Search PubMed⌕ Search

Biomedical subjects

K M Carroll

Publications and source records attributed to K M Carroll.

68 records · Page 4Linked to original sources
PubMed1993

A comparison of alternate systems for diagnosing antisocial personality disorder in cocaine abusers.

We evaluated rates, reliability, internal consistency, factor structure, and clinical and predictive validity of antisocial personality disorder (ASP) across three diagnostic systems which varied in emphasis on a) core sociopathic traits and b) independence of antisocial behaviors from substance use in 399 cocaine abusers. Rates of ASP ranged from 7% (Research Diagnostic Criteria) to 53% (DSM-III-R). The DSM-III-R diagnosis of ASP was more reliable at 1 month and 1 year than the Research Diagnostic Criteria. Items assessing core traits of sociopathy had very low reliability and were poorly correlated with other criteria. Across all systems, cocaine abusers with ASP had earlier onset of drug dependence, more psychosocial dysfunction, and higher rates of other psychiatric disorders. Finally, only the DSM-III-R diagnosis of ASP was associated with treatment retention and short-term prognosis. These findings suggest that current diagnostic systems which require core sociopathic traits and independence of criminal behaviors from substance use may be more unreliable and of weaker prognostic significance than less restrictive systems.

Adult↗
PubMed1993

Alcoholism in treatment-seeking cocaine abusers: clinical and prognostic significance.

Two hundred ninety-eight treatment-seeking and 101 community cocaine abusers were interviewed using the Schedule for Affective Disorders and Research Diagnostic Criteria. Alcoholism was the most frequently diagnosed current and lifetime psychiatric disorder in both samples. Several findings from this study converge with recent evidence which suggests a particularly strong relationship between cocaine abuse and alcoholism that may differ from other types of alcohol-drug comorbidity. First, rates of alcoholism among cocaine abusers doubled those of comparable samples of opioid addicts. Second, while virtually all cocaine abusers in this sample reported some alcohol use during the past month, a lifetime diagnosis of alcoholism was associated with more severe cocaine dependence. Third, the onset of alcoholism followed the onset of drug dependence for the majority of alcoholic cocaine abusers, a pattern which contrasts that typically seen in other types of drug-alcohol comorbidity and suggests that cocaine abuse may increase vulnerability to secondary alcoholism. Prognostically, cocaine abusers who were alcoholic at baseline interview were more likely to remain alcoholic at 1-year follow-up but did not differ from nonalcoholic cocaine abusers on other measures of outcome.

Adult↗
PubMed1992

Contrast of treatment-seeking and untreated cocaine abusers.

Eighty-nine cocaine abusers seeking treatment were compared with 89 untreated cocaine abusers recruited through chain referral. The community users reported significantly higher levels of polysubstance abuse, fewer negative consequences of cocaine use, lower levels of participation in adult social roles, and greater involvement with the legal system and illegal activities. The two groups were found to be comparable on measures of severity of cocaine use, utilization of self-control strategies to restrict cocaine use, and rates of current and lifetime psychiatric disorders. Findings suggest that high rates of psychiatric comorbidity among cocaine abusers are not uniquely a feature of clinical populations. Moreover, many of the untreated cocaine abusers were found to be heavy users who might benefit from treatment but who tended to minimize the negative consequences of their cocaine use and who lacked support and pressure to enter treatment.

Adult↗
PubMed1992

Improving treatment outcome in pregnant opiate-dependent women.

Outcomes for 6 pregnant methadone-maintained opiate-dependent subjects in enhanced treatment were compared to those of 6 women receiving conventional methadone maintenance. Enhanced treatment consisted of weekly prenatal care, relapse prevention groups, thrice weekly urine toxicology screening with positive contingency awards for abstinence, and therapeutic child care during treatment visits in addition to treatment as usual. Treatment as usual included daily methadone, group counseling, and random urine toxicology screening. Study patients differed from the comparison group in three important ways, having fewer urine toxicology screens positive for illicit substances (59% vs. 76%), three times as many prenatal visits (8.8 vs. 2.7), and heavier infants (median birth weight, 2959 vs. 2344 grams). These results suggest that enhanced drug treatment can improve pregnancy outcome and, in particular, reduce low birth weight for this high-risk population.

Adult↗
PubMed1991

A comparative trial of psychotherapies for ambulatory cocaine abusers: relapse prevention and interpersonal psychotherapy.

Despite the widespread use of psychotherapy as treatment for cocaine abuse, the effectiveness of psychotherapy has not been explored through clinical trials. Forty-two outpatients who met DSM-III criteria for cocaine abuse were randomly assigned to one of two forms of purely psychotherapeutic treatments of cocaine abuse, either relapse prevention (RPT) or interpersonal psychotherapy (IPT). Subjects assigned to relapse prevention were more likely than subjects in IPT to attain three or more continuous weeks of abstinence (57 versus 33%), be classified as recovered at the point of treatment termination (43 versus 19%), and complete treatment (67 versus 38%). Whereas these differences did not reach statistical significance, significant differences by treatment group did emerge when subjects were stratified by severity of substance use: Among the subgroup of more severe users, subjects who received RPT were significantly more likely to achieve abstinence (54 versus 9%) and be classified as recovered (54 versus 0%). Among the subgroups of subjects with lower severity of substance abuse, outcome was comparable for both treatment types. Comparison of results from this investigation with historical controls from a structurally similar pharmacotherapy trial suggests that purely psychotherapeutic treatments may be both viable and effective approaches for many ambulatory cocaine abusers.

Adolescent↗
PubMed1991

Relapse prevention strategies for the treatment of cocaine abuse.

A variety of promising pharmacotherapies, psychotherapies, and other treatments for cocaine abuse have recently been developed, many of which may facilitate the initiation of abstinence in cocaine abusers. This paper describes specific interventions and therapeutic strategies used in the treatment of cocaine abuse, adapted from Marlatt's theory of relapse prevention. These strategies extend Marlatt's primarily psychoeducational approach to address the unique difficulties presented in the treatment of cocaine abuse, which may include wide variations in patients' severity of abuse, available psychosocial resources, and coexistent psychopathology. This approach attempts to integrate relapse prevention techniques into a psychotherapeutic, rather than a purely psychoeducational approach, in order to enhance its effectiveness with cocaine abusers.

Adaptation, Psychological↗
PubMed1988

Differentiation of rat small intestinal epithelial cells by extracellular matrix.

The role of extracellular matrix as a determinant of intestinal cell maturation was explored by growing a normal, but immature, rat small intestinal cell line (IEC-6) on basement membrane extract from Engelbreth-Holm-Swarm (EHS) sarcoma cells (ECM). Grown on plastic or glass, these cells are relatively immature and proliferate rapidly. In contrast, cells on ECM attached more rapidly, stopped proliferating, and rapidly organized into multicellular complex structures. Ultrastructurally, cells grown on ECM displayed significantly more mitochondria, rough endoplasmic reticulum, apical microvilli, and complex golgi apparatus, consistent with greater maturity and synthetic activity. By indirect immunofluorescence, sucrase, alkaline phosphatase, and cellular apolipoprotein B were present in cells grown on ECM only. In contrast to cells grown on glass, these cells also demonstrated Na-dependent glucose absorption, a function unique to mature villus cells (7). We conclude that the basement membrane may be a key determinant of intestinal epithelial cell maturation. The development of a mature villuslike intestinal cell in vitro may have wide application for future studies of induction and regulation of intestinal maturation and function.

Animals↗
PubMed1988

Glucose enhancement of transcellular calcium transport in the intestine.

Glucose stimulates calcium transport in vitro in rat duodenal tissue and isolated enterocytes. Under short-circuited conditions, glucose increased mucosal to serosal calcium flux (JCa(m----s)) without altering serosal to mucosal calcium flux (JCa(s----m)) in the duodenum, the primary site of active calcium absorption in the rat small intestine. The half-maximal dose (ED50) of the glucose stimulatory effect was less than 1 mM, and an increase in JCa(m----s) of 80% over control was seen at a glucose concentration of 50 mM. Glucose did not increase calcium flux in the ileum where active calcium absorption is minimal. Glucose stimulated net calcium uptake by 35% in isolated duodenal enterocytes. Glucose did not alter calcium efflux from preloaded enterocytes suspended in calcium-free buffer. Glucose enhancement of net calcium uptake in enterocytes was not caused by altered cell membrane integrity or functional viability. The nonmetabolizable glucose analogue alpha-methylglucoside did not stimulate calcium transport. Our findings suggest that glucose can stimulate intestinal calcium absorption, at least partially, by enhancing transcellular calcium transport and that cellular glucose metabolism is necessary for stimulation of this route of calcium transport.

Animals↗
PubMed1986

Sex differences in tobacco withdrawal syndrome.

Prospective data from an inpatient (n = 20) and outpatient (n = 50) study were examined for sex differences in tobacco withdrawal symptoms. With each subject serving as his/her own control, changes in a wide range of physiological, psychological and behavioral measures were determined from baseline to tobacco abstinence condition. For all 46 measures, no statistically significant differences between men and women were found in either the number or severity of tobacco withdrawal symptoms.

Chewing Gum↗
PubMedDate not supplied

History and significance of childhood attention deficit disorder in treatment-seeking cocaine abusers.

Thirty-five percent of 298 treatment-seeking cocaine abusers met DSM-III-R criteria for childhood attention deficit hyperactivity disorder (ADHD). Subjects with childhood ADHD were likely to be male (78%), meet Research Diagnostic Criteria (RDC) for conduct disorder (93%) and antisocial personality disorder (47%), and report a history of conduct disorder in first-degree relatives. With respect to those without the disorder and regardless of co-occurrence with sociopathy, cocaine abusers with childhood ADHD were younger at presentation for treatment and reported more severe substance use, earlier onset of cocaine abuse, more frequent and intense cocaine use, intranasal rather than freebase or intravenous use of cocaine, higher rates of alcoholism, and more previous treatment. This pattern of cocaine use is consistent with clinical descriptions of self-medication of residual symptoms of ADHD in cocaine abusers. Data from this study suggest that there may be more cocaine abusers with a history of ADHD than previously recognized in clinical samples of cocaine users, and that these individuals may differ in clinically meaningful ways from those without childhood ADHD. Moreover, the poorer outcome of subjects with ADHD in this sample underlines the importance of identifying and treating residual symptoms of ADHD in cocaine abusers.

Adult↗
PubMedDate not supplied

Integrating psychotherapy and pharmacotherapy to improve drug abuse outcomes.

The two major forms of treatment for drug abuse, psychosocial treatments and pharmacologic treatments, have a number of differences in terms of their mode of action, time to effect, target symptoms, durability, and applicability across drugs of abuse. While each has specific indications and strengths, no psychotherapy or pharmacotherapy is universally effective, and both forms of treatment have some limitations, particularly when used alone. Several recent examples of the benefits of combined treatments for drug abusers are reviewed. These suggest that for many substance use disorders, outcomes can be broadened, enhanced, and extended by combining our most effective forms of psychotherapy and pharmacotherapy.

Alcoholism↗
PubMedDate not supplied

Implications of recent research for program quality in cocaine dependence treatment.

Great strides have been made in recent years regarding the development and evaluation of treatments for cocaine dependence. In particular, several behavioral strategies have been developed with demonstrated effectiveness for diverse populations of cocaine-dependent individuals. These include contingency management, cognitive behavioral treatments, and manualized individual disease model approaches. In addition, large-scale client surveys have identified several correlates of good outcome in the treatment of cocaine dependence, including retention in treatment, increasing compliance, providing services and treatments that address the patient's comorbid psychosocial problems, and encouraging involvement in self-help groups. Finally, greater adoption by treatment providers of strategies commonly used in treatment efficacy research might also contribute to improved treatment quality.

Cocaine-Related Disorders↗