*****AMERICAN FAMILY PHYSICIAN/GP***** Laux G Puryear DA Benzodiazepines--misuse, abuse and dependency. AM FAM PHYSICIAN 1984 Nov; 30(5):139-47 Recent European articles report many adverse effects of benzodiazepines, including aberrant symptoms, toxic states, dependency and withdrawal syndromes. The dependency may be primary high-dose, primary low-dose (therapeutic) or secondary dependency (multiple drug abuse). Withdrawal syndromes include rebound effects and benzodiazepine-specific reactions. Anxiolytic use of benzodiazepine should be limited to the treatment of short-term anxiety-producing situations. Lowenstein DH Massa SM Rowbotham MC Collins SD McKinney HE Simon RP Acute neurologic and psychiatric complications associated with cocaine abuse. AM J MED 1987 Nov; 83(5):841-6 This report reviewed 996 emergency room visits and 279 hospital admissions of patients with complications of cocaine abuse seen at the San Francisco General Hospital between 1979 and 1986. In 143 cases, acute neurologic or psychiatric symptoms were the primary complaint, and case-notes provided sufficient detail for analysis. The major neurologic complications included one or more seizures (n = 29), focal neurologic symptoms or signs (12), headache (10), and transient loss of consciousness (six). Psychiatric disturbances included agitation, anxiety, or depression (33), psychosis and paranoia (24), and suicidal ideation (18). The most serious consequences were found in patients with prolonged seizures or strokes, those who jumped out of buildings, and those who attempted suicide by overdosing with other drugs. There was no correlation between the appearance of complications and the reported route of administration, the amount of cocaine used, or prior experience with cocaine. The number of patients who are seeking hospital attention for these or related complaints appears to be rising substantially. Cocaine abuse, regardless of the use pattern, is associated with a variety of potentially severe neurologic and psychiatric complications. Department of Neurology University of California School of Medicine San Francisco 94143. *****AMERICAN JOURNAL OF PSYCHIATRY***** Westermeyer J Neider J Social networks and psychopathology among substance abusers. AM J PSYCHIATRY 1988 Oct; 145(10):1265-9 The authors studied the social networks and psychopathology of 168 patients with diagnoses of substance abuse. Small network size was correlated with higher scores on the Modified Michigan Alcohol-Drug Screening Test, higher symptom reports on the SCL-90 and the Beck Depression Inventory, and more observed psychopathology according to the Brief Psychiatric Rating Scale. Larger network size was correlated with better functioning according to the Global Assessment Scale and DSM-III axis V. The authors conclude that such symptom complexes as paranoia and phobia may undermine the social networks of substance abusers more than such symptom complexes as anxiety and depression. Department of Psychiatry University of Minnesota Minneapolis 55455. Christie KA Burke JD Jr Regier DA Rae DS Boyd JH Locke BZ Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults. AM J PSYCHIATRY 1988 Aug; 145(8):971-5 Data from the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area Program, an epidemiologic survey of five communities, showed that four major disorders commonly begin in late adolescence or young adulthood. The median age at onset for anxiety disorders is 15 years; for major depressive episode, 24 years; for drug abuse or dependence, 19 years; and for alcohol abuse or dependence, 21 years. Findings also suggest that for respondents 18- 30 years old, having a major depressive episode or anxiety disorder doubles the risk for later drug abuse or dependence. Division of Clinical Research National Institute of Mental Health Rockville MD 20857. Post RM Cocaine psychoses: a continuum model. AM J PSYCHIATRY 1975 Mar; 132(3):225-31 The author describes an orderly progression of clinical syndromes (euphoria, dysphoria, paranoid psychosis) with cocaine use that is related to dosage, chronicity, and genetic and experiential predispositions. That affective alternations are caused by a drug which also produces a schizophreniform psychosis suggests a continuum with implications for understanding the endogenous psychoses. The author emphasizes that alternations in the same neurotransmitter substances may be involved in these multiple psychiatric syndromes, which contrasts with previous "one illness, one transmitter" models. Winokur G Black DW Nasrallah A Depressions secondary to other psychiatric disorders and medical illnesses. AM J PSYCHIATRY 1988 Feb; 145(2):233-7 The authors studied 401 patients with depressions secondary to psychiatric illnesses (substance abuse disorders or somatoform, anxiety, or personality disorders) or depressions secondary to medical illnesses. They found that the patients with depressions secondary to psychiatric illnesses had an earlier age at onset, were more likely to have suicidal thoughts or to have made suicide attempts, were less likely to have memory problems, were less improved with treatment and more likely to relapse on follow-up, and had more alcoholism in their families than patients with depressions secondary to medical illnesses. Depressions secondary to medical illnesses seem to fit the category of reactive depression, and depressions secondary to psychiatric illnesses fit the definition of neurotic depression. Department of Psychiatry University of Iowa College of Medicine Iowa City 52242. Mellman TA Uhde TW Obsessive-compulsive symptoms in panic disorder. AM J PSYCHIATRY 1987 Dec; 144(12):1573-6 Previous reports have noted an increased prevalence of obsessive- compulsive symptoms in patients with panic disorder. The authors found a prevalence of obsessive-compulsive symptoms in 19 (27%) of 70 patients with panic disorder. Compared to a subgroup of 25 patients with classic features of panic disorder and no obsessive-compulsive symptoms, the subgroup with obsessive-compulsive symptoms had an earlier onset of illness, were more likely to have personal and family histories of major depression and substance abuse, and showed a poorer outcome after treatment. Unit on Anxiety and Affective Disorders NIMH Bethesda MD 20892. Garvey MJ Tollefson GD Prevalence of misuse of prescribed benzodiazepines in patients with primary anxiety disorder or major depression. AM J PSYCHIATRY 1986 Dec; 143(12):1601-3 Seventy-one patients with major depression or an anxiety disorder were treated with benzodiazepines. They were followed prospectively for evidence of misuse or abuse. There was no evidence of benzodiazepine abuse. Five patients (all with major depression) misused their benzodiazepines. Benedikt RA Kolb LC Preliminary findings on chronic pain and posttraumatic stress disorder. AM J PSYCHIATRY 1986 Jul; 143(7):908-10 Of 225 patients referred to a Veterans Administration pain clinic for treatment of chronic pain, 22 (10%) were later diagnosed as having posttraumatic stress disorder. Many of the 22 also had current or past histories of depression, anxiety, or substance abuse. Aronson TA Craig TJ Cocaine precipitation of panic disorder. AM J PSYCHIATRY 1986 May; 143(5):643-5 The authors describe three patients whose panic disorder began during recreational use of cocaine and continued autonomously even after the drug was stopped. Theoretical and practical implications are discussed. *****ARCHIVES OF GENERAL PSYCHIATRY***** Andreasen NC Grove WM Shapiro RW Keller MB Hirschfeld RM McDonald-Scott P Reliability of lifetime diagnosis. A multicenter collaborative perspective. ARCH GEN PSYCHIATRY 1981 Apr; 38(4):400-5 It is important to determine the reliability of lifetime diagnosis in a nonpatient population, for this type of diagnostic data and this type of sample are used in many genetic, epidemiological, and nosological studies. We examined the reliability of lifetime diagnosis when the Schedule for Affective Disorders and Schizophrenia- Lifetime Version and Research Diagnostic Criteria were used to interview ill and well relatives of probands in the National Institute of Mental Health Collaborative Study of the Psychobiology of Depression. Subjects were interviewed three times, so data are available concerning both short- and long-interval test-retest reliability. Short-interval test-retest reliability was excellent for both diagnoses and symptoms. Reliability was also quite high in the long-interval test-retest study. We conclude that it is possible to make lifetime diagnoses reliably in a nonpatient population. Winstead DK Parker M Willi FJ Propoxyphene on demand. Analgesic-seeking behavior in psychiatric inpatients. ARCH GEN PSYCHIATRY 1977 Dec; 34(12):1463-8 Although anxiety is known to enhance a patient's response to pain, the exact relationship is unclear. This problem is particularly acute among psychiatric patients where analgesics are frequently both used and abused. This study attempts to evaluate factors associated with analgesic use among these patients with the hypothesis that anxiety, other measures of psychopathology, and ward tension would be associated with frequent analgesic use. An unselected series of psychiatric admissions during a three month period were administered the State-Trait Anxiety Inventory, MMPI, and a questionnaire dealing with prior drug use. Propoxyphene napsylate (Darvon-N) was made freely available on request from nurses who recorded details of the interaction on a prepared card. The nursing staff also recorded unusual incidents on the unit and evaluated daily the level of ward tension. The results indicate that, when made freely available to psychiatric inpatients, propoxyphene was used very conservatively and for appropriate complaints. Factors associated with drug seeking behavior are discussed in relation to other research regarding the use and abuse of analgesics. Wood DR Reimherr FW Wender PH Johnson GE Diagnosis and treatment of minimal brain dysfunction in adults: a preliminary report. ARCH GEN PSYCHIATRY 1976 Dec; 33(12):1453-60 Minimal brain dysfunction (MBD) has long been considedrnen adoption studies suggest that MBD may persist into adult life where its existence is concealed by the application of a variety of diagnostic labels. In order to test the hypothesis that MBD does persist into adulthood, 15 putative MBD adults were identified on the basis of current MBD-like complaints, self-description of MBD characteristics in childhood, and a parental rating (on a standardized form) of "hyperactivity" in childhood. Eleven of the 15 subjects were given a double-blind trial of methylphenidate hydrochloride, and all 15 were given an open trial of pemoline, imipramine hydrochloride, or amitryptiline hydrochloride. Eight of the 11 showed a significant response to the double-blind trial of methylphenidate. Of the 15, eight showed a good response to stimulants or tricyclic antidepressants, two showed a moderately favorable response, and five were unresponsive to drug therapy. Atkinson JH Jr Grant I Kennedy CJ Richman DD Spector SA McCutchan JA Prevalence of psychiatric disorders among men infected with human immunodeficiency virus. A controlled study. ARCH GEN PSYCHIATRY 1988 Sep; 45(9):859-64 We used structured diagnostic interviews and rating scales to assess lifetime prevalence of psychiatric disorders, by DSM-III criteria, among an unselected sample of 56 ambulatory homosexual men in four groups: men with acquired immunodeficiency syndrome (AIDS), men with AIDS-related complex (ARC), men asymptomatic or mildly symptomatic but seropositive for antibody to human immunodeficiency virus (HIV), and HIV-seronegative men. An age- and demographically matched comparison group of 22 healthy, heterosexual controls was also studied. The homosexual men had lifetime rates of alcohol or nonopiate drug abuse (22/56 [39.3%]), generalized anxiety disorder (22/56 [39.3%]), and major depression (17/56 [30.3%]) that often preceded diagnosed medical illness or knowledge of HIV status. The six-month point prevalence of these disorders in homosexual men was also high, especially alcohol abuse in patients with AIDS-related complex, and the occurrence of a DSM-III disorder within the previous six months significantly exceeded that in heterosexual controls. The data suggest that there may be a higher prevalence of anxiety disorder and major depressive illness in homosexual men when compared with sociodemographically matched heterosexual men and that the psychiatric morbidity may have preceded the onset of the AIDS epidemic. These findings indicate that awareness of psychiatric history is necessary to comprehensive medical care of men at high risk for AIDS, even among relatively healthy outpatients. Department of Psychiatry UCSD School of Medicine La Jolla 92093. Hesselbrock MN Meyer RE Keener JJ Psychopathology in hospitalized alcoholics. ARCH GEN PSYCHIATRY 1985 Nov; 42(11):1050-5 This study utilized the DSM-III criteria and the National Institute of Mental Health Diagnostic Interview Schedule to assess the prevalence of lifetime psychopathology among hospitalized alcoholics. Antisocial personality (ASP) and substance-use disorder were common psychopathologies among male alcoholics and major depression and phobia were common among female alcoholics. The onset of most psychopathologies preceded the abuse of alcohol among women. In men, however, with the exception of ASP and panic disorder, the onset of psychopathology was subsequent to that of alcohol abuse and/or dependence. Diagnoses of ASP and substance abuse were characterized by early onset of regular intoxication and alcohol abuse. Gender and the presence of specific psychopathology appeared to modify the course and symptom picture of alcoholism. In general, alcoholic women showed a later onset of regular intoxication and a more rapid progression to alcohol abuse and dependence than alcoholic men. *****ARCHIVES OF INTERNAL MEDICINE***** Tennant FS Jr Outpatient treatment and outcome of prescription drug abuse. ARCH INTERN MED 1979 Feb; 139(2):154-6 Forty-six consecutive patients who voluntarily sought outpatient treatment for abuse of one or more prescription drugs were studied. Barbiturates, amphetamines, and diazepam were the most common drugs abused. Desired treatments by patients included counseling, medical withdrawal, or medical maintenance with the drug of abuse or a chemically related drug. Twenty-two (47.8%) patients left treatment and relapsed within one month; another eight (17.4%) patients relapsed between one and three months after entering treatment. Only 13 (28.3%) reported abstinence 90 days after entering treatment. This experience suggests that a wide range of medical, social, and psychologic resources are required to treat prescription drug abuse, and that long-term drug abstinence is difficult to achieve with all patients. *****BRITISH JOURNAL OF CLINICAL PHARMACOLOGY***** Akiskal HS Chen SE Davis GC Puzantian VR Kashgarian M Bolinger JM Borderline: an adjective in search of a noun. J CLIN PSYCHIATRY 1985 Feb; 46(2):41-8 Outpatients diagnosed as borderline (N = 100) were prospectively followed for 6-36 months and examined from phenomenologic developmental, and family history perspectives. At index evaluation, 66 met criteria for recurrent depressive, dysthymic, cyclothymic, or bipolar II disorders, and 16 for those of schizotypal personality. Other subgroups included sociopathic, somatization, panic- agoraphobic, attention deficit, epileptic, and identify disorders. Compared with nonborderline personality controls, borderlines had a significantly elevated risk for major affective but not for schizophrenic breakdowns during follow-up. Prominent substance abuse history, tempestuous biographies, and unstable early home environment were common to all diagnostic subgroups. In family history, borderlines were most like bipolar controls, and differed significantly from schizophrenic, unipolar, and personality controls. It is concluded that, despite considerable overlap with subaffective disorders, the current adjectival use of this rubric does not identify a specific psychopathologic syndrome. *****JOURNAL OF NERVOUS AND MENTAL DISEASE***** Strassman RJ Adverse reactions to psychedelic drugs. A review of the literature. J NERV MENT DIS 1984 Oct; 172(10):577-95 The use of naturally occurring and synthetically derived compounds for their "psychedelic" effects has been a part of human culture for thousands of years. The basic pharmacology of the major synthetic psychedelic compounds (primarily lysergic acid diethylamide [LSD]-25) is described and reference is made to their potentially beneficial psychological effects. Adverse reactions, defined as dysphoric and/or maladaptive/dysfunctional responses to the use of these drugs, sometimes require careful clinical judgment in order to diagnose. These reactions can be effectively classified along a temporal continuum. Acute, short-lived reactions are often fairly benign, whereas chronic, unremitting courses carry a poor prognosis. Delayed, intermittent phenomena ("flashbacks") and LSD-precipitated functional disorders that usually respond to treatment appropriate for the non- psychedelic-precipitated illnesses they resemble, round out this temporal means of classification. The question of organic brain damage as well as permanent changes in personality, attitudes, and creativity in patients and normals who have repeatedly ingested psychedelic drugs is controversial, but tends to point to subtle or nonsignificant changes. Future areas for study of the psychedelics' pharmacological, psychological, and therapeutic effects are suggested. Weller RA Halikas JA Objective criteria for the diagnosis of marijuana abuse. J NERV MENT DIS 1980 Feb; 168(2):98-103 Among 97 chronic marijuana users, 9% were found to have had multiple life problems as a consequence of their marijuana use when evaluated during a 5-year follow-up study. Operationally defined criteria for marijuana abuse are presented which are analogous to criteria commonly used in diagnosing alcoholism. These criteria identified marijuana abusers who manifested many problems from marijuana use, including fighting, panic attacks, and traffic tickets. This was in contrast to the majority of the chronic users who did not have multiple complications from their marijuana use. The marijuana abusers had used marijuana more frequently, had used greater amounts of marijuana, and had begun using it at an earlier age than nonabusers. A high rate of alcoholism was found in the abusers but was not statistically greater than in nonabusers. The objective criteria presented here offer a method for simple, prompt evaluation of potential problems from marijuana use. Kroll P Chamberlain KR Halpern J The diagnosis of Briquet's syndrome in a male population: the Veterans Administration revisited. J NERV MENT DIS 1979 Mar; 167(3):171-4 Fifty psychiatric inpatients at a VA Hospital felt to be at high risk for the development of somatic complaints were surveyed for Briquet's syndrome. When criteria for the syndrome were strictly applied, no men were found with the disorder. If the criteria were minimally relaxed, two patients did have a sufficient number of symptoms in multiple areas to qualify for the diagnosis. However, they had alternative clinical and research diagnoses and none of the personality characteristics noted in previous populations of women surveyed for Briquet's syndrome. Spaulding W The relationships of some information-processing factors to severely disturbed behavior. J NERV MENT DIS 1978 Jun; 166(6):417-28 Thirty-five psychiatric inpatients with heterogeneous diagnoses were given four tasks: Mueller-Lyer Illusion, Wisconsin Card Sorting Text, Object Sorting, and Rokeach dogmatism questionnaire. Tasks were chosen to represent a broad sampling of paradigms, spanning levels of information processing, involving perceptual, conceptual and attitudinal processes. Subjects' behavior was assessed by the Inpatient Multidimensional Psychiatric Scale (IMPS). Each IMPS scale was analyzed in turn as a function of perceptual/cognitive variables, in multiple regression analysis. To provide basis for comparison, traditional clinical measures were included as independent variables (MMPI scales) and dependent variables (intelligence, chronicity, and premorbid adjustment). Results showed that different patterns of disordered behavior were predicted by different perceptual/cognitive variables. MMPI scores were predicted primarily by traditional measures. Interrelationships of all variables suggested three subject groups: chronic, process-type schizophrenics with perceptual abnormalities, paranoid patients with conceptual abnormalities, and affectively disordered patients with predominantly attitudinal abnormalities. Schuckit MA Petrich J Chiles J Hyperactivity: diagnostic confusion. J NERV MENT DIS 1978 Feb; 166(2):79-87 Histories of hyperactive symptoms were evaluated for two samples of young men and women under treatment for drug or psychiatric disorders. More than one in five had shown hyperactivity but almost all of these developed pictures of other psychiatric problems, frequently the antisocial personality, by late adolescence. This picture is felt to reflect inaccurate use of hyperactive labels in difficult-to-handle children. The potential consequences of these practices are discussed. Naditch MP Alker PC Joffe P Individual differences and setting as determinants of acute adverse reactions to psychoactive drugs. J NERV MENT DIS 1975 Nov; 161(5):326-35 The relationship between setting and individual differences in determining acute adverse reactions to psychoactive drugs was examined using retrospective data from 483 drug users. Five dimensions of setting were identified. Although there were some small setting main effects, these effects failed to reach significance when shared variance with individual difference variables was considered. For acute adverse reactions to LSD, however, there were seven independent interaction effects between setting and individual difference variables. There were two interaction effects of smaller magnitude related to acute adverse reactions to marijuana. The significance of these results for the current controversy over the relative importance of situational vs. personality determinants of behavior was discussed. Green BL Lindy JD Grace MC Posttraumatic stress disorder. Toward DSM-IV. J NERV MENT DIS 1985 Jul; 173(7):406-11 posttraumatic stress disorder diagnosis as described in DSM-III. The helpfulness of DSM-III is acknowledged, but gaps in that classification are noted. These are organized into three areas: the etiology of the disorder, its natural history, and diagnostic specificity. Suggestions are made for conceptualizing these issues and for research that needs to be undertaken to help resolve them. The authors urge more theoretical and empirical attention to these important issues in the upcoming years, so that later diagnostic descriptions and understandings will be more precise. *****MAYO CLINIC PROCEEDINGS***** Finlayson RE Hurt RD Davis LJ Jr Morse RM Alcoholism in elderly persons: a study of the psychiatric and psychosocial features of 216 inpatients. MAYO CLIN PROC 1988 Aug; 63(8):761-8 The medical records of 216 elderly persons, admitted to the hospital for treatment of alcoholism, were reviewed. Concern of family and friends was the most common factor motivating patients for admission. Patients with late-onset alcoholism reported an association between a life event and problem drinking more frequently than did the early- onset alcoholics. The most common associated psychiatric disorders were tobacco dependence (67%), organic brain syndrome (25%), atypical or mixed organic brain syndrome (19%), and affective disorder (12%). Fourteen percent of patients also had a drug abuse or dependence problem, all using legally prescribed drugs. Psychiatric diagnoses and results of psychologic testing did not differ between early-onset and late-onset alcoholism groups. In a 60-patient cohort studied for correlation of outcome of treatment for alcoholism with major psychiatric diagnoses, no associations were found. Department of Psychiatry and Psychology Mayo Clinic Rochester MN 55905. *****MEDICAL CLINICS OF NORTH AMERICA***** Kranzler HR Liebowitz NR Anxiety and depression in substance abuse: clinical implications. MED CLIN NORTH AM 1988 Jul; 72(4):867-85 Accurate diagnosis in patients presenting with anxiety and/or depressive symptoms requires that the contribution of substance abuse be carefully considered. When chemical dependence is identified, detoxification may be all that is necessary. However, if indicated, specific treatment of the mood or anxiety disorder may reduce substance use as well. University of Connecticut School of Medicine Farmington. *****POSTGRADUATE MEDICINE***** Schuckit MA Anxiety treatment. A commonsense approach. POSTGRAD MED 1984 Feb 1; 75(2):52-63 Common sense should guide the nonpsychiatrist physician in diagnosing and treating the symptom of anxiety. Possible causes of anxiety include various medical disorders in which anxiety is inherent, chronic illness, CNS stimulant intoxication, CNS depressant withdrawal, and primary psychiatric disorders, including the primary anxiety disorders. If none of these conditions is found, situational anxiety may be the diagnosis by exclusion. Generally, treatment should involve education and supportive psychotherapy, behavioral therapies designed to promote relaxation and adjustment to stress, and short-term pharmacotherapy. Although some clinical data from uncontrolled studies point to the possible importance of others drugs (eg, beta-blocking agents) in treating anxiety, the major pharmacotherapy rests with antianxiety drugs, particularly the benzodiazepine. Because each benzodiazepine appears to be relatively effective, a specific agent is selected for a particular clinical situation on the basis of its kinetic (especially its half-life) and side-effect profiles. A nonbenzodiazepine soon to be released in the United States, buspirone (Buspar), appears to be effective and nonaddictive and is not potentiated by alcohol. However, the final verdict as to its usefulness and safety in treating anxiety awaits results of further testing. *****ACTA PSYCHIATRICA SCANDINAVICA***** Allgulander C History and current status of sedative-hypnotic drug use and abuse. ACTA PSYCHIATR SCAND 1986 May; 73(5):465-78 Sedative-hypnotic drug use and abuse increased in Europe after World War II and peaked about 1972. Clinical and follow-up descriptions of abusers support the concept of a psychiatric addiction syndrome, different from a low-dose withdrawal syndrome. Although these drugs may be prescribed unnecessarily, large portions of the general population with pathological psychic distress and insomnia do not receive psychotropic treatment, in spite of findings pointing to genetic and biochemical factors in the genesis of these. Research on underlying mechanisms and the rationale for maintenance therapy is needed. *****ADDICTIVE BEHAVIORS***** Klajner F Hartman LM Sobell MB Treatment of substance abuse by relaxation training: a review of its rationale, efficacy and mechanisms. ADDICT BEHAV 1984; 9(1):41-55 The efficacy of relaxation training as a treatment for alcohol and drug abuse is reviewed, and directions for future research derived. Such use of relaxation procedures, notably progressive muscular relaxation and meditation, has been widespread and is premised on the assumptions that substance abuse is causally linked to anxiety and that anxiety can be reduced by relaxation training. However, the evidence suggests that such precipitating anxiety is limited to interpersonal-stress situations involving diminished perceived personal control over the stressor, and that alcohol and other drugs are often consumed for their euphoric rather than tranquilizing effects. Consequently, the empirical support for the effectiveness of relaxation training as a treatment for substance abuse in general is equivocal. As well, the existing outcome studies suffer from numerous methodological and conceptual inadequacies. In cases of demonstrated effectiveness, increased perceived control is a more plausible explanation than is decreased anxiety. *****ADOLESCENCE***** Chasanoff E Schrader C A behaviorally-oriented activities therapy for program for adolescents. ADOLESCENCE 1979 Fall; 14(55):569-77 A behaviorally-oriented activities therapy program was designed and implemented with adolescents who manifested problems in school, at home, and with peers. Baseline measures for target behaviors were taken within the activities therapy program and, after a behavioral analysis, specific techniques were chosen to remediate problems. Techniques employed included: contingency contracting, assertiveness training, relaxation training, and cognitive restructuring. Evaluation of the effectiveness of each program was performed through daily measurement of the frequency of the occurrence of the target behaviors. Three case studies are presented which are illustrative of the range of programs which can be successfully implemented with this population. *****ADVANCES IN ALCOHOL AND SUBSTANCE ABUSE***** Gilliland K Bullock W Caffeine: a potential drug of abuse. ADV ALCOHOL SUBST ABUSE 1983-84 Fall-Winter; 3(1-2):53-73 Recent investigations of caffeine abuse have questioned the indiscriminant use of this commonly accepted drug. In some individuals, chronic excessive caffeine consumption leads to the development of caffeinism, a syndrome which includes increased anxiety, depression, frequency of psychophysiological disorders, and possibly degraded performance. This paper reviews research demonstrating the abuse potential of caffeine. Special attention has been given those factors which mediate the wide individual differences in consumption patterns, susceptibility to abuse, and the varied psychological and physiological responses to this drug. While the development of caffeine abuse is probably best viewed as an idiosyncratic process, general guidelines for the recognition of potential abuse, and caffeinism proper, are offered. *****AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE***** Kosten TR Gawin FH Rounsaville BJ Kleber HD Cocaine abuse among opioid addicts: demographic and diagnostic factors in treatment. AM J DRUG ALCOHOL ABUSE 1986; 12(1-2):1-16 Cocaine is becoming a major drug of abuse among the general population and among opiate addicts. Reports from the early 1970s found that most abusers were older Black males with some antisocial characteristics. Cocaine abuse at that time was reported by about 17% of opiate addicts seeking treatment and by 7 to 11% of ex-addicts on methadone maintenance. However, that rate increased dramatically during the 1970s, and in our 1980 study of 533 addicts we found that 74% of opiate addicts applying for treatment used cocaine. It was the second most abused nonopioid drug after marijuana, surpassing alcohol intoxication. Although the mean number of days of abuse over the previous 30 days was substantially lower among the addicts on our methadone maintenance program (mean = 1.4 days, n = 120) than among the addicts applying for treatment (mean = 9 days, n = 204), the following associations with cocaine abuse were consistent in both subsamples. Cocaine abuse was more frequent among Blacks. It was associated with a variety of antisocial indices including Research Diagnostic Criteria antisocial personality disorder, number of arrests, and legal, family, employment, and drug abuse problems as assessed by the Addiction Severity Index and the Social Adjustment Scale. Several differences emerged between Black and White cocaine- abusing addicts, the most interesting being an increased rate of anxiety disorders among White cocaine abusers. Based on these associations, we offer several guidelines for treating cocaine abuse in opiate addicts. *****AUSTRALIAN AND NEW ZEALAND JOURNAL OF PSYCHIATRY***** Vittone BJ Uhde TW Differential diagnosis and treatment of panic disorder: a medical model perspective. AUST NZ J PSYCHIATRY 1985 Dec; 19(4):330-41 The authors present a review of existing literature along with new data regarding the phenomenology, differential diagnosis, course and treatment of panic disorder and agoraphobia. Panic attacks are viewed as central to the development of these disorders, and individual cognitive frameworks contribute to the manner in which a patient's symptoms evolve. An apparent though unclear relation to depressive states is described. Substance abuse may also be a consequence of recurrent panic attacks. A scheme towards differential diagnosis of panic disorder from other psychiatric and medical disorders is proposed. Personality characteristics of these patients vary considerably, but certain factors, such as dependency, are common. Family relations are often strained and assume importance in treatment. Data on the longitudinal course of illness is presented implying a relationship of panic disorder to both depression and stressful life events in many patients. Treatments that thus far seem most effective are pharmacological and behavioural approaches. Imipramine, MAO inhibitors, and alprazolam currently appear to be the most useful medications employed, although other agents may at times be useful alternatives. Dietary interventions, family therapy, and group and individual psychotherapy are also reviewed and discussed as adjunctive therapies in the treatment of panic disorder. *****DISEASES OF THE NERVOUS SYSTEM***** Kochansky GE Hemenway TS 3d Salzman C Shader RI Methaqualone abusers: a preliminary survey of college students. DIS NERV SYST 1975 Jul; 36(7):348-51 A questionnaire was used to survey the methaqualone experiences of college student users, and psychological test data from these users and a control group of non-users were compared. On differential pattern found was that methaqualone users have experimented with a wider variety of psychoactive drugs than have non-users. However, the two groups were essentially indistinguishable on the psychological test variables assessed. A preliminary modal profile of the college student methaqualone abuser and abuse experience was generated. *****DRUGS***** Pinder RM Brogden RN Speight TM Avery GS Doxepin up-to-date: a review of its pharmacological properties and therapeutic efficacy with particular reference to depression. DRUGS 1977 Mar; 13(3):161-218 Doxepin is closely related in structure and general pharmacological properties to other tricyclic antidepressant drugs such as amitriptyline and imipramine. It combines antidepressant activity with a sedative effect and in this respect resembles amitriptyline, with which it shares a similar profile of clinical action. The mood elevating effect of doxepin appears to be similar to that of amitriptyline but is probably less marked than that of imipramine and in some studies has been slower to take effect than imipramine. At dosages which have achieved a similar overall response rate, doxepin tends to cause fewer or less troublesome side-effects than imipramine, amitriptyline or amitriptyline-prephenazine. The more marked sedative properties of doxepin make it more useful than imipramine in depressed patients with sleep distrubances and in depression associated with anxiety. The benzodiazepines remain the drugs of choice in anxiety states. but when anxiety is accompained by significant depression, doxepin is more effective than chlordiazepoxide or diazepam. Doxepin is usually well tolerated, and in particular by the elderly and those with cardiovascular disease. Side-effects are similar in nature to those of other tricyclic antidepressants, with dry mouth, drowsiness and constipation being the most common. Postural hypotension is uncommon. Although doxepin appears to cause fewer cardiovascular side-effects in usual therapeutic doses, it has an intrinsic cardiotoxicity on overdosage similar to other tricyclics. *****ENCEPHALE***** Lamontagne Y Hand I Annable L Gagnon MA [Physiological and psychological effects of biological feed-back training (alpha and EMG) among drug using college students] ENCEPHALE 1977; 3(3):203-6 (Published in FRENCH) Twenty-four volunteer college students, who were regular drug users, were randomly allocated to three training groups of equal size: alpha feedback, EMG feedback and a joked control group. Subjects, who were unaware of which feedback condition they received, were asked to practice at home during a six month follow-up period to achieve a relaxed state similar to that experienced during training. No group was successful in retaining gains made in their alpha levels during each session. The EMG group, however, significantly reduced their muscular activity during training and retained the improvement during follow-up. The alpha and joked groups did not significantly improve their EMG during training but at follow-up achieved the same levels as the EMG group. There was evidence to suggest a reduction in drug use among light and medium users that was maintained during follow- up. Significant and lasting improvements were made by each group in the duration and quality of their sleep. Anxiety levels were also reduced. *****INTERNATIONAL JOURNAL OF THE ADDICTIONS***** Hall SM The abstinence phobias: links between substance abuse and anxiety. INT J ADDICT 1984 Sep; 19(6):613-31 This paper presents a new model to explain the observed relationship between anxiety and substance abuse. Specifically, the concept of "abstinence phobias," common across psychoactive substances, is developed. The evidence needed to support this concept is outlined, and relevant data from studies of opiate, alcohol, and tobacco dependences are reviewed. Parallel data obtained from the treatment of obesity are discussed. It is concluded that the abstinence phobia merits further study; clinical implications are also considered. True WR Pevnick JS Abuse of pentazocine combined with tripelennamine: an interaction of pharmacological and demographic characteristics. INT J ADDICT 1983 Dec; 18(8):1063-71 Abuse of pentazocine (Talwin) and tripelennamine (Pyrabenzamine) (P and T) was studied in a group (N = 16) of inpatients. They were queried about subjective effects and their drug preferences. P and T use was associated with more anxiety than was the opiate or drug-free state. P and T use did not produce euphoria, and users preferred this drug next to last among other abused drugs. P and T use was further studied in outpatients (N = 628) using Client Oriented Data Acquisition Process information. These patients were younger and more often male, Black, and single or separated when compared with opiate users. They began using the drug later and had many fewer years invested in its use. Hobfoll SE Segal B A factor analytic study of the relationship of experience seeking and trait anxiety to drug use and reasons for drug use. INT J ADDICT 1983 May; 18(4):539-49 The relationship of measures of sensation seeking and trait anxiety to drug use and reasons for drug use was studied among a sample of 92 detained or adjudicated adolescent males in a residential detention facility. Experience seeking was found to be related to drug use in general, and especially use of "hard" drugs. Anxiety tended to be related to drug avoidance, except in the case of marijuana and alcohol use. Reasons for drug use which related with experience seeking were excitement and thrill oriented, whereas reasons associated with anxiety were related to feelings of discomfort for this sample. In general, experience seeking was a stronger factor than trait anxiety in these findings. Implications for more action- oriented and less insight-oriented treatment are discussed in light of these results. Orive R Gerard HB Personality, attitudinal, and social correlates of drug use. INT J ADDICT 1980 Aug; 15(6):869-81 Retrospective data on 106 young people collected 10 years prior to this study as well as contemporaneous data were analyzed to determine predictors of drug use. Results indicate that personality factors fared poorly in distinguishing users from nonusers with the exception of anxiety and IQ for hallucinogen use only. Users tended to have high IQs and low anxiety. Social factors seem to play a major role in the spread of drug use. The initiator of the adolescent into drug use is not a group leader but rather an equal status peer group member. Factors in the spread of drug use follow similar patterns for licit as well as illicit drugs. *****JOURNAL OF CLINICAL PHARMACY AND THERAPEUTICS***** Peet M Yates RA Beta-blockers in the treatment of neurological and psychiatric disorders. J CLIN HOSP PHARM 1981 Sep; 6(3):155-71 Beta-blockers, originally introduced into clinical practice for the treatment of cardiovascular disorders, are being increasingly advocated in the treatment of diverse neurological and psychiatric conditions. Thus, propranolol and certain other beta-blockers have been shown to be effective, and may be the drugs of choice, in the treatment of benign essential tremor and the prevention of recurrent migraine attacks. These drugs also have a useful role to play in the treatment of anxiety and alcohol withdrawal states, although beta- blockers have not come into general use in these conditions. The action of propranolol and related drugs in these neurological and psychiatric conditions is generally considered to be mediated by blockade of peripheral beta-adrenergic receptors, although other effects, either central or peripheral, may also be involved. The use of beta-blockers in the treatment of psychosis remains controversial. Current evidence does not support the use of propranolol in schizophrenia, but further studies in mania are warranted. *****JOURNAL OF CLINICAL PSYCHOLOGY***** Charlesworth EA Dempsey G Trait anxiety reductions in a substance abuse population trained in stress management. J CLIN PSYCHOL 1982 Oct; 38(4):764-8 Investigated a 2-week (eight-session) stress management training program into an ongoing psychotherapy group for 11 hospitalized polydrug-abusing patients. These patients were compared to a control group of 14 similar patients on the same ward, who were participating in different psychotherapy groups. Results indicated that the stress management treatment group produced significant decreases in trait anxiety on the STAI (p less than .005) and TMAS (p less than .01). The control group's reduction was not significant, and the difference between the two groups was significant (p less than .05). Subjective reports suggested that treatment Ss used the stress management techniques to overcome insomnia associated with withdrawal, to manage anger, and to reduce situational anxiety. Berger A Wrobel TA Lycaki H Levels of basic personality factors in a psychiatric population. J CLIN PSYCHOL 1980 Apr; 36(2):378-82 Diverse sets of factors have been claimed by various investigators to be basic personality variables of the highest factor order. A sample of 400 psychiatric patient records were rated for pressence or absence of 14 criteria. The data were factor analyzed, and four factors were extracted. Three of the four factors resemble Eysenck's three-factor model of personality at the universal or general level. The fourth factor is interpreted to be a behavioral dimension at a lower level. The results are discussed in terms of the population and the type of data utilized. *****JOURNAL OF PERSONALITY ASSESSMENT***** Gordon LB Preferential drug abuse: defenses and behavioral correlates. J PERS ASSESS 1980 Aug; 44(4):345-50 Response styles and defensive patterns of 30 polydrug abusers, 30 sedative-hypnotic abusers, and 30 hospitalized medical control subjects were assessed. These subjects were drug-free and matched for sex, WAIS IQ, and socioeconomic status. The Rorschach was administered to all subjects. A frustration-producing task (insolvable anagrams) was administered to half of the subjects in each group. Solvable anagrams were administered to the remaining subjects. All subjects were then asked to select one of two stories for each of eight TAT cards and complete a Profile of Mood States Questionnaire. The Rorschach data indicate that polydrug abusers are less well organized, less able to delay gratification, and more restless and distractible when compared to the sedative-hypnotic and control groups. The behavioral data lend support to the pharmacodynamic theory of drug abuse in that each drug abuser group responded to the frustration produced by the inability to solve anagrams in a way consistent with the effects of the abused drugs. Implications of these data for treatment planning are discussed. *****JOURNAL OF PSYCHIATRIC RESEARCH***** Hasin DS Grant BF Psychiatric diagnosis of patients with substance abuse problems: a comparison of two procedures, the DIS and the SADS-L. Alcoholism, drug abuse/dependence, anxiety disorders and antisocial personality disorder. J PSYCHIATR RES 1987; 21(1):7-22 We compared DSM-III and RDC diagnoses from the DIS to RDC diagnoses from the SADS-L for alcohol and drug use disorders, anxiety disorders and Antisocial Personality Disorder in a group of patients with substance abuse problems. Kappa values for substance use disorders were fairly good. The instruments did not agree well on anxiety disorders, or on Antisocial Personality Disorder. Criterion differences gave rise to some of the disagreement between the instruments on Antisocial Personality Disorder, but the causes of disagreement for the anxiety disorders were not so clear. The implications of these findings are discussed. Schuckit MA Sweeney S Substance use and mental health problems among sons of alcoholics and controls. J STUD ALCOHOL 1987 Nov; 48(6):528-34 Data from a questionnaire sent to 864 university male students and nonacademic staff were used to compare self-reports of substance intake patterns and problems as well as family histories of depression and substance abuse across four groups: Group 1, 682 men (79%) who had no alcoholic first or second-degree relative; Group 2, 101 men (12%) who reported an alcoholic second-degree relative only; Group 3, 59 men (7%) who reported an alcoholic first-degree relative only and Group 4, 22 men (3%) with alcoholism in both first- and second-degree relatives. Although few men were already alcoholics or drug abusers and the groups did not differ significantly on the quantity and frequency of alcohol intake, there was an increase in the personal history of alcohol-related problems from Group 1 to Group 4. There were no significant differences across the groups on the proportion of nonalcoholic relatives demonstrating drug abuse or depressive disorders. Veterans Administration Medical Center San Diego California 92161. *****NEUROTOXICOLOGY AND TERATOLOGY***** Jarzembski WB Electrical stimulation and substance abuse treatment. NEUROBEHAV TOXICOL TERATOL 1985 Mar-Apr; 7(2):119-23 The use of electrical currents for the treatment of disease has been considered since antiquity but it has only been in recent years that suitable devices have been available to scientific investigators to provide stimulation currents for clinical use. These devices have been used extensively for the relief of intractable pain and are an accepted treatment modality today. Other investigators have turned to the investigation of the effects of tiny currents, less than one milliampere, applied to the head. Recent investigations have been successful in the alleviation of such symptoms as insomnia, depression, and tremor. Other investigations have shown similar currents to be effective in relieving stress that accompanies withdrawal from substance abuse. In spite of these successes, resulting from scientific investigation of the effects of cranial electrical stimulation, there is still a general reluctance to use this new modality. It is the purpose of this paper to review pertinent aspects of this treatment so the health care practitioner may make judgements with respect to the safety and efficacy of cranial electrical stimulation. *****PHARMACOTHERAPY***** Goldberg HL Buspirone hydrochloride: a unique new anxiolytic agent. Pharmacokinetics, clinical pharmacology, abuse potential and clinical efficacy. PHARMACOTHERAPY 1984 Nov-Dec; 4(6):315-24 Buspirone is the first of a new class of anxioselective agents, the azaspirodecanediones. It achieves peak serum concentrations within one hour and has a serum half-life of 2 to 5 hours. Animal studies have suggested antianxiety activity and the absence of abuse potential. Buspirone is both a dopamine agonist and antagonist, and appears to interact with numerous neurochemical systems in the brain, but not with gamma-aminobutyric acid or at benzodiazepine receptors. Buspirone increases prolactin and growth hormone levels under experimental conditions. In healthy subjects, it has much less effect on psychomotor performance and electroencephalographic results than diazepam. Buspirone offsets some of the impairment due to alcohol when the agents are combined. The drug has anxiolytic properties comparable to those of diazepam, with less sedating effects. It had no abuse potential in tests with casual drug users. *****PHARMAKOPSYCHIATRIE NEURO-PSYCHOPHARMAKOLOGIE***** Carranza J Long term use and abuse of benzodiazepines. PHARMAKOPSYCHIATR NEUROPSYCHOPHARMAKOL 1980 Sep; 13(5):254-8 1. We have stressed the detrimental effect that lay publications, T. V. and mass media has had on the pharmacotherapy of anxiety and depressive reactions with benzodiazepines. 2. We have reviewed the scientific literature and found few well documented cases of benzodiazepine dependence if one considers that benzodiazepines are the most prescribed medications. 3. We discussed the possibility that the seizures reported on withdrawal of benzodiazepines used for very long periods, is not a "proof" of a physical dependence, but rather clinical evidence of the well known anticonvulsant effect of benzodiazepines. 4. We have hypothesized that the withdrawal syndromes associated to high dosages of benzodiazepines might have a different neurochemical mechanism to that observed in alcohol and barbiturates withdrawals. *****PRIMARY CARE; CLINICS IN OFFICE PRACTICE***** *****PSYCHOLOGIE MEDICALE***** Foggitt RH Gossop MR Nicol AR Psychoneurotic disturbance and drug-taking in Borstal boys. PSYCHOL MED 1976 Feb; 6(1):133-7 Their own accounts of their use of drugs, together with a detailed description of psychiatric history and present mental state, were obtained from a sample of institutionalized delinquents, Subjects reporting extensive involvement in drug abuse were found to be disturbed on a number of psychiatric variables; however, those reporting some limited abuse were less disturbed than subjects