Phencyclidine An Update Editor Doris H. Clouet

if possible, and try to manage the patient by placing him in a quiet, secure environment with a few people to relate to. After this period, we encourage the patient to take haloperidol in order to ameliorate the psychotic process as much as possible.

Although it has not been proven that acidification of the urine to increase PCP excretion alters the duration of the symptoms of psy-

1980). Maintaining the urine pH at an acid level for several weeks, even though the mental status is normal, is advised. It is important to test the pH of the urine to ensure compliance with the acidification. We have found that PCP becomes detectable in acidified urine for a time, even after being undetectable in alkaline urine, in previously intoxicated individuals. We have not found a change in mental status to result from such acidification treatment and resultant enhanced PCP excretion.

Finding ways to enhance the treatment alliance and decrease denial are major tasks of the hospital phase of treatment. One method used to engage the patient is to engage the family actively.

Staff spend a lot of their time talking with families, educating them, increasing their understanding of what has happened to their ill family members, and also helping the family to change habitual ways of relating to the patient, patterns that have facilitated or "enabled" rather than discouraged drug use. Often a change in family interaction can make the difference in success or failure of treatment. For example, families are often very tolerant of deviation or irresponsible behavior. Members will continue to support or cover for their family members, fearing that patients will be hurt if held accountable for their actions. In fact, the family members' tolerance has often reinforced the deviant behavior. The family sessions help the family members understand this and also provide support for behavioral change.

Narcotics Anonymous (NA)

Another important focus in developing a workable treatment plan for these patients is promoting their involvement with Narcotics Anonymous, or NA. The phenomenal growth of NA in the Washington, D.C. area over the past 2 to 3 years may be the most hopeful thing that has happened with regard to the drug problem in recent years. Good hospital programs, good detoxification techniques, talented therapists and counselors are weak forces, compared to the pressures that reinforce drug use in the outside community. In our experience, Alcoholics Anonymous has been useful in the past for only a limited number of drug abusers, as many drug-dependent individuals do not identify sufficiently with the dominant alcoholic group, therefore do not remain involved in Alcoholics Anonymous. Narcotics Anonymous is an organization of people who have experienced the drug-use lifestyle, rejected that lifestyle, and are developing another. NA provides a drug-free model for the recovering person, a social milieu, and a value system that

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promotes continued abstinence. NA members state their beliefs loudly and publicly, and provide needed support for each other, especially at times of weakness. Membership in and identification with NA provides, for many, the counterforce needed to withstand the lure of the drug-abusing peer group. Consequently, a major thrust in the PCP admissions service, as well as the other components of the drug-dependence services, is to acquaint the patient with NA and persuade him of the importance of membership and participation.

Aftercare Treatment

The outpatient aftercare phase of the program is where the difficult long-term changes in the individual's relation to drugs take place. Changes commenced in the protective inpatient environment are tested in the outside environment. We recommend that our patients attend a group therapy program for recovering PCP abusers, which meets twice weekly and includes regular monitored urine testing and family involvement. We recommend this program be attended for no less than 6 months. We further recommend daily attendance at NA initially, and continued involvement with NA indefinitely.

Even with the intense involvement of the inpatient program and a carefully devised treatment plan, many drop out of outpatient treatment and return to drug use. Nevertheless, we have found various psychotherapeutic strategies and methods worthwhile.

An educational, behavior modification approach should be taken with the patient. Education about chemical dependency is most important. Expected behavioral changes must be clearly conceived and communicated to the patient. Evaluation of vocational status and skill development require attention.

The patient can be taught to recognize the impulsiveness and sense of powerlessness that leads to the return of use of this drug.

The patient can be introduced to alternatives to a chemicallyinduced sense of invulnerability, and encouraged to practice these alternatives.

it helps to define and accept limited goals. Appropriate security measures are necessary, so that staff can feel safe; also, staff need to be educated about not taking unnecessary risks in handling these patients. Staff frustration has to be recognized and managed.

CONCLUSION

Treating the PCP abuser remains a dangerous and frustrating business. To date, our therapeutic measures have less effect than they do with abusers of other drugs. Part of the solution to the

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problem of PCP abuse may be an understanding of why drug abuse has become acceptable in our society. It may then be possible to devise appropriate primary prevention measures, so that the abuse of other drugs will not develop as has that of PCP.

REFERENCES

Capodonno, A.E.; Fram, D.H.; Holden, R.; and Targum, S.D. The

cyclidine (PCP) abusers. Am J Drug Alcohol Abuse 5:339-414, 1978.

Done, A.K.; Aronow, R.; and Miceli, J.N. Pharmokinetic bases for the diagnosis and treatment of acute PCP intoxication. J Psychedelic Drugs 12:253-258, 1980.

Erard, R.; Luisada, P.V.; and Peele, R. The PCP psychosis: Prolonged intoxication or drug-precipitated functional illness? J Psychedelic Drugs 12:235-251, 1980.

Graeven, D.B., and Sharp, J.G. Initiation, motivation, and cessation of phencyclidine use. J Psychol 108:43-57, 1981.

Luisada, P.V. The phencyclidine psychosis: Phenomenology and treatment. In: Peterson, R.C., and Stillman, R.C., eds. Phencyclidine Abuse: An Appraisal. National Institute on Drug Abuse Research Monograph 21. DHEW Pub. No. 78-728. Washington, D.C.: Supt. of Docs., U.S. Govt. Print. Off., 1978. pp. 241-253.

Russ, C., and Wong, D. Diagnosis and treatment of the phencyclidine psychosis: Clinical observations. J Psychedelic Drugs 11:277-282, 1979.

Wilford, B.B. Drug Abuse. Chicago: American Medical Association, 1981. pp. 3-19.

AUTHORS

David H. Fram, M.D.

Program Director, Adult Drug Dependence Services

Psychiatric Institute of Washington

Chairman, Metropolitan Psychiatric Group

2020 K Street, N.W.

Washington, DC 20006

Nancy Stone, M.D.

Attending Psychiatrist, The Gateway Program

Psychiatric Institute of Washington

Member, Metropolitan Psychiatric Group

4460 MacArthur Blvd., N.W.

Washington, DC 20037

260

While limited supplies last, single copies of the monographs may be obtained free of charge from the National Clearinghouse for Drug Abuse Information (NCDAI). Please contact NCDAI also for information about availability of coming issues and other publications of the National Institute on Drug Abuse relevant to drug abuse research.

Additional copies may be purchased from the U.S. Government Printing Office (GPO) and/or the National Technical Information Service (NTIS) as indicated. NTIS prices are for paper copy. Microfiche copies, at $6.50, are also available from NTIS. Prices from either source are subject to change.

Addresses are:

NCDAI

National Clearinghouse for Drug Abuse Information

P.O. Box 416

Kensington, Maryland 20795

2 OPERATIONAL DEFINITIONS IN SOCIO-BEHAVIORAL DRUG USE RESEARCH 1975. Jack Elinson, Ph.D., and David Nurco, Ph.D., eds.

NCDAI out of stock GPO out of stock

3 AMINERGIC HYPOTHESES OF BEHAVIOR: REALITY OR CLICHE? Bruce J.

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5 YOUNG MEN AND DRUGS: A NATIONWIDE SURVEY. John A. O'Donnell.

7 CANNABINOID ASSAYS IN HUMANS. Robert Willette, Ph.D., ed. GPO out of stock NCDAI out of stock

NTIS PB #251 905/AS $18.95

8 Rx: 3x/WEEK LAAM - ALTERNATIVE TO METHADONE. Jack Blaine, M.D.,

17 RESEARCH ON SMOKING BEHAVIOR. Murray E. Jarvik, M.D., Ph.D., et

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18 BEHAVIORAL TOLERANCE: RESEARCH AND TREATMENT IMPLICATIONS.

22 QUASAR: QUANTITATIVE STRUCTURE ACTIVITY RELATIONSHIPS OF ANALGESICS, NARCOTIC ANTAGONISTS, AND HALLUCINOGENS. Gene Barnett, Ph.D.; Milan Trsic, Ph.D .; and Robert Willette, Ph.D.; eds.

GPO out of stock NCDAI out of stock

NTIS PB #292 265/AS $36.95

23 CIGARETTE SMOKING AS A DEPENDENCE PROCESS. Norman A. Krasnegor,

24 SYNTHETIC ESTIMATES FOR SMALL AREAS: STATISTICAL WORKSHOP PAPERS AND DISCUSSION. Jos. Steinberg, ed. NCDAI out of stock

26 THE BEHAVIORAL ASPECTS OF SMOKING. Norman A. Krasnegor, Ph.D., ed. (Reprint from 1979 Surgeon General's Report on Smoking and Health.)

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27 PROBLEMS OF DRUG DEPENDENCE, 1979: PROCEEDINGS OF THE 41ST ANNUAL SCIENTIFIC MEETING, THE COMMITTEE ON PROBLEMS OF DRUG

28 NARCOTIC ANTAGONISTS: NALTREXONE PHARMACOCHEMISTRY AND SUSTAINED-RELEASE PREPARATIONS. Robert Willette. Ph.D., and

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30 THEORIES ON DRUG ABUSE: SELECTED CONTEMPORARY PERSPECTIVES. Dan J. Lettieri, Ph.D.; Mollie Sayers; and Helen W. Pearson, eds.

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Not available from NTIS

31 MARIJUANA RESEARCH FINDINGS: 1980. Robert C. Petersen, Ph.D., ed.

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32 GC/MS ASSAYS FOR ABUSED DRUGS IN BODY FLUIDS. Rodger L. Foltz, Ph.D.; Allison F. Fentiman, Jr., Ph.D.; and Ruth B. Foltz.

34 PROBLEMS OF DRUG DEPENDENCE, 1980: PROCEEDINGS OF THE 42ND ANNUAL SCIENTIFIC MEETING, THE COMMITTEE ON PROBLEMS OF DRUG

36 NEW APPROACHES TO TREATMENT OF CHRONIC PAIN: A REVIEW OF MULTIDISCIPLINARY PAIN CLINICS AND PAIN CENTERS. Lorenz K.Y.

ANNUAL SCIENTIFIC MEETING, THE COMMITTEE ON PROBLEMS OF DRUG DEPENDENCE, INC. Louis S. Harris, Ph.D., ed. NCDAI out of stock Not available from GPO NTIS PB #82-190760 $42.95

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42 THE ANALYSIS OF CANNABINOIDS IN BIOLOGICAL FLUIDS. Richard L. Hawks, Ph.D., ed.

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43 PROBLEMS OF DRUG DEPENDENCE, 1982: PROCEEDINGS OF THE 44TH ANNUAL SCIENTIFIC MEETING, THE COMMITTEE ON PROBLEMS OF DRUG DEPENDENCE, INC. Louis S. Harris, Ph.D., ed. NCDAI out of stock

45 CONTEMPORARY RESEARCH IN PAIN AND ANALGESIA, 1983. Roger M. Brown, Ph.D.; Theodore M. Pinkert, M.D., J.D.; and Jacqueline P.

48 MEASUREMENT IN THE ANALYSIS AND TREATMENT OF SMOKING BEHAVIOR. John Grabowski. Ph.D., and Catherine S. Bell, M.S., eds.

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NTIS PB 84-145-184 $18.95

49 PROBLEMS OF DRUG DEPENDENCE, 1983: PROCEEDINGS OF THE 45TH ANNUAL SCIENTIFIC MEETING, THE COMMITTEE ON PROBLEMS OF DRUG

51 DRUG ABUSE TREATMENT EVALUATION: STRATEGIES, PROGRESS, AND PROSPECTS. Frank M. Tims, Ph.D., ed.

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52 TESTING DRUGS FOR PHYSICAL DEPENDENCE POTENTIAL AND ABUSE

53 PHARMACOLOGICAL ADJUNCTS IN SMOKING CESSATION. John Grabowski, Ph.D., and Sharon M. Hall, Ph.D., eds.

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54 MECHANISMS OF TOLERANCE AND DEPENDENCE. Charles Wm. Sharp, Ph.D., ed. NCDAI out of stock

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55 PROBLEMS OF DRUG DEPENDENCE, 1984. PROCEEDINGS OF THE 46TH ANNUAL SCIENTIFIC MEETING, THE COMMITTEE ON PROBLEMS OF DRUG DEPENDENCE, INC. Louis S. Harris, Ph.D., ed. NCDAI out of stock GPO Stock #017-024-01242-4 $9.50

56 ETIOLOGY OF DRUG ABUSE: IMPLICAlIONS FOR PREVENTION. Coryl LaRue Jones, Ph.D., and Robert J. Battjes, D.S.W., eds.

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57 SELF-REPORT METHODS OF ESTIMATING DRUG USE: MEETING CURRENT CHALLENGES TO VALIDITY. Beatrice A. Rouse, Ph.D., Nicholas J.

59 CURRENT RESEARCH ON THE CONSEQUENCES OF MATERNAL DRUG ABUSE. Theodore M. Pinkert, M.D., J.D., ed.

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60 PRENATAL DRUG EXPOSURE: KINETICS AND DYNAMICS. C. Nora Chiang, Ph.D., and Charles C. Lee, Ph.D., eds.

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61 COCAINE USE IN AMERICA: EPIDEMIOLOGIC AND CLINICAL PERSPECTIVES. Nicholas J. Kozel, M.S., and Edgar H. Adams, M.S., eds.

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62 NEUROSCIENCE METHODS IN DRUG ABUSE RESEARCH. Roger M. Brown, Ph.D., and David P. Friedman, Ph.D., eds.

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63 PREVENTION RESEARCH: DETERRING DRUG ABUSE AMONG CHILDREN AND ADOLESCENTS. Catherine S. Bell, M.S., and Robert Battjes, D.S.W., eds.

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64 PHENCYCLIDINE: AN UPDATE. Doris H. Clouet, Ph.D., ed. GPO Stock #013-024-01281-5 $6.50

65 WOMEN AND DRUGS: A NEW ERA FOR RESEARCH. Barbara A. Ray, Ph.D., and Monique C. Braude, Ph.D., eds.

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67 PROBLEMS OF DRUG DEPENDENCE, 1985. PROCEEDINGS OF THE 47TH ANNUAL SCIENTIFIC MEETING, THE COMMITTEE ON PROBLEMS OF DRUG DEPENDENCE, INC. Louis S. Harris, Ph.D., ed. NCDAI out of stock GPO Stock #017-024-01292-1 $18

68 STRATEGIES FOR RESEARCH ON THE INTERACTIONS OF DRUGS OF ABUSE. Monique C. Braude, Ph.D., and Harold M. Ginzburg, M.D., J.D ,M.P.H., eds.

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69 OPIOID PEPTIDES: MEDICINAL CHEMISTRY. Rao S. Rapaka, Ph.D.; Gene Barnett, Ph.D .; and Richard L. Hawks, Ph.D., eds.

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70 OPIOID PEPTIDES: MOLECULAR PHARMACOLOGY, BIOSYNTHESIS, AND ANALYSIS. Rao S. Rapaka, Ph.D., and Richard L. Hawks, Ph.D., eds. GPO Stock #017-024-1298-0 $12

71 OPIATE RECEPTOR SUBTYPES AND BRAIN FUNCTION. Roger M. Brown, Ph.D.; Doris H. Clouet, Ph.D .; and David P. Friedman, Ph.D., eds. GPO Stock #017-024-01303-0 $6

72 RELAPSE AND RECOVERY IN DRUG ABUSE. Frank M. Tims, Ph.D., and Carl G. Leukefeld, D.S.W., eds.

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73 URINE TESTING FOR DRUGS OF ABUSE. Richard L. Hawks, Ph.D., and C. Nora Chiang, Ph.D., eds.

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74 NEUROBIOLOGY OF BEHAVIORAL CONTROL IN DRUG ABUSE. Stephen I. Szara, M.D., D.Sc., ed.

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75 PROGRESS IN OPIOID RESEARCH. PROCEEDINGS OF THE 1986 INTERNATIONAL NARCOTICS RESEARCH CONFERENCE. John W. Holaday, Ph.D.; Ping-Yee Law, Ph.D .; and Albert Herz, M.D., eds.

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76 PROBLEMS OF DRUG DEPENDENCE, 1986. PROCEEDINGS OF THE 48TH ANNUAL SCIENTIFIC MEETING, THE COMMITTEE ON PROBLEMS OF DRUG DEPENDENCE, INC. Louis S. Harris, Ph.D., ed.

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IN PRESS

77 ADOLESCENT DRUG ABUSE: ANALYSES OF TREATMENT RESEARCH. Elizabeth R. Rahdert, Ph.D. and John Grabowski, Ph.D., eds.

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