Antoni Tejero

A controlled trial of daily versus thrice-weekly buprenorphine administration for the treatment of opioid dependence.

This study was aimed at determining whether thrice-weekly administration of buprenorphine is as effective as daily administration for treating opioid dependence. A total of 60 treatment-seeking opioid addicts were randomly assigned to take buprenorphine tablets sublingually either every day (8 mg) or thrice-weekly (16 mg on Mondays and Wednesdays and 24 mg on Fridays) over the course of a 12-week, double-blind, parallel trial. The buprenorphine dosing schedule had no significant effect on treatment retention. The rates of opioid-positive urine tests were significantly higher among those subjects who were given buprenorphine thrice weekly (58.5%) than among those who took it daily (46.6%). An analysis of the completers did not detect a significant effect of buprenorphine dosing schedule. The results obtained in our clinical trials indicate the advisability of daily doses of buprenorphine, at least at the beginning of a maintenance programme.

Methadone tapering plus amantadine to detoxify heroin-dependent inpatients with or without an active cocaine use disorder: two randomised controlled trials

The efficacy of methadone tapering plus amantadine to detoxify heroin-dependent patients with or without an active cocaine use disorder was studied in a closed unit with two successive double-blind, placebo-controlled, 14-day trials. In the first trial, 40 heroin-dependent inpatients with an active cocaine use disorder were treated using methadone tapering, as well as amantadine (200-300 mg per day) or placebo. In the second trial, 40 heroin-dependent inpatients without an active cocaine use disorder received the same treatment. In both the trials, amantadine did not have a statistically significant effect on treatment completion, nor did it contribute, in completers, to a more rapid reduction in craving and opiate withdrawal. In the first trial, women were six times more likely than men to be non-completers, and on the last day of treatment, the first trials completers and non-completers presented a comparable clinical state.

Drug-dependent inpatients reporting continuous absence of spontaneous drug craving for the main substance throughout detoxification treatment

INTRODUCTION AND AIMS Drug craving is considered to be an essential component of substance dependence. We aimed to characterise drug-dependent inpatients reporting continuous absence of subjective spontaneous drug craving. DESIGN AND METHODS This is a 3 year chart-review study designed to compare drug-dependent inpatients who did not report craving everyday (non-cravers) and their counterparts who did (cravers). All participants were recruited consecutively and completed a 14 day detoxification treatment. Craving was defined as a desire to use the main detoxification substance. This substance was chosen by patients, who completed a craving visual analogue scale, the Beck Depression Inventory and the State-Trait Anxiety Inventory daily. The Temperament and Character Inventory and the Addiction Severity Index were also used. RESULTS Of the 195 patients who completed the detoxification treatment, 45 (23.1%) were non-cravers and 32 (16.4%) were cravers. The main detoxification substances were alcohol, benzodiazepines, cannabis, cocaine, heroin and methadone. Non-cravers named methadone as the main detoxification substance more frequently than cravers, and benzoylecgonine was less frequently present in their urine at treatment entry. A decreased score on the Temperament and Character Inventory dimension of harm avoidance (i.e. trait anxiety) was the only independent predictor of absence of craving (odds ratio = 1.16, 95% confidence interval = 1.03-1.31). During admission, non-cravers had lower Beck Depression Inventory and State-Trait Anxiety Inventory scores than cravers. These differences were not accounted for by pharmacological treatment. DISCUSSION AND CONCLUSIONS Drug -dependent inpatients who report absence of craving are characterised by relatively low levels of depression and anxiety throughout detoxification treatment, and relatively low levels of trait anxiety.

Personality traits of cocaine-dependent patients associated with cocaine-positive baseline urine at hospitalization.

Background: Cocaine abstinence at treatment entry is considered a predictor of good response in cocaine dependence treatment. Therefore, identification of factors facilitating pretreatment cocaine abstinence could be useful for developing new therapeutic strategies. Objective: This retrospective chart review study examines the association between personality traits and cocaine-positive baseline urinalysis (CPB) in cocaine-dependent inpatients. Methods: All 107 participants met DSM-IV criteria for cocaine dependence, and were admitted consecutively to a closed addiction unit for detoxification treatment. Personality was assessed with the Temperament and Character Inventory and the Millon Clinical Multiaxial Inventory (MCMI-II). Results: CPB was detected in 80 patients (74.8%). The logistic regression model solely based on personality dimensions showed that only the MCMI-II avoidant traits were significantly associated with a decreased probability of cocaine-dependent patients presenting CPB. The logistic regression model based on both personality dimensions and substance use–related variables alike retained the number of days of cocaine use during the last 30 days as a risk factor, and alcohol dependence and the MCMI-II schizoid dimension as protective factors in predicting CPB results. Conclusion and Scientific Significance: Avoidant and schizoid traits are personality dimensions of cocaine-dependent patients that are associated with cocaine abstinence prior to inpatient admission. These findings suggest an inverse relationship between social isolation and CPB. Notwithstanding, more research is needed, not only to assess the generalizability of these findings, but also to enrich the personality and substance use model with variables related to readiness to change.

Indefensión aprendida y dependencia de sustancias

Resumen Objetivo Realizar una revision sistematica de la teoria de la indefension aprendida asi como de la relacion entre esta y la dependencia de sustancias. Material y metodos Se realizo una busqueda sistematica de la bibliografia a traves del sistema MEDLINE y PSYCINFO sobre articulos relacionados con el tema. Resultados La teoria de la indefension aprendida puede aplicarse al ambito de las adicciones como modelo explicativo de la incontrolabilidad, eje central de estos trastornos. Concretamente, la indefension aprendida desempenaria un papel relevante como variable predictora de consumo y como variable relacionada con la evolucion de dicho consumo, asociandose a alteraciones emocionales y deficits neuropsicologicos. Conclusiones La indefension aprendida constituye un paradigma valido aplicable a los trastornos por dependencia de sustancias. Se requiere de mas estudios para determinar sus implicaciones clinicas y terapeuticas en las adicciones.