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Biomedical subjects

J F Maddux

Publications and source records attributed to J F Maddux.

At least 19 recordsLinked to original sources
PubMed1997

The relationship of methadone dose and other variables to outcomes of methadone maintenance.

The authors evaluated the relationship of methadone dose to retention in treatment and to urine tests for morphine and cocaine in a cohort of 610 opioid users admitted to methadone maintenance and followed for 1 year. Methadone dosing was flexible, with patient participation in dose decisions. The maximum dose during treatment ranged from 10 mg to 110 mg, with a mean of 52 mg. Higher doses were associated with increased retention through the dose range of 60 mg-69 mg. Dose was not related to the likelihood of a positive morphine test but was related to the likelihood of a positive cocaine test. In this study, with flexible dosing and patient participation in dose decisions, patients were retained on methadone about as well as was reported in a previous study with patients on a fixed dose of 80 mg.

Adult↗
PubMed1995

Reliability of two brief questionnaires for drug abuse treatment evaluation.

The authors report the inter-interviewer reliability of two brief questionnaires developed to measure the effects of innovations in methadone maintenance. The instruments were designed to answer the research questions, but to intrude only minimally into the clinical assessment and treatment processes. The Initial Interview, completed at the time of admission, yielded information on 23 variables, and the Followup Interview, completed as soon as possible after the first anniversary of admission, yielded information on 20 variables. To assess reliability, a repeat interview was conducted by a different interviewer immediately after the first interview was completed. Repeat interviews were conducted with 19 subjects who completed the Initial Interview and 30 who completed the Followup Interview. Exact agreement was found in all the pairs of responses from the Initial Interview for 5 of the 6 categorical variables and 6 of the 17 quantitative variables. For the remaining 11 quantitative variables, the intraclass correlation coefficients ranged from .700 to .999. Exact agreement was found in all pairs of responses from the Followup Interview for 2 of the 4 categorical variables and 8 of the 16 quantitative variables. For each of the remaining categorical variables, the kappa statistic was significant (.73 and .49). For the remaining 8 quantitative variables, the intraclass correlation coefficients ranged from .750 to .999. The findings signify satisfactory interviewer reliability of the instruments. These brief instruments could easily be adapted for use in other treatment evaluation studies where brevity in data collection is considered desirable.

Humans↗
PubMed1995

Rapid admission and retention on methadone.

An open clinical trial was conducted to compare the effects of rapid (1-day) admission with slow (14-day) admission to methadone maintenance on pretreatment attrition, retention during treatment, and other outcomes. One hundred eighty-six illicit opioid users eligible for methadone maintenance were randomly assigned to rapid admission or slow admission, with 93 subjects assigned to each group. The random assignment produced two groups that were similar on 22 personal variables. All subjects admitted to treatment were followed for 1 year. Follow-up interviews were obtained with 155 (98%) of the 158 subjects admitted to treatment. During the period from initial contact to medication, only 4% of the rapid admission subjects but 26% of the slow admission subjects dropped out. The risk of dropout during slow admission was 6 times that during rapid admission. A higher percentage of rapid admission subjects, 43%, than of slow admission subjects, 39%, remained continuously in treatment for 1 year, but the difference was not significant. The two subgroups that remained in treatment for 1 year did about equally well on measures of illicit drug use and social performance. The findings indicate that pretreatment attrition can be markedly reduced by prompt medication, and the prompt medication does not adversely affect retention during treatment or other outcomes.

Adult↗
PubMed1994

Illicit drug injectors in three Texas cities.

In three Texas cities illicit drug injectors not in treatment were located by outreach and interviewed with a standard questionnaire. In all the cities the drug injectors were predominantly undereducated and unemployed young men from minority groups. In Dallas and Houston most were Black, while in San Antonio most were Hispanic. The most frequently reported primary drug in Houston was cocaine, but in Dallas and San Antonio it was heroin. The high needle risk for AIDS and the low rates of positive HIV antibody tests in these samples present a special window of opportunity for prevention of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Methadone maintenance and recovery from opioid dependence.

While maintained on methadone, heroin users reduce their heroin use and related criminal activity and increase their legitimate employment. These benefits are obtained at the cost of continued opioid dependence. Furthermore, as a consequence of neural adaptation and conditioning, methadone maintenance may impede eventual recovery from opioid dependence. The authors attempt to assess such a possible effect by comparing long-term outcomes after methadone maintenance with those after drug-free treatment. In five long-term follow-up studies of methadone maintenance, the percentages found voluntarily abstinent ranged from 9 to 21. In six long-term follow-up studies of drug-free treatment, the percentages found voluntarily abstinent ranged from 10 to 19. These rates seem remarkably similar. They do not suggest that methadone maintenance impedes eventual recovery from opioid dependence, but they do not clearly exclude such an effect.

Follow-Up Studies↗
PubMed1992

Ten-year follow-up after admission to methadone maintenance.

To assess the long-term effects of methadone maintenance, we compared the 10-year outcomes of 95 chronic opioid users who spent at least one cumulative year on methadone with those of 77 chronic opioid users who spent less than one cumulative year on methadone. All subjects were men and 90% were Mexican-American. The two groups were similar on 12 of 15 background variables. During the 10-year period, the methadone group had a cumulative mean of 54 months on methadone, while the comparison group had a cumulative mean of only 2 months on methadone. On social performance, as measured by months employed and months institutionalized, the methadone group did significantly better than did the comparison group. On months of voluntary abstinence, however, the comparison group did significantly better than did the methadone group. The mean of the comparison group, 36 months, was three times greater than that, 12 months, of the methadone group. At the end of the 10-year period, 26% of the comparison group but only 7% of the methadone group had been in continuous voluntary abstinence for 3 years or longer. Methadone maintenance for 1 year or longer was inversely related to abstinence during and at the end of the 10 years. This finding seems consistent with the hypothesis that methadone maintenance for 1 year or longer impedes eventual recovery from opioid dependence. For many patients, however, the benefits of prolonged maintenance could outweigh the possible cost of diminished likelihood of eventual recovery.

Adult↗
PubMed1991

Methadone dose and urine morphine.

When methadone maintenance was introduced in 1965, daily doses of approximately 100 mg were advocated and used; later, doses under 50 mg became common; recently, doses between 50 and 100 mg have been recommended. In a historical study and a cross-section study in one program the authors found no relationship between methadone dose and urine morphine. Patients on methadone doses under 50 mg had nearly the same percentage of urine tests positive for morphine as did those on doses of 50 mg and more. Gender, ethnic background, and age were also unrelated to urine morphine. Time on methadone was inversely related to urine morphine. Patients maintained on methadone for 3 years or longer showed a marked decrease in urine tests positive for morphine. Increased urine morphine during one decade was associated with program and community changes that could have prompted increased heroin use. These findings suggest that variables other than methadone dose affect heroin use.

Adult↗
PubMed1989

Family and environment in the choice of opioid dependence or alcoholism.

From interviews with 235 opioid-dependent probands, the lifetime prevalence of opioid dependence among their family members was found to be 8.4%, markedly exceeding the estimated lifetime prevalence of 0.9% in the general adult population. Gender-specific lifetime prevalence rates of alcoholism among family members did not consistently exceed rates in the general adult population as estimated from epidemiologic studies based on direct interviews. Because interviews with probands alone tend to underestimate family prevalence of alcoholism, the family rates may have exceeded the general population rates. The probands themselves had a high lifetime prevalence (56%) of alcoholism. A trend toward association of alcoholism in the probands with alcoholism in the parents was found. An intergenerational increase in availability of heroin and in heroin-using peers was accompanied by an intergenerational reversal in prevalence of alcoholism and opioid dependence. The parents of probands had higher rates of alcoholism than of opioid dependence, while the siblings of probands had higher rates of opioid dependence than of alcoholism. This study and preceding studies demonstrate that opioid dependence clusters in families of opioid-dependent probands. Familial clustering is consistent with but not equivalent to familial transmission. The findings suggest that the extrafamilial environment affected choice of alcohol or opioid as the principal substance of dependence.

Adult↗
PubMed1988

Clinical experience with civil commitment.

The unstable motivation of the addicted person has represented a major problem in the treatment of opioid dependence. Only a minority of voluntary patients remained in the two PHS hospitals for treatment beyond withdrawal. Early followup studies at the two hospitals indicated that treatment under legal coercion, especially when combined with compulsory posthospital care, had better outcomes, but not markedly better, than did voluntary treatment. A large proportion, one-third to one-half, of the patients admitted to the hospitals for examination prior to civil commitment were found not suitable for treatment, mainly due to their disruptive or dangerous behavior. Due to attrition after examination and during 6 months of hospital treatment under commitment, only about one-third of the civil commitment patients admitted were discharged to aftercare. The high attrition rate may have been partly due to intensive psychosocial treatment. Patients who absconded from treatment were not prosecuted; consequently, civil commitment provided only a weak coercion to treatment. Two followup studies suggested that the short-term outcomes of the civil commitment patients were somewhat better than those of voluntary patients. Limited and inconclusive research exists on the relation of coercion to long-term stable abstinence. Methadone maintenance is accompanied by improved social adjustment, but it retains in treatment only a minority of opioid drug users. One study suggests that 16 to 30 percent of the population of chronic opioid users in the community is not in treatment. Civil commitment, as one of an array of social and legal coercions, can probably bring some opioid users into treatment who would not voluntarily enter. It has several limitations. Civil commitment cannot overcome deficits in treatment services. Civil commitment, or any other kind of external coercion, can bring drug users into treatment but cannot assure that patients will participate in treatment. Finally, civil commitment is restricted by constitutional guarantees of individual liberty.

Commitment of Persons with Psychiatric Disorders↗
PubMed1987

Depression in opioid users varies with substance use status.

The relation of substance use status to depressed mood during careers of 173 opioid users was estimated using the Zung Self-Rating Depression Scale. The data suggested a progression in severity of depression from those abstinent or using occasionally, who were least depressed, through intermediate substance use states, to those dependent on illicit opioids, who were most depressed. One hundred five subjects completed the Scale in two interviews separated by a mean of 4.5 years. Change in substance use status from not dependent at first interview to dependent at second interview was associated with increased depression.

Adult↗
PubMed1986

Psychoactive substance use among medical students.

A survey of 133 senior medical students revealed that noteworthy proportions had used the following psychoactive substances during their lifetime: cigarettes, 44%; alcohol, 96%; marijuana, 57%; amphetamines, 22%; cocaine, 20%; sedatives, 17%; benzodiazepines, 37%; hallucinogens, 15%; and opioids, 40%. Smaller percentages reported use of these substances during the last year and the last month. Lifetime use did not vary significantly by sex, ethnic status, or marital status. Twelve percent reported nearly daily use of one or more substances during the last month; a different but overlapping 11% reported substance abuse symptoms during the last year. Use of illicit substances and substance abuse symptoms were associated with depressed mood.

Adult↗
PubMed1984

Mexican-American heroin addicts.

Next to Blacks, Mexican-Americans are the largest ethnic minority group among the visible opioid addict population in the United States. Although commonly grouped together with Puerto Ricans and other Spanish-speaking peoples under the rubric "Hispanic," Mexican-Americans have a unique culture and ethnohistory. In this report we review the clinical and research literature and present new data from studies of Mexican-American opioid users in San Antonio. Mexican-American addicts tend to use fewer classes of illicit drugs and are less likely to use stimulants and psychedelics than Whites or Blacks. Onset of daily opioid use occurs at an early age, typically around 20, yet first voluntary admission to treatment usually occurs later than it does for other ethnic groups. Mexican-American addicts tend to be arrested more frequently and spend significantly more years in correctional institutions, but there is also evidence that they spend more time voluntarily abstinent and employed during their careers. The duration of the career is prolonged, however, and typically exceeds 20 years. Mexican-Americans prefer individual to group treatment, and are especially unlikely to participate in traditional therapeutic communities and group psychotherapies. The Mexican-American client is the least likely to complete treatment without adverse termination. The literature seems unanimous in calling for more treatment of Mexican-American addicts by Mexican-American therapists, but we found little empirical outcome data which demonstrated that ethnic matching of therapist and client brings better results.

Adolescent↗
PubMed1984

Heroin addicts and nonaddicted brothers.

Childhood and adult life experiences of 50 heroin addicts are compared with those of their nonaddicted brothers. The sibling pairs came from large families with a median of six children; 45 pairs came from Mexican-American families. The median age of both addicts and brothers was 39. One-third of both addicts and brothers lost a parent before age 16. The addicts showed early deviant behavior preceding heroin use in contrast to the socially conforming behavior of the brothers. Noteworthy discrepancies appeared in the retrospective explanations offered by the addicts and the brothers of conditions leading to addiction in one and abstinence in the other. The addicts attributed the addiction versus abstinence primarily to association with different peer groups; the brothers cited this difference, but also frequently cited personality differences and other differences, thus giving more complex explanations. As adults the addicts showed gross social impairment on dimensions of employment, criminal record, marital adjustment, and other life activities. The brothers, in contrast, seemed socially competent, but they nonetheless showed evidence of some impairment: 40% were arrested one or more times, and 50% had histories of alcohol abuse. Apparently the brothers did not entirely escape the adverse early environments which shaped the careers of the addicts.

Adult↗
PubMed1983

Optional versus mandatory psychotherapy in methadone maintenance.

Treatment outcomes of 23 methadone maintenance patients who were offered optional psychotherapy were compared with those of 31 methadone maintenance patients who received mandatory psychotherapy. There were no statistically significant differences in pretreatment characteristics between the optional group and the mandatory group. Patients in the optional group received less than half as many hours of therapy as patients in the mandatory group. Differences between the two groups in retention, employment, illicit drug use, and arrests were nonsignificant during a 1-year study period. The findings were compatible with those of most previous studies of the effectiveness of psychotherapy in methadone maintenance, which suggest that outcomes with or without psychotherapy do not differ significantly.

Adult↗
PubMed1982

Residence relocation inhibits opioid dependence.

Residence relocation affected opioid drug use among 248 addicts in San Antonio, Tex. One hundred seventy-one subjects reported a total of 465 relocations away from San Antonio during a mean follow-up period of 20 years. Subjects were voluntarily abstinent 54% of the time during relocation and 12% of the time during San Antonio residence. The frequency of one-year abstinence after relocation (17%) was nearly three times greater than that after 1,654 treatment and correctional interactions (6%). Treatment preceding relocation led to a notably higher frequency of abstinence (31%). When abstinent subjects returned to San Antonio, they resumed opioid use within one month in 81% of the cases. Possible explanatory factors include drug availability, conditioned abstinence, and peer modeling. The findings suggest that relocation of patients should often be encouraged rather than discouraged.

Adult↗