Biomedical subjects

Kenneth M Carpenter

Publications and source records attributed to Kenneth M Carpenter.

8 recordsLinked to original sources

PubMed2006

The Type A-Type B classification in a community sample of problem drinkers: structural and predictive validity.

OBJECTIVE: The Type A-Type B multidimensional classification model has been useful for identifying a subgroup of alcohol dependent drinkers with more severe psychosocial problems and a poor prognosis. Evidence suggests its dimensions may be useful for identifying problem drinkers in the general population at risk for developing alcohol dependence. To date, the model has not yet been investigated for this purpose. The present study investigated the Type A/Type B distinction in a community sample of problem drinkers as well as its predictive validity among problem drinkers with no history of alcohol dependence. METHOD: Households from a geographically delimited area in the United States were designated via random digit dialing and randomly designated members were screened for eligibility. A total of 876 participants met eligibility criteria and completed a structured interview (AUDADIS) on alcohol and other health related behaviors at baseline and at 1-year follow-up. A k-means cluster analysis was performed to identify subgroups of problem drinkers. RESULTS: A two-cluster solution adequately fit the data and identified two main subgroups of problem drinkers consistent with a Type A-Type B distinction. The group differences held among those with and without a history of alcohol dependence and the subset of Type B drinkers with no history of alcohol dependence were approximately five times (beta = 1.56, p< or =0.01) more likely to have an initial onset of dependence than Type A drinkers at 1-year follow-up. In contrast, a DSM-IV alcohol abuse diagnosis at baseline did not predict 1-year onset of dependence. CONCLUSIONS: The Type A-Type B model is useful for identifying untreated problem drinkers at risk for developing alcohol dependence. This model may facilitate the development of more targeted prevention efforts.

Adolescent↗

PubMed2006

Drug Stroop performance: relationships with primary substance of use and treatment outcome in a drug-dependent outpatient sample.

A modified Stroop protocol was administered to a sample of 80 dependent drug users (62 males, 18 females) prior to beginning a time-limited outpatient treatment study combining pharmacotherapy and cognitive-behavioral coping skills therapy for cocaine, marijuana, or heroin dependence. Results indicated that cocaine-dependent participants responded more slowly than marijuana-dependent participants to all stimulus words. Cocaine words yielded slower reaction times than neutral words across all treatment groups. The heroin- and cocaine-dependent groups' overall performance did not differ. There was no treatment group by drug word interaction. For cocaine-dependent participants, Stroop performance in the presence of cocaine stimuli was associated with worse treatment outcome. In conclusion, Stroop performance may have prognostic utility among drug-dependent patients in a cognitive-behavioral coping skills intervention and may highlight the mechanisms associated with changing substance use in this treatment modality.

Adult↗

PubMed2006

Behavioral therapy to augment oral naltrexone for opioid dependence: a ceiling on effectiveness?

The effectiveness of antagonist maintenance with oral naltrexone for opioid dependence has been limited by high dropout rates. Behavioral Naltrexone Therapy (BNT) was developed to improve retention on oral naltrexone by integrating voucher incentives, Motivational and Cognitive Behavioral therapies, and a significant other for monitoring medication adherence. In a 6-month, randomized, controlled trial in heroin dependent patients, BNT (N = 36) improved retention in treatment compared to a standard treatment control (Compliance Enhancement (CE); N = 33) (log rank = 4.28; p = .04). Most patients retained beyond 3 months achieved abstinence from opioids, but retention at 6 months was only 22% on BNT and 9% on CE. A systematic review of related controlled trials revealed similar effect sizes in the small to medium range, and substantial dropout. There may be a limit on the extent to which behavioral therapy can overcome poor adherence to oral naltrexone. Future research should consider combinations of behavioral methods with new long-acting injectable or implantable naltrexone formulations.

Behavior Therapy↗

PubMed2006

Behavior therapy for depression in drug dependence (BTDD): results of a stage Ia therapy development pilot.

Limited access to positive reinforcers is a central feature in behavioral formulations of substance use and depression, and evidence suggests both disorders share similar environmental contexts. The Behavioral Therapy for Depression in Drug Dependence (BTDD) was developed to target the density of potential reinforcers in a patient's environment to reduce both depression and illicit substance use using therapeutic techniques from three operant based treatment programs, Community Reinforcement Approach, Changing Reinforcement Events, and Treatment-plan Contingency Management. Results of an uncontrolled Stage Ia trial (n = 29), indicated 48% of the participants demonstrated at least a 50% reduction in baseline depression scores during the 16-session treatment program. Those designated as treatment responders completed more out-of-session behavioral activities, attended more treatment sessions, and demonstrated less benzodiazepine use during the program than non-responders. There were no changes in opiate and cocaine use. BTDD may be a useful adjunct to methadone maintenance for treating comorbid depressive disorders.

Behavior Therapy↗

PubMed2005

Temperament characteristics, as assessed by the tridimensional personality questionnaire, moderate the response to sertraline in depressed opiate-dependent methadone patients.

During a randomized, double-blind, placebo controlled study of the effects of sertraline in depressed methadone-maintained patients, 82 completed the tridimensional personality questionnaire (TPQ) to assess whether temperament dimensions can affect treatment-related changes in mood and drug use. Mood outcome significantly differed according to scores on the reward dependence scale (RD). Low RD participants displayed a significantly better mood response to sertraline than high RD participants. Participants with high harm avoidance (HA) scores were more likely to be abstinent at the end of the 12 week trial of sertraline than low HA participants. High persistence (P) participants were less likely to be abstinent at the end of the 12-week trial. These results suggest that temperament dimensions may be important for identifying substance dependent patients more likely to benefit from pharmacological interventions for comorbid depressive disorders.

Adult↗

PubMed2004

The effect of sertraline and environmental context on treating depression and illicit substance use among methadone maintained opiate dependent patients: a controlled clinical trial.

Psychiatric comorbidity, particularly depressive disorders, is associated with continued substance use and poor social functioning among methadone maintained patients. Evidence suggests similar neurochemical and environmental pathways may link the two disorders and it is reasonable to hypothesize that pharmacological and environmental factors play important roles in the treating comorbid depression and substance use. The present study tested the efficacy of sertraline for treating syndromally defined depressive disorders among non-abstinent methadone maintained opiate dependent patients. The moderating effects of environmental context on treatment outcome were also examined. Ninety-five patients were randomized in a 12-week, double-blind, placebo-controlled trial of sertraline, a serotonin-selective re-uptake inhibitor. There was no main effect of sertraline on either depression or substance use outcomes. However, sertraline demonstrated significant ameliorative effects on depression among patients with a more positive environment or less negative environment. The odds of being abstinent from heroin and cocaine were greater for patients on sertraline in environments with relatively less adversity. The findings support the hypothesis that contextual factors moderate the efficacy of pharmacological treatment for depression among methadone patients. They also suggest future research should examine a pharmacological treatment that is combined with a behavioral intervention targeting the accessibility of reinforcement or reducing the impact of aversive environmental interactions.

Adult↗

PubMedDate not supplied

Does motivation to change mediate the effect of DSM-IV substance use disorders on treatment utilization and substance use?

Evidence suggests that motivation to change may mediate the effect of diagnostic severity on treatment outcome, however, this relationship has not been directly tested. This prospective study tested the mediating effect of motivation to change on the relationship between the severity of DSM-IV substance use disorders at treatment entry and subsequent treatment utilization and substance use. Participants consisted of 150 (89 men and 62 women) alcohol, cocaine, and heroin users entering treatment who completed interviews assessing DSM-IV diagnostic severity (Substance Dependence Severity Scale, SDSS) and substance-specific motivation to change (University of Rhode Island Change Assessment Scale, URICA). All participants were reinterviewed over a 6-month period. DSM-IV alcohol dependence severity predicted less alcohol use and formal treatment use and greater motivation to change and self-help use. Similar associations were demonstrated among cocaine users. Motivation to change alcohol use was not associated with substance use or treatment utilization. The results suggest that alcohol dependence severity has a direct positive effect on motivation to change at treatment entry. However, the effect of alcohol and cocaine dependence severity on treatment utilization and substance use is not mediated by motivation to change substance use at the beginning of a treatment episode.

Adolescent↗

PubMedDate not supplied

Suicide risk in depressed methadone-maintained patients: associations with clinical and demographic characteristics.

Patients with both depression and drug dependence are at an elevated risk for suicide, yet suicide remains rare and difficult to predict. Clinical and demographic features associated with suicide risk among depressed opiate-dependent patients were examined using baseline data from the Addiction Severity Index and Hamilton Depression Scale. Female gender, violent behavior in the past thirty days and lifetime, and less education correlated with a history of suicide attempts. Family conflict and depression severity correlated with current suicidal ideation. When evaluating opiate-dependent patients with depressive disorders, these features should be considered in efforts to identify those at heightened risk for suicide and plan interventions.

Adult↗