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Background: A low-nicotine product standard is currently under consideration by the U.S. Food and Drug Administration (FDA). This standard may be more effective if alternative, non-combusted sources of nicotine are concurrently available. This qualitative study explored the lived experiences of people with depression and anxiety disorders who used very low nicotine content (VLNC) cigarettes with or without e-cigarettes during a randomized controlled trial., Methods: We conducted semi-structured qualitative interviews with participants (n = 20) as they completed a 16-week blinded trial of VLNC cigarettes with or without electronic cigarettes. Interviews explored 1) experiences with these products, 2) social and environmental contexts for use and 3) relative risk perceptions. Interviews were transcribed and analyzed using a hybrid inductive and deductive thematic analysis., Results: Concurrent access to e-cigarettes helped to ease the transition from usual-brand cigarettes to VLNC cigarettes. Some participants held misperceptions that VLNC cigarettes could reduce cancer risk whereas others did not. Participants expressed skepticism about the safety of e-cigarettes and the authenticity of the VLNC cigarettes. Smoking restrictions influenced e-cigarette use in some instances, but product preference was the overriding factor that influenced use. Participants did not note effects on psychiatric symptoms., Conclusions: Should a nicotine reduction policy be implemented with e-cigarettes concurrently available on the market, tailored messaging for people with anxiety and depression disorders may be necessary to educate people about and the availability of alternative sources of nicotine, such as e-cigarettes, as well as the relative risk of VLNC cigarettes and e-cigarettes., Competing Interests: Conflict of Interest The authors have no conflicts to declare., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Cigarette smoking is among the leading preventable causes of global morbidity and mortality. We aimed to determine whether individual differences in loss aversion, a bias in decision-making wherein losses are valued greater than gains, predicts smoking and other addiction risk., Methods: We recruited current daily cigarette smokers (n = 181; > 10 cigarettes per day) and never-smokers (n = 237; < 100 cigarettes lifetime) from the United States using Amazon Mechanical Turk. Groups were matched on gender, educational attainment, and age. All completed items related to current cigarette smoking, alcohol use, other drug use, sleep problems, and depressed mood, and task-based measures of loss aversion and delay discounting, a decision-making bias associated with cigarette smoking., Results: Smokers were less loss averse than never-smokers (F(1, 411) = 24.19, η 2 = 0.02, p < .0001) even after accounting for delay discounting (F(1, 410) = 20.53, η 2 = 0.02, p < .0001). Loss aversion was also a significant independent risk factor for alcohol (F(1, 410) = 21.47, η 2 = 0.02, p < .0001) and other drug use (F(1, 410) = 54.12, η 2 = 0.04, p < .0001), although not other behavioral-health conditions (i.e., sleep disturbance, depressed mood). Further analyses revealed that co-occurring low loss aversion and high delay discounting were independently associated with greater risk for all patterns of substance use., Conclusions: Loss aversion was associated with current cigarette smoking and other substance use patterns independent of delay discounting. Loss aversion may warrant attention as a protective factor and potential target for preventive intervention for substance use and addiction., (Published by Elsevier B.V.)

Background: Identifying predictors of tobacco use patterns that differ in harm among reproductive-aged women may inform efforts to protect women and children against adverse health impacts of tobacco use., Methods: Changes in tobacco use patterns were examined among women (18-49 years) who completed Wave 1 (W1) and Wave 2 (W2), or W2 and Wave 3 (W3) of the U.S. Population Assessment of Tobacco and Health (PATH, 2013-2016) study, and were using cigarettes, filtered cigars and/or cigarillos in the first wave over which data were included for that respondent (Time 1; T1). We examined the proportion of respondents whose tobacco use transitions from T1 to Time 2 (T2) were harm-maintaining (continued using combusted tobacco), harm-reducing (transitioned to electronic nicotine delivery systems (ENDS), or harm-eliminating (quit tobacco). Multinomial logistic regressions (with harm-maintaining as the baseline category) were conducted to examine associations between ENDS use, demographic, and psychosocial characteristics with each transition., Results: A majority of women (83 %) exhibited harm-maintaining transitions, followed by harm-eliminating (14.7 %) and harm-reducing (2.3 %) transitions. Use of ENDS at T1 was associated with increased odds of harm reduction and decreased odds of harm elimination. Younger women were more likely to make both harm-reducing and harm-eliminating transitions. Increased educational attainment, identifying as Black or Hispanic, increased psychiatric symptoms, and pregnancy were associated with harm elimination, whereas living at or above poverty was associated with harm reduction., Conclusions: Study results contribute new information on the impact of ENDS, sociodemographic characteristics, psychiatric symptoms, and pregnancy on tobacco use transitions among reproductive-aged women., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: Nicotine is the addictive component in cigarettes that maintain cigarette smoking that subsequently leads to morbidity and mortality. Methods for assessing the abuse liability of cigarettes are essential to inform new tobacco product standards. This secondary analysis evaluated the utility of one subjective effects measure, the modified Cigarette Evaluation Questionnaire (mCEQ), and one behavioral economic task, the Cigarette Purchase Task (CPT), for predicting acute relative reinforcing efficacy measured by concurrent choice Self-Administration (SA)., Methods: Smokers (N = 169) belonging to one of three vulnerable populations participated in a multi-site, double-blind study evaluating research cigarettes with varying levels of nicotine (0.4, 2.4, 5.2, 15.8 mg/g). Participants sampled cigarettes and completed the mCEQ and CPT. In subsequent sessions, cigarette preference was assessed using a concurrent choice SA procedure. Mixed-model repeated measures analysis of variance tests were used to evaluate the utility of the mCEQ subscales and CPT indices for predicting preference for the higher compared to lower nicotine content cigarettes. In addition, stepwise regressions were used to determine which subscales and indices independently predicted concurrent choice SA., Results: Greater increases on the Satisfaction and Enjoyment of Respiratory Tract Sensations mCEQ subscales independently predicted higher dose preference in concurrent choice testing. Elasticity was the only CPT index that predicted choice. However, its predictive utility differed by dose among opioid-maintained individuals., Conclusion: The mCEQ and CPT predict behavioral measures of relative reinforcing efficacy as assessed in concurrent choice SA, with the mCEQ Satisfaction and Enjoyment of Respiratory Tract Sensations subscales being the strongest independent predictors., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Aims: There is a critical need to reduce infectious disease transmission among individuals with opioid use disorder (OUD). Here we examine the ability of a novel, automated educational intervention, delivered via iPad in a single visit, to improve human immunodeficiency virus (HIV) and Hepatitis C (HCV) knowledge among adults with OUD., Methods: Participants were 25 adults enrolled in a 12-week trial evaluating the efficacy of an Interim Buprenorphine Treatment for reducing illicit opioid use and other risk behaviors during delays to opioid treatment. Participants completed baseline HIV and HCV knowledge assessments with corrective feedback. They then completed an interactive HIV flipbook and HCV video followed by a second administration of the knowledge assessments. The knowledge assessments were repeated at post-intake Weeks 4 and 12., Results: At baseline, participants answered 69% and 65% of items correctly on the HIV and HCV assessments, respectively. The educational intervention was associated with significant increases in knowledge (86% and 86% correct on the HIV and HCV assessments, respectively; p's<.001). These improvements persisted throughout the study, with scores at Week 4 and 12 significantly greater than baseline (p's<.001)., Conclusion: This HIV+Hepatitis Education intervention was associated with significant and sustained improvements in knowledge of HIV + HCV transmission and risk behaviors in this vulnerable group of individuals with OUD. Given the continuing opioid epidemic, efforts are urgently needed to reduce HIV and HCV contraction and transmission among individuals with OUD. Mobile health educational interventions may offer a time- and cost-effective approach for addressing these risks., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose: To examine (1) whether use of a recommended algorithm (Johnson and Bickel, 2008) improves upon conventional statistical model fit (R(2)) for identifying nonsystematic response sets in delay discounting (DD) data, (2) whether removing such data meaningfully effects research outcomes, and (3) to identify participant characteristics associated with nonsystematic response sets., Methods: Discounting of hypothetical monetary rewards was assessed among 349 pregnant women (231 smokers and 118 recent quitters) via a computerized task comparing $1000 at seven future time points with smaller values available immediately. Nonsystematic response sets were identified using the algorithm and conventional statistical model fit (R(2)). The association between DD and quitting was analyzed with and without nonsystematic response sets to examine whether the inclusion or exclusion impacts this relationship. Logistic regression was used to examine whether participant sociodemographics were associated with nonsystematic response sets., Results: The algorithm excluded fewer cases than the R(2) method (14% vs. 16%), and was not correlated with logk as is R(2). The relationship between logk and the clinical outcome (spontaneous quitting) was unaffected by exclusion methods; however, other variables in the model were affected. Lower educational attainment and younger age were associated with nonsystematic response sets., Conclusions: The algorithm eliminated data that were inconsistent with the nature of discounting and retained data that were orderly. Neither method impacted the smoking/DD relationship in this data set. Nonsystematic response sets are more likely among younger and less educated participants, who may need extra training or support in DD studies., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: The high rates of HIV and Hepatitis C (HCV) infection among opioid abusers is a serious public health problem, and efforts to enhance knowledge regarding risks for HIV/hepatitis infection in this population are important. Abuse of prescription opioids (POs), in particular, has increased substantially in the past decade and is associated with increasing rates of injection drug use and HCV infection., Methods: This study describes the effects of a brief HIV/HCV educational intervention delivered in the context of a larger randomized, double-blind clinical trial evaluating the relative efficacy of 1-, 2-, and 4-week outpatient buprenorphine tapers and subsequent oral naltrexone maintenance for treating PO dependence. HIV- and HCV-related knowledge and risk behaviors were characterized pre- and post-intervention in 54 primary PO abusers., Results: The educational intervention was associated with significant improvements in HIV (p<.001) and HCV (p<.001) knowledge. Significant improvements (p<.001) were observed on all three domains of the HIV questionnaire (i.e., general knowledge, sexual risk behaviors, drug risk behaviors) and on 21 and 11 individual items on the HIV and HCV questionnaires, respectively. Self-reported likelihood of using a condom also increased significantly (p<.05) from pre- to post-intervention. No additional changes in self-reported risk behaviors were observed., Conclusion: These results suggest that a brief, easy-to-administer intervention is associated with substantial gains in HIV and HCV knowledge among PO abusers and represents the necessary first step toward the dissemination of a structured prevention HIV and HCV intervention for PO abusers., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Background: Only 56% of outpatient substance abuse treatment programs in the U.S. provide HIV/AIDS education, likely due to the time required to complete existing educational interventions. This report describes results of a third study in a series to develop a brief educational intervention to increase HIV/AIDS knowledge among cocaine-dependent outpatients., Methods: Participants (N=90) were randomized to experimental or control conditions and completed two HIV/AIDS knowledge pre-tests with response formats modified to "true-false-don't know." Pre-test results were later compared to historical controls that completed pre-tests in their original "true-false" format. Next, participants in the experimental condition completed an HIV/AIDS educational intervention while participants in the control condition completed a sham intervention. Participants in both conditions then completed knowledge tests a second time. Participants in both conditions were subsequently crossed over, and then completed knowledge tests a third time. Post-intervention analyses were conducted using test data from all participants who completed the educational intervention (N=56). A subset of these participants (N=40) completed follow-up tests approximately 9 weeks after completing the educational intervention., Results: Scores on both pre-tests were lower than those observed in historical controls (p<.001). Scores on knowledge tests increased from baseline after participants completed the educational intervention (p<.001), but not after the sham intervention (p>.05). Scores at follow-up remained higher than baseline scores (p<.001)., Conclusions: Modifying response formats to include a "don't know" option likely increases identification of baseline knowledge deficits. This brief intervention is effective at increasing HIV/AIDS knowledge among cocaine-dependent outpatients., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: Pupil diameter is a frequently assessed objective index of the pharmacodynamic effects of opioids in adults, but to our knowledge has never been examined in infants. Such a measure could improve assessment and treatment of neonates exposed to opioids in utero. The present study examined changes in pupil diameter after opioid administration in opioid-exposed infants who required pharmacological treatment for neonatal abstinence syndrome (NAS) to test the feasibility of using pupil diameter as a measure of opioid effects in these infants., Methods: Ten infants (2-7 days old) receiving methadone (0.4-0.5 mg every 12 h) for the treatment of NAS participated. A picture of one of each infant's eyes was taken under controlled illumination conditions with a standard digital camera just prior to dosing and 0-1, 2-4, 5-7, and 8-10h after dosing. The diameters of the pupil and iris were measured and relative pupil diameter (pupil diameter expressed as a percentage of iris diameter) was analyzed., Results: Mean (±SE) relative pupil diameter decreased significantly after dosing from 41±2% to 29±2%. After dosing, a significant increasing linear trend was observed over time, with values of 29±2%, 33±3%, 38±3%, and 41±3% at 0-1, 2-4, 5-7, and 8-10h after dosing., Conclusions: Infant pupils respond to opioid administration in the same sensitive, orderly manner as is commonly observed in adults. Pupil diameter appears to be an objective, sensitive measure of neonatal response to opioids that may be a useful complement to, or perhaps at times a replacement for, observer-rated scale scores., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: The association between buprenorphine taper duration and treatment outcomes is not well understood. This review evaluated whether duration of outpatient buprenorphine taper is significantly associated with treatment outcomes., Methods: Studies that were published in peer-reviewed journals, administered buprenorphine as an outpatient taper to opioid-dependent participants, and provided data on at least one of three primary treatment outcome measures (opioid abstinence, retention, peak withdrawal severity) were reviewed. Primary treatment outcomes were evaluated as a function of taper duration using hierarchical linear regressions with pre-taper maintenance duration as a cofactor., Results: Twenty-eight studies were reviewed. Taper duration significantly predicted percent of opioid-negative samples provided during treatment, however pre-taper maintenance period predicted percent participants abstinent on the final day of treatment. High rates of relapse were reported. No significant association between taper duration and retention in treatment or peak withdrawal severity was observed., Conclusion: The data reviewed here suggest taper duration is associated with opioid abstinence achieved during detoxification but not with other markers of treatment outcome. The reviewed studies varied widely on several parameters (e.g., frequency of urinalysis testing, provision of ancillary medications) that may influence treatment outcome and thus could have interfered with the ability to identify relationships between taper duration and outcomes. Future studies evaluating opioid detoxification should utilize rigorous experimental methods and report a wider range of outcome measures in order to help advance our understanding of the association between taper duration and treatment outcomes., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Decreasing smoking during pregnancy is an important public health priority. An important step towards decreasing smoking during pregnancy is wider dissemination of evidence-based smoking cessation interventions. One such intervention is contingency management wherein mothers earn vouchers exchangeable for retail items contingent on biochemically verified smoking abstinence. Wider dissemination may be possible by using smoking verification methods that require minimal training and equipment. One possibility is to use a cotinine-sensitive dipstick (NicAlert) rather than a bench-top cotinine analyzer, which is expensive and requires relatively extensive technician expertise, or breath carbon monoxide analysis, which is relatively nonspecific. The present study was conducted to begin examining the utility of cotinine-sensitive dipsticks for this purpose., Methods: Fifty urine samples from pregnant women enrolled in a smoking cessation program were analyzed to compare three different methods for verifying smoking status: NicAlert strips, a bench-top enzyme multiplied immunoassay technique (EMIT) analyzer, and gas chromatography (GC), the current gold standard for determining cotinine levels in urine., Results: Agreement between GC and NicAlert results were high (96%) and comparable to agreement between GC and EMIT results (94%). Semi-quantitative measurements using NicAlert were low with only 30% of samples in agreement between GC and specific ranges given on the strips., Conclusions: NicAlert strips appear to be a valid measure of determining smoking status among pregnant smokers although not of absolute cotinine concentration. With minimal training and equipment required, NicAlert strips provide a potentially practical method for using urine cotinine to verify smoking status in community treatment settings., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Excessive maternal weight gain during pregnancy can result in serious adverse maternal and neonatal health consequences making it an important outcome to monitor in developing smoking-cessation interventions for pregnant women. Maternal weight gain was investigated in the present study with 154 pregnant participants in controlled trials investigating the efficacy of contingency management (CM) for smoking cessation. Women were assigned to either an abstinence-contingent condition wherein they earned vouchers exchangeable for retail items by abstaining from smoking or to a control condition where they received comparable vouchers independent of smoking status. Mean percent of negative smoking-status tests throughout antepartum was greater in the incentive than control condition (45.2±4.6 vs. 15.5±2.4, p<.001) as was late-pregnancy point-prevalence abstinence (36% vs. 8%, p<.001) but maternal weight gain did not differ significantly between treatment conditions (15.0±0.8kg vs. 15.0±0.9 kg, p=.97). In a comparison of women classified by smoking status rather than treatment condition, a greater percent of negative smoking-status tests predicted significantly more weight gain (0.34 kg per 10% increase in negative tests), an effect that appeared to be attributable to women with greater abstinence having larger infants. This study shows no evidence of excessive maternal weight gain among pregnant women receiving a CM intervention for smoking cessation., (Published by Elsevier Ireland Ltd.)

This study examined the influence of education on smoking status in a cohort (n=316) of pregnant women who were smokers at the time they learned of the current pregnancy. Subjects were participants in clinical trials examining the efficacy of monetary-based incentives for smoking-cessation and relapse prevention. In multivariate analyses, educational achievement was a robust predictor of smoking status upon entering prenatal care, of achieving abstinence antepartum among those still smoking at entry into prenatal care, and of smoking status at 6-month postpartum in the entire cohort and the subsample who received smoking-cessation treatment. In addition to educational attainment, other predictors of smoking status included smoking-related characteristics (e.g., number of cigarettes/day smoked pre-pregnancy), treatment, maternal age, and stress ratings. We suggest that strategies to increase educational attainment be included with more conventional tobacco-control policies in efforts to reduce smoking among girls and young women.

Cigarette smoking remains a leading preventable cause of poor pregnancy outcomes and infant morbidity and mortality. Despite three decades of research encompassing more than 60 trials and 20,000 pregnant women, cessation rates produced by existing interventions are often low (<20%), especially among socioeconomically disadvantaged women. This has led to a call for the development and testing of novel interventions. One strategy for identifying novel interventions for pregnant smokers is to examine efficacious interventions for other types of substance use disorders (SUDs). Pregnant smokers share many sociodemographic similarities with other sub-populations of individuals with SUDs, suggesting that interventions efficacious with the latter may also benefit the former. The National Institute on Drug Abuse's guide, "Principles of Drug Addiction Treatment: A Research-based Guide", presents empirically validated principles of effective treatments for other SUDs. The present report enumerates these principles, briefly describes some of the empirical evidence supporting them, and explores their potential application to the treatment of smoking during pregnancy. Overall, the results of this exercise suggest much promise for enhancing treatment outcomes for pregnant smokers by borrowing from and extending what has been learned with other populations with SUDs.

Delay discounting (DD) describes how the value of a reinforcer decreases as delay to its delivery increases. Relationships between DD and various aspects of drug abuse have been demonstrated reliably. A potential barrier to wider adoption of DD techniques is that results are often expressed in terms that may be too abstract or unfamiliar to a broader audience, particularly when describing or comparing hyperbolic DD functions or values of k. In an effort to potentially make DD results more accessible, the current report explores use of an ED50 value in characterizing DD functions, similar to that used in pharmacology research for characterizing dose-effect functions. The ED50 proposed with regard to DD is the delay that is effective in discounting the subjective value of the delayed reinforcer by 50%. Additionally, a convenient method for calculating ED50 values for DD is discussed.

Postpartum relapse is common among women who stop smoking during pregnancy. We examined predictors of postpartum relapse in 87 women who quit smoking during pregnancy, 48% of whom relapsed by 6 months postpartum. We also explored the circumstances surrounding their first postpartum cigarette. Multivariate analyses revealed that having more friends/family members who smoke, smoking more heavily pre-pregnancy, and having higher depression scores and less concern about weight at the end of pregnancy were associated with increased risk of relapse postpartum. Most women's first postpartum cigarettes were unplanned, in the presence of another smoker, and while experiencing negative affect. The findings suggest targets for interventions to reduce postpartum relapse.

Objective: Any smoking during the initial 2 weeks of attempting to quit predicts poor short- and longer-term outcomes in the general population of cigarette smokers. The present study examined whether that rule applies to pregnant women., Methods: Data were obtained from 129 women participating in clinical trials on smoking-cessation examining the efficacy of voucher-based incentives delivered contingent on biochemically-verified abstinence or a control condition wherein incentives were given independent of smoking status. Smoking status was assessed in weeks 1 and 2 of the cessation effort and again at an end-of-pregnancy assessment scheduled at weeks 28-32 gestation using self-report and biochemical verification., Results: Smoking in weeks 1 or 2 predicted smoking at the end-of pregnancy assessment independent of treatment condition. There was a 79% and 92% chance that those who smoked in weeks 1 or 2 would be classified as smokers at end-of-pregnancy in the contingent-incentive and control conditions, respectively., Conclusions: Clinicians assisting pregnant women trying to quit smoking may want to monitor progress in the initial weeks of the cessation effort and consider enhancing/changing the intervention when smoking is detected.

This study compared the subjective, physiological, and psychomotor effects of atomoxetine and methylphenidate with placebo in healthy volunteers. Sixteen non-dependent light drug users participated in six experimental sessions, receiving placebo, atomoxetine (20, 45 and 90 mg) and methylphenidate (20 and 40 mg) using a double-blind, Latin square design. Subjective drug effects were assessed using Visual Analog Scales (VAS), the Addiction Research Center Inventory (ARCI) and Adjective Rating Scales (ARS). Psychomotor performance was evaluated using the Digit Symbol Substitution Test (DSST). Physiological measures were also collected throughout the sessions. Assessments were conducted before drug administration and 30, 60, 90, 120, 150, 180 and 240 min following dosing. Forty milligrams methylphenidate produced significant increases on the stimulant portions of the VAS and ARS and the benzedrine, amphetamine, morphine-benzedrine and lysergic acid diethylamine (LSD) subscales of the ARCI relative to placebo. Ninety mg atomoxetine was reported to be unpleasurable relative to placebo as indicated by significant increases on the 'bad' and 'sick' portions of the VAS, and on the LSD subscale of the ARCI. Compared with placebo, both methylphenidate doses significantly increased systolic blood pressure (BP) and heart rate (HR). For atomoxetine, 90 mg increased diastolic BP, 45 and 90 mg increased systolic BP, and all three doses increased HR relative to placebo. Neither compound produced significant differences from placebo on DSST performance. These results suggest that atomoxetine does not induce subjective effects similar to methylphenidate and suggest that it is unlikely that atomoxetine will have abuse liability.

We tested associations in structural models among parent individual problems (severity of drug problems, medical problems, psychiatric symptoms), family problems, and children's internalizing and externalizing problems. Results were compared for cocaine versus opiate dependent parents, mothers versus fathers, boys versus girls, and older versus younger children. Cocaine and opiate dependent parents in treatment (N=211) were interviewed about their substance use, psychiatric symptoms, and interpersonal problems and completed a measure of family problems. Parents also rated children's internalizing and externalizing problems. In structural models controlling for the significant correlations between parent and family problems and between children's internalizing and externalizing problems, family problems but not individual parent problems predicted children's internalizing and externalizing symptoms. Models were similar across all groups compared with the exception of parent gender, with significant relations between parent and family problems for mothers but not for fathers. In addition, older girls were more deviant relative to their same-age and gender peers than the younger girls and boys. These results suggest that the personal problems of drug dependent mothers may influence children's problems indirectly by increasing family problems. For drug dependent fathers, family problems were an independent predictor of children's problems.

In this experiment we compared three different schedules of reinforcement for promoting and sustaining short-term drug abstinence. For pragmatic reasons, cigarette smoking was studied as an exemplar of drug self-administration. The three schedules studied were a fixed magnitude of reinforcement for abstinence, a progressive increase in magnitude of reinforcement for abstinence with a reset contingency for drug use, and a progressive increase in magnitude of reinforcement for abstinence without a reset contingency. Eighteen cigarette smokers experienced the three schedules in a counterbalanced order. Each schedule was in effect for 5 consecutive days (M-F), during which time abstinence was reinforced according to the different schedules of reinforcement. The total amount of reinforcement (money) available was the same during each condition. The progressive magnitude with a reset schedule was more effective than the other two schedules in sustaining an initial period of abstinence. These results systematically replicate and extend those from prior studies demonstrating the efficacy of schedules incorporating a progressively increasing magnitude of reinforcement with a reset contingency for sustaining initial drug abstinence, and demonstrate the importance of the reset contingency to that effect.

Psychiatric symptom severity and associated characteristics were assessed in 185 individuals seeking outpatient treatment for cocaine dependence. The sample was divided into groups of low, medium and high psychiatric symptom severity based on Addiction Severity Index psychiatric composite scores. Patients with high symptom severity reported poorer pre-treatment functioning and more adverse consequences of cocaine use than the lower severity groups. Relationships between psychiatric severity and treatment outcome variables were assessed in a subset of 123 patients who received one of three 24-week psychosocial treatments for cocaine abuse: (i) behavioral treatment with a voucher-based incentive program; (ii) the same behavioral treatment without vouchers; (iii) or drug abuse counseling. Psychiatric symptom severity failed to influence treatment outcome with any of these treatments. Thus, in this study the authors found no evidence to indicate that high psychiatric severity predicts poor response to psychosocial treatment for cocaine abuse.

Heroin dependence remains a serious and costly public health problem, even in patients receiving methadone maintenance treatment. This study used a within-subject reversal design to assess the effectiveness of voucher-based abstinence reinforcement in reducing opiate use in patients receiving methadone maintenance treatment in an inner-city program. Throughout the study subjects received standard methadone maintenance treatment involving methadone, counseling, and urine monitoring (three times per week). Thirteen patients who continued to use opiates regularly during a 5-week baseline period were exposed to a 12-week program in which they received a voucher for each opiate-free urine sample provided: the vouchers had monetary values that increased as the number of consecutive opiate-free urines increased. Subjects continued receiving standard methadone maintenance for 8 weeks after discontinuation of the voucher program (return-to-baseline). Tukey's posthoc contrasts showed that the percentage of urine specimens that were positive for opiates decreased significantly when the voucher program was instituted. (P < or = 0.01) and then increased significantly when the voucher program was discontinued during the return-to-baseline condition (P < or = 0.01). Rates of opiate positive urines in the return-to-baseline condition remained significantly below the rates observed in the initial baseline period (P < or = 0.01). Overall, the study shows that voucher-based reinforcement contingencies can decrease opiate use in heroin dependent patients receiving methadone maintenance treatment.

Cigarette smoking (n = 156) and non-smoking (n = 43) individuals seeking out-patient treatment for cocaine-dependence were compared on demographic, drug use and other variables. Smokers were younger, less educated, earned less money, began cocaine use at an earlier age, used cocaine more frequently, were more likely to inject or smoke cocaine, were more likely to report legal troubles and having harmed someone physically as consequences of their cocaine use, and had more severe employment and legal problems than non-smokers as measured by the Addiction Severity Index. Smoking remained a significant predictor of more frequent cocaine use, using more grams of cocaine per week and using cocaine via an injection or smoking route even after adjusting for demographic differences between smokers and non-smokers via regression analyses. Smoking status was not significantly related to treatment outcome. Overall, these results indicate that cocaine-dependent smokers represent a more high-risk group than non-smokers. This relationship between smoking, cocaine use, and associated problems merits further investigation.

Cocaine dependence continues to be a widespread and serious public health problem in the US. Unfortunately, no consensus exists about how to treat cocaine dependence. Various pharmacological and psychological therapies have been investigated with mixed results. In this report we review findings from several studies conducted to assess the efficacy of an outpatient behavioral treatment for cocaine dependence. The treatment is based on the concepts and principles of behavior analysis and behavioral pharmacology. Results obtained to date indicate the treatment is acceptable to patients, retains them in treatment, engenders clinically significant levels of cocaine abstinence and can be adapted to deal with other forms of substance abuse common in this population. Overall, we believe the treatment represents an important step towards the development of empirically based and effective treatments for cocaine dependence.

Drug abuse and dependence are among the most important problems facing society today. Understanding the determinants of drug abuse has been advanced by a considerable quantity of research on environmental and pharmacological factors that control drug taking in a variety of settings and species. Behavioral economics, which is the application of economic principles to the behavior of the individual, may have the potential to integrate a number of these empirical observations in a novel quantitative framework. In this paper the utility of behavioral economics for the study of drug dependence is reviewed. Specifically, we reviewed (i) the parsimony behavioral economics affords via the integration of variables, (ii) a ubiquitous behavioral process it has identified, (iii) the precise quantification of that behavioral process and its predictive utility, (iv) a novel independent variable suggested by behavioral economics, and (v) the utility of behavioral economic notions for the process of medication development. We conclude that behavioral economics provides a novel conceptual framework that has utility for the study of drug dependence.

In four prior studies, caffeine (100 mg) self-administration was assessed by greater self-administration of caffeinated coffee than decaffeinated coffee and caffeine withdrawal was assessed by placebo substitution using six double-blind tests in each subject. This paper collates data across these studies to examine the incidence and predictors of the occurrence of caffeine self-administration and withdrawal. Caffeine self-administration occurred in 31% of subjects when a consistency criterion was used (n = 41) and 27% when a statistical criterion was used. Caffeine withdrawal occurred in 35% and 49% of subjects with each criteria (n = 37). Subjects who had withdrawal headaches and drowsiness were 2.3-2.6 times more likely to self-administer the caffeinated coffee. Several variables (e.g., average caffeine intake) did not predict caffeine self-administration or withdrawal.

This study assessed whether route of cocaine administration (intravenous vs. intranasal) influences cocaine abstinence during the first 6 weeks of outpatient treatment. Fifty-nine persons received behavioral treatment or standard drug counselling in an outpatient clinic. Based on information collected at intake, intravenous users had fewer years of education, were employed in less skilled jobs, were less likely to be married, reported more negative consequences from cocaine use, reported using more cocaine per occasion and spent more money on cocaine per week than intranasal users. Intravenous and intranasal users did not differ significantly in the average duration of continuous cocaine abstinence (mean = 2.6 vs. mean = 3.3 weeks achieved during 6 weeks of treatment). The duration of abstinence between intravenous and intranasal users was equal in the behavioral treatment (mean = 4.2). In standard treatment the average duration was less among intravenous than intranasal users (mean = 0.9 vs. mean = 2.4), but that difference did not achieve statistical significance. Hepatitis and employment instability were associated with shorter periods of cocaine abstinence among intravenous users, whereas employment instability, lower job skill level, drug use severity and reports of memory loss were associated with shorter periods of cocaine abstinence among intranasal users. These results indicate that i.v. cocaine users can achieve a period of initial abstinence in an outpatient setting comparable to the duration of typical inpatient hospitalizations, although special types of outpatient treatment may be necessary to obtain a positive outcome.

Seven healthy normal male and female volunteers (19-42 years) were trained to discriminate between the benzodiazepine triazolam (0.32 mg/70 kg; e.g. drug A) and placebo (e.g. drug B). During the first four daily sessions, drug A and drug B were administered orally in capsules 60 min prior to the session on alternate days and subjects were informed of the drug label at the time of drug administration. Subsequently, drug A and drug B were administered in a randomized-block fashion and subjects identified the drug code they thought they received. Subjects were informed of the drug code post-session. Once the criterion for discrimination was met (i.e. correct drug code identification on four consecutive sessions), the dose-effect curve for triazolam (0.1-0.75 mg/70 kg) was determined. The discrimination was acquired in all subjects; triazolam (0.32 mg/70 kg) and placebo produced approximately 85-95% correct responding. During the dose-effect curve determination, triazolam produced dose-related increases in triazolam-appropriate responding and self-reported sedation and drug strength. These results indicate that a triazolam-placebo discrimination can be acquired and that the triazolam discriminative stimulus effect is related to dose and to self-reported sedation.

Index Medicus (1966-1990) was searched to quantify and characterize the scientific/clinical community's responses to the cocaine epidemic. The rate of growth in the cocaine literature was compared with the rate of growth in the heroin and marijuana literatures in the 1960s and 1970s. Articles on cocaine increased dramatically over the past 7 years suggesting a clear response from the scientific/clinical community to the public health problems presented by the cocaine epidemic. That literature spans a wide range of areas addressing many scientific and health-care issues. This increase in cocaine citations is similar to that which occurred previously in response to use of heroin and marijuana.

The effects of naloxone (10 mg/70 kg) given 6 h following acute exposure to morphine (4, 8, 16 mg/70 kg) were assessed in 5 opiate-abusing volunteers who were not physically dependent upon entering the study. Naloxone increased cortisol plasma levels more following morphine than placebo pretreatment. Naloxone reversed the effects of morphine on pupil diameter and oral temperature and decreased skin temperature as a function of morphine pretreatment. Subjects' ability to detect the effects of naloxone, their scores on an opiate-withdrawal questionnaire, and their visual-analog ratings of 'bad effects', 'chills', 'confused' and 'restlessness' increased when naloxone followed pretreatment with 8 and 16 mg, but not 4 mg, of morphine. Performance on the Digit Symbol Substitution Test was not discernibly affected under any of the dose conditions. Overall, results from the present study provide further evidence in humans that the administration of naloxone shortly following acute morphine pretreatment increases naloxone sensitivity, produces signs and symptoms typical of opiate withdrawal and that these effects are dependent on the dose of morphine administered.

This study examined the effects of contingent vs. non-contingent delivery of a methadone dose supplement on relapse to illicit opiate use in the context of a methadone outpatient detoxification program. Following a 3-week methadone stabilization period on 30 mg, patients (N = 39) were randomly assigned to a contingent, a non-contingent, or a control treatment group. All patients received identical gradual reductions in their assigned methadone dose. During the dose reduction period (weeks 4-11), members of the contingent (N = 13) and non-contingent groups (N = 13) could obtain daily methadone-dose supplements up to 20 mg, but contingent group members could obtain supplements only if their most recent urinalysis results were opiate negative. Control subjects (N = 13) did not have dose increases available. The contingent group presented significantly lower opiate-positive urines during weeks 8-11 (14% positive) of the detox than the non-contingent (38% positive) or control (50% positive) groups. Additionally, the availability of extra methadone improved treatment retention and increased clinic attendance above levels observed in the control group. The potential for further use of methadone's reinforcing properties in the treatment of opiate dependence is discussed.

In the present study, a choice procedure was used in an outpatient methadone maintenance clinic to examine preferences for different double-blind methadone dose increases in 5 male patients. Subjects chose between 50 mg vs. 50 mg, 60 mg, 75 mg and 100 mg of methadone. In the 50 mg vs. 50 mg condition, each alternative was selected equally often. Percent selection of the higher doses (60, 75 and 100 mg) over the 50 mg dose of methadone increased in a dose-related fashion. Subject self-reports were consistent with methadone's opiate-like properties with dose-related trends being noted in most scales (e.g. opiate effects, drug liking). Overall, the results show that a choice procedure can be used successfully to assess the reinforcing properties of drugs in methadone maintenance patients and that methadone dose increases can function as a reinforcer in this population even under blind dosing conditions.