Showing papers on "Addiction published in 1982"

Heterogeneity of Psychiatric Diagnosis in Treated Opiate Addicts

Abstract: A survey evaluated current and lifetime rates of psychiatric disorders in 533 opiate addicts in treatment at a multimodality program. Information was gathered using a structured interview format, the Schedule for Affective Disorders and Schizophrenia-Lifetime version, and the criteria were the Research Diagnostic Criteria. Most were give the diagnosis of at least one psychiatric disorder in addition to opiate addiction. The most common diagnoses were major depressive disorder, alcoholism, and antisocial personality, and rates of chronic minor mood disorders and anxiety disorders also were found to be elevated in comparison with those found in a community population. In contrast, rates of schizophrenia and mania were very low and did not exceed those reported for the general population. The findings are interpreted as suggesting the importance of detecting and attending to psychopathology associated with opiate addiction.

Benzodiazepine Withdrawal Syndrome: A Literature Review and Evaluation

Abstract: The capacity of the benzodiazepine drugs to produce dependence and addiction has been associated with what has recently been recognized as a benzodiazepine withdrawal syndrome. Abrupt discontinuati...

The significance of alcoholism in treated opiate addicts.

Abstract: This paper presents an evaluation of clinical characteristics of opiate addicts who also have a current or past history of alcoholism diagnosed according to Research Diagnostic Criteria. Based on data derived from a survey of 533 treated opiate addicts, the following findings were obtained. First, alcoholism in treated opiate addicts was found to be a common problem occurring at rates far exceeding those in the surrounding community in all demographic groups. Second, regarding the sequence of alcoholism and opiate addiction, most alcoholic addicts in this sample had alcohol problems before developing a drug use disorder or seeking treatment for opiate addiction. Third, entrance into treatment did not appear to lead to either increased or decreased alcohol abuse, and alcohol abuse while in treatment usually took place in those who had a history of alcohol problems. Fourth, when compared with nonalcoholic addicts, alcoholic addicts had fewer assets and more liabilities including a more disruptive childhood history, heavier history of legal problems and polydrug abuse, more severe problems with social functioning, and higher rates of psychiatric disorders. Fifth, despite these liabilities follow-up findings 6 months after seeking treatment indicate that alcoholism was of little prognostic significance in relationship to treatment outcome.

History of childhood hyperactivity in a clinic population of opiate addicts.

Abstract: Although childhood hyperactivity has been shown to be related to a variety of adult psychiatric disorders, no previous study has specifically explored its relation to adult opiate addiction. In this study, 22 per cent of a population of 157 opiate addicts seeking treatment reported childhood histories of hyperactivity. Demographic and developmental features such as high male to female sex ratio, normal intelligence quotient but lower level of educational and occupational achievement, and earlier arrest record supported the retrospective diagnosis. In addition, the subgroup with a history of childhood hyperactivity differed in symptom and personality measures from those without such a history in a way suggesting that those with a history of hyperactivity in childhood were manifesting adult sequelae of the disorder.

Animal studies of alcohol intake.

Abstract: Animal studies of alcohol intake can be divided into two groups based on the methodology. General findings of each group will be reviewed especially as they relate to current areas of research interest. Some implications of research findings for theories of alcoholism and drug addiction will be mentioned.

Help for the helper. Confronting a chemically-impaired colleague.

Abstract: "She's a nurse-she can't be an alcoholic." That was my thought when, as a new clinical nurse specialist in alcoholism and drug abuse, I found that one of my first patients was a woman who had been a nurse for many years. Nurses are somehow supposed to be above that kind of thing. They should know better. Through contact with that nurse/patient and others, I learned that nurses are human too. One of the most demanding and sensitive professional problems that you can face in your nursing career is dealing with a nurse colleague who is impaired by alcoholism or drug addiction. The actual incidence of addiction to alcohol or drugs is very difficult to determine. LeClair Bissell, MD, nationally known for her expertise and research on addicted health care professionals, estimates that there are about 40,000 alcoholic nurses in the United States. It has been stated that the rate of narcotic addiction among nurses closely parallels that of physicians, and the estimate is that narcotic addiction among physicians is 30 to 100 times greater than it is in the general population (1-3). It has been suggested that the populations of three medical schools and 10 nursing schools are lost to narcotic addiction alone each year(4). Even though figures on the incidence of alcoholism and narcotic addiction are estimates, it is clear that the problem is significant. And, the figures stated do not include nurses who may be experiencing problems with such non-narcotic drugs as tranquilizers, barbiturates, or amphetamines. Despite the frequency of the problem, incidence is only a secondary concern. The main reason for concern over impaired nurses is the impact of this problem on the entire health care delivery system. On the personal level, the tragedy is that nurses suffer from illnesses that go undetected and untreated for years, while they work among providers of health care services. On a professional level, the danger is that patient care will be jeopardized by nurses whose judgment and skills are impaired. Within the work unit, the entire system can be adversely affected by one nurse's impairment. Continui y of care and teamwork are compromised as other nurses attempt to pick up the slack for the impaired nurse. Frustrations and resentment build as peers cover for latenesses, absences, and unfinished assignments. As job performance deteriorates, supervisors try everything to keep the system functioning, but nothing seems to work. At this point, each person involved can become a victim of stress, and job performance can suffer as a result. The impaired nurse is often given chance after chance. She may be protected, blamed, promoted, transferred, or ignored. But the problem remains. Indeed, the higher up the system the nurse moves, the greater her responsibilities and the less chance she has of being identified, confronted, and coerced into receiving the help she needs. By covering for the impaired nurse, her peers and supervisors may indeed be killing her with kindness. If nursing is caring, then nurses must care enough to learn how to help nurses who struggle with the devastating disease of addiction. Addiction is an insidious process that occurs as the result of (a) prolonged intake of a chemical, (b) processes going on within the individual (including genetic, psychological, and chemical), and (c) processes external to the individual (that is, the actions and reactions of family, friends, coworkers, supervisors, and society). On a p actical level, addiction is present any time a chemical interferes with any aspect of a person's life and that person keeps using the chemical. The focus here will be on occupational interferences, even though by the time the addiction affects job performance, it may already be having a negative impact on the person's family, social, financial, psychological, legal, physical, or spiritual life. By detecting the problem early, the supervisor may help to stop the process before permanent damage is done in any sphere of the nurse's life. However, the supervisor's major concern must be with job performance.

Part II. Addiction and Psychological Disorders: The Self‐Medication Hypothesis: PSYCHOLOGICAL (STRUCTURAL) VULNERABILITIES AND THE SPECIFIC APPEAL OF NARCOTICS

Abstract: The study of human dependence on opiates offers an opportunity to understand important, if not basic, aspects of mental life, emotional pain, and mental illness. The addictions are a place where the biology and psychology of the mind meet. It is a place that promises to resolve some of the mysterious manners in which the body and the mind affect each other, and to unravel better the “mysterious leap from the mind to the body,” with which psychoanalysts and clinicians have concerned themselves for a long time. Recent discoveries of the opiate receptors and endogenous opioid peptides have prompted us to consider how the brain and the mind produce their own analgesia for biochemical modulation of physical pain and to consider as well how such processes might also be involved in the modulation and regulation of emotional distress and human psychological suffering. My presentation today will be based on my understanding of opiate dependence as a clinician and as a psychoanalyst.* However, before embarking on such a tack, I experience a certain sense of uneasiness and trepidation in my approach, given that the promising discoveries of opiate receptors and peptides have been based on very sophisticated methods of investigation. These discoveries have been the result of a fast-growing, complex technology that has allowed researchers a more concrete, precise means to examine microscopically, molecularly, and quantitatively how the brain and mind function. In contrast, the approach of a clinician and psychoanalyst involves less precise, more abstract techniques and methods of investigation that attempt to understand and explain the problems of opiate dependence in its human, experiental contexts, usually by studying single individuals in great detail and in depth, one-at-a-time. Such an approach utilizes macroscopic constructs concerned with structures, functions, and qualities of the mind and mental life. The two approaches need not compete, and more likely they are complementary, albeit the focus of their respective interests and observations at times seem far apart. Having expressed a concern at the outset that sounds apologetic, I set it aside and proceed by assuring myself, and hopefully my audience, that my approach is a valid and useful one. It is an approach that needs no apology any more than the pathologist apologizes for the validity and usefulness of autopsies, instead of the electron microscope, in understanding pathology and dysfunction. Considered from a psychoanalytic perspective, opiate dependence may be approached and considered in terms of human processes involving affects,

Women, Crime and Drugs:

Abstract: This paper is directed towards an examination of the relationship between substance abuse among women and related patterns of crime. Women are still primarily property offenders and juvenile offenders are still predominantly taken into custody for larceny/theft and running away from home. In contrast to males, female addicts are likely to be younger, white, and less dependent on illegal activities for income. Their choice of criminal activities is consistent with their skills and opportunities which explains their involvement in prostitution, larceny/theft, and drug sales. Estimates of the extent of female addict participation in prostitution as well as other offenses varies extensively because of the failure to clarify whether these figures refer to exclusive, primary, or secondary participation. Two typologies are examined to help clarify this question.

Acupuncture Therapy for the Treatment of Tobacco Smoking Addiction

Abstract: Acupuncture has been reported as an effective treatment for some addictions. The purpose of this study was to evaluate acupuncture treatment effect on the cigarette smoking habit with a motivated population in a controlled clinical setting. From a volunteer research population, sixteen matched pairs were assembled according to age, sex, and severity of smoking habit. Research subjects were randomly assigned to real or sham acupuncture treatment groups. Self-reported cigarette logs were measured pre-treatment and post-treatment. Analysis of variants confirmed homogeneity of group pre-treatment cigarette consumption. Cigarette consumption significantly decreased in both th e real and sham treatment groups. Treatment group, age, sex, or severity of smoking habit were not significant factors in treatment effects for cessation of smoking. Legitimate crossover treatment for sham research group showed a significant decrease (p less than or equal to 0.05) in cigarette consumption; this change was not statistically different from change in cigarette consumption during placebo treatment. A discussion of acupuncture point selection rationale is made as is an analysis of Tehchi sensations and subjective reports of appetite for cigarettes. Acupuncture did not enhance the cessation of cigarette smoking in this study.

Drug addiction among Quebec physicians

Abstract: Data collected by the Quebec Board of Physicians show that during the 5 years from 1974 to 1978 the prevalence of addiction to opiates among Quebec physicians was 2.8/1000. The physician addicts had greater mobility and a higher attrition rate than their peers. The typical addict was male, a general practitioner and married. He often suffered from pain, fatigue, overwork, and financial and marital difficulties. His addiction had begun at approximately 35 years of age and had become evident about 3 1/2 years later. Meperidine was the preferred opiate. Some of the physicians lost their licences to practise for variable periods of time; for these the prognosis was gloomy. Depression was the main psychiatric disorder diagnosed.

Narcotic Withdrawal Syndrome in the Newborn

Abstract: The passive addiction of fetuses to narcotics has been a matter of record for nearly a hundred years. But even as late as the first half of this century, few physicians were aware of the manifestations of withdrawal by the newborn or its therapy. From the late 1950s, when narcotic addiction increased to become a widespread major health calamity, to the present a great deal has been learned about addiction among pregnant women and its effects upon the fetus and newborn. For two decades addiction was most commonly due to heroin but, following the widespread establishment of methadone maintenance clinics, that synthetic opioid now may be the most frequently encountered addictive agent among pregnant women and their newborn infants in the United States. Some appears as unprescribed "street" methadone, which is usually used with an opiate. Moreover, uncooperative participants in methadone maintenance programs also take opiates. As a consequence, there may be homogeneous groups of pregnant heroin addicts and hornogenous groups of pregnant women taking methadone alone but there is a great deal of drug heterogeneity among addicts. Hence, much is known about opiate addiction in pregnancy and its effects upon the fetus and newborn, but much less is certain about the effects of methadone alone.

Biological aspects of schizophrenia and addiction

Abstract: Introducing a new hobby for other people may inspire them to join with you. Reading, as one of mutual hobby, is considered as the very easy hobby to do. But, many people are not interested in this hobby. Why? Boring is the reason of why. However, this feel actually can deal with the book and time of you reading. Yeah, one that we will refer to break the boredom in reading is choosing biological aspects of schizophrenia and addiction as the reading material.

Sexual dynamics and strength of heroin addiction: a three-factor model of an ideology.

Abstract: The association between heroin addicts' strength of addiction (SOA) and sexuality is documented. A three-factor behaviorally operational model based on psychoanalytic theory was constructed to explain the contingencies of the association. While the family, self and eroticism factors have insignificant main effects on SOA, the effect of the three-factor model as a whole is significant. A type of heroin addict associated with high SOA emerges from the analysis: A male from a surrogate family background, possessing a strongly autonomous impulsive self and finds erotic satisfaction in the needle-specific, pharmacogenic orgasm, as opposed to the genital-specific, physiogenic orgasm.

Behavioral Pharmacology of Alcohol

Abstract: Although alcohol is one of the earliest drugs used by man to change behavior and to modulate subjective states, less is known about its behavioral pharmacology than about many drugs of more recent origin. This is probably due to a complex interweaving of social attitudes and beliefs about alcohol which have evolved from a common familiarity with drinking and the effects of alcohol intoxication. For many years, the assumption that all is known, coupled with denial that alcoholism is a form of drug addiction, and ambivalence about problem drinking, tended to limit experimental interest in the study of alcohol and behavior (Mello, 1976b, 1978b). Gradually, over the past 15 years, an increasing number of studies have examined the behavioral effects of alcohol in normal social drinkers and in alcohol addicts. The early evidence that alcoholism is a form of addiction (Victor and Adams, 1953; Isbell et al., 1955; Mendelson, 1964) has been consistently reaffirmed (Mello and Mendelson, 1977 for review). As more empirical studies have examined the effects of alcohol during intoxication rather than relying on retrospective self-reports, the limitations of commonly shared expectancies about alcohol’s effects have become increasingly evident. The disparities between anticipated and observed effects of intoxication illustrate how far we now are from a comprehensive understanding of the behavioral pharmacology of alcohol (Mello and Mendelson, 1978 a for review).

The Organization of a Methadone Maintenance Program

Abstract: This paper examines the organizational structure and operation of a methadone maintenance program whose major emphasis is on rehabilitation. Explicit program goals include teaching clients real life problem solving and enabling some program members to give up methadone. The program is hierarchically structured and rule making and rule enforcement are managed through a clearly defined “chain of command”. Small counseling groups are the major rehabilitative structure. They help to motivate client collaboration and teach problem solving in order to enhance skills, model behaviors, provide success experiences and allow individuals to master difficulties in order to limit social anxiety. These small groups engage and maintain addicts in treatment. However, they may paradoxically impede full return to the community because the client's dependency needs are met in the group setting. Problems for the program's organization include 1) monitoring psychiatric disorder in the client population since deviant behaviors...

Amenability to Counseling of Opiate Addicts on Probation or Parole

Abstract: Fifty-two opiate addicts were classified as abstainers or continued abusers by their probation or parole officer. Eighteen variables—nine demographic and nine psychological—were evaluated for all subjects. Following factor analysis, 13 remaining variables were entered into a stepwise discriminant function analysis which significantly differentiated the abstaining and abusing groups. Abstainers were characterized by less dogmatism, higher education and personality integration, fewer aggressive incidents and previous drug arrests, and older age. The discriminant function classified 78.8% of the observations correctly and accounted for 27% of the variance. Rokeach's Dogmatism Scale, the Personality Integration Subscale of the Tennessee Self-Concept Scale, and the effective demographic discriminators have been included in a screening battery for counseling amenability by which incoming opiate addicts scoring like abstainers are granted priority in treatment assignment.

Benzodiazepines: selective use to avoid addiction.

Abstract: When judiciously used, benzodiazepines are therapeutically effective and remarkably safe. Long-term use may result in addiction and physical dependence in some patients. The physician's awareness of this risk helps in the prevention of dependence. Four variables play a part in the development of dependence, ie, dose, duration of treatment, the history, and the patient's personality. A dosage higher than the usual therapeutic dose not only is not needed in most patients but produces more side effects. Short term therapy carries a low risk of dependence and is preferred. It is advisable not to use benzodiazepines in patients with a history of alcohol or drug abuse, as dependent personalities pose a higher risk than other personality types.

No fraud found in alcoholism study.

Abstract: An investigating committee has cleared researchers Linda and Mark Sobell of allegations that they fabricated data in a project on treatment of alcoholics. Their research, which suggested that some alcoholics can reject abstinence and learn to moderate their drinking, was disputed by other researchers. The investigating committee did not judge whether alcoholics can indeed become moderate drinkers but concluded that the Sobells had carried out the research as reported except for one lapse ascribed to carelessness. The procedures of the committee, which was appointed by the Addiction Research Foundation where the Sobells are now employed, have been questioned by critics.