J. Douglas Sellman

Elevated levels of acute phase plasma proteins in major depression

Levels of acute phase and other plasma proteins were measured in 21 men with major depression, 28 men with alcohol dependence, and 12 men who acted as controls. The depressed men had significantly elevated levels of the acute phase proteins, haptoglobin and alpha-1-antichymotrypsin, and of immunoglobulin G. The elevations in haptoglobin and alpha-1-antichymotrypsin were highly correlated with each other, and were correlated with the severity of depression and negatively correlated with the thyroid stimulating hormone response to thyrotropin. The alcoholic men had elevated haptoglobin levels, but significantly decreased levels of immunoglobulin G. These findings provide further evidence for an inflammatory response during depression.

A prototype screening instrument for cannabis use disorder: the Cannabis Use Disorders Identification Test (CUDIT) in an alcohol-dependent clinical sample

The Cannabis Use Disorders Identification Test (CUDIT) was used for the first time as part of a randomized controlled trial for brief interventions in mild to moderate alcohol-dependent out-patients. This sample may be seen as a population at increased risk of cannabis use disorder. The CUDIT was developed by modifying the Alcohol Use Disorders Identification Test (AUDIT). The ability of the CUDIT to accurately screen for cannabis abuse or dependence was examined in the portion of the sample who reported some cannabis use over the preceding 6 months (n=53), as was self-reported frequency of cannabis use in the preceding 6 months. The CUDIT was superior to the frequency measure, achieving positive predictive power of 84.6% and sensitivity of 73.3% at a cut-off of 8, compared to positive predictive power of 81.8% and sensitivity of 60.0% for 80 or more cannabis use-days. These results indicate the viability of a screening measure for identifying cannabis use disorder in at risk populations.

An improved brief measure of cannabis misuse: the Cannabis Use Disorders Identification Test-Revised (CUDIT-R).

BACKGROUND Cannabis is widely used and significant problems are associated with heavier consumption. When a cannabis misuse screening tool, the CUDIT, was originally published it was noted that although it performed well there was concern about individual items. METHODS 144 patients enrolled in a clinical trial for concurrent depression and substance misuse were administered an expanded CUDIT, containing the original 10 items and 11 candidate replacement items. All patients were assessed for a current cannabis use disorder with the SCID. RESULTS A revised CUDIT-R was developed containing 8 items, two each from the domains of consumption, cannabis problems (abuse), dependence, and psychological features. Although the psychometric adequacy of the original CUDIT was confirmed, the CUDIT-R was shorter and had equivalent or superior psychometric properties. High sensitivity (91%) and specificity (90%) were achieved. CONCLUSIONS The 8-item CUDIT-R has improved performance over the original scale and appears well suited to the task of screening for problematic cannabis use. It may also have potential as a brief routine outcome measure.

Temperament and substance abuse in schizophrenia: is there a relationship?

The influence of temperament on substance abuse in schizophrenia is poorly understood, whereas it is known to play an important role in other clinical populations. In a sample of 28 male schizophrenics, Cloningers dimensions of temperament were measured with the use of the Tridimensional Personality Questionnaire (TPQ). Levels of four commonly used substances were recorded. There was a significant correlation between the novelty-seeking dimension and past use of alcohol, cannabis, and caffeine and current use of caffeine and nicotine. There was no relationship between substance use and clinical symptoms or demographic variables. The possible implications of abnormal mean TPQ scores in the sample as well as a weak correlation between symptom patterns and TPQ scores are discussed. The findings suggest that novelty-seeking type behaviors contribute to substance use in schizophrenia.

Barriers to optimal care for patients with coexisting substance use and mental health disorders.

Objective: This paper describes qualitative research that was carried out as part of a project aimed at drawing up a series of guidelines for the assessment and management for people with coexisting substance use and mental health disorders, or dual diagnosis [1]. Method: A core consultation team of 14 experts with experience in the areas of both substance use and mental health in New Zealand was established to advise on the development of eight clinical scenarios. The clinical scenarios were selected to highlight a range of real life issues in the treatment of people with coexisting substance use and mental health disorders and were presented at 12 focus groups around New Zealand. The 261 participants of the focus groups were asked to comment on what was optimal management for each of the scenarios and to identify barriers to optimal care in their region. Written notes were analysed for recurring and strongly stated themes and these comprise the results of the study. Results: While there was marked regional variation in treatment approaches and service structures, many of the barriers to optimal care that were identified were common to all regions. The results are considered under the headings of systems issues, clinical issues and attitudes. Conclusions: A wide variety of barriers that impede the delivery of optimal care have been identified. These range from the attitudes of individual clinicians to the structure of the systems within which they work. A system of key principles and processes for organizing treatment in a way which helps overcome these barriers is proposed.

Health status of clients receiving methadone maintenance treatment using the SF-36 health survey questionnaire

This study investigated the health status of a representative sample of clients (35 Maori, 72 non-Maori) receiving methadone maintenance treatment in New Zealand, using the SF-36 health survey. The publication of New Zealand norms in 1999 enabled comparisons of the health of the Methadone Treatment Programme study participants with that of the New Zealand population. Although over 50% of participants rated their health as good, very good or excellent, 44% rated their health as fair or poor and compared with population norms, the health of the study participants was significantly poorer on all eight SF-36 scales. Male and female participants rated their health similarly to male and female clients attending another New Zealand Methadone Treatment Programme. Results highlighted the impact of a chronic disorder and co-existing health-related problems on the health and well-being and day-to-day functioning of this client group. Higher frequency of benzodiazepine use was associated with poorer social functioning, mental health and role functioning and higher frequency of cannabis use was associated with poorer role functioning due to emotional problems. Findings support routine monitoring of health status with clients receiving methadone maintenance treatment as a guide to preventative and treatment interventions and health maintenance strategies.

Drinking goal selection and treatment outcome in out-patients with mild-moderate alcohol dependence

Selection of drinking goal is examined at baseline, post-treatment and at 6 months follow-up for a sample of mild-moderate alcohol-dependent out-patients. Drinking goal is identified as abstinent or controlled drinking, with the latter group being asked to further specify per session and per week drinking limits. Group comparisons for drinking goal post-treatment show those who were not assigned motivational enhancement therapy, had more drinking days and lower scores on the Alcohol Problems Questionnaire and Internal Motivation were more likely to choose controlled drinking. The only variable to predict independently whether or not the controlled drinking goal was within the promoted drinking guidelines was age, with younger participants more likely to choose a goal above this limit. Goal selection was significantly related to drinking outcome, with those aiming to drink within guidelines having better outcome than those aiming for higher limits. There was no significant difference in drinking outcome ca...

The pattern of intravenous drug use and associated criminal activity in patients on a methadone treatment waiting list.

Sixty-four patients on the Christchurch Methadone Treatment Programme waiting list were questioned on their drug-use behaviour, criminal activity and sources of income, both legal and illegal, for the preceding 7 days. Opioids used included morphine sulphate tablets, methadone and opium poppies, while other drugs used included tranquillizers, cannabis and alcohol. A significant minority were prescribed opioids. The mean cost of drugs used in 7 days across all subjects was 882 dollars. The mean financial gain from criminal sources for the same period was 1079 dollars and was derived from drug-related crime, property crime and prostitution. Few gender differences were found relating to criminal activity or drug use. The majority of the sample were on unemployment benefits of varying types while a minority were in paid employment. Those in paid employment did not earn significantly less from criminal activity, nor did they spend significantly less on drug use than did those not in paid employment. An important implication of these findings is that untreated opioid users are a substantial financial burden to the community, strongly supporting the argument for greater treatment provision.

Optimal Treatment for Maori with Alcohol and Drug-Use-Related Problems: An Investigation of Cultural Factors in Treatment

There is an increasing emphasis on taking account of the diversity of social, psychological, and cultural factors in the assessment and treatment of alcohol and drug-use-related problems. In New Zealand the increasing use of customary Maori values, beliefs, and practices in the treatment of Maori with alcohol and drug-use-related problems has also been accompanied by the adaptation and integration of Western approaches to fit contemporary Maori sociocultural needs. This paper reports on an investigation of cultural factors and cultural identity in the alcohol and drug-user treatment of a clinical sample of Maori. The essential finding was a very high endorsement of the importance of cultural factors in treatment-irrespective of age, gender, mood, level of dependence, previous admissions, cultural connectedness, or whether they were treated in a Maori dedicated program or not. A significant number believed that a sense of belonging to an Iwi (tribe), identifying as a Maori and having pride in being Maori were also important in the recovery/healing process. The findings of this study support the need to investigate the relationship between specific “cultural factors” and other clinical components of effective treatment for Maori.

Novelty seeking and a dopamine transporter gene polymorphism (DAT1)

About 10 years ago, Cloninger defined the behavioral trait “novelty seeking” (NS) (Cloninger 1986, 1987). Two twin studies estimated the heritability of NS to be about 50% (Heath et al 1994; Stallings et al 1996). In early 1996, two papers reported significant associations between NS and a polymorphism of the type 4 dopamine receptor gene (DRD4) (Benjamin et al 1996; Ebstein et al 1996). A subsequent Finnish study did not replicate these findings (Malhotra et al 1996), and we were also unable to reproduce these findings (Sullivan et al in press). Consequently, the importance of individual variation at DRD4 to the behavioral trait of NS is uncertain. In planning the above study, it seemed that the dopamine transporter (DAT) might be an additional candidate gene for the behavioral trait of NS: 1) DAT plays a pivotal role in terminating dopaminergic neurotransmission (Giros and Caron 1993; Giros et al 1996); 2) DAT “knockout” mice are markedly hyperlocomotory (Giros et al 1996), perhaps analogous to high NS humans (Cloninger et al 1994); and 3) the DAT polymorphism DAT1 has been associated with attention-deficit hyperactivity disorder (ADHD), a disorder reminescent of high NS. The purpose of the present study was to investigate whether DAT1 was associated with NS in two groups of New Zealand subjects. Based on prior data (Cook et al 1995), we hypothesized that the DAT1 10-repeat allele would be associated with higher NS scores.