Thomas Kosten

..This opportunity has a three-year window, however, and a critical need will be to attract a sufficient number of physicians into prescribing buprenorphine/naloxone in order to allow our patients increased access to this treatment...

..The 'escalating CM' was eliminated during months 4-6 to assess any reduction in drug-free urines...

..DMI and CM had independent and additive effects in facilitating cocaine-free urines in buprenorphine maintained patients. The antidepressant appeared to enhance responsiveness to CM reinforcement...

..Other immunotherapy may include treatment of drug overdose, prevention of brain or cardiac toxicity and protection of a fetus during pregnancy in a drug abuser...

..Platelet aggregation after ADP showed no significant change during the month, but reduced rCBF significantly improved after 1-month treatment with amiloride compared with placebo and cocaine abstinence alone...

..Despite the effectiveness of medications, they must be used in conjunction with appropriate psychosocial treatments...

..Cocaine-free urines showed no association with depression. This poor outcome with desipramine and buprenorphine suggests that this medication combination is not indicated in depressed opioid-dependent patients...

..Pemoline might be the best option for minimizing the risk of SUD complicating comorbid ADHD with BPD...

..Current immunotherapies already show efficacy, but improved antigen design and antibody engineering promise highly specific and rapidly developed treatments for both existing and future addictions...

..The CU+ patients showed a treatment effect of DMI. This DMI effect was significant in patients maintained on BUP but not on Meth...

..Thus, in agreement with the negative results from acute dosing studies in primates and humans, chronic ketoconazole treatment does not appear to reduce cocaine or opioid use in humans maintained on methadone...

..Thus, the therapeutic vaccine was well tolerated with dose related increases in antibody levels, and a high proportion of patients recruited into the study were retained...

..This physiological activation was a better predictor of relapse than subjective reports of craving, and may be a useful target for treatment development...

..Animal studies also suggest that tailoring treatment to subgroups of patients based on genotype may improve responses...

..These preliminary findings do not support the efficacy of BUPRO, in combination with BUPRE, for the concurrent treatment of opioid and tobacco addiction...

..While a recent clinical study has demonstrated the potential utility of topiramate for smoking cessation in alcohol-dependent smokers, the effects of topiramate on tobacco addiction have not been systematically examined in humans...

..How these enhanced subjective amphetamine responses affect cocaine use behavior remains to be determined in future clinical trials...

..Although preclinical studies support the contribution of the noradrenergic system activation in mediating the acute effects of amphetamines, these findings have not been followed up in clinical studies...

..Attenuation of the rating of 'bad effects' by carvedilol suggests that noradrenergic activation may also mediate the aversive effects of nicotine...

..The goal of this study was to determine minocycline's effects on the acute physiological, behavioral, and subjective responses to dextroamphetamine (DAMP) in healthy volunteers...

..This hypothesis needs to be tested in prospective clinical trials...

..e., methadone, buprenorphine) often produces favorable outcomes, detoxification followed by treatment with the μ-opioid receptor antagonist naltrexone may offer a potentially useful alternative to agonist maintenance for some patients...

..The mechanism accounting for these findings is unclear, but may involve processes other than decreased glutamate release by riluzole. The effects of glutamate medications on psychostimulant responses need to be further examined...

..These preclinical studies have not been followed up in systematic human studies...

..Heroin users had statistically similar striatal DA and brainstem and diencephalon 5-HT transporter availability compared with controls. No associations between transporter availability and heroin use characteristics were found...

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..Further exploration of these factors seems warranted...

..No effective pharmacotherapies exist for cocaine dependence, although contingency management (CM) has demonstrated efficacy...

..GABA medications, including tiagabine, are currently being evaluated in controlled clinical trials for the treatment of cocaine dependence...

..Initial promising findings with genetic polymorphism, brain activation, and stress response have also been found and need to be replicated in future studies...

..This review aims to cover these developments in the pharmacotherapy of alcohol and opiates, two addictive drugs for which we have the majority of our FDA approved pharmacotherapies...

..60 vs. 0.73; U=4837, p<.04). These preliminary findings do not support the efficacy of progesterone in male cocaine users. The efficacy of progesterone in female cocaine users remains to be determined in future studies...

..Cocaine abuse has no established pharmacotherapy, but active immunotherapy with a cocaine vaccine shows promise as a therapeutic intervention...

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..These findings encourage a controlled trial to determine if this work has efficacy for practitioners in substance abuse treatment...

..A preliminary study examined whether lofexidine decreases stress-induced and cue-induced opioid craving and improves opioid abstinence in naltrexone-treated opioid-dependent individuals...

..The results indicate that neither citalopram nor citalopram augmented with bupropion were more effective than placebo in the treatment of opioid abuse...

..GABAergic medications appear to reduce the reinforcing effects of cocaine by attenuating cocaine-induced dopamine release. This study evaluated gabapentin and tiagabine compared to placebo in reducing cocaine taking behavior...

..Last, a cocaine vaccine that slows entry of cocaine into the brain holds promise. These promising findings need to be further tested in controlled clinical trials...

..These results highlight important sex differences in the association between antisocial personality and distress processing in cocaine-dependent individuals...

..Identifying neural activity associated with stress and stress-induced cocaine craving is important in understanding the neurobiology of cocaine craving and relapse...

..The vasodilatation produced by alcohol may attenuate some of the vasoconstriction and neurotoxic effects of cocaine, accounting for the fewer deficits in this group...

..Overall, immunotherapy offers a range of potential treatment options: drug treatment, as well as the treatment of overdose, prevention of brain or cardiac toxicity and fetal protection in pregnant drug abusers...

..These results suggest that baseline cocaine urine results should be considered as stratifying variables in clinical trials for cocaine dependence...

..We sought to evaluate the safety and efficacy of the GABAergic agent tiagabine in reducing cocaine use among methadone-treated patients...

..CONCLUSIONS: Because DS shows treatment efficacy for cocaine addiction, results from this study suggest potential treatment agents should enhance, not attenuate, locomotor sensitization in rats...

..The ND cocaine-abusing, opiate-dependent patients may be more responsive to the anticraving effects of DMI...

..These results suggest that isradipine alone or in combination with naltrexone attenuates some of the physiological effects of cocaine...

..Naloxone attenuated D-cycloserine-induced increases in systolic blood pressure. These results suggest that D-cycloserine at doses up to 500 mg/70 kg may have some limited usefulness in relieving symptoms of opioid withdrawal...

..These deficits may represent segmental cerebral vasospasm that was reversed by this vasodilating agent in cocaine abusers with areas of hypo-perfusion (deficits) as baseline...

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..Medications that increase synaptic noradrenaline should be used with care in opioid-dependent patients...

..The possibility of different neural mechanisms underlying relapse in men and women, and the implications for utilizing specialized treatments are discussed...

..While perfusion abnormalities have been shown to relate to cognitive deficits in this substance abuse population, the relationship between cognitive performance and the magnitude of perfusion abnormality has yet to be fully determined...

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..These results suggest that an efficacious maintenance dose is necessary for contingencies to be effective in facilitating both opioid and cocaine abstinence...

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..These data support our initial finding of decreased cortical excitability in abstinent cocaine-dependent subjects. We interpret this finding as a compensatory mechanism against the stimulating and epileptogenic effects of cocaine...

..This study compares effects of buprenorphine and methadone and evaluates the efficacy of combining contingency management with maintenance treatment for patients with co-occurring cocaine and opioid dependence...

..The efficacy of this vaccine for relapse prevention is under investigation. Many initial promising findings need to be replicated in larger, controlled clinical trials...

..Further research is needed to develop new pharmacotherapies for substance use disorders and establish clinical guidelines on how to use these medications most effectively...

..This study examined whether cocaine-dependent patients have perfusion abnormalities associated with poor decision-making ability as measured by the Iowa Gambling Task (IGT)...

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..The effects of progesterone treatment on cocaine dependence need to be further studied in controlled trials...

..Available manualized behavioral treatments are reviewed, noting their strengths and limitations as behavioral therapy platforms for pharmacotherapy trials and as potential concomitant therapies in clinical practice...

..Increasing the understanding of specific financing and services delivery barriers that clinicians face is needed to inform the development of effective integrated services models and policies to facilitate OBOT implementation...

..These results suggest that isradipine attenuates and dextromethorphan enhances some of the behavioral effects of naloxone in opioid-dependent humans...

..These results suggest that smoking abstinence differentially alters VSWM in schizophrenic vs. control smokers, and that cigarette smoking has beneficial effects on VSWM in schizophrenic, but not control, smokers...

..4. To examine depression as a predictor of response. 5. To examine three month follow-up status after completing the treatment trial for continuation in treatment, abstinence from illicit drugs, and depressive symptoms. ..