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Biomedical subjects

Maxine Stitzer

Publications and source records attributed to Maxine Stitzer.

7 recordsLinked to original sources
PubMed2005

Medication screening for smoking cessation: a proposal for new methodologies.

RATIONALE: The purpose of medication screening studies is to quickly and cheaply evaluate the clinical potential of medications, so that promising drugs proceed to large-scale clinical trials and unpromising drugs do not. Screening procedures for smoking cessation medications either are not sufficiently practical or lack clinical validity. Clinical trials have clinical validity but are often impractical as initial tests of efficacy (i.e., screening) or suffer from limited statistical power. The alternative approach of short-term, laboratory-based studies of purported mechanisms of efficacy may overcome some of the practical problems of clinical trials but appear to have limited clinical validity. OBJECTIVES: This commentary identifies some of the limitations of current short-term screening procedures and provides suggestions for improving such studies. RESULTS: Short-term screening studies typically use smokers unmotivated to abstain (i.e., nontreatment seekers) as participants and examine brief medication effects on clinical markers or potential mechanisms of action, including relief of withdrawal and craving during enforced abstinence or on reduction in the reinforcing effects of smoked tobacco. The limitation of these approaches is shown by their insensitivity to effects of nicotine replacement and bupropion, which are effective in clinical trials for smoking cessation. CONCLUSIONS: The clinical validity of short-term screening studies may improve if these studies simulate some clinical trial procedures within practical limitations. Thus, they should recruit smokers motivated to abstain, emphasize smoking abstinence as a primary index of medication response, examine effects over sufficiently long time periods to encompass the drug's mechanism of action, and assess responses in the natural environment. Whether these changes improve the sensitivity of screening studies is testable. Other research aimed specifically at identifying the mechanisms of therapeutic action of a medication may also profit from using this approach of simulating a short-term clinical trial.

Administration, Cutaneous↗
PubMed2005

Something of value: the introduction of contingency management interventions into the New York City Health and Hospital Addiction Treatment Service.

This paper explores the impact of the adoption of the contingency management approach by the Chemical Dependency Treatment Services of the New York City Health and Hospitals Corporation (HHC). The utilization of this approach grew out of an alliance between NIDA Clinical Trials Network-affiliated clinicians and researchers and a leadership team at the HHC. Interviews and dialogues with administrators, staff, and patients revealed a shared sense that the use of contingency management had: (1) increased patient motivation for treatment and recovery; (2) facilitated therapeutic progress and goal attainment; (3) improved the attitude and morale of many staff members and administrators; and (4) developed a more collegial and affirming relationship not only between patients and staff, but also among staff members.

Attitude of Health Personnel↗
PubMed2004

Cocaine craving and attentional bias in cocaine-dependent schizophrenic patients.

Cocaine craving has been implicated as a major factor underlying addiction and drug relapse. From a cognitive viewpoint, craving may reflect, in part, attentional processing biased in favor of drug-related cues and stimuli. Schizophrenic individuals (SZ), however, abuse cocaine in high numbers but typically manifest baseline cognitive deficits that impair their ability to selectively allocate their attentional resources. In this study, we examined the relationship between attentional bias and craving in patients with cocaine dependence (COC; n=20), schizophrenic patients comorbid for cocaine dependence (COC+SZ; n=23), as well as two other comparison groups using a modified version of the Stroop test to include cocaine-relevant words. Results revealed that only the COC patients demonstrated Stroop interference on the cocaine-related words. Moreover, COC patients' attentional processing biases were significantly associated with their cocaine craving severity ratings. COC+SZ patients, in contrast, did not demonstrate Stroop interference and manifested significantly fewer craving symptoms than their COC counterparts. These results suggest that COC+SZ patients' inability to selectively encode their drug-use experience may limit and shape their subjective experience of craving cocaine and motivation for cocaine use.

Adult↗
PubMed2004

Abstinence incentive effects in a short-term outpatient detoxification program.

Despite being widely available, outpatient detoxification has limited efficacy as a stand-alone treatment. This study examined whether abstinence-contingent incentives would improve outcomes for patients entering outpatient opiate detoxification. Participants (N = 211) received a 100 US dollars voucher on the last day of detoxification either contingent on opiate and cocaine abstinence or noncontingently. Urine samples were collected at intake, on Wednesday, Friday (the last day of detoxification), and the following Monday. Among contingent-voucher participants, 31% were drug-free on Friday compared with 18% of noncontingent controls (Z = 2.4, p < .05). Few (12-13%) participants tested negative on Monday. Results support the ability of vouchers to produce modest improvements in abstinence initiation rates during brief detoxification but suggest that additional interventions are needed to sustain improvements.

Adult↗
PubMed2004

Comparative drug use and psychosocial profiles of opioid dependents applying for medication versus medication-free treatment.

Drug treatment-seeking abusers generally self-select their treatment modality. Most opioid-dependent individuals select either methadone maintenance or detoxification followed by medication-free outpatient treatment. This study examined demographic, drug use, and drug abuse treatment history for opioid dependent patients entering an opioid agonist (n = 203) or a medication-free (n = 155) treatment program located on the same hospital campus. Similar demographic profiles support the assertion that samples were drawn from the same inner city urban opioid using population. Patients entering drug-free treatment, however, reported more extensive prior use of both cocaine and alcohol. Further, these patients had a generally more severe profile of psychosocial problems in medical, legal, employment, family/social, and psychiatric areas as measured by the Addiction Severity Index (ASI). These findings suggest that outpatient drug-free programs enrolling opioid abusers are faced with a unique service delivery challenge that involves service needs in multiple arenas. The findings further suggest that patient self-selection of treatment programs may in some cases result in a discrepancy between patient needs and the ability of treatment programs to retain patients and deliver an appropriate array of services.

Adult↗