Academic journal article Journal of Cognitive Psychotherapy

Cocaine Dependence and Anxiety Sensitivity among Patients Presenting for Residential Drug Use Treatment

Academic journal article Journal of Cognitive Psychotherapy

Cocaine Dependence and Anxiety Sensitivity among Patients Presenting for Residential Drug Use Treatment

Article excerpt

Cocaine use and dependence remains an important public health concern. Thus, the identification of individual difference factors that may maintain cocaine use remains an important goal. The goal of the current study is to test whether the cognitive vulnerability of anxiety sensitivity (AS), an identified risk factor for anxiolytic use and use-related disorders, is related to cocaine dependence diagnosis (n 5 168) among a sample of drug users currently enrolled in residential treatment (N 5 304). Results demonstrated that AS was significantly related to cocaine dependence and remained significant after controlling for sex, age, alcohol dependence, hallucinogen dependence, major depressive disorder, panic disorder, and posttraumatic stress disorder. Taken together, these data suggest that AS may have a specific relation to cocaine dependence, calling into question the notion that AS is positively related only to drugs with anxiolytic properties.

Keywords: cocaine; substance dependence; substance use disorders; anxiety sensitivity; anxiety

Cocaine use and cocaine use disorders (CUDs) remain a serious public health concern. According to the latest National Survey on Drug Use and Health (Substance Abuse and Mental Health Services Administration [SAMHSA], 2009b), estimates of current (past-month) cocaine use and CUDs among people aged 12 years and older have remained quite stable over the past 6 years. Further, nearly 75% of current cocaine users met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV; American Psychiatric Association [APA], 1994) criteria for a CUD (dependence or abuse), making CUD the third most common illicit substance use disorder (SUD; SAMHSA, 2009b). Cocaine use has also been associated with various negative outcomes including hospitalization, increased vulnerability to other serious medical conditions or infections, and even death (DeBeck et al., 2009; Minkoff et al., 2008; Shannon et al., 2008; SAMHSA, 2008, 2009a). According to two annual reports generated through the Drug Abuse Warning Network (DAWN), cocaine was the most frequently cited illicit substance involved in all hospital emergency department visits, followed by marijuana, heroin, and other stimulants (SAMHSA, 2008). Cocaine appears to be involved in approximately one-third of all emergency department visits for substance misuse, and seven of eight participating states reported increases in percentages of drug-related deaths between 2006 and 2007 (SAMHSA, 2008, 2009a).

Approximately 19% of current cocaine users use crack cocaine (SAMHSA, 2009b). Among the many impairments associated with crack cocaine use, repeated crack cocaine use has been identified as a central risk factor for several infectious diseases, including human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), human papillomavirus (HPV) infection, and viral hepatitis C (HCV) infection (DeBeck et al., 2009; Minkoff et al., 2008; Shannon et al., 2008). Several factors can contribute to infectious diseases vulnerability among crack cocaine users. Crack cocaine users may be at an increased vulnerability to contract disease either directly, via the sharing of contaminated needles and drug paraphernalia (e.g., Latkin et al., 2009), or indirectly, through the frequent high-risk sexual behaviors that these individuals tend to engage while intoxicated (e.g., Minkoff et al., 2008). In sum, repeated crack cocaine use may place individuals at risk for substantial adverse health and social consequences associated with use.

Given the serious public health issues linked to cocaine use and its disorders, the need to identify individual difference factors that may maintain crack cocaine use remains an important goal. One individual difference that appears relevant to substance use and substance dependence is anxiety sensitivity (AS), or fear of anxiety-related sensations (e.g., increased heart rate, sweating, muscle tension, headaches) caused by the belief that there will be some negative physical, social, or mental outcome as a result of having those symptoms. …

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