Dissociation of physiology and behavior in PTSD.

We have previously reported that subjects with posttraumatic stress disorder (PTSD) differ from trauma controls in their ability to produce and withhold responses in the Stop-Signal Task depending on the motivational context as determined by financial reward. This experiment measured skin conductance and heart rate to assess autonomic changes accompanying these different patterns of behavior. Fowles hypothesized that heart rate would increase with behavioral activation and that increases in skin conductance would accompany behavioral inhibition. Both PTSD and comparison groups showed the expected behavioral changes in response to rewards, but they differed in their physiological responses. The subjects in the traumatized comparison group showed changes in skin conductance and heart rate consistent with Fowles' hypothesis and the observed changes in behavioral inhibition and activation. However, PTSD subjects showed no significant change in either physiological measure. These results demonstrate a dissociation between autonomic reactivity and motivated behavior in PTSD that may represent one aspect of emotional numbing.

Relative abuse liability of triazolam: experimental assessment in animals and humans.

The abuse liability of a drug is a positive, interactive function of the reinforcing and adverse effects of the drug. The relative abuse liability of the hypnotic benzodiazepine, triazolam, has been controversial. This paper reviews animal and human studies bearing on its relative abuse liability, including data on pharmacological profile, reinforcing effects, liking, speed of onset, discriminative stimulus effects, subjective effects, physiological dependence, rebound and early morning insomnia, drug produced anxiety, lethality in overdose, psychomotor impairment, interactions with ethanol, anterograde amnesia, impaired awareness of drug effect, and other psychiatric and behavioral disturbances. It is concluded that the abuse liability of triazolam is less than that of the intermediate duration barbiturates such as pentobarbital. Although there are considerable data indicating similarities of triazolam to other benzodiazepines, there is also substantial speculation among clinical investigators and some limited data suggesting that the abuse liability of triazolam is greater than that of a variety of other benzodiazepines, and virtually no credible data or speculation that it is less. Further research will be necessary to clarify definitively the abuse liability of triazolam relative to other benzodiazepines.

Diazepam and triazolam self-administration in sedative abusers: concordance of subject ratings, performance and drug self-administration.

The reinforcing effects of diazepam (DZ), triazolam (TZ) and placebo were examined in eight male subjects with histories of sedative abuse. DZ (40 or 80 mg), TZ (1.0 or 2.0 mg) and placebo were each individually available for oral self-administration using a double-blind within-subject design. After an initial sampling exposure, subjects could self-administer a single dose of drug on each of 6 days by completing a progressively increasing bicycle riding requirement. All subjects initially self-administered DZ and TZ but a decreasing number of subjects continued to self-administer drugs on the remaining days; there was no difference between DZ and TZ in the total number of self-administrations. Placebo was self-administered only by one subject on two occasions. Performance measures showed that TZ produced greater memory impairment than DZ and that DZ produced residual psychomotor impairment on the next day. With repeated dosing, evidence of tolerance was seen for both drugs on psychomotor and memory performance and subject ratings of drug liking. A few modest correlations of drug self-administration and subject-ratings were obtained, suggesting some correspondence of subject verbal and drug self-administration behaviors, but these measures did not covary in a completely consistent manner.

Orally delivered alprazolam, diazepam, and triazolam as reinforcers in rhesus monkeys.

RATIONALE: Benzodiazepines are among the most frequently prescribed drugs and are usually taken by mouth. However, there have been few studies of oral self-administration of these drugs, and the results of IV self-administration studies indicate that benzodiazepines are modest reinforcers. OBJECTIVES: To determine if orally delivered alprazolam, diazepam, and triazolam could serve as reinforcers for rhesus monkeys, and to determine some of the conditions under which benzodiazepine reinforced behavior occurs. METHODS: Diazepam or midazolam was initially established as a reinforcer by a fading procedure whereby increasing concentrations were added to a 1 or 2% ethanol solution, and subsequently the ethanol concentration was decreased in steps to zero. Diazepam- and midazolam-reinforced responding persisted in the absence of ethanol. Triazolam and alprazolam served as reinforcers when substituted for diazepam or midazolam. RESULTS: Alprazolam, diazepam, and triazolam served as effective reinforcers across a wide range of concentrations and under fixed-ratio sizes of 16 and 32. Rates of responding were usually far higher than that for the concurrently available vehicle, water. Drug intake (mg drug/kg body weight) generally increased with increases in drug concentration. When large drug amounts were consumed, signs of intoxication were observed. CONCLUSIONS: In contrast to reports of low response rates and weakly maintained behavior, the present results show that the three benzodiazepines can serve as effective reinforcers.

Isradipine, a dihydropyridine-class calcium channel antagonist, attenuates some of d-methamphetamine's positive subjective effects: a preliminary study.

RATIONALE: Dopamine (DA) pathways in the midbrain mediate d-methamphetamine's rewarding effects associated with its abuse liability. Isradipine, a dihydropyridine-class calcium channel antagonist, reduces the rewarding effects of psychostimulants such as cocaine and d-amphetamine, presumably by antagonizing these central DA pathways. This is the first experiment to test the hypothesis that the rewarding effects of d-methamphetamine, like other psychostimulants, can be reduced by isradipine. OBJECTIVE: We studied the effects of high dose isradipine (0.21 mg/kg orally), on the positive subjective effects associated with the abuse liability of low and high dose d-methamphetamine (0.21 mg/kg and 0.42 mg/kg orally, respectively). METHODS: Using a double-blind, double-dummy, placebo-controlled, Latin-Square, cross-over design, 18 healthy male and female volunteers received each of the following six treatments separated by a rest period of 2-7 days: a) placebo+placebo; b) low-dose d-methamphetamine+placebo); c) high-dose d-methamphetamine+placebo; d) high dose isradipine+placebo); e) low-dose d-methamphetamine+high dose isradipine, and f) high-dose d-methamphetamine+high dose isradipine. RESULTS: d-Methamphetamine produced orderly increases in positive subjective measures of both stimulation and mood. Pre-treatment with isradipine significantly reduced some of these positive subjective effects and craving for d-methamphetamine. CONCLUSION: Isradipine as an anti-reward or craving reducing medication is a promising therapeutic agent for the treatment of d-methamphetamine dependence.

Acute effects of marijuana smoking on aggressive, escape and point-maintained responding of male drug users.

Aggressive, escape and point-maintained operant responding of male marijuana smokers were measured during six 25-min sessions conducted over an 8-h experimental day. Aggressive responding ostensibly subtracted points exchangeable for money from another subject. Escape responding protected the subject's counter from point subtractions initiated by the other subject for some period of time. Aggressive and escape responding were engendered by subtracting points from the subjects and maintained by initiation of intervals free of point subtractions. Point subtractions presented to the subjects were attributed to other persons. Subjects earned points exchangeable for money on a third response option. Subjects participated in one session prior to smoking and five sessions after smoking. Subjects smoked placebo or three different potencies of active marijuana cigarettes. Marijuana smoking effects on escape responding were not significant and depended upon the frequency of provocation. Point-maintained responding was decreased after marijuana smoking. Aggressive responding was increased for the first hour after smoking and returned to placebo levels later in the day. These effects of marijuana smoking on aggressive responding are discussed in terms of subject characteristics, particularly drug use history.

Relative abuse liability of diazepam and oxazepam: behavioral and subjective dose effects.

The effects of diazepam (10-160 mg) and oxazepam (30-480 mg) were studied in volunteers with histories of drug abuse. Oral doses were administered every third day under double-blind and counterbalanced conditions. Dose-effects with area under the time-action curve data (AUC) showed diazepam to be 2.6-5.7-times more potent than oxazepam on various psychomotor, cognitive, staff-rated, and subjective measures. Comparison of relative potencies showed diazepam to be relatively more potent in producing 'liking' than in producing psychomotor and cognitive effects. Diazepam produced greater peak effects than oxazepam on a number of staff- and subject-rated measures, including liking. Onset of effect was more rapid and time to maximal effect was shorter (1-2 h versus 4-12 h) with diazepam than oxazepam, while time to offset of effect was similar for the two drugs. Diazepam was categorized as producing barbiturate-like subjective effects (38.3%) more frequently than was oxazepam (13.8%), while oxazepam was identified as placebo more often than diazepam. Repeated administration of 160 mg diazepam and 480 mg oxazepam showed that AUC liking was greater for diazepam than oxazepam and that tolerance to psychomotor and cognitive effects occurred with oxazepam but not diazepam. This study suggests that diazepam may have a higher abuse liability than oxazepam.

Effects of caffeine deprivation on complex human functioning.

Twenty-five managers who reported an average daily caffeine consumption of 575 mg participated in two complex simulations. A double-blind cross-over design was employed to assess the effects of normal caffeine consumption versus caffeine deprivation upon seven validated measures of managerial effectiveness. Data from a Caffeine Withdrawal Questionnaire indicated discomfort upon deprivation. Systolic blood pressure increased during "normal" caffeine consumption levels but fell quickly and remained lower during deprivation. Several measures of managerial performance indicated decreased effectiveness upon caffeine deprivation. In contrast to prior research from simpler task settings, cognitive effectiveness (during complex task performance) was diminished. However, a measure of strategic performance which requires a relatively high level of cognitive effort showed no impact of caffeine deprivation.

Repeated administration of diazepam and triazolam to subjects with histories of drug abuse.

The present study examined the effects of repeated administration of diazepam (DZ) and triazolam (TZ) on psychomotor performance and subject-rated drug liking. Subjects were 11 males (30-41 years) who had documented histories of drug abuse and who resided on a behavioral pharmacology research ward. Six subjects received 80 mg DZ every third day (3 subjects) or every sixth day (3 subjects) for a total of 3-6 dosing occasions and six subjects received TZ (2.0 or 3.0 mg) every second day (4 subjects) or every third day (2 subjects) for a total of 3-5 dosing occasions. The results showed that on the first dose occasion, the two drugs produced generally similar degrees of psychomotor impairment and subject-rated drug liking. Following the first DZ dose, subsequent doses produced less of an effect (i.e. single-dose tolerance). Across at least the first three dose occasions, progressive tolerance development was observed with DZ but no tolerance was observed with TZ. It is hypothesized that pharmacokinetic differences between DZ and TZ may account for the difference in the development of tolerance.

Triazolam and ethanol effects on human matching-to-sample performance vary as a function of pattern size and discriminability.

The effects of placebo, triazolam (2.0, 4.0 and 8.0 micrograms/kg) and ethanol (0.25, 0.5, 1.0 g/kg) on perceptual-motor performance were examined using a visual pattern matching-to-sample procedure in which pattern size and comparison stimulus discriminability were systematically varied. Baseline response rates and accuracy increased as the discriminability of the comparison stimuli increased. At the highest dose, both drugs decreased response accuracy. This disruption of accuracy was attenuated by increasing the discriminability of non-matching stimuli. Triazolam produced dose-related decreases in response rate while ethanol produced only slight decreases at the highest baseline rates of responding. Thus, triazolam produced response rate slowing at relatively lower doses than ethanol.

Alprazolam-reinforced medication use in outpatients with anxiety.

The reinforcing effects of alprazolam were investigated in 14 patients who had generalized anxiety or panic disorder, but were not current users/abusers of other psychoactive substances. Using a double-blind outpatient choice procedure, color-coded alprazolam (0.5 mg) and placebo capsules were provided to patients for use 'as needed' in the treatment of anxiety symptoms. Comparisons of alprazolam and placebo during a 2 week sampling period in which placebo and alprazolam were available sequentially revealed no significant differences on measures of medication usage or anxiety levels, although alprazolam did increase subjective ratings of drug effects side effects. During a 4 week choice period, alprazolam was strongly preferred over placebo in 11 out of 14 patients indicating that alprazolam functioned as a reinforcer. Medication usage ranged from zero to 4.0 mg alprazolam in a day. Variations in daily medication-use were positively correlated with anxiety level fluctuations for a majority of patients. For a majority of patients, the results indicate that alprazolam functioned as a reinforcer without accompanying signs of abuse or addiction.

Ethanol decreases responding on behavior maintained under concurrent schedules of both positive reinforcer presentation and avoidance in humans.

Six human volunteers were tested during 15min sessions under the behavioral contingencies of a concurrent fixed-ratio, fixed-ratio schedule of point-gain reinforcement and point-loss avoidance. Completion of each fixed-ratio 50 (FR 50) on the point-gain lever produced 10 points, which were exchanged for money ($.01 per point) after each week of the study. Point losses of 10 points were scheduled to occur during the session on a variable-time 60sec schedule. The total amount of money accumulated was continuously displayed on video monitor. Subjects were exposed to the concurrent schedule until responding under the schedules of point gain and point loss stabilized. After responding had stabilized under these contingencies (4-5 sessions), subjects were tested each day 30min following administration of ethanol, in doses of 0.32, 0.64 or 0.96g/kg, or placebo. Ethanol decreased responding in all subjects and produced dose-related decreases in overall response rates in three subjects. These effects were not related to self-reported current alcohol consumption. Response rates on the reinforcement and the avoidance schedules were both decreased by ethanol. Thus, under these conditions, behavioral effects of ethanol on concurrent FR responding did not depend on the nature of the consequent event.

Effects of spirometric administration of tobacco smoke containing varying amounts of nicotine on physiological measures and subject ratings.

A previously developed spirometric methodology of tobacco smoke administration was evaluated by determining the effects of varying nicotine delivery on various physiological and subjective measures. Eight male tobacco smoking subjects were administered 60cc volumes of tobacco smoke drawn from University of Kentucky research cigarettes, or air. Subjects were exposed to four bouts of smoke administration conducted over an 8h day. Each smoking bout was separated by 2h and involved 20 smoke administrations at the rate of one every 30sec. Each smoke administration consisted of 60cc of air or 60cc drawn from 0.3, 1.2 or 2.7mg nicotine yield cigarettes, followed by 1 liter of air which forced the smoke or air deep into the lungs. Carbon monoxide (CO), blood pressure, and heart rate were measured before and after each smoking bout, and subject ratings of smoke effects were completed after each smoking bout. In a separate study, blood samples were collected on two occasions before and after administration of the two highest nicotine yield cigarettes to determine changes in nicotine plasma levels. Data indicated that the spirometric method produced: (1) similar CO boosts across nicotine yields, and (2) changes in heart rate, blood pressure, subject ratings and plasma nicotine levels which were directly related to the nicotine yield of cigarettes.

The effects of codeine on human aggressive responding.

Ten healthy male research subjects received placebo, 25, 50 and 75 mg/70 kg of codeine in a controlled laboratory setting. During each session subjects had two response options. The non-aggressive response option was maintained by points exchangeable for ten cents. The aggressive response option ostensibly subtracted a point from the subject's fictitious partner. Aggressive responding was engendered by point subtractions attributed to a fictitious partner. Codeine did not significantly alter the frequency of monetarily reinforced, nonaggressive, responding. Aggressive responding was significantly increased at the 50 mg/70 kg dose of codeine. The frequency of aggressive responses during the placebo sessions preceding administration of the first codeine dose were significantly and positively correlated with scores on the Buss-Durkee Hostility Scale. Aggressive responding increased for four of five subjects scoring below the median on the Buss-Durkee Hostility Scale at the 50 mg/70 kg dose; while administration of 50 mg/70 kg increased aggressive responding of one subject who scored above the median. Aggressive responding for both groups of subjects was unaffected by the 75 mg/70 kg dose.

Effects of benzodiazepines on taste aversions in a two-bottle choice paradigm.

Diazepam (DZ) and chlordiazepoxide (CDP) were tested for their ability to antagonize LiCl-established conditioned taste aversions (CTAs) to saccharin in a two-bottle free-choice paradigm. CTAs to saccharin were established in male Sprague-Dawley rats on a chronic fluid-deprivation schedule by the administration of LiCl (3 mEq/kg, IP) following a forced-choice exposure to a novel saccharin solution (0.1%, w/v). Three days later, rats were provided with a two-bottle choice presentation of saccharin and distilled water. Conditioned rats drank distilled water almost exclusively while unconditioned animals preferred saccharin. Pretreatment with DZ (6, 9, 12 mg/kg, IP) and CDP (12 mg/kg, IP) significantly increased the saccharin intake of conditioned rats indicating an attenuation of the manifestation of the CTA. While these results are consistent with the known disinhibitory effects of benzodiazepines, alternative mechanisms involving polydipsia or interactions with the taste characteristics of saccharin could not be excluded. Both hypertonic saline (16%, w/v NaCl) and Barbital Sodium (100 mg/kg) produced polydipsia without attenuating CTAs suggesting that the two-bottle procedure is capable of distinguishing between polydipsic effects and anti-aversion effects for these drugs.

5-hydroxytryptophan-induced conditioned taste aversion to ethanol in the rat.

This experiment was conducted to determine the efficacy of 5-HTP in producing conditioned taste aversions (CTAs) to ethanol in rats restricted to a one-hour daily access to fluid. Administration of 100 mg/kg of DL-5-HTP immediately following novel exposure to ethanol resulted in an aversion of such magnitude that some rats refused to consume the ethanol solution. Since ethanol was the only fluid available to these rats, they eventually died, presumably of dehydration. By comparison, LiCl administration also produced a CTA to ethanol, but no such persistent rejection was observed. Both 5-HTP and LiCl also produced CTAs when saccharin and tartaric acid solutions were used as novel fluids, but these aversions were short-lived and all rats resumed drinking. The causative factor(s) in the persistent ethanol rejection until death observed in rats treated with 5-HTP remain undetermined but the results have indicated that simple CS-UCS associative learning mechanisms are probably not a primary causative factor.

Interactions of diazepam and caffeine: behavioral and subjective dose effects in humans.

The effects of diazepam (DZ) (0, 10, and 20 mg) and caffeine (CAF) (0, 200, 400, and 600 mg) alone and in combination were examined in nine healthy male subjects using a within-subject experimental design in which all subjects received all twelve possible dose combinations. Drug effects were assessed using various psychomotor and cognitive performance tasks, staff (observer) ratings of subject behavior, and subject ratings of mood and drug effect. DZ treatment alone impaired performance on all tasks and produced staff and subject ratings indicative of sedative drug effects. CAF treatment alone facilitated performance on two psychomotor tasks requiring rapid reaction speed and increased staff ratings of subject restlessness and subject ratings of tension, alertness, arousal, and CAF symptoms. CAF generally antagonized the DZ-induced ratings of sedation and impairment of psychomotor performance; however, CAF did not consistently antagonize the DZ impairment of immediate recall or delayed recognition memory performance. DZ antagonized the CAF-induced staff-rated restlessness, and subject-ratings of tension, alertness, arousal and CAF symptoms. The results generally support the hypothesis that DZ and CAF produce antagonistic effects through functionally opposing mechanisms, however, the observed effects of drug combinations are dependent on the specific doses being tested and on the measures of drug effect being examined.

Effects of triazolam on human aggressive, escape and point-maintained responding.

Placebo and triazolam (0.125, 0.25 and 0.5 mg/70 kg of body weight) were administered to male subjects under double-blind conditions prior to experimental sessions which provided three operant response options. These options were: 1) responding maintained by the presentation of points exchangeable for money, 2) responding which ostensibly resulted in the subtraction of points from a fictitious person was termed aggressive since this responding resulted in the delivery of an aversive stimulus to another person, and 3) responding which ostensibly protected the subject's point counter from subtractions initiated by the other person and was termed escape. Aggressive and escape responding were initiated by subtracting points from the subject. Point subtractions were attributed to the other person. Aggressive and escape responding were maintained by initiation of provocation-free intervals (PFI), during which no further point subtractions were presented. Triazolam produced dose-dependent decreases in point-maintained and escape responding. The effects of triazolam on aggressive responding varied across subjects.

Reinforcing effects of triazolam in sedative abusers: correlation of drug liking and self-administration measures.

Six male subjects with histories of sedative abuse were allowed to orally self-administer a maximum of 18 color-coded triazolam and placebo capsules during daily 3-h sessions. The schedule of reinforcement was a signaled fixed-interval 10-min schedule in which triazolam and placebo were concurrently available as mutually exclusive choices. Triazolam was shown to be a reinforcer in four of the six subjects. The two subjects who did not self-administer triazolam in preference to placebo also had lesser histories of drug dependence. Self-administration of triazolam (0.125 or 0.25 mg per capsule) was generally stable over 7-10 days. Manipulations of triazolam dose (0.0312-0.25 mg) per capsule in two subjects showed that the number of capsules self-administered was inversely related to capsule dose. Subject ratings of drug liking obtained from experimenter-administered doses of triazolam were correlated with self-administration behavior occurring 1-7 days later. Of the subject ratings, next day ratings obtained on the day after dosing resulted in significant correlations whereas same day ratings obtained while subjects were under the influence of triazolam did not. These results have important implications for abuse liability prediction and suggest that next day ratings have greater predictive validity than measures collected while subjects are under the influence of benzodiazepines.

Acute effects of smoking marijuana on hormones, subjective effects and performance in male human subjects.

Four healthy male subjects smoked two marijuana cigarettes or one marijuana cigarette and one placebo cigarette, or two placebo cigarettes on separate days in a random order crossover design. Each marijuana cigarette contained 2.8% delta-9-tetrahydrocannabinol (THC). Plasma hormones and THC were measured before and after each smoking session. Plasma LH was significantly depressed and cortisol was significantly elevated after smoking marijuana. Nonsignificant depressions of prolactin, FSH, testosterone and free testosterone and elevation of GH also occurred. Concurrent measures of subjective effects via subscales of the Addiction Research Center Inventory, Single Dose Questionnaire and a Visual Analog Scale were generally elevated. Significant impairment on a psychomotor performance task paralleled elevations in subjective effects, hormone effects and peak THC determinations. Although all the hormone effects were within normal basal ranges, interactions between these systems, and their effects on behavior cannot be discounted.