Objective: To compare the acute subject-rated effects of oral cocaine, methylphenidate and sibutramine in stimulant abusers. Methods: Five human volunteers with recent histories of cocaine use received oral doses of cocaine (100, 200, 300mg), methylphenidate (30, 60, 90mg) and sibutramine (25, 50, 75mg). Drug effects were assessed before drug administration and periodically afterwards using a battery of subjective-effects questionnaires and performance measures. Results: Three scales were used to assess subjective "high." For the report of ‘sensitive-stimulant adjectives’ and ratings of ‘rush,’ cocaine separated from placebo at all doses, methylphenidate did so only at 90mg, and sibutramine never did. LSD scores (from Addiction Research Center Inventory) revealed cocaine produced stimulant-type effects at the two higher doses, as did methylphenidate, although to a lesser degree. Sibutramine never showed effects beyond placebo. Conclusion: Sibutramine (Meridia) is indicated in the treatment of obesity. The present findings are concordant with those from previously published studies that assessed the abuse potential of sibutramine is low.

Objective: Recent media reports suggest a growing illicit use of OxyContin (Oxycodone-Controlled Release, hereafter OCR) in the United States. In particular, numerous pharmacy break-ins and overdoses related to the drug have been widely publicized. Despite this, there is little scientific research examining the characteristics of those individuals who misuse, abuse, or are clinically dependent upon OCR. Methods: Admission notes for all patients (n=265) consecutively admitted to a locked, dual diagnosis unit over the period of 4 months were evaluated. Two groups were identified. +OCR—Those individuals reporting any history of OCR use and -OCR—those individuals with Opioid Dependence without a history of OCR use. Results: (a) 40 patients (15%) were identified as +OCR, and 44 patients (17%) were identified as -OCR. Most (55% & 64% respectively) had a primary diagnosis of opioid dependence. (b) Demographics for +OCR & -OCR individuals respectively: Male 68% vs 70%; Female 32% vs 30%; Caucasian 97% vs 92%; Mean age: 28 vs 38 (p<.0001); Not Married 70% vs 75%; Unemployed 43% vs 63%; (c) Current illicit drug use 50% vs 77%; Current IVDA 20% vs 39%; Current Mood Disorder 40% vs 43%; Current Suicidal Ideation 35% vs 34%; Past Suicide Attempt 20% vs 18%; Current Violent Ideation 15% vs 16%; (e) Mean CAGE score 2 vs 2.5; Mean DAST score 15 vs 15. Conclusions: Given the public health concern surrounding nonmedical use of prescription medication, additional research, including prospective studies, is needed to further describe the natural history of OCR misuse, abuse or clinical dependence.

Objective: The aim of this study was to comprehensively characterize suicidal behavior among a sample of consecutively hospitalized patients with comorbid mood and substance use disorders. Methods: Thirty-eight (22 males and 16 females) patients were administered the Scale for Suicide Ideation, the Suicide Intent Scale, and the Lethality Scale for Suicide Method to provide a comprehensive assessment of the different domains of suicidal behavior. Results: Thirty-one patients (83%) reported a desire to attempt suicide. Twenty-five patients (66%) made an active suicide attempt prior to admission. Of these, 17 (68%) reported more than one prior suicide attempt, with eight of them reporting more than three prior attempts. Most patients (n=19, 79%) did not tell anyone of the plan to commit suicide. Half stated that their current attempt was a serious attempt to end their life, and most patients (n=13, 56.5%) believed that death was probable or certain. Also, half of them reported the suicide attempt was impulsive. Alcohol and other drugs were used to facilitate the attempt by a substantial number of patients. Most frequent method used included drug overdose, cutting, and shooting. Over half of the attempts required intensive medical treatment. Conclusions: Our findings suggest that comorbid mood and substance use disorder patients are likely to make serious suicide attempts and have high expectations to be successful. They tend to act impulsively and do not communicate their intent. Alcohol and other drugs appear to be used by a substantial number of patients to facilitate the suicide attempt.

Objective: To explore the characteristics of under-reporters (URs) of drug use, self-report and urine drug screen results of 180 individuals in a pharmacologic treatment trial for cocaine dependence. Method: Individuals were characterized as an UR if they had at least two occurrences of a urine-positive drug screen after denying cocaine use in the previous three days. The URs (n=39) were compared to individuals with a urine-positive drug screen who admitted to cocaine use in the previous three days, truthful-reporters (TRs, n=43). Results: The proportion of employed individuals was higher among the URs than TRs (p=0.013). URs used less than half the amount of cocaine in the month before treatment as TRs ($1,917.88 vs. $801.15 respectively, p=0.008). URs attended more study sessions (p<0.001), were more likely to complete the study (p<0.001) and were less likely to report other drug use than TRs (p=0.007). Individuals with a history of or current affective disorder were less likely to under-report cocaine use (p<0.013). In addition, individuals with passive-aggressive or dependent personality disorders were less likely to under-report cocaine use (p=0.011 and p=0.003 respectively). Conclusion: Information concerning the clinical characteristics of URs may be important in guiding the judicious use of urine drug screening in clinical as well as research settings.

Objective: Few studies have characterized the patterns of employment of individuals in drug treatment. This study linked 3,441 drug treatment client records from a city-maintained administrative database to state wage records. Two extreme groups were compared: 1) "chronically unemployed" clients, defined as having no wages before, during, and after treatment (n = 937; 27% of total) and 2) "stably employed" clients, defined as having earned wages prior to, during, and after treatment (n = 1,092; 32% of total). Methods: A logistic regression model was used to examine the associations between client factors (i.e., age, sex, race/ethnicity and drug use pattern), treatment factors (source of referral, treatment modality, length of stay, treatment completion, and the individual treatment program), and group membership. Results: The results indicated clear discrimination between the two employment groups, P2(40) = 424.59, p < .0001, generalized R2 = 0.19. Stably-employed subjects, in comparison to chronically-unemployed clients, were more likely to be: male, younger, and self-referred for treatment. In addition, they were more likely to have completed treatment and come from any of a variety of equally successful treatment programs. Conclusions: More intensive services are needed to improve chances for employment in the large proportion of clients who are chronically unemployed. Future research is needed to determine whether client and treatment characteristics identified in this study can help predict changes in employment following drug treatment.

Ross, Stephen, New York University School of Medicine and Bellevue Hospital, New York, NY; Levounis, P; Choy-Shan, A; Galanter, M

Wines, James D Jr; Idiculla, T; Leonard, A; Eisen, SV, McLean Hospital, Harvard Medical School, Belmont, MA

Objective: There is evidence of an increased rate in the use of Dextromethorphan (DXM) in the adolescent population. Marketed as a cough suppressant it is found in a wide variety of over the counter cough and cold preparations. Ease of obtaining the drug, the lack of evidence of use on drug screening and the experience are reported as reasons for DXM abuse. DXM is a d-omer of levomethorphan, with no inherent analgesic properties. It has agonist actions on serotonergic neurotransmission, and antagonist NMDA properties. This drug and others of the same class, the dissociative anesthetics, are associated with animal studies showing NMDA antagonist neurotoxicity in the posterior cingulate and retrosplenial cortex. Method: This is a retrospective study of adolescents reporting the use of DXM on entering a partial hospital substance abuse treatment program with residence. The sample includes 527 adolescents, male and female, 12-to-18-year olds, identified by their family, the legal system, school or counselor to have a substance use problem. The assessment of drug use included direct questioning of the use of "cough medications." Of the young people entering this program over a two-year period starting in the fall of 1999, 14.5% had at least tried DXM. The charts correlating to positive use were then divided into three categories of use "tried," "occasional," and "drug of choice." Results: Clinical vignettes of the subjective experience of young people using DXM at differing levels of frequency and dose were presented. There is very little recognition of the potential toxicity associated with the use of this drug in the adolescent population. Conclusions: This survey, by providing a description of the prevalence of DXM use in an outpatient program, will contribute to the limited body of literature on this subject. It is intended that a more knowledgeable discussion of recommendations for more effective prevention and treatment may result.

Hill, Kevin P; Patkar, AA; Thornton C; Gottheil, E; Weinstein, SP, Thomas Jefferson University Hospital, Philadelphia PA

Objective: The literature on the treatment of severe alcohol withdrawal with continuous infusions of benzodiazepines is minimal, limited to a few case studies on the use of lorazepam and midazolam in critical care units. Our objective is to identify the pattern of dosing using continuous intravenous lorazepam infusion for the treatment of severe alcohol withdrawal in a transition care unit. Methods: A retrospective study of 67 patient episodes treated in the transition care unit at the San Francisco General Hospital from December 2000 to June 2001 for severe alcohol withdrawal was done. Pharmacologic data were reviewed for all patients who received continuous intravenous lorazepam infusion. Patients were given continuous IV lorazepam infusion with additional IV boluses of lorazepam PRN for agitation. Continuous bedside telemetry and oxygen saturation monitoring with frequent nursing assessments of CIWA-Ar scores and sedation level were employed. Results: The average length of infusion was five days, range 1-17 days. The total infusion dose ranged from 30-9,900 mg with an average of 1,320 mg. The average daily dose of lorazepam was 252 mg, ranging from 10-1,900 per day. Of the 67 episodes, 26 (39%) required additional neuroleptic medication to treat symptoms of delirium. Conclusion: Intravenous lorazepam was administered in a wide range of total daily doses. A subset of patients who required extremely high doses of lorazepam were identified (outliers). Patients treated repeatedly for withdrawal accounted for 50% of the outliers, supporting either the theory of kindling phenomena where repeated withdrawal episodes produce future withdrawals of greater severity, or a tolerance effect from the lorazepam infusion.

Objective: There has been a need to identify "dual" patients early in detox in order to stabilize the underlying co-morbid psychiatric condition thus allowing the patient to take full cognitive and emotional advantage of the treatment options offered. Utilizing self-assessments of mood and behavior we were able to identify dual patients within 5 days of detoxification, and initiate aggressive psychopharmacological intervention. Method: Two-hundred seventy-five patients in various stages of detoxification (0 to >30 days) were assessed utilizing the Zung depression and anxiety indices and the Marin apathy, Barratt impulsivity and Maudsley obsessivity self-assessment scales. A single index of psychopathology was derived from these scores. One-hundred eighty-six non-chemically dependent patients with a psychiatric disorder were similarly assessed. Ninety-two patients were assessed pre and post 60-day dual inpatient treatment. Diagnosis of the dual disorder was made by a DSM-IV based interview blind to the results of the assessments. Results: Dual patients had significant and persisting pre-treatment elevations of the index when compared with a similar detoxed, non-dual diagnosis CD population at 0-5 days (p<.05), 6-10 days (p<.01), 11-30 days (p<.01), and .>30 days (p<.01). Non dual patients had mild elevations at 0-5 days but were normal at 6-10, 11-30 and >30.days. In dual patients completing an inpatient program, there was a significant reduction in the pre treatment index compared with post treatment (p<.01) There were no significant differences in specific assessment scores within the dual diagnosis group when patients were separated based on diagnosis or drug of choice categories with the exception of obsessivity. Elevated scores were found on the Maudsley scale (nl<7) in cocaine (16.7, CI=2.41) and methamphetamine (16.43, CI=2.89) dependent patients compared with alcohol (10.26, CI=2.28), polysubstance (8.54, CI=3.77), cannabis (8.75, CI=4.39), opioid (7.30, CI=5.11), and anxiolytic (4.25, CI=6.79) dependent patients. These elevated pre-treatment values were reduced in all categories after the 60-day treatment period with the exception of the stimulant dependent groups. Conclusion: This preliminary data suggests that there is significant global alteration in mood and behavior dimensions in dual diagnosis patients unaffected by type of substance use or length of time since detoxification. Using an index of psychopathology these patients can be distinguished from non-dual CD patients as early as 5 days post-detoxification. Aggressive psychosocial and pharmacological intervention markedly reduces these dysfunctional symptom states. The unexpected high levels of obsessivity unrelated to drug seeking found in stimulant abuse suggests a disruption in obsessivity-compulsivity neural circuitry that in stimulant users may not be immediately reversible. Further studies are underway to clarify this phenomenon.

Efficacy of a Cognitive Behavioral Therapy Program (Based on Dialectical Behavioral Therapy) in the Treatment of Patients with Co-Morbid Chemical Dependence and Primary Affective, Anxiety, or Personality Disorders

Background: It has long been recognized that patients with both addiction and a primary affective, anxiety, or personality disorder have a complicated course of treatment. These dually-diagnosed patients often cite attempts to regulate affect or reduce pain and psychological distress as triggers predisposing them to relapse. These patients have repeatedly demonstrated equally poor outcomes in both traditional chemical dependency and psychiatric treatment programs. Recently, Dr. Marsha Linehan has demonstrated the efficacy of Dialectical Behavioral Therapy (DBT) in a population of drug-dependent women with borderline personality disorder. When compared with a treatment-as-usual group, the patients randomized to DBT showed significantly less drug use for up to a 16-month follow-up. Method: In this current study, we aim to investigate the efficacy of a cognitive-behavioral therapy program (based upon the DBT model) for the treatment of patients diagnosed with co-morbid chemical dependence and depression, anxiety, and/or a personality disorder. The DBT-based program has been integrated into a partial hospital, chemical dependency program in which there are a majority of professional/high-accountability patients (health-care and other professionals). The program consists of four modules: Mindfulness/Relaxation, Emotion/Affect Regulation, Distress Tolerance, and Interpersonal Effectiveness. Patients in the partial hospital program spend one week on each module and most complete each module twice. Results: Using the Rush Behavioral Outcomes 31-Item Questionnaire (RB0-31), outcome data is being collected to measure the long-term efficacy of this integrative approach in sustaining abstinence from mood-altering substances. In addition, each patient’s level of depression, anxiety or self-destructive urges/behaviors is also being measured to assess the impact that the DBT-based program has on these indices. Preliminary results demonstrate significant reductions in anxiety (p=0.38), depression (p<0.001), functional impairment (p<0.001), and overall symptom severity (p=0.001) after completion of the four, week-long modules.

Introduction: Tryptophan, a naturally occurring amino acid, has shown promise in pre-clinical studies to be a novel and safe pharmacotherapy for cocaine dependence. Purpose: The present double-blind randomized clinical trial examined the interaction of tryptophan and a proven behavioral intervention, contingent financial incentives (i.e., vouchers) for cocaine dependence treatment using a relapse prevention approach. Methods: Cocaine dependent participants (N=l99) were stratified and randomized to one of four groups: tryptophan + vouchers (TV); tryptophan + no vouchers (TN); placebo + vouchers (PV); or placebo + no vouchers (PN). The study included: an inpatient stabilization (four to nine days) where participants achieved initial cocaine abstinence; an outpatient treatment evaluation (16 weeks) where participants could receive medication, vouchers, and urine sample testing for cocaine thrice weekly (M/W/F); and disposition. Results: Preliminary results show no significant differences among the groups on baseline characteristics or the mean number of days in inpatient (TV=7.6; TN= 8.3; PV =8.7; PN=7.5) or outpatient phases (TV=32.1; TN=28.5; PV =34.7; PN=35.3). Post-hoc results showed that PV had significantly lower overall cocaine-positive urine sample percentage compared to TN (23.8 vs. 43.0;P<.05). Final results and other outcome measures were presented. Conclusion: The tryptophan and voucher interaction may not preferentially retain individuals in treatment yet results may support the use of vouchers in a cocaine relapse prevention approach.

Hepatitis C in Patients with Co-occurring Mental Disorders and Substance Use Disorders: Tobacco Use—A Possible Risk Factor

Insomnia and the Course of Alcoholism in a Community Sample

Objective: Studies suggest that alcoholic patients who enter treatment with severe insomnia are more likely than patients without insomnia to relapse three to five months later. Because alcoholic individuals who seek treatment may be a biased subset of the general alcoholic population, this study looked for an association between baseline insomnia and persistent alcoholism at one-year follow-up in a nationally representative sample. Method: The sample was selected from the Epidemiological Catchment Area survey, and included all 262 respondents who met the following criteria: had a current (past six months) diagnosis of alcoholism at baseline; had baseline data regarding insomnia in the past six months; and completed a second diagnostic interview one year later. Insomnia was assessed by asking, "Have you ever had a period of two weeks or more when you had trouble falling asleep, staying asleep, or with waking up too early?" An affirmative response was scored positively only if the symptom was not always the result of physical illness, medication, or substance use. Results: 19% of alcoholic respondents met criteria for insomnia at baseline. At one-year follow-up, rates of persistent alcoholism did not differ between those with and without baseline insomnia: 42.9% (21 of 49) vs. 39.4% (84 of 213), respectively (X2=0.19, df=1, p=0.66). Conclusions: Baseline insomnia was not associated with the one-year course of alcoholism. These results differ from those of clinical studies, possibly because of differences across studies in sampling, criteria for alcoholism and insomnia, outcome measures, and duration of follow-up.

Background: Substance use disorders (SUD) affect 15% of individuals over the age of 18 in the United States. Among individuals with a psychiatric diagnosis, 65-76% have a comorbid SUD. Despite this high comorbidity, the education and teaching of SUD to both medical students and psychiatric residents has received less attention than other medical and psychiatric disorders. Objective: To determine if the amount of literature focused on SUD education has changed over time, what substance(s) have been addressed in the literature, and the differential amount of literature focused on residents versus medical students. Method: A literature review was conducted on PubMed and Medline with keywords: psychiatry resident, medical student, education, and substance use. Results: The resulting search yielded 56 articles between 1967 and 2001. There has been a gradual increase in the number of articles published during this period. Substances addressed in the literature focused primarily on alcohol, with other substances grouped as SUD. Only 14 of the 56 articles were concerned with the training of psychiatric residents. Conclusion: There is sparse literature focused on the education of SUD to medical students and psychiatry residents despite the prevalence of these disorders among psychiatric patients. While most articles addressed commonly abused substances, there was a noticeable deficit in newer club drugs. There was also a disproportionate amount of literature focused on the education of SUD to medical students. Clearly, there is a great need for SUD education of both psychiatry residents and medical students with the inclusion of newer substances of abuse.

Objective: This is an analysis of the initial participants who enrolled in a unique research project. The Naltrexone Parolee Project is a NIDA-supported randomized study of 150 males/50 female opiate-dependent parolees referred by local criminal justice referral agencies. The purpose of the study was to evaluate the efficacy of six months of individual and group CBT psychotherapy with and without Naltrexone. Naltrexone—an opiate antagonist—has been used in the treatment of narcotic addiction for over 25 years. Several clinical trials have illustrated its efficacy for those patients with motivation to remain abstinent. We were interested in determining whether these initial study participants were representative of the local convicted population. Methods: A demographic profile was constructed to examine characteristics of the patients referred to this study to date. Of the first 77 patients referred for participation in the study, 52 patients signed informed consents. Age, race, gender and educational level percentages were calculated for this group. This data was then compared to Philadelphia data compiled by the National Institute of Justice. Results: Parolee patients: Male=85%, Female=15%, Age 15-25yo=25%, 26-35yo=33%, 36+yo=42%. Caucasian=38%, African-American=33%, Hispanic=29%. Education: 12yrs+=15%, 12yrs/GED=35%, <12yrs=40%, unknown =10%. Conclusions: Preliminary data shows that the initial participants differ from the local criminal justice population. They are older, more educated and more likely of Hispanic background.

Nicotine’s Effects in Major Depressive Disorder

Major Depressive Disorder (MDD) is often comorbid with nicotine dependence. No common neural mechanism is known for these two disorders. Nicotine enhances cholinergic and dopaminergic release in the brain. The pharmacological properties of nicotine may ameliorate some of the symptoms of MDD (e.g., depressed mood). Objective: To evaluate whether chronic nicotine use modifies subjective mood states in MDD and control patients. Methods: 40 MDD patients (smokers n=18, non-smokers n=22) and 36 controls (smokers n=16, non-smokers n=20) participated in this study. Self-report questionnaires (e.g., Profile of Mood States) were used to evaluate mood states. Results: The Fagerström test score was correlated with number of cigarettes smoked in MDD and controls (r=.57; p=.000). HAM-D score was not associated with smoking patterns. MDD smoker subjects reported less fatigue than MDD non-smokers (p=.02). No other differences were found in the report of mood states between MDD and non-MDD subjects (smokers or non-smokers). Conclusions: Chronic nicotine use did not modify the self-report of mood in MDD patients. It is likely that the comorbidity between smoking and MDD is associated with nicotine’s effects in cognition rather than its effect in mood.

Psychological and Demographic Correlates of Internet Addiction

Objective: The prevalence, demographics, and psychological correlates of Internet addiction or dependency, also known as Pathological Internet Use (PIU), were investigated in a sample of 100 undergraduate and postgraduate Information Technology students at Bond University. Method: Students were assessed using the Internet Dependency Screening Test, the Zung Depression Self-Rating Scale, the UCLA Loneliness Scale, and a Personal Information Questionnaire. Results indicated that 21 of the 100 Information Technology volunteers could be classified as pathological users of the Internet based on their Internet Dependency scores, whereas 55 students demonstrated limited symptomatology and 24 exhibited no symptoms. Those classified as exhibiting PIU showed significantly higher depression and loneliness scores than those not meeting PIU criteria. Implications for the etiology, prevention, and treatment of PIU are discussed.

Objective: The public safety implications of driving while intoxicated (DWI) are striking. For example, the National Highway Traffic Safety Administration reports that 38% of traffic fatalities in 1999 in the United States were alcohol-related. Despite the acknowledged difficulties in treating this population, especially in the presence of comorbid disorders, little has been written on either comorbidity or DWI reoffense. This poster reported findings on comorbidity and reoffense in one DWI program that treats multiple offenders. Methods: (1) We examined a cohort of 32 DWI offenders using structured psychiatric assessments. (2) We also used the database of the Massachusetts Criminal History Systems Board to follow a separate cohort of 1270 offenders for between two and three years to determine reoffense rate. Results: (1) Of the cohort of 32: a) more than 50% had more than one substance use disorder and b) male offenders had elevated anger scores. (2) Of the cohort of 1,270: a) At two years, 5.8% had been arrested for DWI and 8.2% for any substance-related offense and b) at completion of follow-up, 10.8% had been arrested for DWI, 15.2% for any substance-related offense, and 38.3 for any offense (including violent offenses). Conclusions: Comorbidity and reoffense are common among those who complete this DWI program for multiple offenders.

Objective: Patients with substance use disorders complicated by psychiatric illness exhibit poor treatment outcomes. Cocaine-dependent patients are especially difficult to treat. The aim of this study was to assess the efficacy of risperidone for both the cocaine dependence and psychiatric disorder. Methods: Sixteen patients admitted to an intermediate-care inpatient substance abuse program for men and diagnosed with cocaine dependence (DSM-III-R) were assessed by Structured Clinical Interview for DSM-III-R (SCID) for comorbid psychiatric illness. They were started on risperidone in an open-label, non-blinded, naturalistic trial. Patients were assessed weekly during their inpatient stay, using the Clinical Global Impressions scale (CGI), craving scale, Abnormal Involuntary Movement Scale (AIMS) and laboratory studies. Results: 1) Thirteen (81%) patients were improved or much improved; 2) All sixteen patients reported no craving and no cocaine use, and none of the patients was discharged for cocaine use; 3) Psychiatric diagnoses were: nine bipolar disorder, six major depression, three post-traumatic stress disorder, three psychotic disorders and two anxiety disorders; 4) Thirteen patients were on another psychiatric medication. Three patients were referred to the program on anticholinergic medication, and two of these were also referred on a typical antipsychotic; both were tapered during inpatient admission; 5) All patients had at least one other substance use diagnosis; 6) No patient developed extrapyramidal side effects or hypomania; one patient reported mild sedation, and one, also on benztropine and haloperidol, reported sedation and dizziness; 7) Laboratory studies revealed three patients with baseline abnormalities, which remained stable during the course of treatment. 8) Mean daily risperidone dose was 3.9 mg; 9) Average length of inpatient follow-up was 24 days; nine (56%) patients went on to residential treatment programs; 10) For the 12 patients for whom date of last substance use was established, mean period of abstinence prior to starting risperidone was 39 days. Conclusions: The results of our study suggest that in low doses risperidone is safe, effective and well tolerated in the extremely difficult to treat patient with comorbid cocaine dependence and psychiatric illness. In the short term, risperidone may also be effective in reducing cocaine craving and use.

Background: This report is designed to determine if sweet preference would predict pharmacotherapy outcome in alcoholism and is part of the NIAAA-sponsored study "Sertraline with Naltrexone for Alcohol Dependence." Methods: Twelve alcohol-dependent patients (11 males and 1 female) drinking 7.4+0.9 (M+SEM) drinks per drinking day (drinks/day) over 14.9+2.4 (M+SEM) drinking days per month (DD/month) were treated with Naltrexone (50 mg/day) and randomized to Sertraline (100 mg/day) or placebo for 12 weeks. Sweet-liking was assessed using the standard Sweet Preference Test. Subjects preferring the strongest (0.83 M) sucrose concentration of five choices were designated as sweet likers (SL) and those preferring 0.05-0.4 M sucrose solutions as sweet dislikers (SDL). Results: Analysis showed an overall 59% reduction in drinks/day (p=0.0003) with no reduction in DD/month (p>0.05). SDL patients demonstrated a tendency (p=0.0956) to have a better therapeutic response (82% reduction of DD/month), compared to SL patients (50% reduction of DD/month). Furthermore, we found a strong negative correlation between craving for sweets and different parameters of clinical efficacy: latency before first relapse to heavy drinking (r=-0.7; p=0.03), decrease in DD/month (r=-0.8; p=0.005), and decrease in drinks/day (r=-0.7; p=0.04). Conclusions: Hedonic response to sweets and craving for sweets may predict the therapeutic response to pharmacotherapy in alcoholism. The final analysis will be performed after recruiting and testing additional subjects and breaking the blind at the end of the study.

Objective: Hunger (H), anger (A), loneliness (L), tiredness (T), and negative affect (NA) are five states thought to trigger urges to drink (U) in newly abstinent alcoholics. However, relatively little is known about the temporal relationship between these states and the occurrence of urges. Method: Data on these "triggering" states and U were obtained 4+ times daily from 22 alcohol-dependent male, outpatient or residential treatment subjects in their first month of abstinence. Within subjects, we calculated correlation coefficients between levels of each trigger and urges to drink. We also assessed, within subjects, the coincidence of peaks in levels of each "trigger" and peaks in urges to drink. Results: The correlations revealed 14 subjects in which negative affect levels significantly positively correlated with urges to drink versus eight subjects in which there was no such correlation. No subjects had a negative correlation between negative affect and urges to drink. Anger was positively correlated with urges to drink in nine of 22 subjects while 13 subjects showed no positive correlation. Hunger, loneliness, and tiredness were positively correlated with urges to drink less often. There was great inter-individual variation in the pattern of coincidence between peaks in hunger, anger, loneliness, tiredness, and negative affect and urges to drink. Twelve of 22 subjects evidenced significant co-occurrence between peaks in negative affect and urges to drink. Conclusion: In summary, negative affect was the best predictor of urges to drink. However, study of the individual-specific relationships between "triggers" and urges to drink might help tailor treatments for patients in the future. Supported by VA Merit Review.

Objective: Accurate and timely documentation of patient care is of utmost importance in the current clinical environment. The standards of many accreditation organizations such as JCAHO require documentation of a Master Treatment Plan (MTP) with appropriate problems, individualized goals and interventions. In addition, all subsequent notes must reflect progress on the goals listed in the MTP. Clinicians, faced with ever-increasing patient care responsibilities, often find it difficult to complete such documentation with the degree of attention and timeliness required. Method: To determine if a newly developed MTP template and weekly note (Plan of Care Review) template could facilitate documentation of care and staff satisfaction within an intensive outpatient substance abuse treatment setting, a chart survey was conducted using a Quality Assurance Checklist (maximum score of 70) to assess chart documentation prior to initiating the new templates and six months after template initiation. To assess staff satisfaction, a Staff Satisfaction Survey was given prior to and six months after template initiation. Results: Initial review of proficiency with the new templates by three case managers found a mean improvement from 50/70 to 68/70 on the Quality Assurance Checklist. In addition, staff satisfaction with the clinical documentation process increased on several analog measures. Conclusions: This small study suggests that the use of templates that link the MTP and weekly notes can increase documentation quality and staff satisfaction in an outpatient substance abuse treatment setting.

Objective: Attention deficit/hyperactivity disorder (ADHD) is frequently comorbid with drug and alcohol use disorders in adults. This open trial assessed the safety and efficacy of venlafaxine for the treatment of comorbid alcohol abuse and ADHD. Methods: Ten patients with DSM-IV diagnoses of ADHD and alcohol/cocaine abuse were enrolled in a 12-week open trial of venlafaxine (flexible dose). Patient’s vital signs and alcohol breathlyzer tests were checked at each visit and urine toxicology tests were performed approximately once a month. The patients were seen weekly for the initial four weeks and at weeks eight and 12. ADHD symptoms, alcohol craving and use were monitored. Results: Nine out of 10 patients completed at least four weeks of the study. There was a significant improvement in the ADHD symptoms as reported by a self-report assessment and clinical interview. There was a significant improvement in the alcohol craving intensity and a trend toward improvement in frequency as measured by the visual analog craving scales. Patients also reported a decrease in the average number of drinks per drinking day. All but one subject had a significant decrease in alcohol use during the follow-up period and three reported complete abstinence. Conclusion: This pilot study indicates that venlafaxine may improve both ADHD symptoms and craving alcohol use in patients with comorbid ADHD and alcohol abuse. Further double-blind controlled investigation of venlafaxine for ADHD in adults with comorbid alcohol use disorders is warranted.