Impulsivity and Treatment Outcomes in Individuals with Cocaine Use Disorder: Examining the Gap between Interest and Adherence.

Background: Impulsivity is implicated in the development and maintenance of Cocaine Use Disorder (CUD). Less work has examined impulsivity's role on interest in initiating treatment, treatment adherence, or treatment response. No pharmacotherapies are approved for CUD, so efforts to understand and bolster the effects of psychotherapy are important in guiding and refining treatment. The present study examined the impact of impulsivity on interest in treatment, treatment initiation, treatment adherence, and treatment outcomes in individuals with CUD. Methods: Following the completion of a larger study on impulsivity and CUD participants were offered 14 sessions of (12 weeks) Cognitive Behavioral Relapse Prevention (CBT-RP). Before starting treatment, participants completed seven self-report and four behavioral measures of impulsivity. Sixty-eight healthy adults (36% female) with CUD (aged 49.4 ± 7.9) expressed an interest in treatment. Results: Greater scores on several self-report measures of impulsivity, and fewer difficulties with delayed gratification were associated with increased interest in treatment in both males and females. 55 participants attended at least 1 treatment session, while 13 participants did attend a single session. Individuals who attended at least one treatment session scored lower on measures of lack of perseverance and procrastination. Still, measures of impulsivity did not reliably predict session attendance nor the frequency of cocaine-positive urine samples throughout treatment. Males attended nearly twice as many treatment sessions as females despite nonsignificant associations between impulsivity in males and the number of sessions attended. Conclusions: Greater impulsivity in individuals with CUD was associated with expressing an interest in treatment, but not treatment adherence or response.

Gabapentin increases the abuse liability of alcohol alone and in combination with oxycodone in participants with co-occurring opioid and alcohol use disorder.

BACKGROUND: People who have co-occurring Alcohol Use Disorder (AUD) and Opioid Use Disorder (OUD) carry a higher risk of adverse outcomes, including drug overdose. Early clinical and preclinical studies suggested that gabapentin may be effective in treating both disorders. The present study was designed to assess the effects of gabapentin on the subjective and physiological effects of oxycodone (OXY) and alcohol (ALC), alone and in combination. METHODS: During an 8-week, inpatient, within-subject, randomized, double-blind, placebo-controlled crossover study, non-treatment seeking participants (N = 13; 12 M/1F; 44.1 ± 3 years of age) with OUD and AUD were maintained on oral morphine (120 mg daily). Under gabapentin (1800 mg/day) and placebo (0 mg/day) maintenance, participants completed nine separate test sessions (three sessions per week) during which they received an oral solution containing 0, 15, or 30 mg/70 kg OXY in combination with 0, 0.5, or 0.75 g/kg ALC. During test sessions, subjective effects and physiological responses were assessed repeatedly on 100-mm visual analog scales (VAS). The primary outcome variable was the VAS rating of drug liking after receiving the drug challenge. RESULTS: Alcohol alone (but not oxycodone alone) produced dose-related increases in several positive subjective responses, including drug liking. Gabapentin significantly increased drug liking when given in combination with ALC and OXY + ALC (p < 0.05). Gabapentin did not clinically compromise respiration or other vital functions. CONCLUSIONS: Gabapentin may increase the abuse liability of ALC and OXY + ALC in those with co-occurring OUD and AUD.

The Madreporic cementless total hip arthroplasty: short-term North American experience.

Forty-four Madreporic, cementless, total hip arthroplasties performed on 41 patients were reviewed, with special attention to overall clinical results and radiologic findings. Follow-up averaged 17 months (range from 6 to 27 months). Subjectively, 87% of patients rated the results of their operation as being excellent or good; objectively, 92.5% were in the excellent or good category, using the Harris hip scale rating system. Short-term radiologic findings were of major interest, with proximal medial calcar reabsorption (7 hips), thickening of the lateral cortex at the tip of the femoral stem (2 hips) and sclerosis at the tip of the femoral component (15 hips) all being present. Complications were associated with 11 operations, but adversely affected long-term results in only two hips. The authors conclude that short-term clinical results using Madreporic total hip replacement are satisfactory. However, long-term biomechanical effects of stress shielding and use of a large, rigid, femoral component in the uncemented total hip replacement are unknown. A long-term, follow-up study is necessary to demonstrate whether the early radiologic findings in this series are progressive and whether they will result in serious morbidity with time. The authors strongly believe that the Madreporic cementless total hip arthroplasty should be used only in centres dealing with a large volume of hip conditions where staff are committed to documenting and reporting the results of surgery regularly.

Bunions in children: treatment with a modified Mitchell osteotomy.

Modifications to the original Mitchell osteotomy of the first metatarsal for bunions in children are described. The reasons for these modifications are stressed, and the results of the modified version of the operation in 45 feet are discussed. Long-term cosmetic and functional results with this operation have been excellent in growing children.