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CORK Bibliography: Cocaine

122 citations. January 2011 to present

Prepared: September 2011

Abdon JG; Wallin E; Andreasson S. The "Clubs against Drugs" program in Stockholm, Sweden: Two cross-sectional surveys examining drug use among staff at licensed premises. Substance Abuse, Treatment, Prevention and Policy 6: article 2, 2011. (38 refs.)

Background: The objective of this study is to examine self-reported drug use among staff at licensed premises, types of drugs used, attitudes towards drugs, and observed drug use among guests. Results are presented from two measurement points (in 2001 and 2007/08). This study was carried out within the framework of the "Clubs against Drugs" program, which is a community-based multi-component intervention targeting licensed premises in Stockholm, Sweden. Methods: Two cross-sectional surveys were conducted, the first in 2001 and the second in 2007/08. Staff at licensed premises attending server training were asked to participate in the anonymous survey. A survey was administered in a classroom setting and consisted of four sections: 1) demographics, 2) respondents' own drug use experience, 3) respondents' attitudes towards drug use, and 4) observed drug use among guests at licensed premises. Results: Data were collected from 446 staff in 2001 and 677 staff in 2007/08. The four most commonly used drugs among staff were cannabis, cocaine, amphetamine, and ecstasy. The highest rates of drug use were reported by staff in the two youngest age groups, i.e., those younger than 25 and those between the ages of 25 and 29. In 2007/08 staff reported significantly lower rates of drug use than staff in 2001. Last year drug use for the sample in 2007/08 was 19% compared to 27% for the 2001 sample. While drug-using staff compared to non drug-using staff reported more observations of drug use among guests, they were less inclined to intervene. Overall, staff reported restrictive attitudes towards drugs. Conclusions: The prevalence of life-time and last year drug use among staff at licensed premises is high compared to the general population in Sweden. Lower rates of self-reported drug use among staff were reported in 2007/08. The results of this study highlight that staff at licensed premises represent an important target population in club drug prevention programs.

Accornero VH; Anthony JC; Morrow CE; Xue L; Mansoor E; Johnson AL et al. Estimated effect of prenatal cocaine exposure on examiner-rated behavior at age 7 years. Neurotoxicology and Teratology 33(3): 370-378, 2011. (69 refs.)

Prenatal cocaine exposure has been linked to increased child behavior difficulties in some studies but not others. Objective: The primary aim was to estimate the relationship between in utero cocaine exposure and child behavioral functioning at age 7 years with ratings made by blinded examiners during a structured testing session. A second aim was to examine whether caregiver drug use and psychological problems might mediate suspected relationships between prenatal cocaine exposure and aspects of examiner-rated behavior. Methods: 407 children (212 cocaine-exposed, 195 non-exposed) participating in the longitudinal Miami Prenatal Cocaine Study (MPCS) were rated with regard to their behavior during a neuropsychological assessment conducted at age 7 years. Raters were trained research psychometricians blinded to drug exposure status. Individual behavioral items were summarized and the cocaine-behavior relationship was estimated within the context of latent variable modeling, using Mplus software. Results: Two latent variables, Behavioral Regulation and Sociability, were derived via exploratory latent structure analysis with promax rotation. Prenatal cocaine exposure, statistically controlling for child sex, test age, and prenatal exposure to alcohol, tobacco, and marijuana, was associated with Behavioral Regulation (estimated slope beta = -0.25; 95% CI = -0.48. -0.02; p = 0.04) but not Sociability (estimated slope beta = 0.03; 95% Cl = -0.26, 0.20; p = 0.79). Neither postnatal drug use by caregivers nor the severity of their psychological problems at age 5 follow-up predicted levels of child Behavioral Regulation or Sociability at age 7 years (p>0.10). Conclusions: Examiner ratings of child behavior at age 7 revealed less optimal behavioral regulation for prenatally cocaine-exposed compared to non-exposed children, in contrast with what had been previously found from parent-report data. This evidence highlights the potential value of trained observers in assessing behavioral outcomes of children exposed in utero to drugs and other toxicants.

Acuda W; Othieno CJ; Obondo A; Crome IB. The epidemiology of addiction in sub-saharan Africa: A synthesis of reports, reviews, and original articles. (review). American Journal on Addictions 20(2): 87-99, 2011. (67 refs.)

Use of alcohol and other psychoactive substances is associated with serious social and public health problems, but the extent of the problem in Sub-Saharan Africa is not well known. We set out to review epidemiological publications on alcohol and other psychoactive substances in Sub-Saharan Africa by performing a systematic search of electronic databases and paper records. Ten Sub-Saharan African countries are among the 22 in the world with the highest increase in per capita alcohol consumption. Cannabis, tobacco, and khat are widely used, and use of cocaine, stimulants, and heroin is increasing. More epidemiological research and implementation and evaluation of interventions is needed. Collaboration between African researchers and those in developed countries could help.

Adimora AA; Schoenbach VJ; Taylor EM; Khan MR; Schwartz RJ. Concurrent partnerships, nonmonogamous partners, and substance use among women in the United States. American Journal of Public Health 101(1): 128-136, 2011. (34 refs.)

Objectives. We determined the prevalence, distribution, and correlates of US women's involvement in concurrent sexual partnerships, a sexual-network pattern that speeds population-wide HIV dissemination. Methods. We used sexual partnership dates reported by 7643 women in the 2002 National Survey of Family Growth to determine prevalence of concurrent sexual partnerships during the preceding 12 months. We examined associations between concurrency and sociodemographic characteristics and risk behaviors. Results. Prevalence of concurrent partnerships was 5.7% based on reported partnerships and 8.3% after adjustment for possible underreporting. Concurrency was associated with younger age (22 to 24 years: prevalence odds ratio [POR]=2.44) versus older age (40 to 44 years); marital status (formerly married: POR=6.56; never married: POR=3.81; vs married); Black race/ethnicity (POR=1.78); younger age at first sexual intercourse (12 to 13 years: POR=2.89) versus 18 years or older); having a nonmonogamous sexual partner (POR=6.96); having intercourse while "high" on drugs or alcohol (POR=1.61); binge drinking (POR=1.70); and crack or cocaine use (POR=2.72). Conclusions. The association of concurrency with nonmonogamous sexual partners and substance use suggests the existence of extensive sexual networks that link people at higher risk for HIV infection with increased opportunities for disseminating infection.

Albert L; DeMattia JA. Cocaine-induced encephalocele: Case report and literature review. Neurosurgery 68(1): E263-E266, 2011. (16 refs.)

BACKGROUND AND IMPORTANCE: The abuse of cocaine can lead to significant destruction of midline craniofacial structures. This process occurs secondary to myriad mechanisms, including ischemic necrosis, irritation by chemical adulterants, and direct trauma during its administration. Coupled with a prolonged chronic infection of intranasal and anterior skull base regions, an encephalocele can be formed. We report a case of an encephalocele secondary to cocaine use and its associated complications. CLINICAL PRESENTATION: A 56-year-old man presented with altered mental status and cerebritis secondary to the presence of an intranasal encephalocele. On computed tomography, extensive destruction of the anterior cranial fossa was observed. The patient had a 30-year history of intranasal cocaine abuse, and his urine tested positive for the presence of cocaine on admission. The patient was treated with intravenous antibiotics and underwent a repair of his cranial defect and resection of the encephalocele. The patient made a good recovery after treatment. CONCLUSION: Alternative causes of an encephalocele, including trauma, surgery, and congenital malformation, were ruled out in this patient. Histopathological analysis of the necrotic tissue and the absence of renal or pulmonary disease also indicated that the patient did not suffer from Wegener granulomatosis, a known cause of spontaneous intranasal lesions. To the best of our knowledge, this is the first report of an encephalocele likely induced solely by cocaine abuse.

Alford DP; LaBelle CT; Kretsch N; Bergeron A; Winter M; Botticelli M et al. Collaborative care of opioid-addicted patients in primary care using buprenorphine: Five-year experience. Archives of Internal Medicine 171(5): 425-431, 2011. (27 refs.)

Background: Opioid addiction is a chronic disease treatable in primary care settings with buprenorphine hydrochloride, but this treatment remains underused. We describe a collaborative care model for managing opioid addiction with buprenorphine hydrochloride-naloxone hydrochloride dihydrate sublingual tablets. Methods: Ours is a cohort study of patients treated for opioid addiction using collaborative care between nurse care managers and generalist physicians in an urban academic primary care practice during a 5-year period. We examine patient characteristics, 12-month treatment success (ie, retention or taper after 6 months), and predictors of successful outcomes. Results: From September 1, 2003, through September 30, 2008, 408 patients with opioid addiction were treated with buprenorphine. Twenty-six patients were excluded from analysis because they left treatment owing to preexisting legal or medical conditions or a need to transfer to another buprenorphine program. At 1 year, 196 of 382 patients (51.3%) underwent successful treatment. Of patients remaining in treatment at 12 months, 154 of 169 (91.1%) were no longer using illicit opioids or cocaine based on urine drug test results. On admission, patients who were older, were employed, and used illicit buprenorphine had significantly higher odds of treatment success; those of African American or Hispanic/Latino race had significantly lower odds of treatment success. These outcomes were achieved with a model that facilitated physician involvement. Conclusion: Collaborative care with nurse care managers in an urban primary care practice is an alternative and successful treatment method for most patients with opioid addiction that makes effective use of time for physicians who prescribe buprenorphine.

Arendt M; Munk-Jorgensen P; Sher L; Jensen SOW. Mortality among individuals with cannabis, cocaine, amphetamine, MDMA, and opioid use disorders: A nationwide follow-up study of Danish substance users in treatment. Drug and Alcohol Dependence 114(2-3): 134- 139, 2011. (74 refs.)

This is a register-based cohort study of 20,581 individuals in treatment for illicit substance use disorders in Denmark between 1996 and 2006. All in all, 1441 deaths were recorded during 111,445 person-years of follow-up. Standardized mortality ratios (SMRs) associated with different primary substance types were calculated and Cox-regression analyses were performed in order to establish hazard ratios (HR) associated with injection drug use and psychiatric comorbidity. SMRs for primary users of specific substances were: cannabis: 4.9 (95% confidence interval (Cl): 4.2-5.8), cocaine: 6.4 (Cl: 3.9-10.0), amphetamine: 6.0 (Cl: 4.2-8.3), heroin: 9.1 (Cl: 8.5-9.8), and other opioids 7.7 (Cl: 6.6-8.9). For MDMA ('ecstasy') the crude mortality rate was 1.7/1000 person-years (Cl: 0.4-7.0) and the SMR was not significantly elevated. Injection drug use was associated with significantly increased hazard ratios in users of opioids and cocaine/amphetamine. Overall, psychiatric comorbidity was not associated with increased mortality (HR: 1.1 [Cl: 0.9-1.2], p = .28), but an association was found specifically among cocaine/amphetamine users (HR: 3.6 [Cl: 2.1-6.4], p <.001).

Argyriou AA; Karanasios P; Makridou A; Vlachou M; Giannakopoulou F; Makris N. Cocaine use and abuse triggering sporadic young-onset amyotrophic lateral sclerosis. Neurodegenerative Diseases 8(3): 146-148, 2011. (11 refs.)

To our knowledge, we describe for the first time the case of a male patient with sporadic young-onset amyotrophic lateral sclerosis, most likely attributed to chronic regular cocaine use and abuse. Our case supports the view that cocaine use and abuse may trigger a process of motor neuron degeneration by mechanisms implicating alterations in the neurobiology of the excitatory neurotransmitter glutamate and its receptors.

Atwoli L; Mungla PA; Ndung'u MN; Kinoti KC; Ogot EM. Prevalence of substance use among college students in Eldoret, western Kenya. BMC Psychiatry 11: article 34, 2011. (24 refs.)

Background: Substance use among college and university students predicts substance related problems in later life. Few studies on this phenomenon have been carried out in low income countries, and most focus on primary and secondary school students. This study therefore aimed to establish the prevalence and factors associated with drug use among university and college students in a low income country. Methods: Design: A descriptive cross-sectional survey using the Self-Administered WHO Model Core Questionnaire to collect information on use of various drugs among students in colleges and university campuses within Eldoret Municipality in Western Kenya. Setting: Four tertiary learning institutions in Eldoret Municipality were randomly selected for inclusion in the study-three tertiary level non-university institutions and one university campus. Subjects: Five hundred students who gave consent to participate in the study, 125 from each of the four participating institutions. The mean age was 22.9 years (18-32, s. d. 2.5), and males made up 52.2% of the sample. Results: Lifetime prevalence rate of any substance use was 69.8%, and none of the socio-demographic factors was significantly associated with this. Lifetime prevalence rate of alcohol use was 51.9%, and 97.6% of alcohol users had consumed alcohol in the week prior to the study. The prevalence rate of cigarette use was 42.8%, with males having statistically significantly higher rates than females (p < 0.05). Other substances used were cannabis (2%) and cocaine (0.6%). Among those who admitted to using substances, 75.1% were introduced by a friend while 23.5% were introduced by a relative other than a member of the nuclear family. Majority of those using substances wanted to relax (62.2%) or relieve stress (60.8%). Problems associated with alcohol use included quarrelling and fights, loss and damage to property, problems with parents, medical problems and unplanned unprotected sex. Conclusion: The prevalence of substance use among college and university students in Eldoret is high and causes significant physical and psychosocial problems in this population. A large proportion of those using alcohol reported serious adverse effects, raising the necessity of targeted interventions to reduce the risk of subsequent substance dependence and other deleterious consequences.

Banerjee SC; Greene K; Yanovitzky I. Sensation seeking and dosage effect: An exploration of the role of surprise in anti-cocaine messages. Journal of Substance Use 16(1): 1-13, 2011. (40 refs.)

This article examines emotional and cognitive responses to graphic illustrations of the effects of cocaine among a sample of low and high sensation seekers (LSS & HSS). Two-hundred-and-five (n = 205) undergraduate students at a large northern university in the United Kingdom participated in the study and were randomly assigned to one of two conditions: low-image or high-image print adverts about the consequences of cocaine use. Results indicated that although high sensation seekers report greater cocaine use as compared with low sensation seekers, report less surprise and have less dominant cognitions than LSS, they do not differ from LSS in terms of other affective responses when exposed to anti-cocaine visual messages. However, the high-image advert was more successful than the low-image adverts in eliciting surprise, which has important theoretical and empirical implications for the design of effective messages targeting HSS.

Bauer CR; Lambert BL; Bann CM; Lester BM; Shankaran S; Bada HS et al. Long-term impact of maternal substance use during pregnancy and extrauterine environmental adversity: Stress hormone levels of preadolescent children. Pediatric Research 70(2): 213-219, 2011. (33 refs.)

Prenatal cocaine exposure (PCE) is associated with blunted stress responsivity within the extrauterine environment. This study investigated the association between PCE and diurnal salivary cortisol levels in preadolescent children characterized by high biological and/or social risk (n = 725). Saliva samples were collected at their home. Analyses revealed no group differences in basal evening or morning cortisol levels; however, children with higher degrees of PCE exhibited blunted overnight increases in cortisol, controlling for additional risk factors. Race and caregiver depression were also associated with diurnal cortisol patterns. Although repeated PCE may contribute to alterations in the normal or expected stress response later in life, sociodemographic and environmental factors are likewise important in understanding hormone physiology, especially as more time elapses from the PCE. Anticipating the potential long-term medical, developmental, or behavioral effects of an altered ability to mount a normal protective cortisol stress response is essential in optimizing the outcomes of children with PCE.

Bell RP; Foxe JJ; Nierenberg J; Hoptman MJ; Garavan H. Assessing white matter integrity as a function of abstinence duration in former cocaine-dependent individuals. Drug and Alcohol Dependence 114(2-3): 159- 168, 2011. (69 refs.)

Current cocaine-dependent users show reductions in white matter (WM) integrity, especially in cortical regions associated with cognitive control that have been associated with inhibitory dysfunction. A key question is whether these white matter differences are present following abstinence from drug use. To address this, WM integrity was examined using diffusion tensor imaging (DTI) obtained on 43 cocaine abstinent patients (abstinence duration ranged between five days and 102 weeks) and 43 non-using controls. Additionally, a cross-sectional comparison separated the patients into three groups (short-term, mid-term and long-term) based upon duration of cocaine abstinence. The 43 cocaine abstinent patients showed lower fractional anisotropy (FA) in the left anterior callosal fibers, left genu of the corpus callosum, right superior longitudinal fasciculus, right callosal fibers and the superior corona radiata bilaterally when compared against non-using controls. Higher FA in the cocaine abstinent patients was observed in the splenium of the corpus callosum and right superior longitudinal fasciculus. Differences between the cocaine abstinent groups were observed bilaterally in the inferior longitudinal fasciculus, right anterior thalamic radiation, right ventral posterolateral nucleus of the thalamus, left superior corona radiata, superior longitudinal fasciculus bilaterally, right cingulum and the WM of the right precentral gyrus. The results identified WM differences between cocaine abstinent patients and controls as well as distinct differences between abstinent subgroups. The findings suggest that specific white matter differences persist throughout abstinence while other, spatially distinct, differences discriminate as a function of abstinence duration. These differences may, therefore, represent brain changes that mark recovery from addiction.

Benotsch EG; Martin AM; Koester S; Cejka A; Luckman D. Nonmedical use of prescription drugs and HIV risk behavior in gay and bisexual men. Sexually Transmitted Diseases 38(2): 105-110, 2011. (56 refs.)

Background: Previous research has demonstrated associations between substance use and sexual risk behavior in men who have sex with men (MSM). Recent trends in substance use show increasing use of prescription medications (e. g., Vicodin) without a physician's prescription, yet associations between the nonmedical use of prescription drugs (NMUPD) and HIV risk behavior have not been well examined in MSM. Methods: MSM attending a gay pride festival completed a self-report measure assessing NMUPD, motivations for use, use of traditional recreational drugs, and HIV risk behavior. Results: More than one-third of the sample (38%) reported lifetime NMUPD and 17% reported NMUPD in the previous 3 months. The most common class of medications used was prescription analgesics. Men reporting NMUPD also reported higher rates of the use of marijuana, poppers, ecstasy, cocaine, methamphetamine, GHB, ketamine, heroin, and rohypnol, and had significantly higher rates of HIV risk behaviors, including more sexual partners and more unprotected sex. Conclusions: A significant minority of MSM are using prescription medications without a doctor's consent. Men who do so are risking negative consequences of such use, including the potential for addiction, potentially dangerous interactions between prescription and recreational drugs, and greater risk for contracting HIV.

Bhargava S; Arora RR. Cocaine and cardiovascular complications. American Journal of Therapeutics 18(4): E95-E100, 2011. (61 refs.)

Thirty-six million Americans older than 12 years of age have used cocaine in their lifetime. Cocaine abuse is on the rise and it brings the challenges to treat the complication associated with it, particularly cardiovascular complications. As the understanding of pathophysiology of cocaine-associated cardiovascular complications is advancing, the treatment modalities are also modifying. In this article, common cardiovascular complications associated with acute or chronic cocaine use and their treatment are reviewed.

Black AC; Rosen MI. A money management-based substance use treatment increases valuation of future rewards. Addictive Behaviors 36(1-2): 125-128, 2011. (23 refs.)

Objective: A positive association between delay discounting and substance use has been documented substance users tend to discount future rewards more than non-users. However studies detailing the responsiveness of delay discounting to interventions are lacking and few have examined how any behavioral intervention affects delay discounting and whether these effects moderate changes in substance abuse. This study assesses the effectiveness of a money management intervention Advisor-Teller Money Manager (ATM) in reducing delay discounting over time and the relationship of these effects to changes in cocaine use. Method: Ninety psychiatric patients with histories of cocaine and/or alcohol use were randomly assigned to 36 weeks of ATM treatment or to a minimal attention control condition. Delay discounting and cocaine use were measured throughout the intervention with a 52-week follow up measure of cocaine use. Analyses were conducted of (a) the effect of ATM on slopes of delay discounting and cocaine abstinence and (b) the relationship between change in delay discounting and change in cocaine abstinence Results: The ATM intervention was associated with significantly less delay discounting and less cocaine use over time relative to controls Increases in delay discounting were associated with decreased abstinence from cocaine Conclusions ATM treatment decreased delay discounting rates and these effects extended to cocaine use. Concrete conceptualizations of future events as occur in financial planning with higher perceived probability may account for higher valuation of future rewards in counseled patients.

Bohnert ASB; Ilgen MA; Galea S; McCarthy JF; Blow FC. Accidental poisoning mortality among patients in the Department of Veterans Affairs health system. Medical Care 49(4): 393-396, 2011. (14 refs.)

Background: Accidental poisoning mortality is an increasingly important concern, particularly for health systems, which distribute potentially poisoning medications and treat substance use disorders. Objectives: To describe the rate of accidental poisoning mortality in the Veterans Health Administration (VHA) during fiscal year 2005, assess differences with rates observed in the general US population, and describe the frequency with which specific drugs and medications were mentioned on the death records of accidental poisoning decedents. Research Design: Cohort study. Subjects: All 5,567,621 individuals aged 18+ who received VHA inpatient or outpatient services in fiscal year 2004 (October 1, 2003 to September 30, 2004) or fiscal year 2005 and were alive at the start of fiscal year 2005. Measures: The National Death Index indicated vital status and cause of death, the National Patient Care Database indicated who used VHA services and consequently was in the study cohort, and the Web-based Injury Statistics Query and Reporting System indicated poisoning mortality rates in the general US population. Results: The crude rate of accidental poisoning mortality in the VHA for fiscal year 2005 was 19.85 deaths per 100,000 person-years. After accounting for gender and age distribution, VHA patients had nearly twice the rate of fatal accidental poisoning compared with adults in the general US population (standardized mortality ratio = 1.96; 95% confidence interval: 1.83, 2.08). Opioid medications and cocaine were frequently mentioned as the agents causing poisoning on death records. Conclusions: The present work indicates that a substantial need exists for interventions to reduce the risk of accidental poisoning among VHA patients.

Bowser BP; Lewis D; Dogan D. External influences on drug treatment interventions: East Palo Alto's Free-at-Last. Journal of Addiction Medicine 5(2): 115- 122, 2011. (25 refs.)

External influences on community-based drug treatment program outcomes have not been adequately accounted by either treatment providers or evaluators. In 2001-2003, a cohort of 197 African American and Latino crack cocaine and heroin users was interviewed at intake into the Free-at-Last's treatment program in East Palo Alto, California. Objective: The goal of this research was to identify, and then measure, the impact of a series of theory-based, hypothesized external influences on 3 client treatment outcomes: (1) program completers, (2) dropouts, and (3) referrals to more intensive inpatient treatment. Methods: All program clients were interviewed using the Government Performance and Results Act and the California Alcohol and Drug Data System questionnaires. Supplemental questions hypothesized the external influences and were based on prior research and staff focus groups. Results: There were statistically significant differences in treatment outcomes based on employment status, homelessness, living situation, and jail time. Regression analyses indicated that the strongest outcome predictors were treatment intensity, followed by prior crack use, homelessness, income, and number of illegal drugs used. Path analysis showed that former crack use and time in jail formed a particularly strong cluster of external influences on treatment outcomes. This cluster was the result of court-mandated treatment of arrested crack users who chose treatment over incarceration. If users failed treatment, they went back to jail. In a community such as East Palo Alto, court-mandated referrals had a powerful external influence on treatment and, therefore, need to be considered when evaluating a treatment program.

Brennan BP; Kanayama G; Hudson JI; Pope HG. Human growth hormone abuse in male weightlifters. American Journal on Addictions 20(1): 9-13, 2011. (40 refs.)

In a study of performance-enhancing substance use among 231 experienced young male weightlifters, we found that 27 (12%) reported illicit use of human growth hormone (HGH) or its bioactive derivative, insulin-like growth factor-1. All of these 27 men also reported use of anabolic-androgenic steroids (AAS) and 22 (81%) met criteria for current or past AAS dependence. Fifteen (56%) also reported current or past dependence on opioids, cocaine, and/or ecstasy. These findings suggest that among young male weightlifters, illicit HGH use has become a common form of substance abuse, frequently associated with both AAS dependence and classical substance dependence.

Caiaffa WT; Zocratto KF; Osimani ML; Martinez PL; Radulich G; Latorre L et al. Hepatitis C virus among non-injecting cocaine users (NICUs) in South America: can injectors be a bridge? Addiction 106(1): 143-151, 2011. (38 refs.)

Aim: To investigate the factors associated with hepatitis C virus (HCV) infection among non-injecting cocaine users (NICUs) and to compare practices associated with HCV and HIV infection. Design: An intercountry cross-sectional study. Setting: Buenos Aires and Montevideo metropolitan areas. Participants: A total of 871 NICUs. Measurements: NICUs were interviewed and their blood was drawn and used for HCV, HIV, HBV surface antigen (HbsAg), HB-anticore and Venereal Disease Research Laboratory (VRDL) antibody assays. Bivariate and multivariate logistic regression analyses included comparisons of HCV and HIV mono-infected participants with HCV-HIV seronegatives. Findings: Prevalence rates were 8.8 [95% confidence interval (CI): 6.9-10.8) for HCV and 7.9 (95% CI: 6.1-9.7) for HIV. HCV-infected NICUs were twice as likely as HCV-HIV seronegatives to have shared straws for cocaine snorting or sniffing, even when adjusted for other variables. HCV prevalence rates ranged from 3.6% among NICUs who denied sharing straws and having had an injection drug user (IDU) or an HIV-positive sexual partner to 12.6% among participants who reported ever having shared straws or having had either an IDU- or HIV-positive sexual partner (chi 2(trend) = 6.56, P = 0.01). Conclusions: Non-injecting cocaine users from South America are vulnerable to multiple infections and HCV infection appears to occur through the sharing of straws. HCV infection is associated with intimate relationships with IDUs or HIV-seropositive partners, supporting the hypothesis that HCV risk may be due primarily to risk-taking behaviour associated with drugs in this population.

Calafat A; Blay NT; Hughes K; Bellis M; Juan M; Duch M et al. Nightlife young risk behaviours in Mediterranean versus other European cities: are stereotypes true? European Journal of Public Health 21(3): 311-315, 2011. (25 refs.)

Background: Mediterranean lifestyle has long been hailed as protective against certain risk behaviours and diseases. Mediterranean drinking patterns of moderate alcohol consumption as part of daily life have often been assumed to protect young people from harmful alcohol consumption, in contrast to Northern European drinking patterns. Nightlife environments are strong related to alcohol and drugs use, and other health risk behaviours but few cross-national studies have been undertaken amongst young Europeans frequenting bars and nightclubs. This study aims to understand differences in nightlife risk-taking behaviours between young nightlife users from Mediterranean and non-Mediterranean cultures, including alcohol and illicit drug use, unprotected sex, violence and driving under the influence of alcohol. Methods: A total of 1363 regular nightlife users aged 16-35 years were surveyed in nine European cities by means of a self-reported questionnaire. Sample selection was done through respondent driven sampling techniques. Results: after controlling for demographic variables, no differences among the Mediterranean and non-Mediterranean samples were found in current alcohol, tobacco, cannabis, or cocaine use, neither in violent behaviours, but Northern people were more likely to get drunk [adjusted odds ratio (AOR) = 0.53], while Mediterranean were more likely to have unprotected sex (AOR = 2.01) and to drive drunken (AOR = 5.86). Conclusion: Our data suggest that stereotypes are partially confirmed, and that Mediterranean lifestyle is protective for some risk behaviours (drunkenness, ecstasy and amphetamines current use), but not for all of them. Further research in depth is needed in order to clarify the relations between cultural patterns, social norms and nightlife risk behaviours assumed by the young people.

Carrillo X; Curos A; Muga R; Serra J; Sanvisens A; Bayes-Genis A. Acute coronary syndrome and cocaine use: 8-year prevalence and inhospital outcomes. European Heart Journal 32(10): 1244- 1250, 2011. (34 refs.)

Aims: The use of cocaine as a recreational drug has increased in recent years. The aims of this study were to analyse the prevalence and inhospital evolution of acute coronary syndrome (ACS) associated with cocaine consumption (ACS-ACC). Methods and results Prospective analysis of ACS patients admitted to a coronary care unit from January 2001 to December 2008. During the study period, 2752 patients were admitted for ACS, and among these 479 were <= 50 years of age. Fifty-six (11.7%) patients had a medical history of cocaine use with an increase in prevalence from 6.8% in 2001 to 21.7% in 2008 (P = 0.035). Among patients younger than 30 years of age, 25% admitted to being users compared with 5.5% of those aged 45-50 years (P = 0.007). Similarly, the prevalence of positive urine tests for cocaine was four times higher in the younger patients (18.2 vs. 4.1%, P = 0.035). Acute coronary syndrome associated with cocaine consumption patients (n = 24; those who had a positive urine test for cocaine or who admitted to being users upon admission) had larger myocardial infarcts as indicated by troponin I levels (52.9 vs. 23.4 ng/mL, P < 0.001), lower the left ventricular ejection fraction (44.5 vs. 52.2%, P = 0.049), and increased inhospital mortality (8.3 vs. 0.8%, P = 0.030). Conclusions: The association between cocaine use and ACS has increased significantly over the past few years. Young adults with ACS-ACC that require admission to the coronary care unit have greater myocardial damage and more frequent complications.

Catalano RF; White HR; Fleming CB; Haggerty KP. Is nonmedical prescription opiate use a unique form of illicit drug use? Addictive Behaviors 36(1-2): 79-86, 2011. (35 refs.)

Nonmedical prescription opiate (NMPO) use is of great concern because of its high addiction potential, cognitive impairment effects and other adverse consequences (e g hormonal and Immune system effects hyperalgesia and overdose). Due to the combination of drugs used by those who are NMPO users it is difficult to isolate the negative effects of NMPO use from the effects of other legal and illicit drugs. Based on a stage model of substance use this study tested whether NMPO use represents a unique form of illicit drug use among emerging adults and whether there are unique consequences of early NMPO use We used longitudinal data from 912 emerging adults from the Raising Healthy Children study who were interviewed at least annually from the first or second grade through age 21. The findings indicated that almost all NMPO users have also used marijuana and a large majority has also used other drugs such as cocaine and ecstasy In addition more frequent users of NMPOs are also more frequent users of other drugs. Except for violent behavior NMPO use explained little unique variance in negative outcomes of use (e g drug use disorder mood disorder nonproductive behavior poor health and property crime) beyond that explained by other illicit drug use. Future studies examining the predictors or consequences of NMPO use and nonmedical use of other prescription drugs need to consider use within the context of other drug use.

Cavanaugh CE; Floyd LJ; Penniman TV; Hulbert A; Gaydos C; Latimer WW. Examining racial/ethnic disparities in sexually transmitted diseases among recent heroin-using and cocaine-using women. Journal of Women's Health 20(2): 197-205, 2011. (42 refs.)

Background: This study examined racial differences in the prevalence of sexual risk behaviors and their associations with sexually transmitted diseases (STDs) among recent heroin-using and cocaine-using women. Methods: Participants were 214 women (59% black, 41% white) who were recruited during 2002-2010 using targeted sampling to participate in a study in Baltimore, Maryland, and reported using heroin, cocaine, or crack during the previous 6 months. Participants completed self-report questionnaires about their drug use, sexual risk behaviors, and lifetime history of one of six STDs, including gonorrhea, syphilis, chlamydia, genital herpes, genital warts, or trichomoniasis. Results: More black women (50%) than white women (28%) reported a lifetime STD. Although there were no racial differences in the lifetime prevalence of sexual risk behaviors assessed, there were racial differences in the sexual behaviors associated with ever having a lifetime STD. Simple logistic regressions revealed that ever having a casual sex partner or anal sex were correlates of having a lifetime STD among black women but not among white women. Multiple logistic regression analyses revealed that ever having a casual sex partner was significantly associated with having a lifetime STD among black women, and ever trading sex for money was significantly associated with having a lifetime STD among white women. Conclusions: Findings are consistent with national studies and elucidate racial disparities in STDs and associated sexual behaviors among recent heroin-using and cocaine-using women. Findings underscore the need to tailor STD prevention interventions differently for black and white recent heroin-using and cocaine-using women.

Chan G; Gelernter J; Oslin D; Farrer L; Kranzler HR. Empirically derived subtypes of opioid use and related behaviors. Addiction 106(6): 1146- 1154, 2011. (37 refs.)

Aims: To identify and validate homogeneous subtypes of opioid use and related behaviors. Design: Family-based and case-control genetic studies of opioid and/or cocaine dependence. Settings: Clinical and general community samples from Connecticut, Massachusetts, Pennsylvania and South Carolina. Participants: A total of 4061 individuals (2003 individuals from 835 families and 2058 unrelated individuals) recruited to participate in genetic studies. Measurements: The computer-assisted Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) was used to assess participants' demographics, medical history, substance use behaviors and disorders and other psychiatric disorders. Findings: Five homogeneous subtypes were identified, which differed on opioid-related measures, demographics and prevalence rates of substance use and psychiatric disorders. Heritability estimates for the two most severely affected subtypes exceeded 0.60. Conclusions: An empirical approach based on opioid use and related behaviors can yield homogeneous subtypes that could be of value in gene finding for opioid dependence.

Chang AM; Walsh KM; Shofer FS; McCusker CM; Litt HI; Hollander JE. Relationship between cocaine use and coronary artery disease in patients with symptoms consistent with an acute coronary syndrome. Academic Emergency Medicine 18(1): 1-9, 2011. (44 refs.)

P>Objectives: Observational studies of patients with cocaine-associated myocardial infarction have suggested more coronary disease than expected on the basis of patient age. The study objective was to determine whether cocaine use is associated with coronary disease in low- to intermediate-risk emergency department (ED) patients with potential acute coronary syndrome (ACS). Methods: The authors conducted a cross-sectional study of low- to intermediate-risk patients < 60 years of age who received coronary computerized tomographic angiography (CTA) for evaluation of coronary artery disease (CAD) in the ED. Patients were classified into three groups with respect to CAD: maximal stenosis < 25%, 25% to 49%, and >= 50%. Prespecified multivariate modeling (generalized estimating equations) was used to assess relationship between cocaine and CAD. Results: Of 912 enrolled patients, 157 (17%) used cocaine. A total of 231 patients had CAD >= 25%; 111 had CAD >= 50%. In univariate analysis, cocaine use was not associated with a lesion 25% or greater (12% vs. 14%; relative risk [RR] = 0.89, 95% confidence interval [CI] = 0.5 to 1.4) or 50% or greater (12% vs. 11%; RR = 1.15, 95% CI = 0.6 to 2.3). In multivariate modeling adjusting for age, race, sex, cardiac risk factors, and Thrombosis in Myocardial Infarction (TIMI) score, cocaine use was not associated with the presence of any coronary lesion (adjusted RR = 0.95, 95% CI = 0.69 to 1.31) or coronary lesions 50% or greater (adjusted RR = 0.78, 95% CI = 0.45 to 1.38). There was also no relationship between repetitive cocaine use and coronary calcifications or between recent cocaine use and CAD. Conclusions: In symptomatic ED patients at low to intermediate risk of an ACS, cocaine use was not associated with an increased likelihood of coronary disease after adjustment for age, race, sex, and other risk factors for coronary disease.

Childs K; Dembo R; Belenko S; Wareham J; Schmeidler J. A comparison of individual-level and community-level predictors of marijuana and cocaine use among a sample of newly arrested juvenile offenders. Journal of Child & Adolescent Substance Abuse 20(2): 114-134, 2011. (73 refs.)

Variations in drug use have been found across individual-level factors and community characteristics, and by type of drug used. Relatively little research, however, has examined this variation among juvenile offenders. Based on a sample of 924 newly arrested juvenile offenders, two multilevel logistic regression models predicting marijuana test result and cocaine test result were separately examined. The results highlighted a strong association between individual-level socio-demographic characteristics, most notably age and seriousness of arrest charge, and drug use. Residential stability was related to cocaine use, yet none of the community variables were related to marijuana use. These findings suggest that different risk factors are related to adolescent marijuana and cocaine use. The research implications of the findings are discussed.

Ciccarone D. Stimulant abuse: Pharmacology, cocaine, methamphetamine, treatment, attempts at pharmacotherapy. Primary Care 38(1): 41+, 2011. (146 refs.)

The high prevalence of stimulant abuse and its harmful consequences make the screening, diagnosis, and referral for treatment of persons with stimulant abuse a top concern for primary care providers. Having a working knowledge of use patterns, clinical symptomatology, end-organ effects, and advances in treatment of stimulant abuse is essential. Although cocaine and amphetamine have different use patterns, duration of action, and so forth, the consequences of use are remarkably similar. Primary care is at the forefront of screening, brief risk reduction interventions, and diagnosis of medical sequelae, with referral to addiction specialist treatment when necessary.

Cole C; Jones L; McVeigh J; Kicman A; Syed Q; Bellis M. Adulterants in illicit drugs: A review of empirical evidence. (review). Drug Testing and Analysis 3(2): 89-96, 2011. (90 refs.)

Widespread public perception is that illicit drugs contain substances that are a serious risk to health, even though adulterants are often not considered in clinical or forensic toxicology. This review attempts to present an evidence-based overview of adulterants in illicit drugs, and their associated toxicity. Adulterants are deliberately added to increase bulk, enhance or mimic a pharmacological effect, or to facilitate drug delivery. Those present unintentionally are as a result of poor manufacturing techniques. From the reports gathered, adulterants are predominantly substances which are readily available, commonly being caffeine, procaine, paracetamol, and sugars. These are likely to have minimal impact on users' health at low dosages. Other adulterants, particularly in injectable drugs, have the potential to cause serious health issues, but the quantities reported, such as strychnine in heroin, are not life-threatening. The most commonly identified bacterial contaminants identified are Bacillus and Clostridium species. When death or serious illness due to adulteration occurs, circulation of information is particularly vital, such as in the USA regarding heroin and cocaine adulterated with fentanyl, and in Scotland recently regarding anthrax contaminated heroin. The complex interactions of supply, demand, and control of illicit drugs have a tangible impact on their adulteration. Continuing vigilance and the circulation of information is, therefore, desirable as a public health issue. As part of that strategy, analyses performed for adulterants needs to be encouraged, which are considerably limited in number and scope at the moment.

Copenhaver MM; Lee IC; Margolin A; Bruce RD; Altice FL. Testing an optimized community-based human immunodeficiency virus (HIV) risk reduction and antiretroviral adherence intervention for HIV-infected injection drug users. Substance Abuse 32(1): 16-26, 2011. (23 refs.)

The authors conducted a preliminary study of the 4-session Holistic Health for HIV (3H+), which was adapted from a 12-session evidence-based risk reduction and antiretroviral adherence intervention. Improvements were found in the behavioral skills required to properly adhere to HIV medication regimens. Enhancements were found in all measured aspects of sex-risk reduction outcomes, including HIV knowledge, motivation to reduce sex-risk behavior, behavioral skills related to engaging in reduced sexual risk, and reduced risk behavior. Improvements in drug use outcomes included enhancements in risk reduction skills as well as reduced heroin and cocaine use. Intervention effects also showed durability from post-intervention to the follow-up assessment point. Females responded particularly well in terms of improvements in risk reduction skills and risk behavior. This study suggests that an evidence-based behavioral intervention may be successfully adapted for use in community-based clinical settings where HIV-infected drug users can be more efficiently reached.

Cunha PJ; Bechara A; de Andrade AG; Nicastri S. Decision-making deficits linked to real-life social dysfunction in crack cocaine-dependent individuals. American Journal on Addictions 20(1): 78-86, 2011. (60 refs.)

Crack cocaine-dependent individuals (CCDI) present abnormalities in both social adjustment and decision making, but few studies have examined this association. This study investigated cognitive and social performance of 30 subjects (CCDI x controls); CCDI were abstinent for 2 weeks. We used the Social Adjustment Scale (SAS), Wisconsin Card Sorting Test (WCST), and Iowa Gambling Task (IGT). Disadvantageous choices on the IGT were associated with higher levels of social dysfunction in CCDI, suggesting the ecological validity of the IGT. Social dysfunction and decision making may be linked to the same underlying prefrontal dysfunction, but the nature of this association should be further investigated.

Curcio F; Villano G; Masucci S; Plenzik M; Veneruso C; De Rosa G. Epidemiological survey of Hepatitis C virus infection in a cohort of patients from a ser.t in Naples, Italy. Journal of Addiction Medicine 5(1): 43-49, 2011. (28 refs.)

Hepatitis C virus (HCV) has infected an estimated 170 million people worldwide, most of whom are chronically infected (60% to 80%). In Italy, the estimate of anti-HCV antibody (Ab) prevalence, in the general population of Northern Italy, is 3.2%; in Central and Southern Italy, it is 8.4% to 22.4%. Highest prevalence of infection (70% to 90%) is found among intravenous drug users. Our purpose is to monitor HCV infection among drug users treated in a Drug Addiction Centre (Ser.T) in Naples and to gain a better understanding of that relationship with the abused substance(s). Epidemiological data are shown for viral coinfections. Finally, the authors investigate access to specific HCV therapy in an Italian Ser.T. The study analyzed a group of 1753 consecutive subjects treated from 1988 to 2008 in the O.U. Ser. T D. S. 31 (Gesu e Maria Hospital), ASL Napoli 1 Centre. HCV Abs were detected by enzyme immune assay method and confirmed by recombinant immunoblot assay III method. During the entire period, we performed real-time polymerase chain reaction at random for 312 patients. The incidence (per year) of HCV infection showed a rapid spread decrease from 49.5% in 2003 to 14.5% in 2008. The overall prevalence of HCV was 48.1%. We tested 312 randomly selected patients for viral replication. Our study showed active viral replication in 201 (64.4%) patients as follows: 97 of 201 (31.1%) resulted infected by genotype (gt) 1; 3 of 201 (1.0%) gt 2; 84 of 201 (26.9%) gt 3; and 4 of 201 (1.3%) gt 4. Coinfection data showed that HCV Ab prevalence was 58.5% (48 of 82) in hepatitis B virus chronically infected patients. Human immunodeficiency virus (HIV)/HCV coinfection resulted in 95.2% (80 of 84) HIV patients. The prevalence of HIV Abs in HCV-infected patients was 8.99% (80 of 889). Analysis of drug abuse showed high prevalence of opiate addicted, multiabusers, and with high-risk factors. Cocaine abuser prevalence was 14.4%, and incidence, during past 4 years of the study, rose to 42.6%. Alcohol abuser prevalence represented 5.8% of patients and incidence rose to 17.7% in final 4 years of the study. In those opiate addicted, HCV infection was 61.0% (805 of 1320). HCV infection in cocaine-addicted patients was 9.5% (24 of 253). In 78 delta-9-tetra-hydrocannabinol addicted patients, 5.1% of tests were positive (4 of 78). In alcohol abusers, HCV infection was 9.8% (10 of 102). Access to HCV treatment in our cohort from 2000 to 2008 resulted low (15.4%). Enhancing the Ser.Ts efficiency can result in health and financial benefits.

de los Cobos JP; Sinol N; Trujols J; Banuls E; Batlle F; Tejero A. Drug-dependent inpatients reporting continuous absence of spontaneous drug craving for the main substance throughout detoxification treatment. Drug and Alcohol Review 30(4): 403-410, 2011. (43 refs.)

Introduction and Aims. Drug craving is considered to be an essential component of substance dependence. We aimed to characterise drug-dependent inpatients reporting continuous absence of subjective spontaneous drug craving. Design and Methods. This is a 3 year chart-review study designed to compare drug-dependent inpatients who did not report craving everyday (non-cravers) and their counterparts who did (cravers). All participants were recruited consecutively and completed a 14 day detoxification treatment. Craving was defined as a desire to use the main detoxification substance. This substance was chosen by patients, who completed a craving visual analogue scale, the Beck Depression Inventory and the State-Trait Anxiety Inventory daily. The Temperament and Character Inventory and the Addiction Severity Index were also used. Results. Of the 195 patients who completed the detoxification treatment, 45 (23.1%) were non-cravers and 32 (16.4%) were cravers. The main detoxification substances were alcohol, benzodiazepines, cannabis, cocaine, heroin and methadone. Non-cravers named methadone as the main detoxification substance more frequently than cravers, and benzoylecgonine was less frequently present in their urine at treatment entry. A decreased score on the Temperament and Character Inventory dimension of harm avoidance (i.e. trait anxiety) was the only independent predictor of absence of craving (odds ratio = 1.16, 95% confidence interval = 1.03-1.31). During admission, non-cravers had lower Beck Depression Inventory and State-Trait Anxiety Inventory scores than cravers. These differences were not accounted for by pharmacological treatment. Discussion and Conclusions. Drug-dependent inpatients who report absence of craving are characterised by relatively low levels of depression and anxiety throughout detoxification treatment, and relatively low levels of trait anxiety.

de los Cobos JP; Sinol N; Puerta C; Cantillano V; Zurita CL; Trujols J. Features and prevalence of patients with probable adult attention deficit hyperactivity disorder who request treatment for cocaine use disorders. Psychiatry Research 185(1-2): 205-210, 2011. (44 refs.)

To characterize those patients with probable adult attention deficit hyperactivity disorder (ADHD) who ask for treatment of cocaine use disorders; to estimate the prevalence of probable adult ADHD among these patients. This is a cross-sectional and multi-center study performed at outpatient resources of 12 addiction treatment centers in Spain. Participants were treatment-seeking primary cocaine abusers recruited consecutively at one center and through convenience sampling at the other centers. Assessments included semi-structured clinical interview focused on Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) ADHD criteria adapted to adulthood, and the Wender-Utah Rating Scale (WURS) for screening childhood history of ADHD according to patients. Probable adult ADHD was diagnosed when patients met DSM-IV criteria of ADHD in adulthood and scored WURS > 32. All participants were diagnosed with current cocaine dependence (n = 190) or abuse (n = 15). Patients with probable adult ADHD, compared with patients having no lifetime ADHD, were more frequently male, reported higher impulsivity, and began to use nicotine, alcohol, cannabis, or cocaine earlier. Before starting the current treatment, patients with probable adult ADHD also showed higher cocaine craving for the previous day, less frequent cocaine abstinence throughout the previous week, and higher use of cocaine and tobacco during the previous month. Impulsivity and male gender were the only independent risk factors of probable adult ADHD in a logistic regression analysis. The prevalence of probable adult ADHD was 20.5% in the sub-sample of patients consecutively recruited (n = 78). A diagnosis of probable adult ADHD strongly distinguishes among treatment-seeking cocaine primary abusers regarding past and current key aspects of their addictive disorder; one-fifth of these patients present with probable adult ADHD.

DeBeck K; Buxton J; Kerr T; Qi JZ; Montaner J; Wood E. Public crack cocaine smoking and willingness to use a supervised inhalation facility: Implications for street disorder. Substance Abuse Treatment Prevention and Policy 6: article 4, 2011. (44 refs.)

Background: The health risks of crack cocaine smoking in public settings have not been well described. We sought to identify factors associated with public crack smoking, and assess the potential for a supervised inhalation facility to reduce engagement in this behavior, in a setting planning to evaluate a medically supervised crack cocaine smoking facility. Methods: Data for this study were derived from a Canadian prospective cohort of injection drug users. Using multivariate logistic regression we identified factors associated with smoking crack cocaine in public areas. Among public crack smokers we then identified factors associated with willingness to use a supervised inhalation facility. Results: Among our sample of 623 people who reported crack smoking, 61% reported recently using in public locations. In multivariate analysis, factors independently associated with public crack smoking included: daily crack cocaine smoking; daily heroin injection; having encounters with police; and engaging in drug dealing. In sub analysis, 71% of public crack smokers reported willingness to use a supervised inhalation facility. Factors independently associated with willingness include: female gender, engaging in risky pipe sharing; and having encounters with police. Conclusion: We found a high prevalence of public crack smoking locally, and this behavior was independently associated with encounters with police. However, a majority of public crack smokers reported being willing to use a supervised inhalation facility, and individuals who had recent encounters with police were more likely to report willingness. These findings suggest that supervised inhalation facilities offer potential to reduce street-disorder and reduce encounters with police.

Degenhardt L; Singleton J; Calabria B; McLaren J; Kerr T; Mehta S et al. Mortality among cocaine users: A systematic review of cohort studies. (review). Drug and Alcohol Dependence 113(2-3): 88-95, 2011. (37 refs.)

Aims: To conduct a systematic review of mortality among cohort studies of cocaine users. Methods: Three electronic databases were searched (EMBASE, Medline and PsychINFO); other online databases were searched using online libraries and repositories of reports and literature in the drug and alcohol field, with requested contributions from trained librarians and experts. Searches and extraction were undertaken using protocols and cross-checking of decisions by two authors. Additional data were requested from study investigators where studies did not report relevant data. Results: 1911 articles and 2 reports were identified from searches, with data from another four studies located from review articles. Seven cohorts of "problem" or dependent cocaine users reported data that permitted mortality rates to be estimated. Crude mortality rates ranged from 0.53 (95% CI: 0.10-1.58) to 6.16 (95% CI: 5.21-7.11) per 100PY. Standardised mortality ratios (SMRs) reported in four studies suggested that mortality was four to eight times higher among cocaine users than age and sex peers in the general population. Conclusions: There are limited data on the extent of elevated mortality among problematic or dependent cocaine users and it is unclear how generalisable the results of these studies may be to other populations of problematic cocaine users. Greater attention to both the method of recruitment, and the characteristics of cocaine users, would enhance our understanding of the mortality risks of problematic cocaine use.

Demarie D; Marletta G; Imazio M; Cappa C; Ferro S; Compostino R et al. Cardiovascular-associated disease in an addicted population: An observation study. Journal of Cardiovascular Medicine 12(1): 51-54, 2011. (16 refs.)

Background: Illicit drugs such as cocaine, and methadone can induce acquired long QT syndrome. Objective: The aim of this study was to evaluate the prevalence of cardiovascular disease and to assess the risk of torsades de pointes in substance abuse patients either with methadone or buprenorphine maintenance therapy, or without any specific therapy for opiate addiction. Methods: From November 2008 to December 2009, 190 patients (153 men, mean age 38.2 years, 22-56 years) with a substance use disorder according to DSM IV TR criteria were included in the study. All patients underwent blood tests, serial electrocardiogram (ECG) and, when necessary, additional testing, including echocardiogram, exercise test and Holter monitoring. Age and sex-matched healthy controls were also evaluated and compared with the cases. Results: One hundred and twenty-five patients (65.7%) had associated diseases. The prevalence of coronary artery disease and hypertension was, respectively, 2.1 and 5.2% in the addicted population. The percentage of abnormal ECGs was 34.2% in the addicted population and 4.7% in the nonaddicted population (P<0.001). Twenty-five addicted patients had a QT interval prolongation (10 patients >= 480 ms). There were no sudden deaths or major cardiac events during the observation period. Conclusions: Our results indicate that the QT interval prolongation is not a negative prognostic marker in the addicted population, even with associated diseases. ECG should be performed when other drugs potentially prolonging QT interval are associated. Substance abuse patients should be followed by multidisciplinary teams, and blood tests and ECGs should be performed regularly.

Dowse MS; Shaw S; Cridge C; Smerdon G. The use of drugs by UK recreational divers: Illicit drugs. Diving and Hyperbaric Medicine 41(1): 9-15, 2011. (24 refs.)

Aims: Anecdotal observations suggest the use of illicit drugs takes place amongst recreational divers but, to date, there has been little open debate within the diving community concerning possible prevalence. This study investigated the prevalence and type of illicit drugs used by recreational divers in the United Kingdom (UK). Methods: Anonymous questionnaires were circulated via UK dive clubs, dive schools, dive shows and conferences. Questions incorporated diver and diving demographics and general health, which included anxiety, depression and panic attacks, alcohol use, smoking and illicit drug use since learning to dive and closest time to a dive. Questions pertaining to over-the-counter and prescription drug use were also asked. Results: 479 divers responded (66% males and 34% females) in the age range 16 to 59 years. Of the respondents, 22% had used one or more illicit drug since learning to dive, reporting benzodiazepines, amphetamines, cocaine, ecstasy, LSD, cannabis, heroin, and 'magic mushrooms'. Illicit drugs had been used by 3.5% of respondents in the last 12 months, and 3% in the last month. Cannabis, cocaine and ecstasy use was reported within 6 hours of a dive. Logistic regression confirmed a relationship between illicit drug use and depression (P = 0.014), and also between illicit drug use and anxiety (P = 0.024). Conclusion: These data support anecdotal reports that recreational divers use a range of illicit drugs. The significant relationship between illicit drug use and depression and anxiety supports the literature in non-diving populations.

Dunn M; Thomas JO; Swift W; Burns L. Recreational substance use among elite Australian athletes. Drug and Alcohol Review 30(1): 63-68, 2011. (29 refs.)

Introduction and Aims. The study aimed to investigate the prevalence of illicit drug use among elite Australian athletes with a focus upon cannabis, ecstasy, meth/amphetamine, cocaine, GHB and ketamine; explore perceptions concerning the extent of drug use among this group; ascertain opinions regarding specific drugs of concern; and investigate predictors of recent drug use. Design and Methods. Data were taken from surveys with 974 elite athletes. Results. One-third of the sample had been offered or had the opportunity to use illicit drugs in the past year; despite this, the self-reported prevalence of all six drugs under investigation was lower than that reported by the general population. Sixteen per cent of athletes believed that there was a drug of concern in their sport, with ecstasy, cocaine and alcohol being nominated. Knowing other athletes who use illicit drugs, being offered or having the opportunity to use drugs and identifying as a 'full-time athlete' were significant predictors of recent drug use. Discussion and Conclusions. The present study found that one-third of the athlete sample had been offered or had the opportunity to use illicit drugs in the past year; despite this, there was low self-reported drug use. Despite media discussion regarding alcohol use in sport, alcohol was nominated as a drug of concern only by a small proportion of athletes, and further research investigating this issue may be warranted.

Dunning JP; Parvaz MA; Hajcak G; Maloney T; Alia-Klein N; Woicik PA et al. Motivated attention to cocaine and emotional cues in abstinent and current cocaine users: An ERP study. European Journal of Neuroscience 33(9): 1716- 1723, 2011. (41 refs.)

Event-related potentials (ERPs) are a direct measure of neural activity and are ideally suited to study the time-course of attentional engagement with emotional and drug-related stimuli in addiction. In particular, the late positive potential (LPP) appears to be enhanced following cocaine-related compared with neutral stimuli in human participants with cocaine use disorders (CUD). However, previous studies have not directly compared cocaine-related with emotional stimuli while examining potential differences between abstinent and current cocaine users. The present study examined ERPs in 55 CUD (27 abstinent and 28 current users) and 29 matched healthy controls while they passively viewed pleasant, unpleasant, neutral and cocaine-related pictures. To examine the time-course of attention to these stimuli, we analysed both an early and later window in the LPP as well as the early posterior negativity (EPN), established in assessing motivated attention. Cocaine pictures elicited increased electrocortical measures of motivated attention in ways similar to affectively pleasant and unpleasant pictures in all CUD, an effect that was no longer discernible during the late LPP window for the current users. This group also exhibited deficient processing of the other emotional stimuli (early LPP window - pleasant pictures; late LPP window - pleasant and unpleasant pictures). Results were unique to the LPP and not EPN. Taken together, results support a relatively early attention bias to cocaine stimuli in cocaine-addicted individuals, further suggesting that recent cocaine use decreases such attention bias during later stages of processing but at the expense of deficient processing of other emotional stimuli.

Eiden RD; Granger DA; Schuetze P; Veira Y. Child behavior problems among cocaine-exposed toddlers: Indirect and interactive effects. Development and Psychopathology 23(2): 539- 550, 2011. (71 refs.)

This study examined the role of maternal psychopathology and maternal warmth as mediators of the association between prenatal cocaine and other substance exposure and toddler behavior problems. It was also hypothesized that infant cortisol reactivity and environmental risk may moderate these associations. Participants were 220 caregiver-infant dyads (119 cocaine exposed, 101 not cocaine exposed; 49% boys). Mother-infant dyads were recruited at delivery with assessments at 4-8 weeks and 7, 13, and 18 months of child ages. Results yielded no direct associations between prenatal cocaine/other substance exposure and toddler behavior problems, but significant indirect associations between prenatal cigarette/alcohol exposure and toddler behavior problems at 18 months. With regard to moderation, results indicated an indirect association between prenatal cocaine exposure and toddler behavior problems via lower maternal warmth for children with higher, but not lower, cortisol reactivity at 7 months. Results suggest potential pathways to toddler behavior problems among children at high biological risk.

Eiden RD; Schuetze P; Colder CR; Veira Y. Maternal cocaine use and mother-toddler aggression. Neurotoxicology and Teratology 33(3): 360-369, 2011. (84 refs.)

This study examined the direct and indirect associations between maternal cocaine use during pregnancy and mother-toddler aggression in an interactive context at 2 years of child age. We hypothesized that in addition to direct effects of cocaine exposure on maternal and child aggression, the association between maternal cocaine use and mother-toddler aggression may be indirect via higher maternal psychiatric symptoms, negative affect, or poor infant autonomic regulation at 13 months. Participants consisted of 220 (119 cocaine exposed, 101 non-cocaine exposed) mother-toddler dyads participating in an ongoing longitudinal study of prenatal cocaine exposure. Results indicated that mothers who used cocaine during pregnancy displayed higher levels of aggression toward their toddlers compared to mothers in the control group. Results from model testing indicated significant indirect associations between maternal cocaine use and maternal aggression via higher maternal negative affect as well as lower infant autonomic regulation at 13 months. Although there were no direct associations between cocaine exposure and toddler aggression, there was a significant indirect effect via lower infant autonomic regulation at 13 months. Results highlight the importance of including maternal aggression in predictive models of prenatal cocaine exposure examining child aggression. Results also emphasize the important role of infant regulation as a mechanism partially explaining associations between cocaine exposure and mother-toddler aggression.

Ersche KD; Barnes A; Jones PS; Morein-Zamir S; Robbins TW; Bullmore ET. Abnormal structure of frontostriatal brain systems is associated with aspects of impulsivity and compulsivity in cocaine dependence. Brain 134(Part 7): 2013-2024, 2011. (96 refs.)

A growing body of preclinical evidence indicates that addiction to cocaine is associated with neuroadaptive changes in frontostriatal brain systems. Human studies in cocaine-dependent individuals have shown alterations in brain structure, but it is less clear how these changes may be related to the clinical phenotype of cocaine dependence characterized by impulsive behaviours and compulsive drug-taking. Here we compared self-report, behavioural and structural magnetic resonance imaging data on a relatively large sample of cocaine-dependent individuals (n = 60) with data on healthy volunteers (n = 60); and we investigated the relationships between grey matter volume variation, duration of cocaine use, and measures of impulsivity and compulsivity in the cocaine-dependent group. Cocaine dependence was associated with an extensive system of abnormally decreased grey matter volume in orbitofrontal, cingulate, insular, temporoparietal and cerebellar cortex, and with a more localized increase in grey matter volume in the basal ganglia. Greater duration of cocaine dependence was correlated with greater grey matter volume reduction in orbitofrontal, cingulate and insular cortex. Greater impairment of attentional control was associated with reduced volume in insular cortex and increased volume of caudate nucleus. Greater compulsivity of drug use was associated with reduced volume in orbitofrontal cortex. Cocaine-dependent individuals had abnormal structure of corticostriatal systems, and variability in the extent of anatomical changes in orbitofrontal, insular and striatal structures was related to individual differences in duration of dependence, inattention and compulsivity of cocaine consumption.

Esseiva P; Gaste L; Alvarez D; Anglada F. Illicit drug profiling, reflection on statistical comparisons. Forensic Science International 207(1-3): 27-34, 2011. (16 refs.)

This paper presents reflexions about statistical considerations on illicit drug profiling and more specifically about the calculation of threshold for determining of the seizure are linked or not. The specific case of heroin and cocaine profiling is presented with the necessary details on the target profiling variables (major alkaloids) selected and the analytical method used. Statistical approach to compare illicit drug seizures is also presented with the introduction of different scenarios dealing with different data pre-treatment or transformation of variables. The main aim consists to demonstrate the influence of data pre-treatment on the statistical outputs. A thorough study of the evolution of the true positive rate (TP) and the false positive rate (FP) in heroin and cocaine comparison is then proposed to investigate this specific topic and to demonstrate that there is no universal approach available and that the calculations have to be revaluate for each new specific application.

Fortney JC; Tripathi SP; Walton MA; Cunningham RM; Booth BM. Patterns of substance abuse treatment seeking following cocaine-related emergency department visits. Journal of Behavioral Health Services & Research 38(2): 221-233, 2011. (45 refs.)

Chest pain is the most common medical complaint among cocaine-using emergency department (ED) patients. Correlates of substance abuse treatment seeking were examined using 3-month post-discharge surveys from 170 ED patients admitted with cocaine-related chest pain. Four treatment categories were specified as the dependent variable in an ordered logistic regression: no treatment (74.7%), informal treatment only (7.1%), formal treatment only (5.9%), and both formal and informal treatment (12.4%). The following variables were found to be positively associated with a higher treatment category: frequency of cocaine use (OR = 1.07, CI95 = 1.01-1.15, p = 0.03), global severity index (OR = 2.26, CI95 = 1.04-4.90, p = 0.04), number of endorsed stigma barriers (OR = 4.40, CI95 = 1.41-13.78, p = 0.01), interpersonal consequences (OR = 1.41, CI95 = 1.01-1.88, p = 0.02), and pre-baseline informal treatment (OR = 6.69, CI95 = 1.58-28.36, p = 0.01). Physical consequences were found to be negatively associated with a higher treatment category (OR = 0.63, CI95 = 0.47-0.85, p < 0.01). ED visits for cocaine-related chest pain represent missed opportunities to link patients to substance abuse treatment, and interventions are needed to motivate patients to seek care.

Fox HC; Bergquist KL; Casey J; Hong KA; Sinha R. Selective cocaine-related difficulties in emotional intelligence: Relationship to stress and impulse control. American Journal on Addictions 20(2): 151-160, 2011. (30 refs.)

Emotional Intelligence (EI) comprises the ability to perceive, use, understand, and regulate emotions and may potentially contribute to variability in risk-related factors such as stress perception and impulse control in cocaine dependent individuals. The main objective of the current study is to better define EI in cocaine dependent individuals compared with healthy controls, using the Mayer, Salovey, and Caruso Emotional Intelligence Test (MSCEIT). Secondary analysis investigates the association between EI, IQ factors, perceived stress, and impulse control in both populations. Seventy-two abstinent treatment-seeking cocaine patients and 52 healthy controls were administered the MSCEIT as well as measures of IQ, perceived stress, and impulse control. Findings showed that cocaine dependent participants demonstrated highly selective EI difficulties compared with healthy controls, specifically with regard to higher-level emotional reasoning including the understanding, management, and regulation of emotion. These EI problems were associated with increased perceived stress and impulse control difficulties. IQ was significantly associated with all MSCEIT measures in the cocaine dependent participants, but not controls. Findings indicate that specific aspects of EI may be of clinical importance to cocaine dependent populations, impacting relapse-related factors such as stress dysregulation and impulse control.

Fucci N. Maybe a new killer in illicit cocaine. Forensic Science International 209(1-3): E23-E25, 2011. (10 refs.)

This is the study of the author that refers about a case of a 46 years old man found dead inside his house, the death was related to cocaine intake. The police found the corpse laying in his bed with a sheet of newspaper rolled up and a few plastic coverings containing trace of cocaine on the desk. Toxicologyogical analysis was performed and drug levels measured by means of gas chromatography/mass spectrometry technology. Based on the autopsy findings and toxicological results the cause of death was related to an acute intoxication due to cocaine "overdose". In addition to the presence of cocaine and smaller alkaloids, in the sheet made of newspaper rolled up and eluted of the nasal mucosas has been highlighted the presence of 2,6-disopropylnaphtalene (2,6-DIPN), a fungicidal pesticide very health hazard for human. A very easy, simple and selective gas chromatography mass spectrometry method was employed for the detection of 2,6-DIPN in the cocaine powder.

Garcia-Fernandez G; Secades-Villa R; Garcia-Rodriguez O; Alvarez-Lopez H; Sanchez-Hervas E; Fernandez-Hermida JR et al. Individual characteristics and response to contingency management treatment for cocaine addiction. Psicothema 23(1): 114-118, 2011. (39 refs.)

Voucher-based contingency management (CM) research has demonstrated efficacy for treating cocaine addiction, but few studies have examined associations between individual baseline characteristics and response to CM treatments. The aim of this study, involving 50 cocaine outpatients receiving CM for cocaine addiction, was to assess the impact of baseline characteristics on abstinence outcomes after six months of treatment. Patients who were abstinent after six months of treatment accounted for 58% of the sample. Patients with higher scores on the Alcohol area of the EuropASI and patients that were non-abstinent during the first month of treatment were less likely to achieve abstinence. These outcome predictors have implications both for treatment research and for clinical practice. Patients who do not respond early to treatment may need a more intensive intervention, and concomitant problematic alcohol use should be detected and treated. The remaining baseline variables examined were not statistically significant predictors of abstinence. This finding is important for the generalizability of CM across the range of individual characteristics of treatment-seeking cocaine abusers.

Garcia-Fernandez G; Secades-Villa R; Garcia-Rodriguez O; Alvarez-Lopez H; Fernandez-Hermida JR; Fernandez-Artamendi S et al. Long-term benefits of adding incentives to the Community Reinforcement Approach for cocaine dependence. European Addiction Research 17(3): 139- 145, 2011. (40 refs.)

Background: The community reinforcement approach (CRA) with vouchers is a well-established program developed for the treatment of cocaine addiction. It involves an incentive program in which patients earn vouchers that can be exchanged for goods or services contingent upon abstinence from cocaine use. Aim: To examine the contributions of incentives to retention, abstinence, and psychosocial outcomes in the CRA + vouchers program at the 12-month follow-up. Methods: 58 cocaine addicts were randomly assigned to CRA treatment with or without an added incentive program in a community setting for cocaine dependence in Spain. Results: 65.5% of patients in the group with vouchers completed 12 months of treatment, versus 48.3% in the novoucher group. In the CRA + vouchers group, mean percentage of cocaine-negative samples was 95.76%, versus 79.31% in the group without vouchers. There were significant improvements in psychosocial functioning in both treatments, but when differences were observed, they supported CRA with vouchers over CRA alone. Conclusion: Combining CRA with incentives improves treatment outcomes in cocaine-dependent outpatients. Additive benefits of vouchers remain 6 months after the incentive program ends.

Gjerde H; Normann PT; Christophersen AS; Samuelsen SO; Morland J. Alcohol, psychoactive drugs and fatal road traffic accidents in Norway: A case-control study. Accident Analysis and Prevention 43(3): 1197-1203, 2011. (50 refs.)

A case-control study was conducted on 204 drivers fatally injured in road traffic accidents in southeastern Norway during the period 2003-2008. Cases from single vehicle accidents (N = 68) were assessed separately. As controls, 10 540 drivers selected in a roadside survey in the same geographical area during 2005-2006 were used. Blood samples were collected from the cases and oral fluid (saliva) samples from the controls. Samples were analysed for alcohol, amphetamines, cannabis, cocaine, opioid analgesics, hypnotics, sedatives and a muscle relaxant; altogether 22 psychoactive substances. Equivalent cutoff concentrations for blood and oral fluid were used. The risk for fatal injury in a road traffic accident was estimated using logistic regression adjusting for gender, age, season of the year, and time of the week. The odds for involvement in fatal road traffic accidents for different substances or combination of substances were in increasing order: single drug < multiple drugs < alcohol only < alcohol + drugs. For single substance use: medicinal drug or THC < amphetamine/methamphetamine < alcohol. For most substances, higher ORs were found when studying drivers involved in single vehicle accidents than for those involved in multiple vehicle accidents, but confidence intervals were wider.

Gouin K; Murphy K; Shah PS. Effects of cocaine use during pregnancy on low birthweight and preterm birth: systematic review and metaanalyses. (review). American Journal of Obstetrics and Gynecology 204(4): article 340.e1, 2011. (44 refs.)

OBJECTIVE: To review systematically maternal antenatal cocaine exposure and adverse perinatal outcomes. STUDY DESIGN: Medline, Embase, CINAHL and secondary references in relevant studies were searched. English language studies of antenatal cocaine exposure and pregnancy outcomes published from 1966 to July 2009 were included. Metaanalyses were performed using the random effects model. RESULTS: Thirty-one studies were included. Cocaine use during pregnancy was associated with significantly higher odds of preterm birth (odds ratio [OR], 3.38; 95% confidence interval [CI], 2.72-4.21), low birthweight (OR, 3.66; 95% CI, 2.90-4.63), and small for gestational age infants (OR, 3.23; 95% CI, 2.43-4.30), as well as shorter gestational age at delivery (-1.47 week; 95% CI, -1.97 to -0.98 week) and reduced birthweight (-492 g; 95% CI, -562 to -421 g). CONCLUSION: Prenatal cocaine exposure is significantly associated with preterm birth, low birthweight, and small for gestational age infants.

Guydish J; Chan M; Bostrom A; Jessup MA; Davis TB; Marsh C. A randomized trial of probation case management for drug-involved women offenders. Crime & Delinquency 57(2): 167-198, 2011. (100 refs.)

This article reports findings from a clinical trial of a probation case management (PCM) intervention for drug-involved women offenders. Participants were randomly assigned to PCM (n = 92) or standard probation (n = 91) and followed for 12 months using measures of substance abuse, psychiatric symptoms, social support, and service utilization. Arrest data were collected from administrative data sets. The sample included mostly African American and White women (age M = 34.7, education M = 11.6 years). Cocaine and heroin were the most frequently reported drugs of abuse, 86% reported history of incarceration, and 74% had children. Women assigned to both PCM and standard probation showed clinical improvement change over time on 7 of 10 measured outcomes. However, PCM group changes were no different than those observed for the standard probation group. Higher levels of case management, drug abuse treatment, and probationary supervision may be required to achieve improved outcomes in this population.

Hadjiefthyvoulou F; Fisk JE; Montgomery C; Bridges N. Everyday and prospective memory deficits in ecstasy/polydrug users. Journal of Psychopharmacology 25(4): 453-464, 2011. (52 refs.)

The impact of ecstasy/polydrug use on real-world memory (i.e. everyday memory, cognitive failures and prospective memory [PM]) was investigated in a sample of 42 ecstasy/polydrug users and 31 non-ecstasy users. Laboratory-based PM tasks were administered along with self-reported measures of PM to test whether any ecstasy/polydrug-related impairment on the different aspects of PM was present. Self-reported measures of everyday memory and cognitive failures were also administered. Ecstasy/polydrug associated deficits were observed on both laboratory and self-reported measures of PM and everyday memory. The present study extends previous research by demonstrating that deficits in PM are real and cannot be simply attributed to self-misperceptions. The deficits observed reflect some general capacity underpinning both time-and event-based PM contexts and are not task specific. Among this group of ecstasy/polydrug users recreational use of cocaine was also prominently associated with PM deficits. Further research might explore the differential effects of individual illicit drugs on real-world memory.

Hadjiefthyvoulou F; Fisk JE; Montgomery C; Bridges N. Prospective memory functioning among ecstasy/polydrug users: Evidence from the Cambridge Prospective Memory Test (CAMPROMPT). Psychopharmacology 215(4): 761- 774, 2011. (50 refs.)

Prospective memory (PM) deficits in recreational drug users have been documented in recent years. However, the assessment of prospective memory has largely been restricted to self-reported measures that fail to capture the distinction between event-based and time-based prospective memory. The aim of the present study is to address this limitation. Extending our previous research, we augmented the range laboratory measures of prospective memory by employing the CAMPROMPT test battery to investigate the impact of illicit drug use on prospective remembering in a sample of cannabis only, ecstasy/polydrug and non-users of illicit drugs, separating event and time-based prospective memory performance. We also administered measures of executive function and retrospective memory in order to establish whether ecstasy/polydrug deficits in prospective memory were mediated by group differences in these processes. Ecstasy/polydrug users performed significantly worse on both event and time-based prospective memory tasks in comparison to both cannabis only and non-user groups. Furthermore, it was found that across the whole sample, better retrospective memory and executive functioning was associated with superior prospective memory performance. Nevertheless, this association did not mediate the drug-related effects that were observed. Consistent with our previous study, recreational use of cocaine was linked to prospective memory deficits. prospective memorP deficits have again been found among ecstasy/polydrug users, which appear to be unrelated to group differences in executive function and retrospective memory. However, the possibility that these are attributable to cocaine use cannot be excluded.

Hagan H; Perlman DC; Des Jarlais DC. Sexual risk and HIV infection among drug users in New York City: A pilot study. Substance Use & Misuse 46(2-3): 201-207, 2011. (28 refs.)

Measures of sexual health were assessed during 2008-2009 in a New York City sample of 102 injection and noninjection users of heroin, cocaine, or crack. There was considerable overlap and transitioning between crack smoking and injecting. Crack users were also significantly more likely to be gay, lesbian, or bisexual than other drug users. In multivariate analysis, HIV infection was independently associated with crack use and with being gay or bisexual. In New York City, HIV prevention for drug users has focused on syringe access, safe injection, and drug user treatment, but further progress in HIV control will require strategies to address sexual health among people who use drugs. The study's limitations are noted.

Haw CM; Hawton K. Problem drug use, drug misuse and deliberate self-harm: Trends and patient characteristics, with a focus on young people, Oxford, 1993-2006. Social Psychiatry and Psychiatric Epidemiology 46(2): 85-93, 2011. (34 refs.)

Drug misuse is related to self-harm and suicide. However, relatively little is known about deliberate self-harm (DSH) in patients with drug problems and whether drug misuse by DSH patients is increasing. We used data collected by the Oxford Monitoring System for Attempted Suicide to study the characteristics of DSH patients with drug problems who presented to the general hospital in Oxford between 1993 and 2006, and who underwent psychosocial assessment at their first presentation in the study period. We also studied trends in problem drug use and drugs misused over this period. During the 14-year study period, 11,426 patients presented of whom 9,248 underwent psychosocial assessment and it was known whether or not they had a drug problem. Problem drug use was present in 805/9,248 (8.7%) patients. Problem drug use was more common in males (13.6%) than in females (5.3%). Problem drug users were younger, more likely to be socially disadvantaged, to have a personality disorder and comorbid alcohol problems and to have a further episode of DSH within a year. Problem drug use in young females was associated with higher suicidal intent scale (SIS) scores. During the study period, problem drug use and drug misuse increased in females, but not in males. Cannabis and cocaine misuse increased with time. Provision of help for DSH patients with problem drug use is particularly challenging due to their complex social and clinical characteristics and increased risk of further self-harm, suicide and accidental death. It may require extensive liaison between different services. The increasing misuse of drugs by female DSH patients and the higher SIS scores of young females are of concern.

Hedden SL; Hulbert A; Cavanaugh CE; Parry CD; Moleko AG; Latimer WW. Alcohol, drug, and sexual risk behavior correlates of recent transactional sex among female black South African drug users. Journal of Substance Use 16(1): 57-67, 2011. (34 refs.)

Methods: In order to inform HIV interventions, drug, and sexual risk behavior correlates of recent transactional sex among a descriptive epidemiological, cross-sectional sample of 189, black South African women in Pretoria were examined using log binomial regression. Results: Prevalence of HIV seropositivity was extremely high among non-transactional sex workers (47.1%) and transactional sex workers (54.6%), albeit not significantly different. Adjusted regression results indicated that the probability of transactional sex was greater for drug using women who tested positive for cocaine use [adjusted prevalence ratio (APR) = 1.3, 95% CI = 1.1, 1.5] and knew of anyone who died of AIDS (APR = 1.5, 95% CI = 1.1, 2.1). The probability of transactional sex was lower for female drug users who reported greater education (APR = 0.6, 95% CI = 0.4, 0.8), condom use in their first sexual encounter (APR = 0.7, 95% CI = 0.6, 1.0), or reported a recent steady sexual partnership (APR = 0.8, 95% CI = 0.7, 0.9). Conclusions: Drug use-related interventions for female transactional sex workers may need to focus on methods for the reduction of not only drug use, especially cocaine use, but also the reduction of sexual risk behaviors.

Herrero MJ; Domingo-Salvany A; Brugal MT; Torrens M. Incidence of psychopathology in a cohort of young heroin and/or cocaine users. Journal of Substance Abuse Treatment 41(1): 55-63, 2011. (35 refs.)

A prospective study was carried out in Barcelona, Spain, to determine the incidence of mental disorders including substance use disorders (SUDs). From a cohort of 288 young adult (aged 18-30 years) cocaine and/or heroin users recruited in nonclinical settings, 158 were reinterviewed 18 months later using the Psychiatric Research Interview for Substance and Mental Disorders. During follow-up, 18% of subjects presented a new SUD, and nearly 11% a new non-SUD Axis 1 disorder. Incidence was highest for mood disorders (8%). Being a woman, a lower frequency of substance use at baseline, a younger age of heroin first use, and a worsening of SUD were associated with a higher likelihood of presenting a new Axis 1 disorder. Having received drug treatment ever (at baseline) or during follow-up was not associated with progress of SUD. An overall improvement in the psychiatric status of these young substance users was observed.

Hiestand BC; Smith SW. Cocaine chest pain: Between a (crack) rock and a hard place ... (editorial). Academic Emergency Medicine 18(1): 68-71, 2011. (25 refs.)

Hughes CE; Lancaster K; Spicer B. How do Australian news media depict illicit drug issues? An analysis of print media reporting across and between illicit drugs, 2003-2008. International Journal of Drug Policy 22(4): 285-291, 2011. (35 refs.)

Background: Media reporting on illicit issues has been frequently criticised for being sensationalised, biased and narrow. Yet, there have been few broad and systematic analyses of the nature of reporting. Using a large sample and methods commonly adopted in media communications analysis this paper sought to identify the dominant media portrayals used to denote illicit drugs in Australian newspapers and to compare and contrast portrayals across drug types. Methods: A retrospective content analysis of Australian print media was carried out over the period 2003-2008 from a sample comprised of 11 newspapers. Articles that contained one or more mention of five different drugs (or derivatives) were identified: cannabis, amphetamines, ecstasy, cocaine and heroin. A sub-sample of 4397 articles was selected for media content analysis (with 2045 selected for full content analysis) and a large number of text elements coded for each. Key elements included topic, explicit or implicit messages about the consequences of drugs/use and three value dimensions: overall tone, whether drugs were portrayed as a crisis issue and moral evaluations of drugs/use. Results: The dominant media portrayals depicted law enforcement or criminal justice action (55%), but most articles were reported in a neutral manner, in the absence of crisis framings. Portrayals differed between drugs, with some containing more narrow frames and more explicit moral evaluations than others. For example, heroin was disproportionately framed as a drug that will lead to legal problems. In contrast, ecstasy and cocaine were much more likely to emphasise health and social problems. Conclusion: Media reporting on illicit drugs is heavily distorted towards crime and deviance framings, but may be less overtly sensationalised, biased and narrowly framed than previously suggested. This is not to suggest there is no sensationalism or imbalance, but this appears more associated with particular drug types and episodes of heightened public concern.

Hungerbuehler I; Buecheli A; Schaub M. Drug checking: A prevention measure for a heterogeneous group with high consumption frequency and polydrug use. Evaluation of Zurich's Drug Checking services. Harm Reduction Journal 8(e-article 16), 2011. (9 refs.)

Background: The increasing party culture in Zurich presents new challenges, especially regarding the consumption of alcohol and so-called party drugs. Streetwork, the youth advisory service of the city of Zurich, has provided onsite and stationary Drug Checking facilities since 2001 and 2006, respectively. Drug Checking always involves filling out an anonymous questionnaire, which allows the collection of important information about a largely unknown group of users and their consumption patterns. Methods: The questionnaires assessed sociodemographic characteristics, consumption patterns, Drug Checking experiences, information behavior and social support. The collected data were statistically analyzed by the Research Institute for Public Health and Addiction (RIPHA). Results: The majority of Drug Checking service patrons were male and between 20 and 35 years old. These patrons reported high lifetime prevalences and high consumption frequencies of legal and illegal substances, and they often reported polydrug use. Aside from tobacco and alcohol, the most consumed drugs during typical party nights were ecstasy, amphetamines, cannabis and cocaine. Party drug consumers using Drug Checking services form a heterogeneous group with respect to sociodemographic characteristics and consumption patterns. Users of the onsite Drug Checking facilities were significantly younger, were less experienced with drug testing, and reported more polydrug use than users of the stationary Drug Checking service. Conclusions: Drug Checking combined with a consultation appears to be an important harm reduction and prevention measure that reaches a group of consumers with high consumption frequency and polydrug use. Because of the heterogeneity of the target group, different prevention measures must be offered and embedded in an overall local concept.

Ingersoll KS; Farrell-Carnahan L; Cohen-Filipic J; Heckman CJ; Ceperich SD; Hettema J et al. A pilot randomized clinical trial of two medication adherence and drug use interventions for HIV plus crack cocaine users. Drug and Alcohol Dependence 116(1-3): 177-187, 2011. (60 refs.)

Background: Crack cocaine use undermines adherence to highly active antiretroviral therapy (HAART). This pilot randomized clinical trial tested the feasibility and efficacy of 2 interventions based on the Information-Motivation-Behavioral Skill model to improve HAART adherence and reduce crack cocaine problems. Methods: Participants were 54 adults with crack cocaine use and HIV with <90% HAART adherence. Most participants were African-American (82%) heterosexual (59%), and crack cocaine dependent (92%). Average adherence was 58% in the past 2 weeks. Average viral loads (VL) were detectable (log VL 2.97). The interventions included 6 sessions of Motivational Interviewing plus feedback and skills building (M/+), or Video information plus debriefing (Video+) over 8 weeks. Primary outcomes were adherence by 14day timeline follow-back and Addiction Severity Index (ASI) Drug Composite Scores at 3 and 6 months. Repeated measure ANOVA assessed main effects of the interventions and interactions by condition. Results: Significant increases in adherence and reductions in ASI Drug Composite Scores occurred in both conditions by 3 months and were maintained at 6 months, representing medium effect sizes. No between group differences were observed. No VL changes were observed in either group. Treatment credibility, retention, and satisfaction were high and not different by condition. Conclusions: A counseling and a video intervention both improved adherence and drug problems durably among people with crack cocaine use and poor adherence in this pilot study. The interventions should be tested further among drug users with poor adherence. Video interventions may be feasible and scalable for people with HIV and drug use.

Ip EJ; Barnett MJ; Tenerowicz MJ; Perry PJ. The Anabolic 500 Survey: Characteristics of male users versus nonusers of anabolic-androgenic steroids for strength training. Pharmacotherapy 31(8): 757-766, 2011. (34 refs.)

Study Objective. To contrast the characteristics of two groups of men who participated in strength-training exercise those who reported anabolic-androgenic steroid (AAS) use versus those who reported no AAS use. Design. Analysis of data from the Anabolic 500, a cross-sectional survey. Participants. Five hundred six male self-reported AAS users (mean age 29.3 yrs) and 771 male self-reported nonusers of AAS (mean age 25.2 yrs) who completed an online survey between February 19 and June 30, 2009. Measurements and Main Results. Respondents were recruited from Internet discussion boards of 38 fitness, bodybuilding, weightlifting, and steroid Web sites. The respondents provided online informed consent and completed the Anabolic 500, a 99-item Web-based survey. Data were collected on demographics, use of AAS and other performance-enhancing agents, alcohol and illicit drug use, substance dependence disorder, other Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnoses, and history of sexual and/or physical abuse. Most (70.4%) of the AAS users were recreational exercisers who reported using an average of 11.1 performance-enhancing agents in their routine. Compared with nonusers, the AAS users were more likely to meet criteria for substance dependence disorder (23.4% vs 11.2%, p<0.001), report a diagnosis of an anxiety disorder (10.1% vs 6.1%, p=0.010), use cocaine within the past 12 months (11.3% vs 4.7%, p<0.001), and report a history of sexual abuse (6.1% vs 2.7%, p=0.005). Conclusion. Most of the AAS users in this study were recreational exercisers who practiced polypharmacy. The AAS users were more likely than nonusers to meet criteria for substance dependence disorder, report a diagnosis of an anxiety disorder, report recent cocaine use, and have a history of sexual abuse. The information uncovered in this study may help clinicians and researchers develop appropriate intervention strategies for AAS abuse.

Irvine RJ; Kostakis C; Felgate PD; Jaehne EJ; Chen C; White JM. Population drug use in Australia: A wastewater analysis. Forensic Science International 210(1-3): 69-73, 2011. (26 refs.)

Accurate information on drug use in communities is essential if health, social and economic harms associated with illicit drug use are to be addressed efficiently. In most countries population drug use is estimated indirectly via surveys, medical presentations and police and custom seizures. All of these methods have at least some problems due to bias, small samples and/or long time delays between collecting the information and analysing the results. Recently the direct quantification of drug residues in wastewater has shown promise as a means of monitoring drug use in defined geographical areas. In this study we measured 3,4-methylenedioxymethamphetamine (MDMA), methamphetamine and benzoylecgonine in sewage inflows in metropolitan and regional areas of Australia and compared these data with published European data. Cocaine use was small compared to European cities (p < 0.001) but was compensated for by much greater consumption of methamphetamine (p < 0.001) and MDMA (p < 0.05). MDMA was more popular in regional areas (p < 0.05) whereas methamphetamine and cocaine were mainly consumed in the city (p < 0.05). Greater than 5-fold increases in MDMA use were detected on weekends (p < 0.001). This approach has the potential to improve our understanding of drug use in populations and should be further developed to improve prevention and treatment programs.

Ivsins A; Roth E; Nakamura N; Krajden M; Fischer B. Uptake, benefits of and barriers to safer crack use kit (SCUK) distribution programmes in Victoria, Canada-A qualitative exploration. International Journal of Drug Policy 22(4): 292-300, 2011. (75 refs.)

Background: Crack use is prevalent amongst street drug users in Canadian cities, and associated with severe drug use, health and social problems. Whilst few targeted interventions are available for crack use, the common use and sharing of hazardous makeshift paraphernalia are a key concern, as these risks may be associated with oral injury and blood-borne virus (BBV) - e.g., hepatitis C virus (HCV) - transmission amongst users. Recently, distribution programmes of so-called 'safer crack use kits' (SCUMs) have been initiated in select Canadian cities, primarily to reduce the use of unsafe materials and paraphernalia sharing amongst crack users. This study explored uptake and benefits of, barriers to, and possible improvements to two recently implemented SCUK distribution programme in Victoria, Canada. Methods: N=31 regular crack smokers were recruited through community-based efforts between June and August 2010, and assessed via an interviewer-administered protocol involving quantitative and qualitative data items. Descriptive analyses were completed with the quantitative data, and thematic content analyses were conducted with the qualitative data in order to identify and extract prominent themes and issues. Results: The sample indicated high levels of socio-economic marginalization, poly-substance use, health problems, lengthy crack use histories and common crack paraphernalia sharing. Most participants exclusively utilized the SCUK programme including glass-stems in addition to other paraphernalia materials. Participants described: lesser need to share - or to commit property crimes to obtain resources for - crack to paraphernalia, increased health awareness, and increased personal and community safety as benefits experienced from SCUK use. Limitations in SCUK resources and distribution, shortcomings in materials, and police interference were cited as barriers to current SCUK program delivery. Conclusions: SCUM distribution in Victoria appears to result in a variety of individual and community health benefits. These benefits could be solidified by addressing current programme limitations, including better resourcing, expanding geographic distributions and eliminating police interference.

Kasperski SJ; Vincent KB; Caldeira KM; Garnier-Dykstra LM; O'Grady KE; Arria AM. College students' use of cocaine: Results from a longitudinal study. Addictive Behaviors 36(4): 408-411, 2011. (24 refs.)

College students have high rates of heavy drinking and other risky behaviors, but little is known about trends in their use of cocaine. In this longitudinal study of 1253 college students at one large, public university in the mid-Atlantic region, annual interviews assessed opportunity to use cocaine, cocaine use, and DSM-IV criteria for cocaine abuse and dependence. Follow-up rates exceeded 87% annually. Data from the first four years of college were analyzed to detect changes over time and possible gender differences. By their fourth year of college, 36%(wt) of students had been offered cocaine at least once in their lifetime, and 13%(wt) had used cocaine. Annual prevalence of cocaine use increased significantly over time (4%(wt) in Year 1 to 10%(wt) in Year 4) and remained similar across genders. Opportunities to use cocaine were significantly more prevalent for males than females during Years 2 through 4. Cocaine use given opportunity increased significantly over time for both males and females. Among 243 cocaine users, females (n = 113) had more serious use patterns than males, with higher average frequency of use (18.39 vs. 8.83 days during the peak year of use, p<.05) and greater likelihood of meeting criteria for cocaine dependence (9.3% vs. 2.5%, p<.05). Gender differences in typical cocaine dosage were not apparent. College administrators and health providers should be aware of the prevalence of cocaine use among student populations and design strategies to address the problem.

Khan U; Nicell JA. Refined sewer epidemiology mass balances and their application to heroin, cocaine and ecstasy. Environment International 37(7): 1236-1252, 2011. (153 refs.)

The detection of illicit drugs in environmental matrices may be a cause for concern, both from the perspective of their potential environmental impacts and the fact that their presence in detectable concentrations would be an indicator of significant drug use. The primary goal behind recent studies on this subject has been to use measured influent concentrations of selected illicit drugs or their in vivo metabolites in the environment as a means of estimating the abuse level of these drugs and patterns of consumption. Thus-far, such calculations have hinged on the use of solitary excretion estimates from single studies of limited scope and/or studies of limited applicability. Therefore, the need exists to conduct a comprehensive meta-analysis of metabolic disposition studies to construct excretions profiles for the various illicit drugs and their in vivo metabolites. The constructed excretory profiles should not only provide mean excretion values but also indicate the expected variations in excreted fractions that arise due to differences not only in the metabolic capacity of users but also in the efficiencies of various routes of administration for a given illicit drug. Therefore, the primary goal of the research presented here was to refine sewer epidemiology extrapolation mass balances for various illicit drugs of interest by constructing their excretory profiles segregated by route-of-administration. After conducting such a study with a multi-national scope on illicit drugs including cocaine, heroin and ecstasy, the results obtained clearly indicate that extrapolation factors currently being used in literature for these drugs to enumerate prevalence of abuse required significant refinement to increase their reliability.

Kidorf M; King VL; Pierce J; Kolodner K; Brooner RK. Benefits of concurrent syringe exchange and substance abuse treatment participation. Journal of Substance Abuse Treatment 40(3): 265-271, 2011. (45 refs.)

Participation in syringe exchange programs (SEPs) is associated with many individual and public health benefits but may have little impact on reducing drug use without concurrent treatment engagement. This study evaluated rates of drug use, other risk behaviors, and illegal activities in newly registered SEP participants (N = 240) enrolled versus not enrolled in substance abuse treatment over a 4-month observation window and examined the effect of days in treatment on these outcomes. After controlling for baseline differences, SEP registrants enrolled in treatment (n = 113) reported less days of opioid and cocaine use, injection drug use, illegal activities, and incarceration than those not enrolled in treatment (n = 127). For those enrolled in treatment, days of treatment was strongly correlated with each of these outcomes. These findings provide good evidence for a dose response effect of treatment in syringe exchangers and suggest that substance abuse treatment significantly expands the harm reduction benefits of SEP participation.

Kuzenko N; Sareen J; Beesdo-Baum K; Perkonigg A; Hofler M; Simm J et al. Associations between use of cocaine, amphetamines, or psychedelics and psychotic symptoms in a community sample. Acta Psychiatrica Scandinavica 123(6): 466- 474, 2011. (58 refs.)

Objective: To investigate the association between use of cocaine, amphetamines, or psychedelics and psychotic symptoms. Method: Cumulated lifetime data from a prospective, longitudinal community study of 2588 adolescents and young adults in Munich, Germany, were used. Substance use at baseline, 4-year and 10-year follow-up and psychotic symptoms at 4-year and 10-year follow-up were assessed using the Munich-Composite International Diagnostic Interview. Data from all assessment waves were aggregated, and multinomial logistic regression analyses were performed. Additional analyses adjusted for sociodemographics, common mental disorders, other substance use, and childhood adversity (adjusted odds ratios, AOR). Results: After adjusting for potential confounders, lifetime experience of two or more psychotic symptoms was associated with lifetime use of cocaine (AOR 1.94; 95% CI 1.10-3.45) and psychedelics (AOR 2.37; 95% CI 1.20-4.66). Additionally, when mood or anxiety disorders were excluded, lifetime experience of two or more psychotic symptoms was associated with use of psychedelics (AOR 3.56; 95% CI 1.20-10.61). Conclusion: Associations between psychotic symptoms and use of cocaine, and/or psychedelics in adolescents and young adults call for further studies to elucidate risk factors and developmental pathways.

Lam PK; Wong TW; Lau CC. Pneumomediastinum after smoking cocaine: A case report and review of literature. Hong Kong Journal of Emergency Medicine 18(1): 26-30, 2011. (26 refs.)

Cocaine abuse has become more affordable and popular amongst drug abusers locally in recent years. Spontaneous pneumomediastinum is an uncommon but a well-reported complication after smoking "crack" cocaine in the West. We report a case of spontaneous pneumomediastinum after smoking cocaine. The patient was managed conservatively and he recovered uneventfully. A review of literature on the mechanism, clinical presentation and management is presented.

Li L; Zhang X; Levine B; Li GH; Zielke HR; Fowler DR. Trends and pattern of drug abuse deaths in Maryland teenagers. Journal of Forensic Sciences 56(4): 1029-1033, 2011. (29 refs.)

The Office of the Chief Medical Examiner of Maryland recorded a total of 149 drug abuse deaths of teenagers aged 13-19 years between 1991 and 2006. Of these deaths, 96 (64.4%) were caused by the use of narcotic drugs only, 29 (19.5%) by both narcotics and cocaine, four (2.7%) by both narcotics and methylenedioxymethamphetamine, six (4.0%) by cocaine only, and 14 (9.4%) by volatile substances (e.g., butane, Freon, nitrous oxide, and propane). The annual death rate from drug abuse for teenagers increased from 1.4 deaths per 100,000 population in 1991 to 2.7 deaths per 100,000 population in 2006 (chi-square test for time trend, p < 0.01). The increase in teenager drug abuse deaths occurred in 1999 and since has remained at a higher rate. Further analysis revealed that the increase in drug abuse deaths was attributable to a large degree to narcotic drugs, particularly heroin / morphine and methadone, and was confined to teenagers residing in the suburban and rural areas.

Licata SC; Penetar DM; Ravichandran C; Rodolico J; Palmer C; Berko J et al. Effects of daily treatment with citicoline: A double-blind, placebo-controlled study in cocaine-dependent volunteers. Journal of Addiction Medicine 5(1): 57-64, 2011. (32 refs.)

Many pharmacotherapies for treating cocaine dependence are aimed at reducing drug effects, alleviating craving, and preventing relapse. We demonstrated previously that citicoline, a compound used to repair neuronal damage in stroke and brain injury, is safe in cocaine-abusing volunteers. Objectives: This study assessed the effectiveness of an 8-week citicoline treatment period and 4-week follow-up in cocaine-dependent individuals. Methods: Twenty-nine healthy nontreatment-seeking, cocaine-dependent male and female volunteers were randomized in this double-blind, placebo-controlled study, 18 of whom completed the treatment period of the study. Participants took citicoline (500 mg twice daily) or matched placebo each day and recorded the measures of craving and drug use. Participants visited the laboratory twice a week for urine screens and to attend weekly group therapy sessions. Results: Citicoline had no effect on cocaine craving or total use. Conclusions: Although the current preliminary results from this small trial suggest that citicoline is not an effective treatment for heavy cocaine users, further investigation on efficacy citicoline as a treatment for substance dependence in other settings may be warranted.

Liu SJ; Lane SD; Schmitz JM; Waters AJ; Cunningham KA; Moeller FG. Relationship between attentional bias to cocaine-related stimuli and impulsivity in cocaine-dependent subjects. American Journal of Drug and Alcohol Abuse 37(2): 117-122, 2011. (26 refs.)

Background: Cocaine-dependent subjects show attentional bias to cocaine-related stimuli, increased impulsivity on questionnaires, and impaired inhibitory control (one component of impulsivity on behavioral tasks). However, the relationship between attentional bias, impulsivity, and inhibitory control in cocaine-dependent subjects is unknown. Objective: To investigate the relationship between attentional bias to cocaine-related stimuli, impulsivity, and inhibitory control in cocaine dependence. Methods: This study employed the cocaine Stroop task to measure attentional bias to cocaine-related stimuli, immediate memory task (IMT) to measure inhibitory control, and Barratt Impulsiveness Scale version 11 to measure impulsivity. Thirty-two controls and 37 cocaine-dependent subjects were recruited through newspaper advertisement. Results: Cocaine-dependent subjects had higher attentional bias to cocaine-related words, higher scores for Barratt Impulsiveness Scale, and higher commission error rate on the IMT than controls. The attentional bias was positively correlated with the commission error rate on the IMT in the cocaine-dependent subjects but not in control subjects. Conclusions: Cocaine-dependent subjects showed attentional bias to cocaine-related words, increased impulsivity, and poor inhibitory control compared with controls. The attentional bias was associated with inhibitory control in cocaine-dependent subjects but not in control subjects. Scientific Significance: Our findings suggest that cocaine-dependent subjects with poor inhibitory control may show higher attentional bias to cocaine-related words compared with controls and those with better inhibitory control.

Lopez-Quintero C; de los Cobos JP; Hasin DS; Okuda M; Wang S; Grant BF et al. Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: Results of the National Epidemiology Survey on Alcohol and Related Conditions (NESARC). Drug and Alcohol Dependence 115(1-2): 120- 130, 2011. (109 refs.)

Background: This study aims to estimate general and racial-ethnic specific cumulative probability of developing dependence among nicotine, alcohol, cannabis or cocaine users, and to identify predictors of transition to substance dependence. Methods: Analyses were done for the subsample of lifetime nicotine (n = 15,918), alcohol (n = 28,907), cannabis (n = 7389) or cocaine (n = 2259) users who participated in the first and second wave of the National Epidemiology Survey on Alcohol and Related Conditions (NESARC). Discrete-time survival analyses were implemented to estimate the cumulative probability of transitioning from use to dependence and to identify predictors of transition to dependence. Results: The cumulative probability estimate of transition to dependence was 67.5% for nicotine users, 22.7% for alcohol users, 20.9% for cocaine users, and 8.9% for cannabis users. Half of the cases of dependence on nicotine, alcohol, cannabis and cocaine were observed approximately 27, 13, 5 and 4 years after use onset, respectively. Significant racial-ethnic differences were observed in the probability of transition to dependence across the four substances. Several predictors of dependence were common across the four substances assessed. Conclusions: Transition from use to dependence was highest for nicotine users, followed by cocaine, alcohol and cannabis users. Transition to cannabis or cocaine dependence occurred faster than transition to nicotine or alcohol dependence. The existence of common predictors of transition dependence across substances suggests that shared mechanisms are involved. The increased risk of transition to dependence among individuals from minorities or those with psychiatric or dependence comorbidity highlights the importance of promoting outreach and treatment of these populations.

Lopez-Quintero C; Hasin DS; de los Cobos JP; Pines A; Wang SA; Grant BF et al. Probability and predictors of remission from life-time nicotine, alcohol, cannabis or cocaine dependence: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Addiction 106(3): 657-669, 2011. (57 refs.)

Aim: To estimate the general and racial/ethnic specific cumulative probability of remission from nicotine alcohol cannabis or cocaine dependence, and to identify predictors of remission across substances. Design: Data were collected from structured diagnostic interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version. Setting: The 2001-2002 National Epidemiological Survey of Alcohol and Related Conditions (NESARC) surveyed a nationally representative sample from US adults (n = 43 093) selected in a three-stage sampling design. Participants: The subsamples of individuals with life-time DSM-IV diagnosis of dependence on nicotine (n = 6937), alcohol (n = 4781), cannabis (n = 530) and cocaine (n = 408). Measurements: Cumulative probability estimates of dependence remission for the general population and across racial/ethnic groups. Hazard ratios for remission from dependence. Findings: Life-time cumulative probability estimates of dependence remission were 83.7% for nicotine, 90.6% for alcohol, 97.2% for cannabis and 99.2% for cocaine. Half of the cases of nicotine, alcohol, cannabis and cocaine dependence remitted approximately 26, 14, 6 and 5 years after dependence onset, respectively. Males, Blacks and individuals with diagnosis of personality disorders and history of substance use comorbidity exhibited lower hazards of remission for at least two substances. Conclusions: A significant proportion of individuals with dependence on nicotine, alcohol, cannabis or cocaine achieve remission at some point in their life-time, although the probability and time to remission varies by substance and racial/ethnic group. Several predictors of remission are shared by at least two substances, suggesting that the processes of remission overlap. The lower rates of remission of individuals with comorbid personality or substance use disorders highlight the need for providing coordinated psychiatric and substance abuse interventions.

Mackie CJ; Castellanos-Ryan N; Conrod PJ. Developmental trajectories of psychotic-like experiences across adolescence: Impact of victimization and substance use. Psychological Medicine 41(1): 47-58, 2011. (65 refs.)

Background. Research suggests that psychotic-like experiences (PLEs) in the general population are common, but can reflect either transitory or persistent developmental phenomena. Using a general adolescent population it was examined whether different developmental subtypes of PLEs exist and whether different trajectories of PLEs are associated with certain environmental risk factors, such as victimization and substance use. Method. Self-reported PLEs were collected from 409 adolescents (mean age 14 years 7 months) at four time points, each 6 months apart. General growth mixture modelling was utilized to identify classes of adolescents who followed distinct trajectories of PLEs across this period. Predictors of class membership included demographics, personality, victimization, depression, anxiety and substance use. Results. We identified the following three developmental subgroups of PLEs: (1) persistent; (2) increasing; (3) low. Adolescents on the persistent trajectory reported frequent victimization and consistent elevated scores in depression and anxiety. Adolescents on the increasing trajectory were engaging in cigarette use prior to any increases in PLEs and were engaging in cocaine, cannabis and other drug use as PLEs increased at later time points. Conclusions. The findings suggest that different developmental subgroups of PLEs exist in adolescence and are differentially related to victimization and substance use.

Madoz-Gurpide A; Blasco-Fontecilla H; Baca-Garcia E; Ochoa-Mangado E. Executive dysfunction in chronic cocaine users: An exploratory study. Drug and Alcohol Dependence 117(1): 55-58, 2011. (49 refs.)

Introduction: Chronic cocaine use is associated with some executive deficits. We assessed executive functions using ecologically valid tests in chronic cocaine users. Objectives: To investigate the relationship between executive deficits and three measures of severity of cocaine use: years of use, quantity used, and frequency of use. Methods: Twenty-four cocaine users were compared with twenty-seven community controls. We used Student's t-test and Chi-squared to compare means and categorical variables, respectively. Linear regression analyses for the adjusted comparative analysis between cases and controls, and severity of cocaine use among cocaine users were performed. Results: Chronic cocaine users performed worse on measures of attention and working memory (Forward and Backward Digit Span, p < .001), set-shifting abilities (difference score between the Trail Making B and A, TMB-A, p=.006), cognitive test of mental flexibility and response inhibition (Rule Shift Cards) (p < .001), and prefrontal functioning (Wisconsin Card Sorting Test, WCST, p=.023) than controls. Years of cocaine use were associated with deficits in the Backward Digit Span (p=.041; CI 95%: -.760 to -.002), the TMB-A (p=.026; CI 95%: .687 to 9.761), the Zoo Map (p=.034; CI 95%: -.480 to -.021), and the Rule Shift Cards (p=.006; CI 95%: -.836 to -.164), among others. Quantity of cocaine use was associated with executive deficits measured by the Forward Digit Span (p=.007; CI 95%: -.727 to -.133), the TMB-A (p=.021; CI 95%: 5.304-57.945), and the number of perseverative errors in the WSCT (p=.002; CI 95%: -10.654 to -2.800). Frequency of cocaine was associated with deficits in the Backward Digit Span (p=.042; CI 95%: -1.548 to -.030). Conclusions: Chronic use of cocaine is associated with executive deficits, which may influence patients' functionality, prognosis, and therapeutic failure.

Malchy LA; Bungay V; Johnson JL; Buxton J. Do crack smoking practices change with the introduction of safer crack kits? Canadian Journal of Public Health 102(3): 188-192, 2011. (28 refs.)

Objectives: Crack smoking has increased in Vancouver despite the harms associated with its use. Many people who smoke crack share their equipment, thereby increasing their risk for infectious disease. This project explored the effects of outreach distribution of "safer crack kits" on smoking practices. Methods: Two cross-sectional surveys were conducted, the first prior to kit distribution and the second a year later. Participants were individuals who smoked crack and lived in Vancouver's inner city. Crack smoking practices and use of items in the crack kit were documented. Results: The results of the second survey (i.e., following 12 months of kit distribution) showed an increase in availability and use of safer use items; mouthpieces and condoms provided in the kit were used by 79% and 59% of recipients, respectively. Unsafe practices were reported post distribution: although 42% used brass screens, the majority reported that they usually used Brillo (R); over 40% of respondents reported using syringe plungers to scrape crack resin; and participants reported sharing crack-use paraphernalia. Conclusion: While kit distribution made safer use items more accessible, its impact on safer use practice was limited. Our findings highlight the need for targeted distribution of safer use items. Future research should explore the dynamics of unsafe crack smoking practices and ways to leverage safer use messaging.

Mariani JJ; Cheng WY; Bisaga A; Sullivan M; Carpenter K; Nunes EV et al. Comparison of clinical trial recruitment populations: Treatment-seeking characteristics of opioid-, cocaine-, and cannabis-using participants. Journal of Substance Abuse Treatment 40(4): 426- 430, 2011. (6 refs.)

This study examined the treatment history and intention to seek treatment among 489 individuals interested in substance use disorder clinical trial participation. Opioid and cocaine users were more likely than cannabis users to report having received treatment for substance use in the past and more likely than cannabis users to report planning to seek treatment for substance use before exposure to recruitment advertising. Free cost was the aspect of clinical trial participation that most influenced the decision to make an intake evaluation appointment for opioid-dependent patients as compared with cocaine- and cannabis-dependent participants, and the availability of individual psychotherapy most influenced those who were cannabis dependent. Cannabis-dependent individuals evaluated for clinical trial participation reported that recruitment advertising was an important factor in leading them to seek treatment. These results have implications for clinical trial recruitment and public health efforts directed at encouraging cannabis-dependent individuals to seek treatment.

Marsden J; Eastwood B; Wright C; Bradbury C; Knight J; Hammond P. How best to measure change in evaluations of treatment for substance use disorder. Addiction 106(2): 294-302, 2011. (30 refs.)

Aims: To compare the performance of the Jacobson & Truax (JT) reliable change index (RCI) with three alternative methods, using data from individuals receiving treatment for substance use disorders. Design: English National Treatment Outcome Monitoring Database for publicly funded specialist community pharmacological and psychosocial interventions. Participants: New adult admissions to treatment across England (1 January-31 December 2008), with in-treatment clinic progress review conducted after an average of 122.8 days for 18 163 individuals. Measurements: Self-reported days using heroin, crack, cocaine powder and alcohol during the 4 weeks before admission and clinical review, recorded using the Treatment Outcomes Profile and analysed using a multi-level, mixed-linear model, with both observed and true scores to estimate the effect of regression to the mean (RTM). Differences in performance among the JT RCI and the alternative methods were assessed by the proportion assigned to a reliably 'improved', 'unchanged' or 'reliably deteriorated' category; level of agreement; difference in effect size for observed and true scores; and receiver operating characteristic parameters. Findings: When compared to the alternative methods, the JT RCI was more conservative in assigning individuals to the improved category, and it showed no evidence of inferiority on any measure. For each method, all individuals categorized as reliably deteriorated and the majority of those categorized reliably improved had outcome scores which fell beyond that expected by RTM. Substituting true scores for observed scores moderated the size of the change effect associated with reduced use of the four substances, but this remained statistically significant. Conclusions: The Jacobson & Truax Reliable Change Index appears to be the optimal measure of change for evaluations of treatment for substance use disorder, in that it is the most conservative for assessing improvement and at least as accurate on all other criteria. Any evaluation of change needs to take account of regression to the mean.

Martin RA; MacKinnon S; Johnson J; Rohsenow DJ. Purpose in life predicts treatment outcome among adult cocaine abusers in treatment. Journal of Substance Abuse Treatment 40(2): 183-188, 2011. (49 refs.)

A sense of purpose in life has been positively associated with mental health and well-being and has been negatively associated with alcohol use in correlational and longitudinal studies but has not been studied as a predictor of cocaine treatment outcome. This study examined pretreatment purpose in life as a predictor of response to a 30-day residential substance use treatment program among 154 participants with cocaine dependence. Purpose in life was unrelated to cocaine or alcohol use during the 6 months pretreatment. After controlling for age, baseline use, and depressive symptoms, purpose in life significantly (p < .01) predicted relapse to any use of cocaine and to alcohol and the number of days cocaine or alcohol was used in the 6 months after treatment. Findings suggest that increasing purpose in life may be an important aspect of treatment among cocaine-dependent patients.

Martinez D; Carpenter KM; Liu F; Slifstein M; Broft A; Friedman AC et al. Imaging dopamine transmission in cocaine dependence: Link between neurochemistry and response to treatment. American Journal of Psychiatry 168(6): 634-641, 2011. (39 refs.)

Objective: Previous research has shown that dopamine signaling in the limbic striatum is crucial for selecting adaptive, motivated behavior and that disrupted dopamine transmission is associated with impulsive and maladaptive behavior. In humans, positron emission tomography (PET) imaging studies have shown that cocaine dependence is associated with the dysregulation of striatal dopamine signaling, which is linked to cocaine-seeking behavior. The goal of the present study was to investigate whether this association applies to the treatment setting. The authors hypothesized that dopamine signaling in the limbic striatum would be associated with response to a behavioral treatment that uses positive reinforcement to replace impulsive cocaine use with constructive personal goals. Method: Prior to treatment, cocaine-dependent subjects underwent two PET scans using [C-11]raclopride, before and after the administration of a stimulant (methylphenidate), for measurement of striatal dopamine D-2/3 receptor binding and presynaptic dopamine release. Results: Both of the outcome measures were lower in the volunteers who did not respond to treatment than in those who experienced a positive treatment response. Conclusions: These findings provide insight into the neurochemistry of treatment response and show that low dopamine transmission is associated with treatment failure. In addition, these data suggest that the combination of behavioral treatment with methods that increase striatal dopamine signaling might serve as a therapeutic strategy for cocaine dependence.

Matuskey D; Pittman B; Forselius E; Malison RT; Morgan PT. A multistudy analysis of the effects of early cocaine abstinence on sleep. Drug and Alcohol Dependence 115(1-2): 62- 66, 2011. (29 refs.)

Objective: To describe the sleep patterns of early cocaine abstinence in chronic users by polysomnographic and subjective measures. Methods: 28 cocaine-dependent participants (ages 24-55) underwent polysomnographic sleep (PSG) recording on the 1st, 2nd and 3rd weeks of abstinence on a research dedicated inpatient facility. Objective measures of total sleep time, total REM time, slow wave sleep, sleep efficiency and a subjective measure (sleep quality) along with demographic data were collected from three different long term research studies over a five year period. Data were reanalysed to allow greater statistical power for comparisons. Results: Progressive weeks of abstinence had main effects on all assessed PSG sleep measures showing decreased total sleep time, REM sleep, stages 1 and 2 sleep, and sleep efficiency: increases in sleep onset and REM latencies and a slight increase in slow-wave sleep time were also present. Total sleep time and slow wave sleep were negatively associated with years of cocaine use. Total sleep time was positively associated with the amount of current ethanol use. Sex differences were found with females having more total REM time and an increase at a near significance level in slow wave sleep. Subjective measures were reported as improving with increasing abstinence over the same time period. Conclusions: Chronic cocaine users show a general deterioration in objective sleep measures over a three-week period despite an increase in subjective overall sleep quality providing further evidence for "occult insomnia" during early cocaine abstinence.

McDonell MG; Angelo F; Sugar A; Rainey C; Srebnik D; Roll J et al. A pilot study of the accuracy of onsite immunoassay urinalysis of illicit drug use in seriously mentally ill outpatients. American Journal of Drug and Alcohol Abuse 37(2): 137-140, 2011. (12 refs.)

Objectives: This pilot study investigated the accuracy of onsite immunoassay urinalysis of illicit drug use in 42 outpatients with co-occurring substance use disorders and serious mental illness. Methods: Up to 40 urine samples were submitted by each participant as part of a larger study investigating the efficacy of contingency management in persons with co-occurring disorders. Each sample was analyzed for the presence of amphetamine, methamphetamine, cocaine, marijuana, and opiates or their metabolites using onsite qualitative immunoassays. One onsite urinalysis was randomly selected from each participant for confirmatory gas chromatography--mass spectrometry (GC--MS) analyses. Results: Agreement between immunoassay and GC--MS was calculated. Agreement was high, with 98%% agreement for amphetamine, methamphetamine, opiate, and marijuana. Agreement for cocaine was 93%. Conclusions: Results of this pilot study support the use of onsite immunoassay screening cups as an assessment and outcome measure in adults with serious mental illness. Scientific significance: Data suggest that onsite urinalysis screenings may be a helpful assessment tool for measuring clinical and research outcomes.

Meade CS; Conn NA; Skalski LM; Safren SA. Neurocognitive impairment and medication adherence in HIV patients with and without cocaine dependence. Journal of Behavioral Medicine 34(2): 128-138, 2011. (93 refs.)

Cocaine abuse among HIV patients is associated with faster disease progression and mortality. This study examined the relationship between neurocognitive functioning and medication adherence in HIV patients with (n = 25) and without (n = 39) current cocaine dependence. Active users had greater neurocognitive impairment (mean T-score = 35.16 vs. 40.97, p < .05) and worse medication adherence (mean z-score = -0.44 vs. 0.27, p < .001). In a multiple regression model, neurocognitive functioning (beta = .33, p < .01) and cocaine dependence (beta = -.36, p < .01) were predictive of poorer adherence. There was a significant indirect effect of cocaine dependence on medication adherence through neurocognitive impairment (estimate = -0.15, p < .05), suggesting that neurocognitive impairment partially mediated the relationship between cocaine dependence and poorer adherence. These results confirm that cocaine users are at high risk for poor HIV outcomes and underscore the importance of treating both neurocognitive impairment and cocaine dependence among HIV patients.

Mieczkowski T. Assessing the potential for racial bias in hair analysis for cocaine: Examining the relative risk of positive outcomes when comparing urine samples to hair samples. Forensic Science International 206(1-3): 29-34, 2011. (36 refs.)

This article examines the conjecture that hair analysis, performed to detect cocaine use or exposure, is biased against African Americans. It does so by comparing the outcomes of 33,928 hair and 105,792 urine samples collected from both African American and white subjects. In making this comparison the analysis seeks to determine if there is a departure in rates of positive and negative outcomes when comparing the results of hair analysis for cocaine to the results from urinalysis for cocaine by racial group. It treats urine as an unbiased test. It compares both the relative ratios of positive outcomes when comparing the two groups and it calculates the relative risk of outcomes for each group for having positive or negative outcomes. The findings show that the ratios of each racial group are effectively same for hair and urine assays, and they also show that the relative risk and risk estimates for positive and negative outcomes are the same for both racial groups. Considering all samples, the cocaine positive risk estimate for the hair samples comparing the two racial groups is 3.28 and for urinalysis the risk estimate is 3.10 (Breslow-Day chi(2).250, 1 df, p = 0.617) a non-significant difference in risk. For pre-employment samples, the cocaine positive risk estimate for the hair samples comparing the two racial groups is 3.10 and for urinalysis the risk estimate is 2.90 (Breslow-Day chi(2).281, df = 1, p = 0.595), also a non-significant difference in risk.

Molinaro S; Siciliano V; Curzio O; Denoth F; Salvadori S; Mariani F. Illegal substance use among italian high school students: Trends over 11 years (1999-2009). PLoS ONE 6(6): e20482, 2011. (29 refs.)

Purpose: To monitor changes in habits in drug use among Italian high school students. Methods: Cross-sectional European School Survey Project on Alcohol and Other Drugs (ESPAD) carried out in Italy annually for 11 years (1999-2009) with representative samples of youth attending high school. The sample size considered ranges from 15,752 to 41,365 students and response rate ranged from 85.5% to 98.6%. Data were analyzed to obtain measures of life-time prevalence (LT), use in the last year (LY), use in the last 30 days (LM), frequent use. Comparisons utilized difference in proportion tests. Tests for linear trends in proportion were performed using the Royston p trend test. Results: When the time-averaged value was considered, cannabis (30% LT) was the most, and heroin the least (2%) frequently used, with cocaine (5%), hallucinogens (2%) and stimulants (2%) in between. A clear gender gap is evident for all drugs, more obvious for hallucinogens (average M/F LY prevalence ratio 2, range 1.7-2.4, p<0.05), less for cannabis (average M/F LY prevalence ratio 1.3, range 1.2-1.5, p<0.05). Data shows a change in trend between 2005 and 2008; in 2006 the trend for cannabis use and availability dropped and the price rose, while from 2005 cocaine and stimulant use prevalence showed a substantial increase and the price went down. After 2008 use of all substances seems to have decreased. Conclusions: Drug use is widespread among students in Italy, with cannabis being the most and heroin the least prevalent. Girls are less vulnerable than boys to illegal drug use. In recent years, a decrease in heroin use is overbalanced by a marked rise in hallucinogen and stimulant use.

Montanari L; Serafini M; Maffli E; Busch M; Kontogeorgiou K; Kuijpers W. Gender and regional differences in client characteristics among substance abuse treatment clients in the Europe Union. Drugs: Education, Prevention and Policy 18(1): 24-31, 2011. (24 refs.)

Aims: To assesses the extent of the gender gap among the treated population of drug users across Europe. Methods: This analysis reports data on 363,170 clients from 4647 treatment units in 23 countries (22 European Union member states and Switzerland). Findings: Overall, males outnumber females by four, but the gender ratio varies not only by geographical region/country, but also by drug. In the majority of countries, the most common primary problem drug is opioids, and the overall gender ratio mirrors the gender ratio of opioid users. In some countries, a considerable proportion of treated drug users have cannabis and stimulants (cocaine/amphetamines/methamphetamines) as primary problem drugs. Stimulants other than cocaine and other drugs have lower, while cannabis has a higher than overall male-to-female gender ratio. Conclusions: The very high male-to-female gender ratios may reveal differential access to treatment. Our findings highlight the need to assess access to treatment for women problem drug users and to make women-focussed programmes more available to increase the proportion of women in drug treatment programmes across Europe.

Morales-Manrique CC; Palepu A; Castellano-Gomez M; Aleixandre-Benavent R; Valderrama-Zurian JC. Quality of life, needs, and interest among cocaine users: Differences by cocaine use intensity and lifetime severity of addiction to cocaine. Substance Use & Misuse 46(4): 390-397, 2011. (27 refs.)

We examined the quality of life (QoL) of 149 patients who were recruited in 2005 at outpatient treatment centers for cocaine dependence in Spain. Important life areas and life areas with potential need and interest to change in order to improve the QoL were analyzed in terms of patients" cocaine use intensity within the previous six months and lifetime severity addiction to cocaine. The Spanish versions of the Drug User Quality of Life Scale and the Lifetime Severity Index for Cocaine were used to measure QoL, needs and interest, and severity addiction to cocaine. The data analysis employed t-tests, linear regression, Mann--Whitney U tests, multivariate regression, and chi-square tests. Tailoring treatment programs to address the life areas that are considered relevant to cocaine users considering their intensity of consumption and lifetime severity addiction to cocaine may improve retention and treatment outcomes. Further research needs to consider patients of different ethnic backgrounds and cultural contexts. The study's limitations are noted.

Moreira M; Buchanan J; Heard K. Validation of a 6-hour observation period for cocaine body stuffers. American Journal of Emergency Medicine 29(3): 299-303, 2011. (13 refs.)

Often, patients are brought in to the emergency department after ingesting large amounts of cocaine in an attempt to conceal it. This act is known as body staffing. The observation period required to recognize potential toxic adverse effects in these patients is not well described in the literature. We sought to validate a treatment algorithm for asymptomatic cocaine body stuffers using a 6-hour observation period by observing the clinical course of cocaine body stuffers over a 24-hour period. A retrospective chart review was performed on all patients evaluated for witnessed or suspected stuffing over 2 years using a standardized protocol. One hundred six patients met final inclusion criteria as adult cocaine stuffers. No patients developed life-threatening symptoms, and no patients died during observation. In our medical setting, starers could be discharged after a 6-hour observation period if there was either complete resolution or absence of clinical symptoms.

Muhuri PK; Gfroerer JC. Mortality associated with illegal drug use among adults in the United States. American Journal of Drug and Alcohol Abuse 37(3): 155-164, 2011. (58 refs.)

Objectives: To examine all-cause and cause-specific mortality over a 15-year follow-up period in relation to at-baseline reported lifetime use of illegal drugs from five classes (marijuana, cocaine, heroin, hallucinogens, and inhalants) among adults in the United States (US) household population. Methods: The study involved 20,983 sample adults who responded to the 1991 National Health Interview Survey Drug and Alcohol Use supplemental questionnaire and also met the eligibility criteria for mortality follow-up. Cox proportional hazards models were estimated to examine the relationships. Results: Adults who at baseline reported lifetime heroin use were at significantly higher risk of all-cause death over the follow-up period (hazard rate ratio or HR = 2.02; 95% confidence interval or CI 1.26-3.23), compared with those who did not report using drugs from any of the five classes, even after adjusting for age, sex, race, education, marital status, cigarette smoking status, and alcohol use status. Those who at baseline reported lifetime cocaine (no heroin) use had a significantly higher rate of death associated with human immunodeficiency virus diseases over the follow-up period than nonusers of drugs from any of the five classes. Several limitations of the analysis are discussed. Conclusions: Further research is needed to understand and track the elevated mortality associated with illegal drug use and the correlates of drug-poisoning deaths.

Netakar A; Koren G. Interpretation of combined hair fatty acid ethyl esters, cocaine and Cocaethylene. (editorial). Therapeutic Drug Monitoring 33(3): 284- 284, 2011. (8 refs.)

Oliveto A; Poling J; Mancino MJ; Feldman Z; Cubells JF; Pruzinsky R et al. Randomized, double blind, placebo-controlled trial of disulfiram for the treatment of cocaine dependence in methadone-stabilized patients. Drug and Alcohol Dependence 113(2-3): 184-191, 2011. (67 refs.)

This study examined the dose-related efficacy of disulfiram for treating cocaine dependence in methadone-stabilized cocaine dependent participants. Design: One hundred and sixty-one cocaine- and opioid-dependent volunteers were entered into a 14-week, double blind, randomized, placebo-controlled clinical trial at two sites. Methods: Participants were stabilized on methadone during weeks 1-2 and received disulfiram at 0, 62.5, 125 or 250 mg/day during weeks 3-14. All participants also received weekly cognitive behavioral therapy. Thrice-weekly urine samples and weekly self-reported drug use assessments were obtained. Results: Baseline subject characteristics, retention and drug use did not differ across groups. Outcome analyses were performed on those who participated beyond week 2. Opioid-positive urine samples and self-reported opioid use did not differ by treatment group. The prevalence of alcohol use was low prior to and during the trial and did not differ by treatment group. Cocaine-positive urines increased over time in the 62.5 and 125 mg disulfiram groups and decreased over time in the 250 mg disulfiram and placebo groups (p<0.0001). Self-reported cocaine use increased in the 125 mg disulfiram group relative to the other three treatment groups (p = 0.04). Conclusions: Disulfiram may be contraindicated for cocaine dependence at doses <250 mg/day. Whether disulfiram at higher doses is efficacious in reducing cocaine use in dually cocaine and opioid dependent individuals needs to be determined.

Ompad DC; Friedman SR; Hwahng SJ; Nandi V; Fuller CM; Vlahov D. HIV risk behaviors among young drug using women who have sex with women (WSWs) in New York City. Substance Use & Misuse 46(2-3): 274-284, 2011. (49 refs.)

Previous research has suggested that multiple stressors may work in tandem to affect the health of women who have sex with women (WSWs). WSWshave been a part of the HIV epidemic in New York City since the beginning, making it an ideal setting to further explore these women's risk. Among a sample of 375 heroin, crack and/or cocaine using women recruited from economically disadvantaged communities in New York City, we examined HIV seroprevalence and risk behaviors among WSWs as compared to women who have sex with men only (WSMOs). We also explore differences between WSWs and WSMOs with respect to potential stressors (i.e., decreased access to resources and health care utilization and violence victimization) that might contribute overall HIV risk. The study's limitations are noted.

Pavarin R; Lugoboni F; Mathewson S; Ferrari AM; Guizzardi G; Quaglio G. Cocaine-related medical and trauma problems: a consecutive series of 743 patients from a multicentre study in Italy. European Journal of Emergency Medicine 18(4): 208-214, 2011. (32 refs.)

Objective. The purpose of this retrospective study was to describe the spectrum of medical and trauma complications associated with self-reported cocaine use. Methods. Patient databases of 23 emergency departments were searched for consultations related to cocaine use between January 2007 and December 2008. Results. The population included 569 men (84.4%) and 105 women (15.6%): 505 (74.9%) patients were nondependent cocaine users and 169 (25.1%) were dependent cocaine users. The majority of patients (63.8%) used other drugs in combination with cocaine. Psychiatric symptoms were most frequently reported (60.9%), followed by cardiopulmonary (38.2%), gastrointestinal (22.5%), neurological (20.8%) and constitutional (17.2%) symptoms. Of psychiatric complaints, anxiety was the most common (31.5%). Sex-adjusted and age-adjusted odds ratio (OR) showed that palpitations were associated within 12 h of cocaine use [OR 2.05; 95% confidence interval (CI): 1.12-3.76], and psychotic symptoms (OR 3.05; 95% CI: 1.02-9.18) and hallucinations (OR 7.50; 95% CI: 1.12-50.31) were associated within more than 12 h of the use of cocaine. In a comparison of dependent and nondependent cocaine users, after adjusting for age and sex, cardiopulmonary symptoms (OR 1.56; 95% CI: 1.08-2.24) and paranoia (OR 2.14; 95% CI: 1.08-4.24) were associated with nondependent use of cocaine, and lethargy (OR 7.14; 95% CI: 1.55-35.56) was associated with dependent use of cocaine. The primary cause of trauma was unintentional injuries (32.4%). Sex-adjusted and age-adjusted OR showed a major risk for unintentional injuries with nondependent use of cocaine (OR 6.17; 95% CI: 1.38-42.29). Conclusions. The study shows that cocaine users experience diverse symptoms and may present with a wide range of physical findings.

Perkisas S; Vrelust I; Martin M; Gadisseur A; Schroyens W. A warning about agranulocytosis with the use of cocaine adulterated with levamisole. Acta Clinica Belgica 66(3): 226-227, 2011. (5 refs.)

Since 2004, the US Food And Drug Administration and the European Medicine Agency are giving warnings about cocaine adulterated with levamisole. Levamisole is primarily used as an anti-helminthic. One of the side-effects of levamisole is a decreased bone marrow function. Herein we describe the first case of agranulocytosis and neutropenic fever due to cocaine adulterated with levamisole reported in Europe.

Postigo C; de Alda ML; Barcelo D. Evaluation of drugs of abuse use and trends in a prison through wastewater analysis. Environment International 37(1): 49-55, 2011. (26 refs.)

Illicit drugs and metabolites have been recognized recently as a group of emerging contaminants of concern, as a consequence of their high volumes of use and production. Drug residue levels in the aquatic environment have also been pointed out as good indicators of illicit drug abuse. The present work assesses for the first time drug abuse in a penal complex from the levels of different drug residues measured in the prison sewage waters and evaluates the suitability of this approach to track and control illicit drug usage in such facilities. The presence of various drugs of abuse and metabolites in sewage waters from a penal complex was determined by an analytical method based on on-line solid phase extraction-liquid chromatography-tandem mass spectrometry. Levels of consumption indicators measured in this water were used to back-calculate drugs usage in the penal complex. Daily use was observed for methadone (average of 156 doses/day/1000 inh), alprazolam (129 doses/day/1000 inh), ephedrine (46 doses/day/1000 inh), cannabis (33 doses/day/1000 inh.) and cocaine (3 doses/day/1000 inh). Sporadic consumption was observed for heroin, amphetamine, methamphetamine, and ecstasy. In spite of the fact that this and other sewage epidemiological approaches described may suffer from bias that still need to be investigated and refined, it provides near "real-time" information on collective drug use in an anonymous way and constitutes a very useful, economic and fast tool to evaluate the efficiency of measures adopted to control and track drug abuse in this type of facilities (or any other provided that has a STP associated or an accessible collector system).

Prisciandaro JJ; McRae-Clark AL; Maria MMMS; Hartwell KJ; Brady KT. Psychoticism and neuroticism predict cocaine dependence and future cocaine use via different mechanisms. Drug and Alcohol Dependence 116(1-3): 80-85, 2011. (55 refs.)

Background: Personality characteristics have been associated with cocaine use. However, little is known about the mechanisms through which personality could impact drug use. The present study investigated the cross-sectional and prospective relationships between personality dimensions (i.e., impulsivity, neuroticism) and problematic cocaine use. Reactivity to a pharmacological stressor as a potential mediator of the relationship between neuroticism and future cocaine use was also examined. Methods: Participants were 53 cocaine-dependent individuals and 47 non-dependent controls. Subjects completed the Eysenck Personality Questionnaire (EPQ) at baseline and were administered i.v. corticotrophin releasing hormone (CRH; 1 mu g/kg). Cocaine use in the 30 days following CRH administration was measured. Results: Cocaine-dependent individuals had higher scores on the psychoticism (i.e., impulsivity, aggression; p = 0.02) and neuroticism (p < 0.01) scales of the EPQ than non-dependent controls. Cocaine-dependent individuals also had a greater subjective stress response to CRH than controls (p < 0.01). Cocaine-dependent individuals with elevated psychoticism used significantly more cocaine over the follow-up period (p < 0.05), whereas individuals with elevated neuroticism trended towards using cocaine more frequently over the follow-up (p = 0.07). Finally, there was a trend for an indirect effect of neuroticism on frequency of cocaine use through subjective reactivity to CRH. Conclusions: The findings extend past research on the association between personality and cocaine use, and suggest that motives for cocaine use may systematically vary across personality characteristics. Moreover, tailoring therapeutic interventions to individuals' personalities may be an area that warrants further investigation.

Reske M; Delis DC; Paulus MP. Evidence for subtle verbal fluency deficits in occasional stimulant users: Quick to play loose with verbal rules. Journal of Psychiatric Research 45(3): 361-368, 2011. (38 refs.)

Psychostimulants like cocaine and amphetamine are commonly abused by young adults who often state that they take these drugs to increase social or cognitive performance. The current study tested the hypothesis that individuals at early stages of occasional stimulant use show subtle executive dysfunctions such as verbal fluency deficits. 155 young (age 18-25), non-dependent occasional users of stimulants and 49 stimulant naive comparison subjects performed the Delis-Kaplan Verbal Fluency test. Correlation and median split analyses were conducted to account for stimulant history and co-drug use. Compared to stimulant naive subjects, occasional stimulant users generated significantly more responses on an over-learned verbal fluency task (Category Fluency), but at the expense of increased error rates (Set Loss and Repetition Errors). These performance differences were not related to lifetime uses of stimulants or marijuana. Taken together, these results support the hypothesis that individuals who are using stimulants occasionally exhibit subtle executive dysfunctions when required to generate verbal sets under time pressure. In particular, occasional stimulant users apply quickly but inaccurately verbal rules, which may represent a mix of diminished cognitive flexibility along with increased rigidity and impulsivity. This specific executive dysfunction may help to identify individuals at risk for stimulant use or dependence.

Roettger ME; Swisher RR; Kuhl DC; Chavez J. Paternal incarceration and trajectories of marijuana and other illegal drug use from adolescence into young adulthood: Evidence from longitudinal panels of males and females in the United States. Addiction 106(1): 121-132, 2011. (52 refs.)

Aims: One-eighth of young adults in the United States report that their biological father has ever been incarcerated (FEI). This study is the first to examine associations between FEI and trajectories of substance use during the transition from adolescence into young adulthood for the US population. Design: Using multi-level modeling techniques, trajectories of marijuana and other illegal drug use are examined, with FEI as the primary independent variable. Setting: Data are from the first three waves of the National Longitudinal Study of Adolescent Health, a nationally representative sample of US adolescents beginning in 1995. Participants: Panels of 7157 males and 7997 females followed from adolescence (7th-12th grades) into early adulthood (ages 18-27 years). Measurements: Dependent variables included an ordinal measure of marijuana frequency of use in last thirty days, and a dichotomous measure for whether respondent had any use in the last thirty days of illegal drugs such crystal meth, cocaine, heroin, hallucinogens, PCP, LSD, speed, and ecstasy. Findings: Among males and females, respectively, FEI is associated with an increased frequency of marijuana use, and increased odds of any other illegal drug use. Interactions between FEI and age further reveal that FEI is associated with an accentuated trajectory (i.e. a steeper slope) of marijuana use, and an elevated risk (i.e. higher mean level) of other illegal drug use. Conclusions: Analysis provides some of the first evidence that paternal incarceration is significantly associated with drug use among U.S. males and females, even after controlling for a number of family background, parental, and individual characteristics.

Roozen HG; van der Kroft P; van Marle HJ; Franken IHA. The impact of craving and impulsivity on aggression in detoxified cocaine-dependent patients. Journal of Substance Abuse Treatment 40(4): 414- 418, 2011. (38 refs.)

Patients with substance use disorders are frequently associated with impulsivity that may underlie elevated levels life-threatening types of behavior, including aggression. In addition, craving is a prominent feature of addiction and appears to be closely related to impulsivity. This study assessed the unique contribution of cocaine craving and impulsivity in predicting aggression by means of correlational and mediational analyses. Forty inpatient detoxified cocaine-dependent patients and 40 matched healthy controls were enrolled. These participants filled out the Obsessive Compulsive Drug Use Scale, the Dickman Impulsivity Inventory, and the Aggression Questionnaire. The patient group showed elevated levels of impulsivity and aggression as compared with the control group. Although cocaine craving is positively correlated with both impulsivity and aggression, craving did not mediate the relationship between both constructs. It is concluded that craving does not have an impact on the relationship between impulsivity and trait aggression in this patient sample.

Rossi SS; Botre F. Prevalence of illicit drug use among the Italian athlete population with special attention on drugs of abuse: A 10-year review. Journal of Sports Sciences 29(5): 471-476, 2011. (21 refs.)

The objective of this study was to assess the prevalence of illicit drugs use among young adults, in particular elite athletes. This study considers the data obtained from anti-doping analyses performed on nearly 100,000 urine samples from 2000 to 2009 by the World Anti-Doping Agency accredited Italian Anti-Doping Laboratory. The percentage of adverse analytical findings varies on a yearly basis, but it is in the range 1.0-1.8% (not considering atypical findings, such as an altered endogenous steroid profile). Among positive results, there is a high prevalence of stimulants and drugs of abuse. The drug of abuse found most frequently is the tetrahydrocannabinol (cannabis) metabolite, accounting for 0.2-0.4% of the total samples analysed (18% of the positive results). The second most frequently encountered drug is cocaine, as detected from cocaine metabolites, accounting for 0.1% of the total samples analysed (7% of positive results). Other stimulants found included amphetamines, ephedrines, carphedon, modafinil, and anorexic compounds. No amphetamine-like designer drugs were detected. These data are indicative of the widespread prevalence of cocaine and cannabis use among the young adult population. However, due to the particular population studied, it must be considered an underestimation of the phenomenon among elite athletes with respect to the general population.

Sanchez E; Villanueva RJ; Santonja FJ; Rubio M. Predicting cocaine consumption in Spain: A mathematical modelling approach. Drugs: Education, Prevention and Policy 18(2): 108-115, 2011. (28 refs.)

In this article, we analyse the evolution of cocaine consumption in Spain and we predict consumption trends over the next few years. Additionally, we simulate some scenarios which aim to reduce cocaine consumption in the future (sensitivity analysis). Assuming cocaine dependency is a socially transmitted epidemic disease, this leads us to propose an epidemiological-type mathematical model to study consumption evolution. Model sensitivity analysis allows us to design strategies and analyse their effects on cocaine consumption. The model predicts that 3.5% of the Spanish population will be habitual cocaine consumers by 2015. The simulations carried out suggest that cocaine consumption prevention strategies are the best policy to reduce the habitual consumer population. In this article, we show that epidemiological-type mathematical models can be a useful tool in the analysis of the repercussion of health policy proposals in the short-time future.

Secades-Villa R; Garcia-Rodriguez O; Garcia-Fernandez G; Sanchez-Hervas E; Fernandez-Hermida JR; Higgins ST. Community Reinforcement Approach plus vouchers among cocaine-dependent outpatients: Twelve-month outcomes. Psychology of Addictive Behaviors 25(1): 174-179, 2011. (24 refs.)

The aims of this study were to assess the effectiveness of the Community Reinforcement Approach (CRA) plus vouchers treatment in a cohort of Spanish cocaine-dependent outpatients, and to examine the maintenance of treatment effects after the voucher intervention was discontinued. Sixty-four adult outpatients were randomly assigned to one of two treatment conditions, CRA plus vouchers or standard care. The vouchers program was implemented from weeks 1 to 24. Among patients assigned to the CRA plus vouchers condition, 65.5% completed 12 months of treatment versus 28.6% of those assigned to the standard care condition (p = .003). At the 12-month assessment, 58.6% of patients assigned to the CRA plus vouchers condition were abstinent, compared with 25.7% in the standard care condition (p = .008); furthermore, 34.5% of patients assigned to the CRA plus vouchers condition achieved twelve months of continuous cocaine abstinence, versus 17.1% in the standard care condition. Those treated in the CRA plus vouchers condition also achieved greater improvements in psychosocial functioning than those treated in the standard care condition. Overall, these results reveal an extension of the effectiveness of the CRA plus vouchers treatment to a community sample of cocaine-dependent outpatients, while also supporting the maintenance of treatment effects for 6 months after completion of the voucher program.

Shannon LM; Havens JR; Oser C; Crosby R; Leukefeld C. Examining gender differences in substance use and age of first use among rural Appalachian drug users in Kentucky. American Journal of Drug and Alcohol Abuse 37(2): 98-104, 2011. (40 refs.)

Background: Previous research suggests gender differences exist in types of substances used and age of first use. Recent studies exploring contextual differences in substance use between rural Appalachian and urban environments show different patterns of substance use in rural environments. Objective: This study explores whether previously established differences in gender and age of first use exist within a rural Appalachian environment. Methods: Data are from a community-based study of drug users in rural Appalachia (N = 400). Self-reported substance use was recorded using an interviewer-administered questionnaire with questions from the Addiction Severity Index (ASI). Results: On average, participants were 32 years old ((X) over bar = 32.33; median = 31.00; interquartile range (IQR) = 12) and the majority were male (59%). Examining the past 30-day substance use, more males reported alcohol (adjusted odds ratio (AOR): 2.11, 95% CI: 1.36, 3.23; p = .001) and any illegal drug use (AOR: 1.85, 95% CI: 1.16, 2.95; p = .010), which included heroin, cocaine, crack cocaine, methamphetamine, marijuana, and hallucinogens, after controlling for sociodemographic characteristics. ANCOVA analyses showed that males reported the use of alcohol (p = .000), marijuana (p = .007), and hallucinogens (p = .009) at a significantly younger age than females. Conclusion: Findings: suggest more men report the use of alcohol and "street" drugs, including heroin, crack cocaine, methamphetamine, marijuana, and hallucinogens. Furthermore, males report the use of alcohol, marijuana, and hallucinogens at a significantly younger age. Scientific Significance: Understanding gender differences in substance use as well as other differences among individuals living in rural Appalachia presents important opportunities to incorporate this knowledge into substance abuse early intervention, prevention, and treatment efforts.

Sherman SG; Reuben J; Chapman CS; Lilleston P. Risks associated with crack cocaine smoking among exotic dancers in Baltimore, MD. Drug and Alcohol Dependence 114(2-3): 249- 252, 2011. (20 refs.)

Background: There is a dearth of research focusing on sex work in exotic dance clubs. We conducted a cross-sectional study to examine the prevalence and correlates of crack cocaine smoking among a sample of exotic dancers. Methods: The "block," a historical red-light district in downtown Baltimore, MD, is comprised of 30 adult-entertainment establishments. Between 01/09 and 08/09, we conducted a survey with exotic dancers (N = 98). The survey explored demographic, and drug and sexual/drug risk behaviors. Bivariate and multivariate analysis was conducted using Poisson regression with robust variance estimates to examine correlates of current crack smoking. Results: Crack cocaine smokers compared to non-crack cocaine smokers were significantly more likely to report: older age (29 vs. 23 years, respectively, p < 0.0001); being White (79% vs. 50%, respectively, p = 0.008); having been arrested (93% vs. 67%, respectively, p = 0.008); daily alcohol consumption (36% vs. 17%, p = 0.047); current heroin injection (57% vs. 13%, p < 0.001); and current sex exchange (79% vs. 30%, p < 0.001). In the presence of other variables, crack cocaine smokers compared to non-crack cocaine smokers were significantly older, more likely to report current heroin injection, and more likely to report current sex exchange. Discussion: We found high levels of drug use and sexual risk behaviors as well as a number of risks behaviors associated with crack cocaine smoking among this very under-studied population. Targeted interventions are greatly needed.

Smith GW; Farrell M; Bunting BP; Houston JE; Shevlin M. Patterns of polydrug use in Great Britain: Findings from a national household population survey. Drug and Alcohol Dependence 113(2-3): 222-228, 2011. (55 refs.)

Background: Polydrug use potentially increases the likelihood of harm. As little is known about polydrug use patterns in the general population, it is difficult to determine patterns associated with highest likelihood. Methods: Latent class analysis was performed on nine illicit substance groups indicating past year use of cannabis, cocaine, amphetamines, ecstasy, LSD, mushrooms, amyl nitrate, tranquillisers and heroin or crack. Analyses were based on data from a large multi-stage probability sample of the population of Great Britain (n=8538) collected in 2000. Multinomial logistic regression was performed highlighting associations between classes, and demographic and mental health variables. Results: A three class solution best described patterns of polydrug use; wide range, moderate range, and no polydrug use. For males and young people, there was a significantly increased chance of being in the wide and moderate range polydrug use groups compared to the no polydrug use class. Hazardous drinking was more likely in the wide and moderate polydrug classes with odds ratios of 9.99 and 2.38 (respectively) compared to the no polydrug use class. Current smokers were more likely to be wide and moderate range polydrug users compared to the no polydrug use class with odds ratios of 4.53 and 5.85 respectively. A range of mental health variables were also related to class membership. Conclusions: Polydrug use in Great Britain can be expressed as three distinct classes. Hazardous alcohol use and tobacco use were strongly associated with illicit polydrug use, polydrug use appeared to be significantly associated with mental health, particularly lifetime suicide attempts.

Stulz N; Thase ME; Gallop R; Crits-Christoph P. Psychosocial treatments for cocaine dependence: The role of depressive symptoms. Drug and Alcohol Dependence 114(1): 41-48, 2011. (57 refs.)

Background: The association between cocaine use and depression has been frequently observed. However, less is known about the significance of depression in the treatment of cocaine use disorders. This study examined possible interrelations between drug use and depression severity among cocaine-dependent patients in psychosocial treatments for cocaine dependence. Methods: Monthly assessed drug use and depression severity scores of N=487 patients during 6-month psychosocial treatments for cocaine dependence were analyzed using hybrid latent growth models. Results: Results indicated a moderate but statistically significant (z = 3.13, p<.01) influence of depression severity on increased drug use in the upcoming month, whereas drug use did not affect future depression severity. Conclusions: Findings suggest that depression symptoms are an important predictor of drug use outcomes during psychosocial treatments for cocaine dependence and, hence, underline the importance of adequately addressing depression symptoms to improve treatment outcomes.

Terplan M; Wright T. The effects of cocaine and amphetamine use during pregnancy on the newborn: Myth versus reality. (editorial). Journal of Addictive Diseases 30(1): 1-5, 2011. (45 refs.)

Van Horn DHA; Drapkin M; Ivey M; Thomas T; Domis SW; Abdalla O et al. Voucher incentives increase treatment participation in telephone-based continuing care for cocaine dependence. Drug and Alcohol Dependence 114(2-3): 225- 228, 2011. (15 refs.)

Background:Telephone-based monitoring is a promising approach to continuing care of substance use disorders, but patients often do not engage or participate enough to benefit. Voucher incentives can increase retention in outpatient treatment and continuing care, but may be less effective when reinforcement is delayed, as in telephone-based care. We compared treatment utilization rates among cocaine-dependent patients enrolled in telephone continuing care with and without voucher incentives to determine whether incentives increase participation in telephone-based care. Method: Participants were 195 cocaine-dependent patients who completed two weeks of community-based intensive outpatient treatment for substance use disorders and were randomly assigned to receive telephone continuing care with or without voucher incentives for participation as part of a larger clinical trial. The 12-month intervention included 2 in-person orientation sessions followed by up to 30 telephone sessions. Incentivized patients could receive up to $400 worth of gift cards. Results: Patients who received incentives were not more likely to complete their initial orientation to continuing care. Incentivized patients who completed orientation completed 67% of possible continuing care sessions, as compared to 39% among non-incentivized patients who completed orientation. Among all patients randomized to receive incentives, the average number of completed sessions was 15.5, versus 7.2 for patients who did not receive incentives, and average voucher earnings were $200. Conclusions: Voucher incentives can have a large effect on telephone continuing care participation, even when reinforcement is delayed. Further research will determine whether increased participation leads to better outcome among patients who received incentives.

van Nuijs ALN; Mougel JF; Tarcomnicu I; Bervoets L; Blust R; Jorens PG et al. Sewage epidemiology: A real-time approach to estimate the consumption of illicit drugs in Brussels, Belgium. Environment International 37(3): 612-621, 2011. (33 refs.)

The sewage epidemiology approach was applied to a one-year sampling campaign in the largest wastewater treatment plant (WWTP) in Belgium. The consumption of cocaine (COC), amphetamine (AMP). methylenedioxymethamphetamine (MDMA). methamphetamine (METH), methadone (MTD) and heroin (HER) was evaluated based on measured concentrations of the parent compound and/or metabolites in daily 24-hour composite influent wastewater samples. The inevitable back-calculations used in the sewage epidemiology approach were adapted to newly available information regarding the stability of the compounds in wastewater and the excretion pattern of illicit drugs. For COC, three different back-calculation approaches were evaluated. In addition, for the first time, efforts were made to calculate the number of inhabitants living in the catchment area of the WWTP in a real-time and dynamic way, based on concentrations of nitrogen, phosphorus and oxygen in the wastewater samples. Clear variations in the amount of inhabitants in the catchment area of the WWTP were observed. For COC, AMP and MDMA a significant higher weekend use was observed while for HER and MTD no significant daily variations could be found. METH consumption was negligible. Generally, the sewage epidemiology calculations were in agreement with official statistics. This manuscript shows that sewage epidemiology provides consistent and logical results and that it is a promising tool that can be used in addition to classical studies to estimate illicit drug use in populations. Therefore, efforts should be made to further optimize this approach in the future.

Vaszari JM; Bradford S; O'Leary CC; Ben Abdallah A; Cottler LB. Risk factors for suicidal ideation in a population of community-recruited female cocaine users. Comprehensive Psychiatry 52(3): 238- 246, 2011. (53 refs.)

Introduction: Suicide, as the 11th leading cause of death in America, is a significant public health concern. Previous studies have shown that drug users are a population at especially high risk for suicidal ideation (SI). Although most people who think about killing themselves do not ultimately commit suicide, identifying those at risk for such thoughts is important. Methods: In this analysis, data from a sample of 462 cocaine-using women (87% African American) recruited using street outreach methods for a National Institute on Drug Abuse-funded study were examined to identify risk factors for lifetime SI. Sociodemographic factors, adverse childhood experiences, sexual behaviors, psychiatric comorbidities, and drug abuse and dependence were examined as potential risk factors using both bivariate and logistic regression analysis. Results: Fifty percent of the sample met at least one criterion for lifetime SI, and 32% of the sample reported a lifetime suicide attempt. In the final logistic regression model, childhood physical abuse, childhood sexual abuse, rape after the age of 15 years, posttraumatic stress disorder, and number of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, depression criteria met emerged as significant independent predictors of lifetime SI. Conclusion: These findings identify important risk factors for SI among female substance abusers in community settings.

Viana M; Postigo C; Querol X; Alastuey A; de Alda MJL; Barcelo D et al. Cocaine and other illicit drugs in airborne particulates in urban environments: A reflection of social conduct and population size. Environmental Pollution 159(5, special issue): 1241- 1247, 2011. (12 refs.)

Levels of cocaine and other psychoactive substances in atmospheric particulate matter (PM) were determined in urban environments representing distinct social behaviours with regard to drug abuse: night-life, university and residential areas. Three cities (with population >1 million and <0.3 million inhabitants) were selected. Mean daily levels of drugs in PM were 11-336 pg/m(3) for cocaine, 23-34 pg/m(3) for cannabinoids, and 5-90 pg/m(3) for heroin. The highest levels were recorded on weekends, with factors with respect to weekdays of 1-3 for cocaine, 1-2 for cannabinoids and 1.1-1.7 for heroin. Higher levels were detected in the night-life areas, pointing towards consumption and trafficking as major emission sources, and possibly ruling out drug manufacture. The similarities in temporal trends at all sites suggested a city-scale transport of psychoactive substances. Correlations were detected between cocaine and amphetamine consumption (r(2) = 0.98), and between heroin and cannabinoids (r(2)>0.82).

Waiser MJ; Humphries D; Tumber V; Holm J. Effluent-dominated streams. Part 2: Presence and possible effects of pharmaceuticals and personal care products in Wascana Creek, Saskatchewan, Canada. Environmental Toxicology and Chemistry 30(2): 508-519, 2011. (58 refs.)

Recent worldwide surveys have not only established incomplete removal of pharmaceuticals and personal care products (PPCPs) by sewage treatment plants, but also their presence in surface waters receiving treated sewage effluent. Those aquatic systems where sewage effluent dominates flow are thought to be at the highest risk for ecosystem level changes. The city of Regina, Saskatchewan, Canada (population 190,400) treats its sewage at a modern tertiary sewage treatment facility located on Wascana Creek. The Wascana Creek hydrograph is dominated by one major event: spring snow melt. Thereafter, creek flow declines considerably and in winter treated sewage effluent makes up almost 100% of stream flow. Four water surveys conducted on the creek from winter 2005 to spring 2007 indicated that PPCPs were always present, in nanogram and sometimes microgram per liter concentrations downstream of the sewage treatment plant. This mixture included antibiotics, analgesics, antiinflammatories, a lipid regulator, metabolites of caffeine, cocaine and nicotine, and an insect repellent. Not surprisingly, concentrations of some PPCPs were highest in winter. According to hazard quotient calculations and homologue presence, ibuprofen, naproxen, gemfibrozil, triclosan, erythromycin, trimethoprim, and sulfamethoxazole were present in Wascana Creek at concentrations that may present a risk to aquatic organisms. The continual exposure to a mixture of pharmaceuticals as well as concentrations of un-ionized ammonia that far exceed Canadian and American water quality guidelines suggests that Wascana Creek should be considered an ecosystem at risk. Although the Wascana Creek study is regional in nature, the results highlight the considerable risks posed to aquatic organisms in such effluent-dominated ecosystems.

Watkins S; Holmes PA; Howard RS. Ictal asystole due to unsuspected cocaine abuse. (editorial). Clinical Medicine 11(2): 199-200, 2011. (9 refs.)

Wheeler RA; Aragona BJ; Fuhrmann KA; Jones JL; Day JJ; Cacciapaglia F et al. Cocaine cues drive opposing context-dependent shifts in reward processing and emotional state. Biological Psychiatry 69(11): 1067- 1074, 2011. (49 refs.)

Background: Prominent neurobiological theories of addiction posit a central role for aberrant mesolimbic dopamine release but disagree as to whether repeated drug experience blunts or enhances this system. Although drug withdrawal diminishes dopamine release, drug sensitization augments mesolimbic function, and both processes have been linked to drug seeking. One possibility is that the dopamine system can rapidly switch from dampened to enhanced release depending on the specific drug-predictive environment. To test this, we examined dopamine release when cues signaled delayed cocaine delivery versus imminent cocaine self-administration. Methods: Fast-scan cyclic voltammetry was used to examine real-time dopamine release while simultaneously monitoring behavioral indexes of aversion as rats experienced a sweet taste cue that predicted delayed cocaine availability and during self-administration. Furthermore, the impact of cues signaling delayed drug availability on intracranial self-stimulation, a broad measure of reward function, was assessed. Results: We observed decreased mesolimbic dopamine concentrations, decreased reward sensitivity, and negative affect in response to the cocaine-predictive taste cue that signaled delayed cocaine availability. Importantly, dopamine concentration rapidly switched to elevated levels to cues signaling imminent cocaine delivery in the subsequent self-administration session. Conclusions: These findings show rapid, bivalent contextual control over brain reward processing, affect, and motivated behavior and have implications for mechanisms mediating substance abuse.

Whitaker TM; Bada HS; Bann CM; Shankaran S; LaGasse L; Lester BM et al. Serial pediatric symptom checklist screening in children with prenatal drug exposure. Journal of Developmental and Behavioral Pediatrics 32(3): 206-215, 2011. (38 refs.)

Objective: To examine screening results obtained by serial annual behavioral assessment of children with prenatal drug exposure. Method: The Maternal Lifestyle Study enrolled children with prenatal cocaine exposure (PCE) at birth for longitudinal assessments of developmental, behavioral, and health outcomes. At 8, 9, 10, 11, and 12 years of age, caregivers rated participants on the Pediatric Symptom Checklist (PSC). Serial PSC results were compared with an established broad-based behavioral measure at 9, 11, and 13 years. PSC results were analyzed for 1081 children who had at least 2 annual screens during the 5-year time span. Most subjects (87%) had 4 or more annual screens rated by the same caregiver (80%). PSC scores (and Positive screens) over time were compared at different time points for those with and without PCE. Covariates, including demographic factors and exposures to certain other substances, were controlled. Results: Children with PCE had significantly higher scores overall, with more Positive screens for behavior problems than children without PCE. Children with PCE had more externalizing behavior problems. Children exposed to tobacco prenatally and postnatally also showed higher PSC scores. Over time, PSC scores differed slightly from the 8-year scores, without clear directional trend. Earlier PSC results predicted later behavioral outcomes. Conclusion: Findings of increased total PSC scores and Positive PSC screens for behavioral concerns in this group of children with prenatal substance exposure support the growing body of evidence that additional attention to identification of mental health problems may be warranted in this high-risk group.

Wilcox CE; Teshiba TM; Merideth F; Ling J; Mayer AR. Enhanced cue reactivity and fronto-striatal functional connectivity in cocaine use disorders. Drug and Alcohol Dependence 115(1-2): 137- 144, 2011. (67 refs.)

Chronic cocaine use is associated with enhanced cue reactivity to drug stimuli. However, it may also alter functional connectivity (fcMRI) in regions involved in processing drug stimuli. Our aims were to evaluate the neural regions involved in subjective craving and how fcMRI may be altered in chronic cocaine users. Fourteen patients with a confirmed diagnosis of cocaine abuse or dependence (CCA) and 16 gender, age, and education-matched healthy controls (HC) completed a cue reactivity task and a resting state scan while undergoing functional magnetic resonance imaging. CCA showed increased activation compared to HC in left dorsolateral prefrontal and bilateral occipital cortex in response to cocaine cues but not to appetitive control stimuli. Moreover. CCA also showed increased activation within the orbital frontal cortex (OFC) for cocaine cues relative to the appetitive stimuli during a hierarchical regression analysis. A negative association between subjective craving and activity in medial posterior cingulate gyrus (PCC) was also observed for CCA. CCA exhibited increased resting state correlation (positive) between cue-processing seed regions (OFC and ventral striatum), and negative connectivity between cue-processing regions and PCC/precuneus. These alterations in fcMRI may partially explain the neural basis of increased drug cue salience in CCA.

Wimmer K; Schneider S. Screening for illicit drugs on Euro banknotes by LC-MS/MS. Forensic Science International 206(1-3): 172-177, 2011. (22 refs.)

A method for the simultaneous quantification of illicit drugs on Euro banknotes, using an ultra-performance liquid chromatography tandem mass spectrometry, was developed and validated. The method included cocaine, benzoylecgonine, MDMA, MDEA, MDA, methamphetamine, diacetylmorphine, 6-MAM, morphine and Delta(9)-THC. Drug residues were monitored and quantified via positive ESI mode using multiple reaction monitoring. Banknotes were extracted with methanol by vigorous shaking. Recovery rates were in the range of 60-80%. Calibration was performed with spiked banknotes in the range of 10-100 ng/note (R-2 0.98-0.99). Intra-day analysis showed fair precision and accuracy (<= 15%). Matrix effects were in the range from 27% to 235%. 7-15 samples of each denomination were analyzed. The calculated median values per note were 106 ng cocaine, 43 ng benzoylecgonine, 41 ng heroin, 15.5 ng 6-MAM, 16.5 ng morphine, 9 ng MDMA and 7 ng methamphetamine. Delta(9)-THC was detected on 4 banknotes. MDEA and MDA were not detected on any note. A widespread background contamination for cocaine and opiates was demonstrated.

Winstanley EL; Bigelow GE; Silverman K; Johnson RE; Strain EC. A randomized controlled trial of fluoxetine in the treatment of cocaine dependence among methadone-maintained patients. Journal of Substance Abuse Treatment 40(3): 255-264, 2011. (31 refs.)

Background: Cocaine abuse and dependence continue to be widespread. Currently, there are no pharmacotherapies shown to be effective in the treatment of cocaine dependence. Methods: A 33-week outpatient clinical trial of fluoxetine (60 mg/day, po) for cocaine dependence that incorporated abstinence-contingent voucher incentives was conducted. Participants (N = 145) were both cocaine and opioid dependent and treated with methadone. A stratified randomization procedure assigned subjects to one of four conditions: fluoxetine plus voucher incentives (FV), placebo plus voucher incentives (PV), fluoxetine without vouchers (F), and placebo without vouchers (P). Dosing of fluoxetine/placebo was double blind. Primary outcomes were treatment retention and cocaine use based on thrice-weekly urine testing. Results: The PV group had the longest treatment retention (M = 165 days) and lowest probability of cocaine use. The adjusted predicted probabilities of cocaine use were 65% in the P group, 60% in the F group, 56% in the FV group, and 31% in the PV group. Conclusions: Fluoxetinc was not efficacious in reducing cocaine use in patients dually dependent on cocaine and opioids.

Wise RA; Kiyatkin EA. Differentiating the rapid actions of cocaine. (review). Nature Reviews. Neuroscience 12(8): 479-484, 2011. (74 refs.)

The subjective effects of intravenous cocaine are felt almost immediately, and this immediacy plays an important part in the drug's rewarding impact. The primary rewarding effect of cocaine involves blockade of dopamine reuptake; however, the onset of this action is too late to account for the drug's initial effects. Recent studies suggest that cocaine-predictive cues-including peripheral interoceptive cues generated by cocaine itself-come to cause more direct and earlier reward signalling by activating excitatory inputs to the dopamine system. The conditioned activation of the dopamine system by cocaine-predictive cues offers a new target for potential addiction therapies.

Wu LT; Woody GE; Yang CM; Blazer DG. How do prescription opioid users differ from users of heroin or other drugs in psychopathology: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Addiction Medicine 5(1): 28-35, 2011. (26 refs.)

Objectives: To study substance use and psychiatric disorders among prescription opioid users, heroin users, and nonopioid drug users in a national sample of adults. Methods: Analyses of data from the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093). Results: Four groups were identified among 9140 illicit or nonprescribed drug users: heroin-other opioid users (1.0%; used heroin and other opioids), other opioid-only users (19.8%; used other opioids but never heroin), heroin-only users (0.5%; used heroin but never other opioids), and nonopioid drug users (78.7%; used drugs but never heroin or other opioids). After adjusting for variations in socioeconomic characteristics, history of substance abuse treatment, and familial substance abuse, heroin-other opioid users had greater odds of several substance use disorders (SUDs; cocaine, hallucinogen, sedative, amphetamine, and tranquilizer) when compared with the other groups; heroin-only users had reduced odds of sedative and tranquilizer use disorders when compared with other opioid-only users. Nonopioid drug users had reduced odds of all SUDs and other mental disorders (mood, anxiety, pathologic gambling, and personality) when compared with other opioid-only users. Past-year other opioid-only users also reported slightly lower scores on quality of life than past-year nonopioid drug users. Conclusions: All opioid users had higher rates of SUDs than nonopioid drug users, and these rates were particularly increased among heroin-other opioid users. The findings suggest the need to distinguish between these 4 groups in research and treatment as they may have different natural histories and treatment needs.

Yorgason JT; Jones SR; Espana RA. Low and high affinity dopamine transporter inhibitors block dopamine uptake within 5 sec of intravenous injection. Neuroscience 182: e125- 132, 2011. (68 refs.)

Extensive evidence suggests that the reinforcing effects of cocaine involve inhibition of dopamine transporters (DAT) and subsequent increases in dopamine (DA) levels in the striatum. We have previously reported that cocaine inhibits the DAT within 4-5 s of i.v. injection, matching the temporal profile of the behavioral and subjective effects of cocaine. Intravenous injection of GBR-12909, a high affinity, long-acting DAT inhibitor, also inhibits DA uptake within 5 s. Given that high affinity, long-acting drugs are considered to have relatively low abuse potential, we found it intriguing that GBR-12909 had an onset profile similar to that of cocaine. To further explore the onset kinetics of both low and high affinity DAT inhibitors, we examined the effects of i.v. cocaine (1.5 mg/kg), methylphenidate (1.5 mg/kg), nomifensine (1.5 mg/kg), GBR-12909 (1.5 mg/kg), PTT (0.5 mg/kg), and WF23 (0.5 mg/kg) on electrically-evoked DA release and uptake in the nucleus accumbens core. Results indicate that all of the DAT inhibitors significantly inhibited DA uptake within 5 s of injection. However, the timing of peak uptake inhibition varied greatly between the low and high affinity uptake inhibitors. Uptake inhibition following cocaine, methylphenidate, and nomifensine peaked 30 s following injection. In contrast, peak effects for GBR-12909, PTT, and WF23 occurred between 20 and 60 min following injection. These observations suggest that the initial onset for iv. DAT inhibitors is extremely rapid and does not appear to be dictated by a drug's affinity.