Karen K. Downey

Treatment of heroin-dependent poly-drug abusers with contingency management and buprenorphine maintenance.

This study targeted poly-drug (cocaine plus heroin) abstinence among buprenorphine-maintained participants with a 12-week voucher-based reinforcement therapy (VBRT) phase versus a yoked control condition. Baseline levels of cocaine and heroin use were significant predictors of treatment outcome, regardless of treatment assignment. Overall, there were no significant group differences on treatment outcome. However, among the subsample that produced one or more poly-drug-free urine results, VBRT participants had significantly increased cocaine-but not heroin and poly-drug-abstinence, although all results were in the predicted direction. Results suggest that for those who achieve poly-drug abstinence, VBRT may enhance treatment outcome. However, improved interventions, perhaps targeting single-drug abstinence, increasing reinforcement magnitude, or both, may be necessary to promote initial poly-drug abstinence in this population.

Personality differences related to smoking and adult attention deficit hyperactivity disorder

Tridimensional Personality Questionnaire (TPQ) scores are compared for three groups of adults: (a) current smokers with Attention Deficit Hyperactivity Disorder (ADHDSmk, n = 14); (b) current smokers without ADHD (NonADHDSmk, n = 21); and (c) ADHD never smokers (ADHDNevSmk, n = 17). The ADHASmk participants started smoking at a significantly younger age than NonADHDSmk participants. On the TPQ Novelty Seeking (NS) scale, all groups scored more than a standard deviation above the norm, and ADHDSmk participants scored significantly higher than NonADHDSmk participants. The earlier onset of smoking in ADHD adults suggests that smoking prevention efforts may be particularly important for ADHD children. Previous studies have reported that both smokers and ADHD patients have elevated NS scores; this study suggests an additive effect for smokers with ADHD. This exaggerated tendency towards thrill seeking in ADHDSmk participants may complicate smoking-cessation treatment in this population, because the health consequences of smoking may be of less concern to ADHD smokers.

Predicting the emergence and persistence of alcohol dependence in young adults: The role of expectancy and other risk factors.

The relationship of alcohol outcome expectancies and other risk factors: demographic, personality, and affectivity, to alcohol dependence status was examined over a 3.5-year interval in 1,007 young adults. Lifetime prevalence of alcohol dependence was 18.1% at baseline. Of persons classified as current alcohol dependent at baseline, 66.9% experienced remission at the 3.5-year follow-up. Of persons classified as remitted alcohol dependent at baseline, 11.3% were current alcohol dependent at the 3.5-year follow-up. At follow-up, 5% of persons with no history of alcohol dependence at baseline met criteria for current alcohol dependence. Male gender, higher extraversion, and lower positive affect scores predicted emergent current alcohol dependence at the 3.5-year interval. Persistent current alcohol dependence was predicted by the expectation of improved social and sexual experiences following alcohol use. The findings suggest that positive expectancies may be an important factor in persistence of alcohol dependence and that their modification may enhance treatment of alcohol dependence in young adults.

Relationship between problem gambling and substance use in a methadone maintenance population

Few studies have examined the relationship between pathological gambling and substance abuse treatment outcome. This study assessed the gambling behavior of 62 patients enrolled in a methadone maintenance treatment program. Eleven (17.7%) met current SOGS criteria for probable pathological gambling. Patients with and without probable pathological gambling were compared on substance abuse treatment outcome measures including urine toxicology results for heroin and cocaine use, and clinic dropout. Results indicated that those who were probable pathological gamblers were more likely to use cocaine through therapy, and more likely to drop out of the clinic treatment program than nonpathological gamblers. Implications for substance abuse treatment are discussed.

Alexithymia and negative affect: Relationship to cigarette smoking, nicotine dependence, and smoking cessation

Alexithymia is associated with substance abuse and may interfere with successful psychotherapy. Alexithymias relation to smoking, nicotine dependence, and smoking cessation therapy is unknown, and potentially overlaps with negative affect. Three studies addressed the relations between alexithymia, negative affect, and smoking. In Study 1, 67 young adult smokers were more depressed than 370 past or never smokers, but no different on the Toronto Alexithymia Scale total or subscale scores. In Study 2, negative affect--but not alexithymia--was related to greater nicotine dependence among 99 chronic smokers. In Study 3, alexithymia tended to predict increased patient participation in cognitive-behavioral therapy for smoking; low nicotine dependence--but neither alexithymia nor negative affect--predicted abstinence from smoking at treatment end. Alexithymia appears to be independent of negative affect and unrelated to cigarette smoking or nicotine dependence, suggesting that the affect regulation deficits in alexithymia play a negligible role in nicotine addiction.

Effects of menstrual phase and smoking abstinence in smokers with and without a history of major depressive disorder

Although considerable progress has been made towards understanding the role of menstrual cycle phase in smoking, little is known about the possible effects of menstrual phase upon nicotine intake, withdrawal symptomatology, and craving in women with psychiatric cofactors. Fourteen women with and without a history of Major Depressive Disorder (MDD) were studied during five biologically-confirmed phases over the course of one menstrual cycle: smoking logs, salivary cotinine, and ratings of craving and withdrawal were collected daily. During a second cycle, subjects remained abstinent for 3 consecutive days during the postmenses and premenstrual phases. Although a significant omnibus F-test emerged for cigarettes per day across phases during ad libitum smoking, only trends were observed post hoc and supported midcycle rather than premenstrual elevations. There were no significant phase differences for cotinine. Withdrawal symptomatology was markedly elevated during smoking abstinence and in women with a history of depression. but showed no evidence of phase effects. Thus, the hypothesis that depressed individuals would be differentially affected by phase and abstinence was not strongly supported by our results, though overall elevations emphasize the need for special attention to withdrawal severity in this population. Craving was significantly elevated during smoking abstinence and was significantly higher during postmenses, consistent with the midcycle elevation in smoking rate, but showed no group differences. Our findings overall lend little support for the need to control for menstrual phase under conditions of ad libitum smoking. The strong association of self-reported menstrually related dysphoria during abstinence with both craving and withdrawal symptoms, however, is consistent with an exacerbation of smoking abstinence effects in women with severe menstrual symptomatology.

Impulsivity and voucher versus money preference in polydrug-dependent participants enrolled in a contingency-management-based substance abuse treatment program

Thirty-four polydrug-dependent participants enrolled in a voucher-based substance abuse treatment program were given choices between hypothetical amounts of money and hypothetical amounts of vouchers, which are traded for goods and services, to determine their preferences for the two payment modalities. It was hypothesized that the majority of participants would prefer money to voucher because under the circumstances of the treatment program, the delay associated with money exchange is shorter than the delay associated with voucher exchange. It was further hypothesized that those participants who selected money over voucher also would have greater levels of impulsivity as assessed by the Barratt Impulsiveness Rating Scale (BIS) (Barratt, 1965). The results show large individual differences in money/voucher preference with approximately half of the participants preferring money to voucher when the two amounts are equivalent. In addition, as the magnitude of the money/voucher comparisons increased from 0.50 dollars to 32.00 dollars, the percentage of participants that preferred money increased. No correlations were found between money/voucher preference and impulsivity scores.

Contingency management for accurate predictions of urinalysis test results and lack of correspondence with self-reported drug use among polydrug abusers.

Contingency management procedures have proven effective in the treatment of drug-dependent patients. These procedures, however, often require frequent urine testing, which is too costly for community treatment programs. To make urine-testing procedures more cost effective, the feasibility of reinforcing accurate predictions of urine drug screen (UDS) results was evaluated. Participants made extremely accurate UDS predictions, particularly when they made drug-positive predictions, regardless of whether predictions were reinforced. However, self-reports of recent drug use had poor correspondence with predictions of UDS results. Results suggested that if programs only tested samples predicted to be drug free, considerable cost savings could be incurred. Further research is needed to determine if validity would be enhanced by using a proportion of costs saved to provide nominal reinforcement when samples were verified to be drug free.

MMPI/MMPI-2 critical items for panic symptoms

Abstract Fifteen psychologists selected MMPI items that they considered to be face-valid indicators of the presence of panic symptoms. The 15 items selected by at least 60% of the clinicians were empirically validated through Chi-square analyses. Item response frequencies were contrasted for 60 Panic Disordered patients, 60 demographically matched psychiatric controls, and the normative sample of MMPI-2. Each of the 15 items differentiated panic patients from normal controls ( p