Correlates of nicotine withdrawal severity in smokers during a smoke-free psychiatric hospitalization.

Psychiatric hospitals are increasingly adopting smoke-free policies. Tobacco use is common among persons with mental illness, and nicotine withdrawal (NW), which includes symptoms of depression, anxiety, anger/irritability, and sleep disturbance, may confound psychiatric assessment and treatment in the inpatient setting. This study aimed to characterize NW and correlates of NW severity in a sample of smokers hospitalized for treatment of mental illness in California. Participants (N=754) were enrolled between 2009 and 2013, and averaged 17 (SD=10) cigarettes/day prior to hospitalization. Though most (70%) received nicotine replacement therapy (NRT) during hospitalization, a majority (65%) reported experiencing moderate to severe NW. In a general linear regression model, NW symptoms were more severe for women, African American patients, and polysubstance abusers. Though invariant by psychiatric diagnostic category, greater NW was associated with more severe overall psychopathology and greater cigarette dependence. The full model explained 46% of the total variation in NW symptom severity (F [19, 470]=23.03 p<0.001). A minority of participants (13%) refused NRT during hospitalization. Those who refused NRT reported milder cigarette dependence and stated no prior use of NRT. Among smokers hospitalized for mental illness, NW severity appears multidetermined, related to cigarette dependence, demographic variables, psychiatric symptom severity, and other substance use. Assessment and treatment of NW in the psychiatric hospital is clinically warranted and with extra attention to groups that may be more vulnerable or naïve to cessation pharmacotherapy.

Antecedents and consequences of cannabis use among racially diverse cannabis users: an analysis from Ecological Momentary Assessment.

BACKGROUND: Cannabis remains the most commonly used illicit substance and use rates are rising. Notably, the prevalence of cannabis use disorders (CUD) nearly equals that of other illicit substance use disorders combined. Thus, the present study aimed to identify cognitive, affective, and situational predictors and consequences of ad-lib cannabis use in a racially diverse sample. METHODS: The sample consisted of 93 current cannabis users (34.4% female; 57.1% non-Hispanic Caucasian), 87.1% of whom evinced a current CUD. Ecological Momentary Assessment was used to collect frequent ratings of cannabis withdrawal, craving, affect, cannabis use motives, and peer cannabis use over two weeks. Mixed effects linear models examined within- and between-day correlates and consequences of cannabis use. RESULTS: Withdrawal and craving were higher on cannabis use days than non-use days. Withdrawal, craving, and positive and negative affect were higher immediately prior to cannabis use compared to non-use episodes. Withdrawal and craving were higher among those who subsequently used cannabis than those who did not. Cannabis use resulted in less subsequent withdrawal, craving, and negative affect. Enhancement and coping motives were the most common reasons cited for use. Withdrawal and negative affect were related to using cannabis for coping motives and social motives. Participants were most likely to use cannabis if others were using, and withdrawal and craving were greater in social situations when others were using. CONCLUSIONS: Data support the contention that cannabis withdrawal and craving and affect and peer use play important roles in the maintenance of cannabis use.

Relationship of impulsivity and depression during early methamphetamine withdrawal in Han Chinese population.

OBJECTIVE: High level of impulsivity as well as depression is thought to be involved in the maintenance and development of methamphetamine (METH) addiction. However, the relationship between impulsivity and depression has not been studied thoroughly in METH dependence subjects, especially in early METH abstinent subjects. In this study, our objective is to explore the interplay between the depressive symptoms and impulsivity in early METH abstinent subjects. METHODS: A total of 182 early abstinent METH dependent subjects (abstinence for 1-7 days) were recruited and the level of impulsivity was measured by the Barratt Impulsiveness Scale (BIS-11). Depressive symptoms and anxiety symptoms were assessed by the short 13-item Beck Depression Inventory (BDI-13) and Beck Anxiety Inventory (BAI) respectively. RESULTS: Global impulsivity of BIS-11 was significantly correlated with depressive symptoms among early METH abstinent subjects (r=0.283, p=0.001). Moreover, all subscales of BIS-11 were also found to be correlated with depressive symptoms: correlation with attentional impulsivity (r=0.202, p=0.006); correlation with motor impulsivity (r=0.267, p=0.001); and correlation with non-planning impulsivity (r=0.177, p=0.017). CONCLUSIONS: This study showed a relationship between impulsivity and depression, which may further the comprehension of motivational elements contributing to the maintenance and development of METH use disorder. Future research would be dedicated to exploring underlying mechanisms of association between impulsivity and depression.

From "Kickeando las malias" (kicking the withdrawals) to "Staying clean": The impact of cultural values on cessation of injection drug use in aging Mexican-American men.

Drug use among older adults is a growing concern, particularly for the burgeoning Hispanic population. Older adults seeking drug treatment will double over the next decade to almost 6 million. Cultural factors influence drug use, and more specifically, Hispanic cultural values influence heroin use. This study explored Mexican-American injection drug users' adherence to traditional Hispanic cultural values and their impact on cessation. Ethnographic interviews endorsed contextualized influences of values on heroin use. Cultural values functioned dichotomously, influencing both initiation and cessation. Understanding the impact of cultural values on substance abuse is critical given the changing demographics in American society.

Smoking abstinence-related expectancies among American Indians, African Americans, and women: potential mechanisms of tobacco-related disparities.

Research has documented tobacco-related health disparities by race and gender. Prior research, however, has not examined expectancies about the smoking cessation process (i.e., abstinence-related expectancies) as potential contributors to tobacco-related disparities in special populations. This cross-sectional study compared abstinence-related expectancies between American Indian (n = 87), African American (n = 151), and White (n = 185) smokers, and between women (n = 231) and men (n = 270) smokers. Abstinence-related expectancies also were examined as mediators of race and gender relationships with motivation to quit and abstinence self efficacy. Results indicated that American Indians and African Americans were less likely than Whites to expect withdrawal effects, and more likely to expect that quitting would be unproblematic. African Americans also were less likely than Whites to expect smoking cessation interventions to be effective. Compared with men, women were more likely to expect withdrawal effects and weight gain. These expectancy differences mediated race and gender relationships with motivation to quit and abstinence self-efficacy. Findings emphasize potential mechanisms underlying tobacco-related health disparities among American Indians, African Americans, and women and suggest a number of specific approaches for targeting tobacco dependence interventions to these populations.

The acute tobacco withdrawal syndrome among black smokers.

Black smokers have greater difficulty quitting tobacco than White smokers, but the mechanisms underlying between-race differences in smoking cessation are not clear. One possibility is that Black smokers experience greater acute withdrawal than Whites. We investigated whether Black (n = 104) and White smokers (n = 99) differed in abstinence-induced changes in self-report, physiological, and cognitive performance measures. Smokers not wishing to quit completed two counterbalanced experimental sessions. Before one session, they abstained from smoking for at least 12 hr. They smoked normally before the other session. Black smokers reported smaller abstinence-induced changes on a number of subjective measures including the total score of the 10-item Questionnaire for Smoking Urges (QSU) and the total score of the Wisconsin Smoking Withdrawal Scale (WSWS). However, on most subjective measures, and on all objective measures, there were no between-race differences in abstinence-induced change scores. Moreover, Black participants did not report lower QSU and WSWS ratings at the abstinent session, but they did experience significantly higher QSU and WSWS ratings at the nonabstinent session. Abstinence-induced changes in subjective, physiological, and cognitive measures in White smokers were similar for smokers of nonflavored and menthol-flavored cigarettes. There was no evidence that Black smokers experienced greater acute tobacco withdrawal than Whites. To the contrary, Black participants experienced smaller abstinence-induced changes in self-reported craving and withdrawal on some measures. Racial differences in smoking cessation are unlikely to be explained by acute withdrawal.

Scopolamine detoxification technique for heroin dependence: a randomized trial.

BACKGROUND: Easing psychological symptoms associated with heroin use and heroin relapse are important goals in the treatment of heroin dependence. However, most detoxification methods are designed to decrease withdrawal-related discomfort and complications, but not to reduce the psychological effects of heroin addiction. OBJECTIVE: The objective of this study was to evaluate the efficacy of scopolamine detoxification technique (SDT) relative to standard methadone detoxification (MD) to treat heroin withdrawal and psychological symptoms associated with heroin use and relapse. METHODS: In this 10-week randomized, controlled trial, treatment-seeking heroin-dependent participants were enrolled consecutively from Ningbo Addiction Research and Treatment Center, Ningbo, China. Opioid dependence was confirmed by a naloxone challenge test. Participants were included if they met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for opioid dependence, were without major comorbid psychiatric illness, and were not allergic to scopolamine and chlorpromazine. Participants (N = 91; 18-50 years) were admitted to inpatient beds for 15 days and randomly assigned to receive either SDT (N = 46) or MD (N = 45) prior to being discharged and undergoing 8 weeks of outpatient treatment. During the inpatient stay, all participants received methadone during days 1-3. Those in the MD group then underwent a 10-day gradual dose-reduction regimen. Those in the SDT group underwent an SDT, such that subjects were given scopolamine (0.03-0.05 mg/kg, intravenously) and chlorpromazine (0.6-1.0 mg/kg, intravenously) under light anesthesia for 4-6 h once per day on days 4-6 or 4-7, depending on the severity of opioid-withdrawal symptoms. Self-reported withdrawal symptoms were assessed each day during the in-patient treatment phase. Heroin craving (assessed using a visual analog scale), Beck Depression Inventory, Self-Rating Anxiety Scale, and working memory and attention tests (assessed using the Digit-span test and d2 test) were measured before (day 0) and after detoxification (day 15). Retention was assessed during the inpatient phase and the outpatient phase. Urine tests for opioids were assessed twice weekly in the follow-up phase. Reasons for Relapse Questionnaires were completed when each participant's urine sample was positive. RESULTS: The vital signs of participants were stable and no serious adverse anesthetic events were observed during SDT. SDT considerably suppressed heroin withdrawal symptoms, which did not increase during the post-detoxification phase. Although groups did not differ on retention or the percentage of opioid-positive urine samples (SDT 73.2 ± 30.1% and MD 75.1 ± 37.6%), SDT significantly attenuated heroin craving, depression, and anxiety compared with MD (P < 0.001). There was a significant difference in the mean reductions (%) of amount of first heroin use after hospital discharge between the SDT group and the MD group (t 71 = 6.09, P < 0.01). There were no significant differences in the scores of the Digit-span and d2 tests by treatment conditions (P > 0.05). The percentage of participants citing "drug craving" and "anxiety and depression" as the primary reasons for relapse was significantly lower in the SDT group than in the MD group. CONCLUSIONS: SDT may be an alternative to conventional detoxification techniques, especially for patients with psychological symptoms.

Facilitating medical withdrawal from opiates in rural Ontario.

CONTEXT: The abuse of oxycodone in Northwestern Ontario, Canada, has escalated at alarming rates raising concerns that opiate use has reached epidemic proportions, particularly among the First Nations communities. The authors were involved in establishing Ontario's first rural inpatient medical withdrawal unit to serve patients seeking abstinence. ISSUES: The development of the medical withdrawal support services (MWSS) required creative and adaptive strategies to respond to the geographical, cultural and institutional circumstances. LESSONS LEARNED: Key factors to support program efficacy and successful outcomes for clients during the inaugural eight months of operation are interprofessional and collaborative approaches with a cultural awareness.Key words: addiction, Canada, First Nation, medical withdrawal.

Factors associated with smoking menthol cigarettes among treatment-seeking African American light smokers.

BACKGROUND: Smoking menthol cigarettes is more prevalent among African Americans (AA) compared to Whites. Menthol has been found to be inversely related to smoking cessation among AA, yet little is known about the factors associated with menthol smoking among AA light smokers. This study examines baseline demographic, psychological, and smoking factors associated with smoking menthol cigarettes among AA light smokers (≤10 cigarettes per day). METHODS: Participants (n=540) were enrolled in a double blind, placebo-controlled randomized trial of bupropion in combination with health education counseling for smoking cessation. Bivariate differences between menthol and non-menthol smokers were explored and baseline factors associated with smoking menthol cigarettes were identified. RESULTS: Participants averaged 46.5 years in age, predominantly female (66.1%), and smoked an average of 8.0 cpd (SD=2.5). The majority (83.7%) smoked menthol cigarettes. In bivariate analysis, menthol cigarette smokers were younger (mean age: 45 vs. 52 years p<0.0001), were more likely to be female (68% vs. 52% p=0.003) and had smoked for shorter duration (28 vs. 34 years p<0.0001) compared to non-menthol smokers. While depression and withdrawal scores were slightly higher and exhaled carbon monoxide values were lower among menthol smokers, the differences were not statistically significant. CONCLUSIONS: Among AA light smokers, younger individuals and females were more likely to smoke menthol cigarettes and may be more susceptible to the health effects of smoking. Appropriately targeted health education campaigns are needed to prevent smoking uptake in this high-risk population.

Association of race and ethnicity with withdrawal symptoms, attrition, opioid use, and side-effects during buprenorphine therapy.

Some studies report differences in opioid withdrawal between racial/ethnic groups. However, it is not known if these differences are reflected in differential treatment response. Data from National Institute on Drug Abuse (NIDA) Clinical Trials Network-003 were used to examine racial/ethnic differences before and during stabilization with buprenorphine. At induction, non-Hispanic Caucasians had higher objective and subjective withdrawal scores and greater opioid craving than minority participants. No significant between-group differences were observed on these scales following buprenorphine. Non-Hispanic Caucasians and Hispanics reported more adverse events than African Americans. Although ethnic and racial differences were observed prior to buprenorphine treatment, scores following buprenorphine treatment were similar between groups.

Racial variations in the incidence of severe alcohol withdrawal.

UNLABELLED: The use of race as a risk assessment tool and pharmacologic target has garnered recent attention and debate. It is currently unclear if a relationship between race and the development of severe alcohol withdrawal exists. We explored this potential relationship using several study groups. METHODS: A simultaneous prospective enrollment of patients and retrospective chart review of severe alcohol withdrawal in two separate settings was performed comparing both the incidence of withdrawal and alcoholism based on race. These two study groups were then compared to an "at risk" group of alcoholics and the general ED population to determine differences in the distribution of race. RESULTS: Individuals of white race in both study groups were at increased odds [OR 1.93 (CI 1.11-3.39) and 2.19 (CI 1.41-3.40)] of having severe alcohol withdrawal when compared to non-White "at risk" alcoholics. Blacks in both study groups however, appear to have lower odds [OR 0.23 (CI 0.11-0.47) and 0.11 (CI 0.05-0.23)] of having severe alcohol withdrawal when compared to non-Black "at risk" alcoholics. CONCLUSIONS: Despite the controversial use of race in medical research and targeting therapies, there appears to be a difference in the odds of severe alcohol withdrawal based on race. The reasons for this finding are currently unclear.

Light versus heavy smoking among African American men and women.

The majority of smoking cessation research has focused on heavy smokers. African Americans (AA) are less likely than the general population to be heavy smokers. Thus, little is known about the smoking and psychosocial characteristics of lighter AA smokers. The present study compared the baseline demographic, smoking, and psychosocial characteristics of light (5-10 cigarettes per day; n=86) and moderate to heavy (>10 cigarettes per day; n=286) AA smokers enrolled in a smoking cessation clinical trial. Results indicated no differences between groups on demographic variables. However, light smokers (LS) were less dependent on smoking, reported more previous quit attempts, and had higher self-efficacy to quit than moderate to heavy smokers (MHS). On a measure of withdrawal, LS reported less pre-quit craving and less difficulty concentrating than MHS. In addition, LS reported lower perceived stress, fewer symptoms of depression, and greater positive affect than AA MHS. These findings highlight important similarities and differences between AA LS and MHS, and have implications for the treatment of AA smokers.

Nicotine differentially inhibits the acoustic startle reflex in African American and Caucasian American smokers.

Research suggests that there are racial disparities in smoking behaviors, cessation rates, mortality, and morbidity. However, little is known regarding racial differences in affect regulation by smoking. The purpose of this study was to examine racial differences in the effects of nicotine deprivation and administration on smokers' startle responding to smoking and affective cues. 104 African American (AA) and Caucasian American (CA) smokers completed 4 laboratory sessions crossing nicotine deprivation (12-hour deprived vs. nondeprived) with nicotine nasal spray (active vs. placebo). Participants viewed affective (positive, neutral, and negative) and smoking slides while startle probes were administered. The results showed that relative to placebo, AA smokers given nicotine spray exhibited significantly lower startle responses when they were exposed to smoking cues and CA smokers given nicotine spray exhibited significantly lower startle responses when they were exposed to negative and neutral cues. Although nicotine suppresses startle responding in both AA and CA smokers, the effect is modulated by different cue conditions, suggesting that there may be racial differences in components of smoking motivation.

Race differences in nicotine dependence in the Collaborative Genetic study of Nicotine Dependence (COGEND).

In a general population sample from the Detroit site of the Collaborative Genetic Study of Nicotine Dependence (COGEND), we tested Black-White differences in nicotine dependence, measured by "how soon after wake-up the smokers smoked their first cigarette (time to first cigarette TTFC)", and its relationship with number of cigarettes per day (CPD). Analysis was conducted on respondents who have smoked > or =100 cigarettes in lifetime and were current smokers (n = 1,442; 1,087 Whites and 355 Blacks). In univariate analysis, we found no significant race differences on time to first cigarette (chi2 = 2.9, p value = 0.41), but significant race differences on CPD (chi2 = 154.3, p<.01), both categorized by the Fagerström Test of Nicotine Dependence (FTND) cutoffs. We estimated the probability of TTFC < or =30 min given CPD using probit models. The interactions between race and CPD indicated significant differences in dependence at various levels of CPD. The same probability of nicotine dependence was associated with smaller increments in CPD for Blacks than for Whites. The data support the hypothesis that the relationship between CPD and nicotine dependence as reflected in relapse varies by race, and that Black smokers are dependent at lower levels of CPD than Whites.

Psychometric properties of the Minnesota Nicotine Withdrawal Scale: a Korean version.

Smoking is considerably more common among Korean American male individuals compared with all U.S. males, but no reliable and valid nicotine withdrawal scale has been available to measure withdrawal symptoms from the Korean American perspective, which is the aim of the present study. Translation and back-translation of the Minnesota Nicotine Withdrawal Scale (MNWS) was conducted to obtain a measure consistent with the Korean cultural understanding of smoking withdrawal symptoms. Following satisfactory interrater agreements, the Korean version (MNWS-K) was administered to 118 Korean American male smokers. Data were analyzed for internal consistency reliability and stability as well as construct validity. Internal consistency reliability was satisfactory for the total scale and factors (.88, .88, .79) and intraclass correlation coefficient (ICC) for the total score over a 1-month period was fair (r = .51). Exploratory factor analysis with orthogonal rotation yielded two factors. Together, Factor I, early-occurring disturbances in mental functioning, and Factor II, disturbances in physiological functioning and late-occurring disturbances in mental functioning, explained 66% of the variance in the scale. Theoretically related variables to the MNWS-K, number of smoking quit attempts and self-efficacy, showed modest but statistically significant correlations with the MNWS-K total and factored scales. Satisfactory internal consistency coefficients together with the validity findings suggest the MNWS-K warrants use with the Korean American population.

Exploring the prevalence of menopause symptoms in midlife women in methadone maintenance treatment.

Menopause is a natural process that occurs in women's lives as part of normal aging. Many women go through the menopausal transition with few or no symptoms, while some have significant or even disabling symptoms. The purpose of this paper is to describe the menopausal symptom experience of 135 urban methadone-maintained midlife women between the ages of 40 and 55 years. A cross-sectional survey comprising sample characteristic questions and a 14-item menopause symptom checklist was administered. Ninety-six percent reported one or more symptoms with a mean of 6.2 symptoms. Symptom reporting was found to be relatively high, with more than half of the sample reporting hot flashes, night sweats, sleep disturbances, joint pains, and fatigue in the two weeks preceding the survey. However, the psychological symptoms (irritability and depression) were the two most common symptoms in this sample. This study documents a relatively heavy burden of symptoms in an aging cohort of methadone-maintained women. The physical and psychological impact of aging and, in particular, the experience of menopause in these women is rarely studied and poorly understood. This gap in critical knowledge is further complicated by the remarkable similarity of many symptoms associated with menopause and opiate withdrawal. Aging, drug-related health problems, and poor access to health care further complicate the picture and underscore the importance of better integration of health care with social work intervention.