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S M Mirin

Publications and source records attributed to S M Mirin.

54 records · Page 3Linked to original sources

Psychopathology and mood during heroin use: acute vs chronic effects.

In the context of evaluating the effects of a narcotic antagonist on opiate acquisition, 14 detoxified addicts self-administered increasing doses of unblocked heroin intravenously over a ten-day period. Early in the addiction cycle, subjects experienced tension relief and euphoria but this was followed shortly by a shift in the direction of increasing dysphoria and psychopathology. Nonetheless, individual injections of the drug continued to induce brief episodes of positive mood, an effect enhanced by frequent injection. Heroin self-administration was sharply reduced when subjects were blocked with naltrexone, a narcotic antagonist, and the negative effects observed during unblocked drug use were not observed.

Acute Disease↗

Analysis and modification of opiate reinforcement.

The authors describe a research protocol for the evaluation of narcotic antagonists which examines the heroin-seeking behavior of hard-core heroin addicts on a research ward under blocked and unblocked conditions. Each patient served as his own control. This paper serves as an introduction to a series of papers which follow dealing with behavioral, psychiatric, and aftercare results. It describes detailed methods and preliminary results for the first 21 subjects admitted to the study. More specific results are reported in the papers that follow.

Adult↗

Opiate antagonists and the modification of heroin self-administration behavior in man: an experimental study.

The heroin self-administration behavior of 8 inpatient heroin addicts was examined for 10 days under blocked (i.e., following ingestion of narcotic antagonists--naloxone or naltrexone) and unblocked (no antagonist) conditions. In the unblocked state, subjects injected all the available heroin, but they ceased heroin use almost completely following antagonist administration. Possible explanations for these results are discussed along with their implications for treatment.

Adult↗

Psychopathology, craving, and mood during heroin acquisition: an experimental study.

Six detoxified addict volunteers were allowed to self-administer intravenous heroin on an essentially self-determined schedule. Two periods of heroin acquisition were compared: an unmodified cycle in which patients could become intoxicated and a later cycle in which the effects of heroin were blocked with a narcotic antagonist. In the unblocked condition, patients initially experienced an increase in positive mood, but with chronic administration there was a significant rise in psychopathology and the development of a generalized dysphoric state. Similar changes did not occur when the same patients took heroin while blocked with a narcotic antagonist. Drug craving rose dramatically when "unblocked" heroin was available, but gradually fell during methadone detoxification. Following treatment with a narcotic antagonist, the presence of heroin failed to elicit any sustained rise in craving and drug taking was dramatically reduced.

Adult↗

Effects of heroin and methadone on plasma cortisol and testosterone.

Narcotic addicts self-administered heroin intravenously for 10 days under controlled research ward conditions and were subsequently detoxified with methadone for 7 days. Plasma testosterone levels decreased signifcantly when heroin dosage was between 45 and 65 mg/day contrasted to predrug base-line levels. Testosterone levels remained depressed during methadone withdrawal. No statistically significant changes in a.m. plasma cortisol levels were observed during both heroin acquisition and methadone withdrawal.

Adult↗

The effects of heroin on catecholamine metabolism in man.

In a study of the effects of heroin administration in nine human subjects, urinary catecholamines and metabolites were examined during an initial drug-free baseline period, a ten-day period of heroin administration and a subsequent period of methadone detoxification. All catecholamines and metabolites tended to be increased over baseline values on the first day of heroin administration. However, markedly different patterns of change emerged on subsequent days of heroin administration. Norepinephrine and normetanephrine remained increased throughout heroin administration. Epinephrine was increased during the early phase of heroin administration but returned to baseline values during the latter phase of heroin administration. After the increase on the first day of heroin administration, metanephrine decreased and substantial decrements below baseline values occurred during the latter phase of heroin administration. After increasing on the first day of heroin administration, 3-methoxy-4-hydroxy-mandelic acid (VMA) returned to approximately baseline values. During heroin administration, an increase in 3-methoxy-4-hydroxyphenylglycol (MHPG) excretion was observed in a subgroup of four of the nine subjects studied. This is in contrast to the increase in normetanephrine excretion and the decrease in metanephrine excretion that was observed in the entire group of nine subjects. It is conceivable that persistance of, or development of, tolerance might account for the failure to observe an increase in MHPG excretion in all of the subjects. It appeared as if the increase in MHPG excretion began on the day prior to the administration of heroin in the subgroup of patients with increased MHPG excretion during heroin administration, suggesting the possibility of an anticipatory or conditioned response, with the anticipation of heroin producing an increase in MHPG excretion.

Catecholamines↗

Psychopathology in drug abusers and their families.

Demographic, clinical, and family pedigree data obtained on 350 hospitalized drug-dependent patients showed that 52% also met DSM-III criteria for alcohol abuse or dependence, while 37% met DSM-III criteria for a concurrent axis I psychiatric disorder other than substance abuse. Cyclothymic disorder was significantly more common among cocaine abusers, while generalized anxiety disorder and panic disorder were more common among sedative-hypnotic abusers. Data on 1,478 first-degree relatives revealed that the prevalence of alcoholism and affective disorder was highly correlated with the occurrence of similar psychopathology in the probands. These findings suggest a relationship between drug of choice and comorbid psychopathology, a role for familial factors in the transmission of these disorders, and the importance of diagnostic subtypes in the evaluation and treatment of substance abusers.

Adult↗

Personality disorders in cocaine dependence.

To assess the relationship between cocaine dependence and personality disorders, we administered the Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) to 50 patients who were hospitalized for cocaine dependence. We modified the SCID-II so that patients were asked to indicate whether personality traits (if present) occurred during periods of drug use, abstinence, or both. Thirty-seven patients (74%) received at least one axis II diagnosis; 69% of these diagnoses were present both during periods of drug use and abstinence. Only one patient received a diagnosis during periods of drug use alone. These findings suggest that personality disorder diagnoses in cocaine-dependent patients remain relatively stable regardless of current drug use patterns. These data support clinicians' addressing these maladaptive personality traits as part of treatment for cocaine dependence.

Adult↗