Kenneth M. Certa

Polymorphism in the serotonin transporter gene and response to treatment in African American cocaine and alcohol-abusing individuals.

The serotonin transporter (5‐HTT) regulates serotonin transmission and modulates behavioral effects of drug of abuse. A polymorphism in the promoter region of the serotonin transporter gene (5‐HTTLPR) yielding a short (S) and long (L) allele has been associated with severity of substance abuse. The aims of the study were to investigate whether 5‐HTTLPR genotypes differed in their response to treatment in cocaine‐ and alcohol‐abusing patients. Polymerase chain reaction‐based genotyping of a 44 base pair insertion/deletion polymorphism was performed in 141 African American cocaine‐dependent patients with concurrent alcohol use who were entering a 12‐week behaviorally oriented outpatient treatment program. In treatment, end of treatment and 6‐month follow‐up outcome measures included changes in Addiction Severity Index (ASI) scores, urine drug screens, days in treatment, individual/group sessions, dropout and completion rates. As expected, there was a reduction in substance abuse by the end of treatment and follow‐up (F = 5.15, p = 0.000). However, there were no differences in the reduction in cocaine use across the LL, LS and SS genotypes. Interestingly, individuals with the S allele showed greater severity of alcohol use at admission (F = 4.84, p = 0.03), and the SS genotype showed less improvement in alcohol measures than the LL at follow‐up (F = 3.68, p = 0.03), after controlling for baseline variables. While we found no association of the 5‐HTTLPR variants with severity of cocaine abuse or any cocaine‐related outcome measures, the data suggested that the 5‐HTTLPR polymorphism may distinguish responders from non‐responders to behavioral treatment in terms of alcohol use. Further investigations are required to determine the role of the 5‐HTTLPR polymorphism in influencing treatment – outcome among substance abusers.

Changing Patterns of Illicit Substance Use Among Schizophrenic Patients: 1984–1996

Over 1,700 psychiatric emergency room visits of schizophrenic and schizoaffective patients between 1984 and 1996 were reviewed, and urine drug screens (UDS) were recorded. Illicit drug use increased significantly over the 12-year period, with a large increase for cocaine (0% to 73% of positive UDS), a decline for amphetamines (60% to 0%), and a small increase for marijuana (0% to 27%). Opiate and sedative use remained unchanged. The results support the impression that cocaine use increased dramatically among urban schizophrenic patients beginning in 1988 and continuing to the present. Furthermore, cocaine seems to have replaced amphetamines as the preferred drug of abuse among schizophrenic persons following the crack epidemic.

Relationship of serum prolactin with severity of drug use and treatment outcome in cocaine dependence

RationaleAlteration in serum prolactin (PRL) levels may reflect changes in central dopamine activity, which modulates the behavioral effects of cocaine. Therefore, serum PRL may have a potential role as a biological marker of drug severity and treatment outcome in cocaine dependence.ObjectiveWe investigated whether serum PRL levels differed between cocaine-dependent (CD) subjects and controls, and whether PRL levels were associated with severity of drug use and treatment outcome in CD subjects.MethodsBasal PRL concentrations were assayed in 141 African–American (AA) CD patients attending an outpatient treatment program and 60 AA controls. Severity of drug use was assessed using the Addiction Severity Index (ASI). Measures of abstinence and retention during 12 weeks of treatment and at 6-month follow-up were employed as outcome variables.ResultsThe basal PRL (ng/ml) in CD patients (9.28±4.13) was significantly higher than controls (7.33±2.94) (t=3.77, P<0.01). At baseline, PRL was positively correlated with ASI-drug (r=0.38, P<0.01), ASI-alcohol (r=0.19, P<0.05), and ASI-psychological (r=0.25, P<0.01) composite scores, and with the quantity of cocaine use (r=0.18, P<0.05). However, PRL levels were not significantly associated with number of negative urine screens, days in treatment, number of sessions attended, dropout rate or changes in ASI scores during treatment and at follow-up. Also, basal PRL did not significantly contribute toward the variance in predicting any of the outcome measures.ConclusionAlthough cocaine use seems to influence PRL levels, it does not appear that PRL is a predictor of treatment outcome in cocaine dependence.