Biomedical subjects

Kathleen T Brady

Publications and source records attributed to Kathleen T Brady.

At least 19 recordsLinked to original sources

PubMed2006

Characteristics of cocaine- and marijuana-dependent subjects presenting for medication treatment trials.

Evaluation of the characteristics of individuals presenting for substance abuse treatment can provide important information to help focus treatment services. In this study, demographic and clinical characteristics of individuals presenting for medication trials for the treatment of cocaine or marijuana dependence were compared. Marijuana-dependent subjects were generally younger than cocaine-dependent subjects, more likely to be Caucasian, and completed more years of education. Marijuana-dependent subjects also reported significantly more days using than cocaine-dependent subjects, as well as higher levels of craving. Some differences in psychiatric symptomatology were also noted, with cocaine-dependent subjects more likely to report anxiety symptoms and marijuana-dependent subjects reporting more past depressive episodes. Past and current other drug use was similar between the two groups. These results highlight the significant impairments associated with marijuana and cocaine dependence.

Adult↗

PubMed2006

Changes in PTSD symptomatology during acute and protracted alcohol and cocaine abstinence.

Previous research with substance users has demonstrated, across a variety of psychiatric disorders, significant decreases in psychological symptoms during early substance abstinence. To build on this literature, the current study prospectively assessed trauma symptomatology over 28 days during acute and protracted cocaine and alcohol abstinence. Participants were 162 male and female cocaine and/or alcohol dependent outpatients who reported a history of trauma. Trauma-related symptoms and substance use were assessed at 2, 5, 10, 14, 21, and 28 days following last substance use. For participants who were known to relapse, assessments began again after the last day of substance use. Latent growth modeling was employed to estimate changes in posttraumatic stress disorder (PTSD) symptoms. Consistent with studies of other psychiatric syndromes, PTSD symptoms declined across the 28-day study period regardless of withdrawal substance (i.e., cocaine or alcohol). The majority of change in trauma symptoms occurred within 2 weeks of last substance use. Moreover, while trauma symptoms for the PTSD participants were more severe than those reported by the non-PTSD participants, trauma symptoms declined across the study period at the same rate irrespective of PTSD status.

Acute Disease↗

PubMed2006

Triggers for cocaine and alcohol use in the presence and absence of posttraumatic stress disorder.

The present study compared high-risk triggers and substance use situations among 72 (34 men, 38 women) individuals with alcohol (AD) or cocaine dependence (CD), with or without comorbid PTSD. Consistent with the self-medication hypothesis, individuals with PTSD reported significantly greater use of substances in response to negative situations, such as unpleasant emotions and physical discomfort, as compared to individuals without PTSD. CD individuals were significantly more likely than AD individuals to report using in temptation situations, regardless of PTSD status. Also, CD individuals with PTSD reported greater use of cocaine during pleasant times with others, as compared to those without PTSD. The findings highlight the importance of addressing individual-specific high-risk situations in relapse prevention.

Adult↗

PubMed2006

A preliminary report on the use of virtual reality technology to elicit craving and cue reactivity in cocaine dependent individuals.

In the present feasibility study, we developed a 3-dimensional virtual "crack" cocaine environment and evaluated the environment's ability to elicit subjective craving and cue reactivity (i.e., subjective emotional responding, heart rate and skin conductance) in 11 crack cocaine dependent individuals. Each of the seven 3-D crack cocaine scenes in the cocaine environment depicted actors engaging in a range of using-related behaviors (i.e., smoking crack) whereas the neutral environment contained scenes depicted 3-D aquariums with active aquatic life (baseline measures were obtained following immersion in the neutral environment). Results indicated that craving was significantly elevated during the cocaine-related scenes as compared to baseline. Craving varied by scene content, with scenes depicting active cocaine use eliciting the highest levels of craving. Heart rate was significantly higher in four of the scenes with drug use content and positive affect (i.e., happiness) ratings were significantly lower during cocaine scenes as compared to baseline. Overall, the results suggest that a standardized and stimulus rich virtual reality environment effectively elicits craving and physiologic reactivity. Such technology has potential utility in the development and refinement of exposure-based behavioral and pharmacological interventions for substance use disorders.

Adult↗

PubMed2006

PTSD and the HPA axis: differences in response to the cold pressor task among individuals with child vs. adult trauma.

Hypothalamic pituitary adrenal (HPA) axis and subjective stress response to a cold-water immersion task, the cold pressor task (CPT), in individuals (N=89) with post-traumatic stress disorder (PTSD) were examined. All tests were conducted at 08:00h after an overnight hospital stay. Plasma adrenocorticotrophin hormone (ACTH), cortisol, and subjective stress were examined at baseline and five post-task time points in controls (n=31), subjects with PTSD as a result of an index trauma during childhood (i.e. before age 18; n=25), and subjects with PTSD as a result of an index trauma as an adult (n=33). Approximately, 50% of individuals in both trauma groups were alcohol dependent, and the impact of this comorbidity was also examined. Subjects with PTSD, regardless of age of index trauma, had a less robust ACTH response as compared to controls. Regardless of the presence or absence of comorbid alcohol dependence, subjects with childhood trauma had lower cortisol at baseline and at all post-task measurement points and did not demonstrate the decrease in cortisol over the course of the 2h monitoring period seen in subjects with adult index trauma and controls. The findings reveal differences in the neuroendocrine response to the CPT in individuals with PTSD compared to control subjects, and differences in PTSD subjects when examined by age of index trauma.

Adaptation, Psychological↗

PubMed2006

Stress reactivity: biological and subjective responses to the cold pressor and Trier Social stressors.

The cold pressor test (CPT) and Trier Social Stress Test (TSST) have been shown to reliably increase HPA activity; however, little research has compared responses to these stressors. In this study, biological (plasma cortisol and ACTH levels) and subjective (e.g., stress and mood) responses were compared in 31 subjects administered both the CPT and TSST. Subjects were diagnosed with alcohol dependence and post-traumatic stress disorder (PTSD) (n = 11), alcohol dependence without PTSD (n = 10), PTSD without alcohol use disorder (n = 4), and neither PTSD nor alcohol use disorder (n = 6). All subjects completed both the CPT and TSST. In all groups, the TSST elicited higher levels of ACTH and cortisol than the CPT, and the response time course differed between tasks. The TSST also produced lower mood ratings than the CPT. A comparison of all diagnosed groups with normal controls revealed group differences in ACTH responding for the CPT but not the TSST. The results suggest that the TSST results in a greater HPA response than the CPT; however, the CPT may have utility in diagnostically heterogeneous patients.

Adrenocorticotropic Hormone↗

PubMed2006

Advances in diagnosis of adolescent substance abuse.

Screening and diagnosis of adolescent substance abuse is a challenging but achievable component of primary care practice. Successful integration of these procedures into office visits requires an understanding of prevalence, risk factors, and strategies for prevention and treatment. The authors provide a synopsis of recent advances and important issues in this area and propose a stepwise, evidence-based approach to evaluation of substance abuse in adolescents.

Adolescent↗

PubMed2006

Menstrual cycle phase effects on nicotine withdrawal and cigarette craving: a review.

Evidence suggests that women are less likely to quit smoking than are men. This may reflect differences in nicotine dependence and, more specifically perhaps, nicotine withdrawal and craving. However, there is conflicting research on gender differences on the experience of withdrawal and craving. Menstrual cycle effects may moderate this relationship. Given hormonal changes during the menstrual cycle, abstinence-related symptoms such as withdrawal and craving may vary as a function of menstrual phase as well. This qualitative review summarizes the modest but expanding body of research in this area. One of the challenges inherent in interpreting this literature is the difficulty in distinguishing withdrawal symptomatology from premenstrual symptomatology. Methodological variation, including limited sample size and possible selection bias, in which several studies finding null effects excluded women with severe premenstrual dysphoric disorder, may explain some of the inconsistent findings across studies. Nonetheless, some of the 13 studies included in this review found heightened experiences of withdrawal or craving within the latter days of the menstrual cycle (i.e., the luteal phase). Further research is necessary to replicate these findings, but they may suggest the need for focused cessation treatment during the luteal phase or quit attempts that are well timed relative to specific menstrual phases.

Female↗

PubMed2006

Symptom improvement in co-occurring PTSD and alcohol dependence.

This study investigated the temporal course of improvement in PTSD and alcohol dependence symptoms among individuals participating in a 12-week outpatient treatment study. Participants were 94 individuals with comorbid PTSD and alcohol dependence enrolled in a double-blind, placebo-controlled medication trial. Outcome measures included PTSD symptoms (as measured by the Clinician Administered PTSD Scale, Impact of Events Scale, and Civilian Mississippi Scale for PTSD) and alcohol use severity (as measured by the Time Line Follow Back). Study completion rates were significantly higher for individuals who demonstrated improvement in both disorders. Improvements in PTSD had a greater impact on improvement in alcohol dependence symptoms than the reciprocal relationship. Improvement in hyperarousal PTSD symptoms, in particular, was related to substantially improved alcohol use. Examination of the temporal course of symptom improvement revealed that alcohol symptoms tended to start improving either before or in conjunction with PTSD symptoms. Although preliminary in nature, these findings suggest that co-occurring PTSD symptoms may have a strong impact on alcohol dependence treatment outcome, and that PTSD treatment may be important to optimizing outcomes for patients with comorbid PTSD and alcohol dependence.

Adolescent↗

PubMed2006

Cold pressor task reactivity: predictors of alcohol use among alcohol-dependent individuals with and without comorbid posttraumatic stress disorder.

BACKGROUND: The association between stress and alcohol dependence has been well established. Abnormalities in stress reactivity and hypothalamic-pituitary-adrenal axis (HPA) function may be involved in the mechanistic connection between stress and the initiation, development, and/or maintenance of alcohol dependence. Posttraumatic stress disorder (PTSD) commonly co-occurs with alcohol dependence and is characterized by HPA axis abnormalities. This study investigated the relationship between subjective and neuroendocrine stress reactivity to the cold pressor task (CPT) and prospective alcohol use among individuals with alcohol dependence, with and without comorbid PTSD. METHODS: Participants were 63 individuals with (a) alcohol dependence only (n=35) or (b) comorbid alcohol dependence and PTSD (n=28). Participants completed the CPT, a widely used physical laboratory stressor. Subjective stress, craving, adrenocorticotrophin (ACTH), and cortisol were measured before, immediately after, and at 5, 30, 60, and 120 minutes after the CPT. Alcohol use during 1 month following testing was also assessed. RESULTS: For the alcohol-only group, change in craving immediately following the CPT and craving during the 120-minute recovery phase were predictive of follow-up alcohol use. For the alcohol/PTSD group, change in craving was not predictive of follow-up use. Baseline drinking was, however, predictive of followup alcohol use for the alcohol/PTSD group. For the alcohol-only group, a blunted ACTH response coupled with a higher change in craving following the CPT was associated with significantly greater frequency and intensity of drinking during the follow-up phase. CONCLUSIONS: These preliminary findings demonstrate significant differences between the alcohol-only and the alcohol/PTSD group in predictors of relapse. For the alcohol-only group, reactivity to an acute laboratory stressor may be predictive of subsequent alcohol use. This was not true for the alcohol/PTSD group. Although preliminary, the findings may help shed light on the mechanistic relationship between stress reactivity and increased risk for alcohol relapse and dependence in individuals with and without other Axis I comorbidity.

Adrenal Glands↗

PubMed2006

The impact of alcohol dependence and posttraumatic stress disorder on cold pressor task response.

OBJECTIVE: Posttraumatic stress disorder (PTSD) is commonly comorbid with alcohol-use disorders. Abnormalities in the hypothalamic-pituitary-adrenal (HPA) axis response are common in both disorders. The objective of this study was to investigate HPA axis reactivity to the cold pressor task (CPT) among individuals with alcohol dependence, PTSD, and comorbid alcohol dependence and PTSD. METHOD: Participants were 119 individuals with alcohol dependence only (n = 31), comorbid alcohol dependence and PTSD (n = 28), PTSD without alcohol dependence (n = 30), and a control group (n = 30). Subjective response, adrenal corticotropic hormone (ACTH), and cortisol were measured before, immediately after, and for 120 minutes after each subject completed the CPT. RESULTS: There were significant group and gender differences found in the subjective and ACTH response, with significantly higher subjective stress ratings and decreased ACTH response in the alcohol-dependent, PTSD, and comorbid alcohol dependent-PTSD groups compared with the control group. CONCLUSIONS: There were differences in the HPA axis and subjective response to the CPT between the control group and both the alcohol and PTSD groups. The HPA response in the comorbid alcohol-PTSD group was not significantly different than that of the alcohol-only or PTSD-only groups.

Adolescent↗

PubMed2005

Cocaine dependence and PTSD: a pilot study of symptom interplay and treatment preferences.

Cocaine dependence and posttraumatic stress disorder (PTSD) frequently co-occur. Little is known, however, about patients' perceptions of symptom connectedness and preferences for treatment. This pilot study preliminarily investigated perceptions of symptom interplay and preferences regarding concurrent or sequential models of psychotherapy, therapy format, and treatment modalities. Participants were 23 individuals with current cocaine dependence and PTSD. The majority (95.5%) reported a functional relationship between cocaine use and PTSD symptoms (p<0.001). Improvement in PTSD symptoms was typically (63.6%) associated with a decrease in cocaine use (p<0.01). Similarly, a worsening of PTSD symptoms was typically (86.4%) associated with an increase in cocaine use (p<0.001). In contrast, improvement/deterioration in cocaine use was not significantly related to subsequent improvement/deterioration in PTSD symptoms. This finding suggests that changes in PTSD may be an important risk factor to consider among individuals with cocaine dependence and PTSD. Approximately 41% preferred a concurrent model of therapy in which the cocaine use and PTSD are treated simultaneously in therapy. The findings highlight the functional relationship between these two disorders and have direct implications for treatment interventions.

Adult↗

PubMed2005

Practical considerations for estimating clinical trial accrual periods: application to a multi-center effectiveness study.

BACKGROUND: Adequate participant recruitment is vital to the conduct of a clinical trial. Projected recruitment rates are often over-estimated, and the time to recruit the target population (accrual period) is often under-estimated. METHODS: This report illustrates three approaches to estimating the accrual period and applies the methods to a multi-center, randomized, placebo controlled trial undergoing development. RESULTS: Incorporating known sources of accrual variation can yield a more justified estimate of the accrual period. Simulation studies can be incorporated into a clinical trial's planning phase to provide estimates for key accrual summaries including the mean and standard deviation of the accrual period. CONCLUSION: The accrual period of a clinical trial should be carefully considered, and the allocation of sufficient time for participant recruitment is a fundamental aspect of planning a clinical trial.

Humans↗

PubMed2005

Gender differences in stress reactivity among cocaine-dependent individuals.

RATIONALE: Recent investigations suggest that stress reactivity may play an important role in the relationship between stress and substance use. Important gender differences, such as reasons for using substances, have been well documented, and it is likely that men and women also differ in their stress response. OBJECTIVES: In this study, gender differences in stress reactivity to two laboratory stress manipulations were examined among 18 men and 21 women with current cocaine dependence. METHODS: Participants completed a psychological stress task, the Mental Arithmetic Task (MAT), and a physical stress task, the Cold Pressor Task (CPT). Subjective stress responses (i.e., feelings of stress, anxiety, nervousness, pain, mood), physiological stress responses (i.e., heart rate, skin conductance), and cocaine craving were assessed. RESULTS: In response to both the MAT and the CPT, significant increases in subjective and physiological stress were observed among participants. Women, however, demonstrated greater subjective reactivity, as evidenced by significantly higher ratings of stress, nervousness, and pain as compared to men. Women also immersed their hand in the cold water bath for a significantly shorter period of time as compared to men. CONCLUSIONS: The current findings are among the first to report on gender differences in stress reactivity among cocaine-dependent individuals. The findings suggest that the mechanisms linking stress and substance use may be gender-specific, and that stress reactivity may play a different role for women than for men. Future research and implications for clinical interventions are discussed.

Adult↗

PubMed2005

Alcohol dependence and posttraumatic stress disorder: differences in clinical presentation and response to cognitive-behavioral therapy by order of onset.

Alcohol dependence (AD) and posttraumatic stress disorder (PTSD) frequently co-occur. However, little systematic study has examined the importance of their temporal order of onset. In this study, differences in clinical presentation and response to cognitive-behavioral substance-use therapy by order of onset were examined among 94 (51 men and 43 women) individuals with AD and PTSD. The findings revealed that women with primary AD and men with primary PTSD presented as more distressed and/or depressed than their counterparts at treatment entry. A relationship between increased alcohol intake and higher PTSD symptom levels was observed during treatment. In general, the primary PTSD group derived greater overall benefit (e.g., in physical health, alcohol use, social functioning) as compared with the primary AD group. Finally, women with primary AD appeared particularly vulnerable to continued psychiatric distress and depression at the end of treatment. These findings increase awareness of the importance of considering the order of onset and may ultimately lead to treatment improvements for this population.

Adult↗

PubMed2005

Pharmacotherapy of comorbid mood, anxiety, and substance use disorders.

Mood and anxiety disorders commonly co-occur with substance use disorders. Exploration of the neurobiology of substance use disorders and mood and anxiety disorders have found that the neural circuitry in mood, anxiety, and substance use disorders is clearly overlapping. These discoveries have encouraged the exploration of a number of pharmacotherapeutic agents in the treatment of co-occurring mood, anxiety, and substance use disorders. In this article, recent data on the pharmacotherapeutic treatment of mood and anxiety disorders in individuals with substance use disorders are reviewed. Some of the barriers to the use of pharmacotherapy in individuals with substance use disorders are discussed.

Anxiety Disorders↗

PubMed2005

Attention-deficit/hyperactivity disorder, medication treatment, and substance use patterns among adolescents and young adults.

OBJECTIVE: The aim of this study was to examine the relationship between current active attention-deficit/hyperactivity disorder (ADHD) symptoms, medication treatment, and substance use patterns among college students. METHOD: Three hundred and thirty-four students at a local college were surveyed for current ADHD symptoms and psychopharmacological treatment. The survey was conducted in conjunction with an annual national survey that probes students about their substance use patterns and attitudes. RESULTS: Participants with ADHD as ascertained by medication treatment of ADHD had greater past-year tobacco and marijuana use. Among those with ADHD, participants with active ADHD symptoms were more likely to have past-year tobacco and other drug (besides tobacco, alcohol, and marijuana) use as compared to those without active ADHD symptoms. In addition, participants with active ADHD symptoms were more likely to have past-month "other" drug use as compared to those without active ADHD symptoms. Among those prescribed medications for ADHD, 25% reported ever using their medication to "get high" and almost 29% reported ever giving or selling their medication to someone else. CONCLUSIONS: Results of our preliminary study indicated that ADHD symptom control may be important to protect against increased risk of substance use (particularly tobacco and drugs other than alcohol and marijuana) among college-age students with ADHD. Further studies of misuse/diversion of prescription stimulant medication among college students are needed.

Adolescent↗

PubMed2005

Sertraline in the treatment of co-occurring alcohol dependence and posttraumatic stress disorder.

BACKGROUND: Posttraumatic stress disorder (PTSD) frequently co-occurs with alcohol use disorders. This study investigated the use of sertraline, a serotonin reuptake inhibitor, in treating co-occurring symptoms of alcohol dependence and PTSD. METHODS: A total of 94 individuals with current alcohol dependence and PTSD were randomly assigned to receive sertraline (150 mg/day) or placebo for 12 weeks. Post hoc cluster analysis of baseline characteristics was used to define subgroups of participants. RESULTS: There was a significant decrease in alcohol use during the trial in both the sertraline and the placebo groups. Cluster analysis revealed significant medication group by cluster interactions for alcohol-related outcomes. Sertraline-treated participants with less severe alcohol dependence and early-onset PTSD had significantly fewer drinks per drinking day (p < 0.001). For participants with more severe alcohol dependence and later onset PTSD, the placebo group had significantly greater decreases in drinks per drinking day (p < 0.01) and average number of drinks consumed per day (p < 0.05). CONCLUSIONS: There may be subtypes of alcohol-dependent individuals who respond differently to serotonin reuptake inhibitor treatment. Further investigation of differential responders may lead to improvements in the pharmacological treatment of co-occurring alcohol dependence and PTSD.

Adult↗