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Biomedical subjects

K J Brower

Publications and source records attributed to K J Brower.

At least 37 records · Page 2Linked to original sources
PubMed1991

Symptoms and correlates of anabolic-androgenic steroid dependence.

Forty-nine male weight lifters, all users of anabolic-androgenic steroids (AASs), completed an anonymous, self-administered questionnaire to investigate addictive patterns of use. At least one DSM-III-R symptom of dependence was reported by 94% of the sample. Three or more symptoms, consistent with a diagnosis of dependence, were reported by 57%. Dependent users (n = 28) could be distinguished from non-dependent users (n = 21) by their use of larger doses, more cycles of use, more dissatisfaction with body size, and more aggressive symptoms. Multiple regression analysis revealed that dosage and dissatisfaction with body size were the best predictors of dependent use. Patterns of other substances used, although not predictive of AAS dependence, revealed very low cigarette use and at the same time high alcohol consumption. These data support the notion that AASs are addicting, and suggest that dissatisfaction with body size may lead to dependent patterns of use. The implications for both prevention and treatment are discussed.

Adult↗
PubMed1991

Clinical assessment and urine testing for anabolic-androgenic steroid abuse and dependence.

The emerging epidemic of anabolic-androgenic steroid use, no longer confined to elite athletes, is associated with adverse health consequences for which users may seek treatment. As with other forms of drug abuse, patients may deny or hide their use of steroids while seeking treatment for bothersome side effects or other problems. Thus, clinicians may increasingly, but unknowingly, see patients who are using steroids. Early detection and treatment of steroid abuse and dependence is critical in order to prevent serious and potentially fatal consequences. Therefore, it is incumbent upon clinicians to know the signs and symptoms of using steroids, and to be familiar with the clinical indications for urine testing. Using case examples, the authors review the assessment of steroid abuse and dependence in clinical practice and illustrate the role of urine testing in the assessment process.

Adult↗
PubMed1989

Treatment implications of chemical dependency models an integrative approach.

Five basic models of chemical dependency and their treatment implications are described. The moral model, although disdained by most treatment professionals, actually finds expression in over half the steps of Alcoholics Anonymous. The learning model, albeit the center of the controlled drinking controversy, is also utilized by most abstinence-oriented programs. The disease model, which enjoys current popularity, sometimes ignores the presence of coexisting disorders. The self-medication model, which tends to regard chemical dependency as a symptom, can draw needed attention to coexisting disorders. The social model emphasizes the importance of environmental and interpersonal influences in treatment, although the substance abuser may endorse it as a justification to adopt a victim's role. A sixth model, the dual diagnosis model, is presented as an example of how two of the basic models can be integrated both to expand the treatment focus and to increase treatment leverage. Whereas the five basic models are characterized by a singular, organizing treatment focus, the dual diagnosis model is viewed as an example of a multifocused, integrative model. It is concluded that effective therapy requires (a) flexibility in combining elements of different models in order to individualize treatment plans for substance abusers, and (b) careful assessment of both the therapist's and the substance abuser's beliefs about treatment models in order to insure a treatment match based on a healthy alliance.

Alcoholics Anonymous↗
PubMed1989

Anabolic-androgenic steroid dependence.

The authors believe that this is the first published case report of a patient whose dependence on a combination of anabolic and androgenic steroids meets the DSM-III-R criteria for psychoactive substance dependence. Tolerance, withdrawal symptoms, and the use of steroids to alleviate withdrawal symptoms occurred. An uncontrolled pattern of steroid use continued, despite adverse consequences, such as severe mood disturbance, marital conflict, and deterioration of the patient's usual values. Clinicians should be alerted to the possibility of dependence when asked to prescribe anabolic or androgenic steroids and should suspect steroid use among athlete patients who have mood or psychosocial disturbances.

Adult↗
PubMed1988

Screening for alcoholism.

Alcoholism is one of the largest public health problems of the nation and is a significant cofactor in such ubiquitous diseases as hypertension, developmental abnormalities, heart failure, liver failure, and many other conditions. The cost to the nation's health is immense. One strategy for reducing morbidity and cost has been to establish methods for screening in order to increase recognition rates leading to increased rates of therapeutic intervention. In this article, the rationale for two methods of alcohol screening, brief interviews and biological markers of excessive drinking, the relevant statistical issues bearing on this problem, and the current research on screening exams are reviewed and summarized. Finally, some of the newer approaches toward alcoholism screening as well as the consequences to the medical care system should alcohol screening eventuate on a large scale are briefly described.

Alcoholism↗
PubMed1988

Self-medication of migraine headaches with freebase cocaine.

The following report describes a patient who began cocaine use as a self-treatment for migraine headaches and developed a full-blown cocaine dependency disorder. Treatment implications are discussed in relation to the self-medication hypothesis of addictive disorders. The discussion concludes that both initiating and perpetuating factors in substance abuse must be addressed for effective treatment to occur.

Adult↗
PubMed1988

A comparison of self-reported symptoms and DSM-III-R criteria for cocaine withdrawal.

The frequencies of 15 self-reported symptoms of cocaine withdrawal were compared in 75 subjects to the symptoms listed as criteria by DSM-III and DSM-III-R for either amphetamine or cocaine withdrawal. Three of the four most frequently reported symptoms, depression (75%), sleep disturbance (71%), and fatigue (69%), corresponded to DSM-III and DSM-III-R criteria. The only other DSM-III symptom, increased dreaming (33%), was infrequently reported, lending support to its deletion by DSM-III-R. Physical withdrawal symptoms, which are generally unappreciated in cocaine withdrawal, were reported by 64% of the sample. Neither the DSM-III criteria nor the new DSM-III-R criteria include other frequent symptoms which might contribute to relapse and impaired functioning, such as craving (69%), apathy/amotivation (67%), and restlessness (64%). Thus, these criteria may be too narrowly defined for treatment purposes.

Cocaine↗
PubMed1986

Recent trends in cocaine abuse in a VA psychiatric population.

An anonymous questionnaire completed by 473 patients seeking psychiatric treatment at a metropolitan Veterans Administration medical center indicated that 23 percent were currently using cocaine and 46 percent had used the drug at least once in their lifetime. Typically current users were black males in their early thirties who favored the freebase method of drug use and who were similar to nonusers in occupation, education, and low income. Analyses of freebasers, intravenous users, and intranasal users indicated that freebasers were more likely to be black, to have used more cocaine in the preceding 30 days, to be seeking treatment specifically for cocaine abuse, and, along with intravenous users, to have experienced a greater number of psychosocial disruptions. Freebasers were also least likely to have changed to other methods of cocaine use.

Adult↗
PubMedDate not supplied

Risk factors for anabolic-androgenic steroid use in men.

The illicit use of anabolic steroids to enhance athletic performance and physical appearance can cause numerous psychiatric and other adverse effects. In order to prevent steroid use and its negative consequences, knowledge of risk factors is needed. We conducted an anonymous survey of 404 male weight lifters from community gymnasiums who completed a 20-min, self-administered questionnaire. The sample for this study included all 35 men who were thinking about using steroids ("high-risk" nonusers), 50 randomly selected nonusers who were not thinking about using steroids ("low-risk" nonusers) and all 49 steroid users. The three groups differed in age, training characteristics, other performance-enhancers tried, body image, acquaintance with steroid users, and perception of negative consequences. When groups were compared along a continuum from low risk to high risk and from high risk to actual use, we found increasing amounts of competitive bodybuilding, performance-enhancers tried, and steroid-using acquaintances. Groups did not differ in their use of addictive substances. Nearly three-fourths of the high-risk group felt "not big enough," compared to 21% of the low-risk group and 38% of the steroid users (p < .001). These data suggest that steroids do work to increase satisfaction with body size, and that dissatisfaction with body size may contribute to the risk of using steroids.

Adult↗
PubMedDate not supplied

Treatment of alprazolam withdrawal with chlordiazepoxide substitution and taper.

We describe the first case series (n = 6) of using chlordiazepoxide to accomplish a rapid, well-tolerated withdrawal from alprazolam. After abruptly discontinuing alprazolam, we substituted a 50-mg dose of chlordiazepoxide for each 1 mg of alprazolam (except for one elderly patient where we substituted 25 mg) and gave additional chlordiazepoxide doses (25-50 mg every 4-6 hours) as needed for the first 1-2 days of hospitalization. With this approach, the mean "substitution ratio" of chlordiazepoxide to alprazolam was 86 to 1. We then tapered chlordiazepoxide by an average of 10% each day over a 7- to 14-day period according to the symptoms manifested and tolerated by individual patients. No seizures or other serious side effects occurred. Incomplete cross-dependence, as described elsewhere in the literature, was not observed. The rapidity and familiarity of the method are advantages for inpatient units, but careful titration of dosage, diagnostic clarity, and extended follow-ups are necessary when applying this approach.

Adult↗