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Biomedical subjects

H D Kleber

Publications and source records attributed to H D Kleber.

At least 73 records · Page 4Linked to original sources
PubMed1986

Cocaine abuse among opioid addicts: demographic and diagnostic factors in treatment.

Cocaine is becoming a major drug of abuse among the general population and among opiate addicts. Reports from the early 1970s found that most abusers were older Black males with some antisocial characteristics. Cocaine abuse at that time was reported by about 17% of opiate addicts seeking treatment and by 7 to 11% of ex-addicts on methadone maintenance. However, that rate increased dramatically during the 1970s, and in our 1980 study of 533 addicts we found that 74% of opiate addicts applying for treatment used cocaine. It was the second most abused nonopioid drug after marijuana, surpassing alcohol intoxication. Although the mean number of days of abuse over the previous 30 days was substantially lower among the addicts on our methadone maintenance program (mean = 1.4 days, n = 120) than among the addicts applying for treatment (mean = 9 days, n = 204), the following associations with cocaine abuse were consistent in both subsamples. Cocaine abuse was more frequent among Blacks. It was associated with a variety of antisocial indices including Research Diagnostic Criteria antisocial personality disorder, number of arrests, and legal, family, employment, and drug abuse problems as assessed by the Addiction Severity Index and the Social Adjustment Scale. Several differences emerged between Black and White cocaine-abusing addicts, the most interesting being an increased rate of anxiety disorders among White cocaine abusers. Based on these associations, we offer several guidelines for treating cocaine abuse in opiate addicts.

Adult↗
PubMed1985

Clonidine in outpatient detoxification from methadone maintenance.

Inpatient narcotic detoxification with clonidine hydrochloride has been used since 1978. Outpatient withdrawal, potentially more useful, has not been adequately studied. This report describes a double-blind random assignment of 49 methadone hydrochloride-maintained patients whose dose had been lowered to 20 mg. Twenty-five were detoxified using methadone at 1-mg decrements, 24 by abrupt substitution with clonidine. Approximately 40% of both groups achieved successful detoxification, with one third maintaining abstinence over the subsequent six months. The groups were also largely equivalent on withdrawal symptoms, but the clonidine group experienced symptoms in the first half of the study and the methadone group in the second half. Clonidine appears to be a safe and efficacious outpatient treatment for opiate withdrawal, although the results were less favorable than those obtained in open or inpatient studies.

Adult↗
PubMed1985

Untreated opiate addicts. How do they differ from those seeking treatment?

Treatment-seeking opiate addicts were compared with an untreated, community sample identified through the chain-referral technique. Community and treatment-seeking addicts were found to be comparable in duration and severity of opiate use and in current engagement in risky, illegal activities connected with procurement of drugs. However, community addicts reported more adequate social functioning, fewer drug-related legal problems, and lower rates of depressive disorders. Despite the comparatively less severe problems in current functioning, community addicts were found to be a substantially impaired group whose failure to seek help appeared more related to misunderstanding of the severity of their drug use and of treatment opportunities than to the lack of need for help.

Adult↗
PubMed1985

Nontolerance to the opioid antagonism of naltrexone.

Controlled opiate challenges of naltrexone-pretreated human subjects have established that naltrexone is an effective opioid antagonist. However, these challenges have been conducted after relatively acute dosing with naltrexone, and tolerance to this antagonism after chronic treatment is possible. We therefore administered morphine challenges in a double-blind, placebo-controlled design to nine ex-addicts who had been taking naltrexone for a mean of 9.4 months. None of the ex-addicts experienced euphoria; instead, most of these blockaded ex-addicts had a dysphoric histaminelike response to the intravenous morphine. The only physiological change was a slight increase in heart rate. We conclude that tolerance does not develop to the opioid antagonist properties of naltrexone up to as long as 21 months of treatment.

Adult↗
PubMed1985

Naltrexone.

Naltrexone (Trexan R), a long acting, orally affective narcotic antagonist was approved by the Food & Drug Administration in November, 1984 for use as an adjunct in the treatment of Opioid Addiction. This research capsule will explore what is known about naltrexone, and the most appropriate ways of using the drug.

Humans↗
PubMed1985

Parental alcoholism in opioid addicts.

Using the family history method, the authors examined the relationships of parental alcoholism to alcoholism, depression, and antisocial personality disorder among 638 opioid addicts. It was concluded that, compared to addicts without parental alcoholism; addicts with parental alcoholism were more frequently concurrent alcoholics; addicts with parental alcoholism not only had alcoholism more often, but also depression and antisocial personality disorder; among alcoholic addicts, those with parental alcoholism had more severe problems with alcohol abuse; and addicts with parental alcoholism reported more disruptive childhood events. The independent additive effects of disruptive childhood events and parental alcoholism on the severity of addict disorders including alcoholism were also examined. Although alcoholic addicts had experienced more disruptive childhood events than nonalcoholic addicts, these events did not substantially contribute to increasing the severity of alcohol-related problems. Similar results were obtained for depression and antisocial behaviors in these addicts. The conclusions concerning addicts supported some of those described for "familial alcoholism" among nonaddict alcoholics, but other characteristics of alcoholics with familial alcoholism were not found among addicts.

Adult↗
PubMed1985

Comparison of clinician ratings to self reports of withdrawal during clonidine detoxification of opiate addicts.

Opiate withdrawal symptom ratings by trained clinicians were compared to self-reports of withdrawal discomfort during an outpatient, blinded, randomized clinical trial of clonidine detoxification for methadone maintained subjects. The randomized comparison group of subjects were detoxified using a slow tapering of methadone over 1 month. For all 39 subjects in this study the observer and self-ratings were substantially correlated (r = .75), but moderate levels of disagreement also occurred and the observer ratings were often lower. The difference in actual withdrawal scores and amount of shared variance between the observer and self-ratings were used as indices of disagreement for each individual subject. We found that detoxification failures had significantly less interrater agreement than the successes and that subjects who reported more distress than the observers noted were more likely to fail at detoxification. Subjects being detoxified using clonidine were more likely to fail at detoxification. Subjects being detoxified using clonidine were more likely to demonstrate this association between failure and disagreement on self versus observed withdrawal than were the methadone group. We concluded that self-reports are as important as observer ratings in assessing treatment efficacy and in the clinical use of clonidine for outpatient detoxification.

Adult↗
PubMed1985

Ethnic and gender differences among opiate addicts.

This study compares the clinical characteristics of and treatment implications for five demographic groups of addicts: Black and White males and females and Hispanic males evaluated in Spanish. Among the 522 addicts, the 60 Puerto Rican males had the most frequent unemployment, the least education, the most polydrug abuse and violent crimes, the highest rate of schizophrenic or anxiety disorders, and more neurotic and depressive symptoms than the other male addicts. These addicts seem to have the greatest liabilities of any group and may need residential treatment. The 126 female addicts had frequent unemployment, high rates of depression and anxiety disorders, and more severe medical problems than men. This suggested that they have some treatment needs that are different than those of male addicts, including care for dependent children. Some differences between Black and White males in drug use were also found between Black and White females. White males (177) had a high rate of antisocial personality and polydrug abuse but had fairly good economic functioning. A structured treatment program to deal with their common illicit activities may be necessary for these addicts. The 159 Black males had poor occupational functioning but relatively little psychopathology. Vocational rehabilitation may be needed for them.

Adolescent↗
PubMed1985

Brief effective treatment strategies: pharmacological therapy for opiate addicts.

This paper has examined the possibilities of applying significant pharmacologic help to a variety of psychiatric problems that may accompany narcotic addiction. It has been shown that many of the patients do have such difficulties, with affective disorders being most common. As far as the various psychotropic drugs are concerned, neuroleptics for schizophrenia and lithium for manic disorders are generally agreed upon. A more extensive trial of lithium in a variety of situations seems indicated. Minor tranquilizers for anxiety and MAO-inhibitors for depression are both seen as problematic in this population--the former because of the possibility of abuse, the latter because of the danger of drug interaction associated with the addict's careless lifestyle. Tricyclic antidepressants may clearly have a role in treating major depression in opiate addicts on or off methadone, but the lability of the syndrome over time with frequent spontaneous remission argues against their routine use until it is clear that depression has persisted 3-6 months into methadone. Disulfiram appears to be a useful adjunct for drug abusers with serious alcohol problems. Psychotropic agents are most helpful to opiate addicts when used to treat coexisting psychopathology. While there is no clear evidence that such agents will reduce or affect the addiction itself, they may help keep patients available for rehabilitation efforts. Failure to intervene may make treatment dropout and recidivism more likely. Given the relative frequency of potentially treatable psychiatric disorders in these patients and the consequences of undiagnosed and untreated conditions, it is important for clinicians to maintain a high index of suspicion for concomitant psychiatric illness and for programs to have a mechanism for routinely diagnosing either all patients or, at a minimum, all patients not doing well. If programs used a standard instrument such as the SADS, it would be possible to compare various programs on this factor; in addition, it would provide a rich source of data for outcome studies.

Alcoholism↗
PubMed1984

Naltrexone precipitated opiate withdrawal in methadone addicted human subjects: evidence for noradrenergic hyperactivity.

The noradrenergic alpha-2 receptor agonist, clonidine, suppresses many of the effects of opiate withdrawal in both humans and other animals and this is consistent with the data indicating important interactions of opiate and noradrenergic systems in brain. This evidence supports the hypothesis that central noradrenergic hyperactivity is involved in the expression of major signs and symptoms of the opiate withdrawal syndrome, but to date clinical studies have not provided biochemical data consistent with this idea. In order to assess whether naltrexone precipitated opiate withdrawal in methadone addicted human subjects is associated with changes in noradrenergic function, a double-blind study was completed in which 15 methadone-dependent subjects received naltrexone and 8 subjects received placebo. Signs and symptoms of the opiate abstinence syndrome increased significantly in the 15 subjects who received naltrexone compared with the 8 who received placebo. Plasma concentrations of free MHPG also increased significantly in those subjects who took naltrexone compared to the placebo treated subjects. In addition, withdrawal signs and symptoms were significantly correlated with plasma MHPG concentration. Since several compounds which suppress central noradrenergic activity also reduce the severity of the withdrawal syndrome, the noradrenergic hyperactivity suggested by the present clinical study may be a functional mechanism for at least part of the opiate withdrawal syndrome.

Adult↗
PubMed1984

Cocaine abuse treatment. Open pilot trial with desipramine and lithium carbonate.

We conducted an open clinical trial of desipramine hydrochloride or lithium carbonate as adjuncts to psychotherapy in cocaine abusers. Subjects who were treated with desipramine hydrochloride showed marked decreases in a measure of cocaine craving after two to three weeks of treatment and became abstinent regardless of whether an affective disorder was also present. Lithium carbonate was effective only in cyclothymic subjects. Other subjects treated with lithium carbonate, as well as nonpharmacologically treated subjects, continued their cocaine use.

Adult↗