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Biomedical subjects

H D Kleber

Publications and source records attributed to H D Kleber.

At least 91 records · Page 5Linked to original sources
PubMed1984

Clonidine treatment of neonatal narcotic abstinence syndrome.

Clonidine hydrochloride, an alpha 2-adrenergic agonists, was used to treat seven infants who were passively addicted to narcotics because of maternal methadone maintenance. In six of seven infants, the major symptoms of narcotic withdrawal were ameliorated after a total daily oral dose of 3-4 micrograms/kg/day was achieved. One infant failed to respond. No toxic side effects of clonidine were observed at the dosage level used. The results of this pilot study suggest that clonidine may be a safe therapeutic agent for the treatment of neonatal narcotic abstinence syndrome (NNAS). Clonidine treatment of NNAS remains strictly investigational at this time. The relative efficacy and safety of clonidine versus other currently used drug regimens for NNAS also remains to be determined.

Administration, Oral↗
PubMed1984

Methylphenidate (Ritalin) treatment of cocaine dependence--a preliminary report.

The authors report on three cases of cocaine dependence treated with methylphenidate. All patients treated showed marked to dramatic improvement with regard to toxic/abstinence signs and symptoms, craving behavior and other behavioral disturbances associated with heavy and chronic cocaine abuse. The authors explore the possibility that cocaine dependence is associated with pre-existing or resulting psychopathology, particularly mood disturbances. Emphasis is also placed on a predisposing or de novo attention deficit disorder (ADD) as possibly contributing to heavy or continued reliance on cocaine.

Adult↗
PubMed1984

The impaired physician: changes from the traditional view.

The traditional impaired physician has been a "therapeutic addict," self-medicating pain, fatigue, or stress. The rise of recreational drug abuse in the population from which physicians are drawn has led to a new breed of "nontherapeutic addicts" who, like their street counterparts, primarily use drugs for euphoria and tend to be polysubstance abusers. This may have important implications for prevention and treatment. Treatment outcome, in general, for impaired physicians has been assumed to be better than for other drug abusers but the studies have lacked adequate controls, need broader outcome measures, and may not be relevant to the new type of abuser.

Humans↗
PubMed1984

Is there a need for "professional psychotherapy" in methadone programs?

The role of "professional psychotherapy" in methadone programs has been unclear because of its expense as compared to counseling, shortage of trained, experienced personnel, and confusion in the literature as to its efficacy. This research capsule reviews some recent studies pertaining to this and some of the methodological difficulties in arriving at a clear answer. Psychotherapy so far appears most helpful for patients with a defined psychiatric diagnosis in addition to their drug diagnosis. In addition, benefits appear to be greater if patients are treated early in their treatment program.

Adult↗
PubMed1984

Psychological assessment of psychopathology in opiate addicts.

A sample of 99 opiate addicts seeking treatment were assessed on three well established clinical assessment procedures; the Loevinger Sentence Completion, the Bellak Ego Functions Interview, and the Rorschach. Their scores were compared using normal and clinical reference groups. On all three procedures, opiate addicts had a significantly greater impairment than normals but significantly less thought disorder and impairments in ego functions than hospitalized borderline and psychotic patients. The results indicate that a primary disturbance in opiate addicts appears to be their relative inability to conceptualize people as well differentiated, articulated, and involved in meaningful, purposeful, and constructive activity. In addition, opiate addicts appear to have greater affective lability. These difficulties in interpersonal relations and affect modulation are consistent with disturbances in the neurotic range and suggest that opiate addicts have selected a particularly untoward, self-destructive, isolated mode of adaptation for achieving the satisfactions and pleasures most people seek in intimate personal relationships.

Adaptation, Psychological↗
PubMed1984

Perceived marital and family environment of opiate addicts.

Addicts have described their family environment as providing inadequate modeling of social and role skills, while having high expectations for achievement. These self-reports have not been compared to either the reports of other family members or observer ratings of addict families. Observer ratings are important because addicts have also described their families as having significantly less conflict than normative families. We administered the Moos Family Environment Scale (FES) to 73 addicts and found that our addicts' scores supported the previous descriptions of addicts' perceived family environment. Addicts' perceived family environment differed from normative samples. They perceived their family as providing little preparation for social roles, while expecting high achievement. When addicts' wives or mothers completed the FES (n = 27), they disagreed with the addicts' perceptions of having high expectations for achievement in the marriage or family. Relative to their mothers and wives, the addicts seemed to be insensitive to the lack of effective organization and limit setting in either their family of origin or marriage. However, the mothers and wives agreed with the addicts in reporting low levels of conflict, but behavioral ratings of the married addicts and their wives (n = 16) showed a poor correlation between the observed behavior and the couples' perceptions. Furthermore, the level of conflict appeared to be above rather than below normative samples. Thus, addicts' perceptions of their family environment demonstrated significant discrepancies from the perceptions of their wives and mothers and from ratings of their marital behavior.

Adult↗
PubMed1984

Strategies to improve compliance with narcotic antagonists.

The pharmacologic promise of naltrexone has not been matched by therapeutic usefulness. Plagued by difficulties in the induction period and very high dropout, the drug remains limited to a very small segment of the opiate-addited population. Some programs have managed, however, to substantially improve on these problems and such strategies will be discussed. The paper will look at the different problems raised during the high dropout periods of induction, the first month of stabilization, and the later stages of maintenance. It will then focus on methods to deal with these problems. Strategies examined will include among others individual and group counseling, family and couples' therapy, and contingency contracting. Strengths and weaknesses of each of these both from our own 7 years of experience and in the literature will be examined.

Combined Modality Therapy↗
PubMed1984

The spectrum of cocaine abuse and its treatment.

There is as yet no definitive treatment for cocaine abusers, nor is there consensus as to their degree of psychopathology. Some researchers have found a high incidence of major affective and bipolar disorders, while others have not. Psychological treatment consists of behavioral, supportive, and psychodynamic approaches, with the choice based on the severity of the cocaine abuse. Experimental pharmacologic approaches using tricyclic antidepressants, lithium, or stimulants are being tried both as diagnosis-specific agents and as general treatment adjuncts, but no adequate controlled trials have yet been published.

Ambulatory Care↗
PubMed1984

Naltrexone induction: psychologic and pharmacologic strategies.

Attempts ot improve naltrexone retention during the induction and stabilization phases of treatment are described. During induction, street addicts appear to do better than postmethadone patients and to benefit more from counseling. Inpatient withdrawal and induction appear to be more successful than outpatient, but use of new techniques such as clonidine and clonidine/naltrexone may improve results in outpatients. Prolonged withdrawal symptoms and drug craving appear to contribute to the high dropout rate during stabilization. Pharmacologic and psychological methods of treatment, and future research strategies for these first two parts of naltrexone treatment, are summarized.

Ambulatory Care↗
PubMed1983

Short-term interpersonal psychotherapy in methadone-maintained opiate addicts.

A clinical trial was used to evaluate short-term interpersonal psychotherapy (IPT) as treatment for psychiatric disorders in opiate addicts who were also participating in a full-service methadone hydrochloride maintenance program. Seventy-two opiate addicts were randomly assigned to one of two treatment conditions for six months: (1) IPT, consisting of weekly individual psychotherapy, and (2) low-contact treatment, consisting of one brief meeting per month. Recruitment was a problem, as only 5% of eligible clients agreed to participate and only around half of the subjects completed the study treatment. The outcome was similar for the two study groups. However, in many of the outcome areas, subjects in both treatment conditions attained significant clinical improvement. Several factors limited the generalizability of findings and may have biased against showing a psychotherapy effect.

Adult↗
PubMed1983

Imipramine as treatment for depression in addicts.

This report describes the results of a placebo-controlled double-blind clinical trial evaluating imipramine hydrochloride, a tricyclic antidepressant, as treatment for depression in methadone-maintained opiate addicts. Forty-six subjects were assigned randomly to either the imipramine or placebo group for up to eight weeks. All patients also received mandatory once weekly group therapy as part of the methadone program. Outcome measures included attrition, depressive symptoms, global improvement, side effects, social functioning, and urine specimen results positive for illicit drugs. The therapeutic response in the two conditions was similar. Addicts receiving either imipramine or placebo experienced a substantial reduction of depressive symptoms during the eight weeks of the study. These findings are compared with other studies that treat depression in addicts and nonaddicts.

Adult↗
PubMed1983

Relationship of depression to psychosocial stressors in heroin addicts.

Psychosocial stressors are commonly classified according to such recent life events (RLE) as arguments and exits. Based on retrospective studies, exit events, e.g., deaths and marital separations, are generally believed to precede the onset of depression. We are reporting the first prospective study of RLE in 123 addicts, who were evaluated for depression using the Beck Inventory, then treated for drug abuse and reevaluated 6 months later for depression and the occurrence of intervening RLE. During the 6 months, only 31 per cent (38) of the addicts either remained (26) or became depressed (12), but 98 per cent (120) had RLE with a mean of 6.3 +/- 2.9. Both "normals" (1.1) and primary depressives (3.4) have fewer RLE. Among the 36 addicts with low numbers of RLE (zero to four), 25 per cent either remained or became depressed, while among the 26 addicts with high numbers of RLE (nine to 15), 50 per cent either remained or became depressed. When RLE were categorized into exit and argument events, arguments had a stronger relationship than exits to depression. Furthermore, only arguments showed the expected relationship to recovery from depression, that is, addicts who recovered from depression were less likely to have argument events than addicts who remained depressed. Thus, among the 58 addicts who had argument RLE, 45 per cent either remained or became depressed, 36 per cent recovered from depression, and 19 per cent remained asymptomatic; among the 60 addicts who had exit RLE, 36 per cent either remained or became depressed, 40 per cent recovered from depression, and 23 per cent remained asymptomatic. When the post-therapeutic analysis included several outcome events other than depression, argument RLE were most strongly related to depression and exit RLE to resumption of illicit drug use during treatment. We conclude that recovery from depression in addicts is related to negative RLE such as arguments and that treatment should focus on helping addicts control their response to these RLE to facilitate recovery from depression.

Adult↗
PubMed1983

Concurrent validity of the addiction severity index.

The concurrent validity of the Addiction Severity Index (ASI), a new scale for assessing a range of clinical dimensions in drug and alcohol abusers, was evaluated in 204 opiate addicts applying for treatment. This study is the first independent validation study of this measure. The ASI subscales were found to have good concurrent validity with self-report measures in the areas of psychological problems, social adjustment problems, legal problems, and employment problems (r = .55 to .39). Drug abuse problems showed limited concurrent validity and medical problems were not concurrently assessed in our study. Addicts with psychiatric diagnoses beyond opiate abuse were effectively identified by the ASI, and depressed addicts were particularly well screened with a sensitivity of 89 per cent and a specificity of 67 per cent. A cluster analysis demonstrated that the six ASI scales could be used to discriminate depressed addicts, antisocial addicts, and addicts without psychiatric disorders. Thus, the ASI was demonstrated to be a potentially important evaluation instrument for opiate addicts.

Alcoholism↗
PubMed1983

Family denial as a prognostic factor in opiate addict treatment outcome.

Opiate addicts living with family members generally have better treatment outcomes than addicts who live alone, but family support for the addict remaining drug-free depends on the family being aware of the addiction. We found that many addicts deny their drug abuse to their families and we hypothesized that these addicts would have poor treatment outcomes, even though they lived with nonaddict family members. To test this hypothesis, four groups of addicts in a naltrexone program were compared: 28 male addicts with their spouses, 27 addicts living with their parents, 23 addicts who denied their drug abuse to the family members with whom they lived, and 28 addicts who lived alone. The first two groups participated in family therapy, and these addicts remained drug-free longer than the other two addict groups (analysis of variance, p less than 0.001). The addicts who denied their drug abuse to their families remained drug-free for significantly less time than those who admitted their drug abuse to their families. Furthermore, addicts who admitted their drug abuse to their spouse, but denied it to their parents, remained drug-free for shorter times than married addicts who also told their parents. Thus, maximum family involvement in treatment including spouses and parents was associated with a better prognosis.

Adult↗
PubMed1983

Identifying alcoholism in treated opiate addicts.

The authors evaluated the usefulness of the Michigan Alcoholism Screening Test in detecting alcoholism (as defined by the Research Diagnostic Criteria) in opiate addicts. The test was found to be adequately sensitive and specific in detecting current cases of alcoholism but inadequate for detecting alcoholic opiate addicts whose drinking was currently under control.

Alcoholism↗
PubMed1982

Clonidine and naltrexone. A safe, effective, and rapid treatment of abrupt withdrawal from methadone therapy.

Clonidine hydrochloride and naltrexone hydrochloride, given in combination, were found to provide a safe, effective, and extremely rapid treatment of abrupt withdrawal from methadone hydrochloride therapy. Under controlled inpatient conditions established to assess dosage guidelines and to examine specific signs and symptoms of withdrawal, ten (91%) of 11 patients were able to withdraw completely from methadone therapy by the end of a six-day period. Six days of clonidine hydrochloride treatment, with a peak mean dose of 2.9 mg/day on treatment day 2, attenuated the withdrawal-inducing effects of naltrexone. Naltrexone hydrochloride was gradually increased from an initial 1-mg dose on treatment day 2 to 50-mg maintenance dose on treatment day 5 without an associated increase in withdrawal symptoms. Clonidine significantly decreased BP without producing clinical problems. The withdrawal symptoms of anxiety, restlessness, and muscular aching were most resistant to treatment, but at discharge most patients were completely asymptomatic.

Adult↗
PubMed1982

Ego development in opiate addicts. An application of Loevinger's stage model.

This paper reports findings from a study of ego functioning in a sample of 97 opiate addicts applying for treatment and a demographically matched control group of 29 applicants at a job training program. Level of ego development was evaluated using the Loevinger Sentence Completion Test. In addition, in the addict sample, we assessed the correlation between level of ego development and other clinical features including present and past drug use, criminal history, psychological symptoms, and social functioning. The mean ego development scores for the opiate addicts and controls were not significantly different although both groups achieved scores that were, on the average, one full stage lower than those obtained in other studies of nonclinical adult populations. Ego development ratings indicated that around one third of both addict and control groups seemed to be relying on internalized standards for self-regulation. Within the addict group, those at lower levels of ego development reported more psychological symptomatology, poorer social functioning, and heavier drug use. Implications for treatment planning and rehabilitative efforts are discussed.

Adult↗