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F Gawin

Publications and source records attributed to F Gawin.

14 recordsLinked to original sources
PubMed1994

One-year follow-up of psychotherapy and pharmacotherapy for cocaine dependence. Delayed emergence of psychotherapy effects.

BACKGROUND: Neither the durability of brief ambulatory treatments for cocaine dependence nor the relative ability of psychotherapy vs pharmacotherapy to effect lasting change has been evaluated in well-controlled randomized trials. METHODS: We conducted a 1-year naturalistic follow-up of 121 ambulatory cocaine abusers who underwent psychotherapy (cognitive-behavioral relapse prevention or clinical management) and pharmacotherapy (desipramine hydrochloride or placebo) in a 2 x 2 design. Subjects were interviewed 1, 3, 6, or 12 months after the termination of a 12-week course of outpatient treatment. Eighty percent (n = 97) of the subjects who were randomized to treatment were followed up at least once. RESULTS: First, the effects of study treatments appeared durable over the follow-up; as for the full sample, measures of cocaine use indicated either improvement or no change over posttreatment levels. Second, abstinence during treatment was strongly associated with less cocaine use during follow-up. Third, random effects regression models indicated significant psychotherapy-by-time effects, suggesting a delayed improved response during follow-up for patients who received cognitive-behavioral relapse prevention compared with supportive clinical management. CONCLUSIONS: Our findings suggest a delayed emergence of the effects of cognitive-behavioral relapse prevention, which may reflect the subjects' implementation of the generalizable coping skills conveyed through that treatment. Moreover, these data underline the importance of conducting follow-up studies of substance abusers and other groups because delayed effects may occur after the cessation of short-term treatments.

Adaptation, Psychological↗
PubMed1992

Cocaine use and withdrawal: the effect on sleep and mood.

Three recreational cocaine users (age, 26.7 years), after one adaptation night, spent 5 days and nights in the laboratory where their EEG, EOG, and submental EMG were recorded during all of their sleep. On the second afternoon and evening of the study, subjects used an estimated 1 to 2 g cocaine intranasally. They all slept between 2:00 A.M. and 9:00 A.M. that night. Blood samples were drawn each evening and morning. Absolute plasma cocaine levels and patterns of elimination were consistent with subjects report of dose and time of administration. Mood ratings were made repeatedly throughout the study. There was suppression of REM sleep during the use of cocaine followed by a rebound which is specific to REM sleep and is not seen in other stages of sleep. REM variables subsided to normal levels on the third recovery night following cocaine use.

Adult↗
PubMed1991

Psychiatric diagnoses of treatment-seeking cocaine abusers.

In a sample of 298 cocaine abusers seeking inpatient (n = 149) or outpatient (n = 149) treatment, rates of psychiatric disorders were determined by means of the Schedule for Affective Disorders and Research Diagnostic Criteria. Overall, 55.7% met current and 73.5% met lifetime criteria for a psychiatric disorder other than a substance use disorder. In common with previous reports from clinical samples of cocaine abusers, these overall rates were largely accounted for by major depression, minor bipolar conditions (eg, hypomania, cyclothymic personality), anxiety disorders, antisocial personality, and history of childhood attention deficit disorder. Affective disorders and alcoholism usually followed the onset of drug abuse, while anxiety disorders, antisocial personality, and attention deficit disorder typically preceded drug abuse.

Adult↗
PubMed1991

Clinical phenomenology and neurobiology of cocaine abstinence: a prospective inpatient study.

OBJECTIVE: This study was undertaken to document symptoms and changes in dopaminergic function emerging after abrupt cessation of cocaine use. METHOD: After admission, 22 patients with DSM-III-R cocaine dependence were observed drug free for 3 weeks. The patient-rated Ribicoff Abstinence Rating Scale, Symptom Rating Scale, Physical Symptom Scale, Patient Rated Anxiety Scale, Beck Depression Inventory, and visual analogue scales for 16 subjective states were completed daily, and nurses rated 13 patients with the global anxiety and depression items of the Short Clinical Rating Scale. Serial blood samples were obtained three times weekly, and the patients' levels of prolactin, growth hormone (GH), and homovanillic acid (HVA) were measured. Their prolactin and GH values were compared with those of matched normal subjects. RESULTS: A total of 62 subjective symptom variables were evaluated. At baseline, the symptom ratings were mildly elevated. At 3 weeks there were significant decreases from baseline in 28 variables and nearly significant decreases in six additional variables. Nurse-rated anxiety and depression also changed, but in a more variable pattern. There was a small but significant increase from baseline over time in plasma prolactin, but there were no significant changes in GH or HVA. The patients' prolactin and GH values did not differ from those of the normal subjects. CONCLUSIONS: These findings suggest that symptoms after inpatient cessation of uncomplicated cocaine addiction are relatively mild and decrease linearly over the first month. Evidence of dysregulated central dopamine function was limited. The findings do not support routine use of pharmacological agents in the inpatient management of such patients.

Adult↗
PubMed1988

Treating cocaine abusing methadone maintenance patients with desipramine.

Intravenous cocaine use in methadone patients has become a major problem because of both the complications of cocaine use and the potential spread of AIDS. During an eight week open trial we found that desipramine reduced cocaine craving and use in eight cocaine abusing methadone maintenance patients compared to eight patients getting no medication execept methadone.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Psychopharmacological trials in cocaine abuse treatment.

Recent research has produced encouraging preliminary data on general pharmacological treatments for cocaine abuse as well as on pharmacotherapies specific for cocaine abusers with Axis 1 psychiatric disorders. Pharmacotherapy trials with antidepressants, lithium, and stimulants in chronic cocaine abusers as well as recent clinical, diagnostic, and pre-clinical studies will be reviewed. Symptom presentation, severity of abuse, and phase of recovery are discussed as potential guides in treatment selection.

Cocaine↗
PubMed1986

Pharmacologic treatments of cocaine abuse.

Because current studies have small sample sizes and limited controls, firm conclusions or treatment recommendations cannot be made at present, but pharmacologic approaches probably have a place in the treatment of cocaine abuse. Pharmacologic treatments of cocaine abusers may relate to underlying psychiatric diagnoses. Cocaine abusers with adult attention deficit disorder appear to respond well to methylphenidate, but other cocaine abusers have increased cocaine craving when getting this medication. Cyclothymic cocaine abusers appear to respond to lithium with reduced cocaine use. Depressed cocaine abusers, who may constitute about 30 per cent of abusers, have decreased cocaine craving and increased abstinence when treated with desipramine. Other cocaine abusers without underlying psychiatric disorders may also respond well to desipramine if they fail to reduce their cocaine use during psychotherapy.

Attention Deficit Disorder with Hyperactivity↗
PubMed1985

Interpersonal psychotherapy adapted for ambulatory cocaine abusers.

The authors describe the strategies and goals of Klerman et al.'s Interpersonal Psychotherapy (IPT) as revised for application to cocaine abusers. IPT is a brief, individual psychological treatment suitable for use by experienced psychotherapists. The goals are reduction or cessation of cocaine use and development of more productive strategies for dealing with social and interpersonal problems associated with the onset and perpetuation of cocaine use. The treatment has four definitive characteristics: (a) adherence to a medical model of psychiatric disorders; (b) focus on patient's difficulties in current interpersonal functioning; (c) brevity and emphasis on consistency of focus; and (d) use of an exploratory stance by the psychotherapist which is similar to that of supportive and exploratory psychotherapies. It is currently being used in combination with medications in a clinical trial evaluating the efficacy of desipramine, lithium carbonate, methylphenidate, and placebo as treatment for ambulatory cocaine abusers.

Adult↗
PubMed1984

Methylphenidate (Ritalin) treatment of cocaine dependence--a preliminary report.

The authors report on three cases of cocaine dependence treated with methylphenidate. All patients treated showed marked to dramatic improvement with regard to toxic/abstinence signs and symptoms, craving behavior and other behavioral disturbances associated with heavy and chronic cocaine abuse. The authors explore the possibility that cocaine dependence is associated with pre-existing or resulting psychopathology, particularly mood disturbances. Emphasis is also placed on a predisposing or de novo attention deficit disorder (ADD) as possibly contributing to heavy or continued reliance on cocaine.

Adult↗