Jim Mintz

Clinical Experience with Naltrexone

(1975). Clinical Experience with Naltrexone. The American Journal of Drug and Alcohol Abuse: Vol. 2, No. 3-4, pp. 365-377.

Conditioning of narcotic abstinence symptoms in human subjects

Clinical evidence suggests the possibility of conditioning of narcotic abstinence symptoms. Addicts report subjective and objective signs of withdrawal/craving when exposed to certain stimuli. This may partially explain the high rate of relapse to drug seeking behavior when treated addicts return to their home environment. Conditioning of narcotic abstinence symptoms was produced experimentally in five of eight volunteer subjects. Brief naloxone precipitated abstinence was the unconditioned response. The conditioned stimulus was a tone and odor. After an average of seven training trials, the tone and odor produced a conditioned abstinence response. The conditioned response consisted of subjective components (feelings of sickness, nausea, cramps, craving) and objective components (yawning, tearing, rhinorrhea, irregular respiration and transiently increased blood pressure). These laboratory findings support the anecdotal evidence regarding the existence of conditioned abstinence phenomena.

Rapid intake: A method for increasing retention rate of heroin addicts seeking methadone treatment

HE VALUE of methadone in treating narcotic addiction has been demonstrated by numerous studies.‘-4 Many patients who become engaged in treatment have been shown to decrease or stop their involvement with the drug culture and to make meaningful progress toward vocational and social rehabilitation. Despite its proven efficacy, a substantial proportion of known addicts are not in treatment. Estimates of the percentages of addicts in methadone treatment include 15%40% in Kansas City,5 about 50% in New Orleans,6 and 20% in Philadelphia. * Many of these patients may never seek treatment; others drop out after just a few visits. Program policies may exert strong effects on whether patients seek or continue treatment. The Massachusetts General Hospital drug program, which offers methadone detoxification, reports program changes improving their drop-out rate from a staggering 97% of patients failing to come for a second appointment’ to 76% coming twice and 57% coming 3 or more times.8 These motivational and dropout problems have been experienced at the Philadelphia VA Drug Dependence Treatment Center since its opening 255 years ago. Some delays and administrative red-tape are probably an inevitable feature of treatment in large institutions such as ours. We considered it likely that any negative consequences produced by delays might be maximized in a group of patients such as ours since many observers describe addicts as being impulsive, passive, having a low frustration tolerance and an inability to postpone gratification.e~‘O~ll These character traits would make addicts extremely sensitive to delays. We hypothesized therefore that changing our intake procedure so as to decrease delays would increase retention rates. This paper reports on the consequences of one such change: contact with a physician and other treatment staff on the day of arrival at the clinic.

Follow-up of Vietnam veterans. I. relapse to drug use after Vietnam service

A sample of 202 former army enlisted men who served in Vietnam between 1971 and 1972 were studied 28 months after their return to a large metropolitan area. Subjects were divided into three groups, frequent (n = 98), occasional (n = 55) and nonusers (n = 49) according to their inservice narcotics use. Results indicated that in spite of high rates of inservice narcotics use, only 39% of those addicted in Vietnam, and 11% of those who used narcotics occasionally, continued to use narcotics after returning to the United States. However, other types of substances, such as alcohol and marijuana, were used more heavily in all groups. A series of multiple correlations indicated that preservice variables also played a significant role in determining postservice drug involvement.

Drug Flashbacks. II. Some Additional Findings

A subsample was drawn from an earlier collection of data in order to answer a number of questions related to acid (LSD, STP) flashbacks. Acid users who reported flashbacks also reported significantly more marijuana use than those who did not; the two groups did not differ on use of other drugs, including acid. Simple correlations and multiple regression analyses both showed extent of marijuana use to be the only drug variable significantly related to acid flashbacks. No optimal combination of marijuana and acid improved flashback prediction. Among acid users, correlations between amounts of use for various drugs were high and significant, excepting only the marijuana-acid correlation.

Double-blind detoxification of methadone maintenance patients.

Twenty-four methadone maintenance patients were assigned to (1) decreasing dose (N = 12) or (2) continued methadone maintenance (N = 12), matching for dose, initial complaint levels, and counselor. After 14 weeks most patients in both groups had terminated from the study. Detoxifying patients usually terminated by obtaining a dose increase or dropping out; maintenance patients usually terminated for external reasons. Prior to terminating, detoxifying patients reported increased withdrawal complaints but no awareness doses had decreased. Termination was not directly related to dose level or percentage decrease. In both groups, terminators were likely to have been high in complaints during the baseline period.

FOLLOW-UP OF VIETNAM VETERANS II. SOCIAL ADJUSTMENT

Vietnam veterans were divided into three groups according to their inservice narcotics use: frequent users (n = 98), occasional users (n = 55) and nonusers (n = 49). Using a blind interview procedure the three groups were found to differ in the areas of employment/education, family adjustment, physical health, and depression. A composite Social Adjustment Factor was derived from these four areas, and a series of multiple correlations were computed in order to assess the effect of Vietnam drug use on the Social Adjustment Factor when preservice variables were held constant. Both the Social Adjustment Factor and two of its components, family adjustment and depression, continued to correlate significantly with the Vietnam drug group after the influence of preservice variables had been accounted for. Correlations between the two components employment/education and physical health and Vietnam drug group were no longer significant. The authors conclude that current social adjustment is determined by the interaction of preservice conditions and the Vietnam experience itself.

A Correlational Method for the Investigation of Systematic Trends in Serial Data.

THE investigator working with serial data, e.g., a sample of occasions within a single case, may wish to evaluate systematic trends over time within such data. This can be done for any variable V by correlating the V values over the series of occasions sampled with the orthogonal polynomial coe5cients for J = N L‘gfoups,” where N = the number of occasions sampled. To the extent to which one can assume that the intervals between occasions are equal, the resulting correlation coefficients can be taken to represent the extent to which systematic trends over time account for variability in the data. . By assigning the polynomial coefficients to the occasions as “scores” one creates, in effect, hypothetical orthogonal variables with perfectly linear, quadratic, cubic and SO forth trends. Correlating the actual V scores with these hypothetical variables actually partitions the total V variance into orthogonal components; each squared correlation coe5cient represents the proportion of total variance accounted for by the trend component involved. These correlation coefficients can be tested for significance in the usual manner, i.e., t = r -d N 2 /1/ l r ’ , with N 2 degrees of freedom. However, such a test is based on the assumption that no other trend component than the one being tested is associated with the variable. If more than one trend component is significant, then the separate test for each is excessively conservative.

Student therapists' assessment of diagnostic testing.

Summary Seventy-three student therapists (psychologists, psychiatrists and social workers) at a psychoanalytic training center responded to a survey questionnaire on attitudes and behavior relating to psychodiagnostic reports. Factor analysis of the questionnaire yielded three substantive dimensions: (a) General Diagnostic Utility, (b) Independent Action, and (c) Cry for Help. The latter two factors related to age and profession of the respondent. In general the respondents indicated psychodiagnostics could be of significant utility, though some evidence suggested they may serve primarily a confirmatory function. Conflicts between teaching and service roles of a training clinic were discussed.

Intraclass Correlation as a Reliability Check on Nominal Data.

MANY research problems require judges to assign objects or stimuli (often people) to discrete categories. The results of these categorical assignments may be used as a dependent or an independent variable for further research. Concerned about the reliability of these judgments, the investigator may wish to know, before proceeding with further study, the extent to which judges agree on their assignments.