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Biomedical subjects

Nancy M Petry

Publications and source records attributed to Nancy M Petry.

At least 55 records · Page 3Linked to original sources
PubMed2004

Prize reinforcement contingency management for treating cocaine users: how low can we go, and with whom?

AIMS: This study evaluated the efficacy of a low-cost, prize reinforcement contingency management (CM) intervention for reducing cocaine use. SETTING: Community-based treatment centers. PARTICIPANTS AND DESIGN: Cocaine-abusing out-patients (n = 120) were assigned randomly to one of three 12-week conditions: standard treatment, standard treatment plus CM with an expected maximum of $80 of reinforcement or standard treatment plus CM with an expected maximum of $240 of reinforcement. INTERVENTION: In the CM conditions, patients earned the opportunity to win prizes for submitting negative urine samples and completing goal-related activities. MEASUREMENTS: Drug use was measured at intake and throughout a 3-month treatment period. FINDINGS: Patients in the $240 CM condition achieved more abstinence than patients in the standard condition. Patients who initiated treatment with positive urinalysis results were most responsive to the CM intervention, with the $240 CM condition engendering the best effects in this subgroup. In contrast, patients who initiated treatment with negative urinalysis results generally remained abstinent during treatment, regardless of treatment assignment. On average, patients in the two CM conditions earned $36 and $68 in prizes. CONCLUSIONS: This study suggests that prize reinforcement CM may be suitable for community-based settings, and beneficial effects may be magnitude-dependent in more severe patients.

Adult↗
PubMed2004

Heroin and cocaine abusers have higher discount rates for delayed rewards than alcoholics or non-drug-using controls.

AIMS: To test a prediction of the discounting model of impulsiveness that discount rates would be positively associated with addiction. The delay-discount rate refers to the rate of reduction in the present value of a future reward as the delay to that reward increases. DESIGN AND MEASUREMENTS: We estimated participants' discount rates on the basis of their pattern of choices between smaller immediate rewards ($11-80) and larger, delayed rewards ($25-85; at delays from 1 week to 6 months) in a questionnaire format. Participants had a one-in-six chance of winning a reward that they chose on one randomly selected trial. PARTICIPANTS AND SETTING: Heroin (n = 27), cocaine (n = 41) and alcohol (n = 33) abusers and non-drug-using controls (n = 44) were recruited from advertisements. They were tested in a drug abuse research clinic at a medical school. FINDINGS: On average, the cocaine and heroin groups had higher rates than controls (both P < 0.001), but alcoholics did not (P = 0.44). Abstinence was associated with lower rates for heroin abusers (P = 0.03), but not for cocaine or alcohol abusers (both P > 0.50). CONCLUSIONS: These data suggest that discount rates vary with the preferred drug of abuse, and that high discount rates should be considered in the development of substance abuse prevention and treatment efforts.

Adult↗
PubMed2004

Age of gambling initiation and severity of gambling and health problems among older adult problem gamblers.

This study examined the relationship between age at first gambling experience and severity of gambling and related problems among older adult problem gamblers. Fifty-two problem gamblers over the age of 65 years completed self-report instruments that assessed gambling problems as well as the Short Form 36 health survey. The median age at first gambling experience was 21 years. Compared with gamblers who had a late onset of gambling, those with an early onset wagered more frequently and had more severe medical and psychiatric problems. These data suggest that gambling that begins in adolescence may be associated with an elevated severity of problems throughout the life span among older adult problem gamblers.

Adult↗
PubMed2003

Discounting of money, health, and freedom in substance abusers and controls.

Impulsivity is implicated in drug dependence, and discounting of delayed events may be an objective indicator of impulsiveness. This study evaluated the manner in which outcomes are devalued over time in drug abusers (n=101) and non-substance abusing controls (n=40). Four conditions were presented in which participants chose between hypothetical outcomes available after various delays or immediately. Two were monetary outcomes, and the other two were non-monetary-months of health or freedom. In all conditions, hyperbolic discounting functions provided a good fit of the data. One hundred dollars were discounted more rapidly than $1000, and freedom was discounted more rapidly than health. Drug abusers discounted all types of delayed outcomes at higher rates than controls, even though they placed equivalent subjective monetary values on freedom and health. Rates of discounting were not correlated across domains. These results replicate prior studies showing that drug abusers discount delayed monetary outcomes more rapidly than controls, and they extend these findings to new domains. The rapid discounting of freedom and health may provide a theoretical framework for understanding illegal and risky health behaviors in drug abusers.

Adult↗
PubMed2003

Single versus multiple drug focus in substance abuse clinical trials research.

Complex patterns of multiple substance use pose clinical and methodological challenges for substance abuse clinical trials research. To increase measurement precision and internal validity, the modal approach has been to target both treatment interventions and outcome assessment to a single class of abused substance. This strategy warrants reconsideration because it entails limitations in recruitment feasibility and generalization of study findings. This report reviews pros and cons of single versus multiple targeted drugs, suggests guidelines for choosing between these strategies and outlines methods for broadening the scope of substance abuse clinical trails to take abuse of multiple substances into account. We recommend that investigators consider moving away from a single drug focus in three ways. First, include systematic assessment of a wide range of psychoactive substance use throughout the trial and evaluate the impact of study treatments on use of all classes of drugs. Second, except where contraindicated, include patients who use and abuse multiple classes of substances even in trials evaluating treatment of a single targeted drug. Third, consider inclusion of polysubstance abusers or those who primarily abuse multiple classes of substances in the same clinical trial. Although many treatment efficacy questions can best be answered by single focus studies, we recommend that such designs be adopted only after less restrictive designs are first considered.

Clinical Trials as Topic↗
PubMed2003

A comparison of African American and non-Hispanic Caucasian cocaine-abusing outpatients.

An understanding of how different racial and ethnic groups vary with respect to demographic characteristics and severity of psychosocial problems is necessary to better address the treatment needs of these subgroups. This study evaluated similarities and differences between African American and non-Hispanic Caucasian cocaine users initiating substance abuse treatment at community-based programs. At intake to treatment, patients completed the addiction severity index (ASI). African Americans (n=161) and Caucasians (n=86) differed with respect to gender, income and age. After controlling these demographic variables and treatment site, race-related differences were noted in many of the ASI composite scores. While African Americans had more severe employment problems, they had less severe alcohol, legal, family/social and psychiatric difficulties than Caucasians. These differences suggest that African Americans and Caucasians may benefit from treatment emphasizing different aspects of their psychosocial problems. Specifically, for many African American patients, employment-training programs may be particularly useful. Caucasians may be in greater need of treatment that focuses on concurrent cocaine and alcohol problems, as well as family and psychiatric difficulties.

Adolescent↗
PubMed2003

Patterns and correlates of Gamblers Anonymous attendance in pathological gamblers seeking professional treatment.

Although Gamblers Anonymous (GA) is a popular intervention for gamblers, many attendees later present for professional treatment. This study evaluated gambling and psychosocial problems in individuals seeking professional treatment for gambling and compared those with and without a history of GA attendance. At intake to treatment, 342 pathological gamblers completed the Addiction Severity Index (ASI) and South Oaks Gambling Screen (SOGS). Fifty-four percent attended GA previously. Compared to non-GA attendees, GA attendees were older, had higher incomes, and were less likely to be single. They had higher SOGS scores, more years of gambling problems, and larger debts. GA attendees also had more serious family conflicts and less serious drug problems. Individuals with a history of GA attendance were more likely to be abstinent from gambling 2 months after treatment initiation. Logistic regression revealed that the number of professional sessions and GA meetings attended during treatment was independently associated with short-term abstinence. These data suggest that individuals entering professional treatment for gambling with a history of GA attendance differ from those who do not, and these differences may impact treatment recommendations and outcomes.

Adult↗
PubMed2003

Antisocial personality in treatment-seeking cocaine abusers: Psychosocial functioning and HIV risk.

Antisocial personality disorder (ASP) is common in substance abusers and may be associated with increased severity of psychosocial problems and risk of HIV infection. This study compared 174 treatment-seeking cocaine abusers with and without ASP on Addiction Severity Index (ASI) scores and the HIV risk behavior scale. Patients with ASP comprised 35% of the sample. These patients evidenced more severe problems than non-ASP patients on alcohol, legal, and psychiatric indices of the ASI. Patients with ASP also reported greater participation in lifetime sexual risk behaviors, including number of casual sexual partners, inconsistent condom use, and frequency of anal sex. This study suggests the importance of screening for ASP when patients initiate treatment. Specific and more intensive treatment may be necessary to improve outcomes in this patient population.

Adult↗
PubMed2003

A comparison of pathological gamblers with and without substance abuse treatment histories.

This study evaluated the prevalence and correlates of substance abuse histories in 341 consecutive admissions to gambling treatment programs. After controlling for gender, income, and site, gamblers with substance abuse treatment histories (SATH; 31%) had more severe problems than gamblers with no substance abuse treatment histories (NSATH) on the Gambling, Alcohol, Drug, Psychiatric, and Employment scales of the Addiction Severity Index. The SATH group had more years of gambling problems and gambled more days in the month prior to initiating gambling treatment. The SATH gamblers were also more likely to be receiving treatment for mental health problems and reported greater lifetime psychiatric distress than NSATH gamblers. These data suggest that pathological gamblers with substance abuse treatment histories may present more persistent and severe gambling dysfunction and psychiatric problems than those without such histories.

Adult↗
PubMed2003

A comparison of treatment-seeking pathological gamblers based on preferred gambling activity.

AIMS: To compare and contrast gamblers with different forms of problematic gambling activities. DESIGN, SETTING AND MEASUREMENTS: Pathological gamblers completed the Addiction Severity Index (ASI) and gambling questionnaires when initiating out-patient treatment. PARTICIPANTS: Participants (n = 347) were categorized by their most problematic form of gambling activity: sports, horse/dog-races, cards, slots and scratch/lottery tickets. Differences in demographics, gambling variables, and ASI composite scores were compared across groups. FINDINGS: After controlling for demographic variables, the types of gamblers differed in severity of gambling, alcohol and psychiatric problems. Horse/dog-race gamblers were generally older, male and less educated; they began gambling regularly at a young age and spent relatively high amounts of money gambling. Sports gamblers were young males and had intermediary gambling problems; they had relatively high rates of current substance use but few psychiatric problems. Card players spent low to moderate amounts of time and money gambling, and they generally reported few alcohol problems and little psychiatric distress. Slot machine players were older and more likely to be female. Slot gamblers began gambling later in life, had high rates of bankruptcy and reported psychiatric difficulties. Scratch/lottery gamblers spent the least amount of money gambling, but they gambled the most frequently and had relatively severe alcohol and psychiatric symptoms. CONCLUSIONS: Gambling patterns and severity of psychosocial problems vary by form of problematic gambling, and these differences may influence treatment recommendations and outcomes.

Adult↗
PubMed2003

Validity of a gambling scale for the addiction severity index.

This study assessed the validity of an adaptation of the Addiction Severity Index (ASI) for evaluating severity of gambling problems. Participants (N = 597) from four different populations (pathological gamblers enrolled in a treatment study, pathological gamblers initiating outpatient treatment at a community-based program, frequent gamblers recruited from advertisement, and substance abusers) completed the ASI, along with a supplemental gambling subscale (ASI-G). Internal consistency of the ASI-G was good (alpha =.90), and a principal components analysis indicated a single factor explained 73% of the variance in responses. ASI-G scores demonstrated excellent convergent validity with other measures of gambling and convergent validity with external sources, including collateral informant and clinician-rated reports. ASI-G scores discriminated among the samples tested. Temporal stability of ASI-G scores was high during a 1-month period for patients with substance abuse disorder who were not seeking gambling treatment. For treatment-seeking gamblers, the number of treatment sessions attended was significantly associated with reductions in ASI-G scores. Together, these data suggest that the ASI-G subscale may be a useful tool for assessing severity of gambling problems in a variety of populations.

Adult↗
PubMed2003

The role of psychosocial treatments in pharmacotherapy for alcoholism.

Medication treatment for alcohol use disorders often includes a psychotherapy component. The most appropriate psychotherapy to use may depend upon characteristics of the patient, the medication, the setting, and the experiences of the provider. To date, little empirical research has investigated these issues with respect to outcomes in clinical trials that combine pharmacotherapy and psychotherapy. This paper reviews seven major types of psychotherapy for treatment of alcohol use disorders: brief interventions, motivational enhancement therapy, cognitive-behavioral therapy, cue exposure therapy, behavioral treatments, behavioral marital therapy, and twelve-step therapy. The theoretical basis for and empirical evidence supporting the efficacy of the therapies are reviewed, with an emphasis on studies that provided pharmacotherapy in conjunction with psychotherapy. Directions for future research in this area are also suggested.

Alcoholics Anonymous↗
PubMed2003

Gambling participation and problems among South East Asian refugees to the United States.

OBJECTIVE: Gambling is common among South East Asian refugees, but no known studies have evaluated the prevalence of pathological gambling in these populations. The purpose of this study was to assess rates of gambling participation and gambling problems among South East Asian refugees. METHODS: Ninety-six immigrants to the United States from Laos, Cambodia, and Vietnam who attended community service organizations for these ethnic groups in Connecticut were asked to complete the South Oaks Gambling Screen (SOGS), which had been translated into their native languages. Demographic information as well as data on recent gambling activities were also obtained. RESULTS: The SOGS retained high internal consistency in the sample, with a Cronbach's alpha of .90. The lifetime prevalence of pathological gambling was 59 percent. Rates of gambling problems did not differ across the three ethnic groups. However, being male, divorced or separated, and younger were significant predictors of pathological gambling. More than half of all the respondents had gambled within two weeks of the interview, and 42 percent had wagered more than 500 US dollars in the previous two months. CONCLUSIONS: These data call for more research into the social, environmental, and cultural context of gambling among South East Asian refugees. Ethnically sensitive prevention and intervention strategies are needed to address the extraordinarily high rates of gambling problems in this population.

Adult↗
PubMed2003

Gambling participation and problems among older adults.

Few studies have evaluated rates of gambling participation and problems in older adults. This study recruited 492 adults aged 65 years and older from bingo sites (n = 132) and senior centers (n = 360). Compared to those recruited from senior centers, participants recruited at bingo events had higher South Oaks Gambling Screen (SOGS) scores and greater gambling frequency and expenditures. Lifetime rates of combined problem and pathological gambling were 12.9% in the bingo sample and 9.7% in the senior center sample (10.6% overall). Compared to non-problem gamblers, problem and pathological gamblers were more likely to be younger (73 versus 76 years) and male (52% versus 27%). Overall, 39.1% reported gambling at least twice per month over the past year, and 33.7% wagered dollars 50 or more over the prior 2 months. This study suggests that subsets of active older adults have high rates of gambling participation and problems.

Age Factors↗
PubMed2003

Disordered gambling in adolescents : epidemiology, diagnosis, and treatment.

Rapid expansion of legalized gambling has been associated with increased rates of gambling disorders among adults and adolescents worldwide. Epidemiologic studies suggest that, in North America, up to 6% of adults and 20% of adolescents have a gambling problem. Despite increasing prevalence rates of gambling disorders, little research is available on how to treat such disorders in adolescents. Much of what is known about how to treat adolescent problem and pathological gambling comes from research on psychosocial and psychopharmacologic treatments for adult pathological gambling. Risk factors for adolescent gambling disorders include male gender, alcohol and drug use, deviant peers, family history of gambling, and impulsive behavior. While several risk factors characterize disordered gambling among adolescents, the extent to which these characteristics are related remains to be determined. In terms of screening for adolescent problem and pathological gambling, several instruments designed to reflect the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria for pathological gambling are available. Psychosocial approaches used to treat adult pathological gambling include Gamblers Anonymous, cognitive-behavioral therapy (CBT), and motivational enhancement therapy (MET). Among adolescents, CBT as well as an eclectic therapy have been helpful in reducing problematic gambling behavior. In terms of pharmacotherapy, three classes of psychotropic drugs have been used to treat adult pathological gambling - serotonin reuptake inhibitors, opioid antagonists, and mood stabilizers. While some of these pharmacotherapies have been efficacious in treating adult pathological gambling, additional double-blind, placebo-controlled studies are needed to determine the long-term effectiveness of these treatments. No known study has evaluated the use of psychopharmacologic agents in treating adolescent pathological gambling. Possible reasons for the lack of research on treatment for adolescent gambling disorders include lack of motivation to pursue treatment, feelings of self-control, and negative perception of therapy. Referrals from parents, teachers, and peers of adolescents, as well as community outreach programs, may be useful in successfully deriving a treatment population. Clinicians are advised to be sensitive to behavioral risk factors and to screen for disordered gambling in high risk adolescents. A combination of CBT and MET, as well as medication for any comorbid psychiatric condition, is recommended.

Adolescent↗