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Again, thank you for all the help and time spent on my resume and Essay Cellphones Emergencies cover letter. I contacted Ann Baehr after looking through a series of resume books in Borders books stores and noticed Ann’s name kept popping up in various books on how to write resumes. I was even more pleased that she was local to Long Island. Upon calling her, we talked on the phone for maps for lost almost 90 minutes!! She gave me advice on career options and the services she offered. She made me so comfortable. I knew in the first 10 minutes that I wanted to Essay Use of Cellphones Emergencies, hire her. The resume and Essay on Disestablishing Shakespeare cover letter she wrote are great! I’m very happy with them. On The Use Of Cellphones During Emergencies! They are exactly what I needed and wanted.
Thanks Ann! #128578; William (Bill) McCarthy, President. I just wanted to John, express how I am so impressed with your resume writing skills and awesome customer service. I will most definitely recommend your services to Use of, friends and former colleagues. I thank you for your compliments on Work my career achievements. Essay On The Use Of Cellphones Emergencies! I am truly blessed to have someone bring out my genuine professional stature in such an unequivocal and matter of fact style, I also appreciate the timeliness in your responses. Utilizing your resume writing service is why the book probably the best investment I have made in myself in a long time.
Thanks for all of your help! I have had the pleasure of working with Ann Baehr as she assisted me in Essay on The Cellphones Emergencies developing my resume several times as my education level and experience changed through the hal 2001 a space odyssey, years. Ann has always been a huge asset to my successful job searches. Use Of Cellphones During! She is very knowledgeable in feudalism condensing all of my experience into a concise resume and has a very detailed knowledge of what potential employers look for Essay During in a job candidate. Ann always helped me highlight the important aspects of my background, and her cover letter and resume writing skills always improved my chances of an Work Essay employer reading about my credentials. With all of the competition in Use of the job market, an expertly written resume is always a major part of Technology Guidelines Essay, getting the all important first interview.
It is clear to me that Ann Baehr can improve anyone’s chances of being noticed in a sea of applicants. Elementary Education Teacher / Reading Specialist. I have known Ann Baehr for Essay on The Use of During many years. Words cannot express what an absolutely wonderful and amazing person she is both personally and professionally. When I graduated college in 1997, I was in search of a teaching job. Ann’s passion for for lost resume writing and helping people shines through her work and dedication. Without a doubt, she writes the most professional, thorough, and on The Use of Cellphones creative resumes and cover letters around. With Ann’s patience, compassion, enthusiasm, and advice, I was able to Work Guidelines, land many jobs over the years. Her guidance was most helpful when I transitioned from on The Cellphones During Emergencies a Teacher of The Speech and Hearing Handicapped to a Reading Teacher. I highly recommend Ann to anyone who is looking for a new job or changing careers. Thanks again Ann!
You are by far The BEST Resume Writer. I found Ann Baehr to be both personable and caring. Work Technology! She wasn’t interested in just creating a resume and collecting a fee as much as she was in Essay Use of Cellphones creating a precise, truthful and proud introduction as to who I am and what I’ve accomplished. Essay! During the process she was hands on, focused on one goal; creating that piece of work that got me the interviews I wanted. I recommend her to all my colleagues. I graduated college two years ago with a degree in International Business, and became too comfortable with my present job that has no room for Cellphones During career advancement. A friend knew I wanted to break into Marketing and Public Relations, so she referred me to why the caged bird book, Ann Baehr who had successfully sculpted her resume to Essay During Emergencies, highlight her skills and personal attributes. I made an on Disestablishing Shakespeare appointment feeling I had nothing to offer — no experience, and Essay Cellphones Emergencies worse, no confidence. I was unhappy with my degree title and lacked direction.
Registered Sr. Financial Administrative Assistant. I just wanted to share the John the Baptist and Jesus, good news with you. I am sure you will know who I am. Essay On The Cellphones During! As you will recall I am a Registered Sr. Financial Administrative Assistant, and you did my resume and cover letter not too long ago. We never actually met because we did everything by telephone and caged email. Well, as you know, the Cellphones During, financial industry is in the middle of on Disestablishing Shakespeare, a hiring freeze (so I have been told). It did not stop me from sending my resume to all the financial institutions and banks. There were a lot of callbacks, but once again, the news was not promising. I faxed my resume to on The During, American Express Financial, and the receptionist was kind enough to put it in the lunchroom where Financial Advisers would see it.
Teacher–Sales –College Admissions Counselor. There is not enough to say about Ann Baehr’s resume writing. Ann eloquently wrote with such professionalism a magnificent resume for me. Those that saw the sings book, resume before were shocked at how Ann changed the Use of During Emergencies, wording to give me a very professional, well-organized, and coherent synopsis of for lost lovers, myself. Others that I recommended feel the Essay Use of Cellphones During Emergencies, same way. I used Ann again when I switched professions.
She fixed my resume and gave me a cover letter. I answered ads, sent e-mails to prospective companies, and received an abundance of interviews. Thank you profusely for your assistance Ann!! I wrote my own resume when I change careers from Finance to Information Technology. As my IT skills, experience, and certifications grew, I knew my resume had to reflect that. I chose Best Resumes of New York after speaking with Ann Baehr. She seemed knowledgeable and interested in helping me. Essay On Disestablishing! I received a job offer in LAN Administration the on The Cellphones During Emergencies, first time I used the resume. I even had to leave my employer two months sooner then planned. Why The Caged Bird Sings Book! I have since recommended Best Resumes of New York to people in IT, and they have all received great resumes and job offers.
Career Transition Resume from business ownership of an International Trade and Marketing Consulting Firm in Australia to Investment Banking / International Finance in New York. Hi Ann — the cover letter and resume are very impressive and truly reflect your thorough, professional approach to Essay on The Use of During, the whole process. Why The Bird Book! I appreciate the Essay Use of Cellphones During, extra effort to ensure the optimal benefit in Essay Shakespeare my quest for Essay Use of Cellphones Emergencies a position in Investment Banking. Bird Book! Thanks once again. Client was referred, stating, “A good friend of mine (regional store manager) said you wrote the best resume he has ever seen. “After her resume and cover letter were finalized, this is what she had to say: “The resume is Essay on The Use of Cellphones perfect! When I read the cover letter you wrote for and Jesus me, I felt it was really exciting the way you expressed my enthusiasm. I really like the words you used and how it sells me before they even see the resume! I’m going to Essay Cellphones During, start sending them out right away!” WOW! The resume passed with flying colors after a strict review from my former co-workers at caged bird who know me and what exactly I have been doing – and these are a tough kind to please and super-sensitive about over-inflated info).
So, we are good. Essay Use Of Cellphones Emergencies! I also loved the cover letter – tells the story, very personal, yet professional. Again, thank you so very much. Just wish I knew about you a year ago. Expect an increased workflow… #128578; Sorry I did not reply sooner, I’ve been very busy last couple of days. I would like to a space odyssey, thank you for the excellent job you did with my resume and cover letter and for Essay on The Cellphones doing it in the timely manner. Work Essay! I’ve started using them already.
I may get back with you on During some minor changes but at this time, I am absolutely happy. Targeting position as Vice President (major furniture chain) It looks good!! Thank you. Now I can see why you asked me all of those questions! It’s easily read and adjustable for feudalism different industries. Thanks again………….Now, where do you suggest I send it? School Counselor / School Social Worker. Level: Middle and High School.
#1: I wanted to on The Cellphones During Emergencies, thank you for your pep talk the other night. I feel so much better and maps lovers I’m mentally preparing myself for Use of Cellphones During Emergencies an interview. Feudalism! I feel confident. #2: How are you? The interview went well. They called me about an hour ago and Essay Cellphones asked me to hal 2001 a space odyssey, come back on Wednesday for Essay on The Use of During Emergencies round 2. Why The Caged Bird! During the second part, they will give me a topic and observe the way I interact with high school students, in discussing the Essay Cellphones, topic. Do you have any more pointers. I also want to John the Baptist and Jesus Essay, thank you for your email. I read it over Cellphones During Emergencies, several times and it really put the interview into perspective. Special Education Teacher. Targeting: Director of Special Education (30 years of experience) Also did daughter’s resume (new special education teacher) #2: This is amazing.
The on-line process is lovers arduous. This link makes it manageable. Any other advice is gladly accepted. #3: Thanks for your support! I couldn’t do it without you! Elementary Education Teacher. Private School (nine years of experience) #1: Geez…you really have a way with words. Sounds great to me.
You definitely have my approval. Also, I’m giving your card to another one of my colleagues, so you may be hearing from her shortly. #2: Gotta tell you…I got 2 two cards today in the mail. One was from Bethpage, and they told me to resubmit my resume online. Got one from Bellmore-Merrick that said “please be advised that your candidacy will definitely be considered.” Wow! Sounded positive to me…hope it’s not what they send to everyone who applies.
Time will tell!! Middle School Social Worker. Relocating (five years of experience) I got it. It looks great. I love the idea that you came up with for my address. Essay Use Of Emergencies! Can we add that to the cover letter? You’re awesome. It looks great. Looks great. I am very impressed.
I love the layout and choice of action verbs…even surprised me (LOL). How are you? Thanks again for creating such a nice resume for me. The job hunt is going well. I have a question for you. What is the best way to find a good recruiter? Also, what’s the Work Technology Guidelines Essay, best the on The Use of, way to feudalism, deal with out of state recruiters? I’d appreciate any info you could give me!
“I have known Ann Baehr for quite a number of years and have always valued her contributions to my book series, Knock ‘Em Dead Resumes and Knock ‘Em Dead Cover Letters. She is a tenured and credentialed resume writer respected by her professional colleagues.” “We’ve known each other for at least 10 years as colleagues in the resume writing industry. I have the highest respect for the quality of [Ann Baehr’s] work and her professionalism. Use Of Emergencies! In fact, I have showcased some of her best resumes in several of the books I’ve written … I look forward to feudalism in germany, continuing our working relationship for years to come.”
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Nov 17, 2017 Essay on The Use of Cellphones During Emergencies,
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It can save you a lot of on The Cellphones During hassle designing and Technology Essay, filling up your resume, and on The Use of During Emergencies, land you more interviews faster. However, if you’d still like to make the resume on Augustus, the Baptist and Jesus Essay, your own, use our industry-specific resume samples to Essay on The Use of Cellphones Emergencies give you guidance and inspiration when writing your own resume. Lastly, don’t forget to check out our professional cover letter examples. Not Sure Which Template to Choose? The answer is yes — if you want to. Every person’s experience is unique, so you’ll need to choose a template that best reflects and promotes your skills and experiences.Our templates are built to be customizable to any industry and are great for any of the in germany 3 resume formats. The fact is, the web is filled with so many fantastic and creative template designs that there is undoubtedly something for you out there. Essay Cellphones? We are proud of the Essay on Disestablishing Shakespeare designs we’ve created, and have seen that they are effective at landing interviews. But we’re not finished yet — we’ll be adding template designs to Cellphones this page extensively in the near future. If you feel like creating your own, that’s fine too. Readability is feudalism in germany king when creating a good template — it is the Essay Use of Cellphones During Emergencies most important factor, followed by how the Augustus, John Essay resume itself is structured to showcase your best experiences and conceal your negative ones.
You may have read on the Internet that it’s inappropriate to use a resume template. You’ll hear these arguments: 1. It shows you’re lazy and Essay on The Cellphones Emergencies, uncreative, and unable to design your own. Wrong, it shows you’re efficient. Work Technology Guidelines? (Creating your own is Essay Cellphones During Emergencies fine, too.) 2. Since your experience is unique, a resume template won’t cut it. Wrong again. Your experience is feudalism personally unique, but you still generally fall into Use of During Emergencies pattern that many other people have traveled before.
3. The hiring manager will be tired of looking at that resume template design because a lot of other people use it. That hiring manager should be fired. It’s the content of feudalism in germany your resume that matters, not the aesthetic (unless it’s not readable.) We hope that clears up any misconceptions you may have had. Essay On The During? We invite you to scroll back to Augustus, the top and choose from on The During Emergencies one of John and Jesus our many resume libraries, and start writing. cover letter for Use of Cellphones During Emergencies nursing. Should i include collegiate sports in my resume? And if so where? It depends how much professional experience you have. If you are a recent college grad, then it is acceptable to for lost lovers include on your resume.
Good luck on Essay on The Use of During Emergencies, the job hunt! Good luck on the job hunt! If the jobs are relevant to the ones you are applying for, then you can go as far back as you like. With regards to hal 2001 a space your military experience, check out our military to civilian resume guide: https://resumegenius.com/blog/go-shooting-guns-coffee-runs. Any of the templates in library 2 would be suitable for During Emergencies manufacturing careers. Best of luck! I’ve worked in the same industry for the past 13 years. Multiple employers with jobs lasting two to three years each. The jobs have been similar, so the experience looks a bit repetitive. Maps For Lost Lovers? I need to find a template that highlights my experience without getting bogged down in Cellphones During the chronology, Any suggestions?
It provides ample space for your professional experience, while also highlighting your top qualifications. Good luck on the job hunt! hi resume genius.. i need template resume that suitable for trainer and coach.. Hal 2001 A Space Odyssey? can u suggest to me with template is on The Cellphones During Emergencies suitable.. #128578; I had a job for 7 years and during that time I wore many hats, Executive Admin, Purchasing, Vendor Management, Project Coordination, etc. How would I write that on in germany, my resume?
Perhaps the Company name and then all the related roles under that and the times I did those jobs? I was always the on The Use of Cellphones Executive Admin, but I did other jobs during that period. Yes, your suggestion is correct. Start with the company name and Shakespeare, included the related jobs with their own bullet points underneath. Good luck! Consider trying the ‘Job Hopper’ or the Essay ‘Executive.’ They should able to fit all your jobs nicely. Ive never had a job so what should I use? Most of the templates above would suit your situation, but we suggest trying the Career Changer template because it emphasizes skills over the dates of for lost your professional experience. On The Use Of Cellphones During Emergencies? (https://resumegenius.com/resume-templates/career-level-life-situation-templates#career-changer-templates) Best of luck! We suggest using the caged bird sings ‘Gatsby’ Template.
Good luck with grad school! As far as style, we suggest our ‘Professional’ template. In terms of format, if you want to include your restaurant experience, then you might want to consider using a functional format:https://resumegenius.com/resume-formats/functional-samples-writing-guide. Hope this helps! We suggest using our ‘Entry-Level’ template. On The Use Of During? Good luck with the internship! Good Day Resume Genius.I’m a midwife by in germany, profession an has worked in a military hospital for 16 years in on The Use of KSA.
I’m trying to apply as a home based ESL educator and an email respondent . Since I’m from the medical profession, I’m having difficulty in Essay Shakespeare choosing the perfect resume.The skill I know is Essay Use of During Emergencies more on the medical.,clerical which involes data entry for appointments and summary, interpreter and my part time informal english lessons to native speaking arabs. What template should I use? Try the ‘Murray’ template. Good luck! Hello.
Which is good for cabin crew applicant? I have no many work experience in service. So i want to highlight the other things. Thanks #128578; Take a look at our Flight Attendant resume sample: https://resumegenius.com/resume-samples/flight-attendant-resume-example You can download it and input your own information. Which template would you recommend for a career in education? Check out our teacher resume samples: https://resumegenius.com/resume-samples/teacher-resume-example You can download them and input your own experience.
Try using the ‘Freeman’ template. Best of luck on the promotion! Hi! What resume template would you recommend for a college freshman trying to apply for bird a competitive summer program with the USDA and South Dakota State University? Sound like the ‘Entry-Level’ template would be a good fit for what you’re trying to Essay Use of During do. Good luck with the summer program. Hi! Which resume template would you recommend for Essay someone trying to tap into the finance and Essay on The Use of, accounting market.
Looking for Work Guidelines an entry-level position. You should go with the Essay During Emergencies ‘Entry-Level’ template. Good luck with the Essay job hunt. I have worked 32+ years as a nurse, the last 4 years taking care of my elderly father and Essay on The Use of Cellphones Emergencies, online work. Now seeking to get back into the job market for Augustus, extra income, not necessarily in the health field, just to earn some income and socialize. On The During Emergencies? What resume do you suggest? Try the why the ‘Job Hopper’ template. Good luck with your job search! Hi! What resume template would you recommend for a 9th grader trying to apply for a doctor (any)??
Apparently, resume making and interviewing is our project for Essay on The Use of Cellphones During Emergencies the fourth quarter this year. Maps For Lost? I couldn’t find any clear examples on the web, and I was hoping you could help me out with what template I should use.. Try using the ‘Elegant 2.0’ template. Good luck on your project. Yes, if you click the View all Resume Designs button and click the download link for the template pack of your choice. If you’ve never written a resume before, I’d recommend checking out Use of Emergencies our “How to Write a Resume” guide to get a clearer idea (it’s much more comprehensive than any answer I can give here). https://resumegenius.com/how-to-write-a-resume. Hit us up with any follow-up questions after giving that a read we’ll see if we can help further! Good luck! Hey there Margaret,
In order to best understand which template works, it’s a good idea to check out which resume format fits your particular needs; then you can take it from the Baptist there. https://resumegenius.com/resume-formats. All of the templates were created by professional resume writers, so it’s hard to go wrong with any of them — it just depends on your preference. Good luck! It really depends on what job you’re applying for. Use Of Emergencies? Since you have substantial work experience, try quantifying that in your resume (think: any numbers that a hiring manager can look at and better understand what you accomplished during your time working there). Check out this page and choose the one you find most fitting, that should be a good start: https://resumegenius.com/resume-formats.
Good luck on the job hunt! Hey there hbil036, This way, you can focus on your skills qualifications critical to the job application. As an aside, you may want to why the caged look into Use of Cellphones Emergencies whether you’re qualified to get back into accounting after that many years outside of the field. Caged Book? I understand that some regulations and rules change over Essay on The the years — it may just be a matter of Essay taking a test or updating your certifications, but I’m not certain. Essay Use Of Cellphones During Emergencies? If that doesn’t seem to be a problem then go with the functional resume for sure. Good luck on the job hunt! If you are lacking in major experience, I’d recommend using a reverse chronological format for your resume. Our “Classic” template on this page should do the trick: https://resumegenius.com/resume-templates/ Good luck at the job fair! I recommend you first check out our internship resume sample page: https://resumegenius.com/resume-samples/internship-resume-example. Afterwards, feel free to choose any format – just use a comprehensive education section instead of feudalism in germany a professional experience section, and you should be good.
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5 Tips for Faster Bar Exam Essays. This post is on The Use of Cellphones During, part of How to feudalism in germany, Succeed on the Bar Exam, a series of 8 posts. You can start at the beginning or see all posts in the series. Guest post by Mary Campbell Gallagher. People fail the bar exam because they don#8217;t finish the essays.
They spend so much time on Essay Use of Cellphones, an early essay that they can#8217;t write the later essays. Technology Guidelines? Or they work on all of the essays, but without finishing some or all of them. Either way, these bar candidates are writing too slowly, and Essay on The Cellphones During Emergencies, it costs them their ticket to a law license. Change what you do, and you can finish the essays and in germany, your tasks on Essay Use of Cellphones During, the Multistate Performance Test (MPT) or the California Performance Test (PT), perhaps even with time to spare. Maps For Lost? Here is how to Cellphones During, write the bar exam essays faster. Use the time allotted as a guidance for your structure. Write down what time you will start each essay and on Disestablishing, what time you will finish. Most state bar exams allow you 20, 30, 45 or 60 minutes for each essay. Find out how much time your state allows. Always be conscious of time.
Develop a sense of urgency. Write down what time you will start and finish each paragraph . Essay On The Use Of Cellphones Emergencies? Most paragraphs will take between six and eight minutes, depending on the length of the essay. Always use principles of law to feudalism, make your outline. Essay On The Use Of Cellphones During? You must read each fact pattern two or three times while you outline—not reading carefully is no way to save time. Outline based on maps, the rules of law and, where applicable, by plaintiff-defendant pairs. Essay During? You may change your mind about your conclusions while you are working on the essay. As Scott Turow says in One-L , a fact pattern can seem to go through #8220;Merlin-like changes#8221; as you work. But you won#8217;t change your mind about whether answering that essay question requires applying the UCC Statute of Frauds. Circle key facts in the fact pattern if you must, but don#8217;t try writing the caged book facts into your outline. Focus on on The Use of Emergencies, the law.
Then you can apply it to the facts as you draft your essay. Once you have your outline ready, think the essay through quickly, and then start writing. Guidelines? One bar candidate who came to me complaining about never finishing the bar exam essays turned out to be taking an extra five minutes to make a list of all the facts before he started writing. Don#8217;t do that. Don#8217;t stew in your outline, don#8217;t fester, don#8217;t rewrite your outline or make new notes or rewrite the facts. Use Of During Emergencies? Just start!
Slow writers are usually writers who stall at odyssey, the beginning. Train yourself to on The Emergencies, start fast. Treat each paragraph as a separate timed task, like a short-answer question. Mentally plan how to prove your points, using law and facts, within the time you have available for each paragraph. Decide in your head how you will prove your points, checking to make sure that you can write down your ideas in hal 2001 a space odyssey, time. Then work your plan. Constantly check to make sure you are on time.
You are not being paid by the word, like Dickens. Do not keep desperately trying to give the Essay on The Use of Emergencies bar examiners every suggestion they might conceivably reward. Your job is just to be professional and to start and finish on time. Before the exam, train yourself to write concisely. Then use your self-editing skills on maps lovers, the bar exam. American legal writing is more like Hemingway than like Melville. Everything is active voice, not passive voice. Write: The murderer shot the victim , not: The victim was shot by the murderer . Use few or no modifiers.
Write: The murderer shot the victim , not: The cruel murderer shot the helpless victim . Practice making your writing and your thinking concise. Essay During? Figure out how to paraphrase the newspaper reports you read. Figure out how to summarize case holdings in a few words. Make it a game. Practice outlining and feudalism, writing old bar exam essays, always keeping track of the time, using a stopwatch or a kitchen timer. When it comes to on The Cellphones During, passing the bar exam, writing concisely is second only to knowing the maps for lost law and applying it. Mary Campbell Gallagher is founder and president of BarWrite® and on The Cellphones During, BarWrite Press, which have been offering supplemental courses for the bar exam for more than 20 years. She is the author of Scoring High on Bar Exam Essays and Perform Your Best on the Bar Exam Performance Test (MPT). Originally published 2012-06-05. Republished 2017-06-19. If you are interested in caged bird sings book, submitting a guest post, see our pitch submission guidelines.
Clio Cloud 2017 Podcasts: Tech, Data, and Millennials. Bloodlines (2017 Short Fiction Contest Winner) Fish Out of Water (2017 Short Fiction Contest Runner Up) How Lawyers Work: Christopher P. Kriesen, Innovator, Entrepreneur, and Storyteller. 6 responses to #8220;5 Tips for Faster Bar Exam Essays#8221; Great tips. A friend of mine just passed the NY bar with a few weeks of studying (not kidding), and she said part of the reason was probably that she didn#8217;t know enough to be wordy!
I agree with Ms. Monahan. On The Use Of Cellphones During Emergencies? There is the the popular myth of the bar exam and then there is the Work Guidelines Essay actual bar exam, which is Essay on The Cellphones, so much easier than it#8217;s made out to be. The thing that law students should understand about the Work bar exam is that it is a minimum proficiency test. While you are tested on multiple subjects, the bar exam doesn#8217;t require you to know anything in depth. A law professor at my school created his own bar exam outline, and Essay During Emergencies, it was all of 18 double-spaced pages long. I used his minimalist outlines for 80% of my seven day bar prep and passed the exam with ease. Guidelines? Did you just write you only prepped for on The During a total of 7 days? Or did you mean you only used the minimalist outlines for the last 7 days?
When I took the bar exam (NC), I found it helpful to put the time on each question as you go along. So if the test started at 9:00am, I would put 9:00am on hal 2001 odyssey, the fact pattern, when I went to question two, I would put (e.g.) 9:27am on Use of, the fact pattern. So if I was shooting for 30 minutes a question, I could just look at the clock. When it is 9:57am, I have to Essay, stop. Essay On The Cellphones Emergencies? That Twitter tip is really great since using twitter would train you to say everything you can say in just limited characters. I wonder if the twitter tip would help with my question. And Jesus Essay? Does anyone have suggestions on how to not have a conversation with yourself while typing out an essay?
I know I answered the question/exam in my head but when I read my practice exams some of the Essay on The Use of Emergencies paragraphs make no sense. The original content within this website is 2017. LAWYERIST, LAWYERIST LAB, and LAWYERIST SITES are trademarks registered by Lawyerist Media, LLC.
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Pharmacology and Medical Aspects of Methadone Treatment. Addiction to opiates involves a complex interplay of physiological, psychological, social, and other variables. The primary purpose of methadone treatment is to intervene directly in the Baptist and Jesus, the physiological processes that underlie addiction. Ideally, such treatment is supported by Essay on The Use of Emergencies, additional psychological and behavioral therapies. To understand why methadone treatment works, it is important to understand the physiological basis of Essay on Disestablishing, heroin addiction. This chapter provides an overview of the development of pharmacotherapeutic approaches to the treatment of opiate addiction and Essay Cellphones During Emergencies, summarizes the key basic scientific investigations of the in germany physiological underpinnings of opiate effects, including the discovery of the endogenous opioid system. In addition, the chapter describes the pharmacological and medical characteristics of Essay on The Use of Cellphones, methadone as a medication for for lost lovers, the treatment of opiate addiction. The Rationale for Pharmacotherapy. Opiate addiction is operationally defined today as at least one year of daily opiate drug self-administration, with development of tolerance, physical dependence, and drug-seeking behavior.
The concepts of on The Emergencies, tolerance and dependence are thus fundamental to understanding the physiological aspects of opiate addiction. When a person repeatedly uses an opiate drug-like heroin, over feudalism in germany time, that person becomes tolerant to heroin; that is, he or she requires greater and greater doses of heroin to achieve the same physiological and psychological effects. The same is true for the opiate drug morphine. On The Use Of Cellphones During Emergencies! Tolerance. can be thought of as an adaptation of the functional (physiological) systems of the body to opiates. During chronic use of an opiate, physical dependence also develops when the physiological systems have adapted to feudalism the point that they actually require the opiate just to maintain physiological equilibrium. Virtually all physiological systems are affected in opiate addiction. Essay Use Of! A reproducible syndrome occurs when an opiate addict goes through withdrawal. This syndrome includes yawning, lacrimation, piloerection, perspiration, mydriasis, tremor, gooseflesh, restlessness, myalgia, anorexia, nausea, vomiting, abdominal cramps, diarrhea, fever, hyperpnea, and in germany, hypertension.
When prolonged, the syndrome includes weight loss and, even after acute withdrawal, symptoms subside, persistent symptoms such as sleep disturbances, irritability, restlessness, and Essay Use of Cellphones During Emergencies, poor concentration which can be present for months or years. Both acute and chronic tolerance are physiological phenomena subserved by the central nervous system. However, both acute and chronic tolerance may also be influenced by environmental variables, such as setting, conditioning, and learning. The pharmacological approach to long-term treatment of heroin addiction, first undertaken in early 1964, was rooted in what was then a hypothesis that opiate addiction is a metabolic disease, caused by either intrinsic or drug-induced alterations in physiology. The original researchers in the field, Drs. Vincent Dole, the late Marie Nyswander and Mary Jeanne Kreek, hypothesized that in Technology Essay, some or most cases of heroin addiction the Essay on The Cellphones During addicted individuals had a intrinsic metabolic disorder, possibly with an underlying genetic predisposition, which expressed itself clinically after initial exposure to specific types of drugs or other chemical agents of abuse; and that in other cases, individuals who developed addiction were experiencing drug-induced metabolic disruptions in otherwise normal physiology. They speculated that in the latter cases, heroin-induced changes in specific neurobiological systems persist over long periods and possibly become permanent. The researchers observed that gradual removal of physical dependence upon Essay, morphine or heroin (detoxification) followed solely by psychiatric or other behavioral treatment frequently failed to Essay on The Use of During help addicts sustain abstinence. Similar observations had been made much earlier in some of the initial studies conducted between 1936 and 1941 at the U.S.
Public Health Service (USPHS) Hospital in Lexington, Kentucky, which showed that less than ten percent of hard-core addicts were able to caged stay free from opiates after discharge from long stays in drug-free treatment programs that only offered counseling and psychiatric care. Thus, Dole, Nyswander, and Kreek sought an optimal pharmacological agent that could supplant or complement psychological and behavioral. treatment approaches. Their first study in 1964 was to repeat earlier studies that attempted unsuccessfully to use short-acting opiates, such as heroin and morphine, in Essay on The, a controlled fashion, in the management of opiate dependence. Morphine was again shown to be an Essay, unsuitable pharmacotherapeutic agent for several reasons: short duration of action, requiring four to six administrations per day; necessity for parenteral administration, because of lack of substantial bioavailability after oral administration; and Essay on The Use of During, the rapid development of increasing tolerance. Regular, frequent increments in doses were needed to prevent the emergence of withdrawal symptoms. The poor suppression of craving (drug hunger) and drug-seeking behavior, unless doses were regularly increased, made it difficult to reach a steady state. In view of the anticipated limitations of why the sings book, morphine as a maintenance agent, a search was made for a medication that would block withdrawal symptoms of heroin addicts and that would be orally effective, long-acting, nonsedating, and devoid of adverse side effects. Methadone, a synthetic opiate compound originally synthesized in Germany for use as an analgesic in World War II, was selected for study in Use of Cellphones, 1964. Methadone had been introduced between 1958 and 1962 at the USPHS hospital in Lexington, at maps lovers the Bellevue Medical Center in New York City, and at a limited number of Essay on The Use of Cellphones, other sites for bird sings book, detoxification treatment of heroin addiction. In the During early detoxification programs it was given in Essay, three or four small daily doses, usually 5 to 10 mg each, because the Essay Use of Cellphones prolonged duration of action was not yet appreciated and a space odyssey, no analytical techniques existed for objective measurements of pharmacokinetics.
The purpose of these detoxification programs was to wean patients off heroin so that they could pursue a drug-free lifestyle. However, these efforts largely failed. Within weeks following methadone detoxification all patients quickly relapsed and returned for repeat detoxification in Essay Emergencies, a revolving-door fashion. Certain characteristics were thought to Technology Guidelines Essay be important for successful pharmacotherapy for opiate addiction, including systematic bioavailability after oral administration and prolonged duration of action. An oral route of administration was thought to be more acceptable to patients and, thus, would enhance patient compliance. Oral medication would also eliminate the risk of blood-borne infection (principally serum hepatitis) associated with intravenous administration coupled with use of unsterile or shared needles and syringes. Essay Cellphones! Lastly, oral administration would disrupt the symbolic linkage to an illicit lifestyle and, practically, diminish the behavior of congregating to share needles and other drug paraphernalia. A prolonged duration of action (a long-acting pharmacokinetic profile) was desired so that the dosing regimen could be infrequent, preferably once daily. In addition to ensuring better compliance with the medication, long intervals between doses would minimize inter-dose opiate withdrawal or abstinence symptoms. It was hypothesized that such a long-acting pharmacokinetic profile.
would also permit normalization of specific physiological functions disrupted by chronic use of short-acting opiates such as heroin. It was further hypothesized, and later proven, that long-acting agents would be effective at a stable dose for a much longer period of a space odyssey, time owing to Essay Cellphones Emergencies slower development and sustained level of tolerance. In fact, subsequent studies have shown that once the daily dose of methadone has been stabilized, tolerance does not develop to the essential effects of methadone (prevention of opiate abstinence symptoms and prevention of drug hunger or craving) as used in maintenance treatment. Thus, steady constant doses can be used for hal 2001 a space odyssey, years to treat heroin addiction effectively. On The Emergencies! In 1964, only why the bird book methadone met the criteria of being orally effective and long-acting.
In 1993, another related synthetic opiate, LAAM, was approved by FDA as a pharmacotherapeutic agent for opiate addiction. LAAM has an Use of Cellphones During, even slower onset of action than methadone and more prolonged duration of action. 1 (See Pescor, 1943; Dole et al., 1966; Kreek, 1973c, 1987b; Dole, 1988; Kreek, 1991, Kreek 1992a, Kreek 1992b, Kreek 1992c.) While clinicians treating heroin addicts were developing new pharmacotherapeutic approaches, important discoveries from for lost lovers, basic science regarding opiate physiology began to emerge. A breakthrough in the study of the neurobiological basis of opiate effects was the Essay on The Use of Emergencies discovery in 1973 by three independent groups, those of Snyder at Johns Hopkins University, Simon at New York University, and Terenius at the University of Uppsala (Sweden), of specific opiate receptors.
These studies revolutionized the field of neuropharmacology and neurochemistry and were based, in part, on the earlier work of Dole and Goldstein. Later, three typesmu, delta, and kappaof specific opiate receptors were identified. In 1975, the first class of feudalism, endogenous opioid peptide ligands, the enkephalins, were discovered by Kosterlitz and on The Use of Cellphones Emergencies, Hughes. Lovers! Such compounds, generically called endorphins, can be thought of as the body's endogenous morphine-like substances in that they share structural and physiological similarities with morphine and heroin. Soon thereafter, attention focused on three separate classes of endogenous opioid ligands that bind to Essay Use of During the specific opioid receptors. In animals, many of the Shakespeare well-known opiate effects have been reproduced by administering large amounts of Essay on The Use of Emergencies, these endogenous opioids.
This pharmacologic effect depends primarily on the metabolism of the parent LAAM compound to two active metabolites, noracetylmethadol and dinoracetyl-methadol. These two metabolites are pharmacologically active and are even longer acting than LAAM, permitting an on Disestablishing Shakespeare, every two- or even every three-days dosing schedule. Tolerance develops to Use of During Emergencies some of these natural opioid peptide effects. Work Technology Essay! The specific relationships between the action of endogenous opioid peptides and discrete physiological functions are still being defined. Endogenous opioids or endorphins include the enkephalins, dynorphins, and beta-endorphin. The three opioid peptide genes have been cloned, and each encodes a single large peptide, which is then processed to Essay on The Use of Cellphones Emergencies yield all of the feudalism in germany opioid peptides within a class: proenkephalin, prodynorphin, and proopiomelanocortin, the latter of which contains both beta-endorphin and other important nonopioid peptide hormones including adrenocorticotropin hormone (ACTH). As mentioned above, there are at least three types of specific opiate receptors, mu, delta, and Use of During Emergencies, kappa, each of which may have several subtypes. Maps For Lost Lovers! The genes for each of Emergencies, these receptor types have also been cloned very recently.
Recent studies using transfected opioid receptors have shown that methadone binds primarily or exclusively to the mu type of opiate receptor, with greater selectivity than morphine or most other commonly used mu receptor preferring ligands. Currently, studies are in progress to localize and characterize gene expression of the endogenous opioid system peptide and receptor genes, to assess the effects of drugs of abuse and treatment agents on gene expression, and to understand the complex molecular biological interactions of this system. Both basic and clinical studies have focused on the possible role of the endogenous opioid system in the biological basis of addiction. Maps For Lost! This system involves numerous brain regions and types of opioid peptides. On The Use Of Cellphones Emergencies! Although the complex interactions of this system within the brain are not fully understood, data suggest that cycles of heroin addiction severely disrupt this system and that chronic, steady-state methadone maintenance attenuates this disruption.
A metabolic disease concept has been suggested, in addition, which holds that some individuals may be predisposed to heroin addiction because variations in their genes result in abnormal levels of endogenous opioid peptides, levels that can be corrected by taking heroin (Goldstein, 1994). The effect of heroin addiction on the genetic regulation of the endogenous opioid system is currently an active area of research that is beginning to reveal intriguing clues about the Technology biological underpinnings of Essay on The During, addiction. Another area of particular interest is the possible role the endogenous opioid system plays in in germany, stress. It has been hypothesized that an atypical responsivity to stress, including the common stresses in our daily environment, may contribute to the acquisition of drug-seeking behavior, and both laboratory and on The Use of Cellphones Emergencies, basic clinical research studies have been conducted to define the stress responsive axis in why the bird, humans with addictive diseases and in on The Use of During Emergencies, animal models. Hal 2001! One of the most important modulators of stress responsivity is the hormones of the hypothalamic-pituitary-adrenal axis. It is known that a peptide hormone released from the hypothalamus, corticotropin releasing factor (CRF), drives.
the anterior pituitary in humans to release peptides from one important gene product, proopiomelanocortin (POMC), which yields both the long known peptide hormone ACTH and as one of the endorphins, beta-endorphin. ACTH then acts peripherally on the adrenal gland to cause release of the critically important glucocorticoid steroid in Essay on The Use of, humans, cortisol. In addition to many peripheral actions, cortisol acts in a negative feedback control manner to caged control both CRF release from the hypothalamus and the release of POMC peptides, ACTH, and beta-endorphin, from the anterior pituitary in humans. Essay Emergencies! Studies using opioid antagonists have shown that the endogenous opioids-like exogenous opiods, modulate the stress responsive axis. However, whether the effects of the antagonists are mediated wholly through central actions of the brain opiods, or whether peripheral βEndorphin plays a role remains to be determined. (See Dole, 1970; Ingoglia and Dole, 1970; Goldstein et al., 1971; Kreek, 1973a, Kreek, 1973c; Pert and Snyder, 1973; Simon et al., 1973; Terenius, 1973; Hughes et al., 1975; Kreek, 1978b; Kreek and maps lovers, Hartmen, 1982; Kreek, Schaefer, et al., 1983; Kreek, Wardlaw, et al., 1983; Kreek, Raghunath, et al., 1984; Kreek, Schneider, et al., 1984; Kreek, 1987a; Branch et al., 1992; Evans et al., 1992; Hurd et al., 1992; Kiefer et al., 1992; Kreek, 1992c; Chen et al., 1993a, 1993b; McGinty et al., 1993; Spangler et al., 1993a, 1993b, 1994; Wang et al., 1993; Yasuda et al., 1993; Unterwald et al., 1993; Kreek, Simon, et al., 1994; Spangler et al., (in press.) When methadone maintenance was in its early stages of research and development as a possible treatment for opiate addiction, there were no adequately sensitive and specific analytic methods (e.g., gas-liquid chromatography, mass spectrometry, high-performance liquid chromatography or radioimmunoassay techniques) with which to assess the pharmacokinetics of methadone (or any other opiate such as morphine and heroin); that is, the Use of Cellphones Emergencies time course of distribution, metabolism, and on Disestablishing Shakespeare, clearance in the body.
Some researchers turned to animal models for initial pharmacodynamic and sometimes pharmacokinetic research. These were not helpful, however, because the pharmacokinetic profile and duration of action of methadone (and also LAAM) were much longer in humans than in rodent models. On The Use Of Cellphones During Emergencies! Consequently, the Essay on Disestablishing Shakespeare relative duration of action of opiates was assessed by careful clinical observations of pain patients and opiate addicts receiving methadone in on The Use of Emergencies, clinical research settings. Both morphine-induced analgesia in pain patients and euphoria in opiate addicts have a rapid onset and decline; within 46 hours, another dose is. required. However, clinical studies demonstrated important differences between morphine and methadone in these two patient groups. Although in early studies methadone seemed to provide full analgesia for only 46 hours in pain patients, similar to morphine, when repeated doses of methadone were given over caged bird 24 hours, opiate-like side effects were observed. This suggested an Essay on The Use of Cellphones During Emergencies, accumulation of methadone and, thus, a much longer half-life of this medication. When methadone was given to heroin addicts, it seemed to Augustus, John and Jesus Essay prevent signs and symptoms of on The Cellphones During Emergencies, withdrawal for 24 hours. During oral administration of methadone to opiate addicts on maps lovers, doses selected to be less than those to which tolerance had been developed, the high or euphoria, and Use of During, all other perceived opiate effects, are minimal or even absent.
In the early 1970s, appropriate analytical techniques were developed to measure plasma levels of methadone. These techniques substantiated the maps for lost lovers early clinical observations and showed that there was a gradual onset of action of orally administered methadone and that low peaks of Essay on The Cellphones Emergencies, methadone were reached. Peak plasma levels were usually less than twice the trough levels, and relatively steady-state sustained plasma levels of methadone were maintained during the remainder of the 24-hour dosing interval. The mechanisms that maintain the steady-state plasma levels were shown to include binding of caged bird book, methadone in body tissues (primarily the liver), with subsequent release into the circulation, and extensive plasma protein binding, which limits plasma total and unbound concentrations of methadone and prolongs the pharmacological actions of methadone in patients receiving a daily maintenance dose. LAAM has also been shown to share this reservoir property with methadone. Thus, methadone, unlike the short-acting opiates such as morphine and heroin, appears to have its own timed-release mechanism within the body and this makes it very well suited to daily interval dosing. The resultant prolonged pharmacokinetic half-life probably accounts for the diminished or absent physiological and Essay on The During, behavioral effects typical of short-acting opiates. (See Inturrisi, and Verebely, 1972; Sullivan et al., 1972; Dole and Kreek, 1973; Kreek, 1973d; Anggard et al., 1974; Hachey et al., 1977; Kreek et al., 1978; Kreek, Hachey, et al., 1979; Nakamura et al., 1982; Kreek, 1991c) In maintenance treatment of Shakespeare, opiate addicts, methadone is administered as a single constant daily dose after the induction period is Essay on The Use of Cellphones During Emergencies over. On this schedule patients exhibit no signs of opiate withdrawal during the 24-hour interval between doses. If a daily dose is missed or omitted, however, a patient on.
methadone maintenance will exhibit signs and symptoms of opiate withdrawal, usually within 24 to 36 hours after the Guidelines last dose of methadone. The intensity of these signs and symptoms increases gradually if the patient remains off methadone. A daily dose of methadone stabilizes a maintenance patient pharmacologically by the creation of a drug reservoir in the tissues of the body that holds the plasma level within narrow limits. This buffering action makes short-term minor fluctuations in medication release from the tissue reservoir unimportant. On The Use Of Emergencies! Although opiate withdrawal symptoms can be prevented with low doses, it is important to provide adequate treatment doses (60120 mg/day in Work, most patients) to on The Cellphones Emergencies assure plasma levels that blockade the effects of any superimposed short-acting opiates. The well-documented importance of constant, steady blood levels argues strongly against the sometimes-used practice of using methadone dose level as a reward or punishment variable in so-called contingency contracting or other behavioral interventions. There are conditions under which the tissue reservoir appears to be less effective and withdrawal symptoms may appear earlier or more often. One of these is severe, chronic liver disease, such as postviral or alcoholic cirrhosis, which probably results in a reduction in the amount of hepatic storage capacity for methadone. Work! Less severe liver disease does not seem to have this effect. Also, drug interactions of specific types may accelerate the metabolism of methadone and decrease its effectiveness (see below).
(See Dole et al., 1966; Kreek, 1973c; Kreek, 1978b; Kreek, Oratz, and Rothschild, 1978; Novick, Fanizza, et al., 1981; Kreek, 1983a; Novick, Kreek, Arns, et al., 1985; Ball and Essay Use of Emergencies, Ross, 1991, Kreek, 1991c.) Effects, Side Effects, and Special Pharmacological Issues. In the original maintenance research in 1964, divided methadone doses were used very briefly, but, as already mentioned, soon it was found that a single daily dose of methadone could suppress withdrawal symptoms for 24 hours. Caged Book! Then, cross-tolerance or narcotic blockade and on The, treatment studies were conducted to determine if methadone could be used to stabilize former active heroin addicts on a single, steady, oral dose, and thus prevent withdrawal symptoms, craving, and drug-seeking behavior. The level of tolerance to methadone developed during maintenance treatment, and cross-tolerance to other superimposed opiate drugs, is high. In the 1964 research, the feudalism phenomenon of narcotic blockade was described in which cross-tolerance blocks the effect of any superimposed short-acting opiate drug.
In double-blind studies conducted on on The Use of, former heroin addicts stabilized on full treatment doses of a space odyssey, methadone, doses of heroin far exceeding those that. might be used illicitly had no effects in the research subjects. Occasional medication errors have also been reported in which a stabilized, long-term, methadone-maintained patient has been given up to 10 times the usual dose of medication and, in most cases, there were no untoward effects except for Essay on The, somnolence. The strength of feudalism in germany, narcotic blockade and the level of tolerance and cross-tolerance in maintained patients, however, are dependent upon the dose of methadone. On The Use Of! For example, a 40-mg dose or less of methadone can easily be overridden by common street doses of heroin. Studies have confirmed that continued illicit heroin use is much more prevalent among addicts on lower doses of methadone compared with those receiving higher doses (60 mg and more daily). The early and subsequent ''blockade'' or cross-tolerance studies have shown that it is difficult for patients to override methadone doses of 60120 mg/day with heroin to get any euphoria or any other perceived or observable opiate effects. This lack of any override effect has been established in the clinical research laboratory and Augustus, Essay, subsequently on the street. Studies have demonstrated that the double-blind administration of heroin, morphine, hydromorphoneall administered in typical street doses to methadone-maintained patient subjectsproduced no narcotic-like effects. In addition, single-blind administration of heroin in increasing doses to methadone-maintained research volunteers had no effects until the doses of on The Cellphones During Emergencies, heroin administered (up to 200 mg) exceeded street amounts commonly used at lovers that time. On The During Emergencies! Such studies have demonstrated that the margin of safety with respect to respiratory depression is feudalism very high.
Consequently, if an individual maintained on methadone sought to get high on heroin (which frequently is attempted during the first few weeks in treatment), he or she is not likely to Essay Use of Cellphones During Emergencies experience any desired or adverse effects. Although some methadone is diverted to the street, the why the bird sings book instances of primary addiction to methadone are extremely rare. Use Of Cellphones During! Illicit methadone is used primarily by addicts to self-medicate for a short time for detoxification purposes or for extended periods in a maintenance mode. (See chapter 4 for Work, an extended discussion of diversion.) The acute effects of any opiate in a naive individual are significantly different from chronic effects because tolerance develops, albeit at varying rates to most, but not all, of the opiate effects. Diverse acute effects of opiates involving multiple organ systems have been recognized for Essay on The Use of Cellphones Emergencies, years and more carefully defined and studied in recent years. The protocol for induction into methadone treatment that was developed in the initial studies of methadone maintenance treatment is still used today. During the first few weeks of maintenance treatment, the daily dose gradually is increased at a rate slow enough to prevent any appearance of narcotic-like effects. From around two months onward, doses are held constant at an adequate blockading level, usually of 60 to 120 mg, to provide cross-tolerance and thus prevent any appearance of euphoria if the patient should attempt to superimpose the a space use of illicit heroin. The patient is, thus, stabilized on pharmacotherapy so that withdrawal symptoms and Essay on The Use of Cellphones During, drug hunger or craving are fully suppressed, but are unaccompanied by intolerable side effects.
The side effects, which may occur if methadone is John the Baptist and Jesus Essay used in Essay on The Use of Cellphones During Emergencies, doses exceeding the degree of tolerance developed, are somnolence, drowsiness, nausea, vomiting, insomnia, difficulty in urination, edema of the lower extremities, and constipation (to be discussed later). They diminish as tolerance develops and may be prevented with administration of appropriate doses of a space, methadone. Chronic liver disease is the most common medical problem seen in heroin addicts, and the chronic sequelae of liver infection or injury persist during methadone treatment. Essay During Emergencies! The majority of heroin addicts entering methadone maintenance treatment have biochemical evidence of chronic liver disease, and, until very recently, 80 to 90 percent have serological evidence of exposure to hepatitis B and/or hepatitis C. In some regions of the country, up to 30 percent also have serological evidence of infection with hepatitis delta. Of patients maintained on methadone for Shakespeare, months to years, over one-half have persistent biochemical liver abnormalities. In these patients, the abnormalities result from the complications of Essay Use of During Emergencies, previous heroin addiction and include viral hepatitis of one or more type, comorbidity with alcoholism, or both. Methadone itself is not hepatotoxic; patients entering treatment with normal liver function maintain normal liver function during long-term treatment. Chronic renal disease is a medical problem in some heroin addicts entering methadone maintenance, but the presence of chronic renal disease does not result in lovers, the systemic accumulation of methadone or its metabolites. In such patients plasma levels of methadone remained within the Essay Use of Cellphones During appropriate therapeutic ranges for the doses received. Work! This is on The Use of Cellphones During Emergencies because methadone metabolites are inactive; also, unlike morphine and for lost, heroin, methadone and its metabolites are normally excreted in part in feces as well as in urine and may be exclusively excreted by the hepatobiliary fecal route in the presence of renal disease.
The influence of pregnancy on Essay on The During, the use and effects of methadone has also been investigated. Plasma concentrations of methadone are significantly lower and systemic elimination of methadone more rapid as pregnancy progresses through the third trimester. Thus, some women report symptoms of opiate withdrawal during late pregnancy, even when the daily dose of methadone remains constant. Accordingly, increased methadone doses (and certainly no dose reduction) may be required to maintain adequate levels of methadone for effective treatment during the third trimester. In addition to minimizing risk of. relapse, it is important to suppress withdrawal symptoms, because they can trigger premature labor. To date, the caged sings only adverse effects of methadone maintenance treatment on the fetus have been the production of Essay During Emergencies, physical dependence, which causes mild to modest opiate withdrawal signs and symptoms in the early postnatal period in many, but not all, babies.
This is readily managed by appropriate treatment with an opiate such as paregoric, tincture of opium, or oral morphine. No chronic sequelae of maternal methadone treatment have been found, nor have any teratogenic effects been reported. (See Dole et al., 1966; Cherubin et al., 1972; Gordon and John and Jesus Essay, Appel, 1972; Kreek, Dodesn, et al., 1972; Kreek, 1973a; Stimmel et al., 1973; Kreek, Schecter, Gutjahr, Bowen, et al., 1974; Kreek, 1978b; Kreek, 1979; Beverly et al., 1980; Kleber et al., 1980; Kreek, Gutjahr, and Hecht, 1980; Hartman et al., 1983; Kreek, 1983b; Novick, Farci, Karayiannis, 1985; Pond et al., 1985; Kreek, Khuri, et al., 1986; Novick, Khan, and Kreek, 1986; Novick, Stenger, et al., 1986; Kreek, Des Jarlais, et al., 1990; Kreek, 1991c; Kreek, 1992b; Novick, Richman, et al., 1993; Novick, Reagan, et al., in press.) Physiological Functions Disrupted During Heroin Addiction. Addicts inject (or self-administer by another route) themselves repeatedly with increasingly larger doses of heroin, usually sufficient to achieve the desired euphoria or high effect during chronic use of on The Use of Cellphones Emergencies, opiates, and modified responses, or tolerance, to the drug develop. Hal 2001! The first self-administrations of heroin by Essay on The Use of Cellphones During, a curious adolescent are likely to hal 2001 a space odyssey cause nausea with or without an accompanying pleasurable feeling. On The Use Of Cellphones Emergencies! Later, with repeated use of heroin, tolerance rapidly develops to the nausea-producing effect and the euphoria predominates. The euphoric experience becomes central to the addict's life; but with additional heroin use, the addict finds it progressively more difficult to John the Baptist and Jesus achieve euphoria, unless an increasing dose of Essay on The Cellphones During, heroin is used. Tolerance also develops at different rates to most of the opiate effects of methadone as used in maintenance treatment. Most of the initial opiate effects, predominantly somnolence, can be avoided by starting treatment at relatively low doses and increasing the dose gradually to appropriate treatment levels.
Other important physiological functions that are deranged during cycles of heroin addiction include (1) central nervous system stress responses that are mediated by the hypothalamic-pituitary-adrenal axis; (2) reproductive biology hormones of the hypothalamic-pituitary gonadal axis with resultant abnormal function; (3) various indices of immune function that are linked to or modulated by neuroendocrine function. These altered functions, which may contribute to or be part of the feudalism mechanism underlying drug-seeking behavior, have been shown to on The Emergencies normalize during long-term steady-dose methadone treatment. Adverse neuroendocrine effects of heroin, which cause menstrual irregularities in heroin-addicted women, and sexual dysfunction in men and women, reverse in over 80 percent of patients within one to three years. Constipation, a side effect of both short- and long-acting opiates, persists for a protracted period of time; with slow development of tolerance, this effect on Augustus, the Baptist and Jesus, the gastrointestinal tract diminishes. Excessive sweating is a side effect of methadone treatment that, in some patients, does not remit. Some patients (less than 20 percent) continue to complain of Essay Use of Cellphones During, sleep and sexual dysfunction for up to one year or longer, and may experience constipation for up to three years; up to 50 percent experience excessive sweating for even longer periods of time. In contrast to the gradual development of tolerance expressed by reduction at different rates of these diverse side effects, tolerance to sedative and also analgesic effects of opiates develops rapidly and fully in methadone-maintained patients. Consequently, such methadone-maintained patients will experience pain with delivery of a child, surgery, injury, and painful diseases and pharmacologic pain management is hal 2001 odyssey necessary.
Such management can be achieved by use of the usual approved pharmacotherapeutic approaches normally used in Essay During, each medical situation. This includes the use of opiate drugs, such as morphine, when these are the usually indicated medications. The upper range of normal doses of opiate medications, however, and shortened dosing intervals as clinically required of book, short-acting narcotics, are often necessary and effective. (See Blinick, 1968; Renault et al., 1972; Cushman, 1973; Kreek, 1973b; Santen, 1974; Mendelson et al., 1975a, 1975b; Santel et al., 1975; Kosten et al., 1986a, 1986b; Kreek 1987b; Kosten et al., 1992; Kreek, 1992c; Terenius, O'Brien, et al., 1992; Culpepper-Morgan et al., 1993.) Interactions of Methadone with Other Drugs. A fundamental public health issue related to methadone maintenance was whether or not a methadone-maintained patient would be in Essay Cellphones During, jeopardy of overdose if he or she self-administered heroin during methadone treatment. As noted above, the the Baptist Essay 1964 cross-tolerance studies documented that the risk of Cellphones During Emergencies, morbidity or death in methadone patients receiving a full treatment dose (60 to 120 mg per day) is extremely low because of the high level of tolerance (and cross-tolerance to other opiates) developed during treatment. In addition to blocking the euphoric effects of superimposed, short-acting opiate drugs, methadone and its accompanying narcotic blockade may serve. a relapse-prevention function. The suppression and ultimate extinction of drug-seeking behavior should result, theoretically at least, when illicit opiate self-administration is uncoupled from the anticipated and desired opiate effect of euphoria.
The now well-documented significant reduction or cessation of Essay on Disestablishing Shakespeare, illicit opiate use by former heroin addicts stabilized on steady and adequate doses of methadone suggests that this may be due partly to Use of Cellphones the effects of counseling, as well as to the direct biological effects of the drug. As mentioned above, severe liver disease can impair the disposition and bioavailability of methadone, but it is not the sole cause. One major, widely used, antituberculosis drug, rifampin, interacts with methadone to accelerate methadone metabolism in the liver. This interaction is important because opiate addicts are particularly vulnerable to feudalism in germany tuberculosis. Rifampin has been shown to alter significantly the clinical efficacy of methadone by accelerating its metabolism in the liver and thus its rapid removal from the body. This rapid biotransformation of methadone leads to the appearance of on The Use of Cellphones During Emergencies, withdrawal symptoms in patients otherwise well-maintained on methadone. The two major effects of rifampin on methadone metabolism, a lowering of plasma concentrations and increased urinary excretion of the major metabolite, suggest that the drug exerts its effect by enhancing hepatic microsomal enzyme activity.
Another important interaction occurs between the antiseizure drug phenytoin and methadone. Maintained patients can experience moderately severe opiate withdrawal within three to four days of beginning phenytoin therapy for management of epileptic seizures. Studies have shown that phenytoin accelerates methadone metabolism, and methadone dosing adjustments need to be anticipated when phenytoin is John the Baptist Essay initiated or discontinued. Although the question of a possible interaction of methadone with cocaine has been raised, no conclusive data have been forthcoming. Preliminary studies suggest that methadone does not alter cocaine metabolism. However, some studies have suggested that cocaine may, in on The Use of Cellphones Emergencies, some cases, accelerate the metabolism of methadone. Also common in caged bird, a heroin-addicted population is the comorbid incidence of alcohol abuse.
It is on The Use of Emergencies estimated that at least one in four or five heroin addicts, and former addicts maintained on methadone, abuse alcohol. Methadone treatment has been positively associated with reduced alcohol consumption while alcoholic heroin-addicted patients are in treatment; also, increased alcohol consumption is reported by alcoholic heroin addicts when not taking heroin or methadone. Disulfiram (Antabuse) has been used to hal 2001 a space odyssey deter alcoholic abusers from further drinking on the basis of aversive effects of the alcohol-disulfiram interaction. Although alcoholic opiate addicts maintained on methadone can usually be treated safely with disulfiram, in a few patients unwanted side effects have been observed, suggesting a possible methadone-disulfiram interaction that could lead to on The Use of During excess sedation. A theoretical basis for. this effect could include a disulfiram-induced inhibition of the liver microsomal enzymes that are responsible for the metabolism of Essay, methadone, but such an interaction was not found in one study in which average doses of disulfiram were administered to methadone-maintained subjects. Essay Use Of Cellphones Emergencies! This phenomenon, however, might occur when high doses of disulfiram are used, or in patients with severe alcoholic cirrhosis with compromised hepatic drug-metabolizing enzyme capacity. High levels of alcohol itself have been shown to have two opposing interactions with many therapeutic agents, including methadone, and chronic addicts with comorbidity may use large amounts of alcohol. Alcohol is metabolized by the hepatic microsomal enzymes. Why The Sings! When present in on The Use of Cellphones, large amounts, alcohol may retard the caged biotransformation of medications that are metabolized by Essay on The Emergencies, the hepatic P450 enzyme related systems; yet when alcohol levels fall, drug metabolism may be accelerated due to the chronic effects of alcohol on for lost lovers, hepatic microsomal enzyme activity. (See Kreek, 1973; Kreek, Garfield, et al., 1976; Kreek, Gutjahr, et al., 1976; Kreek, 1978a; Tong et al., 1980; Kreek, 1981; Tong et al., 1981; Kreek, 1983a; Kreek, 1987a; Kreek, 1990a; Borg et al., 1993.)
Impact of Methadone Maintenance on Infectious Diseases. By the on The Cellphones During late 1960s, infectious serum hepatitis could be defined more precisely owing to the development of serological tests for hepatitis B disease. The injecting heroin addict was identified as being at very high risk for acquisition and spread of hepatitis B. On Disestablishing! In multiple studies, over 80 percent of the injecting heroin addicts entering methadone treatment had markers of prior infection and 5 to 15 percent had hepatitis B antigenemia. On The During Emergencies! 2 However, studies have also shown that after 10 years or more in why the caged book, maintenance treatment, the percentage of patients with hepatitis B antigenemia drops to less than 5 percent. By the late 1970s a second and lethal form of on The Use of Cellphones During Emergencies, hepatitis, caused by a viroid-like circular RNA agent (delta agent) that requires hepatitis B for its own infectiousness, was discovered and its biology defined.
By retrospectively examining banked sera and by prospectively testing those entering treatment for addiction, it was found that hepatitis delta had entered the untreated heroin addict population in New York City by the mid-1970s. By 1984, approximately 90 percent of the untreated heroin addicts on the streets of New York City. A positive marker for hepatitis B virus antigen, indicating the feudalism presence of live hepatitis B virus and thus potential viral replication. continued to show evidence of having been infected with hepatitis B, as evidenced by Essay on The Cellphones Emergencies, the presence of Work, some marker for that disease; and approximately 30 percent by on The During, that time had evidence of John, hepatitis delta infection. Recently, the third type of hepatitis virus infection, hepatitis C, was identified. Studies have shown hepatitis C virus infection in 80 to 90 percent of Essay Use of, heroin addicts and former heroin addicts in the Baptist Essay, methadone treatment.
In 1981, shortly after the clinical symptoms of AIDS were characterized, the etiological viral agent HIV-1 was identified. By examining blood samples that had been banked prospectively from 1969 onward, it was found that HIV-1 infection had reached the drug-injecting population in New York City in 1978 and infection had progressed rapidly until 19831984, when the prevalence of HIV-1 infection reached a level of over 50 percent of Essay on The Cellphones During Emergencies, intravenous users in why the caged sings book, the inner city area. Essay Use Of During! Of public health importance, investigators further found that heroin addicts in New York City who had entered effective methadone maintenance treatment programs before the 1978 advent of the maps AIDS epidemic and who remained in treatment displayed a much lower incidence of HIV-1 infection in Use of, 1984 than did untreated heroin addicts: less than 10 percent of such methadone patients were infected in 1984, compared to over 50 percent of untreated heroin addicts. Studies of HIV-1 infection in long-term, methadone-maintained patients have been reported in Sweden and other countries worldwide with similar findings of efficacy of methadone treatment in the prevention of HIV-1 infection. It should be recognized that sharing of unsterile needles is not the only mode of HIV-1 transmission among addicts.
Cocaine use by methadone patients is also a risk factor for Work, HIV-1 infection, owing to promiscuous sexual behavior commonly associated with cocaine, including sex as payment for Essay Use of Cellphones Emergencies, the drug. Concurrent use of cocaine by heroin addicts is estimated to be between 50 and 90 percent and, thus, is an feudalism, added risk factor in the heroin-using population. Once in treatment, the prevalence of cocaine use among heroin addicts generally drops to between 20 and 40 percent. Finally, and Essay Use of, of potentially great importance, studies have shown that multiple indices of in germany, immune function are deranged during cycles of heroin addiction, probably because of many factors, including lifestyle, multiple infectious diseases, and Essay During Emergencies, possible direct or indirect effects of the hal 2001 drug use. Immune factors, however, normalize during chronic long-term methadone treatment. Natural killer cell activity is not altered by methadone in vitro . Long-term methadone maintenance permits return to Essay on The Cellphones normal levels of natural killer cell activity, as well as to normal absolute numbers of B cells and T cell subsets, which may have important implications for immune system function and, possibly, for retarding the progress of Augustus, John Essay, HIV-1 infection to AIDS. (See Kreek, Dodesn, et al., 1972; Kreek, 1978b; Kreek, 1983b; Des Jarlais, Marmor, et al., 1984; Novick, Farci, Karayiannis, et al., 1985; Kreek, Khuri, et al., 1986; Novick, Khan, et al., 1986; Novick, Kreek, Des Jarlais, et al., 1986; Blix, 1988; Novick, Farci, Croxson, et al., 1988; Chaisson et al., 1989; Des Jarlais et al., 1989; Kreek, 1989; Novick, Ochshorn, Ghali, et al., 1989a; Ochshorn et al., 1989; Kreek, 1990b, 1990c; Kreek et al., 1990; Ochshorn et al., 1990; Kreek, 1991b; Novick, Ochshorn, and Kreek, 1991; Novick, Reagon, et al., in press.) Albeck, H, Woodfield, S, and Kreek, MJ. 1989. Quantitative and pharmacokinetic analysis of naloxone in plasma using high performance liquid chromatography with electrochemical detection and solid phase extraction. Essay Cellphones During! Journal of Chromatography 488:435445.
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Jaffe, eds. New York: Raven Press. Pp. 205230. Kreek, MJ, Des Jarlais, DC, Trepo, CL, Novick, DM, Abdul-Quader, A, and Raghunath, J. 1990. Contrasting prevalence of Essay Use of During Emergencies, delta hepatitis markers in parenteral drug abusers with and without AIDS. Journal of Infectious Diseases 162:538541. Kreek, MJ, Dodes, L, Kane, S, Knobler, J, and Martin, R. 1972. Long-term methadone maintenance therapy: Effects on liver function. In Germany! Annals of Internal Medicine 77:598602. Kreek, MJ, Garfield, JW, Gutjahr, CL, and Giusti, LM.
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Annals of the New York Academy of Sciences 281:350370. Kreek, MJ, Hackey, DL, and why the bird book, Klein, PD. 1979. Stereoselective disposition of methadone in man. Life Sciences 24:925932. Kreek, MJ, and Cellphones, Hartman, N. Hal 2001 A Space! 1982. Essay Cellphones During! Chronic use of opioids and antipsychotic drugs: Side effects, effects on the Baptist Essay, endogenous opioids and toxicity. Annals of the New York Academy of Sciences 398:151172. Kreek, MJ, Khuri, E, Fahey, L, Miescher, A, Arns, P, Spagnoli, D, Craig, J, Millman, R, and Harte, E. 1986. On The Cellphones During! Long-term follow-up studies of the for lost lovers medical status of adolescent former heroin addicts in chronic methadone maintenance treatment: Liver disease and immune status.
In: Problems of Drug Dependence, 1985; Proceedings of the 47th Annual Scientific Meeting of The Committee on Problem of Drug Dependence . L.S. Harris, ed. NIDA Research Monograph 67, Rockville, Md., DHHS Publication No.(ADM) 86-1448. Pp. Essay On The Use Of Emergencies! 307309. Kreek, MJ, Oratz, M, and Rothschild, MA. 1978.
Hepatic extraction of long-and short-acting narcotics in the isolated perfused rabbit liver. Gastroenterology 75:8894. Kreek, MJ, Raghunath, J, Plevy, S, Hamer, D, Schneider, B, and Hartman, N . Technology! 1984. ACTH, cortisol and beta-endorphin response to metyrapone testing during chronic methadone maintenance treatment in humans. Use Of During! Neuropeptides 5:277278. Kreek MJ, Schaefer, RA, Hahn, EF, and Fishman, J. 1983. Naloxone, a specific opioid antagonist, reverses chronic idiopathic constipation. Lancet (Feb. 5) 261262. Kreek, MJ, Schecter, A, Gutjahr, CL, Bowen, D, Field, F, Queenan, J, and Merkatz, I. 1974.
Analyses of methadone and other drugs in maternal and neonatal body fluids: Use in in germany, evaluation of symptoms in Essay Use of Cellphones, a neonate of mother maintained on methadone. American Journal of Drug and Alcohol Abuse 1:409419. Kreek, MJ, Schecter, AJ, Gutjahr, CL, and Hecht, M. 1980. Lovers! Methadone use in patients with chronic renal disease. Drug and Cellphones During Emergencies, Alcohol Dependence 5:197205. Kreek, MJ, Schneider, BS, Raghunath, J, and Plevy, S. 1984. Prolonged (24 hour) infusion of the Work Technology opioid antagonist naloxone does not significantly alter plasma levels of cortisol and ACTH in humans. Abstracts of the Seventh International Congress of Endocrinology, Excerpta Medica , International Congress Series 652, Amsterdam Oxford-Princeton. P. 845. July.
Kreek, MJ, Simon, E, Evans, C, Uhl, G, Wang, J-B, Johnson, P, Imain, Y, Waltherm, D, Wu, JM, Wang, WF., Moriwaki, A, Yu, L, Min, B, Augustin, L, Felsheim, R, Fuchs, J, Hoh, H, and Inturrisi, C. In press. Use Of! Symposium for 20th anniversary. In: Problems of Drug Dependence, 1994; Proceedings of the 56th Annual Scientific Meeting of the Committee on Problems of Drug Dependence , L.S. Essay Shakespeare! Harris, ed. NIDA Research Monograph Series, Rockville, Md. Kreek, MJ, Wardlaw, SL, Hartman, N, Raghunath, J, Friedman, J, Schneider, B, and Frantz, AG. 1983. Essay On The Emergencies! Circadian rhythms and levels of beta-endorphin, ACTH, and cortisol during chronic methadone maintenance treatment in maps, humans. Life Sciences 33 (Suppl.
I):409411. McGinty, JF, Daunais, JB, and on The Use of, Roberts, CS. 1993. Essay! Cocaine self-administration causes an increase in preprodynorphin, but not c-fos, mRNA in rat Striatum. In: Problems of on The Cellphones During, Drug Dependence, 1992: Proceedings of the 54th Annual Scientific Meeting of the Committee on Problems of Drug Dependence, NIDA Research Monograph Series, Rockville, Md. P. 143. Mendelson, JH, Mendelson, JE, and Patch, YD. 1975a. Plasma testosterone levels in feudalism, heroin addiction and during methadone maintenance. Journal of Pharmacology and Experimental Therapeutics 192:211217. Mendelson, JH, Meyer, RE, Ellingboe, J, et al.
1975b. Effects of heroin and Essay on The Cellphones Emergencies, methadone on plasma cortisol and testosterone. Journal of Pharmacology and Experimental Therapeutics 195:296302. Nakamura, K, Hachey, DL, Kreek, MJ, Irving, CS, and why the bird sings, Klein, PD. 1982. Use Of Cellphones During Emergencies! Quantitation of methadone enantiomers in humans using stable isotope-labeled 2H3, 2H5, 2H8 methadone. Journal of Pharmaceutical Sciences 71:3943.
Novick, DM, Farci, P, Croxson, ST, Taylor, MB, Schneebaum, CW, Lai, EM, Bach, N, Senie, RT, Gelb, AM and Kreek, MJ. 1988. On Disestablishing! Hepatitis delta virus and human immunodeficiency virus antibodies in parenteral drug abusers who are hepatitis B surface antigen positive. Journal of Infectious Diseases 158:795803. Novick, DM, Farci, P, Karayiannis, P, Gelb, AM, Stenger, RJ, Kreek, MJ, and Thomas, HC. Essay Use Of During! 1985. Hepatitis D virus antibody in HBsAg-positive and HBsAg-negative substance abusers with chronic liver disease. For Lost! Journal of Medical Virology 15:351356. Novick, DM, Khan, I, and Kreek, MJ.
1986. Acquired immunodeficiency syndrome and infection with hepatitis viruses in individuals abusing drugs by injection. United Nations Bulletin on on The Use of During, Narcotics 38:1525. Novick, DM, Kreek, MJ, Arns, PA, Lau, LL, Yancovitz, SR, and Gelb, AM. 1985. Effects of severe alcoholic liver disease on the disposition of methadone in maintenance patients.
Alcoholism, Clinical and Experimental Research 9:349354. Novick, D, Kreek, MJ, Des Jarlais, D, Spira, TJ, Khuri, ET, Raghunath, J, Kalyanaraman, VS, Gelb, AM, and hal 2001 odyssey, Miescher, A. 1986. Antibody to LAV, the putative agent of AIDS, in parenteral drug abusers and methadone-maintained patients: Abstract of clinical research findings: Therapeutic, historical, and Essay on The Cellphones, ethical aspects. In: Problems of Drug Dependence, 1985; Proceedings of the 47th Annual Scientific Meeting of the Committee on Problems of Drug Dependence . L.S. Harris, ed. NIDA Research Monograph Series, Rockville, Md., DHHS Publication No. (ADM) 86-1448. Pp.
318320. Novick, DM, Kreek, MJ, Fanizza, AM, Yancovitz, SR, Gelb, AM, and Stenger, RJ. 1981. Methadone disposition in patients with chronic liver disease. Clinical Pharmacology and Therapeutics 30:353362. Novick, DM, Ochshorn, M, Ghali, V, Croxson, TS, Mercer, WD, Chiorazzi, N, and Kreek, MJ. 1989. Natural killer cell activity and lymphocyte subsets in on Disestablishing Shakespeare, parenteral heroin abusers and long-term methadone maintenance patients. Journal of Pharmacology and Experimental Therapeutics 250:606610. Novick, DM, Ochshorn, M, and Kreek, MJ.
1991. In vivo and in vitro studies of opiates and cellular immunity in narcotic addicts. In: Drugs of Abuse, Immunity and Immunodeficiency , H. Friedman, In press. Essay On The Cellphones During Emergencies! New York: Plenum Press. Pp. 159170. Novick, DM, Reagan, KJ, Croxson, TS, Gelb, AM, Stenger, RJ, and Kreek, MJ.
Hepatitis C virus serology in Essay on Disestablishing, parenteral drug users with chronic liver disease. In: Problems of Drug Dependence, 1994: Proceedings of the 56th Annual Scientific meeting of the Committee on Essay on The Use of Cellphones Emergencies, Problems of Drug Dependence , L.S. Harris, ed. Technology Guidelines Essay! NIDA Research Monograph Series, Rockville, Md. Novick, DM, Richman, BL, Friedman, JM, Friedman, JE, Fried, C, Wilson, JP, Townley, A, and Kreek, MJ. Essay During! 1993. On Disestablishing! The medical status of methadone-maintained patients in treatment for 1118 years. Cellphones! Drug and a space, Alcohol Dependence 33:235245. Novick, DM, Stenger, RJ, Gelb, AM, Most, J, Yancovitz, SR, and Kreek, MJ. 1986.
Chronic liver disease in abusers of alcohol and parenteral drugs: A report of 204 consecutive biopsy-proven cases. Alcoholism, Clinical, and Experimental Research 10:500505. Ochshorn, M, Kreek, MJ, Khuri, E, Fahey, L, Craig, J, Aldana, MC, and Albeck, H. 1989. Normal and abnormal natural killer (NK) activity in methadone maintenance treatment patients. In: Problems of Drug Dependence, 1988: Proceedings of the 50th Annual Scientific Meeting of the Committee on Problems of Drug Dependence , L.S.
Harris, ed. During! NIDA Research Monograph Series, Rockville, Md., DHHS Publication No. (ADM) 89-1605. P. On Disestablishing Shakespeare! 369. Ochshorn, M, Novick, DM, and Kreek, MJ. 1990. In vitro studies of methadone effect on natural killer (NK) cell activity. Israel Journal of Medical Sciences 26:421425. Pert, CB, and Essay on The Emergencies, Snyder, SH.
1973. Caged Bird Sings Book! Opiate receptor: demonstration in nervous tissue. Science 179:10111014. Pescor, MJ. On The Use Of Emergencies! 1943. Feudalism! Follow-up study of treated narcotic drug addicts. Public Health Report (Suppl.) 170:1. Pond, SM, Kreek, MJ, Tong, TG, Raghunath, J, and Benowitz, NL. 1985. Essay On The During Emergencies! Altered methadone pharmacokinetics in on Disestablishing Shakespeare, methadone-maintained pregnant women. Journal of Essay on The, Pharmacology and Experimental Therapeutics 233:16.
Renault, PF, Schuster, CR, Heinrich, RL, et al. 1972. Guidelines! Altered plasma cortisol response in patients on methadone maintenance. Essay Use Of During Emergencies! Clinical Pharmacology and Therapeutics 13:269273. Santen, RJ. 1974. How narcotics addiction affects reproductive function in women. Caged Book! Contemporary OB/GYN 3:9395. Santen, RJ, Sofsky, J, Bilic, N, et al. 1975.
Mechanism of action of narcotics in the production of menstrual dysfunction in women. Fertility and Sterility 26:538548. Simon, EJ, Hiller, JM, and Edelman, I. On The Emergencies! 1973. Stereospecific binding of the potent narcotic analgesic [3H]Etorphine to sings rat-brain homogenate. On The Use Of Cellphones During! Proceedings of the National Academy of Sciences 70:19471949.
Spangler, R, Unterwald, EM, Branch, A, Ho, A, and hal 2001 odyssey, Kreek, MJ. 1993a. Chronic cocaine administration increases prodynorphin mRNA levels in the caudate-putamen of rats. In: Problems of Essay Emergencies, Drug Dependence, 1992; Proceedings of the 54th Annual Scientific Meeting of the on Disestablishing Committee on Problems of Drug Dependence . L.S. Harris, ed, NIDA Research Monograph Series, Rockville, Md. DHHS Publication No. (ADM) 93-3505. Essay Cellphones During Emergencies! P. 142.
Spangler, R, Unterwald, EM, and Technology Guidelines Essay, Kreek, MJ. 1993b. ''Binge'' cocaine administration induces a sustained increase of prodynorphin mRNA in rat caudate-putamen. Molecular Brain Research 19:323327. Spangler, R, Zhou, Y, Unterwald, EM, and Kreek, MJ. On The Use Of Cellphones! In press. Opioid receptor mRNA levels in the rat brain determined by TCA precipitation of John and Jesus, mRNA:cRNA hybrids. In: Problems of Drug Dependence, 1994; Proceedings of the 56th Annual Scientific Meeting of the Essay on The Use of Committee on Problems of Drug Dependence , L.S. Harris, ed. NIDA Research Monograph Series, Rockville, Md. Stimmel, B, Vernace, S, Heller, E, et al. 1973.
Hepatitis B antigen and antibody in former heroin addicts on methadone maintenance: Correlation with clinical and histological findings. Why The Caged Bird Book! In: National Association for the Prevention of Addiction to Narcotics, Proceedings of the Fifth National Conference on methadone Treatment . Vol. 1. New York: NAPAN. Pp. 501513. Sullivan, HR, Smits, SE, Due, SL, Booher, RE, and McMahon, RE. 1972. Metabolism of d -methadone: Isolation and identification of analgesically active metabolites. Life Sciences 11(1):10931104. Terenius, L. 1973. Stereospecific interaction between narcotic analgesics and a synaptic plasma membrane fraction of During, rat cerebral cortex.
Acta Pharmacologica ET Toxicologica 32:317320. Terenius, L, and O'Brien, CP. 1992. Technology Guidelines! Receptors and endogenous ligands: Implications for on The Emergencies, addiction. Technology Essay! In: Addictive States CP O'Brien and JH Jaffe, eds. New York: Raven Press. On The Cellphones During! Pp. 123130. Tong, TG, Benowitz, NL, and Kreek, MJ.
1980. Methadone-disulfiram interaction during methadone maintenance. Journal of Clinical Pharmacology 20:506513. Tong, TG, Pond, SM, Kreek, MJ, Jaffery, NF, and the Baptist, Benowitz, NL. 1981. Phenytoin-induced methadone withdrawal. Use Of During! Annals of Internal Medicine 94:349351.
Unterwald, EM, Horne-King, J, and Kreek, MJ. 1993. Chronic cocaine alters brain mu opioid receptors. Brain Research 584:314318. Unterwald, EM, Rubenfeld, JM, Spangler, R, Wang, JB, Uhl, GR, and Kreek, MJ. 1994. Essay Shakespeare! Mu opioid receptor mRNA levels following chronic naltrexone administration. Abstracts of the International Narcotics Research Conference . Unterwald, EM, Rubenfeld, JM, and Kreek, MJ. In press.
Repeated cocaine administration upregulates κ and μ, but not δ, opioid receptors. NeuroReport . Wang, JB, Imai, Y, Eppler, CM, Gregor, P, Spivak, C, and Uhl, GR. Emergencies! 1993. Mu-opiate receptor: cDNA cloning and expression. Proceedings of the Work Guidelines National Academy of Sciences 90:10,23010,234. Yasuda, K, Raynor, K, Kong, H, Breder, CD, Takeda, J, Reisine, T, and Bell, GI.
1993. Essay Cellphones During Emergencies! Cloning and functional comparison of kappa and delta opioid receptors from mouse brain. Essay Shakespeare! Proceedings of the National Academy of Sciences 90:67366740. 500 Fifth St., NW | Washington, DC 20001. For nearly three decades, methadone hydrochloride has been the Essay Use of Emergencies primary means of treating opiate addiction. Today, about 115,000 people receive such treatment, and thousands more have benefited from it in hal 2001 a space, the past. Even though methadone's effectiveness has been well established, its use remains controversial, a fact reflected by the extensive regulation of its manufacturing, labeling, distribution, and use.
The Food and Drug Administration regulates the safety and effectiveness of on The Use of Cellphones During Emergencies, methadone, as it does for all drugs, and Work, the Drug Enforcement Administration regulates it as a controlled substance. However, methadone is also subjected to a unique additional tier of regulation that prescribes how and on The During Emergencies, under what circumstances it may be used to treat opiate addiction. Federal Regulation of Methadone Treatment examines current Department of Health and Human Services standards for hal 2001 a space, narcotic addiction treatment and Essay Use of Cellphones, the regulation of methadone treatment programs pursuant to those standards. The book includes an evaluation of the effect of federal regulations on the provision of methadone treatment services and an exploration of Technology, options for Essay Use of Cellphones, modifying the regulations to allow optimal clinical practice. The volume also includes an assessment of alternatives to the existing regulations. Front Matter i–xii Executive Summary 1–16 Introduction 17–36 Pharmacology and caged book, Medical Aspects of Methadone Treatment 37–60 Who Are the Recipients of Treatment? 61–91 Methadone Diversion Control 92–119 Federal Regulation of Methadone Treatment 120–150 Methadone Treatment 151–184 Treatment Standards and Optimal Treatment 185–216 Implementing Standards--And Beyond 217–238. You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on on The Use of During Emergencies, our website. Do you want to take a quick tour of the OpenBook's features? Show this book's table of contents , where you can jump to any chapter by name.
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In what circumstances can attitudes predict behaviour. In what circumstances can attitudes predict behaviour? This essay aims to show that attitudes do not always predict behaviour, and a number of other variables should be in place before we can estimate the likelihood of a person behaving according to their attitudes. Social Psychologists have suggested that variables such as the intention to act according to attitudes, the perceived control over Essay Use of one's actions, the strength and accessibility of feudalism in germany, attitude, and the situational context shape the circumstances in which attitudes predict behaviour. Attempts to predict behaviour from attitudes without making these crucial qualifications have found a lack of Essay, correlation between attitudes and behaviour. There was a time when the concept of attitudes was hailed as the most important contribution of Social Psychology (Allport 1935). The term 'attitude' is now taken for caged bird, granted in our everyday lay vocabulary, but has been treated with increasing scepticism by Essay, some Social Psychologists. John The Baptist! A major blow to popular assumptions about attitudes came from evidence of a discrepancy between attitudes and behaviour.
This posed serious problems for the study of attitudes, because it was previously believed that attitudes could be inferred from Essay on The Use of Emergencies, behaviour. This apparent discrepancy has led to a re-thinking and refining of the definition of attitudes. The simplest definition of attitude is 'a feeling or opinion about John Essay, something or someone' (Cambridge International Dictionary, 2002). This much Social Psychologists agree on, but from here they diverge. A key difference is over how many components attitudes consist of. The three major models are as follows: The one component model (pioneered by Thurstone), which sees attitudes as emotional assessment of objects; the two component model, which stresses the predisposition to negative or positive action towards an Essay on The Cellphones evaluated object; and on Disestablishing Shakespeare, the three component model, which asserts that attitudes are made up of cognitive, affective and on The Use of During, behavioural components (Hogg, 1998: 118).. It is implicit in the two and three component models that attitudes predict behaviour. The discrepancy between attitude and Work Technology Essay, behaviour, mentioned above, forces us to question these models. On The Cellphones Emergencies! This discrepancy was most dramatically observed in Augustus, John and Jesus, an experiment by LaPiere. Accompanied by Emergencies, two Chinese, he visited 66 hotels, auto-camps and tourist homes, and 184 restaurants. Only one establishment turned them away.
Six months later, LaPiere sent around a questionnaire to the places he had visited, asking 'will you accept members of the Chinese race as guests in your establishment?' 92 per cent of the replies were negative, only one per cent were positive, and the remainder claimed that it would depend on why the book the circumstances (Hogg 1998: 124). Further studies have confirmed LaPiere's findings, and Wicker concluded that at most, attitudes predict only 9 per cent of our behaviour (Wicker 1969). If attitudes do not predict behaviour then perhaps the concept of the attitude is on The Use of, not of such great use after all. Attitudes are also notoriously difficult to measure accurately. Questionnaires are the main techniques for attitude measurement, which rely on honest answers from participants. However, people do not always wish to share their private attitudes, especially if they run counter to the values of the given culture. For example, in Britain today, fewer people would admit to holding racist attitudes than the why the bird sings number that actually have them, because such attitudes are no longer generally considered acceptable. If the measured attitude is Use of Cellphones During, not the same as the actual attitude then it is even harder to assess whether attitudes are predicting behaviour. Maps Lovers! We must remember that 'attitude' is a theoretical construct, which is valid only if it can withstand scientific testing. Cellphones! Because the measurement of attitudes is hal 2001 a space odyssey, imprecise, we cannot really say with confidence what an attitude is. Other methods have been devised for measuring attitudes with greater accuracy, but these are fairly controversial.
The bogus pipeline technique dupes participants into Use of During thinking that they are connected to a 'lie detector' which can judge their emotional responses (Hogg 1998:155). Participants are consequently more honest about their attitudes, since they are led to believe that they cannot hide them if they try. A Space! This method is Essay Cellphones Emergencies, quite effective, but is possibly unethical, as it intentionally misleads participants. Physiological measures of attitude which test skin resistances, heart-rate, and pupil dilations overcome the problem of participant honesty, but have problems of their own. Bird Sings! Other factors than emotional attitudes can influence the physical response, including nervousness induced by being assessed. Furthermore, such physiological measures cannot distinguish negative from on The Cellphones During, positive feelings, as strong feelings of both kinds elicit similar responses (Hogg, 1998: 153). However, these dilemmas have not led Social Psychologists to abandon the study of attitudes.
Ajzen and Fishbein refine the link between attitudes and behaviour, reckoning that attitudes can indeed predict behaviour, but it is a mistake to try to predict specific behaviour from on Disestablishing, general attitudes. Specific attitudes can predict specific behaviour, and general attitudes can predict general behaviours using a multiple act criterion as a behavioural index based on a mean or combination of a number of specific behaviours (Hogg 1998: 126). Fishbein and Ajzen's theory of reasoned action states that behaviour cannot be predicted by attitude alone. Intention to Essay on The Use of During Emergencies, act in a certain way plays a crucial part in Augustus, John the Baptist and Jesus, determining whether or not the action is taken. The actor's intention is Essay on The Use of Cellphones Emergencies, influenced by his own attitude towards the behaviour, and subjective norms, which are the perceived beliefs of other people. Essay On Disestablishing! The value that the Essay individual places on these factors can also vary. Some people are more concerned than others about subjective norms, and in Work Technology Essay, different cases different people care more or less about the object of on The During, their attitudes. Ajzen further refined his perspective on Essay on Disestablishing Shakespeare attitudes with his theory of planned behaviour. This theory also incorporates the effect of the individual's belief that he has control over his actions. People with a greater sense that certain behaviour is feasible are more likely to actually behave in Essay Cellphones, that way.
Madden (1992) showed that students' perceived control over their actions correlates with their intentions to behave and feudalism in germany, their actual behaviour, especially with behaviour that is actually easier to control. Terry (1993) applied the theory of planned behaviour to During, the issue of caged bird sings, safe sex, and found that the degree of control that people believe they have substantially improves the prediction of behaviour from attitudes in this real world context. Both the theory of reasoned action and Use of Cellphones During Emergencies, the theory of planned behaviour place emphasis on the rationality of human behaviour, but not all kinds of behaviour are equally reasoned. A Space! Habit is an important example of behaviour which is not thought through, but occurs almost unconsciously without being mediated by attitudes. Habits are the on The Cellphones result of Essay, repeated previous behaviour, and they guide future behaviour. Cellphones Emergencies! Addictions are extreme kinds of habits, and it is physically and psychologically harder to break them. In the case of smoking, the smoker's behaviour is sings, determined more by his habit than by Essay Use of During, attitudes. A survey showed that 71 per cent of smokers agreed that 'cigarette smoking causes disease and death' (Oskamp 1984), yet the habit had such a hold on them that this attitude did not determine their behaviour. There are also ways in which previous experience can strengthen attitudes and therefore make them more likely to predict behaviour.
Fazio and Zanna (1978) found that the attitudes of students who had previously participated in psychology experiments gave a more accurate prediction of whether they would participate in future psychology experiments than the hal 2001 a space odyssey attitudes of Essay Use of During Emergencies, students who had only read about such experiments.. Fazio proposes attitude accessibility as a factor in determining which attitudes will predict behaviour. Strong attitudes can be more easily accessed from the memory, and Essay Shakespeare, therefore have a greater influence over behaviour. Attitudes which are directly concerned with one's own life are generally stronger, as well as those which are based on direct experience. Simple repetition is also enough to Cellphones, reinforce an attitude. The accessibility of attitudes held by in germany, participants who were asked their attitude six times was greater than that of participants who were only asked once (Powell and Fazio 1984). These theories of attitude do not apply equally to all people at all times. There are a variety of Essay on The Use of During Emergencies, moderator variables which can improve the predictions made of behaviour from attitudes by adjusting the hal 2001 a space odyssey hypotheses to different situations. People tend to express or act on attitudes which are consistent with social norms. Terry argues that attitudes are more likely to predict behaviour if they are markers of a social group with which the person identifies. The more strongly the individual feels associated with the group, the more likely he will be to act on the shared attitudes (Hogg 1998: 133)..
The dispositional perspective emphasises the influence of personality in determining whether attitudes predict behaviour. According to Bem and Allen (1974), people who score consistently on personality tests are more likely to Essay, be consistent in their behaviour across different situations. More accurate predictions can thus be made over whether a person's attitudes will determine their behaviour if the individual has a stable and clearly defined personality. Although we often assume that attitudes predict behaviour, Social Psychologists have seen the need to Augustus, the Baptist, qualify that statement. Social Psychologists have also found that there are instances in Essay Emergencies, which behaviour influences attitudes. The theory of Essay on Disestablishing Shakespeare, cognitive dissonance states that people prefer consistency between their various attitudes and also between their attitudes and on The Use of Cellphones During Emergencies, behaviour. When our beliefs are at odds with our behaviour, we experience feelings of unease, which we wish to reduce by restoring the Essay harmony (Eiser and Pligt 1988: 32).
We can either bring our behaviour in line with our attitudes, or we can bring our attitudes in Essay Use of, line with our behaviour. In many cases, it is more convenient to change our attitudes than our actual behaviour, especially if social or economic circumstances limit the action we can take. We may therefore conclude that attitudes do exert an influence over behaviour, but that the relations between attitudes and Technology, behaviour are not one-sided but dialectical. Previous behaviour can also form and Cellphones, strengthen attitudes, and attitudes can change in order to justify habitual behaviour that is harder to reverse. Caged Sings Book! Attitudes predict behaviour only once strength of habit and many other factors are assessed. Behaviour is guided by Essay Use of Cellphones Emergencies, many things, not merely the attitude of the individual.
In the hal 2001 a space recent decades, Social Psychologists have recognised this and Emergencies, refined their concept of attitude to fit it into the wider context. Behaviour can be predicted from attitudes only if we know the Essay Shakespeare details of the attitudes, the details of the specific situation, and the extent to which the individual wishes to act on his attitudes and During Emergencies, feels that he can. Allport, 1935, 'Attitudes', in Murchison, Handbook of Essay on Disestablishing, Social Psychology, Clark University Press. Bem and Allen, 1974, 'On predicting some of the people some of the time', Psychological Review, 81. Eiser and Pligt, 1988, Attitudes and Decisions , Routledge. Fazio and Zanna, 1978, 'Attitudinal qualities relating to the strength of the attitude-behaviour relation', in on The Use of Cellphones Emergencies, Journal of Experimental Social Psychology, 14. Hogg and Vaughan,1998, Social Psychology , Prentice Hall Madden, 1992, 'A comparison of the Augustus, theory of planned behaviour and the theory of Use of, reasoned action', Personality and Social Psychology Bulletin, 18. Oskamp, 1984, Applied Social Psychology, Prentice Hall. Powell and Fazio, 1984, 'Attitude accessibility as a function of repeated attitudinal expression', Personality and Social Psychology Bulletin, 10.
Terry, 1993, The Theory of Reasoned Action: Its Application to Aids-Preventive Behaviour , Pergamon Marx obfuscated cal1966's realism theory. Wicker, 1969, 'Attitudes versus actions' Journal of Social Issues, 25. If this essay isn't quite what you're looking for, why not order your own custom Coursework essay, dissertation or piece of coursework that answers your exact question? There are UK writers just like me on hand, waiting to help you. Each of us is qualified to a high level in our area of expertise, and we can write you a fully researched, fully referenced complete original answer to your essay question. Just complete our simple order form and bird sings, you could have your customised Coursework work in your email box, in as little as 3 hours. This coursework was submitted to us by a student in Essay on The Cellphones During, order to help you with your studies. This page has approximately words. If you use part of this page in your own work, you need to provide a citation, as follows: Essay UK, In What Circumstances Can Attitudes Predict Behaviour . Available from: http://www.essay.uk.com/coursework/in-what-circumstances-can-attitudes-predict-behaviour.php [03-10-17].
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