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Biomedical subjects

C P O'Brien

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

At least 73 records · Page 4Linked to original sources
PubMed1997

The Addiction Severity Index in clinical efficacy trials of medications for cocaine dependence.

In sum, the ASI provides a standard and multidimensional initial evaluation of the subject. Furthermore, a profile of subjects is obtained that can be compared at different evaluation points, providing secondary outcomes. However, for the purposes of clinical trials evaluating pharmacotherapy for cocaine abusers, supplemental measures are needed at both baseline and followup to more specifically address cocaine use and problems.

Cocaine↗
PubMed1996

Amantadine in the early treatment of cocaine dependence: a double-blind, placebo-controlled trial.

A 4-week, double-blind, placebo-controlled trial of amantadine was conducted in 61 cocaine dependent outpatients. Subjects received 100 mg of amantadine 3 times daily. A follow-up visit was conducted at week 8. There were no significant differences between groups in treatment retention, or in the number of benzoylecgonine positive urine samples. Self-reported drug and alcohol use declined in both groups. At week 8 follow-up, self-reported drug use was significantly lower in the placebo group. Amantadine was not effective, and discontinuation of it may have been associated with an increase in cocaine use.

Adult↗
PubMed1996

Failure of ritanserin to block cocaine cue reactivity in humans.

As part of a double-blind placebo-controlled study of the effects of ritanserin on cocaine use and craving, reactivity to cocaine-related events was assessed both before and during medication. Twenty-two patients receiving ritanserin and 23 receiving placebo were exposed to cocaine cues while continuous measures of heart rate, skin temperature, and skin resistance were taken. Self-reports of high, withdrawal, and craving were also collected. The cues produced significant physiological responding as well as significant increases in high and craving during both sessions. Ritanserin reduced cue-elicited decreases in skin temperature, but had no effect on heart rate and skin resistance or on cue-induced high and craving. The results demonstrate that cue reactivity is a robust phenomenon across two assessment sessions but fail to support the use of ritanserin as a means of reducing cue-elicited drug states.

Arousal↗
PubMed1996

Recent developments in the pharmacotherapy of substance abuse.

Modern concepts of addictive disorders emphasize the compulsive and relapsing drug-taking behaviors rather than tolerance and physical dependence. As with any chronic disorder, long-term treatment is necessary and medications may aid in the rehabilitative process. Specific medications have been demonstrated to be helpful for psychiatric disorders coexisting with addiction. Medications have also been demonstrated in controlled studies to aid in the rehabilitation of patients dependent on nicotine, alcohol, or opiates. Thus far, no medication has been clearly demonstrated to benefit patients suffering from abuse or dependence on cocaine, cannabinoids, nonalcohol sedatives, or hallucinogens.

Cannabis↗
PubMed1996

Crack cocaine abuse: an epidemic with many public health consequences.

In the mid-1980s a new, smokable form of cocaine, called crack, was introduced in the United States. Soon thereafter, it became apparent that crack cocaine abuse was a serious and important public health concern. Over the past several years, crack cocaine use has increasingly been associated with a myriad of immediate and long-term adverse effects. During this same period, crack cocaine use has progressively moved away from experimentation and recreational use to chronic and compulsive drug use.

Chronic Disease↗
PubMed1996

Evaluating the effectiveness of addiction treatments: reasonable expectations, appropriate comparisons.

Problems of alcohol and drug dependence are costly to society in terms of lost productivity, social disorder, and avoidable health care utilization. The dollar costs of alcohol and drug use run into billions of dollars, and from one-eighth to one-sixth of all deaths can be traced to this source. However, the efficacy of treatment for addiction is often questioned. A rationale for reasonable expectations of addiction treatments is offered, from which are derived three outcome criteria for judging the effectiveness of treatments: reduction in substance use; improvement in personal health and social function; and reduction in public health and safety risks. Based on these criteria, treatment was shown to be effective, especially when compared with alternatives like no treatment or incarceration. These evaluations, which were conducted in a scientific manner, support the continued value of public spending for carefully monitored treatment of addiction.

Attitude to Health↗
PubMed1996

Exercise prescription: lessening the risk of physical activity.

The benefits of exercise to healthy individuals and cardiac patients is well established. Mortality rates and morbidity rates are reduced significantly by engaging in low intensity exercise. A large proportion of the population do not engage in regular exercise. Healthcare professionals should be proactive in dissipating positive information regarding safe exercise participation, thus reducing the risk factor of physical inactivity.

Cardiac Rehabilitation↗
PubMed1996

"Rugby neck": cervical degeneration in two front row rugby union players.

PURPOSE: To highlight the insidious effect of long term front row play on the cervical spine. CASE SUMMARY: Two rugby union front row players presented with neck pain in the middle of the 1991-1992 season. Both had been playing rugby from an early age in the front row. Both had represented their country at school level. They also had both played senior rugby in the Leinster province of Ireland from the age of 19 years. One of the players presented with neck pain with associated radicular radiation. The other player presented with an insidious chronic neck pain. There was no history of acute trauma save the week-in/week-out collisions that occur in the front row of the rugby scrum. Radiological evaluation revealed chronic cervical vertebral and disk degeneration. One of the subjects had an acute disk prolapse. This was surgically removed. The second subject had evidence of chronic disk degeneration. Both players have now retired from rugby at the age of 31. DISCUSSION: Both injuries would appear to be caused by the high loading that front row play places on the cervical spine. RELEVANCE: A high index of suspicion is needed when assessing cervical spine injuries in front row rugby players. Seemingly, minor injuries may signpost more serious, and potentially catastrophic neck pathology.

Adult↗
PubMed1995

Carbamazepine treatment for cocaine dependence.

We report on a double-blind, placebo-controlled study of carbamazepine (CBZ) treatment for cocaine dependence. A previously reported uncontrolled study found CBZ to be a beneficial pharmacotherapy for cocaine dependence. Statistical analyses were performed on data from 82 subjects who were randomized to 10 weeks' treatment with either CBZ, titrated to 4-12 micrograms/ml, (n = 37) or placebo (n = 45). The two treatment groups did not differ for primary outcome measures of retention time in treatment, urine samples positive for cocaine metabolite, subject reported desire for cocaine or for subject reported side-effects. CBZ was not an effective treatment in this study.

Adult↗
PubMed1995

Effect of random versus nonrandom assignment in a comparison of inpatient and day hospital rehabilitation for male alcoholics.

Alcoholic patients randomly assigned to day hospital or inpatient rehabilitation were compared with patients who self-selected these treatment settings to examine differences in substance use and psychosocial outcomes under experimental and nonexperimental designs. Patients who self-selected treatment did not have better outcomes than those who were randomly assigned, and there were no significant differences between day hospital patients and inpatients on any of the 11 outcome measures. Significant interactions between treatment setting and assignment were found with only 2 outcome measures. Therefore, the comparisons between day hospital and inpatient treatment yielded similar outcomes under both "scientific" conditions and the conditions that more closely approximate the experiences of most patients. Implications for the use of nonrandomized participants in alcoholism treatment research and limitations of the study were also discussed.

Adult↗
PubMed1995

Effect of naltrexone on alcohol "high" in alcoholics.

OBJECTIVE: Subjective effects of alcohol in alcoholics treated with naltrexone or placebo were compared. METHOD: In a previously reported double-blind clinical trial of 50 mg/day of naltrexone or placebo for treatment of alcoholism, 36 of 70 detoxified male veterans deviated from abstinence. Of these 36, 29 subsequently reported on the subjective effects of drinking during the trial. RESULTS: A larger proportion of naltrexone-treated subjects (seven of 12) than placebo-treated subjects (two of 17) reported that the "high" produced by alcohol during the study was significantly less than usual. The naltrexone-treated subjects also drank less alcohol than the placebo-treated subjects during the first drinking episode. There was no difference between groups in reported intoxication, craving, memory, or loss of temper. CONCLUSIONS: The lower alcohol consumption by the naltrexone-treated subjects may have resulted from naltrexone's blockage of the pleasure produced by alcohol.

Alcohol Drinking↗
PubMed1995

Psychotherapy in community methadone programs: a validation study.

OBJECTIVE: The authors tested the efficacy of individual psychotherapy in the rehabilitation counseling of psychiatrically symptomatic opiate-dependent patients during methadone maintenance treatment in community programs. METHOD: Volunteers in three community programs were randomly assigned to 24 weeks of counseling plus supplemental drug counseling or to counseling plus supportive-expressive psychotherapy. Follow-ups were done 1 and 6 months after treatment ended. A total of 84 subjects were evaluated at both follow-up points. RESULTS: During the study the patients receiving supportive-expressive psychotherapy and those receiving drug counseling had similar proportions of opiate-positive urine samples, but the patients receiving supportive-expressive psychotherapy had fewer cocaine-positive urine samples and required lower doses of methadone. One month after the extra therapy ended both groups had made significant gains, but there were no significant differences between groups. By 6-month follow-up many of the gains made by the drug counseling patients had diminished, whereas most of the gains made by the patients who received supportive-expressive psychotherapy remained or were still evident; many significant differences emerged, all favoring supportive-expressive psychotherapy. CONCLUSIONS: Psychotherapy can be delivered to psychiatrically impaired patients in community methadone programs. Additional counseling is associated with early benefits comparable to those from psychotherapy, but these gains are not sustained. The gains associated with psychotherapy persist and in some cases strengthen for at least 6 months after the end of therapy.

Adult↗
PubMed1995

Naltrexone in the treatment of alcoholism: predicting response to naltrexone.

The pooled results of 99 subjects from our Veterans Affairs population show that naltrexone-treated subjects had a greater reduction in alcohol craving, number of drinking days, and alcoholic relapse rates when compared with placebo-treated subjects. Based on our findings and results from other double-blind trials of naltrexone, we conclude that naltrexone is a safe and useful adjunct in the rehabilitation of alcohol-dependent patients. Increased baseline levels of psychological distress and craving as well as higher levels of somatic distress, anxiety, phobic anxiety, and obsessive-compulsive symptoms predicted an increased number of drinking days during the study. Significant interactions between naltrexone treatment, initial craving, and somatic distress suggest that naltrexone may be useful for subjects who present with high levels of craving and somatic symptoms.

Adult↗
PubMed1995

Medical management of alcohol dependence: clinical use and limitations of naltrexone treatment.

Historically, pharmacological and psychosocial treatments for alcohol dependence have demonstrated only modest effectiveness in reducing alcohol drinking. However, the recent US Food and Drug Administration approval of naltrexone for the treatment of alcohol dependence offers a new, safe and effective medication to reduce relapse following alcohol detoxification. This paper reviews the various psychosocial and pharmacological treatments currently available and the effectiveness of these treatments. This paper also reviews preclinical research which demonstrates the involvement of the opioid system in the reinforcing effects of alcohol. This research led to clinical trials on the use of the opioid antagonist, naltrexone, to reduce alcohol's pleasurable effects and enhance the effectiveness of psychosocial therapy. In two randomized clinical trials, naltrexone treatment reduced rates of alcohol relapse, number of drinking days and alcohol craving. The clinical efficacy of all pharmacological treatments for substance abuse are limited by compliance with taking the medication. Also, pharmacological treatment does not address the psychosocial complications which often result from chronic alcohol dependence. Therefore, the integration of medications such as naltrexone and psychosocial therapies may offer the best treatment. The further development and investigation of new pharmacological agents will enable matching of patient populations with specific treatments, offering more successful treatment outcomes.

Alcoholism↗
PubMed1995

Enhancing the effectiveness of methadone using psychotherapeutic interventions.

There is consistent evidence that the efficacy of methadone can be enhanced by psychotherapeutic interventions. For individual psychotherapy, the increased efficacy is most demonstrable among methadone patients also suffering from psychiatric disorders. Patients with severe psychiatric problems generally show little response to drug counseling alone. There is no evidence of a consistent advantage of one type of psychotherapy over another. Contingency contracting using take-home doses of methadone to reinforce drug-free urines has been shown to be effective, at least over the short term. Rewarding clean urines by vouchers exchangeable for retail items is supported by a growing experimental database, although practical issues remain for publicly funded methadone programs. The use of methadone dose as a reinforcer has shown some efficacy, but there are both ethical and conceptual problems. Finally, while there are likely to be some benefits from simply administering methadone alone in the most economical way, the available evidence clearly shows that a relatively minor investment in counseling, individual psychotherapy, or contingency contracting can result in major improvements in the results of this medication.

Combined Modality Therapy↗