Biomedical subjects

Michael V Pantalon

Publications and source records attributed to Michael V Pantalon.

10 recordsLinked to original sources

PubMed2006

A trial of integrated buprenorphine/naloxone and HIV clinical care.

BACKGROUND: Untreated opioid dependence adversely affects the care of human immunodeficiency virus (HIV)-positive patients. Buprenorphine, a partial opioid agonist, is available for maintenance treatment of opioid dependence in HIV specialty settings. We investigated the feasibility and efficacy of integrating buprenorphine, along with 2 levels of counseling, into HIV clinical care. METHODS: HIV-positive, opioid-dependent patients were enrolled in a 12-week pilot study and randomized to receive daily buprenorphine/naloxone treatment along with either brief physician management or physician management combined with nurse-administered drug counseling and adherence management. Primary outcomes included treatment retention; illicit drug use, assessed by urine toxicology test and self-report; CD4 lymphocyte counts; and log(10) HIV type 1 (HIV-1) RNA levels. RESULTS: Of the 16 patients who received at least 1 dose of buprenorphine, 13 (81%) completed 12 weeks of treatment. The proportion of opioid-positive weekly urine test results decreased from 100% at baseline to 32% (month 1), 20% (month 2), and 16% (month 3). Only 4 patients reported any opioid use (in the prior 7 days) during the 12-week study. CD4 lymphocyte counts remained stable over the course of the study. The mean log(10) HIV-1 RNA level (+/- standard deviation) declined significantly, from 3.66+/-1.06 log(10) HIV-1 RNA copies/mL at baseline to 3.0+/-0.57 log(10) HIV-1 RNA copies/mL at month 3 (P<.05). No significant differences based on counseling intervention were detected. All 13 patients who completed the study continued to receive treatment in an extension phase of at least 0-15 months' duration. CONCLUSIONS: We conclude that it is feasible to integrate buprenorphine into HIV clinical care for the treatment of opioid dependence. Patients experienced good treatment retention and reductions in their opioid use. HIV biological markers remained stable or improved during buprenorphine/naloxone treatment.

Administration, Sublingual↗

PubMed2006

Counseling plus buprenorphine-naloxone maintenance therapy for opioid dependence.

BACKGROUND: The optimal level of counseling and frequency of attendance for medication distribution has not been established for the primary care, office-based buprenorphine-naloxone treatment of opioid dependence. METHODS: We conducted a 24-week randomized, controlled clinical trial with 166 patients assigned to one of three treatments: standard medical management and either once-weekly or thrice-weekly medication dispensing or enhanced medical management and thrice-weekly medication dispensing. Standard medical management was brief, manual-guided, medically focused counseling; enhanced management was similar, but each session was extended. The primary outcomes were the self-reported frequency of illicit opioid use, the percentage of opioid-negative urine specimens, and the maximum number of consecutive weeks of abstinence from illicit opioids. RESULTS: The three treatments had similar efficacies with respect to the mean percentage of opioid-negative urine specimens (standard medical management and once-weekly medication dispensing, 44 percent; standard medical management and thrice-weekly medication dispensing, 40 percent; and enhanced medical management and thrice-weekly medication dispensing, 40 percent; P=0.82) and the maximum number of consecutive weeks during which patients were abstinent from illicit opioids. All three treatments were associated with significant reductions from baseline in the frequency of illicit opioid use, but there were no significant differences among the treatments. The proportion of patients remaining in the study at 24 weeks did not differ significantly among the patients receiving standard medical management and once-weekly medication dispensing (48 percent) or thrice-weekly medication dispensing (43 percent) or enhanced medical management and thrice-weekly medication dispensing (39 percent) (P=0.64). Adherence to buprenorphine-naloxone treatment varied; increased adherence was associated with improved treatment outcomes. CONCLUSIONS: Among patients receiving buprenorphine-naloxone in primary care for opioid dependence, the efficacy of brief weekly counseling and once-weekly medication dispensing did not differ significantly from that of extended weekly counseling and thrice-weekly dispensing. Strategies to improve buprenorphine-naloxone adherence are needed. (ClinicalTrials.gov number, NCT00023283 [ClinicalTrials.gov].).

Adult↗

PubMed2006

Gender differences among recreational gamblers: association with the frequency of alcohol use.

This study examines the interactive effects of alcohol use and gender on health and gambling attitudes and behaviors in recreational gamblers. The Gambling Impact and Behavior Study (D. Gerstein et al., 1999) surveyed by telephone 2,417 adults targeted to be representative of the U.S. adult population. The authors compared male and female recreational gamblers (n = 1,471) who were stratified by frequency of alcohol use on measures of health and gambling. Significant Gender x Alcohol Use group interactions were observed such that moderate-to-high frequency alcohol consumption correlated with heavier gambling in men than in women, whereas such an association did not exist among abstinent or low frequency drinkers. There were few gender differences in the correlations between alcohol consumption and health. Future research should consider gender-related influences when examining alcohol use and gambling behaviors.

Adolescent↗

PubMed2005

Methadone versus buprenorphine with contingency management or performance feedback for cocaine and opioid dependence.

OBJECTIVE: Physicians may prescribe buprenorphine for opioid agonist maintenance treatment outside of narcotic treatment programs, but treatment guidelines for patients with co-occurring cocaine and opioid dependence are not available. This study compares effects of buprenorphine and methadone and evaluates the efficacy of combining contingency management with maintenance treatment for patients with co-occurring cocaine and opioid dependence. METHOD: Subjects with cocaine and opioid dependence (N=162) were provided manual-guided counseling and randomly assigned in a double-blind design to receive daily sublingual buprenorphine (12-16 mg) or methadone (65-85 mg p.o.) and to contingency management or performance feedback. Contingency management subjects received monetary vouchers for opioid- and cocaine-negative urine tests, which were conducted three times a week; voucher value escalated during the first 12 weeks for consecutive drug-free tests and was reduced to a nominal value in weeks 13-24. Performance feedback subjects received slips of paper indicating the urine test results. The primary outcome measures were the maximum number of consecutive weeks abstinent from illicit opioids and cocaine and the proportion of drug-free tests. Analytic models included two-by-two analysis of variance and mixed-model repeated-measures analysis of variance. RESULTS: Methadone-treated subjects remained in treatment significantly longer and achieved significantly longer periods of sustained abstinence and a greater proportion drug-free tests, compared with subjects who received buprenorphine. Subjects receiving contingency management achieved significantly longer periods of abstinence and a greater proportion drug-free tests during the period of escalating voucher value, compared with those who received performance feedback, but there were no significant differences between groups in these variables during the entire 24-week study. CONCLUSIONS: Methadone may be superior to buprenorphine for maintenance treatment of patients with co-occurring cocaine and opioid dependence. Combining methadone or buprenorphine with contingency management may improve treatment outcome.

Adult↗

PubMed2005

Development and implementation of an emergency practitioner-performed brief intervention for hazardous and harmful drinkers in the emergency department.

OBJECTIVES: 1) To develop and teach a brief intervention (BI) for "hazardous and harmful" (HH) drinkers in the emergency department (ED); 2) to determine whether emergency practitioners (EPs) (faculty, residents, and physician associates) can demonstrate proficiency in the intervention; and 3) to determine whether it is feasible for EPs to perform the BI during routine clinical care. METHODS: The Brief Negotiation Interview (BNI) was developed for a population of HH drinkers. EPs working in an urban, teaching hospital were trained during two-hour skills-based sessions. They were then tested for adherence to and competence with the BNI protocol using standardized patient scenarios and a checklist of critical components of the BNI. Finally, the EPs performed the BNI as part of routine ED clinical care in the context of a randomized controlled trial to test the efficacy of BI on patient outcomes. RESULTS: The BNI was developed, modified, and finalized in a manual, based on pilot testing. Eleven training sessions with 58 EPs were conducted from March 2002 to August 2003. Ninety-one percent (53/58) of the trained EPs passed the proficiency examination; 96% passed after remediation. Two EPs left prior to remediation. Subsequently, 247 BNIs were performed by 47 EPs. The mean (+/- standard deviation) number of BNIs per EP was 5.28 (+/- 4.91; range 0-28). The mean duration of the BNI was 7.75 minutes (+/- 3.18; range 4-24). CONCLUSIONS: A BNI for HH drinkers can be successfully developed for EPs. EPs can demonstrate proficiency in performing the BNI in routine ED clinical practice.

Alcoholism↗

PubMed2004

Linking process and outcome in the community reinforcement approach for treating cocaine dependence: a preliminary report.

This preliminary study evaluated the relationship between therapy process variables (mechanistic processes and interpersonal processes), and treatment outcome (i.e., retention and cocaine abstinence) among 16 cocaine-dependent pregnant or postpartum women treated with the Community Reinforcement Approach (CRA). Two new rating scales were developed for this purpose. The Mechanisms of Action Rating Scale (MARS) assesses five CRA mechanistic domains (Big Picture goals, functional analyses of behavior, nondrug-related activities, skills training, and homework). The Interpersonal Variables Rating Scale (IVRS) measures three nonspecific or interpersonal dimensions of psychotherapy (i.e., empathy, response to resistance, and therapeutic alliance). These rating scales were used to rate one, early treatment, videotaped CRA session for each subject. Results indicated that: 1) sessions with patients who achieved three or more consecutive weeks of cocaine abstinence were rated significantly higher on therapist empathy and positive responses to resistance, and total IVRS scores (all of which indicate positive interpersonal processes); and 2) Big Picture goals, positive therapeutic alliance, and total IVRS scores were significantly and positively correlated with number of consecutive weeks of cocaine-negative urine toxicology tests. Only MARS homework scores were significantly and positively associated with number of study weeks completed. Finally, the pattern of interrelationships among the MARS subdomains suggests the coherence of the multifaceted CRA treatment. The findings of this preliminary study suggest the importance of monitoring both mechanistic and interpersonal processes during CRA treatment of cocaine dependence.

Alcoholism↗

PubMed2003

Use of the University of Rhode Island Change Assessment to measure motivational readiness to change in psychiatric and dually diagnosed individuals.

In this report, the original 4-factor structure of the University of Rhode Island Change Assessment (URICA; C. C. DiClemente & S. O. Hughes, 1990) was replicated, and the scale's internal consistency was found to be acceptable in a sample of 120 psychiatric and dually diagnosed inpatient participants, who had participated in a randomized clinical trial comparing standard treatment (ST) and ST plus motivational interviewing. Contrary to the authors' hypotheses, participants classified as having low motivational readiness to change, based on their URICA scores, demonstrated greater treatment adherence than high-readiness participants, in that they attended a greater proportion of therapy groups while hospitalized (54% vs. 39%; p < .05) and clinic appointments during their 1st month postdischarge (77% vs. 53%; p < .05). Low-readiness participants were also more likely to attend all of their scheduled clinic appointments (26%) than were high-readiness participants (10%; p < .05).

Adult↗

PubMed2002

Treatment of heroin dependence with buprenorphine in primary care.

Buprenorphine is an effective treatment for heroin dependence. The feasibility and potential efficacy of buprenorphine with brief counseling in primary care is unknown. We enrolled 14 heroin dependent patients in a 13-week clinical trial using thrice weekly buprenorphine along with brief counseling in the primary care center of an urban medical center. Primary outcomes included urine toxicology and treatment retention. Opioid-positive urine toxicology tests reduced over the 13-week period from 95 to 25% (p < 0.05). Eleven patients (79%) had greater than or equal to one week of opioid-free urine toxicologies. Nine patients (64%) had greater than or equal to three weeks of opioid-free urine toxicologies. Eleven patients (79%) were retained through the maintenance phase. We conclude that buprenorphine maintenance is feasible in a primary care setting.

Administration, Sublingual↗

PubMed2002

The URICA as a measure of motivation to change among treatment-seeking individuals with concurrent alcohol and cocaine problems.

The original 4-factor structure of the University of Rhode Island Change Assessment (URICA; C. C. DiClemente & S. O. Hughes, 1990) was replicated, and the scale's internal consistency was found to be acceptable in a sample of 106 cocaine- and alcohol-dependent participants receiving either disulfiram or no medication in a psychotherapy trial. In addition, participants categorized as having high Committed Action (CA), a new URICA composite, had a significantly greater percentage of days abstinent from both alcohol and cocaine (85.6%) than low-CA participants (72.7%, p < .01). Furthermore, a significant Treatment x CA interaction emerged, suggesting that low-CA participants had better outcomes than those with high CA when assigned to medication, whereas high-CA participants fared equally well with or without medication.

Adult↗

PubMedDate not supplied

Gender differences in adolescent gambling.

BACKGROUND: Although adolescent gambling has been linked to a wide array of risk behaviors, little is known regarding the correlates of gambling in adolescent girls as compared with adolescent boys. METHODS: We examined by logistic regression a nationally representative U.S. sample (n = 534) of 16- and 17-year-olds from the 1998 Gambling Impact and Behavior Study (GIBS) (1) to investigate the influence of gender on: 1) the association between gambling and psychiatric symptomatology; and, 2) gambling attitudes and behaviors. RESULTS: Gambling was associated with elevated rates of alcohol use and abuse/dependence in both boys and girls, and dysphoria/depression in girls only. Boy gamblers reported heavier gambling and higher rates of gambling problems than did girl gamblers. CONCLUSIONS: Adolescent gambling may be associated with more severe psychiatric symptoms in girls than in boys, though future research will be needed to replicate and extend these findings. Gender considerations are important in understanding youth gambling and the relationship between gambling and psychiatric disorders in adolescents.

Adolescent↗