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Methamphetamine dependence, psychiatric disorders, and treatment outcomes in individuals treated with methylphenidate
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Abstracts / Drug and Alcohol Dependence 146 (2015) e34–e117
(n = 403) cocaine abusers participating in one of six randomized clinical trials comparing CM to standard care. Results: General Linear Modeling analyses revealed a significant 3-way interaction between race, baseline cocaine urine toxicology results and treatment group on the percentage of negative samples submitted during treatment (F[1,835] = 5.46, p < .05) and weeks retained in treatment (F[1,835] = 5.32, p < .05), but this interaction effect was not significant for longest duration of abstinence achieved during treatment, F(1, 835) = 2.04, p = .15. Specifically, African American and White adults who initiated treatment with a cocaine-negative urine sample remained in treatment for similar durations and submitted a comparable proportion of negative samples during treatment regardless of treatment type. Whites who began treatment with a cocaine positive sample remained in treatment longer and submitted a higher proportion of negative samples when assigned to CM than standard care. African Americans who initiated treatment with a cocaine positive sample, however, did not remain in treatment longer with CM compared with standard care, and gains in terms of drug use outcomes were muted in nature relative to Whites. This interaction effect persisted through the 9-month follow-up period. Conclusions: CM is not equally effective in reducing drug use among all subgroups, specifically African American patients who are using cocaine upon treatment entry. African Americans are in need of effective treatment that will not only prevent relapse but also initiate cocaine abstinence. Financial support: This research was supported by NIH grants P30-DA023918, P50-DA09241, R01-DA016855, R01-DA027615, and R01-HD075630. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.490 Delay discounting in polysubstance dependence Lara Moody 1,2 , Chris Franck 1,3 , Laura Hatz 1 , Warren K. Bickel 1,2 1 Psychology, Virginia Tech Carilion Research Institute, Roanoke, VA, United States 2 Psychology, Virginia Tech, Blacksburg, VA, United States 3 Statistics, Virginia Tech, Blacksburg, VA, United States
Aims: Substance dependence is a major public health concern in the United States. Moreover, most individuals with substance dependence are engaged in poly substance abuse with 75% of individuals in treatment for alcohol and cocaine dependence also smoke cigarettes. The effects of concurrent substance dependencies are pertinent to treatment planning, treatment efficacy and understanding the neurobiological underpinnings of addiction. One measure of the impact of multiple drug dependencies is to examine the extent that such individuals discount future rewards. A prerequisite to targeted corrective interventions is an understanding of the differences between non-substance users, mono-substance users, and poly-substance users. We hypothesize that increased number of dependencies will correlate with steeper discounting of future rewards. Methods: We compared 62 individuals with no substance dependencies, 143 individuals with nicotine dependence, 218 individuals with co-occurring nicotine and cocaine, alcohol or cocaine and alcohol dependence. Each participant completed a delay discounting task to measure the rate of discounting of future rewards.
Results: Individuals with co-occurring alcohol, cocaine, and nicotine dependence discounted future rewards significantly more than individuals who were tobacco dependent. Furthermore, individuals with no substance dependencies discounted future rewards significantly less than individuals with multiple substance dependencies. Conclusions: These results provide evidence that polysubstance dependent individuals discount future rewards more than controls and mono-dependent cigarette smokers. These results support the importance of further study regarding the impact of co-occurring substance dependencies and how treatment for individuals with multiple dependencies may require different approaches than those with single dependencies. Financial support: NIDA (R01DA024080, R01DA030241), NIAAA Supplement (R01DA024080), and the VTCRI. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.491 Methamphetamine dependence, psychiatric disorders, and treatment outcomes in individuals treated with methylphenidate Larissa Mooney, Maureen P. Hillhouse, Alfonso Ang, J. Jenkins, Walter Ling UCLA Integrated Substance Abuse Programs, Los Angeles, CA, United States Aims: The aim of this study is to examine the prevalence of psychiatric disorders and the association between psychiatric disorders and treatment outcomes in a sample of MA-dependent study participants. Methods: This secondary analysis utilizes data collected in randomized, double-blind, placebo-controlled study of 110 MAdependent adults randomly assigned to pharmacotherapy with methylphenidate (MPH) or placebo for 10 weeks in combination with weekly cognitive behavioral therapy (CBT), followed by 4-weeks of single-blind placebo. To examine the relationship between psychiatric diagnoses and substance use outcomes, psychiatric diagnoses were assessed with the MINI at baseline, and MA use was assessed using the Treatment Effectiveness Score (TES) which calculates a score using urine drug screens (UDS) collected twice weekly. Results: A total of 67.3% (N = 74) of the sample met DSM-IV criteria for a psychiatric disorder; 30.3% (N = 33) for Major Depressive Disorder, current; 10.1% (N = 11) for a psychotic disorder, and 32.1% (N = 35) for Antisocial Personality Disorder. The presence of a psychiatric disorder was associated with a significantly greater likelihood of amphetamine positive UDS at the end of the active medication phase (i.e. weeks 9 and 10 [P = 0.006]). Having a psychiatric disorder was also associated with increased CBT attendance in the placebo group (P = 0.01) but was not associated with treatment retention in either group. Conclusions: This study included a relatively high prevalence of psychiatric diagnoses among participants, similar to other treatment research. The presence of a psychiatric disorder was associated with MA use outcomes suggesting the need for attention to screening and treatment needs within dually diagnosed populations. Financial support: National Institute on Drug Abuse DA015084, medication supplied by Janssen Pharmaceuticals. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.492
Abstracts / Drug and Alcohol Dependence 146 (2015) e34–e117
(n = 403) cocaine abusers participating in one of six randomized clinical trials comparing CM to standard care. Results: General Linear Modeling analyses revealed a significant 3-way interaction between race, baseline cocaine urine toxicology results and treatment group on the percentage of negative samples submitted during treatment (F[1,835] = 5.46, p < .05) and weeks retained in treatment (F[1,835] = 5.32, p < .05), but this interaction effect was not significant for longest duration of abstinence achieved during treatment, F(1, 835) = 2.04, p = .15. Specifically, African American and White adults who initiated treatment with a cocaine-negative urine sample remained in treatment for similar durations and submitted a comparable proportion of negative samples during treatment regardless of treatment type. Whites who began treatment with a cocaine positive sample remained in treatment longer and submitted a higher proportion of negative samples when assigned to CM than standard care. African Americans who initiated treatment with a cocaine positive sample, however, did not remain in treatment longer with CM compared with standard care, and gains in terms of drug use outcomes were muted in nature relative to Whites. This interaction effect persisted through the 9-month follow-up period. Conclusions: CM is not equally effective in reducing drug use among all subgroups, specifically African American patients who are using cocaine upon treatment entry. African Americans are in need of effective treatment that will not only prevent relapse but also initiate cocaine abstinence. Financial support: This research was supported by NIH grants P30-DA023918, P50-DA09241, R01-DA016855, R01-DA027615, and R01-HD075630. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.490 Delay discounting in polysubstance dependence Lara Moody 1,2 , Chris Franck 1,3 , Laura Hatz 1 , Warren K. Bickel 1,2 1 Psychology, Virginia Tech Carilion Research Institute, Roanoke, VA, United States 2 Psychology, Virginia Tech, Blacksburg, VA, United States 3 Statistics, Virginia Tech, Blacksburg, VA, United States
Aims: Substance dependence is a major public health concern in the United States. Moreover, most individuals with substance dependence are engaged in poly substance abuse with 75% of individuals in treatment for alcohol and cocaine dependence also smoke cigarettes. The effects of concurrent substance dependencies are pertinent to treatment planning, treatment efficacy and understanding the neurobiological underpinnings of addiction. One measure of the impact of multiple drug dependencies is to examine the extent that such individuals discount future rewards. A prerequisite to targeted corrective interventions is an understanding of the differences between non-substance users, mono-substance users, and poly-substance users. We hypothesize that increased number of dependencies will correlate with steeper discounting of future rewards. Methods: We compared 62 individuals with no substance dependencies, 143 individuals with nicotine dependence, 218 individuals with co-occurring nicotine and cocaine, alcohol or cocaine and alcohol dependence. Each participant completed a delay discounting task to measure the rate of discounting of future rewards.
Results: Individuals with co-occurring alcohol, cocaine, and nicotine dependence discounted future rewards significantly more than individuals who were tobacco dependent. Furthermore, individuals with no substance dependencies discounted future rewards significantly less than individuals with multiple substance dependencies. Conclusions: These results provide evidence that polysubstance dependent individuals discount future rewards more than controls and mono-dependent cigarette smokers. These results support the importance of further study regarding the impact of co-occurring substance dependencies and how treatment for individuals with multiple dependencies may require different approaches than those with single dependencies. Financial support: NIDA (R01DA024080, R01DA030241), NIAAA Supplement (R01DA024080), and the VTCRI. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.491 Methamphetamine dependence, psychiatric disorders, and treatment outcomes in individuals treated with methylphenidate Larissa Mooney, Maureen P. Hillhouse, Alfonso Ang, J. Jenkins, Walter Ling UCLA Integrated Substance Abuse Programs, Los Angeles, CA, United States Aims: The aim of this study is to examine the prevalence of psychiatric disorders and the association between psychiatric disorders and treatment outcomes in a sample of MA-dependent study participants. Methods: This secondary analysis utilizes data collected in randomized, double-blind, placebo-controlled study of 110 MAdependent adults randomly assigned to pharmacotherapy with methylphenidate (MPH) or placebo for 10 weeks in combination with weekly cognitive behavioral therapy (CBT), followed by 4-weeks of single-blind placebo. To examine the relationship between psychiatric diagnoses and substance use outcomes, psychiatric diagnoses were assessed with the MINI at baseline, and MA use was assessed using the Treatment Effectiveness Score (TES) which calculates a score using urine drug screens (UDS) collected twice weekly. Results: A total of 67.3% (N = 74) of the sample met DSM-IV criteria for a psychiatric disorder; 30.3% (N = 33) for Major Depressive Disorder, current; 10.1% (N = 11) for a psychotic disorder, and 32.1% (N = 35) for Antisocial Personality Disorder. The presence of a psychiatric disorder was associated with a significantly greater likelihood of amphetamine positive UDS at the end of the active medication phase (i.e. weeks 9 and 10 [P = 0.006]). Having a psychiatric disorder was also associated with increased CBT attendance in the placebo group (P = 0.01) but was not associated with treatment retention in either group. Conclusions: This study included a relatively high prevalence of psychiatric diagnoses among participants, similar to other treatment research. The presence of a psychiatric disorder was associated with MA use outcomes suggesting the need for attention to screening and treatment needs within dually diagnosed populations. Financial support: National Institute on Drug Abuse DA015084, medication supplied by Janssen Pharmaceuticals. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.492