Cocaine withdrawal symptoms identify "Type B" cocaine-dependent patients.

Ahmadi J, Kampman K, Dackis C, Sparkman T, Pettinati . Center for the Study of Addictions, Treatment Research Center, University of Pennsylvania, Philadelphia, PA, USA. jamshid_ahmadi@yahoo.com Recent studies of su stance dependence typolo!ies riefly sho" that multivariate systems ori!inally developed for identifyin! su types of alcoholics, such as #a or$s Type A and # system, may also e valid in a users of other su stances, such as cocaine. Type # patients are characteri%ed y an earlier onset of addiction and more severe symptoms of their addiction, psychopatholo!y, and impulsivity. The Type # classification has also een associated "ith deficits in serotoner!ic function. &e have found that patients "ho e'hi it more severe cocaine "ithdra"al symptoms, as measured y scores on the Cocaine Selective Severity Assessment (CSSA), have poor treatment outcome and share many characteristics "ith *Type #* patients. +n this paper, "e revie" aseline characteristics of cocaine,dependent patients from several recently completed outpatient cocaine dependence treatment trials to assess the association of cocaine "ithdra"al symptom severity and the Type # profile. +dentifyin! su types of cocaine,dependent patients may improve our a ility to treat cocaine dependence y tar!etin! treatments for specific su types of patients. &e e'amined the a ility of the CSSA scores to capture Type # characteristics in cocaine dependence y analy%in! a series of cocaine medication trials that included -.. cocaine,dependent su jects. /i!h CSSA scores at aseline "ere associated "ith a history of violent ehavior, a family history of su stance a use, antisocial personality disorder, hi!her addiction severity, and co,mor id psychiatric diseases. Patients "ith hi!h CSSA scores are also more li0ely to meet criteria for Type # (Type ++) cocaine dependence. +dentifyin! Type # cocaine, dependent patients may help to develop tar!eted psychosocial or pharmacolo!ical treatments for these difficult,to,treat patients. P1+23 45-467-6 8Pu 1ed , inde'ed for 192:+;9<

anna!is withdrawal predicts se"erity of canna!is in"ol"ement at #-year follow-$p amon% treated adolescents.
Ch$n% T, &artin CS, Corneli$s J', Clark DB. &estern Psychiatric +nstitute and Clinic, University of Pitts ur!h 1edical Center, Pitts ur!h, PA 4.-4=, USA. chun!ta@upmc.edu A+1S3 Controversy e'ists re!ardin! the inclusion of canna is "ithdra"al as an indicator of dependence in the ne't revision of the 2ia!nostic and Statistical 1anual of 1ental 2isorders (2S1) and +nternational Classification of 2iseases (+C2). This study contrasted the concurrent and predictive validity of three operational definitions of canna is "ithdra"al in a sample of treated adolescents. 29S+>;3 Prospective study of treated adolescents "ith 4,year follo",up. S9TT+;> A;2 PART+C+PA;TS3

Adolescents (n?-46) "ere recruited from intensive out,patient treatment pro!rams for su stance a use, and follo"ed at 4 year (@-A retention). Bouth "ho "ere included in the analyses reported re!ular canna is use. 19ASUR919;TS3 The num er of 2S1, +C canna is a use and dependence symptoms at aseline and 4,year follo",up, past year freDuency of canna is use at aseline and follo",up, and periods of a stinence at 4,year follo",up. Canna is "ithdra"al "as defined ased on (i) the presence of t"o or more canna is "ithdra"al symptomsE (ii) a definition proposed y #udney and collea!ues (-FFG) that reDuires four or more "ithdra"al symptoms (four,symptom definition)E and (iii) the use of latent class analysis to identify su !roups "ith similar canna is "ithdra"al symptom profiles. H+;2+;>S A;2 CI;C:US+I;S3 All three definitions of canna is "ithdra"al demonstrated some concurrent validity. Inly the four,symptom and latent class,derived definitions of "ithdra"al predicted severity of canna is,related pro lems at 4,year follo",up. ;o canna is "ithdra"al definition predicted freDuency of use at follo",up. Hurther research is needed to determine the clinical utility and validity of the four,symptom definition, as "ell as alternative definitions of canna is "ithdra"al, to inform revisions leadin! to 2S1,C and +C2,44.

harmacotherapy and psychotherapy in canna!is withdrawal and dependence.

Benyamina A, (ecache$) &, Blecha (, 'eyna$d &, ($kasiewc* &. Centre d$9nsei!nement, de Recherche et de Traitement des Addictions, /Jpital Paul #rousse, @65F6 Cillejuif Cede', Hrance. amine. enyamina@p r.aphp.fr Canna is has lon! een perceived as a dru! causin! Duestiona le dependence. Inly recently has a clinically reco!ni%ed "ithdra"al syndrome een descri ed, thus layin! the foundations for specific treatment evaluations. Si' different pharmacotherapies have een studied in canna is "ithdra"al. If these, only oral tetrahydrocanna inol, and perhaps mirta%apine, have sho"n some promise in the specific treatment of "ithdra"al symptoms. +n canna is dependence, rimona ant, and perhaps uspiron, have sho"n promisin! results. Clinical trials of oral tetrahydrocanna inol "ere less convincin!. Co!nitive and ehavioral therapies and motivational enhancement therapies have proven their efficacy in several randomi%ed controlled trials. #rief therapies have also een associated "ith !ood compliance and efficacy. Com inations "ith voucher incentives in certain populations have een associated "ith improved treatment compliance and reduced canna is use. Inly t"o studies have analy%ed the cost,efficacy of psychotherapies. +t "ould seem that rief com ined co!nitive and ehavioral therapies, and motivational enhancement therapies are the most cost effective. Hor the moment, it is uncertain "hether the additional treatment costs associated "ith voucher incentives are proportional to the accrued a stinence duratio

anna!is reinforcement and dependence+ role of the canna!inoid CB# receptor.

Cooper ,D, aney &.

2ivision on Su stance A use, ;e" Bor0 State Psychiatric +nstitute, 2epartment of Psychiatry, Colle!e of Physicians and Sur!eons of Colum ia University, ;e" Bor0, ;B 4FF=-, USA. A"areness of canna is dependence as a clinically relevant issue has !ro"n in recent years. Clinical and la oratory studies demonstrate that chronic marijuana smo0ers can e'perience "ithdra"al symptoms upon cessation of marijuana smo0in! and have difficulty a stainin! from marijuana use. This paper "ill revie" data implicatin! the canna inoid C#4 receptor in re!ulatin! the ehavioral effects of 2elta(@), tetrahydrocanno inol (T/C), the primary psychoactive component of canna is, across a ran!e of species. The ehavioral effects that "ill e discussed include those that directly contri ute to the maintenance of chronic marijuana smo0in!, such as re"ard, su jective effects, and the positive and ne!ative reinforcin! effects of marijuana, T/C and synthetic canna inoids. The role of the C#4 receptor in the development of marijuana dependence and e'pression of "ithdra"al "ill also e discussed. :astly, treatment options that may alleviate "ithdra"al symptoms and promote marijuana a stinence "ill e considered.