Continuity of Care and Desipramine in Primary Cocaine Abusers

Sm, Hall; Tunis, Sandra L.; Triffleman, Elisa; Banys, Peter; Hw, Clark; Tusel, Donald J.; Stewart, Paul W.; Presti, David E.

doi:10.1097/00005053-199410000-00007

Cited by 33 publications

(8 citation statements)

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“…Of these drugs, desmethylimipramine (DMI) has been studied most extensively and has been shown to possess modest anti-craving properties. Chronic treatment with DMI reduces self-reports of craving and increases the incidence of abstinence in some, but not all, patient populations (Kosten et al 1987(Kosten et al , 1992Weiss 1988;Gawin et al 1989;Fischman et al 1990; Levin and Lehman 1991;Campbell et al 1994;Hall et al 1994). Variability in the dosing and duration of DMI treatment may account for the discrepancies among these Þndings.…”

Section: Introductionmentioning

confidence: 99%

Predictive validity of the extinction/reinstatement model of drug craving

et al. 1998

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The effects of chronic desmethylimipramine (DMI) treatment on measures of incentive motivation for cocaine were assessed in order to investigate the predictive validity of the extinction/reinstatement model of drug craving. Rats were trained to respond for cocaine infusions (0.75 mg/kg per 0.1 ml i.v.) or received yoked-saline infusions during daily 3-h sessions. A light and tone were presented with the infusions. Following self-administration training, each group received daily injections of either saline or DMI (10 mg/kg, i.p.) for 21 days of withdrawal from the self-administration regimen. On days 12-21 of withdrawal, rats were allowed to respond in the absence of cocaine reinforcement (extinction phase). After reaching an extinction criterion of no responses for 1 h, the cocaine-paired stimuli were repeatedly presented to reinstate responding (reinstatement phase). In the control group, DMI treatment did not alter responding during either test phase, but increased the response latency during the extinction phase. In contrast, DMI treatment in the cocaine group decreased responding and increased the response latency during both test phases, and decreased the extinction latency during the extinction phase. Overall, the effects of DMI were consistent with a reduction of incentive motivation for cocaine, lending support for the predictive validity of the extinction/reinstatement model of drug craving.

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Section: Introductionmentioning

confidence: 99%

Predictive validity of the extinction/reinstatement model of drug craving

et al. 1998

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“…Hall et al 7 noted a mean blood level of 157 ng/ml of subjects, while inpatient fell to 123 ng/ml during the ¢rst outpatient week and to 23 ng/ml at study end. Few side e¡ects were reported, and subjects were instructed to increase dosage to at least 200 mg daily.…”

Section: Retention In Treatmentmentioning

confidence: 97%

Comparison of Desipramine or Carbamazepine to Placebo for Crack Cocaine‐Dependent Patients

et al. 2003

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The authors compared the effects of desipramine or carbamazepine to placebo in an intensive outpatient program for cocaine abuse. Subjects recruited from an urban drug treatment program were randomly assigned to a double-blind, placebo-controlled, eight-week trial of desipramine, carbamazepine, or placebo. Patient ratings, urine drug screens, and blood samples were obtained weekly. Using survival analysis, the three groups did not differ in time to drop out of treatment. While subjects improved over time on all self-ratings related to cocaine use, mood, and craving, only two items related to mood were significantly different over time as a function of treatment group. Subjects in the two treated groups reported significantly more improvement on self-ratings of depression and irritability. No treatment differences were noted for sustained abstinence or for proportion of positive urine drug screens. Desipramine subjects who attained a minimum blood level were retained in treatment significantly longer than placebo or other non-compliant treatment groups. This finding supports previous reports of a possible role for desipramine in cocaine abuse treatment.

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“…High attrition rates among cocaine abusers in some clinical trials, 1,2 as well as the demonstrated relationship between exposure to treatment and improved outcomes in other subgroups of substance abusers, 3–6 have stimulated interest in the question of treatment retention 7–13 . Two recent reports have summarized retention rates in a number of clinical studies of treatments for cocaine abuse, 3,14 but attempts to compare the findings of different investigations are complicated by differences in treatment settings, sample characteristics, the choice and definition of predictor variables, and the choice and definition of the dependent variables measuring retention 15–18 .…”

mentioning

confidence: 99%

A Two‐Rate Hypothesis for Patterns of Retention in Psychosocial Treatments of Cocaine Dependence: Findings from a Study of African‐American Men and a Review of the Published Data

et al. 1999

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In this article, we examine patterns of retention in psychosocial treatment programs for cocaine dependence. We present new data from a comparison trial of Drug Counseling and Supportive-Expressive Psychotherapy and review published data from all studies utilizing psychosocial interventions alone. We compared Drug Counseling and Psychotherapy on rates of pretreatment and during-treatment attrition in a sample of 294 African-American men seeking treatment for cocaine dependence (mean age, 37.6). Survival analyses were utilized to identify significant differences in during-treatment attrition between the two treatments and to identify significant changes in the rate of attrition during the course of each treatment. We then compared the patterns of retention in this study with those from other available published reports of psychosocial treatments for cocaine abuse. The weekly during-treatment attrition rate was not constant in either treatment condition, and the change in rate of attrition occurred at week six for both Drug Counseling and Psychotherapy. Comparison with other studies suggested that the during-treatment pattern of attrition among most psychosocial treatments for cocaine abuse is typified by two rates, with the rate of subject attrition early in treatment being greater than the rate of later attrition and also exhibiting greater variance. Future studies of treatment retention should identify significant shifts in the rate of during-treatment attrition, examine if the pattern of attrition is typified by two rates, and, if so, determine where the shift occurs. Future studies should also assess if changes in the rate of during-treatment attrition signal the timeframes within which strategies that enhance retention can be implemented in the treatment program.

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Continuity of Care and Desipramine in Primary Cocaine Abusers

Cited by 33 publications

References 0 publications

Predictive validity of the extinction/reinstatement model of drug craving

Predictive validity of the extinction/reinstatement model of drug craving

Comparison of Desipramine or Carbamazepine to Placebo for Crack Cocaine‐Dependent Patients

A Two‐Rate Hypothesis for Patterns of Retention in Psychosocial Treatments of Cocaine Dependence: Findings from a Study of African‐American Men and a Review of the Published Data

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