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CORK Bibliography: Cocaine

104 citations. October 2006 to present

Prepared: September 2007

Accornero VH; Amado AJ; Morrow CE; Xue LH; Anthony JC; Bandstra ES. Impact of prenatal cocaine exposure on attention and response inhibition as assessed by continuous performance tests. Journal of Developmental and Behavioral Pediatrics 28(3): 195-205, 2007. (61 refs.)

Objective: This study examined the influence of prenatal cocaine exposure on attention and response inhibition measured by continuous performance tests (CPTs) at ages 5 and 7 years. Methods: The baseline sample consisted of 253 cocaine-exposed and 223 non-cocaine-exposed children enrolled prospectively at birth and assessed comprehensively through age 7 years in the longitudinal Miami Prenatal Cocaine Study. This report includes a subsample of 415 children (219 cocaine-exposed, 196 non-cocaine-exposed) who completed at least one CPT assessment at ages 5 and/or 7 years. Prenatal cocaine exposure was measured by maternal self-report and maternal and infant bioassays. Deficits in attention and response inhibition are estimated in relation to prenatal cocaine exposure using generalized estimating equations within the general linear model. Results: Results indicate cocaine-associated increases in omission errors at ages 5 and 7 as well as increases in response times for target tasks (i.e., slower reaction times) and decreased consistency in performance at age 7. There were no demonstrable cocaine-associated deficits in commission errors. Estimates did not change markedly with statistical adjustment for selected prenatal and postnatal covariates. Conclusion: Evidence supports cocaine-associated deficits in attention processing through age 7 years.

Adrian M; Truong MV; Osazuwa T. Measuring levels of co-morbidity in drug user emergency patients treated in Ontario hospitals. Substance Use & Misuse 42(2/3): 199-224, 2007. (59 refs.)

We examined the nature and extent of health problems in drug user patients initially treated in emergency departments and who were subsequently admitted to all hospitals in Ontario, using data from the Hospital Medical Records Institute (HMRI). The modified standardized morbidity ratio (modified SMR) is introduced to improve the measurement and visual display of reduced morbidity as well as excess morbidity. During 1985-86, about 75% of drug user patients entered hospital through the emergency department. There were 5077 emergency patients with primary drug use-related diagnoses and 9827 with secondary drug use-related diagnoses. Cases with poisoning diagnosis made up over 80% of all drug use cases treated in emergency departments. Cases with non-dependent abuse of drugs accounted for 8-12% of emergency drug user patients, whereas those with drug dependence accounted for about 3% of emergency drug user patients. These patients had more than three times the comorbidity experience of all hospital patients. They had excess comorbidity due to mental disorders, infectious and parasitic disorders, and injury and poisoning diagnoses. However, they had reduced comorbidity due to complications of pregnancy, childbirth, and the puerperium and from congenital anomalies and conditions originating in the perinatal period. Cocaine patients were more likely to have infectious parasitic diseases and diseases of the skin and subcutaneous tissue, while amphetamine patients were more likely to have diseases of the digestive system and of the musculo-skeletal system and connective tissue.

Bansal D; Eigenbrodt M; Gupta E; Mehta JL. Traditional risk factors and acute myocardial infarction in patients hospitalized with cocaine-associated chest pain. Clinical Cardiology 30(6): 290-294, 2007. (25 refs.)

Background: Cocaine causes coronary artery constriction and may cause acute myocardial infarction (AMI). The role of traditional coronary risk factors in cocaine-associated myocardial infarction is unclear. Hypothesis: We hypothesized that traditional risk factors play a major role in predicting AMI in patients admitted with cocaine-associated chest pain Methods: After reviewing, 165 admissions for chest pain in patients with a history of recent cocaine use and/or a positive drug screen from January 2001 to December 2004, we identified 151 patients with information available on at least 6 of the following, 7 risk factors: gender, hypertension, hyperlipidemia, diabetes, smoking, family history of coronary artery disease (CAD) and known CAD. AMI was diagnosed using WHO criteria. A risk score was calculated on the basis of the number of risk factors, gender and age. Association of AMI was evaluated with the individual risk factors and with the risk score. Results: AMI was identified in 21 patients (14%). All patients diagnosed with AMI were smokers. Continuous risk score (p < 0.0001), highest vs. lowest quartile of risk score (p = 0.007), known CAD, age, hyperlipidemia and family history of CAD were individually associated with the diagnosis of AMI (p <= 0.05). Each quartile of risk score was associated with increased odds of the diagnosis of AMI and score of 8 or higher was statistically significant. Conclusion: Several traditional risk factors are associated with the diagnosis of AMI among patients hospitalized with cocaine-associated chest pain and increasing risk factor score was associated with increasing odds of AMI diagnosis.

Bastos FI; Caiaffa W; Rossi D; Vila M; Malta M. The children of mama coca: Coca, cocaine and the fate of harm reduction in South America. (editorial). International Journal of Drug Policy 18(2): 99-106, 2007. (34 refs.)

The paper reviews the main findings from substance misuse research carried out over the last two decades in South America looking at the main initiatives aimed at reducing drug related harm and curbing the spread of HIV/AIDS and other sexually transmitted and blood-borne diseases. The current challenges faced by harm reduction in the region are analysed from the perspective of the history of coca and its different uses in South America. Except in Brazil and Argentina, the implementation of initiatives to reduce drug related harm in South America has been very cautious. The paper aims to link the analysis of harms associated with the use of illicit substances, with the often paradoxically harmful effects of supply-side drug policies in the world's largest coca/cocaine producing area. Despite the undeniable success of many initiatives, the broader context of harm maximization through structural violence and entrenched corruption acts as a major disincentive for the comprehensive adoption of sound public health policies.

Bell SC; Hanes RD. A microfluidic device for presumptive testing of controlled substances. Journal of Forensic Sciences 52(4): 884-888, 2007. (11 refs.)

A simple microfluidic device (MFD) has been developed to perform multiple color and crystal tests for controlled substance analysis. The MFD method uses less sample and reagents and generates less waste than traditional spot plate methods while performing several tests simultaneously. This methodology provides significantly more analytical information for a single sample analysis. The current generation device is the size of a microscope slide with four analytical channels: one for microcrystal tests and three for color tests. The optimized devices were subjected to a rigorous validation study using comparative replicate analyses and several operators. Target analytes were methamphetamine, amphetamine, cocaine, and oxycodone and color test reagents used were the Marquis, Simon, and cobalt thiocyanate. For the crystal tests, platinic chloride was used. The validation study showed the MFD's limits of detection to be in the picogram range. Positive tests results were observed in complex mixtures in which the controlled substance was present at concentrations of 5-10% (w/w). The microcrystal reagents showed greater sensitivity than color test reagents when used in the device. Reagent use and waste generation using the devices was 95% less that that used and generated using the traditional methods. The device performance was also shown to be operator independent.

Bhinder SK; Majithia V. Cocaine use and its rheumatic manifestations: A case report and discussion. Clinical Rheumatology 26(7): 1192-1194, 2007. (14 refs.)

Cocaine use can be associated with a wide spectrum of rheumatic manifestations. It poses a diagnostic challenge as the patients usually withhold the information of cocaine use, and no serological tests are available to establish this diagnosis. We report a patient with vasculopathic syndrome secondary to cocaine use. Despite initial denial of drug abuse, skin biopsy suggested the diagnosis, which was subsequently confirmed by urine drug testing. Differentiating cocaine-associated pseudovasculitis from true vasculitis is necessary, as conventional treatment is usually ineffective without complete abstinence from cocaine use and may be associated with significant morbidity as well as mortality.

Bono KE; Sheinberg N; Scott KG; Claussen AH. Early intervention for children prenatally exposed to cocaine. Infants and Young Children 20(1): 26-37, 2007. (59 refs.)

This article brings together information from our experience of providing research-based intervention to more than 600 children who were prenatally exposed to cocaine and from the research literature on the effects of prenatal cocaine exposure. Based on our experience and this literature, it is now clear that there are no large negative independent effects of cocaine exposure and that there is no "crack baby" syndrome. However, many of these children who have been exposed to cocaine are at risk for poor developmental outcomes, particularly in the area of language development, primarily because of the environmental factors that are associated with parental substance abuse. As our intervention research shows, early intervention can be effective in ameliorating some of this risk. Suggestions are made regarding programmatic steps that should be taken next to further improve program effectiveness and enhance the knowledge base.

Camprodon JA; Martinez-Raga J; Alonso-Alonso M; Shih MC; Pascual-Leone A. One session of high frequency repetitive transcranial magnetic stimulation (rTMS) to the right prefrontal cortex transiently reduces cocaine craving. Drug and Alcohol Dependence 86(1): 91-94, 2007. (20 refs.)

Background: Cocaine dependence is a public health problem affecting 2 million individuals in USA. Craving is a predictor of subsequent cocaine use and is related to changes in brain activity in networks involving the prefrontal cortex. Methods: We investigated the efficacy of one session of high frequency repetitive transcranial magnetic stimulation (rTMS) to reduce craving in cocaine addicted subjects. Six patients underwent two sessions of 10 Hz rTMS over left or right dorsolateral prefrontal cortex (DLPFC). Before, immediately after and 4 h after rTMS we measured craving using visual analogue scales. Results: Right. but not left, DLPFC stimulation significantly reduced craving over time (F(2,10)= 11.07, p=0.0029). The reduction was 19% (13.4-24.6%) from baseline and disappeared after 4 h. The interaction of time by site of stimulation for craving was also significant (F(2,25) = 6.13, p = 0.0068). Conclusion: One session of 10 Hz rTMS over right, but not left, DLPFC transiently reduces craving in cocaine dependent individuals. These results highlight the potential of non-invasive neuromodulation as a therapeutic tool for cocaine addiction.

Casale JF. Cocaethylene as a component in illicit cocaine. (letter). Journal of Analytic Toxicology 31(3): 170-171, 2007. (3 refs.)

Cheng TC; McElderry CG. How do drug use and social relations affect welfare participation? Social Service Review 81(1): 155-165, 2007. (17 refs.)

This study analyzes whether welfare use is longitudinally related to drug use and various measures of social relations. It conducts secondary analyses on data from a sample of 382 women. The data, which stem from the National Longitudinal Survey of Youth, were gathered between 1984 and 2002. The results suggest that use of marijuana or cocaine does not affect women's welfare participation to a statistically significant degree. Attending religious services and receiving low levels of child support are associated with statistically significant declines in welfare participation. Changes in marital status are linked to increases in welfare participation.

Chinet L; Stephan P; Zobel F; Halfon O. Party drug use in techno nights: A field survey among French-speaking Swiss attendees. Pharmacology, Biochemistry and Behavior 86(2): 284-289, 2007. (27 refs.)

This study was designed to investigate the lifestyle and substance use habits of dance music event attendees together with their attitudes toward prevention of substance misuse, harm reduction measures and health-care resources. A total of 302 attendees aged 16-46 years (mean=22.70, S.D.=4.65) were randomly recruited as they entered dance music events. Rates for lifetime and current use (last 30 days) were particularly high for alcohol (95.3% and 86.6%, respectively), cannabis (68.8% and 53.8%, respectively), ecstasy (40.4% and 22.7%, respectively) and cocaine (35.9% and 20.7%, respectively). Several patterns of substance use could be identified: 52% were alcohol and/or cannabis only users, 42% were occasional poly-drug users and 6% were daily poly-drug users. No significant difference was observed between substance use patterns according to gender. Pure techno and open-air events attracted heavier drug users. Psychological problems (such as depressed mood, sleeping problems and anxiety attacks), social problems, dental disorders, accidents and emergency treatment episodes were strongly related to party drug use. Party drug users appeared to be particularly receptive to harm reduction measures, such as on-site emergency staff, pill testing and the availability of cool water, and to prevention of drug use provided via counseling. The greater the involvement in party drug use, the greater the need for prevention personnel to be available for counseling. General practitioners appeared to be key professionals for accessing health-care resources.

Collins SL; Evans SM; Foltin RW; Haney M. Intranasal cocaine in humans: Effects of sex and menstrual cycle. Pharmacology, Biochemistry and Behavior 86(1): 117-124, 2007. (30 refs.)

Studies have shown that smoked and intravenous cocaine's effects differ in cocaine-dependent women compared to men and across the menstrual cycle. However, this has not been systematically investigated with intranasal cocaine. Thus, a range of intranasal cocaine doses was examined in cocaine-dependent women across the menstrual cycle. Female cocaine users were admitted to the hospital once during the luteal phase and once during the follicular phase of their menstrual cycle; menstrual cycle phase during admissions was counterbalanced. During each admission, an intranasal cocaine dose-response curve (0.06, 0.34, 0.69 and 1.37 mg/kg) was determined during four laboratory sessions. Cocaine produced similar dose-related increases in ratings of "positive" subjective effects, cardiovascular effects and cocaine plasma levels in women in both menstrual cycle phases. To assess sex differences in the effects of intranasal cocaine, the current data were compared to published data collected in men using an identical procedure. Cocaine produced similar dose-related increases in ratings of positive subjective effects, cardiovascular effects and cocaine plasma levels in men and women. Thus, in contrast to studies examining smoked or intravenous cocaine administration, there were no sex differences or menstrual cycle effects on the subjective or cardiovascular response to intranasal cocaine, suggesting that the influence of sex and menstrual cycle on cocaine's effects vary as a function of route of administration.

Cox S; Johnson CH; Meikle S; Jamieson DJ; Posner SF. Trends in rates of hospitalization with a diagnosis of substance abuse among reproductive-age women, 1998 to 2003. Wowmen's Health Issues 17(2): 75-83, 2007. (33 refs.)

Objective. To describe trends in hospitalizations with a diagnosis of substance abuse among reproductive-age women from 1998-2003. Methods. Data were obtained from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Hospitalizations with a diagnosis of substance abuse were categorized into subgroups by age, primary expected payer, substance-specific diagnoses, concomitance, and hospital location. Trends in hospitalization rates per 100,000 women aged 15-44 were tested using a weighted least-squares method. Results. From 1998-2003, there was no change in the overall rate of hospitalization with a diagnosis of substance abuse among women aged 15-44. Alcohol abuse was the most common substance-specific diagnosis. The rate of hospitalization with a diagnosis of cocaine abuse decreased 22%; for a diagnosis of cannabis abuse, the rate increased 35%. The rate of hospitalization with a diagnosis of amphetamine abuse doubled from 1998-2003. Among women aged 15-24, the rate of hospitalization with a diagnosis of substance abuse increased 23%. Conclusion. Although we did not observe a change in the overall rate of substance-abuse hospitalization among reproductive-age women, there were dramatic changes in the rate of substance-specific diagnoses. These data may be used to quantify emerging trends in substance abuse and promote the use of hospital-based interventions.

Dalley JW; Fryer TD; Brichard L; Robinson ESJ; Theobald DEH; Laane K et al. Nucleus Accumbens D2/3 receptors predict trait impulsivity and cocaine reinforcement. Science 315(5816): 1267-1270, 2007. (45 refs.)

Stimulant addiction is often linked to excessive risk taking, sensation seeking, and impulsivity, but in ways that are poorly understood. We report here that a form of impulsivity in rats predicts high rates of intravenous cocaine self-administration and is associated with changes in dopamine (DA) function before drug exposure. Using positron emission tomography, we demonstrated that D2/3 receptor availability is significantly reduced in the nucleus accumbens of impulsive rats that were never exposed to cocaine and that such effects are independent of DA release. These data demonstrate that trait impulsivity predicts cocaine reinforcement and that D2 receptor dysfunction in abstinent cocaine addicts may, in part, be determined by premorbid influences.

Day M; Norman LR. An exploration of gender differences in the initiation of and attitudes toward crack cocaine use in the English-speaking Caribbean. Addiction Research & Theory 15(3): 285-297, 2007. (45 refs.)

The aim of this article is to examine the contextual factors associated with the initiation of and attitudes toward crack cocaine use from a sample of out-of-treatment male and female users from three islands in the English-speaking Caribbean. Data from 111 persons who reported using crack cocaine in the previous 30 days are analyzed. Females were more likely than males to have been initiated into crack cocaine use by a sex partner ( 63% vs. 22%, p = 0.007). Women were more likely to report a history of exchanging sex in relation to crack cocaine ( 93% vs. 66%, p < 0.0001). Most men and women reported no perception of danger associated with crack before initiation; however, at time of interview, almost everyone perceived it as very dangerous. These findings suggest the importance of developing drug education messages that are substance-specific. Given the dangers associated with crack cocaine use, special efforts must be made to prevent initiation of use.

de Azevedo RCS; Botega NJ; Guimaraes LAM. Crack users, sexual behavior and risk of HIV infection. Revista Brasileira de Psiquiatria 29(1): 26-30, 2007. (40 refs.)

Objective: To compare a sample of injecting cocaine users and crack users, assessing sexual behavior, risk for infection by HIV and its seroprevalence. Method: 109 injecting cocaine users and 132 crack users were assessed, using the World Health Organization questionnaire from the expanded "Cross-Site Study of Behaviors and HIV Seroprevalence among Injecting Drug Users" and HIV serology. Data were assessed by Multiple Correspondences Analysis. Results: Crack users showed less time of drug consumption when compared to the injecting cocaine users. Despite this fact, they had higher rates of risky sexual activity, differences in poli-consumption of drugs, and higher rates of involvement in illegal issues. HIV seroprevalence among crack users, although lower than for injecting cocaine users (7% vs. 33%) is high when compared to the general population at the same age. Conclusions: Sexual behavior of crack users in the studied sample may be considered a risk factor for HIV infection. Crack users have access to information on HIV/AIDS, but do not make use of it to change risk behaviors that may expose them to HIV infection and dissemination. HIV seroprevalence among crack users (7%) is concerning, which makes it necessary to create preventive strategies for HIV infection and dissemination that are specifically directed toward this population.

Decelle L; Cosyns JP; Georges B; Jadoul M; Lefebvre C. Acute interstitial nephritis after cocaine sniffing. Clinical Nephrology 67(2): 105-108, 2007. (14 refs.)

We report the case of a 42-year-old man who developed biopsy-confirmed acute interstitial nephritis (AIN) after cocaine sniffing. He required a few hemodialysis sessions but fully recovered within 3 weeks after cocaine withdrawal and a short course of corticosteroids. AIN should be recognized as a potential cause of acute renal failure in cocaine users, and a history of cocaine use should be carefully elicited in patients with unexplained AIN.

Duggal HS. Cocaine use as a risk factor for ziprasidone-induced acute dystonia. General Hospital Psychiatry 29(3): 278-279, 2007. (17 refs.)

Cocaine use is an under-recognized risk factor of antipsychotic-induced acute dystonia. A case of a patient with psychotic illness and concurrent cocaine use developing acute dystonia with ziprasidone is described.

Easton CJ; Babuscio T; Carroll KM. Treatment retention and outcome among cocaine-dependent patients with and without active criminal justice involvement. Journal of the American Academy of Psychiatry and the Law 35(1): 83-91, 2007. (33 refs.)

In this study, we examined differences between cocaine- and alcohol-dependent patients with and without active criminal justice involvement. Data were combined from two randomized controlled trials, in which 243 participants were randomly assigned to manual-guided behavioral therapies and medication (either disulfiram or placebo). Fifty-five (23%) participants of the combined sample had active criminal justice involvement, defined as being referred to treatment by a court official or a probation or parole officer. Regarding treatment outcome, there were no significant differences between participants with and without criminal justice involvement with regard to frequency of cocaine or other substance use during the three months of study treatment or the one-year follow-up. Although the criminal justice-referred group had significantly more new arrests during the one-year follow-up, when antisocial personality disorder was utilized as a covariate, there were no significant differences between criminal justice groups in number of arrests at the one-year follow-up. These data suggest that participants with active criminal justice involvement do not necessarily have poorer retention or substance use outcomes than do individuals who are self-referred or referred by other sources when treated in well-defined protocols.

Epstein AE. Baseball, crackers, green dust, nose candy, and snow cones: Cocaine, defibrillation, and ICDs (editorial). Journal of Cardiovascular Electrophysiology 18(7): 726-727, 2007. (17 refs.)

This editorial provides a commentary on an article in this issu by Chen et al. which identifies a heretofore unrecognized cardiovascular problem associated with cocaine use, elevation of the defibrillation threshhold.

Forrester MB; Merz RD. Risk of selected birth defects with prenatal illicit drug use, Hawaii, 1986-2002. Journal of Toxicology and Environmental Health. Part A, Current Issues 70(1): 7-18, 2007. (50 refs.)

The literature on the association between prenatal illicit drug use and birth defects is inconsistent. The objective of this study was to determine the risk of a variety of birth defects with prenatal illicit drug use. Data were derived from an active, population-based adverse pregnancy outcome registry. Cases were all infants and fetuses with any of 54 selected birth defects delivered during 1986 - 2002. The prenatal methamphetamine, cocaine, or marijuana use rates were calculated for each birth defect and compared to the prenatal use rates among all deliveries. Among all deliveries, the prenatal use rate was 0.52% for methamphetamine, 0.18% for cocaine, and 0.26% for marijuana. Methamphetamine rates were significantly higher than expected for 14 (26%) of the birth defects. Cocaine rates were significantly higher than expected for 13 (24%) of the birth defects. Marijuana rates were significantly higher than expected for 21 (39%) of the birth defects. Increased risk for the three drugs occurred predominantly among birth defects associated with the central nervous system, cardiovascular system, oral clefts, and limbs. There was also increased risk of marijuana use among a variety of birth defects associated with the gastrointestinal system. Prenatal uses of methamphetamine, cocaine, and marijuana are all associated with increased risk of a variety of birth defects. The affected birth defects are primarily associated with particular organ systems.

Fox HC; Axelrod SR; Paliwal P; Sleeper J; Sinha R. Difficulties in emotion regulation and impulse control during cocaine abstinence. Drug and Alcohol Dependence 89(2-3): 298-301, 2007. (21 refs.)

Rationale: Prior research has shown that cocaine dependence is associated with dysfunction of brain systems involved in emotions and motivational states. Objectives: To examine whether difficulties in emotion regulation are associated with early cocaine abstinence using the recently validated Difficulties in Emotion Regulation Scale (DERS). Method: Recently abstinent treatment-seeking cocaine patients (n = 60) completed the DERS during their first week of inpatient treatment and at discharge (3-4 weeks later), and scores were compared with community controls (n = 50). Results: Compared with controls, cocaine-dependent individuals reported difficulties relating to understanding emotions, managing emotions and impulse control in the first week of abstinence. With continued abstinence, cocaine-dependent individuals showed continued difficulties only in impulse control. Conclusion: Cocaine-dependent individuals report emotion regulation difficulties, particularly during early abstinence. Additionally, protracted distress-related impulse control problems suggest potential relapse vulnerability.

Franken IHA; van Strien JW; Franzek EJ; de Wetering BJV. Error-processing deficits in patients with cocaine dependence. Biological Psychology 75(1): 45-51, 2007. (40 refs.)

Cocaine abuse and addiction can be characterized by a persisting use of cocaine in the face of adverse consequences. In the present study we focus on one specific element of adverse consequences: the making of errors. The aim of this study was to determine whether cocaine-dependent persons have error-processing deficits as measured using error-related negativity (ERN) and error positivity (Pe). Event-related potentials (ERPs) during an Eriksen flanker task were recorded from cocaine-dependent patients and a control group. Cocaine-addicted patients showed reduced ERN and Pe components as compared to a control group. On the behavioral level, patients showed reduced post-error accuracy improvement. The present findings reveal that cocaine addiction is associated with reduced error processing and impaired behavioral correction of errors after an error is made. These deficits may be associated with a compromised dopamine system. It is argued that these cognitive deficits may contribute to the maintenance of the cocaine addiction.

Garcia-Algar O; Felipe A; Puig C; Monleon T; Pacifici R; Pichini S. Fetal exposure to cocaine and infections during the first 18 months of life in infants from a mediterranean city. Acta Paediatrica 96(5): 762-763, 2007. (5 refs.)

Aim: The incidence of infections during the first 18 months of life was investigated in 36 infants prenatally exposed to cocaine and in 72 non-exposed controls from Barcelona, Spain. Methods: Fetal exposure to cocaine was ascertained by meconium analysis, infections by structured questionnaire. Results: A higher incidence of infections, if excluding those acquired in utero, was not found in exposed infants versus non-exposed infants of similar demographical and socioeconomic characteristics. Conclusions: A possible role for life style factor in those cases where increased infections are associated with fetal exposure to cocaine is hypothesized.

Garlow SJ; Purselle DC; Heninger M. Cocaine and alcohol use preceding suicide in African American and white adolescents. Journal of Psychiatric Research 41(6): 530-536, 2007. (46 refs.)

The goal of this investigation was to determine whether cocaine and ethanol use was a differentiating factor between African American and white teenage suicide victims. This is a retrospective analysis of medical examiner's records of all completed suicides in Fulton County, GA from 01/1989 to 12/2003, and included 1296 cases. There were 79 suicide victims aged 19 and younger during the study interval, and of this group, 49 (62%) were African American, 26 (33%) were white, and 4 (5%) other race, compared to adults (20 <= years) where 28.5% were African American, 68.6% white and 2.9% other race (chi(2) = 42.678, d.f. = 2, p < 0.0001). Of the black teenaged victims, 82.2% had no cocaine or alcohol detected at autopsy, while 41.7% of the white victims were positive for one or both substance (chi(2) = 4.633, d.f. 1, p = 0.04). Only 8.9% of the black teenage suicide victims had used cocaine prior to death compared to 28% of the whites (chi(2) = 4.432; d.f. = 1; p < 0.04). The suicide rate (suicide/100,000/year) for black teens was 5.48 compared to 4.16 for whites, but the rate of cocaine positive teen suicides was 1.12 for whites and 0.45 for blacks. The pattern of cocaine use changes dramatically in the adult group, with 27% of African American suicide victims compared to 7.7% of whites being positive (chi(2) = 73.272; d.f. = 1; p < 0.001). Use of intoxicating substances does differentiate teenage suicide victims, as only a small proportion of black teenagers had used cocaine or alcohol prior to death compared to almost half of all whites.

Garrity TF; Leukefeld CG; Carlson RG; Falck RS; Wang JC; Booth BM. Physical health, illicit drug use, and demographic characteristics in rural stimulant users. Journal of Rural Health 23(2): 99-107, 2007. (30 refs.)

Context: There is growing concern about illicit rural stimulant use, especially regarding methamphetamine use and its health consequences. Purpose: The present study describes associations between aspects of stimulant use and illness experience in rural areas, with additional focus on the role of demographic characteristics in these associations. Methods: The research participants were 710 stimulant drug users who were recruited from rural areas of Arkansas, Kentucky, and Ohio using Heckathorn's respondent-driven sampling method. Health was measured by self-reports of perceived health and extent of current, recent, and lifelong health problems. Drug use was measured with self-reports of type and frequency of use. Findings: Several associations were found between drug use and illness, controlling for demographics. Stimulant use pattern related significantly with the sum of health problems in the previous 6 months and the sum of lifetime illness diagnoses, after adjustment for demographic factors. Extent of illicit drug use in the past month and self-perceived drug and alcohol problems were associated with several measures of health. Conclusions: In this sample of stimulant users, methamphetamine use was associated with fewer recent medical problems than crack cocaine, combined crack and powder cocaine use, and use of all 3 of these stimulants. These results, across the 3 sites, suggest that prevalent assumptions about the methamphetamine "plague" and its negative health consequences must be viewed cautiously and examined with additional research.

Ghitza UE; Epstein DH; Preston KL. Nonreporting of cannabis use: Predictors and relationship to treatment outcome in methadone maintained patients. Addictive Behaviors 32(5): 938-949, 2007. (30 refs.)

Underreporting of drug use is common and influenced by multiple factors. Cannabis (THC) use nonreporting and its relationship to heroin and cocaine use were investigated in 690 patients enrolled in 25-to 29-week clinical trials of contingency management plus methadone maintenance. Urine specimens and self-reports of drug use were collected 3 times/week. Potential predictors of THC use nonreporting were analyzed by multiple logistic regression; relationships between THC use nonreporting and % cocaine- and opiate-positive urines were analyzed by multiple regression. Compared to non-THC users (n = 317), patients with THC-positive urines (n = 373) were more likely to be male and have more years of THC use, but were not different on other characteristics. Nonreporting to user ratios were: THC 191/373 (51.2%); opiates 17/686 (2.5%); cocaine 21/681 (3.1%). Predictors of THC use nonreporting were low rate of THC-positive urines during treatment, fewer days of THC use in the last 30 before treatment, African-American race, and absence of antisocial personality disorder. Nonreporting of THC use was associated with significantly greater opiate and cocaine use. Contingency management decreased cocaine use in THC nonreporters to the level of reporters. Nonreporting of THC use is a significant predictor of greater cocaine and heroin use. This association can be eliminated with contingency management therapy.

Ghitza UE; Rothman RB; Gorelick DA; Henningfield JE; Baumann MH. Serotonergic responsiveness in human cocaine users. Drug and Alcohol Dependence 86(2/3): 207-213, 2007. (56 refs.)

Background: Animal experiments show that repeated cocaine injections induce changes in brain serotonin (5-hydroxytryptamine, or 5-HT) function which can be detected by altered neuroendocrine responsiveness to serotonergic drug challenge. Studies of human cocaine users given a serotonergic challenge have produced inconsistent results. Methods: Hormone responses evoked by the 5-HT releaser D,L-fenflurainine (FEN) were examined in eight human cocaine users who resided on a closed research ward. FEN (60 rug oral) was given after a 7-day cocaine-free period and 3 days after a 5-day period of daily double-blind administration of intranasal cocaine (96 mg) and active placebo (4 mg cocaine). Plasma cortisol and prolactin levels were measured after FEN challenges, and after cocaine and placebo administration. Results: Cocaine significantly elevated plasma cortisol levels to a similar clearee, on the first and fifth days of administration, but did not alter prolactin levels on either day. The first FEN challenge significantly increased plasma prolactin and cortisol, whereas the second challenge increased only prolactin. Conclusions: Intranasal cocaine increases plasma cortisol without affecting prolactin, with no evidence for tolerance. The reduction in FEN-induced cortisol secretion after cocaine exposure suggests that deficits in 5-HT transmission during early cocaine abstinence might contribute to the maintenance of drug dependence.

Gillespie NA; Neale MC; Prescott CA; Aggen SH; Kendler KS. Factor and item-response analysis DSM-IV criteria for abuse of and dependence on cannabis, cocaine, hallucinogens, sedatives, stimulants and opioids. Addiction 102(6): 920-930, 2007. (32 refs.)

Aims: This paper explored, in a population-based sample of males, the factorial structure of criteria for substance abuse and dependence, and compared qualitatively the performance of these criteria across drug categories using item-response theory (IRT). Design: Marginal maximum likelihood was used to explore the factor structure of criteria within drug classes, and a two-parameter IRT model was used to determine how the difficulty and discrimination of individual criteria differ across drug classes. Participants A total of 4234 males born from 1940 to 1974 from the population-based Virginia Twin Registry were approached to participate. Measurements DSM-IV drug use, abuse and dependence criteria for cannabis, sedatives, stimulants, cocaine and opiates. Findings For each drug class, the pattern of endorsement of individual criteria for abuse and dependence, conditioned on initiation and use, could be best explained by a single factor. There were large differences in individual item performance across substances in terms of item difficulty and discrimination. Cocaine users were more likely to have encountered legal, social, physical and psychological consequences. Conclusions: The DSM-IV abuse and dependence criteria, within each drug class, are not distinct but best described in terms of a single underlying continuum of risk. Because individual criteria performed very differently across substances in IRT analyses, the assumption that these items are measuring equivalent levels of severity or liability with the same discrimination across different substances is unsustainable. Compared to other drugs, cocaine usage is associated with more detrimental effects and negative consequences, whereas the effects of cannabis and hallucinogens appear to be less harmful. Implications for other drug classes are discussed.

Glauser J; Queen JR. An overview of non-cardiac cocaine toxicity. Journal of Emergency Medicine 32(2): 181-186, 2007. (66 refs.)

Cocaine use in the United States continues to be a significant problem. Cocaine use is responsible for approximately 143,000 Emergency Department visits annually. The cardiac effects of cocaine are well known and much is written on this topic; this is beyond the scope of this article. Cocaine use is also responsible for a variety of non-cardiac, systemic complications, which it is our purpose to review. Multiple systemic effects of cocaine are seen with both acute and chronic use. These systems include: psychological and psychiatric, neurological, renal, pulmonary, gastrointestinal, obstetrical, and otolaryngological.

Golder S; Logan TK. Correlates and predictors of women's sex trading over time among a sample of out-of-treatment drugs abusers. AIDS and Behavior 11(4): 628-640, 2007. (73 refs.)

This research addressed two research questions: (a) controlling for crack use, what are the factors associated with women's engagement in ever having traded sex? and (b) controlling for crack use, what are the factors associated with women's engagement in sex trading in the past 90 days? The sample included 149 sexually active, crack using women selected from a subsample of participants in the Kentucky NIDA AIDS Cooperative Agreement. Bivariate analyses indicated that in addition to the pattern of crack use, 13 of the candidate variables were significantly related to sex trading, ever and 11 related to sex trading in the past 90 days. The multivariate models accounted for more than 40% of the variance in sex trading, ever and almost 59% of the variance in sex trading over the past 90 days. Suggestions for HIV /AIDS prevention and intervention among drug-involved women are discussed; implications for future research are suggested.

Goldstein RZ; Alia-Klein N; Tomasi D; Zhang L; Cottone LA; Maloney T et al. Is decreased prefrontal cortical sensitivity to monetary reward associated with impaired motivation and self-control in cocaine addiction? American Journal of Psychiatry 164(1): 43-51, 2007. (41 refs.)

Objective: This study attempted to examine the brain's sensitivity to monetary rewards of different magnitudes in cocaine abusers and to study its association with motivation and self-control. Method: Sixteen cocaine abusers and 13 matched healthy comparison subjects performed a forced-choice task under three monetary value conditions while brain activation was measured with functional magnetic resonance imaging. Objective measures of state motivation were assessed by reaction time and accuracy, and subjective measures were assessed by self-reports of task engagement. Measures of trait motivation and self-control were assessed with the Multidimensional Personality Questionnaire. Results: The cocaine abusers demonstrated an overall reduced regional brain responsivity to differences between the monetary value conditions. Also, in comparison subjects but not in cocaine abusers, reward-induced improvements in performance were associated with self-reports of task engagement, and money-induced activations in the lateral prefrontal cortex were associated with parallel activations in the orbitofrontal cortex. For cocaine abusers, prefrontal cortex sensitivity to money was instead associated with motivation and self-control. Conclusions: These findings suggest that in cocaine addiction 1) activation of the corticolimbic reward circuit to gradations of money is altered; 2) the lack of a correlation between objective and subjective measures of state motivation may be indicative of disrupted perception of motivational drive, which could contribute to impairments in self-control; and 3) the lateral prefrontal cortex modulates trait motivation and deficits in self-control, and a possible underlying mechanism may encompass a breakdown in prefrontal-orbitofrontal cortical communication.

Goldstein RZ; Tomasi D; Alia-Klein N; Zhang L; Telang F; Volkow ND. The effect of practice on a sustained attention task in cocaine abusers. Neuroimage 35(1): 194-206, 2007. (56 refs.)

Habituation enables the organism to attend selectively to novel stimuli by diminishing no-longer necessary responses to repeated stimuli. Because the prefrontal cortex (PFC) has a core role in monitoring attention and behavioral control especially under novelty, neural habituation responses may be modified in drug addiction, a psychopathology that entails PFC abnormalities in both structure and function. Sixteen cocaine abusers and 12 gender-, race-, education-, and intelligence-matched healthy control subjects performed an incentive sustained attention task twice, under novelty and after practice, during functional magnetic resonance imaging. For cocaine abusers practice effects were noted in the PFC (including anterior cingulate cortex/ventromedial rostral PFC, dorsolateral PFC, and medial frontal gyrus) and cerebellum (signal attenuations/decreases: return to baseline); activations in these regions were associated with craving, frequency of use, and length of abstinence. In the control subjects practice effects were instead restricted to posterior brain regions (precuneus and cuneus) (signal amplifications/increases: deactivation away from baseline). Also, only in the cocaine abusers, increased speed of behavioral performance between novelty to practice was associated with a respective attenuation of activation in the thalamus. Overall, we report for the first time a differential pattern of neural responses to repeated presentation of an incentive sustained attention task in cocaine addiction. Our results suggest a disruption in drug addiction of neural habituation to practice that possibly encompasses opponent anterior vs. posterior brain adaptation to the novelty of the experience: overly expeditious for the former but overly protracted for the latter. Overall, cocaine addicted individuals may be predisposed to an increased challenge when required to maintain alertness as a task progresses, not able to optimally utilize a prematurely habituating PFC to compensate with an increased attribution of salience to a desired reward.

Goldstein RZ; Woicik PA; Lukasik T; Maloney T; Volkow ND. Drug fluency: A potential marker for cocaine use disorders. Drug and Alcohol Dependence 89(1): 97-101, 2007. (21 refs.)

The goal of the current study was to tailor semantic fluency to increase its sensitivity and ecological validity in the study of drug use disorders. On a newly modified "drug" fluency task, individuals with cocaine use disorders who tested positive for cocaine at study day named more drug-related words than control subjects. The number of words provided on the classical semantic fluency task (animals and fruits/vegetables) did not differ between the groups. While the individuals with cocaine use disorders who tested negative for cocaine at study day did not differ from the control subjects in total words named on this task, a qualitative analysis indicated that both cocaine subgroups provided significantly more words pertaining to the experience of using drugs (paraphernalia, administration) than the matched control subjects. These results demonstrate that compared to classical neurocognitive assessment tools, newly tailored measures may be more sensitive to cocaine use disorders, psychopathologies that are often characterized by mild neuropsychological deficits but a well-circumscribed attentional bias to drug-related cues. Future studies are needed to probe the exact cognitive processes and neural circuitry underlying performance on this cue-sensitive 1-min measure.

Goudie AJ; Sumnall HR; Field M; Clayton H; Cole JC. The effects of price and perceived quality on the behavioural economics of alcohol, amphetamine, cannabis, cocaine, and ecstasy purchases. Drug and Alcohol Dependence 89(2-3): 107-115, 2007. (33 refs.)

Behavioural economic models of substance use describe the relationship between changes in unit price and consumption. However, these models rarely take account of the perceived quality (i.e. potency) of controlled drugs. Therefore we investigated the effects of both price and quality on the decision to purchase controlled drugs by polysubstance misusers. Forty current polysubstance misusers (29 males, I I females; mean age 23.8) were recruited into the study. Participants were asked to hypothetically purchase drugs from a price list of alcohol, amphetamine, cannabis, cocaine and ecstasy at different levels of quality and price (i.e. better quality drugs cost more money). The disposable income available for those purchases was systematically varied in order to determine the impact of income on the decision to purchase drugs. Demand for both normal and strong alcohol was income inelastic. Demand for both poor and average quality cannabis and ecstasy was income inelastic, but demand for good quality cannabis and ecstasy was income elastic. The demand for poor quality cocaine was income inelastic, with the demand for both average and good quality cocaine being income elastic. Participants reported too few purchases of amphetamine, which precluded behavioural economic analysis. These results suggest that, like other goods, controlled drugs are purchased based upon the consumer's interpretations of their relative value. Therefore, it is probable that the purchase and subsequent use of controlled drugs by polysubstance misusers will be heavily influenced by the economic environment.

Grassi MC; Cioce AM; Giudici FD; Antonilli L; Nencini P. Short-term efficacy of Disulfiram or Naltrexone in reducing positive urinalysis for both cocaine and cocaethylene in cocaine abusers: A pilot study. Pharmacological Research 55(2): 117-121, 2007. (38 refs.)

Cocaine abusers frequently report taking the drug in association with alcohol. This combined intake leads to the synthesis of cocaethylene, an active metabolite with effects similar to those of cocaine, but more prolonged. Since pharmacological effects of cocaethylene may partially account for the habit of cocaine abusers to take the drug in combination with ethanol, a main therapeutic goal in these patients should be making body fluids negative for cocaethylene. This randomized controlled open study conducted on 12 subjects co-abusers of cocaine and alcohol, evaluates the efficacy of a 12-week pharmacological treatment with Disulfiram (DIS) 400 mg daily or Naltrexone (NTX) 50 mg daily associated with Cognitive Behaviour Therapy (CBT), as compared to CBT alone, in terms of: (i) stay in treatment; (ii) drug-free urinalyses for cocaine and cocaethylene; (iii) reduction of alcohol and cocaine craving. Data presented in this study are restricted to the first 4 weeks of treatment when all the enrolled subjects were still available for examination. In fact, of the 12 subjects enrolled in the study only 4 (33%) completed the 12-week treatment. Of these, three were in the CBT group and one in the NTX/CBT group. Results show that CBT treated subjects remained in treatment longer than those assigned to either DIS/CBT or NTX/CBT therapies. However, during the first 4 weeks of treatment, CBT-group urine tested positive almost always for both cocaine and cocaethylene. In contrast, both DIS/CBT and NTX/CBT treatments were associated to a statistically significant reduction, of positive urinalysis for both cocaine and cocaethylene, with respect to CBT alone. Moreover, across the first 4 weeks of treatment DIS/CBT and NTX/CBT treated subjects maintained lower scores at Visual Analogue Scales (VAS) for both cocaine and alcohol craving than subjects receiving CBT alone. This pilot study suggests that the transient efficacy of pharmacological treatments in maintaining subjects drug free, does not add to the capability of CBT to retain them in treatment.

Haile CN; Kosten TR; Kosten TA. Genetics of dopamine and its contribution to cocaine addiction. (review). Behavior Genetics 37(1): 119-145, 2007. (312 refs.)

Cocaine addiction is a major health and social problem for which there are presently no effective pharmacotherapies. Many of the most promising medications target dopamine based on the large literature that supports its role in addiction. Recent studies show that genetic factors are also important. Rodent models and gene knock-out technology have helped elucidate the involvement of specific genes in the function of the dopamine reward system and intracellular cascades that lead to neuronal changes in this system. Human epidemiological, linkage, and association studies have identified allelic variants (polymorphisms) that give rise to altered metabolism of dopamine and its functional consequences. Individuals with these polymorphisms respond differently to psychostimulants and possibly to pharmacotherapies. Here we review the literature on genetic variations that affect dopamine neurotransmission, responses to psychostimulants and potential treatments for cocaine addiction. Behavioral responses to psychostimulants in animals with different or modified genetics in dopamine signaling are discussed. We also review polymorphisms in humans that affect dopaminergic neurotransmission and alter the subjective effects of psychostimulants. Pharmacotherapies may have increased efficacy when targeted to individuals possessing specific genetic polymophisms in dopamine's metabolic and intracellular messenger systems.

Hall W; Degenhardt L. Prevalence and correlates of cannabis use in developed and developing countries. Current Opinion in Psychiatry 20(4): 393-397, 2007. (51 refs.)

Purpose of review: The aim of this article is to review recent research on the prevalence, antecedents and correlates of cannabis use in young adults in developed and developing countries. Recent findings Cannabis is the most widely used illicit drug globally and its use appears to be increasing in developed and developing countries. In developed countries rebelliousness, antisocial behaviour, poor school performance, and affiliation with drug-using peers are risk factors for early and regular cannabis use. Similar antecedents are now being reported in developing countries. Dependence is an underappreciated risk of cannabis that affects one in six to seven adolescents who use cannabis in developed countries. Adolescent cannabis dependence is correlated with an increased risk of using other illicit drugs, symptoms of depression, and symptoms of psychosis. The plausibility of cannabis playing a contributory causal role has increased for symptoms of psychosis in longitudinal studies but remains contentious. In the case of other illicit drug use and mood disorders common causal explanations remain difficult to exclude. Summary: Early and regular cannabis use in adolescence predicts an increased risk of cannabis dependence which in turn predicts an increased risk of using other illicit drugs, and reporting symptoms of mood and psychotic disorders.

Hart CL; Haney M; Collins ED; Rubin E; Foltin RW. Smoked cocaine self-administration by humans is not reduced by large gabapentin maintenance doses. Drug and Alcohol Dependence 86(2/3): 274-277, 2007. (14 refs.)

Previously, we reported that gabapentin, a X-aminobutyric acid (GABA) agonist, significantly reduced "positive" subjective effects of cocaine without reducing cocaine self-administration. We speculated that the gabapentin doses used in that study were too low to detect subtle shifts in the reinforcing effects of cocaine. Thus, the present study examined the effects of larger gabapentin maintenance doses on cocaine-related effects, including self-administration. During this 48-day double-blind, crossover design study, the effects of gabapentin maintenance (0, 2400, 3200 mg/day) on response to cocaine (0, 12, 25, 50 mg) were investigated in six cocaine-dependent individuals not seeking treatment for their cocaine use. Active cocaine significantly increased choice to self-administer cocaine, subjective-effect ratings (e.g., "Good Drug Effect"), blood pressure, and heart rate. Gabapentin did not decrease cocaine self-administration, cardiovascular measures, or most subjective effects of cocaine. These data agree with findings from a clinical trial examining the effects of similar gabapentin doses on cocaine use by treatment-seeking cocaine-dependent individuals and suggest that gabapentin does not show promise as a treatment medication for cocaine dependence. reserved.

Higgins ST; Heil SH; Dantona R; Donham R; Matthews M; Badger GJ. Effects of varying the monetary value of voucher-based incentives on abstinence achieved during and following treatment among cocaine-dependent outpatients. Addiction 102(2): 271-281, 2007. (22 refs.)

Aims: This study examined whether increasing the amount of abstinence achieved during outpatient treatment for cocaine dependence is an effective method for increasing longer-term cocaine abstinence. Design A two-condition, parallel groups, randomized controlled trial was conducted. Setting The trial was conducted in a university-based research clinic. Participants A total of 100 cocaine-dependent outpatients participated in the trial. Intervention Participants were assigned randomly to receive treatment based on the community reinforcement approach (CRA) plus voucher-based incentives set at a relatively high monetary value (maximal value = $1995/12 weeks) or CRA with vouchers set at a relatively low monetary value (maximal value = $499/12 weeks). Vouchers were earned contingent on cocaine-negative urinalysis results during the initial 12 weeks of the 24-week outpatient treatment. Measurements Outcomes were evaluated using urine-toxicology testing, questionnaires and other self-report instruments. Findings Increasing voucher value increased the duration of continuous cocaine abstinence achieved during the 24-week treatment period. Point-prevalence cocaine abstinence assessed every 3 months throughout an 18-month follow-up period was greater in the high- than low-value voucher conditions. The duration of abstinence achieved during treatment predicted abstinence during follow-up, although that relationship weakened over time. Conclusions: Increasing the value of abstinence-contingent incentives during the initial weeks of treatment appears to represent an effective method for increasing during-treatment and longer-term cocaine abstinence, but the positive association of during-treatment abstinence with longer-term outcome dissipates with time.

Hsue PY; McManus D; Selby V; Ren XS; Pillutla P; Younes N et al. Cardiac arrest in patients who smoke crack cocaine. American Journal of Cardiology 99(6): 822-824, 2007. (15 refs.)

The aim of the study is to determine the clinical features and outcomes of cocaine users admitted to the hospital after cardiac arrest and compare them with nonusers. Cocaine is associated with cardiovascular complications, including ventricular arrhythmias; however, resuscitated cardiac arrest in relation to cocaine use is not a well-defined clinical entity. We reviewed available hospital charts at San Francisco General Hospital with the International Classification of Diseases, Ninth Revision diagnosis of cardiac arrest and cocaine use from 1994 to 2006. Clinical features and outcomes of cocaine users were compared with those of randomly selected control patients and age-matched controls with resuscitated cardiac arrest without cocaine use. We identified 22 patients with resuscitated cardiac arrest in the setting of cocaine use. Their average age was 42 +/- 10 years, > 20 years younger than nonusers (68 +/- 16 years, p < 0.01). After cardiac arrest, 12 of 22 patients (55%) who used cocaine had complete neurologic recovery in contrast to only 3 of 20 unmatched controls (15%, p < 0.01) and 7 of 41 age-matched controls (17%, p < 0.01). Only 10 of 22 cocaine users (46%) died compared with 15 of 20 unmatched controls (75%, p = 0.05) and 32 of 41 age-matched controls (78%, p < 0.01). In a combined analysis of all patients, cocaine use was the only significant predictor of neurologic recovery (p < 0.01) and survival (p < 0.01). In conclusion, cocaine use is associated with cardiac arrest. In patients with cardiac arrest, cocaine users are younger than nonusers and more likely to survive with neurologic recovery, even compared with age-matched controls with cardiac arrest.

Hyman SM; Paliwal P; Sinha R. Childhood maltreatment, perceived stress, and stress-related coping in recently abstinent cocaine dependent adults. Psychology of Addictive Behaviors 21(2): 233-238, 2007. (45 refs.)

The authors examined associations between a personal history of childhood maltreatment and the perceived stress and stress-coping styles of recently abstinent and treatment-engaged cocaine dependent adults. Fifty men and 41 women at an inpatient treatment and research facility were administered the short form of the Childhood Trauma Questionnaire (D. P. Bernstein & L. Fink, 1998; D. P. Bernstein et al., 2003), the Perceived Stress Scale (S. Cohen, T. Kamarck, & R. Mermelstem, 1983), and the COPE Questionnaire (C. S. Carver, M. R. Scheier, & J. K. Weintraub, 1989). Simple and multiple linear regression analyses were used to analyze relationships while adjusting for relevant covariates. Findings indicate that overall childhood maltreatment severity was significantly associated with greater perceived stress and greater use of avoidance stress-coping strategies. These findings suggest that having a history of childhood maltreatment may influence how recently abstinent cocaine dependent individuals experience and cope with stress. Stress and stress-coping focused interventions may be particularly indicated for cocaine dependent individuals with histories of childhood maltreatment.

Isralowitz R; Reznik A. Gender differences among Israeli adolescents in residential drug treatment. Drugs: Education, Prevention and Policy 14(2): 167-172, 2007. (17 refs.)

Aims: The use of licit and illicit drugs is considered to be primarily a male problem. Numerous studies, however, question the extent of gender differences. This article reports on last 30 day drug use and related problem behaviour among male and female youth prior to residential treatment. Methods: Self-report data were collected from 95 male and female adolescents, age 13 to 18 years, at intake for treatment. Findings: Gender was not a factor differentiating the youth for cigarette, alcohol, cannabis, ecstasy, inhalant, and amphetamine use. Males were more likely to report hashish use. Females, however, were more likely to report use of prescription drugs, cocaine and heroin. No gender differences were found for binge drinking, driving a car after drinking or being a passenger in a car after the driver had been drinking, selling drugs, deterioration of relations with friends and family, gambling, taking loans or using personal money to buy drugs. Conclusion: Drug use and related behaviour among adolescents in residential treatment does not appear to be predominately a male problem. Further research is needed to understand the role of gender status in relation to what drugs are used and how for prevention, treatment and public health purposes.

Johanson CE; Lundahl LH; Schubiner H. Effects of oral cocaine on intravenous cocaine discrimination in humans. Experimental and Clinical Psychopharmacology 15(3): 219-227, 2007. (46 refs.)

This study was designed to evaluate the drug discrimination paradigm as a model for assessing the ability of potential agonist medications to block the effects of intravenous cocaine. Previous research has demonstrated that oral cocaine attenuated the subjective and physiological effects of intravenous cocaine injections, and in the absence of a known efficacious medication for cocaine use disorders, a proof-of-concept approach was used in which cocaine was acutely administered orally to block intravenous cocaine's discriminative-stimulus effects. During training, 11 cocaine-dependent participants were able to discriminate between intravenous saline and 20 mg/70 kg iv cocaine, and 8 of these participants completed the study. After training, participants ingested capsules containing either placebo or 300 mg/70 kg cocaine 60 min prior to the intravenous injection of different doses of cocaine during test sessions with no contingencies in place. Each cocaine dose was administered twice, once under each oral pretreatment condition. Training sessions were interspersed among the test sessions. Physiological and subjective effects were measured throughout each session. Oral cocaine moderately increased some of the subjective and physiological effects of the lower doses of intravenous cocaine, whereas effects at the higher doses were unaltered. Similar changes were seen for the discrimination results. Thus, although oral cocaine given acutely likely is not a viable treatment medication for cocaine dependence, the usefulness of the drug discrimination model in the evaluation of agonist treatment medications remains unclear.

Kalivas PW. Neurobiology of cocaine addiction: Implications for new pharmacotherapy. American Journal on Addictions 16(2): 71-78, 2007. (55 refs.)

The development of pharmacotherapies for cocaine addiction has been disappointingly slow. However, new neurobiological knowledge of how the brain is changed by chronic pharmacological insult with cocaine is revealing novel targets for drug development. Certain drugs currently being tested in clinical trials tap into the underlying cocaine-induced neuroplasticity, including drugs promoting GABA or inhibiting glutamate transmission. Armed with rationales derived from a neurobiological perspective that cocaine addiction is a pharmacologically induced disease of neuroplasticity in brain circuits mediating normal reward learning, one can expect novel pharmacotherapies to emerge that directly target the biological pathology of addiction.

Karisson G; Rehman J; Kalaria V; Breall JA. Increased incidence of stent thrombosis in patients with cocaine use. Catherization and Cardiovascular Interventions 69(7): 955-958, 2007. (27 refs.)

Introduction: Coronary stent thrombosis is a rare occurrence in the era of dual-antiplatelet therapy. It is not known whether patients who use cocaine have a higher risk of thrombosis following coronary stent placement. Methods: We studied 247 consecutive patients who underwent coronary stent placement at an inner-city hospital. Results: Twelve patients (4.9%) were actively using cocaine at the time of PCI. Of these twelve patients, four patients presented with stent thrombosis (33%) at a mean of 51 +/- 40 days (median 45 days), after the index revascularization procedure. Only 2 of the 235 patients without documented cocaine use (0.85%) had stent thrombosis during the same period (P < 0.0001). Conclusion: The patients who actively use cocaine have a markedly higher risk of stent thrombosis when compared with patients without a documented history of cocaine use. We discuss various factors that potentially predispose cocaine users to stent thrombosis.

Kenna GA; Nielsen DM; Mello P; Schiesl A; Swift RM. Pharmacotherapy of dual substance abuse and dependence. (review). CNS Drugs 21(3): 213-237, 2007. (212 refs.)

The US FDA has approved a limited number of treatments for alcohol, nicotine and opioid dependence; however, no treatments for other abused drugs such as marijuana, cocaine or methamphetamine are approved. This review focuses on research into drug pharmacotherapies, particularly single-drug therapies, for substance abuse and dependence contributing to the most important dual substance use disorders (SUDs). Given the implications of poly-substance abuse, it is essential that clinicians and researchers be aware of potential pharmacotherapies for the treatment of dual SUDs. A substantial number of patients abuse more than one drug concurrently, complicating the treatment of SUD and leaving clinicians with few FDA-approved drug options for their patients. In this era of evidence-based medicine, such patients are typically treated with therapeutically proven medications, but in ways that are outside the scope of a drug's original indication by the FDA. Such 'off-label' prescribing has become an important therapeutic strategy for practitioners seeking treatments for other diseases in subpopulations such as paediatrics and gerontology or for medical conditions such as oncology or mental illness. Similarly, the information that most clinicians use to make their decisions for treating patients abusing multiple drugs stems from trials treating a single SUD, anecdotal experiences from their own practice or that of their colleagues, or single-case studies reported in the literature. The existing evidence suggests there are few treatments for SUDs that confer significant reductions in substance use across a broad patient population. Moreover, even fewer clinical efficacy trials have been conducted that provide evidence of therapeutic benefit for these drugs. Recognising the difficulty in making the proper drug choice for facilitating maximum treatment success, this review highlights the single drugs or drug combinations that show some potential for treating dual SUDs. This review finds strongest support for the use of disulfiram for treatment of alcohol and cocaine dependence (with or without concomitant methadone maintenance), baclofen for alcohol and cocaine dependence (but not opioid-dependent cocaine users), tiagabine for cocaine dependence in methadone-maintained patients, and topiramate for alcohol, nicotine and cocaine dependence. While ondansetron and olanzapine show some efficacy in treating alcohol and cocaine dependence, more research is needed to better delineate the subpopulation in which these drugs may provide their maximum effect.

Kertesz SG; Mullins AN; Schumacher JE; Wallace D; Kirk K; Milby JB. Long-term housing and work outcomes among treated cocaine-dependent homeless persons. Journal of Behavioral Health Services & Research 34(1): 17-33, 2007. (47 refs.)

Communities across the United States have initiated plans to end chronic homelessness. In many of these communities, addiction treatment programs remain the default point of entry to housing and services. This study examined the percentage of cocaine-using homeless persons (all with psychiatric distress) attaining stable housing and employment 12 months after entering a randomized trial of intensive behavioral day treatment, plus one of the following for 6 months: no housing; housing contingent on drug abstinence; housing not contingent on abstinence. Of 138 participants, the percentages with stable housing and employment at 12 months were 34.1 and 33.3%, respectively. Analyses suggested superior outcomes in trial arms that offered housing as part of the behavioral treatment. The majority of participants, however, did not achieve housing or employment, in part because of the limited capacity of the local housing programs to accommodate persons who had not achieved perfect abstinence. The findings demonstrate a helpful role for addiction treatment and suggest the need for services to support housing of persons who reduce but do not eliminate all substance use.

Kertesz SG; Pletcher MJ; Safford M; Halanych J; Kirk K; Schumacher J et al. Illicit drug use in young adults and subsequent decline in general health: The coronary artery risk development in young adults (CARDIA) study. Drug and Alcohol Dependence 88(2-3): 224-233, 2007. (49 refs.)

Background: The long-term health consequences of drug use among healthy young adults in the general population are not well described. We assessed whether drug use predicted decline in general self-rated health (GSRH) in a community-based cohort, healthy at baseline. Methods: A prospective cohort of 3124 young adults (20-32 years old) from four US cities, the Coronary Artery Risk Development in Young Adults Study, was followed from 1987/1988 to 2000/2001. All reported "Good" or better GSRH at baseline, with reassessment in 2000/2001. Drug use in 1987/1988 was as follows: 812 participants were Never Users; 1554 Past Users Only; 503 Current Marijuana Users Only; 255 Current Hard Drug Users (e.g. cocaine, amphetamines, opiates). Analyses measured the association of drug use (1987/1988) with decline to "Fair" or "Poor" GSRH in 2000/2001, adjusting for biological and psychosocial covariates. Results: Reporting health decline were: 7.2% of Never Users; 6.5%, Past Use Only; 7.0%, Current Marijuana Only; 12.6%, Current Hard Drugs (p < 0.01). After multivariable adjustment, Current Hard Drug Use in 1987/1988 remained associated with health decline (Odds Ratio (OR), referent Never Use: 1.83, 95% confidence interval (CI) 1.07-3.12). The health decline associated with Current Hard Drugs appeared to be partly mediated by tobacco smoking in 2000/2001, which independently predicted health decline (OR 1.66, 95% CI 1.08-2.50) and weakened the apparent effect of Current Hard Drugs (OR 1.21, 95% CI 0.62-2.36). Conclusions: Hard drug use in healthy young adults, even when hard drug use stops is associated with a subsequent decrease in general self-rated health that may be partially explained by persistent tobacco use.

Kliewer W; Murrelle L. Risk and protective factors for adolescent substance use: Findings from a study in selected Central American countries. Journal of Adolescent Health 40(5): 448-455, 2007. (25 refs.)

Purpose: To identify the prevalence of substance use and problems with use, and risk and protective factors at different levels of the adolescent's ecology associated with substance use among adolescents in selected Central American countries. Methods: Results of a survey of 17,215 students from Panama, Costa Rica, and Guatemala conducted in 2000-2001 served as the basis for the analyses. Lifetime use of alcohol, tobacco, marijuana, and five other drugs (inhalants, tranquilizers, cocaine, crack, and ecstasy), and problems with drugs and alcohol were the outcome variables. Risk factors included dysregulation, family problems with drugs/alcohol, negative family interactions, school disengagement, peer deviance, and exposure to community violence. Protective factors included a personal belief in God, positive family interactions, parent religiosity, and positive student-teacher interaction. Both hierarchical linear regression and logistic regression analyses were used to model main and interaction effects of risk and protective factors. Results: There was a linear association between number of risk and protective factors and substance use, however, risk factors were more strongly associated with substance use than were protective factors. There were significant risk-by-protective-factor interactions for alcohol and marijuana use, and for problems with drugs and alcohol. Risk interacted most consistently with a personal belief in God, but also with parent religiosity and with student-teacher communication. Conclusions: It is important to consider risk and protective factors at different levels of an adolescent's ecology. Prevention and intervention efforts should focus on interactions adolescents have in different microsystems (e.g., with parents, teachers, and peers).

Kondziella D; Danielsen ER; Arlien-Soeborg P. Fatal encephalopathy after an isolated overdose of cocaine. (editorial). Journal of Neurology, Neurosurgery, and Psychiatry 78(4): 437-438, 2007. (5 refs.)

Kouimtsidis C; Padhi A. A case of late-onset dependence on cocaine and crack. Addiction 102(4): 666-667, 2007. (4 refs.)

Aims: To raise awareness among the professional clinical and research community of the risk of cocaine misuse among elderly patients. Methods: Case report of a male patient, aged 72 years, who presented to a community substance misuse service with cocaine use disorder (hydrochloride and base form). Results The development of the disorder was marked by high levels of cocaine (and later crack cocaine use), repeated periods of abstinence followed by relapse in the past 4 years, with severe consequences to the patient and his family. Treatment involved a close collaboration between several specialist addictions and old-age psychiatry teams in National Health Service. Implications: Although dependence on cocaine among the elderly is considered very rare, clinical management can be challenging and is likely to require the involvement of several specialist and general health services.

Kraus L; Augustin R; Kunz-Ebrecht S; Orth B. Drug use patterns and drug-related disorders of cocaine users in a sample of the general population in Germany. European Addiction Research 13(2): 116-125, 2007. (55 refs.)

Aims: The prevalence of cocaine use is still very low in Germany, but rates have been increasing over the past few decades. Patterns of drug consumption and related adverse consequences in individuals who have used cocaine were investigated in order to distinguish different types of cocaine users. Methods: Data come from two national representative surveys on substance abuse in the German general population conducted in 1997 and 2000 using self-administered questionnaires. Overall response rates were 65 and 51%, respectively. The two samples were pooled (n = 16,159) and latent cluster analysis was conducted using a sub-sample of 272 lifetime cocaine users. Results: Three clusters were derived: the majority belonged to the group of mainly unproblematic users (UPG, 80%), the second group comprised non-amphetamine poly-problem drug users (NAPPG, 12%), and a small group was composed of poly-problem drug users (PPG, 8%). Comparisons of sociodemographic characteristics, consumption patterns and age of onset for licit and illicit drug use revealed significant differences between the groups. Conclusions: The majority of cocaine users in the general population are experimental or occasional users of licit and illicit drugs. Rather than being a major drug, cocaine is one of many other licit and illicit drugs. Cocaine use as part of predominantly poly-drug use behaviour is strongly associated with substance-related disorders.

Lejuez CW; Bornovalova MA; Reynolds EK; Daughters SB; Curtin JJ. Risk factors in the relationship between gender and crack/cocaine. Experimental and Clinical Psychopharmacology 15(2): 165-175, 2007. (66 refs.)

Female inner-city substance users evidence greater crack/cocaine use and are more likely to be dependent on this drug than on any other drug. Additionally, female inner-city substance users evidence greater crack/cocaine use and are more likely to be dependent on this drug than their male counterparts, despite no consistent difference demonstrated in use and dependence across other drugs. Because no published work has empirically examined the factors underlying this link between females and crack/cocaine, the current study examined the role of theoretically relevant personality and environmental variables. Among 152 (37% female) individuals in a residential substance-use treatment program, females evidenced greater use of crack/cocaine (current and lifetime heaviest) and were significantly more likely to evidence crack/cocaine dependence than their male counterparts. In contrast, no gender differences were found for any other substance across alcohol, cannabis, and hallucinogens (including PCP). Surprisingly, females were more impulsive than their male counterparts, with impulsivity serving as a risk factor in the relationship between gender and crack/cocaine dependence and lifetime heaviest use. Females also evidenced higher levels of negative emotionality and childhood abuse, but neither variable served as a risk factor in the relationship between gender and crack/cocaine dependence or use. Limitations and future directions are discussed, including the need for further exploration of impulsivity across its various dimensions as well as the inclusion of additional variables such as social context variables to account more fully for this complex link between gender and crack/cocaine.

Lemos PA. Hidden drugs, hidden risks - Is cocaine use a new risk factor for stent thrombosis? (editorial). Catherization and Cardiovascular Interventions 69(7): 959-960, 2007. (8 refs.)

Lin YH; Lee MR; Lee RJ; Ko WK; Wu SM. Hair analysis for methamphetamine, ketamine, morphine and codeine by cation-selective exhaustive injection and sweeping micellar electrokinetic chromatography. Journal of Chromatography A 1145(1-2): 234-240, 2007. (35 refs.)

We established a capillary electrophoretic method with high sensitivity and specificity for testing hair taken from addicts. After pretreatment of hair sample, the cation-selective exhaustive injection and sweeping micellar electrokinetic chromatography (CSEI-Sweep-MEKC) was used to test for the presence of abused drugs in human hair. These drugs include morphine (M), codeine (C), ketamine (K) and methamphetamine (MA). First, an uncoated fused-silica capillary (40 cm, 50 mu m I.D.) was filled with phosphate buffer (50 mM, pH 2.5) containing 30% methanol, followed by high conductivity buffer (100 mM phosphate, 6.9 kPa for 99.9 s). Electrokinetic injection (10 kV, 600 s) was used to load samples and to enhance sensitivity. Stacking steps and separations were performed at -20 kV with detection at 200 nm, using phosphate buffer (25 rum, pH 2.5) containing 20% methanol and 100 mM sodium dodecyl sulfate. Using CSEI-Sweep-MEKC, the analytes could be simultaneously analyzed and have a detection limit down to the level of picogram per milligram hair. During method validation, calibration plots were linear (r >= 0.999) over a range of 0.15-80 ng/mg hair for MA and K, 0.3-30 ng/mg hair for C and 0.5-50 ng/mg hair for M. The limits of detection were 50 pg/mg hair for MA and K, 100 pg/mg hair for C and 200 pg/mg hair for M (S/N = 3, sampling 600 s at 10 kV). Our method was applied for analysis of real hair samples taken from addicts. The addicts' specimens were also analyzed by LC-MS, and showed good coincidence of results. This method has proven feasible for application in detecting trace levels of abused drugs in forensic analysis.

Lociciro S; Hayoz P; Esseiva P; Dujourdy L; Besacier F; Margot P. Cocaine profiling for strategic intelligence purposes, a cross-border project between France and Switzerland - Part I. Optimisation and harmonisation of the profiling method. Forensic Science International 167(2-3): 220-228, 2007. (27 refs.)

Optimisation and harmonisation of analytical and statistical methodology have been carried out between two forensic laboratories (Lausanne, CH and Lyon, F) in order to provide drug intelligence for cross-border cocaine seizures. The aim was to improve the gas chromatographic analysis of cocaine samples for profiling. Some important validation parameters were tested to verify the developed method and demonstrate its profiling capacity: the selectivity of the method with retention time reproducibility, the choice of a derivatisation agent improving the chromatography (MSTFA, BSA, TMSI and BSTFA + TMCS 1%), the cutting agents influence (matrix effect), the influence of the sample storage conditions and the sample quantity to weigh for analyses. Eight main alkaloids, which represent the sample signature, have been selected: ecgonine methyl ester, ecgonine, tropacocaine, benzoylecgonine, norcocaine, cis- and trans-cinnamoylcocaine and 3,4,5-trimethoxycocaine. Their stability in the solvent used (CHCl3/pyridine) was demonstrated. In order to reach the final objective, which is the comparison of samples seized and analyzed in two different laboratories, the harmonisation of the profiling method between the two laboratories had to be ensured and is the subject of ongoing research.

Lopez A; Becona E. Depression and cocaine dependence. Psychological Reports 100(2): 520-524, 2007. (22 refs.)

Presence of depression in cocaine-dependent users is relevant for treatment of these persons. This study assessed the presence of depressive symptomatology with a published Spanish translation of the Beck Depression Inventory for a sample of 115 Spanish cocaine-dependent users who were in outpatient treatment at Centers of Drug Dependence of Galicia, Spain. The mean score was 13.7 (SD= 10.3), with 24.3% of the sample having scores which indicate clinical depression (cut off >= 21). These data underscore the need to assess the presence of depression in cocaine-dependent users who require treatment.

Lundahl LH; Lukas SE. Negative cocaine effect expectancies are associated with subjective response to cocaine challenge in recreational cocaine users. Addictive Behaviors 32(6): 1262-1271, 2007. (16 refs.)

Although many studies have shown that cognitive effect expectancies are associated with drug use and drug treatment outcomes, few studies have compared effect expectancies with drug response following drug challenge. Healthy male and female volunteers (n = 19, ages 21-35) who reported using cocaine 1-4 times per month completed the Cocaine Effect Expectancy Questionnaire (CEEQ: [Schafer, J. and Brown, S.A. (199 1). Marijuana and cocaine effect expectancies and drug use patterns. Journal of Consulting and Clinical Psychology, 59, 558-565.]), were challenged with cocaine (0.9 mg/kg, i.n.), then completed a series of visual analog scales (VAS) and the Addiction Research Center Inventory (ARCI) at 15 min intervals for 3 h following cocaine administration. Significant positive correlations were found between global negative expectancies and peak responses on the VAS measures "Good," "Happy," "High," "Stimulated," and "Desire to Use Cocaine," and on the LSD subscale of the ARCI post-cocaine administration, and between global positive expectancies and the MBG subscale of the ARCI, and on VAS items "Anxious" and "Good" post-cocaine administration. Global positive expectancies also were positively correlated with peak systolic blood pressure, and global negative expectancies with peak heart rate after cocaine administration. These results suggest that negative and positive effect expectancies both play a complex role in the subjective experience of cocaine effects, and thus likely in the progression of non-use to recreational use, in the transition to abuse, and in individualized treatment strategies.

Maher L; Li JO; Jalaludin B; Chant KG; Kaldor JM. High hepatitis C incidence in new injecting drug users: A policy failure? Australian and New Zealand Journal of Public Health 31(1): 30-35, 2007. (22 refs.)

Objective: Evidence of ongoing hepatitis C (HCV) transmission among injecting drug users (IDUs) suggests a need for a better understanding of seroconversion characteristics among new IDUs and other vulnerable subgroups. This study aimed to determine incidence of HCV and associated risk factors among new IDUs in Sydney. Methods: IDUs who had injected drugs in the past six months and who were unaware of their antibody HCV status or knew their serostatus to be negative were recruited through street-based outreach, methadone clinics and needle and syringe programs in south-western Sydney. Anti-HCV negative IDUs (n=215) were enrolled and followed-up at 3-6 monthly intervals. New IDUs (n=204) were defined as aged below 30 years or injecting for! 6 years at baseline. Results: A total of 61 seroconversions were observed and incidence was 45.8 per 100 person years. Independent predictors of seroconversion were duration of injecting < 1 year (IRR=3.10; 95% Cl 1.47-6.54), female gender (IRR=2.0; 95% Cl 1.16-3.45), culturally and linguistically diverse background (CALDB) (IRR=2.03; 95% Cl 1.06-3.89) and intravenous cocaine use (IRR=2.37; 95% Cl 1.26-4.44). While new IDUs shared common risk factors, strong associations were observed between HCV seroconversion and sharing syringes, sharing other injecting equipment and backloading in CALDB new IDUs. Conclusion: Incidence of HCV infection among new IDUs in Sydney is unacceptably high. Implications: Extremely high rates of incident infection among newly initiated CALDB IDUs indicate an urgent need for enhanced policy and resource commitments to reduce the vulnerability of this group to HCV and other blood-borne infections.

Maher L; Li J; Jalaludin B; Wand H; Jayasuriya R; Dixon D et al. Impact of a reduction in heroin availability on patterns of drug use, risk behaviour and incidence of hepatitis C virus infection in injecting drug users in New South Wales, Australia. Drug and Alcohol Dependence 89(2-3): 244-250, 2007. (59 refs.)

In early 2001, Australia experienced a sudden and dramatic reduction in the availability of heroin. Research examining the impact of the reduction on drug-related harms has yielded a conflicting picture. The current study uses data from a prospective cohort study of anti-HCV negative injecting drug users (IDU) (n = 368) to examine patterns of injecting drug use, risk behaviours and HCV incidence before and after the reduction. The proportion of participants mainly injecting heroin declined sharply from 74% to 47% after the onset of the reduction and continued throughout 2001. There was marked shift to other drugs, mainly cocaine and amphetamine. Cocaine injectors had the highest risk profile and the highest incidence of HCV (82.6 per 100 person years, 95% CI 52.0-131.0). While HCV seroconversions increased by year, this increase was not statistically significant. We observed a reduction in heroin injection and a concomitant increase in cocaine injection and a significant association between cocaine injection and incident HCV infection during a period of reduced heroin availability. Results suggest that attempts to suppress drug markets by manipulating availability may result in collateral damage in the form of drug-related harms, indicating a need for more sophisticated understandings of the potential trade-offs involved in attempting to suppress the supply of illicit drugs.

Mardikian PN; LaRowe SD; Hedden S; Kalivas PW; Malcolm RJ. An open-label trial of N-acetylcysteine for the treatment of cocaine dependence: A pilot study. Progress in Neuro-Psychopharmacology & Biological Psychiatry 31(2): 389-394, 2007. (30 refs.)

Recent preclinical studies implicate N-acetylcysteine (NAC), a cysteine prodrug, as a potential medication for preventing relapse to cocaine use; however, little is known about the safety and tolerability of NAC in cocaine-dependent subjects in an outpatient setting. This pilot study examines the safety and tolerability of 3 doses of NAC for the treatment of cocaine dependence. Twenty three treatment-seeking cocaine-dependent patients participated in a 4-week medication trial and received NAC at doses of 1200 mg/day, 2400 mg/day or 3600 mg/day. Results suggested that the three doses were well tolerated. Overall, the retention rates appeared to favor higher doses of NAC (2400 mg/day and 3600 mg/day). The majority of subjects who completed the study (n = 16) either terminated use of cocaine completely or significantly reduced their use of cocaine during treatment. Overall the findings suggest that it is feasible to treat cocaine-dependent treatment seekers with N-acetylcysteine on an outpatient basis.

Maremmani I; Pani PP; Mellini A; Pacini M; Marini G; Lovrecic M et al. Alcohol and cocaine use and abuse among opioid addicts engaged in a methadone maintenance treatment program. Journal of Addictive Diseases 26(1): 61-70, 2007. (42 refs.)

Alcohol and cocaine abuse result in unsatisfactory treatment outcomes for heroin and illicit opioid addicts engaged in Methadone Maintenance Treatment Programs (MMTPs). This study aims to clarify the impact of MMT, which focuses on cessation of opioid abuse and diminishing psychopathology to acceptable levels (stabilization) on alcohol and cocaine abuse. Of specific interest was whether reduction of polysubstance abuse and associated psychopathological complications diminished illicit opioid abuse and/or increased retention in treatment. Changes in cocaine and alcohol use that occurred in 53 heroin addicts who had been stabilized were monitored. A control group was composed of patients terminated from treatment due to noncompliance with treatment recommendations, poor attendance, or failure to have opioid abuse stabilized, within a year. The association of psychiatric severity with alcohol and cocaine abuse in these methadone maintained patients was assessed. Cessation of illicit opioid abuse and retention in treatment are positively correlated with decrease in alcohol and cocaine abuse and the absence of the psychosocial complications associated with such abuse.

Martins SS; Copersino ML; Soderstrom CA; Smith GS; Dischinger PC; McDuff DR et al. Risk of psychoactive substance dependence among substance users in a trauma inpatient population. Journal of Addictive Diseases 26(1): 71-77, 2007. (27 refs.)

One measure of a substance's addictive risk is the proportion of users who become dependent. This study evaluates the lifetime and current risk of substance dependence among lifetime substance users among trauma inpatients and provides a relative ranking of addictive risk among the substances. Data on use of 8 substance groups (alcohol, opiates, cannabis, cocaine, other stimulants, sedative-hypnotics, hallucinogens, other drugs) were obtained by interview (Structured Clinical Interview for the DSM-III-R) from 1,118 adult trauma inpatients. Prevalence of lifetime dependence among lifetime users ranged from 80.7% for opiates and 70.9% for cocaine to 33.3% for hallucinogens and 26.6% for sedative-hypnotics. The rank order of addictive risk was similar to that found in the general population. Trauma inpatients had a higher absolute addictive risk than the general population, comparable to the risk found in patients in treatment for substance use disorders, suggesting the importance of screening trauma inpatients for substance dependence.

Mayes L; Snyder PJ; Langlois E; Hunter N. Visuospatial working memory in school-aged children exposed in utero to cocaine. Child Neuropsychology 13(3): 205-218, 2007. (70 refs.)

Objective: Among the neurocognitive impairments reported as associated with prenatal cocaine exposure, slower response time, and less efficient learning in school-aged children are common to findings from several laboratories. This study presents performance data on a spatial working memory task in 75 prenatally cocaine exposed (CE) and 55 nondrug-exposed (NDE) 8- to 10-year-old children. Methods: Children were administered a novel neuropsychological measure of immediate-and short-term memory for visuospatial information, the Groton Maze Learning Test (c) (GMLT), a computer-based hidden maze learning test that consists of a "timed chase test" (a simple measure of visuomotor speed), eight learning trials followed by a delayed recall trial after an 8-minute delay and a reverse learning trial. Performance is expressed as correct moves per second and number of errors per trial. Results: Across all trials, the cocaine-exposed group showed significantly slower correct moves per second and made significantly more errors. There were no significant main effects for amounts of alcohol, tobacco, or marijuana exposure. After an 8-minute delay and compared to the eighth trial, cocaine-exposed children showed less consolidation in learning compared to nonexposed children. When asked to complete the maze in reverse, cocaine-exposed children showed a greater decrement in performance (decreased correct moves per second and increased errors) compared to the eighth learning trial. Conclusions: Children exposed in utero to cocaine exhibit a possible impairment in procedural learning and diminished efficiency in creating and accessing an internal spatial map to master the hidden maze.

Mazzone A; Giani L; Faggioli P; Pichini S; Pacifici R. Cocaine-related peripheral vascular occlusive disease treated with iloprost in addition to anticoagulants and antibiotics. Clinical Toxicology 45(1): 65-66, 2007. (14 refs.)

We describe a case of acute ischemia of the 2(nd), 3(rd) and 4(th) fingers of the right hand secondary to peripheral vascular occlusive disease induced by repeated intra-arterial cocaine injections. The complete occlusion of the distal arteries resolved following treatment with iloprost, a synthetic stable analogue of prostacyclin PG12, in addition to anticoagulants and antibiotics.

McRae AL; Hedden SL; Malcolm RJ; Carter RE; Brady KT. Characteristics of cocaine- and marijuana-dependent subjects presenting for medication treatment trials. Addictive Behaviors 32(7): 1433-1440, 2007. (25 refs.)

Evaluation of the characteristics of individuals presenting for substance abuse treatment can provide important information to help focus treatment services. In this study, demographic and clinical characteristics of individuals presenting for medication trials for the treatment of cocaine or marijuana dependence were compared. Marijuana-dependent subjects were generally younger than cocaine-dependent subjects, more likely to be Caucasian, and completed more years of education. Marijuana-dependent subjects also reported significantly more days using than cocaine-dependent subjects, as well as higher levels of craving. Some differences in psychiatric symptomatology were also noted, with cocaine-dependent subjects more likely to report anxiety symptoms and marijuana-dependent subjects reporting more past depressive episodes. Past and current other drug use was similar between the two groups. These results highlight the significant impairments associated with marijuana and cocaine dependence.

Miech R. The formation of a socioeconomic disparity a case study of cocaine and marijuana use in the 1990s. American Journal of Preventive Medicine 32(6, Supplement S): S171-S176, 2007. (10 refs.)

Background: Around the year 1990, the reputation of cocaine use changed from glamorous to undesirable, and at the same time, a socioeconomic disparity in cocaine use emerged. This study examined (1) whether the socioeconomic disparity was created by differential incidence, differential cessation, or both, (2) whether a socioeconomic disparity also developed in marijuana use, and (3) whether disparities formed across race, Hispanic ethnicity, and/or gender. Methods: The analyses center on 6544 respondents aged 14-21 in 1979 in the National Longitudinal Survey of 1979 that provided information on past-year use of powder cocaine and marijuana use before and after 1990-specifically, in 1984, 1988, 1992, 1994, and 1998. Results: Both differential incidence and differential cessation across education contributed to the formation of the socioeconomic disparity in cocaine use, although differential cessation played a more influential role in this cohort. A socioeconomic disparity in marijuana use also came about around the same time. No emerging disparities by race, Hispanic ethnicity, or gender were observed. Conclusions: This case study suggests that the redefinition of a health behavior as unhealthy will result in a socioeconomic disparity in the behavior across socioeconomic strata as a result of both differential incidence and cessation, but disparities will not necessarily form by race, ethnicity, or gender.

Mills JH. Drugs, consumption, and supply in Asia: The case of cocaine in colonial India, c.1900-c.1930. Journal of Asian Studies 66(2): 345-362, 2007. (32 refs.)

This article examines the market for cocaine in India during the early twentieth century and the efforts of the colonial state to control it. The British authorities issued regulations to prohibit the drug's use as early as 1900, and yet by the start of World War 1, cocaines appeal had become socially diverse and geographically wide. This account of significant market for a powerful new drug suggests that Indian society was able to rapidly develop a demand for such products even when the colonial state had no part in their introduction. Indians used these new products in complex ways -- as medicines, as tonics, and as intoxicants, albeit through the localized medium of the everyday paan leaf. The study points to a reconsideration of a number of debates about the history of drugs and modern medicines in Asia.

Moeller FG; Schmitz JM; Steinberg JL; Green CM; Reist C; Lai LY et al. Citalopram combined with behavioral therapy reduces cocaine use: A double-blind, placebo-controlled trial. American Journal of Drug and Alcohol Abuse 33(3): 367-378, 2007. (40 refs.)

Cocaine dependence continues to be a significant problem in the United States, without any approved pharmacotherapy. Promising findings from preclinical research on the effects of cocaine on serotonin lead to examination of selective serotonin reuptake inhibitors (SSRIs) as potential treatments for cocaine dependence with mixed results, possibly due to drug interactions or specifics of concomitant behavioral therapy. The purpose of this study was to examine whether the SSRI citalopram would reduce cocaine positive urines in a 12-week, double-blind placebo-con trotted trial. Seventy-six cocaine dependent patients received either citalopram 20mg per day or placebo along with cognitive behavioral therapy (CBT) and contingency management (CM). Citalopram treated subjects showed a significant reduction in cocaine-positive urines during treatment compared to placebo treated subjects. No differences were noted in retention between the two groups.

Mooney ME; Schmitz JM; Moeller FG; Grabowski J. Safety, tolerability and efficacy of levodopa-carbidopa treatment for cocaine dependence: Two double-blind, randomized, clinical trials. Drug and Alcohol Dependence 88(2-3): 214-223, 2007. (53 refs.)

Rationale: The role of dopamine in cocaine abuse has been long recognized. Cocaine use can profoundly alter dopaminergic functioning through depletion of this monoamine and changes in receptor functioning. Based on these facts, levodopa (L-dopa) pharmacotherapy may be helpful in reducing or abolishing cocaine use. Objective: The current studies sought to evaluate the safety, tolerability and efficacy of L-dopa as a treatment for cocaine dependence. Methods: In Study 1, 67 cocaine-dependent subjects were randomized in a 5-week, double-blind, placebo-controlled safety trial. Subjects received either placebo, or 400 mg L-dopa plus 100 mg of the peripheral decarboxylase inhibitor, carbidopa, in a sustained-release preparation (Sinemet CR (R)). In Study 2, 122 cocaine-dependent subjects were enrolled in a 9-week, randomized, double-blind, placebo-controlled trial to compare placebo to 400/100 mg and 800/200 mg L-dopa/carbidopa treatments. Placebo or L-dopa were administered twice daily in both studies. Results: L-dopa was well tolerated with similar retention and medication adherence rates compared to placebo. Only two side effects occurred more often in L-dopa-treated patients: nausea and dizziness. L-dopa lowered diastolic blood pressure in a dose-dependent fashion. In these trials, L-dopa had no effect on cocaine use, cocaine craving, or mood. Conclusion: These two studies demonstrate the safety and tolerability of L-dopa pharmacotherapy in cocaine-dependent patients. No evidence for greater efficacy of L-dopa compared to placebo was observed. The possibility of enhancing treatment effects by combining L-dopa with other behavioral or pharmacological interventions is discussed.

Moore C. Cocaine found on all Irish bank notes. (news). Chemistry World 4(2): 30-30, 2007. (1 refs.)

Morales-Manrique CC; Valderrama-Zurian JC; Castellano-Gomez M; Aleixandre-Benavent R; Cocaine C V Group. Exploratory factor analysis and validation study of the Lifetime Severity Index for Cocaine, Spanish version (LSI-C-Spanish). Journal of Nervous and Mental Disease 195(6): 532-536, 2007. (18 refs.)

The purpose of the study was to do an exploratory factor analysis and to examine the criterion-related and discriminant validity of the Lifetime Severity Index for Cocaine (LSI-C), Spanish version. A sample of 171 outpatients from 10 drug centers in Spain participated in the study. We conducted the factor analysis with orthogonal rotation and examined correlations between the LSI-C total score and criterion variables as well as the score obtained by a quality of life measure. The factor analysis revealed 2 principal factors that explain 65.8% of the variance. Lower LSI-C scores were associated with taking medication, receiving social help, using cocaine fewer than 30 times during the previous 6 months, and with better scores on quality of life measures. Higher LSI-C scores were associated with unstable housing, overdose, hospitalization, cocaine consumption more than 100 times during the previous 6 months, and more years of drug consumption. The LSI-C Spanish version shows acceptable criterion-related and discriminant validity.

Najavits LM; Harned MS; Gallop RJ; Butler SF; Barber JP; Thase ME; Crits-Christoph P. Six-month treatment outcomes of cocaine-dependent patients with and without PTSD in a multisite national trial. Journal of Studies on Alcohol 68(3): 353-361, 2007. (54 refs.)

Objective: This study examined 6-month treatment outcomes among 428 cocaine-dependent outpatients with (n = 34) and without (n = 394) posttraumatic stress disorder (PTSD) in a randomized controlled multisite clinical trial of manual-based psychotherapies for substance use disorder (SUD). Method: Assessments were completed at baseline and monthly during the 6-month treatment. With longitudinal mixed-effects models, we compared outcomes between SUD-PTSD and SUD-only patients and also examined rates of within-group change. Results: Results indicated a highly consistent pattern: the SUD-PTSD patients were more impaired to begin with and remained so across time compared with SUD-only patients (with the exception of substance use and addiction-related legal and employment problems, which did not differ between groups). Also, the SUD-PTSD patients improved less than SUD-only patients in alcohol use and the majority of addiction-related psychosocial problems. However, the two groups did not differ significantly in improvement over time on drug use or global psychological severity. Conclusions: The greater impairment and relative lack of improvement of SUD-PTSD patients, compared with those with SUD-only, suggest a need for dual-diagnosis treatments that more directly target their areas of difficulty.

Pechansky F; Kessler FHP; von Diemen L; Bumaguin DB; Surratt HL; Inciardi JA. Brazilian female crack users show elevated serum aluminum levels. Revista Brasileira de Psiquiatria 29(1): 39-42, 2007. (11 refs.)

Objective: There is no information in the literature on the impact of crack smoking using crushed aluminum cans as makeshift pipes, a common form of crack use in Brazil, Since aluminum intake is associated with neurological damage, we measured serum aluminum levels in crack smokers. The objective of this study was to ascertain the levels of aluminum in crack users who smoke on makeshift aluminum pipes. Method: 71 female crack smokers, their mean age being 28.0 (+/- 7.7), provided information about their drug use, and had blood samples tested for serum aluminum level. Results: 56 (79%) subjects smoked crack from crushed can pipes, while 15 (21%) smoked from other containers. Fifty-two (73.2%) out of the 71 subjects presented a serum aluminum level of 2 mu g/l and 13 (18.3%) had a serum aluminum level of 6 mu g/l cut-off point, which is above the reference value. When compared to non-drug users matched by their mean age and gender, they had similar median values and interquartile, ranges for serum aluminum level [3 (2-4.6) for crack smokers; 2.9 (1.6-41) for controls], but with different means and standard deviations (4.7 +/- 4.9 and 2.9 +/- 1.7, respectively). Discussion: Crack smokers have high serum aluminum level, but we are unsure of its complete association with aluminum cans. Further studies are needed. If such association is proven true in future research, further issues will be raised in dealing with this important disorder including proper planning and evaluation of public health policies in this area.

Peters RJ; Williams M; Ross MW; Atkinson J; Yacoubian GS. Codeine cough syrup use among African-American crack cocaine users. Journal of Psychoactive Drugs 39(1): 97-102, 2007. (17 refs.)

While studies show evidence of a clear problem with the prevalence of crack cocaine and codeine cough syrup use separately, the relationship between these substances of abuse and concurrent polydrug use is unknown. In an attempt to ascertain beyond anecdotal evidence, the authors carried out a cross-sectional study among 482 African-American crack users to investigate the differences between those who were concurrently codeine cough syrup users and those who were not codeine cough syrup users in Houston, Texas. Logistic regression indicated that codeine use was significantly associated with lower participant age and lower education; codeine cough syrup users were significantly more likely than nonusers to not have a main sexual partner. In addition, codeine users had significantly higher odds of ever trading sex for money, marijuana use, and fry use. These findings are important in determining the "cultural novelties" relative to crack and codeine use among younger African Americans.

Petry NM; Alessi SM; Hanson T. Contingency management improves abstinence and quality of life in cocaine abusers. Journal of Consulting and Clinical Psychology 75(2): 307-315, 2007. (53 refs.)

Contingency management (CM) treatments enhance drug abstinence. This study evaluated whether CM also improves quality of life and if these effects are mediated by abstinence. Across 3 independent trials, cocaine abusers in intensive outpatient treatment (n = 387) were randomly assigned to 12 weeks of standard treatment as usual or standard treatment with CM. The Quality Of Life Inventory (QOLI) was administered at baseline and at Months 1, 3, 6, and 9. Changes in QOLI scores over time differed significantly by treatment, with QOLI scores rising over time in CM participants and remaining stable in standard treatment participants. CM participants also achieved greater durations of abstinence, and duration of abstinence was correlated with posttreatment QOLI scores. During-treatment abstinence mediated the relationship between treatment condition and QOLI scores over time.

Poling J; Kosten TR; Sofuoglu M. Treatment outcome predictors for cocaine dependence. American Journal of Drug and Alcohol Abuse 33(2): 191-206, 2007. (80/data refs.)

Over the past decade, a large number of potential medications have been examined in clinical trials for cocaine dependence. Unfortunately, no effective pharmacotherapies for cocaine dependence have been found to date. Although effective treatments for cocaine dependence are still being investigated, a few variables have been found to significantly predict cocaine treatment response. These variables include cocaine use variables, such as days of cocaine use in the month before treatment, baseline urine cocaine results, and cocaine withdrawal symptoms. Comorbid depression and alcohol use have also been shown to be risk factors for relapse. Among personality variables, impulsivity and similar personality traits may predict treatment response. Initial promising findings with genetic polymorphism, brain activation, and stress response have also been found and need to be replicated in future studies.

Preti A. New developments in the pharmacotherapy of cocaine abuse. (review). Addiction Biology 12(2): 133-151, 2007. (236 refs.)

Despite huge advances in the neuroscience of substance abuse and dependence in the past 20 years, no approved pharmacological treatment exists for cocaine abuse. The available drugs for the treatment of cocaine abuse are poorly effective, hence the need for new compounds to be screened and tested for efficacy: targeting symptoms might improve the effectiveness of the treatment of cocaine abuse and dependence. On the basis of the known neurochemistry of cocaine, some target compounds have been studied: among others, BP-897, a D3 partial agonist; vanoxerine, a highly selective inhibitor of dopamine uptake; aripiprazole, a partial mixed-action agonist approved for the treatment of schizophrenia. Recently modafinil, approved for the treatment of narcolepsy, proved effective in favouring cocaine abstinence in cocaine-abusing people. Some placebo-controlled studies also reported the effectiveness of topiramate, a licensed antiepileptic drug, and of tiagabine, a gamma-aminobutyric acid (GABA) re-uptake inhibitor also approved as an anticonvulsant; both compounds increased cocaine abstinence with no serious adverse events. Promising results came from two more compounds acting on the GABA circuits, baclofen and valproic acid. Finally disulfiram, prescribed with active psychosocial therapy, was found to favour higher retention rates and longer abstinence periods from both alcohol and cocaine in polydrug-abusing patients. An alternative approach rests on the use of vaccines, to date in the experimental stage still. Psychosocial treatments are a useful companion in the pharmacotherapy of cocaine abuse, with group therapy and contingency management therapies improving motivation and social functioning, particularly in patients abusing alcohol as well.

Reid LW; Elifson KW; Sterk CE. Ecstasy and gateway drugs: Initiating the use of ecstasy and other drugs. Annals of Epidemiology 17(1): 74-80, 2007. (46 refs.)

PURPOSE: The main purposes of this study are to examine whether and to what extent ecstasy use serves as a gateway to the use of such hard drugs as cocaine, heroin, and methamphetamine and compare ages of onset of alcohol and marijuana use and subsequent use of cocaine, heroin, and methamphetamine among young adult ecstasy users. METHODS: Face-to-face surveys were conducted with 268 young adult ecstasy users in Atlanta, GA. Subjects were solicited by using the community identification process, including targeted sampling and guided recruitment. Data analysis involved discrete-time event-history analysis. RESULTS: Results suggest that age of onset of ecstasy use influences the initiation of cocaine and methamphetamine use for our sample of active ecstasy users. In addition, alcohol and marijuana use precedes the initiation of cocaine and methamphetamine use, but only marijuana use influences the initiation of heroin use. CONCLUSIONS: The sequential progression of drug use proposed in the gateway literature is not immutable. Researchers must take into account the changing popularity of drugs over time, such as the emergence of ecstasy use, when identifying patterns of drug-use onset.

Reulbach U; Biermann T; Bleich S; Hillemacher T; Kornhuber J; Sperling W. Alcoholism and homicide with respect to the classification systems of Lesch and Cloninger. Alcohol and Alcoholism 42(2): 103-107, 2007. (30 refs.)

Aims: Worldwide criminal statistics show a disproportionately high incidence of violent offences committed under the influence of alcohol. A psychopathological subtyping of alcohol dependence in offenders who committed homicide has mainly been related to impulsive and dissocial personalities up to now. Methods: In an investigation on 48 alcohol-dependent offenders who committed homicide, a subtyping according to the multidimensional classification systems of Lesch and Cloninger has now been conducted for the first time. Results: In Lesch's classification, there was a high incidence of homicides committed by type II and type III subjects with the comorbidity anxiety and cyclothymia. While type III offenders were more often repeat offenders, there was a remarkably high rate of first offenders among type II subjects (Chi-squared test; chi(2) = 30.0, df = 3, P < 0.001). With respect to Lesch's typology, the blood alcohol concentrations did differ significantly in the group of offenders (Kruskal-Wallis, chi(2) = 18.3, df = 3, P < 0.001), whereas the blood alcohol concentration of type II offenders at the time of offence was significantly lower than in type III offenders (Mann-Whitney-U, Z = -3.47; P = 0.001). Regarding to the Cloninger's typology, no significant differences in the aforementioned parameters could be found. Discussion: An excessive noradrenergic reaction of anxiety offenders with initial withdrawal is discussed as a possible explanatory model.

Ribeiro M; Dunn J; Sesso R; Lima MS; Laranjeira R. Crack cocaine: A five-year follow-up study of treated patients. European Addiction Research 13(1): 11-19, 2007. (29 refs.)

Objectives: To follow-up a group of 131 crack cocaine users and examine drug use, treatment experience, employment status, involvement in crime and mortality at 2 and 5 years. Methods: Consecutive crack-dependent patients who were admitted to a detoxification unit in Sao Paulo between 1992 and 1994 were re-interviewed on two occasions: 1995-1996 and 1998-1999. Results: 5 years after treatment information was obtained on 124 (95%) of the original cohort. 39.7% (n = 52) of the patients reported having been abstinent from cocaine for at least the last year, and 21.4% (n = 28) had used the drug. Of those subjects not using cocaine at 2 years, 19 (62%) were still abstinent at 5 years. Twenty-three (17.6%) patients had died by the 5-year follow-up with homicide, due to firearms or other weapons, being the commonest cause ( n = 13). The annual adjusted mortality rate for the sample was 24.92 deaths/1,000 individuals, the excess mortality rate was of 21.64 deaths/1,000 individuals, and the standardized mortality ratio was 7.60. A history of injecting drug use, unemployment at the time of the index admission and administrative discharge at the index admission were factors that contributed to the risk of dying over the next 5 years. Conclusions: There was a progressive movement towards abstinence over the follow-up period, and there was evidence that once abstinence had been achieved it was maintained. On the other hand, the mortality rate was extremely high and was higher among those who were still using crack at 2 years.

Ribeiro IM; Vale PJ; Tenedorio PA; Rodrigues PA; Bilhoto MA; Pereira HC. Ocular manifestations in fetal alcohol syndrome. European Journal of Ophthalmology 17(1): 104-109, 2007. (10 refs.)

PURPOSE. To report the prevalence of ocular abnormalities in a group of Portuguese children with a complete fetal alcohol syndrome (FAS). METHODS. Complete ophthalmologic examination in a sample of consecutive children with FAS. Ocular fundus photography was carried out on the cooperative FAS children and on 25 reference Children. Ocular fundus anomalies were recorded by the observation of ocular fundus photography. The ratio between the distance of the center of the disc to the fovea and optic disc diameter (DM/DD) was determined. Small optic disc was defined as a DM/DD ratio above mean control group +1 SD. RESULTS. The authors studied 32 children with FAS (mean age: 9 5 years; 72% boys). The mean corrected visual acuity (VA) was 0.8 +/- 0.2. Refraction ranged from -23.00 to +6.50 spherical equivalent. Ocular findings included short horizontal palpebral fissure (81% of children), strabismus (28% of children), epicanthus (27% of eyes), blepharoptosis (16% of eyes), telecanthus (13% of children), nystagmus (1 child), and cataract (1 eye). Ocular fundus photography analysis showed retinal vessel tortuosity in 30% of the eyes and optic disc hypoplasia in 25%. The mean DM/DD for the control and FAS groups was 2.72 +/- 0.20 and 2.89 +/- 0.25 (p=0.001). Forty percent of the eyes of FAS children had small optic discs. CONCLUSIONS. The most common ocular findings were anomalies of retinal fundus and minor changes in the outer region of the eyes. The authors noted better VA and less severity of disease than others, which might be due to a different selection of patients, different Pattern of alcohol consumption, or genetic differences.

Ross MW; Timpson SC; Williams ML; Bowen A. The impact of HIV-related interventions on HIV risk behavior in a community sample of African American crack cocaine users. AIDS Care 19(5): 608-616, 2007. (54 refs.)

While there are reports of the impact of specific interventions designed to reduce HIV drug and sexual risk behaviors, there are few reports of the impact of HIV interventions in a community-based sample. We report on baseline data from a sample of African American crack smokers who were about to participate in an intervention designed to reduce HIV-related risk behaviors. The majority were male ( 80%), single ( 70%) and homeless ( 52%). Data indicated that 29% of the sample had been in a previous HIV intervention in the past 12 months, the majority in a correctional setting or CBO program. There were few systematic demographic differences between the two groups. Those who had been in an intervention reported using male and female condoms significantly more frequently on all measures of condom use, had positive condom use outcome expectations for male condoms and higher affective and situational condom-related self-efficacy beliefs. These data suggest that, at a community level, the spectrum of HIV risk-reduction programs does produce a significant improvement in condom use and related cognitions, although there is a need to cover a greater proportion of the population. Previous exposure to interventions must be a critical covariate in assessing the impact of future interventions.

Rothman RB; Blough BE; Baumann MH. Dual dopamine/serotonin releasers as potential medications for stimulante and alcohol addictions. (review). AAPS Journal 9(1): E1-E10, 2007. (84 refs.)

We have advocated the idea of agonist therapy for treating cocaine addiction. This strategy involves administration of stimulant-like medications (eg, monoamine releasers) to alleviate withdrawal symptoms and prevent relapse. A major limitation of this approach is that many candidate medicines possess significant abuse potential because of activation