Arnold M. Washton

Drugs and sexual effects: role of drug type and gender

This study investigated gender differences in the relationship between psychoactive substance use and sexual thoughts, feelings, and behaviors. Participants (N = 464) were male and female alcohol, opiate, cocaine, and methamphetamine users enrolled in an outpatient treatment program at any of 8 sites. A self-report survey that inquired about the specific sexual thoughts, feelings, and behaviors of the participant during previous instances of being under the influence of their primary drug of dependence served as the data source. The results indicate that different categories of psychoactive agents were associated with different effects on sexual behavior, and that those effects vary by gender. Development of a valid measure assessing the type and strength of these relationships may be beneficial for use by treatment programs in promoting abstinence from drug and alcohol use and preventing relapse.

Naloxone‐precipitated withdrawal: A method for rapid induction onto naltrexone

We examined naloxone‐precipitated withdrawal as a meansfor rapid opiate detoxification and induction onto naltrexone, In 29 patients dependent on methadone (5 to 20 mg/day), abstinence was precipitated by an injection qf naloxone. Repeated injections of naloxone were given subsequently until symptoms of abstinence were no longer induced. Successive injections induced less intense withdrawal assessed by vital signs and ratings on abstinence scales. The most rapid procedure consisted of 1.2 mg naloxone every 30 min for 3 to 6 hr, followed by hourly increasing doses of naltrexone. This procedure allowed transition from opiate dependence to naltrexone maintenance (50 to 100 mg/day) within 48 hr. The results are consistent with assumptions that antagonists actively displace opiates from receptor sites.

Survey of 500 callers to a national cocaine helpline

Abstract Information gathered during extensive telephone interviewing of 500 cocaine users calling the 800-COCAINE helpline revealed a high incidence of dysfunctional cocaine use associated with numerous physical, psychological, and social problems. The typical caller was a white, middle-income male between 25 and 40 years old with no history of drug dependence or serious psychiatric problems. The findings are discussed with regard to the high abuse potential of cocaine and adverse effects.

CLINICAL OUTCOME WITH NALTREXONE

Much work on clinical applicability of narcotic antagonists in treatment of opiate abuse has focused on two interrelated questions: Which patients are more likely to benefit from antagonist treatment, and How effective is this modality of treatment in combating opiate abuse? When cyclazocine was first introduced as a treatment for detoxified opiate addicts, patients were accepted for treatment after meeting minimum psychiatric and medical eligibility criteria. Cyclazocine was the only treatment offered in our clinic at that time and no attempt was made to select the most appropriate treatment modality for each individual. It soon became evident cyclazocine was helpful for only a small proportion of patients; many patients discontinued it and became readdicted to opiates almost immediately. Clinical impressions suggested cyclazocine was not an appropriate form of treatment for certain “types” of opiate addicts. This impression was explored by Resnick et al.’ who presented a typological classification of opiate addicts, based on patients’ self-ratings of the role opiates played in their daily lives. The self-rating scale consisted of eleven statements, such as: On heroin the patient felt closer to others, better about himself, more ambitious, and generally more capable of functioning “normally,” as compared with periods when he was “clean” (i.e., opiate free). Each statement was rated by the patient on a scale from 1 (always true) to 5 (always false) and a total score was obtained. After administering this scale to 31 patients on cyclazocine for varying periods of time, investigators found patients who remained in treatment for as long as two and one-half years had significantly higher scores, reflecting less dependence on opiates for normal functioning than those who discontinued treatment within the first six months. It was also found that patients involved in a stable “marital” relationship with a nonaddict mate were more likely to sustain cyclazocine and remain abstinent than patients who lacked such a relationship. It was suggested that, in general, patients with low scores are better suited for methadone maintenance treatment because they perceive themselves as needing opiates in order to feel and function “normally.” Patients with a high score, on the other hand, do not use opiates to relieve chronic difficulties in feeling or functioning; these patients often do well in antagonist treatment. In a subsequent study, Resnick et ai.’ assessed the power of these self-rating scores and demographic variables to predict treatment outcome with cyclazocine. “Success” in treatment was defined as sustained use of cyclazocine for at least six months, without use of opiates or “excessive” use of non-narcotic substances. Unlike the earlier findings, there was no difference in mean scores between success and failure groups. As for demographic variables, marital and employment

Clonidine and Lofexidine: New Nonopiate Treatments for Opiate Withdrawal

Recent studies (Gold et al, 1978; Washton et al, 1980a) showing that the non-opiate antihypertensive agent, Clonidine hydrochloride, suppresses signs and symptoms of opiate withdrawal, have suggested that Clonidine and similar drugs might be useful in the clinical management of opiate detoxification. The fact that Clonidine is not an opiate drug and does not itself produce addiction or euphoria suggests some unique and potentially useful applications of this medication in the treatment of opiate-dependent persons. For example, Clonidine might be used to block the emergence of abstinence symptoms during a gradual methadone detoxification. Clonidine might also serve as a transitional treatment between opiate dependence and induction onto the long-acting opiate antagonist, naltrexone (Resnick et al, 1979). If withdrawal symptoms were controlled by Clonidine, patients might be able to abruptly discontinue chronic opiate use and remain abstinent during the minimum 10-day opiate-free period that is required before starting naltrexone aftercare treatment. In general, Clonidine might increase the chances of detoxification success and allow patients greater access to naltrexone and drug-free modalities.