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Showing papers in "American Journal of Drug and Alcohol Abuse in 1995"


Journal ArticleDOI
TL;DR: The results obtained can be effectively used to identify which patients are not likely to enter aftercare alcoholism treatment, and the discharge plans of patients at risk for appointment noncompliance should be given special attention.
Abstract: Objective: The objective of this research was to ascertain whether geographical accessibility (in conjunction with other patient characteristics) reduced the probability of participating in alcoholism aftercare treatment. Methods: A sample of 4,621 United States male veterans discharged with an outpatient appointment from one of 33 Department of Veterans Affairs inpatient Alcohol Dependency Treatment Programs was identified. The outpatient records of each patient were obtained to determine whether aftercare services were utilized following discharge. Binary choice analysis was used to model the decision to enter aftercare treatment as a function of travel distance, age, marital status, ethnicity, severity of illness, and urbanization. Results: Travel barriers significantly reduced aftercare participation, especially for elderly and rural veterans. Both younger and older veterans were less likely to keep their aftercare appointment than middle-aged veterans. Married patients were more likely to utilize out...

159 citations


Journal ArticleDOI
TL;DR: This study hypothesized that some hospitalized patients with low craving levels might believe their risk of relapse to be high in another setting, and developed a series of five questions to measure different aspects of cocaine craving, which revealed a high level of internal consistency.
Abstract: Despite its common use, the term “craving” is controversial. Moreover, its measurement can be problematic, since craving is purely subjective and is highly influenced by setting and drug availability. Thus, one might expect patients in protective settings such as hospitals to experience little craving, despite potentially being at high risk to relapse upon discharge. In this study of 73 patients hospitalized for cocaine dependence, we developed a series of five questions to measure different aspects of cocaine craving: 1) current intensity, 2) intensity during the previous 24 hours, 3) frequency, 4) responsiveness to drug-related conditioned stimuli, and S) imagined likelihood of use if in a setting with access to drugs. We hypothesized that some hospitalized patients with low craving levels might believe their risk of relapse to be high in another setting. We then examined the relationship between inpatient craving levels and 3-month treatment outcome. Results revealed a high level of internal consistenc...

108 citations


Journal ArticleDOI
TL;DR: The 60-mg fluoxetine group showed least effectiveness, the group with detectable blood levels had less cravings, and the fluoxettine subjects who were abstinent at the start of treatment were somewhat less likely to avoid relapse than those on placebo.
Abstract: Three methods of analysis were used to determine the effects of the combination of counseling with fluoxetine (20, 40, or 60 mg) and "active" placebo (diphenhydramine, 12.5 mg) randomly assigned. Forty-five cocaine-only dependent subjects were treated as outpatients with "interpersonal" counseling, medication, and drug use monitoring three times per week for up to 12 weeks. Treatment effects were analyzed: first, by comparing the three original assignments and placebo; second, by comparing the placebo group to fluoxetine subjects with detectable fluoxetine/norfluoxetine blood levels and those with no detectable medication blood level; third, by examining relapse prevention versus use cessation through stratifying the subjects into four groups according to fluoxetine or placebo assignment and initial urine cocaine positivity or negativity. All three analyses showed improvement on some measures over time regardless of group assignment. The 60-mg fluoxetine group showed least effectiveness, the group with detectable blood levels had less cravings, and the fluoxetine subjects who were abstinent at the start of treatment were somewhat less likely to avoid relapse than those on placebo.

81 citations


Journal ArticleDOI
TL;DR: The findings show the dual threat drug injectors face for HIV infection, through sex and needle risk behaviors, and the pivotal role IDUs play in the heterosexual transmission of HIV to noninjectors.
Abstract: This study was designed to assess gender differences in high-risk sex behaviors related to the transmission of HIV among injection drug users (IDUs) and crack smokers. Using a standard national survey instrument, 593 verified drug users were questioned about their sexual activities and drug use in the 30-day period prior to the interview. High-risk sex behaviors included nonuse of condoms, exchanging sex for drugs or money, sex with an IDU, and sex with more than one partner. Results showed that IDUs who engaged in needle risk practices were more likely to report nonuse of condoms than IDUs who practiced safer needle use. African-American ethnicity was a more powerful determinant of exchanging sex than smoking crack cocaine. Sex with more than one partner in the previous 30 day was reported by 11% of married males and 15% of married females. Independently, marital status was found to be a marker for high-risk sex behaviors, in particular, sex with an IDU and nonuse of condoms, behaviors reported more ofte...

71 citations


Journal ArticleDOI
TL;DR: In this paper, the outcomes of a 21-day inpatient drug detoxification and rehabilitation program including length of stay, transfer to further treatment, and HIV risky behavior were investigated, and the authors concluded that detoxification programs have the potential for reducing relapse to drug use when followed by residential drug-free treatment.
Abstract: We investigated the outcomes of a 21-day inpatient drug detoxification and rehabilitation program including length of stay, transfer to further treatment, and HIV risky behavior. Clients (n = 567) were predominantly White, male, currently unemployed, and their treatment was not covered by third party payment. 78% were detoxified with methadone. The median length of stay was 18 days. Higher education, not living with spouse or children, English as primary language, admission during fall or winter months, and greater knowledge of HIV transmission were independent predictors of greater length of stay. Among those with follow-up (n = 450), 19% were transferred to residential drug-free programs and 7% to outpatient programs. Taking into account loss to follow-up, the overall rate of treatment transfer could be as low as 21%. Greater length of stay was associated with higher rates of transfer to residential treatment. Relapse rates to either any drug use or injection drug use were lower among subjects transferred to residential treatment than either clients transferred to outpatient programs or those with no further treatment. Among subjects who continued to inject drugs at follow-up, no reduction in HIV risky behaviors was found regardless of further treatment. We conclude that detoxification programs have the potential for reducing relapse to drug use when followed by residential drug-free treatment.

68 citations


Journal ArticleDOI
TL;DR: Bivariate correlations showed that females reported less self-esteem and family support, as well as more self-blame and parental blame, than did their male counterparts, and females were most likely to display low esteem when they engaged in high embracement of the 12-step ideology.
Abstract: Although much research has compared males and females who seek substance abuse treatment, little attention has been given to factors that moderate or mediate relations between gender and dependent measures such as psychological functioning and retention. Consequently, this study examined whether family support, prior homelessness, embracement of the 12-step ideology, and attributions for addiction modified or accounted for these relations. Bivariate correlations showed that females reported less self-esteem and family support, as well as more self-blame and parental blame, than did their male counterparts. In contrast, males displayed more prior homelessness and less program completions than did die females. Multivariate analyses indicated that the relatively poor functioning of females was linked to lower family support and greater tendencies to blame themselves and their parents for their addictions. In addition, females were most likely to display low esteem when they engaged in high embracement of the...

60 citations


Journal ArticleDOI
TL;DR: Concerns are raised that HMPAO-SPECT methods employed were inadequate for assessing human regional brain function during phases of opiate addiction, and other emerging functional brain imaging technologies should be evaluated relative to improved HMPAo- SPECT methods for this purpose.
Abstract: Naloxone (0.8 mg, s.c.) effects on opiate withdrawal signs and symptoms and regional brain function were assessed in 10 methadone-maintained patients and 10 healthy subjects in a double-blind, placebo-controlled study. Regional brain function was assessed using single photon emission computerized tomography (SPECT) by evaluating the uptake of [99mTc]d,l-hexamethylpropyleneamine oxime (HMPAO) in the brain, a process related to regional cerebral perfusion. Comparisons of patients and healthy subjects after saline infusion suggested that chronic opiate dependence was associated with lower corrected activity ratios (regional count density/whole brain count density) in frontal and parietal cortices and greater activity ratios in the thalamus. Opiate-dependent patients, but not healthy subjects, developed opiate withdrawal signs and symptoms after naloxone administration. Following naloxone administration, patients undergoing opiate withdrawal exhibited lower whole brain count density than healthy subjects. They also had lower activity ratios in frontal and parietal cortices and increased thalamic activity ratios relative to healthy subjects receiving naloxone. Naloxone administration in healthy subjects, but not opiate withdrawal in patients, was associated with decreased right parietal cortex and increased right temporal cortex and left basal ganglia activity ratios. Relative to naloxone effects in healthy subjects, opiate withdrawal was associated with decreased whole brain count density and a reduced right temporal cortex activity ratio. This preliminary study reports an initial evaluation of HMPAO-SPECT imaging for assessing regional alterations in brain function during opiate dependence and withdrawal. While group differences were reported, the small magnitude of regional alterations in patients undergoing opiate withdrawal raised concern that HMPAO-SPECT methods employed were inadequate for assessing human regional brain function during phases of opiate addiction. Other emerging functional brain imaging technologies should be evaluated relative to improved HMPAO-SPECT methods for this purpose.

58 citations


Journal ArticleDOI
TL;DR: Neither instrument should be administered only once to provide a reliable lifetime diagnostic profile of comorbidity in substance abusers.
Abstract: This study examines the test-retest reliability of two interview schedules (computer- and clinician-administered) in diagnosing lifetime comorbidity in treated substance abusers. The Computerized Diagnostic Interview Schedule (C-DIS) and the Structured Clinical Interview for DSM-III-R (SCID) were both administered to 173 substance abusers after random assignment to one of two groups. Within 1 to 2 weeks, subjects in the first group repeated the C-DIS and subjects in the second group were reinterviewed by a different clinician, blind to the results of the initial SCID. Both instruments showed good to excellent reliability for DSM-III-R psychoactive substance use disorders with kappas ranging from .50 to .89 for individual disorders. However, the reliability of comorbid other mental disorders was substantially poorer on both instruments, particularly the SCID. C-DIS kappas ranged from -.05 for generalized anxiety to .70 for simple phobia. SCID kappas ranged from .31 for panic disorder to .83 for antisocial personality disorder. Anxiety disorders as a category, some phobic disorders, and antisocial personality disorder showed acceptable levels of test-retest reliability on both instruments. There was a trend for borderline or threshold cases to account for some of the disagreement on the C-DIS. Differences of opinion between clinicians on organicity accounted for some of the disagreements on panic disorder and major depression. The C-DIS, unlike the SCID, tended to diagnose more disorders at initial interview, perhaps a result of its tedious probe structure. Neither instrument should be administered only once to provide a reliable lifetime diagnostic profile of comorbidity in substance abusers.

56 citations


Journal ArticleDOI
TL;DR: This study shows how drug abuse treatment programs can be made more attractive to decision makers and funding agencies by first highlighting why economic evaluation is a critical component of drug Abuse treatment research.
Abstract: Research has shown that drug abuse treatment can help many individuals. Yet funding is often lacking for treatment because these programs compete for scarce resources with other important and effective social programs. This study shows how drug abuse treatment programs can be made more attractive to decision makers and funding agencies by first highlighting why economic evaluation is a critical component of drug abuse treatment research. Next, an evaluation methodology is presented that can be followed by program staff and researchers. The evaluation methodology includes aspects of cost-and-outcome analysis, cost-effectiveness analysis, and benefit-cost analysis. Methods and findings are then discussed from most of the major economic evaluation studies of drug and alcoholism treatment. Lastly, guidelines for conducting future economic evaluations are presented along with suggestions for how the results can be used for policy purposes and program planning.

55 citations


Journal ArticleDOI
TL;DR: Results suggest that stage of abstinence initiation may be a potentially useful category to employ as an independent variable in future pharmacotherapy trials for the treatment of cocaine addiction in this patient population.
Abstract: We conducted a double-blind, randomized clinical trial of mazindol (n = 37) for the prevention of relapse to cocaine abuse in methadone-maintained patients who were in the “action” stage of change, i.e., had a history of cocaine dependence but who had been abstinent for at least 2 weeks prior to entry into the study. Eight-one percent of subjects completed the 12-week course of treatment. Overall, cocaine use during the study was comparatively low–17% of the urine screens submitted were positive for cocaine metabolite. Differences between the mazindol and placebo groups of rates of relapse, number of days to relapse, and cocaine use did not reach statistical significance, but were in the direction of a treatment effect. Results suggest that stage of abstinence initiation may be a potentially useful category to employ as an independent variable in future pharmacotherapy trials for the treatment of cocaine addiction in this patient population.

51 citations


Journal ArticleDOI
TL;DR: A multiple regression analysis of factors contributing to aggression in the boys revealed that a paternal personality factor characterized by stress reactivity, alienation, and aggression was the most robust contributor to aggression among the boys.
Abstract: An association between childhood aggression and risk for subsequent development of a substance abuse disorder is now well-accepted. In order to better understand the relationship between the presence of paternal substance abuse and aggression among their offspring, 10-12 year old sons of fathers with (n = 34) and without (n = 39) a history of a substance abuse disorder were contrasted on demographics, aggressivity, biological indices of reproductive maturation, and the presence of psychiatric diagnoses. In addition, personality factors, the potential for physical abuse, and psychiatric diagnoses were also ascertained among their fathers. Sons of substance-abusing fathers were found to be significantly more aggressive than sons of nonsubstance abusers. However, they also differed from comparison boys on the basis of SES and school grade attained, as well as the proportion with specific psychiatric disorders. Substance-abusing fathers differed from nonsubstance-abusing men in terms of personality factors and the presence of specific psychiatric disorders, including antisocial personality. They also showed significantly higher child abuse potential scores. A multiple regression analysis of factors contributing to aggression in the boys revealed that a paternal personality factor characterized by stress reactivity, alienation, and aggression was the most robust contributor to aggression among the boys. The boys' diagnoses of attention deficit disorder, oppositional defiant disorder, and lower household socioeconomic status were also significant predictors of aggressivity. Contrary to expectations, paternal, psychiatric diagnoses, substance abuse status, and potential for physical abuse were noncontributory. The results suggest potential mechanisms by which both aggression and risk for substance abuse may be transmitted from father to son.

Journal ArticleDOI
TL;DR: It is concluded that concurrent halfway house placement can aid in aftercare retention and completion in male veterans enrolled in the Birmingham VAMC Outpatient Substance Abuse Clinic.
Abstract: One hundred twenty-four male veterans were enrolled in the Birmingham VAMC Outpatient Substance Abuse Clinic (OSAC) aftercare program following inpatient treatment for alcohol, cocaine, or mixed alcohol-cocaine abuse/dependence. Forty-two of the patients were concurrently admitted to a nearby halfway house (HH) while the remaining 82 patients made community-based (CB) living arrangements. Chi-square analysis showed the two groups were matched, p >. 05, in regard to age, race, marital status, presenting problem, and referral source. The CB group experienced significantly, p <. 05, higher early dropout (40 vs 0%) from aftercare. Of the others engaging in treatment, the HH patients stayed in OSAC aftercare 60 days longer and had significantly, p <. 01, more clinic visits. A higher proportion, p <. 01, of HH patients completed each of four treatment milestones: education group, psychological testing, psychological interview, and treatment planning/update. On average, the HH patients remained in OSAC an additi...

Journal ArticleDOI
TL;DR: Results suggest that clients' motivation to seek help for cocaine use is related primarily to adverse consequences of use, similar to motivational and decisional models.
Abstract: Motivational and decisional models suggest that those who seek help for substance use problems may differ from those who do not seek help in terms of their belief that substance use is creating social and personal negative consequences and their perceived dependence. In this study, help seeking for cocaine use was hypothesized to be a function of the negative consequences from cocaine, perceiving oneself as dependent on cocaine, quantity and frequency of use, cost of use, and route of administration. A sample of 161 substance abusers in treatment who had used any cocaine in the last 6 months completed questionnaires regarding the quantity, frequency, history, and perceptions of the consequences of their cocaine use. Of the 161 subjects, 113 (70.2%) had at some time sought help from someone for their cocaine use. After controlling for marital and employment status, a logistic regression revealed that the number of negative consequences experienced, feeling dependent on cocaine, and the amount of cocaine us...

Journal ArticleDOI
TL;DR: This paper focuses on the development and preliminary validation of the Expected Treatment Outcome Scale, a multiattribute value model reflecting the opinions of an expert panel, and shows a correlation of .89 between the experts' average ratings of hypothetical clients and scores based on the scale.
Abstract: The Expected Treatment Outcome Scales was developed to gather information on clients who abuse drugs or alcohol, to assess their severity of illness, and to evaluate the effectiveness of drug treatment in nonrandomized clinical studies. The scale is based upon a multiattribute value model reflecting the opinions of an expert panel. The experts identified 25 variables, or predictors of relapse, from which 48 questions were constructed. Answers to the questions are individually scored. These scores are summed to produce an overall Expected Treatment Outcome score. This paper focuses on the development and preliminary validation of the Expected Treatment Outcome Scale. Results of our analysis show a correlation of .89 between the experts' average ratings of hypothetical clients and scores based on our scale. This finding suggests that the Expected Treatment Outcome Scale has face validity and accurately simulates the experts' judgments regarding treatment outcome. Further research is necessary to assess the reliability as well as the concurrent and predictive validity of our instrument.

Journal ArticleDOI
TL;DR: Overall, there did not appear to be any advantage to receiving bromocriptine versus placebo during the first 3 weeks following cocaine use cessation with the possible exception of changes in activity and appetite level.
Abstract: Twenty-nine cocaine-dependent male veterans without other drug dependence completed a double-blind controlled, randomly-assigned study examining the efficacy of bromocriptine versus placebo in the management of cocaine abstinence symptomatology. Serum prolactin (PL) and growth hormone (GH) levels were obtained prior to and after the study was completed. Patients were seen daily and completed several self-report questionnaires, including the Symptom Checklist-90-Revised, the Beck Depression Inventory, and a Cocaine Craving Report. The patients were also asked to rate a variety of cocaine withdrawal symptoms. Overall, there did not appear to be any advantage to receiving bromocriptine versus placebo during the first 3 weeks following cocaine use cessation with the possible exception of changes in activity and appetite level. The placebo group showed a statistically significant increase in activity level during the first week in treatment and a significant increase in appetite throughout the study. Patients ...

Journal ArticleDOI
TL;DR: Results showed that at time of admission suicidal clients reported more psychological dysfunction and more help-seeking behavior as evidenced by self-referral, number of previous treatment episodes, attendance at self-help meetings, and higher scores on motivational measures of desire for help.
Abstract: Previous work has shown that suicide is a significant cause of death among substance abusers, including methadone-maintained clients, and that the prediction of suicidal ideation and behavior is difficult. Preliminary review of data collected at admission on a population of 438 methadone-maintained clients found 55 expressing some level of suicidal behaviors during the course of treatment. These clients were compared with a randomly selected comparison group of 55 nonsuicide clients matched for gender and race/ethnicity on measures of psychological dysfunction, drug use, family dysfunction, and help-seeking behaviors. Results showed that at time of admission suicidal clients reported: 1) more psychological dysfunction as evidenced by higher levels of depression, social dysfunction, hostility, risk-taking, and previous thoughts of suicide; 2) less family support at the present time and during childhood; and 3) more help-seeking behavior as evidenced by self-referral, number of previous treatment episodes, attendance at self-help meetings, and higher scores on motivational measures of desire for help. Differences in preadmission drug-using behaviors were not found between the two groups.

Journal ArticleDOI
TL;DR: The results suggest that personality psychopathology in drug addicts is associated with lower self-esteem, more negative self-valuation, and longer duration of use.
Abstract: Two groups of drug users on an inner-city inpatient drug detoxification unit were studied: 42 heroin addicts and 47 cocaine addicts. The two groups were compared on personality disorder diagnoses, personality traits, and demographic variables. Cocaine and heroin addicts scored similarly on: 1) number and kind of personality disorder diagnoses, with the exception of antisocial personality; 2) all personality traits measured; 3) positive and negative temperament; 4) description of self-concepts; and 5) positivity and negativity of self-concepts. It was also found that heroin addicts showed significantly higher levels of social deviance than the cocaine group, with significantly more antisocial personality disorder diagnoses, higher levels of social deviance, and lower scores on a Propriety Scale. Character pathology was more heterogeneous among cocaine users. Heroin addicts had used significantly longer and showed less educational and occupational achievement than the cocaine group. Our results also suggest that personality psychopathology in drug addicts is associated with lower self-esteem, more negative self-valuation, and longer duration of use.

Journal ArticleDOI
TL;DR: The results suggest that common generational links in substance abuse and antisocial behavior in males may be associated with detectable biological parameters in susceptible youth.
Abstract: Recent research suggests that dopaminergic/noradrenergic system dysfunction may be associated with substance abuse and/or antisocial behavior. In order to determine whether male youth of fathers with these disorders would manifest differences in these systems when compared with youth of nonsubstance-abusing or nonantisocial fathers, levels of homovanillic acid (HVA), the metabolite of dopamine (DA) and dopamine-β-hydroxylase (DBH), the enzyme facilitating the conversion of dopamine to norepinephrine, were studied in offspring blood samples. The subjects were 65 male youth aged 6–15 years admitted to a residential center because of behavioral disorders. Parental substance abuse and antisocial behavior were assessed through interviews, rating scales, and/or chart review. HVA and DBH were determined from blood samples obtained after admission. The findings indicated that youth of substance-abusing fathers had significantly greater levels of HVA than youth of nonsubstance-abusing fathers. Younger (< 12.0 year...

Journal ArticleDOI
TL;DR: Dual diagnosis patients may initially perform more poorly than substance only diagnosis patients in substance dependence treatment, however, in the presence of psychiatric care, they eventually exhibit comparable success.
Abstract: This study examines outcome of treatment for psychoactive substance dependence in a clinic which made psychiatric care readily available. Veterans entering outpatient treatment for substance dependence (n = 222) received psychiatric evaluation for additional Axis I disorders using DSM-III-R criteria. Patients provided urine toxicology specimens at least weekly. Outcome (urinalysis results and treatment retention) was compared for patients with dual diagnosis (n = 103, 46.4%) and with substance only diagnosis (n = 119, 53.6%). Psychotropic medications were prescribed for 80.4% of the dual diagnosis subjects. In the first 6 months of treatment, dual diagnosis subjects compared to substance only diagnosis subjects gave a significantly greater percentage of urines positive for cocaine and opioids. In the second 6 months, dual diagnosis subjects who remained (n = 72, 70.0%) significantly reduced from the first 6 months their percentage of cocaine and opioid positives and did not differ in percent positives fro...

Journal ArticleDOI
TL;DR: It is indicated that pretreatment attrition can be markedly reduced by prompt medication, and the prompt medication does not adversely affect retention during treatment or other outcomes.
Abstract: An open clinical trial was conducted to compare the effects of rapid (1-day) admission with slow (14-day) admission to methadone maintenance on pretreatment attrition, retention during treatment, and other outcomes. One hundred eighty-six illicit opioid users eligible for methadone maintenance were randomly assigned to rapid admission or slow admission, with 93 subjects assigned to each group. The random assignment produced two groups that were similar on 22 personal variables. All subjects admitted to treatment were followed for 1 year. Follow-up interviews were obtained with 155 (98%) of the 158 subjects admitted to treatment. During the period from initial contact to medication, only 4% of the rapid admission subjects but 26% of the slow admission subjects dropped out. The risk of dropout during slow admission was 6 times that during rapid admission. A higher percentage of rapid admission subjects, 43%, than of slow admission subjects, 39%, remained continuously in treatment for 1 year, but the differe...

Journal ArticleDOI
TL;DR: While alcohol availability, consumption, and abuse were not related to statewide homicide rates in the United States, alcohol consumption, but not availability or abuse, was associated with statewide suicide rates.
Abstract: While alcohol availability, consumption, and abuse were not related to statewide homicide rates in the United States, alcohol consumption, but not availability or abuse, was associated with statewide suicide rates.

Journal ArticleDOI
TL;DR: The discriminant function suggests that members in the cocaine drug of choice group as contrasted with those in the heroin preference group can be characterized as more socially inhibited and more self-defeating after adjusting for differences in age, duration of use of illicit substances, and marital status.
Abstract: This study was conducted to investigate the relationship between the indicators of psychiatric disorders of individuals and their choice of either cocaine or heroin, drugs that differ markedly in their pharmacological effects. Cocaine acts as an intense stimulant, and heroin has profound sedative effects. This investigation examined the relationship between preference for heroin or cocaine and indicators of psychiatric impairment. Data from 282 subjects were grouped according to drug of choice and analyzed. Ninety-three percent of these subjects were African-American, 32% were female, and the average age was 34. Univariate and multivariate statistical analyses, such as discriminant analyses, were used to determine group differences. The results are evaluated and interpreted in relation to both the current empirical findings and to the hypotheses and theories postulated as a result of earlier clinical observations on drug of choice and psychopathology. Discriminant analysis yielded an overall correct classification rate of 75%. The discriminant function suggests that members in the cocaine drug of choice group as contrasted with members in the heroin preference group can be characterized as more socially inhibited and more self-defeating after adjusting for differences in age, duration of use of illicit substances, and marital status. Those who favored cocaine as contrasted with those who favored heroin were more likely to have never married, be younger, and have used illicit substances for a shorter period of time.

Journal ArticleDOI
TL;DR: This article reviews the available literature on ambulatory detoxification and attempts to summarize and synthesize what is known about this area in order to make ambulatory medical detoxification readily reproducible in clinical practice.
Abstract: In the past decade, ambulatory medical detoxification for alcohol withdrawal has become increasingly utilized due to pressures to contain cost of treatment and research demonstrating its effectiveness. The research that describes this area spans the last 15 years. This article reviews the available literature on ambulatory detoxification and attempts to summarize and synthesize what is known about this area in order to make ambulatory medical detoxification readily reproducible in clinical practice. Finally, this article concludes with an analysis of the advantages and disadvantages of outpatient alcohol detoxification as compared to inpatient treatment.

Journal ArticleDOI
TL;DR: The use of a structured diagnostic interview with 58 consecutively admitted general adult psychiatric patients revealed that 62.1% of them abused alcohol and 58.6% had a substance use disorder.
Abstract: The use of a structured diagnostic interview (The Schedule for Affective Disorders and Schizophrenia) with 58 consecutively admitted general adult psychiatric patients revealed that 62.1% of them abused alcohol and 58.6% had a substance use disorder. The drug abusers did not differ significantly from the nonabusers on mean psychoticism (Brief Psychiatric Rating Scale) scores. However, they received higher doses of antipsychotic agents (mean daily dose 1022 mg CPZ EQ (SD = 614) vs 609 mg CPZ EQ (SD = 481); z = 2.58, p < .01) to achieve stabilization. The clinical implications of this finding are discussed.

Journal ArticleDOI
TL;DR: The analysis of Kentucky's 77 dry counties indicates that the distance variable is significantly and negatively related to rate of alcohol-related injury crashes but does not appear to be a substantial determinant of accident rates in dry counties.
Abstract: Variations in alcohol control laws can cause problems if individuals travel to less restrictive jurisdictions to purchase alcohol to circumvent more restrictive regulations. The establishment of a national minimum drinking age of 21 is an example of an attempt to eliminate the phenomenon known as “border drinking.” However, it exists today in many southern states that have dry counties. The present study analyzes Kentucky's 77 dry counties to determine if rates of six types of motor vehicle crashes are affected by distance to legal alcohol. The analysis indicates that the distance variable is significantly and negatively related to rate of alcohol-related injury crashes but does not appear to be a substantial determinant of accident rates in dry counties.

Journal ArticleDOI
TL;DR: To determine the reliability of serial naloxone challenges, five heroin addicts stabilized on methadone were given 0.2 mg naloxin intravenously on three consecutive days and withdrawal tended to be slightly more severe for the first challenge.
Abstract: To determine the reliability of serial naloxone challenges, five heroin addicts stabilized on methadone were given 0.2 mg naloxone intravenously on three consecutive days. Two-factor ANOVA revealed that the between-subjects effect accounted for at least 63% of the variance in each of the dependent measures, and the effect of challenge number for at most 22%. Withdrawal tended to be slightly more severe for the first challenge. Intraclass correlation coefficients were calculated for the area-under-the-curve of the change from baseline: subject-rated (.74) and observer-rated (.71) withdrawal, pulse (.88), systolic blood pressure (.58), diastolic blood pressure (.85), and skin temperature (.63).

Journal ArticleDOI
TL;DR: Women in the sex industry are more enmeshed in the drug-using scene and occupy a more constricted set of social roles than other women, and will therefore lack the resources and have fewer opportunities to engage in safer behaviors compared to women who support themselves by other means.
Abstract: The addicted prostitute faces a risk of AIDS from both her sexual practices and intravenous drug use. While the sexual practices of these women have been studied, much less is known about their needle-using practices. We suggest women in the sex industry are more enmeshed in the drug-using scene and occupy a more constricted set of social roles than other women. They will therefore lack the resources and have fewer opportunities to engage in safer behaviors compared to women who support themselves by other means. The analysis is based on 9,055 addicted women not in treatment. Women who trade sex for money and/or drugs are less likely to use new needles on any consistent basis or to clean old needles. They are more likely to share needles with others compared to women who support themselves by other means. Three identifiable patterns of needle-using practices emerge: indiscriminate sharing, monogamous sharing with a sexual partner, and exclusive use of new needles. To reach those engaged in promiscuous sharing, needle-swapping programs must be particularly "user friendly." Where needle-using behaviors reflect an intimate relationship, the spouse/sex partner must be engaged if change is to take place. Finally, policymakers and practitioners should capitalize on the strengths and strategies of those who report they consistently use sterile needles.

Journal ArticleDOI
TL;DR: Examination of advocacy and coordination at two programs where the mandate was assessment, referral, and case management found that females were more likely than males to receive advocacy and those over 65 years were most likely to receive both Advocacy and coordination.
Abstract: Although advocacy and coordination are recognized as important aspects of the addictions treatment process, little research has been done in these areas. The present study examined advocacy and coo...

Journal ArticleDOI
TL;DR: The utility of this approach in designing treatment regimens, addressing client problems in addition to their substance abuse, increasing client satisfaction with service provided, and decreasing treatment attrition is discussed.
Abstract: This study used the Addiction Severity Index (ASI) to identify the various problems substance abuse clients present when seeking treatment at a Department of Veterans Affairs Medical Center. The sample was 98% male and 73% African-American, with a mean age of 37 years. Cluster analysis was used to identify commonalities and divergences in self-reported employment, legal, family, substance abuse, psychological, and medical problems. Four distinct clusters emerged, each of which could be characterized by a dysfunctional pattern. The utility of this approach in designing treatment regimens, addressing client problems in addition to their substance abuse, increasing client satisfaction with service provided, and decreasing treatment attrition is discussed.

Journal ArticleDOI
TL;DR: The German accomplishments in the past 6 years in treating addicts with methadone confirm the experience elsewhere: Methadone treatment is a highly desired alternative to many who wish to escape the life of the street addict; it is very effective in benefiting the individual patient as well as the general community; and it can be expanded rapidly and on a large scale.
Abstract: During the past quarter-century there have been innumerable reports throughout the world documenting the effectiveness of methadone maintenance treatment. None have been as consistently positive as those from Germany, where just a few years ago methadone was effectively banned. The German accomplishments in the past 6 years in treating addicts with methadone confirm the experience elsewhere: Methadone treatment is a highly desired alternative to many who wish to escape the life of the street addict; it is very effective in benefiting the individual patient as well as the general community; and it can be expanded rapidly and on a large scale. What is needed today is not further discussion but a firm commitment to make treatment available on request to every addict willing to accept it. With methadone maintenance--one treatment approach among many--this goal is achievable. There is no justification for settling for less.