Background: The United States is currently experiencing an epidemic of opioid abuse. Individuals with opioid dependence may also have major depressive disorder (MDD) as a co-morbid state. MDD is one of the commonest mental health problems in the United States, affecting approximately 7% of the adult population. The relationship between opioid dependence and MDD and the factors that correlate with them have not been fully investigated. This study is designed to evaluate the prevalence of MDD and its associations with risk factors and health conditions such as age, race, sex, liver problems, anxiety, bipolar disorders, hypertension, heart diseases, neurologic damage, head injury and alcohol in opioid dependent patients. Method: The study population comprises of 1646 opioid dependent patients from the National Drug Abuse Treatment Trial Network (CTN) - CTN 0027. Baseline information on sex, age, race, liver disease, bipolar disorder, anxiety, neurologic damage, heart disease, hypertension, alcohol dependence, allergies, gastrointestinal problems and head injury were collected. Data analysis was done using univariate and multiple logistic regression to estimate the odds ratio (OR) and 95% confidence interval (CI). Results: The prevalence of MDD among patients with opioid dependence was 28.3% (22.8% for males and 39.5% for females). The prevalence initially increased with increasing age stratum but declined after age 50 years with the highest prevalence in the age 36 – 49years group. The multiple logistic regression analysis showed that MDD in opioid dependent patients was significantly associated with being female (OR =1.83, 95%CI = 1.32 -2.55; p = 0.003), liver disease (OR = 1.64, 95%CI = 1.15 - 2.34, p = 0.006), anxiety (OR = 6.12, 95%CI = 4.44 - 8.44, p

Department of Psychology. Bibliography : leaves 72-76.

Increased demands on amphetamine dependence treatment services point to a need for effective pharmacotherapies for withdrawal symptom suppression. However, empirical data on which to base effective treatments are scarce. To address the need for an evidence base, four studies were conducted in two countries - Australia and Thailand. Firstly, the time course and severity of amphetamine withdrawal symptoms were characterised in two inpatient samples of amphetamine users. Results identified the first week of abstinence as an acute withdrawal phase characterised by increased sleeping, eating and a cluster of mood and anxiety - related symptoms. Following the acute phase, most withdrawal symptoms remained stable and at low levels for the remaining two weeks of abstinence ( the sub - acute phase ). Data from these two studies formed the basis for a new instrument, the Amphetamine Cessation Symptom Assessment scale ( ACSA ). On psychometric testing, the ACSA showed satisfactory reliability and a clear psychometric structure, delineating symptom clusters and their correlates with a three factor solution providing the best fit to the data. Using the ACSA to measure outcome, the safety and efficacy of the serotonin and noradrenaline reuptake inhibitor antidepressant mirtazapine ( 15 - 60 mg per day, n = 13 ), and the wake-promoting drug, modafinil ( 400mg per day, n = 14 ) were assessed in successive, open - label, inpatient pilot trials. Study medication was administered for up to ten days. An historical comparison group ( n = 22 ) who received treatment as usual consisting of pericyazine 2.5 - 10mg per day for control of agitation served as a comparison. Results showed that modafinil and mirtazapine were well tolerated, producing minimal positive subjective effects. There were significant group differences in withdrawal severity ( F = 18.6, df 2,219 p < 0.001 ). Post - hoc analysis showed that modafinil was more effective than mirtazapine ( p = 0.041 ), and both were more effective than treatment as usual ( both p < 0.001 ) in ameliorating withdrawal severity. Overall, these studies identified a peak in withdrawal severity during the first week of abstinence ; demonstrated the reliability and validity of the ACSA and identified modafinil as a safe and potentially effective pharmacotherapy for the treatment of amphetamine withdrawal symptoms. / Thesis (Ph.D.)--Medical School, 2005.

Relapse is a common occurrence in the treatment of adolescent substance abuse. It is estimated that one out of three adolescents will relapse after treatment termination. Although much attention has been given to family factors which influence an adolescent's use and abuse of drugs, this same vigorous attention has not been given to determining if family factors play a role in an adolescent resuming drug use after treatment termination. It has been theorized that the same family factors which increase the risk of an adolescent to use and abuse drugs also can help in gaining an understanding of why relapse occurs. Three prominent theories used to explain family factors associated with drug use/abuse and relapse are genetic and social learning theories, and family dysfunction. The purpose of this study was to investigate if familial factors, as proposed from the theories presented, were predictive of relapse. The sample in this study consisted of 31 adolescents who entered drug treatment between 1986 and 1988. Follow-up data of the adolescent's pattern of drug use since treatment discharge were collected through telephone interviews with the parent or guardian of the adolescent one and a half to nineteen months after treatment. The family information used in this study was collected through self-report questionnaires given to the adolescent at time of treatment. Specific family variables used in this study were: parental and sibling substance abuse history, number of parents in residence, past experience of physical and/or sexual abuse, and history of running away from home. Regression analyses were used to assess if these family variables were associated with relapse. Results of the data analyses found partial support for genetic and social learning theories of relapse, as well as relapse from a family dysfunction perspective. Findings indicated that adolescents who lived with only one parent or neither parent in comparison to those who lived with both parents, those who had experienced physical and/or sexual abuse, and those who perceived their father as not having a history of substance abuse were more at risk to relapse. Findings further indicated a cross-gender effect in that male adolescents who reported mother as having a substance abuse history were more likely to relapse. This same finding was not found for females in this study. The results indicate that given specific family dynamics, a sub-population of adolescents may be targeted on entrance to treatment to be at greater risk to relapse. / Graduation date: 1991

published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

published_or_final_version / Public Administration / Master / Master of Public Administration

No description available.

The subject of this thesis is criminal justice sentencing policy. The thesis examines the role of the Drug Court in diverting drug dependent offenders from the conventional Criminal Justice System. A large percentage of convicted offenders have a drug addiction problem and such offenders impose staggering burdens on an already overwhelmed Criminal Justice System. Diversion programs offer a practicable alternative to the traditional court system, and this thesis will investigate the feasibility of a Drug Court in Vancouver, British Columbia, Canada. In examining the advantages and disadvantages of this method of sentencing, the thesis assesses the value of compulsory treatment and determines whether criminal justice sanctions should incorporate compulsory treatment initiatives. To aid in this analysis, additional diversion programs for drug addicted offenders are examined. The Drug Court is assessed through a comparison of the court with traditional sentencing principles. This thesis analyses the success of the Drug Court in other jurisdictions and looks at how the Drug Court deals with the sociological and environmental factors linked to drug abuse and criminality. In determining whether a Drug Court is a feasible option for Vancouver, the thesis examines these external crimogenic factors and the strategies undertaken by the City to combat drug-related crime. It is argued that the conventional criminal justice system provides little, if any, progressive and pro-active drug abuse intervention. This thesis concludes that Vancouver should implement a Drug Court to divert offenders from the traditional court system, and argues that the Drug Court diversion program should be available for drug-dependent property offenders. It identifies how the court can operate alongside pre-existing community services to ensure that post-release environmental conditions are conducive to drug abstinence and legitimate activity. In recommending adoption of the drug court program, the thesis stresses the importance of making this diversion scheme part of a community-based, long-term, holistic intervention strategy. The thesis ends with practical suggestions for implementation of a Drug Court program in Vancouver.

Cocaine is one of the most reinforcing drugs of abuse and has caused serious medical and social problems. There is no FDA-approved medication specific for cocaine. It is of a high priority to develop an effective therapeutic treatment for cocaine abuse. Human butyrylcholinesterase (BChE) has been recognized as a promising candidate of enzyme therapy to metabolize cocaine into biologically inactive metabolites and prevent it from reaching central nervous system (CNS). However, the catalytic activity of wide-type human BChE against cocaine is not sufficiently high for treatment of cocaine abuse. Dr. Zhan’s lab has successfully designed and discovered a series of high-activity mutants of human BChE specific for cocaine metabolism. This dissertation is mainly focused to address the possible concerns in further development of promising human BChE mutants for cocaine detoxification, including whether the administration of this exogenous enzyme will affect the cholinergic system, whether it can efficiently hydrolyze cocaine’s toxic metabolites, and whether the commonly used therapeutic agents will significantly affect the catalytic activity of the BChE mutants against cocaine when they are co-administered. According to the results obtained, all of the examined BChE mutants have a considerably improved catalytic efficiency against (-)-cocaine, without significantly improving the catalytic efficiency against any of the other examined substrates, including neurotransmitter acetylcholine. Two representative mutants (including E12-7) also have a considerably improved catalytic activity against cocaethylene (formed from combined use of cocaine and alcohol) compared to wild-type BChE, and E12-7 can rapidly metabolize cocaethylene, in addition to cocaine, in rats. Further evaluation of possible drug-drug interactions between E12-7 and some other commonly used therapeutic agents revealed that all of the examined agents, except some tricyclic antidepressants, do not significantly inhibit E12-7. In addition, an effort to discover new mutants with further improved activity against cocaine led to the discovery of a new BChE mutant, denoted as E20-7, according to both the in vitro and in vivo assays. The encouraging outcomes of the present investigation suggest that it is possible to develop a more effective enzyme therapy for cocaine abuse treatment using one of the most promising BChE mutants, such as E12-7 or E20-7.

Thesis (Ph. D.)--West Virginia University, 2005. / Title from document title page. Document formatted into pages; contains iv, 64 p. Includes abstract. Includes bibliographical references (p. 28-32).