Frank R. Funderburk

Differential effects of cocaine and cocaine alcohol on neurocognitive performance.

Objective: To investigate the dose-related effects of cocaine with or without alcohol use on the CNS by measuring performance on neurobehavioral tests. Background: Chronic use of cocaine is associated with persistent decrements in cognitive function that are most pronounced in heavy users. Specific neurobehavioral deficits in areas such as executive function and impulsivity would make it difficult for the cocaine abuser to discontinue using drugs. Because alcohol is often used in conjunction with cocaine, the CNS effects of alcohol when taken with cocaine deserve further investigation. Method: The authors evaluated the dose-related effects of cocaine and alcohol use on performance in a variety of neuropsychological tests after 1 to 3 days of abstinence and again after 4 weeks of abstinence. Fifty-six chronic cocaine abusers who had used cocaine during the past 24 to 48 hours volunteered to perform a battery of neuropsychological tests on two separate occasions during a period of enforced abstinence. In addition to using cocaine, most of the volunteers consumed alcohol. Approximately half of the participants consumed more than 10 alcohol-containing drinks per week. Results: After controlling for the effects of age, sex, and intelligence on performance, the authors found dose-related associations between neurobehavioral performance and cocaine dose and alcohol dose. When the influences of cocaine and alcohol on neurobehavioral performance were taken separately, cocaine and alcohol each selectively affected performance on different neurobehavioral tests after 1 to 3 days of abstinence, with these effects persisting after 4 weeks of abstinence. Conclusion: The concomitant use of cocaine and alcohol may have additive negative effects on the brain as compared to the use of only one of these two substances.

Reduction of perseverative errors in patients with schizophrenia using monetary feedback.

The influence of monetary feedback on Wisconsin Card Sort Test (WCST) performance of 14 male schizophrenics was investigated. Patients were administered the test under standard instructions and with monetary feedback in counterbalanced order. Monetary reinforcement reduced perseverative errors and increased correct responses (p less than .05). These findings suggest that the WCST perseverative errors of schizophrenics reflect motivational as well as cognitive factors.

Impaired Wisconsin Card Sort Performance in Schizophrenia May Reflect Motivational Deficits

To the Editor.— During the past several years important reports have appeared in theArchives 1-3 concerning relationships between regional cerebral blood flow and impaired Wisconsin Card Sort (WCS) performance in schizophrenia. One provocative finding has been that impairment on this task is not corrected by instruction. 4 The WCS task requires the respondent to match cards that vary simultaneously in a number of dimensions (color, form, and number of elements) to one of four models. The subject is told whether each placement is correct or incorrect and must discover the correct sorting rule from this feedback. The first rule is to sort by color. When this rule has been learned, the correct dimension is changed, first to form and then to number. The subject is not informed of this change; rather, he or she must discover the new rule. 5 Although many different scores can be derived from the

Mortality and illness in male alcoholics: An 8-year follow-up

An 8-year follow-up was conducted on a group of male alcoholics. Their mortality and illness records were examined. The number of observed deaths is 4.7 times that expected. The excess deaths appear to be due to causes frequently associated with alcoholism. Patient characteristics predictive of mortality are presented. Inpatient stays in general hospitals, for reasons other than alcoholism, totaled almost four times the duration expected. The relationships between drinking patterns and hospitalizations are studied. Clinical tests, which show improvement in response to abstinence, are suggested as positive reinforcers for patients in alcoholism treatment.

Polysomnogram changes in marijuana users who report sleep disturbances during prior abstinence

BACKGROUNDnAbrupt discontinuation of heavy marijuana (MJ) use is associated with self-reports of sleep difficulty. Disturbed sleep is clinically important because MJ users experiencing sleep problems may relapse to MJ use to improve their sleep quality. Few studies have used polysomnography (PSG) to characterize changes in sleep architecture during abrupt abstinence from heavy MJ use.nnnMETHODSnWe recorded PSG measures on nights 1, 2, 7, 8, and 13 after abrupt MJ discontinuation in 18 heavy MJ users residing in an inpatient unit.nnnRESULTSnAcross abstinence, Total Sleep Time (TST), Sleep Efficiency (SEff), and amount of REM sleep declined, while Wake after Sleep Onset (WASO) and Periodic Limb Movements (PLM) increased. Furthermore, quantity (joints/week) and duration (years) of MJ use were positively associated with more PLMs.nnnCONCLUSIONnThe treatment of sleep disturbance is a potential target for the management of cannabis use disorders since poor sleep could contribute to treatment failure in heavy MJ users.

Relative abuse liability of lorazepam and diazepam: an evaluation in ‘recreational’ drug users

The subjective, psychomotor and cognitive effects of oral doses of lorazepam (0, 1.5, 3 and 6 mg) and diazepam (0, 10, 20 and 40 mg) were studied under double-blind conditions in 14 volunteers with histories of recreational benzodiazepine use/abuse. For each subject, drug was administered over 4 test days in a 2 (drug) by 4 (dose level) mixed design. Drug was the between-groups factor while dose was the within-subjects factor. Test days were separated by at least 1 week. The results showed that subjective ratings of drug liking and the psychomotor and cognitive effects of lorazepam were generally similar to those of diazepam over the range of doses studied. Lorazepam, however, tended to produce effects of longer duration than diazepam. Since previous studies have shown that diazepam has a relatively high abuse liability among the benzodiazepines, the present findings suggest that lorazepam shares this property with diazepam is subjects with a history of recreational drug use/abuse.

Phenylpropanolamine: Effects on Subjective and Cardiovascular Variables at Recommended Over‐the‐Counter Dose Levels

Two controlled clinical studies evaluated the effects of phenylpropanolamine HCL (PPA) on measures of blood pressure, pulse, and subjective state (mood). One hundred fifty subjects participated in a parallel groups design that compared a 75‐mg sustained release (SR) preparation with a 25‐mg tid. dosing regimen and placebo. Fifty‐nine of these subjects participated in an additional cross‐over component that compared SR PPA 75 mg with placebo. Measures of blood pressure, pulse, and subjective drug effect were obtained nine times throughout the course of a 12‐hour session. Data analysis revealed no clinically and few statistically significant effects due to drug treatment. As expected, most measures showed circadian changes on both the cardiovascular and mood variables, which were not related to drug treatment. No euphorogenic or “amphetaminelike” effects were noted. Although further work is warranted regarding the effects of chronic or higher‐than‐normal doses of PPA, the current studies suggest that PPA, at currently recommended dose levels, is not associated with adverse effects on either cardiovascular or subjective functioning.

Controlled Drinking and Abstinence in Alcoholic Men: Beliefs Influence Actions

A group of alcoholic men were asked 8 years postdischarge from hospital if they could drink alcohol with control. Subjects who said no (the NCD group) were compared to those who said yes (the CD group). A majority of the NCD group had been abstinent during the year preceding the 8-year evaluation, whereas none of the CD group had been. In the model developed, troubles resulting from drinking are seen as instrumental in changes from a CD to a NCD belief. The clinical relevance of our results is discussed.

Evaluation of the Multiple Offender Alcoholism Project: Quasiexperimental Evaluation Strategy with a Focus on Individual Change and Quality of Life.

Abstract The development, implementation, and evaluation of a treatment program for violent criminal offenders with alcohol abuse/alcoholism is described. The treatment program was based on a contingency management system that rewarded program attendance and participation. The evaluation of the program, using quasiexperimental techniques (including comparisons with national samples and two independent local control samples), indicated that active program clients engaged in significantly fewer violent crimes and showed significantly improved life functioning (“quality of life”) in areas of employment and social adjustment during participation in the program. These beneficial changes were correlated with program participation and were also predictive of desired social outcomes, as defined by the criminal justice system, such as reduced alcohol consumption and reduced violent crime. This presentation illustrates that the goals of mental health treatment programs and traditional criminal justice system agencies (and their associated definitions of “quality of life”) are not necessarily incompatible.

Evaluation of the abuse potential of the novel analgesic flupirtine maleate

To evaluate the psychopharmacological effects and potential abuse liability of the novel analgesic flupirtine maleate the subjective and behavioral effects of orally administered flupirtine, lorazepam and placebo were studied in polydrug abusers. Effects were measured before and for 6 h after drug administration under double-blind conditions. At therapeutic doses flupirtine was not differentiated from placebo. Lorazepam and higher doses of flupirtine produced increases in subject-rated liking, ARCI MBG scale scores, and sedative-like effects including impaired psychomotor performance. Flupirtine, but not lorazepam, increased ratings on measures indicating dysphoric effects. The results indicate that flupirtine has some sedative-like effects but that its abuse potential is probably modest.