Lithium: effects on subjective functioning and morphine-induced euphoria.

The therapeutic usefulness of lithium in decreasing the euphoria and other symptoms associated with manic behavior and the hypothesis of a common final mechanism for elevations in mood have led to speculation that lithium may block the euphoria induced by drugs of abuse. In this study, lithium alone was antieuphoric in drug-free opiate addicts and, further, did not block morphine-induced euphoria.

Abrupt withdrawal from therapeutically administered diazepam. Report of a case.

Subjective, behavioral, and physiologic changes followed abrupt withdrawal of diazepam (Valium) in a patient who had been treated with 30 to 45 mg of diazepam daily for 20 months. Precipitous weight loss and orthostatic pulse rate increase were a part of the abstinence syndrome, which occurred between the fifth and ninth days of withdrawal. Accompanying these changes in physiologic measures were discomforting symptoms and dysphoria that were aversive and reinforcing to drug taking since the patient sought diazepam administration. These observations suggest that changes in mood, feeling states, and behavior may be the most prominent characteristics of the abstinence syndrome associated with physical dependence on this dose level of diazepam.

Changes in mood, craving, and sleep during short-term abstinence reported by male cocaine addicts. A controlled, residential study.

We examined changes over 28 days in mood states, craving for cocaine, and sleep during short-term abstinence reported by 12 male, predominantly intravenous-using, cocaine-addicted subjects residing in a research facility. For comparison, we examined 10 nonaddicted control subjects. There were no significant differences between cocaine addicts and controls regarding demographics and selected DSM-III-R diagnoses other than psychoactive substance use disorder and antisocial personality disorder. There were significantly higher scores of psychiatric symptoms reported by cocaine addicts 1 week before admission. Mood-distress and depression scores recorded at admission and during short-term abstinence were significantly greater than those reported by controls. Addicts' mood-distress scores and craving for cocaine were greatest at admission and decreased gradually and steadily during the 28-day study. There were no significant differences between groups regarding reports of sleep other than difficulty falling asleep and clearheadedness on arising. Although there were significant differences in resting heart rate at admission and over time, there were no significant differences in weight gain or blood pressure. Given the absence of a classic "withdrawal" pattern, "short-term abstinence" may be a more appropriate classification of psychological and physical phenomena experienced by cocaine addicts who initiate abstinence in a controlled environment.

EEG and brainstem auditory evoked response potentials in adult male drug abusers with self-reported histories of aggressive behavior.

Auditory brainstem evoked response (BAER) and spontaneous electroencephalogram (EEG) were measured in 124 adult male drug abusers. We examined the relationships among psychiatric diagnoses, paper and pencil measures of aggression and hostility, and electrophysiological features. Subjects meeting criteria for antisocial personality disorder (ASP), as defined by DSM-III, were not significantly different from non-ASP subjects for either BAER or spontaneous EEG measures. The more overtly aggressive subjects had significant delays in BAER latency. Aggressive subjects also had more delta activity and less alpha activity in the spontaneous EEG, as have been observed in "psychopaths" and "criminals." Although ASP and aggression are related, these data indicate that aggressiveness may be a separate, albeit overlapping, trait. As both early aggression and a diagnosis of ASP are predictors of later drug use, the findings that only aggression was associated with EEG slowing and brainstem delays may indicate that ASP and aggression make independent contributions to vulnerability to the development of drug abuse.

Strength of drug habits: for heroin, morphine, methadone, alcohol, barbiturates, pentobarbital, benzedrine, cocaine, and marijuana.

The drug habits for 78 confirmed opiate addicts were studied on eight scales from the Process Association Test of Addiction (PATA) for many drug names. Through cluster analysis eight stages of addiction were defined: "to be clean", "to learn about drugs", "to hustle", "to chip" (also "to be high"), to be psychologically dependent or "to need a shot", "to be hooked" "to kick a habit" and "to be in treatment". Associations stimulated by the words heroin and morphine were very similar over the eight stages of addiction in opiate addicts. The subjects were especially inclined to associate morphine and heroin with the most severe level of addiction, "to be hooked". Associations to both methadone and cocaine were elevated at the "hooked" stage, but in other respects associations to these drugs were opposite. Thus, associations to cocaine were focused on the stage of psychological dependence and the lower intermediate stage of addiction, "to chip" and "to be high", whereas associations to methadone suggested a turning away from addiction as indicated by avoidance associations ("to come down" and "to kick a habit") as well as associations to "treatment" and "to be clean". Marijuana, Benzedrine, "goofball" (barbiturates) and alcohol habits were prominent at an intermediate stage of addiction ("to chip" and "to be high"). Avoidance associations were common for Benzedrine and "goofballs" (also pentobarbital) but not for marijuana or alcohol. "Hustling" associations were frequent for marijuana but not for alcohol.

Reinforcements from the first drug experience can predict later drug habits and/or addiction: results with coffee, cigarettes, alcohol, barbiturates, minor and major tranquilizers, stimulants, marijuana, hallucinogens, heroin, opiates and cocaine.

The relationship between the reinforcing quality of the first drug experiences and eventual habits for a variety of drugs was studied in 42 male drug abusers who were predominantly opiate addicts. These subjects volunteered for drug studies carried out by the Addiction Research Center. The degree of reinforcement they derived from their first drug experience was related to their subsequent habit. This was true for alcohol, barbiturates, minor tranquilizers, cocaine, stimulants, marijuana, glue or solvents, hallucinogens, opiates other than heroin and heroin. Positive but non-significant correlations were found for coffee and major tranquilizers. The correlation for cigarettes was contrary to expectations. Of the components to the index of reinforcement, degree of liking of a drug on the first occasion was most related to the subsequent habit. The greatest initial reinforcement scores were found for heroin, cocaine and opiates other than heroin. drugs which were not well liked on the first occasion included major tranquilizers, cigarettes, coffee, and glue.

The development of a cocaine craving questionnaire.

Two versions of a 45-item questionnaire on cocaine craving were administered to 225 cocaine users. The Now version asked about current craving for cocaine, and the General version asked about average craving over the preceding week. Factor analyses showed that a four-factor solution best described the item structure for both versions of the questionnaire. Higher-order analyses indicated that each version was permeated by a single second-order factor. Factor scales derived for each primary and second-order factor had moderate to high reliabilities. Examination of item content, correlations of factors across versions, and external correlates of the factors suggested that both versions were represented by the same hierarchical factor structure. The theoretical and clinical implications of the results from these craving instruments are discussed.

Self-report vs. laboratory measures of aggression as predictors of substance abuse.

Measures of aggressive behavior, antisocial personality, criminality, and impulsivity were obtained on a sample of 85 drug abusing volunteers for studies at the Addiction Research Center in Baltimore. Measures included the Buss-Durkee Hostility Inventory, Diagnostic Interview Schedule Antisocial Personality Disorder diagnosis, Elliott-Huizinga Lifetime Events Scale, Eysenck's Impulsiveness-Venturesomeness-Empathy scales, and a laboratory measure of aggression patterned after the Buss 'aggression machine'. All of the self-report measures of aggression and antisocial personality were moderately correlated with each other, but did not correlate with the laboratory aggression measure. This laboratory measure, nevertheless, made a significant contribution to the prediction of certain substance abuse diagnoses over and above the contributions of the other measures.

Cocaine-induced locomotor activity in rats.

Rats were injected SC or IP with a dose of cocaine at 20 mg/kg twice daily or saline (2 ml/kg) for 15 consecutive doses. Horizontal (including ambulatory and repetitive activity) and ambulatory locomotor activities were assessed following the first (acute) and the 15th (chronic) injections. Total locomotor activity (area under curve, AUC) following the acute and the chronic administration of cocaine were comparable, regardless of the route of drug administration. However, the temporal patterns of activity were significantly different; the peak of locomotor activity occurred earlier (chronic vs. acute, 20 vs. 40 min after IP; 130 vs. 180 min after SC) following chronic cocaine administration. Furthermore, the peak activity was significantly higher (3-fold after IP and 50% after SC) in chronically than in acutely treated rats, providing evidence for sensitization. In contrast, activity in the late session (240-280 min after SC) was significantly lower following the chronic SC cocaine administration, providing evidence for desensitization. The absolute slope values of the ascending phase and the descending phase were significantly larger following chronic administration of cocaine than that following the acute dosing. The possibility of changes in locomotor activity with alteration of pharmacokinetics on chronic cocaine treatment is discussed.

The psychopharmacologic and prolactin response after large doses of naloxone in man.

Large doses of naloxone (150-300 mg), placebo, and morphine (15-30 mg) were given intramuscularly to human volunteers and compared using measures of subjective feeling states, physiological measures and discriminative features. Plasma prolactin responses after naloxone 210 mg and placebo were compared. The subjective measures and discriminative features of naloxone revealed that the drug is subtly psychoactive but the stimulus is vague and cannot be identified clearly as an opioid agonist or antagonist in nondependent opioid-using volunteers. The physiologic and prolactin responses closely resembled opiate agonist activity. We conclude that naloxone in this dose range may act as an opiate agonist in man.

Multidimensional scaling of subjective judgements of drug similarities among ketocyclazocine, morphine, cyclazocine, naloxone and placebo.

Profiles of the subjective and physiologic effects of opioid drugs in man cannot be assigned with precision to specific opioid drug-receptor interactions. We administered a set of training doses of ketocyclazocine, morphine, cyclazocine, naloxone and placebo to 10 drug-using volunteers and obtained similarity judgements between each of 2 test doses of the drugs and a training dose. These data were submitted to multidimensional scaling analysis (INDSCAL) using both neighboring cells estimates and root mean square estimates to estimate missing cells in the data matrices. The results of these analyses are convergent, appear valid and indicate that there are three drug dimensions expressed in this data set: morphine versus placebo and naloxone; cyclazocine and ketocyclazocine versus placebo and naloxone; and ketocyclazocine versus cyclazocine. We interpret this result as supporting evidence that in the set of five drugs studied, three subjective states are induced.

Patterns of alcohol, cigarette, and caffeine and other drug use in two drug abusing populations.

Relationships were explored among the frequencies of use of various drugs by a sample of drug-abusing clients of the Addiction Research Foundation (ARF) in Toronto and by drug abusers volunteering to participate in research at the Addiction Research Center (ARC) in Baltimore. The two groups of drug-abusing individuals differed in a number of characteristics. Those from ARF were admitted primarily for diagnosis and possible treatment for alcohol and non-opioid drug problems, whereas those from the ARC were admitted for participation in research on other drugs of abuse, primarily involving opioids. Patterns of use of certain drugs tended to covary in both groups. Of particular interest was the finding that severity of alcoholism was directly related to various measures of tobacco and caffeinated beverage use. In contrast, there was little correlation between the frequency of use among other drugs of abuse (e.g., heroin, cannabis, glue) and the use of tobacco and caffeine. These findings suggest that dependence on nicotine, caffeine, and alcohol may be governed by the same factors and possibly should be considered jointly in the treatment of alcoholic persons. Frequency of use of other drugs examined may be controlled by other factors than those which determine level of use of tobacco and caffeine.

Simulation of gambling responses on the Addiction Research Center Inventory.

The present study investigated possible commonalities between compulsive gambling and abuse of psychoactive drugs. Nineteen volunteers with histories of compulsive gambling were tested twice using the Addiction Research Center Inventory (ARCI): Once answering items as they felt at the time of the test, the other time simulating how they felt while winning at gambling. The main findings were that, as measured on the ARCI, "simulated winning at gambling" produced a euphoria similar to the euphoria induced by the psychoactive drugs of abuse, particularly psychomotor stimulants; secondly, that as a group, the pathological gamblers, demonstrated elevated psychopathy scale scores similar to psychopathy scores found among persons with histories of drug dependence.

Variation in the suppression or enhancement of responses related to drug habits as a function of stimulus classes and competing response categories.

Male prisoners who were opiate addicts (N = 47) were given three Process Association Tests of Addiction containing stimuli which evoked responses characteristic of three levels of drug habits: beginning and ending stage of addiction, intermediate stage of addiction, and an advanced level of addiction. Each test required subjects to associate 278 word stimuli with one of five options which were randomly selected from among 20 options covering the stages of addiction, steps in drug taking, and drug effects. The purpose of the study was to determine whether responses to particular options suppressed or enhanced responses to other options. A strong interaction was found between the classes of stimuli and the response options which produced suppression or enhancement. This interaction made it possible to develop a suppression scale to measure the effect of each class of stimulus. Popular responses most frequently suppressed responses of other options. Thus, when the stimuli were clean, responses of "to be clean" and "to live a normal life," which are sensitive indicators of the beginning or ending stages of addiction , suppressed responses of other stages. The response of "to be high," a prime indicator of an intermediate habit, suppressed responses of other options when the stimuli were drug names. Responses of "to be hooked" and "to fix," which are specific indicators of a strong habit, and "to be high," which is a nonspecific indicator of a strong habit, suppressed responses of many other options. In the development of new association tests the analysis of suppression could provide a basis for selectively varying option groupings in order to increase or decrease the frequently of certain responses.

Slang knowledge as an indicator of a general social deviancy subcultural factor.

Evidence for a general social deviancy subcultural factor was found using the Kulik, Sarbin, and Stein (1971) slang test on drugs, gangs, law enforcement, and general words. The slang scores of 68 confirmed opiate addicts exceeded those of normals and young delinquents reported by Kulik, et al. (1971), including delinquents who were recidivists. Addicts knew more drug and alcohol slang than slang in the three other categories. It was recommended that more attempts should be made to subdivide measures of social deviancy by means of slang as there is some evidence of possible further differentiation of subcultural types by means of slang.

Geophysical variables and behavior: LXV. Seasonal changes in mood in opioid addicts on the Addiction Research Center Inventory.

Seasonal changes in mood using the Addiction Research Center Inventory (ARCI) were tested in 243 male opioid addicts when they were free of drug and withdrawal effects. No significant changes were found on scales which measure euphoria (MBG), tension-anxiety (LSD), excitement (Ex), or dysphoric effects (SOW). A significant difference between seasons was found for lowered motivation (PCAG) in the summer and spring relative to winter, but these effects were not consistent with a winter seasonal affective disorder. Significant changes were more common for spring-fall and summer seasons relative to winter on items of the inventory.

Degree of suppression of associations to stages of addiction by the response of "high".

Male heroin or opiate addicts (N = 78) had a great inclination to give the association "to be high" to the names of nine drugs of abuse in a multiple-forced-choice association test irrespective of whether they had weak or strong habits for the drugs used as stimulus words. The tendency to give the "high" response was so great that other responses indicative of stages of addiction, steps in drug-taking, or drug effects were suppressed below the chance level. When scales were scored so that the response of "high" had no effect, the habit status of the sample revealed by associations with a specific set of words became clearer. A pattern of a strong habit for opiates evoked by opiate names became more evident after elimination of the effect of the response to "high," as did the strong habit pattern in response to drug relevant words. However, the pattern of responses characteristic of a nonaddictive status evoked by clean words remained relatively stable even including the effect of the response of "high." The study suggests that more meaningful responses are found when the response options are multiple rather than fixed.

Measurement of psychopathy as a state.

It was hypothesized that psychopathic states could be measured by systematically changing items in psychopathy scales so as to suggest current feelings, thoughts, motives, and actions. The scales chosen for revision were the Psychopathic Deviate, Mania, and Antisocial scales of the Minnesota Multiphasic Personality Inventory (MMPI); Responsibility and Socialization scales of the California Psychological Inventory (CPI); and Psychopathy scale from the Addiction Research Center Inventory (ARCI). Male alcoholics (N = 53) and opiate addicts (N = 28) exemplifying psychopaths were compared with normals (N = 54) on each of the above scales. Alcoholics and opiate addicts were significantly higher on the total of the psychopathic scales and each of the above state scales except for Mania. Reliability was significant on all scales except the Antisocial scale. Also, 58% of 560 items differentiated these groups from normals.