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Biomedical subjects

A Margolin

Publications and source records attributed to A Margolin.

At least 37 records · Page 2Linked to original sources
PubMed1995

"Self" and addiction: the role of imagery in self-regulation.

In this paper we discuss the role of self-regulation and self-perception in sustaining addictive behavior. We suggest that self-regulation techniques are unlikely to have a sustained positive effect on changing addictive behavior in the absence of a change in "addict" self-perception. We describe treatment approaches that emphasize the use of guided imagery for facilitating a shift in self-perception that may be more compatible with self-regulation.

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PubMed1995

A single-blind investigation of four auricular needle puncture configurations.

In order to identify an appropriate needle puncture control for clinical trials of acupuncture we conducted a study in which ten cocaine dependent subjects rated local and systemic effects of four auricular needle puncture configurations (a) sites commonly used for addiction; (b) sites proximate to addiction specific sites; (c) sites not specific for cocaine addiction; and (d) sites in the helix. Subjects received one treatment per day on four successive days. The addiction specific sites were rated highest on local effects; proximal sites a common control were rated highest on systemic effects. A majority of patients ranked the addiction specific sites as the most preferred treatment and the helix points as the least preferred. Results suggest that needle insertion into proximate and non-specific sites may be too active for use as controls; helix regions may be more suitable.

Acupuncture Points↗
PubMed1995

Reliability of sequential naloxone challenge tests.

To determine the reliability of serial naloxone challenges, five heroin addicts stabilized on methadone were given 0.2 mg naloxone intravenously on three consecutive days. Two-factor ANOVA revealed that the between-subjects effect accounted for at least 63% of the variance in each of the dependent measures, and the effect of challenge number for at most 22%. Withdrawal tended to be slightly more severe for the first challenge. Intraclass correlation coefficients were calculated for the area-under-the-curve of the change from baseline: subject-rated (.74) and observer-rated (.71) withdrawal, pulse (.88), systolic blood pressure (.58), diastolic blood pressure (.85), and skin temperature (.63).

Adrenocorticotropic Hormone↗
PubMed1995

Mazindol for relapse prevention to cocaine abuse in methadone-maintained patients.

We conducted a double-blind, randomized clinical trial of mazindol (n = 37) for the prevention of relapse to cocaine abuse in methadone-maintained patients who were in the "action" stage of change, i.e., had a history of cocaine dependence but who had been abstinent for at least 2 weeks prior to entry into the study. Eight-one percent of subjects completed the 12-week course of treatment. Overall, cocaine use during the study was comparatively low-17% of the urine screens submitted were positive for cocaine metabolite. Differences between the mazindol and placebo groups of rates of relapse, number of days to relapse, and cocaine use did not reach statistical significance, but were in the direction of a treatment effect. Results suggest that stage of abstinence initiation may be a potentially useful category to employ as an independent variable in future pharmacotherapy trials for the treatment of cocaine addiction in this patient population.

Adult↗
PubMed1993

Effects of sham and real auricular needling: implications for trials of acupuncture for cocaine addiction.

We conducted a single-blind study (n = 48) comparing subjective evaluations of needles inserted into sham and real auricular acupuncture points. Both ears were needled concurrently, one in sham sites and the other in active points used in the treatment of cocaine addiction. Subjects then completed a questionnaire rating the intensity of five sensations in each ear, and also attempted to identify which ear received sham and which ear received real acupuncture. Results showed that real points were more painful than sham; there were no other overall differences. Subjects' ability to identify which ear received sham and which ear received real acupuncture did not rise above the level of chance.

Acupuncture Points↗
PubMedDate not supplied

A randomized controlled trial of auricular acupuncture for cocaine dependence.

BACKGROUND: Partly because of a lack of a conventional, effective treatment for cocaine addiction, auricular acupuncture is used to treat this disorder in numerous drug treatment facilities across the country for both primary cocaine-dependent and opiate-dependent populations. OBJECTIVE: To evaluate the effectiveness of auricular acupuncture for the treatment of cocaine addiction. METHODS: Eighty-two cocaine-dependent, methadone-maintained patients were randomly assigned to 1 of 3 conditions: auricular acupuncture, a needle-insertion control condition, or a no-needle relaxation control. Treatment sessions were provided 5 times weekly for 8 weeks. The primary outcome was cocaine use assessed by 3-times-weekly urine toxicology screens. RESULTS: Longitudinal analysis of the urine data for the intent-to-treat sample showed that patients assigned to acupuncture were significantly more likely to provide cocaine-negative urine samples relative to both the relaxation control (odds ratio, 3.41; 95% confidence interval, 1.33-8.72; P =. 01) and the needle-insertion control (odds ratio, 2.40; 95% confidence interval, 1.00-5.75; P =.05). CONCLUSIONS: Findings from the current study suggest that acupuncture shows promise for the treatment of cocaine dependence. Further investigation of this treatment modality appears to be warranted.

Acupuncture Points↗
PubMedDate not supplied

Differences between responders and nonresponders to cocaine cues in the laboratory.

Previous research has shown that a majority of drug-dependent subjects respond to drug cues in the laboratory with increased craving; however, approximately one-third are not cue responsive. The current study examined differences between responders and nonresponders to cocaine cues in a sample of 69 cocaine-dependent methadone patients. Subjects completed questionnaires assessing selected dimensions of addiction and participated in a cue-reactivity protocol that assessed both cocaine craving and cocaine aversion in response to cues. Four groups of subjects were identified on the basis of their cue responses: (a) increased craving plus decreased aversion; (b) increasing craving only; (c) decreased aversion only; (d) no increase in craving and no decrease in aversion ("nonresponders"). No group differences were found in severity of cocaine dependence, depression, or on any demographic variable, with the exception of parental status. Group differences were found on measures of cocaine expectancies and self-efficacy. There is a discussion of the bearing of these findings upon explanations offered in the literature for nonreactivity to drug cues.

Adult↗
PubMedDate not supplied

Changes concurrent with initiation of abstinence from cocaine abuse.

In an exploration of changes that occur with initiation of cocaine abstinence, this study examined treatment outcomes in four domains--behavior (cocaine use), affect (depression), cognition (schematic self-representations), and psychophysiology (reactivity to drug cues). Nineteen patients initially entered this 8-week outpatient psychopharmacotherapy trial for the treatment of cocaine dependence. Thirteen completed treatment, and eleven maintained abstinence during the last four weeks of the study. In addition to a demonstrated change in their cocaine-using behavior, these "abstainers" reported reduced depression, increased congruency with "ideal" self-schemas, increased discrepancy with "addict" self-schemas, and generally more positive self-representations. In addition, "abstainers" reported reduced posttreatment craving in the presence of cocaine cues, but evidenced no change in physiological reactivity. Implications of these findings for research and treatment are discussed.

Adult↗
PubMedDate not supplied

Cue-elicited cocaine craving and autogenic relaxation. Association with treatment outcome.

Prior to entering a pharmacotherapy trial for the treatment of cocaine dependence, 19 patients participated in a pretreatment cue-reactivity protocol that concluded with a relaxation exercise. Measures included self-reported craving and skin conductance level (SCL). Post hoc exploratory analyses suggest that neither craving nor change in SCL in response to cocaine cues differentiated patients who subsequently achieved abstinence from those who did not. Craving following the relaxation procedure did differentiate the two groups: patients who subsequently initiated abstinence in treatment reported a reduction in cue-elicited craving to below baseline levels; craving reported by patients who did not successfully complete treatment remained elevated.

Adult↗
PubMedDate not supplied

Acupuncture for the treatment of cocaine addiction. Investigation of a needle puncture control.

We conducted a 6-week, single-blind study of acupuncture for cocaine dependence in methadone-maintained patients (N = 40) for the purpose of identifying an appropriate needle puncture control for use in future large-scale clinical trials. Patients were randomly assigned to receive daily acupuncture in three auricular sites plus one body site (LI-4), or in control sites within 2-3 mm of the four active sites. Overall, there was a positive response to treatment on a variety of drug-related and psychosocial measures. Cocaine use decreased significantly for patients in both needle puncture groups. The only statistically significant difference between the two types of needle puncture was on ratings of craving. Subjects rated each type of needle puncture as equally credible and perceived no significant differences on the acute effects of the two types of needle insertions. Power calculations based on these findings suggest that very large sample sizes would be required to detect treatment differences between this control condition and active acupuncture. Alternative controls are suggested, and the challenges inherent in implementing controlled clinical trials of acupuncture are discussed.

Acupuncture Points↗
PubMedDate not supplied

Association between self-report of cognitive impairment, HIV status, and cocaine use in a sample of cocaine-dependent methadone-maintained patients.

HIV-disease as well as chronic cocaine abuse may both produce neuropsychological deficits that could potentially interfere with psychoeducational treatments for drug abuse. In this study, the Neuropsychological Impairment Scale (NIS), a 95-item self-report assessment instrument, was administered to 120 cocaine-dependent methadone-maintained patients (59 HIV-seropositive; 61 seronegative) to assess self-awareness of cognitive deficits in this patient population. HIV-seropositive cocaine users reported significantly more impairment than did HIV-seronegative cocaine users on all summary scores and six of seven clinical subscales. Controlling for the influence of sociodemographic variables (age, sex, ethnicity, and education), acute and chronic cocaine use, and effective distress, there was still a significant relationship between HIV status and self-report of neuropsychological impairment. Relative to patients with known neuropsychological deficits, 41% of HIV-seropositive cocaine users and 31% of HIV-seronegative cocaine users scored in the impaired range on the Global Impairment Index. Implications for treatment are discussed.

Adult↗
PubMedDate not supplied

Methodological investigations for a multisite trial of auricular acupuncture for cocaine addiction: a study of active and control auricular zones.

We evaluated objective criteria for defining points for needle insertion prior to conducting a multisite clinical trial of auricular acupuncture for cocaine addiction. Thirty-four cocaine-abusing subjects participated in a study in which the trial's active zones (Shenmen, Liver, Lung, and Sympathetic) and control zones (located on the ear helix) were divided into quadrants and assessed along four dimensions: electrical resistance, skin discoloration, skin topography, and tenderness. Acute effects of needles inserted into points of low electrical resistance in one ear and high electrical resistance in the other were also assessed. Results showed that the active zones had lower overall electrical resistance and more subcutaneous ridges than control zones. Zones did not possess significant variability along any single dimension. Acute effects of needling high and low resistance points were similar, differing only for "fullness." Based on these findings, and in view of the difficulty of accurately measuring electrical resistance at ear points, we do not recommend the use of electrical devices for point determination in the multisite study. At present, there seems to be little scientific basis for the preselection of specific points for needle insertion within auricular zones. Needle placement should be based upon clinical judgement.

Acupuncture Points↗
PubMedDate not supplied

A comprehensive pharmacologic-psychosocial treatment program for HIV-seropositive cocaine- and opioid-dependent patients. Preliminary findings.

HIV-seropositive opioid-dependent patients maintained on an opiate-agonist who continue to use cocaine and to engage in other high-risk behaviors may benefit from enhanced treatment services; however, there is currently little data to guide the formulation of such services. We report on a preliminary study in which six HIV-seropositive opioid-and cocaine-dependent patients were provided a 12-week comprehensive pharmacologic/psychosocial treatment program developed specifically to meet the treatment needs of HIV-seropositive drug users. This program was comprised of buprenorphine (12 mg/day), bupropion (150 mg/day), and twice weekly manual-guided group therapy. Results showed significant decreases in intravenous cocaine use, cocaine craving, and symptoms of depression. A post-hoc comparison to outcomes of eight HIV-seropositive patients receiving standard methadone-maintenance found no improvements for patients receiving standard care. Controlled investigation of enhanced drug treatment programs for HIV-seropositive patients may be warranted.

Adult↗
PubMedDate not supplied

Cocaine abuse in methadone maintenance programs: integrating pharmacotherapy with psychosocial interventions.

Cocaine abuse by methadone-maintained patients threatens to undermine the success of methadone programs by sustaining a drug-abusing lifestyle as well as contributing to the spread of HIV. The search for a pharmacotherapeutic agent for the treatment of cocaine has met with limited success. The most promising results emerge when specific agents, such as desipramine, are matched appropriately to specific patient characteristics, such as depression or antisocial personality disorder. For some patients, abstinence from cocaine may also require the addition of intensive psychosocial treatments that target the considerable problems faced by inner-city opioid-addicted individuals. This article discusses ways in which future research could be directed toward investigating the interaction between psychosocial services and pharmacologic treatments, while at the same time developing and testing hypotheses concerning appropriate patient-treatment matching variables.

Cocaine↗
PubMedDate not supplied

Pemoline for the treatment of cocaine dependence in methadone-maintained patients.

The authors conducted an open-label trial of pemoline, a dopaminergic CNS stimulant, for the treatment of cocaine addiction in methadone-maintained patients. Ten patients who met DSM-III-R criteria for cocaine dependence participated in an eight-week study. Findings showed that 50% of patients were discontinued from the study due to complaints of side-effects. Patients who completed treatment submitted 79% positive urine toxicology screens over the course of the study. Patients who dropped out tended to submit fewer cocaine-positive urine screens than treatment completers. In view of suggestions that dopaminergic agents in the treatment of addictions may be enhanced when combined with serotonergic agents, a single-case study of pemoline plus fenfluramine is also reported. Except for one urine sample, all of this patient's urine screens were positive for cocaine. Although findings from these studies do not support the effectiveness of pemoline for the treatment of cocaine abuse in methadone-maintained patients, conclusions must be qualified by the lack of a control group.

Adult↗
PubMedDate not supplied

Motivational factors in cocaine pharmacotherapy trials with methadone-maintained patients: problems and paradoxes.

Phamacotherapy trials for cocaine abuse among methadone-maintained patients have typically reported negative findings as well as high rates of cocaine use during the trial. The contribution of motivational factors to these results is a potentially important, under investigated area. This article points out that some methadone-maintained patients may enter a trial for cocaine abuse with little desire for treatment, motivated primarily to continue receiving methadone or to avoid program sanctions for continued cocaine use. Participants in clinical trials may constitute a phase delaying discharge in a cyclic pattern of multiple treatment episodes. Testing a pharmacologic agent in a motivationally inappropriate sample may not provide a good estimate of the agent's effectiveness. In view of the important public health role that methadone maintenance programs play in preventing HIV transmission, and the subversion of this role by intravenous cocaine use, solutions to these problems are urgently needed. The authors suggest several possible approaches, including pre- and posttreatment motivation assessment, as well as the inclusion of psychosocial interventions that provide the context for the emergence of potential medication effects.

Cocaine↗