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Biomedical subjects

C P O'Brien

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

At least 127 records · Page 7Linked to original sources
PubMed1990

Psychotherapy and counseling for methadone-maintained opiate addicts: results of research studies.

Data have been presented about the potential role of psychotherapy for psychiatrically impaired methadone-maintained opiate addicts. Complete data from one study, and preliminary data from a second, indicate that professional psychotherapy can be helpful as a supplement to ongoing drug-counseling services for patients having clinically significant psychiatric symptoms. If psychotherapy is to be used, care must be taken to integrate it into the ongoing clinical services of the methadone-treatment program. Not all therapists are equally adept at engaging and working with addicts. In hiring therapists, attempts should be made to identify those who are not only technically competent but also interested and comfortable with this population. It should also be emphasized that there is considerable variability among methadone programs in such vital areas as leadership, staffing patterns, organization, dosing procedures, location, physical plant, and availability of ancillary services. These administrative differences may play a significant role in the feasibility and success of attempts to use psychotherapy in drug-treatment programs. Finally, it should be noted that there is no evidence that psychotherapy cures addiction or that it can be used successfully without integrating it into other important services, such as drug counseling, methadone treatment, and the overall program structure. There is reason to believe, however, that it can provide additional and clinically meaningful benefits to that subgroup of methadone patients who are psychiatrically impaired.

Antisocial Personality Disorder↗
PubMed1989

Comparative effectiveness and costs of inpatient and outpatient detoxification of patients with mild-to-moderate alcohol withdrawal syndrome.

We compared the effectiveness, safety, and costs of outpatient (n = 87) and inpatient (n = 77) detoxification from alcohol in a randomized, prospective trial involving 164 male veterans of low socioeconomic status. The outpatients were evaluated medically and psychiatrically and then were prescribed decreasing doses of oxazepam on the basis of daily clinic visits. The inpatient program combined comprehensive psychiatric and medical evaluation, detoxification with oxazepam, and the initiation of rehabilitation treatment. The mean duration of treatment was significantly shorter for outpatients (6.5 days) than for inpatients (9.2 days). On the other hand, significantly more inpatients (95 percent) than outpatient (72 percent) completed detoxification. There were no serious medical complications in either group. Outcome evaluations completed at one and six months for 93 and 85 percent of the patients, respectively, showed substantial improvement in both groups at both follow-up periods. At one month there were fewer alcohol-related problems among inpatients and fewer medical problems among outpatients. However, no group differences were found at the six-month follow-up, nor were differences found in the subsequent use of other alcoholism-treatment services. Costs were substantially greater for inpatients ($3,319 to $3,665 per patient) than for outpatients ($175 to $388). We conclude that outpatient medical detoxification is an effective, safe, and low-cost treatment for patients with mid-to-moderate symptoms of alcohol withdrawal.

Adult↗
PubMed1989

Thrombolysis.

Explore the source record for details and available documents.

Fibrinolytic Agents↗
PubMed1989

Evaluation of treatment for cocaine dependence.

1. At the Philadelphia VA Medical Center, veterans applying for treatment of cocaine dependence were significantly different from applicants dependent on opiates or alcohol without cocaine. The cocaine dependent patients were almost all black and they were mostly employed. Few were involved in crime and, for most, this was the first course of substance abuse treatment. Their use of cocaine began within the past three years and they had relatively few psychiatric, medical, employment or family problems when compared with other applicants for substance abuse treatment. 2. Completion rate for a course of outpatient treatment for cocaine dependence varies from a low of 37% in the general Day Treatment Program to 76% in a special Behavioral Treatment Program and 78% among methadone patients receiving an additional medication for cocaine dependence. Completion of a 28 day course of inpatient treatment was 86% whether the patient selected inpatient care or was assigned to it on a random basis. 3. Those outpatients who remained in treatment generally did well and refrained from cocaine use even during the course of outpatient, either day hospital treatment or behavioral treatment. When both inpatients and outpatients were re-examined four months after beginning treatment, there was significant improvement on almost all ASI categories. Both drop-outs and completers were re-examined. Despite the significantly greater completion rate for the patients assigned to inpatient treatment, both groups showed equal levels of improvements at the 4-month follow up point. 4. These preliminary results from five different treatment populations suggest that cocaine dependent patients can be engaged in treatment and that significant improvement is possible.

Adult↗
PubMed1988

Endogenous opioids in cerebrospinal fluid of opioid-dependent humans.

Endogenous opioid systems may be altered as a consequence of addiction, but evidence to support this idea is meager so far. We obtained 136 cerebrospinal fluid (CSF) samples from 72 opioid addicts during four distinct states: methadone maintenance, detoxification from methadone, opioid antagonist treatment, and drug-free status. CSF endorphins were measured in 86 patients samples using a radioreceptor assay (RRA), and beta-endorphin levels were measured in 85 patient samples using a radioimmuno assay (RIA). During detoxification, both RRA fraction I and beta-endorphin showed a generally similar pattern of changes. Both were lowest when measured 40-50 hr after the last opioid dose, and both showed an apparent rebound to higher than methadone maintenance values at 60-70 hr following the last dose. During methadone maintenance and drug-free states, the addicts' levels of fraction I RRA endorphins in the CSF were higher than levels found in a normal control group. Fraction II endorphins were also elevated in the addicts who were drug free. In contrast, CSF beta-endorphin during both methadone maintenance and drug-free states was lower in the addicts as compared to the normal, drug-naive group. Except for the pattern found during detoxification, there were no consistent changes in endorphin levels across different states of addiction.

Adult↗
PubMed1988

Reactivity to alcohol stimuli in alcoholics: is there a role for temptation?

Two studies investigated conditioned reactions to alcohol in alcoholics. In the first, alcoholic and control subjects were exposed to alcoholic and non-alcoholic stimuli and physiological parameters were measured. No significant differences were found to indicate that alcoholics reacted differentially to alcoholic stimuli. As this was contrary to other findings, procedural differences were examined. In the second study, a series of case studies, subjects were selected for extreme alcohol dependence and the procedure was varied by persuading the subjects that they might consume the stimuli. Under conditions in which the alcoholic stimulus was available and the subjects were able to consume it, two of the three subjects exhibited responses consonant with conditioned reactions to alcohol stimuli. We conclude that such conditioned reactions do exist but that their prevalence and the conditions under which they can be elicited are unknown. From these studies it appears to us that one of the most important parameters may be that of temptation.

Adult↗
PubMed1988

Treatment response and safety of ambulatory medical detoxication.

An ambulatory medical detoxication program for alcoholics with limited social and environmental supports is described. The treatment response of all 49 patients who underwent treatment and the short-term outcome and safety of 15 patients (31%) who failed to complete treatment are reviewed. Treatment completers were found to attend over 90% of their scheduled daily appointments and drinking during the treatment term was infrequent. The average duration for completed treatments was approximately 5 appointment days. Treatment noncompleters also attended their scheduled appointments regularly prior to discontinuation and, except for several patients who were transferred to inpatient treatment because of continued drinking, drinking during detoxication was relatively infrequent. The short-term outcome and safety of treatment noncompleters was reviewed. No instance of serious medical or psychiatric consequences following discontinuation from treatment was revealed. It was concluded that discontinuation of treatment by a patient is not in all cases indicative of a poor outcome. It was further concluded that ambulatory medical detoxication is a relatively successful treatment for mild to moderate alcohol withdrawal symptomatology and for patients not requiring immediate medical or psychiatric attention.

Accident Prevention↗
PubMed1988

Classically conditioned responses in opioid and cocaine dependence: a role in relapse?

We have shown that conditioned phenomena occur in a number of drug-related settings and that they can be reliably elicited and studied. Our recent work suggests that conditioned craving is an extremely prevalent, if poorly understood, response to drug-related stimuli and that it can occur independent of conditioned withdrawal responses. Our current extinction protocols are effective in reducing the conditioned responses to both opioid and cocaine-related test stimuli. How well this extinction training generalizes to the "real world," is, of course, the crucial clinical question. We are trying to maximize the generalization of extinction through use of realistic, individualized drug "reminders." The final clinical impact of these extinction procedures awaits completion of our ongoing treatment/outcome studies in abstinent opioid and cocaine abusers.

Cocaine↗