Table of Contents

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Volume 39, Number 2

June 2007

Getting Into Ecstasy: Comparing Moderate and Heavy Young Adult Users — Claire E. Sterk, Ph.D.; Katherine P. Theall, Ph.D. & Kirk W. Elifson, Ph.D.  

Experiences of Gamma Hydroxybutyrate (GHB) Ingestion: A Focus Group Study —Judith C. Barker, Ph.D.; Shana L. Harris, M.A. & Jo E. Dyer, Pharm.D. 

Cannabis and Psychosis: What is the Link? — Mohamed Ben Amar, B.Pharm., D.C.B., M.Sc. & Stéphane Potvin, B.Sc., M.A., Ph.D. 

Subjective Effects of Salvia Divinorum —Phil Dalgarno, Ph.D. 

Self-Medication Hypothesis of Substance Use: Testing Khantzian’s Updated Theory — Danny H. Hall, Ph.D. & John E. Queener, Ph.D. 

The Relationship Between Lifetime Abuse and Suicidal Ideation in a Sample of Injection Drug Users —Jacqueline J. Lloyd, Ph.D., M.S.W.; Erin P. Ricketts, M.S.P.H.; Jennifer R. Havens, Ph.D., M.P.H.; Llewellyn J. Cornelius, Ph.D., M.A.; David Bishai, M.D., Ph.D.; Steven Huettner, B.S.; Carl Latkin, Ph.D. & Steffanie A. Strathdee, Ph.D  

An Open-Label Pilot Study of Risperidone in the Treatment of Methamphetamine Dependence — Charles W. Meredith, M.D.; Craig Jaffe, M.D.; Elisia Yanasak, Ph.D.; Monique Cherrier, Ph.D. & Andrew J. Saxon, M.D. 

Mental Health Provider Perspectives on Co-occurring Substance Use Among Severely Mentally Ill Clients —Amy A. Mericle, Ph.D.; M.S.W.; JenniferAlvidrez, Ph.D. & Barbara E. Havassy, Ph.D. 

A Faith-Based Intervention for Cocaine-Dependent Black Women — Gerald J. Stahler, Ph.D.; Kimberly C. Kirby, Ph.D. & MaryLouise E. Kerwin, Ph.D. 

Mobility of Hard Drug Users: Patterns and Characteristics Relevant for Deconcentration of Facilities — Dike van de Mheen, Ph.D.; Agnes van der Poel, M.A.;  Ankie Lempens, M.A. & Nicole Maalsté, M.A. 

SHORT COMMUNICATION

The Effect of Extreme Marijuana Use on the Long-Term Course of Bipolar I Illness: Single Case Study — Rif S. El-Mallakh, M.D. & Carl Brown, J.D.

COVER ART - Friends and Lovers by Sue Averell  (www.sueaverell.com)

Abstracts

Getting Into Ecstasy: Comparing Moderate and Heavy Young Adult Users — Claire E. Sterk, Ph.D.; Katherine P. Theall, Ph.D. & Kirk W. Elifson, Ph.D.

Abstract—In this article, the authors examine factors associated with initial and present Ecstasy use among young adults. Face-to-face structured interviews were conducted in Atlanta, Georgia among 261 active Ecstasy users. The median age at which respondents first heard of Ecstasy was 16 years, whereas the median age of first Ecstasy use was 18 years. Initial Ecstasy use frequently involved polydrug use, including alcohol (50.4%). In terms of their current use, 47.5% of respondents were considered heavy Ecstasy users (using on 10 or more separate occasions in the last 90 days). White respondents, those who used more than one pill during their initial use, and those who used again within one month after their initial use were more likely to be current heavy Ecstasy users. Women, those who waited a longer time between initial and subsequent Ecstasy use, and those who considered themselves in the upper SES bracket were less likely to be current heavy Ecstasy users. A better understanding of initial and current Ecstasy use patterns, including polydrug use, is essential for effective prevention and intervention efforts.

Keywords—drug use, Ecstasy, MDMA, young adult

Experiences of Gamma Hydroxybutyrate (GHB) Ingestion: A Focus Group Study —Judith C. Barker, Ph.D.; Shana L. Harris, M.A. & Jo E. Dyer, Pharm.D.

Abstract—GHB (gamma hydroxybutyrate) is a significant new drug of abuse added to the United States Controlled Substance Act in 2000. The majority of the published literature on GHB consists of clinical case reports, mainly from emergency departments, and a collection of laboratory-based studies, focused mainly on anesthesia. While comments about the various experiences and behaviors of human users are often included in such studies or reports, these aspects of GHB are only just beginning to be systematically investigated or detailed. Reported here are data from a qualitative study using focus group methods on the consumption habits, experiences, and beliefs of GHB users. A total of 51 people, 30 men and 21 women, mean age of 31.1±7.6 years (range 18 to 52 years), who report having used GHB for an average of 4.3±2.5 years (range one to 11 years), were interviewed in 10 separate groups held in 2004. This article discusses broadly the general experience of the GHB high, major perceived benefits including sexual responses to the drug, perceived risks and dangers of ingestion, co-ingestion, and various contexts of use. It concludes with a discussion of the implications drawn from this information for clinicians treating patients who use GHB.   

Keywords—drug effects, gamma hydroxybutyrate, perceptions of risk and benefit, qualitative study, users’ experiences

Cannabis and Psychosis: What is the Link? — Mohamed Ben Amar, B.Pharm., D.C.B., M.Sc. & Stéphane Potvin, B.Sc., M.A., Ph.D.

Abstract—Growing evidence supports the hypothesis that cannabis consumption is a risk factor for the development of psychotic symptoms. Nonetheless, controversy remains about the causal nature of the association. This review takes the debate further through a critical appraisal of the evidence. An electronic search was performed, allowing to identify 622 studies published until June 1st 2005. Longitudinal studies and literature reviews were selected if they addressed specifically the issues of the cannabis/psychosis relationship or possible mechanisms involved. Ten epidemiological studies were relevant: three supported a causal relationship between cannabis use and diagnosed psychosis; five suggested that chronic cannabis intake increases the frequency of psychotic symptoms, but not of diagnosed psychosis; and two showed no causal relationship. Potential neurobiological mechanisms were also identified, involving dopamine, endocannabinoids, and brain growth factors. Although there is evidence that cannabis use increases the risk of developing psychotic symptoms, the causal nature of this association remains unclear. Contributing factors include heavy consumption, length and early age of exposure, and psychotic vulnerability. This conclusion should be mitigated by uncertainty arising from cannabis use assessment, psychosis measurement, reverse causality and control of residual confounding.

Keywords—cannabis, marijuana, psychosis, schizophrenia

Subjective Effects of Salvia Divinorum — Phil Dalgarno, Ph.D.
Abstract—Salvia divinorum is a hallucinogenic plant native to Mexico, where the Mazatec Indians use it in divinatory rituals as a facilitator for contacting the spirits of the dead. A number of traditions surrounding the ritualistic use of Salvia are still observed. Generally the leaves are chewed for the visionary effects. Salvia has recently been embraced by Western drug cultures, where the traditional methods of ingestion are generally eschewed for the more immediately effective technique of smoking the dried leaves. This article discusses the history and indigenous cultural uses of Salvia before outlining its rediscovery in the 1960s and its subsequent introduction to the Western drug scenes (particularly Britain) since the mid 1990s. Qualitative data from 10 Salvia users were collected by means of email interviews. The participants were asked to provide as in-depth responses as possible. No time or space limit on answers was imposed. Their responses to each question are presented verbatim. The effects of Salvia appear to vary between users and seem sensitive to situational factors. Users who understand something of the ritualistic setting for traditional use would appear to have a fuller experience than those who do not.
Keywords—qualitative, Salvia divinorum, subjective effects

Self-Medication Hypothesis of Substance Use: Testing Khantzian’s Updated Theory — Danny H. Hall, Ph.D. & John E. Queener, Ph.D.
Abstract—Substance use research has been a salient focus for mental health professionals in recent years. Several organizations, including the American Psychological Association, have been pressing for more substance use research, particularly clinically relevant, theory-based investigations. However, there are few theories of substance use, and even fewer with scientific support. One theory is the Self Medication Hypothesis by Khantzian (1977, 1974), a theory with 30 years of research. However, recent modifications in Khantzian’s theory (1999) have not been properly tested. Specifically, two areas require further investigation: Khantzian’s belief that more negative affect should be related directly to more substance use, and expanding the number of affective states examined, including alexithymia, to better operationalize Khantzian’s belief that several painful and ambiguous forms of affect may be implicated in the self-medicating process. The current study assessed anxiety, depression, hostility and alexithymia levels in 70 methadone maintenance treatment patients. Results indicated that affective measures did not have the expected relationship with reported substance use. The authors advocate for the exploration of multiple factors, not merely emotional regulation, in the variability of substance use.
Keywords—addiction, affect, alexithymia, self-medication

The Relationship Between Lifetime Abuse and Suicidal Ideation in a Sample of Injection Drug Users — Jacqueline J. Lloyd, Ph.D., M.S.W.; Erin P. Ricketts, M.S.P.H.; Jennifer R. Havens, Ph.D., M.P.H.; Llewellyn J. Cornelius, Ph.D., M.A.; David Bishai, M.D., Ph.D.; Steven Huettner, B.S.; Carl Latkin, Ph.D. & Steffanie A. Strathdee, Ph.D.
Abstract—This study examined the relationship between lifetime abuse and suicidal ideation in a sample of 245 injection drug users (IDUs) who attended the Baltimore Needle Exchange Program and received a referral for opiate agonist therapy. Data were obtained from baseline interviews and HIV antibody tests. The sample mean age was 42.2 (SD = 8.1); 77% were African American; 69% were male. Overall, 27% reported thoughts of suicide in the last six months, and lifetime emotional, physical and sexual abuse was reported by 17%, 12% and 10%, respectively. In bivariate analyses, recent suicidal ideation was associated with emotional (odds ratio [OR] = 3.2; p = 0.001), physical (OR = 2.5; p = 0.026), and sexual abuse (OR = 5.0; p < 0.001). In multiple logistic regression models controlling for HIV status and Center for Epidemiological Studies Depression (CES-D) score, individuals who experienced emotional abuse were more than twice as likely to report recent suicidal ideation (adjusted odds ratio [AOR] = 2.6; p = 0.011); those who experienced sexual abuse were four times more likely to report suicidal ideation (AOR = 4.0; p = 0.004). These findings suggest that emotional and sexual abuse might be risk factors for suicidality among IDUs and also might suggest that suicide prevention should be an integral part of drug treatment for treatment-seeking IDUs.
Keywords—emotional abuse, injection drug use, physical abuse, sexual abuse, suicide ideation

An Open-Label Pilot Study of Risperidone in the Treatment of Methamphetamine Dependence — Charles W. Meredith, M.D.; Craig Jaffe, M.D.; Elisia Yanasak, Ph.D.; Monique Cherrier, Ph.D. & Andrew J. Saxon, M.D.

Abstract—Psychopharmacological treatments for methamphetamine (MA) dependence have questionable efficacy. Open-label risperidone was evaluated in veterans seeking MA dependence treatment. Participants (N = 11) received four weeks of risperidone. They provided weekly self-reports of substance use, urine drug screens, and adverse effects. Neuropsychological assessments and psychiatric symptomatology (Brief Symptom Inventory; BSI) were measured at baseline and follow-up. The eight completers had an average risperidone dose of 3.6mg/day and decreased days of MA use during the trial from a mean of 13.0 (SD = 6.5) in the 30 days prior to starting risperidone to a mean of 0.125 (SD = 0.4; t = 5.7, p = .001). When measured over time, fine motor function (Grooved Peg Board Dominant Hand) was the only neuropsychological domain to improve significantly. No other domain changed significantly from baseline to follow-up among study completers. BSI data were converted to demographically corrected T-scores utilizing appropriate normative data (mean = 50, SD = 10). BSI somatization T-scores declined from a mean of 59.0 (SD = 8.4) to 51.8 (SD = 8.3; t = 2.7, p < .05), and positive symptom distress declined from a mean of 52.8 (SD = 8.0) to 41.7 (SD = 8.6; t = 3.0, p < .05). Risperidone was well tolerated and associated with decreased MA use.

Keywords—amphetamine, methamphetamine, neuropsychology, risperidone, stimulant, treatment

A Faith-Based Intervention for Cocaine-Dependent Black Women — Gerald J. Stahler, Ph.D.; Kimberly C. Kirby, Ph.D. & MaryLouise E. Kerwin, Ph.D.
Abstract—The purpose of the present study was to obtain preliminary data on the effectiveness of a faith-based treatment adjunct for cocaine-using homeless mothers in residential treatment. The Bridges intervention utilizes various Black church communities to provide culturally-relevant group activities and individual mentoring from volunteers. Eighteen women who were recent treatment admissions were randomly assigned to receive Standard Treatment plus Bridges or Standard Treatment with an Attention Control. Participants were assessed at intake and three and six months after intake. Bridges treatment resulted in significantly better treatment retention (75% vs. 20% at six months) than standard residential treatment alone. In addition, Bridges produced superior outcomes at the six month follow-up assessment on a secondary measure of cocaine abstinence. Creating a community of social support through Black churches appears feasible and promising, and may be a cost-effective means of providing longer-term post-treatment support for cocaine-addicted women.
Keywords—community-based interventions, faith-based interventions, substance abuse, women

Mobility of Hard Drug Users: Patterns and Characteristics Relevant for Deconcentration of Facilities — Dike van de Mheen, Ph.D.; Agnes van der Poel, M.A.; Ankie Lempens, M.A. & Nicole Maalsté, M.A.

Abstract—Mobility is related to problematic hard drug use. It remains unclear, however, to what extent the availability of care facilities attracts drug users. The aim of the study is to gain insight into the mobility of problematic hard drug users, with particular focus on the possibilities for deconcentration of facilities. Quantitative and qualitative methods were used: a survey and in-depth interviews with problematic hard drug users. The results show that the extent of mobility is not related to specific characteristics of the target group. The most relevant concepts related to possible deconcentration/displacement of problematic drug users are the nature of mobility and visibility of the users. A high level of mobility does not necessarily lead to more visibility and nuisance. Having a structured daily pattern (housing and/or working) largely determines visibility. More purposeful movement of drug users is associated with a lower level of visibility and nuisance. Mobility of users is strongly determined by the need to buy drugs. Low-threshold facilities are not a trigger for mobility as such, and need to be located near places where drug users stay and/or close to well-known dealing areas.

Keywords—care facilities, hard drugs, mobility, use patterns

SHORT COMMUNICATIONS

The Effect of Extreme Marijuana Use on the Long-Term Course of Bipolar I Illness: Single Case Study — Rif S. El-Mallakh, M.D. & Carl Brown, J.D.

Abstract—The effect of marijuana on bipolar disorder has never been systematically evaluated. Subjective reports by patients suggest an overall positive effect, but these may be unreliable. We herein report a case in which mood data was prospectively collected over two years of total substance abstinence and two years of extreme marijuana use. Marijuana use did not alter the total number of days of abnormal mood, however, marijuana was associated with an increase in the number of hypomanic days and a decrease in the number of depressed days. While not conclusive, the data suggest that marijuana may indeed have an effect on mood in bipolar patients that needs to be systematically examined.

Keywords—bipolar disorder, manic-depression, marijuana, prospective mood ratings