Gregory Carlson

Psychopathology in pathological gamblers seeking treatment

High rates of psychiatric symptoms have been reported in pathological gamblers. This study of psychiatric comorbidity in pathological gamblers is the first to use structured psychiatric interviews assessing DSM-III-R Axis I and II disorders. The Structured Clinical Interview for DSM III-R (SCID-P, SCID-II) was administered to 40 (25 male, 15 male) pathological gamblers seeking outpatient treatment in Minnesota for gambling, and 64 (41 male, 23 female) controls. High lifetime rates of Axis I (92%) but not Axis II (25%) psychopathology were found in pathological gamblers as compared to controls. No differences between male and female gamblers were found in rates of affective, substance use or personality disorders. Females had higher rates of anxiety disorders and histories of physical/sexual abuse. Possible associations between psychiatric disorders and pathological gambling are discussed along with gambler typologies and implications for future research.

Impulse Control Disorders and Attention Deficit Disorder in Pathological Gamblers

Little systematic research has been done on psychiatric comorbidity of pathological gambling, an impulse control disorder. This report describes the occurrence of attention deficit disorder and impulse control disorders in 40 pathological gamblers in treatment for gambling problems and 64 controls. Diagnoses were made by structured interviews which utilized operationalized diagnostic criteria. An impulse control disorder other than pathological gambling was noted in 35% of the pathological gamblers, compared to 3% of the controls (p < .001). Compulsive buying (p < .001) and compulsive sexual behavior (p < .05) were significantly higher in pathological gamblers than controls. A strong association was seen among pathological gambling, attention deficit, and other impulse control disorders. Attention deficit disorder was seen in 20% of the pathological gamblers. Rates of impulse control disorders did not differ by gender. Implications of these high rates of comorbidity are discussed.

The measurement of craving in cocaine patients using the Minnesota cocaine craving scale

Drug craving is an irresistible urge that compels drug-seeking behavior, and which often accounts for relapse among treated cocaine users. A cocaine craving scale that has proven reliable and practical in clinical treatment research with cocaine-using subjects is presented. It assesses intensity, frequency, and duration of this entirely subjective phenomenon. Data from 234 scales completed by 35 patients in treatment showed that craving for cocaine was of variable intensity, experienced relatively few times per day (zero to two), and of short duration (less than 20 minutes). Internal consistency among the three scales was robust, shown by a standardized item alpha of .826. The use of this scale should allow for each component of craving to be studied separately.

Psychoneuroendocrine effects of methadone maintenance

A variety of neuroendocrine and psychiatric dysfunctions have been demonstrated in humans maintained on opiates, but both have not previously been examined in the same population. We performed a series of neuroendocrine challenge tests in men participating in a methadone maintenance clinic and in normal controls. Psychiatric diagnoses were made with DSM-III Criteria, using the Diagnostic Interview Schedule, and subjects also completed the Symptom Checklist. Our results in the methadone group suggest (a) near-maximal stimulation of prolactin secretion, with a blunted prolactin response to insulin hypoglycemia, (b) mild suppression of cortisol levels, but an exaggerated cortisol response to stimulation, (c) a delayed and inhibited insulin response to food ingestion with resulting mild hyperglycemia, (d) low body weight, but elevated calorie ingestion, and (e) inability to concentrate urine when dehydrated, which was partially corrected by administration of arginine vasopressin. Phobic disorder was associated with a lower prolactin response to both inhibitory and stimulatory challenges. Depression did not appear to be related to the increased cortisol response to stimulation. These results suggest several potentially fruitful areas for future investigation, including the prolactin system and anxiety disorders, nutrient ingestion and metabolism, and posterior pituitary function.

Cocaine reduction in unmotivated crack users using carbamazepine versus placebo in a short-term, double-blind crossover design.

On the basis of cocaine‐caused kindling in animals and the usefulness of carbamazepine in treating kindling‐type seizures, carbamazepine has been tried in clinical settings with cocaine‐dependent individuals. This report presents findings of a 20‐day, double‐blind, placebo‐controlled crossover study in 32 non–treatment‐motivated, paid, chronic crack cocaine users. Carbamazepine significantly lowered the mean number of positive urine specimens compared with placebo. Of clinical importance, serum carbamazepine levels of 4 μg/ml (17 μmol/L) or more were associated with greater improvement. A consistent, clinically important trend linked therapeutic levels with improvement for all subjective and objective outcome variables. Comparison of daily acknowledged cocaine use or professed cocaine abstinence, with cocaine use indicated by daily urinalysis in these chronic cocaine users, has suggested the possibility of cocaine saturation as an important methodologic limitation inherent in outpatient studies of cocaine use in humans.

Influence of Attention-Deficit/Hyperactivity Disorder Symptoms on Methadone Treatment Outcome

A review of 687 consecutive admissions to a Midwestern methadone maintenance program was undertaken to establish the prevalence of ADHD symptoms and their association with treatment outcome. Of the 687 admissions, 396 (58%) patients self-reported experiencing one or more ADHD symptoms during the two weeks prior to admission, and 131 (19%) patients reported ADHD symptoms that significantly interfered with functioning in daily activities. At nine months post-admission, the patients who reported significant symptoms of ADHD were able to reduce their drug use but were less likely to have achieved abstinence than those who did not report significant symptoms (p < or = 0.001). The authors discuss the importance of screening for ADHD symptoms in methadone treatment programs and propose interventions believed helpful in improving management of ADHD symptoms and improving outcome.

Characteristics and Treatment Outcome of Older Methadone-Maintenance Patients

OBJECTIVE There are over 160,000 persons receiving methadone maintenance treatment in the United States. Surveys indicate that 5% to 6% of these patients are older than age 55. Authors hypothesized, from a survey of methadone programs, that methadone patients older than age 55 would have higher rates of medical and psychiatric problems and higher rates of unemployment, and would do less well in treatment, as compared with their younger counterparts. METHODS Authors reviewed 759 consecutive admissions to a Midwestern methadone-maintenance program. RESULTS It was unexpectedly found that patients older than age 55 (N=54) were not different from their younger counterparts in terms of medical and psychiatric problems or employment; they were more likely to be married, and did significantly better in treatment. CONCLUSIONS Older methadone patients may, in fact, have fewer problems and do well in treatment. This finding has implications regarding allocation of resources for methadone programs serving these patients.

Treatment of crack cocaine use with carbamazepine.

Crack is a rock crystalline alkaloid form of cocaine which can be smoked. At the University of Minnesota, we have developed an experimental pharmacologic treatment for cocaine abusers. Of 26 patients treated to date, 16 have been crack cocaine users. During the hundred days preceding treatment, the 16 crack subjects used cocaine by all routes an average of 71 days each. Improvement was based on a self-reported decrease in cocaine frequency of use. Using carbamazepine, seven highly successful and six partially successful patients reduced their use to 0.7 days and 26 days per 100 days, respectively. These results, though hopeful, must be viewed with caution and considered preliminary and tentative.

Superior methadone treatment outcome in Hmong compared with non-Hmong patients

The Hmong are a distinct ethnic group from Laos. Little is known about how opiate-addicted Hmong respond to methadone maintenance treatment. Therefore, opium-addicted Hmong (exclusive route of administration: smoking) attending an urban methadone maintenance program in Minneapolis, MN, were matched by gender and date of admission with predominately heroin-addicted non-Hmong (predominant route of administration: injection) attending the same program, and both groups were evaluated for 1-year treatment retention, stabilization dose of methadone, and urine drug screen results. Hmong had greater 1-year treatment retention (79.8%) than non-Hmong (63.5%; p < .01). In both groups, methadone dose was significantly associated with retention (p = .005). However, Hmong required lower doses of methadone for stabilization (M = 49.0 vs. 77.1 mg; p < .0001). For both groups, positive urine drug screens were associated with stopping treatment. Further research to determine levels of tolerance and psychosocial and pharmacogenetic factors contributing to differences in methadone treatment outcome and dosing in Hmong may provide further insight into opiate addiction and its treatment.

AIDS-Related Illness and AIDS Risk in Male Homo/Bisexual Substance Abusers: Case Reports and Clinical Issues

Little has been written about the treatment of substance use disorders among seropositive HIV patients or high-risk seronegative substance abusers. Demographic and clinical characteristics, along with treatment issues, were examined based on experience with 18 patients in a substance abuse program in a university medical center (3 AID, 3 ARC, 9 seropositive only, and 3 seronegative high risk). Scores on a substance abuse rating scale were extremely high. Most of them abused three or more different substances, had used drugs parenterally, had more than 50 sex partners, and/or had received previous substance abuse treatment. Affective disorder, suicide attempt, and antisocial personality were frequent in this group. About half of the patients complied with treatment and showed improvement in their substance disorder. Several common themes in the management of these patients are described.