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Biomedical subjects

C P O'Brien

Publications and source records attributed to C P O'Brien.

At least 55 records · Page 3Linked to original sources
PubMed1998

Predictors of participation in aftercare sessions and self-help groups following completion of intensive outpatient treatment for substance abuse.

OBJECTIVE: The goals of this study were to identify predictors of greater participation in aftercare treatment sessions and self-help groups during the first 3 months following completion of a 4-week intensive outpatient rehabilitation (IOP) program. METHOD: The subjects were 138 male veterans who met DSM-III-R criteria for lifetime diagnoses of both alcohol and cocaine dependence (n = 67), alcohol dependence only (n = 48) or cocaine dependence only (n = 23); completed an IOP program; and expressed a desire to enter a formal aftercare program. Analyses examined relationships between predictor variables from five different domains and number of aftercare sessions and self-help groups attended in the last week of each month of the follow-up period. RESULTS: Of the many potential predictor variables that were examined, only remission from cocaine and alcohol dependence during IOP and higher AIDS risk behavior scores in the prior 6 months contributed independently to the prediction of greater participation in aftercare. Further analyses identified several variables that were differential predictors of participation in individualized relapse prevention aftercare versus standard 12-step focused group aftercare. More years of cocaine use, greater current legal problems and a lack of current alcohol dependence predicted greater self-help participation at the level of a trend. CONCLUSIONS: The achievement of remission from substance use dependence during IOP may be an important criterion for moving to the next level of care. However, the results of the present study also point to the need for an increased focus on factors present during the course of aftercare in future studies of retention in aftercare following outpatient rehabilitation.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Clinical correlations with carbohydrate-deficient transferrin levels in women with alcoholism.

Carbohydrate-deficient transferrin (CDT) has received increasing attention as a potential biological marker for heavy drinking or as an objective marker of relapse in patients who are treated for alcohol dependence. Previous studies have demonstrated the utility of CDT among men, but there are fewer and inconsistent reports on the utility of CDT among women. This study reports in a sample of 40 alcohol-dependent women, the association between CDT levels, and several different types of measures of drinking intensity including frequency of heavy drinking. Although the majority of drinking indices correlated with CDT levels in men, among women, CDT levels were significantly correlated with the percentage of days of heavy drinking when heavy drinking day was defined as drinking 6 or more drinks per drinking day. The results also support an association between current menstrual function, CDT levels, and drinking indices. These findings suggest that the pattern of drinking (combining high frequency and high intensity) may be an important determinant of CDT levels in women with alcohol dependence, compared with men.

Adult↗
PubMed1998

Effects of naltrexone administered repeatedly across 30 or 60 days on ethanol consumption using a limited access procedure in the rat.

The present study examined the effects of naltrexone, 1.0 mg/kg, administered repeatedly across both 30 and 60 days on the consumption of an unsweetened ethanol solution by outbred Wistar rats in a limited access procedure. Naltrexone significantly suppressed consumption of ethanol across both 30 and 60 days. These results provide no evidence for the development of tolerance based on such factors as receptor upregulation or supersensitivity due to the repeated administration of naltrexone across extended periods. Ethanol consumption during the final one-third of the naltrexone sessions, for both the 30- and 60-day groups, was significantly lower than during the initial sessions. These results suggest an associative component. That is, the rats apparently learned that ethanol consumption was no longer reinforcing across repeated exposures. After termination of naltrexone treatment, consumption of ethanol immediately increased. However, consumption in those rats who were administered naltrexone for 60 days remained significantly suppressed, compared with consumption in those rats who were administered naltrexone for 30 days. These results suggest that naltrexone reduces ethanol consumption by blocking endogenous opioid receptors that mediate, at least in part, ethanol's reinforcing properties. In addition, these data suggest that longer clinical use of naltrexone, as a pharmacological adjunct to psychosocial treatment for alcohol-dependent patients, may be beneficial in reducing the number of relapses experienced.

Alcoholism↗
PubMed1997

A range of research-based pharmacotherapies for addiction.

Modern approaches to the treatment of addiction have been influenced by several important factors. These include advances in our understanding of the nature of addiction based on longitudinal studies, and progress in elucidating the biological underpinnings of addictive behavior. In addition, changes in the system for delivery of services have begun to shape the way that addiction is treated.

Alcoholism↗
PubMed1997

Problem-service 'matching' in addiction treatment. A prospective study in 4 programs.

BACKGROUND: Our initial attempts to "match" substance-abuse patients from an employee assistance program to an optimal setting or program failed. Scientifically, we found no differential predictors of better outcomes by setting or program. From a practical perspective, it was impossible to place patients in the intended programs. This led to a second study, designed to identify specific patient problems and match professional services to those problems within each of the 4 programs. METHODS: Ninety-four new patients admitted to 4 substance-abuse treatment programs were randomly assigned to standard treatment and treated in the usual manner or were assigned to "matched" services, in which patients received at least 3 professional sessions directed at their important employment, family, or psychiatric problems. RESULTS: Matched patients stayed in treatment longer, were more likely to complete treatment, and had better posttreatment outcomes than did the standard patients treated in the same programs. CONCLUSIONS: For logistical, financial, and clinical reasons, it is improbable that patients will be matched to specific types of programs. However, within any program, it is possible and practical to match appropriate services to patients' specific treatment problems. This strategy was clinically and administratively practical, attractive to patients, and responsible for a 20% to 30% increase in the effectiveness of this substance-abuse treatment system.

Adult↗
PubMed1997

Naltrexone and alcohol dependence. Role of subject compliance.

BACKGROUND: Two previous double-blind, placebo-controlled studies demonstrated that naltrexone (50 mg/d) reduces alcohol drinking in alcohol-dependent subjects. In both studies, treatment compliance was excellent. However, a robust treatment effect size for naltrexone relative to placebo has been shown for compliant subjects but not for subjects who missed research visits. The goal of this study was to determine the effectiveness of naltrexone in subjects who received psychosocial treatment in a more naturalistic setting with respect to the role of treatment attendance and medication compliance. METHODS: Ninety-seven alcohol-dependent subjects were randomly assigned to receive either naltrexone (n = 48) or matching placebo (n = 49) for 12 weeks. All subjects received individual counseling (twice per week for the first month followed by once per week). RESULTS: Overall, naltrexone showed only modest effects in reducing alcohol drinking for the 12 weeks of treatment. However, naltrexone treatment efficacy improved across a variety of outcome measures for subjects who completed treatment and were highly compliant with taking medication. CONCLUSIONS: Naltrexone is clinically effective relative to placebo in individuals who comply with the treatment protocol and take medication. The modest treatment effects in the entire sample suggest that the clinical efficacy of naltrexone could be improved by enhancing treatment compliance.

Adult↗
PubMed1997

Effect of naltrexone on subjective alcohol response in subjects at high and low risk for future alcohol dependence.

We investigated specific subjective effects of naltrexone pretreatment or placebo during various intervals on the breath alcohol level (BAL) curve in nonalcoholic volunteers. Fifteen high-risk (social drinkers with an alcoholic father) and 14 low-risk (no alcoholic relatives in at least two generations) subjects were tested in a double-blind placebo-controlled study of the effects of 50 mg oral naltrexone on response to a moderate dose of alcohol. Dependent measures included subjective stimulation and sedation subscales from the Biphasic Alcohol Effects Scale (BAES) and mood subscales from the Profile of Mood States (POMS). At rising BALs, high-risk subjects showed a naltrexone-related attenuation of BAES stimulation. This effect was not evident in low-risk subjects, who directionally showed the opposite effect, although nonsignificant. For both groups, there were no significant naltrexone-related effects for BAES sedation; however, naltrexone did affect several POMS scales on alcohol response, such as decreased vigor, and increased fatigue, tension, and confusion. Confusion was significantly elevated for the high-risk group during rising BALs of the naltrexone session. The results suggest a differential response to naltrexone, based on paternal history of alcoholism and level of stimulation experienced during alcohol drinking.

Adult↗
PubMed1997

Group counseling versus individualized relapse prevention aftercare following intensive outpatient treatment for cocaine dependence: initial results.

Ninety-eight male cocaine-dependent patients who completed an intensive outpatient program (IOP) were randomly assigned to either standard group counseling (STND) or individualized relapse prevention (RP) aftercare. Heavier cocaine and alcohol use during IOP and low self-efficacy predicted more cocaine use during the treatment phase of the study, whereas lifetime diagnoses of alcohol dependence, major depression, and any anxiety disorder predicted less cocaine use. Rates of complete abstinence during the 6-month study period were higher in STND than RP, whereas RP was more effective in limiting the extent of cocaine use in those who used during Months 1-3. Matching analyses indicated patients who failed to achieve remission from cocaine dependence during IOP and those with a commitment to absolute abstinence did better in RP than in STND, whereas patients with other abstinence goals did better in STND than RP. Several differences in experiences before cocaine use and "near-miss" episodes were also identified.

Adult↗
PubMed1997

Relationship of perceived competencies, perceived social support, and gender to substance use in young adolescents.

OBJECTIVE: This survey study explores the relationship between area-specific perceived self-competence, perceived social support, gender, and substance use in young adolescents. METHOD: Questionnaires were administered to 140 male and 131 female adolescents attending middle school to assess self-perception of competencies, social support, and substance use. Correlations were performed between the predictor variables and the substance use measures. Hierarchical multiple regressions were also used to identify potential interactions between gender, perceived competencies, and perceived social support in the prediction of specific substances. RESULTS: Higher perceived scholastic competence was associated with less substance use in both genders. In boys, more perceived support from teachers, and to a lesser degree parents, was associated with less substance use, particularly in those with low scholastic competence. In girls, social support was unrelated to substance use except for support from classmates, which was associated with more cigarette and marijuana use. However, in girls with low scholastic competence, more support from peers was consistently associated with more substance use. CONCLUSIONS: The gender differences in risk factors for early substance use identified in this study deserve further investigation, in view of their potential relevance for adolescent substance abuse prevention and early intervention.

Achievement↗
PubMed1997

Naltrexone in the treatment of alcoholism.

Alcoholism affects nearly 12.5 million Americans and is responsible for annual costs of over $130 billion from loss of job productivity, deleterious health effects, and direct treatment expenses. Research on treating alcoholism from the standpoint of relapse prevention using psychosocial interventions alone has produced only modest results. Studies on the efficacy of adjunctive medications using multiple medications in placebo-controlled and open trials combined with psychosocial interventions have shown mixed results. Recently, a safe and well-tolerated opiate antagonist, naltrexone, was approved by the Food and Drug Administration (FDA) for the adjunctive treatment of alcoholism. This review describes the pertinent preclinical and clinical research that led to the FDA's approval. Details are provided describing the subjects, methods, and results of the two pivotal human studies that led to the FDA review for this indication. Clinical therapeutic guidelines, appropriate patient selection, and future directions are also elucidated.

Alcoholism↗
PubMed1997

Carbohydrate-deficient transferrin: an investigative biochemical marker of heavy alcohol consumption.

Carbohydrate-deficient transferrin (CDT) has been identified as a potential biochemical marker of heavy alcohol consumption. Published studies to date primarily have focused on the ability of CDT levels to distinguish individuals with heavy alcohol drinking from nondrinking populations. In contrast, this study examines the utility of CDT levels in distinguishing alcohol-dependent patients who drink heavily from those who drink smaller amounts. This study also evaluates the potential relationship of CDT to severity of alcohol dependence and its gender differences. Serum was collected in 38 DSM-III-R alcohol-dependent outpatients at treatment entry (22 males, 16 females). CDT levels correlated with the extent of alcohol drinking in the month before treatment in males (r = 0.56, df = 20, p < .01), but not in females (r = 0.08, df = 14, NS). CDT levels also correlated with alcohol severity at pre-treatment in males (r = 0.53, df = 20, p < .05), but not in females (r = 0.27, df = 14, NS). Thus, elevated CDT levels may be mediated by alcohol severity, distinguishing CDT not only as a marker of heavy drinking, but also as an indicator of the severity of drinking-related biological and psychosocial dysfunction that may require further intervention.

Adult↗
PubMed1997

Psychiatric symptoms, risky behavior, and HIV infection.

These data are internally consistent and lead to several conclusions, as follows: Elevated levels of psychiatric symptoms were found among IDUs in methadone treatment as compared to their counterparts who were out of treatment. IVDUs who entered treatment had higher symptom levels than those who did not enter treatment. Higher symptom levels were found among injectors than noninjectors, and needle sharers had especially high psychiatric symptom levels. Higher symptom levels were found among those who seroconverted in the 6 months following notification, but not thereafter. Symptom levels did not distinguish between HIV-positive and HIV-negative individuals 24 months following notification of seropositivity. Taken together, these findings indicate that elevated psychiatric symptoms are risk factors for continued high risk behavior, as well as for seroconversion. The data add to those of Brooner and colleagues (1993), who demonstrated that ASPD serves as a risk factor for HIV infection. The fact that antisocial personality disorder and psychiatric severity are associated with risky behavior and with actual HIV infection further expands earlier findings showing that these two factors are associated with poorer treatment outcome. Other axis II disorders (e.g., borderline or narcissistic), as well as other axis I disorders with high symptom levels that were not well represented in these studies (schizophrenia, manic depressive illness), may also show similar elevated rates of risky behavior and seroconversion, although there is a scarcity of data currently available to assess the risk behavior of these patients. The evidence from treatment studies that psychiatrically focused therapies, when combined with substance abuse treatment, can improve overall outcome for patients with clinically significant levels of psychiatric symptoms may be relevant in the design of future risk reduction efforts. That is, these treatment outcome studies may serve as a starting point for exploring the feasibility and efficacy of using psychiatrically focused treatment to reduce risky behavior and HIV infection among psychiatrically symptomatic IDUs.

Antisocial Personality Disorder↗
PubMed1997

Naltrexone biotransformation and incidence of subjective side effects: a preliminary study.

When administered orally, naltrexone undergoes extensive biotransformation and is metabolized to 6 beta-naltrexol and other minor metabolites. Naltrexone has been recently approved by the Food and Drug Administration for the treatment of alcohol dependence. An important clinical issue with naltrexone treatment is predicting patient compliance, which may be influenced by adverse side effects experienced during the medication. We investigated whether subjective side effects were related to urinary concentrations of naltrexone and its metabolite 6 beta-naltrexol 3 hr after administration of 50 mg po naltrexone in 24 male moderate-to-heavy social drinkers. The results showed significantly higher levels of urinary 6 beta-naltrexol (p < 0.05) in those subjects who experienced one or more side effect (i.e., headache, nausea, anxiety, or erection). Urinary naltrexone levels did not differ between the groups. Results also showed an approximate 10:1 ratio of 6 beta-naltrexol to naltrexone levels and a significant positive correlation between the parent compound and metabolite, suggesting parallel renal clearance. The results of this study suggest a possible mechanism for the side effects observed after acute administration of naltrexone.

Administration, Oral↗
PubMed1997

Gender differences in comorbidly depressed alcohol-dependent outpatients.

UNLABELLED: Clinical profiles of alcohol-dependent male and female outpatients were evaluated at treatment entry to compare the level of clinical severity in alcoholics with a coexistent comorbid depressive disorder to alcoholics who have never been depressed. Due to a higher proportion of females than males in the depressed alcoholic population, selected patient groups were oversampled to create a study group with equivalent number of males and females with and without comorbid depression. Clinical severity was assessed by examining both the extent of alcohol problems, and depressive symptomatology at treatment entry with respect to gender differences (unrelated to depression), effects of comorbid depression (unrelated to gender), and effects from the interaction of gender and depression. There were 93 DSM-III-R alcohol-dependent outpatients (50 males, 43 females), half of whom had a current or lifetime DSM-III-R depressive disorder. The amount of drinking in the 90 days before treatment entry, the degree of alcohol severity, and the number of lifetime drinking-related consequences were collected in the first week after detoxification. Diagnoses of lifetime and current depression were determined via the Structured Clinical Interview for DSM-III-R, and depressive symptoms were evaluated with rating scales 1 week after detoxification. In most cases, a depressive disorder was diagnosed only if sometime in the patient's history depressive symptoms had either predated problem drinking or been present during a 6-month abstinent period. RESULTS: depressed males had a more severe clinical profile with respect to their alcoholism (i.e., more drinking, drinking-related problems, and alcohol severity than depressed females and never-depressed males). Surprisingly, females who had never been depressed (also no family history of depression) reported drinking the same quantities of alcohol in the 90 days before treatment and had comparable alcohol severity and number of consequences as males who had never been depressed. Depressed females, however, were more severely depressed (i.e., reported more intensive depressive symptoms than depressed male alcoholics). Thus, determining the type and extent of clinical severity at treatment entry in comorbidly depressed alcoholics depends on the gender of the patient The significant interaction between gender and the presence of comorbid depression that was found in this study may have important implications for predicting success in treatment.

Alcohol Drinking↗