Acupuncture treatment for drug abuse: a technical review.

Conflicting opinions exist regarding the efficacy of acupuncture for the treatment of substance abuse. On October 23, 1991, the National Institute on Drug Abuse (NIDA) sponsored a technical review to discuss this issue. The purpose of the meeting was to review the current status of research regarding acupuncture treatment for drug abuse and to propose directions for future studies. This report represents a summary of the meeting which consisted of presentations by individuals currently involved in acupuncture treatment and discussions by a panel of experts in the field of substance abuse treatment research.

A pilot trial of gepirone vs. placebo in the treatment of cocaine dependency.

An interim analysis of 41 evaluable patients compared gepirone to placebo treatment in a randomized, double-blind, 12-week study of cocaine dependence without opiate abuse. The response to gepirone at a mean dose of 16.25 mg/day did not differ from placebo by measures of time in study, positive urine cocaine screens (greater than 6 weeks), Clinical Global Impressions (CGI) Global Improvements Scale, Cocaine Craving Scale (CCS), Quantitative Cocaine Inventory (QCI), Addiction Severity Index (ASI), Global Assessment Scale (GAS), Hamilton Rating Scale for Depression (HAM-D), and Hamilton Anxiety Scale (HAM-A). Both treatment groups showed similar modest, average improvements during the study in all treatment measures. Adverse events were not treatment limiting. The following demographic and study measures suggested favorable trends for study outcomes: older age, divorced status, higher pre-treatment cocaine use, lower CCS scores, and lower self-reports of cocaine use according to QCI.

Use of ECT in the United States in 1975 and 1980.

The authors examined data from the National Institute of Mental Health regarding the use of ECT in the United States in 1975 and 1980. A total of 33,384 hospitalized patients were treated with ECT in 1980, representing 2.4% of all patients hospitalized in psychiatric facilities. The use of ECT decreased by 46% between 1975 and 1980. Of the type of facilities surveyed, only public general hospitals did not decrease their use of ECT. Patients with affective disorders received 69.8% of the ECT given, and patients with schizophrenia received 16.6%. Although more women than men received ECT, diagnosis and age were more important factors than sex.

Antidepressant drug therapy: the role of the new antidepressants.

Three new antidepressants have been marketed in the United States since 1980, and about two dozen more are being evaluated. In a 1983 workshop convened by the National Institute of Mental Health, participants examined the claims made for the newer antidepressants in relation to clinical efficacy, speed of onset, cardiovascular effects, and other adverse reactions. In this summary report of the workshop, primarily covering amoxapine, maprotiline, trazodone, and the investigational drug bupropion, the authors note that none of the new antidepressants demonstrate greater effectiveness than standard tricyclics, although some produce a different profile of side effects. The main benefit of the newer drugs is that they offer new options for the treatment of patients who cannot tolerate side effects of the traditional drugs or have responded unsatisfactorily to them.

The role of antidepressants in the treatment of affective disorders.

The paper reviews studies of the effectiveness of antidepressants in acute depression and variables accounting for nonresponsiveness. Data supporting continuation and maintenance therapy are presented. The authors discuss nonspecific psychotherapeutic components of drug management and also review studies of the usefulness of antidepressant and psychotherapy, alone and in combination.

A comprehensive psychiatric approach to drug dependence.

A comprehensive approach to the treatment of drug-abusing and dependent persons is proposed based on a knowledge of the psychopathology and the psychodynamics of drug abuse and psychological dependence. The role of psychiatric understanding of drug dependence is historically developed. The recent contributions of clinicians and researchers evolving from psychoanalytic ego theory as well as psychopharmacological orientation are discussed. The authors argue that categorizing people in terms of overt behavior - drug abuse or dependence - is not sufficient. Specific psychopathological and/or psychodynamic conditions should be diagnosed and utilized as the basis for treatment.

Compulsive heroin use and interpersonal orientation.

This research attempt to clarify and quantify the ways in which heroin addicts deal with interpersonal relations. A sample of heroin addicts on a methadone maintenance program were given the Fundamental Interpersonal Relations Orientation-Behavior (FIRO-B) scale. An accidental sample consisted of 35, approximately one-half, of the clinic's population. A mean interpersonal orientation profile is established and interpreted. An analysis of variance was performed for each of the six FIRO-B scores. Patients needs based on FIRO-B scores are discussed with regard to the descriptions of addicts life-styles as described in the literature. The possible etiological basis for these interpersoanl orientations is also discussed. Several therapeutic approaches, as indicated by FIRO-B scores, are explored.

Early clinical studies of levo-alpha acetylmethadol (LAAM): an opiate for use in the medical treatment of chronic heroin dependence.

Opiate maintenance with methadone has been demonstrated to be an effective treatment modality for many chronic heroin-dependent individuals. However, the many clinical and societal advantages of a longer-lasting medication prompted the development of LAAM, which could be administered three days a week rather than daily. Early Phase II clinical trials of LAAM in about 750 patients have been reviewed and have demonstrated the safety and effectiveness of this drug and confirmed its usefulness for treatment of this chronic disease.

Marijuana effects on simulated flying ability.

The authors studied the effects of marijuana intoxication on the ability of 10 certified airplane pilots to operate a flight simulator. They used a randomized double-blind crossover design to compare the effect of active versus placebo marijuana. They found that all 10 pilots showed a significant decrease in measurements of flying performance 30 minutes after smoking active marijuana. For a group of 6 pilots tested sequentially for 6 hours, a nonsignificant decrease in flying performance continued for 2 hours after smoking the active drug. The authors conclude that the effects of marijuana on flying performance may represent a sensitive indicator of the drug's psychomotor effects.

Simulated flying performance after marihuana intoxication.

Ten pilots smoked, in counterbalanced order on a double blind basis, a social dose of marihuana (.09 mg/kg delta-9-tetrahydrocannabinol) and a matched placebo after being trained to fly a specific flight sequence on an ATC-510 flight simulator. In contrast to placebo, marihuana caused a gross decrement in flying performance, with increased prevalence of major errors, minor errors, altitude deviations, heading deviations, and radio navigation errors. These effects of active marihuana persisted for at least 2 hr and generally had disappeared by 4 to 6 hr after marihuana administration.