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Biomedical subjects

H D Kleber

Publications and source records attributed to H D Kleber.

At least 109 records · Page 6Linked to original sources
PubMed1982

The significance of alcoholism in treated opiate addicts.

This paper presents an evaluation of clinical characteristics of opiate addicts who also have a current or past history of alcoholism diagnosed according to Research Diagnostic Criteria. Based on data derived from a survey of 533 treated opiate addicts, the following findings were obtained. First, alcoholism in treated opiate addicts was found to be a common problem occurring at rates far exceeding those in the surrounding community in all demographic groups. Second, regarding the sequence of alcoholism and opiate addiction, most alcoholic addicts in this sample had alcohol problems before developing a drug use disorder or seeking treatment for opiate addiction. Third, entrance into treatment did not appear to lead to either increased or decreased alcohol abuse, and alcohol abuse while in treatment usually took place in those who had a history of alcohol problems. Fourth, when compared with nonalcoholic addicts, alcoholic addicts had fewer assets and more liabilities including a more disruptive childhood history, heavier history of legal problems and polydrug abuse, more severe problems with social functioning, and higher rates of psychiatric disorders. Fifth, despite these liabilities follow-up findings 6 months after seeking treatment indicate that alcoholism was of little prognostic significance in relationship to treatment outcome.

Adult↗
PubMed1982

History of childhood hyperactivity in a clinic population of opiate addicts.

Although childhood hyperactivity has been shown to be related to a variety of adult psychiatric disorders, no previous study has specifically explored its relation to adult opiate addiction. In this study, 22 per cent of a population of 157 opiate addicts seeking treatment reported childhood histories of hyperactivity. Demographic and developmental features such as high male to female sex ratio, normal intelligence quotient but lower level of educational and occupational achievement, and earlier arrest record supported the retrospective diagnosis. In addition, the subgroup with a history of childhood hyperactivity differed in symptom and personality measures from those without such a history in a way suggesting that those with a history of hyperactivity in childhood were manifesting adult sequelae of the disorder.

Achievement↗
PubMed1982

Pathways to opiate addiction: an evaluation of differing antecedents.

This paper defines and tests a typology of addicts defined through assessment of the sequence of three types of key events: (a) traumatic childhood events such as death of a parent or child abuse; (b) onset of regular delinquent activity; and (c) initiation of illicit drug use. By evaluating the sequence of these events three groups are defined: (a) an initial childhood trauma group; (b) an early delinquency group; and (c) an initial drug use group. Data derived from a sample of treated opiate addicts are used to define and differentiate these three groups.

Adolescent↗
PubMed1982

The treatment of narcotic withdrawal: a historical review.

The history of narcotic withdrawal treatment is filled with "cures" enthusiastically received and then quietly dropped when they turned out to be either ineffective, dangerous, or both. Methods reviewed include the Towns-Lambert belladonna treatment, sodium thiocyanate, bromide sleep treatment, Narcosan, insulin, autogenous serum, ECT, hibernation, methadone, phenothiazines, propranolol, propoxyphene, acupuncture, vitamin C, and the naloxone flush. There is need to be aware of the psychologic as well as physical aspects of withdrawal. Better detoxification techniques would help patients who are ready to discontinue the use of methadone as well as those who want to start naltrexone treatment.

History, 19th Century↗
PubMed1981

The clinical use of clonidine in abrupt withdrawal from methadone. Effects on blood pressure and specific signs and symptoms.

Clonidine hydrochloride was found to be effective in the treatment of methadone hydrochloride withdrawal. Under controlled inpatient conditions established to assess dosage guidelines and to examine specific signs and symptoms of withdrawal, 20 of 25 (80%) patients were able to withdraw completely from methadone by the end of a two-week period. In most patients, ten to 11 days of clonidine administration, with a peak mean dose of 16 micro g /kg/day, resulted in a perceived reduction in symptoms compared with previous attempts to become opiate free. At these doses clonidine significantly reduced standing blood pressure without producing clinical problems. The withdrawal symptoms of anxiety, restlessness, insomnia, and muscular aching were most resistant to clonidine treatment and were reported by the majority of patients.

Adult↗
PubMed1981

Evidence for an endorphin dysfunction in methadone addicts: lack of ACTH response to naloxone.

Chronic exogenous opiate administration might be responsible for the acute and protracted abstinence syndrome by producing a prolonged decrease in the availability of endogenous opioids (endorphins). However, the hypothesis that potent exogenous opiates may have anti-endorphin effects has been difficult to test. We have been investigating this hypothesis with neuroendocrine test paradigms which have provided preliminary evidence of anti-endorphin effects for chronic methadone. Naloxone-induced ACTH response data from chronic methadone addicts offers preliminary support for the hypothesis that chronic exogenous opiate administration has anti-endorphin effects. The subjects were 7 male methadone addicts who had been addicted to greater than or equal to 40 mg of methadone and 7 male healthy opiate-naive volunteers. Naloxone failed to produce a significant increase in ACTH in methadone addicts while opiate-naive normal volunteers demonstrated a significant naloxone-induced release of ACTH. Five of the seven methadone addicts ahd no demonstrable ACTH response to naloxone. These impaired naloxone response data reported here for recently detoxified addicts suggest that chronic methadone administration comprises the functional integrity of the endorphin system. Prolonged abstinence, post-detoxification depression and other affective symptoms which contribute to relapse may result from a prolonged endorphin derangement.

Adrenocorticotropic Hormone↗
PubMed1981

Multiple family therapy and naltrexone in the treatment of opiate dependence.

The effect of multiple family therapy on client compliance and retention in a high intervention, naltrexone treatment program was examined retrospectively. The population consisted of 65 opiate-dependent individuals consecutively treated with naltrexone and a standard program of counseling and supportive psychotherapy. Twenty-five of these individuals, in addition, received multiple family therapy. The data presented are suggestive of the efficacy of combining multiple family therapy and high intervention in patients being treated with naltrexone. Analysis of the data demonstrated that the group receiving multiple family therapy had a larger continuous time of naltrexone ingestion and remained in the treatment program longer than clients who did not receive multiple family therapy. These effects were independent of race and employment status. The implication of the results for treatment and avenues for future research are discussed.

Adolescent↗
PubMed1981

Comparison of opiate addicts' reports of psychiatric history with reports of significant-other informants.

This study compares self-reports by a sample of 50 opiate addicts with reports of 50 "significant other" informants, on past and current functioning. Moderate to high levels of agreement are found using the Intraclass Correlation Coefficient (ICC) in reporting current opiate use, current employment, and current legal pressures. This finding is consistent with previous studies which found good agreement between addicts and informants in these areas. However, much poorer agreement between addicts and informants is found in assessing the severity of addict's social, employment, and psychological problems, and in assessing the more detailed aspects of drug use. A comparison of the percent agreement data with ICC data used in this study provides empirical support for the argument that percent agreement data represents an inflated estimate of concordance between raters. These findings suggest that addicts and their families have rather divergent perceptions of the addict's problems and, in addition, indicate the value of including family members or significant others in the process of evaluating and treating opiate addicts. The results of the statistical analysis underscore the need in reliability studies of rigorous statistics that take into account chance agreement.

Adolescent↗