Director's Report 2/95 - Clinical and Services Research

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Director's Report to the National Advisory Council on Drug Abuse
February, 1995

Research Findings

Clinical and Services Research

Nosology, Diagnosis and Clinical Assessment.

A validation study in diagnosis and classification of drug and alcohol dependence (James Langenbucher, Jon Morgenstern, and Erich Labouvie, Rutgers University, in collaboration with Peter Nathan, University of Iowa) demonstrated diagnostic concordance of substance use disorders when diagnoses were made according to rules presented in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R), DSM-IV, and the World Health Organization's International Classification of Diseases, Tenth Edition (ICD-10). Results from the study will be published in the journal Drug and Alcohol Dependence. Another paper based upon this work that focuses on the generalizability of the dependence syndrome and the lifetime DSM-IV diagnosis of cannabis, cocaine and opiate dependence will appear in Addiction.

Smoking Cessation for Depressed Patients.

Smokers with a history of major depressive disorder constitute a significant proportion of smokers who present for cessation treatment. These smokers experience more frequent and intense depressive symptoms upon initial cessation and relapse at higher rates than other smokers. New and innovative interventions are needed to address the needs of these more recalcitrant smokers who may be unable to quit with standard interventions that are not matched or tailored to their particular needs.

Dr. Richard Brown, a NIDA investigator in Providence, Rhode Island, examined whether adding cognitive-behavioral treatment for depression to a standard smoking cessation protocol would enhance the achievement and maintenance of smoking cessation in smokers with a history of major depressive disorder. Preliminary results suggest that the addition of cognitive-behavioral treatment for depression (to standard smoking cessation treatment) results in superior rates of abstinence for smokers with a history of major depressive disorder, relative to standard smoking cessation treatment alone.

Dr. Arthur Garvey of the Harvard School of Dental Medicine found depressed smokers given nicotine gum were more likely to remain abstinent compared to depressed smokers receiving placebo gum. Although nicotine replacement appears to aid depressed smokers in their attempts to quit, this population may require a combination of nicotine replacement with other methods (anti-depressants, mood management therapy) to elevate abstinence rates.

Effects of Maternal Drug Use on Infant Birth Weight and ZOther Indices of Development and Health.

Preliminary analyses of early infant outcomes following prenatal exposure to cocaine and other drugs have been reported from a number of ongoing NIDA studies1,2,3,4. In one project, full-term infants exposed in-utero to cocaine were smaller in average birth weight, birth length, and head size than infants who were either drug-free or alcohol/non-cocaine-exposed, a finding consistent with several reports in the literature. There were no significant differences among the groups with regard to significant brain lesions (detected by cranial ultrasonography1), a finding also reported in another ongoing study2.

In one sample of 3-year-old children, prenatal exposure to marijuana is associated with impaired development of cognition in both African-American and white children3. For white children, there was a significant negative effect on performance on the Stanford-Binet Intelligence Scale which was offset by preschool/day-care attendance, while for the African-American children, significant effects were found on the composite score, short-term memory, and verbal reasoning subscales and the effects were not moderated by preschool/day-care attendance. Similar negative effects of prenatal marijuana exposure on the development of cognition (verbal reasoning and memory) have been reported in a different sample of 4-year old white children. At 5 and 6 years of age, prenatal marijuana exposure was not associated with performance on global tests of cognition and language, but at approximately these ages and slightly older, tests that examined more specific aspects of behavior (i.e., sustained attention) did appear to suggest a relationship between prenatal exposure and performance4. (1. Bandstra, ES; Montalvo, BM; Frank, JL et al. Cranial ultrasonography in term infants exposed in-utero to cocaine, Ped Res. 33:201, 1993; 2. Eyler, FD; Behnke, M; Woods, NS et al. Birth outcome from a longitudinal study of prenatally matched cocaine-using and non-using women, Ped Res 35:268a, 1994; 3. Day, NL; Richardson, GA; Goldschmidt, N; et al. Neurotoxicol Teratol, 16(2): 169-175, 1994; 4. Fried, P et al. Behavioral outcomes in preschool and school-age children prenatally exposed to marijuana: A review and speculative interpretation, NIDA Monograph Behaviors of Drug Exposed Offspring: Research Update, in press:, also Arch Toxicol, in press).

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