Ahmadi Jamshid, Kampman Kyle, Dackis Charles, Sparkman Thorne, Pettinati Helen
Center for the Study of Addictions, Treatment Research Center, University of Pennsylvania, Philadelphia, PA, USA.
Am J Addict. 2008 Jan-Feb;17(1):60-4. doi: 10.1080/10550490701755999.
Recent studies of substance dependence typologies briefly show that multivariate systems originally developed for identifying subtypes of alcoholics, such as Babor's Type A and B system, may also be valid in abusers of other substances, such as cocaine. Type B patients are characterized by an earlier onset of addiction and more severe symptoms of their addiction, psychopathology, and impulsivity. The Type B classification has also been associated with deficits in serotonergic function. We have found that patients who exhibit more severe cocaine withdrawal symptoms, as measured by scores on the Cocaine Selective Severity Assessment (CSSA), have poor treatment outcome and share many characteristics with "Type B" patients. In this paper, we review baseline characteristics of cocaine-dependent patients from several recently completed outpatient cocaine dependence treatment trials to assess the association of cocaine withdrawal symptom severity and the Type B profile. Identifying subtypes of cocaine-dependent patients may improve our ability to treat cocaine dependence by targeting treatments for specific subtypes of patients. We examined the ability of the CSSA scores to capture Type B characteristics in cocaine dependence by analyzing a series of cocaine medication trials that included 255 cocaine-dependent subjects. High CSSA scores at baseline were associated with a history of violent behavior, a family history of substance abuse, antisocial personality disorder, higher addiction severity, and co-morbid psychiatric diseases. Patients with high CSSA scores are also more likely to meet criteria for Type B (Type II) cocaine dependence. Identifying Type B cocaine-dependent patients may help to develop targeted psychosocial or pharmacological treatments for these difficult-to-treat patients.
近期关于物质依赖类型学的研究简要表明，最初为识别酗酒者亚型而开发的多变量系统，如巴博尔的A类和B类系统，在其他物质滥用者（如可卡因滥用者）中可能也有效。B类患者的特点是成瘾 onset 较早，成瘾、精神病理学和冲动性症状更严重。B类分类还与血清素能功能缺陷有关。我们发现，通过可卡因选择性严重程度评估（CSSA）得分衡量，表现出更严重可卡因戒断症状的患者治疗效果较差，且与“B类”患者有许多共同特征。在本文中，我们回顾了最近完成的几项门诊可卡因依赖治疗试验中可卡因依赖患者的基线特征，以评估可卡因戒断症状严重程度与B类特征之间的关联。识别可卡因依赖患者的亚型可能会通过针对特定亚型患者的治疗来提高我们治疗可卡因依赖的能力。我们通过分析一系列包括255名可卡因依赖受试者的可卡因药物试验，研究了CSSA得分捕捉可卡因依赖中B类特征的能力。基线时CSSA得分高与暴力行为史、物质滥用家族史、反社会人格障碍、更高的成瘾严重程度以及共病精神疾病有关。CSSA得分高的患者也更有可能符合B类（II型）可卡因依赖的标准。识别B类可卡因依赖患者可能有助于为这些难以治疗的患者开发有针对性的心理社会或药物治疗方法。
