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Biomedical subjects

K M Carroll

Publications and source records attributed to K M Carroll.

At least 55 records · Page 3Linked to original sources
PubMed1996

Psychotherapeutic considerations in pharmacological trials.

Recent studies have demonstrated the favorable influence of psychotherapy on trials of pharmacological agents for the treatment of patients with alcohol abuse or dependence. When appropriate psychosocial therapies are used, the effects of pharmacotherapy can be more thoroughly evaluated because the use of psychosocial therapy can increase patient retention, enhance medication compliance, and foster the acquisition of new skills that reinforce the effects of the medication. Therefore, psychosocial therapy should be included in studies designed to evaluate the efficacy of pharmacological agents for the treatment of alcohol abuse or dependence.

Alcohol Deterrents↗
PubMed1996

Case report: paravesical suture granuloma resembling bladder carcinoma on CT scanning.

Paravesical granuloma formation is a rare complication of inguinal herniorrhaphy. Infected non-absorbable suture material is the usual cause. We present a case of paravesical granuloma that was initially thought to be bladder carcinoma both clinically and on CT scanning. The patient presented with urinary symptoms. Repeated biopsies revealed only reactive changes with no evidence of malignancy. CT showed a mass which appeared to arise from the anterior aspect of the bladder with a central area of low attenuation. The diagnosis was established at cystoscopy with deep resection of the mass, when two retained silk stitches with surrounding pus and granulation tissue was found. The diagnosis of paravesical suture granuloma (PSG) should be considered in patients with suprapubic symptoms, no haematuria, an atypical mass and a history of herniorrhaphy, which may have been many years prior to the time of presentation.

Cystoscopy↗
PubMed1996

A pilot study of primary-care-based buprenorphine maintenance for heroin dependence.

The treatment of heroin dependence with opioid maintenance has traditionally employed methadone and more recently buprenorphine administered in traditional drug treatment settings. In this pilot study we evaluated buprenorphine maintenance for the treatment of heroin dependence in a program administered by primary-care providers in a primary-care setting. Seven patients were admitted to this nonblinded open-label pilot study and were offered 6 months of primary-care-based buprenorphine maintenance. Buprenorphine was administered in doses of 16 mg on Monday and Wednesday and 32 mg on Friday. Patients were seen weekly by primary-care providers and attended self-help meetings. Of the seven patients admitted to the study, five (71%) completed the 6-month pilot study and two (29%) were removed from the study. Urine toxicology data showed that the majority of urines tested were clear of opioids in four out of five patients who remained in treatment. These results suggest that primary-care-based opioid maintenance using buprenorphine shows promise as a new approach to the treatment of heroin dependence.

Adult↗
PubMed1996

Neonatal withdrawal syndrome in infants exposed to cocaine and methadone.

The effect of concomitant cocaine and methadone use on the neonatal withdrawal syndrome was examined in a group of 68 infants born to mothers participating in a methadone maintenance program. Fifty-three (78%) of the mothers in the sample reported regular use of cocaine during their pregnancy and/or had positive urine screens. Infants exposed to both cocaine and methadone had significantly higher first withdrawal scores. However, cocaine exposed infants did not require more medication for withdrawal management either in terms of dosage or of days treated. Additionally, there was no difference in the occurrence of intrauterine growth retardation, prematurity, or early perinatal complications such as respiratory distress.

Cocaine↗
PubMed1995

Primary care-based ambulatory opioid detoxification: the results of a clinical trial.

OBJECTIVE: To determine the feasibility of primary care-based ambulatory opioid detoxification (AOD) using two protocols: clonidine and clonidine plus naltrexone. SETTING: The Central Medical Unit (CMU)--a freestanding primary care medical clinic staffed by physicians and nurse practitioners. PATIENTS: Injection drug users (IDUs) seeking substance abuse treatment between the ages of 18 and 50 years who were addicted to opioids (e.g., heroin) and not currently in drug treatment. INTERVENTIONS: In the clonidine protocol, clonidine was administered every 4 hours "as needed" for up to 12 days. In the clonidine plus naltrexone protocol, clonidine was administered and naltrexone was administered in increasing doses over five days. Both protocols included "adjuvant" medications for muscle cramps, insomnia, and vomiting. Successfully detoxified patients were referred to ongoing drug treatment. DESIGN: A prospective nonrandomized clinical trial. MEASUREMENTS AND MAIN RESULTS: One hundred forty opioid-addicted IDUs were referred to the medical clinic for AOD. Among the 125 patients who enrolled in the study, 57 selected clonidine and 68 selected clonidine/naltrexone. The treatment groups (clonidine vs clonidine/naltrexone) were similar at baseline with respect to: age at first heroin use (21 years vs 23 years), mean admission opioid craving score (45/100 vs 49/100), and withdrawal symptom score (19/72 vs 18/72). Overall, 70% (88/125) of the AODs were successful, including 42% (24/57) for clonidine and 94% (64/68) for clonidine/naltrexone (p < 0.001). CONCLUSIONS: This study suggests that primary care-based AOD can be safely and effectively carried out by primary care providers and that clonidine/naltrexone may be more effective in this setting than is clonidine alone. Ambulatory opioid detoxification can give internists a larger role in initiating drug treatment for IDUs who are addicted to opioids.

Adolescent↗
PubMed1995

Subtypes of cocaine abusers: support for a type A-type B distinction.

The replicability and generalizability of a multidimensional alcoholism typological system was systematically assessed in 399 inpatient, outpatient, and non-treatment-seeking cocaine abusers. Two different cluster-analytic procedures supported the construct, concurrent, and predictive validity of the Type A-Type B distinction in cocaine abusers. Participants classified as Type B (33%) cocaine abusers exhibited higher rates of premorbid risk factors (family history, childhood behavior problems, personality, age of onset), more severe drug and alcohol abuse, more addiction-related psychosocial impairment, more antisocial behavior, and more comorbid psychiatric problems than Type A participants (67%). Multidimensional typological systems have had a major impact on the alcoholism field and may be equally important for the assessment, prevention, treatment, and theoretical understanding of other substance use disorders.

Adult↗
PubMed1995

Differential symptom reduction in depressed cocaine abusers treated with psychotherapy and pharmacotherapy.

We evaluated treatment response for depressed versus nondepressed ambulatory cocaine abusers in a 12-week randomized controlled trial of desipramine and cognitive-behavioral treatment, alone and in combination. Subjects with depressive symptomatology at baseline tended to have better retention and better cocaine outcomes compared with nondepressed subjects. Desipramine was an effective antidepressant in this sample and was associated with significantly greater reduction in depressive symptoms than was placebo; however, desipramine treatment was not associated with greater reductions in cocaine use for either the depressed or euthymic subgroup. Cognitive-behavioral relapse prevention treatment was associated with significantly longer periods of consecutive abstinence and better retention compared with supportive clinical management for the depressed subgroup, but psychotherapy condition did not have an effect on depressive symptoms. These data point to differential symptom reduction in depressed cocaine addicts and underscore the importance of evaluating combined psychotherapy-pharmacotherapy approaches for this population.

Adult↗
PubMed1994

Psychotherapy and pharmacotherapy for ambulatory cocaine abusers.

BACKGROUND: At present, there is no consensus regarding effective treatment for cocaine abuse or the most productive roles for the two major forms of treatment, pharmacotherapy and psychotherapy. We conducted the first randomized clinical trial evaluating psychotherapy and pharmacotherapy, alone and in combination, as treatment for ambulatory cocaine abusers. METHODS: One hundred thirty-nine subjects were assigned to one of four conditions offered over a 12-week abstinence initiation trial: relapse prevention plus desipramine hydrochloride, clinical management plus desipramine, relapse prevention plus placebo, and clinical management plus placebo. All treatments were manual-guided, delivered by experienced therapists, and monitored to promote the integrity of both forms of treatment. RESULTS: First, although all groups showed significant improvement, significant main effects for medication or psychotherapy, or their combination, were not found for treatment retention, reduction in cocaine use, or other outcomes at 12 weeks. Second, baseline severity of cocaine use interacted differently with psychotherapy and pharmacotherapy: higher-severity patients had significantly better outcome when treated with relapse prevention than with clinical management, while desipramine was associated with improved abstinence initiation among lower-severity subjects. Third, desipramine was significantly more effective than placebo in reducing cocaine use over 6, but not 12, weeks of treatment. Fourth, depressed subjects had greater reduction in cocaine use than nondepressed subjects and had better response to relapse prevention than to clinical management. CONCLUSION: These findings underscore the significance of heterogeneity among cocaine abusers and the need to develop specialized treatments for clinically distinct subgroups of cocaine abusers.

Adult↗
PubMed1994

One-year follow-up of psychotherapy and pharmacotherapy for cocaine dependence. Delayed emergence of psychotherapy effects.

BACKGROUND: Neither the durability of brief ambulatory treatments for cocaine dependence nor the relative ability of psychotherapy vs pharmacotherapy to effect lasting change has been evaluated in well-controlled randomized trials. METHODS: We conducted a 1-year naturalistic follow-up of 121 ambulatory cocaine abusers who underwent psychotherapy (cognitive-behavioral relapse prevention or clinical management) and pharmacotherapy (desipramine hydrochloride or placebo) in a 2 x 2 design. Subjects were interviewed 1, 3, 6, or 12 months after the termination of a 12-week course of outpatient treatment. Eighty percent (n = 97) of the subjects who were randomized to treatment were followed up at least once. RESULTS: First, the effects of study treatments appeared durable over the follow-up; as for the full sample, measures of cocaine use indicated either improvement or no change over posttreatment levels. Second, abstinence during treatment was strongly associated with less cocaine use during follow-up. Third, random effects regression models indicated significant psychotherapy-by-time effects, suggesting a delayed improved response during follow-up for patients who received cognitive-behavioral relapse prevention compared with supportive clinical management. CONCLUSIONS: Our findings suggest a delayed emergence of the effects of cognitive-behavioral relapse prevention, which may reflect the subjects' implementation of the generalizable coping skills conveyed through that treatment. Moreover, these data underline the importance of conducting follow-up studies of substance abusers and other groups because delayed effects may occur after the cessation of short-term treatments.

Adaptation, Psychological↗
PubMed1994

Should tolerance and withdrawal be required for substance dependence disorders?

Despite the historical importance of tolerance and withdrawal in the substance abuse nomenclature, empirical evaluations of tolerance and withdrawal relative to other, non-physical, dependence criteria have been infrequent. Based on data from 521 subjects from a newly completed survey evaluating proposed options for DSM-IV substance use disorders, we found, first, across classes of drugs, requiring tolerance or withdrawal had little effect on rates of dependence, as most subjects who met dependence criteria for each drug class also reported tolerance. Second, tolerance and withdrawal did not emerge as superior to the other dependence criteria on several indicators of concurrent and predictive validity, including severity.

Adolescent↗
PubMed1994

Blind man's bluff: effectiveness and significance of psychotherapy and pharmacotherapy blinding procedures in a clinical trial.

No study has reported on the comparative effectiveness of blinding procedures for psychotherapy and pharmacotherapy conditions in treatment efficacy studies or the potential impact of failure to maintain a psychotherapy blind. In a randomized clinical trial, we found, from the perspective of clinical evaluators who were unaware of the patient's treatment assignment, procedures intended to protect the psychotherapy blind were only modestly effective but comparable to standard procedures used to maintain pharmacotherapy blinds. Second, accuracy of guessing each form of treatment (psychotherapy or pharmacotherapy) was not independent of the other. Third, findings suggested the importance of maintaining both psychotherapy and pharmacotherapy blinds, as subjective ratings of treatment outcome were significantly different depending on whether the clinical evaluator had correctly guessed the patients' true treatment condition.

Cocaine↗
PubMed1994

Sensation seeking, substance abuse, and psychopathology in treatment-seeking and community cocaine abusers.

Sensation seeking, substance abuse severity, and psychiatric disorders were systematically assessed in a clinical and a community sample of 335 cocaine abusers. In contrast to low-sensation-seeking cocaine abusers, high-sensation seekers exhibited more severe symptoms of substance abuse, exhibited more severe psychosocial impairment, were more likely to be polysubstance abusers, and had an earlier age of onset for substance use and abuse. High-sensation seekers were more likely to report both a lifetime history and family history of antisocial personality, attention deficit disorder, and conduct disorder. Sensation seeking was related to several dimensions that are important for defining subtypes of substance abusers and was consistent with other features of a Type II classification.

Adult↗
PubMed1994

Issues in the selection and development of therapies in alcoholism treatment matching research.

There are a large number of possible approaches to the treatment of alcohol abuse and dependence. From a practical and methodological standpoint, however, only a limited number of interventions can realistically be included in research studies of treatment matching. A key question in planning studies of matching is what treatments to include. The recent book by Beutler and Clarkin on systematic treatment selection in general psychotherapy provides a framework within which to discuss alcoholism treatment matching and the criteria applied to decisions concerning (1) modes of treatment, (2) treatment format, (3) specific therapeutic strategies and the (4) treatment setting. The methodological and practical issues raised and the decisions reached in Project MATCH are presented in each of these areas. The therapies chosen for Project MATCH, based on these criteria, are described.

Alcoholism↗
PubMed1994

Implementing treatment and protecting the validity of the independent variable in treatment matching studies.

Treatment matching research is predicated on heterogeneity among subjects and their differential response to treatments. The sine qua non of a treatment matching study is the integrity of the treatment variable, since detection of client-treatment interactions requires delivery of treatments that are highly specific, consistent and distinct. Matching research thus presents particular challenges in treatment implementation, as greater heterogeneity in subjects may generate a broader array of problems than study treatments are designed to address, leading to several potential threats to treatment integrity. Moreover, as practiced outside of research settings, treatments for alcoholism are marked by ideological heterogeneity and a lack of purity across approaches. In this article we describe the strategies used in Project MATCH to protect treatment integrity while treating a large and heterogeneous sample of alcoholics in a number of geographically distant sites. These include: strategies for treating a variety of alcoholics within a single treatment approach; development of clinical care guidelines and clinical deterioration criteria; specification of treatments in manuals with minimization of overlapping active ingredients; selection criteria for therapists intended to enhance both generalizability of findings as well as treatment integrity; and extensive therapist training and monitoring.

Alcoholism↗
PubMed1994

Process assessment in treatment matching research.

A complete understanding of the effects of treatment requires an examination of the process by which the treatment produces the outcome as well as a thorough assessment of the outcomes. Process assessment assumes even greater importance in matching research than in other types of treatment research, since client-treatment interactions are hypothesized to be moderated or mediated by specific treatment components. The role of process assessment in treatment matching research is examined using Project MATCH as an illustrative example. Four process domains, including dose of treatment, within-session treatment activities, the therapeutic alliance and extra-session activities, are described in terms of their role as mediators or moderators of treatment outcome and the perspectives by which they are assessed in Project MATCH.

Alcoholism↗
PubMed1993

In situ stimulation of aerobic PCB biodegradation in Hudson River sediments.

A 73-day field study of in situ aerobic biodegradation of polychlorinated biphenyls (PCBs) in the Hudson River shows that indigenous aerobic microorganisms can degrade the lightly chlorinated PCBs present in these sediments. Addition of inorganic nutrients, biphenyl, and oxygen enhanced PCB biodegradation, as indicated both by a 37 to 55 percent loss of PCBs and by the production of chlorobenzoates, intermediates in the PCB biodegradation pathway. Repeated inoculation with a purified PCB-degrading bacterium failed to improve biodegradative activity. Biodegradation was also observed under mixed but unamended conditions, which suggests that this process may occur commonly in river sediments, with implications for PCB fate models and risk assessments.

Aerobiosis↗
PubMed1993

One-year follow-up status of treatment-seeking cocaine abusers. Psychopathology and dependence severity as predictors of outcome.

While the prognostic significance of comorbid psychopathology and dependence severity has been demonstrated with opiate addicts and alcoholics, no previous reports have examined these issues in cocaine abusers. We reinterviewed 94 cocaine abusers 1 year after they sought treatment to assess predictors of treatment retention and outcome. Results suggested that: a) Many cocaine abusers did comparatively well; fully a third reported complete abstinence during the 12 months preceding the follow-up interview. b) Three variables emerged as consistent predictors across several outcome domains: severity of drug use, poorer psychiatric functioning, and presence of concurrent alcoholism. c) The data supported a unidimensional model of outcome for cocaine abuse that emphasized reduction in level of substance use. However, abstinence was not strongly associated with improved functioning in all outcome areas. d) Variables associated with longer retention in treatment also tended to predict poorer outcome.

Adult↗