Michael Vergare | Thomas Jefferson University (original) (raw)
Papers by Michael Vergare
Academic Psychiatry, 2012
Health Services (MHS) Committee of the Group for the Advancement of Psychiatry (GAP) used APA dat... more Health Services (MHS) Committee of the Group for the Advancement of Psychiatry (GAP) used APA data to demonstrate that early and mid-career psychiatrists now work more hours in organizational settings than in private practice (1). The article concluded that, as a result, psychiatric residency programs need to provide more comprehensive training in systems-based practices (SBP), one of the six core competencies required by the Accreditation Council of General Medical Education (ACGME). The ACGME describes SBP as an "awareness of and responsiveness to the larger context and system of healthcare, as well as the ability to call effectively on other resources in the system to provide optimal healthcare" (2, 3).
Addictive Disorders & Their Treatment, 2003
ABSTRACT We investigated whether pretreatment measures of sensation seeking, impulsivity, and agg... more ABSTRACT We investigated whether pretreatment measures of sensation seeking, impulsivity, and aggression were related to severity of cocaine use. Assessments of sensation seeking (SSS), impulsivity (BIS), and aggression (BDHI) were obtained for 140 African-American cocaine-dependent individuals entering outpatient treatment. We explored whether these variables were associated with addiction severity measures including quantity, frequency, and duration of cocaine use, scores on the Addiction Severity Index (ASI), and the admission urine drug screen status. A significant positive association was found between the total BDHI score and duration and frequency of cocaine use. Furthermore, SSS scores showed a significant positive correlation with frequency of cocaine use and cocaine positive admission urines. The BIS scores were significantly associated with 2 of the 7 ASI scales. Multiple regression analyses showed that the 3 measures contributed significantly toward predicting severity of cocaine use, but the contribution to the overall variance was modest. Measures of aggression and sensation seeking seem to be of clinical value in the assessment of cocaine abusers. However, these measures may need to be combined with other clinical and behavioral variables to accurately predict the severity of cocaine use. Several lines of evidence support an association between traits of aggression, sensation seeking, and impulsivity, and substance abuse. First, high rates of substance abuse have been reported in clinical disorders such as bipolar disorders 1 and antisocial personality disorders 2 that are characterized by aggression and impulsivity. Lifetime prevalence rates of substance abuse have been reported to be over 90% among selected populations such as impulsive offenders. 3 Second, substance abusers have been found to exhibit significantly increased rates of impulse control disorders and violent behaviors compared with controls. 4-6 Third, studies employing psychometric assessments have found that cocaine abusers scored higher on measures of aggression and impulsivity compared with controls. 7,8 Fourth, childhood disorders associated with aggression and impulsivity such as conduct disorders and attention deficit disorders are consistently related to development of substance abuse in adolescence and adulthood. 9,10 It has been suggested that aggressive and impulsive individuals frequently experience negative emotional states such as irritability, anxiety, and dysphoria, and that substance use may be an attempt to alleviate the internal negative emotions. 11 Biologic studies also tend to support a link between aggression, impulsivity, and cocaine use. Cocaine has potent effects on cortical and subcortical dopamine systems that mediate initiation and control of behavior. 12 Chronic cocaine use has also been reported to impair serotonergic activity 13,14; serotonergic deficits have been linked to aggressive and impulsive behaviors. 15,16 These traits seem to be clinically important. Increased levels of aggression and impulsivity have been found to predict reduced retention and abstinence for cocaine abusers in treatment. 17,18 More disturbingly, self-destructive behavior, in particular violent suicide attempts, seem to be related to impulsive and aggressive traits among substance abusing patients. 16 Over the past decade, studies have examined several variables that may be associated with severity of drug use among cocaine abusers. Severity of cocaine use has been found to be related to demographic factors such as age and employment status, 19,20 anxiety and depressive symptoms, 20,21 polysubstance use, 22 antisocial personality, 23 and social stress. 24,25 Recent studies have also implicated biologic, possibly genetic factors, in determining severity of cocaine use. 26 Surprisingly, few studies have specifically studied the relationship between traits of aggression, sensation seeking, and impulsivity, and cocaine use, and the data is not consistent. In a study of 50 cocaine outpatients, Moeller et al 17 found that impulsivity was significantly correlated with severity of self-reported cocaine use and severity of cocaine withdrawal. Similarly, measures of aggression have been reported to be associated with substance abuse. 5 In contrast, Kasabrada et al 27 found no significant consistent relationship between sensation seeking and severity of cocaine use. Consistent with the literature, we had previously found that cocaine-dependent patients exhibit higher levels of aggression, sensation seeking, and impulsivity compared with controls. 28 The objective of this study was to examine whether measures of aggression, sensation seeking, and impulsivity are related to severity of cocaine use.
Psychopharmacology, 2003
The serotonin transporter (5HTT) regulates the magnitude and duration of serotonergic neurotransm... more The serotonin transporter (5HTT) regulates the magnitude and duration of serotonergic neurotransmission. Although nicotine and other constituents of tobacco smoke may influence serotonin turnover among animals, few studies have examined whether smoking is associated with alteration in 5HTT in humans. We investigated whether tobacco smokers and non-smokers differed in platelet tritiated paroxetine binding, a measure of 5HTT sites, and whether severity of nicotine dependence (ND) was related to 5HTT measures. Tritiated paroxetine binding sites on platelets were assayed in 26 African-American smokers and 30 non-smokers. Severity of smoking was assessed using the Fagerstrom Test for Nicotine Dependence (FTND). Relationships between FTND scores and maximum number of transporter sites (B(max)) and affinity constant (K(d)) of paroxetine binding were determined. B(max) values showed a significant negative correlation with FTND scores (rho=-0.28, P<0.01). Notably, smokers with higher ND h...
Community mental health journal, 1987
New Directions for Mental Health Services, 1986
During the 198Os, interest in studying the origins and nature of homelessness has grown. However,... more During the 198Os, interest in studying the origins and nature of homelessness has grown. However, homelessness is not a new problem, nor is research exploring its social and psychological roots. In nineteenth-century England, workhouses were established based on the notion that characterological defects, such as moral weakness or laziness, were responsible for vagrancy. In the United States the economic depression at the turn of the century brought with it a major increase in the numbers of unemployed immigrants and uprooted persons who congregated in sections of large metropolitan areas that later became known as skid rows. These were communities of primarily destitute, impoverished men whose daily lives centered on the sharing of alcohol and the search for a night's lodging.
Nicotine & Tobacco Research, 2003
Despite a close association between tobacco and cocaine use, few studies have systematically exam... more Despite a close association between tobacco and cocaine use, few studies have systematically examined whether smoking predicts an adverse outcome for cocaine-dependent patients. We investigated whether severity of nicotine dependence was related to treatment outcome for cocaine-dependent individuals. Standardized assessments of nicotine dependence (Fagerström Test for Nicotine Dependence; FTND), cocaine use, and personality were obtained for 105 African American cocaine-dependent outpatients. Outcome measures included negative urine drug screens, days in treatment, dropout, and number of treatment sessions attended. The sample was stratified into cocaine-positive and cocaine-negative groups based on admission urine drug screens, and relationships between nicotine dependence and outcome measures were examined in each group. In the cocaine-negative group, higher FTND scores were negatively correlated with number of negative urine drug screens during treatment even after controlling for other predictors, whereas FTND scores were not correlated to outcome in the cocaine-positive group. It seems that severity of tobacco use predicts poor outcome for cocaine-dependent patients who are cocaine free at the time of admission into outpatient treatment.
International Journal of Medical Education, 2015
Objectives: This study was designed to explore the underlying construct of measures of empathy, o... more Objectives: This study was designed to explore the underlying construct of measures of empathy, optimism, and burnout in medical students. Methods: Three instruments for measuring empathy (Jefferson Scale of Empathy, JSE); Optimism (the Life Orientation Test-Revised, LOT-R); and burnout (the Maslach Burnout Inventory, MBI, which includes three scales of Emotional Exhaustion, Depersonalization, and Personal Accomplishment) were administered to 265 thirdyear students at Sidney Kimmel (formerly Jefferson) Medical College at Thomas Jefferson University. Data were subjected to factor analysis to examine relationships among measures of empathy, optimism, and burnout in a multivariate statistical model. Results: Factor analysis (principal component with oblique rotation) resulted in two underlying constructs, each with an eigenvalue greater than one. The first factor involved "positive personality attributes" (factor coefficients greater than .58 for measures of empathy, optimism, and personal accomplishment). The second factor involved "negative personality attributes" (factor coefficients greater than .78 for measures of emotional exhaustion, and depersonalization). Conclusions: Results confirmed that an association exists between empathy in the context of patient care and personality characteristics that are conducive to relationship building, and considered to be "positive personality attributes," as opposed to personality characteristics that are considered as "negative personality attributes" that are detrimental to interpersonal relationships. Implications for the professional development of physicians-in-training and in-practice are discussed.
Psychiatry-interpersonal and Biological Processes, 2003
Tobacco smoking is the most important preventable cause of death and disease. Despite an increase... more Tobacco smoking is the most important preventable cause of death and disease. Despite an increased awareness of the addictive nature of smoking and availability of effective treatments, smoking continues to be widespread among individuals with psychiatric disorders. Moreover, mental health professionals remain reluctant to address smoking among their patients for a variety of reasons. Recent research has provided a wealth of data that have shaped the concept of tobacco smoking as a chronic addictive disorder and also demonstrated the efficacy of smoking cessation interventions. This paper reviews the important factors that contribute to smoking and the various pharmacological and psychosocial interventions for smoking cessation from a biopsychosocial perspective. It also makes recommendations for the rational use of these interventions to treat nicotine dependence in individuals with psychiatric disorders.
Psychiatric Genetics, 2004
Alterations in the serotonin transporter (5-HTT) have been implicated in a variety of psychiatric... more Alterations in the serotonin transporter (5-HTT) have been implicated in a variety of psychiatric disorders including cocaine dependence. A polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) appears to influence the expression of 5-HTT in human cell lines. We investigated whether 5-HTTLPR variants were related to differences in measures of platelet 5-HTT sites in cocaine-dependent patients and healthy volunteers (controls). Polymerase chain reaction-based genotyping of a 44 base pair insertion/deletion polymorphism in 5-HTTLPR was performed in 138 cocaine-dependent African-American subjects and 60 African-American controls. This yielded a short (S) and a long (L) allele. Platelet 5-HTT sites were measured using the tritiated paroxetine binding assay. Relationships of 5-HTTLPR genotypes with Bmax (density of serotonin transporter) and Kd (affinity constant) were examined. Bmax values were significantly lower in cocaine-dependent patients (640 +/- 233) than controls (906 +/- 225) (P &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;lt; 0.001); however, 5-HTTLPR genotype distributions or allele frequencies did not differ between the two groups. There were no significant differences in Bmax between the three genotypes among cocaine-dependent patients (LL = 690 +/- 246, LS = 620 +/- 235, SS = 587 +/- 183; P = 0.14) or controls (LL = 909 +/- 233, LS = 938 +/- 279, SS = 866 +/- 143; P = 0.65). All three genotypes in cocaine-dependent patients showed comparable reductions in Bmax from the corresponding genotypes in controls. Demographic variables, severity of substance use or depression were unrelated to Bmax or 5-HTTLPR genotypes. Although platelet 5-HTT densities are reduced in patients with cocaine dependence compared with healthy volunteers, these genotypic variations in the serotonin transporter do not seem to influence levels of platelet 5-HTT in cocaine-dependent patients or healthy volunteers.
Psychopharmacology, 2004
Rationale: Alteration in serum prolactin (PRL) levels may reflect changes in central dopamine act... more Rationale: Alteration in serum prolactin (PRL) levels may reflect changes in central dopamine activity, which modulates the behavioral effects of cocaine. Therefore, serum PRL may have a potential role as a biological marker of drug severity and treatment outcome in cocaine dependence. Objective: We investigated whether serum PRL levels differed between cocaine-dependent (CD) subjects and controls, and whether PRL levels were associated with severity of drug use and treatment outcome in CD subjects. Methods: Basal PRL concentrations were assayed in 141 African-American (AA) CD patients attending an outpatient treatment program and 60 AA controls. Severity of drug use was assessed using the Addiction Severity Index (ASI). Measures of abstinence and retention during 12 weeks of treatment and at 6-month follow-up were employed as outcome variables. Results: The basal PRL (ng/ml) in CD patients (9.28±4.13) was significantly higher than controls (7.33±2.94) (t=3.77, P<0.01). At baseline, PRL was positively correlated with ASI-drug (r=0.38, P<0.01), ASI-alcohol (r=0.19, P<0.05), and ASIpsychological (r=0.25, P<0.01) composite scores, and with the quantity of cocaine use (r=0.18, P<0.05). However, PRL levels were not significantly associated with number of negative urine screens, days in treatment, number of sessions attended, dropout rate or changes in ASI scores during treatment and at follow-up. Also, basal PRL did not significantly contribute toward the variance in predicting any of the outcome measures. Conclusion: Although cocaine use seems to influence PRL levels, it does not appear that PRL is a predictor of treatment outcome in cocaine dependence.
Psychiatric Services, 2007
Recovery has emerged over the past decade as a dominant theme in public mental health care. The 2... more Recovery has emerged over the past decade as a dominant theme in public mental health care. The 2006 Pennsylvania Consensus Conference brought together 24 community psychiatrists to explore the barriers they experienced in promoting recovery and their recommendations for change. Twelve barriers were identified and classified into one of three categories: psychiatry knowledge, roles, and training; the need to transform public mental health systems and services; and environmental barriers to opportunity. Participants made 22 recommendations to address these barriers through changes in policies, programs, and psychiatric knowledge and practice. The recommendations identify areas for change that can be accomplished through individual psychiatrist action and organized group efforts.
Nicotine & Tobacco Research, 2003
Despite a close association between tobacco and cocaine use, few studies have systematically exam... more Despite a close association between tobacco and cocaine use, few studies have systematically examined whether smoking predicts an adverse outcome for cocaine-dependent patients. We investigated whether severity of nicotine dependence was related to treatment outcome for cocaine-dependent individuals. Standardized assessments of nicotine dependence (Fagerström Test for Nicotine Dependence; FTND), cocaine use, and personality were obtained for 105 African American cocaine-dependent outpatients. Outcome measures included negative urine drug screens, days in treatment, dropout, and number of treatment sessions attended. The sample was stratified into cocaine-positive and cocaine-negative groups based on admission urine drug screens, and relationships between nicotine dependence and outcome measures were examined in each group. In the cocaine-negative group, higher FTND scores were negatively correlated with number of negative urine drug screens during treatment even after controlling for other predictors, whereas FTND scores were not correlated to outcome in the cocaine-positive group. It seems that severity of tobacco use predicts poor outcome for cocaine-dependent patients who are cocaine free at the time of admission into outpatient treatment.
Journal of the American College of Cardiology, 2002
Journal of Addictive Diseases, 2004
We investigated whether measures of impulsivity, aggression and sensation seeking differed betwee... more We investigated whether measures of impulsivity, aggression and sensation seeking differed between cocaine-dependent subjects and controls, and whether these measures were related to treatment-outcome for cocaine patients. Pre-treatment assessments of impulsivity (Barratt Impulsivity Scale [BIS]), aggression (Buss-Durkee Hostility Inventory [BDHI]) and sensation seeking (Zuckerman Sensation Seeking Scale [SSS]) were obtained for 141 African-American cocaine-dependent patients entering a 12-week, intensive outpatient treatment program and 60 controls. The outcome measures were number of negative urine drug screens, days in treatment, dropout rates and number of treatment sessions. Cocaine patients reported significantly higher scores on the SSS, the BIS and the BDHI than controls. Furthermore, the SSS scores showed a significantly negative correlation with days in treatment and negative urines, and a significant positive correlation with the dropout rate. The BIS and the BDHI scores were significantly associated with days in treatment and dropout rates respectively. A combination of the three variables contributed significantly toward predicting retention and abstinence. Higher levels of pretreatment impulsivity and aggression and sensation seeking seem to associated with poor treatment outcome for cocaine dependent patients receiving intensive outpatient treatment. Combining these behavioral measures with other clinical predictors may help in early identification of &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;poor responders&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; who may benefit from additional or alternative treatment approaches.
Journal of Addictive Diseases, 2004
We investigated whether pretreatment characteristics and measures of outcome differed for alcohol... more We investigated whether pretreatment characteristics and measures of outcome differed for alcohol-, cocaine-, and multisubstance-dependent patients receiving outpatient substance abuse treatment. One hundred and forty substance dependent individuals (32 alcohol, 76 cocaine, and 32 multisubstance) enrolled in a 12-week outpatient treatment program were compared across measures of addiction severity, personality, and treatment-readiness at admission. In-treatment, end-of-treatment and 9-month follow-up assessments of treatment outcome were then compared across the three groups. Outcome measures included reduction in problem severity, abstinence, retention, number of sessions attended, dropout, and counselor and patient ratings of treatment benefit. At admission, the multisubstance group had a higher proportion of positive urines, reported more severe drug, alcohol and psychiatric problems, and displayed higher impulsivity and anxiety scores than one or both of the other groups. However, multisubstance patients were more treatment ready in terms of adopting a total abstinence orientation than alcohol or cocaine patients. While a significant reduction in symptoms occurred for the total sample during treatment as well as at follow-up, comparisons of outcomes did not consistently favor any particular group. The three groups had equivalent improvements in eleven of fourteen during-treatment and five of seven follow-up measures. Despite pretreatment differences, in severity and treatment-readiness, outcomes were more similar than different for alcohol-, cocaine-, and multisubstance-dependent patients. Clinicians should be cautious about forecasting treatment-outcomes for addicted patients based on their primary substances of abuse.
![Research paper thumbnail of Seasonal variations in the binding of [3H]paroxetine to the platelet serotonin transporter sites in African-American cocaine-dependent patients and healthy volunteers](https://attachments.academia-assets.com/44367728/thumbnails/1.jpg)
](Human Psychopharmacology: Clinical and Experimental, 2003
Academic Psychiatry, 2004
American Journal on Addictions, 2005
Despite the widespread use of tobacco and marijuana by cocaine abusers, it remains unclear whethe... more Despite the widespread use of tobacco and marijuana by cocaine abusers, it remains unclear whether combined tobacco and marijuana smoking is more harmful than tobacco smoking alone in cocaine abusers. We investigated the differences in medical symptoms reported among 34 crack cocaine abusers who did not smoke tobacco or marijuana (C), 86 crack cocaine abusers who also smoked tobacco (C + T), and 48 crack abusers who smoked both tobacco and marijuana (C + T + M). Medical symptoms were recorded using a 134-item self-report instrument (MILCOM), and drug use was assessed using the Addiction Severity Index (ASI). After controlling for clinical and demographic differences, the C + T + M group reported significantly more total symptoms on the MILCOM as well as on the respiratory, digestive, general, and nose/throat subscales than the C + T or C groups. The C + T group reported higher total and respiratory and nose/throat symptoms than the C group. HOwever, the C group had the highest number of mood symptoms among the three groups. The C + T and C + T + M groups were comparable in number of cigarettes smoked and ASI scores. Although tobacco smoking is associated with higher reports of medical problems in crack abusers, smoking both marijuana and tobacco seems to be associated with greater medical problems than smoking tobacco alone. Tobacco smoking was not related to changes in cocaine use. Also, marijuana smoking does not appear to be associated with a reduction in tobacco or cocaine use.
The American Journal of Drug and Alcohol Abuse, 2003
We studied whether pretreatment levels of learned helplessness (LH) were related to outcomes for ... more We studied whether pretreatment levels of learned helplessness (LH) were related to outcomes for substance-dependent individuals receiving high-structure, behaviorally oriented (HSB) or low-structure, facilitative (LSF) treatment. The subjects were 120 substance-dependent patients randomly assigned to the HSB or the LSF treatment style for up to 12 weeks of weekly individual counseling. The two groups were compared across pretreatment characteristics as well as in-treatment, end-of- treatment, and 9-month postadmission follow-up outcome measures. Outcomes reflected reduction in problem severity, abstinence, retention, dropout rate, and ratings of treatment benefit. Significant and comparable reductions in symptoms occurred for the HSB and LSF patients both during treatment and at follow-up. Comparisons of other outcomes also did not consistently favor either treatment style. However, significant and consistent interactions were observed between LH and treatment styles with respect to several outcome measures, and these effects were independent of pretreatment levels of depression, addiction severity, and readiness for treatment. Specifically, the more &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;amp;quot;helpless&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;amp;quot; patients did significantly better in HSB treatment, whereas the less &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;amp;quot;helpless&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;amp;quot; patients had better outcomes in LSF treatment. A matching approach that assigns patients to high- and low-structure treatments based on pretreatment levels of LH might improve treatment outcomes for substance-dependent patients.
Academic Psychiatry, 2012
Health Services (MHS) Committee of the Group for the Advancement of Psychiatry (GAP) used APA dat... more Health Services (MHS) Committee of the Group for the Advancement of Psychiatry (GAP) used APA data to demonstrate that early and mid-career psychiatrists now work more hours in organizational settings than in private practice (1). The article concluded that, as a result, psychiatric residency programs need to provide more comprehensive training in systems-based practices (SBP), one of the six core competencies required by the Accreditation Council of General Medical Education (ACGME). The ACGME describes SBP as an "awareness of and responsiveness to the larger context and system of healthcare, as well as the ability to call effectively on other resources in the system to provide optimal healthcare" (2, 3).
Addictive Disorders & Their Treatment, 2003
ABSTRACT We investigated whether pretreatment measures of sensation seeking, impulsivity, and agg... more ABSTRACT We investigated whether pretreatment measures of sensation seeking, impulsivity, and aggression were related to severity of cocaine use. Assessments of sensation seeking (SSS), impulsivity (BIS), and aggression (BDHI) were obtained for 140 African-American cocaine-dependent individuals entering outpatient treatment. We explored whether these variables were associated with addiction severity measures including quantity, frequency, and duration of cocaine use, scores on the Addiction Severity Index (ASI), and the admission urine drug screen status. A significant positive association was found between the total BDHI score and duration and frequency of cocaine use. Furthermore, SSS scores showed a significant positive correlation with frequency of cocaine use and cocaine positive admission urines. The BIS scores were significantly associated with 2 of the 7 ASI scales. Multiple regression analyses showed that the 3 measures contributed significantly toward predicting severity of cocaine use, but the contribution to the overall variance was modest. Measures of aggression and sensation seeking seem to be of clinical value in the assessment of cocaine abusers. However, these measures may need to be combined with other clinical and behavioral variables to accurately predict the severity of cocaine use. Several lines of evidence support an association between traits of aggression, sensation seeking, and impulsivity, and substance abuse. First, high rates of substance abuse have been reported in clinical disorders such as bipolar disorders 1 and antisocial personality disorders 2 that are characterized by aggression and impulsivity. Lifetime prevalence rates of substance abuse have been reported to be over 90% among selected populations such as impulsive offenders. 3 Second, substance abusers have been found to exhibit significantly increased rates of impulse control disorders and violent behaviors compared with controls. 4-6 Third, studies employing psychometric assessments have found that cocaine abusers scored higher on measures of aggression and impulsivity compared with controls. 7,8 Fourth, childhood disorders associated with aggression and impulsivity such as conduct disorders and attention deficit disorders are consistently related to development of substance abuse in adolescence and adulthood. 9,10 It has been suggested that aggressive and impulsive individuals frequently experience negative emotional states such as irritability, anxiety, and dysphoria, and that substance use may be an attempt to alleviate the internal negative emotions. 11 Biologic studies also tend to support a link between aggression, impulsivity, and cocaine use. Cocaine has potent effects on cortical and subcortical dopamine systems that mediate initiation and control of behavior. 12 Chronic cocaine use has also been reported to impair serotonergic activity 13,14; serotonergic deficits have been linked to aggressive and impulsive behaviors. 15,16 These traits seem to be clinically important. Increased levels of aggression and impulsivity have been found to predict reduced retention and abstinence for cocaine abusers in treatment. 17,18 More disturbingly, self-destructive behavior, in particular violent suicide attempts, seem to be related to impulsive and aggressive traits among substance abusing patients. 16 Over the past decade, studies have examined several variables that may be associated with severity of drug use among cocaine abusers. Severity of cocaine use has been found to be related to demographic factors such as age and employment status, 19,20 anxiety and depressive symptoms, 20,21 polysubstance use, 22 antisocial personality, 23 and social stress. 24,25 Recent studies have also implicated biologic, possibly genetic factors, in determining severity of cocaine use. 26 Surprisingly, few studies have specifically studied the relationship between traits of aggression, sensation seeking, and impulsivity, and cocaine use, and the data is not consistent. In a study of 50 cocaine outpatients, Moeller et al 17 found that impulsivity was significantly correlated with severity of self-reported cocaine use and severity of cocaine withdrawal. Similarly, measures of aggression have been reported to be associated with substance abuse. 5 In contrast, Kasabrada et al 27 found no significant consistent relationship between sensation seeking and severity of cocaine use. Consistent with the literature, we had previously found that cocaine-dependent patients exhibit higher levels of aggression, sensation seeking, and impulsivity compared with controls. 28 The objective of this study was to examine whether measures of aggression, sensation seeking, and impulsivity are related to severity of cocaine use.
Psychopharmacology, 2003
The serotonin transporter (5HTT) regulates the magnitude and duration of serotonergic neurotransm... more The serotonin transporter (5HTT) regulates the magnitude and duration of serotonergic neurotransmission. Although nicotine and other constituents of tobacco smoke may influence serotonin turnover among animals, few studies have examined whether smoking is associated with alteration in 5HTT in humans. We investigated whether tobacco smokers and non-smokers differed in platelet tritiated paroxetine binding, a measure of 5HTT sites, and whether severity of nicotine dependence (ND) was related to 5HTT measures. Tritiated paroxetine binding sites on platelets were assayed in 26 African-American smokers and 30 non-smokers. Severity of smoking was assessed using the Fagerstrom Test for Nicotine Dependence (FTND). Relationships between FTND scores and maximum number of transporter sites (B(max)) and affinity constant (K(d)) of paroxetine binding were determined. B(max) values showed a significant negative correlation with FTND scores (rho=-0.28, P<0.01). Notably, smokers with higher ND h...
Community mental health journal, 1987
New Directions for Mental Health Services, 1986
During the 198Os, interest in studying the origins and nature of homelessness has grown. However,... more During the 198Os, interest in studying the origins and nature of homelessness has grown. However, homelessness is not a new problem, nor is research exploring its social and psychological roots. In nineteenth-century England, workhouses were established based on the notion that characterological defects, such as moral weakness or laziness, were responsible for vagrancy. In the United States the economic depression at the turn of the century brought with it a major increase in the numbers of unemployed immigrants and uprooted persons who congregated in sections of large metropolitan areas that later became known as skid rows. These were communities of primarily destitute, impoverished men whose daily lives centered on the sharing of alcohol and the search for a night's lodging.
Nicotine & Tobacco Research, 2003
Despite a close association between tobacco and cocaine use, few studies have systematically exam... more Despite a close association between tobacco and cocaine use, few studies have systematically examined whether smoking predicts an adverse outcome for cocaine-dependent patients. We investigated whether severity of nicotine dependence was related to treatment outcome for cocaine-dependent individuals. Standardized assessments of nicotine dependence (Fagerström Test for Nicotine Dependence; FTND), cocaine use, and personality were obtained for 105 African American cocaine-dependent outpatients. Outcome measures included negative urine drug screens, days in treatment, dropout, and number of treatment sessions attended. The sample was stratified into cocaine-positive and cocaine-negative groups based on admission urine drug screens, and relationships between nicotine dependence and outcome measures were examined in each group. In the cocaine-negative group, higher FTND scores were negatively correlated with number of negative urine drug screens during treatment even after controlling for other predictors, whereas FTND scores were not correlated to outcome in the cocaine-positive group. It seems that severity of tobacco use predicts poor outcome for cocaine-dependent patients who are cocaine free at the time of admission into outpatient treatment.
International Journal of Medical Education, 2015
Objectives: This study was designed to explore the underlying construct of measures of empathy, o... more Objectives: This study was designed to explore the underlying construct of measures of empathy, optimism, and burnout in medical students. Methods: Three instruments for measuring empathy (Jefferson Scale of Empathy, JSE); Optimism (the Life Orientation Test-Revised, LOT-R); and burnout (the Maslach Burnout Inventory, MBI, which includes three scales of Emotional Exhaustion, Depersonalization, and Personal Accomplishment) were administered to 265 thirdyear students at Sidney Kimmel (formerly Jefferson) Medical College at Thomas Jefferson University. Data were subjected to factor analysis to examine relationships among measures of empathy, optimism, and burnout in a multivariate statistical model. Results: Factor analysis (principal component with oblique rotation) resulted in two underlying constructs, each with an eigenvalue greater than one. The first factor involved "positive personality attributes" (factor coefficients greater than .58 for measures of empathy, optimism, and personal accomplishment). The second factor involved "negative personality attributes" (factor coefficients greater than .78 for measures of emotional exhaustion, and depersonalization). Conclusions: Results confirmed that an association exists between empathy in the context of patient care and personality characteristics that are conducive to relationship building, and considered to be "positive personality attributes," as opposed to personality characteristics that are considered as "negative personality attributes" that are detrimental to interpersonal relationships. Implications for the professional development of physicians-in-training and in-practice are discussed.
Psychiatry-interpersonal and Biological Processes, 2003
Tobacco smoking is the most important preventable cause of death and disease. Despite an increase... more Tobacco smoking is the most important preventable cause of death and disease. Despite an increased awareness of the addictive nature of smoking and availability of effective treatments, smoking continues to be widespread among individuals with psychiatric disorders. Moreover, mental health professionals remain reluctant to address smoking among their patients for a variety of reasons. Recent research has provided a wealth of data that have shaped the concept of tobacco smoking as a chronic addictive disorder and also demonstrated the efficacy of smoking cessation interventions. This paper reviews the important factors that contribute to smoking and the various pharmacological and psychosocial interventions for smoking cessation from a biopsychosocial perspective. It also makes recommendations for the rational use of these interventions to treat nicotine dependence in individuals with psychiatric disorders.
Psychiatric Genetics, 2004
Alterations in the serotonin transporter (5-HTT) have been implicated in a variety of psychiatric... more Alterations in the serotonin transporter (5-HTT) have been implicated in a variety of psychiatric disorders including cocaine dependence. A polymorphism in the promoter region of the serotonin transporter gene (5-HTTLPR) appears to influence the expression of 5-HTT in human cell lines. We investigated whether 5-HTTLPR variants were related to differences in measures of platelet 5-HTT sites in cocaine-dependent patients and healthy volunteers (controls). Polymerase chain reaction-based genotyping of a 44 base pair insertion/deletion polymorphism in 5-HTTLPR was performed in 138 cocaine-dependent African-American subjects and 60 African-American controls. This yielded a short (S) and a long (L) allele. Platelet 5-HTT sites were measured using the tritiated paroxetine binding assay. Relationships of 5-HTTLPR genotypes with Bmax (density of serotonin transporter) and Kd (affinity constant) were examined. Bmax values were significantly lower in cocaine-dependent patients (640 +/- 233) than controls (906 +/- 225) (P &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;lt; 0.001); however, 5-HTTLPR genotype distributions or allele frequencies did not differ between the two groups. There were no significant differences in Bmax between the three genotypes among cocaine-dependent patients (LL = 690 +/- 246, LS = 620 +/- 235, SS = 587 +/- 183; P = 0.14) or controls (LL = 909 +/- 233, LS = 938 +/- 279, SS = 866 +/- 143; P = 0.65). All three genotypes in cocaine-dependent patients showed comparable reductions in Bmax from the corresponding genotypes in controls. Demographic variables, severity of substance use or depression were unrelated to Bmax or 5-HTTLPR genotypes. Although platelet 5-HTT densities are reduced in patients with cocaine dependence compared with healthy volunteers, these genotypic variations in the serotonin transporter do not seem to influence levels of platelet 5-HTT in cocaine-dependent patients or healthy volunteers.
Psychopharmacology, 2004
Rationale: Alteration in serum prolactin (PRL) levels may reflect changes in central dopamine act... more Rationale: Alteration in serum prolactin (PRL) levels may reflect changes in central dopamine activity, which modulates the behavioral effects of cocaine. Therefore, serum PRL may have a potential role as a biological marker of drug severity and treatment outcome in cocaine dependence. Objective: We investigated whether serum PRL levels differed between cocaine-dependent (CD) subjects and controls, and whether PRL levels were associated with severity of drug use and treatment outcome in CD subjects. Methods: Basal PRL concentrations were assayed in 141 African-American (AA) CD patients attending an outpatient treatment program and 60 AA controls. Severity of drug use was assessed using the Addiction Severity Index (ASI). Measures of abstinence and retention during 12 weeks of treatment and at 6-month follow-up were employed as outcome variables. Results: The basal PRL (ng/ml) in CD patients (9.28±4.13) was significantly higher than controls (7.33±2.94) (t=3.77, P<0.01). At baseline, PRL was positively correlated with ASI-drug (r=0.38, P<0.01), ASI-alcohol (r=0.19, P<0.05), and ASIpsychological (r=0.25, P<0.01) composite scores, and with the quantity of cocaine use (r=0.18, P<0.05). However, PRL levels were not significantly associated with number of negative urine screens, days in treatment, number of sessions attended, dropout rate or changes in ASI scores during treatment and at follow-up. Also, basal PRL did not significantly contribute toward the variance in predicting any of the outcome measures. Conclusion: Although cocaine use seems to influence PRL levels, it does not appear that PRL is a predictor of treatment outcome in cocaine dependence.
Psychiatric Services, 2007
Recovery has emerged over the past decade as a dominant theme in public mental health care. The 2... more Recovery has emerged over the past decade as a dominant theme in public mental health care. The 2006 Pennsylvania Consensus Conference brought together 24 community psychiatrists to explore the barriers they experienced in promoting recovery and their recommendations for change. Twelve barriers were identified and classified into one of three categories: psychiatry knowledge, roles, and training; the need to transform public mental health systems and services; and environmental barriers to opportunity. Participants made 22 recommendations to address these barriers through changes in policies, programs, and psychiatric knowledge and practice. The recommendations identify areas for change that can be accomplished through individual psychiatrist action and organized group efforts.
Nicotine & Tobacco Research, 2003
Despite a close association between tobacco and cocaine use, few studies have systematically exam... more Despite a close association between tobacco and cocaine use, few studies have systematically examined whether smoking predicts an adverse outcome for cocaine-dependent patients. We investigated whether severity of nicotine dependence was related to treatment outcome for cocaine-dependent individuals. Standardized assessments of nicotine dependence (Fagerström Test for Nicotine Dependence; FTND), cocaine use, and personality were obtained for 105 African American cocaine-dependent outpatients. Outcome measures included negative urine drug screens, days in treatment, dropout, and number of treatment sessions attended. The sample was stratified into cocaine-positive and cocaine-negative groups based on admission urine drug screens, and relationships between nicotine dependence and outcome measures were examined in each group. In the cocaine-negative group, higher FTND scores were negatively correlated with number of negative urine drug screens during treatment even after controlling for other predictors, whereas FTND scores were not correlated to outcome in the cocaine-positive group. It seems that severity of tobacco use predicts poor outcome for cocaine-dependent patients who are cocaine free at the time of admission into outpatient treatment.
Journal of the American College of Cardiology, 2002
Journal of Addictive Diseases, 2004
We investigated whether measures of impulsivity, aggression and sensation seeking differed betwee... more We investigated whether measures of impulsivity, aggression and sensation seeking differed between cocaine-dependent subjects and controls, and whether these measures were related to treatment-outcome for cocaine patients. Pre-treatment assessments of impulsivity (Barratt Impulsivity Scale [BIS]), aggression (Buss-Durkee Hostility Inventory [BDHI]) and sensation seeking (Zuckerman Sensation Seeking Scale [SSS]) were obtained for 141 African-American cocaine-dependent patients entering a 12-week, intensive outpatient treatment program and 60 controls. The outcome measures were number of negative urine drug screens, days in treatment, dropout rates and number of treatment sessions. Cocaine patients reported significantly higher scores on the SSS, the BIS and the BDHI than controls. Furthermore, the SSS scores showed a significantly negative correlation with days in treatment and negative urines, and a significant positive correlation with the dropout rate. The BIS and the BDHI scores were significantly associated with days in treatment and dropout rates respectively. A combination of the three variables contributed significantly toward predicting retention and abstinence. Higher levels of pretreatment impulsivity and aggression and sensation seeking seem to associated with poor treatment outcome for cocaine dependent patients receiving intensive outpatient treatment. Combining these behavioral measures with other clinical predictors may help in early identification of &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;poor responders&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; who may benefit from additional or alternative treatment approaches.
Journal of Addictive Diseases, 2004
We investigated whether pretreatment characteristics and measures of outcome differed for alcohol... more We investigated whether pretreatment characteristics and measures of outcome differed for alcohol-, cocaine-, and multisubstance-dependent patients receiving outpatient substance abuse treatment. One hundred and forty substance dependent individuals (32 alcohol, 76 cocaine, and 32 multisubstance) enrolled in a 12-week outpatient treatment program were compared across measures of addiction severity, personality, and treatment-readiness at admission. In-treatment, end-of-treatment and 9-month follow-up assessments of treatment outcome were then compared across the three groups. Outcome measures included reduction in problem severity, abstinence, retention, number of sessions attended, dropout, and counselor and patient ratings of treatment benefit. At admission, the multisubstance group had a higher proportion of positive urines, reported more severe drug, alcohol and psychiatric problems, and displayed higher impulsivity and anxiety scores than one or both of the other groups. However, multisubstance patients were more treatment ready in terms of adopting a total abstinence orientation than alcohol or cocaine patients. While a significant reduction in symptoms occurred for the total sample during treatment as well as at follow-up, comparisons of outcomes did not consistently favor any particular group. The three groups had equivalent improvements in eleven of fourteen during-treatment and five of seven follow-up measures. Despite pretreatment differences, in severity and treatment-readiness, outcomes were more similar than different for alcohol-, cocaine-, and multisubstance-dependent patients. Clinicians should be cautious about forecasting treatment-outcomes for addicted patients based on their primary substances of abuse.
Human Psychopharmacology: Clinical and Experimental, 2003
Academic Psychiatry, 2004
American Journal on Addictions, 2005
Despite the widespread use of tobacco and marijuana by cocaine abusers, it remains unclear whethe... more Despite the widespread use of tobacco and marijuana by cocaine abusers, it remains unclear whether combined tobacco and marijuana smoking is more harmful than tobacco smoking alone in cocaine abusers. We investigated the differences in medical symptoms reported among 34 crack cocaine abusers who did not smoke tobacco or marijuana (C), 86 crack cocaine abusers who also smoked tobacco (C + T), and 48 crack abusers who smoked both tobacco and marijuana (C + T + M). Medical symptoms were recorded using a 134-item self-report instrument (MILCOM), and drug use was assessed using the Addiction Severity Index (ASI). After controlling for clinical and demographic differences, the C + T + M group reported significantly more total symptoms on the MILCOM as well as on the respiratory, digestive, general, and nose/throat subscales than the C + T or C groups. The C + T group reported higher total and respiratory and nose/throat symptoms than the C group. HOwever, the C group had the highest number of mood symptoms among the three groups. The C + T and C + T + M groups were comparable in number of cigarettes smoked and ASI scores. Although tobacco smoking is associated with higher reports of medical problems in crack abusers, smoking both marijuana and tobacco seems to be associated with greater medical problems than smoking tobacco alone. Tobacco smoking was not related to changes in cocaine use. Also, marijuana smoking does not appear to be associated with a reduction in tobacco or cocaine use.
The American Journal of Drug and Alcohol Abuse, 2003
We studied whether pretreatment levels of learned helplessness (LH) were related to outcomes for ... more We studied whether pretreatment levels of learned helplessness (LH) were related to outcomes for substance-dependent individuals receiving high-structure, behaviorally oriented (HSB) or low-structure, facilitative (LSF) treatment. The subjects were 120 substance-dependent patients randomly assigned to the HSB or the LSF treatment style for up to 12 weeks of weekly individual counseling. The two groups were compared across pretreatment characteristics as well as in-treatment, end-of- treatment, and 9-month postadmission follow-up outcome measures. Outcomes reflected reduction in problem severity, abstinence, retention, dropout rate, and ratings of treatment benefit. Significant and comparable reductions in symptoms occurred for the HSB and LSF patients both during treatment and at follow-up. Comparisons of other outcomes also did not consistently favor either treatment style. However, significant and consistent interactions were observed between LH and treatment styles with respect to several outcome measures, and these effects were independent of pretreatment levels of depression, addiction severity, and readiness for treatment. Specifically, the more &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;amp;quot;helpless&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;amp;quot; patients did significantly better in HSB treatment, whereas the less &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;amp;quot;helpless&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;amp;quot; patients had better outcomes in LSF treatment. A matching approach that assigns patients to high- and low-structure treatments based on pretreatment levels of LH might improve treatment outcomes for substance-dependent patients.