Recognizing and managing "illy" intoxication.
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Humans↗
Biomedical subjects
V Modesto-Lowe
Publications and source records attributed to V Modesto-Lowe.
Naltrexone vs. nefazodone for treatment of alcohol dependence. A placebo-controlled trial.
This study compared the effects of nefazodone, a serotonergic antidepressant, with the opioid antagonist naltrexone, and an inactive placebo in 183 alcohol-dependent subjects receiving weekly relapse prevention psychotherapy. Following a single-blind, placebo lead-in period, subjects were randomly assigned to receive study medication, which they took under double-blind conditions for 11 weeks. Naltrexone treatment was associated with significantly more adverse neuropsychiatric and gastrointestinal effects, poorer compliance, and a greater rate of treatment attrition. There were no reliable between-group differences in drinking behavior. These results indicate that nefazodone is not efficacious for treatment of alcohol dependence. Furthermore, the clinical utility of naltrexone seems to be limited by its adverse effects, a finding that has important implications for efforts to develop medications to treat alcohol dependence.
Adult↗
Pharmacologic treatments for drug and alcohol dependence.
Pharmacotherapy remains a relatively underused strategy for the treatment of patients with psychoactive substance-use disorders. This is partly because of a widely held view among the public and the substance-abuse treatment community that substance-use disorders are non-medical and should be treated through nonpharmacologic means. Furthermore, the pharmaceutical industry has been slow in developing medications for the treatment of patients with these disorders because of skepticism over the potential profitability of such medications. These factors have limited research activity in this area, with much of the impetus for study of these medications coming from the National Institute on Drug Abuse and the National Institute on Alcohol Abuse and Alcoholism, where the substantial public health implications of medications development for substance-use disorders have been recognized. Despite limitations, considerable advances in medication development for patients with substance-use disorders have occurred in recent years, and more can be expected in the near future. This is most evident in the treatment of patients with nicotine and opioid dependence, for whom several pharmacologic options exist. Recently renewed interest in the pharmacologic treatment of patients with alcohol dependence is likely to advance that therapeutic area substantially with time. Ongoing efforts should focus on identifying new compounds, systematically assessing them for activity in specific substance-use disorders, and educating the public and the treatment community about the substantial benefits that can accrue from medication development for patients with substance-use disorders.
Alcohol Deterrents↗
Using cue reactivity to evaluate medications for treatment of cocaine dependence: a critical review.
AIMS: The aim of this article is to examine the validity of a cue-reactivity paradigm for evaluating medications to treat cocaine dependence and to critically review cocaine pharmacotherapy studies that use this method. METHODS: A Medline computerized search was performed to identify randomized, controlled medication studies for cocaine dependence that employed a cue-reactivity paradigm. Relevant bibliographies of these articles were also reviewed. Eleven placebo-controlled studies were identified in the English language literature. Four of these studies used agents that block dopaminergic neurotransmission, two studies used agents that modify the serotonergic system, and two studies used nicotinergic agents. The other three studies employed a mood stabilizer, an opioid antagonist or a psychostimulant. RESULTS: There has been little research examining the theoretical basis of the cue-reactivity model, as applied to the screening of medications to treat cocaine dependence. From a methodological viewpoint, most studies have shown that exposure to cocaine-related stimuli increases subjective and physiological reactivity in cocaine-dependent patients, but methods used to present the cues and to measure cue reactivity have not been consistent across studies. Similarly, the observed increase in subjective and physiological reactivity to cocaine cues has varied within and across studies. CONCLUSIONS: If a cocaine cue-reactivity paradigm is to be used to evaluate medications for treatment of cocaine dependence, the validity of the model must first be demonstrated and a consistent methodology for cue presentation and measurement of responses must be developed.
Cholinergic Agents↗
Validity of the Obsessive Compulsive Drinking Scale (OCDS): does craving predict drinking behavior?
OBJECTIVE: The Obsessive Compulsive Drinking Scale (OCDS), a 14-item, self-report questionnaire, was developed to measure alcohol-related craving. The OCDS may provide a measure of the state of illness among alcohol-dependent individuals and may have value in predicting subsequent drinking behavior. The present study was conducted to evaluate the factor structure and the concurrent, construct, and predictive validity of the OCDS. METHODS: Data on desire to drink and on drinking behavior were obtained from 127 alcohol-dependent subjects who participated in a 12-week outpatient pharmacotherapy trial and a 3-month posttreatment follow-up. RESULTS: Principal components analysis of the OCDS indicated that three factors best described its structure: obsessions, drinking control and consequences, and alcohol consumption. Data also supported the concurrent and discriminant validity of the OCDS. However, the OCDS total score showed limited validity in predicting drinking during a posttreatment follow-up period. Furthermore, the only empirically derived factor that predicted drinking during this period was the alcohol consumption factor. CONCLUSIONS: As might be expected, the OCDS questions on drinking behavior predict subsequent drinking behavior. However, the instrument does not appear to provide a general measure of alcohol-related illness. The utility of the OCDS in studies of alcoholism treatment outcome requires clearer definition.
Adolescent↗
Diagnosis and treatment of alcohol-dependent patients with comorbid psychiatric disorders.
Psychiatric disorders occur more often among alcoholics than among the general population. The psychiatric disorders that alcoholics most frequently experience include mood disorders (e.g., depression), anxiety disorders, and antisocial personality disorder. The evaluation of psychiatric symptoms in alcoholic patients is complicated by the multiple relationships that exist among heavy drinking, psychiatric symptoms, and personality factors. For example, alcoholics with co-occurring depression may be at greater risk of psychosocial problems, relapse, and suicide. Conversely, heavy drinking may produce or worsen symptoms of depression or anxiety. Although clinical experience provides general guidance for treating these patients, further research is needed to develop effective psychosocial and pharmacological therapies aimed at specific combinations of psychiatric and addictive disorders.
Alcoholism↗
PROP taster status and parental history of alcohol dependence.
Pelchat and Danowski [Physiol. Behav. 1992;51:1261-1266] reported an association between the ability to taste 6-n-propylthiouracil (PROP) and a parental history of alcoholism. Kranzler et al. [Alcohol Clin. Exp. Res. 1996a;20:1496-1500] previously failed to replicate these findings in a sample of subjects with only a paternal history of alcohol dependence. The present study was conducted to examine this putative association in a sample of subjects that is heterogeneous with respect to parental alcoholism history. Among the 90 alcohol-dependent subjects studied, the proportion of PROP nontasters was comparable to that observed among nonalcoholics. Analysis revealed no association of parental history with PROP taster status, even after controlling for potential confounding variables. We conclude that no reliable association exists between taste sensitivity to PROP and either a diagnosis of alcohol dependence or a parental history of alcohol dependence.
Adult↗
Sustained-release naltrexone for alcoholism treatment: a preliminary study.
UNLABELLED: This 12-week study examined the bioavailability, tolerability, and potential efficacy of an injectable sustained-release preparation (SRP) of naltrexone (NTX). Twenty alcohol-dependent subjects took NTX 50 mg po daily for 2 weeks, followed by a 2-week, no-medication Washout Period, a 4-week Injection Period, and a 4-week Follow-up Period. Fifteen subjects (75%) received a single subcutaneous injection of 206 mg of sustained-release NTX, and five subjects (25%) received a placebo injection. All subjects also received eight weekly coping skills sessions during the Oral NTX, and the Washout and Injection Periods. RESULTS: After injection, NTX plasma concentrations exceeded a mean of 1 ng/ml for 21 days. Adverse effects produced by the SRP of NTX were comparable with those resulting from oral NTX therapy. Compared with placebo, the SRP of NTX significantly reduced the frequency of heavy drinking days during the Injection and Follow-up Periods. CONCLUSIONS: The results of this preliminary study support the potential clinical utility of the SRP of NTX for treatment of alcohol dependence.
Administration, Oral↗
Effects of naltrexone on cue-elicited craving for alcohol and cocaine.
This study examined the effects of naltrexone (50 mg/day) on mood and self-reported desire for alcohol and cocaine in 26 patients with comorbid alcohol and cocaine abuse/dependence. Two laboratory sessions were conducted, separated by 1 week. During the sessions, subjects viewed 5-min films containing either cocaine, alcohol, or neutral cues. The first session occurred prior to random assignment to medication group and the second session was held after 1 week of double-blind treatment with either naltrexone or placebo. The cocaine-related film induced a greater desire to use cocaine than the desire for alcohol that was induced by the alcohol-related film. This finding was observed using both a simple, one-item analog scale administered during the films and more complex craving questionnaires administered immediately after the films. Collectively, the alcohol and cocaine-related films evoked greater levels of self-reported anxiety and elation, and lower levels of concentration, than the neutral film. Naltrexone did not differ from placebo in reducing the desire to use either cocaine or alcohol.
Adolescent↗