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Biomedical subjects

C P O'Brien

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

At least 145 records · Page 8Linked to original sources
PubMed1988

Pharmacological and behavioral treatments of cocaine dependence: controlled studies.

The cocaine epidemic has stimulated novel treatments aimed at reducing relapse to this extremely addicting drug. After detoxification and standard treatment, former cocaine users continue to exhibit strong cocaine craving and physiological changes when presented with cocaine-related stimuli. Because these conditioned responses may increase the risk of relapse, a new treatment has been developed to extinguish such responses. The extinction process, consisting of repeated presentations of cocaine-related stimuli until the stimuli gradually lose their ability to evoke conditioned responses, is integrated into a comprehensive rehabilitation program. Cocaine dependence is often combined with opiate dependence. Desipramine has been added to methadone maintenance in an attempt to reduce dependence on both substances. Methadone impedes catabolism of desipramine so that relatively low doses of desipramine may produce antidepressant effects and possibly reduce the desire to use cocaine. Preliminary evidence from a placebo-controlled study of desipramine in combination with methadone suggests that desipramine produces significant improvements in psychological functioning, but its effects on reduction of cocaine use are less dramatic.

Animals↗
PubMed1987

Effect of naltrexone on food intake, hunger, and satiety in obese men.

Increasing doses of naltrexone (25 to 200 mg) given over 4 consecutive days reduced intake of laboratory luncheon meals by 30% in 17 obese men. Meal size remained suppressed in the laboratory during the week following naltrexone administration. Water intake in the laboratory and body weight were not affected. Rates of ingestion and subjective ratings suggested that naltrexone reduced appetite rather than promoted early satiation. Nausea and other side effects occurred on 1 or 2 days during the naltrexone week in seven subjects whose food intake was reduced. Food intake was also reduced in seven of the remaining 10 subjects who reported no adverse reactions. These results suggest that a conditioned taste aversion or a conditioned anorexia may have developed in some subjects.

Adolescent↗
PubMed1987

Twelve-month follow-up of psychotherapy for opiate dependence.

To provide information on the long-debated issue of the value of psychotherapy as an addition to paraprofessional counseling services for opiate addicts receiving methadone maintenance, the authors obtained 12-month follow-up data on 93 such patients randomly assigned to a 6-month course of either paraprofessional drug counseling or counseling plus professional psychotherapy. The psychotherapy patients had a significantly better overall status at 7-month follow-up and also at 12-month follow-up, 6 months after the psychotherapy ended. The authors conclude that psychotherapy can be evaluated by using scientific methods and that it can have measurable and sustained benefits in the treatment of opiate addiction.

Adolescent↗
PubMed1986

Opiate receptors, neuropeptides in CNS and CSF of two Macaca species with different responsiveness to opiates.

Of two related Macaca species, the rhesus (M. mulatta), acquires opiate tolerance and dependence more readily than the cynomolgus (M. fascicularis). In the cynomolgus, mu-opiate receptors were significantly fewer in the caudate nucleus and globus pallidus; delta-sites were fewer in the thalamus. kappa-Sites showed no species difference. The levels of [Met5]enkephalin, substance P and dynorphin B in various brain areas were comparable. On the other hand, receptor-assayed endorphin activity was higher in CSF of cynomolgus than rhesus monkeys.

Animals↗
PubMed1986

Extinguishing conditioned responses during opiate dependence treatment turning laboratory findings into clinical procedures.

Former opiate addicts (even those who have remained drug-free for several months) often report symptoms of opiate withdrawal (eg. nausea, gooseflesh, etc.) and/or intense drug craving when exposed to stimuli previously associated with the act of drug injection. This phenomenon of learned or "conditioned" withdrawal/craving is widely reported and is potentially important in explaining relapse to drug use. However, no effective, clinically applicable intervention had been available to "extinguish" these conditioned phenomena. An ongoing project to develop such an intervention has revealed: Conditioned withdrawal and craving are pervasive among both methadone maintained patients (even though actual physical withdrawal is blocked) and drug-free patients even after 30 days of inpatient Therapeutic Community rehabilitation. Conditioned withdrawal and craving can be effectively extinguished in an intensive, three-week, inpatient procedure. Emotional states such as anger, depression and anxiety can elicit and exacerbate conditioned withdrawal and craving. They may also act as an integral part of a conditioned stimulus complex. The authors discuss the problems associated with turning a laboratory-based procedure into a clinical intervention. Encouraging preliminary results from an integrated treatment "package" are presented.

Behavior Therapy↗
PubMed1986

Conditioned responses in a methadone population. A comparison of laboratory, clinic, and natural settings.

The incidence of conditioned high, craving, and withdrawal in methadone-maintained patients was compared across three settings: an artificial laboratory setting, clinic extinction sessions, and in self-reports from the natural home environment. A significant proportion of methadone patients showed increased craving and withdrawal in response to drug-related stimuli, even in the artificial laboratory setting. As stimulus opportunities became more varied (clinic extinction sessions) and closer to those in the patient's own home environment, the proportion of patients experiencing subjective craving and withdrawal increased. These results are discussed in terms of the nature of, and inter-relationships among, the conditioned responses found in opiate abusers and the potential role of these responses in relapse to drug use in the abstinent patient.

Conditioning, Psychological↗
PubMed1986

Alcohol and drug abuse treatment in three different populations: is there improvement and is it predictable?

Prior research had shown that alcohol and drug abuse treatments were effective and that the results of treatments could be predicted from pretreatment information regarding the patient's employment, family, and especially psychiatric problems. However, this research had been conducted entirely with adult male service veterans, largely from lower socioeconomic strata. Three treatment centers were included in the present study to examine these conclusions with other populations containing adolescents, females, and patients from higher socioeconomic strata. Data from the Addiction Severity Index was collected at treatment admission and again at independent follow-up, 6 months later. Results confirmed prior observations. Both alcohol and drug abuse treatments showed substantial improvements in the chemical use problems of their patients and in the important areas of employment, criminal behavior, family relations, and psychological health. As in earlier reports, a global measure of the nature and extent of pretreatment psychiatric problems was the single best predictor of treatment response for both alcoholics and drug-dependent samples.

Adult↗
PubMed1986

Role of conditioning factors in the development of drug dependence.

Conditioned opioid phenomena have now been documented in both opiate-dependent and abstinent patients. Although the existence of these phenomena is generally accepted, their potential role in drug use and relapse is still under study. Our own research indicates that both physiologic and subjective responses may be conditioned, and that these responses are present in a significant proportion of patients who abuse opiates. Patients' responsivity (for example, craving or a reduction in skin temperature) may vary depending upon mood, cognitive set, and the individual relevance of the drug-related stimuli. Extinction procedures have been developed that are effective in reducing both subjective and physiologic conditioned responses. The clinical impact of these extinction procedures is now being assessed in a large-scale treatment-outcome study with abstinent patients. The results of this project will help determine the actual clinical significance of these complex but potentially important phenomena.

Affect↗
PubMed1986

Psychotherapy for substance abuse.

Professional psychotherapy can provide benefits for substance abuse patients. It is probably most helpful for specific types of patients and only under certain conditions. Work that carefully defines these patient subtypes and conditions is only just beginning.

Allied Health Personnel↗
PubMed1985

Therapist success and its determinants.

This study examined the relatively unexplored contribution of the therapist's performance in determining outcomes of treatment. Nine therapists were studied: three performed supportive-expressive psychotherapy; three, cognitive-behavioral psychotherapy; and three, drug counseling. Profound differences were discovered in the therapists' success with the patients in their case loads. Four potential determinants of these differences were explored: patient factors; therapist factors; patient-therapist relationship factors; and therapy factors. Results showed that patient characteristics within each case load (after random assignments) were similar and disclosed no differences that would have explained the differences in success; therapist's personal qualities were correlated with outcomes but not significantly (mean r = .32); an early-in-treatment measure of the patient-therapist relationship, the Helping Alliance Questionnaire, yielded significant correlations with outcomes (mean r = .65); among the therapy techniques, "purity" provided significant correlations with outcomes (mean r = .44), both across therapists and within each therapist's case load. The three therapist-related factors were moderately associated with each other.

Adolescent↗
PubMed1985

Sociopathy and psychotherapy outcome.

One hundred ten nonpsychotic opiate addicts were randomly assigned to receive paraprofessional drug counseling alone or counseling plus professional psychotherapy. The outcomes of patients who received psychotherapy were examined in terms of their DSM-III diagnoses. Four groups were compared: those with opiate dependence alone (N = 16); opiate dependence plus depression (N = 16); opiate dependence plus depression plus antisocial personality disorder (N = 17); and opiate dependence plus antisocial personality disorder (N = 13). Those with opiate dependence plus antisocial personality disorder alone improved only on ratings of drug use. Patients with opiate dependence alone or with opiate dependence plus depression improved significantly and in many areas. Opiate-dependent patients with antisocial personality plus depression responded almost as well as those with only depression. Antisocial personality disorder alone is a negative predictor of psychotherapy outcome, but the presence of depression appears to be a condition that allows the patient to be amenable to psychotherapy, even though the behavioral manifestations of sociopathy are present.

Adolescent↗