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Biomedical subjects

C P O'Brien

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

At least 163 records · Page 9Linked to original sources
PubMed1985

Nondependent monkeys self-administer hydromorphone.

Four monkeys, 2 rhesus and 2 cynomolgus, were trained to perform a multiple fixed-ratio extinction (MULT/FR/EXT) schedule for banana pellets. Subsequently, all animals were given hydromorphone (HYM) self-administration training, which consisted of substitution of FR (fixed ratio) 2 cocaine for FR 80 banana pellets and substitution of FR 2 HYM for FR 2 cocaine. All of the animals acquired cocaine self-administration. They also acquired HYM self-administration when it was substituted for cocaine. Next, 50 HYM self-maintenance sessions were given. During these sessions, animals were allowed to self-administer a total cumulative dose of 1 mg/kg/day of HYM. The animals were observed for spontaneous withdrawal while they performed an operant for food 24 and 48 hr after their last maintenance dose of HYM. Because none of the monkeys showed signs of spontaneous withdrawal or disruption of the appetitive baseline during the first postmaintenance appetitive session, a 0.4-mg dose of naloxone was administered noncontingently to test for precipitated withdrawal. Naloxone disrupted appetitive responding for banana pellets in the 2 rhesus monkeys. Naloxone had no effect on responding for food in the cynomolgus monkeys. Because none of the monkeys showed signs of spontaneous withdrawal or disruption of their appetitive baseline during the second postmaintenance session, a HYM challenge dose of 1 mg/kg was given noncontingently to assess whether tolerance to the daily maintenance dose had been acquired. The bolus dose of HYM suppressed lever pressing for food in both species, a result indicating a lack of tolerance. These results suggest that the positive reinforcing properties of HYM are sufficient to maintain opioid self-administration and that tolerance and physical dependence are not necessary.

Animals↗
PubMed1985

New data from the Addiction Severity Index. Reliability and validity in three centers.

The Addiction Severity Index (ASI) is a clinical/research instrument which has been in wide use during the past 6 years to assess the treatment problems found in alcohol- and drug-abusing patients. In a study of male veterans, a preliminary evaluation of the ASI has indicated reliability and validity. The present report presents an expanded examination of these issues; 181 subjects from three treatment centers were studied. Results of concurrent reliability studies indicate that trained technicians can estimate the severity of patients' treatment problems with an average concordance of .89. Test-retest studies show that the information obtained from the ASI is consistent over a 3-day interval, even with different interviewers. Comparisons of the ASI severity ratings and composite measures with a battery of previously validated tests indicate evidence of concurrent and discriminant validity. The reliability and validity results were consistent across subgroups of patients categorized by age, race, sex, primary drug problem, and treatment center. The authors discuss the strengths and limitations of the instrument based upon 5 years of use. The overall conclusion is that the ASI is a reliable and valid instrument that has a wide range of clinical and research applications, and that it may offer advantages in the examination of important issues such as the prediction of treatment outcome, the comparison of different forms of treatment, and the "matching" of patients to treatments.

Adult↗
PubMed1984

Severity of psychiatric symptoms as a predictor of benefits from psychotherapy: the Veterans Administration-Penn study.

One hundred ten nonpsychotic opiate addicts were randomly assigned to receive paraprofessional drug counseling alone, counseling plus cognitive-behavioral psychotherapy, or counseling plus supportive-expressive psychotherapy. Patients were classified low-severity, mid-severity, or high-severity on the basis of the number and severity of their psychiatric symptoms. Overall, the addition of professional psychotherapy was associated with greater benefits than was drug counseling alone. Low-severity patients made considerable and approximately equal progress with added psychotherapy or with counseling alone. Mid-severity patients had better outcomes with additional psychotherapy than with counseling alone, but counseling did effect numerous significant improvements. High-severity patients made little progress with counseling alone, but with added psychotherapy made considerable progress and used both prescribed and illicit drugs less often.

Adolescent↗
PubMed1984

Use of naltrexone to extinguish opioid-conditioned responses.

Opioid use generates many conditioned responses associated with the sights, sounds, smells, and rituals experienced during addiction. Environmental stimuli alone can provoke withdrawal symptoms and contribute to relapses in treated patients. The use of naltrexone in a program designed to progressively extinguish conditioned drug responses is described. Since naltrexone effectively blocks opiate effects at the receptor level, heroin injections produce no euphoria. Unreinforced self-injections diminish the responses learned during the period of drug abuse and protect the patient from rapid readdiction. Patients are confronted with a hierarchical set of drug-related stimuli and taught a muscular relaxation procedure to relieve arousal and discomfort. The continued administration of naltrexone, the self-induced relaxation response, and the repeated presentation of drug-related stimuli result in the eventual diminution or extinction of the arousal properties of the imagery and environmental stimuli associated with addiction.

Adult↗
PubMed1984

Treatment of behavioral and psychiatric problems associated with opiate dependence.

Many difficult and complex behavioral and psychiatric problems can occur in a methadone treatment program. Some behavioral problems are very serious, and it is essential that the program place a high priority on controlling them. This is best done by structuring the treatment milieu via program rules. Careful attention must be paid to consistent, fair, and accurate enforcement of these rules. A proper staffing pattern is essential; this should include counselors along with medical, administrative, and pharmacy personnel, and police. Written policies explaining clinic procedures such as treatment plans, use of ancillary medications, and take-home policies are most helpful. They provide structure for the staff and increase the chances that work will be done in an organized and consistent manner. The physical facility may have features which either enhance or interfere with treatment and must be taken into account when planning. Attention should be paid to accurate diagnosis and treatment of the patients' psychiatric, behavioral, and social problems, and staff morale must be maintained. The best general ingredients for good patient management appear to be a combination of structure and support, applied in a systematic and coordinated way by a well-trained staff. Finally, integration of research and clinical efforts may present unique problems but has considerable benefit in most programs.

Antisocial Personality Disorder↗
PubMed1984

Assessment and extinction of conditioned withdrawal-like responses in an integrated treatment for opiate dependence.

Recent data have generally been consistent with our pilot findings: a significant proportion--33 to 40%--of opiate-dependent patients show a time-linked decrease in skin-temperature in response to standard drug-related stimuli, suggestive of conditioned withdrawal. Patients' physiological changes are often accompanied by subjective craving and withdrawal, but the correlation among these measures is modest. Though craving seems to diminish with repeated exposure to drug-related stimuli, withdrawal-like symptoms are often persistent and slow to extinguish. Our current design initially assumed that most patients would show conditioned craving and withdrawal to our standard stimuli and that our current procedure would be adequate to produce complete extinction for these "responders.' As it turned out, not all patients respond to our standard stimuli, and our extinction procedure is not completely effective for those who do. Given these two findings, our current design does not permit the best test of the potential clinical benefits of extinction. Our rich experience during the first phase of this project has stimulated several procedural changes which should increase our accuracy in determining the incidence of these conditioned phenomena, our effectiveness in extinguishing them, and permit a better assessment of their potential clinical benefit. These are as follows: Individualize eliciting (drug-related) stimuli--We initially chose to use standard (the same for all patients) stimuli for practical and experimental reasons. However, their use may have resulted in an underestimate of the incidence of conditioned craving and withdrawal, and in less relevant extinction for many patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Naltrexone: a clinical perspective.

The narcotic antagonist naltrexone was studied in over 300 opiate addicts. Patient selection was a major factor in determining retention and treatment outcome. Treatment time ranged from 1 week to over a year (mean = 2 months). A quarter of the study patients had multiple treatment episodes. Stabilized patients had few side effects, except for occasional nausea and abdominal cramps. Almost half the subjects tested naltrexone by using opiates at least once; all reported satisfactory narcotic blockade. Very few subjects switched to nonopiates to get high, although several did increase their alcohol consumption during the first weeks of therapy. One-third of subjects contacted in a follow-up study were opiate-free 6 months after stopping naltrexone, indicating a successful short-term treatment modality.

Adult↗
PubMed1984

Psychiatric disorders in opioid-dependent patients.

An examination of substance abusers in contemporary practice reveals a high frequency of psychiatric disorders. In some cases, these probably represent preexisting conditions, but in others the disorder may be initiated or aggravated by the biologic and social consequences of substance abuse. The severity of a patient's psychiatric disorder is predictive of response to substance abuse treatment. A high proportion of affective disorders has been found among opioid-dependent patients; these are responsive to psychotherapy and to antidepressant treatment with doxepin. Careful psychiatric diagnosis in the management of substance abuse can discriminate those patients who are likely to require psychotherapy or psychoactive medication from those who may do well with standard drug counseling alone.

Counseling↗
PubMed1983

Use of disulfiram for alcoholics in methadone maintenance programs. A Veterans Administration Cooperative Study.

A multicentered clinical trial studied the efficacy and safety of disulfiram in controlling heavy alcohol consumption by patients on methadone maintenance regimens. The trial was stopped when sample size targets were not achieved. Efficacy comparisons were based on 82 patients who started the study; safety comparisons were based on 35 patients who completed 12 weeks of study. Patients received either disulfiram and methadone or placebo and methadone. Disulfiram was administered at a dosage of 125 mg/day for seven days and 250 mg/day thereafter for 36 weeks. No significant differences between the disulfiram and placebo groups were observed in either the retention in study or any other important end point. Both groups showed improvement in control of drinking during the study. There were no serious adverse reactions that could be attributed to the combined use of the two drugs.

Adult↗
PubMed1983

Predicting response to alcohol and drug abuse treatments. Role of psychiatric severity.

Male alcoholics (n = 460) and drug addicts (n = 282) were evaluated at six-month follow-up after treatment in six rehabilitation programs. Initial analyses of the unstratified samples showed significant patient improvement, but no evidence of differential effectiveness from different treatments or from "matching" patients to treatments. The two samples were then divided into groups based on the number, duration, and intensity of their psychiatric symptoms at admission, ie, their overall "psychiatric severity." Patients with low psychiatric severity improved in every treatment program. Patients with high psychiatric severity showed virtually no improvement in any treatment. Patients with midrange psychiatric severity (60% of the samples) showed outcome differences from different treatments and especially from specific patient-program matches. These findings support the effectiveness and specificity of different substance abuse treatments, suggest methodologic reasons for the lack of similar findings in previous studies, and demonstrate the importance of psychiatric factors in substance abuse treatment.

Alcoholism↗
PubMed1983

Psychotherapy for opiate addicts. Does it help?

Opiate addicts beginning a new treatment episode on a methadone maintenance program were offered random assignment to drug counseling alone or to counseling plus six months of either supportive-expressive psychotherapy or cognitive-behavioral psychotherapy. Sixty percent of patients meeting the study criteria expressed an interest and 60% of these actually became engaged. One hundred ten subjects completed the study intake procedure and kept three or more appointments within the first six weeks of the project. Measures including standardized psychological tests, independent observer ratings, and continuous records of licit and illicit drug use were done at baseline and seven-month follow-up. All three treatment groups showed significant improvement, but patients receiving the additional psychotherapies showed improvement in more areas and to a greater degree than those who received counseling alone, and with less use of medication. More than a third of opiate addicts in our treatment program thus both were interested in professional psychotherapy and apparently benefitted from it. Certain administrative procedures appear necessary to maximize the chances that psychotherapy can be used effectively with drug-addicted patients.

Adult↗
PubMed1983

Predictors of favorable outcome following naltrexone treatment.

In order to determine the type of patient most likely to benefit from opiate antagonist therapy, a series of multivariate regression analyses were performed on a sample of male veterans who completed induction on naltrexone. Patient background characteristics, demographic factors and during-treatment variables were used to predict outcome measured at 1-month follow-up. Employment at the start of naltrexone and length of naltrexone therapy were significantly related to better outcome at 1-month follow-up. Treatment duration was clearly the best outcome predictor. The finding that at least 30 days of naltrexone therapy was necessary for significant improvement at 1-month follow-up but that longer periods of treatment were not necessarily associated with greater gains suggests that treatment can be limited and still be relatively successful. A second set of analyses attempted to discover patient characteristics predictive of longer treatment duration. Results showed that patients who were employed and/or married at the start of naltrexone therapy were more likely to stay in treatment longer. Similar results have been obtained by others suggesting that these patients have the best family and social supports to sustain a positive treatment outcome. In addition, they may also be more 'motivated' since they have the most to lose personally and financially by readdiction.

Employment↗