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Biomedical subjects

H D Kleber

Publications and source records attributed to H D Kleber.

At least 55 records · Page 3Linked to original sources
PubMed1988

Rapid death during cocaine abuse: a variant of the neuroleptic malignant syndrome?

A mechanism for rapid death in cocaine abusers is proposed based on the neuroleptic malignant syndrome (NMS). The mechanism involves decreased postsynaptic availability of dopamine either through direct receptor blockade, as postulated in classical NMS, or through relative dopamine depletion, as postulated in cocaine withdrawal. The hallmark symptoms of NMS include hyperpyrexia and muscular rigidity, but the cocaine associated syndrome is atypical in having minimal rigidity. This lack of muscle rigidity, however, appears to be consistent with NMS-like syndromes accompanying other conditions involving dopamine depletion rather than blockade. Treatment implications are that dopamine antagonists, which are usually prescribed for cocaine overdose, may be contraindicated and instead, dopamine agonists may reverse this rapidly fatal syndrome.

Body Temperature Regulation↗
PubMed1987

A 2.5-year follow-up of cocaine use among treated opioid addicts. Have our treatments helped?

During a 2.5-year follow-up study of opioid addicts, we found that cocaine abuse had become an increasing and major problem through 1983. Cocaine abuse had only minimally declined during the follow-up period despite treatment, and the number of opioid addicts with at least weekly cocaine abuse had doubled. The clear effect of methadone maintenance treatment in reducing opioid abuse was not evident for cocaine abuse. During the follow-up period, more cocaine use was reported by the methadone-treated subjects than by those undergoing detoxification only. Prognostically, cocaine users were more likely to be nonwhites and men. Subjects who increased their cocaine use during the follow-up period were more likely to have depressive disorders and more likely to be found among methadone- and "drug-free"-treated subjects than among detoxification subjects. Thus, among methadone- and drug-free-treated subjects, depression appeared to be a risk factor for escalating cocaine abuse; this risk factor may benefit from specific interventions.

Adult↗
PubMed1987

Clonidine and naltrexone in the outpatient treatment of heroin withdrawal.

Clonidine hydrochloride (an alpha-2 adrenergic agonist) and naltrexone hydrochloride (an opioid antagonist), given in combination, provided a safe and effective treatment of abrupt opioid withdrawal over 5 days in an outpatient/day setting. Before starting the clonidine, a naloxone challenge test was used to verify and quantify opioid dependence, and the naloxone challenge test score was then used to determine initial medication doses. Initial naloxone challenge test scores predicted subsequent patient discomfort during the 5-day clonidine-naltrexone protocol. Twelve of 14 (86%) heroin users successfully withdrew from opioids and simultaneously initiated naltrexone maintenance.

Adult↗
PubMed1987

Predictors of 2.5-year outcome in opioid addicts: pretreatment source of income.

A recent 6-month follow-up of methadone maintenance (MM) suggested that addicts supported by public assistance before seeking MM have a globally poor prognosis compared to addicts supported by employment or illegal activities. We therefore examined 2.5-year outcome among addicts prognostically stratified by three major sources of pretreatment income: employment (n = 48), welfare (n = 46), and criminal activities (n = 57). Significant improvements in substance abuse, family, legal, and psychological problems were reported by all three groups. Furthermore, the welfare group showed the most improvement in medical status and on the Social Adjustment, Maudsley neuroticism, and Beck Depression scales. Thus, the welfare patients did not appear to have a globally poorer prognosis, although they showed the least improvement in employment and legal problems. To examine whether welfare patients on MM had no more than "expected" improvement in legal and employment problems, patients treated with MM (n = 83) were compared to those getting only detoxification (DT) (n = 40). Welfare patients showed no more improvement in these two areas from MM treatment than from DT alone, while at follow-up the "employed" and "criminal" groups had substantially less illegal income and unemployment with MM than with DT alone. Thus, welfare patients may do relatively poorly in some areas when treated on MM.

Adult↗
PubMed1987

The antecedents and benefits of achieving abstinence in opioid addicts: a 2.5-year follow-up study.

This report examines long-term and short-term benefits of achieving abstinence from opioids in a sample of opioid addicts who were reevaluated 2.5 years following seeking treatment. Extensive assessment of drug use history and drug-associated problems had been obtained when the subjects applied for treatment. At follow-up evaluations, detailed information was obtained on intervening course of drug use, treatment, legal problems, psychological problems, social functioning, occupational functioning, and medical status. The results were as follows: (1) Achieving abstinence from illicit opioids was associated with concurrent improvement in other aspects of functioning including reduction of criminal activity, improved medical status, improved social functioning, and reduced abuse of other psychoactive substances. However, many of these improvements were reversed immediately if relapse to opioid use occurred. (2) Achieving abstinence was associated with being in drug treatment, especially treatment in a methadone maintenance program. (3) Achievement of abstinence was not successfully predicted by client characteristics measured at entrance into treatment. (4) Long-range benefits of abstinence were detectable in social functioning even for those who had relapsed at the time of follow-up reevaluation.

Adult↗
PubMed1987

Relationship of marital structure and interactions to opiate abuse relapse.

Several aspects of marital functioning were associated with subsequent relapse to opiate abuse in 17 married addicts. The addicts and spouses were evaluated in a task-oriented interview and rated using the Beavers Timberlawn Family Assessment instrument. The global health-pathology ratings on this instrument indicated that most couples had rigid patterns of interacting, rather than a chaotic lack of structure or a flexible, negotiated partnership. Within this range of rigid functioning, higher ratings were associated with longer times drug-free (up to 18 months with a mean of 7 months). On the seven subscales of the Beavers', five were significantly correlated with the time drug-free: effective and clear leadership, closeness between the spouses, a nonhostile mood, empathy, and efficient negotiation and problem solving. The subscales associated with drug abstinence were quite different for a group of seven single ex-addicts participating in the same outpatient program, but living with their parents. For these single ex-addicts three subscales were correlated with the time drug-free: parental reaction to separation strivings, the open expression of thoughts and feelings, and empathy. This difference in the subscales associated with abstinence for married versus single addicts suggested some specificity in the characteristics of family structure and interaction that may be related to drug abstinence.

Adult↗
PubMed1986

A preliminary study of beta endorphin during chronic naltrexone maintenance treatment in ex-opiate addicts.

Because opioid antagonists acutely produce rises in serum beta endorphin, we studied beta endorphin levels in 21 former opiate addicts chronically taking naltrexone. The mean AM (19.5 pg/ml) beta endorphin level was higher than the AM mean for 39 normals under 40 years old (12.1 pg/ml) (t = 3.2, p less than 0.001); the mean PM level for the naltrexone treated patients was 13.6 pg/ml. Four patients had beta endorphin levels more than 2 S.D. above the mean for the normals (greater than 26.4 pg/ml), and six others had relatively elevated PM levels. Thus, 47% (10/21) had abnormal patterns of beta endorphin levels. We had previously reported abnormally high cortisol levels in these patients, and AM cortisol correlated with AM beta endorphin levels (r = 0.7, p less than 0.001). We concluded that sustained beta endorphin elevations may occur during chronic naltrexone treatment.

Adolescent↗
PubMed1986

Abstinence symptomatology and psychiatric diagnosis in cocaine abusers. Clinical observations.

Abstinence symptoms and psychiatric diagnoses were evaluated in 30 chronic cocaine abusers. Structured diagnostic interviews were done within an experimental design intended to maximize differentiation of enduring symptoms from symptoms linked to binges of cocaine use. Longitudinal evaluations showed a three-phase sequence of post-cocaine abuse abstinence symptoms. Over half the sample also met criteria for ed 3 DSM-III, axis I psychiatric disorders. The findings present specific implications for treatment design.

Adult↗
PubMed1986

A 2.5-year follow-up of depression, life crises, and treatment effects on abstinence among opioid addicts.

Follow-up studies have suggested that treatment increases addicts' likelihood of remaining abstinent and that depression and life crises are associated with decreased abstinence. An important issue is to what extent receiving treatment can ameliorate psychosocial risk factors such as life crises and depression and decrease ex-addicts' vulnerability to continued drug abuse. In our 2.5-year follow-up of 268 opiate addicts, drug abuse treatment was generally associated with increased abstinence, and life crises and depression were significant risk factors for continued drug abuse. The impact of these risk factors, however, was ameliorated by drug abuse treatment. Although life crises had a greater impact than depression, these two risk factors had additive effects in increasing the risk for continued drug abuse. Among the types of life crises, arguments and losses ("exits") had very strong additive effects with depression as predictors of drug abuse.

Depression↗
PubMed1986

Prognostic significance of psychopathology in treated opiate addicts. A 2.5-year follow-up study.

Two different methods for assessing psychopathology in opiate addicts were compared as predictors of long-term treatment outcome: (1) categorical psychiatric diagnosis using the Schedule for Affective Disorders and Schizophrenia--Lifetime Version and the Research Diagnostic Criteria and (2) global rating of psychiatric impairment using the Psychiatric Severity scale of the Addiction Severity Index (ASI). Follow-up interviews were completed 2.5 years after treatment seeking in 76% of a sample of 361 opiate addicts. Five dimensions of treatment outcome were assessed, including current functioning, psychosocial adjustment, substance use impairment, legal problems, and medical disability. Most lifetime psychiatric disorders with a prevalence of greater than 10% were significantly related to the outcome dimensions of current functioning and/or psychosocial adjustment and were unrelated to substance use impairment, legal problems, and medical disability. The ASI Psychiatric Severity rating more robustly predicted poorer functioning in the same two areas and less severe legal problems. While controlling for ASI Psychiatric Severity, the only Research Diagnostic Criteria diagnosis that remained significantly related to treatment outcome was major depression, suggesting that, as regards their prognostic characteristics, the other diagnoses are accounted for by a global underlying severity dimension.

Follow-Up Studies↗
PubMed1986

A 2.5 year follow-up of treatment retention and reentry among opioid addicts.

Two-hundred and sixty eight opioid addicts completed a 2.5 year follow-up during which we examined the psychosocial antecedents and consequences of leaving, reentering and remaining in treatment. Compared to those addicts who obtained more sustained treatment, the addicts who were only detoxified had fewer psychological problems and were more often male, black and younger. These baseline differences complicated comparisons between these minimally treated addicts and the rest, but among those who had more than minimal treatment, continuous treatment was better than intermittent treatment in controlling substance abuse and legal problems. Further analyses involved dividing the 30 months of follow-up into 6 month blocks and comparing the 6 months before, during and after leaving or reentering treatment. We found that addicts left treatment at periods of relative abstinence and good psychosocial adjustment, although they increased their alcohol abuse during the period of leaving treatment. During the 6 months after leaving, patients often returned to drug abuse and then rapidly deteriorated in social adjustment. When reentering treatment, the majority (75%) stayed for over 6 months and improved steadily in most areas. At reentry patients also had less criminal activity, less physical disability, and less opiate use suggesting a carry-over of treatment benefits, but they had more problems with their spouse and more alcohol and cocaine use than they had when first entering treatment suggesting new precipitants for reentry into treatment.

Adult↗
PubMed1986

The combined use of clonidine and naltrexone as a rapid, safe, and effective treatment of abrupt withdrawal from methadone.

Combined clonidine and naltrexone treatment allowed 38 of 40 patients addicted to methadone to withdraw completely in 4-5 days. For most patients naltrexone was gradually increased from 1 mg/day to 50 mg/day over 4 days. Clonidine reduced the intensity of naltrexone-induced withdrawal symptoms. Clonidine significantly decreased blood pressure without producing syncope and caused sedation but no other clinical problems. The withdrawal symptoms of anxiety, anorexia, insomnia, restlessness, and muscular aching were most resistant but were mild or nonexistent at discharge. Clonidine-naltrexone treatment should succeed with patients receiving methadone doses up to 50 mg/day, facilitate naltrexone maintenance, and apply to many clinical settings.

Adult↗
PubMed1986

The effect of multiple family therapy on addict family functioning: a pilot study.

Family therapy may help addicts remain drug abstinent by improving family functioning. In a outpatient pilot study eight addict families were evaluated before and after 16 weeks of multiple family therapy (MFT), while the addict was maintained on naltrexone, an opiate antagonist. The Beavers Timberlawn Family Assessment was used to rate videotapes on problem solving, family structure, individual autonomy, and affect. The 8 families showed significant improvement in global functioning, problem solving, structure, and autonomy, but not in affect. One addict relapsed during the 10 month follow up, and his was the only family that functioned worse at follow up. We concluded that MFT can help addict families progress from chaotic interactions to more stable family structures and from rigid to more flexible family functioning. This improvement in family functioning may be associated with ex-addicts remaining abstinent.

Adult↗