Frank H. Gawin

Neuropsychological impairment in chronic cocaine abusers

Twenty chronic cocaine abusers were compared with age and education matched controls using standardized neuropsychological assessment procedures to determine whether the cocaine abusers were impaired. Fifty percent of the cocaine abusers in contrast to 15% of the controls scored in the impaired range on the summary index of the Neuropsychological Screening Exam. The cocaine abusers also performed more poorly on the Halstead Category Test, the Symbol Digit Modalities Test, the WAIS-R Arithmetic Test, and a test of verbal memory (forgetting). In the cocaine abuser sample, neuropsychological performance was related to the amount and recency of cocaine use, suggesting a direct role of cocaine on cognitive functioning.

A comparative trial of psychotherapies for ambulatory cocaine abusers : relapse prevention and interpersonal psychotherapy

Despite the widespread use of psychotherapy as treatment for cocaine abuse, the effectiveness of psychotherapy has not been explored through clinical trials. Forty-two outpatients who met DSM-III criteria for cocaine abuse were randomly assigned to one of two forms of purely psychotherapeutic treatments of cocaine abuse, either relapse prevention (RPT) or interpersonal psychotherapy (IPT). Subjects assigned to relapse prevention were more likely than subjects in IPT to attain three or more continuous weeks of abstinence (57 versus 33%), be classified as recovered at the point of treatment termination (43 versus 19%), and complete treatment (67 versus 38%). Whereas these differences did not reach statistical significance, significant differences by treatment group did emerge when subjects were stratified by severity of substance use: Among the subgroup of more severe users, subjects who received RPT were significantly more likely to achieve abstinence (54 versus 9%) and be classified as recovered (54 versus 0%). Among the subgroups of subjects with lower severity of substance abuse, outcome was comparable for both treatment types. Comparison of results from this investigation with historical controls from a structurally similar pharmacotherapy trial suggests that purely psychotherapeutic treatments may be both viable and effective approaches for many ambulatory cocaine abusers.

Gender differences in cocaine use and treatment response

Much of our understanding of treatment efficacy in drug abuse is based on male drug abusers. In order to determine if there are gender differences in baseline drug use and treatment response, we compared male and female cocaine abusers who participated in an outpatient randomized clinical trial (RCT) evaluating pharmacotherapies for cocaine abuse. Although females had more severe drug problems at intake, they were as successful as males in the RCT and more successful at 6-month follow-up.

Cocaine Abuse among Opioid Addicts: Demographic and Diagnostic Factors in Treatment

Cocaine is becoming a major drug of abuse among the general population and among opiate addicts. Reports from the early 1970s found that most abusers were older Black males with some antisocial characteristics. Cocaine abuse at that time was reported by about 17% of opiate addicts seeking treatment and by 7 to 11% of ex-addicts on methadone maintenance. However, that rate increased dramatically during the 1970s, and in our 1980 study of 533 addicts we found that 74% of opiate addicts applying for treatment used cocaine. It was the second most abused nonopioid drug after marijuana, surpassing alcohol intoxication. Although the mean number of days of abuse over the previous 30 days was substantially lower among the addicts on our methadone maintenance program (mean = 1.4 days, n = 120) than among the addicts applying for treatment (mean = 9 days, n = 204), the following associations with cocaine abuse were consistent in both subsamples. Cocaine abuse was more frequent among Blacks. It was associated with a variety of antisocial indices including Research Diagnostic Criteria antisocial personality disorder, number of arrests, and legal, family, employment, and drug abuse problems as assessed by the Addiction Severity Index and the Social Adjustment Scale. Several differences emerged between Black and White cocaine-abusing addicts, the most interesting being an increased rate of anxiety disorders among White cocaine abusers. Based on these associations, we offer several guidelines for treating cocaine abuse in opiate addicts.

Neuroleptic reduction of cocaine-induced paranoia but not euphoria?

Central dopaminergic activation is hypothesized to underly schizophrenia and, paradoxically, stimulant euphoria. Four cocaine abusers with histories of stimulant-induced paranoid psychoses reported selective reduction in psychotic symptoms but not euphoria when treated with dopamine blockers. This provides preliminary evidence against efficacy of neuroleptics in cocaine abuse prevention, and suggests euphoria and paranoia may have discriminable neurophysiological substrates.

Methylphenidate treatment of cocaine abusers without attention deficit disorder: a negative report.

Five cocaine abusers without diagnoses of Attention Deficit Disorder (ADD) were treated with methylphenidate in an open trial. In contrast to previously described patients with ADD, none of these patients showed clinical improvement or decreased cocaine use.

Methylphenidate (Ritalin®) treatment of cocaine dependence—A preliminary report

The authors report on three cases of cocaine dependence treated with methylphenidate. All patients treated showed marked to dramatic improvement with regard to toxic/abstinence signs and symptoms, craving behavior and other behavioral disturbances associated with heavy and chronic cocaine abuse. The authors explore the possibility that cocaine dependence is associated with pre-existing or resulting psychopathology, particularly mood disturbances. Emphasis is also placed on a predisposing or de novo attention deficit disorder (ADD) as possibly contributing to heavy or continued reliance on cocaine.

Interpersonal Psychotherapy Adapted for Ambulatory Cocaine Abusers

The authors describe the strategies and goals of Klerman et al.s Interpersonal Psychotherapy (IPT) as revised for application to cocaine abusers. IPT is a brief, individual psychological treatment suitable for use by experienced psychotherapists. The goals are reduction or cessation of cocaine use and development of more productive strategies for dealing with social and interpersonal problems associated with the onset and perpetuation of cocaine use. The treatment has four definitive characteristics: (a) adherence to a medical model of psychiatric disorders; (b) focus on patients difficulties in current interpersonal functioning; (c) brevity and emphasis on consistency of focus; and (d) use of an exploratory stance by the psychotherapist which is similar to that of supportive and exploratory psychotherapies. It is currently being used in combination with medications in a clinical trial evaluating the efficacy of desipramine, lithium carbonate, methylphenidate, and placebo as treatment for ambulatory cocaine abusers.

Cocaine use and withdrawal : the effect on sleep and mood

Three recreational cocaine users (age, 26.7 years), after one adaptation night, spent 5 days and nights in the laboratory where their EEG, EOG, and submental EMG were recorded during all of their sleep. On the second afternoon and evening of the study, subjects used an estimated 1 to 2 g cocaine intranasally. They all slept between 2:00 A.M. and 9:00 A.M. that night. Blood samples were drawn each evening and morning. Absolute plasma cocaine levels and patterns of elimination were consistent with subjects report of dose and time of administration. Mood ratings were made repeatedly throughout the study. There was suppression of REM sleep during the use of cocaine followed by a rebound which is specific to REM sleep and is not seen in other stages of sleep. REM variables subsided to normal levels on the third recovery night following cocaine use.

Intravenous cocaine challenges during naltrexone maintenance: A preliminary study

In 1976 Byck hypothesized that opioid antagonists would block the euphoric effect of cocaine, and recent clinical observations have suggested lower rates of cocaine abuse by people receiving naltrexone (NTX) than by those receiving methadone (Kosten et al 1989). Although early workers found that both rodents and primates maintained on antagonists showed no attenuation of cocaine self-administration (Killian et al 1978; Carroll et al 1986), more recent studies have found attenuation with NTX administration (Mello et al 1990; DeVry et al 1989; Ramsey and van Ree 1991). Furthermom, Bain and Kornetsky (1987), using rewarding brain stimulation in rodents, showed that the antagonist naloxone can reverse cocaines potentiation of this stimulation. An early human study using cocaine administration found a potentiation rather than a reduction of cocaine effect after acute high-dose naloxcne (20 mg i.e.; Byck et al 1982), but this situation is clearly different from maintenance blocking with lower doses of NTX. We therefore undertook the current cocaine challenge study during chronic NTX.