Steven M. Mirin

Drug Abuse as Self-Medication for Depression: An Empirical Study

The authors empirically studied the self-medication hypothesis of drug abuse by examining drug effects and motivation for drug use in 494 hospitalized drug abusers. Most patients reported that they used drugs in response to depressive symptoms and experienced mood elevation, regardless of their drug of choice. Drug use to relieve depressive symptoms was far more likely in men if they had major depression, but was equally common in women with and without major depression. Information regarding a history of self-medication may thus be more helpful in diagnosing major depression in men than in women. Difficulties in diagnosing psychiatric disorders in substance abusers are discussed, as are the limitations of obtaining retrospective data on drug-using behavior. The implications of these limitations on the generalizability of the findings are reviewed.

Psychopathology in Cocaine Abusers: Changing Trends

The authors studied a group of 149 hospitalized cocaine abusers as a follow-up to previous research performed in 1980-82, which had revealed a high prevalence of affective disorder in cocaine abusers. The authors hypothesized that the changing epidemiology of cocaine abuse since that time may have been accompanied by changes in the characteristics of patients seeking treatment for dependence on the drug. The cocaine abusers were compared with 293 other drug abusers to see whether clinical changes over time were specific to individuals abusing cocaine. The authors found slightly more affective disorder in the cocaine abusers when compared with the other patients (26.8% vs. 20.1%), with a significantly higher rate of cyclothymic disorder (11.4% vs. 2.7%, p<.001). Affective illness was significantly more prevalent in the first-degree relatives of the cocaine abusers when compared with the sex-matched relatives of the other patients (p<.05). Diagnostic trends changed a great deal, however, between the original 1980-82 study sample and the follow-up 1982- 86 sample. The rate of affective disorder decreased over time from 50.0% to 21.0% (p<.01), and the rate of affective illness in the families also declined, from 31.0% to 11.5% in females (p<.001) and from 14.3% to 2.2% in males (p<.001). No such change occurred in the comparison group of opioid and central nervous system depressant abusers. The authors conclude that although a substantial number of cocaine abusers suffer from concurrent affective disorder, this form of premorbid psychopathology has become a less important risk factor for the development of chronic cocaine abuse as cocaine use has become more widespread.

Psychopathology in Chronic Cocaine Abusers

A group of 30 hospitalized cocaine abusers were studied, along with 124 hospitalized patients who were dependent upon opiates or central nervous system depressants. DSM-III diagnoses, family history data, demographic characteristics, and measures of current depressive symptomatology were compared in the two groups. Nineteen (63%) of the cocaine abusers met criteria for an Axis I diagnosis other than substance abuse; sixteen (53%) had affective disorder. These figures reflected a significantly higher prevalence rate of affective disorder among the cocaine abusers than among the opiate and depressant abusers. In addition, a significantly higher rate of affective disorder was found in the first degree relatives of the cocaine abusers when compared to the other group. Since these findings suggest that a substantial number of cocaine abusers may be suffering from other psychiatric disorders, careful diagnostic evaluation is indicated in this population.

Psychopathology in drug abusers and their families

Demographic, clinical, and family pedigree data obtained on 350 hospitalized drug-dependent patients showed that 52% also met DSM-III criteria for alcohol abuse or dependence, while 37% met DSM-III criteria for a concurrent axis I psychiatric disorder other than substance abuse. Cyclothymic disorder was significantly more common among cocaine abusers, while generalized anxiety disorder and panic disorder were more common among sedative-hypnotic abusers. Data on 1,478 first-degree relatives revealed that the prevalence of alcoholism and affective disorder was highly correlated with the occurrence of similar psychopathology in the probands. These findings suggest a relationship between drug of choice and comorbid psychopathology, a role for familial factors in the transmission of these disorders, and the importance of diagnostic subtypes in the evaluation and treatment of substance abusers.

Acute effects of heroin and naltrexone on testosterone and gonadotropin secretion: A pilot study

Abstract (1) Two detoxified male heroin addicts were given 10 mg of intravenous heroin and experienced a rapid fall in plasma LH. FSH levels were unchanged. (2) Approximately 4 hr after LH suppression (by heroin), plasma testosterone levels also dropped markedly. (3) Naltrexone pretreatment prevented opiate-induced suppression of both LH and testosterone. (4) Instead, an increased number of secretory bursts of LH occurred after naltrexone administration, and mean plasma LH levels were higher than those obtained during a saline control period. (5) Testosterone and FSH secretion were not appreciably affected by naltrexone treatment.

Diagnosing major depression in cocaine abusers: The use of depression rating scales

This study compared the sensitivity and specificity of three rating scales in detecting major depression in 149 hospitalized cocaine abusers. Patients were administered the Beck Depression Inventory (BDI), the Hamilton Rating Scale for Depression, and the Symptom Checklist-90 at admission and at 2 weeks and 4 weeks of hospitalization. The admission BDI score offered the best combination of sensitivity and specificity. However, the low specificity of all the scales and the low prevalence rate of major depression in this population made the positive predictive power of the instruments weak. The results support some limited use of the BDI as an initial screening instrument in cocaine abusers.

Treatment of chronic cocaine abuse and attention deficit disorder, residual type, with magnesium pemoline

Research suggests that attention deficit disorder (ADD) may persist into adulthood, perhaps predisposing certain individuals to stimulant abuse. The authors describe two adults with chronic cocaine abuse and apparent residual ADD. After failing to respond to conventional treatment modalities, these patients were administered magnesium pemoline. Both displayed a sustained reduction in their cocaine use, without abusing pemoline. This finding suggests that the diagnostic assessment of cocaine abusers should include a search for a history of ADD. A carefully selected subgroup of this population may benefit from treatment with other stimulant medications.

Eating Disorders in Hospitalized Substance Abusers

Among 386 consecutive patients hospitalized for substance abuse, 15% of 143 women had a lifetime diagnosis of anorexia or bulimia nervosa, compared to only 1% of 243 men. Women with eating disorders had significantly higher rates of stimulant abuse and lower rates of opioid abuse than women without eating disorders.

Psychopathology and Mood During Heroin Use

In the previous chapter operant data relative to work output and the frequency of heroin self-administration were discussed from the perspective of learning theory. Data were presented supporting the notion that heroin-seeking behavior and consumption may be influenced by a variety of interoceptive and exteroceptive stimuli that suggest heroin availability. In individual subjects the level of drug craving was identified as a sensitive indicator of the strength of such cues, wherein the subjective sense of craving correlated with actual drug-seeking behavior by blocked and unblocked subjects. This chapter will present data on the subjective effects of heroin associated with the readdiction process, as well as those feeling states associated with periods of abstinence.

Opiate Antagonists and the Modification of Heroin Self-Administration Behavior in Man: An Experimental Study

The heroin self-administration behavior of 8 inpatient heroin addicts was examined for 10 days under blocked (i.e., following ingestion of narcotic antagonists--naloxone or naltrexone) and unblocked (no antagonist) conditions. In the unblocked state, subjects injected all the available heroin, but they ceased heroin use almost completely following antagonist administration. Possible explanations for these results are discussed along with their implications for treatment.