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Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature

Wilens, Timothy E; Adler, Lenard A; Adams, Jill; Sgambati, Stephanie; Rotrosen, John; Sawtelle, Robert; Utzinger, Linsey; Fusillo, Steven
OBJECTIVE: Recent studies have provided variable information on the frequency and context of diversion and the use of nonprescribed and prescribed stimulant medications in adolescent and young adult populations. The purpose of this systematic review of the literature is to evaluate the extent and characteristics of stimulant misuse and diversion in attention-deficit/hyperactivity disorder (ADHD) and non-ADHD individuals. METHOD: We conducted a systematic review of the literature of available studies looking at misuse and diversion of prescription ADHD medications using misuse, diversion, stimulants, illicit use, and ADHD medications as key words for the search. RESULTS: We identified 21 studies representing 113,104 subjects. The studies reported rates of past year nonprescribed stimulant use to range from 5% to 9% in grade school- and high school-age children and 5% to 35% in college-age individuals. Lifetime rates of diversion ranged from 16% to 29% of students with stimulant prescriptions asked to give, sell, or trade their medications. Recent work suggests that whites, members of fraternities and sororities, individuals with lower grade point averages, use of immediate-release compared to extended-release preparations, and individuals who report ADHD symptoms are at highest risk for misusing and diverting stimulants. Reported reasons for use, misuse, and diversion of stimulants include to concentrate, improve alertness, 'get high,' or to experiment. CONCLUSIONS: The literature suggests that individuals both with and without ADHD misuse stimulant medications. Recent work has begun to document the context, motivation, and demographic profile of those most at risk for using, misusing, and diverting stimulants. The literature highlights the need to carefully monitor high-risk individuals for the use of nonprescribed stimulants and educate individuals with ADHD as to the pitfalls of the misuse and diversion of the stimulants
PMID: 18174822
ISSN: 0890-8567
CID: 93597

Effect of job skills training on employment and job seeking behaviors [Meeting Abstract]

Bogenschutz, MP; Pallas, D; Foley, K; Daw, R; Tonigan, JS; Forcehimes, A; Chavez, R; Svikis, DS
ISI:000256497200742
ISSN: 0145-6008
CID: 1792522

Alcohol subtypes and differential treatment outcomes from the combine study [Meeting Abstract]

Pettinati, HM; Bogenschutz, MP; Tonigan, JS
ISI:000256497201074
ISSN: 0145-6008
CID: 1792722

Training and fidelity monitoring of 12-step facilitation adapted for alcoholics with serious psychiatric disorders [Meeting Abstract]

Bogenschutz, MP; Nowinski, J; Tonigan, JS; Kushner, R; Vogel, H; Hume, D; Treacher, R; Hyde, R
ISI:000256497200697
ISSN: 0145-6008
CID: 1792502

Reliability of self-report measures in seriously mentally ill alcoholics [Meeting Abstract]

Tonigan, JS; Bogenschutz, MP; Chavez, R; O'Nuska, M
ISI:000256497200705
ISSN: 0145-6008
CID: 1792512

Utilization of treatment and AA: Relative contributions to early abstinence [Meeting Abstract]

Tonigan, JS; Bogenschutz, MP; Forcehimes, AA
ISI:000256497200695
ISSN: 0145-6008
CID: 1792702

Mortality risk among recent-onset injection drug users in five U.S. cities

Vlahov, David; Wang, Cunlin; Ompad, Danielle; Fuller, Crystal M; Caceres, Wendy; Ouellet, Lawrence; Kerndt, Peter; Jarlais, Don C Des; Garfein, Richard S
To quantify the risk of death among recent-onset (< 5 years) injection drug users, we enrolled 2089 injection drug users (IDUs) age
PMID: 18365941
ISSN: 1082-6084
CID: 1535792

Music therapy: a novel motivational approach for dually diagnosed patients

Ross, Stephen; Cidambi, Indra; Dermatis, Helen; Weinstein, Jason; Ziedonis, Douglas; Roth, Serena; Galanter, Marc
Co-occurring mental illness and addiction is very common and results in worse treatment outcomes compared to singly diagnosed addicted individuals. Integrated treatment for co-occurring disorders is associated with better treatment outcomes; however there is a wide range of what is included in integrated treatment. Due to patient and staff interests, integrated treatment often includes complementary and alternative therapies, including music and art therapy. There is a need to study how these approaches effect treatment engagement, retention, and outcome. This study was a prospective naturalistic non-randomized pilot study without a control group that sought to evaluate how participation in a music therapy program affected treatment outcomes for individuals with co-occurring mental illness and addiction. In summary, music therapy appears to be a novel motivational tool in a severely impaired inpatient sample of patients with co-occurring disorders. Future studies of music therapy in integrated co-occurring disorder setting should include a control group
PMID: 18551887
ISSN: 1055-0887
CID: 79568

Long-term follow-up study of patients with refractory obsessive-compulsive disorder

Ross, Stephen; Fallon, Brian A; Petkova, Eva; Feinstein, Suzanne; Liebowitz, Michael R
The authors prospectively followed patients with treatment-resistant obsessive-compulsive disorder (OCD). Between 1988 and 1995, 56 patients with a history of inadequate response to oral clomipramine received 14 infusions of intravenous clomipramine. The follow-up period ranged from 4 to 11 years after treatment. Of the 44 subjects interviewed at follow-up, 70.5% had current OCD and 29.5% had sub-threshold OCD. Almost half reported feeling much improved or very much improved compared to their state prior to treatment with intravenous clomipramine
PMID: 19196930
ISSN: 1545-7222
CID: 94525

Ketamine and addiction

Ross S.
Ketamine is a schedule III drug with a well-established safety profile that has been used extensively as an anesthetic for close to 4 decades. It has long been described as a drug of abuse and has become known as one of the 'club drugs,' used by adolescents and young adults in rave and circuit party settings. Ketamine is a congener of phencyclidine and acts as a noncompetitive N-methyl-D-aspartate (NMDA) antagonist. Through a complicated and not completely understood process, NMDA antagonism increases dopamine levels in reward-related areas such as the ventral tegmental area and the nucleus accumbens. In addition to its addictive liability, there is also evidence to suggest that ketamine might have anti-addictive properties when used as an adjunct to psychotherapy that takes advantage of its ability to produce spiritually oriented altered states of consciousness. This technique has been applied to patients with alcohol and opiate use disorders. Ketamine's potential anti-addictive properties can be understood by looking at biologic and psycho-spiritual models
EMBASE:2009121435
ISSN: 1082-6319
CID: 97570