ASSESSMENT OF PSYCHOLOGICAL ISSUES RELATED TO SUBSTANCE ABUSE TREATMENT

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The psychological assessment of subjects participating in clinical trials has become an important part of the section's research interest. Several studies were conducted: a comparison of drug abusers seeking treatment and not seeking treatment; an evaluation of personality disorders in cocaine dependent individuals seeking research treatment; and a survey of motivation for treatment. An important issue facing researchers and treatment providers is the reporting and representation of women and minorities in cocaine abuse pharmacotherapy clinical trials. Sociodemographic representation in 61 reports of outpatient pharmacotherapy for cocaine abuse, published in refereed, English language journals, between 1983 and 1993 was compared to the epidemiology of frequent cocaine use in the 1990 NIDA National Household Survey of Drug Abuse (NIDA-HS). The findings showed that important sociodemographic data is often not reported in papers, and raise issues of quality of research reports, generalizability of results, social equity, and accessibility for certain groups in cocaine abuse pharmacotherapy research. In procedural studies to identify improved outcome variable in clinical trials, the usefulness of quantitative urinalysis for cocaine metabolite and creatinine correction techniques and the relationship between these data and self-reported drug use were assessed with data collected in a clinical trial (N = 37) of a contingency management behavioral treatment intervention. Rules were developed to differentiate between occasions of new use and carry-over in positive qualitative urine tests. Preliminary analyses suggest: qualitative and quantitative urine testing show greater rates of drug use than that shown by self report; quantitative testing provides a means of differentiating incidences of new drug use from residual carry-over; the identification of new use with quantitative testing may help to reconcile differences between rates of drug use indicated by qualitative urine screens and self-report. Sweat patches have been proven effective in measuring cocaine and opiate use in controlled clinical laboratory settings but have not previously been tested under more realistic settings such as our treatment clinic. Collection of sweat as a method of monitoring drug use may be more accurate and reliable over a longer period of time than the urine testing method currently used. The purpose to evaluate the effectiveness of collecting sweat as an alternative method of monitoring drug use. Results will be compared to drug use as monitored by urine samples collected three times a week.