Herbert D. Kleber

Concurrent validity of the addiction severity index.

The concurrent validity of the Addiction Severity Index (ASI), a new scale for assessing a range of clinical dimensions in drug and alcohol abusers, was evaluated in 204 opiate addicts applying for treatment. This study is the first independent validation study of this measure. The ASI subscales were found to have good concurrent validity with self-report measures in the areas of psychological problems, social adjustment problems, legal problems, and employment problems (r = .55 to .39). Drug abuse problems showed limited concurrent validity and medical problems were not concurrently assessed in our study. Addicts with psychiatric diagnoses beyond opiate abuse were effectively identified by the ASI, and depressed addicts were particularly well screened with a sensitivity of 89 per cent and a specificity of 67 per cent. A cluster analysis demonstrated that the six ASI scales could be used to discriminate depressed addicts, antisocial addicts, and addicts without psychiatric disorders. Thus, the ASI was demonstrated to be a potentially important evaluation instrument for opiate addicts.

Cocaine dependence and d2 receptor availability in the functional subdivisions of the striatum: relationship with cocaine-seeking behavior.

Striatal dopamine D2 receptors have been implicated in the neurobiology of cocaine addiction. Previous imaging studies showed reduced striatal D2 receptor availability in chronic cocaine abusers, and animal studies suggested that low D2 receptor availability promotes cocaine self-administration. Here, D2 receptor availability was assessed with positron emission tomography (PET) and [11C]raclopride in the limbic, associative, and sensori-motor subdivisions of the striatum in 17 recently detoxified chronic cocaine-dependent (CCD) subjects and 17 matched healthy control (HC) subjects. In addition, the relationship between regional D2 receptor availability and behavioral measures obtained in cocaine self-administration sessions was investigated in CCD subjects. [11C]Raclopride binding potential was significantly reduced by 15.2% in the limbic striatum, 15.0% in the associative striatum, and 17.1% in the sensori-motor striatum in CCD subjects compared to HC subjects. In CCD subjects, no relationship was detected between D2 availability in striatal regions and either the positive effects of smoked cocaine or the choice of cocaine over an alternative reinforcer (money) following a priming dose of cocaine (a laboratory model of relapse). Thus, this study confirms previous reports of a modest decrease in D2 receptor availability in CCD subjects, and establishes that this decrease is generalized throughout the striatum. However, this study failed to demonstrate a relationship between D2 receptor availability and cocaine-induced cocaine-taking behavior. Additional research is warranted to unravel potential neurobiological traits that might confer vulnerability to relapse in detoxified CCD subjects.

The economic costs of heroin addiction in the United States

This study documents the costs of heroin addiction in the United States, both to the addict and society at large. Using a cost-of-illness approach, costs were estimated in four broad areas: medical care, lost productivity, crime, and social welfare. We estimate that the cost of heroin addiction in the United States was US

Prevalence of adult attention-deficit hyperactivity disorder among cocaine abusers seeking treatment

21.9 billion in 1996. Of these costs, productivity losses accounted for approximately US

Imaging dopamine transmission in cocaine dependence: link between neurochemistry and response to treatment.

11.5 billion (53%), criminal activities US

Lower Level of Endogenous Dopamine in Patients With Cocaine Dependence: Findings From PET Imaging of D 2 /D 3 Receptors Following Acute Dopamine Depletion

5.2 billion (24%), medical care US

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

5.0 billion (23%), and social welfare US

Treatment of cocaine abuse with buprenorphine

0.1 billion (0.5%). The large economic burden resulting from heroin addiction highlights the importance of investment in prevention and treatment.

Clonidine and Naltrexone in the Outpatient Treatment of Heroin Withdrawal

In this study, 281 cocaine abusers seeking treatment were assessed for adult attention-deficit hyperactivity disorder (ADHD). Structured assessments included the SCID for DSM-IV, a SCID-like module for ADHD, and a pattern of drug use questionnaire. The sample consisted of 82% men, 67% African-Americans, 19% Hispanics, and 14% Caucasians identified at several treatment sites. Average age was 33.7 +/- .4 years. Twelve percent (n = 34) of the sample met DSM-IV criteria for childhood ADHD. Of the entire sample, 10% (n = 27), or 79% of the patients diagnosed with childhood ADHD, had adult ADHD. A history of conduct disorder and antisocial personality disorder were prevalent among those with adult ADHD (63% and 52%, respectively). This subpopulation of cocaine abusers may be one of the most difficult-to-treat cocaine-abusing groups, particularly if the ADHD remains undetected. To provide effective treatment for cocaine abusers, clinicians may need to identify subpopulations of patients, such as those with ADHD, and target both pharmacologic and nonpharmacologic interventions for these groups.

Role of opioid antagonists in treating intravenous cocaine abuse

OBJECTIVE Previous research has shown that dopamine signaling in the limbic striatum is crucial for selecting adaptive, motivated behavior and that disrupted dopamine transmission is associated with impulsive and maladaptive behavior. In humans, positron emission tomography (PET) imaging studies have shown that cocaine dependence is associated with the dysregulation of striatal dopamine signaling, which is linked to cocaine-seeking behavior. The goal of the present study was to investigate whether this association applies to the treatment setting. The authors hypothesized that dopamine signaling in the limbic striatum would be associated with response to a behavioral treatment that uses positive reinforcement to replace impulsive cocaine use with constructive personal goals. METHOD Prior to treatment, cocaine-dependent subjects underwent two PET scans using [(11)C]raclopride, before and after the administration of a stimulant (methylphenidate), for measurement of striatal dopamine D(2/3) receptor binding and presynaptic dopamine release. RESULTS Both of the outcome measures were lower in the volunteers who did not respond to treatment than in those who experienced a positive treatment response. CONCLUSIONS These findings provide insight into the neurochemistry of treatment response and show that low dopamine transmission is associated with treatment failure. In addition, these data suggest that the combination of behavioral treatment with methods that increase striatal dopamine signaling might serve as a therapeutic strategy for cocaine dependence.