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Spring 2011, Vol 14 No 3

Research Update

 

Mark de la Hey

 

Moderate drinkers more likely to abuse amphetamines

Moderate alcohol consumption may increase risk of amphetamine abuse, according to research from the University of Kentucky College of Medicine in Lexington. Researchers examined data from four studies that gave drinkers comparable amphetamine self-administration tests. Sixteen participants were considered moderate drinkers (consuming at least seven alcoholic drinks per week), while the remaining 17 were light drinkers. Participants were given either placebo or low (8–10 mg) or high (16–20 mg) doses of amphetamine, with the dose divided into eight capsules administered at each session. In self-administration sessions, participants worked at computers and were expected to earn their capsules by clicking the mouse a predetermined number of times, with the number of clicks required increasing for each subsequent capsule. Moderate drinkers worked for more capsules of either dose of amphetamine than of placebo, but this was true only for the high dose of amphetamine among light drinkers. Moderate drinkers also self-administered more capsules containing the high dose than did light drinkers. At high doses, moderate drinkers reported more stimulant effects (e.g., being alert, experiencing a rush, being willing to take the drug again or to pay for it) from the amphetamine than did light drinkers. These results suggest that even moderate alcohol consumption can increase the likelihood that an individual will abuse stimulants.

Alcoholism: Clinical and Experimental Research, March 2011, v. 35(3): 1–11. Matthew D. Stanley et al., Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky.

 

Caregivers of individuals with schizophrenia face high levels of distress

Caregivers of individuals with schizophrenia experience higher levels of psychological distress than the general population, according to a study from the Psychiatric Hospital of Athens in Greece. The study compared 87 caregivers of individuals with chronic schizophrenia with 90 healthy individuals. The individuals with schizophrenia had all been diagnosed at least two years before the study and had been receiving treatment. Their caregivers scored significantly higher than controls on measures of depression, anxiety, obsessive-compulsive symptoms, interpersonal sensitivity, hostility and somatisation (the perception of physical symptoms that appear to have no physical origin). Female caregivers experienced more psychological distress than did males. Distress increased with the duration of illness. Distress was also heightened by the presence of both positive and negative symptoms of schizophrenia. (Positive symptoms include delusions, hallucinations and disordered thoughts; negative symptoms include apathy, lack of emotion and poor social functioning.) The researchers found that distress was unaffected by whether the caregiver was a parent, sibling or spouse, or whether they lived with or apart from the individual with schizophrenia. The authors recommend long-term clinical trials of psychological and pharmacological interventions for caregivers. They also suggest that interventions may need to be adapted to better meet the needs of female caregivers.

Social Psychiatry and Psychiatric Epidemiology, December 17, 2010 online, doi: 10.1007/s00127-010-0325-9. Charalampos Mitsonis et al., Psychiatric Hospital of Athens, Athens, Greece.

 

Physicians conflicted over prescribing antidepressants to pregnant women

Recent studies have provided conflicting information about the safety of antidepressant use during pregnancy. A new study of Australian and Canadian physicians conducted at the University of Melbourne shows that primary care physicians often have difficulty deciding whether to treat pregnant women with antidepressants. The study involved 61 Australian and 35 Canadian GPs. Questionnaire responses showed that 53 per cent of Australian physicians and 48 per cent of Canadian physicians believed that pregnant women who are depressed should be treated differently than non-pregnant women with depression. They were equally likely to be concerned about misinformation regarding the safety of antidepressant use (75% vs. 82%) and to have concerns about their legal liability when prescribing medication to pregnant women (55% for both). However, Canadian physicians were more likely than Australian physicians to perceive antidepressants as safe during pregnancy (83% vs. 42%) and to perceive them as safe for the fetus (48% vs. 10%), and were more likely to be confident about giving advice about antidepressant use during pregnancy (57% vs. 33%). Both Australian and Canadian physicians were highly likely to be influenced by patient concerns when making prescription decisions (95% vs. 83%). The authors note that women with recurring depression who discontinue antidepressants are six times more likely to relapse than those who continue. They conclude that their results point to the need for national practice guidelines for physicians.

Archives of Women’s Mental Health, November 30, 2010 online, doi: 10.1007/s00737-010-0197-8. Justin L. C. Bilszta et al., Department of Psychiatry, University of Melbourne, Melbourne, Australia.

 

Trauma-focused CBT helps children with PTSD

Children with post-traumatic stress disorder (ptsd) resulting from exposure to domestic violence can benefit from trauma-focused cognitive-behavioural therapy (tf-cbt), according to research from Allegheny General Hospital in Pittsburgh, Pennsylvania. In the study that involved 124 children aged 7 to 14, the children and their mothers underwent eight sessions of either tf-cbt or child-centered therapy (cct). tf-cbt involves learning about trauma, developing relaxation and coping skills and creating a narrative about the child’s traumatic experience in which the child is encouraged to confront distressing reminders and events. cct attempts to reverse problems resulting from disempowerment and violation of trust by creating a trusting relationship between the therapist and the child and parent, and encouraging them to direct the content of treatment. Children who underwent tf-cbt showed greater improvement in ptsd symptoms than those in the cct group. They were also more likely to meet criteria for remission of ptsd after treatment than children in the cct group. The authors note that the study had a high dropout rate (40%), likely resulting from the difficult circumstances faced by participants, including traumatic experiences occurring during therapy, the threat of homelessness, continuing violence and legal and financial difficulties.

Archives of Pediatrics and Adolescent Medicine, January 2011, v. 165(1): 16–21. Judith A. Cohen et al., Department of Psychiatry, Allegheny General Hospital, Pittsburgh, Pennsylvania.

 

Mood may improve with smoking cessation

Research from Brown University in Providence, Rhode Island, indicates that people who attempt to quit smoking experience some relief from depression, contradicting the common belief that smokers experience more depressive symptoms when they try to quit. Researchers followed 236 heavy-drinking smokers over 26 weeks, periodically measuring abstinence rates and depression. All participants were smokers at the beginning of the study. Ninety-nine continued smoking throughout the study; 44 were abstinent at the two-week assessment; 33 were abstinent at both two weeks and eight weeks; and 31 were abstinent at all assessments. (The remaining 29 didn’t fit any of these patterns.) While the average participant tended to experience a slight increase in depressive symptoms over time, participants generally experienced a reduction in depression scores whenever they were able to abstain from smoking. Those who maintained abstinence had particularly low levels of depression at the beginning of the study, which remained low at all follow-up assessments. Participants who continued smoking experienced gradual increases in depression scores. The fact that participants were all heavy drinkers leads the authors to caution about generalizing the results. They advise that smoking cessation campaigns should highlight the fact that smokers are likely to experience improved psychological well-being when they quit.

Nicotine and Tobacco Research, November 24, 2010 online, doi: 10.1093/ntr/ntq213. Christopher W. Kahler et al., Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island.

 

Heroin-assisted treatment reduces benzodiazepine use among heroin users

Benzodiazepine use among individuals who are heroin dependent is known to be associated with poor psychosocial adjustment, higher levels of multiple drug use and increased risk-taking. New research from University Medical Centre Hamburg-Eppendorf in Germany shows that heroin-assisted treatment (HAT) can reduce benzodiazepine use. The 12-month study involved 1,015 heroin-dependent individuals who were assigned to either hat (involving the administration of intravenous heroin) or methadone maintenance treatment (MMT). At the beginning of the study, 736 participants used benzodiazepines, and 279 were considered non-users. Those who were benzodiazepine users at onset were less likely to remain in treatment, but did not have poorer treatment outcomes. Urine tests over the course of the study showed that participants treated with heroin were more likely than those given methadone to discontinue benzodiazepine use, with an average 52 per cent of participants in the hat group testing positive, compared with 60 per cent in the mmt group. Those who continued to use benzodiazepines throughout treatment generally had poorer health outcomes than those who discontinued, including less work satisfaction and more alcohol use. Among ongoing benzodiazepine users, those in the hat group performed better than those in the mmt group on measures of alcohol use, drug use and legal problems. The authors posit that heroin-assisted treatment may be the best treatment option for heroin-dependent individuals who also have benzodiazepine dependence. They suggest that cautious prescription of benzodiazepines to heroin users to treat underlying anxiety may help to reduce illicit benzodiazepine use.

 

Heavy alcohol use heightens risk of violence

Heavy alcohol use increases the likelihood of engaging in violent behaviour, according to research from the University of Michigan in Ann Arbor. The study recruited 160 men and women from addiction treatment programs who were enrolled in a brief violence prevention intervention. Details regarding alcohol and drug use and interpersonal conflict incidents were obtained through semi-structured interviews. The results showed that acute heavy alcohol use was associated with significant increases in levels of violence resulting in injury, especially with someone other than a partner. There was no relationship between alcohol use and partner violence, but the researchers caution that their analysis for partner violence was based on fewer conflict incidents than for other types of violence. Acute cocaine use and male gender significantly increased the odds of violence with or without injury. Acute heroin use was associated with involvement in violence without injury. Marijuana use decreased the likelihood of all forms of violence. The authors conclude that their findings provide support for pharmacologically based explanations of the relationship between substance use and violence. One such explanation of the relationship between alcohol and violence is that alcohol use impairs cognitive processing (e.g., attentional processing, problem solving and evaluating consequences), which increases the risk of violence. The authors recommend further research to explore the effects of demographics, different substances and social, motivational and situational factors on interpersonal violence.

Drug and Alcohol Dependence, December 1, 2010, v. 112(3): 194–200. Stephen T. Chermack et al., Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.