The purpose of this project is to improve upon the assessment and treatment effectiveness of Antisocial Personality (ASP) disordered intravenous drug abusing (IVDA) opiate dependent patients. The development of more effective treatment methods for intravenous drug abusers has attained increased urgency given the recognition of this form of drug use as a major HIV transmission route. Psychiatric characterization studies of opiate dependent patients have revealed significant proportions with concurrent psychiatric disorders amenable to treatment. However, these studies consistently report that ASP is the second most frequently made concurrent psychiatric diagnosis. Unfortunately, the only thing we definitely know about the treatment of this cohort is that they are highly resistant to clinical interventions, generally difficult to manage, and are likely to evidence continuing patterns of intravenous drug use after entering treatment. Preliminary data has also recently linked ASP, opiate dependent patients to high rates of intravenous cocaine use. The present project will focus upon IVDA patients with ASP entering methadone treatment, a context that permits frequent contact and objective assessment of drug use behavior and treatment performance. In Study 1, we will determine the diagnostic profiles among newly admitted cocaine abusing and nonabusing opiate dependent patients, and begin further validation of a behaviorally anchored measure of current antisocial behaviors. In Study 2, these diagnostic measures will be related to treatment performance data in the further development of behavioral measures that are sensitive to identification and ongoing evaluation of patients with concurrent RDC and/or DSM-IIIR diagnoses of ASP. Study 3 will focus on an evaluation of a novel structured contingency management intervention for improving clinical outcome among patients with concurrent ASP. Overall, the results will contribute to more effective assessment and treatment of a significant subset of intravenous drug abusers, potentially reduce the spread of HIV transmission, and extend the validation of a new, and possibly more efficient, diagnostic instrument to an outpatient drug abuse population.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA005569-03
Application #
3211986
Study Section
Drug Abuse Clinical and Behavioral Research Review Committee (DACB)
Project Start
1989-07-01
Project End
1994-06-30
Budget Start
1991-07-01
Budget End
1992-06-30
Support Year
3
Fiscal Year
1991
Total Cost
Indirect Cost
Name
Johns Hopkins University
Department
Type
Schools of Medicine
DUNS #
045911138
City
Baltimore
State
MD
Country
United States
Zip Code
21218
Peirce, Jessica M; Kindbom, Kori A; Waesche, Matthew C et al. (2008) Posttraumatic stress disorder, gender, and problem profiles in substance dependent patients. Subst Use Misuse 43:596-611
Neufeld, Karin J; Kidorf, Michael S; Kolodner, Kenneth et al. (2008) A behavioral treatment for opioid-dependent patients with antisocial personality. J Subst Abuse Treat 34:101-11
Disney, Elizabeth R; Kidorf, Michael; King, Van L et al. (2005) Prevalence and correlates of cocaine physical dependence subtypes using the DSM-IV in outpatients receiving opioid agonist medication. Drug Alcohol Depend 79:23-32
Brooner, Robert K; Kidorf, Michael S; King, Van L et al. (2004) Behavioral contingencies improve counseling attendance in an adaptive treatment model. J Subst Abuse Treat 27:223-32
King, V L; Kidorf, M S; Stoller, K B et al. (2001) Influence of antisocial personality subtypes on drug abuse treatment response. J Nerv Ment Dis 189:593-601
Brooner, R K; Kidorf, M; King, V L et al. (1998) Preliminary evidence of good treatment response in antisocial drug abusers. Drug Alcohol Depend 49:249-60
Brooner, R; Kidorf, M; King, V et al. (1998) Drug abuse treatment success among needle exchange participants. Public Health Rep 113 Suppl 1:129-39
Brooner, R K; King, V L; Kidorf, M et al. (1997) Psychiatric and substance use comorbidity among treatment-seeking opioid abusers. Arch Gen Psychiatry 54:71-80
Rousar, E; Brooner, R K; Regier, M W et al. (1994) Psychiatric distress in antisocial drug abusers: relation to other personality disorders. Drug Alcohol Depend 34:149-54
Brooner, R K; Herbst, J H; Schmidt, C W et al. (1993) Antisocial personality disorder among drug abusers. Relations to other personality diagnoses and the five-factor model of personality. J Nerv Ment Dis 181:313-9