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One important factor in the abuse potential of an opioid product is the ease with which active drug can be extracted. There are currently no standards for testing or reporting extractability. This article describes the development of an Extractability Rating System for use by the pharmaceutical industry and regulators. Despite several limitations, this effort serves as a call for standardized testing and reporting so that products can be accurately rated, and should help establish goals for drug developers who wish to develop "abuse-resistant" opioid products.

Background The growing trends in opioid abuse, assessment of the abuse liability of prescription opioid products, and growing efforts by the pharmaceutical industry to develop 'abuse-resistant' formulations highlight a need to understand the features that make one product more 'attractive' than another to potential abusers. We developed a scale to measure the 'attractiveness' of prescription opioids to potential abusers, and used the scale to measure the relative attractiveness of 14 opioid analgesic products. Methods First, the concept of attractiveness was empirically defined with a group of prescription opioid abusers and experts in opioid abuse using a process called Concept Mapping. Abuse liability consisted of two components: factors intrinsic to the drug formulation (e.g., speed of onset, duration) and factors extrinsic to drug formulation (e.g., availability, availability of alternatives, cost). A 17-item Opioid Attractiveness Scale (OAS) was constructed, focusing on factors intrinsic to the drug product. Results A total of 144 individuals participated in tests of validity and reliability. Internal consistency was excellent (Cronbach's α = 0.85–0.94). Drug rankings based on OAS scores achieved good inter-rater agreement (Kendall's W 0.37, p < 0.001). Agreement on drug OAS scores between the developmental sample and a confirmation sample was good (IntraClass Correlations [ICC] of 0.65–0.69). Global ratings of overall attractiveness of the 14 selected opioid products by substance abuse counselors corresponded with the rankings based on OAS ratings of the abuser group. Finally, substance abuse counselors completed the OAS, yielding a high level of correspondence with ratings by the abuser group (ICC = 0.83, p = 0.002). The OAS differentiated attractiveness among 14 selected pharmaceutical opioid products. OxyContin, Dilaudid, and Percocet were ranked highest (most attractive); Talwin NX and Duragesic were ranked lowest (least attractive). Conclusion An initial examination of the psychometric properties of the OAS suggests that it is a valid and reliable scale. The OAS may be useful in providing important guidance on product features that are attractive to potential abusers.

Background Self-report of nonmedical prescription opioid use (NMPU) is a cornerstone of drug abuse surveillance, policymaking, and treatment service planning, but misclassification creates bias and may confuse or undermine NMPU estimates [1]. We detected old OxyContin (OC) abuse reports long after a reformulated version (OP) was released (August 2010). This study explored sources of possible NMPU misclassification and proposed solutions. Materials and methods A mixed-methods approach identified demographic, behavioral, and cognitive factors influencing endorsement of old formulations in: a) multivariable regression analyses of NMPU data from the ASI-MV surveillance program [2] examined predictors of endorsing old (vs. new) formulations during the post-reformulation period (n = 8032); b) prevalence estimates of OC availability from an online recreational drug user forum survey (fall 2013; n = 459); and c) semistructured interviews (n = 29) and cognitive interviews (n = 7) among residential and outpatient substance abuse treatment program clients reporting past 2-year use of OC/OP. A coding guide identified patterns and themes of misidentification in transcribed interviews.

s / Drug and Alcohol Dependence 146 (2015) e34–e117 e35 ASmay enhance patient beliefs in their ability to change, which has been shown to be an important predictor of treatment outcome. Financial support: Effort on this projectwas supported byNIDA grants K24DA022288 and R03DA034102. http://dx.doi.org/10.1016/j.drugalcdep.2014.09.465 Web-based medical school education on substance use disorders A.T. McLellan1,2, Brenda L. Curtis1, B. Nordstrom3, J. Skrajewski4 1 Treatment Research Institute, Philadelphia, PA, United States 2 University of Pennsylvania, Philadelphia, PA, United States 3 Dartmouth College, Hanover, NH, United States 4 Betty Ford Institute, Rancho Mirage, CA, United

Aims: Screening, briefmotivational counseling interventionand referral to treatment (SBIRT) has shown to be effective in reducing substance use and related harms among adolescents in clinical settings but it had not been adapted for use in schools. This translational research study aimed to (a) develop a proof of concept, (b) test the feasibility of conducting SBIRT in two urban New York schools, and (c) examine the economic sustainability. Methods: With the cooperation of the New York OSAS, licensed “health clinics” were createdwithin these schools, equippedwith a computer screening program and a trained substance abuse counselor. The computer presented a standard substance screening; provided tailored prevention information to the student and provided counselor guidance for an immediate, private Motivational Interviewing counseling session. Results: In Spring 2012, 248 students were randomly approached to participate; 100% accepted the screening; 42% of them (n=105) reported substance use (vs. 28% reported in schoolwide, anonymous survey). Importantly, 99% of positively screened students voluntarily accepted onemotivational counseling session and68% returned for additional counseling sessions. The SBIRTprocedure did not interfere with academic activities. Conclusions: The SBIRT was feasible to implement and attractive to students, teachers and administration. We believe the acceptance and participation was due the use of non-school personnel and the private, professional and confidential procedures employed. The data offer clear indication that further effectiveness testing is warranted and potentially valuable. SBIRT, as implemented, has been approved for Medicaid (and some private insurance) reimbursement without co-payment to the parents or students. Economicmodeling demonstrates the current national SBIRT reimbursement rates to be adequate to broadly implement and sustain school-based SBIRT in most mid to largesized schools. Financial support: Phoenix House and Treatment Research Institute.

The role of therapist characteristics in therapy training was examined for 62 therapists in a multisite psychotherapy outcome study that included cognitive therapy (CT), supportive-expressive (SE) psychodynamic therapy, and individual drug counseling (IDC) for cocaine-dependent patients. Demographic variables and experience and competence ratings prior to training were correlated with measures of change in competence during the training phase. Higher competence ratings before training were associated with greater change in competence for SE and higher average competence for IDC. More years of experience were associated with greater change in competence for CT therapists, but more hours of pre-training supervision in the CT treatment modality were associated with less change.

The Addiction Severity Index (ASI) includes items to assess patients' history of trauma (physical or sexual). The goal of this study was to assess the sensitivity and specificity of those questions in relation to the Trauma History Questionnaire (THQ), a more thorough measure of lifetime trauma and, in addition, to an actual posttraumatic stress disorder (PTSD) diagnosis.At the start of treatment cocaine dependent outpatients (N = 110, 65.5% male) were assessed on the ASI, the THQ and a PTSD symptom checklist as part of a multisite clinical trial.Specificity of the ASI questions was higher than sensitivity for both sexual trauma (specificity = .96, sensitivity = .46) and physical trauma (specificity = .71, sensitivity = .50), while for PTSD the sensitivity of the ASI (.91) was higher than its specificity (.43). Other findings indicated that patients were more likely to report trauma on the THQ than on the ASI (which may be due to the self-report format of the THQ); that the ASI was better at assessing sexual than assessing physical trauma; and that the higher the number of ASI trauma items endorsed, the more likely was the PTSD diagnosis. Finally, PTSD patients had greater severity than non-PTSD patients on other ASI items (e.g., psychological severity, need for treatment).The ASI trauma questions show stronger utility as a screen for PTSD than for trauma. Results of the study are discussed in light of ways to modify the ASI to screen more accurately for trauma, clinical implications, and limitations of the study method.

This article describes a clinical management tool, the Value Accounting System, developed for use by a national organization of psychiatric treatment facilities. The system integrates patient case-mix variables with data on services provided, key administrative and clinical processes, clinical effectiveness, and cost/price. A comprehensive database links critical quality information with fiscal information, yielding a management tool that is national is scope, standardized, and versatile enough (1) to address general questions of the effectiveness and value of psychiatric services and (2) to provide an empirical base for rational, clinical management decision making. Descriptive data are presented from an attempt to establish a database and implement the system. The management and scientific potential of the Value Accounting System to improve the quality and efficiency of mental health services are discussed.

16 female substance abusers were assessed for the presence of personality disorders using two structured interviews and two self-report questionnaires. Although high prevalence of personality disorders was detected by each instrument, there was little agreement among the four methods for assessing these disorders.

A sentence in discourse may appear in the passive voice to emphasize the logical object rather than the logical subject when it is thematically more important. Two experiments are reported that explore the impact of this textual function of voice on sentence memory. The first experiment required subjects to listen to prose passages and then recall them. Sentences were recalled predominantly in the active voice regardless of voice or thematic focus in the prose passage, showing that the English-language bias for the active voice was a more important determinant of sentence reconstruction than was the experimental manipulation of thematic context. The second experiment required subjects to listen to or read either prose passages or lists of unrelated sentences and then to try to recognize “key” sentences that were either unchanged or changed lexically, semantically, or in voice. Recognition, both overall and specifically for voice, was better for sentences that were read than for those that were heard, and recognition for semantic change was consistently higher than for any other. Only when passages were read was there evidence in support of a thematic textual influence on memory for sentence voice.

Ponto-geniculo-occipital (PGO) spikes, which may be the most critical phasic event associated with REM sleep, cannot be recorded directly in humans. A partial indicator of PGO activity in humans is phasic integrated potentials (PIPs). Individuals differ in the degree to which PIPs are dispersed out of REM sleep into NREM sleep. In this study, the PIPs of 15 normal men were recorded during sleep. The following morning they were administered Rorschachs. There was a significant and positive correlation between the frequency of NREM PIPs and the number of Human Movement responses on the Rorschach, replicating the finding of an earlier study.