Diagnostic Criteria For Dependence Research Articles

Clinical and Demographic Correlates of the Type and Frequency of Criminal Behavior Among Jail Inmates with a Substance Use Disorder

This study sought to identify the clinical and demographic correlates of offenders with a violent instant offense as well as those with a history of greater criminal recidivism among a sample of county jail inmates with a substance use disorder. Clinical, demographic, and arrest data from 176 male inmates (76.0% Caucasian) incarcerated in a county jail facility were utilized to address the present study’s objectives. All inmates were repeat offenders and met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association [APA], 1994) diagnostic criteria for dependence on one or more substances based on a structured clinical interview. Clinical variables included patterns and prevalence of various DSM-IV substance-specific dependence diagnoses (i.e., alcohol, cannabis, cocaine, and heroin), as well as several non-substance use disorder psychiatric diagnoses (e.g., posttraumatic stress disorder [PTSD], antisocial personality disorder). Demographic variables included age, race, marital status, employment status, educational attainment, and estimated annual income level. Inmates with a violent instant offense had a higher prevalence of PTSD, antisocial personality disorder, and both major depressive and manic episodes relative to non-violent offenders. The only significant associations between number of prior bookings and all the studied clinical and demographic variables involved the presence of a PTSD diagnosis and income level. Co-occurring psychiatric disorders are prevalent among substance-dependent violent offenders, while very few of the studied variables appear significantly related to the frequency of prior criminal behavior. Research implications and clinical implications for county jail classification procedures are discussed.

Should criteria for drug dependence differ across drugs?

To examine the pros and cons of using the same diagnostic criteria for dependence across all drugs versus using dependence criteria specific to the drug of interest. A qualitative review of the similarities and differences in nicotine versus alcohol and opiate dependence is used as an example of the utility of using generic versus drug-specific criteria. Many scientists implicitly recognize that nicotine dependence is different when they do not include nicotine dependence when studying 'drug dependence'. Nicotine and alcohol/opiate dependence have many similarities (e.g. both can cause withdrawal). Among the several differences, the most important is that nicotine dependence does not cause acute behavioral impairment. Some of the generic dependence criteria do not apply to nicotine dependence (e.g. giving up activities to use the drug) and some well-validated measures of nicotine dependence (e.g. time to first cigarette) are not included in the generic criteria. Empirical tests of the relative utility of generic versus drug-specific criteria are needed.

Construction of a Medication Dependence Questionnaire in Headache Patients (MDQ‐H) Validation of the French Version

To construct and validate a questionnaire measuring dependence on analgesics and on migraine attack treatments in headache patients. The items were obtained using the Diagnostic and Statistic Manual of Mental Disorders (4th ed.) (DSM-IV) diagnostic criteria for dependence. The construct validity of the scale was investigated by confirmatory analysis in a sample of 156 patients. Regression analysis was used to explore predictive validity. The 21 items of the scale were grouped into seven first-order factors corresponding to seven dependence items described in the DSM-IV. There was a second-order factor that may be considered as a general dependence factor. The global questionnaire score predicted the number of units of treatment taken per week, the number of days of headache, the number of days medications were taken, and emotional distress. Patients with headache associated with chronic substance use had a significantly higher score (P < .000) than migraine and tension headache patients. It is a practical and valid tool for measuring medication dependence, including the behavioral dimension of dependence, in patients with headache associated with chronic substance use. It can prevent patients and clinicians from only focusing on pharmacological dependence.

Cocaine Tolerance: Behavioral, Cardiovascular, and Neuroendocrine Function in Men

Cocaine tolerance was assessed by comparing the acute effects of cocaine in drug-abstinent men who reported occasional cocaine use (n = 6) and in men who met DSM-III-R diagnostic criteria for dependence on both cocaine and opiates (n = 6). Peak plasma cocaine levels were equivalent in the two groups, and pharmacokinetic analyses revealed no significant differences in cocaine levels at any time. Cocaine induced a significantly greater increase in ACTH in the occasional cocaine users than in the cocaine dependent men (p < .01). Heart rate and systolic and diastolic blood pressure increases after cocaine were also significantly greater in the occasional cocaine users than in the cocaine-dependent men (p < .05). These neuroendocrine and physiologic differences were paralleled by significantly greater subjective reports of “high” and “euphoria” by the occasional cocaine users (p < .03 to .0001). These data are consistent with the conclusion that tolerance to cocaine’s physiologic, neuroendocrine, and subjective effects may occur as a function of chronic use.