risk. The following causal pathways are proposed: (1) initiation of and/or increasing reliance on drug use as a method of coping with the sexual abuse experience, (2) problems with sexual adjustment related to sex risk taking, and (3) psychopathology (e.g. depression) which increases the likelihood of an individual participating in HIV risk behaviours. These hypothesized pathways are based on the characteristics and behaviours of individuals with histories of sexual abuse and do not take into account the influence of the individual's social environment. Increasingly, evidence suggests that understanding the social context of HIV risk is crucial to the development of preventive interventions. Therefore, a final pathway is explored which suggests that specific social network characteristics (e.g. network membership type, social support, and social isolation) influence HIV risk exposure opportunities among women with sexual abuse histories.
Although a number of studies have examined the comorbidity of anxiety disorders and substance use disorders, much less is known about the impact of anxiety symptoms on substance use and on substance abuse treatment outcome. In the current study, we examined how self-reported anxiety levels, as measured by the Spielberger State-Trait Anxiety Inventory, were related to cocaine use variables and patterns following substance abuse treatment. There were 108 patients in substance abuse treatment who met DSM-III-R diagnostic criteria for cocaine abuse or dependence who completed an assessment battery at pretreatment, posttreatment, and 3-month follow-up. State anxiety scores significantly declined from pre- to posttreatment and remained stable into the 3-month follow-up period regardless of relapse status. Trait anxiety was correlated positively with negative consequences due to cocaine use and negatively correlated with days in treatment. State and trait anxiety both were correlated positively with the Alcohol Composite Index of the Addiction Severity Index (ASI). These findings suggest that elevated anxiety scores at pretreatment subside with time, do not require clinical management of associated anxiety symptoms, and may be a temporary by-product of experiencing negative consequences due to recent cocaine use.
Depression has been identified as a disorder of clinical significance among cocaine users. Even so, its prevalence in cocaine-abusing populations is uncertain. This research employed a cross-sectional design to determine the prevalence of current depressive symptomatology among a sample of 430 not-in-treatment crack-cocaine users. Depression was assessed with the Beck Depression Inventory (BDI). The mean BDI score was 19.1. Overall, 80% of the sample had BDI scores that suggested more than minimal depression, and 55% had symptoms of moderate to severe depression. The results of a cumulative logistic regression analysis showed that men, African-Americans, and individuals with some college education were less likely to be depressed. Individuals with higher Addiction Severity Index composite scores for family/social, medical, legal, and alcohol problems had a greater likelihood of reporting symptoms of depression. Frequency of cocaine use and perceived need for treatment were also positively associated with higher BDI scores. The results suggest that the prevalence of depression among crack users is higher than has been previously reported. Treatment programs should routinely screen crack-cocaine users for depression. The BDI may be a suitable tool for such efforts since it has an acceptable level of internal consistency when employed with crack users (a = 0.89).
To describe the prevalence of cocaine and other drug use in secondary school students in Oviedo (Asturias, Northern Spain) and determine the personality features and levels of sensation seeking in cocaine users.
2,862 secondary school students (mean age +/- SD = 15.87+/-1.48 years; 50.6% males) were interviewed during the 1998-1999 academic year. For evaluation, the World Health Organization questionnaire for drug consumption, the Eysenck Personality Questionnaire (EPQ) for adults and the Zuckerman Sensation Seeking Scale were used.
The prevalence of lifetime, previous year and previous month cocaine use among secondary school students was 6.1, 4.9 and 2.7%, respectively. Cocaine ranked sixth among illicit drugs ever used by this population. Once individuals had used cocaine for the first time, they were likely to use it again (44.8% of those who had ever used cocaine reported that they had done so in the previous month). Compared to students who had never used cocaine (but who may have used other substances), cocaine users had a more extensive drug abuse history. Students who had used cocaine at some point during their lifetime scored significantly higher on the EPQ psychoticism subscale and reported higher levels of sensation seeking.
There is a significant rate of cocaine consumption amongst secondary school students of both sexes. Cocaine users are polyconsumers of other substances, both legal and illicit. Those who consume cocaine have a different psychological profile, characterized by high sensation seeking and high levels of psychoticism.
This review aims to present and interpret evidence that methamphetamine dependence is associated with disorder of brain function that is required for top-down control of behavior.
Presented here are findings from brain imaging studies of human research participants with histories of chronic methamphetamine abuse in the context of functional consequences and implications for treatment of their dependence on methamphetamine.
Brain imaging studies have revealed differences in the brains of research participants who have used methamphetamine chronically and then abstained from taking the drug, compared with healthy control subjects. These abnormalities are prominent in cortical and limbic systems, and include deficits in markers of dopaminergic and serotonergic neurotransmitter systems, differences in glucose metabolism and deficits in gray matter. These abnormalities accompany cognitive deficits, including evidence of impaired inhibitory control.
Cortical deficits in abstinent methamphetamine abusers can affect a wide range of functions that can be important for success in maintaining drug abstinence. These include but are not limited to modulation of responses to environmental stimuli as well as internal triggers that can lead to craving and relapse. Potential therapies may combine behavioral approaches with medications that can improve cognitive control.
Comorbidity between drug abuse and mental illness is very common, but the association of such comorbidity with specific responses to drugs of abuse remains obscure. The current study examined the relationship between the presence of non-psychotic Axis I psychiatric diagnoses and the frequency and severity of cocaine-induced psychosis. We interviewed 243 unrelated cocaine-dependent adults [37% European American (EA), 52.3% African American (AA); 58.8% male] using the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) to establish DSM-IV diagnoses, and two instruments for the identification of cocaine-induced paranoia, the Cocaine Experience Questionnaire (CEQ) and the Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP). Comorbid substance use and psychiatric disorders were common in this cocaine-dependent sample. Ninety percent of subjects met criteria for substance use disorders other than cocaine dependence; common non-substance-use disorders included antisocial personality disorder (ASPD), adult ASPD, major depression, and attention deficit-hyperactivity disorder (ADHD). Comorbid opioid dependence was more common in EA subjects than in AA participants. After correction for multiple comparisons, a lifetime diagnosis of ADHD was associated with the categorical presence of CIP (p = 0.007), as well as significantly more severe CIP symptoms. Comorbid substance use and psychiatric disorders are very common among individuals with cocaine dependence. Comorbid ADHD increases the odds of an individual endorsing CIP, suggesting some common basis for these phenomena.
In recent studies of the structure of affect, positive and negative affect have consistently emerged as two dominant and relatively independent dimensions. A number of mood scales have been created to measure these factors; however, many existing measures are inadequate, showing low reliability or poor convergent or discriminant validity. To fill the need for reliable and valid Positive Affect and Negative Affect scales that are also brief and easy to administer, we developed two 10-item mood scales that comprise the Positive and Negative Affect Schedule (PANAS). The scales are shown to be highly internally consistent, largely uncorrelated, and stable at appropriate levels over a 2-month time period. Normative data and factorial and external evidence of convergent and discriminant validity for the scales are also presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Cocaine was considered incapable of producing dependence in 1980 but was recently proclaimed the drug of greatest national
health concern. Recent clinical and preclinical investigations demonstrate that cocaine produces unique abuse and withdrawal
patterns that differ from those of other major abused drugs and suggest that long-term cocaine abuse produces neurophysiological
alterations in specific systems in the central nervous system that regulate the capacity to experience pleasure. It will be
necessary to develop clinically pertinent research models before these findings can be considered definitive, but these evolving
ideas have already led to applications of promising experimental treatments for cocaine abuse.
Analyzing self-report interview data from a multi-site collaborative study of mental disorders in the community, we examined suspected differences between 611 cocaine users and 126 heroin users in relation to indicators of drug dependence. Cocaine users were less likely to report dependence-related problems as compared to heroin users. These epidemiologic sample data underscore concerns about the generalizability of published clinical sample data on self-reported cocaine dependence.
Research findings suggest that alcoholism and drug abuse may be predisposed by inherited behavioral propensities or temperaments. These inherited predispositions, through interaction with the physical and social environments, shape the development of personality. As discussed herein, there is strong evidence linking certain personality characteristics, specifically antisocial and neurotic traits, with the risk for substance abuse. Thus, personality and its precursor, temperament, comprise an important diathesis. However, an adverse outcome also depends on a variety of developmental and environmental factors.
In an investigation of personality differences between oral and intravenous drug addicts, 59 subjects attending a London clinic were given the Eysenck Personality Questionnaire. Both groups scored highly on the neuroticism and psychoticism dimensions, though oral users were found to have significantly higher scores on both of these scales. High P scorers have been found to be cold, unfriendly, hostile, etc., and it is suggested that the lower P scores of the intravenous users may be partly due to possible hostility-reducing effects of the narcotics used by this group. Other implications of these findings are also discussed.
The author describes an orderly progression of clinical syndromes (euphoria, dysphoria, paranoid psychosis) with cocaine use that is related to dosage, chronicity, and genetic and experiential predispositions. That affective alternations are caused by a drug which also produces a schizophreniform psychosis suggests a continuum with implications for understanding the endogenous psychoses. The author emphasizes that alternations in the same neurotransmitter substances may be involved in these multiple psychiatric syndromes, which contrasts with previous "one illness, one transmitter" models.
In a sample of 298 cocaine abusers seeking inpatient (n = 149) or outpatient (n = 149) treatment, rates of psychiatric disorders were determined by means of the Schedule for Affective Disorders and Research Diagnostic Criteria. Overall, 55.7% met current and 73.5% met lifetime criteria for a psychiatric disorder other than a substance use disorder. In common with previous reports from clinical samples of cocaine abusers, these overall rates were largely accounted for by major depression, minor bipolar conditions (eg, hypomania, cyclothymic personality), anxiety disorders, antisocial personality, and history of childhood attention deficit disorder. Affective disorders and alcoholism usually followed the onset of drug abuse, while anxiety disorders, antisocial personality, and attention deficit disorder typically preceded drug abuse.
In a 12-year longitudinal study of a birth cohort 1577 men were questioned at the age of 19 and again at 31 years. Personality, social background and substance use were connected with subsequent consumption of alcohol, tobacco and cannabis, using correlation and discriminant analysis on the total and on two split samples, respectively. The preceding level of substance use was the best predictor for later use. Antisocial attitudes, depressiveness and psychosomatic complaints were associated as non-specific indicators. The following predictors were specific for: Alcohol: parental consumption, self-description as aggressive-extraverted; Tobacco: broken home, low level of vocational training, extraversion; Cannabis: alienation from society. The results are related to various theoretical frameworks and discussed with regard to possible efforts for prevention.
Sensationalism and shifting acceptance of drug use have influenced much of what has been written about cocaine. This review attempts a reasoned psychiatric appraisal of the prototypical abused psychomotor stimulants, cocaine and the amphetamines. We review the historical and epidemiologic features of the recent upsurge in cocaine abuse, summarize clinical psychiatric observations about stimulant abuse and emerging treatment approaches, and describe new perceptions of the biologic nature of stimulant addiction. Because emergency medical treatment of stimulant overdose and medical complications of cocaine and amphetamine abuse have been reviewed recently, we have excluded these topics.
It is clear that cocaine is a powerful reinforcer that can lead to life-attenuating behavior. Although certain people, because of personality structure or life situation, might become more easily overinvolved, it is likely that anyone with access to cocaine in quantity is at risk. All laboratory animals can become compulsive cocaine users. The same might be said of humans. Instances of mature, stable, well-integrated individuals who acquired a pervasive craving for cocaine are well known. We have spoken of the cocaine trap: the inability to stop using despite the loss of pleasurable, and the upsurge of unpleasurable, effects. The cause may be an ingrained and, in some instances, irreversible conditioning. We have said less of the cocaine paradox: that what starts out as elation and hypomania ends as dysphoria and depression.
This chapter develops an index of cocaine use that incorporates route of ingestion, frequency of use and quantity of use and examines self-reported progression in cocaine use and related physical and social consequences of use.
Data from a 6-year follow-up period were used to analyze the mortality of adults who had been continuously enrolled in a prepaid group practice health maintenance organization (HMO) for the previous 7 years. Thirteen percent of the HMO members were classified as consistently high users of outpatient care. Even after adjustment for age, sex, and cigarette smoking, this high user group's mortality rates during the follow-up period were significantly greater than those of the other HMO enrollees. The HMO members as a whole had mortality rates marginally lower than the mortality of the general Oregon population. It can be concluded that HMO enrollees who consistently use high quantities of health care resources generally have significant medical problems in addition to psychosocial difficulties. Assuming that mortality reflects health, long-term HMO members as a group are not much healthier than ordinary Oregonians.
The authors describe changes in DSM-III substance use disorders to be included in the revised version, DSM-III-R. Major revisions include removal of the distinction between "abuse" and "dependence" and broadening the definition of "dependence" to a syndrome of clinically significant behaviors that indicate a serious degree of involvement with psychoactive drugs; creation of a new category of "psychoactive substance neuroadaptation syndrome" for individuals whose physiological adaptations to high doses of psychoactive substances did not arise from their own behavior; use of an identical set of symptoms and behaviors to determine dependence on all different classes of psychoactive substances; and provision of a system for rating severity of dependence.
This study examined the role of the Thomas and Chess conceptualization of 'difficult' temperament or behavioral style and tobacco, alcohol and marijuana use in the 133 subjects of the New York Longitudinal Study. Results indicate that the possession of difficult temperamental characteristics (slow adaptability, withdrawal responses, negative mood, high tensity of reactions, and biological irregularity) at age five and in early adulthood are associated with tobacco, alcohol and marijuana use in young adulthood. Furthermore results indicate that the continued use of marijuana throughout adolescence and alcohol and tobacco use from ages thirteen through sixteen were related to the subjects' difficult temperament characteristics in young adulthood.
Several previous studies have reported personality differences between addicts and normal subjects. In the present investigation, the Eysenck Personality Questionnaire was administered to 221 addicts at three London treatment centres, and to 310 normal subjects. An item analysis showed that a large number of items discriminated between the two groups. An ‘Addiction Scale’ was constructed from the 32 items on which the groups differed most, (all at p<0.001). Most of the A-Scale items were drawn from the Neuroticism Scale and identified feelings of anxiety and depression. It is suggested that this neurotic component may be artificially inflated. Addicts may have learned to present neurotic problems through such symptoms being rewarded in therapeutic institutions. The neurotic component seems to play a lesser role in distinguishing female addicts from controls. These and other findings are discussed.
Comorbidity of mental disorders with alcohol and other drug abuse
- D A Regier
- M E Farmer
- D S Rae
- B Z Locke
- S J Keith
- L L Judd
- F K Goodwin
Regier, D.A., Farmer, M.E., Rae, D.S., Locke, B.Z., Keith, S.J., Judd, L.L. and Goodwin, F.K. (1990) Comorbidity of mental disorders with alcohol and other drug abuse. J. Am. Med. Assoc. 264: 19, 2511-2518.
National Institute of Mental Health Diagnostic Interview Schedule, Version III-Revised
- L N Robins
- J E Helzer
- L Cottler
- E Golding
Robins, L.N., Helzer, J.E., Cottler, L. and Golding, E. (1989) National Institute of Mental Health Diagnostic Interview Schedule, Version III-Revised. Rockville, MD., National Institute of Mental Health.
Smoking and Tobac-co Use: United States 1987. United States Department of Health and Human Services, Public Health Service
- Ca Schoenborn
- G M Boyd
Schoenborn, CA. and Boyd, G.M. United States National Center for Health Statistics. (1989) Smoking and Tobac-co Use: United States 1987. United States Department of Health and Human Services, Public Health Service, DHHS Publication No. 89-1597, Vital and Health Statistics Series 10, No. 169. Hyattsville, Maryland.