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1.
Addict Behav ; 38(12): 2868-73, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24018232

RESUMO

OBJECTIVES: There are few systematic assessments of street-obtained buprenorphine use from community-based samples in the United States. The objective of this study was to characterize the prevalence, correlates, and reasons for street-obtained buprenorphine use among current and former injection drug users (IDUs) in Baltimore, Maryland. METHODS: In 2008, participants of the ALIVE (AIDS Linked to the IntraVenous Experience) study, a community-based cohort of IDUs, were administered a survey on buprenorphine. Street-obtained buprenorphine represented self-reported use of buprenorphine obtained from the street or a friend in the prior three months. RESULTS: Six hundred and two respondents were predominantly male (65%), African-American (91%), and 30% were HIV-positive. Overall, nine percent reported recent street-obtained buprenorphine use, and only 2% reported using to get high. Among active opiate users, 23% reported recent use of street-obtained buprenorphine. Use of buprenorphine prescribed by a physician, injection and non-injection drug use, use of street-obtained methadone and prescription opiates, homelessness, and opioid withdrawal symptoms were positively associated, while methadone treatment, health insurance, outpatient care, and HIV-infection were negatively associated with recent street-obtained buprenorphine use in univariate analysis. After adjustment, active injection and heroin use were positively associated with street-obtained buprenorphine use. Ninety-one percent reported using street-obtained buprenorphine to manage withdrawal symptoms. CONCLUSIONS: While 9% reported recent street-obtained buprenorphine use, only a small minority reported using buprenorphine to get high, with the majority reporting use to manage withdrawal symptoms. There is limited evidence of diversion of buprenorphine in this sample and efforts to expand buprenorphine treatment should continue with further monitoring.


Assuntos
Buprenorfina/provisão & distribuição , Drogas Ilícitas/provisão & distribuição , Entorpecentes/provisão & distribuição , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Baltimore/epidemiologia , Métodos Epidemiológicos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Pessoas Mal Alojadas/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Abstinência a Substâncias/epidemiologia , Síndrome de Abstinência a Substâncias/reabilitação
3.
Drug Alcohol Depend ; 105 Suppl 1: S56-64, 2009 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-19767155

RESUMO

Drugs affecting the central nervous system span a broad range of chemical entities, dosage forms, indications, and risks. Unintended consequences include potential abuse and overdose in non-patient drug abusers, deliberate tampering of drug dosage forms, and criminal behavior associated with diversion. Regulators must consider diverse factors to find the appropriate conditions of approval to minimize unintended consequences while enabling a level of access desired by health care providers and patients. This commentary appears as part of a special issue of Drug and Alcohol Dependence that focuses on risk management and post-marketing surveillance and addresses key issues that pose real-world challenges to pharmaceutical sponsors and regulators in particular. For example, in the U.S., Controlled Substances Act drug scheduling can be considered a risk management strategy but its legal authorities and administrative processes are independent from those of risk management (including Risk Evaluation and Mitigation Strategies or REMS); better harmonization of these approaches is vital from drug development and regulatory perspectives. Risk management would ideally be implemented on a strong science foundation demonstrating that the tools employed to mitigate risks and ensure safe use are effective. In reality, research and evaluation of tools in this area is in its infancy and will necessarily be an evolutionary process; furthermore, there is little precedent for linking interventions and program evolution to unintended consequences such as regional outbreaks of abuse and diversion. How such issues are resolved has the potential to stimulate or stifle innovations in drug development and advance or imperil health care.


Assuntos
Fármacos do Sistema Nervoso Central/efeitos adversos , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Controle de Medicamentos e Entorpecentes/métodos , Vigilância de Produtos Comercializados/métodos , Medição de Risco/métodos , Gestão de Riscos/métodos , Aprovação de Drogas , Humanos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle
5.
Drug Alcohol Depend ; 105 Suppl 1: S65-71, 2009 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-19783383

RESUMO

The abuse and diversion of medications is a significant public health problem. This paper is part of a supplemental issue of Drug and Alcohol Dependence focused on the development of risk management plans and post-marketing surveillance related to minimizing this problem. The issue is based on a conference that was held in October 2008. An Expert Panel was formed to provide a summary of the conclusions and recommendations that emerged from the meeting involving drug abuse experts, regulators and other government agencies, pharmaceutical companies and professional and other non-governmental organizations. This paper provides a written report of this Expert Panel. Eleven conclusions and 11 recommendations emerged concerning the state of the art of this field of research, the regulatory and public health implications and recommendations for future directions. It is concluded that special surveillance tools are needed to detect the emergence of medication abuse in a timely manner and that risk management tools can be implemented to increase the benefit to risk ratio. The scientific basis for both the surveillance and risk management tools is in its infancy, yet progress needs to be made. It is also important that the unintended consequences of increased regulation and the imposition of risk management plans be minimized.


Assuntos
Fármacos do Sistema Nervoso Central/efeitos adversos , Diretrizes para o Planejamento em Saúde , Vigilância de Produtos Comercializados/métodos , Gestão de Riscos/legislação & jurisprudência , Controle de Medicamentos e Entorpecentes/legislação & jurisprudência , Controle de Medicamentos e Entorpecentes/tendências , Humanos , Gestão de Riscos/métodos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle
6.
Am J Prev Med ; 32(3): 231-8, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17236741

RESUMO

BACKGROUND: Drug use among parenting women is a significant risk factor for a range of negative child outcomes, including exposure to violence, child maltreatment, and child behavior problems. Implementation of brief interventions with this population may be greatly facilitated by computer-based interventions. DESIGN: Randomized clinical trial with 4-month follow-up. SETTING/PARTICIPANTS: Participants were 107 postpartum women recruited from an urban obstetric hospital primarily serving a low-income population. Women were randomized into assessment only versus assessment plus brief intervention conditions; 76 (71%) returned for follow-up evaluation. INTERVENTION: A 20-minute, single-session, computer-based motivational intervention (based on motivational interviewing methods), combined with two nontailored mailings and voucher-based reinforcement of attendance at an initial intake/treatment session. MAIN OUTCOME MEASURES: Illicit drug use as measured by qualitative urinalysis and self-report. RESULTS: Frequency of illicit drug use other than marijuana increased slightly for the control group, but declined among intervention group participants (p<0.05, between-group Mann-Whitney U; d=0.50); the magnitude of intervention effects on changes in marijuana use frequency was similar, but did not reach statistical significance. Point-prevalence analysis at follow-up did not show significant group differences in drug use. However, trends under a range of assumptions regarding participants lost to follow-up all favored the intervention group, with most effect sizes in the moderate range (odds ratios 1.4 to 4.7). CONCLUSIONS: Results tentatively support the efficacy of this high-reach, replicable brief intervention. Further research should seek to replicate these findings and to further develop the computer as a platform for validated brief interventions.


Assuntos
Computadores , Promoção da Saúde/métodos , Drogas Ilícitas , Período Pós-Parto , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adulto , Negro ou Afro-Americano/psicologia , Feminino , Humanos , Abuso de Maconha/etnologia , Abuso de Maconha/prevenção & controle , Mães/psicologia , Motivação , Estudos Prospectivos , Fatores de Risco , Autorrevelação , Autoeficácia , Transtornos Relacionados ao Uso de Substâncias/etnologia , Estados Unidos
7.
Psychopharmacology (Berl) ; 185(3): 327-38, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16518646

RESUMO

OBJECTIVE: Preclinical investigations have established that methamphetamine (MA) produces long-term changes in dopamine (DA) neurons in the striatum. Human studies have suggested similar effects and correlated motor and cognitive deficits. The present study was designed to further our understanding of changes in brain function in humans that might result from chronic high dose use of MA after at least 3 months of abstinence. METHOD: Brain function in abstinent users was compared to controls using neuroimaging of monoamine transporters and cognitive assessment. Striatal levels of DA transporter (DAT) and vesicular monoamine transporter type-2 (VMAT2) were determined using [11C]methylphenidate and [11C]dihydrotetrabenazine positron emission tomography, respectively. Cognitive function was evaluated using tests of motor function, memory, learning, attention, and executive function. RESULTS: Striatal DAT was approximately 15% lower and VMAT2 was 10% lower in MA abusers across striatal subregions. The MA abusers performed within the normal range but performed more poorly compared to controls on three of the 12 tasks. CONCLUSIONS: Failure to find more substantial changes in transporter levels and neurocognitive function may be attributed to the length of time that MA users were abstinent (ranging from 3 months to more than 10 years, mean 3 years), although there were no correlations with length of abstinence. Persistent VMAT2 reductions support the animal literature indicating a toxic effect of MA on nigrostriatal nerve terminals. However, the magnitude of the MA effects on nigrostriatal projection integrity is sufficiently small that it is questionable whether clinical signs of DA deficiency are likely to develop.


Assuntos
Transtornos Relacionados ao Uso de Anfetaminas/fisiopatologia , Cognição/efeitos dos fármacos , Corpo Estriado/efeitos dos fármacos , Metanfetamina/efeitos adversos , Substância Negra/efeitos dos fármacos , Adolescente , Adulto , Transtornos Relacionados ao Uso de Anfetaminas/metabolismo , Corpo Estriado/metabolismo , Dopamina/metabolismo , Proteínas da Membrana Plasmática de Transporte de Dopamina/metabolismo , Feminino , Humanos , Masculino , Metanfetamina/administração & dosagem , Pessoa de Meia-Idade , Testes Psicológicos , Substância Negra/metabolismo , Proteínas Vesiculares de Transporte de Monoamina/metabolismo
8.
Drug Alcohol Depend ; 83 Suppl 1: S8-14, 2006 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16483729

RESUMO

This article is part of a supplemental issue of the journal devoted entirely to papers on how abuse liability of medications is affected by their formulation for medical use. This article reviews the history of abuse and addiction to medications in the United States and the legislation designed to control these problems. The provisions in legislation related specifically to formulations of medications designed to decrease their abuse potential will be noted. In addition, the role of the College on Problems of Drug Dependence (CPDD) as an organization initially founded to develop analgesic medications with less abuse potential than morphine is briefly reviewed. Examples of current approaches to the development of formulations of medications to decrease their abuse potential discussed in detail in the articles to follow are outlined. Finally, the use of behavioral economic analyses to better delineate the relative abuse potential of new medication formulations is discussed.


Assuntos
Química Farmacêutica/história , Prescrições de Medicamentos , Tratamento Farmacológico/tendências , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Preparações de Ação Retardada , Saúde Global , História do Século XIX , História do Século XX , História do Século XXI , Humanos
9.
Drug Alcohol Depend ; 83(3): 274-8, 2006 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-16413146

RESUMO

This study examined the adoption of buprenorphine for the treatment of opiate dependence among U.S. substance abuse treatment facilities and their characteristics at the time of the initial availability of the medication. Data come from a 2003 national survey of all substance abuse treatment facilities in the U.S. Out of our sample of 13,060 facilities, 5.5% of facilities reported they offered buprenorphine. Not unexpectedly, the prevalence was higher in certified opioid treatment programs (11.3%) compared to other facilities (4.6%). For opioid treatment programs, offering Naltrexone (OR=8.34, 95% CI=5.53, 12.58) and offering medically supervised withdrawal (OR=2.76, 95% CI=1.38, 5.52) were independent and robust predictors of offering buprenorphine. These same variables were independent predictors for the non-opioid treatment programs as well (Naltrexone, OR=14.32, 95% CI=7.85, 26.10; and medically supervised withdrawal services, OR=4.42, 95% CI=3.01, 6.49). Our results suggest that the adoption of buprenorphine soon after the Food and Drug Administration approved its use for treatment of opioid dependence and the shipping of the medication commenced was associated with facilities already offering pharmacotherapies such as Naltrexone and medically assisted withdrawal. These findings provide baseline data to track the adoption of buprenorphine by substance abuse treatment programs in future years.


Assuntos
Buprenorfina/uso terapêutico , Entorpecentes/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/reabilitação , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Buprenorfina/efeitos adversos , Coleta de Dados , Aprovação de Drogas , Humanos , Naltrexona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Transferência de Tecnologia , Estados Unidos , United States Food and Drug Administration
10.
Drug Alcohol Depend ; 82(1): 19-24, 2006 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-16144747

RESUMO

The rate hypothesis of psychoactive drug action holds that the faster a drug reaches the brain and starts to act, the greater its reinforcing effects and abuse liability. A previous human study using a single cocaine dose confirmed the rate hypothesis for subjective responses, but found no rate effect on cardiovascular responses. We evaluated the rate hypothesis in 17 experienced cocaine users (7 [all men] provided complete data; 6 participated in only 1-2 sessions) by administering IV cocaine at each of three doses (10, 25, 50 mg) and injection durations (10, 30, 60 s) in a double-blind, placebo-controlled, escalating dose design. Heart rate, blood pressure, and positive (e.g., rush, high) and negative (e.g., feel bad, anxious) subjective effects (100-mm visual analogue scales) were measured for 1h after dosing. Peak change from baseline, time to peak, and area under the time-response curve were evaluated with repeated measures mixed linear regression analyses, allowing use of data from all sessions for all subjects, including non-completers. Both dose (mg) and infusion rate (mg/s) significantly influenced most subjective and cardiovascular variables. Analysis of the interaction suggested that dose had a stronger impact than rate. Rate had a stronger influence on positive subjective effects than on negative subjective effects or cardiovascular variables. These findings provide support for the rate hypothesis as it applies to both subjective and cardiovascular effects of IV cocaine administration in humans.


Assuntos
Ansiedade/induzido quimicamente , Pressão Sanguínea/efeitos dos fármacos , Transtornos Relacionados ao Uso de Cocaína/epidemiologia , Transtornos Relacionados ao Uso de Cocaína/fisiopatologia , Cocaína/administração & dosagem , Cocaína/efeitos adversos , Frequência Cardíaca/efeitos dos fármacos , Periodicidade , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/fisiopatologia , Adulto , Relação Dose-Resposta a Droga , Eletrocardiografia , Eletroencefalografia , Humanos , Masculino , Prevalência
11.
J Subst Abuse Treat ; 28(4): 305-12, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15925264

RESUMO

Computer-based brief motivational interventions may be able to reach a high proportion of at-risk individuals and thus have potential for significant population impact. The present studies were conducted to determine the acceptability and preliminary efficacy of a computer-based brief motivational intervention (the motivation enhancement system, or MES). In Study 1, quantitative and qualitative feedback from 30 postpartum women and 17 women in treatment for drug use were used to modify the software. In Study 2, 50 urban postpartum women who reported drug use in the month before pregnancy completed the intervention and provided repeated within-session ratings of state motivation. In Study 3, 30 women were randomly assigned to intervention or control conditions with 1-month follow-up. Overall, women rated the MES as highly acceptable and easy to use and reported significant increases in state motivation at postintervention and at 1-month follow-up (d = .49). These preliminary results are encouraging and suggest that further work in this area is warranted.


Assuntos
Motivação , Período Pós-Parto , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Terapia Assistida por Computador , Adulto , Feminino , Seguimentos , Humanos , Projetos Piloto , Gravidez , Software
13.
Am J Addict ; 13(5): 438-46, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15764422

RESUMO

Smoking cessation attempts are often complicated by dysphoria/depression, weight gain, craving, and other nicotine withdrawal symptoms. Fluoxetine's antidepressant and anorectant properties, along with its capacity to attenuate compulsive behavior, suggest that this medication might facilitate smoking cessation treatment. We examined the effect of fluoxetine on smoking cessation in the context of a program that included group cognitive-behavioral therapy (six weeks) and transdermal nicotine patch(ten weeks). In a double-blind randomized trial of fluoxetine for smoking cessation, 150 daily smokers were assigned to placebo (n=48), 20 mg (n=51), or 40 mg fluoxetine (n=51). Fluoxetine did not significantly improve smoking cessation rates, either for those with or without major depressive disorder(MDD)histories or elevated current depression. Our results suggest that fluoxetine may moderate withdrawal symptoms, even if that was not manifested in improved smoking cessation rates. Our results, however, clearly favor the use of fluoxetine if weight gain is a major clinical obstacle to smoking cessation.


Assuntos
Terapia Cognitivo-Comportamental , Fluoxetina/uso terapêutico , Psicoterapia de Grupo , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Abandono do Hábito de Fumar/métodos , Tabagismo/terapia , Administração Cutânea , Adulto , Transtorno Depressivo Maior/tratamento farmacológico , Método Duplo-Cego , Feminino , Estimulantes Ganglionares/administração & dosagem , Estimulantes Ganglionares/uso terapêutico , Humanos , Masculino , Oxazinas/administração & dosagem , Oxazinas/uso terapêutico , Placebos , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Resultado do Tratamento , Aumento de Peso
14.
Neuropsychopharmacology ; 28(11): 2000-9, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-12902992

RESUMO

The clinical effectiveness of opioid maintenance for heroin dependence is believed to result from a medication's ability to decrease mu-opioid receptor (muOR) availability thereby replacing agonist effects, alleviating withdrawal symptoms and attenuating heroin effects. We empirically tested this hypothesis in five heroin-dependent volunteers who were successively maintained on 32, 16, 2, and 0 mg daily buprenorphine (BUP) tablet doses. We predicted and confirmed that higher BUP doses would decrease in vivo muOR availability (measured with PET and [(11)C]carfentanil), increase plasma levels of BUP and its metabolite nor-BUP, and decrease withdrawal symptoms and hydromorphone (HYD) responses. Relative to placebo, BUP significantly decreased mean (+/-SEM) whole-brain muOR availability 41+/-8, 80+/-2, and 84+/-2% at 2, 16, and 32 mg, respectively. Regions of interest (ROIs) (prefrontal cortex, anterior cingulate, thalamus, amygdala, nucleus accumbens, caudate) showed similar dose-dependent effects. Changes in muOR availability varied across ROIs (prefrontal cortex, 47% vs amygdala, 27%) at BUP 2 mg, but were more homogeneous across ROIs at BUP 32 mg (94-98%; except thalamus, 88%). Relative to placebo (0 ng/ml), peak plasma levels of BUP and nor-BUP were comparable and dose-dependent (0.5-1, 5-6, and 13-14 ng/ml at 2, 16, and 32 mg, respectively). muOR availability decreases were negatively correlated with BUP plasma level and positively correlated with questionnaire-based opioid withdrawal symptoms and attenuation of HYD symptoms. These findings suggest that high-dose BUP maintenance produces near-maximal muOR occupation, muOR availability correlates well with plasma levels, and BUP-related opioid symptoms and antagonist blockade exhibit concentration-effect relationships.


Assuntos
Buprenorfina/administração & dosagem , Buprenorfina/metabolismo , Dependência de Heroína/metabolismo , Antagonistas de Entorpecentes/metabolismo , Receptores Opioides mu/metabolismo , Adulto , Análise de Variância , Buprenorfina/sangue , Relação Dose-Resposta a Droga , Feminino , Dependência de Heroína/sangue , Dependência de Heroína/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Antagonistas de Entorpecentes/administração & dosagem , Receptores Opioides mu/agonistas , Receptores Opioides mu/antagonistas & inibidores , Tomografia Computadorizada de Emissão/métodos
16.
Drug Alcohol Depend ; 69(2): 169-73, 2003 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-12609697

RESUMO

The abuse liability of medications is a growing concern as the number of newly approved psychoactive medications increases. Postmarketing surveillance can assist in determining abuse liability, but strategies are not well-defined for medications believed to be at low abuse risk. Using a newly approved medication (sibutramine--an anorectic drug), a novel approach to postmarketing abuse surveillance was introduced. A one-page anonymous questionnaire covering sibutramine, a scheduled anorectic drug (phentermine), and a fabricated name was added to the intake process of 58 treatment programs. From the 8780 completed questionnaires, 8.8% had heard of sibutramine and phentermine. For continued use to get high (a proxy for abuse), the rate for sibutramine was lower than for phentermine (0.6 vs. 2.2%, McNemar's chi(2) = 110.45, P < 0.001) but was higher than for the fabricated name (0.6 vs. 0.3%, McNemar's chi(2) = 11.86, P < 0.001). These results suggest the risk of abuse associated with sibutramine was lower than that associated with a known abused drug, one that itself is considered low risk despite decades of population exposure. The relatively high rate of hearing of sibutramine may be due to the direct-to-consumer advertisement. This approach is only one indicator in a surveillance framework but appears promising and validates findings from laboratory-based abuse liability studies that also indicate low abuse liability for sibutramine.


Assuntos
Depressores do Apetite , Ciclobutanos , Vigilância de Produtos Comercializados/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Feminino , Humanos , Masculino , Fentermina , Centros de Tratamento de Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Inquéritos e Questionários
17.
Am J Drug Alcohol Abuse ; 29(4): 759-73, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-14713138

RESUMO

Two studies were conducted to investigate the effectiveness of contingency management techniques in promoting punctual counseling attendance among methadone maintenance patients. In Study 1, 50 participants were recruited from an inner-city methadone maintenance program. Study 1 used an A-B-A design with baseline, intervention, and return-to-baseline phases. On-time attendance was reinforced during the intervention phase with a voucher that was redeemable for a draw out of a box containing 100 tokens with values varying from 0.00 dollars to 100.00 dollars. Methadone maintenance patients who exhibited poor attendance during baseline showed a significant positive response during the contingency management intervention phase. Study 2 used the same design as Study 1 except that the 52 participants were randomized into reinforcement groups that received either the variable rate of reinforcement as in Study 1 or a fixed value reinforcer of 3.25 dollars. As in Study 1, Poor Attenders significantly improved counseling attendance during the intervention. There were no differences between the variable and fixed reinforcement groups. Overall, results suggest that targeting Poor Attenders with contingency management techniques may be a cost-effective method of improving counseling attendance. Targeting Poor Attenders early in treatment may be especially important for improving treatment outcomes.


Assuntos
Analgésicos Opioides/uso terapêutico , Aconselhamento/métodos , Metadona/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Cooperação do Paciente/psicologia , Reforço por Recompensa , Adulto , Idoso , Análise de Variância , Aconselhamento/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Michigan , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/reabilitação , Transtornos Relacionados ao Uso de Opioides/urina , Avaliação de Programas e Projetos de Saúde , Serviços Urbanos de Saúde/estatística & dados numéricos
18.
Exp Clin Psychopharmacol ; 10(3): 286-94, 2002 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-12233989

RESUMO

In this 12-week double-blind placebo-controlled trial of methylphenidate (MTP) versus placebo in 48 cocaine-dependent attention-deficit/hyperactivity disorder (ADHD) adults, the authors sought to determine whether MTP would be safe, control ADHD symptoms, and affect cocaine use. Efficacy indexes revealed significantly greater ADHD symptom relief in the MTP group. There were no group differences in self-reported cocaine use, urinalysis results, or cocaine craving. Because of the relatively small sample size, the results are preliminary. However, we found that MTP improved subjective reports of ADHD symptoms and did not worsen cocaine use while participants were in treatment.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Metilfenidato/uso terapêutico , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Estimulantes do Sistema Nervoso Central/efeitos adversos , Transtornos Relacionados ao Uso de Cocaína/psicologia , Comorbidade , Método Duplo-Cego , Feminino , Humanos , Masculino , Metilfenidato/efeitos adversos , Pessoa de Meia-Idade , Pemolina/uso terapêutico , Escalas de Graduação Psiquiátrica
19.
J Psychoactive Drugs ; 34(1): 33-8, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12003111

RESUMO

The information gathered in a centralized intake unit (CIU) allows payers and administrators to examine if there are access issues for their population. For this study, the authors examined whether there were gender differences in the rate at which people are admitted to treatment within 30 days of assessment. Of the 5,004 individuals seeking publicly-funded substance abuse treatment in Detroit for the years 1996-97, 50.3% of those assessed at the CIU actually entered treatment. Women (31% of the people assessed) had a lower rate of admission (45% for women versus 53% for men) a difference that was maintained even after controlling for known risk factors. Women who were given priority for admission (i.e., those who were pregnant, had children, or injected drugs) had a higher rate of admission than other women (73% versus 39%), but only 17% of the women presenting were included in the priority groups. Men who were injecting drugs (a priority group) also had a higher rate of admission than other men (83% versus 49%). In multivariate analysis controlling for priority groups and known risk factors, women were still less likely to be admitted to treatment within 30 days of admission than men. Establishing priorities improves the rate of admission within 30 days of assessment for those groups, but more needs to be done to improve the admission rate for women. These results demonstrate that a CIU allows administrators to monitor for access issues.


Assuntos
Admissão do Paciente/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/organização & administração , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Mulheres , Adulto , Feminino , Humanos , Masculino , Gravidez , Fatores Sexuais , Abuso de Substâncias por Via Intravenosa/reabilitação , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Resultado do Tratamento , Estados Unidos
20.
J Psychoactive Drugs ; 34(1): 39-50, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-12003112

RESUMO

Client-treatment matching assumes treatment outcome will be improved if characteristics of clients are matched to specific elements of treatment. Few empirical studies, however, have examined matching across different types of treatment settings. The present research examined differences in demographics and substance-related problems in populations admitted to three substance abuse treatment settings--outpatient (n = 1132), intensive outpatient (n = 1190), and residential (n = 149)--and tested whether interactions between client characteristics and type of setting predicted rates of 30-day retention and treatment completion. In addition, three specific hypotheses based on prior theoretical and empirical investigations were tested. Client characteristics included demographic information (e.g., sex, age, race) and Addiction Severity Index (ASI) composite scores. Client-setting interactions were found for both retention and completion. All three hypotheses received at least partial support. Implications for client assignment and future research are discussed.


Assuntos
Centros de Tratamento de Abuso de Substâncias/organização & administração , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Alcoolismo/complicações , Alcoolismo/psicologia , Alcoolismo/reabilitação , Bases de Dados Factuais , Família , Feminino , Humanos , Modelos Logísticos , Masculino , Alta do Paciente , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/complicações , Fatores de Tempo , Resultado do Tratamento
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