Baseline trajectories of heavy drinking and their effects on postrandomization drinking in the COMBINE Study: empirically derived predictors of drinking outcomes during treatment

The COMBINE Study sought to answer questions about the benefits of combining behavioral and pharmacological interventions (naltrexone and acamprosate) in alcohol-dependent patients. Our goals were to identify trajectories of heavy drinking prior to randomization in COMBINE, to characterize subjects in these trajectories, and to assess whether pre-randomization trajectories predict drinking outcomes. We analyzed daily indicators of heavy drinking in 90 days prior to randomization using a trajectory-based approach. Each subject was assigned to the most-likely pre-randomization heavy drinking trajectory, and the baseline characteristics of participants in the baseline trajectories were compared. Main and interactive effects of these trajectories and treatment factors (acamprosate, naltrexone or CBI) on summary drinking measures during active treatment (16 weeks) were assessed. We identified five trajectories of heavy drinking pre-randomization: “T1: frequent heavy drinkers”, “T2: very frequent heavy drinkers”, “T3: nearly daily heavy drinkers”, “T4: daily heavy drinkers” and “T5: daily heavy drinkers stopping early” prior to randomization. Trajectory membership was significantly associated with all drinking outcomes. Subjects in “T5: daily heavy drinkers stopping early” had comparable drinking outcomes to the subjects in “T1: frequent heavy drinkers” while the remaining trajectories were associated with significantly worse outcomes. Baseline trajectory did not interact significantly with treatment condition. These exploratory analyses confirmed the hypothesis that baseline trajectories predict post-randomization drinking outcomes. Interestingly, “T5: daily heavy drinkers stopping early” had outcomes that were comparable to the least severe baseline trajectory “T1: frequent heavy drinkers” and baseline trajectories of heavy drinking did not moderate treatment effects

Family Therapy

Family therapy is psychotherapy that directly involves family members and attends explicity to interactions among family members. In family therapy, the relational and communicational processes of families are utilized as the primary context for treating psychiatric disorders or solving clinical problems. During the latter 20th century, psychodynamic, structural, strategic, cognitive-behavioral, and postmodern family therapies matured as distinct clinical traditions. More recently, family psychiatry has emerged as a compilation of skills that psychiatrists can utilize in the biopsychosocial treatment of individual patients. Family psychiatry emphasizes family assessment, psychoeducation, and family interventions that reduce symptoms and build resilience against illness recurrence. © 2008 John Wiley & Sons, Ltd

Genomewide Linkage Scan for Opioid Dependence and Related Traits

Risk of opioid dependence is genetically influenced. We recruited a sample of 393 small nuclear families (including 250 full-sib and 46 half-sib pairs), each with at least one individual with opioid dependence. Subjects underwent a detailed evaluation of substance dependence–related traits. As planned a priori to reduce heterogeneity, we used cluster analytic methods to identify opioid dependence–related symptom clusters, which were shown to be heritable. We then completed a genomewide linkage scan (with 409 markers) for the opioid-dependence diagnosis and for the two cluster-defined phenotypes represented by >250 families: the heavy–opioid-use cluster and the non–opioid-use cluster. Further exploratory analyses were completed for the other cluster-defined phenotypes. The statistically strongest results were seen with the cluster-defined traits. For the heavy–opioid-use cluster, we observed a LOD score of 3.06 on chromosome 17 (empirical pointwise P=.0002) for European American (EA) and African American (AA) subjects combined, and, for the non–opioid-use cluster, we observed a LOD score of 3.46 elsewhere on chromosome 17 (empirical pointwise P=.00002, uncorrected for multiple traits studied) for EA subjects only. We also identified a possible linkage (LOD score 2.43) of opioid dependence with chromosome 2 markers for the AA subjects. These results are an initial step in identifying genes for opioid dependence on the basis of a genomewide investigation (i.e., a study not conditioned on prior physiological candidate-gene hypotheses)

Crack Use and Correlates of Use in a National Population of Street Heroin Users†

Traditionally, researchers and clinicians have viewed street heroin users as representing an end point in a drug-using career. It is toward this population that major national treatment efforts have been directed. Concomitant with the historical national concern about heroin use has been concern about the increase in crack cocaine use. There has been speculation that crack use may have become a substitute for the higher risk of heroin injection. This article examines the impact of crack use in a national population of heroin users. It was consistently found that there was a correlation between the frequency of crack use and the frequency of speedballing as well as the use of other forms of cocaine, amphetamines, and marijuana. There was also a positive relationship between frequency of crack use and such HIV risk behaviors as renting needles and having a large number of sex partners. The data suggest that in this population of heroin users, crack is not a substitute for heroin but rather is a part of a drug-use pattern that includes an increased use of other drugs and increased high-risk behaviors for contracting HIV. © 1992 Taylor & Francis Group, LLC