Shannon Robinson - Academia.edu (original) (raw)

Papers by Shannon Robinson

Research paper thumbnail of Integrated Care Increases Treatment and Improves Outcomes of Patients with Chronic HCV Infection and Psychiatric Illness or Substance Abuse

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, Jan 24, 2015

Patients with hepatitis C virus (HCV) infection with psychiatric disorders and/or substance abuse... more Patients with hepatitis C virus (HCV) infection with psychiatric disorders and/or substance abuse face significant barriers to antiviral treatment. New strategies might be needed to improve treatment rates and outcomes. We investigated whether an integrated care (IC) protocol, which includes multi-disciplinary care coordination and patient case management, could increase the proportion of patients with chronic HCV infection who receive antiviral treatment (a combination of interferon-based and direct acting antiviral agents) and achieve a sustained virologic response (SVR). We performed a prospective, randomized trial at 3 medical centers in the US. Participants (n=363 patients attending HCV clinics) had been screened and tested positive for depression, post-traumatic stress disorder, and/or substance use; they were randomly assigned (1:1) to groups that received IC or usual care (controls) from March 2009 through February 2011. A mid-level mental health practitioner was placed in e...

Research paper thumbnail of Randomized Placebo-Controlled Trial of a Selective Serotonin Reuptake Inhibitor In the Treatment of Nondepressed Tinnitus Subjects

Psychosomatic …, Jan 1, 2005

To assess the efficacy of a selective serotonin reuptake inhibitor (paroxetine) for relief of tin... more To assess the efficacy of a selective serotonin reuptake inhibitor (paroxetine) for relief of tinnitus. One hundred twenty tinnitus sufferers participated in a randomized double-blind placebo-controlled trial. Paroxetine or placebo was increased to a maximally tolerated dose (up to 50 mg/day), and patients were treated for a total of 31 days at the maximal dose. Patients with chronic tinnitus were recruited from our university-based specialty clinic by referral from otolaryngologists and audiologists in the local community and by advertisement. Patients with psychotic or substance use disorders or suicidal ideation were excluded, as were those using psychoactive medications (this resulted in only 1 subject with major depression in the study) or any other medications that interact with paroxetine and those with inability to hear at one's tinnitus sensation level. Fifty-eight percent of patients were male, 92% were Caucasian, and the average age was 57. Tinnitus matching, the Tinnitus Handicap Questionnaire, the question: How severe (bothered, aggravating) is your tinnitus? Quality of Well-Being and other psychological questionnaires. Paroxetine was not statistically superior to placebo on the following tinnitus measures (tinnitus matching, 5- or 10-db drop, Tinnitus Handicap Questionnaire, quality of well-being measures, how severe, how bothered, positive change). There was a significant improvement in the single item question, How aggravating is your tinnitus? for those in the paroxetine group compared with the placebo group. These results suggest that the majority of individuals in this study did not benefit from paroxetine in a consistent fashion. Further work remains to be done to determine if subgroups of patients (e.g., those who tolerate higher doses, those who are depressed) may benefit.

Research paper thumbnail of Acute Ethanol Effects on Brain Activation in Low- and High-Level Responders to Alcohol: Acute Ethanol Effects on Brain Activation

Alcoholism Clinical and Experimental Research, Jul 1, 2010

Background: A low level of response (LR) to alcohol is an important endophenotype associated with... more Background: A low level of response (LR) to alcohol is an important endophenotype associated with an increased risk of alcoholism. However, little is known about how neural functioning may differ between individuals with low and high LRs to alcohol. This study examined whether LR group effects on neural activity varied as a function of acute alcohol consumption.

Research paper thumbnail of Integrated Care Increases Treatment and Improves Outcomes of Patients with Chronic HCV Infection and Psychiatric Illness or Substance Abuse

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, Jan 24, 2015

Patients with hepatitis C virus (HCV) infection with psychiatric disorders and/or substance abuse... more Patients with hepatitis C virus (HCV) infection with psychiatric disorders and/or substance abuse face significant barriers to antiviral treatment. New strategies might be needed to improve treatment rates and outcomes. We investigated whether an integrated care (IC) protocol, which includes multi-disciplinary care coordination and patient case management, could increase the proportion of patients with chronic HCV infection who receive antiviral treatment (a combination of interferon-based and direct acting antiviral agents) and achieve a sustained virologic response (SVR). We performed a prospective, randomized trial at 3 medical centers in the US. Participants (n=363 patients attending HCV clinics) had been screened and tested positive for depression, post-traumatic stress disorder, and/or substance use; they were randomly assigned (1:1) to groups that received IC or usual care (controls) from March 2009 through February 2011. A mid-level mental health practitioner was placed in e...

Research paper thumbnail of Management of Chronic Hepatitis C in Veterans: The Potential of Integrated Care Models

The American Journal of Gastroenterology, 2008

The prevalence of hepatitis C virus (HCV) infection is higher among veterans than nonveterans, bu... more The prevalence of hepatitis C virus (HCV) infection is higher among veterans than nonveterans, but only about 14% of all identified infected veterans have ever received antiviral therapy. High rates of comorbid psychiatric and substance use disorders are major barriers to receiving antiviral treatment for veterans, and characteristics associated with poor virologic response are more common in this population. However, accumulating evidence indicates that patients with psychiatric and substance use disorders can successfully receive interferon-based antiviral therapies in an integrated or multidisciplinary health-care setting. The broad aims of integrated care models include reducing fragmentation and improving continuity and coordination of care. Although, to date, there are no randomized controlled trials of specific care models for patients with HCV, studies of integrated care for other chronic diseases suggest several strategies for optimizing outcomes for patients with HCV. Components of an HCV clinic incorporating these principles have been tested in a nonrandomized setting and include routine screening of all patients for psychiatric and substance use disorder risk factors, collaboration with mental health providers within the HCV clinic, following a defined integrated medical/psychiatric clinical protocol, provision of ongoing integrated support during antiviral treatment or retreatment, and educating patients on principles of chronic disease self-management.

Research paper thumbnail of Primary outcomes of a multisite randomized trial of an integrated care model for HCV patients

Research paper thumbnail of Integrated Substance Use Disorder and PTSD Treatment in A VA Substance Abuse Residential Rehabilitation Treatment Program (SARRTP)

Research paper thumbnail of Review of biological mechanisms and pharmacological treatments of comorbid PTSD and substance use disorder

Neuropharmacology, 2012

Posttraumatic stress disorder (PTSD) and alcohol/substance use disorder (A/SUD) are frequently co... more Posttraumatic stress disorder (PTSD) and alcohol/substance use disorder (A/SUD) are frequently comorbid. Comorbidity is associated with poorer psychological, functional, and treatment outcomes than either disorder alone. This review outlines biological mechanisms that are potentially involved in the development and maintenance of comorbid PTSD and A/SUD including neurotransmitter and hypothalamic-pituitary-adrenal dysregulation, structural differences in the brain, and shared genetic risk factors. The literature regarding pharmacological treatments that have been investigated for comorbid PTSD and A/SUD is also reviewed. Empirical data for each proposed mechanism and pharmacological approach is reviewed with the goal of making recommendations for future research.

Research paper thumbnail of Psychiatric Comorbidity Does Not Predict Interferon Treatment Completion Rates in Hepatitis C Seropositive Veterans

Journal of Clinical Gastroenterology, 2007

Goals: The aim of this study was to evaluate the impact of common psychiatric disorders on treatm... more Goals: The aim of this study was to evaluate the impact of common psychiatric disorders on treatment completion of antiviral therapy prescribed to a series of hepatitis C virus (HCV) positive US veterans.

Research paper thumbnail of Characteristics and Impact of Methamphetamine Use in Patients With Chronic Hepatitis C

Journal of Addiction Medicine, 2014

Methamphetamine (MA) use has increased in the United States in the last 20 years and is a risk fa... more Methamphetamine (MA) use has increased in the United States in the last 20 years and is a risk factor for hepatitis C virus(HCV) infection. The purpose of this study was to determine the characteristics and HCV infection outcomes of patients with a history of MA use. Subjects consisted of newly entered patients in the Veterans Affairs (VA) HCV registry at a single VA medical center from January 1, 2004, to June 30, 2004, and from January 1, 2007, to June 30, 2007. Univariate and multivariate analyses related to HCV infection antiviral treatment outcomes through 2010 was performed. A total of 198 consecutive eligible HCV registry patients were analyzed, and 40% had a history of MA use. Of patients with MA use history, 46% (36/79) had active use (within 6 months) at initial contact. Active MA users were significantly younger (mean age, 45.5 years), with more concomitant drug use (86%), compared with patients without MA use (mean age, 53.5 years; 42% minority; 29% other drug use). Overall, 71% of the 198 patients reported a history of problematic alcohol use, and 47% of those reported active abuse. Logistic regression analyses indicated that MA use did not significantly adversely affect antiviral treatment initiation, completion, or sustained virological response rates compared with that in patients without MA use. Active alcohol users had lower treatment initiation than patients without alcohol use. MA use is common in recent US veterans with HCV infection and occurs in younger patients with polysubstance use. Prior history or active MA use does not seem to adversely affect HCV infection clinic treatment compared with that in HCV-infected patients without MA use.

Research paper thumbnail of Rapid oral loading of extended release divalproex in patients with acute mania

General Hospital Psychiatry, 2005

Background: Oral loading with the delayed release formulation of divalproex sodium is widely used... more Background: Oral loading with the delayed release formulation of divalproex sodium is widely used for the treatment of patients with acute mania and produces rapid attainment of therapeutic serum levels. Recently, an extended release formulation of divalproex sodium (divalproex ER) was approved for treatment of migraine headaches. This formulation may be a useful treatment option for patients with acute mania. Method: A retrospective review of medical records was conducted on 14 inpatients with acute mania whose treatment included initiation of divalproex ER at a dose of 30 mg kg À1 day À1 in a single dose. Doses, serum levels and side effects associated with this treatment were recorded from the medical records of these patients. Results: The average dose of divalproex ER was 2034 mg day À1 (range, 1500-3000 mg day À1 ). Two of the 14 patients (14%) had documented side effects, none of which were severe. The average level obtained on day 3 after initiation of divalproex ER treatment was 93.2 Ag ml À1 (range, 47-136 Ag ml À1 ), and in all but three patients valproate levels at this time point were within the therapeutic range of 50 -125 Ag ml À1 . In no case was divalproex ER discontinued due to a perceived lack of efficacy. Conclusion: The results suggest that divalproex ER can be safely administered by oral loading in inpatients with acute mania and that using a standard loading protocol can result in therapeutic serum levels in most patients in 3 days or less. D

Research paper thumbnail of M1778 Characteristics and Impact of Methamphetamine Use in Patients with Chronic Hepatitis C

Gastroenterology, 2009

Methamphetamine (Me) use has increased in the US in the last 20 years and is a risk factor for he... more Methamphetamine (Me) use has increased in the US in the last 20 years and is a risk factor for hepatitis C (HCV). The US is second to Asia/Pacific Islands in the population percentage of amphetamine users, with an estimated 3.7 million current users in North America (UN World Drug Report 2008). No data exists regarding the potential impact of Me addiction or dependence on HCV patients in terms of compliance with HCV evaluation and treatment. The purpose of this study was to determine the characteristics and HCV-related outcomes of patients with Me dependence. Methods: Subjects consisted of newly entered patients in the VA HCV registry, a record of all HCV cases in the local VA system identified daily by new HCV antibody positivity or ICD9 diagnosis, from 1/1/04 to 6/30/04. Medical records were reviewed, and outcomes recorded included demographics, severity of substance use, psychiatric conditions, SUD treatment, HCV clinic attendance, and antiviral treatment outcomes through 2008. Results: 201 cases were entered into the local VA HCV registry. Of these, 28 were excluded based on severe illness or severe ESLD, leaving 173 new patients for analysis. Of the 173 patients, 34% had a history of Me use. One third of Me patients had documented active Me use at initial contact. Me patients were younger (mean 46.4 yrs) with fewer minority (34%) compared with non-Me patients (mean 53.4 yrs and 40% minority). Me users were 4 times more likely to be current or past marijuana users compared with non-Me patient (p<0.0001). 90% of the 173 patients had a history of alcohol (ETOH) use with 52% reporting active abuse. Multivariate analyses indicated that Me use did not adversely affect referral, evaluation, or treatment rates compared with patients without Me use and patients with prior ETOH abuse. Active ETOH users had lower treatment initiation and success rates compared with Me groups. Patients actively using illicit drugs were 66% less likely to attend a liver biopsy (p=0.015). Conclusions: Me use is common in recent US veterans diagnosed with hepatitis C and occurs in younger patients with frequent concomitant marijuana use. Prior history or recent/active Me use alone does not appear to adversely affect overall HCV clinic referral, testing, evaluation, or treatment compared with new HCV patients without Me use and patients with prior ETOH abuse. Although, overall rates of treatment initiation are low in all groups at 17-20% and tended to be lowest in patients with active ETOH abuse (12%). These data indicate that facilitated access to SUD treatment in HCV clinics may be of benefit for multiple SUD issues to increase HCV treatment rates.(VA HSR&D grant IIR 07-101-3)

Research paper thumbnail of Acute Ethanol Effects on Brain Activation in Low- and High-Level Responders to Alcohol

Alcoholism: Clinical and Experimental Research, 2000

Background: A low level of response (LR) to alcohol is an important endophenotype associated with... more Background: A low level of response (LR) to alcohol is an important endophenotype associated with an increased risk of alcoholism. However, little is known about how neural functioning may differ between individuals with low and high LRs to alcohol. This study examined whether LR group effects on neural activity varied as a function of acute alcohol consumption.

Research paper thumbnail of Associations of Variations in Alcohol Dehydrogenase Genes With the Level of Response to Alcohol in Non-Asians

Alcoholism: Clinical and Experimental Research, 2006

Background: Risk and protective factors for alcohol use disorders (AUDs) are complex and reflect ... more Background: Risk and protective factors for alcohol use disorders (AUDs) are complex and reflect both environmental and genetic factors. Genetic components account for about 50% of the variation and influence several phenotypes, including the level of response (LR) to alcohol as well as alcohol-metabolizing enzyme polymorphisms. Variations in the ADH1B and ADH1C genes may influence the LR to alcohol by increasing levels of acetaldehyde during alcohol metabolism, although most data on this question come from Asian populations.

Research paper thumbnail of Alcohol Attenuates Activation in the Bilateral Anterior Insula during an Emotional Processing Task: A Pilot Study

Alcohol and Alcoholism, 2011

Aims: Alcohol acutely reduces agitation and is widely used in social situations, but the neural s... more Aims: Alcohol acutely reduces agitation and is widely used in social situations, but the neural substrates of emotion processing during its intoxication are not well understood. We examine whether alcohol's social stress dampening effect may be via reduced activity in the cortical systems that subserve awareness of bodily sensations, and are associated with affective distress. Methods: Blood oxygen level-dependent activation was measured through 24 functional magnetic resonance imaging sessions in 12 healthy volunteers during an emotional face-processing task following ingestion of a moderate dose of alcohol and a placebo beverage. Results: Results revealed that bilateral anterior insula response to emotional faces was significantly attenuated following consumption of alcohol, when compared with placebo (clusters >1472 μl; corrected P < 0.05). Conclusion: Attenuated response in the anterior insula after alcohol intake may explain some of the decreased interoceptive awareness described during intoxication.

Research paper thumbnail of Predictors of Treatment Retention for Substance-Dependent Adults with Co-occurring Depression

The American Journal on Addictions, 2011

Low attendance in addiction treatment, particularly in cases of comorbidity, has been identified ... more Low attendance in addiction treatment, particularly in cases of comorbidity, has been identified as a pervasive challenge. We examine predictors of treatment retention in a sample of veterans (N = 253) participating in a clinical trial comparing two types of psychotherapy for co-occurring depression and substance use disorders. The study protocol included 24 weeks of outpatient group psychotherapy in either a newly developed Integrated Cognitive Behavioral Therapy (ICBT) or Twelve-Step Facilitation Therapy (TSF). Using a model of treatment utilization developed by Aday and Anderson, we analyzed predictors categorized into predisposing factors, enabling resources, need for treatment, and type of treatment received. Outcome included total number of sessions attended (maximum of 36 sessions). Treatment retention did not differ between the two study interventions. Bivariate analyses indicated that predisposing factors were most predictive, with older participants, Caucasians, and those using only alcohol in the month before treatment attending more sessions, and individuals who had recently experienced a health event remained in treatment longer. Importantly, several factors were not related to treatment retention: marital status, education, neuropsychological functioning, financial stress, chronic health problems, treatment motivation, and psychiatric severity. In the combined model of predisposing, enabling and need factors, age and ethnicity were the only significant predictors.

Research paper thumbnail of Integrated Care Increases Treatment and Improves Outcomes of Patients with Chronic HCV Infection and Psychiatric Illness or Substance Abuse

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, Jan 24, 2015

Patients with hepatitis C virus (HCV) infection with psychiatric disorders and/or substance abuse... more Patients with hepatitis C virus (HCV) infection with psychiatric disorders and/or substance abuse face significant barriers to antiviral treatment. New strategies might be needed to improve treatment rates and outcomes. We investigated whether an integrated care (IC) protocol, which includes multi-disciplinary care coordination and patient case management, could increase the proportion of patients with chronic HCV infection who receive antiviral treatment (a combination of interferon-based and direct acting antiviral agents) and achieve a sustained virologic response (SVR). We performed a prospective, randomized trial at 3 medical centers in the US. Participants (n=363 patients attending HCV clinics) had been screened and tested positive for depression, post-traumatic stress disorder, and/or substance use; they were randomly assigned (1:1) to groups that received IC or usual care (controls) from March 2009 through February 2011. A mid-level mental health practitioner was placed in e...

Research paper thumbnail of Randomized Placebo-Controlled Trial of a Selective Serotonin Reuptake Inhibitor In the Treatment of Nondepressed Tinnitus Subjects

Psychosomatic …, Jan 1, 2005

To assess the efficacy of a selective serotonin reuptake inhibitor (paroxetine) for relief of tin... more To assess the efficacy of a selective serotonin reuptake inhibitor (paroxetine) for relief of tinnitus. One hundred twenty tinnitus sufferers participated in a randomized double-blind placebo-controlled trial. Paroxetine or placebo was increased to a maximally tolerated dose (up to 50 mg/day), and patients were treated for a total of 31 days at the maximal dose. Patients with chronic tinnitus were recruited from our university-based specialty clinic by referral from otolaryngologists and audiologists in the local community and by advertisement. Patients with psychotic or substance use disorders or suicidal ideation were excluded, as were those using psychoactive medications (this resulted in only 1 subject with major depression in the study) or any other medications that interact with paroxetine and those with inability to hear at one&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s tinnitus sensation level. Fifty-eight percent of patients were male, 92% were Caucasian, and the average age was 57. Tinnitus matching, the Tinnitus Handicap Questionnaire, the question: How severe (bothered, aggravating) is your tinnitus? Quality of Well-Being and other psychological questionnaires. Paroxetine was not statistically superior to placebo on the following tinnitus measures (tinnitus matching, 5- or 10-db drop, Tinnitus Handicap Questionnaire, quality of well-being measures, how severe, how bothered, positive change). There was a significant improvement in the single item question, How aggravating is your tinnitus? for those in the paroxetine group compared with the placebo group. These results suggest that the majority of individuals in this study did not benefit from paroxetine in a consistent fashion. Further work remains to be done to determine if subgroups of patients (e.g., those who tolerate higher doses, those who are depressed) may benefit.

Research paper thumbnail of Acute Ethanol Effects on Brain Activation in Low- and High-Level Responders to Alcohol: Acute Ethanol Effects on Brain Activation

Alcoholism Clinical and Experimental Research, Jul 1, 2010

Background: A low level of response (LR) to alcohol is an important endophenotype associated with... more Background: A low level of response (LR) to alcohol is an important endophenotype associated with an increased risk of alcoholism. However, little is known about how neural functioning may differ between individuals with low and high LRs to alcohol. This study examined whether LR group effects on neural activity varied as a function of acute alcohol consumption.

Research paper thumbnail of Integrated Care Increases Treatment and Improves Outcomes of Patients with Chronic HCV Infection and Psychiatric Illness or Substance Abuse

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, Jan 24, 2015

Patients with hepatitis C virus (HCV) infection with psychiatric disorders and/or substance abuse... more Patients with hepatitis C virus (HCV) infection with psychiatric disorders and/or substance abuse face significant barriers to antiviral treatment. New strategies might be needed to improve treatment rates and outcomes. We investigated whether an integrated care (IC) protocol, which includes multi-disciplinary care coordination and patient case management, could increase the proportion of patients with chronic HCV infection who receive antiviral treatment (a combination of interferon-based and direct acting antiviral agents) and achieve a sustained virologic response (SVR). We performed a prospective, randomized trial at 3 medical centers in the US. Participants (n=363 patients attending HCV clinics) had been screened and tested positive for depression, post-traumatic stress disorder, and/or substance use; they were randomly assigned (1:1) to groups that received IC or usual care (controls) from March 2009 through February 2011. A mid-level mental health practitioner was placed in e...

Research paper thumbnail of Management of Chronic Hepatitis C in Veterans: The Potential of Integrated Care Models

The American Journal of Gastroenterology, 2008

The prevalence of hepatitis C virus (HCV) infection is higher among veterans than nonveterans, bu... more The prevalence of hepatitis C virus (HCV) infection is higher among veterans than nonveterans, but only about 14% of all identified infected veterans have ever received antiviral therapy. High rates of comorbid psychiatric and substance use disorders are major barriers to receiving antiviral treatment for veterans, and characteristics associated with poor virologic response are more common in this population. However, accumulating evidence indicates that patients with psychiatric and substance use disorders can successfully receive interferon-based antiviral therapies in an integrated or multidisciplinary health-care setting. The broad aims of integrated care models include reducing fragmentation and improving continuity and coordination of care. Although, to date, there are no randomized controlled trials of specific care models for patients with HCV, studies of integrated care for other chronic diseases suggest several strategies for optimizing outcomes for patients with HCV. Components of an HCV clinic incorporating these principles have been tested in a nonrandomized setting and include routine screening of all patients for psychiatric and substance use disorder risk factors, collaboration with mental health providers within the HCV clinic, following a defined integrated medical/psychiatric clinical protocol, provision of ongoing integrated support during antiviral treatment or retreatment, and educating patients on principles of chronic disease self-management.

Research paper thumbnail of Primary outcomes of a multisite randomized trial of an integrated care model for HCV patients

Research paper thumbnail of Integrated Substance Use Disorder and PTSD Treatment in A VA Substance Abuse Residential Rehabilitation Treatment Program (SARRTP)

Research paper thumbnail of Review of biological mechanisms and pharmacological treatments of comorbid PTSD and substance use disorder

Neuropharmacology, 2012

Posttraumatic stress disorder (PTSD) and alcohol/substance use disorder (A/SUD) are frequently co... more Posttraumatic stress disorder (PTSD) and alcohol/substance use disorder (A/SUD) are frequently comorbid. Comorbidity is associated with poorer psychological, functional, and treatment outcomes than either disorder alone. This review outlines biological mechanisms that are potentially involved in the development and maintenance of comorbid PTSD and A/SUD including neurotransmitter and hypothalamic-pituitary-adrenal dysregulation, structural differences in the brain, and shared genetic risk factors. The literature regarding pharmacological treatments that have been investigated for comorbid PTSD and A/SUD is also reviewed. Empirical data for each proposed mechanism and pharmacological approach is reviewed with the goal of making recommendations for future research.

Research paper thumbnail of Psychiatric Comorbidity Does Not Predict Interferon Treatment Completion Rates in Hepatitis C Seropositive Veterans

Journal of Clinical Gastroenterology, 2007

Goals: The aim of this study was to evaluate the impact of common psychiatric disorders on treatm... more Goals: The aim of this study was to evaluate the impact of common psychiatric disorders on treatment completion of antiviral therapy prescribed to a series of hepatitis C virus (HCV) positive US veterans.

Research paper thumbnail of Characteristics and Impact of Methamphetamine Use in Patients With Chronic Hepatitis C

Journal of Addiction Medicine, 2014

Methamphetamine (MA) use has increased in the United States in the last 20 years and is a risk fa... more Methamphetamine (MA) use has increased in the United States in the last 20 years and is a risk factor for hepatitis C virus(HCV) infection. The purpose of this study was to determine the characteristics and HCV infection outcomes of patients with a history of MA use. Subjects consisted of newly entered patients in the Veterans Affairs (VA) HCV registry at a single VA medical center from January 1, 2004, to June 30, 2004, and from January 1, 2007, to June 30, 2007. Univariate and multivariate analyses related to HCV infection antiviral treatment outcomes through 2010 was performed. A total of 198 consecutive eligible HCV registry patients were analyzed, and 40% had a history of MA use. Of patients with MA use history, 46% (36/79) had active use (within 6 months) at initial contact. Active MA users were significantly younger (mean age, 45.5 years), with more concomitant drug use (86%), compared with patients without MA use (mean age, 53.5 years; 42% minority; 29% other drug use). Overall, 71% of the 198 patients reported a history of problematic alcohol use, and 47% of those reported active abuse. Logistic regression analyses indicated that MA use did not significantly adversely affect antiviral treatment initiation, completion, or sustained virological response rates compared with that in patients without MA use. Active alcohol users had lower treatment initiation than patients without alcohol use. MA use is common in recent US veterans with HCV infection and occurs in younger patients with polysubstance use. Prior history or active MA use does not seem to adversely affect HCV infection clinic treatment compared with that in HCV-infected patients without MA use.

Research paper thumbnail of Rapid oral loading of extended release divalproex in patients with acute mania

General Hospital Psychiatry, 2005

Background: Oral loading with the delayed release formulation of divalproex sodium is widely used... more Background: Oral loading with the delayed release formulation of divalproex sodium is widely used for the treatment of patients with acute mania and produces rapid attainment of therapeutic serum levels. Recently, an extended release formulation of divalproex sodium (divalproex ER) was approved for treatment of migraine headaches. This formulation may be a useful treatment option for patients with acute mania. Method: A retrospective review of medical records was conducted on 14 inpatients with acute mania whose treatment included initiation of divalproex ER at a dose of 30 mg kg À1 day À1 in a single dose. Doses, serum levels and side effects associated with this treatment were recorded from the medical records of these patients. Results: The average dose of divalproex ER was 2034 mg day À1 (range, 1500-3000 mg day À1 ). Two of the 14 patients (14%) had documented side effects, none of which were severe. The average level obtained on day 3 after initiation of divalproex ER treatment was 93.2 Ag ml À1 (range, 47-136 Ag ml À1 ), and in all but three patients valproate levels at this time point were within the therapeutic range of 50 -125 Ag ml À1 . In no case was divalproex ER discontinued due to a perceived lack of efficacy. Conclusion: The results suggest that divalproex ER can be safely administered by oral loading in inpatients with acute mania and that using a standard loading protocol can result in therapeutic serum levels in most patients in 3 days or less. D

Research paper thumbnail of M1778 Characteristics and Impact of Methamphetamine Use in Patients with Chronic Hepatitis C

Gastroenterology, 2009

Methamphetamine (Me) use has increased in the US in the last 20 years and is a risk factor for he... more Methamphetamine (Me) use has increased in the US in the last 20 years and is a risk factor for hepatitis C (HCV). The US is second to Asia/Pacific Islands in the population percentage of amphetamine users, with an estimated 3.7 million current users in North America (UN World Drug Report 2008). No data exists regarding the potential impact of Me addiction or dependence on HCV patients in terms of compliance with HCV evaluation and treatment. The purpose of this study was to determine the characteristics and HCV-related outcomes of patients with Me dependence. Methods: Subjects consisted of newly entered patients in the VA HCV registry, a record of all HCV cases in the local VA system identified daily by new HCV antibody positivity or ICD9 diagnosis, from 1/1/04 to 6/30/04. Medical records were reviewed, and outcomes recorded included demographics, severity of substance use, psychiatric conditions, SUD treatment, HCV clinic attendance, and antiviral treatment outcomes through 2008. Results: 201 cases were entered into the local VA HCV registry. Of these, 28 were excluded based on severe illness or severe ESLD, leaving 173 new patients for analysis. Of the 173 patients, 34% had a history of Me use. One third of Me patients had documented active Me use at initial contact. Me patients were younger (mean 46.4 yrs) with fewer minority (34%) compared with non-Me patients (mean 53.4 yrs and 40% minority). Me users were 4 times more likely to be current or past marijuana users compared with non-Me patient (p<0.0001). 90% of the 173 patients had a history of alcohol (ETOH) use with 52% reporting active abuse. Multivariate analyses indicated that Me use did not adversely affect referral, evaluation, or treatment rates compared with patients without Me use and patients with prior ETOH abuse. Active ETOH users had lower treatment initiation and success rates compared with Me groups. Patients actively using illicit drugs were 66% less likely to attend a liver biopsy (p=0.015). Conclusions: Me use is common in recent US veterans diagnosed with hepatitis C and occurs in younger patients with frequent concomitant marijuana use. Prior history or recent/active Me use alone does not appear to adversely affect overall HCV clinic referral, testing, evaluation, or treatment compared with new HCV patients without Me use and patients with prior ETOH abuse. Although, overall rates of treatment initiation are low in all groups at 17-20% and tended to be lowest in patients with active ETOH abuse (12%). These data indicate that facilitated access to SUD treatment in HCV clinics may be of benefit for multiple SUD issues to increase HCV treatment rates.(VA HSR&D grant IIR 07-101-3)

Research paper thumbnail of Acute Ethanol Effects on Brain Activation in Low- and High-Level Responders to Alcohol

Alcoholism: Clinical and Experimental Research, 2000

Background: A low level of response (LR) to alcohol is an important endophenotype associated with... more Background: A low level of response (LR) to alcohol is an important endophenotype associated with an increased risk of alcoholism. However, little is known about how neural functioning may differ between individuals with low and high LRs to alcohol. This study examined whether LR group effects on neural activity varied as a function of acute alcohol consumption.

Research paper thumbnail of Associations of Variations in Alcohol Dehydrogenase Genes With the Level of Response to Alcohol in Non-Asians

Alcoholism: Clinical and Experimental Research, 2006

Background: Risk and protective factors for alcohol use disorders (AUDs) are complex and reflect ... more Background: Risk and protective factors for alcohol use disorders (AUDs) are complex and reflect both environmental and genetic factors. Genetic components account for about 50% of the variation and influence several phenotypes, including the level of response (LR) to alcohol as well as alcohol-metabolizing enzyme polymorphisms. Variations in the ADH1B and ADH1C genes may influence the LR to alcohol by increasing levels of acetaldehyde during alcohol metabolism, although most data on this question come from Asian populations.

Research paper thumbnail of Alcohol Attenuates Activation in the Bilateral Anterior Insula during an Emotional Processing Task: A Pilot Study

Alcohol and Alcoholism, 2011

Aims: Alcohol acutely reduces agitation and is widely used in social situations, but the neural s... more Aims: Alcohol acutely reduces agitation and is widely used in social situations, but the neural substrates of emotion processing during its intoxication are not well understood. We examine whether alcohol's social stress dampening effect may be via reduced activity in the cortical systems that subserve awareness of bodily sensations, and are associated with affective distress. Methods: Blood oxygen level-dependent activation was measured through 24 functional magnetic resonance imaging sessions in 12 healthy volunteers during an emotional face-processing task following ingestion of a moderate dose of alcohol and a placebo beverage. Results: Results revealed that bilateral anterior insula response to emotional faces was significantly attenuated following consumption of alcohol, when compared with placebo (clusters >1472 μl; corrected P < 0.05). Conclusion: Attenuated response in the anterior insula after alcohol intake may explain some of the decreased interoceptive awareness described during intoxication.

Research paper thumbnail of Predictors of Treatment Retention for Substance-Dependent Adults with Co-occurring Depression

The American Journal on Addictions, 2011

Low attendance in addiction treatment, particularly in cases of comorbidity, has been identified ... more Low attendance in addiction treatment, particularly in cases of comorbidity, has been identified as a pervasive challenge. We examine predictors of treatment retention in a sample of veterans (N = 253) participating in a clinical trial comparing two types of psychotherapy for co-occurring depression and substance use disorders. The study protocol included 24 weeks of outpatient group psychotherapy in either a newly developed Integrated Cognitive Behavioral Therapy (ICBT) or Twelve-Step Facilitation Therapy (TSF). Using a model of treatment utilization developed by Aday and Anderson, we analyzed predictors categorized into predisposing factors, enabling resources, need for treatment, and type of treatment received. Outcome included total number of sessions attended (maximum of 36 sessions). Treatment retention did not differ between the two study interventions. Bivariate analyses indicated that predisposing factors were most predictive, with older participants, Caucasians, and those using only alcohol in the month before treatment attending more sessions, and individuals who had recently experienced a health event remained in treatment longer. Importantly, several factors were not related to treatment retention: marital status, education, neuropsychological functioning, financial stress, chronic health problems, treatment motivation, and psychiatric severity. In the combined model of predisposing, enabling and need factors, age and ethnicity were the only significant predictors.