Recording of clinical information in a Scotland-wide drug deaths study: Baldacchino, A. ;Crome, IB ;Zador, D. ;McGarrol, S. ;Taylor, A. ;Hutchison, S. ;Fahey, T. ;Hickman, M. ;Kidd, B.
doi: 10.1177/0269881109103797pmid: 19351800
The aim of this study was to analyse the nature and extent of data extracted from case files of deceased individuals in contact with services 6 months prior to drug deaths in Scotland during 2003. A cross-sectional descriptive analysis of 317 case notes of 237 individuals who had drug-related deaths was undertaken, using a data linkage process. All contacts made with services in the 6 months prior to death were identified. Information on clinical and social circumstances obtained from social care, specialist drug treatment, mental health, non-statutory services, the Scottish Prison Service and Criminal Records Office was collated. More than 70% (n = 237) were seen 6 months prior to their drug death. Sociodemographic details were reported much more frequently than medical problems, for example, ethnicity (49%), living accommodation (66%), education and income (52%) and dependent children (73%). Medical and psychiatric history was recorded in only 12%, blood-borne viral status in 17% and life events in 26%. This paucity of information was a feature of treatment plans and progress recorded. The 237 drug deaths were not a population unknown to services. Highly relevant data were missing. Improved training to promote in-depth recording and effective monitoring may result in better understanding and reduction of drug deaths.
Randomised double-blind, placebo-controlled trial of the effects of the ‘party pills’ BZP/TFMPP alone and in combination with alcohol: Thompson, I. ;Williams, G. ;Caldwell, B. ;Aldington, S. ;Dickson, S. ;Lucas, N. ;McDowall, J. ;Weatherall, M. ;Robinson, G. ;Beasley, R.
doi: 10.1177/0269881109102608pmid: 19329546
The objective of this study was to determine the clinical effects of party pills containing benzylpiperazine (BZP) and trifluoromethylphenylpiperazine (TFMPP) when taken alone and in combination with alcohol. The study was a randomised, double-blind, placebo-controlled trial conducted in a hospital-based clinic in Wellington, New Zealand. Thirty-five volunteers who had previously used party pills containing BZP were included in this trial. Participants received one of the following four treatments: 300 mg/74 mg BZP/TFMPP and placebo, 300 mg/74 mg BZP/TFMPP and 57.6 g (6 units) alcohol, placebo and 57.6 g (6 units) alcohol and double placebo. The primary outcome variable was a measure of driving performance, the standard deviation of lateral position (SDLP) measured at 6.5 h. Secondary measures included adverse events, cardiovascular effects, psychological function and delayed effects on sleep. The study was stopped early, after 35 of the planned 64 subjects had undertaken testing, because of severe adverse events that occurred in four of 10 BZP/TFMPP-only subjects, three of seven combined BZP/TFMPP and alcohol subjects, none of the 6 placebo subjects, and none of the 12 alcohol-only subjects. The overall rate of severe adverse events (defined as causing considerable interference with usual activity and/or rated by subject as severe) in those receiving BZP/TFMPP was seven of 17 (41.2%, 95% CI 18.4—67.1). The severe events included agitation, anxiety, hallucinations, vomiting, insomnia and migraine. BZP/TFMPP significantly improved the driving performance, decreasing SDLP at −4.2 cm (95% CI −6.8 to −1.6, P = 0.002). The effect of alcohol was to increase SDLP: 2.3 cm (95% CI −0.3 to 4.9, P = 0.08). BZP/TFMPP also resulted in increased heart rate and blood pressure and in difficulty in getting to sleep. BZP/TFMPP alone or with alcohol carries a significant risk of severe adverse events when taken in similar doses to those recommended by manufacturers.
Carryover effects to addiction-associated stimuli in a group of marijuana and cocaine users: Sharma, Dinkar ;Money, Sharon
doi: 10.1177/0269881109350079pmid: 19939860
Addiction has been characterized as an attentional bias towards drug-related cues. In two experiments we investigate the effects of non-words that have been associatively trained to addiction-related images in a group of marijuana and cocaine users. These associated non-words were presented along with unstudied non-words in a subsequent addiction Stroop task. Results indicate a slowdown in responding to the colour of non-words that were paired with cocaine-related images compared with non-cocaine related images. The slowdown was also characterized as a carryover effect, with the largest effect occurring on trials following the addiction-associated non-word. No effects were found for marijuana images associated with non-words.
Neuropsychological consequences of alcohol and drug abuse on different components of executive functions: Fernández-Serrano, María José ;Pérez-García, Miguel ;Río-Valle, Jacqueline Schmidt;Verdejo-García, Antonio
doi: 10.1177/0269881109349841pmid: 20007413
Several studies have shown alterations in different components of executive functioning in users of different drugs, including cannabis, cocaine and heroin. However, it is difficult to establish a specific association between the use of each of these drugs and executive alterations, since most drug abusers are polysubstance abusers, and alcohol is a ubiquitous confounding factor. Moreover, in order to study the association between consumption of different drugs and executive functioning, the patterns of quantity and duration of drugs used must be considered, given the association between these parameters and the executive functioning alteration degree. Based on the multicomponent approach to executive functions, the aims of the present study were: (i) to analyse the differential contribution of alcohol versus cocaine, heroin and cannabis use on executive functions performance; and (ii) to analyse the contribution made by the severity of the different drugs used (quantity and duration patterns) on these functions in a sample of polysubstance abusers that requested treatment for cannabis-, cocaine- or heroin-related problems. We administered measures of fluency, working memory, analogical reasoning, interference, cognitive flexibility, decision-making and self-regulation to two groups: 60 substance-dependent individuals (SDIs) and 30 healthy control individuals (HCIs). SDIs had significantly poorer performance than HCIs across all of the executive domains assessed. Results from hierarchical regression models showed the existence of common correlates of the use of alcohol, cannabis and cocaine on verbal fluency and decision-making; common correlates of quantity of cannabis and cocaine use on verbal working memory and analogical reasoning; common correlates of duration of cocaine and heroin use on shifting; and specific effects of duration of cocaine use on inhibition measures. These findings indicate that alcohol abuse is negatively associated with fluency and decision-making deficits, whereas the different drugs motivating treatment have both generalized and specific deleterious effects on different executive components.
Reduced attentional blink for alcohol-related stimuli in heavy social drinkers: Tibboel, Helen ;De Houwer, Jan ;Field, Matt
doi: 10.1177/0269881109106977pmid: 19843628
Researchers have used various paradigms to show that attentional biases for substance-related stimuli are an important feature of addictive behaviours. However, it is not clear whether these attentional biases occur at the level of encoding or at later post-attentive processing stages. We examined attentional bias at the level of encoding with the attentional blink paradigm in a sample of non-clinical heavy and light-drinking students. Our results show a diminished attentional blink effect for alcohol-related words compared with soft drink-related words among heavy drinkers. The attentional blink was equally strong for alcohol-related and soft drink-related words among light drinkers. This suggests that alcohol-related information is processed relatively more efficiently in the former group. Even though these results are promising, our study shows that the internal consistency of the attentional blink can be improved.
The effect of nicotine on visuospatial attention in chronic spatial neglect depends upon lesion location: Vossel, S. ;Kukolja, J. ;Thimm, M. ;Thiel, CM ;Fink, GR
doi: 10.1177/0269881109105397pmid: 19477881
The deficit to reorient attention from ipsilesional to contralesional space is one key feature of the spatial neglect syndrome. As previous studies suggest that reorienting of visuospatial attention is modulated by cholinergic neurotransmission, we investigated whether cholinergic stimulation with nicotine (Nicorette® 2 mg, Pharmacia/Pfizer, Helsingborg, Sweden) facilitates attentional reorienting in spatial neglect patients. Nine nonsmoking patients with stable neglect symptoms were investigated in a within-subject cross-over design. We used a location-cueing paradigm and analysed reaction time (RT) differences between validly and invalidly cued, as well as between neutrally cued and uncued targets as a function of hemifield and drug. Moreover, since the nicotine effect is mediated by parietal brain areas in healthy subjects, we tested whether lesion location influences the pharmacological effect. Nicotine speeded RTs in valid and invalid trials nonspecifically, without modulating the validity effect in the location-cueing task in the whole group of patients. Lesion-symptom mapping revealed a relationship between lesion site and the pharmacological effect on reorienting to contralesional space in right parietal and temporal brain regions. We conclude that in patients with chronic spatial neglect the performance in the location-cueing paradigm can be modulated by a cholinergic stimulant provided that the lesion spares right parietal and temporal cortex.
An open pilot study of tiagabine in alcohol dependence: tolerability and clinical effects: Paparrigopoulos, T. ;Tzavellas, E. ;Karaiskos, D. ;Malitas, P. ;Liappas, I.
doi: 10.1177/0269881109103799pmid: 19346278
There is evidence that GABAergic anticonvulsants can be efficacious in the treatment of alcohol dependence and in the prevention of alcohol relapse because these agents act on the substrate that is involved in alcoholism. Tiagabine, a selective GABA transporter1 reuptake inhibitor, may be a promising candidate for the treatment of alcohol-dependent individuals. In this randomized, open pilot study, we aimed to investigate the efficacy and tolerability of tiagabine as adjunctive treatment of alcohol-dependent individuals (N = 60) during the immediate post-detoxification period and during a 6-month follow-up period following alcohol withdrawal. A control non-medicated group of alcohol-dependent individuals (N = 60) was used for comparisons in terms of anxiety and depressive symptoms, craving and drinking outcome. Although a steady improvement in terms of psychopathology, craving and global functioning was observed in both groups throughout the study, subjects on tiagabine improved significantly more compared to the control subjects (P < 0.001). Furthermore, the relapse rate in the tiagabine group was lower than in the control group (7 vs 14.3%). Tiagabine was well tolerated and only a minority of the participants reported some adverse effects in the beginning of tiagabine treatment. Results from this study suggest that tiagabine is a safe and effective medication for the management of alcohol dependence when given adjunctively to a standard psychotherapy treatment. Further studies are warranted before definite conclusions can be reached.
mCPP: an undesired addition to the ecstasy market: Bossong, MG ;Brunt, TM ;Van Dijk, JP ;Rigter, SM ;Hoek, J. ;Goldschmidt, HMJ ;Niesink, RJM
doi: 10.1177/0269881109102541pmid: 19304863
A new ecstasy-like substance, meta-chlorophenylpiperazine (mCPP), has been detected in street drugs in the Netherlands. Theoretically, mCPP possesses the potential to become a non-neurotoxic alternative for methylenedioxymethamphetamine (MDMA), the regular psychoactive substance of ecstasy. Since its introduction on the Dutch market of synthetic drugs, the percentage of mCPP-containing tablets has increased, including both tablets that contain only mCPP and tablets containing a combination of mCPP and MDMA. These tablets occur in many different colours, shapes and sizes and with various logos, making it impossible to distinguish mCPP-containing tablets from regular MDMA tablets. In addition, the reports of users concerning the effects of mCPP are predominantly negative. All these aspects together lead to the conclusion that mCPP is an undesired addition to the ecstasy market from the user’s perspective.