Amantadine may facilitate detoxification of cocaine addicts.

The effectiveness of amantadine hydrochloride was evaluated in a double-blind placebo controlled drug trial. The subjects were 42 cocaine dependent men enrolled in a day hospital program. Twenty-one patients were prescribed 100 mg/bid of amantadine to be taken over 10.5 days and 21 were prescribed an equivalent amount of placebo. The primary outcome measures were the Addiction Severity Index at 1 month after study entry and urines during the drug trial (end of weeks 1 and 2) and 1 month after study entry. Urines obtained at the end of the drug trial (2 weeks) indicated that the subjects receiving amantadine (93%) were more likely (P = 0.040) to be free of cocaine than the placebo (60%) subjects. Urine toxicology data at 1-month follow-up again indicated that more of the amantadine subjects (83%) were free of cocaine than the placebo (53%) subjects (p = 0.049); although no differences were found in self-reports of cocaine or other substance use in the past 30 days. The urine findings provided preliminary indication that amantadine may have some effectiveness in reducing cocaine use in cocaine dependent patients.

The use of case vignettes for Addiction Severity Index training.

In an attempt to enhance the reliability of Addiction Severity Index (ASI) interviewer severity ratings (ISRs), we developed a set of eight ASI vignettes, fictionalized narrative case summaries that reproduced the quantitative ASI information in case report format. Each vignette has an ISR answer key, a consensus ISR of two expert ASI trainers for each problem area. Additionally, for four of the vignettes the rationale for the correct ISRs was operationalized. This report is a description of the ASI vignette packet, its use as a supplement to standard ASI training and the results of a pilot study to gauge its effectiveness in improving criterion validity of ISRs. Five ASI videotapes were also developed for the purposes of this investigation. There was limited evidence in this preliminary investigation that the addition of the ASI vignette packet to standard ASI training increased agreement with expert consensus ISRs. The ASI vignettes, relative to videotaped or live observed interviews, do however provide a brief means of assessing the adequacy of ASI interviewer skills with regard to ISRs.

Cocaine withdrawal symptoms and initial urine toxicology results predict treatment attrition in outpatient cocaine dependence treatment.

This study evaluated the ability of cocaine withdrawal symptoms, measured by the Cocaine Selective Severity Assessment (CSSA) and initial urine toxicology results, to predict treatment attrition among 128 cocaine dependent veterans participating in a 4-week day hospital treatment program. The CSSA was administered and a urine toxicology screen was obtained at intake and at the start of the day hospital (about 1 week later). The combination of a positive urine toxicology screen and a high CSSA score at intake predicted failure to complete treatment. Urine toxicology results at the start of the day hospital, but not at intake, predicted failure to complete treatment. Among participants without other psychiatric illness, high CSSA scores at intake predicted failure to complete treatment. The presence of cocaine withdrawal symptoms and a positive urine toxicology screen are clinically useful predictors of treatment attrition.