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Background: The Obsessive Compulsive Drug Use Scale (OCDUS) and the Desires for Drug Questionnaire (DDQ) are two frequently used drug craving questionnaires. Although both heroin and cocaine versions of the questionnaires exist, only the heroin versions have been psychometrically evaluated. The present study was conducted to evaluate the psychometric qualities of the cocaine versions of the OCDUS (OCDUS-C) and DDQ (DDQ-C)., Methods: Cocaine-dependent inpatients (n = 101) completed both scales as well as a Visual Analogue Craving Scale (VACS), an alternative, one-item index for assessing momentary craving. We examined the reliability (internal consistency), construct validity (factor structure), and concurrent validity (correlations among both questionnaires, the VACS, and indicators of severity of dependence). A subsample also completed the OCDUS-C and DDQ-C for a second time, one week after the initial administration to obtain a preliminary investigation of the test-retest reliability., Results: In general, both questionnaires displayed good internal consistency, test-retest reliability, and concurrent validity. Further, the construct validity of both the DDQ and OCDUS was demonstrated by means of confirmatory factor analyses showing the expected three-factor models., Conclusion: Our results indicate that the OCDUS and DDQ for cocaine are both easy to administer and reliable instruments to assist the clinical practitioner or researcher to measure craving in cocaine dependent subjects. Moreover, the factor structure for the cocaine versions were similar to the heroin versions, indicating the OCDUS and the DDQ can be reliably used to measure craving for both substances, enabling a direct comparison between heroin and cocaine craving.

This study compared the characteristics of opioid-addicted adults seeking (n = 169) and not seeking (n = 74) methadone treatment in Baltimore, Maryland. Participants entering treatment were recruited from six methadone treatment programs, while out-of-treatment participants were recruited from the streets using targeted sampling methods. Measures included the Addiction Severity Index, a Supplemental Questionnaire, and urine drug test. Data were analyzed using ANOVA, chi(2), and regression, holding key background variables constant. Despite the lack of differences between the samples in demographic characteristics, the out-of-treatment sample reported significantly more days of heroin, cocaine, and alcohol use and spent significantly more money on drugs and earned more illegal income at baseline.

Seventeen non-treatment seeking cocaine-dependent individuals participated in three-week longitudinal inpatient studies of cognitive changes during drug use and abstinence. Protocols included three days drug-free baseline, three days cocaine self-administration, and two weeks complete abstinence. A repeatable cognitive battery showed attention and delayed verbal recognition memory but not working memory to be impaired in cocaine users compared to age- and sex-matched normative values. Attention was significantly poorer during the first and second week of abstinence compared to days on which cocaine was used suggesting that certain cocaine-induced impairments may be acutely normalized by cocaine use, but resurface during abstinence.

This study involved cluster analysis of Millon Clinical Multiaxial Inventory-II (MCMI-II) records of 304 cocaine dependent males and examined differences among personality-based clusters in medical, legal, employment, drug, alcohol, family, and psychiatric problem severity at treatment intake and in outcome status during the 12 months after completion of residential drug treatment. A hierarchical cluster analysis (Ward's method) was used to identify 4 cluster subgroups: antisocial, subclinical, neurotic, and high psychopathology. MANOVA revealed that membership in Neurotic and High Psychopathology Cluster subgroups was linked with more severe family and psychiatric problems at treatment intake than found in the Subclinical Cluster Subgroup (all ps < .05). The High Psychopathology Cluster Subgroup also had more severe drug problems at intake than did the Subclinical Subgroup (p < .05). Logistic regression analysis revealed that membership in the High Psychopathology Subgroup predicted relapse/loss to follow-up status after controlling for age, education, ethnicity, treatment program attended, and pretreatment cocaine use frequency (X(2) = 21.25, df = 3, p < .001).

An assay in which groups perform at both similar and significantly different levels within the same test session may have experimental advantages both in understanding underlying behavioral-cognitive processes and in helping to resolve neuroimaging issues regarding functional significance vs. performance confounds. Here we report behavioral data from a response inhibition (Go/No-Go) task with two levels of No-Go difficulty (easy, hard). The sample included individuals with current cocaine dependence (N=18) and controls (N=15). Using signal detection methodology (d' and Beta), significant main effects were observed for group and trial type on d'. Post-hoc analyses revealed the cocaine-dependent individuals performed significantly worse than controls on difficult, but not easy, trials. Differences on d' but not Beta, and slower reaction times in cocaine subjects, suggest that response inhibition deficits were related to disruption in visual information processing rather than inhibition of motor activity.

Background: Cocaine-dependent individuals demonstrate attentional bias when measured by Stroop color-naming tasks that have been modified to include cocaine-related words. However, the relationship between attentional bias and the treatment-seeking status of cocaine-dependent individuals has never been explored. The purpose of this study was to compare attentional bias towards cocaine-related verbal stimuli between treatment-seeking and nontreatment-seeking cocaine abusers., Methods: We examined performance on a Stroop task modified to include drug-related words in 17 cocaine-dependent treatment-seeking male participants and 20 cocaine-dependent nontreatment-seeking male participants., Results: Although treatment seekers reported less experience with cocaine than nontreatment seekers, they exhibited increased response latency and made more errors when identifying the colors of cocaine-related words, relative to neutral words (p<.05), whereas nontreatment seekers did not., Conclusions: Factors other than a high frequency of cocaine use may contribute to the difference in attentional bias towards cocaine cues between these subgroups of cocaine users.

This article reports on the prevalence of probable mental health disorders among clients entering outpatient substance abuse treatment, their clinical characteristics, and past access to substance abuse and mental health care. Four hundred fifteen individuals (74% of those eligible) entering three publicly funded outpatient substance abuse treatment facilities in Los Angeles County were screened for a probable mental health disorder. Of the 210 with a positive screener (just over 50% of those screened), 195 (93%) were interviewed. Depression and anxiety were the most common disorders, and more than a third had two or more probable disorders. Close to 70% reported using alcohol, and almost half reported using crack or cocaine. Half had never received any mental health treatment, and for a third this was their first episode of addiction treatment; 22% were on psychotropic medications. Levels of physical and mental health functioning were lower than the 25th percentile of the U.S. population norms. Our results indicate high rates of co-occurring mental health disorders among individuals entering these outpatient substance abuse treatment clinics in Los Angeles. Identifying people with probable mental health disorders as they enter treatment has the potential to increase access to care among those with limited prior access.

This study examined differences in substance abuse severity, trauma history, posttraumatic stress disorder (PTSD) symptomatology and psychiatric comorbidity among treatment-seeking women (N= 74) with PTSD and either comorbid cocaine or alcohol dependence. Women in the cocaine/PTSD group, compared with the alcohol/PTSD group, demonstrated greater occupational impairment (e.g., greater severity on the employment subscale of the Addiction Severity Index, less monthly income, fewer days worked in past month), more legal problems (e.g., greater number of months incarcerated and arrests for prostitution), and greater social impairment (e.g., fewer number of close friends, less likely to be married). Women in the alcohol/PTSD group evidenced higher rates of exposure to serious accidents, other situations involving serious injury, and other extraordinarily stressful life events. Rates of major depression and social phobia were higher among the alcohol/PTSD group than the cocaine/PTSD group. Women in the alcohol/PTSD group scored higher on the CAPS avoidance, hyperarousal, and total subscale scores. The current findings enhance our understanding of the substance-specific profiles of women with PTSD and comorbid substance use disorders and may have important implications for the design of dual-diagnosis interventions.

Context: Treating high-risk substance abusers who are members of minority groups may require varied protocols depending on differences among minority groups., Objectives: To explore cocaine abuse (CA)/ dependence with physiological dependence (CDPD) and posttraumatic stress disorder (PTSD) diagnosis differences between out-of-treatment Hispanic and African American adults, in order to identify cultural differences in how experiences and attitudes affect cocaine use behaviors., Design, Setting, and Participants: This study uses data collected between February and November 2000, as part of a three-year longitudinal study. A cohort of 347 out-of-treatment, Hispanic and African American cocaine-using adults from the Houston metropolitan area were interviewed to measure differences between cocaine users who are dually diagnosed and those that are not., Main Outcome Measures: Meeting the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. criteria for dual diagnoses of CA/PTSD or CDPD/PTSD., Results: For the dual diagnoses categories, 102 (29%) participants met the requirements for CA/PTSD or CDPD/PTSD. Logistic regression models were used, with CA/PTSD and CDPD/PTSD as the dependent variables. Age, race, gender, and income were used as the independent variables. Results indicate that individuals with higher income have a greater probability of developing CA/PTSD (beta = 0.919, p < 0.05). For both dual diagnoses categories of CA/PTSD and CDPD/ PTSD, results indicate that being female increases the likelihood of developing both of these dual diagnoses, (beta = 2.106, p < 0.05) or (beta = 2.510, p < 0.05). However, being an older female decreases the probability that an individual would develop these dual diagnoses (beta = -2.227, p < 0.05) (beta = -2.577, p < 0.05)., Conclusions: No differences were found for race/ethnicity among the dually diagnosed Hispanics and African Americans, however, gender differences were found. Being female increases an individual's probability of developing a dual diagnosis of CA/PTSD or CDPD/PTSD. In addition to being female, being a young female further increases an individual's probability of being dually diagnosed.

Background: We previously reported that cocaine-dependent patients with a reduced blue cone b wave electroretinogram (ERG) responses had significantly more cue-elicited craving., Methods: A new series of 21 recently withdrawn cocaine-dependent patients completed a craving questionnaire at baseline and following cue exposure; an ERG was also performed., Results: Cocaine-dependent patients with a blunted ERG blue cone response (<0.5 microV) showed greater increases in craving following cue exposure. When subjects were included from our preliminary study (N = 14), these differences became highly significant., Conclusions: Patients with a reduced ERG response may represent a subgroup more vulnerable to cocaine craving and future relapse.

The purpose of this pilot study was to evaluate potential gender differences in cocaine craving among non-treatment seekers with cocaine dependence. We examined 10 female and 11 male individuals matched by demographic characteristics and severity of drug use; we used a multidimensional questionnaire that assesses various aspects of craving: (a) current intensity, (b) projected intensity, (c) resistance to use cocaine, (d) responsiveness to drug-related conditioned stimuli, and (e) imagined likelihood of use if in a setting with access to drugs. Other instruments utilized were the Hamilton Rating Scale for Depression and Addiction Severity Index. Female subjects had higher total craving scores (p < .05), with post hoc tests showing more present desire to use cocaine and responsivity to drug-conditioned stimuli, along with lower scores on the desire not to use cocaine. In exploratory analyses, we found greater depressive symptomatology (p = .02) and severity of family/social problems (p = .02) in females than their males counterparts. These results suggest that gender may influence different aspects of cocaine craving. As estrogen is purported to modulate craving-related dopaminergic systems, further studies will be needed to confirm these observed gender differences and to investigate their possible mechanisms, particularly estrogen-dopamine interactions and their effect on craving and mood.

Self-report and physiological data from 27 male and 8 female cocaine-abusing volunteers exposed to cocaine (80 mg/70 kg p.o.) and placebo were examined for sex differences in their responses. Females reported significantly greater baseline ratings on the Pentobarbital-Chlorpromazine-Alcohol Group (PCAG) (sedation) and Lysergic Acid Diethylamide (LSD) (dysphoria) subscales of the Addiction Research Center Inventory-Short Form (ARCI) relative to males. In addition, females reported significantly greater ratings on the Visual Analogs Scales (VAS) Bad Drug Effects and Anxious/Nervous scales relative to males, regardless of drug. Cocaine produced greater increase in systolic blood pressure in males following cocaine, whereas females showed greater increases following placebo. These results suggest that a placebo control is necessary to determine sex differences in response to an active drug.

The individual variables that determine the effects of cocaine in humans are not well understood. In this study, we examined the relationship between the subjective response to cocaine and selected individual variables in cocaine-dependent participants. A single 0.4-mg/kg dose of smoked cocaine was received by 75 smoked cocaine users. The variables associated with increased subjective response to cocaine were male sex, presence of alcohol use, higher baseline Beck Depression Inventory (BDI) scores, and duration of cocaine use. The change in heart rate and diastolic blood pressure in response to cocaine delivery were also positively associated with the subjective response to cocaine. In contrast, body weight, years of schooling, and the change in the heart rate with the expectation of cocaine delivery were associated with a diminished subjective response to cocaine. The importance of these variables in maintaining the cocaine use behavior needs to be studied further.

An interview study was conducted among a group of incoming prisoners in a county jail in Ohio during the summers of 1997 and 1998 to assess their current drug treatment needs. "Incoming prisoners" refers to individuals who were being transferred from this county jail to the state prison system. Marijuana and cocaine were the most commonly tried illegal drugs among the subjects as well as the drugs of choice during the month prior to imprisonment. The Diagnostic Interview Schedule, combined with questions employed in the Drug Use Forecasting (DUF) project, was used to construct the questionnaire for this study. Based on the criteria of DSM-IV diagnoses, 57.5% of those interviewed had exhibited drug dependency at some point in their lives, and 51% were currently dependent on some substance. Thus, more than half of the incoming prisoners were in need of treatment for use of at least one substance. Cocaine dependence was the greatest problem facing this group of inmates, with an especially notable problem among the older females. Younger males were more likely to have current marijuana dependence. The study found that individuals currently dependent on cocaine or opiates perceived that they had a need for drug treatment, while those currently dependent on marijuana did not share this perception.

This study examines 5225 out-of-treatment crack users and drug injectors drawn from five different geographic areas to examine selected factors associated with homelessness. Of these crack users, 27% considered themselves undomiciled, and 60% had previously entered some type of drug treatment. Logistic regression found that substance abusers who were married, female, and persons of color were less likely to be without a home when other variables were controlled. Trading sex for money and perceived chance of getting acquired immunodeficiency syndrome (AIDS) were associated positively with homelessness, while participating in methadone detoxification and methadone maintenance programs seemed to offer some protection from homelessness.

Intimate physical assault and post-traumatic stress disorder (PTSD) were assessed in a sample of 91 adults seeking treatment for cocaine dependence. Physical assault included self-report of aggravated assault with a weapon, aggravated assault without a weapon, and simple assault. PTSD was assessed with a structured interview. Overall, 85.7% of the participants reported having been physically assaulted at least once during their lifetime. Slightly less than half of these individuals (46.2%) reported physical assault by an intimate partner. Close to half also met criteria for PTSD at some point in their lives. Women were more likely than men to be physically assaulted by an intimate partner and to report PTSD. Men who experienced physical assault by an intimate were more likely to report PTSD than men assaulted by others. Male victims of intimate violence had higher scores on certain subscales measuring addiction severity than male victims assaulted by others. Findings suggest careful assessment of intimate violence is essential given its high prevalence among cocaine-dependent women and men and its association with PTSD.

Greater substance abuse severity has been associated with less reliable self-reports of drinking in individuals with only an alcohol use disorder. In addition, individuals with multiple substance use disorders often report greater substance abuse severity. Therefore, it is important to be confident in the self-reports of substance use in individuals with multiple substance use disorders. Although there is considerable confidence in the use of collateral reports as a measure of drinking in individuals with only a diagnosis of alcohol abuse or dependence, information about subject-collateral agreement for individuals who meet the criteria for more than one substance use disorder is lacking. In this study, we examined subject-collateral reports of substance abuse in individuals presenting for alcohol treatment who met DSM-III-R criteria for alcohol and cocaine use disorder (n = 85). We then compared subject-collateral reports of those individuals to subject-collateral reports for individuals with only a diagnosis of alcohol abuse or dependence (n = 99). Overall, the results demonstrate that self-reports of individuals with alcohol and cocaine use disorders are generally valid. The results revealed no significant differences between groups on measures of subject-collateral consistency for several alcohol use variables. However, a significant difference was found for the number of days of drug use, with subject-collateral agreement being greater for individuals with an alcohol and cocaine use disorder. Additional analyses revealed that subject-collateral discrepancy scores were positively related to the participants' severity of alcohol and drug dependence. Recommendations for enhancing the accuracy of self-reports of drinking and drug use in alcoholics with comorbid cocaine use disorders are discussed.

This study uses an algorithm to determine whether patients dually diagnosed with a mood disorder and cocaine dependence have either (a) an autonomous mood disorder (onset of mood disorder prior to substance use disorder (SUD) or mood disorder symptoms persist during periods of abstinence or (b) a nonautonomous mood disorder (onset of SUD preceded mood disorder and mood disorder symptoms remit during periods of abstinence). The relationship among autonomy, patient characteristics, and treatment completion is examined. The sample included 67 methadone patients with a mood disorder (87% major depression, 13% bipolar) who were enrolling in a 6-month psychosocial treatment for cocaine use. Of these subjects, 27% were rated as having an autonomous mood disorder and 73% a nonautonomous mood disorder. Mean age was 37 years; 55% were female and 82% were Hispanic or African-American. All subjects had been stabilized on methadone (mean = 70 mg). During the 30 days prior to study intake, subjects with an autonomous mood disorder, compared to subjects with a nonautonomous mood disorder, reported fewer days using cocaine (12.5 versus 21.1) and fewer days drinking four or more drinks of alcohol (1.1 versus 6. 1). Treatment completion was associated with less cocaine use, autonomy, and African-American ethnicity. However, when these variables were controlled using logistic regression, only autonomous mood disorder and ethnicity predicted treatment completion. These results suggest that autonomy may be a useful construct to measure, and that subjects with nonautonomous mood disorders may need special efforts to ensure treatment retention.

The epidemic of cocaine abuse has led to numerous studies on the substance. While extent of use, characteristics of users, patterns of use, and consequences of dependence are well documented for both powder cocaine and crack, few studies have dealt with the sequence or progression of use between the two forms of cocaine. This paper draws on arrestee data collected from county jails in Los Angeles, California. It identifies four sequences of powder cocaine and crack use and examines each sequence in terms of user characteristics, history of use, dependence, contact with the criminal justice system, and concomitant use of other drugs. Findings not only confirm some already established observations, but also offer new knowledge on powder cocaine and crack abuse. For instance, (a) whereas powder cocaine-initiated users are more likely to progress to crack than to restrict their use to powder cocaine only, crack-initiated users tend more often to use crack only than to progress to powder cocaine; and (b) powder cocaine and crack, when used interchangeably, can interact and reinforce each other, resulting in a higher level of use and dependence on both forms of the substance. This paper contributes to the understanding of powder cocaine and crack use among criminal offenders, in particular, and across the adult population, in general. It also sheds light on prevention, treatment, and social control policies of both cocaine abuse and overall illicit drug use.

This paper examines the validity of self-report of drug use in several important high-risk samples by comparing survey answers with urinalysis results. The analyses include data obtained from face-to-face interviews with 1536 patients in sexually transmitted disease (STD) clinics, 1564 patients in hospital emergency rooms (ERs), and 2034 recent arrestees in jails. Using urinalysis as the criterion measure, considerable underreporting was observed, particularly among STD and ER subjects using cocaine and opiates. A logistic regression analysis on factors related to the underreporting was conducted for both cocaine and opiates. The results showed that a lower degree of underreporting was associated with subjects at jail sites (compared to STD subjects) and those who self-reported lifetime drug dependence.

Recent studies comparing self-admitted cocaine use with hair and urine test results have raised concerns about underreporting due to variations across situations and settings. Because of the frequent need for self-report data in conducting treatment evaluations, more information is needed on factors that affect the credibility of this information. The present study examines records of cocaine use collected as part of an evaluation of prison-based treatment (N=396). Specifically, self-reported cocaine use from 6-month postrelease follow-up interviews, completed with treatment graduates and a comparison sample of parolees who were eligible but not sent to treatment, was examined in relation to urine and hair test results. Overall, cocaine use was underreported when compared to hair test results, but underreporting was lower for program graduates than for the untreated comparison group. Furthermore, program graduates originally admitted to prison on a drug-related arrest were the most likely to underreport cocaine use, seemingly due to a heightened concern about potential consequences, such as returning to prison on another drug-related charge. Given that the validity of self-report for high-risk individuals varies greatly and is difficult to predict across studies, future research with criminal justice samples should continue to assess the validity of these measures under specific research conditions and for diverse types of individuals.

Cocaine use is common among individuals with schizophrenia and schizoaffective illness, with a prevalence ranging from 15-60% of patient samples. It is hypothesized that some schizophrenic cocaine abusers may use cocaine as an attempt to improve anhedonic symptoms or combat neuroleptic side-effects. Flupenthixol (FLX) has the distinct advantage of being both a neuroleptic medication and a potential treatment for cocaine abuse. We evaluated the efficacy of FLX in this dually diagnosed population in an open pilot study consisting of a 4-week inpatient phase and a 6-week outpatient phase. Eight individuals were initially cross-tapered off their neuroleptic medication and were given FLX in a dose of 40 mg of the decanoate every 2 weeks. Psychiatric symptomatology was assessed weekly, using the Positive and Negative Symptom Scale (PANSS) and the Beck Depression Inventory (BDI). Medication side-effects were monitored weekly, using the Simpson Neurological Rating Scale and the Abnormal Involuntary Movement Scale (AIMS). Substantial improvement in psychiatric symptomatology was noted when preadmission scores were compared to scores obtained during the last week of study enrollment. On the PANSS, positive symptom scores and negative symptom scores decreased by 31% and 29%, respectively. Similarly, BDI scores decreased by 57%. Comparing preadmission urine results to those for the last 6 weeks of enrollment in the study showed that cocaine-positive urines decreased by 28%, although most of the patients had a reduction of >75%. Missed clinic visits decreased by 26%. Thus, FLX was well-tolerated by schizophrenic cocaine abusers, suggesting that FLX may be useful for the treatment of this dually diagnosed population.

The concurrent external validity of the diagnosis of cocaine abuse, based on the DSM criteria, is shown to be established to an unexpectedly high degree, based on a method of determining the association between a summary score derived by quantifying the DSM criteria and another summary score derived from weighting several measures of frequency of use of cocaine and a measure of its mode of use. The degree of validity was cross-validated by performing the same analysis on two study samples: one of inpatients (N = 179) and one of urban-community African-Americans (N = 204).