Publications (17)42.1 Total impact
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Article: Pain and Associated Substance Use among Opioid Dependent Individuals Seeking Office-Based Treatment with Buprenorphine-Naloxone: A Needs Assessment Study.
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ABSTRACT: A paucity of studies has examined the pain experiences of opioid dependent individuals seeking office-based buprenorphine-naloxone treatment (BNT). We set out to examine, among those seeking BNT: (a) the prevalence of pain types (i.e., recent pain, chronic pain), (b) the characteristics of pain (intensity, frequency, duration, interference, location, and genesis), and (c) substance use to alleviate pain. We surveyed 244 consecutive individuals seeking office-based BNT for opioid dependence about physical pain and associated substance use. Thirty-six percent of respondents reported chronic pain (CP) (i.e., pain lasting at least 3 months) and 36% reported "some pain" (SP) (i.e., past week pain not meeting the threshold for CP). In comparison to SP respondents, those with CP were, on average, older; reported greater current pain intensity, pain frequency, typical pain duration, typical pain intensity, and typical pain interference; were more likely to report shoulder or pelvis and less likely to report stomach or arms as their most bothersome pain location; and were more likely to report accident or nerve damage and less likely to report opioid withdrawal as the genesis of their pain. Both pain subgroups reported similarly high rates of past-week substance use to alleviate pain. The high rates of pain and self-reported substance use to manage pain suggest the importance of assessing and addressing pain in BNT patients. (Am J Addict 2013; 22:212-217).American Journal on Addictions 05/2013; 22(3):212-7. · 1.74 Impact Factor -
Article: The Psychometric Properties of the Iowa Personality Disorder Screen in Methadone-Maintained Patients: An Initial Investigation.
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ABSTRACT: The psychometric properties of the Iowa Personality Disorder Screen (IPDS) were examined in 150 methadone-maintained patients who completed measures of demographic, psychopathology, substance use, pain, and methadone maintenance treatment (MMT) characteristics. An exploratory factor analysis revealed a two-factor solution that explained 45% of the scale variance. The first factor captured internalizing tendencies, such as inhibition and hypersensitivity to others. The second factor comprised externalizing tendencies, such as impulsivity and insensitivity to others. The IPDS item subsets, derived factors, and the total score were significantly related to race/ethnicity but not sex. The effects of race/ethnicity were controlled statistically when the IPDS was compared to other measures of psychopathology, self-reported substance use, pain variables, and MMT characteristics. In general, the IPDS appears to be reliable and valid for use with methadone-maintained patients. The two-factor structure found in this study may have clinical utility and merits further investigation in other MMT samples.Journal of personality disorders 02/2013; · 3.08 Impact Factor -
Article: The Recovery Line: A pilot trial of automated, telephone-based treatment for continued drug use in methadone maintenance.
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ABSTRACT: The current pilot study evaluated feasibility, acceptability, and initial efficacy of a therapeutic Interactive Voice Response (IVR) system ("the Recovery Line") for patients receiving methadone maintenance who continue to use illicit drugs. Patients were randomized (N=36) to 4weeks of treatment-as-usual (TAU) or Recovery Line plus TAU. Ratings of the Recovery Line were high and remained stable throughout the study. However, despite instructions and reminders, patients used substantially less than the recommended daily use (<10days of 28). Patients were more likely to report abstinence from opioids and cocaine on days they used the Recovery Line (p=.01) than those they did not. Conditions did not differ significantly on patient satisfaction, urine screen outcomes, or coping efficacy. As with other computer-based treatments, findings suggest the Recovery Line is acceptable and feasible. However, additional methods to increase patient utilization of automated systems and larger clinical trials are needed.Journal of substance abuse treatment 01/2013; · 2.90 Impact Factor -
Article: A Randomized Trial of Cognitive Behavioral Therapy in Primary Care-based Buprenorphine.
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ABSTRACT: To determine the impact of cognitive behavioral therapy on outcomes in primary care, office-based buprenorphine/naloxone treatment of opioid dependence. We conducted a 24-week randomized clinical trial in 141 opioid-dependent patients in a primary care clinic. Patients were randomized to physician management or physician management plus cognitive behavioral therapy. Physician management was brief, manual guided, and medically focused; cognitive behavioral therapy was manual guided and provided for the first 12 weeks of treatment. The primary outcome measures were self-reported frequency of illicit opioid use and the maximum number of consecutive weeks of abstinence from illicit opioids, as documented by urine toxicology and self-report. The 2 treatments had similar effectiveness with respect to reduction in the mean self-reported frequency of opioid use, from 5.3 days per week (95% confidence interval, 5.1-5.5) at baseline to 0.4 (95% confidence interval, 0.1-0.6) for the second half of maintenance (P<.001 for the comparisons of induction and maintenance with baseline), with no differences between the 2 groups (P=.96) or between the treatments over time (P=.44). For the maximum consecutive weeks of opioid abstinence there was a significant main effect of time (P<.001), but the interaction (P=.11) and main effect of group (P=.84) were not significant. No differences were observed on the basis of treatment assignment with respect to cocaine use or study completion. Among patients receiving buprenorphine/naloxone in primary care for opioid dependence, the effectiveness of physician management did not differ significantly from that of physician management plus cognitive behavioral therapy.The American journal of medicine 01/2013; 126(1):74.e11-7. · 4.47 Impact Factor -
Article: Use of Conventional, Complementary, and Alternative Treatments for Pain Among Individuals Seeking Primary Care Treatment With Buprenorphine-Naloxone.
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ABSTRACT: : Previous studies have not examined patterns of pain treatment use among patients seeking office-based buprenorphine-naloxone treatment (BNT) for opioid dependence. OBJECTIVES:: To examine, among individuals with pain seeking BNT for opioid dependence, the use of pain treatment modalities, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment while in BNT. METHODS:: A total of 244 patients seeking office-based BNT for opioid dependence completed measures of demographics, pain status (ie, "chronic pain (CP)" [pain lasting at least 3 months] vs "some pain (SP)" [pain in the past week not meeting the duration criteria for chronic pain]), pain treatment use, perceived efficacy of prior pain treatment, and interest in receiving pain treatment while in BNT. RESULTS:: In comparison with the SP group (N = 87), the CP group (N = 88) was more likely to report past-week medical use of opioid medication (adjusted odds ratio [AOR] = 3.2; 95% CI, 1.2-8.4), lifetime medical use of nonopioid prescribed medication (AOR = 2.2; 95% CI, 1.1-4.7), and lifetime use of prayer (AOR = 2.8; 95% CI, 1.2-6.5) and was less likely to report lifetime use of yoga (AOR = 0.2; 95% CI, 0.1-0.7) to treat pain. Although the 2 pain groups did not differ on levels of perceived efficacy of prior lifetime pain treatments, in comparison with the SP group, the CP group was more likely to report interest in receiving pain treatment while in BNT (P < 0.001). CONCLUSIONS:: Individuals with pain seeking BNT for opioid dependence report a wide range of conventional, complementary, and alternative pain-related treatments and are interested (especially those with CP) in receiving pain management services along with BNT.Journal of Addiction Medicine 10/2012; · 1.95 Impact Factor -
Article: Prevalence of mood and substance use disorders among patients seeking primary care office-based buprenorphine/naloxone treatment.
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ABSTRACT: BACKGROUND: Psychiatric comorbidity can adversely affect opioid dependence treatment outcomes. While the prevalence of psychiatric comorbidity among patients seeking methadone maintenance treatment has been documented, the extent to which these findings extend to patients seeking primary care office-based buprenorphine/naloxone treatment is unclear. AIMS: To determine the prevalence of mood and substance use disorders among patients seeking primary care office-based buprenorphine/naloxone treatment, via cross sectional survey. METHODS: 237 consecutive patients seeking primary care office-based buprenorphine/naloxone treatment were evaluated using modules from the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Current (past 30days) and past diagnoses were cataloged separately. RESULTS: Patients ranged in age from 18 to 62years old (M=33.9, SD=9.9); 173 (73%) were men; 197 (83%) were white. Major depression was the most prevalent mood disorder (19% current, 24% past). A minority of patients met criteria for current dysthymia (6%), past mania (1%), or past hypomania (2%). While 37 patients (16%) met criteria for current abuse of or dependence on at least one non-opioid substance (7% cocaine, 4% alcohol, 4% cannabis, 2% sedatives, 0.4% stimulants, 0.4% polydrug), 168 patients (70%) percent met criteria for past abuse of or dependence on at least one non-opioid substance (43% alcohol, 38% cannabis, 30% cocaine, 9% sedatives, 8% hallucinogens, 4% stimulants, 1% polydrug, and 0.4% other substances). CONCLUSION: Mood and substance use comorbidity is prevalent among patients seeking primary care office-based buprenorphine/naloxone treatment. The findings support the need for clinicians to assess and address these conditions.Drug and alcohol dependence 07/2012; · 3.60 Impact Factor -
Article: Counseling and directly observed medication for primary care buprenorphine maintenance: a pilot study.
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ABSTRACT: : Counseling and medication adherence can affect opioid agonist treatment outcomes. We investigated the impact of 2 counseling intensities and 2 medication-dispensing methods in patients receiving buprenorphine in primary care. : In a 12-week trial, patients were assigned to physician management (PM) with weekly buprenorphine dispensing (n = 28) versus PM and directly observed, thrice-weekly buprenorphine (DOT) and cognitive-behavioral therapy (CBT) (PM+DOT/CBT; n = 27) based on therapist availability. Fifteen-minute PM visits were provided at entry, after induction, and then monthly. Cognitive-behavioral therapy was weekly 45-minute sessions provided by trained therapists. : Treatment groups differed on baseline characteristics of years of opioid use, history of detoxification from opioids, and opioid negative urines during induction. Analyses adjusting for baseline characteristics showed no significant differences between groups on retention or drug use based on self-report or urines. Patient satisfaction was high across conditions, indicating acceptability of CBT counseling with observed medication. The number of CBT sessions attended was significantly associated with improved outcome, and session attendance was associated with a greater abstinence the following week. : Although the current findings were nonsignificant, DOT and individual CBT sessions were feasible and acceptable to patients. Additional research evaluating the independent effect of directly observed medication and CBT counseling is needed.Journal of Addiction Medicine 05/2012; 6(3):205-11. · 1.95 Impact Factor -
Article: Group-based strategies for stress reduction in methadone maintenance treatment: what do patients want?
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ABSTRACT: To assess methadone maintenance treatment (MMT) patients' willingness to use, and perceived efficacy of, conventional and unconventional group stress reduction treatments. A survey, developed by the authors, was administered to 150 MMT patients. Levels of treatment willingness and perceived efficacy for both conventional and unconventional treatments were relatively high; however, ratings for conventional interventions were, on average, significantly higher than those for unconventional ones. The highest rated conventional and unconventional treatments in terms of willingness and perceived efficacy were nutrition and spiritual counseling, respectively, whereas the lowest rated conventional and unconventional group treatments were anger management and visualization training, respectively. White race was a significant predictor of lower willingness to try conventional and unconventional group therapies and lower perceived efficacy of unconventional group treatment, whereas female sex and older age were significant predictors of higher levels of willingness to try unconventional group treatment. Higher levels of substance use problems were associated with increased willingness to try conventional group treatment. Higher levels of anxiety emerged as a significant independent predictor of treatment willingness and perceived efficacy for both conventional and unconventional group treatments. The relatively high levels of treatment willingness and perceived efficacy of conventional and unconventional group stress reduction treatments point to the feasibility of offering these interventions in MMT and suggest that, in particular, high levels of anxiety are associated with greater treatment willingness and perceived treatment efficacy.Journal of Addiction Medicine 09/2011; 5(3):181-7. · 1.95 Impact Factor -
Article: Conventional and unconventional treatments for stress among methadone-maintained patients: treatment willingness and perceived efficacy.
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ABSTRACT: We surveyed 150 methadone maintenance treatment (MMT) program patients about willingness to use, and perceived efficacy of, conventional and unconventional nonpharmacological stress-related treatments. Although levels of treatment willingness and perceived efficacy for both conventional and unconventional treatments were high, ratings for conventional interventions were, on average, significantly higher than those for unconventional ones. Dimensions of psychiatric distress-but not demographic or MMT characteristics-predicted treatment willingness for conventional therapies and treatment willingness and perceived efficacy for unconventional therapies. These findings are likely to have implications for resource and program planning in MMT programs.American Journal on Addictions 03/2011; 20(2):137-42. · 1.74 Impact Factor -
Article: Exploring relations among traumatic, posttraumatic, and physical pain experiences in methadone-maintained patients.
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ABSTRACT: Differences in lifetime trauma exposure and screened symptoms of posttraumatic stress disorder (PTSD) were examined in methadone maintenance treatment (MMT) patients with a variety of pain experiences. Parametric and nonparametric statistical tests were performed on data obtained from 150 patients currently enrolled in MMT. In comparison to MMT patients reporting no pain in the previous week, those with chronic severe pain (CSP) (ie, pain lasting at least 6 months with moderate to severe pain intensity or significant pain interference) exhibited comparable levels of trauma involving sexual assault but reported significantly higher levels of trauma involving physical assault, number of traumatic events, and screened symptoms of PTSD. A third group, non-CSP MMT patients reporting some pain in the past week, differed significantly from the CSP group on number of traumatic events but reported comparable levels of sexual assault and physical assault. In comparison to men, women reported higher levels of sexual assault and were more likely to score above the cutoff on the PTSD screener but reported comparable levels of physical assault and number of traumatic events. Pain-related differences in trauma and screened symptoms of PTSD exist in MMT patients and may have implications for program planning and outreach efforts. PERSPECTIVE: This article demonstrates that trauma and screened symptoms of PTSD vary as a function of sex and pain status in methadone-maintained patients. Future studies may benefit from developing and assessing interventions that address chronic pain, PTSD, and opioid dependence in MMT.The journal of pain: official journal of the American Pain Society 01/2011; 12(1):22-8. · 3.78 Impact Factor -
Article: Computer-based interventions for drug use disorders: a systematic review.
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ABSTRACT: A range of innovative computer-based interventions for psychiatric disorders have been developed and are promising for drug use disorders due to reduced cost and greater availability compared to traditional treatment. Electronic searches were conducted from 1966 to November 19, 2009, using MEDLINE, Psychlit, and EMBASE. Four hundred sixty-eight nonduplicate records were identified. Two reviewers classified abstracts for study inclusion, resulting in 12 studies of moderate quality. Eleven studies were pilot or full-scale trials compared to a control condition. Interventions showed high acceptability despite substantial variation in type and amount of treatment. Compared to treatment-as-usual, computer-based interventions led to less substance use and higher motivation to change, better retention, and greater knowledge of presented information. Computer-based interventions for drug use disorders have the potential to dramatically expand and alter the landscape of treatment. Evaluation of Internet- and telephone-based delivery that allows for treatment-on-demand in patients' own environment is needed.Journal of substance abuse treatment 12/2010; 40(3):215-23. · 2.90 Impact Factor -
Article: Pain catastrophizing and pain coping among methadone-maintained patients.
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ABSTRACT: The aim of this study was to examine the association of pain catastrophizing and pain coping strategies with characteristic pain intensity (an average of worst, least, and typical pain intensity in the past week) and recent pain-related disability (an average of three measures of past week pain interference) in opioid-dependent patients enrolled in a methadone maintenance treatment program (MMTP) who reported recent pain. Cross-sectional survey. One hundred and eight MMTP patients who reported recent pain. Participants completed measures of demographics, pain status (i.e., "chronic severe pain" [pain lasting at least 6 months with at least moderate pain intensity or significant pain interference in the past week] vs "some pain" [pain in the past week not meeting the threshold of chronic severe pain]), characteristic pain intensity, recent pain-related disability, somatization, depression, catastrophizing, and pain coping strategies. Catastrophizing explained a significant proportion of the variance in characteristic pain intensity (14%) and recent pain-related disability (11%) after controlling for demographics, pain status, somatization, and depression. Mirroring the findings of studies of non-opioid-dependent chronic pain patients, greater catastrophizing was associated with greater pain intensity and increases in recent pain-related disability. On average, the "chronic severe pain" group reported higher levels of catastrophizing than the "some pain" group. Consistent with studies of patients with chronic pain who are not opioid dependent, our findings emphasize the importance of assessing and addressing catastrophizing in MMTP patients with pain.Pain Medicine 11/2010; 12(1):79-86. · 2.35 Impact Factor -
Article: Conventional and nonconventional pain treatment utilization among opioid dependent individuals with pain seeking methadone maintenance treatment: a needs assessment study.
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ABSTRACT: We surveyed 293 individuals seeking methadone maintenance treatment (MMT) for opioid dependence about pain, pain treatment utilization, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment while in MMT. Among the 213 respondents reporting recent pain of at least moderate typical pain intensity, those with and those without a lifetime history of chronic pain endorsed similar rates of conventional (with the exception of past-week medical use of nonopiate medication), complementary, and alternative medicine utilization for pain reduction and a numerically smaller proportion endorsed last-week utilization of complementary and alternative medicine when compared with conventional medicine. The most frequently endorsed lifetime conventional pain treatments included opiate and over-the-counter medications, whereas the most frequently endorsed lifetime complementary and alternative medicine pain treatments included stretching, physical exercise, physical therapy, heat therapy, and prayer. Perceived efficacy of prior pain treatment but not interest in pain treatment was associated with chronic pain history status. These findings may have implications for resource and program planning in MMT programs.Journal of Addiction Medicine 06/2010; 4(2):81-7. · 1.95 Impact Factor -
Article: Allopathic, Complementary, and Alternative Medical Treatment Utilization for Pain among Methadone‐Maintained Patients
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ABSTRACT: We surveyed 150 methadone maintenance treatment program (MMTP) patients about pain, pain treatment utilization, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment at the MMTP. Respondents with chronic severe pain (CSP) (ie, pain lasting at least six months with moderate to severe pain intensity or significant pain interference) and “some pain” (ie, pain reported in the previous week but not CSP) endorsed similar rates of past-week and lifetime allopathic or standard medical (with the exception of lifetime medical use of non-opiate medication) and complementary and alternative medicine (CAM) utilization for pain reduction. Prior pain treatments were perceived to be less effective by CSP than SP patients but both groups had equivalent high rates of interest in pain treatment associated with the MMTP. These findings may have implications for resource and program planning in MMTPs.American Journal on Addictions 09/2009; 18(5):379 - 385. · 1.74 Impact Factor -
Article: Conventional and non-conventional pain treatment utilization among opioid dependent individuals with pain seeking methadone maintenance treatment: A needs assessment study.
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ABSTRACT: OBJECTIVE AND METHODS: We surveyed 293 individuals seeking methadone maintenance treatment (MMT) for opioid dependence about pain, pain treatment utilization, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment while in MMT. RESULTS: Among the 213 respondents reporting recent pain of at least moderate typical pain intensity, those with and those without a lifetime history of chronic pain endorsed similar rates of conventional (with the exception of past-week medical use of non-opiate medication), complementary, and alternative medicine utilization for pain reduction and a numerically smaller proportion endorsed last-week utilization of complementary and alternative medicine as compared to conventional medicine. The most frequently endorsed lifetime conventional pain treatments included opiate and over-the-counter medications, whereas the most frequently endorsed lifetime complementary and alternative medicine pain treatments included stretching, physical exercise, physical therapy, heat therapy, and prayer. Perceived efficacy of prior pain treatment but not interest in pain treatment was associated with chronic pain history status. CONCLUSION: These findings may have implications for resource and program planning in MMT programs.Journal of Addiction Medicine 09/2009; 18(5):379-385. · 1.95 Impact Factor -
Article: Manual assisted cognitive treatment for deliberate self-harm in borderline personality disorder patients.
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ABSTRACT: This study examines the efficacy of a short-term individual therapy, Manual Assisted Cognitive Treatment (MACT), which was developed to treat parasuicidal (suicidal or self-harming) patients. In this trial, MACT was modified to focus on deliberate self-harm (DSH) in patients with borderline personality disorder (BPD). Thirty BPD patients who were engaged in DSH while in ongoing treatments, i.e., treatment-as-usual (TAU), were randomly assigned to receive MACT (N = 15) or not. DSH and level of suicide ideation were assessed at the baseline, at completion of the MACT intervention, and six months later. Results indicated that MACT was associated with significantly less frequent DSH upon completion of the intervention and with significantly decreased DSH frequency and severity at the six months follow-up. Moreover, MACT's contribution to reducing DSH frequency and severity was greater than the contribution by the amount of concurrent treatments. In contrast, MACT did not affect the level of suicide ideation and time-to-repeat of DSH. In conclusion, MACT seems to be a promising intervention for DSH in patients with BPD. More definitive studies are needed.Journal of Personality Disorders 11/2006; 20(5):482-92. · 2.31 Impact Factor -
Article: Allopathic, complementary, and alternative medical treatment utilization for pain among methadone-maintained patients.
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ABSTRACT: We surveyed 150 methadone maintenance treatment program (MMTP) patients about pain, pain treatment utilization, perceived efficacy of prior pain treatment, and interest in pursuing pain treatment at the MMTP. Respondents with chronic severe pain (CSP) (ie, pain lasting at least six months with moderate to severe pain intensity or significant pain interference) and "some pain" (ie, pain reported in the previous week but not CSP) endorsed similar rates of past-week and lifetime allopathic or standard medical (with the exception of lifetime medical use of non-opiate medication) and complementary and alternative medicine (CAM) utilization for pain reduction. Prior pain treatments were perceived to be less effective by CSP than SP patients but both groups had equivalent high rates of interest in pain treatment associated with the MMTP. These findings may have implications for resource and program planning in MMTPs.American Journal on Addictions 18(5):379-85. · 1.74 Impact Factor
Top co-authors
Top Journals
Institutions
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2013
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Yale-New Haven Hospital
New Haven, CT, USA
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2009–2012
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Yale University
- Department of Psychiatry
New Haven, CT, USA
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2006
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Harvard University
- Department of Psychiatry
Boston, MA, USA
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