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Gender, problem-gambling severity, and the incidence of substance use disorders
Abstracts / Drug and Alcohol Dependence 140 (2014) e169–e251
Make your own cigarette smoking: Toxicant exposure and behavioral changes Wallace Pickworth, L. Canlas, Z. Rosenberry, J.L. Potts Battelle, CAPH, Baltimore, MD, United States Aims: Increased price of factory made (FM) cigarettes have led to dramatic increases in the use of make your own (MYO) cigarettes, however, behavior changes and toxicant exposure associated with MYO use have not been evaluated. Methods: Six FM smokers (4 men) experimentally switched to exclusively smoking MYO cigarettes for 15 days. Cigarettes were made using a machine to inject loose tobacco into preformed filtered cigarette tubes, PMM. At Visit 1 (V1), their usual FM cigarette was smoked through a puff topography instrument; heart rate (HR), carbon monoxide (CO), and blood samples were taken before and after smoking. Participants were instructed how to make PMMs using a provided machine, tobacco, and tubes. Thereafter, participants made and exclusively smoked PMM. At each subsequent lab visit (3; approximately 4 days apart), they made 5 PMMs and smoked one through the topography unit. Results: Cigarettes smoked per day were the same (22) with FM and PMM. Participants became efficient producers of PMMs as evidenced in the reduced time to make 5 PMMs in the lab (377 s at V1 to 211 s at V4). Participants reported it easy and enjoyable to make and smoke PMMs, however the PMM cigarettes (0.78 g) were significantly smaller (p < 0.01) than their usual FM cigarettes (0.94 g). Over all conditions, nicotine plasma levels averaged 18.0 ± 2.4 ng/ml before smoking and 34.0 ± 5.3 ng/ml after smoking; there were no significant differences in the plasma nicotine boost (average 17.7 and 15.4 ng/ml after FM and PMM smoking, respectively). Compared to the V1 FM cigarette, the PMMs were smoked faster and with more puffs, averaging higher puff volumes and velocitiest. Compared to the FMs, the PMMs at V3 (p < .05) and V4 (p < .10) caused higher HR boost (4 bpm vs. 8 bpm) and lower CO boost (7.3 ppm vs. 4.1 ppm; p < 0.05). Participants progressively accepted the PMM cigarettes, however, one month after the study none were smoking PMM. Conclusions: This study demonstrated FM smokers can readily adopt PMM preparation. Smoking PMM cigarettes exposes users to similar levels of nicotine with reduced CO. Financial support: Supported by National Cancer Institute (1R01CA138973-01). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.496 Methamphetamine self-administration in humans during d-amphetamine maintenance Erika Pike 1 , William W. Stoops 1,2 , P.E. Glaser 3,4 , L.R. Hays 3 , C.R. Rush 1,2,3 1 Psychology, University of Kentucky, Lexington, KY, United States 2 Behavioral Science, University of Kentucky, Lexington, KY, United States 3 Psychiatry, University of Kentucky, Lexington, KY, United States 4 Anatomy and Neurobiology, University of Kentucky, Lexington, KY, United States
Aims: Translational research suggests that agonist replacement may be a viable treatment approach for managing stimulant use disorders. This study sought to determine the effects of d-amphetamine maintenance on methamphetamine selfadministration in stimulant using human volunteers. We predicted
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d-amphetamine maintenance would reduce methamphetamine self-administration. Methods: Eight volunteers completed the protocol that tested two d-amphetamine maintenance conditions in counter-balanced order (0 and 40 mg/day). Volunteers completed 4 experimental sessions under each maintenance condition in which they first sampled one of four doses of intranasal methamphetamine (0, 10, 20, or 30 mg). Volunteers then had the opportunity to respond on a computerized progressive ratio task to earn portions of the sampled methamphetamine dose. Subject-rated drug-effect and physiological measures were completed at regular intervals prior to and after sampling methamphetamine. Results: Methamphetamine was self-administered as an orderly function of dose regardless of the maintenance condition. Methamphetamine produced prototypical subject-rated effects, some of which were attenuated by d-amphetamine maintenance. Methamphetamine was well tolerated during d-amphetamine maintenance and no adverse events occurred. Conclusions: Although d-amphetamine attenuated some subject-rated effects of methamphetamine, the self-administration results are concordant with those of a clinical trial showing that d-amphetamine did not reduce methamphetamine use. Human laboratory self-administration studies can be used to screen other putative agonist replacement pharmacotherapies prior to clinical trial testing. Financial support: NIDA R01 DA025032 (PI: CRR). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.497 Gender, problem-gambling severity, and the incidence of substance use disorders Corey E. Pilver, D.J. Libby, R.A. Hoff, M.N. Potenza Yale School of Medicine, New Haven, CT, United States Aims: To investigate whether the prospective association between problem-gambling severity and incident substance use disorders (SUDs) differed in women compared to men. In crosssectional data, pathological gambling (PG) is more strongly associated with SUDs in women versus men; thus, we hypothesized that incident SUDs (both as a group and as relating to alcohol, tobacco- and other drug-use disorders) would follow the same pattern. Methods: Wave-1 and Wave-2 National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) data from 34,006 non-institutionalized US adults were analyzed. Wave-1 participants were categorized as non-gambling/low-frequency gambling (NG/LFG), low-risk gambling (LRG), and at-risk/problem gambling (ARPG) based on the ten inclusionary criteria for pathological gambling (PG). Dependent variables were any substance-use disorder (SUD), alcohol abuse/dependence (AUDs), nicotine dependence (ND), and drug abuse/dependence (DUDs). Results: Gender moderated the effects of problem-gambling severity on incident ND and DUDs, with effects stronger in women relative to men. Among women, LRG (OR = 1.38; p = .0037) and ARPG (OR = 2.14; p = .0023) were associated with elevated odds for ND, relative to LFG/NG; odds were not elevated in men (LRG: OR = 1.02; p = .79; ARPG: OR = 0.95; p = .84). While the gender difference in DUDs at the level of LRG was significant (Interaction OR = 1.90; p = .028), the gender-specific relationships between LRG and DUDs were not (women: OR = 1.31; p = .24; men: OR = 0.69; p = .05). Incident AUDs in relation to ARPG followed a distinct pattern, with associations observed in men (OR = 2.27; p = .0008) but not women (OR = 1.02; p = .96).
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Abstracts / Drug and Alcohol Dependence 140 (2014) e169–e251
Conclusions: Study findings highlight the relevance of considering gender in the prevention and treatment of SUDs. Those factors underlying the progression of specific SUDs in women and men with greater problem-gambling severity warrant identification, particularly as incident AUDs as compared to ND and DUDs showed gender-related differences that differed from cross-sectional patterns. Financial support: Supported by grants from NIMH, NIDA, and NCRG. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.498 Association between AAS use, muscle dysmorphia and illicit drug use among gym frequenters S. Pipet 1 , R. Halpern 1 , George E. Woody 2 , Claudia Szobot 1 1 Pós-graduac¸ão em saúde coletiva, ULBRA, Canoas, Brazil 2 Treatment Research Institute, University of Pennsylvania, Philadelphia, PA, United States
Aims: The use of anabolic-androgenic steroids (AAS) has increased among gym frequenters. Many people are involved in strength training to enhance their appearance, but this population might be at higher risk for of use of external ergogenic substances to achieve the muscular development desired. The aim of this study was to evaluate the prevalence of AAS use among gym frequenters and associated factors, such as muscle dysmorphia and illicit drugs. Methods: In a cross-sectional study, from a consecutive and proportional sample (n = 278) of adult gym frequenters, in the South of Brazil, anonymous questionnaires were self-completed by adults. Results: The prevalence of AAS use was 9.7%. It was found a strong association between AAS use and distorted body selfimage (PR = 6.33; p ≤ 0.01; CI95% 2.42–16.55) and with other illicit drugs such as marijuana/cocaine use (PR = 4.80, p = 0.03, CI95% 1.08–21.21). Conclusions: There was a high prevalence of AAS use among gym frequenters. Our results indicate that AAS use is not a healthy behavior, as usually suggested in the media, linking muscles with health. On the contrary, AAS was associated to self-destructive behavior – marijuana and cocaine. Corroborating this idea, it was not a surprise the strong association between AAS use and distorted self-image, an indicative of their exaggerated concern with the appearance of their muscles. We can understand these individuals as a special vulnerable group, usually involved with other destructive behavior, who will use any external way to achieve the desired shape, even if they have to disregard the substantial health. Financial support: None. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.499
Drug use trends following the 12-weeks OST in the Republic of Georgia (RCT) Gvantsa Piralishvili 1 , David Otiashvili 2 , Z. Sikharulidze 3 , G. Kamkamidze 4 , S. Poole 5 , George E. Woody 5 1 Centre for Mental Health and Prevention of Addiction, Tbilisi, Georgia 2 Addiction Research Center, Alternative Georgia, Tbilisi, Georgia 3 Centre for Medical, Socio-economic and Cultural Issues Uranti, Tbilisi, Georgia 4 Maternal and Child Care Union, Tbilisi, Georgia 5 Psychiatry, University of Pennsylvania, Phila, PA, United States
Aims: To obtain data on the acceptability and impact on drug use and HIV risk achieved by a 12-week course of daily-observed Suboxone® or methadone among opioid addicted Subutex® injectors. Methods: Randomized controlled 12-week trial of dailyobserved methadone or buprenorphine–naloxone with weekly counseling. Weekly urine tests on opioids, amphetamines, benzodiazepines and marijuana, and self-reports (TLFB); ASI at weeks 0, 4, 8, 12, 20. Results: Of the 80 patients (40/group, 4 women), 68 (85%) completed the 12-week study treatment and 66 (82.5%) showed up for the 20-week follow-up. 68.4% participants in methadone group and 72.5% in Suboxone® group reported injecting more than one illicit drug in last 30 days prior to randomization. Illicit drug use was dramatically reduced during the treatment (weeks 1–12) with significantly more urine samples positive for opioids in methadone group (1.5% vs. 0.2%; p = 0.03), for amphetamines (2.8% vs. 0.2%; p < 0.001) and marijuana (10.2% vs. 1.7%; p < 0.001) – in Suboxone® group (1–12 weeks). Of 836 urine test results and TLFB responses obtained during 1–12 weeks, 96.7% were in agreement. At followup (week 20) assessment (n = 66), participants remaining in OST (n = 37; 46%) used significantly less opioids (5.6% vs. 27.6%; p < 0.001), less illicit buprenorphine (2.7% vs. 13.8%; p = 0.005) less benzodiazepines (13.5% vs. 34.5%; p < 0.001), and less marijuana (2.8% vs. 20.7%; p < 0.001), compared to those who left the treatment. Conclusions: OST with daily observed methadone or buprenorphine–naloxone and weekly counseling is effective for reducing opioid and other psychoactive substances use in the Republic of Georgia. Financial support: R21-DA-026754-NIDA. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.500 The NK1 antagonist Aprepitant reduces stress-induced cocaine and alcohol craving in a human laboratory study Jennifer G. Plebani, A.L. Henninger, J. Burrell, E. Brown, Kyle M. Kampman Psychiatry, University of Pennsylvania, Philadelphia, PA, United States Aims: Initial studies of Neurokinin 1 (NK1) antagonism demonstrated reductions in stress-induced alcohol craving. This study extended such investigations to stress-induced cocaine and alcohol craving using the NK1 antagonist Aprepitant. Methods: Non-treatment seeking adult cocaine and alcohol dependent subjects (n = 12) were enrolled in a four-session outpatient human laboratory study. Subjects received placebo or
Make your own cigarette smoking: Toxicant exposure and behavioral changes Wallace Pickworth, L. Canlas, Z. Rosenberry, J.L. Potts Battelle, CAPH, Baltimore, MD, United States Aims: Increased price of factory made (FM) cigarettes have led to dramatic increases in the use of make your own (MYO) cigarettes, however, behavior changes and toxicant exposure associated with MYO use have not been evaluated. Methods: Six FM smokers (4 men) experimentally switched to exclusively smoking MYO cigarettes for 15 days. Cigarettes were made using a machine to inject loose tobacco into preformed filtered cigarette tubes, PMM. At Visit 1 (V1), their usual FM cigarette was smoked through a puff topography instrument; heart rate (HR), carbon monoxide (CO), and blood samples were taken before and after smoking. Participants were instructed how to make PMMs using a provided machine, tobacco, and tubes. Thereafter, participants made and exclusively smoked PMM. At each subsequent lab visit (3; approximately 4 days apart), they made 5 PMMs and smoked one through the topography unit. Results: Cigarettes smoked per day were the same (22) with FM and PMM. Participants became efficient producers of PMMs as evidenced in the reduced time to make 5 PMMs in the lab (377 s at V1 to 211 s at V4). Participants reported it easy and enjoyable to make and smoke PMMs, however the PMM cigarettes (0.78 g) were significantly smaller (p < 0.01) than their usual FM cigarettes (0.94 g). Over all conditions, nicotine plasma levels averaged 18.0 ± 2.4 ng/ml before smoking and 34.0 ± 5.3 ng/ml after smoking; there were no significant differences in the plasma nicotine boost (average 17.7 and 15.4 ng/ml after FM and PMM smoking, respectively). Compared to the V1 FM cigarette, the PMMs were smoked faster and with more puffs, averaging higher puff volumes and velocitiest. Compared to the FMs, the PMMs at V3 (p < .05) and V4 (p < .10) caused higher HR boost (4 bpm vs. 8 bpm) and lower CO boost (7.3 ppm vs. 4.1 ppm; p < 0.05). Participants progressively accepted the PMM cigarettes, however, one month after the study none were smoking PMM. Conclusions: This study demonstrated FM smokers can readily adopt PMM preparation. Smoking PMM cigarettes exposes users to similar levels of nicotine with reduced CO. Financial support: Supported by National Cancer Institute (1R01CA138973-01). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.496 Methamphetamine self-administration in humans during d-amphetamine maintenance Erika Pike 1 , William W. Stoops 1,2 , P.E. Glaser 3,4 , L.R. Hays 3 , C.R. Rush 1,2,3 1 Psychology, University of Kentucky, Lexington, KY, United States 2 Behavioral Science, University of Kentucky, Lexington, KY, United States 3 Psychiatry, University of Kentucky, Lexington, KY, United States 4 Anatomy and Neurobiology, University of Kentucky, Lexington, KY, United States
Aims: Translational research suggests that agonist replacement may be a viable treatment approach for managing stimulant use disorders. This study sought to determine the effects of d-amphetamine maintenance on methamphetamine selfadministration in stimulant using human volunteers. We predicted
e177
d-amphetamine maintenance would reduce methamphetamine self-administration. Methods: Eight volunteers completed the protocol that tested two d-amphetamine maintenance conditions in counter-balanced order (0 and 40 mg/day). Volunteers completed 4 experimental sessions under each maintenance condition in which they first sampled one of four doses of intranasal methamphetamine (0, 10, 20, or 30 mg). Volunteers then had the opportunity to respond on a computerized progressive ratio task to earn portions of the sampled methamphetamine dose. Subject-rated drug-effect and physiological measures were completed at regular intervals prior to and after sampling methamphetamine. Results: Methamphetamine was self-administered as an orderly function of dose regardless of the maintenance condition. Methamphetamine produced prototypical subject-rated effects, some of which were attenuated by d-amphetamine maintenance. Methamphetamine was well tolerated during d-amphetamine maintenance and no adverse events occurred. Conclusions: Although d-amphetamine attenuated some subject-rated effects of methamphetamine, the self-administration results are concordant with those of a clinical trial showing that d-amphetamine did not reduce methamphetamine use. Human laboratory self-administration studies can be used to screen other putative agonist replacement pharmacotherapies prior to clinical trial testing. Financial support: NIDA R01 DA025032 (PI: CRR). http://dx.doi.org/10.1016/j.drugalcdep.2014.02.497 Gender, problem-gambling severity, and the incidence of substance use disorders Corey E. Pilver, D.J. Libby, R.A. Hoff, M.N. Potenza Yale School of Medicine, New Haven, CT, United States Aims: To investigate whether the prospective association between problem-gambling severity and incident substance use disorders (SUDs) differed in women compared to men. In crosssectional data, pathological gambling (PG) is more strongly associated with SUDs in women versus men; thus, we hypothesized that incident SUDs (both as a group and as relating to alcohol, tobacco- and other drug-use disorders) would follow the same pattern. Methods: Wave-1 and Wave-2 National Epidemiologic Survey of Alcohol and Related Conditions (NESARC) data from 34,006 non-institutionalized US adults were analyzed. Wave-1 participants were categorized as non-gambling/low-frequency gambling (NG/LFG), low-risk gambling (LRG), and at-risk/problem gambling (ARPG) based on the ten inclusionary criteria for pathological gambling (PG). Dependent variables were any substance-use disorder (SUD), alcohol abuse/dependence (AUDs), nicotine dependence (ND), and drug abuse/dependence (DUDs). Results: Gender moderated the effects of problem-gambling severity on incident ND and DUDs, with effects stronger in women relative to men. Among women, LRG (OR = 1.38; p = .0037) and ARPG (OR = 2.14; p = .0023) were associated with elevated odds for ND, relative to LFG/NG; odds were not elevated in men (LRG: OR = 1.02; p = .79; ARPG: OR = 0.95; p = .84). While the gender difference in DUDs at the level of LRG was significant (Interaction OR = 1.90; p = .028), the gender-specific relationships between LRG and DUDs were not (women: OR = 1.31; p = .24; men: OR = 0.69; p = .05). Incident AUDs in relation to ARPG followed a distinct pattern, with associations observed in men (OR = 2.27; p = .0008) but not women (OR = 1.02; p = .96).
e178
Abstracts / Drug and Alcohol Dependence 140 (2014) e169–e251
Conclusions: Study findings highlight the relevance of considering gender in the prevention and treatment of SUDs. Those factors underlying the progression of specific SUDs in women and men with greater problem-gambling severity warrant identification, particularly as incident AUDs as compared to ND and DUDs showed gender-related differences that differed from cross-sectional patterns. Financial support: Supported by grants from NIMH, NIDA, and NCRG. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.498 Association between AAS use, muscle dysmorphia and illicit drug use among gym frequenters S. Pipet 1 , R. Halpern 1 , George E. Woody 2 , Claudia Szobot 1 1 Pós-graduac¸ão em saúde coletiva, ULBRA, Canoas, Brazil 2 Treatment Research Institute, University of Pennsylvania, Philadelphia, PA, United States
Aims: The use of anabolic-androgenic steroids (AAS) has increased among gym frequenters. Many people are involved in strength training to enhance their appearance, but this population might be at higher risk for of use of external ergogenic substances to achieve the muscular development desired. The aim of this study was to evaluate the prevalence of AAS use among gym frequenters and associated factors, such as muscle dysmorphia and illicit drugs. Methods: In a cross-sectional study, from a consecutive and proportional sample (n = 278) of adult gym frequenters, in the South of Brazil, anonymous questionnaires were self-completed by adults. Results: The prevalence of AAS use was 9.7%. It was found a strong association between AAS use and distorted body selfimage (PR = 6.33; p ≤ 0.01; CI95% 2.42–16.55) and with other illicit drugs such as marijuana/cocaine use (PR = 4.80, p = 0.03, CI95% 1.08–21.21). Conclusions: There was a high prevalence of AAS use among gym frequenters. Our results indicate that AAS use is not a healthy behavior, as usually suggested in the media, linking muscles with health. On the contrary, AAS was associated to self-destructive behavior – marijuana and cocaine. Corroborating this idea, it was not a surprise the strong association between AAS use and distorted self-image, an indicative of their exaggerated concern with the appearance of their muscles. We can understand these individuals as a special vulnerable group, usually involved with other destructive behavior, who will use any external way to achieve the desired shape, even if they have to disregard the substantial health. Financial support: None. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.499
Drug use trends following the 12-weeks OST in the Republic of Georgia (RCT) Gvantsa Piralishvili 1 , David Otiashvili 2 , Z. Sikharulidze 3 , G. Kamkamidze 4 , S. Poole 5 , George E. Woody 5 1 Centre for Mental Health and Prevention of Addiction, Tbilisi, Georgia 2 Addiction Research Center, Alternative Georgia, Tbilisi, Georgia 3 Centre for Medical, Socio-economic and Cultural Issues Uranti, Tbilisi, Georgia 4 Maternal and Child Care Union, Tbilisi, Georgia 5 Psychiatry, University of Pennsylvania, Phila, PA, United States
Aims: To obtain data on the acceptability and impact on drug use and HIV risk achieved by a 12-week course of daily-observed Suboxone® or methadone among opioid addicted Subutex® injectors. Methods: Randomized controlled 12-week trial of dailyobserved methadone or buprenorphine–naloxone with weekly counseling. Weekly urine tests on opioids, amphetamines, benzodiazepines and marijuana, and self-reports (TLFB); ASI at weeks 0, 4, 8, 12, 20. Results: Of the 80 patients (40/group, 4 women), 68 (85%) completed the 12-week study treatment and 66 (82.5%) showed up for the 20-week follow-up. 68.4% participants in methadone group and 72.5% in Suboxone® group reported injecting more than one illicit drug in last 30 days prior to randomization. Illicit drug use was dramatically reduced during the treatment (weeks 1–12) with significantly more urine samples positive for opioids in methadone group (1.5% vs. 0.2%; p = 0.03), for amphetamines (2.8% vs. 0.2%; p < 0.001) and marijuana (10.2% vs. 1.7%; p < 0.001) – in Suboxone® group (1–12 weeks). Of 836 urine test results and TLFB responses obtained during 1–12 weeks, 96.7% were in agreement. At followup (week 20) assessment (n = 66), participants remaining in OST (n = 37; 46%) used significantly less opioids (5.6% vs. 27.6%; p < 0.001), less illicit buprenorphine (2.7% vs. 13.8%; p = 0.005) less benzodiazepines (13.5% vs. 34.5%; p < 0.001), and less marijuana (2.8% vs. 20.7%; p < 0.001), compared to those who left the treatment. Conclusions: OST with daily observed methadone or buprenorphine–naloxone and weekly counseling is effective for reducing opioid and other psychoactive substances use in the Republic of Georgia. Financial support: R21-DA-026754-NIDA. http://dx.doi.org/10.1016/j.drugalcdep.2014.02.500 The NK1 antagonist Aprepitant reduces stress-induced cocaine and alcohol craving in a human laboratory study Jennifer G. Plebani, A.L. Henninger, J. Burrell, E. Brown, Kyle M. Kampman Psychiatry, University of Pennsylvania, Philadelphia, PA, United States Aims: Initial studies of Neurokinin 1 (NK1) antagonism demonstrated reductions in stress-induced alcohol craving. This study extended such investigations to stress-induced cocaine and alcohol craving using the NK1 antagonist Aprepitant. Methods: Non-treatment seeking adult cocaine and alcohol dependent subjects (n = 12) were enrolled in a four-session outpatient human laboratory study. Subjects received placebo or